Does Couples Counseling Work? Here’s Everything You Need to Know

One of the most essential needs we have as human beings is the need for companionship. Healthy relationships help us thrive and also fulfill our emotional needs. We all desire affection, and we feel good when we know that other people care deeply about us. Relationships, whether they are romantic, friendships or familial fulfill our need for intimacy and teach us to receive, share and express love.

Like with all other forms of relationships, romantic relationships require hard work and effort. Just like our physical bodies, they require constant maintenance to keep them running smoothly. Most people visit the doctor for a routine check-up once in while to ensure that every organ is working the way that it should. This is the same attitude we should have towards relationships.

Sadly, a lot of people view relationship counseling as a last ditch effort in saving a doomed relationship. In fact, research shows that the average couple is unhappy for 6 years before making the decision to see a counselor. Couples therapy is really beneficial for all relationships, and it helps to improve overall relationship satisfaction even when things are running smoothly. In this article, we explore what relationship counseling is, what it entails and how it can benefit your relationship.

At Thrivetalk, we are committed to making therapy as accessible as possible. Our mission is to change the way couples therapy has been traditionally practiced and make it more accessible and affordable for the couples who need it. We also help couples overcome the stigma that’s attached to going to couples therapy. Our therapists are trained to listen with empathy and used their expertise to assist couples in improving their relationship.

If you need relationship counseling, our therapists are ready to help you. All our therapists are well trained and certified. We list only the best therapists and we match you with an experienced therapist based on your needs and preferences. Our process is simple and we will help you find the perfect therapist in minutes. You can use the online booking system to set up a free 15-minute consultation.

What Is Couples Counseling?

Couples counseling, also known as couples therapy or relationship counseling is a type of psychotherapy. Couples counseling helps all types of couples recognize and resolve conflict, and rebuild intimacy in their relationships. It is helpful for all couples, whether the partners are considering separation or seeking new ways to improve their relationship. In couples counseling, the focus is on the relationship, however, each partner is encouraged to pay attention to self-improvement and self-awareness.

Couples counseling is usually provided by Licensed Marriage and Family Therapists (LMFT). These therapists usually have graduate or postgraduate degrees and they choose to be approved by the American Association for Marriage and Family therapy (AAMFT). Couples counseling is great for couples who are experiencing difficulties such as constant arguments, feelings of distance, dissatisfaction, lack of intimacy and affection and resentment.

What Does Couples Counseling Involve?

Couples therapy usually starts with the therapist asking the couple questions about their relationship as well as personal questions about each partner. The therapist will then help the couple pinpoint the issue that will be the focus of the treatment, set treatment goals and plan a treatment structure. During treatment, the therapist will help the couple understand the problem, provide them with healthy tactics for navigating it, and help both partners understand their role in solving the problem. The therapist will also give assignments to help them apply the skills that they’ve learned in therapy to their daily interactions.

Types Of Couples Counseling

Couples counseling is beneficial to couples in all types of intimate relationships, regardless of sexual orientation or marital status. Here are some of the different types of couples counseling.

Premarital Counseling

This is the specialized type of therapy that helps couples prepare for a long-term commitment such as marriage. Premarital counseling helps couples build a healthy, strong foundation for their union. It also helps couples identify and address potential areas of conflict in their relationships such as finances, children, parenting, sex, decision making, and marriage roles.  The couple then learns effective strategies for discussing and resolving conflict. Furthermore, it helps couples identify and establish their expectations for the marriage.

A study published in the Journal of Family psychology showed that couples who go through premarital counseling are 31% less likely to divorce. Premarital counseling is usually provided by a specialist over the course of a few sessions. During these sessions, the couple might be asked to do some activities both separately and together to understand how they work together and their level of compatibility.

Marriage Counseling

Marriage counseling helps married couples understand and resolve conflicts in a healthy manner. The therapist provides the couple with tools to communicate better and solve problems. Marriage counseling helps couples rediscover themselves and their feelings for each other

Group Counseling

Group counseling is usually used alongside private couples therapy. Here, the couple is grouped with other couples facing the same issues. There are discussions on how to communicate better, healthy ways to argue, dealing with feelings of anger and rejection, how to rekindle intimacy, etc. This helps the couple realize that they’re not the only couple who has issues.

When Should We Go To Couples Counseling?

Every couple experiences conflict at one point or the other and it can be hard to know when it’s time to seek help. When do you know it’s time to consider couples counseling? It’s important to note that experts agree that it’s best to seek couples counseling as soon as you become unhappy in a relationship. Therapy shouldn’t be delayed until there’s a full-blown crisis. Here are some examples of situations where couples counseling is necessary.

Preparing for changes in the relationship- When a major change is about to occur in your relationship, such as marriage or childbirth or separation it’s advised that you seek couples therapy. Couples who are about to get married will greatly benefit from premarital counseling. Couples who have decided to separate will also benefit from couples therapy As it will help them explore buried wounds, heal and separate on a healthy note.

Trust concerns

Once trust is broken, relationships shatter. It’s essential to seek couples therapy once there has been a breach of trust or a suspected breach of trust. Couples therapy helps partners to rebuild trust by allowing them to vulnerably express themselves and by providing them with the skills to move on.

Couples Counseling

Increasing Conflict

When you and your partner seem to argue about the same things over and over again, it could mean that there are problems beneath the surface that you’re refusing to deal with. Couples therapy helps you to dig deep, find out what these problems are, and resolve them healthily.

Communication problems

Proper and healthy communication is the fuel of every relationship. If you notice that you and your partner barely talk and share how you really feel, or you’re constantly misunderstand each other, or maybe you really don’t just know what’s going on in each other’s lives anymore. This is a sign that you need couples counseling. One of the great benefits of couples counseling is that it helps to increase healthy communication. The therapist helps you learn how to listen to and understand each other much better.

Intimacy problems

Relationships thrive on physical and emotional intimacy. If you feel like the ‘spark’ is gone and you’re no longer excited about each other, couples therapy can help to bring back memories of the things you love about each other and why you’re so crazy about each other. If your sex life has changed significantly, you might need a counselor’s help to reignite the flames.

Does Couples Counseling Actually Work?

According to the American Psychological Association, couples counseling is 75% effective. This is based on research that was carried out over a period of 25 years. Couples counseling can help to improve relationships greatly. When both partners are actively involved and completely committed to improving their relationship, couples therapy is most effective. Also, the more open each partner is to changing their habits and seeing things from a different point of view, the more successful couples therapy is likely to be.

Challenges Of Couples Counseling

Couple therapy teaches couples to improve their relationship by communicating better and strengthening their emotional bond. However, couples may face some challenges that stall their progress. Here are some challenges that might occur during couples counseling.

  • One of the partners may be reluctant or unwilling to undergo couples counseling.
  • The couple may have inaccurate assumptions about couples counseling.
  • Sometimes, couples are more interested in blaming each other rather than taking responsibility for their own shortcomings and working together towards the goal of fixing the relationship.
  • Some partners find it difficult to come clean during therapy sessions and keep secrets about issues such as affairs and addictions.
  • Some partners don’t follow through by refusing to do what the therapist asks them to or refusing to apply the lessons they’re learning to the relationship.
  • Some couples wait too long before getting the help they need. Sometimes, it’s too late to salvage the relationship.

Couples Counseling Online

Relationship counseling helps you and your partner release pent-up emotions, learn more about each other and learn to treat each other better. It also teaches you both to be conscious of your actions and decisions. All of this is done with the help of a qualified relationship counselor who helps you to process all these feelings and arrive at a solution that works for you both in a safe space. Online therapy has several advantages that may not be available in traditional face to face couples therapy.

One of the major benefits of online relationship therapy is that you can easily fit it into both your schedules, so it’s easier to convince your partner to join you in therapy because there’s no need to go to the therapist’s office. Also, if you have kids and have difficulty finding childcare, online relationship counseling is great because you can access your therapist from the comfort of your home without having to leave your kids.

Couples counseling is usually not covered by most insurance plans and a few sessions can be quite expensive. A lot of couples don’t go for relationship therapy because they’re unable to afford it. Online therapy is a much more affordable alternative and helps couples resolve their relationship issues without breaking the bank.

After online relationship counseling, a lot of couples gain insight into the patterns in their relationship, learn to express themselves better and possess the skills to communicate with each other more effectively.

Find a Therapist Now

Here at ThriveTalk, we’re all about providing honest therapy for everybody. We understand therapy can feel like a big commitment and that it can feel scary or shameful. That’s why we’ve created this blog, to talk about tough subjects and demystify the world of mental health and therapy. And that’s also why we try to be straightforward and upfront in everything that we do. We have our pricing here. You can meet some of our therapists here.

Through all of this, our job is to help you in whatever way we can, whether that’s answering your questions or helping walk you through the hard times in your life. So if you think you might need therapy, just have a few simple questions, or just plain don’t know what to do, get in touch with us here, and we’ll do everything we can to help you make the best choice for your life. We’re here to help you take care of you.

Making the decision to undergo couples counseling can be difficult. However, it is worth it. If you have a troubled relationship, seeking help is the best decision you can make. Most couples come out of couples counseling with stronger relationships.

The ThriveTalk Starter Guide to Depression

Depression is a complex and serious mental condition which many people will suffer from to some degree at some time in their lives. It is expressed in severe mood changes where the person feels overwhelmingly sad and lacking in positive emotions.

What is Depression?

All of us suffer moments when we feel sad, discouraged or demotivated, and we may say that we feel depressed. Depression, however, is when this feeling of sadness is overwhelming and affects all aspects of our daily life. Sadness is a normal emotional reaction to a loss or a painful event which goes away with time. Depression is a state of mental shutdown, where normal thought processes do not function. People with depression are unable to think in a positive and productive way.

Types of Depression

Depression is divided into different categories based on symptoms, cause, and duration. Depression can be described as mild, moderate, or severe. Some types of depression only last a short period of time, while others may extend over long periods or be recurring.

Major Depressive Disorder

A Major Depressive Disorder is also known as a clinical depression, and it is the most serious of the depressive conditions. Sufferers experience feelings of extreme sadness and hopelessness often accompanied by expressions of guilt and worthlessness. They frequently have recurrent thoughts about death or committing suicide. They can exhibit many different symptoms which cause a total disruption of their normal activities and which, if left untreated, can extend over a long period of time.

