Anxiety, Dissociative and Somatoform Disorders · 6:21pm Oct 17th, 2013
Well, dang. After this I'm gonna do some serious studying. And yes, we are going to talk about dissociative identity disorder here. Hold on to your seats and buckle your pants!
Hey, did you know that Brazil is the only country in the world that changed the name leprosy to hanseniasis in order to fight back the social stigma that this condition carries?
Psychotic Syndromes
Humour Disorders
Anxiety, Dissociative and Somatoform Disorders
Personality Disorders
Eating Disorders
The concept of normality: A psychopathological approach
Organic Mental Disorders
The anxiety disorders configure a group that encompasses the most common psychiatric disorders, causing a higher demand in health services. The anxiety is an uncomfortable state of mood, a sense of defense that alerts the individual to the possibility of danger or imminent threat or something like it. The fear is also an alert sign, but it is defined as an answer to a known threat.
Anxiety is characterized by a vague, diffuse and unpleasant feeling of apprehension that can be experienced in the most diverse ways for each individual. It is present in the normal development of the human being, allowing the person to prepare for adverse situations, such as physical threats, pain or situations of separation and/or loss. The anxiety experience can be divided in psychiatric and physical signs and symptoms, as shown as follows:
Physical symptoms
Autonomic ones: Tachycardia, vasoconstriction, sweating, higher peristalsis, nausea, mydriasis, hair erection and vertigo.
Muscular ones: Pains, contractions, tremors, tension.
Kinesthetic ones: Paresthesia, chills, waves of heat.
Respiratory ones: Feeling of being suffocated and asphyxia.
Phychiatric symptoms
Nervousness, apprehension, insecurity, difficulty to focus, sensation of something weird happening, personality alterations (something weird withing oneself) and loss of reality (sensation of surreality regarding the ambient).
The anxiety disorders characterize themselves for inadequate responses to situations that can cause anxiety (real or imaginary), particularly regarding the intensity of the clinical spectrum. The ICD-10 and DSM-IV adopt similar classifications, basically dividing the anxiety disorder in: panic disorder and agoraphobia, obsessive-compulsive disorder, social phobia and specific phobias, generalized anxiety disorder, post-traumatic stress disorder and depression-anxiety mixed disorder.
The prevalence of anxiety disorders is greater in women from middle to lower social strata. Some psychological theories have been utilized to explain the development of such disorders, especially in regarding the psychodynamical defense mechanisms.
Besides that, in the neurobiological aspect, three neurotransmitters seem to be strongly associated with anxiety: noradrenaline (A.K.A. norepinephine), serotonin and gamma-aminobutyric acid (GABA). Some patients also seem to show alterations in the autonomous nervous system, with higher sympathetic tonus. Genetic components seem to contribute to the development of anxiety disorders. Studies with neuroimaging in patients with anxiety disorders reveal alterations in the right temporal lobe, caudate nucleus and the para-hippocampus. From these studies, it has been postulated that the limbic system and the cerebral cortex are implicit in the neuroanatomy of these disorders.
The superposition of anxiety disorders and other clinical conditions is very frequent. The symptoms can include those of panic, generalized anxiety and obsessive-compulsive symptoms. Thus, the main differential diagnosis to be done includes organic conditions and psychiatric ones in which anxiety can be associated as a primary or secondary way.
The treatment of such conditions involve the removal of the prime cause (treatment of the basal cause or removal of the substance used) associated with, if necessary, benzodiazepines, anti-depressants and psychotherapy. It is a well known fact in the psychiatric literature that patients with anxiety disorders, regardless of the classification, tend to "shrug" at their symptoms, claiming that it is just a manifestation of "who they are", allowing for the condition to progress further and further as the time passes. Thus, most patients with an anxiety disorder seek medical attention once their personal, social and professional life has been significantly destructured.
I - Panic Disorder
The panic disorder is characterized by the spontaneous, unexpected occurrence of panic attacks, in a recurrent form. The panic attacks are acute and grave attacks of anxiety, with a short duration and their symptoms can be confused with other clinical conditions. For this reason, the patients frequently seek emergency medical services. The panic disorder tends to be accompanied by agoraphobia, that is, the fear of being alone in public places (especially in those in which any prompt kind of help can be hard or unavailable, in case a panic attack occurs).
