Categories
Sexual Disorders

Understanding Sexual Dysfunction

Sex has become a topic discussed with serious intent. While situations and cultures vary, contention surrounding sex has been voiced openly by all sides. Women and men are embracing their sexual identity and preferences with a renewed vigor. The dark side of sex has also been exposed, with the emergence of social movements representing communities who have been victims of sexual assault and unwanted sexual advances. Sex, in general, has become a constant conversation however, there are hardly any discussions concerning people who for various reasons, have trouble or difficulty with sex. Conversations involving sexual dysfunction often target men struggling with impotence, plights commonly turned into jokes driven by stigma and sensationalism. Ignorance hinders people from addressing topics that are important. Furthermore, a large population is excluded from the conversation frequently due to embarrassment.

Sexual dysfunction is referred to as “a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity,” (Cleveland Clinic, n.d., para. 1). The sexual response cycle has four stages: excitement, plateau, orgasm, and resolution (Cleveland Clinic, n.d.).  Excitement involves elevated heart rate, increased genital blood flow and secretion of a lubricating substance (MedicineNet, n.d.). Excitement is different for every person and can range from minutes to hours (MedicineNet, n.d.). Plateau suggests intensification of excitement stage characteristics, lasting seconds to minutes (SexInfo, n.d.). Orgasm, the shortest stage, usually lasts seconds (SexInfo, n.d.). Orgasm involves reproductive organ contractions and ejaculation of semen in men. Resolution, the final stage is commonly associated with fatigue and intimacy (SexInfo, n.d.). Resolution in men includes a refractory period preventing subsequent arousal lasting seconds to days increasing with age (SexInfo, n.d.).

Sexual dysfunction can be present at any age displaying a negative correlated with health, with people over 40 more likely to experience dysfunction (Cleveland Clinic, n.d.). Sexual dysfunction consists of four diagnostic categories: desire disorders, arousal disorders, orgasm disorders, and pain disorders (Cleveland Clinic, n.d.). Desire disorders deal with lack of desire or interest in sex. Arousal disorders imply inability to become excited or physically aroused during sexual activity. Orgasm disorders involve inability to climax or delay orgasm, whereas pain disorders suggest pain during intercourse.

Causes of sexual dysfunction vary. Physical causes include diabetes, hormonal imbalance, drug side effects and chronic disease (Cleveland Clinic, n.d.). Psychological causes include trauma, anxiety, depression, body image concerns and relationship problems (Cleveland Clinic, n.d.). Mood disorders, psychotic disorders, and anxiety are often comorbid with sexual dysfunction (Ciocca, Ochoa, & Jannini, 2018). Research suggests sexual dysfunction is common but insufficiently recorded (Ciocca et al., 2018), with) “43% of woman and 31% of men report some degree of sexual difficulty (Cleveland Clinic, n.d., para. 2). Mental health and sexual dysfunction are negatively correlated with higher rates of dysfunction exhibited in people with mental illness (Ciocca et al., 2018). Men experiencing psychological stress display higher prevalence of sexual dysfunction (Gürtler, Brunner, Dürsteler-MacFarland, & Weisbeck, 2019).

“Despite growing research investigating sexual desire disorders, little is known or understood about the impact on individuals, their partners, and relationship functioning” (Frost, & Donovan, 2019, para. 1). Sexual dysfunction may affect relationships and confidence but it’s important to acknowledge it’s common and often natural (SexInfo, n.d.). Sexual dysfunction can be managed by medication, psychoeducation, mechanical aids, behavioral treatments, psychotherapy and sex therapy (Cleveland Clinic, n.d.). Mindfully discussing sexual dysfunction will aid in others feeling more comfortable and inclined to seek treatment, no one should be judged or ridiculed for something they cannot control.

References

Cleveland Clinic. (n.d.). Sexual Dysfunction. Retrieved from https://my.clevelandclinic.org/health/diseases/9121-sexual-dysfunction

MedicineNet. (n.d.). Sexual Response Cycle (Phases of Sexual Response). Retrieved from https://www.medicinenet.com/sexual_response_cycle_phases_of_sexual_response/article.htm

SexInfo. (n.d.). The Sexual Response Cycle. Retrieved from http://www.soc.ucsb.edu/sexinfo/article/sexual-response-cycle

Jannini, E. A., & Siracusano, A. (2018). Epidemiology of sexual dysfunctions in persons suffering from psychiatric disorders. In Sexual dysfunctions in mentally ill patients (pp. 41-51). Cham, Switzerland: Springer.

