Anxiety has been referred to as ‘inner battle’ by Sigmund Freud. In a lay man’s language it is a general feeling of apprehension about possible danger. The adaptive value of anxiety may derive from the face that it helps one to plan for & prepare for possible threat, & in mild to moderate degrees, anxiety actually enhances learning & performance. Although anxiety is often adaptive in mild or moderated degrees, it is maladaptive when it becomes chronic (old) and severe and may lead to anxiety disorders. Anxiety disorders are generally characterized by unrealistic, irrational fear or anxiety of disabling intensity at its core & also its principal & most obvious manifestation. Anxiety might not always be obvious to the person involved or to others, if psychological defense mechanisms are able to deflect or mask it. So anxiety can exist in either of the forms called Covert Anxiety (hidden) or Overt Anxiety (evident).
- Phobia (specific or social) / Phobic Disorder.
- Panic Disorder (with or without agoraphobia).
- Generalized Anxiety Disorder (GAD)
- Obsessive Compulsive Disorder (OCD)
- Post Traumatic Stress Disorder (PTSD)
PHOBIC DISORDER
A phobia is a persistent & disproportionate fear of some specific object or sitration that present little or no actual danger to a person. In such a case, the person experiences fight or flight response. Thus physiological response & behaviorally the phobic response is identical to that which would occur in an encounter with an objectively terrifying situation such as being chased by a grizzly bear. A person suffering from phobia is likely to go to great lengths to avoid encounters with their phobic stimulus, or even seemingly innocent reminders of it such as pictures.
Types of Phobia
Specific Phobia also known as Simple Phobia may involve fears of other species such as snakes or spiders or fears of various aspects of environment such as water of heights. In other words, if a person shows “marked” & persistent fear that is excessive or unreasonable, accompanied by the presence or anticipation of a specific object or situation & when exposure to the phobic stimulus almost invariably provoke an immediate anxiety response that resembles panic attack except for the existence of a clear external trigger.
List of some common phobias & their relative objects
Acrophobia - Heights
Algophobia - Pain
Astraphobia - Thunderstorms, lightning
Claustrophobia - Enclosed places
Hydrophobia - Water
Monophobia - Being alone
Mysophobia
- Contamination or germs
Nyctophobia - Darkness
Ochlophobia - Crowds
Pathophobia - Disease
Pyrophobia - Fire
Zoophobia - Animals or some particular animal
Specific phobias are quite common especially in women. Life time prevalence rate has been established by studies as 14% for women & 8% for men. The average age for the onset for specific types of simple phobia varies widely.
Animal phobia usually begins in childhood as do blood-injury phobias & dental phobias. However other phobias such as claustrophobia & agoraphobia tend to begin in adolescence & early adulthood.
Social phobia has been identified as fear of negative evaluation by others and has been further categorized as -
Specific Social Phobia is characterized by having a disabling fear of one or more discrete social situation in which an individual fears of being exposed to the scrutiny of others and may act in embarrassing or humiliating manner e.g. public speaking, urinating in public toilets, eating, reading or writing in public.
Generalized Social Phobia is about having significant fears of most social situations. This may often be accompanied by Avoidant Personality Disorder (). A distinctive feature of this type of phobia is that the individual when performing same tasks alone shows no impairment or difficulty or anxiety.
Social phobias typically begin during adolescence or early adulthood about equally often in women and men. The probability of an individual suffering with social phobia suffering from one or more Generalized Anxiety Disorder or Depressive Disorder, Substance Abuse, alcohol abuse may be high e.g. drinking before going to a party.
Panic disorder is characterized by the occurrence of “unexpected” panic attacks that often seem to come “out of the blue”. In order to be diagnosed with panic disorder, the person must have experienced recurrent unexpected attacks and must have been persistently concerned about having another attack for at least a month. The symptoms for panic attack may range from feelings of losing control, going crazy, shortness of breath, heart palpitations, sweating, dizziness, depersonalization or derealization, fear of dying etc… These symptoms may develop abruptly and usually reach the peak within 10 minutes; the attack usually subsides within 20-30 minutes and rarely lasts for up to an hour. When fight or flight response is activated by a phobic object, it is referred to as learned alarm but since it is triggered when there is no obvious trigger, as in case of panic attacks, so it’s called learned false alarm which continues to trigger panic attacks.
Panic Disorder may or may not be accompanied by Agoraphobia. (Agoraphobia involves fear of being in places or situations from which escape would be physically difficult or psychologically embarrassing or in which immediate help would be unavailable in the event that something bad happened such as getting sick or having a panic attack). In moderate cases the person may even be uncomfortable venturing outside the home alone, doing this in itself causes severe anxiety whereas in very severe cases, the person cannot go beyond the narrow confines of home or even particular parts of home. Agoraphobia is generally accompanied by Panic Attacks and it is rarely the case that person suffering from it does not experience panic attacks.
Panic Disorder with and without agoraphobia affects is many people. Some of the studies indicate that approximately 1.5% of adult population had pure panic attack at some point of their life, with approximately 5% qualifying for diagnosis for agoraphobia. The life time prevalence rate for panic disorder has been estimated to be nearly 4% by yet another study.
