Anxiety has been referred to as ‘inner battle’ by Sigmund Freud. In a lay man’s language it is a general feeling of apprehension about possible danger. The adaptive value of anxiety may derive from the face that it helps one to plan for & prepare for possible threat, & in mild to moderate degrees, anxiety actually enhances learning & performance. Although anxiety is often adaptive in mild or moderated degrees, it is maladaptive when it becomes chronic (old) and severe and may lead to anxiety disorders. Anxiety disorders are generally characterized by unrealistic, irrational fear or anxiety of disabling intensity at its core & also its principal & most obvious manifestation. Anxiety might not always be obvious to the person involved or to others, if psychological defense mechanisms are able to deflect or mask it. So anxiety can exist in either of the forms called Covert Anxiety (hidden) or Overt Anxiety (evident).
- Phobia (specific or social) / Phobic Disorder.
- Panic Disorder (with or without agoraphobia).
- Generalized Anxiety Disorder (GAD)
- Obsessive Compulsive Disorder (OCD)
- Post Traumatic Stress Disorder (PTSD)
A phobia is a persistent & disproportionate fear of some specific object or sitration that present little or no actual danger to a person. In such a case, the person experiences fight or flight response. Thus physiological response & behaviorally the phobic response is identical to that which would occur in an encounter with an objectively terrifying situation such as being chased by a grizzly bear. A person suffering from phobia is likely to go to great lengths to avoid encounters with their phobic stimulus, or even seemingly innocent reminders of it such as pictures.
Types of Phobia
Specific Phobia also known as Simple Phobia may involve fears of other species such as snakes or spiders or fears of various aspects of environment such as water of heights. In other words, if a person shows “marked” & persistent fear that is excessive or unreasonable, accompanied by the presence or anticipation of a specific object or situation & when exposure to the phobic stimulus almost invariably provoke an immediate anxiety response that resembles panic attack except for the existence of a clear external trigger.
List of some common phobias & their relative objects
Acrophobia - Heights
Algophobia - Pain
Astraphobia - Thunderstorms, lightning
Claustrophobia - Enclosed places
Hydrophobia - Water
Monophobia - Being alone
Mysophobia - Contamination or germs
Nyctophobia - Darkness
Ochlophobia - Crowds
Pathophobia - Disease
Pyrophobia - Fire
Zoophobia - Animals or some particular animal
Specific phobias are quite common especially in women. Life time prevalence rate has been established by studies as 14% for women & 8% for men. The average age for the onset for specific types of simple phobia varies widely.
Animal phobia usually begins in childhood as do blood-injury phobias & dental phobias. However other phobias such as claustrophobia & agoraphobia tend to begin in adolescence & early adulthood.
Social phobia has been identified as fear of negative evaluation by others and has been further categorized as -
Specific Social Phobia is characterized by having a disabling fear of one or more discrete social situation in which an individual fears of being exposed to the scrutiny of others and may act in embarrassing or humiliating manner e.g. public speaking, urinating in public toilets, eating, reading or writing in public.
Generalized Social Phobia is about having significant fears of most social situations. This may often be accompanied by Avoidant Personality Disorder (). A distinctive feature of this type of phobia is that the individual when performing same tasks alone shows no impairment or difficulty or anxiety.
Social phobias typically begin during adolescence or early adulthood about equally often in women and men. The probability of an individual suffering with social phobia suffering from one or more Generalized Anxiety Disorder or Depressive Disorder, Substance Abuse, alcohol abuse may be high e.g. drinking before going to a party.
Panic disorder is characterized by the occurrence of “unexpected” panic attacks that often seem to come “out of the blue”. In order to be diagnosed with panic disorder, the person must have experienced recurrent unexpected attacks and must have been persistently concerned about having another attack for at least a month. The symptoms for panic attack may range from feelings of losing control, going crazy, shortness of breath, heart palpitations, sweating, dizziness, depersonalization or derealization, fear of dying etc… These symptoms may develop abruptly and usually reach the peak within 10 minutes; the attack usually subsides within 20-30 minutes and rarely lasts for up to an hour. When fight or flight response is activated by a phobic object, it is referred to as learned alarm but since it is triggered when there is no obvious trigger, as in case of panic attacks, so it’s called learned false alarm which continues to trigger panic attacks.
Panic Disorder may or may not be accompanied by Agoraphobia. (Agoraphobia involves fear of being in places or situations from which escape would be physically difficult or psychologically embarrassing or in which immediate help would be unavailable in the event that something bad happened such as getting sick or having a panic attack). In moderate cases the person may even be uncomfortable venturing outside the home alone, doing this in itself causes severe anxiety whereas in very severe cases, the person cannot go beyond the narrow confines of home or even particular parts of home. Agoraphobia is generally accompanied by Panic Attacks and it is rarely the case that person suffering from it does not experience panic attacks.
