Borderline Personality Disorder

PRESENTATION

A 24 yr old female client reported that for the last 1 month she has difficulty in falling asleep even after a long tiring day. She cannot keep her eyes closed. She also had difficulty in controlling her anger. She could not tolerate dishonesty and fake promises, and got infuriated in office about petty issues. She had an abusive relationship with her boyfriend and had hit him on several occasions. But when the anger subsides, she would to him and would be ready to do anything to please him. She sought therapy at the point when her boyfriend was threatening to leave her and she could not tolerate it and cut her wrists. She also reported of being abused by parents and of having a disturbed family environment.

OUR SUGGESTION

The therapist explained that her anger was an expression of a stifled cry of the psychological pain inside her which she was unable to express in words. Her expressions of distress came out in the form of abusive behavior, which further alienated those around her. This further increased her distress which again got manifested as anger – either on others or on herself. She could not sleep because of her psychological distress. The therapy was aimed at enabling her to understand her reactions and connect it to her feelings. Gradually she was be able to explore negative feelings and was be in a better position to handle it and could communicate it in a language and manner which was understood by others.

Depression

PRESENTATION

I am a 47 year old woman and work for the Post Office. I am finding it very difficult to motivate myself to go to work every day for past 2 months. I am thinking of resigning from my job. I have difficulty in getting up from bed in the mornings. I am a very sincere worker and try to do everything perfectly. However, because of frequent staff absenteeism and staff shortages, my supervisors tend to rotate me in various departments, to fill in the shortage. I feel very low and have stopped enjoying anything. I do not have any problems in my personal life as my husband and mother in law are very supportive of my work and help me to look after my children. I have never felt like this before as I am a very dedicated worker and have always worked beyond my working hours to complete all duties. Please advise what I should do?

OUR SUGGESTION

I feel you are suffering from depressive disorder. Work stress is the cause for your illness. Unfortunately, your need to do everything perfectly is contributing to your problems. You are in a difficult position- because of your reputation as a sincere worker; your supervisors rely on you and post you to sections where work is pending. You are a perfectionist and therefore you try and complete everything and maybe taking on too much burden without realising that it is causing you stress and anxiety. The symptoms you are describing are typical of depressive disorder: feeling lethargic, inability to get up from bed in the morning, having poor quality of sleep and feeling tired and listless, inability to enjoy things which used to interest you indicate you have depression. I feel the first step you should take is to speak to your supervisor and explain your situation. Request him not to keep on posting you to different departments. You can take some time off on leave and go for a holiday if it is possible. Try and get some regular exercise and even after this if your problems persist, you may need to see a Psychiatrist for help.

Developmental Delay / Autism

PRESENTATION

I have a two and half year old son and I am very worried about him. He is still not able to walk and can only crawl and uses 2 or 3 words like “baba” and “ma”, although I think he uses them randomly instead of using them meaningfully. My neighbor’s daughter is of the same age but is now walking and speaks in 2-3 word phrases. I am very worried, please advise what should we do.

OUR SUGGESTION

From your description, it is clear that your son’s developmental milestones are delayed. After birth, as children are growing up, they develop and grow at an expected rate. For example, they are supposed to sit, walk and start speaking within an expected time frame. The simplest rule for parents to remember is that children usually develop social smile by the time they complete 2 months, can hold their head steadily by the time they complete 4 months, can sit alone with little support by 8 months and can stand alone by 12 months. Social smile means that the child smiles back at you when you smile at the child. When the child is delayed in development, then these milestones are not reached within that specified period.
Most children start using 1-2 words by 12 months apart from baba or ma and start using 10-20 words between 1-2 years. Children walk unsupported between 1 -2 years. Therefore, from your description, it appears that your son is not being able to meet the expected milestones at the age when he should have done so. This indicates that he is delayed in development. You need to urgently consult your child’s paediatrician and find out what could be the cause. Additionally, you will also need to find a good clinical psychologist or a special educator who will be able to tell you what you need to do with the child so that his development is hastened.

WHEN You Should CONTACT US

Seeking professional help when you notice persistent, uncharacteristic behavior in your family member or a friend is the wisest.

In children and young people

Delays in milestone acquisition, poor school performance, excessive use of gadgets, disruptive behaviour are the commonest reasons for seeking help.

In Adults

Poor work performance, anxiety, depression, relationship conflicts, stress related symptoms and memory problems are some concerns for which we can be consulted.