Age for the onset of panic disorder with or without agoraphobia is typically 20s, although it is quite common for these disorders to begin in late adolescence or not until 30s. Studies report that panic disorder without agoraphobia is as common in men as in women which is not true of agoraphobia, which occurs much more frequently in women than in men.
GENERALIZED ANXIETY DISORDER (GAD)
Generalized Anxiety Disorder is characterized by chronic excessive worry about a number of events and activities. This state was most commonly described as free-floating anxiety because it was not anchored to a specific object or a situation as with specific or social phobias. Unlike other anxiety disorders, in this state the person do not have any very effective anxiety avoidance mechanism. The symptoms for GAD may range from restlessness, feels of being keyed up or on an edge, sense of being easily fatigued, difficulty concentrating, mind going blank, irritability, muscle tension, sleep disturbance. So the general picture of a person suffering from GAD is that they live in constant state of tension, worry, diffuse uneasiness.
Barlow refers to the fundamental process as one of Anxious Apprehension, which is defined as a future oriented mood state in which a person attempts to be constantly be ready to deal with upcoming negative events. This mood state is characterized by high levels of negative affect, chronic over arousal, and a sense of uncontrollability. In addition to their excessive levels of worrying and anxious apprehension people with generalized anxiety disorder often have difficulty concentrate and making decisions, dreading to make mistakes. They may engae in subtle avoidance activities such as procrastination or checking but these are not very helpful in reducing anxiety. They also tend to show a marked vigilance for possible signs of threat in their environment. Their high level of tension is often reflected in strained postural movements and overreaction to sudden or unexpected stimuli. They may also complain of muscle tension, especially neck and upper shoulders, sleep disturbance including insomnia and nightmares. No matter how well things seem to be going, people with GAD are apprehensive and anxious. Their nearly constant worries leave them continually upset, uneasy and discouraged. A study indicated that their most common spheres of worry were found to be family, finances, work and personal illness. Even after going to bed people suffering from GAD are not likely to feel the relief. Often they review each mistake, real or imagined, recent or remotely past. When they are not reviewing or regretting the events of past, they are anticipating all the difficulties that may arise in future. They have no appreciation for logic most of people in general have in concluding that it is no point to torment ourselves to about possible outcomes over which we have no control on. Although it may seem at times that they are looking for things to worry about, it is their feeling that they cannot control their tendency to worry.
GAD is relatively common, with current estimates that it is experienced by approximately 4% of the population in any one year period. However, perhaps because most people with GAD do manage to function in spite of their high levels of worry and anxiety, they are less likely to come to clinics for treatment than are people with panic disorders or major depression, which are frequently more debilitating conditions. GAD is somewhat more common in women than in men. Age of onset is often difficult to determine, with large portion of patients reporting that they remember having been anxious nearly all their lives, many others report slow and insidious onset.
OBSESSIVE COMPULSIVE DISORDER (OCD)
OCD is defined by the occurance of unwanted and intrusive obsessive thoughts or distressing images; these are usually accompanied by compulsive behaviors designed to neutralize the obsessive thoughts or images or to prevent some dreaded event or situation. Obsessions involve “recurrent persistent thoughts, impulses or images that are experienced at some time during the disturbance, as intrusive and inappropriate. The person tries to suppress or ignore such thoughts, impulses or images or to neutralize them with some other thought or action. Compulsions involve “repetitive behaviors” (e.g. handwashing ordering, checking or mental acts such as praying, counting, repeating words silently) that the person feels driven top perform in response to an obsession or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.. In most cases people do have some realization that their behavior is irrational bu they cannot seem to control it.
One year prevalence rate of OCD in a study was found 1.6% and the average life time prevalence was 2.5%. Although disorder generally begins in late adolescence or early adulthood, it is uncommon in children, where its symptoms are strikingly similar to those of adult cases. In most cases the disorder has a gradual onset, but once it becomes a serious condition it tends to be chronic, although the severity of symptoms usually waxes and wanes in intensity over time. Earlier it was believed that women are more likely to get affected with OCD but newer figures show no significant gender difference.
POST TRAUMATIC STRESS DISORDER (PTSD)
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that some people get after seeing or living through a dangerous event. It can be looked upon as a natural emotional reaction to a deeply shocking and disturbing experience. In other words, it is a normal reaction to an abnormal situation. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.
When faced with a danger, it’s natural to feel scared. At this moment, the body is prepared for fight-or-flight response as an outcome of physiological changes that it undergoes. “Fight-or-Flight” response is a healthy reaction which is meant to protect a human being from potential danger but in a person suffering from PTSD, this reaction is either changed or damaged. This reaction gets triggered even when the person is not under threat and the body starts preparing itself for either fight or to flee from the situation. The symptoms may range from frequently having upsetting thoughts or memories about the traumatic event, recurrent nightmares, acting or feeling as if the traumatic event was happening again “flashback”, having strong feelings of distress when reminded of the traumatic event, being physically responsive such as experiencing surge in heart rate, sweating, making efforts to avoid talking about the traumatic event, making efforts to avoid places and people related to the traumatic event, loss of interest in activities which were once considered positive, feeling distant from others, difficulty experiencing positive feelings such as happiness and love, difficulty sleeping or staying asleep, irritable, anger outbursts, difficulty concentrating, feeling constantly on guard, being jumpy or easily startled.
