5 tips for dating someone with a mental illness

  

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It’s February, so romance is on everyone’s minds. Love is such an important emotion. It can change lives in a way that nothing else can. We all need love, and that includes those of us with mental health issues. Here are some suggestions to help you if you are dating someone with a mental illness.

1. Ask appropriate questions.

You need to be reasonably respectful of your partner’s privacy, but don’t be afraid to ask questions. Preface them with, “You don’t have to answer this, but I’d like to know…” so that he doesn’t feel like he is being pressured. Focus on what pertains to you. “What do you want me to know about your condition and how it makes you feel?” “How can I be helpful?” “What are signs that your symptoms are worsening and what do you need when that happens?” It matters a lot when someone takes the time to find out how she can be supportive.

2. Give him space – or don’t.

At a time when your partner is doing reasonably well, talk about how much space she needs and when she needs it. Also talk about when he should not be alone. For instance, someone with PTSD might not want to be touched while experiencing flashbacks. Discuss those boundaries. Alternately, depressed people tend to shy away from others, but it isn’t always healthy. Asking in advance, is it okay to take initiative when these times come? If serious suicidal thoughts are an issue, make sure that your partner has someone to be around at all times. Support and space are equally important and it’s helpful to know when each is needed.

3. Focus on her strengths.

Mental illness can make you feel vulnerable, inferior – even useless. Some people feel like they aren’t contributing enough to the relationship or that they are being a burden. This is why it’s very important to make note of when he does something positive. Notice specific actions and comment on them. Things as simple as “Thank you for making me dinner,” “You look nice today,” and “I appreciate that you spent time with me today,” can boost self-confidence and foster positive emotions. A lot of people with mental illness need reassurance, so knowing they did something right can bring peace of mind.

4. Be accommodating and flexible.

Part of the challenge of mental illness is that it’s unpredictable. Sometimes there’s a reason that symptoms flare up, such as stress or failure, but other times random little things can set off an episode. Work with what you have at any given time. If you had a dinner and movie date planned, but your partner is too anxious to leave the house, order takeout and watch something on Netflix. If physical intimacy is difficult, go slowly and let him take the lead. If she has a hard time being around strangers, don’t drag her to big social events. 

5. Set your own boundaries.

Having a partner with a mental illness can be stressful. At times, you might find yourself in a caretaker role and it can be draining. This is why it’s important that you set boundaries. For instance, make sure you have enough time to take care of yourself. You might need to state that when he starts yelling at you, you will leave until he has calmed down. It might be helpful to make clear that there are some things she can’t blame on her illness (and what they are). It’s important to be understanding, but if you are struggling, you need to have the space to take a break and gather your strength. You can’t be as helpful if you aren’t doing well yourself.

Mental illness is hard on both partners, but it isn’t an impossible barrier to a happy relationship. While your partner might have some challenges, he also has gifts to offer. Living with a mental illness can make you empathetic, brave, considerate, grateful, persistent, thoughtful, strong and any other number of positive qualities. It encourages deep feelings and that includes love. In the end, both of you are just people. You have frustrating qualities as well. But love is beautiful in that it can make everything else disappear, if only for a moment at a time. Love is worth whatever it takes.

Check back on Tuesday to hear about dating from the other side.

What have you found helpful in dating someone with a mental illness? Tell us in the comments.

10 commonly used psychological assessments

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Sometimes, meeting with a client in therapy isn’t enough for a therapist to know what is going on. You are seeing someone out of her regular context, moved into a intrusive (though supportive) environment. You aren’t the same self in therapy as you are the rest of the time, so it can be good to get a closer look at traits and symptoms. If your therapist needs more insight into your situation, he might request that you take one or a series of assessments. Following are some of the most widely used ones.

1. Clinical interviews

Clinical interviews are a series of set questions that focus on any symptoms you may have, helping the clinician better assess if you have a diagnosable disorder. During the interview, you will be asked open-ended questions. The interviews generally last between 30 minutes and two hours. Sometimes, the clinician that is administering the test will assess 

attitudes, appearances and behaviors in order to 

supplement the verbal answers given.

