Stanbro Healthcare Group’s child, adolescent and adult psychiatric care covers a wide range of services, allowing patient care to be administered in a comprehensive manner and tailored to each individual patient's needs. Avenues of treatment include: Medication Evaluation & Management.

Anxiety FAQ

Some of the more well-known anxiety disorders include Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD).

Frequently Asked Questions about Anxiety

  • Generalized Anxiety Disorder (GAD)
  • Obsessive-Compulsive Disorder (OCD)
  • Panic Disorder
  • Post-Traumatic Stress Disorder (PTSD)
  • Social Phobia or Social Anxiety Disorder

Generalized Anxiety Disorder (GAD) is an exaggerated anxiety and tension that persists for months on end and affects approximately 6.8 million Americans or about 3.1 percent of the population. GAD causes people to anticipate catastrophe and worry excessively about many things, from overarching concerns such as health, money or work to more routine concerns such as car repairs or appointments. GAD affects twice as many women as men, and the anxiety becomes so severe, normal life and relationships become impaired. Worries can be accompanied by physical symptoms, such as fatigue, headaches, muscle tension and aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. The disorder usually develops gradually and may begin anytime during life, although the risk is highest between childhood and middle age. It is diagnosed when someone spends at least six months worrying excessively without a specific focus of the fear and an inability to control the anxiety.

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder marked by fearful ideas and ritualistic behaviors. Obsessions are repetitive thoughts or impulses, such as a fear of getting infected from someone else’s germs or hurting a loved one. These obsessions create excessive anxiety and stress for the person affected. Although the thoughts are intrusive and unwanted, the person with OCD cannot stop them. Compulsions are repetitive behaviors people with OCD feel compelled to perform in an attempt to control or decrease the anxiety created by the obsessions. This can include things like constantly checking that an oven is off to prevent a fire, or frequent cleaning or hand-washing to avoid contamination.

Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom or a fear of losing control. Panic attacks can occur at any time, even during sleep.

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. After traumatic events, such as death, an earthquake, war, car accidents, floods, fire, it is not uncommon for people to experience feelings of heightened fear, worry, sadness or anger. If the emotions persist, however, or become severe, or the person gets triggered into reliving the event in their daily life, this can affect the person’s ability to function and may be a sign of PTSD.

Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others. In its most severe form, social phobia may be so broad that a person experiences symptoms almost anytime they are around other people.

Primary care physicians and psychiatrists diagnose someone as having an anxiety disorder if symptoms occur for six months on more days than not, and significantly interfere with the person’s ability to function at home, work or school.

Doctors perform physical and psychological evaluations to rule out other causes for the symptoms of anxiety. Cardiovascular disease, thyroid problems, menopause, substance abuse and/or drug side effects, such as from steroids, may cause symptoms similar to those of an anxiety disorder.

Stress is a normal physical response to events that make one feel threatened or that upset one’s balance in some way. When the body senses danger – real or imagined – the body’s defenses kick into high gear in a rapid, automatic process known as the ‘fight-or-flight’ reaction, or the stress response. The nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol, that rouse the body for emergency action.

Stress during development has often been regarded as a potentially disruptive force, capable of inducing disease states if overly prolonged or exceedingly intense. It can also, however, favor resiliency and adaptive processing that are crucial to navigating a human life. Countless studies have indicated that severe neglect during infancy, both in humans and in laboratory animals, results in long-term abnormal development of biological systems involved in the regulation of emotions, but the response to stress is also a key driver to individual development. The biological system responsible for physical reactions to a stressor not only coordinates immediate responses to external challenges but also functions as a tool that enables the characterization of an environment as favorable or threatening. Thus the stress response system promotes long-term adaptive processes that prepare the individual to cope with specific external challenges.

  • Cognitive symptoms include memory problems; inability to concentrate; poor judgement; anxious or racing thoughts and constant worrying.
  • Emotional symptoms include moodiness; irritability or short temper; agitation; inability to relax, a feeling of overwhelm; a sense of loneliness and isolation.
  • Physical symptoms include aches and pains; diarrhea or constipation; nausea; dizziness; chest pain; rapid heartbeat.
  • Behavioral symptoms include eating more or less; sleeping too much or too little, isolating yourself from others; procrastinating or neglecting responsibilities; using alcohol, cigarettes, or drugs to relax; engaging in nervous habits (e.g., nail biting, pacing).

Youth of all ages, but especially younger children, may find it difficult to recognize and verbalize when they are experiencing stress. For children, stress can manifest itself through changes in behavior. Common changes can include irritability, withdrawal from formerly pleasurable activities, routine expression of worries, excessive complaints about school, frequent crying, display of surprising fearful reactions, separation anxiety, sleeping too much or too little, or eating too much or too little. With teens, while spending more time with and confiding in peers is a normal part of growing up, significantly avoiding parents, abandoning long-time friendships for a new set of peers, or expressing excessive hostility toward family members may indicate that the teen is experiencing significant stress.

In the physical sciences, materials and objects are termed resilient if they resume their original shape upon being bent or stretched. In people, resilience refers to the ability to ‘bounce back’ after encountering difficulty.

Long term studies of trauma survivors have identified ten common practices in people who have shown resilience in the face of extreme stress:

  • Maintaining an optimistic but realistic outlook
  • Facing fear (ability to confront one’s fears)
  • Reliance upon own inner, moral compass
  • Turning to religious or spiritual practices
  • Seeking and accepting social support
  • Imitation of sturdy role models
  • Staying physically fit
  • Staying mentally sharp
  • Cognitive and emotional flexibility (finding a way to accept that which cannot be changed)
  • Looking for meaning and opportunity in the midst of adversity

Attention Deficit Hyperactivity Disorder (ADHD) FAQ

Frequently Asked Questions about Attention-Deficit Hyperactivity Disorder (ADHD)

Attention, deficit hyperactivity disorder (ADHD) is a neurobehavioral condition that interferes with a person’s ability to pay attention and exercise age-appropriate inhibition. A person with ADHD is so inattentive or impulsively hyperactive, or both, that daily functioning at home, school and work is compromised. ADHD usually becomes apparent in children during preschool and early school years.

ADHD affects 3 to 5 percent of all American children. While typically diagnosed in children, adults can also have the condition. Adults with ADHD may be unaware they have the disorder, yet know they have difficulty getting organized and staying focused. Everyday tasks such as waking up, getting dressed, day’s work, getting to work on time or being productive on the job can be major challenges for the ADHD adult.

