Categories
Psychological Storybook Obsessive Compulsive Disorder

Oben’s Problems at Work

Oben could not stop thinking about what just happened. The day was going fine, he had had a good bout of meetings with his clients. Everything was going great in fact. But his heart dropped when he went back into his office.

Oben had a neat array of fountain pens, always on the right side of his desk. They were color-coded. And each pen was aligned neatly, the capped nib facing his revolving chair. But when he came back into his office, he noticed that one of the pens was missing.

It was his midnight blue pen, one that he had just gotten this summer.

His mind started racing as he began to think about all the places that he might have dropped his pen.

It couldn’t be that far from my office – I never take these pens off my desk unless I have to! He thought.

So, he began searching. Oben began by shifting the table to see underneath it. But then, exasperated, he began emptying the drawers. The notebooks that he threw out made heavy thuds against the floor and the furniture. People from outside his office started noticing until a colleague, Roma, who he was dating opened the door.

“Oben, is everything alright?” But then she stopped.

Oben was frantically now skimming through the shelf behind his chair, clearing all the papers and files out onto the floor.

“It was just here! I don’t believe how it could be anywhere else!”

This was not the first time that Roma and several other colleagues had seen Oben ‘lose his mind’ over very small things. He had had a similar breakdown when he noticed that a paper weight was missing.  

And Roma had only borrowed it. Well, she should have told him beforehand, but she thought, that’s nothing to freak out over, right?

Hearing the commotion, a colleague of Oben’s summoned the HR. Safe to say, Oben was not liked. But it took more than 10 minutes for the HR team to convince him to join them in the conference room.

Oben felt exasperated. But he also knew he was in trouble. He had promised them that he would be taking regular sessions with his shrink. But, this time he could not control himself.

Because of the damage that was caused to the shelf and the desk and the ‘disruptiveness’ of Oben’s actions, he was given a 2 week suspension from work. This was not the first time Oben had had such a mental breakdown.

But the HR representative’s message this time was clear:

‘Get your act together, or do not join the office again.”

But Oben felt hopeless, powerless.

2 weeks later, Oben returned. He had had made an active effort to not lose it anymore. Roma met him at the door and greeted him with a donut. While Roma and Oben had had conversations within this time, he told her that he was busy working on himself.

‘So, what’s up? How do you feel?’ Roma inquired.

‘Everything’s fine, Roma. Absolutely fine!’ Oben cheerily replied, as he began arranging his pens neatly on the right side of his desk.

Categories
Psychological Storybook Agoraphobia

Agra’s Problems at Work

Storybook

This is a snapshot story from a storybook that contains clinical presentations of various mental disorders. The characters present maladaptive (and adaptive) psychological features that are associated with their disorders.

Agra felt a surge of dread wash over her as her assistant, Fera, said that she had parked her car in the parking lot.

It was Agra’s practice to park her car in front of the building of the software house. She had asked special permission from the CEO of the company, to allow her this. Unfortunately, today, she had made the mistake of giving her car to Fera to fetch breakfast for her. And the assistant had decided that the parking lot was to be the best place for a car to be parked.

Agra began shouting at Fera.

“I gave you one job! You know I cannot park my car anywhere other than the front of the building!”

But the assistant was simply clueless. Agra had kept her fear hidden from the people around her for over a year. She remembered this and she tried to calm herself down.

Agra had never been a fan of airy, vacant spaces. They seemed to stretch on forever. It had always felt like the scariest thing in the world, crossing from one end of the road to the other when she was trying to get to home from college later in the night. She had been an employee at this software house for 2 years and she had never really liked the parking lot either.

It seemed vacant. And endless.

And then, a year ago, a colleague of Agra’s was robbed in the parking lot. That was the final nail in the coffin. She could not go there. Even after the firm had assured all the employees that security was now tighter than ever, she could not walk towards the lot. As soon as she entered the space through the basement floor, she felt that she could either just not move or she had to run to her car.

Who knows what could happen in this empty, endless vacuum of a place?

To quell her concerns, the CEO had allowed her to park the car in front of the building. Even that seemed a bit of a hassle. But Agra knew that this was the best he could do about it.

But Agra let the work consume her for now. She buried her face back in the files.

Finished with work, she packed her stuff. As she remembered that the car was parked in the parking lot, she felt a surge of dread. She tried calling her assistant, but then remembered that Fera had taken off earlier as she had to run some errands.

Agra felt cold as she walked down the basement. The stairs seemed unbearable. As she opened the door to the lot, she frantically spotted her car and sprinted towards it. It was like she could hear her heartbeat and each running step seemed to take her only a little closer.

Finally, she got to the car, fumbled with the car keys, got in and slammed the door shut.

She then took a deep breath and hurtled out of the parking lot, toppling a bin over on her way out.

Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, and Features of Body Dysmorphic Disorder

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR) defines body dysmorphic disorder (BDD) as a condition in which a person is fixated on what they think is wrong with their appearance when in reality they look fine. BDD is a common mental illness that is often not recognized. It is marked by an overwhelming focus on perceived flaws in the body, which can lead to upsetting repeated behaviors and, in some cases, suicidal thoughts and actions. People who have BDD often seek surgery that is not necessary.

The Italian doctor Enrico Morselli first talked about BDD more than 100 years ago. He came up with the word “dysmorphophobia,” which comes from the Greek word “dysmorphia,” which means “ugliness.” However, there is evidence that it is still not being identified enough.

According to the empirical evidence, Due to the obsession, the stress that comes with it, and the worry that other people will reject them, there is almost always impairment in one or more areas of social, professional, academic, and role performance. Patients may avoid close relationships, stop going to school or work, stop doing social things, and even end up being unable to leave their homes at all. A lot of people with BDD also think about killing themselves. A new meta-analysis found that people with BDD were four times more likely than people without BDD to have suicidal thoughts and 2.6 times more likely to try to kill themselves. Additionally, sources report that 7.4% of people who work in mental health settings have BDD while in cosmetic and skincare settings, the rate of incidence is higher (20.0%).