2. Screening inventories 

A screening inventory is an assessment that is looking at client symptoms and distress. They can be used both to diagnose mental illnesses and to look at therapy progress and outcomes, depending on the test and context you are taking it in. For instance, the Outcome Questionnaire-45 (OQ-45) can be used before each session to check in on where the client is at. The Beck Depression Inventory (BDI) might be used to get a better handle on a client’s depression symptoms. The Symptom Checklist-90-R (SCL-90-R) might be used to look at a number of symptom clusters while conducting a psychological study. There are a wide variety of tests to suit many purposes.

3. Rorschach test

The Rorschach test (also known as the inkblot test) is perhaps the most famous psychological test of all time. It is a projective assessment wherein the subject is shown a series of symmetrical images created by ink on paper. The subject says what she sees in the images and the test administrator will write down everything, no matter how trivial it may seem. These statements are later interpreted in regards to personality, emotional functioning and to detect thought disorders. 

4. Thematic Apperception Test (TAT)

The TAT is another projective assessment. In this one, the subject is shown ambiguous images of people. The client will tell the proctor stories about the individuals the pictures, which can be interpreted in a multitude of ways. This test is considered a glimpse into the subconscious and the way people see the world. It has been used to study a variety of items, such as motives, concerns, personality and emotional stability. 

5. Rotter Incomplete Sentence Blank (RISB)

A third commonly used projective test is the RISB. In this assessment, the subject is given a list of 40 sentence stems, or incomplete sentences. These are deliberately vague and encompass such phrases as, “I need…,” “Other people…” and “My greatest fear…”. The subject simply completes the sentences however he wants. There is not much in terms of standardized scoring, but themes will emerge, such as a preoccupation with ones appearance or social anxiety. These can help the therapist better tailor treatment to areas of concern. 

                                                                                                                   6. Wechsler Adult Intelligence Scale (WAIS)

   

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The WAIS, currently in its fourth edition, is an intelligence test. It measures raw intelligence and gives you an IQ score. The average IQ is 100. It focuses on a variety of areas, including working memory, processing speed, arithmetic and vocabulary. It has questions ranging from picture completion to finding similarities between words. This test measures your aptitude, not how well you are actually doing in the areas tested.

7. Woodcock-Johnson Tests of Cognitive Abilities

The Woodcock-Johnson, in contrast to the WAIS, is made to measure cognitive performance. It shows how well you actually do in the areas of math, reading and writing. You may score higher or lower than your actual IQ would indicate; for this reason, it can be useful in identifying learning disorders. 

8. Minnesota Multiphasic Personality Inventory (MMPI)

The MMPI is the most commonly used psychological test. It is used to assess personality and psychopathology. Depending on the version of the test you take, you answer either 338 or 567 true or false questions about yourself. This is used to gauge your level of pathology in areas such as depression, hysteria and paranoia. Based on the areas you have the highest scores in, a portrait of your personality and psychological issues can be made. There is also an adolescent version of this assessment, the MMPI-A, which is 478 items long.

9. Millon Clinical Multiaxial Inventory (MCMI)

Used strictly to assess psychopathology, the MCMI does not tell you about personality in the same way the MMPI does. It has a clear focus on psychological symptoms, as it identifies personality disorders and clinical syndromes. It is, however, much shorter than the MMPI, only having 175 true or false questions that can generally be answered in 25-30 minutes. The adolescent version of this assessment is called the Millon Adolescent Clinical Inventory (MACI) and is 160 items long.

10. Child Behavior Checklist (CBCL)

This test is designed to be used with minors, starting as young as 18 months of age. A parent or caregiver takes the test and reports social, behavioral and emotional observations of the subject. There are also versions of the test that can be filled out by teachers or the youth themselves. The assessment asks how true certain statements are, such as “talks or walks in sleep” or “acts too young for his/her age.” Because parents and teachers have higher access to the youth than the therapist does, it can be helpful to get input from someone used to seeing the child in other settings. 

Have you taken any psychological assessments? Did you learn anything interesting about yourself? Talk about it in the comments. 

10 signs of mental illness you should never ignore

   

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There are a lot of symptoms of mental illness, more than anyone can list off the top of their heads. But some are more severe than others. Here are a few of the ones where you should immediately seek advice from a mental health professional. 

