 N
times past,
it was generally thought that only someone who was
“crazy,” or someone who had a “nervous breakdown,” had
reason to see a psychologist.
Today, psychologists
still treat serious mental disorders, but they also can provide services
for other reasons as well. Many of us today feel lost or empty in a world
with a cultural emphasis on superficiality and immediate gratification. In
fact, a healthy, meaningful, and spiritual life
should be the core of human existence. Anyone can benefit from
psychological services that enhance and maintain physical and mental health,
and that promote honesty and intimacy in daily
life.
Problems and
Symptoms
Even though everyone
could benefit from psychological guidance, not everyone wants to see a
psychologist. Here’s why some people need psychological help.
Problems
Let’s
begin by defining the nature of a
problem.
A problem exists when there is a discrepancy between what you are doing
and what you would like to be doing.
If you can put
things into concrete terms as clear as that, then not only do you know you
have a problem, but you are already on the way to solving it as well. And
you probably don’t need professional help.
Sometimes, however,
there can be complications that interfere with your ability to solve your
own problems:
1.
|
It may happen
that despite your best intentions to change things, you still can’t
make any progress. In psychological language, you have encountered an
unconscious block to your progress. With the help of
a psychologist you can get over a block like this. |
2. |
It might
also happen that you simply feel vaguely
dissatisfied with your life, but you can’t get a clear sense
of what the problem is. In this case you might consult a psychologist to
help define the problem. Once the problem
is clearly defined, you might be able to proceed on you own, or you might
discover an unconscious block as well. |
The good news
is that once you have learned this basic strategy for defining and solving
problems, you aren’t likely to need professional help any
more.
Symptoms
If a problem
cannot be solved cleanly and simply, it can turn into a
symptom.
A symptom is an illusion created by your unconscious to hide from yourself
the ugly truth of your own life.
Many persons
try to “get rid” of symptoms by drowning them with work, with
entertainment, with sexuality, and with substances
(such as food, or alcohol, or drugs). But, ironically, these things only
cause more problems that usually degenerate into more symptoms. The only
genuine solution for a symptom is to do the hard psychological
work necessary to face up to the truth of your
life that you so desperately dread to admit.
Below are several
topics that will be discussed on this page:
Note.
This is not meant to be a comprehensive list of all applications of psychology.
The topics below simply represent some of the varied applications of
clinical psychology. Not all psychologists can
be expected to be familiar with all these topics; you may have to
“shop around” to find a psychologist
with expertise in the area with which you need help. Feel comfortable
asking questions.
Anxiety
Let’s
begin with a simple graphic explanation of anxiety. First, consider the concept
of
fear, which
must be distinguished from
anxiety.
If you were sitting in a room and suddenly a large rattlesnake crawled through
the door, you would have good reason to be afraid. That’s
fear because
it refers to an actual threat. Fear, in some cases, can be healthy because it
often keeps us alive.
But if
you were always worried that a rattlesnake might crawl into the room, even
if no rattlesnakes were anywhere in sight, that’s
anxiety.
Anxiety is most often not helpful because the threat is imaginary, and a
lot of time and energy can be wasted worrying about things that might—but
not necessarily will—happen.
|
The psychological
basis for anxiety can usually be located in childhood experiences that lack
clear explanations and guidance from parents who tend to be disinterested,
critical, or abusive. Hence the children grow to dread circumstances that
have unknown or unpredictable aspects. |
|
Some
individuals live with a constant, general sense of worry and anxiety, as
in Generalized Anxiety
Disorder. Typical symptoms are tension,
restlessness, fatigue, irritability, sleep disturbance, and difficulty
concentrating.
Other persons
feel a more focused anxiety, as in a Panic
Attack, where their heart beats faster and faster,
and there is a sudden onset of apprehension, terror, or impending doom, to
such an extent that they might feel they are going crazy—or having a
heart attack. In fact, it’s quite common for patients to appear in hospital
emergency rooms complaining of having a heart attack when they are really
experiencing a panic attack.
Furthermore, some
persons have such anxiety that they develop
Agoraphobia or
Social
Phobia.
•
|
Agoraphobia,
sometimes referred to as a fear of open spaces, really is more a fear of
fear itself. That is, the agoraphobic tends to avoid situations which might
cause fear—and eventually so many situations are avoided that the
agoraphobic cannot even leave the house. A common consequence of agoraphobia
is depression, and common associated symptoms are drug or alcohol use, as
self-medication.
|
• |
Social
Phobia involves a persistent fear of situations which might involve being
scrutinized by others. Common social phobias are a fear of public speaking,
of participating in meetings, of using public restrooms, of eating in front
of others, of interacting with strangers, and of interacting with authority
figures. Note that a fear of interacting with authority figures (such as
psychologists) can make it very difficult to seek treatment for a social
phobia.
|
Specific Phobias are also a form of anxiety (although
they are sometimes mixed with fear). There are many kinds of phobias, including
anxiety about animals, natural events, blood or injury, situations (such
as elevators, tunnels, heights, flying, etc.), or germs and
illness.
