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We are in the midst of a mental health crisis. The closing of state mental hospitals and change in state laws have led to increased homelessness, death, victimization, and criminalization of those who suffer from brain disorders, known as severe mental illnesses. Now more people are treated in jails than mental institutions. This reactive rather than proactive approach is not conducive to a civilized society. Things must change. Learn 3 simple actions we can take to bring about change and to save lives.
1. Get Educated
Find out what your state's current mental health laws are and how your state handles Assisted Outpatient Treatment (AOT).
Learn about bills currently in the Senate and Assembly
Follow the laws being introduced in your State Senate and Assembly
Contact your local representatives and urge them to support mental health
Work to end discrimination and criminalization of those with severe mental illness
3. Get Involved
Learn more about the programs National Alliance on Mental Illness (NAMI) offers.
Support community education.
Join your local NAMI Affiliate
Donate, Sponsor, and Participate in a NAMI Walk
Unless otherwise noted, information provided in the Glossary is from NAMI, the National Alliance on Mental Illness, http://www.nami.org/ . Click on the links to find out more information:
SUMMARY: Anosognosia is a neurological syndrome that produces unawareness of illness. It is caused by damage to specific parts of the brain, especially the right hemisphere. The word comes from the Greek word for disease (nosos) and knowledge (gnosis) and literally means “to not know a disease.” The condition affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder and is the most common reason that individuals with schizophrenia and bipolar do not take their medications. When taking medications, awareness of illness improves in some patients.
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What is impaired awareness of illness?
Anosognosia is a neurological syndrome that produces unawareness of illness. It is caused by damage to specific parts of the brain, especially the right hemisphere. It is often called "unawareness of illness" or "lack of insight." The Treatment Advocacy Center in 2010 presented a workshop on anosognosia at the National Alliance on Mental Illness convention in Washington, DC. "Confronting Anosognosia: How to Get Help to Those Who Don't Know They're Sick" may be viewed online.
How big a problem is anosognosia?
Many studies of individuals with schizophrenia report that approximately half of them have moderate or severe impairment in their awareness of illness. Studies of bipolar disorder suggest that approximately 40 percent of individuals with this disease also have impaired awareness of illness. Anosognosia in bipolar is most common among individuals whose disorder includes psychotic features.
Is this a new problem?
Impaired awareness of illness in individuals with psychiatric disorders has been known for hundreds of years. Playwright Thomas Dekker in his 1604 play “The Honest Whore” has a character say, “That proves you mad because you know it not.” The term anosognosia was first used by a French neurologist in 1914. Among neurologists, unawareness of illness has long been recognized in some individuals with strokes, brain tumors, Alzheimer’s disease and Huntington’s disease. In psychiatry, impaired awareness of illness has only become widely discussed since the late 1980s.
Is impaired awareness of illness the same thing as denial of illness?
No. Denial is a psychological mechanism we all use at times to deflect or reject unpleasant information. Impaired awareness of illness has a biological basis and is caused by damage to the brain, especially the right brain hemisphere. The specific brain areas that appear to be most involved are the frontal lobe and part of the parietal lobe.
Can a person be partially aware of their illness?
Yes. Impaired awareness of illness is a relative, not an absolute, problem. Insight in some individuals may also fluctuate over time, with awareness being heightened during periods of remission but lost during periods of relapse.
Are there ways to improve a person’s awareness of their illness?
Studies suggest that approximately one-third of individuals with schizophrenia improve in awareness of their illness when they take antipsychotic medication. Studies also suggest that a larger percentage of individuals with bipolar disorder improve on medication.
Why is impaired awareness of illness important in schizophrenia and bipolar disorder?
Impaired awareness of illness is the most common reason why individuals with schizophrenia and bipolar disorder do not take medication. They do not believe they are sick, so why should they? Without medication, the person’s symptoms become worse. This often makes them more vulnerable to the consequences of non-treatment, which include arrest, incarceration, homelessness, victimization, suicide and violence.
Information courtesy of The Treatment Advocacy Center (http://treatmentadvocacycenter.org/problem/anosognosia)
For more information, read these two recommended books:
painful or apprehensive uneasiness of mind usually over an impending or anticipated ill; fearful concern or interest; an abnormal and overwhelming sense of apprehension and fear often marked by physiological signs (as sweating, tension, and increased pulse), by doubt concerning the reality and nature of the threat, and by self-doubt about one's capacity to cope with it (http://www.merriam-webster.com/dictionary/anxiety)
]Asperger Syndrome involves several social impairments and restricted interests. A diagnosis of Asperger Syndrome is given to individuals who experienced no speech or cognitive delay as children—they were talking on time and have at least a normal IQ—but who nevertheless display a range of autistic-like behaviors and ways of taking in the world. Hallmark characteristics of Asperger’s include emersion in an all-consuming interest and a one-sided, self-focused social approach. Not everyone who is eccentric has Asperger’s and not everyone with Asperger’s is a genius. Each person is differently able across several areas of challenge and giftedness.