Epidemiology
The panic disorders show a prevalence of 1.5% to 5% and the panic attacks, 3% to 5.6% during a person's life. It is more frequent in women (2:1) and the average age for the disease to manifest itself is 25 years old. The only social factor identified that seems to be involved in the development of the panic disorder is a recent history of divorce. The prevalence of agoraphobia is of 0.6% to 6% and can be present even without an associated panic disorder. In many cases, the start of the disease is related to a traumatic event. Frequently, other mental disorders, such as depression, risk of suicide and substance abuse can be associated.
Etiology
Some patients show a higher sympathetic tonus. The main neurotransmitters involved are noradrenaline (A.K.A. norepinephrine), serotonin and GABA. Some substances can induce the panic attacks in individuals that bear these disorders. Some of these substances, also called panicgenics, are: carbon dioxide, bicarbonate and lactate. Studies with neuroimages appear to indicate alterations in the temporal lobes, especially an atrophy of the right temporal lobe. As for the genetic factors, there has been shown a high from four to eight times in the risk for developing a panic disorder in patients whose parents have any kind of psychiatric disorder. Defense mechanisms, such as regression, seem to be related as well.
Clinical characteristics
The first panic attack occurs, in the majority of times, spontaneously. In some cases, however, it can happen after physical exercise, emotional trauma, sexual activity and substance abuse (such as alcohol, caffeine and others). Frequently, it has a duration of approximately 30 minutes, with a rapid progression of the symptoms, hitting the peak in approximately 10 minutes. Rare are the times in which it is extended for over an hour. The main psychic symptoms are: extreme fear, feeling that death or/and a catastrophe is imminent, fear of going insane or losing control, lack of insight regarding reality and dispersonalization. The physical symptoms include palpitations, sweating, shaking, dry mouth, chills or sensing heat, feeling a lack of air or asphyxia, thoracic pain or discomfort, nausea or abdominal pain, dizziness and paresthesia.
The patient abandons any activity he/she is doing to look for help. They are, mostly, worried about a cardiac arrest. Syncope can happen.
In agoraphobia, the patients show anxiety towards situations in which it can be difficult getting help (stores, open spaces, etc.) or in which help might not be available, hence why they often prefer to be accompanied by friends or family. The agoraphobic situations are avoided or beard with great suffering.
Diagnosis
Panic attacks can happen in other psychiatric disorders, especially social and specific phobias, and in post-traumatic stress disorder. For this reason, the criteria for panic attacks are listed differently from those that classify a panic disorder (this one, with or without agoraphobia). Both the DSM-IV and ICD-10 use the frequency of panic attacks as a diagnostic criteria for panic disorders. The DSM-IV uses as a criteria the panic attack followed by, at least, one month worrying about having a new episode. The ICD-10 demands there must be at least three panic attacks in three weeks or four in for weeks. The diagnosis of agoraphobia without a history of panic disorder is characterized by the fear of getting incapacitating or embarrassing symptoms.
II - Obsessive-Compulsive Disorder
The Obsessive-compulsive disorder (OCD) is characterized by the existence of obsessive thoughts and compulsive behaviors. The obsessive thoughts are ideas, feelings or intrusive images that invade the person's thoughts repetitively and without his/her consent. These bring much anxiety and the realization of the compulsive acts lessens said anxiety. The compulsions are repetitive behaviors or stereotypical mental acts that have the purpose of alleviate the obsessive thoughts. The great majority of such patients have the insight that their compulsive actions have no real effect on the obsessive thoughts, but they feel unable to stop doing them either way.
Epidemiology
The prevalence of OCD in the general population, during the entire life period, is estimated in 2% to 3%. In the adult age, both sexes have equal propensity and the middle age for the symptoms to develop is around 20 years of age.
Etiology
The main neurotransmitter involved is serotonin, a fact that is corroborated by the high rates of success when treating with serotoninergic drugs. The cerebral areas most afflicted seem to be the frontal cortex, basal ganglia and the cingulus. There is a significant genetic component. Some psychodynamic defense mechanisms are related with this disorder, such as isolation (the obsessive idea is not accompanied by affection), anulation (trying to reduce the thoughts by performing compulsive acts) and reactive formation (production of a behavior to satisfy a wish/will).
