Clinical Clarity for Complex Diagnoses

What is attention deficit/hyperactivity disorder?

Attention deficit-hyperactivity disorder (ADHD) is a mental health disorder that encompasses multiple symptoms such as, difficulty concentrating, increased energy, cannot sit still for any extended period of time and impulsivity. This can lead to issues in relationships, impairment in work and school, low self-esteem and other problems.

It is often called adult ADHD, usually symptoms will develop in childhood and continue on into adulthood. Sometimes ADHD is not acknowledged or even diagnosed until adulthood. ADHD symptoms in adults may not be as noticeable as the symptoms in children. In adults, there is a struggle with restlessness, the issues with concentration may continue but the hyperactivity may decrease.

The treatment for children with ADHD is similar to treatment of adults. Treatment for adults includes medication, psychotherapy (counseling) and treatment for any other mental health disorders that may co-occur with ADHD.

Attention Deficit/Hyperactivity Disorder (ADHD)

Symptoms

Adult ADHD symptoms are as follows:

● Low tolerance for frustration

● Concentration problems

● Issues with doing multiple tasks at one time

● Planning is poor

● Persistent mood swings

● Difficulty following through and completing tasks

● Problems dealing with stress

● Angry outbursts

● Time management skills are poor

● Issues with organizing and prioritizing tasks

● Impulsivity

Causes

The causes of ADHD are not known, research continues to work on finding out what causes ADHD. There are some factors that play a role in ADHD:

● Genetics: ADHD can run in families, and studies are showing that genetics may be a cause.

● Environment: Lead exposure can be an environmental factor that may increase the risk of ADHD.

● Issues during childhood development: problems with the central nervous system at crucial moments in development may be a contributor to the development of ADHD.

Complications

Having ADHD can be pretty difficult for individuals diagnosed with this mental health condition, it can contribute to problems in:

● Employment

● Financial problems

● Poor self-image

● Suicide attempts

● Issues with law enforcement

● Poor work or school performance

● Unstable relationships

● Physical and mental health issues

Frequent accidents

● Substance abuse with alcohol and/or drugs

Diagnosis

Signs and symptoms of ADHD in adults can be difficult to recognize. The main symptoms start as a child, most likely before the age of 12 and continue into adulthood, which can cause severe issues in daily functioning.

Making a diagnosis can include:

● Meeting full criteria in the DSM-5: all psychologists, therapists, medical providers and psychiatrists must use this book as a way to see if the individual showing ADHD symptoms fits the full criteria for a diagnosis.

● Physical examination: this is a process of elimination to make sure there are not any other physical problems causing/contributing to the symptoms of ADHD.

● ADHD rating scales or psychological testing: to help to gather and assess information about the symptoms.

● Information collection: asking questions about recent physical problems, family and personal medical history, and needing a history of the symptoms.

Treatment

Most common treatment for ADHD in adults involves psychological counseling, medication, education about symptoms of ADHD and building coping skills. A combination of these treatments is the most efficient treatment available. These treatments can help with learning how to cope with the ADHD symptoms, but it is not a cure. Everyone is different so it may take some time to find what treatment works best for the individual showing signs of ADHD.

Medications

It is best to discuss the different medications available and the side effects of taking certain medications.

● Stimulants: these include methylphenidate or amphetamine, they are the most commonly prescribed medications for ADHD, but the doctor may find that a different kind of medication may work better for their patient. The stimulants help to balance the neurotransmitters in the brain.

● Other medications: the other medications that are used to treat ADHD can include non-stimulant atomoxetine and certain antidepressants such as bupropion. Atomoxetine and antidepressants take more time to work than stimulants do, but these medications can be a good option for people that cannot take stimulants.

Psychological counseling

Therapy for adults that have symptoms of ADHD or have been diagnosed includes psychotherapy, which is receiving psychoeducation about the disorder and learning skills to be able to cope appropriately with the symptoms.

