Dissociative Identity Disorder: An Overview

What is DID?

Dissociative Identity Disorder (DID), also known as Multiple Personality Disorder (MPD), is a severe manifestation of the group of psychological disorders known as Dissociation. DID is characterized by an individual experiencing a splitting or fragmenting of their original personality into two or more different ones.

This leads to a lack of clarity in a person’s thought, emotions, memories and actions.

What causes it?

Extensive research by organisations such as the American Psychiatric Association shows that DID is more often than not caused by severe emotional, physical or environmental trauma in a person’s past. These causes include physical, sexual, and mental abuse, the loss of a loved one, and life-threatening or near-death incidents, usually occurring around the age of 6.

Who does it affect?

DID occurs very rarely; studies show that it affects 0.1% to 1% of the general population. But when it does occur, there is no age bracket or cases of medical history within which patients fall. DID can affect anyone, living at any place, of any age, or with any background. The onset is commonly observed to be during childhood, but the symptoms may take years to manifest, making it very difficult to diagnose and treat the individuals.

However, it is also commonly agreed-upon by medical professionals that females are more susceptible to this disorder than men.

How can you recognize it?

The following symptoms have been recognized and grouped among individuals with DID:

  •       Eating and Sleeping disturbances
  •       Amnesia
  •       Hallucinations
  •       Self-injurious behavior
  •       Prolonged headaches and migraines due to irregular sleep patterns

One other symptom that is observed is an alternation of personalities; a radical shift in thoughts, behavior and emotions, due to the emergence of the different ‘alters’.

Methods of Treatment

  • Psychotherapy: Also called ‘talk therapy’, it is designed to work through whatever triggers the DID.
  •  Hypnotherapy: Clinical hypnosis can be used to help the person access and deal with repressed memories and feelings that are potential causes of DID.

Another effective form of therapy is encouraging the affected individual to indulge in the creative arts, music, or exercise; anything that can help to reduce stress in a positive way.

Misconceptions about DID

Multiple personality disorder, as DID is more commonly known, has been featured time and again in novels, television series, and movies, the most famous of them being the character of Gollum in JRR Tolkien’s The Lord of the Rings series, and Alfred Hitchcock’s blockbuster hit, Psycho (1960). While it makes a good premise for pop culture, the severity of this mental illness is often disregarded and misunderstood.

Though most fictitious characterizations show one or more of the personalities as being ‘good’ or ‘soft’, and some as being ‘violent’ or ‘psychopathic’, in reality, one can never predict the nature of the ‘alters’. So it is best to seek professional help when dealing with a person with DID. 

How can I help?

You can help the patient by recognizing the symptoms at the right time and taking immediate action. DID is a very serious condition that needs to be treated as soon as it is diagnosed.

You can find out more here:

https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders

https://www.psychologytoday.com/intl/conditions/dissociative-identity-disorder-multiple-personality-disorder

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Dissociative-Disorders

 

 

Schizophrenia – An overview

 

What is Schizophrenia?

Schizophrenia is a chronic and severe mental health disorder that is characterized by distortions in thinking, perceptions, emotions, sense of self and behavior. Common experiences include hallucinations and delusions.

These experiences may be difficult to describe to friends and family members, yet seem completely real to the affected person. This may make it difficult for others to understand that these are the effects of the illness.

 

Who is susceptible?

Schizophrenia affects an estimated 20 million people worldwide. The disorder is relatively infrequent, about 1 in 2000 people are affected. Schizophrenia also commonly starts earlier in men. 

People with Schizophrenia are 2-3 times more likely to die early than the general population. The illness starts mainly in young people, ages 15 to 30, however it may start at other ages as well.

 

Why is someone affected by it?

It is widely thought that a combination of genetics, environmental factors such as stress or even psychological factors may contribute to Schizophrenia. 

Schizophrenia can be inherited but in most cases, children of Schizophrenic patients do not develop the illness. Stress can exacerbate the illness or cause a relapse for recovering patients.

 

How is it treated?

