ACTUALIZING

Complicated Grief

2009-01-02T01:00:00.000-08:00

Definition

Losing a loved one is one of the most distressing and emotional experiences people face. But because death is such a common life experience, virtually everyone deals with grief at some point. Despite the emotional difficulty, most people experiencing normal grief and bereavement endure a period of sorrow, numbness, and even guilt and anger, followed by a gradual fading of these feelings as they accept the loss and move forward.

For some people, though, this normal grief reaction becomes much more complicated, painful and debilitating, or what's known as complicated grief. In complicated grief, painful emotions are so long lasting and severe that you have trouble accepting the death and resuming your own life.

Researchers are beginning to pay more attention to complicated grief because of the serious toll it can exact — possibly leading to depression and thoughts of suicide. Researchers have even developed a new treatment that may help people with complicated grief come to terms with their loss and reclaim a sense of joy and peace.

Symptoms

Mental health experts are still analyzing how complicated grief symptoms differ from those of normal grief or other bereavement reactions. During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually start to fade within six months or so, those of complicated grief get worse or linger for months or even years. Complicated grief is like being in a chronic, heightened state of mourning.

Signs and symptoms of complicated grief can include:

Extreme focus on the loss and reminders of the loved one
Intense longing or pining for the deceased
Problems accepting the death
Numbness or detachment
Preoccupation with your sorrow
Bitterness about your loss
Inability to enjoy life
Depression or deep sadness
Difficulty moving on with life
Trouble carrying out normal routines
Withdrawing from social activities
Feeling that life holds no meaning or purpose
Irritability or agitation
Lack of trust in others

Causes

It's not known what causes complicated grief. As with many mental health disorders, it may involve a complex interaction between your genes, environment, your body's natural chemical makeup and your personality.

Some researchers believe in the five stages of grief theory, attributed to the late psychiatrist Elizabeth Kubler-Ross, M.D. Although she intended this process for people at the end of their lives, some researchers said that bereaved survivors also went through these stages in an orderly fashion:

Denial, shock or isolation
Anger
Bargaining
Depression or sadness
Acceptance of the loss

People who didn't follow the steps in order or who became stuck at one of these stages were thought to be in an unhealthy grieving pattern. Today, though, most grief experts don't embrace this theory, instead believing that while grief is an evolution, most people don't go through organized stages.

Risk factors

Complicated grief is considered relatively uncommon. Because research about complicated grief is evolving, it's difficult to know how many people are affected. Some estimates suggest that as few as 6 percent or as many as 20 percent of bereaved people develop complicated grief.

While it's not known specifically what causes complicated grief, researchers continue to learn more about the factors that may increase the risk of developing it. These risk factors may include:

An unexpected or violent death
Suicide of a loved one
Lack of a support system or friendships
Traumatic childhood experiences, such as abuse or neglect
Childhood separation anxiety
Close or dependent relationship to the deceased person
Being unprepared for the death
In the case of a child's death, the number of remaining children
Lack of resilience or adaptability to life changes

When to seek medical advice

It's normal to experience grief after a significant loss. Most people who experience normal or uncomplicated grief can move forward eventually with support from family and friends. But if it's been several months or more since your loss and your emotions remain so intense or debilitating that you have trouble going about your normal routine, consider talking to your health care provider.

Specifically, you may benefit from professional help if you:

Can focus on little else but your loved one's death
Have persistent pining or longing for the deceased person
Have thoughts of guilt or self-blame
Believe that you did something wrong or could have prevented the death
Feel as if life isn't worth living
Have lost your sense of purpose in life
Wish you had died along with your loved one

At times, people with complicated grief may consider suicide. If you're considering suicide, reach out to someone as soon as possible. The best choice is to call 911 or your local emergency services number.

Tests and diagnosis

Complicated grief isn't yet recognized by mental health providers as an actual disorder. However, there's growing consensus that it should be. And even though it's not an official disorder, you may still be diagnosed with complicated grief.

To help diagnose complicated grief, mental health providers perform a thorough psychological evaluation. They ask many questions about the events surrounding the loss of your loved one, your mood, thoughts and behavior, your lifestyle and social situation, and sleeping and eating patterns, for example. You may also fill out psychological questionnaires. And you may have a physical exam to check for any other health problems that may be causing or contributing to your symptoms.

Because bereavement also can lead to other disorders, such as depression or post-traumatic stress disorder, you may be evaluated for those conditions.

Generally, to be diagnosed with a certain mental health disorder, someone must meet specific criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Because complicated grief isn't yet considered an actual disorder, it's not listed in the current DSM and has no official diagnostic criteria. However, some researchers have proposed adding complicated grief as a specific disorder in the next version of the DSM, scheduled for publication in 2011. Different diagnostic criteria have been proposed. One proposal that has gotten support includes these criteria:

Intense pining or longing for the deceased that occurs daily or is distressing or disruptive
Trouble accepting the death
Inability to trust others after the death
Difficulty moving forward with life
Excessive bitterness or anger related to the death
Feeling emotionally numb or detached from others
A feeling that life is now meaningless
A belief that the future won't be fulfilling
Increased agitation or jumpiness

For diagnosis of complicated grief, these symptoms must last at least six months and cause impairment or disruption in your ability to function in daily life, such as at work or in social engagements.

Complications

Complicated grief can affect you physically, mentally and socially. Without appropriate treatment, these complications can include:

Depression
Suicidal thoughts or behaviors
Increased risk of heart disease, cancer and high blood pressure
Anxiety
Long-term impairment in daily living
Post-traumatic stress disorder
Substance abuse
Smoking or nicotine use

Treatments and drugs

Complicated grief treatment hasn't been standardized because mental health providers are still learning about the condition. Research studies testing various types of treatment have had mixed results. That isn't to say that treatment isn't helpful, though. More study is needed to help determine which treatment options may be best for complicated grief.

Psychotherapy
Some studies have shown big benefits from treating complicated grief with a newly developed type of psychotherapy called complicated grief treatment, also called complicated grief therapy. This form of psychotherapy, which borrows from cognitive behavior therapy and trauma therapy, is comprehensive and sometimes intense. You may learn about such topics as grief reactions, complicated grief symptoms, adjusting to your loss and redefining your life's goals.

This therapy also includes holding imagined conversations with your loved one and retelling the circumstances of the death, perhaps several times to help you become less distressed by images and thoughts of your loved one. Although some people find this therapy painful, others find it ultimately rewarding and freeing after what may have been years of chronic mourning.

Other forms of therapy, such as interpersonal therapy or psychodynamic psychotherapy, also may be effective. Therapy can help you explore and process emotions, improve coping skills and reduce feelings of blame and guilt.

Medications
There's little solid research on the use of psychiatric medications to treat complicated grief. However, some research has shown benefits from using antidepressants in the class of selective serotonin reuptake inhibitors (SSRIs) to reduce complicated grief symptoms.

Prevention

It's not clear how to prevent complicated grief with any certainty. Some studies suggest that participating in a brief course of counseling or psychotherapy soon after a loss may help, especially for those at increased risk of developing complicated grief. In addition, caregivers providing end-of-life care for a loved one may benefit from counseling and support to help prepare for death and its emotional aftermath.

Through early counseling, you can explore emotions surrounding your loss and learn healthy coping skills. This may help prevent negative beliefs about your loss from gaining such a strong hold that they're difficult to overcome. People who themselves may be at risk of suicide following a loved one's suicide may especially benefit from grief counseling or other treatment.

Finding support from family, friendships, group therapy or social support groups after a loss can promote healthy grieving. You can also take steps to improve your resilience skills to help cope with hardships and loss.

Coping and support

Although it's important to get professional treatment for complicated grief, you can take steps on your own to cope, including:

Stick to your treatment plan. Take medications as directed and attend therapy appointments as scheduled.
Exercise regularly. Physical exercise helps relieve depression, stress and anxiety and can redirect your mind to the activity at hand.
Take care of yourself. Get enough rest, eat a balanced diet and take time to relax. Don't turn to alcohol or unprescribed drugs for relief.
Reach out to your faith community. If you follow religious practices or traditions, you may gain comfort from rituals or guidance from a spiritual leader.
Practice stress management. Learn how to better manage stress. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
Socialize. Stay connected with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.
Plan ahead for special dates or anniversaries. Holidays, anniversaries and special occasions can trigger painful reminders of your loved one. Find new ways to celebrate or acknowledge your loved one that provide you comfort and hope.
Learn new skills. If you were highly dependent on your loved one, perhaps to handle the cooking or finances, for example, try to master these tasks yourself. Ask family, friends or professionals for guidance, if necessary. Seek out community classes and resources, too.
Join a support group. You may not be ready to join a support group immediately after your loss, but over time you may find shared experiences comforting and you may form meaningful new relationships.

Complex PTSD

2008-12-18T12:14:00.000-08:00

From: http://www.ncptsd.va.gov

by
Julia M. Whealin, Ph.D. and Laurie Slone, Ph.D.

Differences between the effects of short-term trauma and the effects of chronic trauma?

The diagnosis of PTSD accurately describes the symptoms that result when a person experiences a short-lived trauma. For example, car accidents, natural disasters, and rape are considered traumatic events of time-limited duration. However, chronic traumas continue or repeat for months or years at a time. Clinicians and researchers have found that the current PTSD diagnosis often does not capture the severe psychological harm that occurs with such prolonged, repeated trauma. For example, ordinary, healthy people who experience chronic trauma can experience changes in their self-concept and the way they adapt to stressful events. Dr. Judith Herman of Harvard University suggests that a new diagnosis, called Complex PTSD, is needed to describe the symptoms of long-term trauma. Another name sometimes used to describe this cluster of symptoms is: Disorders of Extreme Stress Not Otherwise Specified (DESNOS).

Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met criteria for PTSD, Complex PTSD was not added as a separate diagnosis. Complex PTSD may indicate a need for special treatment considerations.

What are examples of types of captivity that are associated with chronic trauma?

Judith Herman notes that during long-term traumas, the victim is generally held in a state of captivity, physically or emotionally. In these situations the victim is under the control of the perpetrator and unable to flee.

Examples of captivity include:

Concentration camps
Prisoner of War camps
Prostitution brothels
Long-term domestic violence
Long-term, severe physical abuse
Child sexual abuse
Organized child exploitation rings

What are the symptoms of Complex PTSD?

The first requirement for the diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization. Those symptoms include:

Alterations in emotional regulation

This may include symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger

Alterations in consciousness

This includes things such as as forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body

Changes in self-perception

This may include a sense of helplessness, shame, guilt, stigma, and a sense of being completely different than other human beings

Alterations in the perception of the perpetrator

For example; attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge

Alterations in relations with others

Variations in personal relations including isolation, distrust, or a repeated search for a rescuer

Changes in one's system of meanings

This may include a loss of sustaining faith or a sense of hopelessness and despair

What other difficulties do those with Complex PTSD tend to experience?

Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.
Survivors may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma.
Survivors may also engage in self-mutilation and other forms of self-harm.

There is a tendency to blame the victim.

A person who has been abused repeatedly is sometimes mistaken as someone who has a "weak character."

Because of their chronic victimization, in the past, survivors have been misdiagnosed by mental-health providers as having Borderline, Dependent, or Masochistic Personality Disorder. When survivors are faulted for the symptoms they experience as a result of victimization, they are being unjustly blamed.

Researchers hope that a new diagnosis will prevent clinicians, the public, and those who suffer from trauma from mistakenly blaming survivors for their symptoms.

Summary

The current PTSD diagnosis often does not capture the severe psychological harm that occurs with prolonged, repeated trauma. For example, long-term trauma may impact a healthy person's self-concept and adaptation. The symptoms of such prolonged trauma have been mistaken for character weakness. Research is currently underway to determine if the Complex PTSD diagnosis is the best way to categorize the symptoms of patients who have suffered prolonged trauma.

References

Ford, J. D. (1999). Disorders of extreme stress following war-zone military trauma: Associated features of Posttraumatic Stress Disorder or comorbid but distinct syndromes? Journal of Consulting and Clinical Psychology, 67, 3-12.

Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.

Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 10, 539-555.

Complex post-traumatic stress disorder

2008-12-18T00:53:00.000-08:00

From: Wikipedia

Complex post-traumatic stress disorder (C-PTSD) is a clinically recognized condition that results from extended exposure to extremes of social and/or interpersonal trauma, including sexual abuse (especially child sexual abuse), physical abuse, emotional abuse, domestic violence, and torture. A differentiation between the diagnostic categorizations of C-PTSD and that of Post traumatic stress disorder (PTSD) has been suggested, as C-PTSD better describes the pervasive negative impact of chronic trauma than does PTSD alone.[1][2] As a descriptor, PTSD fails to capture some of the core characteristics of C-PTSD. These elements include psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized, and, most importantly, the loss of a coherent sense of self. It is this loss of a coherent sense of self, and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD.[3]

Symptom profile

C-PTSD is characterized by chronic difficulties in many areas of emotional and interpersonal functioning. Symptoms may include:^[3]^[2]

Difficulties regulating emotions, including symptoms such as persistent sadness, suicidal thoughts, explosive anger, or covert anger, which is characteristic of passive-aggressive behavior

Variations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes of dissociation (during which one feels detached from one's mental processes or body)

Changes in self-perception, such as a sense of helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings

Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge

Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer

Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair

Treatment

Treatment for C-PTSD tends to require a multi-modal approach.^[4] It has been suggested that treatment for C-PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems.^[5] Six suggested core components of complex trauma treatment include:^[4]

Safety
Self-regulation
Self-reflective information processing
Traumatic experiences integration
Relational engagement
Positive affect enhancement

Multiple treatments have been suggested for C-PTSD. Among these treatments are group therapy, cognitive behavioral therapy, eye movement desensitizations and reprocessing, and psychodrama. As C-PTSD is a fairly new concept, therapeutic protocols are just being developed.^[6] Current medical care includes the use of SSRIs^{[citation needed]}, and sometimes the atypical antipsychotics^{[citation needed]}.

Since C-PTSD shares symptoms with both PTSD and borderline personality disorder,^[7] it is likely that a combination of treatments utilized for these conditions would be helpful for an individual with C-PTSD, such as dialectic behavior therapy and exposure therapy.^{[citation needed]}

Footnotes

^ van der Kolk BA, Courtois CA (2005). "Editorial comments: Complex developmental trauma". J Trauma Stress 18 (5): 385–8. doi:10.1002/jts.20046. PMID 16281236.
^ ^a ^b Julia M. Whealin, Ph.D. and Laurie Slone, Ph.D.. "Complex PTSD". National Center for Posttraumatic Stress Disorder. United States Department of Veteran Affairs.
^ ^a ^b Herman, Judith Lewis (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books. pp. 119–122. ISBN 0465087302.
^ ^a ^b Cook, A.; Blaustein, M.; Spinazzola, J.; Van Der Kolk, B. (2005). "Complex trauma in children and adolescents". Psychiatric Annals 35 (5): 390–398. http://doi.apa.org/?uid=2005-05449-004. Retrieved on 29 March 2008.
^ van der Kolk BA, Roth S, Pelcovitz D, Sunday S, Spinazzola J (2005). "Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma". J Trauma Stress 18 (5): 389–99. doi:10.1002/jts.20047. PMID 16281237.
^ Treating Complex PTSD http://www.cavalcadeproductions.com/ptsd-treatment.html
^ Taylor S, Asmundson GJ, Carleton RN (2006). "Simple versus complex PTSD: a cluster analytic investigation". J Anxiety Disord 20 (4): 459–72. doi:10.1016/j.janxdis.2005.04.003. PMID 15979838.

References

Appleyard, K.; Osofsky, J.D. (2003). "Parenting after trauma: Supporting parents and caregivers in the treatment of children impacted by violence". Infant Mental Health Journal 24 (2): 111–125. doi:10.1002/imhj.10050.
Cook, A.; Blaustein, M.;Spinazzola, J.; and van der Kolk, B., (2003) Complex trauma in children and adolescents. White paper from the National Child Traumatic Stress Newtork Complex Trauma Task Force.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., et al., (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390-398.
Herman, JL (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
Scott, Catherine V.; Briere, John (2006). Principles of Trauma Therapy : A Guide to Symptoms, Evaluation, and Treatment. Thousand Oaks: Sage Publications. ISBN 0-7619-2921-5.
Ford JD (1999). "Disorders of extreme stress following war-zone military trauma: associated features of posttraumatic stress disorder or comorbid but distinct syndromes?". J Consult Clin Psychol 67 (1): 3–12. PMID 10028203.
Roth S, Newman E, Pelcovitz D, van der Kolk B, Mandel FS (1997). "Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder". J Trauma Stress 10 (4): 539–55. PMID 9391940.
van der Kolk, B.A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). "Disorders of extreme stress: the empirical foundation of a complex adaptation to trauma". Journal of Traumatic Stress 18, 389-399.

External links

Complex post-traumatic stress disorder at the Open Directory Project
U.S. Department of Veterans Affairs
Recommended DSM criteria
Carrot of Hope PTSD group
Sidran Institute traumatic stress information

PTSD and Physical Health

2008-12-17T14:46:00.000-08:00

From: Veterans Affairs Canada

A National Center for PTSD Fact Sheet
By Kay Jankowsi, Ph.D.

Exposure to traumatic events such as military combat, physical and sexual abuse, and natural disaster, can be related to poor physical health. Posttraumatic Stress Disorder (PTSD) is also related to health problems. This fact sheet provides information on the relationships between trauma, PTSD, and physical health; specific health problems associated with PTSD; health-risk behaviors and PTSD; mechanisms that help explain how PTSD and physical health could be related; and a clinical agenda to address PTSD and health.

Before addressing these topics, it is necessary to provide some basic information about how existing studies have measured physical health. The most common way to measure physical health is by having people report about their own health conditions, symptoms, and overall physical health. Self-report measures of physical health can be valid indicators of actual illness, but they should be interpreted with caution because they may be influenced by psychological health. The most reliable measure of physical health involves a physician's diagnosis or laboratory tests.

Is psychological trauma related to physical health?

A considerable amount of research has found that trauma has negative effects on physical health. The relationship is clearest when examining self-report of physical health problems and trauma experienced as a result of time in the military, sexual assault, childhood abuse, and motor vehicle accidents. Greater self-report of military trauma, sexual assault, childhood abuse, and motor vehicle accidents is related to greater self-report of health problems. However, when health status is measured by physician diagnosis, associations are not as consistent for military trauma and sexual assault in adulthood. There is, however, a probable association for survivors of natural disaster. Two recent studies found that reports of childhood abuse and neglect were related to an increase in physician diagnosed disorders including cancer, ischemic heart disease, and chronic lung disease. It is also likely that a relationship exists between the experience of a trauma and an increase in utilization of medical services for physical health problems. In addition, health care costs have been found to be higher among women who report a history of childhood abuse or neglect than among women who report no history of maltreatment as a child.

What is the relationship between physical health and PTSD?

A growing body of literature has found a link between PTSD and physical health. Some studies have found that PTSD explains the association between exposure to trauma and poor physical health. In other words, trauma may lead to poor health outcomes because of PTSD. When health problems are measured by self-report, there is a clear association with PTSD for veterans and active duty personnel, civilian men and women, firefighters, and adolescents. Those who report that they have PTSD symptoms are more likely to have a greater number of physical health problems than those who do not have PTSD. Similar results are found when physical health is measured by physician report or by laboratory tests. PTSD also has been found to be associated with greater medical service utilization for physical health problems. At present, however, an association between PTSD and illness via physician diagnosis and medical service utilization has only been examined in veteran populations. Further research is indicated to examine PTSD, physical illness, and medical service utilization in both veteran and other traumatized populations.

Existing research has not been able to determine conclusively that PTSD causes poor health. Thus, caution is warranted in making a causal interpretation of what is presented here. It may be the case that something associated with PTSD is actually the cause of greater health problems. For example, it could be that a factor associated with PTSD, such as smoking, is the actual cause of the increased health problems. This is not likely, however, given that we know that PTSD is associated with poor physical health even when behavioral factors such as smoking are controlled.

PTSD may promote poor health through a complex interaction between biological and psychological mechanisms. The National Center for PTSD and other laboratories around the world are studying these mechanisms. Current thinking is that the experience of trauma brings about neurochemical changes in the brain. These changes may have biological, as well as psychological and behavioral, effects on one's health. For example, these neurochemical changes may create a vulnerability to hypertension and atherosclerotic heart disease that could explain in part the association with cardiovascular disorders. Research also shows that these neurochemical changes may relate to abnormalities in thyroid and other hormone functions, and to increased susceptibility to infections and immunologic disorders associated with PTSD.

The psychological and behavioral effects of PTSD on health may be accounted for in part by comorbid depressive and anxiety disorders. Many people with PTSD also experience depressive disorders or other disorders. Depressed individuals report a greater number of physical symptoms and use more medical treatment than do individuals who are not depressed. Depression also has been linked to cardiovascular disease in previously healthy populations and to additional illness and mortality among patients with serious medical illness. PTSD also may be related to poor health through symptoms of comorbid anxiety or panic. The evidence linking anxiety to cardiovascular morbidity and mortality is quite strong, but the mechanisms are largely unknown.