Panic Disorder with and without agoraphobia affects is many people. Some of the studies indicate that approximately 1.5% of adult population had pure panic attack at some point of their life, with approximately 5% qualifying for diagnosis for agoraphobia. The life time prevalence rate for panic disorder has been estimated to be nearly 4% by yet another study.
Age for the onset of panic disorder with or without agoraphobia is typically 20s, although it is quite common for these disorders to begin in late adolescence or not until 30s. Studies report that panic disorder without agoraphobia is as common in men as in women which is not true of agoraphobia, which occurs much more frequently in women than in men.
GENERALIZED ANXIETY DISORDER (GAD)
Generalized Anxiety Disorder is characterized by chronic excessive worry about a number of events and activities. This state was most commonly described as free-floating anxiety because it was not anchored to a specific object or a situation as with specific or social phobias. Unlike other anxiety disorders, in this state the person do not have any very effective anxiety avoidance mechanism. The symptoms for GAD may range from restlessness, feels of being keyed up or on an edge, sense of being easily fatigued, difficulty concentrating, mind going blank, irritability, muscle tension, sleep disturbance. So the general picture of a person suffering from GAD is that they live in constant state of tension, worry, diffuse uneasiness.
Barlow refers to the fundamental process as one of Anxious Apprehension, which is defined as a future oriented mood state in which a person attempts to be constantly be ready to deal with upcoming negative events. This mood state is characterized by high levels of negative affect, chronic over arousal, and a sense of uncontrollability. In addition to their excessive levels of worrying and anxious apprehension people with generalized anxiety disorder often have difficulty concentrate and making decisions, dreading to make mistakes. They may engae in subtle avoidance activities such as procrastination or checking but these are not very helpful in reducing anxiety. They also tend to show a marked vigilance for possible signs of threat in their environment. Their high level of tension is often reflected in strained postural movements and overreaction to sudden or unexpected stimuli. They may also complain of muscle tension, especially neck and upper shoulders, sleep disturbance including insomnia and nightmares. No matter how well things seem to be going, people with GAD are apprehensive and anxious. Their nearly constant worries leave them continually upset, uneasy and discouraged. A study indicated that their most common spheres of worry were found to be family, finances, work and personal illness. Even after going to bed people suffering from GAD are not likely to feel the relief. Often they review each mistake, real or imagined, recent or remotely past. When they are not reviewing or regretting the events of past, they are anticipating all the difficulties that may arise in future. They have no appreciation for logic most of people in general have in concluding that it is no point to torment ourselves to about possible outcomes over which we have no control on. Although it may seem at times that they are looking for things to worry about, it is their feeling that they cannot control their tendency to worry.
GAD is relatively common, with current estimates that it is experienced by approximately 4% of the population in any one year period. However, perhaps because most people with GAD do manage to function in spite of their high levels of worry and anxiety, they are less likely to come to clinics for treatment than are people with panic disorders or major depression, which are frequently more debilitating conditions. GAD is somewhat more common in women than in men. Age of onset is often difficult to determine, with large portion of patients reporting that they remember having been anxious nearly all their lives, many others report slow and insidious onset.
OBSESSIVE COMPULSIVE DISORDER (OCD)
OCD is defined by the occurance of unwanted and intrusive obsessive thoughts or distressing images; these are usually accompanied by compulsive behaviors designed to neutralize the obsessive thoughts or images or to prevent some dreaded event or situation. Obsessions involve “recurrent persistent thoughts, impulses or images that are experienced at some time during the disturbance, as intrusive and inappropriate. The person tries to suppress or ignore such thoughts, impulses or images or to neutralize them with some other thought or action. Compulsions involve “repetitive behaviors” (e.g. handwashing ordering, checking or mental acts such as praying, counting, repeating words silently) that the person feels driven top perform in response to an obsession or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.. In most cases people do have some realization that their behavior is irrational bu they cannot seem to control it.
One year prevalence rate of OCD in a study was found 1.6% and the average life time prevalence was 2.5%. Although disorder generally begins in late adolescence or early adulthood, it is uncommon in children, where its symptoms are strikingly similar to those of adult cases. In most cases the disorder has a gradual onset, but once it becomes a serious condition it tends to be chronic, although the severity of symptoms usually waxes and wanes in intensity over time. Earlier it was believed that women are more likely to get affected with OCD but newer figures show no significant gender difference.
POST TRAUMATIC STRESS DISORDER (PTSD)
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that some people get after seeing or living through a dangerous event. It can be looked upon as a natural emotional reaction to a deeply shocking and disturbing experience. In other words, it is a normal reaction to an abnormal situation. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.
