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Anxiety and Stress Disorders

How to Identify A Mental Disorder?

03/05/2001

Question:

I`m 22 years of age and I want to find out more about anxiety stress disorders also about bipolar disorder and chemically imbalanced and borderline personality disorder. I have been given four different diagnosis. They`re listed above. I also have Post-traumatic Stress Disorder. I have been very violent towards my husband for the last couple of weeks. He is scared of me he believes I could hurt him, harm him especially kill him because of my rage and anger. He can say something as a joke and I get offended by it and we end up arguing for a half hour or more. There is times that I would be playing with him like wrestling and one thing lead to another I would actually be fighting him.

There is more but I just want to know if I have been off of my medication since 1996 of November, do I need to get back on them? I also need to know if this might be considered schizophrenic? I`ve been told that I do have different personalities because I am nice one minute and the next I am throwing things , breaking things and another minute I am wanting to kill whoever it is. I never harmed anyone in my life and I think it is just the devil trying to put that kind of stuff in my head please, help me if possible.

Answer:

You inquired about a number of different disorders, each of which has distinct features. Although they differ from one another, it can, at times, be difficult to tell certain disorders apart.

We will do our best to give a brief description of each disorder for you. In some cases we have left out symptoms or other important information to give just a brief overview of the disorder. Please understand that these descriptions are very brief, and should not be used to diagnose yourself or someone else-this should only be done by a mental health professional.

Bipolar Disorder (also known as manic-depression) is a mood disorder, which means the main difficulties are ones of maintaining a stable mood. Individuals with bipolar disorder cycle between feeling extremely sad, down or lack pleasure or interest in activities which used to make them feel good. This sad or `hollow` mood lasts for approximately 2 weeks or more and interferes with daily living (`major depression`). At the other end, these individuals experience feelings of extreme high mood, or mania.

Typically individuals experiencing a manic episode will need far less sleep (but still feel normally energetic) or will feel like they have a great deal more energy, to the point of starting many different projects or activities, often without completing ones they have started.

In some cases individuals in a manic episode will spend money recklessly (esp. spending money they do not have) or engage in other impulsive behaviors, such as initiating sexual relationships with people they do not know, or shoplifting. Some individuals experience hallucinations or problems with their thinking (esp. feeling like thoughts are racing through their head, or feelings of paranoia).

Normal cycles of mood are common, but individuals with Bipolar Disorder experience very extreme changes in mood. These swings can be separated by many months in some cases.

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder. This means that the main symptoms are ones associated with feelings of anxiety. This disorder requires that you have experienced or witnessed a traumatic event (e.g., you might have been raped, witnessed a murder, or had an experience in which you almost died).

This experience keeps coming back to you in `flashbacks` or nightmares, where you feel like you are reliving the experience. You may feel good at one moment, then suddenly remember this event and feel like it is occurring all over again, or you may feel intense anxiety when you are in situations which remind you of this unpleasant event. In addition, individuals with PTSD often have difficulty with their mood--they may feel depressed, irritable or have difficulty controlling their moods.

They also typically have `hypervigilance` which means that they are always paying attention to things that might be threatening or harmful, and may show extreme reactions to even small indications of danger (e.g., if they hear a car backfire, they may respond by running for cover or they may be paralyzed by fear). Often individuals with this disorder feel like their surroundings are not real, or as though they have `left their body,` particularly when they are having a flashback.

Borderline Personality Disorder is considered a personality disorder, which means that it refers to the way a person generally behaves or interacts with his/her world, rather than a difficulty of mood or anxiety (or other area of functioning).

Individuals with Borderline Personality Disorder typically struggle in their relationships with others, finding themselves to have very intense, emotional relationships with others, which can often end suddenly. Typically these relationships are `stormy`--marked by frequent fighting, followed by a `honeymoon` period.

In addition, individuals with Borderline PD often are highly sensitive and respond to stress with strong negative feelings--they often feel they cannot cope with stress (esp. in relationships). There are other features of Borderline PD, which vary among individuals. However, this disorder requires that you have started having difficulties before the age of 18, and experience difficulties in a wide variety of situations and relationships. `Chemical Imbalance` is not actually a medical diagnosis.

This is simply used to indicate that the chemical messengers in your brain (neurotransmitters) are not in the right balance. You may have too little or too much of a particular chemical in your brain, which impacts your behavior. Most disorders are linked to different types of difficulties with neurotransmitters (e.g., depression is associated with difficulties in balancing serotonin, dopamine, etc.).

Many medications are designed to help bring levels of these neurotransmitters back into balance.

Schizophrenia is commonly thought of as being a disorder in which an individual has `two personalities` but, in fact, individuals with schizophrenia do not have more than one personality (that would be `Dissociative Identity Disorder` or `multiple personality disorder`). Instead, individuals with schizophrenia have a difficult time with reality. The most common symptoms of schizophrenia include hallucinations (seeing, hearing or feeling things that are not really there. For example, many individuals with schizophrenia hear voices (usually talking or whispering). These voices may talk to the person, or about them, or may be difficult to understand. Another common difficulty is having difficulties with thoughts. For example, some individuals with schizophrenia believe that they are being controlled by other people or things, or that they have thoughts placed in their heads. Some individuals feel that others are out to get them, even though there is no evidence that anyone is trying to hurt or harm them.

Some show odd behavior or tics, such as wearing many jackets on a hot day, or twirling around the street. Other individuals with schizophrenia show a lack of response to the world-they may seem almost as though they are not really `there` (catatonic) or may have little motivation to do things. Unfortunately, many of these disorders share similar symptoms or have overlap in symptoms.

Individuals with Bipolar Disorder often have `stormy` relationships similar to those shown by individuals with Borderline Personality Disorder, but the reasons for these difficulties with others are caused by changes in mood, rather than other difficulties.

Individuals who are feeling depressed may not be motivated to go out of the house, bathe or spend time with others, but these might also be symptoms of schizophrenia, though in the first case the problems are associated with a sad mood, and they go away when mood improves, while in the case of schizophrenia these symptoms are longer lasting.

In addition, an individual can have more than one of these diagnoses, so it becomes difficult to say that there is just one problem, when an individual may in fact be suffering from many different disorders.

We cannot diagnose you with any disorder, but if you have a doctor with whom you have a good relationship, this is probably a good time to start seeing him/her again. If your husband is concerned about your safety, or his own, this may be a sign that your difficulties are increasing.

If you have been violent with yourself or others then it is important to get help as soon as possible. You, yourself, note feeling out of control one minute and in control the next--certainly not pleasant feelings!

If you do not have a regular doctor, we encourage you to find a psychiatrist or mental health professional who can help you better understand your difficulties. You indicated you have taken medication previously. It is important to talk to your doctor about the types of medicines you have taken before, how well they worked for you, and what side effects they had.

You and your doctor might decide to try these medications again, or may find newer medications that can help you feel more in control of yourself, your feelings and your thoughts.

Good luck

For more information:

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Response by:

Norman B Schmidt, PhD
Associate Professor
College of Social and Behavioral Sciences
The Ohio State University

Kathleen Kara Fitzpatrick, MA
Clinic Staff
College of Social and Behavioral Sciences
The Ohio State University