Hostility, or anger, is another possible mediator of the relationship between PTSD and physical health. It is commonly associated with PTSD and decades of research on the health risks associated with the Type A behavior pattern have isolated hostility as a crucial factor in cardiovascular disease. PTSD and poor health also may be mediated in part by behavioral risk factors for disease such as smoking, substance abuse, diet, and lack of exercise.

Little is known about how coping and social support relate to health in PTSD, but it is likely that both play important roles. Further research is needed to better understand these potential protective factors.

What specific health problems are related to PTSD?

There is not a lot of information about what specific health problems are associated with PTSD. Many studies have not looked at specific health problems but instead report only the number of overall health problems associated with PTSD. Some studies have examined specific health problems, but these problems have been primarily self-reported. However, there is some evidence to indicate PTSD is related to cardiovascular, gastrointestinal, and musculoskeletal disorders. There is also one study with similar findings that evaluated physician diagnosed disorders and PTSD in relation to specific body systems.

A number of studies have found an association between PTSD and poor cardiovascular health. These studies found that self-report of circulatory disorders and symptoms of cardiovascular trouble were each associated with PTSD in veteran populations, civilian men and women, and male firefighters. Among studies that have examined PTSD in relation to cardiovascular illness via physician diagnosis or laboratory findings, PTSD has been consistently associated with a greater likelihood of cardiovascular morbidity. In a recent study, researchers used electrocardiogram (ECG) findings to compare the cardiovascular function of Vietnam veterans with PTSD to the cardiovascular function of veterans without PTSD. After controlling for risk factors such as alcohol consumption, weight, current substance abuse, and smoking, in addition to controlling for current medication use, PTSD was found to be associated with nonspecific ECG abnormalities, atrioventricular conduction defects, and infarctions. Because the PTSD group in this study included only those veterans with severe PTSD, it is important to interpret this study with caution. It is unknown whether men with less severe PTSD would show the same ECG abnormalities. It is also important to be cautious about generalizing the findings in this study since there have been no studies specifically evaluating cardiovascular morbidity and PTSD in women.

The gastrointestinal and musculoskeletal systems have also been shown to be associated with PTSD, but the relationship of PTSD to these two systems has not been as extensively researched as the relationship between PTSD and the cardiovascular system. The majority of the studies that have been conducted have gathered information about veterans, but a study of civilian young men and women found that there is a relationship between gastrointestinal symptoms and PTSD. Similarly, researchers found that PTSD was related to musculoskeletal symptoms among male firefighters. Additional research is needed to learn more about how these and other bodily system troubles may be related to PTSD.

What is the agenda for clinical practice?

One agenda for clinical practice is for mental-health workers to increase collaboration with primary and specialty medical care professionals in order to better address this relationship between PTSD and health problems. Medical personnel need to become more aware of the potential harmful effects trauma and PTSD can have on health. Specifically, it is important to screen for PTSD in medical settings. Studies of patients seeking physical-health care show that many have been exposed to trauma and experience posttraumatic stress but have not received appropriate mental-health care. In answer to this problem, it might be useful to integrate PTSD treatment services with medical care services.

The Numbers Count: Mental Disorders in America

2008-12-12T21:45:00.000-08:00

From: National Institute of Mental Health

Mental Disorders in America

Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.¹ When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.²Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness.¹ In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44.³ Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.¹

In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).⁴

Mood Disorders

Mood disorders include major depressive disorder, dysthymic disorder, and bipolar disorder.

Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.¹
The median age of onset for mood disorders is 30 years.⁵
Depressive disorders often co-occur with anxiety disorders and substance abuse.⁵

Major Depressive Disorder

Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.³
Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.¹
While major depressive disorder can develop at any age, the median age at onset is 32.⁵
Major depressive disorder is more prevalent in women than in men.⁶

Dysthymic Disorder

Symptoms of dysthymic disorder (chronic, mild depression) must persist for at least two years in adults (one year in children) to meet criteria for the diagnosis. Dysthymic disorder affects approximately 1.5 percent of the U.S. population age 18 and older in a given year.¹ This figure translates to about 3.3 million American adults.²
The median age of onset of dysthymic disorder is 31.¹

Bipolar Disorder

Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year.¹
The median age of onset for bipolar disorders is 25 years.⁵

Suicide

In 2004, 32,439 (approximately 11 per 100,000) people died by suicide in the U.S.⁷
More than 90 percent of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.⁸
The highest suicide rates in the U.S. are found in white men over age 85.⁹
Four times as many men as women die by suicide⁹; however, women attempt suicide two to three times as often as men.¹⁰

Schizophrenia

Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year,¹¹ have schizophrenia.
Schizophrenia affects men and women with equal frequency.¹²
Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties.¹²

Anxiety Disorders

Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia).

Approximately 40 million American adults ages 18 and older, or about 18.1 percent of people in this age group in a given year, have an anxiety disorder.¹
Anxiety disorders frequently co-occur with depressive disorders or substance abuse.¹
Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5 ⁵

Panic Disorder

Approximately 6 million American adults ages 18 and older, or about 2.7 percent of people in this age group in a given year, have panic disorder.¹
Panic disorder typically develops in early adulthood (median age of onset is 24), but the age of onset extends throughout adulthood.⁵
About one in three people with panic disorder develops agoraphobia, a condition in which the individual becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.¹²

Obsessive-Compulsive Disorder (OCD)

Approximately 2.2 million American adults age 18 and older, or about 1.0 percent of people in this age group in a given year, have OCD.¹
The first symptoms of OCD often begin during childhood or adolescence, however, the median age of onset is 19.⁵

Post-Traumatic Stress Disorder (PTSD)

Approximately 7.7 million American adults age 18 and older, or about 3.5 percent of people in this age group in a given year, have PTSD.¹
PTSD can develop at any age, including childhood, but research shows that the median age of onset is 23 years.⁵
About 19 percent of Vietnam veterans experienced PTSD at some point after the war.¹³ The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence; terrorism; natural or human-caused disasters; and accidents.

Generalized Anxiety Disorder (GAD)

Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, have GAD in a given year.¹
GAD can begin across the life cycle, though the median age of onset is 31 years old.⁵

Approximately 15 million American adults age 18 and over, or about 6.8 percent of people in this age group in a given year, have social phobia.¹
Social phobia begins in childhood or adolescence, typically around 13 years of age.⁵

Agoraphobia

Agoraphobia involves intense fear and anxiety of any place or situation where escape might be difficult, leading to avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area.⁵

Approximately 1.8 million American adults age 18 and over, or about 0.8 percent of people in this age group in a given year, have agoraphobia without a history of panic disorder.¹
The median age of onset of agoraphobia is 20 years of age.⁵

Specific Phobia

Specific phobia involves marked and persistent fear and avoidance of a specific object or situation.

Approximately 19.2 million American adults age 18 and over, or about 8.7 percent of people in this age group in a given year, have some type of specific phobia.¹
Specific phobia typically begins in childhood; the median age of onset is seven years.⁵

Eating Disorders

The three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia¹⁴ and an estimated 35 percent of those with binge-eating disorder¹⁵ are male.
In their lifetime, an estimated 0.5 percent to 3.7 percent of females suffer from anorexia, and an estimated 1.1 percent to 4.2 percent suffer from bulimia.¹⁶
Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.^15,17
The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.¹⁸

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD, one of the most common mental disorders in children and adolescents, also affects an estimated 4.1 percent of adults, ages 18-44, in a given year.¹
ADHD usually becomes evident in preschool or early elementary years. The median age of onset of ADHD is seven years, although the disorder can persist into adolescence and occasionally into adulthood.⁵

Autism

Autism is part of a group of disorders called autism spectrum disorders (ASDs), also known as pervasive developmental disorders. ASDs range in severity, with autism being the most debilitating form while other disorders, such as Asperger syndrome, produce milder symptoms.

Estimating the prevalence of autism is difficult and controversial due to differences in the ways that cases are identified and defined, differences in study methods, and changes in diagnostic criteria. A recent study reported the prevalence of autism in 3-10 year-olds to be about 3.4 cases per 1000 children.¹⁹
Autism and other ASDs develop in childhood and generally are diagnosed by age three.²⁰
Autism is about four times more common in boys than girls. Girls with the disorder, however, tend to have more severe symptoms and greater cognitive impairment.^19,20

Alzheimer's Disease

AD affects an estimated 4.5 million Americans. The number of Americans with AD has more than doubled since 1980.²¹
AD is the most common cause of dementia among people age 65 and older.²²
Increasing age is the greatest risk factor for Alzheimer’s. In most people with AD, symptoms first appear after age 65. One in 10 individuals over 65 and nearly half of those over 85 are affected.²³ Rare, inherited forms of Alzheimer’s disease can strike individuals as early as their 30s and 40s.²⁴
From the time of diagnosis, people with AD survive about half as long as those of similar age without dementia.²⁵

For More Information

Mental Health Information and Organizations from NLM's MedlinePlus (en Español).

References

1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

2. U.S. Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02) Source: Population Division, U.S. Census Bureau Release Date: June 9, 2005. http://www.census.gov/popest/national/asrh/

3. The World Health Organization. The World Health Report 2004: Changing History, Annex Table 3: Burden of disease in DALYs by cause, sex, and mortality stratum in WHO regions, estimates for 2002. Geneva: WHO, 2004.

4. American Psychiatric Association. Diagnostic and Statistical Manual on Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.

5. Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005 Jun;62(6):593-602.

6. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 2003; Jun 18;289(23):3095-105.

7. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (producer). Web-based Injury Statistics Query and Reporting System (WISQARS). Available online from: URL: http://www.cdc.gov/ncipc/wisqars/default.htm accessed December 2006.

8. Conwell Y, Brent D. Suicide and aging I: patterns of psychiatric diagnosis. International Psychogeriatrics, 1995; 7(2): 149-64.

9. Kochanek KD, Murphy SL, Anderson RN, Scott C. Deaths: final data for 2002. National Vital Statistics Reports. 2004 Oct 12;53 (5):1-115.

10. Weissman MM, Bland RC, Canino GJ, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine, 1999; 29(1): 9-17.

11. Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry. 1993 Feb;50(2):85-94.

12. Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.

13. Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koen KC, Marshall R. The psychological risk of Vietnam for U.S. veterans: A revist with new data and methods. Science. 2006; 313(5789):979-982.

14. Andersen AE. Eating disorders in males. In: Brownell KD, Fairburn CG, eds. Eating disorders and obesity: a comprehensive handbook. New York: Guilford Press, 1995;177-87.

15. Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A, Devlin M, Mitchell J, Hasin D, Horne RL. Binge eating disorder: its further validation in a multisite study. International Journal of Eating Disorders. 1993 Mar;13(2):137-53.

16. American Psychiatric Association Work Group on Eating Disorders. Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry. 2000 Jan;157(1 Suppl):1-39..

17. Bruce B, Agras WS. Binge eating in females: a population-based investigation. International Journal of Eating Disorders. 1992;12:365-73.

18. Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry. 1995 Jul;152(7):1073-4.

19. Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. Prevalence of Autism in a US Metropolitan Area. The Journal of the American Medical Association.. 2003 Jan 1;289(1):49-55.

20. Fombonne E. Epidemiology of autism and related conditions. In: Volkmar FR, ed. Autism and pervasive developmental disorders. Cambridge, England: Cambridge University Press, 1998; 32-63.

21. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Archives of Neurology. 2003 Aug;60(8):1119-22.

22. National Institute on Aging, Progress Report on Alzheimer’s disease 2004-2005. NIH Publication No. 05-5724. Bethesda, MD: National Institute on Aging, 2005. Available from http://www.alzheimers.org/pr04-05/index.asp

23. Evans DA, Funkenstein HH, Albert MS, Scherr PA, Cook NR, Chown MJ, Hebert LE, Hennekens CH, Taylor JO. Prevalence of Alzheimer's disease in a community population of older persons: Higher than previously reported. The Journal of the American Medical Association. 1989 Nov 10;262(18):2551-6.

24. Bird TD, Sumi SM, Nemens EJ, Nochlin D, Schellenberg G, Lampe TH, Sadovnick A, Chui H, Miner GW, Tinklenberg J. Phenotypic heterogeneity in familial Alzheimer's disease: a study of 24 kindreds. Annals of Neurology. 1989 Jan;25(1):12-25.

25. Larson EB, Shadlen MF, Wang L, McCormick WC, Bowen JD, Teri L, Kukull WA. Survival after initial diagnosis of Alzheimer disease. Annals of Internal Medicine. 2004 Apr 6;140(7):501-9.

Examples of Post Traumatic Stress Disorder (PTSD)

2008-12-12T02:11:00.000-08:00

From: www.anxietybc.com

What is Post Traumatic Stress Disorder?

PTSD stands for Post Traumatic Stress Disorder. PTSD is an anxiety disorder that can develop after an individual has experienced or witnessed a major trauma.

There are many different types of symptoms that someone can have after a trauma, but PTSD symptoms fall into 3 categories:

Reliving or re-experiencing the trauma
Attempts to avoid thoughts, situations, or people that are reminders of the trauma
Increased anxiety or arousal, including being constantly on guard for danger, and being easily startled

People with PTSD will have at least one or more symptoms of each of these categories

Recognizing PTSD. Do I Have It?

John's Story

John is a 54-year-old man who witnessed his grandson die in an automobile accident. A semi-truck trailer crashed into the car John was driving. His grandson was a passenger in the front seat. Although John had some minor injuries after the accident, his grandson died at the scene. Before the accident, John ran a successful small business and was very close to his family.

Since the accident 8 months ago, John has been having flashbacks, or very vivid images, of the crash; these flashbacks will sometimes cause him to dissociate, that is, he will lose track of where he is and feel like he is back at the scene of the accident. He is very scared of these flashbacks, and worries that it is a sign that he is going "crazy". He tries to avoid anything that reminds him of the crash, and will avoid looking at pictures of his grandson, going to his grave site, or talking about him with friends and family.

John also seems to be using work as a way of avoiding thinking about the accident. His wife is very concerned, because he is working over 10 hours a day and has started going in to work most weekends. However, when he is at work, he is constantly distracted and has difficulty concentrating. He also finds it hard to make important decisions. Several of his employees have told him that they are worried about the changes they have seen in him.

John has started drinking every day when he gets home. He does this to try to stop the memories and to lessen his feelings of anxiety. He feels angry and irritable much of the time. Although he is worried that he is pushing his family and friends away, he says that he often feels numb. He says that he has not felt positive feelings of love, joy, or sexual arousal for quite some time. He has not been able to drive by the place where the accident took place, and he will not take any passengers in his car. He is also extremely nervous when driving alone, and as a result tries to use public transit as much as possible, despite the inconvenience. John has difficulty remembering certain parts of the accident, even though he did not lose consciousness or hit his head. Recently, he has been thinking that life is not worth living this way, even though he never thought he would consider taking his own life. He does not want to hurt his family.

Sharon's Story

Sharon is a 23-year-old single woman who lives with her older sister. She left university two years ago after being raped while out on a date with a male student she met through class. Since being assaulted, she has experienced a variety of symptoms that have not gone away with time. She has unwanted memories of her trauma whenever she sees a man who looks like the person who assaulted her. She often has nightmares about the rape, and sometimes they are so upsetting that she is not able to fall back asleep without leaving the lights on or taking an extra sleeping pill. She has also had several panic attacks when thinking about the rape, and avoids watching movies that may show a rape scene. She has not been able to talk about the assault with her family doctor, even though she is afraid that she may have been exposed to a sexually transmitted disease. She has never told any friends or family about it either, because she is scared that they won't believe her or that they will think badly of her.

Sharon has been unable to go back to university, because she fears that she might see the man who raped her. She also worries that she won't be able to pay attention in class and do her homework because she now has a very hard time concentrating. Sharon says that she no longer feels any enjoyment when she is with her friends and family. She has let all of her hobbies go, including quitting the soccer team and not reading her favourite books anymore. She says that she feels cut off from everyone around her, and she doubts that she will ever be able to be intimate with a man again. This is especially upsetting to her, because she is afraid that this means she will never be able to start a family, and having children some day has always been very important to her.

When Sharon is out in public, she is constantly on guard, especially if men are around. She is finding it difficult to keep a job, and she lives with her sister because she no longer feels safe living on her own. Recently, she got very angry at her sister when she brought some male friends over to their apartment. Sharon's relationship with her sister is now quite tense.

What kind of trauma leads to PTSD?

There is no one type of trauma that can lead to PTSD. Rather, there are several different kinds of traumatic situations that can do this, all of which have certain common elements:

The trauma was life threatening or it led to an actual or potentially serious injury
The individual reacted to the trauma with intense fear, helplessness, or horror.

You can develop PTSD if you have been directly involved in a serious traumatic event, or if you witnessed a traumatic event. Some common traumas that can lead to PTSD include:

Being in, or seeing, a serious car accident
Being sexually assaulted/raped
Experiencing long-term sexual or physical abuse
Undergoing major surgery (bone marrow transplant, extensive hospitalization, severe burns)
Experiencing or witnessing natural disasters (earthquakes, hurricanes, floods, fire)
Experiencing torture, a terrorist attack, or being a prisoner of war
Experiencing or witnessing a violent crime (kidnapping, physical assault, assault or murder of a loved one)
Being involved in a war or witnessing violence or death during wartime

Symptoms of PTSD

In order to receive a diagnosis of PTSD, you need to be currently experiencing at least one symptom from each of the following three categories.

1. Symptoms of reliving or "re-experiencing" the trauma

Upsetting memories about the event. This usually involves having vivid images about the trauma come up again and again even when you do not want to have them. For example, if you were physically attacked, you might keep remembering your attacker's face. Or, if you were in a car accident, you might have strong memories about the sound of the crash or a vivid picture of blood all over yourself or someone else involved.
Nightmares about the trauma.People with PTSD will often have very vivid nightmares of either the trauma or themes surrounding the trauma. For example, if you were in a car accident, you might have frequent nightmares about being in the accident yourself, or about other people being involved in accidents. Some people with PTSD who were assaulted will have nightmares of being chased, and the person chasing them in the dream might not be the person who assaulted them.
Acting as if the trauma were happening again ("reliving the trauma"). This is also called "dissociation", where an individual loses touch with the present, and feels as if they are living through the trauma again. Some people with this symptom might speak and act as if they are physically in the traumatic situation, whereas others might appear to simply stare off into space for a period of time. Some people with PTSD will also have "flashbacks", which are very vivid images of the trauma they experienced. Flashbacks can seem very real, and some people describe it as a picture or movie that they can see clearly in their minds.
Anxiety or distress when reminded of the trauma. Some people with PTSD become extremely upset or feel very anxious whenever they are confronted with a person, place, situation, or conversation that reminds them of the trauma. This can include becoming very upset when hearing tires squeal if you were in a car accident, or feeling anxious when watching violence on TV if you were assaulted.

Why do I have flashbacks and upsetting intrusive thoughts? When you live through a traumatic experience, your mind processes and stores the memory a little differently than it stores regular experiences. Sensory information about the trauma, that is, smells, sights, sounds, tastes, and the feel of things, is given high priority in the mind, and is remembered as something threatening. Once this happens, whenever you are faced with a touch, a taste, a smell, a feel, or a sight that reminds you of your trauma, the memory (and the feeling of threat) comes back up and you might have vivid memories or flashbacks about the trauma. This is just the way the mind works. It is not dangerous or a sign that you are going crazy.

2. Symptoms of avoidance

Avoiding reminders of the trauma. Many people with PTSD will try very hard to avoid anything that is associated with, or reminds them of, the traumatic event they experienced. Reminders can include:
- Circumstances (e.g., the actual date of the event, clothes worn, place where the event occurred, etc.)
- Things associated with the trauma (e.g. being in a car if the trauma was a car accident)
- General signs of danger (e.g. TV shows about violence, news programs, police or fire department sirens, fire alarms, etc.)
Avoiding thoughts, feelings, or memories related to the trauma. Although many people with PTSD will avoid any reminders of their traumatic experience, it is also common for people to avoid even thinking about what happened. For example, you might avoid talking to anyone about the trauma, and if you have thoughts or memories about what happened, you might try to push them out of your head.
Not able to recall parts of the trauma. It is not uncommon for people who have lived through a trauma to have difficulty remembering parts of it, or the entire trauma, or to be confused about the timeline of events.
Reduced interest in previously enjoyed activities. For example, after a trauma, you might stop wanting to spend time with friends and family, or you might stop all activities that you used to enjoy (such as sports or hobbies).
Feeling detached/estranged from others. People with this symptom describe feeling cut off from others, even though they might have family and/or friends around them.
Feeling numb/unable to experience feelings. Some people with PTSD will say that they generally feel numb, and don't experience loving feelings anymore (such as love, joy, or happiness). People with this symptom might have a hard time even describing how they feel, and are not able to recognize when they are happy, sad, or angry.
Feeling of foreshortened future. It is not uncommon for people with PTSD to say that they have a feeling of "impending doom"; that is, they say that they don't expect to live long, that something bad is likely to happen again soon, or that they feel hopeless about the future.

