N-acetyl Cysteine…New Miracle for Bipolar

N-acetyl Cysteine… New Miracle for Bipolar?

Hello, people… hope everyone is well! In last week’s blog, I introduced you to N-acetyl cysteine, or NAC, an amino acid supplement that’s garnering some serious attention in shrinky circles, as it has shown major potential to help treat multiple psych conditions. Recall from last week that NAC is most renowned for its ability to replenish levels of the body’s strongest antioxidant, glutathione, while it also regulates the very important neurotransmitter, glutamate, acta as an anti-inflammatory, and assists the body’s detoxification system.

The rationale for administering NAC for psych conditions is based on those roles: being a precursor of glutathione, as well as its action as a modulating agent of glutamatergic, dopaminergic, neurotropic, and inflammatory pathways. Those are the mechanics of NAC, the how and why it’s beneficial for brain function: NAC helps to produce glutathione, which, being the chief free radical scavenger, takes up all those nasties, reducing cellular damage. NAC also acts as an anti-inflammatory, so it decreases the blood levels of molecules that cause inflammation in the body and brain, such as interleukin-6, which incidentally may play a role in the pathogenesis of schizophrenia, bipolar disorder, and depressed mood. A third mechanism of action that has been proposed for NAC involves the stimulation, increased synthesis, and release of the neurotransmitters glutamate and dopamine. Let’s talk about those two for a moment.

As the most abundant neurotransmitter in the brain and CNS, glutamate plays an important role during brain development, as well as helping with learning and memory. Glutamate is an excitatory neurotransmitter. What is that? Excitatory neurotransmitters have excitatory effects on the neuron, meaning that they increase the likelihood that the neuron will fire a signal- called an action potential- in the receiving neuron. Because neurotransmitters can increase action potential, you can then probably imagine why neurotransmitter levels are very important. At high concentrations, glutamate can overexcitenerve cells and cause more neuronal firing. Prolonged excitation is toxic to nerve cells, and causes damage over time. So having excess glutamate, as an excitatory neurotransmitter, causes more neuronal firing, and you can actually damage cells this way. In fact, you can excite cells to death… a process referred to as “excitotoxicity.” Having too much glutamate in the brain has been associated with neurological diseases such as Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, stroke, and ALS, amyotrophic lateral sclerosis or Lou Gehrig’s disease. Problems in making or using glutamate have also been linked to a number of mental health disorders, including autism, schizophrenia, depression, and obsessive-compulsive disorder, OCD. Glutamate is also a metabolic precursor for another neurotransmitter called GABA, gamma-aminobutyric acid. GABA is the main inhibitory neurotransmitter in the central nervous system- the flip-side of the coin- which decreases the likelihood that the neuron it acts upon will fire. That’s why glutamate is so important, it’s the dominant neurotransmitter used for neural circuit communication, and it’s estimated that well over half of all synapses in the brain release glutamate. 

Dopamine is the “feel good” neurotransmitter that’s strongly associated with pleasure and reward. It’s a contributing factor in motor function, mood, and decision making, and is also associated with some movement and psychiatric disorders. Dopamine is released when your brain is expecting a reward; when you come to associate a certain activity with pleasure, just the anticipation alone can be enough to raise dopamine levels. It could be a specific food, sex, shopping, or just about anything else that you enjoy. If your go-to comfort food is homemade chocolate chip cookies, your brain may increase dopamine levels when you smell them baking or see them come out of the oven. Then when you eat them, the flood of dopamine you receive acts to reinforce the craving, causing you to focus on satisfying it in the future. Dopamine is all about the cycle of motivation, reward, and reinforcement. Now imagine that you’ve been jonesing for those cookies all day, but your co-workers scarfed them all down while you were sidetracked by a conference call. Your disappointment might well lower your dopamine levels and dampen your mood. It might also intensify your desire for chocolate chip cookies, making you want them even more. Dopamine plays the main role in all of that, but keep in mind that dopamine doesn’t act alone. It works with other neurotransmitters and hormones, things like serotonin and adrenaline. Aside from its “feel good” function, dopamine is involved in many body functions, including blood flow, digestion, memory and focus, mood and emotions, motor control, pain processing, sleep, stress response, heart and kidney function, pancreatic function, and insulin regulation. Once again, as with all neurotransmitters, levels are important… theright amount of dopamine generally equates to a good mood. Ultimately, dopamine contributes to feelings of alertness, focus, motivation, and happiness, and a flood of dopamine can produce temporary feelings of total euphoria.

Those mechanisms I mentioned- glutathione reducing cellular damage, anti-inflammatory action, and the stimulation, increased synthesis, and release of the neurotransmitters glutamate and dopamine- are the proposed how NAC works, but why does NAC help people with varying psych diagnoses? Why might it work across so many conditions? This is the most intriguing thing to me. First and foremost, it seems to target biological pathways that are common across many mental disorders. For example, we know that patients with bipolar disorder have significantly higher levels of oxidative stress, and higher glutamate concentrations in their brains, especially during acute mania. It’s been suggested that people with schizophrenia may have the same, and that this may predispose them to changes in neuronal cell membranes and mitochondrial function that later manifest as symptoms of schizophrenia. It appears that NAC supplementation, by increasing CNS glutamate levels and reducing overall oxidative stress, may reduce the severity of these psychotic symptoms. 

A meta-analysis and systematic review of placebo-controlled studies on NAC as a stand-alone treatment of depressed mood in people diagnosed with major depressive disorder, bipolar disorder, and other psychiatric disorders, found evidence for “moderately improved” depressed mood and improved global functioning. In a four-month, double-blind study, individuals treated with NAC plus their usual antidepressant improved more than individuals taking a placebo with their antidepressant medication. 

In a large, six-month, double-blind study, individuals with schizophrenia who had failed to respond to multiple trials on antipsychotics were treated with 1,000 mg NAC twice daily versus a placebo, while also taking their usual antipsychotic medication. Those taking NAC experienced moderate improvements in symptoms of apathy and social withdrawal, the so-called “negative” symptoms of schizophrenia, as well as improvements in day-to-day functioning, and fewer of the abnormal involuntary movements that are commonly caused by some antipsychotic meds. 

NAC has also been investigated as a treatment for substance use disorders, with promising results. The findings of small, placebo-controlled studies suggest that NAC helped heavy Cannabis users to reduce their use, and that it may reduce the intensity of withdrawal and cravings in people in early stages of cocaine recovery. As in mood disorders, the beneficial effects of the NAC may be related to its role in restoring neurotransmitter activity that has been affected by chronic substance abuse. 

In addition to its mood-enhancing benefits, there is evidence that NAC may reduce trichotillomania (compulsive hair pulling) and other impulse control disorders, like nail-biting, skin picking, and pathological gambling. There was one eight-week, open-label study on pathological gamblers, and over 80 percent of them responded to NAC. They were then subsequently enrolled in a six-week, placebo-controlled trial, and continued to report “significant reductions” in gambling.

As for potential treatment targets, a systematic review of all of the evidence suggests that NAC may be effective at treating major depressive disorder, bipolar disorder, drug addiction, obsessive-compulsive disorder, impulse control disorders, autism, schizophrenia, Alzheimer’s disease, and even certain forms of epilepsy, specifically progressive myoclonic seizures. NAC has also been shown to potentially reduce the severity of mild traumatic brain injury in soldiers, and animal studies show that it can improve cognition after moderate traumatic brain injury. Other disorders such as anxiety and ADHD have some interesting preliminary evidence, but require larger studies.

The jury’s still out as to the mechanism, whether NAC’s benefits are the result of glutathione reducing cellular damage, the anti-inflammatory action, or the actions on glutamate and dopamine. Even though we don’t know exactly why yet, on a clinical level, NAC seems to help with ruminations, the difficult to control, extreme negative self-thoughts. These thoughts are very common in depression and anxiety disorders, and also in eating disorders, schizophrenia, and OCD. NAC seems to help some patients when other modalities, even meds and psychotherapy, haven’t helped much. It doesn’t always work, but when it does, irrational thoughts seem to gradually decrease in intensity and frequency. Negative thoughts, like “I’m a bad person,” “Nobody likes me,” or ruminations about other people or other issues that can’t seem to be quieted by reasonable evidence to the contrary- those really pesky negative thoughts that keep intruding on someone’s awareness, hour after hour, day after day, despite all efforts to control them- seem to decrease with NAC. If they do continue to occur, they’re less distressing, and can be observed from more of a distance, and are less likely to trigger depression or other negative effects.

Overall, NAC seems pretty special. Its ability to successfully cross the blood-brain-barrier to increase CNS glutathione levels, while reducing glutamate and overall oxidative stress, in addition to its anti-inflammatory properties- all conditions linked to depression and other mental health disorders- makes it an interesting treatment candidate for many psych conditions. If you take NAC, you’re basically giving your body an efficient way to soak up excess glutamate, an excitatory neurotransmitter that’s not good in excess concentrations. You’re also reducing oxidative stress and inflammation by giving it glutathione. As a result, this seems to help alleviate a number of different mental health conditions: depressed mood, schizophrenia, impulse control disorders, and substance use disorders. Studies indicate that people benefit from taking anywhere between 250 mg to 500 mg daily. Lower doses are better because high doses of NAC can sometimes redistribute heavy metals into the brain… this is not a good thing, so you obviously want to avoid that. You can take NAC with leucine, another amino acid, as taking leucine with it prevents mercury from being reabsorbed into the central nervous system. As always, please bear in mind that large placebo-controlled studies are needed to confirm the beneficial effects of NAC in mental health care, and to determine safe, optimal dosages for standalone or adjunctive treatment. But if you think it might be helpful, talk to your physician to determine if NAC is a good supplement choice for you. 

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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N-ACETYL CYSTEINE

N-Acetyl Cysteine

Hello, people! Last week, we finished up our discussion on the darker side of OCD and talked about the most difficult subtype to deal with, the pure hell of pure obsession OCD, aka Pure O. As promised, we’re back this week with a new topic, N-acetyl Cysteine, or NAC. NAC is an amino acid used by the body to build antioxidants. Antioxidants are vitamins, minerals, and other nutrients that protect and repair the body’s cells from damage, usually referred to as oxidative stress. Historically, NAC has been used mainly in emergency rooms to treat people who overdose on acetaminophen… I’ve ordered it innumerable times for this very purpose. These days, it can be purchased as a supplement OTC, and new studies have begun investigating its effectiveness as both a stand-alone and adjunctive treatment for depressed mood associated with depression, bipolar disorder, schizophrenia, OCD, and trichotillomania, as well as abuse and dependence on nicotine, Cannabis, and cocaine. And it has shown some promising results. 

Before we get to that, let’s talk about some things NAC does in the body. 

1. NAC is essential for making the body’s most powerful antioxidant, glutathione. Along with two other amino acids- glutamine and glycine- NAC is needed to make and replenish glutathione, which helps neutralize free radicals that can cause oxidative stress- damage to cells and tissues in your body. It’s essential for immune health and for fighting cellular damage, and some researchers believe it may even contribute to longevity. Its antioxidant properties are also important for combatting numerous other ailments caused by oxidative stress, such as heart disease, infertility, and some psychiatric conditions. More on those later.

2. NAC helps detoxify the body to prevent or diminish kidney and liver damage, helping to prevent deleterious side effects of drugs and environmental toxins. This is why doctors regularly give intravenous NAC to people with acetaminophen overdose. It’s usually organ failure that gets you in acetaminophen overdose, and NAC helps to prevent or reduce damage to the kidneys and liver, increasing the chances of survival. NAC also has applications for other liver diseases due to its antioxidant and anti-inflammatory benefits.

3. NAC helps regulate levels of glutamate, the most important neurotransmitter in your brain, and this may improve some psych disorders and addictive behavior. While glutamate is required for normal brain function, excess glutamate paired with glutathione depletion can cause brain damage. This state- excess glutamate with glutathione depletion- is commonly seen in certain psych disorders; specifically, it’s thought to contribute to bipolar disorder, schizophrenia, obsessive-compulsive disorder, and addictive behavior.

For people with bipolar disease and depression, NAC may help decrease symptoms and improve overall ability to function, and research suggests that it may also play a role in treating moderate to severe OCD. In addition, an animal study implied that NAC may minimize the so-called negative effects of schizophrenia, such as social withdrawal, apathy, and reduced attention span. NAC supplements can also help decrease withdrawal symptoms and prevent relapse in cocaine addicts, and preliminary studies show that NAC may decrease marijuana and nicotine use and cravings. Many of these disorders currently have limited or ineffective treatment options, so NAC may be an effective option for individuals with these conditions. More on this in a moment.

4. NAC can help relieve symptoms of respiratory conditions by acting as an antioxidant and expectorant, loosening mucus in the air passageways. As an antioxidant, NAC helps replenish glutathione levels in your lungs, and reduces inflammation in the bronchial tubes and lung tissue. People with chronic obstructive pulmonary disease (COPD) experience long-term oxidative damage and inflammation of lung tissue, which causes airways to constrict, leading to shortness of breath and coughing. NAC supplements have been used to improve these COPD symptoms, leading to fewer exacerbations and less overall lung decline. In a one-year study, 600 mg of NAC twice a day significantly improved lung function and symptoms in people with stable COPD. But those with chronic bronchitis can also benefit from NAC. Bronchitis is the term for when the mucous membranes in your lungs’ bronchial passageways become inflamed, restricting airflow to the lungs. Not much fun. By thinning the mucus in the bronchial tubes, while also boosting glutathione levels, NAC may help decrease the severity and frequency of wheezing and coughing in respiratory attacks. In addition to relieving COPD and bronchitis, NAC may improve other lung and respiratory tract conditions like cystic fibrosis, asthma, and pulmonary fibrosis, as well as symptoms of garden variety nasal and sinus congestion due to allergies or infections. Ultimately, NAC’s antioxidant and expectorant capacity can improve lung function in everyone by decreasing inflammation and breaking up and clearing out mucus.

5. NAC boosts brain health by regulating glutamate and replenishing glutathione. The neurotransmitter glutamate is involved in a broad range of learning, behavior, and memory actions, while the antioxidant glutathione helps reduce oxidative damage to brain cells associated with aging. Glutamate levels are subject to the three bears law: you need some, but too much isn’t good, as it’s an excitatory neurotransmitter. Because NAC helps regulate glutamate levels and replenish glutathione, it may benefit those with brain and memory ailments. The neurological disorder Alzheimer’s disease slows down a person’s learning and memory capacity, and animal studies suggest that NAC may slow the loss of cognitive ability in people with it. Another brain condition, Parkinson’s disease, is characterized by the deterioration of cells that generate the neurotransmitter dopamine. Oxidative damage to cells, and a decrease in antioxidant ability, contribute to this disease, and NAC supplements appear to improve dopamine function as well as disease symptoms, such as tremor.

6. NAC may improve fertility in both men and women. Approximately 15% of all couples trying to conceive are affected by infertility, and in nearly half of these cases, male infertility is the main contributing factor. Many male infertility issues increase when antioxidant levels are insufficient to combat free radical formation in the male reproductive system, leading to oxidative stress and cell death, culminating in reduced fertility. In some cases, NAC has been shown to combat this, improving male fertility. One condition that contributes to male infertility is varicocele. This is when veins inside the scrotum become enlarged due to free radical damage; surgery is currently the primary treatment. In one study, 35 men with varicocele were given 600 mg of NAC per day for three months post-surgery. The combination of surgery and NAC supplement improved semen integrity and partner pregnancy rate by 22% as compared to the control group with surgery alone. Another study in 468 men with infertility found that supplementing with 600 mg of NAC and 200 mcg of selenium for 26 weeks improved semen quality. Researchers suggested that this combined NAC/ selenium supplement should be considered as a treatment option for male infertility. In addition, NAC may improve fertility in women with polycystic ovary syndrome (PCOS) by inducing or augmenting the ovulation cycle which is altered by the condition. 

7. NAC may stabilize blood sugar by decreasing inflammation in fat cells. High blood sugar and obesity contribute to inflammation in fat tissue. This can lead to damage or destruction of insulin receptors, which puts you at a much higher risk of type 2 diabetes. When insulin receptors are intact and healthy, they properly remove sugar from your blood, keeping levels within normal limits. When the insulin receptors are damaged, blood sugar levels are more difficult to control. Animal studies show that NAC may stabilize blood sugar by decreasing inflammation in fat cells, keeping receptors happy, and thereby improving insulin resistance. That said, human research on NAC is needed to confirm these effects on blood sugar control.

8. NAC may reduce heart disease risk by preventing oxidative damage. Oxidative damage is caused by free radicals, and this type of damage to heart tissue often leads to heart disease, causing strokes, heart attacks, and other serious cardiovascular conditions.

NAC may reduce heart disease risk by reducing oxidative damage to tissues in the heart. It has also been shown to increase nitric oxide production, which helps veins dilate, improving blood flow. This expedites circulation and blood transit back to your heart, and this can lower the risk of heart attack. Interestingly, a test-tube study showed that when combined with green tea, another well recognized antioxidant, NAC appears to reduce damage from oxidized “bad” LDL cholesterol, another bigtime contributor to heart disease.

9. NAC and its ability to boost glutathione levels appears to increase immune function, boosting immune health. Research on certain diseases associated with NAC and glutathione deficiency suggests that immune function might be improved, and potentially even restored, by supplementing with NAC. 

This has been studied mostly in people with human immunodeficiency virus (HIV). In two studies, supplementing with NAC resulted in a significant increase in immune function, with an almost complete restoration of natural killer cells, the main patrol cells. High levels of NAC in the body may also suppress HIV-1 reproduction. A test-tube study indicated that in other immune-compromised situations, such as the flu, NAC may hamper the virus’s ability to replicate; this could potentially reduce the symptoms and lifespan of the associated viral illness. Other test-tube studies have similarly linked NAC to cancer cell death and blocked cancer cell replication. Great news, but more human studies are needed. 

This is a short blog, but that’s a good place to stop for this week. Next week, we’ll talk about how NAC may alleviate the symptoms of multiple psychiatric disorders, as well as reduce addictive behavior; and we’ll talk about some preliminary study findings as well. I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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Dark Side of OCD (Part 4)

The Dark Side of OCD

Hello, people~ welcome back to the blog! The last few installments, we’ve been talking about some of the more unusual subtypes or presentations of OCD. Last week, I told you about POCD, pedophilia OCD. This is a devastating harm based subtype that causes people to worry that they might be attracted to children, and could potentially act on that attraction. To reiterate, these are not predators that actually want to harm or molest children. They are simply- or not so simply- obsessed with the idea that they could. Somewhere along the line, that becomes locked in their brain due to the OCD, and they worry about it incessantly. As a result, they avoid all contact with children, and this can have a huge impact on family dynamics. It causes a great deal of shame and guilt for the person who has it, as they fear being judged by others, while always judging themselves very harshly. And it can also be very damaging to the children in that person’s life, since they miss out on the time and affection that person would have otherwise devoted to them. As you can imagine, all of these things often lead to a great deal of anxiety and depression, and many times, people with POCD suffer through it alone. This week, we’ll be continuing the series with a look at perfectionism. 

Perfectionism is a pretty self-explanatory subtype, the obsession with appearing and being “perfect.” Perfectionism is kind of an unusual trait. It isn’t unique to OCD; not all perfectionists have OCD, and not all people with OCD are obsessed with being perfect. But perfectionism underlies many OCD subtypes, as it can contribute to the need to do a ritual perfectly, or have things arranged just right. But when it’s extreme, perfectionism can really be thought of as its own OCD subtype; when it’s rooted in obsession(s), followed by compulsion(s), and causes dysfunction in the person’s life, it falls into a class of its own. 

Perfectionism can look very different from person to person, but there are some common overarching themes. Perfectionists feel the need to follow rules very rigidly. I’m sure you’ve heard the addage “Anything worth doing is worth doing right.” Some versions end with “well,” but this isn’t strictly true for perfectionists, it must be right. Things must be done in a certain way- perfectly- or not at all. This is tough to live up to at best, and the pressure to achieve this standard can become so great, that at times it’s far easier to give up on doing something altogether. In addition, perfectionists generally need to feel that they are in control of a situation at all times. By definition, they are excessively concerned with making mistakes, especially when other people could potentially see those mistakes. Ultimately, they think that these errors have some bearing on their overall value as a person, that they define them. They also tend to have an overwhelming need to please others. As a result, relationships with authority figures- people like bosses and parents- can be fraught with anxiety. Perfectionists also have trouble with prioritizing. They can’t make a list of five things they want to accomplish, and then decide which to give 100 percent effort to, 80 percent, and 50 percent. That doesn’t work for them, it’s very all or nothing. Every time they came across a task, whether it’s a strength of theirs or a weakness, whether they have expertise in it or not, they always feel like they must perform it at a high level.

There’s nothing wrong with doing things well, or with being very diligent and detail oriented. These are great qualities, and they work well for people, when they’re functional qualities. But when it gets in the way of getting things done- when it becomes dysfunctional- it’s a problem. I had a patient that was a student, a freshman in college, and he loved school. He was all about it, very intelligent, studied a lot, and worked so hard on papers and projects. Too hard as it turns out. He would begin a lab write up or a paper, but would edit as he wrote. He would then write more, then edit that; then he’d try to stitch them together and get frustrated. Ultimately, he’d have to start all over again. It just went on and on in this way, and it took him forever to do a very simple write up. Something that took his peers maybe a couple of hours tops would take him days of work, because it was nearly impossible for him to write it start to finish, then edit start to finish, a reasonable number of times. There was never an end point- he always felt it needed to be better- and was compelled to improve on it, so sometimes he simply couldn’t finish things. His brain just didn’t want to let him. 

Many years ago, I worked with young children in a hospital setting, with a wide array of diagnoses. One young girl, about nine years old, would undoubtedly have a diagnosis of perfectionism. I remember her very well, but her parents made an especially unique impression. When I gave them my assessment, it was quite clear that her being a perfectionist wasn’t a problem for them- this was written all over their faces. The mother especially, she had a little smile, almost of satisfaction or even pride. It was like I was telling them it was a good thing, or maybe too much of a good thing, like having too much money. She was a great student, very precocious, and a great kid, very meticulous. But if she did something imperfectly, if it didn’t meet her standards- which I suspect she may have learned from her mom, or her mom had a hand in planting- it was a problem. She would begin something with such enthusiasm, which was so great to see given her anxiety; but once she realized the task wasn’t going to be up to par, she would just give up and shut down. It was like watching a bright beautiful flower wilt and wither right in front of you. A sad thing at nine years of age.

This is basically a form of avoidance, which is a common compulsion for perfectionists. Better to totally blow something off than to not do it perfectly. Another example of this is something my student patient would do. If he was late for class, he couldn’t bring himself to go in. If he could see from the window that the professor had already started lecturing, and the students were all sitting there, facing front and listening, he would imagine how it would feel to open the door, and have all those heads turn to look at him. He couldn’t take that, everyone seeing his screw up, so he just wouldn’t go, he’d skip class. Then the next class, he was so concerned about showing his face after missing the previous one, it had a tendency to snowball. Even though he was smart and worked very hard, between his lack of participation in class and his issues in completing tasks, he ended up receiving poor grades, or even failing classes, with shocking regularity. 

Perfectionism is difficult for those with it to gain insight about, because it’s so engrained within their personality. They like to be focused, discerning, fastidious, and detail oriented. Sometimes it works well for them, but when it works against them, it takes much longer to realize it. All of this makes it hard to treat. Despite the suffering it causes, many times, patients initially resist the idea of abandoning their ways completely. And I get that. Some elements of perfectionism backfire, but there are parts that are beneficial, that help people reach their goals. You don’t want to necessarily eradicate it from their lives altogether, throw the baby out with the bathwater. I understand the hesitation. Somewhere in the dysfunction is function. In my student patient’s case, there were times he got A’s on papers. It took him 40 hours instead of two, but the end result was good, no argument there. So how do you find the happy medium, how do you eliminate the dys- from the functional in treatment? We want people to work hard, to be attentive, accurate, and competent. In treating it, and designing exposures, we don’t want to make a person act stupidly or underperform- proofing and editing is good if you don’t want to send out a paper to your professor, or letter to your boss, filled with typos. That would be nearly impossible to get them to do anyway, even if it was designed as an exposure to treat them. We don’t want to weed out the good parts, or necessarily challenge the outcome or the goal, but we need to challenge how they’re getting there. In the case of my student patient, the exposure would be to write without editing, start to finish, one draft, even if there were mistakes. Other ideas would be to show assignments to other people before they’re turned in, as well as to put max time limits on how long a project can take. Practice doing things well, instead of perfectly, to help them see that they can in fact deal with imperfection. That’s the true reality anyway- nothing is ever perfect. If you want perfection, to the point that you reject anything less than that, you’re going to end up rejecting things you shouldn’t, and missing out on a lot in the bargain.  

