How to get a Better Nights’ Sleep!

Do you suffer from insomnia? Have a hard time falling asleep? Have a hard time staying asleep? Do you toss and turn for hours, counting how much sleep you will get if you fall asleep “right now?” I use to be just like you, but not anymore. Sleep is something we all require. Like food, water, and air, it is essential to our survival. Although the scientific reasons for why we need sleep are still being investigated, we do know that without adequate sleep, humans can suffer from poor quality of life, as well as physical and mental disorders. Certain things do make sleeping (rather falling or staying), easier, and insomnia is something that can be managed, usually without the use of medication.

Insomnia is a common problem. You are not alone. It is especially prevalent in individuals who range in age from 18-25… college years. This is such a common age for individuals with insomnia because of the added stress of college, moving away from home, school work, and homesickness. But, do not worry, I have some suggestions for how you can achieve a full nights’ sleep, without taking any drugs.

Sleep comes in stages. We all know that falling asleep is easy when you are relaxed and in a peaceful state of mind. That’s the first step in falling asleep. Relax. Do not think about stressful things. Learning to mediate before bed may be helpful in this, especially if you are a college student and stressed about school work. Stage one of sleep is very light; you may have experienced this stage while slowly passing out on your living room couch. You are essentially still aware of what is going on around you.

Stage two of sleep is a little deeper, it is associated with the loss of awareness. Stage three of sleep is deeper still, and stage four  is the deepest sleep of all. Most people go through a sleep cycle; stage one-to stage two-to stage three-to stage four, back to stage one, that lasts about ninety minutes. As a person moves from stage four to stage one they enter REM sleep. REM sleep is characterized by dreams, and, scientifically, by the loss of muscle control, and rapid eye movement (REM). REM is also known as paradoxical sleep because of the bodies and brains increased activity, while muscle activity is pretty much non-existent. In order to achieve a full night’s rest, one must enter all of these stages for a period of time throughout the night.

If one suffers from insomnia, a quality night’s sleep sounds like heaven; I know. Let’s talk about some tips to get you there.

First and foremost: DICTH THE TV! If you have a hard time sleeping at night, it may be your TV keeping you awake. Turn it off. Even better, take it out of your bedroom. Read a book. A real book. Do not get on social media, do not get on your phone, do not read a book from your phone. Read a real book.

Second: BE CONSISTENT! Try going to bed and waking up at the same time every day; even on the weekends. Try not to disrupt your circadian rhythm; stay on a schedule. Limit day time naps to only thirty minutes. Napping does not “make up” lost sleep, but a short nap can help to improve mood, and increase attentiveness and performance. Establish a bedtime routine; yes, just like what you had as a child. An example of a relaxing bedtime routine may include, a nice hot bath or shower, some stretching, maybe some meditation, and a good book. A bedtime routine helps your body recognize that it is bed time. Try to avoid anything that is emotionally upsetting before bed. Do not pick this time to talk about your deepest feelings with your significant other. The brain must be relaxed to fall asleep; save that conversation for morning. You’ll be happy you did.

Third: NO STIMULANTS BEFORE BED! Alright, this means do not eat fatty foods or greasy foods before you go to bed. Do not smoke, or dink carbonated or caffeinated beverages before bed. The food may cause heart burn, which will keep you awake. The caffeine and cigarettes can keep you awake. Stimulants such as alcohol or marijuana, both of which people associate with a good night’s sleep, may actually have the opposite effect. Alcohol may help you fall asleep, but during the second half of the night, when your body starts processing the alcohol, it can disrupt your sleep; best to stay clear. Marijuana has been showed to have an effect on the amount of time a long term user spends in REM sleep. So, while marijuana may help, if you are an occasional user, after years of use, it will deprive you of dream time; disrupting your sleep cycle. If you stop using marijuana you may experience what is called REM rebound. REM rebound is where a person experiences exceptionally vivid dreams after quitting marijuana; this usually only lasts a short period as your body adjusts to having more time in REM sleep than it is used to.

