Fitzpatrick Consultation and Treatment, LLC

Trauma

Mon, 22 Mar 2010 15:14:00 +0000

Trauma can come in many forms. In can be small, incidious and repeats over and over again for years (the little "t" traumas). Or it can be large and can take over your life (the big "T" Trauma). Small traumas are ones that we no longer count as trauma, such as small but repetitive comments from a parent regarding their looks while growing up, or having to deal with silent violence of neglect. The big traumas are the ones that are easily identified and often treated appropriately, such as sexual assault, natural disaster, witnessing or being a victim of violence, and war. Most poignant example of the big "T" trauma is like 9/11/01 attack. Whatever the trauma is if left unprocess and undigested, it can rear it's ugly head when least expected, leaving the individual feeling off balance, out of control and isolated.

I find that there are many folks walking around day to day with so much trauma that they are not themselves. The worse part is that they don't even know those experiences have changed them to the core. These folks lose connections with loved ones and cannot seem to make new ones to replace them, they also find themselves reacting to small, sometimes benigh situations with such anger and frustrations that the response does not seem to fit the stimulus; for example, an adult blowing up screaming at a 3 year old for simplying spilling milk on the kitchen floor.

Now, most people say to me, "it happened XYZ years ago! It doesn't bother me anymore." Yet, they are engaging in abusive behaviors, perhaps alcohol or drugs, saying to yourself, "Pot is not a drug, besides, its the only thing that helps me sleep." Or may be it's shopping for some of you, maybe its sex, or may be it binging and purging what you've eaten, or even cutting or burning yourself. Whateven it is, we can't seem to stop and we feel the need to keep all of it a secret from the ones we love and trust (which adds to the isolation). Repressing and suppressing memories without dealing with them and processing them only makes things worse (almost like a pressure cooker), and these destructive behaviors are the little valve that lets off steam from time to time to keep the whole thing from blowing up.

If you are reading this and finding that it sounds familiar, you probably are dealing with some kind of history of trauma. You would get significant relief from feeling like you are constantly under pressure and need to act, sometime destructively, and impulsively, with appropriate treatment. If you would like to further discuss your history and treatment options, please call us at 609-429-0094 or 908-419-8931and make an appointment for initial consultation/evaluation.

Attention-Deficit/Hyperactivity Disorder

Thu, 01 Oct 2009 17:21:00 +0000

ADHD is one of the disorders under the Pervasive Developmental Disorders category. This is a disorder of childhood, which means that the development of symptoms is usually in one's childhood and not in adulthood. Symptoms of Bipolar Disorder or Personality disorders are often misdiagnosed as ADHD, which can have detrimental results for the misdiagnosed individual.

Symptoms of ADHD do not suddenly appear in adulthood. They are something that dates back to ones young years and these symptoms must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level of the individual.

There are two categories of symptoms that one with ADHD can exhibit. They are categorized as either inattention symptoms or hyperactivity-impulsivity symptoms.

Individuals with inattention symptoms are:

1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

2. often has difficulty sustaining attention in tasks or play activities

3. often does not seem to listen when spoken to directly

4. often does not follow through on instructions and fails to finish projects or assignments unintentionally

5. often has difficulty with organizing

6. often avoids, dislikes, or is reluctant to engage in activities that require sustained mental effort

7. often loses things (i.e., keys, tools, assignments)

8. is often easily distracted

9. is often forgetful.

Individuals with hyperactivity-impulsivity symptoms are:

1. often fidget or has difficult time sitting still

2. often has difficult time remaining seated

3. often runs or climbs excessively in situations in which such behavior is inappropriate

4. often talks excessively and interrupts others when they are talking

5. often blurts out answers even before the questions have been completed

6. often has difficult time awaiting ones turn

7. often intrudes on others’ conversations or activities without invitations to do so.

One can have ADHD that have combined symptoms of inattention and hyperactivity-impulsivity or just have one or the other.

