Wednesday, 28 December 2011

Mental Illness


Mental illness might sometimes seem like an unbearable burden, but treatment can help. Of the many treatment options available, the most common are psychotherapy and medications. 

Sometimes different types of treatment are combined to boost their effectiveness. The treatments best suited for your needs depend on such factors as the type of mental illness you have, how long you've had it, other medical issues, previous treatments, personal preferences and even cost and insurance coverage. Talk to your doctor about which options are best for you. 

Here's an overview of different types of treatment for mental illness. 

Psychotherapy is a general term for a way of treating mental and emotional disorders by talking about your condition and related issues with a mental health professional. It's also known as talk therapy, counseling or psychosocial therapy. 

Through these talk sessions, you'll learn about the causes of your condition so you can better understand it. You'll also learn how to identify and make changes in troubling behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of happiness and control in your life and help alleviate symptoms caused by mental illness, such as hopelessness and anger. 

Treatment can be short term, lasting just a couple of sessions over a few weeks, or it can take many sessions over several years. Psychotherapy can take place in individual, couples, family or group sessions. 

There are many types of psychotherapy. Among them: 

Behavior therapy. Behavior therapy focuses on changing unwanted or unhealthy behaviors, typically using a system of rewards, reinforcements of positive behavior, and desensitization. Desensitization is a process of confronting something that causes anxiety, fear or discomfort and overcoming those responses. If you have a fear of germs that prompts you to excessively wash your hands, for instance, you might be trained in ways to stop the excessive washing. 

Cognitive therapy. This type of therapy is designed to help you identify and correct distorted thought (cognitive) patterns that can lead to feelings and behaviors that are troublesome, self-defeating or self-destructive. It's based on the premise that how you interpret your experiences in life determines the way you feel and behave. If you're depressed, for instance, you might see yourself and your experiences in negative ways, which adds to the symptoms of depression. Like behavior therapy, cognitive therapy focuses on your current problems to alleviate symptoms, rather than addressing underlying or past conflicts. Unlike behavior therapy, however, your experiences are an important part of the cognitive therapy process. 

Cognitive-behavioral therapy. This type of talk therapy combines features of both cognitive and behavior therapy to identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you behave. Even if an unwanted situation has not changed, you can change the way you think and behave in a positive way. 

Creative art therapy. This type of therapy uses the creative process to help people who might have difficulty expressing their thoughts and feelings. Creative arts can help you increase self-awareness, cope with symptoms and traumatic experiences, and foster positive changes. Creative art therapy includes art, dance and movement, drama, music and even poetry. 

Dialectical behavior therapy. This is a type of cognitive-behavioral therapy whose primary objective is to teach behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others. It was designed for people with borderline personality disorder, who often have suicidal behavior. But it has been adapted for other conditions, too, including people with eating disorders or substance abuse issues. It's derived, in part, from a philosophical process called dialectics, in which seemingly contradictory facts or ideas are weighed against each other to come up with a resolution or balance. For instance, you might learn about accepting who you are while at the same time making changes in your thoughts and behaviors. 

Exposure therapy. This is a form of behavior therapy that deliberately exposes you to the very thing that you find upsetting or disturbing. It's especially useful for people with obsessive-compulsive disorder or post-traumatic stress disorder. Under controlled circumstances, exposure to the event or things that triggers your obsessive thoughts or traumatic reactions can help you learn to cope with them and work through the traumas. 

Interpersonal therapy. This approach focuses on your current relationships with other people. The goal is to improve your interpersonal skills — how you relate to others, including family, friends and colleagues. You'll learn how to evaluate the way you interact with others and develop strategies for dealing with relationship and communication problems. 

Play therapy. This type of therapy is geared for young children at specific development levels. It uses a variety of techniques, including playing with dolls or toys, painting or other activities. These techniques allow children to more easily express emotions and feelings if they lack the cognitive development to express themselves with words. 