When faced with a danger, it’s natural to feel scared. At this moment, the body is prepared for fight-or-flight response as an outcome of physiological changes that it undergoes. “Fight-or-Flight” response is a healthy reaction which is meant to protect a human being from potential danger but in a person suffering from PTSD, this reaction is either changed or damaged. This reaction gets triggered even when the person is not under threat and the body starts preparing itself for either fight or to flee from the situation. The symptoms may range from frequently having upsetting thoughts or memories about the traumatic event, recurrent nightmares, acting or feeling as if the traumatic event was happening again “flashback”, having strong feelings of distress when reminded of the traumatic event, being physically responsive such as experiencing surge in heart rate, sweating, making efforts to avoid talking about the traumatic event, making efforts to avoid places and people related to the traumatic event, loss of interest in activities which were once considered positive, feeling distant from others, difficulty experiencing positive feelings such as happiness and love, difficulty sleeping or staying asleep, irritable, anger outbursts, difficulty concentrating, feeling constantly on guard, being jumpy or easily startled.
PTSD commonly is associated with battle–scarred soldiers or military combat affecting men but unlike this notion PTSD can be experienced by anyone who has had overwhelming life experience especially if the event feels unpredictable and uncontrollable. PTSD develops differently from person to person and the symptoms may develop in the hours or days (commonly) following the traumatic event, though it can sometimes take weeks, months, or even years before they surface.
Most common events which may lead to PTSD- War natural Disaster, Car or plane crash, terrorist attack, sudden death of a loved one, Rape, Kidnapping, Assault, Sexual or physical abuse, Childhood neglect
Though above mentioned events would be perceived as traumatic by most people but there could be other events that may be powerful enough for some individuals to develop PTSD as an outcome. In other words any shattering event that effects a person making them feel stuck, helpless and hopeless may lead to PTSD (e.g. bullying, domestic violence etc…)
There are also differences between men and women in the presentation of PTSD. Women are more likely to have symptoms of numbing and avoidance and men are more likely to have the associated features of irritability and impulsiveness. Men are more likely to have comorbid substance use disorders and women are more likely to have comorbid mood and anxiety disorders, although many disorders comorbid with PTSD are commonly seen in both men and women.
Somatoform Disorder is the presence of physical symptoms that suggest a general medical condition. The symptoms cause clinically significant distress or impairment in social occupational or other areas of functioning. Somatoform disorder is essentially different from fictitious disorders and malingering. (Factitious disorder leads a person to acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms e.g. consuming hallucinogens, infecting the urine samples etc… Malingering refers to fabrication or exaggeration of the symptoms of mental or physical disorders for a variety of secondary gains which may include avoiding school, work or military service, getting lighter criminal sentences or to attract attention and gain sympathy etc…) Unlike in anxiety disorders, anxiety is not necessarily observable in somatoform disorders. In this condition, the individual complains of bodily symptoms that suggest a physical defect or dysfunction for which no physiological basis can be found. In other words, in somatoform disorders, the psychological disorders take physical form. The physical symptoms of somatoform disorders are not under voluntary control and are thought to be linked to psychological factors, presumably anxiety.
Types of Somatoform Disorders
- Conversion Disorder
- Somatization Disorder
- Pain Disorder
- Body Dysmorphic Disorder
CONVERSION DISORDER (HYSTERIA)
Refers to sensory or motor symptoms such as a sudden loss of vision or paralysis, suggests an illness related to neurological damage of some sort though the bodily organs and nervous system are found to be fine. The individual may experience partial or complete paralysis of arms or legs, seizures and coordination disturbances, a sensation of pricking, tingling, or creeping on the skin, insensitivity to pain or loss or impairment of sensations, serious visual impairment, tunnel vision or complete blindness, loss of voice, loss or impairment of sense of smell. Although medically the individual suffering from somatoform disorder may be normal but experiences gross impairment due to the symptoms. The symptoms (episode) may end abruptly but sooner or later is likely to return in its original form or with a symptom of a different nature. Hysteria, the term originally used to described what are now known as conversion disorders. Conversion symptoms usually develop in adolescence or early adulthood. More women than men are diagnosed with conversion disorder.
SOMATIZATION DISORDER (BRIQUET’S SYNDROME)
Recurrent, multiple somatic complaints for which medical attention is sought but that have no apparent physical cause is the basis for this disorder. Somatization disorder and conversion disorder share many of the same symptoms. It can also be the case the an individual is diagnosed with both the disorders. The symptoms may range from pain in different body parts, gastrointestinal problems other than for diarrhea and vomiting, fainting, blindness or any other form of sensory impairment, menstrual difficulties and sexual indifferences or erectile dysfunction (ED). It is thought to occur in 0.2% to 2% of females and 0.2% of males. Somatization disorder typically begins in early adulthood and last for years. It also seems to run in families; it is found to be about 20% of first degree relatives of individuals diagnosed as having Somatization disorder.