Gürtler, M. A., Brunner, P., Dürsteler-MacFarland, K. M., & Weisbeck, G. A. (2019). Sexual dysfunction in primary health care [Abstract]. Praxis, 108(1), 23-30. doi:10.1024/1661-8157/a003172

Frost, R., & Donovan, C. (2019). A qualitative exploration of the distress experienced by long-term heterosexual couples when women have low sexual desire [Abstract]. Sexual and Relationship Therapy, 1-24. doi:10.1080/14681994.2018.1549360

Cleveland Clinic. (n.d.). Sexual Dysfunction: Management and Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/9121-sexual-dysfunction/management-and-treatment

Categories
Obsessive Compulsive Disorder

Peace in Calamity

You made sure multiple times to unplug your steam iron but now you’re in your Chemistry lab, unable to focus on your lab report for the past half an hour because you can’t seem to be sure if you really did unplug it and if it would cause the entire building to burn down. You’re having thoughts about walking back to the dormitory and seeing everything aflame. Police cars, ambulance, fire trucks and people crying all over because you forgot to unplug that iron. How will you ever live past being responsible for the lives of all those unsuspecting students? Jail is waiting for you and you’ll have to give up all your dreams of getting into grad school. What would your family and friends think? How would you console the parents of these students? This is the thought process of those enduring symptoms related to the checking form of Obsessive Compulsive Disorder (OCD).

OCD is different from person to person and is considered a chronic disease. If diagnosis of this mental illness in itself wasn’t difficult enough due to the existence of the numerous variations (ruminations, contamination, checking, hoarding, etc.), finding the right treatment also becomes problematic. Presently, OCD can be treated through a combination of means, but there is not necessarily a cure. If proper treatments are employed, a chance for recovery over time is definitely possible. A lot of different medications and treatment methods have been tested and were found ineffective and the research is still ongoing. According to Stanford Medicine: Clozapine, carbamazepine, lithium, clonidine, stimulants, ECT, sleep deprivation, and bright light therapy are not effective.

So then, what actually works? Medications such as selective and non-selective Serotonin Reuptake Inhibitors (SRIs), antidepressants, neuroleptics and other psychiatric ones are now commonly being used. Clinical psychologists or psychiatrists may prescribe more than one medication to effectively control OCD symptoms. Side effects are common with any form of medications but the risk for self-harm and suicide is higher with psychiatric meds. Although it’s reported that about 50% of patients respond well with solely behavior therapy, there are still many who have to take medication in conjunction with other forms of behavior therapy as well.

Some patients have tried forms of therapy which include: support groups, cognitive behavioral therapy (CBT), aversion therapy, psychoeducation, rational emotive behavior therapy, Exposure-response prevention (ERP), psychotherapy, systematic desensitization, group psychotherapy, and etc (Mayo Clinic). Out of these, many claim that ERP has been the most effective. Exposure-response prevention is a type of Cognitive Behavior Therapy (CBT) which has the patient face his or her fear without allowing them to perform their rituals (compulsions). It is effective for many, but not for all.

The ERP exposures may be applied in two ways; in real life (in vivo) or in imagination (imaginal). To better illustrate this form of treatment, in vivo ERP for someone experiencing concerns related to contamination would consist of having the patient shake hands with someone and having them resist the compulsions related to hand washing. Imaginal ERP for the same would involve having the patient imagine scenarios where they would shake hands and resist washing their hands. These procedures are followed through a structured manual and even if they don’t necessarily decrease the resulting distress, they are said to increase the tolerance towards the patient’s fears. It is then overtime repeated until the patient’s rituals in response to the fear decreases.

Although it isn’t discussed enough, OCD is one of the most debilitating mental illnesses. For similar reasons, it is often underdiagnosed and therefore, access to specialized treatment is also very limited. Everything related to treatment becomes even more difficult when there are chances of comorbidity with OCD and other forms of mental illnesses. For example, the relationship between obsessional ruminations and depression is particularly close: a diagnosis of obsessive-compulsive disorder should be preferred only if ruminations arise or persist in the absence of a depressive disorder. This makes it strenuous for those who are experiencing a variety of these symptoms. Research revolving more effective treatment is still at large and an ongoing effort. Hopefully, the search leads to giving these patients a peace of mind in their tumultuous times.

References:

The Different Types of Obsessive-Compulsive Disorder. Retrieved October 09, 2017, from www.ocduk.org/types-ocd

My experience of Postpartum OCD (2013, October 13). Retrieved October 09, 2017, from http://www.ocduk.org/my-postpartum-ocd

Obsessive-compulsive disorder (OCD). (2016, September 17). Retrieved October 09, 2017, from http://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/treatment/txc-20245962

Behavior Therapy. (n.d.). Retrieved October 09, 2017, from http://ocd.stanford.edu/treatment/psychotherapy.html

Gillihan, S. J., Williams, M. T., Malcoun, E., Yadin, E., & Foa, E. B. (2012, May 30). Common Pitfalls in Exposure and Response Prevention (EX/RP) for OCD. Retrieved October 09, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423997/

 

Categories
Anxiety and Anxiety Disorders Bipolar Disorder

Bipolar Vs. Anxiety: The Unlikely Relatives

Imagine being on a euphoric mental high so powerful, it makes you dangerous to yourself and others. It makes quickly spending your life savings and engaging in risky sexual behaviors seem like a natural course of action for the intense euphoria you’re experiencing.  After this “high,” your mental state quickly takes a downturn. You crash, you hit the proverbial wall. It becomes hard to function, even though everything was so effortless just days before.  As one patient, comparing her mental state during highs and lows to a sprinting race, puts it,Life, everyone and everything in life, me included, are exquisitely and fabulously beautiful. But then the sprint and marathon race inside my brain finishes. My brain becomes completely exhausted — depleted of everything it had.” By definition, you are experiencing the manic and depressive episodes shared by all sufferers of this disorder, commonly known as bipolar.  

