Posts tagged psychiatry

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Dependent Personality Disorder

Dependent personality disorder (DPD) is one of a cluster of disorders defined by symptoms of anxiety and fear. 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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Avoidant (or Anxious) Personality Disorder

This is very similar to generalized social phobia. Those with the disorder think of themselves as being inadequate, unlikeable and socially inept. They fear being rejected, criticised or ridiculed and would rather avoid most social situations. The reasons can differ may be related to emotional neglect and peer group rejection in childhood and/ or adolescence. Symptoms may include the following:

- Hypersensitivity to rejection/criticism

- Self-imposed social isolation

- Extreme shyness or anxiety in social situations. (However, the person still has a strong desire for close and meaningful relationships)

-  May avoid physical contact with others (because it is associated with emotional or physical pain)

- Painful feelings of inadequacy

- Poor self-esteem

- Intense feelings of self consciousness

- Self hatred or self-loathing

- Mistrust of others

- Emotional distancing/ fear of intimacy

- Highly critical of their ability to relate naturally and appropriately to others

- Do not feel they can connect with others (although others may view them as easy to relate to)

- Intense feelings of inferiority.

- In more extreme cases, may suffer from agoraphobia.

Treatment approaches include social skills training, cognitive therapy, gradually increasing exposure to social situations, group therapy and, occasionally, drug therapy. Gaining and keeping the client’s trust is essential for progress to be made.

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The 7 Emotional Needs of Children

All children are born with emotional needs. These needs must be met by the adults in their life if they’re to grow into confident and independent adults.  The acronym PARENTS summarises children’s needs (Protection, Acceptance, Recognition, Enforced limits, Nearness, Time and Support).

Protection: It’s crucial that all children feel safe and secure. This is essential for their very survival – and all children fear rejection and abandonment.  They need a sense of order and predictability, routine, peace and stability – so they can learn to trust others, and build relationships. However, if trust is absent, and they feel insecure, they’ll start to put up walls to keep other people out, and they’ll find it hard to trust and get close to anyone.

Acceptance: All children need to feel that they are loved and accepted - for who and what they are – without any strings attached. They so desperately want to be worthy of acceptance, and cherished and loved despite their limits and their failings. This is crucial information - for their parent is a mirror who reflects back to them the world’s perception of the child. It should tell them they are valuable and worthy of love – so the child learns to value and believe in themselves. However, if a parent is demanding, harsh or critical then the child will develop chronic low self-esteem.

Recognition: Children have an innate need to make their parents happy, and are desperate for praise, and to hear their parents say: “I’m so proud of you. You did a fabulous job.” But if approval is withheld, so the child feels they are worthless, they’ll likely give up hope, and they will lose the will to try. This may show itself in angry, acting out behaviour … or the child may withdraw, and expect little in life.

Enforced Limits: Children need a sense of predictability. They need to see that rules are followed, so life is NOT chaotic. For the world feels scary and doesn’t make much sense if boundaries are fluid and “just anything goes”.

Nearness: Expressing love is crucial for communicating love - so children need to be held and be hugged by their parents. In a very concrete way, this sends the powerful message that the child’s needs matter, and their parents care for them.  

Time: Children don’t distinguish between quality time and just hanging out, and spending lots of time with parents. They need to be in their presence, and to have their full attention, as that sends the message “I like being with you.” They then believe that others will like and want them, too.

Support:  The outside world is a scary place for children. It’s full of unknown dangers and unmet challenges. Thus, to launch out and discover they can cope and survive, children need to be certain that their parents’ will be there. That is, they need their encouragement, their affirmation, their constant support and their belief in the child. That helps the child to venture into and explore the outside world, so they develop independence and increased autonomy.

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Some Symptoms of Depression

- An inability to function normally in everyday life

- Lethargy, fatigue, and the feeling that doing things takes too much energy

- Persistent sadness, including fits of crying (either uncontrollably or being set off easily)

- Feelings of anxiety or emptiness

- Feelings of worthlessness, self-blame and low self esteem

- Sleeping a lot more or less than usual, or experiencing insomnia

- Compulsive overeating, or a loss of appetite

- Finding thinking or concentrating difficult, “foggy” thinking; inability to make clear decisions; forgetfulness

- Pessimism; feeling that life is hopeless, pointless and futile

- Numbness/ an inability to feel anything at all

- Aches and pains, digestive problems, headaches

- Generally feeling irritable and restless

- Being troubled by suicidal thoughts/ thoughts of dying.