A lot of different mental illnesses have been linked to BDD. The most common ones are major depressive disorder, social fear, obsessive-compulsive disorder, and drug abuse disorders. A person may be diagnosed with another problem along with their BDD, but the BDD may not be picked up, so they do not get the right care they need.

Not recognizing BDD can have bad effects on a person’s health and mental health, and if they don’t get help, BDD seems to last a long time. Hence timely diagnosis and management of the disorder is crucial. The following are the diagnostic criteria and features of BDD in light of DSM 5 TR.

Diagnostic Criteria

A. Being preoccupied with one or more flaws or faults in one’s look that others don’t see or think are not important.
B. At some point during the disorder, the person has done repeated actions or thoughts (like looking in the mirror, over-grooming, picking at their skin, or looking for confirmation) because they were worried about how they looked around other people.
C. The obsession causes pain or poor performance in social, professional, or other important areas of functioning that are clinically significant.
D. The obsession with looks cannot be explained by worries about body fat or weight in a person whose symptoms meet the standards for an eating disorder.

Specify if:

With muscle dysmorphia: When someone has muscle dysmorphia, they are obsessed with the idea that their body is too small or not strong enough. It is okay for the person to be focused on other parts of their body; this specifier is still used.  

Specify if:

Rate how much you understand about the beliefs that cause body dysmorphic disorder, such as “I look ugly” or “I look deformed.”
With good or fair insight: If someone has a good or fair understanding, they know that their body dysmorphic disorder views are either definitely false or probably false, or they know that they may or may not be true.
With poor insight: With little or no understanding, the person believes that the views about body dysmorphic disorder are most likely true.
With absent insight/delusional beliefs: If someone has missing understanding or delusional beliefs, they are sure that their body dysmorphic disorder beliefs are true.

Diagnostic Features

  • Body dysmorphic disorder (previously dysmorphophobia) causes people to obsess about one or more physical imperfections they perceive make them ugly, unpleasant, strange, or deformed (Criterion A).
  • People notice problems that are not there or appear small to others.
  • People worry about looking “ugly”, “not right” “hideous” or “like a monster.”
  • Most preoccupations include the skin (acne, scars, lines, wrinkles, or pallor), hair (“thinning” hair or “excessive” body or facial hair), or nose. However, it can be the eyes, teeth, weight, stomach, breasts, legs, etc.
  • Some worry about their body’s unevenness.
  • Preoccupations are irritating, unwelcome, and time-consuming (3–8 hours a day). They are difficult to avoid and manage.
  • Concern causes excessive mental or behavioral behaviors like comparison (Criterion B).
  • Despite being unpleasant and maybe harmful, the person must perform these tasks. They are time-consuming and difficult to handle.
  • Common behaviors include comparing one’s appearance to others, looking at perceived flaws in mirrors or other reflective surfaces or directly, taking too many “selfies,” over-grooming (e.g., combing, styling, shaving, plucking, or pulling hair), wanting reassurance about perceived flaws, touching areas one does not like to check out, overworking out or lifting weights, and looking for cosmetic procedures.
  • To disguise a “pale” complexion or acne, some people tan too much, change their clothes often, or spend too much on cosmetic goods.
  • People regularly pick at their skin to repair defects, which can damage it, cause disease, or rupture blood vessels.
  • Body dysmorphic disorder sufferers repeat actions to disguise perceived faults.
  • They may repeatedly wear cosmetics, shirts, or caps or alter their hair to conceal their eyes or forehead.
  • Criteria C requires clinically severe discomfort or impairment in social, professional, or other critical performance domains from the obsession.
  • Body dysmorphic disorder and eating disorders must be distinguished.
  • An obsession with imperfections in the appearance of someone else, generally a partner or spouse but sometimes a parent, child, sibling, or stranger, is called body dysmorphic disorder via proxy.

Categories
Cognitive Psychology Psychological Interventions Psychological Tips

Psychoeducation (REBT): How ‘Musts’ or Demandingness Lead to Behavioral Disorders

Imagine a scenario where something unexpected happens. This situation stresses you out immensely. You do not know how this problem will resolve, but you want it to just go away. Someone must help you. The event that distressed you must not happen again. You must resolve it quickly.

In short, the world must comply with what you want. Or else, things will be in disarray. Or else, you cannot be satisfied or be happy.

This is what demandingness or ‘musturbation’ is. And no, it definitely isn’t a typo!

Musturbation is a colorful term, coined by clinical psychologist Albert Ellis, as one of the major reasons for psychological disturbances that lead to behavioral disorders. This forms one of the bases of Rational Emotive Behavior Therapy (REBT).

In this essay, I will attempt to show you how demandingness or musturbation can lead to major psychological issues.

Types of ‘Musts’

It is first important to understand the major types of musts in demandingness. These are related to:

  • Beliefs about oneself
  • Beliefs about others
  • Beliefs about the world.

This is directly parallel to Aaron Beck’s Cognitive Triad.

Musts about Oneself

Often times, we have certain demands on ourselves. We expect that we would be able to perform certain tasks or attain certain consequences. However, sometimes, these demands are not reasonable. They could be beyond our capabilities at a time. It could be that our circumstances might make it impossible to pursue a goal.

In these cases, if we continue to believe that we must accomplish something and realistically, it is not even a little probable, we can identify these beliefs as ‘musts’ about ourselves.

Musts about Others

At times, we might expect things from others. We might expect our parents to be caring, loving and willing to go out of their way for us. We might expect our friends to do so as well.

However, we might be overlooking the fact that they might simply not consent to do that.

When this consent, based on others’ personal motivations, does not help us fulfill what we want fulfilled, there we can see our musts about others.