Psychotherapy may help in these areas:

● Increase self-esteem

● Develop certain techniques that help the client deal with their anger

● Learn how to have healthy relationships with family, peers, co-workers and friends

● Learn how to better control impulsivity

● Develop problem solving skills

● Improve organizational and time management skills

Common types of psychotherapy for ADHD include:

● Cognitive Behavioral Therapy- (CBT): this intervention helps clients to learn how to change their negative thinking patterns into positive ones. It will improve the ability to manage and change unwanted behavior. It can assist in dealing with the challenges in life, such as work, relationship issues or school, and can help to manage other co-occurring mental health issues, such as substance abuse, depression and many more.

● Family, couples and marriage counseling: this therapy can assist family members and friends deal with the stressors that may exist dealing or living with someone with ADHD and gives them answers as to what they can do to help their loved one. This type of counseling can also enhance problem-solving and communication skills.

References:

https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878

https://www.mayoclinic.org/diseases-conditions/adult-adhd/diagnosis-treatment/drc-20350883

Schizophrenia is a severe mental health disorder, individuals that received a diagnosis of this mental illness have difficulty being able to differentiate between reality and hallucinations and delusions because reality is interpreted abnormally with schizophrenia. This mental health condition can cause symptoms of auditory and visual hallucinations, tactile, olfactory and gustatory are less common; symptoms of delusions, disorganized thinking, impairment in daily functioning that can lead to individuals becoming disabled.

Schizophrenia

Symptoms

Schizophrenia includes multiple issues with thinking (cognitions), emotions and behavior. Symptoms vary between individuals but generally include delusions, hallucinations or unorganized articulation, most have an impairment in functioning. Symptoms are as follows:

● Delusions: fictitious beliefs that are not realistic. For example, one with schizophrenia may believe that someone is talking about them or out to get them; they are extraordinary, believe a person is in love with them, or something destructive is going to happen. Delusions are common in people that have schizophrenia.

● Hallucinations: seeing or hearing things that do not exist. A person with a diagnosis of schizophrenia will see and/or hear unrealistic sights and sounds that others around them are not experiencing. Hearing voices is the most common sound.

● Disorganized thinking (speech): Disorganized thoughts is in conjecture from disorganized speech. Communication is greatly impaired, answers to questions may be irrelevant to what was asked. Sometimes individuals put together incomprehensible words, sometimes called “word salad.”

● Extremely disorganized or abnormal motor behavior: This can be shown in multiple ways, unforeseeable agitation to acting childlike. It is difficult to complete simple tasks, refusal to receive instructions, improper demeanor, complete absence of response, or extreme or ineffective movement.

● Negative symptoms: individuals do not have the ability to function ordinarily. The person with this mental illness may not groom regularly or does not show emotion and will not make eye contact, flat effect of facial expressions, or tone of voice is usually monotone. The individual loses interest in daily activities, isolates or does not experience enjoyment.

Each person with schizophrenia has a different level of severity regarding their symptoms, there will be times when the symptoms will become more severe and even an exemption of symptoms but stressors seem to increase the symptoms.

In males, schizophrenia symptoms tend to develop in the early to mid 20s. In females, the symptoms begin in the late 20s. It is not common for children to be diagnosed with schizophrenia and very rare with individuals older than 45 years old.

Symptoms in Teens

The symptoms in teens correlate with those of adults, but it may be difficult to notice. This may happen because some of the early symptoms of schizophrenia in teens are common for development during teenage years, such as;

● Isolation from others

● Performance in school may decline

● Difficulty sleeping

● Irritability or depression

● Motivation has decreased

● Teens are less likely to have delusions

● More likely to have visual hallucinations

Note: Recreational substance use can mirror signs and symptoms.

When to seek professional help

Individuals with schizophrenia may not recognize that their symptoms may need professional attention and may stem from a mental health disorder. Family and friends are usually the ones to seek help for them.