All specific
phobias have three basic elements:
1.
|
Excessive fear
cued by the presence or anticipation of a specific object or
situation. |
2. |
Exposure to the
object or situation provokes an immediate anxiety response. |
3. |
The object or
situation is avoided (or tolerated with intense distress). |
Thus, because
the anxiety comes and goes with the situation, it would be possible, for
example, to have a phobia about encountering persons who are blind, but it
would be impossible to have a phobia about becoming blind. You might develop
a phobia about specific objects or situations that could cause blindness,
but a general fear about injury to your own body would not be a psychiatric
disorder; instead, it would be considered psychoanalytically to be a form
of castration anxiety.
The Psychological
Basis for Phobias
Psychologically,
many phobias can derive from conflicts and terror about one’s
dark inner reality.
|
For example,
in one case, a man had a fear of heights. His life tended to follow the
status quo and he avoided taking any creative risks to improve himself.
Hence his fear of heights: he was afraid to “rise above
himself.”
In another case, a man had a fear of crossing bridges and going through tunnels.
He had been preparing all his life for a career in sports, and then suddenly
he had an injury that ended his dreams of how he wanted his life to be. Yet
he didn’t know what to do with his life thereafter. He felt like he
was in the dark, not knowing where he was going, and he was afraid to make
any changes. Hence, his fear of “dark tunnels” and of “crossing
bridges.” |
|
For information
about desensitizing phobias, see my page on
Self-administered Systematic Desensitization.
For more information about the fear of flying, see my page on
Fear of Flying
and its associated page,
Basic Principles of Aircraft Flight.
|
In
Obsessive-Compulsive Disorder
(OCD) anxiety takes the form of either
obsessions or compulsions.
•
|
Obsessions
are recurrent and persistent thoughts, impulses, or images which are experienced
as intrusive or inappropriate.
|
• |
Compulsions
are repetitive behaviors (e.g., hand washing) or mental acts (e.g., repeating
words) which a person feels driven to perform in response to an
obsession. These behaviors or mental acts are intended to avoid harm and so are
aimed at preventing or reducing anxiety or distress, or preventing some dreaded
event.
Compulsions
should not be confused with disorders of impulse control, in which a person
fails to resist a temptation. In some ways, this distinction as made by the DSM-IV can seem
confusing. Note that the DSM-V has clarified
this.[1]. The point is that an Impulse Control
Disorder can be diagnosed only if the the lack of impulse control occurs
apart from any other disorder. Thus,
Intermittent Explosive
Disorder is characterized by discrete episodes
of failure to resist aggressive impulses such that serious assaults (often
as domestic violence) or destruction of property
results;
Kleptomania is
characterized by recurrent failure to resist impulses to steal objects not
needed for personal use or monetary value;
Pyromania is
characterized by a pattern of fire setting for pleasure or relief of tension;
Pathological
Gambling is characterized by recurrent and
persistent maladaptive gambling behavior; and
Trichotillomania
is characterized by recurrent pulling out of one’s
hair.
|
The underlying
dynamic of obsessive-compulsive behavior is usually the
unconscious attempt to neutralize feelings of
guilt that derive from hidden experiences of anger which
are perceived by the afflicted person as objectionable and shameful. (In contrast,
a disorder of impulse control often involves blatant acts of hostility,
destructiveness, danger, or risk.)
In this regard,
psychological research into early infant development has shown that experiences
of rage, and subsequent feelings of guilt, happen to us all right from early
infancy. Every parent will make mistakes in empathic bonding with a child, and
every child will feel emotionally hurt by those mistakes and will crave the
satisfaction of revenge: to hurt the other “as I have been hurt.”
These impulses
to hurt others are universally human and do not mean that anyone experiencing
them is “bad.” As adults, anyone—even those we care about, and even innocent
babies—can irritate us. As such, we experience thoughts of resentment,
hostility, or violence because we feel injured, insulted, obstructed, or hurt in
some emotional, physical, or material way. OCD, however, is a neurotic way of coping
with feelings of guilt that seem too “bad” to admit to anyone—not even to
yourself.
The solution to
all of this is amazingly simple (and is actually a form of
cognitive-behavioral treatment): admit those frightening
thoughts to yourself openly, rather than try to deny them; then tell yourself that
even though some part of you finds them satisfying, you have
no intention of actually carrying out any of those impulses; then resolve to act
with kindness and forgiveness. Remember, the fact that
you can have “bad” impulses does not mean that you are
“bad.”
But if you try
to hide your frightening thoughts and impulses, they will get driven into your
unconscious where they will turn into unconscious anger.
So there’s an irony: if you admit those frightening thoughts to yourself, and
deal with them gracefully, it’s proof you love others, but if you try to hide
those thoughts and impulses in fear of them your drive them into anger—and that
unconscious anger is what harms others and causes you to feel so
guilty.
|
OCD should
not be confused with Obsessive-Compulsive
Personality Disorder, which is characterized
by a pervasive pattern of preoccupation with orderliness, perfectionism,
and mental and interpersonal control. Such a
personality can be inflexible, rigid, stubborn, and
miserly.