Fourth: GET PLENTY OF EXERCISE AND SUNLIGHT! As little as ten minutes of exercise, especially if it takes place outside, can drastically improve one’s night of sleep. For most people, intense physical exercise right before bed doesn’t work, however, a brisk walk, or jog after dinner can have a tiring effect a few hours later. Exercise in the morning, can help wake you up, and help to tire you out at night. Experiment to see what works best for you.

Fifth: CREATE A PLESANT SLEEP ENVIRONMENT! I already said to ditch the TV, and I’m going to reiterate it here; DITCH the TV! If you are scared of the dark, or just want something to light the way, try a soft blue light in the bathroom, so it doesn’t disturb your sleep. Make your bed as comfortable as possible to best suit your desires. I, personally, like to feel like I’m sleeping on a cloud; we have lots of down pillows. The temperature should be between sixty and sixty-seven degrees for optimal sleep. Some people sleep best with a fan, this may be because the fan works as a white noise machine, and white noise machines have proven to help with insomnia. Consider trying black out curtains, eye mask, and/or ear plugs. Turn your smart technologies off or over so the light cannot disturb you.

Most people find that just a few minor changes in sleep habits can have a significant impact on their sleep quality. Experiment with these techniques and see what works best for you. If you are experiencing prolonged sleeplessness, consider consulting your doctor; you may have other psychological disorders that are preventing you from falling asleep; such as anxiety, PTSD, or depression.

Generalized Anxiety Disorder

Psychological disorders are malfunctions in the mind that involve one’s thoughts, behaviors, or emotions that cause an individual significant distress and dysfunction over a period of time. Psychological disorders may interfere with a person’s ability to function in everyday life; they may be unable to meet their own personal needs, and/or be a danger to themselves or others. Generalized anxiety disorder is not considered to a dangerous disorder, however, it can cause some severe dysfunction in patients’ lives. In this paper, I will discuss generalized anxiety disorder from a neurobehavioral perspective.

Generalized Anxiety Disorder

According to the Diagnostic and Statistical Manual, Fifth Edition, (DSM-V), generalized anxiety disorder is characterized by excessive worry and apprehension that last longer than six months and pervades every aspect of the person’s life, or nearly every aspect, and the individual finds it difficult to control these thoughts (DSM-V, 2013). This anxiety causes a variety of symptoms of which three or more must be present for more days than not over the six-month period; restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and/or sleep disturbances. These disturbances in a person’s life cannot be explained by either an addiction, such as a drug or alcohol addiction, or by another psychological disorder (DSM-V, 2013).

Biopsychosocial Theory

Generalized anxiety disorder is a disease that is caused by a variety of factors. Anxiety is generally considered to be a disorder that people are genetically predisposed too. Research has shown that generalized anxiety disorder has a heredibility factor, however, one’s environment will contribute a great deal to rather or not one develops generalized anxiety disorder (Brown, O’Leary, & Barlow, 2001). Although one may be predisposed to develop generalized anxiety disorder, evidence shows that stressful life events in childhood may play a contributing factor, events such as child abuse, the loss of a parent, or insecure attachments to caregivers (Brown, O’Leary, & Barlow, 2001). It is a comorbid disorder often occurring along with other disorders such as; autism, depression, sleep disorders, or substance abuse.

Evidence shows that the amygdala and areas of the forebrain are involved in generalized anxiety disorder. The basolateral amygdala complex (BLA), and centromedial amygdala complex, receive information about potentially negative emotions, activating the GABA neurotransmitters, leading to somatic manifestations of anxiety (Nuss, 2015).

Epidemiology

Generalized anxiety disorder is not a rare disease. In fact, it’s prevalence in the US may range as high as five percent of the population. It is found to be more prevalent in low income families, white, adult, women, and within those social groups of people who are widowed, separated, or divorced (Weisberg, 2009).