Autism and Asperger’s were first studied at the same time, but in different parts of the world. Leo Kanner, who developed the first child psychiatric service in the United States, described autism in 1943 and it became widely known as the basis for the modern concept of autism. Hans Asperger, an Austrian pediatrician, worked with children who, although bright, exhibited difficulty with non-verbal communication, prone to behavior problems, and appeared clumsy. His work remained unknown until it was translated into English in 1991, when it was finally included in the Diagnostic and Statistical Manual-IV and the International Classification of Diseases-10.
Social And Emotional
People with Asperger’s have a hard time understanding socially what is really going on around them. There are claims that their desire to interact is what sets them apart from those with traditional autism. Children with Asperger’s tend to be active but odd. They are not content to be alone all the time and they long to form friendships with others. Since they cannot read social or emotional cues well, they come off as insensitive, pushy or strange, yet have very little insight into how they are perceived. They have very little idea how to make a friendship work. A child’s social deficits may not come to light until later as they become involved in informal playgroups or preschool. Normally around this time, parents first become aware of the way their child functions in a social setting. People with Asperger’s are often characterized as lacking empathy. This does not mean that they are devoid of all compassion, but rather that they are more self-centered with an attitude that can range from indifference to deep concern. Rarely is it ever malicious in nature.
No Speech Delay
Language is acquired on time or even early. The trouble comes with reading non-verbal cues, such as body language and facial expression as well as difficulty with prosody and pragmatic language. Prosody refers to how one speaks—tone, volume, and speed--while pragmatic language refers to the art of conversation. This includes taking turns speaking, staying on a topic for a polite number of turns, and showing interest in someone else’s comments. People living with Asperger’s tend to talk at people instead of with them, and will often talk about their favorite topics long after the other person has become tired of the subject.
People with Asperger’s must have suffered from no cognitive delays during their first three years of life. This means that they will have at least a “normal” IQ. Having a normal or higher IQ allows a person to learn and know, to push the envelope in intellectual ability, and to rejoice in the pursuit of some realm of knowledge, but there can also be negative effects. When someone is aware he is different, when, for all his intelligence, he cannot successfully make a friend, or get a date, or keep a job, he may end up far more prone to depression and despair than a person with a lower IQ. It has been found that children with both high-functioning autism and Asperger’s suffer from depression and anxiety more than their typical peers. This is also one of the reasons that people advocating for Asperger’s face the challenge of conveying to others the truly crippling extent of the disability, to counter the instant assumption that “high IQ” equates with “non-disabled.”
Those living with Asperger’s are known for having one, or several, intensely focused interests. Persons with Asperger’s seem drawn or driven to their special interests, zoning out on them in the middle of school, spending hours on them during free time, and talking about them to anybody who will listen. Topics vary widely, from computers to deep fryers. Even if the topic is not that unusual, the intensity of the focus is. The link has even been made to the anxiety experienced by adults with Asperger’s and the intense need for routine and predictability.
Coping with stress, confusion, and frustration is an enormous challenge for individuals with Asperger’s. They depend on predictability, and living in the day-to-day world can be taxing. Added stress for those living with Asperger’s can come from wanting to connect with others, but rarely succeeding, resulting in meltdowns. Tantrums—or rage attacks in the case of children—often take place either only at school where the stress is greatest, or only at home where they are free to let it all out. One way to help alleviate this “Jekyll and Hyde” character is to notice the patterns or total stress load around the meltdowns and intervene before a blow-up. Working to know what types of stressors build up to crisis and helping the person with Asperger’s recognize and defuse the situation is an important goal.
Individuals with the disorder have been observed to exhibit poor motor skills and clumsiness. Children with Asperger’s often display an odd or uneven gait when walking or running, trouble with ball skills, difficulty with balance, poor handwriting skills, and difficulty imitating or mirroring others’ postures, gestures or movements. Researchers have theorized that they are due to faulty propioception, a problem with the sensory system that provides information about where one’s body is in space and how one is moving. This would explain the variable results that have been obtained across many studies on motor deficits, and would also explain why a child described as having poor eye-hand coordination could perform nearly perfect on computer games requiring eye-hand coordination. It has been suggested that clumsiness and motor skills deficits might be a factor that distinguishes people with Asperger’s from those with high-functioning autism.
