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QUESTIONS OF
THE WEEK
May
through July, 1997
May 5, 1997
Q I entered
psychological treatment a year ago. I feel much better, and many of my
problems have been resolved, but I do not have a sense as to how long
treatment will last, and my doctor just schedules a return appointment
for me each week...have no health insurance coverage and (I) pay
personally for each visit.
A In the treatment
plan that was discussed with you when you first entered psychological
care, you were to be given a diagnosis and a treatment plan. Unless
there have been new problems arising or old problems that are not
resolving, your psychological care should be adhering to that
treatment plan. If this plan and its goals were not discussed with
you, then this needs to be addressed at this time.
Your care should be related to your
diagnosis. Many managed care companies, had you been covered by
insurance, would have required these data from your doctor and
authorized a fixed number of visits. Another issue may be that you
have these concerns, and perhaps doubts regarding your care, but you
are not directly requesting that your doctor clarify for you the
structure these issues.
May 12, 1997
Q If diet and exercise
are central to physical health, are there similar standards of mental
health maintenance?
A Arguably, both diet
and exercise are equally important to mental health, but in more
direct answer to your question, central aspects of mental health
involve introspection and resolution.
A psychologically healthy individual
must examine his/her own thoughts, feelings and behavior. The
individual must decide if the responses are appropriate and
proportionate to the situation. This self-examination is most
frequently referred to as introspection. When the individual
introspects, he/she decides why a specific event is occurring, his/her
role in its occurrence and what are the optional ways of responding to
the event. That response involves not only the physical response but
also how to "look at" what is occurring and what is the most
reasonable reaction to the event.
Resolution of the event is the
emotional acceptance of what has occurred or what is occurring and
likely to occur; to decide whether you can emotionally deal with the
situation and, if you cannot accept it at present, are you capable of
accepting it in the future.
Introspection regarding one's own
physical and emotional responses and resolution of the events which
make demands upon us are among the core issues of psychological
health.
May 19, 1997
Q What is the best way
for me to determine if I, or for that matter any member of my family,
is suffering from a psychological disorder.
A There are specific
diagnostic criteria for each mental disorder. The use of these
criteria enhances not only the appropriateness of care but also
requires specific clinical training. All fifty States require
licensure to practice, and licensure demands specific standards of
education, training and continuing education. Just as each of us may
suspect that our sore throat is indicative of "strep
throat", there are specific exam and lab studies to validate that
diagnosis. If our sore throat, for example, is simply a viral illness,
then antibiotic medication will not be effective.
Although it is theoretically possible
for each of us to diagnose our own physical and psychological
disorders, those determinations are best left to professionals we
consult who have the objective distance to be less biased in their
decision making. Few of us are truly objective when it comes to
members of our own family.
However, the concern for ourselves or
our family should begin when we note a change in the level of
functioning. This may include changes in energy, appetite,
concentration, memory, and social interaction. Symptoms such as weight
change, sleep alteration, mood fluctuations, anxiety, impatience,
irritability, and physical functioning/complaints can be significant
warning signs of both psychological and physical disorder.
Most individuals would begin their
investigation of cause of their problems with their family physician,
internist or pediatrician, we also must be responsible for
self-examination of probable psychological stressors which could be
giving rise to changes in our daily functioning.
May 26, 1997
Q I recently was involved in an
automobile accident. I was not paying attention and ran off the road
and struck several trees before the car stopped. I was pretty bruised
up, but the car was a total loss. Aside from the aches and complaints,
I felt okay but then a few days later started having trouble sleeping
and increasing fear when driving. Is this indication of a
psychological problem from that accident or is it pretty normal?
A Your response, as
you describe it, seems within normal limits. The things you must look
for are distress in excess of what would be expected such as refusing
to drive or ride in a vehicle, impairment in your social and work
interactions, a sense of detachment, feelings of detachment,
nightmares, intrusive thoughts and alarm when exposed to anything that
reminds you of your accident. Your symptoms, if they are mild, may
represent what is called an adjustment disorder. If the accident
itself was, to you, horrifying and/or you felt that your your life was
seriously threatened, you may be having symptoms of an acute stress
disorder. If re-experiencing the event, avoidance of similar settings
and symptoms of increased arousal lasted greater than one month, then
there would be concern for posttraumatic stress disorder. In most
cases, the symptoms after an accident begin to fade within short order
and are considered transient stressors. Often, how you will respond
and recover is based upon how you coped with other stressors in the
past.
June 2, 1997
Q We run a pretty open
office setting. No one locks their desk drawers or puts passwords on
their computers. But we have this one fellow who seems suspicious of
all of us, seems to get angry easily and never gets over it, and
rarely shares personal data with us. One of the supervisors calls him
"paranoid". What does this sound like, and is he truly
paranoid?
