,

Do I Need Therapy? Quiz

,

Am I Depressed? Quiz

,

7 Ways to Start Dealing With Depression Now

Depression is a serious psychological disorder which may impact negatively on an individual’s quality of life and relationships with others. There are, however, a lot of ways of dealing with depression and moving on again in life.

What is Depression?

Depression is a psychological disorder that comes with significant morbidity and mortality. It remains a major cause of suicide, substance abuse, and impaired quality of life. Depression is not the same as the occasional mood fluctuations and transient gloominess everyone has in response to challenges of everyday life. People living with depression experience a long-lasting depressed mood, loss of energy, reduced ability to think or concentrate, reduced interest in activities they once enjoyed, and sleep disturbance. Approximately 80% of adults with depression reported some difficulty with home, work, and social activities as a result of their symptoms.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies depressive disorders into major depressive disorder, premenstrual dysphoric disorder, disruptive mood dysregulation disorder, persistent depressive disorder, and depressive disorder due to a medical condition. However, the hallmarks of all these classes of depression are the presence of irritable mood, difficulty thinking, poor concentration and attention span, difficulty carrying out daily tasks, and a reduced quality of life.

Stats about Depression

Depression is a common issue globally, with more than 300 million people affected worldwide. During 2013-2016, about 8.1% of American adults aged 20 years and more had depression in a given 2-week period and women were found to be twice (10.4%) as likely as men (5.5%) to have had it. From 2007-2008 to 2015-2016, the prevalence of depression among American adults did not change significantly. It was also revealed that the prevalence of depression was lower among non-Hispanic Asian adults than in Hispanic, non-Hispanic white, and non-Hispanic black adults.

7 Tips to Start Dealing with Depression Now

Dealing with depression requires a lot of commitment and action and this may seem exhausting for a depressed person. It’s not just medications that help treat depression, lifestyle changes, and dietary modifications can also contribute to the improvement of your symptoms and a better quality of life. The following practical tips may restore your mood and quality of life:

1. Practice Self Compassion

Depression could take a huge toll on your emotions and mental health. However, the journey to recovery begins by showing yourself some compassion. Developing love and kindness for yourself will, in time, make you feel less moody and irritable and more alive. Self-compassion involves being warm to yourself when you do not achieve the small goals you set for yourself. Instead of being overly critical of yourself in perceived inadequacies or failures, you can talk about your strengths, feel good about them, and accept your weaknesses.

Another way of showing self-compassion is forgiving yourself. Many people develop depression as a result of life events, such as the death of a loved one, divorce, broken relationships, which they perceive were caused by them. In these situations, the first great step to recovery is letting go of that hurt and guilt and forgiving yourself. Not forgiving oneself keeps the guilt in, which will form a focal point of the negative thoughts and emotions, and the depressive symptoms may linger despite treatment.

In addition, you have to do things that energize you in order to overcome depressive symptoms. Depression, on its own, leaves you with no interest or drive to do what you once loved. However, to develop those interests again, you need to push yourself into doing them: engage in a sport, pick up a new hobby, learn a new music, or take a trip to the ballpark or museum. Even if your symptoms do not improve immediately, you will feel slightly better and that feeling would improve as long as you are persistent.

2. Keep a Depression Journal

Journaling your experiences with depression helps to make your thoughts and emotions clearer to you. When your thoughts, fears, and insecurities swirl around, it helps to take control and manage these emotions if you pen them down. Journaling empowers you to take steps that will eliminate those worries and make you feel better.

Also, writing how you feel or what events happen during the day helps you to notice patterns: You can easily identify a potential stressor or trigger when you keep track of your emotions by writing them down. For instance, you may identify that your symptoms become worse during a certain time of the day or when you engage in a certain activity in a day. This helps you to identify the stressor so you can avoid them in the future.

Journaling also gives you insight into how your symptoms are improving over time. If you flip through the pages to look back at older entries, you may notice how better or worse your symptoms have gone over time. You can make your journal private or share it with your therapist. Whichever you do, it helps to keep your worries in the surface so you could take practical steps to resolve them.

3. Challenge Negative Thinking

Depression often comes with the feeling of worthlessness, the feeling of being powerless or weak. These result from negative thinking patterns stemming from past experiences or perceived failures. It is important to know that these feelings and negative attitudes are not realistic and are distortions caused by the disorder. Life is made of the good and the bad experiences, mistakes and successes, however, in depression, the mistakes and failures are exaggerated and the success or strengths of the individual are downplayed or forgotten, draining them of the energy to do or achieve something.

Challenging these negative thinking patterns is a major step in recovering from depression. Some of these patterns include thinking that one shortcoming means one is a total failure, generalizing a single negative event and expecting it to hold true to other aspects of one’s life, and making negative conclusions about a situation without having any evidence. These patterns of thinking foster depression and must be replaced by positive and more rational thought patterns. For example, instead of thinking that a stranger dislikes you without even having a conversation with you, ask yourself if there’s any way a stranger will not like you if they don’t know you and tell yourself that if a stranger does not like you without knowing you, it is no fault of yours.

4. Set up a Routine

Depression robs one of a stable life and one sure way of combatting it is by creating a stable pattern of living, even if you don’t feel like it. In setting up a routine, the following tips may help:

  • Establish the same sleep and wake-up times every day. This ensures you get the right amount of sleep, creating time for other activities during the day. Getting good sleep also helps to improve your mood and brain functions.
  • Set up meal times each day. This prevents excessive eating or poor eating which may be associated with depression.
  • Set time for social activities every daytime to visit a friend, time to go to the cinema, time to read a book, time to hit the gym etc.

Having a stable pattern gradually keeps your mind focused on the day’s activities rather than engaging the depressive thoughts and feelings.

5. Practice Sleep Hygiene

Sleep is an important factor that helps your brain and mind restore itself and feel rejuvenated. Experts recommend that you get 7 -8 hours of sleep every day to keep your mind functioning properly. Having less or way over that may leave you feeling fatigued, tired, worn out, and not well rested. These may exacerbate the depressive symptoms. Sleep hygiene practices include:

  • Limit your daytime nap to 30 minutes
  • Establish a regular bedtime and wake-up schedule
  • Ensure the sleep environment is comfortable – comfortable mattress and pillows, turn off the lights or adjust them at bedtime so you could fall asleep easily, and keep the temperature cool.
  • Avoid stimulants such as nicotine and caffeine close to bedtime
  • Avoid heavy, fatty, spicy, or fried foods at bedtime, as these foods could cause an uncomfortable heartburn which disrupts sleep.
  • Ensure adequate exposure to natural light during the day.

6. Get Some Exercise

Exercise elevates your mood and keeps not just your body but your mind rejuvenated. Research has shown that exercise may be as effective in improving the symptoms of depression as medications. To get the most benefit, you should engage in regular exercises for at least 30 minutes every day. If you are new to exercises, you can start with mild ones for short durations, then gradually increase the intensity and duration.

Starting and sticking to an exercise routine may seem daunting at first, but regular exercise has been found to improve energy levels and mood. You can get the most benefits from rhythmic exercises such as walking, swimming, dancing, martial arts, and cycling in which your arms and legs are in constant motion.

Dealing with Depression

7. Reach Out to Friends and Loved Ones

It helps to reach out and stay connected to other people when you have depression. Depression creates a tendency to isolate yourself and withdraw from other people, but this, in itself, may worsen your symptoms and allow the negative emotions and thoughts to fester.

You may feel exhausted or pessimistic about social activities, but engaging in them keeps you alive and connected to the world. Participating in positive social activities can help improve your mood and change your attitude about life.

In addition, staying connected to people helps you access the needed emotional support which will help reduce your symptoms. Talking to someone about your feelings help you feel better about them, and having someone listen to you will make you feel loved and cared for. In addition to receiving emotional support, staying connected to people provides you with avenues to support others. Providing care and sharing love to others have been found to give an even bigger boost to your mood and emotional wellbeing.

What are the Traditional Treatments for Depression?

There are a number of conventional methods for treating depression including medications and psychotherapy. However, a combination of both antidepressant medications and psychotherapy is effective in relieving the depressive symptoms. Treatment with only one of those methods is usually not as effective.

Therapy for Depression

Therapy for persons with depression is centered on helping the individual deal better with their symptoms by promoting new thinking, emotional, and behavioral patterns. Examples of therapy for depression include interpersonal psychotherapy, emotion-focused therapy, problem-solving therapy, and cognitive behavior therapy. Nowadays, there are even online options to work with.

Medications for Depression

Medicines used for treating depression are called antidepressants and are of many classes. Some of these drugs include Selective serotonin reuptake inhibitors (SSRIs) such as Fluoxetine, Sertraline, and Citalopram and tricyclic antidepressants such as imipramine and Nortriptyline. Your physician will prescribe these drugs, usually starting at the lowest tolerable dosage and adjust it as required.

What are Alternative Methods of Dealing with Depression?

There are other methods of treating depression. These measures may complement conventional methods or may be as applied if the individual does not respond to these methods.

ECT for Depression

Electroconvulsive therapy (ECT) is highly effective for the treatment of depression. It is usually indicated for individuals who do not respond to medications, those who have become suicidal, or if a fast reduction of symptoms is required.

ECT has an onset of action that is more rapid than drug therapies, with improvement in symptoms seen within a few days of commencing therapy. However, ECT is associated with a number of risks including post-treatment confusion, short-term memory loss, and problems caused by the anesthesia.

Ketamine for Depression

Ketamine is a drug used for anesthesia to numb pain sensation during a surgical procedure, however, when misused for recreational purposes, it may cause severe effects such as hallucinations, mood distortions, and losing touch with reality.

New studies, however, has suggested that ketamine may be effective in the treatment of severe depression, especially in individuals who do not respond to other forms of treatment or those who are suicidal. Ketamine may be administered via intravenous routes or through inhalation. Ketamine acts quickly with improvement in symptoms observed within a short time after use.

CBD Oil for Depression

Cannabinoid (CBD) is a naturally occurring chemical substance found in the hemp plant, cannabis. It is one of the most common naturally-occurring compounds in hemp. CBD oil has been found to be effective in the treatment of depression by potentiating the effects of chemical substances in the body which help regulate mood, sleep, and appetite. CBD oil is considered safe for use with minimal risk of side effects and, contrary to popular belief, CBD is not addictive and does not cause the user to get high.