Complications

Generalized anxiety disorder is more than just excessive worrying. It can impair one’s ability to think clearly, and concentrate on a task. It can sap a person’s energy, and make it hard for them to sleep. It can lead to a worsening of, or be the cause of other psychological disorders such as; depression, substance abuse, insomnia, digestive problems, headaches, and may even cause heart problems. Generalized anxiety disorder has also been linked to suicidal tendency, and some people who suffer from the disorder to manage to carry out their suicide (Mayo Clinic Staff, 2016).

Treatment Options

The two main treatment options for generalized anxiety disorder are psychotherapy, or medication; usually a combination of both. Cognitive behavioral therapy is the most effective therapy for generalized anxiety disorder, as it involves teaching the patient how to respond better to stress and negative emotions. Several different medications are used to treat generalized anxiety disorder including antidepressants, antianxiety, and benzodiazepines (Mayo Clinic Staff, 2016).

Antidepressants such as selective serotonin reuptake inhibitors (SSRI’s), and serotonin norepinephrine reuptake inhibitor (SNRI), are usually the first choice of physicians when treating anxiety disorders. Antidepressants and antianxiety medications take up to several weeks to work, and the side effects can be drastic, to include suicidal thoughts; physicians are advised to carefully monitor patients, changing medications if severe side effects do occur. Benzodiazepines are only used on short term basis for patients who are suffering from acute anxiety attacks, and should not be used for patients with a history of substance abuse because they can be addicting (Mayo Clinic Staff, 2016).

Conclusion

Generalized anxiety is a psychological disorder that is quite prevalent in the population of the United States. People who suffer from this disorder are likely to stress and worry over the smallest thing in an uncontrollable manner, and this stress is likely to affect their personal life increasing the likely hood of them developing another psychological disorder. But, anxiety can be controlled with the assistance of a physician, through the use of psychotherapy, and medications. I believe Juliana Hatfield described anxiety, and its symptoms, best when she said, “Sometimes I feel like a human pincushion. Every painful emotion hits me with ridiculously exaggerated force. And, the anxiety feels like hands inside of me, squeezing my guts really hard.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Nuss, P. (2015). Anxiety disorders and GABA neurotransmission: a disturbance of

modulation. Neuropsychiatric Disease and Treatment11, 165–175.

http://doi.org/10.2147/NDT.S58841

Brown, Timothy A., O’Leary, Tracy A., & Barlow, David H.(2001). Clinical Handbook of

            Psychological Disorders, Third Edition: A Step-by-Step Treatment Manual, Chapter

Four. Retrieved from:

http://commonweb.unifr.ch/artsdean/pub/gestens/f/as/files/4660/21992_121827.pdf

Weisberg, Risa B. (2009). Overview of Generalized Anxiety Disorder: Epidemiology,

Presentation, and Course. Journal of  Clinical Psychiatry 2009;70(suppl 2):4-9. Retrieved

from: http://www.psychiatrist.com/jcp/article/Pages/2009/v70s02/v70s0201.aspx

Mayo Clinic Staff. (2016). Generalized Anxiety Disorder, Complications. Retrieved from:

http://www.mayoclinic.org/diseases-conditions/generalized-anxiety-

disorder/basics/complications/con-20024562

Juliana Hatfield. Retrieved from: https://www.brainyquote.com/quotes/keywords/anxiety.html

Evidence for Climate Change

Climate Change throughout History

To determine if the world’s temperature is increasing, several different methods are used, including data, where data exists, historical documents, glacier activity, sediment, tree rings, ice cores, corals, and carbon fourteen dating (Botkin & Keller, 2013). I will talk about only a couple of these. One way that scientist’s used to discovering the past climate and compare its changes throughout history, that I found interesting, is the use of historical documents.