Schizophrenia is effectively treated by a combination of medicines and psycho-social support. As a family member or friend you can help by,

  1. Understanding the illness better
  2. Encouraging the patient to access treatment
  3. Encouraging the patient to get back to social roles as much as possible
  4. Taking care of your personal health and mental well-being
  5. Feeling confident to deal with the stigma and discrimination that you and the patient might experience

However, most patients with chronic Schizophrenia lack access to treatment. About 90 percent of untreated Schizophrenic cases are from low and middle income countries. There is also clear evidence that out-dated mental hospital treatment is not effective and transfer of care from mental health institutions to the community needs to be prioritized.

 

Where can you head to find out more?

This article has been derived almost exclusively from the WHO and SCARF websites. The following pieces can further your understanding of Schizophrenia.

Facts:

https://www.who.int/news-room/fact-sheets/detail/schizophrenia

https://www.nhp.gov.in/disease/neurological/schizophrenia

Articles on Schizophrenia by NGOs:

https://www.whiteswanfoundation.org/search-result/?q=schizophrenia&tag=True

https://www.scarfindia.org/scarf-media/2019/08/what-is-schizophrenia.pdf

Opinion articles on Schizophrenia:

https://www.thehindu.com/sci-tech/health/people-with-schizophrenia-open-up-about-the-myths-and-assumptions-surrounding-the-condition/article27186122.ece

https://theconversation.com/the-concept-of-schizophrenia-is-coming-to-an-end-heres-why-82775

Report on status of mental health in India:

https://timesofindia.indiatimes.com/india/lancet-report-mental-health-disorders-on-the-rise-in-india/articleshow/66156376.cms


 

Peace and PTSD

Trigger warning: Mentions of death and trauma.

Peace.

Such a deceptive word. Such an abstract concept. Such an elusive feeling.

But the guardians of peace, they’re as real and tangible as you and I. The Armed Forces lead lives that most of us cannot and they do so willingly, without an ounce of doubt or hesitation. And their mental health issues are as real and tangible as ours. 

Those of us who lead relatively safe and peaceful lives do not appreciate the Army enough. Most troopers go unacknowledged and unnoticed despite their valiant attempts to safeguard our lives, and needless to say, once they retire, they do not get the right emotional support as they rightfully should.

‘Service Before Self’ is the motto of the Indian Army, and while it is very honourable, one has to wonder if it is a healthy idea. The ugly truth is that 11% to 20% of veterans suffer from mental illnesses such as PTSD, anxiety, and depression, stemming from their experiences in war.  

Not many of us are familiar with Post Traumatic Stress Disorder (PTSD) and so don’t recognize the symptoms that are right in front of our eyes. As the name suggests, a person develops PTSD due to trauma suffered in the past.  In veterans, the trauma may be caused by killing someone, watching someone die, or even due to the sheer number of threats they face every day. It can be anything that is shocking and/or impactful enough for the person to feel disturbed by it. In fact, some veterans even see the intense training they go through as traumatic.

PTSD manifests itself in several ways.  Some common symptoms are insomnia, restlessness, and anxiety and panic attacks, which will eventually lead to the person falling into a depression.

Army veterans are more commonly susceptible to PTSD in the form of insomnia and depression. Ever heard of soldiers unable to sleep due to recurring violent dreams? Chances are high that they are suffering from insomnia.  Ever felt seen a veteran insisting on always being armed, scouting out all the exits in a place, and jumping at even the tiniest sounds? That could very well be anxiety and restlessness. All of which are indicators of PTSD.

So the question is, how do we deal with PTSD? Well, this is a very harmful mental health issue and needs to be treated immediately by qualified medical professionals. However, here are some quick tips that might help in the meantime:

 

  • Go Outdoors: It is an old saying that there is no medicine quite like fresh air, and let me tell you, our elders knew what they were talking about. People suffering from PTSD quite commonly feel suffocated or claustrophobic, and pursuing outdoor activities like swimming and jogging can help in clearing your head, and will also help in improving your physical health. 

