Dec 08

Image: WikiCommons licenseAdolescents who were abused and neglected have less gray matter in some areas of the brain than young people who have not been maltreated, a new Yale School of Medicine study shows. The brain areas impacted by maltreatment may differ between boys and girls, may depend on whether the youths had been exposed to abuse or neglect, and may be linked to whether the neglect was physical or emotional.

The results, published in the Dec. 5 issue of the Archives of Pediatric Adolescent Medicine, show that 42 adolescent subjects who reported being either abused or neglected show a reduction in gray matter — the tissue containing brain cells — even though they had not been diagnosed with a psychiatric disorder.

“Here we have teenagers who may not have a diagnosable illness but still have physical evidence of maltreatment,” said Hilary Blumberg, associate professor in the Departments of Psychiatry and Diagnostic Radiology and in the Yale Child Study Center, who is senior author of the study. “This could help to explain their trouble with school performance or increase their vulnerability to depression and behavioral difficulties.”

The reduction of gray matter was seen in prefrontal areas, no matter whether the adolescent had been physically abused or emotionally neglected. However, in other areas of the brain the reductions depended upon the type of maltreatment the youth had experienced. For example, emotional neglect was associated with decreases in areas that regulate emotions.

The researchers also found gender differences in patterns of gray matter decreases. In boys, the reduction tended to be concentrated in areas of the brain associated with impulse control or substance abuse. In girls, the reduction seemed to be in areas of the brain linked to depression.

Blumberg stressed these deficits found in adolescents are likely not to be permanent.

“We have found that the brain, particularly in adolescents, shows a great deal of plasticity,” she said (neuroplasticity; comment by R.L.Fellner). “It is critical to find ways to prevent maltreatment and to help the youths who have been exposed.”

(Source: YaleNews; E. E. Edmiston, F. Wang, C. M. Mazure, J. Guiney, R. Sinha, L. C. Mayes, H. P. Blumberg. Corticostriatal-Limbic Gray Matter Morphology in Adolescents With Self-reported Exposure to Childhood Maltreatment. Archives of Pediatrics and Adolescent Medicine, 2011; 165 (12): 1069 DOI: 10.1001/archpediatrics.2011.565)

Oct 31

Have you recently experienced someone acting completely out of line or losing control over themselves?

In Psychiatry, patterns of repetitive behavior during childhood and adolescence where the social norms or boundaries of others are violated are called ‘conduct disorder‘. I am not a particular fan of this term as it reminds me a bit of authoritarian teachers and governments. But what it actually describes if being used by psychiatrists and therapists, is a symptom range of over-aggressive behavior, bullying, lying, cruel behavior toward people and pets, destructive behavior, vandalism and stealing, that should give you an idea of what it actually means.

Often, affected children come from a difficult family background with abusive, aggressive or addicted parents. If the underlying problems aren’t resolved, these children might develop more serious personality disorders as adults: particularly antisocial personality disorder, bipolar disorders or psychopathy . All of these increase the risk to cause or experience physical injuries, to suffer from depression, addiction, incarceration or even homicide and suicide, as they often intimidate others or initiate physical fights.

Antisocial persons don’t feel much of an inhibition to use weapons, and they have a tendency to deceit, con, steal or destroy property. While their behavior might seem confident and decisive at the outside, they can in fact feel very alone, anxious and hopeless, which often leads to alcohol abuse, depression or other problems.

One cause of the aggressive behavior of antisocial persons can be that they developed a ‘proactive’ but in fact mostly inappropriate, extreme form of self protection or need it as a valve to get rid of the emotional tensions they feel, not only inside themselves but also towards others. Unfortunately, in the case of psychopathic personality traits, this particular kind of relief is often combined with a lack of empathy and sympathetic concern for others, which reduces the hurdles to impose emotional or physical force on others. Thus, it is usually a good idea to avoid any open conflict with such aggressors. They would be unable to empathize with their victim or keep the conflict on a verbal level, let alone resolve it in a constructive manner. The best approach is usually to let them cool off and give them space and to give it another try at another day.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011; picture credit:www.corrupt.org)

Oct 31

There is a weakness that is particularly frequent among people in service professions, causing burnout and depression rates in the service industry to be some of the highest.

The ‘Helper Syndrome‘ describes a strong drive to make other people feel better. In some cases it is done to ease or divert the helpers from their own pain. But by no means you have to be a ‘professional’ helper to behave this way, it can be a friend, neighbor, associate or yourself who is vulnerable to getting pulled into responsibilities and tasks that others wouldn’t even think about taking at the first place.