PTSD commonly is associated with battle–scarred soldiers or military combat affecting men but unlike this notion PTSD can be experienced by anyone who has had overwhelming life experience especially if the event feels unpredictable and uncontrollable. PTSD develops differently from person to person and the symptoms may develop in the hours or days (commonly) following the traumatic event, though it can sometimes take weeks, months, or even years before they surface.
Most common events which may lead to PTSD- War natural Disaster, Car or plane crash, terrorist attack, sudden death of a loved one, Rape, Kidnapping, Assault, Sexual or physical abuse, Childhood neglect
Though above mentioned events would be perceived as traumatic by most people but there could be other events that may be powerful enough for some individuals to develop PTSD as an outcome. In other words any shattering event that effects a person making them feel stuck, helpless and hopeless may lead to PTSD (e.g. bullying, domestic violence etc…)
There are also differences between men and women in the presentation of PTSD. Women are more likely to have symptoms of numbing and avoidance and men are more likely to have the associated features of irritability and impulsiveness. Men are more likely to have comorbid substance use disorders and women are more likely to have comorbid mood and anxiety disorders, although many disorders comorbid with PTSD are commonly seen in both men and women.
SOMATOFORM DISORDERS
Somatoform Disorder is the presence of physical symptoms that suggest a general medical condition. The symptoms cause clinically significant distress or impairment in social occupational or other areas of functioning. Somatoform disorder is essentially different from fictitious disorders and malingering. (Factitious disorder leads a person to acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms e.g. consuming hallucinogens, infecting the urine samples etc… Malingering refers to fabrication or exaggeration of the symptoms of mental or physical disorders for a variety of secondary gains which may include avoiding school, work or military service, getting lighter criminal sentences or to attract attention and gain sympathy etc…) Unlike in anxiety disorders, anxiety is not necessarily observable in somatoform disorders. In this condition, the individual complains of bodily symptoms that suggest a physical defect or dysfunction for which no physiological basis can be found. In other words, in somatoform disorders, the psychological disorders take physical form. The physical symptoms of somatoform disorders are not under voluntary control and are thought to be linked to psychological factors, presumably anxiety.
Types of Somatoform Disorders
- Conversion Disorder
- Somatization Disorder
- Pain Disorder
- Body Dysmorphic Disorder
- Hypochondriasis
CONVERSION DISORDER (HYSTERIA)
Refers to sensory or motor symptoms such as a sudden loss of vision or paralysis, suggests an illness related to neurological damage of some sort though the bodily organs and nervous system are found to be fine. The individual may experience partial or complete paralysis of arms or legs, seizures and coordination disturbances, a sensation of pricking, tingling, or creeping on the skin, insensitivity to pain or loss or impairment of sensations, serious visual impairment, tunnel vision or complete blindness, loss of voice, loss or impairment of sense of smell. Although medically the individual suffering from somatoform disorder may be normal but experiences gross impairment due to the symptoms. The symptoms (episode) may end abruptly but sooner or later is likely to return in its original form or with a symptom of a different nature. Hysteria, the term originally used to described what are now known as conversion disorders. Conversion symptoms usually develop in adolescence or early adulthood. More women than men are diagnosed with conversion disorder.
SOMATIZATION DISORDER (BRIQUET’S SYNDROME)
Recurrent, multiple somatic complaints for which medical attention is sought but that have no apparent physical cause is the basis for this disorder. Somatization disorder and conversion disorder share many of the same symptoms. It can also be the case the an individual is diagnosed with both the disorders. The symptoms may range from pain in different body parts, gastrointestinal problems other than for diarrhea and vomiting, fainting, blindness or any other form of sensory impairment, menstrual difficulties and sexual indifferences or erectile dysfunction (ED). It is thought to occur in 0.2% to 2% of females and 0.2% of males. Somatization disorder typically begins in early adulthood and last for years. It also seems to run in families; it is found to be about 20% of first degree relatives of individuals diagnosed as having Somatization disorder.
PAIN DISORDER
A pain disorder is more easily defined as a disorder associated
to pain due to another outside cause. Pain disorders are much
harder to classify compared to other disorders. In pain disorder
the person experiences pain that causes significant distress and
impairment; psychological factors are viewed as playing an
important role in the onset, maintenance and severity of the
pain. The person may be unable to work and may become dependent
on painkillers and / or tranquilizers. A lifetime prevalence
rate of pain disorder 12.3%. Females are twice more prone to
suffer from pain disorder than men.