The underlying
dynamic of excessive orderliness is usually the
unconscious desire to see justice for the offenses
committed against you. Thus you cannot tolerate anything crooked or out of
place because the yearning for “law and order” preoccupies
your mind in the context of unresolved emotional hurt from
childhood. |
|
Anxiety
can also be the basis for mental disorders after exposure to a traumatic
event such as abuse, an accident, a crime, a natural disaster, etc. which
involved death or serious injury, whether actual or threatened.
If symptoms persist for several days and cause a serious impairment in normal
daily functioning, a diagnosis of Acute Stress
Disorder may be made.
Posttraumatic
Stress Disorder (PTSD) may be diagnosed if symptoms
persist for longer than one month and fall into the following characteristic
categories:
• |
Abnormal
arousal (e.g., difficulty sleeping, irritability)
|
•
|
Avoidance/Numbing
(“spacing out,” avoiding situations associated with the
trauma)
|
Also,
trauma can affect one’s sense of identity,
and the trauma of severe child abuse can lead to the development of
multiple personalities or of self-mutilating behaviors.
Finally, you might want to know something about the controversy surrounding
the concept of repressed memories of trauma, and
you might be interested in some trauma support groups
that have sites on the Internet.
Depression and
Mania
Most people
experience periods of depression off and on throughout life. We all have
days when we feel “blue” or “down,” and these distressing times
usually pass. Also, the death of someone close can involve feelings, called
bereavement, that are similar to symptoms of
depression.
Major Depressive
Disorder
is another matter, and it usually requires psychological treatment. Characteristic
of this disorder is at least one Major Depressive Episode (see below). Although
most episodes of Major Depression (unipolar depression) usually resolve
in about six months, even without treatment, those six months or so can be quite
difficult—work and family life can be seriously disrupted, and there
is a high risk of suicide.
Though a Major Depressive
Episode can be treated psychologically without medication, sometimes medication can
be especially helpful. If your psychologist believes that medication
might be helpful as an adjunct to psychotherapy, he or she will discuss the matter with
you and perhaps make a referral to a physician
(generally a psychiatrist) for a medication
evaluation.
|
As with any psychological
complaint, it is advisable that psychological treatment for depression not begin until
you have had a thorough medical exam and blood test to rule out obvious medical causes
of depression. For example, depression can be caused by elevated TSH (Thyroid Stimulating
Hormone) levels resulting from a hypothyroid disorder. Vitamin deficiencies (such as a
lack of
Vitamin D3) can also
contribute to depression. |
|
The good news
is that psychiatric medication for depression, if required, can often be discontinued
(on the advice of the prescribing doctor, of course) after several
months when lifestyle changes (such as brisk exercise; managing
negative thoughts; caffeine reduction; stress
management and anger management techniques) can
incorporated through psychotherapy while taking the
medication.
A
Major Depressive
Episode has the following characteristic
symptoms:
•
|
Depressed mood.
Note, however, that children and adolescents tend to show signs of
irritability rather than depressed mood. |
• |
Anhedonia;
i.e., a lack of interest in usually enjoyable things |
• |
Weight loss or
loss of appetite (although some individuals overeat because of
depression) |
• |
Trouble
sleeping |
• |
Psychomotor
Changes:
Retardation
(e.g., slowed speech, thinking, or movement)
Agitation
(e.g., inability to sit still; pacing) |
• |
Fatigue,
or lack of energy (e.g., staying in bed most of the day) |
• |
Feelings of extreme
worthlessness or guilt |
• |
Trouble
concentrating |
• |
Thoughts of
death, or feeling
suicidal |
Exogenous
depression is a term which describes depression triggered by obvious external social
losses and problems. Endogenous depression is a term which describes
depression that appears to happen for “no apparent reason” and so is
commonly said to be genetic and chemical in nature, but, in my opinion, every
symptom has an unconscious cause, although persons untrained
in the psychology of the unconscious will not be able to recognize unconscious
causes.
Dysthymic
Disorder is a form of depression, less severe
than Major Depression, in which a person feels depressed most of the time
but is still able to function socially and occupationally. A Dysthymic Disorder
usually does not require medication, but it is becoming quite fashionable,
sadly, to take the newer SSRI drugs (Prozac, Zoloft, Paxil, etc.) anyway.
Even though there can be a biological aspect to any form of depression, the
psychological cause of a dysthymic disorder often
has its roots in unexpressed emotions regarding social situations. Many persons,
however, cannot even identify their own emotions,
so psychotherapy may be needed, first to learn
to recognize your inner experiences, and then to learn to express them
openly and appropriately.
A Dysthymic Disorder
has the following characteristic symptoms:
•
|
Depressed mood
for most of the day, for more days than not. Note, however, that children
and adolescents tend to show signs of irritability rather than depressed
mood. |
• |
Poor appetite;
or overeating |
• |
Insomnia; or
hypersomnia (sleeping too much) |
• |
Low energy or
fatigue |
• |
Low
self-esteem |
• |
Poor concentration
or difficulty making decisions |
• |
Feelings of
hopelessness |
“Double
Depression” refers to a Major Depressive
Episode superimposed onto Dysthymic Disorder. So even though a person may
recover from the severe effects of the Major Depression, he or she may rarely
feel “not depressed.”