How to help someone who may have schizophrenia

If there is someone that you care about that may have symptoms of schizophrenia, tell them your concerns. Even though it is not legal to force anyone to get professional assistance, it is important to support and encourage them by finding a professional that is able to help.

If this person is a danger to self or others or cannot provide shelter, food or clothing for themself, please call 911 or any other emergency responders for help so they can get evaluated by a mental health professional.

Sometimes, emergency hospitalization is necessary. The laws vary from state to state regarding involuntary commitment for mental health treatment. Contact mental health agencies or police departments in your area for details.

Treatment

Schizophrenia involves a lifelong treatment, even if the symptoms seem to have decreased. Medication and psychosocial therapy can help individuals to cope with this mental health condition.

Medications

Schizophrenia treatment requires medication, antipsychotic medications are commonly prescribed by professionals. Psychotic medication is to manage and reduce the symptoms, it is essential to use the least amount of medication possible in order to decrease the symptoms. Many individuals with a schizophrenic diagnosis may be hesitant to take medication because of the side effects. Being cooperative with the treatment professional may impact drug choice. For example, a person that struggles to take their medications daily may do better with getting an injection that may last longer than pills.

Feel free to ask the doctor about the benefits and/or side effects of the drugs they may want to prescribe.

Suicidal Thoughts and Behavior

Individuals with schizophrenia can have suicidal thoughts and behaviors it is rather common. If you know of someone who is in danger of taking their own life or has made a suicide attempt, make sure not to leave that person alone. Call 911 or your emergency number in your area immediately. All suicidal tendencies are to be taken very seriously.

Psychosocial Interventions

Once the psychosis is reduced, in addition to taking medications as prescribed, psychological and psychosocial interventions are important. These may include:

● Individual therapy: Psychotherapy can assist in normalizing thought patterns. Learning how to cope with stress in a healthy manner and being able to recognize symptoms to help individuals to better manage their mental illness.

● Social skills training: this helps to build social skills and develop communication and to assist with participation in daily activities.

● Vocational rehabilitation and supported employment: this focuses on assisting individuals with schizophrenia to prepare for, find and keep employment.

Most people with schizophrenia must have some daily living support. There are multiple resources in the community that have programs such as Community Based Rehabilitative Specialists (CBRS), research shows that CBRS workers are helping people with schizophrenia to build skill sets that help to improve their quality of life. Case Managers to assist individuals in linking to resources, make sure they have the proper paperwork to become eligible for programs and services and can take these individuals to the food bank. These providers make sure that each one of their immediate needs are met.

Reference:

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. Arlington, VA: American Psychiatric Association; 2013.

What is Depression?

Depression is a mood disorder that causes feelings of worthlessness, sadness, losing interest in the activities once loved, it contributes to how someone thinks, feels and behaves, it is something to take very seriously.

Depression

Symptoms

Even though depression may develop once in a lifetime, individuals can experience many episodes. When these episodes happen, the symptoms may occur daily, nearly every day, and can encompass:

● Restlessness, fatigue, so it is difficult to complete even one simple task

● It can cause psychomotor to slow down and slows thinking patterns

● Causes self-blame, feelings of worthlessness and/or guilt

● Difficult to concentrate and make choices and cannot remember as well

● Irritability, frustration, feelings of hopelessness/emptiness, and sadness

● It can cause angry outbursts

● Sleep can change to wanting to sleep a lot or not sleeping at all

● Agitation, anxiety or feeling restless

● Losing interest in activities that once brought pleasure

When depression occurs, symptoms can get severe enough to cause impairment in functioning, such as at work, school, social activities or contribute to relationship problems. Some individuals with depression will often feel unhappy or miserable without knowing the reason why. So please get help because everyone deserves to feel happy and to enjoy their everyday lives.

When to get help

If someone feels depression mostly everyday, then it is time to set an appointment with a mental health provider such as, therapist, psychologist or psychiatrist or doctor.

