Dysthymia and Resolving Conflict
Conflict and disagreements are inevitable in relationships. Two people can’t possibly have the same needs, opinions, and expectations at all times. However, that needn’t be a bad thing! Resolving conflict in healthy, constructive ways can strengthen trust between people. When conflict isn’t perceived as threatening or punishing, it fosters freedom, creativity, and safety in relationships.
The ability to manage conflicts in a positive, trust-building way is the fifth key skill of emotional intelligence. Successfully resolving differences is supported by the previous four skills of emotional intelligence. Once you know how to manage stress, stay emotionally present and aware, communicate nonverbally, and use humor and play, you’ll be better equipped to handle emotionally-charged situations and catch and defuse many issues before they escalate.
Tips for resolving conflict in a trust-building way:
• Choose your arguments. Arguments take time and energy, especially if you want to resolve them in a positive way. Consider what is worth arguing about and what is not.
• End conflicts that can't be resolved. It takes two people to keep an argument going. You can choose to disengage from a conflict, even if you still disagree.
• Forgive. If you continue to be hurt or mistreated, protect yourself. But someone else’s hurtful behavior is in the past, remember that conflict resolution involves giving up the urge to punish.
• Stay focused in the present. When we are not holding on to old hurts and resentments, we can recognize the reality of a current situation and view it as a new opportunity for resolving old feelings about conflicts.
Dysthymia and the Use of Humor and Play
Humor, laughter, and play are natural antidotes to life’s difficulties. They lighten our burdens and help us keep things in perspective. A good hearty laugh reduces stress, elevates mood, and brings our nervous system back into balance.
The ability to deal with challenges using humor and play is the fourth skill of emotional intelligence. Playful communication broadens our emotional intelligence and helps us:
• Become more creative. When we loosen up, we free ourselves of rigid ways of thinking and being, allowing us to get creative and see things in new ways.
• Simultaneously relax and energize ourselves. Playful communication relieves fatigue and relaxes our bodies, which allows us to recharge and accomplish more.
• Smooth over differences. Using gentle humor often helps us say things that might be otherwise difficult to express without creating a flap.
• Take hardships in stride. By allowing us to view our frustrations and disappointments from new perspectives, laughter and play enable us to survive annoyances, hard times, and setbacks.
Dysthymia and Nonverbal Communication
Being a good communicator requires more than just verbal skills. Oftentimes, what we say is less important than how we say it or the other nonverbal signals we send out. In order to hold the attention of others and build connection and trust, we need to be aware of and in control of our nonverbal cues. We also need to be able to accurately read and respond to the nonverbal cues that other people send us.
Nonverbal communication is another skill of emotional intelligence. This wordless form of communication is emotionally driven. It asks the questions: “Are you listening?” and “Do you understand and care?” Answers to these questions are expressed in the way we listen, look, move, and react. Our nonverbal messages will produce a sense of interest, trust, excitement, and desire for connection–or they will generate fear, confusion, distrust, and disinterest.
Part of improving nonverbal communication involves paying attention to:
• Eye contact
• Facial expression
• Posture and gesture
• Timing and pace
• Tone of voice
• Touch
Dysthymia and Emotions
Another key skill of emotional intelligence is having a moment-to-moment awareness of your feelings and how they influence your thoughts and actions. Emotional awareness is the key to understanding yourself and others.
Many people are disconnected from their feelings–especially strong core feelings such as anger, sadness, fear, and joy. But although we can distort, deny, or numb our feelings, we can’t eliminate them. They’re still there, whether we’re aware of them or not. Unfortunately, without emotional awareness, we are unable to fully understand our own motivations and needs, or to communicate effectively with others.
What kind of a relationship do you have with your feelings?
• Are your feelings accompanied by physical sensations that you experience in places like your stomach or chest?
• Can you experience intense feelings that are strong enough to capture both your attention and that of others?
• Do you experience discrete feelings, such as anger, sadness, fear, joy, each of which is evident in subtle facial expressions?
• Do you experience feelings that flow, encountering one emotion after another as your experiences change from moment to moment?
• Do you pay attention to your feelings? Do they factor into your decision making?
If any of these experiences are unfamiliar, your feelings may be turned down or turned off. In order to be emotionally healthy and emotionally intelligent, you must reconnect to your core feelings, accept them, and become comfortable with them.
Dysthymia and Reducing Anxiety
Develop your anxiety busting skills by working through the following three steps:
• Discover the anxiety busting techniques that work for you – The best way to reduce anxiety quickly is through the senses: through sight, sound, smell, taste, and touch. But each person responds differently to sensory input, so you need to find things that are soothing to you.
• Identify your anxiety response – Everyone reacts differently to anxiety. Do you tend to space out and get depressed? Become angry and agitated? Freeze with anxiety? The best way to quickly calm yourself depends on your specific anxiety response.
• Realize when you’re anxious – The first step to reducing anxiety is recognizing what anxiety feels like. Many of us spend so much time in an unbalanced state that we’ve forgotten what it feels like to be calm and relaxed.
Dysthymia and Negative Thinking
Dysthymia puts a negative spin on everything, including the way you see yourself, the situations you encounter, and your expectations for the future.
But you can’t break out of this pessimistic mind frame by “just thinking positive.” Happy thoughts or wishful thinking won’t cut it. Rather, the trick is to replace negative thoughts with more balanced thoughts.
Ways to challenge negative thinking:
• Keep a “negative thought log”. Whenever you experience a negative thought, jot down the thought and what triggered it in a notebook. Review your log when you’re in a good mood. Consider if the negativity was truly warranted. For a second opinion, you can also ask a friend or therapist to go over your log with you.
• Replace negatives with positives. Review your negative thought log. Then, for each negative thought, write down something positive. For instance, “My boss hates me. She gave me this difficult report to complete” could be replaced with, “My boss must have a lot of faith in me to give me so much responsibility.”
• Socialize with positive people. Notice how people who always look on the bright side deal with challenges, even minor ones, like not being able to find a parking space. Then consider how you would react in the same situation. Even if you have to pretend, try to adopt their optimism and persistence in the face of difficulty.
• Think outside yourself. Ask yourself if you’d say what you’re thinking about yourself to someone else. If not, stop being so hard on yourself. Think about less harsh statements that offer more realistic descriptions.
Dysthymia and Eating Healthy
What you eat has a direct impact on the way you feel. Aim for a balanced diet of protein, complex carbohydrates, fruits and vegetables.
• Boost your B vitamins. Deficiencies in B vitamins such as folic acid and B-12 can trigger dysthymia. To get more, take a B-complex vitamin supplement or eat more citrus fruit, leafy greens, beans, chicken, and eggs.
• Consider taking a chromium supplement – Some dysthymia studies show that chromium picolinate reduces carbohydrate cravings, eases mood swings, and boosts energy. Supplementing with chromium picolinate is especially effective for people who tend to overeat and oversleep when depressed. Aim for 600 mcg per day.
• Don’t neglect breakfast. A solid breakfast provides energy for the day.
• Don’t skip meals. Going too long between meals can make you feel irritable and tired, so aim to eat something at least every 3-4 hours.
• Focus on complex carbohydrates. Foods such as baked potatoes, whole-wheat pasta, brown rice, oatmeal, whole grain breads, and bananas can boost serotonin levels without a crash.
• Minimize sugar and refined carbs. You may crave sugary snacks, baked goods, or comfort foods such as pasta or french fries. But these “feel-good” foods quickly lead to a crash in mood and energy.
• Practice mindful eating. Slow down and pay attention to the full experience of eating. Enjoy the taste of your food.
Dysthymia and Regular Exercise
When you’re depressed, exercising may be the last thing you feel like doing. But exercise is a powerful tool for dealing with dysthymia. In fact, studies show that regular exercise can be as effective as antidepressant medication at increasing energy levels and decreasing feelings of fatigue.
Scientists haven’t figured out exactly why exercise is such a potent antidepressant, but evidence suggests that physical activity increases mood-enhancing neurotransmitters in the brain, raises endorphins, reduces stress, and relieves muscle tension – all things that can have a positive effect on dysthymia.
To get the most benefit, aim for 30 minutes of exercise per day. But you can start small. Short 10-minute bursts of activity can have a positive effect on your mood. Here are a few easy ways to get moving:
• Pair up with an exercise partner
• Park your car in the farthest spot in the lot
• Take the stairs rather than the elevator
• Take your dog for a walk
• Walk while you’re talking on the phone
As a next step, try incorporating walks or some other enjoyable, easy form of exercise into your daily routine. The key is to pick an activity you enjoy, so you’re more likely to keep up with it.
Develop a Dysthymia-Recovery Toolbox
Come up with a list of things that you can do for a quick mood boost. Include any strategies, activities, or skills that have helped in the past. The more “tools” for coping with dysthymia, the better. Try and implement a few of these ideas each day, even if you’re feeling good.
1. Do something spontaneous.
2. List what you like about yourself.
3. Listen to music.
4. Play with a pet.
5. Read a good book.
6. Spend some time in nature.
7. Take a long, hot bath.
8. Take care of a few small tasks.
9. Watch a funny movie or TV show.
10. Write in your journal.
Dysthymia and Taking Care of Yourself
In order to overcome dysthymia, you have to nurture yourself. This includes making time for things you enjoy, asking for help from others, setting limits on what you’re able to do, adopting healthy habits, and scheduling fun activities into your day.
Do things you enjoy (or used to)—
While you can’t force yourself to have fun or experience pleasure, you can choose to do things that you used to enjoy. Pick up a former hobby or a sport you used to like. Express yourself creatively through music, art, or writing. Go out with friends. Take a day trip to a museum, the mountains, or the ballpark.
Push yourself to do things, even when you don’t feel like it. You might be surprised at how much better you feel once you’re out in the world. Even if your dysthymia doesn’t lift immediately, you’ll gradually feel more upbeat and energetic as you make time for fun activities.
Adopt healthy lifestyle habits—
• Practice relaxation techniques. A daily relaxation practice can help relieve symptoms of dysthymia, reduce stress, and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.
• Expose yourself to a little sunlight every day. Lack of sunlight can make dysthymia worse. Make sure you’re getting enough. Take a short walk outdoors, have your coffee outside, enjoy an al fresco meal, people-watch on a park bench, or sit out in the garden.
• Aim for 8 hours of sleep. Dysthymia typically involves sleep problems. Whether you’re sleeping too little or too much, your mood suffers. Get on a better sleep schedule by learning healthy sleep habits.
Fight dysthymia by managing stress—
Not only does stress prolong and worsen dysthymia, but it can also trigger it. In order to get over dysthymia and stay well, it’s essential to learn how to minimize and cope with stress.
• Go easy on yourself. Many depressed people are perfectionists, holding themselves to impossibly high standards and then beating themselves up when they fail to meet them. Battle this source of self-imposed stress by challenging your negative ways of thinking.
• Identify your stressors. Figure out all the things in your life that are stressing you out. Examples include: work overload, unsupportive relationships, substance abuse, taking on too much, or health problems. Once you’ve identified your stressors, you can make a plan to avoid them or minimize their impact.
• Plan ahead. If you know your stress triggers and limits, you will be able to identify and avoid many landmines. If you sense trouble ahead, protect yourself by dipping into your wellness toolbox and saying “no” to added responsibility.
Dysthymia and Cultivating Supportive Relationships
Getting the support you need plays a big role in lifting the fog of dysthymia and keeping it away. On your own, it can be difficult to maintain perspective and sustain the effort required to beat dysthymia. But the very nature of dysthymia makes it difficult to reach out for help. However, isolation and loneliness make dysthymia even worse, so maintaining your close relationships and social activities are important.
The thought of reaching out to even close family members and friends can seem overwhelming. You may feel ashamed, too exhausted to talk, or guilty for neglecting the relationship. Remind yourself that this is the dysthymia talking. You loved ones care about you and want to help.
• Join a support group for dysthymia. Being with others who are dealing with dysthymia can go a long way in reducing your sense of isolation. You can also encourage each other, give and receive advice on how to cope, and share your experiences.
• Try to keep up with social activities even if you don’t feel like it. When you’re depressed, it feels more comfortable to retreat into your shell. But being around other people will make you feel less depressed.
• Turn to trusted friends and family members. Share what you’re going through with the people you love and trust. Ask for the help and support you need. You may have retreated from your most treasured relationships, but they can get you through this tough time.
Bipolar
While dealing with Bipolar isn’t always easy, it doesn’t have to run your life. But in order to successfully manage Bipolar, you have to make smart choices. Your lifestyle and daily habits have a significant impact on your moods. Read on for ways to help yourself:
• Seek support. It’s important to have individuals you can turn to for help and encouragement. Try joining a recovery group or talking to a trusted friend.
• Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.
• Make healthy choices. Healthy sleeping, eating, and exercising habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important.
• Keep stress in check. Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga, or deep breathing.
• Get educated. Learn as much as you can about Bipolar. The more you know, the better you’ll be at assisting your own recovery.
What you can do to help yourself—
Living well with Bipolar requires certain adjustments. Like recovering alcoholics who avoid drinking or diabetics who take insulin, if you have Bipolar, it’s important to make healthy choices for yourself. Making these healthy choices will help you keep your symptoms under control, minimize mood episodes, and take control of your life.
Managing Bipolar starts with proper recovery, including drugs and therapy. But there is so much more you can do to help yourself on a day-to-day basis. The daily decisions you make influence the course of your illness: whether your symptoms get better or worse; whether you stay well or experience a relapse; and how quickly you rebound from a mood episode.
Get involved in your recovery—
Be a full and active participant in your own recovery. Learn everything you can about Bipolar. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and research all your available recovery options. The more informed you are, the better prepared you’ll be to deal with symptoms and make good choices for yourself.
Using what you’ve learned about Bipolar, collaborate with your psychiatrist or therapist in the recovery planning process. Don’t be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership. You may find it helpful to draw up a recovery contract outlining the goals you and your provider have agreed upon.
Other tips for successful Bipolar recovery:
• Take your prescription as instructed. If you’re taking drugs, follow all instructions and take it faithfully. Don’t skip or change your dose without first talking with your psychiatrist.
• Get therapy. While drugs may be able to manage some of the symptoms of Bipolar, therapy teaches you skills you can use in all areas of your life. Therapy can help you learn how to deal with your disorder, cope with problems, regulate your mood, change the way you think, and improve your relationships.
• Communicate with your treatment provider. Keep the lines of communication open with your psychiatrist or therapist. Your recovery program will change over time, so keep in close contact with your provider. Talk to your provider if your condition or needs change and be honest about your symptoms and any drugs side effects.
• Be patient. Don’t expect an immediate and total cure. Have patience with the recovery process. It can take time to find the right program that works for you.
Monitor your symptoms and moods—
In order to stay well, it’s important to be closely attuned to the way you feel. By the time obvious symptoms of mania or depression appear, it is often too late to intercept the mood swing, so keep a close watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. If you catch the problem early and act swiftly, you may be able to prevent a minor mood change from turning into a full-blown episode of mania or depression.
Know your triggers and early warning signs – and watch for them—
It’s important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of early symptoms that preceded your previous mood episodes. Also try to identify the triggers, or outside influences, that have led to mania or depression in the past. Common triggers include:
• arguments with your loved ones
• financial difficulties
• lack of sleep
• problems at school or work
• seasonal changes
• stress
Knowing your early warning signs and triggers won’t do you much good if you aren’t keeping close tabs on how you’re feeling. By checking in with yourself through regular mood monitoring, you can be sure that red flags don’t get lost in the shuffle of your busy, daily life.
Keeping a mood chart is one way to monitor your symptoms and moods. A mood chart is a daily log of your emotional state and other symptoms you’re having. It can also include information such as how many hours of sleep you’re getting, your weight, meds you’re taking, and any alcohol or drug use. You can use your mood chart to spot patterns and indicators of trouble ahead.
Develop a wellness toolbox—
If you spot any warning signs of mania or depression, it’s important to act swiftly. In such times, it’s helpful to have a wellness toolbox to draw from. A wellness toolbox consists of coping skills and activities you can do to maintain a stable mood or to get better when you’re feeling “off.”
The coping techniques that work best will be unique to your situation, symptoms, and preferences. It takes experimentation and time to find a winning strategy. However, many individuals with Bipolar have found the following tools to be helpful in reducing symptoms and maintaining wellness:
• ask for extra help from loved ones
• attend a recovery group
• call your psychiatrist or therapist
• cut back on sugar, alcohol, and caffeine
• cut back on your activities
• do something fun or creative
• exercise
• get a full eight hours of sleep
• increase or decrease the stimulation in your environment
• increase your exposure to light
• take time for yourself to relax and unwind
• talk to a supportive person
• write in your journal
Create an emergency action plan –
Despite your best efforts, there may be times when you experience a relapse into full-blown mania or severe depression. In crisis situations where your safety is at stake, your loved ones or psychiatrist may have to take charge of your care. Such times can leave you feeling helpless and out of control, but having a crisis plan in place allows you to maintain some degree of responsibility for your own recovery.