According to the International Classification of Diseases-10 the diagnosis of Asperger Syndrome includes four major grouping criteria. First, there must be a lack of any clinically significant general delay in spoken or receptive language or cognitive development. Diagnosis requires that single words should have developed by two years of age or earlier, and that communicative phrases be used by three years of age or earlier. Self-help skills, adaptive behavior, and curiosity about the environment during the first three years should be at a level consistent with intellectual development. However, motor milestones may be somewhat delayed and motor clumsiness is usual. Isolated special skills, often related to abnormal preoccupations are common but are not required for diagnosis.
Second, the person must show qualitative abnormalities in reciprocal social interactions (they exhibit the same criteria as those with traditional autism): the person must also have an unusually intense circumscribed interest or restrictive, repetitive, and stereotyped patterns of behavior, interests and activities. Finally, the disorder is not attributed to other varieties of pervasive developmental disorder, schizotypal disorder, simple schizophrenia, reactive and disinhibited attachment disorder of childhood, obsessional personality, or obsessive-compulsive disorder.
There is no specific treatment or "cure" for Asperger Syndrome. Treatment for Asperger’s strives to improve a child’s abilities to interact with other people and to function effectively in society. Since the severity of symptoms can vary, treatment should be designed to meet individual needs and available family resources. All the interventions outlined below are mainly symptomatic and/or rehabilitational. Specific treatments should be based on individual symptoms.
- Individual psychotherapy to help the individual to process the feelings of being socially handicapped
- Parent education and training
- Behavioral modification
- Social skills training
- Educational interventions
Start by contacting local school districts to find out which services are available. Federal law requires public schools to provide appropriate educational services for people with disabilities (including Asperger's) between the ages of three and 21. In addition, there may be state and local laws or policies to aid children with Asperger's.
Treatment is geared toward improving communication, social skills, and behavior management. A treatment program may be frequently adjusted to be the most advantageous for the child at hand. Activity-oriented groups and focused counseling can also be helpful. Many children with Asperger Syndrome also have other coexisting conditions, including attention deficit hyperactivity disorder (ADHD), bipolar disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, and depression. These conditions can place extra demands on parents who are already dealing with a child with extra needs. These conditions may require treatment with medications and other therapies.
Attention Deficit Disorder (ADD)
ADHD is an illness characterized by inattention, hyperactivity, and impulsivity.
There are actually three different types of ADHD, each with different symptoms: predominantly inattentive, predominantly hyperactive/impulsive, and combined.
Those with the predominantly inattentive type often:
Those with the predominantly hyperactive/impulsive type often:
Those with the combined type, the most common type of ADHD, have a combination of the inattentive and hyperactive/impulsive symptoms.
Autism Spectrum Disorders (ASDs) are complex developmental disorders of brain function. Each can affect a child’s ability through signs of impaired social interaction, problems with verbal and nonverbal communication, and unusual or severely limited activities and interest. These symptoms typically appear during the first three years of life. There is no cure for ASDs, but with appropriate early intervention, a child may improve social development and reduce undesirable behaviors.
ASDs affect an estimated two to six per 1,000 children and strike males about four times as often as females. They do not discriminate against racial, ethnic, or social backgrounds. ASDs are “spectrum disorders” that affect individuals differently and to varying degrees. The ASDs are Autism (the defining disorder of the spectrum), Asperger Syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Rett Syndrome, and Childhood Disintegrative Disorder (CDD). The most severe cases are marked by extremely repetitive, unusual, self-injurious, and aggressive behavior. This behavior may persist over time and prove very difficult to change, posing a tremendous challenge to those who must live with, treat, and teach these individuals. The mildest forms of autism resemble a personality disorder associated with a perceived learning disability.
Common Signs of an ASD
Children diagnosed with an ASD do not embrace the typical patterns of child development. Some hints of future problems may be apparent from birth, while in most cases, signs become evident when a child’s communication and social skills lag further behind other children of the same age. Some parents report the change as being sudden, and that their children start to reject people, act strangely, and lose language and social skills they had previously acquired.
ASDs are defined by a definite set of behaviors that can range from very mild to severe. Children with ASDs may fail to respond to their name and often avoid eye contact. They also have difficulty interpreting tone of voice or facial expressions and do not respond to others’ emotions or watch other people’s faces for cues about appropriate behavior. Many children will engage in repetitive movements such as rocking and hair twirling, or in self-injurious behavior such as nail biting or head-banging. They tend to speak later than other children and may refer to themselves by name instead of “I” or “me.” Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.
