Medication Free

Well this title is a bit of a ‘blanket’ statement so technically no I am not medication free as I still inject four times a day for my diabetes.

But…in terms of mental health I am no longer taking any form of medication…Congratulations to me!!

So here’s the back story. If you haven’t read my ‘The strive for the ‘right’ medication‘ post that may give you a bit of insight into my medication journey regarding anxiety and depression. But to be brief, I started taking medication for anxiety in my last year of college so 2012 (I can’t remember the exact date). I was prescribed propranolol for the symptoms of anxiety; panic attacks etc. At the time my GP and myself (to some extent) put my anxiety down to the stress of a-levels. If you don’t know me that well then it would be pertinent to tell you I put a lot of pressure on myself especially within schooling and academic study! So that was that.

During my first year at university things were going well but at the end of 2012 and beginning of 2013 I decided that I needed to seek some help; I didn’t feel at all like myself. So in the late Winter 2012 and early Spring 2013 I was diagnosed with severe depression. Have a look at ‘Depression and Me’ if you want to understand more about that and how Depression affected me. By the Summer of 2013 after many months of changing anti-depressant medication I had finally found the one for me Sertraline.

So I bet you’re wondering what I am getting at. Well throughout 2016 I had weaned myself down from 100mg of Sertraline to 50mg which I was quite happy with. And by August I had decided that I was going to try not to take that little tablet. The little tablet which I had found to be one of the things that brought me from the depths of despair and my darkest of days. Now, I didn’t try an think about it too much because I must admit it had become a bit of a comfort blanket and I also didn’t tell my close friends and family for a little bit (and anyone else didn’t know I was taking anti-depressants). Stupidly I was scared that if I said it out loud then I would go backwards and have to go back on to them.

So now in January 2017 I can finally say that I no longer take medication for my mental health. I am in such a better place now and I wanted to wait a couple of months until I wrote it down in words. I was never too bothered about taking medication everyday I know others feel real shame about having to take medication for mental health but for me I would have taken anything that would have had the hope of making me better than I was feeling.

So thank you to that little pill that helped me get better and helped the symptoms to subside so I could truly work on what was going on in my head and increase depleted Serotonin in my brain. You truly helped me out of a dark place which I never thought I would be able to climb out of myself.

I did also want to say that if you are thinking about coming off any sort of medication than seek the help of professionals. I didn’t but I wouldn’t advise that’s the best way but for me I knew it was time.I have also discussed previously I don’t think you ever fully heal from Depression or Anxiety you just get better at managing and coping with the ‘illnesses’. So I am under no illusion that in the future I may have to return to taking anti-depressant or medication for anxiety but for now I am mentally well.

So after 5 years of taking a little pill everyday I no longer need to.

I am medication free.

Dissociative Identity Disorder

Dissociative Identity Disorder is the most complex dissociative disorder it is also referred to as multiple personality disorder. This has lead to many seeing the disorder as one to do with personality and thus a personality disorder. However, this disorder is categorised within the ‘dissociative’ disorders of the DSM. The defining feature of this disorder is a severe change in identity.

When a person experiences DID they may experience the shifts in identity as separate personalities. Each identity may be in control of the persons behaviour and thoughts at differing times yet, each has a distinctive pattern of thinking and relating to the world around them. If a person also suffers from amnesia they may not have any memories of what has happened during the shifts in identity. A person whom suffers from DID must have two distinct personality states known as alters to be diagnosed with Dissociative Identity Disorder. 

Diagnostic Features

A. A disruption to ones identity characterised by two or more distinct personalities (in some cultures this may be known as an experience of possession). The disruption in identity involves marked discontinuity in sense of self and sense of agency accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition and/or sensory-motor functioning. This signs and symptoms may be observed by others or reported by the individual.

B. Recurrent gaps in recalling everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.

E. The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Typical Signs and Symptoms

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person’s behavior. With dissociative identity disorder, there’s also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which fluctuate with the person’s split personality.

The “alters” or different identities have their own age, sex, or race. Each has his or her own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals’ behavior and thoughts, it’s called “switching.” Switching can take seconds to minutes to days. When under hypnosis, the person’s different “alters” or identities may be very responsive to the therapist’s requests.

Typical symptoms are:

• feeling like a stranger to yourself
• being confused about your sexuality or gender
• feeling like there are different people within you
• referring to yourself as ‘we’
• behaving out of character
• writing in different handwriting

Causes

While the causes of dissociative identity disorder are still vague, research indicates that it is likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development. As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9).

Prevalence, Risk and Prognostic Factors

The ISSTD in their updated Treatment Guidelines (2011) place the prevalence of dissociative identity disorder at about 1-3% of the general population. Females with dissociative identity disorder dominate in adult clinical settings. Adult males with dissociative identity disorder may deny their symptoms and trauma histories, and this can lead to elevated rates of false negative diagnosis.

Females with dissociative identity disorder present more frequently with acute
dissociative states (e.g., flashbacks, amnesia, fugue, hallucinations, self-mutilation). Males commonly exhibit more criminal or violent behavior than females; among males, common triggers of acute dissociative states include combat, prison conditions, and physical or sexual assaults.

Due to the nature of DID environment plays a large role with regards to the onset of the disorder; trauma and abusive acts increase the risk of Dissociative Identity Disorders.

 

 

Acute Stress Disorder

…Didn’t have to wait too long for this post..this was one already in the pipeline. It may be beneficial to have a look at my previous post about  ‘Stress‘.

Acute stress disorder is characterised by the development of severe anxiety, dissociation and other symptoms after exposure to a traumatic stressor (read about what constitutes a traumatic experience here). ASD usually occurs within one month post-trauma/ exposure to a traumatic incident. As a response the person may develop a number of symptoms which may contribute to ASD. The presentation of this disorder may vary by individual but typically involves an anxiety response which may include some form of ‘reexperience or reactivity’. However in some individuals a dissociative or detached presentation may dominate. Despite the presentation all individuals will typically display strong emotional or physiological reactivity in  response to traumatic reminders. The full symptom picture must be present for at least 3 days after the traumatic event and can be diagnosed only up to 1 month after the event. Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder.

Diagnostic Criteria

A. Experience Trauma

Exposure to acutual or threatened death, serious injury or sexual violation in one or more of the following ways; directly experiencing the trauma, witnessing in person the events to others, learning the events occured to a close family member or friend, experiencing repeated or extreme exposure to aversive details of the traumatic event for instance; first responders collecting human remains, police officers exposed to details of child abuse).

Note: This does not apply to exposure through electronic media, television, movies,
or pictures, unless this exposure is work related.

B. Symptoms

The diagnostic criteria outlines 9 or more of the following symptoms from the 5 categories to be begin or worsen following the traumatic event.

Intrusion Symptoms;

These symptoms as their title denotes any symptom which is seen to be intrusive to the individual. For instance;

1. Experiencing recurrent, involuntary and intrusive memories of the traumatic event or for children repetitive play may occur where themes or aspects of the event is expressed.

2. Recurrent distressing dreams in which the content or affect of the dream are related to the event. In children this may be frightening dreams without recognisable content.

3. Dissociative reactions (flashbacks) where the individual feels or acts as if the traumatic event was occurring. These reactions may occur continuously with the more extreme expression being a complete loss of awareness of present surroundings. In children reenactments may occur within play.

