Conduct Disorder

Conduct disorder (CD) is more than just bad behavior from children or teenagers. It is a mental health condition that is marked by persistent, repetitive behavioral patterns that violate societal rules or the rights of other people.

Conduct Disorder: What Does It Mean?

While most children become disruptive from time to time, conduct disorder involves problematic behaviors that are more serious and long-lasting. These disruptive behaviors generally fall into four groups: aggressive conduct that threatens or causes harm to people or animals, nonaggressive conduct that involves property damage or loss, theft or deceitful conduct, and persistent violations of important rules.

Youths with conduct disorder find it challenging to control their emotions. Disruptive behaviors typically occur in a variety of settings and may cause serious problems. In many cases, people with mental health conditions such as anxiety or depression direct their distress inward. However, individuals with CD direct their distress outward where it may affect other people.

Stats: How Many Suffer from this Disorder?

Approximately 1-4% of children age 9-17 years old have conduct disorder. The prevalence of the condition is consistent across various ethnicities, races, and countries. Conduct disorder is more common among teenagers than younger children. Males are more likely to develop CD than females.

What Causes Conduct Disorder?

The specific causes of conduct disorder are unknown. However, mental health experts believe there are genetic and environmental factors that influence its onset. Conduct disorder is more likely to develop in children who have:

  • A history of physical or sexual abuse
  • Parents with substance addiction
  • Family members with conduct disorder
  • Parents with depression, bipolar disorder, or schizophrenia
  • Abnormalities in brain areas that control emotional regulation

Oppositional defiant disorder (ODD) may be a precursor to conduct disorder. When ODD is untreated, children are more likely to develop conduct disorder later in life.

Signs and Symptoms of Conduct Disorder

Children may show many signs and symptoms of conduct disorder. The disruptive behaviors are persistent, repetitive, and socially inappropriate. Symptoms of conduct disorder may change as children get older, stronger, smarter, and more sexually mature. Problematic behaviors may include:

  • Physically abusing animals or people
  • Bullying others
  • Forced sexual activity
  • Damaging property
  • Breaking into buildings, cars, or houses
  • Shoplifting
  • Lying
  • Skipping school before the age of 13
  • Running away from home at least twice

What are the Common Behaviors/Characteristics?

The behaviors that characterize conduct disorder go beyond what people may expect during teenage rebellion. They cause serious concern among peers, parents, and teachers.

Youths with conduct disorder are usually aggressive. They are more likely to misperceive the actions of others as threatening, and may respond with aggressive behavior they believe is justified. Young people with CD display a low tolerance for frustration, poor self-control, high irritability, recklessness, thrill-seeking behavior, and insensitivity to punishment. Substance misuse is associated with CD, especially among adolescent females. Young people with CD are at higher risk of suicidal ideation and physical fights with a weapon.

Testing: What are the Diagnostic Criteria Per the DSM 5?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) gives the following guidelines for diagnosing conduct disorder:

  • A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

Aggression to People and Animals

  1. Often bullies, threatens, or intimidates others.
  2. Often initiates physical fights.
  3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
  1. Has been physically cruel to people.
  2. Has been physically cruel to animals.
  3. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
  1. Has forced someone into sexual activity.

Destruction of Property

  1. Has deliberately engaged in fire setting with the intention of causing serious damage.
  2. Has deliberately destroyed others’ property (other than by fire setting).

Deceitfulness or Theft

  1. Has broken into someone else’s house, building, or car.
  2. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
  3. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering: forgery).

Serious Violations of Rules

  1. Often stays out at night despite parental prohibitions, beginning before age 13 years.
  2. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
  3. Is often truant from school, beginning before age 13 years.
  • The disturbance in behavior causes clinically significant impairment in social, academic,

or occupational functioning.

  • If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Conduct Disorder and Other Conditions

Conduct disorder is more prevalent among youths with oppositional defiant disorder and attention deficit hyperactivity disorder (ADHD). CD may also occur with other mental health issues such as anxiety, mood disorders, learning disorders, and substance-related disorders. Young people with conduct disorder may have lower intelligence than expected for their age. They may have lower achievement in communication, reading, and other verbal skills.

Conduct Disorder vs Intermittent Explosive Disorder

Conduct disorder and intermittent explosive disorder (IED) are behavioral issues that are characterized by high levels of aggression. However, there are differences between both conditions. Aggressive conduct in CD is often premeditated and purposeful (for example, to gain money or power), while aggressive conduct in IED is impulsive and unplanned. While CD has nonaggressive symptoms such as lying or truancy, IED does not have similar nonaggressive symptoms that characterize the condition.

Conduct Disorder vs Oppositional Defiant Disorder

Conduct disorder and oppositional defiant disorder are marked by disruptive behaviors toward parents, teachers, and other authority figures. However, the behaviors that define conduct disorder are more severe than those in oppositional defiant disorder. Youths with conduct disorder may engage in destruction of property, theft, and physical abuse toward animals or people. While children with ODD have emotional issues such as irritability and anger, young people with CD do not have similar emotional issues that define the condition.

Conduct Disorder vs Antisocial Personality Disorder

Individuals with conduct disorder or antisocial personality disorder tend to externalize their distress. Conduct disorder is usually diagnosed in young people up to the age of 18; adults with similar symptoms may be diagnosed with antisocial personality disorder. Youths with conduct disorder are at higher risk for developing antisocial personality disorder as they age.

Related Conditions

Pyromania and kleptomania are behavioral issues that are related to conduct disorder. Individuals with pyromania are fascinated with fires and my start fires to release pent-up emotions. People with kleptomania have an urge to steal things they do not need. While conduct disorder is more prevalent among males, kleptomania is three times more common among females.

Conduct Disorder In Adults/Children

Although conduct disorder usually affects older children and teenagers, onset may occur during a child’s preschool years. The DSM-5 defines two subtypes of conduct disorder:

  • Childhood-onset type – the child shows at least one criterion symptom of conduct disorder before the age of 10. Children with this subtype are at increased risk of criminal behavior, substance abuse, and antisocial personality disorder in adulthood.
  • Adolescent-onset type – the child does not show any criterion symptoms of conduct disorder before the age of 10. Youths with this subtype tend to achieve adequate occupational and social adjustment as they get older.

Conduct disorder is rarely diagnosed in adults as symptoms may remit by adulthood. However, adults may be given a diagnosis of conduct disorder if symptoms persist and the criteria for antisocial personality disorder is not met.

Example Case of Conduct Disorder

Megan, 16, visits a therapist with her parents after a referral from her doctor. Her father explains that her behavior has become very disruptive over the past 18 months. Megan has been caught shoplifting, setting fires in the school library, and skipping classes without permission. In the past year, she ran away twice. After speaking with Megan, the therapist learns that she has unprotected sex at parties. Megan’s father reveals she was suspended from school a week ago for fighting her classmate. The therapist diagnoses Megan with adolescent-onset type conduct disorder and recommends a combination of peer group therapy and social skills training. After 9 months of bi-weekly sessions, Megan reports better emotional control and improved relationships with her classmates, parents, and teachers.

Conduct Disorder

How to Deal/Coping With Conduct Disorder

Many therapeutic strategies have been developed to help youths cope with conduct disorder. When treating preadolescent children, parent training and family-based interventions have proven to be most effective. As children get older, they may try to individuate and separate from their family. Consequently, older children and teenagers may respond better to individual therapy and peer group therapy.

Look out for These Complications/Risk Factors

Children with conduct disorder tend to have lower academic achievement than their peers. They are also at higher risk of dropping out of school. Frequent behavior problems mean youths with CD have fewer friends and poorer relationships. They are more likely to display violent behavior, misuse substances, have legal problems, and contract sexually transmitted infections.

Children with oppositional defiant disorder are at higher risk of developing conduct disorder. Other risk factors that may contribute to the onset of CD include parents with addiction issues, sexual abuse, physical abuse, and family members with the condition.

Conduct Disorder Treatment

Psychotherapy (talk therapy) is the recommended treatment for conduct disorder. Different types of psychotherapy may be used depending on the specific circumstances of the child. Therapy may be presented in individual, group or family settings. Therapeutic approaches that have proven to be effective include:

  • Functional family therapy – teaches the family about CD and how to improve family interactions.
  • Social skills training – teaches the child how to initiate conversations, respond to others, make requests, and refuse requests.
  • Parent management training – teaches parents behavior management strategies to control aggressive conduct and promote safety.
  • Wilderness school and treatment interventions – offers an intensive therapeutic program that eliminates triggers and focuses on building positive behaviors.
  • Residential placement – provides a therapeutic environment and professional care for children with uncontrollable behaviors and helps keep the family safe
  • Medication – treats coexisting issues

Possible Medications for Conduct Disorder

There are no specific FDA-approved medications that treat conduct disorder. However, medications may be prescribed to treat co-occurring issues such as depression or ADHD.

Home Remedies to help Conduct Disorder

There are no home remedies that are clinically proven to help with conduct disorder.

Living with Conduct Disorder

Conduct disorder can disrupt a person’s school, work, family, and social life. Behaviors that may cause harm to people or animals require immediate professional care.

If your child has been diagnosed with conduct disorder, consider these strategies to improve your family life:

  • Model and promote the healthy behaviors you want your child to imitate
  • Set clear limits to help curb disruptive behavior
  • Establish daily routines
  • Praise your child for his/her positive behaviors
  • Do not overreact to challenges
  • Help older children to understand they are responsible for their conduct

Insurance Coverage for Conduct Disorder

Conduct disorder is a diagnosable behavior disorder. Your child’s insurance plan may provide coverage for this health condition. Call your child’s insurance provider to confirm coverage and obtain any authorization you may need before visiting a doctor or mental health provider.

How to Find a Therapist

Speak with your child’s physician or school guidance counselor if your child is showing symptoms of conduct disorder. They may be able to refer you to a licensed therapist who specializes in behavioral disorders.

What Should I be Looking for in an LMHP?

Your therapist should have training and/or clinical experience in treating behavioral disorders. He or she should relate well to adults and youths, without giving the impression of taking sides. As serious or embarrassing issues may be discussed, it is important for therapists to be direct, positive, and encouraging. Having a therapist who makes your entire family feel comfortable goes a long way toward successful treatment.

Questions to Ask a Potential Therapist

Questions you can ask your child’s therapist include:

  • Does my child have conduct disorder?
  • Which subtype of conduct disorder does my child have?
  • Are there any other co-occurring mental health conditions?
  • What factors contributed to my child developing conduct disorder?
  • Are there any long-term complications?
  • What adjustments may improve my child’s behavior?
  • How long will these behavioral issues last?
  • What treatment do you recommend?

Conduct Disorder Resources and Support Helpline

If your child is threatening to commit suicide or harm others, call any of the following numbers immediately:

  • 911 or your local emergency services number
  • The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a trained therapist

Conduct disorder can cause serious issues in the lives of young people. However, early intervention and effective psychotherapy can help affected youths control their emotions and learn the social skills they need to succeed.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Bressert, S. (2016, May 17). Conduct disorder symptoms. Retrieved from https://psychcentral.com/disorders/conduct-disorder-symptoms/

Conduct disorder. (2013). Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Conduct-Disorder-033.aspx

Connor, M. G. (2014, May 21). Understanding and dealing with conduct and oppositional disorders. Retrieved from http://www.oregoncounseling.org/Handouts/ConductOppositional.htm

Morin, A. (2018, May 26). What are the signs of conduct disorder in children? Retrieved from https://www.verywellmind.com/signs-of-conduct-disorder-in-children-4127239

Parekh, R. (2018). What are disruptive, impulse-control and conduct disorders? Retrieved from https://www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct-disorders

Oppositional Defiant Disorder

Oppositional Defiant Disorder: What does it mean?

Oppositional defiant disorder (ODD) is a psychological disorder characterized by frequent and persistent behavioral patterns of anger, irritability, defiance, and vindictiveness, usually of a child to parents or those in authority. Well-behaved children could occasionally prove stubborn and difficult, but this differs from ODD because in the latter situation, the pattern is more regular, frequent, and occurs for a long period of time, usually a minimum of six months.

The behavioral pattern in oppositional defiant disorder has three components: defiant behavior, obstinate behavior, and vindictive behavior.

Defiant behavior is characterized by deliberately refusing to comply with rules or requests of those in authority and blaming other people for his or her mistakes.

An obstinate behavior refers to a pattern of deliberately annoying others and being unnecessarily resentful and a vindictive pattern of behavior is one characterized by been spiteful or vengeful.

These symptoms must be present in a child within the past 6 months to make a diagnosis of ODD.

Studies show that oppositional defiant disorder has a prevalence rate of 1-11% in the general population. The condition is more common in boys than in girls, before puberty. However, after puberty, it occurs in both boys and girls equally. Oppositional defiant disorder has an age of onset of 8 years.

What Causes Oppositional Defiant Disorder?

Although the exact cause of oppositional defiant disorder is not known, there are certain factors which may contribute to its development.

Genetics – A child’s personality type and temperament contributes significantly to the development of ODD. In addition, certain problems in a child’s brain chemistry and function, such as poor emotional control, high emotional reactivity, and poor stress tolerance may affect a child’s risk of oppositional defiant disorder.

Environmental Factors – Environmental factors such as neglectful or harsh parenting, inconsistent parental discipline, abuse, and excessively authoritarian parenting may contribute to a child’s risk of developing the disease.