When to get emergency help

If someone feels as though they will harm their self or attempt suicide, call 911 or the local emergency room immediately.

Consider these choices if feeling suicidal:

● Call a mental health provider or doctor.

● The Suicid & Crisis Lifeline in the U.S. has a Spanish language phone list at 1-888-628-9454 (toll free).

● U.S. Veterans or service members who are in crisis can call 988 and then press 1 for the Veterans Crisis Line or test 838255 or chat online.

● Reach out to a trusted friend or family member.

If an individual has a loved one who seems to be in danger of suicide or has made a suicide attempt, do not leave that person alone, have someone stay with them. Call 911 or the local emergency number immediately. If it is safe to do, take the person to the nearest hospital emergency room.

Causes

There is no known reason as to why someone will develop depression. Many mental health disorders have multiple reasons why they develop, such as:

● Biological characteristics: Individuals with depression show a physical change in their brain. There is no answer why these changes occur, this information may help to find the reasons why this happens.

● Hormones: Adjustments in the body’s balance of hormones may play a role in triggering or developing depression.

● Inherited traits: Depression is seen in individuals whose biological family members also have had this mental health condition.

Risk factors

Depression will more than likely start in teens, or in the 20s or 30s but it can occur at any age. There are more females diagnosed with depression than males, this may happen since more women will seek treatment than men.

Factors that seem to contribute to triggering or developing depression include:

● Specific characteristics can involve like being pessimistic, critical of oneself, low self-esteem and being too co-dependent on others.

● Having biological relatives that have a history of bipolar, suicide or depression.

● Misuse of alcohol or illicit drugs.

● Having chronic illness, such as a stroke, chronic pain, heart disease or cancer.

● Medications: such as sleeping pills and high blood pressure medication (please first talk to your doctor before stopping any medication).

● Having a history of other mental health disorders, such as an eating disorder, post traumatic stress disorder (PTSD) and/or anxiety disorder.

● Being gay, a lesbian or transgender, or having variations of genital organs that are not clearly female or male (intersex) in a situation without support.

Complications

Depression can take a serious toll on the individual diagnosed and on family and friends. Depression will increase and get worse if not treated, one can develop behavioral, emotional and physical health problems that can negatively impact most aspects of their everyday life.

Difficulties that are affiliated with depression encompass:

● Isolation from others

● Feeling suicidal, making suicide attempts or committed suicide

● Self-harm such as cutting different parts of the body

● Can cause issues in family, relationship problems, and difficulty at work and school

● Gaining weight leading to heart disease and/or diabetes

● Abusing drugs and/or alcohol

● Physical illness and pain

● Social phobia, anxiety and panic disorder

Types of Depression

Symptoms that stem from major depression can be different for each person. In order to clarify the type of depression a therapist, psychologist, psychiatrist or doctor can add one or more specifiers. Definition of specifier is to have depression with distinctive features, is as follows:

● Anxious distress: depression with abnormal restlessness and/or worry about possible circumstances or feeling a loss of control.

● Mixed features: coincides with depression and mania, which is becoming more talkative, increased energy and having a heightened self-esteem.

● Melancholic features: extreme depression with lack of enjoyment of something that used to bring pleasure, irritable mood in the mornings, decrease/increase in appetite, feelings of guilt/shame, agitation and psychomotor movement has slowed.

● Atypical features: an individual can feel happier temporarily, an increased appetite, sensitivity to rejection, feeling weight in the arms and legs and excessive need for sleep.

● Psychotic features: depression can coincide with hallucinations or delusions, which may include personal inadequacy or other negative content.

● Cataonia: depression that includes uncontrollable and pointless movement or fixed and inflexible posture in motor activity.

● Peripartum onset: depression that occurs during pregnancy, weeks or months after delivery (postpartum).

● Seasonal pattern: depression caused by a reduced exposure to sunlight and/or when changes in the seasons have occurred.

