My Diagnosis

Bipolar disorder

Bipolar, or manic-depressive, disorder is a mood disorder that causes radical emotional changes and mood swings, from manic highs to depressive lows. The majority of bipolar individuals experience alternating episodes of mania (an elevated or euphoric mood or irritable state) and depression.

In the United States alone, bipolar disorder afflicts an estimated three million people. According to a report by the National Institutes of Mental Health, the disorder costs over $45 billion annually. The average age of onset of bipolar disorder is from adolescence through the early twenties. However, because of the complexity of the disorder, a correct diagnosis can be delayed for several years or more.

The Diagnostic and Statistical Manual of Mental Disorders,fourth edition text revised (DSM-IV-TR), the diagnostic standard for mental health professionals in the United States, defines four separate categories of bipolar disorder: bipolar I, bipolar II, cyclothymia, and bipolar not otherwise specified (NOS).

Bipolar I disorder is characterized by manic episodes, the “high” of the manic-depressive cycle. A bipolar patient experiencing mania often has feelings of self-importance, elation, talkativeness, increased sociability, and a desire to embark on goal-oriented activities, coupled with the characteristics of irritability, impatience, impulsiveness, hyperactivity, and a decreased need for sleep. Usually this manic period is followed by a period of depression, although a few bipolar I individuals may not experience a major depressive episode. Mixed states, where both manic or hypomanic symptoms and depressive symptoms occur at the same time, also occur frequently with bipolar I patients (for example, depression with the racing thoughts of mania). Also, dysphoric mania is common (mania characterized by anger and irritability).

Bipolar II disorder is characterized by major depressive episodes alternating with episodes of hypomania, a milder form of mania. Bipolar depression may be difficult to distinguish from unipolar depression (depression without mania, as found in major depressive disorder). Patients with bipolar depression tend to have extremely low energy, retarded mental and physical processes, and more profound fatigue(for example, hypersomnia—a sleep disorder marked by a need for excessive sleep or sleepiness when awake) than people with unipolar depression.

Cyclothymia refers to the cycling of hypomanic episodes with depression that does not reach major depressive proportions. A third of patients with cyclothymia will develop bipolar I or II disorder later in life.

A phenomenon known as rapid cycling occurs in up to 20% of bipolar I and II patients. In rapid cycling, manic and depressive episodes must alternate frequently—at least four times in 12 months—to meet the diagnostic definition. In some cases of “ultra-rapid cycling,” the patient may bounce between manic and depressive states several times within a 24-hour period. This condition is very hard to distinguish from mixed states.

Generalized anxiety disorder

Generalized anxiety disorder, or GAD, is a disorder characterized by diffuse and chronic worry. Unlike people with phobias or post-traumatic disorders, people with GAD do not have their worries provoked by specific triggers; they may worry about almost anything having to do with ordinary life. It is not unusual for patients diagnosed with GAD to shift the focus of their anxiety from one issue to another as their daily circumstances change. For example, someone with GAD may start worrying about finances when several bills arrive in the mail, and then fret about the state of his or her health when it is noticed that one of the bills is for health insurance. Later in the day he or she may read a newspaper article that moves the focus of the worry to a third concern.

Generalized anxiety disorder is characterized by persistent worry that is excessive and that the patient finds hard to control. Common worries associated with generalized anxiety disorder include work responsibilities, money, health, safety, car repairs, and household chores. The ICD-10,which is the European equivalent of DSMIV-TR,describes the anxiety that typifies GAD as “free-floating,” which means that it can attach itself to a wide number of issues or concerns in the patient’s environment.

The symptomatology of GAD has changed somewhat over time with redefinitions of the disorder in successive editions of DSM.The first edition of DSMand DSM-IIdid not make a sharp distinction between generalized anxiety disorder and panic disorder. After specific treatments were developed for panic disorder, GAD was introduced in DSM-IIIas an anxiety disorder without panic attacks or symptoms of major depression. This definition proved to be unreliable. As a result, DSM-IVconstructed its definition of GAD around the psychological symptoms of the disorder (excessive worrying) rather than the physical (muscle tension) or autonomic symptoms of anxiety. DSM-IV-TRcontinued that emphasis.

According to the DSM-IV-TR,the symptoms of GAD are:

• excessive anxiety and worry about a number of events or activities, occurring more days than not for at least six months
• worry that cannot be controlled
• worry that is associated with several symptoms such as restlessness, fatigue, irritability, or muscle tension
• worry that causes distress or impairment in relationships, at work, or at school

In addition, to meet the diagnostic criteria for GAD,

the content or focus of the worry cannot change the diagnosis from GAD to another anxiety disorder such as panic disorder, social phobia, or obsessive-compulsive disorder, and the anxiety cannot be caused by a substance (a drug or a medication).

