Most people experience periods of depression off and on throughout life. We all have days when we feel “blue” or “down,” and these bad times usually pass. Also, the death of someone close can involve feelings, called bereavement, that are similar to symptoms of depression.
Major Depressive Disorder is another matter, and it usually requires treatment. Characteristic of this disorder is at least one Major Depressive Episode (see below). It’s true that most episodes of Major Depression usually resolve in about six months, even without treatment, but those six months or so can be quite difficult—work and family life can be seriously disrupted, and there is a high risk of suicide.
A Major Depressive Episode can often be treated without medication. If your psychologist believes that medication might be helpful as well, he or she will discuss the matter with you and perhaps make a referral to a physician or psychiatrist for a medication evaluation.
Bipolar Disorder can take several forms, but they all hinge on the presence of at least one Manic Episode (see below), with or without a Major Depressive Episode (see above). The old diagnostic term, Manic-Depressive Disorder referred to the clinical presence of both mania and depression—not both at the same time, of course; usually, the depression follows the mania.
Cyclothymic Disorder is to Bipolar Disorder what Dysthymic Disorder is to Major Depressive Disorder; that is, similar in nature, but far less severe. It involves numerous periods of depressive symptoms alternating with hypomanic episodes. The most convenient treatment (that is, aside from intensive psychotherapy) for a cyclothymic disorder, like a bipolar disorder, is often a mood-stabilizing medication.
Let’s begin with a simple graphic explanation of anxiety. First, consider the concept of fear, which must be distinguished from anxiety. If you were sitting in a room and suddenly a large rattlesnake crawled through the door, you would have good reason to be afraid. That’s fear because it refers to an actual threat. Fear is healthy because it often keeps us alive. But if you were always worried that a rattlesnake might crawl into the room, even if no rattlesnakes were anywhere in sight, that’s anxiety. Anxiety is most often not helpful because the threat is imaginary, and a lot of time and energy can be wasted worrying
about things that might—but not necessarily will—happen.
Some individuals live with a constant, general sense of worry and anxiety, as in Generalized Anxiety Disorder. Typical symptoms are tension, restlessness, fatigue, irritability, sleep disturbance, and difficulty concentrating.
Other persons feel a more focused anxiety, as in a Panic Attack, where there is a sudden onset of apprehension, terror, or impending doom, to such an extent that they might feel they are going crazy—or having a heart attack. In fact, it’s quite common for patients to appear in hospital emergency rooms complaining of having a heart attack when they are really experiencing a panic attack.
And some persons have such anxiety that they might develop Agoraphobia or Social Phobia: Agoraphobia, sometimes referred to as a fear of open spaces, really is more a fear of fear itself. That is, the agoraphobic tends to avoid situations which might cause fear—and eventually so many situations are avoided that the agoraphobic cannot even leave the house. A common consequence of agoraphobia is depression, and common associated symptoms are drug or alcohol use, as self-medication.
Social Phobia involves a persistent fear of situations which might involve being scrutinized by others. Common social phobias are a fear of public speaking, of participating in meetings, of using public restrooms, of eating in front of others, of interacting with strangers, and of interacting with authority figures. Unfortunately, a fear of interacting with authority figures can make it very difficult to seek treatment for a social phobia.
Specific Phobias are also a form of anxiety (although they are sometimes mixed with fear). There are many kinds of phobias, including anxiety about animals, natural events, blood or injury, situations (such as elevators, tunnels, heights, flying, etc.), or germs and illness.
All specific phobias have three basic elements:
1. Excessive fear cued by the presence or anticipation of a specific object or situation.
2. Exposure to the object or situation provokes an immediate anxiety response.
3. The object or situation is avoided (or tolerated with intense distress)
Posttraumatic Stress Disorder (PTSD) may be diagnosed if symptoms persist for longer than one month and fall into the following characteristic categories:
• Abnormal arousal (e.g., difficulty sleeping, irritability)
• Avoidance/Numbing (“spacing out,” avoiding situations associated with the trauma)
Also, trauma can affect one’s sense of identity, and the trauma of severe child abuse can lead to the development of multiple personalities or of self- mutilating behaviors.
Many health issues can be addressed through the use of psychology. In fact, the field of Health Psychology is a new and fast-growing application of psychology.
Following are several treatment applications of this field.
Substance Abuse is an indication of a serious growing problem in someone, and it refers to a maladaptive pattern of substance use leading to clinically significant impairment or distress characterized by such things as
• Recurrent substance use resulting in failure to fulfill major role obligations (e.g., work, school, family);
• Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile);
• Recurrent substance-related legal problems;
• Continued use of the substance despite having persistent problems caused by its use.
Substance Dependence reflects a grave problem more serious than Substance Abuse and refers to a maladaptive pattern of substance use leading to
clinically significant impairment or distress characterized by such things as
• Tolerance (a need for increased amounts of a substance to achieve the desired effects, or diminished effect with continued use of the same substance);
• Withdrawal (see below);
• Taking the substance in larger amounts or over a longer time than was intended;
• Persistent desire or unsuccessful efforts to cut down the substance use;
• Spending a great amount of time in activities necessary to obtain the substance;
• Giving up or reducing important social, occupational, or recreational activities because of substance use;
• Continuing the use of the substance despite knowledge that its use is causing problems.
If you can answer “Yes” to any of the Substance Abuse items, you may be headed for serious trouble unless you get help. If you can answer “Yes” to three or more of the Substance Dependence items, you’re already in over your head and need help immediately.