In summary, children do not outgrow ASDs, but studies show that early diagnosis and intervention lead to significantly improved outcomes. Signs to look for include:
Symptoms of an ASD do not remain static over a lifetime. About a third of children with an ASD—especially those with severe cognitive impairment and motor deficits—will eventually develop epilepsy. In many children, symptoms of an ASD improve with intervention or as the children mature. Some eventually lead normal or near-normal lives. ASDs in adolescence could worsen behavior problems in some children as they may become depressed or increasingly unmanageable. Parents should be aware and ready to adjust treatment to fit their child’s changing needs.
Although much about ASDs is not known, the consensus is: the earlier the diagnosis, the earlier interventions and treatment can begin. Evidence over the past decade or more indicate that intensive, early intervention in optimal educational settings for at least two years during the preschool years result in improved outcomes in most young children. Currently, no medical test exists to determine if a child has or will develop an ASD. Therefore, when evaluating a child, clinicians rely on behavioral characteristics to make a diagnosis. Some of the characteristic behaviors of ASDs might be apparent in the first few months of a child’s life, but most often they appear at any time during the early years. A clinical diagnosis would come from an observed problem in at least one of the areas of communication, socialization, or restricted behavior before the age of three.
Diagnosis can be difficult for doctors because ASDs vary widely in severity and symptoms, and may go unrecognized, especially in mildly affected individuals or in those with multiple disabilities. Another consideration is that many of the behaviors associated with autism are shared by other disorders. Therefore, various medical tests may be ordered to rule out or identify other possible causes. For this reason, researchers have developed several sets of diagnostic criteria for ASDs. They include:
Diagnosis requires a two-stage process. The first stage involves developmental screening during “well child” check-ups. Several screening instruments have been developed to quickly gather information about a child’s social and communicative development within medical settings.
The second stage of diagnosis must be done by a multidisciplinary team composed of a psychologist, a neurologist, a psychiatrist, a speech therapist, or other professionals who diagnose children with ASDs.
Treatment / Cure
At present, there is no specific cure for ASDs. Therapies or interventions are designed to remedy specific symptoms in each individual. The best-studied therapies include educational/behavioral and medical interventions, but these remedies do not ensure substantial improvement. The lack of proven treatments prompts many parents to pursue their own research, often using “trial and error.” Parents should use caution before subscribing to any particular treatment. Counseling for the families of people with autism also may assist them in coping with the disorder. While the public has become more aware of ASD in recent years, it still remains one of the lowest funded areas of medical research by both public and private sources.
Educational / Behavioral Interventions
Educational and behavioral approaches are often a core feature of the overall treatment plan for children with an ASD. These strategies emphasize highly structured and often intensive, skill-oriented training that is tailored to the individual child. Therapists work with children to help them develop social and language skills. Recent evidence suggests that early intervention has a good change of favorably influencing brain development. Applied behavior (ABA) is the most well known of the behavioral approaches.
Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder.
Five major types of anxiety disorders are:
This is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life as well as among individuals. Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from days to months that often begin in adolescence or early adulthood, and occasionally even in children. Most people generally require some sort of lifelong treatment. While medication is one key element in successful treatment of bipolar disorder, psychotherapy, support, and education about the illness are also essential components of the treatment process.
Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
Depression is the other phase of bipolar disorder. The symptoms of depression may include:
A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state depressed mood accompanies manic activation.
Sometimes individuals may experience an increased frequency of episodes. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common in women.
Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.1 There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases.2,3 Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.4 Yet, with help, many improve over time and are eventually able to lead productive lives.
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day.5 These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders (http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml)
There are several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder.
Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.
Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:
Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.
Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.1
Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.2
Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression). Visit the NIMH website for more information about bipolar disorder.
People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness.
Anorexia nervosa is a serious, occasionally chronic, and potentially life-threatening eating disorder defined by a refusal to maintain minimal body weight within 15 percent of an individual's normal weight. Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, denial of the seriousness of the illness, and amenorrhea (absence of at least three consecutive menstrual cycles when they are otherwise expected to occur).
There are two subtypes of anorexia nervosa. In the restricting subtype, people maintain their low body weight purely by restricting their food intake and, possibly, by excessive exercise. Individuals with the binge eating/purging subtype also restrict their food intake, but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Many people move back and forth between subtypes during the course of their illness. Starvation, weight loss, and related medical complications are quite serious and can result in death. People who have an ongoing preoccupation with food and weight even when they are thin would benefit from exploring their thoughts and relationships with a therapist. The term anorexia literally means loss of appetite, but this is a misnomer. In fact, people with anorexia nervosa often ignore hunger signals and thus control their desire to eat. Often they may cook for others and be preoccupied with food and recipes, yet they will not eat themselves. Obsessive exercise that may accompany the starving behavior can cause others to assume falsely that the person must be healthy.