3. Symptoms of increased anxiety or "hyperarousal"

Sleep difficulties. Some people with PTSD will have trouble falling asleep or staying asleep. This often happens when you feel quite anxious throughout the day.
Anger outbursts or irritability. It is not uncommon for people with PTSD to feel more irritable and angry. If you have this symptom, you might find yourself snapping at people, or getting extremely angry in a situation that reminds you of your trauma. For example, if you were in a car accident, and while driving someone cuts you off, you might get very angry and even yell or act inappropriately.
Concentration difficulties. Many people with PTSD report that they have a hard time paying attention or concentrating while completing daily tasks. This is often the result of being very anxious; it is not a sign that there is something wrong with your memory.
Hypervigilance. Often, people with PTSD feel as if they are "on guard" or "on alert" all the time. People with this symptom will be very easily startled, and will jump at the slightest sound (for example, the telephone ringing, someone tapping you on the shoulder).

KEEP IN MIND: Although most people with PTSD will develop symptoms within three months of the traumatic event, some people don't notice any symptoms until years after it occurred. A major increase in stress, or exposure to a reminder of the trauma, can trigger symptoms to appear months or years later.

When is it (and when is it NOT) PTSD

As you probably noticed, there are many symptoms of PTSD, and very few people have all of them. Also, it is normal to experience times of greater anxiety in your life, particularly when you are under a lot of stress. Some of the symptoms of PTSD, such as sleep or concentration problems, for example, are also seen in other anxiety disorders. So how do you know if you might have PTSD? Here are two tips that might be helpful: Tip #1: If you have at least one symptom in each of the 3 categories, and your symptoms only started after a traumatic event, then you might have PTSD. If your anxiety symptoms were already present before the trauma, then it is probably not PTSD.

Tip #2: It is normal to feel more anxious right after a trauma. But over time, these anxious feelings will settle down. Remember: not everyone who lives through a trauma will develop PTSD. But if your symptoms have been present for over one month, and you find that they are interfering significantly in your life, then you might have PTSD.

How else can I recognize if I have PTSD?

Many adults with PTSD have strong feelings of shame, guilt, or despair about what happened. It is also not uncommon to have increased feelings of hostility or anger, this is sometimes directed towards entire groups of people (for example, you might find yourself being very angry and suspicious of men if you were raped, or you might get extremely angry at drivers who speed if you were in a serious car accident).

Because living through a trauma can be such a life-changing experience, some adults with PTSD find that their relationships with others are different after a trauma. For instance, you might have difficulty maintaining a romantic relationship or trusting other people and their intentions following a sexual assault, or you might have some sexual or intimacy problems.

REMEMBER: Adults with PTSD can sometimes feel like they are "going crazy" or are "broken" following a trauma. But it is important to keep in mind that PTSD is a treatable anxiety disorder. No matter how bad you feel or how hopeless it seems, there is help for PTSD.

PTSD: The Facts

Several studies have shown that a majority of people will likely experience at least one traumatic event in their lives; but many of them will NOT develop PTSD.
The chance of developing PTSD goes up if the trauma was very severe, chronic (that is, lasted a long time), or you were physically close to the event, that is, if the trauma happened right next to you or in front of you.
Certain traumas are more likely to lead to PTSD than others. For example, you are more likely to develop PTSD if the trauma you experienced was a rape/sexual assault, combat exposure, or childhood neglect/physical abuse.
If you develop PTSD symptoms within one month of a traumatic event, this is called acute PTSD. If you don't develop any symptoms until at least six months after the trauma, this is called delayed onset PTSD.
Adults with PTSD can have other problems as well, including depression, drug and alcohol abuse, or other anxiety problems (for example, panic disorder, social anxiety).

Post-traumatic Stress Disorder (PTSD) -Symptoms, Treatment, and Self-Help

2008-12-10T16:33:00.000-08:00

From: www.helpguide.org

If you went through a traumatic experience and are having trouble getting back to your regular life and reconnecting to others, you may be suffering from post-traumatic stress disorder (PTSD). When you have PTSD, it can seem like you’ll never get over what happened or feel normal again. But help is available – and you are not alone. If you are willing to seek treatment, stick with it, and reach out to others for support, you will be able to overcome the symptoms of PTSD and move on with your life.

What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a disorder that can develop following a traumatic event that threatens your safety or makes you feel helpless. Most people associate PTSD with battle-scarred soldiers – and military combat is the most common cause in men – but any overwhelming life experience can trigger PTSD, especially if the event is perceived as unpredictable and uncontrollable.

Post-traumatic stress disorder (PTSD) can affect those who personally experience the catastrophe, those who witness it, and those who pick up the pieces afterwards, including emergency workers and law enforcement officers. It can even occur in the friends or family members of those who went through the actual trauma.

Traumatic events that can lead to post-traumatic stress disorder (PTSD) include:

War
Rape
Natural disasters
A car or plane crash

Kidnapping
Violent assault
Sexual or physical abuse
Medical procedures (especially in kids)

Wendy’s Story

Three months ago, Wendy was in a major car accident. She sustained only minor injuries, but two friends riding in her car were killed. At first, the accident seemed like just a bad dream. Then Wendy started having nightmares about it: waking up in a cold sweat to the sound of crunching metal and breaking glass. Now, the sights and sounds of the accident haunt her all the time. She has trouble sleeping at night, and during the day she feels irritable and on edge. She jumps whenever she hears a siren or screeching tires, and she avoids all TV programs that might show a car chase or accident scene. Wendy also avoids driving whenever possible, and refuses to go anywhere near the site of the crash.

PTSD is a response by normal people to an abnormal situation

The traumatic events that lead to post-traumatic stress disorder are usually so overwhelming and frightening that they would upset anyone. When your sense of safety and trust are shattered, it’s normal to feel crazy, disconnected, or numb – and most people do. The only difference between people who go on to develop PTSD and those who don’t is how they cope with the trauma.

After a traumatic experience, the mind and the body are in shock. But as you make sense of what happened and process your emotions, you come out of it. With post-traumatic stress disorder (PTSD), however, you remain in psychological shock. Your memory of what happened and your feelings about it are disconnected. In order to move on, it’s important to face and feel your memories and emotions.

Symptoms of post-traumatic stress disorder (PTSD)

Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD. It’s very common to have bad dreams, feel fearful or numb, and find it difficult to stop thinking about what happened. But for most people, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift.

If you have post-traumatic stress disorder (PTSD), however, the symptoms don’t decrease. You don’t feel a little better each day. In fact, you may start to feel worse. But PTSD doesn’t always develop in the hours or days following a traumatic event, although this is most common. For some people, the symptoms of PTSD take weeks, months, or even years to develop.

The symptoms of post-traumatic stress disorder (PTSD) can arise suddenly, gradually, or come and go over time. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell. While everyone experiences PTSD differently, there are three main types of symptoms, as listed below.

Re-experiencing the traumatic event

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

PTSD symptoms of avoidance and emotional numbing

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

PTSD symptoms of increased arousal

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

Getting help for post-traumatic stress disorder (PTSD)

If you suspect that you or a loved one has post-traumatic stress disorder (PTSD), it’s important to seek help right away. The sooner PTSD is confronted, the easier it is to overcome. If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past. This process is much easier with the guidance and support of an experienced therapist or doctor.

It’s only natural to want to avoid painful memories and feelings. But if you try to numb yourself and push your memories away, post-traumatic stress disorder (PTSD) will only get worse. You can’t escape your emotions completely – they emerge under stress or whenever you let down your guard – and trying to do so is exhausting. The avoidance will ultimately harm your relationships, your ability to function, and the quality of your life.

Why Should I Seek Help for PTSD?

Early treatment is better. Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.
PTSD symptoms can change family life. PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.
PTSD can be related to other health problems. PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.

Source: National Center for PTSD

Finding a therapist for post-traumatic stress disorder (PTSD)

When looking for a therapist for post-traumatic stress disorder (PTSD), seek out mental health professionals who specialize in the treatment of trauma and PTSD. You can start by asking your doctor if he or she can provide a referral, however, he or she may not know therapists with experience treating trauma. You may also want to ask other trauma survivors for recommendations, or call a local mental health clinic, psychiatric hospital, or counseling center.

Beyond credentials and experience, it’s important to find a PTSD therapist who makes you feel comfortable and safe, so there is no additional fear or anxiety about the treatment itself. Trust your gut; if a therapist doesn’t feel right, look for someone else. For therapy to work, you need to feel respected and understood.

Help for U.S. veterans with PTSD

If you’re a veteran suffering from PTSD or trauma, you can turn to your local VA hospital or Vet Center for help. Vet Centers offer free counseling to combat veterans and their families. To find out more about the resources and benefits available to you, you can also call the VA Health Benefits Service Center at 1-877-222-VETS.

Click here for a nationwide directory of facilities for veterans, including VA hospitals and Vet Centers, provided by the U.S. Department of Veterans Affairs.

Trauma therapist referral

For help locating a trauma therapist, treatment center, or support group in your area, contact the Sidran Traumatic Stress Institute by email or by phone at (410) 825-8888 ext. 203.

Treatment for post-traumatic stress disorder (PTSD)

Treatment for post-traumatic stress disorder (PTSD) relieves symptoms by helping you deal with the trauma you’ve experienced. Rather than avoiding the trauma and any reminder of it, you’ll be encouraged in treatment to recall and process the emotions and sensations you felt during the original event. In addition to offering an outlet for emotions you’ve been bottling up, treatment for PTSD will also help restore your sense of control and reduce the powerful hold the memory of the trauma has on your life.

Types of treatments for post-traumatic stress disorder (PTSD)

Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.
EMDR (Eye Movement Desensitization and Reprocessing) – EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed.
Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems.
Medication. Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety, but it does not treat the causes of PTSD.

Self-help and support for post-traumatic stress disorder (PTSD)

Recovery from post-traumatic stress disorder (PTSD) is a gradual, ongoing processing. Healing doesn’t happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many things you can do to cope with residual symptoms and reduce your anxiety and fear.

Reach out to others for support

Post-traumatic stress disorder (PTSD) can make you feel disconnected from others. You may be tempted to withdraw from social activities and your loved ones. But it’s important to stay connected to life and the people who care about you. Support from other people is vital to your recovery from PTSD, so ask your close friends and family members for their help during this tough time.

Also consider joining a support group for survivors of the same type of trauma you went through. Support groups for post-traumatic stress disorder (PTSD) can help you feel less isolated and alone. They also provide invaluable information on how to cope with symptoms and work towards recovery. If you can’t find a support group in your area, look for an online group.

Avoid alcohol and drugs

When you’re struggling with the difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But while alcohol or drugs may temporarily make you feel better, they make post-traumatic stress disorder (PTSD) worse in the long run. Substance use worsens many symptoms of PTSD, including emotional numbing, social isolation, anger, and depression. It also interferes with treatment and can add to problems at home and in your relationships.

Challenge your sense of helplessness

Overcoming your sense of helplessness is key to overcoming post-traumatic stress disorder (PTSD). Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times.

One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that contributes to trauma.

Post-traumatic stress disorder (PTSD) and the family

If a loved one has post-traumatic stress disorder (PTSD), it’s essential that you take care of yourself and get extra support. PTSD can take a heavy toll on the family if you let it. It can be hard to understand why your loved one won’t open up to you – why he or she is less affectionate and more volatile. The symptoms of PTSD can also result in job loss, substance abuse, and other stressful problems.

Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. In order to take care of your loved one, you first need to take care of yourself. It’s also helpful to learn all you can about post-traumatic stress disorder (PTSD). The more you know about the symptoms and treatment options, the better equipped you'll be to help your loved one and keep things in perspective.

Helping a loved one with PTSD

Be patient and understanding. Getting better takes time, even when a person is committed to treatment for PTSD. Be patient with the pace of recovery and offer a sympathetic ear. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.
Try to anticipate and prepare for PTSD triggers. Common triggers include anniversary dates; people or places associated with the trauma; and certain sights, sounds, or smells. If you are aware of what triggers may cause an upsetting reaction, you’ll be in a better position to offer your support and help your loved one calm down.
Don’t take the symptoms of PTSD personally. Common symptoms of post-traumatic stress disorder (PTSD) include emotional numbness, anger, and withdrawal. If your loved one seems distant, irritable, or closed off, remember that this may not have anything to do with you or your relationship.
Don’t pressure your loved one into talking. It is very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Never try to force your loved one to open up. Let the person know, however, that you’re there when and if he or she wants to talk.

To Learn More: Related Helpguide Articles

Emotional Trauma: Causes, Symptoms, Effects, and Treatment
EMDR Therapy: A Guide to Making An Informed Choice.

Stress Relief: Yoga, Meditation, and Other Relaxation Techniques
Coping with Grief and Loss: A Guide to Grieving and Bereavement

Grief after Suicide

2008-12-08T23:46:00.000-08:00

From: Canadian Mental Health Association

Coming to terms with the death of a loved one is one of life’s most challenging journeys. When the death is from suicide, family members and friends can experience an even more complex kind of grief. While trying to cope with the pain of their sudden loss, they are overwhelmed by feelings of blame, anger and incomprehension. Adding to their burden is the stigma that still surrounds suicide.

Survivors of suicide and their friends can help each other and themselves by gaining an understanding of grief after suicide. For survivors, it helps to know that the intensity of their feelings is normal. Friends can learn how to support the bereaved.

A Different Grief

Survivors of suicide – the family and friends of a person who completes suicide – feel the emotions that death always brings. Adding to their suffering is the shock of a sudden, often unexpected death. As well, they may feel isolated and judged by society, friends and colleagues.

Some people compare the emotional stress to being trapped on an endless roller-coaster. Survivors may feel:

guilt, anger, blame, shame, confusion, relief, despair, betrayal, abandonment
disconnected from their loved one because he or she chose to die
consumed by a need to find the meaning and reasons for the suicide
an exaggerated sense of responsibility for the death
the suicide was malicious, or a way for the deceased to get back at them.

Stigma Affects Mourning

Suicide is a difficult topic for many people. Cultural and religious taboos can lead to judgmental or condemning attitudes. Some people prefer to avoid even discussing suicide and their lack of knowledge about it makes them fearful. Attitudes like these can isolate and further stress survivors.

Stigma leads survivors to feel abandoned by their social network. They describe:

Being avoided by friends or acquaintances
Feeling judged
People behaving as if the death had not occurred

Some survivors perceive stigma that is not really there. They may anticipate difficult questions and disapproval, and withdraw in order to protect themselves.

Whether it is real or perceived, stigma can affect a survivor’s journey to acceptance.

What Survivors Should Know

First, know that you are not alone. Approximately 1 out of 4 people know someone who died by suicide. It can also help to know that:

Suicide was the decision of the person who died
It is estimated that the majority of suicides are the result of untreated depression or other mental illness

Survivors Are at Risk

Survivors of suicide are at high risk of completing suicide themselves. The experience suddenly makes the idea of suicide very real, and it is not uncommon for survivors to experience suicidal thoughts. Another factor is that suicide-related illnesses like depression run in families.

Because of this increased risk for suicide, survivors should not be isolated, but rather supported and encouraged to talk about all their feelings – even the most difficult ones.

Survivor Coping Strategies

No two people ever experience grief in the same way, or with the same intensity, but there are strategies that can help you cope with your loss.

Acknowledge that the death is a suicide
Recognize your feelings and loss
Talk openly with your family so that everyone’s grief is acknowledged and can be expressed
Reach out to your friends and guide them if they don’t know what to say or do
Find support groups where you can share your stories, memories and methods of coping
Be aware that anniversaries (e.g. birthdays) can be especially difficult and consider whether to continue old traditions or begin new ones
Develop rituals to honour your loved one’s life

How Can I Help My Friend?

Showing a willingness to listen is probably the most important thing you can do for a friend who is a survivor of suicide. It may be distressing at first, but you’re not expected to provide answers. Instead, you can be a comforting, safe place for someone who desperately needs to talk.

What you can do:

Listen with non-judgmental compassion
Understand that your friend will need time to deal with their loss
Avoid clichés
Talk about the person who has died
Offer practical assistance such as shopping, cooking, driving
Find and offer information on resources, support groups, etc.
Be aware of difficult times, like anniversaries and holidays

Where To Go For More Information

For further information, contact a community organization like the Canadian Mental Health Association to find out about support and resources in your community.

Suicide Prevention Day: New Study Links Suicide Mortality Rates to Alcohol-related Factors

2008-12-07T01:07:00.000-08:00

From: Center of Addiction and Mental Health

For Immediate Release - September 8, 2006 (TORONTO) – Suicide Prevention Day (September 10) challenges us to better understand this tragic phenomenon, and a new study from the Centre for Addiction and Mental Health (CAMH) offers important evidence on the link between alcohol and suicide. The study shows that high levels of alcohol consumption increase suicide rates. These results confirm the significant relationship between the amount of alcohol consumed in the population and the number of suicide deaths.

Lead by Dr. Robert Mann, Senior Scientist at CAMH, this study aimed to identify alcohol-related factors that influence suicide mortality rates in Ontario. Researchers examined the impact of: per capita or average consumption of total alcohol; per capita consumption of distilled spirits, beer, and wine; unemployment rates; and Alcoholics Anonymous (AA) membership on suicide rates in Ontario between 1968 and 1991. They investigated the impact of these factors on suicide rates for the total population, and for males and females separately.

Dr. Mann and his colleagues found that as alcohol consumption levels rise, suicide mortality rates increase as well. The researchers observed this link for total alcohol consumption, and for consumption of beer, wine or spirits separately. Unemployment rates also impacted suicide mortality, with suicide mortality increasing as unemployment rates increased. However, increasing AA membership acted to decrease suicide rates.

Said Dr. Mann, “these results suggest that a 1-litre increase in alcohol consumption led to an increase of 11% to 39% in suicides. This observation is consistent with individual-level studies that show that heavy drinking, alcohol abuse and alcohol dependence increase a person’s risk of suicide substantially. Similarly, increasing unemployment rates increased suicide rates as well. However, it was heartening to see that increasing AA membership was related to reduced suicide mortality rates.”

Also, the study found interesting gender differences. In particular, the relationships of suicide rates to alcohol factors seemed to be stronger for females than for males. This observation stands in contrast to earlier observations by these investigators, which showed that the influence of alcohol factors on death rates from alcohol-related liver disease was similar for both males and females.

Suicide is a major cause of death. According to Statistics Canada, there were 3,688 deaths due to suicide in 2001. Identifying factors that can increase or reduce suicide deaths is a public heath priority. It is important to identify programs and policies that will help reduce suicide rates, but doing this is extremely difficult.

According to Dr. Mann, “other research shows that introducing substance use policies can have an important beneficial effect on suicide mortality rates. Our research results provide support for the potential of substance-related policy measures, particularly those related to alcohol, to influence suicide rates.”

The Centre for Addiction and Mental Health (CAMH) is a specialized teaching hospital fully affiliated with the University of Toronto, and is the largest mental health and addiction facility in Canada. CAMH is also a Pan American Health Organization and a World Health Organization Collaborating Centre.

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For more information or to schedule interviews with survey investigators, please contact Michael Torres, Media Relations Coordinator, CAMH, at (416) 595-6015.

Post Traumatic Stress Disorder

2008-11-15T23:22:00.000-08:00

From: Canadian Mental Health Association

Difficult situations are part of life. We all must cope with tough circumstances, such as bereavement or conflict in our personal and professional relationships, and learn to move on. But sometimes people experience an event which is so unexpected and so shattering that it continues to have a serious effect on them, long after any physical danger involved has passed. Individuals with this kind of experience may suffer flashbacks and nightmares, in which they re-live the situation that caused them intense fear and horror. They may become emotionally numb. When this condition persists for over a month, it is diagnosed as post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is one of several conditions known as an anxiety disorder. This kind of medical disorder affects approximately 1 in 10 people. They are among the most common of mental health problems. Children and adults can develop PTSD. The disorder can become so severe that that the individual finds it difficult to lead a normal life. Fortunately, treatments exist to help people with PTSD bring their lives back into balance.

What causes it?

PTSD is caused by a psychologically traumatic event involving actual or threatened death or serious injury to oneself or others. Such triggering events are called 'stressors'; they may be experienced alone or while in a large group.

Violent personal assault, such as rape or mugging, car or plane accidents, military combat, industrial accidents and natural disasters, such as earthquakes and hurricanes, are stressors which have caused people to suffer from PTSD. In some cases, seeing another person harmed or killed, or learning that a close friend or family member is in serious danger has caused the disorder.

What are the signs?

The symptoms of PTSD usually begin within 3 months of the traumatic event. However, sometimes they surface many years later. The duration of PTSD, and the strength of the symptoms, vary. For some people, recovery may be achieved in 6 months; for others, it may take much longer.

