What are Mental Disorders?

Mood disorders

Depression

Clinical Depression: Part of the mood disorders category and also known as Major Depressive Disorder or Unipolar Depression, this type of recurrent depression is characterised by dampened mood (more or less permanent feelings of sadness), low self-esteem, and a loss of interest in normally enjoyable activities. Often misunderstood as being something that individuals should be able to overcome by will-power alone, major depression often requires antidepressant medication but this will only be a band-aid solution. Studies have shown that depression is best treated with therapy, if the person is taking medication at the same time.

Bipolar Disorder

Bipolar Disorder: Part of the mood disorders category and previously known as Manic-Depression, bipolar disorder is characterised by episodes of uplifted mood, arousal, and/or energy levels, often interspersed with contrasting episodes of depressed mood. Bipolar Disorder is usually a chronic psychological disorder, often necessitating hospitalisation during the most intense phases of the illness, and medication (lithium).

Schizophrenia

Schizophrenia: Schizophrenia is a psychotic disorder characterised by auditory hallucinations, paranoia, bizarre delusions, and/or disorganised thinking. CBT protocoles have been designed for schizophrenia, particularly in the stabilisation phase of the disorder. It has been shown that gaining basic life-skills can help strengthen the stabilisation phase. Schizophrenia, like bipolar disorder, is a chronic mental illness.

Anxiety Disorders

Panic Disorder

Part of the anxiety disorders category, a panic attack is a short period (usually 5-10 minutes) of intense fear (accompanied by thoughts of imminent death or danger) with an abrupt onset. It is characterised by increased heart rate, shortness of breath, dizziness, numbness, and changes in body temperature, even changes in depth (ocular) perception. Individuals with panic disorder have recurring panic attacks and often the fear of the attacks themselves become the focus of their anxiety. Panic Disorder often occurs together with Agoraphobia, the fear of public places. This is because individuals develop a fear of having an attack in public places, leaving themselves vulnerable.

Obsessive-Compulsive Disorder

Part of the anxiety disorders category, OCD is characterised by uncontrollable thoughts (obsessions) that may or may not lead to repetitive behaviours (compulsions) aimed at relieving the anxiety brought on by the initial thoughts. A frequent obsession has to do with cleanliness and fear of germs, leading to compulsions of excessive hand-washing, for example. Obsessions to do with safety of one’s house can lead to repeated checking, nervous rituals. Another example of OCD includes extreme hoarding. Unlike those with Obsessive-Compulsive Personality Disorder (see below), individuals with OCD often recognise that their obsessions are irrational and therefore experience greater anxiety and feelings of helplessness. CBT has proved successful in alleviating distress and inducing positive change in individuals suffering from OCD.

Generalised Anxiety Disorder

Part of the anxiety disorders category, Generalised Anxiety Disorder (often shortened to GAD) is characterised by disproportionate worry about everyday things (such as money, health, or relationships) that is ongoing and uncontrollable. It is often expressed in the form of somatic symptoms such as headaches, nausea, fatigue, loss of appetite, or insomnia. Psychological discomfort appears in the form of irritability, fidgeting, hyperactivity, amongst other symptoms. Managing stress, relaxation techniques and learning to restructure our thoughts are CBT methods which work particularly well for this disorder. Unfortunately, many people don’t seek treatment for anxiety disorders, mainly because they think the symptoms are not bad enough or simply because they have lived with the condition for so long, it has become a part of their lives and coping strategies – often very finely-tuned – have developed over the course of the individual’s life.

Phobias

Part of the anxiety disorders category, a phobia is a persistent fear of certain objects or situations in which the individual goes to great lengths to avoid the object or situation in a way that is irrational and disproportional to the objective threat of danger. Common phobias include a fear of insects, dogs, airplanes, elevators, blood, needles. Exposure treatment and systematic desensitisation work well to treat phobias. Social Anxiety Disorder is a special type of phobia in which the individual has an extreme fear of social interaction. It is treated differently to phobias. Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognise and change negative thoughts about yourself and acquire skills to help you gain confidence in social situations. In exposure-based cognitive behavioural therapy, you gradually work up to facing the situations you fear most. This therapy can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others, for example Assertiveness training.