A pain disorder is more easily defined as a disorder associated to pain due to another outside cause. Pain disorders are much harder to classify compared to other disorders. In pain disorder the person experiences pain that causes significant distress and impairment; psychological factors are viewed as playing an important role in the onset, maintenance and severity of the pain. The person may be unable to work and may become dependent on painkillers and / or tranquilizers. A lifetime prevalence rate of pain disorder 12.3%. Females are twice more prone to suffer from pain disorder than men.
BODY DYSMORPHIC DISORDER
A person suffering from body Dysmorphic disorder is essentially pre occupied with an imagined or exaggerated defect in physical appearance. For e.g. facial wrinkles, excessive facial hair or the shape or size of nose etc. These concerns could lead to severe distress and further lead to frequent visits to specialist (plastic surgeons, cosmetic surgeons). The symptoms may range from spending hours each day checking on their defect, looking at themselves in mirrors to taking steps to completely avoid the defect by eliminating mirrors from their homes. The disorder is linked to significantly diminished quality of life and can be co-morbid with major depressive disorder and social phobia, also known as chronic social anxiety. With a completed-suicide rate more than double that of major depression (three to four times that of manic depression) and a suicidal ideation rate of around 80%, extreme cases of BDD linked with dissociation can be considered a risk factor for suicide; however, many cases of BDD are treated with medication and counseling.
Individuals suffering from Hypochondriasis are preoccupied with fears of having serious diseases or illness, which persist despite medical reassurance to the contrary. These individuals are likely to over react to ordinary physical sensations and minor abnormalities e.g. irregular heartbeat, sweating. A source spot stomach ache, head ache etc. these minor symptoms serve as evidence for their beliefs about fall prey to certain major forms of illness. Individuals are likely to focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. The duration of these symptoms and preoccupation is normally found to be 6 months or longer. Studies have shown that Hypochondriasis affects about 3% of the visitors to primary care settings.
Psychosomatic condition refers to a state which involves both the mind and the body. A psychosomatic illness originates with emotional stress or damaging thought patterns, and progresses with physical symptoms, usually when a person's immune system is compromised due to stress. A common misconception is that a psychosomatic condition is imaginary, or "all in someone's mind". Actually, the physical symptoms of psychosomatic conditions are real, and should be treated quickly, as with any other illness.
Types of psychosomatic
Psychogenic disease can be explained as the physical diseases caused by emotional stress. The mind changes the body’s physiology so that the body parts break down. In other words it is a set of symptoms which arises due to complex interactions between frontal lobe of the brain and the system in which the symptoms or complaints manifest. Psychogenic illness shows the powerful effect of stress and its effect on body. Think of how "stage fright" can cause nausea, shortness of breath, headache, dizziness, a racing heart, a stomachache or even diarrhea. Your body can have a similar strong reaction to the stressful situations involved in mass psychogenic illness. A variety of evidences implicate the role of frontal lobe of the brain where most complex processes such as cognition, personality, mood, and memory are carried out, as a mediator if not the source of the psychogenic complaints. Conditions such as ulcers and asthma are an example of psychogenic conditions.
Somatogenic diseases in contrast with psychogenic disease refer to the conditions that originate in the body under the influence of external forces. In other words, physical diseases caused by the mind increases the body’s susceptibility to either have disease causing organisms (germs) or natural degenerative processes. Cold and other similar infections, cancer, rheumatoid arthritis belong to this category of ailments.
Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When an individual has depression, these feelings starts interfering with daily life and causes pain for both the individual and those who care for him/ her. Depression is a common but is a serious illness. In other words, clinical depression is a mood disorder in which the symptoms may range from feeling sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless. A person suffering from depression may lose interest in activities that once were pleasurable including sex, may have sudden outbursts of anger, experience loss of appetite or overeating, or problems such as concentrating, remembering details or making decisions are also common. Depressed people may additionally contemplate or attempt suicide. A few other symptoms such as insomnia, excessive sleeping, fatigue, loss of energy, aches & pains or digestive problems that are resistant to treatment may also be present in a person suffering from depression. These symptoms grossly interfere with everyday life of the person for a longer period of time. Though symptoms in children with depression can be a different range of symptoms altogether. It may be helpful to see signs or patterns changing in the sleep, general behaviors or school work.
Types of Depression
- Adolescent depression
- Bipolar disorder
- Depression in the elderly
- Major depression
Adolescence Depression affects teenagers characterized by sadness, discouragement, loss of Self worth, interest in their usual activities. The most common reasons for development of this state in teenagers include normal process of maturing and its related stress, influence of sex hormones, death of a friend or close relative, conflict between parents and child on issues such as independence and privacy, relationship break up, failure in academia. In severe cases the causes may include bullying, harassment, physical and/ or sexual abuse, disabilities etc… Suicide/ suicidal activities may be a risk for all the teenagers. Adolescents who have low self esteem, are too critical of themselves, feel less/ no control on negative events in life are more likely develop depression. Additionally, girls are twice as likely to develop depression as compared with boys.
disorder or Manic Depressive Disorder is a mood
disorder characterized by the presence of one or more episodes
of abnormally elevated energy levels,
mood with or without one or more depressive episodes.
