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What’s the difference between autism and Asperger’s disorder?

<a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Swedish climate activist Greta Thunberg describes herself as having <a href="https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower">Asperger’s</a> while others on the autism spectrum, such as Australian comedian Hannah Gatsby, <a href="https://www.theguardian.com/stage/2022/mar/19/hannah-gadsby-autism-diagnosis-little-out-of-whack">describe</a> themselves as “autistic”. But what’s the difference? Today, the previous diagnoses of “Asperger’s disorder” and “autistic disorder” both fall within the diagnosis of autism spectrum disorder, or ASD. Autism describes a “neurotype” – a person’s thinking and information-processing style. Autism is one of the forms of diversity in human thinking, which comes with strengths and challenges. When these challenges become overwhelming and impact how a person learns, plays, works or socialises, a diagnosis of <a href="https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder">autism spectrum disorder</a> is made. <h2>Where do the definitions come from?</h2> The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the criteria clinicians use to diagnose mental illnesses and behavioural disorders. Between 1994 and 2013, autistic disorder and Asperger’s disorder were the two primary diagnoses related to autism in the fourth edition of the manual, the DSM-4. In 2013, the DSM-5 collapsed both diagnoses into one <a href="https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">autism spectrum disorder</a>. <h2>How did we used to think about autism?</h2> The two thinkers behind the DSM-4 diagnostic categories were Baltimore psychiatrist Leo Kanner and Viennese paediatrician Hans Asperger. They described the challenges faced by people who were later diagnosed with autistic disorder and Asperger’s disorder. Kanner and Asperger observed patterns of behaviour that differed to typical thinkers in the domains of communication, social interaction and flexibility of behaviour and thinking. The variance was associated with challenges in adaptation and distress. Between the 1940s and 1994, the majority of those diagnosed with autism also had an intellectual disability. Clinicians became focused on the accompanying intellectual disability as a necessary part of autism. The introduction of Asperger’s disorder shifted this focus and acknowledged the diversity in autism. In the DSM-4 it superficially looked like autistic disorder and Asperger’s disorder were different things, with the Asperger’s criteria stating there could be no intellectual disability or delay in the development of speech. Today, as a legacy of the recognition of the autism itself, the <a href="https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism">majority of people</a> diagnosed with autism spectrum disorder – the new term from the DSM-5 – don’t a have an accompanying intellectual disability. <h2>What changed with ‘autism spectrum disorder’?</h2> The move to autism spectrum disorder brought the previously diagnosed autistic disorder and Asperger’s disorder under the one new diagnostic umbrella term. It made clear that other diagnostic groups – such as intellectual disability – can co-exist with autism, but are separate things. The other major change was acknowledging communication and social skills are intimately linked and not separable. Rather than separating “impaired communication” and “impaired social skills”, the diagnostic criteria changed to “impaired social communication”. The introduction of the spectrum in the diagnostic term further clarified that people have varied capabilities in the flexibility of their thinking, behaviour and social communication – and this can change in response to the context the person is in. <h2>Why do some people prefer the old terminology?</h2> Some people feel the clinical label of Asperger’s allowed a much more refined understanding of autism. This included recognising the achievements and great societal contributions of people with known or presumed autism. The contraction “Aspie” played an enormous part in the shift to positive identity formation. In the time up to the release of the DSM-5, <a href="https://xminds.org/resources/Documents/Web%20files/Aspie%20Criteria%20by%20Attwood.pdf">Tony Attwood and Carol Gray</a>, two well known thinkers in the area of autism, highlighted the strengths associated with “being Aspie” as something to be proud of. But they also raised awareness of the challenges. <h2>What about identity-based language?</h2> A more recent shift in language has been the reclamation of what was once viewed as a slur – “autistic”. This was a shift from person-first language to identity-based language, from “person with autism spectrum disorder” to “autistic”. The neurodiversity rights movement describes its aim to <a href="https://researchonline.jcu.edu.au/71531/1/JCU_71531_AAM.pdf">push back</a> against a breach of human rights resulting from the wish to cure, or fundamentally change, people with autism. The movement uses a “social model of disability”. This views disability as arising from societies’ response to individuals and the failure to adjust to enable full participation. The inherent challenges in autism are seen as only a problem if not accommodated through reasonable adjustments. However the social model contrasts itself against a very outdated medical or clinical model. Current clinical thinking and practice focuses on <a href="https://www.collegianjournal.com/article/S1322-7696(22)00122-6/fulltext">targeted</a> supports to reduce distress, promote thriving and enable optimum individual participation in school, work, community and social activities. It doesn’t aim to cure or fundamentally change people with autism. A diagnosis of autism spectrum disorder signals there are challenges beyond what will be solved by adjustments alone; individual supports are also needed. So it’s important to combine the best of the social model and contemporary clinical model.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223643/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, Professor of Nursing, School of Health and Human Sciences, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-autism-and-aspergers-disorder-223643">original article</a>.

Mind

Kate Winslet reveals secret health battle

Kate Winslet has opened up about a secret health battle that she faced following the success of Titanic in the late 1990s. The British actress shared how the global success of the film propelled her into stardom, which welcomed a whole new level of scrutiny about her image. Now, the 48-year-old has spoken candidly about her battles with an eating disorder during the height of her fame. "I never told anyone about it," Winslet told the <a href="https://www.nytimes.com/2024/03/03/magazine/kate-winslet-the-regime.html" target="_blank" rel="noopener">New York Times</a>. "Because guess what – people in the world around you go: 'Hey, you look great! You lost weight!'" Now, even 26 years after the peak of the attention, Winslet says that "even the compliment about looking good is connected to weight. And that is one thing I will not let people talk about." "If they do, I pull them up straight away." While this is the first time Winslet admitted to having an eating disorder, it is not the first time she has addressed unwelcome comments over her appearance. On a podcast in 2022, the actress said she wished she had hit back at critics of her body at the time instead of remaining silent. "I would have said, 'Don't you dare treat me like this. I'm a young woman, my body is changing, I'm figuring it out, I'm deeply insecure, I'm terrified, don't make this any harder than it already is'," Winslet said on the Happy Sad Confused podcast. She continued, "It can be extremely negative. People are subject to scrutiny that is more than a young, vulnerable person can cope with. But in the film industry, it is really changing." "When I was younger my agent would get calls saying, 'How's her weight?' I kid you not. So it's heartwarming that this has started to change." Image credits: Getty Images

Caring

How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

<a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life. However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals. Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>. <h2>Weight loss and eating disorders</h2> Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting. Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>. As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms. <h2>Eating disorders and ‘weight suppression’</h2> In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy). Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa. <a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain. There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa. <h2>Ozempic and other semaglutide drugs</h2> Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake. Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>. Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As. Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication. <h2>Risks of dieting and weight-loss drugs</h2> The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders. Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>. Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>. The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain. Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>. People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221514/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, PhD Candidate, Clinical Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders-221514">original article</a>.

Body

Why do people with hoarding disorder hoard, and how can we help?

<a href="https://theconversation.com/profiles/jessica-grisham-37825">Jessica Grisham</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>; <a href="https://theconversation.com/profiles/keong-yap-1468967">Keong Yap</a>, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a>, and <a href="https://theconversation.com/profiles/melissa-norberg-493004">Melissa Norberg</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Hoarding disorder is an under-recognised serious mental illness that <a href="https://pubmed.ncbi.nlm.nih.gov/25909628/">worsens with age</a>. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/31200169/">2.5% of the working-age population</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27939851/">7% of older adults</a>. That’s about 715,000 Australians. People who hoard and their families often feel ashamed and don’t get the support they need. Clutter can make it hard to do things most of us take for granted, such as eating at the table or sleeping in bed. In the gravest cases, homes are completely unsanitary, either because it has become impossible to clean or because the person <a href="https://pubmed.ncbi.nlm.nih.gov/23482436/">saves garbage</a>. The <a href="https://pubmed.ncbi.nlm.nih.gov/18275935/">strain on the family</a> can be extreme – couples get divorced, and children grow up feeling unloved. So why do people with hoarding disorder hoard? And how can we help? <h2>What causes hoarding disorder?</h2> Saving millions of objects, many worthless by objective standards, often makes little sense to those unfamiliar with the condition. However, most of us<a href="https://www.sciencedirect.com/science/article/pii/S2352250X21000282?via%3Dihub"> become attached to at least a few possessions</a>. Perhaps we love the way they look, or they trigger fond memories. Hoarding involves this same type of object attachment, as well over-reliance on possessions and <a href="https://pubmed.ncbi.nlm.nih.gov/32402421/">difficulty being away from them</a>. Research has shown genetic factors play a role but there is no one <a href="https://pubmed.ncbi.nlm.nih.gov/27445875/">single gene that causes hoarding disorder</a>. Instead, a range of psychological, neurobiological, and social factors can be at play. Although some who hoard report being deprived of material things in childhood, emotional deprivation may play a <a href="https://pubmed.ncbi.nlm.nih.gov/20934847/">stronger role</a>. People with hoarding problems often report excessively cold parenting, difficulty connecting with others, and more <a href="https://pubmed.ncbi.nlm.nih.gov/34717158/">traumatic experiences</a>. They may end up believing people are unreliable and untrustworthy, and that it’s better to rely on objects for comfort and safety. People with hoarding disorder are often as attached or perhaps <a href="https://akjournals.com/view/journals/2006/11/3/article-p941.xml">more attached to possessions</a> than to the people in their life. Their experiences have taught them their self-identity is tangled up in what they own; that if they part with their possessions, they will lose themselves. Research shows <a href="https://www.sciencedirect.com/science/article/pii/S0005789421000253?via%3Dihub">interpersonal problems</a>, such as loneliness, are linked to greater <a href="https://pubmed.ncbi.nlm.nih.gov/32853881/">attachment to objects</a>. Hoarding disorder is also associated with high rates of <a href="https://pubmed.ncbi.nlm.nih.gov/34923357/">attention deficit and hyperactivity disorder</a>. Difficulties with <a href="https://pubmed.ncbi.nlm.nih.gov/30907337/">decision-making</a>, planning, <a href="https://akjournals.com/view/journals/2006/12/3/article-p827.xml">attention</a> and categorising can make it hard to organise and <a href="https://pubmed.ncbi.nlm.nih.gov/20542489/">discard possessions</a>. The person ends up avoiding these tasks, which leads to unmanageable levels of clutter. <h2>Not everyone takes the same path to hoarding</h2> Most people with hoarding disorder also have strong beliefs about their possessions. For example, they are more likely to see beauty or usefulness in things and believe objects possess <a href="https://link.springer.com/article/10.1023/A:1025428631552">human-like qualities</a> such as intentions, emotions, or free will. Many also feel responsible for objects and for the environment. While others may not think twice about discarding broken or disposable things, people with hoarding disorder can <a href="https://pubmed.ncbi.nlm.nih.gov/30041077/">anguish over their fate</a>. This need to control, rescue, and protect objects is often at odds with the beliefs of friends and family, which can lead to conflict and <a href="https://pubmed.ncbi.nlm.nih.gov/32853881/">social isolation</a>. Not everyone with hoarding disorder describes the same pathway to overwhelming clutter. Some report more cognitive difficulties while others may have experienced more emotional deprivation. So it’s important to take an individualised approach to treatment. <h2>How can we treat hoarding disorder?</h2> There is specialised cognitive-behavioural therapy (CBT) tailored for hoarding disorder. <a href="https://academic.oup.com/edited-volume/46862/chapter-abstract/413932715?redirectedFrom=fulltext">Different strategies</a> are used to address the different factors contributing to a person’s hoarding. Cognitive-behavioural therapy can also help people understand and gradually challenge their beliefs about possessions. They may begin to consider how to remember, connect, feel safe, or express their identity in ways other via inanimate objects. Treatment can also help people learn the skills needed to organise, plan, and discard. Regardless of their path to hoarding, most people with hoarding disorder will benefit from a degree of exposure therapy. This helps people gradually learn to let go of possessions and resist acquiring more. Exposure to triggering situations (such as visiting shopping centres, op-shops or mounds of clutter without collecting new items) can help people learn to tolerate their urges and distress. Treatment can happen in an individual or group setting, and/or via <a href="https://pubmed.ncbi.nlm.nih.gov/35640322/">telehealth</a>. Research is underway on ways to <a href="https://pubmed.ncbi.nlm.nih.gov/34409679/">improve</a> the <a href="https://www.sciencedirect.com/science/article/pii/S2666915322001421">treatment</a> options further through, for example, learning different emotional regulation strategies. <h2>Sometimes, a harm-avoidance approach is best</h2> Addressing the emotional and behavioural drivers of hoarding through cognitive behavioural therapy is crucial. But hoarding is different to most other psychological disorders. Complex cases may require lots of different agencies to work together. For example, health-care workers may work with fire and housing officers to ensure the person can <a href="https://pubmed.ncbi.nlm.nih.gov/31984612/">live safely at home</a>. When people have severe hoarding problems but are reluctant to engage in treatment, a <a href="https://pubmed.ncbi.nlm.nih.gov/21360706/">harm-avoidance approach</a> may be best. This means working with the person with hoarding disorder to identify the most pressing safety hazards and come up with a practical plan to address them. We must continue to improve our understanding and treatment of this complex disorder and address barriers to accessing help. This will ultimately help reduce the devastating impact of hoarding disorder on individuals, their families, and the community.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208102/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jessica-grisham-37825">Jessica Grisham</a>, Professor in Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>; <a href="https://theconversation.com/profiles/keong-yap-1468967">Keong Yap</a>, Associate Professor of Psychology, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a>, and <a href="https://theconversation.com/profiles/melissa-norberg-493004">Melissa Norberg</a>, Professor in Psychology, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-people-with-hoarding-disorder-hoard-and-how-can-we-help-208102">original article</a>.