Situational Depression

Situational depression is the term used when a person reacts in an abnormal way to an unexpected stressful event. This could be a death in the family, a loss of employment, or some other traumatic occurrence. They often exhibit extreme anxiety and may present reckless behavior. They have a high suicide and self-damaging risk. Symptoms appear within three months of the precipitating stressful event and do not last more than six months after the event has ended.

Medical Condition Related Depression

About 10-15-percent of depressions are thought to be related to medical conditions. Thyroid imbalance and heart disease are two of the most common medical conditions that are linked to depression. Others include cancer, stroke, and erectile dysfunction in men. Certain types of viruses and infections, immune system diseases, nutritional deficiencies, endocrine disorders, and degenerative neurological conditions are also associated with mood disorders and depression.

Melancholia

Melancholia used to be classified as a separate mental illness, but it is now considered to be a specifier of a major depressive disorder subtype. It is characterized by a profound inability to find pleasure in anything or to respond positively to agreeable stimuli. Sufferers often experience disrupted sleep patterns, waking up much earlier than usual, and feeling at their worst first thing in the morning. Frequently, they have a decreased appetite, and so lose weight, and their movements may be slowed or agitated.  Their depression is not related to any identifiable cause.

Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (DMDD) is an extreme form of premenstrual syndrome which is thought to affect between 3-8-percent of menstruating women.  Sufferers exhibit irritability and severe depression one or two weeks before menstruation begins. These go away one or two days after the arrival of the menstrual period but return again on the next cycle.

Substance/Medication-Induced Depressive Disorder

Depression can sometimes be caused by medications such as steroids or blood pressure and heart medications. Antibiotics, antifungals, antimicrobials, and antivirals can also produce depression, as can tranquilizers, sedatives, and insomnia aids. Depression is also common in people who are withdrawing from amphetamines and cocaine.

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) is the name given to a kind of depression which occurs during the winter months. It affects between 1-2-percent of the population and is more common in young people and women.  As the hours of daylight decrease, sufferers tend to spend more time asleep, they gain weight, they are unable to concentrate, and they reduce their social activities. As spring arrives they begin to feel less depressed and start to resume their normal activities. This kind of depression responds well to light therapy.

Related Diagnoses

Other kinds of depressive disorders include-

Persistent Depressive Disorder- where the person experiences a mild level of depressive symptoms for a period longer than two years.

Bipolar disorder -where the sufferer experiences periods of high-energy or manic activity interspersed with periods of depression.

Depression with Psychotic Features- where the depression is accompanied by psychotic symptoms such as hallucinations, delusions, and paranoia.

Peripartum (Postpartum) Depression- many women experience a mild form of depression – “baby-blues”- after giving birth, but this is a more serious and debilitating depression.

Take This Short Quiz to Find Out if You’re Depressed

Stats: How Many Suffer from this Disorder?

It is estimated that 6.9-percent of the adult US population (or 16-million people) live with major depression and just over 10-million will have experienced a severe depressive period within the last year. Women are nearly twice as likely to suffer from depression as men.

Causes of Depression

Depression is believed to be caused by a mixture of psychological, biological, environmental, and genetic factors. A chemical imbalance in the brain, an abnormal reaction precipitated by an external cause, or a genetic predisposition can all produce depression.

Signs and Symptoms of Depression

People with depression can exhibit a wide range of different symptoms which interfere with their day-to-day activities. They often have problems in their relationships, at their job or school, and in their social activities. No two people experience depression in the same way.

Sadness, Hopelessness, and Other Emotions

Depressed people are profoundly sad. They are often tearful and express feelings of guilt, worthlessness, and emptiness. They have trouble concentrating and making decisions and often become forgetful. People with depression are unable to make future plans or to see any hope of a better time to come. They may be irritable and have angry outbursts over seemingly unimportant issues. This is frequently due to the frustration that they feel at their inability to regain control of their emotions.

Anhedonia

Anhedonia means that a person is unable to find pleasure in positive things. A person with depression is often totally incapable of reacting in a cheerful or positive way to any kind of pleasurable situation. For example, when they receive a visitor, they do not smile or express any positive visible emotion.

Fatigue

Most people with depression experience a chronic fatigue that makes doing anything an insurmountable effort. This causes them to stop participating in activities such as hobbies, sports, and sex. Their body movements, speech, and thought process are all sluggish, although sometimes they can have periods of agitation and outbursts of anger. Their sleep pattern is often altered, with some sleeping less than normal, and others sleeping more. Often sufferers of depression have unexplained pains such as headaches, and back, or leg pain.

Weight and Appetite Changes

Depressed people usually have little interest in food and can not be bothered to prepare regular meals, so leading to weight loss. Occasionally, the opposite occurs, and the person craves certain foods and eats excessively. This is considered a clinical symptom if the change is more than 10% total body weight either gained or lost within a one month period.

Helplessness

Sufferers of depression can feel that they have completely lost all control of their life and of their emotions which gives them a feeling of total helplessness.

Self-Harm and Suicide

Some people with depression may try to take their own life or to physically harm themselves. The expression of suicidal thoughts or talking about death and dying should always be taken very seriously and people in this condition should always be accompanied by a caring person. They should also not be exposed to situations where they could complete their intent.

Depression in Adults/Children

Depression can occur to anyone and at any age. Often the symptoms of depression can be missed in children, but it is estimated that over 3-million youngsters aged between 12 and 17, in the US, have experienced one, or more, major depressive episode over the last twelve months. It is thought that as many as 3-percent of younger children in the 6-12 years range may have a serious depression.

Depression

Example Case of Depression

Victor was described by his wife as a friendly, fun-loving guy with no history of mental illness in the family. He worked as a building laborer, enjoyed an active lifestyle, and was in good health. He was a devoted father and husband.

His wife noticed a gradual deterioration in his condition over a period of nearly three years. She describes how slowly he seemed to lose his interest and enthusiasm for things that he had always enjoyed doing.  At first, she put this down to his long hours of hard physical work. However, when Victor no longer wanted to play with his young kids and received their artwork and presents without even a smile, she suggested he went to a doctor. He reacted angrily to this idea and moved out of their joint bedroom to sleep alone in the spare room. He refused to join the family at meal times and would spend hours wandering aimlessly around the house during the day and night. Eventually, he stopped going to work and was fired. He seemed indifferent to this and would just spend long hours sitting staring into space. He spoke little and had a profound air of sadness and despair.

Finally, his wife decided to call in a doctor who made a home visit and on assessing the situation, managed to convince Victor to admit himself into hospital for some tests. He was placed on a suicide watch and immediately started on a course of anti-depressants.

He responded quickly and positively to the treatment and within a short time was able to return to his home and family. He and his family attend regular therapy sessions and he has managed to find a new job. He continues to take a small dose of an antidepressant to control the chemical imbalance thought to have been the cause of his depressive episode.

How to Deal/Coping with Depression

Depression responds well to treatment, so seeking medical help as soon as symptoms are noticed can prevent the development of the condition. Often the person suffering from depression is unaware that they have a treatable condition, or they do not even have the motivation to seek help. For this reason, it is vitally important that family and friends support and guide the person to find the necessary medical treatment to alleviate their suffering.

Look out for These Complications/Risk Factors

If there is a history of depression in the family the person is more likely to develop the condition.

If they have suffered a major, traumatic, stressful change in their lives, this can cause a depressive period.

If they are suffering from certain medical conditions or taking certain medicines these can contribute to the development of depression.

Always take seriously any talk by the person about death, dying, or suicide, and call one of the national hotlines for support and help.

Depression Treatment

Depression is normally treated with medication, psychotherapy, or, most commonly, with a combination of both. In extreme cases or those which do not respond to other treatments, brain stimulation therapies such as electroconvulsive therapy (ECT) may bring about a recovery. Depending on the causes, and on the response to treatment, many people can make a full and complete recovery.

Possible Medications for Depression

Antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs) are normally used to treat Depression. These include citalopram, escitalopram, paroxetine, fluoxetine, and sertraline. SSRIs have fewer side-effects than other kinds of antidepressants. They usually take 2-4-weeks to have a noticeable effect and patients should be encouraged to keep taking their tablets even if they don’t immediately notice an improvement in their condition. Sometimes it is necessary to try several different medicines to find the one best suited to the person.

Home Remedies to Help with Depression

There are several herbs and supplements that may help to treat depression. These include St. John’s Wort, SAMe, Omega-3 fatty acids, Saffron, 5-HTP, and DHEA. None of these are approved by the FDA, but some people have found them to be effective. Always consult with your doctor before taking any home remedy, and do not stop taking your prescribed medication. As with all mental illnesses, people suffering from depression will benefit from the support, patience, and love of their friends and family.

Insurance Coverage for Depression

Depression is covered by most medical health insurance policies, but the extent of coverage may vary depending on your location.

Ketamine Trials for Depression

Treatment using Ketamine has been found to be helpful in patients who have not found symptom relief from other treatments. It has not been approved by the FDA yet, but many sufferers have found relief in clinics offering off-label treatment. Find out more about Ketamine trials here.

Hospitalization

Hospitalization is often required for people with severe depression or without family support available. This allows medical staff to ensure that medicines are taken correctly and to monitor the patient’s response to medication and to observe for side effects.  In cases of severe depression, the sufferer may occasionally be more prone to attempt suicide once treatment has begun.  For this reason, close observation of depressed patients should always be maintained.

How to Find a Therapist

Many types of depression respond well to therapy and your healthcare provider will be able to advise you as to what kind of therapist would be most helpful for you. Cognitive-behavioral therapy (CBT), problem-solving therapy, or interpersonal therapy (IPT) may be recommended.

What Should I be Looking for in an LMHP?

Look for a therapist who has relevant current qualifications, and experience in dealing with depression. Choose someone who you feel that you will be comfortable talking to. Successful therapy depends on a strong patient-therapist relationship based on trust.

Questions to Ask a Potential Therapist

How long will I need to receive therapy for?

Will I come alone or with my family?

How often will we meet for therapy?

Will having therapy mean that I can stop taking medication?

Stigma and Societal Problems with Depression

As our knowledge about the brain’s functioning and mental illnesses increases, there is much less stigma and social negativity attached to having depression or another mental illness. People are now beginning to accept mental illness just as they do physical illness.

Depression is a very common mental illness, and with an early diagnosis and the correct treatment program, the chances of a complete recovery and a return to normal life, are very good.