That makes me think of a book about OCD by Judith Rapoport called The Boy Who Couldn’t Stop Washing. It’s about a law school student with contamination obsessions that agonized over cleaning his apartment. He obsessed about how long the cleaning would take, and especially about how quickly it would get dirty again. He eventually started to avoid going home, so that its cleanliness would be maintained; it wouldn’t be disturbed by the messiness of his living in it. This escalated to the point that he wound up sleeping on a park bench, willingly homeless, all to avoid his apartment. This might seem radically counterintuitive. How could a person with contamination obsessions- who’s afraid of germs- stand to sleep outside, in a park, with all the dirt that goes with it, all for the sake of cleanliness? This is the dark side of OCD when you have perfectionism. 

I was thinking about positive perfectionism, and out of curiosity, read about the top career choices for perfectionists. Clearly, positive perfectionism can give a person a set of traits that can help them excel in life, especially in certain careers. Accuracy, attention to detail, persistence, conscientiousness, and organization lend themselves well to roles where design, math, and very complex procedures are essential to their tasks. Mechanics, inspectors, accountants, surveyors, tailors, and engineers would be top choices. Artists and creative types seem to suffer the most from perfectionism. Claude Monet, the highly celebrated French Impressionist, was a perfectionist… the perfectionist impressionist! I read that he was set for an exhibition in May of 1908, featuring his newest works, the result of three years of work. But when he took his final look, he decided the paintings weren’t good enough. Amid great protests, he took a knife and a paint brush to the paintings- worth $100,000 at the time- defacing them irrevocably. Today, they would be priceless. His actions prompted all sorts of ethics discussions; should an artist have the right to destroy his own work? Evidently at least one expert thought so, and actually praised him for being a true “arteest” and told the New York Times, “It is a pity, perhaps, that some other painters do not do the same.” A similar, but more tragic story is told in a book from 1886 called L’œuvre, translated as The Masterpiece. It tells the story of another artist who becomes obsessed with creating a large canvas that he worked on incessantly, but it never satisfies him. He kept painting on more and more layers, to the point that the canvas was destroyed. Then he would start over, again and again. He became so distraught and depressed that eventually, he went insane.

So how do you tell the difference between healthy and unhealthy perfectionism? The difference is when you move from a detail oriented, conscientious place, to a rigid and controlling one. When the ideas of perfection prevent you from doing anything at all, a healthy sense of perfectionism has been taken over by a dysfunctional one; putting you in a place where mistakes are catastrophic, where they say something about you, where you have to live up to other people’s expectations. This induces such anxiety that it becomes crippling, because eventually everything needs to be perfect- even things that other people would never even notice start needing to be perfect. Once again, the pressure from that becomes so intense, it’s easier to just forget it, to give in altogether. But in my view, the only way to truly fail at something is to not try at all. If you fail at something, it’s not because you’re not perfect, but because you didn’t try. Most perfectionists don’t subscribe to this; they seem to mostly have a fear of being average. They want to succeed perfectly, but if they’re going to fail, they’re going to do so spectacularly. A healthier point of view is to accept that nothing is ever perfect… but it won’t be anything if you don’t do it in the first place.

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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OBSESSIVE COMPULSIVE DISORDER (Darker Subtypes)

Hello, people! Welcome back to the blog, where we’re continuing our discussion of some darker OCD subtypes. Last week we talked about emotional contamination OCD, which is when people become obsessed with the idea that they may become “infected” by the thoughts or beliefs of another person. This can happen any number of ways; through air, electronic media, by touch, by talking about them, or even by being in the presence of someone who’s been in their presence. It’s difficult to deal with- trying to avoid this influence can become so consuming that it completely alters the course of a person’s life. This week, we’re going to talk about a particularly devastating subtype called pedophilia OCD, which features an obsession with the idea that you might be attracted to children, and could potentially act on that attraction. 

Before we get started, I want to make a very important distinction. People with pedophilia OCD or POCD are not people you need to hide your children from. They are not predators, and have no actual desire to molest children. They have an unusual form of OCD where an idea basically gets trapped in their brain, and because of the OCD, it gets twisted in such a way that they worry they may act on it. Maybe they see a news segment that gives details on a molestation case, or they read an article, or participate in a discussion; that may be all it takes. The idea of harming a child is as horrifying to them as it is to you and to me, but unfortunately, the OCD allows the possibility to take root. They wonder if their worry about pedophilia means they have desire. They fear they could act, and they obsess about the fear. It can be very debilitating. I’ve had patients that were so afraid of what they “could” do that they were often unable to get out of bed in the morning. They think these thoughts must mean something… why would they have them otherwise? It can be a real mind screw. 

Pedophilia OCD is an example of harm based OCD, and there may be many variations on that general theme. It may be a fear that they may hurt or kill strangers, or even parents or siblings. For any person with harm based OCD, the biggest fear is that they are dangerous. The object of harm can remain the same for years, or may change for no obvious reason. A patient I consulted on, a 20-something named Heidi, obsessed about harming her boyfriend. She would find herself worrying she might push him down the stairs, stab him with the carrot peeler, or run him over with her car. She worried about it for three years before she admitted it to anyone… three years! Can you imagine? Once she initiated therapy for that, the focus shifted to a pedophilia based fear; she worried she might molest her baby nephew. It was her first time as an aunt, and she loved the little guy. She didn’t want to hurt him, it was just her OCD talking to her, filling her head with nonsense. She constantly wondered ‘Am I attracted to this; do I want to molest him? Why did I have this thought? This must mean something about me…. this must be who I am.’

It was a nightmare for her. She couldn’t trust herself to be alone with her new nephew, and yet was understandably afraid to tell her sister she was having these thoughts. She wasn’t able to sleep at night, worried she would do something to him while everyone was sleeping. Eventually, she confessed what she was thinking to her mother. With her support, she was then able to talk to her sister, and then her whole family, who all supported her. Sadly, not all do; but she was able to turn to them to seek reassurance. This is a fairly common compulsion for people with stereotypical OCD- they compulsively need another person to tell them what they’re obsessing about isn’t true. Heidi would call her sister or mom and tell them when she was having these scary thoughts, and they would reassure her that she was a good person, she wasn’t going to molest him. It helped take the edge off, but only for about ten seconds. Then it was back to worrying. Remember that OCD is a disorder of doubt. Even after she was diagnosed with OCD, at the back of her mind, Heidi was even unsure if her thoughts came from that, or if it was truly something darker. 

Sometimes pedophilia OCD thoughts first center on a parent. People with it may wonder if perhaps they’re attracted to a parent, and/ or if they were molested as children, if something was done to them to cause the thoughts. That’s never happened in any of the cases I’ve been involved in, it’s simply the obsessive mind looking for reason. These thoughts torment people with pedophilia OCD, and many say that they thought they were going crazy before they were diagnosed with OCD. If their fears revolve around molesting children, they will do all they can to avoid them, and not even talk about them. When they can’t avoid the topic, their anxiety and uncertainty is multiplied. They will desperately review every movement they made around a child to help them figure out whether their actions were inappropriate, and they’ll constantly seek reassurance from loved ones, provided they’re aware of it. If not, they suffer alone. They know they would never hurt a child, but they can’t trust themselves, so they really need to hear it from someone else. Self-compassion is often non-existent, self-loathing is more the rule. They believe they should be able to control their thoughts. Since they can’t, they constantly judge themselves, and that often leads to depression. 

As you can imagine, it’s hard for them to seek treatment, because they’re afraid of being judged. They live in fear that family and friends will find out the “true” nature of their thoughts, and they’ll be ostracized, labeled as a pedophile, as disgusting or evil. People with POCD feel extreme shame and guilt for their thoughts. Most people don’t understand that pedophilia OCD is not the same as pedophilia. Imagine this: you see a kid and you’re like, ‘Awww, so cute!’ If you have POCD, your next thought is something like, ‘Oh, my god. Does that mean I’m a pedophile?’ Clearly, babies are cute, everyone knows that, nothing wrong with it. But the POCD tries to spin it, so if you have it, it makes you worry that you’re a deviant. 

Last week, I talked about exposure therapy for OCD, and POCD is treated the same way- it requires putting the person face to face with the ideas and “temptations” of pedophilia. Just reassuring them that they’re not a pedophile doesn’t work; they don’t believe it. Instead, people with POCD have to become comfortable with the uncertainty, with the risk that their very worst fears are true. Then they have to figure out how to live their lives despite that risk. POCD exposures might include going to a park where children are playing, or to a children’s store, maybe handling clothing. They could watch that pageant show with the nutty parents- might as well try to get a laugh while working on it. At some point, exposures might re-introduce behaviors the person has been avoiding- like having someone who has been avoiding changing a diaper or giving a bath start doing so again- even if it makes them anxious and fearful. As scary as it can be for them, not doing these things can be much more damaging to the children in that person’s life, since people with POCD often avoid giving affection, spending time, or caring for children because of their fears. Ideally, as exposures continue, the person begins to understand that what they’re afraid of isn’t true. The goal is for them to learn that they can trust themselves to do these things without molesting a child or hurting them in any way. As hard as it may be to get there, every patient I’ve worked with has been willing to do whatever it took to reach that realization. It may not make 100% of the obsessive thoughts stop, but it gives them the ability to call bs on them and keep it moving. 

Speaking of, that’s it for this week. Next week, another OCD subtype, perfectionism. 

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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Dark Side of OCD

Dark Side of OCD

Hello, people! Thanks for checking out the blog. Last week, I introduced a new series on unusual OCD subtypes, the darker side of OCD, with compulsions that go beyond the stereotypical examples most people think of. While doubt is still the core issue, people with these obsessions aren’t arranging their colored pencils, checking the light switches, or washing their hands until they’re red and raw. These obsessive thoughts often center more on function- am I swallowing correctly? Can I still blink? Those are examples of the first subtype we covered last week, hyperawareness OCD, also called sensorimotor or somatic OCD. This is an obsession with a part of the body, or with an involuntary bodily function. Breathing, blinking, and swallowing are the top three obsessions, but it can involve the location of a mole or freckle, placement of hands, or even how the skin feels, if it’s itchy, for example. This week, I’m going to cover another subtype, called emotional contamination OCD.

Contamination OCD generally revolves around the classic “feeling germy” or disease obsession. I have patients with this that may take 8 to 10 showers a day, sometimes more if they’re really “in it.” Others have to wear cotton gloves because they’ve washed their hands so much the skin has deep, angry cracks that bleed, yet they still worry they aren’t clean. But with emotional contamination OCD, the obsessive thoughts center on “catching” more abstract things from others, like ideas, values, and traits, as if they are infectious. They constantly ask themselves, what if being near this person causes me to lose my values and assimilate theirs… what if I start believing in what they believe in, instead of what I believe in? It’s a scary thought, right? Imagine having to worry that if you sit next to someone on a train to work, when you arrive, you might not think like you any longer, you might be infected with their thoughts. Will you even still know how to do your job? Yikes! What if you meet someone who’s immoral or a criminal? If you stand near them, touch them inadvertently, or sit in a chair they once sat in, those immoral thoughts may transfer to you, like a virus. You might start stealing things, or cheating on your wife. People with emotional contamination doubt the authenticity and stability of their thoughts. If a thought pops into their heads, it’s ‘did I think that? Or did I catch it from that person?’ And once the thought of contamination begins, it’s so hard to stop. 

The obsessive trigger may be a person, a geographical location, or an object, and by touching it, sitting near it, or even going to a place associated with it, people with emotional contamination OCD think they’ll somehow become contaminated with its essence. I had a patient we’ll call John. Great guy- a kid, really- who developed terrible emotional contamination. He was in college on a scholarship, and lived with a roommate, a guy named Mike, who was pretty successful academically as well. They were both business majors, so it sounded like a great setup. Well, as it turns out, Mike was successful because he was entitled and ruthless, and always took advantage of people that offered to help him. This didn’t sit well with John at all, he was a sensitive kind of guy, and he began to worry that he would start to think and act like Mike. He didn’t know why, but he found himself thinking about it constantly, obsessing about it. He was terrified that if he kept living with Mike, or even came into contact with him, that he’d become a ruthless user too. So he started avoiding him, and any friends who interacted with him. He stopped going to the coffee shop where he studied, the bars he frequented, and the restaurants where he ate. He even switched his major so that he and Mike wouldn’t have any crossover. If someone in one of his classes had taken a course in the business building- where Mike took classes- John would have to drop out of that class. Not only that, but he felt so contaminated that he had to throw away the books and study materials, and even the clothes he was wearing when he saw that person. Like many people with emotional contamination OCD, John felt that the traits could also spread through the air, through an association with other people, and even through the internet, so that anything and everything could really become contaminated at any time. 

Before long, John had to give up his scholarship and drop out of school. He continued to get rid of his belongings repeatedly- books, computer, clothes- it had to go if it had any prior affiliation with Mike. He had to move into a room above his parent’s garage, he couldn’t go into the main house because Mike’s name had been mentioned there. But Mike had never been discussed in that room, so that was a “Mike free” zone. When he tried to take classes online, he found that even the internet was contaminated by Mike, because his social media profiles were also on the web. When he reached the point where he was getting ready to move into another apartment in a town fifteen miles from his parents, and he was about to buy his fifth computer, he finally decided to get help, and came to see me. 

People with emotional contamination OCD feel compelled to avoid the person or idea that’s contaminating them, and that quickly becomes a gargantuan task. Not only does it spread through air, people, objects, and the internet, it can spread through language, so even hearing a word or phrase that sounds like the obsession can trigger the fear and feelings of danger. People end up avoiding television, newspapers, radio, the internet, computers- a constantly expanding circle of people, places, and things- completely isolating themselves to avoid any risk of a potential reminder of their obsession. Eventually, that circle can make it nearly impossible to function. 

Imagine you develop emotional contamination around Hershey, Pennsylvania. Very quickly, it wouldn’t be enough to just avoid that town; you wouldn’t be able to go to any towns surrounding it, either. Then you wouldn’t be able to eat Hershey’s chocolate bars, because they share the same name. Then, you’d have to avoid parts of the grocery store, because you’d see the chocolate bars. Then you realize, much to your horror, that Hershey’s makes other food products too, and you need to avoid them. Then you’re stuck in the grocery store for hours, reading labels to make sure you don’t have any contact with Hershey’s products. You can see how it swiftly becomes a big problem. And who knows when and where else you might randomly be triggered. Maybe you go to grandma’s and she asks you to get her favorite hot cocoa from the cabinet, and you discover it comes in a tin that says… you guessed it. You don’t think about the connections between things in life, until they cause you anxiety. When you have emotional contamination, you’re constantly thinking about exactly that, because you have to avoid certain things. But it’s difficult to completely avoid being triggered, even when you’re trying to.

Emotional contamination is rooted in what’s called magical thinking, a psychological concept that your thoughts, imagination, or beliefs will lead to something actually happening in the real world. The phenomenon is present in many subtypes of OCD, but is especially prevalent in emotional contamination. Sometimes people’s thinking can become so “magical” that emotional contamination OCD can even be misdiagnosed as psychosis if a therapist hasn’t dealt with it before. It can be difficult to get a handle on because it’s so nebulous, but the good news is that, like all types of OCD compulsions, emotional contamination can be treated using ERP therapy- exposure and response prevention therapy- which is considered the gold standard for OCD treatment. 

If you’ve ever tried to not think about something, you know how hard it is to control your thoughts. If I tell you don’t think about that dumb purple dinosaur Barney, and definitely don’t sing his silly song in your head. What are you doing right now? Are you singing “I love you, you love me, we’re a happy family…” Exactly. So ERP therapy takes the opposite approach; instead of trying to make yourself stop your obsessive thoughts, you welcome them, and deal with them. The concept behind it is that repeated exposure to the obsessive thoughts, and thus the discomfort that comes with them, affords you the best chance to avoid the compulsion and alleviate that discomfort. When you continually submit to the urge to do compulsions, it only strengthens the need to engage in them. But on the flip side, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to deal with them, and that generally leads to a reduction in anxiety. 

Because doubt and uncertainty are at the core of the obsessions, ERP gives you a chance to live with it, to experience it and get through it another way. During ERP therapy, you discuss and track your obsessions and compulsions, and develop a list of alternative ways to face your fears. A therapist then designs exposures, which slowly put you into situations that bring on your obsessions, and cause anxiety or discomfort. You respond, eventually, hopefully in a way that is not compulsory, and this reduces or eliminates the anxiety. In other words, you regain some control, so you prevent yourself from performing whatever compulsion you normally do, be it a physical or mental compulsion, and that eliminates the anxiety or discomfort. Get it? Exposure and response prevention. It can take time, but with continued exposures, you build toward reaching whatever goal you’ve set. ERP therapy can make a huge difference in an OCD patient’s life, and it has a decent success rate, about 80 percent. 

That’s a good place to stop for this week. Next week, another OCD subtype, one you won’t want to miss. I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in officeand on Amazon. 

Thank you and be well people!

MGA

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OCD SUBTYPES PART 1

The Darker Side of OCD

Hello, people! Last week we finished up our discussion on the importance of vitamin D, so I hope everyone spent a few minutes in the sun over the weekend to get a dose… gotta have it! This week, we’re starting another series on OCD, Obsessive Compulsive Disorder. What’s the first thing that comes to mind when you hear about OCD? It’s probably neatness, everything in its exact place, like making sure all the edges of the silverware are perfectly aligned in the drawer. Or maybe it’s repetitive hand washing, counting steps, or checking the locks on all the doors in the house. While those stereotypical obsessions are definitely common symptoms, in reality, OCD can involve any persistent, intrusive, obsessive thought that causes anxiety; it’s then generally paired with a behavior that attempts to quell that anxiety. But the scope of it can reach much further than worry over germs or counting and checking, as it is limited only by the person’s mind. Some obsessions are much darker, incorporating a person’s deepest darkest fears and worries. How about obsessing about killing your mother? All of your thoughts center on how you’d go about it, how it would feel. While these types of obsessions may be less common, they can clearly be much harder to talk about, and for that reason, can remain undiagnosed for years, even if a person seeks help. In the best case scenario, it can take an average of 14 to 17 years for people to find treatment, even though OCD usually emerges in childhood.

Think about having an obsession centering on a bodily function, let’s say swallowing. How many times do you swallow in a day, whether eating or drinking or not… ever noticed? Probably not, unless that happens to be an obsessive thought for you. Do you ever worry about the ability to swallow when you need to… do you doubt it? Can you imagine how debilitating something like that could be? And most people have more than one obsession that draws their focus. I did have a patient with OCD who thought he was Jesus, so all of his obsessions centered on that. He dressed like Jesus, wore his hair and beard like Jesus, and acted like Jesus- or how I imagine Jesus would act- with this “peace, brother” persona that he never dropped. He was court ordered, but totally harmless. The total effect was, well… honestly, kinda eerie. That could’ve been me- for some reason, it gave me flashbacks to confirmation classes as a kid. Anyhoo, he was so sure of his true identity that he would only date women named Mary. Yep. Sometimes in OCD, all of the obsessions are present in the mind at once, competing for attention, while at other times, one will take center stage, while the others wait in the wings. Depending on the year, the day, or even the minute, OCD can look completely different, even within one individual.

At its core, OCD is a disorder of doubt. A person can’t be sure that their thoughts aren’t indicative of something that may happen in real life. They can’t be sure of their safety, their intentions, their motives, or even their true realities. And yet, most people with OCD are completely, and usually painfully, aware that what they’re thinking isn’t true. For example, a person with a contamination obsession knows deep down that they don’t need to wash their hands for the 100th time, but they cannot get past the possibility that there could be germs lingering there. They’re haunted by the reality that there could be. Are those germs dangerous… could they make them sick, even kill them? That doubt is what they obsess over. So they continue to wash. When people find out what I do, at cocktail parties and the like, they’ll sometimes ask me, what’s the weirdest/ worst/ scariest symptom or diagnosis you see? Well, when it comes to OCD, there’s really no hierarchy to suffering- one obsession isn’t necessarily inherently worse than another- the worst obsession is the one that’s right now. Still, some forms of OCD are more challenging to deal with, diagnose, and treat. To start with, the content of some obsessions are so taboo that people simply won’t divulge it, so they suffer without finding the help they need. Sometimes they don’t even know that they have OCD, that that’s what’s driving these obsessive thoughts. So this week we’ll be talking about the darker side of OCD, examining some lesser known types you may have never heard of. 

Before we start, a note on these subtypes. Although all forms of OCD have symptoms in common, the way these symptoms present themselves in daily life differs a lot from person to person. Usually, OCD fixates around one or more themes, and some of the most common themes are contamination, harm, checking, and perfection. The content of a person’s obsessions isn’t ultimately the important part, though it’s certainly what feels important in the moment. Someone’s subtype is really just their manifestation of symptoms- the particular way their OCD affects them. What does the mind focus on, and what thoughts and actions result from this focus? Psych geeks like me call a condition like OCD “heterogeneous” because it varies so much from one person to the next, but there are a few common “clusters” of symptoms. There’s a lot of discussion about these symptom clusters, and even more debate about whether or not they should be classified as more specific categories or subtypes. But there are clear groups of obsessions and compulsions that pop up regularly in people with OCD. Many clinicians try not to talk about subtypes because there isn’t any real research backing them. They’re not perfect categories or neat little boxes you’re supposed to fit into, so if you have OCD, it’s not worth spending too much time trying to figure out which subtype you fit into if it’s not immediately apparent. That said, for lots of folks with OCD, the immediate recognition of their own experience in a list of subtypes is a powerful thing, and may actually be the start of the treatment process. 

So ultimately, I’ve chosen to go with calling these subtypes, but you can call them forms of OCD, or whatever you want, really. The point is that the symptoms seem to fall into groups naturally, and the info just needs to be out there so there’s more awareness of what lots of folks with OCD struggle with on a daily basis. Imagine that you’ve thought of yourself as truly- and totally uniquely- messed up for a long time. No way anyone has ever had the thoughts you have, or so you think. All of a sudden, you’re crusing the interwebs and see a list of symptoms that match yours exactly. Recognizing yourself in this OCD subtype, you’re not alone anymore- there are enough people like you out there to have your own type. Maybe you don’t have to feel hopeless anymore, because other people have clearly faced similar struggles, with similar types of obsessions and compulsions. There’s no realization that comes close to that kind of hope. Listing subtypes may be an imperfect way of categorizing OCD, because people may mistakenly think of them as distinct conditions rather than common manifestations of the same diagnosis, but I think it’s the way it should be. All of that said, keep in mind that there are hundreds of different ways OCD can show up in someone’s life- people don’t fit in boxes, they can have more than one subtype, and while the subtypes are relatively stable over time, they can change- new symptoms can appear and old ones might fade. Not a lot of rules when it comes to the brain’s capacity for imagination and change. So now, finally, we’ll begin discussing some unusual OCD subtypes, just to illustrate the mosaic of experiences associated with the diagnosis, and to illuminate some of what goes on in the OCD mind. 

Hyperawareness OCD

Hyperawareness OCD is an obsession with a part of the body, or with an involuntary bodily function. The patient I mentioned earlier, with the swallowing obsession, had hyperawareness OCD. It’s also called sensorimotor or somatic OCD. At any given moment, your brain, through your entire CNS, is sending and receiving signals about what different parts of your body are doing- like where your hands are, what your heart rate is, or if your stomach is empty or full. These are done subconsciously, so most people don’t pay attention to them. Everyone blinks and swallows, but very rarely do you give it any consideration. With sensorimotor OCD, a function like this can become an obsession. A person can get stuck in this place where they become hyperaware of some part of their body, or of the signal controlling it in their brain. I had a patient obsessed with blinking. Every morning, her first thought upon waking was to check to make sure she was still blinking, or still able to blink. And the thought persisted throughout the day… am I blinking now? It was consuming her life, not only was it the first thing she thought about, but also the last. She even kept herself awake with it, because she would close her eyes to sleep and would have to open them and make sure she could still blink. 

