Sunday, January 31, 2016

Mental Health Series - PTSD (Post Traumatic Stress Disorder)

Post-Traumatic Stress Disorder (PTSD) 

Recently I went through a PTSD crisis. It occurred because of a trigger that happened several weeks ago. A couple of days after that trigger, another trigger occurred. Then, a couple of days later, another trigger occurred. They weren't monumental triggers like having the same traumatic event happen. They were triggers of telling the event in various ways and talking about it to fill out some disability paperwork. Then the next trigger was a personal lesson during bible study. The third trigger was just a discussion on forgiveness.  Just a simple word and a simple non-related discussion.

However, each event built upon the other causing very serious symptoms in me. I became anxious, increasingly emotional, flashbacks, nightmares, insomnia, loss of desire to be with others, lack of ability to concentrate on activities, and eventually a series of panic attacks that escalated throughout the two weeks I attempted to cope with it on my own, until I ended up in the psychiatric ward of the hospital for intense, immediate and safe treatment. Especially, because I started having suicidal thoughts.

I'm out of the hospital now, but I'm not "cured." I'm not over the PTSD crisis. It's still there. But, I'm better able to cope because of the skills I learned while hospitalized, the addition of a mood stabilizer, and a medication to help me sleep. All of these combined, still do not make the PTSD crisis go away. I still need to work with my psychiatrist and my therapist to develop a treatment plan. Hopefully, this plan will include EMDR therapy. I've had EMDR therapy before, but it was nearly six years ago. Because the of the intensity of the triggers, I believe another session is required. 

When someone is feeling threatened, a “flight or fight” response is triggered that protects them from harm. However, in someone with PTSD, the “flight or fight” response is changed or damaged in some way. Someone with PTSD can feel stressed or frightened even when there is no threat of danger.

How does PTSD develop? 
PTSD usually develops after a terrifying, horrific ordeal that either involved physical harm or the threat of physical harm. Usually the person who develops PTSD may have been the one to be harmed, or the harm could have happened to a loved one, or the person who develops PTSD could have witnessed a harmful event that happened to a loved one or even to strangers. These result in the person developing Fear Memories.

Even though PTSD was first brought to the public’s attention by war veterans, PTSD can result from a variety of traumatic events: assault, muggings, rape, torture, kidnapped, held captive, child abuse (physical/sexual), childhood neglect, sudden death of a loved one, car accidents, train wrecks, plane crashes, terrorist attacks, bombings, or some kind of natural disaster such as flood or earthquake.

The person involved in the event can develop PTSD or other people can be affected who have to pick up the pieces of the tragic event afterwards such as: emergency workers, law enforcement officers, friends, and/ or family.

PTSD development varies from person to person. Symptoms can occur within hours or days of an event, it can sometimes take weeks, months, or even years before the symptoms actually appear.

How are Fear Memories created? 
Scientists are currently working on studying genes that play a role in creating fear memories. Like other mental disorders, it is likely many genes with small effects are at work in PTSD: (Stathmin, GRP, 5-HTTLPR)

What are the causes of PTSD? 
While scientists study the brain and fear and stress to determine the causes of PTSD, environmental factors are also considered: childhood trauma, head injury, or a history or mental illness.

How common is PTSD?
Although it’s been said that any of us can suffer from PTSD given the right circumstances, it’s estimated that approximately 5% of men and 10% of women suffer from PTSD at some point in their lives.

What are the signs or symptoms of PTSD?
PTSD can cause many symptoms. These symptoms are grouped in three categories: 

1. Re-experiencing Symptoms
2. Avoidance and Numbing Symptoms
3. Increased Anxiety and Emotional Arousal Symptoms

What symptoms do the three categories have? 
1. Re-Experiencing the Traumatic Event

  • Intrusive, upsetting memories of the event 
  • Flashbacks, (acting or feeling like the event is happening again) 
  • Nightmares (either of the event or of other frightening things) 
  • Feelings of intense distress when reminded of the event 
  • Intense physical reactions to reminders of the event (such as: pounding heart, rapid breathing, nausea, muscle tension, sweating) 

 2. Avoidance and Numbing

  • Avoiding activities, places, thoughts, or feelings that remind you of the trauma 
  • Inability to remember important aspects of the trauma 
  • Loss of interest in activities and life in general 
  • Feeling detached from others and emotionally numb 
  • Sense of limited future (you don’t expect to live a normal life span, get married, have a career) 

 3. Increased Anxiety and Emotional Arousal

  • Difficulty falling or staying asleep 
  • Irritability or outbursts of anger 
  • Difficulty concentrating 
  • Hyper-vigilance (on constant “red alert”) 
  • Feeling jumpy and easily startled 

 Other common symptoms of PTSD include: anger and irritability, guilt, shame, or self-shame, substance abuse, feelings of mistrust and betrayal, depression and hopelessness, suicidal thoughts and feelings, feeling alienated and alone, and physical aches and pains.

Who is at risk for PTSD?
Although it’s impossible to predict who will develop PTSD in response to any trauma in their life, there are certain risk factors that can increase your vulnerability.