Other disorder that cause depression symptoms

The mental health disorders below, involve depression as a symptom. Getting a correct diagnosis is essential to receiving the proper treatment.

● Bipolar I & II: these mood disorders involve major mood swings; going from highs (mania) to lows (depression). It is difficult to differentiate between depression and bipolar disorder at times.

● Cyclothymic disorder: cyclothymic has a lower level of highs and lows unlike bipolar, which is more extreme.

● Disruptive mood dysregulation disorder: this mood disorder in children involves chronic and extreme irritability and anger with repeated angry outbursts.

● Persistent depressive disorder: oftentimes called dysthymia, this is not as severe but is a more chronic kind of depression. It is usually not debilitating, persistent depressive disorder can impair daily functioning and prevent an individual from living a full and happy life.

● Premenstrual dysphoric disorder: depression symptoms that are affiliated with hormonal changes that start a week before and improve within a few days after the onset of the menstrual cycle, and are minimal or gone after the cycle has ended.

● Other depressive disorders: this is depression caused by the use of substances such as illicit/recreational drug use, prescribed medications, side effects or a medical condition.

Treatment

Psychotherapy is practiced by a therapist, psychologist or psychiatrist and medication are the treatment options available for treating depression. A psychiatrist, nurse practitioner and doctor can prescribe medication to reduce symptoms.

If a person has extreme depression they may need to stay at a hospital, or an outpatient treatment program until the symptoms have decreased. There are many types of medications to help such as, but not limited to Selective Serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine, Tricyclic Antidepressants, Atypical Antidepressants, Monoamine Oxidase Inhibitors (MAOIs), and other medications may be added to antidepressants to enhance antidepressant effect. It may take some time to find the right medication, once this is found it will help to decrease the symptoms.

Psychotherapy

What is psychotherapy?

The word psychotherapy encompasses multiple treatment strategies for depression. During psychotherapy sessions with a licensed or trained mental health professional who assists the individual in recognizing and learning how to cope with the triggers of depression.

Sometimes they entail genetic factors or chemicals that are imbalanced in the brain to trigger depression. The physiological and psychological elements of depression are equally important when treating this mental health condition.

How does psychotherapy help with depression?

● Learn coping strategies and problem solving skills

● Regain control and pleasure in life

● Get familiar with the behaviors, thoughts that may contribute to emotions and depression.

● Learn how to recognize and be aware of life issues or experiences such as a major illness, a loss in the family, loss of employment or a divorce-that can greatly contribute to depression and then assist with helping people to understand which area of the problems they may be able to solve and improve.

What are the types of therapy?

● Individual: this therapy includes one client and the therapist/clinician

● Group: when there are two or more clients that are participating in therapy at the same time. The clients will share their experiences and learn that others may feel the same way and maybe have the same experiences with depression.

● Marital/couples: this type of therapy helps marital couples and intimate partners understand their loved one who has depression, what changes can help, and how to cope.

● Family: plays a key part of the team that assists individuals with depression to get better, it helps for loved ones to understand what their family member is going through and how they can help.

Approaches to therapy

There are different paths that therapists, clinicians and psychologists take to provide therapy. The therapist will first develop a therapeutic alliance with the client, which is building rapport and trust. This alliance is crucial regarding therapy because the client must have trust for the therapist they are working with for it to be successful. After this is built the therapist will assess the client while they give information about their depression and then decide what would be the best approach for the client.

Psychodynamic therapy

Psychodynamic therapy is the premise that the client is depressed because of negative and hurtful experiences they have had in their life, which can cause unconscious conflict and what stems from childhood. The main goal of this therapy is to teach the client how to better cope with their depression symptoms and how to talk about the feelings that contribute or cause their depression. Psychodynamic therapy is done over three to four months, although it can sometimes last years.