BODY DYSMORPHIC DISORDER
A person suffering from body Dysmorphic disorder is essentially
pre occupied with an imagined or exaggerated defect in physical
appearance. For e.g. facial wrinkles, excessive facial hair or
the shape or size of nose etc. These concerns could lead to
severe distress and further lead to frequent visits to
specialist (plastic surgeons, cosmetic surgeons). The symptoms
may range from spending hours each day checking on their defect,
looking at themselves in mirrors to taking steps to completely
avoid the defect by eliminating mirrors from their homes. The
disorder is linked to significantly diminished
quality
of life and can be
co-morbid
with
major depressive disorder and
social
phobia, also known as chronic
social
anxiety. With a completed-suicide rate more than double that
of major depression (three to four times that of manic
depression) and a
suicidal ideation rate of around 80%, extreme cases of BDD
linked with dissociation can be considered a risk factor for
suicide; however, many cases of BDD are treated with medication
and counseling.
HYPOCHONDRIASIS
Individuals suffering from Hypochondriasis are preoccupied with
fears of having serious diseases or illness, which persist
despite medical reassurance to the contrary. These individuals
are likely to over react to ordinary physical sensations and
minor abnormalities e.g. irregular heartbeat, sweating. A source
spot stomach ache, head ache etc. these minor symptoms serve as
evidence for their beliefs about fall prey to certain major
forms of illness. Individuals are likely to focus on a
particular symptom as the catalyst of their worrying, such as
gastro-intestinal problems,
palpitations,
or muscle
fatigue. The duration of these symptoms and preoccupation is
normally found to be 6 months or longer. Studies have shown that
Hypochondriasis affects about 3% of the visitors to primary care
settings.
PSYCHOSOMATIC DISORDERS
Psychosomatic condition refers to a state which involves both
the mind and the body. A psychosomatic illness originates with
emotional stress or damaging thought patterns, and progresses
with physical symptoms, usually when a person's immune system is
compromised due to stress. A common misconception is that a
psychosomatic condition is imaginary, or "all in someone's
mind". Actually, the physical symptoms of psychosomatic
conditions are real, and should be treated quickly, as with any
other illness.
Types of psychosomatic
disorders:
Psychogenic disease can be explained as the
physical diseases caused by emotional stress. The mind changes
the body’s physiology so that the body parts break down. In
other words it is a set of symptoms which arises due to complex
interactions between frontal lobe of the brain and the system in
which the symptoms or complaints manifest. Psychogenic illness
shows the powerful effect of stress and its effect on body.
Think of how "stage fright" can cause nausea, shortness of
breath, headache, dizziness, a racing heart, a stomachache or
even diarrhea. Your body can have a similar strong reaction to
the stressful situations involved in mass psychogenic illness. A
variety of evidences implicate the role of frontal lobe of the
brain where most complex processes such as cognition,
personality, mood, and memory are carried out, as a mediator if
not the source of the psychogenic complaints. Conditions such as
ulcers and asthma are an example of psychogenic conditions.
Somatogenic diseases in contrast with
psychogenic disease refer to the conditions that originate in
the body under the influence of external forces. In other words,
physical diseases caused by the mind increases the body’s
susceptibility to either have disease causing organisms (germs)
or natural degenerative processes. Cold and other similar
infections, cancer, rheumatoid arthritis belong to this category
of ailments.
DEPRESSION
Everyone occasionally feels blue or sad. But these feelings are
usually short-lived and pass within a couple of days. When an
individual has depression, these feelings starts interfering
with daily life and causes pain for both the individual and
those who care for him/ her. Depression is a common but is a
serious illness. In other words, clinical depression is a mood
disorder in which the symptoms may range from feeling sad,
anxious, empty, hopeless, helpless, worthless, guilty,
irritable, or restless. A person suffering from depression may
lose interest in activities that once were pleasurable including
sex, may have sudden outbursts of anger, experience loss of
appetite or overeating, or problems such as concentrating,
remembering details or making decisions are also common.
Depressed people may additionally contemplate or attempt
suicide. A few other symptoms such as insomnia, excessive
sleeping, fatigue, loss of energy, aches & pains or digestive
problems that are resistant to treatment may also be present in
a person suffering from depression. These symptoms grossly
interfere with everyday life of the person for a longer period
of time. Though symptoms in children with depression can be a
different range of symptoms altogether. It may be helpful to see
signs or patterns changing in the sleep, general behaviors or
school work.
Types of Depression
:
-
Adolescent depression
-
Bipolar disorder
-
Depression in the elderly
-
Dysthymia
-
Major depression
Adolescence Depression
affects teenagers characterized by sadness, discouragement, loss
of Self worth, interest in their usual activities. The most
common reasons for development of this state in teenagers
include normal process of maturing and its related stress,
influence of sex hormones, death of a friend or close relative,
conflict between parents and child on issues such as
independence and privacy, relationship break up, failure in
academia. In severe cases the causes may include bullying,
harassment, physical and/ or sexual abuse, disabilities etc…
Suicide/ suicidal activities may be a risk for all the
teenagers. Adolescents who have low self esteem, are too
critical of themselves, feel less/ no control on negative events
in life are more likely develop depression. Additionally, girls
are twice as likely to develop depression as compared with boys.