Signs and Symptoms of Oppositional Defiant Disorder

A child with oppositional defiant disorder is often confused for a strong-willed child. However, the persistence of the symptoms, impairing a child’s relationship with parents and other authority figures and, in turn, daily functioning at home and school creates a need for therapy.

Signs of ODD manifest in preschool years, although it may develop later in some individuals. However, in almost all cases, symptoms begin to manifest by the early teen years. These symptoms include:

  • Having frequent temper tantrums and aggressive outbursts.
  • Being easily irritated and offended
  • Being angry most of the time
  • Arguing frequently with parents and other adults
  • Disobeying requests or instructions given by an adult
  • Always questioning rules and disobeying them
  • Deliberately annoying others, including adults
  • Blaming others for one’s mistakes or misbehaviors.
  • Speaking aggressively and without considering the other’s feelings
  • Seeking revenge for anything done wrong to them

What are the Diagnostic Criteria for Oppositional Defiant Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines oppositional defiant disorder as a recurrent pattern of irritable/angry mood, argumentative/defiant behavior, or vindictiveness in an individual for a minimum of 6 months. An individual must have at least 4 of the following criteria to fulfill this diagnosis.

Angry/Irritable Mood

  • Often loses temper
  • Often touchy or easily annoyed
  • Often angry and resentful

Argumentative/Defiant Behavior

  • Often argues with authority figures or with adults (if a child or adolescent)
  • Often actively defies or refuses to comply with requests from authority figures
  • Often deliberately annoys others
  • Often blames others for his or her mistakes or poor behavior

Vindictiveness

  • Has been spiteful or vindictive at least twice within the past 6 months

These symptoms are distinguishable from behaviors that are developmentally normal for children of different ages: for children younger than 5 years, these symptoms should occur on most days; for children 5 years or older, the symptoms should occur at least once per week.

Furthermore, these symptoms may occur at home, in the community, at school, with peers, or in all settings. Mild ODD is characterized by the presence of symptoms in only one setting, moderate ODD occurs with symptoms in at least two settings, while severe ODD is characterized by the presence of symptoms in three or more settings.

Oppositional Defiant Disorder and Other Conditions

The symptoms of oppositional defiant disorder closely overlap with several other disorders and it is essential to differentiate them clinically.

Oppositional Defiant Disorder vs. Conduct Disorder

Both oppositional defiant disorder and conduct disorder have several similarities. However, conduct disorder is an extreme psychological disorder characterized by the violation of others’ rights and societal norms. The symptoms of conduct disorder are typically more extreme than those of oppositional defiant disorder and include aggressive behavior toward people and animals, physical fights with others, physical cruelty to animals, deliberately destroying property, and using a weapon that could cause harm on self or others.

Oppositional Defiant Disorder vs. Intermittent Explosive Disorder

Both disorders have a number of similarities, however, while the symptoms of intermittent explosive disorder typically manifest in late adolescent years, the symptoms of oppositional defiant disorder manifests earlier, at the age of 8. Another key difference between both conditions is that symptoms of intermittent explosive disorder are not pre-meditated and usually occur within 30 minutes, after which the patient feels guilt and remorse. Typical symptoms of intermittent explosive disorder include short episodes of symptoms of aggression such as tremors, restlessness, rage, and racing thoughts, as well as aggressive outbursts characterized by temper tantrums, shouting, physical fights, destruction of property, heated arguments, and threats which are out of proportion to the inciting situation.

Related Disorders

Attention-deficit hyperactivity disorder is a common comorbidity in patients with oppositional defiant disorder. Children with ADHD are particularly vulnerable to developing ADHD in the presence of environmental risk factors including harsh parenting and inconsistent punishment. Studies reveal that half of the children with ADHD have oppositional defiant disorder. Other conditions related to oppositional defiant disorder include antisocial personality disorder which is characterized by persistent rebellious behavior, lack of remorse, and gross social irresponsibility.

Oppositional Defiant Disorder in Adults/Children

Oppositional defiant disorder usually manifests at the age of 8 and is among the commonest mental health disorders in childhood. Although the symptoms may remit spontaneously as the child grows, about 50% of children with ODD may continue experiencing symptoms through adulthood. Some of these adults may go on to develop antisocial personality disorder.

Example Case of Oppositional Defiant Disorder

John, a 5-year-old boy is brought to the clinic by his parents on account of his temper tantrums at home and in school. The parents noted that John is always arguing with them when they give him an instruction, and he eventually refuses to carry out the tasks he is asked to do. They also noted that when they try to discipline him by removing his desert privilege, he becomes very aggressive, breaking his toys and tearing his school notes. The parents affirmed that they thought it was just a “childish” behavior, but he exhibits the same behavior in school and has resulted in poor performance and several bad reports from his teachers.

Oppositional Defiant Disorder

How to Deal with Oppositional Defiant Disorder

Oppositional defiant disorder is a complex disorder which is common among children. Symptoms may spontaneously remit over time or may progress into adulthood. Risk factors for oppositional defiant disorder to look out for include:

  • Temperament – A child with a temperament which is characterized by difficulty control his or her emotions or being unable to endure stress or frustrating situations has a high risk of developing oppositional defiant disorder.
  • Poor parenting – A child who experiences parental neglect, harsh parenting, or physical abuse from parents has a high risk of developing oppositional defiant disorder. In addition, a child who lives with a parent with mental health issues or substance abuse disorders is likely to develop oppositional abuse disorder. Positive parenting is, therefore, essential in improving behavior and preventing complications.
  • Environmental factors – Oppositional defiant disorder can be exacerbated by inconsistent discipline from authority figures.

Oppositional and defiant behavior often begins with mild symptoms which may progress to causing serious complications which include:

  • Poor school performance
  • Poor social relationships and antisocial behavior
  • Substance use disorder
  • Suicidal tendency.

Oppositional Defiant Disorder Treatment

Children with ODD show significant improvement with early treatment, and this could restore the child’s self-esteem, positive attitude, and rebuild positive social relationships. Treatment for ODD includes the use of certain medicines, parental training, personal and family therapy, and parent-child interaction therapy.

Possible Medicines for ODD

Medicines are not often used in treating ODD, as the mainstay of treatment is therapy. However, children with co-occurring disorders such as ADHD may be treated with agents such as Ritalin, Dexmethylphenidate, and antidepressants including imipramine.

Home Remedies to Help ODD

In addition to clinical therapy instituted by your doctor, the following home strategies may help improve your child’s symptoms:

  • Recognize and reward your child’s positive behaviors. The rewards should be specific and consistent.
  • Model the desired behavior – Modeling appropriate social behavior which you desire in your child may help them improve their behavior and social relationships.
  • Set clear boundaries – Behavioral patterns should be limited by clear boundaries and the consequences should be consistent so the desired behavior is reinforced.
  • Spend time together – creating a consistent and regular schedule for spending time with your child may help in improving their behavior.
  • Assign tasks – Give clear instructions for your child to carry out tasks which will not be done if the child does not do it.

Living with ODD

It may be challenging dealing with a child with ODD. Parents, tutors, and other adults who take care of such children need to be patient with them and work together to ensure the inappropriate behavioral pattern is eliminated.

  • Parents and other family members may also seek the help of a therapist to learn coping strategies to help them overcome the emotional distress which comes with being a parent of a child with ODD.
  • Build supportive relationships which would help you acquire coping strategies and help provide support for the child.

Insurance Coverage for ODD

Check your insurance plan benefits for coverage of mental or behavioral health services. You may inquire through your human resources unit for employer-sponsored health coverage for treatment of this condition or contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access the mental health services under your insurance plan.

How to Find a Therapist

After an initial evaluation, your primary care physician will refer your child to a psychiatrist or child psychologist for therapy. You may also ask friends and family for good therapists, or check through online resources and directory to find the right therapist for you.

What should I be looking for in a Licensed Mental Health Professional (LMHP)?

Qualities you should look for in an LMHP include:

  • Good Communication Skills: An effective LMHP should be able to effectively communicate their expert ideas about your child’s symptoms effectively.
  • Empathy: You do not want a counselor who would rush through medical facts without considering your emotional needs or the needs of your child. You need an LMHP that is considerate, patient, calm, and compassionate with you.
  • Problem-Solving Skills: Your chosen LMHP must be knowledgeable enough to help you through to a satisfactory resolution of your child’s symptoms. While your child’s remission is not entirely up to your counselor, they must demonstrate ample ability to help manage your symptoms effectively.
  • Good multicultural Relationship: Your counselor must be able to strike a strong patient-therapist relationship with you and your family irrespective of your racial, ethnic, or cultural differences. Therapy must be devoid of such prejudices which may hamper on the effectiveness of treatment.

Questions to ask for Potential Therapist

You should ask a potential therapist the following questions to help you gain more insight into your symptoms and the scope of your treatment options.

  • What do you think is causing my child’s symptoms?
  • How will the diagnosis be determined?
  • Does my child have oppositional defiant disorder?
  • Is the condition self-limiting or chronic?
  • What factors contribute to the problem?
  • Does my child require screening for other mental health disorders?
  • What are the likely complications of this condition?
  • What is the treatment approach you recommend?
  • How long will therapy be for, if necessary?
  • What medications will my child be on?
  • What side effects should I expect from those drugs?
  • Should I inform my child’s school teachers about the diagnosis?
  • Are there effective strategies to use at home and school to improve my child’s behavior?
  • Do you recommend family therapy?
  • Are there any resources or websites you recommend?

Oppositional Defiant Disorder: Overview

Oppositional defiant disorder is a chronic psychological disorder characterized by at least 6 months duration of a child demonstrating angry and irritable mood, defiant behavior, and vindictiveness. Oppositional defiant behavior may remit spontaneously or require medications for comorbidities and sessions of family therapy, parent-child interaction therapy, and parental training.

Resources

https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

https://emedicine.medscape.com/article/918095-overview?pa=VHBMDPEH9oTIMFc1J11foa4cNqTJAgJTl2n0aSltiYsubVgPPj%2BYZdBteA84GyM743mU9jD%2B1DtnxY47OmyybA%3D%3D#a1

https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/oppositional_defiant_disorder_90,P02573

https://www.verywellmind.com/signs-of-conduct-disorder-in-children-4127239

https://www.aafp.org/afp/2008/1001/p861.html

 

 

Intermittent Explosive Disorder: Clinical Anger Issues

Do know someone who occasionally seems to explode with anger and even aggression? Of perhaps you sometimes feel full of rage that seems disproportionate to the situation, but is also difficult to control? Such symptoms may be signs of intermittent explosive disorder. This is a little known mental health condition that requires psychological treatment to eliminate the symptoms and improve functioning:

Intermittent Explosive Disorder: What Does It Mean?

The primary symptom of intermittent explosive disorder is repeated and sudden impulsive episodes of anger, aggression, and even violence. There may be yelling and throwing or breaking objects. The reaction may be in response to some situation, but it is typically out of proportion to that situation. This may appear in incidents of road rage and even domestic abuse. In younger people, this might appear like a temper tantrum. Such behaviors often cause problems at home, work, and school.

Stats: How Many Suffer from This Disorder?

Intermittent explosive disorder is diagnosed in approximately 7.3% of adults and is more common among men. Approximately 67.8% of these individuals have some history of direct aggression towards people or objects. Most have a history of exposure to violence, abuse, or other traumas.

What Causes Intermittent Explosive Disorder?

Intermittent explosive disorder has no one known cause. Research suggests several biological and environmental factors may contribute to the development of it. Biological factors include genetic predisposition and brain chemistry, with certain neurochemical imbalances playing a role. Environmental factors may include growing up in a family where they witnessed explosive behavior and/or experienced physical abuse. Seeing such violence makes it more likely a person will replicate it.

Signs and Symptoms of Intermittent Explosive Disorder

As noted, the primary symptom of intermittent explosive disorder is the episodes of anger and aggression. These episodes typically occur with impulsively from the person. The episode may seem quite sudden and there is usually no warning that any such behaviors are about to occur. On average, the episodes will last less than 30 minutes. An episode could occur frequently or rather infrequently, even weeks or months apart. Episodes may also occur to varying degrees.

What are the Common Behaviors/Characteristics?

Individuals with intermittent explosive disorder may seem irritable all the time. People who interact with that person might come to view them as chronically angry. Even when not in an explosive episode, these individuals might appear impulsive and aggressive.

Just prior to an episode there might be increased irritability and rage. The person may experience racing thoughts and excess energy. They may also have physical symptoms such as tingling or tremors, palpitations, and chest tightness.

During an explosive episode, the person may demonstrate verbal tirades, heated arguments, shouting, and physical violence. Such violence might include shoving, pushing, and slapping. This could potentially escalate to a full physical fight and property damage.

Individuals with intermittent explosive disorder may feel some relief after the episode. They may also be quite tired. Later, there may be feelings of embarrassment, regret, and remorse.

Testing: What are the Diagnostic Criteria Per the DSM-5

If you are concerned about your own behavior or the behavior of a loved one, then you will want to seek help or encourage that person to seek help. Visiting a mental health provider is recommended. Typically, the provider will want a physical exam to rule out physical problems and substance abuse as a cause. Then, a psychological evaluation will be used to identify the relevant symptoms, thoughts, feelings, and behavior. This information will be used to make a formal mental health diagnosis. To assign a diagnosis, mental health professionals must use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents these criteria to define conduct disorder:

  • Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.
  • The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.
  • The aggressive behavior is not better account for by another mental disorder.