ADHD’s principal characteristics are inattention, hyperactivity and impulsivity. Children may exhibit one or all of these three behavioral subtypes of ADHD:

  • Predominantly hyperactive-impulsive type (without significant inattention)
  • Predominantly inattentive type (without significant hyperactive-impulsive behavior) sometimes called ADD – an outdated term formerly used for the entire disorder
  • Combined type (that displays both inattentive and hyperactive-impulse symptom)

ADHD symptoms appear over many months, often with impulsiveness and hyperactivity preceding those of attention. Different symptoms may appear in different settings, depending on the demands the situation poses for the child’s self-control.

Additional symptoms of ADHD may include:

  • Difficulty organizing tasks and activities
  • Avoids activities requiring sustained mental effort
  • Loses needed items
  • Forgetful of daily activities
  • Restlessness, often fidgeting with hands or feet, or squirming while seated
  • Running, climbing or leaving a seat in situations where sitting or quiet behavior is expected
  • Blurting out answers before hearing the whole question
  • Difficulty waiting in line or taking turns
  • Ignores details; makes careless mistakes
  • Has trouble sustaining attention in work or play
  • Does not seem to listen when directly addressed
  • Does not follow through on instructions; fails to finish
  • Demonstrates symptoms of both inattention and hyperactivity-impulsivity (six or more symptoms of both)
  • Has symptoms that have persisted for at least six months

Because symptoms may vary across settings, ADHD can be difficult to diagnose. A diagnosis of ADHD is based on the number, persistence and history of symptomatic behaviors, and the degree to which they impede a child’s performance in more than one setting. Parents or teachers may be the first to notice possible signs of ADHD. Diagnosis of adult ADHD is based on symptoms, impairment and history. Adults with ADHD might experience symptoms such as lack of focus, disorganization, restlessness, difficulty finishing projects and/or losing things. They may also have difficulties at work, at home or with personal relationships. Also, adults diagnosed with ADHD must have had symptoms prior to age 7 that continued for at least six months.

Diagnosis should always be made by a professional with training in ADHD or mental disorders.

Physical examinations are given to exclude such things as undetected seizures, temporal lobe seizures and middle ear infections; psychological tests can rule out conditions such as specific learning disabilities, anxiety or affective disorders. Ideally, reviews are made of school records, which include evaluations by teachers and others about a child’s behavior based on rating scales. Parents and others who know the child well may be interviewed. Intelligence and learning tests may be administered. The specialist uses all this information to make a diagnosis of ADHD.

ADHD is a neurological disorder and research indicates that it may be due to alterations in the brain and the way it functions. The cause is not entirely known but family and twin studies reveal ADHD is genetic. Between 10 and 35 percent of children with ADHD have a close relative with ADHD, and nearly half of parents who had ADHD as a child also have a child with the disorder. Studies in families of children with ADHD show that relatives are at high risk for ADHD, other psychiatric disorders and learning disabilities.

There is no cure for ADHD and no single treatment for every child. Although ADHD is very treatable, children with the disorder seldom outgrow it. They usually develop adaptive measures to compensate for their condition. Current ADHD treatments focus on symptom management with medications and behavioral modification or with cognitive behavioral therapy.

Autism FAQ

Autism, more commonly referred to as Autism Spectrum Disorder (ASD) by clinicians and families, is a biological condition that limits a child’s ability to develop social relationships and communicate. As a result, children often have significant problems in learning and experience may behavioral difficulties. The condition is usually life-long, although overall outcome is improving.

Frequently asked questions about Autism

Autism Spectrum Disorders /autism ASDs represent a range of brain disorders that are characterized by restricted patterns of behavior and impairments in social communication and interactions. These disorders share common origins and features, but are classified as spectrum disorders because symptoms and severity vary among individuals.

Symptoms/behaviors of ASDs can range from mild to severe, and may seem to appear gradually or suddenly. Atypical development may be observed from birth, or more commonly, become noticeable during the 12-to-36-month period. Symptoms include:

  • Social Deficits – Children with autism have difficulty in social interactions. They may avoid eye contact and interactions with people and resist or passively accept attention. They are often unable to read social cues or exhibit emotional reciprocity. Thus, they are unable to predict or understand other peoples’ behavior. They may also have difficulty controlling emotion, may be disruptive or aggressive at times, or may lose control, especially when frustrated or presented with a new situation or environment. Head-banging, hair-pulling and arm-biting may occur.
  • Communication Difficulties – Communication skills are affected in children with autism, but difficulties vary. Some children may have good basic language skills, but exhibit difficulty initiating or sustaining conversations, such as not giving others the opportunity to respond. Others may experience delays or regression in language development; still others remain mute or may use language in unusual ways, such as repeating a phrase, or parroting what they hear (echolalia). Body language is also often hard to read in children with autism. Facial expressions, tone of voice and gestures often do not match verbal content and emotions. They have difficulty expressing what they want or need. They may also appear deaf, not responding to their names or attempts at conversation.
  • Repetitive Behaviors – Patterns of behavior, interests and activities may be restricted, repetitive or stereotyped. For example, a child may spend long periods of time arranging specific toys in a particular manner, rather than playing with the toys. Intense preoccupation with certain topics, such as obsessively studying maps, may also be seen. Odd repetitive motions, either extreme or subtle, such as arm-flapping, freezing, rocking back and forth or walking on their toes may also occur. Often, people with autism demand consistency in their environment. A minor change in routine may be tremendously upsetting.
  • Sensory Difficulties – In children with autism, the brain seems unable to balance the senses appropriately. Many autistic children are highly attuned or even painfully sensitive to certain sounds, textures, tastes or smells. Some seem oblivious to cold or pain, but react hysterically to things that wouldn’t bother other children. In some people, the senses are even scrambled. For example, touching a certain texture may induce a gagging response.
  • Unusual Abilities – In rare cases, some children with ASDs display remarkable abilities, such as drawing detailed, realistic pictures at a young age or playing an instrument without training. Some can memorize difficult lists of items, such as statistics or names (this is called islets of intelligence or savant skills).

Autistic Disorder, commonly referred to as autism, is the most prevalent ASD and severely impairs a child’s social interaction and communication abilities.

Asperger’s Syndrome (AD) is a neurodevelopmental disorder affecting the ability to effectively socialize and communicate. Those with AD are considered to be on the “high functioning” end of the Autism Spectrum Disorder (ASD). Affected children and adults have difficulty with social interactions and exhibit a restricted range of interests and/or repetitive behaviors. Motor development may be delayed, leading to clumsiness or uncoordinated motor movements. Compared to those affected by other forms of ASD, however, those with Asperger’s Syndrome do not have significant delays or difficulties in language or cognitive development. Some even demonstrate precocious vocabulary – often in a highly specialized field of interest.

