Mental Health is an individual’s emotional and psychological well being. It is equally important as physical health. However, we often see that because mental health is not ‘visible’, it gets less attention. This also results in a lot of misunderstandings about mental health. In the following section, we attempt to learn the correct facts about mental health. After all, mental health is everyone’s business!
What is Depression?
Depression is one of the commonest mental disorders. Though common, it is a serious disorder that affects the well being of an individual.
Seek help if you notice some (5 or more) of these symptoms for over a period of 2-3 weeks:
Tips to take care
Small steps to help you or your loved ones along the way.
Depression is a mood disorder but it affects the way an individual thinks, feels and behaves. Approximately, 36% of Indians suffer from depression. it must be noted that depression is the second leading cause of deaths in the world. It is on a rise among the adolescents and younger population. People of all ages are likely to suffer from depression. Women are twice likely as men to suffer from depression. Most often, depression sets in at the age of 25-44 years but people below and above that age are also equally likely to suffer.
Depression is caused due to various factors- usually a combination of genetic, biological, environmental, and psychological factors. It is a disorder that runs in families. Factors like traumatic experiences, heavy losses, poor environment and other socio-economic factors play a role in contributing to the development of depression.
Depression is a mood disorder but it affects the way an individual thinks, feels and behaves. Approximately, 36% of Indians suffer from depression. it must be noted that depression is the second leading cause of deaths in the world. It is on a rise among the adolescents and younger population. People of all ages are likely to suffer from depression. Women are twice likely as men to suffer from depression. Most often,
- Try to seek out professional help as soon as possible.
- Persistent sad, anxious, mood
- Feelings of hopelessness
- Feelings of guilt, worthlessness, or helplessness
- Decreased energy or fatigue
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
- Loss of interest or pleasure in hobbies and activities that were once interesting
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Appetite and/or weight changes
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Continue to learn more about depression
In the presence of these symptoms, one may consult a counselor or a psychotherapist. Medication along with psychotherapy works best for depression. Continue to learn more about depression.
- Eat healthy and a balanced diet
- Exercise regularly
- Sleep well in the night
- Follow a hobby
- Interact with people around you
- Talk to family and friends about your feelings
- Don’t bottle up your feelings
- Meditation and yoga under guidance may help
What is Anxiety?
Anxiety disorder is a serious and another common mental disorder. It is characterized by unexpected and repeated episodes of feeling fear and tenseness.
Seek help if you notice some (5 or more) of these symptoms for over a period of 2-3 weeks:
Tips to take care
Small steps to help you or your loved ones along the way.
Though feeling anxious at times is completely normal, the disorder is very discomforting for the individual. The feeling of anxiety is manifold as compared to usual anxious feelings and it is repetitive and overwhelming. Anxiety disorders disrupt daily functioning along with personal and social relationships. There are several types of anxiety disorders (social anxiety, GAD, panic attack, panic disorder etc), which will be discussed in later blogs.
On an average, one in four individuals suffer from an anxiety disorder. On an average, the age at which anxiety occurs is 19 years but research shows that it has and it can develop in children as small as 14 years also. The likelihood of adolescents suffering from this disorder is on the rise. Women are more likely to develop anxiety disorders than men.
The cause for anxiety disorders is a combination of genetic, biological, environmental, and psychological factors. It is a disorder that runs in families. Factors like stress creating situations are a major factor of anxiety disorders, especially so when adequate support to deal with stress and anxiety is absent.
- “Racing” heart or heart palpitations
- Feeling weak, faint, or dizzy
- Tingling or numbness in the hands and fingers
- Sense of terror, or impending doom or death
- Feeling sweaty or having chills
- Chest pains
- Muscle tension
- Breathing difficulties
- Feeling a loss of control
- Difficulty to pay attention and concentrate
In the presence of these symptoms, one may consult a counsellor or a psychotherapist. Medication along with psychotherapy works best for anxiety disorders.
- Eat healthy and a balanced diet
- Exercise regularly
- Sleep well in the night
- Relaxation techniques for breathing under guidance
- Reduce consumption of caffeine
- Talk to family and friends about your anxious feelings
- Let people know that you need support
- Meditation and yoga under guidance may help
What is Epilepsy?
Epilepsy is a neurological problem in which people get unexpected and repeated seizures or fits.
Seek immediate care if any of these symptoms are present
Tips to take care
Small steps to help you or your loved ones along the way.
It is a chronic disorder that continues for a long term of period. Approximately 50 out of every 100,000 people develop epilepsy each year and about 50 million people have epilepsy globally.
The seizures occur because of a sudden surge of electrical activity in the brain – there is an overload of electrical activity in the brain. Epileptic seizures are often associated with particular triggers or changes in your daily habits or routine.The onset of epilepsy is most common during early childhood and after age 60, but the condition can occur at any age. If someone from the family has epilepsy, then the person is more likely to develop epilepsy.