Now, imagine you are fearfully anticipating an upcoming event. Your anticipation is so pervasive it makes it hard to think about anything else or to focus on things that need to be accomplished for school or for work. In fact, it’s even affecting you physically, in the form of muscle tension and lightheadedness. “It feels like a constant heaviness in your mind; like something isn’t quite right, although oftentimes you don’t know exactly what that something is.” You would be experiencing generalized anxiety.  

Now put the two together, the manic highs and depressive lows, the heavy thoughts and the fearful anticipation. This combination of bipolar and anxiety disorders, something psychologists refer to as comorbidity, is in fact what many bipolar patients experience regularly.  According to a study performed on bipolar patients who were part of the National Epidemiologic Survey on Alcohol and Related Conditions, an estimated 60% of people diagnosed with bipolar have also suffered from an accompanying anxiety disorder. This is in contrast to the 2.9% of the population of American adults that suffer from anxiety disorders who may or may not have an accompanying mental illness. Although anxiety may be hard to distinguish from the highly aroused mental state that comes with bipolar manic highs, Dr. Naiomi M. Simon, Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Assistant Professor in psychiatry at Harvard Medical School, says that several key factors can help in making a diagnosis. The presence of anxious mood, general worry, panic attacks, or related anxiety symptoms, extended periods of sleeplessness when not in a manic state, and even the time frame during which anxiety symptoms develop, all aid in making a proper diagnosis for an accompanying anxiety disorder.

The fact that these two diseases are so closely tied together is problematic for several reasons. First, some studies show that individuals diagnosed with both disorders were twice as likely to be hospitalized during a depressive episode than those strictly diagnosed with bipolar. The study also correlated stronger bipolar symptoms, such as more manic and depressive episodes and a higher likelihood of suicidal behavior, with a co-occurrence of an anxiety-related diagnosis. Second, just as bipolar is tied to a higher likelihood of experiencing anxiety, the reverse is true as well; those experiencing symptoms solely related to an anxiety diagnosis are nine times more likely to develop bipolar disorder at some point in their lifetime.  Third, treatment for comorbid anxiety and bipolar may be more difficult, as some of the medications prescribed for anxiety may trigger manic episodes even when the patient is taking medicine to control the effects of their bipolar. In addition, antidepressants are sometimes addictive, which may be especially problematic for those more prone to substance abuse as a result of their bipolar.

Despite the potential complications in treatment, there is still hope for decreased symptoms for those struggling with both bipolar and anxiety. According to the Anxiety and Depression Association of America, therapy, in addition to taking prescribed medication, may play a crucial role in mitigating patients’ anxiety symptoms. Research is still being done to investigate the effectiveness of these techniques as they relate to anxiety and bipolar comorbidity.

Though bipolar and anxiety treatment together is still proving to be a challenge for healthcare providers, the combination of both disorders is certainly not uncommon or unique by any means. The comorbidity of these two disorders affects over half of the those diagnosed with bipolar, an important and startling statistic. According to this statistic, patients of both illnesses would actually be in the majority.  Dealing with this sort of mental illness is a complex battle, but with continued research and developments in this field of psychology, perhaps bipolar may one day feel a little less like an exhaustive marathon race and anxiety may feel a little less all-consuming. In the meantime, perhaps increased awareness for the complications of both these disorders can give those of us who do not have to suffer under the grip of manic and depressive episodes and generalized anxiety a better understanding of what sufferers of these disorders experience regularly, perhaps every day.

References:

Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.

Walz, S. (2017, September 19). How Having Bipolar Disorder Is Like Running a Marathon. Retrieved September 20, 2017, from https://themighty.com/2017/09/what-bipolar-disorder-is-like-running-marathon-sprint/

Hall, A. (2015, June 3). This Is What Anxiety Feels Like. Retrieved September 20, 2017, from http://www.huffingtonpost.com/alivia-hall/what-anxiety-feels-like_b_7495122.html

Pedersen, T. (2015). Bipolar Symptoms Stronger When Anxiety Disorder is Present. Psych Central. Retrieved on September 20, 2017, from https://psychcentral.com/news/2012/05/14/bipolar-symptoms-stronger-when-anxiety-disorder-is-present/38634.html

Anxiety and Depression Association of America (ADAA) – Anxiety and Depression Association of America. (2016). Bipolar Disorder. Retrieved September 22, 2017 from https://adaa.org/understanding-anxiety/related-illnesses/bipolar-disorder-3

LaBouff, L. (2016). Two Anxiety Disorders Tied to Bipolar Disorder. Psych Central. Retrieved on September 20, 2017, from https://blogs.psychcentral.com/bipolar-laid-bare/2016/06/two-anxiety-disorders-tied-to-bipolar-disorder/

Walters, L. (2016). Co-Occurring Anxiety Disorder and Bipolar Disorder. Psych Central. Retrieved on September 22, 2017, from https://blogs.psychcentral.com/coping-depression/2016/11/co-occurring-anxiety-disorder-and-bipolar-disorder/

Categories
Anxiety and Anxiety Disorders Depression

Combating Anxiety: An Interview

This interview was done with a current college student who recently began her journey towards improved mental health. The article anonymously covers her journey from seeking treatment, combating symptoms, and discussing concerns about the perception of anxiety by the greater public.