4. Intense or prolonged psychological distress or reactions in response to internal or external cues which may symbolise or resemble aspects of the trauma.

The recollections are spontaneous or triggered in a response to a stimulus that is reminiscent of the traumatic experience e.g. fireworks may trigger memories of gunshots. These memories often include sensory (sensing heat from a traumatic house fire), emotional (the fear of believing that the individual is about to be raped) or physiological (shortness of breath if the individual suffered from near- drowning). Whilst distressing dreams may contain themes that are representative or thematically related to major threats involved in the traumatic event. For instance, in the case of a motor vehicle accident survivor the distressing dream may involve cars crashing generally.

Negative Mood

Negative mood is solely based on the individuals inability to experience positive emotions for example; happiness, joy or loving emotions.

Dissociative Symptoms 

Dissociation in the DSM is defined as the splitting off of clusters of mental contents from conscious awareness. The term is used to describe the separation of an idea from its emotional significance and affect. These symptoms may;

1. Alter the sense of reality of one’s surroundings and oneself. For example, seeing yourself from another’s perspective, being in a daze or experience time slowing.

2. The individual may be unable to remember important aspects of the trauma which is typically due to dissociative amnesia. Dissociative amnesia occurs when a person blocks out certain information, usually associated with a stressful or traumatic event, leaving him or her unable to remember important personal information. With this disorder, the degree of memory loss goes beyond normal forgetfulness and includes gaps in memory for long periods of time or of memories involving the traumatic event.

Dissociative states may last from a few seconds to several hours, or even days, during
which components of the event are relived and the individual behaves as though experiencing the event at that moment. While dissociative responses are common during a traumatic event, only dissociative responses that persist beyond 3 days after trauma exposure are considered for the diagnosis of acute stress disorder.

Alterations in awareness can include depersonalisation, a detached sense of oneself (e.g.,
seeing oneself from the other side of the room), or derealisation, having a distorted view of
one’s surroundings; perceiving that things are moving in slow motion, seeing things
in a daze.

Avoidance Symptoms

These symptoms directly relate to triggers of the trauma whereby the individual may consciously choose to avoid situations which may remind them of the trauma. These symptoms include efforts to avoid distressing memories, thoughts or feelings and efforts to avoid external reminders (people, places, conversations, activities, objects of situations) which may arouse distressing memories, thoughts or feelings closely associated with the traumatic event.

The individual may refuse to discuss the traumatic experience or may engage in avoidance strategies to minimise awareness of emotional reactions (e.g., excessive alcohol use when reminded of the experience). This behavioural avoidance may include avoiding watching news coverage of the traumatic experience, refusing to return to a workplace where the trauma occurred, or avoiding interacting with others who shared the same traumatic experience.

Arousal Symptoms

These symptoms are related to the individuals arousal of certain physiological aspects. The individual may suffer from sleep disturbance (difficulty falling or staying asleep), irritability and anger outbursts (with little or no provocation) typically verbal of physical aggression towards people or objects, hypervigilance, problems with concentration and exaggerated startle response (being on edge).

Some individuals with the disorder do not have intrusive memories of the event itself,
but instead experience intense psychological distress or physiological reactivity when
they are exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., windy days for children after a hurricane, entering an elevator for a male or female who was raped in an elevator, seeing someone who resembles one’s perpetrator). The triggering cue could be a physical sensation (e.g., a sense of heat for a burn victim), particularly for individuals with highly somatic presentations.

C. Duration

Duration of the disturbance/ symptoms is 3 days to 1 month after trauma
exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.

D. Impairment

The disturbance/symptoms cause clinically significant distress or impairment in social, occupations and/or other important areas of functioning.

E. No Other Causes

The symptoms are not attributable to the physiological effects of a substance or other medical condition and is not better explained by another mental disorder.

Prevalence

The prevalence of acute stress disorder in recently trauma-exposed populations (i.e.,
within 1 month of trauma exposure) varies according to the nature of the event and the
context in which it is assessed.

Risk, Cause and Prognostic Factors

There are psychological and physical reasons for the extreme way some people react to trauma. For example, flashbacks are the brain’s way of determining how best to be prepared should such an experience happen again. The adrenaline the body produces following a trauma is the body’s flight-or-flight response, designed to help you defend against danger. If your trauma was extreme, then this response can stay on and leave you constantly edgy. It’s as if the body expects more danger and can’t relax. But it’s not known exactly why some people develop PTSD and others  experience ASD or stress.

The DSM discusses three areas which account for developing ASD; temperamental, environmental and genetic/physiological factors. With regards to a persons’ temperament risk factors include prior mental disorders, high levels of negative affectivity (neuroticism), greater perceived severity of the traumatic event and an avoidant coping style. Catastrophic appraisals of the trauma characterised by exaggerated appraisals of future harm, guilt, or hopelessness are strong predictors for ASD. Firstly a person must have experienced or been exposed to trauma to present with acute stress disorder. Therefore this is the main focus of environment. However, a history of prior trauma may increase the likelihood of developing ASD. According to the DSM genetic factors of ASD females are at a greater risk for developing this disorder. Sex-linked neurobiological
differences in stress response may contribute to females’ increased risk for acute stress disorder. The increased risk for the disorder in females may be attributable in
part to a greater likelihood of exposure to the types of traumatic events with a high conditional risk for acute stress disorder, such as rape and other interpersonal violence. The cultural bias of males openly discussing mental health may contribute to the over representation of females amongst the sample.

Treatment

As with many mental health conditions accessing the right form of help and assistance is beneficial to alleviating symptoms, coping with the disorder and readjusting important areas of functioning. CBT is seen to be the most effective in treating trauma related illnesses including ASD. It aims to find strategies to help cope with symptoms of ASD such as; relaxation arousal symptoms, cognitive restructuring for avoidance and intrusive symptoms. Desensitisation is also increasingly helpful in coping with intrusion memories and nightmares. Pharmocotherapy has also been found to be helpful in treating ASD and alleviating symptoms. SSRIs can be helpful in dealing with the core symptoms (including anxiety, depression, withdrawal, and avoidance) and can play a central role in longer-term treatment. Beta-blockers may also prove beneficial in treating hyperarousal in ASD sufferers.

Life Update

24th February 2016

Well I always wonder who it is whom reads these posts…if I had the ability to peak into the inner lives of others lives I would (not in a stalkerish way but in reading a blog). I have found through doing this I have found it easier to open up and talk to people truthfully and honestly in many aspects of my life that very few have had the pleasure of displeasure of knowing. When I was ill only my inner family knew…well even my brother didn’t know fully and my close knit friends a.k.a. my chosen family knew and even then I was unable to try and explain some things. I’m not saying that I have written profound statements that truly explain me because I haven’t I mean some things I wouldn’t want to talk about or air my dirty laundry all over the internet especially with my primary career choices.

But, this blog has helped me reach out to people otherwise known as strangers and potentially help those in some way. I know I haven’t written a ‘psychological scientific’ post recently but I am enjoying just externalising my inner most thoughts and well this, this post may suit those of you whom I’ve not seen for a while, long lost friends, mentors, family members etc.

So Annabelle what’s going on with you? 