Emergency Resources and Support Helpline

US Suicide Prevention Lifeline 1-800-273-8255

Crisis Chat or Crisis Text Line Text HOME to 741741

NDMDA Depression Hotline – Support Group 800-826-3632

Suicide Prevention Services Crisis Hotline 800-784-2433

Suicide Prevention Services Depression Hotline 630-482-9696

Suicide & Depression Hotline – Covenant House 800-999-9999

Resources

  1. https://www.nimh.nih.gov/health/topics/depression/index.shtml
  2. https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf
  3. https://www.health.harvard.edu/mind-and-mood/what-causes-depression
  4. https://www.psychologytoday.com/us/blog/theory-knowledge/201610/three-kinds-depressive-episodes
  5. https://psychcentral.com/lib/telephone-hotlines-and-help-lines/
  6. https://www.psychologytoday.com/us/conditions/adjustment-disorder
  7. https://www.goodtherapy.org/learn-about-therapy/issues/melancholia
  8. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/clinical-depression/faq-20057770
  9. https://www.webmd.com/health-insurance/health-reform-depression-treatments

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 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.

 

What is Schizotypal Personality Disorder?

Schizotypal Personality Disorder: What Does It Mean?

Schizotypal personality disorder is a disorder characterized by difficulties in making and maintaining relationships due to extreme discomfort. Someone with the disorder will also usually display odd or eccentric personality traits and may have difficulty in displaying emotions.

Schizotypal Definition

Psychology Today defines the disorder as follows:

“Schizotypal personality disorder is a pattern of social and interpersonal difficulties that includes a sense of discomfort with close relationships, eccentric behavior, and unusual thoughts and perceptions of reality. Speech may include digressions, odd use of words or display “magical thinking,” such as a belief in clairvoyance and bizarre fantasies. Patients usually experience distorted thinking, behave strangely, and avoid intimacy. They typically have few, if any, close friends, and feel nervous around strangers although they may marry and maintain jobs. The disorder, which may appear more frequently in males, surfaces by early adulthood and can exacerbate anxiety and depression.”

Stats: How Many Suffer from this Disorder?

Studies into schizotypal personality disorder have found that around 3.9% of the population will suffer from the disorder during their lifetime. It is slightly more common in men, with 4.2% diagnosed with the disorder compared to 3.7% of women.

Research indicates that the odds of developing the disorder are significantly higher among black women. Asian men are much less likely to have the disorder than any other grouping. People with lower incomes are also more likely to develop the disorder, as well as those who are widowed, divorced or separated.

A recent study has found that people diagnosed with the disorder are less likely to live independently or to have obtained a bachelor’s degree. They are much more likely to work in an isolated job and earn below the national average.  The study also indicates that none of these things seem to be as a result of cognitive impairment or intellectual inability.

What Causes Schizotypal Personality Disorder?

There is not one known cause of schizotypal personality disorder currently. However, it is believed to be developed as a result of a combination of causes.

Genetic vulnerability to the disorder is a significant factor. People who have a direct family member who displays schizotypal symptoms are 50% more likely to display schizotypal symptoms themselves, which may result in being diagnosed with this disorder.

Research is on-going, but some scientists believe that people with this disorder have a significantly different makeup in their brains than those without. Specifically, it is believed that certain areas of the brain have less brain matter and that there are abnormalities of the neurotransmitter dopamine.

There is a possible link to childhood experiences although no research has so far proven this. Other childhood-related factors that increase the likelihood of developing the disorder include a lower birth weight, a small head circumference at 12 months old and a mother smoking whilst pregnant with the child in question.

Signs and Symptoms of Schizotypal Personality Disorder

What are the Common Behaviors/Characteristics?

One of the most common characteristics of people with this disorder is extreme discomfort around other people and in social situations. Developing relationships and maintaining relationships is often extremely difficult. This can often result in the person only having a relationship with direct family members and can cause unhappiness due to lack of friendship. Even interacting in seemingly insignificant social situations, such as a store or workplace, can cause anxiety for someone with this disorder.

People with this disorder often have odd or unusual beliefs or fantasies. They may be very superstitious about particular actions or believe they possess magical powers. A person with this disorder may believe there is significant meaning in a normal occurrence or that they are being sent a sign through an innocuous gesture. They may also be very suspicious of other people and/or have paranoid tendencies.

Another common behavior is having different or odd speech. Someone with schizotypal personality disorder will often use strange phrasing or use words out of context. Their appearance is often unusual also, they may wear dirty or ill-fitting clothing.

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

The DSM 5 criteria for schizotypal personality disorder is:

“A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) ideas of reference (excluding delusions of reference)

(2) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)

(3) unusual perceptual experiences, including bodily illusions

(4) odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)

(5) suspiciousness or paranoid ideation

(6) inappropriate or constricted affect

(7) behavior or appearance that is odd, eccentric, or peculiar

(8) lack of close friends or confidants other than first-degree relatives

(9) excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

  1. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.”

Schizotypal Personality Disorder and Other Conditions

Schizotypal Personality Disorder vs Schizophrenia

Schizophrenia and schizotypal personality disorder are frequently mixed up but there are many significant differences. The differences mainly center around the ways people with these disorders experience delusions and psychotic episodes.

Although people with schizotypal personality disorder do suffer from psychotic episodes, they are far less frequent and long-lasting than the psychotic episodes someone with schizophrenia will experience. Equally, those with schizophrenia will experience much more severe delusions and usually can’t differentiate between a delusion and reality, whereas someone with schizotypal personality disorder usually can.

The two disorders are often treated the same way and can sometimes be referred to as on the same spectrum.

Schizotypal Personality Disorder vs Schizoaffective Disorder

Schizotypal personality disorder and schizoaffective disorder are both similar in name and in symptoms. They are both classified as personality disorder and can both cause the sufferer to display similar behaviors. However, the main difference is the thought process behind the behavior.

Someone with schizotypal disorder will avoid interaction with others and forming relationships because it causes them great stress and anxiety. A person will schizoaffective disorder will also avoid developing long-lasting relationships with others but because -put simply- they see no benefit to such interactions or to social relationships.

As the two conditions share such similar behaviors to an onlooker, it is essential that a doctor or mental health professional take time to get to know the patient and the reasoning behind their behaviors, in order to make a correct diagnosis.

Related Conditions

People diagnosed with this disorder are also very likely to be diagnosed with additional disorders. It is estimated that between 30 and 50% of people with schizotypal personality disorder will also be diagnosed with a major depressive disorder. A second personality disorder is also likely, such as paranoid personality disorder. The risk of developing schizophrenia is also much higher for people with this disorder.

Schizotypal Personality Disorder In Adults/Children

The signs and symptoms of schizotypal personality disorder normally begin in childhood or adolescence, with the most obvious signs being avoidance of social situations and a tendency to seek alone-time. For people who are not diagnosed until they are adults, it is likely that these behaviors were being displayed in their childhood and the diagnosing party will usually ask the patient about their childhood and adolescence.

Example Case of Schizotypal Personality Disorder

Bex Gibbons wrote about her experience suffering from schizotypal personality disorder for the online publication The Mighty. After being diagnosed with the disorder in 2017, they said:

“When it comes to talking to people I’m unfamiliar with or even ordering a coffee in a cafe — I struggle to find the words and string a sentence together due to my social anxiety and shyness, but then i’ll quite comfortably sit on my own, muttering and whispering to myself, having a conversation and quietly smiling and laughing at myself. When I do venture out it’s a real challenge because the constant fear I’m being watched, observed and followed is a reoccurring thought in my mind. There have been a few occasions I’ve ran down the street running away from those following me, when realistically no one is following. I guess my mind plays treacherous tricks on me, but what do I believe when I feel suspicious of those people unknown to me — feeling “paranoid” — although I dislike the use of that word and I don’t use it lightly.

I don’t have many friends, in fa,ct I probably have two or three people I would call “friends.” I have more feline friends than human and I don’t mind at all — I love cats, who doesn’t. There have been moments of unusual thinking, believing the male pharmacists at my pharmacy have tampered with my medication, only trusting females and only collecting my medications from the female staff; fortunately, I have a pharmacy team who are very understanding, sympathetic, friendly and always asking how I am. Feeling uncomfortable around males I’m unfamiliar with and avoiding eye contact is a real struggle, which I am working on.”

You can read Bex’s full story here: https://themighty.com/2018/03/schizotypal-personality-disorder-diagnosis/

Schizotypal Personality Disorder

How to Deal/Coping With Schizotypal Personality Disorder

Look out for These Complications/Risk Factors

People with this disorder are at risk of developing other mental health disorders, such as depression and schizophrenia. The increased risk of depression is a particular risk due to both the higher likelihood of developing it as well as the increased risk of suicidal tendencies.

Some research indicates that people with this disorder may be more likely to develop issues with alcohol and drug abuse.

The issues with socializing and developing relationships can cause substantial complications. For example, a person with this disorder is at high risk of becoming isolated from society and avoiding necessary health care treatment.

Schizotypal Personality Disorder Treatment

Treatment for this disorder is usually a combination of medication and therapy. Of course, due to the one of the main symptoms of the disorder being extreme social interaction anxiety, it can be very difficult for a person with the disorder to engage in therapy. Those with severe symptoms may require hospitalization in order to undergo treatment.

Psychotherapy, such as cognitive behavior therapy (CBT), is the most common type of therapy offered for someone with this disorder. The therapy will often focus on teaching the patient about social interaction, helping with speech and teach methods to copy with anxiety.

Possible Medications for Schizotypal Personality Disorder

Due to it’s similarity to schizophrenia, people with schizotypal personality disorder are often prescribed the same or similar medications. Antipsychotic medications have proven to be a successful treatment, such as amoxapine, as they will help with symptoms such as illusions and severe anxiety. SSRIs such as fluoxetine are also sometimes prescribed and will work on symptoms such as depression and anxiety.

Home Remedies to help Schizotypal Personality Disorder

There isn’t one particular home remedy recommended for someone with this disorder. In fact, in order to avoid causing more harm or reinforcing negative aspects of the disorder, it is vital that someone with the disorder work closely with their doctor or mental health professional before they attempt any home remedy.

A therapist or doctor can work with a patient on tasks or activities to carry out outside the appointment, if they feel it’s in the patient’s best interests.

Living with Schizotypal Personality Disorder

Due to the risks of social isolation or ostracization, this disorder can be very difficult to live with. That’s why it’s essential to seek treatment as soon as possible. Although someone may never be cured of this disorder, they can learn ways to manage it that will alleviate some of the associated anxieties and stress.

