Tag Archives: Post-Traumatic Stress Disorder

Psychiatric Diagnoses I’ve Been Given

I just checked out the “30 days of mental illness awareness” challenge and was inspired to write a timeline of my mental health. Then I realized I already wrote it in 2015. Another question in the 30-day challenge though is what you’re currently diagnosed with. Seriously, I don’t know what exactly my current diagnosis is. I know what the university hospital psychologist diagnosed me with, but I am not sure the psychiatrist at my current community treatment team agrees.

I’ve had a lot of diagnoses in the past. I’ve had even more suggested diagnoses that never made it into my file. Today, I will write a list of the diagnoses I’ve had. I will comment on them too.

1. Autism spectrum disorder. I was first diagnosed with this twice in 2007, then again in 2010. I lost my diagnosis in 2016 and was rediagnosed in 2017. This is the only diagnosis I’m pretty sure of that I agree with 100%. It’s the only diagnosis that I’ve been given through a proper evaluation (several, in fact).

2. Adjustment disorder. This was my diagnosis upon admission to the mental hospital in 2007. I didn’t meet the criteria for depression or any other serious mental health condition but needed care anyway. I was at the time fine with that diagnosis and think the crisis team psychiatrist who made it, did a pretty good job of assessing me.

3. Impulse control disorder NOS. I was never told why I got this diagnosis. I just found it on my treatment plan in May 2008. Probably, it was a replacement for the adjustment disorder, which you can only have for six months once the stressor that caused it goes away. I never agreed with this diagnosis and didn’t really take it all that seriously.

4. Dissociative identity disorder. This was diagnosed in November of 2010 and was probably the most controversial diagnosis I’ve ever had. I wasn’t properly assessed for it and my psychologist at the time took what I told her almost at face value. I never believed deep down that I met the full criteria for this. I mean, yes I do have alters and I do have pretty bad dissociative symptoms sometimes, but amnesia is the exception. I find this terribly hard to admit but I do have to acknowledge this diagnosis was in part based on (self-)suggestion. I do believe, like I said, that I have some dissociative symptoms.

5. Post-traumatic stress disorder. I got this diagnosis together with the DID. I don’t really know why. I mean, yes, I did (and still do) have some symptoms, but I’m not sure I have nough and I never reported more than I actually had. I did get some assessment for this. I do currently believe I definitely do have some PTSD symptoms, particularly complex PTSD symptoms. Then again, there is a lot of overlap with borderline personality disorder traits.

6. Borderline personality disorder. This was diagnosed in 2013 and replaced DID and PTSD. It was later “downgraded” to BPD traits. I do agree I have BPD traits, but I am more the quiet borderline type.

7. Dependent personality disorder. I was given this diagnosis in 2016. Never quite agreed with it, except in the sense that I could be led to believe I had every disorder that was ever suggested to me.

8. Depression. This was diagnosed in 2017 by the university hospital psychologist. I had previously been diagnosed with depressive disorder NOS, but that, according to my psychologist, was only because a diagnosis on axis I (anything other than a personality disorder) is required for treatment. I admit I was pretty badly depressed in the months that I had my assessment at the university hospital, but am not sure it was bad enough for a diagnosis. I mean, I didn’t meet the criteria in 2007, so how could I meet them in 2017? I’m assuming my current psychiatrist removed that diagnosis.

T – #AtoZChallenge on Mental Health

Welcome to the letter T post in the #AtoZChallenge on mental health. I’m a little late once again to publish this post, because this was a hard letter and I have once again been very tired. Here goes.

Transition

Transition or transfer happens when a patient moves from one setting into another. This could be from an acute unit to a rehabilitation, resocialization or long-term care unit. It could also be from a psychiatric unit into supported housing or community care.

Trauma

Like I said yesterday, many psychiatric patients have endured some form of trauma. Trauma is experienced differently by different people. The diagnostic manual defines trauma for the purpose of diagnosing post-traumatic stress disorder as having endured, been confronted with or witnessed a situation that is life-threatening, threatened or actually caused physical harm, or sexual violation. Starting with DSM-5, it is made explicit that being confronted with such a situation through the media does not count. As such, people who for exampe watched the 9/11 terrorist attacks on TV (ie. virtually the whole world) cannot claim to have been traumatized by it. First responders who witnessed the events themselves, of course, can. So can people who lost loved ones in the terrorist attacks.