A When there is a
pattern of suspiciousness and distrust in which the motives of others
are seen as somehow evil, and the person feels he/she may be exploited
or deceived, that others are disloyal or will use information against
him or her, is unforgiving of insults, angrily attacks the character
of others and is preoccupied with fidelity of friends or spouse, there
is concern for what is called paranoid personality pattern. This
pattern develops by early adulthood. This must be differentiated from
the various types of what are called Delusional Disorder. The patient
suffering from delusional disorder differs from the patient with
"paranoid personality" in that the person with delusion
disorder harbors an organized, specific and precise belief system of
either persecution and/or inflated self-importance. The individual
will then organize behavior around that belief system.
June 9, 1997
Q I have a
sister-in-law who seems to act like two different people. Much of the
time she is warm, caring and supportive, but there are other times
when she is hostile, vindictive, and manipulative. It is like she has
more than one personality. I wondered if she could be suffering from
multiple personality disorder like those cases you hear about.
A The current
diagnostic label for the disorder that is shown in books and movies
and reported in legal cases is referred to as Dissociative Identity
Disorder. Such individuals exhibit two or more distinct personality
states or identities. Each of the personality states has its own
pattern of relating to others and referring to itself. Each
personality state recurrently assumes control over the individual's
actions. There are significant aspects of personal information that
the individual does not recall. More likely, your sister-in-law has a
personality style (and perhaps even a personality disorder) that has
developed as a means of coping with internal and external stressors.
When threatened, she behaves in one fashion as a means of dealing with
the situation. When unthreatened, she is less anxious, less defensive
and more able to respond in a manner that you, and perhaps others,
feel is appropriate. Her behavior actually sounds more within the
realm of most of human behavior: a interpersonal style that varies
with the comfort in specific situations. If she was largely unaware of
some of these periods, there would be more concern for the
comparatively less common Dissociative identity disorder.
June 16, 1997
Q My sorority sister
has been in a series of relationships. The guys she dates have been
cruel, and I am certain that at least two of them abused her. She
stays in these relationships even though she is mistreated. Is there a
disorder or condition that would account for this?
A There are those
individuals who feel helpless when being left alone, fearing that they
will not be able to care for themselves, and such individuals will
seek another relationship as soon as the one they are in reaches
closure. Such individuals may have difficulty making every day
decisions without seeking advice from others. They seek someone to
assume responsibility for major areas of their life, will volunteer to
do unpleasant tasks to insure that they receive support from others,
and often have fear of expressing disagreement due concerns over
disapproval. Such individuals display this as a pervasive submissive
and clinging behavior and are referred to as suffering from dependent
personality disorder.
June 23, 1997
Q My wife injured her
back at work. This was several months ago. She has been told that
surgery will not help her. She is supposed to learn to live with the
pain. One of the biggest problems is that she does not sleep even
though she appears exhausted and takes medication that makes her
drowsy. Is there any method that would enable her to sleep better?
A There are several
areas which need to be examined before it can be determined how best
for you to assist your wife. You need to determine if she is napping
during the day and, thereby, decreasing the night time need for sleep.
The concern would be whether she is spending too much time in bed.
Additionally, how much caffeine does she consume during the day and
especially in the evening? For example, many soft drinks, ice tea and
chocolate have significant caffeine levels so the concern would be for
more than just caffinated coffee. Her medications would also be a
concern. There are many pain relieving medications that agitate some
patients even though the medication makes them drowsy. Thus, these
patients either become drowsy and do not sleep or the nature of their
sleep, due to the medication, does not permit adequate rest. Another
concern is depression. Depressed patients often have a particular
style of sleep characterized by rapid onset of sleep followed by
frequent and prolonged awakenings. So, the first step would be to find
out if one or more of these factors are affecting her sleep and first
address them. After they are addressed, there are relaxation
procedures, medications and sleep management approaches that should
bring her substantial relief.
June 30, 1997
Q I neither smoke nor
drink and I exercise regularly. My wife, however, says I am a
"caffeine junkie" because I drink diet colas. She tells me
that I never seem to relax, seem restless to her, and that it is the
caffeine causes my problems with sleep, stomach and chest complaints.
I do not want to give up my diet drinks and am not certain I could. Is
there any information that supports her beliefs?
A Coffee and tea are
not the only sources of caffeine. Chocolate and some diet beverages
also contain caffeine. Some people show caffeine intoxication with 2-3
cups of coffee. Flushing of the face, rapid or irregular heart beat,
restlessness, sleeplessness, rapid and rambling speech, nervousness,
and muscle sensations are among the many symptoms of having consumed
excessive caffeine. There are disorders that can arise from caffeine
consumption including sleep and anxiety disorder as well as problems
discontinuing or even tapering the amount of caffeine consumed.