Bottom Line: Dealing with Depression

Depression is a disorder that takes a huge toll on a person’s quality of life and interpersonal relationships. However, it is possible to overcome the symptoms and lead a happier and healthier life. It may be difficult but persistence and commitment in practicing healthy lifestyle habits and professional care will see those symptoms lose their grip on you over time.

Resources

https://www.helpguide.org/articles/depression/coping-with-depression.htm

https://www.huffingtonpost.com/hannah-sentenac/mental-health-news_b_5678778.html

https://www.psychologytoday.com/us/blog/compassion-matters/201110/eight-ways-actively-fight-depression

http://www.who.int/news-room/fact-sheets/detail/depression

https://www.cdc.gov/nchs/products/databriefs/db303.htm

https://www.webmd.com/depression/features/writing-your-way-out-of-depression

https://www.healthyplace.com/blogs/copingwithdepression/2017/02/successful-coping-with-depression-requires-routine

https://sleepfoundation.org/sleep-topics/sleep-hygiene

https://emedicine.medscape.com/article/286759-treatment#d8

https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain#1

 

 

What is Cataplexy?

Many individuals report feeling very weak or even losing control of their muscles and body when they experience strong emotions. This condition is called cataplexy and it is almost always a feature of the sleep disorder called narcolepsy.

Cataplexy: What does it mean?

Cataplexy is a condition characterized by a sudden and transient loss of voluntary muscle tone triggered by strong and, often pleasant emotions such as laughter and happiness. The loss of muscle tone, typically, affects both sides of the body and the attack lasts between a few seconds to less than 2 minutes after which normal muscle tone and function returns.

Cataplexy usually occurs during waking hours and it may range from mild to severe. While laughter is the most common trigger of cataplexy, it may also be triggered by other emotions such as excitement, anger, fear, stress, and surprise. It may also occur after abrupt discontinuation of an antidepressant medication.

Stats: How many People suffer from this Disorder?

Cataplexy is a common feature of Narcolepsy, however, it may be seen in other rare disorders including Wilson’s disease, Prader-Willi syndrome, and Niemann-Pick disease. Additionally, some patients with stroke, multiple sclerosis, traumatic brain injury, and encephalitis may also develop this condition.

Narcolepsy is a neurological disorder characterized by excessive daytime sleepiness and it occurs in 2 in 100 adults worldwide, however, the incidence of cataplexy is a little lower than this as not all persons with narcolepsy have cataplexy. Cataplexy which occurs with narcolepsy typically begins in childhood and early adulthood with an age of onset between 7 and 25 years, although it may begin at any time.

How many episodes of cataplexy people with the condition experience varies from as small as one per year to as many as several attacks in a day. However, on average, a person with cataplexy will experience at least one attack every week.

What Causes Cataplexy?

The exact cause of cataplexy is not clearly understood, however, scientists suggest that it may occur as a result of an inability of the brain to regulate the sleep-wake cycle. The stage of sleep called the rapid eye movement (REM) sleep is characterized by normal loss of muscle tone. In cataplexy, this feature occurs during wake hours, suggesting that there is an overlap between sleep and wake phases.

The cause of this intrusion of sleep into waking hours is unknown, however, a contributing factor is a loss of brain cells which produce a chemical substance called hypocretin (or orexin) which is involved in keeping an individual awake and alert within a sleep-wake cycle. Some studies have suggested that this loss of brain cells that produce hypocretin is caused by an autoimmune process in which antibodies destroy these cells.

Signs and Symptoms of Cataplexy

Symptoms of a cataplectic episode vary widely and may be mild and undetectable or severe. These symptoms include:

 

  • Jaw tremor
  • Nodding of the head, in partial loss of muscle tone.
  • Drooping of the eyelids
  • Difficulty speaking
  • Trembling of the knees
  • Muscle twitching
  • Making unusual tongue movements
  • Facial twitching and grimacing
  • In severe cases, the person may collapse and develop a transient inability to move.

During a cataplectic attack, an individual is usually conscious and able to breathe. These symptoms usually last a few minutes or less and resolve without any intervention. Some persons may fall asleep afterward.

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

Cataplexy is the diagnostic feature of narcolepsy and its presence typically suggests that an individual has narcolepsy. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Narcolepsy is defined as recurrent episodes of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months. There also must be the presence of at least one of the following: 

  • Episodes of cataplexy occurring at least a few times per month
  • Hypocretin deficiency
  • REM sleep latency ≤15 minutes, or a mean sleep latency ≤8 minutes and two or more sleep-onset REM periods (SOREMPs)

Cataplexy and other Conditions

There are a number of conditions which are characterized by or which presents similarly to cataplexy and which should be distinguished clinically.

Cataplexy vs. Narcolepsy

Narcolepsy is a sleep disorder that is characterized by the tetrad of excessive daytime somnolence, sleep paralysis, hallucinations just before falling asleep, and cataplexy. However, cataplexy is the diagnostic symptom of narcolepsy, such that if an individual develops excessive daytime sleepiness with cataplexy, they likely have narcolepsy. Cataplexy occurring without narcolepsy is rare and its cause is unknown. Narcolepsy is also associated with trouble sleeping at night and nocturnal compulsive behavioral patterns such as sleep-eating and night smoking.

Cataplexy vs. Catatonia

Catatonia is a state of unresponsiveness to external stimuli and it is characterized by an apparent inability to move in a person who is apparently awake. Catatonia often occurs in severely ill individuals with certain psychiatric or medical conditions.

Individuals with catatonia present with mutism, opposition or no response to instructions or external stimuli, agitation that is not influenced by an external trigger, grimacing, mimicking another’s speech, and mimicking another’s movements. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition classifies catatonia into three types: (i) catatonia associated with another mental illness, (ii) catatonia resulting from a medical condition, and (iii) unspecified catatonia.

Cataplexy vs. Stroke

Cataplexy may be distinguished from stroke by the short timeline of the symptoms of the former. While symptoms of muscle paralysis in cataplexy lasts for a few minutes or less and resolve without intervention, symptoms of stroke typically last longer and requires treatment. However, in the case of transient ischemic attacks, symptoms may last for several hours but resolve within 24 hours.

In addition, stroke presents typically with convulsions, sudden severe headache, numbness in one half of the body and face, trouble speaking, transient blindness in one or both eyes, and difficulty walking.

Related Conditions

Sleep paralysis is a condition related to cataplexy but which usually occurs during awakening or when falling asleep. In sleep paralysis, the patient is typically unable to move when they wake, however, unlike in cataplexy, hallucinations are associated with this paralysis.

A severe form of cataplexy may be mistaken for convulsions, however, the difference is that, unlike in convulsions, the individual remains conscious during a cataplectic episode and is able to recount all that happened during the attack.

Cataplexy in Adults and Children

Cataplexy with narcolepsy typically begins in childhood and early adulthood between the ages of 7 and 25. However, children with cataplexy may also manifest some atypical movement disturbances, such as repetitive movement patterns which resolve later in the course of the disease. Also, children with cataplexy develop an unusual facial appearance during each attack, characterized by repetitive mouth opening, drooping of the eyelids, and tongue protrusion. In addition, the emotional triggers of cataplexy, such as laughter or excitement, are not always present in children.

Example Case of Cataplexy

John, a 14-year-old college student is referred to the sleep clinic by his primary care physician on account of his excessive daytime sleepiness which has been occurring on most days of every week for the past three months. John notes that these symptoms began with recurrent episodes of falls to the ground from his seat whenever he laughs or jokes with his classmates. He claims that he remains conscious during each attack and can remember what happens. He notes that each “attack” typically begins with drooping of his eyelids, inability to continue with whatever he was doing at the time before he falls to the ground.

Cataplexy

How to Deal/Coping with Cataplexy

Cataplexy may be a debilitating condition, impairing a person’s daily activities, interpersonal relationships, and productivity at work or school. It is essential to consult a physician or expert before it causes serious complications. Certain lifestyle changes may help to reduce the symptoms and frequency of cataplexy and to reduce the risk of developing serious injuries.

Look out for these Complications/Risk Factors

Complications of Cataplexy include:

  • Since cataplexy can occur without any notice and at any time, an episode may cause injuries and even death if the individual is driving or doing an activity that involves dangerous objects.
  • An individual may avoid both pleasant and unpleasant emotions for fear of an attack.
  • A strain on interpersonal and social relationships
  • Poor work or school performance as a result of the intermittent disruption of activities cataplexy causes.

Although cataplexy has been associated with reduced levels of the chemical substance, hypocretin in the brain, there are other factors which may increase the risk of this disorder. These include:

  • Traumatic brain injuries
  • Brain tumors around the areas of the brain that regulate sleep.
  • Autoimmune conditions – characterized by overactive immune cells which mistake normal cells for foreign objects, destroying them in the process.
  • Viral infections and vaccinations against viral infections.

Cataplexy Treatment

Treatment of cataplexy includes the use of medicines, lifestyle modifications, and dietary changes. People with cataplexy need emotional support at work/school and at home and should be provided with their special academic needs and other social requirements such as insurance and driver’s license.

Possible Medications for Cataplexy

Common medications for treating cataplexy, with or without narcolepsy, include antidepressants such as tricyclic antidepressants such as clomipramine, and selective serotonin reuptake inhibitors including Fluoxetine. Sodium oxybate is another medication commonly used to treat cataplexy. Individuals that have narcolepsy with cataplexy may also be treated with modafinil and stimulant drugs such as Ritalin.

Home Remedies to Help Cataplexy

Lifestyle changes and dietary modifications may help in reducing the frequency and intensity of cataplexy. Sleep hygiene is an important factor which may help reduce the intensity and frequency of cataplexy.

Practicing the following sleep hygiene measures may help reduce the symptom of cataplexy:

  • Keep a regular sleep schedule which ensures that you get up and go to bed at the same time every day.
  • Ensure you aim at getting a minimum of 7 to 8 hours of sleep daily.
  • Make the bedroom quiet and keep the temperature cool to allow for comfortable sleep.
  • Limit your exposure to light in the evening to prevent a delayed sleep onset.

Other lifestyle changes which help reduce these symptoms include:

  • Engage in regular exercise
  • Avoid consuming alcohol
  • Avoid taking caffeine in the afternoon or close to bedtime.
  • Take at least one short nap during the day.
  • Maintain a healthy diet.

