Conversion disorder is a situation where psychological stress (e.g. depression) is manifested in a physical way. Conversion disorder frequently develops after an intensely stressful event. The physical features of Conversion disorder may have no underlying cause and one has not control over the symptoms. In most cases, conversion disorder will present with an inability walk or use the arms, have difficulty hearing or seeing or one may not be able to speak. There are also rare instances where the individual may develop hallucinations, seizures, be unable to urinate or may have no sensation of pain. The symptoms can be very dramatic and acute, but in most individuals there is rapid clinical improvement in a matter of days or a few weeks
What causes conversion disorder?
The exact cause of conversion disorder is unknown but it is believed that the area of brain responsible for muscle control somehow is now controlled by emotions. It is believed that this is one way in which the brain reacts to an apparent menace.
What are risk factors for conversion disorder?
Female gender especially 20-30 years of age
Recent emotional trauma or stress
Already having a diagnosis of generalized anxiety, major depression or having a certain personality (hysterical)
Having a close family member with conversion disorder
History of physical or sexual trauma
What is the outlook for people with conversion disorder?
In the majority of individuals with a diagnosis of conversion syndrome, the outlook is good. With reassurance and supportive treatment most will improve. About ¼ of individuals may develop recurrent symptoms, chiefly because they fail to seek treatment or remain non compliant. In cases of recurrent symptoms, it is important to be aware that there may be an underlying brain disorder, which is giving rise to the seizures or tremors. There are reports that some patients who have a neurological disorder can also develop a conversion disorder.
The diagnosis of sexual aversion disorder is only made if the individual mentions the problem to the healthcare worker. Most people are too shy or embarrassed to mention the problem and often the diagnosis remains delayed. Even when the patient mentions the problem to the primary doctor or gynecologist, very rarely is the patient referred to a mental health professional for a formal work up. Whenever a diagnosis of sexual aversion disorder is suspected, a physical cause should always be ruled out first. Some common causes that may mimic sexual aversion disorder include a physical deformity of the genitals, presence of certain sexually transmitted infections or simply a lack of personal hygiene (which is probably one of the most common causes of sexual aversion disorder).
In order to make the diagnosis of sexual aversion disorder, not only does the individual avoid all genital contact with the partner but must also have intense repulsive feelings when such contact is made. In addition, these feelings are disruptive and affect the individual’s lifestyle. Often sexual aversion disorder is mistaken for hypoactive sexual disorder. In this disorder, the affected individual does not have repulsive feelings but simply a lack of desire for sex with all partner(s). These individuals have no interest in any type of sexual activity such as foreplay, kissing, cuddling or caressing. On the other hand, an individual with sexual aversion disorder, may have normal sexual fantasies or sexual activities with other partners, but not with one specific partner. Further, these individuals do enjoy being caressed, cuddled and do indulge in other affectionate activities but not genital contact.
Sexual aversion disorder is usually treated with some type of psychotherapy. The person and the partner may benefit from some type of family or marriage counseling. The treatment is long term and relapses are common. The therapy involves resolving any interpersonal conflicts. When there is infidelity involved, most partners have a great deal of animosity and are often unforgiving. Separation and divorce are often the end result in such cases. Any associated symptoms like panic attacks or anxiety are treated with low doses of medications. Even though psychotherapy does help resolve the issue in some people, in some cases, the treatment does not work. Individuals with long standing sexual aversion disorder combined with other mental health disorders are often difficult to treat and rarely comply with therapy.
When the diagnosis of sexual aversion disorder is missed or delayed, it usually results in a tumultuous relationship with ongoing unhappiness and eventually, divorce.
Sexual aversion disorder occurs in both males and females. It usually peaks in the 3-4 decade of life and is slightly more common in females. The condition may be temporary but in some cases, it may be permanent. In people who have had sexual trauma in the past, the sexual aversion may be life long. Women and men who cheat commonly develop sexual aversion to their husband or wife, but fortunately this is not permanent. Sexual aversion is caused by both physical and psychological conditions.
The exact number of people with sexual aversion disorder is not known but it is not miniscule. Too few people seek therapy for fear of ridicule or embarrassment. Not many people come to the therapist bragging that they have cheated on their spouse and have now developed an aversion to the partner. Common psychological causes of sexual aversion disorder include past traumatic experiences (both sexual and non-sexual) and interpersonal conflicts.
Common interpersonal causes of sexual aversion are discovering that the partner has been unfaithful, domestic violence, lack of personal hygiene of the partner, and disagreements on finances and management of children.
Common traumatic causes of sexual aversion range from rape, sexual molestation, or even painful intercourse. In some religions and cultures, sexual aversion disorder may be caused by teachings/fear that generate excess guilt with sexual activity.
When a person develops sexual aversion, it is not like having low interest in sex but a very strong dislike of the sexual activity. There is disgust or absolute revulsion at the thought of having sex with that person. These feelings do not arise during hugging but may appear during kissing or some type of genital activity. The aversion may even come on at the sight of the partner’s genitals or the smell of his/her naked body. It is a feeling of intense disgust and the affected individual wants the sexual activity to cease immediately. With milder forms of sexual aversion disorder, the person may only develop revulsion at sexual activity and not to kissing.