It is also worth noting that living with someone with this disorder can be extremely difficult, too. It’s important to seek support when you need it and there are resources below that can help.

Insurance Coverage for Schizotypal Personality Disorder

Every insurance company will have a different insurance policy so it’s important to contact the relevant provider and ask about their insurance coverage for the specific disorder or for personality disorders. Ask for all the policy details, including outpatient and inpatient treatment, along with the cost for medications etc.

How to Find a Therapist

What Should I be Looking for in an LMHP?

For someone with schizotypal personality disorder, finding a mental health professional can be extremely difficult due to the anxiety over social interactions. Therefore, it may be easier to seek recommendations from a trusted doctor or to research online.

Look for a therapist that has experience in this particular condition, with similar personality disorders and with schizophrenia. It’s important that a therapist will understand the worries and anxieties that someone with this disorder will have, especially those behaviors that will make attending appointments very challenging.

Questions to Ask a Potential Therapist

Ask a potential therapist about their experiences with this disorder and similar and what kind of treatment they usually provide for this condition. You may wish to ask about their insurance policies, particularly about cancelation costs.

You may consider asking a therapist whether they do home visits or can provide therapy a third location that both parties would be comfortable attending.

Schizotypal Personality Disorder Resources and Support Helpline

  • National Suicide Prevention Lifeline      1-800-273-TALK (1-800-273-8255)
  • Mental Health Helpline                        (855) 653-8178
  • National Hopeline Network                  800-784-2433
  • NAMI (National Alliance for the Mentally Ill) 1-800-950-NAMI (800-950-6264)

References

What is Brief Psychotic Disorder?

A Brief Psychotic Disorder is a relatively rare psychotic condition which lasts from twenty-four hours to one month.  Sufferers experience delusions and hallucinations which cause them to act in bizarre ways,

Brief Psychotic Disorder: What Does It Mean?

A person suffering from this condition experiences transitory periods of severe hallucinations, delusions, confusion, and other symptoms which can often include violent or self-harming behavior. These periods of psychotic behavior can last from as little as 24-hours, and up to a maximum of one month. Some people only experience a single episode and then return to their normal comportment, while others have repeated relapses, although between them they function with normality,

What is a Psychotic Break?

A psychotic break is the name given to the rapid, unannounced onset of psychotic symptoms which last less than one month.

Stats: How Many Suffer from this Disorder?

A true Brief Psychotic Disorder occurs in between one and four people per 100,000 or 0.001-0.004 percent of the population. It is more common in women than in men and usually develops between the age of thirty and fifty years.  The average psychotic episode lasts for seventeen days.

What Causes Brief Psychotic Disorder?

A Brief Psychotic Disorder is frequently triggered by a traumatic event in a susceptible person’s life. The death of a close family member or friend, an accident, a natural disaster, or an assault, can all provoke an attack. However, this is probably not the cause of the condition, but a precipitating factor. There is evidence that suggests that Brief Psychotic Disorder may be genetically inherited, as it is quite common to find several members of the same family who have suffered at some time from the condition. There are also theories that environmental, biological, and neurological factors may cause the condition. A Brief Psychotic Disorder may also be the first symptom of a chronic psychiatric condition such as schizophrenia, bipolar disorder or psychotic depression.  The abuse of illegal drugs can provoke a Brief Psychotic Disorder although they are not considered as the cause.

Signs and Symptoms of Brief Psychotic Disorder

For a diagnosis of Brief Psychotic Disorder to be reached, the person must present one of the following symptoms

  • These are fixed erroneous beliefs. Often the person believes that they are being persecuted or plotted against. Less commonly, the person believes themselves to be rich, famous, powerful, or with supernatural powers.
  • These can be visual, auditory or tactile. They are false perceptions of a sound, sight, or sensation that does not exist. Hallucinations are frequently terrifying in nature and can evoke violent responses from the sufferer.
  • The sufferer does not know where they are, what date or time it is, and may not recognize people who are known to them.
  • Disorganized speech. Characterized by rambling disjointed sentences and a lack of fluid thought and rational thinking. Speech is often the response to the hallucinations and delusions and is incoherent and illogical.
  • At least one of these symptoms must be observed for more than one day, but less than one month. Psychotic symptoms which persist for longer periods do not meet the criteria of a Brief Psychotic Disorder. Other symptoms that are commonly observed in a person suffering from a Brief Psychotic Disorder include anxiety and agitation, immobility (catatonic behavior), intellectual impairment, hypochondria, insomnia, and constipation.

To reach a diagnosis of Brief Psychotic Disorder the psychiatrist must rule out other mental or physical health conditions which could be the cause of the symptoms or which could exist concurrently.

Some psychologists classify this type of event as a risk factor for future psychotic events and not as a disorder in itself. Statistics show that after one such event the person has a fifty percent chance that another will occur in the future.

What are the Common Behaviors/Characteristics?

Although the actual onset of the psychotic period may be rapid and without warning, it is quite common for mild symptoms to be developing over a period of years. These can include a general deterioration in intellectual abilities often revealed by lowering grades in studies or a decrease in efficiency at work. A reduction in self-esteem, often manifested in scruffy dress and an unkempt appearance, is also common.

During the psychotic period, the sufferer acts in a bizarre way usually in the response to their delusions and hallucinations, and extreme mood swings are common. Their actions depend on the nature of the irrational belief which they hold. Some may believe they are making a movie and that everyone around them is part of the filming. They may believe that they are a prophet and preach to their followers. They may believe that they have supernatural powers or that they are a dog. Whatever form the delusional thinking takes, the person perceives these thoughts as completely real and cannot be convinced that they are not. They misinterpret external information to fit into their delusional thought patterns.

Sufferers of Brief Psychotic Disorder exhibit bizarre and often violent behavior. They follow the instructions of their auditory hallucinations and are prone to self-harm, suicide, and unprovoked attacks on others. Sufferers may take off their clothes, run about on all fours, or remain immobile in one position for hours (catatonia). They are completely unaware that their behavior is inappropriate or strange. They are often disoriented and confused. They cannot recall the date or time, they don’t know where they are, and they don’t recognize people who should be familiar to them. Their speech is jumbled and illogical and they are completely detached from reality. Attempts to reason with them are impossible, and they can become aggressive if their delusional thoughts are questioned.

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

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM–5), the standard used in the US for diagnosis and treatment of mental illnesses, Brief Psychotic Disorder is described as-

“A thought disorder in which a person will experience short-term, gross deficits in reality testing, manifested with at least one of the following symptoms:

  • Delusions- strange beliefs and ideas which are resistant to rational/logical dispute or contradiction from others.
  • Hallucinations- auditory, or visual.
  • Disorganized Speech- incoherence, or irrational content.
  • Disorganized or Catatonic behavior- repetitive, senseless movements, or adopting a pose which may be maintained for hours. The individual may be resistant to efforts to move them into a different posture or will assume a new posture they are placed in.

To fulfill the diagnostic criteria for Brief Psychotic Disorder, the symptoms must persist for at least one day but resolve in less than one month. The psychotic episode cannot be attributed to substance use (ethanol withdrawal, cocaine abuse) or a medical condition (fever and delirium) and the person does not fit the diagnostic criteria for Major Depressive disorder with psychotic features, Bipolar disorder with psychotic features, or Schizophrenia.

There are five specifiers that can be used to further describe the disorder:

  • With marked stressors- the psychotic episode appears following an acute stressor, or series of stressors, which would overtax the coping skills of most individuals.
  • Without marked stressors- there is no apparent stressor preceding the psychotic episode.
  • Post-partum- this disorder can appear during pregnancy or within one month following childbirth.
  • With catatonia.
  • Severity – The clinician can rate the severity of the psychotic episode during the last seven days using a five-point scale- Zero (Absent) to Four (Present and severe).

This disorder will manifest over a period of about two weeks or less, resolve in less than one month, and the person will return to their pre-morbid level of functioning prior to the psychotic state”.

Brief Psychotic Disorder and Other Conditions

Brief Psychotic Disorder vs Schizophrenia

Brief Psychotic Disorder displays basically the same symptoms as Schizophrenia, but, as the name indicates, Brief Psychotic Disorder, only lasts for a short period of time. For a diagnosis of Brief Psychotic Disorder, the person must exhibit psychotic symptoms for between one day and one month. After this time, they return to their normal behavior.  An episode of Brief Psychotic Disorder can repeat itself at intervals, but between attacks, the person maintains a normal life. A diagnosis of schizophrenia requires the presence of two psychotic symptoms, whereas a Brief Psychotic Disorder only requires the presence of one.

Brief Psychotic Disorder vs Schizoaffective

A person suffering from a Schizoaffective disorder manifests many of the same psychotic symptoms associated with schizophrenia and Brief Psychotic Disorder, but usually, the psychotic periods are interspersed with periods of depression or bipolar disorder. People with Brief Psychotic Disorder experience periods when they are free of symptoms, and they only display psychotic behavior for a maximum of one month.

Brief Psychotic Disorder in Adults/Children

Brief Psychotic Disorder usually occurs for the first time in early adulthood but can appear up the age of fifty. It is uncommon in children and teenagers. In most cases with repeated episodes of psychotic symptoms, these do not continue past the age of fifty.

Example Case of Brief Psychotic Disorder

Andrew was a grade A student throughout school and college. His teachers described him as disciplined and intelligent and his fellow pupils said he was just a regular nice guy. Andrew went on to graduate from a major law school and began practicing his profession in NYC.

Five years ago, at the age of 33, Andrew was arrested in a public park, half dressed and screaming obscenities. He was confused, disoriented and delusional. Interviews with a psychiatrist suggested that he was suffering from a psychotic episode. The doctors managed to contact his mother who revealed that she had been concerned about her son. He normally contacted her regularly, but in recent weeks had not been calling. One day when she had managed to reach him he had rambled on in a very disjointed and disconcerting manner. He had mentioned during the conversation that his beloved Doberman had been run over and killed in the street, in front of his eyes.

It would appear that this was the event that sparked Andrew’s Brief Psychotic Disorder. He was taken to a state mental hospital due to his delusional state and his inability to care for himself. While there, he received a course of antipsychotic medication. This helped to reduce his delusions and hallucinations, and ten days after his admission he was sent home.

Andrew has not had another psychotic episode. He is no longer on any medication, but he has been receiving therapy to help him to deal with his anxiety and to make him aware of any signs of a possible recurrence of his psychotic symptoms.