  • Previous traumatic experiences, especially in early life 
  • Family history of PTSD or depression 
  • History of physical or sexual abuse 
  • History of substance abuse 
  • History of depression, anxiety, or another mental illness 
  • High level of stress in every day life 
  • Lack of support after the trauma 
  • Lack of coping skills 

What are the treatments for PTSD? 
Education plays a big part of treating others for Post-Traumatic Stress Disorder (PTSD). It helps to provide information about the illness to help the person manage their symptoms. Psychological and medical help is also given to those with PTSD. When receiving education about PTSD, the person who suffers from PTSD will learn about others, their traumas, and that it is caused by stress rather than weakness in the person involved.

Cognitive Behavioral Therapy is an important part of using therapy to help those with PTSD. This many even be combined with group therapy. It helps people who suffer from PTSD to recognize and adjust their trauma-related thoughts.

Eye-Movement Desensitization and Reprocessing (EMDR), a form of cognitive therapy, has been found to be extremely successful in helping those with PTSD. It works by the person with PTSD talking about the trauma they suffered and the negative feelings they associate with the event, while focusing on a rapidly moving object or a tone while wearing headphones.

Medications are also helpful. They help the various environmental and/or physical symptoms demonstrated by the person with PTSD, such as serotonergic antidepressants. Other medications such as mood stabilizers and antipsychotics have also been found to be helpful.

Those with PTSD who maintain their medical regime are less likely to experience a relapse of their illness if the antidepressant treatment is continued for at least a year.

When should someone who suspects PTSD see a doctor? 
If symptoms occur for more than a month, it may mean the person is suffering from PTSD. It doesn’t necessarily mean you have PTSD if you’ve experienced a traumatic event and suffered some occasional fear and anxiety, lack of concentration, sadness or changes in sleeping or eating habits, or even bouts of crying. However, if the symptoms are severe enough to impede the person’s ability to get back to a normal life he / she should see a medical professional. If the symptoms are so strong that someone in the person’s life such as a friend or family member feel that they may harm themselves, seek medical attention immediately.

I should have let my psychiatrist and therapist know immediately how severely affected I was due to the PTSD triggers. It's possible, the right treatment could have been started immediately, thus, avoiding an Emergency trip to the hospital resulting in hospitalization.

I beg you. If you or someone you know experiences anything like what I've described here in this article, please seek professional help immediately. Don't wait. It only makes the situation worse.

 Image Copyright: unkreatives / 123RF Stock Photo

Monday, January 18, 2016

Mental Health Series - Eating Disorders

Having an Eating Disorder is a serious illness that causes abnormal disruptions to a person’s every day nutrition intake to the detriment of a person’s physical or mental health.  These disruptions could be anything from eating small amounts of food to severely overeating. A person with an Eating Disorder can be concerned about body weight or shape to the point of it causing severe distress. The most common Eating Disorders are: anorexia nervosa, bulimia nervosa, and binge-eating disorder.

In the United States, 20 million women and 10 million men suffer from some type of eating disorder in their lifetime. [1]

Eating disorders can be deadly. Up to 20 percent of people with anorexia die from their disorder, making it the deadliest mental illness there is. [2]

What Causes an Eating Disorder?
According to the National Institute of Mental Health, “Researchers are finding that Eating Disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors.” [3]

Many people with eating disorders also suffer from body dysmorphic disorder, which alters the way people see themself. [4]

Social idealisms of thinness and youthfulness have contributed to eating disorders affecting various people. One study showed that girls with ADHD have a greater chance of getting an eating disorder than those not affected by ADHD. [5]

Types of Eating Disorders

Anorexia Nervosa (AN)
Not maintaining a healthy body weight, an obsessive fear of gaining weight or refusal to do so, and an unrealistic perception, or non-recognition of the seriousness, of current low body weight, characterizes this disorder. Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity, etc. It greatly stresses the heart, increasing the risk of heart attacks and related heart problems. The risk of death is very high in individuals with this disease.

Typical Symptoms of Anorexia Nervosa [6]
·      Extreme thinness (emaciation)
·      A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
·      Intense fear of gaining weight
·      Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
·      Lack of menstruation among girls and women
·      Extremely restricted eating

Severe Symptoms of Anorexia Nervosa [7]
·      Thinning of the bones (osteopenia or osteoporosis)
·      Brittle hair and nails
·      Dry and yellowish skin
·      Growth of fine hair all over the body (lanugo)
·      Mild anemia and muscle wasting and weakness
·      Severe constipation
·      Low blood pressure, slowed breathing and pulse
·      Damage to the structure and function of the heart
·      Brain damage
·      Multi-organ failure
·      Drop on internal body temperature, causing a person to feel cold all the time
·      Lethargy, sluggishness, or feeling tired all the time
·      Infertility

Bulimia Nervosa (BN)
Recurrent or frequent binge eating followed by compensating behaviors such as purging (self-induced vomiting, excessive use of laxatives/diuretics, or excessive exercise) characterizes this disorder. Fasting and / or excessive exercise may also be used as a method of purging following a binge-eating episode.