Psychoanalysis. In this therapeutic approach, you examine memories, events and feelings from the past to understand current feelings and behavior. It's based on the theory that childhood events and biological urges create an unconscious mind that drives how you think, feel and behave. In this therapy, you explore those unconscious motivations to help make changes to improve your life. You might also do dream analysis and free association — talking about whatever happens to come to mind. This is a long-term, intensive therapy and often involves several sessions a week with a psychoanalyst for several years. In formal psychoanalysis, you lay on a couch and the therapist sits unseen behind you. It evolved out of theories developed by Sigmund Freud. 

Psychodynamic psychotherapy. This type of therapy, based on the theories of psychoanalysis, focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights about your motivations, and resolving conflicts to live a happier life. It's one of the most common types of psychotherapy. It's less intense than psychoanalysis and is usually done sitting face to face with a therapist. It's also less frequent — usually once a week — and is shorter term, usually a year or less. It includes a variety of therapeutic techniques, such as exploring your past, confronting your beliefs and actions, offering support, and interpreting your thoughts and behavior. That process allows you to become aware of and acknowledge the link between a feeling, thought, symptom or behavior and an unconscious meaning or motivator. With that new understanding, you can modify unwanted behavior or thoughts. 

Psychoeducation. This approach focuses on teaching you — and sometimes family and friends — about your illness. Psychoeducation explores possible treatments, coping strategies and problem-solving skills. You might learn about resources in your community, such as support groups. You can also learn about symptoms that might indicate a potential relapse so you can take steps to get appropriate treatment. It can be especially useful for people with chronic or severe illnesses, such as schizophrenia. 


Medications can be an effective treatment for mental illness. Although they don't cure mental illness, medications can control symptoms and improve your coping abilities, which can help reduce the severity of your condition. 

A variety of psychiatric medications are available. Among them are: 

Antidepressants. These medications are used to treat various forms of depression. There are several types of antidepressants, grouped by how they affect brain chemistry. These include the newer selective serotonin reuptake inhibitors and the older monoamine oxidase inhibitors. They may also help improve symptoms in other disorders. 

Mood stabilizers. These medications are generally taken to help treat bipolar disorder, which is characterized by swings in mood between depression and mania. The medications work by balancing out such mood swings. 

Anti-anxiety medications. Although antidepressants can also help improve anxiety, some medications that specifically target anxiety can work more quickly to relieve symptoms, often within 30 to 90 minutes. These medications have two major drawbacks: They don't improve depression and they can become habit-forming. 

Antipsychotics. These medications, also called neuroleptics, are typically used to treat psychotic disorders, such as schizophrenia. They may also be used to treat severe cases of depression accompanied by psychosis. 

Like psychotherapy, medication treatment can be short term or long term. Because there are so many medications to choose from, you might have to try several different medications before finding the one that works best for you. Which one or which combination might be best depends on your illness, your symptoms and their severity, other medical issues, possible side effects, lifestyle, cost and personal preference. 

You might benefit most from a combination of psychotherapy and medication. Studies indicate that treating chronically depressed people with an antidepressant plus psychotherapy can be more effective than either medication or counseling alone. 

Certain herbal and dietary supplements, such as St. John's wort, have also been used to treat mental illness. Because there's little concrete data about their effectiveness, safety and interaction with other medications, consult your doctor before taking any supplements. 

Other medical treatments

Your doctor might also recommend: 

Electroconvulsive therapy (ECT). During ECT, a small amount of electrical current is delivered to your brain through electrodes, producing a seizure that usually lasts 30 to 60 seconds. Doctors believe that chemical aspects of brain functioning are altered during and after this seizure activity. When ECT is administered on a regular basis, these chemical changes build upon one another, reducing symptoms. ECT can be an effective treatment for severe depression, especially when other treatments have failed or when you need immediate results and can't wait for medications to begin working. It remains controversial because of negative perceptions and the possibility of side effects, including memory impairment. 

Light therapy. In this type of therapy — also known as phototherapy — you spend time bathed in light from a full-spectrum light source, called a light box. It's designed for people with seasonal affective disorder (SAD), a type of depression that seems to be related to fluctuations in exposure to natural light. SAD usually begins in autumn and can last through the winter. Phototherapy can help reduce symptoms by mimicking natural light in a way not possible with regular light bulbs. 

