What Is the mental illness

What is mental illness?  It’s a hot topic in the news recently, because of proposed gun control legislation. I saw a photo yesterday of people holding up a huge sign saying, “Keep guns out of the hands of mentally ill.”

There is far more to the demonization of the mentally ill than just the firearms issue. It spills over into the Federal Aviation Administration and the Department of Transportation. It is not just guns; it is airplanes and trucks as well. This brings us to the core question of, “What is mental illness?”  The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is the current handbook for classifying mental disorders.  DSM-V is in the final stages of development and will be published in May 2013. That is only next month.

Which brings us back to the original question of what exactly is mental illness?  In New York, a man’s home was raided, his Concealed Carry Permit revoked and guns confiscated because someone told the police he was taking an anti-anxiety medication.  I have received emails in the past week from several friends about this issue.  One of them is a vet, M?F transgendered. She is concerned about being able to renew her own Concealed Carry Permit (CCP). As a veteran and avid target-shooting hobbyist, she is well trained in gun safety and use. As a transgender woman, she is a target and prey according to FBI statistics. Hate crimes against LGBT people are at a 14-year high.

According to the DSM-IV-TR, “Gender Identity Disorder” is one of the mental illnesses. In the DSM-V, it is renamed “Gender Dysphoria.”  While claiming it is not a mental illness, the fact that Gender Dysphoria is in the DSM-V in the first place makes it suspect in the eyes of many. Two days ago, she sent this excerpt from a local outlet:

The enforcement action started on March 29th when New York State Police asked the Erie County Clerk’s Office to pursue revoking the man’s pistol permit because he owned guns in violation of the mental health provision of New York’s newly enacted guns law called the SAFE ACT.

The allegation turned out to be untrue and his guns returned to him. As it turned out, the police, sua sponte, initiated the action. The only lawyer involved in the matter was the man’s own attorney.

Erie County Clerk Chris Jacobs said, “When the State Police called to tell us they made a mistake and had the wrong person…it became clear that the State did not do their job here, and now we all look foolish.”

Flaws in the mental health reporting provisions of the NY SAFE Act were blamed for the misunderstanding.  The county clerk added, “Until the mental health provisions are fixed, these mistakes will continue to happen” (source: WKBW-TV)

The bigger issue is how come taking an anxiolytic prescribed by one’s family doctor disqualifying?  It would be interesting to know just how many of those raiding officers, and their supervisors, are taking medication for anxiety, depression or sleep.

Is mild anxiety a reason to stigmatize someone, and possibly violate his or her civil rights?  It gets better. The FAA Medical Examiner will not allow psychiatric medications for any class of Medical Certificate. If a psychiatric medication, it is an automatic disqualification. Several non-psychiatric medications are disqualifying as well. When Tagamet (cimetidine) was first released to treat ulcers and hyperacidity, it disqualified one from holding an FAA Medical Certificate in order to fly.  I first heard about that from a friend who was an Aviation Medical Examiner at the time. He told me the FAA put Tagamet on the list because, “It acts on the central nervous system.”

What is mental illness? Some say it is anything that is in the DSM. However, as I have pointed out in court many times, the DSM is a handbook put together by a committee. Everyone has heard the old joke about what a committee produces: “An elephant is a mouse designed by a committee.”

The new DSM-V will be expanding the definition of ADHD.  The definition of PTSD is supposed to be clarified in the final definition.  Homosexuality was removed from the DSM-IV. If it was a mental illness, the why was it removed? The answer to that is simple. It is not a mental illness.

How prevent the mental illness

There's no sure way to prevent mental illness. However, if you do have a mental illness, taking steps to control stress, to increase your resilience and to boost low self-esteem may help keep your symptoms under control. Follow these steps:

 Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends in watching for warning signs.
  

Get routine medical care. Don't neglect checkups or skip visits to your family doctor, especially if you aren't feeling well. You may have a new health problem that needs to be treated, or you may be experiencing side effects of medication.
  

Get help when you need it. Mental health conditions can be harder to treat if you wait until symptoms get bad. Long-term maintenance treatment also may help prevent a relapse of symptoms.
  

Take good care of yourself. Sufficient sleep, healthy eating and regular physical activity are important. Try to maintain a regular schedule. Talk to your doctor if you have trouble sleeping or if you have questions about diet and exercise.

The brain and mental health

The brain is a complex grouping of nerve cells and other structures that help us think, react to the environment, make decisions and plans, and carry them out. In conjunction with the nervous system, some parts of our brain are responsible for our vital bodily functions, such as breathing and the heartbeat. Other parts of our brain control learning and memory, our senses (sight, smell, hearing, taste, and touch), and emotions.

To keep the many functions of the body and mind working properly, the billions of nerve cells in the brain (which are also called neurons) must communicate with each other and work together frequently. Brain chemicals called neurotransmitters help to send electrical signals or messages from one neuron to another. At any given moment, millions of these messages are transmitted throughout the brain, allowing it to process information and send instructions to various parts of the body. In response, we engage in a wide range of behaviors, some of which we are aware of and can control, like making choices, and some of which are more automatic, like breathing.

There are many conditions which can affect our brain health, and this can have a wide range of effects on our ability to function normally. Scientific advances in recent years have made it clear that the brain plays a central role in mental health. We understand mental illnesses as conditions that negatively affect a person's thoughts, emotions, and behaviors. Mental illness disrupts one's ability to relate to others and to function when meeting the demands of daily life.

Mental illnesses include mood disorders such as major depression and bipolar disorder, schizophrenia, and anxiety disorders, to name a few. Researchers studying the role of the brain in these illnesses have found strong evidence that imbalances in certain types of neurotransmitters can cause abnormalities in the communication among neurons. When this occurs, the brain may not send the proper instructions to the body, which may, in turn, lead to certain symptoms of mental illness.

In addition to imbalances in brain chemicals, changes in the size and shape of actual structures in the brain can also contribute to certain mental illnesses. These neurological abnormalities observed in people with some types of mental illnesses are a good demonstration of the overlap between the symptoms of neurological and psychiatric illnesses. Because of the prominent brain abnormalities that have been observed, certain conditions that are considered to be mental illnesses, such as schizophrenia have been theorized by some scientists to be neurological diseases.

Dementia is another excellent example of the overlap between brain abnormalities and psychiatric symptoms. As an illness with both neurological and psychological symptoms, dementia affects thoughts, personality, feelings, and behavior. The causes of dementia, although not fully understood, have been in large part, traced to structural and chemical deterioration in the brain. For this reason, various types of dementia are diagnosed and treated by teams of professionals that include both neurologists and psychologists, both of whom are trained to assess and treat illnesses that involve brain health.