Living with Cataplexy

People with cataplexy need to take extra precautions because of the nature of the condition:

  • Inform your friends and loved ones that you have the condition and tell them how to identify the symptoms. This will help them better understand the condition and help you to cope with it.
  • Ensure you drive with a companion or have them drive you as often as possible.
  • Be prepared for situations which may provoke strong emotions and have a friend keep a close eye on you in those situations.
  • Ensure you get as much sleep as possible – a short nap in the afternoon and seven to eight hours of sleep each night.
  • Be aware of potential dangers such as sharp objects, heights, and glass
  • Practice relaxation techniques such as yoga.
  • Avoid driving a car or operating machinery until you have been cleared by a medical professional.

Insurance Coverage for Cataplexy

Check your plan benefits for coverage of sleep therapy or neurological 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 the 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 evaluation of your symptoms, will refer you to a neurologist or a sleep medicine specialist for treatment. 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 or sleep specialist include:

  • Good Communication Skills – Your LMHP should be able to effectively communicate their expert ideas and thoughts about your symptoms.
  • 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 reduction 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 the effectiveness of treatment.

Questions to ask for 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.

  • What may be causing these symptoms?
  • Do I have cataplexy?
  • Should I inform my school/employer/colleagues about the condition?
  • What is the treatment approach you recommend?
  • What medications will I be on?
  • What side effects should I expect from those drugs?
  • Are there effective home remedies I can employ?
  • What precautions should I take in living with this condition?
  • How will you monitor my treatment progress?
  • Are there any resources or websites you recommend?

Cataplexy is a brief, sudden loss of muscle control and tone triggered by strong emotions such as laughter, excitement, fear, and anger. Cataplexy is almost exclusively associated with narcolepsy, a sleep disorder characterized by excessive daytime sleepiness. Although cataplexy has no cure, its intensity and symptoms may be reduced with medications, sleep hygiene practices, and dietary changes.

References:

https://sleepfoundation.org/narcolepsy/content/cataplexy

https://www.medicalnewstoday.com/articles/307668.php

https://www.sleepassociation.org/sleep-disorders/narcolepsy/about-narcolepsy-cataplexy-2/

https://www.livestrong.com/article/83013-diet-therapy-narcolepsy/

https://www.researchgate.net/publication/262813425_Cataplexy_-_Clinical_aspects_pathophysiology_and_management_strategy

https://emedicine.medscape.com/article/1188433-overview#a1

https://emedicine.medscape.com/article/1154851-overview#a1

What is Circadian Rhythm Disorder?

Do you have a difficult time maintaining an optimal sleep schedule?  Perhaps you have considered yourself a “night owl” because you stay awake so late. Or perhaps you consider yourself a “morning lark” because you awaken so early. If you experience this and subsequent excessive drowsiness, you may have a condition called circadian rhythm disorder (sometimes called Non-24). Learn more about this condition, how it could affect your daily functioning, and what to do about it:

Circadian Rhythm Disorder: What Does It Mean?

Everyone has a circadian rhythm that is generally controlled by parts of brain and exposure to light. This circadian rhythm is like an internal body clock that determines the timing of many biological functions. Typically, these functions follow a 24-hour cycle. Chief among these functions is your sleep schedule. However, some people have an occasional or continuous disruption to their sleep patterns, which may result in bouts of insomnia or excessive sleepiness. This disruption is called a circadian rhythm disorder.

Stats: How Many Suffer from This Disorder?

Circadian rhythm disorder is most common in blind individuals because they are unable to perceive light changes, which means their brain does not get all the typical cues to induce sleep. In sighted individuals, it is estimated that 1 in 600 adults may have a circadian rhythm disorder that affects their sleep.

What Causes Circadian Rhythm Disorder?

Circadian rhythm disorder can be caused by factors such as shift work, time zone changes, alterations in routine, medications, pregnancy, and other medical or mental health problems.

Signs and Symptoms of Circadian Rhythm Disorder

There are multiple specific subtypes of Circadian Rhythm Disorder. While each type has commonalities in that they all affect sleep cycles, each type does also have some unique and different symptoms.

What are the Common Behaviors/Characteristics?

The most common symptom of circadian rhythm disorder is a disrupted sleep schedule due to a discrepancy between the expected 24-hour cycle and an individual’s internal body clock. Beyond that, the specific symptoms may vary from person to person with the disorder.

Some individuals with circadian rhythm disorder may experience a delay in their sleep phase. This means they are often more alert and productive at night, and then often go to bed much later than is ideal. This specific symptom is most common in adolescents and young adults.

If a person struggles with this disorder and they can sleep in as late as they like, they will likely manage well enough. However, if their school or work demands require an earlier wake-up time, then they will eventually become sleep deprived. This can lead to daytime sleepiness, which will, in turn, affect school and work performance. It can be challenging to live with.

Other people struggle with advanced sleep phase disorder where they feel a strong need to go to bed early and awake early. They may become tired in the late afternoon. This could affect their work to some degree. It may also affect their home life, parenting, and other relationships.

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

If you experience problems with your sleep and suspect circadian rhythm disorder, you will want to seek help for a diagnosis and treatment. Medical providers may be the best to assess your symptoms and make a diagnosis. They will likely do a holistic evaluation to rule out any illnesses or physical causes for your disrupted sleep. To further assess the sleep symptoms, providers will likely ask you to maintain a sleep diary, where you record your sleeping and waking times. They may also ask you to wear a wristband that could record this information automatically. In some cases, you may be asked to complete a more formal sleep study, in which you visit a sleep clinic that can measure your sleep patterns.

All this information will be used to make a formal diagnosis of circadian rhythm disorder. To assign a diagnosis, professionals may use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents the following criteria to define circadian rhythm disorder:

  • A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia, due to a mismatch between the sleep-wake schedule required for the person’s environment and his or her circadian sleep-wake pattern.
  • The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The disturbance does not occur exclusively during the course of another disorder.
  • The disturbance does not occur due to the effects of a substance or medical condition.

When a diagnosis of circadian rhythm disorder is made, providers can also specific whether it is an altered sleep phase type, a shift work type, or a jet lag type. It can be further specified whether the condition is episodic (one episode), recurrent, or persistent.

Circadian Rhythm Disorder and Other Conditions

When making a diagnosis, medical and mental health professionals also rule out similar conditions:

Circadian Rhythm Disorder vs Narcolepsy

Narcolepsy is another disorder that affects sleep. It is characterized by excessive sleepiness. Further, individuals who have narcolepsy sometimes suddenly and unexpectedly fall asleep. During sudden sleep episodes, they may experience cataplexy, which is a loss of muscle control. While both conditions affect sleep, circadian rhythm disorder involves an alteration in one’s general biologically driven sleep schedule, while narcolepsy may not. Instead, the sudden bouts of sleep can occur at any time and usually last a brief time, in spite of any other sleep patterns.

Circadian Rhythm Disorder vs Jet Lag

When an individual experiences jet lag, there is some conflict between their typical pattern of sleep/wakefulness, their internal biological clock, and their current time zone. Some individuals find it more difficult to adjust to new time zones, which may be considered a circadian rhythm disorder. However, most jet lag typically resolves after an adjustment period, whereas circadian rhythm disorder is a more chronic condition that is unlikely to resolve on its own.

Related Conditions

Another condition that can disrupt sleep is shift work disorder. This usually occurs for individuals that work at night or that have rotating shifts. These work schedules can affect the body’s natural rhythms. Some individuals may have more difficulty adjusting to those changes. The resulting symptoms tend to be problematic sleep patterns such as insomnia and fatigue.

Insomnia may also be confused for circadian rhythm disorder. However, the conditions are distinct. Individuals with insomnia struggle to fall asleep or wake frequently and then have difficulty returning to sleep. Individual with circadian rhythm disorder can fall asleep, it just occurs at a less than optimal schedule. The discrepancy between their natural body-driven sleep schedule and the demands of life may result in insomnia and/or fatigue during waking hours.

Circadian Rhythm Disorder in Adults/Children

Children may exhibit circadian rhythm disorders and require specialized treatment from a specialist. During adolescence, many teens do experience some challenge in their sleep schedule and this may be due, in part, to hormonal changes.

Example Case of Circadian Rhythm Disorder

Consider this example of circadian rhythm disorder to see if it reminds you someone you know:

Max has an 8 to 5 job but often finds himself arriving late due to being so tired that he oversleeps. Sometimes he is then also drowsy during the workday. Max would like to practice good sleep routines; however, he finds it very difficult to fall asleep at an ideal time.

Circadian Rhythm Disorder

 

How to Deal/Coping with Circadian Rhythm Disorder

Individuals with circadian rhythm disorder will likely feel distressed by the effects that their symptoms have on their waking hours, including their lifestyle, work performance, and relationships. Others may also feel frustrated with the person if they are unable to complete their necessary tasks.

Look Out for These Complications/Risk Factors

As noted, some individuals with circadian rhythm disorder will experience negative repercussions in their daily life. Further, any sleep deprivation they experience could have deleterious effects on their physical and mental health. In some extreme cases, the condition and its negative side negative effects lead to severe mental health problems, such as suicidality. Seek out medical and mental health assistance to get help for reducing your symptoms.

Circadian Rhythm Disorder Treatment

Individuals with circadian rhythm disorder will want to seek medical and potentially mental health treatment. Treatment options vary, and the specific recommendations will be intended to match your specific symptoms. In some cases, medications and/or light therapy may be prescribed to manage the symptoms. Mental health treatment in the form of behavioral therapy is also frequently recommended.

Possible Medications for Circadian Rhythm Disorder

If a doctor determines that medications will be helpful in the treatment of your circadian rhythm disorder, there are multiple options for aiding sleep and inducing wakefulness. Melatonin is a popular choice. This is actually a hormone that plays a role in the biological clock and sleep induction. It is available over-the-counter, but you may want to consult a doctor before use.

Home Remedies to Help Circadian Rhythm Disorder

As noted, individuals who have circadian rhythm disorder can learn behavioral techniques, to use at home, that will be helpful in better regulating their sleep schedule. One behavioral approach is called chronotherapy. In this approach, the person gradually shifts their sleep schedule. It takes a high degree of commitment as it can be challenging. Choosing to use bright light therapy is also an intervention that can be done from home. In this, you expose yourself to more lighting, at the right times, to reset your internal circadian rhythm. Other approaches include setting a regular bedtime and following a regular pattern of behaviors before sleep.