If an individual meets the criteria, then the diagnosis of intermittent explosive disorder may be assigned.

Intermittent Explosive Disorder and Other Conditions

When making any diagnosis, a mental health professional must also rule out other similar conditions:

Intermittent Explosive Disorder vs Conduct Disorder

Individuals with conduct disorder may show aggression and outbursts like those seen in intermittent explosive disorder. However, the latter condition tends to have more impulsive outbursts, while conduct disorder includes behaviors that are more often planned or premeditated. Conduct disorder also includes many other symptoms required for diagnosis.

Intermittent Explosive Disorder vs Oppositional Defiant Disorder

Oppositional defiant disorder is most often seen in children. Just as the name implies, these children tend to be oppositional and defiant towards authority figures. They may also seem irritable. Like intermittent explosive disorder, it is an impulse control disorder. However, in intermittent explosive disorder there are more outbursts of anger and aggression.

Related Conditions

Intermittent explosive disorder might sometimes appear like a manic episode. The distinction might be the degree of anger that is expressed in an explosive episode, whereas in manic episodes there may be more euphoria. Intermittent explosive disorder may also appear like borderline personality disorder. In individuals with borderline personality disorder, there is difficulty managing emotions. However, this condition is accompanied by many other symptoms that are not necessarily seen in intermittent explosive disorder.

Intermittent Explosive Disorder in Adults/Children

Intermittent explosive disorder is believed to typically begin during the teen years. However, in children, such symptoms may just seem like temper tantrums and may go undiagnosed. It is once the teen years occur that the behaviors seem less appropriate and more concerning to parents.

Example Case of Intermittent Explosive Disorder

Consider this example of IED to see if it reminds you of yourself or someone you know:

Rick often finds himself easily frustrated. Sometimes that frustration is so strong it feels like a rage. He often gets angry in traffic and is known for his expressive road rage, which typically includes yelling and some cursing. When he is frustrated at home he might yell and may even hit things. One time he punched a hole in the wall. These behaviors always sudden and impulsive.

Intermittent Explosive Disorder

How to Deal/Coping with Intermittent Explosive Disorder

Individuals with intermittent explosive disorder may not initially see themselves as having any problem. During the explosive episodes they are usually acting impulsively and without giving their actions much thought. After the episodes they may regret them. They may also struggle with the consequences of their actions such as impaired interpersonal relationships and legal problems.

Look Out for These Complications/Risk Factors

Many people develop intermittent explosive disorder as a result of being exposed to violence or experiencing other traumatic events. Although these experiences are difficult to entirely prevent, therapy to address the lingering feelings from such experiences and their current effects may be helpful in reducing the intermittent explosive disorder symptoms.

Additionally, people with intermittent explosive disorder are also more likely to have other mental conditions including antisocial personality disorder, borderline personality disorders, and ADHD. The symptoms of those disorders can exacerbate the symptoms of intermittent explosive disorder. Again, therapy can help to teach people how to manage all their symptoms.

The symptoms of intermittent explosive disorder can also be exacerbated by low mood and anxiety, so these conditions would need to be similarly managed. Individuals with intermittent explosive disorder are more likely to abuse alcohol and drugs, which is problematic because substances can also make it more difficult to control the behaviors associated with the disorder.

Those who have the disorder often have difficult relationships with others because of their episodes, which can later them feeling isolated and depressed. The disorder is associated with health problems, including high blood pressure and heart problems. A history of intermittent explosive disorder is also associated with self-harm and suicidality, which necessitate treatment.

Intermittent Explosive Disorder Treatment

Individuals who have intermittent explosive disorder need to manage the disorder by taking measures to prevent the problematic episodes. Therapy is essential for learning methods to manage the disorder. In therapy you might learn new ways of thinking, new ways to solve problems, new ways to communicate, and new ways to relax. These skills can help to prevent and manage explosive episodes.

Possible Medications for Intermittent Explosive Disorder

Depending on the specific symptoms and circumstances, various medications might be prescribed to help manage intermittent explosive disorder. Certain antidepressants, anticonvulsant mood stabilizers, and other drugs may all be considered by your providers.

Home Remedies to Help Intermittent Explosive Disorder

Intermittent explosive disorder is not typically addressed well with just home remedies. Therapy is needed to learn how to manage anger and how to express emotions in better ways. Once those approaches are learned in therapy, it will be key to practice them at home. Other helpful measures will include avoiding substances and practicing general relaxation techniques.

Living with Intermittent Explosive Disorder

Individuals who have intermittent explosive disorder may experience some distress if they feel regret or remorse for their actions. They may also experience distress in response to the consequences of those actions (such as loss of relationships and/or effects on their workplace standing). Others who interact with the individual may also experience distress, especially if that person does become violent. It can be helpful for loved ones to also receive therapy and identify steps they will be able to take to keep themselves safe during those explosive episodes.

Insurance Coverage for Intermittent Explosive Disorder

Mental health and medical providers consider intermittent explosive disorder a mental health condition. When someone has this condition and receives a formal diagnosis, it is likely that health insurance will cover any necessary counseling or therapy. Call your insurance company to ask about it. Your provider’s office may also be able to assist with checking about coverage.

How to Find a Therapist

If you are concerned about your own or someone else’s emotional outbursts, you might start by asking your medical provider to refer you to a mental health provider. You can also search online for therapists in your location, using the name of your city/state. You can research providers online and even read reviews to ensure your prospective therapist seems like the right fit.

What Should I be Looking for in an LMHP?

When seeking out a mental health provider for intermittent explosive disorder, you will certainly want to make sure that they are trained and licensed in their respective field. You will also want to find a provider who is specially trained to work with emotional disorders. It is even better if they specifically have experience working with intermittent explosive disorder.

Questions to ask a Potential Therapist

When meeting with a potential therapist, ask about their training and experiences working with intermittent explosive disorder. You may also want to ask about their typical approach to therapy and how they would plan to address your symptoms. You may also want to ask how they plan to measure progress and how long they anticipate the course of therapy might last.

Intermittent Explosive Disorder Resources and Support Helpline

There are resources online regarding intermittent explosive disorder that may be helpful:

  • Psychology Today is a website with a search tool for local mental health providers.
  • SAMSHA has a provider locator to find local and low-cost treatment options.

If you have questions about your mental health or the mental health of a loved one, consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline. If you have symptoms that seem difficult to live with and experience suicidality, consider calling the Suicide Prevention Lifeline. If you are in a relationship with someone who has intermittent explosive disorder and have experienced domestic violence or abuse, consider using the domestic violence hotline for support.

Although the symptoms of intermittent explosive disorder can be difficult to deal with and may have repercussions for your life, it is a diagnosable condition and help is available. Consider seeking therapy and other mental health support so that you can improve your life and your relationships.

Silent Childhood Anxiety: Selective Mutism

Selective Mutism: What Does It Mean?

Selective mutism is a childhood anxiety disorder that causes a child to be unable to speak in certain situations. It is usually social settings, such as school, in which a child cannot communicate. It’s usually a result of severe anxiety or shyness.

For some selectively mute children, they are unable to communicate at all in social settings. Others may whisper or only be able to talk to particular people.

Definition of “Selective”

Selective means to affect some things but not others. In the case of selective mutism, this means that it is only particular settings that cause a child not to speak, rather than a total inability to speak. In all other settings, the child will be able to communicate.

The use of the word ‘selective’ does not mean that the child has the ability to select to speak or not speak, nor which settings to do so in. It is a much more complex process and the child is not intentionally choosing their behaviors.

Stubborn or Sick?

It is due to the selective nature of this disorder that selective mutism has been misinterpreted as stubbornness. The condition has often been misinterpreted by teachers and parents because the child has spoken at home but not at school or vice versa. This has lead to the adult believing that the child is purposely being ‘difficult’ or ‘defiant’.

Although in recent years there have been several studies in selective mutism, information is still lacking compared to other childhood disorders. A lack of information often means a lack of awareness and this is probably the true cause behind the misunderstanding of selective mutism symptoms.

Stats: How Many Suffer from this Disorder?

Studies suggest that selective mutism is a relatively rare condition, affecting between 0.47 to 0.76 of the population. Some studies indicate that it is slightly more common in females than males, although this is disputed by other studies so it’s not completely clear which are correct.

Children are normally diagnosed with the condition between the ages of five and eight, although symptoms usually begin earlier, as young as three years old.

Of children who are being treated in behavioral health settings, 1% have selective mutism. A 2005 study found that selective mutism was more prevalent in immigrant children and children who are in the language-minority of the area.

What Causes Selective Mutism?

The causes of selective mutism are not 100% agreed upon in the scientific community. In fact, they are frequently disputed and research results can often be contradictory. However, the following causes outlined are the most widely accepted reasons at present.

Suffering from severe anxiety or a social phobia is extremely common in children later diagnosed with selective mutism. In fact, over 90% of children with selective mutism also have social anxiety or a social phobia.

A genetic disposition to anxiety has been found in the majority of children diagnosed with selective mutism. In other words, one or more close family member of the child will have a tendency to be anxious. Of these children, the symptoms of severe anxiety are usually present from infancy: shyness, sleeping difficulties, separation anxiety etc.

There may be an environmental link to developing the disorder. Some research has found that children with reduced opportunities for social contact or who have had avoidance behaviors reinforced are more likely to develop anxiety related speech problems.

Shyness or having a timid nature has been linked to children with the disorder, although this is often disputed.

There is no evidence that selective mutism is caused by experiencing a trauma or suffering from abuse or neglect.

There is not one single cause identified for selective mutism and research seems to point towards causes being multifactorial rather than by a singular factor.

Signs and Symptoms of Selective Mutism

What are the Common Behaviors/Characteristics?

Aside from the inability to speak in particular settings, Selective Mutism Center lists the following symptoms as the most common characteristics:

Temperamental Inhibition: A tendency to be shy and timid in new and unfamiliar situations. The child will often have had separation anxiety from infancy.

Social anxiety: Being extremely uncomfortable in any social situations, including meeting new people, having any attention brought upon them in a group setting, or being teased. The child may be scared to eat in front of other people or may urinate due to their fear.

Social Being: Children with this disorder do still have a normal need for socializing and having friends, despite their condition. They may have several close friends that they can communicate with, either in a group setting or in one-to-ones.

Physical symptoms: Some of the physical symptoms associated with selective mutism include headaches, vomiting and shortness of breath. They may experience feelings of anxiety and fear and therefore all the associated physical symptoms of these feelings.

Appearance and body language: A child with selective mutism can often appear ‘frozen’ in body language. They can be expressionless and their body stiff. This is especially true for younger children with selective mutism as often the ‘frozen’ body language will lessen with age or be less present in an older child who develops selective mutism.

Emotions: A younger child with selective mutism will often not show any signs of being upset at their condition, perhaps because of a lack of self-awareness and also that younger children are more accepting/ unaware of social differences. An older child with the condition may become upset at their condition.

Other emotional behaviors displayed may include frequent tantrums, mood swings, being withdrawn and acting out.

Developmental Delays: Some children with selective mutism also have developmental delays in communication, motor skills and social development.

Sensory Processing Difficulties: There are some professionals who believe that a sensory processing disorder may be the underlying cause of selective mutism. They theorize that too much sensory input causes the child to ‘shut down’ which explains why the condition is so commonly present in busy settings such as the classroom.  Symptoms of sensory processing issues include covering eyes from bright lights, holding hands over ears to block out noise and being a very picky eater and sensitive to fabrics and touch.

In the classroom: Children with the condition will often seek out their own space in a classroom, staying away from the crowd. They will usually play alone or not at all. They may have difficulties in following instructions or staying focused.

Testing: What are the Diagnostic Criteria Per the DSM 5?

  • The child shows consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school), despite speaking in other situations.
  • The disturbance interferes with educational or occupational achievement or with social communication.
  • The duration of the disturbance is at least 1 month (not limited to the first month of school).
  • The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  • The disturbance is not better explained by a communication disorder (e.g., child-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Selective Mutism and Other Conditions

Selective Mutism vs Social Anxiety Disorder

Although the conditions can often be co-present, not all children with selective mutism will be diagnosed with social anxiety disorder.

Many children with social anxiety disorder will not display any of the symptoms of selective mutism or may only display some for a short period of time.

Likewise, although a child with selective mutism may show signs of anxiety, sometimes the anxiety will fade or completely go away whilst the selective mutism continues.

Social anxiety disorder is a complex condition and medical professionals will be careful to distinguish between the two when diagnosing.

Related Conditions

There are many other conditions associated with selective mutism and most are connected to anxiety and/or developmental or learning disabilities.

A child with the disorder will often also have co-existing conditions such as enuresis (urinating themselves), encopresis (soiling themselves), obsessive-compulsive disorder, depression, other language abnormalities, developmental delay, and Asperger’s disorders.

Panic disorders, social phobias, and extreme anxiety are often present.

Research suggests that nearly 40% of children diagnosed with selective mutism will also have experienced speech and language difficulties.

Selective Mutism In Adults/Children

Selective mutism is mostly a childhood disorder and is usually diagnosed in childhood years. However, if not treated properly or not diagnosed, the condition can continue on into adulthood.