When anyone starts to think about things like involuntary processes- even for people without OCD- they can become heightened. If thinking about “it” makes it happen, and if “it” happening makes you think about it… well, you can see how easily this could lead to an obsession in the mind. To make matters worse, a lot of the anxiety in OCD lies in the person’s fear that they’ll never stop thinking about the blinking or swallowing, or whatever the obsession may be. And of course, the more they monitor it, the more they try to control it, the less automatic it feels, the more controlled it feels, and the more it seems like they’re never going to stop thinking about it. It’s a never ending cycle, and it produces a lot of other obsessions like, what if this drives me crazy, what if I never stop, if I’m permanently distracted by it? And in fact, my blinking patient also had a tendency for projection, so she imagined obsessing over blinking for the rest. of. her. life… ife… ife… ife…. I should point out that I make light of it, because one of the ways to combat an obsession is, oddly enough, to examine it in detail, so that includes looking at the futility of obsessing over an automatic bodily process that you cannot control… forever. It sounds counterintuitive, but dealing with it that way is a form of mindfulness- for those of you who read my blog on that many moons ago- examining whatever the thought may be, and the body part it involves, in an effort to soothe and assure. It can’t control it, but it can help lead to acceptance of the thought, which can take away its power. 

While sensorimotor OCD is relatively rare, in addition to blinking, the top three obsessions also include swallowing and breathing; but it can focus on the function of literally any part of the body. It can even involve non-functional parts, like the location of a mole or freckle, or hyperawareness of normal occurrences like itching or heart rate. As you can imagine, it can be very debilitating and isolating. My swallowing patient had a very hard time eating in front of anyone- these obsessions tend to be very self-propagating- and she was too anxious over being anxious about her swallowing. And it’s very difficult to talk about these symptoms, even with a therapist or a shrink, so unfortunately, people really suffer. It’s easier to just keep it simple and tell people that you have OCD and let them think you spend all your time straightening silverware or washing your hands, rather than risk being judged for the other manifestations. It’s a tough situation- while I understand it may be easier, it’s not necessarily better in the end. Some clinicians don’t understand sensorimotor OCD, or recognize that people with it have compulsions. Compulsions are the actions or rituals the person is basically “required” to complete in order to make the obsession, and therefore the resulting anxiety, stop. For instance, in contamination OCD, the obsession is germ exposure, and the compulsion is the continual hand washing. But in sensorimotor OCD, the compulsions are there, but they’re just not obvious. It’s more about the mental rituals taking place in sensorimotor, like reviewing or checking to see how that bodily sensation feels, or maybe trying to actively replace the obsessive thought with another thought. 

Given the lack of understanding, one of the biggest barriers to treatment is the isolation that the patients feel. Meds are helpful, and there are specially licensed therapists for treating serious OCD. Regardless of the subtype, treatment essentially the same. The gold standard of treatment is exposure and response prevention therapy, or ERP, which is sort of a combined approach. I’ll talk more about that later, but as with anything else, acceptance is key. If you’re a person that thinks about blinking, then you’re a person that thinks about blinking. Hopefully treatment stops that, but if it doesn’t, are you going to let it run your life? Once there’s acceptance, that then becomes the question, as opposed to being concerned about it. That’s where mindfulness comes in. If you pay attention to your blinking, then that’s one thing, but if you’re worried about it, that’s kind of pointless. You’ve proven you’re doing it right, and that your blink isn’t broken, about 18 times in the last minute alone. Did you know that that’s the average number of times a person blinks in one minute, 18? Sounds like a lot. Anyway, there’s a difference between watching your behavior in a mindful way, and not trying to change it, versus actively thinking about it and trying to figure out if you’re doing it the “right” way. Personal acceptance of anything means being less judgmental about the internal experience of it. Admittedly, it’s a lot easier said than done. There shouldn’t be any trivializing how upsetting it would be to think about blinking, or swallowing, or where a mole is. These things may seem banal to you, but they may be the center around which another person’s life revolves. When you think about accepting anything, but especially OCD, maybe just ask yourself, what would my patient Jesus do?  

Next week… more OCD subtypes! I hope you enjoyed this blog and found it to be interesting, and of course, educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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Personality disorders Cluster C

Hello people, welcome back to the blog! Last week, we finished with the Cluster B personality disorders, borderline, histrionic, and narcissistic personality disorders. This week, we’ll complete the entire series with the Cluster C “anxious and fearful” disorders: avoidant personality disorder, dependent personality disorder and obsessive compulsive personality disorder, not to be confused with obsessive compulsive disorder OCD. 

Avoidant Personality Disorder

AvPD or APD is characterized by extreme shyness, feelings of inadequacy, and extreme sensitivity to criticism. The key word here is avoid. People with AvPD are often unwilling to get involved with other people unless they’re certain they’ll be liked, otherwise, they’re not going to take the chance of being rejected. They’ll sooner avoid all social interaction than risk being ridiculed, humiliated, or disliked. They’re constantly preoccupied with how they’re being perceived, are hypervigilant of criticism, and may view themselves as not being good enough or socially inept. They typically avoid new activities or meeting strangers like the plague. For many of them, just the thought of something as simple as asking a stranger for the time is inconceivable. As a result of these constant fears, they’re extremely restrained, even in their intimate relationships. They can appear very socially awkward, not only due to lack of experience, but also because they tend to excessively monitor internal reactions, their own and everyone else’s, and this keeps them from engaging naturally in social situations. As with many personality disorders, a vicious cycle can take over in which the more they monitor their internal reactions, the more inept they feel; and the more inept they feel, the more they monitor their internal reactions.

Signs and symptoms of AvPD may include:

-Anhedonia, lack of pleasure in activities

-Self-isolation

-Severe anxiety in social situations

-Avoiding conflict, being a “people-pleaser”

-Avoidance of social interaction despite a strong desire for intimacy

-Avoiding interaction in work settings or turning down promotions

-Avoiding making decisions

-Avoiding situations due to fear of rejection

-Easily hurt by criticism or disapproval

-Extreme self-consciousness, lack of assertiveness

-Fearful and tense demeanor, lack of trust in others

-Constant worry about being ridiculed, shamed, or ‘found out’ and rejected

-Feeling inadequate, inferior, or unattractive

-Misinterpreting neutral situations as negative

-No close friends/lacking a social network

-Unwilling to take risks or try new things

AvPD affects about 2.5 percent of the population, with roughly equal numbers of men and women being afflicted. As you can probably guess, AvPD is strongly associated with anxiety disorders, especially social anxiety, and can be associated with actual or felt rejection by parents or peers in childhood. In fact, childhood emotional neglect and peer group rejection are risk factors for development of AvPD, but it can occur without any notable abuse or neglect history. Generally speaking, people with the diagnosis are typically very shy as children, but Captain Obvious says that not every child who is shy goes on to develop the disorder, and not every adult who is shy has it. We all have people, places, and things we don’t like, or which make us anxious, that we’d like to avoid. The difference lies in how the person experiences them. With AvPD, even just the fear of rejection or disapproval can be an extremely painful experience, and this makes them struggle to maintain relationships in their personal and professional lives.  

Dependent Personality Disorder

DPD is characterized by an inability to be alone. People with DPD rely on other people for comfort, reassurance, advice, and support regarding all areas of their lives. They develop symptoms of anxiety when they’re lacking these outside sources of guidance. They fear separation, and are most often described as clingy or needy. They are submissive and passive by nature, and allow others to direct their lives because they are unable to do so themselves. They tend to be indecisive and unable to take the initiative, allowing other people such as spouses or parents to make all the major life decisions, including where to live, what type of career to pursue, and where to work. They have difficulty initiating projects or doing things on their own due to a lack of self-confidence in judgment or abilities, as opposed to a lack of motivation or energy. Because of their reliance on others, they may not learn the skills of independent living, and this perpetuates their dependency. Being often preoccupied with the thought of being left to fend for themselves, if they ever do disagree with any decision made for them, they would rarely express it; they would simply adjust their opinion to match that of their champion for fear of abandonment. In fact, the idea of being alone may cause such discomfort that some will go to considerable lengths to secure and maintain relationships. As you can imagine, this can be a big problem if they get roped in with an individual who doesn’t have their best interests in mind. This can be a very dangerous and destructive situation, especially when they believe that they are under the protection of someone who they idealize as competent and powerful, someone who’s their hero champion, and towards whom they behave in a self-effacing and ingratiating manner. People with DPD often end up with people with a cluster B personality disorder, as the latter feed on the unconditional regard in which the former holds them. I’ve had many patients that have coupled up in this manner, and it can be an unholy nightmare to untangle. Generally speaking, people with DPD maintain a naïve perspective, and have limited insight into themselves, and certainly even less into others. This entrenches and perpetuates their dependency, leaving them vulnerable to abuse and exploitation.

Signs and symptoms of DPD may include:

-Difficulty making everyday decisions

-Requiring others to assume responsibility for most major areas of his or her life

-True fear of having to provide self-care or fend for themselves if left alone

-Submissive or clingy behavior

-Tendency for naiveté

-Lack of self-confidence, requiring excessive advice and reassurance from others 

-Instinctively agree with others for fear of disapproval

-Going to excessive lengths to obtain support from others, even if it includes unpleasant tasks

-Tolerance of poor or abusive treatment, even when other options are available

-Feeling uncomfortable, anxious, bored, or helpless when alone

-Difficulty doing projects due to lack of confidence in abilities

-Urgent need to start a new relationship when a close one has ended

People with DPD normally first show signs in early to mid-adulthood, and males and females are generally equally diagnosed. True DPD is somewhat rare, with an estimated prevalence ranging from 0.49 to 0.6 percent. People with DPD are very prone to separation anxiety, and can become devastated when relationships and friendships are severed. When alone, a person with DPD may experience severe anxiety, panic attacks, and hopeless despondence. Clearly, some of these symptoms are the same for people with anxiety disorders, but people with medical conditions such as depression or even menopause may also experience some of these symptoms. Some factors that might contribute to the development of this disorder include having a history of a neglectful or an abusive upbringing, having overprotective or authoritarian parents, and

having a family history of anxiety disorders.

In addition, having a diagnosis of separation anxiety disorder or a history of chronic illness during childhood can increase the risk of developing DPD. Most people deal with feelings of insecurity at some point in their lives. It’s natural and perfectly normal to need other people to care for us or give us reassurance at times. The difference is that people with DPD require reassurance from others to simply function in their daily lives. A healthy balance involves being able to both depend on others as well as being independent enough to fend for oneself.

Obsessive Compulsive Personality Disorder

Aka Anankastic Personality Disorder

OCPD is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control, even at the expense of efficiency. People with OCPD have an obsessive need to follow rules and regulations, and they have a strict moral and ethical code from which they will not deviate… they’re always right. They often have such a level of perfectionism that they cannot finish tasks because they become too fixated on the details. They generally have an unwillingness to delegate or share tasks, unless the person they’re working with agrees to perform them exactly as they ask. They may be so preoccupied with details and order that the major point of the activity is lost. The rigidity that accompanies having OCPD often interferes with the person’s ability to relate to others and vice versa. While they can often improve their quality of life if they seek treatment, they rarely perceive that there’s a problem, so the condition tends to go untreated. As you can imagine, people with OCPD can be extremely difficult to work with or have a relationship with because they typically only see things their way. They believe that their approaches are the best way, and usually cannot understand another person’s point of view. They are often excessively devoted to work and productivity, to the exclusion of leisure activities and friendships. They generally have a miserly spending style toward both themself and others; money is something to be hoarded for future catastrophes. They are often unable to discard worn-out or worthless objects, even when they have no sentimental value. OCPD should not be confused with OCD, obsessive compulsive disorder. While some mannerisms and compulsions are similar, there is a BIG difference: people with OCD are aware that their compulsions are illogical, while people with OCPD are not. In fact, in their way of thinking, their thinking is logical, and if other people followed their rules, everything in their life would be fine. Just ask them, they’ll tell you… sometimes you don’t even have to ask! The problem comes in especially when rules and procedures don’t dictate the correct answer; decision making can become a painful, time-consuming process. In this case, the person with OCPD may have such difficulty deciding which tasks take priority or what’s the best way of doing a certain task, that they may never get started on anything, let alone finish. They’re prone to anger in situations in which they’re unable to maintain control of their physical environment, although they don’t typically express it directly. They’ll often find a more passive aggressive way to express it; for example, leaving a poor tip at a restaurant instead of speaking to management. When anger is expressed, it’s usually done with righteous indignation, often over a seemingly minor matter.

Signs and symptoms of OCPD may include:

-Overwhelming need for order and perfection, such that it interferes with task completion 

-Fixation on organization, detailed schedules, list making 

-An overwhelming need to be punctual

-Strict personal moral and ethical codes

-Excessive devotion to work at the expense of family or social relationships

-Often seen as ungenerous or frugal

-Display hoarding behaviors, such as refusing to throw things away

-Significant rigidity and stubbornness

-Inability to share or delegate work due to fear it won’t be done right

-Often feel righteous, indignant, and angry

-Socially isolated

-Stiff, formal, or rigid mannerisms

In relationships, people with OCPD are very aware of their relative status, and they tend to display excessive deference to an authority they respect, and excessive resistance to an authority they don’t. When they express affection, it’s done in a very controlled manner, and they’re very uncomfortable when they’re around other people who are emotionally expressive. Their everyday relationships have a formal quality to them, and they’re usually very stiff in situations where most others are smiling and happy. They’re often so preoccupied with logic and intellect, they tend to carefully hold themselves back in conversations until they’re sure that whatever they say will be the perfect thing. 

As with most personality disorders, the intensity of OCPD symptoms will decrease with age, and the most extreme symptoms have usually nearly ceased by the time the majority of people are in their 40s or 50s. OCPD is approximately twice as prevalent in males than females, and occurs in between 2.1 and 7.9 percent of the general population, making it the most prevalent personality disorder. A childhood with very controlling or protective parents or caregivers, or one in which they were often unavailable, may increase the risk of developing OCPD. But Captain Obvious says a person may have OCPD without any of the above factors as causes. In some case studies, adults can recall experiencing OCPD from a very early age. They may have felt that they needed to be a perfect or perfectly obedient child. This need to be good and follow the rules then carries over into adulthood. People with OCPD often experience anxiety that occurs with depression; and OCPD is generally seen as a coping mechanism, a way for the person to establish order in their lives and deal with their feelings. People experiencing OCPD often don’t recognize that their behavior is problematic, so they generally take some convincing before they agree to seek treatment. This can be very overwhelming to family members, especially if they’re dealing with constant criticism. The good news is that with time and treatment, many people with OCPD can find the motivation to change.

Personality Disorder not otherwise specified 

Each person is an individual and behaves in unique ways, so not everyone fits neatly into the personality disorders I’ve discussed. If a person doesn’t have enough symptoms to fully meet the criteria of a specific type, PD-NOS is the diagnosis used in this case. This may also be known as personality disorder trait specified PD-TS. These names can sound like opposites, but they both focus on the fact that the person has some personality disorder traits, but not enough of one specific type to fit in the box.

And as for personality disorders, in the words of Porky Pig… that’s all folks! 

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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Personality Disorders

Personality Disorders

Hello people, I hope everyone had a great holiday weekend! Did everyone set off a bunch of fireworks? Did you grill some burgers or dogs, have some baked beans, and a scoop of potato salad? Top it off with some apple pie? Me neither. Can I just ask, why do people shoot off fireworks on Saturday day, like before the sun sets? Are they testing them to see if they’re loud enough? Just wondering. Maybe they can’t wait. Anyhoo, last week, we talked about Antisocial Personality Disorder, the first Cluster B personality disorder, the dramatic and erratic disorders. If you recall, ASPD is the official diagnostic term for the colloquial terms sociopathy and psychopathy. That’s the big takeaway. So this week, we’ll be continuing with the Cluster B’s with Borderline Personality Disorder. 

Borderline Personality Disorder

BPD is also sometimes called Emotionally Unstable Personality Disorder, or EUPD, but I prefer Borderline. It always reminds me of that 80’s song. BPD is the most commonly diagnosed personality disorder, and was so called, because it was thought to lie on the “borderline” between neurotic disorders (meaning anxiety disorders) and psychotic disorders, such as schizophrenia and bipolar disorder. BPD is characterized by difficulties in regulating emotion. People with BPD experience big mood swings, and they feel a great sense of instability and insecurity. They feel emotions very intensely, often for extended periods of time, and it’s generally harder for them to return to a stable baseline after an emotionally triggering event. This difficulty can lead to impulsivity, poor self-image, and intense emotional responses to stressors. Struggling with self regulation and having a poor self-image essentially equates to a lack of a sense of self, and as a result, they often experience feelings of emptiness and extreme fears of abandonment, whether these are real or just perceived. They generally have a pattern of instability in their relationships, and there can be violence involved, especially in response to criticism. These unstable personal relationships often involve “splitting,” where the person alternates between idealization “I’m so in love!” and devaluation “I hate him!” Suicidal threats and acts of self-harm are common, and this is how and why many people with BPD frequently come to medical attention. Extreme stress responses can lead to dissociative feelings, meaning they feel disconnected from their thoughts or themselves, have “out of body” type feelings, potentially even psychotic episodes. They basically check out, and may not remember these events well afterwards. 

BPD signs and symptoms may include:

-Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, reckless driving, gambling, overuse of substances, and binge eating

-Distorted and unstable self-image affecting moods, values, opinions, goals, and relationships

-Wide mood swings, often as a reaction to interpersonal stress

-Unstable and intense relationships

-Suicidal behavior or threats of self-injury

-Intense fear of being alone or abandoned, may be real or imagined

-Periods of intense depressed mood, irritability, or anxiety lasting a few hours to a few days

-Ongoing feelings of emptiness

-Frequent, intense displays of anger, often followed by shame and guilt

-Stress-related paranoia that comes and goes; when stress is severe, it can lead to brief psychotic episodes

It has been suggested that BPD often results from childhood sexual abuse, and that it is more common in women, in part because women are more likely to suffer sexual abuse. However, some argue that BPD is more common in women simply because women presenting with angry and promiscuous behavior tend to be labeled with it, whereas men presenting with similar behaviors tend instead to be labeled with ASPD, Antisocial PD. More recent research seems to back this up. Women are more likely to receive the diagnosis, because it is commonly thought of as a “female” disorder, even though there’s no such thing. In fact, of the estimated 1.4 percent of the adult U.S. population with BPD, nearly 75 percent of them are women.

Histrionic Personality Disorder

HPD is characterized by a pattern of excessive emotion and attention seeking. People with HPD generally like to be the center of attention at all times, and may actually be uncomfortable when they’re not. They often use physical appearance to draw attention to themselves, are often flirtatious, and can employ exaggerated or rapidly shifting emotions as a means to reach this goal. The surprise is that they usually lack a sense of self-worth, and they depend on attracting this attention to seek the approval of others in order to boost their wellbeing. They often seem to be dramatizing or playing a part in a bid to be seen and heard. The word “histrionic” is derived from the Latin histrionicus, meaning “pertaining to the actor.” People with HPD may take great care of their appearance, and behave in a manner that is overly charming or inappropriately seductive. Because they crave excitement, they tend to act on impulse and are easily suggestible, and they may place themselves at risk of an accident, or fall prey to exploitation. Their dealings with others often seem insincere or superficial, and in the long term, this can adversely impact their social and romantic relationships. They find this to be especially distressing, as they are very sensitive to criticism and rejection, and they react very poorly to loss or failure. It can result in a vicious cycle in which the more rejected they feel, the more histrionic they become, and the more histrionic they become, the more rejected they feel. Achieving any emotional or sexual intimacy may be difficult, and they may play a victim role, potentially without being aware of it. They may also try to control their partner using seduction or emotional manipulation, while becoming very dependent on them. They tend to be too trusting, especially of authority figures who they think may be able to solve all their problems. They often think relationships are closer and more intimate than they really are. They crave novelty and tend to bore easily, so they may change jobs and friends frequently. Delayed gratification is very frustrating to them, so their actions are often motivated by obtaining immediate satisfaction. 

HPD signs and symptoms may include:

-Constantly seeking attention

-Into instant gratification

-Excessively emotional, dramatic, or sexually provocative to gain attention

-Excessive concern with physical appearance

-Speaks dramatically with strong opinions, but few facts or details to back them up

-Makes rash decisions

-Easily influenced by others

-Shallow, rapidly changing emotions

-Believes relationships with others are closer than they really are

-Gullible and easily influenced by others

-Excessively sensitive to criticism or disapproval

-Low tolerance for frustration, easily bored by routine, often beginning projects without finishing them or skipping from one event to another

-Self-centered, rarely showing concern for others

-Good social skills, but use them to manipulate others, to be the center of attention

The estimated prevalence of HPD is less than 2 percent of the general population. It is usually evident by early adulthood, and is diagnosed more often in women than in men, but this may simply reflect the higher prevalence of women in clinical settings. There is a clear tendency for HPD to run in families, which suggests a genetic susceptibility, but the child of a parent with the disorder might simply be repeating learned behavior. Other environmental factors that might be involved include a lack of criticism or punishment as a child, and unpredictable attention given to a child by his or her parent(s), which tends to lead to confusion about what types of behavior earn parental approval.

Narcissistic Personality Disorder

NPD is characterized by an extreme feeling of self-importance, a sense of entitlement, and a need to be admired. The person is envious of others, and expects them to be the same of him. They typically lack empathy, and readily lie, exploit, or take advantage of others to achieve aims. To others, they may seem self-absorbed, controlling, intolerant, selfish, and/ or insensitive. If they feel ridiculed or obstructed, they can become very angry and even vengeful. Fueled by a belief that they’re special, and more important than others, they can have a reaction called “narcissistic rage,” which can have disastrous consequences for all involved. It’s human nature to be aware of and express our own needs, as well as want others to be aware of our abilities and achievements. These aren’t bad things, but people with NPD take this to the extreme. At the heart of it, they have fragile self-esteem, so they rely on others to recognize their worth and their needs. They are generally unhappy and disappointed when they’re not given the praise or special favors they believe they deserve. This can cause problems in all areas of life, work

school, and relationships. People with NPD usually put themselves on a pedestal, where they can look down on others and direct them, as they believe they are better than. They exaggerate their own talents and accomplishments, while downplaying those of others. They are usually preoccupied by power, success, and beauty, and may engage in impulsive behaviors, such as risky sex and gambling, in their pursuits of these goals.

NPD signs and symptoms may include:

-Fantasies about power, success, and attractiveness

-Entitled, conceited, snobby

-Exaggeration of achievements or talents

-Expectation of constant praise and admiration

-Exaggeration of intimacy with others, especially those with wealth or VIP status

-React negatively to criticism

-Show great charm but quickly become irritated or angry

-Talking at length about their own concerns but lacking interest in those of others

-Show aggression when faced with a threat to their ego

-Resent the successes of other people

-Arrogant, dismissive, or unaware of other people’s needs

-Perceived superiority that covers a deep seated insecurity

-Unreasonable expectations of favors and advantages

-Envy of others accompanies belief that others envy them

-Unfulfilling relationships; become unhappy, angry, and confused when things don’t go their way

-Typically have ongoing issues with work, school, relationships, finances, alcohol, substances

Research indicates that NPD affects 6.2 percent of the U.S. population, and is much more common in men than women, affecting 7.7 percent of men and 4.7 percent of women. There may be cultural influences associated with NPD, but this may be a stereotype. Diagnosing NPD specifically can be challenging, as the features tend to have so much overlap with other disorders. In addition, a person with NPD may not recognize that problems in their life stem from their own behavior, and they may blame others instead. Narcissists can be especially difficult to deal with. I’ve done a lot of family counseling for it, but the person with the diagnosis must accept it to make headway. Some NPD traits may appear similar to confidence, but healthy confidence and NPD aren’t the same thing. People who have healthy self-esteem are usually humble, while people with NPD, by definition, never are. It takes a lot of work on the patient’s part to modify behavior, but it can be done with sufficient motivation.

That’s the end of Cluster B Personality Disorders. Next week, we’ll tackle Cluster C disorders. 