Bipolar
disorder or Manic Depressive Disorder is a mood
disorder characterized by the presence of one or more episodes
of abnormally elevated energy levels,
cognition,
and
mood with or without one or more depressive episodes.
Individuals who experience manic episodes also commonly
experience
depressive episodes, or a
mixed state in which features of both mania and depression
are present at the same time.
Bipolar disorder can be
categorized in three main categories:
Type I Individuals with type
I bipolar disorder has had at least one manic episode and
periods of
major depression. Earlier bipolar disorder type I was
referred to as manic depression.
Type II Individuals with
type II bipolar disorder have never had full mania but they
experience periods of high energy levels and impulsiveness as
extreme or intense as mania, also known as hypomania. In bipolar
disorder type II periods of hypomania alternate with episodes of
depression.
Cyclothymia is a less
intense or milder form of depression called
cyclothymia. It involves less severe mood swings and
individuals suffering with this form alternate between hypomania
and mild depression.
Symptoms during the manic state, which
may last from several days to months may range from being easily
distracted, little or no need for sleep, poor judgment, poor
temper control, lack of self control or reckless behavior, sex
with many partners, binge eating or drinking, excessive
activity, spending spree, elated mood, increased energy, racing
thoughts, talking a lot, very high self esteem, over involvement
in activities, agitated, irritated. Whereas during the depressed
state, the symptoms may include daily low mood and sadness,
difficulty concentrating, remembering or decision making,
problem with eating (loss of or increase in appetite) resulting
in change of body weight, fatigue, lack of energy, feeling
worthless, hopeless, guilty, apathy, low self esteem, suicidal
ideation/ thoughts, too less or too much sleep, socially
withdrawn etc… The condition can deteriorate in case of
substance abuse or alcohol dependence and risk of suicide
increases manifold.
Though there has been no clear cut
evidence for the cause of Bipolar Disorder but it has been seen
that a few conditions are more likely to trigger this condition
than others such as change in life due to child birth,
sleeplessness, recreational drug use, certain kind of
medications can also contribute to the development of this
condition.
Depression in Elderly
is a wide spread problem but is seldom recognized and reported.
It is characterized by persistent feelings of sadness,
discouragement, hopelessness, demotivation, lack of self worth.
This can either be a sign of illness or it can be a
psychological reaction to illness or directly caused by illness.
Physical illnesses such as hypothyroidism, heart disease,
stroke, Parkinson’s disease, cancer etc may increase the risk of
developing depression in elders. Depression may also occur as
symptoms of Alzheimer’s disease or side effect of certain
prescribed drugs. The risk of depression may also be elevated
due to incidents such as loneliness, feelings of isolation,
chronic pain, multiple illnesses, memory issues, unable to think
clearly, loss of independence etc… Symptoms of depression in
elderly range from feeling confused, forgetful, reduced
appetite, lack of personal hygiene (not bathing/ shaving/
cleaning) and grooming, unorganized or scattered home,
irregularity with medicine, isolating and withdrawn from others.
Dysthymia is
another form of mood disorder consisting of chronic depression
which is less intense and severe than major depressive disorder.
People with dysthymia have a higher chance of developing major
depressive disorder. Double Depression refers to an intense
episode of depression occurring in presence of dysthymia.
Due to less severe nature of symptoms, the sufferer may continue
to bear the symptoms before it is diagnosed. In fact, due to
chronic nature of the condition, the sufferer may believe that
depression is a part of their character and so they may not even
consider discussing the symptoms with family or friends.
Symptoms of dysthymia may be shared in a major depressive
disorder also but these symptoms tend to be less intense and can
fluctuate in intensity. A person with dysthymia may feel
hopeless; suffer from insomnia or hypersomnia, poor
concentration, difficulty making decisions, poor appetite or
overeating, low energy or fatigue, low self esteem, low sex
drive and irritability. The cause of this condition
remains unknown. Though it has been found that dysthymia runs in
families. Some of the factors that may contribute towards
development of this ailment in elderly include lowered ability
or complete inability to care for themselves, isolation, mental
decline and medical illness.
Major Depression
previously known as major depressive disorder (MDD) is a major
mental disorder characterized by low mood, sad, blue, unhappy,
miserable or down in the dump, low self esteem, loss of
interest, apathy etc… It is a disabling condition which
adversely affects a person’s personal life, work or academic
life, sleeping and eating habits with general health.
Depression can grossly change or distort the way you see
yourself, your life and others around you. A person affected by
depression is more likely to see things with a more negative
attitude, unable to believe and think that any problem or
situation can be solved in a positive way. The symptoms of
depression can include agitation, restlessness, irritability,
change in appetite, change in weight (gain or loss), very
difficult to concentrate, lack of energy, fatigue, feelings of
hopelessness, helplessness, feelings of worthlessness,
self-hate, guilt, becoming withdrawn and isolated, loss of
interest, inability to feel pleasure, inability to enjoy things
that were once enjoyable, trouble with sleeping (less or too
much), thoughts of death or suicide. In severe cases, depressed
people may have symptoms of psychosis (abnormal condition of
mind involving loss of touch with reality). These symptoms may
include delusions (false belief with absolute conviction) or
hallucinations (perception in absence of stimulus or perceptions
in awake and conscious state in the absence of external stimulus
having elements of real perceptions) which are usually
unpleasant.