Please note that this definition is only used for the purpose of diagnosing PTSD. People can be diagnosed with another stressor-related disorder (eg. adjustment disorder with PTSD features) if their experience does not meet the criteria for trauma but is still distressing.

Treatment Planning

Treatment plans, like I explained when discussing care plans, describe the person’s overall treatment and diagnosis. On long-term psychiatric units, treatment plans are revised every six months or so. A patient has the right to contribute to their treatment plan and to review it, but on my unit, during the actual meeting, patients are not in attendance. I have only been asked to contribute once and am lucky if I know when my treatment plan revision is. Obviously, informal patients (and most patients on a section) must consent to their treatment plan before it can be implemented. In reality though, I’ve not seen my treatment plan in years so I think consent is automatically assumed.

Dissociation #Write31Days

31 Days of Mental Health

Welcome to day 28 in the 31-day writing challenge on mental health. Today, I will be discussing dissociation. I used to have a diagnosis of dissociative identity disorder, but dissociation is also common in post-traumatic stress disorder and borderline personality disorder.

Dissociation refers to a detachment from reality: disconnection from one’s surroundings, one’s own body, one’s mental processes or one’s identity. there are five different domains of dissiociation:


  • Depersonalization: a disconnection from one’s own body or mental processes. People who experience depersonalization feel “unreal”.

  • Derealization: a disconnection from one’s environment. The world around people who are derealized seems unreal or vague, as if looking through a glass wall.

  • Amnesia or memory loss. People who experience dissociative amnesia can be triggered by things that remind them of an unpleasant memory, but they do not remember the unpleasant event. Amnesia can also refer to “time loss”, where the person does not know what happened during a specific time period. Identity amnesia refers to a person not remembering who they are.

  • Identity confusion. This refers to being unsure of who one is. I have always believed that everyone has a level of identity confusion, but when I did a structured interview for dissociation, it appeared as though this isn’t really normal.

  • Identity alteration or “switching”. This refers to a person becooming “someone else”. This ccan be apparent on the outside, like by the person having a change in non-verbal communication that is unlike them. It can also be apparent on the inside, where the person just feels as though they’re “someone else”.


Dissociation is different from psychosis in that people who dissociate are still aware of reality. Most people with dissociative experiences do not experience delusions or hallucinations, though a PTSD flashback coupled with dissociation can look like it. At least in my case, I’ve appeared quite disorganized and out of my mind when in a flashback.

Dissociation to a certain extent is normal. Most people on occasion get “lost” in a book or movie, for example. When dissociation is more severe, you may have a dissociative disorder. There are several different dissociative disorders.


  • Depersonalization/derealization disorder is characterized primarily by depersonalization and/or derealization. This disorder can only be diagnosed if the depersonalization/derealization is not due to another mental disorder, such as a panic disorder.

  • Dissociative amnesia is primarily characterized, as the name suggests, by amnesia.

  • Dissociative fugue. This is a subtype of dissociative amnesia where the affected person travels away from their home or work and has amnesia for their entire life prior to travelling away. They also often adopt a new identity.

  • Dissociative identity disorder is characterized by both amnesia and dissociative phenomena affecting identity, ie. identity confusion and alteration. DID is considered to be the most severe dissociative disorder.

Depersonalization and derealization can, as I said, be part of another mental disorder, such as panic disorder. There is also a subtype of PTSD which is characterized by depersonalization and derealization. Other causes of depersonalization and derealization include stress and certain substances, such as marijuana.

The other dissociative disorders are believed to be trauma-based. Treatment involves psychotherapy. The psychotherapeutic treatment of DID consists of three phases:


  1. Stabilization. In this phase of treatment, a person learns coping skills to deal with flashbacks, keep themself safe and stay grounded.

  2. Processing the trauma that caused DID.

  3. Integration. This can refer to merging of the alters, but also to rehabilitation.


In 2011, Onno van der Hart, Kathy Steele and Suzette Boon published a manual for skills training in the first phase of DID treatment called Coping with Trauma-Related Dissociation.

