Disorders

ANXIETY DISORDER

Most people experience anxiety in certain everyday situations like giving an interview, at the hospital, waiting for results or before giving a solo performance etc.

Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30% of adults at some point in their lives. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

The dominant symptoms are highly variable, but complaints of continuous feelings of nervousness, trembling, muscular tension, sweating, light-headedness, palpitations, dizziness, and epigastric discomfort are common. Fears that the sufferer or a relative will shortly become ill or have an accident are often expressed, together with a variety of other worries. This disorder is more common in women, and often related to chronic environmental stress.

The sufferer must have primary symptoms of anxiety most days for at least several weeks at a time, and usually for several months. These symptoms should usually involve elements of: (a)apprehension (worries about future misfortunes, feeling "on edge", difficulty in concentrating, etc.); (b)motor tension (restless fidgeting, tension headaches, trembling, inability to relax); and (c)autonomic overactivity (lightheadedness, sweating, tachycardia or tachypnoea, epigastric discomfort, dizziness, dry mouth, etc.).

Types of anxiety disorders

Generalized anxiety disorder : Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. It includes prolonged, vague, unexplained and intense fears that are not attached to any situation or object. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments.

Panic disorders : Brief or sudden attacks of intense terror and apprehension characterize panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. They usually occur after frightening experiences or prolonged stress but may also occur without a trigger. An individual experiencing a panic attack may misinterpret it as a life-threatening illness and may make drastic changes in behavior to avoid future attacks.The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination:

  • Palpitations, pounding heart or rapid heart rate
  • Sweating
  • Trembling or shaking
  • Feeling of shortness of breath or smothering sensations
  • Chest pain
  • Feeling dizzy, light-headed or faint
  • Fear of dying
  • Feeling of choking
  • Numbness or tingling
  • Chills or hot flashes
  • Nausea or abdominal pains
  • Feeling detached
  • Fear of losing control

Because the symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness. They may go to a hospital emergency department. Panic attacks may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason. The mean age for onset of panic disorder is 20-24. Panic attacks may occur with other mental disorders such as depression or PTSD.

Phobias : Phobias are an irrational fear and avoidance of a particular object or situation. Phobias are not like other anxiety disorders, as they relate to a specific cause. Example: not using an elevator and insisting on using the staircase. Fear of heights, closed spaces, public spaces, etc.

A person with a phobia might acknowledge a fear as illogical or extreme but remain unable to control feelings anxiety around the trigger. Triggers for a phobia range from situations and animals to everyday objects. There are many different types of phobias according to the object or situation feared. Phobias can be grouped into three main types, i.e. specific phobias, social phobias and agoraphobia.

Specific phobias are the most commonly occurring type of phobia. This group includes irrational fears such as intense fear of a certain type of animal, or of being in an enclosed space. Intense and incapacitating fear and embarrassment when dealing with others characterises social anxiety disorder (social phobia). Agoraphobia is the term used when people develop a fear of entering unfamiliar situations. Many people with agoraphobia are afraid of leaving their home. So their ability to carry out normal life activities is severely limited.

Separation anxiety disorder : (SAD) is another type of anxiety disorder. Individuals with separation anxiety disorder are fearful and anxious about separation from attachment figures to an extent that is developmentally not appropriate. Children with SAD may have difficulty being in a room by themselves.

DEPRESSION

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite — weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide

Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression. In typical depressive episodes of all three varieties (mild , moderate, and severe), the individual usually suffers from depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatiguability and diminished activity. Marked tiredness after only slight effort is common.

Other common symptoms are:

  • Reduced concentration and attention
  • Reduced self-esteem and self-confidence
  • Ideas of guilt and unworthiness (even in a mild type of episode)
  • Bleak and pessimistic views of the future
  • Ideas or acts of self-harm or suicide
  • Disturbed sleep
  • Diminished appetite.

The lowered mood varies little from day to day, and is often unresponsive to circumstances, yet may show a characteristic variation as the day goes on. As with manic episodes, the clinical presentation shows marked individual variations, and atypical presentations are particularly common in adolescence. In some cases, anxiety, distress, and motor agitation may be more prominent at times than the depression, and the mood change may also be masked by added features such as irritability, excessive consumption of alcohol, histrionic behaviour, and exacerbation of pre-existing phobic or obsessional symptoms, or by hypochondriacal preoccupations. For depressive episodes of all three grades of severity, a duration of at least 2 weeks is usually required for diagnosis, but shorter periods may be reasonable if symptoms are unusually severe and of rapid onset.

Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.

Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can occur at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. There is a high degree of heritability (approximately 40%) when first-degree relatives (parents/children/siblings) have depression.

Depression Is Different From Sadness or Grief/Bereavement

The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”

But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

  • In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.
  • In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
  • In grief, thoughts of death may surface when thinking of or fantasizing about “joining” the deceased loved one. In major depression, thoughts are focused on ending one’s life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.

Grief and depression can co-exist. For some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.

Distinguishing between grief and depression is important and can assist people in getting the help, support or treatment they need.

Risk Factors for Depression

Depression can affect anyone—even a person who appears to live in relatively ideal circumstances.

Several factors can play a role in depression:

  • Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.
  • Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.
  • Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.
  • Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.

Self-help and Coping

There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improves mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

Depression is a real illness and help is available. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, a first step is to see your family physician or psychiatrist. Talk about your concerns and request a thorough evaluation. This is a start to addressing your mental health needs.

SCHIZOPHRENIA

Schizophrenia is the descriptive term for a group of psychotic disorders in which personal, social, and occupational functioning deteriorate as a result of disturbed thought processes, strange perceptions, unusual emotional states, and motor abnormalities. Schizophrenia is a chronic brain disorder. When schizophrenia is active, symptoms can include delusions, hallucinations, disorganized speech, trouble with thinking and lack of motivation. However, with treatment, most symptoms of schizophrenia will greatly improve, and the likelihood of a recurrence can be diminished. It is a debilitating disorder. The social and psychological costs of schizophrenia are tremendous, both to patients as well as to their families and society.

While there is no cure for schizophrenia, research is leading to innovative and safer treatments.

Experts also are unraveling the causes of the disease by studying genetics, conducting behavioral research, and using advanced imaging to look at the brain’s structure and function. These approaches hold the promise of new, and more effective therapies.

The complexity of schizophrenia may help explain why there are misconceptions about the disease. Schizophrenia does not mean split personality or multiple-personality. Most people with schizophrenia are not any more dangerous or violent than people in the general population. While limited mental health resources in the community may lead to homelessness and frequent hospitalizations, it is a misconception that people with schizophrenia end up homeless or living in hospitals. Most people with schizophrenia live with their family, in group homes or on their own.

Research has shown that schizophrenia affects men and women fairly equally but may have an earlier onset in males. Rates are similar around the world. People with schizophrenia are more likely to die younger than the general population, largely because of high rates of co-occurring medical conditions, such as heart disease and diabetes.

SYMPTOMS

The symptoms of schizophrenia can be grouped into three categories, positive symptoms (i.e. excesses of thought, emotion, and behaviour), negative symptoms (i.e. deficits of thought, emotion, and behaviour), and psychomotor symptoms.

Positive symptoms are ‘pathological excesses’ or ‘bizarre additions’ to a person’s behaviour. Delusions, disorganised thinking and speech, heightened perception and hallucinations, and inappropriate affect are the ones most often found in schizophrenia. Many people with schizophrenia develop delusions.

A delusion is a false belief that is firmly held on inadequate grounds. It is not affected by rational argument, and has no basis in reality. Delusions of persecution are the most common in schizophrenia. People with this delusion believe that they are being plotted against, spied on, slandered, threatened, attacked or deliberately victimised. People with schizophrenia may also experience delusions of reference in which they attach special and personal meaning to the actions of others or to objects and events. In delusions of grandeur, people believe themselves to be specially empowered persons and in delusions of control, they believe that their feelings, thoughts and actions are controlled by others.

People with schizophrenia may not be able to think logically and may speak in peculiar ways. These formal thought disorders can make communication extremely difficult. These include rapidly shifting from one topic to another so that the normal structure of thinking is muddled and becomes illogical (loosening of associations, derailment), inventing new words or phrases (neologisms), and persistent and inappropriate repetition of the same thoughts (perseveration).