Musts about the World

We often think in cosmic terms. For example, we might think that the world is favorable or unfavorable to us. We might also expect that social norms and rules should be a certain way. Particularly in the way that satisfies us physically, psychologically or ideologically.

But, here, imagine that people violate norms regularly. If we are not able to understand why people do so, it is possible that we have some unrealistic demands of the world. These could be demands of a completely honest system.

We could also demand that the world is always fair. But we do understand that the world probably isn’t fair.

Here, demandingness could lead to helplessness.

Having understood the types of demands that we might have, it is now time to see the direct link between demandingness and major psychological issues.

Demandingness is Irrational

Psychiatric disorders are characterized by psychological disturbances. These disturbances interact significantly with biological mechanisms involved in our experience. These mechanisms range from how we perceive things after the process of sensation, to our physiological arousal before, during and/or after an event.

Musturbation or demandingness, is an individual’s tendency to unrealistically demand the factors around them to obey the individual’s rules and wishes.

In reality, we cannot control others. We can bind them with personal, social or legal contracts, but we cannot completely control the way they think or behave.

Thus, our demands that things or situations remain exactly how we please are irrational.

Irrational beliefs frequently come into friction with reality and this causes psychological distress. This is often a precipitating factor of emotional and behavioral disorders.

Demandingness Can Lead to the Downward Spiral of Emotions

Demandingness also leads to higher feelings of stress. In fact, it doesn’t just increase in stress to oneself, but in their family as well. Stress, in turn, can manifest through milder symptoms of anxiety, panic or depression.

Further ‘musts’ can materialize during these symptoms as they can lower one’s mood even more or make them anxious and hyper vigilant about what they are going through. One might attribute these symptoms to their personal characteristics or to external events completely.

So, they could hold themselves completely responsible for what they are going through. On the flip side, they can hold others responsible for it. Neither of these two beliefs or thoughts is based on reality.

Hence, demandingness and stress could interact with each other and create maladaptive thoughts and even beliefs. This could, in turn, cause more negative interpretations of stressful events, heightening the irrational beliefs, emotions and behaviors.

And thus, demandingness leads an individual into a downward spiral of emotions.

Conclusion

Demands that are unrealistic are far less likely to materialize. Unfortunately, the fact that they do not materialize does not usually convince us that these demands are irrational.

Rather, a constant habit or thought processing based on irrational demands could lead us to make alternative demands that are irrational as well. This thought-system is what can be identified in many of the psychiatric disorders. While Ellis understood that we are biological beings and there is a biological basis of these mental conditions, what usually precipitates or maintains them are our irrational beliefs.

If you find that you might have problems similar to this, it could be that you are simply placing demands that are too high. If you do not know how, try talking to a professional about it. Remember, there are ways to make your experiences better.

Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, and Features of Trichotillomania

Trichotillomania, also known as hair-pulling disorder, is an obsessive-compulsive disorder in which people repeatedly pull out hair from any part of their body. Studies reveal that there have not been many large epidemiological studies on this disorder, but estimates of its frequency show that between 0.5% and 2% of the general population has it. However, because some people with trichotillomania are ashamed of their disorder, the real number of people who have it may be higher. Epidemiologic data on children are not very common, but the total frequency is thought to be between 1% and 3%. The head, eyebrows, eyelashes, and pubic area are the most popular places to get rid of hair. The number of women with trichotillomania is four times that of men with the disorder in adults. Pediatric trichotillomania mostly affects girls between the ages of 9 and 13, and most of the time, they deny having the disorder. Moreover, as many as 80% of people who have trichotillomania also have another mental illness at some point in their lives. Anxiety, major sadness, drug abuse, eating disorders, PTSD, personality disorders, and body dysmorphic disorder are some of the most common disorders that go along with it. It has been linked to skin-picking and biting nails.

According to the empirical evidence, the severity of the situation can range from mild to serious. People usually start pulling their hair out in late childhood or early teens. Since the disorder starts so early in life, trichotillomania is often linked to low self-esteem, bad quality of life, and avoiding social events like getting a haircut, swimming, being outside on a windy day, sports, or going on dates. Stress, boredom, or “downtime” can all be signs that you should pull. Additionally, a lot of people don’t even realize they are pulling. This is called “automatic” pulling, and it is a more common form of the problem. Ten to twenty percent of people with trichotillomania eat their hair after pulling it out, a condition called trichophagia. This can block the digestive tract and cause hairballs to form in the intestines, which can be so big that they need surgery to remove.

Trichotillomania is a problem with many aspects that need to be treated in a number of different ways. Such treatments often involve specialists from different fields working together. The person could see a general care doctor, a dermatologist, a psychiatrist, or a qualified clinical psychologist. Part of the treatment is likely to be therapy, and drugs may also be used. Cognitive behavioral therapy (CBT) and habit reversal training are two types of therapy that are being studied right now as ways to treat trichotillomania.

However, proper diagnosis is required to identify the symptoms of trichotillomania so that the required treatment can be sought. The DSM 5 TR outlines the following criteria and diagnostic features for trichotillomania:

Diagnostic Criteria

A. Pulling out one’s hair over and over again which leads to hair loss.

B. Trying over and over to lose hair or stop pulling it out.

C. Pulling your hair out causes clinically significant distress or problems in important areas of working in social, professional, or other areas.

D. Neither hair-pulling nor hair loss is caused by another medical condition, like a skin disease.

E. The hair pulling cannot be explained by signs of another mental disease, like trying to fix what you think is wrong with your looks in body dysmorphic disorder.