Complementary and alternative treatments 

Nontraditional therapies also might be useful in treating mental illness. They can help you respond to signals from your own body and learn new, healthy ways to cope with feelings and behaviors that mental illness can trigger. 

Biofeedback. Biofeedback teaches you to control body functions, such as muscle tension or brain wave patterns. Electrodes and other sensors on your body monitor your responses to stimuli and give you visual or auditory feedback that enables you to control how your body reacts. Biofeedback can help ease tension and anxiety and improve concentration. 

Guided imagery. This is a type of focused relaxation that encourages you to create calming, peaceful images in your mind. It can help reduce stress, anxiety, panic and uncertainty — feelings often associated with mental illness. 

Hypnosis. This technique leads you into a deep state of relaxation in which your mind stays narrowly focused and you're open to suggestion. It can be a powerful means of directing your imagination to control physical response to stress and pain, manage certain symptoms of mental illness, and to stop unwanted habits, such as smoking. 

Meeting your needs

The therapeutic process can be daunting and uncomfortable, especially in the beginning. But within a few weeks, you should begin to see an improvement in your symptoms, including relief from distress, better decision-making abilities, improved relationships and new coping skills. 

If that's not happening, talk to your doctor. You might not be getting the right kind of treatment for your situation. 

Treatment must be tailored to an individual, if results aren't what you hoped for or you don't feel right about the treatment, get a second opinion. Therapy is not a one-size-fits-all treatment. With so many different types of treatment available, you and your health care provider can sort through the options and work toward improving the quality of your life.

Keeping Your Emotional Health 

People with good emotional health are in control of their thoughts, feelings and behaviors. They feel good about themselves and have good relationships. They can keep problems in perspective. 

It's important to remember that people with good emotional health sometimes have emotional problems or mental illness. Mental illness often has a physical cause such as a chemical imbalance in the brain. Stress and problems with family, work or school can sometimes trigger mental illness or make it worse. However, people with good emotional health have learned ways to cope with stress and problems. They know when they need to seek help from their doctor or a counselor. 

What about anger? 

People are sometimes not aware of what causes their anger, how much anger they are holding inside or how to express anger. Certain events or actions by other people can make you angry. Also, many little things can build up to make you feel that life is treating you unfairly. 

If you find yourself becoming increasingly irritable or taking unhealthy risks (like drinking too much or abusing drugs), it may be because you have a problem dealing with anger. It's very important to talk with your doctor or a counselor about getting help. 

What can I do to avoid problems? 

First, try to recognize your emotions and understand why you are having them. Learning how to sort out the causes of sadness, frustration and anger in your life can help you better manage your emotional health.  

Tips on dealing with your emotions 

Learn to express your feelings in appropriate ways. Keeping feelings of sadness or anger inside takes extra energy and can cause problems in your relationships and at work or school. It's important to let people close to you know when something is bothering you. 

Think before you act. Emotions can be powerful. But before you get carried away by your emotions and say or do something you might regret, consider the possible positive and negative consequences. 

Strive for balance in your life. Don't obsess about problems at work, at school or at home. Focus on positive things in your life. Make time for things you enjoy. 

Take care of your physical health. Physical and mental health are 2 sides of the same coin. Take care of your body by exercising regularly, eating healthy meals and getting enough sleep. Don't abuse drugs or alcohol. 

How does stress affect my emotions?

Stress can come from situations such as having personal or work problems, having too much to do or too many responsibilities, working too hard and being exhausted. 

Your body responds to stress by making stress hormones. These hormones help your body respond to situations of extreme need. But when your body makes too many of these hormones for a long period of time, the hormones wear down your body ­- and your emotions. People under stress are often emotional, anxious, irritable and even depressed. 

If possible, try to change the situation that is causing your stress. Relaxation methods, such as deep breathing and meditation, and exercise are useful ways to cope with stress. 

Can emotional problems be treated?

Yes. Counseling, support groups and medicines can help people who have emotional problems or mental illness. If you have an ongoing emotional problem, talk to your family doctor. He or she can help you find the right type of treatment. 

