Q: People call me moody because of mood swings. Does frequent mood swings imply that I have Bipolar Mood disorder or any other mental health issues?
A: An individual is called moody, if he/she has unpredictable changes of mood, especially sudden bouts of gloominess or sullenness. Whereas mood swings can happen to anybody; can be with or without reason & it depends on many factors like sleep, diet, stress, substance use etc. Mood swings doesn’t imply that the person has Bipolar mood disorder(BMD).
In BMD unlike mood swings; emotions (either elation & depression) tends to stay for longer duration causing significant impairment in one’s day to day activities. These abnormal mood states can lead to abnormal behaviors & often they can cause harm to self or others.
Q: I tend to overthink a lot about my day today activities. Is it abnormal or does that mean I have OCD?
A: Overthinking is not a sign of OCD nor it is abnormal. For e.g. if a person has to do a presentation in the office the next day, he will be focused & majority of his mental energy will be focused on that task. On the other hand Ruminations; where one tends to think about a single issue needlessly causing a lot of dysfunction in his/her life, can become a significant mental health problem.
OCD is a mental health condition where an affected individual gets repeated obsessions (intrusive thoughts, images etc) & repeated acts to reduce the anxiety generated (compulsions). Individuals affected with OCD spend the majority of their time in these loops of obsessions & compulsions; leading to lot of suffering.
Q: I lose my temper often & when I get angry I lose control of myself. Is it a symptom of mental illness? How can I control it?
A: Anger is a normal emotion characterized by antagonism toward someone or something who has deliberately wronged you. It doesn’t necessarily mean that the individual expressing anger has mental health issues. But repeated uncontrolled anger expressed with verbal & physical aggression with minimal provocation needs to be evaluated in order to prevent significant social dysfunction.
Expression of Anger can vary greatly but it mainly presents itself in the form of passive aggression, active aggression, hostility, constructive anger etc. As such Anger can either be normal or abnormal; it can be either provoked or abnormal.
Anger can also be a symptom of underlying mental illness, underlying brain pathology (especially in elderly), sign of depression in children (suffering from dyslexia & abuse), physical health issues & disability.
Detailed evaluation & treating the underlying cause will help in resolution of anger. In some cases, CBT (Cognitive Behavior therapy) is needed.
Q: I have difficulty in trusting people easily & often feel suspicious about other’s intentions. Is it a sign of Paranoia?
A: Trusting people & feeling suspicious although appears similar superficially, there is a subtle difference between them.
Trust is a firm belief in someone on whom you can rely without any fear. Trust issues & difficulty in establishing trust depends both on you & on the person on whom you need to trust. Personally one might have difficulty in trusting others due to reasons like bad experiences in the past, abuse, trauma & dysfunctional family setting etc. Obviously a person perceived negatively by many will not be trustworthy.
Whereas being suspicious can be a totally different issue. Feeling suspicious about someone can be normal; but if it persists even after it being proved otherwise, then it needs to be evaluated. Suspiciousness can also be a part of various mental illnesses like Schizophrenia, Delusional disorder, Paranoid personality disorders & sometimes even seen in Dementia.
Q: I have been a shy person since childhood. How is it different from Social anxiety disorder or Autism spectrum disorders?
A: Being shy doesn’t necessarily mean that the person has Social anxiety disorder. Shyness is not an uncommon issue, where one feels uncomfortable in social situations. But the person can motivate himself/herself when social situations arise to act accordingly.
Whereas in Social anxiety, there is excessive preoccupation about attending social situations, irrational fear of embarrassment, psychological & physiological symptoms of anxiety; & the person tries to avoid the social situations even if it is causing significant dysfunctions in his/her life.
Autistic spectrum disorder (ASD) is a childhood onset illness characterized by a triad of 1) Persistent difficulties with social communication & Language; 2) Persistent difficulties with social interaction; 3) Rigid and repetitive behaviours, Lack of imagination & narrowed interests.
Q: My Child does not have many friends. Do I need to worry about Autism?
A: A child having not many friends might be due to many normal or abnormal reasons. It may depend on Child’s temperament, family dynamics, cultural & social factors. Also interpersonal issues in the family, childhood abuse, depression & anxiety disorders, specific learning disorders might be some of the causative factors for a child’s reduced social interaction.
On the other hand in Autism; along with reduced social interaction (not just with peers but also with parents & close relatives), they also exhibit difficulty in communications, rigid repetitive behaviors, difficulty in establishing a meaningful relation etc.
If your child has reduced social interaction, one needs thorough assessment to find the underlying cause.