Diagnostic Features

  • The main sign of trichotillomania (hair-pulling disorder) is repeatedly pulling out one’s own hair (Criterion A).
  • Hair pulling can happen anywhere on the body where hair grows, but it happens most often on the head, eyebrows, and eyes.
  • Less often, it happens in the axillary, face, pubic, and perirectal areas.
  • The places where people pull their hair may change over time.
  • People who pull out their hair may do it for short periods of time throughout the day, or they may do it less often but for longer periods of time that can last for hours.
  • This type of hair-pulling can last for months or even years.
  • Criterion A says that pulling out hair must cause hair loss.
  • However, people who have this problem may pull hair in a manner that makes it hard to see where they are pulling hair out (i.e., pulling single hairs from all over a site).
  • Some people may also try to hide or disguise their hair loss by wearing makeup, scarves, or wigs.
  • People who have trichotillomania have tried many times to cut down on or stop pulling out their hair (Criterion B).
  • Based on criterion C, hair pulling causes distress or problems in social, professional, or other important areas of performance that are clinically significant.
  • The word “distress” refers to the bad feelings that people who pull their hair out may have, like losing control, being embarrassed, or feeling ashamed.
  • People may have trouble working in a number of areas, such as socially, professionally, academically, and for fun.
  • This is partly because they avoid going to work, school, or other public places.
Categories
Commentary Current Affairs

Khalil-Ur-Rehman, Crimes, Hypocrisy and Sadism in Pakistan

In July, 2024, a kidnapping made headlines across Pakistani media. According to the victim, the famous screenwriter Khalil-ur-Rehman Qamar, he was lured at night to a place by a woman named ‘Aamna Urooj’ where his phone, cash and wallet were snatched from him. The snatchers then made Qamar transfer about Rs 250,000 to their account and blindfolded him, leaving him at an unknown location.

On paper, this appears to be a harrowing account of ‘honey trap’ kidnapping. However, a significant portion of the digital Pakistani audiences found it anything but serious. A few hours after the incident, the memes were already pooling in.

The memes were generally about the fact that Qamar had said he chose nighttime to be the right hour to go to the woman’s place because his physician told him he could not go out in the sun.

In more recent days, a video was also leaked in which Qamar can be seen being intimate with Aamna Urooj. Qamar says that he was held at gunpoint, to perform those acts. However, once again, the internet responded viciously to Qamar’s apparent plight.

In this brief analysis, I will attempt to reason how it could be that such an incident would receive widespread ridicule rather than condemnation.

Hypocrisy

It is public news that Khalil-ur-Rehman is apparently against ‘obscene’ acts of ‘intimacy’ among members of the opposite sex. He has publicly spoken out against co-education and also lambasted Aurat March for its bold posters.

However, inconsistencies between these beliefs and Qamar’s own actions are very obvious. For example, while being a critic of environments employing and/or providing education to both sexes, his own dramas feature both sexes. This is a very basic inconsistency that has yet to be explored meaningfully in any interview that the screenwriter has given.

Furthermore, there is a clear inconsistency in Qamar’s beliefs that women should be allowed to choose who they want for marriage, but are automatically invalidated if they engage in intimate actions.

This is seemingly even more incompatible with Qamar’s decision to visit Urooj at late night.

There are many auto-immune conditions that could be grounds for not going out in the sun. However, the sun sets before dusk. There is plenty of time to schedule the meeting at a much less suspicious time.

These apparent instances of inconsistencies are the main drivers of the memes online.

Seriousness of the Kidnapping

If one had only the memes and the online discourse as a source, what happened to Khalil-ur-Rehman appears comical.

Many detractors of the seriousness of this incident claim that Qamar got what he deserved.

However, here is a question:

Does a person with double standards deserve to be put through a potentially deadly crime?

According to Qamar, his valuables were snatched from him in a place where he was expecting to meet alone with a person. There was consent involved for Qamar to come to this place. To then be robbed and kidnapped vindicates Qamar of his supposed hypocrisy – simply because he was not forcing anyone here to do anything.

Moreover, firearms were also involved, which could have potentially escalated the incident into a more heinous crime.

Even if we consider the fact that no physical harm was done, Qamar was under gunpoint and blindfolded and driven off to an unknown place. This is disorienting and resembles a near-death experience. Victims of kidnapping can develop major psychiatric problems including major depression, post-traumatic stress disorder (PTSD) and Stockholm’s Syndrome.

All of these conditions are serious mental issues.

So, why would anyone joke about kidnapping?

Sadism in Pakistan

Sadism, in its essence, is finding pleasure in the misery of others.

Unfortunately, as can be seen in the online discourse of major figures in Pakistan, sadism has become common. Sadism can be found in people making jokes on cricketing star Haris Rauf’s reaction to a fan hassling him in public. Sadism can also be found in people trolling the death of former Prime Minister Nawaz Shareef’s mother and his own poor health.

I do understand that I would probably be very unfair in discounting the context for this trolling. After all, all of these figures have been involved in major upsets for the public of Pakistan.

However, making fun of one’s experience of being kidnapped is an act of sadism which has become too common. Even political commentators with clout, like Muzammil Shah can be seen making light of this violent crime.

But what is the problem with making fun of the kidnapping?

The problem lies in laughing at the victim. It normalizes a pathological behavior of deriving pleasure out of violence inflicted on others. This is indicative of psychopathic tendencies and to see how prevalent it is at the current moment should be cause for alarm.

Why?

It is a problem when we open up the risk of dehumanizing victims with genuine concerns. We open our mainstream discourse to ridicule others publicly.

We risk hurting those who have gone through traumatic experiences.

Even when we ridicule a certain public figure, this could change our attitude as a society towards crimes like kidnapping and robbery.

Conclusion

It is nigh impossible to stop the trolling culture in Pakistani digital spheres. This is because technology has been disseminated to every wrung of society. Almost everyone is on social media. Almost everyone has an opinion.

And many of these opinions are very egocentric.

Another equally impossible problem is of our own sadistic tendencies. No matter who the victim is, a violent crime is a violent crime. It has no legal justification – otherwise it would not be a crime.