 

  • Develop Trust:  Lack of trust and hopelessness accompany any and all forms of depression, and people suffering from PTSD, in particular, experience restlessness and anxiety because of loss of trust in people around them. So the solution is to trust that you are safe. Trust in the future. And most importantly, trust in yourself.
  • Get Support: There is nothing wrong in asking for help. Confiding your worries in at least one person and getting support from them will prove to be extremely helpful. There are so many loved ones waiting to support and encourage you. The only thing you need to do is ask.
  • Ground Yourself: When you feel a panic attack coming on, or when you feel depression weighing down on you, try to calm yourself down through small distractions. You can try humming your favourite song, or counting to 1000, or even reciting the alphabets backwards. If you are in a quiet place, you can also practice meditation or pranayama. They not only help in regulating your body functions but also prove effective in stopping your attacks. 

We often think of army men and women as being these infallible heroes. And while they deserve to be celebrated as such, one has to remember that they are as much flesh-and-blood as any living being, and hence frequently fall prey to illnesses.

Because denial is the first barrier to treating PTSD; it’s not only the people around who are in denial but oftentimes the people themselves deny that there is anything wrong with them. This is especially true of veterans, who easily dismiss the symptoms of PTSD and other disorders because they feel that they do not have the liberty to show weaknesses. 

What they don’t realise is that our weaknesses are what make us human.

Team LonePack salutes all soldiers and veterans, and wishes them a very happy National Army Day!

Thank you for your service.

 

Dreaming Lives Away: A look into Maladaptive daydreaming

Everybody daydreams. Whether it be out of boredom or excess creativity, we all have times where we space out and makeup scenarios and situations inside of our heads, controlling details and plots. But what if the daydreaming starts taking over and controlling us?

 

Maladaptive daydreaming is a relatively recently discovered mental health condition that fits the bill. Yes, you read it right. As the name suggests, MD, as it is generally called, is a condition wherein daydreaming becomes an obsessive and compulsive action that interferes with daily life activities instead of acting as a creative outlet to boredom. 

 

The concept of Maladaptive daydreaming was brought to light to the research community by Prof. Eli Somer. He defined MD as an ‘‘extensive fantasy activity that replaces human interaction and/or interferes with academic, interpersonal, or vocational functioning”. A quick google search will show a lot of forums and medical journals discussing this newly discovered condition. To sum up, the most commonly experienced symptoms of MD include but are not limited to

 

  • highly vivid and immersive daydreams
  • abnormally long daydreams that are hard to escape
  • an inability to carry out daily tasks
  • daydreams triggered by external events or stimuli, such as watching a film or listening to music
  • sleep disruption and insomnia
  • repetitive and unconscious movements when daydreaming, such as rocking back and forth or twitching

[Source: Medicalnewstoday]

These are only common and apparent symptoms, and they can vary widely from person to person. Since this is a relatively new addition to the world of mental health and a lot of research in ongoing, not a lot of credible and solid data is currently available to us. So, the best possible resources to look to at the moment would be to forums run by people for people who are experiencing MD. Taking a look at these forums, it becomes clear that a lot of people all over the world have taken solace in knowing that they are not alone in experiencing things that they thought were exclusive to them. Many people in forums on the internet share their experiences wherein they state that they never truly realised that constantly daydreaming up to half of your day away wasn’t something that everyone did or experienced. When we look deeper into what could trigger these daydreams, a lot of people mentioned music and certain situations in their lives where they wanted a different and idealistic outcome than what they are currently living in to be the major triggers. They also shared that experiencing these highly vivid and compulsive daydreams also affected their social and academic and professional lives.

This could very well be the first time that you are coming across MD. This short article is only to serve as a note of information on this particular mental health condition so that you as a reader can take a deeper look into it, understand and become aware of this lesser-known phenomenon. To those who might feel like they relate to this particular article, it can be confusing to distinguish what the limit to a normal amount of daydreaming is and if at all this is a problem worth addressing. However, if you feel that your daydreaming is taking over your life and you aren’t able to fully control it, looking for professional help to properly diagnose the condition is the best option. 