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How to Cope with Depression

Depression can often be difficult to fight as it usually drains you of your energy. And though you can’t overcome it by willpower alone, you still have some control, no matter how you feel. The suggestions below can help you with this.

1. Keep doing the activities you previously enjoyed (even if you don’t enjoy them as much when you’re depressed).

2. Try and build some exercise into your day as it releases endorphins – the body’s “feel good” hormones.

3. Know what your triggers and your risk factors are. For example, loneliness, stress, disappointment and pain are common triggers and risk factors for depression.

4. Stay in touch with your friends. Often those who are depressed start to isolate themselves – but that leads to loneliness - which makes depression worse.

5. Try and maintain some kind of routine, especially when it comes to getting up and going to bed. Taking naps in the daytime can cause insomnia and leave you feeling drained, so you have no energy.

6. Try to get a handle on how much you tend to worry. Take note of your thought patterns; don’t dwell on negatives. Instead, challenge faulty thinking so it’s much less pessimistic … and try to be thankful … and look for positives.

7. Make sure you do things that make you feel more relaxed. Often people who’re depressed feel uptight and agitated. So it’s important that you find things that help you to relax.  

8. Resist the temptation to self-medicate (especially through alcohol or substance abuse.) That will lead to greater problems - and make you feel much worse.

9. Seek out support. Talk to a good friend, or someone that you trust. You’ll usually find there’s someone who genuinely cares.

10. Talk to your doctor. It may be medication is the answer for you so don’t be afraid to try and get professional help.

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How to Overcome Emotional Numbness

Emotional numbness is where we experience mild to severe feelings of detachment – so it’s hard for us to access normal feelings any more. This includes both negative and positive emotions as you can’t decide to shut just one feeling off. Common causes of emotional numbness include different stresses or traumas … from receiving bad news … to being in an accident … to recovering from the death of someone close … to a relationship breakup … to feeling deeply humiliated or ashamed. So how do you overcome emotional numbness and live with emotional integrity again?

1. The first thing to do is to choose to respect and allow all emotions – no matter what they are. Also, try and grasp the fact that suppressing your emotions will likely lead to heartache and problems later on (as they’ll possibly resurface at inappropriate times.)

2. Try and understand that feelings and actions are two very different, and unrelated, things.  That is, you can still feel angry without becoming violent – so don’t assume your feelings will affect your actions, too.

3. Try to figure out the message behind intense emotions. Are you angry because you’ve been hurt, used or abused? Are you sad because deep down you feel that you’ll never find true love - as you can’t believe that anyone will love you for yourself?

4. Take that risk – and find the courage to ask someone for help. If you’re honest with yourself, you’ll know that there are those who genuinely love you like – like a true and caring friend. The important thing is not to try and isolate yourself, and to make the extra effort to prioritise self-care. You need other people to help you work through this.

5. Seek professional help if the symptoms persist. There are excellent counsellors and therapists out there who have the training and skills to help you to get free – so you can live a more fulfilling and normal, healthy life.

6. Be patient within yourself. It’s likely to take time – as you will need to learn to trust, and take some barriers down, so you can be yourself again (and that is often hard to do when you’ve experience hurt and pain).  

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If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather.

Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.

Stephen Fry

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What are the Different Types of Abuse

Abuse can take many forms. It can include:

1. Physical abuse such as hitting, pushing, pinching, shaking, misusing medication, ; withholding food or drink; force-feeding ,scalding, restraint and hair pulling, ; failing to provide physical care and aids to living.

2. Sexual abuse such as rape, sexual assault, or sexual acts to which the person has not or could not have consented, or pressurising someone into sexual acts they don’t understand or feel powerless to refuse.

3. Psychological or emotional abuse such as threats of harm or abandonment, being deprived of social or any other form of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse and being prevented from receiving services or support.

4. Financial or material abuse such as theft, fraud or exploitation, pressure in connection with wills, property, or inheritance, misuse of property, possessions or benefits.

5. Neglect such as ignoring medical or physical care needs and preventing access to health, social care or educational services or withholding the necessities of life such as food, drink and heating, or failing to ensure adequate supervision or exposing a person to unacceptable risk.

6. Discriminatory abuse such as that based on race or sexuality or, harassment, /slurs / maltreatment because of someone’s race, gender, disability, age, faith, culture, or sexual orientation

7. Institutional abuse can sometimes happen in residential homes, nursing homes or hospitals when people are mistreated because of poor or inadequate care, neglect and poor practice that affects the whole of that service.