What is the good mental helth

Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

In most countries, particularly low- and middle-income countries, mental health services are severely short of resources - both human and financial. Of the health care resources available, most are currently spent on the specialized treatment and care of the people with mental illness, and to a lesser extent on an integrated mental health system. Instead of providing care in large psychiatric hospitals, countries should integrate mental health into primary health care, provide mental health care in general hospitals and develop community-based mental health services.

Even less funding is available for mental health promotion, an umbrella term that covers a variety of strategies, all aimed at having a positive effect on mental health well-being in general. The encouragement of individual resources and skills, and improvements in the socio-economic environment are among the strategies used.

Mental health promotion requires multi-sectoral action, involving a number of government sectors and non-governmental or community-based organizations. The focus should be on promoting mental health throughout the lifespan to ensure a healthy start in life for children and to prevent mental disorders in adulthood and old age.

Social phobia

Social phobia, also called Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work,
Social phobia
A diagnosis of social phobia is made only if his avoidance, fear or anxious anticipation of a social or performance situation interferes with daily routine, occupational functioning, social life or if he is markedly distressed by having the phobia. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR(tm)) provides the following criteria for diagnosing social phobia. Please note: guidelines are provided for information only; they cannot substitute a visit to a doctor or mental health practitioner.

    Fear of one or more social or performance situations if the person is exposed to unfamiliar people. And the individual fears that she will behave in a manner that causes embarrassment
    Exposure to social situations causes intense anxiety
    The level of anxiety is recognized by the individual as excessive
    The feared situation must be avoided, or endured with anxiety and distress
    The avoidance, anxious anticipation, or distress interferes significantly with the person's social, academic or occupational functioning
Social phobia symptoms
school, or other activities. While many people with social phobia recognize that their fear of being around people may be excessive or unreasonable, they are unable to overcome it. They often worry for days or weeks in advance of a dreaded situation. In addition, they often experience low self-esteem and depression.

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 -- or, in its most severe form, a person experiences symptoms whenever they are around other people. If left untreated, social phobia can have severe consequences. For example, it may keep people from going to work or school on some days. Many with this illness are afraid of being with people other than family members. As a result, they may have a hard time making and keeping friends.

Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, and other symptoms of anxiety, including difficulty talking and nausea or other stomach discomfort. These visible symptoms heighten the fear of disapproval, and the symptoms themselves can become an additional focus of fear. Fear of symptoms can create a vicious cycle: as people with social phobia worry about experiencing the symptoms, the greater their chances of developing the symptoms.

Social phobia often runs in families and may be accompanied by depression or other anxiety disorders, such as panic disorder and obsessive-compulsive disorder. Some people with social phobia self medicate themselves with alcohol or other drugs, which can lead to addiction.

Kleptomania

You don't need that thing, and you can afford to buy it, but you can't help yourself: you just take it. Kleptomaniacs compulsively steal items that are not needed or have little monetary value, and experience a rush of pleasure as a result.

Kleptomania is defined by a number of features including a consistent tendency to steal items not needed for personal use or monetary value. The objects are stolen despite that they are typically of little value to the individual, who could have afforded to pay for them and often gives them away or discards them.

Another aspect of kleptomania involves experiencing tension before the theft and feelings of pleasure, gratification or relief when committing the theft. The stealing is not done to express anger or vengeance, or in response to a delusion or hallucination, and is not attributed to conduct disorder, a manic episode or antisocial personality disorder.

Occasionally the individual may hoard the stolen objects or surreptitiously return them. Although someone with this disorder will generally avoid stealing when immediate arrest is probable (such as in full view of a police officer), they usually do not plan the thefts or fully take into account the chances of apprehension. The stealing is done without collaboration with others.

Dysthymia

Dysthymia, sometimes referred to as mild, chronic depression, is less severe than major depression. With dysthymia, the depression symptoms can linger for a long period of time, often two years or longer. Those who suffer from dysthymia can also experience periods of major depression.
What Causes Dysthymia?

Experts are not sure what causes dysthymia or depression. Genes may play a role, but many affected people will not have a family history of depression, and others with family history will not have depression problems. Changes in levels of brain chemicals are also believed to be involved. Major life stressors, chronic illness, medications, and relationship or work problems may also increase the chances of dysthymia.
What Are the Signs and Symptoms of Dysthymia?

The symptoms of dysthymia are the same as those of major depression but not as intense and include the following:

     1.sadness or depressed mood most of the day or almost every day

     2. loss of enjoyment in things that were once pleasurable

     3. major change in weight (gain or loss of more than 5% of weight within a month) or appetite

     4.insomnia or excessive sleep almost every day

     5.physically restless or rundown that is noticeable by others

     6.fatigue or loss of energy almost every day

     7. feelings of hopelessness or worthlessness or excessive guilt almost every day

     8.problems with concentration or making decisions almost every day

     9. recurring thoughts of death or suicide, suicide plan, or suicide attempt

Night Eating Syndrome

        The person has little or no appetite for breakfast. Delays first meal for several hours after waking up. Is not hungry or is upset about how much was eaten the night before.

        Eats more food after dinner than during that meal.

        Eats more than half of daily food intake during and after dinner but before breakfast. May leave the bed to snack at night.

        This pattern has persisted for at least two months.

        Person feels tense, anxious, upset, or guilty while eating.

        NES is thought to be stress related and is often accompanied by depression. Especially at night the person may be moody, tense, anxious, nervous, agitated, etc.

        Has trouble falling asleep or staying asleep. Wakes frequently and then often eats.

        Foods ingested are often carbohydrates: sugary and starch.

        Behavior is not like binge eating which is done in relatively short episodes. Night-eating syndrome involves continual eating throughout evening hours.

         This eating produces guilt and shame, not enjoyment.

Narcissistic personality

Narcissistic personality disorder is characterized by dramatic, emotional behavior, which is in the same category as antisocial and borderline personality disorders.

Narcissistic personality disorder symptoms may include:

     1. Believing that you're better than others

      2.Fantasizing about power, success and attractiveness

     3.Exaggerating your achievements or talents

     4. Expecting constant praise and admiration

     5.Believing that you're special and acting accordingly

     6. Failing to recognize other people's emotions and feelings

     7.  Expecting others to go along with your ideas and plans

     8.Taking advantage of others

     9. Expressing disdain for those you feel are inferior

    10.  Being jealous of others

    11.Believing that others are jealous of you

    12.Trouble keeping healthy relationships

    14.13.Setting unrealistic goals

    15.Being easily hurt and rejected

    16.Having a fragile self-esteem

    17.Appearing as tough-minded or unemotional

Although some features of narcissistic personality disorder may seem like having confidence or strong self-esteem, it's not the same. Narcissistic personality disorder crosses the border of healthy confidence and self-esteem into thinking so highly of yourself that you put yourself on a pedestal. In contrast, people who have healthy confidence and self-esteem don't value themselves more than they value others.