It is up to us to create awareness about lesser-known mental health issues so that we as a community can help people who feel like they might be the only ones suffering and battling their condition.

References and resources:

[1] Maladaptive daydreaming: Evidence for an under-researched mental health disorder by Jayne Bigelsen, Jonathan M. Lehrfeld, Daniela S. Jopp, Eli Somer, Consciousness and Cognition 42 (2016) 254–266.

[2] https://wildminds.ning.com/ is a place that has a very active forum dedicated to Maladaptive daydreaming.  

High Functioning yet Dysfunctional

Some of the worst times for me was when I was 17 and felt extremely confused and left out about what I was feeling. The world seemed too big and too heavy on my shoulders and I was feeling downright miserable. My anxiety skyrocketed to the point where it manifested as physical pains and I was pretty sure that there had to be a name to call out to all the helplessness and sadness I was feeling. But I was very young and unexposed to the world of mental health, so as any other person would do, I took to Google. I put in all the things I was feeling and thought that I’d arrive at some sort of an idea as to what was going on with me. None of the people around me looked like they were suffering like I did and I didn’t have the courage to talk to it to my parents. But then my confusion increased manifold as I stared at the screen; all my signs led to Depression but I fit none of the “symptoms”. I wasn’t losing appetite, my sleep pattern didn’t change drastically yet I knew I was feeling miserable. And this prompted me to start doing more research into what I was feeling and if anyone else out there was feeling the same as I yet didn’t fit into the box of “depression and anxiety symptoms”. And a revelation was made; High-Functioning Disorders.

Let me digress for a bit. You see, the students and working professionals that make a majority of people who take their lives seem to fit a certain profile. Most of them were academically well off and seemed to have a normal relationship with their friends and family. No visible symptoms of depression or anxiety could be visibly seen and they didn’t look any different, their daily activities weren’t affected in any way, and all of them seemed normal and as they would every other day. Their suicides came as a big, unpredictable blow to their friends and family since to them, literally, nothing pointed to their loved one suffering from any kind of mental health issues or, so they thought.

This observation or the lack of it reveals a darker truth. Most of us aren’t aware of a class of disorders that has now become to be known as “high-functioning” disorders. It is a recent development in the field of psychology and one that has come in a much-needed time.

For those who don’t know what they are, High-functioning disorders are the same as any other mental health disorder that one may suffer from but possess a darker trait, they do not affect your daily life. Psychologists are more worried about the people who suffer from this class of disorders since they are extremely difficult to diagnose. People with high-functioning versions of disorders such as anxiety and depression will not seem any different from a person without the disorders, superficially. They will continue with their normal lives as if nothing affects them at all, their body and brain cope very well with their conditions and as a result, their work and academic lives remain undisturbed. They’re social and active, all smiles and whatnot but on the inside, they’re still suffering and unable reach out to anyone.

hfd

[Image source: Betterhelp]

For someone who is suffering and looks to the internet first to arrive at some kind of a self-diagnosis, it really doesn’t help when none of the mental health disorders’ so-called “symptoms” fit them. Not many articles relating to these high functioning forms of disorders are present even on the internet, which is one of, if not the largest communicative space globally. And hence understandably, not much awareness is present with regard to these issues.

However, people, one by one, are now coming forward to share their experiences with high-functioning disorders. This is an article written by a woman who suffers from High-Functioning Anxiety and Depressionhttps://themighty.com/2017/11/high-functioning-anxiety-depression-looks-like/

If you are suffering from not being the best version of yourself and doubt that it could be anxiety or depression or any other issues but experience none of the visible giveaways, do consult a psychologist.

It is never easy to battle these on your own and you shouldn’t either. The world is here to listen and to help. And if you doubt that one of your loved ones is suffering but do not know what to do since they do seem normal to everyone else, sit them down and talk to them. Ask them if they’re doing okay and if not, tell them that you’re there to help them get through this.

Everyone needs a hand sometimes. You could end up saving a life from further suffering because of the lack of awareness. Do your bit and spread the word.

