The Scariest Mental Disorders of All Time
Hello, people! I hope everyone had an excellent Thanksgiving! Is everybody on tryptophan overload? I know I am, but man was the turkey great this year! And the stuffing, the mashed potatoes, the gravy, the pineapple casserole… you get the idea. Anyhoo, last week and 5 pounds ago I finished up our series on the dark side of ADHD. I hope everyone learned something. Squirrel!! Again, if you don’t get that joke, check out the series. This week, I want to talk about the weirdest and scariest psych disorders out there. I remember this section from med school- it really caught my attention- you’ll see why shortly. Imagine suffering from a mental illness that causes you to believe your significant other is an imposter, hell bent on harming you, or one that convinces you that books are for eating, not reading. Or that your genitals are shrinking? YIKES!! Or the ultimate… that you have somehow become the walking dead. Pretty scary, right?
While a very small percentage of people are forced to live with these unusual disorders, 450 million people worldwide suffer from mental illness. In the United States alone, one in four families is affected. While some mental disorders, like depression, usually occur naturally, others are the result of brain trauma or other injuries. Although it’s certainly fair to say that any mental illness can be scary for those suffering from it- as well as their families- there are a few rare disorders that are especially terrifying. Those are what I’m going to talk about this week, so jump on the empathy train and buckle up, people… it’s about to get wild.
Also known as Body Integrity Disorder or Amputee Identity Disorder, Apotemnophilia is a disorder that sort of blurs the lines between neurology and psychiatry- we aren’t certain of the origins- so I’ll call it a neuropsych disorder. Whatever it is, apotemnophilia is typically characterized by the overwhelming desire to amputate or permanently damage healthy, functional parts of the body. More rarely, affected individuals have the express desire to be paraplegic, and in some exceptionally rare cases, they seek sensory deprivation, such as blindness or deafness. Oddly enough, the first description of this condition traces back to a series of letters published in Penthouse magazine in 1972, but the first scientific report of this disorder came about in 1977 with the medical description of two cases. As happens, two have become many, and now there may be thousands of people with apotemnophilia desiring amputation. They seem to gather on the interwebs, and some even have their own websites seeking support or pleading their cases. I mean, Captain Obvious says that the vast majority of surgeons won’t just amputate healthy limbs upon request… hello, Hippocratic Oath… so some sufferers of apotemnophilia feel forced to perform amputations on their own. DIY surgery? That’s a very dangerous scenario to be sure. But there have been some cases who have had a limb removed by a doctor, and most are reportedly very happy with their decision.
Since little was known about it, one American shrink made an attempt to further illuminate the disorder by surveying 52 volunteers desiring amputation. Thanks to his work, a number of key features were identified: there seems to be a gender prevalence, as most individuals are men, as well as a side preference, with left-sided amputations being most frequently desired. He also found that there was a preference toward amputation of the leg versus the arm. Until recently, the explanation for apotemnophilia has been in favor of a psychiatric etiology; it was thought to be a pathological desire driven strictly by a sexual compulsion. But a neurological explanation has recently been proposed, in the form of damage to, or dysfunction of, the right parietal lobe, thereby leading to a distorted body image and subsequent desire for amputation. In order to investigate this potential etiology, recent studies have utilized electrophysiological and neuroimaging techniques in an attempt to identify neurological correlates of body representation impairments. That work is ongoing. What’s interesting is that, in my experience, most of these folks seek limb amputation primarily to “feel complete” as they put it, as opposed to wanting to satisfy any sexual proclivities, but the debate about the reasons behind the desire rage on as studies continue. Sounds a little oxymoronic, to remove something to feel more complete, but that’s apotemnophilia.
Also known as imposter syndrome or Capgras syndrome after Joseph Capgras, a French psychiatrist who was fascinated by the illusion of doubles, Capgras is a debilitating mental disorder in which one irrationally believes that the people and/ or things around them have been replaced by identical imposters. Sort of like Leonardo Di Caprio in Inception, but without a totem to tell if you’re in the real world. Whether it’s a close friend, spouse, family member, pet, or even a home, people suffering from Capgras feel that their reality has been altered, that the real thing has been substituted for a fake. And if that weren’t bad enough, even worse, the imposters are usually thought to be planning to harm them. Capgras is usually transient, ranging from minutes to months, but unfortunately, also usually recurrent.
