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 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‘)

Sep 04

That psychotropic drugs and other psychoactive drugs often have negative effects on behavior, is well-known to most. That their use can cause aggression, is known with antidepressants such as Prozac and Ritalin. However, there haven’t been any systematic examinations of these drugs and drug groups for their impact on violent behavior.

Now, U.S. scientists from the Institute for Safe Medication Practices published a study in the open access journal PLoS One based on data provided by the Federal Drug Administration (FDA), in which for 31 of a total of 484 studied drugs they found an unusually strong coincidence with reports of violence against others. This does not mean that these drugs directly cause violence, but there could be a connection.

31 drugs of a total of 464 drugs evaluated were associated with 79 percent of cases of violence during a period of 69 months. This included 11 antidepressants, 3 drugs for the treatment of Attention Deficit Disorder/Hyperactivity Syndrome (ADD / ADHD), 5 sedatives and varenicline which is used during smoking cessation. Its active ingredient is sold under the name Champix and has numerous side effects, including suicidal behavior and aggression – therefore, the FDA has recently issued a warning for this substance. The use of varenicline has to be consiedered as highly questionable after this study and is at the top of the list of problematic drugs. One-fifth of the reports of violence were associated with this drug, the tendency to violence is 18 times higher with it than for the other drugs. Bupropion (in Germany acted as Elontril) which is also used for smoking cessation, has a smaller connection to violent behavior, but is primarily used as an antidepressant.

However, there are links to violence with all antidepressants: all ahead is fluoxetine (Prozac) with more than ten times likeliness of violent outbreaks, paroxetine is in third place. With all antidepressants, the connection to violence is 8.4 times more likely than for all other psychoactive drugs. There is also a high probability for amphetamines as Atomexitin (Strattera) and methylphenidate (Ritalin), which are used to treat ADHD and a 9 – and 3.4-fold higher risk of having connection to violence. Of the psychoactive drugs, there is the sleeping drug triazolam (Halcion) with a 8.7-fold and zolpidem with an 6.7-fold increased risk. Among the non-psychoactive drugs was mefloquine (Lariam), which is used for prophylaxis and treatment of malaria, with a 9.5-fold risk.

(Links to research papers and tables: “Medikamente und Gewalt” (German language; in: telepolis 12.01.2011)

May 03

When blood pressure rises, neck veins swell – and the rational mind is suspended. Aggression ‘beams’ us back to an early stage of our development … but once the adrenaline rush is gone, we often feel repentance over the damage we’ve done in our rush of emotions (be verbally or physically).

There are basically two categories of aggression: Affective Aggression (revenge, hostility, the tendency toward impulsive and uncontrolled behavior) and Instrumental Aggression (hunting, goal-oriented, deliberate behavior,). Empirical studies show that most people who have a tendency to Affective Aggression also have a lower IQ than those who do not.

Aggression is not synonymous for violence – but it can trigger violence. And there are cultural differences in the ways aggression is expressed. Studies have shown that people from the Southern states of America turn to physical violence more often than those in the Northern states than the Japanese, which prefer verbal conflict resolution. The same applies to people living in Northern and Southern countries of Europe. The murder rate is higher in these regions as well, and there is also a link between the tendency to violence and socialization. People who grow up in families with a high potential for aggression (verbal, mental or physical abuse experiences), adjust their behavior accordingly and have a tendency to outbursts of aggression later in their lives as well.

The same applies for the social acceptance of violence, such as violence against specific ethnic groups: a dynamic that is probably responsible for the never-ending spiral of violence in the Middle East. Many people also react aggressively when they feel they are not understood or taken seriously, or when they can’t achieve their goals and hopes. From a psychological perspective, this is mostly rooted in low self-esteem.

Many relationships are burdened by inappropriate expressions of aggression. Studies show that men are more likely to express aggression physically and directly, while women do it more verbally and indirectly. Relationship criseses often lead to escalating patterns – starting with a verbal exchange of blows, and at some point one partner loses control of himself/herself and injures the other one either physically or psychologically. The more regularly such processes occur, the more difficult it may be to resolve the conflict patterns in couples therapy, which again proves that the earlier professional help is sought, the more promising the results!