There are three categories of symptoms. The first involves re-experiencing the event. This is the main characteristic of PTSD and it can happen in different ways. Most commonly the person has powerful, recurrent memories of the event, or recur-rent nightmares or flashbacks in which they re-live their distressing experience. The anniversary of the triggering event, or situations which remind them of it, can also cause extreme discomfort. Avoidance and emotional numbing are the second category of symptoms. The first occurs when people with PTSD avoid encountering scenarios which may remind them of the trauma. Emotional numbing generally begins very soon after the event. A person with PTSD may withdraw from friends and family, they may lose interest in activities they previously enjoyed and have difficulty feeling emotions, especially those associated with intimacy. Feelings of extreme guilt are also common.

In rare cases, a person may enter dissociative states, lasting anywhere from a few minutes to several days, during which they believe they are re-living the episode, and behave as if it is happening all over again. The third category of symptoms involves changes in sleeping patterns and increased alertness. Insomnia is common and some people with PTSD have difficulty concentrating and finishing tasks. Increased aggression can also result.

Other illnesses may accompany PTSD

People with PTSD may develop a dependence on drugs or alcohol. They may become depressed. It is not uncommon for another anxiety disorder to be present at the same time as PTSD. As well, dizziness, chest pain, gastrointestinal complaints and immune system problems may be linked to PTSD. These are often treated as self-contained illnesses; the link with PTSD will be revealed only if a patient volunteers information about a traumatic event, or if a doctor investigates a possible link with psychological trauma.

How is PTSD treated?

Medication can help with the depression and anxiety often felt by people with PTSD, and assist them in re-establishing regular sleep patterns.

Cognitive-behavioural therapy and group therapy are generally felt to be more promising treatments for PTSD. They're often performed by therapists experienced in a particular type of trauma, such as rape counsellors. Exposure therapy, in which the patient re-lives the experience under controlled conditions in order to work through the trauma, can also be beneficial.

Research into the causes of PTSD and its treatment is ongoing. Determining which treatments work best for which types of trauma is currently under study.

Where to go for more information

For further information about post-traumatic stress disorder, contact a community organization like the Canadian Mental Health Association to find out about support and resources available in your community.

World Suicide Prevention Day - 10th September 2008

2008-09-10T17:26:00.000-07:00

From: International Association for Suicide Prevention

2008 - Think Globally, Plan Nationally, Act Locally

(Click the link above to find World Suicide Prevention Day flyers in English, French, German, Italian, Spanish and Chinese, and to find a listing of activities from around the world.)

Think Globally - Extent of the Problem
Think Globally - Collaboration
Think Globally - Research
Plan Nationally - Strategy
Plan Nationally - Evaluation
Plan Nationally - Collaboration
Act Locally - Implementation of Programs
Act Locally - Community Initiatives
Act Locally - Advocacy
What You can do to Support World Suicide Prevention Day

World Suicide Prevention Day Activities Submission Form

World Suicide Prevention Day is held on September 10 each year as an initiative of the International Association for Suicide Prevention (IASP), and is co-sponsored by the World Health Organisation (WHO). The 2008 theme is "Think Globally. Plan Nationally. Act Locally." This phrase, first used by the movement to save the environment, can equally well be applied to suicide prevention:

to develop global awareness of suicide as a major preventable cause of premature death,
to describe the political leadership and policy frameworks for suicide prevention provided by national suicide prevention strategies,
and to highlight the many practical prevention programmes that translate policy statements and research outcomes into activities at local, community levels.

This year's theme "Think Globally. Plan Nationally. Act Locally", is an opportunity for all sectors of the community: the public, charitable organizations, communities, researchers, clinicians, practitioners, politicians and policy makers, volunteers and those bereaved by suicide, to join with the IASP and WHO on World Suicide Prevention Day in focusing public attention on the unacceptable burden and costs of suicidal behaviours with diverse activities to promote understanding about suicide and highlight effective prevention activities.

Think Globally - Extent of the Problem

The WHO estimates that one million people die in the world each year by suicide. These figures represent an annual world mortality rate from suicide of 14.5 per 100 000 population. The reality is that every minute there are two more deaths by suicide.

In many developed countries suicide can be either the 2nd or 3rd leading cause of death among teenagers and young adults and is the 13th leading cause of death worldwide for people of all ages. In addition to those who die by suicide, many millions make non-fatal suicide attempts in the context of emotional distress and suffering for the people involved and their families.

There are substantial variations in suicide rates among different countries. However, one must be cautious in comparing suicide rates between countries since some countries report accurate suicide data and others fail to count a significant proportion of their suicides. Suicide rates, as reported to the WHO, are highest in Eastern European countries including Lithuania, Estonia, Belarus and the Russian Federation. These countries have suicide rates of the order of 45 to 75 per 100 000.

By contrast, reported suicide rates are lowest in the countries of Mediterranean Europe and the predominantly Catholic countries of Latin America (Colombia, Paraguay) and Asia (such as the Philippines) and in Muslim countries (such as Pakistan). These countries have suicide rates of less than 6 per 100 000. In the developed countries of North America, Europe and Australasia suicide rates tend to lie between these two extremes, ranging from 10-35 per 100 000.

Suicide data are not available from many countries in Africa and South America. In 2009 IASP will provide an opportunity for countries in South America to highlight the problem of suicide and to share knowledge in order to expand suicide prevention activities at its 25th International Congress in Montevideo, Uruguay.

Most suicides in the world occur in Asia, which is estimated to account for up to 60% of all suicides. Together, three countries - China India and Japan - because of their large populations, may account for up to 40% of all world suicides. However, because of the sheer size of their populations, some of these countries do not have complete national registration systems for deaths, including suicide, and may lack comprehensive medical verdict or coronial systems. Official mortality data which are reported to the WHO may be based on a sample of the population which is not necessarily representative. In addition, accurate suicide data may be difficult to establish if suicide remains stigmatized, criminalized or penalized.

A recent study attempted to overcome some of these problems to estimate suicide rates more accurately. This study was conducted in Tamil Nadu, India, and used trained lay interviewers to conduct 'verbal autopsy' interviews with family members for 39 000 deaths. Using this approach, the study found that suicide rates were 10 times those reported officially to the WHO. If these findings are applicable to other countries they suggest that global suicide deaths may, in fact, be much higher than the near one million previously estimated.

Think Globally - Collaboration

A number of international agencies including IASP, WHO the United Nations, and International NGOS working in the voluntary sector have all identified suicide as a largely preventable public health problem, called for recognition of this issue at a global level and work actively in suicide prevention activities internationally.

There are many cross-national collaborative suicide research and prevention efforts. For example, people from Norway work in Uganda, the American Foundation for Suicide Prevention funded research in Hungary to explore the high suicide rates in that country; the University of Rochester works in China training local suicide researchers; researchers and funders from the UK, Europe and Australia are conducting research trials in Asia trying to reduce suicides by pesticide ingestion; researchers from Canada and Denmark evaluated a Befrienders-funded programme in Denmark and Lithuania to improve children's coping skills. Collaborative research and prevention efforts such as these advance and disseminate information about suicide.

The study conducted in India which reported high rates of suicide also found that about half of these suicides were by self-poisoning, generally by agricultural pesticides. Similar findings are reported for rural China where it is estimated that 60% of suicides involve pesticides, and rural Sri Lanka where pesticides may be involved in as many as 70% of suicides. In these regions pesticides also account for an estimated more than two million hospital admissions for self-poisoning. Pesticides are widely used and valued in agriculture in developing countries and usually stored in the home. Their ready availability may result in impulsive, stress-related suicide attempts with relatively low intent to die resulting in tragic deaths.

Recent initiatives concerning the prevention of suicides involving pesticides provide another example of collaborative efforts in suicide prevention. Given the extent of the problem of suicide in Asia and the predominance of pesticides in suicide in this region, global suicide rates will only fall if we can achieve reductions in pesticide suicides. A number of organizations including IASP and WHO, multinational companies, and university-based international programmes are involved in community efforts in Asia and Central America to reduce suicide by pesticides.

Since the 10th of September, 2004, World Suicide Prevention Day has become established around the world as a well-recognized occasion to increase public awareness about suicide prevention and to appeal to governments, policymakers and regional health authoritues to take leadership and to set and meet targets for reducing suicide.

Think Globally - Research

While suicide rates differ widely around the world research conducted in different countries tends to produce findings about the causes of suicide which are remarkably similar across countries and cultures.

This year a large study of suicide, involving 85 000 adults in 17 countries, found that the prevalence of suicidal behaviours varied between countries but there was strong consistency in the characteristics and risk factors for these behaviours across countries. In particular, this study showed that risk factors for suicidal behaviour that were consistent across countries were being female, younger, having fewer years of education, being unmarried and having a mental disorder. People who had more than one mental disorder had significantly increased suicide risk compared to people who had one disorder. Interestingly, the strongest risk factor for suicidal behaviour in high income countries was a mood disorder, whereas an impulse control disorder was the strongest factor in middle and low income studies.

These findings from global studies highlight the fact that suicidal behaviour is a complex phenomenon and, usually, no single cause is sufficient to explain a suicidal act. During the last three decades an extensive body of knowledge has accumulated about the biological, cultural, social, psychological and contextual factors that can influence risk of suicidal behaviour.

Risk of suicide can be influenced by individual vulnerability or resiliency related to age, gender, ethnicity, religious values, genetic and biologic factors, personality traits and sexual orientation. People from socially and economically disadvantaged backgrounds are at increased risk of suicidal behaviour. Childhood adversity and trauma, and various life stresses as an adult influence risks of suicidal behaviour.

Serious mental illnesses, most commonly depression, substance abuse, anxiety disorders and schizophrenia, are associated with increased risk of suicide. Diminished social interaction increases suicide risk, particularly among adults and older adults. At a population level, social cohesion and integration protect against suicide. At a community level factors such as the availability of means of suicide (such as firearms or pesticides) and media reporting practices may increase suicide risk.

All of these various risk factors tend to act cumulatively to increase suicide risk. The fact that there are multiple causes of suicidal behaviour and the absence of a single, readily identifiable high risk group accounting for the majority of suicides, implies that many different types of programmes and activities are needed to prevent suicide. Each programme and action may contribute to reducing suicide.

Plan Nationally - Strategy

In 1996 the United Nations and subsequently, the World Health Organisation, recommended that individual countries should develop national suicide prevention policies, linked where possible to other public health programmes, and establish national co-ordinating committees to monitor their implementation and evaluation.

In response to this counsel an increasing number of countries have developed national suicide prevention plans. Generally these plans adopt a public health framework. National strategies are valuable in that they compel governments to acknowledge the problem of suicide, increase national awareness about suicide, have the capacity to enact legislation for suicide prevention (for example, to ensure stricter controls on firearms) and may increase funding for suicide prevention. Such political championship is highly effective, indeed it appears to be vital, in maintaining a government focus on suicide prevention.

National suicide prevention plans generally include a broad range of strategies which typically include efforts to:

Control the access to means of suicide;
Enhance training, recognition, assessment, treatment and management of depression by medical practitioners, particularly in primary care;
Increase public awareness of depression by public programmes;
Improve assessment, treatment and follow-up care of people who make suicide attempts and present to emergency departments;
Enhance access to mental health services and Improve the care of people with serious mental illness;
Provide targeted prevention programmes for identified high-risk populations
Encourage responsible media reporting and portrayal of suicide;
Improve control of alcohol;
Provide crisis centres and crisis counselling;
Encourage school-based competency-promoting and skill-enhancing programmes for young people;
Provide effective support for families and others bereaved by suicide;
Encourage research, evidence-based approaches to programme development, evaluation of components of the national strategy, and the production of timely and accurate statistics on suicide and attempted suicide.

Plan Nationally - Evaluation

An important factor in advancing national plans is the formation of national expert committees to oversee the implementation, evaluation and revision of these plans, as recommended by the United Nations and WHO. However, not all countries have appointed such committees and, overall, the evaluation of national strategies tends to have been conducted poorly and infrequently.

Finland provides one exception. The Finnish national suicide prevention strategy was built strongly on the findings of local research and consisted of a broad national framework which was implemented at a local level. The national strategy was evaluated, and the decline in the suicide rate subsequent to the introduction of the strategy may well be attributable to the strategy.

Generally, however, despite the fact that most countries are now attempting to address suicide in some way at a national level, plans for both implementation and evaluation are generally much less developed than what would constitute a complete national strategy. World Suicide Prevention Day may provide an opportunity to highlight the strengths and promise of national strategies by presenting results of the evaluations of suicide prevention initiatives.

Plan Nationally - Collaboration

Another interpretation of the "think globally, act locally" maxim is IASP's practice of establishing task forces of members of the association to consider topical issues and problems in suicide prevention.

The task forces consider specific issues which are of global interest, such as developing recommendations for the media reporting and portrayal of suicide, suicide in the military and police, suicide in prisons, suicide in older adults, and establishing support for people bereaved by suicide. Recommendations and guidelines developed by these task forces are disseminated widely on the web and in publications and their adaptation, interpretation and implementation in local contexts are encouraged.

Act Locally - Implementation of programmes

Think Globally, Plan Nationally, Act Locally is particularly relevant in considering the local implementation of national plans for suicide prevention and the development of suicide prevention activities at the local level where national plans do not exist.

Internationally, there is broad consensus about the types of interventions which are effective in suicide prevention. National plans articulate more specific policy agendas that are adapted to national specificities. However, the translation of those policy agendas requires effective implementation at a local level. At a local level national plans must be customized and implemented to meet the distinct ecological, economic, and cultural requirements of their communities. Further, while global and national efforts may take years to implement, community efforts may be substantially less time consuming.

This process of local execution of national plans raises important issues about how broad policy directions by governments and ministries can be translated into effective locally based programmes. Greater use of the principles of prevention science by community planners and service providers may help resolve these issues. A prevention science approach requires that broad policy action advocated by governments and ministries is carefully translated into service development.

The key principles of programme development within the prevention science framework include: using theory and research evidence to develop promising policies and interventions; using pilot, model and demonstration programmes to determine the acceptability, feasibility, safety and effectiveness of a proposed programme to the targeted population; programme evaluations to examine the processes by which the programme is delivered and the efficacy, effectiveness and cost-effectiveness of the programme; identifying meaningful outcome measures, and refining and identifying the critical elements of effective programmes.

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Act Locally - Community Initiatives

Of course, the Think Globally, Plan Nationally, Act Locally process is not uni-directional and does not always involve the devolution from national plans to local activities.

An example of local programme development evolving to national and global action is provided by a current collaborative project, the European Alliance Against Depression. This developed from a community-based project, the Nuremberg Alliance Against Depression, established in the German city of Nuremberg (population 500 000). Based on research that shows depression is the most common risk factor for suicide, the aims of this project were to improve the care of depressed people and thereby prevent suicide. A four-component intervention was mounted which included: increasing public awareness about suicide; improving the care provided by primary care practitioners; educating community gatekeepers; and targeting care available to high-risk groups. On the basis of evaluation results indicating sigtnificant decreases in suicide attempts and suicides, more than 40 German towns have implemented the Nuremberg model under the umbrella of the German Alliance Against Depression.

The model has been expanded further with the European Commission funding 20 partners in 18 countries to implement the programme. These sites have adapted programme materials somewhat to take account of differing cultures and heterogeneous health and social service structures. While individual partner sites will conduct evaluations (acting locally), the rationale for the programme and its development is based upon research findings around the world (thinking globally).

Another example of a local community suicide prevention programme is provided by the US Air Force. The institution employed a multimodal strategy involving changing institutional policies and norms in order to encourage helpseeking for mental health, substance abuse or psychosocial problems, strengthening social support, and promoting effective coping strategies. The programme was associated with reductions in suicide, homicide and family violence, and is now being adapted to college and workplace settings.

Act Locally - Advocacy

In many countries, local voluntary organizations have been extremely effective in influencing governments to develop national suicide prevention strategies and increase funding for suicide prevention activities. For example, SPAN in the United States, is an organization of survivors, persons bereaved by suicide. This organization was instrumental in convincing the national government to develop, implement and finance a national strategy for suicide prevention.

Suicide prevention is a young field. Despite the large body of research about the risk factors for suicidal behaviour, the field is only now converting this information into effective programmes to prevent and reduce suicide. Although it is now possible to develop clearly articulated policies and goals for suicide prevention at global and national levels, we know less about how these goals can be translated into effective action. In the coming decades the major challenges for the Think Globally, Plan Nationally, Act Locally dictum is to find ways of linking international ideals and national policies with well-implemented and well-evaluated local programmes and actions.

WHAT YOU CAN DO TO SUPPORT WORLD SUICIDE PREVENTION DAY

World Suicide Prevention Day 2008 provides a unique opportunity to organize local, regional and national activities to increase public awareness of the problem of suicidal behaviour, and the opportunities for suicide prevention. All people who are interested in and involved in suicide prevention at international, national, state, regional and community levels can participate in various activities on World Suicide Prevention Day 2008. Those activities may call attention to the global burden of suicidal behaviour, discuss national strategies for suicide prevention and how they can be implemented and evaluated, and showcase local community initiatives and responses for suicide prevention.

Initiatives which actively educate and involve people are likely to be most effective in helping people learn new information about suicide and suicide prevention. Examples of activities which can support World Suicide Prevention Day include:

Launching new initiatives, policies and strategies on World Suicide Prevention Day
Holding conferences, open days, educational seminars or public lectures and panels
Writing articles for national, regional and community newspapers and magazines
Holding press conferences
Placing information on your website
Securing interviews and speaking spots on radio and television
Organizing memorial services, events, candlelight ceremonies or walks to remember those who have died by suicide
Asking national politicians with responsibility for health, public health, mental health or suicide prevention to make relevant announcements, release policies or make supportive statements or press releases on WSPD
Holding depression awareness events in public places and offering screening for depression
Organizing cultural or spiritual events, fairs or exhibitions
Organizing walks to political or public places to highlight suicide prevention
Holding book launches, or launches for new booklets, guides or pamphlets
Distributing leaflets, posters and other written information
Organising concerts, BBQs, breakfasts, luncheons, contests, fairs in public places
Writing editorials for scientific, medical, education, nursing, law and other relevant journals
Producing press releases for new research papers
Holding training courses in suicide and depression awareness

A list of initiatives and activities that have been undertaken around the world on previous World Suicide Prevention Days can be accessed in the right panel of this page. We encourage you to consult this list and see what others have done to publicise suicide prevention. Also, please fill out World Suicide Prevention Day Activities Form to tell us what activities you plan for WSPD 2008.

What is Mental Illness?

2008-08-24T14:49:00.000-07:00

From: National Alliance on Mental Illness
1-800-950-NAMI; info@nami.org

What is Mental Illness: Mental Illness Facts
Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder. The good news about mental illness is that recovery is possible.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.

In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups, and other community services can also be components of a treatment plan and that assist with recovery. The availability of transportation, diet, exercise, sleep, friends, and meaningful paid or volunteer activities contribute to overall health and wellness, including mental illness recovery.

Here are some important facts about mental illness and recovery:

Mental illnesses are biologically based brain disorders. They cannot be overcome through "will power" and are not related to a person's "character" or intelligence.
Mental disorders fall along a continuum of severity. Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 Americans — who suffer from a serious mental illness. It is estimated that mental illness affects 1 in 5 families in America.
The World Health Organization has reported that four of the 10 leading causes of disability in the US and other developed countries are mental disorders. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.
Mental illnesses usually strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.
Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives; The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.
The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.
With appropriate effective medication and a wide range of services tailored to their needs, most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence. A key concept is to develop expertise in developing strategies to manage the illness process.
Early identification and treatment is of vital importance; By ensuring access to the treatment and recovery supports that are proven effective, recovery is accelerated and the further harm related to the course of illness is minimized.
Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.

Myths About Suicide

2008-07-23T16:24:00.000-07:00

From: Canadian Mental Health Association

Talking about suicide may give someone the idea.

Talking about suicide does not create or increase risk. The best way to identify the intention of suicide is to ask directly.
Open talk and genuine concern is a source of release, and one of the key elements in preventing the immediate risk of suicide.

A person who attempts suicide is only looking for attention.

For some, these behaviors are serious invitations to others to help them live. If help is not available, they may feel it will never come
Ignoring suicidal thoughts or actions can be dangerous.
Help with problems and help in finding others to show need is more likely to be effective in reducing suicidal behaviors.

Those who attempted suicide in the past won’t try it again.

4 out of 5 people who have died by suicide have made at least one previous attempt.

Most suicides are caused by one sudden traumatic event.

A sudden traumatic event may hasten a decision to suicide, but most often many feelings and events have occurred for a long time.

A suicidal person clearly wants to die.

What they want most often is a way to handle circumstances in their life that are difficult and impossible to bear. Escape from the pain of these events may be their intention.
They may not actually want to carry through with suicide, but instead, desire to avoid life in its present form.

Suicide is generally carried out without warning.

80% of suicides have been preceded with warning signs.

Males have the highest rate of suicidal behavior in North America.

Males die by suicide approximately 4 times more often than females, yet females at attempt suicide approximately 4 times more often than males. Therefore, females have the highest RATE of suicidal behavior.