Capgras syndrome is most commonly associated with Alzheimer’s disease or dementia, both of which affect memory and can alter one’s sense of reality. Schizophrenia, especially paranoid hallucinatory schizophrenia, can cause episodes of Capgras syndrome, as this also affects one’s sense of reality and can cause delusions. In rare cases, a brain injury that causes cerebral lesions, especially in the back of the right hemisphere, can also cause Capgras syndrome, as that’s the area of the brain that facilitates facial recognition. Rarely, people with epilepsy and migraine may also experience temporary Capgras syndrome as well. There are several theories on what causes the syndrome. Some researchers believe that it’s caused solely by a problem within the brain, by conditions like atrophy, lesions, or cerebral dysfunction, while others believe that it’s a combination of physical and cognitive changes, causing feelings of disconnectedness. Still others believe that it’s a problem with processing information, or an error in perception which coincides with damaged or missing memories. For all we know about the brain, there is still so much we don’t. Occurring more commonly in females than males, Capgras is relatively rare, and is most often seen after traumatic injury to the brain. No matter the how and why, Capgras is upsetting for both the person experiencing the delusion and the person who is accused of being an imposter, and it’s easy to see why it’s one of the scariest disorders of all time.
Diogenes Syndrome is more commonly referred to as simply hoarding, and is one of the most misunderstood behavioral disorders. Named after the Greek philosopher Diogenes of Sinope- who was, ironically, a minimalist- this syndrome is usually characterized by the overwhelming desire to collect seemingly random items, to which an emotional attachment is then formed. In addition to uncontrollable hoarding, people with Diogenes syndrome often exhibit extreme self neglect, apathy towards themselves or others, social withdrawal, and no shame for their habits. It is very common among the elderly, those with dementia, and people who have at some point in their lives been abandoned, or who have lacked a stable home environment. Occurring in both men and women, people with Diogenes syndrome often live alone, tend to withdraw from life and society, and are seemingly unaware that anything is wrong with the condition of their home and lack of self-care. The conditions they live in often lead to illnesses like pneumonia, or accidents like falls or fires, and in fact, it’s often through these situations that the person’s condition becomes known.
Diogenes syndrome is often linked to mental illnesses such as schizophrenia, obsessive compulsive disorder, depression, dementia, and addiction, especially to alcohol. While there are defined risk factors for developing Diogenes, having one or even more doesn’t necessarily mean it will occur. In many cases, a specific incident becomes a trigger for the onset of symptoms. This can be something like the death of a spouse or other close relative, retirement, or divorce. Medical conditions may also trigger symptom onset: stroke, congestive heart failure, dementia, vision problems, increasing frailty, depression, and loss of mobility due to any number of reasons are the most common medical triggers.
This condition can be difficult to treat, and it can be very frustrating to care for people who have it. While Diogenes syndrome is sometimes diagnosed in people who are middle aged, it usually occurs in people over 60. Symptoms usually appear over time, and in early stages, generally include withdrawing from social situations and avoiding others. People may then start to display poor judgment, changes in personality, and inappropriate behaviors. Due to the associated isolation, people typically have this condition for a long time before it’s diagnosed. Warning symptoms in an undiagnosed person may include skin rashes caused by poor hygiene, fleas or lice, matted, unkempt hair, overgrown toenails and fingernails, body odor, unexplained injuries, malnutrition, and dehydration. The person’s home generally exhibits signs of neglect and decay, with possible rodent infestation, overwhelming amounts of garbage in and around the home, and an intense, unpleasant smell. Despite all of these factors, people with Diogenes syndrome are typically in denial of their situation and usually refuse support or help.
Most people cringe at the first sniffle that may indicate a potential cold or illness, but not people with Factitious disorder, as this scary mental disorder is characterized by an obsession with being sick. Factitious comes from the Latin word meaning artificial, so as the name suggests, people with factitious disorders will present artificial symptoms of real medical conditions. They will often go to incredible lengths to imitate symptoms of a real medical condition, and some will go so far as to intentionally harm themselves to feign symptoms. I’ve seen people inject bacteria into their bodies, intentionally contaminate lab tests, and take hallucinogenic drugs to feign symptoms of whatever illness they’re aiming for, and they’re often willing to be hospitalized and even undergo unpleasant or painful medical tests in order to further their efforts. I should note that factitious disorders are similar to hypochondriasis, in that the symptoms or complaints are not the result of having true, tangible medical conditions, but there is one key difference between factitious disorders and hypochondriasis: people with hypochondriasis believe that they are ill, whereas people with factitious disorders know that they are not.
