Intermittent Explosive Disorder

Intermittent Explosive Disorder – More Than Just Anger

Intermittent Explosive Disorder (also called IED, that is appropriate as it can go off unexpectedly and cause significant damage)

Intermittent Hulk Explosive DisorderProbably everyone knows that teenage boy (or girl) who punched a hole through the wall.  Perhaps for some, this became a regular pattern of behavior during adolescence but most of those teenagers outgrew it.  In fact, at least one-quarter of teenage boys has done something dumb like punching a wall.

One boy I knew in high school even broke his hand by punching the roof of his car, and some boys were routinely doing stupid stuff.  Despite that, all of it was teenage angst and changes that can be attributed to the massive amounts of testosterone flowing through the male adolescent body – none of them had intermittent explosive disorder.

Intermittent Explosive Disorder is worse than punching a hole through a wall.

It typically is first identified in the early teens – but can be seen much earlier in some cases.    In order to be actually characterized as intermittent explosive disorder, an individual must have had three episodes of explosive behavior that is severely out of proportion to the stressor.

Intermittent Explosive Disorder HulkinsectThey must have broken or smashed something that is monetarily valuable (more than a few dollars), physically attacked or made explicit threats to attack someone with the intent of causing harm.  If these three episodes occur within the space of 12 months, the disorder is considered to be more severe.

Here is the catch.

How do you distinguish between IED, average – though extreme teenage behavior and other psychiatric conditions?  It turns out that IED is probably a diagnosis of “if nothing else fits” as other psychiatric disorders certainly overlap with similar symptoms – and you have to rule out the adolescent hormone issue.

Bipolar disorder may cause outbursts of extreme anger and agitation, Borderline personality disorder may cause outbreaks, ADHD patients can exhibit a severe lack of self-control, and drug abuse is always a potential cause.  Even though those diseases may cause IED-like events, a sustained behavior pattern is something to address.

Intermittent Explosive Disorder WarningA recent study reported by the National Institutes of Health shows that IED can actually affect up to 4 percent of adults and lead to an estimated 43 attacks over a lifespan.  The disorder may also increase that chance of depression, anxiety and substance abuse disorders.  People with IED have an obvious increased risk of legal trouble, financial difficulties, and divorce – that’s a no-brainer.

So the biggest problem for mental health professionals, like many other disorders, is to untangle all of the information leading in and out with a mix of behaviors and a mix of causes.  What came first – the chicken or the egg?  What came first – the drug abuse or the anger?  Which illness is more important – bipolar disorder or the IED?

One of the biggest clues may be in examining (or better, paying attention to) behavior that occurs before puberty.  In other words: What came first – the behavior or puberty?  Clearly if the behavior started before puberty, there was and is an issue.  If the behavior begins during adolescence – you have to wait (and hope) to see if the behavior goes away once the hormones are settled.

IED is not a simple diagnosis.

It requires a careful examination of an entire psychiatric and behavioral history – and the “ruling out” of a lot of other disorders that may be to blame.  Unfortunately, in the end – unless an underlying cause can be found, there is no medicationAnger management and cognitive behavioral therapy are likely the only answer – minimization of harm, not very satisfactory if it was your car window that got smashed in a fit of rage.

Melissa Lind

Borderline Personality Disorder in the News

In the news (and movies): Borderline Personality Disorder

Borderline Personality Disorder (BPD) doesn’t get a lot of “press” or screen time.

We have all seen movies and news stories about people with bipolar disorder. (Girl Interrupted, Mad Love, Borderline Personality Disorder Newsand the unforgettable Who’s Afraid of Virginia Wolf, drug addiction) (Chris Farley, Philip Seymore Hoffman, and Anna Nicole Smith), and major depression (Robin Williams, Owen Wilson, and Princess Diana).  Many of these movies or real-life examples also show how mental disorders are intertwined.

Depression comes with alcoholism, bipolar disorder comes with drug addiction, bipolar disorder comes with a lot of issues – but not much attention gets paid to Borderline Personality Disorder.

Borderline Personality Disorder has a few issues:

  1. It is a personality disorder and not a psychiatric disorder that can be treated with medication
  2. It is hard to diagnose and can often be confused with other disorders
  3. Borderline patients may misrepresent their behavior to medical professionals
  4. Borderline patients are often “difficult” to be around
  5. Borderline personality disorder is not well known – make it not well known… and, for this reason, there is no reason to write a news story or make a movie about it.

“Good news”;

I put that in parentheses because the diagnosis is not great – but it is good that BPD is getting a bit of attention.  Two notable examples – one not so great and one which may or may not be great.