The following behaviors are often associated with Asperger’s Syndrome. However, they are seldom all present in any one individual and vary widely in degree:

  • Limited or inappropriate social interactions
  • “Robotic” or repetitive speech
  • Challenges with nonverbal communication (gestures, facial expression, etc.) coupled with average to above average verbal skills
  • Tendency to discuss self rather than others
  • Inability to understand social/emotional issues or nonliteral phrases
  • Lack of eye contact or reciprocal conversation
  • Obsession with specific, often unusual topics
  • One-sided conversations
  • Awkward movements and/or mannerisms

Asperger’s Syndrome often remains undiagnosed until a child or adult begins to have serious difficulties in school, the workplace or their personal lives. Indeed, many adults with the condition receive their diagnosis when seeking help for related issues such as anxiety or depression. Diagnosis tend to center primarily on difficulties with social interactions.

Children with Asperger’s Syndrome tend to show typical or even exceptional language development. However, many tend to use their language skills inappropriately or awkwardly in conversations or social situations such as interacting with their peers. Often, the symptoms of Asperger’s Syndrome are confused with those of other behavioral issues such as Attention Deficit and Hyperactivity Disorder (ADHD). Indeed many persons affected by Asperger’s Syndrome are initially diagnosed with ADHD until it becomes clear that their difficulties stem more from an inability to socialize than an inability to focus their attention. For instance, someone with Asperger’s Syndrome might initiate conversations with others by extensively relating facts related to a particular topic of interest. He or she may resist discussing anything else and have difficulty allowing others to speak. Often, they do not notice that others are no longer listening or are uncomfortable with the topic. They may lack the ability to “see things” from the other person’s perspective.

Another common symptom is an inability to understand the intent behind another person’s actions, words and behaviors. Children and adults affected by Asperger’s Syndrome may miss humor and other implications. Similarly, they may not instinctually respond to such “universal” nonverbal cues such as a smile, frown or “come here” motion.

For these reasons, social interactions can seem confusing and overwhelming to individuals with Asperger’s Syndrome. Difficulties in seeing things from another person’s perspective can make it extremely difficult to predict or understand the actions of others. They may not pick up on what is or is not appropriate in a particular situation. For instance, someone with Asperger’s Syndrome might speak too loudly when entering a church service or a room with a sleeping baby and not understand when “shushed.”

Some individuals with Asperger’s Syndrome have a peculiar manner of speaking. This can involve speaking overly loud, in a monotone or with an unusual intonation. It is also common, but not universal, for people with Asperger’s Syndrome to have difficulty controlling their emotions. They may cry or laugh easily or at inappropriate times.

Another common, but not universal, sign is an awkwardness or delay in motor skills. As children, in particular, they may have difficulties on the playground because they cannot catch a ball or understand how to swing on the monkey bars despite their peers’ repeated attempts to teach them.

Not all people with Asperger’s Syndrome display all of these behaviors. Additionally, each of these symptoms tends to vary widely among affected individuals. It is very important to note that the challenges presented by Asperger’s Syndrome are very often accompanied by unique gifts. Indeed, a remarkable ability for intense focus is a common trait.

Rett Syndrome is a genetic disorder almost exclusively found in females. After early normal development, autistic symptoms begin to develop between 6 and 18 months, which typically include shunning social contact, talking cessation, unique motor behaviors, and a regression In skills. A single gene mutation has been identified as a cause of Rett Syndrome, a finding that may enable researchers to develop improved diagnostic, earlier interventions and better treatments for the condition.

ASDs are usually evident by the age of three, though diagnosis may be made as early as 12 to 18 months, and as late as four to six years (or later). According to the Center for Disease Control (CDC), about one in 88 children have an autism spectrum disorder. ASDs are three to four times more common in boys than in girls. However, girls with these disorders tend to have more severe symptoms and lower intelligence. Some children will need ongoing supervision, while others, with the right support, may pursue higher education and fulfilling jobs. These disorders affect people of all racial, ethnic and socioeconomic groups.

To date no biological diagnostic tests exist that detect autism. But scientists are hopeful that advanced imaging techniques and differences in blood levels of proteins in autistic versus normal children may have implications for diagnosis. Already, improved diagnostic procedures have allowed clinicians to diagnose children at a younger age.

Formal diagnosis involves parental input and structured and systematic screening instruments, such as the Modified Checklist for Autism in Toddlers (M-CHAT) and the Autistic Behavioral Checklist (ABC) for older children. The Childhood Autism Rating Scale (CARS) and the Autism Diagnostic Inventory-Revised (ADI-R) are used, as well. These tools measure the prevalence of symptoms. Symptoms may present from birth, or may occur after months of normal development. However, no two children with these disorders behave the same way. Children as young as 18 months may be diagnosed, but have different clinical features than an older child with autism.

Between 18 months and 36 months, symptoms may include:

  • Limited pretend play
  • Lack of pointing to demonstrate interest
  • Reduced gaze following
  • Less frequent demonstration of repetitive, stereotypic behaviors

In children with autism between 2 and 3 years of age, the following features may be observed:

  • Communication difficulties
  • Socialization deficits with caregivers
  • Perceptual sensitivity
  • Other difficult behaviors

Some combination of genetic, biological and environmental factors is believed to cause ASDs. Researchers are exploring several genes which are believed to contribute to the development of these disorders as well as several brain regions that have been linked to the disorders. Abnormal brain development during the first months of life is being studied to determine if structural abnormalities, such as in the mirror neuron systems, may be caused by genetic and/or environmental factors. Researchers are also exploring the effects of genetic imprinting in which a gene’s expression is determined by which parent donates the gene copy. Certain neurotransmitters, such as serotonin, dopamine, and epinephrine, may also function abnormally. In some cases, scientists are exploring the possibility that a faulty immune response to a virus, elevated concentrations of proteins in the blood at birth, dysregulation of specific neuropeptides or a major stress during pregnancy may lead to the disorder.

There is no one treatment for ASDs; however, it is widely accepted that the earliest interventions allow the best outcomes. Treatments generally address both cognitive and behavioral functioning. They may include a combination of medications (for challenging behaviors), behavioral therapy, psycho-education, family support groups, educational interventions, speech and language therapy, occupational therapy and specialized training to develop and improve acquisition of necessary skills.

Research has found that a newer class of atypical antipsychotic medications may better treat the serious behavioral disturbances in children with autism who are between 5 and 17 years old. Applied behavioral analysis may be effective adjunctive treatment in reinforcing desirable and reducing undesirable behaviors. Other work focuses on improving social communication in children with autism. Some have found that structured multidisciplinary behavioral programs are more successful. Parental involvement, a predictable schedule, regular behavioral reinforcement and active engagement of attention in highly structured activities to enhance a strength or ability may all contribute to creating an effective treatment program.