Whatever Khalil-ur-Rehman’s beliefs are. However nonsensical and intellectually deficient they might be, it does not take away from the violent nature of the crime.

It is truly unfortunate that crime in Pakistan is now being justified based on the victim’s borderline benign beliefs.

Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, and Features of Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a common mental illness that affects 1-3% of the world’s population. It is marked by unwanted thoughts, or obsessions, doing the same things over and over again, or compulsions. These symptoms make patients’ lives very difficult because they take up a lot of time, make them very upset, and make it hard for them to do things.

According to sources, cognitive-behavioral theories have long said that obsessions often make people feel more anxious or uncomfortable and that compulsions are actions that people do because of their obsessions. There is some proof, though, that compulsive behavior is what starts it all and obsessions happen after the fact to explain these behaviors. This idea needs more research, though. Most people who have OCD are very aware that their obsessive symptoms are too much and wish they could control them better.

OCD may be caused by genetic, neural, behavioral, cognitive, and environmental factors. It appears as though OCD runs in families, which suggests a possible genetic link. Scientists are still looking into this. Brain imaging tests have also shown that people with OCD have brains that work in unique ways. Children with OCD may show signs after getting an illness, such as group A streptococcal diseases like strep throat, Lyme disease, or the H1N1 flu virus. This set of OCD symptoms in kids may be called pediatric acute-onset neuropsychiatric syndrome (PANS) by doctors. If a kid has PANS, their symptoms come on quickly and get worse over a few days.

Learning-based theories say that people with OCD learn to avoid things or situations that make them afraid by doing routines that make the perceived risk smaller. The first fear might start during a time of high stress, like after a stressful event or a big loss. When someone links a scary thing or situation with their OCD, they start to avoid that thing or situation in a way that defines their disorder. One more idea is that people get OCD when they get their thoughts wrong. Most people have unwanted or bothersome thoughts from time to time, but for people with OCD, these thoughts become more important or extreme.

Studies also report that it is still not clear if traumatic events and stressful life events can cause OCD on their own or if they can act as a trigger for people who are already more likely to have it.  Some things that can happen in the environment that might make OCD worse are problems during pregnancy or birth changes in reproduction that come with getting older, social and economic issues, hurt badly, or a very bad illness. Also, people with OCD may have post-traumatic stress disorder (PTSD). OCD is a mental illness typified by compulsive behaviors and obsessions. These obsessions and compulsions can take up a lot of time and make it hard to go about daily life and be with other people. Therefore, it is important to identify the signs and get the required treatment. The following are the diagnostic criteria and diagnostic features of OCD, as highlighted by DSM 5 TR:

Diagnostic Criteria

A. Existence of Obsessions, compulsions, or a combination of both
(1) and (2) describe what an obsession is:
1. Thinking, wanting, or seeing things over and over again that you find annoying and don’t want to be there; these thoughts, urges, or pictures usually cause a lot of worry or distress in people.
2. The person tries to avoid or push away these thoughts, urges, or pictures, or they try to cancel them out with a different thought or action (i.e. by doing a compulsion).
(1) and (2) explain what compulsions are:
1. Doing the same things over and over, like washing hands, putting things in order, or checking, or doing the same thoughts over and over, like praying, counting, or softly repeating words, because they feel like they have to or because of rules that must be followed exactly.
2. The actions or thoughts are meant to stop or lessen worry or discomfort, or to avoid a feared event or situation. However, these actions or thoughts are either not really related to what they are meant to stop or lessen, or they are clearly too much.
Note: Young children might not be able to explain why they are doing or thinking these things.

B. The compulsions or obsessions take up a lot of time—more than an hour a day, for example—or they significantly impede social, occupational, or other crucial areas of functioning, or they cause clinically substantial discomfort.

C. The obsessive-compulsive symptoms are not caused by the body reacting to a substance (like an illegal drug or a medicine) or another health problem.

D. The problem cannot be explained by signs of another mental illness, like worrying too much, like in generalized anxiety disorder, or being too focused on how you look, like in body dysmorphic disorder (for example, hoarding disorder involves throwing away or parting with things; trichotillomania (hair-pulling disorder) includes pulling at the skin; stereotypes (like in stereotypic movement disorder); regulated eating (like in eating disorders); obsession with drugs or gambling (like in substance-related and addictive disorders); obsession with having an illness (like in illness anxiety disorder); sexual urges or fantasies (like in paraphilic disorders); impulses (like in disruptive, impulse-control, and conduct disorders); culpable thoughts (for major depressive disorder); thought insertion or delusional preoccupations (for schizophrenia spectrum and other psychotic disorders); or recurring trends of action (for autism spectrum disorder).

Diagnostic Features

  • OCD induces thoughts and compulsions (Criterion A).
  • Obsessives repeat ideas, images, or sensations like “contamination” or “violent or horrific scenes” “to stab someone”.
  • Obsessions are unpleasant and generate tension and suffering in most individuals.
  • The individual attempts to forget or repress these urges or replace them with a new idea or behavior.
  • Compulsion sufferers repeat actions like checking, washing, mentally counting, or speaking words to themselves. They do these things because they are obsessive or have to obey regulations.
  • OCD sufferers often experience obsessions and compulsions.
  • Obsessions and compulsions frequently involve concern about getting filthy when you wash your hands or being wounded when you inspect something repeatedly.
  • Some believe they undertake compulsions to relieve tension from their habits or prevent becoming sick.
  • To prevent injury to a loved one, organizing things equally is not a good method to connect to the dreaded scenario.
  • However, daily lengthy showers are excessive. Compulsion sufferers don’t do them for enjoyment, but they may feel better.
  • Obsessions and compulsions vary by individual.
  • Some themes or aspects are prevalent. Cleaning, symmetry, forbidden thoughts, and harm are examples.
  • Some people have problems getting rid of things and wind up collecting them due to habits and compulsions like fear of hurting others.
  • These compulsions are distinct from the hoarding disorder’s core accumulation behaviors, which will be discussed later in this chapter.
  • These motifs are seen in many nations, persist in individuals with the disease, and may be connected to brain regions.
  • People typically have many indications.
  • Criterion B requires an addiction or habit to take up more than an hour a day or produce clinically substantial anxiety or impairment to be declared OCD.
  • These needs distinguish the disease from unpleasant thoughts or behaviors like double-checking the door latch. OCD sufferers have many and varied obsessions and compulsions.
  • Some have mild to moderate symptoms and obsess or compel one to three hours a day, while others have practically continual intrusive thoughts or compulsions that make it hard to perform anything.
Categories
Psychological Interventions Psychological Tips