A plan of action typically includes:
• A list of all meds you are taking, including dosage information
• A list of emergency contacts (your psychiatrist, therapist, close family members)
• Information about any other health problems you have
• Symptoms that indicate you need others to take responsibility for your care
• Recovery preferences (who you want to care for you; what treatments and meds do and do not work, who is authorized to make decisions on your behalf)
Reach out to other individuals—
If your loved one has Bipolar, you can be an instrumental support throughout the recovery process.
Having a strong recovery system is vital to staying happy and healthy. Creating a supportive environment includes not just who you surround yourself with, but who you choose to avoid. In order to take care of yourself, it’s necessary to limit your contact with individuals who drain your emotional energy or leave you feeling discouraged, ashamed, or guilty. Instead, spend time with individuals who truly value you and make you feel better.
• Build new relationships – Isolation and loneliness make Bipolar worse. If you don’t have a recovery network you can count on, take steps to develop new relationships. Try taking a class, joining a church or a civic group, volunteering, or attending events in your community.
• Join a Bipolar recovery group – Spending time with individuals who know what you’re going through and can honestly say they’ve “been there” can be very therapeutic. You can also benefit from the shared experiences and advice of the group members. To find a recovery group in your area, use the Depression and Bipolar Support Alliance’s Support Group Locator or contact your local branch of the National Alliance on Mental Illness.
• Turn to friends and family – Recovery for Bipolar starts at home. It’s important to have individuals you can count on to help you through rough times. Isolation and loneliness can cause depression, so regular contact with supportive friends and family members is therapeutic in itself.
Develop a daily routine—
Your lifestyle choices, including your sleeping, eating, and exercise patterns, have a significant impact on your moods. There are many things you can do in your daily life to get your symptoms under control and to keep depression and mania at bay.
• Keep a strict sleep schedule. Getting too little sleep can trigger mania, so it’s important to get plenty of rest. For some individuals, losing even a few hours can cause problems. However, too much sleep can also worsen your mood. The best advice is to maintain a normal sleep schedule, going to bed and waking up at around the same time each day.
• Exercise regularly. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise is especially effective at recovering from depression. Try to incorporate at least 30 minutes of activity five times a week into your routine. Walking is a good choice for individuals of all fitness levels.
• Build structure into your life. Developing and sticking to a daily schedule can help stabilize the mood swings of Bipolar. Include set times for sleeping, eating, socializing, exercising, working, and relaxing. Try to maintain a regular pattern of activity, even through emotional ups and downs.
Keep stress to a minimum—
Stress can trigger episodes of mania and depression in individuals with Bipolar, so keeping it under control is extremely important. Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time to yourself if you’re feeling overwhelmed.
• Appeal to your senses. Stay calm and energized by appealing to the five senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.
• Learn how to relax. Relaxation techniques such as deep breathing, meditation, yoga, and guided imagery can be very effective at reducing stress and keeping you on an even keel. Studies show that a daily relaxation practice of 30 minutes or more can improve your mood and keep depression at bay.
• Make leisure time a priority. Do things for no other reason than that it feels good to do them. Go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.
Watch what you put in your body—
From the food you eat to the vitamins and drugs you take, the substances you put in your body have an impact on the symptoms of Bipolar – both for better or worse.
• Avoid alcohol and drugs. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Even moderate social drinking can upset your emotional balance. Substance use also interferes with sleep and may cause dangerous interactions with your meds. Attempts to self-medicate or numb your symptoms with drugs and alcohol only create more problems.
• Be cautious when taking any drugs. Certain prescription and over-the-counter meds can be problematic for individuals with Bipolar. Be especially careful with antidepressant drugs, which can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid drugs.
• Eat a healthy diet. There is an undeniable link between food and mood. For optimal mood, eat plenty of fresh fruits, vegetables, and whole grains and limit your fat and sugar intake. Space your meals out through the day, so your blood sugar never dips too low. High-carbohydrate diets can cause mood crashes, so they should also be avoided. Other mood-busting foods include chocolate, caffeine, and processed foods.
• Get your omega-3s. Omega-3 fatty acids may decrease mood swings in Bipolar. Omega-3 is available as a nutritional supplement. You can also increase your intake of omega-3 by eating cold-water fish such as salmon, halibut, and sardines, soybeans, flaxseeds, canola oil, pumpkin seeds, and walnuts.
Bipolar: Key Recovery Concepts—
• Support. Working toward wellness is up to you. However, support from others is essential to maintaining your stability and enhancing the quality of your life.
• Self Advocacy. Become an effective advocate for yourself so you can get the services and recovery you need, and make the life you want for yourself.
• Perspective. Depression and manic-depression often follow cyclical patterns. Although you may go through some painful times and it may be difficult to believe things will get better, it is important not to give up hope.
• Personal Responsibility. It’s up to you to take action to keep your moods stabilized. This includes asking for help from others when you need it, taking your drugs as prescribed and keeping appointments with your health care providers.
• Hope. With good symptom management, it is possible to experience long periods of wellness. Believing that you can cope with your mood disorder is both accurate and essential to recovery.
• Education. Learn all you can about your illness. This allows you to make informed decisions about all aspects of your life and recovery.
Common Red Flags for Bipolar Relapse—
Warning signs of depression:
• I crave chocolate.
• I don’t care about anybody else.
• I no longer want to be around individuals.
• I quit cooking meals
• I start having headaches.
• Individuals bother me.
Warning signs of mania or hypomania:
• Friends tell me that I’m crabby.
• I can’t concentrate.
• I feel irritable.
• I find myself reading five books at once.
• I find myself talking faster than usual.
• I need to move around because I have more energy than usual.
• I’m hungry all the time.
10 tips for reaching out and building relationships—
1. Accompany someone to the movies, a concert, or a small get-together.
2. Ask a loved one to check in with you regularly.
3. Call or email an old friend.
4. Confide in a counselor, therapist, or clergy member.
5. Go for a walk with a workout buddy.
6. Have lunch or coffee with a friend.
7. Help someone else by volunteering.
8. Meet new individuals by taking a class or joining a club.
9. Schedule a weekly dinner date
10. Talk to one person about your feelings.
Healthy sleep habits for managing Bipolar—
• Avoid exercising or doing other stimulating activities late in the day.
• Avoid or minimize napping, especially if it interferes with your sleep at night.
• Go to bed and wake up at the same time each day.
• No caffeine after lunch or alcohol at night. Both interfere with sleep.
• Seek support. It’s important to have individuals you can turn to for help and encouragement. Try joining a recovery group or talking to a trusted friend.
• Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.
• Make healthy choices. Healthy sleeping, eating, and exercising habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important.
• Keep stress in check. Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga, or deep breathing.
• Get educated. Learn as much as you can about Bipolar. The more you know, the better you’ll be at assisting your own recovery.
What you can do to help yourself—
Living well with Bipolar requires certain adjustments. Like recovering alcoholics who avoid drinking or diabetics who take insulin, if you have Bipolar, it’s important to make healthy choices for yourself. Making these healthy choices will help you keep your symptoms under control, minimize mood episodes, and take control of your life.
Managing Bipolar starts with proper recovery, including drugs and therapy. But there is so much more you can do to help yourself on a day-to-day basis. The daily decisions you make influence the course of your illness: whether your symptoms get better or worse; whether you stay well or experience a relapse; and how quickly you rebound from a mood episode.
Get involved in your recovery—
Be a full and active participant in your own recovery. Learn everything you can about Bipolar. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and research all your available recovery options. The more informed you are, the better prepared you’ll be to deal with symptoms and make good choices for yourself.
Using what you’ve learned about Bipolar, collaborate with your psychiatrist or therapist in the recovery planning process. Don’t be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership. You may find it helpful to draw up a recovery contract outlining the goals you and your provider have agreed upon.
Other tips for successful Bipolar recovery:
• Take your prescription as instructed. If you’re taking drugs, follow all instructions and take it faithfully. Don’t skip or change your dose without first talking with your psychiatrist.
• Get therapy. While drugs may be able to manage some of the symptoms of Bipolar, therapy teaches you skills you can use in all areas of your life. Therapy can help you learn how to deal with your disorder, cope with problems, regulate your mood, change the way you think, and improve your relationships.
• Communicate with your treatment provider. Keep the lines of communication open with your psychiatrist or therapist. Your recovery program will change over time, so keep in close contact with your provider. Talk to your provider if your condition or needs change and be honest about your symptoms and any drugs side effects.
• Be patient. Don’t expect an immediate and total cure. Have patience with the recovery process. It can take time to find the right program that works for you.
Monitor your symptoms and moods—
In order to stay well, it’s important to be closely attuned to the way you feel. By the time obvious symptoms of mania or depression appear, it is often too late to intercept the mood swing, so keep a close watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. If you catch the problem early and act swiftly, you may be able to prevent a minor mood change from turning into a full-blown episode of mania or depression.
Know your triggers and early warning signs – and watch for them—
It’s important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of early symptoms that preceded your previous mood episodes. Also try to identify the triggers, or outside influences, that have led to mania or depression in the past. Common triggers include:
• arguments with your loved ones
• financial difficulties
• lack of sleep
• problems at school or work
• seasonal changes
• stress
Knowing your early warning signs and triggers won’t do you much good if you aren’t keeping close tabs on how you’re feeling. By checking in with yourself through regular mood monitoring, you can be sure that red flags don’t get lost in the shuffle of your busy, daily life.
Keeping a mood chart is one way to monitor your symptoms and moods. A mood chart is a daily log of your emotional state and other symptoms you’re having. It can also include information such as how many hours of sleep you’re getting, your weight, meds you’re taking, and any alcohol or drug use. You can use your mood chart to spot patterns and indicators of trouble ahead.
Develop a wellness toolbox—
If you spot any warning signs of mania or depression, it’s important to act swiftly. In such times, it’s helpful to have a wellness toolbox to draw from. A wellness toolbox consists of coping skills and activities you can do to maintain a stable mood or to get better when you’re feeling “off.”
The coping techniques that work best will be unique to your situation, symptoms, and preferences. It takes experimentation and time to find a winning strategy. However, many individuals with Bipolar have found the following tools to be helpful in reducing symptoms and maintaining wellness:
• ask for extra help from loved ones
• attend a recovery group
• call your psychiatrist or therapist
• cut back on sugar, alcohol, and caffeine
• cut back on your activities
• do something fun or creative
• exercise
• get a full eight hours of sleep
• increase or decrease the stimulation in your environment
• increase your exposure to light
• take time for yourself to relax and unwind
• talk to a supportive person
• write in your journal
Create an emergency action plan –
Despite your best efforts, there may be times when you experience a relapse into full-blown mania or severe depression. In crisis situations where your safety is at stake, your loved ones or psychiatrist may have to take charge of your care. Such times can leave you feeling helpless and out of control, but having a crisis plan in place allows you to maintain some degree of responsibility for your own recovery.
A plan of action typically includes:
• A list of all meds you are taking, including dosage information
• A list of emergency contacts (your psychiatrist, therapist, close family members)
• Information about any other health problems you have
• Symptoms that indicate you need others to take responsibility for your care
• Recovery preferences (who you want to care for you; what treatments and meds do and do not work, who is authorized to make decisions on your behalf)
Reach out to other individuals—
If your loved one has Bipolar, you can be an instrumental support throughout the recovery process.
Having a strong recovery system is vital to staying happy and healthy. Creating a supportive environment includes not just who you surround yourself with, but who you choose to avoid. In order to take care of yourself, it’s necessary to limit your contact with individuals who drain your emotional energy or leave you feeling discouraged, ashamed, or guilty. Instead, spend time with individuals who truly value you and make you feel better.
• Build new relationships – Isolation and loneliness make Bipolar worse. If you don’t have a recovery network you can count on, take steps to develop new relationships. Try taking a class, joining a church or a civic group, volunteering, or attending events in your community.
• Join a Bipolar recovery group – Spending time with individuals who know what you’re going through and can honestly say they’ve “been there” can be very therapeutic. You can also benefit from the shared experiences and advice of the group members. To find a recovery group in your area, use the Depression and Bipolar Support Alliance’s Support Group Locator or contact your local branch of the National Alliance on Mental Illness.
• Turn to friends and family – Recovery for Bipolar starts at home. It’s important to have individuals you can count on to help you through rough times. Isolation and loneliness can cause depression, so regular contact with supportive friends and family members is therapeutic in itself.
Develop a daily routine—
Your lifestyle choices, including your sleeping, eating, and exercise patterns, have a significant impact on your moods. There are many things you can do in your daily life to get your symptoms under control and to keep depression and mania at bay.
• Keep a strict sleep schedule. Getting too little sleep can trigger mania, so it’s important to get plenty of rest. For some individuals, losing even a few hours can cause problems. However, too much sleep can also worsen your mood. The best advice is to maintain a normal sleep schedule, going to bed and waking up at around the same time each day.
• Exercise regularly. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise is especially effective at recovering from depression. Try to incorporate at least 30 minutes of activity five times a week into your routine. Walking is a good choice for individuals of all fitness levels.
• Build structure into your life. Developing and sticking to a daily schedule can help stabilize the mood swings of Bipolar. Include set times for sleeping, eating, socializing, exercising, working, and relaxing. Try to maintain a regular pattern of activity, even through emotional ups and downs.
Keep stress to a minimum—
Stress can trigger episodes of mania and depression in individuals with Bipolar, so keeping it under control is extremely important. Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time to yourself if you’re feeling overwhelmed.
• Appeal to your senses. Stay calm and energized by appealing to the five senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.
• Learn how to relax. Relaxation techniques such as deep breathing, meditation, yoga, and guided imagery can be very effective at reducing stress and keeping you on an even keel. Studies show that a daily relaxation practice of 30 minutes or more can improve your mood and keep depression at bay.
• Make leisure time a priority. Do things for no other reason than that it feels good to do them. Go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.
Watch what you put in your body—
From the food you eat to the vitamins and drugs you take, the substances you put in your body have an impact on the symptoms of Bipolar – both for better or worse.
• Avoid alcohol and drugs. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Even moderate social drinking can upset your emotional balance. Substance use also interferes with sleep and may cause dangerous interactions with your meds. Attempts to self-medicate or numb your symptoms with drugs and alcohol only create more problems.
• Be cautious when taking any drugs. Certain prescription and over-the-counter meds can be problematic for individuals with Bipolar. Be especially careful with antidepressant drugs, which can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid drugs.
• Eat a healthy diet. There is an undeniable link between food and mood. For optimal mood, eat plenty of fresh fruits, vegetables, and whole grains and limit your fat and sugar intake. Space your meals out through the day, so your blood sugar never dips too low. High-carbohydrate diets can cause mood crashes, so they should also be avoided. Other mood-busting foods include chocolate, caffeine, and processed foods.
• Get your omega-3s. Omega-3 fatty acids may decrease mood swings in Bipolar. Omega-3 is available as a nutritional supplement. You can also increase your intake of omega-3 by eating cold-water fish such as salmon, halibut, and sardines, soybeans, flaxseeds, canola oil, pumpkin seeds, and walnuts.
Bipolar: Key Recovery Concepts—
• Support. Working toward wellness is up to you. However, support from others is essential to maintaining your stability and enhancing the quality of your life.
• Self Advocacy. Become an effective advocate for yourself so you can get the services and recovery you need, and make the life you want for yourself.
• Perspective. Depression and manic-depression often follow cyclical patterns. Although you may go through some painful times and it may be difficult to believe things will get better, it is important not to give up hope.
• Personal Responsibility. It’s up to you to take action to keep your moods stabilized. This includes asking for help from others when you need it, taking your drugs as prescribed and keeping appointments with your health care providers.
• Hope. With good symptom management, it is possible to experience long periods of wellness. Believing that you can cope with your mood disorder is both accurate and essential to recovery.
• Education. Learn all you can about your illness. This allows you to make informed decisions about all aspects of your life and recovery.
Common Red Flags for Bipolar Relapse—
Warning signs of depression:
• I crave chocolate.
• I don’t care about anybody else.
• I no longer want to be around individuals.
• I quit cooking meals
• I start having headaches.
• Individuals bother me.
Warning signs of mania or hypomania:
• Friends tell me that I’m crabby.
• I can’t concentrate.
• I feel irritable.
• I find myself reading five books at once.
• I find myself talking faster than usual.
• I need to move around because I have more energy than usual.
• I’m hungry all the time.
10 tips for reaching out and building relationships—
1. Accompany someone to the movies, a concert, or a small get-together.
2. Ask a loved one to check in with you regularly.
3. Call or email an old friend.
4. Confide in a counselor, therapist, or clergy member.
5. Go for a walk with a workout buddy.
6. Have lunch or coffee with a friend.
7. Help someone else by volunteering.
8. Meet new individuals by taking a class or joining a club.
9. Schedule a weekly dinner date
10. Talk to one person about your feelings.
Healthy sleep habits for managing Bipolar—
• Avoid exercising or doing other stimulating activities late in the day.
• Avoid or minimize napping, especially if it interferes with your sleep at night.
• Go to bed and wake up at the same time each day.