People with schizophrenia may have hallucinations, i.e. perceptions that occur in the absence of external stimuli. Auditory hallucinations are most common in schizophrenia. Patients hear sounds or voices that speak words, phrases and sentences directly to the patient (second-person hallucination) or talk to one another referring to the patient as s/he (third-person hallucination). Hallucinations can also involve the other senses. These include tactile hallucinations (i.e. forms of tingling, burning), somatic hallucinations (i.e. something happening inside the body such as a snake crawling inside one’s stomach), visual hallucinations (i.e. vague perceptions of colour or distinct visions of people or objects), gustatory hallucinations (i.e. food or drink taste strange), and olfactory hallucinations (i.e. smell of poison or smoke).

People with schizophrenia also show inappropriate affect, i.e. emotions that are unsuited to the situation. Negative symptoms are ‘pathological deficits’ and include poverty of speech, blunted and flat affect, loss of volition, and social withdrawal. People with schizophrenia show alogia or poverty of speech, i.e. a reduction in speech and speech content. Many people with schizophrenia show less anger, sadness, joy, and other feelings than most people do. Thus, they have blunted affect. Some show no emotions at all, a condition known as flat affect. Also, patients with schizophrenia experience avolition, or apathy and an inability to start or complete a course of action.

People with this disorder may withdraw socially and become totally focused on their own ideas and fantasies. People with schizophrenia also show psychomotor symptoms. They move less spontaneously or make odd grimaces and gestures. These symptoms may take extreme forms known as catatonia. People in a catatonic stupor remain motionless and silent for long stretches of time. Some show catatonic rigidity, i.e. maintaining a rigid, upright posture for hours. Others exhibit catatonic posturing, i.e. assuming awkward, bizarre positions for long periods of time.

Cognition is another area of functioning that is affected in schizophrenia leading to problems with attention, concentration and memory, and to declining educational performance. Symptoms of schizophrenia usually first appear in early adulthood and must persist for at least six months for a diagnosis to be made. Men often experience initial symptoms in their late teens or early 20s while women tend to show first signs of the illness in their 20s and early 30s. More subtle signs may be present earlier, including troubled relationships, poor school performance and reduced motivation. Before a diagnosis can be made, however, a psychiatrist should conduct a thorough medical examination to rule out substance misuse or other neurological or medical illnesses whose symptoms mimic schizophrenia.

RISK FACTORS

Researchers believe that a number of genetic and environmental factors contribute to causation, and life stressors may play a role in the start of symptoms and their course. Since multiple factors may contribute, scientists cannot yet be specific about the exact cause in each individual case.

BIPOLAR DISORDER

Bipolar disorder is a brain disorder that causes changes in a person's mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.

People without bipolar disorder experience mood fluctuations as well. However, these mood changes typically last hours rather than days. Also, these changes are not usually accompanied by the extreme degree of behavior change or difficulty with daily routines and social interactions that people with bipolar disorder demonstrate during mood episodes.

Bipolar disorder can disrupt a person’s relationships with loved ones and cause difficulty in working or going to school.

People with bipolar I disorder frequently have other mental disorders such as anxiety disorders, substance use disorders, and/or attention-deficit/hyperactivity disorder (ADHD). The risk of suicide is significantly higher among people with bipolar I disorder than among the general population.

This disorder is characterized by repeated (i.e. at least two) episodes in which the patient's mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (mania or hypomania), and on others of a lowering of mood and decreased energy and activity (depression). Characteristically, recovery is usually complete between episodes, and the incidence in the two sexes is more nearly equal than in other mood disorders. As patients who suffer only from repeated episodes of mania are comparatively rare, and resemble (in their family history, premorbid personality, age of onset, and long-term prognosis) those who also have at least occasional episodes of depression, such patients are classified as bipolar (F31.8). Manic episodes usually begin abruptly and last for between 2 weeks and 4-5 months (median duration about 4 months). Depressions tend to last longer (median length about 6 months), though rarely for more than a year, except in the elderly. Episodes of both kinds often follow stressful life events or other mental trauma, but the presence of such stress is not essential for the diagnosis. The first episode may occur at any age from childhood to old age. The frequency of episodes and the pattern of remissions and relapses are both very variable, though remissions tend to get shorter as time goes on and depressions to become commoner and longer lasting after middle age. Although the original concept of "manic-depressive psychosis" also included patients who suffered only from depression, the term "manic-depressive disorder or psychosis" is now used mainly as a synonym for bipolar disorder.