One categorization of GAD symptoms that some psychiatrists use in addition to the DSMframework consists of three symptom clusters:

• symptoms related to high levels of physiological arousal: muscle tension, irritability, fatigue, restlessness, insomnia
• symptoms related to distorted thinking processes: poor concentration, unrealistic assessment of problems, recurrent worrying
• symptoms associated with poor coping strategies: procrastination, avoidance, inadequate problem-solving skills

Post-traumatic stress disorder

Post-traumatic stress disorder, often abbreviated as PTSD, is a complex disorder in which the affected person’s memory, emotional responses, intellectual processes, and nervous system have all been disrupted by one or more traumatic experiences. It is sometimes summarized as “a normal reaction to abnormal events.” The DSM-IV-TR(the professional’s diagnostic manual) classifies PSTD as an anxiety disorder.

PTSD has a unique position as the only psychiatric diagnosis(along with acute stress disorder) that depends on a factor outside the individual, namely, a traumatic stressor. A patient cannot be given a diagnosis of PTSD unless he or she has been exposed to an event that is considered traumatic. These events include such obvious traumas as rape, military combat, torture, genocide, natural disasters, and transportation or workplace disasters. In addition, it is now recognized that repeated traumas or such traumas of long duration as child abuse, domestic violence, stalking, cult membership, and hostage situations may also produce the symptoms of PTSD in survivors.

A person suffering from PTSD experiences flashbacks, nightmares, or daydreams in which the traumatic event is experienced again. The person may also experience abnormally intense startle responses, insomnia, and may have difficulty concentrating. Trauma survivors with PTSD have been effectively treated with group therapy or individual psychological therapy, and other therapies have helped individuals, as well. Some affected individuals have found support groupsor peer counseling groups helpful. Treatment may require several years, and in some cases, PTSD may affect a person for the rest of his or her life.

DSM-IV-TRspecifies six diagnostic criteria for PTSD:

• Traumatic stressor: The patient has been exposed to a catastrophic event involving actual or threatened death or injury, or a threat to the physical integrity of the self or others. During exposure to the trauma, the person’s emotional response was marked by intense fear, feelings of helplessness, or horror. In general, stressors caused intentionally by human beings (genocide, rape, torture, abuse, etc.) are experienced as more traumatic than accidents, natural disasters, or “acts of God.”
• Intrusive symptoms: The patient experiences flashbacks, traumatic daydreams, or nightmares, in which he or she relives the trauma as if it were recurring in the present. Intrusive symptoms result from an abnormal process of memory formation. Traumatic memories have two distinctive characteristics: 1) they can be triggered by stimuli that remind the patient of the traumatic event; 2) they have a “frozen” or wordless quality, consisting of images and sensations rather than verbal descriptions.
• Avoidant symptoms: The patient attempts to reduce the possibility of exposure to anything that might trigger memories of the trauma, and to minimize his or her reactions to such memories. This cluster of symptoms includes feeling disconnected from other people, psychic numbing, and avoidance of places, persons, or things associated with the trauma. Patients with PTSD are at increased risk of substance abuse as a form of self-medication to numb painful memories.
• Hyperarousal: Hyperarousal is a condition in which the patient’s nervous system is always on “red alert” for the return of danger. This symptom cluster includes hypervigilance, insomnia, difficulty concentrating, general irritability, and an extreme startle response. Some clinicians think that this abnormally intense startle response may be the most characteristic symptom of PTSD.
• Duration of symptoms: The symptoms must persist for at least one month.
• Significance: The patient suffers from significant social, interpersonal, or work-related problems as a result of the PTSD symptoms. A common social symptom of PTSD is a feeling of disconnection from other people (including loved ones), from the larger society, and from spiritual or other significant sources of meaning.

Depersonalization/Derealization

Depersonalization is a mental state in which a person feels detached or disconnected from his or her personal identity or self. This may include the sense that one is “outside” oneself, or is observing one’s own actions, thoughts or body.

A person experiencing depersonalization may feel so detached that he or she feels more like a robot than a human being. However, the person always is aware that this is just a feeling; there is no delusion that one is a lifeless robot or that one has no personal identity. The sense of detachment that characterizes the state may result in mood shifts, difficulty thinking, and loss of some sensations— a state that can be described as numbness or sensory anesthesia. Twice as many women as men are treated for depersonalization, which can last from a few seconds to years. Episodes may increase after traumatic events such as exposure to combat, accidents or other forms of violence or stress. Treatment is difficult and the state is often chronic, although it may occur during discrete periods or increase and decrease in intensity over time. Individuals with depersonalization often feel that events and the environment are unreal or strange, a state called derealization.

Source: http://www.minddisorders.com