- A convulsion with no temperature (no fever).
- Short spells of blackout, or confused memory.
- Intermittent fainting spells, during which bowel or bladder control is lost. This is frequently followed by extreme tiredness.
- For a short period the person is unresponsive to instructions or questions.
- The person becomes stiff, suddenly, for no obvious reason
- The person suddenly falls for no clear reason
- Sudden bouts of blinking without apparent stimuli
- Sudden bouts of chewing, without any apparent reason
- For a short time the person seems dazed, and unable to communicate
- Repetitive movements that seem inappropriate
- The person becomes fearful for no apparent reason, he/she may even panic or become angry
- Peculiar changes in senses, such as smell, touch and sound
- The arms, legs, or body jerk, in babies these will appear as cluster of rapid jerking movements.
- If some of these symptoms are present, you must see your general practitioner who will then guide you to see a neurologist. The treatment of epilepsy involves the use of medication (anti-epileptic drugs) or in some severe or untreatable conditions, surgery also helps.
- Get plenty of sleep each night — set a regular sleep schedule, and stick to it.
- Learn stress management and relaxation techniques.
- Avoid drugs and alcohol.
- Take all of your medications as prescribed by your doctor.
- Avoid bright, flashing lights and other visual stimuli.
- Skip TV and computer time whenever possible.
- Avoid playing video games.
- Eat a healthy diet.
What is Autism Spectrum Disorder?
ASD is a group of neurological & developmental disorders. Often begins in early childhood and can significantly affect daily living.
Seek care if any of these symptoms are present. Visit your paediatrician first.
Tips to take care
Due to the wide range of symptoms, there is no single best and appropriate therapy or treatment optional available for ASD and hence it is best to choose an elective approach towards treating ASD.
Autism spectrum disorder (ASD) is a group of neurological and developmental disorders. It begins early in childhood and lasts throughout a person’s life and significantly affects social and communication skills. Usually, parents may identify certain behaviors in toddlers between 18 to 24 months of age.
It is referred to as a “spectrum” because it involves numerous closely related disorders and an entire range of symptoms that may differ in different individuals. While some may be mildly impaired, others can be severely affected. However, in many cases, individuals with ASD may show great strength and excellence in a particular field.
- No response to their name by 12 months of age
- Rarely sharing enjoyment of objects or activities by pointing or showing things to others
- Repeating certain behaviors or having unusual behaviors
- Flap their hands, rock their body, or spin in circles
- Get aggressive and upset by minor changes
- Have unusual reactions to the way things sound, smell, taste, look, or feel
- Has trouble understanding other people’s feelings or talking about own feelings
- Has flat or inappropriate facial expressions
- Avoids or resists physical contact
- Reverses pronouns (e.g., says “you” instead of “I”)
- Gives unrelated answers to questions
- Does not understand jokes, sarcasm, or teasing
- Has to follow certain routines
- Has poor eye contact
- Has difficulty recognizing nonverbal cues, such as interpreting other people’s facial expressions, body postures or tone of voice
- Has specific food preferences, such as eating only a few foods, or refusing foods with a certain texture
- Difficulty or failure to make friends with children the same age
Behaviour programs mainly focus on social kills, communication and parent interaction. Specially trained professionals will work with both children and parents to facilitate change in challenging behaviors.
There are different forms of therapy used to treat ASD. Some of them include speech and language therapy, music therapy, occupational therapy and neurofeedback. There is no way to prevent ASD but early diagnosis and intervention can go a long way in reducing the intensity of symptoms and improving daily functioning.
ASD is a lifelong condition but with the right treatment programme, symptoms can be considerably managed and controlled. Medication is usually prescribed to help with irritability, aggression, repetitive behaviours, hyperactivity, anxiety and depression.
- Sex: Boys are about four times more likely to develop autism spectrum disorder than girls are.
- Genetics: Parents who may have a child with ASD are likelier to have another child who may also develop ASD. 20% of children with ASD may also have other genetic conditions like Downs syndrome, fragile X syndrome, tuberous sclerosis and Rett’s syndrome.
- Older parents are at an increased risk for having children who may develop ASD.
The exact cause of ASD is unknown. Apart from the listed risk factors, there can be multiple triggers that may co plicate the problem to an another degree like bullying, problems in school, unemployment, over dependency on others, social exclusion and familial stress and ill treatment.
Diagnosing ASD is a difficult task due to the overlapping of symptoms with other disorders especially in older adults. Usually there is a general screening that looks at any family, physiological and genetic factors which may point towards the disorder.