“Postpartum
Depression” is sometimes used as a popular
term, but it isn’t really a
DSM-IV [2] disorder. The phrase “With Postpartum Onset” can
be used as a specifier for any of the depressive disorders or manic
disorders. Nevertheless, the idea of a postpartum depression deserves some
mention. In case you haven’t guessed, postpartum refers to
childbirth, and it often happens that a woman will feel depressed soon after
giving birth. And here things can get complicated. On the one hand, the nature
of a woman’s labor can significantly affect her emotional state after
delivery. If a woman perceives a low level of support from her family or
the hospital staff, if there are elements of blame
or being blamed involved in the pregnancy (especially if it was unwanted
or unplanned), or if she perceives a lack of control
or high levels of fear for her own well-being during the course of the labor,
she can experience some of the symptoms (including depression and anxiety)
characteristic of Posttraumatic Stress Disorder
(PTSD). [3]
On the
other hand, “postpartum depression” need not be a clinical depression,
and it need not even be associated with childbirth. In fact, many events
in life, when successfully completed, can bring on a sense of temporary
“depression.”
|
I myself felt
sick and “depressed” when I successfully passed all my comprehensive
exams on the way to my PhD; the same thing happened when I passed my licensing
exams for my psychologist license. And on the very afternoon that I passed
my flight exam for my private pilot’s license I developed flu symptoms
that lasted for two days of misery. All of this really relates to the existential
experience of investing tremendous energy to achieve something—and then,
when it is finally achieved, feeling a profound inner void. I now understand
that this is a spiritual problem, for when we fail
to live with devout humility and emptiness of self—as I sadly failed
to do in those years—we are blind to any grounding in spiritual stability,
and we instead skip from one social accomplishment to another, with gaps
of despair in between. |
|
Bipolar
Disorder can take several forms. Bipolar I Disorder
hinges on the history of at least one Manic Episode (see below) with several
variations regarding the most recent episode, which can be Manic, Depressed,
Mixed, or Hypomanic. Bipolar II Disorder hinges on the presence (or history)
of a Hypomanic Episode (see below) and the presence (or history) of
a Depressive Episode (see above). The old diagnostic term, Manic-Depressive
Disorder is not used in the
DSM-IV [4]; it referred to the clinical presence of both mania and
depression—not both at the same time, of course; usually, the depression
follows the mania.
Some of the following
can help to distinguish bipolar depression from unipolar depression.
• |
History of treatment
resistant to antidepressants |
• |
Family history of bipolar
disorder |
• |
Psychotic symptoms |
• |
Symptoms such as hyper-somnia
(excessive sleeping), extreme fatigue, and increased appetite |
Click
here for a short discussion about treatment for
mania. |
A
Manic
Episode refers to a period of elevated,
expansive mood, lasting about a week. A Hypomanic
Episode refers to a period of elevated,
expansive mood, lasting a shorter time than a manic episode, but that can lead to
an intense manic episode of severe grandiosity, delusions, being out of control,
and poor judgment. Both consist of some of the following:
• |
Inflated self-esteem
or grandiosity |
• |
Decreased need
for sleep |
• |
More talkative
than usual or pressure to keep talking |
• |
Less shy or inhibited |
• |
Overly optimistic |
• |
Surging feelings of lust |
• |
Flight of ideas,
or subjective experience that thoughts are racing |
• |
Distractibility |
• |
Irritability and impatience |
• |
Increase in
goal-directed activity or psychomotor agitation |
•
|
Spending too much money |
Cyclothymic
Disorder is to Bipolar Disorder what Dysthymic
Disorder is to Major Depressive Disorder; that is, similar in nature, but
far less severe. It involves numerous periods of depressive symptoms alternating
with hypomanic episodes (see above). The most common treatment
(that is, aside from intensive psychotherapy) for
a cyclothymic disorder, like a bipolar disorder, is often a mood-stabilizing
medication.
Family
Issues
Many family conflicts
can best be treated in family therapy because, curiously enough, the
family’s own attempts to solve a problem can actually cause new problems.
Health
Issues
Those who do not understand
psychology, especially the psychology of the unconscious, tend to
attribute the causes of physiological symptoms to defects in physiology itself. But
practitioners of Health Psychology and alternative medicine know better. They are well
aware that many health issues can be treated through the use of psychology and dietary
changes. In fact, the field of Health Psychology is a new and fast-growing application
of psychology. Following are several treatment applications of this field.
Addictions. The word addiction is actually a popular term which
tends to get applied to either of the two
DSM-IV [5] diagnoses regarding Substance-Related
Disorders.
