Akosua is a 16 year old who wets her bed. She used to wet her bed from birth till the age of 12, but got cured due to the combination of medication and the bedtime urine alarm treatment. After her mum died at age 16, she began to wet her bed again. Her dad not understanding why a 16year old should still wet their bed, tried to get her to stop by taking her wet bedsheets to her school and around the neighborhood to be shamed by her peers. His attempts to make her stop failed and only fed into her anxiety and guilt about causing him problems; she couldn’t understand why she couldn’t stop and this made her believe that she was unable to control her urges and therefore reinforced her Enuresis (his actions only made her worse). Her peers ostracized her, nobody in the neighborhood wanted to talk to her and her dad constantly ridiculed and yelled at her, this led her to developed a low self image which continued even after she had stopped wetting her bed again.

Enuresis is the habitual voiding of urine during the day or night into ones clothes bed or floor. This behavior is mostly involuntary but may be intentional in rare situation. It mostly occurs during sleep but can sometimes occur during the day time. It is associated with clinical distress and with impairments in social academic and other areas of functioning and the disorder can drastically affect the families of the patient.

Symptoms: Children with Enuresis tend to be fearful and apprehensive about not being able to control their bladders, sensitive to imagined or real parental disappointment and disapproval and frightened of peer ridicule. They may withdraw from peer relationships or may be ostracized by other children. They mostly develop a low self-esteem.

Causes: unrealistic toilet training demands placed on a child, delayed or lax toilet training, a stressful life situation such us the death of a parent or the birth of a new sibling and disturbed family patterns can cause this disorder. Unsympathetic parents can make the problem worse by putting greater pressure on the child. The viscous cycle continues, the child wets the bed, which leads to condemnation by one or both parents, which causes the child to feel intense guilt and anxiety about causing the problem, which fosters the child’s belief in being unable to control the urge to urinate which reinforces the Enuresis. Some biological causes of this disorder include delayed maturation of the urinary tract, delays in the development of the normal Rhythms of urine production, hypersensitivity or small bladder, family history and decreased production of hormones that control urination.

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Rachel lost her husband and daughter in the same month. She resorted to binge-eating sweets as a way to cope with her loss. She started getting sick so she decided to go to the hospital. She was diagnosed with diabetes. This news led her to be depressed. After a year of living with depression and diabetes, she met someone, fell in love and decided to re-marry. They were perfect for each other but had major troubles when it came to their sex life. The diabetes coupled with depression had lowered her sexual drive, arousal and enjoyment satisfaction. This low arousal caused vagina dryness which led to pain anytime her husband tried to penetrate her. There were a few times she was able to have sexual intercourse successfully, but even with that, she never experienced an orgasm.

FEMALE ORGASMIC DISORDER CAUSES: Individuals who have this disorder can desire and be aroused but have delayed orgasm or cannot experience it at all. This disorder can be caused by diabetes which lowers one’s sexual arousal, drive and enjoyment satisfaction. Cardiovascular diseases, multiple sclerosis, kidney failure and spinal cord injury are all factors that can cause this disorder. Low levels of estrogen also reduces arousal. Drugs such is antihypertensive drugs,antidepressants, lithium and tranquilizers can reduce sexual drive and arousal which in turn causes this sexual disorder.

PENETRATION DISORDER CAUSES:

This disorder is characterized by pain during sexual intercourse. The pain may be shallow during intromission(insertion into the vagina) or deep during thrusting. This pain is normally caused by vagina dryness which may be caused by antihistamines or other drugs, infection of the clitoris or the vulva, injuries or irritations to the vagina, tumors of the internal reproductive organ, tampons, douches, vaginal contraceptives, radiation therapy and injuries during child birth that haven’t healed properly. Low level of estrogen, diabetes and other diseases also reduce arousal which reduces vagina lubrication, therefore causing dryness which leads to pain.