Clinical characteristics
Classically, obsessive symptoms coexist with compulsions. The obsessive symptoms are thoughts, urges or recurrent images that are difficult to resist, often experienced as intrusive and inadequate, leading to anxiety. The compulsions configure repetitive behavioral or mental actions that the individual feels compelled to execute as the answer to the obsessive thought or to try to lower his/her anguish. Both the obsessions and the compulsions are lived as something different from his/her personality, that is, they are recognized as absurd or irrational and, many times, the patients try to resist these urges with no success.
There can be many types of obsessions and compulsions. The most common symptom is the contaminant obsession, followed by the compulsive washing of objects that are supposedly contaminated. Patients with these symptoms can have dermatological wounds on their skins, caused by repetitive exposure to water and other irritants from cleaning products. The second most common pattern is the obsession of doubt, returning many times to check, for example, if the door was locked or the stove wasn't leaking any gas. The third most common pattern is one that consists of intrusive thoughts but no compulsions. These obsessions, usually, consist in repetitive thoughts about some form of sexual or aggressive act, reprehensible by the eyes of the patient. The fourth most common pattern is the need for simmetry or precision, followed by the compulsion of lentification. The patients can, for instance, take many hours to do a meal or to shave. Worrying with the order or lucky numbers can also be observed.
Diagnosis
The diagnostic criteria are based on the presence of recurring obsessive thoughts that cause significant anxiety and/or compulsive acts, executed in order to try to minimize that anxiety. It is absolutely necessary that the patient must, in at least one phase of the disease, to recognize such symptoms as excessive or irrational.
Course and prognosis
Over 50% of patients experiment a subtle start of the symptoms after a stressful event (pregnancy, death of a relative). However, they can take five to ten years before starting the treatment. In most cases there is a partial relief of the symptoms and the course has a tendency to be chronic. Approximately one third of the patients can have depressive symptoms associated.
III - Generalized Anxiety Disorder
It is probably the most common anxiety disorder. It consists of a wide and excessive worry, followed by a variety of somatic symptoms that jeopardize significantly the sociooccupational functioning and/or can create accentuated suffering. It doesn't happen exclusively, not even preferentially, for a determined situation. The anxiety has a "fluctuation" aspect.
Epidemiology
The anual prevalence is of 3% to 8% and it is more frequent in women (2:1), tending to first manifest on the second decade of age. Many times it is related with life situations with constant stress. Only one third of the patients seek psychiatric help.
Etiology
Serotoninergic and GABAergic neurotransmitters seem to be involved. Studies with neuroimaging show that the occipital lobe, limbic system and frontal cortex is related with the disorder. It has been observed a rate of concordance between monozygotic twins that range from 50% to 20%. Psychossocial theories would be linked with the hypothesis that the patients are responding incorrectly to the dangers that they perceive, or, that the symptoms of anxiety are related to unsolved unconscious conflicts.
Clinical characteristics
The clinical spectrum is characterized by generalized and persistent anxiety, not restricted to an environmental situation or a specific object, accompanied by:
- Motor tension: shaking, spasms, muscular tension, restlessness, easy fatigue and pains.
- Autonomic hyperactivity: heart palpitations, feelings of asphyxia, sweating, cold and humid hands, difficulty to swallow, feeling "a knot in the throat".
- Vigilance: Impatience, easily scared, feeling incapable, difficulty to focus, insomnia, irritability and memory lapses.
Diagnosis
The diagnosis is based on the presence of anxiety or excessive worry about different circumstances in life for, at least, six months. There is a difficulty in controlling these worries and the anxiety can cause an intense affliction or signification loss. Three or more of the above-described symptoms must be present. The differential diagnosis must be made with clinical conditions that can cause anxiety, such as caffeine intoxication, stimulant abuse, alcohol and sedative abstinence, panic disorders, phobias, OCD, depressive disorder and dysthymia.
Course and prognosis
The course tends to be chronic and fluctuating. In light cases, the patients can be forwarded to psychotherapy, many times without a pharmacological intervention. General orientation, such as the practice of exercises and reduced intake of alcohol and caffeine can also be useful. The treatment can be long, in some cases lasting for the entirety of the patient's life.
IV - Social and Specific Phobia
Fobia: Irrational fear that can cause anticipatory anxiety and conscious behavior to avoid the feared object, activity or specific situation. It can cause a loss in the functional capacity if the individual, that recognizes his own actions as excessive.