We must never give up on the potential of people to recover

2008-07-02T17:48:00.000-07:00

From: www.theglobeandmail.com
by CAROLYN ABRAHAM, The Globe and Mail
June 20, 2008

Psychiatrist David Goldbloom talks about the stigma surrounding mental illness in Canada and some essential first steps in changing things for the better

David Goldbloom is the vice-chair of the Mental Health Commission of Canada, a professor of psychiatry at the University of Toronto and the senior medical adviser of education and public affairs at the Centre for Addiction and Mental Health, where he was also the inaugural physician-in-chief. Dr. Goldbloom has worked in psychiatry for more than 23 years treating patients, teaching young doctors and schooling the public about mental illness and the stigma that it still carries.

One of the main goals of the Mental Health Commission is to combat stigma. Why — in this age of reality television, tell-alls and a general tendency to publicize the personal — are people still so reluctant to talk openly about mental illness?

It can't be because it's a rare phenomenon. The reality is that one in five Canadians over the course of their lives can experience mental illness in one of its many manifestations, and what that ultimately means is that every single family in Canada has in some way been affected by mental illness. There's nobody in our country who can stand up and say, "Not my family, not my aunts or uncles or cousins or grandparents, children, siblings, spouse or self." And yet the reluctance to talk about it, to acknowledge it openly, to treat it as a form of human suffering like any other illness, relates in part to how threatening this set of illnesses is to our sense of who we are.

It's about the core of our identity.

That's right. If you break your leg, you're still you. If your mind is somehow broken by mental illness, you're not you in the eyes of yourself and you're often not you in the eyes of other people.

Your mental abilities are the last frontier of acceptable discrimination at work. Do you agree?

We're living in an increasingly postmodern world, which means that the things for which we're often most valued in the workplace is our above-the-neck capacity, our cognitive abilities, but also our relationship abilities and other manifestations of our minds and our brains. The problem is that when mental illness hits — and I should point out, it doesn't discriminate on the basis of intelligence — and if we think about it in the context of the workplace, it's not simply that it makes you feel sad. It interrupts your cognitive abilities — your ability to concentrate, pay attention, make decisions, remember things, feel motivated — and it leads to judgment by colleagues and managers that your productivity has dropped off, you shouldn't be here.

You've been travelling the country, going to workplaces from Empress, Alta., speaking to oil rig workers, to Bay Street, speaking to wealth-management groups. What's that about?

What we're seeing is a growing awareness in the Canadian workplace that this is a hot-button issue. Good data now shows us that in the Canadian public sector and in the Canadian private sector, these are the leading causes of short-term disability. It has a profound economic impact on the workplace. So it's enlightened self-interest for business places to understand this set of problems better and it's also a compassionate response.

And, unlike other medical conditions that tend to strike later in life, mental illness most often hits people in their prime.

That is a distinguishing characteristic. When you think of the other sets of illnesses that we have championed as a nation, whether it's heart and stroke or cancer or dementia, these hit, in the mean, a different age group than the people who are affected by mental illness. Most mental illness has its onset in late adolescence and early adulthood, just as people are coming into their own personal identities, their work identities, starting to form long-lasting relationships at an adult level. So the disruption is substantial. The World Health Organization predicts that by the year 2020 depression will become the No. 2 cause worldwide of years lost due to disability. That's a profound impact. A large, palpable, expensive set of human problems has been neglected far longer than any other set of problems in the context of the health of Canadians.

What similarities are there between the oil-rig workers in Empress and the financial wizards on Bay Street when it comes to mental illness?

People are ultimately concerned about the same things: themselves and the people they care about in their immediate sphere, and the barriers they face.

I had the experience a little while ago of a woman who was very friendly and chatty with me just before I went up to the podium. She was a woman in her mid-50s and she said, "How do you like my new haircut?" and she had very short hair. I said, "It looks nice, it looks kind of punky," and she said, "Well, you know what, I had breast cancer last year and I had radiation and chemo and all my hair fell out. I used to have shoulder-length hair and now I'm thinking of keeping it this way." And I said, "Tell me, you and I just met two minutes ago. If you had been hospitalized for depression last year, do you think you would have told me in the first two minutes?" And she said, "Absolutely not."

The interesting coda was she said, "And you know something? I know depression, my husband has been hospitalized for depression." Despite her intimate familiarity with that type of suffering, she was able to recognize in herself she would have felt a greater barrier to divulging her depression than to divulging her recent breast cancer, and that speaks volumes.

What are the consequences of not talking about it?

Shame. And shame is a pretty profound and negative human emotion. When people get depressed, the way they perceive themselves typically becomes more negative. That happy me that people saw before was a sham. That successful, productive me was fake. The silence that surrounds that person in the workplace or among friends only confirms that self-perception.

Can you talk about the impact of language?

There's a study that compares 764 newspaper citations when they searched for the word cancer and when they searched for the word schizophrenia. In 28 per cent of citations that involved the word schizophrenia, it was used as a metaphor — "The weather is acting schizophrenic today." It's an archaic notion of split personality, but for somebody with schizophrenia, to see this word casually tossed about, not reflecting either the reality of the illness or the suffering. And when they looked in the obituaries, schizophrenia was never mentioned once, but you can be sure that people with schizophrenia die. In fact, they die earlier than people without schizophrenia. Cancer was mentioned with very high frequency in obituaries. So even in death, the language banishes people to silence.

Is there reason for optimism?

I think there is. We're seeing around the developed world a whole new set of initiatives, a whole new level of investment, a whole new level of public awareness. The establishment of the Mental Health Commission here in Canada was a watershed event. We are the only G8 country that lacks a national mental-health strategy. The goal is to have a strategy that actually generates action.

What would the benefits be?

If we look at other jurisdictions that have had mental-health commissions, such as New Zealand, it has resulted in very tangible things. One is an increase in per capita funding spent in support of people with mental illness. Another thing is a re-skilling of people who work in the mental-health arena to bring their skill levels up to the evolving knowledge base in our field.

Looking to the future, in terms of the way primary care works, how will it look?

Primary care is the first stop for most Canadians when they experience mental illness. And our primary-care physicians across Canada will be the first to tell you that they are under-resourced in terms of health professionals as well as more informal supports — social agencies, community groups, things like that. But primary care is a linchpin in making change happen.

I've heard you quote a figure on the number of suicides linked to depression in Canada.

The number of suicides over all in Canada is almost 4,000 people a year. The vast majority occur in the context of mental illness and/or substance abuse. For people aged 15 to 24 in Canada, suicide is the No. 2 cause of death, second only to motor-vehicle accidents — and some of those single-vehicle accidents may also be suicide. We also know the rates are high for men over the age of 55 — it's another high-risk group for suicide. And that's an enormous problem.

I was struck by the talk you gave recently at the MaRS Centre, a medical research facility here in Toronto, where a staff member had recently killed herself after battling depression. A lot of people turned out and you began the talk with a very compelling letter.

The letter was written in 1841 by a young lawyer to his law partner and he wrote as follows: "I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would be not one cheerful face on Earth. Whether I shall ever be better, I cannot tell. I awfully forebode I shall not. To remain as I am is impossible. I must die or be better, it appears to me." Those words were written by Abraham Lincoln in 1841 about 19 years before he assumed the presidency of the United States and changed the face of his nation forever. It's not only an eloquent statement of self-perception, it's a testament to recovery. We must never give up on the potential of people to recover from mental illness.

Abraham Lincoln's family sent him away.

They sent him away to stay with relatives because there was no treatment for his suffering. They thought: in the absence of treatment, containment. Keep him in a cabin and keep him away from the edge of the river.

You have also mentioned other historical figures who suffered mental illness and the euphemisms that were used around their absences — suddenly they discovered the need to "spend time with their family" or they were "suffering from exhaustion." But there has been progress — with what happened with the Western Australian premier, for example.

Yes, it's happening around the globe. Congressman Patrick Kennedy in the United States has been very candid about his struggle with depression. The former democratic presidential nominee Michael Dukakis, the former governor of Massachusetts, his wife, Kitty Dukakis, has written a marvellous book about her depression and her need for electric convulsive therapy.

Most recently in Western Australia, the premier, Geoff Gallop, was an extraordinarily popular politician who went on television in January, 2006, and read to a surprised electorate the following announcement: "It's my difficult duty to inform you today that I'm currently being treated for depression. Living with depression is a very debilitating experience which affects different people in different ways. It has certainly affected many aspects of my life, so much so that I sought expert help last week. My doctors advised me that with treatment, time and rest, this illness is very curable. However, I cannot be certain how long I will need. My commitment to politics has always been 100 per cent plus. I need that time to restore my health and wellbeing."

And with those words, he exited the political stage, got treatment, made a recovery and is now back at work. And he was celebrated in Australia for his plain speaking, his candour — he just said what it was, that it's debilitating, there's hope, and I will get better but I don't know how long it's going to take. Those statements are true whether you're a Bay Street wealth manager or an Empress, Alta., pipe fitter.

Serotonin Link To Impulsivity, Decision-making, Confirmed

2008-06-22T13:22:00.000-07:00

From: ScienceDaily.com

ScienceDaily (June 11, 2008) — New research by scientists at the University of Cambridge suggests that the neurotransmitter serotonin, which acts as a chemical messenger between nerve cells, plays a critical role in regulating emotions such as aggression during social decision-making.

Serotonin has long been associated with social behaviour, but its precise involvement in impulsive aggression has been controversial. Though many have hypothesised the link between serotonin and impulsivity, this is one of the first studies to show a causal link between the two.

Their findings highlight why some of us may become combative or aggressive when we haven't eaten. The essential amino acid necessary for the body to create serotonin can only be obtained through diet. Therefore, our serotonin levels naturally decline when we don't eat, an effect the researchers took advantage of in their experimental technique.

The research also provides insight into clinical disorders characterised by low serotonin levels, such as depression and obsessive compulsive disorder (OCD), and may help explain some of the social difficulties associated with these disorders.

This research, funded by the Wellcome Trust and the Medical Research Council, suggests that patients with depression and anxiety disorders may benefit from therapies that teach them strategies for regulating emotions during decision making, particularly in social scenarios.

The researchers were able reduce brain serotonin levels in healthy volunteers for a short time by manipulating their diet. They used a situation known as the 'Ultimatum Game' to investigate how individuals with low serotonin react to what they perceive as unfair behaviour. In this game one player proposes a way to split a sum of money with a partner. If the partner accepts, both players are paid accordingly. But if he rejects the offer, neither player is paid.

Normally, people tend to reject about half of all offers less than 20-30% of the total stake, despite the fact that this means they receive nothing - but rejection rates increased to more than 80% after serotonin reductions. Other measures showed that the volunteers with serotonin depletion were not simply depressed or hypersensitive to lost rewards.

PhD student Molly Crockett, a Gates Scholar at the University of Cambridge Behavioural and Clinical Neuroscience Institute, said: "Our results suggest that serotonin plays a critical role in social decision-making by normally keeping aggressive social responses in check. Changes in diet and stress cause our serotonin levels to fluctuate naturally, so it's important to understand how this might affect our everyday decision-making."

Where do we get Serotonin?

The only way to get the raw material for serotonin (tryptophan) is through the diet. Therefore, serotonin levels are lower when you haven't eaten, an effect that the researchers take advantage of in their experimental technique. Eating tryptophan rich foods like poultry (chicken soup) and chocolate can boost serotonin levels - some have speculated that this is why these are "feel good" foods.

Journal reference:

M.J. Crockett; L. Clark; T.W. Robbins, G. Tabibnia; M.D. Lieberman. Serotonin Modulates Behavioural Reactions to Unfairness. Science, 06 June 2008

Adapted from materials provided by University of Cambridge.

University of Cambridge (2008, June 11). Serotonin Link To Impulsivity, Decision-making, Confirmed. ScienceDaily. Retrieved June 22, 2008, from http://www.sciencedaily.com /releases/2008/06/080605150908.htm

Norepinephrine: From Arousal to Panic

2008-06-19T01:25:00.000-07:00

From: www.enotalone.com

Norepinephrine (NE) is the neurotransmitter often associated with the “fight or flight” response to stress. Strongly linked to physical responses and reactions, it can increase heart rate and blood pressure as well as create a sense of panic and overwhelming fear/dread. This neurotransmitter is similar to adrenaline and is felt to set threshold levels to stimulation and arousal. Emotionally, anxiety and depression are related to norepinephrine levels in the brain, as this neurotransmitter seems to maintain the balance between agitation and depression.

Low levels of norepinephrine are associated with a loss of alertness, poor memory, and depression. Norepinephrine appears to be the neurotransmitter of “arousal” and for that reason, lower-than-normal levels of this neurotransmitter produce below-average levels of arousal and interest, a symptom found in several psychiatric conditions including depression and ADHD. It is for this reason that medications for depression and ADHD often target both dopamine and norepinephrine in an attempt to restore both to normal level.

Mild elevations in our norepinephrine levels produce heightened arousal, something known to be produced by stimulants. This arousal is considered pleasurable and several “street drugs” such as cocaine and amphetamines work by increasing the brains level of norepinephrine. This increased sense of arousal is pleasurable, linking these substances to their potential for addiction. Research tells us that some individuals using antidepressants develop a state of “hypomania” or emotional elation and physical arousal in this same manner. For that reason, individuals using modern antidepressants are often cautioned to notify their treating physician/psychiatrist if they become “too happy”.

Moderately high levels of norepinephrine create a sense of arousal that becomes uncomfortable. Remembering that this neurotransmitter is strongly involved in creating physical reactions, moderate increases create worry, anxiety, increased startle reflex, jumpiness, fears of crowds & tight places, impaired concentration, restless sleep, and physical changes. The physical symptoms may include rapid fatigue, muscle tension/cramps, irritability, and a sense of being on edge. Almost all anxiety disorders involve norepinephrine elevations.

Severe and sudden increases in norepinephrine are associated with panic attacks. Perhaps the best way to visualize a panic attack is to remember the association with the “flight or fight” response. The “flight or fight” response is a chemical reaction to a dramatic and threatening situation in which the brain produces excessive amounts of norepinephrine and adrenaline – giving us extra strength, increased energy/arousal, muscle tightness (for fighting or running), and a desperate sense that we must do something immediately. This animal response was activated in early man when a bear showed up at his cave or when faced with a tiger in the woods. In modern times, imagine your reaction if while calmly watching television, someone or something started trying to knock your front door in to attack you. In the “flight or fight” reaction, your brain and body chemistry prepare you to either run from the situation or fight to the death!

A panic attack is the activation of the “flight or fight” chemical reaction without a bear at the door. It’s as though the self-protection animal response is kicking-off accidentally, when no real life-threatening situation is present. Known now as panic attacks, they can surface at the grocery, at church, or when you least expect it. As norepinephrine is a fast-acting neurotransmitter, the panic attack may last less than ten minutes (feels like hours however!) but you’ll be rattled/shaken for several hours. Panic attacks are strong physical and chemical events and include the following symptoms:

· Palpitations, pounding heart or rapid heart rate

· Sweating and body temperature changes

· Trembling or shaking

· Shortness of breath of smothering sensations

· Choking sensations

· Chest pain and discomfort

· Nausea or stomach distress

· Dizziness, lightheadedness, or feeling faint

· Sense of unreality, as though you are outside yourself

· Fear of losing control or going crazy

· Fear of dying

· Numbness and tingling throughout the body

· Chills and hot flushes

If we think about the automobile example, a panic attack is the equivalent of your dashboard warning lights coming on – your stress level is too high. Panic attacks, or surges of norepinephrine, can also occur by accident as when created by the use of certain medications. The medications for certain medical conditions can cause a panic attack or increase our level of anxiety. Medications often used for asthma, for example, can create anxiety or panic attacks.

Treating low or elevated levels of norepinephrine in the brain involve different approaches. Low levels of norepinephrine are often treated using newer antidepressants. Many new antidepressants, known as Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s) with brand names like Effexor and Serzone, treat depression by increasing levels of both serotonin and norepinephrine neurotransmitters.

Treatment for high levels of norepinephrine, as found in anxiety and panic disorders, involves decreasing neurotransmitter levels directly or using medications which increase another neurotransmitter that inhibits or decreases the action of norepinephrine. One of those inhibiting neurotransmitters is GABA, also known as Gamma-Aminobutyric Acid.

Church response to the mentally ill

2008-06-17T15:03:00.000-07:00

From: http://www.canadianchristianity.com/christianliving/070809ill.html
By Peter Andres, CanadianChristianity.com
August 9/2007

Are people of faith with a mental illness different from those who have a physical illness? Much about mental illness still remains a mystery. That's one of the reasons people are tempted to spiritualize the problem. They hope that the person with mental illness would be able to gain spiritual strength and thus gain victory over the illness.

What remains hard for many to understand is that having a mental illness and being a strong person of faith is no different than having a serious physical illness and being a strong person of faith.

How can church leaders encourage support of people with a mental illness? What does a person with a mental illness need to help him or her feel accepted and part of the congregation? How does the Christian message and experience take on meaning under these circumstances? What exactly is mental illness, anyway?

Marja Bergen, in her book Riding the Roller Coaster (Northstone, 1999), describes her experiences living with bipolar disorder. She talks about the many important factors that helped make her life with this illness tolerable and manageable. Having a supportive husband, friends, and service systems were critical, but she also acknowledges the importance of a spiritual home.

Her church friends learned to understand her illness and provided spiritual nurture, especially during difficult times. She speaks about friendships which include a common belief as being the most valuable ones she'll have. But she also admits that she was fortunate in this regard.

Sadly, many people with mental illness who look for spiritual help during difficult times face ignorance, stigma, avoidance, and judgment. The spiritual counsel and prayer these people receive frankly do more harm than good.

Understanding mental illness, even from the professional, scientific perspective, is still very much a work in progress. Schizophrenia and its related disorders, bipolar disorder (also known as manic depression), major depression, panic and obsessive-compulsive disorders, are all considered mental illnesses. It is estimated that between 15 percent to 20 percent of North Americans will, at some time in their lives, experience a mental illness. Most of these will suffer debilitating depression.

Evidence suggests there are probably organic (biochemical) reasons for the illness, or psycho-social origins -- or a combination of the two. Treatments that deal with the symptoms include medications, psychotherapy or a blend of both.

What is clear to people working in the field is that the experience of the illness goes far beyond living with the symptoms. While a person who has a physical illness -- even cancer -- suffers discomfort and anxiety related to the illness, those who have a mental illness suffer from a constellation of additional issues. These all affect their ability to return to wellness. One of them is stigma, both internally and externally imposed. There's also the loss of self-worth and self-efficacy that might come with a loss of job, friends, marriage and the feelings of being separated from God.

How can the church assist someone in a situation as devastating as this?

1. Church leaders and church members need to know that a mental illness is not the same as a spiritual crisis. Nor is the absence of healing, especially after fervent prayer, a sign of judgment or lack of faith.

2. There should be no judgment about the use of mood altering medications. Medications are commonly needed to treat the bio-chemical causes for the disorder and radically help many keep their symptoms under control.

3. Quality of life for a person suffering from mental illness does not depend on a complete remission from the illness.

What church members need to know is that many experience a recovery which allows them to return to an active and fulfilling life -- but still continue to experience times that are difficult. Recovery from mental illness means: the return of a positive sense of self, usually through meaningful endeavour (work, vocation), a circle of meaningful relationships, a place to live that the person can call his or her own, and a spiritual life that feels a reconnection with God.

The recovering person can be experiencing personal brokenness and limitations, yet have valuable gifts to offer to the church community.

Peter Andres is a regional director for MCC Supportive Care Services, a non-profit charitable organization which supports people with disabilities -- including people with mental health issues.

Schizophrenia: Twice As Common As HIV/AIDS, But Survey Shows Americans Misinformed

2008-06-15T22:22:00.000-07:00

From: Medical News Today

10 Jun 2008

Twice as many Americans live with schizophrenia than with HIV/AIDS, but a major report by the National Alliance on Mental Illness (NAMI) reveals most Americans are unfamiliar with the disease.

"Americans are not sure what to think about schizophrenia," said NAMI executive director Mike Fitzpatrick. "They know schizophrenia is a medical illness affecting the brain, but it is largely misunderstood. There are gaps in knowledge- and access to treatment. Misinformation, misperceptions, and misunderstanding represent a public health crisis."

The report is available at www.nami.org/schizophreniasurvey. It is based on an on-line survey conducted by Harris Interactive among the general public, caregivers and individuals living with schizophrenia.

Approximately two million Americans live with schizophrenia. Two-thirds do not receive treatment, even though the disease can be managed successfully.

The survey found the average age at onset was 21, but a nine-year gap exists between symptoms and treatment.

85% of Americans recognize schizophrenia as an illness, 79% believe that with treatment, people with the diagnosis can lead independent lives, but only 24% are familiar with it. Many cannot recognize symptoms or mistakenly believe they include "split" or multiple personalities (64%).
79% want friends to tell them if they have schizophrenia, but only 46% say they would themselves. Even with treatment, 49% are uncomfortable with the prospect of dating a person with schizophrenia.
Among people living with schizophrenia, 49% said doctors take their medical problems less seriously, even though the report notes that the death rate from causes like heart disease or diabetes is 2-3 times that of the general population.
A vast majority believe that better medications (96%) and health insurance (82%) would be most helpful to improving their condition,
Caregivers agree better medications are needed. Approximately 80% have difficulty getting services for loved ones, 63% have difficulty finding time for themselves, and 41% have provided care for more than 10 years.