Now at the start of this week I had a call from my university asking, what I was up to at the moment? That question seemed daunting to me…what am I actually doing with my life? Well I’m working not necessarily in the career that I would like but I’m working, earning and developing transferable skills anyway, and lets be fair it is a bit of a laugh and I’ve made some fabulous friends.

However, I’m currently looking for jobs in the field of mental health…my passion. To get my foot in the door and start gaining experience in the clinical field. I have come to decide that a MSc for me this year is not going to happen and  I am thoroughly happy with that…I need experience in the field I want to go into before I start  further study. The likelihood is that I would get on to a course and complete the MSc but afterwards I am worried that I would be in the same position as I am in now. No matter how many letters you have after your name you still need valid in some cases paid experience and that is what I plan on doing in the intervening year. As my Dad has said in many occasions life is a marathon not a sprint at the end of the day I am 21 years old, have a mature head on my shoulders (if I do say so myself) and I have another 50 years of my working life ahead I’m not expecting to walk into my dream job straight away and I’m definitely not afraid of working hard to get there.

Other than working, some may say ungodly hours (well my Auntie especially). I am just living each day as it comes. For example, today I had planned on staying in and getting some life stuff done and one of those included a scientific blog post. Instead I had a lazy morning and then got in contact with a friend which was in Manchester…instead of doing housework I had an impromptu trip to see her and lovely meal out to celebrate her birthday tomorrow. Sometimes it’s better not to plan things; I’ve always found night outs that have been planned for ages and looked forward to aren’t necessarily the best some are the impromptu nights out…those are the best nights and it’s the same in life generally.

I’m enjoying as much time as I can with my family and friends; when work permits and there schedules do to. Recently I enjoyed a great night out with my friends (my family) to celebrate two birthday’s. Now I was only able to meet them at 9.30 but I managed to catch up and despite that I ended the night cutting my knee up falling over I had a fabulous time. So despite, the scar that will most likely be on that knee forevermore I will never forget that night out and the fun we had.

I’m potentially planning a trip to London with my Mum whilst she’s working down there…not a definite just yet but it’s got potential.

I’m trying my very best to keep up-to-date with the psychological world and recent research. I am continuing to write on here as much as I can and feel able to.

On a mental health note; I have recently reduced my anti-depressants; I’m not sure if anyone actually knows about this. So I decided that it was about time to reduce my anti-depressant Sertraline. Now, let me make this clear I have not had any medical assistance. After quite a few years of being stable on 100mg of Sertraline- 3 years in March (oh how time flies when you are having fun) I didn’t feel ‘depressed’ but I knew I wasn’t feeling right. I have always been able to know how I’m feeling I think its my awareness related to my diabetes. So after a week or so of wondering I decided to start taking half of my tablet and I feel a lot better for it. Now everyone has there down days and I’m sure that will come up eventually
but for now I feel good, I feel less like a dull version of me- the best way of describing it. Now for anyone out there I would seek assistance I probably should have in all fairness so don’t berate me for not doing but 3 years is a long time to rely on a strong anti-depressant. Now I’m not saying that I’m coming off medication because unlike others I’m used to taking medication and will be for the rest of my life so one tablet in the evening doesn’t really make much of a difference to the benefits of actually having it. So that’s my update for mental health related information.

In other news, well I’ve not got any really that’s me for now. Aslong as those whom I’m close to are ok and happy, life will continue…that’s the thing with time it can’t really be stopped; then I am ok and life, well life is life you just have to take every negative knock with a pinch of salt and appreciate the positives in your life because believe me if you look hard enough you will find something and if you can’t then you have me perhaps the other side of the world, perhaps making no sense at all, whom loves you and appreciates everything you do in the world. Because well without us what would this world be like? I’d like someone to say well Annabelle without you x, y and z wouldn’t be the same. Just a side note- a fear of mine is not being remembered after I die…in many years to come so hopefully if you do something positive in your life, you will be remembered and you will live on in the lives of others because you helped them, made a difference and made the world a better place. Oh this has gotten deep…in the words of a friend from volunteering I’ll have to get my wellies on!

So for tonight ladies and gentlemen…that’s me that’s my life as of now. Just as it is. I hope this has been intriguing for you because like I’ve said earlier in this post I would love to hear the inner thoughts of some people in my life and truly know what’s happening in their lives. Remember to appreciate the little moments, appreciate the people in your life and give yourself a bit of credit…celebrate the little victories and live your life in a way you want to be remembered. Wow that was a bit profound wasn’t it?

Good luck and Good night, until next time my loves. 

Trichotillomania

Personally, I had never heard about this disorder until I came across a Mental Health YouTuber called Beckie0. She documented the challenges she faced after being diagnosed with Trichotillomania and took a picture of herself for everyday for over 6 years (if my memory is right) she even dedicated a YouTube channel to her and this condition called TrichJournal…which I advise anyone who wants to know more about it in a personal sense to have a look at.

What is Trichotillomania? 

Trichotillomania is a condition whereby the individual feels compelled to pull out their hair (this is not limited to pulling but tearing etc). The hair is not limited to their hair on their head but; eyebrows, eyelashes, facial hair, body hair or pubic hair.

This disorder is described by the NHS as an impulse-control disorder, where the individual is physically unable to control or stop them from pulling their hair. The person will feel an intense urge to pull their hair and will not feel relief until they have carried out this behaviour.

As with any mental health condition, Trichotillomania is paired more than likely with negative feelings such as; guilt, depression and anxiety. The person may feel ashamed and embarrassed about their condition and therefore may try to deny or conceal their ‘illness’.

Diagnostic Criteria

A. Recurrent pulling out of one’s hair, resulting in hair loss.

B. Repeated attempts to decrease or stop hair pulling.

C. The hair pulling causes clinically significant distress or impairment to important areas of functioning; social, occupational etc.

D. The hair pulling or hair loss is not attritutable to any other medical condition e.g. dermatological condition.

E. The hair pulling is not better explained as symptoms of another mental disorder e.g. improve perceived defect or flaw in appearance in body dysmorphic disorder.

Diagnostic Features

The essential feature to this condition is the recurrent pulling out of one’s own hair (Criterion A). Hair pulling can occur from any region of the body in which hair grows; the most common sites according to the DSM are; the scalp, eyebrows and eyelids whilst less common sites
are facial and pubic regions. These sites may also vary over time and severity of condition. Hair pulling episodes may occur briefly; scattered throughout the day or during less frequent but more sustained periods that can continue for hours. As such the person may endure hair pulling for months or years. Criterion A requires the hair pulling to result to loss of hair, the individuals with this disorder may pull hair in a vastly distributed pattern therefore hair loss may not be clearly visible. Alternatively the individual may attempt to conceal or camouflage hair loss.

Criterion B acknowledges that individuals with this disorder may make repeated attempts to decrease or stop hair pulling.

Whilst, Criterion C indicates that hair pulling will cause clinically significant distress or impairment in social, occupational and other areas of functioning.

The term distress includes negative affects that may be experienced by a person with this particular condition; feeling a loss of control, embarrassment and shame.

Significant impairment may occur in several areas of functioning and the individual may take part in avoidance behaviours.

Associated Features Supporting Diagnosis

Hair pulling may be accompanied by a range of behaviours or rituals related to or involving hair. A individual may therefore search for a particular kind of hair to pull e.g. pulling hair with a specific texture or colour; they may try to pull out hair in a specific way e.g. the root comes out intact; or may visually examine, tactile or orally manipulate their hair after it’s been pulled e.g. rolling the hair between their fingers, pulling the hair between the teeth, biting the hair or swallowing the hair.