Common Signs of Anorexia Nervosa
The hallmark of anorexia nervosa is a preoccupation with food and a refusal to maintain minimally normal body weight. One of the most frightening aspects of the disorder is that people with anorexia nervosa continue to think they look fat even when they are bone-thin. Their nails and hair become brittle, and their skin may become dry and yellow. People with anorexia nervosa often complain of feeling cold (hypothermia) because their body temperature drops. They may develop lanugo (a term used to describe the fine hair on a new born) on their body.
Persons with anorexia nervosa develop odd and ritualistic eating habits such as cutting their food into tiny pieces, refusing to eat in front of others, or fixing elaborate meals for others that they themselves don't eat. Food and weight become obsessions as people with this disorder constantly think about their next encounter with food. Generally, if a person or their family fears he or she has anorexia nervosa, a doctor knowledgeable about eating disorders should make a diagnosis and rule out other physical disorders. Other psychiatric disorders can occur together with anorexia nervosa, such as depression, anxiety disorders and substance abuse disorders.
Binge Eating Disorder (BED)
Individuals with binge eating disorder (BED) engage in binge eating, but in contrast to people with bulimia nervosa (BN) they do not regularly use inappropriate compensatory weight control behaviors such as fasting or purging to lose weight. Binge eating, by definition, is eating that is characterized by rapid consumption of a large amount of food by social comparison and experiencing a sense of the eating being out of control. Binge eating is often accompanied by uncomfortable fullness after eating, and eating large amounts of food when not hungry, and distress about the binge eating. There is no specific caloric amount that qualifies an eating episode as a binge. A binge may be ended by abdominal discomfort, social interruption, or running out of food. Some who have placed strict restrictions on what and when it is OK to eat might feel like they have binged after only a small amount of food (like a cookie). Since this is not an objectively large amount of food by social comparison, it is called a subjective binge and is not part of binge eating disorder.
When the binge is over, the person often feels disgusted, guilty, and depressed about overeating. For some individuals, BED can occur together with other psychiatric disorders such as depression, substance abuse, anxiety disorders, or self-injurious behavior. The person suffering from BED often feels caught up in a vicious cycle of negative mood followed by binge eating, followed by more negative mood. Over time, individuals with BED tend to gain weight due to overeating; therefore, BED is often, but not always, associated with overweight and obesity. Previous terms used to describe these problems included compulsive overeating, emotional eating, or food addiction.
When identifying and diagnosing BED, doctors and mental health professionals refer to the criteria in the Diagnostic and statistical Manual IV (DSM-IV) which says, a person must have had, on average, a minimum of two binge-eating episodes a week for at least six months. Although this is a somewhat arbitrary criterion and any amount of binge eating should be attended to.
Common Signs of BED
Most people who suffer from BED tend to do so in secret. They tend to limit their binge episodes to when they are alone, thus it is not easy to identify someone with BED. Weight gain is a common sign, but not everyone who gains weight does so because they binge eat. Many people with BED struggle with depressed and/or anxious mood. Some individuals with BED can develop strict rules about what foods are “good” vs. “bad” to eat. In turn, they become preoccupied with enforcing these rules as a means for distracting from their painful feelings, tension, and anxiety. In the end, this preoccupation only serves to perpetuate the need for these rigid rule-based behaviors.
Bulimia nervosa is a serious eating disorder marked by a destructive pattern of binge-eating and recurrent inappropriate compensatory behaviors to control one's weight. It can occur together with other psychiatric disorders such as depression, obsessive-compulsive disorder, substance dependence, or self-injurious behavior. Bulimia nervosa is an invisible eating disorder, because patients are of normal weight or overweight. Binge eating is the rapid consumption of an unusually large amount of food in a short period of time. Unlike simple overeating, the hallmark feature of a binge is feeling out of control. This means that one cannot stop the urge to binge once it has begun or that one has difficulty ending the eating episode even when far past being full. "Inappropriate compensatory behavior" to control one's weight may include purging behaviors (such as self-induced vomiting, abuse of laxatives, diuretics, or enemas) or non-purging behaviors (such as fasting or excessive exercise). Some people who have placed strict restrictions on what and when it is OK to eat might feel like they have binged after only a small amount of food (like a cookie). Since this is not an objectively large amount of food by social comparison, it is called a subjective binge.
There are two types of bulimia nervosa. In the purging type, the person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. In the nonpurging type, the individual uses fasting or excessive exercise to control weight, but does not regularly purge.
People with bulimia nervosa often feel a lack of control during their eating binges. Food is often eaten secretly and rapidly. A binge is usually ended by abdominal discomfort, social interruption, or running out of food. When the binge is over, the person with bulimia often feels guilty and purges to rid his or her body of the excess calories. To be diagnosed with bulimia nervosa, a person must have had, on average, a minimum of two binge-eating episodes a week for at least three months. However any amount of binge eating and purging is unhealthy and is worthy of an evaluation.