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Talking to Someone about their Mental Health Problem

1. Take the lead: If you know someone has been unwell, don’t be afraid to ask how they are. They might want to talk about it, they might not. But just letting them know they don’t have to avoid the issue with you is important.

2. Avoid clichés: Phrases like ‘Cheer up’, ‘I’m sure it’ll pass’ and ‘Pull yourself together’ definitely won’t help the conversation! Being open minded, non-judgemental and listening will.

3. Ask how you can help: People will want support at different times in different ways, so ask how you can help.

4. Don’t just talk about mental health: Keep in mind that having a mental health problem is just one part of the person. People don’t want to be defined by their mental health problem so keep talking about the things you always talked about. Just spending time with the person lets them know you care and can help you understand what they’re going through.

5. Don’t avoid the issue: If someone comes to you to talk, don’t brush it off because this can be a hard step to take. Acknowledge their illness and let them know that you’re there for them.

6. Give them time: Some people might prefer a text or email rather than talking on the phone or face to face. This means they can get back to you when they feel ready. What’s important is that they know you’ll be there when they’re ready to get in touch.

7. Find out more: If you feel awkward or uncomfortable about the conversation, find out more about mental illness.


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Mental Illness: Truth or Fiction

Those with mental illnesses are often stigmatised as people are confused over what is the truth … and a lot of what we hear is simply misinformation! For example,

1. Fiction: There’s no hope for those diagnosed with mental illness.
Truth: There are numerous treatments and forms of support that make it possible for those with mental illness to hold down jobs and lead a normal life.

2. Fiction: There’s nothing I can do to make a difference in their lives.
Truth: The way you speak and act can make a huge difference. It can promote understanding or it can add to the burden. For example, seek to separate the person from the diagnosis (So instead of calling him or her a schizophrenic, describe them as a person with schizophrenia). Also, don’t label them as crazy or inferior. That is both insulting and inaccurate. Those with mental illness should be treated with respect; they have the same rights as others in society.

3. Fiction: They’re more likely to be violent than the average person.
Truth: There is no evidence that those with mental illness are any more violent than another person (but they ARE more likely to be victims of crime.)

4. Fiction: I’m not at risk of mental illnesses myself.
Truth: Mental illnesses are common - more than half the population will receive a diagnosis at some point in their life. It will likely affect their wider family, too.

5. Fiction: Mental illness is related to mental retardation.
Truth: The two are not related in any way at all. Mental illness affects a person’s mood, thoughts and behaviour; retardation affects their intellectual functioning and creates some challenges for daily functioning.

6. Fiction: Mental illnesses are caused by a weak character.
Truth: Mental illnesses are caused by a number of factors – social, biological, emotional, psychological, environmental, or a mix of these.

7. Fiction: Those with mental illnesses can’t hold down a job (or they’re less effective than most other employees).
Truth: Studies conducted by the National Institute of Mental Health (NIMH) and the National Alliance for the Mentally Ill (NAMI) showed no differences in productivity between those with mental illness and those without mental illness.

8.  Fiction: Children don’t suffer from mental illnesses. What we see is bad behaviour due to poor parenting. Many kids just want attention and have been spoiled by their parents.
Truth: 5-9 % of children are diagnosed with a recognised form of mental illness. However, they can still succeed at school and in relationships if they receive the understanding and support they deserve.  

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Attachment Disorder

Attachment disorder is where a child or adult is unable to form normal healthy attachments. This is usually due to detrimental early life experiences - such as neglect, abuse, separation from their parents or primary caregivers (after six months of age and before three years of age), frequent change of caregivers, and lack of responsiveness from their caregivers.

Symptoms vary depending on age. In adults, they fall under one of two categories – either avoidant or anxious/ ambivalent personalities. These are summarized below.

1. Avoidant

· Intense anger and hostility

· Hypercritical of others

· Extremely sensitive to criticism, correction or blame

· Lacks empathy

· Sees others as untrustworthy and unreliable

· Either sees themselves as being unlovable or “too good” for others

· Relationships are experienced as either being too threatening or requiring too much effort

· Fear of closeness and intimacy

· Compulsive self-reliance

· Passive or uninvolved in relationships

· Find it hard to get along with co-workers and authority figures

· Prefers to work alone, or to be self employed

· May use work to avoid investing in relationships

2. Anxious/ Ambivalent

· Demonstrates compulsive caregiving

· Problems with establishing and maintaining appropriate boundaries

· Feels they give they give more than they get back

· Feels their efforts aren’t noticed or appreciated

· Idealizes people

· Expects their partner to repeatedly demonstrate their love, affection and commitment to them, and the relationship

· Emotionally over-invests in friendships and romantic relationships

· Are preoccupied with close relationships

· Overly dependent on their partner

· Believes that others are out to use them or to take advantage of them

· Fears rejection

· Is uncomfortable with anger

· Experiences a roller coaster of emotions – and often these are extremes of emotion

· Tends to be possessive and jealous; finds it hard to trust

· Believes they are essentially flawed, inadequate and unlovable.