Bipolar Disorder FAQ

Formerly know as manic-depressive illness, bipolar disorder is a brain and behavior disorder characterized by severe shifts in a person’s mood and energy, making it difficult for the person to function.

Frequently Asked Questions about Bipolar Disorder

Bipolar disorder is a brain and behavior disorder characterized by severe shifts in a person’s mood and energy, making it difficult to function. More than 5.7 million adults or 2.6 percent of the population age 18 or older in any given year have bipolar disorder. The condition typically starts in late adolescence or early adulthood, although it can show up in children and in older adults. People often live with the disorder without having it properly diagnosed and treated.

Bipolar disorder causes repeated mood swings, or episodes, that can make someone feel very high (mania) or very low (depressive). The cyclic episodes are punctuated by normal moods.

Mania Episode Signs and Symptoms:

  • Increased energy, activity, restlessness
  • Euphoric mood
  • Extreme irritability
  • Poor concentration
  • Racing thoughts, fast talking, jumping between ideas
  • Sleeplessness
  • Heightened sense of self-importance
  • Spending sprees
  • Increased sexual behavior
  • Abuse of drugs, such as cocaine, alcohol and sleeping medications
  • Provocative, intrusive or aggressive behavior
  • Denial that anything is wrong

Depressive Episode Signs and Symptoms:

  • Sad, anxious or empty-feeling mood
  • Feelings of hopelessness and pessimism
  • Feelings of guilt, worthlessness and helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy, fatigue
  • Difficulty concentrating, remembering or making decisions
  • Restlessness and irritability
  • Sleeplessness or sleeping too much
  • Change in appetite, unintended weight loss or gain
  • Bodily symptoms not caused by physical illness or injury
  • Thoughts of death or suicide

Bipolar disorder cannot yet be diagnosed physiologically by blood tests or brain scans. Currently, diagnosis is based on symptoms, course of illness, and family history. Clinicians rule out other medical conditions, such as a brain tumor, stroke or other neuropsychiatric illnesses that may also cause mood disturbance. The different types of bipolar disorder are diagnosed based on the pattern and severity of manic and depressive episodes. Doctors usually diagnose brain and behavior disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM.

According to the DSM, there are four basic types of bipolar disorder:

  • Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.
  • Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
  • Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.
  • Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.

While no cure exists for bipolar disorder, it is treatable and manageable with psychotherapy and medications. Mood stabilizing medications are usually the first choice in medication. Lithium is the most commonly prescribed mood stabilizer. Anticonvulsant medications are usually used to treat seizure disorders, and sometimes offer similar mood-stabilizing effects as antipsychotics and antidepressants. Bipolar disorder is much better controlled when treatment is continuous. Mood changes can occur even when someone is being treated and should be reported immediately to a physician; full-blown episodes may be averted by adjusting the treatment.

In addition to medication, psychotherapy provides support, guidance education to people with bipolar disorder and their families. Psychotherapeutic interventions increase mood stability, decrease hospitalizations and improve overall functioning. Common techniques include cognitive behavioral therapy, psychoeducation, and family therapy.

The main difference between bipolar disorder and major clinical depression is the presence of manic episodes. This is why depression alone is not enough to diagnose an individual with bipolar disorder. However, one manic episode (meeting DMS-IV criteria) is sufficient to make a bipolar diagnosis.

Borderline Personality Disorder (BPD) FAQ

Borderline Personality Disorder (BPD) is a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image and functioning.

Frequently Asked Questions about Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image, and functioning. These experiences often result in impulsive actions and unstable relationships. A person with BPD may experience intense episodes of anger, depression, and anxiety that may last from only a few hours to days.

Some people with BPD also have high rates of co-occurring mental disorders, such as mood disorders, anxiety disorders, and eating disorders, along with substance abuse, self-harm, suicidal thoughts and behaviors, and suicide.

People with BPD may experience extreme mood swings and can display uncertainty about who they are. As a result, their interests and values can change rapidly. Other symptoms include:

  • Frantic efforts to avoid real or imagined abandonment
  • A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
  • Distorted and unstable self-image or sense of self
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
  • Recurring suicidal behaviors or threats or self-harming behavior such as cutting
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or problems controlling anger
  • Having stress-related paranoid thoughts
  • Having severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality

Seemingly ordinary events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations, such as vacations, business trips, or sudden changes of plans, from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Some of these signs and symptoms may be experienced by people with other mental health disorders, and even by people without mental illness, and do not necessarily mean that they have BPD. It is important that a qualified and licensed mental health professional conduct a thorough assessment to determine whether or not a diagnosis of BPD or other mental disorder is warranted, and to guide treatment options when appropriate.

Unfortunately, BPD is often underdiagnosed or misdiagnosed. BPD is diagnosed based on a thorough interview, comprehensive medical examination, and historical review, which can help rule out other possible causes of symptoms. A mental health professions may ask about symptoms, personal and family medical histories, including any history of mental disorders.

The causes of BPD are not yet clear, but research suggests that genetic, brain, environmental and social factors are involved.

  • Genetics – BPD is five times more likely to occur if a person has a close family member (first-degree biological relatives) with the disorder
  • Environmental and Social Factors – Many people with BPD report experiencing traumatic life events, such as abuse or abandonment during childhood. Others have been exposed to unstable relationships and hostile conflicts. However, some people with BPD do not have a history of trauma and many people with a history of trauma do not have BPD
  • Brain Factors – Studies show that people with BPD have structural and functional changes in the brain, especially in the areas that control impulses and emotional regulation.

Cognitive Behavioral Therapy (CBT) FAQ

Referrals for {CBT} Therapy

Frequently Asked Questions about Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do. CBT is brief and time-limited compared to other therapeutic techniques. A sound therapeutic relationship is necessary for effective therapy, but is not the focus of the treatment. It is based on aspects of stoic philosophy and is a collaborative effort between the therapist and the client. Using the Socratic Method, DBP is structured and directive, based on an educational model. CBT theory and techniques rely on the Inductive Method.

