Mental Health Issues
Written below is some information about a few common mental health problems
What is Depression?
- Famous People
- What is Depression?
If you have depression you’re in good company.
Famous people with clinical depression (Courtesy of Rethink):
- - Drew Barrymore (Charlies Angels and child star of E.T)
- - Irving Berlin (German composer)
- - Ray Charles (Musician,singer)
- - Karen Carpenter (singer 1970’s and 80’s)
- - Eric Clapton
Famous people who have written about their experiences of depression:
Best known for his lively physical comedy and almost rubber like facial expressions, interview that the inspiration for his funniness was "desperation".:
"There are peaks, there are valleys. But they're all kind of carved and smoothed out, and it feels like a low level of despair you live in. Where you're not getting any answers, but you're living OK. And you can smile at the office. You know? But it's a low level of despair." - Jim Carrey, 2004 quoted in 60 Minutes
Sheryl Crowe was quoted by Easy Living magazine:
"It's the sort of depression that doesn't necessarily make you want to kill yourself - you just don't want to be, you want to switch it off and stop."
Following the birth of her child, Emma Thompson went through further depression when three more cycles of in vitro were unsuccessful:
"That was terrible - I blamed myself, and no-one could persuade me that it wasn't my fault - and that led to another depression."
According to the Mental Health Foundation up to 2 in 3 people have depression at some point in their lives. Many people experience two to three separate episodes of depression throughout their lifetimes.
"Black Dog" was Churchill's name for his depression, and as is true with all metaphors, it speaks volumes. The nickname implies both familiarity and an attempt at mastery, because while that dog may sink his fangs into one's person every now and then, he's still, after all, only a dog, and he can be cajoled sometimes and locked up other times.
by Sue Chance, M.D.
What is depression?
Most people feel low or fed up sometimes. Indeed if we did not feel low we would not be able to communicate to other people that we may be in need of help and care. However for some, “feeling blue” lasts longer than a couple of weeks and they describe feelings of being trapped in unhappiness and despair.
There are many symtoms of depression. You need to have experienced a certain number of the following emotional and behavioural signs at a particular level of intensity to receive a diagnosis from a psychiatrist.
- - Feelings of hopeless and sadness
- - A loss of pleasure from previously enjoyed activities
- - Loss of sex drive
- - Poor appetite and significant weight changes (increase or decrease)
- - Changes in sleep pattern (oversleeping or reduced sleep)
- - Fatigue or loss of energy
- - Feelings of self hatred and guilt
- - Loss of concentration and memory problems
- - Irritability, frustration and anger.
- - Aches and pains
- - Recurrents thoughts of death or suicidal thoughts
What does treatment look like?
Cognitive behaviour therapy has been found to be one of the most effective treatments for depression. This powerful approach targets and breaks into the individual’s self defeating patterns of thinking and behaving so that they can reduce the intensity of their problematic emotions and learn to deal with their distress in new ways. For instance, the client is taught to notice how their thinking has become negative and distorted – almost as if they are wearing a pair of dark spectacles all the time and see the world only through tinted lenses.
“Evidence shows that psychological therapies like cognitive behavioural therapy (CBT) are at least as effective as pills and can benefit people with severe mental illness as well as those with mild depression….” - Rethink,2008
First, your problems will be assessed by asking you a few questions about your past experience, focusing on your recent experiences of anxiety. This step is necessary to decide how to best help you. Therapy will be collaborative and active. If you decide to proceed past assessment, you may be expected to keep a regular diary of occurrences of anxiety during the week to be discussed in sessions. Records will help us to understand which situations make you feel anxious and what you think at these times. Being actively involved will ensure that you become even more of an expert on you in anxiety and the skill of self monitoring could be applicable to other emotional problems. As a result, if you experience serious emotional issues at another time in your life, you will not need to have to spend valuable time and money on therapy again!
In line with this active approach the expectation is that you will go away and practice the more adaptive ways of approaching situations. These new ways of coping will be discussed in session and may lead to between session activities. In some situations, these ‘out of session’ activities may involve telephone contact with a therapist if you want help putting the skills into practice.
What is Anxiety?
