Amateur Pshrink V

I am pretty partial to this disorder too. I feel just like this lady looks in the picture, much of the time. Only doing other things distracts me from sometimes tearing my hair out with tears of despair and hopelessness.
I like all of the DSM disorders, as a matter of fact. I am thinking of collecting them, like baseball cards...

Somatoform disorder (also known as Briquet's syndrome) is a psychological disorder characterized by physical symptoms that mimic disease or injury for which there is no identifiable physical cause or physical symptoms such as pain, nausea, depression, and dizziness. Somatoform disorder is a condition in which the physical pain and symptoms a person feels are related to psychological factors. These symptoms can not be traced to a specific physical cause. In people who have Somatoform disorder, medical test results are either normal or don't explain the person's symptoms. People who have this disorder may undergo several medical evaluations and tests to be sure that they do not have an illness related to a physical cause or central lesion. Patients with this disorder often become very worried about their health because the doctors are unable to find a cause for their health problems. Their symptoms are similar to the symptoms of other illnesses and may last for several years. People who have Somatoform disorder are not faking their symptoms. The pain that they feel is real, and they feel what they say they are feeling.

A person faking their symptoms may have factitious disorder (an unknown psychological cause for making oneself sick) or malingering (making oneself sick for personal or monetary gain; i.e. disability, insurance, etc). This is not at all related to the Somatoform Disorder, however.

A diagnosis of a Somatoform disorder implies that psychological factors are a large contributor to the symptoms' onset, severity and duration. It is important to note that Somatoform disorders are not the result of conscious malingering or factitious disorders.
The Somatoform disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association are:

• Conversion disorder
• Somatization disorder
• Hypochondriasis
• Body dysmorphic disorder
• Pain disorder
• Undifferentiated somatoform disorder - only one unexplained symptom is required for at least 6 months.

Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria).

• Somatoform disorder NOS

Additional proposed somatoform disorders are:

• Abridged somatization disorder - at least 4 unexplained somatic complaints in men and 6 in women
• Multisomatoform disorder - at least 3 unexplained somatic complaints from the PRIME-MD scale for at least 2 years of active symptoms

These disorders have been proposed because the recognized somatoform disorders are either too restrictive or too broad. In a study of 119 primary care patients, the following prevalences were found:

• Somatization disorder - 1%
• Abridged somatization disorder - 6%
• Multisomatoform disorder - 24%
• Undifferentiated somatoform disorder - 79%

In my case, I suspect false pregnancy would be tough to carry out, and right now I´d settle for a reasonable duration of urinary retention prior to wetting my diapers.


But in other words, we can´t explain what is wrong, but we gotta tell the insurance company something, so we made up this fancy title that means ¨we don´t know what is wrong, but this fella is REAALLY SICK!¨

Amateur Pshrink IV

Dr. Moench drew this cartoon on a napkin, when my parents came to get me from the nut hatch at LDS Hospital many years ago. This is one diagnosis from the DSM that is pretty straight-forward.

Major depressive disorder (also known as clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it is also used to describe a more temporarily depressed state of mind, more precise terminology is preferred for the disorder in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of all people who commit suicide have depression or another mood disorder.
The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status exam. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 30 and 40 years, with a later peak between 50 and 60 years. Major depression is reported about twice as frequently in women as in men, although men are at higher risk for suicide.
Most patients are treated in the community with antidepressant medication and some with psychotherapy or counseling. Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT), under a short-acting general anaesthetic. The course of the disorder varies widely, from one episode lasting months to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses. Current and former patients may be stigmatized.
The understanding of the nature and causes of depression has evolved over the centuries, though many aspects of depression remain incompletely understood and are the subject of discussion and research. Psychological, psycho-social, evolutionary and biological causes have been proposed. Psychological treatments are based on theories of personality, interpersonal communication, and learning theory. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine, and dopamine that are naturally present in the brain and assist communication between nerve cells. Monoamines have been implicated in depression, and most antidepressants work to increase the active levels of at least one.

Major depression is a serious illness that affects a person's family, work or school life, sleeping and eating habits, and general health. Its impact on functioning and well-being has been equated to that of chronic medical conditions such as diabetes.
A person suffering a major depressive episode usually exhibits a very low mood that pervades all aspects of life and an inability to experience pleasure in activities that formerly were enjoyed. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self hatred. Other symptoms include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide. Insomnia is common: in the typical pattern, a person wakes very early and is unable to get back to sleep. Hypersomnia, or oversleeping, is less common. Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. The person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries according to the World Health Organization's criteria of depression. Family and friends may notice that the person's behavior is either agitated or lethargic. Older depressed persons may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements. In severe cases, depressed people may have symptoms of psychosis such as delusions or, less commonly, hallucinations, usually of an unpleasant nature.