Mental Illness: Recognizing the Warning Signs 

Most people believe that mental disorders are rare and “happen to someone else." In fact, mental disorders are common and widespread.  

Most families are not prepared to cope with learning their loved one has a mental illness. It can be physically and emotionally trying, and can make us feel vulnerable to the opinions and judgments of others. 

If you think you or someone you know may have a mental or emotional problem, it is important to remember there is hope and help. 

What is mental illness?

A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines. 

There are more than 200 classified forms of mental illness. Some of the more common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorders. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal. 

Mental health problems may be related to excessive stress due to a particular situation or series of events. As with cancer, diabetes and heart disease, mental illnesses are often physical as well as emotional and psychological. Mental illnesses may be caused by a reaction to environmental stresses, genetic factors, biochemical imbalances, or a combination of these. With proper care and treatment many individuals learn to cope or recover from a mental illness or emotional disorder. 

How to cope day-to-day

Accept your feelings 

Despite the different symptoms and types of mental illnesses, many families who have a loved one with mental illness, share similar experiences. You may find yourself denying the warning signs, worrying what other people will think because of the stigma, or wondering what caused your loved one to become ill. Accept that these feelings are normal and common among families going through similar situations. Find out all you can about your loved one’s illness by reading and talking with mental health professionals. Share what you have learned with others. 

Handling unusual behavior 

The outward signs of a mental illness are often behavioral. Individuals may be extremely quiet or withdrawn. Conversely, he or she may burst into tears or have outbursts of anger. Even after treatment has started, individuals with a mental illness can exhibit anti-social behaviors. 

When in public, these behaviors can be disruptive and difficult to accept. 

The next time you and your family member visit your doctor or mental health professional, discuss these behaviors and develop a strategy for coping. 

Establishing a support network 

Whenever possible, seek support from friends and family members. If you feel you cannot discuss your situation with friends or other family members, find a self-help or support group. These groups provide an opportunity for you to talk to other people who are experiencing the same type of problems. They can listen and offer valuable advice. 

Seeking counseling 

Therapy can be beneficial for both the individual with mental illness and other family members. A mental health professional can suggest ways to cope and better understand your loved one’s illness. 

When looking for a therapist, be patient and talk to a few professionals so you can choose the person that is right for you and your family. It may take time until you are comfortable, but in the long run you will be glad you sought help. 

Taking time out 

It is common for the person with the mental illness to become the focus of family life. When this happens, other members of the family may feel ignored or resentful. Some may find it difficult to pursue their own interests. 

If you are the caregiver, you need some time for yourself. Schedule time away to prevent becoming frustrated or angry. If you schedule time for yourself it will help you to keep things in perspective and you may have more patience and compassion for coping or helping your loved one. Only when you are physically and emotionally healthy can you help others. 

It is important to remember that there is hope for recovery, and that with treatment many people with mental illness return to a productive and fulfilling life. 

Warning Signs and Symptoms
The following are signs that your loved one may want to speak to a medical or mental health professional. 

In adults: 

confused thinking 
prolonged depression (sadness or irritability) 
feelings of extreme highs and lows 
excessive fears, worries and anxieties 
social withdrawal 
dramatic changes in eating or sleeping habits 
strong feelings of anger 
delusions or hallucinations 
growing inability to cope with daily problems and activities 
suicidal thoughts 
denial of obvious problems 
numerous unexplained physical ailments 
substance abuse 

In older children and pre-adolescents: 

substance abuse 
inability to cope with problems and daily activities 
change in sleeping and/or eating habits 
excessive complaints of physical ailments 
defiance of authority, truancy, theft, and/or vandalism 
intense fear of weight gain 
prolonged negative mood, often accompanied by poor appetite or thoughts of death 
frequent outbursts of anger 

In younger children: 

changes in school performance 
poor grades despite strong efforts 
excessive worry or anxiety (i.e. refusing to go to bed or school) 
persistent nightmares 
persistent disobedience or aggression 
frequent temper tantrums 

Anxiety Disorders 

Alternative Names
Common Causes
Different Kinds of Anxiety Disorders?
Treatments for Anxiety Disorders? 


