Thursday, December 30, 2010

What is PMDD? Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of Premenstrual syndrome (PMS), afflicting 3% to 8% of women. It is a diagnosis associated with the luteal phase of the menstrual cycle.


PMDD is premenstrual syndrome (PMS) that is so severe it can be debilitating due to either physical, mental or emotional symptoms.

The hallmark feature of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is the predictable, cyclic nature of symptoms or distinct on/offness that begins in the late luteal phase of the menstrual cycle and remits shortly after the onset of menstruation. PMDD is distinguished from PMS by the severity of symptoms, predominance of mood symptoms, and role dysfunction, particularly in personal relationships and marital/family domains.

Treatment is recommended because PMDD interferes with the sufferer's ability to function in her social or occupational life. The cardinal symptom—surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding—is irritability. Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include:

feelings of deep sadness or despair, possible suicide ideation
feelings of tension or anxiety
increased sensitivity to rejection or criticism
panic attacks
mood swings, crying
lasting irritability or anger, increased interpersonal conflicts. Typically sufferers are unaware of the impact they have on those close to them
apathy or disinterest in daily activities and relationships
difficulty concentrating
food cravings or binge eating
insomnia or hypersomnia; sleeping more than usual, or (in a smaller group of sufferers) being unable to sleep
feeling overwhelmed or "out of control"
increase or decrease in sex drive
increased need for emotional closeness
physical symptoms: bloating, heart palpitations, breast tenderness, headaches, joint or muscle pain, swollen face and nose

Other symptoms that are common and more specific to PMDD include: physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain.
an altered view of one's body - a sensation of 'bloating', feeling fat or actual weight gain.

Five or more of these symptoms may indicate PMDD. Symptoms occur during the 2 weeks before the menstrual cycle and disappear within a few days after the onset of the bleeding.

In a recent study published in the journal Biological Psychology and led by Susan Girdler, Ph.D., professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine, demonstrated that PMDD women had greater sensitivity and respond to stress and pain.


Lifestyle changes such as regular exercise and a well balanced diet may ameliorate some of the effects of PMDD. There is some evidence that vitamin B6 in doses up to 100 mg can alleviate symptoms. Certain SSRIs provide relief as well. The U.S. Food and Drug Administration (FDA) has approved four medications for the treatment of PMDD: Fluoxetine (also known as Prozac), was approved by the U.S. Food and Drug administration for PMDD in 2000. Sertraline (Zoloft) was approved in 2002, Paroxetine HCI (Paxil) and also Escitalopram oxalate (Lexapro) has also been approved by the FDA. The patent for Fluoxetine expired in 2001, but Eli Lilly was able to extend patent protection until 2007 for its use in the treatment of PMDD, and thereafter marketed it heavily for this use under the trade name Sarafem. Fluoxetine is available as a generic in the same doses used in Sarafem, with the generic price generally a fraction of the cost for branded Sarafem. L-tryptophan, a serotonin precursor, was found in two studies to provide significant relief when supplemented daily in a large dose of (six grams) per day.

Article From Wikipedia

Thursday, December 23, 2010

Consequences of Sexual Abuse

Consequences of Sexual Abuse; Effects of Child Abuse; Symptoms of Child Molestation; Child Sexual Abuse Signs

By: Wendy Moelker, psychologist in charge of Emergis, Goes, the Netherlands and Jacob Palme, professor, Stockholm University. First version: 22 Jul 2008. Latest revision: 24 Aug 2008.

What are the consequences of sexual abuse? What are the effects of child abuse? What are the symptoms of child molestation?

Note that other traumatic events can cause the same symptoms as sexual molestation. Thus, occurrence of the symptoms listed below is not proof of sexual molestation.

Depending on the seriousness, the duration and the sort of abuse, some of those who were abused in their childhood, or recently retain certain problems due to this trauma. These can be divided into psychological, social, sexual and physical problems.

Psychological problems:

Fears, panic attacks, sleeping problems, nightmares, irritability, outbursts of anger and sudden shock reactions when being touched.

Little confidence, and self-respect and respect for one's own body may change.

Behavior that harms the body: addiction to alcohol and other substances, excessive work or sports, depression, self-destruction and prostitution.

Social problems:

Have little confidence in other people.

Fear of loss of control in relationships.

Sexual problem:

While making love problems often occur. The partner may be confused by a certain remark, touch or behavior that brings back memories of the abuse.

Patients sometimes don't want to make love at all anymore or make love less.

Sexual relation problems may occur, together whit pain while making love, not wanting to make love and problems in getting aroused. Problems with the orgasm and coming also occur.

Physical complaints:

Abdominal pain, pain while making love, menstrual pain, intestinal complaints, stomach ache, nausea, headache, back pain, painful shoulders, in short all kinds of chronic pain may occur. The pain is often inexplicable.

Eating disorders often occur in sexually abused people. More.

When the patients, in reaction to a harmful event, disordered for more than a month in such a way that they can't go to school, can't work, isolate themselves or experience other negative consequences, one can talk about a post-traumatic stress syndrome More information. This disorder originates in reaction to a very harmful event and has three characteristic symptoms:

Denial and repression alternating with re-experiencing,and they are always over irritated.

