Up and Down, Up and Down. Do You Have Bipolar Affective Disorder?

Bipolar Affective Disorder used to be called Manic Depression. It affects from 1 – 2% of the population and affects men and women equally. Average age of onset is 15 – 25 years. It is difficult to diagnose, often co-occurs with a broad assortment of physical ailments and causes great distress for sufferers and their families.

People are often confused by this illness but it’s not too difficult to understand.

How many times have you woke up in a great mood. Your feet touch the floor and you know it’s going to be an amazing day. The traffic lights change as you approach and the lettuce you buy is always sweet.

Conversely, we have all had those days…you know you’ve had them, where you wake knowing it’s a miserable day. You’re grumpy and out of sorts and hate everything. Nothing goes your way, and everything irritates you.

Bipolar affective disorder looks like this:

For the sake of a simple discussion, let’s assume that the normal range of emotion occurs between 2 and 4 on the scale above. Those great days are 4 on the scale. But those other days are on 2. Most of us fluctuate between 2.5 and 3.5. (Remember I’m using a graph to demonstrate this disorder, NOT to suggest numerical ranges for our feelings.) When people have manic episodes, their highs go above the best that we feel.  On the graph, these are the points 5 and 6. When people have depression, their moods drop below those bad days into another realm.

These cycles are beyond the control of the individual going through them. Talking, directives and therapy are not solutions for this disorder. It requires medication and extreme attentiveness to the person’s health and well being. But sometimes neither of these work and the individual goes through a repeated cycle of hospitalization and release.

The length of a cycle is measured from one peak or valley, to the next Rarely a person will cycle only once in a lifetime but more likely cycle several times per year.

By the way, the graph represents balanced cycles of the illness, but some people remain manic for much longer than they are in depression or vice versa.

Bipolar affective disorder is extremely hard to diagnose. It never goes away. (At best, medication is used to control the symptoms.)

If you look at the line above, you will notice that on the way from mania (a peak) an individual’s mood or affect will settle and move through normal into depression. Ditto on the way back up.  People with this disorder show long periods of time when their behavior appears normal. And is. But these times are misleading, because they are simply part of the process of the disease. Up and down, alwaus passing through normal in each cycle. But of course the time spent within that normal range is determined by the length of each cycle.

At the extreme, Mania is the cycle of the illness that usually gets the most attention. In this phase, behavior is often publicly disordered. Symptoms include  extremely high energy (feeling high), little if any sleep, rapid firing speech, increased sexual drive, increased recklessness without regard for the consequences, grandiosity and major thought disturbances.   It is in this stage that people may read a book faster than they can turn the pages, or take off their clothes and dance down Main Street in the middle of rush hour. This is the time they ‘realize’ that the local pawn shop is mistakenly selling real diamonds for next to nothing and they will beg, borrow or steal money to buy all of them in every pawn shop in town.  They may start binge drinking, drugging and eating. Or sleeping with anyone available. They may talk extremely fast and becoming extremely cunning and sly. Extreme drinking and drug use may also happen in a manic stage. Periods of extreme creativity are also common – paintings, books and musical scores often come from these periods, although their quality can be questionable. Ironically it is this ‘high’ that patients hate to give up. They feel accomplished, productive and super-capable in the manic stage.

When the body and brain are exhausted, the individual’s mood starts to slide down into normal. Often at this time, remorse, embarrassment and humiliation are common and sometimes overwhelming. Inevitibly depression takes over and the individual is full of self loathing and hopelessness. Suicide ideation or attempts happen at the bottom of the depressive stage, which mimics depression that is more common in society.

Psychosis, hallucinations and delusions may occur at either end of the spectrum.

Also, remember I’m talking generalities and clear, delineated stages, which isn’t how it happens. But I think it helps for understanding.

Treatment includes a regimen of psychotropic medication (drugs for the brain) and stress management. A friend of mine has this illness. As long as he is absolutely rigid about his sleep, exercise, nutrition and creative practices, he can live a productive and happy life. He has three teenaged children and is actively involved in their lives. He’s happily married too. But he is very clear, his mental health comes first. But remember, we don’t know where his illness lies on the continuum of mental health and illness. And his rigidity may not help the next person with BAD.

As always, people with this illness have a chemical imbalance in their brains that drives them to behave in ways that cause them and their loved ones embarrassment, shame and loss. But the next time you see someone behaving like this, say a prayer and send kind thoughts. If they could behave differently, they would.

There is some thought that this illness can show up in children as young as six. But in this situation, the cycles are usually hourly and the mania is expressed as rage. The problem is that none of the meds used to treat adults have been approved for children.