Social phobia: Excessive fear of being humiliated or embarrassed in various social contexts (speaking or writing in public, for example). It can be connected with the performance of a determined situation or be generalized, when the fears include most situations.
Specific phobia: Accentuated and persistent fear of objects clearly discernible or isolated situations. It can be classified in many kinds, depending on the object/situation that is focused.
Epidemiology
They are common mental disorders and, most of the time, aren't diagnoses. It is estimated that 5% to 15% of the entire worldwide population shows phobic symptoms, resulting in different degrees of incapacitation or suffering. It is usually more frequent in women. The age of start is at the start of adolescence, but the condition can manifest itself anywhen from 5 to 35 years. The specific phobia is more common than the social phobia.
Etiology
The interation between biological, genetic and environmental factors seem to be the key of this pathology. Psychodynamical factors seem to be involved, this meaning, the phobic symptom would be related to the conscious expression of unconscious conflicts. The dislocation has been described as one of the main defense mechanisms (the anxiety is separated from the original idea or situation, being dislocated to another symbolic object or situation).
In the specific phobia, the symptom could result between the association of an object or situation with experiences of fear that has already been lived before. They tend to have a familiar incidence, mainly the blood-injection-wounds kind. Some patients with social phobia may have shown a behavioral inhibition during infancy. Not only that, but first-degree relatives of those with social phobia have a chance to develop the condition that is three times higher when compared to patients with no relatives affected.
Contraphobic attitutde: The phobic anxiety remains occult through a pattern of behavior that represents the denial that the feared object is dangerous. The patients confront the phobic situations instead of trying to avoid them.
Clinical characteristics
The phobias are characterized by the development of a severe anxiety when the patient is exposed to a specific situation or object or when he foresees said exposition. Usually, patients try to avoid the phobic stimuli. It is common for panic attacks to happen in patients with social and specific phobia. There can be an association with other anxiety disorders, depressive disorders or disorders related to the abuse of substances.
The social phobia refers to the pathological fear of performing activities in public, such as writing checks, reading, writing, eating, speaking or any other situation in which the individuals feel exposed or ridiculed in front of others. It is classified as circunscrit, when restricted to a specific situation or generalized, when the phobic behavior encompasses all social situations. The anticipatory anxiety, that is, the surfacing of anxiety before the presence of the phobic stimuli is a characteristic that can reach a high level of incapacitating suffering, affecting sleep, appetite and concentration. Other symptoms include blushing, muscular contractions and anxiety related to the judgment passed unto by others.
The specific phobias are restricted to specific situations or object, appearing usually during the childhood and can persist for the rest of the patient's life. They can be divided according the phobic situation/object and the most common ones are: animals, storms, highs, diseases, injuries-blood-injection, death and closed spaces. The feared situation, although limited, can cause great anxiety, be it anticipatory or during the contact.
Diagnosis
The diagnosis is based on the occurrence of accentuated and persistent fear, revealed by the presence or anticipation of the phobic object/situation, be it specific or related with social performance. The exposition to the object/situation will almost always cause anxiety, something that can assume the for of a panic attack. The individual recognizes that the fear is irrational and excessive.
It is important to differentiate specific or social phobias from proper fear and normal shyness, respectively. In the phobias, the symptoms jeopardize the functional capacity of the individual. Substance abuse, central nervous system tumors and cerebrovascular diseases must be discarded. Schizophrenia and depressive disorder are also part of the differential diagnosis.
V - Post-Traumatic Stress Disorder (PTSD)
It develops after the experience of a traumatic experience, be it a pshysical or emotional one (for instance: wars, tortures, rape, accidents, natural disasters, etc.). The individual starts to relive the traumatic situation though dreams or flashbacks, associated to the persistent avoidance of situations that might make them remember the trauma, cognitive difficulties, anxious and depressive symptoms.
PTSD has a prevalence estimated between 1% and 14% in the worldwide population. It can happen in any age, although it is more frequent in young adults. The development of this disorder seems to be related to the subjective significance of the stressing factor (traumatic event) for the patients. However, biological and psychodynamical factors are also implicated on the etiology of this process. The symptoms usually begin in the first three months after the triggering event, varying from a few weeks to six months.
