Post Traumatic Stress Disorder (PTSD)

Post traumatic stress disorder (PTSD) is a severe anxiety disorder that may develop after an event that results in psychological trauma, such as a threat of death, a threat to physical, sexual, or psychological integrity, a near-death experience, etc.

The trauma preceding PTSD overwhelms the person's ability to cope in a normal manner.

Diagnostic symptoms include re-experiencing the original trauma through flashbacks or nightmares; avoidance of stimuli associated with the trauma; difficulty falling or staying asleep; anger; and hypervigilance.  symptoms would last more than one month and would cause significant impairment in social, occupational, or other important areas of functioning.

PTSD is believed to be caused by either physical trauma or psychological trauma, and frequently a combination of both.  Possible sources of trauma include experiencing or witnessing childhood or adult physical, emotional or sexual abuse.

In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers).

Treatment for PTSD

Treatment for PTSD usually involves psychotherapy, especially Cognitive Behavioral Therapy and Dialectical Behavioral Therapy.  Relaxation therapy is also helpful to reduce and cope with residual anxiety.

A variety of medications have been applied to the disorder, including mood stabilizers, anti-depressants, and anti-psychotics.

Many PTSD medications list possible dependence (addiction) as one of the side effects.

Many of the medications prescribed for PTSD have the potential for creating a secondary condition of substance abuse or substance dependence.  Some long-term users of PTSD medications report that they felt compelled to take other prescription drugs and even illegal drugs to enhance the waning effects of their medication over time.  Other users reported a transition to illegal drugs with similar effects when the PTSD was withdrawn.

Dual Diagnosis/Co-Occurring Disorder

PTSD often occurs together with substance abuse and substance dependence disorders.  Often the substance use is the result of an attempt to "self-medicate" but just as often substance dependence is the primary disorder with PTSD being secondary.  In either case, both disorders must be treated simultaneously to achieve an effective outcome.

Social Anxiety Disorder

Social anxiety disorder is an anxiety disorder characterized by intense fear in social situations, causing distress and impaired ability to function in daily life.

Social anxiety disorder is a potentially disabling disorder, but can be controlled and successfully treated.

Physical symptoms often accompanying social anxiety disorder include excessive blushing, sweating (hyperhidrosis), trembling, palpitations, nausea, and stammering.  Panic attacks may also occur under intense fear and discomfort.

An early diagnosis may help minimize the symptoms and the development of additional problems such as depression.

Social anxiety disorder often occurs alongside low self-esteem and clinical depression, due to lack of personal relationships and long periods of isolation from avoiding social situations.  An early diagnosis may help minimize the symptoms and the development of additional problems.

Substance Abuse and Social Anxiety Disorder

People with social anxiety disorder may use alcohol or other drugs to attempt to reduce their anxiety and alleviate depression, which can lead to substance abuse.  It is estimated that one-fifth of patients with social anxiety disorder also suffer from alcohol dependence

In addition, many who "self-medicate" an undiagnosed social anxiety disorder may not seek the professional help they need.  Because of this many people suffering from social anxiety disorder are only diagnosed after they seek treatment for their substance abuse or substance dependence problems.

Dual Diagnosis/Co-Occurring Disorder

Social anxiety disorder often occurs together with substance abuse and substance dependence disorders.  Often the substance use is the result of an attempt to "self-medicate" but just as often substance dependence is the primary disorder with social anxiety disorder being secondary.  In either case, both disorders must be treated simultaneously to achieve an effective outcome.

Depression Disorder

Depression is a major psychiatric disorder that affects millions of Americans and their families, friends, and colleagues.  The National Institute of Mental Health reports that 18.8 million adults, or about 9.5 percent of the U.S. adult population, suffer from some form of depressive disorder.

The linkage between depression and physical illnesses makes it, in the words of the World Health Organization, "the world's second-most disabling disease after heart disease."

Symptoms of depression

• Ongoing sad, anxious or empty feelings
• Feelings of hopelessness
• Feelings of guilt, worthlessness, or helplessness
• Feeling irritable or restless
• Loss of interest in activities or hobbies that were once enjoyable, including sex
• Feeling tired all the time
• Difficulty concentrating, remembering details, or difficulty making decisions
• Not able to go to sleep or stay asleep (insomnia); may wake in the middle of the night, or sleep all the time
• Overeating or loss of appetite
• Thoughts of suicide or making suicide attempts
• Ongoing aches and pains, headaches, cramps or digestive problems that do not go away.

What is Depression?

The American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) lists nine symptoms for major depression, five or more which must be present over the same two-week period, including one of the first two:

• Feeling depressed most of the day, nearly every day.
• Markedly diminished pleasure.

The other seven symptoms include:

• Significant weight gain or loss.
• Insomnia or hypersomnia.
• Psychomotor agitation or retardation.
• Fatigue or loss of energy.
• Feelings of worthlessness or inappropriate guilt.
• Diminished ability to think or concentrate.
• Recurrent thoughts of death, suicidal thinking, and suicide attempts.

How is depression treated?

Medications and counseling are the cornerstones of depression therapy.  Reacting to depression as soon as it is noticed is important. With prompt treatment, a depressed person can return to a happier lifestyle and more balanced outlook on life.  There are effective treatments for depression, including antidepressants and talk therapy.  Most people do best by using both.