Another friend has a little girl who put her fists through walls at seven. She had been expelled from school because when she cycled, they couldn’t protect her or the other students.

Diagnosis took a long time (in part because of the illness and in part because psyciatrists are often loath to ‘label’ someone so young). But eventually they found the right meds and she settled down, becoming a normal, sensitive, happy little girl. She was a different child. Truly an amazing turn-around.

After eighteen months, the physical side effects of the medication were more serious than the illness so she was taken off them. Within weeks she was behaving in the same old ways with one exception: this time she knew how different her behavior was and why the other kids called her crazy. And then, this gorgeous little girl actively tried to take her life not once but twice.

She is twelve now and going through adolesence while dealing with the disease which is subdued by meds but not controlled. Their home is difficult, at best. A prayer for them would be appreciated.

Credit for fact verification and additional information is available at:

http://emedicine.medscape.com/article/286342-overview

http://www.obad.ca/information_bipolar

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

http://www.obad.ca/

http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

Do you know anyone with this illness?  Have you seen this behavior?

 

Bring on the Boxes. I’m Moving! I’m Moving!

As mentioned previously, this blog is moving to its own website.  Yay!!!

After reading all the posts about moving your website (thanks to Melinda VanLone and Marcy Kennedy), I hired the wonderful Steena Holmes to make it happen.

Steena is a dear to take this project on right now. Her book, Finding Emma is an Amazon bestseller and has been high in the charts for the month of August. I’m sure she has better things to do, including dancing with joy and glee and absolute delight, than build my website. But that’s Steena – she always follows through.

So this site will be going dark as soon as WordPress acknowledges my email. In a few days, a week at most, I’ll be up and running at my new home. Website addy should be the same, but I’ll do my best to let you all know via twitter and FB once the site is live.

In the meantime, enjoy the long weekend. I’ll be back with my series on mental health and mental illness as soon as the new site is up and running.

Until then, be well.

Given that You Have One, Do You Know How it Works?

For years we have been fascinated with the brain and how it works. It is only recently (the past couple of decades) that the technology exists to allow us to look at the brain of a living person and begin to understand what’s happening. Suffice it to say, there’s way more we don’t know than we know, but the research is ongoing and information is increasing exponentially.

We’re going to look at the structure and function of the brain as a way of moving into a discussion of mental illness. Please don’t take anything I say to a doctor, nurse, psychiatrist or medical professional, because they’ll laugh. <vbg> I’m going to leave out a whole bunch and put the rest in layman’s terms so that we can use this information as writers.

So let’s begin

There are a number of types of cells in the brain, all with very specialized functions. Brain cells, aka neurons,  is one of these; their sole purpose is to transmit the electrical impulses of the brain. This electrical activity controls everything we do, think and feel.

There are about 100 billion of these specialized cells and each interacts with about another thousand cells!  They interact with each other in neural or neuronal pathways (depending on the expert’s word choice). In the real world, you’ve seen the equivalent of these pathways: cows always walk the same path to return to the barn. In the city, people always walk the same path when they’re cutting the corner of a lot or a park. On those pathways the grass is dead and a rut is worn into the earth.

No soil in your brain, but the same kind of thing happens. Cells communicate with each other. The more two specific cells communicate (ie share electricity) the stronger the path. Over time, those paths become the only way these two neurons communicate. As a result, we see what we expect, fill in the missing pieces etc. This is also why it’s so hard to stop the negative self talk – it follows a neural pathway over and over and over again. You know how long it takes the grass to grow back into a worn path. It takes longer than that to dismantle a neural pathway. By the way, the simplest example of a simple neural pathway is the knee jerk reaction when the doctor taps your knee.

There are three parts to these brain cells: The dendrites, body and axon.

Free image courtesy of FreeDigitalPhotos.net

The cell body is the main part of the brain and functions as any other cell body. This is the ‘gray matter’ we so often hear about in reference to the brain.

Dendrites take in the electrical charge and axons pass it on to the next cell.  But it is rarely a 1:1 exchange. Each neuron can take input from multiple cells and pass it on to multiple cells.  As with any interaction, if the same information comes into the cell from multiple sources, the information (or charge) is increased and amplified. But if the sources provide conflicting information, the strength of the charge may be diminished or neutralized. This is the same as having colored water. If you add more color to the water, the color deepens. But if you add more water, the color is lightened. (On the diagram above, the dendrites are on the top half of the picture, above the cell body.)