Not So Great;

The trial of Jodi Arias.  In 2008, Travis Alexander was brutally murdered.  He was stabbed over 20 times, shot, and photographed after his death.  The alleged perpetrator: his girlfriend, Jodi Arias.

The case has been pending for many years – one of the reasons may be the development of a clear understanding of why Arias acted the way that she did after the murder.  Reportedly, Arias was witnessed immediately after Alexander’s memorial (including explicit text messages sent for “flirting”), and she has been pegged as a possible borderline patient.  This is in addition to Alexander’s former friends that reported her stalking behavior, and her statements that the boyfriend was a pedophile and a domestic abuser.

Arias’ own friends and a court psychologist have reported erratic behavior, similar to that of BPD.  No verdict has been issued as of yet, and we may never know, but it does bring BPD into the news (not in a nice way but into the light, however).

In fact, some mental health professionals have expressed the belief that BPD patients may be more dangerous – both emotionally and physically – than most other mental disorders, some likening it to a form of sociopathy.

Possibly good news;

Borderline Personality Disorder in the NewsOn the movie front, Kristen Wiig (of Bridesmaids –and the new, all-female Ghostbusters) has starred in a”dramedy”. Dramedy is  a combination of a comedy and drama that is centered around a woman with BPD.   In Welcome to Me, the character, portrayed by Wiig, wins the lottery and uses part of the money to start a talk show.

Along the way, she skips out on treatment, quits taking her meds and ends up living in a casino.  No word on reviews for the show, but it has some big names including Joan Cusack and Tim Robbins. It is produced in part by Will Farrell, and even though it premiered at the Toronto International Film Festival, theater showings have not been announced.

If you know a BPD patient – imagine what he or she might do after winning the lottery.  BPD is hard to diagnose, hard to predict and even tougher to be around.

Whether the movie is any good, whether the trial comes to a just end…

Melissa Lind

Borderline Personality Disorder has gotten some attention!

Work Stress Issues

Company owners and employees have their share of work stress problems

Employees have different levels of stress compared to business owners. They don’t have much of primary responsibilities as the owner of a company.
No Office StressOf course, we can’t say that only rank and file can experience stress because in the bigger picture, owners and managers also have their struggles.

Some notable causes of stress at work that both employees and managers should be aware of is the primary cause of stress; being overworked. Even the most outstanding employee will feel pressured when bombarded with work with a very limited period. Such thing might be irrational, but it happens all the time.

One of the causes for stress at work is a promotion. In some cases, employees get bored with their daily job and for this reason they would want to experience more challenging work for a greater compensation.

When you feel that you are overly stressed, make an effort to save yourself from self-destruction, and find ways to alleviate your current situation.

You can minimize stressful instances in your daily life if you know how to manage stress effectively. The key is never to let small responsibilities left unattended. Little things left unnoticed will pile up until such time that you can no longer bear the bulk of stress.

Organize your task according to its importance and time frame. There are tasks that are crucial, but you should have time to work it out. For this reason, it should be listed next to the urgent and Relax No Stress Pleaseimportant ones. Once you are done categorizing, create a timeline plan and make sure to include a break time and a day off in it.

Do not use your break time to finish an incomplete task. Break time is intended to your mind and body to rest. A break time will allow you to rest your brain and nerves as well as your body from the stress caused by too much work. Remember, you are responsible for keeping your physical and emotional health in good shape.

Do not ignore any sign of fatigue because it could lead to a more serious problem. If you feel that you are overly worn-out, take a rest. If you are feeling depressed, anxious and irritable, go ahead and rest. If you can’t concentrate on what you are doing and you are losing interest on it, rest.

If you are using drugs and alcohol to cope up with stress, stop and reflect!

Work StressYou have already reached the limit. Do not allow yourself to reach this far!

Strive to reduce your work stress by taking good care of yourself. You may start in restoring your physical and your emotional health. Once these two are addressed adequately, it will be easier for you to take care of your other needs as you are more optimistic and stronger when you are feeling better inside and out.

Once you are more stable physically and emotionally, your next step to getting rid of work stress is by organizing and prioritizing things. Make an effort to organize things first, and then you prioritize. Once you have done this, you are more guided, and you will regain control over stuff. This way you can well manage stress with self-control and confidence.

As an employee, it is your responsibility to take care of your health. No matter how hectic your schedule is, take your breaks and rest.

Excessive stress is not part of work related issues, but “typical” stress is!

Borderline Personality Disorder or Traumatic Stress Disorder

Borderline Personality Disorder – What if it is a traumatic stress disorder?

When most people think of Borderline Personality Disorder – they think of bad behavior.  It is someone that is very difficult to deal with, someone that you have to be on guard against, Borderline Disordersomeone who will try their best to manipulate you.
But, while that may be the outcome, just like most psychiatric disorders, it isn’t exactly their fault.