My Experience With Therapy and Counseling #Write31Days

31 Days of Mental Health

Welcome to day 23 in the #Write31Days challenge on mental health. Today, I’ll focus on another question in the 30-day mental illness awareness challenge. For day 23, the topic is your opinion on therapy. I will share my experiences of therapy and my opinion on various approaches. I have decided to include both traditional psychotherapy approaches and non-verbal approaches.

I had my first experience of therapy as a child, when I had four sessions of play therapy. I didn’t like the therapist, didn’t have insight into my problems, and four sessions obviously wasn’t enough to garner any results. In hindsight, my play behavior did show my problems with rigid thinking, emotion regulation and behavioral control. For example, I’d throw out the dollhouse dolls with purple hair because “people don’t have purple hair”. I also preferred to play with toys that allowed me to show anger, such as toy guns. One vivid memory I have is of me trying to overflow the water tray. The therapist did show me why it wouldn’t work, but I tried anyway.

My first experience with verbal therapy was when I was nineteen and attending the rehabilitation center for the blind. Once again, I didn’t like the therapist, who appeared a bit inpatient towards my difficulties adjusting to blindness and misunderstanding of my social ineptitude. She tried to offer practical advice, while I felt I needed to process the rollercoaster ride that my life had become. Of course, time constraints – I had only about twelve sessions -, prevented us from going deeper.

During my first sixteen months in the psychiatric hospital, I didn’t have a psychologist. I did do movement therapy, which helped me greatly to release my emotional tension. It was here that I learned to rate my distress level – I came up with a system myself. Thhat being said, when later people asked me to rate my distress level, I was often stuck. This moveement therapist I had at the acute ward was one of the more helpful therapists I’ve had.

At the resocialization ward, I tried cognitive-behavioral therapy for a bit. It hardly worked, because I and my therapist agreed I had good reason to be anxious. Then, when I was diagnosed with DID and PTSD, the therapist pushed me to try EMDR, but I resisted. I didn’t have that severe PTSD symptoms, after all, and did have quite a bit of trouble with self-regulation and dissociation.

When I moved to my current institution, I got diagnosed with BPD. My therapist’s expertise was schema-focused therapy, an approach I’d wanted to use for a while. Unfortunately, it didn’t work out. The therapist told one of my parts, who hides her inner weakness behind a stubborn attitude, that she’s a “punitive parent” and needs to disappear. I strongly feel that each part of my personality has a function, so this dismissive attitude didn’t fit me well. Besides, though I learned some from the book the therapist recommended, most of the information was just a bit too abstract.

This therapist left in 2014 and I’ve had a new psychologist for a little over a year now. With her, I focus on supportive counseling and rehabilitation. I find this is most constructive. I do hope that, in the future, I can get some formal psychotherapy again. I have a dialectical behavior therapy self-help book, which is quite interesting. Then again, I find it hard to make a long-term commitment to sticking to one thing to focus on. That is probably the main thing keeping me from engaging properly in psychotherapy.

Animals and Mental Health #Write31Days

31 Days of Mental Health

Welcome to day 21 in the 31-day writing challenge on mental health. Today on a mental health E-mail list I’m a member of, the daily question for discussion was about animals. This inspired me to write a post on how animals can impact mentnal health and help people who struggle with mental illness.

There are many ways in which animals, and especialy pets, can help someone with a mental health problem. For example:


  • Pets provide uncomplicated love. While your relationships with family and friends might be strained because of your mental illness, a pet doesn’t care whether you hurt its feelings and doesn’t give you unwanted advice.

  • Pets give you a sense of responsibility. While pets do not ask for much, they require a certain level of care. This may seem overwhelming when you’re struggling with mental illness, but it can actually help you focus on something positive instead of on your negative mood.

  • Pets require you to get moving. While becoming physically active may seem hard when you’re in the pit of depression or another mental illness, it will actually help improve your mood. Having a pet who requires you to be active, such as a dog, can really help you get motivated to get your butt off the couch.

  • Pets help establsih a routine. They need regular feeding, walking or other care. A proper daily routine is good for your mental health.

  • With a pet, you’re never alone. You may withdraw from contact with friends or relatives, but your pet is always by your side.

  • Pets can help you engage in social interaction. Pets can be an easy topic to talk about that is not laden with negativity. Pets also often function as ice-breakers, for example when you are walking your dog or waiting at the vet’s. Even when your mental illness makes you appear reclusive, people will start interacting with your pet.