Axons are long, thin, cable-like projections from the cell body which carry the electrochemical messages along the length of the cell. Depending upon the type of neuron, axons can be covered with a thin layer of myelin which is a type of fat that insulates the axon. Myelin helps to speed transmission the charge down the axon. Myelinated neurons are typically found in the peripheral nerves (sensory and motor neurons), while nonmyelinated neurons are found within the brain and spinal cord. (This is the long tail below the cell body.)

One other little detail: If any of the sheath falls off, the result is Muscular Sclerosis. When you think of all the myelin in the brain (and that’s why we all need some fat in our food) it is easy to see why it’s so hard to diagnose MS and why the symptoms can be varied and progressive.

The axons can extend from your finger tip to the brain. Or they can be micro-millimeters long.

The axon and dendrites never touch. The small space between them is called the synaptic cleft. Since these cells sit in cerebrospinal fluid (don’t you just love that word?) which is proteins and sugar in a liquid, an electrical charge isn’t safely transmitted between neurons.  To ensure this communication, the sending neuron surrounds the charge with a neurotransmitter, of which there are more than 100 in the brain. The accepting neuron takes in the charge but doesn’t want the neurotransmitter, which is left in the brain fluid.

Given that the amount and consistency of the brain fluid is critical to healthy functioning, the axon terminal which released the neurotransmitter takes it back in.  This process is called reuptake.

The neurons take in information from the environment, usually through our five senses and pass it along to the appropriate parts of the brain to make decisions. For example: last week the cells in my thumb realized the boiling water I had touched was hot. It sends that message to the neurons in the brain, which told me to pull my thumb out of the hot water.  And this all happened in a nano-second.

Isn’t it amazing?

Again, I’ve kept this simple and hopefully light so you’re not all running to the hills screaming about the biology of the brain. I hope you found it the least bit interesting. And it will be useful as we move forward in our discussion.

By the way, I used the following sites to confirm what I knew and correct what I had wrong:

Http://www.bris.ac.uk/synaptic/basics/basics-1.html

http://www.animatlab.com/NeuralNetworkEditor/FiringRateNeuralNet/NeuronBasics.htm

http://science.howstuffworks.com/environmental/life/human-biology/nerve1.htm

photo credit: <a href=”http://www.flickr.com/photos/juliendn/3347475063/”>juliendn</a&gt; via <a href=”http://photopin.com”>photo pin</a> <a href=”http://creativecommons.org/licenses/by-nc-sa/2.0/”>cc</a&gt;

We All Have One, But How Are You Using It?

We’ve spent some time on this site looking at family roles, personality disorders, and a variety of other topics, including burnout. Although I’ve worked to keep the focus on facts, I’ve tried to ensure there would be value for writers as well.

Many of our stories include villains who have some sort of brain dysfunction. I have received a number of emails asking questions about these irregularities and how they might affect behavior. So in the interest of sharing writing information, we’re going to spend a few weeks looking at the brain. Now don’t panic. I promise it won’t be neurobiology kind of stuff.  I’ll make it as non-medical as possible. And it will be fun, really.

Writing (good or bad) starts here, in the brain.

Science is learning more and more about the brain – how it functions, learns and remembers. A recent article in the Huff Post talked about ‘super-seniors’ whose brain function in their 80’s is better than most people in their 60’s. (This is good news for me.)

Our brains are small, weighing only 2% of average body weight but use up to 20% of the body’s energy. Each of our brains have about 100 billion neurons, each of which look like this:

Free image courtesy of FreeDigitalPhotos.net

Each of these neurons link to thousand of other neurons (from 1,000 to 10,000), but they never touch. In early pregnancy, they increase by 250,000 neurons per minute in the fetal brain, but in adulthood, the entire brain is only the size of a small cauliflower or about 3 pounds.

New research shows that neurons (aka brain cells) can reproduce in response to new activity (especially juggling), but child abuse can slow or stop brain development in children.

Gender affects our brains. Male brains react differently to pain than women’s, so the two sexes can’t discuss pain easily. Estrogen (present in both genders) enhances memory, which may be why so many women report memory problems in menopause.

The brain holds almost 20% of the body’s blood at any given time, but it is 3/4 water. Its computational power is astonishing. It can complete between 10 ¹³ to 10 ¹⁶ operations per second. And it needs good fats to do all this work. (Told you to continue reading.)

These operations include:

• Controlling body temperature, blood pressure, heart rate and breathing.
• Accepting and processing information from our senses (seeing, hearing, smelling, tasting and touching). (This will be important when we’re talking about delusions and hallucinations.)
• Handling physical movement when walking, talking, standing or sitting.
• Allowing thinking, dreaming, reasoning and experiencing emotions.

Pretty amazing, isn’t it?

All of this happens in the midst of a dynamic, ever-changing ‘soup’ of chemicals, also known as neurotransmitters.

