Agoraphobia: Fear of Spaces Part 2

While agoraphobia is not life threatening, it can severely limit one’s life style. Without treatment, many people are not able to leave their home. These individuals become entirely dependent on others for food, money or any other type of daily living activity. With time, depression and anxiety set in and many of these individuals turn to alcohol/substance abuse to help cope with the loneliness, seclusion and shame.

The treatment of agoraphobia is taxing and usually means facing one’s fears. The basic treatments include medications and psychotherapy. Current medications used to treat these individuals include SSRIs like Paxil, Zoloft or Prozac. Additional medications may include an anti anxiety medication like xanax or clonazepam. Drug treatment alone is seldom sufficient for control of agoraphobia and several types of psychotherapy may help. Cognitive behavior therapy helps change detrimental behaviors through desensitization. One also learns methods to cope with symptoms via relaxation techniques. For those who are afraid to leave the home to visit a psychotherapist, one can arrange treatment sessions at home or in a safe neighborhood.  Of course, this also adds to the expense and more importantly, psychotherapy is not cheap.
Self-care remedies that may help cope with agoraphobia include learning reassuring skills, practicing relaxation techniques, and not avoiding feared spaces. There are many online support groups where one can reach out for help. 

The overall prognosis of individuals with agoraphobia depends on the severity of symptoms. If medications are discontinued, relapse is common. Transient improvements do occur but overall most individuals lead a poor quality of life.

Agoraphobia: Fear of Spaces Part 1

Agoraphobia is a type of anxiety disorder that is linked to fear. Individuals who have agoraphobia generally have fear of being in a place where they do not feel safe. Individuals with agoraphobia usually avoid places where they feel they may develop a panic attack. In general, most public places are avoided because of the irresistible fear that they may not be able to seek help. The majority of these individuals remain trapped in their homes, where they feel safe and live a life of seclusion.

The typical symptoms of agoraphobia include extreme fear of being alone, fear of being in a crowded places, fear of losing control in a public place, feelings of insecurity when leaving the home, a dreadful sense of helplessness when outside the home, extreme dependence on others and a feeling that body is imaginary. The physical symptoms are similar to a panic attack and may include dizziness, fast heart rate, difficulty breathing, nausea, flushing, chest pain, feeling a loss of control, difficulty swallowing and stomach upset.
Some experts believe that agoraphobia is simply an extension of panic disorder. However not all individuals with a panic disorder develop agoraphobia.

Agoraphobia usually starts in late adolescence and peaks in the 2/3^rd decade of life. It is estimated that nearly 1-5 percent of individuals develop some degree of agoraphobia during their lifetime. The disorder tends to affect women more than men. Like most mental disorders, the exact cause of agoraphobia is a mystery. Rick factors for agoraphobia include having a diagnosis of panic disorder, having experienced physical, sexual or emotional abuse during childhood, tendency of being edgy or anxious, having a history of alcohol/substance abuse, and being a female.

Antisocial Personality Disorder Part 2

Antisocial personality disorder occurs in 5 % of men and about 1% of women, but these numbers are believed to be under estimates. As the disorder progresses, there is severe depression, anxiety, suicidal and reckless behavior, violence, risky and impulsive behavior, incarceration, alcohol and drug abuse and difficult interpersonal relationships. The majority end up being loners. The diagnosis of antisocial personality is based on the history.


Like many mental disorders, the treatment of anti social personality disorder is multidisciplinary. Treatment options vary from psychotherapy, stress and anger management and use of medications.

Psychotherapy and anger management are widely used to treat antisocial personality disorder but most of these individual have very little insight into their behavior and are not compliant with therapy. These individuals never voluntary seek treatment but only come to treatment when compelled to do so by law enforcement or risk incarceration.

Unfortunately there are no medications to cure this disorder. However, those who are depressed or anxious may be prescribed anti depressants or mood stabilizers. Extreme agitation or psychosis is often treated with anti psychotics. Those who are not able to manage themselves or in danger of harming themselves or others are often admitted to the hospital.

The prognosis for antisocial personality disorder is poor. Most treatments do not work chiefly because these individuals are not compliant with therapy and refuse to seek help. Because there is no way to prevent this disorder, experts recommend identifying those at the highest risk such as children who are abused or neglected. Taking steps at an early age can help boost self esteem and increase confidence. Both parents and teachers may be able to spot signs of trouble in early childhood and this is the point in time when behaviour therapy can help make a big difference in outcomes.

Antisocial Personality Disorder Part 1

Antisocial personality disorder is a chronic mental disorder where one’s thinking, perceiving things and relationship with others is impaired. Individuals with antisocial personality disorder do not care about what is right or wrong, they do whatever they please. The one current theme in their behavior is violating the rights of others and consistently ending up in conflicts. These individuals continue to lie, are angry, violent and also abuse alcohol and drugs. The majority of these individual have problems at home, school and at work.