1. Hallucinations

Hallucinations are experiencing the presence of something that is actually not there. Visual and auditory hallucinations are the most well-known, but they can also be smells, tastes, tactile stimulation and more. Hallucinations are a symptom of several serious mental illnesses, so they should always be taken seriously. It is possible that there is a more benign explanation – it could be a lack of sleep or the side effect of a medication. But it can be difficult to judge what the  cause of a hallucination is,
                                                                                                                   meaning that a professional evaluation is called for.

2. Antisocial behavior

Antisocial behavior is not a reference to being introverted and liking alone time; rather, it’s deviating from the norms and laws of society. This often is expressed through aggressiveness, dishonesty, disregard for safety and criminal behavior. Antisocial actions can have long-lasting consequences for both the person performing them and for others, so it’s important to get it under control. When there’s a pattern of these types of behaviors, it’s important to seek help in order to prevent more permanent damage.

3. Identity confusion

There are times when people start questioning who they really are and what they want their lives to look like. Adolescence and mid-life crises are a couple examples. But if taken too far, this uncertainty is potentially dangerous. If someone suddenly abandons what was previously loved and don’t know what to replace them with, it could be a sign that something more serious is going on. At the extreme, there might be complete blank on who one is, which can be indicative of amnesia. It’s important to talk to a mental health professional to identify the cause of losing one’s sense of self.

4. Mania

Everyone gets worked up and excited sometimes, leading to increased activity in one’s life. But sometimes, it becomes out of control. If someone has persistent and abnormal elevated or irritable moods for over a week, it might be a manic episode. These episodes, a hallmark of bipolar disorder, might present with an inflated sense of self-esteem, a decreased need for sleep, racing thoughts, distractibility, being unusually productive or engaging in behaviors that will have serious negative consequences. Because of the lasting impact these episodes can have on one’s life, professional help is warranted.

5. Learning difficulties

It’s normal to struggle with learning sometimes. We are all better at some things than others. But when someone is, in at least one area, several grade levels below where one should be, it could be a learning disability. This doesn’t mean that someone’s stupid, but rather indicates a lack of the ability to learn in certain areas. Learning difficulties could also be indicative of a high level of distress, which needs to come down before one can resume regular patterns of learning. A sharp change in one’s ability, like suddenly being unable to perform tasks one could do before, should also be looked into.

6. Self-injury

Self-injury is indicative of severe distress. It often means that someone is in a lot of pain and is unable to cope with it in a healthy way. Self-injurious behaviors include cutting, burning, bruising, interfering with wound healing and intentionally sustaining injuries. While most of the time there is no intent to cause lasting damage, it might happen anyway. This is one reason why, when someone engages in self-injury, it’s important to intervene. Talking with a therapist can help in terms of finding healthier alternatives and in understanding what caused the behavior in the first place.

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7. Delusions

Delusions are beliefs that are unique to oneself and that contradict the generally accepted reality. Some examples include believing that one is under surveillance by the government without sufficient reason; thinking a song was written about oneself despite never even having met the artist; and insistence that a partner is cheating despite a complete lack of evidence. Something like believing in alien visitations or prevalent conspiracy theories are not delusions, as they are beliefs shared by lots of people. Delusions can seriously impact quality of life and might even lead to people making dangerous decisions, so talking to a professional is important.

8. Substance abuse

As discussed in an earlier post, substance abuse is highly correlated with mental illness. The two can feed off of each other, with substances being used to mask symptoms which in turn become worse due to the substances. While not all substance abuse is indicative of mental illness, it is a serious problem that should be addressed either way. It can also cause physical health problems or lead to acting impulsively in a risky way. There are lots of professionals that specialize in treating substance abuse, so find someone with experience.

9. Major shifts in personality/goals

People are generally pretty consistent in how they act and what they want. While some variations are normal, like deciding to end a relationship or to take up a new hobby, there are times when changes can be a cause for alarm. These changes are more notable when they occur rapidly. A consistently cheery person might abruptly become frequently cynical or someone may suddenly drop out of school despite indications that things were going well. It is important to take a good look at what caused these types of change, as they can be a sign of distress or mental illness. 