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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Personality Disorders

Personality Disorders

Hello people, welcome back to the blog, people! I hope everyone had a fantastic father’s day. Last week, we started getting into the signs and symptoms of personality disorders. We talked about the Cluster A odd and eccentric disorders: paranoid, schizoid, and schizotypal personality disorders. This week, we’ll be getting into Cluster B disorders, the dramatic and erratic disorders. 

Cluster B disorders are characterized by overly emotional or unpredictable thinking or behavior, and include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. People with these disorders typically have difficulty regulating their emotions, as well as maintaining relationships, as others often see their behaviors as threatening or disturbing. Treating any personality disorder is challenging, but Cluster B has some of the most difficult to treat disorders for a variety of reasons, not the least of which is the stigma associated with the diagnosis. Another factor has to do with the affected person’s propensity to give an inaccurate account of signs and symptoms. These can be especially true for antisocial personality disorder or ASPD.

Antisocial personality disorder is characterized by a pervasive pattern of disregard for the rights of others. People with this disorder consistently show no regard for right and wrong, and ignore the feelings of the other people around them. This generally begins in childhood or early adolescence and continues into adulthood. After treating many people with ASPD, I can tell you that they can be the most charming, entertaining, witty, and fun to be around people you’ll ever meet. But in severe cases, they can live to exploit others in something akin to sport. ASPD makes people uncaring. They can act rashly, unsafely, and destructively, without an ounce of guilt when their actions hurt other people. That may even be the goal. They tend to be callous, cynical, and contemptuous of the feelings of others. They can be very manipulative, and due to these tendencies, it’s often difficult to tell whether they’re lying or telling the truth.

Speaking of, let me correct a myth. Two common terms affiliated with ASPD are psychopath and sociopath, but these terms are not interchangeable. Neither psychopath or sociopath are actual diagnoses in the world of psychiatry. They are colloquial terms to describe people with impulsive or reckless personalities who lack empathy for others. A psychopath is someone whose actions more tend to reflect calculation, manipulation, and cunning. They are deceptively charismatic and charming, and tend to mimic rather than experience emotions. They can do so with ease, as this is their stock in trade. By contrast, sociopaths are more able to form attachments to others, but they still tend to act insensitively, or in an unfeeling manner, and generally disregard social rules. They are also more easily agitated, and have a tendency to be more impulsive. Psychopaths are usually thought of as more deviant and violent, and less likely to blend into society than sociopaths. Everyone has their own definitions of the words psycopathy and sociopathy, and they probably come from movies and television. In reality, in the world of psychiatry, both carry a diagnosis of ASPD, and psycopathy is just a very severe form of ASPD. These are the individuals I was referring to that can be the most charming. Believe me, they make it easy to want to lower your guard, but with some, you may do so at your peril. 

ASPD signs and symptoms may include:

-Disregard for right and wrong

-Persistent lying or deceit to exploit others

-Callous, cynical, and disrespectful of others

-Criminal behavior

-Applying charm or wit to manipulate others for personal pleasure

-Arrogance, a sense of superiority, extremely opinionated

-Lack of compassion and empathy for others

-Unremorseful when confronted with wrongdoing

-Inability to admit mistakes

-Bullying demeanor, use threats to deal with personal conflict

-Impulsiveness or failure to plan ahead

-Unnecessary risk-taking or dangerous behavior 

-No regard for the safety of self or others

-Instability when it comes to work and home life

-Hostility, irritability, agitation, aggression, intimidation, violence

-Consistently irresponsible and repeatedly fail to fulfill work or financial obligations

-Mental health issues, may include talk of suicide or threatening suicide

ASPD affects approximately 2 to 4 percent of the population, often occurs alongside problems with drugs and alcohol, and is much more common in men. Some research has suggested when ASPD does develop in women, the condition may become more severe; and women with ASPD are even more likely to abuse substances than men. That said, research also indicates antisocial behavior may persist longer in men, and men with ASPD have an increased risk of early death. People with ASPD frequently fail to consider the negative consequences of their behavior, and they don’t generally learn from them either. In addition, they often violate the law, and behave violently or impulsively, becoming criminals. They are commonly unable to fulfill daily responsibilities related to family, school, or work. For all of these reasons, the highest prevalence of ASPD- 70 percent- is found among males who are in jails, prisons, or similar institutions. 

The risk factors associated with ASPD have been better studied than some of the other personality disorders. The genetic component applies, especially family history of ASPD or another personality disorder. But of note, adults with ASPD typically show symptoms of another disorder in childhood called conduct disorder, before the age of 15. Signs and symptoms of conduct disorder include serious, persistent behavioral problems, such as aggression toward people and animals, serious violation of rules, destruction of property, lying, cheating, and theft. Although ASPD is considered lifelong, in some people, there are certain symptoms- especially destructive and/ or criminal behavior- that may decrease over time. It’s not very clear on whether this is due to aging, or an increased awareness of the consequences of their behavior. Speaking of, some of the complications associated with ASPD can include homicidal or suicidal behaviors, low social and economic status, homelessness, and premature death, usually as a result of violence. Behaviors have consequences, that’s the lesson many people with ASPD fail to learn. 

Like anything else, symptoms occur on a spectrum, and vary in severity. ASPD doesn’t have to mean a person is violent or evil. The stigma associated with personality disorders in general, and ASPD in particular, may make it even more difficult for people who want to improve to get the help they need. More than 90 percent of people diagnosed with ASPD also live with another mental health issue, most often depression and/ or anxiety. Early intervention may be the key to treatment, so the ability of caregivers and educators to spot childhood conduct disorder is important. Negative attitudes toward “delinquents” may reinforce ideas such as, “I’m bad,” “I’ll never amount to anything,” or “No one cares what happens to me,” and these play a role in the development of ASPD. 

When people with ASPD do enter treatment, it’s more often to get help for a co-occurring condition, or because a legal authority or family member has required to do so. Among those who do get help, many drop out of treatment early. Negative attitudes and ineffective treatment methods can contribute to this. It’s important for people with ASPD to work with therapists who are willing to try a range of approaches to find the most effective treatment. A key factor in successful therapy is recognizing individual fault. People with ASPD who can’t admit or accept that their actions are harmful may not be able to improve. Exploring state of mind, including emotions, desires, and feelings toward others is critical for progress. Once the person better understands their thoughts, they can use this understanding to address their impulses, and potentially help control them. Research has shown treatment can help improve many of the behaviors associated with ASPD, with the strict caveat that the person is willing to work toward change. When successful, treatment not only improves the quality of life for the person with ASPD, it also has a positive impact on the people in their lives. 

Next week, we’ll continue with cluster B disorders, starting with borderline personality disorder.

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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Personality Disorder Part 3

Personality Disorders, part 3

Hello, people! In last week’s blog, we talked about the cause of personality disorders, sort of the nature versus nurture debate, and how both genetics and environment play a role in developing these disorders. We also discussed some of the requirements for diagnosis: how the maladaptive behaviors or personality traits must be relatively stable over time and consistent across situations; that they must cause significant impairment in self and interpersonal functioning; and that they cannot be a result of the direct effects of a substance or general medical condition. Each of the ten disorders has its own set of diagnostic criteria based on the various signs and symptoms typically exhibited. And that’s what we’ll be getting into today- the signs and symptoms of personality disorders.

As I mentioned before, the DSM-5 allocates each of the ten personality disorders to one of three groups or clusters, A, B, or C, based on similar characteristics and symptoms. Many people with one personality disorder also have signs and symptoms of at least one additional personality disorder, and it is usually within the same cluster. I should note that it’s not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed. So let’s get started on the first cluster.

Cluster A Personality Disorders

These are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

Paranoid Personality Disorder

PPD is defined by mistrust and suspicion so intense that it permeates thought patterns and behavior, interfering with daily functioning. A person with PPD feels very wary of others, believing that they want to harm them. They are always on guard for signs that someone is trying to threaten, mistreat, or deceive them. No matter how unfounded their beliefs, they may repeatedly question the faithfulness, honesty, or trustworthiness of the people around them, whether they are friends, family, spouse, and/ or lovers. They may be defensive or sarcastic, which may elicit a hostile response from others. This response, in turn, then seems to confirm their original suspicions, reinforcing their beliefs. When they perceive they’re being persecuted, rejected, or slighted, they’re likely to respond with hostility, angry outbursts, and/ or controlling behavior; and they often deflect any blame onto others. Their fearful and distrustful perceptions make forming and maintaining close relationships very difficult. In addition, they’re often able to find and exaggerate the negative aspects of any situation or conversation, which also strains relationships. These qualities affect their ability to function at home, work, and school. Because of these symptoms, the condition often results in social withdrawal, tenseness, irritability, and lack of emotion.

Common PPD symptoms include:

-Suspecting, without justification, that others are trying to exploit, harm, or deceive them.

-Doubting or obsessing on the lack of loyalty or trustworthiness of family, friends, and acquaintances.

-Refusing to confide in people for fear that any information they divulge will be used against them.

-Becoming detached or socially isolated 

-Interpreting hidden, malicious, demeaning, or threatening subtext or meanings in innocent gestures, events, or conversations.

-Having trouble working with others, being argumentative and defensive.

-Being overly sensitive to perceived insults, criticism, or slights. 

-Quickly feeling anger, snapping to judgment, and holding grudges.

-Responding to imagined attacks on their character with anger, hostility, or controlling behavior.

-Repeatedly suspecting, without basis, their romantic partner or spouse of infidelity.

-Having trouble relaxing due to an inability to let their guard down.

PPD affects approximately 1 to 5 percent of people worldwide, though I’ve seen estimates of up to 10 percent. It often first appears in early adulthood, and is more common in men than women. Research suggests it may be most prevalent in those with a family history of schizophrenia. Despite being one of the most common personality disorders, PPD can be difficult to detect until symptoms progress from mild to more severe. This is because most people behave in mistrustful, suspicious, or hostile ways at some point in their lives without warranting a diagnosis of PPD. Spotting the signs can be further complicated as it often occurs with another mental health problem, such as an anxiety disorder, obsessive-compulsive disorder (OCD), substance abuse, or depression. When people with PPD have other diagnoses, it can compound their PPD symptoms. For example, depression and anxiety affect mood, and shifts in mood can make someone with PPD more likely to feel paranoid and isolated.

Professional treatment can help someone with PPD manage symptoms and improve their daily functioning. But due to the very nature of the disorder, most people with PPD don’t seek help, as they don’t see their suspicious behavior as unusual or unwarranted. Rather, they see it as rational. They are defending themselves against the bad intentions and deceptive, untrustworthy activities of those around them. As far as they’re concerned, their fears are justified, and any attempts to change how they think only confirms their suspicions that people are “out to get them” in some way. In addition, their intense suspicion and mistrust of others often includes mental health professionals. They question their motives in trying to help, and it can take a fair amount of time to build enough trust so they feel comfortable confiding in them and following their advice. 

Schizoid Personality Disorder

The term “schizoid” indicates a natural tendency to direct attention toward one’s inner life and away from the external world. Please note that while their names sound alike, and they might have some similar symptoms, schizoid personality disorder is not the same thing as schizophrenia. People with schizoid PD tend to be distant, detached, aloof, and more prone to introspection. They often choose to be alone, and have little to no desire for social or sexual relationships. In addition to being indifferent to other people, they are also indifferent to social norms and conventions. They seem to not care about external praise or criticism, and commonly demonstrate a lack of emotional response. They are generally “loners” who prefer solitary activities. Many people with schizoid personality disorder are able to function fairly well, although they tend to choose jobs that allow them to work alone, such as night security officers, library, or lab workers. 

A competing theory about people with schizoid PD is that they are in fact highly sensitive with a rich inner fantasy life. That they experience a deep longing for intimacy, but find initiating and maintaining close relationships too difficult or distressing, and as a result, choose to retreat into their inner world, which they create with vivid detail. 

Common Schizoid PD symptoms include:

-Lack of interest in social or personal relationships, preferring to be alone

-Limited range of emotional expression

-Inability to take pleasure in most activities

-Inability to pick up normal social cues

-Difficulty relating to others

-Appearance of being cold or indifferent to others

-Little or no interest in intimacy or in having sex with another person

-May commonly daydream and/or create vivid fantasies of complex inner lives.

-Often reclusive, organize life to avoid contact with other people

Available statistics suggest that between 3 to 4 percent of the general population has schizoid PD, though it’s very difficult to accurately assess the prevalence, because people with schizoid PD rarely present for medical attention. This is because they generally function so well, and their preferences have few or no negative legal or societal consequences. Schizoid PD usually begins in late adolescence or early adulthood, affects men more often than women, and is more common in people who have close relatives with schizophrenia.

Schizotypal Personality Disorder

STPD is characterized by oddities of appearance, behavior, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen in schizophrenia. People with STPD have a higher than average probability of developing schizophrenia, and the condition used to be called “latent schizophrenia.” Their anomalies of thinking can include odd beliefs, suspiciousness, obsessive ruminations, and magical thinking, which is being overly superstitious or thinking of themselves as psychically powerful. An example may be believing that they have a “sixth sense” or thinking that speaking of the devil can make him appear. This may lead them to develop what are called ideas of reference- the false belief or intuition that occurrences, events, or details in the world relate or refer directly to themselves. People with STPD generally don’t understand how relationships form, or the impact of their behavior on others. They may react oddly in conversations, not respond, or talk to themselves. They have difficulty with responding appropriately to social cues, often misinterpret people’s motivations and behaviors, and develop significant distrust of others. This can cause excessive social anxiety, and can lead them to fear social interaction, thinking that other people are harmful. While people with STPD and people with schizoid PD both avoid social interaction, people with STPD do so because they fear others, whereas people with schizoid PD do so simply because they have no desire to interact with others, or find interacting with them too difficult. 

Schizotypal personality disorder typically includes five or more of these signs and symptoms:

-Being a loner and lacking close friends outside of the immediate family

-Limited or inappropriate emotional responses, “flat emotions”

-Persistent and excessive social anxiety, tendency to be stiff and awkward when relating to others

-Very uncomfortable with intimacy

-Commonly misinterpret events, ie feeling that something has a direct personal offensive meaning, when it is actually harmless or inoffensive 

-Distorted perceptions or odd perceptual experiences, ie mistaking noises for voices, hearing a voice whisper their name, or sensing an absent person’s presence

-Peculiar, eccentric, or unusual thinking, beliefs, or mannerisms

-Suspicious or paranoid thoughts and constant doubts about the loyalty of others

-Belief in special powers, such as mental telepathy or superstitions

-Dressing in peculiar ways, such as wearing oddly matched clothes or appearing unkempt

-Peculiar style of speech: highly variable, this may include unusual patterns of speaking, rambling oddly during conversations, vague speech, or speaking in excessive detail, in metaphors, or in an overly elaborate manner. 

The prevalence of STPD ranges from approximately 1 to 4 percent of the population, and is more common in men than in women. STPD occurs more often in relatives of patients with schizophrenia or another Cluster A personality disorder. In fact, people that have an immediate family member with STPD can be as much as 50 percent more likely to develop it, as compared to people without that family history. People with STPD typically disagree with the suggestion their thoughts and behavior are disordered, and seek medical attention for depression or anxiety as opposed to the disorder. While it is typically diagnosed in early adulthood, some signs and symptoms, such as increased interest in solitary activities, or a high level of social anxiety, may be seen in the teen years. These children may also underperform in school, or appear socially out of step with peers, and this may result in teasing or bullying. STPD is likely to endure across the entire lifespan, though treatment, such as medications and therapy, can improve symptoms. Without treatment, individuals with STPD are at high risk for having major difficulty with work and relationships. 

That’s the end of Cluster A personality disorders. Next week, we’ll cover Cluster B.

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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Personality Disorders part 2

Welcome back to the blog, people. Last week we started a new series on personality disorders, which are one of the most common of the severe mental disorders. A personality disorder is marked by rigid patterns of thoughts and behaviors that cause significant life impairment, and deviate from what is generally expected, or considered “normal” by society. There are four core defining features that are common to all personality disorders. They are distorted thinking patterns, problematic emotional responses, impulse control issues, and interpersonal difficulties. In order for a diagnosis to be made, a person must demonstrate significant and lasting difficulties in at least two of those four areas. We’ll talk more about diagnosis later; first let’s talk about what causes personality disorders.

As we talked about last week, personality is the combination of thoughts, emotions and behaviors that makes you unique. It’s the way you view, understand, and relate to the outside world, as well as how you perceive yourself. Your personality forms during childhood, and it’s shaped through an interaction of your genetics and your environment, often referred to as nature and nurture. Have you ever been told ‘You remind me of Uncle Jimmy, the way you do xyz.’ This may be because certain personality traits can be passed on to you by your parents through inherited genes. That is to say, these natural traits may be heritable. The nurture refers to your environment, the surroundings you grew up in, the events that occurred, and your relationships with family members and others.

The exact cause of personality disorders isn’t known. Just as personalities are shaped by genetics and environment, personality disorders are thought to be caused by a combination of these genetic and environmental influences. It’s thought that your genetics may make you prone to developing a personality disorder, and then something in your environment- some life situation- may trigger the actual development. In other words, the tendency to develop a personality disorder can be inherited, but not the disorder itself. The disorder only arises if/when something interferes with the development of the healthy personality. For most personality disorders, levels of heritability are about 50 percent, which is similar to, or even higher than, that of many other major psychiatric disorders. There’s no clear reason why some people develop the feelings and behaviors associated with personality disorders, while other people don’t. The social circumstances we grow up in and the quality of the care we receive greatly affect the way our personality develops, so they seem to be part of the equation. 

The nurture side of the coin carries a lot of weight in developing personality disorders. Most of the patients I’ve diagnosed had something happen during their childhood. They may have had a chaotic family life, too little parental support, or a history of traumatic event(s). Trauma doesn’t have to mean emotional, physical, or sexual abuse; it may be the loss of a parent, or extreme poverty or neglect. Captain Obvious says that not everyone who experiences a traumatic situation will develop a personality disorder, and not everyone who develops a personality disorder will have had a traumatic experience. People have unique reactions, and develop different coping methods to deal with the situation they’re presented with. That’s often the core of the issue in the way personality disorders can develop; the strategies needed for coping with pain, fear, and anxiety as a child aren’t ones that are helpful or appropriate in adult life, and may in fact be harmful. That should sound familiar, no… perhaps maladaptive? 

Although we can’t label a precise cause, we know that there are certain factors that seem to increase the risk of developing or triggering the condition. In addition to an abusive, unstable, or chaotic family life during childhood, other risk factors seem to include a diagnosis of childhood conduct disorder, and variations in brain chemistry and structure. A family history of personality disorders or other mental illness is another risk factor. We know of some specific links; for example, a family history of depression may increase the risk of developing borderline personality disorder and/ or obsessive-compulsive personality disorder.

Diagnosing Personality Disorders

This can be a difficult diagnosis to make, and it never happens quickly. It involves a thorough medical and social history and multiple assessments, often over an extended length of time. Each of the ten personality disorders have criteria that must be met to qualify for diagnosis. Generally speaking, it requires finding a persistent, inflexible pattern of maladaptive traits across many life circumstances. They must also cause significant distress and impairment in at least two of the four aforementioned core areas: the way you perceive and interpret yourself, other people and events; the appropriateness of your emotional responses; how well you function when dealing with other people and in relationships; and whether you can control your impulses. 

It’s important to remember that everyone can exhibit maladaptive behavior from time to time. In order to meet the diagnostic requirement of a personality disorder, these traits must cause functional impairment and/or subjective distress, and they must be persistent and inflexible; meaning they can be repeatedly observed without regard to time, place, or circumstance. Other considerations are age of onset and the exclusion of other possible causes, like other mental health disorders, substance use, or history of head trauma. 

Next week, we’ll start taking a closer look at the ten personality disorders; we’ll talk about the signs and symptoms for cluster A, the “Odd and Eccentric” disorders: paranoid, schizoid, and schizotypal personality disorder.

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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The Cult of Personality…Disorders

The Cult of Personality… Disorders

Hello, people! Last week, we talked about thyroid disease and mental health, how they may exist together, and how some of the symptoms overlap. It’s definitely something to keep in mind when you’re looking for a diagnosis, and even once you’ve been diagnosed with one, as it doesn’t eliminate the other. And that brought the thyroid series to a close. If you remember nothing else, it should be that since the thyroid regulates metabolism- how every cell in the body uses energy from food to do its thing- its function controls literally everything in the body. So when it’s not working properly, the symptoms can vary widely. It may seem subtle at first, but eventually, you’re going to know about it, so the sooner you pick up on it, the better. 

Now moving on to our next topic, personality disorders. What are they? Disorder is fairly straightforward, so let’s talk about personality. Our personality is the collection of thoughts, feelings, and behaviors that makes each one of us the individuals we are. The traits of our personalities represent our patterns of thinking, perceiving, reacting, and relating to people, places, and things in our world. We don’t always think, feel, and behave in exactly the same way- that depends on the situation we’re in, the people we’re with, and all sorts of other interconnecting factors. We’re meant to be flexible to a point, but our personality traits remain relatively stable over time. Are you very talkative or very quiet? Are you constantly moving or are you a couch potato? A social butterfly or a bookworm? Are you a worry wart, always anxious, or laid back and unconcerned? These fundamental patterns make up our personality traits, and they imply consistency and stability. 

Personality disorders exist when these traits become so pronounced, rigid, and maladaptive that they impair interpersonal function. Maladaptive is such a great shrinky word. It just means more harmful than helpful, as opposed to adaptive, more helpful than harmful. Fun fact: every living organism, from bacteria to humans, displays maladaptive and adaptive traits, though they don’t pertain to behavior or personality in every case. In this case, maladaptations are patterns of behavior that are detrimental or counterproductive, that interfere with life. As applied to personality disorders, these maladaptive patterns of behavior deviate from what is considered “normal” or expected by society. Put it all together, and what is a personality disorder? It’s a type of mental disorder marked by rigid and enduring patterns of thoughts and behaviors that deviate from the expectations of society, and cause significant impairment in many areas of a person’s life. 

According to the shrink bible, the DSM-5, personality disorders are primarily problems with self identity and interpersonal functioning. That’s a shrinky way of saying people with personality disorders have problems with how they perceive themselves and how they interact with others. This affects how they form and maintain relationships with employers, family, friends, and intimate partners. They generally have poor coping skills, and tend to repeat patterns of behavior which are often volatile, confusing, and difficult. Maladaptive behavior may have consequences, and can cause significant problems in relationships, social activities, work, school, and potentially every facet of life. Some disorders may be so problematic that people actually avoid relationships whenever possible. These problems lead to distress, not only to the person with the disorder, but to those around them. Unlike people with anxiety or mood disorders- who know they have a problem but are unable to control it- people with personality disorders are often not aware that they have a problem, and as a result, will not seek treatment on their own. If they do, it’s the distress caused by the consequences of the maladaptive behaviors that lead them to seek treatment, rather than any discomfort with their own intrinsic thoughts and feelings. In my experience, when they do seek treatment, the chief complaint is often of depression or anxiety rather than the actual manifestations of the personality disorder.

Personality disorders are among the most common of the severe mental disorders, and often occur along with other mental illnesses, such as substance abuse disorders, anxiety disorders, and mood disorders, like depression and bipolar disorder. It’s estimated that 10 percent to 13 percent of the world’s population suffer from some form of personality disorder, and it’s thought to be underdiagnosed. While signs are sometimes apparent during childhood, most personality disorders start to become evident during the teenage years, as the personality further develops and matures. As a result, almost all diagnoses occur after the age of 18. As far as prevalence, there are no clear distinctions in terms of ethnicity. Regarding gender, most differences exist in the manifestation of symptoms within each disorder, as opposed to prevalence of diagnosis among the ten disorders, with three exceptions: antisocial personality disorder is far more common in men, while borderline and histrionic personality disorders are more common in women. Though they’re considered chronic or enduring, more recent studies indicate that some types of personality disorders may become less severe over time. 

Personality Disorders: Ten Types

The DSM-5 allocates each of the ten personality disorders to one of three groups or clusters: A, B, or C. Each disorder rarely appears in its “textbook” form, they often blur into one another. Their division into clusters is intended to reflect this tendency, with any given personality disorder most likely to blur with others within its cluster. Many people diagnosed with one personality disorder also have signs and symptoms of at least one other, typically within the same cluster.

Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

Cluster B personality disorders are characterized by dramatic, overly emotional, erratic or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Please note this is not the same as obsessive-compulsive disorder, OCD.

Our understanding of personality disorders and what it means to experience them is constantly evolving. It can be a controversial diagnosis, especially in regard to terminology.  

Incidence and prevalence statistics ultimately depend on where clinicians draw the line between a “normal” personality and one that leads to significant impairment. Diagnosing personality disorders reliably is difficult. Why? How far from “normal” must personality traits deviate before they can be counted as disordered? How significant is “significant impairment”? And how is “impairment” to be defined? Next week, we’ll continue with personality disorders, though I won’t be answering those questions… those are just food for thought. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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Treating Thyroid Disease

Hello, welcome back to the blog, people! We’re continuing our look at thyroid disease. Last week, we took a pretty deep dive into diagnosis, especially lab tests. I mentioned that the TSH (thyroid stimulating hormone) test is considered by most practitioners as the gold standard test, as it regulates the release, and therefore balance, of the thyroid hormones T4 and T3. A T4 (thyroxine) test is commonly ordered with the TSH, as together, they offer a good snapshot of overall function, as well as suggest a cause for an abnormality. A T3 (triiodothyronine) test is usually only ordered to support a diagnosis of hyperthyroidism, as it’s not very helpful in hypothyroidism, since it’s the last hormone to be affected. Thyroid antibody tests can also be run to help identify different types of autoimmune thyroid conditions, such as Hashimoto’s hypothyroidism and Graves’ Disease hyperthyroidism. 

There are different recommendations on how to screen for abnormal thyroid hormone levels, and your health insurance may “help” determine what tests are done and when. In most US states, and probably elsewhere as well, you can order your own thyroid tests on the interwebs, and this may be a more affordable way to have them done. You can find plenty of analyzers there too, so you can enter your results if you’re confused about what they mean. 

A TSH alone can be a sufficient screening test for abnormalities, and it can be followed by a T4 and/or T3 should any be found. 

Generally speaking, an elevated TSH, with or without low T4 or T3, is associated with hypothyroidism, and a low TSH with high T4 and/or high T3 is associated with hyperthyroidism. I should note that in order to receive a diagnosis of hyperthyroidism, lab tests must demonstrate that one or both thyroid hormones are elevated, so there must be a high T3 and/ or T4. 

In addition to lab tests, diagnosis of thyroid disease generally involves a review of signs and symptoms, physical examination of the neck to feel for masses or nodules, while noting the condition of hair, nails, and eyes, with imaging and ultrasound tests to further evaluate findings if needed. A primary care physician can make the diagnosis and formulate an effective treatment plan, but a physician who specializes in the thyroid, an endocrinologist, is very helpful, and may be required in some cases. 

Once diagnosed, treatment is aimed at correcting the imbalance and returning thyroid hormone levels to normal, in order to alleviate the symptoms the person is experiencing. This can be done in a variety of ways, depending on the cause, and whether the imbalance has resulted in a hyper- or hypothyroid condition. 

Hyperthyroidism Treatment

Several treatments for hyperthyroidism exist. The best approach depends on your age, personal preference, physical condition, and the underlying cause and severity of your disorder. 

Radioactive Iodine 

Taken by mouth, radioactive iodine is given to a large percentage of adults with hyperthyroidism, as it effectively destroys the cells of your thyroid, preventing it from making high levels of thyroid hormones. It also causes the gland to shrink, which may make it a good choice in cases of goiter. Symptoms usually subside within several months, and excess radioactive iodine disappears from the body in weeks to months after treatment is discontinued. This treatment may cause thyroid activity to slow enough to actually be considered underactive, meaning that it may result in secondary hypothyroidism; so you may eventually need to take medication every day to replace thyroxine. Common side effects include dry mouth, dry eyes, sore throat, and changes in taste. Precautions may need to be taken for a short time after treatment to limit or prevent radiation exposure to others.

Antithyroid Medications 

Medications like methimazole (aka Tapazole) and propylthiouracil gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones. Symptoms usually begin to improve within several weeks to months, but treatment typically continues for at least one year, and often longer. For some people, this clears up the problem permanently, but other people may experience a relapse. These drugs can be pretty gnarly. If you’re allergic, you can develop skin rashes, hives, fever, or joint pain. They can make you more susceptible to infection, and can cause serious liver damage, sometimes even leading to death. Because propylthiouracil has caused far more cases of liver damage, it should really only be used when you can’t tolerate methimazole.

Beta Blockers

Beta blockers such as propranolol and Inderal are usually used to treat high blood pressure. They don’t affect thyroid levels, but they can ease some symptoms, such as tremor, sweating, rapid heart rate, and palpitations. For this reason, your physician may prescribe them to alleviate symptoms until your thyroid levels are closer to normal. For patients with temporary forms of hyperthyroidism, ie thyroiditis, inflammation of the thyroid gland, beta blockers may be the only treatment required. Once the thyroiditis resolves, they can be discontinued. These medications are generally well tolerated, but aren’t recommended for people who have asthma, and side effects may include fatigue and sexual dysfunction.

Surgical Thyroidectomy

In a thyroidectomy, most of your thyroid gland is permanently removed. If you’re pregnant, can’t tolerate antithyroid drugs, and don’t want or can’t have radioactive iodine therapy, you may be a candidate for thyroid surgery- although this is usually an option of last resort, as it is permanent. Risks of this surgery include damage to your vocal cords and parathyroid glands, those four tiny glands situated on the back of your thyroid gland that help control the level of calcium in your blood. Postoperatively, you’ll need lifelong treatment with synthetic hormone to supply your body with normal amounts of thyroid hormone. If your parathyroid glands are also removed, you’ll need medication to keep your calcium levels normal as well.

Hypothyroidism Treatment

If you have hypothyroidism, low levels of thyroid hormones, the main treatment option is to replace the hormone. Daily use of the synthetic form of thyroid hormone thyroxine, called levothyroxine, ie Levo-T and Synthroid, restores adequate hormone levels, and reverses the signs and symptoms of hypothyroidism. Determining proper dosage may take time, but you should start to feel better soon after you start treatment. To determine the proper initial dosage, your physician may check your TSH level after six to eight weeks. With a proper diet, the medication will gradually lower cholesterol levels elevated by the disease, and may also reverse any weight gain. Treatment with levothyroxine will be lifelong, but because the dosage you need may change, your physician should check your TSH levels periodically as needed. If you have coronary artery disease or severe hypothyroidism, your physician may start treatment with a smaller dose and increase it gradually. This progressive replacement allows your heart to adjust to the increase in metabolism.

Levothyroxine

Having excessive amounts of this hormone can cause side effects, such as increased appetite, insomnia, heart palpitations, and tremor or shakiness. It causes virtually no side effects when used in the appropriate dose and is relatively inexpensive, but try to stick to the same brand, as there can be some variances in dosing. Don’t skip doses or stop taking it because you’re feeling better; if you do, your symptoms will return. Food hinders absorption of levothyroxine, so it should be taken on an empty stomach at the same time every day. Ideally, you take it in the morning and wait one hour before eating or taking other medications. If you take it at bedtime, wait four hours after your last meal or snack. Certain medications, supplements, and even some foods may seriously affect your ability to absorb it. Tell your physician if you eat large amounts of soy products or a high fiber diet, or you take other medications, such as iron supplements or multivitamins that contain iron, aluminum hydroxide, which is commonly found in antacids, and calcium supplements. 

Thyroid Disease: Prognosis 

Generally speaking, even if you have a thyroid disease, you can usually live a normal life without many restrictions, as long as you have appropriate treatment. The overall prognosis varies depending on your diagnosis. With hypothyroidism, your levels and overall symptoms may improve with medication, but it’s a condition you’ll be treating for the rest of your life. You’ll take medication daily, and your physician will likely monitor you to make adjustments over time if needed. But this is not necessarily the case with hyperthyroidism. If antithyroid medications work, then your thyroid hormone levels will most likely return to normal without any further issues. That said, once you have any form of thyroid disease, your physician may need to monitor your condition with occasional blood tests to make sure your thyroid hormones are at optimal levels.

Thyroid Disease: Complications

As with any disease, early diagnosis and treatment of symptoms improves the long term outlook. The complications of undiagnosed, uncontrolled, and/or inadequately controlled thyroid disease can lead to a number of health problems that can affect your long term quality of life, and in some cases, can even be life threatening. 

Even if you are under treatment or have received treatment for thyroid disease, if you start to notice signs of any of the following issues, see your physician to check your thyroid levels, or seek emergency treatment when appropriate.

Hyperthyroidism: Complications

Heart problems

Some of the most serious complications of hyperthyroidism involve the heart. These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation, which increases your risk of stroke, and congestive heart failure, a condition in which your heart can’t circulate enough blood to meet your body’s needs.

Brittle bones

Excess thyroid hormone interferes with your body’s ability to incorporate calcium into your bones, so untreated hyperthyroidism can lead to weak, brittle bones and osteoporosis. 

Eye problems

People with Graves’ Disease can develop eye problems, including bulging, red or swollen eyes, sensitivity to light, and blurry or double vision. When left untreated, severe eye problems can lead to vision loss.

Red, swollen skin

People with Graves’ disease can develop Graves’ dermopathy. This affects the skin, causing redness and swelling, often on the shins and feet.

Thyroid Storm

Thyroid storm, aka thyrotoxic crisis, is a life threatening hypermetabolic state induced by excessive release of thyroid hormones, resulting in a sudden worsening of symptoms. An individual’s heart rate, blood pressure, and body temperature can reach dangerously high levels, causing delirium. This requires urgent medical attention, as without prompt, aggressive treatment, thyroid storm is often fatal.

Hypothyroidism Complications

Goiter

Constant stimulation of your thyroid to release more hormones may cause the gland to become larger, a condition called goiter. Although it’s generally not painful, a large goiter can affect your appearance and may interfere with swallowing or breathing.

Heart problems

Hypothyroidism puts you at greater risk for heart disease and heart failure, and can raise your levels of LDL, low-density lipoprotein or “bad” cholesterol.

Mental health issues

Hypothyroidism can cause depression that becomes more severe over time. You may notice decreased interest in activities you used to enjoy. It can also cause slowed mental functioning, and memory or concentration lapses.

Peripheral neuropathy

Long term uncontrolled hypothyroidism can cause damage to your peripheral nerves that carry information from your brain and spinal cord to the rest of your body. Peripheral neuropathy causes pain, numbness, and tingling in affected areas, most often the legs and feet.

Joint pain

Uncontrolled hypothyroidism can cause you to have aches and pains in your joints and muscles, as well as tendonitis.

Infertility 

Low levels of thyroid hormone can interfere with ovulation, which greatly impairs fertility. In addition, some autoimmune causes of hypothyroidism can also impair fertility.

Myxedema

Myxedema is a life threatening condition that can result from undiagnosed hypothyroidism. The term “myxedema” can be used to mean severely advanced hypothyroidism. But it’s also used to describe skin changes in someone with severely advanced hypothyroidism. The classic skin changes include swelling of your face, including lips, eyelids, and tongue, and/ or the swelling and thickening of skin anywhere on your body, but especially on your lower legs. Signs and symptoms include intense cold intolerance and drowsiness, followed by profound lethargy and unconsciousness. In people with severe hypothyroidism, trauma, infection, exposure to the cold, and certain medications can trigger a life threatening condition called myxedema coma, which causes a loss of consciousness and hypothermia, extremely low body temperature. If you have signs or symptoms of myxedema, you need immediate emergency medical treatment.

That’s all for this week, folks. Next week will be devoted to thyroid disease and mental health issues. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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Thyroid 2

Welcome back, people! Last week I introduced a new topic- the thyroid- and hopefully you remember that it’s a butterfly shaped endocrine gland that wraps around the windpipe in the forward aspect of the middle throat. It plays a major role in regulating the body’s metabolism, growth, and development by production and release of thyroid hormones, called T3 and T4, into the bloodstream. When it doesn’t work properly, it can have a huge impact on multiple systems throughout the entire body. We also talked about how all of the functions of the endocrine glands are interlinked, and that the thyroid works especially closely with the pituitary gland located in the brain. In order to make the right amount of T3 and T4, the thyroid gland needs the help of the pituitary, to “tell” it- through its own hormone called thyroid stimulating hormone, TSH- when to produce and release more or less hormones into the bloodstream. And we left off with an introduction on the two basic states that result from thyroid disease or dysfunction: hyperthyroidism, when you make too much thyroid hormone, and hypothyroidism, when you make too little. 

This week, we’ll get deeper into thyroid disease and talk about the various symptoms of thyroid imbalance. But I should remind that the endocrine system and the thyroid are very dynamic and can change temporarily in response to normal natural processes other than disease. If and when the body needs more energy in certain situations- if it’s during a growth spurt, time in a very cold environment, or during pregnancy for example- the thyroid gland may temporarily produce more hormones. That increase in T3 and T4 increases the basal metabolic rate, so all of the cells in the body work harder. That causes a faster pulse and stronger heartbeat, a rise in body temperature, and activation of the nervous system and then other systems needed to accomplish whatever the situation may call for. Because the cells are working harder, they need more energy, so energy stored in the liver and body is broken down and utilized faster, and food is used up more quickly as well. When the situation has ended- say the growth phase is over, or mom has the baby- the demand is lessened, the thyroid will produce less T3 and T4, the basal metabolic rate will slow, and energy requirements will reduce to previous levels.  Ultimately, the thyroid and entire endocrine system will return to their previous functional levels, ready to respond next time. 

Thyroid Disease by the Numbers

Thyroid disorders are very common, and very commonly run in families, and affect more than 12 percent of Americans, or an estimated 20 million people. They can occur in anyone- men, women, teens, children, or infants- at any time, meaning they can be present at birth or may develop later. Hypothyroidism is much more common than hyperthyroidism, though the latter is easier to diagnose. About one in 20 people has some kind of thyroid disorder, which may be temporary or permanent, and up to 60 percent of people with thyroid disease are unaware of their condition. While they can occur in anyone, thyroid disease affects 5 to 8 times more women than men, so one woman in 8 will develop some type of thyroid disease at some point in her life. 

When the thyroid is properly balanced, it produces and replaces just the right amount of hormones to keep your metabolism working at the proper rate. When the thyroid makes too much hormone, as in hyperthyroidism, that’s sometimes also called overactive thyroid. And the flip-side of this, when your thyroid makes too little hormone, in hypothyroidism, that’s sometimes called underactive thyroid. These conditions can be standalone or caused by other diseases and conditions that impact the way the thyroid gland works, including genetic and inherited disease.

Hyperthyroidism Causes and Conditions

There are several conditions that can cause overactive thyroid, or hyperthyroidism. The most common cause is an inherited autoimmune disorder that affects 1% of the general population, called Graves’ disease. This causes immune cells attack the thyroid gland, which responds by enlarging and secreting excess thyroid hormone. Immune cells may also go on to attack the muscles and connective tissue of the eyes, causing them to bulge, a state known as exophthalmos, and this eye condition is usually then referred to as thyroid eye disease or Graves’ eye disease. 

Thyroid nodules, which are small, round, usually benign masses present within the thyroid gland tissue, can also cause thyroid overactivity. There may be a single autonomously functioning nodule or a condition called toxic multinodular goiter, where there are multiple nodules within the thyroid which produce too much hormone. As the nodules increase in size and/ or number, it can cause a large, externally obvious swelling called a goiter in the neck. 

Having excess iodine in your body can also stimulate the thyroid to make more hormone than it needs, since iodine is the mineral used to make T3 and T4. Excessive iodine can be found in some cough syrups and other medications like amiodarone, a heart medication. 

An inflammatory process of the thyroid called thyroiditis may also cause hyperthyroidism. The person may or may not be aware of it, as it can be painful or not felt at all. In early stages of some types of thyroiditis, the thyroid may release or leak hormones that were stored there, and this hyperthyroid state can last for a few weeks or months. If it continues, the inflammation will eventually impair the production of thyroid hormone, and this will result in hypothyroidism.

Hypothyroidism Causes and Conditions

Some of the conditions associated with underactive thyroid, or hypothyroidism, include other types of thyroiditis, where the swelling of the thyroid gland impairs hormone production. Hashimoto’s thyroiditis is the most common cause of hypothyroidism. This is an inherited autoimmune disorder whereby the body’s own immune cells attack the thyroid, causing inflammation and damage to the tissue that inhibits or halts production of hormone. 

Postpartum thyroiditis is a usually temporary condition that occurs in 5% to 9% of women after childbirth, whereby the thyroid is temporarily inflamed and underactive as a result. 

An iodine deficiency is a common cause of underactive thyroid, or hypothyroidism, outside of the US. When the body is deficient in iodine, it simply doesn’t have enough to produce a sufficient amount of T3 and T4 hormone. Even today, iodine deficiency affects several million people around the world. 

Sometimes, the thyroid gland simply doesn’t work correctly from birth, and for obvious reasons, this can have severe implications. This condition affects about 1 in 4,000 newborns. If left untreated, the child can have both physical and mental issues in the future. Because of the potential consequences, all newborns are given a screening blood test in the hospital to check their thyroid function.

Thyroid Disease Risk Factors

The causes of thyroid dysfunction are largely unknown, but there are several factors that can place you at a higher risk of developing a thyroid disease. The first and most obvious is if you have a family history of thyroid disease, as it is commonly familial. Also, if you have had treatment for a past thyroid condition, such as a partial thyroidectomy, or cancer treatment such as radiation, you are more likely to have thyroid issues later. If you are Caucasian or Asian your risk is slightly higher. If you have prematurely graying hair, your risk for developing thyroid disease is higher. In addition, if you have certain other medical conditions like Down Syndrome, Turner syndrome, and bipolar disorder, it increases your risk. If you have autoimmune or related disorders, you are at especially increased risk: lupus, rheumatoid arthritis, pernicious anemia, celiac disease, type 1 diabetes, primary adrenal insufficiency, Sjögren’s syndrome, Addison’s disease, or vitiligo. If you take a medication that’s high in iodine, such as amiodarone, this excess iodine increases the risk for developing hyperthyroidism. And if you are over 60 years old, your risk increases. This is especially true in women, as their risk is already so much greater than men. 

Thyroid Disease Symptoms 

Because there are such a variety of symptoms associated with thyroid disease, many can be very similar to the signs and symptoms of other medical conditions, as well as general stages of life changes. This can make it difficult to know if your symptoms are related to a thyroid issue or something else entirely. 

Symptoms of Hyperthyroidism

Because the thyroid is overactive, it speeds cellular activity and generally causes the body processes to move faster. This causes the body to use energy too quickly, so people with hyperthyroidism usually have increased appetite, and may feel weak unless they consume more food to keep up with energy demands; and even if they do, they may still lose weight unintentionally. In addition, it may cause them to have trouble sleeping and sleep disturbances, confounding the fatigue they feel. Hyperthyroidism also tends to cause increased heart rate, stronger heart beat, tremors, heat sensitivity, itching, and increased sweating. It often results in feelings of anxiety, irritability, and nervousness, and causes racing thoughts, and difficulty focusing on one task. It may cause an enlarged thyroid gland to the point of goiter, where it is visible externally, as well as problems with vision or eye irritation, including protruding or bulging eyes called exophthalmos. Women with hyperthyroidism will typically have light and irregular menstrual periods. And rarely, men with hyperthyroidism can see some breast development. Be aware that if someone experiences symptoms like irregular heart rate, dizziness, shortness of breath, and/ or loss of consciousness, that requires immediate medical attention. Hyperthyroidism can cause atrial fibrillation, which is a dangerous arrhythmia that can lead to strokes as well as congestive heart failure. This is an extreme medical emergency. 

Symptoms of Hypothyroidism

When the thyroid is underactive, body processes move more slowly, and this causes people to feel extremely tired and fatigued. Because cellular processes move more slowly, less energy is required, so less stored energy is utilized. Because the metabolism is sluggish, less food is required and more is stored, so having hypothyroidism makes someone much more likely to gain weight. Mentally, people commonly experience depression, mental slowness, and forgetfulness. Physically, they commonly experience constipation, puffy face, muscle cramps, dry skin, brittle nails, dry and coarse hair, hair loss, hoarse voice, and intolerance to cold temperatures. They may experience fatigue and shortness of breath with exercise. They are likely to have joint pain, stiffness, and swelling, and even carpal tunnel syndrome. Women with hypothyroidism are likely to have frequent and heavy menstrual periods.

Kids and teens with hypothyroidism can have all of the signs above, but may also have delays in sexual maturity or puberty, growth delays and shorter stature, slow mental development, and slower development of permanent teeth. 

Infants and babies with hypothyroidism may have no symptoms at all. But if symptoms do present, they can include cold hands and feet, constipation, extreme sleepiness, weak or hoarse cry, little or no growth, poor feeding habits, puffy face, stomach bloating, swollen tongue, and umbilical hernia. In addition, you may notice low muscle tone, sometimes called floppy baby, as well as persistent jaundice, which is yellowing of the skin and whites of the eyes. These symptoms require immediate medical attention. 

I think we’ll pick up there next week, with complications and prognosis.

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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Xanax Withdrawl

Xanax Withdrawal

Welcome back, people! Last week we continued our foray into all things Xanax and talked about dependence and use disorder. The next step in the chain- withdrawal- can be a special kind of beastie, definitely deserving of its own blog, so this week will be all about Xanax withdrawal.

As I mentioned last week, some folks can take their bit of Xanax a couple of times a day as directed for umpteen years, and never develop a tolerance or pathological dependence. Others start out taking it as directed, but develop a tolerance and maybe start to abuse it- take too much too often- and then begin to develop a more pathological dependency. Others may abuse it recreationally on occasion, to netflix and chill, find they really like it, then develop a severe addiction. It may not sound like these people have much in common, but they do. When they stop taking it, they’re all going to go through withdrawal.

They won’t do so alone, though. In 2017, doctors wrote nearly 45 million prescriptions for Xanax, so it’s no surprise that these prescribing practices have contributed to thousands of cases of abuse and dependence. With those numbers, there has been all sorts of research and stats examined on benzos, and I read that in 2018, an estimated 5.4 million people over the age of 12 misused prescription benzodiazepines like Xanax. That’s a lot of people, people.

To many patients that take their Xanax exactly as prescribed, it seems to come as a surprise that they’re facing a withdrawal experience, but Xanax doesn’t discriminate- so anyone taking enough of it for more than a few weeks will develop a physical dependence. Once you have become physiologically dependent on a drug, you will experience withdrawal symptoms when you stop or reduce your dose. Simple as that.

Withdrawal is different for everyone. Depending on the dose and how often you’ve been using it, the withdrawal experience typically ranges from uncomfortable to very unpleasant, but it can also be medically dangerous. The only safe way to quit is to slowly taper down the dose under the direction of a physician, or in an in-patient treatment center setting, depending on the situation. If you’ve been taking high doses of Xanax several times a day, then quitting is going to take a great deal of time, patience, and determination. Please note that quitting cold turkey can cause extremely dangerous withdrawal symptoms. This can include delirium, which is a state characterized by abrupt, temporary cognitive changes that affect behavior; so you can be irrational, agitated, and disoriented- not a good combo. Sudden withdrawal can also cause potentially lethal grand mal (aka tonic-clonic) seizures. These are like electrical storms in the brain, where you lose consciousness and have violent muscular contractions throughout the body. It’s not a risk you want to take, people- so don’t do this on your own! Even if you’ve been taking Xanax illicitly, that doesn’t mean you have to go it alone. Just fess up to a physician and tell them exactly how much you’ve been taking so they can design a taper schedule for you, or help you find a treatment center. There is a lot of help available if you make the effort.  

Tapering your dose is the best course of action for managing withdrawal symptoms, but that doesn’t mean it’s a picnic in the shade. While you taper down the dose, you’ll likely experience varying degrees of physical and mental discomfort. You may feel surges of anxiety, agitation, and restlessness, along with some unusual physical sensations, like feeling as though your skin is tingling or you’re crawling out of your skin. But keep in mind that these are all temporary. 