- Anxiety Problems
- Classification of anxiety problems
If you have anxiety problems you’re in good company!
You may be interested to know that as many as 1 in 20 people have an anxiety disorder at some point in their lives (Mental Health Foundation Statistic, 2005). Approximately one person in ten will visit a doctor to seek help for anxiety problems.
Famous People with Anxiety Problems:
- - Kim Basinger (Actress – 91/2 Weeks and Batman)
- - Earl Campbell (American Footballer)
Anxiety is a normal part of the human condition and we all experience it from time to time. Indeed, it is necessary for us to become anxious when we need to prepare ourselves for action: to run out of the way of a speeding car or perform well in a race. Unfortunately, problems happen when you perceive threat from the environment when there is no actual current danger. There may have been danger present in the past as often happens with post traumatic stress responses, but to all intents and purposes the real threat to well being, life and health is no longer there. It is almost as if your body has a faulty threat detector and you may detect threat more often when you have anxiety problems.
How anxiety affects you physically:
- - Heart pounding
- - Sweating
- - Breathlessness
- - Chest pain
- - Dry mouth
- - Dizziness
- - Faintness
- - Headache
- - Tiredness
- - Loss of appetite
Common anxious thoughts
“I thought I was going to have heart attack”
“I feel as if I can’t breathe and I might choke and die”
“I might throw up”
Anxiety problems are classified into different diagnoses by psychiatrists and psychologists. A few are listed below:
Panic disorder involves individual episodes of panic attacks, which happen severely and suddenly, often for no apparent reason. During a panic attack people experience frightening physical symptoms including a racing heart, difficulty breathing and swallowing, chest pains and sickness. Symptoms can last between minutes. Some people become so frightened that they call an ambulance or present at A&E.
Generalised Anxiety Disorder (GAD)
This is best described as a state of uncontrollable worry. People with this diagnosis often recognise themselves as being “worriers for as long as they can remember”. The symptoms of GAD can come and go but can be described as a constant state of feeling on edge and irritable.
Socially anxious people often avoid situations that involve interpersonal interaction. When in a social interaction or conversation, they believe that others think they are stupid, foolish or socially inadequate and understandably feel worried or embarrassed. As a result, they usually leave the anxiety provoking situation or avoid social interacting altogether!
Agoraphobia is when people fear going out by themselves. Places avoided may include anywhere where there are crowds such as the public transport system or restaurants. Literally translated, the word “agoraphobia” means “fear of the market place”.
Indeed today it still manifests itself in the same way and many people with agoraphobia have difficulties shopping in their local Tesco’s or equivalent superstore!
Obsessive Compulsive Disorder
OCD is diagnosed when a person has distressing recurring thoughts, which are usually come with compulsions and strong urges to perform certain acts. Commonly these obsessions and compulsion involve fear of being contaminated, blaspheming or causing harm to others. The person with OCD could find themselves checking things over and over again, so much so they may find themselves late for appointments and meetings (hopefully not there their therapy meetings)! In all seriousness, these symptoms may cause the sufferer a lot of distress.
Anxiety and Depression
In many circumstances the reality of dealing with anxiety and the avoidant strategies people use to cope can understandably lead to feelings of low self esteem and depression. Depressed people commonly experience; low levels of pleasure, low mood, sleep disturbance, appetite disturbance, poor concentration, tiredness, guilt and a reduced sex drive.
What is the therapy and what will treatment look like?The good new is that there are now several therapies that have been found to be very effective in helping people deal with their anxiety. Therapy allows a high proportion of people to reduce the level and intensity of their anxiety. For others, treatment prevents anxiety interfering with their lives.
Cognitive behaviour therapy can be used to understand the unhelpful patterns that anxious people fall into so that the “vicious cycles” of thought, emotional reaction and behaviour can be changed.
First, your problems will be assessed by asking you a few questions about your past experience and many questions about your recent experiences of anxiety. This step is necessary to decide how to best help you. Therapy will be collaborative and active. If you decide to proceed past assessment, you may be expected to keep a regular diary of your episodes of anxiety to be discussed in sessions. Records will help us to understand which situations make you feel anxious and what you think at these times. That way you will become even more of an expert on you in anxiety and not need to have to spend valuable time and money on therapy again if you experience emotional issues at another time in your life!
