Mental Disorders

Mental Disorders

 

Anxiety, Obsessive-Compulsive, and Related Disorders:

My friend's mother has been afraid of lightning, a perceived serious threat to her well-being, since her young age. I am seeing this from my childhood and I always wondered and laughed at it internally as I knew it is fictional as she was never struck with a lightning before. Even after crossing her sixties, she constantly fears lightning and thunder. In addition, she has cultivated several other fears such as fear of thieves, accident, rejection, illness, fear of being infected by Covid-19, fear or death, etc. In the pandemic time, she closed herself in her room for a couple of years in Covid-anxiety. After self-quarantine for two years, now her family finds that her fear has increased severely and is now elevated into a moment-to-moment fear strike. The reason is vague, and she is mostly unconscious of it. She rejects if family points out her fear frenzy. The fears are supported by perception of intense doubt. She doubts whether anyone or anything might help her ever. She suspects everyone and throws judgement at everyone.  Recently, her family managed to take her for psychiatric treatment to give medication. It was evident that he has a disorder marked by persistent and excessive feelings of anxiety and worry about numerous events and activities. It can be noted that the pre-conditions of General Anxiety disorder (GAD) match with her state of mind:

• For 6 months or more, the person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters

• The symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems

• Significant distress or impairment. 

Currently, the disorder has worsened. On a 0-100 scale she would have 90% anxiety disorder. She also shows symptoms of obsessive-compulsive disorder such as repeated thoughts, urges, or extreme negative thinking. She is often compelled to think negatively and jump into negative conclusions. She used to have medicines from a psychiatrist but now she rarely consumes it. Even now, she does not believe that she has any mental issues and so is totally reluctant to seek further mental health help. So how do we help such a person? Which treatment would be effective for her? 

 

Stress, PTSD, and Acute stress disorder​:

When a person views a threatening situation as dangerous and our fight-flight-freeze system responds, 'stress' is produced. Posttraumatic stress disorder (PTSD) is one kind of stress disorder that affects at least 3.5 percent of people in the United States each year! It is most common with women and low-income people. 75% of such people seek treatment. 

The root cause of stress is trauma. Even though many people do not talk about it, everyone faces trauma in their lives at some point. When pain is experienced in life, it becomes a trauma when left inexperienced and left under the carpet. It becomes an acute stress disorder when symptoms last shortly after the trauma and lasts for less than a month. It becomes a post-traumatic stress disorder (PTSD) when symptoms surface long time after the event - months or years. Apart from a direct traumatic experience, even witnessing a trauma can lead to PTSD.

Symptoms for both disorders include increased arousal, anxiety, and guilt. The person may feel as though the event is happening over and over again, and each time it happens, the trauma increases in intensity. Such a person avoids the situation at any cost and tend to overreact. The person also shares the scares with others by threatening, and it can lead to trauma of the listeners. For e.g.: a person who was cheated by a partner may fear every man and avoid men altogether. Such a trauma may have arisen out of Adverse Childhood Experiences (ADE). ADE is potentially traumatic events that occur in childhood. Early childhood experiences that created the pain goes deep into our unconscious and remain for a long period of time. As we grow older, we tend to experience more of its kind and effectively deepen the trauma within. The disorders such as fear, anxiety and guilt increase as we stress out more of similar traumatic events or even on the advent of them. As we experience more traumatic events such as death, severe injury, or sexual abuses, the intensity of the disorder keeps on rising. Thereby, as PTSD increases, the person begins to experience repeated, uncontrolled, and distressing memories. He sees nightmares based on the trauma recurs. The person gets easily upset, when he experiences something related to the trauma, out of proportion to the event. And if anyone raises the topic of trauma, quite often, physical reactions such as shivering, anger, profuse sweating, fighting, violence, etc., occurs. Such a person becomes increasingly difficult to relate with.

 

Dissociative identity disorder 

It happens when two or more distinct personalities (sub-personalities) develop with its own unique set of memories, behaviors, thoughts, and emotions. Stress triggers the switching of one personality to another and can create confusion. And those personalities interact with each other inside and can cause inner conflicts and dilemma. The person will have a feeling of detachment from own mental processes or body. He may observe himself from outside – as a stranger. He may feel people or objects are unreal or detached. In extreme cases, such a person will stop recognizing his loved ones. As per Psychodynamic model, dissociative disorders are caused by repression driven by very traumatic childhood events. A therapist would help to integrate their subpersonalities into one functional personality.

 

Early identification will lead to easier treatments. Cognitive processing therapy, mindfulness-based techniques, and even more, virtual reality therapy is also available these days. Virtual reality therapy is becoming more common these days and is safe. If helped, a traumatized person could prosper, or in some cases, they grow into being successful individuals in life. 