Denial and repression; they deny or repress the harmful event(s): they don't want to talk about or avoid certain situations. At an older age, memory of sexual abuse is often completely suppressed, but can sometimes be recovered in psychotherapy.

It is, however, difficult to determine if such recovered memories are memories of real experiences of memories of dreams or imagined events. This difficulty can be a problem if you want to prosecute the abuser, but it is not a problem for treatment using modern psychotherapeutic methods.

Re-experiencing ; they experience the event(s) again; unintentionally they are confronted with memories of the abuse, for example through nightmares, sudden memories or unexplainable physical problems.

Over irritation ; they are easily affected, hot-tempered, jumpy, excessively alert and don't fall asleep easily.

Sunday, December 12, 2010

What Are The Differences Between Mania & Hypomania And Bipolar I&II?

Excerpts from article: Alternative Depression Therapy
Benjamin Schwarcz MFT - Psychotherapist

Bipolar Symptoms are difficult to recognize without looking at your behavior patterns over time. The typical symptoms of bipolar disorder will depend on what type of episode you are going through.

To break it down as simply as possible, bipolar symptoms will show up in one of four types of episodes:

Depression (may look identical to any typical, "uni-polar" depression)
Mania (extreme elevated mood)
Hypomania (mild to moderate elevated mood)
Mixed (combination of depressive symptoms and increased energy, anxiety or agitation)
Different people experience different symptoms and patterns of this illness. Some may experience periodic manic or hypomanic episodes, followed by periods of normal moods. Others may crash into mild or severe depression, which may last for weeks or even months before resolving. When a person's bipolar symptoms cycle through four or more episodes within a 12 month period, it is called "rapid cycling." Rapid cycling can vary widely in it's frequency, and for some people can cycle several times within a day ("ultra rapid-cycling") or even one minute to the next ("ultra-ultra rapid cycling").

Alternative Mania or Hypomania is generally the only tip-off that a person may have Bipolar Disorder. In the case of "Soft Bipolar" - a milder form of Bipolar II - diagnosis may be especially difficult. And it must be determined that the the apparent bipolar symptoms are not caused by:

head injury or other neurological problem
over-active thyroid
allergic reaction/ food allergies
stimulant or other substance use
other mental illness such as Attention Deficit Hyperactivity Disorder (ADHD), Schizophrenia or Schizoaffective Disorder. (Schizophrenia is a diagnosis characterized by hallucinations and/or delusions, while Schizoaffective Disorder has the addition of bipolar symptoms).
What about "Spiritual Awakening", "Spiritual Crisis" or "Spiritual Emergence"?

Rarely acknowledged by traditional psychiatry, the spiritual dimension of mania and what is most often labeled as "psychosis" may often times reflect a deeper spiritual emergence, a dissolution of ego, or higher state of consciousness. This is rarely a pure spiritually realized state, but rather a sudden, intense expansion of consciousness which is a blend of true spiritual insight, intuition, wisdom, and even psychic experiences -- mixed with ego-level fear, anxiety and confusion. Professionals and crisis workers often fail to respect or recognize the spiritual truths that are part of this experience and instead focus on the "delusional" or psychotic process as pathological and meaningless. This is does a terrible disservice to the person in crisis.

Once the manic episode resolves, the person is often left feeling confused, depressed, frightened of their experience and alienated from others because the spiritual element of the experience is never validated and they cannot find meaning or value in the experience.

"The Natural Medicine Guide to Bipolar Disorder" by Stephanie Marohn, lists twenty factors in Bipolar Disorder. These factors can cause, or contribute to, bipolar symptoms. They are as follows:

genetic vulnerability
chemical toxicity
heavy metal toxicity (such as mercury, lead, copper and aluminum)
food allergies
intestinal dysbiosis
sensitivity to food additives (two common ones are MSG and Aspartame)
nutritional deficiencies or imbalances
neurotransmitter deficiencies or dysfunction
hormonal imbalances
structural factors (cranial compression due to birth trauma or later injury)
medical conditions
lack of sleep
lack of exercise
lack of light
energy imbalances
psychospiritual issues

Bipolar Disorder is frequently misdiagnosed as depression or anxiety and it often takes more than 10 years for the average person to receive an accurate diagnosis.
In mainstream medical practices, considerations for making a diagnosis are usually restricted to the following:

Personal history/ patterns of mood changes/ symptomology
Response to medication
Family History - especially, blood relatives with Bipolar Disorder, or Depressive Illness.
Personal reflection, and observation by family and friends of a distinct pattern of changing moods, including periods of sustained, abnormally elevated mood, are usually the most reliable means of diagnosis.

"In the pre-drug era, bipolar patients were usually asymptomatic between episodes; 85% returned to their usual occupations; and they showed no signs of long-term cognitive decline. Today, bipolar patients are much more symptomatic; only about one-third return to their usual occupations; and they become cognitively impaired over the long term."
-Robert Whitaker, author of Anatomy of an Epidemic

There is a clear genetic influence for Bipolar Disorder, and although other factors can influence or trigger it, genetics can predispose you to the illness (sometimes referred to as a genetic vulnerability). According to the National Institute of Mental Health, more than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression.