In line with this active approach the expectation is that you will go away and practice the more adaptive ways of approaching situations, which will be discussed in session and carry out other ‘out of session’ activities. In some situations, these ‘out of session’ activities may involve telephone contact with a therapist if you want help putting the skills into practice.
- Self-harm and self-destructive behaviour
- Why do people self harm?
What is self-harm and self-destructive behaviour?
Self destructive behaviours are anything a person does to help them to overcome their difficulties feeling that puts them at risk.
- - Cutting
- - Burning
- - Overdosing
- - Scratching
- - Biting
- - Pulling out hair
- - Head banging
- - Sexual risk taking
- - Overspending
- - Substance misuse
- - Vomiting up food (purging)Binge eating
- - Laxative abuse
Why do people self harm
People tend to self harm for a range of different reasons and careful assessment is often needed to decide how the impulsive behaviours 'work' for them. Reasons could include:
• To distract from painful emotions such as shame, anxiety, boredom and sadness.
• To increase emotional experiencing and 'feel real'
• To punish oneself
• To increase a sense of self control
• To communicate distress to others
Although initially, these self destructive behaviours can 'work' in the sense they can do all or some of the above, in the long term they often become destructive; they make people's lives unbearable. For instance, retail 'therapy' may bring some amount of pleasure but excessive spending may lead to large debts, home repossession and even depression. What will therapy look like?
What does treatment look like?
The good news is that therapy can be very effective in helping people reduce or even stop doing impulsive, self destructive acts. In particular, dialectical behaviour therapy, a well established form cognitive therapy, can be used break dysfunctional patterns.
First, your problems will be assessed by asking you a few questions about your past experience and many questions about your recent experiences of anxiety. This step is necessary to decide how to best help you. Therapy will be collaborative and active. If you decide to proceed past assessment, you may be expected to keep a regular diary of your episodes of anxiety to be discussed in sessions. Records will help us to understand which situations cause you distress and what types of emotions, thoughts and urges happen at these times. That way you will become even more of an expert on you in anxiety and not need to have to spend valuable time and money on therapy again if you experience emotional issues at another time in your life!
In line with this active approach there is an expectation that you will learn more adaptive skills and go away and practice better ways of approaching 'trigger' situations. These new strategies will be discussed at appointments and carried out during ‘out of session’ activities. In some situations, these ‘out of session’ activities may involve telephone contact with your therapist if you want help putting the skills into practice in your 'real life'.
Borderline Personality Disorder (BPD)
- What is BPD?
- Making a diagnosis
- Advice & Tips
- Famous people with BPD
- Useful Websites
What is Borderline Personality Disorder?
'I wish I had never been diagnosed with BPD. With another diagnosis yet similar behaviour I was treated so differently. Possibly the most painful part of this illness (I will call it that) is the discrimination. And the only reason for this is the diagnosis, not the way I feel, behave or speak, because that was the same before.'
Almost 1.6 million people have a diagnosis of borderline personality disorder (BPD). However, chances are that you would be hard pressed to find someone you know with these particular set of emotional and behavioural difficulties. However everyone should know more about BPD: Unfortunately, the immense pain and confusion that is characteristic of the diagnosis means that 8-10% of those diagnosed with borderline personality disorder successfully commit suicide.
Borderline personality disorder is arguably one of the most controversial diagnoses classified by the Diagnostic and Statistical Manual (i.e. the booklet that clinicians us to people psychiatric diagnoses). The costs of the consequences of the problems associated with BPD are high to the individual (e.g. broken relationships) families (e.g. deaths of family members), the NHS (e.g. multiple in patient admissions) and society (e.g. illness benefits, child/adult protection and housing) alike.
Personality disorders are diagnosed when it is felt that a person’s personality is causing problems in their everyday lives. This is usually because their temperament and past traumas combine together to make them see the world, themselves and relationships in an extremely rigid and often maladaptive way. This leads them to operate in line with particular set of thoughts, feelings and behaviours that tend to lead to self defeating behavioural patterns.