Hair pulling may also be preceded or accompanied by various emotional states; it may be triggered by anxiety or boredom, may be preceded by and increasing sense of tension or may lead to gratification, pleasure or sense of relief. The hair pulling may also involve varying degrees of conscious awareness, some individuals may display more focussed attention to pulling hair whilst for others it may be considered more automatic behaviour (without awareness).

Patterns of hair loss are highly variable; areas of completed alopecia, thinned hair density are common.

Hair pulling according to the DSM-5 does not usually occur in the presence of other people other than family members. However, individuals may have urges to pull hair and therefore may find opportunities to do some surreptitiously. Some individuals may also use replacement and may pull hair from other sources; pets, dolls and other fibrous materials.

The majority of people with Trichotillomania may also have one or more other body-focused repetitive behaviours including; skin picking, nail biting and lip chewing.

Prevalence, Development and Course

The condition is found predominantly in females. It usually develops at an early age from adolescence to early twenties and often can stay with the sufferer throughout their life until they get treatment. Trichotillomania may be present in infants, but the peak age of onset is 9 to 13.

The lifetime prevalence of this disorder is 0.6% of the population (in 2009) leading to 370,752 people possibly affected. However, as with many mental health disorder under-reporting is extremely likely to to the negative emotions associated with the condition.

Causes of Trichotillomania

It’s not known what causes Trichotillomania, but there are several theories. The NHS suggests that this condition may be a type of addiction; the more you pull, the more likely you want to continue the behaviour. It may also be a reflection of other mental health problems; anxiety, depression or stress. In some cases its suggested that this condition may also be a form of self-harm where the person deliberately pulls the hair to seek temporary relief from emotional distress.

Evidence also suggests that the condition can have a genetic link as with OCD.

 

Treatment

Treatments advised by OCD-UK and evidence based reports link highly to CBT and medication treatment. However, a technique utilised by many cognitive-behavioural therapists is Habit Reversal Training (HRT). This technique was developed in the 1970’s by psychologists Nathan Azrin and Gregory Nunn for treating nervous habits which are done automatically, such as pulling, tics, stammering and skin-picking.

HRT is based on the principle that hair pulling is a conditioned response to specific situations and events, and that the individual with Trichotillomania is unaware of these triggers. Therapy often focuses initially on developing Habit Awareness through the use of journals; why, when and where they pull. HRT challenges the problems of sufferers as a two-fold. Firstly, the individual with Trichotillomania learns how to become more consciously aware of situations and events that trigger hair-pulling episodes. Secondly, the individual learns to utilise alternative behaviours in response to these situations and events. The therapist will encourage individuals suffering from this condition to develop and awareness of the times of day, emotional states and other factors which have lead to hair pulling.

Exposure Therapy has also been utilised in the treatment of Trichotillomania.

Conclusion

Well that’s my best effort at explaining from the DSM what Trichotillomania is, as I have never suffered from this condition I cannot begin to imagine to explain how it makes an individual feel. However, through research and watching Beckie0 on YouTube I have come to understand the condition and the affect it can have on a person. Treatment is available to evaluate thought patterns, behaviours and the urge to pull. Accepting that you are experiencing this condition and reaching out for help is the first step to a journey of learning and potentially changing behaviours.

Further Information;

NHS; http://www.nhs.uk/conditions/trichotillomania/Pages/introduction.aspx

OCD UK; http://www.ocduk.org/trichotillomania

Hoarding Disorder

This disorder as with many mental health conditions has been within the public eye through the use of television programmes based on Hoarding such as; Obsessive Compulsive Hoarder, The Hoarder Next Door and Britain’s Biggest Hoarders. These are often presented as extreme cases whereby other services have had to become involved to help the person discard personal possessions.

So, what is Hoarding? 

Hoarding disorder is characterised by persistent difficulty discarding or parting with possessions, regardless of their value as a result of a strong perceived need to save the items and the distress associated
with parting from them. This disorder however differs from ‘normal collecting’ as, the symptoms of this disorder result in the accumulation of a large number of possessions that take over, clutter active living areas to the extent that their intended use is substantially compromised. This disorder consists of excessive collecting, buying or stealing items that are not actually recquired for which there is no available space and stored in a chaotic manner.

Diagnostic Criteria

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

B. This difficult is due to the perceived need to save the items and to distress associated with discarding them.

C. This difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties e.g. family members, authorities or cleaners.

D. The hoarding causes clinically significant distress or impairment in social, occupational,or other important areas of functioning (including maintaining a safe environment for self and others).

E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

F. The hoarding is not better explained by the symptoms of another mental disorder (e.g.,obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in
major neurocognitive disorder, restricted interests in autism spectrum disorder).

Specifiers

With excessive acquisition; to put it bluntly this specifier is linked  with the nature of acquisition’…e.g. the extreme severity of the situation- are they buying these possessions? Sought out for free or stolen?

According to the DSM-5, approx.  80-90% of individuals display excessive acquisition. The most frequent form of acquisition is excessive buying, followed by acquisition of free items e.g. leaflets. Stealing is less common. Some people deny excessive acquisition when first assessed, yet it may appear later in their course of treatment. Individuals typically experience distress if they are unable or prevented from acquiring items.

With good or fair insight; the person recognises that their beliefs are problematic.

With poor insight; the person recognises that their beliefs and behaviours are not problematic despite evidence on the contrary.

With absent insight/ delusional beliefs; The person is utterly convinced that their beliefs and behaviours are not problematic despite contrary evidence.

Diagnostic  Criteria

The essential feature of hoarding is the persistent difficulties discarding parting with possessions, regardless of actual value (Criterion A).

The term persistent indicates a long-standing difficulty rather than more transient life circumstances that may lead to excessive clutter e.g. inheriting a property.

The difficulty in discarding possessions refers to any form of discarding e.g. throwing away, selling, giving away or recycling. The main reasons for these issues are due to the perception that the possessions can be utilised, may have aesthetic value or sentimental attachment. Some individuals feel responsible for the fate of their possessions and often go to great lengths to avoid waste. Fear of losing important information is also common. Commonly saved items are; newspapers, magazines, old clothing, bags, books, mail and paperwork but virtually any item can be saved or hoarded. It must also be noted that hoarded items do not have to have little value but can also be more valuable and these items can be seemingly mixed with the clutter and chaotic hoarded possessions.

People with hoarding disorder purposefully save possessions and experience distress when facing the prospect of discarding them (Criterion B). This criteria emphasises that saving these possessions are intentional, which discriminated hoarding disorder from other forms of mental illness that are characterised by the passive accumulation of items or the absence of distress with the items are removed.

Individuals accumulate large numbers of items that fill up and clutter active living areas to the extent that their intended use is no longer possible (Criterion C). For example, the person may not be able to prepare food in their kitchen or are forced to sleep on their sofa. If the space can be used, it is only with great difficulty.

Clutter  is defined as a large group of usually unrelated or marginally related objects piled together in a disorganised fashion in spaces designed for other purposes e.g. tabletops, floors, hallway.