As the following chart shows, family genetics seems to play a strong role in bipolar disorder, but is not the only factor. Environmental and other factors such as stress, trauma, lack of sleep, drug and alcohol use, and giving birth, can trigger or "uncover" a bipolar vulnerability - setting the disorder in motion. (See the above list of bipolar factors)

Evaluation by a qualified mental health professional is extremely important in order to make an accurate diagnosis. Medical causes of mood changes (such as thyroid problems) should always be tested and ruled out first by a medical doctor before treating bipolar symptoms. Other problems should be ruled our as well, such as food allergies or nutritional deficiencies. Your medical doctor may disregard or minimize this as a relevant cause of bipolar symptoms, so you may need to see a holistic health practitioner for this type of evaluation. Mainstream doctors very rarely consider nutrition and diet in diagnosis or treatment.

"....I never noticed anything out of the ordinary about Jim before. He's a really high energy person - a real people person. He's incredibly driven and manages to be very successful in his own business and still have time for friends and family. But lately, since his father died, he's been going without sleep. He's started to act strangely and keeps talking about magical powers. He says he can read people's minds. He's been making huge purchases of office equipment that we don't even need. He's been drinking more than usual, and gets even more bizarre, and even hostile when he's had a few drinks. It's almost impossible to get a word in when he's talking and he jumps from one subject to another. He says he's on a mission from God. Today he was nearly arrested for reckless driving...."

Signs and symptoms of mania (or a manic episode) include*:

Increased energy, activity, and restlessness
Excessively "high," overly good, euphoric mood
Extreme irritability
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can't concentrate well
Little sleep needed
Unrealistic beliefs in one's abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present. Of all Bipolar Symptoms, manic symptoms are the most easy to identify by an outside observer.

Signs and symptoms of depression (or a depressive episode) include*:

Lasting sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed, including sex
Decreased energy, a feeling of fatigue or of being "slowed down"
Difficulty concentrating, remembering, making decisions
Restlessness or irritability
Sleeping too much, or can't sleep
Change in appetite and/or unintended weight loss or gain
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer. Bipolar Symptoms showing up as a depressive episode are difficult to diagnose as Bipolar Disorder, without a known history of manic or hypomanic episodes.

A mild to moderate level of mania is called hypomania. Hypomania (characteristic of Bipolar Type 2)may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar symptoms, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood - a common and transitory state when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania - a characteristic of Bipolar Type 2), and then severe mania (which is required for a diagnosis of Bipolar Type I).

In some people, however, bipolar symptoms may include elements of both mania and depression -- what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized. This can be extremely disruptive to a person's sense of order and sense of self. And it can be confusing to family and friends because it is so hard to understand what the person is experiencing.

Much research has been done, and continues to show that fish oil is useful as a mood stabilizer and anti-depressant, and it is non-toxic. It is widely recognized as a natural medicine for depression and bipolar symptoms. It also has multiple other health benefits including heart health, prevention of stroke, diabetes, cancer, and arthritis.   

This information may serve as a self-help tool, but the use of this information does not constitute a therapist/client relationship and should not serve as a means of self-diagnosis or a substitution for actual psychotherapy. The information on this site is for informational purposes only. If you are experiencing depressive or bipolar symptoms it is advised that you see your doctor or therapist for an evaluation. If you are having active thoughts of suicide please call 911 or your local Psychiatric Emergency Service, or call the National Suicide Hotline: 1-800-SUICIDE.

Do You Have Bipolar One Disorder (Mania)? Online Test

This free online Bipolar Test is only a preliminary screening, and even a positive outcome suggesting Bipolar Disorder does not warrant a conclusive diagnosis. A proper diagnosis can only be accurately made by a mental health professional. It is recommended that you print this page, and share the results of this bipolar test with your doctor, psychiatrist or therapist.

Screening for Bipolar (History of Mania)

I. Has there ever been a period of time when you were not your usual self and...

1. felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?



2. were so irritable that you shouted at people or started fights or arguments?



3. felt much more self-confident than usual?



4. got much less sleep than usual and found you didn't really miss it?



5. were much more talkative or spoke much faster than usual?



6. ...thoughts raced through your head or you couldn't slow your mind down?



7. were so easily distracted by things around you that you had trouble concentrating or staying on track?



8. had much more energy than usual?



9. were much more active or did many more things than usual?



10. were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?



11. were much more interested in sex than usual?



12. did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?



13. ...spending money got you or your family into trouble?



II. If you checked YES to more than one of the above, have several of these ever happened during the same period of time?



III. How much of a problem did any of these cause you - like being unable to work; having family, money or legal troubles; getting into arguments or fights?

No Problem

Minor Problem

Moderate Problem

Serious Problem

IV. Have any of your blood relatives had bipolar disorder ("manic-depression")?



V. Has a health professional ever told you that you have manic depressive illness or bipolar disorder?



If you answered "YES" to 7 or more items in section I, and....

if you answered "YES" to question II, and....

answered "moderate" or "serious" problems for question III

Then this is considered a positive screen for Bipolar Disorder, and further evaluation by a mental health professional is strongly recommended. This free online Bipolar test is a commonly used initial assessment tool. Other causes of your symptoms will have to be ruled out before a diagnosis can be accurately made. Your therapist or psychiatrist may choose to use an additional bipolar test, and should conduct a full diagnostic interview. The bipolar test is also more accurate when close family or friends can offer accurate history and observations of your behavior.