There are basically three types of factitious disorders. The first is Munchausen syndrome, where people will repeatedly fake symptoms of medical problems. The symptoms will usually be exaggerated, and they tend to go to great lengths to convince others that those symptoms are real. Munchausen syndrome patients have been known to undergo multiple unnecessary medical procedures, even surgeries, and they tend to go to different medical facilities so as not to be detected. The second is Munchausen by proxy, which is like Munchausen, but when by proxy, the person suffering from factitious disorder will force someone else into the patient role. Most commonly, it is the parent(s) or caregiver(s) forcing children into the proxy role, putting them through various medical procedures, making up symptoms that the child has, encouraging the child to lie, falsifying medical reports, and/or altering tests to give the appearance of a sick child. The third is Ganser syndrome, which is a rarer factitious disorder that mostly occurs amongst prisoners, whereby they’ll display faked psychological symptoms such as psychosis. At times, they know they’re not going to get anything out of it, but they’ll give it a try anyway. Psychological testing and sharp shrinks usually tell the true tale with Ganser syndrome.
It can be difficult to identify factitious disorders because the perpetrators are often very adept in feigning symptoms, and they may go to great lengths to physically cause symptoms. I had one case where a woman was admitted to a hospital complaining about vomiting blood, and she insisted on receiving surgery. When an endoscopy didn’t show any stomach bleeding or other source of blood, she shoved her fingers up her nose to make it bleed down her throat. The ruses almost always include elaborate stories, long lists of symptoms, and jumping from hospital to hospital. As you can imagine, it’s incredibly difficult to get an accurate depiction of how prevalent factitious disorders are, because many people are so masterful at faking their symptoms. The estimated lifetime prevalence in clinical settings is 1.0%, and in the general population, it is estimated to be approximately 0.1%, but it ranges widely across different studies, from 0.007% to 8.0%. In one study of patients in a Berlin hospital, it was shown that approximately .3% of hospitalized patients had a factitious disorder. I suspect that whatever the actual number is, these disorders may be much more common than previously thought. Since people with factitious disorders can be very persistent, physicians have to carefully monitor people for it.
Experts have not identified one solid cause of factitious disorders. Some experts believe that these people suffer from a sense of inadequacy or unstable self worth, and use the factitious behaviors to get attention and sympathy, and this essentially defines their self worth. Most likely, they’re caused by a combination of emotional aspects. Such an obsession with sickness often stems from past trauma or serious illness, and it can be linked to a history of hospitalization or sickness during childhood which the patient tries to recreate, in order to return to normalization. Another possible cause is that someone close to the person really was chronically ill, and the person became jealous of the attention, and began to feign symptoms in order to get that same attention. People with factitious disorders will almost always insist that their symptoms are real, even despite clear medical evidence to the contrary, and this makes them very difficult to treat. Unfortunately, most factitious patients will steadfastly deny it and refuse any sort of treatment, but when help is sought, it’s often able to be at least limited with psychotherapy.
That’s a good place to stop for this week. Next week, we’ll talk about more weird and scary psych 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!
Somatization disorder (also Briquet’s disorder or, in antiquity, hysteria) is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin. The disorder must begin before the patient turns 30 years of age and could last for several years, resulting to either medical seeking behavior or significant treatment. One common generaletiological explanation is that internal psychological conflicts are unconsciously expressed as physical signs. Patients with somatization disorder will typically visit many doctors in pursuit of effective treatment.
Examples of manifestations of Pychosomatic disorder are as such: a child itches in response to family issues, and experiencing repressed anger and/or fear. Thus, The child grows and wakes up itching in the same locations, though not aware of the repressed memory causing the suffering in later life, or the patient is engaged in seeking psychotherapy for somatization.
Somatization disorder is a somatoform disorder. The DSM-IV establishes the following five criteria for the diagnosis of this disorder:
- a history of somatic symptoms prior to the age of 30
- pain in at least four different sites on the body
- two gastrointestinal problems other than pain such as vomiting or diarrhea
- one sexual symptom such as lack of interest or erectile dysfunction
- one pseudoneurological symptom similar to those seen in Conversion disorder such as fainting or blindness.