Question: Can you tell me a little bit about your diagnosis?

Response: I was officially diagnosed this past summer…it’s a combination of depression and anxiety, so I’m treated for both. As far as my condition goes, it’s not circumstantial; it is more of an everyday kind of thing, it’s always constantly being worried you aren’t being productive enough but at the same time being constantly worried that you’re not resting enough, you never feel like you’re in a balance.

Q: How did you discover it?

R: I had been feeling very not-myself for awhile, especially since coming [to college] because it’s different, so having to change everything definitely made it more difficult for me and it got really bad towards the end of last spring, and when I went home I was still having some issues so I was like alright I’m going to get checked out, make sure everything is fine and that when that happened.

Q: What would you describe as your biggest struggle?

R: My biggest struggle is to remember that everything is going to be fine. I think the hardest thing for me is remembering that everything is going to be fine. How anxious you feel and how everything possible that could go wrong might go wrong, and you have to just learn that everything will eventually be ok; that’s the hardest part for me.

Q: What do you do to combat/calm your nerves and anxiety?

R: Sometimes I just have to remove myself from a situation. Sometimes if I’ve been sitting there for hours working on something and I get really worked up about it because things aren’t going the way I want them to go, I have to get up and walk away; out of sight out of mind. I might talk to a friend, or go eat or try to remember to do the bare necessities and then come back to it when it is a little easier to deal with. 

Q: Have you faced any misunderstandings with either your diagnosis or why you do the things you do?

R: The hardest thing for me in terms of social awareness is that there are a lot of people out there who, really advertise anxiety for what it’s not. They create a stigma where people don’t take it as seriously, I think, as they should because they might not necessarily understand [the disorder] or they might think that ‘oh, everyone has some form of anxiety’ but it depends on the level. Is it just freaking out every once in awhile or is it this constant think that’s always on your mind. I think the stigma that’s been created is that it’s not as significant as other mental disorders. I just think when anxiety is falsely advertised or over advertised it is taken less seriously.

Q: Do you think that is the case with anxiety more so than other disorders/Have you come across anything personally?

R: Specifically for me, it took so long for me to acknowledge that I had something I needed to deal with because of that stigma. [People will downplay] the severity of the disorder, but I thought because I didn’t have any of those things [bipolar, depression, everything] that it wasn’t as important so I didn’t feel as much inclination to address it [my disorder] and I feel like that’s the case with a lot of people. They might feel that other people have it worse, so I shouldn’t be complaining, but that doesn’t mean that you shouldn’t try to get help if you think you need it.

Q: What was your process of getting help when you decided you needed it?

R: When I realized it wasn’t just school that was causing it, I went home and for at least 2 months it continued on that way. I realized if I’m not at school, then there must be something else going on and to be honest, my family didn’t really believe me.They thought “oh you’re being dramatic” and that also made it really hard for me to go get help because I didn’t feel supported. But I ended up going anyways and when i came home with a prescription and everything else they finally took it seriously.

Q: Did you go to therapy on your own or did you have someone with you?

R: I went on my own…it was scary but I have other friends that had gone before and they told me what to expect and I really thought that I needed the help so I’m glad that I went. To be honest, I would have rather gone alone than with someone in my family who didn’t really understand what was going on or support what I was doing.

Q: Has therapy helped, or have you seen a difference in yourself since starting therapy?

R: Yes, It helped me because it finally felt like someone was on my side, someone was willing to listen to all my problems and I was just unloading anything on anyone. It’s hard to talk to your friends sometimes because you know they’re going through a lot and you don’t want to complain about your life when you know they’re going through stuff too. It’s someone on the outside who can understand and also give you new perspective, they help you look at it in different ways and go “Oh I have reason to feel this way” or “Oh, maybe I don’t have reason to feel this way, and I’m just thinking about it all wrong.” So it definitely helped me gain perspective and help me learn how to cope in more productive ways. It helped me a lot, I still go. I see a family therapist, just because that’s what’s available near where I live, but I go to a psychiatrist and a family therapist that are within the same practice. They’ll make sure my medication is the right dose, doing what it should be doing and monitoring everything.

Seeking out treatment and combating stigma is a concern regardless of the perceived intensity of a disorder. Though occasional anxiety is a normal part of life, anxiety disorders involve more than a temporary feeling. Anxiety disorders disrupt the flow of your daily activities and can impact your professional and academic life, as well as relationships. It is important to recognize anxiety disorders as serious mental diagnoses that require proper treatment.

Categories
Depression

New Avenues for Treatment: Brain Imaging Study Identifies Different Types of Depression

Most of the estimated 16 million adults who live with depression find little relief with antidepressants. This is a problem that most researchers say lies in the way the disease is diagnosed.

In modern-day psychiatry, depression is diagnosed from a list of criteria. If a patient exhibits low mood and four additional symptoms from a list of nine, they are considered to be clinically depressed. However, depression is often not this black and white. Diagnosing depression from a list of nine very different and specific symptoms has led psychiatrists to use the same medication and treatment methods for a disease that manifests very differently from person to person. One individual might be gaining weight and sleeping a lot, while another might be losing weight and feeling anxious much of the time. However, under today’s protocol, both of these individuals would receive the same types of treatment for their depression.