"We know what to do to increase recovery, but it requires public support, which depends on public attitudes," Fitzpatrick said.

The report offers five recommendations:

Public education
Closing the gap between symptoms and treatment
A welcoming healthcare system
Education and support for caregivers and individuals living with the illness
Greater investment in medical research

Serotonin: From Bliss to Despair

2008-06-13T20:08:00.000-07:00

From: www.enotalone.com
by Joseph M. Carver, Ph.D.

Serotonin, first isolated in 1933, is the neurotransmitter that has been identified in multiple psychiatric disorders including depression, obsessive-compulsive disorder, anorexia, bulimia, body dysmorphic disorder (nose doesn't look perfect after ten surgeries), social anxiety, phobias, etc. Serotonin is a major regulator and is involved in bodily processes such as sleep, libido (sexual interest), body temperature, and other areas.

Perhaps the best way to think of Serotonin is again with an automobile example. Most automobiles in the United States are made to cruise at 70 miles per hour, perfect for interstate highways and that summer vacation. If we place that same automobile on a racetrack and drive day-after-day at 130 mph, two things would happen. Parts would fail and we would run the engine so hot as to evaporate or burnout the oil. Serotonin is the brain’s “oil”.

Like a normal automobile on a race track, when we find ourselves living in a high stress situation for a prolonged period of time, we use more Serotonin than is normally replaced. Imagine a list of your pressures, responsibilities, difficulties and environmental issues (difficult job, bad marriage, poor housing, rough neighborhood, etc.). Prolonged exposure to such a high level of stress gradually lowers our Serotonin level. As we continue to “hang on” we develop symptoms of a severe stress-produced depression.

An automobile can be one, two or three quarts low in oil. Using the automobile as an example, imagine that brain Serotonin can have similar stages, being low (one quart low), moderately low (two quarts low), and severely low (three quarts low). The less Serotonin available in the brain, the more severe our depression and related symptoms.

When Serotonin is low, we experience problems with concentration and attention. We become scatterbrained and poorly organized. Routine responsibilities now seem overwhelming. It takes longer to do things because of poor planning. We lose our car keys and put odd things in the refrigerator. We call people and forget why we called or go to the grocery and forget what we needed. We tell people the same thing two or three times.

As stress continues and our Serotonin level continues to drop, we become more depressed. At this point, moderately low or “two quarts” low, major changes occur in those bodily functions regulated by Serotonin. When Serotonin is moderately low, we have the following symptoms and behaviors:

· Chronic fatigue. Despite sleeping extra hours and naps, we remain tired. There is a sense of being “worn out”

· Sleep disturbance, typically we can’t go to sleep at night as our mind/thought is racing. Patients describe this as “My mind won’t shut up!” Early-morning awakening is also common, typically at 4:00 am, at which point returning to sleep is difficult, again due to the racing thoughts.

· Appetite disturbance is present, usually in two types. We experience a loss of appetite and subsequent weight loss or a craving for sweets and carbohydrates when the brain is trying to make more Serotonin.

· Total loss of sexual interest is present. In fact, there is loss of interest in everything, including those activities and interests that have been enjoyed in the past.

· Social withdrawal is common – not answering the phone, rarely leaving the house/apartment, we stop calling friends and family, and we withdraw from social events.

· Emotional sadness and frequent crying spells are common.

· Self-esteem and self-confidence are low.

· Body sensations, due to Serotonin’s role as a body regulator, include hot flushes and temperature changes, headaches, and stomach distress.

· Loss of personality – a sense that our sense of humor has left and our personality has changed.

· We begin to take everything very personally. Comments, glances, and situations are viewed personally and negatively. If someone speaks to you, it irritates you. If they don’t speak, you become angry and feel ignored.

· Your family will have the sense that you have “faded away”. You talk less, smile less, and sit for hours without noticing anyone.

· Your behavior becomes odd. Family members may find you sitting in the dark in the kitchen at 4:00 am.

Individuals can live many years moderately depressed. They develop compensations for the sleep and other symptoms, using sleeping medication or alcohol to get some sleep. While chronically unhappy and pessimistic, they explain their situation with “It’s just my life!” They may not fully recognize the depressive component.

Very low levels of Serotonin typically bring people to the attention of their family physician, their employer, or other sources of help. Severe Serotonin loss produces symptoms that are difficult to ignore. Not only are severe symptoms present, but also the brain’s ideation/thinking becomes very uncomfortable and even torturing. When Serotonin is severely low, you will experience some if not all of the following:

· Thinking speed will increase. You will have difficulty controlling your own thoughts. The brain will focus on torturing memories and you’ll find it difficult to stop thinking about these uncomfortable memories or images.

· You’ll become emotionally numb! You wouldn’t know how you feel about your life, marriage, job, family, future, significant other, etc. It’s as though all feelings have been turned off. Asked by others how you feel – your response might be “I don’t know!”

· Outbursts will begin, typically two types. Crying outbursts will surface, suddenly crying without much warning. Behavioral outbursts will also surface. If you break the lead in a pencil, you throw the pencil across the room. Temper tantrums may surface. You may storm out of offices or public places.

· Escape fantasies will begin. The most common – Hit the Road! The brain will suggest packing up your personal effects and leaving the family and community.

· Memory torture will begin. Your brain, thinking at 100 miles an hour, will search your memories for your most traumatic or unpleasant experiences. You will suddenly become preoccupied with horrible experiences that may have happened ten, twenty, or even thirty years ago. You will relive the death of loved ones, divorce, childhood abuse – whatever the brain can find to torture you with – you’ll feel like it happened yesterday.

· You’ll have Evil Thoughts. New mothers may have thoughts about smothering their infants. Thoughts of harming or killing others may appear. You may be tortured by images/pictures in your memory. It’s as though the brain finds your most uncomfortable weak spot, then terrorizes you with it.

· With Serotonin a major bodily regulator, when Serotonin is this low your body becomes unregulated. You’ll experience changes in body temperature, aches/pains, muscle cramps, bowel/bladder problems, smothering sensations, etc. The “Evil Thoughts” then tell you those symptoms are due to a terminal disease. Depressed folks never have gas – it’s colon cancer. A bruise is leukemia.

· You’ll develop a Need-for-Change Panic. You’ll begin thinking a change in lifestyle (Midlife Crisis!), a divorce, an extramarital affair, a new job, or a Corvette will change your mood. About 70 percent of jobs are lost at this time as depressed individuals gradually fade away from their life. Most extramarital affairs occur at this time.

· As low Serotonin levels are related to obsessive-compulsive disorders, you may find yourself starting to count things, become preoccupied with germs/disease, excessively worry that appliances are turned off or doors locked, worry that televisions must be turned off on an even-numbered channel, etc. You may develop rituals involving safety and counting. One auto assembly plant worker began believing his work would curse automobiles if their serial number, when each number was added, didn’t equal an even number.

· Whatever normal personality traits, quirks, or attitudes you have, they will suddenly be increased three-fold. A perfectionist will suddenly become anxiously overwhelmed by the messiness of their environment or distraught over leaves that fall each minute to land on the lawn. Penny-pinchers will suddenly become preoccupied with the electric and water consumption in the home.

· A “trigger” event may produce bizarre behavior. Already moderately low in Serotonin, an animal bite or scratch may make you suddenly preoccupied with rabies. A media story about the harmful effects of radiation may make you remember a teenage tour of the local nuclear power plant – suddenly feeling all your symptoms are now the result of exposure to radiation.

· When you reach the bottom of “severely low” Serotonin, the “garbage truck” will arrive. Everyone with severely low Serotonin is told the same thing. You will be told 1) You’re a bad spouse, parent, child, employee, etc., 2) You are a burden to those who love or depend on you, 3) You are worsening the lives of those around you, 4) Those who care about you would be better if you weren’t there, 5) You would be better if you weren’t around, and 6) You and those around you would be better off if you were totally out of the picture. At that point, you develop suicidal thoughts.

Clinical Depression is perhaps the most common mental health problem encountered in practice. One in four adults will experience clinical depression within their lifetime. Depression is the “common cold” of mental health practice – very common and much easier to treat today than in the past.

Treatment for depression, as might be expected, involves increasing levels of Serotonin in the brain. Since the mid-eighties, medications have been available that attempt to specifically target and increase Serotonin. Known as Selective Serotonin Reuptake Inhibitors (SSRI’s), these medications such as Prozac, Zoloft, and Paxil are felt to work by making more Serotonin available in the brain.

Like all neurotransmitters, we can have too much Serotonin. While elevated levels of Serotonin produce a sense of well-being, bliss, and “oneness with the universe” – too much Serotonin can produce a life-threatening condition known as Serotonin Syndrome (SS).

Likely to occur by accident by combining two Serotonin-increasing medications or substances, Serotonin Syndrome (SS) produces violent trembling, profuse sweating, insomnia, nausea, teeth chattering, chilling, shivering, aggressiveness, over-confidence, agitation, and malignant hyperthermia. Emergency medical treatment is required, utilizing medications that neutralize or block the action of Serotonin as the treatment for Serotonin Syndrome (SS).

Like Dopamine, Serotonin can be accidentally increased or decreased by substances. One method of birth control is known to produce severe depression as it lowers Serotonin levels. A specific medication for acne has also been linked with depression and suicidal ideation. For this reason, always inform your physicians if you are taking any medication for depression. Also avoid combining antidepressants with any herbal substances reported to be of help in Depression such as St. John’s Wort.

Fibromyalgia: New Insights Into a Misunderstood Condition

2008-06-12T12:43:00.000-07:00

From: medscape via http://www.psychlinks.ca/forum/showthread.php?t=12326

by Jack J. Chen, PharmD, BCPS, CGP, FCPhA
American Pharmacists Association 2008 Annual Meeting
June 9, 2008

Despite the classification of fibromyalgia nearly 20 years ago, this chronic condition continues to be shrouded in controversy and skepticism. At the recent annual meeting of the American Pharmacists Association (APhA), experts provided an evidence-based discussion of the fibromyalgia syndrome. The information provided there was intended to help clinicians better understand current diagnostic and therapeutic considerations of this medical disorder.

Ironically, the lead author on the 1990 diagnostic guidelines was originally a skeptic who questioned the credibility of fibromyalgia, said Linda Krypel, PharmD, Professor of Pharmacy Practice at Drake University College of Pharmacy and Health Sciences, Des Moines, Iowa. The recent publication of treatment guidelines and the emergence of a new therapy for fibromyalgia can be viewed as trends toward increased acceptance of this condition by the medical community.

Fibromyalgia is the most common chronic pain syndrome encountered in general medicine and rheumatology. Approximately 2% to 10% of the US population (more than 6 million people) are believed to meet the current diagnostic criteria for fibromyalgia. The disorder overwhelmingly affects more females than males.

Fibromyalgia is characterized by multiple symptoms, of which chronic, widespread pain is the sine qua non. Classification criteria established by the American College of Rheumatology (ACR) include diffuse soft-tissue pain that is present for at least 3 months, and pain on palpation in at least 11 of 18 tender points. Table 1 (see attachment) outlines the symptoms of fibromyalgia and common situations or triggers that can aggravate the condition.

If a patient reports chronic widespread pain, clinicians should look for other symptoms of fibromyalgia such as non-refreshing sleep, fatigue, presence of tender or trigger points (commonly found on the elbows, inside of the knees, on or near the neck, and laterally on both hips), and cognitive problems (such as memory loss, language and learning difficulties), often referred to as "fibrofog." If fibromyalgia syndrome is suspected, the patient should be referred to a clinician familiar with treating the condition.

Neurotransmitter Dysfunction and Sensitized Nociceptive Pathways
The pathophysiology of fibromyalgia is complex and multifactorial, Dr. Kryper explained. Currently, fibromyalgia is considered a disorder of pain regulation, due in part to heightened generalized pain sensitivity that arises from pathologic processing of nociceptive stimuli. Central and peripheral sensitization of nociceptive systems and hypothalamic-pituitary-adrenal axis dysfunction are involved.

Reduced levels of bioaminergic neurotransmitters, such as dopamine, norepinephrine, and serotonin, are believed to play a major role in pathologic nociceptive sensitization. Defects in serotonin transporters and decreased dopamine and norepinephrine levels have been documented and associated with decreased delta sleep and higher than normal activity of substance P.

Additionally, sensitization of peripheral nociceptive pathways is associated with chronic sympathetic activation, resulting in muscle hypoxia and exercise intolerance. Table 2 (see attachment) provides a more extensive overview of the pathophysiologic mechanisms involved in fibromyalgia.

The Role of Nonpharmacologic Management
Evidence-based treatment guidelines for fibromyalgia have become available only recently. Raylene M. Respond, PharmD, Dean and Professor of Pharmacy Practice, Drake University, summarized the Guidelines for the Management of Fibromyalgia Syndrome Pain in Adults and Children from the American Pain Society (APS), and the European League Against Rheumatism (EULAR) recommendations for management of fibromyalgia syndrome.

Of the 2, the EULAR guidelines are more recent, and they use more restrictive criteria to analyze currently available evidence, Dr. Respond said. For instance, clinical studies must have measured pain by visual analog scale and have measured function by the Fibromyalgia Impact Questionnaire (FIQ). These guidelines also recommend agents not currently available in the United States.

Treatment recommendations in both guidelines are based upon the type of evidence available, ranging from strong (eg, consistent benefit as supported by randomized, controlled trials) to weak (eg, supported only by nonrandomized trial data) (Table 3 - see attachment). A key point of both the APS and EULAR treatment guidelines is that various nonpharmacologic and pharmacologic interventions are supported by strong levels of evidence, and the combination of both forms of therapy is encouraged.

Nonpharmacologic treatments are an important component of fibromyalgia management and should not be overlooked. Clinicians should educate patients that integrating exercise or increased physical activity into their daily routine is important and beneficial in managing fibromyalgia. The goals of increased physical activity and exercise are to improve or maintain general fitness and overall health, give the patient a feeling of control over the condition, and improve physical function and emotional well-being, which often are negatively affected by fibromyalgia.

The clinician-patient relationship provides a unique opportunity to use targeted discussions, support, and consistent follow-up to encourage fibromyalgia patients to adopt a more physically active lifestyle. Examples of beneficial exercise include strength training, aerobic conditioning, aquatic therapy, and stretches and balance exercises. Patients should start slowly with a few minutes of exercise per day and increase gradually up to 30 minutes per day. Routine exercise also reduces stress, which can exacerbate fibromyalgia symptoms.

Patients should be encouraged to seek information about fibromyalgia through organized programs and educational resources (eg, National Fibromyalgia Association, American College of Rheumatology). Finally, complementary and alternative techniques (eg, acupuncture, biofeedback) may be considered if exercise, stress reduction, and education combined with pharmacologic treatment are not achieving desired results.

Restoring Neurotransmitter Balance Through Pharmacology
According to Dr. Rospond, strong evidence has emerged to support the use of various pharmacologic agents for managing fibromyalgia symptoms (Table 4 - see attachment). These agents include cyclobenzaprine, duloxetine, gabapentin, pregabalin, tramadol, and the tricyclic antidepressants. Pregabalin is currently the only drug approved by the US Food and Drug Administration (FDA) for management of fibromyalgia.

Tricyclic Agents
Tricyclic agents (antidepressants and cyclobenzaprine) represent an older class of drugs that is still considered the first line of therapy for fibromyalgia. These agents have been clinically evaluated more than any other class of drugs. The primary agents in this class are amitriptyline (a tricyclic antidepressant) and cyclobenzaprine (a tricyclic muscle relaxant).

Amitriptyline inhibits presynaptic reuptake of serotonin (and norepinephrine to a small degree). Increases in synaptic serotonin and norepinephrine are associated with increased slow wave sleep or delta sleep, as well as increased release of endogenous endorphins. Because anticholinergic adverse effects are common with amitriptyline (and other tricyclic antidepressants), the dosage should be increased slowly to obtain maximum efficacy with minimal side effects.Amitriptyline should be initiated at low doses (eg, 5-10 mg taken 1-3 hours before bedtime and increased by 5 mg every 2 weeks until a target maintenance dose of 25-50 mg is achieved). Daily doses at this level produce clinical improvements in pain, sleep, fatigue, and overall wellbeing in 25% to 45% of patients with fibromyalgia.

Cyclobenzaprine, commonly used as a muscle relaxant in the United States, is structurally related to the tricyclic antidepressants. This drug has been shown to modify the descending nociceptive pathways by decreasing gamma and alpha efferent neuron activity originating at the brain stem. The dosage should be started at 5-10 mg taken at bedtime and increased to 20-30 mg, taken either at night or in divided doses during the day. Compared with amitriptyline, cyclobenzaprine may be associated with better patient acceptance due to fewer side effects and more rapid onset of relief.

Serotonin-Norepinephrine Reuptake Inhibitors and Selective Serotonin Reuptake Inhibitors
Currently available evidence suggests that certain serotonin-norepinephrine reuptake inhibitors (SNRIs) are effective for fibromyalgia, although more studies of specific agents within this class are needed. In April 2007, the manufacturer of duloxetine filed a new drug application for a fibromyalgia indication. Duloxetine is a reuptake inhibitor of serotonin and norepinephrine, and to a lesser extent, dopamine.

Analysis of pooled data from two 12-week randomized, placebo-controlled, double-blind clinical trials found that duloxetine 60 mg daily or 60 mg twice daily in women with fibromyalgia was superior to placebo on all efficacy measures, including pain scores, mean tender point threshold, Clinical Global Impression of Severity, and Patient Global Impression of Improvement. The results of this pooled analysis suggest that duloxetine is an effective treatment for both the pain and functional impairment associated with fibromyalgia in female patients.

However, another randomized, double-blind, placebo-controlled study did not find any difference between placebo, duloxetine 60 mg once daily, or duloxetine 120 mg once daily on the primary outcomes of pain severity and self-reported global improvement scores at the end of a 6-month treatment period.[28] While between-group differences on the primary outcomes were noted at several timepoints throughout the study, differences at 6 months were non-significant. Duloxetine-treated patients did maintain significant improvement compared with placebo on secondary measures such as mental health, clinician-rated global improvement, and fatigue scores.

This latter study was 1 of only a few long-term (ie, 6 months or longer) studies, Dr. Rospond noted, and the results raise questions about the long-term efficacy of duloxetine as well as other agents studied, because the duration of most blinded studies of fibromyalgia treatment is only up to 12 weeks long.

For the treatment of fibromyalgia, doses of duloxetine are initiated at 20 mg daily and titrated to 60 mg twice daily over a 2-week period. Titration minimizes the incidence of side effects, such as constipation, dry mouth, nausea, and sleepiness. Clinicians should also be aware that a recent FDA statement prohibits the use of duloxetine in patients with any type of hepatic insufficiency.

Some clinicians have also been treating fibromyalgia with venlafaxine, which selectively inhibits neuronal uptake of serotonin, norepinephrine, and dopamine. However, studies using 75 mg per day for 6 weeks have yielded variable results, and additional studies are warranted.

Milnacipran (not marketed in the United States) belongs to the same class of drugs as duloxetine but exhibits greater inhibition of norepinephrine reuptake. In December 2007, the manufacturers of milnacipran filed a new drug application for a fibromyalgia indication. Milnacipran doses of 100 mg once or twice daily have demonstrated significant improvement in the outcomes of pain, mood, global wellbeing, function, and fatigue. Adverse effects include anxiety, dysuria, itchiness, nausea, sweating, shivering, and vertigo.

Agents with the most selectivity and specificity for serotonin reuptake inhibition appear to be associated with lower efficacy in fibromyalgia, Dr. Rospond said. For example, citalopram, a selective serotonin-reuptake inhibitor (SSRI) with high selectivity, has shown no efficacy (in terms of the primary outcome of pain severity) in studies of patients with fibromyalgia, while fluoxetine (a lower selectivity SSRI compared with citalopram) has been found effective for fibromyalgia. However, citalopram has demonstrated improvement on secondary outcomes such as sleep, cognitive function, fatigue, and concomitant depression.

Pregabalin: First FDA-Approved Agent for Fibromyalgia
In June 2007, pregabalin became the first agent to receive FDA-approved labeling for the treatment of fibromyalgia. (Pregabalin also carries FDA-approved indications for management of partial seizures, painful diabetic peripheral neuropathy, and postherpetic neuralgia.) Unlike other agents that work by modulating serotonin and norepinephrine activity, researchers believe that pregabalin works by inhibiting excitatory inputs to the spinal cord and raising the threshold required to activate nociceptive neurons. Pregabalin also increases delta sleep.

