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Questions of
the Week
January
through March, 1998
January 5, 1998
Q A
teacher at my child's pre-school said that my son has
"pica." What she talking about, and is this serious?
A Pica is
the persistent ingestion (eating) of substances that have no nutritive
basis. A common form of pica is when a child eats clay. There are some
studies that indicate that some forms of pica arises from nutritional
deficiency. You do not mention the age of your child, but it is common
for children to chew on toys, blankets and a variety of items
especially when they are teething. The first step would be to check
with the teacher and determine what it is that she observes him eating
and the context in which this occurs. Then check with his pediatrician
to determine in diagnostic studies are needed if the eating behavior
is not age appropriate.
January 12, 1998
Q What is
meant by hysterical? Does this refer to someone who is out of control?
A The
current terminology for hysteria is histrionic personality disorder.
These individuals are shallow and attention seeking. They need to be
the center of attention, and they are often seductive with rapidly
shifting superficial emotional expression. They misassess their
relationships, are self-dramatizing and attempt to draw attention to
themselves by their physical appearance. There is additional
discussion of this personality disorder in the January, 1998 issue of
The Psychological letter.
January 19, 1998
Q My wife
says I am depressed, but I do not feel sad. I will admit that I am
irritable and perhaps a bit forgetful. Your thoughts?
A
Age and health factors impact memory. However, if you are sleeping
poorly, showing appetite change, have low energy, have difficulty
making decisions, decreased self-esteem and problems with decision
making, you should also consider seeking consultation to determine if
you are suffering from a mood disorder. Let me know what you learn as
a result of that consultation.
January 26, 1998
Q My
brother has a real social phobia. He is 31, sees himself as a "clutz",
as unattractive, and is preoccupied with being embarrassed. Won't
medication help him?
A In
social anxiety disorder the individual has pronounced anxiety to
specific or generalized social situations. The person recognizes the
fear as irrational. Often anxiolytic medications will lower the
anticipatory anxiety sufficiently that the person can re-learn how to
socially interact. However, the situation could also be explained by a
more pervasive avoidant personality disorder which is more likely to
respond to behavioral therapies rather than medication.
February 2, 1998
Q I have
the same problem as another girl in my class. I have the urge to pluck
my eyelashes and sometimes my eye brow. I cannot say it feels
"good," but I do feel better. Friends say that this is sick
and that I need to see a doctor. Do we have a common problem and what
do we do?
A You are
describing an impulse disorder called trichotillomania. This can be an
anxiety driven disorder, but it also can arise from a skin condition
which has not been diagnosed. Assuming that you have explored what a
dermatologist determines is the cause, you may wish to check with your
local psychological association for clinicians in your area who have
behavior therapies for this recurring impulse. Let me know what you
learn.
February 9, 1998
Q I am
human services director for a computer graphics company. We offer our
employees an insurance policy that allows for psychological
disability. We have concern regarding abuse of this policy, people
just taking time from work. Care to comment?
A Three
issues need to be addressed by the company:
1. Is the work-environment inordinately stressful and/or attracting
employees with problems?
2. Does the company truly accept psychological disorders as
potentially disabling.
3. Are the doctors treating these patients aware that psychological
diagnosis does not automatically imply psychological disability.
These considerations would be the cornerstone of determining the value
of these disability benefits.
February 16, 1998
Q I have fibromyalgia and am
in continual pain. My rheumatologist thinks I should see a
psychologist. My concern is that he thinks the pain is "all in my
head." Can you help me understand this?
A When in continual pain, a
patient may develop a pattern of inactivity, social isolation,
obsessive thinking about their plight, depressed mood, feelings of
helplessness and hopelessness as well as tendencies toward
self-medication. He may be also concerned that there are activities in
which you could, and/or formerly, engaged which would assist you in
coping with your pain. It would be appropriate to ask him what his
goals are in making the psychological referral.
February 23, 1998
Q This is a bit of a
departure, but I wondered if I could ask about UFOs and the Roswell
Incident, specifically do you believe that these are psychological
rather than actual occurrences?
A That is not inappropriate
but falls more in the discipline of social psychology rather than
clinical psychology. There are no data of which I am aware that people
reporting sightings suffer from psychological disorder. The question
that many ask remains unanswered: a. if the event occurred and is part
of a cover-up, why the conspiracy? b. if the event did not occur, the
why the interest. In reverse order: the interest likely stems from a
sense of mortality and aloneness in the world, one in which people
need to believe that something of scientific foundation exists beyond
this planet. It also adds a degree of intrigue to life. If the event
and a cover-up occurred, it may imply that governments see people as
fragile and unable to deal with such material since it takes control
away from our species and would indicate that humans are not the
supreme biological power or intellect. If you reflect upon both the
possibility that it is a "social wish" or a "social
fear", it may tell you a great deal about our concerns and our
hopes.