Substance
Abuse is an indication of a serious growing
problem in someone, and it refers to a maladaptive pattern of substance use
leading to clinically significant impairment or distress characterized by
such things as
• |
Recurrent substance
use resulting in failure to fulfill major role obligations (e.g., work, school,
family); |
• |
Recurrent substance
use in situations in which it is physically hazardous (e.g., driving an
automobile); |
• |
Recurrent
substance-related legal problems; |
• |
Continued use
of the substance despite having persistent problems caused by its
use. |
Substance
Dependence reflects a grave problem more
serious than Substance Abuse and refers to a maladaptive pattern of
substance use leading to clinically significant impairment or distress
characterized by such things as
•
|
Tolerance
(a need for increased amounts of a substance to achieve the desired effects,
or diminished effect with continued use of the same
substance); |
• |
Withdrawal
(see below); |
• |
Taking the substance
in larger amounts or over a longer time than was intended; |
• |
Persistent desire
or unsuccessful efforts to cut down the substance use; |
• |
Spending a great
amount of time in activities necessary to obtain the substance; |
• |
Giving up or
reducing important social, occupational, or recreational activities because
of substance use; |
• |
Continuing the
use of the substance despite knowledge that its use is causing
problems. |
Withdrawal refers to
•
|
The development
of a substance-specific syndrome due to the cessation of, or reduction in,
substance use that has been heavy and prolonged; |
• |
The
substance-specific syndrome causes clinically significant distress or impairment
in important areas of functioning. |
|
By the way, it
should be noted that, in regard to withdrawal, stopping nicotine
“cold turkey” can be a nuisance, and stopping heroin “cold
turkey” can be grueling, but stopping alcohol “cold turkey”
can be fatal. Therefore, withdrawal from alcohol requires proper medical
supervision—that is, if you want to survive the process. |
|
If you can answer
“Yes” to any of the Substance Abuse items, you may be headed
for serious trouble unless you get help. If you can answer “Yes”
to three or more of the Substance Dependence items, you’re already
in over your head and need help immediately.
Treatment
Alcohol and street
drugs are often used as self-medication for undiagnosed psychiatric problems
such as depression, mania, or anxiety, so any substance abuse treatment should
look carefully for other underlying disorders.
Although the
initial treatment for an addiction to drugs or alcohol is usually undertaken
in an inpatient detoxification treatment program, a psychologist can be of
help in the later stages of recovery. Psychological treatment can be a
cognitive-behavioral form of support to maintain
a healthy lifestyle, or (after recovery is well established) it can focus
on the underlying despair which fueled the addiction
in the first place.
The core
of any addiction involving intoxication or euphoria is your feeling so deprived
of your primal desire—real love from
your parents, especially through the lack of your
father—and so
angry about it, that you use the addiction
to wash away the “stain” of the anger. Thus you settle for any
satisfaction of excitement and intensity, and then, because the intensity
of the satisfaction is short-lived, you crave it all the more.
Addictions draw
their strength from your lack of believing in anything greater than yourself.
When you lack having something greater than yourself to define the addiction
as harmful, and when despair is therefore the unconscious essence of your
life, then nothing in you can stand up to the overwhelming urge for momentary
pleasure and say, “Wait! This isn’t right.”
Note that the
12-Step abstinence programs can be useful adjuncts to psychological treatment
for recovery from addictions to alcohol, drugs, and gambling. Of course,
total abstinence from food is not an option for recovery from bulimia
(see below). And then, for sexual addictions,
sexual abstinence is often rejected outright. “I’ll die if I
can’t have sex,” people say. And then, sadly, many die because
of it.
Alcoholism as
a Disease
It’s true
that some persons have a genetic predisposition (a) to craving alcohol as
a defense against emotional vulnerability or (b) to becoming addicted to
alcohol once it is used as such a defense. And once addicted, such persons
can be subjected to changes in body chemistry that are beyond their conscious
control.
Still, if alcoholism
is a disease, it’s an unusual one. A person with brain cancer, for example,
can’t just wake up one morning and say, “You know, I’m sick
of this illness. Today I’m going to stop having cancer.” Yet an
alcoholic has to do almost precisely that. He or she has to say, “Today
I’m going to stop drinking. And if I can’t do it myself, I will
get into a treatment program that will force me to stop drinking.” In
other words, treatment for alcoholism is behavioral. If you’re an alcoholic,
your behavior has to change. You have to stop drinking. And, once you get
clean and sober, in all likelihood you will have to continue to refrain from
drinking thereafter. It’s all a matter of personal choice, regardless
of genetics or brain chemistry.
Dentistry. Many persons get anxious just thinking about a visit to
the dentist, and they become terrified of major dental procedures. Imagine
how nice it would be to sit comfortably in the dental chair, completely relaxed,
and free of pain. Sure, you could use “laughing gas,” but why not
use the resources of your own mind to stay calm?
When I visit a dentist, I can even stop bleeding when my dentist requests.
More and more today, dentists and their patients are utilizing the services
of a psychologist to learn these remarkable techniques.
Eating
Disorders. Two common eating disorders are
Bulimia Nervosa and Anorexia Nervosa.
In
Bulimia
Nervosa, a person binge eats and then uses
compensatory behavior to control weight.
•
|
A person with
the Purging Type of bulimia engages in self-induced vomiting or misuses
laxatives or enemas. |
• |
A person with
the Nonpurging Type of bulimia uses fasting or exercise to control
weight. |
In
Anorexia
Nervosa, a person fails to maintain a minimally
normal body weight and exhibits a fear of gaining weight or becoming fat.
