AUTISM

Autism, also known as Autism Spectrum Disorder involves impairment in several areas of development, which includes social interactions, communication with others, and everyday behaviors, interests, and activities.

Richard, a child with autism, shows a range of deficits characteristic of this disorder.

“Richard, aged 3½ years, appeared to be aloof from others. He did not greet his mother in the morning nor his father when he returned from work, and when left with a baby-sitter, he would scream much of the time. He had no interest in other children and ignored his younger brother. His babbling had no conversational intonation. At age 3 he could understand simple practical instructions. His speech consisted of echoing some words and phrases he had heard in the past, with the original speaker’s accent and intonation; he would use one or two such phrases to indicate his simple needs. For example, if he said, “Do you want a drink?” he meant he was thirsty. He did not communicate by facial expression nor use gesture nor mime, except for pulling someone along with him and placing his or her hand on an object he wanted. He was fascinated by bright lights and spinning objects and would stare at them while laughing, flapping his hands, and dancing on tiptoe. He was intensely attached to a miniature car, which he held in his hand, day and night, but he never played imaginatively with this or any other toy. From age 2 he had collected kitchen utensils and arranged them in repetitive patterns all over the floor of the house. These pursuits, together with occasional periods of aimless running around, constituted his whole repertoire of spontaneous activities.

The major management problem was Richard’s intense resistance to any attempt to change or extend his interests. Removing his toy car, even retrieving, for example, an egg whisk or a spoon for its legitimate use in cooking or trying to make him look at a picture book, precipitated temper tantrums that could last an hour or more, with screaming, kicking, and biting himself or others. These tantrums could be cut short by restoring the status quo. Psychological testing gave Richard a mental age of 3 years in non-language-dependent skills (such as assembling objects) but only 18 months in language comprehension”. 

Let us analyse the case of Richard that shows a range of deficits attributed to this disorder.

Autism involves three types of deficits. The first type is deficits in social interaction, such as lack of interaction with family members. As infants, children with autism may not smile and coo in response to their caregivers or initiate play with their caregivers, the way most young infants do. They may not want to cuddle their parents, even when they are frightened. Whereas most infants love to gaze at their caregivers as the caregivers gaze adoringly at them, infants with autism may hardly ever make eye contact. When they are a bit older, children with autism may not be interested in playing with other children, and may prefer to remain in solitary play. They also do not seem to react to other people’s emotions.

The second type of deficit in autism involves communication. Approximately 50 percent of children with autism do not develop useful speech. Those who do develop language may not use it as other children do. In the above mentioned case, Richard showed several of the communication problems of children with autism. Rather than generating his own words, he simply echoed what he had just heard, a phenomenon called echolalia. He reversed pronouns, using “you” when he meant “I”.  When he did try to generate his own words or sentences, he did not modulate his voice for expressiveness, instead sounded almost like a voice generating machine.

The third type of deficit involves activities and interests of children with autism. Rather than engaging in symbolic play with toys, they are preoccupied with one part of a toy or an object, as Richard was preoccupied with his miniature car. They may engage in bizarre, repetitive behaviors with toys.

Routines and rituals often are extremely important to children with autism. When any aspect of the daily routine is changed—for example, if the mother stops at the bank on the way to school—they may fly into a rage. Some children perform stereotyped and repetitive behaviors using some parts of their body, such as incessantly flapping their hands or banging their head against the wall. These behaviors are referred to as self-stimulatory behaviors. 

Children with autism often do poorly on measures of intellectual ability, such as IQ tests, with 50 to 70 percent of children showing moderate to severe intellectual impairments (Sigman, Spence, & Wang, 2006). The deficits of some children with autism, however, are confined to skills that require language and understanding others’ point of view, and they may score in the average range on subtests that do not require language skills.

However, there are some autistic children who have above average intelligence and special talents such as the ability to play music without being taught or to draw extremely well, or exceptional memory and mathematical calculation ability as depicted in the movie “Rain Man“. The symptoms of autism have their onset before age three. 

Several studies have shown remarkable improvement in cognitive skills, intellectual and educational functioning and behavioral control in children with autism who were treated with a comprehensive behavior therapy administered both by their parents and in their school setting.

GENERALIZED ANXIETY DISORDER (GAD)

The phobias and panic disorder involve periods of anxiety that are acute, usually short-lived, and specific to certain objects or situations.

However, some individuals are anxious all the time, in almost all situations. These individuals may be diagnosed with generalized anxiety disorder (GAD).