When you have narcissistic personality disorder, you may come across as conceited, boastful or pretentious. You often monopolize conversations. You may belittle or look down on people you perceive as inferior. You may have a sense of entitlement. And when you don't receive the special treatment to which you feel entitled, you may become very impatient or angry. You may insist on having "the best" of everything — the best car, athletic club, medical care or social circles, for instance.

But underneath all this behavior often lies a fragile self-esteem. You have trouble handling anything that may be perceived as criticism. You may have a sense of secret shame and humiliation. And in order to make yourself feel better, you may react with rage or contempt and efforts to belittle the other person to make yourself appear better.

Parasomnias

Parasomnias are disruptive sleep disorders that can occur during arousals from REM sleep or partial arousals from non-REM sleep. Parasomnias include nightmares, night terrors, sleepwalking, confusional arousals, and many others.

Nightmares

Nightmares are vivid nighttime events that can cause feelings of fear, terror, and/or anxiety. Usually, the person having a nightmare is abruptly awakened from REM sleep and is able to describe detailed dream content. Returning to sleep is usually difficult. Nightmares can be caused by many factors, including illness, anxiety, the loss of a loved one, or negative reactions to a medication. Call your doctor if nightmares occur more than once a week or if nightmares prevent you from getting a good night's sleep for a prolonged period of time.

Night Terrors

A person experiencing a night terror abruptly awakes from sleep in a terrified state, but is confused and unable to communicate. They do not respond to voices and are difficult to fully awaken. Night terrors last about 15 minutes, after which time the person usually lies down and appears to fall back asleep. People who have night terrors (sometimes called sleep terrors) usually don't remember the events the next morning. Night terrors are similar to nightmares, but usually occur during deep sleep.

People experiencing sleep terrors may pose dangers to themselves or others because of limb movements. Night terrors are fairly common in children, mostly between the ages of 3 and 5. Children with sleep terrors will often also talk in their sleep or sleepwalk. This sleep disorder, which may run in families, also can occur in adults. Strong emotional tension and/or the use of alcohol can increase the incidence of night terrors among adults.

sleepwalking

Sleepwalking occurs when a person appears to be awake and moving around but is actually asleep. He or she has no memory of the episode. Sleepwalking most often occurs during deep non-REM sleep (stages 3 and 4 sleep) early in the night and it can occur during REM sleep in the early morning. This disorder is most commonly seen in children between the ages of 8 and 12; however, sleepwalking can occur among younger children, adults, and seniors.

Sleepwalking appears to run in families. Contrary to what many people believe, it is not dangerous to wake a person who is sleepwalking. The sleepwalker simply may be confused or disoriented for a short time upon awakening. Although waking a sleepwalker is not dangerous, sleepwalking itself can be dangerous, because the person is unaware of his or her surroundings and can bump into objects or fall down. In most children, it tends to stop as they enter the teen years.

Confusional Arousals

Confusional arousals usually occur when a person is awakened from a deep sleep during the first part of the night. This disorder, which also is known as excessive sleep inertia or sleep drunkenness, involves an exaggerated slowness upon awakening. People experiencing confusional arousals react slowly to commands and may have trouble understanding questions that they are asked. In addition, people with confusional arousal often have problems with short-term memory; they have no memory of the arousal the following day.

Parkinson's disease

Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50.  Early symptoms of PD are subtle and occur gradually.  In some people the disease progresses more quickly than in others.  As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities.  Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.  There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD.  Therefore the diagnosis is based on medical history and a neurological examination.  The disease can be difficult to diagnose accurately.   Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.
Parkinson's disease


At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms.  Usually, patients are given levodopa combined with carbidopa.  Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain.  Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply.  Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all.  Anticholinergics may help control tremor and rigidity.  Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine.  An antiviral drug, amantadine, also appears to reduce symptoms.  In May 2006, the FDA approved rasagiline to be used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD.

In some cases, surgery may be appropriate if the disease doesn't respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly.

PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time.  Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and other symptoms are more troublesome.  No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms also varies from person to person.

Aspects of morbid jealousy

Morbid jealousy is encountered in general, old age and forensic psychiatry, and clinicians in each specialty should be familiar with its recognition and management. As well as clinical matters, the issue of risk to the patient and others is prominent in the consideration of morbid jealousy. Hospitalisation is sometimes required, the use of compulsory admission is not infrequent and treatment in secure settings is occasionally warranted. This review addresses the nature of morbid jealousy, its psychopathology, diagnostic issues, associations, risks and management.

Jealousy is a common, complex, ‘normal’ emotion. The Oxford English Dictionary defines the word jealous as ‘feeling or showing resentment towards a person one thinks of as a rival’. This definition indicates that it is the belief in the presence of rivalry that is the key issue, and that whether or not such a rivalry truly exists is less important. Jealousy within a sexual relationship has clear advantages in evolutionary terms: behaviour that ensures the absolute sole possession of a partner allows the propagation of one’s own genes at the expense of those of a true rival (Daly et al, 1982). However, when the belief in rivalry is mistaken, much time and effort may be wasted in attempting to eliminate a false threat.

Morbid jealousy describes a range of irrational thoughts and emotions, together with associated unacceptable or extreme behaviour, in which the dominant theme is a preoccupation with a partner’s sexual unfaithfulness based on unfounded evidence (Cobb, 1979). It is noteworthy that individuals may suffer from morbid jealousy even when their partner is being unfaithful, provided that the evidence that they cite for unfaithfulness is incorrect and the response to such evidence on the part of the accuser is excessive or irrational. Healthy people become jealous only in response to firm evidence, are prepared to modify their beliefs and reactions as new information becomes available, and perceive a single rival. In contrast, morbidly jealous individuals interpret conclusive evidence of infidelity from irrelevant occurrences, refuse to change their beliefs even in the face of conflicting information, and tend to accuse the partner of infidelity with many others (Vauhkonen, 1968).

