|
Questions of
the Week
February-April,
1997
February 3, 1997
Q My doctor has placed
me on antidepressants, but I doubt that I am depressed. How do I know?
A Many depressed
individuals feel a loss of interest or pleasure, feeling a sense of
emptiness rather than a sense of sadness. Sometimes this is observed
by the individual's family. Accompanying this may be a change in
appetite with significant weight gain or weight loss, a decreased
ability for sleep or an increased amount of time sleeping accompanied
by fatigue and loss of energy. The individual may be agitated,
irritable, impatient and easily frustrated. Difficulty concentrating
and making decisions are seen in some individuals. There may be
accompanying feelings of guilt or worthlessness. And, for some who are
depressed, there may be recurrent thoughts of death. There are many
effective antidepressants and forms of psychotherapy which have proved
effective in managing clinical depression. Browse this website for
additional information on diagnosis and treatment.
February 10, 1997
Q What is considered a normal amount of
nervousness?
A Anxiety is a mild level of fear that
becomes attached to social, occupational and interpersonal
interactions. Anxiety itself is part of the human condition. Most
people feel some degree of anxiety, usually mild, about something,
much of the time. Common examples are concern for the health and well
being of the family, worry about career advancement, apprehension
regarding financial obligations and perhaps preoccupation with social
obligations. When this anxiety leads to constructive change in the way
we approach problem solving, it is considered normal and likely
helpful. When anxiety is disruptive, creates preoccupying thoughts and
interferes with daily functioning then seeking professional care is
indicated.
February 17, 1997
Q A coworker suggested
that my nausea is psychosomatic. Doesn't this mean he thinks
it's `all in my head'?
A Psychosomatic (or
psychophysiologic) is a term used to describe physical problems that
are believed to arise as a result of your emotional state. One of the
most common examples is tension headache in which the stress in your
life has created muscle tension which has expressed itself as muscle
spasm and pain. Psychosomatic does not mean that you are imagining
your problems. It means that understanding the physical complaints may
require that you look at current demands in your life and why they are
expressing themselves through physical symptoms. Quite often when you
identify and begin to resolve the sources of the stress, the
associated physical complaints will also resolve.
February 24, 1997
Q We have a woman at
work whom I believe is faking both psychological and physical
symptoms. I can't figure out why she would be doing this. Is someone
who fakes symptoms actually just as sick as someone with real
symptoms... perhaps just sick in a different way?
A There are several
reasons why someone would want to behave as though they had
psychological or physical problems. If they are doing this because
they will receive disability benefits or some other tangible
incentive, we refer to this as malingering. Malingering is falsifying
symptoms for purpose of obtaining a definable goal. But your co-worker
could be suffering from what is called a factitious disorder. She may
feel impelled to fabricate symptoms because she wants to receive the
attention and affection we typically provide to people who are ill.
Although malingering and factitious disorders initially sound quite
similar, as you can see the patient's goals in each of these two
deliberate attempts at fabrication of symptoms are quite different.
March 3, 1997
Q I hear people talk
about "personality disorder". What exactly does that mean
and how do you know if you have such a disorder?
A Personality Disorder
refers to a pattern of experience and behavior that differs from the
expectancies of your culture. It may manifest itself as problems in
the ways you interpret events around you, the way in which you express
your emotions, the means by which you interact with others or how you
handle your impulses. People with a personality disorder display their
maladaptive patterns in a range of social and interpersonal
interactions, and the pattern causes problems in social and
occupational functioning.
March 10, 1997
Q What is a
hypochondriac? Is that a technical term or just slang for someone who
acts like they are sick?
A Hypochondriasis is
grouped within what are called Somatoform Disorders;
conditions in which an individual is preoccupied, sometimes to the
point of disability, with their physical functioning. In the case of
hypochondriasis, the person has a preoccupation with fears of having,
or belief that he/she has, a serious disease. This belief continues
even when clinical evaluation fails to reveal the condition, and the
individual has been reassured. For the diagnosis of
hypochondriasis, the preoccupation must have lasted at least six
months. Those individuals with poor insight fail to recognize that
their fear is excessive, unreasonable and disproportionate, and their
social occupational functioning can be impaired by the belief.
March 24, 1997
Q I have had recurrent
problems with sleep, and I read something recently about "sleep
hygiene," but I am not certain that has anything to do with my
sleep problems.
A There are several
types of sleep disorders. The most common is referred to as
"primary insomnia" in which the person has difficulty
initiating or maintaining sleep and then cannot function well during
the day. There are also "primary hypersomnias" where the
excessive sleepiness expressed as sleeping excessive hours and/or
sleeping during the day interferes with daily activities. There is
also "narcolepsy" in which the individual has irresistible
onset of sleep occurring during the day. There are sleep disorders
created by "breathing-related" problems, sleep disorders
associated with sleep-wake cycle (circadian rhythm sleep disorder),
sleep disorders associated with nightmares, sleep terror, and sleep
walking. The term "sleep hygiene" refers to the structure
you set for sleep environment. Many individuals create a sleep
environment that complicates, or even creates, their sleep problems.
It is important to eliminate physical causes of sleep disruption, and
there are several health problems that will disrupt sleep. It is
important to determine whether you have a "primary" sleep
problem or a sleep problem that comes from underlying health problems.
March 31, 1997
Q My husband says that
men are less likely to be depressed than are women, but I believe that
men just do not admit that they are depressed. Is there a difference
between the sexes in the frequency of depression or just the
willingness to admit to it?