I have to admit I am always shocked when people ride motorcycles without a helmet. Why would anyone risk such a marvelous piece of internal equipment? We pack our laptop in a protective case with foam to keep it from bouncing and then pack it in a saddle bag on a bike, and climb on, without protecting our noggin.

By the way, you can’t tickle yourself, since your brain recognizes your touch as…well…your touch.

The brain is arguably the most important part of the body and yet we know comparatively little about it.  Brains from those who have died can’t tell researchers much about the dynamic, active processes of the brain. And yet most of us are unwilling to have those same doctors put needles and scalpels into our brains.

So what kind of information is out there and how might it affect you as a writer? Join me as I provide a layman’s look at the brain – what works and what doesn’t and why. We are going to look at a whole spectrum of brain function, from mental health to mental illness.  (We all know thriller authors love mental illness.) In the process, I hope you’ll find some interesting tidbits of information, some understanding of those who have debilitating illnesses most of us understand very little and an appreciation for the gray and white matter between your ears.

Don’t forget I’m moving to my own website.  More details to come.

The image of the brain, above, is from photopin.com.

photo credit: <a href=”http://www.flickr.com/photos/hawkexpress/4734545741/”>hawkexpress</a&gt; via <a href=”http://photopin.com”>photo pin</a> <a href=”http://creativecommons.org/licenses/by-nc-nd/2.0/”>cc</a&gt;

 

What is a Stale Book and Why am I so Pi$$ed?

What’s a stale book you ask?  Let me tell you.

I recently bought a book for my e-reader and settled in for a good read. It is out of my usual genre (romance) and more like the books Diane Capri writes,which means it is a thriller.  (If you like thrillers, hers are great and are available here.)

The book I’m so unhappy with is set in the middle east during an American CIA mission on which the fate of the world depends.

Great setting, right?

Wrong.

The book opens with a CIA executive briefing the American president about the risks to American safety and the future of the free world. Apparently these risks are posed by one man who wants to:

1. Build a dirty bomb

2. Set off a chemical bomb

3. Create terrorist activities on US soil

4. And so forth

Obviously I’m in for a spine tingling, sit on the edge of my chair read. But wait…what name is this?

Saddam Hussein?  Whaaaaaat?

In all honesty I couldn’t finish the book.  The former leader was not the villain by any stretch of the imagination but the premise of the book was: We have to get the bad guy before he gets to Saddam and they destroy the world.

Uhmmm not.

One of the advantages of indie publishing is the ability to have our books on the electronic shelf forever. But forever means time changes and if I want a book to remain ‘real’ to my reader, I have to ensure that it is current and topical.

By the way, it’s not just thrillers. I bought several of my favorite romance writer’s ebooks and was most disappointed to see she hadn’t updated her backlist – so the hero popped a cassette into the car stereo, used a phone booth, and went home to check email.  OOPS. Right away I’m out of the story and into my head about what’s wrong with this book

So tell me, how do you ensure that your books stay current over the long haul?  Do you pay attention to these questions when you write? Or when your book is published? Or do you consider them at all?

Keeping Your Butt in the Chair and Out of the Fire

After sharing my experience with burnout, I thought it might be wise to talk about the more common symptoms and how they manifest in most people.  Again, symptoms are always unique for each of us. But having said that, there are some signs we need to watch for.  Especially those of us who are in the trenches working with our creative juices and still trying to meet all the other demands on us: families, work, craft, responsibilities, and isolation.

When we are working as hard as we can, but not making noticeable progress, we are susceptible to burnout.  How many of you have submitted and submitted and submitted without landing an agent or a deal?  How many times has your agent submitted without landing a contract? How many times have your kids, spouse, or family asked you to do something but you’ve declined because you have to write (paint, draw, model etc etc). And still you are not seeing the external rewards of your effort.

How many times have you tweeted, facebooked (is that a word?) or blogged with no change in sales? Are you an introvert but forcing yourself to participate in a group: online, face to face or at conference.

When we work in an environment where we have little control, we are at risk for burnout.  Are any of you free of this risk? Are you blogging with limited reach?

Are you working too much and too hard with too little time away?

Are you the victim of others’ high expectations of you?

Are you shorting yourself on sleep?

How many close, supportive, understanding relationships do you have? This can be critical if your closest relationships don’t ‘get’ the creative life.

On a personal level, do you tend to be a perfectionist, always striving for more?

Do you see the world and your role in it as half-full or half-empty?

Are you willing to hire the help you need, accepting you can’t do it all?

Have your activities lost the fun they once provided?

