It's All In Your Head

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People with PTSD may also experience dissociation. Dissociation is an experience where a person may feel disconnected from himself and/or his surroundings. Similar to flashbacks, dissociation may range from temporarily losing touch with things that are going on around you (kind of like what happens when you daydream) to having no memories for a prolonged period of time and/or feeling as though you are outside of your body.

Both flashbacks and dissociation may occur as a result of encountering triggers, or a reminder of a traumatic event. To the extent that people are not aware of their triggers, flashbacks and dissociation can be incredibly disruptive and unpredictable events that are difficult to manage. However, you can take steps to better manage and prevent flashbacks and dissociation. These are described below.

Know Your Triggers

In coping with flashbacks and dissociation, prevention is key. Flashbacks and dissociation are often triggered or cued by some kind of reminder of a traumatic event (for example, encountering certain people, going to specific places), or some other stressful experience. Therefore, it is important to identify the specific things that trigger flashbacks or dissociation.

By knowing what your triggers are, you can either try to limit your exposure to those triggers, or if that is not possible (which is often the case), you can prepare for them by devising ways to cope with your reaction to those triggers.

In addition to reducing flashbacks and dissociation, knowing your triggers may also help with other symptoms of PTSD, such as intrusive thoughts and memories of a traumatic event.

Identify Early Warning Signs

Flashbacks and dissociation may feel as though they come “out-of-the-blue.” That is, they may feel unpredictable and uncontrollable. However, there are often some early signs that a person may be slipping into a flashback or a dissociative state. For example, a person’s surroundings may begin to look “fuzzy,” or someone may feel as though he is separating from or losing touch with his surroundings, other people, or even himself.

Flashbacks and dissociation are easier to cope with and prevent if you can catch them early on. Therefore, it is important to try to increase your awareness of early symptoms of flashbacks and dissociation. Next time you experience a flashback or dissociation, revisit what you were feeling and thinking just before the flashback or dissociation occurred. Try to identify as many early symptoms as possible. The more early warning signs you can come up with, the better able you will be to prevent future flashbacks or episodes of dissociation.

Learn Grounding Techniques

As the name implies, grounding is a particular way of coping that is designed to “ground” you in the present moment. In doing so, you can retain your connection with the present moment and reduce the likelihood that you slip into a flashback or dissociation. In this way, grounding may be considered to be very similar to mindfulness.

To ground, you want to use the five senses (sound, touch, smell, taste, and sight). To connect with the here and now, you want to do something that will bring all your attention to the present moment. A couple of grounding techniques are described below.

·         Sound: Turn on loud music: Loud, jarring music will be hard to ignore. And as a result, your attention will be directed to that noise, bringing you into the present moment.

·         Touch: Grip a piece of ice. If you notice that you are slipping into a flashback or a dissociative state, hold onto a piece of ice. It will be difficult to direct your attention away from the extreme coldness of the ice, forcing you to stay in touch with the present moment.

·         Smell: Sniff some strong peppermint. When you smell something strong, it is very hard to focus on anything else. In this way, smelling peppermint can bring you into the present moment, slowing down or stopping altogether a flashback or an episode of dissociation.

·         Taste: Bite into a lemon. The sourness of a lemon and the strong sensation it produces in your mouth when you bite into it can force you to stay in the present moment.

·         Sight: Take an inventory of everything around you. Connect with the present moment by listing everything around you. Identify all the colors you see. Count all the pieces of furniture around you. List off all the noises you hear. Taking an inventory of your immediate environment can directly connect you with the present moment.

Enlist the Help of Others

If you know that you may be at risk for a flashback or dissociation by going into a certain situation, bring along some trusted support. Make sure that the person you bring with you is also aware of your triggers and knows how to tell and what to do when you are entering a flashback or dissociative state.

Seek Treatment

In the end, the best way to prevent flashbacks and dissociation is to seek out treatment for your PTSD. Flashbacks and dissociation may be a sign that you are struggling to confront or cope with the traumatic event you experienced. Treatment can help with this. You can find PTSD treatment providers in your area through the Anxiety Disorder Association of America website, as well as UCompare HealthCare from About.com. The International Society for the Study of Trauma and Dissociation (ISSTD) also provides a wealth of information on the connection between trauma and dissociation, how to cope with dissociation, and provides links to therapists who treat trauma and dissociation.

