Social Anxiety Disorder

As a child, Kyle was very outspoken, funny and adventurous. His friends used to call him the “talkative”. He changed so much during his adolescence. He became overly self-conscious and concerned about other people’s opinions about him. He became very shy and reserved. He stopped talking and answering questions in class. He believed that if he spoke to people, they would judge how he looked, dressed or even spoke. He was afraid that people would reject and humiliate him and therefore did everything in his power to avoid having conversations. In school he would avoid any situation which would lead to an interaction with his peers. He went to class earlier than his classmates. He left for lunch break after everyone had left. He avoided eating in the canteen; he would sneak his food into the washroom to eat. He made it a point to walk home alone all the times. On occasions where he had to work in a group for an assignment, he avoided eye contact with the other students. The few times he had interactions, he trembled, had heart palpitations, he was confused and dizzy and had a full panic attack.

Symptoms: They are anxious at social gatherings. They are afraid of being rejected or judged or humiliated. In social situations they may develop full panic attacks. They reduce their anxiety by avoiding eye contact and social gatherings. They excessively rehearse what they would say in an interaction. The quality of their interactions are reduced because they fail to self-disclose.

Causes: Genetics play a role in social anxiety. Genes do not exactly cause social anxiety disorder but it gives you the tendency to be anxious in situations. People have excessive high standards for their social performance, that is, they believe that they should be liked by everyone. People with this disorder evaluate their body harshly. They also notice potentially threatening social cues such as a grimace on an individual’s face and misinterpret these cues in self-defeating ways. Most children who develop this disorder have parents who are over protective, controlling, critical and negative.

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SCHIZOPHRENIA

Charles was diagnosed with schizophrenia when he was only 12. His late mother and grandmother were victims of schizophrenia. He had trouble with attention and memory. He couldn’t concentrate or focus his attention on a specific thing in his environment. He had difficulties separating relevant information from irrelevant information. Due to this difficulty, he was afflicted by a deluge of information that he couldn’t properly process; this led him to hallucinate and be delusional, taking everything to be true or real.

Charles strongly believed that his classmates were conspiring against him. He even went the extra mile to sue them, and even when there was compelling evidence contradicting his claim, he assumed that he was being silenced by these “conspirers”.

He would hear voices that weren’t there, feel bugs crawling on his skin even though there were no bugs and see faces and figures that didn’t exist.

When asked a question, he would give an answer that had nothing to do with the question. When he spoke, he would say things that were not coherent.

As a psychotic person, he had problems expressing his emotions; he always expressed himself through sudden shouting and pacing about. He sometimes even publicly masturbated in-front of his class. These strange acts of his scared his classmates away. He had no friends and was always isolated from the lot.

Symptoms: people with this disorder are mostly delusional. They may strongly believe that their minds are being controlled by someone’s else, that they have great power and are more important than any one in this world or that people are conspiring against them. Schizophrenic people also experience hallucinations. These hallucinations could be auditory; where they hear voices that don’t exist, tactile; where they believe that something is happening outside their body eg. the perception that bugs are crawling on your back and somatic; which involves the perception that something is happening inside the person eg. the believe that worms are eating one’s intestines. They have disorganized thoughts and speech. They speak incoherently and when asked questions, they give answers unrelated to the question presented. They have problems with attention, memory and the speed at which they process information. Schizophrenic people also have a severe reduction in or absence of emotional expressions.

Causes: genetics play a role in the acquisition of schizophrenia; we can say it runs in families. A gross reduction of the gray matter and deficits in the hippocampus could also cause this disorder. Excess dopamine is also known to be a common cause. Stress alone cannot cause schizophrenia but it triggers schizophrenic episodes.

MentalMondays by Akwama

Dissociative Identity Disorder (multiple personality disorder)

Mary was a beautiful 26year old renowned lawyer during the day, and a prostitute and drug addict by the night. She woke up every morning with a hangover and needle marks all over her body. She always wondered what had happened the night before; she had no memory of how and why she had these needle marks and why she always woke up with a severe headache. She would wake up to numerous texts from unknown numbers telling her how they enjoyed having sex with her and how they would like to schedule for another appointment. She changed her number severally but this didn’t change anything. She thought her colleague was playing tricks on her so she just let it be until one day her boyfriend called her to break up with her. He sent her pictures of her doing drugs at a club. According to him, his friend had seen her a few times and decided to send him pictures. She was dumbfounded so she decided to seek help from a psychiatrist.