Signs and Symptoms

The major signs and symptoms of Xanax withdrawal vary from person to person. Research indicates that roughly 40% of people taking benzodiazepines for more than six months will experience moderate to severe withdrawal symptoms, while the remaining 60% can expect milder symptoms. It’s very common to feel nervous, jumpy, and on edge during your taper. And because Xanax induces a sedative effect, when the dose is reduced, most people will experience a brief increase in their anxiety levels. Depending on the severity of your symptoms, you may experience a level of anxiety that’s actually worse than your pre-treatment level. Support from mental health professionals can be very beneficial during and after withdrawal, as therapy and counseling may help you control and manage the emotional symptoms of benzo withdrawal.

Physical Withdrawal Symptoms

As a central nervous system depressant, Xanax serves to slow down heart rate, blood pressure, and temperature in the body- in addition to minimizing anxiety, stress, and panic. Xanax may also help to reduce the risk of epileptic seizures. Once the brain becomes used to this drug slowing all of these functions down on a regular basis, when it is suddenly removed, these CNS functions generally rebound quickly, and that is the basis for most withdrawal symptoms. Symptoms can start within hours of the last dose, and they can peak in severity within 1 to 4 days. The physical signs of Xanax withdrawal can include: headache, blurred vision, muscle aches, tension in the jaw and/ or teeth pain, tremors, nausea, vomiting, diarrhea, numbness of fingers, tingling in arms and legs, sensitivity to light and sound, alteration in sense of smell, loss of appetite, insomnia, cramps, heart palpitations, hypertension, sweating, fever, delirium, and seizures.

Psychological Withdrawal Symptoms

Xanax, as a benzodiazepine, acts on the reward and motivation regions of the brain, and when a dependency is formed, these parts of the brain will be affected as well. When an individual dependent on Xanax then tries to quit taking the drug, the brain needs some time to return to normal levels of functioning. Captain Obvious says that whenever you stop a benzo, because it acts as an anxiolytic, you’re going to experience a sudden increase in anxiety levels. While there are degrees of everything, the psychological symptoms of Xanax withdrawal can be significant, as the lack of Xanax during withdrawal causes the opposite of a Xanax calm, which is to say something akin to panic. At the very least, that can make you overly sensitive, and less able to deal with any adverse or undesired feelings. Withdrawal can leave people feeling generally out of sorts, irritable, and jumpy, while some individuals have also reported feeling deeply depressed. Unpredictable shifts in mood have been reported as well, such as quickly going from elation to being depressed. Feelings of paranoia can also be associated with Xanax withdrawal.

Nightmares are often reported as a side effect of withdrawal. I included insomnia in physical symptoms, but trouble sleeping can also be a psychological symptom, as it is both mentally and physically taxing. People can be overtaken by anxiety and stress during withdrawal, and that may cause this trouble sleeping at night, which then contributes to feelings of anxiety and agitation, so it’s a cycle that can be tough to break free of. Difficulty concentrating is also reported, and research has found that people can have cognitive problems for weeks after stopping Xanax. Ditto for memory problems. Research shows that long-term Xanax abuse can lead to dementia and memory problems in the short-term, although this is typically restored within a few months of the initial withdrawal. Hallucinations, while rare, are sometimes reported when people suddenly stop using Xanax as well. Suicidal ideation is sometimes reported, as the anxiety, stress, and excessive nervousness that can occur during withdrawal can lead to, or coexist with suicidal thoughts. Finally, though rare, psychosis may occur when a person stops using Xanax cold turkey, rather than being weaned off of it.

Xanax Withdrawal Timeline

Xanax is used so commonly for anxiety and panic disorders because it works quickly, but that also means it stops working quickly and leaves the body quickly. Xanax is considered a short-acting benzodiazepine, with an average half-life of 11 hours. As soon as the drug stops being active in the plasma, usually 6 to 12 hours after the last dose, withdrawal symptoms can start. Withdrawal is generally at its worst on the second day, and improves by the fourth or fifth day, but some symptoms can last significantly longer. If you go cold turkey and don’t taper your dose, your withdrawal symptoms will grow increasingly intense, and there really is no way to predict how bad they may get, or how you’ll be affected. 

Unfortunately, five days doesn’t signal the end of withdrawal for some people, as some may experience protracted withdrawal. Estimates suggest that about 10% to 25% of long-term benzodiazepine users experience protracted withdrawal, which is essentially a prolonged withdrawal experience marked by drug cravings and waves of psychological symptoms that come and go. Protracted withdrawal can last for several weeks, months, or even years if not addressed by a mental health professional. In fact, these lasting symptoms may lead to relapse if not addressed with continued treatment, such as regular therapy.

Factors Affecting Withdrawal

Withdrawal is different for each individual, and the withdrawal timeline may be affected by several different factors. The more dependent the body and brain are to Xanax, the longer and more intense withdrawal is likely to be. Regular dose, way of ingestion, combination with other drugs or alcohol, age at first use, genetics, and length of time using or abusing Xanax can all contribute to how quickly a dependence is formed and how strong it may be. High stress levels, family or prior history of addiction, mental health issues, underlying medical complications, and environmental factors can also make a difference in how long withdrawal may last for a particular individual and how many side effects are present. 

Coping with Xanax Withdrawal

The best way to avoid a difficult and potentially dangerous withdrawal is to slowly taper down your dose of Xanax, meaning to take progressively smaller doses over the course of up to several weeks. By keeping a small amount of a benzo in the bloodstream, drug cravings and withdrawal may be controlled for a period of time until the drug is weaned out of the system completely. It may sound like designing a taper would be a no-brainer, but it’s definitely not recommended to taper without a physician’s guidance. Why? Because Xanax is a short-acting drug, your body metabolizes it very quickly. Controlling that is challenging because the amount of drug in your system goes up and down with its metabolism. To help you avoid these peaks and valleys, doctors often switch you from Xanax to a longer acting benzo during withdrawal, as it may make the process easier. And believe me, that’s what you want. If the physician goes this switch route, once you’ve stabilized on that med, you’ll slowly taper down from that a little bit at a time, just as you would with Xanax. 

Another reason not to play doctor on this one is if you start to have breakthrough withdrawal symptoms when your dose is reduced, your physician can pause or stretch out your taper. It’s up to him or her, through discussion with you, to design the best tapering schedule for your individual needs. Sometimes it’s a fluid and changing beastie.

In addition, adjunct medications like antidepressants, beta-blockers, or other pharmaceuticals/ nutraceuticals may be effective in treating specific symptoms of Xanax withdrawal, and you’ll need a physician to recommend and/ or prescribe those as well. 

Alleviating Symptoms of Withdrawal

An individual may notice a change in appetite and weight loss during Xanax withdrawal, so it’s important to make every attempt to eat healthy and balanced meals during this time. It may sound obvious, but a multivitamin including vitamin B6, thiamine, and folic acid is especially helpful, as these are often depleted in addiction and withdrawal. There are some herbal remedies that may be helpful during withdrawal, such as valerian root and chamomile for sleep. Meditation and mindfulness are very useful for managing blood pressure and anxiety during withdrawal, so be sure to check out my March 15 blog for more on mindfulness. Considering the insomnia and fatigue that may occur during withdrawal, it may seem counterintuitive to commit to exercise, but it has been shown to have positive effects on mitigating withdrawal symptoms and decreasing cravings. Exercise stimulates the same pleasure and reward systems in the brain, so it stands to reason that it can also help to lift feelings of depression or anxiety that may accompany physical withdrawal symptoms.

Xanax Withdrawal Safety

Some of the things I’ve mentioned are so important they bear repeating. Xanax should not be stopped suddenly, or cold turkey, and vital signs like blood pressure, heart rate, respiration, and temperature need to be closely monitored during withdrawal. This is because these may all go up rapidly during this time, and this can contribute to seizures that can lead to coma and even death. 

People with a history of complicated withdrawal syndromes and people with underlying health issues should work very closely with their physician during withdrawal, as should the elderly and people with cognitive issues, as there can be unique risks involved. If you have acquired your Xanax illicitly, you can still work with a doctor to taper down your dose. Start by visiting a primary care physician or urgent care center and tell them that you are in, or are planning to be in, benzodiazepine withdrawal. If you don’t have insurance, visit a community health center. If you plan to or have become pregnant, you will need to discuss your options with your prescribing physician and OB/GYN about the risks and benefits of continuing versus tapering Xanax or other benzos. Some women continue taking them throughout their pregnancy, while others follow a dose tapering schedule.

The key to achieving the goal of getting off of Xanax is to follow the tapering schedule to the very end. By the end of your taper, you might be cutting pills into halves or quarters. Note that some individuals may be better suited for a harm reduction approach, in which the taper leads to a maintenance dose rather than abstinence. If you’re very concerned about the risks involved in Xanax tapering for any reason, discuss these concerns with your physician, because you may be better suited for inpatient detoxification. While this is more expensive, it is covered by many insurance plans.

No matter how you slice it, quitting Xanax takes time, patience, and determination. If you’ve been using it for longer than a few months, quitting can be hard, and there will be days where you want to give up and give in. But with medical supervision and support, you can be successful, and in the long-term, the health benefits are considerable. Withdrawal isn’t a picnic, but if Xanax is both the alternative to it, and a problem for you, it beats that alternative hands down. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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Alprazolam Use Disorder

Alprazolam Use Disorder

Helll-ooo people! I hope everyone had a great holiday weekend, maybe bit the head off a big bunny- a chocolate one of course. We’ve been talking about alprazolam, trade name Xanax. Last week I warned you about the dangers of buying it off of the street. If you’ve forgotten why it’s dangerous, it’s because it’s nearly always counterfeit crap made in some moron’s basement with fentanyl and heaven knows what else, and you don’t want that. If you think I have a pretty clear opinion on fake Xanax, or any fake pharmaceutical for that matter, Captain Obvious says you’d be right. 

If you read the first blog in this series a couple of weeks ago, you already know that Xanax, generic name alprazolam, is a member of the class of anxiolytic drugs called benzodiazepines, and very commonly prescribed for anxiety and panic disorders- mainly because it’s very effective and works quickly. But it also has serious addiction potential and is a common drug of abuse, and this is something that patients and their families must be aware of up front. With that in mind, this week’s blog will focus on the signs and symptoms of Xanax abuse, and how that progresses to the diagnosis of sedative use disorder, or more specifically Xanax use disorder. 

Some people who are prescribed Xanax for anxiety or panic disorders can take their prescribed dose twice a day for years and never experience an issue, unless or until they stop taking it. They become dependent upon it, but only in that their body becomes used to having the drug in their system- it’s not a pathological dependence. Upon stopping it, they’ll still experience withdrawal symptoms, but they don’t develop Xanax use disorder, because their use is quite literally not disordered. Incidentally, I’ll be focusing on withdrawal from Xanax next week. In contrast, far too many people develop a pathological dependence upon Xanax. Even if they have a genuine anxiety disorder and start out taking it only as prescribed, they begin to abuse it by taking too much and/ or too often, and they develop a use disorder, which progresses to what we colloquially call an addiction. 

This is a process that generally starts because they begin to develop a tolerance to the drug and require more of it to achieve the desired effect, whether that is to quell their symptoms of anxiety, or to get high. Tolerance is a phenomenon that occurs with many drugs, but it is especially dangerous in a drug like Xanax, as it’s a closed circuit- the more you need, the more you take, and the more you take, the more you need. Ideally, a patient informs their prescribing physician if they feel that their current dose is no longer adequate. But that doesn’t always happen, and patients may choose to increase the dose on their own; and at that point, they’re abusing the drug. 

Some of the most common physical signs and symptoms of Xanax abuse include slurred speech, poor motor coordination, confusion, blurred vision, drowsiness, dizziness, difficulty breathing, loss of consciousness, and an inability to reduce intake without symptoms of withdrawal. Beyond the physical symptoms, when a person begins to abuse Xanax, there will likely be noticeable changes in their behavior as well. Some of the most common behavioral signs of Xanax abuse include the following:

-Taking risks in order to buy Xanax: some people may do things they wouldn’t have previously considered in order to obtain it. For instance, they may steal, often from loved ones, in order to pay for Xanax.

-Losing interest in normal activities: as Xanax abuse takes a firmer hold in a person’s life, they commonly lose interest in activities they formerly enjoyed.

-Risk-taking behaviors: as Xanax abuse continues, the person may become more comfortable taking big risks, such as driving while on Xanax.

-Maintaining stashes of Xanax: to ensure that they will not have to go without Xanax, they will attempt to stockpile it.

-Relationship problems: Xanax abuse invariably leads to interpersonal problems and social issues, but this often isn’t enough to motivate the person to stop.

-Obsessive thoughts and actions: the person will spend an inordinate amount of time and energy obtaining and using Xanax. This may include activities like doctor shopping or looking for alternate sources of it, or asking friends, family, and/ or colleagues for it. 

-Legal issues: this can be related to illegally obtaining Xanax, being arrested/ incarcerated for drugged driving, or for other disturbances as a consequence of use. 

-Solitude and secrecy: when abusing Xanax, it’s very common for people to withdraw from friends and family to protect their use.

-Financial difficulties: to pay for Xanax, a person may drain their financial resources and/ or those of family and friends.

-Denial: this includes setting aside valid concerns about Xanax abuse to protect ongoing use of the drug. For example, minimizing or refusing to recognize the dangers of buying it on the street.

As Xanax abuse progresses, it reaches what most people would term an addiction. But the actual diagnosis recognized in the psych nerd’s bible, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) is termed use disorder. If the person is using Xanax, we call it sedative use disorder or Xanax use disorder, but there is opioid use disorder as well- essentially anything that is abused can fill in the blank. In order for a person to be diagnosed with a sedative use disorder, they must exhibit a certain number of signs and symptoms within a one year period. The more symptoms that are present, the higher the grading the sedative use disorder will receive, and this places the severity of the disorder on a continuum, be it mild, moderate, or severe.

Paraphrased versions of the assessed symptoms of Xanax use disorder are as follows:

-Repeated problems in meeting obligations in the areas of family, work, or school because of Xanax use.

-Spending a significant amount of time acquiring Xanax, using it, or recovering from side effects of use.

-Continued Xanax use despite hazardous circumstances.

-Continued Xanax use despite the complications it causes with social interactions and interpersonal relationships.

-Continued Xanax use despite experiencing one or more negative personal outcomes.

-Using more Xanax or using it for longer than recommended or intended.

-An inability to stop using Xanax despite an ongoing desire to do so.

-Obsessive craving for Xanax.

-Ceasing or reducing participation in work, social, or family affairs due to Xanax use.

-Building tolerance over time, necessitating the use of increasing amounts of Xanax to achieve desired effect.

-Experiencing withdrawal symptoms upon decreasing the dose of Xanax.

These last two signs- building tolerance that requires continual dosage increases, and experiencing withdrawal symptoms when dosage is decreased- are indicative of physical dependence and ultimately addiction. These are natural body processes that occur when the brain and body habituate to drug use over time. Once the body becomes accustomed to having the drug, a sort of new normal is established in its presence. Thereafter, when the drug use stops, the body will issue its demand for more of the drug in the form of withdrawal symptoms. And that’s exactly where we’ll pick up next week. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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CounterfeitDrugs:Fake Xanax

Counterfeit Drugs: Fake Xanax

For this week’s alprazolam blog, I want to know if I can fake you out. We’re going to talk about fake Xanax. Look at the picture above. Can you tell which Xanax are fake? Are you certain? Enough to roll the dice with your life on the pass line? Because, make no mistake- if you get your Xanax from anywhere other than a licensed pharmacy, you are absolutely, positively doing so every single time you take it. By the end of this blog, you’ll definitely know the answer to the first question. As to the second, I’d hope you already know the answer, because even Captain Obvious won’t bother with that one, people. 

When you think of counterfeit drugs, you may not be too concerned if you consider them to be just weakened copycat versions of the real thing, made with a bunch of essentially harmless junk. Probably the worst that could happen is it won’t work, right? Wrong! Obviously, the main problem with counterfeit drugs in general is that they’re clearly illegal and therefore unregulated, so you don’t know what you’re getting. I mean, with counterfeit drugs, there’s no truth in advertising. And helll-ooo, they’re produced in somebody’s gnarly basement, so there sure as hell isn’t any quality control. While they can be cut with innocuous things like baking soda or baby powder, they can also be laced with extremely harmful substances, things like rat poison, bleach, and formaldehyde. Unfortunately, many drug users don’t know, or don’t care, how dangerous it is to ingest substances like these. But there are cases where counterfeit drugs are especially dangerous, and fake or counterfeit Xanax is at the top of that list. In late 2015, the entire country learned this lesson the hard way when in three months, there were nine documented cases where people in San Francisco suddenly overdosed from “Xanax.” To be clear, it wasn’t Xanax at all. That number included a baby, who had picked a tab of it up off the floor and put it in their mouth. It also included one person who didn’t even get to live to regret it. I think we got off pretty easily in that singular event, but obviously more have followed. 

By the Numbers… Without Numbers (?)

Again, since production and sale of fake Xanax is illegal, underground, and unregulated, there aren’t national or global databases to collect information or statistics as there are with other drugs. But I found some reports from various global sources that were interesting. And by that I mean frightening. Some highlight snippets include a report citing that 25% of 2018 drug overdose deaths in Northern Ireland were caused by counterfeit Xanax. Another report from U.S. Customs and Border Protection stated that in the first four months of 2020, during unspecified smuggling attempts, their CBP officers seized 27 shipments of fake Xanax, totalling over 35 pounds. I also listened to part of a podcast on the subject that featured an officer from Portland, Oregon talking about a spate of teenage overdoses on fake Xanax, and the subsequent investigation. They apparently did a round up of all the street dealers they could find, and busted down doors and did everything they could to clean up the area. The goal was to get every Xanax pill off the street, and he stated that of all the “Xanax” pills they recovered, not a single one was legit. He didn’t say exactly how many that was, but it seemed like a lot. Every pill in the area was fake. That’s huge. And very scary. 

Fake Xanax: Beyond the Obvious

“Good” counterfeit Xanax pills look exactly like the real thing. And clearly, by “good” I don’t mean that in the traditional sense. That means they have the same color, size, shape, and pharmaceutical markings, aka imprints, on the pills as the bonafide prescription versions do. While the difference isn’t obvious to the naked eye, there is one huge difference between real and fake Xanax that makes it especially scary: the latter usually contains fentanyl, an extremely potent opioid that is responsible for countless accidental overdoses in numerous counterfeit and legal preparations. In fact, it’s estimated that many thousands of U.S. citizens ingest a deadly dose of  each year without ever even realizing it. How horribly tragic and senseless is that?  

Fentanyl is a schedule II synthetic opioid that is 50 to 100 times stronger than heroin and morphine, respectively. It is typically prescribed by a specialized physician strictly for patients struggling with severe or chronic pain, and it is such a potent and dangerous drug that the DEA has advised officials to take extra protective precautions, like gloves, even just when handling it, to avoid accidental death. This is because it is easily absorbed through the skin, and takes so little to be lethal. While other opiate doses are measured in milligrams, fentanyl is dosed in micrograms, and an amount equal to two grains of salt is lethal to nearly all individuals. Clearly, a drug that is 100 times stronger than morphine is no joke, and it officially now kills more Americans annually than any drug in history.

People who take fentanyl accidentally will be unaware of what they have taken, or how much, so they face an even higher risk of an opioid overdose. In the case of fake Xanax exposure, if or when a person does overdose on it, in the unlikely event that they’re lucky enough to make it to a hospital, it presents a unique problem. As a physician, I can tell you that when a person’s symptoms present differently from what is expected, it delays treatment, and Xanax overdose and fentanyl overdose present very differently. So when it’s reported that a person took “Xanax,” or some pills are found on their person, but their symptoms don’t look like a benzodiazepine overdose, those few minutes a medic or doc takes to assess the situation may be the few that end up costing them their lives. But that can be the case fake percocet or oxycodone as well, because fentanyl is commonly used in producing counterfeit versions of all of those. Even cocaine- maybe especially so because of the cost differential- fentanyl is so much cheaper that it’s very commonly used to cut it. And talk about presenting differently: cocaine and fentanyl overdose are not even remotely similar to one another. Even if users are aware that fentanyl is in the product, and aren’t that concerned about it, there’s still no way to know how much fentanyl is in it, or exactly how potent that fentanyl is. As a result, it is extremely easy to overdose after consuming any counterfeit product. 

Since the pills look exactly like the real thing, it’s nearly impossible to tell the difference. But, if someone consumes counterfeit Xanax made with fentanyl, there will be noticeable symptoms and side effects that wouldn’t ordinarily be present with genuine Xanax. The side effects of fentanyl include excessive itching, slowed breathing, nausea and vomiting, flushed skin, and constricted pupils. These can quickly progress to overdose, and those signs and symptoms are progressively shallow breathing, usually followed by gurgling or choking sounds, or sounds like “snoring,” pale, blue, cold, or clammy skin, limp body or unresponsiveness, and finally suppressed breathing. People often report that they didn’t recognize that someone was overdosing, even though they literally sat there watching it. They usually think they’ve nodded out and are snoring, and then just stop snoring. In reality, they’re really choking, then their breathing is severely suppressed, and when they stop making noise, they’ve simply stopped breathing. Fentanyl also yields some dangerous psychological effects, such as depression, hallucinations, difficulty sleeping, and nightmares. These are all signs to be aware of if you ever take a drug from a questionable source.

Fake Xanax: How it’s Done

Counterfeit Xanax is made using a pill press, which is exactly what it sounds like: it’s a device that is used to press powders together with a binding agent, to make the substance into a solid pill form. Pill pressing devices can be smaller than the size of a person’s palm, or large enough to need a small room for storage. Pill molds are added to the pill press to press the pills into certain sizes and to make markings or indentations. Sometimes they’re called “stamps,” and manufacturers use these to customize the appearance of the pill and mimic the exact imprint used by the legit pharmaceutical company. Currently, it’s not illegal to own a pill press, and in fact, some people use them to make their own vitamins or supplements at home. But it is illegal to own a pill mold that is used in a pill press. As a result, counterfeit pill molds are usually designed in other countries and sold to the U.S. as “spare parts” or “equipment.” This allows street dealers and manufacturers to purchase their supplies without gaining attention from the police, and continue to make fake drugs in their gnarly basements.

Fake Xanax: Why it’s Done

Helll-oooo! People who sell drugs don’t do so because they enjoy it, they do it to earn a profit. It behooves them to find a way to make their drugs cheaper and more potent, because that’s the best way to generate more profit from a smaller amount of product- that’s just common business sense. Believe it or not, many street-level dealers can get their hands on fentanyl very cheaply, either through theft, or through overseas production of cheap, sketchy fentanyl look-a-likes, so they commonly use it to cut their drugs, and this actually makes their products cheaper and more potent. To be clear, these fake products may not even contain the actual primary component. But in cases of fake Xanax, if it does contain actual alprazolam, the combination makes it even more dangerous-  but the fentanyl alone can just as easily provide or mimic the effects the user is looking for. The result is a product that looks and feels pretty much like real Xanax, but is infinitely more dangerous; sold at a fraction of the price, as compared to the real thing, brought to you by your friendly neighborhood street thug. 

Fake Xanax: How to Avoid It

Clearly, the easiest way to avoid purchasing fake Xanax is to never purchase the drug on the streets in the first place. In fact, the only reason anyone should ever take Xanax in the first place is if they have a prescription for it and are instructed to by their doctor. Unfortunately, some people who are prescribed the medication seek out cheaper ways to fill their prescription, such as purchasing it from shady online pharmacies or from overseas stores. But you’d be surprised how enterprising some dealers are, and a “pharmacy” selling counterfeit drugs is certainly not unheard of. So kids, the take home lesson is that if you have a Xanax prescription, you should always get it filled at a licensed pharmacy.

Fentanyl: The Masked Killer

As a final word of caution, I just wanted to include a short synopsis of three stories I read about counterfeit drugs containing fentanyl. None of them have happy endings. 

A 28-year-old smoked “a powdery substance” at his mother’s home, where he was living at the time. His mother found him unresponsive in the living room, and having no idea of what had happened, called 911. He was pronounced dead on arrival. The death investigation determined that the substance had been given to him by a friend, who stated they both thought it was cocaine. Toxicology confirmed that while he had a non-lethal level of cocaine in his system at the time of death, the cause of death was acute fentanyl intoxication- he died of a fentanyl overdose.