10. Suicidal thoughts

Thoughts of suicide should always be addressed. The risks that come with brushing it off or not seeking help are not worth it. Suicides have permanent impacts on both those who commit them and their loved ones. It’s not a decision that happens and stays in a vacuum. Surviving a suicide attempt can also lead to lasting health problems. If you feel like ending your life or suspect someone else might, talk to a professional. The earlier one gets help, the easier treatment will likely be. To learn about what suicidal people talk about, read this. I have also put together a list of hotlines, which can be found here. 

What symptoms made you seek help? Have you seen these signs in a loved one and encouraged him or her to get help? Let us know in the comments.

7 signs you need a new therapist

Not every therapist is a good match for every client. This means that sometimes, finding someone else is the best thing to do to progress in your recovery. There are, of course, reasons to stay with the one you have. By working through your differences, you develop a stronger bond and learn how to manage relationships outside the therapy room. But if any of the following points are a problem, then it might be time to find someone new.

1. You are not being respected.

One of the great tasks in life is learning to get along and grow with those who are different than us. The variety of people in the world should be celebrated, as it allows humanity to reach its highest potential. But these differences can also be a source of prejudice and unkind behavior. If your therapist is devaluing your experiences, not honoring your belief system, asking you to change culturally appropriate behavior or making you feel inferior in any way, it’s time to switch therapists.

2. You can’t establish trust.

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Sometimes, we just don’t trust people. Maybe they remind us of someone that hurt us in the past or appear similar to a stereotype we have problems with. If this is the case, the first thing you should do is talk to your therapist about it. Working through that mistrust can be huge in terms of personal growth. But if you’ve tried your best and just can’t make yourself trust her, find someone that makes you feel more secure.

3. Your therapist is crossing boundaries.

Your therapist should be your therapist and nothing else. He is not a potential business partner. She is not someone you’ll hang out with at social events. He is not the friend you call at 3:00 a.m. Most importantly, she is not a romantic or sexual partner. If your relationship with your therapist is expanding into these areas, that needs to stop immediately. It’s highly unethical and could even have legal implications for your therapist. If he can’t stick to his job, find someone who can. 

4. Your therapist doesn’t respect your time.

When you go into a session, that is your hour. Your therapist should not be focusing her attention on anything but you. He should not, for example, answer calls when with you. She should also be more or less on time and not frequently canceling sessions. Be understanding that occasionally, something major might be going on. But if you see a pattern of these behaviors, you might want to look into finding someone else.

5. Your therapist breaks confidentiality.

Your therapist has to keep all information about you private. He can’t give your information to anyone, even another therapist or healthcare provider, without your permission in written form. If someone asks, she can’t even acknowledge whether or not she’s seeing you for therapy. The only exceptions are related to major safety concerns and rare legal orders, which can be read about here. But if your therapist is, for instance, chatting with your significant other about your progress without your express permission, that’s an ethical violation and a legitimate reason to dump the therapist. 

6. Your personalities clash. 

We all have certain types of people we just don’t get along with. If your therapist has a personality that is particularly irritating or difficult for you, don’t give up right away. You can become a more open and accepting person by working through those issues with your therapist. If it doesn’t work, though, it doesn’t work. On the other hand, sometimes self-improvement is secondary to an immediate concern, in which case, find someone you get along with.

7. Nothing is happening.

Progress in therapy is not as simple as a line gradually moving upwards. You’ll be all over the place. Sometimes, you’ll have a huge change for the better, while other times you’ll take a few steps back. There is some truth to the “getting worse before it gets better” concept, so don’t jump ship just because you become a bit more symptomatic. It’s part of the healing process. But if everything just stays the same, then something’s wrong and you could be better off working with someone else. 

Have you ever switched therapists? Why did you do so and how did it go? Report your experiences in the comments.

5 things suicidal people talk about

    

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Being suicidal can come with a wide range of symptoms and behaviors. It will manifest in as many different ways as there are people. But there are commonalities that tend to appear. One of those is what they talk about. If the following topics come up, you may want to pry further to check on the wellbeing of the person in question.