Physically, common symptoms include exhaustion, and anger (whether expressed or not) at those who are making demands on your time. When you meet those demands, do you criticize yourself? Are you irritable?  (I call it itchy, twitchy and bitchy). How about headaches and tummy problems that are relatively new. Have you gained or lost weight recently without the decision or action to make that happen? Are you more susceptible to colds, the flu, or headaches?

The list is long and it’s easy to ignore several of these signs, because we’re busy, loving what we do and involved in life.  But I can’t encourage you enough to give burnout the respect it deserves.  I was lucky.  Six weeks away gave me the time I needed to figure out what was going on, to replenish my energy and to consciously plan how to manage my life when I got back in the saddle.

My work isn’t going to change for a while. My family is unchanged. My staff and I seem to have come to terms with our loss.  I have made some firm decisions about what I can and cannot do and when I will do it. Most of all, I’ve recognized that just because I’m single; just because I live alone, just because my life is good doesn’t mean I can live like Lucy in the cartoon.

It will if I push…is a fallacy and one that takes a toll on all of us.

If you have a chronic health problem, you’re at even greater risk for burnout to happen even sooner.

What are you willing to change to ensure you don’t burn out? What relationships need to be nurtured and which ones need to be curtailed? What about your activities? Step up and let us know how you’re doing. I know we can learn from each other and I’m looking forward to it.

Burnout – Usually You Don’t Know You Got It ‘Til It Knocks You on Your A$$

If you follow this blog, you know I planned a two week vacation in early July. Here it is mid August and I’m just coming back.  Some of you have emailed or FB’d me asking about my health and plans.  Thank you so much for caring. Your contact meant more than I can say.

So what happened? Why the delay?  In a word, Burnout.  But if I’m to be honest, it was more than that. It was the perfect storm of demands, hopes, health and dreams that drove me into social withdrawal.

I have never had an episode of burnout. My motto has always been the Charlie Brown cartoon where Lucy asks Charlie

“How many times does twelve go into six?

He replies “It doesn’t.

She responds, “It will if you push.”

I have lived my life knowing that moderation was a rumor, especially if I was excited and interested in a project or activity. Working out?  Hell yeah.  Two hours at a time, three or four times a week.  A food plan? Oh yeah.  Managing my life, finances, work and writing?  Yes.  If you push through the time constraints anything and everything is possible.

from http://www.freephotosbank.com/9333.html

Until it isn’t.

So what happened? My perfect storm had a number of components.

1. My professional life took off in a totally new, high demand direction.  I have worked to make this happen, loved it, and was busy every minute of every day.  There was rarely a moment to catch  my breath in any given day through May and June.

2. I got lazy with my food plan.  As many of you know I’m a celiac and I’m very fussy about gluten both internally and topically.  BUT, a two year old took over my body and if she couldn’t have gluten, she wanted grain based carbs at every meal.  Because of this, I was so exhausted I had trouble staying awake to drive to work, or home. I would drop into a coma for two hours after dinner. I couldn’t push through the exhaustion to do more than minimally get through each day.

3. On April 27, one of my staff came to me and asked for a couple of hours off to go to the doctor. She had a cold she couldn’t shake.  Of course I gave her the time. And when she called later that day to say her doctor had told her to take a week off because she was exhausted, I agreed. At the end of the week she called to tell me her doctor decided it was a lung infection and she would be off for another two weeks.  Before the end of the two weeks, he booked her for a CT scan then told her to go to the local cancer clinic because she had stage 4 lung cancer. This non-smoker died on July 8 at the age of fifty.

She was a widow, whose two children (25 yo and 18 yo) are now orphans.

There’s not much to say, is there?  Life is precious and short.

4. Then there’s my first book. It came to my attention that it hadn’t been edited very well.  I had a number of people go through it and I paid for editing because I have no ability for details.  But given a couple of reviews and a comment or two (thanks for being honest with me, ladies) I realized I had to do something about the book.  So I stewed and I wondered and I thought.  Should be a simple decision but it wasn’t. I churned and churned and churned. What? How? Who? Why? All were redundant questions.  Fix the darn book Louise and make it right. Should be easy. But that was a clue for me that I was struggling mentally and emotionally. I knew what had to be done but I was unwilling and unable to do it. Looking back, that should have been a key: when you can’t do something you know you have to do but you keep thinking about it, feeling bad, worrying…you’re in burnout.

5 I couldn’t raise the energy to write. Anything. Reports at work. My blog. My book. My novella. Letters.  Emails. You name it, it was hard work to get any of them done.

6. After not blogging for a couple of weeks, I couldn’t face the idea of doing it again. Don’t get me wrong–I love blogging and following yours, but I just couldn’t fathom writing on a regular basis.  So I didn’t.

