Disorders in adulthood
The wide mental functioning creates a multitude of dynamics that generate specific functions and different personality profiles.
Despite the fact that there are categories, within which a problem can be relayed, the analysis and management of a psychological problem goes beyond all this. We could see the diagnosis as the summary of the problem and the symptomatology developed by the person and psychotherapy as the glue of all these parts, thanks to which a specific symphony can be created.
Let’s see from the side some of the problems dealt with daily in my psychotherapy journeys.
Within mood disorders the patient experiences an important change in mood tone. There are clear and specific criteria for talking about mood disorders. Among them we identify, over time, that it interferes with the person’s normal social and work functions. Pharmacological treatment may or may not be provided, when of one of the different mood disorders is present. It will be the care of the specialist at the beginning of the therapeutic plan, the focus on a treatment that includes the pharmacological aspect.
Bipolar disorder is identified by the alternation of opposing moods (depression and mania) over the course of time and the individual’s life.
Specific diagnoses of bipolar disorder are identified which are: type I bipolar disorder, type II bipolar disorder, cyclothymia and substance-induced bipolar disorder.
- At least one manic episode is sufficient for the diagnosis of type I bipolar disorder.
- The DSM-5 defines at least one episode of major depression (recent or past) and at least one hypomaniac episode (recent or past) for type II bipolar disorder. The duration of the major depressive disorder must be at least two weeks and the hypomaniac episode at least 4 days. The presence of only one manic episode directs the diagnosis towards type I;
- Cyclotimic disorder is characterized by frequent changes in mood tone (for at least two years) that do not reach the intensity of the symptoms of bipolar disorder II. The criteria for the depressive, manic or hypomaniac episode must not be met.
Anxiety can be detected in a state of psychic agitation and insecurity, not necessarily linked to a specific object. Prolonged periods of anxiety inevitably lead the body to discharge itself, as if it were consuming more than expected. In this picture can arise a picture with depressive symptoms, greater self-closure and related devaluation of oneself.
We can identify different sub-categories of anxiety.
Generalized anxiety: permanent state of anxiety and excessive worries, lasting at least six months. The experience is of enormous anxiety and has consequences on daily life going to touch all areas. Tiredness, muscle tension, pain, headache and / or bellyache, agitation, sleep disturbances, difficulty concentrating, bad mood are the main symptoms that are detected in it.
Panic attacks: a sudden fear emerges, and feelings of death and imminent catastrophes are triggered. Although the duration varies from person to person, the panic attack has a peak and then declines. In some cases, the peak may last longer, leaving a feeling of real exhaustion at its end.
The panic attack can generate fear of the panic attack itself, leading the person to an anxiety circle.
Phobias: it is an irrational, intense and specific fear of a particular object or situation. Fear can affect closed places, crowds, animals, objects, food.
Social phobia, also called social anxiety, can be identified as a disorder, characterized by very intense fear, that affects one or more well-defined social situations.
People suffering from social phobia experience intense emotional reactions related to specific social contexts. One element that emerges significantly is the constant fear of being judged negatively.
We focus on the prototype of the anxiety-inducing situation when speaking in public.
We define phobia as a marked and disproportionate fear of a specific element. It is read as irrational when compared to common fears.
There is a constant with respect to the symptoms that emerge from the phobia. The phobic stimuli vary from person to person.
We see a subdivision of phobias based on the phobic stimulus:
- Animal (e.g. spiders, insects, dogs).
- Natural environment (e.g. heights, storms, water);
- Blood-injections-wounds (e.g., needles, invasive medical procedures);
- Situational (e.g. airplanes, elevators, enclosed spaces);
- Other different stimuli not related any categories described above.
Obsessive Compulsive Disorder (DOC)
As the term indicates, we identify in this disorder the presence of obsessions and compulsions or just obsessions, such that the investment during the day interferes significantly with daily activities.
When we speak of obsessions, we mean ideas, thoughts, impulses or images that suddenly arise in the mind. When we talk about compulsions, we are referring to “mental and/or behavioral” actions, which are generated in response to obsessions. The reason for their existence is related to an attempt to resolve obsessive thoughts. This is in fact achieved, but only temporarily.
Obsessive compulsive disorder becomes truly disabling when it occurs with high intensity. The mind is perceived out of its own control, and in fact it becomes fundamental to work on this aspect in psychotherapy: the illusory control one has over mental processes.