In The Elderly

Memory problems, depression, anxiety and personality change are symptoms for which people reach out.

Dealing with addiction, both to drugs, alcohol and gadgets, across the age span is also problem for which we provide therapeutic support and treatment.

WHEN You Should CONTACT US

Seeking professional help when you notice persistent, uncharacteristic behavior in your family member or a friend is the wisest.

In children and young people

Delays in milestone acquisition, poor school performance, excessive use of gadgets, disruptive behaviour are the commonest reasons for seeking help.

In Adults

Poor work performance, anxiety, depression, relationship conflicts, stress related symptoms and memory problems are some concerns for which we can be consulted.

In The Elderly

Memory problems, depression, anxiety and personality change are symptoms for which people reach out.

Dealing with addiction, both to drugs, alcohol and gadgets, across the age span is also problem for which we provide therapeutic support and treatment.

Marital Conflict

PRESENTATION

We got married six months back. Our parents had arranged our marriage through some relatives. Incidentally, I had been engaged before, but that had not worked out in the end. So this time I did not want to prolong the engagement and we got married within a month of getting to meet each other. She is from a different state and the eldest amongst her three siblings, while I am the younger one of two siblings. And then I started noticing the differences. Our viewpoints wouldnt match, we would get into endless arguements which led to shoving and hitting each other. My parents, relatives, family friends have tried to talk to her and asked her to adjust, but she is adamant. She is constantly on the phone with her parents, and they blame me for not taking adequate care of her- they have pampered her so much.

OUR SUGGESTION

Marriage between two individuals results in the individuality of two people coming together. The way we look at life and deal with different issues- vary from family to family. So when two people marry, they bring together different adjustment strategies from their family of origin. Hence the initial time period is the most difficult as the differences become more noticeable. It is how both the husband and wife accept and respect each other that determines how the issues will be sorted. No one person can be solely responsible for the adjustment. It is a teamwork. Family members mean well, but end up introducing their own biases rather than allowing the couple the space to develop their own set of dynamics. Mutual respect, privacy, and giving each other some space-helps foster patience and understanding. Marital therapy will give you guidelines about how to develop a healthier relationship. Also some of the individual personality difficulties can also be addressed so as to ease the process of adjustment. At the end of the day both you and your wife are one team, so the problems need to be worked on rather than blamed on each other.

Obsessive Compulsive Disorder

PRESENTATION

My daughter is 13 years old. She is very intelligent. She is very good in her studies and also a very good dancer. But for the last 7-8 months she is behaving peculiarly. Whenever she goes to the toilet she takes almost 1 to 11/2 hour and never comes out early. Whenever she goes to wash her hands she goes on washing for a long time. If she thinks that she won’t sit at a particular place then nobody can make her sit there. While dressing up she keeps on changing her mind before finally selecting one. Sometimes she is very lazy. But once she gets to do what she likes, she behaves actively. I’ve tried to make her understand that whatever she is doing is not right. She temporarily understands my point but again goes back to her former self. She thinks that whatever she is doing is not perfect and then again redoes that particular thing. I’m very tensed. I can’t understand whether this is just a prank or is she going through any difficult psychological problem? Please help.

OUR SUGGESTION

No I am fairly certain it’s not a prank your child is playing. As is true for most emotional disorders family members often find it difficult to identify the exact problem, as these are disorders of thought and happens in the “internal” mental space of the child. Children are often under equipped to verbalise these thoughts and feelings clearly. What is visible to you are odd and apparently useless activity patterns. A trained person like a clinical psychologist or a psychiatrist will be able to understand and help the person verbalise the thinking and action patterns.
Obsessive Compulsive Disorder cause an irrational thought image or impulse like “its still dirty”, “if I don’t tap 9times ill luck will befall on my family”, self doubts, to repeat itself without the intent of the person. This causes extreme distress in the person, as the thoughts are always negative and erroneously so. In order to reduce the distress persons resort to meaningless superstitious acts like repeatedly washing the clean bathroom, or tapping 9times before doing any work, or checking repeatedly. These are time consuming and can affect work life. However it brings temporary relief from the distress feelings. Then again it’s a cyclic process and the person finds him or herself facing another bout of irrational negative thought.
There are evidence-based methods like Cognitive behaviour therapy to equip the client come out of these ‘thought and action traps’. Depending on the severity of the problem the person may need medications. The manner in which the family reacts to these problems can either be helpful or often increase the problem. So you need to seek family counseling, which is part of a treatment programme. OCD is a heterogeneous disorder and can present with multitude of themes. Relapses in OCD are also common. Follow up treatment and well checks are also necessary in the long run like once every 6 months to a year.
You need to visit a psychiatrist or psychologist soon.