Mind

Why young people are self-diagnosing illnesses

A lot of people turn to Google when they get symptoms of being sick, and jump to the conclusion that it may be a serious issue, however, for the younger crowd - Dr Google is now Dr TikTok. The social media app is filled with content about all sorts of topics, known for its 15-second clips it has been applauded for starting important conversations about mental health, especially among young people. It allows people to share experiences and support each other. However, as beneficial as that may be, it’s causing a lot of children to self-diagnose themselves with several mental and neurological disorders. These conditions include autism, attention deficit hyperactivity disorder (ADHD), borderline personality disorder (BPD), dissociative identity disorder (DID), obsessive-compulsive disorder (OCD), Tourette’s syndrome, and more. It’s troublesome as a doctor must diagnose a patient with an illness, and kids are taking it into their own hands based on videos that resonate with them. Psychologist Doreen Dodgen-Magee, said, “There are many accounts, hosted by educated, trained, and licensed professionals where reliable information can be found,” says Dr. Dodgen-Magee. But not all posts contain accurate, science-backed information — and many people scrolling through TikTok don’t know this”. It’s an issue that continues to grow as young people are getting medical advice from fellow TikTokers rather than seeing a doctor. If you have any symptoms of poor physical or mental health then you must be professionally diagnosed and set up with a treatment plan. Don’t rely on a social media app targeted towards children to diagnose you with health issues. Image credit: Shutterstock

Mind

“I’m not gonna be 80": Michael J. Fox's tragic admission

Beloved actor Michael J. Fox is acknowledging how difficult his more than 30-year battle with Parkinson’s disease has become. “I’m not gonna be 80,” the Back to the Future star said in a preview for an upcoming episode of the American current affairs program CBS Sunday Morning, according to Page Six. In the clip, Journalist Jane Pauley tells Fox that he has “not squandered” but that his condition will eventually “make the call” as to when it’s his time to go. “Yeah, it’s, it’s banging on the door,” the actor said. “I’m not gonna lie. It’s gettin’ hard, it’s gettin’ harder. It’s gettin’ tougher. Every day it’s tougher.” Fox revealed that he had surgery to remove a benign tumour on his spine, but the procedure “messed up” his walking and so he started to “break” other parts of his body, including his arm, elbow, face and hand. He added that the “big killer” of Parkinson’s disease is “falling” and can also be “aspirating food and getting pneumonia”, pointing out that it is “all these subtle ways that gets you.” You don’t die from Parkinson’s. You die with Parkinson’s,” he said. “So – so I’ve been – I’ve been thinking about the mortality of it.” The actor was diagnosed with the brain disorder at just 29. He has since become a leading advocate for research on the condition, with the launch of the Michael J. Fox Foundation in 2000 to help educate the public and fund studies. He has previously revealed that he does not fear death. “I’m really blunt with people about cures. When they ask me if I will be relieved of Parkinson’s in my lifetime, I say, ‘I’m 60 years old, and science is hard. So, no,’” he admitted in an AARP magazine profile in December 2021. “I am genuinely a happy guy. I don’t have a morbid thought in my head — I don’t fear death. At all.” Image credit: Instagram

Caring

Obsessive compulsive disorder is more common than you think. But it can take 9 years for an OCD diagnosis

Obsessive compulsive disorder, or OCD, is a <a href="https://www.sciencedirect.com/science/article/abs/pii/S2211364916301579">misunderstood </a>mental illness despite affecting <a href="https://pubmed.ncbi.nlm.nih.gov/18725912">about one in 50 people</a> – that’s about half a million Australians. Our <a href="https://www.tandfonline.com/doi/full/10.1080/00050067.2023.2189003">new research</a> shows how long and fraught the path to diagnosis and treatment can be. This initial study showed it takes an average of almost nine years to receive a diagnosis of OCD and about four months to get some form of help. <h2>What is OCD?</h2> OCD affects children, adolescents and adults. <a href="https://www.nature.com/articles/mp200894">About 60%</a> report symptoms before the age of 20. One misconception is that OCD is mild: someone who is extra tidy or likes cleaning. You might have even heard someone say they are “<a href="https://theconversation.com/you-cant-be-a-little-bit-ocd-but-your-everyday-obsessions-can-help-end-the-conditions-stigma-49265">a little bit OCD</a>” while joking about having beautiful stationery. But OCD is not enjoyable. Obsessions are highly distressing and there are repetitive, intrusive thoughts a person with OCD can’t control. They might believe, for instance, they or their loved ones are in grave danger. <a href="https://iocdf.org/about-ocd/">Compulsions</a> are actions that temporarily alleviate, but ultimately exacerbate, this distress, such as checking the door is locked. People with OCD spend hours each day consumed by this cycle, instead of their normal activities, such as school, work or having a social life. It can also be very distressing for <a href="https://www.tandfonline.com/doi/abs/10.1586/ern.11.200">family members</a> who often end up completing rituals or providing excessive reassurance to the person with OCD. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/Cl7ElJqBg4f/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/Cl7ElJqBg4f/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by ABC Health (@abchealth)</a> </div> </blockquote> <h2>How is it diagnosed?</h2> People with OCD often don’t tell others about their disturbing thoughts or repetitive rituals. They often feel <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/%28SICI%291099-0879%28199905%296%3A2%3C80%3A%3AAID-CPP188%3E3.0.CO%3B2-C">ashamed or worried</a> that by telling someone their disturbing thoughts, they might become true. Doctors <a href="https://www.ncbi.nlm.nih.gov/books/NBK56470/#ch2">don’t always ask about</a> OCD symptoms when people first seek treatment. Both lead to delays getting correctly diagnosed. When people do feel comfortable talking about their OCD symptoms, a diagnosis might be made by a GP, psychologist or other health-care professional, such as a psychiatrist. Sometimes OCD can be <a href="https://link.springer.com/article/10.1007/s10566-009-9092-8">tricky to differentiate</a> from other conditions, such as eating disorders, anxiety disorders or autism. Having an additional mental health diagnosis <a href="https://www.nature.com/articles/s41572-019-0102-3">is common</a> in people with OCD. In those cases, a health-care provider experienced in OCD is helpful. To diagnose OCD, the health professional asks people and/or their families questions about the presence of obsessions and/or compulsions, and how this impacts their life and family. <h2>How is it treated?</h2> After someone receives a diagnosis, it helps to learn more about OCD and what treatment involves. Great places to start are the <a href="https://iocdf.org/">International OCD Foundation</a> and <a href="https://www.ocduk.org/">OCD UK</a>. Next, they will need to find a health-care provider, usually a psychologist, who offers a special type of psychological therapy called “exposure and response prevention” or ERP. This is a type of <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive-behavioural therapy</a> that is a <a href="https://doi.org/10.1016/j.jocrd.2021.100684">powerful, effective treatment</a> for OCD. It’s recommended people with OCD try this first. It involves therapists helping people to understand the cycle of OCD and how to break that cycle. They support people to deliberately enter anxiety-provoking situations while resisting completing a compulsion. Importantly, people and their ERP therapist <a href="https://pubmed.ncbi.nlm.nih.gov/18005936/">decide together</a>what steps to take to truly tackle their fears. People with OCD learn new thoughts, for example, “germs don’t always lead to illness” rather than “germs are dangerous”. There are a range of medications that also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967667/">effectively</a> <a href="https://pubmed.ncbi.nlm.nih.gov/27663940/">treat</a> OCD. But more research is needed to know more about when a medication should be added. For most people these are best considered a “boost” to help ERP. <h2>But not everything goes to plan</h2> Delays in being diagnosed is only the start: <ul> <li> treatment is challenging to access. Only <a href="https://www.sciencedirect.com/science/article/abs/pii/S0887618518301038?via%3Dihub">30% of clinicians</a> in the United States offer ERP therapy. There is likely a similar situation in Australia </li> <li> many people receive therapies that appear credible, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12337?casa_token=Wn3bgnvINSsAAAAA%3A2sqam0BKtCzFA680_f6ln4scp1SKVpN_cOB6Tg8vQyEiNDZPwS-Z-NNveLelKYF6iz4PFqQSXyHKZYJS">but lack evidence</a>, such as general cognitive therapy that is not tailored to the mechanisms maintaining OCD. Inappropriate treatments waste valuable time and effort that the person could use to recover. Ineffective treatments can make OCD symptoms worse </li> <li> even when someone receives first-line, evidence-based treatments, <a href="https://www.sciencedirect.com/science/article/pii/S0005796722001413?via%3Dihub">about 40-60%</a> of people don’t get better </li> <li> there are no Australian clinical treatment guidelines, nor state or national clinical service plans for OCD. This makes it hard for health-care providers to know how to treat it </li> <li> there has been <a href="https://journals.sagepub.com/doi/full/10.1177/00048674221125595">relatively little research funding</a> spent on OCD in the past ten years, compared with, for example, psychosis or dementia. </li> </ul> <h2>What can we do?</h2> Real change demands collaboration between health-care professionals, researchers, government, people with OCD and their families to advocate for proportionate funding for research and clinical services to: <ul> <li> deliver public health messaging to improve general knowledge about OCD and reduce the stigma so people feel more comfortable disclosing their worries </li> <li> upskill and support health professionals to speed up diagnosis so people can receive targeted early intervention </li> <li> support health-care professionals to offer evidence-based treatment for OCD, so more people can access these treatments </li> <li> develop state and national service plans and clinical guidelines. For example, the Australian government funds the <a href="https://nedc.com.au/">National Eating Disorders Collaboration</a> to develop and implement a nationally consistent approach to preventing and treating eating disorders </li> <li> research to discover new, and enhance existing, treatments. These include ones for people who don’t get better after “exposure and response prevention” therapy. </li> </ul> <h2>What if I think I have OCD?</h2> The most common barrier to getting help is not knowing who to see or where to go. Start with your GP: tell them you think you might have OCD and ask to discuss treatment options. These might include therapy and/or medication and a referral to a psychologist or psychiatrist. If you choose therapy, it’s important to find a clinician that offers specific and effective treatment for OCD. To help, we’ve started <a href="https://ocd.org.au/directory">a directory</a> of clinicians with a special interest in treating OCD. You <a href="https://iocdf.org/ocd-finding-help/how-to-find-the-right-therapist/#:%7E:text=Tips%20for%20Finding%20the%20Right%20Therapist&text=Also%2C%20remember%20that%20some%20therapists,the%20phone%20or%20in%20person">can ask</a> any potential health professional if they offer “exposure and response prevention”. If they don’t, it’s a sign this isn’t their area of expertise. But you still can ask them if they know of a colleague who does. You might need to call around, so hang in there. Good treatment can be life changing. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/obsessive-compulsive-disorder-is-more-common-than-you-think-but-it-can-take-9-years-for-an-ocd-diagnosis-196651" target="_blank" rel="noopener">The Conversation</a>.