1. Wanting to die

The idea that suicidal people don’t talk about suicide is definitely a myth. They frequently give indications of their desire to die, sometimes even flat out saying that they want to commit suicide. Saying it does not mean that they won’t do it. Sometimes it’s more indirect, with statements like, “I wish I’d just get hit by a bus.” If someone says anything at all that indicates a desire to be dead, it should be pried
                                                                                                                    into.

2. Feeling stuck, hopeless and having no reason to live

Suicide sometimes happens because there seem to be no other options. Talking about hopelessness or entrapment can therefore be a warning that the person is headed in that direction. There are always options. We may not like them, but they are there. When suicidal, though, those options can seem to disappear. This topic is an indicator that should be taken seriously.

3. Being a burden

Being suicidal can make one feel like a waste of space. Suicidal individuals might feel like they are simply a problem in the lives of others. They might think that others would be better off without them. This can be especially true when illness is present that requires assistance. If the person can’t contribute in the same way others are contributing, it can set off thoughts about the lives of loved ones being better without him or her.

4. Suddenly making big improvements

Sometimes, suicide is preceded by a significant increase in mood. The person might be a lot happier and more positive. This can come from feeling at peace with the decision to actually end ones life. Talking about how something “won’t be a problem any longer” or “doesn’t matter anymore” can stem from the decision to not be around at all. The more rapid and extreme the change is, the more you should ask questions to see what’s really going on.

5. Saying goodbye

It is normal to want a sense of closure. That’s why suicidal people sometimes go around and say goodbye to or make amends with others. It might be in an indirect way, such as, “I value our friendship and would miss it if we were away from each other,” or, “If anything happens to me, I want you to know…” The hypotheticals might not be so hypothetical after all, so it’s important to look out for these statements.

In combination with other warning signs, especially, it is important to take action. Always make sure that the person you care about has resources. There are suicide hotlines, doctors, therapists and community mental health organizations. If you aren’t sure of what to do, you can reach out to these resources as well and ask for appropriate advice. If you believe suicide is imminent or there is an actual attempt, call 911 or take the person to the emergency room. It may cause some upset in the short term, but having an angry loved one is better than having a dead one.

Have you talked to someone and worried about suicidality? How did you know that you needed to reach out?

7 signs of abuse in children

Child abuse is one of the greater evils in society. It can be incredibly damaging to children and affect them for the rest of their lives. This is why it’s so important to catch abuse as often or early as possible. Here are some signs to look out for. (This list is by no means comprehensive.) 

1. Problems regulating emotions

It’s hard for abused children to safely express emotions, so they might have outbursts of strong feelings. This can manifest in their behavior as well. When the child does something somewhat explosive, try to find out what feelings were behind it. This trouble regulating emotions can continue into adulthood.

 

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2. Excessive fear of doing something wrong

When a child has a strong fear of doing something wrong, it might be because she is used to being punished for her mistakes and shortcomings. Even trivial decisions might be difficult due to fear of making the wrong choice. This fear might also manifest as being withdrawn or anxious. It might be a fear related to a certain type of choices or a generalized fear.

3. Unexplained physical injuries

Look for bruises, cuts and other injuries. If the child has no explanation – or provides an unconvincing one – monitor it. If there is abuse in the home, it may be continuous, leading the child to have frequent injuries. Accident proneness is one thing, but that will have more credible explanations (though it might still indicate neglect). 

4. Extremes in behavior

Another sign of abuse in children is that they are very extreme in their behaviors. This can go either way. They might be very rigid or they might be disorganized. They can be excessively obedient or completely rebellious. If a child is “too much” of anything and completely lacks the ability to navigate a middle ground, it’s a bad sign.

5. Age-inappropriate sexual knowledge

If a child seems to know a lot more about sex than he should, it might be a sign of sexual abuse. This can manifest both verbally and in behaviors. They might have a lack of appropriate physical boundaries with others or even be overtly seductive. This can, however, also swing to the other extreme, where the child is wary of touch in general.