Living with Circadian Rhythm Disorder

Individuals who have circadian rhythm disorder may experience some distress as a result of their symptoms and the effect those symptoms have on their functioning in life. Medical treatment and support through counseling or therapy can be helpful to reduce that distress. Taking prescribed medications and following any other recommendations will also be helpful.

Insurance Coverage for Circadian Rhythm Disorder

The medical and mental health fields consider circadian rhythm disorder as a diagnosable condition. It is likely that health insurance will cover any necessary treatment including medical and therapeutic interventions. Call your personal insurance company to ask about your options. Your provider’s office may also be able to assist you in checking about your insurance coverage.

How to Find a Therapist

If you are concerned about your own or someone else’s unusual sleeping patterns, you should first seek help by asking your medical provider about your symptoms. They may prescribe medical tests and physical exams to determine a diagnosis. They may also recommend therapeutic support from a mental health provider. You can also search online for therapists near you, using the name of your location.

What Should I be Looking for in an LMHP?

When looking for a mental health provider to assist with your circadian rhythm disorder, you will want to make sure they are trained and licensed in their respective field. You will also want to find a provider who is specially trained to work with circadian rhythm disorder.

Questions to ask a Potential Therapist

When meeting with a therapist, ask about their training for working with circadian rhythm disorder. You may also want to ask about their general approach to therapy, how they would plan to help you/monitor your success in therapy, and the likely duration of treatment.

Circadian Rhythm Disorder Resources and Support Helpline

There are resources online regarding circadian rhythm disorder that may be helpful:

If you have concerns about your health and functioning, or the health of a loved one, and suspect they may have a mental health condition, consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline. If you experience suicidality, call the Suicide Prevention Lifeline.

Although the symptoms of circadian rhythm disorder can be challenging, it is a diagnosable condition and help is available to improve your functioning. Consider seeking appropriate treatment from medical and mental health providers so that you can improve your overall quality of life.

 Enuresis: Problems with Bedwetting

Enuresis is the name given to bedwetting which occurs in children who have reached the age when most are able to pass the night without urinating in the bed.

Enuresis What Does It Mean?

Enuresis means that your child repeatedly wets the bed during the night. This is perfectly normal in children up to the age of five, and many children continue to involuntarily pass urine in the bed up until the age of seven years. If your child is over seven years of age and continues to wet the bed two or three nights a week you should talk to your doctor. This is known as Primary Enuresis. You should also consult with him if your child suddenly starts bedwetting again after a period when he did not, which is called Secondary Enuresis. There are other types of Enuresis but here we will be considering nocturnal enuresis, also known as nighttime incontinence, or bedwetting.

Stats: How Many Suffer from this Disorder?

Enuresis is more common in boys than girls. At 5 years of age, it is estimated that 7-percent of boys and 3-percent of girls suffer from Enuresis or 5-10-percent of all children. By the time they are ten, just three-percent of boys and two-percent of girls continue with bedwetting issues, and by the age of 15, one percent still have problems. However, some studies suggest that the numbers could be much higher, with as many as ten percent of children of 10 years old still suffering from the condition. That translates to about 9-million children across the US.

What Causes Enuresis?

Enuresis in children has many different possible causes, most of which resolve themselves naturally as the child grows.

  • Bladder size. Your child’s bladder simply may not be large enough, as yet, to contain all of the urine produced during the night.
  • Not registering the need to get up and go to the bathroom. In some children, the nerves which advise that the bladder is full, develop more slowly. That means, that particularly if your child sleeps deeply, he does not realize that he needs to visit the bathroom.
  • Our bodies produce an anti-diuretic hormone (ADH) which slows down the production of urine during the night. Sometimes children do not produce enough of this hormone.

Occasionally, bedwetting can indicate some other health problem. If your child has any of the symptoms below you should consult with your doctor, as Enuresis can also be caused by the following conditions-

  • If your child experiences pain while urinating, must urinate frequently, or the urine is dark in color, he could be suffering from a urinary tract infection.
  • Sleep apnea. If your child snores or is sleepy during the day, he could be suffering from sleep apnea which causes the interruption of regular breathing during sleep. This can be due to inflammation or enlargement of the adenoids or tonsils.
  • If your child urinates large quantities at a time, is always thirsty, is tired during the day, or starts bedwetting after having achieved bladder control he could be developing Diabetes.
  • If your child has trouble opening his bowels every day, this can cause bedwetting as the same muscles control both urine and stool evacuation.
  • Structural problem. Very rarely the cause of Enuresis is due to a physical problem in the urinary tract or in the nervous system.
  • Sometimes a stressful situation, such as a death in the family, or a change of house, can precipitate the condition.

Signs and Symptoms of Enuresis

The most obvious sign is a wet bed and pajamas and an embarrassed child.

What are the Common Behaviors/Characteristics?

Bedwetting is quite common until the age of five. Even if your child is “potty-trained” during the day, often at night they do not make it to the bathroom. This is often because their small bladder gets overfull and they pass urine before they can get to the bathroom. Or, that they sleep so soundly they do not wake up until it is too late.

Patience and understanding are very important. The child does not deliberately wet the bed, and so, even though it makes a lot of extra work don’t blame the child or tell them off. Put a plastic cover over the mattress to prevent the urine passing through or put a piece of plastic over the center of the bed with a small draw sheet over it.  Always have clean sheets and nightclothes ready nearby. Always wash your child’s buttocks and genitals before putting on the clean dry pajamas and apply a little soothing cream if there is any redness or irritation.

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

  1. Repeated voiding of urine into bed or clothes, whether involuntary or intentional.
  2. The behavior is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
  3. Chronological age is at least 5 years (or equivalent developmental level).
  4. The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spinabifida, a seizure disorder).

Enuresis and Other Conditions

Enuresis can be related to other conditions and you should visit your doctor if your child exhibits any of the following conditions.

Enuresis vs Encopresis

Encopresis is the term given for an uncontrolled bowel movement. Most children learn to control their anal sphincter by the age of four years old. If your child continues to soil the bed or his clothes after this age you should see your doctor. Enuresis and Encopresis can occur together.

Enuresis vs Neurogenic Bladder and Other Medical Conditions

Neurogenic Bladder is the term given to a lack of control over the bladder due to a problem in the nervous system. This, and other medical conditions can be the cause of Enuresis, and the diagnosis and treatment of the underlying condition can solve the bedwetting.

Related Conditions

Other related conditions can be, chronic constipation, sleep apnea, diabetes, or a urinary tract infection.

Enuresis in Adults/Children

Enuresis is much more common in children who normally grow out of the condition. Approximately one percent of the population suffer Enuresis throughout their lives. In old age, it is common for people to develop enuresis as the bladder muscles weaken or as nerve functioning deteriorates, often due to a stroke.

Example Case of Enuresis

“Douglas” went through “potty training” without any trouble and by the age of 4½, he was in complete control of both his urine and his stools. From this age on, he very rarely wet the bed. At the age of seven, his family moved to another city and “Douglas” had to change schools and make new friends. Shortly after moving he started wetting the bed. His parents tried their best not to make a big thing of it, but they were obviously concerned about the situation. “Douglas” was extremely distressed about his nighttime accidents particularly as he had not experienced many in his earlier childhood. He became withdrawn and found it hard to make new friends at his new school.

After about four months with regular bedwetting, they went to see the doctor. He asked them when the problem began, and they explained that it coincided with the move. The doctor felt that the stress caused by the change in his life was the cause of the Secondary Enuresis and recommended visiting a therapist.

The therapist worked with “Douglas” on his poor self-esteem and on showing him how to relate to new people and to make new friends. She also recommended to his parents that they reduce the amount of liquids he drank in the evening and cut out Cola drinks, of which he was quite fond. She also encouraged them to be patient and understanding and to have a quick and simple clean-up routine. She also suggested that “Douglas” should be encouraged to help by putting his wet pajamas and sheets straight into the washing machine ready for washing. In this way, he would feel more responsibility and more able to control the situation.

After just a few months of therapy, “Douglas” had stopped wetting the bed and was happily attending sleepovers with his new mates.

Enuresis

How to Deal/Coping with Enuresis

Patience and understanding are the key factors in dealing with Enuresis. Also,

  • Have a simple efficient clean-up routine
  • Encourage communication and offer support
  • Praise liberally when the child has a dry night
  • Do not tell the child off or complain about a wet night
  • Don’t allow siblings to tease
  • Make simple life changes to reduce urine production at night

Some parents find that a bedwetting alarm can help. This is a small alarm which sounds when it senses moisture. The idea is that it wakes the child so that he can stop the flow of urine and go to the bathroom to evacuate his bladder. It can take several weeks before they have a noticeable effect.

Look out for These Complications/Risk Factors

Notice-

  • If your child goes to the bathroom a lot.
  • If they pass a lot of urine at one time
  • If the urine is dark or cloudy
  • If there is any pain while passing urine
  • If the child is stressed or worried about something
  • If they are lacking in self-confidence

Enuresis Treatment

Normally Enuresis sorts itself out as the child grows or by making simple routine changes. Sometimes, your doctor may prescribe a medicine to help, but often the problem can return when the medication is stopped.

Possible Medications for Enuresis

Desmopressin (DDVAP) is sometimes prescribed to decrease the amount of urine which is produced at night.

Oxybutynin may help to decrease bladder contractions and to increase bladder capacity.

Imipramine has been shown to achieve dryness in 10-50-percent of children, but how it does this is not certain.

Home Remedies to Help Enuresis

Make sure that it is easy for your child to get from his bed to the bathroom. Leave nightlights on to mark the way, and maybe leave the doors to both rooms open. Sometimes bedwetting can be aggravated by the incapacity to get to the bathroom quickly and without fear. Nights, when your child remains dry, congratulate them in the morning. If you have other children don’t allow them to tease or ridicule the bedwetter. Some children can become very distressed about their condition and it can prevent them from wanting to join in normal childhood activities like sleepovers or camp. Be understanding and encourage your child to talk about the problem, as stress and shame can make the condition worse.

Try to make sure that your child avoids all caffeine-based drinks which can stimulate the bladder. Also, reduce the amount of liquid that your child drinks in the evening. Get your child into the habit of visiting the bathroom at regular intervals throughout the day. At bedtime, encourage your child to use the bathroom when you are starting your bedtime routine and then again just before going into bed.