What now?

In simple terms, I didn’t do much. I went to work, read a bit of email, talked to my friends, shared my feelings and worked on my next book. I sent book 1, Family Ties to a good editor, got it re-done and re-uploaded (you should get a notice from Amazon any day).When I had the energy, I sent my December novella to the same editor. I worked through the Beta comments on Book 2 (Family Lies). And I changed what I’m eating (more paleo than anything these days), so now I have a wealth of energy.  For the first time in months I feel like myself again. Perhaps a little more fragile than before, but I’m back at full steam.

There is lots of information on the web about burnout. I’ve included some good links below. But remember, it looks different for each of us. It feels different for each of us. It behaves differently for each of us.

I am the family hero. I never give up and I never give in. Lucy’s comment to Charlie is how I’ve lived my life. Anything is possible if you focus, work hard and go to any lengths. But the combination of the wrong nutrients, a death on my team, and the acknowledgement that my work wasn’t as good as I wanted it to be combined to knock me on my backside.

That’s as close to burnout as I want to come.

Blog posts will start to appear regularly again over the next few weeks.  But I’m going to a self-hosted site (thanks to those of you with the great posts on how to do that and thanks to Steena Holmes for doing it for me), so I’ll be asking you to change your subscription to the new site in a few weeks.  I hope you’ll join me.

Until then, here are the links I promised. Take care of yourselves. Life is short and sweet.

http://www.helpguide.org/mental/burnout_signs_symptoms.htm

There’s a simple test here

http://www.stressdoc.com/four_stages_burnbout.htm

http://stress.about.com/od/burnout/a/stressn_burnout.htm

http://www.mayoclinic.com/health/burnout/WL00062/

Have you ever burned out?  Do you know what caused it? What was your healing process?

Last But Not Least: Schizoid Personality Disorder is Not Schizophrenia But It Shares Symptoms

from the Calgary Stampede

Our look at personality disorders is coming to an end.  It seems a good time, since the blog is going on vacation for a couple of weeks.  Yay!!!  I’m not going away but I’m going to edit my next two books, mow my grass and spend some time at the Calgary Stampede.  It’s a tough job, but I can’t wait.

I received some questions about Schizoid Personality Disorder.  It’s not one that is commonly heard of and it is often confused with Schizophrenia, so I thought we’d discuss this personality disorder now, then after vacation, we’ll talk about some of the mental illnesses that plague 20% of our population.

First of all, a quick reminder that personality disorders are not chemically caused conditions.  You can’t run a test for these.  Rather they are ways of ‘being in the world’ that result in long-standing patterns of thinking and acting that are very different from what society considers ‘normal’. When coupled with great rigidity, personality disorders cause great distress and interfere with many areas of life, including social and work functioning. People with these disorders usually have limited coping skills and great difficulty forming healthy relationships. And since the disorder is the lens through which they see the world, they don’t feel there’s anything wrong with them.

Definition: Schizoid personality disorder is diagnosed when a person has a lifelong pattern of indifference to others. They avoid social activities and avoid interaction with others. Others see you as a loner although you have no idea how to form these relationships. People with this disorder lack emotional affect, which in ‘shrink talk’ means they don’t show emotion. They appear not to care about others but in fact may feel sensitive and lonely. They can function fairly well, as long as they are able to structure their lives in a way that supports their need to be alone.  For example, night shift security might offer someone with this disorder a way to support themselves but have minimal social interaction.

Symptoms:

Most difficult for family to deal with is the reclusive nature of these people, who will go to great lengths to avoid social contact. Many live with their parents for their entire lives, especially if they can have space in the basement or some other slightly removed space.

Additionally:

• They prefer to be alone, so choose solitary jobs and activities.
• They experience pleasure in few activities, including sex.
• They value extreme independence so have few, if any close friends,
• They don’t know how to interact socially as they have difficulty relating to others.
• They are indifferent to praise or criticism
• They are aloof and show little emotion, seeming to be dull, indifferent or emotionally cold.
• They might daydream and/or create vivid fantasies of complex inner lives.
• They are unmotivated which results in underperformance at work and school
• Always are followers, rather than leaders.

No hard numbers for the prevalence of this disorder is known, since they seldom seek help and keep to themselves.  It is known to affect more men than women and is more common when a relative has schizophrenia, which leads to conjecture there might be a significant genetic predisposition.

People with Schizotypal Personality Disorder, a subset of Schizoid Personality Disorder, also are socially distant but they have additional problems in relating to the world.