Physiotherapy

PRESENTATION

My child is suffering from hypotonia? does that mean she has less strength in her muscles ?

OUR SUGGESTION

The low muscle tone associated with hypotonia must not be confused with low muscle strength. In body building, good muscle tone is equated with good physical condition, with taut muscles, and a lean appearance, whereas an out-of-shape, overweight individual with fleshy muscles is said to have “poor tone.” Neurologically, however, muscle tone cannot be changed under voluntary control, regardless of exercise and diet.
In an article by Diane E Gagnon, M.Ed., PT, she explains “True muscle tone is the inherent ability of the muscle to respond to a stretch. For example, if you quickly straighten the flexed elbow of an unsuspecting child with normal tone, the biceps will quickly contract in response (automatic protection against possible injury). When the perceived danger has passed, which the brain figures out really quickly once the stimulus is removed, the muscle then relaxes, and returns to its normal resting state. The child with low tone has muscles that are slow to initiate a muscle contraction, contract very slowly in response to a stimulus, and cannot maintain a contraction for as long as his ‘normal’ peers. Because these low-toned muscles do not fully contract before they again relax (muscle accommodates to the stimulus and so shuts down again), they remain loose and very stretchy, never realising their full potential of maintaining a muscle contraction over time.”

Sensory Integration

PRESENTATION

My son’s age is 5yrs and he does not concentrate in school. Teachers have complained that he does not follow actions and is unable to play with his classmates. Can I suspect these issues are sensory. If yes, then what can be done?

OUR SUGGESTION

Yes. All children rely on the ability to successfully modulate and discriminate the sensory information they are receiving from the world around them to develop the skills needed to successfully participate in occupational roles, including that of student. The school readiness skills that are influenced by sensory integration include, but are not limited to, the ability to sustain attention to task; follow directions (praxis on verbal command); complete a series of tasks independently (praxis); use in-hand manipulation skills; demonstrate handwriting skills including grasp, visual tracking, and visual praxis skills; use postural control to maintain an upright sitting position at a desk or on the floor; and demonstrate the gross motor skills needed to support play during recess activities.
When sensory integration deficits are suspected, Therapist with specialized training can administer the Sensory Integration and Praxis Tests (SIPT; Ayres, 1989) to determine the specific areas of sensory integration that are problematic for the child. If the evaluation results indicate that the child is having underlying problems processing sensory information, the therapist would recommend therapy using an ASI® approach.

Trauma

PRESENTATION

I am a 24 year old woman. I work in Park Street in a private firm and I happened to witness the horrific fire at Stephen’s Court recently. Since that night, I have not been able to sleep and I am getting repeated nightmares of the various scenes of the incident. There is one particular scene which comes into my mind whenever I am closing my eyes – it is that of a young woman shrieking for help from the window of her office. I later found out that she died due to the fire. I just see her terrified face whenever I close my eyes and now I am afraid to close my eyes, as I am scared that her image will haunt me. I am unable to concentrate on my work, do not feel like talking to anyone and am just filled with anger. I have realised that human life has no certainty and planning for future is pointless as I can die tomorrow. Please help me.

OUR SUGGESTION

You have witnessed an exceptionally traumatic event which had terribly tragic consequences. Witnessing such an event triggers a chain of emotional reaction, which you are now experiencing. Psychiatrists call this reaction PTSD (Post Traumatic Stress Disorder). In persons who have PTSD, flashbacks of the traumatic scene occur repeatedly, as you are experiencing. You find yourself are re-living the event, again and again. This can happen both as a ‘flashback’ in the day and as nightmares when you are asleep. These can be so realistic that it feels as though you are living through the experience all over again. You see it in your mind, but may also feel the emotions and physical sensations of what happened – fear, sweating, smells, sounds, pain.
These kinds of traumatic events are shocking because they undermine our sense that life is fair, that it is reasonably safe and that we are secure. A traumatic experience like this makes it very clear that we can die at any time. Your reactions therefore are a natural reaction to a narrowly-avoided death. You may be thinking that it could easily have happened to you and hence a sense of hopelessness and anger at the authorities who are callous is understandable. If your problems are continuing for more than more than 6 weeks since the event, and these experiences do not seem to be getting better, it is worth talking it over with a Psychiatrist.