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Help for a Shame-Based Personality

If you think you have a shame-based personality then the following suggestions might help you deal with this.

First … What NOT to do

1. Recognise that you’re being lied to –what they’re saying isn’t true. The truth is you’re a valuable and worthwhile individual. Choose to believe that this is true. Accept – and don’t reject – yourself.

2. Realise that it is pointless to argue against those who are in the habit of shaming, and putting you down. They don’t care about the truth - so save your breath; don’t waste your time.

3. Avoid the person who is shaming you as much as you can. You don’t need that kind of toxic person in your life.

4. Recognise and resist when they attempt to control you by embarrassing, shaming or manipulating you. Relationships are based on a healthy respect. You discuss and negotiate - you don’t try to control.  

Second … What TO Do

1. Remember that “Nobody can make you feel bad about yourself without your consent.”  When others try to dump on you, refuse to take it. Healthy people don’t dump shame on others. So, recognise that the problem is theirs – not yours.

2. Remove yourself from the influence of the shamer. That’s not a healthy place for you to be.

3. When you feel more confident. Think about confronting the shamer. Tell them (respectfully) that you’re not accepting that kind of treatment, then end the conversation and walk away.

4. Deliberately surround yourself with healthy people who can see your strengths and who will treat you well.

5. Notice and affirm your good qualities and strengths – and stop thinking of those lies that the shamer dumped on you. Focus only on the positives - and choose to LOVE YOURSELF! 

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Mental Health Facts

1. About half of mental disorders begin before the age of 14. Around 20% of the world’s children and adolescents are estimated to have mental disorders or problems, with similar types of disorders being reported across cultures.

2. Depression is characterized by sustained sadness and loss of interest along with psychological, behavioural and physical symptoms. It is ranked as the leading cause of disability worldwide.

3. On average, about 800 000 people commit suicide every year. Mental disorders are one of the most prominent and treatable causes of suicide.

4. War and other major disaster have a large impact on the mental health and psychosocial well-being. Rates of mental disorder tend to double after emergencies.

5. Mental disorders contribute to unintentional and intentional injury.

6. Stigma about mental disorders and discrimination against clients and families prevent people from seeking mental health care. Contrary to expectations, levels of stigma were higher in urban areas and among people with higher levels of education.

7. Human rights violations of psychiatric patients are routinely reported in most countries. These include physical restraint, seclusion and denial of basic needs and privacy. Few countries have a legal framework that adequately protects the rights of people with mental disorders.


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What are the Signs of a Narcissist?

1. They are arrogant and have a sense of entitlement: This is one of the key indicators of a narcissist. He or she believes that they are special, superior to others and deserve to be treated better than others. They like to brag of their successes and accomplishments, and want everyone to tell them how wonderful they are. At social events, they must be the centre of attention, and everyone must talk about what he or she wants to talk about.

2. They use and exploit other people:  The narcissist sees people as being there for them. Hence, they use other people to help them reach their goals. Also, they’ll often prey on others, and use them sexually. So they’ll charm, seduce and use you – then rapidly move on. he damage, or the heartache they may cause.

3. They lack empathy: The narcissistic person can’t form relationships. To them feelings don’t matter; they don’t have empathy. They don’t care about the damage on the heartache they may cause. Also, they won’t support or help you when life is difficult.

4. They have poor boundaries: The narcissistic person won’t respect your boundaries. They’ll take what’s yours and use it – and see that as their right. They’re rude, they insult others, they comment on their looks, and violate the standards that others see as just.

Some tips on dealing with a narcissist

(a) First, you need to recognise your personal vulnerabilities so you don’t get taken in by a charming narcissist – who makes you feel you’re special, or the best thing in this world. (b)Second, understand this individual is not a normal person. They won’t be there for you as they don’t have empathy. Recognise those telltale signs which indicate they’re self-obsessed.

(c) Third, establish and maintain healthy, stringent boundaries.

(d) Finally, if it’s always about them and there’s no real give and take, recognise you should move on and get that person out your life.

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