Individuals with Generalized Anxiety Disorder worry about their performance on the job, their relationships with family and colleagues, and their health. The focus of their worries may shift frequently, and they tend to worry about many things instead of focusing on only issues of foremost concern. Their worry is accompanied by physiological symptoms, including muscle tension, sleep disturbances, and chronic restlessness. People with GAD feel tired much of the time, probably due to chronic muscle tension and sleep loss.

The disorder most commonly begins in childhood or adolescence.

Over 50 percent of people with GAD also develop another anxiety disorder. Over 70 percent experience a mood disorder, and 33 percent have a substance use disorder (Craske & Waters, 2005; Kessler et al., 2002).

The Diagnostic and Statistical Manual of Mental Disorders, Text Revision-IV (DSM-IV-TR) provides the framework of the criteria of Generalized Anxiety disorder.

  • Excessive anxiety and worry (apprehensive expectation) must be persistently present for more days than not for 3 to 6 months, about several events or activities (such as work or school performance etc.).
  • The person finds it difficult to control the worry.
  • The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 3 to 6 months).

1. Restlessness or feeling keyed up or on edge

2. Muscle tension

3.Difficulty concentrating or mind going blank

4. Irritability

5. Being easily fatigued

6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

Due to anxiety and worry about situations, individuals frequently spend inordinate amounts of time and energy preparing for feared situations or avoiding those situations and are immobilized by procrastination, indecision, and seek reassurance from others. These behavioural symptoms of anxiety are very common and lead to significant impairment in an individual`s life.

Understanding the development of Generalized Anxiety Disorder

The cognitions of people with GAD are focused on threat, at both the conscious and unconscious levels. At the conscious level, people with GAD make several maladaptive assumptions, such as “It’s always best to expect the worst” and “I must anticipate and prepare myself at all times for any possible danger.” Many of these assumptions reflect concerns about losing control. People with GAD believe that worrying can help them avoid bad events by motivating them to engage in problem solving. Yet they seldom get to the problem-solving approach. Although they are always anticipating a negative event, they actively avoid visual images of what they worry about, perhaps as a way of avoiding the associated negative emotion. The maladaptive assumptions lead people with GAD to respond to situations with automatic thoughts that stir up anxiety, cause them to be hypervigilant, and lead them to overreact.

When facing an exam, a person with GAD might ruminate, “I do not think I can do this,” “I’ll fall apart if I fail this test,” and “My parents will be furious if I do not get good grades.”

The unconscious cognitions of people with GAD also appear to focus on detecting possible threats in the environment. In the Stroop colour-naming task, participants are presented with words printed in colour on a computer screen. Their role is to say what colour the word is printed in. In general, people are slower in naming the colour of words that have special significance to them (such as disease or failure for people with chronic anxiety) than in naming the colour of nonsignificant words. Presumably they are paying more attention to the content of those words than to the colours (Mathews & MacLeod, 2005).

Why do some individuals become vigilant for signs of threat? Individuals who have experienced stressors or traumas that were uncontrollable or unpredictable develop chronic anxiety and therefore become more watchful for signs of threat.

Treatment for Generalized Anxiety Disorder involves Cognitive-behavioral treatment that focuses on helping individuals with GAD confront the issues they worry about the most; challenge their negative, catastrophizing thoughts; and develop coping strategies.

PANIC DISORDER

Many of us experience occasional panic attacks, especially during times of stress. For most of us, the attacks are annoying, but these events do not change how we live our lives. Nevertheless, when panic attacks become a common occurrence, when they are not usually provoked by any situation, and when a person begins to worry about having them and changes behaviours as a result of this worry, a diagnosis of Panic disorder may be made.

The Diagnostic and Statistical Manual of Mental Disorders, Text Revision-IV (DSM-IV-TR) provides the framework of the criteria of Panic disorder.

A) Recurrent unexpected panic attacks, defined as a discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes:

  1. Palpitations, pounding heart, sweating
  2. Trembling or shaking
  3. Shortness of breath or choking
  4. Chest pain or discomfort, feeling of getting choked
  5. Nausea or abdominal distress
  6. Feeling dizzy, light-headed
  7. Derealization or depersonalization
  8. Fear of losing control or going crazy
  9. Fear of dying, chills or hot flushes
  10. Paresthesia (tingling, pricking, or burning sensation on the skin)

B) At least one of the attacks is followed by one month (or more) of one or more of the following:

1. Persistent concern about having additional attacks

2. Worry about the implications of the attack or its consequences

3. A clinically significant change in behavior related to the attacks

Some individuals with panic disorder have many episodes in a short period of time, such as every day for a week, and then go weeks or months without any episodes, followed by another period of frequent attacks. Other individuals have attacks less frequently but more regularly, such as once every week for months. Between full-blown attacks, they may possibly experience minor bouts of panic.