Interpersonal therapy

Interpersonal therapy concentrates on the relationships the client has with family and friends, what their interactions and behaviors are like around these people. Communication skills and increasing self esteem is done over a short period of time. This therapy also lasts up to three to four months and usually works well for depression caused by major life events, social isolation, relationship conflict and mourning the loss of a loved one.

Cognitive behavioral therapy (CBT)

Cognitive Behavioral Therapy, helps clients with depression to recognize and change incorrect apprehensions that they see in themselves and the world. The therapist helps the client to change their faulty thinking by introducing positive thoughts and affirmations. Clients learn the “right” and “wrong” way they perceive about themselves and others.

Therapy tips

Remember, therapy will work best for clients that show up to all of their scheduled sessions. The outcome of therapy depends on the efforts put forth by the client. Therapy requires time, honesty, work and consistency. When you start therapy, work on building some goals with the therapist. It is important to take time to review the progress made with the counselor. It is crucial to be honest with the therapist, to communicate to the therapist if the client does not like the approach chosen or does not like the therapist that is helping them.

References:

https://www.my.clevelandclinic.org/health/treatments/9300--psychotherapy-for-depression

http://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

http://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

There are normal levels of anxiety that play a role in everyday life. When individuals have an anxiety disorder they will experience persistent and extreme worry and feel fearful about daily circumstances. Anxiety will come on quite suddenly, causing panic and fear that reaches abnormal levels within minutes, which will often develop into panic attacks if the anxiety is not reduced in a timely manner.

Anxiety

Anxiety becomes a serious problem when the feelings of anxiety and panic impair one's daily functioning, is a challenge to control and is an exaggerated response to a danger that is not seen as severe by others. People with extreme anxiety will avoid certain areas or situations that trigger their anxiety, is a way to avoid these feelings. These symptoms can start at childhood and extend into adulthood.

The different types of anxiety disorders consist of generalized anxiety disorder, social anxiety disorder and separation anxiety disorder. People can have co-occurring (more than one), anxiety disorder at one time.

Treatment is key to learning how to cope with anxiety and to reducing its impact.

Symptoms

The symptoms of anxiety are listed below:

● Rapid breathing to the point of hyperventilating at times

● Shakiness

● Increased heart rate

● Feelings of nervousness or restlessness

● Sweating

● Tiredness or weakness

● Sleeping issues

● Difficulty concentrating

● Avoiding things that cause anxiety

● Worry is excessive and is difficult to control

● Focusing on worry

● Having gastrointestinal (GI) issues

Multiple types of anxiety disorders that exist:

● Generalized anxiety disorder: extreme and excessive worry about events or activities, including ordinary or routine issues. The worry is over exaggerated to the actual situation, it is problematic to manage and impacts how someone feels physically. It will often develop along with depression, other mental health disorders and/or other anxiety disorders.

● Panic disorder (Panic attacks): repeated interludes of abrupt feelings of severe fear, terror and anxiety that will spike within minutes. An individual with this disorder may experience feelings of imminent doom, have chest pain, accelerated heart beat, heart palpitations and difficulty breathing. These are known as panic attacks, which often lead to excessive worry that this will happen again or develop avoidance of situations or locations that trigger a panic attack.

● Agoraphobia (ag-uh-ruh-FOE-be-uh): this anxiety disorder in which fear causes an avoidance of situations or places that can bring on panic and can cause feelings of being powerless, trapped or ashamed. If the disorder is severe enough individuals will be fearful of leaving their home.

● Social Anxiety Disorder: extreme levels of anxiety and fear that can cause feeling self conscious and being concerned with not being accepted by others, which can lead to avoiding social situations.

● Separation anxiety disorder: this occurs during childhood when the child experiences severe anxiety that is too extreme for the developmental level of the child, which is associated with separation from parents or others in nurturing roles.

Risk Factors:

These risks may enhance the chances of developing an anxiety disorder:

● Personality: Individuals with specific personality types are more likely to have anxiety disorders than others would be.