Anxiety is a feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress it can cause. 

Alternative Names: 

Feeling uptight; Stress; Tension; Jitters; Apprehension 


Stress is a normal part of life. In small quantities, stress is good -- it motivates people and can help them be more productive. However, too much stress can actually harm the brain and body. Persistent and unrelenting stress often leads to anxiety. 

Anxiety is an emotion often accompanied by various physical symptoms, including the following: 

Twitching or trembling 

Muscle tension 
Dry mouth 
Difficulty swallowing

Sometimes other symptoms may also accompany anxiety: 

Rapid or irregular heart rate 
Rapid breathing 
Diarrhea or frequent need to urinate 
Sleeping difficulties 
Decreased concentration 
Sexual problems 

Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety. They include specific phobias, obsessive-compulsive disorder, and social phobia.

Common Causes: 

Actual danger (where stress is an appropriate reaction) 
Emotional stress 
Physical stress such as a medical illness 
Cold remedies 
Tricyclic antidepressants 
Other stimulants such as Ritalin and thyroid supplements
Medication side effects 
Withdrawal from drugs (including caffeine and nicotine) 
Substance dependence (including alcohol) 
Poor diet (deficiency of vitamin B12) 
Hyperventilation syndrome 
Thyroid problems (particularly hyperthyroidism) 
Low blood sugar 
Cardiac problems
In extremely rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the source of anxiety. 

Most people experience feelings of anxiety before an important event such as a big exam, business presentation or first date. Anxiety disorders, however, are illnesses that cause people to feel frightened, distressed and uneasy for no apparent reason. Left untreated, these disorders can dramatically reduce productivity and significantly diminish an individual's quality of life. 

What Are the Different Kinds of Anxiety Disorders? 

Panic Disorder-Characterized by panic attacks, sudden feelings of terror that strike repeatedly and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, feelings of unreality, and fear of dying. 

Obsessive-Compulsive Disorder-Repeated, intrusive and unwanted thoughts or rituals that seem impossible to control. 

Post-Traumatic Stress Disorder-Persistent symptoms that occur after experiencing a traumatic event such as war, rape, child abuse, natural disasters, or being taken hostage. Nightmares, flashbacks, numbing of emotions, depression, and feeling angry, irritable, distracted and being easily startled are common. 

Social Phobia-Extreme, disabling and irrational fear of something that really poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives. 

Generalized Anxiety Disorder-Chronic, exaggerated worry about everyday routine life events and activities, lasting at least six months; almost always anticipating the worst even though there is little reason to expect it. Accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea. 

What Are the Treatments for Anxiety Disorders? 

More medications are available than ever before to effectively treat anxiety disorders. These include antidepressants or benzodiazepines. If one medication is not effective, others can be tried. New medications are currently under development to treat anxiety symptoms. 

The two most effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy. Behavioral therapy tries to change actions through techniques such as diaphragmatic breathing or through gradual exposure to what is frightening. In addition to these techniques, cognitive-behavioral therapy teaches patients to understand their thinking patterns so they can react differently to the situations that cause them anxiety. 

Is it Possible for Anxiety Disorders to Coexist with Other Physical or Mental Disorders? 

It is common for an anxiety disorder to accompany another anxiety disorder, or in some cases depression, eating disorders or substance abuse. Anxiety disorders can also coexist with physical disorders. In such instances, these disorders will also need to be treated. Before undergoing any treatment, it is important to have a thorough medical exam to rule out other possible causes. 

Anti-Stigma: Do You Know the Facts? 

Stigma is not just a matter of using the wrong word or action. Stigma is about disrespect. It is the use of negative labels to identify a person living with mental illness. Stigma is a barrier. Fear of stigma, and the resulting discrimination, discourages individuals and their families from getting the help they need. An estimated 22 to 23 percent of the U.S. population experience a mental disorder in any given year, but almost half of these individuals do not seek treatment. 

The educational information in this page encourages the use of positive images to refer to people with mental illness and underscores the reality that mental illness can be successfully treated. 