 

Depressive and Bipolar Disorders:
Depression is a low state of mind where we feel sad, lack of energy, low self-worth, guilt, or similar symptoms. It is a state in which we do not feel any kind of positive emotions such as joy, love, gratitude, etc. Even the interest in pursuing pleasure would disappear. Such a person will not be able to listen to motivating talks or can self-motivate. His interest will be "How can I destroy/end my life?". More than themselves, others would be distressed. While Mania is a state or episode of euphoria or frenzied activity. They believe that the world is theirs, they 'own' everything and like to 'possess'. The person has too much euphoria. It becomes a disorder when the symptoms persist causing significant impairment in daily life for more than six months. Unipolar disorder is a state where there is no history of mania, only depression. 

There is a deep link between depression and grief. When a loved one dies, an unconscious process begins and the mourner regresses to the oral stage and experiences introjection—a directing of feelings for the loved one onto oneself. For most people, introjection is temporary. For some, grief worsens over time. It is strange to know that a person with over-met needs also has a high tendency to fall into depression. Such a person often experiences “symbolic” (or imagined) loss instead of real losses. A loss in any aspect of life can lead to grief and if it is severe and long-lasting, depression results.

Generally, the depressed person feels “miserable,” “empty,” or “humiliated”. He lacks drive, initiative, and spontaneity in life. Thus, he becomes less active, and less productive. This will reduce his ability to earn and thus could make the person deprived of money. He holds negative views of himself and others and enter into relationship conflicts. This leads to relationship break ups and can lead to loss of personal life. Once he loses people in life, he enters into a deeper level of depression and becomes suicidal. It is said that between 6 percent and 15 percent of those with severe depression die by suicide. (https://www.hhs.gov/answers/mental-health-and-substance-abuse/does-depression-increase-risk-of-suicide/index.html).

Dysphoria is opposite of euphoria – decreased capacity of feeling joy. Females struggle with Premenstrual dysphoric disorder –depression or mood swings around menses.  This disorder causes severe irritability, depression, or anxiety a few days before their monthly periods. Symptoms usually lasts two to three days after the period starts. “Postpartum depression” means depression after childbirth. Those who develop postpartum depression are at greater risk of developing major depression later on in life. Symptoms such as “Extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, inability to cope, suicidal thoughts” can lasts up to a year or more. It creates an impact on the baby as mother is not in a state to give love to the newborn baby. Triggered by hormonal changes of childbirth – a physiological reaction that occurs in a few. Genetic tendency is a main factor of cause. 

How do we diagnose unipolar depression disorder? “For a 2-week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day.” Considerable weight change or appetite change; appetite can increase or decrease in extremes depending on the person. The person may find it difficult to sleep or may sleep too much (insomnia or hypersomnia). He feels tired for no reason and likes to take rest most often. The person gets agitated for no reason, especially if we try to hurt him touching is worthiness. Internally, such a person feels worthless and laments on constant guilt. As he loses focus and cannot make decisions, he becomes unable to sustain his life alone. 

In bipolar disorder, the person faces constant variations in mood, switch in personalities or sub-personalities. The person seems like a totally different person in each personality. Even his feelings change and thus it is very difficult to find out the authenticity of the person. In bipolar disorder, intermixed periods of mania and depression occurs. Mania is a state of extreme high of highs and depression is a low of lows and can alternate between mania and depression at different periods. Such a person could say ‘yes’ completely authentically, say ‘no’ with the same genuine feelings. A Manic episode may last for 1 week or more, person displays a continually abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of every day. Person also experiences at least three of the following symptoms

• Grandiosity or overblown self-esteem

• Reduced sleep need

• Rapidly shifting ideas or the sense that one’s thoughts are moving very fast

• Attention pulled in many directions

• Heightened activity or agitated movements

• Excessive pursuit of risky and potentially problematic activities

• Significant distress or impairment. 

As it becomes increasingly difficult to relate with such a person, relationships wither away. 

The onset usually occurs between the ages of 15 and 44 years. In most cases, the manic and depressive episodes eventually subside, only to recur at a later time. Generally, when episodes recur, the intervening periods of normality grow shorter and shorter.

Depression seems higher rate among elderly people than otherwise. Depression is ti ed to weak or unavailable social support, isolation, and lack of intimacy and elderly people are more prone to such isolating situations. 

In psychodynamic view, Freud says that depression arises due to loss in people (real or imagined), or objects, job, wealth, possessions, etc. Depression results when their relatives leave them, feeling unsafe and insecure (especially in early life). The intensity of hurts of loss is connected to poorly met childhood needs. Early losses and inadequate parenting sometimes lead to depression. However, it becomes a disorder when it repeats due to later losses in life.  In psychodynamic therapy, the therapist seeks to bring these issues into consciousness and heal the past wounds. The therapist help review past events and feelings, unveil the unconscious and release the past stored emotions. As the psychic wounds heal, depression reduces. However, depressed clients often are too passive and weary to participate fully and thus psychodynamic therapy may not be effective. 