The Helper Syndrome can contribute to outright abusive forms of relationships: the ‘helper’ might increasingly experience signs of burnout or feel exploited, and their highest efforts might increasingly be taken as a matter of course with little gratitude for their support – no matter how much energy the helper invests, he might never get to a point where everyone is satisfied.

Another unhealthy aspect of the helper syndrome can be a lack of self-awareness and abuse of the responsibility a helper has towards the helped. This is because a helping relationship is typically unbalanced; people are not on equal footing. A good helper will be sensitive to the imbalance, while an abusive helper will ignore or even seek it. Instead of supporting the other in becoming stronger or looking for additional (often: professional) means of support, the helper tries to keep them dependent, and focuses on reaching their very own goals. To achieve their goals they might even abuse their power, or the trust of the recipient.

So whether the motives for such behavior are altruistic (‘I want to give something back‘, ‘I don’t want them to do the same mistakes I did‘, ‘I want to share‘, ‘I can do it!’) or driven by dubbing their own psychological issues, it is always a sign of emotional imbalance and exploitation, of oneself or others, if someone ignores their own limits and tries to ‘fix’ everything only by themselves.

Typical forms of ‘helper’ relationships are: long-term relationships of non-addicts with addicted, aggressive, selfish or controlling personalities or relationships defined by a strong imbalance (with one partner being the ‘teacher’, ‘the sugar-daddy’ or ‘the boss’). They are functional for both, but quite resistant (and vulnerable) to change, which prevents at least one of the partners from achieving greater self-esteem and realizing his or her full potentials. While professional helpers can use supervision to reflect their work, in our private lives we can just try to take care for ourselves to avoid getting entangled in dysfunctional helping ambitions.

(Picture credit: http://westallen.typepad.com; This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Oct 26

Almost everyone has seen it or even have personal experiences with what is commonly called ‘addictive relationships’. These are the forms of relationships where everyone around a particular couple might raise their hands in disbelief over why both partners are still together.

There might be a strong and obvious imbalance between both of them, sometimes aggressiveness or jealousy of one partner towards the other or blackmailing, but still, for some reason, the ‘addicted’ partner can’t find a way to ultimately break up or might even excuse their loved one’s behavior. Others are highly indifferent to the unhealthy aspects of their relationship as they are hard to see, especially if one is in the middle of it.

I have helped numerous clients get rid of their addictions over the years, and in working with couples (another major field of my work), I couldn’t help but notice certain patterns in chronically difficult relationships that resemble problems of addicts that their partners or family members have to fight with.

An addictive relationship thus is unthinkable without one partner who is emotionally unstable and would in most cases require professional support to successfully deal with their problems for one. This person might also be very self-centered and look very independent and self-confident – or very needy on the other hand. But this since they are not ready to do that or because they are delusional, it needs someone who is ready to ‘support’, or in better words: invest their time, energy and often enough money to take the edge off the other’s imminent issues and to keep not only themselves, but also the relationship going, hoping for things to get better in the near future.
But often enough, it just keeps a vicious circle going – a circle the partner might actually already have experienced during their entire life, sometimes extreme behavior endured by helpful souls who took care for them along the way.

7 Signs of Addictive Relationships:

  • Dishonesty. Both partners don’t communicate openly about their real intentions, needs or worries.
  • Unrealistic expectations. Both partners hope for the other one to ‘fix’ their problems, be it their self-esteem, body image, family, or existential problems. They believe the ‘right relationship’ will make everything better. Yet, they’re in a disastrous addictive relationship.
  • Instant gratification. One of both expects the other one to be there for him whenever he needs her; he’s using her to make him feel good, and isn’t relating to her as a partner – well, because she’s like a drug.
  • Compulsive control. Imminent threats of one partner to leave if the other one doesn’t behave a certain way, and anxious worries of the other one if this idea comes up. Both might feel ‘stuck’ together – for good or for evil.
  • Lack of trust. Neither partner is 100% certain about being ‘truly’ loved by the other one as sometimes they can sense the feelings of hate or desperation their partner is experiencing.
  • Social isolation. Nobody else is invited into their relationship ‚Äď not friends, family, or work acquaintances. People in addictive relationships want to be left alone and can react harshly if someone is asking about the status of their relationship.
  • Cycle of pain. Often, couples living in a relationship determined by addictive patterns regularly experience cycles of pleasure, pain, disillusionment, blaming, and (often emotionally or sexually¬† loaded) reconnection. The cycle repeats itself until both partners seek professional help or one partner breaks free of the addictive relationship.