Source: http://ptsd.about.com/od/selfhelp/a/flashcoping.htm

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1. Promise not to do anything right now

Even though you’re in a lot of pain right now, give yourself some distance between thoughts and action. Make a promise to yourself: “I will wait 24 hours and won’t do anything drastic during that time.” Or, wait a week. Your suicidal thoughts do not have to become a reality.

2. Avoid drugs and alcohol

Suicidal thoughts can become even stronger if you have taken drugs or alcohol. It is important to not use nonprescription drugs or alcohol when you feel hopeless or are thinking about suicide.

3. Make your home safe

Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms. If you are unable to do so, go to a place where you can feel safe. If you are thinking of taking an overdose, give your medicines to someone who can return them to you one day at a time as you need them.

4. Take hope - people DO get through this

Even people who feel as badly as you are feeling now manage to survive these feelings. Take hope in this. There is a very good chance that you are going to live through these feelings, no matter how much self-loathing, hopelessness, or isolation you are currently experiencing.

5. Don’t keep these suicidal feelings to yourself

Many of us have found that the first step to coping with suicidal thoughts and feelings is to share them with someone we trust. It may be a friend, a therapist, a member of the clergy, a teacher, a family doctor, a coach, or an experienced counselor at the end of a helpline. Find someone you trust and let them know how bad things are. Don’t let fear, shame, or embarrassment prevent you from seeking help.

Source: http://www.helpguide.org/mental/suicide_help.htm

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Dependent personality disorder (DPD) is one of a cluster of disorders defined by symptoms of anxiety and fear. It is the most diagnosed personality disorder and is found equally in women and men. Unlike other conditions, it appears quite late – typically in early to middle adulthood.

The specific, identifying symptoms include:

·         Being emotionally dependent on others; feeling they can’t take care of themselves

·         Investing a lot of time and effort in trying to please significant people

·         Displaying clingy, passive and needy behavior

·         Avoiding disagreements for fear of losing approval and support

·         Experiencing separation anxiety and intense fear of abandonment

·         Finding it hard to be alone

·         Putting the needs of others before their own

·         Tolerating mistreatment and abuse for fear of disapproval and abandonment

·         Being crushed, and feeling helpless, when relationships end – and forming new relationships as soon as possible

·         Being unable to make even the simplest decision without the input and reassurance of others

·         Rarely taking the initiative

·         Avoiding personal responsibility

·         Avoiding responsible jobs and careers that require independent, autonomous functioning

·         Being over-sensitivity to criticism

·         Feeling negative and pessimistic; expecting to disappoint and fail

·         Having low self esteem and lacking confidence, including a belief that they are unable to care for themselves.

The cause of disorder is still unclear, and probably includes both a genetic and environmental component. Some researchers have speculated that it could be linked to an authoritarian or overprotective parenting style – which acts as a trigger for a genetic predisposition.

Treatment is usually initially sought for some other problem or concern – such as feeling overwhelmed – so that they can’t cope with life. Also, sufferers will often have a mood disorder so they seek help for depression or anxiety at first.

The normal treatment for this particular disorder is counselling or psychotherapy. However, the emphasis is short term therapy so the person doesn’t form a dependency – and then look to the counsellor to take care of them. Prognosis with support is generally good.

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Asperger syndrome is form of autism. People with this syndrome have difficulty interacting socially, repeat behaviors, and often are clumsy. Motor milestones may be delayed. Although people with Asperger syndrome often have difficulty socially, many have above-average intelligence. They may excel in fields such as computer programming and science. There is no delay in their cognitive development, ability to take care of themselves, or curiosity about their environment.

Symptoms

·         People with Asperger have problems with language in a social setting.

·         It may be difficult to choose a topic of conversation, their body language may be off, and it may be difficult for them to recognize that the other person has lost interest in the topic.

·         They may speak in a monotone, and may not respond to other people’s comments or emotions.

·         They may have difficulty understanding sarcasm or humor.