Mary had a rough childhood. She was sexually abused by her father every night for a year when she was just six. In an attempt to cope with this intolerable trauma, she developed an alternate personality called Anna. These 2 identities had their individual personalities and memories. Anna was strong, adventurous and wild while Mary was meek, humble and scared. Anna knew what Mary did during the day but Mary didn’t have the slightest Idea about Anna’s existence till she visited the Psychiatrist.

This disorder is developed as a result of coping strategies used by a person to deal with trauma they are powerless to escape; often during their childhood. Most people with this disorder have been victims of sexual abuse. An alternative explanation for why this disorder is developed is that people adopt the narrative of multiple personality disorder as an explanation for the way they live. The identities are not true personalities with clear-cut demarcations. Patients in this category are not faking their multiple personalities but are rather playing out roles that help them deal with everyday stress in their lives.

Symptoms: people with this disorder are highly suggestible to hypnosis. They use self-hypnosis to dissociate and escape their traumas. They may create alternate personalities to help them cope with these traumas the way most kids create imaginary friends to ease their loneliness.

NB: these personalities may or may not be aware of each other.

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Substance Abuse Disorder (Cocaine)

When Jane first entered medical school the stress was new to her. The short nights, long hours of work and the need to excel constantly wore her out. She was introduced to marijuana by her roommate which seemed to do the job just fine as a stress reliever. But after a while, its benefits became short term; it relieved her depression for a short while until its effects wore off and her depression came back even worse. During her final year she met a guy she wanted to marry. He proposed to her earlier than expected. The stress of planning a wedding coupled with being in school became unbearable; the marijuana no longer sufficed. One night she went for a party where she tried cocaine for the first time. The cocaine gave her an immediate gratification to counter her depression. For the first time in a long time she felt alive and happy; like she was in control of her life. And even though her depression came back worse after the cocaine’s effects wore off, to her it was better than nothing. She started taking cocaine everyday from then. The little money she had could not fund her new found “expensive hobby”. She used her school fees, allowance and money meant to plan her wedding to satisfy her urges. She became a wreck; she couldn’t continue medical school. She called of her wedding and became continuously nervous and irritable. She became a liability to herself and her family.

Cocaine is a type of stimulant that activates the central nervous system, causing feelings of happiness, energy and power. People who are addicted to cocaine often develop a tolerance for the substance; they experience diminished effects from the same dose of the substance and require more and more of it to achieve intoxication. Cocaine addicts undergo some behavioral changes in sociability; they are angered easily, anxious, hyper vigilant and have an impaired judgment. They also go through physiological changes such as rapid heart beat, dilation of the pupils, elevated or lowered blood pressure, weight loss, psychomotor retardation or agitation, muscular weakness and slow breathing. They get a lot of seizures and are mostly confused and lost.

Parents who are drug addicts are likely to produce drug addictive children. This is because most children view their parents behaviors as good and acceptable and therefore are likely to copy them. Also, the “highs” produced by the stimulant encourages peoples to indulge in such behaviors; people like to feel happy and calm. Environmental factors such as poverty, job loss and peer pressure are also factors that can cause one to abuse drugs. Since some areas of the frontal cortex play an important role in controlling our urge to drink, smoke or use drugs, a deficit in such areas can cause one to be drug addictive.

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Paraphilic Disorders Involving Non-human Objects

Scenario 1 (Fetishism)

Peter’s sexual excitement started at age 10 when he popped up in his mother’s room and saw her in stockings. In adolescence, he would steal his older sister’s stockings and masturbate to them. Increasingly, he observed that he ejaculates to fantasies of women in stockings anytime he masturbated. In adulthood, he only had sex with women who wore stockings. He was simply unable to maintain an erection or ejaculate anytime he slept with a woman who didn’t have stockings on.

Scenario 2 (Transvestic Fetishism)

Paul grew up cross-dressing as a child. He would put on makeup and wear his mother’s clothes and heels for fun. He would borrow his mother’s heels and masturbate in them because that was the only way he could attain sexual gratification. He never married because he wasn’t interested in having sexual intercourse with anybody. Masturbating in heels was all he needed to get by sexually. He wasn’t a homosexual, neither did he have homosexual tendencies.