In fibromyalgia studies, pregabalin improved outcomes of pain, fatigue, sleep, and quality of life. In an 8-week placebo-controlled study, patients with fibromyalgia were randomized to treatment with placebo or 1 of 3 pregabalin doses (150 mg, 300 mg, or 450 mg once daily). At the end of the study, the 450 mg dose was associated with a significantly greater reduction in pain severity and fatigue than placebo. In addition, a 50% reduction in pain was reported by about 30% of subjects in the 450 mg dose group compared with fewer than 15% of subjects in the placebo group. Patients treated with 150 mg and 300 mg also demonstrated significant improvement. The 2 higher doses of pregabalin were also associated with significant improvements in sleep quality.

In a second double-blind, placebo-controlled trial, monotherapy with pregabalin was found to be efficacious and safe for treatment of pain associated with fibromyalgia. Subjects were randomized to placebo or pregabalin 300 mg, 450 mg, or 600 mg per day (doses divided and taken twice daily) for 13 weeks. Patients in all of the pregabalin-treated groups showed significant improvement in pain compared with placebo, as well as improvements in assessments of sleep and patients' impressions of their global improvement.

Therapy with pregabalin should be initiated at 75 mg twice daily and increased to 150 mg twice daily over 7 days. Dr. Rospond pointed out that effects can be seen quickly (within 1 week), and recent data demonstrate sustained effectiveness for 6 months or longer. Adverse effects include blurred vision, constipation, dizziness, drowsiness, edema, and weight gain.

Although not FDA-indicated for fibromyalgia, gabapentin has also demonstrated efficacy for fibromyalgia at doses of 1200 mg to 2400 mg per day in 3 divided doses. The most frequent side effects of gabapentin include sedation and dizziness. The incidence of edema with gabapentin appears to be lower than that with pregabalin.

Analgesics
With diffuse pain being the primary symptom of fibromyalgia, it would seem logical to include analgesics in the treatment plan. Tramadol, an atypical opioid, is the only analgesic with demonstrated efficacy in treating fibromyalgia. Not only does tramadol bind to the mu-opiate receptors in the central nervous system, it also inhibits the reuptake of serotonin and norepinephrine. These latter effects on neurotransmitter activity may partially explain tramadol's effectiveness in treating fibromyalgia.

In a randomized, double-blind, placebo-controlled clinical trial, patients with fibromyalgia were first enrolled into an open-label phase and treated with tramadol 50-400 mg per day. Patients who tolerated a perceived benefit from tramadol were then randomized to continued treatment with tramadol or placebo in a 6-week double-blinded phase. The primary efficacy outcome measure was time to exit from the double-blind phase because of inadequate pain relief. Significantly more subjects in the tramadol group completed the double-blind phase compared with those in the placebo group.

Tramadol in combination with acetaminophen is also effective for fibromyalgia. In a 3-month, randomized, double-blind study, tramadol with acetaminophen (37.5 mg tramadol with 325 mg acetaminophen) administered 4 times daily was compared with placebo. At the end of the study, tramadol-treated patients recorded significantly less pain, better pain relief, and greater improvement in FIQ scores than placebo-treated patients.

To minimize dizziness and vertigo, tramadol therapy should be initiated at a dose of 25 mg per day and titrated every 3 days in 25 mg increments until a total dose of 100 mg (25 mg 4 times daily) is achieved. Doses may then be increased incrementally every 3 days to a total of 200 mg (50 mg 4 times daily). Caution must be employed to avoid prescribing more than 4 g of acetaminophen per day to reduce the risk of hepatotoxicity with chronic therapy.

Dr. Rospond reminded the audience that the evidence supporting the effectiveness of nonsteroidal anti-inflammatory agents for fibromyalgia is weak. Additionally, data are insufficient to support the use of narcotic opioids or corticosteroids to reduce fibromyalgia pain. These agents should only be considered when patients are experiencing inadequate benefit or intolerable side effects from other agents.

Miscellaneous Agents
Benzodiazepines and nonbenzodiazepine hypnotics have not demonstrated efficacy in reducing pain or improving function in fibromyalgia. However, drugs within these classes (eg, zolpidem) can be useful as add-on therapies for persistent insomnia.

Preliminary data suggest that pramipexole, a dopamine receptor agonist approved in the United States for the treatment of Parkinson's disease and restless legs syndrome, is also effective for fibromyalgia. In 1 randomized, double-blind, placebo-controlled, 14-week trial, pramipexole 4.5 mg every evening improved outcomes for pain, fatigue, and overall function. Postmarketing reports of pathologic compulsive behaviors (eg, pathologic gambling) have been reported in patients with Parkinson's disease and restless leg syndrome who were taking dopamine agonists. Whether this would occur in patients with fibromyalgia is unknown and deserves further exploration.

Tropisetron is an antiemetic that blocks the serotonin 5-HT3 receptor and increases levels of serotonin. Although not available in the United States, preliminary data suggest efficacy in treating fibromyalgia.

Although a variety of other agents hold promise for fibromyalgia therapy, several have no evidence or only weak evidence to support their use. (Table 4 - see attachment) Recombinant human growth hormone has been tested in women with fibromyalgia and low serum insulin-like growth factor (IGF) levels. In 1 trial, doses of 0.0125 mg/kg were administered subcutaneously once daily (to maintain an IGF-1 level of about 250 ng/mL) for 9 months. At the end of that period, the treated group experienced significant improvement in symptoms (as measured by the FIQ) and signs (measured by the tender point score). Although patients experienced an improvement in functional ability, complete remission of symptoms was not observed. In general there was a lag of about 6 months before patients started to note improvement.

Sodium oxybate is a commercially available preparation of naturally occurring gamma hydroxybutyrate. Doses of 6 g at bedtime have resulted in significant improvements in pain, tenderness, sleep quality, and fatigue. Other agents with no evidence or only weak evidence of efficacy in the management of fibromyalgia include calcitonin, , dehydroepiandrosterone , guaifenesin, 5-hydroxytryptamine, magnesium, melatonin, S-adenosyl-methionine , and thyroid hormones. Further study is needed with all of these agents.

Conclusion
Although fibromyalgia remains a challenging condition to manage, a number of effective therapies are available for patients (Table 5 - see attachment). Only 1 agent, pregabalin, is FDA-approved for the treatment of fibromyalgia, but clinicians should be familiar with other agents that are also effective, as supported by available scientific evidence.

Clinicians can serve as important resources for patients with fibromyalgia. They can help educate patients on the scientific mechanisms of fibromyalgia (ie, involvement of neurotransmitter and nociceptive pathways), the role of nonpharmacologic modalities, and the benefits and risks of available pharmacotherapies. Pharmacists can also assist with selection of nonprescription products for concomitant symptoms such as constipation, headache, and sleep difficulties.

SSRI
An SSRI (Selective Serotonin Reuptake In hibitor) is a newer form of antidepressant which prevent neurons (brain cells) from absorbing free serotonin (one of the major brain neurochemicals or neurotransmitters) in the synapse, thus making more serotonin available for brain function. In addition to depression, SSRIs are also used in the treatment of anxiety disorders and other mental disorders and conditions.

Fibromyalgia-New Insights Into a Misunderstood Condition.pdf

Emotional and Psychological Trauma: Recognizing the Symptoms and Getting Help

2008-06-02T17:17:00.000-07:00

From: www.helpguide.org

If you’ve gone through a traumatic experience, you may be struggling with painful emotions, frightening memories, or a sense of constant danger that you just can’t kick. Or you may feel numb, disconnected, and unable to trust other people. But you can overcome trauma’s paralyzing hold on your present life. With treatment and support, you can heal and move on from psychological and emotional trauma, putting it in the past where it belongs.

What is emotional or psychological trauma?

Trauma is the result of extraordinarily stressful events that shatter your sense of security, making you feel helpless and vulnerable in a dangerous world. Traumatic experiences often involve a threat to life or safety, but any situation that leaves you feeling frightened and alone can be traumatic, even if it doesn’t involve physical harm. Experiences involving betrayal, verbal abuse, or any major loss can be just as traumatizing as a life-threatening catastrophe, especially when they happen during childhood.

Whether the threat is physical or psychological, trauma results when an experience is so overwhelming that you freeze, go numb, or disconnect from what’s happening. While this automatic response protects you from the terror you feel, it also prevents you from moving on. Despite being cut off from your trauma-related feelings, you can’t escape them completely. They remain outside of conscious awareness in all their original intensity, influencing the way you see the world, react to everyday situations, and relate to others.

Causes of emotional or psychological trauma

Emotional or psychological trauma results from experiences that make you feel:

Terrified
Helpless

Unprepared
Alone

Not all potentially traumatic events lead to lasting emotional and psychological trauma. Some people rebound quickly from even the most tragic and shocking experiences. Others are devastated by experiences that, on the surface, appear to be less upsetting. It’s not the objective facts that determine whether an event is traumatic, but your subjective emotional experience of the event. The more endangered, helpless, and unprepared you feel, the more likely you are to be traumatized.

The types of events that can cause trauma are numerous. Emotional trauma can be caused by single-blow, one-time occurrences, such as a house fire, a plane crash, a violent crime, or an earthquake. Psychological and emotional trauma can also be caused by experiences of ongoing and relentless stress, such as fighting in a war, living in a crime-ridden neighborhood, enduring chronic abuse, or struggling with a life-threatening disease.

Though, people respond differently to stressful experiences, a traumatic event is most likely to cause negative effects if it is:

Inflicted by humans
Repeated and ongoing
Unexpected or unpredictable

Sadistic or intentionally cruel
Experienced in childhood

People are also more likely to be traumatized as adults if they have a history of childhood trauma or if they’re already under a heavy stress load.

Attachment or developmental trauma

Stressful experiences in childhood—whether a one-time event such as a car accident or an ongoing situation caused by an unavailable or abusive parent—can be traumatizing. Childhood trauma, known as attachment or developmental trauma, results from anything that disrupts a child’s sense of safety and security. This includes such things as an unstable or unsafe environment, separation from a parent, or a serious illness. Attachment trauma is most severe, however, when it involves betrayal or harm at the hands of a caregiver.

Attachment trauma has a negative impact on a child’s physical, emotional, cognitive, and social development. Children who have been traumatized see the world as a frightening and dangerous place. When childhood trauma is not resolved, this fundamental sense of fear and helplessness can carry over into adulthood, setting the stage for further trauma.

How childhood trauma affects adult relationships

The quality of the attachment bond between mother and baby affects the child’s ability—even as an adult—to feel safe in the world, trust others, handle stress, and rebound from disappointment. Early-life trauma disrupts this important attachment bond, resulting in adult relationship difficulties.

Read: Attachment and Adult Relationships

Normal responses to traumatic events

When it comes to recognizing psychological and emotional trauma, it’s important to distinguish between normal reactions to traumatic events and symptoms of a more serious and persistent problem.

Following a traumatic event, most people experience a variety of emotions, including shock, fear, anger, and relief to be alive. Often, they can think or talk of little else other than what happened. Many others feel jumpy, detached, or depressed. Such reactions are neither a sign of weakness nor a positive indicator of lasting trouble. Rather, they represent a normal response to an abnormal event.

Common reactions to trauma:

Guilt and self-blame
Anxiety and edginess
Mood swings and irritability
Feeling disconnected or numb
Distressing memories about the event

Insomnia or bad dreams
Withdrawing from others
Loss of appetite
Difficulty concentrating
Feeling sad or hopeless

These symptoms and feelings typically last from a few days to a few months, gradually fading as you process the trauma. But even when you’re feeling better, you may be troubled from time to time bym painful meories or emotions—especially in response to triggers such as an anniversary of the event or an image, sound, or situation that reminds you of the traumatic experience.

Grieving is normal following a traumatic event

Whether or not a traumatic event involves death or physical harm, survivors must cope with the loss, at least temporarily, of their sense of safety and security. The natural reaction to this loss is grief. Like people who have lost a loved one, trauma survivors go through a grieving process. This process, while inherently painful, is easier if you turn to others for support, take care of yourself, and talk about how you feel.

Read: Coping with Grief and Loss

Recovering from a traumatic event takes time, and everyone heals at his or her own pace. But if months have passed and your symptoms aren’t letting up, you may be experiencing emotional or psychological trauma.

When to seek professional help

It’s a good idea to seek professional help from a therapist or doctor if you’re:

Having problems at home or work
Living in constant fear and anxiety
Haunted by overwhelming memories or emotions
Avoiding more and more things that remind you of the trauma

Signs and symptoms of psychological or emotional trauma

Recognizing psychological and emotional trauma may be difficult, especially if the traumatic event occurred in your childhood. Further complicating the picture, the signs and symptoms of unresolved emotional trauma are often mistaken for other metal health problems, including depression and anxiety.

Unfortunately, antidepressants, anxiety medications, and other conventional therapies and treatments won’t heal trauma-induced wounds, so it’s important to get to the root of the symptoms.

Is Emotional Trauma a Factor in Your Life?

Respond yes or no to the following to determine if you might be living with the aftermath of a traumatic event:

Can you stand to be alone without turning on your cell phone, computer, or TV?
Do you rely on coffee, cigarettes, or alcohol to lift and/or calm you?
Are you plagued by physical conditions for which there appear to be no cures?
Do you “lose it” with certain people or in certain situations?
Do you avoid things you wish you could do?
Do you have to be accomplishing something in order to feel good?
Do you frequently behave in ways that you regret?
Do you suffer from mysterious ailments that come and go?
Do you find it impossible to focus on some things for more than a time?
Is it hard for you to trust people?
Do you feel depressed or anxious although you have tried conventional treatments?
Is it difficult for you to commit to a relationship?

If you answered “yes” to 3 or more questions, you might be suffering from emotional trauma.

Source: Emotional Intelligence by Jeanne Segal

While the potential signs and symptoms of unresolved emotional trauma are numerous, the most common indicators include:

Emotional numbness and detachment
Inability to form close, satisfying relationships
Sense of the world as a cold and dangerous place
Hair trigger stress response (dizziness, pounding heart, nausea)
Disturbing memories, nightmares, or flashbacks
Sense of a foreshortened, limited future

Post-traumatic stress disorder (PTSD)

PTSD is the most severe form of trauma. Its primary symptoms include intrusive memories or flashbacks, avoiding things that remind you of the traumatic event, and living in a constant state of “red alert”.

Read: Post-Traumatic Stress Disorder (PTSD)

Healing from psychological or emotional trauma

In order to heal from psychological and emotional trauma, you must face and resolve the unbearable feelings and memories you’ve long avoided. Otherwise they will return again and again, unbidden and uncontrollable. The healing journey involves two interrelated steps:

Processing the memory of the trauma
Discharging pent-up “fight-or-flight” energy

Working through trauma can be scary, painful, and potentially retraumatizing. Because of the risk of retraumatization, this healing work is best done with the help of an experienced trauma specialist.

Processing the memory of the trauma

Traumatic memories are very different from normal memories. Extreme stress functions like a pause button on your brain, preventing you from integrating your experience into a coherent memory of what happened. Without a “story” that you can revisit and interpret, it’s impossible to put the experience in the past.

As a result, traumatic memories are relived rather than simply remembered. They may exist only in split-off fragments—raw emotions, bodily sensations, frightening images, smells and sounds, physical pain—that feel just as real as they did during the original trauma. Reconnecting to these emotional fragments allows you to process the memory and put it in perspective at long last.

Discharging fight-or-flight energy

When confronted with a threat, your body instantly prepares for emergency action in an automatic, biological process known as the fight-or-flight response. The fight-or-flight response gives you extra energy to either fight or escape the threat. Once the danger passes, you gradually return to a relaxed and normal state.

But when a threat is so overwhelming that survival seems impossible, the natural response is to freeze. This frozen state of shock traps the intense energies of the fight-or-flight response in the body. In essence, your nervous system gets stuck in overdrive.

The symptoms of trauma are the result of your body’s attempts to control this pent-up energy. To heal from trauma, this excess energy must be discharged in a physical way, such as:

Trembling
Shaking
Crying
Sweating
Breathing deeply
Laughing

Treatment and therapy for emotional or psychological trauma

The following therapies are used in the treatment of emotional or psychological trauma.

Somatic experiencing takes advantage of the body’s unique ability to heal itself. The focus of therapy is on bodily sensations, rather than thoughts and memories about the event. By concentrating on what’s happening in your body, you gradually get in touch with trauma-related energy and tension. From there, your natural survival instincts take over, safely releasing this pent-up energy through shaking, crying, and other forms of physical release.
EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation. In a typical EMDR therapy session, you focus on traumatic memories and associated negative emotions and beliefs while tracking your therapist’s moving finger with your eyes. These back-and-forth eye movements are thought to work by “unfreezing” traumatic memories, allowing you to resolve them.

To learn more, see EMDR Therapy: A Guide to Making An Informed Choice.

Find a trauma specialist

Click here to find a somatic experiencing specialist
Click here to find a sensorimotor psychotherapist
Click here to find an EMDR therapist

Cognitive-behavioral therapy helps you process and evaluate your thoughts and feelings about a trauma. While cognitive-behavioral therapy doesn’t treat the physiological effects of trauma, it can be helpful when used in addition to a body-based therapy such as somatic experiencing or EMDR. Cognitive-behavioral therapy for trauma typically includes exercises and homework designed to help you challenge irrational thoughts about the traumatic event, cope with and control painful memories and emotions, and reduce stress and self-blame. Cognitive-behavioral therapy may also include education about the nature of trauma-related disorders.

Post-traumatic Stress Disorder (PTSD): Symptoms, Help, and Treatment
Coping with Grief and Loss: A Guide to Grieving and Bereavement
EMDR Therapy: A Guide to Making An Informed Choice.

Rasing Emotional Intelligence: Learning to Experience Intense Emotions
Defusing Stress: Finding Quick Stress Relief that Works for You
Attachment and Adult Relationships: How the Attachment Bond Shapes Adult Relationships

Brain Chemistry Basics

2008-05-19T16:59:00.000-07:00

You've probably heard the term "neurotransmitter" before, but what does this really mean? Neurotransmitters are chemical messengers in the brain that facilitate communication between nerve cells. Let's illustrate with serotonin. Figure 1 depicts the junction between two nerve cells. Packets of serotonin molecules are released from the end of the presynaptic cell (the axon) into the space between the two nerve cells (the synapse). These molecules may then be taken up by serotonin receptors of the postsynaptic nerve cell (the dendrite) and thus pass along their chemical message. Excess molecules are taken back up by the presynaptic cell and reprocessed.

Several things might potentially go wrong with this process and lead to a serotonin deficit. Just to enumerate a few possibilities:

Not enough serotonin is produced,
Not enough receptor sites to receive serotonin,
Serotonin is being taken back up too quickly before it can reach receptor sites,
Chemical precursors (molecules that serotonin is manufactured from) may be in short supply, or
Molecules that facilitate the production of serotonin may be in short supply.

As you can see, if there is a breakdown anywhere along the path, neurotransmitter supplies may not be adequate for your needs. Inadequate supplies lead to the symptoms that we know as depression.

The Primary Players

There are three basic molecules, known chemically as monoamines, which are thought to play a role in mood regulation: norepinephrine, serotonin and dopamine.

In the 1960s Joseph J. Schildkraut of Harvard University cast his vote with norepinephrine as the causative factor for depression in the now classic "catecholamine" hypothesis of mood disorders. He proposed that depression stems from a deficiency of norepinephrine in certain brain circuits and that mania arises from an overabundance of this substance.1 There is indeed a large body of evidence2 that supports this hypothesis, however, changes in norepinephrine levels do not affect mood in everyone. The implication is that medications such as reboxetine, which specifically targets norepinephrine, will work for some persons but not others.3

Obviously there must be some other factor that interacts with norepinephrine to cause depression. Serotonin has been found to be this other factor. This molecule has taken center stage in the past two decades thanks to Prozac and other Selective Serotonin Reuptake Inhibitors (SSRI's), which selectively act on this molecule. Serious investigations into serotonin's role in mood disorders, however, have been going on for almost 30 years, ever since Arthur J. Prange, Jr., of the University of North Carolina at Chapel Hill, Alec Coppen of the Medical Research Council in England and their co-workers put forward the so-called "permissive hypothesis". This view held that synaptic depletion of serotonin was another cause of depression, one that worked by promoting, or "permitting," a fall in norepinephrine levels. So, although, norepinephrine still played a major role in depression, serotonin levels could be manipulated to indirectly raise norepinephrine. Newer antidepressants like Effexor are actually targeted at both serotonin and norepinephrine.4 Tricyclics (TCAs) also affect both norepinephrine and serotonin, however, they have the added effect of influencing histamine and acetylcholine, which produces the side-effects that TCAs are known for, such as dry mouth or eyes, peculiar taste in mouth, sensitivity to light of the eyes, blurry vision, constipation, uninary hesitancy, and others. SSRIs do not affect histamine and acetylcholine and thus do not have the same side-effects as the older medications.5

A third substance that may play a role in mood is dopamine. Dopamine is associated with the reward, or reinforcement, that we get which causes us to continue participating in an activity. It has been implicated in such conditions as Parkinson's Disease and schizophrenia. There is also some evidence that, at least for a subset of patients, dopamine plays a role in depression.6 Dopaminergic substances and stimulants have been used as antidepressants when other measures have failed.7 Some studies have investigated dopaminergic agents as a rapid method of relieving depression (in contrast to medications which may take up to six weeks to exhibit their full effect).8

Although agents that work selectively on dopamine have the benefit of fast action, they have also exhibited some properties which have kept them from being as widely used as other antidepressants. Dopamine is a neurotransmitter that is associated with addiction and it's production is stimulated by drugs such as cocaine, opiates and alcohol (which may explain why depressed persons choose to self-medicate with drugs and alcohol.9) Drug specifically targeted at dopamine, for example amineptine (Survector), present the potential for abuse.10 For this reason, amineptine is not approved for use in the US or Britain at this time.