● Other mental disorders: Individuals with depression and other co-occurring mental health disorders will frequently have an anxiety disorder.

● Stress that develops from a physical illness: worry and concern about treatment and what may happen by having a serious physical illness or health condition can cause stress.

● Trauma: Children that have experienced or witnessed traumatic events have a higher chance of acquiring an anxiety disorder at some point of their lives. Many adults who have been through trauma can develop an anxiety disorder as well.

● Stress that is not dealt with in a healthy manner: Extreme stress that is ignored can lead to a severe anxiety disorder due to multiple stressors building up over time. Example: A loss of a loved one, work stress and/or financial problems that are completely ignored.

● Alcohol and Drugs: alcohol use, the misuse of and withdrawal or can cause anxiety or make it more severe if it already exists.

● Genetics can play a role in developing an anxiety disorder: anxiety disorders are known to run in families.

Diagnosis

It would be wise to check with the doctor to make sure there are not any physical health issues that may be causing anxiety. The doctor can check for any medical conditions that may be underlying. If there does not seem to be any physical issues contributing to or causing anxiety, then it should be time to see a mental health specialist who is able to diagnose and treat mental health disorders. Psychotherapy works well in order to treat anxiety and other mental illnesses.

To diagnosis an anxiety disorder:

● A psychological evaluation: this involves the client communicating his/her feelings, thoughts and behaviors in order to find a proper diagnosis and can pinpoint other related problems if necessary. Since this is a cash pay practice then the client has the choice of whether they want to have a paper trail or not of their diagnosis.

● Meeting the criteria in the DSM: Diagnostic and Statistical Manual of Mental Disorders (DSM): this book is used by all medical and mental health professionals in order to make a proper diagnosis regarding mental illness. This is published by the American Psychiatric Association. A client will have to fit the full criteria of symptoms in the DSM before a diagnosis can be made, the DSM must be used for all mental health diagnoses.

Treatment

There are two main treatments for anxiety disorders, which are medications and psychotherapy. Individuals will most likely benefit from using both of these methods but it may take some time to find out what treatments and medications work best for you.

Psychotherapy

This type of therapy is also known as “talk therapy” or counseling, this includes working with a therapist to learn how to cope with the symptoms of anxiety. Using many different coping methods will be introduced to the client so they can choose the ones that work well to reduce their symptoms. This can be rather effective and helps the client to feel more in control of their anxiety disorder.

Cognitive Behavioral Therapy (CBT) works well for anxiety disorders, which is a form of psychotherapy. This is usually a short-term treatment, CBT’s focus is to teach clients coping skills in order to decrease the symptoms of anxiety.

CBT involves exposure therapy, which a client will slowly confront the item or circumstances that trigger the anxiety, which helps to build confidence and the client can learn how to cope with symptoms and circumstances on their own.

Medications

There are many different medications to reduce anxiety symptoms so check with your doctor or a psychiatrist to find the medication that works best for you.

Reference:

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. Arlington, VA: American Psychiatric Association; 2013.

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is a mental health condition that influences the way people think and feel about “self” and others. This can cause an impairment in daily functioning. It involves self-esteem problems, difficult time controlling behavior and emotions, and there seems to be issues with relationships.

The individuals that have Borderline Personality Disorder (BPD) have extreme fear of abandonment and/or uncertainty and cannot tolerate being alone. Individuals with BPD may push others away by having inappropriate anger, impulsivity and mood swings, even though the person wants to have sustainable and loving relationships with others.

BPD will usually start by early adulthood. This mental health issue is known to worsen during young adulthood but may get better in time.

So many people struggle with BPD, so no one is alone; there are many clients that go on and have a productive life with BPD after receiving treatment through psychotherapy.