Common Signs of Bulimia Nervosa
Constant concern about food and weight is a primary sign of bulimia. Common indicators of self-induced vomiting are the erosion of dental enamel (due to the acid in the vomit) and scarring on the backs of the hands (due to repeatedly pushing fingers down the throat to induce vomiting).
A small percentage of people with bulimia show swelling of the glands near the cheeks called parotid glands. People with bulimia may also experience irregular menstrual periods and a decrease in sexual interest. A depressed mood is also commonly observed as are frequent complaints of sore throats and abdominal pain. Despite these telltale signs, bulimia nervosa is difficult to catch early. Binge eating and purging are often done in secret and can be easily concealed by a normal-weight person who is ashamed of his or her behavior. Characteristically, these individuals have many rules about food -- e.g. good foods, bad foods -- and can be entrenched in these rules and particular thinking patterns. This preoccupation and these behaviors allow the person to shift their focus from painful feelings and reduce tension and anxiety perpetuating the need for these behaviors.
These disorders are marked by a dissociation from or interruption of a person's fundamental aspects of waking consciousness (such as one's personal identity, one's personal history, etc.). Dissociative disorders come in many forms, the most famous of which is dissociative identity disorder (formerly known as multiple personality disorder). All of the dissociative disorders are thought to stem from trauma experienced by the individual with this disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally dissociates himself from a situation or experience too traumatic to integrate with his conscious self. Symptoms of these disorders, or even one or more of the disorders themselves, are also seen in a number of other mental illnesses, including post-traumatic stress disorder, panic disorder, and obsessive compulsive disorder.
Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.
People with generalized anxiety disorder can't seem to shake their concerns. Their worries are accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. (http://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml)
This is a serious medical illness affecting 15 million American adults, or approximately 5 to 8 percent of the adult population in a given year. Unlike normal emotional experiences of sadness, loss, or passing mood states, major depression is persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. Among all medical illnesses, major depression is the leading cause of disability in the
Depression occurs twice as frequently in women as in men, for reasons that are not fully understood. More than half of those who experience a single episode of depression will continue to have episodes that occur as frequently as once or even twice a year. Without treatment, the frequency of depressive illness as well as the severity of symptoms tends to increase over time. Left untreated, depression can lead to suicide.
Major depression, also known as clinical depression or unipolar depression, is only one type of depressive disorder. Other depressive disorders include dysthymia (chronic, less severe depression) and bipolar depression (the depressed phase of bipolar disorder or manic depression). People who have bipolar disorder experience both depression and mania. Mania involves unusually and persistently elevated mood or irritability, elevated self-esteem, and excessive energy, thoughts, and talking.
The onset of the first episode of major depression may not be obvious if it is gradual or mild. The symptoms of major depression characteristically represent a significant change from how a person functioned before the illness. The symptoms of depression include:
When several of these symptoms of depressive illness occur at the same time, last longer than two weeks, and interfere with ordinary functioning, professional treatment is needed.
a delusional mental disorder that is marked by feelings of personal omnipotence and grandeur (http://www.merriam-webster.com/dictionary/megalomania)
Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.
Signs & Symptoms
People with OCD may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. They may be obsessed with germs or dirt, and wash their hands over and over. They may be filled with doubt and feel the need to check things repeatedly. (http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml)
A person who experiences recurrent panic attacks, at least one of which leads to at least a month of increased anxiety or avoidant behavior, is said to have panic disorder, a type of anxiety disorder. Panic disorder may also be indicated if a person experiences fewer than four panic episodes but has recurrent or constant fears of having another panic attack.
Doctors often try to rule out every other possible alternative before diagnosing panic disorder. To be diagnosed as having panic disorder, a person must experience at least four of the following symptoms during a panic attack: sweating; hot or cold flashes; choking or smothering sensations; racing heart; labored breathing; trembling; chest pains; faintness; numbness; nausea; disorientation; or feelings of dying, losing control, or losing one's mind. Panic attacks typically last about 10 minutes, but may be a few minutes shorter or longer. During the attack, the physical and emotional symptoms increase quickly in a crescendo-like way and then subside. A person may feel anxious and jittery for many hours after experiencing a panic attack.
Panic attacks can occur in anyone. Chemical or hormonal imbalances, drugs or alcohol, stress, or other situational events can cause panic attacks, which are often mistaken for heart attacks, heart disease, or respiratory problems.
a psychosis characterized by systematized delusions of persecution or grandeur usually without hallucinations; a tendency on the part of an individual or group toward excessive or irrational suspiciousness and distrustfulness of others (http://www.merriam-webster.com/dictionary/paranoia)
PTSD is an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. PTSD can result from personally experienced traumas (e.g., rape, war, natural disasters, abuse, serious accidents, and captivity) or from the witnessing or learning of a violent or tragic event.