Individuals who experience manic episodes also commonly
depressive episodes, or a
mixed state in which features of both mania and depression
are present at the same time.
Bipolar disorder can be categorized in three main categories:
Type I Individuals with type I bipolar disorder has had at least one manic episode and periods of major depression. Earlier bipolar disorder type I was referred to as manic depression.
Type II Individuals with type II bipolar disorder have never had full mania but they experience periods of high energy levels and impulsiveness as extreme or intense as mania, also known as hypomania. In bipolar disorder type II periods of hypomania alternate with episodes of depression.
Cyclothymia is a less intense or milder form of depression called cyclothymia. It involves less severe mood swings and individuals suffering with this form alternate between hypomania and mild depression.
Symptoms during the manic state, which may last from several days to months may range from being easily distracted, little or no need for sleep, poor judgment, poor temper control, lack of self control or reckless behavior, sex with many partners, binge eating or drinking, excessive activity, spending spree, elated mood, increased energy, racing thoughts, talking a lot, very high self esteem, over involvement in activities, agitated, irritated. Whereas during the depressed state, the symptoms may include daily low mood and sadness, difficulty concentrating, remembering or decision making, problem with eating (loss of or increase in appetite) resulting in change of body weight, fatigue, lack of energy, feeling worthless, hopeless, guilty, apathy, low self esteem, suicidal ideation/ thoughts, too less or too much sleep, socially withdrawn etc… The condition can deteriorate in case of substance abuse or alcohol dependence and risk of suicide increases manifold.
Though there has been no clear cut evidence for the cause of Bipolar Disorder but it has been seen that a few conditions are more likely to trigger this condition than others such as change in life due to child birth, sleeplessness, recreational drug use, certain kind of medications can also contribute to the development of this condition.
Depression in Elderly is a wide spread problem but is seldom recognized and reported. It is characterized by persistent feelings of sadness, discouragement, hopelessness, demotivation, lack of self worth. This can either be a sign of illness or it can be a psychological reaction to illness or directly caused by illness. Physical illnesses such as hypothyroidism, heart disease, stroke, Parkinson’s disease, cancer etc may increase the risk of developing depression in elders. Depression may also occur as symptoms of Alzheimer’s disease or side effect of certain prescribed drugs. The risk of depression may also be elevated due to incidents such as loneliness, feelings of isolation, chronic pain, multiple illnesses, memory issues, unable to think clearly, loss of independence etc… Symptoms of depression in elderly range from feeling confused, forgetful, reduced appetite, lack of personal hygiene (not bathing/ shaving/ cleaning) and grooming, unorganized or scattered home, irregularity with medicine, isolating and withdrawn from others.
Dysthymia is another form of mood disorder consisting of chronic depression which is less intense and severe than major depressive disorder. People with dysthymia have a higher chance of developing major depressive disorder. Double Depression refers to an intense episode of depression occurring in presence of dysthymia.
Due to less severe nature of symptoms, the sufferer may continue to bear the symptoms before it is diagnosed. In fact, due to chronic nature of the condition, the sufferer may believe that depression is a part of their character and so they may not even consider discussing the symptoms with family or friends. Symptoms of dysthymia may be shared in a major depressive disorder also but these symptoms tend to be less intense and can fluctuate in intensity. A person with dysthymia may feel hopeless; suffer from insomnia or hypersomnia, poor concentration, difficulty making decisions, poor appetite or overeating, low energy or fatigue, low self esteem, low sex drive and irritability. The cause of this condition remains unknown. Though it has been found that dysthymia runs in families. Some of the factors that may contribute towards development of this ailment in elderly include lowered ability or complete inability to care for themselves, isolation, mental decline and medical illness.
Major Depression previously known as major depressive disorder (MDD) is a major mental disorder characterized by low mood, sad, blue, unhappy, miserable or down in the dump, low self esteem, loss of interest, apathy etc… It is a disabling condition which adversely affects a person’s personal life, work or academic life, sleeping and eating habits with general health.