People with panic disorder often fear that they have a life-threatening illness. Even after such an illness is ruled out, they may continue to believe they are about to die of a heart attack, seizure, or other physical crisis. Another common but erroneous belief is that they are “going crazy” or “losing control.”

About 3 to 5 percent of people develop panic disorder at some time (Craske & Waters, 2005; Kessler et al., 2005), usually between late adolescence and the mid-thirties. It is more common in women and tends to be chronic (Craske & Waters, 2005).

Those with panic disorder who are depressed or who abuse alcohol may be at increased risk for suicide attempts (Goodwin & Roy-Byrne, 2006).

Let us look at the potential causes for Panic disorder.

  • The Integrated Model

Many people who develop panic disorder seem to have a biological vulnerability to a hypersensitive fight-or-flight response. With only a mild stimulus, their heart begins to race, their breathing becomes rapid, and their palms begin to sweat. They typically will not develop frequent panic attacks or a panic disorder, however, unless they engage in catastrophizing thinking about their physiological symptoms. This thinking increases physiological activation, and a full panic attack ensues. For example: A person prone to panic disorder who feels a bit dizzy after standing up too quickly might think, “I’m really dizzy. I think I’m going to faint. Maybe I’m having a seizure. What’s happening?”

This kind of thinking increases the subjective sense of anxiety as well as physiological changes such as increased heart rate. The person interprets these feelings catastrophically and is on the way to a full panic attack. These cognitions also make the individuals hypervigilant for signs of another panic attack, putting them at a constant mild to moderate level of anxiety. This anxiety increases the probability that they will become panicked again, and the cycle continues.

Some individuals then begin to associate certain situations with symptoms of panic and may begin to feel them again if they return to the situations.

By avoiding these situations, they reduce their symptoms, thereby reinforcing their avoidance behavior. This process is known as a conditioned avoidance response. Thus, a man who has a panic attack while sitting in a theater may later associate the theatre with his symptoms and begin to feel anxious whenever he is near it. By avoiding it, he can reduce his anxiety. He may associate other places, such as his home or a specific room, with lowered anxiety levels, so being in these places is reinforcing. Eventually, he confines himself only to his safe places and avoids a wide range of places he thinks are unsafe. As a result, agoraphobia develops.

Treatment for Panic disorder involves Cognitive-behavioral therapy: that teaches clients to use relaxation exercises and to identify and challenge their catastrophic styles of thinking. Often panic attacks are induced in therapy sessions in order to challenge catastrophic thinking.

Cognitive-behavioural therapy facilitates clients to confront the thoughts and situations that arouse anxiety. Confrontation helps in two ways: It allows irrational thoughts about these situations to be challenged and changed, and it extinguishes anxious behaviour.

  1. First, clients are taught relaxation and breathing exercises, which impart some control over symptoms.
  2. Second, the therapist guides clients in identifying the catastrophizing cognitions. Clients may keep diaries of their thoughts on days between sessions, particularly at times when they begin to feel they are going to panic.
  3. Third, clients practice relaxation and breathing exercises while experiencing panic symptoms in the session. If attacks occur during sessions, the therapist talks to the client, coaching them in the use of relaxation and breathing skills and suggesting ways of improving their skills. The therapist notes the clients’ success in using the skills to control the attacks.
  4. Fourth, the therapist challenges clients’ catastrophizing thoughts and teaches them to challenge these thoughts themselves.
  5. Fifth, the therapist uses systematic desensitization therapy to expose clients gradually to a hierarchy of fears while helping them maintain control over their symptoms.

OPPOSITIONAL DEFIANT DISORDER (ODD) IN CHILDREN

Oppositional defiant disorder, categorized as a Behaviour Disorder in Childhood is considered a less severe pattern of chronic misbehaviour among children.

Children with oppositional defiant disorder are not aggressive toward people or animals, do not destroy property, and do not show a pattern of theft and deceit. However, these children have been increasingly difficult to manage since nursery school.

At school, they tease and kick other children, stumble on them, and call them names. They are described as bad-tempered and irritable, though at times they seem to enjoy school. Often, these children appear to be deliberately trying to annoy other children, though they always claim that others have started the argument. They do not get in serious fights but do occasionally exchange a few blows with other peers. They sometimes refuse to do what teachers tell them to do and give many reasons why they should not have to do the work and argue when told to do it.