He has returned to his job and keeps in regular contact with his mother. He has expressed fear that another episode could occur but is hopeful that this was a once-off experience.

Brief Psychotic Disorder

How to Deal/Coping with Brief Psychotic Disorder

The person suffering from a Brief Psychotic Disorder is usually oblivious to their condition and their behavior during the acute phase of the attack. Afterward, they may retain some memory of the events, but this is usually fragmented. Those witnessing a person suffering from a Brief Psychotic Disorder may feel frightened and impotent. The vehemence with which the patient experiences their delusions and their reaction to the hallucinations can be a tough event to witness.

It is unwise to try and restrain a person in this delusional state and appropriate medical help should be sought immediately. It is also unwise to contradict them in their delusions as this can provoke intense anger. However, the delusion should not be reinforced either. Patients experiencing extreme delusions and hallucinations will require medication and sometimes restraint to prevent them from hurting themselves or others. It can be very distressing for family members to see a loved one in this condition, but their unconditional support is very important for the patient to achieve a complete recovery.

Look out for These Complications/Risk Factors

Early signs of the onset of a Brief Psychotic Disorder can be restlessness, agitation, anxiety, and insomnia. When the psychotic symptoms are at their peak the patient should be closely monitored at all times as there is a high risk of self-injury, suicide, and unprovoked attacks on others. After an incident, many people can feel ashamed or embarrassed by their behavior. Therapy can help them to understand their condition and to overcome any stigma which may be attached to it.

Brief Psychotic Disorder Treatment

Brief Psychotic Disorder is treated primarily with anti-psychotic medication. Short-term psychotherapy and Cognitive Behavioral Psychotherapy (CBP) are also employed.

Possible Medications for Brief Psychotic Disorder

Second-generation antipsychotic medications such as Aripiprazole, Asenapine, Closapine, Iloperidone, Olanzapine, Paliperidone, Quetiapine, Risperidone, Urasidone, Ziprasidone, are commonly used to treat this disorder.

First-generation antipsychotic medication such as Chlorpromazine, Fluphenazine, Haloperidol, Thioridazine, Thiothixene, Trifluoperazine and Perphenazine may also be employed.

Serotonergic and other anti-depressant medications are also used where depression is evident.

Home Remedies to Help Brief Psychotic Disorder

Vitamins and minerals such as B-vitamins, D-Alanine, D-Serine, Melatonin, N- Acetylcysteine (NAC) and Sarcosine may help sufferers of a Brief Psychotic Disorder.  Avoiding excessive alcohol consumption and recreational drugs, along with practicing ways in which to reduce and control stress, such as yoga, may help to prevent a Brief Psychotic Disorder.

Living with Brief Psychotic Disorder

Many people who have suffered through an experience of Brief Psychotic Disorder are fearful of a repeat attack. With therapy and support, most can overcome the condition and achieve a complete recovery, to continue with their lives as before.

Insurance Coverage for Brief Psychotic Disorder

Most insurance policies cover mental health conditions. You should consult with your provider to see if your policy covers you or if another would serve your needs better.

How to Find a Therapist

Ask your mental health care team to recommend therapists qualified to help with sufferers of Brief Psychotic Disorder.

What Should I be Looking for in an LMHP?

Ensure that the therapist has current relevant qualifications and that they are accustomed to treating people with Brief Psychotic Disorder.

Short-term psychotherapy can assist the sufferer of a Brief Psychotic Disorder to understand the condition and to guide them towards a complete recovery. Those who do not seek treatment are more likely to experience a repeat occurrence.

Cognitive behavioral psychotherapy can help to control some of the symptoms and assists the sufferer to understand his condition and the impact of his behavior on others. It may assist in preventing the development of an acute attack.

Questions to Ask a Potential Therapist

What type of therapies would you use?

How would these benefit the sufferer?

How long would the course of therapy last?

How often would sessions take place?

In many cases, a Brief Psychotic Disorder is an isolated event in the life of a person and they make a complete recovery. Even those who experience multiple events enjoy periods of normality in between, and the condition is not indicative of a chronic mental illness. With support, therapy, and medications, most people overcome this disorder and resume their lives as before.

Brief Psychotic Disorder Resources and Support Helpline

National Alliance on Mental Illness (NAMI) www.nami.org

Phone: 1-800-950-NAMI 1-800-950-6264 hotline for help with depression 703-524-7600 Fax: 703-524-9094

National Rehabilitation Information Center: https://www.naric.com/?q=en/content/resources-specific-disabilities

National Suicide Prevention Lifeline:  https://suicidepreventionlifeline.org/

1-800-273-8255 available 24 hrs a day

Crisis Text Line: Text “home” to 741741

Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357)

Resources

  1. https://www.psychologytoday.com/us/conditions/brief-psychotic-disorder
  2. https://www.merckmanuals.com/professional/psychiatric-disorders/schizophrenia-and-related-disorders/brief-psychotic-disorder
  3. https://www.livescience.com/53388-brief-psychotic-breaks-remain-a-mystery.html
  4. https://medlineplus.gov/ency/article/001529.htm
  5. https://www.nami.org/Blogs/NAMI-Blog/March-2017/Understanding-Psychotic-Breaks
  6. https://nypost.com/2017/09/20/this-is-what-a-psychotic-breakdown-actually-feels-like/
  7. https://www.theravive.com/therapedia/brief-psychotic-disorder-dsm–5-298.8-(f23)
  8. https://www.medicinenet.com/brief_psychotic_disorder/article.htm#where_can_people_get_more_information_on_brief_psychotic_disorder

What is Dissociative Amnesia?

Dissociative amnesia is an uncommon disorder causing sufferers to forget important information and experiences. This is usually brought on by traumatic experiences. Read on to find out more about this do

Dissociative Amnesia: What Does It Mean?

Dissociative amnesia is a condition that causes a person to forget certain memories, information and experiences. The memories forgotten are usually associated with trauma or stressful situations. As well as forgetting the memories around the trauma/stress, they may also or instead forget important information about their identity. The type of memory that is lost is described as autobiographical memory.

This condition is part of a group of conditions called dissociative disorders.

Amnesia Definition

Amnesia is medically defined as an impairment to or loss of memory. It can cause issues with either recalling past memories or creating new memories. It doesn’t normally affect people’s intelligence or their skills, such as the ability to read or write or ride a bike.

Stats: How Many Suffer from this Disorder?

The Cleveland Clinic believes that dissociative amnesia affects around 1% of men and 2.6% of women in the general population. Other research suggests that the condition may affect up to 7% of the US population. Some psychologists believe that dissociative amnesia is actually more prevalent but is under-diagnosed.

Rates of the population with dissociative amnesia tend to go up after a natural disaster, war, or other such traumatic experiences. It’s believed that up to 7% of people will experience at least one episode of dissociative amnesia in their lifetime, although they may not be diagnosed as such.

Of the women diagnosed with dissociative amnesia, 68% of them have experienced a sexual trauma.

What Causes Dissociative Amnesia?

Psychogenic Causes

Dissociative amnesia is caused by experiencing or witnessing a traumatic or stressful event, either recently or in the past. Experiencing rape or sexual abuse is a common cause for women diagnosed with the condition.

It is believed that ‘blocking out’ memories of the traumatic or stressful event is the coping mechanism of the brain. Likewise, the brain may ‘block out’ any other memories associated with the event or time period, resulting in a loss of additional memories.

The most common psychogenic cause of the condition is trauma from witnessing a loved one commit suicide or being murdered. 38% of all people diagnosed with the condition developed it after undergoing these experiences.

Research has indicated that there may be a genetic element of the development of the condition, as many people diagnosed with dissociative amnesia also have relatives with the condition or a similar condition.

Acquired Brain Injuries

The definition of dissociative amnesia means that it can not be attributed to a brain injury or any other such neurological condition. Dissociative amnesia is thought to be based on an over-corrective defense mechanism, instead of physical damage to memory related parts of the brain.

Signs and Symptoms of Dissociative Amnesia

What are the Common Behaviors/Characteristics?

The main symptom of this condition is memory loss. There are three different types of memory loss that a person suffering from this condition may have. They may show signs of just one type, two types or all three. They are:

Localized memory loss: forgetting a specific event or a period of time

Selective memory loss: forgetting certain parts about an event or period of time, or forgetting certain events within a period of time

Generalized memory loss: a complete loss of identity and life history.

The period of memory loss can range from minutes through to decades. It may also involve forgetting people and places.

Another common symptom of the condition is feeling detached from oneself. This could be described as feeling in a dream-like state. It can also affect the ability to feel any emotions or have an emotional response to either a present situation or a past situation.

A person with dissociative amnesia may struggle with their perception of others. People may appear ‘blurry’ or ‘unreal’. There may a general sense of detachment from other people and a sense that others aren’t quite there.

People with the condition can have an altered sense of identity. They can struggle with a sense of self or knowing who they really are.

Stress can be a huge problem for people with dissociative amnesia. They may have extreme issues with dealing with any kind of stressful situation, whether that’s in their own personal life or in work situations. This could involve either overreacting or an inability to react, as well as many other improper or unhealthy behaviors.

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

“A. An inability to recall important autobiographic information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: Dissociative Amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, other neurological condition).

D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.”

Dissociative Fugue

Dissociative fugue is a rare version of dissociative amnesia that occurs whenever a person forgets all, or mostly all, of their own identity and life history. This can include their own name, who their friends are, where they live etc.

One of the most common ways someone with dissociative fugue will get noticed is after suddenly ‘appearing’ in a new place. People with this condition can travel to new places, sometimes a long distance away from their hometown. They will often have no idea where they have come from or how they got there.

The period of dissociative fugue may last anywhere from hours up to years. The sufferer may take on a new identity, make new friends and have a career. Often other people will have no idea that their friend, loved one or colleague suffers from the condition. It usually only becomes noticeable when the sufferer tries to recall their past, which can cause great distress and trigger other mental health issues such as depression, aggression and/or suicidal thoughts.

The condition is estimated to affect .2% of the population. Having dissociative amnesia does not that mean that one will develop dissociative fugue.

Dissociative Amnesia and Other Conditions

Dissociative Amnesia vs Dissociative Identity Disorder

Although the names of these two conditions are very similar, they are actually very different conditions. Dissociative Identity Disorder was formally known as multiple personality disorder and is described as having two or more very distinct personalities. These seemingly different personalities are actually fragments of a person’s identity, rather than completely different identities.

