Trichotillomania FAQ

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What is trichotillomania?

Individuals with trichotillomania repetitively pull out their own hair. Trichotillomania as an impulse-control disorder. Nail-biting, skin-picking, and thumb-sucking are considered to be related conditions.

What are the causes?

Scientific research regarding trichotillomania has been conducted primarily in the past 10 years and causes are only theoretical. Psychoanalytic theories suggest that the behavior is a way of dealing with unconscious conflicts or childhood trauma. Biological theories look for a genetic basis. For instance, people with trichotillomania often have a first-degree relative with an obsessive-compulsive spectrum disorder. Researchers are also evaluating similarities between trichotillomania and Tourette’s disorder. Behavioral theories assume that symptoms are learned, that a child may imitate a parent who engages in hair-pulling. The behavior may also be learned independently if it serves a purpose. For example, hair-pulling may begin as a response to stress and then develop into a habit.

What are the symptoms?

• noticeable hair loss (alopecia) due to recurrent hair-pulling
• tension immediately before hair-pulling, or when attempting to resist hair-pulling
• reduction of tension, or a feeling of pleasure or gratification, immediately following hair-pulling
• significant distress or impairment in social, occupational, or other important areas of functioning

Insomnia FAQ

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What is insomnia?

Insomnia is a condition that occurs when a person in unable to get long enough or refreshing enough sleep at night. Insomnia can result from an inability to fall asleep, an inability to stay asleep, or waking too early before having gotten enough sleep.

What are the causes?

Many different things are thought to cause or contribute to insomnia. Such stressors as starting a new job or changes in routine, such as beginning to work a different shift, can lead to temporary sleep problems. Sleep problems can become aggravated, and persist after the worry or change causing the sleep problem has been resolved. This persistence is thought to be related to the anxiety created by attempting to go to sleep and not expecting to fall asleep. Anxiety about sleep loss can lead to a vicious circle in which the person has more and more concern about being able to fall asleep, making it ever increasingly difficult to do so. Some people even report that they are better able to fall asleep when they are not in their beds. This relative success is thought to occur because the new environment is not associated with the fear and anxiety of not being able to sleep, therefore making it easier to fall asleep.

Many other factors are thought to lead to or perpetuate insomnia. These include drinking tea or coffee, eating a large meal, taking certain medications or drugs of abuse that have a stimulating effect, or exercising heavily in the hours before attempting to sleep. Also, attempting to sleep in a room with too much light or noise can make it harder for some people to sleep. Doing activities in bed that are not associated with sleep, such as reading or watching television, can make it more difficult for some people to fall asleep when they finally want to. Sleep may be even more difficult if the television show or book was frightening or upsetting.

What are the symptoms?

The symptoms of insomnia can vary greatly from person to person. Some people find that they have trouble falling asleep at night and can lie in bed for hours without being able to drift off. Others find that they fall asleep easily but wake many times during the night. Other people awaken too early in the morning and are then unable to get back to sleep. Some people even get enough hours of sleep but find that they do not feel rested, often because their sleep is too light.

Not all people experiencing insomnia have symptoms that occur during the daytime, but many do. Some people experience such symptoms as reduced ability to concentrate or pay attention, decreased alertness, and mental sluggishness. Some people have trouble staying awake. More people think that they have this symptom than actually do. Upon clinical examination many people who think that they are excessively sleepy during the day actually are not.

Untreated insomnia has potentially serious consequences, including an increased risk of motor vehicle accidents, impaired school or job performance, and a high rate of absenteeism from work.

Adjustment disorder FAQ

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What is adjustment disorder?

An adjustment disorder is a type of mental disorder resulting from maladaptive, or unhealthy, responses to stressful or psychologically distressing life events. This low level of adaptation then leads to the development of emotional or behavioral symptoms.

What are the causes?

Often, a person experiences a stressful event as one that changes his or her world in some fundamental way. An adjustment disorder represents significant difficulty in adjusting to the new reality.

The stressful events that precipitate an adjustment disorder vary widely. They may include the loss of a job; the end of a romantic relationship; a life transition such as a career change or retirement; or a serious accident or sickness. Some are acute “one-time” stressors, such as relocating to a new area, while others are chronic, such as caring for a disabled child.

What are the symptoms?

DSM-IV-TR states that the symptoms of an adjustment disorder must appear within three months of a stressor; and that they must meet at least one of the following criteria: 1) the distress is greater than what would be expected in response to that particular stressor; 2) the patient experiences significant impairment in social relationships or in occupational or academic settings. Moreover, the symptoms cannot represent bereavement, as normally experienced after the death of a loved one.

DSM-IV-TR specifies six subtypes of adjustment disorder, each with its own predominant symptoms:

• With depressed mood: The chief manifestations are feelings of sadness and depression, with a sense of accompanying hopelessness. The patient may be tearful and have uncontrollable bouts of crying.
• With anxiety: The patient is troubled by feelings of apprehension, nervousness, and worry. He or she may also feel jittery and unable to control his or her thoughts of doom. Children with this subtype may express fears of separation from parents or other significant people, and refuse to go to sleep alone or attend school.
• With mixed anxiety and depressed mood: The patient has a combination of symptoms from the previous two subtypes.
• With disturbance of conduct: This subtype involves such noticeable behavioral changes as shoplifting, truancy, reckless driving, aggressive outbursts, or sexual promiscuity. The patient disregards the rights of others or previously followed rules of conduct with little concern, guilt or remorse.
• With mixed disturbance of emotions and conduct: The patient exhibits sudden changes in behavior combined with feelings of depression or anxiety. He or she may feel or express guilt about the behavior, but then repeat it shortly thereafter.
• Unspecified: This subtype covers patients who are adjusting poorly to stress but who do not fit into the other categories. These patients may complain of physical illness and pull away from social contact.