Exact cause of depression has not yet been established though
researchers do believe that the reasons may include affected
levels of neurotransmitters serotonin, norepinephirine and
dopamine; which can be due to genetic reasons or triggered by
certain stressful events or may be a combination of both. Most
antidepressant medicines increase the levels of one or more of
the three monoamines – the neurotransmitters serotonin,
norepinephirine and dopamine in the synaptic cleft between
neurons in the brain. Other factors which may have a role to
play in depression are alcohol or drug abuse, certain medical
conditions such as hypothyroidism, cancer, chronic pain, certain
drugs such as steroids, sleep problems, stressful life events
such as relationship breakup, death or illness of someone
closely related, divorce, childhood abuse, neglect, job loss and
social isolation.
Life time prevalence for depression in general population is 10%
- 25% for women and from 5% - 12% for men. Population studies
indicate that depression is twice as common in women as in men.
Though MDD may begin at any age but the average age at onset is
in the mid-20s. Some individuals have isolated episodes that are
separated by many years without any depressive symptoms, whereas
others have clusters of episodes, and still others have
increasingly frequent episodes as they grow older. After the
first episode of this disorder, there is a 60% chance of having
a second episode. After the second episode, there is a 70%
chance of having a third, and after the third episode, there is
a 90% chance of having a fourth. Some form of depression run in
families; first-degree biological relatives of individuals with
Major this disorder are 1.5-3 times more likely to develop Major
Depressive Disorder.
Some other common forms of depression also include :
Postpartum Depression
refers to depression that affects more women than men after
childbirth. It can occur anytime in the first year postpartum.
The symptoms may include sadness, hopelessness, low self esteem,
guilt, feeling overwhelmed, sleep and eating disturbance,
inability to be comforted, exhaustion, emptiness, inability to
experience pleasure that were once enjoyable, social withdrawal,
low or no energy, easily become frustrated, feeling inadequate
in taking care of the baby, impaired speech and writing, anger
spells towards others, increased anxiety and panic attacks, low
sex drive. A recent research study conducted using Edinburgh
Postnatal Depression Scale indicated that women who developed
depression were significantly more likely to be single, to lack
social support and have an unwanted pregnancy, compared to
subjects who did not become depressed.
Premenstrual Dysphoric Disorder (PMDD) is
characterized by symptoms of depression around a week before the
woman’s menstrual periods and goes away after the menstruation
is complete. PMDD is a severe form of Premenstrual syndrome
(PMS). PMDD generally follows a cyclic pattern and is
accompanied by emotional symptoms as well as mood symptoms which
may cause substantial disruption to personal relationships. Main
disabling symptoms can include feelings of deep sadness and
despair, possible suicidal ideation, feelings of tension and
anxiety, panic attacks, increased or decreased sex drive,
increased need for emotional closeness, difficulty
concentrating, increased sensitivity to criticism and rejection,
apathy, disinterest, binge eating, mood swings, crying, fatigue,
difficulty concentrating, irritability, increased interpersonal
conflicts, insomnia, hypersomnia, feelings of being out of
control, feeling overwhelmed, breast tenderness or swelling,
heart palpitations, headache, joint or muscle pains, swollen
face and nose, sensation of bloating, distorted view of body or
actual weight gain.
Seasonal
Affective Disorder (SAD) refers to an episode of
depression that returns ar certain time of the year. It is also
referred to as winter blues, winter depression, summer blues,
summer depression or seasonal depression.
Symptoms of SAD may consist of difficulty waking up in the
morning, morning sickness, tendency to oversleep and over eat,
especially a craving for carbohydrates, which leads to weight
gain. Other symptoms include a lack of energy, difficulty
concentrating on completing tasks, and withdrawal from friends,
family, and social activities. All of this leads to the
depression,
pessimistic feelings of hopelessness, and lack of pleasure.
People suffering from summer blues or summer depression show
symptoms such as insomnia, anxiety, irritability, decreased
appetite, weight loss, social withdrawal, an increased sex drive
and suicidal ideation.
The disorder may begin during the teen years or in early adulthood. Like other forms of depression, it occurs more often in women than in men. People living in places with long winter nights are at greater risk for SAD. Amount of light, genes, hormones and body temperature are a few important factors than can contribute in the development of SAD.
Schizophrenia
Schizophrenia is a major mental disorder that gravely affects
the global well being of an individual. The person may have two
or more of these symptoms like hallucinations, delusions,
disorganized speech, grossly disorganized or catatonic behavior.
The characteristics symptoms of schizophrenia involve a range of
cognitive and emotional dysfunctions that include problems in
perception, thinking, language and communication, behavior,
monitoring, affect, fluency and productivity of thought and
speech, volition and drive, and attention. WHO reports 24
million people throughout the world are affected with the
disorder. The annual incidence of schizophrenic disorder
probably ranges between 0.1 to 0.5 per 1000 people. Though
incidence rates reported from India have been higher than in the
western countries. Although incidence of schizophrenia in men
and women is about equal, the age of onset of schizophrenia is
earlier in men than in women. The average age for the onset of
first psychotic episode of schizophrenia is in the early to
mid-20s for men and in the late 20s for women.