• No caffeine after lunch or alcohol at night. Both interfere with sleep.
BORDERLINE PERSONALITY DISORDER
While BORDERLINE PERSONALITY DISORDER is a serious condition that requires treatment by qualified mental health professionals, there are also sources of self-help (or self-guided strategies for symptom reduction) for individuals with BORDERLINE PERSONALITY DISORDER. These self-help strategies should be used in conjunction with formal treatments for BORDERLINE PERSONALITY DISORDER (such as psychotherapy and medication).
The symptoms of BORDERLINE PERSONALITY DISORDER, including erratic mood shifts, self-harming behaviors, suicidality, intense emotional experiences, sensitivity to problems in your relationships and problems with impulsive behaviors, may all be related to one core feature: emotion dysregulation, where individuals have very strong emotional responses, difficulty managing those responses and often engage in harmful behaviors in attempts to escape from these emotions. Recovery strategies can help to reduce emotion dysregulation and the other symptoms of BORDERLINE PERSONALITY DISORDER.
What are Recovery strategies?
Since emotion dysregulation is such an important feature of BORDERLINE PERSONALITY DISORDER, many treatments for BORDERLINE PERSONALITY DISORDER emphasize the importance of building recovery strategies to better manage emotions when they arise. What exactly are recovery strategies? They are healthier ways of addressing situations and their resulting emotions.
Why Learn New Recovery strategies?
Why is it important to learn new, healthier ways of coping? By using healthful recovery strategies you may:
• Build confidence in your ability to handle difficult situations
• Improve your ability to be able to continue to function well even when in stressful circumstances
• Reduce the intensity of the emotional distress you feel
• Reduce the likelihood that you will do something harmful (e.g., engage in self- harming behaviors) to attempt to escape from the emotional distress
• Reduce the likelihood that you will engage in behaviors that destroy relationships (e.g., physical aggression) when you are upset
• Ultimately reduce your overall experience of emotion dysregulation
What are Some Different Types of Recovery strategies?
There are literally thousands of different recovery strategies that individuals use to manage stressful situations and the emotions that result. Here are a few types of recovery strategies that work for many individuals:
• Active Problem-Solving. Consider the problem at hand: Is there a way to solve the problem directly?
• Behavioral Activation. Engage in an activity that might take your mind off the stressful situation for a little while.
• Grounding. Practice grounding exercises that are designed to keep you "grounded" in the present moment, rather than caught up in replaying events in your head, worrying about the future or zoning out.
• Mindfulness Meditation. Practice mindfulness meditation, which helps you to observe and describe your experiences without judging or rejecting them.
• Relaxation Exercises. Practice a relaxation exercise, such as deep breathing or progressive muscle relaxation.
• Social Support. Talk to others who may understand what you are going through.
How To Learn Healthier Recovery strategies—
Ready to learn some new, healthier ways of coping? One way to do this is by seeking treatment. Many psychological treatments for BORDERLINE PERSONALITY DISORDER, including cognitive behavioral treatments such as Dialectical Behavior Therapy (DBT), focus on teaching healthier recovery strategies to manage strong emotions. There are online resource pages that can help you find a cognitive behavioral therapist or a DBT provider.
When you are having an intense emotion, it can be hard to know what to do. Unfortunately, many individuals with BORDERLINE PERSONALITY DISORDER turn to unhealthy behaviors in an attempt to cope with emotional pain (e.g., self-harm, substance use, or aggression). Want to replace unhealthy habits with new, healthier skills? Try some of the recovery strategies listed below.
1. Be Mindful— Practice mindfulness of your emotion. Notice the emotion you are having, and let yourself experience it as a wave, without trying to block it, suppress it, or hold on to it. Try to accept the emotion for what it is.
2. Breathe Deeply— Sit or lie somewhere quiet and bring your attention to your breathing. Breathe evenly, slowly, and deeply. Watch your stomach rise and fall with each breath.
3. Call Someone— Reaching out to others can really help when you are struggling with strong emotions. Call a supportive friend or family member. If you don’t have someone in mind that is supportive, call a helpline (for example, in the U.S. you can call the National Suicide Hotline at 1-800-273-TALK).
4. Do Something— Engage in a highly engaging activity. Television or computer activities do not count here -- these are too passive. Instead, take a walk, dance, clean your house, or do some other activity that gets you engaged and distracts you from your current emotions.
5. Ground Yourself— When emotions seem to be taking you out of the current moment (e.g., you are starting to feel “zoned out” or can’t see anything else going on at the moment), do something to ground yourself. Grab an ice cube and hold it in your hand for a few moments, snap a rubber band against your wrist, “snap yourself back” into the moment.
6. Help Someone Else— Do something nice for someone else. It doesn't have to be something big; you can walk to the nearest store, buy a pack of gum, and give the cashier a smile and say "have a great day." It may sound silly, but small gestures like this can really reduce emotional pain.
7. Play Music— Play music that creates an emotion that is the opposite of the one you are struggling with. For example, if you are feeling very sad, play happy, upbeat music. If you are feeling anxious, play slow, relaxing music.
8. Pray— Are you a religious or spiritual person? If you are (or even if you’re not but have considered trying), praying can be tremendously helpful in times of extreme stress.
9. Ride It Out— The peak of most strong emotional reactions (and the urges to engage in harmful activities, like self-harming or drinking, that can go along with these reactions) last for a few minutes and then begin to subside. Grab an egg timer from the kitchen, and set it for 10 minutes. Wait the 10 minutes, and practice riding out the emotion.
10. Take a Warm Bath or Shower— Try to lose yourself in the sensations of the warm water, the smell of the soap, etc. Allow the sensations to distract you from the situation you are upset about.
What is Mindfulness Meditation?
Mindfulness meditation has been defined in many ways, but perhaps one of the most widely-used definitions comes from Jon Kabat-Zinn, Ph.D., (the creator of a treatment for stress and chronic pain called “Mindfulness-Based Stress Reduction”), who defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.”
When you practice mindfulness meditation, you practice being in the present moment, and noticing all of your experiences. You practice being aware of things happening outside of yourself (e.g., things you see, smell, hear), and things happening internally (e.g., your thoughts, feelings and sensations). Importantly, mindfulness meditation involves being aware without judgment. So, you are paying attention to all of these experiences, without labeling them as good or bad.
Mindfulness is a concept that comes from the Buddhist spiritual tradition. For almost almost 3,000 years, Buddhist monks have practiced mindfulness meditation -- but in recent years mindfulness practice has become increasingly widespread and applied outside of the Buddhism. In fact, most Eastern practitioners who use mindfulness think of it as a skill that can be used separately from any kind of religious or spiritual practice. So, no matter what your religious background, mindfulness meditation may be helpful for you.
What Does Mindfulness Meditation Have to Do With BORDERLINE PERSONALITY DISORDER?
Marsha Linehan, Ph.D., who created Dialectical Behavior Therapy for BORDERLINE PERSONALITY DISORDER was one of the first to apply mindfulness meditation training to the recovery of BORDERLINE PERSONALITY DISORDER. Often, individuals with BORDERLINE PERSONALITY DISORDER not only experience intense emotions, they can become “stuck” in these emotions and judge both the emotions and themselves (e.g., “This is a terrible feeling and I am such a weak person for feeling this way”).
Unfortunately, this can end up making the emotion feel even more intense. And, judgmental thoughts can add other emotions to the mix — if you tell yourself you are weak for feeling sad you may end up feeling both sad and ashamed.
Mindfulness meditation training can help individuals with BORDERLINE PERSONALITY DISORDER to feel less “stuck” in their emotions, and less judgmental of the emotions and themselves. Mindfulness meditation training may also help individuals with BORDERLINE PERSONALITY DISORDER be more effective in applying healthy recovery strategies in the midst of emotional pain, because mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.
For example, imagine being in a verbal argument with someone you love. During the argument you may feel very intense feelings, such as anger, fear and rage. Without mindfulness skills, you are more likely to act on these feelings without being able to see the consequences -- maybe you yell at your loved one, throw something or storm out. With mindfulness meditation practice, you may be able to notice the emotions you are having (e.g., you may think to yourself “I’m feeling really angry, hurt, and afraid right now”), and you may be able to step back and chose your behavior (e.g., “I am too upset to talk about this and I am may say or do something I’ll regret later. I need to take a time out from this discussion”).
How to Practice Mindfulness Meditation—
There are a variety of ways to begin practicing mindfulness meditation. Usually you can begin practicing mindfulness by trying some exercises that promote mindfulness.
Self-Help Emotional Processing and Expression—
Some individuals find that processing or expressing emotions on their own can be a very useful way to engage in self-help. For example, some individuals write in a journal or blog, others draw or paint -- and some find other creative, healthy ways to express their emotions. There is some research that suggests that expressive writing, for example, can have a variety of positive consequences, including better physical health and reduced psychological symptoms.
It is important to note that for some individuals, engaging in these types of strategies can feel overwhelming or triggering. If you feel you do not have the recovery strategies needed to manage the emotions that come from emotional processing activities, then you probably need to start with some recovery strategies training. However, if you and your therapist think you are ready to try emotional processing exercises, you may find that writing in a journal can be a good place to start.
The symptoms of BORDERLINE PERSONALITY DISORDER, including erratic mood shifts, self-harming behaviors, suicidality, intense emotional experiences, sensitivity to problems in your relationships and problems with impulsive behaviors, may all be related to one core feature: emotion dysregulation, where individuals have very strong emotional responses, difficulty managing those responses and often engage in harmful behaviors in attempts to escape from these emotions. Recovery strategies can help to reduce emotion dysregulation and the other symptoms of BORDERLINE PERSONALITY DISORDER.
What are Recovery strategies?
Since emotion dysregulation is such an important feature of BORDERLINE PERSONALITY DISORDER, many treatments for BORDERLINE PERSONALITY DISORDER emphasize the importance of building recovery strategies to better manage emotions when they arise. What exactly are recovery strategies? They are healthier ways of addressing situations and their resulting emotions.
Why Learn New Recovery strategies?
Why is it important to learn new, healthier ways of coping? By using healthful recovery strategies you may:
• Build confidence in your ability to handle difficult situations
• Improve your ability to be able to continue to function well even when in stressful circumstances
• Reduce the intensity of the emotional distress you feel
• Reduce the likelihood that you will do something harmful (e.g., engage in self- harming behaviors) to attempt to escape from the emotional distress
• Reduce the likelihood that you will engage in behaviors that destroy relationships (e.g., physical aggression) when you are upset
• Ultimately reduce your overall experience of emotion dysregulation
What are Some Different Types of Recovery strategies?
There are literally thousands of different recovery strategies that individuals use to manage stressful situations and the emotions that result. Here are a few types of recovery strategies that work for many individuals:
• Active Problem-Solving. Consider the problem at hand: Is there a way to solve the problem directly?
• Behavioral Activation. Engage in an activity that might take your mind off the stressful situation for a little while.
• Grounding. Practice grounding exercises that are designed to keep you "grounded" in the present moment, rather than caught up in replaying events in your head, worrying about the future or zoning out.
• Mindfulness Meditation. Practice mindfulness meditation, which helps you to observe and describe your experiences without judging or rejecting them.
• Relaxation Exercises. Practice a relaxation exercise, such as deep breathing or progressive muscle relaxation.
• Social Support. Talk to others who may understand what you are going through.
How To Learn Healthier Recovery strategies—
Ready to learn some new, healthier ways of coping? One way to do this is by seeking treatment. Many psychological treatments for BORDERLINE PERSONALITY DISORDER, including cognitive behavioral treatments such as Dialectical Behavior Therapy (DBT), focus on teaching healthier recovery strategies to manage strong emotions. There are online resource pages that can help you find a cognitive behavioral therapist or a DBT provider.
When you are having an intense emotion, it can be hard to know what to do. Unfortunately, many individuals with BORDERLINE PERSONALITY DISORDER turn to unhealthy behaviors in an attempt to cope with emotional pain (e.g., self-harm, substance use, or aggression). Want to replace unhealthy habits with new, healthier skills? Try some of the recovery strategies listed below.
1. Be Mindful— Practice mindfulness of your emotion. Notice the emotion you are having, and let yourself experience it as a wave, without trying to block it, suppress it, or hold on to it. Try to accept the emotion for what it is.
2. Breathe Deeply— Sit or lie somewhere quiet and bring your attention to your breathing. Breathe evenly, slowly, and deeply. Watch your stomach rise and fall with each breath.
3. Call Someone— Reaching out to others can really help when you are struggling with strong emotions. Call a supportive friend or family member. If you don’t have someone in mind that is supportive, call a helpline (for example, in the U.S. you can call the National Suicide Hotline at 1-800-273-TALK).
4. Do Something— Engage in a highly engaging activity. Television or computer activities do not count here -- these are too passive. Instead, take a walk, dance, clean your house, or do some other activity that gets you engaged and distracts you from your current emotions.
5. Ground Yourself— When emotions seem to be taking you out of the current moment (e.g., you are starting to feel “zoned out” or can’t see anything else going on at the moment), do something to ground yourself. Grab an ice cube and hold it in your hand for a few moments, snap a rubber band against your wrist, “snap yourself back” into the moment.
6. Help Someone Else— Do something nice for someone else. It doesn't have to be something big; you can walk to the nearest store, buy a pack of gum, and give the cashier a smile and say "have a great day." It may sound silly, but small gestures like this can really reduce emotional pain.
7. Play Music— Play music that creates an emotion that is the opposite of the one you are struggling with. For example, if you are feeling very sad, play happy, upbeat music. If you are feeling anxious, play slow, relaxing music.
8. Pray— Are you a religious or spiritual person? If you are (or even if you’re not but have considered trying), praying can be tremendously helpful in times of extreme stress.
9. Ride It Out— The peak of most strong emotional reactions (and the urges to engage in harmful activities, like self-harming or drinking, that can go along with these reactions) last for a few minutes and then begin to subside. Grab an egg timer from the kitchen, and set it for 10 minutes. Wait the 10 minutes, and practice riding out the emotion.
10. Take a Warm Bath or Shower— Try to lose yourself in the sensations of the warm water, the smell of the soap, etc. Allow the sensations to distract you from the situation you are upset about.
What is Mindfulness Meditation?
Mindfulness meditation has been defined in many ways, but perhaps one of the most widely-used definitions comes from Jon Kabat-Zinn, Ph.D., (the creator of a treatment for stress and chronic pain called “Mindfulness-Based Stress Reduction”), who defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.”
When you practice mindfulness meditation, you practice being in the present moment, and noticing all of your experiences. You practice being aware of things happening outside of yourself (e.g., things you see, smell, hear), and things happening internally (e.g., your thoughts, feelings and sensations). Importantly, mindfulness meditation involves being aware without judgment. So, you are paying attention to all of these experiences, without labeling them as good or bad.
Mindfulness is a concept that comes from the Buddhist spiritual tradition. For almost almost 3,000 years, Buddhist monks have practiced mindfulness meditation -- but in recent years mindfulness practice has become increasingly widespread and applied outside of the Buddhism. In fact, most Eastern practitioners who use mindfulness think of it as a skill that can be used separately from any kind of religious or spiritual practice. So, no matter what your religious background, mindfulness meditation may be helpful for you.
What Does Mindfulness Meditation Have to Do With BORDERLINE PERSONALITY DISORDER?
Marsha Linehan, Ph.D., who created Dialectical Behavior Therapy for BORDERLINE PERSONALITY DISORDER was one of the first to apply mindfulness meditation training to the recovery of BORDERLINE PERSONALITY DISORDER. Often, individuals with BORDERLINE PERSONALITY DISORDER not only experience intense emotions, they can become “stuck” in these emotions and judge both the emotions and themselves (e.g., “This is a terrible feeling and I am such a weak person for feeling this way”).
Unfortunately, this can end up making the emotion feel even more intense. And, judgmental thoughts can add other emotions to the mix — if you tell yourself you are weak for feeling sad you may end up feeling both sad and ashamed.
Mindfulness meditation training can help individuals with BORDERLINE PERSONALITY DISORDER to feel less “stuck” in their emotions, and less judgmental of the emotions and themselves. Mindfulness meditation training may also help individuals with BORDERLINE PERSONALITY DISORDER be more effective in applying healthy recovery strategies in the midst of emotional pain, because mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.
For example, imagine being in a verbal argument with someone you love. During the argument you may feel very intense feelings, such as anger, fear and rage. Without mindfulness skills, you are more likely to act on these feelings without being able to see the consequences -- maybe you yell at your loved one, throw something or storm out. With mindfulness meditation practice, you may be able to notice the emotions you are having (e.g., you may think to yourself “I’m feeling really angry, hurt, and afraid right now”), and you may be able to step back and chose your behavior (e.g., “I am too upset to talk about this and I am may say or do something I’ll regret later. I need to take a time out from this discussion”).
How to Practice Mindfulness Meditation—
There are a variety of ways to begin practicing mindfulness meditation. Usually you can begin practicing mindfulness by trying some exercises that promote mindfulness.
