Tag: psychiatry

Personality Disorders 101: Paranoid PD

2 June 2018 /

The first in the series of personality disoders is Paranoid Personality Disorder (PPD). Although experiencing paranoia in a stressful situation is common, PPD refers to a much bigger idea; a permanent fear that someone or something is trying to cause you harm, and that you are in almost-constant danger.

A person with PPD will treat every experience, however neutral or friendly, as a personal attack and a sign of their “put-upon” status. They will feel like they always need to be on guard to defend themselves. Someone with PPD will struggle to trustanything, as they fear (or expect) that everything in their world could be revealed as a lie or trick at any moment. This uncertainty may drive someone with PPD towards anger and constant arguments with other people, who they assume are lying or hiding information. Alternately, the person may isolate themselves from the world and from others so they cannot be decieved.

To be diagnosed with PPD in the DSM-5, someone must meet 4 of these criteria;

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Personality Disorders 101 : How are PDs diagnosed?

1 June 2018 /

The study of psychological differences and “abnormal” behaviour has received more public attention than many other branches of psychology, but this attention isn’t always beneficial. “Abnormal” behaviour is associated with sensationalist news headlines more than sensible conversation. As a result, people often know about psychological conditions through their portrayals in mass media, rather than from factual explanations.

Of the many psychological differences, the category of personality disorders is most frequently misunderstood. The individual personality disorders (PDs) are often mis-represented, while the idea of a “disordered personality” sparks criticism from anti-psychiatry groups and people diagnosed with PDs.

So what are PDs, and what do we mean by “personality” in this context?

Currently, personality disorders are defined as groups of traits, experiences and behaviours that are significantly different from the majority of people; that affect someone’s thinking, emotions and impulses; and are associated with personal distress and dysfunction. These general criteria needs to be met for any PD diagnosis.

So to be diagnosed with a PD, someone needs to have a collection of unusal behaviours and traits which affects a large portion of their everyday life. Those behaviours and traits must start before early adulthood. They need to cause negative consequences for the person, who should be upset by or annoyed at those behaviours.  The name “personality disorder” attempts to represent how far-reaching and impactful those behaviours and experiences are upon almost every aspect of the person’s understanding of themselves and their ability to relate to others.

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Mental Health Online: Forums

23 June 2015 /

In 1994, Dr Phillip Long founded www.mentalhealth.com aiming to create a cross-cultural encyclopaedia of mental health conditions. The site is looking a little archaic now, using older DSM categories not commonly used now, and containing diagnostic ideas that didn’t really catch on, such as analysing all mental health symptoms through Greek personality dimensions.

While the site may not be entirely relevant these days, it’s a fascinating and detailed read. Moreover, it’s attached forum has been consistently running since 2005. In internet terms, this is an incredibly long time. Imagining friendships possibly extending for 10 years, its easy to see the best part of forums; their ability to connect people with others across time and space, providing friendships built on common experience and support.

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Mental Health Online: Tumblr

11 June 2015 /

Of all the major social networks, Tumblr is the one I wanted to write about the most, because its a dramatic difference from the stoicism of Twitter and the envy-inducing highlight reel of Facebook. Just like most of its users, its young, bold, and easily misunderstood.

# history

For the uninitiated, Tumblr is a microblogging site with a very “anything goes” attitude towards content: drawings, videos, music, gifs, longform text, links and pretty much anything else you can think of are all found there. Its major feature is reblogging, which is reposting someone else’s content onto your own feed and adding commentary, opinions, or a visual response- a cross between a Twitter retweet and a standard blog’s comment chain. Posts are organised and collected using hashtags, which are essential for posts being discovered and read.

Part of Tumblr’s appeal is how it conveys the impression of a private, almost clandestine association. (In reality, there are over 100 million tumblr users, and it got bought by Yahoo! for over a billion dollars). Unlike most social networks, pseudonymity can prevail; a user can change their name as often as they want and hide all personal information, while the lacking search function works solely on tagged words, effectively making untagged content invisible except for to followers. Because of this, Tumblr can seem far more private than other social networks. Many posts are made seemingly without considering a potential audience- often off-the-cuff, reactionary, self-depreciatingly, or holding nothing back about mental health difficulties.

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Mental Health Online: Twitter

1 May 2015 /

Compared to Facebook, I didn’t think of Twitter as a useful place for discussing mental health issues. This was partly due to the 140 character limit; I couldn’t see the use of tweets for in-depth discussion compared to something like a blog post or video.

However, when I looked through my twitter feed more closely, there was a lot of talk about mental health. Most of the people talking were advocates; either they wanted to start conversations, to support mental health organisations, or start their own campaigns. And most of these advocates were survivors, using their experiences with mental health to show others why researching mental health matters.

#Academia

Twitter doesn’t have the same kind of scare-headline news stories as Facebook, and there isn’t any research saying it affects people negatively. However, there is some research on  responses to individual hashtags. Shepherd et al studied the #DearMentalHealthProfessionals thread, a conversation set up by Amanda O’Connell in August 2013, and found there were four main types of discussion:

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Mental Health Online: Facebook

7 April 2015 /

Everyone, their mum, and their cat has Facebook, or so it can often seem.  As one of the most subscribed-to places online, and perhaps some people’s only online connection, looking at what Facebook has to do with mental health could be important on a large scale.