Unfortunately, there is no simple ‘recipe’ on how to help such partners effectively, as the one who suffers most is often very resistant to all efforts aimed at helping them get back on their feet again. Often, someone with a neutral viewpoint as a counselor can help, but if both partners feel determined enough, have strong self-control and are able to accept mutual accountability they might also find back to a fulfilling, balanced relationship.

Strategies for Overcoming Addictive Relationships:

  • Make your ‘recovery’ the first priority in your life.
  • Courageously face your own problems and shortcomings.
  • Cultivate whatever needs to be developed in yourself, i.e., fill in gaps that have made you feel undeserving or bad about yourself and/or get rid of the problems that turned you into an addict in the first place.
  • Learn to stop managing and controlling others; focus more on your own needs for a while and improve your self-esteem to become more independent
  • Find out what brings you peace and serenity and commit some time to that endeavor on a daily basis.
  • Learn not to get ‘hooked’ into the games of relationships; avoid dangerous roles you tend to fall into, e.g., ‘rescuer’ (helper), ‘persecutor’ (blamer), ‘victim’ (helpless one).
  • Find a support group of friends who understand and share your experiences.
  • Consider getting professional help to speed up the recovery process.

Many of you will know firsthand how many times friends or acquaintances entangled in an addictive relationship end up emotionally damaged, financially weakened or even physically injured. What you as a fellow friend can do is to avoid getting sucked into the ‘black hole’ of such an relationship yourself and to push both of them to seek professional advice.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011; Image source: bhaskar.com; Laurie Pawlik-Kienlen, Counselor; Hints on how to overcome AR based on Robin Norwood’s book ‘Women Who Love Too Much‘)

Aug 18

A nice friend just sent me a link to this article:

Addiction is a brain disease, experts declare
(Source: L.A. Times, August 16, 2011)

But wait: addiction is now ‘a brain disease‘?!

Well, be warned – here comes a therapist’s viewpoint on that! ūüėČ

The scientific community in the US and Europe is highly influenced (or corrupted?) by the money invested into neuronal and neurochemical research (especially by the pharma and the genetic research industry, but also the American government and the EU for various reasons).

As a result, there are only comparably little funds available for more research on utilizing psychotherapy or even neuroplasticity, because with those becoming more effective, these huge money-maker industries would lose cash and stock value.

That’s why a huge part of this particular scientific community is still seeing us as machines (just like in the 18th and 19th century!), which just need the correct surgery or pill in order to work ‘as intended’ (whatever that is..) again.

The simplified claim that the brain is ‘responsible’ for addiction is actually ridiculous and just possible if such a scientist is wearing blinders, completely blinding out all other research fields related to human behavior. If these theories were right, it would not be possible for patients to successfully stop taking drugs, gambling, over-eating etc. within just 2-3 months during a successful psychotherapy.

But it is.

It would be as if I would announce that I have found prove that ants are only able to crawl because they have legs. Yeah right, but there is a little bit more to ants than just legs.

And even though I would agree that our consciousness, our psyche is at least to a large extent -if not completely- a product of our brain, it would still be incorrect to blank out all the other means this ‘computer’ has to repair itself apart from pills or a scalpel.

Aug 05

Mark Twain said, “Quitting smoking is easy. I’ve done it a thousand times.” Well, we all know: quitting smoking reduces the risk of terrible illnesses like cancer and cardiovascular disease. It increases fertility levels, breathing and overall fitness. Another benefit of quitting is enjoying the taste of food again. You will look and smell better and on top of it all, save a lot of money.¬† Why then is it so hard for many to stop the habit – or addiction – of smoking?

The reasons for smoking addiction can be cut down to 2 important factors: nicotine and habits.

Nicotine, for one, is a highly addictive substance that occurs naturally in tobacco, and hooks your brain by stimulating it with a shot of dopamine, the hormone that tells us that food and sex are pleasurable. It also increases activity in areas of the brain that are believed to be involved in cognitive functions, so a cigarette can make you feel sharper and more focused. As if that weren’t enough, nicotine also increases the endorphin levels, the proteins that give you feelings of euphoria. Needless to say that having a ‘tool’ that can make you feel better in these ways, is something you don’t give it up easily. Quitting may leave you feeling deprived, and you may exhibit serious withdrawal symptoms if you have to go without nicotine.