At home, on some days they are defiant and rude to their parents, needing to be told to do everything several times, though they usually comply eventually. Other days they are charming and volunteer to help, but their unhelpful days predominate. The least little thing upsets them, and then they shout and scream at home. These children tell many minor lies,  though when pressed they are truthful about significant topics”.

To recapitulate, the behaviour of children with Oppositional Defiant Disorder is described by the following characteristics, which are prevalent for alteast six months:

  1. Frequently loses temper and quarrels with grownups

2. Actively disobeys rules or requests

3.Intentionally irritates others and blames others for errors or misconduct

4. Gets easily annoyed by other people and is vindictive.

Symptoms of oppositional defiant disorder often begin during the toddler and preschool years. Some affected children seem to outgrow these behaviours by late childhood or early adolescence.

However, others, particularly those who tend to be aggressive, go on to develop conduct disorder in childhood and adolescence.

Biological factors that have been implicated in the development of ODD include genetics and imbalance of neurotransmitters. In addition, psychological factors such as poor parental supervision, parental uninvolvement & parental violence are associated with ODD.

Treatment for ODD involves Cognitive-behavioural therapy that focuses on changing hostile cognitions & teaching children problem-solving skills.

Alongside, parents are instrumental in a child`s life. Parents should create a supportive-accommodative structured environment that will promote learning, enforce discipline, and boost self-esteem of children.

Conduct Disorder(CD) in children

We have all known bullies and troublemakers all through our school days. However, a small number of children engage in other serious transgressions of societal norms for behaviour and demonstrate a chronic pattern of unconcern for the basic rights of others.

The Diagnostic and Statistical Manual of Mental Disorders, Text Revision-IV (DSM-IV-TR) provides the framework of the criteria of Conduct Disorder

A) Repetitive and persistent pattern of behavior in which the basic rights of others or societal norms are violated. This is demonstrated by the presence of three or more of the following characteristics in the past 12 months, with atleast one in the past 6 months.

  • Aggression to people and/or animals

1. Often bullies, threatens, or intimidates others and initiates physical fights

2. Has used a weapon that can cause serious physical harm to others

3. Has been physically cruel to animals

  • Destruction of property

1. Has deliberately engaged in fire setting with the intention of causing serious damage

2. Has deliberately destroyed others’ property (other than by fire setting)

  • Deceitfulness or theft

1. Has broken into someone else’s house, building, or car

2. Often lies to obtain goods or favors or to avoid obligations

3. Has stolen items of crucial value without confronting the victim (e.g., shoplifting but without breaking and entering; forgery)

  • Serious violations of rules

1. Often stays out at night despite parental prohibitions, beginning before age 13 years.

2. Has run away from home overnight at least twice while living in a parental home.

3. Is often Truant from school.

Truancy, also called skipping school, is defined as “unexcused absences from school without the knowledge of a parent or guardian”. There are several factors contributing to truancy which are broadly classified in two categories namely:

  • School and its facilities-When students feel unsafe, unchallenged, or unimportant at school, they may decide not to attend. School-related factors contributing to truancy include poor supervision and maintenance of school facilities, Teachers and school officials failing to address behavioral problems, harsh punishments for minor infractions, such as automatic suspensions etc., lack of notification to parents when a child is not attending or performing as expected.
  • Student’s home life and personal related factors: Abuse or neglect by the child’s parents or guardian, substance abuse by family members or self, parents’ lack of interest in education, financial issues, such as single parents working multiple jobs to make ends meet, low self-esteem, often due to poor grades and undiagnosed or untreated mental health issues.

B) These disturbances in behavior cause clinically significant impairment in social, academic, or occupational functioning.

Let us look at the potential causes for conduct disorder in children.

  • Biological factors: Genetics and neurological problems are implicated in the development of conduct disorder.
  • Children with conduct disorder tend to have parents who are harsh and inconsistent in their discipline practices and model aggressive, antisocial behaviour. Psychologically, children with conduct disorder tend to process information in ways likely to lead to aggressive reactions to the behaviours of others.

The conduct problems of some children diminish with age, a pattern called adolescent-limited antisocial behavior.

Unfortunately, many children with conduct disorder continue to violate social norms in adolescence and adulthood. This pattern is called life-course-persistent antisocial behaviour.