6. Avoiding someone specific

A child may be trying to escape abuse by avoiding the abuser as much as she can. If there is no obvious reason for the child to avoid this person, it’s worth looking into. This is more than just going to his room because he doesn’t feel like being around someone. The child might hide when the person is nearby or even run away from home.

7. Regressing to earlier behaviors

An abused child might use coping skills from a younger age. This might include wetting the bed, fear of the dark, thumb-sucking, needing a comfort object and clinginess. It can even extend to the child being less skilled in language usage, talking like someone who is younger. It is especially worrying if the child has quit the behavior before, but is returning to it.

If you suspect that a child is being abused, you need to contact someone. A good starting point is a child abuse hotline. In the U.S., the national number is 1-800-4-A-CHILD (1-800-422-4453). If you live elsewhere, search online for a number or contact local authorities. It is better to be safe than sorry when it comes to children who might continue to be hurt if you don't seek help.

Do you feel like you could notice if a child is being abused? Talk about what helps identify these children in the comments.

Mental health myths: children and mental illness

I am taking some time to discuss issues related to childhood and adolescent mental health. Let’s start with a very basic mental health myth.

Myth: Children cannot develop mental illnesses.

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Fact: A significant number of children and teens struggle with mental health issues. 

Sadly, being a minor does not eliminate the possibility of having mental health issues. According to the National Institute of Mental Health, 13 percent of kids and teens between the ages of 8 and 15 struggle with a severe mental health condition. For teens between 13 and 18, that number increases to 20 percent. And those are just severe conditions – there are even more that are struggling with mild and moderate mental health issues.

There are dozens of diagnoses that are considered childhood disorders. These include learning disorders, but also conditions related to development, attachment, behavior, and more. In addition, mental illnesses that adults get can have separate diagnostic criteria for childhood versions of the same condition.

By some estimates, there are more children suffering from mental illnesses than physical ones in North America. These conditions can be devastating not only to children, but to entire families. When one family member struggles with mental illness, it affects the whole family. The family dynamic is disrupted and other family members can experience stress, anger, guilt, shame or denial. It is therefore important for everyone’s needs to be considered, not just those of the one struggling with mental health issues.

By being young, kids and teens won't always have the perspective of knowing what is and isn't normal in terms of their psychological health. We assume that others are like us, so until someone points out that, no, most people don't have to wash their hands repetitively, they might think it's the standard. Some children have never really had a chance to not struggle with mental health, so they don’t know that there is something wrong. That’s why it’s so important for adults to look for signs of mental illness in children.

Some symptoms to watch out for in children and teens include:

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• Being unable to cope with everyday problems.

• Not doing well at school (especially if the child is really trying).

• Difficulty concentrating.

• Loss of interest in activities and friends.

• Persistent negative moods.

• Sleep problems, including disrupted sleep, nightmares and sleepwalking.

• Frequent physical symptoms, such as headaches and stomachaches.

• Changes in eating habits.

• Unwarranted amounts of worry and anxiety.

• Regressing to behaviors of a younger age, such as becoming clingy or bedwetting.

• Risk-taking behavior.

• Repeated anger outbursts.

• Frequent disobedience and aggressive behavior.

• Self-injury.
• Substance abuse.

• Unusual amounts of time spent alone.

• Disproportionately intense feelings.

• Seeing or hearing things that aren’t there.

Take these symptoms seriously. On Saturday, there will be a post detailing how to get help when children and teens experience mental health concerns.

Do you have an experience with childhood or adolescent mental illness that you’d like to share? Please post in the comments.

Diagnosis spotlight: posttraumatic stress disorder

Life isn’t always kind. No one is immune to twisting an ankle or feeling heartbreak. The difficult aspects of life are just normal a part of the experience. Trauma, on the other hand, is something damaging that is outside the realm of normal human experiences. It’s not something that is expected and it can be very difficult to cope with. War, sexual assault, major natural disasters and life-threatening accidents are all examples of this.

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Traumatic events can leave anyone shaken for a while, but when symptoms won’t go away, it can become an illness. When the aftereffects of the trauma seriously interfere with major areas of your life for an extended time, it might be post traumatic stress disorder (PTSD). According to the guidelines in DSM-5 (a volume used for mental health diagnosis), this is a psychiatric condition that is the result of “exposure to actual or threatened death, serious injury, or sexual violence.” It can be a result of something that you experienced, witnessed or (in a few cases) heard about. Symptoms have to occur in each of four different areas: reexperiencing, avoidance, cognition/mood alteration and hyperarousal.