As she looks at herself in a mirror, she may even see herself as fat, even
though she may be so thin as to be near death.
•
|
A person with
the Restricting Type of anorexia does not regularly engage in binge-eating
or purging behavior; thinness in maintained by restricting food intake or
by excessive exercise. |
• |
A person with
the Binge-Eating/Purging Type of anorexia regularly engages in
binge-eating or purging behavior while also restricting food intake or exercising
excessively. |
|
The dangers of
Anorexia Nervosa are very real: loss of the menstrual period is a
warning for women, and loss of bone mass and sudden cardiac arrest can be
unfortunate consequences of the disorder. |
|
Family conflicts,
with issues involving identity and
self-esteem, influenced by a desire to control feelings
of anger— usually at a
father who is lacking in gentleness and
guidance because he is manipulative or controlling—are core factors
of anorexia. In addition, the inability to understand one’s
emotions—technically called alexithymia—can be a complicating
factor. When anger, frustration, sadness, fear, and so on get confused with
hunger, then the stage is set for disaster. Note that anorexia can be an
occupational hazard for dancers, actresses, and models who must adhere
to the ideal of a thin body type and at the same time cannot manage emotional
setbacks very well.
Obesity does not get classified by the DSM-IV as a true eating disorder
because “it has not been established that it is consistently associated
with a psychological or behavioral syndrome.” Thus the DSM-IV treats
obesity as a general medical condition.
The general
facts about weight gain, however, are governed by a simple law of physics:
if you consume more calories than you expend in exercise, you will gain
weight. There are two points to consider in this
regard:
•
|
Some persons
have—or through yo-yo dieting have created—a metabolism that tends
to store food intake as body fat, and for such persons it can be a
trial—but not impossible—to maintain a normal body
weight. |
• |
Some obese persons
will claim, in all seriousness, that they do not eat very large meals. But,
if their eating habits are examined closely, it is often discovered that
they “nibble” or “snack” almost constantly throughout
the day. All of this points to the way that you can
unconsciously deceive even yourself about your
true behavior. |
Psychological
factors, therefore, can play a role in obesity, either as a
primary cause, or as
secondary causes underlying a medical
condition.
Anger.
Unconscious anger can generate feelings
of victimization, guilt,
and self-loathing. Consider the following
examples:
• |
Some individuals
will resist physical exercise and disciplined eating habits (saying that
it’s all “too much trouble” or “unfair”) because
they lacked protection and guidance as children. |
• |
Some individuals
will use food as a way to stuff down feelings of irritation and resentment
because they don’t know what to do with those feelings. |
• |
Some individuals
will eat to compensate for their emotional “hunger” for acceptance
from their mother, a mother who criticized, neglected, or rejected them. |
• |
Some individuals
will overeat as a way to punish themselves, saying to themselves, “I
don’t care how much this harms my body; I don’t deserve any
better.” |
• |
Some individuals
will derive a certain satisfaction, and pride, from “throwing their
weight around” as compensation for their feelings of social and emotional
helplessness. |
|
Body
Armor. Some individuals, usually women who have been sexually
abused as children, use body fat unconsciously as a sort of body armor
to deflect the sexual desires of others. |
Deadened
Emotional Awareness. Some individuals, usually because of
the emotional emptiness of growing up in dysfunctional
families, have so deadened their emotional awareness, as a psychological
defense, that they perceive all
emotions as hunger. Anger, frustration, fear,
sadness, loneliness—it all feels like hunger. But, at its psychological
depth, it’s really a hunger for emotional acceptance, not for
food. |
Deprivation.
Some individuals who felt deprived of emotional or material
resources as children will, as adults, resist the self-restraint of healthy
eating because it feels like another form of deprivation. |
Reward.
Some individuals have grown up in families that use food
as a reward for being “good,” and so, as adults, they can use food
for self-soothing when they feel “bad.” |
Hypertension
(High Blood Pressure). Medical
research [6] has demonstrated the efficacy of nondrug interventions in
preventing and controlling high blood pressure (HBP).
The following
are some behavioral life-style changes that can help reduce HBP:
• |
Lose
weight. |
• |
Increase physical
activity. |
• |
Eliminate alcohol
intake, or limit it to 1 ounce per day. |
• |
Reduce sodium
(salt) intake to less than 1 teaspoon per day. |
• |
Stop
smoking. |
• |
Consume adequate
potassium (about 3.5 grams per day). |
•
|
Reduce
“stress” by practicing a
relaxation technique such as
Progressive Muscle Relaxation or
Autogenics. (We know that a stressful environment
can produce a tendency toward HBP, and we know that relaxation techniques
can lower HBP at least temporarily, but we have no conclusive evidence yet
that any relaxation technique, by itself, can produce a lasting decrease
in blood pressure. But dedicated practice of a relaxation technique in conjunction
with the other items above may allow you to reduce your blood pressure without
medication.) |
|
Note.