Depression is a major cause of morbidity worldwide. Lifetime prevalence varies widely, from 3% in Japan to 17% in the US. In most countries the number of people who would suffer from depression during their lives falls within an 8–12% range. In North America the probability of having a major depressive episode within a year-long period is 3–5% for males and 8–10% for females. Population studies have consistently shown major depression to be about twice as common in women as in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this. The relative increase in occurrence is related to pubertal development rather than chronological age, reaches adult ratios between the ages of 15 and 18, and appears associated with psychosocial more than hormonal factors.
People are most likely to suffer their first depressive episode between the ages of 30 and 40, and there is a second, smaller peak of incidence between ages 50 and 60.The risk of major depression is increased with neurological conditions such as stroke, Parkinson's disease, or multiple sclerosis and during the first year after childbirth. It is also more common after cardiovascular illnesses, and is related more to a poor outcome than to a better one. Studies conflict on the prevalence of depression in the elderly, but most data suggest there is a reduction in this age group.
Depression is often associated with unemployment and poverty. Major depression is currently the leading cause of disease burden in North America and other high-income countries, and the fourth-leading cause worldwide. In the year 2030, it is predicted to be the second-leading cause of disease burden worldwide after HIV, according to the World Health Organization. Delay or failure in seeking treatment after relapse, and the failure of health professionals to provide treatment, are two barriers to reducing disability.
The World Health Organization updated its report The global burden of disease in 2004. Their "Years Lost due to Disability", or YLD, is a measurement of the equivalent years of healthy life lost through time spent in states of less than full health, and they state that in all regions, "neuropsychiatric conditions are the most important causes of disability, accounting for around one third of YLD among adults aged 15 and over." Specifically, unipolar depressive disorders are the leading cause in both males and females, in high-income countries and in low- and middle-income countries.

Amateur Pshrink II

I like this one too. Can I be both? Huh, can I, can I ?

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others.

People with this disorder are usually able to function at a high level and can be successful socially and professionally. People with histrionic personality disorder usually have good social skills, but they tend to use these skills to manipulate other people and become the center of attention. Furthermore, histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. People with this disorder may seek treatment for depression when romantic relationships end, although this is by no means a feature exclusive to this disorder. They often fail to see their own personal situation realistically, instead tending to dramatize and exaggerate their difficulties. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression.

The cause of this disorder is unknown, but childhood events such as deaths in the immediate family, divorce of parents and genetics may be involved. Histrionic Personality Disorder is more often diagnosed in women than men; men with some quite similar symptoms are often diagnosed with antisocial personality disorder.However, Psychiatrist Dr. Rhoda Hahn supposes that it may be more often diagnosed in women because attention-seeking and sexual forwardness are typically considered to be less socially acceptable for women than for men, and, as suggested by Jonathan Oore, a more efficient means of initial social advancement.

Little research has been conducted to determine the biological sources of this disorder. Psychoanalytic theories incriminate seductive and authoritarian attitudes by fathers of these patients.

The symptoms include:

* Constant seeking of reassurance or approval.
* Excessive dramatics with exaggerated displays of emotions.
* Excessive sensitivity to criticism or disapproval.
* Inappropriately seductive appearance or behavior.
* Excessive concern with physical appearance.
* A need to be the center of attention (self-centeredness).
* Low tolerance for frustration or delayed gratification.
* Rapidly shifting emotional states that may appear shallow to others.
* Opinions are easily influenced by other people, but difficult to back up with details.
* Tendency to believe that relationships are more intimate than they actually are.
* Making rash decisions.
* Threatening or attempting suicide

The person's appearance, behavior, and history, along with a psychological evaluation, are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed. Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with symptoms such as depression. Psychotherapy may also be of benefit.

The Diagnostic and Statistical Manual of Mental Disorders, a widely used manual for diagnosing mental disorders, defines histrionic personality disorder as a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Is uncomfortable in situations in which he or she is not the center of attention
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
3. Displays rapidly shifting and shallow expression of emotions
4. Consistently uses physical appearance to draw attention to self
5. Has a style of speech that is excessively impressionistic and lacking in detail
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion
7. Is suggestible, i.e., easily influenced by others or circumstances
8. Considers relationships to be more intimate than they actually are.