Criterion C emphasises the ‘active living areas’ of the hom
e, rather than more peripheral areas such as; garages, attics or basements, that are usually cluttered in homes where people do not suffer from Hoarding disorder. However, people with hoarding disorder often have possessions that spill beyond the active living areas and occupy and impair the use of living spaces and other spaces such as; vehicles, yards, gardens and storage spaces. In some cases however, living areas may be uncluttered due to the intervention of third parties such as family members this may then force the person to undertake renting storage units or using other spaces to hold their possessions.

Hoarding disorder is distinctively different from normal collecting behaviour as collecting is usually systematic and organised. The actual amount of possessions may be similar however the storage of these possessions is obviously different as normative collecting does not produce the clutter, distress or impairment of typical hoarding disorder.

Criterion D outlines that symptoms must cause clinically significant distress or impairment in normal functioning. In some cases where a person has poor insight the person may not report distress and the impairment may be only apparent to people around them. However, any attempts to discard or clear the possessions by other parties results in high levels of stress.

Prevalence, Development and Course of Hoarding Disorder

Figures from Help for Hoarders UK suggest that approximately 2-5% of the UK population, potentially over 1.2 million people suffer from Hoarding disorder where clinical, psychological help may be required.

According to the DSM-5 Hoarding Disorder affects both males and females however, epidemiological studies suggest that there is a significantly greater prevalence in males compared to clinical samples which predominantly feature females.

Hoarding symptoms appear to begin early in life and spans well into late stages of life. These symptoms are reported to emerge around ages 11-15 years old, they start to interfere with daily functioning in the mid 20’s and cause clinically significant impairment by the mid-30’s. Once symptoms are presented of Hoarding the course of hoarding is often chronic as these symptoms tend to increasingly become more severe throughout their life span.

Risk and Prognostic Factors

Tempremental; Indecisiveness according to the DSM is a prominent featutre of an individual with hoarding. As they are unable to come to a clear decision about whether a possession may be required in the future and therefore keep it to be on the safe side.

Environmental; Individuals with hoarding disorder often retrospectively report stressful and traumatic life events preceding to the onset of the disorder or the traumatic event may exacerbate the development of the disorder.

Genetic and Physiological; Hoarding disorder is believed to be familial with about 50% of people who hoard report having a relative whom also hoards. Twin studies suggest that 50% of variability in hoarding behaviour is due to genetic factors.

Interaction; The DSM states that their is evidence to suggest a genetic link to hoarding disorder. However, this may also be due to the person’s environment; sharing environments with a person who hoards may impart beliefs and understanding within their own children’s mind which may increase the likelihood of them picking up on hoarding behaviours and developing the disorder themselves.

GENETICS + ENVIRONMENT = POTENTIAL DISORDER

Treatment

The NHS website outlines the treatment for individuals suffering from Hoarding Disorder. These treatments include; CBT, SSRI medication treatment. I would also suggest Exposure therapy may also be helpful for the person to gain insight and gradually understand that these possessions do not necessarily need to be kept and understand their own thought patterns behind the behaviour.

Conclusion

Hoarding although chronic in course and can affect a persons life increasingly treatments have been seen to be effective in retraining a persons thought patterns and behaviours to acknowledge that the do not need to keep hold of possessions that are not required. These treatments may help the person to gain insight into their illness and try to understand why they hold beliefs about discarding possessions. Successful support and assistance however is the most important step. Treating someone with CBT away from the hoarding environment may prove to be ineffective, truthfully individuals need to be treated at home where their disorder stems from and disrupts to truly make a difference.

Personally, I am quite a sentimental person so I do have memory boxes on my bookshelf and a jar full of corks from special events which I am going to reuse and make into some art…you may see it eventually. I wouldn’t say I’m a hoarder in the slightest but I do attach sentimental values to items I suppose if I was a good at writing journals or scrapbooks then the memory boxes may be different but lets face it this blog I suppose could be considered hoarding of information and memories lets just remember the look back over 2015 posts. As with any mental condition it comes down to the person’s ability I believe to cope effectively if their disorder is clinically distressing and impedes on their life then clearly some intervention is required but I wouldn’t say that keeping hold of things which are sentimentally significant is a bad thing because well I do it. So please don’t think that I think keeping things that are sentimentally valuable or collecting things that you may feel is valuable or necessary is a bad thing, it is just when these need to keep and not discard anything impinges on your life that these beliefs and behaviours need to be addressed.

Further Information;

NHS;http://www.nhs.uk/conditions/hoarding/Pages/Introduction.aspx 

OCD UK; http://www.ocduk.org/hoarding

Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a preoccupation with one or more ‘perceived defects or flaws’ in a persons’ physical appearance that are usually not obvious or appear slightly to others. It is also characterised by repetitive behaviours such as; mirror checking, excessive grooming, skin picking or seeking reassurance from others or mental acts such as; comparing oneself to others. These preoccupations are not better explained by other concerns; body fat, weight or eating disorder.

It is estimated that up to one in 100 people in the UK may currently have BDD. As with any statistic this may be considered an underestimate due to people concealing their illness. The condition can affect all age groups but onset tends to occur during adolescence or young adulthood; when people are generally most sensitive about their appearance.

Statistics also suggest that is more common for people whom have a history of depression or social phobia. It often occurs alongside OCD, generalised anxiety disorder and eating disorders such as; anorexia or bulimia.

[Information taken from NHS website]

Diagnostic Criteria

The Diagnostic Criteria according to the DSM-5;

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

B. At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g. comparing their appearance with that of others) in response to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

The DSM also specifies if;

• With Muscle Dysmorphia; The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.
• Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., ‘I look ugly’ or ‘I look deformed’).
  • With good or fair insight; The individual recognises that the BDD beliefs are definitley or probably not true or that they may or may not be true.
  • With poor insight; The individual thinks that the BDD beliefs are probably true.
  • With absent insight/ delusional beliefs; The individual is completley convinced that the BDD beliefs are true.

Diagnostic Features

A person whom is suffering from BDD are preoccupied with one or more percieved defects or flaws in appearance which they believe they look; ugly, abnormal, unattractive or deformed (Criterion A). The perceived flaws are not observable or may appear slight to other people. Concerns may range from; ‘unattractive’ or ‘not right’ to looking ‘hideous’ or ‘like a monster’. Preoccupations can focus on one or more body areas most commonly the skin (e.g. acne, scars, lines, wrinkles, paleness), hair (e.g. thinning, excessive body or facial hair) or nose (e.g. size or shape). However, any area can be the focus of conern. Some individuals are concerned about perceived symmetry of body areas. These preoccupations are intrusive, unwanted, time-consuming (occuring on average 3-8 hours per day) and usually difficult to resist or control.

Excessive repetitive behaviours or mental acts are performed in response to the preoccupations (Criterion B). The individual may feel driven to perform these behaviours which are not pleasurable and may increase anxiety and dysphoria. They are typically time-consuming and difficult to resist or control. Common behaviours are; comparing ones appearance to that of others, repeatedly checking defects in mirrors or examining them directly, excessively grooming (e.g. combing, styling, shaving, plucking or pulling hair); camouflaging (e.g. applying make up, or covering disliked areas with other objects e.g. hats, clothing); seeking reassurance about how the perceived flaws look, touching disliked areas to check them, excessively exercising or weight lifting and seeking cosmetic procedures.  Some individuals may excessively tan (to darken pale skin or diminish acne), repeatedly change their clothes (camouflage perceived defects) or compulsively shop (for beauty products). Compulsive skin picking intended to improve perceived skin defects is common and can cause skin damage, infections or ruptured skin vessels.