Caring

Global review shows link between social media use, body image and eating disorders

Body image has remains a <a href="https://www.missionaustralia.com.au/what-we-do/research-impact-policy-advocacy/youth-survey" target="_blank" rel="noopener">top personal concern</a> for young people in Australia, with 76% concerned about the issue. Social media use by teens is rising at the same time – with <a href="https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Social-Media-and-Teens-100.aspx" target="_blank" rel="noopener">more than 90% on platforms</a> like Facebook, YouTube, Instagram, Snapchat, WeChat and TikTok. While there have long been concerns about the association between social media, body image and eating disorders the connection remains relatively unexplored as a public health issue. Now, researchers from University College London in the UK have undertaken a systematic review of 50 scientific studies across 17 countries showing clear links between social media use and body image concerns. The paper, <a href="https://doi.org/10.1371/journal.pgph.0001091" target="_blank" rel="noopener">published</a> in PLOS Global Public Health, analyses the relationship between body image or eating disorders in young people and social media use. The researchers identify specific aspects of social media – platforms with an emphasis on photos, and engaging with “fitspiration” and “thinspiration” trends – as the factors most closely linked to body image concerns, disordered eating and poor mental health. Other key risk factors included female gender, high body-mass-index and pre-existing body image concerns. The researchers note further studies are needed into the direction of causality. “For example, do body image dissatisfaction and disordered eating occur because of social media usage, or do these pre-exist, encourage engagement in certain online activities, and result in unfavourable clinically significant outcomes?” they ask. Eating disorders involve disturbed attitudes to body image, pre-occupation with weight and body shape and are associated with significant negative outcomes such as cardiovascular disease, reduced bone density, and psychiatric conditions. In Australia, the <a href="https://butterfly.org.au/" target="_blank" rel="noopener">Butterfly Foundation</a> reports eating disorders affect around one million people, with the conditions causing more people die each year than the road toll. Image credits: Getty Images This article was originally published on <a href="https://cosmosmagazine.com/health/social-media-use-body-image/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Petra Stock.

Technology

New study to “give hope” to childhood trauma survivors with depression

A new study has challenged our understanding of how to treat adults with a history of childhood trauma, revealing that using psychotherapy, medication or a combination of the two are effective treatments for those with depression. Childhood trauma, defined as abuse or neglect of a person before they are 18 years old, is a known risk factor for major depressive disorders in adulthood. It often results in symptoms that start earlier, last longer and are more frequent, and increases the risk of developing co-occurring diseases and conditions. The study, published in <a href="https://doi.org/10.1016/S2215-0366(22)00227-9" target="_blank" rel="noopener">The Lancet Psychiatry</a>, found that adult survivors of childhood trauma who receive these common treatments experience improved symptoms at the same rate as those without childhood trauma. While previous studies have indicated that common treatments for major depressive disorders are less effective for people with childhood trauma, the team argues that these findings are inconsistent. The team then examined data from 29 clinical trials of psychotherapy and pharmacotherapy (the use of prescribed medications) among adults with major depressive disorders to determine whether those with trauma were more severely depressed before treatment, had more unfavourable outcomes after treatment, and whether they were less likely to benefit from treatment in comparison to those without trauma. Among the 46 percent of participants with childhood trauma, the team found that they showed more severe symptoms at the start of treatment and after treatment in comparison to the control group (those without trauma). But, they found that both groups experienced an improvement in symptoms at a similar rate. Erika Kuzminskaite, a PhD candidate and the first author of the study, said that this finding could be a source of hope. “Finding that patients with depression and childhood trauma experience similar treatment outcome when compared to patients without trauma can give hope to people who have experienced childhood trauma,” Kuzminskaite said. “Nevertheless, residual symptoms following treatment in patients with childhood trauma warrant more clinical attention as additional interventions may still be needed.” Antoine Yrondi, a professor at the University of Toulouse who wasn’t involved in the research, wrote that the study provides a message of hope for patients. “This meta-analysis could deliver a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms,” Dr Yrondi said. “However, physicians should keep in mind that childhood trauma could be associated with clinical features which may make it more difficult to reach complete symptomatic remission and, therefore, have an impact on daily functioning.” According to <a href="https://blueknot.org.au/resources/blue-knot-fact-sheets/trauma-classification/what-is-childhood-trauma/" target="_blank" rel="noopener">Blue Knot</a>, childhood trauma can have a wider and more extreme impact than trauma we experience as adults because a child’s brain is still developing. If the trauma is unresolved, coping strategies developed during childhood can become risk factors for poorer psychological and physical health in adulthood. But, it is possible to recover from childhood trauma, with this latest study going to show that common treatments can be effective. If you’re in need of support, you can contact Lifeline on 13 11 14 or Blue Knot on 1300 657 380. Image: Getty Images

Mind

We studied how COVID affects mental health and brain disorders up to two years after infection – here’s what we found