Symptoms of Schizotypal Personality Disorder include those listed above AND:

• Cognitive and/or perceptual distortions
• Inaccurate interpretation of casual incidents and events as having a specific meaning for them.
• Unusually superstitious (including magical thinking) and possibly preoccupied with paranormal phenomena.
• Unusual perceptual experiences, including bodily illusions (e.g. phantom pain)
• Suspiciousness or extreme paranoia
• Behavior or dress that is odd, eccentric, or peculiar
• Respond peculiarly to social cues (the Schizoid PD will ignore these) and then blame their social failures on others.
• Speech that is disjointed, unusual and inappropriate; often it is a series of words strung together without reference to sentence structure or grammar.

Individuals with Schizotypal Personality Disorder often seek treatment for the associated symptoms of anxiety, depression, or other problems rather than for the personality disorder.

Both these disorders are regularly confused with Schizophrenia although they are not the same. Schizophrenia is a chronic illness for which there is no cure and symptoms usually get worse over time.  These Personality Disorders can be treated, with varying degrees of success, with therapy and medication, although treatment is rarely sought.

This brings to an end this discussion of personality disorders.  It is a fascinating discussion and impacts many of us in our social, work and family relationships.  I hope you have a better understanding of human behaviour and perhaps a little bit of empathy for people who are plagues with these constellations of symptoms.

And if you’re a writer, I hope you’ve got fodder for a variety of characters in your upcoming books.

Have you met someone or heard of someone with this disorder? Do you think you could incorporate it into a book?  Can you see how someone with either of these problems might be misconstrued as being the guilty party to a crime, when that’s not likely?

Love to hear from you.  Let me know what you think.  And please enjoy the next few weeks.  I’m going to relax and drink some wobbly pops and write.

Do You Like Making Decisions or Do You Defer in ALL Things to Somone Else? Dependent Personality Disorder

For most of us, our teen years are simply the time between childhood and adulthood.  We can’t wait until we are adults and can make our own decisions and set our own path.  We long for independence.

But for some of us, we never truly become independent, fully functioning adults. Rather we develop and live with Dependent Personality Disorder. 

What is it?  Dependent personality disorder is a long-term condition in which people depend too much on others to meet their emotional and physical needs. They live with debilitating feelings of nervousness and fear and are also plagued by helplessness, submissiveness, a need to be taken care of and for constant reassurance, and an inability to make decisions. In short, they need to be taken care of and fear being abandoned or separated from individuals in their life.  As a result they often engage in submissive behaviors which causes other to become their care givers. From outside the relationship it looks ‘clingy’ and needy.

Symptoms of Dependent Personality Disorder

Dependent personality disorder is characterized by overwhelming fear that leads to “clinging behavior”. It can be diagnosed in early adulthood. It includes a majority of the following:

• Avoids being alone; will tolerate abuse to avoid aloneness
• Unable to make everyday decisions without an excessive amount of advice and reassurance from others
• Needs others to assume responsibility for most major areas of his or her life
• Has difficulty expressing disagreement with others; over-sensitive to criticism
• Pessimism and lack of self-confidence, including belief in their personal inability to take care of themselves
• Has difficulty doing things alone, without ongoing reassurances
• Intense fear of abandonment; unable to be without a primary relationship,
• Urgently seeks another relationship as a source of care and support when a close relationship ends
• Goes to excessive lengths to obtain nurturance and support from others, to the point of offering to do unpleasant things
• Preoccupied with fears of being left to take care of him or herself
• Lives in fantasy and remain naïve

Dependent Personality Disorder is only diagnosed in adults.  It is determined by a psychological evaluation in concert with an evaluation of the duration and severity of the symptoms. Although it won’t be in the DSM-V, it is one of the most commonly diagnosed personality disorders.

Generally, people with this disorder do not seek treatment for it, but rather for a problem they’re experiencing. The problem usually arises because of one or more of their symptoms affecting their ability to function in a way they deem normal and healthy. They may seek help for depression or anxiety, common co-occurrences with this disorder.  Or they may seek help for substance abuse problems which also co-occur in alarming numbers.

If these co-occurring symptoms are serious, a physician may treat the patient with anti-depressant medications which also alleviate anxiety.

Treatment will include some form of talk therapy. Together all these approaches will help alleviate the symptoms, but at this time, the disorder is never ‘cured’. Rather the symptoms are managed and controlled, usually decreasing with age.

Ironically it is the very dependence on others that pushes people away. We get burned out taking care of someone who is so reliant on us. Or, the dependent person will attach themselves to an abusive partner who will affirm their belief in their inability to make decisions and to live without someone else controlling everything. It is logical to see how people with this disorder will stay in highly abusive situations, rather than risk being on their own – the responsibility is simply overwhelming.