(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 src:allhealthsite.com)

Jan 14

When they hear the word ‘depression’, many people think of sad or hopeless individuals who can’t cope with a life event, who are living withdrawn and are often crying their existence.

But in fact this is only rarely the case. In a U.S. study published in 1996, for example, only a third of the patients suffering from depression could name a stressful or dramatic experience that took place before the disease kicked in. And it is by no means only negative events that can trigger depression in some people, but also such as the birth of a child or winning a business contract. That not all people who experience dramatic events develop depression also suggests that other factors such as stress or genetic factors may be involved. For patients themselves or their environment is therefore usually not even possible to identify a potential reason for a probable depression – which usually leads to long delays in search for the correct diagnosis for the malaise they feel in.

Physical symptoms are another, often misinterpreted facet of depressive disorders. Headaches, insomnia, reduced memory and concentration, but also other kinds of physical pain, digestive problems or a general lack of energy are typical physical symptoms of depression.

The lack of perspective that is typical for depression, quite often also leads to self harm. Most people who commit suicide previously suffered from an (often unrecognized or untreated) depression. But it doesn’t need to be suicide: other self-defeating forms of behavior, such as alcohol and drug abuse, self-destructive eating habits or risky driving are, as studies illustrate, linked to depression in about 60% of the cases.

Particularly in older men, depression often manifests on aggression, particularly of the verbal kind, like ranting, looking down or lashing out on others or constant cynicism. Again, these persons are only rarely aware that they actually suffer from depression, but explain their inner discontent and anger with external circumstances over which they usually can’t complain too loudly and often.

About 20-25% of women and 7-12% of men suffers with depression at least once in their life time. However, the real figures are probably higher due to the frequent misdiagnoses and years of suffering without a proper diagnosis and adequate treatment.

(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)

Nov 18

Bipolar Disorder: Caught between depression and excitement

John always felt that his wife was ‘changeful’ – but it took both of them years to find out that she was in fact suffering from so-called ‘bipolar disorder’. People with what was formerly called ‘manic depressive disorder’ cycle between unusually intense emotional states that occur in distinct periods: ‘manic episodes’ are defined by overly joyful or overexcited states, and ‘depressive episodes’ by extremely sad or hopeless feelings. However, sometimes symptoms of one state may also occur during the other, depending on the variation of the disorder which has been estimated to afflict about one of every 45 adults, independent of sex, culture or ethnic group.

One of the most common problems of persons dealing with this disorder is that they have serious difficulty set ting and achieving goals and maintaining stable relationships in their lives. During their manic episodes, they often experience an increase in energy, set themselves highly ambitious goals and might break up their relationships with people they consider as inferior or slowing them down. They tend to self-medicate, often through substance abuse (particularly stimulants or depressants, alcohol, cocaine or sleeping pills). Some of them tend to gambling, others might become aggressive or violent or experience a break with reality. As soon as the depressive episode kicks in, almost nothing of that remains: now, feelings of sadness, anxiety and guilt are dominating, and the person might feel isolated and hopeless. The formerly high sexual drive now almost disappears, fatigue, apathy or even suicidal thoughts may occur: The rate of bipolar patients committing suicide at certain points in their lives is very high.

Today, we still know little about the causes for bipolar disorders, but studies have indicated a substantial genetic contribution, as well as environmental influence (like an unstable or traumatic childhood). It is also likely that certain triggers are required to cause an outbreak of the disorder in some people, particularly relationship issues, cultural or job-related stress or physical illness. The basis of treatment usually consists of medication (which especially for this kind of disorder should really only be prescribed by a psychiatrist!) and complimentary psychotherapy to work on environmental triggers and efficiently learn to deal with the symptoms. The prognosis for most individuals with bipolar disorder is a good one – provided that they were diagnosed accurately and received the correct treatment.