The preoccupation must cause clinically significant distress or cause impairment in social occupational or other important areas of functioning (Criterion C).

Development and Course

According to the DSM the mean age of disorder onset is 16-17 years however, the most common age of onset is 12-13 years. Two thirds of individuals have disorder onset before the age of 18. BDD does occur in the elderly but little is known about the disorder in this age group. Individuals whom develop the disorder before the age of 18 are increasingly likely to attempt suicide.

Causes of BDD

According to Mind UK;

• Abuse or Bullying; if an individual experiences bullying or abuse a person may develop a negative self image which may lead to obsessions about their appearance. This is particularly true if this is endured during adolescence.
• Low self-esteem; if a person has low self-esteem they may become fixated upon aspects of appearance that they wanted to improve. This is more likely if a person attaches a lot of importance upon their appearance…if you think that your appearance is the most valuable thing about you.
• Fear of being alone or isolated; if you worry about fitting in to a group of friends or developing intimate relationships then a person may develop thought patterns that could lead to BDD.
• Perfectionism or Competing with others; if you try to appear physically perfect or regularly compare your appearance to others you may have a greater risk of BDD.
• Genetic; suggested by the NHS many mental disorders have a link to hereditary.
• Chemical Imbalances within the brain; due to successful treatment and alleviation of symptoms with the use of SSRIs; this suggests that a chemical imbalance can be present with people experiencing BDD.

Functional Consequences of BDD

Nearly all individuals with BDD experience impaired psychosocial functioning because of appearance concerns. Impairment can range from moderate (avoidance) to extreme and incapacitating (inability to leave the home). On average psychosocial functioning and quality of life are markedly poor for people with BDD. Most individuals will experience impairment in their job, academic or role functioning (parent) which is often severe (performing poorly, missing school or work or lack of attendance). Impairment in social functioning including avoidance is common.

Treatment

The NICE guidelines for treating BDD recommend;

• CBT
• Medication; usually perscribed are SSRIs to improve serotonin levels within the brain.
• Specialist support

Conclusion

Despite the affect that BDD can have on a person, there are treatment techniques which can help a person understand their dysfunctional thoughts and alleviate repetitive behaviours. Treatments such as; CBT and Medications can help a person understand and potentially reduce their feelings of inadequacy and gain insight into their appearance. BDD I imagine can be extremely frustrating and soul destroying but with the right, effective help treatment can help to reduce symptoms and readjust dysfunctional thought patterns.

Further Information; 

MIND; http://www.mind.org.uk/information-support/types-of-mental-health-problems/body-dysmorphic-disorder-bdd/about-body-dysmorphic-disorder-bdd/#.VpP6zvmLRaQ

NHS; http://www.nhs.uk/conditions/body-dysmorphia/Pages/Introduction.aspx

Body Dysmorphic Foundation; http://bddfoundation.org/ 

Obsessive Compulsive Disorder (OCD)

OCD is characterised by the presence of obsessions and/ or compulsions. Obsessions are recurrent and persistent

The OCD Cycle

thoughts, urges or images that are experienced as intrusive and unwanted. Compulsions are repetitive behaviours or mental acts the individual feels driven to perform in response to an obsession or according to rules according to their obsession. These obsessions and compulsions significantly interfere with the ability to function on a day-to-day basis as the obsessions and compulsions are incredibly difficult to ignore. People with OCD often realise that their obsessional thoughts are irrational yet they believe that the only way to relieve the anxiety is to perform compulsive behaviours often to prevent perceived harm happening to themselves, or more often than not a loved one.

OCD can present itself in many ways, and certainly goes far beyond the common perception that obsessive-compulsive disorder is merely ‘hand washing’ and ‘checking light switches or doors’. Despite this the four main forms of OCD are;

1. Checking
2. Contamination or Mental Contamination
3. Hoarding
4. Ruminations and Intrusive Thoughts

[According to OCD UK Website]

This  condition is incredibly debilitating and disabling as it affects many areas of a persons life. The World Health Organisation (WHO) has ranked OCD as being in the top 10 of the most disabling illnesses of any kind in terms of its lost earnings and diminished quality of life.

Diagnostic Criteria

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or imahes that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2. The individual attempts to ignore or supress such thoughts, urges or images, or to neutralize them with some other thought or action i.e. by performing a compulsion.

Compulsions are defined by (1) and (2):

1. Repetitive behaviours e.g. hand washing, ordering, checking or mental acts e.g. praying, counting, repeating words silently the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralise or prevent or are clearly excessive.

B. The obsessions or compulsions are time-consuming e.g. taking more that 1 hour per day or cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a disturbance or other medical condition.

D. The disturbance is not better explained as the symptoms of another mental disorder; excessive worries in Generalised Anxiety Disorder, preoccupation with appearance in Body Dysmorphic disorder, difficulty parting or discarding possessions in Hoarding etc.

Diagnostic Features

The characteristic symptoms of OCD are the presence of obsessions and compulsions (Criterion A) outlined previously. Both obsessions and compulsions are not carried out for pleasure or experienced as voluntary per se although they can relieve the person from anxiety or distress. Criterion B emphasises that obsessions and compulsions must be time consuming or cause clinically significant distress to daily life. This helps to distinguish this disorder from the occasional intrusive thought or repetitive behaviour. However, the frequency and severity of compulsions vary across individuals with OCD.

Associated Features Supporting Diagnosis

The specific content of obsessions and compulsions varies greatly between individuals. However, certain themes, or dimensions are common which includes; cleaning (contamination obsessions and cleaning compulsions), symmetry (symmetry obsessions and repeating ordering and counting compulsions), forbidden or taboo thoughts (e.g. aggressive, sexual, religious obsessions and related compulsions) and harm (fears of harm to oneself or others and checking behaviours). Some individuals also have difficulties discarding and hoarding objects as a consequence of typical obsessions and compulsions, such as fears of harming others.

Individuals with OCD experience a range of affective responses when confronted with triggering situations to their obsessions and compulsions. For example, many individuals experience marked anxiety which include recurrent panic attacks. Others report strong feelings of disgust. Whilst performing compulsions people report a distressing sense of incompleteness or uneasiness until thinks look, feel, or sound just right.

It is also common for people with OCD to take part in avoidance behaviours, things that may trigger their obsessions and compulsions e.g. people, places etc. For example, people with contamination concerns they may avoid public situations to reduce exposure to contaminants.

Prevalence, Development and Course

According to OCD UK, this illness currently affects as many as 12 in every 1000 people (1.2% of the population) from young children to adults, regardless of gender, social or cultural background.

OCD affects males and females equally, and on average begins to affect people during late adolescence for men and during their early twenties for women. Onset after the age of 35 is rare but does occur. The onset of symptoms is typically gradual; however acute onset also exists.

Sufferers however, often go un-diagnosed for many years, partly because of a lack of understanding of the condition by the individual themselves and amongst health professionals, and partly because of the intense feelings of embarrassment, guilt and sometimes even shame associated with this and many other mental disorders. This often leads to delays in diagnosis of the illness and delays in treatment, with a person often waiting an average of 10–15 years between symptoms developing and seeking treatment.