March 2, 1998
Q My wife left two months ago.
The marriage is over. I know I am depressed, but I am working and
doing well by the kids. I feel nervous and sleep poorly, and I have an
appointment to see a psychologist. I do have a concern that he will
see me as very ill when I am not. Input please.
A There is a diagnostic
category called adjustment disorder, these arise within three months
of a stressful event and, by definition, do not last for more than six
months beyond the termination of that stressor. Many people have an
acute response to a stressful event, conflict, or loss. When it
interferes with occupation, academic and/or social functioning, it is
considered an adjustment disorder. Such disorders can be characterized
by changes in mood, increase in anxiety, and/or disturbance in conduct
(violating the rights of others). Your psychologist will recognize the
causal relationship between the stressor and the onset of whatever
symptoms you are having. His initial assistance will be to help you
understand and resolve this recent event. It is only if your symptoms
persist after this stressor is resolved (for example, your symptoms
persist six months after your divorce [if that occurs] ), and the
problems with social and occupational functioning continue, he would
have to consider other contributory explanations for your problems.
Examples would be previously undiagnosed anxiety, mood or personality
disorder. But let me reiterate, the vast majority of these adjustment
disorders resolve within months of the onset of the stressor that
triggered them.
March 9, 1998
Q "Friends and family
refer to me as schizophrenic because I seem to have two personalities;
I am calm and reasonable at work and irritable and demanding at home.
Do I need treatment for schizophrenia?"
A It is likely that the
difference between demands at work and at home evoke from you two
different ways of dealing with your environment. Likely, the
irritability is not tolerated at work and/or you find something
frustrating and intolerable at home. All of this can be easily
addressed. You do not have two personalities, but you have two ways of
responding to two separate environments.
By contrast, schizophrenic disorders are characterized by such
symptoms as hallucinations (E.g. hearing thoughts as though they were
external voices), delusions (false beliefs), in coherent speech,
disorganized behavior and lack of ability to appropriate select
emotions. Relationships and occupational functioning is impaired.
Schizophrenia is often treated by a class of medications called
neuroleptics. Many schizophrenic individuals function in environments
with proper professional assistance and monitoring of their
medication. There is no cure for the disorder and currently, we manage
the patient's symptoms rather than "cure" them.
The use of schizophrenia to describe the behavior of others is not
uncommon, but the term is frequently used incorrectly to describe
simply a pattern of unpredictability that we see in those with whom we
associate. You might want to consult the suggest readings section of
CyberPsych for articles on the subtypes of schizophrenia.
March 16, 1998
Q I went to see a psychologist
and in the first visit, he asked me many questions about my physical
health history and physical symptoms. I went to see him because I felt
nervous and did not know why. I do not understand why he asked these
questions. Can you explain this to me?"
A There are many physical diseases and
conditions that mimic psychological problems. Disorders of endocrine
function not uncommonly present with changes in mood and anxiety.
Conversely, there are many psychological problems for which many
patient believe initially there is entirely a physical basis. Asking
you questions about your health history, health habits, diet,
exercise, sleep and physical problems within the family as well as
allergies and medication intolerance is important to determining if
psychological care is what is needed or should you be concurrently
seeing a family physician or internist. You did not mention whether
you asked the psychologist why these questions were important, but one
of the greatest concerns we have is that patients are uncomfortable
with some aspect of diagnosis or care and do not openly discuss those
concerns. If you have a return visit, it might be very helpful to you
to determine if the psychologist had specific concerns for the
possibility of a physical basis for your symptoms.
March 23, 1998
Q My uncle is diagnosed as
having a schizotypal personality. I have no idea what that means. He
is an unusual person, and it would be helpful if you would clarify
this for me."
A Schizotypal personality disorder is
characterized by a pervasive pattern of social and interpersonal
deficits. The person is uncomfortable and has minimal capacity for
close relationship. Such individuals may have eccentricities in
thought and behavior as well as perceptual distortions. They may have
exceptionally odd or superstitious beliefs, strange sensations and
concepts as to the functioning of their bodies, unusual patterns of
speech, be excessively suspicious and unable to adequately express
emotions. They have few friends and appreciable social anxiety arising
from their fears of others. This pattern is noted by early adulthood
and results in a very constricted and isolated lifetyle.
March 30, 1998
Q This question is more
academic than personal. I had not heard of the Schizotypal Personality
Disorder you outlined last week. I had heard of something called a
Schizoid Personality Disorder. Are these the same disorder?."
A Schizoid personality disorder
represents a pattern of detachment from relationship and a restricted
range of emotional expression beginning by adulthood. The individual
prefers solitary activities, has little sexual interest, lacks close
friends, does not seek to be part of a family, appears indifferent to
both praise and criticism and seems aloof, cold and remote with little
emotional variability. As you can see, this disorder is different in
many ways to the previously discussed Schizotypal personality
disorder.
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