The occurrence of mental health conditions and neurological disorders among people recovering from COVID has been a concern since early in the pandemic. Several studies have shown that a <a href="https://www.sciencedirect.com/science/article/pii/S2215036621000845" target="_blank" rel="noopener">significant proportion</a> of adults <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00042-1/fulltext" target="_blank" rel="noopener">face problems</a> of this kind, and that the risks are greater than following other infections. However, several questions remain. Do the risks of psychiatric and neurological problems dissipate, and if so, when? Are the risks similar in children as in adults? Are there differences between COVID variants? Our new study, published in <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext" target="_blank" rel="noopener">The Lancet Psychiatry</a>, explored these issues. In analyses led by my colleague Maxime Taquet, we used the electronic health records of about 1.25 million people diagnosed with COVID, mostly from the US. We tracked the occurrence of 14 major neurological and psychiatric diagnoses in these patients for up to two years. We compared these risks with a closely matched control group of people who had been diagnosed with a respiratory infection other than COVID. We examined children (aged under 18), adults (18-65) and older adults (over 65) separately. We also compared people who contracted COVID just after the emergence of a new variant (notably omicron, but earlier variants too) with those who did so just beforehand. Our findings are a mixture of good and bad news. Reassuringly, although we observed a greater risk of common psychiatric disorders (anxiety and depression) after COVID infection, this heightened risk rapidly subsided. The rates of these disorders among people who had COVID were no different from those who had other respiratory infections within a couple of months, and there was no overall excess of these disorders over the two years. It was also good news that children were not at greater risk of these disorders at any stage after COVID infection. We also found that people who had had COVID were not at higher risk of getting Parkinson’s disease, which had been a concern early in the pandemic. Other findings were more worrying. The risks of being diagnosed with some disorders, such as psychosis, seizures or epilepsy, brain fog and dementia, though mostly still low, remained elevated throughout the two years after COVID infection. For example, the risk of dementia in older adults was 4.5% in the two years after COVID compared with 3.3% in those with another respiratory infection. We also saw an ongoing risk of psychosis and seizures in children. <figure class="align-center "><img src="https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" alt="A woman sits by a window, hiding her head." /><figcaption>Rates of depression and anxiety were higher after COVID, but only for a short time. <a class="source" href="https://www.shutterstock.com/image-photo/beautiful-young-blonde-caucasian-female-feeling-2057071157" target="_blank" rel="noopener">Stock Unit/Shutterstock</a></figcaption></figure> In terms of variants, although our data confirms that omicron is a much milder illness than the previous delta variant, survivors remained at similar risk of the neurological and psychiatric conditions we looked at. However, given how recently omicron emerged, the data we have for people who were infected with this variant only goes up to about five months after infection. So the picture may change. Mixed results Overall, our study reveals a mixed picture, with some disorders showing a transient excess risk after COVID, while other disorders have a sustained risk. For the most part, the findings are reassuring in children, but with some concerning exceptions. The results on omicron, the variant currently dominant around the world, indicate that the burden of these disorders is likely to continue, even though this variant is milder in other respects. The study has important caveats. Our findings don’t capture people who may have had COVID but it wasn’t documented in their health records – perhaps because they didn’t have symptoms. And we cannot fully account for the effect of vaccination, because we didn’t have complete information about vaccination status, and some people in our study caught COVID before vaccines became available. That said, in <a href="https://pubmed.ncbi.nlm.nih.gov/35447302/" target="_blank" rel="noopener">a previous study</a> we showed the risks of these outcomes were pretty similar in people who caught COVID after being vaccinated, so this might not have significantly affected the results. Also, the risks observed in our study are relative to people who had had other respiratory infections. We don’t know how they compare to people without any infection. We also don’t know how severe or long lasting the disorders were. Finally, our study is observational and so cannot explain how or why COVID is associated with these risks. Current theories include persistence of the virus in the nervous system, the immune reaction to the infection, or problems with blood vessels. These are being investigated in <a href="https://academic.oup.com/braincomms/advance-article/doi/10.1093/braincomms/fcac206/6668727?searchresult=1" target="_blank" rel="noopener">separate research</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/188918/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-harrison-1371295" target="_blank" rel="noopener">Paul Harrison</a>, Professor of Psychiatry, <a href="https://theconversation.com/institutions/university-of-oxford-1260" target="_blank" rel="noopener">University of Oxford</a> This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-studied-how-covid-affects-mental-health-and-brain-disorders-up-to-two-years-after-infection-heres-what-we-found-188918" target="_blank" rel="noopener">original article</a>. Image: Getty Images

Mind

How eye disorders may have influenced the work of famous painters

Vision is an important tool when creating a painted artwork. Vision is used to survey a scene, guide the artist’s movements over the canvas and provide feedback on the colour and form of the work. However, it’s possible for disease and disorders to alter an artist’s visual perception. There is a <a href="http://digicoll.library.wisc.edu/cgi-bin/HistSciTech/HistSciTech-idx?type=article&did=HISTSCITECH.NATURE18720321.I0007&id=HistSciTech.Nature18720321&isize=M">long history</a> of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1869328/">scientists and clinicians</a> arguing <a href="https://www.ncbi.nlm.nih.gov/pubmed/8510952">particular artists</a> were affected by <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">vision disorders</a>, based on signs in their works. Some argued the <a href="https://www.ncbi.nlm.nih.gov/pubmed/8510952">leaders of the Impressionist movement were short-sighted</a>, for instance, and that their blurry distance vision when not using spectacles may explain their broad, impetuous style. Supporting evidence of such disorders and their influence on artworks is often speculative, and hampered by a lack of clinical records to support the diagnosis. A particular challenge to verifying these speculations is that artists are, of course, free to represent the world in whatever fashion they like. So, is a particular style the result of impoverished vision, or rather a conscious artistic choice made by the artist? Here are three artists who it has been claimed suffered vision impairments. <h2>El Greco</h2> Architect, painter and sculptor of the Spanish Renaissance, El Greco (1541-1614) is known for vertically elongating certain figures in his paintings. In 1913, ophthalmologist <a href="https://pdfs.semanticscholar.org/5059/8e2c07220d1bb76b52f02508ee7f09ce0077.pdf">Germán Beritens argued</a> this elongation was due to astigmatism. Astigmatism typically results when the cornea – the front surface of the eye and the principal light-focusing element – is not spherical, but shaped more like a watermelon. This means the light bends in different amounts, depending on the direction in which it’s passing through the eye. Lines and contours in an image that are of a particular orientation will be less in focus than others. Beritens would demonstrate his astigmatism theory to house guests using a special lens that produced El Greco-like vertical elongations. But there are several problems with Beriten’s theory. A common objection is that any vertical stretching should have affected El Greco’s view of both the subject being painted and the canvas being painted on. This would mean the astigmatism effects <a href="https://www.ncbi.nlm.nih.gov/pubmed/24577418">should largely cancel out</a>. Possibly <a href="https://www.ncbi.nlm.nih.gov/pubmed/24577418">more problematic</a> is that uncorrected astigmatism mainly causes blurry vision, rather than a change in image size. Plus, <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">other evidence suggests</a> El Greco’s use of vertical elongation was a deliberate artistic choice. For example, in his 1610 painting, St Jerome as Scholar (above), the horizontally oriented hand of the saint is also elongated, just like the figure. If El Greco’s elongated figures were due to a simple vertical stretching in his visual perception, we would expect the hand to look comparatively stubby. <h2>Claude Monet</h2> Elsewhere, the influence of eye anomalies in artworks is more compelling. Cataracts are a progressive cloudiness of the lens inside the eye, producing blurred and dulled vision that can’t be corrected with spectacles. Cataracts are often brown, which filter the light passing through them, impairing colour discrimination. In severe cases, blue light is almost completely blocked. Claude Monet was <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">diagnosed with cataracts in 1912</a>, and recommended to undergo surgery. He refused. Over the subsequent decade, his ability to see critical detail reduced, as is documented in his medical records. Importantly, his colour vision also suffered. In 1914, he <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">noted how reds appeared dull and muddy</a>, and by 1918 he was reduced to selecting colours from the label on the paint tube. The visual impact of his cataracts is demonstrated in two paintings of the same scene: the Japanese footbridge over his garden’s lily pond. The first, painted ten years prior to his cataract diagnosis, is full of detail and subtle use of colour. In contrast, the second – painted the year prior to his eventually relenting to surgery – shows colours to be dark and murky, with a near absence of blue, and a dramatic reduction in the level of painted detail. There is good evidence such changes were not a conscious artistic choice. In a 1922 <a href="https://psyc.ucalgary.ca/PACE/VA-Lab/AVDE-Website/Monet.html">letter to author Marc Elder</a>, Monet confided he recognised his visual impairment was causing him to spoil paintings, and that his blindness was forcing him to abandon work despite his otherwise good health. One of <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">Monet’s fears</a> was that surgery would alter his colour perception, and indeed after surgery he complained of the world appearing too yellow or sometimes too blue. It was two years before he felt his colour vision had returned to normal. Experimental work <a href="https://www.ncbi.nlm.nih.gov/pubmed/15518204">has confirmed</a> colour perception is measurably altered for months after cataract surgery, as the eye and brain adapt to the increased blue light previously blocked by the cataract. <h2>Clifton Pugh</h2> In addition to eye disease, colour vision can be altered by inherited deficiencies. Around <a href="http://www.colourblindawareness.org/colour-blindness/">8% of men and 0.5% of women</a> are born with abnormal colour vision – sometimes erroneously called “colour blindness”. In one of its most common severe forms, people see colours purely in terms of various levels of blue and yellow. They can’t distinguish colours that vary only in their redness or greenness, and so have trouble distinguishing ripe from unripe fruit, for example. It has been argued no major artist is known to have <a href="https://www.ncbi.nlm.nih.gov/pubmed/11274694">abnormal colour vision</a>. But <a href="https://www.ncbi.nlm.nih.gov/pubmed/19515095">subsequent research</a> argues against this. Australian artist <a href="https://www.portrait.gov.au/portraits/2006.56/kate-hattam/31931/">Clifton Pugh</a> can readily lay claim to the title of “major artist”: he was three-times winner of the Archibald Prize for Portraiture, is highly represented in national galleries, and even won a bronze medal for painting at the Olympics (back when such things were possible). His abnormal colour vision is <a href="https://www.ncbi.nlm.nih.gov/pubmed/19515095">well documented</a> in biographical information. Owing to the inherited nature of colour vision deficiencies, researchers were able to test the colour vision of surviving family members to support their case that Pugh almost certainly had a severe red-green colour deficiency. But an analysis of the colours used in Pugh’s paintings failed to reveal any signatures that would suggest a colour vision deficiency. This is consistent with <a href="https://academic.oup.com/bjaesthetics/article-abstract/7/2/132/117619?redirectedFrom=fulltext">previous work</a>, demonstrating it was not possible to reliably diagnose a colour vision deficiency based on an artist’s work. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/how-eye-disorders-may-have-influenced-the-work-of-famous-painters-92830" target="_blank" rel="noopener">The Conversation</a>.