CBT does not exist as a distinct therapeutic technique. The term “cognitive-behavioral therapy” is a very general term for the classification of therapies with similarities. There are several approaches to CBT, including:

  • Rational Emotive Behavior Therapy
  • Rational Behavior Therapy
  • Rational Living Therapy
  • Cognitive Therapy
  • Dialectic Behavior Therapy

Most CBTs have the following characteristics:

  • CBT is based on the Cognitive Model of Emotional Response. CBT is based on the idea that our thoughts cause our feelings and behaviors, not external things like people, situations, and events. The benefit if this fact is that we can change the way we think to feel – act better even if the situation does not change.
  • CBT is Brief and Time-Limited. CBT is considered among the most rapid in terms of results obtained. The average number of sessions clients receive (across all types of problems and approaches to CBT) is only 16. Other forms of therapy, like psychoanalysis, can take years. What enables CBT to be briefer is its highly instructive nature and the fact that it makes use of homework assignments. CBT is time-limited in that we help clients understand at the very beginning of the therapy process that there will be a point when the formal therapy will end. The ending of the formal therapy is a decision made by the therapist and client. Therefore, CBT is not an open-ended, never-ending process.
  • A sound therapeutic relationship is necessary for effective therapy, but not the focus. Some forms of therapy assume that the main reason people get better in therapy is because of the positive relationship between the therapist and client. Cognitive-behavioral therapists believe it is important to have a good, trusting relationship, but that is not enough. CBT therapists believe that the clients change because they learn how to think differently and they act on that learning. Therefore, CBT therapists focus on teaching rational self-counseling skills.
  • CBT is a collaborative effort between the therapist and the client. CBT therapists seek to learn what their clients want out of live (their goals) and then help their clients achieve those goals. The therapist’s role is to listen, teach, and encourage, while the client’s role is to express concerns, learn and implement that learning.
  • CBT is based on aspects of stoic philosophy. Not all approaches to CBT emphasize stoicism. Rational Emotional Behavioral Therapy, Rational Behavior Therapy, and Rational Living Therapy emphasize aspects of stoicism. CBT does not tell people how they should feel. However, most people seeking therapy do not want to feel the way they have been feeling. The approaches that emphasize stoicism teach the benefits of feeling, at worst, calm when confronted with undesirable situations. They also emphasize the fact that we have our undesirable situations whether we are upset about them or not. If we are upset about our problems, we have two problems – the problem, and our upset about it. Most of us want to have the fewest number of problems possible. So, when we learn how to more calmly accept a personal problem, not only do we feel better, but we usually put ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem.
  • CBT uses the Socratic Method. Cognitive-behavioral therapists want to gain a very good understanding of their client’s concerns. They encourage their clients to ask questions of themselves, like, “How do I really know that those people are laughing at me?” “Could they be laughing at something else?”
  • CBT is structured and directive. CBT therapists have a specific agenda for each session. Specific techniques/concepts are taught during each session. CBT focuses on the client’s goals. CBT does not tell the client what their goals “should” be, or what they “should” tolerate. It is directive in the sense that it teaches the client how to think and behave in ways to obtain what they want. Therefore, CBT therapists do not tell the client what to do – rather, they teach the client how to do.
  • CBT is based on an educational mode. CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are learned. Therefore, the goal of therapy is to help you unlearn your unwanted reactions and to learn a new way of reacting. The educational emphasis of CBT has an additional benefit – it leads to long term results. When we understand how and why we are doing well, we know what to do to continue doing well.
  • CBT theory and techniques rely on the Inductive Method. A central aspect of Rational thinking is that it is based on fact. Often, we upset ourselves about things, when, in fact, the situation is not like we think it is. If we knew that, we would not waste our time getting upset. Therefore, the inductive method encourages us to look at our thoughts as being hypotheses or guesses that can be questioned or tested. If we find that our hypotheses are incorrect (because we have new information), then we can change our thinking to be in line with how the situation really is.

Dialectical Behavior Therapy (DBT) FAQ

Referrals for {DBT} Therapy

Frequently Asked Questions about Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a specific type of cognitive behavioral psychotherapy that emphasized the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT teaches that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level emotional stimulation, and take a significant amount of time to return to baseline arousal levels.

People who are diagnosed with Borderline Personality Disorder (BPD) sometimes experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions – most of all their own family and a childhood that emphasized invalidation – they do not have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Characteristics of DBT

  • Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about self and their life.
  • Cognitive-based:  DBT helps identify thoughts, beliefs, and assumptions that make life harder.  This requires constant attention to relationships between clients and staff.  In DBT, clients are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with the client.  DBT requires clients to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset.  These skills, a crucial part of DBT, are taught in weekly sessions, reviewed in weekly homework groups, and referred to in every group.  The individual therapist helps the person to learn, apply and master the DBT skills.

Generally, DBT has two main components:

  • Individual weekly psychotherapy sessions that emphasize problem-solving behavior for the past week’s issues and troubles that arose in the person’s life. Self-harm and suicidal behaviors take first priority, followed by behaviors that may interfere with the therapy process.  Quality of life issues and working toward improving life in general may also be discussed.  Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance their own self-respect and self-image.  Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship.  The emphasis is on teaching clients how to manage emotional trauma rather than reducing or taking them out of crises.  Telephone contact with the therapist between sessions is part of DBT procedures.  During the individual therapy sessions, the therapist and client work toward learning and improving many basic social skills.
  • Weekly group therapy sessions, generally 2 ½ hours per session and led by the DBT therapist, where clients learn skills from one of four modules:  Interpersonal effectiveness, Distress tolerance/reality acceptance skills, Emotion regulation, and Mindfulness skills are taught.

The four modules of DBT:

  • Mindfulness: The essential part of all skills taught in skills group are the core of mindfulness skills.  Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?”  Non-judgmentally, one-mindfully, and effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”
  • Interpersonal Effectiveness: Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes.  They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.  This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no).  The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
  • Distress Tolerance: Most approaches to mental health treatment focus on changing distressing events and circumstances.  They have paid little attention to accepting, finding meaning for, and tolerating destress. DBT emphasizes learning to bear pain skillfully.  Distress tolerance skills constitute a natural development from mindfulness skills.  They teach the ability to accept, in a non-evaluative and nonjudgmental way, both oneself and the current situation.  Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval; acceptance of reality is not approval of reality.  Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment.  Four sets of crisis survival strategies are taught:    Distracting, 2.  Self-soothing, 3.  Improving the moment, and 4.  Thinking pros and cons.  Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.
  • Emotion Regulation: Borderline and suicidal individuals are emotionally intense and labile – frequently angry, intensely frustrated, depressed and anxious.  This suggests that borderline clients might benefit from help in learning to regulate their emotions.    DBT skills for emotion regulation include:
    • Identifying and labeling emotions
    • Identifying obstacles to changing emotions
    • Reducing vulnerability to “emotion mind”
    • Increasing positive emotional events
    • Increasing mindfulness to current emotions
    • Taking opposite action
    • Applying distress tolerance techniques

Depression FAQ

Frequently Asked Questions about Depression

Clinical depression (/illness/depression) is a serious condition that negatively affects how a person thinks, feels, and behaves. In contrast to normal sadness, clinical depression is persistent, often interferes with a person’s ability to experience or anticipate pleasure, and significantly interferes with functioning in daily life. Untreated, symptoms can last for weeks, months, or years; and if inadequately treated, depression can lead to significant impairment, other health-related issues, and in rare cases, suicide. (Sources: National Institute of Mental Health HIMH and National Women’s Health Center.)