A mnemonic that can be used to remember the criteria for histrionic personality disorder is PRAISE ME:

* P - provocative (or seductive) behavior
* R - relationships, considered more intimate than they are
* A - attention, must be at center of
* I - influenced easily
* S - speech (style) - wants to impress, lacks detail
* E - emotional lability, shallowness

* M - make-up - physical appearance used to draw attention to self
* E - exaggerated emotions - theatrical

Histrionic Personality Disorder shares a divergent history with Conversion disorder and Somatization Disorder. Historically, they are linked to the ancient notion of hysteria, or "wandering womb." (Note, however, that according to the Online Etymology Dictionary, the word "histrionic" derives not from the Greek hystera, but from the Latin histrionicus, "pertaining to an actor.") Ancient Greeks thought that excessive emotionality in women was caused by a displaced uterus and sexual discontent. Christian ascetics during the Middle Ages blamed women's mental problems on witchcraft, sexual hunger, moral weakness, and demonic possession. By the 19th century, medical explanations proposed a weakness of women's nervous system related to biological sex. Thus, "hysteria" reflected the stereotype for women as vulnerable, inferior, and emotionally unbalanced. The extent to which the definition of Histrionic Personality Disorder currently reflects gender bias remains the subject of a controversy.

"Hysteria" differentiated into conversion hysteria (later to become Conversion disorder) and hysterical personality (later to become Histrionic personality disorder) in the psychoanalytic literature as well as with the writings of Kraepelin, Schneider, and others. Sigmund Freud wrote primarily about conversion hysteria. Wilhelm Reich wrote about hysteria as a set of personality characteristics and differentiated conversion hysteria as a transient disorder from hysterical character. These early conceptualizations of both kinds of hysteria carried notions of women's deficiency due to penis envy and feelings of castration. Paul Chodoff has written about the ways in which these diagnoses paralleled the misogynistic sentiment of the times.

The concept of hysterical personality was well developed by the mid-20th century and strongly resembled the current definition of Histrionic Personality Disorder. The first DSM featured a symptom-based category, "hysteria" (conversion) and a personality-based category, "emotionally unstable personality." DSM-II distinguished between hysterical neurosis (conversion reaction and dissociative reaction) and hysterical (histrionic) personality. In DSM-III, the term Hysterical Personality changed to Histrionic Personality Disorder to emphasize the histrionic (derived from the Latin word histrio, or actor) behavior pattern and to reduce the confusion caused by the historical links of hysteria to conversion symptoms. The landmark case of Ruth E. helped to fully define and emphasize the characteristics of the current DSM-IV diagnostic. DSM-III-R attempted to reduce the overlap between Histrionic Personality Disorder and Borderline Personality Disorder by dropping three overlapping criteria and adding two criteria that emphasized histrionicity. DSM-IV dropped two more criteria that did not appear to contribute to the consistency of the diagnosis, according to research done by Bruce Pfohl.

Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.

Because of the lack of research support for work on personality disorders and long-term treatment with psychotherapy, the empirical findings on the treatment of these disorders remain based on the case report method and not on clinical trials. On the basis of case presentations, the treatment of choice is psychotherapy aimed at self-development through resolution of conflict and advancement of inhibited developmental lines. Group therapy is not recommended for those with HPD because it provides the person with an audience to play to (perform for), giving opportunity to perpetuate histrionic behavior.

* Family therapy
* Medications
* Alternative therapies

The HPD is highly reactive. If there is another major disorder present, such as delusional disorder, then emotional intensity will create anger, rage, abuse and distance in relationships.

It is important for the therapist and family members to monitor and record all situations that trigger the HPD so that the deep underlying overload of pain can be accessed and released for therapeutic change.

Amateur Pshrink

Who fits this characterization?

Narcissistic personality disorder (NPD) is a personality disorder defined by the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic classification system used in the United States, as "a pervasive pattern of grandiosity, need for admiration, and a lack of empathy."

The narcissist is described as turning inward for gratification rather than depending on others, and as being excessively preoccupied with issues of personal adequacy, power, and prestige. Narcissistic personality disorder is closely linked to self-centeredness.