Looking at the treatment plan;

  1. Cognitive-behavioral therapy- focuses on building smooth interpersonal relationships and help them control their angry impulses.
  2. Truancy prevention programs include increased parental involvement, usually through notification of a child’s truancy, joint counseling with the child and his or her parents, family mediation and mentorship.

Attention-Deficit/Hyperactivity Disorder (ADHD) in children

We like to think of childhood as a time relatively free of worry and psychological problems. Just as adults, children too suffer from psychological problems. These may be ranging from simple behavioural, emotional, or learning problems to complex psychological problems.
“Walking through the grocery store, you suddenly hear a child screaming. You look around and see that it is a toddler throwing a temper tantrum because her mother will not give her candy”.
Temper tantrums, periods of fearfulness and shyness are common in children. It is not unusual for children to struggle with emotions and to misbehave in ways that can be as serious as lying or stealing.

Even when children experience significant stressors such as poverty or a parent’s death etc., many remain psychologically healthy. Such children are called “Resilient” because they keep a positive sense of themselves and develop their talents.

How can we tell when a child’s behaviour or cognitive or emotional difficulty crosses the line into abnormality?
It is important to understand when children’s behaviours cross the line from normal difficulties of childhood into abnormal problems that warrant concern. It is also essential to identify how children’s levels of cognitive, emotional, and social development can affect the symptoms shown. Prompt diagnosis and appropriate action increases the likelihood of effective management of these problems and facilitates children to live their lives without breakdowns.

A major focus of socialization is helping children learn to pay attention, control their impulses, and organize their behaviors so that they can accomplish long-term goals. All young children can be naughty, defiant, and impulsive from time to time, which is perfectly normal. However, some children have extremely difficult and challenging behaviours that are outside the norms for their age group.

Analysing Attention-Deficit/Hyperactivity Disorder (ADHD)– Most elementary school-age children can sit quietly for some period and engage in games that require patience and concentration. They can control their impulses to jump up in class or walk into traffic. However, some children cannot. Their behaviour is marked by symptoms of inattention, hyperactivity and impulsivity that is demonstrated from the following behavioural characteristics:

# Often gets distracted easily and has trouble keeping attention on school tasks or play activities.

# Makes careless mistakes in schoolwork, does not follow instructions, and fails to complete schoolwork or other activities.

# Time and again fidgets with hands or feet or squirms in seat and gets up from seat when remaining in seat is expected during class.

# Runs about or climbs when and where it is not appropriate.

# Often has trouble playing with other children.

# Interrupts or intrudes on other children and extremely talkative.

To synopsize, children with ADHD often do poorly in school. Since they cannot pay attention or calm their hyperactivity, they do not gain the required knowledge and perform below their intellectual capabilities. Children with ADHD may have poor relationships with other children and, often are not popular with other children. When interacting with peers, children with ADHD may be intrusive, irritable, and demanding. They want to play by their own rules and have an explosive temper, so when things do not go their way, they may even get physically aggressive.

Biological factors that have been implicated in the development of ADHD include genetics, exposure to toxins prenatally and early in childhood, and abnormalities in neurological functioning.

In addition, psychological and social factors such as complicated family environment, negative parenting, family disharmony, divorce, peer discrimination etc. are also associated with ADHD.

Treatment for ADHD involves Behaviour Therapy that is designed to decrease children’s impulsivity and hyperactivity and help them control aggression which is highly effective in reducing symptoms of ADHD in children.
Behavioural therapies for ADHD focus on reinforcing attentive, goal-directed, and prosocial behaviour and extinguishing impulsive and hyperactive behaviour. These therapies typically engage parents and teachers in changing rewards and punishments in every aspect of the child’s life. For example, a child and his/her parents might agree that he/she will earn a chip every time he/she obeys a request to put away the toys. At the end of each week, the reward can be changed, and he/she can exchange chips for fun activities. Each time the child refuses to comply, he/she loses the reward. Such techniques can help parents break the cycle of arguments with their children that escalate behaviours, which in turn lead to more arguments and perhaps physical violence. Children learn to anticipate the consequences of their behaviour and to make less impulsive choices. They are taught to interact more appropriately with others, including waiting for their turn in games, finding nonaggressive ways to express frustration and listening when others speak.

SOCIAL PHOBIA-IMPACT ON THE HOLISTIC DEVELOPMENT OF AN INDIVIDUAL

Individuals with “social phobia”, also termed as “social anxiety disorder” fear being judged or embarrassing themselves in front of others. Social phobia creates severe disruption in an individual`s daily life.
Many people get nervous when speaking to an audience or joining a group already engaged in a conversation. One study of college students found that 48 percent could be classified as “shy”. However, only 18 percent of these shy students qualified for a diagnosis of social phobia (Lifetime Prevalence of Social Fears in a National Survey, Heiser, Turner, & Beidel, 2003)).