In popular usage, morbid jealousy has been dubbed the ‘Othello syndrome’, with reference to the irrational jealousy of Shakespeare’s Othello (Todd & Dewhurst, 1955). This is misleading, as it suggests that morbid jealousy is a unitary syndrome. Demonstrably, this is not the case, and morbid jealousy should be considered to be a descriptive term for the result of a number of psychopathologies within separate psychiatric diagnoses (Shepherd, 1961)

Anxiety

Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how we feel and behave, and they can manifest real physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can be extremely debilitating, having a serious impact on daily life.
People often experience a general state of worry or fear before confronting something challenging such as a test, examination, recital, or interview. These feelings are easily justified and considered normal. Anxiety is considered a problem when symptoms interfere with a person's ability to sleep or otherwise function. Generally speaking, anxiety occurs when a reaction is out of proportion with what might be normally expected in a situation.
Anxiety is a normal reaction to stressful situations. But in some cases, it becomes excessive and can cause sufferers to dread everyday situations.

This type of steady, all-over anxiety is called Generalized Anxiety Disorder. Other anxiety-related disorders include panic attacks—severe episodes of anxiety which happen in response to specific triggers—and obsessive-compulsive disorder, which is marked by persistent invasive thoughts or compulsions to carry out specific behaviors (such as hand-washing).

Anxiety so frequently co-occurs with depression that the two are thought to be twin faces of one disorder. Like depression, it strikes twice as many females as males.

Generally, anxiety arises first, often during childhood. Evidence suggests that both biology and environment can contribute to the disorder. Some people may have a genetic predisposition to anxiety; however, this does not make development of the condition inevitable. Early traumatic experiences can also reset the body’s normal fear-processing system so that it is hyper-reactive to stress.

The exaggerated worries and expectations of negative outcomes in unknown situations that typify anxiety are often accompanied by physical symptoms. These include muscle tension, headaches, stomach cramps, and frequent urination. Behavioral therapies, with or without medication to control symptoms, have proved highly effective against anxiety, especially in children.

Schizophrenia

Throughout recorded history, the disorder we now know as schizophrenia has been a source of bewilderment. Those suffering from the illness once were thought to be possessed by demons and were feared, tormented, exiled or locked up forever.

In spite of advances in the understanding of its causes, course and treatment, schizophrenia continues to confound both health professionals and the public. It is easier for the average person to cope with the idea of cancer than it is to understand the odd behavior, hallucinations or strange ideas of the person with schizophrenia.

As with many mental disorders, the causes of schizophrenia are poorly understood. Friends and family commonly are shocked, afraid or angry when they learn of the diagnosis. People often imagine a person with schizophrenia as being more violent or out-of-control than a person who has another kind of serious mental illness. But these kinds of prejudices and misperceptions can be readily corrected.

Expectations become more realistic as schizophrenia is better understood as a disorder that requires ongoing -- often lifetime -- treatment. Demystification of the illness, along with recent insights from neuroscience and neuropsychology, gives new hope for finding more effective treatments for an illness that previously carried a grave prognosis.

Schizophrenia is characterized by a broad range of unusual behaviors that cause profound disruption in the lives of people suffering from the condition, as well as in the lives of the people around them. Schizophrenia strikes without regard to gender, race, social class or culture.
One of the most obvious kinds of impairment caused by schizophrenia involves how a person thinks. The individual can lose much of the ability to rationally evaluate his or her surroundings and interactions with others. They often believe things that are untrue, and may have difficulty accepting what they see as "true" reality.

Schizophrenia most often includes hallucinations and/or delusions, which reflect distortions in the perception and interpretation of reality. The resulting behaviors may seem bizarre to the casual observer, even though they may be consistent with the schizophrenic's abnormal perceptions and beliefs.

For instance, someone with schizophrenia may act in an extremely paranoid manner -- purchasing multiple locks for their doors, always checking behind them as they walk in public, refusing to talk on the phone. Without context, these behaviors may seem irrational or illogical. But to someone with schizophrenia, these behaviors may reflect a reasonable reaction their false beliefs that others are out to get them or lock them up.

Nearly one-third of those diagnosed with schizophrenia will attempt suicide. About 10 percent of those with the diagnosis will commit suicide within 20 years of the beginning of the disorder. Patients with schizophrenia are not likely to share their suicidal intentions with others, making life-saving interventions more difficult. The risk of depression needs special mention due to the high rate of suicide in these patients. The most significant risk of suicide in schizophrenia is among males under 30 who have some symptoms of depression and a relatively recent hospital discharge. Other risks include imagined voices directing the patient toward self-harm (auditory command hallucinations) and intense false beliefs (delusions).

The relationship of schizophrenia to substance abuse is significant. Due to impairments in insight and judgment, people with schizophrenia may be less able to judge and control the temptations and resulting difficulties associated with drug or alcohol abuse.

In addition, it is not uncommon for people suffering from this disorder to try to "self-medicate" their otherwise debilitating symptoms with mind-altering drugs. The abuse of such substances, most commonly nicotine, alcohol, cocaine and marijuana, impedes treatment and recovery.

Alzheimer's disease

Alzheimer's disease is the most common cause of dementia, affecting around 496,000 people in the UK. The term 'dementia' describes a set of symptoms which can include loss of memory, mood changes, and problems with communication and reasoning. These symptoms occur when the brain is damaged by certain diseases and conditions, including Alzheimer's disease. This factsheet outlines the symptoms and risk factors for Alzheimer's disease, and describes what treatments are currently available.

Alzheimer's disease, first described by the German neurologist Alois Alzheimer, is a physical disease affecting the brain. During the course of the disease, protein 'plaques' and 'tangles' develop in the structure of the brain, leading to the death of brain cells. People with Alzheimer's also have a shortage of some important chemicals in their brain. These chemicals are involved with the transmission of messages within the brain.

Alzheimer's is a progressive disease, which means that gradually, over time, more parts of the brain are damaged. As this happens, the symptoms become more severe.
Symptoms

People in the early stages of Alzheimer's disease may experience lapses of memory and have problems finding the right words. As the disease progresses, they may:

    become confused and frequently forget the names of people, places, appointments and recent events

    experience mood swings, feel sad or angry, or scared and frustrated by their increasing memory loss

    become more withdrawn, due either to a loss of confidence or to communication problems

    have difficulty carrying out everyday activities - they may get muddled checking their change at the shops or become unsure how to work the TV remote.

As the disease progresses, people with Alzheimer's will need more support from those who care for them. Eventually, they will need help with all their daily activities.

Frotteurism

Frotteurism is a form of sexual assault that involves a person stimulating himself or herself by rubbing against another person who is not a willing participant in a sexual act. This is typically done in a crowded area such as a concert or on a crowded subway, bus, or train. People targeted by this form of assault may not even be aware of the activity. It is a paraphilic disorder that is diagnosable by psychological professionals, and is often treated with various cognitive, behavioral, and pharmacological approaches. Frotteurism should not be confused with “frottage,” which is a similar activity engaged in by consenting individuals for sexual stimulation or gratification.