GENERAL CAUSES OF BOTH (PSYCHOSOCIAL):

Generally, mental disorders such as depression, anxiety disorder, panic disorder, schizophrenia and Obsessive-Compulsive Disorder interfere with sexual arousal. Also people who have been taught that sex is dirty, disgusting or sinful can develop these sexual disorders. People who don’t know enough about their bodies find it difficult to make sex pleasurable. Some people worry to much about whether they are going to be aroused and have an orgasm that it affects their sexual performance. Trauma such as loss of a loved one, unemployment and sexual assault can also cause sexual disorders. Bad communication between couples could cause these sexual disorders, that is, not telling your partner how best to serve you because of fear in general or because you want to protect their ego. Relationship problems in general like trust issues, cheating etc can also cause these disorders. In some cultures, the goal of sexual intercourse is to satisfy a man, once the man has ejaculated the sex is over, attention is not paid to the woman’s needs.

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Growing up, Akosua would always watch her mum and dad give her younger sister much more attention than her. They would always take her to their workplaces to show her off. They did this because people always complimented her younger sister but never her anytime they would go out as a family. These compliments were always about her younger sister’s complexion; people would keep saying “beautiful obroni”. Akosua on the other hand was always ridiculed on how dark she was. People would laugh at her in school saying that she was so dark they couldn’t see her. People made jokes and called her ugly just because of her complexion. She developed insecurities about her complexion because of the constant ridiculing she got from society, but this became worse when she started working. She realized that all the fair girls had some advantage over her not because they were more talented, or more skilled, but simply because they were fair. They were being promoted, favored and were given special treatment over her. Her male colleagues would always ask these “fair” girls out to lunch excluding her. She became constantly obsessive over her complexion. She thought to herself that she wasn’t good enough because she didn’t meet societal standards of what a beautiful girl should look like. She was the only one concerned about this “flaw” of hers. She strongly believed she had a defect in her appearance which made her ugly. When people looked at her she would always think, “they are laughing at me ” or “they are saying I’m too dark”. She would always compare herself to her fair friends and always ask her boyfriend if he thought she was pretty enough. She would frequently look in the mirror and wear clothes to cover her whole body. She usually did make up to make her look fair. She finally decided to bleach her skin to appear more fair. She was so preoccupied with her appearance that, it started to cause major distress in her social life and work place.

Causes: abnormality in brain structure, neurochemistry, genetics, environmental factors (societal standards, culture, child abuse and neglect,) and negative body-image can play a significant role in this disorder.

Symptoms: people with this disorder are extremely preoccupied with a perceived flaw in appearance that to others can’t be seen or seem to appear minor. They believe strongly that they have a defect that makes them appear ugly. They believe that people notice these perceived “flaws” and are constantly attempting to hide them with makeup, clothes and cosmetic surgery, some avoid social situations as a whole. They constantly seek assurance from others. They are so concerned with their “flaws” that it starts to disrupt their daily functioning.

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Kofi was a 39 year old civil engineer with a beautiful wife and daughter. His mum who lived in Kumasi decided to pay her son a visit. Kofi’s wife on wanting to bond with her mother in-law decided to go and pick her up from the airport. On their way back home, their car crushed into a truck and they both died. Upon hearing this tragic news, Kofi fell into severe depression. He couldn’t sleep nor work. He felt himself gradually losing control of his life. To cope, he started binge-eating; he ate throughout the day with no planned meal time. He developed obesity as a result of his eating behavior and later died of a heart attack leaving his daughter to fend for herself.

Symptoms: People with this disorder eat continuously through the day with no planned meal time. Others engage in discrete binges of large amounts of food often in response to stress and to feelings of anxiety and depression. People with binge-eating disorder often are significantly overweight and say they are disgusted with their bodies and ashamed of bingeing. They typically have a history in frequent dieting , membership in weight-loss programs and family obesity.

Causes: it is said to run in families; genes carry a general risk for eating disorders rather than a specific risk for one type of eating disorder. The hypothalamus plays a central role in regulating eating and is implicated in the disordered eating behaviors. An Imbalance of neurochemicals in the brain can also cause this eating disorder. Social factors such as the loss of a loved one also plays a role in this disorder. Some disorders such as depression and anxiety can also predispose a person to the binge-eating disorder.