Please note that an individual suffering from other psychiatric disorders can experience similar symptoms in absence of actual ADHD. If you feel that you have some of most of these symptoms and have had to deal with them for more than 6 months at a time, you should contact a mental health professional for more thorough evaluation.

Dissociative Disorders Series, Part V

Wed, 26 Aug 2009 13:55:00 +0000

Depersonalization Disorder

Depersonalization disorder is characterized by persistent or recurring experiences of feeling detached from and/or as if the individual is an outside observer of, his/her mental processes or body. It is often referred to as dissociative episode and individuals that do experience this describe it as leaving one's body and watching events happen from above or feeling like they are having "an outer body experience" and viewing the events that they themselves are in from "the back seat" or on "a movie screen."

Such experience can be quite frightening to most people, but during such experiences, that individual's ability to know the difference between reality and non-reality (e.g., hallucinations, dreaming state) remains intact. For many, dissociative episodes cause clinically significant distress, impairment, or dysfunction in important areas of their life, such as work, family, and/or school life. It is important to distinguish that dissociative episodes are different from hallucinations or delusions (be it they are from thought disorders like schizophrenia or substance induced). It is not uncommon that individuals that suffer from other dissociative disorders have dissociative episodes. But diagnostic difference is that people with depersonalization disorder does not have diagnostic criteria of other dissociative disorders.

Persons with depersonalization disorder can benefit from psychotherapy (e.g., EMDR or DBT) that works on dealing with and processing traumatic events that often lead to disorders like depersonalization disorder. It is of utmost importance that those who suspect that they may have dissociative disorders of any kind to connect with a mental health professional that specializes in treating such issues.

Dissociative Disorders Series, Part IV

Tue, 25 Aug 2009 15:26:00 +0000

Dissociative Identity Disorder

Formerly known as multiple personality disorder, this particular dissociative disorder became infamous through Hollywood. Movies such as 3 faces of Eve and Sybil put DID on the map of public consciousness. DID's primary characteristic is that the individual presents with two or more distinct identities or personality states, most often each with its own way of perceiving, thinking and relating to the enviroment and others.

The second characteristic is that there are at least two of these identities or personalities that repeatedly take control over the person's behavior. Also, the individual has problem recalling important personal information that is too extensive to be explained by everyday forgetfulness.

Treatment for DID primarily is long-term psychotherapy to deal with possible history of trauma as well as medication that targets psychiatric symptoms that are present. There are no known pharmacological treatment for DID at this time.

The next installment of this series is the last in the dissociative disorder series, so stay tuned.

Dissociative Disorders Series, Part III

Thu, 20 Aug 2009 02:37:00 +0000

Dissociative Fugue

Formerly known as psychogenic fugue, individuals with this disorder primarily present with sudden and unexpected travel away from their home or work, with inability to recall his/her past. They show significant confusion about their personal identity (can't remember name, age, or what they did before the fugue episode), or assume a totally or partially new identity.

This condition usually occurs subsequent to a major stressor or trauma. Apart from inability to recall their past or personal information, patients with dissociative fugue do not behave strangely or appear disturbed to others. Cases of dissociative fugue are more common in wartime or in communities disrupted by a natural disaster.

Next installment of this series will deal with the most famous of dissociative disorders, dissociative identity disorder. So stay tuned.

Dissociative Disorder Series, Part II

Wed, 19 Aug 2009 03:55:00 +0000

Dissociative Amnesia

Formerly known as psychogenic amnesia, it is predominantly characterized by episodes of inability to recall personal information, most often related to events that are traumatic or stressful in nature. But such inability to recall is too significant to attribute to ordinary forgetfulness. Such amnesic episodes cause clinical significant distress or impairment in the affected individual's social, occupational and other parts of his/her life. Dissociative Amnesia is amnesia that cannot be accounted for by possible head injuries or other physical trauma (e.g., concussion), or other cerebral events (e.g., stroke).