  • Touching pets can be soothing and thereby improve your mental health.

The benefits of pets can be even greater when the pet is trained as a service or therapy animal. Pet therapy, also known as animal-assisted therapy, is a form of therapy by which a specially trained pet interacts with individuals with mental health problems. The benfit of animal-assisted therapy over human interaction is that an animal accepts the individual as they are without judging or being threatening. Like I said before, they don’t care whetehr their feelings are hurt. People with emotional difficulties in particular often find it easier to trust pets than humans.

Like I said, animals can also be an ice-breaker, allowing the mentally ill person to open up more eaisly when interacting with the pet and its handler.

Psychiatric service dogs can be helpful to people with post-traumatic stress disorder and dissociative identity disorder, among others. They can, for instance, signal when a person with PTSD or DID is going to dissociate or have a flashback. They can then comfort the person or alert someone else. PTSD service dogs can sense when the sufferer is experiencing a nightmare and then wake them up. They can also enhance the sufferer’s feelings of safety by for example keeping strangers at a safe distance while at the same time encouraging social interaction.

Emotional support or companion animals do not provide any specific tasks for a person with a mental illness, like service animals do. Rather, they are solely there to provide emotional stability and companionship to the mental health sufferer. A licensed mental health professional should indicate that a mental health sufferer requires an emotional support animal. Emotional support animals should wear an identification vest or tag that says they’re an emotional support animal. In the U.S., people with registered emotional support animals are allowed to have their pets live with them even when no-pet policies are in place. People are also entitled to fly with their emotional support animals. However, unlike service animal owners, people with emotional support animals cannot claim access to other public or private places (such as restaurants) with their animals.

Mental Illness: Nature or Nurture? #Write31Days

31 Days of Mental Health

Welcome to the seventh installment of the 31 Days of Mental health series. Today, I picked another of the 30 questions from the 30-day awareness challenge: do you believe nature (biology, physiology, etc.) or nurture (your psychosocial environment) causes mental illness? I am very tired, too tired to find the scientific evidence to back my post up with. will share what I do know off the top of my head, but please don’t ask me to cite my sources.

In medicine in general, there used to be a strictly nature-based model of illness and health. This determined that biological and physiological processes in the body caused illness and there was no contribution of psychological or social influences. This model is called the biomedical model and my health psychology book used it to describe the history of views on physical illness.

In mental illness, there have been many schools of thought that laid blame on the environment, in fact. For example, Freud blamed fixations in one’s psychosexual development for mental illnesses. The school of behaviorism also blamed the environment. Watson, the founding father of behaviorism, at one point said that, if given a handful of babies at birth to raise, he’d be sure he could make whatever you wanted the babies to become from them purely by processes of conditioning (behavioral learning).

It is interesting that there is such a distinction between the biomedical views on physical illness and the psychosocial views on mental illness. After all, though religion may say otherwise, scientists usually see the mind as part of the body. At least the brain is and dysfunction in the brain can cause mental disorders.

I currently study healht psychology at university. Health psychology feels illness as resulting from an interplay of biological, psychological and social factors. Again, they usually study physical illness, but I must say I believe the same goes for mental illness.

I remember when I was still diagnosed with dissociative identity disorder reading a scientific article that said in part that the role of psychological trauma in the cause of what is often diagnosed as DID may be less significant than people think. They used the analogy of borderline personality disorder, which they said most people diagnosed with DID truly have. BPD is commonly thought of as a developmental trauma disorder, but research shows that there may be genetic and other biological factors predisposing to its development. Then again, trauma researchers have made it very clear that trauma and other strong environmental factors alter the brain.

I personally tend to believe there is not a single mental illness that is solely caused by nature or nurture. There are illnesses where biology is the main causative factor, such as schizophrenia, and illnesses where psychosocial factors are the main cause, such as post-traumatic stress disorder. However, stress can trigger psychosis in vulnerable people and trauma only causes PTSD in some of its victims, presumably those biologically predisposed to PTSD.