Do you know that stigma is not a matter of using the wrong word or action? 
Do you know that stigma is about disrespect and using negative labels to identify a person living with mental illness? 
Do you know that stigma is a barrier that discourages individuals and their families from seeking help? 
Do you know that many people would rather tell employers they committed a petty crime and served time in jail, than admit to being in a psychiatric hospital? 
Do you know that stigma can result in inadequate insurance coverage for mental health services? 
Do you know that stigma leads to fear, mistrust, and violence against people living with mental illness and their families? 
Do you know that stigma can cause families and friends to turn their backs on people with mental illness? 
Do you know that stigma can prevent people from getting access to needed mental health services?


Do use respectful language 

Do emphasize abilities, not limitations. 
Do tell someone if they express a stigmatizing attitude.


Don't portray successful persons with disabilities as super human. 
Don't use generic labels such as retarded, or the mentally ill. 
Don't use terms like crazy, lunatic, manic depressive, or slow functioning. 
Borderline Personality Disorder 

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behaviour. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives. 


While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone. 

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments. 

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders. 


Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking. 

Recent Research Findings

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles. 

Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion. 

Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure. 

Future Progress

Research is underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also pinpoint specific environmental factors and personality traits that predict a more favorable outcome. 

Reactive Attachment Disorder 

Reactive Attachment Disorder is a complex psychiatric illness that can affect young children. It is characterized by serious problems in emotional attachments to others and usually presents by age 5. A parent, daycare provider or physician may notice that a child has problems with emotional attachment by their first birthday. Often, a parent brings an infant or very young child to the doctor with one or more of the following concerns: 

severe colic and/or feeding difficulties 
failure to gain weight 
detached and unresponsive behavior 
difficulty being comforted 
preoccupied and/or defiant behavior 
inhibition or hesitancy in social interactions 

Some children with Reactive Attachment Disorder may also be overly or inappropriately social or familiar with strangers. The physical, emotional and social problems associated with Reactive Attachment Disorder may persist as the child grows older. 

The cause of Reactive Attachment Disorder is not known. Most children with this disorder have had severe problems or disruptions in their early relationships. Many have been physically or emotionally abused or neglected. Some have experienced inadequate care in an institutional setting or other out-of-home placement (for example a hospital, residential program, foster care or orphanage). Others have had multiple or traumatic losses or changes in their primary caregiver. 

Children who exhibit signs of Reactive Attachment Disorder need a comprehensive psychiatric assessment and individualized treatment plan. These signs or symptoms may also be found in other psychiatric disorders. A child should never be given this label or diagnosis without a comprehensive evaluation. Treatment of this complex disorder involves both the child and the family. Without treatment, this condition can permanently effect a child's social and emotional development. 

While some therapists have advocated the use of so-called "rebirthing techniques", there is no scientific evidence to support the effectiveness of such interventions. Such unproven and unconventional therapies can also be quite dangerous. Tragically, the use of such techniques has been associated with serious injury and even death. 

Parents of a young child who shows signs or symptoms of Reactive Attachment Disorder should: 

seek a comprehensive psychiatric evaluation prior to the initiation of any treatment 

make sure they understand the risks as well as the potential benefits of any intervention 

feel free to seek a second opinion if they have questions or concerns about the diagnosis and/or treatment plan 

Reactive Attachment Disorder is a serious clinical condition. Fortunately, it is relatively rare. Evaluating and treating children with complex child psychiatric disorders such as Reactive Attachment Disorder is challenging. There are no simple solutions or magic answers. However, close and ongoing collaboration between the child's family and the treatment team will increase the likelihood of a successful outcome. 

Dementia: What Are the Common Signs? 

What is dementia?
What causes dementia?
What are some common signs of dementia?
Who is most likely to suffer from dementia?
How do you treat dementia?
Is there help for caregivers of people with dementia?

What is dementia? 

Dementia is a problem in the brain that makes it hard for a person to remember, learn and communicate. After a while, this makes it hard for the person to take care of himself or herself. 

Dementia may also change a person's mood and personality. At first, memory loss and trouble thinking clearly may bother the person who has dementia. Later, disruptive behavior and other problems may start. The person who has dementia may not be aware of these problems. 