Post which, additional evaluations involve cognitive level or thinking skills, language abilities, age-appropriate skills, blood tests and hearing tests. A child with ASD may have a team of specialists who will help with diagnosis including child psychologists, child psychiatrists, speech pathologists, developmental pediatricians, pediatric neurologists, audiologists, physical therapists and special education teachers who also help with educational determination.
10 Myths and Countering Facts About Mental Health
Globally, mental health is viewed with prejudice, lack of understanding, and considered as taboo. There are several myths regarding mental health that prevent people from accepting its importance and realizing the need to address it. Mental health is important for complete well being and must be talked about.
Myth #1: Mental illnesses are not real illnesses.
Fact: The words we use to describe mental illnesses have changed greatly over time. What hasn’t changed is the fact that mental illnesses are not the regular ups and downs of life. Mental illnesses create distress, don’t go away on their own, and are real health problems with effective treatments. When someone breaks their arm, we wouldn’t expect them to just “get over it.” Nor would we blame them if they needed a cast, sling, or other help in their daily life while they recovered.
Myth #2: Mental illnesses will never affect me.
Fact: All of us will be affected by mental illnesses. Researchers estimate that as many as one in four Indians will experience a mental illness at some point in their life. You may not experience a mental illness yourself, but it’s very likely that a family member, friend, or co-worker will experience challenges.
Myth #3: Mental illnesses are just an excuse for poor behaviour.
Fact: It’s true that some people who experience mental illnesses may act in ways that are unexpected or seem strange to others. We need to remember that the illness, not the person, is behind these behaviours. No one chooses to experience a mental illness. People who experience a change in their behaviour due to a mental illness may feel extremely embarrassed or ashamed around others. It’s also true that people with a history of a mental illness are like anyone else: they may make poor choices or do something unexpected for reasons unrelated to symptoms of their illness.
Myth #4: Bad parenting causes mental illnesses.
Fact: No one factor can cause mental illnesses. Mental illnesses are complicated conditions that arise from a combination of genetics, biology, environment, and life experiences. Family members and loved ones do have a big role in support and recovery.
Myth #5: People with mental illnesses are violent and dangerous.
Fact: Researchers agree that mental illnesses are not a good predictor of violence. In fact, if we look at mental illnesses on their own, people who experience a mental illness are no more violent than people without a mental illness. Excluding people from communities are linked to violence. And people with mental illnesses are often among those who are excluded. It’s also important to note that people who experience mental illnesses are much more likely to be victims of violence than to be violent.
Myth #6: People don’t recover from mental illnesses.
Fact: It is not normal for older adults to be depressed. Signs of depression in older people include a loss of interest in activities, sleep disturbances and lethargy. Depression in the elderly is often undiagnosed, and it is important for seniors and their family members to recognize the problem and seek professional help.
Myth #7: People who experience mental illnesses are weak and can’t handle stress. People with mental illness have a characteristic flaw.
Fact: Stress impacts well-being, but this is true for everyone. People who experience mental illnesses may actually be better at managing stress than people who haven’t experienced mental illnesses. Many people who experience mental illnesses learn skills like stress management and problem-solving so they can take care of stress before it affects their well-being. Taking care of yourself and asking for help when you need it are signs of strength, not weakness.
Myth #8: People who experience mental illnesses can’t work.
Fact: Whether you realize it or not, workplaces are filled with people who have experienced mental illnesses. Mental illnesses don’t mean that someone is no longer capable of working. Some people benefit from changes at work to support their goals, but many people work with few supports from their employer. Most people who experience serious mental illnesses want to work but face systemic barriers to finding and keeping meaningful employment.
Myth #9: Kids can’t have a mental illness like depression. Those are adult problems
Fact: Even children can experience mental illnesses. In fact, many mental illnesses first appear when a person is young. Mental illnesses may look different in children than in adults, but they are a real concern. Mental illnesses can impact the way young people learn and build skills, which can lead to challenges in the future. Unfortunately, many children don’t receive the help they need.
Myth #10: Everyone gets depressed as they grow older. It’s just part of the aging process.
Fact: Depression is never an inevitable part of aging. Older adults may have a greater risk of depression because they experience so many changes in roles and social networks. If an older adult experiences depression, they need the same support as anyone else.
Can High-Functioning Individuals Suffer From Depression?