In social situations, individuals with social phobia may tremble, perspire, feel confused and dizzy, experience heart palpitations, and ultimately have a full panic attack. They think others see their nervousness and judge them as inarticulate, weak, or crazy. They avoid speaking in public and having conversations with others for fear of being judged.
People with social phobia may avoid eating or drinking in public, for fear that they will make noises when they eat, drop food and thus embarrass themselves. They may avoid writing in public, afraid that others will see their hands tremble.
Social phobia tends to develop in either the early preschool years or adolescence when many individuals become self-conscious and concerned about others’ opinions of them.


The Diagnostic and Statistical Manual of Mental Disorders, Text Revision-IV (DSM-IV-TR) provides the framework of the criteria of social phobia.
1) A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing.
2) Exposure to the feared social situation almost invariably provokes anxiety.
3) The feared social or performance situations are avoided or else are endured with intense anxiety and the individual recognises that the fear is excessive or unreasonable.
4) The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the individual`s normal routine, academic and occupational functioning, social activities and relationships.
5) The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition or any other mental disorder.
In individuals under age 18, the duration is at least 6 months.

Understanding the development of social phobia
According to the cognitive theory,
 Individuals with social phobia have excessively high standards for their social performance––for example, they believe they should be liked by everyone.
 They also focus on negative aspects of social interactions and evaluate their own behaviour punitively.
 They are quick to notice potentially threatening social cues (such as a grimace on the face of the person they are speaking to) and to misinterpret them in self-defeating ways.

 Humiliating experiences such as extreme teasing as a child also contribute to symptoms of social phobia.
What creates these cognitive biases?
Adults with social phobia often describe their parents as having been overprotective and controlling but moreover, judgemental, and negative during their childhood.

Treatment plan-Cognitive-behavioural therapy seems particularly useful for social phobia and can be implemented in a group setting where in group members are phobic and are an audience for one another by providing exposure to the very situation each member fears. An individual can practice his/her feared behaviours in front of others while the therapist coaches him/her in the use of relaxation techniques to calm anxiety. The phobic clients are helped to identify and challenge negative, catastrophizing thoughts they have when they experience anxiety. Group cognitive-behavioural therapy effectively treats social phobia and prevents relapse.

OBSESSIVE COMPULSIVE DISORDER (OCD)

Are obsessive thoughts and compulsive behaviour hindering your daily life? Are they impeding your life and are your family members distressed about your behaviour? Furthermore, the COVID-19 pandemic has affected the mental health of individuals with obsessive-compulsive disorder (OCD) due to their predisposition to respond to danger and uncertainty or insecurity. In particular, the hygiene related recommendations in the context of the pandemic may deepen the gravity of the disorder, especially for those with obsessional fears of contamination.


Obsessions” are recurrent and persistent thoughts, images, or impulses, which uncontrollably intrude on consciousness, and certainly cause significant anxiety or distress.
The individual recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind and attempts to ignore or suppress such thoughts, impulses, or images with some other thought or action.


Compulsions” are repetitive behaviors such as hand washing, ordering, checking or mental acts for instance praying, counting, repeating words silently and so on, that an individual feels driven to perform in response to an obsession.
At some point, during the disorder, individuals recognize that the obsessions and compulsions are unreasonable but lack control over it.


Obsessive-compulsive disorder (OCD) is classified as an anxiety disorder because people experience anxiety as a result of their obsessional thoughts and when they cannot carry out their compulsive behaviors. These obsessions and compulsions cause marked distress, are time consuming and significantly interfere with an individual`s standard routine in terms of occupational or academic functioning, as well as social activities and relationships.
The focus of obsessive thoughts seems to be similar across cultures, most commonly consisting of dirt and contamination. An example of Howie Mandel, comedian and host of Deal or No Deal programme. He has obsessions about germs and contamination that keeps him from shaking hands with anyone. When contestants win big money on the show, he will do a fist bump with them but will not shake their hand. He keeps his head shaved because it helps him feel cleaner (Mandel, 2005).
If Howie Mandel does touch someone’s hand or an object that he thinks is dirty, he will wash his hands repeatedly until he feels clean. This compulsive behavior becomes so extreme and repetitive that it is described as irrational.