As for my own mental illness, there are biological factors predisposing me to developing mental disorders. Though I don’t have any family members diagnosed with a mental illness, autistic traits run in my family. NOw again I don’t see autism as a mental illness, but autistic people are more vulnerable to mental illnesses than neurotypicals. I also was a preemie, which may’ve caused brain dysfunction. Lastly, though none of my famly members are mentally ill, a difficult temperament tends to run in my family.

As for psychosocial factors, I am a childhood trauma survivor. I also have had high levels of stress in my life, possibly due to the incongruence between my autistic self and the neurotypical environment. It was a stressful event that sent me over the edge, but it was probably biology that predisposed me to vulnerability to stress.

How I Feel About My Mental Health Diagnoses #Write31Days

31 Days of Mental Health

Welcome to day 6 of the 31 Days of Mental Health for #Write31Days. Today, I’m feeling very ill-inspired, so I checked out the 30 days of mental illness awareness master list. This is an awareness challenge in which mental health sufferers answer 30 questions about their experience of mental illness. I am going to combine day 1 and 2 of the challenge and share how I feel about the diagnoses I have been given over time.

The first mental health diagnosis I received was adjustment disorder. Okay, I received a diagnosis of autism before, but most mental health professionals do not consider this a mental illness and in truth, it isn’t. It’s a neurodevelopmental disorder.

I received the diagnosis of adjustment disorder upon my admission to the psychiatric hospital in 2007. An adjustment disorder basically means an extreme reaction to stress that doesn’t meet the criteria for any other mental disorder (eg. depression). Well, how could I not agree to thsi diagnosis? I was under a lot of stress from living independently and I reacted in an extreme way.

I was fortunate at the time that insurance still covered treatment for an adjustment disorder. It would do in my case under the current policy too, because I was suicidal, but many people with psychosocial problems related to even more severe stressors such as a life-threatening illness go untreated for their mental health problems.

As I said before, I then received a diagnosis of impulse control disorder NOS. I didn’t feel right about this diagnosis. It wasn’t that I didn’t agree I had impulse control issues, but I had so many more issues. Why not diagnose me with half a dozen other NOS disorders?

Years later, I was diagnosed with dissociative identity disorder (DID) and post-traumatic stress disorder (PTSD). To be very honest, these never sat right with me. Though I did feel validated that I had some dissociative experiences, I felt I may not meet the full criteria for DID. I did have a lot of identity confusion and depersonalization/derealization (feelings of unreality), but I didn’t have a lot of identity alteration (switching to different personalities) till after my diagnosis and never quite had amnesia (memory loss). Okay, let me clarify this: I did have a sense of identity alteration long before my diagnosis, but I tried to never show it on the outside. That changed after my diagnosis. Now I feel I might have dissociative disorder NOS, but I don’t want to bring up my experiences again for fear of being told that I imagine it all.

That was, after all, exactly what happened after a few years. I went to a dissociative disorders support group, where the support group leader, herself a DID sufferer, eventually kicked me out. Her reason was that she felt I had an imaginary dissociative disorder. My new therapist, who changed my diagnosis to BPD, didn’t exactly go along with this, but she did say that BPD better explained my symptoms than DID.

With regard to PTSD, I never felt I had the full classic PTSD symptom presentation. Though I did and do have flashbacks and nightmares, they aren’t necessarily specific to the trauma I survived. This is possible in PTSD with young children but not adults. I also did experience emotional numbing but not avoidance of triggers. In fact, I was often drawn to triggers. I still am. I did and do however experience many symptoms of complex PTSD. Then again, these are similar to those of BPD.

In 2013, I was finally diagnosed with borderline persoanlity disorder. I almost instantly agreed I have it, but then again, I did with most conditions I’d been diagnosed with. I do still feel I meet enough criteria for a diagnosis, though I don’t exhibit as many classic BPD behaviors as I used to when first coming to my current institution. This is possibly related to my autistic difficulty adjusting to change.

My #InvisibleFight for Mental Health #IIWK15

Today is the start of INvisible Illness Awareness Week. I already shared a post on ths year’s theme, my invisible fight, last week. This was about my fight for a correct diagnosis and treatment of my physical symptoms.

If all goes as planned, I will be participating in a 31-day writing challenge in October on the topic of mental health. I have lived with mental health problems pretty much all my life, though I didn’t get into the care system till 2007. In today’s post, I’m sharing my fight for proper mental health care.