Art

8 bipolar symptoms you might be ignoring

What is bipolar disorder? There are two commonly diagnosed types of bipolar disorder, a mental illness characterised by mood swings from emotional highs to lows. People with bipolar I have depression alternating with severely elevated mood, or mania. Bipolar II is much more common, and is marked by less severe manic symptoms, called hypomania. Since the characteristics of bipolar disorder exist along a spectrum ranging from non-existent to extreme, and because good or bad moods can be a result of temporary events or circumstances rather than a mental illness, diagnosis of bipolar disorder can be difficult. These signs will reveal if you’re going through a phase or revealing bipolar symptoms. You're downright depressed A bipolar person in a depressive state will have the same symptoms as someone who has only depression. “They have the same problems with energy, appetite, sleep, and focus as others who have ‘plain old depression,’” psychiatrist, Dr Don Malone, tells Health. The period of mania, or elevated mood, that follows the depression is what differentiates a bipolar diagnosis. It’s important to discuss fluctuations in mood with your therapist because the treatment for depression will be different from bipolar disorder treatment. “Antidepressants can be downright dangerous in people with bipolar because they can send them into mania,” says Dr Malone. Signs of depression include: feeling sad or hopeless for long periods of time, withdrawal from family or friends, lack of interest in activities you used to enjoy, significant changes in appetite, lack of energy, slow speech, problems concentrating, and preoccupation with death. You can't sleep It’s common to have periods of insomnia due to stress or anticipation of something exciting on the horizon. But someone in a manic phase of bipolar disorder will require significantly less sleep than usual (sometimes none at all) for days at a time – and still feel energised. During a depressive phase, a person may sleep for longer than usual. Professor of psychiatry, Dr Carrie Bearden, tells Health that staying on a regular sleep schedule is one of the first things she recommends for bipolar patients. You're in a great mood - a really, really great mood! Who wouldn’t love to be in a great mood? And why would anyone see that as a sign of mental illness? “These phases of the disorder may actually be enjoyable to the individual because they allow for increased productivity and creativity that they normally might not experience,” says psychiatrist, Dr Smitha Murthy. But if the mood elevation is extreme, there is no apparent cause for it, it lasts for a week or longer, or it appears in combination with other symptoms, it may be one of your bipolar symptoms. Hypomania, characteristic of bipolar II, may be even harder to differentiate from a generally good mood because the symptoms are milder. Look for a combination of elevated mood with other bipolar symptoms, especially in a repetitive cycle that alternates with depression. You get distracted easily Trouble concentrating, a tendency to jump from task to task, or being generally unable to finish projects may be attributed to flightiness, stress, or other factors. But if you’re so distracted that you’re unable to get anything done, and it’s interfering with your work or relationships, you might be showing bipolar symptoms, says Dr Murthy. You're unusually irritable “This is one of the trickiest symptoms to recognise since it’s a natural reaction to frustration or unfairness,” says Dr James Phelps. Getting upset that someone cut you off on the highway, for example, is pretty normal. “Anger out of proportion to the situation, rising too fast, getting out of control, lasting for hours, and shifting from one person to another, would differentiate the behaviour as a possible bipolar symptom,” he says. You talk - and think - fast A “chatty Cathy” is not abnormal, says Dr Phelps. “But talking so fast that others can’t keep up or understand – especially in phases with other bipolar symptoms, may be hypomania,” he adds. Someone in a manic state may not even let another person get a word in. This type of rapid speech is especially concerning if a person doesn’t speak this way typically. Similarly, racing thoughts or ideas that come so quickly that others – and even you yourself – may not be able to keep up may be indicative of mania. You're extremely confident - but don't make good decisions Normally, high self-esteem is a good thing. In a person with bipolar disorder, excessive confidence could lead to poor decisions. “They feel grandiose and don’t consider consequences; everything sounds good to them,” Dr Malone told Health. This may lead to taking risks and engaging in erratic behaviour you ordinarily wouldn’t attempt, like having an affair or spending thousands of dollars you can’t afford to spend. Drug and alcohol use “People with bipolar disorder have a higher than average rate of a co-occurring substance or alcohol use,” says Dr Murthy. They may try to calm themselves with alcohol or drugs during a manic phase, or use them to cheer up during a depression. Written by Ilisa Cohen. This article first appeared in <a rel="noopener" href="https://www.readersdigest.co.nz/healthsmart/8-bipolar-symptoms-you-might-be-ignoring" target="_blank">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a rel="noopener" href="http://readersdigest.innovations.co.nz/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRA87V" target="_blank">here’s our best subscription offer.</a> Image: Getty Images <img style="width: 100px !important; height: 100px !important;" src="https://oversixtydev.blob.core.windows.net/media/7820640/1.png" alt="" data-udi="umb://media/f30947086c8e47b89cb076eb5bb9b3e2" />

Mind

Genetic link between alcoholism and Alzheimer’s risk discovered

Scientists have found a genetic overlap between alcohol use disorder (AUD) and neurodegenerative disorders such as Alzheimer’s. In a <a rel="noopener" href="https://www.nature.com/articles/s41467-021-25392-y" target="_blank">study</a> published in Nature Communications, the researchers identified several genes associated with alcoholism, including two previously linked to neurodegenerative disorders. <blockquote class="twitter-tweet"> First of its kind study using multi-omics approach identifies large list of candidate genes associated with alcohol use disorder - study shows potential genetic link between <a href="https://twitter.com/hashtag/alcoholism?src=hash&ref_src=twsrc%5Etfw">#alcoholism</a>, <a href="https://twitter.com/hashtag/Alzheimers?src=hash&ref_src=twsrc%5Etfw">#Alzheimers</a> disease, & other neurodegenerative disorders <a href="https://t.co/kzautcL6DN">https://t.co/kzautcL6DN</a><a href="https://twitter.com/hashtag/genetics?src=hash&ref_src=twsrc%5Etfw">#genetics</a> <a href="https://t.co/nUNbvYf2L8">pic.twitter.com/nUNbvYf2L8</a> — Mount Sinai Genetics (@SinaiGenetics) <a href="https://twitter.com/SinaiGenetics/status/1428699409475309571?ref_src=twsrc%5Etfw">August 20, 2021</a></blockquote> “Several of these genes are also associated with neurodegenerative disorders - an intriguing connection because of alcohol’s ability to prematurely age the brain,” David Goldman, a neurogenetics researcher at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) told The Scientist. The scientists compared the genetic data of about 700,000 families involved in the NIAAA’s <a rel="noopener" href="https://www.niaaa.nih.gov/research/major-initiatives/collaborative-studies-genetics-alcoholism-coga-study" target="_blank">Collaborative Studies on the Genetics of Alcoholism</a> (COGA), as well as data from the <a rel="noopener" href="https://www.ukbiobank.ac.uk/enable-your-research/approved-research/alcohol-consumption-and-brain-health" target="_blank">UK Biobank</a>, against analyses of adult and foetal brains to determine which genes were silenced or expressed. Though the study did identify many genes associated with alcohol use, the team focused on the two genes linked to neurodegenerative disorders: SPI1 and MAPT. SPI1 produces a protein that controls the activity of immune cells, while MAPT produces a protein found throughout the nervous system called tau. SPI1 linked to Alzheimer’s <a rel="noopener" href="https://molecularneurodegeneration.biomedcentral.com/articles/10.1186/s13024-018-0277-1" target="_blank">Previous research</a> has shown that SPI1 influenced the likelihood of a person developing Alzheimer’s disease, with some theorising that it influences the activity of microglia, immune cells that are found in the brain. In a <a rel="noopener" href="https://www.nature.com/articles/s41398-019-0384-y" target="_blank">study</a> from two years ago, Manav Kapoor, a neuroscientist and geneticist at the Icahn School of Medicine at Mount Sinai and the new paper’s first author, and his team found evidence that people with AUD might have an overactive immune system - and this new paper could help explain their previous findings. The new study also found an association between the SPI1 gene and both heavy drinking and a diagnosis of AUD. Though alcoholism is already associated with immune dysfunction, the team found that expression of the SPI1 gene was higher in some foetal brains. Kapoor says this finding suggests that those genetically predisposed to AUD and heavy drinking are also predisposed to developing an overactive immune system. If this is the case, when people with particular versions of the gene drink heavily, Kapoor suggests that their immune systems could become overactivated and cause brain immune cells to alter connections between neurons. Kapoor bases this theory on a previous <a rel="noopener" href="https://stke.sciencemag.org/content/13/650/eaba5754" target="_blank">study</a> in mice that found that binge drinking activated brain immune cells, which selectively pruned certain synapses and caused the animals to display anxiety-like behaviours. The activation of these brain immune cells could result in the pruning of connections to neurons that produce dopamine - the chemical behind the “reward” feeling we get after drinking alcohol. As a result, people with certain versions of SPI1 who start drinking regularly would “have to drink more and more to get the same level of reward”, Kapoor says. “And their immune system will get more activated”, pruning more synapses. “It will become a vicious cycle,” Kapoor says. As for MAPT, the gene isn’t associated with AUD, but is associated with consuming more drinks per week. The tau protein it produces is thought to play a major role in neurodegenerative disorders including Alzheimer’s, Parkinson’s, frontotemporal dementia, and supranuclear palsy. However, it is still unclear how tau may factor into the consumption of alcohol. Why this matters Joel Gelernter, a geneticist and neurobiologist at Yale University School of Medicine, who was not involved in the study, says the study is “a really necessary step in unravelling the biology of alcohol intake and alcohol use disorder”. Kapoor says this work could benefit people in a few ways. First, he believes that drugs currently in development to treat neurodegenerative disorders could be repurposed to help people in reducing or stopping drinking. Second, it could be a way of reducing a person’s risk for neurodegenerative disorders. “If we can identify some group of people that are more at risk of Alzheimer’s disease, we can ask them to reduce their drinking,” he says. “That might be beneficial to them.” Image: Getty Images