Another example is that of David Beckham, World-renowned soccer star. He has obsessions about having to keep everything in a straight line or arranging everything in pairs (quoted in Dolan, 2006). Hence, Beckham spends hours arranging the furniture in his house in a particular way or lining up the clothes in his closet by color. Even, the fridge, is all coordinated on either side. In the drinks section, everything is symmetrical. If there are three cans, he will throw away one because it has to be an even number.


Other common obsessions include aggressive impulses such as to hurt one’s child, impulses to do something against one’s moral code and repeated doubts such as worrying that you have not turned off the stove. Although thoughts of this kind occur to most individuals occasionally, most of us can dismiss or ignore them. However, individuals with OCD cannot.

Let us understand the potential causes and treatment approach for OCD.
The Biological theory of OCD suggest that imbalance in neurotransmitter (serotonin) in the brain could result in impairment. Hence, Drug therapy is used to regulate the imbalance in neurotransmitter-serotonin.
The Cognitive-behavioral theory deliberates that people with OCD are unable to turn off the negative, intrusive thoughts that most individuals usually experience in normal circumstances. Subsequently, compulsive behaviors develop when individuals are reinforced with behaviors that reduce anxiety.


“The Exposure and response prevention therapies” have turned out helpful for OCD sufferers. These therapies expose OCD clients to the content of their obsessions while preventing compulsive behavior, so anxiety over the obsessions and the compulsions to perform the behavior is extinguished.

SEPARATION ANXIETY DISORDER IN CHILDREN

Separation anxiety disorder is an emotional disorder whose onset is specific to childhood. Many children turn out to be anxious when they are separated from their loved ones or primary caretakers. As children develop, they understand that their loved ones will return, and they find ways to comfort themselves while their loved ones are away. However, some children continue to be extremely or exceptionally anxious when they are separated from their loved ones.

Each child may experience different symptoms and the degree to which they experience these symptoms may also vary.

The Diagnostic and Statistical Manual of Mental Disorders, Text Revision-IV (DSM-IV-TR) provides the framework of the criteria of Separation Anxiety Disorder.

Children who are found to have Developmentally inappropriate and excessive anxiety concerning separation from home manifest three or more of the following characteristics:

1) Recurrent excessive distress when the child is separated from home or anticipates separation

2) Persistent and excessive worry about losing, or about probable harm befalling loved ones or an untoward event like natural disasters, accidents, kidnapping or getting lost that will lead to separation.

3) Persistent refusal to go to school and excessively fearful to be alone at home without the loved ones because of fear of separation

4) Reluctance to go to sleep without being near a loved one or to sleep away from home and repeated nightmares involving the theme of separation.

5) Repeated complaints of physical symptoms (such as headache, stomachache, nausea, or vomiting) when separation from loved ones occurs or is anticipated.

The disturbance causes clinically significant impairment in social, academic and other important areas of functioning in the child`s life.

Separation anxiety disorder is diagnosed only when symptoms persist for a minimum period of 4 weeks and significantly impairs the child’s functioning.

If left untreated, the disorder can recur throughout childhood and adolescence, significantly interfering with the child’s academic progress and peer relationships.

Let us look at the potential causes of separation anxiety in children.
Firstly, children with separation anxiety disorder tend to have a family history of anxiety and depressive disorders.
Secondly, some children are born high in behavioral inhibition —they are shy, fearful, and irritable as toddlers and cautious, quiet, and introverted as school age children. Hence, they tend to avoid or withdraw from novel situations and are clingy to their parents. They are found to be at an increased risk for developing anxiety disorders in childhood.
Thirdly, parenting experiences are crucial in the early years of child development. Children may learn to be anxious from their parents and parents may encourage fearful behaviour & not encourage appropriate independence.

Fourthly, some children develop separation anxiety after experiencing a traumatic event such as getting lost in a shopping mall or seeing a parent hospitalized for a sudden illness.

Treatment plan: Cognitive-behavioural therapy is found to be effective to treat separation anxiety disorder. Children are taught self-talk to challenge negative thoughts & relaxation techniques are practised to extinguish anxiety.