If you are having trouble meeting the 155/95 limits for blood pressure,
and have already altered your diet, exercise, and relaxation strategies,
you might be interested to know that
MD
Systems, Inc. is marketing a technology, derived from military aviation
research, that can help lower blood pressure without medication. For
more information, see their website. |
|
Illness. Although a physician will be the primary care provider for
any illness, a psychologist can assist with the treatment through
hypnosis, guided imagery, biofeedback, and stress
management to help with nausea and vomiting from chemotherapy, to help
bolster the immune system, and to enhance communication and assertiveness
regarding one’s own treatment.
Aside from
illness whose cause is clearly physiological, there are several Somatoform
Disorders whose basis is largely psychological (and
unconscious):
•
|
Somatization
Disorder describes a condition of many physical
complaints (including four pain symptoms, two gastrointestinal symptoms,
one sexual symptom, and one pseudoneurological symptom) which cannot be fully
explained by a known general medical condition. |
• |
Undifferentiated
Somatoform Disorder describes a condition
of one or more physical complaints (such as fatigue, loss of appetite,
gastrointestinal or urinary complaints) which cannot be fully explained by
a known general medical condition. |
• |
Conversion
Disorder refers to symptoms involving voluntary
motor function or sensory function which cannot be explained by a general
medical condition. These symptoms (such as paralysis of an arm, or blindness
or deafness) are preceded by psychological conflicts or
“stress.” |
• |
Hypochondriasis refers to a preoccupation with fears of having a serious
disease. This fear is usually based on bodily symptoms which are really perceived
but misinterpreted. |
Pain
Management. Psychologists often serve on
Pain Teams in hospitals, as I have done, to make sure that acute
(“new”) pain is properly managed. In addition, psychologists can
help individuals cope with chronic (on-going) pain, especially when
other forms of treatment have been ineffective
Note, however,
that whether the psychologist uses psychological
methods of pain management or assists in the behavioral administration
of pain medications, the goal is not to eliminate
pain but to reduce it to a level which permits a functional life. In other
words, though we must all bear afflictions, we don’t have to be overcome
by them.
Seizures. The
original cause of most seizures is a brain injury. Regardless of the original cause,
though, seizures can be triggered by anger, especially when
the anger “tears you apart” because you are angry with someone from whom you
want love. In such a case, to relieve the recurrence of seizures it will be necessary
to explore the unconscious reasons for the anger and then to
relinquish the anger through the practice of forgiveness.
Smoking Cessation. Psychologists can be of
special help with overcoming the addiction to smoking.
For more
information, see my page about how to
stop smoking. |
“Stress”
Management.
With modern life becoming more and more fast-paced and demanding, techniques
for relaxation are becoming more of a necessity.
Rather than rely on tranquilizers, a person can get help from a psychologist
to cope with the excessive “stress” of
daily life.
Wellness. In contrast to the medical focus on illness, some persons
now focus on the concept of wellness. This refers to the idea that health
and well-being can be actively maintained. A psychologist can offer assistance
in learning how to maintain this new kind of focus.
Performance
Enhancement
Sports Psychology
got started by helping athletes improve their competitive performance by
mentally rehearsing their routines. Now almost every world-caliber athlete
uses these techniques.
Performance
Enhancement—as in autogenics training—can
be used as well by non-athletes to improve concentration and composure in
any area from work to recreation: test taking, speeches, presentations,
stage fright, and so on.
Sometimes, quite
a bit of the work of enhancing performance involves overcoming past
“negative hypnosis.”
Spiritual
Issues
Many, if not
most, psychological problems have roots in issues such as coming to terms
with mortality, finding personal meaning in life, and general life satisfaction
and direction. Psychology, as a science, can only point out to a person that
these “deeper” issues raise questions that somehow need answers.
Although psychology cannot provide those answers, it is possible,
from within the framework of psychotherapy, to discuss and explore spiritual
aspirations.
No
advertising—no sponsor—just the simple truth . . .
|
|
Notes:
1,
2,
4,
5. American Psychiatric
Association: Diagnostic and Statistical Manual of Mental Disorders. Washington,
DC: American Psychiatric Association.
3. Czarnocka J,
Slade P. Prevalence and predictors of post-traumatic stress symptoms following
childbirth. British Journal of Clinical Psychology 2000; 39 (Pt
1):35-51.
6. Labarthe D, Ayala
C. Nondrug interventions in hypertension prevention and control. Cardiol
Clin. 2002 May; 20(2):249-63.
Additional
Resources
Anxiety:
Panic Attack
Recovery offers a free collection of information that can be of
assistance to sufferers of panic attacks.
Panic Cure is
a self-help website.
Depression/Bipolar
Disorder:
Bipolar
Disorder (menu) from the National Institute of Mental Health
(NIMH)
Mood
Disorders from THE MERCK MANUAL.
NIMH
- Depression from the National Institute of Mental Health (NIMH)
Screening
for Depression Across the Lifespan from American Family
Physician.
Seasonal
Affective Disorder from the National Mental Health
Association.
Eating Disorders:
Eating Disorder
Referral and Information Center is dedicated to the prevention
and treatment of eating disorders; it provides information and treatment
resources for all forms of eating disorders.
Eating
Disorders from THE MERCK MANUAL.
The National
Eating Disorders Association provides information and support for
persons with eating disorders.