The term “frotteurism” comes from the French word frotter, which means “to rub,” and frotteur translates as “one who rubs.” Though it is often classified as a misdemeanor under various legal statutes, it is still a form of sexual assault and consequences can be severe depending on the situation. Someone who is the victim of frotteurism may not even be aware of the crime, but may still feel violated or otherwise assaulted by the offending individual. It should also be noted that such actions against a child can be an early warning sign of later sexual abuse against children by a perpetrato
Frotteurism usually consists of one person rubbing against another person to achieve sexual arousal or gratification. While most such actions are perpetrated by men against women, it is not unknown for men to be targeted by women as well. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), frotteurism is typically diagnosed when the impulse to rub against others occurs for six months or more, and leads to negative consequences of some kind. This can include a loss of job or family, arrest and criminal prosecution, and other such indicators of an inability to control these desires.

The term “frottage” was used in some early legal statutes and psychological descriptions of frotteurism, though the two words have since lost their synonymous nature. Frottage is now used to describe sexual acts of rubbing between two or more consenting participants. Some older statutes against frotteurism still include the term “frottage” when discussing the illegality of the practice, though they should not be confused. In general, such acts are considered sexual assault when perpetrated against an unwilling or unknowing target
Frotteurism

Causes

There is no scientific consensus concerning the cause of frotteurism. Most experts attribute the behavior to an initially random or accidental touching of another's genitals that the person finds sexually exciting. Successive repetitions of the act tend to reinforce and perpetuate the behavior.


Symptoms

    1.Recurrent, intense, or sexually arousing fantasies, sexual urges, or behaviors that involve touching and rubbing against a nonconsenting person.
    2.The person has acted on these sexual urges, or the fantasies or urges cause significant distress to the individual or are disruptive to his everyday functioning.

Hypochondriasis

Hypochondriasis is a somatoform disorder characterized by the preoccupation with the idea that one has a serious disease or the fear of having a serious disease. The preoccupation is based on the misinterpretation of one or more bodily signs or symptoms
Hypochondriasis
Symptoms of Hypochondriasis

    1.Preoccupation with bodily functions (heartbeat, sweating)
    2.Preoccupation with minor physical complaints (small sore, occasional cough)
    3.Preoccupation with vague and ambiguous physical sensations (tired heart, aching veins)
    4. Numerous complaints about pain (headaches, stomach aches, back pains)
     5. Hypersensitive to any small physical changes in their body
    6. Concern with having a deadly disease such as AIDS or cancer
    7.Seeking repeated physical examinations, diagnostic tests, and reassurance from physicians
    8.Physician reassurance and medical tests do not decrease the concern
    9. Being alarmed if friends or family are diagnosed with a disease
    10. Seeking reassurance from friends and family about their physical symptoms
    11.Doing extensive research on the disease, such as reading medical journals
    12."Doctor-shopping"—Visiting numerous doctors who will "correctly" identify and treat them.
    12.Complaints that doctors and specialists were not good or were unable to find the problem.
    13.Repeatedly checking own body for signs of disease, such as monitoring blood pressure, pulse, doing breast exams         etc.
    14Avoiding certain foods or activities thought to cause the disease.


the prevalence of hypochondriasis is estimated to be between 4 to 9 percent in those seeking treatment in outpatient settings. It tends to begin in early adulthood and is usually chronic. It is equally common in males and females. It is important to understand that hypochondriasis is not a way of seeking attention from others by pretending to be sick. Individuals honestly believe that they are suffering from a medical condition and feel misunderstood. Most individuals are not concerned with the pain but rather with what the physical symptoms imply.
Current research conducted at our Institute as well as other facilities, indicates that techniques used to treat obsessive compulsive disorder (OCD) are also effective for hypochondriasis. Cognitive therapy and exposure and response prevention (ERP) are the current psychological treatments of choice. Both individual and group treatments have proven successful. In addition, there are certain medications which might be helpful.

Cyclothymia

Cyclothymia is a chronic bipolar disorder characterized by short periods of mild depression and short periods of hypomania, separated by short periods of normal mood. Those who suffer from this disorder are never free of the symptoms of depression or of hypomania for more than two months at a time. Cyclothymia is equally common in men and women and affects up to 1% of the population. The disorder usually begins in the teen years or early adulthood. If left untreated, approximately 30% of those with cyclothymia eventually experience a full-blown manic episode and their diagnosis is changed to Bipolar I or Bipolar.

While a person with cyclothymia is not likely to end up in the hospital, the intense mood swings can seriously disrupt one's life. Imagine feeling on top of the world, ready to take on any project one day, just to wake up the next morning feeling down, depressed and blue. This is what it's like living with cyclothymia.


Symptoms

For cyclothymia to be diagnosed, hypomanic symptoms and depressive symptoms must be present alternately for at least two years. Mood swings seem to occur frequently in people with cyclothymia -- the switch from depression to hypomania and back again may occur every few days or weeks-- even every few hours in extreme cases! Mood swings are consistent; a person with cyclothymia is never symptom-free for longer than two months.

Causes of Cyclothymia

Despite extensive investigation, the exact cause of cyclothymia is still not known. Some researchers have suggested that the cycles of moods are brought on by a viral infection, but there is yet to be any conclusive support for this theory. Others have suggested that the symptoms are triggered by stressful events in one's life.

The most popular theory argues that cyclothymia is caused by a chemical imbalance in the brain. The brain is made up of nerve cells, called neurons, and chemicals, called neurotransmitters. According to this theory, an imbalance of one neurotransmitter, norepinephrine, is thought to cause the symptoms of bipolar disorder. It seems there are unusually high levels of norepinephrine in a person's brain during manic episodes, and low levels during depressive episodes.

Family history is another factor when determining the cause for cyclothymia. While those who have biological family members with cyclothymia are at risk of getting the disorder, it does not mean they will get it.

Dyspareunia

The pain one may feel during or after sexual intercourse is called dyspareunia. It is not a condition in itself but is caused by medical conditions or psychosocial problems.