According to cognitive-behavioral view​, depression results from problematic behaviors and dysfunctional thinking as well. In Beck’s cognitive therapy, he guides to challenge the automatic flow of thoughts and let oneself identify negative thinking and biases. This can trigger initiative in the person to changing primary attitudes and fundamental life cognitions. As one goes deeper, one can attempt to change the perceptions about themselves formed since childhood. In Behavioral interventions, therapist works systematically to increase the number of constructive and pleasurable activities and events in a client’s life. The therapist reintroduces pleasurable events and activities into ones’ life. He sets appropriate rewards for non-depressive and depressive behaviors. Thus, as the person improves, social skills improve as well. 

Online Test:

https://www.psycom.net/depression.central.bipolar-...​ 

 

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Therapies:

 

Most clinicians today utilize an eclectic approach, combining treatment techniques from several models. Research into this movement confirms the effectiveness of using combined approaches over a single model applied to all therapeutic situations. Eclecticism recognizes the interplay of many different factors in the development of psychology disorders. Because of this, there is now an emphasis on integrating the models and understanding more about which types of treatment work best for specific disorders.

 

 

Does depression lead to suicide? Suicidal thoughts happen when a person enters into a desperate state and feels hopeless. “Approximately 9.5% of American adults ages 18 and over, will suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) each year. Women are nearly twice as likely to suffer from major depression than men.” Says the website: https://www.hopkinsmedicine.org/health/wellness-and-prevention/mental-health-disorder-statistics

That is a real high percentage of people suffering from depression! And suicide is on the rise. As most advanced country in the world, we expect the state of happiness to be high in USA. Apparently, “Suicides in the United States have been on the rise, up 33% from 1999 through 2017, and the pace of the increase has been rising since 2006.” https://www.verywellmind.com/suicide-rates-overstated-in-people-with-depression-2330503. Is it a situation to be ignored or take seriously? 

 

Depression and suicide are linked, with an estimate that up to 60% of people who commit suicide have major depression. In fact, 95% of people who commit suicide have some form of mental illness. https://emedicine.medscape.com/article/2013085-overview. Thus, if we identify mental illness in advance and treat it, there is a high chance that the illness won’t lead to death. Quite often, it is too late to recognize that a person has mental illness. Even more, most don’t even realize it at all. Receiving this awareness itself can save us and our loved ones. 

 

To save our loved ones, we can recognize a few symptoms of depression leading to suicide. Normally there will be a change in behavior in that person within a short span of time. The person would have been probably trying to find a way out in life. Failure of survival trials could lead him to further disappointments and cause him to enter into depression. The person may withdraw from people and move into solitude. He may show mood swings and high temper. If we talk to the person, he may talk highly negatively about life. He may say “what is the best way to die,” I hope life just ends,” “dead people are happy! They don’t have to deal with life anymore,” “life is driven by morons and no one can ever win,” etc. He may also show signs of end of his life such as giving away his cash and assets or writing a “will.” He may increase his self-destructive behaviors and would not care about health anymore and indulge in addictive behaviors.  The person may stop taking any medicine all together and stop seeking helps. A person showing any such symptoms may indicate a decision to end his life. Furthermore, as per Cognitive triad of depression, three aspects put together has predictive validity of suicide - negative views about oneself, world and life. The triad of depression is a more valid predictor of suicide than intensity of depression. If we see that the person is showing symptoms in all three, as the predictive validity is high, let him seek professional help. 

 

As beck says, unipolar depression is produced by a combination of maladaptive attitudes, cognitive triad, errors in thinking, and automatic thoughts. And, as Seligman says, depression occurs when people believe they have no control over life’s reinforcements and assume responsibility for this helpless state. Or in other words, they just endure the pain and suffering. Some build up resilience and find a way out, but some may choose to stay and suffer. According to Attribution-helplessness theory, if the suffering is external, the person is less likely to suffer from depression than otherwise. If the person endures the suffering by believing that “I am responsible for my suffering,” the person intensifies depression through guilt. 

 

Treatments for Unipolar Depression:

Beck’s cognitive therapy guides people in four phases as follows: 

Increasing activities and elevating mood: this method involves getting involved with external activities that are fun and 

Challenging automatic thoughts: most of negative thoughts flows out of his control. If once can detach and challenge those thoughts as a third person, he gets a chance to become conscious of its automaticity, that the person is not thinking but that thinking is a process out of control. 

Identifying negative thinking and biases: Through mindfulness, one can become aware of negative thinking. If the symptoms cover the cognitive triad of depression, it is highly likely that the person suffers depression and effective hopelessness. However, if the person can identify the thinking and its biases by himself, he can become open to help.

Changing primary attitudes: Attitude depends on our perceptions sown in childhood upbringing. If we become aware of the mood fluctuations, thought flow, and thinking, one has the option to change he attitude and thereby, changing the moods, thoughts and behaviors.