If OCD is left untreated the course is usually chronic often with waxing and waning symptoms. Some people however, have an episodic course and a minority experience a deteriorating course. Without treatment remission rates in adults are low. Onset in childhood or adolescence can lead to a lifetime of OCD however 40% of individuals who have onset during this period may experience remission by adulthood.

Risk and Prognostic Factors 

Temperamental; greater internalising symptoms, higher degree of negative emotions and behavioural inhibition in childhood are possible temperamental risk factors.

Environmental; physical and sexual abuse in childhood and other stressful and traumatic events have been associated with an increased risk of developing OCD. Infectious agents and post-infectious autoimmune syndrome has also been found to be an environmental factor with the acute onset of OCD.

Genetic and Physiological; Familial transmission, genetic inheritance and dysfunctions within the brain is implicated in a person with OCD. See OCD-UK for biological explanations of OCD causality.

Functional Consequences of OCD

As previously noted by The WHO, OCD is associated with a reduced quality of life due to the high level of social, occupational impairment. This impairment can occur across many different domains of a person’s life and is associated with symptom severity. Avoidance of situations that can trigger obsessions or compulsions can also severely restrict a person’s functioning. Specific symptoms can also create specific obstacles within a persons life. Health consequences may also occur e.g. a person with contamination concerns may avoid doctors, hospitals or develop dermatological problems due to excessive ritualistic behaviours of washing. Sometimes symptoms can also interfere with its own treatment e.g. medication contamination.

If OCD onset occurs during childhood and adolescence people may experience developmental difficulties. OCD is extremely isolating therefore some people may have few peers or significant relationship outside the immediate family circle. Some people with OCD also try to impose rules and prohibitions on family members because of their disorder e.g. strict decontamination rules before coming into the house from outside etc. this can lead to family dysfunction.

Conclusion

Despite the affect that OCD can have on a person, their family and life their are treatment techniques which can help a person understand their obsessive thoughts and ritualistic behaviours such as; CBT and Exposure therapy. It’s not all doom and gloom for a person with OCD, there is a way of managing their illness and living a better quality of life. OCD is indeed a chronic, but also a very treatable medical condition.

Further Information;

OCD-UK; http://www.ocduk.org/ 

NHS; http://www.nhs.uk/conditions/Obsessive-compulsive-disorder/Pages/Introduction.aspx

MIND; http://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/#.Vm8nH0qLRaQ

Medication Therapy for Bipolar Disorder

Medication is often the first type of therapy offered to people with Bipolar disorder. As it is very hard to undertake any other therapies whilst their mood is still swinging from one extreme to another.

The medication offered will depend on various factors which the doctor will take into account when prescribing medication for Bipolar disorder. For instance; the current symptoms, previous symptoms, how a person has responded to treatments in the past, physical health and the person’s sex and age.

Lithium for Bipolar Disorder

Lithium is probably one of the most well-known treatments for people with Bipolar disorder. This form of medication can be very effective treatment for mania, but is less effective in treating symptoms of Depression (Smith,2012). It helps to reduce the severity and frequency of mania, and is often the long-term method of treating Bipolar disorder (Geddes et al., 2004).Evidence suggests that Lithium is most effective for;

• repeated episodes of mania without depression
• episodes of mania and depression with stable periods in between
• people who have a family history of bipolar disorder
• forms of the problem where there is no rapid cycling (moving in between moods rapidly; going up and down)

(Mind, Online).

Lithium acts on a person’s central nervous system. Doctors don’t exactly know how lithium works in stabilising a person’s mood but it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behaviour (Stahl, 2008).

It usually takes several weeks for lithium to begin working (similar to anti-depressants). However, regular blood tests will be required to ensure that normal kidney and thyroid function, as lithium can affect both of these functions (Mind, Online). For lithium to work effectively the medication must have the correct dosage.

Lithium is often paired with side effects, although they may be minor. It can often lead to the person suffering with Bipolar Disorder to stop taking the medication. People with Bipolar disorder also enjoy the feeling of ‘mania’ therefore, medication that dulls the euphoria may not be enjoyed by the person and may be discontinued. Common side effects include; weight gain, drowsiness, hair loss, acne and poor concentration (information taken from NHS, Online).

Anti-convulsants for Bipolar Disorder 

There are a few anti-convulsant drugs that are used as mood stabilisers in the treatment of Bipolar disorder. Carbamazepine and valproate are comparatively effective in treating; mixed episodes, rapid cycling and very severe mania. Lamotrigine  has anti-depressant effects therefore can be used to treat Depression. It is also used to prevent future episodes. Whereas carbamazepine and valproate are used to treat acute episodes of mania rather than a ‘preventative’ treatment (Mind, Online).

Anti-convulsants work by calming the hyperactivity within the brain
(Goldberg, 2014). These medications were initially used to treat epilepsy, a neurological condition. As with all medication these come with some side effects; dizziness, drowsiness, weight gain and tremors. Again, regular blood tests should be carried out as anti-convulsant drugs carry a risk of liver and kidney damage (Ascconape, 2002).

Anti-psychotics for Bipolar Disorder

People who experience psychotic symptoms during mania or depression may be more likely to be prescribed an anti-psychotic. However, more recently these medications are being prescribed to people whom are suffering from severe side effects and/or pregnant as this drug is typically safer for pregnant women. The most likely anti-psychotics to be prescribed are; olanzapine, quetiapine, aripiprazole and risperidone (Mind, Online).

These medications are often prescribed on a short-term basis to control psychotic symptoms such as; hallucinations, delusions and manic symptoms. Often these medications are taken with a mood-stabilising drug and can decrease symptoms of mania until the mood stabilisers take effect.

These drugs help regulate the functioning of brain circuits that control thinking, mood and perception (Goldberg, 2014). It is not clear exactly how these drugs work but evidence suggests that they usually improve manic episodes quickly. Again, side effects can occur with these medications similar to ones previously outlined above.

Anti-depressants for Bipolar Disorder

Some people suffering from Bipolar disorder may be prescribed anti-depressants. A commonly prescribed anti-depressant is SSRI’s (selective serotonin re-uptake inhibitors- see ‘The strive for the right medication’ for an explanation of SSRI’s). 
Often a combination of medications (where possible) will be prescribed to alleviate the symptoms of mania and depression for people with Bipolar disorder.

Further Information;

Mind; http://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/medication.aspx#.Vksn5vnhDIU

Stahl, S. M. (2008) Stahl’s Essential Psychopharmacology: Neuroscientific basis and practical applications. Cambridge University Press.

Goldberg, J. (2014) Anti Convulsant Medication for Bipolar Disorder. [Online] http://www.webmd.com/bipolar-disorder/anticonvulsant-medication

Goldberg, J. (2014) Antipsychotic Medication for Bipolar Disorder. [Online] http://www.webmd.com/bipolar-disorder/antipsychotic-medication

Ascapone, J.J.(2002) ‘Some common issues in the use of antileptic drugs’ Seminars in Neurology. 22 (1) pp.27-39

Geddes, J.R., Burgess, S., Hawton, K., Jamison, K. & Goodwin, G.M. (2004) ‘Long-term tithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials’ The American Journal of Psychiatry. 161 (2) pp.217-222

Smith, D.J. (2002) Medications for bipolar disorder [Online] http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/medicationsbipolardisorder.aspx

NHS; http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx

 

Bipolar Disorder

Bipolar disorder is a ‘mental health’ condition which affects a person’s mood, someone suffering from Bipolar disorder may have rapidly changing moods which may swing from one extreme to another. Typically speaking a person may go from a state of mania to a major depressive episode or my constantly cycle through different moods depending on their illness; quite literally like a roller coaster, going up and down through differing mood states. 