The patient may show feelings of guilt, rejection and humilation; memory and attention compromising; painful reliving of the traumatic event; avoidance or aggressive behavior. There can be suicidal ideation. The differential diagnosis must include epilepsy, substance abuse, other anxiety disorders and humor disorders. The course is fluctuating and there can be complete recovery. The quick start of the symptoms, good pre-morbid functionality and social and familiar support are signs of good prognosis.
VI - Anxiety and Depression Mixed Disorder
Defined by the presence of depressive and anxious symptoms simultaneously but not in enough gravity to make the separated diagnosis. It is present only on the ICD-10.
VII - Adjustment Disorder
These are states of anguish, emotional disturbances, functionality alterations and social performance that appear in a period of adaptation to a change in the lifestyle or as consequence of a stressing life event. It is a short-term mal-adapted reaction. It has a prevalence of 10% in the worldwide population, being more common in women (2:1) during the young years of childhood or in the late ages.
The symptoms don't need to appear simultaneously with the stressing agent. They usually happen 3 months after the event and doesn't last for more than 6 months. Symptoms include: anxiety, depressed humour, conduct perturbations and a mixed form.
The prognosis is good; usually the individual returns to the prior functioning. These patients benefit themselves a lot from psychotherapic counseling.
VIII - Dissociative (or Conversive) Disorders
These are characterized by a partial or complete loss of the normal integration between past memories, conscience of identity and immediate sensations and control of body movements. The dissociation manifests as a defense against traumas. The dissociative defenses execute a double function of helping victims to distance themselves from traumas and, at the same time, they create necessary elaborations that link these with the rest of their lives. These disorders have been previously classified as "conversion hysteria" or simply "hysteria".
As diagnostic directives, we must exclude any and all evidences of physical disorder that can explain the symptoms and search for a more psychological cause, even if denied by the patient. It is good to keep in mind that the dissociative disorders are not simulations (in these last ones, everything that happens is premeditated and the patient is conscious of it). The dissociative disorders are divided into various forms, shown as follows:
Dissociative amnesia
The symptom, amnesia, is common to dissociative escapism, dissociative identity disorder and to dissociative amnesia. The diagnosis is made when the dissociative phenomena are limited to amnesia only. The key-symptom is the incapacity to remember memories already experienced. The forgotten memories are usually about a stressing or traumatic event in the person's life. All evidences of cerebral disorder must be discarded! The capacity to learn new informations is maintained, and this is the most common dissociative symptom. The complete, generalized anxiety is rare and, when it happens, is due to a huge dissociative escapism. Its end it usually abrupt and the recovery is complete.
Dissociative escapism
In this case, the patient has all aspects of dissociative amnesia, followed by a physical retraction from their homes, places of work, self-care and, frequently, assuming a new personality and occupation. It should be remembered that old and recent identities do not alter themselves, such thing only happens in dissociative identity disorder. The etiology is the same as dissociative amnesia. The escapism is usually brief, from hours to days.
Dissociative identity disorder or Multiple personality disorder
This is a chronic disorder in which the cause involved a traumatic event, physical or sexual abuse in the childhood. In this pathology, the person has two or more identities and each one determines the behavior and activities during the period which one is most prominent. It is the gravest of the dissociative disorders. The earlier the symptoms manifest, the worst the prognosis is. It is more severe and chronic and the recovery is, usually, incomplete. A sign that the patient is getting worse is when the other personalities show distinct perturbations, such as mood disorders, personality disorders and others.
Dissociative stupor
In it, there is an extreme lowering (or total absence) of voluntary movement and normal responsiveness to extreme stimuli, such as light, noise and touch. The patient can become immobile for long periods of time, with his/her speech or movements completely or almost completely absent. Usually, the patient will be found with his/her eyes open, being clear that he isn't unconscious or sleeping. The differential diagnosis is "escapism episode" in patients with epilepsy. The prognosis is good and the recovery is complete.
Trance and possession disorders
In it, a temporary pause, both in the sense of personal identity and clean consciousness of the environment, happens. The individual acts as if taken by a personality, spirit or deity. The attention and conscience are limited to the aspects of the immediate environment, in which there can be repetitive movements, positions and vocal expressions. For the diagnosis, such events must happen even involuntarily, undesirably and must be outside religious contexts.