If the problem continues, go to the doctor. He will ask you if there is a history of bedwetting in the family. It is more common for a child to wet the bed if someone else in the family did. The doctor will also want to know if there have been any stressful situations recently in your child’s life. He might ask you to keep a record of when your child drinks, when they use the bathroom and when they have a wet bed. He might want to do some examinations to rule out physical causes such as an infection. Depending on what he discovers the doctor may want to do more tests, or he may prescribe a drug that can help, or he may refer you to a therapist.

Some parents may want to try alternative therapies such as acupuncture, hypnosis, herbs, or visiting a chiropractor. These may be of help but always check with your doctor before starting any alternative treatments.

Living with Enuresis

Fortunately, most of the cases of Enuresis in children end of their own accord with the passing of the years. During the time while the child is bedwetting, it is essential to maintain a positive attitude and to provide the support and security that the child needs to get through this time. You may find help by joining a bedwetting group or forum on the internet.

Insurance Coverage for Enuresis

Enuresis is not normally covered by medical health insurance policies. However, a bed-wetting alarm may be covered by some policies of it is prescribed by your doctor.

How to find a Therapist

Your doctor will be able to recommend a therapist to help you with your child’s Enuresis is he feels that it is necessary.

What Should I be Looking for in an LMHP?

For any therapy to be effective it is important that both you and your child feel comfortable with the therapist and are willing to follow the suggestions and recommendations made by them. Before deciding on a particular therapist see if they have a web page where you can learn more about them and see if they have had success treating other people with this condition.

Questions to Ask a Potential Therapist

How can therapy help my child with this problem?

How long will it take to see the results?

Would therapy be with just the child or with the family?

How often will therapy take place?

Enuresis is normally a passing phase which most children will eventually grow out of without further intervention. However, if the bedwetting persists, or, if it starts after your child has been able to control his nighttime urine, it is important to try to find the cause so that it can be treated. Stress can often be the reason for bedwetting to start, and this can be well managed with therapy. If there is no evident psychological reason, a physical reason should be looked for. If your child is more than seven years old and regularly wets the bed at least twice a week go and talk to your doctor. Not investigating the cause can result in negative effects on both you and your child, so make an appointment to see your doctor today.

Enuresis Resources and Support Helpline

-National Kidney Foundation, 30 East 33rd Street, New York, NY 10016

NKF Cares Patient Information Help Line (855) NKF-CARES (1-855-653-2273) [email protected]

-National Institute of Mental Health: https://www.nimh.nih.gov/index.shtml

-National Alliance on Mental Health: https://www.nami.org/Find-Support/NAMI-HelpLine 1-800-950-NAMI (6264) or [email protected]

References

  1. https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685
  2. https://medlineplus.gov/bedwetting.html
  3. https://www.webmd.com/mental-health/enuresis
  4. https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/nocturnal-enuresis
  5. https://www.kidney.org/patients/bw/BWmeds
  6. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children
  7. https://www.sciencetheearth.com/uploads/2/4/6/5/24658156/dsm-v-manual_pg490.pdf
  8. https://www.poliklinika-djeca.hr/english/for-parents/child-development/enuresis-and-encopresis-how-can-we-help-the-child/
  9. https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/disorders-of-urination/neurogenic-bladder

What is Encopresis?

Sometimes, long after potty-training has passed, some children still find themselves having problems with soiling themselves (called encopresis by doctors). While this can be especially frustrating for parents, it’s a common enough problem that there are many solutions. Find out more below.

Encopresis: What Does It Mean?

This disorder, which is also sometimes referred to as fecal intolerance (or soiling) is the involuntary, repeated passing of feces into places other than a traditional toilet (such as clothing or on the floor.) Encopresis usually occurs after the age of four, or when children typically have already learned how to use the bathroom on their own (without the use of a diaper or parental assistance.) Typically, Encopresis occurs when impacted (retained or “stuck”) stools collect in the colon and rectum of a patient – the colon becomes too full and liquid stool leaks around the retained stool and leaks into a patient’s clothing. If this bowel retention continues, it can eventually cause swelling and the loss of bowel movement control.

Stats: How Many Suffer from Encopresis?

Encopresis, which can be caused by constipation or emotional distress, impacts about 1.5% of school-aged children, and the onset of this disorder can happen at any time during a young child’s development, but usually occurs after the age where children are generally potty-trained. Boys who have Encopresis outweigh girls by a ratio of six to one – although this is the case, scientists are unsure why this disparity occurs. Even though Encopresis occurs more in boys, this condition is not related to family size, birth order, age of parents, or socioeconomic class.

What Causes Encopresis?

This condition can occur in children because of a number of causes, including constipation and emotional distress. In most cases of Encopresis, the onset is caused by chronic constipation – in children, hard, painful to pass stools may cause them to avoid going to the bathroom altogether, which can only exasperate the condition further. The longer stools remain in the patient’s colon, the more the colon stretches. As the colon continues to extend, nerves are impacted – nerves that tell a child when to use the bathroom. When these nerves are impacted (and the colon becomes too full,) soft or liquid stool may leak into the child’s clothing. In addition to leakage, patients can also experience the loss of control of bowel movements. Some factors that can lead to constipation include fear of using the bathroom because of pain or being away from home, not eating enough fiber, not drinking enough fluids, and fear of interrupting play or other activities. Aside from constipation, some of the factors that can influence the emotional distress associated with Encopresis include stressful or overly-controlled potty-training, emotional stressors (such as the birth of another child or separation/divorce,) or dietary changes that may make bowel movements painful.

Signs and Symptoms of Encopresis

Many of the symptoms of Encopresis are physical and are easy to spot – but many of the emotional stressors, such as the birth of a sibling or divorce – may not seem as apparent to parents when attempting to diagnose this condition.

What are the Common Behaviors/Characteristics?

Some of the most common side-effects of Encopresis are:

  • Abdominal pain
  • Avoidance of using the bathroom
  • Constipation, or dry, hard stools
  • Lack of appetite
  • Leakage of the stool into underwear, which may be mistaken for diarrhea
  • Repeated infections of the bladder (more common in girls)

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

The DSM-5, a tool used by mental health professionals to recognize and diagnose mental illnesses and conditions, lays out criteria for the diagnosis of conditions, and Encopresis is no exception. According to the DSM-5,

  • The patient’s chronological age must be at least 4 years;
  • A repeated passage of feces into inappropriate places, e.g., clothing or floor. This can be either intentional or involuntary;
  • At least one such event must occur every month for at least 3 months;
  • The behavior is not attributable to the effects of a substance, e.g., laxative, or another medical condition, with the exception of a mechanism involving constipation.

“In making the diagnosis, it is critical that the clinician, specify which of the following is present:

With constipation and overflow incontinence: through physical examination or medical history, there is evidence of constipation.

Without constipation and overflow incontinence: through physical examination or medical history, there is no evidence of constipation.”

Encopresis and Other Conditions

This condition is referred to as an elimination disorder because it deals with a child’s inability to use the bathroom – whether this is due to chronic constipation or emotional distress. There are, however, some related conditions to Encopresis.

Encopresis vs. Enuresis

Whereas Encopresis deals with a child’s inability to pass fecal matter, Enuresis is the repeated passing of urine in places other than the toilet. The most common form of Enuresis is its nocturnal form, which is referred to as bed-wetting. If a child experiences this during the day, it is referred to as diurnal Enuresis. A child may experience a combination of daytime and nighttime symptoms.

Encopresis vs. Fecal Incontinence

Fecal Incontinence is another way to phrase Encopresis – another phrase commonly used to describe this condition is soiling. Fecal matter builds up in the rectum, which can cause stretching – this stretching can cause loss of control of bowel movements or leakage.

Encopresis in Adults/Children

Although this condition is primarily found in children, it can impact any age group. Senior citizens are especially at risk of Encopresis because the rectum weakens as we become older. Encopresis can impact adults of any age, and reactions to medications such as antidepressants, iron supplements, and antacids can increase the likelihood of Encopresis occurring. In women, pregnancy can also cause Encopresis to occur – the growing womb can press against the bowel and cause discomfort that may exasperate constipation, and hormonal imbalances can also play a role in constipation.

Example Case of Encopresis

Joshua, age 5, has already passed the age where he has been potty-trained. His father notices that he is using the bathroom less (to pass bowel movements,) and while doing the laundry, Joshua’s underwear has fecal matter marks, which he initially mistakes for diarrhea. This pattern continues for about two weeks when he receives a call from Joshua’s teacher saying he passed a bowel movement during recess. Joshua is extremely embarrassed and his father is concerned, so they go to the doctor – after a rectal examination, the doctor finds hard fecal matter lodged in Joshua’s rectum. In order to treat this example of Encopresis, the doctor prescribes a laxative and tells Joshua’s father to keep a log of what his son eats, in order to see if Joshua needs to adjust his diet.

Encopresis

How to Deal/Coping with Encopresis

Living with Encopresis can be quite difficult and frustrating at times – the inability to pass a bowel movement or leakage into clothing can be embarrassing, so it is important to be upfront with family members when discussing your condition. There are a number of medications that can help with Encopresis, so talk to your doctor about these options in addition to dietary changes (if necessary.) If medications are taken as prescribed and you follow the instructions of the doctor, the symptoms of Encopresis will subside with time.

Look out for These Complications/Risk Factors

Although it is unknown if Encopresis is genetic, having a family history of constipation will increase the likelihood that you or your children will suffer from Encopresis. Complications that may occur while suffering from or being treated for Encopresis include vomiting, dry mouth, and pain in the abdomen. Certain side effects of laxatives, such as weakness or dizziness, may become serious – if you experience any of these symptoms, call your doctor right away.

Encopresis Treatment

Although the treatment of Encopresis is more often than not physical, this doesn’t mean there cannot be psychological stressors that cause this condition. Consulting with a doctor or mental health professional will help you or your child get the best care possible.

Possible Medications for Encopresis

Your doctor can recommend a number of medications for Encopresis, including over-the-counter or prescribed laxatives. In older patients with this condition, enema treatment can be used to help evacuate the bowel. Because cramping and abdominal pain can occur during this treatment, it is generally accepted that it should not be administered to children. In addition to medication, therapy can be administered if the fear of using the bathroom comes from emotional trauma.

Home Remedies for Encopresis

In addition to any over-the-counter or prescribed medications or therapy, people suffering from Encopresis may keep a log of what they eat in order to understand their dietary pitfalls such as lack of fiber or in rare cases, over-consumption of cow’s milk. If your child is suffering from Encopresis, try to reassure them and offer to sit by the bathroom when they pass a bowel movement in case any abdominal pain occurs.