A person is diagnosed with a major depression when he or she experiences at least five of the symptoms listed below for two consecutive weeks. At least one of the five symptoms must be either (1) depressed mood or (2) loss of interest or pleasure.

Symptoms include:

  • Depressed mood most of the day, nearly every day
  • Markedly diminished interest or pleasure in activities most of the day, nearly every day
  • Changes in appetite that result in weight loss or gain unrelated to dieting
  • Changes in sleeping patterns
  • Loss of energy or increased fatigue
  • Restlessness or irritability
  • Feelings of anxiety
  • Feelings of worthlessness, helplessness, or hopelessness
  • Inappropriate guilt
  • Difficulty thinking, concentrating, or making decisions
  • Thought of death, suicide or attempts at suicide

(Sources: National Institute of Mental Health HIMH and National Women’s Health Center.)

Depression is twice as common among women as among men. Twenty percent of women will experience at least one episode of depression across their lifetime. Scientists are examining many potential causes for and contributing factors to women’s increased risk for depression. Biological, life cycle, hormonal and psychosocial factors unique to women may be linked to women’s higher depression rates. Researchers have shown, for example, that hormones affect brain chemistry, impacting emotions and mood.

Before adolescence, girls and boys experience depression at about the same frequency. By adolescence, however, girls become more likely to experience depression than boys. Research points to several possible reasons for this imbalance. The biological and hormonal changes that occur during puberty likely contribute to the sharp increase in rates of depression among adolescent girls. In addition, research suggests that girls are more likely than boys to continue feeling bad after experiencing difficult situations or events, suggesting they are more prone to depression. (Sources: National Institute of Mental Health HIMH and National Women’s Health Center.)

Women are particularly vulnerable to depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. Many new mothers experience a brief episode of mild mood changes known as the “baby blues.” These symptoms usually dissipate by the 10th day. PPD lasts much longer than 10 days, and can go on for months following child birth. Acute PPD is a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience PPD often have had prior depressive episodes. (Sources: National Institute of Mental Health HIMH and National Women’s Health Center.)

Menopause is defined as the state of an absence of menstrual periods for 12 months. Menopause is the point at which estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness. (Sources: National Institute of Mental Health HIMH and National Women’s Health Center.)

For older adults who experience depression for the first time later in life, other factors, such as changes in the brain or body, may be at play. For example, older adults may suffer from restricted blood flow, a condition called ischemia. Over time, blood vessels become less flexible. They may harden and prevent blood from flowing normally to the body’s organs, including the brain. If this occurs, an older adult with no family or personal history of depression may develop “vascular depression.” Those with vascular depression also may be at risk for a coexisting cardiovascular illness, such as heart disease or a stroke. (Sources: National Institute of Mental Health HIMH and National Women’s Health Center.)

Treatment-resistant depression (TRD) is a term used in clinical psychiatry to describe cases of major depressive disorder that do not respond to standard treatments (at least two courses of antidepressant treatments). For many people, antidepressant treatment and/or therapy (such as Cognitive Behavioral Therapy) ease symptoms of depression, but with treatment-resistant depression, little to no relief is realized. Treatment-resistant depression symptoms can range from mild to severe and may require a number of approaches to identify what helps. (Source: Biological Psychiatry)

Eating Disorders FAQ

Frequently Asked Questions about Eating Disorders

There are several eating disorders:

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge Eating Disorder
  • Avoidant-Restrictive Food Intake Disorder
  • Other Unspecified Eating Disorders (such as Purging Disorder)

They differ based on the types of problems with eating and the factors thought to motivate those behaviors. Eating too little is often present in all of these illnesses but dominates anorexia nervosa and avoidant-restrictive food intake disorder; in binge-eating disorder and bulimia, there may be problems with eating too much and quickly but then too little most of the time. Problems with eating uncontrollably and compulsively called a binge, are part of both bulimia nervosa and binge-eating disorder. Problems with purging behaviors, such as vomiting or laxatives, can be part of all of the illnesses but is required for bulimia nervosa and purging disorder. Motivations surrounding the initiation of eating disorder behaviors vary a lot and may even change in the course of the disorders. For example, anorexia nervosa and bulimia nervosa tend to have a stronger relationship between one’s own physical appearance and self-worth but fear of eating may motivate food restriction in avoidant-restrictive food intake disorder.

Warning signs are similar to other mental illnesses, and depression and anxiety symptoms are commonly comorbid diagnoses. There is often withdrawal from social activities, a loss of interest in previous activities/friends/family, and preoccupations with food and exercise. People with eating disorders often avoid eating around others but may like to make food for others. Weight loss suggests significant food restriction, and weight loss in the context of eating a lot, can suggest purging behaviors. There are some simple screening questionnaires, including the 5-questions SCOFF and the 11-question eating attitudes test.


Obsessive-Compulsive Disorder (OCD) FAQ

Frequently Asked Questions about Obsessive-Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) (/illness/ocd) is a brain and behavior disorder that is categorized as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). OCD causes severe anxiety in those affected and involved both obsessions and compulsions that interfere with daily life. Research suggests that OCD involves problems in communication between the front part of the brain and deeper structures. These brain structures use a chemical messenger called serotonin. Pictures of the brain at work also show that in some people the brain circuits involved in OCD become normalized with either serotonin medicines or cognitive behavioral therapy (CBT).

OCD causes severe anxiety in those affected and involves both obsessions and compulsions that interfere with daily life. Obsessions are persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress. The most common obsessions are repeated thoughts about contamination, repeated doubts, a need to have things in a particular order, aggressive or horrific impulses, and sexual imagery. Compulsions are the individual's attempt to suppress such thoughts or impulses or to neutralize them with some other thought or action. These can include repetitive behaviors, such as hand washing, ordering or checking on things; or mental acts, such as praying, counting, or repeating words silently.

OCD can start at any time beginning as early as preschool and continuing to adulthood. Age at onset tends to be earlier in males than in females: between ages 6 to 15 years for males and between ages 20 and 29 for females.

Research shows that OCD does run in families and that genes likely play a role in the development of the disorder. Genes appear to be only partly responsible for causing the disorder though and it is thought that it is more likely a combination of genetic susceptibility and environmental influences.

There are no laboratory or brain imaging tests to diagnose OCD. The diagnosis is made based on the observation and assessment of the person’s symptoms by a mental health professional.