Procrastination: Important Factors and How to Deal with It

Imagine an important task that you have to complete in a short time. However, you find yourself only thinking about it, contemplating it for most of the time. You know that it is important that you complete it as early as possible. You understand that you will feel less stressed out. But you keep on finding other, less important things to do.

Procrastination is the behavior of putting off doing what you need to do to reach your goal. It is also considered a product of lack of self-regulated performance.

 In some ways, procrastination shares characteristics of maladaptive daydreaming. Both procrastination and maladaptive daydreaming are thought to delay important tasks that one has to complete. Moreover, procrastination can also involve instances of fantasizing.

However, the primary distinction between procrastination and maladaptive daydreaming is that procrastination is not bound to any single behavior.

In this article, I will explain the main features and types of procrastination. I will then tell you what to do about your habits of procrastination.

Causes of Procrastination

Some people don’t have problems with putting things off.

However, most of the time, procrastination can lead to bad outcomes that can’t be fixed because it stops progress instead of reaching goals. It’s important to note that even though people have different thoughts and meanings of delay, the reasons why workers of companies put things off are still unknown, and sometimes even contradictory results have been found.

So, experts have come up with a list of reasons for it, such as personal, environmental, and goal-related factors.

Individual Factors

Individual factors are generally related to the characteristics of the individual. This could include factors such as personality, ability to concentrate, personal habits etc.

Basically the individual factors that cause procrastination are those that relate to a person’s unique behaviors, patterns of thinking and emotions that are fully or partially independent of the environment.

Environmental Factors

The environment an individual is in also has major effects on his/her behavior of delaying goals. These include social and physical domains. Social environmental factors include the relationships one has.

A social factor could be observed in an individual who is living in an environment where they have to constantly respond to people. This could lead them to put off their task incessantly.

There are also physical environmental factors that influence one’s goal-directed behavior. For example, a study shows how cold weather could lead to delaying of tasks.

Goal-related Factors

Then there is the point regarding the characteristics of the goal itself. One might find that a goal is too difficult to complete in that time period.

On the other hand, one could also think that the goal is too easy and put the work off for some other time. There is also the factor of incentive. The person might find that they are not going to be rewarded enough for their work.

In a nutshell, goal-related factors are those aspects which relate to achievability and attractiveness of the goal.

Is All Procrastination Bad?

It is important to understand that procrastination is not always bad.

People who passively put things off are procrastinators in the usual sense of the word. Passive procrastinators don’t mean to put things off, but they often do because they can’t make choices and act on them quickly. Active procrastinators, on the other hand, can follow through with their plans on time. But they stop what they’re doing on purpose and pay attention to other important things that need to be done.

When a deadline is coming up, inactive procrastinators feel suffocated and negative about their future, especially about their ability to complete the task to their satisfaction. Their feelings of weakness and self-doubt make them more likely to fail and make them feel guilty and depressed.

But active procrastinators like to work when they’re rushed. When they have to do things at the last minute, they feel pushed and driven, which protects them from the kind of pain that passive procrastinators often feel.

Overcoming Procrastination

I have established, based on evidence, that not all procrastination is bad. Now it is important to see how maladaptive procrastination can be replaced with a more adaptive procrastination.

Prepare for the Task

One leaf we could take out of the active procrastination literature is to prepare for the task, if you are delaying it.

Often times we might be tempted to forego thinking about the task completely.

But we’re not going to do that!

Instead, try prepping yourself for the task. If you have an assignment on hold, you could Google more information about it. If you have to practice an instrument, search out video guides that could prep you for it.

The main point here is to be aligned to the goal actively.

Set up a Proper Plan

I use the term proper plan because a true plan would also have some time-frame that you have to follow.

While you gather the information about the goal, set up a brief plan of your mode of action. For that, you would have to place a deadline by which you would at least have some work done. If the task appears to long, break it into 3 or 4 smaller tasks and give yourself shorter deadlines for it.

When you are aligned to your goal actively, setting up a proper plan is the next thing that should happen.

Increase Your Activation Levels in General

Research has shown that more physically active individuals can control procrastination more. In some ways, one can then understand what makes active procrastination such a positive indicator for success.

Staying active can have a very significant indirect effect on procrastination.

When it comes to physical and mental health, people who are physically active have a better opinion of their quality of life. This more positive opinion is linked to less procrastination.

There is also a neuropsychological effect of physical activity as well. Engaging in higher physical activity can better regulate neurotransmitters such as Dopamine and Serotonin, both of which play a part in motivation. In turn, a more motivated individual would find it easier to finish the task at hand.

Conclusion

Procrastination is considered as a maladaptive behavior of putting off important goals. However, the concept, as explored above is far more nuanced than that. In this short article, I went over the causes and types of procrastination and also how can one control passive procrastination.

However, if you believe that your levels of procrastination are becoming too difficult to control, there is no shame in seeking help. After all, our goals are worth fulfilling.

Mostly.

Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, and Features of Agoraphobia

Agoraphobia is the fear that someone will get hurt if they are in a public or busy place where they can’t easily get out or where help might not be easy to find. It is marked by the fear that a panic attack or signs similar to a panic attack could happen in these scenarios. People who have agoraphobia try to stay away from these kinds of places or events.