The person perceives their mind as something foreign, which works in a totally new way. The difficulty to share certain thoughts may emerge, because you are ashamed of them, you are afraid that they will increase and the problem may become even bigger, you are afraid to feel, that that thought is really a wrong thought and an (you may be judged by…?)opinion may come from a non-positive professional.
This involves repeatedly pulling or tearing hair, eyebrows, and/or eyelids, whereas also all body hair can be pulled.
Some people perform this activity automatically while others are fully aware of it. The feeling of tension or anxiety, that is generated in these people, is relieved by pulling their hair, to which a feeling of fulfillment follows.
This disorder consists of the behavior of compulsively stealing without the personal need to do so. The cause of stealing is therefore not a lack of moral awareness, but a mental disorder.
Let’s look at the clinical features of cleptomania and define the criteria identified in the DSM-V:
A. Recurrent inability to resist the impulses to steal objects that are not necessary for personal use or economic value;
B. Increase in voltage immediately before committing the act;
C. Pleasure, gratification or relief in committing the act;
D. Stealing is not committed as an expression of anger or revenge and is not in response to hallucinations;
E. Stealing is not better explained by Conduct Disorder, Manic episode or Antisocial Personality Disorder.
Anorexia Nervosa is identified as an Eating Disorder and is characterized, according to the criteria of the DSM-V, by the following criteria:
- Restriction of the energy supply relative to the need, which induces a significant low weight relative to age, gender, developmental development and physical health. Significant low weight is defined as lower than the normal minimum or, for children and adolescents, lower than the expected minimum;
- Intense fear of gaining weight or gaining weight, or persistent behavior that interferes with weight gain, despite significantly low weight.;
- Anomaly in the way the weight and shape of one’s body is perceived; inappropriate influence of weight and body shape on one’s self-esteem, or persistent loss of the ability to assess the severity of current weight loss.
There are two subtypes:
- With Restrictions during the last three months;
- With Binge/Delete Pipes during the last three months.
Bulimia nervosa is an eating disorder characterized by binge eating, elimination behavior and concern about weight and body shape. It is characterized by the ingestion of excessive amounts of food in a fair amount of time with loss of control (binges) followed by attempts to avoid weight gain by eliminating what has been ingested (compensatory behaviour) and excessive concern about weight and body shape.
This disorder first appeared in the DSM-III-R in 1987. In the latest version “DSM-V” some criteria have been updated.
Anorexia is characterised by a weight below the norm. We note instead that in bulimia nervosa patients can be underweight, normal-weight and overweight.
We can also call this binge eating disorder “uncontrolled eating disorder”. As indicated in DSM-V there are recurring binge eating episodes, which must occur at least once a week for 3 months.
The severity of this disorder is evaluated according to the frequency of binge eating episodes:
- mild if there are 1-3 binge episodes per week;
- moderate if there are 4 to 7 episodes of binge eating per week;
- serious if there are 8 to 13 episodes of binge eating per week;
- extreme if there are 14 or more episodes of binge eating per week.
The merging of hereditary components with environmental aspects will start from childhood until early adulthood to what will be the personality of a person. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) has identified 10 personality disorders organized in 3 clusters (sets), based on distorted thinking, problematic emotional responses, excessive or reduced impulse regulation, interpersonal difficulties.
1. The personality disorders of Cluster A are:
- Paranoid Personality Disorder;
- Schizoid Personality Disorder;
- Schizotypical Personality Disorder.
Significant discomfort emerges in these disorders in the social sphere, social withdrawal and distorted thinking.
2. The personality disorders of Cluster B are:
- Borderline Personality Disorder;
- Narcissistic Personality Disorder;
- Histrionic Personality Disorder;
- Antisocial Personality Disorder.
In this group of disorders, impulse control and emotional regulation emerge as the main difficulty.
3. The personality disorders of Cluster C are:
- Avoiding Personality Disorder;
- Personality Disorder;
- Obsessive-Compulsive Personality Disorder.
The psychological elements that distinguish these personality disorders can be found in high levels of anxiety, social inhibition, feelings of inadequacy and hypersensitivity to negative evaluations.