Thursday, December 9, 2010

Is it ADHD Or Is It Depression? ADDitudes Magazine

ADDitude Magazine

First the bad news: Depression is estimated to be 2.7 times more prevalent among adults with attention-deficit/hyperactivity disorder than among the general adult population.

Now the good news: Effective remedies for depression are readily available, and they work just as well for adults with ADHD as they do for others. If you think you have the condition, there is no need to suffer.

Primary vs. Secondary Depression
Some adults with ADHD become depressed for no obvious reason—the condition strikes even in the absence of unpleasant life circumstances or events (difficulties at work or in school, job loss, relationship problems, chronic illness, and so on). Risk for this form of depression, known as primary depression, seems to be largely inherited.

Take Charge of Secondary Depression
In other cases, depression arises as a direct consequence of the chronic frustration and disappointment of living with untreated or poorly managed ADHD. By some estimates, 25 percent of adults with the disorder haven’t gotten appropriate treatment. Such cases of depression are said to be secondary to ADHD.

“I frequently see depression in adults whose ADHD wasn’t recognized and treated in their younger years,” says Yvonne Pennington, Ph.D., an Atlanta-based psychologist who specializes in adult ADHD. “Having endured so many blows to their self-esteem, they’ve accepted the idea that they’re lazy and stupid—or not good enough to succeed socially or professionally.”

Telling ADHD and Depression Apart
To complicate matters, doctors may mistake ADHD for depression. Differentiating the conditions can be difficult because both disorders bring mood problems, forgetfulness, an inability to focus, and lack of motivation. There are, however, subtle distinctions between ADHD-induced symptoms and those caused by depression.

EMOTIONS. ADHD can cause dark moods, but these are usually linked to specific setbacks. The bad feelings tend to be transient. In contrast, mood problems associated with depression are generally pervasive and chronic, often lasting weeks or months.

And, unlike the bad feelings caused by ADHD (which often begin showing up in childhood), depression typically doesn’t develop until adolescence or later.

MOTIVATION. With ADHD, it seems impossible to accomplish anything, because you’re “in a dither and can’t decide what to do first,” says Roberta Tsukahara, Ph.D., a psychologist in Austin. “With depression, it’s more that you’re lethargic and can’t initiate any activity.”

SLEEP DIFFICULTIES. With ADHD, the problem usually occurs while falling asleep; the mind refuses to "turn off", and keeps adding things to the next day’s to-do list. In contrast, people who are depressed tend to fall asleep readily, but wake up repeatedly during the night (and early in the morning). At each awakening, the mind is filled with negative or anxious thoughts.

What You Should Treat First
“I would not go after ADHD and primary depression at the same time,” says Lenard Adler, M.D., director of the adult ADHD program at the NYU Langone Medical Center in New York City. “Work first on the condition that causes the greater impairment. Problems raised by ADHD are real, but depression can be life-threatening.”

Antidepressants that aim to boost levels of the neurotransmitters serotonin and/or norepinephrine are the primary treatment for severe depression. Your doctor may also prescribe an antidepressant if mild to moderate depression persists, despite lifestyle changes and effective treatment for your ADHD.

Most antidepressants work well alongside ADHD stimulant meds, as well as with the nonstimulant Strattera (atomoxetine), though minor adjustments may need to be made. Wellbutrin (bupropion) is an antidepressant that can also be useful for ADD.

Most of the time, depression improves substantially with the first antidepressant tried. If it doesn’t work, a second one probably will. About half of those who take antidepressants achieve complete relief of depressive symptoms.

Do-It-Yourself Relief
When depression is secondary to ADHD, minor medication or lifestyle adjustments may be all it takes to get out of a funk. What if depression persists despite adherence to an ADHD drug regimen? Doctors recognize that lifestyle changes are likely to help. Aerobic exercise “has a profound effect on the mood level of people with ADHD,” says William Dodson, M.D., a Denver-based psychiatrist. “If you can’t motivate yourself, exercise can normalize your mood.”

Many ADDers find that their mood darkens when they have nothing to do. “The ADD nervous system feeds on interest and challenge,” says Dodson. To guard against idleness, he recommends setting up an “interest closet”: Whenever you come across something interesting—a good book, for instance, or a craft project—stash it in a closet. The next time you find yourself looking for something to do, there will be something waiting for you.
Slide 6 of 6

Meditation and Psychotherapy
Meditation also has its place in treating depression. Sit quietly, with your eyes closed, and focus on your breathing. Each time you exhale, silently repeat a one-syllable word—“one” or “peace” or “om.” Do this for a minute or so, or try it for 10 to 20 seconds whenever you have trouble moving from one activity to another.