Other symptoms may include:

·         Problems with eye contact, facial expressions, body postures, or gestures (nonverbal communication)

·         Singled out by other children as “weird” or “strange”

·         Difficulty developing relationships with children their own age

·         Inability to respond emotionally in normal social interactions

·         Not flexible about routines or rituals

·         Lack of showing, bringing, or pointing out objects of interest to other people

·         Do not express pleasure at other people’s happiness

·         Preoccupied with parts of whole objects

·         Repetitive behaviors, including repetitive behavior that injures themselves

·         Repetitive finger flapping, twisting, or whole body movements

·         Unusually intense preoccupation with narrow areas of interest, such as obsession with train schedules, phone books, or collections of objects

Genetic factors may play a role. The condition appears to be more common in boys than in girls.

Source: http://www.ask.com/health/adamcontent/asperger-syndrome#symptoms

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Everyone experiences symptoms of anxiety, but they are generally occasional and short-lived, and do not cause problems. But when the cognitive, physical and behavioural symptoms of anxiety are persistent and severe, and anxiety causes distress in a person’s life to the point that it negatively affects his or her ability to work or study, socialize and manage daily tasks, it may be beyond the normal range.
The following examples of anxiety symptoms may indicate an anxiety disorder:

1. Cognitive: anxious thoughts (e.g., “I’m losing control”), anxious predictions (e.g., “I’m going to fumble my words and humiliate myself”) and anxious beliefs (e.g., “Only weak people get anxious”).


2. Physical: excessive physical reactions relative to the context (e.g., heart racing and feeling short of breath in response to being at the mall). The physical symptoms of anxiety may be mistaken for symptoms of a physical illness, such as a heart attack.


3. Behavioural: avoidance of feared situations (e.g., driving), avoidance of activities that elicit sensations similar to those experienced when anxious (e.g., exercise), subtle avoidances (behaviours that aim to distract the person, e.g., talking more during periods of anxiety) and safety behaviours (habits to minimize anxiety and feel “safer,” e.g., always having a cell phone on hand to call for help).

Several factors determine whether the anxiety warrants the attention of mental health professionals, including:

• the degree of distress caused by the anxiety symptoms

• the level of effect the anxiety symptoms have on a person’s ability to work or study, socialize and manage daily tasks

• the context in which the anxiety occurs.

An anxiety disorder may make people feel anxious most of the time or for brief intense episodes, which may occur for no apparent reason. People with anxiety disorders may have anxious feelings that are so uncomfortable that they avoid daily routines and activities that might cause these feelings. Some people have occasional anxiety attacks so intense that they are terrified or immobilized. People with anxiety disorders are usually aware of the irrational and excessive nature of their fears. When they come for treatment, many say, “I know my fears are unreasonable, but I just can’t seem to stop them.”   

Source: http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/anxiety_disorders/Pages/anxiety_disorders.aspx

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What is the difference between a psychiatrist, psychologist, therapist and counsellor?

o    A psychiatrist is someone who has trained as a medical doctor and then specialised in different psychological disorders. This ranges from personality disorders (such as schizophrenia) to disorders of aging (such as dementia). A psychiatrist can prescribe medication, as well as providing guidance and counselling.

o    A licensed clinical psychologist will have completed both an undergraduate degree and a 4 to 6 year doctorate program. A psychologist cannot prescribe medication. They provide counselling, guidance and support to clients based on their particular theoretical orientation (for example, behaviourism, CBT, solution focused therapy.)

o    A therapist (or psychotherapist) will have at least a masters degree plus some additional psychotherapy training. Exact training requirement vary from country to country, state to state, and province to province. He or she will have supervised practical experience, and will also have undergone psychotherapy themselves. A therapist works with clients on their problems, using some kind of talking therapy. They are unable to prescribe medication.

o    A counsellor will have extensive training in counselling theory and skills. They will have undergone counselling themselves, and been supervised in their practical skills. They work with clients to help them explore, understand and work towards solutions to their problems. They are unable to prescribe medication.

Note: All psychiatrists, psychologist, therapist and counsellors can specialize in different areas. The most common ones are: couples, family, addictions, eating disorders, anxiety, depression, stress management, PTSD, abuse, grief and loss, life transitions and groups.

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Depression is much more than simple unhappiness. Clinical depression, sometimes called major depression, is a “mood disorder” that is a significant mental health problem.