BIPOLAR I

Bipolar I disorder is diagnosed when a person experiences a manic episode. During a manic episode, people with bipolar I disorder experience an extreme increase in energy and may feel on top of the world or uncomfortably irritable in mood. Some people with bipolar I disorder also experience depressive or hypomanic episodes, and most people with bipolar I disorder also have periods of neutral mood. Symptoms of Bipolar I Disorder.

Manic Episode

A manic episode is a period of at least one week when a person is extremely high-spirited or irritable most of the day for most days, possesses more energy than usual, and experiences at least three of the following changes in behavior:

  • Decreased need for sleep (e.g., feeling energetic despite significantly less sleep than usual
  • Increased or faster speech
  • Uncontrollable racing thoughts or quickly changing ideas or topics when speaking
  • Distractibility
  • Increased activity (e.g., restlessness, working on several projects at once)
  • Increased risky behavior (e.g., reckless driving, spending sprees)

These behaviors must represent a change from the person’s usual behavior and be clear to friends and family. Symptoms must be severe enough to cause dysfunction in work, family, or social activities and responsibilities. Symptoms of a manic episode commonly require a person to receive hospital care to stay safe.

Some people experiencing manic episodes also experience disorganized thinking, false beliefs, and/or hallucinations, known as psychotic features.

Hypomanic Episode

A hypomanic episode is characterized by less severe manic symptoms that need to last only four days in a row rather than a week. Hypomanic symptoms do not lead to the major problems in daily functioning that manic symptoms commonly cause.

Major Depressive Episode

Major Depressive Episode

  • Intense sadness or despair
  • Loss of interest in activities the person once enjoyed
  • Feelings of worthlessness or guilt
  • Fatigue
  • Increased or decreased sleep
  • Increased or decreased appetite
  • Restlessness (e.g., pacing) or slowed speech or movement
  • Difficulty concentrating
  • Frequent thoughts of death or suicide

BIPOLAR II

A diagnosis of bipolar II disorder requires someone to have at least one major depressive episode and at least one hypomanic episode (see above). People return to their usual functioning between episodes. People with bipolar II disorder often first seek treatment as a result of their first depressive episode, since hypomanic episodes often feel pleasurable and can even increase performance at work or school.

People with bipolar II disorder frequently have other mental illnesses such as an anxiety disorder or substance use disorder, the latter of which can exacerbate symptoms of depression or hypomania.

CYCLOTHYMIC DISORDER

Cyclothymic disorder is a milder form of bipolar disorder involving many "mood swings," with hypomania and depressive symptoms that occur frequently. People with cyclothymia experience emotional ups and downs but with less severe symptoms than bipolar I or II disorder.

Cyclothymic disorder symptoms include the following:

  • For at least two years, many periods of hypomanic and depressive symptoms, but the symptoms do not meet the criteria for hypomanic or depressive episode.
  • During the two-year period, the symptoms (mood swings) have lasted for at least half the time and have never stopped for more than two months.

OBSESSIVE COMPULSIVE DISORDER (OCD)

Have you ever noticed someone washing their hands everytime they touch something, or washing even things like coins, or stepping only within the patterns on the floor or road while walking? People affected by obsessive compulsive disorder are unable to control their preoccupation with specific ideas or are unable to prevent themselves from repeatedly carrying out a particular act or series of acts that affect their ability to carry out normal activities. Obsessive behaviour is the inability to stop thinking about a particular idea or topic. The person involved, often finds these thoughts to be unpleasant and shameful. Compulsive behaviour is the need to perform certain behaviours over and over again. Many compulsions deal with counting, ordering, checking, touching and washing. Other disorders in this category include hoarding disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder etc.

The essential feature of this disorder is recurrent obsessional thoughts or compulsive acts. Obsessive thoughts are ideas, images or impulses that enter the individual's mind again and again in a stereotyped form. They are almost invariably distressing (because they are violent or obscene, or simply because they are perceived as senseless) and the sufferer often tries, unsuccessfully, to resist them. They are, however, recognized as the individual's own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks.

ADDICTIONS

Addictive behaviour, whether it involves excessive intake of high calorie food resulting in extreme obesity or involving the abuse of substances such as alcohol or cocaine, is one of the most severe problems being faced by society today. Disorders relating to maladaptive behaviours resulting from regular and consistent use of the substance involved are included under substance related and addictive disorders. These disorders include problems associated with the use and abuse of alcohol, cocaine, tobacco and opiods among others, which alter the way people think, feel and behave.