Self-Help Emotional Processing and Expression—
Some individuals find that processing or expressing emotions on their own can be a very useful way to engage in self-help. For example, some individuals write in a journal or blog, others draw or paint -- and some find other creative, healthy ways to express their emotions. There is some research that suggests that expressive writing, for example, can have a variety of positive consequences, including better physical health and reduced psychological symptoms.
It is important to note that for some individuals, engaging in these types of strategies can feel overwhelming or triggering. If you feel you do not have the recovery strategies needed to manage the emotions that come from emotional processing activities, then you probably need to start with some recovery strategies training. However, if you and your therapist think you are ready to try emotional processing exercises, you may find that writing in a journal can be a good place to start.
Bulimia
What is bulimia?
Bulimia (also called bulimia nervosa) is a condition where you think a lot about your body weight and shape. It affects your ability to have a 'normal' eating pattern. Bulimia nervosa is one of the conditions that form the group of eating disorders that includes anorexia nervosa. There are important differences between these two conditions. For example, in anorexia nervosa you are very underweight, whereas in bulimia, you are most likely to be normal weight or even overweight.
How do you know if you have an eating disorder?
If you answer yes to two or more of these questions then you may have an eating disorder:
• Do you believe you're fat when others think you're thin?
• Do you make yourself sick because you are uncomfortably full?
• Do you worry that you've lost control over how much you eat?
• Have you lost more than 13 pounds in the past three months?
• Would you say that food dominates your life?
Who gets bulimia?
Bulimia nervosa mainly affects women aged 16-40. It most commonly starts around the age of 19 years. It affects around 8 in 100 women in the UK. Bulimia nervosa sometimes develops in men and children. Women are 10 times more likely to develop bulimia nervosa than men. However, bulimia nervosa is becoming more common in boys and men. Bulimia nervosa is more common than anorexia nervosa.
There may be some genetic factor, as the risk of developing bulimia nervosa in close relatives of individuals with bulimia nervosa is four times greater than in the general population.
What are the symptoms of bulimia?
Bingeing and purging are the main symptoms and are usually done in secret.
• Bingeing means that you have repeated episodes of eating large amounts of foods and/or drinks. For example, you may eat a whole large tub of ice cream or two packets of biscuits even if you are not hungry. You feel out of control and unable to stop eating. Binge eating is often done very quickly until you feel physically uncomfortable. This happens not just on one occasion, but regularly. Eating patterns typically become chaotic.
• Purging means that you try and counteract the 'fattening' effects of the food from the bingeing. Self-induced vomiting (making yourself sick) after a bout of bingeing is the most well-known, but not all individuals with bulimia nervosa do this. Other purging methods include taking lots of laxatives, extreme exercise, extreme dieting or even periods of complete starvation, taking diuretics (water tablets) or taking other medicines such as amphetamines.
The reasons why you binge eat and then purge may not be easy to explain. Part of the problem may be due to a fear of getting fat, although it is often not just as simple as that. All sorts of emotions, feelings and attitudes may contribute. The physical act of bingeing and purging may be a way of dealing with your emotions in some way.
What are the physical problems caused by bulimia nervosa?
These are caused by the unusual eating habits and the methods used to purge the body of food (such as vomiting or the excessive use of laxatives). Physical problems do not always develop. They are more likely if you binge and purge often. One or more of the following may develop:
1. Bowel problems— These may occur if you take a lot of laxatives. Laxatives can damage the bowel muscle and nerve endings. This may eventually result in permanent constipation and also sometimes abdominal pains.
2. Chemical imbalances in the body— These are caused by either repeated vomiting or excess use of laxatives. For example, low potassium level which may cause tiredness, weakness, abnormal heart rhythms, kidney damage and convulsions. Low calcium levels can lead to tetany (muscle spasms).
3. Depression— It is fairly common to feel low when you have bulimia nervosa. Some individuals even become depressed, which can respond well to recovery. It is important to talk about any symptoms of depression you may have. Many individuals find they become more moody or irritable.
4. Irregular periods— Many individuals have irregular periods as hormone levels can be affected by poor diet. Periods may even stop all together or you may find that your periods have never started, especially if you started having eating problems when you were younger.
5. Psychological problems— These are very common and include feelings of guilt and disgust after bingeing and purging. Poor self-esteem and mood swings are common.
6. Swelling of hands, feet and face— This is usually due to fluid disturbances in the body. The saliva glands in the face can sometimes swell due to the frequent vomiting.
7. Teeth problems— These can be caused by the acid from the stomach rotting away the enamel as a result of repeated vomiting.
What causes bulimia?
The exact cause is not clear. Some individuals blame the media and the fashion industry which portray the idea that it is fashionable to be slim. This can put pressure on some individuals to try to be slim which can then lead to an eating disorder.
There may be some genetic factor to developing bulimia nervosa, which is triggered by stressful or traumatic life experiences. For example, some individuals with bulimia nervosa have had a childhood where there were frequent family problems with arguments and criticism at home. Some individuals with bulimia nervosa have been abused as a child.
Sometimes bulimia nervosa is also associated with some other psychological problem. (That is, the bulimia nervosa is sometimes just a part of a broader mental health problem.) For example, there is a higher than average rate of bulimia nervosa in individuals with anxiety disorders, obsessive compulsive disorder, depression, post-traumatic stress disorder and some personality disorders.
A chemical called serotonin which is in parts of the brain is thought to have something to do with bulimia nervosa. In some way one or more of the above factors, or even other unknown factors, may lead to a low level of serotonin.
Are there any tests done for bulimia nervosa?
Although there is not an actual test to diagnose bulimia nervosa, your doctor may wish to undertake some blood tests. These are usually done to check your kidney function and potassium levels.
What are the recovery techniques for bulimia?
The aim of recovery is to:
• Encourage healthy eating.
• Help individuals become both physically and mentally stronger.
• Reduce other related symptoms and problems.
• Reduce risk of harm which can be caused by bulimia nervosa.
Many individuals with bulimia nervosa who see their GP will be referred to a specialist mental health team. Members of the team may include psychiatrists, psychologists, nurses, dietitians and other professionals. If you have more severe bulimia nervosa you may be referred to a specialist eating disorder unit.
The sorts of recovery techniques that may be offered include the following:
1. Psychological ('talking') recovery techniques— Cognitive behavioral therapy (CBT) is the most commonly used psychological treatment for bulimia nervosa. It helps you to look at the reasons why you developed bulimia nervosa, aims to change any false beliefs that you have about your weight and body, and it helps to show you how to deal with emotional issues. Talking recovery techniques take time and usually require regular sessions over several months. Recovery may also involve other members of your family going to meetings to discuss any family issues. However, CBT does not suit everyone. About a third of individuals drop out before finishing the course. Other forms of psychological recovery techniques may also be used. For example, cognitive analytic therapy (CAT), interpersonal psychotherapy (IPT) and focal psychodynamic therapy.
2. Medication— A medicine may be advised by your doctor. The most commonly used medicines are selective serotonin reuptake inhibitor (SSRI) antidepressants. These are used to treat depression but, in higher doses, one called fluoxetine can reduce the urge for bingeing or purging. These are not usually recommended if you are younger than 18 years old. Treatment of any physical or teeth problems that may occur. This may include taking potassium supplements, dental care and not using laxatives.
3. Help with eating— It is best if you have regular meals; even if you only eat small meals. It is beneficial to the body to eat at least three times a day. You should try to be honest (with yourself and other individuals) about the amount of food you are actually eating. You should reduce the number of times you weigh yourself; try only to weigh yourself once a week. It may be useful to keep an eating diary in order to write down all the food that you eat.
Self-help measures—
Self-help methods for the recovery of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Self-help support groups are an especially powerful and effective means of ensuring long-term treatment compliance and decrease the relapse rate. Individuals find they can bounce ideas off of one another, get objective feedback about body image, and just gain increased social support. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.
There are a number of self-help books and manuals available. These provide strategies in how to cope with, and overcome, bulimia nervosa. Some individuals find these very helpful and prefer them to 'formal' treatment. It is certainly worth trying a self-help manual if there is a waiting list or difficulty in getting psychological treatment.
Anorexia and bulimia aren’t about food. They’re about using food to cope with painful emotions such as anger, self-loathing, vulnerability, and fear. Disordered eating is a coping mechanism–whether you refuse food to feel in control, binge for comfort, or purge to punish yourself. But you can learn healthier ways to cope with negative emotions.
The first step is figuring out what’s really eating you up inside. Remember, “fat” is not a feeling, so if you feel overweight and unattractive, stop and ask yourself what’s really going on. Are you upset about something? Depressed? Stressed out? Lonely? Once you identify the emotion you’re experiencing, you can choose a positive alternative to starving or stuffing yourself.
Here are a few suggestions to get you started:
• Call a friend
• Listen to music
• Play with a pet
• Read a good book
• Take a walk
• Write in a journal
• Go to the movies
• Get out into nature
• Play a favorite game
• Do something nice for someone else
Emotional Do and Don't Lists—
Do…
• use individuals to comfort you when you feel bad, instead of focusing on food
• let your emotions come and go as they please without fear
• fully experience every emotion
• be open and accepting of all your emotions
• allow yourself to be vulnerable with individuals you trust
Don’t…
• avoid feelings because they make you uncomfortable
• focus on food when you’re experiencing a painful emotion
• let individuals shame or humiliate you for having or expressing feelings
• pretend you don’t feel anything when you do
• worry about your feelings making you fall apart
Improving your self-image—
You are more than what you weigh, a fact you lose sight of when you have an eating disorder. When you base your self-worth on physical appearance alone, you’re ignoring all the other qualities, accomplishments, and abilities that make you beautiful. Think about your friends and family members. Do they love you for the way you look or who you are? Chances are, your appearance ranks low on the list of what they love about you–and you probably feel the same about them. So why does it top your own list?
Placing too much importance on how you look leads to low self-esteem and insecurity. But you can learn to see yourself in a positive, balanced way:
• Challenge negative self-talk. When you catch yourself being self-critical or pessimistic, stop and challenge the negative thought. Ask yourself what evidence you have to support the idea. What is the evidence against it? Just because you believe something, doesn’t mean it’s true. Answering these questions will help you see things in a more realistic light.
• Focus on what you like about your body. Instead of searching for flaws when you look in the mirror, appreciate the things you like about your appearance. If you’re distracted by “imperfections,” remind yourself that nobody’s perfect. Even supermodels get airbrushed.
• Make a list of your positive qualities. Think of all the things you like about yourself. Are you smart? Kind? Creative? Loyal? Funny? What would others say are your good qualities? Include your talents, skills, and achievements. Also think about bad qualities you don’t have.
Learning healthy eating habits—
If you’ve been struggling with an eating disorder, chances are you’ve forgotten what healthy eating looks like. But learning and establishing healthy eating habits is an essential step in recovery from anorexia and bulimia.
• Challenge your strict eating rules. Strict rules about food and eating fuel anorexia and bulimia, so it’s important to replace them with healthier ones. For example, if you have a rule forbidding all desserts, change it into a less rigid guideline such as, “I won’t eat dessert every day.” You won’t gain weight by enjoying an occasional ice cream or cookie.
• Don’t diet. Healthy eating–not dieting–is the key to avoiding weight gain. Instead of focusing on what you shouldn’t eat, focus on nutritious foods that will energize you and make your body strong. Think of food as fuel for your body. Your body knows when the tank is low, so listen to it. Eat when you’re truly hungry, then stop when you’re full. If you follow these simple guidelines -- your body will look and feel its best.
• Stick to a regular eating schedule. You may be used to skipping meals or fasting for long stretches. But when you starve yourself, food becomes all you think about. To avoid this preoccupation, make sure to eat every three hours. Plan ahead for meals and snacks, and don’t skip!
Find a specialist—
The first step in eating disorder recovery is finding a doctor or therapist who specializes in anorexia and bulimia. As you search, focus on finding the right fit. Your relationship with your doctor or therapist is important to the recovery process. Look for someone who makes you feel comfortable, accepted, and safe.
To find an eating disorder recovery specialist in your area:
• Ask your primary care doctor for a referral
• Ask your school counselor or nurse
• Call the National Eating Disorders Association’s toll-free hotline at 1-800-931-2237 (Mon–Fri, 8:30 a.m. to 4:30 p.m. PST)
• Check with local hospitals or medical centers
• Search online at the eating disorder websites listed to the right
Address health problems—
Anorexia and bulimia can be deadly–and not just if you’re drastically underweight. Your health may be in danger, even if you only occasionally fast, binge, or purge, so it’s important to get a full medical evaluation. If the evaluation reveals health problems, they should take top recovery priority. Nothing is more important than your physical well-being. If you’re suffering from any other life-threatening problem, you may need to be hospitalized. While the thought of hospitalization may be scary, try to remember that its sole purpose is to keep you safe!
Make a long-term recovery plan—
Once your health problems are under control, you and your doctor or therapist can work on a long-term recovery plan. First, you’ll need to assemble a complete eating disorder recovery team. Your team might include a family doctor, a psychologist, a nutritionist, a social worker, and a psychiatrist. Then you and your team will develop a recovery plan that’s individualized to meet your needs.
Relapse prevention—
The work of eating disorder recovery doesn’t end once you’ve adopted healthy habits. It’s important to take steps to maintain your progress and prevent relapse.
• Avoid pro-ana and pro-mia websites. Don’t visit websites that promote or glorify anorexia and bulimia. These sites are run by individuals who want excuses to continue down their destructive path. The “support” they offer is dangerous and will only get in the way of your recovery.
• Develop a solid support system. Surround yourself with individuals who support you and want to see you healthy and happy. Avoid individuals that drain your energy, encourage your disordered eating behaviors, or make you feel bad about yourself.
• Fill your life with positive activities. Make time for activities that bring you joy and fulfillment. Try something you’ve always wanted to do, develop a new skill, pick up a fun hobby, or volunteer in your community. The more rewarding your life, the less desire you’ll have to focus on food and weight.
• Identify your “triggers”. Are you more likely to revert to your old, destructive behaviors during the holidays, exam week, or swimsuit season? Know what your triggers are, and have a plan for dealing with them, such as going to therapy more often or asking for extra support from family and friends.
• Keep a journal. Writing in a daily journal can help you keep tabs on your thoughts, emotions, and behaviors. If you notice that you’re slipping back into negative patterns, take action immediately.
• Stick with your eating disorder recovery plan. Don’t neglect therapy or other components of your recovery, even if you’re doing better. Listen to the advice of your recovery team and continue to follow their recommendations.
What is the prognosis?
Bulimia nervosa is the sort of condition that is difficult to cure fully 'once and for all'. Many individuals improve with treatment, but bad spells (relapses) may recur from time-to-time in some cases. Many individuals find they still have issues with food, even after recovery, but they are more in control and can lead happier, more fulfilled lives.
Studies suggest that 10 years after a diagnosis of bulimia nervosa about 5 in 10 individuals are well, about 2 in 10 individuals still have bulimia nervosa, and about 3 in 10 individuals are somewhere in the middle. However, the recent study about CBT treatment (cited at the end) suggests that with good quality CBT, the outlook is probably even better than these 'overall' figures. It is very unusual to die from bulimia nervosa.
Bulimia (also called bulimia nervosa) is a condition where you think a lot about your body weight and shape. It affects your ability to have a 'normal' eating pattern. Bulimia nervosa is one of the conditions that form the group of eating disorders that includes anorexia nervosa. There are important differences between these two conditions. For example, in anorexia nervosa you are very underweight, whereas in bulimia, you are most likely to be normal weight or even overweight.
How do you know if you have an eating disorder?
If you answer yes to two or more of these questions then you may have an eating disorder:
• Do you believe you're fat when others think you're thin?
• Do you make yourself sick because you are uncomfortably full?
• Do you worry that you've lost control over how much you eat?
• Have you lost more than 13 pounds in the past three months?
• Would you say that food dominates your life?
Who gets bulimia?
Bulimia nervosa mainly affects women aged 16-40. It most commonly starts around the age of 19 years. It affects around 8 in 100 women in the UK. Bulimia nervosa sometimes develops in men and children. Women are 10 times more likely to develop bulimia nervosa than men. However, bulimia nervosa is becoming more common in boys and men. Bulimia nervosa is more common than anorexia nervosa.
There may be some genetic factor, as the risk of developing bulimia nervosa in close relatives of individuals with bulimia nervosa is four times greater than in the general population.
What are the symptoms of bulimia?
Bingeing and purging are the main symptoms and are usually done in secret.
• Bingeing means that you have repeated episodes of eating large amounts of foods and/or drinks. For example, you may eat a whole large tub of ice cream or two packets of biscuits even if you are not hungry. You feel out of control and unable to stop eating. Binge eating is often done very quickly until you feel physically uncomfortable. This happens not just on one occasion, but regularly. Eating patterns typically become chaotic.
• Purging means that you try and counteract the 'fattening' effects of the food from the bingeing. Self-induced vomiting (making yourself sick) after a bout of bingeing is the most well-known, but not all individuals with bulimia nervosa do this. Other purging methods include taking lots of laxatives, extreme exercise, extreme dieting or even periods of complete starvation, taking diuretics (water tablets) or taking other medicines such as amphetamines.