Body

5 signs you have body dysmorphic disorder

Signs of BDD 1. Your idea of a “flaw” isn’t realistic. The Diagnostic Manual differentiates between people who are actually obese and are worried or struggling with that, and BDD. With BDD you are concentrating on minute imperfections that are normal aspects of being human, rather than actual body issues that are visible to others. Samantha DeCaro, an assistant clinical director at an eating disorder clinic, says BDD is a fixation on “perceived” flaws. “These flaws are not detectable, or they are barely noticeable, to anyone else,” she says. “People with BDD commonly become obsessed with real or imagined imperfections on their face, their hair, or the size and shape of a particular body part.” 2. You avoid social situations Ever cancelled an event because you can’t find something that makes you look skinny enough to go out? This is a concerning sign that can indicate BDD. Psychotherapist Haley Neidich, a social worker with an online private practice, says those with BDD may “isolate themselves and avoid social situations.” Rosenbaum says the major distinction that helps her diagnose BDD is identifying “how much does this interfere with [a patient’s] life?” “How much of my thinking time does this take? Does my focus on my body keep me from doing things I enjoy, like going out with my friends?” All of these can indicate that you are moving from body dissatisfaction to a more concerning, obsessive disorder. 3. You spend a lot of time staring in the mirror When bodybuilder Greeley finally reached her lowest point and reached out to a therapist, she was diagnosed with BDD, as well as bulimia. “When you are in that world staring in the mirror taking thousands of [progression] photos for coaches, I’d say ‘I can’t see my abs, Oh God,’” she says. Greeley would spend hours “stalking” other people’s Instagram accounts, comparing her body to theirs. “I felt not skinny enough. It became sick and obsessive,” she says. 4. You can’t stand your face Rosenbaum says the pandemic has worsened BDD for many people who are sitting on Zoom calls for hours, staring at their own reflection. She jokes that even she has never “checked her hair” this much. “People are staring at their distorted image all day. For most of us, we are bodies from the chest up. We don’t even have bodies,” Rosenbaum explains. This unreasonable amount of time we can now spend staring at our own features is exacerbating the problem. It’s being called the “Zoom Boom” as plastic surgeons see more patients considering plastic surgery in 2020. DeCaro says we are living in a society obsessed with “fatphobia and ageism,” which causes everyone to be critical of their bodies from time to time, but those with BDD can be constantly concerned with “real or imagined imperfections on their face” or other body parts. 5. You see your body as parts, not a whole healthy being Finding yourself hating a specific body part? This can be one of the difficulties of BDD, as piecing out the body causes us to hyper analyse the flaws of each part, rather than looking at the body as a whole being, Rosenbaum explains. One of the strategies she’s found helpful with patients is helping them to see their bodies as a whole being that serves a function, and to focus on what your body can do. “Appreciate what your body does for you. Every aspect of your body. Learn to appreciate what it does and how it serves you so well… so we need to feed our bodies with fuel to give us energy so our brains work. So we can walk and love and engage in everything our bodies do. Often [people with BDD] only focus on the surface,” Rosenbaum says. That deep dive into our perspective on our bodies, and focus on the importance of certain parts being perfect, is what BDD patients work on in therapy. What to do if you think you have BDD First, determine the severity of the symptoms. Often BDD happens in conjunction with an eating disorder, which can be more dangerous than BDD by itself. Neidich says individuals with BDD are known to pursue or complete medical procedures in order to change their bodies in an effort to rid themselves of the obsession, which can be dangerous. “Given the high prevalence of disordered eating among individuals with BDD, it is important to point out that eating disorders are the most deadly mental health disorder,” she says. Behaviours Rosenbaum says can be more severe including binging and purging, restricting kilojoules, over-exercising, and other typical eating disorder symptoms. Seeking therapy is an important step towards overcoming BDD, and is a great place to start. Next steps People with co-morbid personality disorders may be referred to dialectical behaviour therapy (DBT) treatment, a type of cognitive behaviour therapy that helps teach skills to handle negative emotions. Those with co-morbid post-traumatic stress disorder (PTSD) may be referred to a trauma therapist. Anyone with obsessive-compulsive disorder (OCD) may be referred to a specialist for cognitive behaviour therapy (CBT) combined with Exposure and Response Prevention, a type of therapy that exposes people to their fears. Those with co-morbid substance use disorders will be encouraged to attend 12-step programs and focus on sobriety. Individuals with eating disorders should have a multidisciplinary treatment team. “Just like other mental health conditions, it is possible for people to reach a place in their recovery where they are no longer symptomatic (or minimally so),” Neidich says. “However, individuals with a history of BDD are at a high risk for a recurrence of the symptoms or other mental health conditions in the future, particularly around a time of transition or intense stress in their lives,” she explains. Greeley is finally able to manage, after years of therapy. She says you don’t just wake up and not have BDD anymore, and that sometimes she still has to check herself: “It’s OK to have one Oreo. You can have a cheeseburger and it won’t be the end of the world,” she says. She credits her care team’s support with helping her “learn to love herself all over again.” Written by Alex Frost. This article first appeared in <a href="https://www.readersdigest.co.nz/healthsmart/what-is-body-dysmorphia-5-signs-you-have-body-dysmorphic-disorder">Reader’s Digest</a>. Find more of what you love from the world’s best-loved magazine, <a href="https://readersdigest.innovations.co.nz/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRA93V">here’s our best subscription offer</a>.

Body

Why people with anxiety and other mood disorders struggle to manage their emotions

Regulating our emotions is something we all do, every day of our lives. This psychological process means that we can manage how we feel and express emotions in the face of whatever situation may arise. But some people cannot regulate their emotions effectively, and so experience difficult and intense feelings, often partaking in behaviours such as <a href="https://onlinelibrary.wiley.com/doi/full/10.1348/014466508X386027">self-harm</a>, <a href="https://www.tandfonline.com/doi/abs/10.3109/00952990.2013.877920">using alcohol</a>, and <a href="https://theconversation.com/how-difficulty-in-identifying-emotions-could-be-affecting-your-weight-105917">over-eating</a> to try to escape them. There are several strategies that <a href="https://theconversation.com/emotions-how-humans-regulate-them-and-why-some-people-cant-104713">we use to regulate emotions</a> – for example, reappraisal (changing how you feel about something) and attentional deployment (redirecting your attention away from something). Underlying <a href="https://tu-dresden.de/mn/psychologie/ifap/allgpsy/ressourcen/dateien/lehre/pruefungsliteratur_KN_2013/Ochsner-Gross-2005.pdf?lang=en">neural systems</a> in the brain’s prefrontal cortex are responsible for these strategies. However, dysfunction of these neural mechanisms can mean that a person is unable to manage their emotions effectively. <a href="http://psycnet.apa.org/record/2013-44085-004">Emotion dysregulation</a> does not simply occur when the brain neglects to use regulation strategies. It includes unsuccessful attempts by the brain to reduce unwanted emotions, as well as the counterproductive use of strategies that have a cost that outweighs the short term benefits of easing an intense emotion. For example, avoiding anxiety by not opening bills might make someone feel better in the short term, but comes with the long-term cost of ever increasing charges. These unsuccessful attempts at regulation and counterproductive use of strategies are a core feature of many <a href="https://journals.lww.com/co-psychiatry/Abstract/2012/03000/Emotion_regulation_and_mental_health___recent.11.aspx">mental health conditions</a>, including anxiety and mood disorders. But there is not one simple pathway that causes the dysregulation in these conditions. In fact research has found several causes. <h2>1. Dysfunctional neural systems</h2> In anxiety disorders, dysfunction of the brain’s emotional systems is related to emotional responses being of a much higher intensity than usual, along with an increased <a href="http://people.socsci.tau.ac.il/mu/anxietytrauma/files/2014/04/Pergamin-Height-et-al-2015-CPR.pdf">perception of threat</a> and a negative view of the world. These characteristics influence how effective emotion regulation strategies are, and result in an over-reliance on maladaptive strategies like avoiding or trying to suppress emotions. In the brains of those with anxiety disorders, the system supporting the reappraisal does not work as effectively. Parts of the prefrontal cortex show <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210184">less activation</a> when this strategy is used, compared to non-anxious people. In fact, the higher the levels of anxiety symptoms, the less activation is seen in these brain areas. This means that the more intense the symptoms, the less they are able to reappraise. <iframe width="440" height="260" src="https://www.youtube.com/embed/iALfvFpcItE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe> Similarly, those with <a href="https://www.researchgate.net/profile/David_Mohr3/publication/308172676_Major_depressive_disorder/links/59ce9dfaaca2721f434efc3d/Major-depressive-disorder.pdf">major depressive disorder (MDD)</a> – the inability to regulate or repair emotions, resulting in prolonged episodes of low mood – struggle to use <a href="http://sites.oxy.edu/clint/physio/article/EmotionRegulationinDepressionTheRoleofBiasedCognitionandReducedCognitiveControlClinicalPsychologicalScience-2014-Joormann.pdf">cognitive control</a> to manage negative emotions and decrease emotional intensity. This is due to <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2203837">neurobiological differences</a>, such as decreased <a href="https://www.sciencedirect.com/science/article/pii/S1053811910011857">density of grey matter</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S0006322301013361">reduced volume</a> in the brain’s prefrontal cortex. During emotion regulation tasks, people who have depression show less <a href="http://www.jneurosci.org/content/jneuro/27/33/8877.full.pdf">brain activation</a> and metabolism in this area. People with MDD sometimes show less effective function in the brain’s motivation systems – a network of neural connections from the <a href="https://www.sciencenewsforstudents.org/blog/scientists-say/scientists-say-ventral-striatum">ventral striatum</a>, located in the middle of the brain, and prefrontal cortex – too. This might explain their difficulty in regulating positive emotions (known as <a href="https://www.pnas.org/content/pnas/106/52/22445.full.pdf">anhedonia</a>) leading to a lack of pleasure and motivation for life. <h2>2. Less effective strategies</h2> There is little doubt that people have different abilities in using different regulation strategies. But for some they simply don’t work as well. It’s possible that people with anxiety disorders find reappraisal a <a href="https://s3.amazonaws.com/academia.edu.documents/43509779/Emotional_reactivity_and_cognitive_regul20160308-6583-1i7qqg3.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1544177061&Signature=wG2kJQEWhjSupMVDCGjIjeImecI%3D&response-content-disposition=inline%3B%20filename%3DEmotional_reactivity_and_cognitive_regul.pdf">less effective</a> strategy because their <a href="https://www.researchgate.net/profile/Dominique_Lamy/publication/6598643_Threat-related_attentional_bias_in_anxious_and_nonanxious_individuals_a_meta-analytic_study_Meta-Analysis_Research_Support_Non-US_Gov%27t/links/02bfe510acc10b0e3d000000/Threat-related-attentional-bias-in-anxious-and-nonanxious-individuals-a-meta-analytic-study-Meta-Analysis-Research-Support-Non-US-Govt.pdf">attentional bias</a> means they involuntarily pay more attention towards negative and threatening information. This can stop them from being able to come up with more positive meanings for a situation – a key aspect of reappraisal. It’s possible that reappraisal doesn’t work as well for people with mood disorders either. <a href="https://www.researchgate.net/profile/Lauren_Hallion/publication/51466532_A_Meta-Analysis_of_the_Effect_of_Cognitive_Bias_Modification_on_Anxiety_and_Depression/links/5642034608aeacfd8937f221/A-Meta-Analysis-of-the-Effect-of-Cognitive-Bias-Modification-on-Anxiety-and-Depression.pdf">Cognitive biases</a> can lead people with MDD to interpret situations as being more negative, and make it difficult to think more positive thoughts. <h2>3. Maladaptive strategies</h2> Although maladaptive strategies might make people feel better in the short term they come with long term costs of maintaining anxiety and mood disorders. Anxious people rely more on maladaptive strategies like <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.463.83&rep=rep1&type=pdf">suppression</a> (trying to inhibit or hide emotional responses), and less on adaptive strategies like reappraisal. Though research into this is ongoing, it’s thought that during <a href="https://academic.oup.com/scan/article/10/10/1329/1647887">intense emotional experiences</a> these people find it very difficult to disengage – a necessary first step in reappraisal – so they turn to maladaptaive suppression instead. The use of maladaptive strategies like suppression and <a href="https://www.sciencedirect.com/science/article/pii/S0272735809000907">rumination</a> (where people have repetitive negative and self-depreciating thoughts) is also a common feature of MDD. These, together with <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/bjc.12210">difficulties using adaptive strategies</a> like reappraisal, prolong and exacerbate depressed mood. It means that people who have MDD are even less able to use reappraisal during a depressed episode. It’s important to note that mood disorders don’t just come from neural abnormalities. The research suggests that a combination of brain physiology, psychological and environmental factors are what contributes to the disorders, and their maintenance. While researchers are pursing promising <a href="https://s3.amazonaws.com/academia.edu.documents/45245021/DA_Emotion_Dysregulation.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1544123102&Signature=CuwEuqpH%2B4c78EoNxnkA1i7gGmU%3D&response-content-disposition=inline%3B%20filename%3DEMOTION_DYSREGULATION_MODEL_OF_MOOD_AND.pdf">new treatments</a>, simple actions can help people loosen the influence of negative thoughts and emotions on mood. <a href="https://www.researchgate.net/profile/Tayyab_Rashid2/publication/299155510_Rashid_T_2015_Positive_Psychotherapy_A_Strengths-Based_Approach/links/570951f408aed09e916f9518.pdf">Positive activities</a> like expressing gratitude, sharing kindness, and reflecting on character strengths really do help.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/106865/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/leanne-rowlands-408353">Leanne Rowlands</a>, PhD Researcher in Neuropsychology, <a href="http://theconversation.com/institutions/bangor-university-1221">Bangor University</a> This article is republished from <a href="http://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-people-with-anxiety-and-other-mood-disorders-struggle-to-manage-their-emotions-106865">original article</a>.