On next blog, I'll discuss the dissociative fugue. So stay tuned.

Dissociative Disorders Series, Part I

Tue, 18 Aug 2009 03:04:00 +0000

Overview of Dissociative Disorders

Three faces of Eve, Sybil, and Raising Cain are movies that made dissociative disorders, specifically dissociative identity disorder, on the map of public mental illness consciousness.

Dissociative disorders are named as such because they are marked by a dissociation from or interruption of a person's rudimentary aspects of waking consciousness (i.e., one's personal identity, one's personal history, etc.). Dissociative disorders come in various forms and level of severity. The most famous of which is dissociative identity disorder (formerly known as multiple personality disorder).

All of the dissociative disorders are believe to share a root cause of past trauma experienced by the individual with this disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally dissociates oneself from a situation or experience too traumatic to integrate with his conscious self. In other words, the horror of the trauma is too much for one's mind to process appropriately and the conscious mind turns itself off to avoid having to be aware of traumatic events.

Symptoms of these disorders, or even one or more of the disorders themselves, are also seen in a number of other mental illnesses, including post-traumatic stress disorder, panic disorder, and obsessive compulsive disorder. Treatment for dissociative disorders may include psychotherapy, hypnosis (although quite controversial regarding the efficacy of it), EMDR (to process the traumatic event), and medication. Although treating dissociative disorders can be difficult, many people with dissociative disorders are able to learn new ways of coping and lead healthy, productive lives.

There are four specific types of dissociative disorders:

Dissociative Amnesia (aka psychogenic amnesia)
Dissociative Fugue (aka psychogenic fugue)
Dissociative Identity Disorder (aka multiple personality disorder)
Depersonalization Disorder

For the next several posts, we will describe, explain and discuss each type of dissociative disorders. So, stay tuned.

Personality Disorder Series Part IV

Sun, 16 Aug 2009 03:33:00 +0000

Cluster C Personality Disorders

Cluster C has three types of disorders. They all have a quality to their symptom criteria that it is an underlying and pervasive patterns of behaviors and is not related to or a symptoms of mood, anxiety, or thought disorders.

This first of cluster C is the Avoidant Personality Disorder. Individuals with this avoidant personality disorder exhibits pattern of social inhibition, overwhelming feelings of inadequacy, and hypersensitivity to negative evaluation of one but another. This disorder is evident around early adulthood. People with avoidant personality disorder avoid occupational activities that involve significant interaction with other people due to fear to criticism, disapproval or rejection. They are unwilling to get involved with people unless one is certain to be like and accepted. They often show restraint within intimate relationships because the fear of possible ridicule or being shamed. These individuals are also preoccupied with being criticized or rejected in social situations and are inhibited in new interpersonal settings due to feelings of inadequacy. The also view themselves as socially inept, personally unappealing, and/or inferior to others and is usually reluctant to take personal risks or to engage in any new activities do avoid any situations that may prove them inadequate or embarrassing.

Dependent Personality Disorder is the second in the current cluster. This disorder is characterized by excessive need to be taken care of that leads to clingy and submissive behavior and fear of separation is begins in adulthood. Individuals with dependent personality disorder have difficulty making everyday decisions without an excessive amount of advice and reassurance from others and need others to assume responsibility for major areas of their life. The have difficulty expresssing disagreement with others because fo fear of loss of support or approval. They also have a hard time initiating projects or activities on their own and go to excessive lengths to obtain nurturance and support from others, often by volunteering for activities that are unpleasant. Individuals with this disorder feel uncomfortable and/or helpless when alone due to the fear of unable to take care of him/herself. They fervently see another relationship as a source of care and support when a close relationship ends and lastly, are unrealistically preoccupied with fears of being left to take care of oneself.