It is believed that most children with the disorder develop coping mechanisms and methods that overcome the mutism symptoms. Even if the child grows up to suffer from a related disorder such as social phobia or anxiety disorder, often they will have learned to communicate sufficiently in social settings.

Example Case of Selective Mutism

Adopted from Selective Mutism Foundation testimonial by Dr. Wong in Selective Mutism: A Review of Etiology, Comorbidities, and Treatment:

“Chloe’s parents knew something was wrong when they were told by the four-year-old’s preschool teacher that she had spoken in school that day for the first time after attending preschool for almost eight months. When Chloe entered the classroom, she appeared hesitant and self-conscious and avoided eye contact. She would engage in an assigned task, but not with other children. Her comfort level dropped in a larger group, and she would not interact with the others in a group. If the other children talked to her, she would turn away.

She also did not speak in church or with distant family members, but she was a chatterbox at home. In elementary school, it was not until third grade that Chloe spoke to her teacher for the first time after a devoted teacher did behavioral therapy exercises with her in the summer and prior to and after school. Now in fourth grade, Chloe has made much progress and recently read a report on video. Chloe’s battle with this disorder is not completely over, but she has made tremendous progress.”

Selective Mutism

How to Deal/Coping With Selective Mutism

If a parent, teacher or guardian notices any signs or symptoms of selective mutism it is important to be proactive about seeking further advice. Avoid pressuring the child as this can worsen symptoms of anxiety and could reinforce the issues at hand.

For a child with selective mutism, there are

Look out for These Complications/Risk Factors

The main risk factors associated with this disorder is the development of similar anxiety disorders and further phobias. Treatment is necessary to avoid progression of the disorder into teenager years and adulthood.

A fear of speaking at school could affect a child’s education, either by lack of educational progress or through an avoidance of school altogether. A lack of social interaction could also have negative consequences, such as becoming withdrawn and lonely.

Selective mutism disorder could have an impact on a child’s self-esteem and confidence and this is an area that should be specifically worked on in treatment and in school.

Selective Mutism Treatment

Treatment for selective mutism will be an individually tailored program but there are certain therapeutic treatments are usually used: medication-based treatment and non-medication treatment. Early intervention is paramount to a full recovery so don’t hesitate to seek professional guidance.

Psychodynamic therapy, sometimes referred to as play therapy, is a popularly prescribed treatment. The reason why it’s particularly useful for this disorder is because it’s an extremely non-threatening approach and gives the child a lot of freedom.

Another common approach is the use of behavioral therapy. It usually includes using techniques such as reinforcements, non-verbal play and a slow, subtle introduction to social situations.

Medical professionals may also recommend family therapy, usually in conjunction with other therapies. There hasn’t been much research into the benefits of family therapy for this condition but it has proven effective for other similar conditions.

Possible Medications for Selective Mutism

Research is ongoing into medications for selective mutism but currently, selective serotonin reuptake inhibitors (SSRIs), particularly fluoxetine, have been shown to have some success.

Home Remedies to help Selective Mutism

There isn’t a particular home remedy recommended for selective mutism. Instead, families should closely follow the advice of a mental health professional which will often include suggestions of methods that the family can use at home.

Living with Selective Mutism

For the child with selective mutism, life can be really scary. Going to school, visiting family or going to a playground are all common activities that may trigger their condition. As a result, they may develop severe fears of these places.

A child may also be very frustrated by the condition and/or develop very low confidence. Childhood should be a time of playing, joy and happiness so it’s important to get help quickly so the child can recover.

Insurance Coverage for Selective Mutism

Your insurance provider should have a policy for childhood mental health conditions such as selective mutism. Every insurance provider is different so it’s recommended to contact yours directly and request full information on their policies.

How to Find a Therapist

What Should I be Looking for in an LMHP?

When searching for a LMHP, it’s a good idea to do some research first. Search for the state’s laws on accreditation and make a note of the qualifications you should be looking for. Remember to specify in your search that it’s for a child. You can also the Psychology Today website to find recommended therapists (link below)

You can also ask your physician for a few recommendations but don’t feel pressured if you don’t want to use any of their services.

Questions to Ask a Potential Therapist

Ask a therapist if they have ever worked with a child with selective mutism or an anxiety disorder. Check what treatment they would normally use and why. Ask for their success rate/average treatment time length.

Request references from previous families who have undergone similar treatment. You may also find references online with a means to contacting the referee.

 

Selective Mutism Resources and Support Helpline

Crisis Text Line: Text 741741

Selective Mutism Foundation: [email protected]

Help With Talking: https://beta.helpwithtalking.com/

Selective Mutism: [email protected]

 

 

 

 

 

 

 

 

What is Maladaptive Daydreaming?

Have you ever found yourself sitting at the bus stop, waiting in the supermarket queue, maybe stuck in a dull meeting, and realized your mind was wandering off? Daydreaming is just one of those things people do. But if you find that your fantasies are starting to get in the way of real life, that could be maladaptive daydreaming.

Although it isn’t an officially recognized mental illness, maladaptive daydreaming has been noted by some psychologists.

Maladaptive daydreams are more than just our mind wandering when we’re bored. They’re absorbing, full-blown fantasies that blur your connection with reality slightly.

And while it’s nice to start imagining just what the sand will feel like on your next beach holiday, or put yourself in the shoes of your favorite TV protagonist who’s just about to hook up with that cutie, sometimes it can become a problem.

So let’s take a look at what maladaptive daydreaming disorder (or MD) actually means.

What Exactly Does Maladaptive Mean?

Adaptive behaviors are the set of skills and actions we learn and use to function in daily life and social situations. They’re things as simple as getting dressed in the mornings or catching the bus, to having conversations. These behaviors allow us to meet the challenges of daily life, however small or large they might be.

When you add the prefix “mal” on it becomes the opposite. This Old French word means something bad or wrongful. Maladaptation, therefore, is an inability to cope or manage a situation or circumstance in an appropriate or constructive way.

Maladaptive behaviors are actions that undermine. In some cases, they can even be destructive. They’re often developed as coping mechanisms for certain situations, and tend to be ways of avoiding challenges rather than facing them.

Just like adaptive behaviors, these can be simple things like nail-biting. When we’re stressed, some of us might nibble at our nails as a way to release the tension. Although it doesn’t have any major negative impact, it’s not really socially acceptable and it’s also not great for our fingers.

There are more extreme examples which might be associated with mental disorders or stem from negative experiences like childhood trauma. For example, avoidance coping is when a person avoids stressful thoughts or feelings to protect themselves from psychological hurt. This actually ends up creating more stress and anxiety. More extreme examples could include self-injurious behavior, eating disorders, and substance abuse.

Daydreaming usually isn’t as disruptive as some of these extreme behaviors, but when it starts to

So What Exactly is a Daydream?

Daydreams are thoughts not quite linked to reality. They take place in waking time and, although the individual daydreamer is aware that it’s not reality, they can become quite absorbed in the characters and fantasy.

The type of daydreams we’re referring to here generally aren’t just errant thoughts, planning what’s for dinner or how to fit your power weight class into your busy schedule.

They’re the more involved type when your contact with reality is temporarily blurred as your mind explores an alternative fantasy. Often this has strong visual elements and it tends to be focused around pleasant thoughts, hopes, and ambitions. Individuals with a fantasy-prone personality are more likely to find themselves slipping into these intense daydreams.

You’re probably not alone if a parent, teacher, or someone else with authority has told you “Stop daydreaming!” It can get a bit of a bad rap in general, but the truth is it’s not bad by default.

Daydreaming can be a useful way for us to express our creativity and let our brain sort through thoughts and ideas. It can give us a break from everyday life and give us time to explore our own desires or to work out what’s important to us for in future.

It’s only when daydreams become disruptive to you living your daily life when you could really consider them to be maladaptive. You might find that:

  • You’re using daydreams to avoid or escape dealing with real-life situations.
  • Daydreaming is getting in the way of participating in ordinary life.

The Symptoms of Maladaptive Daydreaming

Like we mentioned, this is not an officially recognized disorder or mental condition. In part, its lack of official status is due to the difficulty of pinning down what daydreams are. Because it has less of an impact on mental health than some other disorders it’s also had less attention.

While there’s no official list of symptoms, there are definitely signs to identify excessive daydreaming behaviors.

  • Your daydreams are very vivid and very immersive. It could be like being in a private movie running in your head. These fantasy worlds may have their own characters, settings, and plots that are totally unrelated to where you are at the time.
  • Your daydreams last for a long time and it’s difficult to break out of them. There’s often the temptation to stay in them, even when you become aware you’ve been fantasizing for a little while.
  • Your daydreams get in the way of completing everyday tasks and start to disrupt day-to-day life.
  • You might choose daydreaming over human interaction.
  • Sometimes other things happening in real life – like listening to music, reading a book, or even hearing people having a conversation – will set you off into your fantasy world.
  • Your sleep is disrupted.
  • You might suddenly become aware that, while daydreaming, you’ve been making repetitive movements unconsciously – like rocking back and forth or twitching. Or you might make facial expressions while you daydream. There can be some similarity to obsessive-compulsive symptoms.
  • Your attention span might be shorter than previously.

There are similarities between maladaptive daydreaming and symptoms of some psychiatric disorders, especially those which involve detachment from reality and becoming absorbed by fantasy. Despite this, someone with maladaptive daydreaming tendencies will still be aware that their dreams are not reality (however much they might like them to be).

Some people who experience maladaptive daydreaming might also experience other issues. This can include Attention Deficit Hyperactivity Disorder (ADHD), dissociative identity disorder, depression, and obsessive-compulsive disorder (OCD).

Maladaptive Daydreaming

A DIY Test

There is actually a maladaptive daydreaming scale for measuring how maladaptive your fantasy tendencies might be. Professor Eliezer Somer of the University of Haifa in Israel came up with a 14-part scale for identifying maladaptive daydreaming. It rates and ranks five main characteristics of daydreams:

  • The content and detail of dreams
  • The person’s ability to control their dreams (as well as their desire to dream)
  • The perceived benefits of daydreaming
  • The distress caused by daydreaming
  • The extent to which the daydreams interfere with the ability to carry out daily activities.

If you just want something a little simpler, you can use these eight statements as a reference point:

  • I’ve lost hours or days fantasizing, sometimes without even realizing I was daydreaming.
  • The imaginary characters, world, and storylines from my daydreams are elaborate enough that they could be a movie or TV show.
  • I have sometimes lost sleep, skipped meals, or neglected other needs because of my daydreams.
  • I often find when I watch films, read books, or listen to music I start daydreaming.
  • I make facial expressions while I daydream, or sometimes find myself making repetitive movements.
  • I miss deadlines or fail to complete important tasks because of my fantasizing.
  • I often loose time I should be spending with family, friends and other people to my daydreams.
  • My daydreams make it hard for me to focus on my job, schoolwork, or other tasks that require concentration.

If you answered yes to at least five of the questions, you may have MD.

Dealing with Maladaptive Daydreaming

There is a range of ways you can start to deal with the disruption daydreaming may be causing in your life.

If you’ve been tired, finding ways to get more sleep and banish fatigue can help. Make your sleeping time precious and protect it. Aim to get either more sleep or find ways to increase your sleep quality. Stick to a schedule, do something calming at least an hour before bed, and stay away from blue screens. Oh – it might also be a good idea to avoid those tempting afternoon stimulants like caffeine.

Let other people know you’ve been daydreaming a bit too much and would like to kick the habit. Tell your friends what the symptoms are, and invite them to interrupt you if they notice it happening.

You can also try to keep track of what sets off daydreaming sessions. When you know what the triggers are, you can either avoid them or simply be more aware of your behavior at those times.

Therapy can sometimes help, especially with identifying triggers and finding techniques for managing and coping. If there’s something you’re avoiding in your life, it may be time to face it. Cognitive behavior therapy can be useful to work out what the underlying causes may be.

When it comes to medication, we suggest trying other techniques first. It’s very rare that daydreaming will be severe enough to deserve medication. Really, it’s a much better idea to try other approaches first. Medication won’t solve the problem, just help manage it.

Don’t Give Up Your Dreams

If your daydreams are disrupting your life, it’s a problem – just like anything else. But remember, you don’t necessarily have to give up your dreams and fantasies, just find a way to keep the balance in check. Daydreaming can be a great outlet for our minds.

Orthorexia Nervosa

What is Orthorexia Nervosa

Orthorexia nervosa is a condition that involves an unhealthy obsession with proper or healthy eating habits. The definition of orthorexia comes from the Greek word meaning “correct diet.” While orthorexia nervosa is not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) (though it can be covered under the diagnosis of Unspecified Feeding or Eating Disorder), orthorexia is recognized by the National Eating Disorders Association and has been gaining more attention in the last several years.

The term ‘orthorexia’ was coined in 1998 by Dr. Steven Bratman, author of the book Health Food Junkies. Dr. Bratman wrote about the condition as not simply conscious, healthy eating, but rather an obsession that closely resembles other eating disorders and ultimately leads to a harmful, unhealthy lifestyle.

Obsession Definition

The definition of obsession is an idea or thought that continuously preoccupies or intrudes someone’s mind. In terms of orthorexia nervosa, the constant thought and fixation on healthy, clean eating invade the individual’s mind. The obsession ultimately causes distress and damages their own well-being. The obsession often leads to high-risk choices, creating rules that are impossible to follow, and feeling guilty if failure occurs.