The reasons why you binge eat and then purge may not be easy to explain. Part of the problem may be due to a fear of getting fat, although it is often not just as simple as that. All sorts of emotions, feelings and attitudes may contribute. The physical act of bingeing and purging may be a way of dealing with your emotions in some way.
What are the physical problems caused by bulimia nervosa?
These are caused by the unusual eating habits and the methods used to purge the body of food (such as vomiting or the excessive use of laxatives). Physical problems do not always develop. They are more likely if you binge and purge often. One or more of the following may develop:
1. Bowel problems— These may occur if you take a lot of laxatives. Laxatives can damage the bowel muscle and nerve endings. This may eventually result in permanent constipation and also sometimes abdominal pains.
2. Chemical imbalances in the body— These are caused by either repeated vomiting or excess use of laxatives. For example, low potassium level which may cause tiredness, weakness, abnormal heart rhythms, kidney damage and convulsions. Low calcium levels can lead to tetany (muscle spasms).
3. Depression— It is fairly common to feel low when you have bulimia nervosa. Some individuals even become depressed, which can respond well to recovery. It is important to talk about any symptoms of depression you may have. Many individuals find they become more moody or irritable.
4. Irregular periods— Many individuals have irregular periods as hormone levels can be affected by poor diet. Periods may even stop all together or you may find that your periods have never started, especially if you started having eating problems when you were younger.
5. Psychological problems— These are very common and include feelings of guilt and disgust after bingeing and purging. Poor self-esteem and mood swings are common.
6. Swelling of hands, feet and face— This is usually due to fluid disturbances in the body. The saliva glands in the face can sometimes swell due to the frequent vomiting.
7. Teeth problems— These can be caused by the acid from the stomach rotting away the enamel as a result of repeated vomiting.
What causes bulimia?
The exact cause is not clear. Some individuals blame the media and the fashion industry which portray the idea that it is fashionable to be slim. This can put pressure on some individuals to try to be slim which can then lead to an eating disorder.
There may be some genetic factor to developing bulimia nervosa, which is triggered by stressful or traumatic life experiences. For example, some individuals with bulimia nervosa have had a childhood where there were frequent family problems with arguments and criticism at home. Some individuals with bulimia nervosa have been abused as a child.
Sometimes bulimia nervosa is also associated with some other psychological problem. (That is, the bulimia nervosa is sometimes just a part of a broader mental health problem.) For example, there is a higher than average rate of bulimia nervosa in individuals with anxiety disorders, obsessive compulsive disorder, depression, post-traumatic stress disorder and some personality disorders.
A chemical called serotonin which is in parts of the brain is thought to have something to do with bulimia nervosa. In some way one or more of the above factors, or even other unknown factors, may lead to a low level of serotonin.
Are there any tests done for bulimia nervosa?
Although there is not an actual test to diagnose bulimia nervosa, your doctor may wish to undertake some blood tests. These are usually done to check your kidney function and potassium levels.
What are the recovery techniques for bulimia?
The aim of recovery is to:
• Encourage healthy eating.
• Help individuals become both physically and mentally stronger.
• Reduce other related symptoms and problems.
• Reduce risk of harm which can be caused by bulimia nervosa.
Many individuals with bulimia nervosa who see their GP will be referred to a specialist mental health team. Members of the team may include psychiatrists, psychologists, nurses, dietitians and other professionals. If you have more severe bulimia nervosa you may be referred to a specialist eating disorder unit.
The sorts of recovery techniques that may be offered include the following:
1. Psychological ('talking') recovery techniques— Cognitive behavioral therapy (CBT) is the most commonly used psychological treatment for bulimia nervosa. It helps you to look at the reasons why you developed bulimia nervosa, aims to change any false beliefs that you have about your weight and body, and it helps to show you how to deal with emotional issues. Talking recovery techniques take time and usually require regular sessions over several months. Recovery may also involve other members of your family going to meetings to discuss any family issues. However, CBT does not suit everyone. About a third of individuals drop out before finishing the course. Other forms of psychological recovery techniques may also be used. For example, cognitive analytic therapy (CAT), interpersonal psychotherapy (IPT) and focal psychodynamic therapy.
2. Medication— A medicine may be advised by your doctor. The most commonly used medicines are selective serotonin reuptake inhibitor (SSRI) antidepressants. These are used to treat depression but, in higher doses, one called fluoxetine can reduce the urge for bingeing or purging. These are not usually recommended if you are younger than 18 years old. Treatment of any physical or teeth problems that may occur. This may include taking potassium supplements, dental care and not using laxatives.
3. Help with eating— It is best if you have regular meals; even if you only eat small meals. It is beneficial to the body to eat at least three times a day. You should try to be honest (with yourself and other individuals) about the amount of food you are actually eating. You should reduce the number of times you weigh yourself; try only to weigh yourself once a week. It may be useful to keep an eating diary in order to write down all the food that you eat.
Self-help measures—
Self-help methods for the recovery of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Self-help support groups are an especially powerful and effective means of ensuring long-term treatment compliance and decrease the relapse rate. Individuals find they can bounce ideas off of one another, get objective feedback about body image, and just gain increased social support. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.
There are a number of self-help books and manuals available. These provide strategies in how to cope with, and overcome, bulimia nervosa. Some individuals find these very helpful and prefer them to 'formal' treatment. It is certainly worth trying a self-help manual if there is a waiting list or difficulty in getting psychological treatment.
Anorexia and bulimia aren’t about food. They’re about using food to cope with painful emotions such as anger, self-loathing, vulnerability, and fear. Disordered eating is a coping mechanism–whether you refuse food to feel in control, binge for comfort, or purge to punish yourself. But you can learn healthier ways to cope with negative emotions.
The first step is figuring out what’s really eating you up inside. Remember, “fat” is not a feeling, so if you feel overweight and unattractive, stop and ask yourself what’s really going on. Are you upset about something? Depressed? Stressed out? Lonely? Once you identify the emotion you’re experiencing, you can choose a positive alternative to starving or stuffing yourself.
Here are a few suggestions to get you started:
• Call a friend
• Listen to music
• Play with a pet
• Read a good book
• Take a walk
• Write in a journal
• Go to the movies
• Get out into nature
• Play a favorite game
• Do something nice for someone else
Emotional Do and Don't Lists—
Do…
• use individuals to comfort you when you feel bad, instead of focusing on food
• let your emotions come and go as they please without fear
• fully experience every emotion
• be open and accepting of all your emotions
• allow yourself to be vulnerable with individuals you trust
Don’t…
• avoid feelings because they make you uncomfortable
• focus on food when you’re experiencing a painful emotion
• let individuals shame or humiliate you for having or expressing feelings
• pretend you don’t feel anything when you do
• worry about your feelings making you fall apart
Improving your self-image—
You are more than what you weigh, a fact you lose sight of when you have an eating disorder. When you base your self-worth on physical appearance alone, you’re ignoring all the other qualities, accomplishments, and abilities that make you beautiful. Think about your friends and family members. Do they love you for the way you look or who you are? Chances are, your appearance ranks low on the list of what they love about you–and you probably feel the same about them. So why does it top your own list?
Placing too much importance on how you look leads to low self-esteem and insecurity. But you can learn to see yourself in a positive, balanced way:
• Challenge negative self-talk. When you catch yourself being self-critical or pessimistic, stop and challenge the negative thought. Ask yourself what evidence you have to support the idea. What is the evidence against it? Just because you believe something, doesn’t mean it’s true. Answering these questions will help you see things in a more realistic light.
• Focus on what you like about your body. Instead of searching for flaws when you look in the mirror, appreciate the things you like about your appearance. If you’re distracted by “imperfections,” remind yourself that nobody’s perfect. Even supermodels get airbrushed.
• Make a list of your positive qualities. Think of all the things you like about yourself. Are you smart? Kind? Creative? Loyal? Funny? What would others say are your good qualities? Include your talents, skills, and achievements. Also think about bad qualities you don’t have.
Learning healthy eating habits—
If you’ve been struggling with an eating disorder, chances are you’ve forgotten what healthy eating looks like. But learning and establishing healthy eating habits is an essential step in recovery from anorexia and bulimia.
• Challenge your strict eating rules. Strict rules about food and eating fuel anorexia and bulimia, so it’s important to replace them with healthier ones. For example, if you have a rule forbidding all desserts, change it into a less rigid guideline such as, “I won’t eat dessert every day.” You won’t gain weight by enjoying an occasional ice cream or cookie.
• Don’t diet. Healthy eating–not dieting–is the key to avoiding weight gain. Instead of focusing on what you shouldn’t eat, focus on nutritious foods that will energize you and make your body strong. Think of food as fuel for your body. Your body knows when the tank is low, so listen to it. Eat when you’re truly hungry, then stop when you’re full. If you follow these simple guidelines -- your body will look and feel its best.
• Stick to a regular eating schedule. You may be used to skipping meals or fasting for long stretches. But when you starve yourself, food becomes all you think about. To avoid this preoccupation, make sure to eat every three hours. Plan ahead for meals and snacks, and don’t skip!
Find a specialist—
The first step in eating disorder recovery is finding a doctor or therapist who specializes in anorexia and bulimia. As you search, focus on finding the right fit. Your relationship with your doctor or therapist is important to the recovery process. Look for someone who makes you feel comfortable, accepted, and safe.
To find an eating disorder recovery specialist in your area:
• Ask your primary care doctor for a referral
• Ask your school counselor or nurse
• Call the National Eating Disorders Association’s toll-free hotline at 1-800-931-2237 (Mon–Fri, 8:30 a.m. to 4:30 p.m. PST)
• Check with local hospitals or medical centers
• Search online at the eating disorder websites listed to the right
Address health problems—
Anorexia and bulimia can be deadly–and not just if you’re drastically underweight. Your health may be in danger, even if you only occasionally fast, binge, or purge, so it’s important to get a full medical evaluation. If the evaluation reveals health problems, they should take top recovery priority. Nothing is more important than your physical well-being. If you’re suffering from any other life-threatening problem, you may need to be hospitalized. While the thought of hospitalization may be scary, try to remember that its sole purpose is to keep you safe!
Make a long-term recovery plan—
Once your health problems are under control, you and your doctor or therapist can work on a long-term recovery plan. First, you’ll need to assemble a complete eating disorder recovery team. Your team might include a family doctor, a psychologist, a nutritionist, a social worker, and a psychiatrist. Then you and your team will develop a recovery plan that’s individualized to meet your needs.
Relapse prevention—
The work of eating disorder recovery doesn’t end once you’ve adopted healthy habits. It’s important to take steps to maintain your progress and prevent relapse.
• Avoid pro-ana and pro-mia websites. Don’t visit websites that promote or glorify anorexia and bulimia. These sites are run by individuals who want excuses to continue down their destructive path. The “support” they offer is dangerous and will only get in the way of your recovery.
• Develop a solid support system. Surround yourself with individuals who support you and want to see you healthy and happy. Avoid individuals that drain your energy, encourage your disordered eating behaviors, or make you feel bad about yourself.
• Fill your life with positive activities. Make time for activities that bring you joy and fulfillment. Try something you’ve always wanted to do, develop a new skill, pick up a fun hobby, or volunteer in your community. The more rewarding your life, the less desire you’ll have to focus on food and weight.
• Identify your “triggers”. Are you more likely to revert to your old, destructive behaviors during the holidays, exam week, or swimsuit season? Know what your triggers are, and have a plan for dealing with them, such as going to therapy more often or asking for extra support from family and friends.
• Keep a journal. Writing in a daily journal can help you keep tabs on your thoughts, emotions, and behaviors. If you notice that you’re slipping back into negative patterns, take action immediately.
• Stick with your eating disorder recovery plan. Don’t neglect therapy or other components of your recovery, even if you’re doing better. Listen to the advice of your recovery team and continue to follow their recommendations.
What is the prognosis?
Bulimia nervosa is the sort of condition that is difficult to cure fully 'once and for all'. Many individuals improve with treatment, but bad spells (relapses) may recur from time-to-time in some cases. Many individuals find they still have issues with food, even after recovery, but they are more in control and can lead happier, more fulfilled lives.
Studies suggest that 10 years after a diagnosis of bulimia nervosa about 5 in 10 individuals are well, about 2 in 10 individuals still have bulimia nervosa, and about 3 in 10 individuals are somewhere in the middle. However, the recent study about CBT treatment (cited at the end) suggests that with good quality CBT, the outlook is probably even better than these 'overall' figures. It is very unusual to die from bulimia nervosa.
Acute Stress Disorder
Acute Stress Disorder (ASD) is characterized by the development of severe anxiety, dissociative, and other symptoms that occurs within one month after exposure to an extreme traumatic stress-event (e.g., witnessing a death or serious accident).
As a response to the traumatic event, the person develops dissociative symptoms. Individuals with ASD have a decrease in emotional responsiveness, often finding it difficult or impossible to experience pleasure in previously enjoyable activities, and frequently feel guilty about pursuing usual life tasks.
An individual with ASD may experience difficulty concentrating, feel detached from their bodies, experience the world as unreal or dreamlike, or have increasing difficulty recalling specific details of the traumatic event (dissociative amnesia).
In addition, at least one symptom from each of the symptom clusters required for Posttraumatic Stress Disorder is present:
1. The traumatic event is persistently re-experienced (e.g., recurrent recollections, images, thoughts, dreams, illusions, flashback episodes, a sense of reliving the event, or distress on exposure to reminders of the event).
2. Reminders of the trauma (e.g., places, individuals, activities) are avoided.
3. Hyper-arousal in response to stimuli reminiscent of the trauma is present (e.g., difficulty sleeping, irritability, poor concentration, hyper-vigilance, an exaggerated startle response, and motor restlessness).
Specific Symptoms of ASD:
ASD is most often diagnosed when a person has been exposed to a traumatic event in which both of the following were present:
• The individual's response involved intense fear, helplessness, or horror
• The individual experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
Either while experiencing or after experiencing the distressing event, the individual has 3 or more of the following dissociative symptoms:
• Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)
• Derealization
• Depersonalization
• A subjective sense of numbing, detachment, or absence of emotional responsiveness
• A reduction in awareness of his or her surroundings (e.g., "being in a daze")
The traumatic event is persistently re-experienced in at least one of the following ways:
• recurrent images, thoughts, dreams, illusions
• flashback episodes
• a sense of reliving the experience
• distress on exposure to reminders of the traumatic event.
ASD is also characterized by significant avoidance of stimuli that arouse recollections of the trauma (e.g., avoiding thoughts, feelings, conversations, activities, places, individuals). The individual experiencing ASD also has significant symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hyper-vigilance, exaggerated startle response, motor restlessness).
For ASD to be diagnosed, the problems noted above must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.
The disturbance in an ASD must last for a minimum of 2 days and a maximum of 4 weeks, and must occur within 4 weeks of the traumatic event. Symptoms also can not be the result of substance use or abuse (e.g., alcohol, drugs, medications), caused by or an exacerbation of a general or preexisting medical condition, and cannot be better explained by a Brief Psychotic Disorder.
Treatment of ASD
The person with acute stress disorder often will not seek treatment because his ability to mobilize and perform necessary tasks is affected. The severity of the disorder may be reduced if professional intervention is initiated soon after the trauma. Treatment for acute stress disorder usually includes a combination of antidepressant medications and short-term psychotherapy.
Initial Assessment—
The initial step in identifying people with acute stress disorder or post traumatic stress disorder involves screening for recent or remote trauma exposure, although the clinical approach may vary depending on the recency of the traumatic event. If eliciting vivid and detailed recollections of the traumatic event immediately after exposure enhances the patient's distress, the interview may be limited to gathering information that is essential to provide needed medical care. The first interventions in the aftermath of an acute trauma consist of stabilizing and supportive medical care and supportive psychiatric care and assessment. After large-scale catastrophes, initial psychiatric assessment includes differential diagnosis of physical and psychological effects of the traumatic event (e.g., anxiety resulting from hemodynamic compromise, hyperventilation, somatic expressions of psychological distress, fatigue) and identification of persons or groups who are at greatest risk for subsequent psychiatric disorders, including ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER. This identification may be accomplished through individual evaluation, group interviews, consultation, and use of surveillance instruments.
Diagnostic evaluation may be continued after the initial period has passed and a physically and psychologically safe environment has been established, the individual's medical condition has been stabilized, psychological reassurance has been provided, and, in disaster settings, necessary triage has been accomplished. It is important for this diagnostic assessment to include a complete psychiatric evaluation that specifically assesses for the symptoms of ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER, including dissociative, re-experiencing, avoidance/numbing, and hyper-arousal symptom clusters and their temporal sequence relative to the trauma (i.e., before versus after 1 month from the traumatic event). Other important components of the assessment process include functional assessment, determining the availability of basic care resources (e.g., safe housing, social support network, companion care, food, clothing), and identifying previous traumatic experiences and comorbid physical or psychiatric disorders, including depression and substance use disorders.