Along with, or instead of, meditation and medication, a form of psychotherapy known as cognitive behavioral therapy (CBT) has proven to be highly effective against depression. The first goal of CBT is to enable the patient to identify and reduce frequent, intense negative thoughts—“This is too hard to do,” for example.

The next step is to replace these self-destructive thoughts and beliefs with more realistic and constructive thoughts—“Yes, this is hard. How can I make it more manageable?” You’re acknowledging the difficulty, but not wallowing in it. You’re pointing yourself toward positive action.

The goal is to reduce the frequency and intensity of symptoms. Don’t expect to eliminate them. But you can manage symptoms that once got in the way of living a happy life.

Sunday, December 5, 2010

How to Improve Your Financial Willpower

How to Improve Your Financial Willpower By RAMIT SETHI New York Times

Ramit Sethi runs the Web site I Will Teach You to Be Rich.

One of my friends has been meaning to fax his health insurance company to stop an overcharge worth hundreds of dollars each month. When I asked him why it’s taking so long to fix it, he gave me an astonishing reason: He said he didn’t have a fax machine.

It’d be easy to point and laugh at him for being lazy. But he’s a successful entrepreneur. So why does he find it so hard to motivate himself?

Many of us think we make rational financial decisions. We believe we’re in control. “If I just try harder,” we say, “I could save $100 more each month.”

Yet time and time again, our willpower fails us, and we yo-yo back to our same spending patterns.

So here’s how to turn a few powerful psychological principles in your favor and save more, pay off debt and live a richer life.
Last year, ClimateWire wrote about a fascinating study in behavioral change. Researchers created a workshop on energy efficiency and invited 40 people to attend.

The results: Participants “significantly knew and cared more about the issues after the workshop than before.” But when the researchers looked at attendees’ actions afterward, the results said otherwise. Only eight people installed low-flow shower heads, even though all 40 participants had been given the shower heads at the workshop.

Behavioral change turns out to be extraordinarily hard — even when we believe it’s important and others try to make it easy for us. So we think that if we only try harder we can do anything.

But new psychological research finally acknowledges that willpower is a limited resource. As Stanford psychologist BJ Fogg says, “In the long term, willpower alone won’t work for difficult behaviors. You need to take a different approach, such as changing your environment, removing triggers and taking baby steps.”

This is why people who try to save on everything — coffee, clothes, going out, travel — often fail, while people who focus on one or two areas are able to save dramatically more.

So keeping all of this in mind, what simple psychological changes can you make to change your own behavior, starting immediately?

Start by changing your defaults.

Researchers found that when 401(k) accounts went from “opt-in,” which requires employees to fill out enrollment paperwork, to automatically enrolling employees and requiring them to “opt-out” if they didn’t want to participate, contribution rates soared from less than 40 percent to nearly 100 percent.

If you had asked these employees if their retirement was important to them, 100 percent of them would have said yes. But when you looked at their behavior, these employees were on track to lose tens of thousands of dollars over their lifetimes due to simple inaction. Research has found that educating them would have done very little. But a change in defaults accomplished a lot.

The same approach works for people who try over and over to save a few hundred dollars each month, but things “just keep coming up.” These people blame themselves for their lack of willpower, but never create systems to automate savings.

Defaults are boring. They’re not sexy. But they work.

Here are three other ways to use psychological principles to change your behavior:

1) Automate your personal finances

Most people complain about money for their entire lives, getting hit with late fees, never saving enough and dreading the task of budgeting. Yet it’s possible to spend less than one hour per month on money and still save for future purchases, pay bills automatically and invest every single month. I’ve outlined what you need to do to make it this happen in a 12-minute video.

And here’s a diagram from my book, “I Will Teach You To Be Rich” that shows my automation system:

Reprinted with permission from “I Will Teach You to Be Rich” (Workman Publishing, 2009)

2. Use your behavior to change your attitude

Many people assume that our attitudes influence behavior, telling ourselves that “I’m frugal, so I don’t buy expensive jeans.” But in psychological research, behavioral change works in reverse, too. Your behaviors can actually affect your attitudes and emotions. For example, researchers have found that if you nod your head when listening to a persuasive message, you’re more likely to be persuaded.

How can we use this to our advantage?

Identify one thing you want to do more of (say, read a fiction book). Now, instead of waiting for some day when you’ll actually do it, add a calendar reminder every week for a month. After that, ask yourself if you still need that calendar reminder.

3. Stop trying to save on everything.

Every morning we wake up facing infinite financial possibilities. Should we pay down debt? Buy that latte? Eat out with friends?

Overwhelmed with choices, we do the same thing we always do: nothing.

Instead of trying to save a little bit on everything, focus on your two biggest discretionary expenses. For example, my two biggest discretionary expenses are eating out and drinking. Over the next six months, cut each down by 25 to 33 percent.