What is Clean Food

Individuals who suffer from orthorexia nervosa have a fixation on eating “clean” food. They feel that if they do not eat clean food they are at immediate risk of falling ill or contracting a disease. In some instances, the quest for clean also embodies a need to feel pure or without toxins, although the concept is magnified in individuals with orthorexia. In general terms of orthorexia nervosa, “clean foods” are organic, whole foods that are free of antibiotics or preservatives.

Most commonly, an individual with orthorexia nervosa will eliminate the following:

  • Artificial colors, flavors or preservatives
  • Pesticides or genetic modification
  • Fat, salt, and/or sugar
  • Animal and/or dairy products (typically both)
  • Other ingredients deemed to be “unhealthy”

However, this short list is taken to the extreme. Individuals with orthorexia will cut out entire food groups, labeling that them as “bad” until there are hardly any “good” food groups left. Individuals will also often experience severe anxiety when eating out and in regards to how their food was prepared. We’ll get more into this and other symptoms in the next section. Ultimately, there are many of us who have weird food habits, but wouldn’t be classified as having orthorexia. However, it is important to be able to understand the warning signs of the condition and recognize whether you could potentially be heading in a dangerous direction.

Orthorexia Symptoms

There are several warning signs and symptoms of orthorexia that you should be on the lookout for in terms of the condition.

No Exceptions

Typically even if you are on a relatively strict eating regimen, you can make an exception here or there. However, individuals suffering from orthorexia nervosa do not make exceptions. Not for anniversaries, weddings, birthday, nothing. Because of this, individuals with orthorexia often don’t participate in group events (particularly when food is around).

Traveling = Anxiety

Traveling often creates anxiety for many individuals, but for people with orthorexia nervosa, this anxiety can go through the roof. Of course, traveling to uber health-conscious Los Angeles or New York may be no problem, but traveling to an unknown place can be terrifying.

Money & Time in Preparation

Individuals with orthorexia nervosa may spend extreme amounts of time and money on meal prepping and making sure that their food choices are appropriate for the lifestyle they want to live. This amount of time and money consequently takes away from spending their time and money doing just about anything else.

Obsessively Reading Labels

People who suffer from orthorexia nervosa will often obsess over labels. In part because of this fixation on ingredients, it is possible that individuals with orthorexia nervosa may consume less food than needed to sustain themselves.

Inflexible Eating Patterns & Creating Rules

You will often find an individual with orthorexia nervosa developing inflexible eating patterns and creating stringent rules that they force themselves to follow. For this reason, you likely will not find someone with orthorexia attending social gatherings centered around food.

Emotional Turmoil & Guilt

There is severe emotional turmoil and guilt that an individual with orthorexia experiences if they accidentally “cheat” on their strict regimen. Additionally, if the “cheating” comes by force, the individual may feel extreme resentment toward the source of that pressure.

Food, Food, Food

You may also recognize orthorexia in the way and the extent to which an individual obsessively talks and thinks about food. Somehow they are able to slide health and diet into just about any conversation.

Loss of Interest

The obsession with eating healthy can also take away from activities and other things that were once enjoyed by the individual. Now, most of their time is consumed by what they are going to eat next and obsessing over whether it fits into the mold of disordered eating habits that they created.

Judgemental Attitude

You may find people with orthorexia nervosa judging others for their eating habits. For this reason, it is common for people with the condition to distance themselves from family and friends who don’t have the same viewpoints on healthy food.

#FITLIFE

An obsession with the gym and working out can also be signs of orthorexia when paired with an all-encompassing fixation on healthy food choices.

Orthorexia

Eliminating “Bad” Food

Another tell-tale sign of orthorexia is when an individual cuts out all “bad” food to the degree that eventually even food that is perfectly healthy, such as fruit, will be eliminated due to extreme reasons such as sugar content (even though the sugar is all natural). Eventually, all “good” food will be up for elimination as well on the quest for healthy eating. This is one of the ways that orthorexia resembles other symptoms of another eating disorder as well as obsessive-compulsive disorder.

Weight Loss

Of course, the elimination of so many vital food groups leads to weight loss. When food groups are cut out abruptly and without replacing the necessary caloric intake with another source, weight loss can be rapid and very apparent.

High-Risk Behavior

We understand that a lot of people have diet choices that may come off as “weird” to others. This is not to say that those individuals have orthorexia, anorexia or bulimia. Furthermore, diets such as the paleo diet may seem extreme to some although it seldom leads to an eating disorder. However, there are several instances where diet can absolutely be a risk factor.

Fruitarian

An extreme diet such as fruitarianism encompasses the condition of orthorexia nearly 100%. More often than not, a person who is a fruitarian has obsessive tendencies when it comes to food which has taken them in a direction where they are now living a dietary lifestyle that has ultimately become extremely unhealthy.

Raw Foods Veganism

Raw foods veganism is another extreme diet that can carry a high risk for developing orthorexia, due to the fact that it is often a difficult diet to maintain safely.

Orthorexia Diagnosis

Orthorexia nervosa is presently not formally recognized in the DSM-5 as being a diagnosable mental health condition. The lack of formal diagnostic criterion for orthorexia nervosa leads to several issues, including making it difficult to accurately assess. Additionally, because there is a not an official diagnostic criterion, it isn’t entirely possible to gauge just how many individuals are suffering from the condition.

It has also difficult to determine whether orthorexia nervosa is a stand-alone eating disorder, or if the condition is a subtype of a preexisting disorder such as anorexia nervosa or obsessive-compulsive disorder. Studies have shown a link between orthorexia nervosa and obsessive-compulsive disorder in that the majority of individuals with orthorexia also have OCD.

The author who coined the term orthorexia, Dr. Steven Bratman, also created an orthorexia test. If you feel that you may be suffering from the condition, we encourage you to look into the self-test here. 

Orthorexia Treatment

Because the DSM-5 doesn’t formally list orthorexia as a mental illness, there is no exact treatment for orthorexia. However, many eating disorder experts treat the condition as a subtype of anorexia nervosa or obsessive-compulsive disorder.

Orthorexia nervosa treatment is still a new area of study. However, it is imperative that individuals suffering from the condition do not let it go unacknowledged. The disorder has the potential to cause serious, irreversible damage if left without attention.

Orthorexia: Final Thoughts

Comparable to anorexia, bulimia, and binge eating disorder, there is certainly hope for individuals suffering from orthorexia nervosa. Those who suffer are not alone. If you feel that you may have orthorexia, we urge you to talk to your mental health professional. The road to recovery may seem like a daunting one, but with support, you can begin today.

Sources:

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

http://www.orthorexia.com/

https://www.eatingdisorderhope.com/information/orthorexia-excessive-exercise/understand-orthorexia

https://www.thecut.com/2014/07/10-ways-to-spot-an-orthorexic.html

 

Depersonalization Disorder: Am I Having an Out of Body Experience?

Have you ever felt that you were having an out of body experience and were not living your life but viewing it from outside?

Have you ever been sleep deprived to the point of feeling that you were not you but watching yourself?

When you feel disconnected from reality does this mean you suffer from depersonalization disorder?

The following will give you more information about this disorder and how to determine what is going on….

Depersonalization/Derealization Disorder: What Does It Mean?

Depersonalization/Derealization disorder is a psychological disorder that is characterized by persistent or recurrent episodes of depersonalization, derealization, or both.

What is Derealization?

Derealization is an experience when an individual has a sense of unreality or a detachment concerning his or her surroundings.  An individual that experiences this feels that some individuals or objects are unreal, dreamlike, foggy, lifeless, or visually distorted.  The individual could feel that they were in a bubble or there was a glass wall between them and the world around them.

What is Depersonalization?

Depersonalization is an experience where an individual may have experiences of unreality, detachment, or feeling that they are an outside observer concerning one’s thoughts, feelings, sensations, body, or actions.    Some of these outside observer thoughts could be perceptual alterations, having a distorted sense of time, feeling unreal or absent from his or her self, and having feelings of emotional or physical numbing.

For the disorder to be diagnosed, the individual may have these experiences separately or together.

Stats: How Many Suffer from this Disorder?

Individuals can experience symptoms of this disorder hours to days and this is common in the general population.  This short time prevalence is called transient symptoms.  It has been found that one-half of all adults have experienced an episode of these transient symptoms.  For the disorder to be diagnosed the symptoms have to be present for a long period.

Lifetime prevalence of this disorder only affects about two percent of the worldwide population.  The commonality of an out of body experience or episode is much more common than the prevalence of this disorder.

What Causes Depersonalization?

There has not been a definite case of personalization and it has been thought to be caused due to a chemical imbalance in the brain.   Dissociative disorders and feelings of depersonalization are usually triggered by past trauma or life-threatening event.

History of Abuse

If an individual experiences a history of abuse or trauma during his or her childhood or adulthood they could be more prone to experience this disorder.  The abuse could range from emotional, physical, sexual, verbal, or physical neglect.

If an individual has been abused it does not mean that he or she will experience this disorder but a history of abuse and exposure to trauma gives an individual a higher risk of prevalence.

Substance Use

It has been found that use of recreational drugs such as hallucinogens and other substances may trigger feelings of depersonalization.   Cannabis use has been found to cause episodes of depersonalization and dissociation as well as withdrawal from this substance.  If an individual is withdrawing from benzodiazepines he or she could experience perceptual disturbances or depersonalization.  Alcohol use can also induce depersonalization in some individuals.

Acquired Brain Injury

Individuals that have experienced a brain injury or significant trauma have a high prevalence of experiencing occasional episodes of depersonalization.  It has been found that at least half of individuals with a brain injury experience these symptoms.

Signs and Symptoms of Depersonalization/Derealization Disorder

The feelings of depersonalization/derealization can occur for an individual on a short-term basis and this can come from sleep deprivation, substance use or withdrawal, exposure to trauma and abuse, and brain injury.  For a true diagnosis of this disorder, the symptoms and experiences must cause significant distress or impairment in social, occupational, or other important areas of daily functioning.

What are Common Behaviors/Characteristics?

Some common features of depersonalization are feeling that you are looking at yourself from the outside or feeling as though you are not having your own emotions or feelings but are watching yourself have them; you could feel like a robot and are not in control of your speech or movements; you feel that your body, legs, or arms appear distorted and either larger or smaller; having a feeling of numbness and cannot feel your own senses or responses to the world; and feeling that your memories lack emotion or that they are not your memories but someone else’s.

Some common features of derealization are feelings of being alienated from or unfamiliar with your surroundings like you are living in a movie; feeling emotionally disconnected from people that you care about; your surroundings appear distorted, blurry, colorless, two-dimensional or artificial, or you experience a heightened awareness and clarity of your surroundings; having distortions in the perception of time or feeling like recent events were really like a distant past; or experiencing a distortion of distance, size, and shape of objects.

Testing: What are the Diagnostic Criteria Per the DSM 5?

For an individual to be diagnosed with this disorder they need to meet the following criteria:

  • The presence of persistent or recurrent experiences of depersonalization, derealization or both:
  • Depersonalization: Experiences of unreality, detachment, or being an outside observer concerning one’s thoughts, feelings, sensations, body, or actions
  • Derealization: Experiences of unreality or detachment concerning surroundings.
  • During the depersonalization or derealization experiences, reality testing remains intact.
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The disturbance is not attributable to the physiological effects of a substance or another medical condition
  • The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.
  • (American Psychiatric Association, 2013)

Depersonalization/Disorder and Other Conditions

Depersonalization/Derealization Disorder vs Out of Body Experiences

If an individual is experiencing an out of body experience they are feeling that they are floating outside of their body.  They may feel like they are an observer or on the outside looking in.  This can happen when a person is falling asleep or almost asleep.

This differs from depersonalization/derealization because when an individual experiences this they are no longer in reality and are detached from their feelings and self and also a detachment from their surroundings.  This happens in different places and not just when an individual is sleeping or attempting to go to sleep.

Depersonalization Disorder vs Dissociative Identity Disorder

Dissociative identity disorder is a disorder where an individual feels that they have two or more distinct personality states.  They do not feel detached but when one personality is present the other personalities are hidden.  Each personality has a chance to live and be active with the individual.  This differs from depersonalization because this is a detachment from self and not a change from one personality to another.

Depersonalization vs Dissociative Fugue

Dissociative fugue is a condition where an individual participates in sudden and unplanned travel away from home, cannot recall past events or important information, and experiences a loss of memory of his or her identity and possibly assumes a new identity.  This differs from depersonalization because it involves the person physically leaving and not just emotionally or rationally detaching as an individual would if they experienced depersonalization.

Related Conditions

Some of the disorders that could be related to depersonalization are illness anxiety disorder, major depressive disorder, obsessive-compulsive disorder, other dissociative disorders, anxiety disorders, psychotic disorders, substance/medication-induced disorders, and mental disorders due to another medical condition.

Depersonalization/Derealization Disorder in Adults/Children

The average age of an individual that experiences depersonalization is 22 years old.  One-third of individuals that experience this disorder have had some symptoms present before the age of 16.  It is more likely to occur with adolescents or young adults.  Children have not been known to experience this disorder.

Example Case of Depersonalization/Derealization Disorder

Some individuals experience depersonalization/derealization disorder and try to cope with the feelings of the detachment and not being emotionally connected to themselves and their surroundings.