 

 

Googling symptoms and believing you have a medical problem: A look into Hypochondria

Hypochondriasis is as covert and confounding as ever. Regarded as a mental disorder in the Diagnostic and Statistical Manual (DSM) it is defined as “preoccupation with fears of having, or the idea that one has, a serious disease, based on a misinterpretation of bodily symptoms or to put it simply, you know how you google a symptom you’ve been experiencing and suddenly everything leads to cancer?; a constant, uncontrollable paranoia of it is what hypochondria is.

Jeff Pearlman, a revered American sports writer accounted his experiences with hypochondria in his article for Psychology Today. Here is an excerpt of it:

I know I am dying, because, well, I just know. I’m certain of it. I can feel it.

That pain on the left side of my stomach still hasn’t gone away. It’s been there for eight or nine months now. The ultrasound came up negative. So did the CT scan, the MRI and the colonoscopy.

“It’s probably nothing,” said one doctor.

“You likely pulled a muscle,” said another.

“I’d ignore it,” advised a third.

They are wrong. I know they are wrong. So, with nowhere else to turn, I seek out reassurance. “What do you think my stomach pain is?” I ask. “Do you think I’m OK?”

Eyes roll. “You’re fine,” my father says. “You’re fine,” my mother says. “You’re fine,” my sister-in-law says.

“You’re 37 years old. You run marathons. You play basketball every Monday. You’ve never even broken a bone,” my wife says. “You’re fine.”

I don’t believe them. I can’t believe them. I refuse to believe them. I wish I could believe them.

This is what it is to be a hypochondriac—what it is to live a life too often based upon the raw, carnal fear of inevitable, forthcoming, around-the-bend death. Though I was only recently diagnosed with the disorder, it has plagued me for more than a decade. Over the past 10 years, I have been convinced that I am dying of (in no particular order): brain cancer, stomach cancer, pancreatic cancer, testicular cancer, lung cancer, neck cancer, Lyme disease. When one ailment is dismissed by doctors, I inevitably rush to the Internet to learn why they are wrong. What? I don’t have colon cancer? Then it must be….”

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 [Image Courtesy: https://www.instagram.com/crazyheadcomics/]

In general most of us are concerned with our health. Any small injury or physical pain becomes a source for our discomfort. With the rise of information availability on the internet, many of us have started the trend of self-diagnosing ourselves. “Self-diagnosing” is an increasing phenomenon wherein any small physical symptom will lead us to believe that we have a major health issue. However what sets hypochondria apart, is the constant fear of having or the idea that one has a disease. Hypochondriacs face clinically significant distress and may often feel a lack in social, occupational or other areas of functioning. Despite  medical reassurances and multiple clinical diagnosis, such people continue be preoccupied with the disbelief of suffering from a serious illness.

Hypochondriasis is a serious condition which has more of a psychological basis than a physical one. Hypochondria can take a huge toll on an individual’s well-being and mental health as a preoccupation with the idea that one’s physical health is on the verge of constant deterioration can prove to be a major source of stress and anxiety.

“The brain is so powerful that it really can convince itself of illness,” says Caroline Goldmacher-Kern, a New York-based psychotherapist who specializes in anxiety disorders. “You know something is wrong because you believe what you’re thinking, and what you’re thinking is what you perceive to be feeling. So you can have five people tell you it’s all in your mind and that’s not good enough.”

The basis for the symptoms of hypochondriasis lie mainly in the preoccupation with one’s health, primarily physical. Incidents like reading an article or hearing about a particular disease can lead to misinterpretation and cause hypochondriacal thoughts. The state with these symptoms is considered as a disorder when the concern of being healthy causes distress and overt clinical disorder.

According to the  Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-4), some of the criteria for hypochondriasis are as follows:

  1. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms.
  2. The preoccupation persists despite appropriate medical evaluation and reassurance.
  3. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The duration of the disturbance is at least 6 months.