How about you?  Do you know someone like this? Met someone like this?  Have you ever felt sorry for someone married to a control freak who told them when to go to the bathroom?  Have you considered that this may be the relationship the more passive or dependent partner needs?

Material for this post was authenticated by these sites:

 http://www.psychologytoday.com/conditions/dependent-personality-disorder

http://psychcentral.com/disorders/sx13.htm

http://my.clevelandclinic.org/disorders/personality_disorders/hic_dependent_personality_disorder.aspx

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001937/

 

 

Admit It: You Wondered About or Double Checked the Iron, Coffee Pot or Washer Before You Left the House or After Leaving on Vacation: Obsessive Compulsive Personality Disorder.

We all do.  It’s natural. Yesterday I turned around about 5 minutes from home because I wasn’t sure I’d closed the garage door.  We all want our homes, possessions, family and selves to be safe. But what happens when that drive for safety becomes overwhelming, affecting our everyday lives?

Obsessive Compulsive Disorder is an anxiety disorder characterized by obsession, (ideas, thoughts, impulses or images) which often result in compulsions (the ritual performance of specific activities or mental acts over and over again). The purpose of the rituals is to get rid of the thoughts and protect those at risk, but of course it doesn’t work. These uncontrollable, unwanted thoughts and repetitive, ritualized behaviors control who you are and how you function in the world. And even though the sufferer knows they’re irrational, they are unable to stop the thoughts or behaviors without external help.

For those of you old enough to remember record players (yes I had one), OCD is like a needle getting stuck on a record and the same thought plays over and over again.

These thoughts and behaviors seem to fall into categories:

• 

  Image from Google Images

  Cleaners are afraid of contamination. They usually have cleaning or hand-washing compulsions which can leave their skin cracked and bleeding.  Usually these activities must be performed in a certain specific, rigid order. For example, one client would come home and stand on a green garbage bag inside the door and in a specific order remove every piece of clothing, put them in the wash and then shower, to ensure that germs from the outside didn’t come inside.

• Worriers repeatedly check things (iron unplugged, washer turned off) that they believe may cause harm to their home. (An unplugged iron will start a fire a burn my house down.) They may also be obsessed with repugnant images (throwing their child into a fire or off the balcony).
• Doubters and sinners are afraid that anything less than perfection will cause something terrible to happen to themselves or a loved one. (If I don’t lock the door, someone will come in and kill my family.) As a result, anything less than perfection will result in a catastrophe.
• Counters and arrangers are obsessed with order and symmetry. Often this includes superstitions about specific numbers, colors, or arrangements. This can include ensuring things happen in threes (or fours) or that phrases and words are ‘finger—typed’.
• Hoarders fear the risk of throwing anything away, so they keep everything, regardless of its usefulness or value. We’ve all seen where this can end up, given reality television.

How do I know my returning home is simply being responsible and not an OCD activity?

1. OCD  thoughts are intrusive and out of control. If I hadn’t returned home, I would not have spent the day worrying about my garage because I made a decision about the likelihood of the door being open.
2. Thoughts are time consuming, chewing up hours of time over a week. If I decided it was unlikely I’d left the door open, I wouldn’t have given it much more thought.
3. OCD thoughts cause a lot of anxiety or distress and interfere with life. I might have wondered once or twice during the day, especially on the return home after work, but otherwise I would have focused on work.
4. My concern about the garage door would not have led me to create a ritual to ‘protect’ my home, even when I knew the door was closed.
5. I wouldn’t (and didn’t) create some ritual to ensure I didn’t leave the door open again (this is not a plan of action to bring to consciousness that I’ve shut the door, but rather an activity (say clapping my hands three times) that is supposed to protect the house, even when I know the door is closed.

OCD usually starts between 18 – 24, although boys seem to get it earlier than girls. Approximately 1 – 2% of the population suffers from this disorder which fluctuates in intensity: when ‘active’ it takes up an inordinate amount of time. But the thoughts and behaviors can recede into the background in certain circumstances.

Treatment is similar to that of any anxiety disorder. Anti-depressives, from the SSRI family (Celeza, Zoloft etc) are commonly prescribed.  Cognitive Behavior Therapy has also had some good results with this disorder.  There is a myriad of valid and valuable self help treatments as well. One of these, developed by Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, offers a four step program for dealing with OCD. As always, outcomes vary. It is rare to be completely symptom free from this disorder but periods of total incapacitation can be minimized.

As alway, no self-diagnosing allowed.  If you worry lots and have rituals to deal with those worries, contact a mental health professional.

I apologize for being late with this post — it’s been that kind of week.