A therapist worked with a woman in her mid-30s who started counseling due to feelings of depression and feeling that she was not living life but just surviving.  She presented with feelings of being a robot and not having any connection to herself, her surroundings, or people.

She thought it was due to being depressed but could not identify feelings of hopelessness, changes in appetite and sleep, or other depressive symptoms.  She reported that she wanted to live and not just be present.

Throughout counseling, she were able to determine that she experienced depersonalization/derealization disorder and had her first symptoms when she was a late teenager.  Using Cognitive Behavioral Therapy and Impact Therapy, she was able to learn how to connect and become more open to her feelings.

She participated in counseling for about two years and maintained her medication regimen prescribed by her doctor throughout treatment. She did struggle some throughout therapy but consistency and being able to become more connected to feelings and the “here and now” she was able to develop the skills needed for her to live and not just exist.

Depersonalization

How to Deal/Coping with Depersonalization

If you start to experience symptoms of depersonalization the first thing that you can do is identify what is going on.  Work to reshape the negative thoughts of being detached and try to become more present with yourself.  Try to become more present in your surroundings becoming aware of the sounds and smells that are present, these can help you try to connect more.

You can attempt to communicate more with others and become connected to others through verbal and nonverbal communication.  Trying to attach to yourself, your surroundings, and others is a great way to work on reducing the negative symptoms and help you to feel better.

Look out for These Complications/Risk Factors

An individual that already experiences depression, dissociative personality disorder, schizophrenia, and obsessive-compulsive disorder is at a higher risk of experiencing depersonalization.   If an individual has experienced trauma and abuse and suffered from posttraumatic stress disorder they will have a higher risk of depersonalization and dissociation disorders.  Anxiety disorders can cause depersonalization in many individuals.  If a person does not get adequate sleep and nourishment they may have a higher risk of experiencing depersonalization episodes.

Depersonalization/Derealization Disorder Treatment

There is currently no distinct treatment for depersonalization or dissociation.

Possible Medications for Depersonalization/Derealization Disorder

Medications that can be used to help relieve symptoms include antidepressants and mood stabilizers.  Experts suggest that a combination of medications like Lamotrigine and a selective serotonin reuptake inhibitor (SSRI) can help an individual experiencing this disorder

Home Remedies to help Depersonalization/Derealization Disorder

Mindfulness activities have been found to help an individual become more present in the “here and now”.  These activities include yoga, meditation, or other relaxation activities.  Doing these activities can help a person become more present which can help them become more attached.  Another way to manage this disorder is to identify triggers to the symptoms.

This can be done through journaling and can help an individual develop a safety plan to help negative reactions to symptoms.  If possible reducing stress can help an individual feel better because it can reduce the negative symptoms and help the individual feel more balanced.

Living with Depersonalization/Derealization Disorder

One of the most important things a person can do to help themselves feel better overall is to make healthy lifestyle choices.  This can be done by getting adequate rest, eating healthy, avoiding addictive substances like caffeine, and working to develop a healthy work/life/family balance.  It is important that an individual who experiences depersonalization/derealization works to feel present and attached to their life and also their surroundings.

Insurance Coverage for Depersonalization/Derealization Disorder

Most all insurance providers should cover this disorder.  If you are experiencing symptoms that affect your daily activities, social, relationship, and occupational functioning it is important you reach out and seek assistance.  If you have insurance, you can contact your insurance provider and locate clinicians in your area that are covered.

How to Find a Therapist?

There are many local resources to find counseling.  Psychology Today has a list of providers in local areas and also identifies the modalities of the providers.  Word of mouth is a great way to seek a counselor.  More people are getting help and asking a trusted friend could assist you in finding the provider that is right for you.

What Should I be Looking for in an LMHP?

Looking for a counselor with experience with cognitive behavioral therapy and trauma therapy would be beneficial because they can help reshape negative feelings and process any past trauma or experiences that have occurred to trigger this disorder.

Questions to ask for Potential Therapist?

Do you have experience treating dissociative disorders, depression, anxiety, and provide trauma-informed care.  Do you utilize homework and assist in the development of skills to assist in reshaping negative thinking?

Depersonalization/Derealization Disorder Resources and Support Helpline

There are many local and online support groups for depersonalization/derealization disorders.  Throughout social media, you can locate support groups and resources to assist individuals that are experiencing this disorder.

Depersonalization/derealization is a rare disorder that only affects 2% of the population.  Half of all individuals experience depersonalization/derealization episodes but only a few experience the hindrances in daily functioning that is needed for a DSM-5 diagnosis.  Individuals that have experienced trauma and abuse, substance users, or those with a history of brain injury are more likely to experience these episodes.

There is not a distinct treatment for this disorder but through therapy and an appropriate medication regimen a person can work to reduce the symptoms and help them to form a better quality of life.  Help is out there but the first step is admitting there is a problem.  The second is locating support and actively participating in the help that has been determined.

Resources

American Psychiatric Association. (2013).  Diagnostic and statistical mental of mental disorders (5th ed.).

Pyromania

Do you or a loved one have an unexplained fascination with fire? Does seeing or starting a fire feel like the only way to find relief from stress? Despite desperately fighting against the urge to start a fire, do you find you can’t seem to stop? If this sounds like you, you may be experiencing symptoms of pyromania and need to seek help immediately. Firesetting can be dangerous and can be hard to talk about, but help is out there!

Pyromania: What Does It Mean?

According to the Social Work Dictionary, pyromania is defined as, “An impulse control disorder in which the person frequently has compelling urges to start or watch fires.”

A person with pyromania starts fires to experience relief from stress or internal tension. They get pleasure from fire but are not motivated by external factors or by malicious intent.

Pyromania is classified under the Disruptive, Impulse-Control, and Conduct Disorders section of the Diagnostic and Statistical Manual of Mental Disorders- 5th Edition (DSM- 5)*.  These disorders all involve problems with controlling emotions or behaviors.

*The DSM-5 is a publication by the American Psychiatric Association which provides detailed diagnostic criteria and information on mental health disorders.

Impulse Control

Impulse control is the ability to control urges to engage in a behavior or delay immediate gratification.

An impulse control disorder is repeatedly being unable to resist urges or temptations despite the harmful or negative consequences the behavior may bring.

What Causes Pyromania?

The exact cause of pyromania is unknown. Not all people who engage in firesetting behaviors fit criteria for a pyromania diagnosis. However, current research indicates that certain individual and environmental factors may increase the risk for someone to engage in firesetting behavior.

Individual risk factors:

·        Antisocial behaviors

·        Sensation seeking

·        Social skills deficits

·        Learning difficulties

·        Low intellectual functioning

·        Desire to provoke a reaction from others

·        Lack of understanding of dangers of fire

Environmental risk factors:

·        Abuse or neglect by parents

·        Limited parental supervision and support

·        Family dysfunction

·        Exposure to fire at an early age

Stats: How Many Suffer from this Disorder?

Pyromania is very rare and reliable data on the number of people affected by this disorder is not available.

Pyromania In Adults/Children

It is rare for a child to be diagnosed with pyromania, however, there have been cases where a fascination with fire has been observed at an early age. Firesetting behavior is more common in teenage boys before the age of 18.

Signs and Symptoms of Pyromania

Someone with pyromania will engage in multiple incidents of fire starting. They start fires for the sole purpose of relieving stress or gaining pleasure. They may feel a sense of craving for fire and will disregard any consequences.  Their firesetting behavior is not due to other mental health conditions, experimenting with fire, or substance use.

What are the Common Behaviors/Characteristics?

A person with pyromania may spend a lot of time alone, they may have difficulty making friends or being in social situations.  They may have difficulty expressing their emotions in a healthy way. People with pyromania may start to show a noticeable build-up of stress and begin to be shorter or aggressive with those around them as tension builds before engaging in firesetting behavior.

They may show an unexplainable fascination for all things fire related and idolize firefighters or other fire-related professions. Sometimes people will research fires and watch videos of fires. They may go to sites where fires are happening and may at times take on professions involving fire.

It is common for people to feel great remorse after they have started a fire, but this remorse alone will not deter them from containing the behavior.  It has also been reported that some people experience suicidal thoughts thinking that is the only way to stop their urges.

Testing: What are the Diagnostic Criteria Per the DSM-5?

To be diagnosed with pyromania, your therapist will complete an evaluation to see if you meet the following diagnostic DSM-5criteria:

A.     Deliberate and purposeful fire setting on more than one occasion.

B.     Tension or affective arousal before the act.

C.     Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences).

D.    Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath.

E.     The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgement (e.g., in major neurocognitive disorder, intellectual disability [intellectual developmental disorder], substance intoxication)

F.     The fire setting is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.

Pyromania and Other Conditions

Intentional fire setting behavior may be seen in people with other mental health disorders, but this does not mean they meet criteria for pyromania. A person with pyromania is different than someone who engages in fire setting behaviors for motives other than immediate gratification or stress relief.

Pyromania vs Arson

Arson is a legal term and according to Merriam-Webster dictionary means, “the willful or malicious burning of property (such as abuilding) especially with criminal or fraudulent intent.”

A person committing arson sets fires for personal gain or to make some type of statement.  This is different than a person with pyromania because they engage in fire setting behaviors for relieving stress or for gratification and not for malicious intent.

Pyromania vs Bipolar Disorder

While the connection of bipolar disorder and pyromania seems to be less common, the high impulsivity usually associated with bipolar disorder may present a greater risk for firesetting behavior.

Pyromania vs Antisocial Personality Disorder

Antisocial Personality Disorder is diagnosed when a person is 18 years old or older. It is diagnosed when a person demonstrates a pattern of disregard for others and engages in behaviors that negatively affect others without remorse.

People with Antisocial Personality Disorder tend to engage in impulsive behaviors and may engage in firesetting, however, this does not mean they fit criteria for pyromania. The motivation for fire setting may differ as they may do it to seek excitement, with criminal intent or to get some sort of personal benefit.

Related Conditions

Pyromania is at times diagnosed in conjunction with other mental health disorders, substance use disorders, depression, gambling disorder and other impulse-control and disruptive conduct disorders.

Example Case of Pyromania

Johnny is 17 years old and has always been a quiet and reserved boy with no friends. His father is verbally abusive when home, but is often away for work.  Ever since he can remember, he has been fascinated by fire and firefighters. He remembers the relief he felt the first time he lit a match when he was around 11 and he began to burn papers in his bathroom sink. Over time, he began to make bigger fires in his fireplace and then he found a small wooded area in his town where he would light fires in some old bins he’d found. He realizes that every time he burns something he feels as if his stress disappears. He feels an intense yearning every time in between what he calls his “fire sessions.” He becomes frustrated easily and cannot focus.  Johnny feels a desire to make bigger fires and his mind often wonders as to how he could do this.

Pyromania

How to Deal/Coping With Pyromania

Fire setting presents a huge risk to self or others. Therefore, it is very important that you get help as soon as you start to notice a strong urge to set fires.  Therapy will be an extremely important part of managing your symptoms.

Look out for These Complications/Risk Factors

As previously mentioned, it is important to be aware that certain individual and environmental factors may increase risk of engaging in firesetting behavior. Access to fire starting materials and lack of supervision can greatly increase risk.

Talk to your mental health provider right away if you notice:

•            Your symptoms have worsened.

•            You develop new symptoms.

•            You are having thoughts of suicide.

•            You have thoughts of hurting others by using fire.

Pyromania Treatment

Cognitive-behavioral therapy (CBT) appears to be effective in treating pyromania. CBT helps you recognize feelings, thoughts and behaviors leading you to act out in this way. It can help you identify coping skills that will allow you to relieve stress or get satisfaction in healthier ways.

Family sessions will be essential to help your support system understand how to best help you manage your urges and safety plan.

Fire-safety education is an extremely important part of treatment. Your therapist may request that you sign a release of information to connect you to the right people who will be able to provide this service.

If the risk to self and others is too great, inpatient treatment may be the best option. This will help you get your urges under control in a safe environment with limited access to fire.

Possible Medications for Pyromania

There is currently not enough research to indicate a specific medication as most effective in treating pyromania. Doctors may prescribe medication depending on what other mental health disorder may be present as well. Some studies have shown success in decreasing urges for fire setting with the use of antidepressants, mood stabilizers, antiseizure medications and some antipsychotic medications.

Home Remedies to help Pyromania

1.     Reach out to your family or friends for support. Give them information on pyromania and help them understand what symptoms they should be looking for and how to best help you when you are feeling strong urges.

2.     Use mindfulness to cope with urges and reduce stress or anxiety that may be related to firesetting behavior. This may be easier said than done and will take a lot of practice, but work with your therapist to find something that works for you. You can use mindfulness apps on your phone to guide you in meditation to cope with urges. Two recommendations are “InsightTimer” and “HeadSpace.” Another great resource for learning how to “Ride the Wave” of urges is the following link: http://portlandpsychotherapyclinic.com/2011/11/riding-wave-using-mindfulness-help-cope-urges/

3.     Limit access to fire starting equipment. When around fire make sure that you have a support person with you for safety.

4.     Have a safety plan! Create a safety plan with your support system for what to do if you engage in firesetting behavior. Have fire extinguishers in your home and make sure to call 9-1-1 in the case of an emergency.

Living with Pyromania

Pyromania does not have to take away your ability to live a full and healthy life. Treatment can help you fight against urges and help you find ways to make positive changes in your life.  You are not alone in this and while pyromania is rare, there are support groups and treatment providers available to help you.