It is this problem that led Conor Liston, a neurobiologist at Weill Cornell Medicine, to study the neurobiology of depression. Liston and his team realized that the current generalized approach to understanding depression has hindered patients from getting treatment that is tailored to their specific needs. In a recent study, Liston and his colleagues set out to find distinguishing characteristics for different types of depression in the form of biological markers.

In Liston’s study, over one thousand fMRI scans of both depressed and non-depressed individuals were analyzed. For each subject, the researchers analyzed 258 brain areas, measuring how strong the connections were within each area of the brain. Researchers found that one brain area, called the subgenual cingulate cortex, has unusually strong connections with other regions of the brain in people who are depressed. This conclusion led Liston and his team to identify four subtypes of depression. The first two subtypes tend to exhibit more fatigue, while the other two subtypes exhibit more restlessness.

This subtyping has implications for both pharmaceutical treatment and different types of therapy. For example, Liston and his colleagues found that individuals that experienced more fatigue with their depression were more likely to benefit from a newer therapy called transcranial magnetic stimulation, or TMS. This method produces small electrical currents in certain areas of the brain, and is usually reserved for individuals who haven’t been responsive to antidepressants. However, because of the identification of different subtypes of depression, Liston and his team are hoping to be able to tell which individuals will not be responsive to antidepressants at all. He is then hoping to develop a method where the physician could scan the patient’s brain through fMRI and target the under-stimulated areas of the brain with more specificity.

This new avenue of treatment and therapy will open up more avenues to treatment than just antidepressants and therapy. Hopefully, more Americans will be able to find treatment that is tailored to their specific depression symptoms, and fewer individuals will continue to suffer in silence.

References:

Drysdale, A. T., Grosenick, L., Downar, J., Dunlop, K., Mansouri, F., Meng, Y., … Liston, C. (2016). Resting-state connectivity biomarkers define neurophysiological subtypes of depression. Nature Medicine, 23(1), 28-38. doi:10.1038/nm.4246

Liston, C., Chen, A. C., Zebley, B. D., Drysdale, A. T., Gordon, R., Leuchter, B., … Dubin, M. J. (2014). Default mode network mechanisms of transcranial magnetic stimulation in depression. Biological Psychiatry, 76(7), 517-526. doi:10.1016/j.biopsych.2014.01.023

Categories
Bipolar Disorder

The Problem with how we Treat Bipolar Disorder

Bipolar disorder is a mental illness that causes unusual changes in energy and activity levels, as well as changes in moods and the ability to perform day-to-day tasks (NIH). Mental illness is an abstract concept because it is not tangible and readily visible unlike a cold or a runny nose. Therefore, it can be difficult to medically diagnose, treat and sometimes accept what’s going on in our own bodies. New York Times author, Linda Logan, describes how her “hormonal chaos of having three children in five years, the pressure of working on a Ph.D. dissertation and a genetic predisposition for a mood disorder took [her] to a dark place” and with the disbelief of her family, friends and herself she could not receive the help she needed straightaway.

Going from one doctor to another and testing her blood for anemia, low blood sugar and hypothyroidism (which were all negative), she began to lose her sense of competence as well as mask the joy derived from her children into grief from the idea that her children will grow old, leave the home and inevitably become deceased. From an outsider’s point of view, her life was full of accomplishments because during her mid-30s she had three children, completed her Ph.D. in geography and was a co-lecturer at M.I.T. However, her success was concealing her pain. She contemplated suicide several nights a week and with access to a gun shop, she knew the path she would take.

After reaching out in order to restore her health, she was labeled as a patient, a room number, and a diagnosis rather than a person with various identities in her community. Later she was introduced to the idea of taking many prescription drugs at once, polypharmacy, by her physician which has been shown to give people “entirely new personalities: happier, lighter, even buoyant” (Logan, 2013). But for her, the ultimate desire was not to turn into someone else, it was to become herself again. With certain medications, her ability to concentrate, remember and express herself were stolen from her as the medication, especially mood stabilizers “turned [her] formally agile mind into mush” (Logan, 2013). Doctors did not respond attentively when she expressed that she was losing herself. Instead, they focused on the tangible: her capability to make eye contact and facial expressions. They monitored her lithium and cortisol levels, took M.R.Is and EKGs and documented every observation. They failed to listen to what could not be observed: “The issue of self just isn’t there” (Logan, 2013) said her physician.

After some time, the author reveals how unique and distinctive mental illness is to an individual. She was diagnosed with Bipolar II which unlike Bipolar I, usually swings between depression and hypomania, a less severe form of mania, like her father. Some people may assume – same diagnosis, same treatment – however like her physician implied, her father was a Ford and she was like a Ferrari, suggesting that although they might be similar and both starts with the letter “F” (meaning they have the same family line), father and daughter are not the same and treatment is case by case.