Currently, there is only one type of medication that has been shown to be effective in treating Obsessive-Compulsive Disorder (OCD). Serotonin Reuptake Inhibitors (SRIs), including clomipramine, have been shown to reduce symptoms in 40%-60% of patients with OCD. Cognitive behavioral therapy (CBT) has also been shown to be effective. Patients who respond to medication usually show a 40% to 60% reduction inn OCD symptoms, while those who respond to CBT often report a 60% to 80% reduction in symptoms. (Source: NARSAD BBR Foundation)


Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Bacteria (PANDAS)
Pediatric Acute Neuropsychiatric Syndrome (PANS)

Frequently Asked Questions About Pandas/Pans

A diagnosis of PANDAS or PANS means a child has had a sudden, acute onset in multiple neuropsychiatric domains and the trigger is derived from a misdirected autoimmune response to streptococcus or other bacterial, viral, environmental or immune dysfunction. It is a clinical diagnosis and a diagnosis of exclusion. PANDAS is a subset of PANS when the trigger is known to be streptococcus.

PANDAS is defined by 5 criteria:

  • Abrupt, significant onset of OCD and/or Tics
  • Includes other neuropsychiatric symptoms
  • Prepubertal onset
  • Association with streptococcal infection
  • Symptoms follow relapsing-remitting course

Diagnostic criteria includes the abrupt, dramatic onset of OCD symptoms or severely restricted food intake; symptoms not better explained by a known neurologic or medical disorder; with 2 or more similarly severe accompanying symptoms:

  • Anxiety
  • Emotional liability and/or depression
  • Irritability, aggression and/or severely oppositional behaviors
  • Behavioral and/or developmental regression
  • Deterioration in school performance
  • Sensory or motor abnormalities
  • Somatic signs including sleep disturbances

Research shows that this syndrome involves a misdirected autoimmune process that affects or weakens the blood brain barrier. The region of the brain primarily affected is the basal ganglia. These are a group of structures that act as “switching stations” in the deepest inner region of the brain. Some of the brain function area managed via the basal ganglia include movement, cognitive perception, habit, executive “logic based” thinking, emotions and the endocrine system.

Research indicates the vast majority of children who develop PANDAS/PANS are between 4 and 12 years old although there are outliers that occur on either side of the age range.

Exacerbations relapse and remit. Symptoms tend to increase in duration and intensity with each episode. Untreated PANDAS/PANS can cause permanent debilitation and in some cases can become encephalitic in nature. Subsequent episodes can be caused by other environmental and infectious triggers different from the original infection. When treated in a timely fashion, PANDAS/PANS can remit entirely.

At the minimum during an initial onset, cases require:

  • Throat swab to rule out strep on a 48-hour culture
  • Blood labs: Streptozyme, ASO and Anti-dnase B
  • Tests to rule out other infections based upon medical history intake
  • Use the PANS Survey at each appointment to measure severity and duration of symptoms

Research indicates that tonsil and adenoid surgery may be important to consider. The longer a child has been ill, discernment of the autoimmune causation is difficult. Evaluations based on the Consensus Statement should be considered. Additional recommendations may include:

  • Antibiotics with a beta-lactam course to treat infection
  • Follow up to confirm remission; continued antibiotic or prophylaxis treatment may be necessary
  • In severe cases, intravenous immunoglobulin (IVIG) or plasmapheresis
  • Residual OCD often benefits from Cognitive Behavioral Therapy (CBT)



Post-Traumatic Stress Disorder (PTSD) FAQ

Frequently Asked Questions about Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) (/illness/ptsd) is an anxiety disorder that some people develop after seeing or living through a dangerous event. When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. In PTSD, this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.

Anyone can develop PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters and many other traumatic events. Not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or harm. The sudden, unexpected death of a loved one can also cause PTSD.

PTSD can cause many types of symptoms. The symptoms can be generally grouped into three categories:

  • Re-experiencing symptoms:
    • Flashbacks – the trauma is relived over and over and includes physical symptoms such as elevated heart rate and perspiration
    • Nightmares
    • Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine.  They can start from the person’s own thoughts and feelings of from outside words, objects or situations that trigger re-experiencing.

Avoidance symptoms:

  • Staying away from places, events or objects that are reminders of the experience
  • Feeling emotionally numb
  • Feeling strong guilt, depression or worry
  • Losing interest in activities that were enjoyable in the past
  • Having trouble remembering the dangerous event

Things that remind a person of the traumatic event can trigger avoidance symptoms.  These symptoms may cause a person to change their personal routine.  For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Hyper-arousal symptoms:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts

Hyper-arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event(s).  They can make the person feel continually stressed and angry, making it difficult to do daily tasks, such as sleeping, eating or concentrating.

It is natural to have some of these symptoms after a dangerous event.  Sometimes people have very serious symptoms that go away after a few weeks.  This is called Acute Stress Disorder (ASD).  When the symptoms last more than a few weeks and become an ongoing problem, it might be PTSD.  Some people with PTSD do not show symptoms for weeks or months.

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children, these symptoms can include:

  • Bedwetting, after having been toilet-trained
  • Forgetting how or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

It is important to remember that not everyone who lives though a dangerous event gets PTSD. In fact, most will not develop the disorder.

Many factors play a part in whether a person will develop PTSD. Some of these are risk factors that make a person more likely to get PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event.

Risk factors for PTSD include:

  • Living through dangerous events and traumas
  • Having a history of mental illness
  • Getting hurt
  • Seeing people hurt or killed
  • Feeling horror, helplessness or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, legal proceedings, or loss of a job or home

Resilience factors that may reduce the risk of PTSD include:

  • Seeking out support from other people, such as friends and family
  • Finding a support group after a traumatic event
  • Feeling good about one’s actions in the face of danger
  • Having a coping strategy, or a way of getting through the bad event and learning from it
  • Being able to act and respond effectively despite feeling fear

A mental health professional who has experience treating people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The diagnosis is made after an assessment is made with the person exhibiting PTSD symptoms.

To be diagnosed with PTSD, a person must have all of the following for at least 1 month:

  • At least one re-experiencing symptom
  • At least three avoidance symptoms
  • At least two hyper-arousal symptoms
  • Symptoms interfere with daily life, such as going to school or work, being with friends, taking care of important tasks

A number of treatment techniques, sometimes combined with one another, are being used with varying degrees of success, to treat PTSD:

  • Cognitive Behavioral Therapy (CBT), to help people recognize their ways of thinking, or “cognitive patterns,” that keep them stuck
  • Exposure Therapy, to help people safely face what they fear, in order to learn to cope with it (virtual reality devices are often used to simulate a situation or setting in which the trauma took place)
  • Eye Movement Desensitization and Reprocessing (EMDR), which combines exposure therapy with a series of guided eye movements that help people process traumatic memories and change the way they respond to those memories
  • Anti-anxiety medications and antidepressants can also ease the symptoms of PTSD; some people with PTSD whose symptoms include insomnia or recurrent nightmares find relief with a medication called prazosin that blocks the effect of adrenaline in the body

A significant number of combat veterans suffer from PTSD; up to 20 percent of those who served in the Iraq and Afghanistan wars and up to 30 percent of those who served in Vietnam. PTSD can result from a variety of traumatic or life-threatening incidents such as sexual assault, child abuse, accidents, bombings, or natural disasters such as tornadoes. Even witnessing a traumatic event can cause PTSD. In the United States, eight out of every 100 people will have PTSD at some point in their lives. Each year, five million adults are coping with PTSD in America.