Typical signs of this disorder include

Disregard and violating rights of others

Persistent lying, cheating or fraudulent behavior

Manipulative

Persistent legal problems

Threatening or intimidating others

Aggressive and violent tendencies

Lack of remorse

Impulsive behavior

Abusive relationships

Irresponsible at work

Anti social personality disorder peaks in the 20s and then the behaviour diminishes over time. The chief reason for this decline is that many individuals end up in prison for their violent acts.

Why the disorder occurs is a mystery but believed to be related to bad genes, bad environment or just bad luck. Individuals at greatest risk for antisocial personality are those who have a family history of mental problems, history of childhood sexual or physical abuse, having a chaotic or unstable childhood or loss of a parent at an early age.

Passive-aggressive behavior disorder: Part 2

Features of the disorder include:

- Repeatedly putting things off
- Deliberately forgetting to do things
- Being stubborn and acting dumb
- Having intense dislike of people in authority
- Frequently complaining and whining about mundane things
- Intentionally working slowly
- Feel unappreciated and want to be constantly praised
- Always blaming others for their misfortunes
- Dislike novel ideas even when practical and useful
- Continuously arguing for no apparent reason

Treatment

There is no easy way to treat this disorder because the individuals are very stubborn and never see themselves as the problem. Unless someone forces them into therapy such as family, friends or employers, the behavior continues for life. These individuals have minimal insight into their negative behavior and always see fault in others. Some individuals may seek therapy after realizing they are not getting anywhere in life.

There are no drugs that can cure passive aggressive behavior. Counseling and supportive therapy do help, but relapse is common. In rare cases, anti depressant drugs may help control the negative attitude but many individuals are not compliant. When the individual is aware of his/her behavior, it is recommended that one stop drinking alcohol as it can make the negative attitude worse. Other methods which have yielded partial success include yoga, family and cognitive behavior therapy.

The prognosis for individuals with passive aggressive behavior is poor. Many end up lonely, isolated, become paranoid and develop depression.

Passive-aggressive behavior disorder: Part 1

Passive aggressive behavior is frequently used to describe individuals who always make up some type of excuse when demands are made of them. The majority of individuals with passive aggressive behavior will indicate that they will perform a task but later respond by making a passive excuse like procrastination, waste time, be stubborn, show intentional deliberate carelessness, pretend to forget and then make irrational condemnation of individuals in high authority. It is estimated that this behavior occurs in at least 1/7 individuals and is most common in both young men and women.

Passive aggressive personality disorder is a chronic disorder where the individual always initially agrees to meet the desires and demands of others, but in reality he/she passively oppose the tasks and then becomes very irate or hostile. These individuals have a long history of negative thoughts when demands are made to perform a duty both at work and in the social environment. This behavior is commonly first seen in the workplace, but in retrospect many families will admit that the behavior has been of long standing at home. Almost always the negative behavior results in breakdown of interpersonal relationships.

The behavior is expressed by repeated postponements, inattentiveness obstinacy, and intentional incompetence. Without fail, this behavior arises when a task is assigned by someone in higher authority.

No one know what causes this passive aggressive behavior but it is most likely related to bad genes or the environment.

Treatment of Borderline Personality Disorder

The treatment of individuals with borderline personality disorder (BPD) is quite difficult. Despite a better understanding of the disorder, most treatments do not live up to expectations. Both group and individual therapy have been shown to be only partially effective in a few patients.

In the last decade, a new psychosocial treatment known as dialectical behavior therapy (DBT) has been used to treat patients with BPD. The treatment combines the standard cognitive behavior techniques for emotional balance and reality testing. The treatment encourages tolerance awareness and acceptance of others. DBT has been derived from the Buddhists meditative ideology and is probably the first therapy to have had any significant benefit in BPD patients.

Drug therapy is often prescribed to treat specific symptoms of the BDP individual. The most commonly used drugs to treat BPD patients include anti-depressants which help alleviate the depressed or labile moods. When there are features of distorted/delusional thinking, anti-psychotics are also often prescribed.

There is now some evidence that the cause of BPD may be partly related to genetic factors and the environment. A number of these individuals do reveal a history of abuse (physical, emotional, sexual), neglect or separation as children. This abuse is most often perpetrated by a non caregiver. There is a strong belief that BPD may be triggered when the individual is re-exposed to any one of the prior abusive factors. Another aspect of BPD therapy is family support. However, these individuals create persistent havoc in the lives of people who try to help them.

When the triggers are identified, avoidance of these factors can make the disorder a lot easier to control with cognitive behavior therapy. Despite all the advances in therapy, majority of individuals with BPD lead a poor quality of life with frequent labile moods, spontaneous anger and impulsivity. Most are loners and make lives of everyone around them miserable.