How long will the depression last?

This depends on how soon you get help. Left untreated, depression can last for weeks, months or even years. The main risk in not getting treatment is suicide. Treatment can help depression lift in 6 to 8 weeks, or less.

Reasons to get help for Depression

• Early treatment helps keep depression from getting worse or lasting a long time.
• Thoughts of suicide are common in people with depression.
• The risk of suicide is higher if you don't get treatment for your depression.
• When depression is successfully treated, the thoughts of suicide will go away.
• Treatment can help you return to your "normal" self, enjoying life.
• Treatment can help prevent depression from coming back.

Other Types of Depression

Dysthymia Depression

Dysthymia is chronic mild to moderate chronic depression, as opposed to major depression. The DSM-IV mandates the same symptoms as for major depression, except for suicidality, but requires only three symptoms in all, so long as they have persisted over two years. Mild to moderate is a misnomer, as dysthymia can make a person’s life as miserable as major depression.

Melancholic Depression

Melancholic depression is major depression with an emphasis on lack of pleasure or lack of reactivity to pleasure. Other characteristics include (three or more): Depressed mood, depression at worst in the morning, early morning awakening, psychomotor agitation or retardation, significant weight loss, and inappropriate guilt.

Atypical Depression

Atypical depression is a misnomer, as more outpatients suffer from atypical depression than from other forms of depression. Atypical depression is major depression that differs from melancholic depression in that patients react positively to external events, plus (two or more): Significant weight gain (as opposed to weight loss), hypersomnia (as opposed to insomnia), leaden paralysis, and sensitivity to personal rejection.

Bipolar Depression

Bipolar depression is a feature of bipolar disorder, also known as manic depression, an illness characterized by mood swings from depression to mania. The diagnostic criteria for bipolar depression are the same as for major depression, but bipolar patients tend to have atypical features. Bipolar patients who rapid cycle can be up and down in a matter of minutes, and in mixed states depression and mania are present at once.

Psychotic Depression

Psychotic depression is a rare form of depression characterized by delusions or hallucinations, such as believing you are someone you are not and hearing voices.

Catatonic Depression

Catatonic depression is a rare form of major depression characterized by (at least two): Stupor, excessive motor activity, extreme negativism, peculiarities in voluntary movement, and repetition of other people's words or actions.

Seasonal Affective Disorder (SAD)

Seasonal affective disorder is major depression that appears in the fall or winter and goes away in spring, thought to be caused by lack of sunlight.

Postpartum Depression

Postpartum depression occurs within four weeks of a women giving childbirth. Most new mothers suffer from some form of the “baby blues.” Postpartum depression, by contrast, is major depression, thought to be triggered by changes in hormonal flows associated with childbirth.

Dual Diagnosis/Co-Occurring Disorder

Depression disorders often occurs together with substance abuse and substance dependence disorders.  Often the substance use is the result of an attempt to "self-medicate" but just as often substance dependence is the primary disorder with depression being secondary.  In either case, both disorders must be treated simultaneously to achieve an effective outcome.

Disclaimer: This assessment is not intended to diagnose or treat any medical or emotional condition. It is advised that you consult your physician with any concerns regarding this condition.

Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is defined "as a prolonged disturbance of personality characterized by depth and variability of moods."  The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; chaotic and unstable interpersonal relationships; unstable self-image, identity, and behavior; and a disturbance in the individual's sense of self.

In extreme cases, this disturbance in the sense of self can lead to periods of dissociation, or mental breakdown.

Borderline personality disorder can have a long-term negative impact on many aspects of a person's life.  This includes sometimes extreme difficulties in relationships at work, home, and in social situations. Self-harming is also a symptom, with attempted (or complete) suicide a possibility, especially without proper care and effective therapy.

The negative emotional states of BPD are grouped into four categories:

• Destructive or self-destructive feelings,
• Extreme feelings in general,
• Feelings of fragmentation or lack of identity, and
• Feelings of victimization.

Individuals suffering from BPD tend to view the world generally as dangerous and malevolent, and tend to view themselves as powerless, vulnerable, and unacceptable.

They can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness.  Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone.

Self-image can also change rapidly from extremely positive to extremely negative.  Impulsive behaviors are common, including alcohol or drug abuse, unsafe sex, gambling and recklessness in general.

Individuals with BPD engage in high levels of intimacy- or novelty-seeking, and yet are very alert to signs of rejection or not being valued.  They tend toward insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.

It is very important to locate professionals who are experienced and qualified in the treatment of borderline personality disorder.

Many professional studies recommend against the use of medication for treating BPD.  Antidepressants, antipsychotics and mood stabilizers such as lithium are often used to treat co-occurring symptoms such as depression.

Dialectical Behavior Therapy (DBT) has been show to be very effective in the treatment of borderline personality disorder.

Several types of psychotherapy for BPD have developed in recent years. Studies suggest that people with BPD can benefit on at least some outcome measures.  Supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals. Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD.

Dual Diagnosis/Co-Occurring Disorder

Borderline personality disorder often occurs together with substance abuse and substance dependence disorders.  Often the substance use is the result of an attempt to "self-medicate" but just as often substance dependence is the primary disorder with BDP being secondary.  In either case, both disorders must be treated simultaneously to achieve an effective outcome.