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Sadness is a typical, universal emotion that is expected in situations of loss, change, or difficult life experiences/situations. One must understand the difference between sadness and depression. Where sadness is an emotion that we all experience at some point of time, depression is not an emotion, it is an illness. Depression is a condition that exists without triggers and continues to be there for a period of time, to an extent that it hampers daily functioning. Depression is more than occasional sadness and not everyone will suffer from depression during their lifetime. Depression involves periods of hopelessness, lethargy, emptiness, helplessness, irritability, and problems focusing and concentrating. Depression needs treatment and it is a treatable condition. Depression is the second leading cause of death across the globe, increasing the burden of illness in the bio-psycho-social realms of society. Depression has multivariate faces with a manifestation in more than 10 types depending upon the context, onset and severity of the illness. Nevertheless, the primary symptoms of depression remain to be seen as-
- Changed patterns of sleep
- Reduced or increased appetite
- Lack of feeling of joy and interest in activities that were previously enjoyed
- Lack of energy; and lethargy
- Low mood
However, when we speak about high functioning individuals, the depression is manifested and overtly seen quite differently and not that obviously. High functioning individual, as understand colloquially, refers to someone who is performing above what would be expected of them. It is usually used with a context of development. Thus, the term is actually a comparative term and rather subjective (or based on someone’s opinion). It may be simplistically used to have an “all or none” connotation – which would entail the person either being high-functioning or not. Most individuals have a mix of skills and abilities and may be high-functioning in certain areas and not in others. It is also important to understand that sometimes, high functioning is understood in the pathological context where the individual is referred to as a high functioning disordered personality and such an individual is one who is able to conceal his/her dysfunctional behaviour in certain public settings and maintain a positive public or professional profile while exposing their negative traits to family members or close ones.
Though no clear statistics are available to demarcate the prevalence of depression among high functioning individuals, the situation tends to prevail. What is characteristically seen in high functioning individuals with depression is that the inhibited energy and desire for activity/action is directed in an effort to succeed with goals. The drive to accomplish often sustains action and moves high-functioning individuals towards getting things done which makes it appear to be relatively constructive diversion of energy. High-functioning depression is similar to low-level depression and can last around five years in adults or one to two years in children and teens, according to the Harvard School of Public Health. And while it may not leave you devastated and hopeless, high-functioning depression can deteriorate quality of life, dampen the enthusiasm for work and also affect school, family, and even social activities. There are certain signs that we may look for, to identify depression in individuals who are high functioning by action and nature-
- Setting higher goals and feelings of dissatisfaction: People with high functioning depression constantly set higher goals for themselves without the appreciation of their achievements. It is difficult for them to accept compliments because they feel they can be better than what they are.
- High functioning individuals with depression are usually low on physical energy but have adequate mental energy that is constructively diverted to work
- It is difficult for them to deny work, especially when given by people in position of authority. They are also typically seen as Type A personalities (workaholic, competitive, self-critical)
- They fear obligation and guilt.
- Depression and anxiety may coexist in the individual
- Irritability is a lesser known symptom of depression, but it’s seen and individuals may be seen displacing these emotions on loved ones and near ones with no apparent reason. The feeling of guilt lingers.
- Feeling drained to maintain relationships may drain out the individual who feels the compulsion to keep contributing more to add value or enrich eh relationship, even in instances when not required.
- Individuals with high functioning depression either sleep too much or too little.
- Depression isn’t a recognisable condition in high functioning individuals as they are able to surface their depression with skills.
- Reduced social interactions and meetings outside work settings. They may be isolative, and this may often translate into distance in relationships with peers and kinship.
- Co-occurring medical conditions, like diabetes or cancer, cause stress and strain that can lead to depression. Depression also lowers the immunity, increasing the vulnerability to acquire other diseases or health problems.
- Family history is an important marker for vulnerability to depression. Individuals with history of family members suffering from depression are at a higher risk of developing depression
- Alcohol or drug dependence, eating disorders or engagement in excessive video game playing may be seen and this may exacerbate symptoms of depression, anxiety and sleep problems, further hindering people’s abilities to cope.
- Affluent, educated people are, surprisingly, more likely to have high functioning depression. It is said that it is a paradox of high functioning depression is that these are very often people who are educated and have important jobs.
Keeping the above points in mind, it is necessary to note that not every individual who may have these symptoms is an individual with high functioning depression. It is important to note the context and duration of symptoms. Nevertheless, having identified depression, it must not be let go of, ignored or delayed with intervention. Earlier intervention (and treatment) helps to better manage symptoms and allows the individual to return to healthier functioning sooner. Early intervention also reduced the chances of relapse (the illness recurring) for the individual. Mental health professionals such as psychiatrists, clinical psychologists and psychotherapists (or sometimes, counsellors) are equipped to understand and manage depression. They must be reached out to for help. Usually, a combination treatment of medication and therapy works the best for treating depression. High functioning tendencies of individuals may be managed through therapy.
The Difference Between Psychologists and Psychiatrists
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The professions and terms ‘psychologist’ and ‘psychiatrist’ are often confused to possess the same meaning and are used interchangeably. This is a result of overlapping job descriptions, content and scope of their respective professions as well as a natural tendency to work together on required cases. Although both these professionals work on patients with similar problems and disorders, there are distinct and crucial differences between the two, making psychology and psychiatry different fields of study. The most noted differences involve nature of treatment, approach, education and training.