Reexperiencing is exactly that: experiencing the trauma over and over again. This can happen in lots of different ways. You might have intrusive memories, nightmares, flashbacks or negative reactions to things that remind you of the event. On the extreme end of the spectrum, you may actually think the trauma is happening right then and there.

Another reaction is to avoid anything that is associated with the event. It could be trying to stay away from external reminders or you might avoid your own thoughts and feelings. If someone was in a serious car accident, he might drive different routes – even when longer – in order to not pass the scene of the accident. An assault victim might go to extreme lengths to distract herself from the memory and associated feelings. It can also include avoiding seemingly benign things, such as teddy bears, frying pans or the rain, if they are somehow reminders of the trauma.

  

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There must also be changes in thoughts and/or feelings as a result of the trauma. It could be being plagued by negative feelings (fear, anger, guilt, etc.) while being unable to experience positive emotions (happiness, calm, love, etc.). Others might be unable to remember an important part of the trauma. Distorted thoughts, such as “it’s my fault that I got mugged” or “nowhere is safe,” can also occur. Feeling detached from others and having a decreased interest in significant activities are also signs.

Hyperarousal refers to having very strong negative reactions to your environment. You can’t feel safe, so you respond as if you are always in danger. An increased startle response or hypervigilance (intense and unwarranted efforts to detect threats) are common reactions. Problems sleeping or concentrating are also potential disruptions. You might also become irritable or angry without being seriously provoked. It can even go as far as engaging in self-destructive behavior. 

Psychotherapy is the most common treatment for PTSD. This can take many forms. Sometimes desensitization to the experience through repeated exposure can reduce symptoms. Other times, processing the event and what it means is called for. Medication might help with individual symptoms, but are not meant to treat the condition as a whole. There are also treatment techniques such as hypnotherapy and what is called EMDR (eye movement desensitization and reprocessing). Talk to your clinician about your treatment options because there might be more than you think. 

PTSD is a normal reaction to an abnormal event. It can seriously interfere with all aspects of living, so it’s very important to seek a professional opinion and subsequent treatment if you are experiencing several of the symptoms described. Recovery might seem unthinkable in the midst of the disorder, but it is possible to overcome extremely difficult parts of your life. It might take a long time, but remember that it can be done and working on it is better than allowing it to take over your life. 

Diagnosis spotlight: seasonal affective disorder

Our environment has a strong influence on our mental health. In fact, an entire disorder is dependent on the time of year: seasonal affective disorder (SAD). Often referred to as the "winter blues," this disorder typically follows an increased depression that begins in the fall and increases as the winter moves on. In some cases, however, the disorder starts up in the spring and peaks in the summer.

Symptoms vary between winter and summer SAD. According to the Mayo Clinic, symptoms of fall and winter SAD include depression, hopelessness, anxiety, loss of energy, a heavy or "leaden" feeling in arms or legs, social withdrawal, oversleeping, loss of interest in activities you once enjoyed, appetite changes (especially a craving for carbohydrates), weight gain and difficulty concentrating. Spring and summer SAD, on the other hand, is demonstrated through anxiety, trouble sleeping, irritability, agitation, weight loss, poor appetite and an increased sex drive.

It's easier to dismiss a problem if it goes away on its own. It can take a long time for someone to be motivated to get help and since SAD dissipates after a few months, some people will never seek treatment. The problem is that this is a cyclical disorder that returns year after year, meaning that it isn't actually going away. 

SAD, though dependent on the seasons, is not any less severe than other forms of depression. It should be taken just as seriously as "regular" depression. This means actively seeking treatment is just as important. The most commonly used treatments are light therapy, medications and psychotherapy.

Light therapy (also known as phototherapy) involves sitting in front of a box that emits specific wavelengths of light. This treatment is based on the idea that a lack of sunlight is partially to blame for the illness, a theory that is supported by increased rates of winter SAD in the north. This is the least invasive treatment and a good first step. Make sure you buy a quality box and consult with your doctor. How long you expose yourself to the light and what time of day you do so is important and should be determined by a professional.