Q: My child is always active & on his toes. Is it a sign of ADHD (Attention deficit hyperactivity disorder)?
A: Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition characterised by a combination of inattention, hyperactivity and impulsive behavior. Usually comes into picture in toddlers and often continues into adulthood.
Apart from that a child might be temperamentally active, be energetic, be social & have a good imagination. Unlike in ADHD, these kids are able to control their impulses and emotions, pay attention, and respond appropriately in school and at home.
Other causes of hyperactivity in children can be due to Bipolar disorder, Autism, Hypoglycemia, Sensory processing disorder, Sleep disorders, Hearing problems, Intellectual disability, family dysfunctions, etc.
Q: After a traumatic event, I have been feeling numb, angry & always on edge. What does it indicate?
A: It might indicate that you are going through a condition called “PTSD”. It is usually triggered by severe traumatic event characterised by Intrusive memories & flashbacks of the traumatic event, Avoidance of situations, places or cues which reminds them of the traumatic event, Negative thoughts, memory problems, Difficulty in interpersonal relationship, Lack of interest & anhedonia, Feeling emotionally numb, Being easily startled, Self-destructive behavior, Trouble sleeping, Nightmares, Trouble concentrating, Irritability, Angry outbursts or aggressive behavior.
Management usually involves a combination of medications & Psychotherapy. Therapies usually involved are Cognitive behaviour therapy (CBT), Eye movement Desensitization and Reprocessing (EMDR), Exposure Therapy, Group therapy
Q: I often get thoughts of injuring myself. Why does it happen & how do I tackle this?
A: Self injury can be of many types & might be caused due to multiple reasons.
Self injurious behaviours are behavioural problems usually seen in children with Intellectual disability or Autistic spectrum disorder; characterised by head butting, biting self, scratching themselves, plucking hair etc.
Whereas “Self injury” can be due to impulsivity, emotional dysregulation, lack of support, suicide, cry for attention, lack adequate coping skills, displacement or channeling of emotional pain to physical pain.
Various modes of Self injury broadly divided into 4 categories as explained below & all of them increases the risk of further attempts.
- Impulsive self injury as the name suggests, the individual attempts to harm oneself during acute stress or crisis without thinking about the consequences. The individual might feel guilty of his/her act after the attempt. It is usually seen during IP conflicts, sudden traumatic events etc.
- Suicide is a mode of self harm where the affected individual has an intent to kill self. Here the individual feels that ending life is the only path & has an inability to look into any other avenues of life. The person will plan for the attempt for many days & will be secretive about the attempt; but give subtle hints about the attempt (Asking questions like - “If I am not there in your life wouldn't be nice?”, “What would you do if I die suddenly?”, Writing his final will, giving away emotionally significant items of his/her life. Etc.). It is seen mainly in depression. Also can be seen in individuals suffering from Chronic debilitating illnesses. Usually individuals use lethal means to commit the act like immolation, hanging, jumping into water, or use of firearms.
The risk of extended suicide is a very serious concern where the individual might want to kill the family members who are dependent on that person & then end one’s own life.
- Parasuicide is apparent attempted suicide without the actual intention of killing oneself. It is a cry for help & attention. It is one of the strongest risk factors for both repetition and eventual suicide.
- Channeling of emotional pain to physical harm is usually seen in individuals with h/o physical or sexual abuse, neglect in childhood, dysfunctional family dynamics, personality disorders. It is a kind of abnormal defense mechanism called “Acting out” where their emotional pain, repressed emotions are displaced into self harm behaviours. It can be in the form of cutting self, Burning, Scratching, Self-hitting, Pinching, Head-banging, Piercing skin with needles or sharp objects, Hair pulling, Inserting objects under the skin, & even fasting for a long time.
- Self harm can also be seen in certain mental health conditions like Depression, Bipolar disorder, OCD, PTSD, Eating disorders, Anxiety disorders, Alcohol and substance use etc.
Management usually involves thorough assessment about an individual’s psychological factors, social factors, ongoing stress, family dynamics, relationship issues, coping skills & stress tolerance etc. Once the assessment is done, the Individual needs therapy aimed to – handle ongoing issues, improve coping skills, increase stress tolerance, improve interpersonal relationships, mindfulness, reduce impulsivity, manage the ongoing crisis etc. Sometimes Inpatient care & medications might also be warranted.
Q: How is sadness different from Clinical depression?