With time and a steady environment, Linda began to feel small changes as she began to experience herself “filling in” (Logan, 2013). Some wise words from her father: “Don’t look at what your disorder has taken away from you, try to find what it has given you” (Logan, 2013) encouraged the author to speak about her experiences making it less traumatic, less painful and most of all less personal.    

She has tried to battle issues with the medical and social treatment of Bipolar Disorder by talking to clinicians and questioning the idea that “psychiatry is moving away from a model in which the self could be discussed” (Logan, 2013). “For many people with mental disorders, the transformation of the self is one of the most disturbing things about being ill” (Logan, 2013) which is worsened by the disengaging culture when dealing with mental illness.   

We should create an atmosphere in which we allow individuals dealing with mental illness to feel whole like a person rather than a patient. Over-identifying with a mental disorder or a diagnosis does not seem to help the healing process portrayed by the author as she felt herself slipping during her hospital stays. The author’s adolescent son once said that “there can’t be a shadow in the darkness” (Logan, 2013) showing the author, that her son understood her depression better than the doctors. The shadow is an individual’s identity; therefore we must take mental illness out of the darkness and allow room for discussion, similar to the author’s support group. Creating a social and medical attentiveness to the self, allowing individuals with mental illness to feel whole and improve towards the path to recovery.

References:

Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.

Logan, L. (2013, April 27). The Problem With How We Treat Bipolar Disorder. Retrieved January 23, 2017, from http://www.nytimes.com/2013/04/28/magazine/the-problem-with-how-we-treat-bipolar-disorder.html?_r=1&%3Bpagewanted=all&%3B

National Institute of Health (NIH) – National Institute of Mental Health. (2016, April). Bipolar Disorder . Retrieved January 23, 2017, from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Categories
Eating Disorders

A Victim of Anorexia: How to Tell

As outlined by DSM-5 guidelines, anorexia nervosa includes restrictive energy intake even lower than daily requirements, extreme fear of gaining weight or becoming fat, and denial of increasingly lower body weight. What does a victim of anorexia look like and how can you tell?

Easy. Look at what is on magazine covers, television screens, and fashion runways: a severely underweight, starving young woman.What is more shocking is that over 1 million women in the United States suffer from anorexia in their lifetime, with 1 in 5 anorexia deaths resulting from suicide (Arcelus et al. 2011; Hudson et al. 2007). While database statistics can better represent an affected population, popular media continues to emphasize that most people who suffer from anorexia are women, women who are young, white, and middle-to-upper class. Elders, minority groups, men, gender non-conforming, the poor–all silently suffering, and current statistics are not enough to emphasize the prevalence of anorexia in these subgroups of society.

Still trying to figure out how to tell if someone is a victim of anorexia? In a world domineered by Western culture, the face is a young white woman. A mere Google search shows you almost nothing else. If other subgroups are affected by this mental disorder, why are we only beaming our eyes towards one angle and averting all other angles?

Media. One of the most influential powers of Western society, media comes in a variety of flavors, from television to Internet to the radio. In between all the sitcoms, news, and movies, commercials can subliminally speak to our hidden insecurities and inner fears, particularly those that target women’s physical appearance. What we do not realize is that others that are not directly targeted are also deeply affected.

TJ’s “nine-year nightmare” ended at the age of 22, when he died in the middle of doing sit-ups. The 2015 tragedy flooded news stations and circulated on the Internet, claiming that he was the “New Face of Anorexia.” TJ, a young white college-student with excellent grades, dreams, and manners did not “want to be skinny. He wanted to have muscles. He wanted to have a six-pack, like the health magazine covers that he had, about 100 of those under his bed. He wanted to be quicker and faster and stronger, and look good,” his mother, Susan, explained. People might be quick to blame Susan for her lack of intervention, but she did monitor him for years until he went off to college. He began lying to her because he was afraid of showing weakness or worry and giving up on his goal. TJ’s demise can be perfectly attributed to the influence of media, those magazines eventually convincing him that he had to be muscular and thin or that he would not be considered a man.

On the other hand, Ahani Ortega, a 25-year-old Latina woman, had found herself trapped in the shadows of the “white anorexia.” Ortega shares with us that as part of her traditional Mexican lifestyle, her family would only eat two meals a day, and skipping meals was even easier at her California high school because no one was watching. Her anorexia escalated into self-harm and bulimia, and at the age of 15, she was hospitalized for overdosing on diet pills and nearly suffering a stroke. She began group therapy, but she was the only Latina “in a room full of white girls.” Her group therapy failed, and her doctors then diagnosed her with EDNOS (eating disorder not otherwise specified) because she did not meet the standards for anorexia, bulimia, or binge eating disorder. Surprisingly, EDNOS is the most common diagnosis in Latina women because like Ortega, many are not focused maintaining “the perfect thin,” defined as curvy, but not too much; thus, because anorexia’s diagnostic requirement is a “preoccupation with thinness,” she fell away from the possibility of receiving the treatment appropriate for her.

Darcy, too, found herself battling with anorexia after her husband died. She stopped eating, dropped fifty pounds, and, one day, the 66-year-old widow living in an “active retirement community” found herself hospitalized after a fainting spell on the golf course. The events leading up to her collapse were a mix of her depression, other women complimenting her on her figure the more weight she lost, and her own desire to lose her “chubby belly,” although she was a 5-foot-5, 90-pound woman. Who was telling her that she was “chubby,” and who knew that she was no longer eating?