Dyspareunia is almost exclusive to women, but it also affects men in rare cases. It is not uncommon for women to feel pain during intercourse; although true dyspareunia in women frequently occurs along with vaginismus, a condition that causes the vaginal muscles to tense up during penetration.
symptoms of Dyspareunia
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
Symptoms include a burning, ripping, tearing, or aching sensation associated with penetration. The pain can be at the vaginal opening, deep in the pelvis, or anywhere between. It may also be felt throughout the entire pelvic area and the sexual organs and may occur only with deep thrusting.
When pain occurs, the woman experiencing dyspareunia may be distracted from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease. Even after the original source of pain has disappeared, a woman may feel pain simply because she expects pain.
For men, the condition can result from such disorders as irritation of the skin of the penis due to an allergic rash; physical abnormalities of the penis, like a tight foreskin or a bowed erection; and infections of the prostate gland or testes.
causes of Dyspareunia
Any part of the genitals can cause pain during sex. Some conditions affect the skin around the vagina. The pain from these conditions is usually felt when a tampon or penis is inserted into the vagina, but pain can also occur even when sitting or wearing pants.
Inflammation or infection may be the cause; such as a yeast infection, urinary tract infection or inflammation of the vagina. Injury to the vagina and the surrounding area can also cause pain. If a diaphragm or cervical cap not fit correctly, sex may also be painful.
Pain during intercourse may feel like it is coming from deep in the pelvis. The uterus may hurt if there are fibroid growths, the uterus is tilted or if the uterus falls into the vagina.
Certain conditions or infections of the ovaries may also cause pain, especially in certain sexual positions. Past surgeries may leave scar tissue that can cause pain. Because the bladder and intestines are close to the vagina, they may also cause pain during sex. Endometriosis and pelvic inflammatory disease may also cause dyspareunia.
The mind and the body work together. This is also seen with sexual problems. Often the problem that first caused the pain may go away, but one has learned to expect the pain. This can lead to further problems because one may be tense during sex or unable to become aroused.
Negative attitudes about sex, misinformation about sex and misinformation about the functions of the woman's body are often associated with some types of pain.
In men, as in women, there are a number of physical factors that may cause sexual discomfort. Pain is sometimes experienced in the testicular or glands area of the penis immediately after ejaculation.
Infections of the prostate, bladder, or seminal vesicles can lead to intense burning or itching sensations following ejaculation. Men suffering from interstitial cystitis may experience intense pain at the moment of ejaculation. Gonorrheal infections are sometimes associated with burning or sharp penile pains during ejaculation. Urethritis or prostatitis can make genital stimulation painful or uncomfortable.
Anatomic deformities of the penis, such as exist in Peyronie's disease, may also result in pain during coitus. One cause of painful intercourse is due to the painful retraction of a too-tight foreskin, occurring either during the first attempt at intercourse or subsequent to tightening or scarring following inflammation or local infection.
During vigorous intercourse or masturbation, small tears may occur in the frenum of the foreskin and can be very painful.

Factitious Disorders

Factitious disorders are conditions in which a person acts as if he or she has a physical or mental illness when he or she is not really sick. Factitious disorder by proxy is when a person acts as if a person in their care has an illness when they do not.

People with factitious disorders deliberately create or exaggerate symptoms of an illness in several ways. They may lie about or fake symptoms, hurt themselves to bring on symptoms, or alter tests (such as contaminating a urine sample) to make it look like they or the person in their care are sick.
People with factitious disorders behave this way because of an inner need to be seen as ill or injured, not to achieve a clear benefit, such as financial gain. People with factitious disorders are even willing and sometimes eager to undergo painful or risky tests and operations in order to obtain the sympathy and special attention given to people who are truly ill or have a loved one who is ill. Factitious disorders are considered mental illnesses because they are associated with severe emotional difficulties.

Many people with factitious disorders also suffer from other mental conditions, particularly personality disorders. People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal. These people generally also have poor coping skills and problems forming healthy relationships.

Factitious disorders are similar to another group of mental disorders called somatoform disorders, which also involve the presence of symptoms that are not due to actual physical or mental illnesses. The main difference between the two groups of disorders is that people with somatoform disorders do not fake symptoms or mislead others about their symptoms on purpose.
types of Factitious Disorder

    Factitious disorder with mostly psychological symptoms: As the description implies, people with this disorder mimic behavior that is typical of a mental illness, such as schizophrenia. They may appear confused, make absurd statements and report hallucinations, the experience of sensing things that are not there; for example, hearing voices. Ganser syndrome, sometimes called prison psychosis, is a factitious disorder that was first observed in prisoners. People with Ganser syndrome have short-term episodes of bizarre behavior similar to that shown by people with serious mental illnesses.
    Factitious disorder with mostly physical symptoms: People with this disorder claim to have symptoms related to a physical illness, such as symptoms of chest pain, stomach problems, or fever. This disorder is sometimes referred to as Munchausen syndrome, named for Baron von Munchausen, an 18th century German officer who was known for embellishing the stories of his life and experiences.
    Factitious disorder with both psychological and physical symptoms: People with this disorder produce symptoms of both physical and mental illness.
    Factitious disorder not otherwise specified: This type includes a disorder called factitious disorder by proxy (also called Munchausen syndrome by proxy). People with this disorder produce or fabricate symptoms of illness in another person under their care. It most often occurs in mothers (although it can occur in fathers) who intentionally harm their children in order to receive attention.

Symptoms of Inhalant Abuse

Inhalants include common household products, such as glues, hair sprays, paints, and lighter fluid, which can be used by individuals to get high. The warning signs of inhalant abuse are similar to indicators that one is under the influence of alcohol. Key signs include:
    1.slurred speech
    2.lack of coordination
    3. euphoria
    4.dizziness
    5.lightheadedness
    6.hallucinations
    7.delusions
Chemicals found in different types of inhaled products may produce a variety of symptoms during and after usage. Repeated inhalant abuse may result in symptoms such as:
    1.loss of inhibitions
    l2.ack of control
    3.periods of drowsy feelings that last several hours
    .4. headache
      5.confusion
    6. nausea
     7.vomiting

Effects of Inhalants Abuse
Inhaling highly concentrated amounts of the chemicals in solvents or aerosol sprays can cause heart failure and death within minutes after repeated inhalation. This syndrome, known as sudden sniffing death, can result from a single session of inhalant use by an otherwise healthy person. In the case of an inhalant addiction where inhalants are used repeatedly, this risk increases substantially.

Many people inhale vapors from common inhalants, referred to as huffing, not knowing that serious health problems can result. Harmful, and potentially irreversible, side effects of inhalant abuse include:

    hearing loss (spray paints, glues, dewaxers, dry-cleaning chemicals, correction fluids)
    peripheral neuropathies resulting in difficulty with moving hands and feet or limb spasms (glues, gasoline, whipped cream dispensers, gas cylinders)
    central nervous system or brain damage (spray paints, glues, dewaxers)
    bone marrow damage (gasoline)
    liver and kidney damage (correction fluids, dry-cleaning fluids)
    blood oxygen depletion (varnish removers, paint thinners)

The process of abusing inhalants displaces air in the lungs and deprives the body of oxygen. This results in a condition known as hypoxia. Hypoxia can damage cells in the brain. The symptoms of brain hypoxia vary depending on which regions of the brain are affected. As an example, the hippocampus is an important brain area for memory that is very sensitive to hypoxia. So someone who repeatedly abuses inhalants may lose the ability to learn new things or may have a hard time carrying on simple conversations if her hippocampus is damaged.