Symptoms

The main symptom of depression is a sad, despairing mood that:

·         is present most days and lasts most of the day

·         lasts for more than two weeks

·         impairs the person’s performance at work, at school or in social relationships.

Other symptoms of depression may include:

·         changes in appetite and weight

·         sleep problems

·         loss of interest in work, hobbies, people or sex

·         withdrawal from family members and friends

·         feeling useless, hopeless, excessively guilty, pessimistic or low self-esteem

·         agitation or feeling slowed down

·         irritability

·         fatigue

·         trouble concentrating, remembering and making decisions

·         crying easily, or feeling like crying but being not able to

·         thoughts of suicide (which should always be taken seriously)

·         a loss of touch with reality, hearing voices (hallucinations) or having strange ideas (delusions).

Depression in women

Major depression can occur in 10 to 25 per cent of women — almost twice as many as men. Many hormonal factors may contribute to the increased rate of depression in women — particularly during times such as menstrual cycle changes, pregnancy and postpartum, miscarriage, pre-menopause, and menopause.

Depression in men

Men with depression typically have a higher rate of feeling irritable, angry and discouraged. This can make it harder to recognize depression in men. The rate of completed suicide in men is four times that of women, though more women attempt it.

Depression in children

A child who is depressed may pretend to be sick, refuse to go to school, cling to a parent or worry that the parent may die. Older children may sulk, get into trouble at school, be negative or grouchy, and feel misunderstood. Because normal behaviours vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary “phase” or has depression.

Misconceptions

·         “People should just get over the blues and get on with their lives.”  Clinical depression is not just unhappiness — it is a complex mood disorder caused by a variety of factors, including genetic predisposition, personality, stress and brain chemistry. While it can suddenly go into remission, depression is not something that people can “get over” by their own effort.

·         “My life will never be normal again.” Most people can and do return to function at the level they did before they became depressed.

Source: http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/depression/Pages/depression_mhfs.aspx

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Schizoaffective disorder is a mental condition that causes both a loss of contact with reality (psychosis) and mood problems. The exact cause is unknown. Changes in genes and chemicals in the brain (neurotransmitters) may play a role. Schizoaffective disorder is believed to be less common than schizophrenia and mood disorders. Women may have the condition more often than men. Schizoaffective disorder tends to be rare in children.

Symptoms

The symptoms of schizoaffective disorder are different in each person. Often, people with schizoaffective disorder seek treatment for problems with mood, daily function, or abnormal thoughts. Psychosis and mood problems may occur at the same time, or by themselves. The course of the disorder may involve cycles of severe symptoms followed by improvement.

The symptoms of schizoaffective disorder can include:

·         Changes in appetite and energy

·         Disorganized speech that is not logical

·         False beliefs (delusions), such as thinking someone is trying to harm you (paranoia) or thinking that special messages are hidden in common places (delusions of reference)

·         Lack of concern with hygiene or grooming

·         Mood that is either too good, or depressed or irritable

·         Problems sleeping

·         Problems with concentration

·         Sadness or hopelessness

·         Seeing or hearing things that aren’t there (hallucinations)

·         Social isolation

·         Speaking so quickly that others cannot interrupt you

·         Treatment can vary. In general, antipsychotic medications are used to treat psychotic symptoms and antidepressant medications or “mood stabilizers” may be prescribed to improve mood. Talk therapy can help with creating plans, solving problems, and maintaining relationships. Group therapy can help with social isolation.

Outlook (Prognosis)

People with schizoaffective disorder have a greater chance of going back to their previous level of function than do people with most other psychotic disorders. However, long-term treatment is often needed, and results can vary from person to person.

Possible Complications

·         Abuse of drugs in an attempt to self-medicate

·         Problems following medical treatment and therapy

·         Problems due to manic behavior (for example, spending sprees, overly sexual behavior)

·         Suicidal behavior.

Source: http://www.nlm.nih.gov/medlineplus/ency/article/000930.htm

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Hallucinations involve sensing things while awake that appear to be real, but instead have been created by the mind. Common hallucinations include:

·         Feeling bodily sensations, such as a crawling feeling on the skin or the movement of internal organs

·         Hearing sounds, such as music, footsteps, windows or doors banging

·         Hearing voices when no one has spoken (the most common type of hallucination). These voices may be critical, complimentary, neutral, or may command someone to do something that may cause harm to themselves or to others.