While it is common to experience a brief state of anxiety or depression after such occurrences, people with PTSD continually re-experience the traumatic event; avoid individuals, thoughts, or situations associated with the event; and have symptoms of excessive emotions. People with this disorder have these symptoms for longer than one month and cannot function as well as they did before the traumatic event. PTSD symptoms usually appear within three months of the traumatic experience; however, they sometimes occur months or even years later.
Schizophrenia often interferes with a person's ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others. The first signs of schizophrenia typically emerge in the teenage years or early twenties, often later for females. Most people with schizophrenia contend with the illness chronically or episodically throughout their lives, and are often stigmatized by lack of public understanding about the disease. Schizophrenia is not caused by bad parenting or personal weakness. A person with schizophrenia does not have a "split personality," and almost all people with schizophrenia are not dangerous or violent towards others while they are receiving treatment. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings.
The symptoms of schizophrenia are generally divided into three categories -- Positive, Negative, and Cognitive:
Tourette’s disorder, or Tourette’s syndrome (TS) as it is frequently called, is a neurologic syndrome. The essential feature of Tourette’s are multiple tics that are sudden, rapid, recurrent, non-rhythmic, stereotypical, purposeless movements or vocalizations.
Although the cause has not been definitely established, there is considerable evidence that Tourette’s syndrome arises from abnormal metabolism of dopamine, a neurotransmitter.3 Other neurotransmitters may be involved. Genetic studies indicate that Tourette’s syndrome is inherited as an autosomal dominant gene but different family members may have dissimilar symptoms. A parent has a 50 percent chance of passing the gene to one of his or her children. The range of symptomatology varies from multiple severe tics to very minor tics with varying degrees of attention deficit-disorder and OCD. Girls with the gene have a 70 percent chance of displaying symptoms, boys with the gene have a 99 percent chance of displaying symptoms. Ratios of boys with Tourette’s syndrome to girls with Tourette’s syndrome are 3:1.
What are the symptoms of Tourette’s syndrome?1
Symptoms can disappear for weeks or months at a time and severity waxes and wanes.
What are the first tics that may be characteristic of Tourette’s syndrome?
Usually, the facial tic, such as rapid blinking of the eyes or twitches of the mouth, may be the first indication a parent has that their child may have Tourette’s syndrome. Involuntary sounds, such as throat clearing and sniffing, or tics of the limbs may be an initial sign in other children.
Are any other symptoms associated with Tourette’s syndrome?
Approximately 50 percent of patients meet criteria for attention deficit hyperactivity disorder (ADHD) and this may be the more impairing problem. Approximately one-third of patients meet criteria for obsessive-compulsive disorder (OCD) or have other forms of anxiety. Learning disabilities are common as well as developmental stuttering. Social discomfort, self-consciousness and depressed mood frequently occur, especially as children reach adolescence.
Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation — such as a fear of speaking in formal or informal situations, or eating or drinking in front of others — or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.
Signs & Symptoms
People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work or school, and other ordinary activities. Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, nausea, and difficulty talking. (http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml)
Darkness is my life. It is all I have known or at least now know. Yet in this world of no light, there is freedom. I am free; however I am a prisoner of my freedom and of the darkness which surrounds me. I fear not this darkness for I am a part of it. It is my world and my life. This knowledge comforts my pain.
Alone I stand here. Here is my home. Darkness lacks not of beauty but of companionship. For friendless as I may be, I am in admiration or rather in complete awe of the simplistic beauty of my prison. Drowning in the dreary beauty of it, I am silenced and alone.
Surrounding me is a world under the weighted veil of a shadow. Perhaps darkness is a poor description of it for it is not completely void of light. Light does penetrate through the thick, constant, black cloud layer hovering heavily overhead. Teasing as this light may be, it is not enough to add the luxury or nuisance of color into my Godless surroundings.
Not that I believe in no God, I merely believe that here He does not dwell. Maybe at one time He did, but there currently is nothing left here but the remains of whatever once was; the ashes of it all. Was God punishing me? Or am I simply just a lucky or cursed survivor of His punishment? If He was here in this vast land of grey, I would ask.
Often times I think to myself doubtingly if this is real. What is real? Does reality have a purpose? If it is true that reality has a purpose, then I do not exist in reality for here there is no purpose best as I can figure.