Mind

Why shopping addiction is a real disorder

UK-based healthcare group the Priory is well-known for treating gambling, sex, drug, alcohol and computing addictions – especially of the <a href="https://www.thesun.co.uk/fabulous/7327125/the-priory-celebrity-guests-katie-price-rehab-centre-cost/">rich and famous</a>. Now it has added a new condition to its list: shopping addiction. Research suggests that as many as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13223">one in 20 people</a> in developed countries may suffer from shopping addiction (or compulsive buying disorder, as it’s more formally known), yet it is often not taken seriously. People don’t see the harm in indulging in a bit of “retail therapy” to cheer themselves up when they have had a bad day. Indulging in the occasional bit of frivolous spending is not a bad thing, if it is done in moderation and the person can afford it. But for some people compulsive shopping is a real problem. It takes over their lives and leads to genuine misery. Their urges to shop become uncontrollable and are often impulsive. They end up spending money they don’t have on things they don’t need. The worst part is that compulsive buyers continue to shop regardless of the negative impact it has on them. Their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMc1805733/">mental health gets worse</a>, they get into serious debt, their social network shrinks, and they may even contemplate suicide – but shopping still provides the brief dopamine rush they crave. There is no doubt that people who engage in this behaviour suffer, and often badly. But it is debatable whether compulsive buying disorder is a condition in its own right or a symptom of another condition. Often it is difficult to diagnose because people with compulsive buying disorder have symptoms of other disorders, such as <a href="https://psycnet.apa.org/record/1994-29953-001">eating disorders and substance abuse</a>. Formal criteria needed The most commonly used manuals for diagnosing mental disorders are the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">DSM</a> and <a href="https://icd.who.int/en">ICD</a>, and neither include diagnostic criteria for compulsive buying disorder. One reason may be that there are many theories about what kind of illness the disorder is. It has been likened to <a href="https://psycnet.apa.org/record/1995-01870-001">impulse control disorder</a>, mood disorders, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1987.tb00424.x">addiction</a> and <a href="https://www.sciencedirect.com/science/article/pii/S0005789402800259">obsessive-compulsive disorder</a>. How the disorder ought to be classified is an ongoing debate. What is also an <a href="https://www.macmillanihe.com/page/detail/Consumption-Matters/?K=9780230201170">ongoing debate</a> is what the disorder should be called. To the general public, it’s known as “shopping addiction”, but experts variously call it compulsive buying disorder, oniomania, acquisitive desire and impulse buying. Researchers also struggle to agree on a definition. Perhaps the lack of a clear definition stems from the fact that research shows that no single factor is sufficiently powerful to explain the causes of this compulsive behaviour. What most experts seem to agree on is that people with this condition find it difficult to stop and that it results in harm, showing that it is an involuntary and destructive kind of behaviour. People with the condition often try to hide it from friends and partners as they feel shame, thereby alienating themselves from the people who are best placed to support them. Although the disorder has not yet been clearly defined by name, symptoms or even category of mental health problem, most researchers agree on one thing: it is a real condition that people truly suffer from. The fact that the Priory, a well-established healthcare group, is treating people with compulsive buying disorder, may help to raise awareness of the condition. Hopefully, this will result in more research being conducted to help define diagnostic criteria. Without the criteria, it will be difficult for healthcare professionals to diagnose the illness and treat it. This is a condition that is crying out to be properly recognised and should not be trivialised.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/123813/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Written by Cathrine Jansson-Boyd, Reader in Consumer Psychology, Anglia Ruskin University. Republished with permission of <a rel="noopener" href="https://theconversation.com/shopping-addiction-is-a-real-disorder-123813" target="_blank">The Conversation</a>.

Retirement Income

Dissociative disorders: What are they and why haven’t we heard about them?

Dissociative disorders are often said to be <a href="http://www.teachtrauma.com/controversial-topics-trauma/myths-media-portrayals-dissociative-identity-disorder/">rare</a>. But our soon-to-be published analysis of <a href="https://www.researchgate.net/publication/334625332">international studies</a> suggest they affect 10-11% of the population at some point in their lives. This makes them nearly as common as <a href="https://journals.sagepub.com/doi/abs/10.1177/070674370404900208">mood disorders</a> (such as clinical depression). So what are dissociative disorders, why is diagnosis controversial and how can people be treated? What is dissociation? Dissociation occurs when a person experiences being disconnected from themselves, including their memories, feelings, actions, thoughts, body and even their identity. People with dissociative disorders have one or more of the following <a href="https://psycnet.apa.org/record/1995-98841-000">symptoms</a>: <ul> <li>amnesia and other memory problems</li> <li>a sense of detachment or disconnection from their self, familiar people or surroundings</li> <li>an inner struggle about their sense of self and identity</li> <li>acting like a different person (identity alteration).</li> </ul> For some people, symptoms can last days or weeks, but for others they can persist for months, years, or a lifetime. Dissociation allows the person to compartmentalise and disconnect from aspects of traumatic and challenging experiences that could otherwise overwhelm their capacity to cope. A person whose spouse has died may become emotionally numb, allowing them to focus on arranging the funeral; a man who has separated from his wife and lost his job soon afterwards may become so disconnected from his identity that he no longer recognises himself in the mirror and feels his life is happening to someone else; and a young woman who is sexually assaulted may remember her attacker moving too quickly towards her, recalls being safely back in her family home, but cannot remember the assault. If the traumatic and overwhelming experiences happen repeatedly over a long period of time, the person’s <a href="https://books.wwnorton.com/books/detail.aspx?id=9227">personality may become fragmented</a>. The traumatised part of the personality that contains the emotions, thoughts, sensations and experiences relating to the trauma becomes separated from the part of the personality that is trying to get on with daily life. This <a href="http://www.hup.harvard.edu/catalog.php?isbn=9780674068063&content=reviews">allows young children to be with frightening and abusive caregivers</a> they can neither fight nor flee from as they are dependent on them. The person may have no (or only some) conscious awareness of the compartmentalised memories, thoughts, feelings and experiences. These may, however, intrude into the person’s awareness. For example, the person may be aware of thoughts, feelings and internal voices that don’t “belong” to them, or may speak or act in ways that are completely out of character. The most extreme form of structural dissociation is <a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">dissociative identity disorder</a>, once known as multiple personality disorder. This is where the person has at least two separate personalities that exist independently of one another and that emerge at different times. These personality differences are not just psychological. <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/aiding-the-diagnosis-of-dissociative-identity-disorder-pattern-recognition-study-of-brain-biomarkers/DCF85A7D69652C06E61524593B266E8C">Neuroimaging confirms structural differences</a> in the brains of people with dissociative identity disorder. A controversial diagnosis There are two competing theories about what causes dissociation: trauma and fantasy. With the <a href="https://psycnet.apa.org/record/2012-06384-001">trauma model</a>, dissociative symptoms arise from physical, sexual and emotional abuse; neglect, particularly in childhood; attachment problems if a child fears the caregiver or the caregiver is not adequately attuned to the child’s emotional or safety needs; and other severe stress or trauma, such as experiencing or witnessing domestic violence. This trauma model is reflected in the <a href="https://icd.who.int/en/">World Health Organisation</a> and <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">American Psychiatric Association</a> past and present diagnostic criteria. However, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24773505">fantasy model</a> is based on the idea that dissociative disorders are not “real”. Instead, they are the delusion of people who are troubled (and often traumatised), suggestible, fantasy-prone and sleep-deprived. Fantasy model theorist <a href="https://www.cambridge.org/core/journals/bjpsych-advances/article/dissociative-identity-disorder-validity-and-use-in-the-criminal-justice-system/C1C27EE9731782570E1376A3EDA48CE4">Joel Paris</a> describes dissociative disorders as a North American “fad” that has nearly died out. Yet <a href="https://www.researchgate.net/publication/334625332">my analysis of 98 studies</a> found rates are not declining. In fact, I found dissociation is an international phenomenon far more common in countries that are comparatively unsafe. This is supported by other research which finds dissociation more common in people that have experienced trauma, such as <a href="https://www.tandfonline.com/doi/abs/10.3109/08039488.2014.977344?src=recsys&journalCode=ipsc20">refugees</a>. All up, the evidence indicates dissociative disorders are real (not imagined) and caused by trauma (not fantasy). Dissociative disorders are under-diagnosed and misdiagnosed Even though there are accurate ways of diagnosing dissociative disorders, most people will <a href="https://www.routledge.com/Humanising-Mental-Health-Care-in-Australia-A-Guide-to-Trauma-informed/Benjamin-Haliburn-King/p/book/9780367076603">never be diagnosed</a>. This is due to the lack of health professional education and training about dissociation, the symptoms being less obvious to observers, and scepticism that the disorder even exists. The person also may not realise they have dissociative symptoms. Even if they do, they may not reveal them due to fear or embarrassment, or may find them difficult to put into words. At least <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/assessment-of-the-prevalence-of-psychiatric-disorder-in-young-adults/5673B18071E22D850EF4E5F3241763FB">three-quarters of people with a dissociative disorder</a> will also have one or more other mental disorders. <a href="https://www.routledge.com/Humanising-Mental-Health-Care-in-Australia-A-Guide-to-Trauma-informed/Benjamin-Haliburn-King/p/book/9780367076603">They may be diagnosed with and treated for other mental health difficulties</a>, such as post-traumatic stress disorder, mood disorders, anxiety disorders, sleep disorders, borderline personality disorder, or psychosis. They may also be treated for addictions, self-harm, and/or suicidal thoughts (<a href="https://www.ncbi.nlm.nih.gov/pubmed/18195639">2% of those diagnosed complete suicide</a>). They may also be misdiagnosed with schizophrenia because <a href="https://www.ncbi.nlm.nih.gov/pubmed/27209638">hearing voices is common to both</a>. But their dissociative disorder usually remains undiagnosed. However, treatment for other mental health issues is not likely to be effective unless the underlying dissociation is addressed. How to treat? What does the evidence say works? The mental health and quality of life of people with a dissociative disorder <a href="https://psycnet.apa.org/record/2012-08580-001">improves </a>significantly with psychotherapy (a type of talk therapy) that recognises the impact of trauma <a href="https://besselvanderkolk.net/the-body-keeps-the-score.html">is physiological</a> (affecting the brain and body) as well as psychological. In therapy consistent with international treatment <a href="https://www.tandfonline.com/doi/abs/10.1080/15299732.2011.537247">guidelines</a>, people can learn skills to cope with unbearable emotions, thoughts and physical sensations. Once people are stable and have constructive coping strategies, therapists can then help people process traumatic and dissociated memories. Dissociative, post-traumatic, and depressive <a href="https://psycnet.apa.org/record/2012-08580-001">symptoms improve</a>. And hospitalisations, self-harm, drug use, and physical pain declines. There is no medication that specifically treats dissociation. Where to get help Dissociative disorders are one of the most common, yet most unrecognised, mental disorders. Symptoms are often debilitating, but significant improvements are possible if the dissociation is diagnosed and treated correctly. If you are concerned, you can speak to your GP and ask for a referral to a therapist knowledgeable about trauma and dissociation. A list of therapists with this expertise in Australia is available from the <a href="https://www.blueknot.org.au/Helpline">Blue Knot Foundation</a> and worldwide from the <a href="https://isstd.connectedcommunity.org/network/network-find-a-professional">International Society for the Study of Trauma and Dissociation</a>. Written by Mary-Anne Kate. Republished with permission of <a href="https://theconversation.com/dissociative-disorders-are-nearly-as-common-as-depression-so-why-havent-we-heard-about-them-116731">The Conversation</a>.