Depression can grossly change or distort the way you see yourself, your life and others around you. A person affected by depression is more likely to see things with a more negative attitude, unable to believe and think that any problem or situation can be solved in a positive way. The symptoms of depression can include agitation, restlessness, irritability, change in appetite, change in weight (gain or loss), very difficult to concentrate, lack of energy, fatigue, feelings of hopelessness, helplessness, feelings of worthlessness, self-hate, guilt, becoming withdrawn and isolated, loss of interest, inability to feel pleasure, inability to enjoy things that were once enjoyable, trouble with sleeping (less or too much), thoughts of death or suicide. In severe cases, depressed people may have symptoms of psychosis (abnormal condition of mind involving loss of touch with reality). These symptoms may include delusions (false belief with absolute conviction) or hallucinations (perception in absence of stimulus or perceptions in awake and conscious state in the absence of external stimulus having elements of real perceptions) which are usually unpleasant.
Exact cause of depression has not yet been established though researchers do believe that the reasons may include affected levels of neurotransmitters serotonin, norepinephirine and dopamine; which can be due to genetic reasons or triggered by certain stressful events or may be a combination of both. Most antidepressant medicines increase the levels of one or more of the three monoamines – the neurotransmitters serotonin, norepinephirine and dopamine in the synaptic cleft between neurons in the brain. Other factors which may have a role to play in depression are alcohol or drug abuse, certain medical conditions such as hypothyroidism, cancer, chronic pain, certain drugs such as steroids, sleep problems, stressful life events such as relationship breakup, death or illness of someone closely related, divorce, childhood abuse, neglect, job loss and social isolation.
Life time prevalence for depression in general population is 10% - 25% for women and from 5% - 12% for men. Population studies indicate that depression is twice as common in women as in men. Though MDD may begin at any age but the average age at onset is in the mid-20s. Some individuals have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. After the first episode of this disorder, there is a 60% chance of having a second episode. After the second episode, there is a 70% chance of having a third, and after the third episode, there is a 90% chance of having a fourth. Some form of depression run in families; first-degree biological relatives of individuals with Major this disorder are 1.5-3 times more likely to develop Major Depressive Disorder.
Some other common forms of depression also include :
Postpartum Depression refers to depression that affects more women than men after childbirth. It can occur anytime in the first year postpartum. The symptoms may include sadness, hopelessness, low self esteem, guilt, feeling overwhelmed, sleep and eating disturbance, inability to be comforted, exhaustion, emptiness, inability to experience pleasure that were once enjoyable, social withdrawal, low or no energy, easily become frustrated, feeling inadequate in taking care of the baby, impaired speech and writing, anger spells towards others, increased anxiety and panic attacks, low sex drive. A recent research study conducted using Edinburgh Postnatal Depression Scale indicated that women who developed depression were significantly more likely to be single, to lack social support and have an unwanted pregnancy, compared to subjects who did not become depressed.
Premenstrual Dysphoric Disorder (PMDD) is characterized by symptoms of depression around a week before the woman’s menstrual periods and goes away after the menstruation is complete. PMDD is a severe form of Premenstrual syndrome (PMS). PMDD generally follows a cyclic pattern and is accompanied by emotional symptoms as well as mood symptoms which may cause substantial disruption to personal relationships. Main disabling symptoms can include feelings of deep sadness and despair, possible suicidal ideation, feelings of tension and anxiety, panic attacks, increased or decreased sex drive, increased need for emotional closeness, difficulty concentrating, increased sensitivity to criticism and rejection, apathy, disinterest, binge eating, mood swings, crying, fatigue, difficulty concentrating, irritability, increased interpersonal conflicts, insomnia, hypersomnia, feelings of being out of control, feeling overwhelmed, breast tenderness or swelling, heart palpitations, headache, joint or muscle pains, swollen face and nose, sensation of bloating, distorted view of body or actual weight gain.
Seasonal Affective Disorder (SAD) refers to an episode of depression that returns ar certain time of the year. It is also referred to as winter blues, winter depression, summer blues, summer depression or seasonal depression.
Symptoms of SAD may consist of difficulty waking up in the morning, morning sickness, tendency to oversleep and over eat, especially a craving for carbohydrates, which leads to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. All of this leads to the depression, pessimistic feelings of hopelessness, and lack of pleasure. People suffering from summer blues or summer depression show symptoms such as insomnia, anxiety, irritability, decreased appetite, weight loss, social withdrawal, an increased sex drive and suicidal ideation.
The disorder may begin during the teen years or in early adulthood. Like other forms of depression, it occurs more often in women than in men. People living in places with long winter nights are at greater risk for SAD. Amount of light, genes, hormones and body temperature are a few important factors than can contribute in the development of SAD.
Schizophrenia is a major mental disorder that gravely affects the global well being of an individual. The person may have two or more of these symptoms like hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior. The characteristics symptoms of schizophrenia involve a range of cognitive and emotional dysfunctions that include problems in perception, thinking, language and communication, behavior, monitoring, affect, fluency and productivity of thought and speech, volition and drive, and attention. WHO reports 24 million people throughout the world are affected with the disorder. The annual incidence of schizophrenic disorder probably ranges between 0.1 to 0.5 per 1000 people. Though incidence rates reported from India have been higher than in the western countries. Although incidence of schizophrenia in men and women is about equal, the age of onset of schizophrenia is earlier in men than in women. The average age for the onset of first psychotic episode of schizophrenia is in the early to mid-20s for men and in the late 20s for women.