Insurance Coverage for Pyromania

Pyromania is a billable diagnosis and most insurance providers should cover mental health treatment costs. Call your insurance provider to get specifics on your coverage.

How to Find a Therapist

You want to find someone with experience in cognitive behavioral treatment, behavior modification, and impulse control disorders.  Call the numbers at the end of this article for resources in your area.

What Should I be Looking for in an LMHP?

Titles for licensed mental health professionals (LMHP) may vary depending on their field of study or where they practice. Some examples are:

·        Psychiatrist

·        Psychologist

·        Licensed Clinical Social Worker

·        Licensed Marriage and Family Therapist

·        Licensed Professional Counselor

·        Psychiatric Nurse Practitioners

Cost of treatment will vary depending on the provider’s area of expertise.

Questions to Ask a Potential Therapist

•            Do have experience working with impulse control disorders?

•            What kind of license do you have?

•            What kind of therapy will you provide?

•            How often will I see you for sessions?

•            How will I know if I’m getting better?

•            What method of payment do you accept?

Pyromania Resources and Support Helpline

There is no national helpline for pyromania.

Here are some resources that can help you find support groups in your area:

National Alliance on Mental Illness (NAMI) Helpline: Provides information on mental health disorders and referrals to local providers. Live person available M-F from 10am-6pm EST.

1-800-950-NAMI
1-800-950-6264

SAMHSA Treatment Referral Helpline: Provides general information on mental health and helps you locate treatment services in your area. Speak to a live person M-F 8am-8pm EST

1‑877‑SAMHSA7
1‑877‑726‑4727

Help for pyromania is out there! Do not keep your urges a secret and reach out to people for help. Find a support group in your area and get treatment as soon as possible. You are not alone.

Am I a Hypochondriac? Living with Illness Anxiety Disorder

Illness Anxiety Disorder: What does it mean to have Hypochondriasis?

Hypochondriasis, which is now referred to as illness anxiety disorder, is a psychological disorder characterized by excessive worry about having an undiagnosed and often severe medical condition in the absence of signs and symptoms or in the presence of minor symptoms, and with physical examinations and medical tests proving the absence of the disease. The anxiety over the disease is often so severe that it disrupts normal functioning and daily activities of the individual.

The hallmark of illness anxiety disorder is an excessive worry about having a health issue which is not present. However, in 10-20% of healthy people, occasional unfounded concern and worry about a presumed medical illness occurs and is normal. Hypochondriasis is chronic and involves a constant fear or preoccupation with having a severe medical condition.

It is also known by other names such as hypochondria and health anxiety.

Illness anxiety disorder occurs equally in men and women and can develop at any age, but it most frequently begins in early adulthood. The disorder has a prevalence rate that ranges from 1.3 percent to 10 percent of the general population.

Several studies have also shown that illness anxiety disorder is more common among people with low educational level, low-income levels, and previous history of traumatic childhood experience.

What Causes Hypochondria?

Although the exact cause of illness anxiety disorder is not clearly understood, a number of factors contribute to its development:

  •   Personal Beliefs – Personal misunderstanding of one’s physical symptoms may lead one to misinterpret them and link them to serious medical illnesses.
  •   Family History – Individuals who have close relatives or family members with a history of excessive anxiety over their health are likely to develop health anxiety later in life.
  •   Personal experience – A childhood experience with a severe medical condition may lead an individual to develop anxiety and excessive concern about any physical symptom they develop later on.
  •   Other Psychological disorders – Depression and obsessive-compulsive disorder (OCD) have been linked to the development of hypochondriasis.

Signs and Symptoms of Illness Anxiety Disorder

The main feature of illness anxiety disorder is an excessive preoccupation with an idea that one has an unconfirmed severe illness and typically, the individual displays certain symptoms on that basis:

  •   Worrying that minor symptoms indicate an ongoing severe medical condition
  •   Being easily frightened by any symptoms
  •   Excessive worry about developing a certain medical illness in the presence of a risk factor
  •   Repeatedly checking the body for signs of disease
  •   Having severe life disruptions and dysfunctional daily activities as a result of the anxiety about the illness
  •   Avoiding certain activities, people, or places for fear of increased risks of having the disease.
  •   Constantly seeking for information on the internet about causes and symptoms of the presumed illness
  •   Constantly talking to friends and loved ones about the possibility of having such health challenges.
  •   Making frequent hospital visits for confirmation or reassurance, and in some cases, avoiding hospital visits for fear of being diagnosed with a severe medical condition
  •   Having no respite from worry and anxiety despite medical tests and physical examinations proving the absence of a severe medical condition.

Diagnostic Criteria for Illness Anxiety Disorder (DSM-5)

The following are the criteria for diagnosing illness anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

  •       The individual is preoccupied with having or acquiring a serious illness.
  •       Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (for example, strong family history is present), the preoccupation is clearly excessive or disproportionate.
  •       The individual has a high level of anxiety about health, and is easily alarmed about personal health status.
  •       The individual performs excessive health-related behaviors or exhibits maladaptive avoidance.
  •       The individual has been preoccupied with illness for at least 6 months.
  •       The individual’s preoccupation is not better explained by another mental disorder.

Illness Anxiety Disorder and Other Conditions

Illness Anxiety Disorder vs. Hypochondriasis

Hypochondriasis is no longer considered a diagnosis according to DSM-5. It is now, instead subsumed under the category of Somatic Symptom Disorder for individuals with illness anxiety who have physical symptoms, those without any somatic symptoms are classified as having the actual illness anxiety disorder. Both of these conditions are contained under the category of Somatic Symptom and Related Disorders in DMS-5.

Illness Anxiety Disorder vs. Somatic Symptom Disorder

Somatic symptom disorder differs from illness anxiety disorder in the individual’s focus on real symptoms, unlike in illness anxiety disorder where the individual is excessively preoccupied with having a disease in the absence of signs or symptoms of the disease.

Furthermore, in symptom somatic disorder, the patient has one or more somatic symptoms such as pain, headache, or fatigue which cannot be traced to a medical condition, and develops an excessive anxiety about the symptoms resulting in significant distress which interferes with the patient’s daily life, as well as their social activities and relationships.

Other Related Conditions

Other psychological disorders related to illness anxiety include conversion disorder and body dysmorphic disorder.

Conversion disorder is characterized by the development of paralysis, muscle weakness, seizures, blindness or other neurologic symptoms which cannot be explained by a medical or neurological condition and often results from a psychological conflict induced by a stressful life experience. Unlike in illness anxiety disorder, patients do not express an overwhelming concern or worry over their symptoms.

Body dysmorphic disorder (BDD) is characterized by a preoccupation with one or more perceived distortions in one’s physical appearance that are not detectable or appear inconsequential to others. Often, this preoccupation causes significant distress which impairs the patient’s daily life including their social and occupational activities. Unlike patients with illness anxiety disorder, concerns are only restricted to physical appearance in patients with BDD.

Illness Anxiety Disorder in Adults/Children

Illness anxiety disorder typically begins in early adulthood and is relatively infrequent in children. This is because children are largely oblivious of symptoms and signs of specific disorders, therefore, do not develop concerns over their symptoms or the presence of specific diseases.

However, children may develop somatic symptoms, such as headaches or recurrent abdominal pain, as a result of psychological stress. A childhood history of somatic symptoms and psychological stress increases a child’s risk of hypochondriasis later in life.

Example Case of Illness Anxiety Disorder

A 35-year-old man presents to his primary care physician with fears that he might have cancer. On questioning about how long he had been having such concerns, he notes that for over two years, he has had a deep belief that he has lung cancer.

He notes that he does not smoke nor stay around a smoker for a long time. When asked about his symptoms, he notes that he has infrequent episodes of cough (usually about two episodes a year), intermittent chest pain, no night sweats, no weight loss, and no blood in sputum when he coughs.

He further states that he’s had multiple chest radiographs and bronchoscopies done which revealed no finding suggestive of lung cancer. He also mentioned that his father died of lung cancer at the age of 55 and thinks that that may affect his risk of the disease.

After being enlightened by the doctor on cigarette smoking and frequent exposure to second-hand smoke being the main risk factor for lung cancer, the patient is counseled on a less invasive procedure to check again. Physical examination was unremarkable, the patient’s chest is clinically clear.

However, the patient requests for a chest CT scan and mediastinoscopy and a “more detailed chest examination”. After many frustrating attempts to convince the doctor otherwise, the patient requests to see a “more experienced doctor”.

How to Deal with Illness Anxiety Disorder

Hypochondriasis occurs in episodes that last from a few months to a few years with symptom-free intervals of the same length. Although many patients with hypochondriasis generally improve over time, the prognosis is tied to a patient’s socioeconomic status, the presence of an enabling personality disorder, and absence of related medical conditions.

Hypochondria may lead to the following complications which require urgent therapy.

  •   Dysfunctional social and personal relationships as a result of the emotional distress
  •   Impaired work-related performance
  •   Physical disability which impedes how effectively a patient carries out their daily activities.
  •   Financial problems caused by excessive hospital visits and cost of unnecessary medical procedures and treatments

Factors which make a patient prone to developing these complications include:

  •   Previous history of a stressful life event such as a divorce.
  •   History of child abuse – physical, sexual, emotional.
  •   A severe childhood illness or a parent with or who died of a severe medical illness.
  •   Personality types which are prone to excessive worry.

Illness Anxiety Disorder

Hypochondria Treatment

Patients with hypochondriasis are usually treated by mental health professionals who conduct an extensive psychological evaluation regarding the patient’s symptoms, past medical and psychiatric history, as well as family history, to diagnose the illness and assess the extent to which it has affected the patient’s life.

Possible Medications for Illness Anxiety Disorder

Medications which may be prescribed for patients with illness anxiety disorder include antidepressants such as Prozac and Paxil, anti-anxiety drugs such as benzodiazepines, and antipsychotic medications including Risperidone. Drugs to treat specific symptoms that are present may also be prescribed.

Home Remedies to Help Illness Anxiety Disorder

Activities which help improve hypochondria include engaging in stress management techniques such as body massage and yoga, as well as limiting foods and drinks that exacerbate anxiety such as caffeine and alcohol. Some anti-inflammatory foods such as grass-fed beef, salmon, tuna, white fish, and mackerel also help lower the symptoms of anxiety.

Living with Illness Anxiety Disorder

Hypochondriasis can significantly impair an individual’s daily activities and cause serious complications. However, a few tips for improving the quality of life of patients living with illness anxiety disorder include:

  •   Cooperating with healthcare Provider – This is important for good treatment response, setting limits on unnecessary medical tests and avoiding visits to different doctors. The patient and mental health professional meet at prearranged schedules to discuss the patient’s concerns, monitor their treatment progress, and help build stronger relationships.
  •   Get active – Patients with hypochondria should engage in exercise programs to help improve their mood and physical function, and reduce anxiety symptoms.
  •   Avoid recreational drugs – These drugs may impair treatment effectiveness, exacerbate the symptoms, and increase the patient’s risk of developing severe complications of the condition.
  •   Avoid searching the internet or inquiring about medical illness one presumes to have. The vast amount of information related to health on the internet, if not well explained or interpreted, may cause confusion which often worsens a patient’s worry and distress over having the illness.
  •   Maintain participation in work and social activities – This provides the needed support and leaves little time for worry about the presumed medical illness.

Insurance Coverage for Illness Anxiety Disorder

Check your plan benefits for coverage of mental or behavioral health services. You may inquire through your human resources unit for employer-sponsored health coverage for treatment of this condition or you may contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access the mental health services under your insurance plan.

How to Find a Therapist

Your primary care physician, after a thorough psychological evaluation of your symptoms, will refer you to a psychiatrist or clinical psychologist for therapy. You may also check through online resources and directory to find the right therapist for you.

What should I be looking for in a Licensed Mental Health Professional (LMHP)?

Qualities you should look for in an LMHP include:

  • Good Communication Skills: Your LMHP should be able to effectively communicate their expert ideas and thoughts about your symptoms clearly, as well as listen carefully to your thoughts before making conclusions.
  • Empathy: You do not want a counselor who would rush through medical facts and treatment protocols without considering your emotional needs. You need an LMHP that is considerate, patient, calm, and compassionate with you.
  • Problem-Solving Skills: Your chosen LMHP must be knowledgeable enough to help you through to a satisfactory resolution of your symptoms. While your complete relief is not entirely up to your counselor, they must demonstrate ample ability to help manage your symptoms effectively.
  • Good multicultural Relationship: Your counselor must be able to strike a strong patient-therapist relationship with you regardless of any racial, ethnic, or cultural differences. Therapy must be devoid of such prejudices which may hamper on the effectiveness of treatment.

Questions to ask a Potential Therapist

You should ask your therapist the following questions to help you gain more insight into your symptoms and the scope and potential effectiveness of available treatment options.

  • Do I have illness anxiety disorder?
  • What is the treatment approach you recommend?
  • Is therapy necessary?
  • How long will therapy be for, if necessary?
  • What medications will I be on?
  • What side effects should I expect from those drugs?
  • Are there effective home remedies I can employ?
  • How will you monitor my treatment progress?
  • Are there any resources or websites you recommend?

Illness anxiety disorder is a psychological disorder characterized by excessive worry about an idea of having a medical illness, usually in the absence of signs and symptoms or presence of minimal signs with diagnostic tests and physical examination proving the absence of the disease. The hallmark of the disorder is the patient’s overt preoccupation with the idea of having an illness that it causes significant distress and impairment of daily activities.