More advertisements portray what young white women should represent, but nobody talks about TJ’s starving himself to death, Anahi’s misdiagnosis because she is Latina, or Darcy’s mid-life struggle with her husband’s sudden passing. Nobody talks because the facts are wrong. Most statistics we have are recorded based on self-reported questionnaires, with questions that target specific populations and create the young white woman bias we see (Streigel-Moore and Franko, 2003).

Given what I have discussed in previous other articles I have published about eating disorders, you can recognize that the experiences of eating disorders are spectral and range from one extreme to the other. To solve part of the bias portrayed in the media, Favaro et al. 2004 suggests to conduct personal interviews across several communities; furthermore, population-based data are needed to ascertain the prevalence in not only anorexia nervosa, but also bulimia nervosa and binge eating disorder (Favaro et al. 2004). From these interviews, we will be better able to assort the data on age-of-onset, duration of the illness, and association with sociodemographic factors (e.g. race, gender, class).

Note that many of the sources in this article date back to approximately ten or more years ago, which demonstrates the evident knowledge gap in anorexia prevalence, pathology, and treatment. On the greener side of research, data analyzed from the National Comorbidity Survey Replication (NCS-R) by Hudson et al. 2007 identifies a wider range of factors to consider, such as the association of anorexia with other mental disorders, the degree of disability, and the history of mental health treatment (Hudson et al. 2007). Other work contributed to the National Institutes of Mental Health (NIMH) reveals that researchers have found that, on the whole, eating disorders are caused by “a complex interaction of genetic, biological, behavioral, psychological, and social factors.” Just from these studies alone, we can start to understand that anorexia does not look the same for every person who lives with the illness.

We like to think that we know the in’s and out’s of anorexia, but we only know what anorexia should look like because the media tells us what to believe. As serious as anorexia nervosa is, a black cloud of social issues still hovers over the mental disorder. Media portrayal of positive body image, self-love and acceptance, and mental health wellness and awareness can lead to profound changes in how we view others and ourselves. TJ, Ahani, and Darcy did not get the help they needed when they were most vulnerable, all because they were not young white women, but emphasizing the level of destruction that a disorder such as anorexia can sustain on an individual can aid in the advocacy of urgent intervention, treatment, and management.

As Gayle Brooks, vice president and chief clinical officer of the Renfrew Center, the country’s first residential treatment facility for eating disorders, says, “When eating disorders were first being recognized, people seeking treatment were young white girls, so the belief developed early that nobody else suffers from them. When that became the core of our understanding, we stopped looking at diversity being an issue. We missed a lot.”

If you or someone you know is struggling with an eating disorder, the National Eating Disorders Association has useful information and resources. Do not hesitate to get help.

References:

American Psychiatric Association. (2013). Feeding and Eating Disorders. Retrieved from http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm10

Arcelus J, Mitchell AJ, Wales J, Nielsen S. (2011). Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry, 68(7):724-731.doi:10.1001/archgenpsychiatry.2011.74

Cartwright, Martina M. (2013). Does Grandma Have an Eating Disorder? Psychology Today. Retrieved from https://www.psychologytoday.com/blog/food-thought/201310/does-grandma-have-eating-disorder

Favaro A, Ferrara S, Santonastaso P. (2004). The Spectrum of Eating Disorders in Young Women: A Prevalence Study in a General Population Sample. Psychosom Med, (65):701–708.

George, J. B. E., & Franko, D. L. (2010). Cultural Issues in Eating Pathology and Body Image Among Children and Adolescents. Journal of Pediatric Psychology, 35(3), 231-242. doi: 10.1093/jpepsy/jsp064

Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358. http://doi.org/10.1016/j.biopsych.2006.03.040

Kloepfer, Chivon. (2015). Friends for Life: Nine-Year Nightmare. WLNS 6 News. Retrieved from http://wlns.com/2015/11/23/friends-for-life-nine-year-nightmare/

Konstantinovsky, Michelle. (2014). Eating Disorders Do Not Discriminate. Slate. Retrieved from http://www.slate.com/articles/double_x/doublex/2014/03/eating_disorders_and_women_of_color_anorexia_and_bulimia_are_not_just_white.html

National Association of Anorexia Nervosa and Associated Disorders. (2016). Eating Disorder Statistics. Retrieved from http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/

National Institutes of Mental Health. (2016). Eating Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

Categories
Post Traumatic Stress Disorder

PTSD, Stigma, and Treatment; the Clinical Perspective.

Nicholas Eaton, Ph.D. is an assistant professor of psychology at Stony Brook University.  As someone who has experience with both the clinical side of psychology as well as research, Professor Eaton has valuable insight into the workings and treatment of various mental health conditions, as well as the numerous factors that influence treatment and willingness to seek professional assistance. Professor Eaton…  

The Humanology Project: 
Can you give me a little summary about your educational background and experience with mental health?
Nicholas Eaton received his PhD clinical psychology from University of Minnesota (2012)

Nicholas Eaton: Then I moved to NY started research on psychopathology, which has mostly been focused on classification. In recent years my focus has been applying this to different groups and trying to understand how oppressive influence may influence mental health.