Borderline personality disorder (BPD) is a particular type of personality disorder, sometimes referred to as ‘emotionally unstable personality disorder’. The characteristic difficulties involve problems understanding and regulating their emotions meaning they usually deal with feelings through acting impulsively in relation to themselves (e.g. self harm and drug/alcohol misuse) and others.
Some people hold the mistaken view a borderline personality disorder is a diagnosis that falls between two diagnostic categories. In fact the ‘borderline’ part of the diagnosis describes the particular tension that individuals with the disorder find themselves in relationship to others.
How would a clinician make a diagnosis?
There is an absence of biological or physical tests for personality disorders; people are given the diagnosis if they describe normally thinking, feeling and behaving in certain ways. People could meet criteria is they experience at least 5 out of 9 symptoms.
Suicidal Behaviour - Past or recent suicide attempts. Suicidal behaviour may also involve threats to commit suicide. The individual may self-harm even when not depressed.
Impulsive Behaviour – Risky behaviour in a least two areas could include drug/alcohol abuse, reckless spending, speeding, binge eating or food restriction, risky sex, shoplifting.
Fear of abandonment – This is a particular real or imagined fear that someone you care about is going to leave you and desperate behaviour to stop them from doing so (e.g. self-harm or barricading exits).
Unstable sense of self – People with an unstable stable identity tend not to know what they want from life and this can lead to multiple changes in direction in terms of jobs, friends, religion and sexuality.
Unstable Relating – Sometimes people with borderline personality disorder may idealise or devalue the same person (i.e. “…one minute I think someone is ‘the best thing since sliced bread’ next minute I think they’re awful”.
Intense and unstable emotions – This may involve strong feelings ranging from irritation and anxiety to sadness and despair, usually lasting for a matter of hours rather than days.
Intense Anger – Commonly described as strong feelings of rage during which people find it difficult to be reasoned with and often perform violent acts towards others or property.
Feelings of emptiness – This has been described as “..feeling like the life has been sucked out”, “needing to do one thing but feeling so empty and restless I do something else or nothing at all”.
Transient Symptoms - Some people describe hearing voices or becoming paranoid in response to stress. Others describe trance-like states (dissociation) in which they loose time or feeling like the world is unreal.
Although is common practice for people to feel they have a particular diagnosis when reading through a list (I must admit I have been known to do unspeakable things with a credit card when let loose in Oxford Street!) people with these particular set of difficulties tend to have most of these difficulties to the extent that they are unable to conduct normal lives and maintain usual roles.
What does treatment look like?
It was not so long ago that borderline personality disorder was regarded as untreatable. For instance, some psychiatrists believed it was impossible to ‘treat’ someone’s personality. Since then, a burgeoning research base has developed, providing evidence that ‘talking therapies’ can help people with BPD to recover. Initially the main body the literature showed support for therapeutic communities, such as the Cassel and the Henderson Hospital.
More recently therapies, which combine aspects of CBT and other psychological approaches, have set themselves apart as powerful tools for enabling change (e.g. DBT and CAT). Mentalisation based therapies, from the psychoanalytic tradition, have also been found to be effective. Psychoanalytic and therapeutic community treatments require clients to talk about their past much more than is expected from CBT influenced models.
Dialectical behaviour therapy (DBT) combines CBT with aspects of Buddhist mindfulness traditions to create a 3rd wave CBT therapy. DBT is the only therapy mentioned in the body of the text in the new NICE Guidelines for Personality Disorder. Using ideas from dialectics, clients are taught to accept their lives and pasts as they are currently whilst paradoxically changing the pain that has been keeping them hostage. It works from the understanding that people with borderline personality disorder have a specific problem with regulating their emotions and their impulsive behaviour represents their attempts to cope with painful emotional states. As a result clients are taught a variety of emotional coping skills, whilst enhancing their motivation to make changes. Clients in the full DBT program are helped to implement coping skills into their everyday contexts by using a '24 hour’ telephone contact service.