Post-traumatic Stress Disorder

Part of the anxiety disorders category, PTSD stands for Post-traumatic Stress Disorder and can develop after exposure to extreme trauma during which the individual feared for their lives. Symptoms include flashbacks, nightmares and hyper-vigilance. Prolonged exposure to trauma in which there was no viable means of escape can lead to a distinct but related disorder known as Complex Post-traumatic Stress Disorder (C-PTSD). Imaginal exposure as part of Prolonged Exposure Therapy (along with learning to control one’s breathing, psycho-education and in vivo exposure – confronting real-world situations that individuals with PTSD may avoid) is highly effective in treating PTSD. Imaginal exposure involves repeatedly revisiting the traumatic experience in memory describing the event aloud in detail. Though this may seem like unnecessarily painful for the client, revisiting the event in this way promotes processing of the trauma memory by activating the thoughts and emotions associated with the trauma in a safe context. Imaginal exposure also helps the client realise he or she can cope with the distress associated with the memory so that they can better manage their everyday life.

Dissociative Disorders

Depersonalisation Disorder

Part of the dissociative disorders category, Depersonalisation Disorder is characterised by frequent feelings of detachment from oneself combined with an awareness of the detachment. To someone experiencing depersonalisation, the external world feels strange and unreal and a person can even get the sense that they are watching themselves from a third person perspective. However, unlike in schizophrenia, the individual remains very much aware of their own existence and is, in fact, overly aware of it. For this reason, depersonalisation disorder is often associated with the philosophy of existentialism. It is not so much a disorder as a symptom and so it can be part of many disorders listed here. Another dissociative disorder is Derealisation, which can be triggered by drug consumption.

Eating Disorders

Anorexia

Anorexia Nervosa is part of the eating disorders category. It is characterised by distorted self-perception and an irrational fear of gaining weight resulting in excessive food restriction and extreme weight loss. It usually develops during adolescence and early adulthood and can lead to serious metabolic and hormonal problems. In its most severe form, hospitalisation is prescribed. This disorder is known to be chronic. Using CBT to minimise negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviours that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals.

Bulimia

Bulimia Nervosa is part of the eating disorders category. It is characterised by binging (eating a large amount of food in a short amount of time) followed by purging (an attempt to rid oneself of the food consumed — typically by vomiting, taking a laxative, and/or exercising excessively). The binge/purge cycle is often followed by periods of fasting and negative feelings about oneself may arise such as intense guilt or feelings of emptiness. Much as for Anorexia, CBT will focus on changing thought patterns, teaching stress management skills and assertiveness to increase low self esteem, as well as behavioural modules of treatment such as adopting alternative behaviours that are incompatible with binge-eating.

Somatic Disorders

Conversion Disorder

Part of the somatic disorders category, Formerly known as hysteria (a common 19th century diagnosis made exclusively in women), conversion disorder occurs when patients suffer apparently neurological symptoms — such as numbness, paralysis, or fits — but without a neurological cause. The term originates in Freud’s belief that, in such cases, a person’s anxiety is being ‘converted’ into physical symptoms.

Illness Anxiety Disorder

Part of the somatic disorders category, a person who suffers from Illness Anxiety Disorder is commonly known as a hypochondriac, who constantly worries about their health even when they have no reason to do so and often any minor symptom is perceived as being a sign of a serious illness.

Neurodevelopmental Disorders

Attention Deficit Hyperactivity Disorder

In most cases ADHD is characterised by difficulty in focusing one’s attention on a single task and a tendency towards hyperactivity and impulsive behaviours (although some individuals are either predominantly inattentive or predominantly hyperactive-impulsive). I can help with issues to do with attention deficit in adulthood. For children, I can advise you on where to go for help.

Personality Disorders

Personality disorders are specific forms of traits that appear systematically in response to a variety of different situations. Distress invariably arises when the behaviour which is applied to situations is typically not adapted. This creates unwanted reactions from others which, in turn, fuels the anxiety and/or depression issues which can accompany personality disorders. Personality disorders are conditions in which people have traits that cause them to feel and behave in socially distressing ways, limiting their ability to function in relationships and other areas of their life, such as work or school. There are many forms of personality disorders…

Borderline

People who suffer from this disorder typically have problems regulating their emotions and thoughts, are impulsive and sometimes reckless in their behaviour, have unstable relationships. There is usually an excessive fear of abandonment and unstable self-image (sense of self is unclear). Mood swings can be violent and there is a risk of suicidal behaviour and self-injury. Emotions of sadness and anger can be quite intense, as well as anxiety provoked by stress. It usually begins during adolescence or early adulthood. Sometimes Borderline personality disorder is difficult to diagnose because it frequently appears with other mental disorders such as depression, anxiety disorders, substance abuse or eating disorders.

Current ideas about the condition focus on ongoing patterns of difficulty with self-regulation (the ability to soothe oneself in times of stress) and trouble with emotions, thinking, behaviours, relationships and self-image. Some people refer to BPD as “Emotional Disregulation.”