I have had a number of diangoses for my mental health problems over the years. At first, in 2007, I was diagnosed with an adjustment disorder caused by the stress of my living independently while being multiply-dsabled. I was hospitalized on a locked psychiatric unit and stayed there for 1 1/2 years. An adjustment disorder can only persist for six months after the stressor has gone (so after I’d been hospitalized), so I had to be diagnosed with something else eventually. My new diagnosis was impulse control disorder nOS. Several years later, I got diagnosed with dissociative identity disorder (formerly known as multiple personality disorder) and post-traumatic stress disorder (PTSD). These finally got changed to borderline personality disorder in 2013.

It’s been a long fight to get the care I deserve and the fight is ongoing. In 2008, when on the locked unit, I was treated with seclusion or threatened seclusion whenever I acted even slightly irritable. I wasn’t told that, being an informally-admitted patient, I had to give consent for this treatment. My problems were treated like willful misbehavior, even though my diagnosis of impulse control disorder should suggest the behaviors were at least to an extent beyond my control.

I had a horribly authoritarian social worker at the time. She was mostly in charge of my care, because I was at this unit awaiting appropriate long-term residential care. At one point, when I objected to applying at a certain supported housing place because I didn’t meet half the admission criteria, she threatened to get me a guardian. Not that my parents, who would’ve been the most likely choice for guardianship, would’ve stood in the way of my making my own decisions. I have said many negative things about my parents, but one positive quality of theirs is that they allow me to be in charge of my own life.

I had to fight to be admitted to a resocialization unit in 2009. I first had to fight my social worker, who wanted to transfer me to a low-level supported housing placement instead. That was just too big a leap. I also had to fight the treatment team at the resocialization unit, who were skeptical I’d be able to cope on an open unit.

Once at the rsocialization unit, I got better treatment than I’d gotten at the locked unit. However, I didn’t get much better. Eventually, medicaiton was suggested. This was a huge step, as the doctor at the locked unit had always ignored my questions and suggestions about possibly going on medication. My antipsychotic is truly a lifesaver. Its dose had to be increased several times and an antidepressant had to be added, but now I’m quite stable.

In 2012, when I’d been diagnosed with dissociative identity disorder for some years but was noticing my psychologist didn’t have a clue how to treat it, I took it upon myself to find a suited therapist. I E-mailed around, was rejected many times, but eventually found someone. Unfortunately, by the time she had a spot for me, I’d transferred to my current institution and my diagnosis had just been changed to borderline personality disorder.

As the years passed, I got to know and love my husband and we eventually married in 2011. We originally weren’t planning on living together, but early this year, I changed my mind. We’ve been working towards discharge for me ever since. Thankfully, my psychologist and social worker are quite cooperative. The fight is not yet over. In fact, now that my discharge is coming closer being probably around three to six months away, I have to fight my inner demons. In other words, I have to fight the fear that I’ll break down again, like I did in 2007. Thankfully, my psychologist and social worker are understanding of this. I am hoping that, once I am settled in at my and my husband’s apartment, I can finally get treatment for my emotion regulation problems.

Everyday Gyaan

Also linking up to Invisible Illness Awareness Week 2015: Your Invisble Fight.

Anxiety

One of the Friday Reflections prompts for this week is to write about anxiety. How does it affect me and what do I do to cope? I will write here about my experiences with various types of anxiety. It ties in nicely with last Monday’s post, in which I share tips for relaxation. However, throughout this post, I will share some coping strategies that have and haven’t worked for me too.

In the psychiatrist’s manual, DSM-5, there are various types of anxiety disorders. Now I don’t have a diagnosis of any of these disorders, but they are a good reference point for the various types of anxiety that people may experience.

Generalized anxiety disorder (GAD) is a condition in which a person feels anxious or worried about a variety of situations. This worry is accompanied by a feeling of restlessness, fatigue, difficulty concentrating, irritability, sleep disturbance and/or muscle tension. Generalized anxiety disorder often co-occurs with depression.

Though I haven’t had a diagnosis of GAD, partly because my owrrying can be explained by my autism, I have been a chronic worrier all my life and experienced many of the associated symptoms I mentioned above. Antidepressants can help this type of anxiety and in fact are more effective for GAD than for depression. I have been taking the antidepressant Celexa since 2010 with moderate success.