Saturday, December 4, 2010

What Was I Thinking?: Consciousness

What Was I Thinking?
By NED BLOCK New York Times

In “Self Comes to Mind,” the eminent neurologist and neuroscientist Antonio Damasio gives an account of consciousness that might come naturally to a highly caffeinated professor in his study. He emphasizes wakefulness, self-awareness, reflection, rationality, “knowledge of one’s own existence and of the existence of surroundings.”
Enlarge This Image

Constructing the Conscious Brain
By Antonio Damasio

Excerpt: ‘Self Comes to Mind’ (Google Books)
That is certainly one kind of consciousness, what one might call self-consciousness. But there is also a different kind, as anyone who knows what it is like to have a headache, taste chocolate or see red can attest. Self-consciousness is a sophisticated and perhaps uniquely human cognitive achievement. Phenomenal consciousness by contrast — what it is like to experience — is something we share with many animals. A person who is drunk or delirious or dreaming can be excruciatingly conscious without being wakeful, self-aware or aware of his surroundings.

The term “conscious” was first introduced into academic discourse by the Cambridge philosopher Ralph Cudworth in 1678, and by 1727, John Maxwell had distinguished five senses of the term. The ambiguity has not abated. Damasio’s distinctive contributions in “Self Comes to Mind” are an account of phenomenal consciousness, a conception of self consciousness and, most controversially, a claim that phenomenal consciousness is dependent on self-consciousness.

Phenomenally conscious content — what distinguishes the experience of blue from the taste of chocolate — is, according to Damasio, a matter of associations that are processed in different brain areas at the same time. What makes a conscious state feel like something rather than nothing is explained as a fusion of mind and body in which neurons become “extensions of the flesh.” Self-consciousness is the result of a procession of neural maps of inner and outer worlds. What’s more, he argues, phenomenal consciousness depends on self-consciousness. Without a self, he writes, “the mind would lose its orientation. . . . One’s thoughts would be freewheeling, unclaimed by an owner. . . . What would we look like? Well, we would look unconscious.”

Even fish and lizards have a kind of minimal self, one that combines sensory integration with control of information processing and action. But Damasio’s self is not minimal. It is inflated with self-awareness, reflection, rationality, deliberation and knowledge of one’s existence and the existence of one’s surroundings, and this is what he ends up arguing a being needs in order to have phenomenal consciousness.

You may have sensed that I think there is a problem with Damasio’s emphasis on self-consciousness: indeed, “Self Comes to Mind” is mainly about self- consciousness rather than experiential phenomenal consciousness. And the book is not about geology or underwear or many other things either. So what?

I can explain the problem by a brief detour into a different book, “The Origins of Consciousness in the Breakdown of the Bicameral Mind” (1976), by the American psychologist Julian Jaynes. Jaynes held that consciousness was invented by the ancient Greeks between 1400 and 600 B.C. He argued that there was a dramatic appearance of introspection in large parts of the “Odyssey,” as compared with large parts of the “Iliad,” which he claimed were composed at least a hundred years earlier. The philosopher W. V. Quine once told me that he thought Jaynes might be on to something until he asked Jaynes what it was like to perceive before consciousness was invented. According to Quine, Jaynes said it was like nothing at all — exactly what it is like to be a table or a chair. Jaynes was denying that people had experiential phenomenal consciousness based on a claim about inflated self-consciousness.

Damasio also denies phenomenal consciousness because of the demand of a sophisticated self-consciousness. You may have noticed an exciting report a few years ago of a patient in a persistent vegetative state (defined behaviorally) studied by the neuroscientists Adrian Owen and Steven Laureys. On some trials, the two instructed the patient to imagine standing still on a tennis court swinging at a ball, and on others to visualize walking from room to room in her home. The patient, they found, showed the same imagistic brain activations (motor areas for tennis, spatial areas for exploring the house) as normally conscious people who were used as controls.

More such cases have since been discovered, and this year Owen and Laureys described a vegetative-state patient who was able to use the tennis/navigation alternation to give yes-or-no answers to five of six basic questions like “Is your father’s name Alexander?” These results are strong evidence — though not proof — of phenomenal consciousness in some of those who showed no behavioral signs of it. But Damasio scoffs, saying that these results “can be parsimoniously interpreted in the context of the abundant evidence that mind processes operate nonconsciously.” His skepticism appears to be grounded in the fact that these patients show no clear sign of self-consciousness and thus constitute a potential roadblock in front of his theory.

Damasio also stumbles over dreaming. In dreams, phenomenal consciousness can be very vivid even when the rational processes of self-consciousness are much diminished. Damasio describes dreams as “mind processes unassisted by consciousness.” Recognizing that the reader will be puzzled by this claim, he describes dreaming as “paradoxical” since the mental processes in dreaming are “not guided by a regular, properly functioning self of the kind we deploy when we reflect and deliberate.” But dreaming is paradoxical only if one has a model of phenomenal consciousness based on self-consciousness — on knowledge, rationality, reflection and wakefulness.

Contrary to Damasio’s point of view, there is good evidence that vivid conscious experience may be antithetical to self-reflective activity. In one experiment, the Israeli neuroscientist Rafi Malach presented subjects with pictures and asked them to judge their own emotional reactions as positive, negative or neutral — a self-oriented, introspective task. He then presented different subjects with the same pictures and asked them to very quickly categorize the pictures as, for example, animals or not. Of course these subjects were seeing the pictures consciously, but Malach found that the brain circuits involved in scrutinizing self-reactions (as indicated by the emotional reaction task) were inhibited in the fast categorization task. Subjects also rated their self-awareness as high in the emotional reaction task and low in the fast categorization task. As Malach puts it, these results comport with “the strong intuitive sense we have of ‘losing our selves’ in a highly engaging sensory-motor act.”