Bipolar disorder can occur at any age although it seems to develop and become prevalent between the ages of 18 and 24. Men and women from all backgrounds are equally likely to develop bipolar disorder. On average it takes 10.5 years to receive a correct diagnosis for bipolar in the UK and before bipolar is diagnosed there is a misdiagnosis an average of 3.5 times (Bipolar UK; Online).

What is mania, hypomania and a depressive episode?

The core difference to Bipolar disorder and Depression (as we know it) is the presence of the person being in a state of mania. Mania or manic episodes is referred to as an elevated mood, feeling high; sometimes feeling exciting and fun but can also be unpleasant and distressing.

Someone experiencing a manic episode may feel; extremely happy, euphoric, uncontrollably excited, often speaks faster, can become irritable and agitated, they may have increased sexual energy, their thoughts may be racing, may perceive to be very confident, adventurous and in some way ‘special’. The person during this state may be; more active than usual, speaking quickly, often making little sense, saying or doing things which are out of character/inappropriate, sleeping very little or not at all, being rude or aggressive, misusing alcohol/drugs, spending excessively, loss of social inhibitions and acting provocatively.

Hypomania is similar to mania but, this state is not as ‘extreme’ as full-blown mania. Hypomania quite literally means ‘less than mania’. A person experiencing hypomania may have similar symptoms and behaviour too mania as outlined above. Yet, these symptoms and behaviours will be lesser than that of a manic episode.  Compared to mania, hypomanic symptoms are likely to feel more manageable and last for a shorter period of time.

A major depressive episode is exactly the same as I have previously outlined
with my posts about Depression (click on the picture to go to that post). Briefly a person experiencing a depressive episode may feel; down, upset, tired, sluggish, may not find enjoyment in previously enjoyed things (anhedonia), experience feelings of guilt or worthlessness etc.

Types of Bipolar

The best way of trying to explain the differences of certain types of bipolar disorder is through the use of line graphs. The blue line at the top of the graph indicates ‘mania’, the red line in the middle indicates a ‘normal’ level of mood, the purple line in between ‘normal’ and ‘mania’ indicates ‘hypomania’ and the green line at the bottom indicates a ‘depressive episode’.

Bipolar I;

This form of Bipolar is dependant upon the person experiencing atleast one episode of mania which has lasted longer than one week. The person may also have experienced depressive episodes but it is not dependant upon this diagnosis. Statistics from Perala et al (2007) suggests that 1-3 people in every 100 will experience Bipolar I.

Bipolar II;

A person may have Bipolar II if they have experienced both; one episode of severe depression but also symptoms of hypomania. The difference here is that the person doesn’t have to hit a manic episode. However, the person must experience hypomania for 4 consecutive days for the majority of the day (DSM-5).

Cyclothymia;

A person who has experienced both hypomanic and depressive mood states over the course of two years of more and there symptoms aren’t severe enough to meet the criteria for diagnosis of Bipolar I or II they may be diagnosed with Cyclothymia. This is where a person cycles through hypomania and low grade depression.

Dysthymia;

Similar to cyclothymia a person will cycle through differing mood states however will be on the ‘depressive’ end of the spectrum rather than manic. This is referred to as a low grade depression.

Causes of Bipolar Disorders

Currently the cause for Bipolar disorders is very much misunderstood. Research has focused on the genetics and biology of the brain but many researchers also feel the social factors may also play a part in the development of this condition.

Childhood Trauma; Evidence suggests that a person may be more likely to develop Bipolar disorder if they have experienced severe emotional distress as a child. Such as; traumatic events, sexual or physical abuse, neglect or the loss of a parent. Experiencing trauma at such a young age can cause a large amount of distress and may have an impact on the child’s ability to regulate emotions effectively.

Stressful life events; The start of Bipolar symptoms can be linked to stressful periods within a person’s life; relationship breakdown, traumatic loss and or poverty. Lower levels of stress are unlikely to ’cause’ bipolar. They can trigger an episode of mania or depression.

Self-esteem problems; Researchers believe that a manic episode can be a way of escape from feeling depressed or having low self-esteem. It is believed that when a person is extremely self-critical or feels very bad about themselves mania increases their self-confidence to help them cope.

Brain Chemistry; Evidence shows that bipolar symptoms can be treated with certain psychiatric medications which are known to act upon the neurotransmitters within the brain. This infers that people with bipolar disorder may therefore have problems with the neurotransmitters functions.

Genetic Inheritance; If you experience Bipolar disorder you are more that likely to have a family member whom is also suffering from bipolar mood or symptoms. This therefore shows that their may be a strong genetic link to bipolar disorder. However, it may be also due to environmental factors which both members of the family may be experiencing rather than a ‘bipolar gene’.

Treatments?

The National Institute for Health and Care Excellence suggest that treatment of bipolar disorder should include both talking treatments and pharmocotherapy (medication). However, treatment tends to depend upon the episode the person is currently in.

Depressive Episode? A person suffering from a depressive episode may be offered medication and structured psychological treatment such as CBT.

Manic or Hypomanic Episode? Again you are likely to be offered medication but you are unlikely to be offered a talking therapeutic treatment.
*I plan on doing an in-depth post discussing treatment for Bipolar disorder.

Conclusion

Many people often use the term bipolar as a adjective to describe their mood or situation e.g. the weather- being sunny one minute and raining the next. This often can negate the seriousness of such a condition and can lead to higher levels of stigmatising attitudes.The social impact of receiving a diagnosis of Bipolar disorder can be extremely distressing. As with any mental illness people still fear the unknown and much of the media stories which is the main way of disseminating information to the general public is often negative and can draw negative associations and inaccurate depictions of a person suffering from Bipolar disorder. Which can impact on the person suffering from this condition seeking appropriate medical help and concealing their illness.

Treatment plans can be extremely challenging for a person experiencing Bipolar disorder as the person may struggle taking medication that can affect their elevated mood. Often when a person is experiencing mania they may feel on top of the world and being euphoric they may refuse medical treatment as that mood feels so good to them. On the flip side a person whom is experiencing mania may be putting themselves in unsafe positions and therefore may need medical treatment. Again, depression can make a person struggle to get out of bed in the morning therefore seeking treatment outside of their comfort zone can be challenging.

Although Bipolar disorder can have very negative associations often people whom have this disorder have been found to be more creative than those without it. When a person is experiencing a manic episode they may have extremely high levels of creativity which can also lead to greater productivity in their working lives.

Further Information;

http://www.bipolaruk.org.uk

http://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/about-bipolar-disorder.aspx#.Vknrc_nhDIU

http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx

Perala et al (2007) ‘Lifetime prevalence of psychotic and bipolar I disorders in a general population‘ Archives of general psychiatry, 64:19-28

http://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems.aspx