Imagine a world of no color, a world of no life. Logic exists only in your mind because this is a world of no logic. There is ocean but there is no life. No life but that of my own. The ocean is black. The thickness of this black is even more so than that of oil. The only reflection the ocean permits is that of the sky overhead which is not black but grey. Even stranger yet is the lack of tides. Ocean water along the infinitely long, lonely shores is stiller than that of a lake on a calm summer’s day or a cold winter’s night. The only waves that occur are due to the terrifying storms.
The land which meets the water is not land at all. It is ashes; Piles and enormous mounds of ashes. Ground, existing as it might, is so deeply covered by these ashes that it would only a waste of time and effort to search for it. Not that time is not plentiful around here: for I have more of it than I know what to do with. Imagine, as you will, the origin of these mountains and valleys of ashes for I know not nor care to know.
Meaningless to me now are words such as trees, flowers, birds, cities, animals, dirt, bugs, and even people. All of these are only distant memories which I can hardly even recall. Memories come as unwanted flashbacks. “Is this hell?” you might ask. Ha! Even hell I am sure is more populated than this, for misery enjoys company or so they say. Except for the fact that I am not miserable, I suppose you could refer to this as my private little hell on Earth.
My memory fails me as to how long I have resided here. Maybe this is all I have known, but vaguely familiar and strange flashbacks remind me of others and other times. Appearance-wise, I do not even remember what I look like except for my body which I can visibly see. I feel not ashamed at the nakedness of my skin for what purposes have I of clothes? The air is neither cold nor hot. By a difference of a few degrees, it only goes from warm to cool but is mostly in between.
Night nor day but simply an average of the two exists. I see no sun nor moon nor even a star. The sky resembles an overcast sky during a sunset when the sun has already gone down, just beyond twilight, when the colors have already just faded out and yet enough light remains to make out the forms of the grey clouds overhead. No more and no less light remains. Now that you have gotten rid of your understanding of night and day, I will explain mine.
Day is merely the night ever so slightly illuminated so that the sky is not two grey shades away from black but maybe seven or so. That is all. Oh, I do suppose the wind is another thing that can be used to characterize night aside from day. Night is the only time of the horrifying screaming winds. Not a steady wind flow but more like gusts of wind. It makes my hairs stand on end and chills creep up and down my back, not because of temperature, but because of the terrifying shrieking screams.
Sometimes cool and sometimes warm, the breezes begin. Unusual as it may sound, these aimless winds carry with them what I identify as human screams; Screams of fear, of confusion, and of knowledge of some impending doom. These aftermath screams tell of some doom befallen upon the world which used to exist around me leaving only the ashes and aftermath wind of screams to remain. The thought is actually quite chilling.
Even odder yet is the miracle of my survival. I drink the tasteless water of the great ocean and eat the tasteless ashes of the land. How I live I cannot explain. Either these do not contain flavor or I have lost all sense of taste. This would not surprise me for I have lost all sense of feelings. Or perhaps all of my feelings and emotions are so deeply shielded that they have only become a blended blur of a single general emotion.
Emotionless, I am neither happy nor sad. I feel neither remorse nor pity for the fact of my survival after the demise of the human population if that is what indeed what has occurred. I merely continue on from day to day with a sort of repetition. Fear I have not for my future nor have I uncertainty. Things shall simply continue as they do and that is all. No unusual complicated explanations exist. This thought brings me neither comfort nor pain.
Pain is only a distant memory. Blurred as it may be, I feel a bit of pain here and there when the flashbacks come. Continually I see a child or rather a baby in these dreamlike states. Meaning has all but been lost for I know not what the baby stands for or who he is. All I do know is that the innocent beauty of the infant comforts the pain I feel from the twinkle in his eyes. Who is this child that haunts me? Had I once been a mother to him? What has happened to separate us and leave me here on this God-forsaken land?
Once again, as the memory fades, so does any remnant of feelings. My emotions again leave me here in this in-between place. In-between I stay with not a care in the world; Or at least not in this world.
Seating myself upon these ashes I stare blankly out over the vast misery around me.
Healthline - A website devoted to health care. Check out their "learning centers" for information on a wide range of medical conditions, including mental illnesses. (Note: While this is an excellent resource, Healthline.com does include targeted advertising on their web pages)
Mayo Clinic - They provide general health information, the ability to check symptoms, research diseases, symptoms, drugs, treatment, etc.
National Alliance on Mental Illness (NAMI) - This is a great resource for getting help. Find your local NAMI organization through this website. Local NAMI organizations offer support groups for individuals who suffer from mental illnesses as well as for families of the mentally ill.
National Institute of Mental Health (NIMH) - A government website that provides general health information.
Treatment Advocacy Center (TAC) - An organization that promotes improvements in the treatment of individuals with severe mental illnesses. Check your state's current mental health laws as well as proposed state and national legislation.