Simply searching for “Facebook” flags up a New Yorker headline- “How Facebook Makes Us Unhappy”. Narrowing it down to “facebook and mental health” adds BrainBlogger’s  “Facebook is no friend to mental health”, and “7 Ways Facebook is Bad For Your Mental Health, from Psychology Today.

The BrainBlogger and Psychology Today articles were almost uniformly negative, showing research that connects Facebook use to envious friendships, jealous relationships and decreased life satisfaction.

The New Yorker article included its fair share of research on the unhappy consequences of Facebook usage, but also included some optimistic findings. Their best answer was: it depends what people are actually doing on Facebook. People actively using Facebook to keep in contact and engage with loved ones benefit from the social connection. People passively browsing their timelines, however, are often left feeling worse after using Facebook.

Facebook as a mental health resource

If actively participating on Facebook is generally beneficial, does that make Facebook a good resource for people with mental health issues?

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Treating Mental Health Issues: Definitions

20 February 2015 /

When talking about treating mental health issues, it’s important to look at what medical staff, researchers, and people with mental health issues consider to be successful treatment. As its a lot harder to measure and accurately define mental health symptoms than physical ones, it is harder to accurately judge treating them. To show what kind of terms are used when treating mental health conditions, I’m  using some hypothetical case studies. Imagine that each of these patients has just been diagnosed as being in their first Major Depressive Episode, and this is their first mental health issue. Each patient starts with a score of 18 on the PHQ-9, representing moderately severe depression using that system, is treated with an antidepressant, and is followed up six months later.

Response

After a six-week course of medication, Patient A retakes the PHQ-9 and scores 14. Six months later, their score is 15. Because their score has stayed lower, Patient A has had a treatment response. Their diagnosis would not change. In a purely medical sense, this is progress. An academic study testing the effectiveness of patient A’s antidepressant would be happy with a 3-point response, and would consider this a successful response. However, the patient themselves won’t see it that way.

A score of 15 is still in the category of moderately severe depression. Their day-to-day feelings and experiences may not have changed in any meaningful way and, depending on what side-effects the medication had, they may not feel the treatment was worth having.

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My Diagnosis Experience, Part 4

15 February 2015 /

Background

Despite having sat through my fair share of mental health assessments, I don’t know much about them. As I don’t personally know anyone who has experienced one, and don’t really have many people I could ask about how they work, my knowledge is entirely from what people have said online.

Out of everything I’ve written about in the last few posts, one meeting has always remained in my mind, because it was simultaneously the worst and the best experience I had with mental health professionals.

Having never had anyone to “compare notes” with, I’m going to explain it here, in case it comes in useful for future reference or for anyone else. Again, personal information has been removed.

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Diagnosing Mental Health Issues: What is Mental Health?

25 January 2015 /

There is currently more published information about mental health than ever before, and it has never been so easy to connect with experts, health workers and charities supporting mental health issues. Yet misinformation, stereotypes and stigma still exist, and often people still don’t know where to turn. The problem isn’t a lack of information, but in communicating what information we currently have, and what we need to have. One of the most basic pieces of information would be a clear description of exactly what people mean when they talk about mental health and mental health issues. Definitions are often expressed differently depending on who the target audience is; articles written for a general audience will often focus on a single problem or dysfunction, while medical articles get more of the complexity across. Here are some examples of different online resources, and their definitions.

Layman’s definitions

Mind: “problems that affect they way you think, feel, or behave”.
Wikipedia: a mental or behavioural pattern or anomaly that causes either suffering or an impaired ability to function in ordinary life (disability), and which is not a developmental or social norm.
BBC Science: symptoms  that go beyond typical responses, and are severe enough to interfere with a person’s ability to function.

Diagnostic Manuals

Now for the big one, the DSM- IV. As you might expect, this is a comprehensive and rigid explanation:

A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. [This] must not be merely an expectable and culturally sanctioned response to a particular event.
A manifestation of a behavioural, psychological, or biological dysfunction in the individual. Neither deviant behaviour (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above.”

Breaking this down, the DSM requires a mental health condition to be a pattern of symptoms that cause suffering to the person, go beyond culturally normal experiences, and are caused by a biological or psychological difference in that person.

The ICD- 10  definition is a common research basis, striking a good balance between comprehension and simplicity. They define a mental illness as “a clinically recognizable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions.”

From Illness to Wellness

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Diagnosing Mental Health Issues: What is the DSM?

25 January 2015 /

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the official instruction book for diagnosing and treating mental health conditions in the US. It is used by psychiatrists, medical staff and academic researchers.

The DSM works based on the principle that psychological symptoms can be objectively classified and observed in the same way as physical symptoms, so psychiatric illness can be diagnosed and studied as medical illnesses. Emil Kraepelin, one of the first psychiatrists, pioneered this idea, which is why systems like the DSM are sometimes described as neo-Kraepelinian methods.

In Kraepelin’s time (1883), people were diagnosed haphazardly, based on their most obvious symptoms. Most doctors also believed in Unitary Psychosis, the idea that all symptoms of mental illness were variants of one overall illness. Kraepelin instead looked for syndromes – patterns and trajectories of symptoms. He wrote an encyclopaedia of psychiatry which contained case histories and trajectories of specific syndromes and also promoted his diagnostic system.

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