Living with Encopresis

Sometimes, children may be anxious about discussing Encopresis with you out of embarrassment or fear. Living with this condition can also be quite painful because of the frequent and uncomfortable constipation that is associated with it. Be sure to talk to your child about this condition and establish that it is okay and you are there to help. Children often outgrow the symptoms of Encopresis with a mixture of therapy, medication, and diet, and these methods can help your child readjust to everyday life.

Insurance Coverage for Encopresis

Because every insurance policy varies, it is best to discuss treatment options with your insurance agent. Explain your child’s condition, and explain the mixture of diet, medication, and therapy you are choosing to use in order to treat your child’s Encopresis. Insurance coverage for therapy can vary from no co-pay to high fees depending on your insurance policy’s mental health coverage, and the same goes for any potential medications your child may take due to Encopresis. Even though navigating insurance can be frustrating at times, clearly explaining your situation to the insurance company will help both you and your child. If you cannot afford therapy or medication, there are a number of state and federally-funded programs you can take advantage of.

How to Find a Therapist

There are many therapists currently practicing today – although it may seem impossible at times to find the perfect therapist for your child, there are a number of steps you can take in order to ensure the right care for your child.

What Should I be Looking for in an LMHP?

When looking for an LMHP (licensed mental health professional) to help your child overcome Encopresis, be sure to ask your potential therapist if they have experience dealing with children. Although many therapists deal with all age groups, Encopresis is a condition that primarily impacts children, so this experience is important. In addition to age specialty, it is important to find out which psychological perspective the therapist adheres to – some psychologists practice Freudian psychology, which focuses on the role of the conscious and subconscious mind, while others practice behavioral-cognitive, which looks at the relationship between thought processes and behaviors. This information can be crucial when determining which therapist your child will visit.

Questions to Ask a Potential Therapist

For the treatment of Encopresis, age experience is one of the most important factors. In addition to age, ask the therapist if they have a history of treating patients with Encopresis, and which methods they used to help treat those children. Also, ask how frequently/for how long your child will be in therapy for.

Encopresis Resources and Support

In addition to a mental health professional and other parents who have had children with Encopresis, there are a number of hotlines you can call to receive help navigating your child’s condition. NAMI, or the National Alliance on Mental Illness, offers a mental health hotline you can call in order to discuss Encopresis and possible treatment options. In addition to this hotline, which can be reached at 1-800-950-NAMI Monday through Friday, 10 a.m.– 6 p.m. ET, there are also a number of blogs featuring parents sharing their stories about the condition and its treatment.

 

7 Benefits of Online Marriage Counseling

Online marriage counseling refers to couples therapy that is conducted over the internet. It helps married and unmarried couples to understand presenting issues, resolve conflicts, and strengthen their relationship.

What is Online Marriage Counseling?

Online marriage counseling, also known as online couples therapy, is a type of psychotherapy that offers a digital alternative to conventional, face-to-face marriage counseling. Online couples therapy helps couples to gain insight into their relationship and make sound decisions on their future. Partners may learn skills to improve their communication and enhance their relationship. In some cases, couples use online marriage counseling to find out how to end their relationship in an amicable manner.

There are many different types of online marriage counseling. Sessions generally take place in the clients’ home and may be conducted via video conferencing, instant messaging, or email paired with telephone conversations. Online marriage counseling is usually a short-term treatment. While both partners are typically involved, one partner may decide to seek counseling alone.

Online marriage counseling is provided by licensed marriage and family therapists (LMFTs). Many LMFTs in the United States are credentialed by the American Association for Marriage and Family Therapy (AAMFT).

Why Online Marriage Counseling?

Couples must nurture, defend, and strengthen their emotional bonds if they want their relationship to last. If a couple is unable to resolve their marital issues on their own, they may seek assistance from a licensed marriage and family therapist. Some partners may go to counseling sessions even if their relationship is in good health. Marriage mates who make use of counseling services before they notice signs of trouble report improved marital functioning, lower rates of separation, and a better sex life.

There are a variety of reasons couples may seek online marriage counseling rather than traditional marriage counseling sessions. Seven key benefits are listed below.

  1. Accessibility

Online marriage counseling is very accessible. Couples may receive relationship assistance on the internet 24 hours per day, 7 days per week. There are several established companies that provide online relationship therapy services. In most cases, partners only need to register an account to use the services offered.

Couples who take advantage of online marriage counseling are able to set regular appointments with a licensed marriage counselor, receive relationship tips, join group therapy sessions, and access many other features. These features are usually available at the click of a button.

  1. Affordability

Some couples may forego traditional marriage counseling—even if they know they need it—because they are unable to afford the service. Although the cost of online marriage counseling may vary, it is typically less expensive than in-person marriage counseling. Some companies provide online relationship therapy services for free, while others offer the option of a monthly subscription. Subscription fees typically start at $18 per month

In addition to paying less for services, online marriage counseling helps couples to save money in other ways. For example, couples do not have to travel to a counselor’s office, buy food on the go, or take time off from work to meet an appointment. Many online marriage counselors offer free initial appointments. As there is a reduced need for office space, furnishings, and appointment setters, online marriage counseling generally has lower overhead costs than conventional marriage therapy.

Online Marriage Counseling

  1. Comfort

Many people feel anxious when visiting a therapist’s office. However, online marriage counseling allows couples to get the help they need from the comfort of their own home. Being in familiar surroundings helps many partners to drop their defenses, open up, and share their concerns. Partners may also feel less intimidated when speaking to a marriage counselor online than face-to-face.

Online marriage counseling also eliminates the hassle of traveling to an appointment. Factors such as heavy traffic, road rage, and unpleasant weather are completely avoided. Even couples with busy schedules may benefit from online marriage counseling. As the approach is highly flexible, an appointment may fit comfortably into a couple’s regular routine.

  1. Privacy

Privacy is a major issue when seeking marriage counseling or other forms of professional care. Many intimate partners feel uncomfortable when other people are aware they are experiencing challenges in their relationship. A lack of privacy may also affect other aspects of a couple’s day-to-day life. For example, some marriage mates may lose sponsorships, endorsements, or certain job opportunities if their marital challenges become public knowledge.

Online marriage counseling offers extremely high levels of privacy. All counseling records and sessions are kept confidential and secure. As sessions are typically conducted in the homes of clients, there is no risk of accidentally meeting friends, acquaintances, workmates, or other family members at a marriage counselor’s office.

  1. Documentation is Accessible

Proper documentation is available for online marriage counseling. Clear and up-to-date records help couples to see the overall progress they are making and keep track of specific changes in their relationship. They may also review recommendations and tips provided by their marriage counselor. Couples may access, open, and review their documentation anytime they want.

  1. Can Help Long Distance Couples

Online marriage counseling is an excellent option for intimate partners who are separated by long distances. This physical separation may be due to work-related travel, a recent conflict in the relationship, or other reasons. Counselors may arrange video conference calls where partners can speak to each other and receive professional guidance on the best way to address their concerns.

  1. Options

Intimate partners who use online marriage counseling services have a range of options available to them. Although professional counselors receive similar training, there are important factors that may influence couples to choose one counselor over another. Some of these factors include:

  • Personality – some couples may respond better to a therapist who is naturally lively, animated, or bubbly. Other couples may prefer a therapist who is calm, measured, and always in control.
  • Counseling style or therapeutic approach – depending on the needs of the couple, marriage counselors may use techniques from a variety of therapeutic modalities. Popular evidence-based modalities such as imago relationship therapy, narrative therapy, the Gottman method, positive psychology, emotionally focused couples therapy, and cognitive behavioral therapy may be used in counseling sessions. Couples may seek assistance from a specific counselor if he or she uses a counseling style that is comfortable and effective.
  • Professional experience – some partners may prefer working with a counselor who has helped many couples over the course of many years. Other couples who have not benefited from traditional marriage counseling techniques in the past may prefer working with a counselor who brings a novel approach to online couples therapy.
  • Personal relationship experience – married couples may feel more comfortable getting advice from a therapist who has been happily married for many years. Some married couples may be concerned that a counselor who has never been married is unable to understand and relate to their issues.
  • Expertise – many marriage counselors specialize in addressing a particular marital or relationship issue. Common marital concerns include intimacy, financial challenges, fertility issues, adoption, dealing with in-laws, chronic health issues, child-rearing, and lack of communication. Couples that are experiencing difficulty in a particular area may prefer to speak to a marriage therapist who specializes in treating their specific concern.
  • Availability – online marriage counseling is available 24 hours per day, 7 days per week. However, individual marriage counselors may have specific times when they provide counseling over the internet. If couples require late night or early morning sessions they may have to search online for a marriage counselor who provides services at those times.
  • Type of platform used – some couples are not as tech-savvy as others. Partners who are comfortable using one type of platform (such as instant messaging) may be unable or unwilling to try others (such as video conferencing). These couples will likely prioritize working with a counselor who uses technology they are familiar with.

There is no standardized approach to online marriage counseling. Relationship issues may vary from couple to couple. Even couples with similar issues may have different experiences. However, the variety of options available means partners are able to access customized care that fits their specific needs and circumstances.

Challenges of Online Marriage Counseling

There are a number of challenges associated with online marriage counseling. Chief among them is the fact that services may be offered by individuals who are untrained or unqualified to provide professional assistance. Some online counselors believe they are exempt from the regulations of conservative professional organizations and choose not to earn licensure. Couples are encouraged to check the credentials of their online marriage counselor before they decide to work with him or her.

Location is another concern for some couples who are interested in online marriage counseling. Many marriage counselors are licensed to provide counseling services in specific states. These restrictions may apply even for services that are offered online. This means a marriage counselor who is licensed to practice in one state may be unable to offer online counseling to marriage mates who live in another state.

While there are many benefits of online marriage counseling, this form of talk therapy is not ideal for everyone. Some couples may be affected by serious mental or emotional issues that cannot be adequately addressed online. For example, partners who are experiencing schizophrenia, dementia, suicidal ideation, severe substance addiction, or other chronic concerns may require medication or intensive forms of treatment in residential or inpatient settings.

Online marriage counseling is not recommended for couples with a history of abuse. An abusive partner is unlikely to participate in therapy and may react violently if he or she discovers his or her partner is speaking to a marriage counselor. Even if the abusive partner consents to counseling, online sessions may not be effective. This is because the abused partner may be afraid to speak openly and honestly about what has taken place in the relationship.