Overeaters
Anonymous
Gambling
Addiction:
Gamblers
Anonymous
The
National Council on Problem Gambling
General:
Library
of Congress Learning Page
Mental Health
Matters provides mental health information services for everyone
with an interest in mental health, mental illness, psychology, psychiatric
disorders, emotional well-being and personal growth.
Mental Health Net is
a comprehensive guide to mental health information on the Internet.
Psych-Web is
another very comprehensive guide. Their Self-Help section has the most useful
links for getting information about specific disorders.
Health Psychology:
Abortion
and Breast Cancer reveals the scientific evidence for the connection
between abortion and breast cancer
Cancer:
Support and Resources from the National Cancer Institute.
Hypertension:
Arterial
Hypertension from THE MERCK MANUAL.
National Heart, Lung,
and Blood Institute (NHLBI)
Medication
information:
The best source for such information is the Physician’s Desk
Reference, but it’s not available as an on-line data base. So check
out these links:
Drug
Information from the FDA/Center for Drug Evaluation and Research
(US).
Drugs.com provides
“Information, Side Effects, Interactions” for prescription drugs.
RxList —the
Internet Drug Index allows you to search for drugs and retrieve a wealth
of information about usage and side-effects.
Pain:
American Academy of Neurology for multispecialty
consensus on diagnosis and treatment of headache (migraine).
American
Family Physician for an article on guidelines for the treatment
of nonmalignant chronic pain.
American Pain
Society
Arthritis
Foundation
International Association
for the Study of Pain
National Headache
Foundation
Pain
from THE MERCK MANUAL.
Smoking Cessation:
Alcohol and Tobacco from athealth.com.
Assessing
Nicotine Dependence is an article from the American Family
Physician.
Do
I Want to Quit Smoking? is a patient handout from the American
Family Physician.
Health
Impact details the health implications of smoking; from the
Tobacco Free Initiative of the World Health Organization.
Smoking
Cessation from THE MERCK MANUAL.
Treating
Tobacco Use and Dependence: Quick Reference Guide for Clinicians from
the U.S. Public Health Service.
Substance Abuse:
Adult Children
of Alcoholics
Alcohol:
What You Don't Know Can Harm You from the National Institute on
Alcohol Abuse and Alcoholism (NIAAA)
Alcoholics
Anonymous
Alcoholism:
Getting the Facts from the National Institute on Alcohol Abuse
and Alcoholism (NIAAA)
Canadian Centre on Substance
Abuse is “a non-profit organization working to minimize the
harm associated with the use of alcohol, tobacco and other drugs.”
Cocaine Anonymous
Drinking
and Your Pregnancy from the National Institute on Alcohol Abuse
and Alcoholism (NIAAA)
Drug
Use And Dependence (Substance Abuse) from THE MERCK MANUAL.
Narcotics Anonymous
The Substance Abuse and
Mental Health Services Administration is an agency of the U.S.
Department of Health & Human Services
Trauma:
Adult Survivors
of Child Abuse (ACSA) is an innovative psychologically based support
group recovery program that offers workshops, peer-guided and professional-guided
support groups, and a guidebook.
The International Society
for Traumatic Stress Studies (ISTSS) provides a forum for the sharing
of research, clinical strategies, public policy concerns, and theoretical
formulations on trauma in the United States and around the world through
its education and training programs and its various publications.
The National Center for
PTSD provides information about PTSD research and a PILOTS data
base linked to the world’s largest collection of traumatic stress
literature.
Suicide
and Posttraumatic Stress Disorder (PTSD) provides information about
suicidal thinking and PTSD.
Trauma Information
Pages provides a comprehensive listing of trauma support info,
disaster info, and related mental health issues on the Internet.
Vitamin D Therapy:
Vitamin D
Council provides information about the role of vitamin
D3 deficiency in physical and mental illness.
Wellness:
Center for the Advancement
of Health is dedicated to a belief that “health care should
direct its energies toward treating the person, not simply the disease.”
It seeks to strengthen the capacity of the biobehavioral research community
to conduct high-quality research; communicate research findings to
decision-makers and the public; and translate and integrate research findings
into the real world of health care policy and practice.
For additional information concerning
protecting your child from child abuse or drug abuse, contact the following
clearinghouses:
Child Abuse and
Neglect Information Clearinghouse
National Center for
Missing and Exploited Children
National Committee to
Prevent Child Abuse
National Clearinghouse for
Alcohol and Drug Abuse Information
Related
pages within A Guide to Psychology and its
Practice:
Choosing a
Psychologist
Diagnosis in Clinical
Psychology
How To Become a
Psychologist
Psychology: Clinical
or Counseling or ...?
Psychology and
Psychiatry
Questions and Answers
about Psychotherapy
Types of Psychological
Treatment
The Unconscious
CONTACT ME
INDEX of all subjects
on this website
SEARCH this
website
|
 |
his is a
FREEWILL WEBSITE with NO
ADVERTISING. If you find this page to be informative and helpful,
please send a donation in appreciation, even if it’s only a few dollars,
to help offset my costs in making this website available, without charge
or advertising, to you and to all.
