Suicide - An Overview

Suicide is a huge issue that is extremely stigmatized and ignored. It ranks among the 10 leading causes of death in most Western countries - and the number of suicides is likely higher than estimated since many deaths are ruled "accidental" rather than being given the stigmatized label of "suicide." 

Anxiety Disorders

In my post about panic disorder, I described fear as an emotion that elicits the "fight-or-flight" response of the autonomic nervous system. In anxiety, unlike fear, there is no activation of the fight-or-flight response. Anxiety is a long-term response oriented towards future events rather than imminent danger. Short-lived, low levels of anxiety can be good because they help prepare a person for upcoming activities such as an exam or sports event. However, long-term high-intensity anxiety creates a state of chronic over-arousal that can lead to physical troubles such as reduced immune response (i.e. susceptibility to disease) and increased blood pressure, as described in my post about the biological effects of stress.

Gender Dysphoria - Homosexuality and Transgender

In the past, there was an amazing amount of stigma against homosexuality. King Henry the VIII of England declared "the detestable and abominable vice of buggery" a felony punishable by death. It was not until 1861 that the maximum penalty in England was reduced to 10 years in prison. Similarly, in 1885, when lesbianism was about to be criminalized, Queen Victoria declared lesbianism to be impossible, and therefore there was no point in making a law against it. In the US, the last law prohibiting homosexuality was struck down by the Supreme Court in 2003. As recently as 1973, homosexuality was a diagnosable disorder in the DSM. 

Paraphilic Disorders

Paraphilias are sexual behavior patterns in which unusual objects, rituals, or situations are required for full sexual satisfaction. And yes, believe it or not, paraphilic disorders are diagnosable in the DSM-5. But in order to have a disorder, you can't just be turned on by unusual situations - it has to involve suffering or humiliation of yourself or others. (Though unfortunately, the suffering may be caused by stigma within society.) I will list several paraphilic disorders and discuss each: 

Dialectical Behavioral Therapy

To supplement my post about borderline personality disorder (BPD), I'll comment on a highly effective therapy developed especially for BPD. I, myself, have been through DBT and can attest to its wonderful results. DBT is a modified form of cognitive behavioral therapy (CBT). CBT focuses on addressing cognitive distortions (thoughts that assume negative reasons for a potentially neutral situation) and practicing changing the way you think about the situation. DBT focuses on accepting the way you think, but changing the way you react to the thoughts. 

Somatic Symptom and Related Disorders

Somatic symptoms are medical complaints that arise from mental illness. In my experience, such symptoms are shrugged off by the general public as "oh, that's not a real symptom, it's just somatic." Well, let me tell you: the symptoms feel very real to the suffering individual.(Something I learned in my work at a suicide hotline and my own intensive outpatient therapy is that what you feel is a real feeling, regardless of what others say.) And sometimes (in fact, maybe a lot of the time) symptoms are due to a "real" medical problem caused by the mental illness. Read my post about the physiological effects of anxiety if you don't believe me.

Borderline Personality Disorder

Borderline personality disorder (BPD) is in Cluster B, but I didn't discuss it in my Cluster B post because I think BPD deserves a post of its own. People with BPD have high impulsivity, drastic mood swings, terror of abandonment, and extremely volatile relationships. Such individuals also have self-images that vary significantly from one moment to the next. 

Dissociative Disorders

Dissociation is when an individual is able to go through complex cognitive processes without explicit knowledge of what they are doing. Someone might suddenly become self-aware while in a completely unfamiliar place without having any idea of how they got there. The DSM-5 recognizes several types of pathological dissociation: depersonalization/derealization disorder, dissociative amnesia, dissociative fugue, and dissociative identity disorder.

The Biological Effects of Anxiety on the Body

Stress and anxiety can wreak havoc upon your body. It can lead to problems with childhood physical development, and affect the immune, endocrine, gastrointestinal, and cardiovascular systems. It can exacerbate diabetes. Stress affects the mind as well, a tragic example being PTSD, where an individual might relive a traumatic event over and over. 

Stress can be either good or bad event - such as marriage or a divorce. Low levels of stress can actually be a good thing - for instance, a small amount of stress might help you prepare for an upcoming exam better than you otherwise would have. But sometimes stress becomes overwhelming, and biological systems in your body that would usually only slightly increase during "good stress," go into overdrive - potentially on a long-term basis. 

Personality Disorders - Cluster C

As mentioned in my opening post about personality disorders, personality disorders are split into three clusters -A, B, and C. This post will discuss cluster C. People with these disorders tend to be  anxious and fearful.

Personality Disorders - Cluster B

As mentioned in my opening post about personality disorders, personality disorders are split into three clusters -A, B, and C. This post will discuss cluster B. People with these disorders tend to be dramatic, emotional, and erratic. 