Dissociative movements and sensations disorders
In it, a loss or interference in the movements, followed or not by sensitive alterations (almost always cutaneous) happens. Physiological and anatomical factors must be discarded.
Ganser's syndrome
It consists of a voluntary production of a grave psychiatric symptomatology. The patient produces erroneous responses and un-purposed speeches. The symptoms tend to be worse when the patient is being observed. The recovery is sudden, and the patient claims amnesia to such happenings
Non-epileptic psychogenic disorders
These can imitate epileptic attacks in movements. Rare are the cases in which ecchymosis due to falls, tongue-biting or urinal incontinence happen.
IX - Somatoform Disorders
These are groups of disorders that involve physical symptoms for which one can't find a suitable medical explanation.
Somatization disorders
It is characterized by multiple somatic symptoms that can't be explained through physical or laboratorial examination. The claims are varied and multiple organ systems are affected. It has also been called "hysteria" in the past. This is a chronic disorder with fluctuating evolution, usually starting on the third decade of life. The relationship between women and men affected is between 5 to 20:1.
The diagnostic criteria are: the patient must show multiple physical symptoms with no laboratorial, imaging or physical alterations for more than two years, followed by a denial that there is no physical cause for the symptoms and a social and familiar jeopardy. Frequently associated with other depressive or anxious symptoms. The course is chronic and, frequently, debilitating.
Conversive disorders
Defined by the presence of one or more neurological symptoms (for example, paralysis, blindness, paresthesia) that cannot be explained by a known neurologic disorder. Can happen in any age and the relation between women and men afflicted is 2:1. The course and prognosis are favorable, with resolution in a couple of days.
Hypochondriac disorders
The term derives from hipochondrium, meaning "below the ribs", referring to the common abdominal complaints in most patients. This disorder is the erroneous or unreal interpretations from the patient regarding symptoms and physical sensations, leading to worry and fear of having serious conditions. Such worries result in suffering and can disrupt their capacity to function in their social, personal and professional roles. It happens mostly on the third decade of life and afflicts both men and women equally.
The course is usually episodic. The duration of these range from months to years and are separated by quiescent periods, equally long. There have been documented a relationship between stressing agents in the patients' life and an exacerbation of the symptoms.
Factitious Disorders (A.K.A. Munchausen Syndrome)
In these disorders, the patients normally produce signs of physical or mental diseases and/or may present those around them with false stories. They have the common objective of assuming the role of "patient". It happens more frequently in men and between health workers. There is no efficient psychic therapy.
You guys must be asking yourselves: why doesn't he tell us how to treat it properly? And that is a very good question. One that shan't be answered, ever.
Also: I would sooner punch a baby than become a surgeon.
Do you know if mood stabilizers would ever be given as treatment for Dissociative Disorders?
1428292 I should probably not tell you this, but given that the answer is "no", then I might actually stop someone from self-medicating, which is a pro.
So... no. Those are only used on humour disorders. Check them out for more info.
1428348
I'm in no danger of self-medicating. I'm just trying to figure out why my doctor is having me go on stuff like Lamotrigine, and Topiramate since mood stabilizers don't do anything for my symptoms.
Thanks for your time Lucefudu. You should blog more often.
1428437 Well, that mostly depends on your diagnosis, not on your symptoms, sir/madam. Granted, the majority of the psychopathologies are syndromic, but there are differences between etiologies.
A word of advice, though: never stop taking the medication by yourself. If you feel like you should stop, talk to your doctor and tell him this. He will ask why and you can explain if you're having side effects or if you think the situation is under control. He'll then either change your medication or instruct you on how to properly stop taking the medication or instruct you how the medication, even if it seems like nothing is happening, is still working.
I'm very, very curious to ask you what you have, but if I eventually grow the nerve to do it, I will not offer a diagnosis and treatment back though. Nothing personal, I just think it's highly unprofessional to e-diagnose someone. Sounds like the kind of thing that will, unfortunately, be allowed in a near future...
If you value your privacy, send me a PM instead.
And thank you for getting interested!
PS: Bellatrix is such a beautiful name for the GaP Trixie.