Psychiatric Management—
Psychiatric management for all individuals with ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER includes instituting interventions and activities to ensure physical and psychological safety, required medical care, and availability of needed resources for self-care and recovery. The patient's level of functioning and safety, including his or her risk for suicide and potential to harm others, is always important to evaluate during initial assessment and may determine the treatment setting. The goals of psychiatric management for individuals with ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER also include establishing a therapeutic alliance with the patient; providing ongoing assessment of safety and psychiatric status, including possible comorbid disorders and response to treatment; and increasing the individuals understanding of - and active adaptive coping with - psychosocial effects of exposure to the traumatic event, such as injury, job loss, or loss of loved ones. Additional goals of psychiatric management include providing education regarding ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER, enhancing treatment adherence, evaluating and managing physical health and functional impairments, and coordinating care to include collaborating with other clinicians.
General Principles of Treatment Selection—
The goals of treatment for people with a diagnosis of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER include reducing the severity of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER symptoms, preventing or treating trauma-related comorbid conditions that may be present or emerge, improving adaptive functioning and restoring a psychological sense of safety and trust, limiting the generalization of the danger experienced as a result of the traumatic situation(s), and protecting against relapse.
Individuals assessed within hours or days after an acute trauma may present with overwhelming physiological and emotional symptoms (e.g., insomnia, agitation, emotional pain, dissociation). Limited clinical trial evidence is available in this area, as randomized designs are difficult to implement; however, clinical experience suggests that these acutely traumatized people may benefit from supportive psychotherapeutic and psycho-educational interventions. Pharmacotherapy may be the first-line intervention for acutely traumatized individuals whose degree of distress precludes new verbal learning or non-pharmacological treatment strategies. Research has not consistently identified patient- or trauma-specific factors that predict the development of ACUTE STRESS DISORDER or interventions that will alter the evolution of ACUTE STRESS DISORDER into POST TRAUMATIC STRESS DISORDER. However, early after a trauma, once the patient's safety and medical stabilization have been addressed, supportive psychotherapy, psycho-education, and assistance in obtaining resources such as food and shelter and locating family and friends are useful.
Effective treatments for the symptoms of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER encompass psychopharmacology, psychotherapy, and psycho-education and other supportive measures. Although studies using a combination of these approaches for ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER are not presently available, combination treatment is widely used and may offer advantages for some individuals. The psychotropic medications used in clinical practice and research for the treatment of ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER were not specifically developed for these disorders but have been used in doses similar to those recommended or approved for other psychiatric illnesses.
For individuals with ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER, choice of treatment includes consideration of age and gender, presence of comorbid medical and psychiatric illnesses, and propensity for aggression or self-injurious behavior. Other factors that may influence treatment choice include the recency of the precipitating traumatic event; the severity and pattern of symptoms; the presence of particularly distressing target symptoms or symptom clusters; the development of interpersonal or family issues or occupational or work-related problems; preexisting developmental or psychological vulnerabilities, including prior trauma exposure; and the patient's preferences.
When the patient's symptoms do not respond to a plan of treatment, selection of subsequent interventions will depend on clinical judgment, as there are limited data to guide the clinician. It is important to systematically review factors that may contribute to treatment non-response, including the specifics of the initial treatment plan and its goals and rationale, the patient's perceptions of the effects of treatment, the patient's understanding of and adherence to the treatment plan, and the patient's reasons for non-adherence if non-adherence is a factor. Other factors that may need to be addressed in individuals who are not responding to treatment include problems in the therapeutic alliance; the presence of psychosocial or environmental difficulties; the effect of earlier life experiences such as childhood abuse or previous trauma exposures; and comorbid psychiatric disorders, including substance-related disorders and personality disorders.
Specific Treatment Strategies—
Psychopharmacology:
Although it has been hypothesized that pharmacological treatment soon after trauma exposure may prevent the development of ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER, existing evidence is limited and preliminary. Thus, no specific pharmacological interventions can be recommended as efficacious in preventing the development of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER in at-risk people.
For individuals with ACUTE STRESS DISORDER, there are few studies of pharmacological interventions. However, selective serotonin reuptake inhibitors (SSRIs) and other antidepressants represent reasonable clinical interventions that are supported by limited findings in ACUTE STRESS DISORDER as well as by findings of therapeutic benefits in individuals with POST TRAUMATIC STRESS DISORDER.
SSRIs are recommended as first-line medication treatment for POST TRAUMATIC STRESS DISORDER. In both male and female individuals, treatment with SSRIs has been associated with relief of core POST TRAUMATIC STRESS DISORDER symptoms in all three symptom clusters (re-experiencing, avoidance/numbing, hyper-arousal). Other antidepressants, including tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs), may also be beneficial in the treatment of POST TRAUMATIC STRESS DISORDER.
Benzodiazepines may be useful in reducing anxiety and improving sleep. Although their efficacy in treating the core symptoms of POST TRAUMATIC STRESS DISORDER has not been established, benzodiazepines are often used in trauma-exposed people and individuals with POST TRAUMATIC STRESS DISORDER. However, clinical observations include the possibility of dependence, increased incidence of POST TRAUMATIC STRESS DISORDER after early treatment with these medications, or worsening of POST TRAUMATIC STRESS DISORDER symptoms after withdrawal of these medications. Thus, benzodiazepines cannot be recommended as mono-therapy in POST TRAUMATIC STRESS DISORDER.
In addition to being indicated in individuals with comorbid psychotic disorders, second generation antipsychotic medications (e.g., olanzapine, quetiapine, risperidone) may be helpful in individual individuals with POST TRAUMATIC STRESS DISORDER. Anticonvulsant medications (e.g., divalproex, carbamazepine, topiramate, lamotrigine), alpha-2-adrenergic agonists, and beta-adrenergic blockers may also be helpful in treating specific symptom clusters in individual individuals.
Psychotherapeutic Interventions:
Some evidence is available about the effectiveness of psychotherapeutic intervention immediately after trauma in preventing development of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER. Studies of cognitive behavior therapy in motor vehicle and industrial accident survivors as well as in victims of rape and interpersonal violence suggest that cognitive behavior therapies may speed recovery and prevent POST TRAUMATIC STRESS DISORDER when therapy is given over a few sessions beginning 2-3 weeks after trauma exposure.
Early supportive interventions, psycho-education, and case management appear to be helpful in acutely traumatized people, because these approaches promote engagement in ongoing care and may facilitate entry into evidence-based psychotherapeutic and psychopharmacological treatments. Encouraging acutely traumatized persons to first rely on their inherent strengths, their existing support networks, and their own judgment may also reduce the need for further intervention. In populations of individuals who have experienced multiple recurrent traumas, there is little evidence to suggest that early supportive care delivered as a stand-alone treatment will result in lasting reductions in POST TRAUMATIC STRESS DISORDER symptoms. However, no evidence suggests that early supportive care is harmful. In contrast, psychological debriefings or single-session techniques are not recommended, as they may increase symptoms in some settings and appear to be ineffective in treating people with ACUTE STRESS DISORDER and in preventing POST TRAUMATIC STRESS DISORDER.
No controlled studies of psychodynamic psychotherapy, eye movement desensitization and reprocessing (EMDR), or hypnosis have been conducted that would establish data-based evidence of their efficacy as an early or preventive intervention for ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER.
For individuals with a diagnosis of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER, available evidence and clinical experience suggest that a number of psychotherapeutic interventions may be useful. Individuals with ACUTE STRESS DISORDER may be helped by cognitive behavior therapy and other exposure-based therapies. In addition, cognitive behavior therapy is an effective treatment for core symptoms of acute and chronic POST TRAUMATIC STRESS DISORDER. EMDR also appears to be effective; however, therapeutic benefit for the rapid eye movement component of this therapy has not been consistently demonstrated. Stress inoculation, imagery rehearsal, and prolonged exposure techniques may also be indicated for treatment of POST TRAUMATIC STRESS DISORDER and POST TRAUMATIC STRESS DISORDER-associated symptoms such as anxiety and avoidance. The shared element of controlled exposure of some kind may be the critical intervention.
Psychodynamic psychotherapy may be useful in addressing developmental, interpersonal, or intrapersonal issues that relate to the nature, severity, symptoms, or treatment of ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER and that may be of particular importance to social, occupational, and interpersonal functioning.
Case management, psycho-education, and other supportive interventions may be useful in facilitating entry into ongoing treatment, appear not to exacerbate POST TRAUMATIC STRESS DISORDER symptoms, and in some pilot investigations have been associated with POST TRAUMATIC STRESS DISORDER symptom reduction. Present-centered and trauma-focused group therapies may also reduce POST TRAUMATIC STRESS DISORDER symptom severity.
Facts and Tips about Acute Stress Disorder—
• ASD begins with contact with an extremely traumatic, horrifying, or terrifying event.
• ASD is a kind of diagnostic category which was started in 1994 to differ the reactions for trauma which are time dependent and reactions from post-traumatic stress disorder (PTSD).
• ASD is the immediate reaction to trauma and if not treated, it could develop into Post traumatic stress disorder (PTSD).
• Clonidine, propanolol, clonazepam and fluoxetine are some medications used to treat the individual symptoms.
• Cognitive behavioral therapy is the most successful treatment to combat ASD.
• Some dissociative symptoms of ASD include derealization, reduction in awareness of vicinity, psychic numbing, depersonalization and sometimes dissociative amnesia.
Useful Terms:
• Trauma- In the context of ASD, a disastrous or life-threatening event.
• Dissociation- A reaction to trauma in which the mind splits off certain aspects of the trauma from conscious awareness. Dissociation can affect the patient's memory, sense of reality, and sense of identity.
• Derealization- A dissociative symptom in which the external environment is perceived as unreal.
• Depersonalization- A dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving.
As a response to the traumatic event, the person develops dissociative symptoms. Individuals with ASD have a decrease in emotional responsiveness, often finding it difficult or impossible to experience pleasure in previously enjoyable activities, and frequently feel guilty about pursuing usual life tasks.
An individual with ASD may experience difficulty concentrating, feel detached from their bodies, experience the world as unreal or dreamlike, or have increasing difficulty recalling specific details of the traumatic event (dissociative amnesia).
In addition, at least one symptom from each of the symptom clusters required for Posttraumatic Stress Disorder is present:
1. The traumatic event is persistently re-experienced (e.g., recurrent recollections, images, thoughts, dreams, illusions, flashback episodes, a sense of reliving the event, or distress on exposure to reminders of the event).
2. Reminders of the trauma (e.g., places, individuals, activities) are avoided.
3. Hyper-arousal in response to stimuli reminiscent of the trauma is present (e.g., difficulty sleeping, irritability, poor concentration, hyper-vigilance, an exaggerated startle response, and motor restlessness).
Specific Symptoms of ASD:
ASD is most often diagnosed when a person has been exposed to a traumatic event in which both of the following were present:
• The individual's response involved intense fear, helplessness, or horror
• The individual experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
Either while experiencing or after experiencing the distressing event, the individual has 3 or more of the following dissociative symptoms:
• Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)
• Derealization
• Depersonalization
• A subjective sense of numbing, detachment, or absence of emotional responsiveness
• A reduction in awareness of his or her surroundings (e.g., "being in a daze")
The traumatic event is persistently re-experienced in at least one of the following ways:
• recurrent images, thoughts, dreams, illusions
• flashback episodes
• a sense of reliving the experience
• distress on exposure to reminders of the traumatic event.
ASD is also characterized by significant avoidance of stimuli that arouse recollections of the trauma (e.g., avoiding thoughts, feelings, conversations, activities, places, individuals). The individual experiencing ASD also has significant symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hyper-vigilance, exaggerated startle response, motor restlessness).
For ASD to be diagnosed, the problems noted above must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.
The disturbance in an ASD must last for a minimum of 2 days and a maximum of 4 weeks, and must occur within 4 weeks of the traumatic event. Symptoms also can not be the result of substance use or abuse (e.g., alcohol, drugs, medications), caused by or an exacerbation of a general or preexisting medical condition, and cannot be better explained by a Brief Psychotic Disorder.
Treatment of ASD
The person with acute stress disorder often will not seek treatment because his ability to mobilize and perform necessary tasks is affected. The severity of the disorder may be reduced if professional intervention is initiated soon after the trauma. Treatment for acute stress disorder usually includes a combination of antidepressant medications and short-term psychotherapy.
Initial Assessment—
The initial step in identifying people with acute stress disorder or post traumatic stress disorder involves screening for recent or remote trauma exposure, although the clinical approach may vary depending on the recency of the traumatic event. If eliciting vivid and detailed recollections of the traumatic event immediately after exposure enhances the patient's distress, the interview may be limited to gathering information that is essential to provide needed medical care. The first interventions in the aftermath of an acute trauma consist of stabilizing and supportive medical care and supportive psychiatric care and assessment. After large-scale catastrophes, initial psychiatric assessment includes differential diagnosis of physical and psychological effects of the traumatic event (e.g., anxiety resulting from hemodynamic compromise, hyperventilation, somatic expressions of psychological distress, fatigue) and identification of persons or groups who are at greatest risk for subsequent psychiatric disorders, including ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER. This identification may be accomplished through individual evaluation, group interviews, consultation, and use of surveillance instruments.
Diagnostic evaluation may be continued after the initial period has passed and a physically and psychologically safe environment has been established, the individual's medical condition has been stabilized, psychological reassurance has been provided, and, in disaster settings, necessary triage has been accomplished. It is important for this diagnostic assessment to include a complete psychiatric evaluation that specifically assesses for the symptoms of ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER, including dissociative, re-experiencing, avoidance/numbing, and hyper-arousal symptom clusters and their temporal sequence relative to the trauma (i.e., before versus after 1 month from the traumatic event). Other important components of the assessment process include functional assessment, determining the availability of basic care resources (e.g., safe housing, social support network, companion care, food, clothing), and identifying previous traumatic experiences and comorbid physical or psychiatric disorders, including depression and substance use disorders.
Psychiatric Management—
Psychiatric management for all individuals with ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER includes instituting interventions and activities to ensure physical and psychological safety, required medical care, and availability of needed resources for self-care and recovery. The patient's level of functioning and safety, including his or her risk for suicide and potential to harm others, is always important to evaluate during initial assessment and may determine the treatment setting. The goals of psychiatric management for individuals with ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER also include establishing a therapeutic alliance with the patient; providing ongoing assessment of safety and psychiatric status, including possible comorbid disorders and response to treatment; and increasing the individuals understanding of - and active adaptive coping with - psychosocial effects of exposure to the traumatic event, such as injury, job loss, or loss of loved ones. Additional goals of psychiatric management include providing education regarding ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER, enhancing treatment adherence, evaluating and managing physical health and functional impairments, and coordinating care to include collaborating with other clinicians.
General Principles of Treatment Selection—
The goals of treatment for people with a diagnosis of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER include reducing the severity of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER symptoms, preventing or treating trauma-related comorbid conditions that may be present or emerge, improving adaptive functioning and restoring a psychological sense of safety and trust, limiting the generalization of the danger experienced as a result of the traumatic situation(s), and protecting against relapse.
Individuals assessed within hours or days after an acute trauma may present with overwhelming physiological and emotional symptoms (e.g., insomnia, agitation, emotional pain, dissociation). Limited clinical trial evidence is available in this area, as randomized designs are difficult to implement; however, clinical experience suggests that these acutely traumatized people may benefit from supportive psychotherapeutic and psycho-educational interventions. Pharmacotherapy may be the first-line intervention for acutely traumatized individuals whose degree of distress precludes new verbal learning or non-pharmacological treatment strategies. Research has not consistently identified patient- or trauma-specific factors that predict the development of ACUTE STRESS DISORDER or interventions that will alter the evolution of ACUTE STRESS DISORDER into POST TRAUMATIC STRESS DISORDER. However, early after a trauma, once the patient's safety and medical stabilization have been addressed, supportive psychotherapy, psycho-education, and assistance in obtaining resources such as food and shelter and locating family and friends are useful.
Effective treatments for the symptoms of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER encompass psychopharmacology, psychotherapy, and psycho-education and other supportive measures. Although studies using a combination of these approaches for ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER are not presently available, combination treatment is widely used and may offer advantages for some individuals. The psychotropic medications used in clinical practice and research for the treatment of ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER were not specifically developed for these disorders but have been used in doses similar to those recommended or approved for other psychiatric illnesses.
For individuals with ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER, choice of treatment includes consideration of age and gender, presence of comorbid medical and psychiatric illnesses, and propensity for aggression or self-injurious behavior. Other factors that may influence treatment choice include the recency of the precipitating traumatic event; the severity and pattern of symptoms; the presence of particularly distressing target symptoms or symptom clusters; the development of interpersonal or family issues or occupational or work-related problems; preexisting developmental or psychological vulnerabilities, including prior trauma exposure; and the patient's preferences.