Types of Schizophrenia:
Paranoid Schizophrenia
is characterized by preoccupation with one or more delusions or
frequent auditory hallucinations such as with content of
persecution, suspicion, grandeur and reference. Individuals
suffering with this kind of schizophrenia have gross
difficulties in interpersonal relationships but speech and
affect remains relatively unaffected.
Catatonic
Schizophrenia has a primary symptom of motor
immobility; this may include waxy flexibility or stupor. A
person may also show excessive motor activity that is apparently
purposeless and not influenced by external stimuli, extreme
negativism which apparently seems motiveless resistance to all
instructions or maintenance of a rigid posture against attempts
to be moved or mutism (inability to speak). The symptoms may
also show peculiarities of voluntary movement including
voluntary assumption of inappropriate of bizarre postures,
stereotyped movements, prominent mannerisms, echolalia
(uncontrollable and immediate repetition of words spoken by
another person) or echopraxia (the abnormal repetition of the
actions of another person) and catatonic behavior.
Disorganized
Schizophrenia is characterized by disorganized
speech and behavior and essentially does not meet the criteria
for catatonic type.
Undifferentiated Schizophrenia is characterized by
symptoms such as delusions, hallucinations disorganized speech
which may include frequent derailment or incoherence, grossly
disorganized behaviors and affective flattening , alogia
(inability to speak because of mental deficiency) but
essentially do not fulfill the criteria for the paranoid,
disorganized, or catatonic types.
Residual Type
Schizophrenia
In this type of schizophrenia, the
individual is unlikely to suffer from any kind of prominent
delusions, hallucinations, disorganized speech and grossly
disorganized or catatonic behaviors. Though there is a
continuing evidence of the disturbance, as indicated by the
presence of symptoms such as emotional hastening, poverty of
speech, associability, apathy (lack of interest in or concern
for things that others find moving or exciting.), and
significant cognitive impairment.
Stress
Stress in itself is not a bad thing. A certain amount of stress
is necessary for every individual to motivate and continue to
ones interest in the activity. In complete absence of stress,
life would become boring, dull and purposeless. This becomes
tricky when one is unable to unable to handle stress in positive
way and it exceeds the healthy levels. Once it exceeds the
healthy level it can be looked at as the reaction people have to
excessive pressures or other types of demand placed upon them.
It arises when they worry that they can’t cope. We can
understand it better by this given equation:
S = D > R
Where S = Stress, D = Demands, R = Resources
When a person believes demands made of them exceed their ability
to cope they will experience unhealthy form of stress.
Types of Stress
Eustress is that form of
stress that is deemed healthful or giving one the feeling of
fulfillment. It has a positive effect, spurring motivation and
awareness, providing the stimulation to cope with challenging
situations and perform optimally. In other words eustress is the
curative stress because it gives an individual the ability to
generate the best performance or maximum output.
A few examples of eustress at play in life are:
· - Thrill and
excitement on amusement ride
-
Feelings of excitement on winning a competition or challenge
- Feelings of
excitement on purchase of house
-
Feeling of pride on getting the first salary cheque
-
Excitement and the proud feeling of being a first time parent
- Feelings of
excitement while going for a long awaited holiday
A certain amount of positive stress keeps individuals pepped up
to meet all challenges and it is necessary the survival and
progress in life.
Distress refers to the
unhealthy amounts of stress that potentially is negative.
Distress is a type of stress which is opposite to the nature of
Eustress. Distress leads to a variety of stress disorders that
are caused by adverse situations and conditions. This type of
stress influences an individual’s ability to cope. It may act as
a contributory factor in minor conditions, such as headaches,
digestive problems, skin complaints, insomnia and ulcers.
Chronic or excessive, prolonged and unrelieved stress can have a
harmful effect on mental, physical and spiritual health.
Some events that may lead to distress are:
- Financial
hardships
-
Death of loved one
-
Consistent major/ heavy workload or responsibilities
-
Difficult relationships
-
Chronic Illnesses or recurrent sickness
Distress can be classified further as acute stress or chronic
stress. Acute stress is short-lived while chronic stress is
usually prolonged in nature. Also Read GAS[G1]
by Dr. Hans Selye
In order to successfully manage stress its
important to understand in what forms distress affect
individuals’ life.
Acute Stress
As the word 'Acute' suggests, this is brief and severe or
intense negative form of stress. This has been one of the most
common forms of stress. This crops up from pressures and demands
of the present and anticipation of them in the near future.
This form of stress is no fun but at the same time is not
terribly dangerous. This in fact help individual to save his
life. It happens whenever feelings of shocked or threat are
perceived, which triggers the fight or flight stress response
system. Our body is flooded with emergency response hormones
such as adrenaline and cortisol. These hormones lead to a
heightened alertness and increased strength, endurance and
energy, thereby allowing a prompt response to imminent danger.