It is worth noting that DBT is done most effectively by teams and there are private therapists who work in this model. Although DBT has been found to be most useful to enable suicidal patients stop impulsive behaviours the aim of the treatment is help clients to build a life worth living (Why would people want to live if they have miserable lives)?
Advice for the Families with Someone with a Diagnosis of BDP
It can be extremely difficult living with and caring for someone with BPD. They may have very low self esteem and be reliant on you emotionally (e.g. frequent telephone calls or requests for reassurance), physically (e.g. they may be not be able to go out alone) or even financially (e.g. if they do not have the confidence or ability to maintain work relationships and paid employment). When they feeling emotionally triggered by your behaviour and worry about being controlled or abandoned, you relative may not talk to you or worse attack you or themselves through self harm and suicide. Many families talk about feeling like they are constantly “walking on egg shells” and feel distressed and powerless.
Tips for Coping with a family Member with Borderline Personality Disorder
Try and remember the positive aspects of your relative’s personality. People with BPD are often the dramatic and colourful people of the world. Without wanting to romanticise a difficult situation, it is worth keeping in mind that the frequent intense emotional displays are not necessary only to do with negative emotions: people with BPD can also be intensely passionate and creative.
It may be worth trying to remember times when your relative’s behaviour had not been so bad. It is very rare that a person remains emotionally and behaviourally dysregulated indefinely! However, our minds are often like untrained puppies and rarely stay in the present: we tend to focus on the past and worry about the future. Try and remain in the present (mindfulness) unless there is reason not to be (e.g. learning or planning).
Set boundaries for how you are willing to help you relative and be available to them. For instance say that you are willing to be contacted at certain times and give them contact details of other who can be contacted if they in need of help (e.g Samaritans). You cannot be of help if you are burnt out and that way you will by modelling to them that you have limits and you can asset your needs. They often need to learn to say no and tolerate being said no to! At the very least, it is unrealistic to expect someone to be available at all times. A contact sheet may form part of a larger crisis document that lays out they different things they can do to cope with emotions if they feel desperate (see below).
Practical self care tips that could help you look after yourself so that you are in a better position to help your relative;
1. breathing and relaxation techniques to help you relax or taking up yoga
2. Accepting that you may need help if you find yourself not coping (e.g. therapy or medication)
3. Find and say the ‘Serenity Prayer’ (do a web search)
4. Negotiating time for yourself to do things you want to do rather than have to do (this may involve good time management and assertiveness skill).
Other skills could help regulate your own emotions in a crisis before you solve the problem more permanently; 1) self soothing through your senses (e.g. have a bath, aromatherapy) 2) going for a walk or counting to ten if you are upset 3) giving yourself encouragements (e.g. “This may be difficult but I can cope with this”). Useful self affirmations to say in a moment of distress can be found in the self help literature.
If you can, perhaps try and find some meaning in your difficult experiences. For instance, if I experience difficulties I can often “Make lemonades out of lemons” by telling myself that the experience may help me one day know what my clients have gone through.
Join a self help group for families
If your relative is subject to the Care Programme Approach you may be able to request that the care coordinator does a Carer’s Assessment to ascertain and cater for your needs.
Unfortunately celebrities with a diagnosis of BPD tend not to ‘shout it from mountain tops’. This may be because up until quite recently, little was known about how to treat the symptoms of BPD and people with the label were often excluded from mental health services as they were believed not to have treatable problem. Furthermore, the stigma associated with diagnosis often leads to patterns of exclusion, which perpetuate the individual’s problems even further.
For instance, when services do not feel equipped to deal with BPD they send service users elsewhere. This not only taps into their pre-existing sensitivities to rejection making them emotionally distressed but it could force them into lifestyles which make them more vulnerable to further emotional problems e.g. living on the streets, prostitution or crime.
As a result, efforts needs to go into implementing the policies and directives set out in the recent documents (e.g. ‘Personality Disorder,: No Longer a Diagnosis of Exclusion’). This paper proposed the need to organisations working with people with personality disorders to change their attitudes towards mental disorder through training which increases the knowledge, understanding and skills set of workforces.
Feel free to peruse the ‘Training’ page on this website for the training services available in Change By Therapy.