People with agoraphobia often also have panic disorder, which causes a lot of suffering. A study was done to look at the differences in symptoms and lengths of treatment between people with panic disorder (PD) and people without agoraphobia (PDA). The results showed that the PDA group had worse anxiety and mood problems than the PD group, according to the results. People who had PDA were more likely to be younger when the symptoms started, to take benzodiazepines for longer periods of time, and to be treated with antipsychotics for longer periods of time. The agoraphobia subscale was linked to panic attacks, sadness, anxiety, and the amount of time someone had been taking drugs. The results show that people with PDA had worse panic symptoms, more serious mental disorders, and a worse course of their illness than people with PD.

According to the National Institute of Mental Health, 1.3% of people experience agoraphobia at some point in their lives, and about 0.9% of people experience it each year. Agoraphobia affects about the same number of men and women each year: 0.8% of men and 0.9% of women.

Since this condition can be dreadful for those who experience it and it can have adverse effects, it is important to diagnose it and seek the required treatment as soon as possible. The following criteria and features, as highlighted by the DSM 5 TR, can help diagnose agoraphobia:

Diagnostic Criteria

A. A lot of worry or fear about two or more of the five events below:
1. Taking public transportation (like cars, buses, trains, ships, and planes).
2. Being in open places like shopping malls, bridges, parking lots, etc.
3. Being in small spaces (like stores, theaters, and movie houses).
4. Having to wait in line or be in a crowd.
5. Being by yourself outside the house.
B. The person avoids or fears these situations because they think it might be hard to get out of them or that they might not be able to get help if they start having panic-like symptoms or other symptoms that make them unable to do things or look bad, like fear of falling for older people or fear of urination.
C. Most of the time, agoraphobic situations make people feel scared or anxious.
D. The agoraphobic situations are actively avoided, need to be with someone else, or are experienced with a lot of fear or anxiety.
E. The person’s fear or worry is out of proportion to the danger they are in and the social and cultural setting.

F. The fear, worry, or reluctance doesn’t go away and usually lasts for at least six months.
It’s clinically significant discomfort or impairment in social, professional, or other important areas of performance because of fear, anxiety, or avoidance.
H. The fear, worry, or avoidance is too much if there is another medical condition present, such as inflammatory bowel disease or Parkinson’s disease.
I. The fear, anxiety, or avoidance isn’t better explained by the symptoms of another mental disorder. For example, the symptoms aren’t limited to a certain type of phobia or situational phobia; they don’t just happen in social situations (as in social anxiety disorder); they aren’t just about obsessions (as in obsessive-compulsive disorder); they aren’t just about perceived flaws or defects in physical appearance (as in body dysmorphic disorder); they aren’t just about body dysmorphic disorder; they can also be caused by traumatic events (as in post-traumatic stress disorder); or they are not just about fear of separation (as in separation anxiety disorder).

Note: Agoraphobia can be identified even if someone also has panic disorder. If a person shows signs of both panic disorder and agoraphobia, they should be given both labels.

Diagnostic Features

  • As a result of being in or thinking about many diverse circumstances, agoraphobia causes strong anxiety or worry (Criterion A).
  • Signs must appear in two of the five cases below to diagnose: 1) Public transportation like vehicles, buses, trains, ships, or aircraft; 2) Open areas like parking lots, markets, or bridges; 3) Closed locations like stores, theaters, or movie theaters; 4) Waiting in line or in a crowd; or 5) Being outside alone.
  • There are more examples than presented; one may be terrified in others.
  • When these occurrences produce anxiety and worry, people assume something unpleasant will happen (Criterion B).
  • Panic-like symptoms or other symptoms that make things hard or humiliating make individuals think they cannot get out of the circumstance or find help.
  • “Panic-like symptoms” are any of the 13 panic attack symptoms. These include dizziness, weakness, and death anxiety.
  • Other symptoms that make it hard to perform tasks or look beautiful include illness, inflammatory bowel symptoms, and, in older individuals, a fear of falling or, in youth, being lost and bewildered.
  • Dread can come before or during an agoraphobic circumstance and depends on how near someone is to the object they dread.
  • The dread or concern might manifest as a full- or limited-symptom panic attack.
  • The person feels anxiety or worry almost every time they encounter their phobia.
  • A person who only gets nervous once in five times when waiting in line is not diagnosed with agoraphobia.
  • The individual deliberately avoids the situation, needs to be with someone, or is afraid or worried if they cannot or will not.
  • Active avoidance is avoiding events that make individuals nervous.
  • People who avoid situations might adjust their daily habits, work near home to avoid public transit or order food delivery to avoid shops and supermarkets.
  • Mental avoidance includes employing diversions to cope with agoraphobia.
  • Avoidance can become so severe that the person cannot leave home.
  • With a spouse, friend, or health professional, people can better handle their fears.
  • The person may also sit near public transit exits or at the movies to feel safer in these scenarios.
  • The person must be fearful, worried, or avoid situations out of proportion to the threat and social and cultural environment (Criterion E).
  • Fears like not leaving the house during a storm are legitimate.
  • It is vital to distinguish between illogical, clinically relevant agoraphobic worries and unsafe scenarios like wandering in a parking lot or catching the bus in a high-crime neighborhood.
  • In diverse cultures and social contexts, avoidance can be difficult to define.
  • In certain countries, observant Muslim women can avoid leaving the house alone without being considered agoraphobic.
  • Second, older persons are more inclined to blame age-related constraints for their anxieties. Less likely to think their worries are disproportionate to the risk.
  • Third, panic attacks and other bodily symptoms make agoraphobics fear they are in danger.
  • Agoraphobia is only diagnosed if the fear, anxiety, or avoidance lasts (Criterion F) and interferes with social, professional, or other vital aspects of life (Criterion G).
  • “Usually lasting for 6 months or more” excludes short-term difficulties.
Categories
Psychiatric Disorders

Prevalence, Diagnostic Criteria, Features and Treatment of Selective Mutism

Selective mutism is a long-lasting and severely limiting mental illness in which a child is unable to speak when they should. Selective mutism is classified as an anxiety condition, but because it is so different and complex, it may be thought of as a neurodevelopmental disease. Children with selective mutism are very rare and have a lot of different symptoms. They usually show up when they are starting school.