What’s the prognosis?

Most adults who are diagnosed with adjustment disorder have a favorable prognosis. For most people, an adjustment disorder is temporary and will either resolve by itself or respond to treatment. For some, however, the stressor will remain chronic and the symptoms may worsen. Still other patients may develop a major depressive disorder even in the absence of an additional stressor.

Acute stress disorder (ASD) FAQ

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What is acute stress disorder?

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms that occur within a month of a traumatic stressor.

What causes it?

ASD, like PTSD, begins with exposure to an extremely traumatic, horrifying, or terrifying event. Unlike PTSD, however, ASD emerges sooner and abates more quickly; it is also marked by more dissociative symptoms. If left untreated, however, ASD is likely to progress to PTSD. Because the two share many symptoms, some researchers and clinicians question the validity of maintaining separate diagnostic categories. Others explain them as two phases of an extended reaction to traumatic stress.

What are the risk factors?

• Age—Older adults are less likely to develop ASD, possibly because they have had more experience coping with painful or stressful events.
• Previous exposure—People who were abused or experienced trauma as children are more likely to develop ASD (or PTSD) as adults, because these may produce long-lasting biochemical changes in the central nervous system.
• Biological vulnerability—Twin studies indicate that certain abnormalities in brain hormone levels and brain structure are inherited, and that these increase a person’s susceptibility to ASD following exposure to trauma.
• Support networks—People who have a network of close friends and relatives are less likely to develop ASD.
• Perception and interpretation—People who feel inappropriate responsibility for the trauma, regard the event as punishment for personal wrongdoing, or have generally negative or pessimistic worldviews are more likely to develop ASD than those who do not personalize the trauma or are able to maintain a balanced view of life.

What are the symptoms?

Acute stress disorder may be diagnosed in patients wh

1. lived through or witnessed a traumatic event to which they
2. responded with intense fear, horror, or helplessness, and are
3. currently experiencing three or more of the following dissociative symptoms:

• • • • psychic numbing
      • being dazed or less aware of surroundings
      • derealization
      • depersonalization
      • dissociative amnesia

Other symptoms that indicate ASD are:

• Reexperiencing the trauma in recurrent dreams, images, thoughts, illusions, or flashbacks; or intense distress when exposed to reminders of the trauma.
• A marked tendency to avoid people, places, objects, conversations, and other stimuli reminiscent of the trauma (many people who develop ASD after a traffic accident, for example, refuse to drive a car for a period of time).
• Hyperarousal or anxiety, including sleep problems, irritability, inability to concentrate, an unusually intense startle response, hypervigilance, and physical restlessness (pacing the floor, fidgeting, etc.).
• Significantly impaired social functions and/or the inability to do necessary tasks, including seeking help.
• Symptoms last for a minimum of two days and a maximum of four weeks, and occur within four weeks of the traumatic event.
• The symptoms are not caused by a substance (medication or drug of abuse) or by a general medical condition; do not meet the criteria of a brief psychotic disorder; and do not represent the worsening of a mental disorder that the person had before the traumatic event.

People with ASD may also show symptoms of depression including difficulty enjoying activities that they previously found pleasurable; difficulty in concentrating; and survivor’s guilt at having survived an accident or escaping serious injury when others did not.

Dissociative Fugue FAQ

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What is dissociative fugue?

Dissociative fugue is a rare condition in which a person suddenly, without planning or warning, travels far from home or work and leaves behind a past life. Patients show signs of amnesia and have no conscious understanding or knowledge of the reason for the flight. Because persons cannot remember all or part of their past, at some point they become confused about their identity and the situations in which they find themselves. In rare cases, they may take on new identities

What causes dissociative fugue?

Episodes of dissociative fugue are often associated with very stressful events. Traumatic experiences such a war, or natural disasters, seem to increase the incidence of the disorder. Other, more personal types of stress might also lead to the unplanned travel and amnesia characteristic of dissociative fugue. The shocking death of a loved one or seemingly unbearable pressures at work or home, for example, might cause some people to run away for brief periods and blank out their pasts.

What are the symptoms?

A person in the midst of a dissociative fugue episode may appear to have no psychiatric symptoms at all or to be only slightly confused. Therefore, for a time, it may be very difficult to spot someone experiencing a fugue. After a while, however, the patient shows significant signs of confusion or distress because he or she cannot remember recent events, or realizes a complete sense of identity is missing. This amnesia is a characteristic symptom of the disorder.

Do the memories return?

The prognosis for dissociative fugue is often good. Not many cases last longer than a few months and many people make a quick recovery. In more serious cases, the patient may take longer to recover memories of the past.