A 20-year-old college student suffering from undiagnosed anxiety was panicking about a test the following day, so consumed a single oxycodone pill he had obtained illegally before going to bed. His roommates found him dead the next morning. Toxicology confirmed that he died from a fentanyl overdose.

A 19-year-old purchased two Percocet from a friend. He consumed both pills and subsequently died from an overdose. His friend confirmed the purchase, but then toxicology showed the presence of lethal levels of fentanyl. His friend swore he didn’t know they were fake and was very distraught. That friend was also later found dead of an overdose. It was confirmed that it was also due to fentanyl, but it wasn’t clear if it was suicide or accidental. 

These are cases where four individuals died of fentanyl overdose, with all of them consuming a different drug, and three of them never even realizing they were consuming fentanyl. On that note, have you decided which group of Xanax in the picture were fake? I’ll tell you now: both are fake. Guess it’s a good thing you couldn’t actually choose. Get my point?

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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When Home Becomes Work:Challenges of Working Remotely

When Home Becomes Work: Challenges of Working Remotely

Captain Obvious says that while coronavirus is responsible for thrusting us (with IT people kicking and screaming) into working remotely as a necessity, it was already a fairly common practice BR (before ‘rona). In fact, a statistic I read indicated an overall global trend toward remote work long BR, with a global increase of 159% between 2005 and 2017. As far as US stats on remote work go, 17% of US employees report that they worked from home five days or more per week BR, but that jumped to 44% DR (during ‘rona). As for the future, polls indicate that totally AR (after ‘rona) a minimum of 16% of American people who had previously worked outside the home BR will switch to working remotely from home at least two days per week AR. In addition, more than one-third of US firms that had employees switch to remote work DR believe that it will remain more common at their company AR. Globally, polls now predict that 25% to 30% of the earth’s workforce will work remotely multiple days per week by the end of 2021. In short, the genie is out of the bottle, and it’s not likely to go back in.

Many employers and business leaders think that going remote is as simple as sending an employee away from the office with a laptop and a to-do list, but unfortunately, it’s not that simple. In truth, there are real life consequences associated with working remotely. It may sound like a dream come true, but from where I’m sitting, it’s become more like a nightmare. A lot of people have gone back to their outside offices now, but many are still working from home. This is either because they- or their employers- are still too reluctant to make the switch and return, or have found it beneficial enough that it behooves them to continue remote operations. Regardless of why you may find yourself doing so, working remotely does present its own set of challenges, not the least of which is that companies were essentially forced into it overnight, without benefit of true preparedness and system checks. 

But in any event, if you are still working remotely at this point, you may find yourself continuing to do so indefinitely. I find that most of my patients enjoy lounging in their pajamas all day as they work from home, never leaving their house because it’s such an effort to get dressed; though they fail to understand why they’re so anxious, irritable, and depressed. The good news is that there is a way to do this work from home deal effectivelyand happily, and even excel at it, while still having a personal life and functioning appropriately. The bad news is there are some not-so-nice ramifications and consequences associated with the routine, and a lot of people are starting to recognize this after far too long being “trapped” at home. Spoiler alert: most people actually are not. The bottom line is that your whole world doesn’t have to change just because you’ve eliminated a commute. Out of necessity DR, it did change for a time, but at this point, it’s time to get out and reclaim some normalcy. Some of the issues that come up with working remotely are more rooted in the personal realm, and deal with basic self care and psychological health, while others center more on professional matters. But don’t kid yourself, there’s a lot of overlap and cross reactivity betwixt and between them. So this blog marks the beginning of a series dedicated to identifying the issues surrounding working remotely, and discussion on how to address them appropriately, with some tips and tricks and coping methods thrown in for good measure.  

Today’s blog will deal with some problems that I’ve noted in video calls and appointments with my patients. I sometimes call them “duh!!” issues, because a lot of you are going to be like, “Duh, Dr. Agresti, we all know that!” Well, what some people know and what they do are two very different things. If you’re depressed, and you haven’t brushed your hair or gotten dressed for a week straight, then you might hear me say, “Duh, go brush your hair and get dressed, you’ll feel better.” I suppose you could also call them “helll-ooo!!” issues, as in, “Helll-ooo… you really need to take a shower!!” That’s a real thing, people. Not all of the things I’ll discuss are quite that extreme, but my list of remote work must-do’s includes some personal care requirements that must become- and remain- second nature to you; they must be part of a regular routine, regardless of the fact that you may be all alone, with nobody even there to see (or smell) you. So that’s where we’re starting; with just some very basic, very simple recommendations for a better life and more success in a remote work situation. Most of these you probably already know, but you may not be doing them. Allow this to be your kick in the can if that’s the case.

-Sleep in your bed, but then get out of said bed when you get up in the morning. Don’t just wake up and roll over to reach for your laptop to start your day. I cannot tell you how many patients I talk to while they’re working in bed; they’re literally in bed 24/7. Get out of bed!

-Create a dedicated office, preferably with a door you can close to keep things quiet and help you avoid distractions. If you don’t have a spare room, then at least create a dedicated work space. Even a corner of a room will do if that’s all you can spare. You really just need room for a table or desk large enough to hold a computer and whatever supplies you need, and a chair. Try to make it as comfortable- and functional- as possible.

-Make a schedule and stick to it. And be sure to keep an accurate account of the hours you work. I’ll be discussing supervisory micromanaging in the next blog, but if you keep a regular schedule and good records of your hours, you’ll have all the info you need if you are questioned by a micromanaging supervisor.

-Now that you aren’t commuting to and from the office, you’re going to be physically moving a lot less. So you must make time each day for exercise. So many of my patients that have switched to working remotely have gained a fair bit of weight and almost all of them have lost serious muscle tone. When you’re working from home, it’s easy to get comfortable and complacent, and turn into a flabby flaccid couch potato. Do something to move your muscles every day. 

-Eat three square meals each day, and no more 24/7 snack attacks. Just because your refrigerator is mere steps away doesn’t mean you should make the trip every 30 minutes. A small midmorning, midafternoon, or late night snack is okay, but that’s it. Note my word choice: or not and. Three decent meals and one small snack each day is acceptable- just try not to go too crazy- and try to make it reasonably healthy, maybe a yogurt, cottage cheese, or piece of fruit. Like, a box of girl scout cookies is not a snack, people. 

-Because you aren’t commuting to and from the office, you’re also rarely going to be required to go outside. So you must make a special point to go outside every day, even if it’s just for 15 minutes after lunch. Human bodies require vitamin D, and nothing’s a better source than sunlight. Try taking a walk around your neighborhood after you have lunch, just something where you’re exposed to the sun. 

-A lot of my patients are complaining of decreased intimacy and a lack of sexual energy since they started working remotely. So my next suggestion is to do whatever you can to be close to your partner. Emotional and physical intimacy are important, so have sex, but maybe don’t combine this suggestion with the one above it, unless you have an excellent privacy fence. 

-When work is over, stop working. It can be tempting to work more hours when you’re at home. This may sound counterintuitive, but it’s true. To avoid this trap, work the same schedule and number of hours each day at home as you would if you were commuting to an office. Don’t try to cram jam in four16 hour days days a week in order to take a 3 day weekend, unless it’s an unavoidable situation, and/ or you receive permission or clearance from a supervisor if applicable.

-Make sure to get adequate sleep. Go to bed at a reasonable time, get up at a reasonable time, and try to stick to a sleep schedule. And remember to avoid blue light exposure for at least two to three hours before you go to bed, otherwise you’ll have a hard time falling asleep. 

-Keep your regular grooming routine- you’ll feel better about yourself. If you didn’t get the hint, shower every day. Brush your hair, and your teeth. Shave and put on makeup if you’re about that life. Work is not a pajama party, so get dressed in appropriate clothing. You don’t have to wear a suit or heels, but make an effort to be presentable, even if there’s no one to present yourself to. 

This isn’t rocket science, people. Basically, you should follow the same routine you always have, and do everything you would do if you were going to an actual outside office or workplace: go to bed at a reasonable and regular time on work nights, get up at a reasonable and regular time each morning, and resist the urge to hit snooze 97 times. Shower, shave, get dressed in decent clothing, and eat breakfast. Then go to work in your in-house office space, just as you would if you were going to commute to an office. Avoid distractions and get your work done. Take a one hour lunch break maximum, and make sure to actually eat something reasonable, but avoid eating at your desk. Think about taking lunch outside for some fresh air, vitamin D, and a change of scenery, and you can kill multiple birds with a single stone. After lunch time is not nap time- and it hasn’t been since kindergarten- so after lunch, go back to work until it’s time to stop at the end of the day. Make sure to put in a full day’s work, while also being careful not to overwork. Behave as if you owned the company and were paying employee salaries. Supervisors will be less likely to micromanage you to death if you give them no reason to mistrust you or doubt your motivations.  

No Nearly Naked Zooming

Captain Obvious says that videoconferencing has become a big part of our lives DR, and will continue to be long AR. Here’s a fun fact for you, Zoom saw phenomenal growth in 2020, and ended the third quarter of 2020 with an astounding report of 367% year-over-year revenue growth. If you had stock in Zoom Video Communications BR, which I did not, that’s a very fun fact for you. And get this… Zoom hosted an average of 300 million meeting participants per day throughout 2020. That’s 300 million people that don’t need to see you in your underwear, people. Same goes for gnarly, used-to-be-white, ripped t-shirts with yellow pit stains. Get it? If you didn’t, here’s the simple concept: put on a shirt. One with at least two buttons at the top. 

Drinks, not Zinks

Even if you dress appropriately for video conferencing calls, there’s really no replacement for real deal interaction, because shockingly, humans are hardwired for human connection. Even Captain Obvious wouldn’t bother with that one. It’s just not possible to simply erase our evolutionary zeitgeist and replace millions of years of in-the-flesh interactions with technologically mediated virtual communications. While Zoom and its brethren have helped us in our attempts to recreate a certain degree of face-to-face experiences, that’s really as much thanks to the power of human imagination as it is to technology; and nothing stifles human creativity and imagination like isolation and loneliness. As a society, we spend a lot of time creating tech to replicate real-life experiences, but it’s a cheap substitute. In most situations, we’re better off spending a larger portion of that time experiencing real-life personal experiences. If you live alone and work from home, you could literally spend days without any human contact. You should make an effort to socialize, but remember to do so responsibly and wear your mask, people. Call a friend and suggest you meet for dinner, coffee, or lunch, or go on a date night. Drinks are hands down better than Zinks, so arrange to meet a friend IRL. 

Loneliness or isolation is one of the most commonly reported issues that remote workers and digital nomads face, along with anxiety, stress, and depression. Next week, in part deux of this remote work blog, I’ll talk more about those, as well as some professional issues that can come into play when working remotely, and I’ll make some suggestions on how to deal with them. Then in part three, I’ll talk about some specific anxiety and stress busting techniques you can incorporate into your routine during the day, as you need them, and they won’t complicate or derail your work schedule, or negatively affect your productivity. In fact, they’ll do just the opposite.

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too.

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well, people!

MGA

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Personality and Behavior: DISC Model

Personality and Behavior: DISC Model

Wikipedia defines personality as the “characteristic set of behaviors, cognitions, and emotional patterns that evolve from biological and environmental factors.” I’m sure they probably go on to list those factors in the third through fifth paragraphs, so this short definition seems neat and tidy without really committing to much. But as we all know, when you’re dealing with humans, things aren’t ever simple. In reality, there’s no formal or universal definition, but that’s okay, because it gives psych nerds something to argue about. Because there’s no universally accepted meaning, all definitions are essentially theories, most of which center somewhere around an individual’s psychological motivations and resulting interactions with their environment. Alternatively, people can refer to it as character, temperament, or disposition, but in my opinion, no matter what you call it, the bottom line is that each person has a unique combination of characteristics or qualities that form a distinctive set, and these govern their perspectives, motivations, and behaviors. 

Now, before I really get into this week’s topic, this is a good place for me to add a disclaimer: When addressing concepts like personalities and behaviors with a large group of people, I have to simplify and generalize, because these are nuanced subjects with far too many influential and individual factors than I could ever address in a blog. So if there are any psych police out there on patrol, please don’t write me a ticket for simplifications and generalizations. 

Now that that’s out of the way, I’ll start with a question: have you ever noticed at times how different the judgement and behaviors of your family and friends can be from your own? My profession means that I literally spend the majority of my life examining what someone does, their behavior(s), and why they do it, their motivation(s). I’m sure you’ve been in many situations where you’ve asked yourself, “Why did he/ she dothat?” or “What were they thinking?” While sometimes it can be frustrating to have a difference of opinion with people, the truth is that life would be boring if we all thought and acted the same way. 

So how do you understand and reconcile these differences? Believe it or not, the starting point of understanding people is actually pretty simple; accept just one fact: that while I’m sure you’re fabulous, everyone is not like you. In point of fact, everyone is not like everyone else, either. If you search for a definition of the word personality, you’ll invariably find the words “characteristic” and “unique” included, along with other synonyms. These are all evidence of, and pretty words to convey, one fact: that we’re all different. We all carry our life experiences and opinions with us, and we filter everything we see, hear, and experience through them, so they color our perceptions and motivations; and these in turn influence our behaviors. I believe the saying goes something like “different isn’t bad, it’s just different,” and I can roll with that. Each of us is unique; we think differently, and therefore behave differently. It’s really a good thing; far, far better than the alternative.

But behavior and personality can be easily misunderstood, and if that becomes chronic, these repeated misunderstandings tend to become areas of stress that affect a person’s happiness, which in turn affects motivation and productivity in every aspect of life. If you’ve ever been in a situation where you felt like you couldn’t “get along” with someone, on some fundamental level, you probably just don’t understand them. A lack of understanding and acceptance of differences can lead to tension, disappointment, and miscommunication. When issues like these go unresolved, they tend to build, and ultimately, can lead to resentment. Resentments can be notoriously difficult to untangle, so in the end, it’s far better to avoid the original problem if you can. Admittedly, that’s often easier said than done, especially if you don’t have a clue what on earth is going on inside the mind of another person. I’ll shed some light on that, so that hopefully by the end of this blog, you’ll have more insight on what that may be.  

If the problem is associated with misunderstanding(s), then it only follows that the solution to that problem probably has a lot to do with understanding. When I say that, I’m not talking about holding hands and singing kumbaya with everybody… I’m saying that accepting that people have different opinions from yours, and then making reasonable attempts at understanding where they’re coming from, will serve you better than being obstinate and absolutely refusing to do so. That said, the success of nearly every solution is in its application, so how exactly do we better understand people? There is a relatively simple visual model that can serve as a key to understanding the basics on how people behave. It’s called The DISC Model of Human Behavior, aka DISC model. It can be applied to loosely categorize a person’s personality traits and extrapolate their motivating factors and behavioral styles. More on that later.

Before I get into the DISC model, time for another disclaimer: Because personality and behavior are such diverse and nuanced human attributes, and since the DISC model is a theoretical one, it isn’t used for diagnostic or clinical applications. In other words, when you come into my office and tell me your life story, I’m not running through it in my head looking to categorize you as one of four types. People are complex and DISC is by nature more simple and general; and rarely, if ever, does anyone fall perfectly into any one type. That said, I’m covering this model today in blog form because I think it’s an interesting and practical way for everyday non-clinical people to better understand themselves and others, and to apply that in an effort to communicate more effectively with people who have differing perspectives… which is basically everyone! 

Why Personality Traits and Behavior Matter

Why should you care to learn about behavior and personality or the DISC model? Believe it or not, personality and people skills are important aspects of life: personal, social, and workplace. If you can’t work in cooperation with other people, it can be really tough to make it in this world. It can affect your ability to keep a job or advance your position, to make friends, and to keep peace with partners, family, and friends. We’re all familiar with IQ, our intelligence quotient, and we spend years in school developing and learning how to effectively use our minds. But developing your personality to effectively use behavior is also vital to successful living. Studies have shown that technical skill, beginning with intelligence and developed through education and experience, accounts for only 15% of success in the workplace; the other 85% has been shown to actually come from people skills. These skills are developed through learning better ways to behave, communicate, and interact with others. The DISC model is commonly applied as a tool to increase your ability to understand yourself and others, and communicate more effectively with everyone.  

History of the DISC Model

Even if it sounds like one, this isn’t a new age, hippy-dippy-trippy idea. Au contraire. Let’s get in the waaay-back-machineand go to Greece, around about 300 B.C.-ish. Why? To see Hippocrates. Whenever I hear his name I can’t help but smile despite myself, because it always makes me think of Bill & Ted’s Excellent Adventure. When they met Hippocrates, they mispronounced his name like the murderous mammal + crates, pronounced like it rhymed with plates, and in their characteristic burner dude affectations. And now the memory of that movie quote is inextricably linked to his name in my mind.. I hear them say it every time. Anyway, back to the topic at hand. Hippocrates was a physician, but also a rebel! And thankfully so. At a time when most of his fellow Greeks were attributing sickness to The Fates, superstition, and the wrath of the gods, Hippocrates espoused the firm belief that all forms of illness had a natural cause. Which, believe me, is a far better alternative than worrying about appeasing The Fates, the witches, and the gods. At any rate, perhaps in pondering the natural basis of illness, or maybe ways to prove his theory to his colleagues, Hippocrates began to recognize that the behaviors of individuals seemed to follow distinct patterns, and he began to loosely categorize the differences in these behaviors. 

While Hippocrates had the original notions on behavioral patterns, many psychologists and scientists continued to explore and expand on his theory. In 1928, Dr. William Marston wrote The Emotions of Normal People, in which he theorized that people are motivated by four intrinsic characteristics or factors that direct predictable behavioral patterns, and described these four factors as personality types. He then created a visual model that utilized a circle divided into quadrants to represent these four personality types. In his original work, he labelled them as D, I, S, C: Dominance, Inducement, Submission, and Compliance. And poof… the DISC model was born.

From what I’ve read, Marston was kind of a freaky guy, and the slightly(?) deviant undertones of his word choices “dominance, inducement, submission, and compliance” seem to confirm this. Even though he was a well respected psychologist by day, he was also a surprisingly successful comic book author by night, and is in fact credited for creating the comic book character “Wonder Woman.” She’s an Amazonian, a race of female warriors from an island where men were not allowed. This actually isn’t too much of a stretch, because Marston was also a champion of women’s rights. Despite this, he seemed to have had more than his fair share of female-centric scandal in his life. I found several references that said that he invented the first lie detector test, but also found some that credit someone else with this feat. Regardless, apparently he wasn’t exactly always on a first name basis with the truth, because he lied to the public about being a bigamist. Evidently, after he married his second wife (who was also a former student) and she moved in with him and his first wife, he told the public she was just a relative staying with them… and they fell for it. So during his bigamist marriage, they all lived together in a ménage à trois, and he actually fathered children with both women. But in spite of the scandal he caused with his colorful private life, Marston’s theories of human behavior are still widely accepted today. 

What is DISC Used For?

The DISC model is applied as a personal assessment tool designed to ascertain a person’s personality traits and behavioral styles. It’s essentially a series of questions that evaluate human behavior in various situations. For example, it looks at how you respond to challenges, rules, and procedures, how you influence others, and what your preferred pace is. 

While Marston’s theories and DISC model were generally well received, some organizations later modified it and created a negative tool used by organizations and employers to weed out undesirables. But in later years, to reflect a change in attitudes, it has since seen several iterations. Now all existing forms of it are used exclusively as positive tools of inclusion rather than being negative and judgemental. DISC assessments are used to foster understanding and respect, improve people skills, build better teams, increase productivity, reduce conflict, and relate and communicate with others more effectively; all of this is meant to translate to increased cooperation and the creation of better working relationships. In fact, the DISC model is widely accepted in the business community; so much so that many organizations and employers incorporate it into all associate training programs, but it is especially used in fields and positions related to sales, marketing, customer service, and management.

I was surprised to learn that DISC assessments have confirmed use in 70% of the Fortune 500 companies, including Exxon/Mobile, General Electric, Chevron, and Walmart. Pretty impressive, as these are strong companies with good management; and according to what I read, that’s where most of them focus their DISC utilization. 

But you can also apply the model to your personal life, to learn more about yourself and grow as a person, increase people skills, illuminate your own motivations, and uncover your strengths and blind spots, some of which you may not even be aware of. As a bonus, you’ll then be better prepared to answer certain questions that may come up in life; for example, when a prospective employer asks “What would you say your strengths are?” or even better, when your spouse or partner looks at you exasperatedly and asks, “Why the *bleep* do you do that?” Wouldn’t it be nice to have a handy answer to that one?! 

In the end, despite its generalizations, the model is sort of like “personalities for dummies”- not that I’m saying you’re dummies- I’m just saying it’s a simple and useful way for non-clinical people to better understand themselves and their own motivations, and apply that knowledge to relationships and everyday interactions, both in and out of the workplace. 

DISC Terminology: Four Behavioral Patterns

Since Marston’s time, while the general concept surrounding the DISC model has remained the same, some of the terminology has changed several times. Some publishers and reference models use a lowercase i in DISC as a way of distinguishing between different models and for trademarking assessments and reports (read: as a way of making money). DISC with a capital I can’t be trademarked, so I’ve used that form for our purposes. The terms used to convey the DISC personality/ behavioral types have also changed for several reasons: to reflect a change in attitudes and more positivity, as a way of distinguishing between different models, and for trademarking purposes; so now there are a few different versions that vary slightly. Different companies and publishers determine and apply their various terms, and I’ve listed the most popular ones, in an order with the ones that I find most applicable first and Marston’s being last.

D: Dominant / Dominance 

I: Inspiring / Interactive / Inducement

S: Supportive / Steadiness / Submission

C: Cautious/ Conscientious / Compliance

No matter what term is used, the basic traits and behavioral styles are essentially the same; I’ll cover those later.

I should note that now some publishers have apparently modified assessments to further extrapolate personality traits and behavioral styles; I’ve seen some that will describe up to twelve types, and even an article that referenced exactly 41 personality types. I didn’t fact-check or verify that, but just wanted to mention it as kind of an outlier. 

DISC Basics

This model is based on two fundamental observations about what drives people to behave the way they do, which are essentially their motivators. I want to emphasize something to keep in mind: as you look at fundamental behaviors, you’re looking at tendencies, not absolutes. Most people will tend to behave more one way than the other, but will behave both ways, to greater and lesser degrees, depending on the situation they find themselves in. Also, behaviors are fluid; they can and do change over time and vary by situation.

DISC: Two Fundamental Observations

(Internal) Motor and (External) Focus

-Some people are more outgoing, while others are more reserved. This is each person’s “pace,” or “internal motor.” It is sometimes simply referred to as the “motor” drive. Some people engage quickly and always seem ready to go, and these are considered outgoing types. Others engage more slowly or more cautiously, and these are considered reserved types.

-Some people are more task-oriented, while others are more people-oriented. This is each person’s “external focus” or “priority” that guides them; sometimes simply referred to as “focus.” Some people are more focused on getting things done, and these are considered task-oriented types. Others are more attuned to the people around them and their feelings, and these are considered to be people-oriented types.

Visualizing the DISC Model

As I mentioned, DISC is a visual model, and it utilizes a circle to represent the range of “normal” human behaviors. You can imagine it as a clock face.

To illustrate the application of the first fundamental observation, aka motor drive, imagine you divide a circle in half horizontally, as from 9 o’clock to 3 o’clock on a clock face. The upper half then represents Outgoing (or fast-paced) people, while the lower half represents Reserved (or slower-paced) people.

To illustrate the application of the second fundamental observation, aka focus drive, imagine you divide a circle in half vertically, as from 12 o’clock to 6 o’clock on a clock face. The left half then represents Task-Oriented people, while the right half represents those who are more People-Oriented.

When the two motor and focus circles are superimposed to combine them, you end up with four behavioral tendencies to help characterize people: Outgoing, Reserved, Task-Oriented, and People-Oriented. The balance of these four tendencies shapes the way each person sees life and those around them. 

To illustrate the incorporation of the two drives (motor and focus) you can imagine one clock face with two divisions (horizontal and vertical) and therefore in four quadrants. Starting at 12 o’ clock and moving clockwise, you would then see Outgoing at 12 o’clock, People-Oriented at 3 o’clock, Reserved at 6 o’clock, and Task-Oriented at 9 o’clock. 