A The commonly sited
statistics indicate that there is a 2:1 female-male ratio with regard
to depression in industrialized nations. In underdeveloped nations,
there appears to be no difference between the sexes with regard to the
incidence of depression. This suggests that a nation's cultural
differences has impact upon occurrence of depression. Major Depressive
Disorder, only one form of depression, is often sited as having an
incidence of 2% for men and 5-9% for women. There have been some
recent studies that suggest that men between the ages of 20 and 30 may
have a higher incidence of depression. In summary, the ratio of women
to men for depression is approximately 2:1 for developed nations. For
Major Depressive Disorder, the ratio may be as high as 3:1 or 4:1. For
Bipolar Disorder ("manic depressive disease"), there does
not appear to be a sexual difference. You are accurate, however, that
women are more to acknowledge symptoms of depression than are men.
Q I am a surgeon
treating chiefly work-related back injuries. I have recent articles
about psychological preparedness for surgery among those who are
injured at work. What factors do you feel are important to examine
before taking an injured worker into spinal surgery?
A Many patients with
back injury have no previous exposure to surgery, or their concept of
surgery is for outpatient procedures. The concept of extended
rehabilitative periods is unfamiliar to them. Additionally, if they
had past surgeries, most have experienced resolution of their symptoms
following surgery or shortly thereafter. Many confronting back surgery
do not anticipate post-surgical pain, nor have they confronted the
concept that pain management is something they must learn to develop.
The injured worker may have unrealistic expectations about the outcome
of back surgery, feeling that there will be absolutely no residual
limitations and that all of their pre-surgical pain will be resolved.
Their employer is choosing a surgeon from a panel, and the patient may
feel a lack of control over the selection process. And although there
are numerous other psychological factors to consider, one of the chief
concerns is how this patient felt about the context in which he/she
was injured and about returning to work in the setting in which the
injury occurred.
April 14, 1997
Q We find it difficult
to relate to my sister. She takes advantage of friends and family,
never seems to care or understand that our needs might be different
from hers, and most people find her to be arrogant. Does her behavior
suggest any specific psychological disorder?
A There is a specific personality
disorder called Narcissistic Personality Disorder which is
characterized by a pervasive pattern of self-involvement, need for
admiration, lack of concern for others and a inflated sense of
self-importance. Such individuals overestimate their accomplishments
and are offended when they are not praised for their efforts. In turn,
they underestimate the accomplishments of others. They feel that their
rewards are long overdue. They see themselves as special and/or unique
and seek to identify themselves with famous individuals. They feel
that they are understood only by unique or gifted people who are, in
some way, special. They feel that ordinary people are not competent to
understand them. Yet their self-image is fragile, and they are
continually concerned with how they measure when compared to others.
They have a great sense of entitlement. They expect to be indulged and
may be enraged when this does not occur. Because of this sense of
entitlement, they are not made uncomfortable by exploiting others to
insure their needs are met, and they appear to care little for the
distress of others even when they are the cause of this distress. The
are preoccupied with envy, yet often misperceive that others are
envious of them. They not only devalue others but are patronizing or
disdainful of them. Some degree of narcissism is healthy and adaptive
in everyone since it can be utilized for emotional survival, but when
it characterizes relationships and disrupts the closeness and comfort
of others, it may well be narcissistic personality disorder.
April 21, 1997
Q I have been having
sexual difficulties, certain problems with performance, and I wondered
about the variety and causes of sexual problems.
A The more common
sexual disorders include: Hypoactive Sexual Desire Disorder, Sexual
Aversion Disorder, Female Sexual Arousal Disorder, Male Erectile
Disorder, Female Orgasmic Disorder, Male Orgasmic Disorder, Premature
Ejaculation, Dyspareunia and Vaginismus. An unwillingness to discuss
sexual dysfunction is almost universal, with each individual fearing
that they are unique in their problem. Men are likely to acknowledge a
problem indirectly, identifying their relationship as unsatisfactory
rather than revealing the more frightening issue, for example, of
erectile failure. The marital conflicts which subsequently arise due
the combination of sexual dysfunction and marital tension further
complicate resolution of other relationship problems. Disorders of
sexual functioning can occur at any of the four stages of the sexual
response cycle (desire, excitement, orgasm, and resolution). Sexual
dysfunction can be caused by metabolic and endocrinologic problems as
well as substance use/abuse. While sexual dysfunction may result in
anxiety and can be rooted in anxiety, it is important to explore both
the possible biological and physical factors concurrently since it is
the duration of the problem which appears to cause the most distress
for the patient.
April 28, 1997
Q I think that I have
some significant emotional problems that are impacting my work, my
family and my social life. I want to make an appointment with a
psychologist, but I have some anxiety about what will occur in that
examination. What should I expect?
A Your first
appointment will likely be a lengthy one. Aside from being asked
questions regarding your family, developmental, education, past
medical and occupational history, you will be given a mental status
exam which is a series of questions regarding your current emotional
functioning. If the exam is thorough, you will then be given a battery
of standardized diagnostic instruments which will tell the examining
doctor about your current emotional functioning, thought process and
symptoms. On your second visit, the results of that examination will
be shared with you as well as a proposed treatment plan, length of
time of anticipated treatment and the costs involved in availing
yourself of care. Questions
Arranged by Year of Posting
|