1428460
That's kind of the issue. According to my social worker, I'm a "Diagnostic nightmare" and have been looked at for everything from Schizophrenia to high-functioning autism and... Ah blast, it's uh... XXY chromosomes, or something... Some birth defect. Aspergers was also looked at along with Psychosis... I think they basically just pulled everything they could. My diagnosis doesn't really exist: Apparently a diagnosis is nice, but ultimately what matters is that the condition is treated, with a diagnosis just smoothing things out a bit. As such, they are literally just throwing mood stabilizers at me and asking me to let them know if they work or not. If they are still working on a formal diagnosis they aren't telling me about it.
I've always been interested in your blogs and guides, you are a very fascinating and intelligent individual from what I've seen. Would be great to see more.
P.S.
Glad you like the name.
Hope you're having a nice day down there.
Stop it, you're scaring me! And I'm a man! Men don't get scared easily!
Before I start replying, I have one thing to announce:
Owlor is a butt.
That is all.
1428543 It's a weird thing, this thing you said. It does seem like they aren't paying enough attention to you, in my honest opinion. Why do I say this? Well, mental pathologies aren't like somatic pathologies; there isn't much secrecy to them in terms of discovering one and classifying it. Not to mention that they made your karyotype, searching for Klinefelter's Syndrome (XXY) without paying attention to other symptoms that would be mandatory if you had Klinefelter's. I don't want to expose the lot of information I gathered from your comment, so please PM me if you want to discuss this further. Again, I won't offer a diagnosis for you, but I can tell you where they went wrong and, hopefully, help you in nudging them to the right direction.
You might wanna cut the compliments, friend. As a person with cyclothymia, my ego can inflate very quickly, bringing nasty, selfish and asshole-y results. I appreciate them nonetheless.
As for me not writing more blogs and shitty stories that nobody gives a flying fuck about: TESTS!
1428547 Not meaning to pick a fight, man, but that's kind of androcentric. We are a community (I refuse to be labeled as a brony) that enjoys a cartoon about magical ponies. While there is nothing inherently wrong with watching p0ne making hugfriends with p0ne, we get enough of that from outside influence.
Also: Don't be scared, man. Through knowledge, the truth will shine forth. There is no reason to fear truth. Let it embrace you. Accept it as your lover. Dance with it under the watchful eyes of the belligerent and make passionate love with it publicly. Fear not the opposition, as you—when equipped with this much-battled-for blessing—will be free from the chains the lazy have bestowed unto you. Wear its armor proudly, but always remember that it ought to be polished, shined and re-smelted frequently. Such is the path of knowledge. Accept and perfect it.
I ought to stop trying to mix science and lyricism before I start a cult.
Read halfway, stopped at the words "love you."
Dude, you're kinda makin me get a bit scared over the fact that you continue to broadcast your worries, troubles and problems. There is absolutely nothing wrong with that, but you're getting deeper into detail, mentioning it a bit more often.
I'm no psychiatrist, but I can give one a run for their money. This right here scares me the most, because it's a repeat about what you've said, and a lot more is being added on. The amount of stress you're going through is dangerously OP high. Like, there are people who are mentally unstable whos' stress is high, and they can't stand it, so they go insane, then there is what I explained where OP is the equivalent to a rich guy who is so rich he could be like "I'll go buy that multi-billion dollar golf course now and use it for about five minutes." It's a fucking wonder you are not stabbing people the moment they add more stress onto what you are already dealing with.
1431484 Waitwaitwaitwaitwaitwaitwaitwaitwaitwaitwaitwaitwaitwaitwaitwait! Wait!
First of all, in this entire page there is only one single mention of the word "love" followed by "you", and that is in your own comment. So I'm even more confused as to what you're talking about.
Secondly, where did you come up with the notion that my life is bad? My life is fine! I'm getting excellent grades (granted, I'm studying like a madmen, but otherwise, everything is awesome). These posts about mental problems are not reflecting my life; they are just things I thought interesting and wanted to share. Do you know what OP means? Since we're not talking about games, it means Original Poster, that is, the person who made the post. Who is me. So there is no reason to say "OP" when I'm right here.
Sorry, man, but your comment isn't making any bit of sense. The part where you're concerned about my life I can even understand, but after "I'm no psychiatrist, but I can give one a run for their money.", everything is lost in confusion.
Also: About that sentence quoted above. I have a problem with it. I have an immense amount of problems with that single sentence right there. But I will refrain from being an asshole and just say it right now:
No, you don't!
1431484 It's not like we study like slaves or anything like it, am I right?