The educational backgrounds of psychologists and psychiatrists vary greatly.
Psychologists obtain a Ph.D. or PsyD doctoral degrees post their Masters in Science or Arts whereas a psychiatrist earns a degree in medicine (MD).
The training involved in the two professions are also different. While graduating, aspiring psychologists rigorously prepare to be able to diagnose and treat mental disorders and behavioral problems. Their training involves interpretation of psychological tests, counseling and therapy techniques.
A psychiatrist, post earning an MD, has four years of residency training in psychiatry. Some also receive additional training in specific areas of interest such as geriatric psychiatry, child, and adolescent psychiatry or addictions.
Psychologists and psychiatrists can work in a variety of research or clinical settings. Psychologists may work at schools, clinics, hospitals and also at corporate houses while studying methods for improving an organization’s work performance.
A psychiatrist’s experience typically involves working in the psychiatric unit of a hospital with a variety of patients, from children and adolescents with behavior disorders to adults with severe cases of mental illness but they may also work at schools or government and social work centers.
The nature of treatment followed by psychologists usually focusses on psychotherapy and behavior intervention. Psychologists in most states are not certified to prescribe medication although efforts are underway to alter this authority. However, they are qualified to conduct psychological tests (e.g., Minnesota Multiphasic Personality Inventory or MMPI, TAT, Rorschach Inkblot Test, etc.). Psychological tests prove to be extremely beneficial as they reveal critical aspects of a person’s personality and unconscious mind which can help the psychologist to choose an effective course of treatment. While treating their patients, psychologists focus on the mind, emotions, patterns of behavior and thought processes through surveys and interviews as well. Psychologists can refer their clients to psychiatrists to receive medication or to clarify if they are taking the appropriate medication in the right dosages.
Psychiatrists, on the other hand, are trained medical doctors and hence have the certified ability to prescribe medication to their patients. Their main focus during treatment is not on psychosocial therapies and administration of tests but in diagnosing mental disorders, management of medication and regulating chemical imbalance.
However, psychiatrists too refer their patients to psychologists when they feel that counseling and mental health therapy is required.
Although psychotherapy has hugely benefited patients to recover from mental illnesses, it uses several approaches to suit the needs of each individual. It is not mandatory that a particular approach may help different sets of individuals even if their symptoms and problems are similar. Psychologists and psychiatrists help such individuals to explore their options for the future in regard to different modes of therapy and an appropriate combination of medication.
In spite of all the differences, the best possible treatments involve a combination of the consultations and opinions of a psychologist as well as a psychiatrist who are working together so as to gain a holistic approach. Psychologists and psychiatrists can support, stimulate and complement each other. They must collaborate in research. While psychiatrists may rely on psychologists for their expertise in research methodology, psychometry and the analysis of behavior, psychologists gain from the psychiatrists’ wide access to patients, medical knowledge and executive powers.
Psychological Abuse in Women
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PSYCHOLOGICAL ABUSE IN WOMEN
Psychological abuse is the systematic use of malicious manipulation through nonphysical acts against an intimate partner, child, or dependent adult. Also known as emotional abuse, these actions can include threatening the physical health of the victim or the victim’s loved ones, purposely controlling the victim’s freedom, and/or acting to undermine or isolate the victim. Psychological abuse affects both men and women but this article deals particularly with psychological abuse in women. Psychological abuse also applies to children and may impair their development into a healthy adult.
Due to the invisible signs of psychological abuse, it may go unnoticed for years unlike physical abuse. This aspect of psychological or emotional abuse does not make it any less traumatic for the victim as compared to victims of physical abuse. Psychological abuse can ultimately end up having a complete control over the woman’s life. It can affect her friendships, relationship with her significant other and children as well as her family. Psychological abuse is responsible for long-term problems with health, self-esteem, depression, and anxiety.