Borderline Personality Disorder (BPD)

Signs and Symptoms

● Feelings of emptiness

● Self-harm, suicidal threats or behavior, can be a response to being fearful of abandonment or rejection

● Some periods of stress-related paranoia and derealization, lasting from minutes to hours

● Risky or impulsivity, such as gambling, unsafe sex, binge eating, drug abuse or reckless driving or being involved with self sabotage

● The person sees themself as bad or as not even existing at all, rapid changes in self-identity and self-image, which can cause a shift in changing goals and values.

● Individual will have an extreme fear of abandonment and will sometimes go to serious measures to avoid real or imagined rejection or separation

● Pattern of unstable relationships, putting someone on a patistole one minute and then thinking they are cruel the next

● Mood swings that can last a few minutes or up to hours, which can lead to happiness, shame, anxiety or irritability

If You Have Suicidal Thoughts

If an individual is seeing mental images of hurting yourself, having suicidal ideation or suicidal tendencies, get help immediately by:

● Call 911 or the local emergency number immediately.

● Call a suicide hotline, In U.S. call or text 988 to Suicide Hotline, available 24/7, or use the Lifeline Chat, free and confidential.

● Call a mental health provider, doctor or other health care provider.

● Contact someone from the faith community.

Remember, take every suicidal threat seriously, get that person help immediately!!!

Complications

Borderline Personality Disorder can impact multiple areas of a person’s life. It can make it difficult to have sustainable relationships, jobs, school, attend social activities and a low self image, which can cause:

● Serve jail time, multiple legal issues

● Attempt or commit suicide

● Not finishing education

● Involved in accidents, unsafe sex, unplanned pregnancies, physical altercations and sexually transmitted diseases due to impulsivity.

In addition, people can have co-occurring disorders, for example:

● Depression

● Anxiety

● Drug and alcohol abuse

● Bipolar

● Post Traumatic Stress

● Attention-Deficit/hyperactivity

● Other personality disorders

● Eating disorders

Treatment

Treatment can be done by using psychotherapy during therapy sessions. Borderline Personality Disorder (BPD) usually will not appear in children or teens. This is because what may seem to be signs and symptoms of BPD may disappear as children develop and become more mature.

Treatment can help clients develop the skills to cope and manage this disorder. It is imperative that a client receive treatment for another mental health condition that is co-occurring with BPD such as, but not limited to depression or substance abuse. Through treatment a person can feel better about themself and live a freeing and happy life.

Psychotherapy

Psychotherapy is also known as-talk therapy-it is a primary treatment approach for Borderline Personality Disorder. The therapist will assess and choose the right therapy approach that is right for the client. The goals for psychotherapy can help you:

● Reduce impulsivity so the client can check into their emotions, instead of acting on them

● Receive psychoeducation about Borderline Personality disorder

● Control emotions that are uncomfortable

● Decrease the impairment in daily functioning

● Work on making relationships more sustainable

Types of Psychotherapy that help:

● Schema-Focused therapy: this type of therapy can help the client to recognize their unmet needs that have negatively impacted life patterns. This therapy teaches the client how to get their needs met and how to increase healthy daily routines.

● Mentalization-based therapy (MBT): it is a talk therapy that assists in recognizing a person’s thoughts and feelings and teaches them how to create another perspective, MBT focuses on thinking before reacting.

● Transference-focused psychotherapy (TFP): known as psychodynamic psychotherapy, TFP assists in helping a person begin to understand their emotions and interpersonal struggles through the development of the client and therapist’s relationship.

● Good psychiatric management: this approach focuses on case management, concentrating on the expectation of school and/or work participation. It makes sense of the emotions that are difficult by considering the interpersonal contexture of feelings. It can include medication, family education, groups and individual therapy.

Medications:

There are not any medications at this time approved by the Food and Drug Administration for treating BOrderline Personality Disorder, some medications may help with reducing symptoms or co-occurring issues such as antidepressants, mood-stabilizing drugs and antipsychotics.

You can talk to the doctor about the side effects and benefits these drugs can offer.

References:

https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/home/ovc-20370232

carmen@inspirational-therapies.com

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