2[Image Courtesy: https://in.pinterest.com/pin/861383866206448155/]

Under the new 5th edition of DSM (DSM-5), hypochondriasis has been redefined as ‘Illness Anxiety Disorder’ which falls under the disorder class of ‘somatic symptoms and other related disorders’. Somatic symptom and related disorders are mental health disorders characterized by an intense focus on physical (somatic) symptoms that cause significant distress and/or interferes with daily functioning. Individuals with this condition may or may not have diagnosed medical conditions, but no serious disease is present in most cases. If a medical condition is present, the person displays anxiety around the illness that is clearly excessive. This new definition drops the idea of the fear of having a physical illness. It is rather the preoccupation with having or acquiring a serious illness.

The new definition focuses more on the anxiety surrounding the illness rather than the fear of it. People with illness anxiety disorder usually do not have physical symptoms, or if symptoms are present, they are mild. However, these mild symptoms may cause a great deal of anxiety. A doctor’s reassurance and even a complete medical evaluation often will not calm the person’s fears. Or, if it does calm them, other worries may emerge later.

To simplify the idea, illness anxiety disorder is similar to obsessive-compulsive disorder(OCD) to some extent, wherein the centre of obsessive behaviour is the idea or a thought of illness which causes people to compulsively do things to reduce the anxiety they feel due to this obsession. These activities include browsing for medical information, regularly visiting the doctor and so on.

The symptoms as per DSM-5 for illness anxiety disorder include:

  1. Preoccupation with having or developing a serious illness
  2. Absence of physical symptoms or, if present, symptoms are mild
  3. Behaviour indicating health anxiety, such as checking for signs of illness
  4. Easy alarm about medical problems; persistent fear despite medical reassurance
  5. Overuse or underuse medical care.
  6. Clinical distress or functional impairment
  7. The patient has been preoccupied with illness for ≥ 6 months, although the specific illness feared may change during that time period.

Individuals with hypochondriasis and illness anxiety disorder are usually apprehensive of approaching a psychologist as they fear that people view the medical symptoms as “all in your head.” Nonetheless, a combination of support and care from the primary care doctor along with psychotherapy (when it is acceptable to the patient can be helpful. Another helpful procedure can be stress management. Learning how to cope with the stress of your health can result in significant benefits. Cognitive Behaviour Therapy(CBT), which is one of the most common form of therapies can help individuals realize what triggers their anxieties or fears with regards to their health and how it can be reduced through meaningful procedures. Nonetheless, hypochondriasis and illness anxiety disorder are still not considered to be serious mental health issues. Many people spend their entire lives not knowing they had such mental health problems. They fear that “it’s all in your head” would be frequently used to ignore their concerns. Awareness and changes in the perception towards such illness can prove to be beneficial to the well-being of all.

If you do think you are experiencing any of these symptoms, then do not hesitate in reaching out for help. There are solutions available and you are not alone in facing this and rightly shouldn’t be.

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[Image Courtesy: https://m.imgur.com/gallery/mp2qoTh]

To know more about Illness Anxiety Disorder and its treatment, read the following articles:

https://www.health.harvard.edu/a_to_z/illness-anxiety-disorder-a-to-z

https://www.psychologytoday.com/intl/conditions/illness-anxiety-disorder

To know more about Hypochondria, read the following articles:

https://www.psychologytoday.com/us/articles/201001/hypochondria-the-impossible-illness

https://www.psychologytoday.com/intl/blog/life-after-50/201703/hypochondria

References:

[1] Pearlman, J. (2010, January 1). Hypochondria: The Impossible Illness. Psychology Today. Retrieved May 9, 2019, from https://www.psychologytoday.com/us/articles/201001/hypochondria-the-impossible-illness

[2]Harvard Health Publishing. (2019, March). Illness Anxiety Disorder. Retrieved May 9, 2019, from https://www.health.harvard.edu/a_to_z/illness-anxiety-disorder-a-to-z

[3]Bidaki, R., Mahmoudi, M., Khalili, B., Abedi, M., Golabbakhsh, A., Haghshenas, A., … Mirhosseini, S. M. (2015). Mismanagement of a hypochondriacal patient. Advanced biomedical research, 4, 24. Retrieved May 9, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333438/