(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)

Dec 29

Eine sehr interessante Auflistung von Studien findet sich in einem Artikel [1] in Telepolis: in diesen wurde nachgewiesen, da√ü bestimmte psychologische Tendenzen oder pers√∂nliche Neigungen sich offenbar in den sozialen Netzen, in denen sie auftreten, im Laufe der Zeit verbreiten. Was in bestimmten F√§llen (Rauchentw√∂hnung, Spa√ü an bestimmten T√§tigkeiten, Lebenszufriedenheit und Gl√ľck) ein Segen sein kann, ist in anderen (Einsamkeit, E√üst√∂rungen, Kriminalit√§t, Depression) wohl ein Fluch… Erkl√§rbar ist diese Neigung wohl mit der enormen Wichtigkeit, die unser engeres soziales¬†Umfeld seit urgeschichtlichen Zeiten hatte. Einzelg√§nger hatten w√§hrend den Anf√§ngen der Menschheit keine Chance zu √ľberleben, jeder war gut beraten, sich mit dem eigenen “tribe” zu arrangieren und die eigenen sozialen Parameter mit jenen der anderen Gruppenmitglieder abzustimmen. Im Grunde ist dies auch heute noch wichtig – wenn es sich viele auch nicht eingestehen m√∂gen, wo doch der Individualismus (z.T. sogar auf Kosten anderer) das aktuelle gesellschaftliche Ideal in der westlichen Kultur darstellt. Die vorliegenden Studien zeigen, wie sehr wir de facto unbewu√üt mit unserem sozialen Umfeld verbunden sind und uns diesem anpassen.

In eine √§hnliche Kerbe schlagen auch zwei andere Artikel der Website: laut aktuellen Statistiken habe sich die H√§ufigkeit von St√∂rungen aus dem Autismus-Spektrum [2] (z.B. auch Asperger-Syndrom) und antisozialem Verhalten [3] w√§hrend der letzten Jahre signifikant erh√∂ht. Bereits 1% der 8-J√§hrigen (1 von 110 Kindern) soll autistisch sein, im Jahre 2007 war es noch 1 von 150 Kindern. Und in England, wo seit 1998 “antisoziales Verhalten” definiert und schlie√ülich die ber√ľchtigten “Anti-Social Behaviour Orders” (ASBO) erlassen wurden, ist mittlerweile angeblich jede Sekunde ein Brite “Opfer von antisozialem Verhalten”. Was nicht allzu verwunderlich ist, liest man in den entsprechenden Unterlagen, da√ü schon “teenagers hanging around on the streets” als antisozial einzustufen sind.
Der sprunghafte Zunahme derartiger Zahlen k√∂nnte ganz einfach darin liegen, dass √Ąrzte, P√§dadogen oder Richter Kinder h√§ufiger entsprechend einstufen:

“Wenn neue Normen und damit Normverletzungen von einer Gesellschaft eingef√ľhrt werden, w√§chst auch die Wahrnehmung daf√ľr. Wenn es sich um vermeintlich abweichendes Verhalten handelt, w√§chst die Angst, die zuvor m√∂glicherweise gar nicht vorhanden war. Ganz √§hnlich ist das mit neuen St√∂rungen und Krankheitsbildern. Pl√∂tzlich gibt es eine Welle an Autismus, Internetsucht oder Aufmerksamkeitsst√∂rungen. Und keiner wei√ü wirklich, ob es neue Krankheitsformen sind oder sich eben nur die Norm verschoben hat.”

Quellen: [1], [2], [3]

Nov 04

Trotz des gro√üen Spektrums antisozialen Verhaltens wollen nun britische Wissenschaftler der University of Cambridge herausgefunden haben, was in m√§nnlichen Jugendlichen f√ľr antisoziales Verhalten mitverantwortlich sein soll. So sollen die K√∂rper von Jugendlichen, die “schwerwiegendes antisoziales Verhalten” gezeigt haben, unter Stress weniger Kortisol aussch√ľtten als Jugendliche, die nicht wegen antisozialen Verhaltens aufgefallen sind. Die Kortisolwerte steigen normalerweise unter Stress, so die Wissenschaftler, und lassen die Menschen vorsichtiger werden, w√§hrend sie gleichzeitig ihre Emotionen, also auch die Aggressivit√§t, besser steuern k√∂nnen. Wenn es eine Verbindung zwischen Kortisolwerten und antisozialem Verhalten gebe, dann m√ľsste man dieses als Ausdruck einer mit physiologischen Symptomen verbundenen Geisteskrankheit betrachten, sagen sie. Danach h√§tte es wenig Sinn, die Jugendlichen mit [Erziehungsma√ünahmen] zu disziplinieren, man m√ľsste sie vielmehr medizinisch behandeln. Manche Menschen w√ľrden also leichter “antisozial”, ebenso wie andere zur Depression oder Angst neigen (allerdings ist hier auch umstritten, ob tats√§chlich die Beeinflussung der vermeintlichen physiologischen Symptome durch Medikamente der therapeutische K√∂nigsweg ist).