·         Seeing patterns, lights, beings, or objects that aren’t there

·         Smelling a foul or pleasant odor

In some cases, hallucinations may be normal. For example, hearing the voice of, or briefly seeing, a loved one who has recently died can be a part of the grieving process.

Causes

·         There are many causes of hallucinations, including:

·         Being drunk or high, or coming down from such drugs as marijuana, LSD, cocaine (including crack), PCP, amphetamines, heroin, ketamine, and alcohol

·         Delirium or dementia (visual hallucinations are most common)

·         Epilepsy that involves a part of the brain called the temporal lobe (odor hallucinations are most common)

·         Fever, especially in children and the elderly

·         Narcolepsy (a sleep disorder that causes excessive sleepiness and frequent daytime sleep attacks)

·         Psychiatric disorders, such as schizophrenia and psychotic depression

·         Sensory problem, such as blindness or deafness

·         Severe illness, including liver failure, kidney failure, AIDS, and brain cancer

A person who begins to hallucinate and is detached from reality should get checked by a health care professional right away. Many medical and psychiatric conditions that can cause hallucinations may quickly become emergencies. A person who begins to hallucinate may become nervous, paranoid, and frightened, and should not be left alone.

Source: http://www.nlm.nih.gov/medlineplus/ency/article/003258.htm

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Schizoid personality disorder is a psychiatric condition in which a person has a lifelong pattern of indifference to others and social isolation. The causes are unknown. This disorder may be related to schizophrenia and it shares many of the same risk factors.

However, schizoid personality disorder is not as disabling as schizophrenia. It does not cause hallucinations, delusions, or the complete disconnection from reality that occurs in untreated (or treatment-resistant) schizophrenia.

Symptoms

A person with this diagnosis:

·         Appears aloof and detached

·         Avoids social activities that involve emotional intimacy with other people

·         Does not want or enjoy close relationships, even with family members

People with this disorder rarely seek treatment, and little is known about which treatments work. Talk therapy may not be effective, because people with schizoid personality disorder have difficulty relating well to others. However, one approach that appears to help is to put fewer demands for intimacy on the person. People with schizoid personality disorder often do better in relationships that do not focus on emotional closeness. They are better at handling relationships that focus only on recreation, work, or intellectual activities and expectations.

Expectations (prognosis)

Schizoid personality disorder is a long-term (chronic) illness that usually does not improve over time. Social isolation often prevents the person from seeking the help or support that might improve the outcome.

Source: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001918/

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Defense mechanisms are unconscious psychological strategies that help us to cope with reality whilst also preserving our self esteem. Normal, healthy people use them regularly. Examples could include humour, thought suppression or sublimation (transforming negative emotions into positive actions - like helping a friend when we’re feeling sad or down). They only become pathological when they lead to problematic behaviours that compromise our health or relationships. Examples of unhealthy defenses include:

Acting out: This is directly expressing an unconscious impulse without realising what is driving the behaviour.

Fantasy: This is retreating to a fantasy world to escape, or resolve, conflicts we are battling with.

Idealization: This is unconsciously choosing to see another person as being more ideal or perfect than they really are.

Passive aggression: This is expressing our anger indirectly, for example, through being late or doing something that “inadvertently” destroys another’s plans.

Projection: This is attributing our own unacknowledged, and unacceptable, thoughts and emotions onto someone else.

Somatization: This is translating negative thoughts and feelings into physical symptoms. For example, suffering from migraines when you’re dealing with a difficult relationship.

Denial: This is refusing to accept reality because it is too painful or threatening.

Regression: This is temporarily reverting to an earlier stage of development to avoid handling problems and concerns in a more appropriate and adult way.

Distortion: This is totally reshaping your picture of reality so it’s now consistent with your internal needs.

Splitting: This is a primitive defense where the negative and positive aspects are split off – and there’s no integration of these parts at all. For example, the person may view others as being either completely good or completely evil, rather than a mixture of good and bad traits.