Typical Symptoms of Bulimia Nervosa [8]
·      Chronically inflamed and sore throat
·      Swollen salivary glands in the neck and jaw area
·      Worn tooth enamel, increasingly sensitive and decaying teeth as a result of exposure to stomach acid
·      Acid reflux disorder and other gastrointestinal problems
·      Intestinal distress and irritation from laxative abuse
·      Severe dehydration from purging of fluids
·      Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack

Binge Eating Disorder (BED)
More common than either Bulimia or Anorexia, Binge eating at least 2-3 times a week without compensating behavior characterizes this disorder. The disorder can develop within people of a wide range of ages and social and economic classes. People with Binge Eating Disorder are often overweight or obese.

Typical Symptoms of Binge Eating Disorder [9]
·      Frequent episodes of consuming very large amount of food but without behaviors to prevent weight gain, such as self-induced vomiting
·      A feeling of being out of control during the binge eating episodes
·      Feelings of strong shame or guilt regarding the binge eating
·      Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior

Consequences of Binge Eating [10]
·      High blood pressure
·      High cholesterol levels
·      Heart disease
·      Type II diabetes mellitus
·      Gallbladder disease

Other Specified Feeding or Eating Disorder (OSFED)
An eating or feeding disorder that does not meet the DSM-5 criteria for AN, BN, or BED characterizes this disorder. Examples of otherwise-specified eating disorders include individuals with atypical anorexia nervosa, who meet all criteria for AN except being underweight, despite substantial weight loss; atypical bulimia nervosa, who meet all criteria for BN except that bulimic behaviors are less frequent or have not been ongoing for long enough; purging disorder; and night eating syndrome.

Treatment Options
The fundamentals of treatment are adequate nutrition, reducing excessive exercise and stopping purging behaviors.

Some forms of psychotherapy or talk therapy and medications have been known to be effective with eating disorders. Usually treatment plans are modified to the person’s needs and may include one or more of the following:[11]

·      Individual, group, and / or family psychotherapy
·      Medical care and monitoring
·      Nutritional counseling
·      Medications

Recovery from an eating disorder is difficult and it takes a lot of time and hard work. It takes professional help, including medical care, psychotherapy, and nutritional counseling, as well as support from friends, family members, and other people with eating disorders. [12]

[1]National Eating Disorders Association www.nation
[2]  Mirror Mirror Eating Disorders
[4]Eating Disorder - Wikipedia
[5]Eating Disorder - Wikipedia

[9]National Eating Disorders Association
[10]National Eating Disorders Association
[12]Mirror Mirror Eating Disorders

Image courtesy of Simple Reminders

Monday, January 11, 2016

Mental Heath Series - Weight Loss / Eating Disorder Issues

Making a change in your life, like losing weight, is not so much about the actual pounds you want to lose, but the change you are making in your life. Your attitude must be positive and you must believe in a positive outcome.

It’s much easier in the long run, to stick to a weight loss program if you have support. That support can come from your family, friends, commercial programs, clinics, behavior modification programs, and social support.

What helps is having the motivation to continue every day with the weight loss goals you’ve set for yourself. Always give yourself a reason why you can accomplish your goals.

It’s been said that no one is perfect. You don’t have to aim to be perfect, either. Just give yourself permission to be a little better today than you were yesterday.

Failure is not an option, and shouldn’t be for you either. One of the easiest ways to lose weight is to start walking. Walk in front of your house. Walk the length of your street. Walk one half a mile. Walk only what you are capable of and then walk a little further. Personally, I lost over 100 pounds just by walking. I started out walking less than one half a mile. I progressed every week, walking a little bit more, and a little bit more, until after a year, I was walking a mile or more. Then by the next year I was walking a few more miles. By the end of the third year I was walking eight miles a day. That’s all I did to change my lifestyle and lose weight.

Someone once said, “Success is not a place that we aspire to, it is a process in which we live by. Often the only ingredient being the ability to not quit.” That’s where you need to dig deep into your soul and know in your heart that this is truly a change you want to make in your life.

Keeping a food journal helps. Writing down everything that you eat, or the calories, or the amounts, whatever you want to track, will help you stay on that road to success.

Keeping a progress journal will also help. Write out your feelings, your successes, your frustrations, your emotions, and get them out of your head and onto paper. Give yourself the opportunity to reveal, in a journal, even if to n o on else, exactly what you’re experiencing as you go through this life change.

Buddy up with another person who wants to make the same changes in their life. It always helps to have someone you can motivate and who can give you the inspiration you need when you’re feeling like you can’t go on.

An Ashanti Proverb goes like this; you must act as if it is impossible to fail. Have faith. Believe with all your heart. Give yourself over to the change and live it, day by day.

In future issues, I'll discuss more about weight loss and eating disorders. Weight loss does not equal healthy eating, nor does being thin. Weight is just a number, diets are not recommended, a lifestyle choice is better. 

If you read previous posts, you'll find out about my struggle with a Binge Eating Disorder and how I've coped.