Types of Schizophrenia:
Paranoid Schizophrenia is characterized by preoccupation with one or more delusions or frequent auditory hallucinations such as with content of persecution, suspicion, grandeur and reference. Individuals suffering with this kind of schizophrenia have gross difficulties in interpersonal relationships but speech and affect remains relatively unaffected.
Catatonic Schizophrenia has a primary symptom of motor immobility; this may include waxy flexibility or stupor. A person may also show excessive motor activity that is apparently purposeless and not influenced by external stimuli, extreme negativism which apparently seems motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved or mutism (inability to speak). The symptoms may also show peculiarities of voluntary movement including voluntary assumption of inappropriate of bizarre postures, stereotyped movements, prominent mannerisms, echolalia (uncontrollable and immediate repetition of words spoken by another person) or echopraxia (the abnormal repetition of the actions of another person) and catatonic behavior.
Disorganized Schizophrenia is characterized by disorganized speech and behavior and essentially does not meet the criteria for catatonic type.
Undifferentiated Schizophrenia is characterized by symptoms such as delusions, hallucinations disorganized speech which may include frequent derailment or incoherence, grossly disorganized behaviors and affective flattening , alogia (inability to speak because of mental deficiency) but essentially do not fulfill the criteria for the paranoid, disorganized, or catatonic types.
Residual Type Schizophrenia
In this type of schizophrenia, the individual is unlikely to suffer from any kind of prominent delusions, hallucinations, disorganized speech and grossly disorganized or catatonic behaviors. Though there is a continuing evidence of the disturbance, as indicated by the presence of symptoms such as emotional hastening, poverty of speech, associability, apathy (lack of interest in or concern for things that others find moving or exciting.), and significant cognitive impairment.
Stress in itself is not a bad thing. A certain amount of stress is necessary for every individual to motivate and continue to ones interest in the activity. In complete absence of stress, life would become boring, dull and purposeless. This becomes tricky when one is unable to unable to handle stress in positive way and it exceeds the healthy levels. Once it exceeds the healthy level it can be looked at as the reaction people have to excessive pressures or other types of demand placed upon them. It arises when they worry that they can’t cope. We can understand it better by this given equation:
S = D > R
Where S = Stress, D = Demands, R = Resources
When a person believes demands made of them exceed their ability to cope they will experience unhealthy form of stress.
Types of Stress
Eustress is that form of stress that is deemed healthful or giving one the feeling of fulfillment. It has a positive effect, spurring motivation and awareness, providing the stimulation to cope with challenging situations and perform optimally. In other words eustress is the curative stress because it gives an individual the ability to generate the best performance or maximum output.
A few examples of eustress at play in life are:
· - Thrill and excitement on amusement ride
- Feelings of excitement on winning a competition or challenge
- Feelings of excitement on purchase of house
- Feeling of pride on getting the first salary cheque
- Excitement and the proud feeling of being a first time parent
- Feelings of excitement while going for a long awaited holiday
A certain amount of positive stress keeps individuals pepped up to meet all challenges and it is necessary the survival and progress in life.
Distress refers to the unhealthy amounts of stress that potentially is negative. Distress is a type of stress which is opposite to the nature of Eustress. Distress leads to a variety of stress disorders that are caused by adverse situations and conditions. This type of stress influences an individual’s ability to cope. It may act as a contributory factor in minor conditions, such as headaches, digestive problems, skin complaints, insomnia and ulcers. Chronic or excessive, prolonged and unrelieved stress can have a harmful effect on mental, physical and spiritual health.
Some events that may lead to distress are:
- Financial hardships
- Death of loved one
- Consistent major/ heavy workload or responsibilities
- Difficult relationships
- Chronic Illnesses or recurrent sickness
Distress can be classified further as acute stress or chronic stress. Acute stress is short-lived while chronic stress is usually prolonged in nature. Also Read GAS[G1] by Dr. Hans Selye
In order to successfully manage stress its important to understand in what forms distress affect individuals’ life.
As the word 'Acute' suggests, this is brief and severe or intense negative form of stress. This has been one of the most common forms of stress. This crops up from pressures and demands of the present and anticipation of them in the near future.
This form of stress is no fun but at the same time is not terribly dangerous. This in fact help individual to save his life. It happens whenever feelings of shocked or threat are perceived, which triggers the fight or flight stress response system. Our body is flooded with emergency response hormones such as adrenaline and cortisol. These hormones lead to a heightened alertness and increased strength, endurance and energy, thereby allowing a prompt response to imminent danger.