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Akosua was a young and beautiful woman who had everything going on for her; she was the best at her job, she was in a healthy, committed and peaceful relationship, she had wonderful friends and she was about finishing her Masters. One fateful evening, she went to the bar with her friends to drink and have fun after she had received word on her imminent promotion. The bar wasn’t far from her house so she didn’t take her car. On her way back home a gang of boys pounced on her and raped her. She was traumatized and afraid to tell anyone so she decided the best thing to do was to try and move past it. Subsequently, she began to fall sick; she was constantly feeling dizzy and vomiting. She decided to visit the hospital only to be told she was pregnant and was infected with herpes. She was so dumbfounded by the news and filled with rage that she didn’t know what to do. She stopped going to work. She stopped eating. She resorted to alcohol because she wanted to get rid of the baby since abortion was not an option due to her catholic faith. In the end the child was born with no visible physical disabilities but was unfortunately born with a severe intellectual disability. In the early stages of his childhood, he had limitations in his vocabulary; he spoke two to three word sentences. He played with toys inappropriately; he would cut up dolls and dismantle toy cars. During his adolescence, he had deficits in language skills, math, reasoning, problem-solving, writing, memory, critical thinking, communication skills, making and keeping friends and understanding peoples experiences. As an adult, he had difficulties in cooking, maintaining hygiene, grocery shopping, managing his own finances and organizing himself to attend a job. He couldn’t travel alone. He was fully dependent on others for all aspects of his daily living, physical care and safety.

symptoms: This disorder involves deficits in the ability to function in the conceptual (eg. Math, reasoning), social (eg. Making friends, empathy) and practical (eg. Cooking, personal hygiene) domain. People with this disorder normally have problems with motor skills such as eye-hand coordination and balance.

Causes: chromosomal and gestational disorders, exposure to toxins prenatally or in early childhood, infections,brain injury, malformation, metabolism and nutrition problems can cause this disorder. This disorder is also normally seen with people who come from low socioeconomic backgrounds.

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Patrick is a 45 year old surgeon who maintains an almost inviolate schedule. He wakes up at 6:00am, eats breakfast at 6:50am, goes to work at 8:00am leaves work at 4:00pm, goes home at 6:00pm, eats dinner at 6:30pm and sleeps at 7:00pm everyday. He even has a routinely planned out food menu. On Monday mornings for example, he eats two eggs and a slice of bread with juice. Any changes in his schedule causes him distress and anxiety.

He is neat and organized. His apartment is meticulously arranged; his books are arranged alphabetically, his cars are arranged according to color, his utensils are organized by their sizes and his clothes are grouped according to their colors and types.

He is the best surgeon in his hospital; he thrives at his workplace because of his attention to detail.

He mostly encounters problems when he has to interact with people. He never had any long-lasting relationships whether it was a girlfriend or a friend because he doesn’t know how to compromise. Things have to go his way and he has to follow the rules which in this case is his schedule. There was a time his girlfriend at the time invited him to dinner after 7:00pm. She couldn’t meet his 6:30pm dinner schedule because she had to work. This made him annoyed and furious and he broke up with her because according to him, she wasn’t ready for a relationship. He has not had any interest in forming relationships since then. His perfectionism drives people away and also drives him away from people; people find him boring and exhausting and find it difficult to adapt to his scheduled life, on the other hand, he regards others as an interference to his otherwise perfect life.

Causes: this disorder is caused by the believe that flaws, defects and mistakes are intolerable. Genetics may also play a role in this disorder.

Symptoms: people with this disorder are perfectionists, dogmative, ruminative, emotionally blocked, cumpolsive, preoccupied with rules, details and order. They base their self-esteem on their productivity and meeting unreasonable high goals. They persist in a task even when their approach is failing. They have difficulties appreciating others. They are rigidly bound to rules. They are tensely in control of their emotions and lack spontaneity. They are workaholics who see little or no time for leisure and friendships.

NB: this disorder shares features with obsessive-compulsive disorder, but obsessive-compulsive personality disorder involves a more general way of interacting with the world than does obsessive-compulsive disorder which often involves only specific obsessional thoughts and compulsive behavior.

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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 time. 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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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.

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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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