Other challenges to online marriage counseling include:

  • Cheaper Chat Options Can Feel Less Personal

Some critics of online marriage counseling believe online marriage counseling is less personal and less effective than traditional couples therapy. They contend that it may be difficult for partners to make eye contact and converse with each other while having to pay attention to a computer screen. Other issues include impaired communication during sessions. For example, a marriage counselor is less likely to notice hand gestures, nervous mannerisms, or other forms of nonverbal communication during the counseling session if it takes place online.

  • Fear of Failure

Despite the fact that online marriage counseling is available for healthy couples, most people seek professional guidance only after they have already given up on their relationship. Rather than a source of constant emotional support and advice, counseling is often viewed as a last resort. Some married couples view online marriage counseling merely as a convenient way to get divorced on friendly terms. Due to the stigma associated with couples therapy, premarital couples and newlyweds may avoid online marriage counseling even though it may help them form stronger emotional bonds in the future.

Getting Started

If couples are experiencing relationship issues they can speak to a licensed marriage and family therapist at Thrive Talk. Thrive Talk offers online access to a dedicated and compassionate team of skilled marriage counselors. Couples may begin their first session in just three easy steps. With Thrive Talk, they can start building the intimate, supportive relationship they truly want, today.

References:

Could your marriage benefit from counseling? (n.d.). Retrieved from https://www.hopkinsmedicine.org/health/healthy_aging/healthy_connections/could-your-marriage-benefit-from-counseling

Heitler, S. (2014, July 9). What’s up with online therapy and marriage counseling? Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/resolution-not-conflict/201407/whats-online-therapy-and-marriage-counseling

Online marriage counseling. (n.d.). Retrieved from https://www.allaboutcounseling.com/library/online-marriage-counseling/

Seen at 11: Online couples counseling. (2014, June 27). Retrieved from https://newyork.cbslocal.com/2014/06/27/seen-at-11-online-couples-counseling/

Tasker, R. (n.d.). 9 best couples counseling techniques and why you should try them. Retrieved from https://guidedoc.com/best-couples-counseling-techniques

The 8 benefits of online couples therapy. (2016, June 20). Retrieved from https://www.marriage.com/advice/therapy/the-8-benefits-of-online-couples-therapy/

9 Questions to Ask Before Marriage: The Benefits of Premarital Counseling

Premarital counseling prepares couples for long-term commitment and can go a far way toward increasing marital satisfaction. While this form of therapy is traditionally conducted face-to-face, couples also have the option of engaging in premarital counseling online.

What is Premarital Counseling?

Premarital counseling is a form of therapy designed to help couples enhance their readiness for marriage. This is done by helping partners to identify issues in their relationship and equipping them with the skills needed to work through present and future conflicts. Couples express their individual needs, preferences, and expectations regarding marriage and learn to resolve differences in ways that are mutually satisfying.

Premarital counseling is usually provided by licensed marriage and family therapists. However, some religious leaders offer counsel to engaged couples as a precondition for conducting their marriage ceremony. Couples typically meet with a therapist for five to seven sessions of premarital counseling. Online sessions help to make the process easier and can be used exclusively or in combination with in-person sessions.

Why Premarital Counseling?

Premarital counseling helps couples to better prepare for the demands of marriage. Within the context of a supportive environment, they learn to communicate more effectively and get the chance to explore topics they might otherwise find difficult to discuss.

Premarital counseling also draws people’s attention to weaknesses in their relationship so these can be addressed in a constructive way. It goes a step further by helping couples to anticipate future problems that could undermine their relationship so they are prepared if and when these arise.

The experience of premarital counseling helps to foster a more favorable attitude toward therapy in general. Couples who engage in premarital counseling are usually more willing to seek marriage counseling should it become necessary later in their relationship. Preliminary studies also suggest that premarital counseling may lower the risk of divorce.

The Questions

Many marital problems can be avoided if couples put as much effort into planning for their marriage as they do for their wedding. One way couples can do this is by actively thinking about issues they need to discuss before marriage and then spending time to work through them together. While it is not possible to anticipate every possible scenario that could develop, the following questions can alert couples to aspects of their relationship they may have overlooked but need to address before marriage.

  1. How do We Handle Family Stress?

Stress is a natural part of life and marriage brings its own fair share of it. Although each individual has his or her own unique way of managing stress, it is important for couples to consider how well these methods complement each other. What if both partners have a tendency to lash out or to fall apart when under pressure? What if one person has the habit of completely shutting the other out whenever difficulties arise? What if one partner prefers to talk through matters together but the other would rather deal with stress privately?  By openly discussing these issues before getting married, couples achieve a deeper understanding of each other and are better prepared to handle family stress as a cohesive unit.

  1. How do We Handle Family Finances?

Few things create as much conflict between married couples as the subject of money. Differences in income, spending habits and attitudes toward debt can place a huge strain on a marriage. Couples must address sensitive issues such as whether or not to keep their finances separate, who should cover various expenses, how much to spend on their first home, or whether to purchase a home in the first place. Conflicts often arise when individuals fail to disclose important details of their financial situation early in a relationship. Finding out after marriage that one’s partner has an enormous debt or a huge backlog in unpaid child support hardly bodes well for the relationship. By being honest and open with each other about matters such as these, couples can spare themselves major headaches and heartaches later on.

  1. How do We Handle Family Decisions?

Couples are faced with numerous decisions in marriage—where to live, how much money to spend, if and when to start a family, just to name a few. Before walking down the aisle, it is a good idea for couples to agree on what types of decisions need to be made together and how they will go about making such decisions. If one person always insists on having the last say, that is a major red flag which should be addressed before marriage. It is also wise for couples to discuss how they will handle situations where they strongly disagree about a particular matter.

  1. Should We Have Kids?

In most Western cultures, few individuals enter marriage without broaching the topic of kids—should they have any and if so, how many? The problem is that even when couples agree on these matters before marriage, their preferences could change afterward. How do they handle such a situation? What if they find out that they cannot conceive naturally? How do they feel about issues such as adoption, surrogacy, and in-vitro fertilization? Once children are in the picture, how will they be cared for? Will one partner become a stay-at-home parent? All of these are matters that should be thoroughly discussed before exchanging vows.

Premarital Counseling

  1. How do We Handle Jobs and Careers?

Since an individual’s job or career has many implications for family life, it is important that couples are clear on each other’s attitudes and expectations regarding work. Will both partners work after marriage or after having children? Is it expected that one or both partners will change jobs in the future, perhaps switching to a less demanding job or seeking a higher paying one? What if these expectations are not met? How committed are both individuals to their jobs or career? How will work affect the amount of time they spend with each other? What if one partner unexpectedly loses his or her job or suddenly decides to quit? And if one partner starts earning significantly more or less than before, how would that affect the relationship?

  1. How do We Handle Personal Space?

Marriage is intended to be a close partnership between two people. But even the most devoted couples need a little space to themselves every once in a while. Whether it’s a few hours alone with the TV remote, a night out on the town with the girls, or a whole week away with the guys, couples must learn to acknowledge and respect this need in their partner. In many cases, problems arise because partners differ greatly in their individual need for personal space. Without communication and mutual understanding in this regard, one partner could be left feeling smothered, lonely, rejected or resentful toward his or her mate.

  1. What Role do Family and Friends Play in Our Marriage?

It’s important to maintain a support system after marriage, but if couples fail to agree on appropriate boundaries, their friends and relatives may drive a serious wedge between them. Among the questions couples need to consider are: How comfortable am I around my partner’s extended family and close friends? Is it okay for my partner to discuss marital plans or problems with them? How involved will the in-laws be in our lives and how involved will we need to be in theirs? What if they become ill and need ongoing care and support? What if family members or friends ask for money? Am I comfortable with my partner communicating with his or her ex? What if my mate has a child with a previous partner, how will that affect our relationship? Needless to say, these are matters best discussed before, not after, marriage.

  1. How do We Handle Conflict?

For couples caught up in a whirlwind romance, a discussion about conflict might be the last thing on their minds. But no marriage is perfect and once the honeymoon phase wears off, couples will have to put their conflict management skills to good use if they want their marriage to survive. Knowing how the other person handles disagreements is important when planning for the future. What if one person insists on resolving conflicts as soon as they arise but the other prefers to wait until he or she is calm? What if one person has a tendency to give the silent treatment or to withhold sex when there is an argument? Do partners tend to say or do things in the heat of the moment that they later regret? How easy is it for them to apologize to each other? And at what point in a conflict would it be okay to ask a neutral party to intervene?

  1. How do We Approach Our Sex Life?

There’s no denying that sex is a big part of marriage. Yet, despite its significance, few couples spend enough time openly discussing their needs, desires, and expectations regarding sex. This is sometimes true even of couples who become intimate before marriage. But by avoiding a frank, honest discussion on the subject, couples risk becoming sexually frustrated and dissatisfied with their partners. How big a role is sex expected to play in their relationship? What if they differ greatly in terms of sexual desire? What if one partner’s interest in sex changes significantly due to illness, stress, or other factors? What are their thoughts regarding things like pornography and open marriages? What sexual acts are definitely off the table? True, it might be uncomfortable, if not difficult, to have these conversations but the benefits of doing so will be apparent long into a marriage.

Challenges of Premarital Counseling

The decision to engage in premarital counseling can arouse feelings of anxiety in some individuals. Whether it’s the thought of revealing one’s deepest emotions in the presence of a complete stranger, the possibility of uncovering hidden aspects of oneself or one’s partner, or the uncertainty of what to expect in therapy, persons may approach premarital counseling with a degree of hesitancy. Fortunately, they can overcome these fears with the help of a supportive therapist.

Other individuals might be uncomfortable discussing some of the sensitive topics typically raised in premarital counseling, such as sex and money. If these topics were never discussed before, some of their partner’s revelations may be experienced as shocking or hurtful. Nevertheless, if partners commit to working through their differences, they often emerge from therapy with a stronger bond than they had before.

The cost of premarital counseling can sometimes present a major challenge for couples. In light of all the expenses associated with planning a wedding, it is no surprise that some couples have difficulty finding counseling services that fit within their budget. It can also be a challenge for couples with busy schedules to find the time needed to attend all their sessions. This is especially true in cases where no suitable therapists are available in their area.