When the patient's symptoms do not respond to a plan of treatment, selection of subsequent interventions will depend on clinical judgment, as there are limited data to guide the clinician. It is important to systematically review factors that may contribute to treatment non-response, including the specifics of the initial treatment plan and its goals and rationale, the patient's perceptions of the effects of treatment, the patient's understanding of and adherence to the treatment plan, and the patient's reasons for non-adherence if non-adherence is a factor. Other factors that may need to be addressed in individuals who are not responding to treatment include problems in the therapeutic alliance; the presence of psychosocial or environmental difficulties; the effect of earlier life experiences such as childhood abuse or previous trauma exposures; and comorbid psychiatric disorders, including substance-related disorders and personality disorders.
Specific Treatment Strategies—
Psychopharmacology:
Although it has been hypothesized that pharmacological treatment soon after trauma exposure may prevent the development of ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER, existing evidence is limited and preliminary. Thus, no specific pharmacological interventions can be recommended as efficacious in preventing the development of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER in at-risk people.
For individuals with ACUTE STRESS DISORDER, there are few studies of pharmacological interventions. However, selective serotonin reuptake inhibitors (SSRIs) and other antidepressants represent reasonable clinical interventions that are supported by limited findings in ACUTE STRESS DISORDER as well as by findings of therapeutic benefits in individuals with POST TRAUMATIC STRESS DISORDER.
SSRIs are recommended as first-line medication treatment for POST TRAUMATIC STRESS DISORDER. In both male and female individuals, treatment with SSRIs has been associated with relief of core POST TRAUMATIC STRESS DISORDER symptoms in all three symptom clusters (re-experiencing, avoidance/numbing, hyper-arousal). Other antidepressants, including tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs), may also be beneficial in the treatment of POST TRAUMATIC STRESS DISORDER.
Benzodiazepines may be useful in reducing anxiety and improving sleep. Although their efficacy in treating the core symptoms of POST TRAUMATIC STRESS DISORDER has not been established, benzodiazepines are often used in trauma-exposed people and individuals with POST TRAUMATIC STRESS DISORDER. However, clinical observations include the possibility of dependence, increased incidence of POST TRAUMATIC STRESS DISORDER after early treatment with these medications, or worsening of POST TRAUMATIC STRESS DISORDER symptoms after withdrawal of these medications. Thus, benzodiazepines cannot be recommended as mono-therapy in POST TRAUMATIC STRESS DISORDER.
In addition to being indicated in individuals with comorbid psychotic disorders, second generation antipsychotic medications (e.g., olanzapine, quetiapine, risperidone) may be helpful in individual individuals with POST TRAUMATIC STRESS DISORDER. Anticonvulsant medications (e.g., divalproex, carbamazepine, topiramate, lamotrigine), alpha-2-adrenergic agonists, and beta-adrenergic blockers may also be helpful in treating specific symptom clusters in individual individuals.
Psychotherapeutic Interventions:
Some evidence is available about the effectiveness of psychotherapeutic intervention immediately after trauma in preventing development of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER. Studies of cognitive behavior therapy in motor vehicle and industrial accident survivors as well as in victims of rape and interpersonal violence suggest that cognitive behavior therapies may speed recovery and prevent POST TRAUMATIC STRESS DISORDER when therapy is given over a few sessions beginning 2-3 weeks after trauma exposure.
Early supportive interventions, psycho-education, and case management appear to be helpful in acutely traumatized people, because these approaches promote engagement in ongoing care and may facilitate entry into evidence-based psychotherapeutic and psychopharmacological treatments. Encouraging acutely traumatized persons to first rely on their inherent strengths, their existing support networks, and their own judgment may also reduce the need for further intervention. In populations of individuals who have experienced multiple recurrent traumas, there is little evidence to suggest that early supportive care delivered as a stand-alone treatment will result in lasting reductions in POST TRAUMATIC STRESS DISORDER symptoms. However, no evidence suggests that early supportive care is harmful. In contrast, psychological debriefings or single-session techniques are not recommended, as they may increase symptoms in some settings and appear to be ineffective in treating people with ACUTE STRESS DISORDER and in preventing POST TRAUMATIC STRESS DISORDER.
No controlled studies of psychodynamic psychotherapy, eye movement desensitization and reprocessing (EMDR), or hypnosis have been conducted that would establish data-based evidence of their efficacy as an early or preventive intervention for ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER.
For individuals with a diagnosis of ACUTE STRESS DISORDER or POST TRAUMATIC STRESS DISORDER, available evidence and clinical experience suggest that a number of psychotherapeutic interventions may be useful. Individuals with ACUTE STRESS DISORDER may be helped by cognitive behavior therapy and other exposure-based therapies. In addition, cognitive behavior therapy is an effective treatment for core symptoms of acute and chronic POST TRAUMATIC STRESS DISORDER. EMDR also appears to be effective; however, therapeutic benefit for the rapid eye movement component of this therapy has not been consistently demonstrated. Stress inoculation, imagery rehearsal, and prolonged exposure techniques may also be indicated for treatment of POST TRAUMATIC STRESS DISORDER and POST TRAUMATIC STRESS DISORDER-associated symptoms such as anxiety and avoidance. The shared element of controlled exposure of some kind may be the critical intervention.
Psychodynamic psychotherapy may be useful in addressing developmental, interpersonal, or intrapersonal issues that relate to the nature, severity, symptoms, or treatment of ACUTE STRESS DISORDER and POST TRAUMATIC STRESS DISORDER and that may be of particular importance to social, occupational, and interpersonal functioning.
Case management, psycho-education, and other supportive interventions may be useful in facilitating entry into ongoing treatment, appear not to exacerbate POST TRAUMATIC STRESS DISORDER symptoms, and in some pilot investigations have been associated with POST TRAUMATIC STRESS DISORDER symptom reduction. Present-centered and trauma-focused group therapies may also reduce POST TRAUMATIC STRESS DISORDER symptom severity.
Facts and Tips about Acute Stress Disorder—
• ASD begins with contact with an extremely traumatic, horrifying, or terrifying event.
• ASD is a kind of diagnostic category which was started in 1994 to differ the reactions for trauma which are time dependent and reactions from post-traumatic stress disorder (PTSD).
• ASD is the immediate reaction to trauma and if not treated, it could develop into Post traumatic stress disorder (PTSD).
• Clonidine, propanolol, clonazepam and fluoxetine are some medications used to treat the individual symptoms.
• Cognitive behavioral therapy is the most successful treatment to combat ASD.
• Some dissociative symptoms of ASD include derealization, reduction in awareness of vicinity, psychic numbing, depersonalization and sometimes dissociative amnesia.
Useful Terms:
• Trauma- In the context of ASD, a disastrous or life-threatening event.
• Dissociation- A reaction to trauma in which the mind splits off certain aspects of the trauma from conscious awareness. Dissociation can affect the patient's memory, sense of reality, and sense of identity.
• Derealization- A dissociative symptom in which the external environment is perceived as unreal.
• Depersonalization- A dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving.
Adjustment Disorder
Work problems, getting married, going away to school, an illness — any number of life changes can cause stress. Most of the time, individuals adjust to such changes within a few months. But if you continue to feel down or self-destructive, you may have an Adjustment Disorder (AD).
An AD is a type of stress-related mental illness. You may feel anxious or depressed, or even have thoughts of suicide. You may not be able to go about some of your daily routines, such as work or seeing friends. Or you may make reckless decisions. In essence, you have a hard time adjusting to change in your life, and it has serious consequences.
You don't have to tough it out on your own, though. Treatment of an AD may help you regain your emotional footing. Most adults get better within just a few months, although teens may struggle longer. Treatment may also help prevent an AD from becoming a more serious problem.
Symptoms—
The signs and symptoms of ADs vary from person to person. The symptoms you have may be very different from those of someone else with an AD. But for everyone, symptoms of an AD begin within three months of a stressful event in your life.
Emotional symptoms of ADs-
Signs and symptoms of AD may affect how you feel and think about yourself or life, including:
• Anxiety
• Crying spells
• Desperation
• Difficulty concentrating
• Feeling overwhelmed
• Hopelessness
• Lack of enjoyment
• Nervousness
• Sadness
• Thoughts of suicide
• Trouble sleeping
• Worry
Behavioral symptoms of ADs-
Signs and symptoms of AD may affect your actions or behavior, such as:
• Avoiding family or friends
• Fighting
• Ignoring bills
• Poor school or work performance
• Reckless driving
• Skipping school
• Vandalism
Length of symptoms-
How long you have symptoms of an AD also can vary:
• Longer than six months (chronic). In these cases, symptoms continue to bother you and disrupt your life. Professional treatment can help symptoms improve and prevent the condition from continuing to get worse.
• Six months or less (acute). In these cases, symptoms may go away on their own, especially if you actively follow self-care measures.
When to see a doctor:
Sometimes the stressful change in your life goes away, and your symptoms of AD get better on their own. But often, the stressful event remains a part of your life. Or a new stressful situation comes up, and you face the same emotional struggles all over again.
You may think that an AD is less serious than other mental health problems because it involves stress, but that's not necessarily true. ADs can affect your whole life. You may feel so overwhelmed, stressed and hopeless that you can't go about your normal daily activities. You may skip work or school, for instance, or not pay your bills. You may drive dangerously or pick fights.
Individuals with ADs also may abuse alcohol or drugs, engage in violence, and have thoughts of suicide. If you or a loved one has suicidal thoughts or is seriously considering hurting someone, seek help immediately.
Talk to your doctor if you're having trouble getting through each day. You can get treatment to help cope better with stressful events and feel better about life again.
Causes—
Individuals of all ages are affected by ADs. Among kids and teens, both boys and girls have about the same chance of having AD. Among adults, women are twice as likely as men to have AD. But researchers are still trying to figure out what causes ADs. As with other mental disorders, the cause is likely complex and may involve genetics, your life experiences, your temperament and even changes in the natural chemicals in the brain.
Risk factors—
Although researchers don't know exactly what causes ADs, they do know some of the risk factors involved, or the things that make you more likely to have an AD.
Stressful events:
One or more stressful life events may put you at risk of developing AD. It may involve almost any type of stressful event in your life. Both positive and negative events can cause extreme stress. Some common examples include:
• Being diagnosed with a serious illness
• Death of a loved one
• Divorce or relationship breakup
• Financial problems
• Going away to school
• Having a baby
• Job loss
• Physical assault
• Problems in school
• Retirement
• Surviving a disaster
In some cases, individuals who face an ongoing stressful situation — such as living in a crime-ridden neighborhood — can reach a breaking point and develop an AD.
Your life experiences:
If you generally don't cope well with change or you don't have a strong support system, you may be more likely to have an extreme reaction to a stressful event.
Some studies also suggest that your risk of an AD is higher if you experienced stress in early childhood. Overprotective or abusive parenting, family disruptions and frequent moves early in life may make you feel like you're unable to control events in your life. When difficulties then arise, you may have trouble coping.
Other risk factors may include:
• Difficult life circumstances
• Exposure to wars or violence
• Other mental health problems
Complications—
Most individuals with AD get better within six months and don't have long-term complications. However, individuals who also have another mental health disorder, a substance abuse problem or a chronic AD are more likely to have long-term mental health problems, which may include:
• Alcohol and drug addiction
• Depression
• Suicidal thoughts and behavior
Compared with adults, teens with AD — especially chronic AD marked by behavior problems — are at significantly increased risk of long-term problems. In addition to depression, substance abuse and suicidal behavior, teens with AD are at risk of developing psychiatric illnesses such as:
• Antisocial personality disorder
• Bipolar disorder
• Schizophrenia
Preparing for an appointment—
If you or your youngster has thoughts of suicide, go to an emergency room or call 911 or your local emergency number immediately.
If you or your youngster has less urgent symptoms of an AD, make an appointment with your family doctor or your youngster's pediatrician. While ADs resolve on their own in most cases, your doctor may be able to recommend coping strategies or treatments that may help you or your youngster feel better sooner.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do:
• Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications you're taking.
• Take a trusted family member or friend along, if you are the one with symptoms of AD. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down any symptoms you've been experiencing, and for how long.
• Write down questions to ask your doctor in advance so that you can make the most of your appointment.
• Write down your key personal information, including any major stresses or recent life changes, both positive and negative. Even happy events such as getting married or adding a new youngster to your family can cause AD.
For AD, some basic questions to ask your doctor include:
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
• Are there any other possible causes?
• Do you recommend any temporary changes at home, work or school to encourage recovery?
• Do you recommend treatment? If yes, with what types of therapy?
• Does AD increase the risk of other mental health problems?
• How soon do you expect symptoms to improve?
• How will you determine the diagnosis?
• Is this condition likely temporary or chronic?
• Should a mental health specialist be consulted?
• Should school staff or work colleagues be made aware of this diagnosis?
• What do you believe is causing these symptoms?
• What will you recommend next if symptoms don't improve within a few months?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor:
Being ready to answer your doctor's questions may save some time to go over any points you want to talk about in-depth.
You or your youngster should be prepared to answer the following questions from your doctor:
• Are you avoiding social or family events?
• Are you having trouble sleeping?
• Are you talking with friends or family about these changes?
• Do you drink alcohol or use illicit drugs? How often?
• Do you have difficulty finishing tasks at home, work or school that previously felt manageable to you?
• Have been having any problems at school or work?
• Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?
• Have you ever thought about harming yourself or others?
• Have you made any impulsive decisions or engaged in reckless behavior that doesn't seem like you?
• How often do you feel anxious or worried?
• How often do you feel sad or depressed?
• What are your symptoms?
• What major changes have recently occurred in your life, both positive and negative?
• What other symptoms or behaviors are causing you or your loved ones distress?
• When did you or your loved ones first notice your symptoms?
What you can do in the meantime:
While you're waiting for your doctor appointment, try reaching out to your friends or family. Talking about your feelings and asking for help is the most important thing you can do to aid your recovery from AD.
If your youngster has symptoms of an AD, try gently encouraging him or her to talk about feelings. Many parents assume that talking about a difficult change, such as divorce, will only make a youngster feel worse. But the opposite is true. Your youngster needs the opportunity to express feelings of grief, and to hear your reassurance that you'll remain a constant source of love and support.
Tests and diagnosis—
ADs are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with AD, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
For an AD to be diagnosed, several criteria must be met, including:
• An improvement of symptoms within six months of the stressful event coming to an end
• Experiencing distress that is in excess of what would normally be expected in response to the stressor or that causes significant problems in your relationships, at work or at school
• Having emotional or behavioral symptoms within three months of a specific stressor occurring in your life
Types of ADs:
Your health care provider may ask detailed questions about how you feel and how you spend your time. This will help him or her pinpoint which specific type of AD you have. There are six main types of ADs. Although they're all related, each type of AD has certain signs and symptoms.
The six types of AD are:
• AD unspecified. Symptoms don't fit the other types of ADs but often include physical problems, problems with family or friends, or work or school problems.
• AD with anxiety. Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Kids who have AD with anxiety may strongly fear being separated from their parents and loved ones.
• AD with depressed mood. Symptoms mainly include feeling sad, tearful and hopeless, and a lack of pleasure in the things you used to enjoy.
• AD with disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting, reckless driving or ignoring your bills. Youngsters may skip school or vandalize property.
• AD with mixed anxiety and depressed mood. Symptoms include a mix of depression and anxiety.
• AD with mixed disturbance of emotions and conduct. Symptoms include a mix of depression and anxiety as well as behavioral problems.
Treatments and drugs—
Most individuals find treatment of AD helpful, and they're in treatment only for several months. Others may benefit from longer treatment, though. There are two main types of treatment for AD — psychotherapy and medications.
• Medications- In some cases, medications may help, too. Medications can help with such symptoms as depression, anxiety and suicidal thoughts. Antidepressants and anti-anxiety medications are the medications most often used to treat ADs. As with therapy, you may need medications only for a few months.
• Psychotherapy- The main treatment for ADs is psychotherapy, also called counseling or talk therapy. You may attend individual therapy, group therapy or family therapy. Therapy can provide emotional support and help you get back to your normal routine. It can also help you learn why the stressful event affected you so much. As you understand more about this connection, you can also learn healthy coping skills. These skills can help you weather other stressful events that may arise in your life.
Lifestyle and home remedies—
When you face a stressful event or major life change, you can take some steps to care for your emotional well-being. Do what works for you. Some examples include:
• Engaging in a hobby you enjoy
• Finding a support group geared toward your situation
• Finding support from a faith community
• Getting regular physical activity
• Sticking to a regular sleep routine
• Talking things over with caring family and friends
• Trying to keep eating a healthy diet
If it's your youngster who's having difficulty adjusting, you can help by:
• Letting your youngster make simple decisions, such as what to eat for dinner or which movie to watch
• Offering encouragement to talk about his or her feelings
• Offering support and understanding
• Reassuring your youngster that such reactions are common
• Touching base with your youngster's teacher to check on progress or problems at school
If you use these kinds of self-care steps but they don't seem to be helping, be sure to talk to your health care provider.