Like dissociative amnesia, one of the main causes of dissociative identity disorder is experiencing trauma. The most similar symptom between the two conditions is the loss of memory, however, with dissociative identity disorder the memory is usually fragmented and divided between the two or more personalities.

Related Conditions

People with dissociative amnesia are more likely to also be diagnosed with acute stress disorder and/or post-traumatic stress disorder. This is due to the common cause between the conditions of stress or experiencing a trauma. The conditions are often diagnosed together and will be treated similarly.

Sleep disorders are also related to dissociative amnesia and may include symptoms such as night terrors, sleepwalking, and confusion.

Dissociative Amnesia In Adults/Children

Much like in adults, dissociative amnesia in children is often caused by witnessing or experiencing a traumatic event or extremely stressful experiences. To block out the trauma, the child will dissociate from the memories and either block them out completely or forget elements surrounding the event/events.

A child with the condition may sometimes appear to be in a ‘trance’ or seem ‘spaced out’. They can become very confused or frustrated when asked about the past or pressed on certain subjects. Children are believed to be more susceptible to dissociative disorders because they have not yet developed the coping skills necessary.

Example Case of Dissociative Amnesia

The following case study is written by David Woo, MD and describes a patient who was diagnosed with dissociative amnesia.

“Mrs. CP is a 64-year-old widowed Filipino woman who came to see a psychiatrist at an outpatient mental health clinic. She had been in treatment intermittently since 1998 for depression and anxiety. Her symptoms included anxious mood, insomnia, hypervigilant behavior, tearfulness, poor concentration, and feelings of palpitations.

She reported that over the past year she had been more forgetful and distractible, forgetting where she had placed her keys, pocket cash, and other items. She would forget to get off the bus at a familiar stop and could not remember to purchase needed items at the grocery store.

Of greater concern, she had left the stove on several times and had limited recollection of this. Mrs. CP’s behavior included unusual incidents such as leaving rotting bananas in the closet and going back into the shower fully clothed after she had just bathed and dressed herself. Because of these behaviors, her younger son and a close friend moved in with her to assist and monitor her behavior…

Mrs. CP was born in the Philippines and had had a turbulent childhood and a severe eating disorder early on…As a teenager, Mrs. CP had a “nervous breakdown” due to depression, and her father consulted with a psychiatrist. ..While she was in her 20s, she made three attempts to end her life…She described feeling driven by the stress of being in an “inescapable, abusive marriage.” Her husband was often drunk, physically abusive, tortured the children—sometimes with an ax—and used them for ‘target practice.’”

Dissociative Amnesia

How to Deal/Coping With Dissociative Amnesia

Look out for These Complications/Risk Factors

One of the major risk factors with this condition is suffering from flashbacks. These can often be so traumatic that they lead to dangerous feelings and thoughts, such as self-harming and suicidal thinking. It is extremely important to seek immediate medical attention in these circumstances.

For people suffering from the condition, there is higher chance of also developing other conditions such a personality disorders, sleep disorders and depression. Alcoholism and drug addiction can also be risks so it’s important to avoid all or frequent use of drugs and alcohol. Seek medical treatment if worried and always be open and honest about usage and symptoms when speaking to medical professionals.

Men with dissociative amnesia also have a higher chance of becoming involved in the criminal system and going to jail. It is believed this is due to being at risk of aggressive behavior.

Dissociative Amnesia Treatment

Treatment for dissociative amnesia is usually a combination of medications and therapy. The type of therapy will depend on the person’s symptoms and severity, but the most common therapies used are Cognitive Behavioral Therapy (CBT) and interpersonal therapy.

Some therapists will also recommend family therapy, depending on the cause of the condition. Creative therapies can also be a very helpful tool for this condition, such as music or art therapy.

Possible Medications for Dissociative Amnesia

At present, there are no medications designed specifically for dissociative amnesia. There are also no medications that will treat memory loss or prevent memory loss. Instead, patients with dissociative amnesia are often prescribed medications that will help with the symptoms, such as anti-depressants for depression, medication for anxiety or sleeping pills for insomnia.

Home Remedies to help Dissociative Amnesia

There aren’t any particular home remedies recommended for dissociative amnesia without first having recommendation and approval from a doctor or mental health professional. Once you have been fully assessed, they may recommend trying meditation and other relaxation techniques.

Living with Dissociative Amnesia

For most people with dissociative amnesia, it will not be a lifelong condition. In fact, in most cases, full memory will return and the symptoms of the condition will disappear. For others, the memories may never come back and they will need to learn coping mechanisms and skills for dealing with memory loss.

The sooner a person seeks treatment for the condition, the better the prognosis so it’s important to speak a doctor or therapist as soon as possible.

Insurance Coverage for Dissociative Amnesia

Each insurance company will have their policies on dissociative amnesia and other dissociative disorders. Ask your insurance company for their policies on these conditions and mental health treatment.

How to Find a Therapist

What Should I be Looking for in an LMHP?

Look for a mental health professional who has experience in working with people with this disorder, or other similar dissociative disorders. The International Society for the Study of Trauma and Dissociation have a searchable database of therapists. You can find the link below, under the resources section.

Questions to Ask a Potential Therapist

Before meeting a potential therapist, you may want to write down some questions to ask them. As well as questions that are specific to the condition and symptoms you’re experiencing, you can also ask them more personal questions. For example, you may have certain personality types you’d prefer to work with or certain types of therapy you prefer. You may also want to ask for reviews from previous patients with similar conditions.

Dissociative Amnesia Resources and Support Helpline

National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255)

International Society for the Study of Trauma and Dissociation: http://www.isst-d.org/default.asp?contentID=18

National Alliance on Mental Illness: 800-950-NAMI     [email protected]   TEXT “NAMI” TO 741741

References

http://traumadissociation.com/dissociativeamnesia#dsm-5-diagnostic-criteria-for-dissociative-amnesia

https://healthresearchfunding.org/22-dissociative-amnesia-statistics/

https://psychcentral.com/disorders/dissociative-fugue-symptoms/

https://www.psychologytoday.com/us/conditions/dissociative-identity-disorder-multiple-personality-disorder

https://www.consultant360.com/articles/case-dissociative-amnesia-older-woman

https://my.clevelandclinic.org/health/diseases/9789-dissociative-amnesia/outlook–prognosis

http://www.minddisorders.com/Del-Fi/Dissociative-amnesia.html

https://www.sciencedirect.com/science/article/abs/pii/014521349390006Q

https://www.msdmanuals.com/en-gb/professional/psychiatric-disorders/dissociative-disorders/dissociative-amnesia

https://www.nami.org/Learn-More/Mental-Health-Conditions/Dissociative-Disorders

 

 

 

Complex Post-Traumatic Stress Disorder (CPTSD)

Complex post-traumatic stress disorder (CPTSD) is a trauma-related mental health condition that results from sustained abuse and powerlessness over time. CPTSD is related to but different from post-traumatic stress disorder (PTSD).

CPTSD: What Does It Mean?

Complex post-traumatic stress disorder develops from life-threatening trauma or abuse that occurs repeatedly and cumulatively over a prolonged period of time. In many cases, the victim feels powerless and sees no hope of escape. The abuse is often premeditated, planned, and carried out by other people.

Complex post-traumatic stress disorder is usually seen within specific relationships or settings. Severe and long-term child abuse, domestic abuse, confinement in prisoner-of-war camps, or forced sexual activity in prostitution brothels may expose individuals to chronic trauma that contributes to the development of CPTSD. People with CPTSD may experience personality issues, emotional deadness, or intense emotional outbursts that overwhelm their ability to cope. They may also have severe relationships issues as well as lapses in judgment, concentration, and problem-solving.

Stats: How Many Suffer from this Disorder?

At present, there are no general prevalence rates of complex post-traumatic stress disorder in the literature. However, a study conducted with a sample of adult survivors of childhood institutional abuse showed 21.4% of survivors had CPTSD. Current research indicates there may be significant gender differences in the onset of CPTSD. In the aforementioned study, women were more than twice as likely to develop CPTSD than men (40.4% to 15.8% respectively).

A second study evaluated a sample of 323 trauma-exposed United States military veterans. In this study, 13% of vets were diagnosed with complex post-traumatic stress disorder.  Approximately 25% to 50% of vets with PTSD also met the criteria for CPTSD.

What Causes CPTSD?

Complex traumatic events are long-lasting, usually interpersonal (caused by someone else), and often occur during a developmentally vulnerable stage in the victim’s life. Interpersonal trauma may result in a more intense emotional response than trauma that is impersonal or accidental.

While there is no specific cause of complex post-traumatic stress disorder, there are circumstances and contexts that may trigger the condition. Factors that contribute to the onset of CPTSD include:

  • Ongoing community violence and poverty
  • Chronic homelessness
  • Incarceration with constant assault and threat
  • Ongoing physical or sexual abuse
  • Severe child neglect
  • Prolonged exposure to war
  • Torture
  • Displacement or refugee status
  • Prolonged exposure to death or inhumane conditions in emergency work

Signs and Symptoms of CPTSD

There are many severe emotional, mental, and relational issues associated with complex post-traumatic disorder. These issues may cause significant impairment in day-to-day functioning. Individuals with CPTSD may experience:

  • Hyperarousal
  • Avoidance of people, places, or things that are reminders of the trauma
  • Low mood
  • Dissociation
  • Uncontrolled anger
  • Self-destructive behavior
  • Nightmares of the trauma
  • Flashbacks of the trauma
  • An ongoing search for a rescuer
  • Preoccupation with revenge
  • Relationship issues
  • Trust issues
  • Hopelessness, worthlessness, or despair
  • Intense guilt or shame
  • Social isolation
  • Digestive issues
  • Sexual promiscuity
  • Physical or medical issues
  • Amnesia
  • Suicidal ideation

What are the Common Behaviors/Characteristics?

People with complex post-traumatic stress disorder generally assign complete power to their abuser. They may feel trapped, overwhelmed, and unable to escape. They may also begin to identify with and protect the person who hurt them most. This puts victims at high risk of continued abuse and re-traumatization.

Victims of complex trauma may also experience dissociation. Dissociation is a state in which you feel emotionally detached from yourself. Survivors of complex trauma often report their abuse as if they watched it happen to another person. Children who are abused by the people they trust most are at higher risk of dissociation than adults

Individuals with CPTSD tend to have severe relationship issues later in life. They may find it difficult to trust or become intimate with other people. In some cases, survivors may believe they are at fault for the trauma they experienced. Consequently, they may feel severe guilt, shame, or believe they are no longer human.