Another important factor for this specific kind of addiction is habits – the patterns that are involved in smoking. Smoking behavior usually becomes closely linked with daily activities and ‘cues’ such as: after a meal, when socializing with friends, to ‘take a break’, when under stress (to relax), when relaxing (to relax further), etc. These aspects of smoking can be just as challenging to overcome as the physical dependence.

Consequently, most people who want to quit smoking once and for all, require an approach that deals with both vulnerabilities: the addiction itself and the behavioral aspects of it. The current ‘traps’ have to be identified and after that, new patterns and routines to be developed that make it easier to ‘skip’ the impulse to look for a cigarette. Hypnotherapy can support in this aspect by allowing our mind to adapt to the new behavior, but it can’t do wonders without the patient’s strong dedication¬† to getting rid of their smoking addiction. The first few weeks without cigarettes are usually the hardest. After 8-12 weeks, most individuals who make it that far start to feel more comfortable without smoking. Still, only 3 in 10 people can successfully stop smoking once and for all.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Aug 05

“What can I do, it’s in my genes!” In recent years, this has become a standard explanation for many of the health problems we have to face in our lives. Indeed, there are few human diseases without scientific studies trying to pinpoint ‘genetical causes’ as the root. Consequently, there are efforts to find genetic roots of mental problems as well. But 150 years after Mendel (the ‘father of modern genetics’) had outlined his ‘Laws of Inheritance’, we have still to see significant therapies that could wipe out major human burdens like cancer, addictions, diabetes or violence by purely genetical means. This is not to say that genetic science doesn’t have potential; but all the other influential factors should not be forgotten.

One of the weirdest aspects of the notion that all things human are genetically predetermined is that it takes everyone completely out of the context of their environment. We might as well not put personal or societal energies into trying to improve ourselves or others, because it’s inevitable and unchangeable anyway… But in fact there is just a very small number of very rare diseases that are truly genetically determined. Most complex conditions like ADHD, schizophrenia, a tendency to violence or addiction might have a predisposition that has a genetic component, but a predisposition is not the same as a predetermination. Genes just seem to give us different ways of responding to our environment. Some of the childhood influences and the method of child rearing in turn also affect gene expression; they can actually turn on or off various genes to put us on a different developmental track which may suit the kind of world we’ve got to deal with.

For example, a study done in Montreal with suicide victims looked at autopsies of the brains of these people and it turned out that if a suicide victim had been abused as a child, the abuse actually caused a genetic change in the brain that was absent in the brains of people who had not been abused. That’s an epigenetic effect: an environmental impact that is capable to either activate or deactivate certain genes.

So, in adaptation to the famous quote of Shakespeare, “There are more things in heaven and earth than are dreamt of in our scientific world.” And there are more things we can do to change ourselves than we might imagine.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

May 03

Brain doping / drug abuseIt’s very simple now to order drugs over the Internet, and most pharmacies in Asia will sell medicines over the counter that are only available by prescription in the West. Most popular products in the online catalogs are amphetamines, potency pills and antidepressants. But self-medication is actually risky, particularly with amphetamines (such as Ritaline / methylphenidate),¬† which can enhance performance and concentration leading to dependency and requiring withdrawal treatment at specialized clinics or psychotherapists after months or years of abuse.

According to a study of U.S. pediatricians, the number of ‘doping’ students has increased by 75 percent over the last 8 years. Often the drugs are used incorrectly, like when the cause of poor concentration or erection problems lies somewhere else than where the drug attaches. Erectile dysfunction in men aged less than 55 years, for instance, mostly has purely psychological causes. Habitual intake often leads to overdosing and increased susceptibility to disease-causing side effects. At some point, the user might in fact just treat the withdrawal syndrome (for erectile dysfunction this is often fear of having sex without first taking the drug) – they feel no significant effect of the drug anymore but can not discontinue its use and thus enter a vicious circle. Multiple dependencies, like the use of amphetamines during the day and then in the evening intake of alcohol and / or tranquilizers or sleeping pills, makes everything even more complicated and dangerous. Abuse of prescribed medications causes more accidental deaths in the United States than anything else except automobile crashes, which kill more than 30,000 Americans every year.