Body

How this rare sleep disorder forced a woman into debt

A UK mum has spoken out about a rare medical condition that resulted in a huge online shopping bill – all while she was sound asleep. Kelly Knipes, from Essex in England first discovered that something was wrong seven years ago, a little while after her first child was born. Speaking to <a href="https://www.mirror.co.uk/">The Mirror</a>, the 37-year-old said that every morning after she would wake up, she would find receipts for items that she had no recollection of purchasing. Now, years later, she believes she has spent over $5,571 including hundreds of dollars on lollies, cookie jars costing $107 and also a “full-size plastic basketball court” that was delivered to her home in a truck. “I bought a full-size basketball court from eBay, and when it turned up at my house the next day, I just refused delivery,” she said. “I would never actually have to put any credit card details when I was buying things online because it was all saved on my phone. “It was all on my phone, and everything that is on my phone is accessible by touch. I was racking up debt everywhere.” According to Ms Knipes, the transactions were made through her phone, which had her credit card details already saved. She was later forced to return the items to avoid falling into debt. Her condition, otherwise known as parasomnia, is a disorder caused by sleep apnoea – a dangerous condition that causes the person affected to stop breathing while they’re sleeping. The symptoms are similar to sleepwalking, which Ms Knipes was known to do as a child. And while shopping seems to not be the worst thing in the world, Ms Knipes has also overdosed on diabetes medication during her pregnancy due to the disorder. “I was having a dream that I was speaking to the doctors, and I kept saying that I didn’t want to take the medicine anymore — but when I woke up, I had taken all the tablets,” she told The Mirror. “Luckily everything was OK — but I was so worried that social services would get involved.” Countless doctors’ appointments later, she finally found the solution by using a continuous positive airway pressure (CPAP) device during the night, which helps her breathe while she sleeps. “When I had the CPAP machine, I felt rested and re-energised for the first time in ages,” she said. “It really has given me my life back. “Since starting CPAP, I have not had any abnormal sleep behaviours, have not shopped online at night, my headaches have ceased, and I am not depressed.” Ms Knipes is now opening up about her journey to raise awareness and help those who are currently facing the same issue.

Body

"I didn’t want to believe it”: Mariah Carey reveals mental illness diagnosis

Mariah Carey has revealed for the first time her private battle with bipolar disorder. In a <a href="http://people.com/music/mariah-carey-bipolar-disorder-diagnosis-exclusive/" target="_blank">People</a> cover story interview published this week, the 48-year-old pop star said she was diagnosed with bipolar disorder in 2001, during her much publicised physical and mental breakdown. "I didn’t want to believe it," Carey said of that dark time, which included splitting form her -husband Nick Cannon and panned E! reality series. It was not until recently the singer-songwriter sought treatment, after "the hardest couple of years [she’s] been through." "Until recently I lived in denial and isolation and in constant fear someone would expose me," she said. "It was too heavy a burden to carry and I simply couldn’t do that anymore. I sought and received treatment, I put positive people around me and I got back to doing what I love — writing songs and making music." <blockquote style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 658px; padding: 0; width: calc(100% - 2px);" class="instagram-media"> <div style="padding: 8px;"> <div style="background: #F8F8F8; line-height: 0; margin-top: 40px; padding: 50.0% 0; text-align: center; width: 100%;"> <div style="background: url(data:image/png; base64,ivborw0kggoaaaansuheugaaacwaaaascamaaaapwqozaaaabgdbtueaalgpc/xhbqaaaafzukdcak7ohokaaaamuexurczmzpf399fx1+bm5mzy9amaaadisurbvdjlvzxbesmgces5/p8/t9furvcrmu73jwlzosgsiizurcjo/ad+eqjjb4hv8bft+idpqocx1wjosbfhh2xssxeiyn3uli/6mnree07uiwjev8ueowds88ly97kqytlijkktuybbruayvh5wohixmpi5we58ek028czwyuqdlkpg1bkb4nnm+veanfhqn1k4+gpt6ugqcvu2h2ovuif/gwufyy8owepdyzsa3avcqpvovvzzz2vtnn2wu8qzvjddeto90gsy9mvlqtgysy231mxry6i2ggqjrty0l8fxcxfcbbhwrsyyaaaaaelftksuqmcc); display: block; height: 44px; margin: 0 auto -44px; position: relative; top: -22px; width: 44px;"></div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/BhbXpN-n4po/" target="_blank">A post shared by Mariah Carey (@mariahcarey)</a> on Apr 11, 2018 at 3:58am PDT </div> </blockquote> Carey says she's now in therapy to help manage her bipolar disorder II, which involves periods of depression as well as hypomania, but is considered less severe than bipolar disorder I. "For a long time I thought I had a severe sleep disorder," added Carey. "But it wasn’t normal insomnia and I wasn’t lying awake counting sheep. I was working and working and working … I was irritable and in constant fear of letting people down. It turns out that I was experiencing a form of mania. Eventually I would just hit a wall. I guess my depressive episodes were characterized by having very low energy. I would feel so lonely and sad — even guilty that I wasn’t doing what I needed to be doing for my career." Carey told People she's now focused on finding the right balance of treatment that works for her. "I’m actually taking medication that seems to be pretty good," she said. "It’s not making me feel too tired or sluggish or anything like that. Finding the proper balance is what is most important."

Mind

How to tell if a child is a future psychopath

We hear about psychopaths all the time – on the news, in movies, books and TV – and while we’ve been told <a href="/lifestyle/relationships/2017/09/scientists-reveal-6-signs-to-spot-a-psychopath/" target="_blank">how to identify one as an adult</a>, how many of us know when to spot one as a child? The <a href="https://www.psychiatry.org/psychiatrists/practice/dsm" target="_blank">Diagnostic and Statistical Manual of Mental Disorders</a> (DSM-5) rules that people under the age of 18 cannot be labelled “psychopaths”, but instead, according to a 2013 decision by the American Psychiatric Association, those between the ages of 12 and 18 can suffer a condition known as “conduct disorder with callous and unemotional traits”. And this condition is more prevalent than you might think. In 2001, a report published in the journal American Family Physician found that six to 16 per cent of boys and two to nine per cent of girls meet the criteria for conduct disorder, however only a fraction display the “callous and unemotional” traits that are seen as a predictor for adult psychopathy. Nikolas Cruz, the 19-year-old charged with 17 counts of murder after the recent Florida School Shooting, allegedly showed classic signs of the disorder as a child, including harming animals. “Psychopaths don’t just appear when they are 20,” psychology professor at the University of New Mexico and author of The Psychopath Whisperer, Kent Kiehl, told <a href="https://nypost.com/2018/03/07/how-to-tell-if-your-child-is-a-future-psychopath/" target="_blank">The New York Post</a>. “They are always different from an early age.” According to the Hare Psychology Checklist Youth Version (the “gold standard” for testing for psychopathy), characteristics to look out for in children include: <ul> <li>Lack of empathy</li> <li>Lack of guilt and regret</li> <li>Pathological lying</li> <li>Grandiose self-worth</li> <li>Failure to accept responsibility for antisocial behaviour (fighting, bullying)</li> </ul> “Individuals who score high on those traits are more likely to produce further violence,” Kiehl explained. “If they are sanctioned but continue on the same path, it’s not a perfect indicator, but it’s enough to cause concern.” There is no “cure” for psychopathy, however, early intervention from the ages of two or three can reduce their harmful potential.

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How this rare sleep disorder forced a woman into debt

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How to tell if a child is a future psychopath