Personality Disorders - Cluster A

As mentioned in my opening post about personality disorders, personality disorders are split into three clusters: A, B, and C. This post will discuss the cluster A personality disorders. Cluster A disorders are characterized by distrust, suspiciousness, and social detachment. Often, people with cluster A personality disorders are considered eccentric or odd.

Personality Disorders - Clusters and Dimensions

Personality disorders are a difficult topic for me. For one thing, they are highly stigmatized. And I think the term "personality disorder" encourages that stigma by suggesting that there is something terribly wrong with a person's identity, rather than implying that people with these disorders respond to the world in a highly ineffective manner that creates problems for themselves and others. In fact, Butcher describes "personality disorder" in his textbook Abnormal Psychology as: characterized by "chronic interpersonal difficulties and problems with one's identity or sense of self." This description is good as long as we accept that the "problem with one's identity" is that one's self-esteem and view of one's relationships with others is unstable. 

Depression - an overview

Depression is a surprisingly common mental health issue, affecting 17% of Americans at some point throughout their lifetimes. Depressions almost always are a result of a stressful life event, though not all of these depressions are severe enough or long enough in duration to be considered a mood disorder. 

Hoarding and Body Dysmorphic Disorders

Obsessive compulsive disorder (discussed in a previous post) is grouped in a DSM-5 category called "obsessive compulsive and related disorders." Other disorders included in this category are hoarding, body dysmorphic, trichotillomania (hair picking), and excoriation (skin picking) disorders. 

Upon publication of the DSM-5, there were a lot of ignorant people laughing at the "new" disorder "hoarding," and giving it as an example of how the DSM-5 encourages over-diagnosis of "normal" individuals. Such people do not understand the dire nature of this disorder. An individual with hoarding disorder finds it extremely distressful to discard objects, regardless of their actual value. These objects fill up their living spaces, leading to impairment of the individual's ability to live a healthy, functional life. 

Obsessive Compulsive Disorder

Most people are familiar with obsessive compulsive disorder as is popularized in many TV shows and movies. My favorite is Monk, a TV show about Adrian Monk, an investigator who works with the San Francisco police department. Due to Monk's severe OCD (along with other disorders), he was forced into retirement as a detective with the San Francisco PD. The show is unflinching about the negative effects of Monk's disorder, but of course it introduces humor into his predicament. 

According to the DSM-5, obsessions are "recurrent and persistent thoughts, urges, or images" that are intrusive and cause distress. The individual attempts to ignore the obsessions, but is generally unable to. Compulsions are repetitive behaviors - such as hand washing, checking, praying, counting, or word repetition - that the individual feels compelled to perform in order to reduce anxiety and distress.

Panic Disorder

Fear is an emotion that elicits the "fight-or-flight" response of the autonomic nervous system. It is an immediate (uncontrollable) response to a direct danger - such as a rattlesnake, a gun pointed at your head, or a fast car driving right at you. Fear is generally a helpful response that allows you to protect or remove yourself from the imminent peril. 

Sometimes the fear response can occur in the absence of any obvious stimulus - this can lead to a panic attack. Panic attacks are terrifying physiological and psychological events in which your autonomic nervous system ramps you up for fight-or-flight. Often, the person becomes terrified that they are dying - usually of a heart attack. Like intense fear, the heart starts pounding, adrenaline flows, breathing races. Sometimes the victim will run from the room - perhaps to a hospital or perhaps with no direction at all - to escape the unseen threat. 

Post Traumatic Stress Syndrome - the Basics

I think we all have some idea of what we think PTSD is, but it turns out PTSD isn't as clear-cut as I thought.

Apparently, when PTSD was first introduced into the DSM, the diagnostic criteria required a traumatic event "outside the range of usual human experience" that would cause "significant symptoms of distress in almost anyone." That fits pretty well with my own perception of PTSD. Rape, war, torture, violent experiences...these all fit into that description. PTSD is a normal response to an abnormal stressor. 

Clinical Mental Health Diagnosis - Psychological Assessment

In my post about the biological assessment of mental health diagnosis, I mentioned that there are three ways a clinician can focus a mental health assessment: biological, psychodynamic, and behavioral. In this post I will discuss the psychodynamic and behavioral assessments of patients. 

I'm not sure what a psychological assessment feels like to the clinician, but I have been through several assessments as a patient. Some of them have been very grueling and embarrassing - my 2 hour long assessment for dialectical behavioral therapy comes to mind. Generally, the mental health worker will ask a series of questions to determine personality (am I maladaptive?), social context (am I from an abusive family? caring for an sick family member? a bullied teen?), and culture (I'm a WASC) .

Clinical Mental Health Diagnosis - Biological Assessment

One of the most difficult tasks for mental health workers is to clinically assess and diagnose mental illnesses - especially when comorbidity (having more than one mental illness) is so common. It usually begins with a psychological assessment through tests, observation, and interviews so the clinician can catalog the symptoms. Then the DSM-5 is consulted to give the diagnosis. 

A clinician may focus the assessment in three ways - biological, psychodynamic, and behaviorally.