Long-term inhalant abuse can also destroy myelin, a fatty tissue that surrounds and protects nerve fibers. As myelin helps nerve fibers carry their messages quickly and efficiently, its break down can lead to muscle spasms and tremors or even permanent difficulty with basic actions such as walking, bending, and talking.

High concentrations of inhalants may also cause death from suffocation by displacing oxygen in the lungs, causing the user to lose consciousness and stop breathing. Deliberately inhaling from a paper or plastic bag or in a closed area greatly increases the chances of suffocation.

Somatization disorder

A person with somatization disorder is chronically preoccupied with numerous "somatic" (physical) symptoms over many years. These symptoms, however, cannot be explained fully by a non-psychiatric diagnosis. Nonetheless, the symptoms cause significant distress or impair the person's ability to function.

The person is not "faking." Somatization disorder is a medical problem. The disorder, however, is probably related to brain functioning or emotional regulation rather than the area of the body that has become the focus of the patient's attention. The symptoms are real and are not under the person's conscious control.

People with somatization disorder report multiple medical problems over many years, involving several different areas of the body. For example, the same person might have back pain, headaches, chest discomfort, and stomach or urinary distress. Women often report irregular periods. Men may report erectile dysfunction (impotence). The person may:

    1.Describe symptoms in dramatic and emotional terms

    2.Seek care from more than one physician at the same time

    3. Describe symptoms in vague terms

    4.Lack signs of defined medical illness

    5.Have complaints that medical tests fail to support

People with somatization disorder do get diagnosable medical illnesses, too, so doctors must be careful not to dismiss symptoms too easily.

A person with somatization disorder also may have symptoms of anxiety and depression. He or she may begin to feel hopeless and attempt suicide, or may have trouble adapting to the stresses of life. The person may abuse alcohol or drugs, including prescription medications.

Spouses and other family members may become distressed because the person's symptoms continue for long periods of time and no medical treatment seems to help.

Symptoms of somatization disorder vary by culture, sometimes depending on how illness or "sick roles" are viewed in a given culture. Cultural factors also affect the proportions of men and women with the disorder.

Female relatives of people with somatization disorder are more likely to develop the disorder. Male relatives are more likely to develop alcoholism and personality disorder.

Scientists do not know the cause of the symptoms reported by people with somatization disorder, but researchers have some theories. It is possible, for example, that people with this disorder perceive bodily sensations in an unusual way. Or they may describe feelings in physical (rather than mental or emotional) terms. Trauma or stress may cause a person's physical sensations to change.

Trichotillomania

Trichotillomania, a hair-pulling disorder, is a mental disorder that involves an irresistible urge to pull out hair. This behavior occurs to the point of noticeable hair loss. The most common areas for hair pulling are the scalp, eyelashes, and eyebrows but may involve hair anywhere on the body.

Trichotillomania is a type of impulse control disorder. Impulse control disorders are mental illnesses that involve the repeated failure to resist impulses, or urges, to act in ways that are dangerous or harmful. People with these disorders know that they can hurt themselves or others by acting on the impulses, but they cannot stop themselves.

In children, trichotillomania occurs equally in males and females. In adults, it is more common in women than in men.
Symptoms of Trichotillomania
A person with trichotillomania cannot control or resist the urge to pull out his or her body hair. Other symptoms that might occur with this disorder include:

    A sense of tension before pulling hair or when trying to resist the urge to pull hair
    A feeling of relief, satisfaction, and/or pleasure after acting on the impulse to pull hair
    Presence of bare patches where the hair has been pulled out
    Presence of other associated behaviors such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on the hair, or eating hair (called trichophagia)

Many people who have trichotillomania try to deny they have a problem and may attempt to hide their hair loss by wearing hats, scarves, and false eyelashes and eyebrows.
Causes to Trichotillomania
The exact cause of trichotillomania is not yet known, but it appears to involve both biological and behavioral factors. Research has found a potential link between impulse control disorders, such as trichotillomania, and certain brain chemicals called neurotransmitters. Neurotransmitters help nerve cells in the brain send messages to each other. An imbalance of these chemicals can affect how the brain controls impulses. It also is believed that stress can trigger the impulsive behavior, and that some people continue the behavior out of habit.

In some cases, people with trichotillomania also have other disorders such as depression or anxiety. This suggests that there might be a link between these disorders and the development of trichotillomania. In addition, the risk of developing trichotillomania is slightly higher in people who have relatives with the disorder, suggesting that a tendency for the disorder may be inherited.

Tardive Dyskinesia Symptoms

There has been little research on the movement disorder known as tardive dyskinesia (TD), which affects approximately 20 percent of patients who have been treated for certain psychoses with medications known as dopamine antagonists. The symptoms of tardive dyskinesia are a side effect of medications that are targeted at the specific dopamine receptor involved in emotion and lower cognitive function. These medications, including metoclopramide (commonly known as Reglan, Deglan and Maxolon to name a few), wind up affecting the function of voluntary muscle control.
Part of the difficulty in diagnosing tardive dyskinesia lies in the fact that symptoms are similar to other types of disorders, including Tourette's syndrome. One variety of tardive dyskinesia, known as tardive tourettism, is so similar that only careful study of the circumstances surrounding the onset of the disorder can determine which condition is actually present.

Other similar disorders include tardive dystonia, akathisia and myoclonus. The first differs from other types of dystonia (muscle spasms and uncontrollable movements in the torso) in that the tardive variety is permanent and is drug-related as opposed to being caused by genetics, injury, infection or environmental toxins.

Akathisia is more internalized and accompanied by inner anxiety. It is also more generalized, involving the entire body. Myoclonus manifests itself most often as brief, jerky contractions of a particular muscle group. However, the term actually refers to a symptom that may be the result of any number of neurological disorders. In most cases, a differential diagnosis is required in order to determine what strain of tardive dyskinesia is present.
Regardless of the variety of the disease, tardive dyskinesia is characterized by sudden, uncontrollable movements of voluntary muscle groups. Signs of classic tardive dyskinesia normally consist of coordinated, constant movements of the mouth, tongue, jaw and cheeks. The patient may move their jaw laterally or up and down, as if chewing. The tongue may suddenly protrude or move about in a squirming, twisting manner. Repeated lip smacking and puffing of the cheeks may also be present. Severity of the condition is indicated by the frequency of these movements or spasms. In extreme cases, the tongue may move well over 60 times a minute.