The last of the personality disorders is the Obessive-Compulsive Personality Disorder. Individuals with OCPD show patterns of preoccupation with orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and eficiency. Such symptoms start by early adulthood. They are preoccupied with details, rules, order, organization or schedules to the extent that the major point of the activitiy is lost. They show perfectionism that interferes with task completion and are excessively devoted to work and productivity to the exculsion of leisure activities and friendships. These individuals are overconscientious, scrupulous, and inflexible about subjects that are related to religion, morality, ethics or values and are unable to discard objects of no use that are worn-out, even if they hold no sentimental values. They are reluctant to delegate tasks or able to work in a group setting, and adopts a miserly spending style in general. Overall, individuals with obsessive-compulsive personality disorder show rigidity and stubborness.

Cluster C personality disorders have an underlying anxiety as a source of their disorders. This marks the end of the personality disorder series. Stay tuned for the next series topic Dissociative disorders.

Personality Disorder Series, Part III

Fri, 14 Aug 2009 16:29:00 +0000

Cluster B Personality Disorders

Cluster B has four types of disorders. They all have a quality to their symptom criteria that it is an underlying and pervasive patterns of behaviors and is not related to or a symptoms of mood, anxiety, or thought disorders.

The first in this cluster is the Antisocial Personality Disorder. People with this particular disorder has a disregard for and violation of the rights of others. It initially manifests around middle adolescence (15 to 17 years;usually diagnosed with Conduct Disorder). This diagnose is reserved for someone over the age of 18. Inidividuals with antisocial personality disorder are characterized by failure to comply with social norms with respent to lawful behaviors which often leads to multiple arrests. These individuals are deceitful (i.e. lying repeatedly, usage of ailias, conning others for their own profit/pleasure), impulsive, easily agitated and resort to aggressive behaviors readily (i.e., fights, assaultive behaviors). They are also exhibit reckless disregard for the safety of others or self and are consistently irresponsible as evidenced by inability to maintain a job or honor financial obligations. The most significant characteristic of someone with antisocial personality disorder is that they lack remorse. They are indifferent to or rationalize having to hurt, mistreat, or steal from others for their gain or pleasure.

The second in the cluster is Borderline Personalit Disorder. Symptoms start to manifest in middle to late adolescence and is marked by instability of interpersonal relationships, self-image, and affects, as well as higher than norm impulsivity. Individuals with Borderline Personality Disorder is characterized by showing frantic efforts to avoid real or imagine abandonement. They also exhibit a pattern of unstable and intense interpersonal relationship marked by alternating between extremes of idealization and devaluation (e.g., "you are the best person even" to "I hate you"). They have unstable self image or sense of self and show impulsivity in potentially self-harming areas (e.g., excessive spending, sex, gambling, self-mutilation). They also often exhibit suicidal behaviors, gestures, or threats, and experience intense moods/reactions that are not congruent to situation or event at hand. They report chronic feelings of emptiness, have inappropriate and intense anger that they cannot control which can lead to physical fights or frequent displays of temper and anger without clear provocation. Lastly, these individuals experience transient, stress-related paranoia or severe dissociative symptoms. Most patients diagnosed with BPD are women between the ages of 16 to 45 and most likely have a history of abuse (most often of sexual in nature).

The third disorder is called the Histrionic Personality Disorder. This one is marked by excessive emotionality and attention seeking behaviors. It usually emerges in early adulthood. Characteristics of this disorder are feelings of discomfort in situations in which they are not the center of attention, interaction with others that are inappropriately sexually seductive or provocative in nature, displays of rapidly shifting emotions with superficial expression. Individuals with histronic personality disorder consistently use physical appearance to draw attention to themselves and has a style of speech that is excessively impressionistic but lacks in any substantive details. They often show self-dramatization, theatricality and exaggerates emotional expression (drama queens), and is quite suggestible or easily influenced by others/circumstances. These people consider relationships to be more intimate than they actually are and often will reveal provocative information about themselves or their lives.