DSM-IV divides personality disorders into three clusters based on symptom similarities. This clustering categorizes the narcissistic personality disorder as a cluster B personality disorder, those personality disorders having in common an excessive sense of self importance. Also in that cluster are the borderline personality disorder, the histrionic personality disorder and the antisocial personality disorder.

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. has a grandiose sense of self-importance
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is "special" and can only be understood by, or should associate with, people (or institutions) who are also "special" or of high status.
4. requires excessive admiration
5. has a sense of entitlement
6. is interpersonally exploitative
7. lacks empathy
8. is often envious of others or believes others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes

Miracles VI: Friends, Doctors, and Sharks

Rehab in Provo was fairly routine. It is the exceptional things that are worth mentioning.

First is that I came there with a renewed sense of purpose. I met repeatedly with my son Robert and his wife Stacy. I was obsessed, perhaps, with a sense of urgency that my life had been spared for a purpose. A short mission, so to speak, to serve so cause for good. I was not aware of the mission yet, Robert and I discussed some possible actions we might take toward directing the lives of his brothers, because I expressed some remorse as an absent father of so many years that I had failed my family and not trained my sons well. Anyway, we discussed many subjects with tentative feelers along those lines.

I also met my friend Michael Golden, several times. In fact, he came with me the one Sunday to the abbreviated Sacrament meeting they held in the little chapel at the hospital. It was a special, spiritual moment for me, and kind of ministering of a special friend that I will try to always remember in my heart. I can never repay Michael for his kindness, but I hope to try to do things half as thoughtful for others, and am hoping to try to instil in my own sons such a sense of selfless charity and friendship. I hope the seed is already there, and it is not too late for them. I hope...

Another thing that happened while I was in the Provo Rehab was that I had a series of "shark attacks" under clinical observation. This is important because the incident was documented by trained medical observers. First at Mountainview, then in the Provo Rehab ward, and finally at the U Neurology Unit, doctors and nurses have seen these attacks, and know that I am not making up the stories. In fact, one man of the psychiatric practice at the U hospital witnessed a "shark attack" while there was quite a crowd of onlookers. I was somewhat absent myself for most of the incident, since they tend to affect me that way, but my dad told me later in rather a bemused demeanor that the doctor seemed rather horrified by the incident. I hope he was not permanently traumatized. When we find some understanding, I want to share it with him personally, just to offer my personal reassurance.

Again, this clinical observation is notable because my doctors stand outside the room and whisper and shake their heads, "somatoform", "deeply psychotic!", "borderline shizofrenic behavior!", and other two- dollar words from the DSM, I've heard them all before. But the blood pressures continue to go higher than ever, and the nurses were alarmed to the point that they were going to call a "code blue", because they had seen nothing like this before, and my respirations were down to almost nil, and blood pressure levels were so too high to be even believed. Later, I heard the nurse describing the incident to the next on duty, in the handing-off briefing. He used the term "freaky!" emphatic and numerous times. I say this not to his discredit, because I think he responded well to the incident. We have found subsequently that the "shark attacks", although alarming, do not seem to produce any serious life-threatening effects beyond the extreme pain. Best to just stand back, and maybe don't watch, if that is your preference, and wait until it passes.

My point is, these attacks are very real, to me. They are happening to me. I don't give a damn if the doctors call the "psychotic complexes" or "somatoform" or "silly putty"! I want to know reasons and explanation this is happening to me, because IT IS! It has happened before, and I know it will happen again! It cannot just go away for no reason. The first attack was obviously associated with the first stroke incident in July. They started then. Why? Why are they continuing? I want to know, even more than reasons for how to stop them from happening, but UNDERSTANDING what is happening to me!   If I had better understanding, even if I could not stop or control these things, at least I could know WHY they are happening to me. As it is, one of the best explanations seems to be to simply shrug your shoulders and turn away and mutter, "he's obviously mad as a hatter!", and dismiss the whole affair.

That might resolve the issue just fine for a doctor who gets to move on to the next disease. But I live inside myself.

I remember Dr. Brin, standing in the circle of doctors in neurology rounds, at the foot of my bed one day, pronouncing, "That's NOT OKAY! -- That's NOT OKAY!" And true to her words, she worked until she found something that was NOT okay. I owe her such a debt of gratitude for that! Finally, a doctor who lived up to the IDEAL of HEALING!

But I get ahead of myself..

I went home from Provo Rehab fully prepared to start over again from the July point.

Little did I know what was in the works, and would so shortly come to pass. The biggest series of miracles in all...

Next instalment:  Interacte