In some cases, tardive dyskinesia patients may experience movement in the limbs and digits. Interestingly, these involuntary movements are more pronounced when the patient attempts to relax. Any emotional arousal or agitation tends to cause these movements to decrease. Symptoms may disappear completely when the patient is asleep.

Claustrophobia

Claustrophobia is a common fear. When people have this phobia they become anxious or panicked when they are in enclosed spaces. What can be defined as an enclosed space is different based on the person with this phobia. They could include elevators, small rooms (like doctor’s examining rooms) with the door shut, cars caught in traffic, or others situations. Like most phobias, claustrophobia is irrational, and usually rational thought can’t cure it. Even if a person knows that closed space poses no danger, they can become extremely panicked when in such a space.

Symptoms of claustrophobia emerge when a person is in an enclosed space. These could include feelings of restlessness, anxiety, perspiration, crying, full-blown panic attacks or increased heart or respiration rate. Some people feel they can’t adequately breathe in enclosed spaces, and are deeply desirous to get out of them as quickly as possible.

Those who suffer from minor claustrophobia may be able to manage the condition on their own. They’d opt for using the stairs instead of stepping into an elevator. They might ask for an open cubicle at work instead of a closed small office. Others find the condition is well beyond manageable and they may require treatment in order to overcome it.
Most treatment for phobias follows a similar path. To address panicked feelings, when true panic attacks occur, a psychiatrist might prescribe anti-anxiety medications. These are commonly either selective serotonin reuptake inhibitors (SSRIs) or a group of tranquilizers called benzodiazepines, which include drugs like Xanax® and Valium®. This is only half the battle because these drugs do nothing to address the fears creating claustrophobia.

The other part of treatment is counseling, usually desensitization therapy. Counselors might first look to identify when the fear emerged, though this isn’t always knowable. They may then work with the claustrophobic person by gradually helping him or her get used to being in smaller spaces while feeling safe at the same time. Another counseling method that may work with people with claustrophobia is cognitive behavioral therapy.

Those suffering from this condition can find that they must avoid so many activities that life becomes difficult to live normally. This is why treatment for the condition is so important. However a lot of people have at least mild claustrophobia, and feel panicked or worried when they are in enclosed small spaces. Size of the space isn’t always that important; sometimes the fear more centers on the fact that the person feels trapped or closed in. Even in a large mall with few windows, a person with significant claustrophobia could feel confined and restricted.

Fortunately, treatment for this condition is often very effective. It can gradually help the person overcome fear of confinement. In the interim, while therapy is in progress, drug treatment may help make panic symptoms more manageable.

Adjustment Disorder

Adjustment Disorder is an abnormal and excessive reaction to an identifiable life stressor. The reaction is more severe than would normally be expected, and can result in significant impairment in social, occupational or academic functioning.

The response may be linked to a single event (a flood or fire, marriage, divorce, starting school, new job) or multiple events (marital problems or severe business difficulties). Stressors may be recurrent events (child witnessing parents constantly fighting, chemotherapy, financial difficulties) or continuous (living in a crime-ridden neighborhood).

Adjustment Disorder often occurs with one or more of the following: depressed mood; anxiety, disturbance of conduct (in which the patient violates rights of others or major age-appropriate societal norms or rules), and maladaptive reactions (problems related to job or school, physical complaints, social isolation).

Adjustment disorders are associated with higher risk of suicide and suicidal behavior; substance abuse; prolonging of other medical disorders or interference with their treatment. Adjustment disorder that persists may progress to become a more serious mental disorder
Adjustment Disorder
causes

    Depressed mood
    Impaired occupational/social functioning
    Agitation
    Trembling or twitching
    Physical complaints (e.g. general aches and pains, stomachache, headache, chest pain)
    Palpitations
    Conduct disturbances (e.g. truancy, vandalism, reckless driving or fighting)
    Withdrawal
    Anxiety, worry, stress and tension
Symptoms may vary widely. The person may or may not be aware of the stressor causing the disturbance.

Diagnosis depends on the following:

    The reaction clearly follows a life stressor. Within three months of stressor onset, emotional and behavioral symptoms develop in response to stressor
    Symptoms seem excessive compared to what would normally be expected in relation to stressor and/or, symptoms significantly impair occupational, school or social functioning
    Symptoms are not explained by another diagnosis
    Symptoms are not part of bereavement
    Symptoms do not last longer than six months after end of stressor
    The diagnosis may be acute (symptoms last less than six months) or chronic (symptoms last six months or longer as when stressors are chronic or have lasting effects)

Sadomasochism

Sadomasochism is a paraphilia that supports both sadistic and masochistic sexual behavioral patterns. The main characteristic of sadomasochism is the eroticizing of pain.
What looks to the average person as to be somewhat painful, even very painful, is experienced to the sadomasochist as completely pleasurable and very sexually arousing to them.

Two people each play a role in this activity. One plays the sadist which is the sadomasochistic role of the pair, and the person who inflicts the pain and/or punishment. The other role is played by the masochist who is the person who submits to enduring the pain, humiliation to their partner the sadist the one who is in control.

This is all played out by having sexual encounters, generally played out like a scripted scene in a theater production. These sexual and simulating interactions between the Sadist who would play the domineering role and the masochist who plays the submissive one.

The characters roles would play out like this; the master or mistress and slave, employer and servant-maid, teacher and student, owner and horse or dog, and parent and child.

Sadomasochists like to play the roles right down to the clothing and may wear black leather masks and being chained to a wall and whipped . Others like to be tied and blind folded to a bed and getting running silk or ice cubes or rabbit fur over their body.

It’s not always about a couple, male and female, some gay males and heterosexuals engage in a genre of sadomasochism known as “leathersex”.

The euphoria experienced by the release of endorphins may explain the need for some “masochists” to want to have this physical and painful experience.

Just as popular as the scenes of humiliation, is the enforcer, and  who has nonphysical punishments placed upon them It is a bit confusing how they get their euphoria high in the attraction, where there is no physical pain.

Sadomasochists occasionally swap their roles from masochistic to the sadistic role. In a softer atmosphere, and without excessive cruelty or bodily pain and punishment, a role of a dominant controlling partner and one of a submissive partner are behaviors that might be found in many marriages and/or relationships found today, or could possibly be a part of some fantasy role-playing.

As sadomasochistic role-playing in their most extreme forms can be physically and psychologically precarious, the larger population engaging in these type of behaviors do so with the knowledge of the dangers and consequences and stay carefully within predetermined limits agreed upon.