The last in this cluster is called the Narcissistic Personality Disorder. This disorder is characterized by a pattern of grandiosity, need for admiration (undeserved), and lack empathy. Individuals with narcissistic personality disorder have grandiose sense of self-importance and are preoccupied with fantasies of success, power, beauty, intelligence or perfect relationships. They believe that they are special and unique and can only be understood by other special or high-status people. These individuals require excessive admiration and have a sense of entitlement (i.e., unreasonable expectations of favorable treatment or abiding by their wishes without question). They are exploitative in their interpersonal relationships and take advantage of others to achieve their own ends. They lack empathy and are unwilling to recognize or identify needs and feelings of others. They are often envious of others or believe that others are envious of them. Lastly, they are arrogant, haughty in behaviors or attitudes.

Cluster B diagnoses are most often seen in practice vs. A or B. They most often have issues that they feel are cause or originated by or due to others around them and have difficult time accepting and working in treatment.

Next blog will address the last of the three personality clusters so stay tuned.

Personality Disorder Series, Part II

Fri, 14 Aug 2009 16:26:00 +0000

Cluster A Personality Disorder

As stated in the previous blog, personality disorders have 3 subcategories. Today, I will discuss the first of the three, Cluster A Personality disorders.

First is called the Paranoid Personality Disorder. It is characterized by pervasive distrust and/or suspiciousness of others to the point that their motives are interpreted as malicious and malevolent, but that such feelings are not related to or experienced during a course of thought disorders such as schizophrenia, or mood disorders with psychotic features. This disorder emerges in early adulthood.

People with this disorder often suspect that they are being exploited, harmed, or deceaved wihtout any evidence to support their suspicion. They also are preoccupied with unjustified doubts about their loved ones' loyalty and trustworthiness and often are resistent to confide in other due to unprovoked fear that the information shared will be used against them somehow. Symptoms of paranoid personality disorder also consists of reading hidden demeaning and threatening meanings into remarks and situations that are benign, and persistently baring grudges, reacts angrily to others due to perceived attack on their reputation and character, which are not apparent to others. Lastly, people with paranoid personality disorders exhibit recurrent suspicion, without justification, about faithfulness of their spouse or sexual partner.

The second is the Schizoid Personality Disorder. This one is characterized by a pervasive pattern of disconnection from social relationships and when in social settings, range of emotional expressions displayed are quite restricted. This disorder emerges in early adulthood and the symptoms are not related to thought or mood disorder episodes.

People with schizoid personality disorder does not feel the need for or enjoy interpersonal relationships or connections (family included). They choose activities that are solitary in nature and has little or no pleasure from them. They have little or no interest in sexual interaction with another person and appears to other to be indifferent to the praise or criticism by others. Individuals with this disorder are often described as cold, detached, or flat in affectivity. They don't care for the company of others but is not averted by it either.

The last type in the cluster A, is called Schizotypal Personality Disorder. It is a pervasive pattern of social/interpersonal marked by extreme discomfort from close relationships, with cognitive and perceptual distortion. It is characterized by eccentricities of behavior, which begins in the early adulthood and the occurence of symptoms are not related to episodes of thought or mood disorders.

People with Schizotypal personality disorders experience idea of reference (inncuous events or caused by or is related to them personally), has odd beliefs or magical thinking that influences their behavior, which is most often not consistent with the societal norms (fantasies, belief in clairvoyance), and exhibits odd thinking and speech. They are quite suspicious and paranoid, their affect is not appropriate for the occasion or mood. They are odd, eccentric, or peculiar and lack close friend or relationships outside of their first degree relatives (parents, siblings). Finally, excessive social anxiety does not diminish with increased familiarity and such anxiety to related, not to negative judgment about self, but paranoid fears.

People who are diagnosed with these personality disorders can be described as odd, eccentric, weird, loners, or bizarre. Treatment for such disorders exist but most often is quite difficult to treat. Also, medication usually has little or no effect on symptoms, mostly because they originate from one personality and not due to issues with brain chemistry.

Next blog will deal with Cluster B personality disorders, which are the most often identified and seen.