The first signs of psychological dependence on drugs can be feelings of insecurity or fear if no intake is possible, or if there is an increase of the dose over time, but the effect of the drug doesn’t feel the same or is completely absent. Another alarm signal could be if over the years, more and more substances are taken in without consulting a medical doctor (this also includes food substitution drugs, injections of hormones, tranquilizers, sleeping pills, nose drops, etc.).

In most cases, drug dependence is admitted very late, after diseases of the organs have developed or accidents occured (often caused by a lack of concentration). For the psychological withdrawal, a combination of psychotherapy and support groups is very effective, but a medical checkup for possible physical damage is also essential.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Sep 14

Many people enjoy gambling, whether betting on a horse or playing poker on their computer. Most of these people don’t have a problem, but some lose control over their gambling. They bet high amounts of money on card games, in casinos or playing slot machines. Today, people don’t even have to leave their homes to satisfy their drive to gamble anymore: the Internet allows one to spend unlimited hours playing games or placing bets without anyone interfering by asking uncomfortable questions – actually, many of the respective companies behind such websites try to keep people gambling as long and for as much money as possible. But once used to the rituals involved in a game, it is very hard for most to resist the urge of doing it again – if ‘only one more time’ in order to reverse their losses…

Typical signs of a serious gambling problem include:

  • Always thinking about gambling
  • Lying about gambling
  • Gambling during work
  • Spending family time gambling
  • Feeling bad after you gamble – but still not quitting
  • Gambling with money needed for other things – asking friends or family members for money or even breaking the law in order to obtain gambling money or recover gambling losses

The difference between a casual gambler and a compulsive gambler is that the latter one feels restless or irritated when they can’t gamble. They need the kick of betting money and will use gambling to relieve tension. While they may have tried to reduce gambling, they were not successful in the end. Effectively, they are losing not only money, but also valuable time from their lives, which are affected not only by the addiction itself but also by the long-term damage it causes them. An Australian study recently showed that 17% of suicidal people were problem gamblers.

Effective treatments for problem gambling involve a combination of counseling, step-based programs, self-help and peer-support. Sometimes medication is prescribed as well, however, only using one of these treatments alone is not considered to be sufficiently efficacious and no medications have been approved for the treatment of pathological gambling by the US Food and Drug Administration (FDA).

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Sep 07

Talking about ‘sex addiction’ in certain Asian cities is like talking about alcoholism during the ‘Oktoberfest’ in Munich: a firework of dirty jokes and winking confessions (‘yes, I’m an addict, too!’) are standard elements of these conversations. However, few people seem to know what sex addiction really is or means.

Sexual addiction (sometimes also called sexual dependency or sexual compulsivity) means that a person is unable to manage her sexual behavior, which is described as ‘compulsive’ in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association. It is thus often also referred as ‘hypersexuality’ in many papers. Excessive sexual drive can cause distress or serious problems not only for the affected persons but also to persons associated with them. Usually they invest a lot of time and money to satisfy their obsession with various activities related to sex, and may risk losing their jobs, ruining their relationships, interfering with their social life, and putting themselves at risk for emotional and physical injury. While for many, their behavior won’t progress beyond compulsive masturbation or the extensive use of pornography or paid sex services, for others, the addiction can involve illegal activities such as exhibitionism, voyeurism, obscene phone calls, sexual harassment or abuse and especially here in Asia, violating various Asian laws like filming sexual activities or organizing sex parties. Many sex addicts spend high percentages of their money due to their lowered sexual inhibitions – basically, most of their money-making and thinking ultimately turns around satisfying their sex drive. However, sex addicts hardly gain lasting satisfaction from their sexual activities and rarely form emotional bonds with their sex partners. To many, it feels like constant hunting – without ever achieving the satisfaction of feeling full.

Unfortunately, it is also typical for sex addicts to engage in distorted thinking – justifying and rationalizing their behavior and blaming others for the problems that arise as a result of their actions. As long as possible, they will deny they have a problem and find excuses for their behavior. Thus, it usually takes a significant event like the loss of their job, the break-up of their marriage, an arrest or a health crisis, to force the addict to admit that there is indeed a problem.

While professionals are still struggling with the exact definition and diagnosis of hypersexuality / sex addiction, there is no doubt that this disorder exists. Hypersexuality is also a criterion symptom of mania in bipolar disorders and schizoaffective disorders and often linked to depression or other forms of addiction, like alcoholism or drug abuse. Treatment of sexual addiction focuses on controlling the addictive behavior and helping the person develop a healthy sexuality.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

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06.01.16