Perhaps the best rule of thumb is that you have a sensation of craving
when you do not have access to the beverages and that there are
sensations of increased agitation and irritability. Often you can
assess your intake as excessive merely by noting the number of such
beverages you seek per day and that you shun other beverages,
including water, in order to have access to the caffinated soft
drinks.
July 7, 1997
Q My girlfriend
exercises almost continually. She is concerned about the size of her
thighs and talks about that concern. Frankly, her thighs seem
"normal" to me; they look like anyone else's, and she is not
overweight. I reassure her that her concerns are excessive, but she
has cancelled dates, missed work, skipped classes and is always
shopping for new exercise equipment. I do not understand her concern
and do not know how to respond.
A You do not indicate
whether her problem is accompanied by an eating disorder such as
Anorexia or Bulimia Nervosa. But assuming that this preoccupation with
an imagined defect, which is slight if any, is interfering with her
social and occupational functioning, she may be suffering from what is
called a body dysmorphic disorder which is a form of somatoform
disorder. This is characterized by an imagined defect in appearance.
This may arise due to a distortion in her own capacity to objectively
assess her bodily configuration or an inordinate preoccupation with
her own social value. It can also arise as a result of perceived
inadequacies in other areas of life. The fact that the problems does
not respond (resolve) in response to reassurance and may be in excess
of objective reality suggests that she should be encouraged to discuss
this with someone who can assist her in better understanding this
concern. You have demonstrated your concern and your inability to
resolve her problem for her. Before it further degrades the
relationship, it may be time to discuss with her whether she considers
it of sufficient concern that she would seek psychological care to
deal with the issue.
July 14, 1997
Q Is there truly such
a thing as a "workaholic"? My husband is preoccupied with
work to the exclusion of family responsibilities. He relates
everything to work, organization, finances, and is not open to
discussing any of this. What is likely wrong with him?
A It is possible that
your husband suffers from obsessive-compulsive personality disorder.
This is a developmental defect in which there is a preoccupation with
control and orderliness. The person is often inflexible/stubborn and
may be more invested in work than family, friends or leisure. Such
individuals become detail orientated, and, for them, organization has
more importance that the larger picture of their lives. Such
individuals often cannot allow others to work effectively, concerned
that others cannot work as precisely or efficiently as they. This need
for control can be all consuming such that the very quality of life,
especially family life, is undermined. You did not mention whether he
considers himself to have a problem and, therefore, whether he would
consider consulting a psychologist regarding a change in this pattern
of behavior.
July 21, 1997
Q I was a welder and
have injured my neck at work. It took them a long time to find out
that I had a ruptured disc in my neck. I had two surgeries but I still
have pain in my low back and my neck. My surgeon says that all of this
pain is not caused by my injury. I did not have the pain before I was
injured. He says I have "chronic pain syndrome." Exactly
what is that and what do I do about it?
A He may be basing
some of his assessment upon the fact that you have low back (lumbar)
pain despite your having had a cervical (neck) injury. There is a
psychological pain disorder which arises as a result of a combination
of a physical problem, such as an injury, along with emotional factors
that appear to amplify that physical problem. In such situations,
psychological factors such as fear regarding your economic future,
depression over coping with continual pain, uncertainty regarding
what, if any, medical assistance is available to you, and even anger
regarding the ways in which others respond to your limitations. This
can be combined with guilt regarding your inability to meet family
demands, disappointment regarding your own expectancies from life,
confusion about the nature of the problem and remorse for your
irritability when in pain. You may wish to sort through such
psychological factors and determine if your pain is increased during
or following those times in which the emotional demands upon you
appear the greatest. There are psychologists who can assist you in
dealing with the psychological aftermath of a condition which has
resulted in chronic residual problems.
July 28, 1997
Q My wife has
absolutely no interest in sex. This began shortly after the birth of
our son. We have only been married for three years. I am quite
miserable and have told her that I think she has a problem. Don't you
think this is terribly unhealthy?
A There are four
factors that the two of you need to consider in deciding how to
identify this situation and determine if it constitutes a sexual
problem or disorder which warrants professional intervention:
- Is you wife saying that she has, in
general, an absent or greatly decreased desire for sexual activity
or sexual fantasies, or
- Is she saying that the problem is
associated with a global change in mood (E.g. depression)
following the birth of your son, or
- Is she attempting to communicate
something about your relationship which she feels she cannot
directly express, and/or
- Is she indirectly communicating her
assessment of just the sexual enjoyment derived from this
relationship?
You will have to determine if she is
able to share directly with you the factors that are influencing her
decreased sexual interest. Based upon those data, you can then decide
whether professional care is indicated.
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