Prevention—
There are no guaranteed ways to prevent AD. But developing healthy coping skills and learning to be resilient may help you during times of high stress. Resilience is the ability to adapt well to stress, adversity, trauma or tragedy. Some of the ways you can improve your resilience are:
• Having a good support network
• Living a healthy lifestyle
• Seeking out humor or laughter
• Thinking positively about yourself
If you know that a stressful situation is coming up — such as a move or retirement — call on your inner strength in advance. Remind yourself that you can get through it. Use stress management and coping skills, such as exercise, yoga, meditation or even a night at the movies with friends. In addition, consider checking in with your health care or mental health care provider to review healthy ways to manage your stress.
Q and A—
What is an adjustment disorder (AD) and how does it occur?
There are six major adjustment disorders:
• Adjustment disorder unspecified
• Adjustment disorder with anxiety
• Adjustment disorder with depressed mood
• Adjustment disorder with disturbance of conduct
• Adjustment disorder with mixed anxiety and depressed mood
• Adjustment disorder with mixed disturbance of emotions and conduct
What are the characteristics associated with an AD?
A person with AD often experiences feelings of depression or anxiety or combined depression and anxiety. As a result, that person may act out behaviorally against the "rules and regulations" of family, work, or society. In some individuals, an AD may manifest itself in such behaviors as skipping school, unexpected fighting, recklessness, or legal problems. Other individuals, however, instead of acting out, may tend to withdraw socially and isolate themselves during their adjustment problems. Still others may not experience behavioral disturbances, but will begin to suffer from physical illness. If someone is already suffering from a medical illness, that condition may worsen during the time of the AD. Individuals in the midst of ADs often do poorly in school or at work. Very commonly they begin to have more difficulty in their close, personal relationships.
Listed below are some of the characteristics associated with ADs:
1. A person with an AD with anxiety would experience anxious feelings, nervousness, and worry.
2. A person with an AD with depressed mood may have mostly a depressed mood, hopeless feelings, and crying spells.
3. A person with an AD with mixed disturbance of emotions and conduct would have a mixture of emotional and conduct problems.
4. An individual with an AD with disturbance of conduct may act out inappropriately. This person may act out against society, skip school, or begin to have trouble with the police.
5. Someone with an AD with mixed anxiety and depressed mood would, obviously, have a mixture of anxious and depressed feelings.
At what age can an AD appear?
ADs can occur at any age. Individuals are particularly vulnerable during normal transitional periods such as adolescence, mid-life, and late life.
Do ADs affect males, females, or both?
In the United States the same number of males and females experience the various ADs.
How is an AD diagnosed?
A mental health professional makes a diagnosis of an AD by taking a careful personal history from the client/patient. It is important to the therapist to learn the details that surround the stressful event or events in that person's life. No laboratory tests are required to make a diagnosis of AD nor are there any physical conditions that must be met. However, it is very important for the therapist not to overlook a physical illness that might mimic or contribute to a psychological disorder. If there is any question whether the individual might have a physical problem, the mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as a part of the physical workup.
How is an AD treated?
Therapy can be very helpful to lessen or alleviate ongoing symptoms of AD before they become disabling. Group therapy can be useful to individuals who are enduring similar stress. In some situations the use of prescription medications can be very useful to ease the depression or the anxiety associated with AD.
How often does AD appear in the community?
AD is very common in the United States. More than five percent (5%) of all persons seen in clinical, outpatient mental health settings have some type of AD.
What can individuals do if they need help?
If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.
What happens to a person with an AD?
The conditions associated with AD develop within three months of the beginning of the stressful problem. An AD usually lasts no longer than three to six months. The condition may persist, however, if an individual is suffering from chronic stress such as that caused by an illness, a difficult relationship, or worsening financial problems.
An AD is a type of stress-related mental illness. You may feel anxious or depressed, or even have thoughts of suicide. You may not be able to go about some of your daily routines, such as work or seeing friends. Or you may make reckless decisions. In essence, you have a hard time adjusting to change in your life, and it has serious consequences.
You don't have to tough it out on your own, though. Treatment of an AD may help you regain your emotional footing. Most adults get better within just a few months, although teens may struggle longer. Treatment may also help prevent an AD from becoming a more serious problem.
Symptoms—
The signs and symptoms of ADs vary from person to person. The symptoms you have may be very different from those of someone else with an AD. But for everyone, symptoms of an AD begin within three months of a stressful event in your life.
Emotional symptoms of ADs-
Signs and symptoms of AD may affect how you feel and think about yourself or life, including:
• Anxiety
• Crying spells
• Desperation
• Difficulty concentrating
• Feeling overwhelmed
• Hopelessness
• Lack of enjoyment
• Nervousness
• Sadness
• Thoughts of suicide
• Trouble sleeping
• Worry
Behavioral symptoms of ADs-
Signs and symptoms of AD may affect your actions or behavior, such as:
• Avoiding family or friends
• Fighting
• Ignoring bills
• Poor school or work performance
• Reckless driving
• Skipping school
• Vandalism
Length of symptoms-
How long you have symptoms of an AD also can vary:
• Longer than six months (chronic). In these cases, symptoms continue to bother you and disrupt your life. Professional treatment can help symptoms improve and prevent the condition from continuing to get worse.
• Six months or less (acute). In these cases, symptoms may go away on their own, especially if you actively follow self-care measures.
When to see a doctor:
Sometimes the stressful change in your life goes away, and your symptoms of AD get better on their own. But often, the stressful event remains a part of your life. Or a new stressful situation comes up, and you face the same emotional struggles all over again.
You may think that an AD is less serious than other mental health problems because it involves stress, but that's not necessarily true. ADs can affect your whole life. You may feel so overwhelmed, stressed and hopeless that you can't go about your normal daily activities. You may skip work or school, for instance, or not pay your bills. You may drive dangerously or pick fights.
Individuals with ADs also may abuse alcohol or drugs, engage in violence, and have thoughts of suicide. If you or a loved one has suicidal thoughts or is seriously considering hurting someone, seek help immediately.
Talk to your doctor if you're having trouble getting through each day. You can get treatment to help cope better with stressful events and feel better about life again.
Causes—
Individuals of all ages are affected by ADs. Among kids and teens, both boys and girls have about the same chance of having AD. Among adults, women are twice as likely as men to have AD. But researchers are still trying to figure out what causes ADs. As with other mental disorders, the cause is likely complex and may involve genetics, your life experiences, your temperament and even changes in the natural chemicals in the brain.
Risk factors—
Although researchers don't know exactly what causes ADs, they do know some of the risk factors involved, or the things that make you more likely to have an AD.
Stressful events:
One or more stressful life events may put you at risk of developing AD. It may involve almost any type of stressful event in your life. Both positive and negative events can cause extreme stress. Some common examples include:
• Being diagnosed with a serious illness
• Death of a loved one
• Divorce or relationship breakup
• Financial problems
• Going away to school
• Having a baby
• Job loss
• Physical assault
• Problems in school
• Retirement
• Surviving a disaster
In some cases, individuals who face an ongoing stressful situation — such as living in a crime-ridden neighborhood — can reach a breaking point and develop an AD.
Your life experiences:
If you generally don't cope well with change or you don't have a strong support system, you may be more likely to have an extreme reaction to a stressful event.
Some studies also suggest that your risk of an AD is higher if you experienced stress in early childhood. Overprotective or abusive parenting, family disruptions and frequent moves early in life may make you feel like you're unable to control events in your life. When difficulties then arise, you may have trouble coping.
Other risk factors may include:
• Difficult life circumstances
• Exposure to wars or violence
• Other mental health problems
Complications—
Most individuals with AD get better within six months and don't have long-term complications. However, individuals who also have another mental health disorder, a substance abuse problem or a chronic AD are more likely to have long-term mental health problems, which may include:
• Alcohol and drug addiction
• Depression
• Suicidal thoughts and behavior
Compared with adults, teens with AD — especially chronic AD marked by behavior problems — are at significantly increased risk of long-term problems. In addition to depression, substance abuse and suicidal behavior, teens with AD are at risk of developing psychiatric illnesses such as:
• Antisocial personality disorder
• Bipolar disorder
• Schizophrenia
Preparing for an appointment—
If you or your youngster has thoughts of suicide, go to an emergency room or call 911 or your local emergency number immediately.
If you or your youngster has less urgent symptoms of an AD, make an appointment with your family doctor or your youngster's pediatrician. While ADs resolve on their own in most cases, your doctor may be able to recommend coping strategies or treatments that may help you or your youngster feel better sooner.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do:
• Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications you're taking.
• Take a trusted family member or friend along, if you are the one with symptoms of AD. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down any symptoms you've been experiencing, and for how long.
• Write down questions to ask your doctor in advance so that you can make the most of your appointment.
• Write down your key personal information, including any major stresses or recent life changes, both positive and negative. Even happy events such as getting married or adding a new youngster to your family can cause AD.
For AD, some basic questions to ask your doctor include:
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
• Are there any other possible causes?
• Do you recommend any temporary changes at home, work or school to encourage recovery?
• Do you recommend treatment? If yes, with what types of therapy?
• Does AD increase the risk of other mental health problems?
• How soon do you expect symptoms to improve?
• How will you determine the diagnosis?
• Is this condition likely temporary or chronic?
• Should a mental health specialist be consulted?
• Should school staff or work colleagues be made aware of this diagnosis?
• What do you believe is causing these symptoms?
• What will you recommend next if symptoms don't improve within a few months?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor:
Being ready to answer your doctor's questions may save some time to go over any points you want to talk about in-depth.
You or your youngster should be prepared to answer the following questions from your doctor:
• Are you avoiding social or family events?
• Are you having trouble sleeping?
• Are you talking with friends or family about these changes?
• Do you drink alcohol or use illicit drugs? How often?
• Do you have difficulty finishing tasks at home, work or school that previously felt manageable to you?
• Have been having any problems at school or work?
• Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?
• Have you ever thought about harming yourself or others?
• Have you made any impulsive decisions or engaged in reckless behavior that doesn't seem like you?
• How often do you feel anxious or worried?
• How often do you feel sad or depressed?
• What are your symptoms?
• What major changes have recently occurred in your life, both positive and negative?
• What other symptoms or behaviors are causing you or your loved ones distress?
• When did you or your loved ones first notice your symptoms?
What you can do in the meantime:
While you're waiting for your doctor appointment, try reaching out to your friends or family. Talking about your feelings and asking for help is the most important thing you can do to aid your recovery from AD.
If your youngster has symptoms of an AD, try gently encouraging him or her to talk about feelings. Many parents assume that talking about a difficult change, such as divorce, will only make a youngster feel worse. But the opposite is true. Your youngster needs the opportunity to express feelings of grief, and to hear your reassurance that you'll remain a constant source of love and support.
Tests and diagnosis—
ADs are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with AD, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
For an AD to be diagnosed, several criteria must be met, including:
• An improvement of symptoms within six months of the stressful event coming to an end
• Experiencing distress that is in excess of what would normally be expected in response to the stressor or that causes significant problems in your relationships, at work or at school
• Having emotional or behavioral symptoms within three months of a specific stressor occurring in your life
Types of ADs:
Your health care provider may ask detailed questions about how you feel and how you spend your time. This will help him or her pinpoint which specific type of AD you have. There are six main types of ADs. Although they're all related, each type of AD has certain signs and symptoms.
The six types of AD are:
• AD unspecified. Symptoms don't fit the other types of ADs but often include physical problems, problems with family or friends, or work or school problems.
• AD with anxiety. Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Kids who have AD with anxiety may strongly fear being separated from their parents and loved ones.
• AD with depressed mood. Symptoms mainly include feeling sad, tearful and hopeless, and a lack of pleasure in the things you used to enjoy.
• AD with disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting, reckless driving or ignoring your bills. Youngsters may skip school or vandalize property.
• AD with mixed anxiety and depressed mood. Symptoms include a mix of depression and anxiety.
• AD with mixed disturbance of emotions and conduct. Symptoms include a mix of depression and anxiety as well as behavioral problems.
Treatments and drugs—
Most individuals find treatment of AD helpful, and they're in treatment only for several months. Others may benefit from longer treatment, though. There are two main types of treatment for AD — psychotherapy and medications.
• Medications- In some cases, medications may help, too. Medications can help with such symptoms as depression, anxiety and suicidal thoughts. Antidepressants and anti-anxiety medications are the medications most often used to treat ADs. As with therapy, you may need medications only for a few months.
• Psychotherapy- The main treatment for ADs is psychotherapy, also called counseling or talk therapy. You may attend individual therapy, group therapy or family therapy. Therapy can provide emotional support and help you get back to your normal routine. It can also help you learn why the stressful event affected you so much. As you understand more about this connection, you can also learn healthy coping skills. These skills can help you weather other stressful events that may arise in your life.
Lifestyle and home remedies—
When you face a stressful event or major life change, you can take some steps to care for your emotional well-being. Do what works for you. Some examples include:
• Engaging in a hobby you enjoy
• Finding a support group geared toward your situation
• Finding support from a faith community
• Getting regular physical activity
• Sticking to a regular sleep routine
• Talking things over with caring family and friends
• Trying to keep eating a healthy diet
If it's your youngster who's having difficulty adjusting, you can help by:
• Letting your youngster make simple decisions, such as what to eat for dinner or which movie to watch
• Offering encouragement to talk about his or her feelings
• Offering support and understanding
• Reassuring your youngster that such reactions are common
• Touching base with your youngster's teacher to check on progress or problems at school
If you use these kinds of self-care steps but they don't seem to be helping, be sure to talk to your health care provider.
Prevention—
There are no guaranteed ways to prevent AD. But developing healthy coping skills and learning to be resilient may help you during times of high stress. Resilience is the ability to adapt well to stress, adversity, trauma or tragedy. Some of the ways you can improve your resilience are:
• Having a good support network
• Living a healthy lifestyle
• Seeking out humor or laughter
• Thinking positively about yourself
If you know that a stressful situation is coming up — such as a move or retirement — call on your inner strength in advance. Remind yourself that you can get through it. Use stress management and coping skills, such as exercise, yoga, meditation or even a night at the movies with friends. In addition, consider checking in with your health care or mental health care provider to review healthy ways to manage your stress.
Q and A—
What is an adjustment disorder (AD) and how does it occur?
There are six major adjustment disorders:
• Adjustment disorder unspecified
• Adjustment disorder with anxiety
• Adjustment disorder with depressed mood
• Adjustment disorder with disturbance of conduct
• Adjustment disorder with mixed anxiety and depressed mood
• Adjustment disorder with mixed disturbance of emotions and conduct
What are the characteristics associated with an AD?
A person with AD often experiences feelings of depression or anxiety or combined depression and anxiety. As a result, that person may act out behaviorally against the "rules and regulations" of family, work, or society. In some individuals, an AD may manifest itself in such behaviors as skipping school, unexpected fighting, recklessness, or legal problems. Other individuals, however, instead of acting out, may tend to withdraw socially and isolate themselves during their adjustment problems. Still others may not experience behavioral disturbances, but will begin to suffer from physical illness. If someone is already suffering from a medical illness, that condition may worsen during the time of the AD. Individuals in the midst of ADs often do poorly in school or at work. Very commonly they begin to have more difficulty in their close, personal relationships.
Listed below are some of the characteristics associated with ADs:
1. A person with an AD with anxiety would experience anxious feelings, nervousness, and worry.
2. A person with an AD with depressed mood may have mostly a depressed mood, hopeless feelings, and crying spells.
3. A person with an AD with mixed disturbance of emotions and conduct would have a mixture of emotional and conduct problems.
4. An individual with an AD with disturbance of conduct may act out inappropriately. This person may act out against society, skip school, or begin to have trouble with the police.
5. Someone with an AD with mixed anxiety and depressed mood would, obviously, have a mixture of anxious and depressed feelings.
At what age can an AD appear?
ADs can occur at any age. Individuals are particularly vulnerable during normal transitional periods such as adolescence, mid-life, and late life.
Do ADs affect males, females, or both?
In the United States the same number of males and females experience the various ADs.
How is an AD diagnosed?
A mental health professional makes a diagnosis of an AD by taking a careful personal history from the client/patient. It is important to the therapist to learn the details that surround the stressful event or events in that person's life. No laboratory tests are required to make a diagnosis of AD nor are there any physical conditions that must be met. However, it is very important for the therapist not to overlook a physical illness that might mimic or contribute to a psychological disorder. If there is any question whether the individual might have a physical problem, the mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as a part of the physical workup.
How is an AD treated?
Therapy can be very helpful to lessen or alleviate ongoing symptoms of AD before they become disabling. Group therapy can be useful to individuals who are enduring similar stress. In some situations the use of prescription medications can be very useful to ease the depression or the anxiety associated with AD.
How often does AD appear in the community?
AD is very common in the United States. More than five percent (5%) of all persons seen in clinical, outpatient mental health settings have some type of AD.
What can individuals do if they need help?
If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.
What happens to a person with an AD?
The conditions associated with AD develop within three months of the beginning of the stressful problem. An AD usually lasts no longer than three to six months. The condition may persist, however, if an individual is suffering from chronic stress such as that caused by an illness, a difficult relationship, or worsening financial problems.
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