SSRI antidepressants are also used to treat SAD, especially in more severe cases. It can take several weeks for the medication to work, so if you know you know have a yearly problem with SAD, you might want to start a regimen before winter (or summer) hits. Make sure to not go off the medication before your doctor recommends it, even if you feel better. 

Psychotherapy can also be effective in treating SAD. While you can't control the coming and going of the sun, you can control other factors that might be influencing the SAD. A therapist can offer suggestions for managing and reducing your symptom. A therapist can also possibly get at other underlying causes of and contributions to the depression, seeing as it is rarely only one thing that is the root of the problem. 

It's unnecessary to suffer from seasonal depression year after year. If you or someone you know struggles at a particular time of year, don't dismiss it. The temporary nature of the disorder does not reduce its seriousness. Schedule an appointment with a doctor or therapist to further explore what your options are in treating SAD.

Do you get more symptomatic at certain times of the year? What has helped you? Share your thoughts in the comments.

When it's time

One of the necessary limitations of being a living creature is that one only has access to one own's experiences and perspectives. (Perhaps this is why so many find the idea of reincarnation appealing.) The problem with this is that, by default, people tend to start out with the assumption that others are like them before gradually working out the differences.

Photo courtesy of @norwigger on Instagram.

A consequence of this phenomenon is that it's hard to tell whether something is normal or abnormal, or, rather, common or uncommon. A nurse can ask two different patients to rate their pain level on a scale from one to ten and get the same answer from someone with a dislocated shoulder and a mother in labor. Objectivity is elusive.

Just like one has to evaluate whether a cut is infected enough to seek medical attention, there is a necessity to evaluate when professional help might be needed in terms of mental health issues. The difference is that the scabs and infections are visible and documented, giving a guide as to when something becomes diseased.

• When does a fear become a phobia?
• When does sadness become depression?
• When does quirkiness become psychopathology?

There is no easy cutoff point and certainly not a universal one. But within the field of mental health, there is a standard that professionals use when evaluating and making diagnoses. To qualify as having a certain condition, one of the criteria is almost always the following:

The symptoms cause clinically significant distress or impairment is social, occupational, or other important areas of functioning.

Basically, if it's interfering with the ability to act within or experience a major aspect of normal life, it probably demands attention. As an analogy, a twisted ankle from a misstep will likely go away on its own within a few days. It's an inconvenience. Breaking a leg, on the other hand, can seriously affect someone's ability to go through their basic routines. In some fields, it eliminates the capacity to perform one's work altogether.

In mental health, the examples might look somewhere along this line:

• A broken-hearted man secludes himself and won't see his friends at all for months after his girlfriend breaks up with him.
• A student regularly cannot complete a quiz in the given time because her mind is highly distracted.
• A grieving widow experiences a complete and continuing lack of appetite for a full year after the unexpected loss of her husband.
• A worker loses his job because he becomes obsessively focused on certain trivial aspects of his duties instead of tackling what he is supposed to be doing.
• A teenager’s life becomes erratic because she comes to in a strange situation with no recollection of how she got there or why, especially if substance use was not involved.

While the amount of significant distress or impairment is a very important marker, it is also important to consider environmental factors. Hating one's job and thereby performing poorly is not necessarily an indication of a psychological disturbance. If one made a career change that would normally be exciting and invigorating, but then still retains the same negative feelings, it might be worth looking at oneself.

If there is still uncertainty after considering this guideline, many mental health practitioners offer a free initial consultation either by phone or in person. While they want clients and will generally be able to claim to help, take care to ask about what she thinks she had to offer. If it seems valuable, it might be worth trying treatment. It's also perfectly okay to consult with more than one practitioner and see which one is the best fit.

It’s often hard to seek help when at this point, so look out for this disturbance in the lives of loved ones. A sudden, huge personality/habit change or a continuing impairment should at least cause consideration for professional help.

If you are/have been in treatment or have helped someone else get it, how did you know it was time to take that step?