Self-talk is basically your inner voice, the voice in your mind that says the things you do not necessarily say aloud. We often don’t even realise that this running commentary is going on in the background, but our self-talk can have a big influence on how we think about who we are (influences our self-esteem). There are two types of self talk: Positive and Negative self-talk
Positive self-talk makes you feel good about yourself and the things that are going on in your life. It’s like having an optimistic voice in your head that always looks on the bright side.
For eg.: ‘These clothes look pretty awesome on me’, ‘I can totally make it through this exam’.
Negative self-talk makes you feel pretty pessimistic about yourself and the things that are going on. It can put a downer on anything, even something good and can even impact on recovery from mental health difficulties.
For eg.: ‘I look stupid in these clothes’, ‘Everyone thinks I’m an idiot’, ‘Everything’s crap’, ‘Nothing’s ever going to get better.’
As therapy progresses, periods of separation from parents are increased in number and duration. Parents are taught to model & reinforce nonanxious behaviour for their children.

MOTIVATED TO SHINE LIKE A STAR

Have you ever deliberated what makes an individual a competent athlete? Or a good mentor? Or a good student? Why do some individuals accomplish their goals while others grind to a halt? It is the grit and passion to achieve long–term goals that makes the difference.


Motivation is a complex phenomenon. Sometimes it is easy to get motivated, and one can find himself or herself enveloped in unimpeded enthusiasm towards accomplishment of goals. Other times, it is nearly impossible to figure out how to motivate oneself and one is entrapped in the twist of procrastination.


What can we do to cross the mental threshold and feel motivated consistently? Motivation can unquestionably be made a “Habit” with the assistance of “The Goldilocks Principle”.
The “Goldilocks Principle” states that human beings experience peak motivation when working on tasks that are right on the edge of their current abilities. Not too hard. Not too easy. “Just right”. Working on tasks that abide by the Goldilocks Rule is one of the keys to sustaining long-term motivation. If you find yourself feeling unmotivated to work on a particular task, it is often because it has glided into an area of boredom or been pushed into an area of great complexity.


Motivation is defined as the process that initiates, guides, and maintains goal-oriented behaviors. Motivation is what causes you to perform most of the times, whether it is reading a book to gain knowledge or engaging in sports inorder to become an active player. Hence goal-setting is the requisite in the voyage of life. In today’s fast-paced domain, our dynamic involvement in our goals is a key challenge. Oftentimes, it’s all about finding the proper channel of motivation. Intrinsic motivation? Extrinsic motivation? Or perhaps a combination of both?
Intrinsic motivation is doing something for the sake of personal gratification. The key motivator is internal (i.e. you don’t expect to get anything in return). It can be said that an individual is intrinsically motivated when he/she does something simply because it makes him/her feel good, is personally challenging and/or leads to a sense of achievement. An example would be painting or sculpting for personal enjoyment, instead of profit.
Extrinsic motivation is doing something to gain a reward or to avoid a punishment. The basic motivator is external (i.e. you expect reward for completing a certain task, or you want to avoid a consequence for not doing something).


It can be ascertained that when we depend too much on external motivators, we learn to compare ourselves to others and may give too much weightage to external opinions. Is my superior happy with me because I did the assignment the right way? If we are always looking outside of ourselves for endorsement, we will be dissatisfied and discontented when that validation is not promptly or objectively obtainable and hence, our self-esteem can weaken. But, at times, the right incentive serves as the hook that gets students or employees devoted in their journey of learning and achievement. Every individual is in the growing phase, hence building a data bank of rich and splendid experiences can provide the basis for intrinsic motivation. The key is discovering the perfect equilibrium.

What to Do When Motivation Dwindles

Inevitably, an individual`s motivation to perform a task will drop or descend at some point. But the challenge ensues “What do we need to remind ourselves of, when we think of “giving up”.

  1. The Human Mind is a Suggestion device.
    Consider that every thought in the human mind is a suggestion, not an order. Right now, as I’m writing this article, my mind is suggesting that “ I am tired, I am bored”. However, if I pause for a moment, I can uncover some novel suggestions. My mind is also suggesting that I have the capability to finish this task and I will feel a great sense of achievement upon completion.
    However, none of these suggestions are orders. They are purely options and hence an individuaI has the power to choose which option to follow.
    Life is respectable, splendid, worthy and discomfort is momentary and transient. Step into this moment of discomfort and let it reinforce and fortify the inner self.
  2. Outline future actions and decrease the resistance or friction of “getting started”. An individual needs to find ways to systematize behavior in advance. Be the architect, designer, originator of your future actions, not the victim of them. Make use of an implementation strategy. An implementation strategy is when an individual declares his/her plan to implement a particular behavior at a specific time in the future. Appropriate use of this strategy can attain two to three times more likely execution of an action in the future.


Life is a constant balance between giving into the ease of distraction or overcoming the pain of discipline. We ought to be motivated and sparkle radiantly, no matter what we chose to do.