It also diminishes a woman’s ability to care and provide for her children and to participate in the work force. Emotional abuse crosses all social classes, ethnic groups, sexual orientations and religions. The common denominators of abusers are personal, social and psychological, not demographic. (Miller, 1995; Burstow, 1992)
Signs and symptoms of psychological abuse involves constant criticism or attempts to manipulate and control, shaming and blaming with` hostile sarcasm or outright verbal assault, the use of shaming and belittling language., verbal abuse (name-calling), withholding affection, punishment and threats of punishment, refusal to accept her part in the dynamic, mind games such as “Gaslighting” (manipulate someone by psychological means into doubting their own sanity), refusing to communicate at all, isolating her from supportive friends and family, using the children to control a woman, for example undermining her authority as a parent or threaten to take them if she should leave, making all of the decisions in the family, withholding information and refusing to consult her or about important matters, controlling the money – what is spent, how it is spent, not allowing a woman access to financial resources, or conversely not contributing to any of the household expenses. (Matthews, 2016)
The marginal role of women and cultural practices that uphold this status are plentiful in history. This can be seen today in bride price and dowry practices in some cultures. Arranged marriages still exist in many societies where the woman has a minimal say in her future. (Papp, 1992)
Effects of long-term psychological abuse include depression, withdrawal, low self-esteem and self-worth, emotional instability, sleep disturbances, physical pain without cause, suicidal ideation, thoughts or attempts, extreme dependence on the abuser, underachievement, inability to trust, feeling trapped and alone and substance abuse. A common consequence of psychological abuse in women can be “walking on eggshells” which is to act with great care and consideration so as not to upset someone. This places the woman in a position where she has a greater tendency to be vulnerable to stress and anxiety and will often doubt or second-guess every move she makes in order to avoid more psychological abuse.
Therapy for psychological abuse begins with a set goal of focusing on reconstructing the battered self-esteem of the woman. Identifying foundations of a healthy relationship is important in order to undo any generalized negative idea formed due to emotional abuse. Therapy can be successful only if the woman is completely honest about the extent of the abuse and damage caused to her mentally. Due to feelings of shame, victims often tend to filter out incidents that have occurred with their abuser. Total knowledge of the intensity of the situation on behalf of the therapist will fuel treatment. Therapy for emotional abuse also helps in developing emotional intelligence, learning to set boundaries and modifying behavior.
Types of therapy common in treating emotional abuse include Individual therapy, Group therapy, Journaling, Psychotherapy (talk therapy), Cognitive behavioral therapy and Somatic therapy.
Therapy can also involve the abuser if the victim wishes to continue the relationship in spite of the past. The abuser can be an ally to the therapist only if he recognizes his responsibility as an abuser. Therapy must not focus on the issues stemming from the abuser but only on accentuating the woman’s personal growth. It is imperative for the abuser to also seek therapy but outside of this individual setting.
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A panic attack is a sudden surge of overwhelming anxiety and fear. They involve sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. There may be no clear reason for the attack. A panic attack may be a one-time occurrence, but many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape. Left untreated, panic attacks can lead to panic disorder and other problems. They may even cause you to withdraw from normal activities.
Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, and having a baby. Severe stress causing situations like graduating from college and entering the workplace, getting married, and having a baby , the death of a loved one, divorce, or job loss can also trigger a panic attack. Panic attacks can also be caused by medical conditions and other physical causes. One can say that the basic cause of panic attacks can be traced to genetic predisposition, early childhood experience with anxiety and risk, and challenging changes on becoming an independent adult. Panic disorder often begins during adolescence, although it may start during childhood.
Panic attacks include at least four of the following symptoms: palpitations, accelerated heart rate, sweating, trembling or shaking, shortness of breath, feelings of chest pain or discomfort and choking, nausea or feeling dizzy, tingling sensations or chills and fear of dying or losing control. Panic attacks are generally brief, lasting less than 10 minutes, although some of the symptoms may persist for a longer time. People who have had one panic attack are at greater risk for having subsequent panic attacks than those who have never experienced a panic attack. When the attacks occur repeatedly, and there is worry about having more episodes, a person is considered to have a condition known as panic disorder.
If not recognized and treated, panic disorder and its complications can be devastating. Panic attacks can interfere with a child or adolescent’s relationships, schoolwork, and normal development. Attacks can lead to not just severe anxiety, but can also affect other parts of a child’s mood or functioning. Children and adolescents with panic disorder may begin to feel anxious most of the time, even when they are not having panic attacks. Some begin to avoid situations where they fear a panic attack may occur, or situations where help may not be available. For example, a child may be reluctant to go to school or be separated from his or her parents. In severe cases, the child or adolescent may be afraid to leave home. Some children and adolescents with panic disorder can develop severe depression and may be at risk of suicidal behavior. As an attempt to decrease anxiety, some adolescents with panic disorder will use alcohol or drugs.
Children and adolescents with panic disorder seem to benefit from treatments that have several components. Children can be taught ways to identify and change dysfunctional thought patterns that serve to perpetuate fear. Children learn to identify “automatic anxious thoughts” that trigger physical feelings of panic, and learn to change these thoughts so that they are more realistic. In essence, the therapist teaches the child or adolescent “healthy thinking”. Another component of panic treatment involves exposure therapy. In therapy, children are also taught specialized techniques for reducing their fear of their physical anxious feelings. With the guide of the therapist, children are taught to utilize their skills to enter situations that they had formerly feared or avoided, and are taught to cope more adaptively with these situations.