Premarital Counseling Online

In today’s technological age, an increasing number of therapists are beginning to see the benefits of offering premarital counseling online. This is often accomplished through the use of video conferencing programs such as Skype and FaceTime. When time, cost, and access to local therapists are an issue, online therapy may be the best option for couples due to the flexibility and convenience it affords. It is also ideal in cases where couples are involved in long distance relationships or frequently travel for work or other reasons.

Couples who opt for online therapy explore the same sort of issues they would in face-to-face sessions with a therapist. The advantage of doing premarital counseling online is that they may feel more at ease with the process since they can remain in the comfort of their own homes. However, if couples are experiencing major issues in their relationship such as addiction or abuse, or if tensions are running unusually high, face-to-face sessions might prove more effective.

If a couple is seriously considering marriage, it can be beneficial to speak to a licensed marriage and family therapist at Thrive Talk. Thrive Talk offers affordable premarital counseling online and all services are available in just a few swipes or clicks. Thrive Talk gives couples the opportunity to build for the long-term. Partners can learn how to resolve current issues and avoid future conflicts, today!

References

Bobby, L. M. (n.d.). Premarital counseling questions: Can you do premarital counseling online? Retrieved from https://www.growingself.com/premarital-counseling-online/

Bonior, A. (2017, May 24). 18 questions to ask before getting married. Retrieved from https://www.psychologytoday.com/us/blog/friendship-20/201705/18-questions-ask-getting-married

Premarital counseling. (n.d.). Retrieved from https://www.goodtherapy.org/learn-about-therapy/modes/premarital-counseling

Premarital counseling. (n.d.). Retrieved from https://www.theravive.com/therapedia/premarital-counseling

Stanford, E. (2016, March 24). 13 questions to ask before getting married. Retrieved from https://www.nytimes.com/interactive/2016/03/23/fashion/weddings/marriage-questions.html

Wong, B. (2018, March 9). 11 questions you should be able to answer before you get married. Retrieved from https://www.huffingtonpost.com/entry/11-questions-you-should-be-able-to-answer-about-your-partner-before-you-get-married_us_5aa022d8e4b0e9381c14bdea

 

What is Persistent Genital Arousal Disorder (PGAD)?

Persistent Genital Arousal Disorder (PGAD) is a rare disorder that affects mostly women and interferes tremendously in social settings, work, relationships and overall happiness.  This article will talk about what PGAD is, treatment options, resources, and similar disorders.

Persistent Genital Arousal Disorder: What Does It Mean?

PGAD is when a woman, and in some small cases, men, experiences arousal that is spontaneous without any precipitating cause.  In other words, it is not linked to sexual arousal and does not go away after orgasm.  It can last from several hours to several days at a time with little relief in between.  Women with this disorder are not necessarily more sexually active as the arousal is not from being sexually aroused, but rather it is a physical symptom.  In contrast, many women avoid sex due to the frustration of not getting relief from an orgasm.  It should be noted that there are a handful of cases that have involved men.

Stats: How Many Suffer from this Disorder?

It is unknown how many women suffer from this disorder, but to date, there are few women who report it.  There are thought to be more than 7,000 women who suffer from this disorder, often in silence.  It is thought that more women suffer from this but avoid reporting it or seeking help due to lack of knowledge or feelings of embarrassment.

What Causes PGAD?

No one knows what causes PGAD, however, there have been cases where PGAD has resulted from the following:

  • Menopause
  • Tourettes Syndrome
  • Tarlov Cysts
  • Trauma to the central nervous system
  • Epilepsy

In some women, PGAD is exacerbated by stress.  Once the stress is decreased the intensity of PGAD may also decrease.

PGAD has also been linked to sudden withdrawal of SSRI’s or antidepressants.  There have been a number of women who say they have developed PGAD after stopping these medications suddenly.

Signs and Symptoms of PGAD

Symptoms of PGAD are:

  1. Irritation, throbbing, pain or pressure in the genitals
  2. Vaginal contractions
  3. Blood flow that has increased to the vaginal walls
  4. A feeling of tingling in the clitoris
  5. uncontrolled orgasms (spontaneous)
  6. Wetness
  7. Itching

What are the Common Behaviors/Characteristics?

Women that have PGAD typically will feel sensitivity in their nipples and genital area.  They become aroused with or without sexual activity and will often say that they can be cooking, walking down the street, working, or other non-sexual activities when they feel aroused.  This is in the absence of sexual thoughts.  Most women find these feelings unwanted and intrusive in nature and causes a great deal of stress in their lives.  PGAD has been linked to depression, isolation, and suicidal thoughts.  There have been a few cases where women actually committed suicide after having this disorder for many years with no relief.

PGAD and Other Conditions

PGAD was once known as PSAS (Persistent Sexual Arousal Syndrome) but it was later changed to PGAD as the later suggested it resulted in or was an increase in sexual desire.

PGAD vs Nymphomania

Nymphomania is different than PGAD in that nymphomania is a woman who is hypersexual or a greater need for sexual satisfaction.  With PGAD, women are not more sexual than women without it and often experience physical and psychological pain as a result, unlike being hypersexual.

PGAD vs Satyriasis

Satyriasis is the male version of Nymphomania which means a man that is hypersexual.  This is different because someone with Satyriasis likes having sex a lot as opposed to PGAD where a person does not necessarily want sex a lot.

Related Conditions

Priapism is related to PGAD in that it is a male genital arousal disorder.  It is a consistent penile erection that may or may not be caused by sexual arousal and is not relieved by orgasm.

Example Case of PGAD

Mary is a 38-year-old woman who has had a relatively normal sex life until now, when she begins experiencing spontaneous arousal in her genitals.  She notices that it is not relieved by sex, nor is it something that she likes.  At times the pain from the constant arousal is so bad that urinating is a chore.  She notices symptoms that include wetness, pressure, and feelings of being on the verge of an orgasm most of the time.  For Mary, the symptoms are distracting and cause her a great deal of anxiety and stress when in the presence of others.  She talks to her husband about it and they make an appointment with her gynecologist who, after giving her a full exam and find no abnormal findings, refers her to a specialist in the area that knows about this disorder.  Mary is treated, however, her symptoms never completely go away.  Instead, she learns to manage her symptoms through therapy and support from her family.

PGAD

How to Deal/Coping With PGAD

Due to the lack of knowledge in the community about this disorder, many women feel alone and suffer in silence.  It is helpful for women to enlist the help of family and friends as well as educate themselves and family members on the disorder in order to have support.  Seeking counseling has also proven to be helpful for some women.  Exploring and ruling out other medical issues is important to ensure there are no medical problems that have caused this disorder.

Look out for These Complications/Risk Factors

It’s important to seek medical treatment to rule out any other medical conditions.  Therapy will be helpful to learn how to manage the symptoms and therefore should be sought to prevent depression and anxiety.  This is not a disorder that should be dealt with alone as it can cause increased frustration and depression.

It should also be noted that when seeking medical treatment, to make sure you find a doctor that has some familiarity with this disorder or can refer to someone who does.  Due to the lack of knowledge about this disorder, many times doctors who are not familiar with this disorder don’t see PGAD as a real disorder and may not treat it correctly.

PGAD Treatment

Cognitive Behavior Therapy (CBT) can be helpful for women to explore triggers and also learn coping skills to assist with living with this disorder.  Often times learning how to decrease stress can prove to be helpful.  In some cases, ECT (electroconvulsive therapy) has been used but usually only in severe cases.  When it has been determined that the woman has Tarlov Cysts, sometimes surgery has been used to remove the cysts which in turn will relieve the symptoms of PGAD.  Some women have found relief using ice on the affected area or numbing agents, however, it should be noted that both of these should be used at the discretion of a medical doctor.

Possible Medications for PGAD

Anti-seizure medications, as well as antidepressants, have proven to be effective in treating the symptoms of PGAD.  If all medical conditions have been ruled out, it is thought that PGAD may be brought on by psychological stress.  Antidepressants can relieve depression and help to alleviate some symptoms.

Home Remedies to help PGAD

Reducing stress has been known to be of some help and using an ice pack on the affected area might be helpful but you should seek medical attention first to rule out other medical conditions.  Some patients have found some relief using an analgesic on the affected area to help numb the sensations.

Living with PGAD

Living with PGAD can be very stressful and can sometimes bring shame or embarrassment to the person affected when they do not know where to turn.  Finding support from those who are close to you and also seeking medical treatment is helpful and may relieve some stress.  Support groups are also a good way to talk with others who are going through the same thing.  Often times you can find online support groups as well.

Insurance Coverage for PGAD

Most insurances will cover this disorder, as the first thing is usually to rule out any medical conditions related to it.  Therapy and medication treatment are the most common forms of treatment and are also covered by most insurances.  Be sure to talk to your doctor about treatment options and what is covered.

How to Find a Therapist

You can locate a Licensed Therapist by searching online at www.psychologytoday.com or www.goodtherapy.org.  Both of these sites will allow you to search for a therapist by location, specialty, and insurance.  Most therapists list themselves and/or their practices on this site.  Your medical doctor may also be able to refer you to a therapist that they work with.

What Should I be Looking for in an LMHP?

When searching for a Licensed Mental Health Professional, a person should search for someone who specializes in sexual disorders and/or Cognitive Behavior Therapy.  The LMHP should be licensed and have some experience dealing with PGAD as well as be knowledgeable about treatment options.

Questions to Ask a Potential Therapist

Questions to ask a potential therapist when seeking treatment for PGAD are:

  1. Are you knowledgeable about PGAD?
  2. Have you ever treated anyone with PGAD, and if so, how many people?
  3. What are your treatment approaches for someone with PGAD?
  4. Do you accept my insurance?

Finding a therapist that you are comfortable talking to is key to helping to cope with this disorder.  A therapist should be willing to listen to you and involve you in the treatment process as much as possible.

PGAD Resources and Support Helpline

For resources and support for PGAD, please visit their website at www.pgad-support.com.  To reach someone at this organization, it is recommended that you contact them by email at [email protected].  Information and support can also be found by contacting the Genetic and Rare Diseases Information Center at 888-205-2311.  They can assist in finding support, resources and information on PGAD.

 

The lack of research, as well as the lack of knowledge surrounding PGAD, has made it difficult for some women to talk to others.  It is important that the person who is affected reaches out to a physician that has some familiarity with this disorder.  Women are cautioned to not give up on treatment options for this disorder as there are a variety of things that have helped different people.  Educating family and friends and even people in the medical field can prove to be effective in spreading the word about this disorder to hopefully one day bring more research and treatment.