Situations that can trigger this state could range from an accident on the road, physical attack, and burglary to the loss of an important contract or a business deal, fighting to meet a deadline, occasional problems with the child at school and so on.
While this type of stress is classified as a bad or unhealthy stress, it is not dangerous because it doesn’t last for long and the body washes away the residual hormones when the danger has passed. This stress helps us to survive though overdoing on this ‘Acute’ or short-term stress can lead to psychological distress, tension headaches, upset stomach, and other symptoms.
Identifying the signs is always helpful. The most common symptoms associated with this form of stress are:
- Muscle problems like strained neck, back pain, headache, pulled muscles and tendons due to muscular tensions;
- Bodily conditions such as heartburn, acidic stomach, flatulence, diarrhea, constipation, irritable bowel syndrome (IBS) and other stomach, gut and bowel related problems;
- Temporal over arousal may lead to state of pounding or racing heart, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath, chest pain etc;
- Emotional arousals and difficulties such as anger, irritability, impatience, desperation, anxiety, and depression.
Acute stress can crop up in anyone's life, and it is highly treatable and manageable.
Episodic Acute Stress
Episodic Acute Stress refers to frequent spells of acute stress in an individual’s life. Typical examples include always rushed, but always late; things going wrong too often despite careful planning. Individuals who fall in this category are most likely take on too much, have too many irons in the fire and fail to organize the slew of self-inflicted demands and pressures. Individuals with this kind of temperament often put themselves into situations that perpetuates and maintains acute levels of stress.
Most common symptoms of episodic acute stress includes being anxious, strained, irritable, over aroused, nervous and short-tempered. They may also experience persistent tension headaches, migraines, hypertension, chest pain, and heart disease. They blame for their woes & worry the external events and other people and tend to worry a lot and catastrophize the ‘not so grave’ situations. People who experience this form of stress are more likely to have a deep rooted sense of insecurity and continue believing that world is an unsupportive, speculative and vindictive place.
Treating episodic acute stress requires intervention on a number of levels, generally requiring professional help, which may take many months. So often than none, lifestyle as well as personality related issues in these individuals are so deep and ingrained that they are unable to see anything wrong with the way of living life.
Unlike the thrill of acute stress, chronic stress is exhausting and wears the individual out day after day, year after year. Chronic stress works on the destruction of both mind and body; hence life! It acts like slow grinding and has a devastating effect on all the levels of individuals’ life. Stresses that crop from issues such as financial hardship, dysfunctional family, unhappy marriage and/ or detested career, lead to generation of chronic stress. In other words it is the stress that brings along the never-ending troubles and the person almost always is stuck with one or the other miserable situation. It's the stress of unrelenting demands and pressures for seemingly everlasting time periods. The individual dealing with this kind of stress starts experiencing feelings of despondence, despair and disconsolate and stops making efforts for improving situations.
Individuals who experience chronic stress during their early years of life start to carry a view of the world, or a belief system, is created that causes unending stress and feelings of misery for the individual. At times individuals also internalize the effect of become internalized and remain forever painful and present. Some experiences profoundly affect personality.
Since chronic stress lasts for a significantly long time in an individual’s life so he get used to it and this is one of the most debilitating aspect of chronic stress. So rather than working towards a solution they rather work on forgetting and believing that it is not there at all. Unlike a prompt response towards management of acute stress, people tend to ignore the chronic stress is relatively familiar leading to the feelings of comfort with it sometimes. This form of stress play havoc on life and may also lead to attempted or completed suicide, violence, heart attack, stroke, and/ or even cancer. People wear down to a state of exhaustion, fatal breakdown. (Read more about GAS by Hans Selye) This is to say because physical and mental resources are depleted through long-term consumption. Treating symptoms and outcome of chronic stress requires regular and extended medical as well as psychological intervention. Stress management training can be especially helpful in the course of treatment.
Additionally, two more categories of stress have been outlined:
Hyperstress – This refers to a state when an individual is stretched beyond his/ her ability to handle, and hence they tend to experience what is known as Hyperstress. In other words, this form of stress results due to overload of demands and requirements. In this state an individual may experience a strong emotional response; even though the trigger is seemingly little. Typically hyperstress is experienced by working mothers, working married women who have to juggle between personal and professional demands, people working in areas which need speed as well as accuracy, poor socio economic status etc…
Hypostress - This type of stress refers to the lack or absence of experience any form of stress. This leads to feelings of boredom. This is likely to experienced by people who are required to perform same routine mundane job for months and years together, e.g. factory workers, housewife etc… who perform similar kind of work in a similar fashion, work that lacks any kind of challenge or novelty. Effect of Hypostress may lead to feelings of restlessness and a lack of inspiration.