Autism: Understanding to Widen Support
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The history of autism dates back to 1939 when Leo Kanner first described it as ‘infantile autism’. Autism is a lifelong condition. Someone may have mild, moderate or severe autism, so it is sometimes referred to as a spectrum, or autism spectrum disorder (ASD). Autistic spectrum disorders (ASD) are a group of neuropsychiatric disorders with specific delays and deviance in social, communicative and cognitive development. Read simply, it is characterised by lack of social communication, social engagement, repetitive, inflexible patterns of behaviour, poor eye to eye contact and the child is seen to be ‘lost in him/herself’. ASD includes- Autism, Asperger’s Syndrome, Rett’s Syndrome, Childhood Disintegrative Disorder and Pervasive developmental disorder- not otherwise specified (PDD-NOS). Most children show normal development till the age of 11/2-2 years and then sudden changes occur that demarcate ASD. There are three common features of autism, which might affect the way a person interacts with others in a social situation, communicates with others is a social space and the way the person thinks about and deals with the situation.
Autism is often confused with a learning disability, one must know that autism is not a learning disability. Though, 10-15% of children with autism may have a learning disability. Children (and later, adults) with Autism may have either an average or borderline intellectual functioning or may also have intellectual impairment. More boys than girls are diagnosed with autism. Autism is seen ten times more in boys as compared to in girls with a ratio of 1:10. A condition of the ASD called as Rett’s Syndrome is commonly seen in girls and rarely in boys. Research suggests that ASD is often missed to be recognised and diagnosed in girls as the manifestation of autism is likely to differ than that seen in boys. There is an ongoing debate about whether this is so for genetic reasons or because the process of diagnosis tends to consider traits of autism more commonly in boys. More research is required to understand the development of ASD in girls.
In general, there are a few commonly notices signs in children with autism. However, we must remember that different people may show different symptoms that depend on various factors such as- sex, socio-economic status, family environment, biological and genetic makeup and other demographic variables. Autism may not be identified or diagnosed right from onset. A lot of times, parents and teachers may pick up the signs only when the child is in the classroom setting of school. Sometimes, medical practitioners or mental health professionals may also want to wait for a while to confirm the diagnosis. In the meanwhile, some of the common signs that can help pick up the signs of autism, will include-
- a lack of responsiveness to noise and sounds
- late development of speech
- obsessive behaviour or attachments to certain objects or toys
- a love of order or routines
- challenging behaviours, such as episodes of frustration or in some cases violent behaviour.
There can be up to more than 25 signs and symptoms that can be observed in the condition of autism. Widely, the prevalence of autism is seen to be increasing, especially so from the last 2 decades to around 1/150. In India, the prevalence varies from 1/500 to 1/150 children. It has been discerned that exposure to environmental toxins during conception, genetic vulnerability and damage to the brain due to trauma or difficult labour, pre- and perinatal complications, late parenthood can be some of the several potential risk factors for autism and has also contributed to the rising rate of autism among children.
When someone with autism spectrum disorder (ASD) leaves school and makes the transition to adult services, college, work, job training, or a new living situation, it is another turning point that transforms their relationship to services and supports. There is no cure for autism, as mentioned, it is a condition for the lifetime. It may be seen that the individual with autism may be found to struggle with daily living skills — hygiene, riding a bus, shopping or preparing a meal — regardless of intelligence. Nevertheless, with support systems in place, autism can be managed to varied extents (depending on the severity of the condition, which differs from one individual to another).
Diagnosing and accepting that the child has autism, can be an emotional one for the parents and family, and getting help from family, friends and professionals is really important to get through the process. Many parents have mixed feelings about the process of diagnosis, and everyone’s experiences differs. It’s also important to remember that, although there is no ‘cure’ for autism, getting a diagnosis can be the first step towards making sure that the individual will get the support they need to make the most out of life.
The signs of autism can be clearly understood by the age of three years. The parents, school teachers, school management and the health professional team, in collaboration, play a crucial role to improve the functioning capability of an individual with autism. Intervention for autism should begin as early as possible, even while evaluation of the condition is not confirmed. The early intervention is deemed best in fit if it targets core features of autism and is specific, evidence-based, structured and in line with the developmental / growth needs of the child. Management should be ideally provided by a comprehensive team of developmental paediatrician or just a paediatrician (who may be the family doctor since the child’s birth) a child neurologist or psychiatrist, clinical psychologist, occupational therapist, speech and language therapist, special educator, nutritionist and social worker.