Die Wissenschaftler meinen jedenfalls, man k√∂nne “neue Behandlungsweisen f√ľr schwere Verhaltensprobleme” entwickeln, wenn man genau herausgefunden hat, warum manche Jugendlichen keine normale Stressreaktion zeigen. Das liefe dann wahrscheinlich darauf hinaus, auff√§llige Kinder und Jugendliche medikament√∂s zu behandeln, um so “das Leben der betroffenen Jugendlichen und das der Gemeinschaft, in der sie leben, zu verbessern”. Zudem k√∂nne sich der Staat vielleicht Milliarden sparen ‚Äď und, so k√∂nnte man hinzuf√ľgen, √§ndern m√ľssten sich auch die Gesellschaft und die Bedingungen nicht, unter denen die Kinder und Jugendlichen aufwachsen.

(Quellen: telepolis, University of Cambridge)

Kommentar R.L.Fellner:

Die Frage, wie man m√∂glichst fr√ľh und effektiv die Entwicklung von “antisozialem Verhalten” unterbinden kann, besch√§ftigt englische Wissenschafter schon seit Jahren. Pikanterweise werden zu diesem Verhalten aber nicht nur Kriminaltaten gez√§hlt, sondern auch verh√§ltnism√§√üig harmlose Handlungen wie etwa Graffitis, Ruhest√∂rung, das Trinken in der √Ėffentlichkeit, M√ľll-hinterlassen, P√∂beln oder der Mi√übrauch von Feuerwerken. Auch allgemein “l√§stiges Betragen” z√§hlt das Innenministerium dazu (Liste).

Aus humanistischer Sicht ist diese Entwicklung nicht nur besorgniserregend, sondern auch in h√∂chstem Ma√üe fragw√ľrdig: wer verfolgt das Interesse an “behandelbarem L√§stigsein”, wer definiert hier die Grenzziehung zu “sozial erw√ľnschtem” Verhalten und wie darf man sich dieses vorstellen? Erh√§lt zuk√ľnftig jedes “ruhest√∂rende”, “M√ľll hinterlassende” Kind seine t√§gliche Anpassungs-Pille und seinen ersten Eintrag in den Datenbanken der Krankenkassen?
Die Jugend ist entwicklungspsychologisch eine Phase der Auflehnung und Unangepasstheit – seit den Anf√§ngen der Menschheit. Konsequenter, aber in gewissem Rahmen nachsichtiger Umgang mit dem Verhalten Jugendlicher und ein multiprofessioneller Ansatz haben sich bei massiver oder dauerhafter Verhaltensauf√§lligkeit bisher gut bew√§hrt – die Ausweitung der pathologischen Grenze, wie sie englische Modell vornimmt, ist deshalb klar abzulehnen. Ein noch weitaus flaueres Magengef√ľhl w√ľrde mir als Engl√§nder allerdings der offensichtlich gesellschaftspolitisch inspirierte Trend verursachen, Widerstand, Auflehnung oder fehlende Sozialkompetenz als behandlungsbed√ľrftige Krankheit zu redefinieren und damit entsprechende Angebote der Pharmaindustrie zu provozieren, statt das entsprechende Geld in die Bek√§mpfung der “anderen” -und wohl viel relevanteren- Ursachen zu stecken: die Verbesserung der sozialen Rahmenbedingungen dieser Jugendlichen, ein besseres Sozialsystem und vor allem Visionen, die ihr kreatives Potenzial und ihre Ressourcen anregen.