Narcissistic

Narcissistic personality disorder is a disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultra-confidence lies a fragile self-esteem that’s vulnerable to the slightest criticism. The disorder causes problems in many areas of life, such as relationships, work, school or financial affairs. Individuals may be generally unhappy and disappointed when they’re not given the special favours or admiration they believe they deserve. Others may find their relationship unfulfilling, so people suffering from Narcissistic personality disorder may be confronted with loss of friendships and other significant relationships.

Narcissistic personality disorder treatment is centred around talk therapy but as with all personality disorders, CBT gets to the core using schema therapy and cognitive restructuring of thoughts, as well as the tolerance of negative emotions. Behavioural aspects may be incorporated, such as confronting issues that the person has been avoiding.

Obsessive-compulsive

Obsessive-compulsive personality disorder (OCPD) is a mental condition in which a person is preoccupied with rules, orderliness and control. There is often a very strong sense of perfectionism and so people with either OCPD or OCD are high achievers and feel a sense of urgency about their actions. They may become very upset if other people interfere with their routines, which they have carefully planned out over time to maximise results. They may not be able to express their anger directly. People with OCPD have feelings that they consider more appropriate, like anxiety or frustration. The condition usually begins in early adulthood. This perfectionism may interfere with the person’s ability to complete tasks, because their standards are so rigid. They may withdraw emotionally when they are not able to control a situation. This can interfere with their ability to solve problems and form close relationships. OCPD can co-occur with anxiety and depression and may hinder a person from moving forward in career situations and in their relationships.

Antisocial

Antisocial personality disorder is a type of chronic mental condition in which a person’s ways of thinking, perceiving situations and relating to others are dysfunctional. Those with antisocial personality disorder tend to antagonise, manipulate or treat others either harshly or with callous indifference. They may often violate the law, landing in frequent trouble, yet they show no guilt or remorse. They may lie, behave violently or impulsively, and have problems with drug and alcohol use. These characteristics typically make people with antisocial personality disorder unable to fulfil responsibilities related to family, work or school. Although CBT has been shown to be quite effective in the removing some of the symptoms, such as as impulsivity, interpersonal difficulties and antisocial behaviour, I do not treat this condition. However, I can advise you on where to go for help.

Schizotypal

Schizotypal personality disorder (SPD) is a mental condition in which a person has disturbances in thought patterns, appearance, and behaviour, but it should not be confused with schizophrenia. People with SPD can have odd beliefs and behaviours, but unlike people with schizophrenia, they are not disconnected from reality, do not have delusions and usually do not hallucinate. They may also have unusual preoccupations and fears, such as fear of being monitored by government agencies. More commonly, people with this disorder behave oddly and have unusual beliefs (such as aliens). They cling to these beliefs so strongly that they have difficulty forming and keeping close relationships. People with SPD may have depression in conjunction with their personality disorder, and also a second personality disorder, such as paranoid personality disorder. They often have poor social skills so CBT can focus on the acquisition of basic life skills (e.g., assertiveness training).

Personality Disorder Trait Specified

Personality Disorder Trait Specified is a catch-all diagnosis in the American Psychiatric Association’s 5th edition of the Diagnostic & Statistical Manual (DSM-V) for those who exhibit specific traits of personality disorders but who do not fit neatly into the other personality diagnoses.

To diagnose a trait specified personality disorder, certain criteria must be met such as interpersonal impairments, self-identity or self-direction issues, negative emotions, detachment, antagonism, disinhibition and psychoticism. The impairments must be stable over time and consistent across situations and are not due to developmental stage or socio-cultural environment. This new classification of personality disorders means that several disorders no longer appear in the diagnostic manual. These are: Histrionic, Dependent, Paranoid, Schizoid.

Avoidant

People with this disorder cannot stop thinking about their own shortcomings. They form relationships with other people only if they believe they will not be rejected. Loss and rejection are so painful that these people choose to be lonely rather than risk trying to connect with others. They are often very sensitive to criticism, they avoid activities or jobs that involve contact with others and are typically very shy, through fear of doing something wrong. They may also hold the view they are not good socially, not as good as other people, or unappealing, so basic life-skills training, such as assertiveness, could help. CBT will also focus on cognitive restructuring of unhelpful thoughts. The aim is to help people with this disorder be less sensitive to rejection. Without treatment, a person with avoidant personality disorder may lead a life of near or total isolation. They may go on to develop a second mental health disorder, such as substance abuse, or a mood disorder, such as depression.