A person with dementia may ask the same questions repeatedly and get lost in familiar places. He or she may be unable to follow directions; be disoriented about time, people, and places; and neglect personal safety, hygiene, and nutrition. 

Older people with dementia were once called senile, and it was thought that becoming senile was just part of getting old. But dementia is not a normal part of aging. It is important to find out the cause of a person's dementia. Some causes of dementia can be treated and reversed. Others are due to irreversible changes in the brain and cannot be cured. 

What causes dementia?

Dementia is caused by many conditions that affect the brain. A head injury, a stroke, a brain tumor or a problem like Alzheimer's disease can damage brain cells. Some people have a family history of dementia. 

Treatable conditions that can cause dementia include a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland, or a minor head injury. Medical conditions like these can be serious and should be treated by a doctor as soon as possible. 

Conditions or diseases that cause irreversible dementia, especially in older people, include Alzheimer's disease (AD), dementia with Lewy bodies, and multi-infarct dementia (MID), also called vascular dementia. 

Alzheimer's disease. AD is the most common cause of dementia. In AD, nerve cells in the brain die. The causes of the brain damage of AD are not yet clear. Symptoms of AD begin slowly with memory problems and become steadily worse. Over time, the brain damage in AD leads to serious problems in thinking, judgment, and the ability to carry out daily activities. 

Dementia with Lewy bodies. This type of dementia is the second most common cause of dementia in older adults. Lewy bodies are abnormal structures found in certain areas of the brain. It is not yet clear whether dementia with Lewy bodies is a separate illness or perhaps a variant of AD or Parkinson's disease. 

Multi-infarct or vascular dementia. In MID, small strokes occur, and blood clots in the blood vessels in the brain cause the death of brain tissue. Symptoms that begin suddenly may be a sign of this kind of dementia. High blood pressure is a cause of strokes and MID. 

Other less common causes of dementia include Huntington's disease, Parkinson's disease, Pick's disease, Binswanger's disease, and AIDS. 

Sometimes depression in older people is mistaken for dementia. 

What are some common signs of dementia?

Dementia causes many problems for the person who has it and for the person's family. Many of the problems are due to loss of memory. Some common signs of dementia are listed below. Not everyone who has dementia will have all of these signs. 

Recent memory loss. All of us forget things for a while and then remember them later. People with dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you already answered that question. They won't even remember that they already asked the question. 

Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it. 

Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want. 

Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home. 

Poor judgment. Even a person who doesn't have dementia might get distracted and forget to watch a child closely for a little while. People who have dementia, however, might forget all about the child and just leave the house for the day. 

Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them. 

Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later. 

Changes in mood. Everyone is moody at times, but people with dementia may have fast mood swings, going from calm to tears to anger in a few minutes. 

Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful. 

Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people. 

Who is most likely to suffer from dementia?

The elderly, those with family histories of dementia, and those with stroke risk factors are at higher risk for dementia. More women than men have dementia because women in general live longer than men.

How do you treat dementia?

Even if the doctor diagnoses an irreversible form of dementia, much can be done to treat the individual and help the family cope. A person with dementia should be under a doctor's care. The doctor can treat the person's physical and behavioral problems and answer questions that the person or family may have. 

For some people in the early and middle stages of AD, there are several drugs that may delay the worsening of some of the disease's symptoms. For people with MID, doctors believe it is very important to try to prevent further strokes by reducing risk factors. This means controlling high blood pressure, monitoring and treating high blood cholesterol and diabetes, and not smoking. 

Other kinds of medicines are used to help control behavioral symptoms of dementia such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes individuals more comfortable and makes their care easier for caregivers. Drugs used include antidepressants, antipsychotics, and anxiolytics. 

Nondrug treatments include assuring that the person with dementia has a healthy diet, exercise, social activities, regular medical care, and a safe environment. Caregivers can learn useful methods to help cope with problem behaviors.

Is there help for caregivers of people with dementia?

Yes. Caring for a person with dementia can be difficult. It can affect your family life, your job, your finances, and your physical and mental health. 

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