Damasio argues that a creature without sensory integration and control of thought and action would be unconscious. But even if that is true, it does not show that phenomenal consciousness requires self-awareness, reflection, wakefulness, or awareness of one’s existence or surroundings. This argument conflates the minimal self with the inflated self.

Is this discussion of any practical importance? Yes. Phenomenal consciousness is what makes pain bad in itself and pleasure good. Damasio’s refusal to regard phenomenal consciousness (without the involvement of the inflated self) as real consciousness could be used to justify the brutalization of cows and chickens on the grounds that they are not self-conscious and therefore not conscious. Damasio, in response to those who have raised such criticisms in the past, declares that in fact he thinks it “highly likely” that animals do have consciousness. But this doesn’t square with the demanding theory he advances in his book, on the basis of which he denies consciousness in dreams and in “vegetative state” patients who can answer questions. He owes us an explanation of why he thinks chickens are conscious even though dreamers and the question-answering patients are not.

Friday, December 3, 2010

Behind the Facade, Post-Traumatic Stress

Behind the Facade, Post-Traumatic Stress by Béatrice de Géa for The New York Times

Robin Hutchins, 25, of Manhattan, had post-traumatic stress disorder for years before
it was diagnosed. A dog has helped lessen the anxiety and panic attacks. By KAREN BARROW
The woman walking her dog is Robin Hutchins, 25. She looks confident and self-assured, and few would guess that a year ago she discovered that she had the stress disorder.

“When I tell people I have P.T.S.D., it’s like I have to convince them it’s a real issue,” she said.
The disorder — in which a traumatic experience leaves the patient suffering from severe anxiety for months or years after the event — is often associated with battlefield combat and natural disasters. But as Dr. Frank Ochberg, a clinical professor of psychiatry at Michigan State University, noted in an interview, the typical trigger is more mundane — most commonly, a traffic accident.

In Ms. Hutchins’s case, it was sexual violence. During her first year in college, on a weekend home to tend to a broken leg, she was raped by a young man she knew. She returned to college without telling her parents about it. “I just really wanted to be a freshman in college,” she said.
Ms. Hutchins spoke to a counselor there and resumed her routine — attending class, hanging out with friends and trying to put the trauma behind her. “Nobody ever said, ‘You need to stop your life and deal with this — you can’t just walk through it,’ ” she said.

The following year she was briefly pinned to a wall by a drunken male student. Seemingly a minor incident, but it sent Ms. Hutchins into a tailspin. Anxiety and panic began to strike her without warning. The prospect of leaving her dorm terrified her. She stopped going to class.
Her reaction was not to get help, but to leave college. She traveled to Mongolia in hopes of clearing her head, but a car accident during her trip only made things worse.

Friends didn’t understand why she never wanted to go out. They would play down her anxiety and say, “Oh, you’re just going to laugh at this in a couple days.” It took years of sleepless nights and paralyzing anxiety over tasks as simple as grocery shopping before she began to look for help.

She sought out psychologists, but some dismissed her. “They’d say, ‘What does a pretty girl like you have to worry about?’ ” she said. Others were simply too expensive. Finally, during an initial consultation, a psychologist heard her full story and said the simple phrase that changed everything: “You have P.T.S.D.”

Dr. Ochberg, the Michigan State professor, who has never met Ms. Hutchins, estimated that as many as 80 percent of rapes may lead to symptoms of post-traumatic stress. But the stigma of rape, along with a general misunderstanding of the disorder and how it can affect anyone who has suffered trauma, often gets in the way of a proper diagnosis.

For Ms. Hutchins, the diagnosis came as good news. “When you can’t control your emotions at work, at home, with friends, you stop trusting yourself,” she said. “Knowing that my panic attacks came from P.T.S.D. was such a relief.” Understanding the cause of her emotional outbursts gave her tools to change them.

Dr. Ochberg explained that the disorder causes violent memories to surface despite a person’s best efforts to tame them.

Worse, the memory often feels more recent than it should. “There’s no sense of place in time,” Dr. Ochberg said.

Studies suggest that the disorder may be associated with structural changes in the brain — in particular, a shrinking of the hippocampus, a region associated with memory.

For most young professionals, a night out at a bar is routine; for Ms. Hutchins, the strange faces and crowds put her on high alert. Crossing the street calls up a swarm of terrifying possibilities: Will the bus hit me? Is that guy following me? Should I run? Should I fight back? If I do, will I put others at risk?

Weekly therapy sessions helped her work through some of those irrational fears, and anxiety medications helped prevent some of the panic attacks. Still, she remained unnaturally vigilant.
Then she met Dexter.

After reading that “emotional support” dogs can be trained to comfort people with post-traumatic symptoms — staying by their side in overwhelming situations, for example — Ms. Hutchins adopted a small Lhasa apso from a shelter. Now, she and Dexter are training each other.