Peter and Paul’s conditions are one of several kinds generally called paraphilia, that is to say, a condition in which one’s sexual arousal and gratification depend on fantasizing about and engaging in sexual behaviors generally considered abnormal and extreme. The objects of paraphilia vary enormously: they can be animate things like children, animals or inanimate things like underwear and feces; they can Involve a particular act, such as inflicting pain on oneself or on others, exposing/humiliating oneself or others. Specifically, Paul and Peter’s conditions are classified under paraphilia involving non-human objects. This type of paraphilia can be seen in two forms:

Fetishism which involves a strong sexual attraction to and fantasies involving inanimate objects.

Transvestic Fetishism which involves extreme sexual arousal obtained through cross dressing.

CAUSES: some theorists believe that these fetishes develop as a result of childhood experiences where an object has been associated with sexual arousal or gratification. It is also believed that when people are deprived of normal social sexual contexts, they go for less socially acceptable means. Whatever the theory, it is believed by many experts that Some men develop these fetishes because of the fear of rejection and humiliation from the opposite sex, or in order to compensate themselves for feeling inadequate or doubting their masculinity; alternately, a child who may have seen or experienced an inappropriate sexual encounter may later imitate it and be reinforced by such behavior.

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Conduct Disorder

As a toddler Kofi was a difficult child. He was demanding, impulsive and disobedient. His mother used his attitude as an excuse to maltreat and abandon him. As a kid he was frequently left at home alone without supervision. His mum beat him, burnt him, starved him and spat on him for the slightest wrong doings. She took any opportunity she got to physically abuse her son even when he hadn’t done anything wrong. To escape from this abusive reality, Kofi found solace in hurting other people and animals. He found joy in killing and dissecting animals; this became his newly found hobby. He also started fist fights so that he could deliberately hurt people. He derived pleasure from these acts. At age 17 he was suspended for setting his High school on fire. These behaviors developed as he grew. He grew up to be irritable and agitated all the time. At work he would be mean to his colleagues and always get into fights with them. He went out of his way to be disobedient to authorities and took pleasure in breaking the rules. He could never develop any stable relationships (friendships included) and abused anyone he got involved with. He grew up all alone with no one around him because he had made a name for himself as an aggressive person.

SYMPTOMS: people with conduct disorder are aggressive towards people and animals. They are usually thieves and take pleasure in violation of rules and destruction of properties.

CAUSES: this disorder can be seen more likely in children whose parents have a history of antisocial personality disorder. Other causes could be a genetic predisposition, exposure to abusive parents and child neglect. Children in the lower socioeconomic class are likely to develop this disorder. People with this disorder mostly have assumptions that others would be aggressive towards them and this leads them to be aggressive towards others.

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Dependent Personality Disorder

Her friends were ‘busying’ her calls; she panicked. She had started to notice the gap in their relationship. Anne sat and wondered if they were fed up with her needy nature. In school, one of the boys who tried to have a relationship with her had told her she was too needy and suffocated people with her ‘love’. Anne was constantly uncertain of what move to make. Even after pestering her friends to help her make a choice, she would spend the following hours contemplating and asking her friends if it really was a right choice. She chose courses because her friends had chosen them. She would hold the same opinions as her friends only to fit in. Whenever she is faced with a difficult situation, she never tries to tackle it on her own. She would always look for someone(friends/boyfriend) to dump it on and tell her what to do. Her current relationship was shaky because her boyfriend was constantly irritated with her. She would always overreact if he was unable to pick her calls or reply her immediately. She was jealous that he had a good friendship with his female classmates. She would call him in the middle of the night to ask him if he really loved her and go on to described how distraught she would be if he ever left her.

SYMPTOMS: people with dependent personality disorder have difficulties in making simple decisions, have a constant need for attention and reassurance, and would never take any initiative unless it will make them ‘belong’. These people are highly prone to being abused in relationships(friendship) because of their fear of loss of that ’emotional support’ and the idea that for once, they would have to do anything independently. They are over accommodating and usually make excuses when the people they depend on hurt them. when they lose the people they depend on, they immediately try to find someone to fill the void.

CAUSES: caused by a combination of biological and development factors. People exposed to authoritarian or overprotective parenting style, chronic physical illness, or separation anxiety during childhood may be more likely to develop dependent personality traits.

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