It is important for the family to be aware of the aspects of autism that the child will have to handle throughout his or her life. This is referred to as psychoeducation where the family members learn about the condition, its features, strengths and weaknesses of the child and how they can help the child to better manage the condition. Accordingly, programmes for better education and occupational learning for the child can be taken up for more effective management. Parent-education and home-interventions are important. The schools can provide individualised education programme (IEP) for the child for better learning. Educational plan should reflect an accurate assessment of the child’s strengths and vulnerabilities and their relation to academic skills. Modified or special curricula must be adapted and provided to meet optimum education needs of the child (ESDM and TEACHH are two effective programmes). Inclusion of the child within the schools is something that is spanning at a slower rate and must be encouraged whole heartedly.
Autism is one of the growing public health burdens on a global scale and a conjoined support can help individuals with autism to coexist with comfort.
Oppositional Defiant Disorder
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It is not unusual for children and teenagers to defy authority every now and then. They may express their defiance by arguing, disobeying or talking back to their parents, teachers or other adults. When this behaviour lasts longer than six months and is excessive compared to what is usual for the child’s age, it may mean that the child has a type of behaviour disorder called Oppositional Defiant Disorder (ODD). ODD is a condition in which a child displays an ongoing pattern of an angry or irritable mood, defiant or argumentative behaviour, and vindictiveness toward people in authority. The child’s behaviour often disrupts the child’s normal daily activities, including activities within the family and at school.
Evidence suggests that between 1 to 16 percentage of children and adolescents have ODD [Loeber R, Burke JD et al (2000)]. ODD usually appears in late preschool or early school-aged children. In younger children, ODD is more common in boys than girls. However, in school-age children and adolescents the condition occurs about equally in boys and girls [Connor DF (2002)] . About half of the adolescents with ODD outgrow this disorder, the other half continue to experience symptoms of ODD through adulthood. Although the disorder seems to occur more often in lower socioeconomic groups, ODD affects families of all backgrounds.
ODD is caused by a combination of biological, psychological and social risk factors that play a role in the development of the disorder [Burke JD et al (2002)]. Children and adolescents are more susceptible to ODD if they have a parent with a history of ODD or other attention deficit/hyperactive or mood disorders, impairment in the part of brain responsible for reasoning, judgement and impulse control, brain-chemical imbalance, exposure to toxins and poor nutrition. Psychological factors include poor relationships with parents, neglectful or absent parents and inability to form social relationships. Social factors include poverty, chaotic environment, abuse and neglect and family instability.
Most children argue with parents and defy authority from time to time, especially when they are tired, hungry, or upset. Some of the behaviours associated with ODD also can arise in children who are undergoing a transition, who are under stress, or who are in the midst of a crisis. Children with ODD show a pattern of defiance and negativity which is constant and lasts at least six months, is disruptive to the people around the individual, is usually directed towards an authoritative figure like parents, teachers and these actions are excessive compared with what is usual for the child’s age. The behavioural symptoms associated with ODD are: frequent temper tantrums, excessive arguments with adults, refusing to comply to rules and questioning rules, deliberately annoying and upsetting others, outburst of anger and resentment and spiteful attitude of revenge seeking.
While there is no single test that can diagnose ODD, a mental health professional can determine whether a child or adolescent has the disorder by assessing the child’s symptoms and behaviours and by using clinical experience to make a diagnosis. ODD is not always easy to accurately diagnose. Open communication among the mental health professional and the parents and child can help overcome the difficulties diagnosing this disorder. Assessment tools, such as rating scales and questionnaires, may help the child’s doctor measure the severity of the behaviours.
There is research that shows that early-intervention, programs along with individual therapy can help prevent ODD [Birmaher B et al (2002)]. Among adolescents, psychotherapy (talk therapy), social-skills training, vocational training, and help with academics can help reduce disruptive behaviour. In addition, school-based programs can be effective in stopping bullying, reducing antisocial behaviour, and improving peer relationships. Parent-management training programs have proven effective in preventing ODD among all age groups. These programs teach parents how to develop a nurturing and secure relationship with their child and how to set boundaries for unacceptable behaviour. Some other programmes/training methods include Cognitive problem solving skills training and Social skills programmes and School based programmes. Medication, however is not the only treatment method alone but could be helpful to control some of the more distressing symptoms of ODD.
It was once thought that most children would outgrow ODD by adulthood but this has been proved incorrect. While some of the symptoms of ODD can go away over time, and many children outgrow the disorder, some children with ODD will continue to experience the consequences of ODD during their later years. For those children that do not receive treatment, ODD can develop into serious Conduct Disorders (CD). Early diagnosis and treatment can help these individuals learn how to cope with stressful situations and manage their behavioural symptoms. Psychotherapy, parent-management training, skills training, and family therapy work. Research shows that children and adolescents respond well to therapy for ODD. In fact, for those who receive treatment, many are symptom-free once therapy has concluded and will go on to lead rewarding and happy lives.