References

Nemeroff, Charles B. The Neurobiology of Depression. Scientific American, June 1998 [journal online]; Internet; cited May 15, 2000.
Goldberg, Ivan T. The Cholinergic Hypothesis of Affective Disorders: A MEDLINE Search. [Web site]; cited May 15, 2000.
Nemeroff.
Ibid.
Gelwan, Eliot. Tricyclic Antidepressants. Posted 9/30/92. [article online]; Internet, cited May 15, 2000.

No longer available)
California State University, Chico, Department of Psychology. Dopamine. [Web site]; cited May 15, 2000.
Nierenberg, AA, Dougherty D, Rosenbaum JF. Dopaminergic agents and stimulants as antidepressant augementation strategies. J Clin Psychiatry, 1998, 59 Suppl 5:60-3, discussion 64. [Web site]; Internet; cited May 15, 2000.
Willner P. The mesolimbic dopamine system as a target for rapid antidepressant action. Int Clin Psychopharmacol, 1997 Jul, 12 Suppl. 3:S7-14. [Web site]; Internet; cited May 15, 2000.
Flaherty, Michael T. What is the Relationship between Depression and Alcohol Use? [article online]; cited May 15, 2000.
Perera, I, Lim L. Amineptine and Midazolam Dependence. Singapore Medical Journal, date unknown. [online journal]; Internet; cited May 15, 2000

Post Traumatic Stress Disorder Research Fact Sheet

2008-05-18T20:37:00.000-07:00

From: The National Institute of Mental Health (NIMH)

Introduction

Post-traumatic stress disorder (PTSD) is an anxiety disorder that some people develop after seeing or living through an event that caused or threatened serious harm or death. Symptoms include flashbacks or bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feeling “on edge,” or avoiding thoughts and situations that remind them of the trauma. In PTSD, these symptoms last at least one month.

To aid those who suffer with PTSD, the National Institute of Mental Health (NIMH) is supporting PTSD-focused research, and related studies on anxiety and fear, to find better ways of helping people cope with trauma, as well as better ways to treat and ultimately prevent the disorder. This research fact sheet will highlight several important areas that NIMH researchers have recently learned about:

possible risk factors,
treating the disorder, and
next steps for PTSD research.

For more information about PTSD, please see the NIMH Post-Traumatic Stress Disorder booklet. You can also find a list of places to find more information about PTSD and NIMH at the end of this fact sheet.

Research on Possible Risk Factors for PTSD

Currently, many scientists are focusing on genes that play a role in creating fear memories. Understanding how fear memories are created may help to refine or find new interventions for reducing the symptoms of PTSD. For example, PTSD researchers have pinpointed genes that make:

Stathmin, a protein needed to form fear memories. In one study, mice that did not make stathmin were less likely than normal mice to “freeze,” a natural, protective response to danger, after being exposed to a fearful experience. They also showed less innate fear by exploring open spaces more willingly than normal mice.¹
GRP (gastrin-releasing peptide), a signaling chemical in the brain released during emotional events. In mice, GRP seems to help control the fear response, and lack of GRP may lead to the creation of greater and more lasting memories of fear.²

Researchers have also found a version of the 5-HTTLPR gene, which controls levels of serotonin — a brain chemical related to mood-that appears to fuel the fear response.³ Like other mental disorders, it is likely that many genes with small effects are at work in PTSD.

Studying parts of the brain involved in dealing with fear and stress also helps researchers to better understand possible causes of PTSD. One such brain structure is the amygdala, known for its role in emotion, learning, and memory. The amygdala appears to be active in fear acquisition, or learning to fear an event (such as touching a hot stove), as well as in the early stages of fear extinction, or learning not to fear.⁴

Storing extinction memories and dampening the original fear response appears to involve the prefrontal cortex (PFC) area of the brain,⁴ involved in tasks such as decision-making, problem-solving, and judgment. Certain areas of the PFC play slightly different roles. For example, when it deems a source of stress controllable, the medial PFC suppresses the amygdala an alarm center deep in the brainstem and controls the stress response.⁵ The ventromedial PFC helps sustain long-term extinction of fearful memories, and the size of this brain area may affect its ability to do so.⁶

Individual differences in these genes or brain areas may only set the stage for PTSD without actually causing symptoms. Environmental factors, such as childhood trauma, head injury, or a history of mental illness, may further increase a person's risk by affecting the early growth of the brain.⁷ Also, personality and cognitive factors, such as optimism and the tendency to view challenges in a positive or negative way, as well as social factors, such as the availability and use of social support, appear to influence how people adjust to trauma.⁸ More research may show what combinations of these or perhaps other factors could be used someday to predict who will develop PTSD following a traumatic event.

Research on Treating PTSD

Currently, people with PTSD may be treated with psychotherapy (“talk” therapy), medications, or a combination of the two.

Psychotherapy

Cognitive behavioral therapy (CBT) teaches different ways of thinking and reacting to the frightening events that trigger PTSD symptoms and can help bring those symptoms under control. There are several types of CBT, including

exposure therapy — uses mental imagery, writing, or visiting the scene of a trauma to help survivors face and gain control of overwhelming fear and distress
cognitive restructuring — encourages survivors to talk about upsetting (often incorrect) thoughts about the trauma, question those thoughts, and replace them with more balanced and correct ones.
stress inoculation training — teaches anxiety reduction techniques and coping skills to reduce PTSD symptosm, and helps correct inaccurate thoughts related to the trauma.

NIMH is currently studying how the brain responds to CBT compared to sertraline (Zoloft), one of the two medications recommended and approved by the U.S. Food and Drug Administration (FDA) for treating PTSD. This research may help clarify why some people respond well to medication and others to psychotherapy

Medications

In a small study, NIMH researchers recently found that for people already taking a bedtime dose of the medication prazosin (Minipress), adding a daytime dose helped to reduce overall PTSD symptom severity, as well as stressful responses to trauma reminders.⁹

Another medication of interest is D-cycloserine (Seromycin), which boosts the activity of a brain chemical called NMDA, which is needed for fear extinction. In a study of 28 people with a fear of heights, scientists found that those treated with D-cycloserine before exposure therapy showed reduced fear during the therapy sessions compared to those who did not receive the drug.¹⁰ Researchers are currently studying the effects of using D-cycloserine with therapy to treat PTSD.

Propranolol (Inderal), a type of medicine called a beta-blocker, is also being studied to see if it may help reduce stress following a traumatic event and interrupt the creation of fearful memories. Early studies have successfully reduced or seemingly prevented PTSD in small numbers of trauma victims.¹¹

Treatment After Mass Trauma

NIMH researchers are testing creative approaches to making CBT widely available, such as with Internet-based self-help therapy and telephone-assisted therapy. Less formal treatments for those experiencing acute stress reactions are also being explored to reduce chances of developing full blown PTSD

For example, in one preliminary study, researchers created a self-help website using concepts of stress inoculation training. People with PTSD first met face-to-face with a therapist. After this meeting, participants could log onto the website to find more information about PTSD and ways to cope, and their therapists could also log on to give advice or coaching as needed. Overall, the scientists found delivering therapy this way to be a promising method for reaching a large number of people suffering with PTSD symptoms.¹²

Researchers are also working to improve methods of screening, providing early treatment, and tracking mass trauma survivors; and approaches for guiding survivors through self-evaluation/screening and prompting referral to mental health care providers based on need.

The Next Steps for PTSD Research

In the last decade, rapid progress in research on the mental and biological foundations of PTSD has lead scientists to focus on prevention as a realistic and important goal.

For example, NIMH-funded researchers are exploring new and orphan medications thought to target underlying causes of PTSD in an effort to prevent the disorder. Other research is attempting to enhance cognitive, personality, and social protective factors and to minimize risk factors to ward off full-blown PTSD after trauma. Still other research is attempting to identify what factors determine whether someone with PTSD will respond well to one type of intervention or another, aiming to develop more personalized, effective and efficient treatments.

The examples described here are only a small sampling of the ongoing work at NIMH. To find more information about ongoing PTSD clinical studies, see NIMH's PTSD clinical trials Web page. As gene research and brain imaging technologies continue to improve, scientists are more likely to be able to pinpoint when and where in the brain PTSD begins. This understanding may then lead to better targeted treatments to suit each person's own needs or even prevent the disorder before it causes harm.

Where Can I Get More Information?

MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health, provides updated information and resource lists for many health topics, including post-traumatic stress disorder (PTSD) (En Español)

Information from NIMH is available online, in PDF, or as paper brochures sent through the mail. If you would like to have NIMH publications, you can order them at http://www.nimh.nih.gov or contact NIMH at the numbers listed below.

National Institute of Mental Health
Office of Science Policy, Planning, and Communications
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443- 4513, 1-866-615-NIMH (6464) toll-free
TTY: 1-866-415-8051 toll free
Fax: 301-443-4279
E-mail: nimhinfo@nih.gov

References

1. Shumyatsky GP, Malleret G, Shin RM, et al. stathmin, a Gene Enriched in the Amygdala, Controls Both Learned and Innate Fear. Cell. Nov 18 2005;123(4):697-709.

2. Shumyatsky GP, Tsvetkov E, Malleret G, et al. Identification of a signaling network in lateral nucleus of amygdala important for inhibiting memory specifically related to learned fear. Cell. Dec 13 2002;111(6):905-918.

3. Hariri AR, Mattay VS, Tessitore A, et al. Serotonin transporter genetic variation and the response of the human amygdala. Science. Jul 19 2002;297(5580):400-403.

4. Milad MR, Quirk GJ. Neurons in medial prefrontal cortex signal memory for fear extinction. Nature. Nov 7 2002;420(6911):70-74.

5. Amat J, Baratta MV, Paul E, Bland ST, Watkins LR, Maier SF. Medial prefrontal cortex determines how stressor controllability affects behavior and dorsal raphe nucleus. Nat Neurosci. Mar 2005;8(3):365-371.

6. Milad MR, Quinn BT, Pitman RK, Orr SP, Fischl B, Rauch SL. Thickness of ventromedial prefrontal cortex in humans is correlated with extinction memory. Proc Natl Acad Sci U S A. Jul 26 2005;102(30):10706-10711.

7. Gurvits TV, Gilbertson MW, Lasko NB, et al. Neurologic soft signs in chronic posttraumatic stress disorder. Arch Gen Psychiatry. Feb 2000;57(2):181-186.

8. Brewin CR. Risk factor effect sizes in PTSD: what this means for intervention. J Trauma Dissociation. 2005;6(2):123-130.

9. Taylor FB, Lowe K, Thompson C, et al. Daytime Prazosin Reduces Psychological Distress to Trauma Specific Cues in Civilian Trauma Posttraumatic Stress Disorder. Biol Psychiatry. Feb 3 2006.

10. Ressler KJ, Rothbaum BO, Tannenbaum L, et al. Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry. Nov 2004;61(11):1136-1144.

11. Pitman RK, Sanders KM, Zusman RM, et al. Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry. Jan 15 2002;51(2):189-192.

12. Litz BT WL, Wang J, Bryant R, Engel CC. A therapist-assisted Internet self-help program for traumatic stress. Prof Psychol Res Pr. December 2004;35(6):628-634.

NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:

NIMH does not endorse or recommend any commercial products, processes, or services, and publications may not be used for advertising or endorsement purposes.
NIMH does not provide specific medical advice or treatment recommendations or referrals; these materials may not be used in a manner that has the appearance of such information.
NIMH requests that non-Federal organizations not alter publications in a way that will jeopardize the integrity and "brand" when using publications.
Addition of Non-Federal Government logos and website links may not have the appearance of NIMH endorsement of any specific commercial products or services or medical treatments or services.

If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Center at 1-866-615-6464 or at nimhinfo@nih.gov.

Borderline: Walking the Line

2008-05-03T17:49:00.000-07:00

From: Psychology Today

Can you live with, and move beyond, a relationship with a borderline parent?
By Matthew Hutson, Psychology Today

Your childhood was full of tantrums—impulsivity, mood swings, neediness, fear of abandonment, and extreme sensitivity to rejection. And this isn't you we're talking about; it's your mom.

If you grew up the constant target of finicky and derisive comments, or the emotional caretaker for one of your parents, you know all too well the pain of having a father or (usually) mother with Borderline Personality Disorder. BPD doesn't just affect the one who receives the diagnosis; it often leaves a wake of turmoil through entire families as the emotional and relational disturbances ripple outward.

When a role model treats you as an extension of herself—there to meet her needs—the trauma can be long lasting. It takes a very strong person to overcome the effects, let alone maintain a constructive relationship with the parent. But there's hope. Here are several guidelines for dealing with a borderline parent, and for moving on with your own life.

Know the Type
Mothers with BPD outnumber fathers, and Christine Lawson, author of Understanding the Borderline Mother, has a taxonomy of the troubled parent: "The Queen is controlling, the Witch is sadistic, the Hermit is fearful, and the Waif is helpless," she says. And each requires a different approach. Don't let the Queen get the upper hand; be wary even of accepting gifts because it engenders expectations. Don't internalize the Hermit's fears or become limited by them. Don't allow yourself to be alone with the Witch; maintain distance for your own emotional and physical safety. And with the Waif, don't get pulled into her crises and sense of victimization; "pay attention to your own tendencies to want to rescue her, which just feeds the dynamic," Lawson says.

Build Fences
Borderline parents often can't separate their own needs from the needs of others. And sometimes they can't meet their own emotional needs, so they look to their children to fill it. When the child doesn't do the job, the parent can get angry, making resistance difficult. "Adult children need to define for themselves their limits and boundaries," says Kimberlee Roth, author of Surviving a Borderline Parent. "Let's say a parent regularly calls late at night to vent. Whatever your needs, communicate them in a calm, non-accusatory way: 'Mom, I'd like to listen but I can't do it late at night. How about if we talk in the morning instead?'" As a last resort, use Caller ID or voicemail.

Be Firm But Sensitive
Personal validation, which is important in any situation, is essential with a borderline parent. Express your awareness of her emotions even as you set boundaries. "You might feel like a broken record," Roth says, "but it's important to keep repeating your acknowledgement of the parent's needs without diminishing your own."

Trust Yourself
In writing her book, Roth encountered many children of borderline parents who said they felt crazy growing up. "They experienced a lot of inconsistencies—an action or statement that earned praise one day would touch off a three-day, stony silent treatment the next—as well as sudden outbursts and overreactions." So they never learn to trust their own judgment or feelings. The most important element to recovery, she says, is to accept that you're not crazy and that "it wasn't me."

Trust Others
People who've survived a borderline parent most frequently suffer from "feelings of worthlessness, fear of abandonment, and fear of people in general," according to Randi Kreger, co-author of the bestselling Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder. Because these adult children received "such mixed messages—you're a great person one day and you're horrible the next—there's a certain mistrust of people because you're always afraid they're going to hurt you." Kreger advises that they find friends and partners unlike the parent: consistent people who can provide unconditional love. And stop looking for sleights; hair-trigger defense systems that developed in the presence of abusive parents often lead people to see ill intentions where they don't exist and end up preemptively sabotaging relationships.

Defend Your Boundaries
Children of borderline parents are often forced to act as the parent themselves—"it's like a child raising a child," Kreger says—and this role can play itself out in other relationships. They grow up very quickly in many ways and act as caretaker for everyone, sometimes at the expense of taking care of themselves. "Having that undue sense of responsibility can leave them feeling very alone in the world," Lawson says. And they allow others to tread their boundaries just as the parent did. So once you learn to set limits for your parent, set them for other people and learn to put yourself first.

None of these steps will come easy. An abusive or inconsistent parent can leave a deep wound. "Trying to manage it can be a lifelong process," Kreger says. But she insists that with a good therapist, and support from a community of other people who have gone through the same thing, "there is real possibility to get better, and I know many people who have."

Suicides increased after antidepressant warning: Manitoba researcher

2008-05-02T21:48:00.000-07:00

From: CBC News

Youth suicides increased after Health Canada warned about the use of antidepressants, a University of Manitoba researcher has found.

Health Canada issued a notice in 2004 that antidepressant drugs were linked to increased rates of suicidal thoughts in children and teens.

It advised patients under the age of 18 who were being treated with selective serotonin reuptake inhibitors (SSRIs) or serotonin noradrenalin reuptake inhibitors (SNRIs) to consult their physicians. A similar warning was issued around the same time in the U.S.

Dr. Laurence Katz, an associate professor of psychiatry at the University of Manitoba, studied provincial data from 2005 and 2006, and found some children and teens with mental illness stopped taking their medication and stopped regularly seeing their doctors following the warning.

Katz, of the university's child psychiatry department and mood and anxiety disorders research group, found youth suicides in Manitoba rose dramatically during that time.

Katz had been worried about the advisory and what it would mean for children's health.

During the two-year period studied, there was a 25 per cent increase in youth suicide and a 14 per cent drop in the use of antidepressants among children and teens.

There was also a 10 per cent drop in the number of doctor visits by depressed kids, suggesting the public didn't really understand the warning, Katz said.

"If people had followed those guidelines and adhered to the concern in the warning, we would have expected to see physician office visits increase. But, in fact, they went down."

More research needed

The results, released Monday in Winnipeg, don't surprise Bill Ashdown of the Mood Disorders Association of Manitoba.

"Having the advisory come out would certainly negatively impact the number of doctors who would simply say, 'No, I'm not going to bother prescribing because it will get me into a hassle.'"

Ashdown is convinced some patients would have simply stopped taking their medication without consulting their doctors. He said the warning should have been issued only to physicians through medical journals.

Katz said he didn't have a problem with the way the warning was worded — the problem was with how it was perceived. More research is needed, he added, into what role the warning played in the study's findings.

ACTUALIZING

Complicated Grief

Definition

Symptoms

Causes

Risk factors

When to seek medical advice

Tests and diagnosis

Complications

Treatments and drugs

Prevention

Coping and support

Complex PTSD

Differences between the effects of short-term trauma and the effects of chronic trauma?

What are examples of types of captivity that are associated with chronic trauma?

What are the symptoms of Complex PTSD?

Alterations in emotional regulation

Alterations in consciousness

Changes in self-perception

Alterations in the perception of the perpetrator

Alterations in relations with others

Changes in one's system of meanings

What other difficulties do those with Complex PTSD tend to experience?

There is a tendency to blame the victim.

Summary

Recommended Reading

References

Complex post-traumatic stress disorder

Symptom profile

Treatment

See also

Footnotes

References

External links

PTSD and Physical Health

The Numbers Count: Mental Disorders in America

Mental Disorders in America

Mood Disorders

Agoraphobia

Specific Phobia

For More Information

References

Examples of Post Traumatic Stress Disorder (PTSD)

What is Post Traumatic Stress Disorder?

Recognizing PTSD. Do I Have It?

John's Story

Sharon's Story

What kind of trauma leads to PTSD?

Symptoms of PTSD

1. Symptoms of reliving or "re-experiencing" the trauma

2. Symptoms of avoidance

3. Symptoms of increased anxiety or "hyperarousal"

When is it (and when is it NOT) PTSD

How else can I recognize if I have PTSD?

PTSD: The Facts

Post-traumatic Stress Disorder (PTSD) -Symptoms, Treatment, and Self-Help

What is post-traumatic stress disorder (PTSD)?

PTSD is a response by normal people to an abnormal situation

Symptoms of post-traumatic stress disorder (PTSD)

Re-experiencing the traumatic event

PTSD symptoms of avoidance and emotional numbing

PTSD symptoms of increased arousal

Other common symptoms of post-traumatic stress disorder

Getting help for post-traumatic stress disorder (PTSD)

Why Should I Seek Help for PTSD?

Finding a therapist for post-traumatic stress disorder (PTSD)

Help for U.S. veterans with PTSD

Trauma therapist referral

Treatment for post-traumatic stress disorder (PTSD)

Types of treatments for post-traumatic stress disorder (PTSD)

Self-help and support for post-traumatic stress disorder (PTSD)

Reach out to others for support

Avoid alcohol and drugs

Challenge your sense of helplessness

Post-traumatic stress disorder (PTSD) and the family

Helping a loved one with PTSD

To Learn More: Related Helpguide Articles

Related links for post-traumatic stress disorder (PTSD)

General information about post-traumatic stress disorder (PTSD)

Symptoms of post-traumatic stress disorder (PTSD)