THP: 
Do you have experience with PTSD clients?
NE: Yes, both research and clinically.

THP: 
What did your PTSD research focus on?
NE: 
My research looks at how PTSD relates to mental disorders and to what extent it’s a unique thing vs. a mixture of things like depression and anxiety. The treatment for PTSD largely looks like anxiety treatment, so cognitive vs. exposure based treatment as well both work.

THP: 
Can you tell me about any unique experiences with your clients who had PTSD?

NE: 
Well PTSD can occur in many different ways and manifestations.
One client in particular I remember had a traumatic work accident. So he came in thinking he had panic disorder. After we talked it, actually turned out he had PTSD. After explaining to him why I thought this was the case, and showed him that his presentation of symptoms, he himself agreed that this seemed to explain why he tried many different things to get over his symptoms, as he thought it was the result of a panic disorder rather than trauma, and therefore why his personality was changing. In that we kind of saw this misconception that PTSD is a disease for Veterans, but after showing them the diagnostic chart it clicked, his personality changed based on an accident, and he kept reliving the incident.

THP: 
Treatments in PTSD/other groups:

NE: 
With Veterans, you gradually get them thinking about service and things that remind them that provoke anxiety of service, and retrain their brain such that they can have a more balanced view of their service. So it’s not like every time they see a uniform or flag they’ll have strong negative reactions, they can tolerate the anxiety and over time it has less pull, and their reactions are less strong, so it becomes livable.

Working with different groups (ethnic minorities, non-gender binary, etc.):
In terms of treatment it doesn’t impact the treatment so long as you take unique factors into consideration. If it is PTSD resulting from someone being assaulted in transphobic attack it behooves the therapist to have knowledge of trans issues as to not miss important complexities.  Particularly when we see people traumatized more vicariously through hate crimes, which are layered in social, cultural, and political impact.  For others outside that attack, when we see our own communities being impacted it makes up worries.  However, regardless of individual circumstance it becomes exposure-based treatment.

THP: 
How does stigma affect the treatment of patients?

NE: So within certain communities, there certainly are stigmas about mental disorder. So for example, in some communities people may feel as though someone with a mental disorder doesn’t have enough willpower, or within other communities, they say within some military context people might view PTSD (historically at least) with some sort of weakness that someone who’s strong enough would be able to overcome or not be affected by. Whereas in other communities there’s actually a reduced stigma. I remember one client I met, a kid who was Hmong and the kid had psychosis; so hallucinations, and normally we would treat the kid with antipsychotic medication but in this case the family really viewed [his illness] as a benefit. That the kid had this kind of extrasensory perception and would be able to serve an important role in the community because of this, so kind of an anti-stigma as well, like quite accepting of these experiences.

THP: 
So this impacted their willingness to get treatment?

NE: Yeah, and they didn’t want treatment.

THP: 
How was that perceived by professionals?

NE: Certainly within the clinic, there was a diversity of opinions. With some people feeling like it was an important cultural difference that must be respected and other people feeling like it was just really almost child abuse.

THP: 
If it’s something that’s seen as potentially harmful to the patient, at what point does a professional step in?

NE: Well professionals are required legally to step in when there’s imminent threat of harm to the patient or to someone else by the patient or when you know someone is being harmed, who’s vulnerable like a kid or an older adult who can’t take care of themself.  But so in general outside of those requirements, the clinician has no authority to do anything unless the person wants treatment.

THP: 
Even in the case of children?

NE: In the case of children who are being abused, as in actual abuse defined by law, than no. In similar cases (Hmong) the courts will side with the parents, due to First Amendment issues.

THP: How have you found that families typically react to members of their family seeking treatment in terms of misunderstandings, or stigmas? Especially in the case of it being “the first” family member to seek treatment?

NE: It varies quite widely. By the time someone seeks treatment, often the family has really wanted them to make some sort of change because they see that they’re in pain; so they’re excited because the person has chosen to seek treatment. But sometimes the family does stigmatize, typically in more traditional settings. But in my experience people are, if they are not leery of psychotherapy or medication, they’re usually pretty happy that someone they care about is pursuing something that may help them.

THP: Have you found that patients coming in have preconceived notions of illness? Especially if they came seeking treatment believing they had one illness and they got diagnosed with something different?

NE: Most people, in my experience, don’t really know enough about these things to have much of a preconception unless they’ve tried researching on their own or have some sort of specialized education. Some people though will definitely disagree with the diagnosis and you really need to clarify for them why you think the diagnosis is appropriate and how that diagnosis fits better than the other diagnosis but in a lot of situations you don’t even talk about the diagnosis. I often don’t. I don’t think it’s necessary for most clients.

Diagnosis to me doesn’t really do very much. It puts a label on something, which for some people is very important, but for some people is very stigmatizing. So for me, I don’t usually find it profitable to do a lot of diagnosis unless a person really needs one, or really wants a name for things. Ultimately I feel like making that careful differential diagnosis is usually not a very good use of time and because most of the similar things wind up being treated similarly anyway, I’m really going to target it to their presentation and their symptoms rather than to a particular diagnosis