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

Complex post-traumatic stress disorder does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although several symptoms of CPTSD are alluded to, no diagnostic criteria are provided in the manual.

CPTSD and Other Conditions

There is a lack of awareness of complex post-traumatic stress disorder among the general public. With no clear, consistent diagnostic criteria for CPTSD, mental health professionals are also more likely to misdiagnose the condition. In some cases, therapists may identify and treat symptoms of anxiety or low mood among individuals with CPTSD. However, they may fail to recognize that these symptoms are part of a greater underlying issue.

CPTSD vs Simple PTSD

There are several differences between CPTSD and simple PTSD.

  1. CPTSD is linked with severe, ongoing trauma or multiple types of trauma where the victim has no hope of escape. PTSD may be triggered by a brief one-time event such as a car crash, armed attack, or natural disaster.
  2. CPTSD has severe symptoms that impair everyday functioning. Symptoms of PTSD may range from mild to severe.
  3. People with CPTSD may experience all the symptoms typically associated with PTSD plus additional symptoms.

Related Conditions

CPTSD and PTSD are trauma-related issues with very similar symptoms. Many people with PTSD also have CPTSD. Other mental health issues with similar symptoms include dependent personality disorder, masochistic personality disorder, and borderline personality disorder.

CPTSD In Adults/Children

Complex post-traumatic stress disorder affects people of all ages. Although the condition usually arises from cumulative trauma experienced during childhood, traumatic events during adulthood may also lead to CPTSD. Individuals with PTSD who were exposed to trauma before the age of 14 are more likely to be diagnosed with CPTSD later in life

Older children, teenagers, and adults with complex post-traumatic stress disorder generally have similar symptoms. However, young children with CPTSD may have different symptoms than adults with the condition. Younger children may experience:

  • Bedwetting
  • Loss of speech
  • Re-enacting the trauma during play
  • Clinging behavior toward a parent

Example Case of CPTSD

Cassandra, 31, visits a psychiatrist after years of emotional issues, self-harming behaviors, and relationship challenges. She believes she suffers from depression and anxiety. Cassandra was in foster care between the ages of 8 and 15. While speaking with the psychiatrist, she reveals that she endured repeated sexual abuse from her foster parents. Cassandra explains that she felt powerless to tell anyone about her abuse because she depended on her foster parents to care for her material needs. Since becoming an adult, she has difficulty controlling her anger, very low self-esteem, and regular nightmares about her childhood experiences. Cassandra finds it hard to trust or become intimate with other people. She also blames herself for what happened to her. The psychiatrist listens carefully, and after asking a few follow-up questions, diagnoses Cassandra with complex post-traumatic stress disorder and prescribes a combination of psychotherapy and antidepressant medication. After 11 months of regular treatment, Cassandra reports improved emotional regulation, better interpersonal relationships, and a greater sense of self-worth.

CPTSD

How to Deal/Coping With CPTSD

Although it can be difficult to cope with the symptoms of CPTSD, there are several steps you can take to manage the condition. It is recommended that you:

  • Learn as much as you can about CPTSD
  • Seek professional care
  • Stay in touch with your loved ones
  • Monitor your symptoms and learn about your triggers
  • Learn and use relaxation techniques
  • Join a support group
  • Take part in activities you enjoy
  • Write about how you feel
  • Exercise regularly
  • Avoid alcohol and unprescribed drugs
  • Engage in spiritual activities
  • Find healthy ways to distract yourself from negative thoughts

Look out for These Complications/Risk Factors

Individuals with a history of severe, continuous trauma over an extended period of time are at increased risk of complex post-traumatic stress disorder. Onset of CPTSD is more likely if the victim is at a vulnerable stage of development (such as childhood) and dependent on the abuser for survival. Other risk factors include a family history of CPTSD, chemical imbalances in the brain, as well as a personal history of depression or anxiety.

People with CPTSD are more likely to have psychiatric issues, engage in risky sexual behavior, and use illicit substances. They are also more likely to commit suicide than their peers.

CPTSD Treatment

Complex posttraumatic stress disorder is a serious mental health issue. However, symptoms can improve with treatment. CPTSD is usually treated with psychotherapy, medication, or a combination of both approaches. Types of psychotherapy that have proven to be effective include:

  • Cognitive behavioral therapy (CBT)
  • Prolonged exposure therapy (PE)
  • Cognitive restructuring therapy
  • Dialectical behavior therapy (DBT)
  • Eye Movement Desensitization and Reprocessing (EMDR)

Possible Medications for CPTSD

Different medications may be prescribed to help treat severe symptoms of CPTSD. These may include anti-anxiety medication, antidepressants, and sleep medication.

Home Remedies to help CPTSD

There are no FDA-approved home remedies that may help with complex post-traumatic stress disorder.

Living with CPTSD

Living with complex post-traumatic stress disorder can be challenging. For many people, it is a lifelong condition. Intense feelings of despair and hopelessness may cause individuals with CPTSD to suffer in silence. However, seeking help is the first step toward recovery.

If you have been diagnosed with CPTSD, professional care from a licensed therapist can help you to manage your symptoms. You can also join a support group where you can share your experiences, receive advice, and get emotional support from people with similar issues. If joining a support group in person seems overwhelming, an alternative is to join a support group online. You can live a rich, rewarding life if you take advantage of the mental health resources that are available to you.

Insurance Coverage for CPTSD

Complex post-traumatic stress disorder is not listed in the DSM-5. However, healthcare professionals are becoming more aware of the condition. Your insurance plan may provide coverage for CPTSD. Speak with your insurance provider to confirm your coverage before you visit your doctor or therapist.

How to Find a Therapist

Speak with your doctor if you are experiencing symptoms of CPTSD. Your doctor will refer you to a licensed therapist who is able to help. A trusted friend or family member may also be able to connect you with a qualified mental health professional in your community.

What Should I be Looking for in an LMHP?

Your therapist should have specialized training in trauma-related issues. An unqualified therapist may cause you to re-experience traumatic past events needlessly. As serious, embarrassing, or painful memories may be discussed in therapy, your therapist should be someone with whom you feel completely at ease. If you are not comfortable opening up to your therapist, it may be best to ask for a referral.

Questions to Ask a Potential Therapist

Ask these and other questions to make the most of your time with your therapist:

  • Have you been trained to treat CPTSD?
  • What is your experience in treating trauma-related issues?
  • Do I have CPTSD?
  • Are there any co-occurring conditions?
  • What treatment do you recommend?
  • Do I need medication?
  • How long will I need to take medication?
  • What are the side-effects of this medication?
  • How long does treatment last?
  • What can I do to improve my health?

CPTSD Resources and Support Helpline

People with complex post-traumatic stress disorder may have thoughts of committing suicide or getting revenge. If you believe you may commit suicide or harm other people, please call any of the following numbers immediately:

  • 911 or your local emergency services number
  • The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a trained therapist
  • Suicide Prevention Services Crisis Hotline at 800-784-2433
  • Suicide Prevention Services Depression Hotline at 630-482-9696

Many mental health resources for PTSD are also beneficial for individuals with CPTSD. Resources you can access online include:

If you are struggling to cope with complex post-traumatic stress disorder, you do not have to face your challenges alone. With appropriate psychotherapy, medication, and a strong support network, you can control your symptoms, find relief, and improve your quality of life.

References:

Cloitre, M., Stolbach, B. C., Herman, J. L., van der Kolk, B., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 0, 1-10. Retrieved from http://www.traumacenter.org/products/pdf_files/jts_oct_09_cloitre_et_al.pdf

Complex post-traumatic stress disorder. (n.d.). Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/complex-post-traumatic-stress-disorder

Complex PTSD symptoms and treatment. (n.d.) Retrieved from https://www.betterhelp.com/advice/ptsd/complex-ptsd-symptoms-and-treatment/

Courtois, C. A. (2014, July 16). Understanding complex trauma, complex reactions, and treatment approaches. Retrieved from http://www.giftfromwithin.org/html/cptsd-understanding-treatment.html

Croft, H. (2015, June 5). Complex post-traumatic stress disorder (C-PTSD) vs. simple PTSD. Retrieved from https://www.healthyplace.com/blogs/understandingcombatptsd/2015/06/complex-posttraumatic-stress-disorder-ptsd-vs-simple-ptsd

Firestone, L. (2012, July 31). Recognizing complex trauma: Educating ourselves on the after-effects of repetitive or cumulative trauma. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/compassion-matters/201207/recognizing-complex-trauma

Gilles, G., & Morrell, K. (2018). Understanding complex post-traumatic stress disorder. Retrieved from https://www.healthline.com/health/cptsd

Knefel, M., & Lueger-Schuster, B. (2013). An evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse. European Journal of Psychotraumatology, 4(10). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851534/

Lucario, L. H. (n.d.). Differences between PTSD and complex PTSD. Retrieved from https://www.healingfromcomplextraumaandptsd.com/ptsd–v–complex-ptsd

Nicholas, E. (2015, December 17). The living nightmare of complex post-traumatic stress disorder. Retrieved from https://www.vice.com/en_us/article/vdxjn8/worse-than-ptsd-the-nightmare-of-complex-post-traumatic-stress-disorder

Phillips, J. (2015, September 25). PTSD in DSM-5: Understanding the changes. Psychiatric Times, 32(9). Retrieved from http://www.psychiatrictimes.com/ptsd/ptsd-dsm-5-understanding-changes

Tull, M. (2018, May 6). How to develop coping skills for PTSD: Healthy ways to deal with post-traumatic stress disorder. Retrieved from https://www.verywellmind.com/coping-with-ptsd-a2-2797563

U.S. Department of Veterans Affairs. (2016, February 23). PTSD: National Center for PTSD: Complex PTSD. Retrieved from https://www.ptsd.va.gov/professional/ptsd-overview/complex-ptsd.asp

Wolf, E. J., Miller, M. W., Kilpatrick, D., Resnick, H. S., Badour, C. L., Marx, B. P., Keane, T. M., Rosen, R. C., Friedman, M. J. (2015). ICD-11 Complex PTSD in US national and veteran samples: Prevalence and structural associations with PTSD. Clinical Psychological Science, 3(2), 215-229. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25750837

 

 

What is Hypersomnia?