Identification of the psychoactive substance used may be made on the basis of self-report data, objective analysis of specimens of urine, blood, etc., or other evidence (presence of drug samples in the patient's possession, clinical signs and symptoms, or reports from informed third parties).

Objective analyses provide the most compelling evidence of present or recent use, though these data have limitations with regard to past use and current levels of use. Many drug users take more than one type of drug.

A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected drugs) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).

There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.

A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:

  • A strong desire or sense of compulsion to take the substance;
  • Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
  • A physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
  • Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
  • Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
  • Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

Many different types of addictions are present, some of the classifications are as follows:

  • Mental and behavioural disorders due to use of alcohol.
  • Mental and behavioural disorders due to use of opioids.
  • Mental and behavioural disorders due to use of cannabinoids.
  • Mental and behavioural disorders due to use of sedatives or hypnotics.
  • Mental and behavioural disorders due to use of cocaine.
  • Mental and behavioural disorders due to use of other stimulants, including caffeine.
  • Mental and behavioural disorders due to use of hallucinogens.
  • Mental and behavioural disorders due to use of volatile solvents.
  • Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances

People who abuse alcohol drink large amounts regularly and rely on it to help them face difficult situations. Eventually the drinking interferes with their social behaviour and ability to think and work. Their bodies then build up a tolerance for alcohol and they need to drink even greater amounts to feel its effects. They also experience withdrawal responses when they stop drinking. Alcoholism destroys millions of families, social relationships and careers. Intoxicated drivers are responsible for many road accidents. It also has serious effects on the children of persons with this disorder. These children have higher rates of psychological problems, particularly anxiety, depression, phobias and substance-related disorders. Excessive drinking can seriously damage physical health.

Heroin intake significantly interferes with social and occupational functioning. Most abusers further develop a dependence on heroin, revolving their lives around the substance, building up a tolerance for it, and experiencing a withdrawal reaction when they stop taking it. The most direct danger of heroin abuse is an overdose, which slows down the respiratory centres in the brain, almost paralysing breathing, and in many cases causing death. Cocaine Regular use of cocaine may lead to a pattern of abuse in which the person may be intoxicated throughout the day and function poorly in social relationships and at work. It may also cause problems in short-term memory and attention. Dependence may develop, so that cocaine dominates the person’s life, more of the drug is needed to get the desired effects, and stopping it results in feelings of depression, fatigue, sleep problems, irritability and anxiety. Cocaine poses serious dangers. It has dangerous effects on psychological functioning and physical well-being.

PERSONALITY DISORDERS

A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work and school.

These types of conditions comprise deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. They represent either extreme or significant deviations from the way the average individual in a given culture perceives, thinks, feels, and particularly relates to others. Such behaviour patterns tend to be stable and to encompass multiple domains of behaviour and psychological functioning.

They are frequently, but not always, associated with various degrees of subjective distress and problems in social functioning and performance. Personality disorders differ from personality change in their timing and the mode of their emergence: they are developmental conditions, which appear in childhood or adolescence and continue into adulthood. They are not secondary to another mental disorder or brain disease, although they may precede and coexist with other disorders. In contrast, personality change is acquired, usually during adult life, following severe or prolonged stress, extreme environmental deprivation, serious psychiatric disorder, or brain disease or injury.

In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you. And you may blame others for the challenges you face.

Personality disorders usually begin in the teenage years or early adulthood. There are many types of personality disorders. Some types may become less obvious throughout middle age.

Personality disorders can significantly disrupt the lives of both the affected person and those who care about that person. Personality disorders may cause problems with relationships, work or school, and can lead to social isolation or alcohol or drug abuse.

Conditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:

  • Markedly disharmonious attitudes and behaviour, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
  • The abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;
  • The abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
  • The above manifestations always appear during childhood or adolescence and continue into adulthood;
  • The disorder leads to considerable personal distress but this may only become apparent late in its course;
  • The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is usually required of the presence of at least three of the traits or behaviours given in the clinical description.

Types of personality: disorders are grouped into three clusters, based on similar characteristics and symptoms. Many people with one personality disorder also have signs and symptoms of at least one additional personality disorder. It's not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed.