Some people worry about specific things happening to them. For example, I have a lot of anxiety about getting a serious illness. This is called hypochondria or health anxiety. In the psychiatrist’s manual, it is classified as a somatic symptom disorder rather than an anxiety disorder, but the symptoms overlap with those of anxiety disorders. Some doctors have tried antidepressants for health anxiety and documented significant improvement in their patients. It is also commonly thought that people’s health anxiety lessens, ironically, when they do get seriously ill.

My health anxiety is associated with compulsive behaviors. For example, when I was a child, I was afraid of contracting leprosy. As a means of keeping my worry at bay, I’d count my fingers and toes, since I heard that people who had leprosy had those fall off.

Later on, when I lived independently, obsessive worrying and the resulting compulsive behaviors extended to other situations. For example, I’d be afraid of carbon monoxide poisoning and would have to check that my heating was off and windows open at night. I often checked this twenty or thirty times a night.

Obsessive compulsive disorder (OCD) is classified in DSM-5 under its own category separate from anxiety disorders. The obsessive compulsive spectrum also includes disorders that aren’t commonly seen as anxiety disorders, such as hoardng and trichotillomania (compulsive hair pulling). However, OCD used to be seen as an anxiety disorder. Antidepressants can help, but so can exposure and response prevention. In this type of psychotherapy, the patient is gradually taught to lessen the compulsive response (eg. checking) to a feared scenario. For example, people who have hygiene-related compulsions gradually move from say a three-hour shower down to normal shower time, decreasing their time under the shower by one minute a day. For me personally, my obsessions and compulsions related to the risk of carbon monoxide poisoning decreased dramatically when I was hospitalized.

Another type of anxiety disorder is specific phobia. Everyone probably has something they are fearful of, but a specific phobia is only diagnosed when the fear and resulting avoidance of situations greatly impairs the person’s daily functioning. Similar to OCD, specific phobias are treated with exposure therapy, where the person is gradually intrduced to the feared situation or object and learns to endure the fear. For example, a person with a spider phobia might be first intrduced to pictures of spiders, then videos, then look at a live spider, etc. You can also be asked to simply imagine the feared scenario (eg. looking at a spider). After all, with certain phobias, it is not feasible for the therapist to take the client on to the real experience.

A final type of anxiety is social phobia. A person with social phobia is extremely fearful of social situations because of the fear of making mistakes or being criticized. As a result, people with social phobia avoid certain or all social situations. Many autistic people develop social anxiety as a result of their real social ineptness. I for one do not consider myself that socially anxious, but when I filled out a social phobia questionnaire online, it said I had very sevre social phobia. This is probably because I get overwhelmd by social situations easily and avoid them because of this.

People with social phobia, often children, may also suffer from a co-existing condition called selective mutism. This is an inability to talk in certain situations (eg. at school) while the child has adequate speech in other situations (eg. with parents). I displayed signs of selective mutism as a teen. Though this was in part anxiety-related, it also related to my autism.

There are still many other types of anxiety and related disorders, such as panic disorder and agoraphobia. Post-traumatic stress disorder (PTSD) also used to be classified as an anxiety disorder. I used to have a diagnosis of PTSD and still have some of its symptoms, but I may discuss this at a later time.

Reflections From Me

To My Baby Self

I have been thinking a lot about my life in the context of premature birth. It may be because I’m currently reading For the Love of Babies by Sue Hall, a neonatologist writing about her experiences treating preemies and other sick babies.

Today I also came across a writing prompt for PTSD survivors, to write to yourself before any trauma occurred. Since my trauma started right with my NICU experience, and I’m over most PTSD symptoms now, I will instead write to my baby self reassuring her that things’ll be okay in the end.

Little baby, born too soon
You feel so insecure
But let me tell you, you’ll be fine
Of that I am sure

You are too young to realize
That you are here to stay
In this world that may be harsh
You will be okay

Times are hard on you, you feel
So often in pain
If you could tell me, would you say
That your life is in vain?

I will tell you, it is not
Your life is worth the fight
I am your older self and feel
That you and I came out alright

Some people may think of you
That you should not survive
But guess what, you did exactly that
And I am here and thrive

You will have many hardships ahead
But please persist and cope
I will wait here to remind you
Not to give up hope