In a 20-year study of trauma survivors, Dennis S. Charney, MD, of the Icahn School of Medicine at Mount Sinai and Steven M. Southwick, MD, of Yale School of Medicine identified ten common practices in people who have shown resilience in the face of extreme stress:

  • Maintaining an optimistic but realistic outlook
  • Facing fear (the ability to confront one’s fears)
  • Relying upon one’s own inner, moral compass
  • Turning to religious or spiritual practices
  • Seeking and accepting social support
  • Learning from and imitating sturdy role models
  • Staying physically fit
  • Staying mentally sharp
  • Cognitive and emotional flexibility (finding a way to accept that which cannot be changed)
  • Looking for the meaning and opportunity in the midst of adversity

Schizophrenia FAQ

Frequently Asked Questions about Schizophrenia

Schizophrenia (/illness/schizophrenia) is a severe and debilitating brain and behavior disorder affecting how one thinks, feels and acts. People with schizophrenia can have trouble distinguishing reality from fantasy, expressing and managing normal emotions and making decisions. Thought processes may also be disorganized and the motivation to engage in life’s activities may be blunted. Those with the condition may hear imaginary voices and believe others are reading their minds, controlling their thoughts or plotting to harm them.

Most people with schizophrenia suffer from symptoms either continuously or intermittently throughout life and are often severely stigmatized by people who do not understand the disease. Contrary to popular perception, people with schizophrenia do not have “split” or multiple personalities and most pose no danger to others. However, the symptoms are terrifying to those afflicted and can make them unresponsive, agitated or withdrawn. People with schizophrenia attempt suicide more often than people in the general population, and estimates are that up to 10 percent of people will complete a suicide in the first 10 years of the illness – particularly young men with schizophrenia.

While schizophrenia is a chronic disorder, it can be treated with medication, psychological and social treatments, substantially improving the lives of people with the condition.

Schizophrenia can have very different symptoms in different people. The way the disease manifests itself and progresses in a person depends on the time of onset, severity and duration of symptoms, which are categorized as positive, negative and cognitive. All three kinds of symptoms reflect problems in brain function. Relapse and remission cycles often occur; a person can get better, worse and better again repeatedly over time.

  • Positive symptoms, which can be severe or mild, include delusions, hallucinations and thought disorders. Some psychiatrists also include psychomotor problems that affect movement in this category.  Delusions, hallucinations and inner voices are collectively called psychosis, which also can be a hallmark of other serious mental illnesses such as bipolar disorder.  Delusions lead people to believe others are monitoring or threatening them, or reading their thoughts.  Hallucinations cause a patient to hear, see, feel or smell something that is no there.  Thought disorders may involve difficulty putting cohesive thoughts together or making sense of speech.  Psychomotor problems may appear as clumsiness, unusual mannerisms or repetitive actions, and in extreme cases, motionless rigidity held for extended periods of time.
  • Negative symptoms reflect a loss of functioning in areas such as emotion or motivation. Negative symptom include loss or reduction in the ability to initiate plans, speak, express emotion or find pleasure in life.  They include emotional flatness or lack of expression, diminished ability to begin and sustain a planned activity, social withdrawal and apathy.  These symptoms can be mistaken for laziness or depression.
  • Cognitive symptoms involve problems with attention and memory, especially in planning and organizing to achieve a goal.  Cognitive deficits are the most disabling for patients trying to lead a normal life.
  • Paranoid schizophrenia – feelings of extreme suspicion, persecution or grandiosity, or a combination of these
  • Disorganized schizophrenia – incoherent thoughts, but not necessarily delusional
  • Catatonic schizophrenia – withdrawal, negative affect and isolation, and marked psychomotor disturbances
  • Residual schizophrenia – delusions or hallucinations may go away, but motivation or interest in life is gone
  • Schizoaffective disorder – symptoms of both schizophrenia and a major mood disorder, such as depression

Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. Men tend to experience symptoms earlier than women. Most of the time, people do not get schizophrenia after age 45. Schizophrenia rarely occurs in children, but awareness of childhood onset schizophrenia is increasing.

It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems and irritability – behaviors that are common among teens.

A combination of factors can predict schizophrenia in up to 80 percent of youth who are at high risk of developing the illness. These factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop the disease, this stage of the disorder is called the “prodromal” period.

Currently, schizophrenia is diagnosed by the presence of symptoms or their precursors for a period of six months. Two or more symptoms, such as hallucinations, delusions, disorganized speech, and grossly disorganized or catatonic behavior, must be significant and last for at least one month. Only one symptom is required for diagnosis if delusions are bizarre enough or if hallucinations consist either of a voice constantly commenting on the person’s behavior/thoughts, or two or more voices “conversing.” Social or occupational problems can also be part of the diagnosis during the six-month period.

Research to find markers, such as abnormal brain scans or blood chemicals that can help detect early disease and allow for quicker interventions is now being done. Scientists are also working to understand the genetic and environmental mechanisms that combine to cause schizophrenia. As more is discovered about chemical circuitry and structure of the brains of people with the disease, better diagnostic tools and early intervention techniques can be developed. This is crucial for schizophrenia as it is believed that with every psychotic episode, increased damage is done to the brain.

While no cure exists for schizophrenia, it is treatable and manageable with medication and behavioral therapy, especially if diagnosed early and treated continuously. Those with acute symptoms, such as severe delusions or hallucinations, suicidal thoughts or the inability to care for oneself, may require hospitalization. Antipsychotic drugs are the primary medications to reduce the symptoms of schizophrenia. They relieve the positive symptoms through their impact on the brain’s neurotransmitter systems. Cognitive and behavioral therapy can then help “retrain” the brain once symptoms are reduced.

These approaches improve communication, motivation and self-care and teach coping mechanisms so that individuals with schizophrenia may attend school, go to work and socialize. Patients undergoing regular psychosocial treatment comply better with medication, and have fewer relapses and hospitalizations. A positive relationship with a therapist or a case manager gives a patient a reliable source of information about the disease, as well as empathy, encouragement and hope. Social networks and family member support have also been shown to be helpful.



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