Cluster A personality disorders:

Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

Paranoid personality disorder

  • Pervasive distrust and suspicion of others and their motives
  • Unjustified belief that others are trying to harm or deceive you
  • Unjustified suspicion of the loyalty or trustworthiness of others
  • Hesitancy to confide in others due to unreasonable fear that others will use the information against you
  • Perception of innocent remarks or nonthreatening situations as personal insults or attacks
  • Angry or hostile reaction to perceived slights or insults
  • Tendency to hold grudges
  • Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful

Schizoid personality disorder

  • Lack of interest in social or personal relationships, preferring to be alone
  • Limited range of emotional expression
  • Inability to take pleasure in most activities
  • Inability to pick up normal social cues
  • Appearance of being cold or indifferent to others
  • Little or no interest in having sex with another person

Cluster B personality disorders

Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.

Antisocial personality disorder

  • Disregard for others' needs or feelings
  • Persistent lying, stealing, using aliases, conning others
  • Recurring problems with the law
  • Repeated violation of the rights of others
  • Aggressive, often violent behavior
  • Aggressive, often violent behavior
  • Impulsive behavior
  • Consistently irresponsible
  • Lack of remorse for behavior
  • Borderline personality disorder
  • Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating
  • Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating
  • Unstable or fragile self-image
  • Unstable and intense relationships
  • Up and down moods, often as a reaction to interpersonal stress
  • Suicidal behavior or threats of self-injury
  • Intense fear of being alone or abandoned
  • Ongoing feelings of emptiness
  • Frequent, intense displays of anger
  • Stress-related paranoia that comes and goes

Histrionic personality disorder

  • Constantly seeking attention
  • Excessively emotional, dramatic or sexually provocative to gain attention
  • Speaks dramatically with strong opinions, but few facts or details to back them up
  • Easily influenced by others
  • Shallow, rapidly changing emotions
  • Excessive concern with physical appearance
  • Thinks relationships with others are closer than they really are

Narcissistic personality disorder

  • Belief that you're special and more important than others
  • Fantasies about power, success and attractiveness
  • Failure to recognize others' needs and feelings
  • Exaggeration of achievements or talents
  • Expectation of constant praise and admiration
  • Arrogance
  • Unreasonable expectations of favors and advantages, often taking advantage of others
  • Unreasonable expectations of favors and advantages, often taking advantage of others

Cluster C personality disorders

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

  • Too sensitive to criticism or rejection
  • Feeling inadequate, inferior or unattractive
  • Avoidance of work activities that require interpersonal contact
  • Socially inhibited, timid and isolated, avoiding new activities or meeting strangers
  • Extreme shyness in social situations and personal relationships
  • Fear of disapproval, embarrassment or ridicule

Dependent personality disorder

  • Excessive dependence on others and feeling the need to be taken care of
  • Submissive or clingy behavior toward others
  • Fear of having to provide self-care or fend for yourself if left alone
  • Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions
  • Difficulty starting or doing projects on your own due to lack of self-confidence
  • Difficulty disagreeing with others, fearing disapproval
  • Tolerance of poor or abusive treatment, even when other options are available
  • Urgent need to start a new relationship when a close one has ended

Obsessive-compulsive personality disorder

  • Preoccupation with details, orderliness and rules
  • Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don't meet your own strict standards
  • Desire to be in control of people, tasks and situations, and inability to delegate tasks
  • Neglect of friends and enjoyable activities because of excessive commitment to work or a project
  • Inability to discard broken or worthless objects
  • Rigid and stubborn
  • Inflexible about morality, ethics or values
  • Tight, miserly control over budgeting and spending money

Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, a type of anxiety disorder.

Causes

Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of:

Your genes Certain personality traits may be passed on to you by your parents through inherited genes. These traits are sometimes called your temperament.

Your environment. This involves the surroundings you grew up in, events that occurred, and relationships with family members and others.

Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Your genes may make you vulnerable to developing a personality disorder, and a life situation may trigger the actual development.

Risk factors

Although the precise cause of personality disorders is not known, certain factors seem to increase the risk of developing or triggering personality disorders, including:

  • Family history of personality disorders or other mental illness
  • Abusive, unstable or chaotic family life during childhood
  • Being diagnosed with childhood conduct disorder
  • Variations in brain chemistry and structure