Besides sexual revulsion, the sexual activity may even bring on panic or severe anxiety. This may present with a fast heart rate (palpitations), excess sweating, fear or dizziness. Because these symptoms are very unpleasant, the person with sexual aversion syndrome may then avoid any further sexual activity. He/she may either go to bed early, come on late at night or will make up any reason to avoid spending time with the partner. Most people will make themselves less sexually desirable and hope that the partner will give up on sex.
I have been unfaithful to my husband and even though I love him I am repulsed when he tries to have sex with me. Do you think I have an under active sex disorder?
No, I think you may have what is known as sexual aversion disorder. In this disorder one may develop revulsion or have lack of desire when it comes to having consensual sex with a partner. It may not occur with hugging or affection but may occur when there is some type of genital or oral contact (eg kissing).
There are many reasons why someone develops a sexual aversion disorder and not all of them are related to negative sexual experiences. For example a female who has just given birth or is about to enter menopause may not feel like having sex. Many people who have undergone major surgery or those who have lost a loved one may also have no desire for sex. Some women do not like to have sex either a few days before or after their menstruation. Other very common reasons for sexual aversion including loss of job, death in family, divorce or loss of finances. Most of these cases are temporary and considered to be normal causes of sexual aversion.
On the other hand, decrease in sexual activity, but not aversion, may occur if you move to another city or have a major career change, and there is loss of privacy (especially if you have moved in with your parents or in laws). Stress, fatigue and depression are other causes of low sexual activity and not strictly classified as causes of aversion.
Once the diagnosis of trichotillomania is made, treatment is recommended. It is rare for the disorder to spontaneously subside. Only the mild short-lived cases are treated with observation. Most individuals with recurrent episodes of trichotillomania need treatment otherwise the quality of life is poor. The first thing to understand is that there is no cure for hair pulling. The treatment is primarily some type of psychotherapy and in rare cases, use of medications.
Psychotherapy is used to help the individual recognize situations when one is likely to pull the hair and substitute this behavior with another positive behavior. Cognitive behavior therapy can help the individual challenge any distorted belief why one pulls the hair. Psychotherapy for hair pulling is not a one shot deal and requires ongoing sessions for months or even years. To prevent relapse, an ongoing relationship with a mental health counsellor is necessary. The results of psychotherapy for trichotillomania are better than use of medications but unfortunately do not help everyone. Anecdotal reports indicate that about 50% benefit. Those patients with no other comorbidity are helped the most. Individuals who have other mental health disorders like anxiety, panic disorder, severe personality disorders and depression often do not respond well to psychotherapy. Compliance with therapy is vital for success.
For acute relief of impulsive symptoms, the use of SSRIs is common. There are a number of SSRIs but no one drug is superior to another. Only a few reports exist on long-term benefits of SSRI in people who pull hair. The SSRIs do work and relieve the urge to pull hair, but the effectiveness of these drugs is not seen in all patients. In addition, most SSRI have adverse effects, which are often not well tolerated. The medications do not cure trichotillomania but decrease the impulsiveness and reduce risk of irrational behavior. At the moment there is no medication that has been approved for use in the treatment of hair pulling. The medication prescribed usually depends on your healthcare provider’s experience. In some cases, the newer generation antipsychotics like olanzapine may be used to regulate the mood and behavior.
Overall, patients do benefit from psychotherapy and it is highly recommended that patients be referred early to a mental health counselor for treatment.
Trichotillomania is defined as an irresistible and recurrent urge to pull one’s own hair, often resulting in obvious hair loss. In most cases, the hair is pulled off from the scalp and/or face. On the face, the hair may be pulled from the eyelashes and eyebrows. However, trichotillomania may also involve other parts of the body like the pubis, legs, chest and arms. The hair may be pulled with the fingers, pins, clamps, tweezers or any other mechanical device available. While in most cases, patchy areas of hair loss is common, sometimes there may be more permanent damage to the skin, with no more hair growth.
In many cases, episodes of trichotillomania are evoked by some type of intense emotional stress that is followed by impulsive behavior resulting in pulling of hair. The urge to pull hair may be experienced while talking on the phone, watching TV or driving a car. The hair pulling is often followed by sensation of relief. While in most cases trichotillomania occurs in response to a stressful situation, the individual may also pull hair during peaceful or calm periods. The hair pulling is often very impulsive and the individual is unaware of what he/she is doing. At least 10% of individuals, who pull their hair, also eat it. This can result in hairballs or bezoars (tangled masses of hair with food), which if large can lead to intestinal obstruction. Surgery is often required to treat this complication.
Trichotillomania is not a new disorder; it has been recognized for over a century. Even though it is a mental health disorder, individuals with trichotillomania continue to be referred to dermatologists rather than psychiatrists.