A: Sadness is a normal emotional state in response to external painful events or noxious stimuli. It is normal to feel sad & express low mood during any negative events. Although everyone feels sad; severity varies greatly due to multiple factors like; the type negative events, stress perceived through that event, personality of the individual, stress coping mechanisms etc
The expression of sadness also has multiple variations in terms of its severity of the event, duration, behaviour associated with sadness, time needed to come out of it etc.
For example: In the event of death of loved ones, an individual goes through “GRIEF” where the individual experiences sadness in waves and usually takes 6 months to come out of it.
In Contrast, Depression is a psychological condition which can be Endogenous (within body) or Exogenous (reaction to external events) presenting with mainly with “sadness of mood” which is pervasive, prolonged (usually lasting for weeks to months) & present throughout the day (although the severity may vary diurnally). Other features are fatigue, lack of energy, loss of interest, anhedonia (loss of pleasure in previously pleasurable activities, irritability, crying spells, reduced interaction, decreased concentration, negative thinking patterns (hopelessness, worthlessness, helplessness, guilt), death wishes. Individuals also present with changes in sleep & appetite, reduced libido.
A typical depression is a unique condition where rather than depressed mood; individual presents with increased sensitivity to rejection & criticisms, apparently preserved emotional reactivity, increased sleep, increased appetite, weight gain, Heavy, leaden feeling in arms or legs that lasts an hour or more in a day.
Q: At times my heart races, I feel jittery & I feel something bad might happen to me. Medical tests show no problems but it keeps happening repeatedly. What is it?
A: Most probable cause of above mentioned condition is Panic attack characterised by sudden feeling of intense fear, sense of impending doom or danger, fear of losing control, palpitations, breathlessness, sweating, giddiness, dryness of mouth & throat, tingling sensation on hands & foot, tremors, feeling jittery, uncomfortable sensation in the abdomen, chills or hot flashes, Feeling of unreality or detachment.
One should be mindful that all of us have an innate mechanism which mimics panic attacks in times of acute stress. It is called “flight or fight response(to run or to fight)”. During this response, the sympathetic nervous system (part of the autonomic nervous system) is activated which makes us ready for the oncoming threat. Once the threat passes, this response should cease in normal cases.
Panic attack is a symptom which can be a part of many types of mental health conditions (like fever can be a symptom of underlying infection & not an illness on its own). Panic attacks can be seen in mental health conditions like Phobias, Social anxiety disorder, Generalized anxiety disorder, Depression etc.
It is also important to note that panic attack-like symptoms can be seen in multiple medical illnesses like Mitral valve prolapse, Hypoglycemia, Pheochromocytoma etc. So it is important to evaluate to rule out underlying medical illness before diagnosing a panic attack
If panic attacks are paroxysmal & happens out of blue without any underlying medical or mental health conditions, diagnosis of “Panic disorder” can be made.
Once adequately evaluated, management usually involves a combination of medications & psychotherapy.
Q: Thoughts of Suicide cross my mind occasionally when I am angry. What should I do?
A: When an Individual goes through negative events it is normal to feel angry. All the individuals have their own way of expressing anger which are either constructive or destructive. Some may scold & shout, some may lash out & assault, some may passively show their anger, some constructively channel their anger. But in some individuals & sometimes, anger can find expression via thoughts of harming self, becoming impulsive & taking hasty decisions.
When an individual is angry it’s common to have fleeting thoughts of harming oneself but real intent to harm might not be present. But if these thoughts happen all the times when one faces negative events which in turn leads to impulsive attempts, the person may need thorough evaluation & Crisis intervention. Also therapies like DBT helps in such situations. Key factor to consider is that impulsive behaviour can also be seen in some personality disorders, drug & alcohol use disorders too.
Q: What is Premenstrual dysphoric disorder (PMDD) & premenstrual syndrome (PMS)
A: Premenstrual syndrome (PMS) is a condition seen in 30% of women during menstruation. Usually symptoms start occurring 10 days prior menstrual bleeding & symptoms often disappear as soon as the bleeding occurs. It has both physical & psychological symptoms. Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMDD affects up to 10% of menstruating women.
Physical symptoms are bloating, breast tenderness, fatigue, abdominal cramps, constipation or diarrhea, headache or backache, clumsiness, lower tolerance for noise or light.
Psychological symptoms are Irritability, sleep problems, appetite changes or food cravings, concentration & memory difficulties, anxiety, depression, crying spells, mood swings & lower interest in sex.
It is thought to be caused due to hormonal changes during menstruation & changes in brain chemicals. It can be managed with the help of certain medications, psychotherapy, good exercise, diet, reducing the use of psychoactive substances (coffee, tobacco, alcohol), proper sleep & stress management.