Everyone is tired from time to time. Depending on your lifestyle, you may be tired a lot of the time. However, if you find yourself napping frequently throughout the day, sleeping much longer at night than is typical for your age group, and still feeling excessively tired, then you may have a condition called hypersomnia or hypersomnolence disorder. This is a lesser-known condition that can require medical and mental health treatment to eliminate the symptoms and improve functioning:

Hypersomnolence Disorder: What Does It Mean?

Hypersomnolence is a disorder defined by excessive sleepiness. This can appear during the daytime with recurrent episodes and frequent napping. It can also occur with prolonged nighttime sleeps. Individuals who have hypersomnolence do not necessarily feel tired due to poor sleep. In fact, they are likely getting more than enough sleep. These individuals are so tired they feel almost compelled to sleep. They may nap during the day, even during inappropriate times (for example, at work). Despite the naps, the person is still tired and feels no sense of relief from their sleepiness. The condition was previously called hypersomnia, but the name was changed to better capture the symptoms.

Somnolence Definition

Originally, the disorder entitled hypersomnia was named to capture two terms: “hyper” meaning “too much” and “somnia” meaning “sleep.” Put together those terms captured the condition of excessive sleeping, called hypersomnia. Later, the terminology was updated to hypersomnolence (meaning too much sleepiness). This new term was intended to capture both long sleep durations and excessive sleepiness that occurs during the daytime.

Idiopathic Hypersomnia

In some classifications, the terminology ‘idiopathic hypersomnia’ is used to define the sleep disorder. Individuals who have ‘idiopathic hypersomnia’ will usually wake still feeling tired even after they have slept for a long period of time. Individuals with this diagnosis will also exhibit difficulty waking up in response to alarms. Once awake, they may demonstrate ‘sleep inertia’ with difficulty thinking (even confusion) and difficulty moving after being awakened(sleep drunkenness).

Is Hypersomnia a Mental Disorder?

Hypersomnia/hypersomnolence is listed in the Diagnostic and Statistical Manual, along with mental health disorders. It can also impair functioning in ways that are similar to the impairment caused by mental health disorders. However, it is not really a mental health disorder. It is considered a neurological disorder. This is because it is often due to an irregularity of one kind or another in the nervous system that acts almost like a sleeping pill on the brain.

Stats: How Many Suffer from This Disorder?

Hypersomnia/hypersomnolence disorder is not very common. Some studies indicate that approximately 4% to 6% of the population may have the disorder. It is even rarer in children.

Why am I Sleeping so Much? – Causes of Hypersomnolence

Some individuals have hypersomnolence due to a genetic predisposition. Certain medications, substance abuse, medical conditions, and other sleep disorders can contribute to these same symptoms. However, in many people there is no known cause for their hypersomnia.

Signs and Symptoms of Hypersomnia

As noted, hypersomnolence is defined primarily by excessive sleepiness. This leads to frequent napping and prolonged sleeps. The excessive sleepiness and excessive time spent sleeping can cause problems in people’s daily life. The compulsion to sleep may override commitments to other obligations. This could affect a person’s life at home and work. It could also affect their relationships.

What are the Common Behaviors/Characteristics?

The most common symptom of hypersomnolence is excessive sleepiness. The most common behaviors are frequent naps and prolonged sleeping. Additional characteristics include difficulty waking from sleep. Individuals with this disorder may awake feeling rather disoriented.

Other symptoms of the disorder can include: increased anxiety, irritation, restlessness, slowed thinking, impaired memory, slower speech, low appetite, and even hallucinations. The symptoms of this disorder can significantly impair functioning at home, work, and other settings.

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

If you experience the symptoms described above, you will need to seek help before your functioning becomes overly impaired. You will want to start by visiting a medical doctor and they may also recommend visiting a mental health provider for additional intervention to improve the symptoms.

Typically, a physical exam will be needed to assess for medical problems that could cause the excessive sleepiness. A doctor may also request a sleep study to further understand what is happening in the brain during sleep. Substance abuse must also be ruled out as a cause of the symptoms. In some cases, a psychological evaluation will be needed to further assess any existing mental health symptoms. This information will be used to make a formal diagnosis. To assign a diagnosis, professionals must use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents the following criteria to define hypersomnolence disorder:

  • Excessive sleepiness for at least one month (in acute conditions) or at least three months (in persistent conditions) as evidenced by either prolonged sleep episodes or daytime sleeping that occurs at least three times per week.
  • Excessive sleepiness causes clinically significant distress or at least impairment in social, occupational, and other important areas of functioning.
  • Excessive sleepiness is not accounted for by insomnia or another sleep disorder (such as narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or parasomnia).
  • Excessive sleepiness is not accounted for by a generally inadequate amount of sleep.
  • This disturbance is not caused by the effects of a substance (medication or drug abuse) or another general medical condition.

The condition of hypersomnolence can occur at the same time as other mental and medical disorders and can be concurrently diagnosed if those other conditions do not fully account for the excessive sleepiness. It is important to discern that the excessive sleepiness is a symptom that is either separate from any other conditions and or is at least significant enough to diagnose it as hypersomnolence.

The symptom of hypersomnia can be caused by physical problems including head trauma, tumor, and other injuries to the nervous system. Medical conditions such as multiple sclerosis, encephalitis, epilepsy, and obesity may also contribute to hypersomnia. Depression and other mental health conditions may also be associated with excessive fatigue. In these causes, hypersomnolence may not be able to be diagnosed. It will be important for a trained professional to fully assess the symptoms and decide.

Hypersomnia and Other Conditions

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

Hypersomnolence Disorder vs Narcolepsy

Narcolepsy is a more familiar sleep disorder. It is similarly characterized by excessive sleepiness. However, narcolepsy also has other symptoms. Individuals who have narcolepsy are not only excessively tired, they also sometimes suddenly and unexpectedly fall asleep. When this occurs, they may experience cataplexy, which is a loss of muscle control. The sleep episodes are sometimes triggered by strong emotions. These individuals may also sometimes experience dream-like hallucinations during the daytime. At night, they may have vivid nightmares.

Related Conditions

Other sleep disorders such as insomnia and sleep apnea can also be associated with excessive sleepiness. In these cases, the fatigue is due to poor sleep. Some other disorders may also include symptoms of excessive fatigue and frequent sleeping. For example, these symptoms are associated with depression. In those cases, the fatigue is a symptom of the broader condition.

Hypersomnia in Adults/Children

Children may exhibit hypersomnia during certain health conditions. However, the distinct disorder of hypersomnolence is relatively rare in children. If you suspect the disorder, consult a pediatrician.

Example Case of Hypersomnia

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

Martha always feels tired. In the evening she goes to bed as soon as she can. She sleeps through the night and struggles to get up in the morning. She often sleeps through her alarm and hits snooze a few times. She drags herself out of bed when she must, to get to work. However, she never feels fully awake. She feels tired all day and tries to work in a few naps when she can. Usually, she skips her lunch break to take a nap. She has fallen asleep a few times during meetings and at her desk. It is starting to affect her success at work.

Hypersomnia

How to Deal/Coping with Hypersomnia

Individuals with hypersomnia and hypersomnolence will likely feel distressed by their symptoms and the repercussions of those symptoms. The condition can affect functioning at school/work and in relationships. Others may also feel frustrated with the symptoms and their effects on the relationship.

Look Out for These Complications/Risk Factors

Some individuals who have hypersomnolence disorder may experience negative repercussions in their daily life. The condition and any negative effects it has could lead to other mental health problems, including suicidality. To avoid these complications, it is important to see out medical and mental health assistance. The appropriate providers can help you reduce the symptoms.

Hypersomnolence Disorder Treatment

Individuals with hypersomnolence disorder will need to seek medical and mental health treatment. Psychotropic medications are frequently prescribed to manage the symptoms. Mental health treatment is also typically recommended. In a therapy setting, behavioral techniques will likely be taught. These can be used to help regulate the sleep schedule to promote daily functioning.

Possible Medications for Hypersomnia

Individuals with hypersomnolence may need medications to reduce their excessive sleepiness. The specific medication prescribed will depend on the individual and their symptoms. Oftentimes, stimulant medications are used. These typically involve dose-controlled amphetamines, which can help to sustain alertness. Sometimes activating antidepressants will be used. Other medications that may be used include clonidine, levodopa, and bromocriptine.

Home Remedies to Help Hypersomnia

As noted, individuals who have hypersomnolence can learn behavioral techniques that will be helpful in regulating their sleep schedule. For example, it is helpful to make a regular schedule with a regular bedtime. This means avoiding work and social activities late at night that might prevent meeting the planned bedtime. Also, avoid caffeine and alcohol that might disrupt sleep. In addition, people with hypersomnia should practice certain routines at bedtime. This includes turning lights down an hour beforehand and doing activities that will promote relaxation and sleep. Morning routines to get one’s energy going will also be helpful to lift the sleepiness.

Living with Hypersomnia

Individuals who have hypersomnia and hypersomnolence disorder may experience some distress about their symptoms and the effect those symptoms have on their life. Medical treatment and psychosocial support through therapy can be helpful to reduce that distress. Taking medications as prescribed and following other recommendations will be helpful.

Insurance Coverage for Hypersomnia

The medical and mental health fields consider hypersomnolence disorder as a serious condition. After a formal diagnosis of this condition, it is likely that health insurance will cover any necessary treatment including therapy. Call your insurance company to ask about your options. Your provider’s office may also be able to assist you with checking into insurance coverage.

How to Find a Therapist

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

What Should I be Looking for in an LMHP?

When seeking out a mental health provider to support you with hypersomnolence disorder, you will want to make sure they are trained and licensed in their field. You will also want to find a provider who is specially trained to work with hypersomnolence disorder.

Questions to ask a Potential Therapist

When meeting with a therapist, ask about their training working with hypersomnolence and other sleep disorders. You may also want to ask about their approach to therapy, how they would plan to address/monitor your symptoms, and the likely duration of treatment.

Hypersomnia Resources and Support Helpline

There are resources online regarding hypersomnia and hypersomnolence disorder that may be helpful:

If you have questions about your own mental health or the mental health of a loved one, consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline. If your hypersomnia symptoms lead to suicidality, consider calling the Suicide Prevention Lifeline for mental health support.

Although the symptoms of hypersomnia/hypersomnolence disorder can be challenging and difficult to manage, it is a diagnosable condition and help is available to alleviate the symptoms. Consider seeking treatment from medical and mental health providers so that you can improve your daily functioning.