Even though the disorder has been known for a long time, its cause remains a mystery; moreover, the treatment of trichotillomania is not very satisfactory. It is believed that the disorder occurs to a variable degree in at least 1 percent of the population. Women, especially in the 2nd and 3rd decade of life, are at a much higher risk than any other subgroup of individuals. This gender difference may be due the fact the women are more likely to visit a healthcare provider compared to men.
Most of us speak fast, never take time to select our words and rarely listen to what others are saying. Now fascinating research shows that in fact the words we choose can nurture our brain and help us communicate much better. The latest work by Dr. Andrew Newberg and Mark Waldman suggest that even the use of a single word may have the power to influence the neural function of the brain. Humans have one gift that most animal species lack, the ability to communicate and yet we have not proven very effective at communicating with others. The right words are necessary for full development of our interpersonal and interprofessional skills.
While it is well known that language is important for our lives, the choice of words is critical. In many cases, human use words that have no meaning or lack any intention. In addition, when words are spoken at the wrong speed or wrong tone, they impart an ineffective means of communication and may impart a different meaning. To aid people into developing better speakers with good communication skills, Newberg has developed a strategy called “compassionate communication.” Research shows that using the twelve steps developed by Newberg helps one build trust, resolve conflicts, stabilize friendship bonds and regain any lost affection. Newberg and Waldman have shown that both verbal and nonverbal language is vital for effective communication and the choice of words affect the speaker’s brain. This means of communication through selection of appropriate words can be learnt and be applied to many professional and interpersonal scenarios. For the healthcare professional, improved communication can create stronger relationships with their patients and has long-term positive effects.
Everyone has dreams but no one really understands the significance of dreams. Do they contribute to the well being of the brain? Are they a form of nutrition for the nerves? Many people can recall their dreams in detail years later, and claim that they came true. Unfortunately it is hard to verify such claims. However, on a personal level, dreams may have a certain significance for the individual. Many people have experienced pious dreams where they have been asked to forgive a person or forget a traumatic event. After following up on the dream, these individuals have gone on to live much fuller lives, with happiness and content. Others who went on to forgive suddenly found that their blood pressure was better controlled, their pain disappeared and they were now living a life that was more fulfilled. Countless such anecdotes exist.
There are also many reports about people having recurrent dreams telling them that they have do perform a certain act or help someone in life. To many people dreams may sound foolish but in these individuals, there is no satisfaction or happiness, until they have followed up on the dream.
There is some evidence indicating that dreams can help some people cope with the daily stressors in life and may modulate mood. Dreams are like an internal psychotherapist promoting positive thoughts and emotions that help reduce stress and induce happiness.
Dreams occur during sleep and there is no doubt that we cannot function without adequate sleep. Animals deprived of sleep have been shown to have fewer neurons in certain parts of the brain.
In humans, encouraging adequate sleep and dreaming have been shown to reduce symptoms of depression. Studies show that people who are able to recall their dreams in general have better moods than people unable to do so. Plus, individuals able to recall their dreams are far more likely to have lower intensity of depression.
While most claims on dreams have not been validated, it certainly does appear that dreams play a role in our social behavior and mood. For those people who would like to use dreams as a therapeutic process, it is essential to get adequate sleep. Dreams certainly do not have adverse affects nor do they have a monetary value. But they can certainly have a powerful effect on daytime social interaction. The problem is no one can control or predict when the dream will start during sleep.
Wearing earplugs is said to benefit people who hear voices. Some evidence indicates that ear plugs can decrease voice activity by nearly 50% in some people. One needs to determine blocking of which ear is most effective. By leaving the other ear unplugged, the person is able to continue with daily living activities such as being able to hear what others are saying or hear the phone ringing. Unfortunately, the benefit from earplugs is not sustained and most people find that the voices do come back. Others find that wearing earplugs is cumbersome and uncomfortable. However, for people who tend to hear voices at night, earplugs may work the best.
Concentrating on items of things other than voices is another way to obscure these auditory hallucinations. The person can focus on any item of choice as long as it is enjoyable and non stressful. One may indulge in a game of monopoly, scrabble or even chess.
Participating in some type of craft activities such as computer games has also been suggested as means to cope with voices. Others may benefit from undertaking simple household tasks such as cleaning, washing or gardening to help cope with the voices. While doing these chores, one may listen to a relaxation tape, which distracts the auditory stimulation. If the voices are common during the night, playing soft relaxing music may help. To ease the daily stress, others recommend some type of exercise, aromatherapy or even massage
There is no one coping method for everyone and different strategies may be required on different occasions. The individual should have a menu of the different coping methods and use them when needed.
There is no doubt that people who experience voices and psychosis are under a lot of stress. However a significant number of these people may also be helped by some type of simple psychological intervention that can be used at any time in any circumstance.
Finally, it is important for the person to have some type of support from family and/or friends. While self coping mechanism do help, at times, it is important for the person to remain connected because love and friendship can make a big difference at times of crises. Isolation only compounds the symptoms of schizophrenia.