According to the empirical evidence, researchers and therapists in both psychology and psychiatry have been puzzled by selective mutism’s dramatic symptoms for almost 150 years. Selective mutism was first thought of as a rebellious behavior disorder, as shown by the names that were used for these kids: “voluntary aphasia” and “elective mutism” which suggested that they choose to be quiet in certain settings or around certain people. The current point of view is less judgmental about children’s reasons. The word “selective” refers to the fact that children only don’t speak in certain situations. Also, most people think that the normal non-speaking behavior of kids with this disorder is caused by fear and nervousness which mostly happens in certain social situations. This is why selective mutism is now seen as an anxiety disorder.

Prevalence of Selective Mutism

Reports say that between 0.7% and 2% of people have selective mutism. The wide range of prevalence could be because of different sampling methods, like using clinical or community samples, sample traits, like age range or immigrant status, or the ways that the prevalence was measured. Selective mutism usually starts between the ages of 2 and 4, but parents often don’t notice until the child starts school. Selective mutism can become chronic if it is not addressed. It can affect a person’s ability to communicate, their mental health, and their quality of life as an adolescent and an adult.

Enuresis, encopresis, obsessive-compulsive disorder, depression, premorbid speech and language problems, developmental delay, and Asperger’s disorders are a few of the comorbidities that can accompany selective mutism. The exact symptoms and level of intensity of these comorbidities change from person to person.

Evidence suggests that a lot of the time, kids who have selective mutism also have social anxiety disorder. Due to this, these kids might need help making friends. Children who have selective mutism often have trouble making friends and are unable to behave normally. Children who have behavioral inhibition may be quiet and hide when they are in a setting that makes them feel anxious. Mutism may be a form of withdrawal that lets the child avoid talking to other people. A child with selective mutism might rather be alone because talking to other kids might make them feel too anxious. Peers may also not talk to a child who selectively mutates because they may not seem interested in playing. Also, kids with selective mutism are less socially adept than kids who are growing normally. Mutism often makes it hard to interact with other kids, and kids may tease those who are mute. On the Child Behavior Checklist, social problems measure, kids with selective mutism have been found to score much higher than the average child. There is a chance that long-term problems will arise with getting along with others and making friends. There are also rebellious and defiant traits that go along with selective mutism. People have said that children with selective mutism are rude, angry, disobedient, sulky, stubborn, negative, manipulating, suspicious, controlling, demanding, and hostile. Children who have selective mutism act defiant and hostile at school and home. Hence, most people think of selective mutism as a long-term problem with a bad result.

Since selective mutism can get in the way of social relationships, academic growth, and well-being, identifying it and getting the required treatment as soon as possible is important. According to the DSM 5 TR, the following criteria and features can help diagnose individuals with selective mutism:

Diagnostic Criteria

A. The person consistently fails to speak up in social settings where they are expected to (for example, at school), even though they do so in other situations.

B. The problem gets in the way of doing well at school, work, or social interactions.

C. The problem has been going on for at least one month, and not just the first month of school.

D. The person does not speak because they don’t know or feel comfortable with the spoken language that was expected in the social setting.

E. The problem is not better explained by a speech disorder (like childhood-onset fluency disorder) and does not only happen in people with autism spectrum disorder, schizophrenia, or another mental disorder.

Diagnostic Features

  • Children with selective mutism don’t talk to others or reply when others talk to them when they are in social activities with other people.
  • People don’t talk when they are with other people, like kids or adults.
  • If a child has selective mutism, they will only talk to close family members at home.
  • They will not talk to close friends or second-degree relatives like grandparents or uncles.
  • Most of the time, the problem is marked by a lot of social nervousness.
  • Selective mutism makes kids often refuse to speak at school, which hurts their grades because teachers have a hard time checking academic skills like reading.
  • People may find it hard to talk to others because they cannot speak.
  • However, kids with this disorder can sometimes communicate without words (for example, by grunting, pointing, or writing), and they may be happy to talk to others when they don’t have to (for example, by playing nonverbal roles in school plays).

Treatment of Selective Mutism

As selective mutism can show up in many different ways, there are also many different ways to treat it. Some of these are behavioral therapy, systemic desensitization, cognitive behavioral therapy, family therapy, and psychotherapy with drugs and anxiety medicines.

According to the sources, behavioral methods are an important part of helping people with selective mutism. Behavioral techniques try to get people to talk more, feel less anxious, and stop acting out or trying to get attention in unsuitable ways. Behavioral methods use positive feedback, stimulus fading, shaping, self-modeling, response start, vocal praise, video feed-forward, systematic desensitization, and revealing a desired prize. The goal of behavioral treatments is to stop rewarding quiet behavior and start rewarding talking behavior.

Systemic desensitization is another way to treat it. Systemic desensitization means learning how to handle and get through situations that make you feel more anxious over time. Peer relationships may be a big part of this type of therapy, which may work especially well for kids who are selectively mute. As a first step in systematic desensitization, a child with selective mutism may be given a job that is meant to make them feel little worry. If the kid is feeling nervous or overwhelmed, comfortable friends may be able to help and support them. One of the long-term goals of care for a child with selective mutism could be to help the child talk to their teacher and classmates without any problems. The discovery of good relationships between peers has implications for how well treatment works. In particular, talking to friends with whom the child is comfortable could help them use their speech with other people and in different places.