Addiction has now become more limited not to one substance but to multiple substances, or associated with behavioral forms of addiction such as gambling, pathological online gambling, food addiction.
DSM 5 sets the following conditions for the diagnosis of a Substance Use Disorder:
3. Interruption or reduction of social, work or recreational activities;
4. Unsuccessful attempts to reduce and control use;
5. Time expenditure;
6. Loss of control over use;
7. Continued use despite the knowledge that drugs are a problem;
8. Recurring use with inability to perform its duties;
9. Use in at-risk situations;
10. Recurring use nevertheless leads to social or interpersonal problems;
A Sexual Dysfunction is characterized by an anomaly in the process that underlies the cycle of sexual response, or by pain associated with sexual intercourse. The normal sexual response cycle can be divided into the following phases:
1. Desire. fantasies about sexual activity and the desire to engage in sexual activity;
2. Excitement. subjective sensation of sexual pleasure and concomitant physiological changes;
3. Orgasm. This phase consists of a peak of sexual pleasure, with relaxation of sexual tension and rhythmic contractions of the perineal muscles and reproductive organs;
4. Resolution. This phase consists of a feeling of muscle relaxation and general well-being.
Each of these phases can generate problems in both men and women.
It is certainly not a diagnosed disorder, but it is certainly an issue well present within different psychotherapeutic pathways.
We can focus on self-esteem as the mainstay of a person, based on that we will build different areas of life.
Like every adult, even for a child or teenager there is a need to talk, to confront, to understand, to ask questions, to have a personalized space where to express oneself.
It is fundamental to have this approach by giving this possibility to a child/young adult. Many adults report what the benefits would have been if only “back then” in their developmental age or as children they would have had the opportunity to go to a psychotherapist.
Obsessive Compulsive Disorder (OCD)
The frequency of “obsessive compulsive disorder (OCD)” appears most frequently between 6 and 15 years of age in males and between 20 and 29 years of age in females. Similarly as in adulthood, this disorder shows recurrent thoughts and/or repetitive behavior. The consequence of this operation generates a significant level of stress.
Obsessions are thoughts, persistent images, ideas, impulses (e.g. aggressive or sexual), perceived as intrusive.
Compulsions are repetitive behaviors or mental acts carried out to avoid that thought experienced as threatening.
Specific Learning Disorders
With Specific Learning Disorders, we see a dysfunctional interest in basic learning processes and a consequent impairment of school success and the overall experience in learning places. The difficulties that emerge therefore concern one (or more) of the functions of reading, writing and calculating. It is very important to highlight, that even for those who enter this clinical field for the first time, that there are no physical or mental characteristics below the norm. The person’s intelligence is therefore average.
Such impairments can occur with different degrees of severity:
Provocative Oppositional Disorder (PDO)
The diagnosis of Provocative Oppositional Disorder (PDO) is made to children who exhibit persistent and evolutionary inappropriate levels of anger, irritability, provocative behavior and opposition.
These highly dysfunctional behaviors cascade problems in adaptation and social function.
Symptoms of Provocative Oppositional Disorder
A. A mode of negativistic, hostile and provocative behaviour that has lasted for at least 6 months, during which 4 (or more) of the following criteria have been present:
1.a) often going into a rage;
2.a) often quarrelling with adults;
3.a) often actively challenging or refusing to comply with adult demands or rules;
4.a) often deliberately irritating people; often blaming others for their mistakes or bad behavior;
5.a) often being susceptible or easily irritated by others;
6.a) often being angry and resentful;
7 .a) often being spiteful and vindictive.
B. Abnormal behavior causes clinically significant impairment of social, school or work functioning.
C. Behaviors do not occur exclusively during the course of a Psychotic Disorder or Mood Disorder.
D. The criteria for Conduct Disorder are not met and, if the subject is 18 years of age or older, the criteria for Antisocial Personality Disorder are not met.
It is very important to say that school phobia does not mean unjustified absence from school.
The level of anxiety and fear of going to and staying at school is such, that regular school attendance is compromised.
The consequences of this disorder affect emotional and social development, school acquisitions, difficulties in relationships with the family.
A dysfunctional pattern of attachment appears in attachment disorder and can have different manifestations.
There are important repercussions of this disorder in adulthood. For this reason, it is essential to be able to identify this disorder as soon as possible, so that future repercussions can be preserved.