One of the problems with BPD is that since it is a “personality disorder“, there is often no recognized medical treatment.

We simply expect that the patient should self-monitor and control their behavior.  Therapy may help this, but how many of us (psychiatric patients, in general) really want to go to therapy.

Many of us have already spent hundreds of hours with a therapist – who may or may not help.  In addition, the best therapists are likely people who can “see through the bullshit” and refuse to be manipulated.  This obviously goes against the nature of someone with Borderline Personality Disorder.

In fact, the stigma is so bad that some therapists won’t even work with Borderline patients.

Co Morbid DisordersOne theory may help.  Some therapists have developed an automatic assumption that a Borderline patient is also a trauma victim.  While this co-morbid condition may not always be true, it can help some therapists feel more comfortable treating the patient.

Due to many soldiers returning from impossible battlefields in the Middle East, Post Traumatic Stress Disorder is fairly well recognized.  Remember; I am not saying that it is easily treatable, but to some extent, the stigma is less.

When therapists look at Borderline patients as truly a PTSD patient, they may be more willing to treat the disorder. And they will attempt to get to the underlying causes of abandonment, impulsive and destructive issues, loss of control and poor self-image.

While PTSD is well defined by the professional psychiatric community, a longer-term disorder currently known as complex traumatic disorder is not.  Most examples of CTSD still involve soldiers, or they may involve women who had difficult pregnancies or who were violently sexually abused, repeatedly.

However, what if you don’t fit any of those recognized categories?

There are more ways to treat traumatic stress disorders such as Cognitive Behavioral Therapy or a newer one, Dialectical Behavior TherapyDBT focuses on four major areas:

•    Regulation of emotionsPost-Traumatic Stress Disorder
•    Tolerance for distress
•    Interpersonal effectiveness
•    Mindfulness

Unlike CBT, there is no “processing” component – making it work well as an initial treatment, starting before the patient has developed coping skills.  It builds up the feeling of emotional safety so that coping skills may develop.

Differentiating between “plain” Borderline patients – and those whose behavior is brought on by traumatic experience may help to eliminate some of the stigma still associated with BPD.  It may also offer actual, more effective treatment than CBT or other approaches.

Melissa Lind

Mental Health Professionals and Suicide

Suicide – Threat of Liability for Mental Health Professionals

Suicide is the third most common cause of death for young adults – and the ninth highest for the general adult population.  This means that a large percentage of mental health professionals will have a patient that commits suicide. It may be as high as 80 percent of psychiatrists, psychologists, social workers, and other therapists, that eventually have a patient who commits suicide.

Serious Mental Health ProfessionalYou might think that professionals are insulated against emotions that come with the death of a friend or acquaintance – but they aren’t.  Many health professionals report that even when death is expected (natural causes), they spend a great deal of time going over their treatment of the patient. They try to find out if they could have done anything different, (given another treatment) in order to help.

But, what may be surprising is the number of liability lawsuits filed against mental health professionals, when a patient commits suicide.  In fact, it is the number-one cause of responsibility lawsuits brought against mental health providers.
The threat of lawsuits, and also the stigma against people working it in the mental-health profession, has led to many psychiatrists refusals to treat the chronically suicidal. The profession sees it as a failure of the doctorMental health professionals are also less likely to see additional suicidal patients after they have had a patient succeed at suicide.

When a therapist or physician is unable, or unwilling, to treat a suicidal patient – it leaves the patient in the lurch.  It produces feelings of failure and hopelessness, without a doubt, compounding the fact that they are suicidal.  It may also be difficult for an extremely suicidal patient to find a new therapist or doctor.  Many patients report that the mental health professionals suddenly “don’t have time”.

We don’t think much about the way suicide will affect those around us – and certainly the professionals are way down the list of people whose feelings are important.

Mental health professionals also report that there is a lack of training on how to deal with suicidal patients, and processing the death of a patient.  More than half of professionals surveyed also Knocking on Heavens Doorstated that they really don’t believe they can prevent a patient from committing suicide.

Oddly, the complaint process against physicians has been shown to increase the risk of the physician becoming depressed. One of the consequences of this will be a worsening of the situation for mentally ill people. (Chronically suicidal patients)

This is a complicated process with no easy answers, but you should know that it is likely that all psychiatrists, therapists, social workers and other counselors probably need to be in counseling themselves.  When you find a new doctor or therapist – you might want to ask.

Even if you aren’t suicidal, you need to know that your counselor is as mentally healthy as possible, certainly healthier than you.

Melissa Lind

Mental Health Professionals Report a Lack of Training on How to Deal With Suicidal Patients