Situations that can trigger this state could range from an
accident on the road, physical attack, and burglary to the loss
of an important contract or a business deal, fighting to meet a
deadline, occasional problems with the child at school and so
on.
While this type of stress is classified as a bad or unhealthy
stress, it is not dangerous because it doesn’t last for long and
the body washes away the residual hormones when the danger has
passed. This stress helps us to survive though overdoing on this
‘Acute’ or short-term stress can lead to psychological distress,
tension headaches, upset stomach, and other symptoms.
Identifying the signs is always helpful. The most common
symptoms associated with this form of stress are:
- Muscle problems like strained neck, back
pain, headache, pulled muscles and tendons due to muscular
tensions;
- Bodily conditions such as heartburn,
acidic stomach, flatulence, diarrhea, constipation, irritable
bowel syndrome (IBS) and other stomach, gut and bowel related
problems;
- Temporal over arousal may lead
to state of pounding or racing heart, sweaty palms, heart
palpitations, dizziness, migraine headaches, cold hands or feet,
shortness of breath, chest pain etc;
-
Emotional arousals and difficulties such as anger, irritability,
impatience, desperation, anxiety, and depression.
Acute stress can crop up in anyone's life, and it is highly
treatable and manageable.
Episodic Acute Stress
Episodic Acute Stress refers to frequent spells of acute stress
in an individual’s life. Typical examples include always rushed,
but always late; things going wrong too often despite careful
planning. Individuals who fall in this category are most likely
take on too much, have too many irons in the fire and fail to
organize the slew of self-inflicted demands and pressures.
Individuals with this kind of temperament often put themselves
into situations that perpetuates and maintains acute levels of
stress.
Most common symptoms of episodic acute stress includes being
anxious, strained, irritable, over aroused, nervous and
short-tempered. They may also experience persistent tension
headaches, migraines, hypertension, chest pain, and heart
disease. They blame for their woes & worry the external events
and other people and tend to worry a lot and catastrophize the
‘not so grave’ situations. People who experience this form of
stress are more likely to have a deep rooted sense of insecurity
and continue believing that world is an unsupportive,
speculative and vindictive place.
Treating episodic acute stress requires intervention on a number
of levels, generally requiring professional help, which may take
many months. So often than none, lifestyle as well as
personality related issues in these individuals are so deep and
ingrained that they are unable to see anything wrong with the
way of living life.
Chronic Stress
Unlike the thrill of acute stress, chronic stress is exhausting
and wears the individual out day after day, year after year.
Chronic stress works on the destruction of both mind and body;
hence life! It acts like slow grinding and has a devastating
effect on all the levels of individuals’ life. Stresses that
crop from issues such as financial hardship, dysfunctional
family, unhappy marriage and/ or detested career, lead to
generation of chronic stress. In other words it is the stress
that brings along the never-ending troubles and the person
almost always is stuck with one or the other miserable
situation. It's the stress of unrelenting demands and pressures
for seemingly everlasting time periods. The individual dealing
with this kind of stress starts experiencing feelings of
despondence, despair and disconsolate and stops making efforts
for improving situations.
Individuals who experience chronic stress during their early
years of life start to carry a view of the world, or a belief
system, is created that causes unending stress and feelings of
misery for the individual. At times individuals also internalize
the effect of become internalized and remain forever painful and
present. Some experiences profoundly affect personality.
Since chronic stress lasts for a significantly long time in an
individual’s life so he get used to it and this is one of the
most debilitating aspect of chronic stress. So rather than
working towards a solution they rather work on forgetting and
believing that it is not there at all. Unlike a prompt response
towards management of acute stress, people tend to ignore the
chronic stress is relatively familiar leading to the feelings of
comfort with it sometimes. This form of stress play havoc on
life and may also lead to attempted or completed suicide,
violence, heart attack, stroke, and/ or even cancer. People wear
down to a state of exhaustion, fatal breakdown. (Read more about
GAS by Hans Selye) This is to say because physical and
mental resources are depleted through long-term consumption.
Treating symptoms and outcome of chronic stress requires regular
and extended medical as well as psychological intervention.
Stress management training can be especially helpful in the
course of treatment.
Additionally, two more categories of stress have been outlined:
Hyperstress – This
refers to a state when an individual is stretched beyond his/
her ability to handle, and hence they tend to experience what is
known as Hyperstress. In other words, this form of stress
results due to overload of demands and requirements. In this
state an individual may experience a strong emotional response;
even though the trigger is seemingly little. Typically
hyperstress is experienced by working mothers, working married
women who have to juggle between personal and professional
demands, people working in areas which need speed as well as
accuracy, poor socio economic status etc…
Hypostress - This
type of stress refers to the lack or absence of experience any
form of stress. This leads to feelings of boredom. This is
likely to experienced by people who are required to perform same
routine mundane job for months and years together, e.g. factory
workers, housewife etc… who perform similar kind of work in a
similar fashion, work that lacks any kind of challenge or
novelty. Effect of Hypostress may lead to feelings of
restlessness and a lack of inspiration.