Dexter keeps Ms. Hutchins calm on airplanes and forces her to go outside for long walks. People who see Dexter in his little blue service jacket smile at him — and at her, calming her further.
She is still working on gaining control of her emotions, and she knows that the post-traumatic symptoms may linger. But there is less anxiety, fewer panic attacks. About Dexter she said, “He’s given me a partner in all of this.”

A Fate That Narcissists Will Hate: Being Ignored

A Fate That Narcissists Will Hate: Being Ignored By CHARLES ZANOR from New York Times

Not that they face imminent extinction — it’s a fate much worse than that. They will still be around, but they will be ignored.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (due out in 2013, and known as DSM-5) has eliminated five of the 10 personality disorders that are listed in the current edition.

Narcissistic personality disorder is the most well-known of the five, and its absence has caused the most stir in professional circles.

Most nonprofessionals have a pretty good sense of what narcissism means, but the formal definition is more precise than the dictionary meaning of the term.

Our everyday picture of a narcissist is that of someone who is very self-involved — the conversation is always about them. While this characterization does apply to people with narcissistic personality disorder, it is too broad. There are many people who are completely self-absorbed who would not qualify for a diagnosis of N.P.D.

The central requirement for N.P.D. is a special kind of self-absorption: a grandiose sense of self, a serious miscalculation of one’s abilities and potential that is often accompanied by fantasies of greatness. It is the difference between two high school baseball players of moderate ability: one is absolutely convinced he’ll be a major-league player, the other is hoping for a college scholarship.

Of course, it would be premature to call the major-league hopeful a narcissist at such an early age, but imagine that same kind of unstoppable, unrealistic attitude 10 or 20 years later.
The second requirement for N.P.D.: since the narcissist is so convinced of his high station (most are men), he automatically expects that others will recognize his superior qualities and will tell him so. This is often referred to as “mirroring.” It’s not enough that he knows he’s great. Others must confirm it as well, and they must do so in the spirit of “vote early, and vote often.”
Finally, the narcissist, who longs for the approval and admiration of others, is often clueless about how things look from someone else’s perspective. Narcissists are very sensitive to being overlooked or slighted in the smallest fashion, but they often fail to recognize when they are doing it to others.

Most of us would agree that this is an easily recognizable profile, and it is a puzzle why the manual’s committee on personality disorders has decided to throw N.P.D. off the bus. Many experts in the field are not happy about it.

Actually, they aren’t happy about the elimination of the other four disorders either, and they’re not shy about saying so.

One of the sharpest critics of the DSM committee on personality disorders is a Harvard psychiatrist, Dr. John Gunderson, an old lion in the field of personality disorders and the person who led the personality disorders committee for the current manual.
Asked what he thought about the elimination of narcissistic personality disorder, he said it showed how “unenlightened” the personality disorders committee is.
“They have little appreciation for the damage they could be doing.” He said the diagnosis is important in terms of organizing and planning treatment.
“It’s draconian,” he said of the decision, “and the first of its kind, I think, that half of a group of disorders are eliminated by committee.”

He also blamed a so-called dimensional approach, which is a method of diagnosing personality disorders that is new to the DSM. It consists of making an overall, general diagnosis of personality disorder for a given patient, and then selecting particular traits from a long list in order to best describe that specific patient.

This is in contrast to the prototype approach that has been used for the past 30 years: the narcissistic syndrome is defined by a cluster of related traits, and the clinician matches patients to that profile.

The dimensional approach has the appeal of ordering à la carte — you get what you want, no more and no less. But it is precisely because of this narrow focus that it has never gained much traction with clinicians.

It is one thing to call someone a neat and careful dresser. It is another to call that person a dandy, or a clotheshorse, or a boulevardier. Each of these terms has slightly different meanings and conjures up a type.

And clinicians like types. The idea of replacing the prototypic diagnosis of narcissistic personality disorder with a dimensional diagnosis like “personality disorder with narcissistic and manipulative traits” just doesn’t cut it.

Jonathan Shedler, a psychologist at the University of Colorado Medical School, said: “Clinicians are accustomed to thinking in terms of syndromes, not deconstructed trait ratings. Researchers think in terms of variables, and there’s just a huge schism.” He said the committee was stacked “with a lot of academic researchers who really don’t do a lot of clinical work. We’re seeing yet another manifestation of what’s called in psychology the science-practice schism.”
Schism is probably not an overstatement. For 30 years the DSM has been the undisputed standard that clinicians consult when diagnosing mental disorders. When a new diagnosis is introduced, or an established diagnosis is substantially modified or deleted, it is not a small deal. As Dr. Gunderson said, it will affect the way professionals think about and treat patients.
Given the stakes, the blow-back from experts in personality disorders should come as no surprise.

Dr. Gunderson has written a letter co-signed by other clinical and research leaders to the trustees of the American Psychiatric Association and the task force that governs DSM-5. And Dr. Shedler and seven colleagues published an editorial in the September issue of The American Journal of Psychiatry. In the relatively small world of mental health diagnostics, this is most certainly a battle worth watching.
Right now, this much seems clear: It is way too early for the narcissists to give up their seat on the bus.

Charles Zanor is a psychologist in West Springfield, Mass.