Resources

https://www.psychologytoday.com/us/conditions/illness-anxiety-disorder

https://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/diagnosis-treatment/drc-20373787

https://www.medicalnewstoday.com/articles/9983.php

https://draxe.com/natural-remedies-anxiety/

https://emedicine.medscape.com/article/290955-overview#a4

https://medlineplus.gov/ency/article/000954.htm

What is Dependent Personality Disorder?

Dependent personality disorder (DPD) is a mental health issue that is characterized by a lack of self-confidence and over-reliance on others for one’s physical and emotional needs. People with the condition usually have an excessive need to be cared for, clinging behavior, and a strong fear of being left on their own.

 

Dependent Personality Disorder: What Does It Mean?

People with dependent personality disorder display an extreme lack of confidence in their own intelligence, abilities, and decision-making skills. They rarely undertake independent projects and rely heavily on others even when handling minor tasks or decisions.

They are overly cooperative and rarely express disagreement out of fear they may be abandoned by the people whose help they need. They may go above and beyond what is expected and may even do things they believe are wrong in an effort to please the people they rely on.

Individuals with DPD often display passive, submissive, and clinging behavior. They experience severe anxiety at the thought of being alone and do not believe they can function effectively without the people (often a single person) they depend on.

Their need for nurturance goes beyond what is considered to be age-appropriate. If a close relationship ends, people with dependent personality disorder are usually eager to form a new relationship as quickly as possible.

 

Stats: How Many Suffer from this Disorder?

Dependent personality disorder affects 0.49 to 0.6% of the general population. The condition is equally prevalent among males and females. Onset typically occurs in early adulthood.

 

What Causes Dependent Personality Disorder?

There are no known causes of dependent personality disorder. However, some mental health experts believe genetic and environmental factors play a role in the development of the condition.

People with authoritarian parents, separation anxiety in childhood, or a history of chronic physical illness may be at increased risk of developing DPD.

 

Signs and Symptoms of DPD

There are numerous signs and symptoms of dependent personality disorder. They include:

 

  • Extreme dependence on others
  • An intense need to be nurtured, instructed, and reassured
  • Low self-confidence
  • Extreme passivity
  • Fear of being alone
  • Unwillingness to disagree with others
  • Avoidance of personal responsibility
  • Fear of disapproval
  • Sensitivity to criticism
  • Tolerance of abuse
  • Inability to start projects or work independently
  • Inability to accomplish everyday tasks without receiving advice
  • Helplessness when left alone
  • Emotional devastation if a close relationship ends
  • Eagerness to start a new relationship when a close one ends

 

What are the Common Behaviors/Characteristics?

Individuals with dependent personality disorder believe other people always have better ideas. They may think of themselves as “stupid” and belittle their own talents or accomplishments.

People with DPD may depend on their spouse or parent to decide what clothes they wear, how they should spend their free time, what type of job they should seek, or who they should befriend.

They also tend to be at higher risk for drug abuse, alcohol abuse, depression, as well as sexual, physical, and emotional abuse.

 

Testing: What are the Diagnostic Criteria Per the DSM 5?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) provides guidelines for diagnosing dependent personality disorder. According to the DSM-5, individuals with DPD must display:

  • An excessive and pervasive need to be taken care of, submissive, clinging, needy behavior due to fear of abandonment.

These issues may be demonstrated by:

  • Difficulty making everyday decisions without the advice, reassurance, or input of others.
  • Requiring others to assume personal responsibilities
  • Fear of disagreeing with others and risking disapproval
  • Difficulty starting projects without support from others
  • Excessive need to be nurtured, even allowing others to impose themselves than risk rejection
  • Feeling helpless or vulnerable when left alone
  • Desperately seeking another relationship when one ends
  • Unrealistic preoccupation with being left alone and unable to care for oneself

 

A qualified mental health professional may provide a diagnosis of dependent personality disorder by evaluating a person’s symptoms and comparing them to the criteria published in the DSM-5.

 

Dependent Personality Disorder and Other Conditions

Dependent personality disorder is a “cluster C” personality disorder. It belongs to a group of personality disorders that are marked by fearful, anxious thinking or behavior. This contributes to challenges in close relationships or at school or work.

 

Dependent Personality Disorder vs Codependency

Dependent personality disorder and codependency are distinct dependency issues. Dependent personality disorder is marked by an over-reliance on others to meet one’s physical and emotional needs. People with DPD usually display nervous, anxious, fearful, helpless, and submissive behaviors. They also display an inability to make independent decisions.

Codependency is marked by a person’s focus on living for or through another individual. Codependent people have an obsessive need to take care of and control the actions of others.

In essence, they are dependent on the other person’s dependence on them.

As a result, caretaking becomes compulsive and may encourage the needy individual to continue on an unhealthy course. Codependent people may also feel victimized by their one-sided relationship and secretly blame the needy partner for the challenges they experience in life.

 

Related Conditions

Dependent personality disorder is a “cluster C” personality disorder. Other conditions in “cluster C” include obsessive-compulsive personality disorder and avoidant personality disorder.

 

Dependent Personality Disorder In Adults/Children

A diagnosis of dependent personality disorder is very rarely given to children as they have a natural dependence on parents and other adults in their lives for physical and emotional support.

Symptoms of the condition usually appear in early adulthood. Older teens and young adults who experienced serious illness or separation anxiety during childhood are more likely to develop dependent personality disorder.

Parents of children who have been diagnosed with dependent personality disorder are encouraged to seek a second opinion from a mental health professional who specializes in pediatric care.

 

Example Case of Dependent Personality Disorder

Jennifer, 24, visits a local psychologist at the suggestion of her new boyfriend. Jennifer tells the psychologist that she regularly doubts herself and relies on her boyfriend to get through the day. She takes his advice on what to eat for breakfast, what to wear, what to have for lunch, and when to exercise.

Jennifer reveals she also had a close relationship with her previous boyfriend, but the relationship did not last. She recalls always giving in to his sexual demands because she was terribly afraid he might leave. When he decided to end the relationship, Jennifer was devastated and constantly worried about how she would care for herself. So she quickly found a new boyfriend she could depend on.

Through questioning, the psychologist learns Jennifer had separation anxiety disorder as a child. The psychologist diagnoses Jennifer with dependent personality disorder and encourages her to come to therapy twice per week.

After a few months of treatment, Jennifer reports feeling much better about herself and claims her relationship with her new boyfriend is stronger and healthier.

 

How to Deal/Coping With Dependent Personality Disorder

Individuals with dependent personality disorder may become anxious at the thought of developing skills to cope on their own. However, a trained therapist can help you learn the skills you need to feel better. A therapist can also help you develop self-care strategies and establish healthy boundaries. This will reduce the likelihood you will be exploited by other people and help you succeed in your own life.

People with DPD are unlikely to seek professional mental health care on their own. It is vital that loved ones encourage them to seek and stick to therapy.

 

Look out for These Complications/Risk Factors

Dependent personality disorder may disrupt the lives of people with the condition as well as their loved ones. Individuals with dependent personality disorder may be at increased risk for drug use, alcohol use, and mood issues such as depression and anxiety.

They are also more likely to be involved in relationships that are physically, sexually, and/or emotionally abusive. Dependent personality disorder may occur in tandem with other personality issues such as avoidant, histrionic, and borderline personality disorders.

 

Dependent Personality Disorder

 

Dependent Personality Disorder Treatment

The recommended treatment for dependent personality disorder is psychotherapy (talk therapy). Cognitive behavioral therapy (CBT) is a type of psychotherapy that is particularly effective in treating DPD. CBT helps people to challenge negative thinking patterns that may influence negative emotions and actions.

Cognitive behavioral therapy may be provided in an individual or group setting. By cooperating with treatment, people with dependent personality disorder can learn how to manage anxiety, become more assertive, sharpen their decision-making skills, and increase their self-confidence.

The goal of therapy is to empower individuals to become more independent. Consequently, therapists should be careful that people in treatment do not become dependent on them.

 

Possible Medications for Dependent Personality Disorder

The Food and Drug Administration (FDA) has not approved any specific medications for the treatment of dependent personality disorder. However, a psychiatrist may prescribe sedatives, tranquilizers, or antidepressants to treat co-occurring or underlying conditions.

 

Home Remedies to help Dependent Personality Disorder

There are no approved home remedies to treat dependent personality disorder.

 

Living with Dependent Personality Disorder

Individuals with dependent personality disorder find it difficult to make even simple decisions. Major life decisions are often left to a parent or spouse. Even when it is appropriate to express anger, people with DPD may hold back due of fear of losing support. However, effective treatment can help affected individuals to improve their quality of life.

The following lifestyle and self-care suggestions may help a person with dependent personality disorder:

  • Learn about dependent personality disorder – The more you understand about your condition the more likely you are to engage in positive interactions and behaviors.
  • Cooperate with your therapist – It may be difficult to cooperate with treatment when you feel anxious. However, being active in therapy will help you achieve better results in less time.
  • Take your medications as prescribed – Do not skip a dosage, even if you feel better. Medications can help you keep co-occurring issues under control so you can focus on getting better.
  • Get lots of exercise – Physical activity can help alleviate many of the symptoms associated with mood issues such as anxiety and depression.
  • Avoid drugs and alcohol – Addictive substance may disrupt your emotional balance, worsen your condition, or interfere with your prescribed medications

There is no definite way to prevent dependent personality disorder. However, cultivating healthy peer relationships from a young age, giving children age-appropriate responsibilities, and helping children develop a healthy sense of independence may promote self-confidence and self-esteem.

 

Insurance Coverage for Dependent Personality Disorder

Dependent personality disorder is a diagnosable mental health issue. Your current insurance provider may offer coverage for this type of mental health treatment.

Contact your insurance provider to verify your coverage and obtain any necessary information or authorization before you visit your therapist or doctor.

 

How to Find a Therapist

If you believe you have symptoms of dependent personality disorder, it is important to speak with your doctor. People with dependent personality disorder may have co-occurring issues and are at higher risk for other mood issues such as anxiety and depression. Your doctor will refer you to a qualified mental health professional who can help.

 

What Should I be Looking for in an LMHP?

Licensed mental health providers are trained to help people with mental health issues such as dependent personality disorder. However, not all mental health professionals may be right for you. Ask your therapist about his/her experience in treating dependent personality disorder. Other important qualities to look for include:

  • Strong communication skills
  • Good listening skills
  • Empathy
  • Warmth
  • Encouraging approach
  • Positivity
  • Willingness to work with you

If you do not think your therapist is a good fit for you, it is recommended that you ask for a referral.

 

Questions to Ask a Potential Therapist

Here are a few questions you can ask your therapist:

  • What personality disorder do you think I have?
  • What is the best treatment for this personality issue?
  • How can psychotherapy help?
  • Do I need to take any medications?
  • How long will I need to take medications?
  • Are there any side-effects associated with these medications?
  • How long does treatment last?
  • Is there anything I can do to help myself?
  • Do you have any brochures I can read?
  • Do you recommend any websites that explain my condition?

 

Dependent Personality Disorder Resources and Support Helpline

People with dependent personality disorder may experience anxiety, depression, and other mood and personality issues. If you are thinking about harming yourself, harming others, or committing suicide, please call any of the following numbers:

  • 911 or your local emergency services number
  • The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a mental health professional

Other helpful resources include:

  • NAMI Helpline National Alliance for the Mentally Ill at 1-800-950-NAMI (1-800-950-6264)
  • National Domestic Violence Hotline at 1-800-799-SAFE (1-800-799-7233)
  • National Institute of Mental Health Information Line at 1-800-647-2642
  • National Mental Health Association at 1-800-969-NMHA (1-800-969-6642)

If you believe you have dependent personality disorder, effective treatment is available. By working with a qualified mental health professional you can increase your self-confidence, build healthier relationships, and develop the skills you need to become more independent.

 

References:

Bressert, S. (2017, December 17). Dependent personality disorder symptoms. Retrieved from https://psychcentral.com/disorders/dependent-personality-disorder/symptoms/

Co-dependency. (n.d.). Retrieved from http://www.mentalhealthamerica.net/co-dependency

Dependent personality. (2017, December 13). Retrieved from https://www.goodtherapy.org/learn-about-therapy/issues/dependent-personality

Dependent personality disorder. (2018, March 6). Retrieved from https://www.psychologytoday.com/us/conditions/dependent-personality-disorder

Dependent personality disorder. (n.d.). Retrieved from http://www.healthofchildren.com/D/Dependent-Personality-Disorder.html

Dependent personality disorder. (2007). Retrieved from https://www.health.harvard.edu/newsletter_article/Dependent_personality_disorder

Mayo Clinic Staff. 92016, September 23). Personality disorders. Retrieved from https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

National hotlines. (n.d.). Retrieved from https://www.networktherapy.com/resources/hotlines.asp

Porter, D. (n.d.). Dependent personality disorder dsm-5 301.6 (F60.7). Retrieved from https://www.theravive.com/therapedia/dependent-personality-disorder-dsm–5-301.6-(f60.7)

Seltzer, L. F. (2014, December 11). Codependent or simply dependent: What’s the big difference? Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/evolution-the-self/201411/codependent-or-simply-dependent-what-s-the-big-difference