By combining the two drives, you now have four total behavioral tendencies: from the upper left quadrant, moving clockwise, those tendencies are then: 

Outgoing and Task-Oriented (upper left quadrant)

Outgoing and People-Oriented (upper right quadrant) 

Reserved and People-Oriented (lower right quadrant)

Reserved and Task-Oriented (lower left quadrant).

Then to further define and describe these four behavioral tendencies, the DISC terms are added, one letter per quadrant: Dominant, Inspiring, Supportive, and Cautious. 

Illustratively, these are added to each of the four corners of the diagram, again starting with the upper left quadrant and moving in a clockwise direction: Dominant in upper left quadrant, Inspiring in upper right quadrant, Supportive in lower right quadrant, and Cautious in lower left quadrant.

Once added, starting with the upper left quadrant and moving in a clockwise direction, each DISC term correlates with the four behavioral tendencies such that:

Dominant types are Outgoing and Task-Oriented (upper left quadrant)

Inspiring types are Outgoing and People-Oriented (upper right quadrant) 

Supportive types are Reserved and People-Oriented (lower right quadrant)

Cautious types are Reserved and Task-Oriented (lower left quadrant).

What emerges is the full graphical description of the complete DISC model. 

Interpreting DISC

To make the quadrants easier to discuss, we typically call each quadrant a behavioral style or type, though some people use the phrase personality type. I’ll spare you the specifics as to why, but technically speaking, it’s not really accurate to use the word “personality” type or style with the DISC model, because it’s actually a behavioral model. While I tend to refer to it as a behavioral style, either term- personality or behavior- is generally acceptable for a colloquial discussion or a blog. 

DISCussion: Four Primary Behavioral Styles

While DISC refers to placement within four primary behavioral styles, always keep in mind that each individual person can, and usually will, display some of all four behavioral styles depending on the situation. The resultant blending of behavioral tendencies is often called a style blend, and each individual’s style blend will have more of some traits and less of others. 

The Dominant “D” Style

An outgoing, task-oriented individual will be focused on getting things done, solving problems, making things happen, and getting to the bottom line, usually as quickly as possible. They can sometimes be blunt, outspoken, and somewhat demanding. The key insights in understanding and developing a relationship with this type of person are respect and results.  

The Inspiring “I” Style

An outgoing, people-oriented individual is generally enthusiastic, optimistic, open, and trusting. They thrive on interaction and love to socialize and have fun. This person places emphasis on persuading others and is usually focused more on what others may think of them. The key insights in understanding and developing a relationship with this type of person are admiration and recognition.

The Supportive “S” Style

A reserved, people-oriented individual will place an emphasis on cooperation, sincerity, loyalty, and dependability. They enjoy working together as a team and thrive on helping or supporting others. They usually focus on creating and/ or preserving relationships and on maintaining peace and harmony. The key insights in understanding and developing a relationship with this type of person are friendliness and sincere appreciation.

The Cautious “C” Style

A reserved, task-oriented individual enjoys independence, and often fears being wrong. They will seek value, consistency, and quality information, and will usually focus on details, facts, rules, accuracy, and being correct. The key insights in understanding and developing a relationship with this type of person are trust and integrity.

I should also note that some organizations use a shortcut in discussing the different behavioral types, where the dominant type is also known as High D, the inspiring type is also known as High I, the supportive type is also known as High S, and the cautious type is also known as High C.

Behavioral Styles: Elevator Test

As you’ll see, this is a pun meant to give you an idea of your own behavioral style and to help you identify others. Captain Obvious says it’s not meant to be scientifically or clinically valid, people, it’s just to illustrate the four behavioral styles in a relatable, “everyday situation” kind of way.

The doors are about to close on a person who is eager to get on an elevator, which already has four people inside. One of the four people already inside glances at their watch, because they’re in a hurry and would prefer not to wait. But also inside is the bubbly, smiling, energetic second passenger who actually holds the door open while encouraging the newcomer to climb aboard. The third rider doesn’t mind if the new person gets on, and they simply step back to make room while patiently waiting for them to do so. The fourth passenger barely looks at the new guy, as they’re busily calculating the sum of everyone’s weight in their head while also looking around to estimate the age of the elevator. 

Did you see yourself in this scenario? Did you recognize the behavioral styles of the other elevator passengers? Read on to find out if you’ve got it.

This scenario demonstrates behavior of the Dominant (outgoing / task-oriented) person who wouldn’t really mind if the elevator door closes before the new guy can get on, because they’re just focused on getting where they need to be as quickly as possible. But that possibility is dashed by the Inspiring (outgoing / people-oriented) person who feels energized by the addition of yet another positive interaction to their day. The Supportive (reserved / people-oriented) person just calmly steps back to make room for the new guy because they empathize with him and are willing to be accommodating. All of this while the Cautious (reserved / task-oriented) person almost can’t help but make sure the added person doesn’t exceed the weight limit of the old elevator and potentially cause them all to get stuck… or worse. 

Notice that there were four different people who responded to the same exact event in very different ways? People are motivated differently, and therefore think differently, so they behave differently. 

Takeaways

Every individual person has a unique combination of characteristics and qualities that form a distinctive set, and these govern their perspectives, motivations, and behaviors. 

The DISC model developed by Marston is used as the basis for varying assessments of personality traits and behavioral styles.

While it is simplified and generalized, it can be an effective and empowering tool to examine motivating factors, to uncover and address blind spots, and to identify, highlight, and articulate strengths.

It can be used by people to better understand themselves and others, and to apply that understanding in an effort to improve people skills and to communicate more effectively with people who have differing perspectives.

It is commonly used in the professional arena, especially in Fortune 500 companies. Employers often use it for determining placement of new employees, to build better teams, increase productivity and communication, reduce and resolve conflict, and foster acceptance and understanding. 

Each person has a unique blend of all of the major personality traits and behavioral styles to a greater or lesser extent.

Behavioral patterns are fluid and dynamic, and can change over time or as a person adapts to his or her environment.

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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Kratom:Panecea or poison?

Kratom: Panacea or Poison?

What is Kratom?

Kratom (scientific name: Mitragyna speciosa) is a tropical evergreen tree in the coffee family that is native to the jungles of Southeast Asia; specifically found in Thailand, Myanmar, and Malaysia. It is also found in Papua New Guinea. Other names for kratom include thang, kakuam, thom, ketum, and biak. Whatever it’s called and wherever it may be found, this tree, or at least the leaves on it, has been causing quite a commotion in recent years.

The Scientific Scoop

Mitragyna speciosa leaves contain multiple active components, referred to as alkaloids, with properties ranging from stimulant-like energizing and uplifting to opiate-like drowsiness and euphoria, so this makes it difficult to characterize kratom as one particular type of drug, i.e. as “stimulant” or “opiate.” Kratom’s two main alkaloids are mitragynine and its active metabolite, 7-hydroxymitragynine, which has strong activity at the µ-opioid receptors (where µ is pronounced like ‘you’ but with an m: mu). This is the main opioid receptor, the same one that is the primary binding target of opioids like heroin and oxycodone. Why is this so important? Why do we need to know exactly where kratom binds and what effect that has? Well, so we know how it may be used. Here in America, the government isn’t so good with just accepting that this ancient Asian secret does xyz just because they said so. Because kratom binds to µ-opioid receptors just like heroin etc, opponents say that it must be categorized as a narcotic and therefore, it must be addictive just like heroin etc. But Narcan/ naloxone is also categorized the same way, and obviously it’s not addictive; in fact, it’s used to save people in cases of opioid overdose. 

There is a great deal of supportive scientific evidence from many independent laboratory studies using mouse models and multiple human cell lines that confirms that kratom’s alkaloid metabolite 7-Hydroxymitragynine is in fact a key mediator of the analgesic effects of kratom, through its agonistic binding to the µ-opioid receptor. This has also been confirmed by the finding that in the presence of the opioid receptor antagonist naloxone, the pharmacological blockade of the analgesic effect will occur. In plain language: they’ve clearly shown that kratom binds specifically to the µ-opioid receptor in human cell lines, and demonstrated that this binding produces analgesic effects by giving it to a specific type of live mouse that essentially models the human system. So after the mice were given kratom, they exhibited analgesic effects from it– through previously established and accepted behaviors that I’m totally not going into here– just trust people. And then, as if that’s not enough, to further prove that this analgesic effect the mice were having was definitely the result of kratom’s binding to the µ-opioid receptor, they then gave the kratom-dosed mice Narcan, aka naloxone, which is a µ-opioid receptor antagonist. What does that mean? Think of it this way: the Narcan “antagonizes” the µ-opioid receptor; it basically bullies anything already bound to that µ-opioid receptor, pushes it off, and then it binds to it and blocks it so that as long as it’s parked there, nothing’s getting by it to bind to those µ-opioid receptors. That’s how and why Narcan saves people from overdose: it pushes all the opioids off all of the µ-opioid receptors and then sits on them, and hopefully that happens soon enough that the person survives the overdose. If they do, and if they then ingest more opioids for several hours after being given the Narcan, they won’t feel the effects of the drugs for as long as the Narcan is present there on those receptors, because the drug’s opioids won’t be able to bind to the µ-opioid receptors, as the Narcan will be sitting there. So there’s been a lot of work done in various labs all over the globe to elucidate kratom’s form and function. But despite all of this work, there’s much more to be done! I’ll talk more about that later.

None of kratom’s uses are clinically proven, as it has not been studied in the human clinical trials that the FDA requires to allow a drug compound to be legally available on the open market. Clinical studies are very important for the development of new drugs, as they help to identify consistently harmful effects, harmful interactions with other drugs, and dosages that are effective, yet not dangerous. That said, there have been many legitimate published laboratory studies with clear demonstrable findings in mouse models and human cell lines that do allow us to at least extrapolate the effects of kratom in humans with some accuracy and relative safety. Most findings have been positive, and there is a large vocal community of kratom supporters with numerous anecdotal testimonials of kratom’s effectiveness in treating various conditions. But despite this, because treatment practices using kratom have not been rigorously studied as either safe or effective, the DEA staunchly maintains that it has no valid medical uses or benefits. In fact, several years ago, the FDA threatened to make kratom a Schedule 1 narcotic, meaning it would be grouped with marijuana, LSD, and ecstasy, among others, and this elicited a huge backlash… tens of thousands of kratom proponents complained vociferously, signed endless petitions and all that yada yada, and the FDA caved, dropping the issue, at least for the time being. But that’s not going to be the end of that story people… not when the government’s involved. So for now, kratom’s status should be listed as “to be continued.”

What is Kratom Used For?

In its native regions of Southeast Asia, kratom has been known to be used as a traditional medicine for more than a century, but has likely been used for multiple centuries. There in Southeast Asia, the leaves of the kratom tree are typically chewed directly from the tree or consumed as a tea, and they induce stimulant and opioid-like analgesic effects, depending on the amount used. This is because the effects felt from ingesting kratom have been found to be dose-dependent: at low doses, which is generally considered 1 to 5 grams, kratom has been reported to work like a stimulant, imparting feelings of being more energetic, more alert, and more sociable. At higher doses, considered to be 10 to 15 grams, kratom has been reported as being more sedating, dulling emotions and sensations while producing euphoric effects. Anything over 15 grams is considered risky.

The stimulant type effects have traditionally made kratom popular among Southeast Asian agricultural workers especially, who use it to aid them in their long hours of hard labor. But for generations there, kratom has also been used successfully in its native regions for several other purposes: as an aphrodisiac to increase sexual desire, as an energy booster, to ameliorate withdrawal symptoms following cessation of opioid use, and for treating cough, diarrhea, and chronic pain. More recently, here in the US, there has been an uptick in the use of kratom by people who are self-treating chronic pain and managing acute withdrawal from opiates, while seeking alternatives to prescription medications. While some people claim to have success using kratom to treat depression and anxiety, and others say that kratom can also be used to treat muscle aches, fatigue, high blood pressure, diarrhea, and post-traumatic stress disorder (PTSD). Some studies report that kratom possesses anti-inflammatory, immunity-enhancing, and appetite-suppressing properties, but obviously more research is needed to confirm these benefits.

Kratom: Processing and Forms

The psychoactive compound referred to as kratom is found in the leaves of Mitragyna speciosa, and the processing seems pretty straightforward: after the plant’s large dark green leaves are harvested, they can be prepared in several ways: fresh leaf, dried leaf that is pulverized and powdered, dried leaf that is simply crushed, and concentrated liquid leaf extract. Kratom can typically be purchased in multiple forms, including paste, capsule, tablet, gum, tincture, and extract. In certain forms it is often combined with added sweetener to overcome its harsh bitterness. Kratom can be brewed into a tea as well, a form that is offered in kratom tea houses present in a few US states. Kratom can also be smoked or vaporized, though this is not very common.

While the use of Mitragyna speciosa is certainly not new, the alkaloid extraction and refinement methods to turn the alkaloids from the plant into kratom has certainly evolved, and now purity is said to be higher. I’ve read that now there are also fortified kratom powders available, and these contain extracts from other plants in a nod to the nutraceutical angle. In the United States, kratom is usually marketed as an alternative medicine, and often found in stores that sell supplements. Kratom can also be found in gas stations and paraphernalia shops in most parts of the US, except in the handful of states and cities that have banned it. Many people purchase kratom over the Internet, where it may be sold for “soap-making and aromatherapy,” a lot like what happened with synthetic marijuana or spice; that’s in an effort to circumvent the FDA’s 2014 ruling that made it illegal to import or manufacture kratom as a dietary supplement in the US.

Is Kratom Legal?

Although kratom is technically legal at the federal level, some US states and municipalities have chosen to ban it, making it illegal to sell, possess, grow, or use it. Other states have imposed age restrictions. In the states of Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin, kratom is illegal to buy, sell, possess or use. There are special cases in some states: while kratom is legal in California, it is banned in San Diego. While it’s legal in Colorado, in Denver it’s considered illegal for human consumption. Kratom is legal in Florida, except for Sarasota Country, where it’s banned. Kratom is legal in Illinois for those over the age of 18, except in the city of Jerseyville, where it is banned. Kratom is legal to use in Mississippi, except in Union County, where it’s banned. In New Hampshire, kratom is only legal for those over the age of 18. Please don’t quote me on these people- make sure to double check if you’re wanting to purchase- not that I’m encouraging that or even saying it’s acceptable btw. 

As far as countries around the globe go, kratom is illegal in: Australia, Denmark, Finland, Israel, Japan, Latvia, Lithuania, Myanmar, Malaysia, New Zealand (unless prescribed by a doctor), Poland, Romania, Russia, Singapore, South Korea, Sweden, Thailand, and Vietnam. Note that most places where native Mitragyna speciosa grows, it’s illegal… funny! Speaking of that, the country of Thailand has recently reconsidered the status of some illegal substances, so kratom might not remain illegal there.

In countries like Ireland, Italy, and the United Kingdom, the rules may vary from one city to the next. It’s also important to note that the status of kratom legality isn’t widely known for some countries. For example, it isn’t clear whether it is legal in China, or in many of the African nations. However, as the drug kratom becomes more widely known, countries, counties, and cities that don’t currently ban kratom may choose to do so at any point.

Is Kratom Safe?

Proponents say kratom is an amazing compound, a game-changer and lifesaver. Opponents, like the FDA, say it has no viable medicinal properties. How the US DEA, medical professionals, and millions of regular kratom users can have such divergent views of the same plant is hard to fathom. The overarching “company line” seems to answer this question “No!!” They state that kratom is considered addictive, that people can develop a physical dependence on it, and that in and of itself indicates that it’s not safe. There are some anecdotal reports of people becoming dependent on kratom, but there are more reports of people successfully using it to recover from opioid addiction; not to mention successfully treating chronic pain, fibromyalgia, anxiety, depression, on and on. So in my book, the jury’s out people. 

The question of kratom’s safety comes down to two factors: the lack of regulation and the interactions with other drugs or substances, whether endogenous or exogenous. 

Lack of Regulation

Any time a substance, including herbal supplements, isn’t regulated by the FDA, there are potential safety hazards. This is because there is no standardization when a substance isn’t regulated. That means that companies, particularly if they’re operating online, can market the product however they want. There are no official drug warning labels for kratom, and people may take it without knowing what other substances it contains. A buyer never knows what level of potency a kratom product could have or whether it’s pure. In addition, the active ingredient in kratom varies widely by plant species. As with marijuana strains, different kratom strains have slightly different effects; there are multiple species of the tree, so this makes kratom’s effects unpredictable. This unpredictable nature leads to a risk of overdose and other serious side-effects, including seizures, hallucinations, chills, vomiting, liver damage, or even death.

Kratom Interactions

Because there is little research currently available on how kratom interacts with other substances, the breadth and severity of effects are yet unknown. This unpredictability adds to the dangers of using kratom in combination with something else, because you’ll have little idea what it could do to you. Potentially negative effects can be even more severe when kratom is combined with other drugs and prescription medicines. Some of the kratom chemicals have been shown to interact with how the liver metabolizes other drugs, which can lead to dangerous interactions. Another risk is presented when people buy commercial versions of kratom that have been combined with other drugs or substances, especially if they too work on the same opioid receptors. The potential consequences of many drug interactions can range from seizures to liver damage.

Various Points on the Kratom Controversy

Depending on what you read and who you believe, kratom is a dangerous, addictive drug with no medical utility and severely deleterious side effects that include overdose and death, or it is an accessible pathway out of undertreated chronic pain and opiate withdrawal, as well as being useful in treating many other health issues. There are great physicians and impressive institutions with interesting facts on both sides of this issue.

Recent increased kratom use in the United States, combined with concerns that kratom represents an uncontrolled drug with abuse potential, has highlighted the need for more careful study of its pharmacological activity. The major active alkaloid found in kratom, mitragynine, has been reported to have opioid agonist and analgesic activity in vitro and in animal models that are consistent with the purported effects of kratom leaf in humans. However, preliminary research has provided some evidence that mitragynine and related compounds may act as atypical opioid agonists, meaning they induce their therapeutic effects like analgesia, while also limiting the negative side effects that often accompany classical opioids. One such side effect that is absent in kratom is constipation. A chronic pain medication like kratom that doesn’t cause constipation like current opioids all do sounds like a good thing, but as I said before, it’s a long way from here to there, especially considering the FDA’s current opinion. And something tells me they won’t be changing their collective mind any time soon. 

As it stands now, there is little to no control or reliable information on growth, processing, packaging, and/ or labeling of the kratom currently sold in the US; and all of this adds to the already considerable uncertainty of its health risks. In 2018, the FDA instituted a mandatory recall of all kratom containing compounds over concerns about Salmonella contamination in these products. More recently, the DEA placed kratom on its “Drugs and Chemicals of Concern” list, but as I mentioned before, it has not yet labeled it as a controlled substance, though not for lack of trying. Time will tell how long that lasts.

Kratom can be addictive due to its opiate-like qualities, and a small minority of users may end up requiring addiction treatment. The CDC claims that between 2016 and 2017, there were 91 deaths due to kratom; but this claim should be met with healthy skepticism, as all but seven of these casualties had other drugs in their system at the time of their deaths, and that makes it totally impossible to uniquely implicate kratom.

A patient wishing to use kratom to treat chronic pain or to mitigate opioid withdrawal symptoms could expect to encounter several problems with doing so, not all of which even have anything to do with the intrinsic properties of the kratom itself.

A patient that wants to use kratom to treat a legitimate illness or condition will likely face four problems for the foreseeable future:

-The first problem is that the DEA still occasionally threatens to make it a Schedule 1 controlled substance, along with drugs like heroin and ecstasy. This would make kratom very difficult to access, and would likely make the supply as a whole even more dangerous than it is now. Generally, it’s not a good idea to use something to treat chronic pain or addiction that may soon become less available and less safe: you want to know it’s going to be readily available, and that as a cure, it won’t cause more problems than the illness it’s being used to treat!

-The second problem is that the complete lack of oversight and quality control in the production and sale of kratom makes its use potentially dangerous.

-The third problem is that kratom has not been well studied for any of the uses its proponents claim it has an affinity in treating! Maybe the FDA hasn’t heard the saying that goes, “Absence of evidence of benefit isn’t evidence of absence of benefit.”

-The fourth and final problem is that kratom doesn’t show up on drug screens. I like kratom’s potential, but I can argue that adding another potentially addictive opiate-like substance while an opiate epidemic is already going on may not be the best course of action. 

Is there a sensible path forward with kratom?

I’m not sure that anyone has the answer to that question, but at a bare minimum, the safety of kratom could be improved through:

-Regulation: it would be safer if people knew the exact dosage of kratom they were truly consuming, and that it was totally free of contamination.

-Education: educated consumers who know all of the potential benefits and dangers of the compound they are consuming are far less vulnerable to misleading claims.

-Research: if kratom does in fact have the benefits that have been demonstrated in the laboratory for treating either addiction or chronic pain, we should absolutely know it and make it known: accurately defining the risks of using kratom is critical, as is making all medical personnel and laypersons informed.

If all four of these points could somehow be accomplished by scientists and public health specialists, without: overdue distortion from corporate interests, anti-drug ideology, and romanticism by kratom enthusiasts, then we should have enough clarity to answer the basic questions about kratom, including the most important question of all…is it harmful or helpful?

Effects of Kratom: Good, Bad, Ugly

The Good

Recall that the expected effects from kratom are dose-dependent: that smaller doses will produce a stimulant-like effect, while larger doses will produce sedative or opioid-like effects. 

A small dose of kratom to produce stimulant effects would be up to just a few grams, and these effects would be felt within 10 minutes after ingestion and can last up to 90 minutes. These expected stimulant effects include increased energy, alertness, and sociability, increased sex drive, decreased appetite, and giddiness.

A larger dose of kratom, between 10 and 25 grams, can have a sedative effect, imparting feelings of sedation, calmness, euphoria, pain reduction, and cough suppression, which last for much longer periods of time, potentially up to six hours.

The Bad

Potential unsafe and negative effects of regular kratom use, even at low doses, can include: agitation, tachycardia, drowsiness, vomiting, confusion, anxiety, tremors, itching, sweating, insomnia, lack of appetite, tremor, coordination problems, and withdrawal symptoms.

There can also be negative effects of high dose kratom, including: addiction, nausea, itching, constipation, and withdrawal symptoms of tremor and sweating.

There can be negative side effects of taking any dose of kratom at irregular times or random intervals as well. Many users of kratom have reported something called “The Kratom Hangover” the day after taking it, the symptoms of which can include irritability, anxiety, nausea, and headaches.

Because kratom can cause problems with coordination and sleepiness, it’s dangerous to drive or operate machinery while using it. For this same reason, pregnant women are also advised never to use kratom. 

The Ugly

There can be grave side effects from taking kratom, which can include seizures and respiratory and/ or cardiac arrest.

If a person takes a high dose of kratom and falls asleep, they may vomit and choke while asleep.

Kratom Overdose

There are numerous calls into the CDC poison centers for kratom overdose every year.

The risk of overdose increases when kratom is taken with another substance, especially opioids.

Recent studies have found evidence of fatal kratom-only overdoses involving severe and negative side effects that can occur when someone takes too much. Some of the symptoms of taking too much kratom can include: impaired motor skills, lethargy, slurred speech, either shallow or very heavy breathing, tremors, listlessness, aggression, delusions, and hallucinations.

Long-term and heavy use of kratom can lead to liver problems, as kratom tends to make it more difficult for the liver and kidneys to process and filter toxins out, contributing to the potential for this type of organ damage.

Signs of liver damage include dark-colored urine and yellow skin and eyes.

Kratom: Necessary Evil or Just Plain Evil?

Kratom is currently considered a dietary supplement, as it is not approved nor regulated by the US FDA. That said, there are anecdotal reports of beneficial effects of kratom use, though there is no clinical evidence yet to support them. In the future, with the proper supporting research, kratom may indeed have proven potential. 

But without this research, there are a lot of unknowns with kratom, such as effective and safe dosage, possible interactions, and possible harmful effects, including death. These are all things that you should weigh before taking any drug, but for kratom, they’re all question marks. In the final analysis, going by laboratory findings, kratom holds great potential. But if you’re thinking about using kratom to treat chronic pain or opioid addiction, or anything else… exercise extreme caution people.

I hope you enjoyed this blog and found it to be interesting and educational. Sharing means caring, so please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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