Researchers can use historical documents such as paintings to reconstruct the climate. For example, “ships logs from the Spanish, Dutch, and English ships crossing the world’s oceans between the sixteenth and twentieth centuries, provide insight into weather patterns and how these change over time” (Oosthoek, 2015, pp. 1, pp.1). Another example, “is the painting of glaciers in the Swiss Alps, in some paintings the glaciers reached down into the valley below, indicating cold times, and in some painting the glaciers were high up in the mountains, showing warm eras” (Botkin & Keller, 2013, p. 482, pp. 1). Several other historical documents are used to include, “people’s written recollections in books, newspapers, journal articles, personal journals, ships’ logs, travelers’ diaries, and farmers’ records, along with dates of wine harvests and small grain crops”  (Botkin & Keller, 2013, p. 482, pp. 1).

Another method I found interesting was how scientists use tree rings to determine how the climate has changed over the centuries. Since the growth of trees is affected by the climate, the tree rings that trees develop over the years can tell scientists a lot about the atmosphere of that tree’s life (Botkin & Keller, 2013). When the tree rings are broad, it means climate conditions were suitable for growth; when the tree rings are narrow, it means climate conditions were not good for growth (Botkin & Keller, 2013).

The Greenhouse Effect

The greenhouse effect is the natural process by which the Earth’s atmosphere traps gases and warms the Earth, most is caused by water vapor (Botkin & Keller, 2013). It is called the greenhouse effect because the gases trapped in the atmosphere act like the window panes of a greenhouse, reflecting that warmth back to the surface of the Earth(Botkin & Keller, 2013). The natural gases in the Earth’s atmosphere, such as carbon dioxide and methane, provide a protective layer of gases from the Sun’s energy. Without that protective layer, the Sun could strike the Earth. Greenhouse gases catch the sun’s rays and reflect some of that warmth back to Earth warming the temperature (Botkin & Keller, 2013). However, human activity has increased the number of greenhouse gases in the atmosphere past natural conditions, causing Earth’s temperature to rise to never before seen temperatures (Botkin & Keller, 2013).

Greenhouse Gases

Carbon dioxide is a greenhouse gas that traps heat in the atmosphere, contributing to global warming and is emitted into the atmosphere naturally. However, human activity has increased the amount of carbon dioxide in the atmosphere to 396 parts per million (ppm), an increase of over a hundred ppm since the Industrial Revolution (Botkin & Keller, 2013).

Methane is a greenhouse gas that contributes to global warming by trapping heat in the atmosphere. Methane is naturally created by certain bacteria’s that live in oxygenless environments, such as the intestines of certain mammals. However, the emittance of methane into the atmosphere over the last two hundred years as increased due to human activity. “Humans contribute methane into the environment by landfills, the burning of biofuels, the production of coal and natural gas, and agriculture” (Botkin & Keller, 2013, p. 494, pp. 3).

“Chlorofluorocarbons (CFC’s) are stable, inert compounds that are used in aerosol cans and refrigerators” (Botkin & Keller, 2013, p. 494, pp. 4). Scientists estimate “that 15% to 25% of the anthropogenic greenhouse effect may be related to CFCs” (Botkin & Keller, 2013, p. 494, pp. 4). The use of CFC was banned by the US government in 1978, which is a good thing because CFCs have the ability to absorb thousands of times more infrared radiation than carbon dioxide (Botkin & Keller, 2013).

Nitrous oxide contributes as much as five percent of greenhouse gases to the greenhouse effect. Human activity contributes this greenhouse gas into the atmosphere by using fertilizers in agricultural activities and by the burning of fossil fuels. Nitrous oxide stays in the environment for several decades (Botkin & Keller, 2013).

Evidence for Global Climate Change

Sea levels rise because of two contributing factors, the melting of land glaciers and the expansion of water. As the atmosphere warms up, much of that extra heat is taken in by our oceans and seas, causing the water to expand (NASA, 2015). Evidence shows that the global sea level has risen 6.7 inches in the last century and with the melting of land glaciers, that number is only going to increase. The rising of global sea levels has already affected some island nations, including the Marshal Islands, whose residents are living in the ocean now, and scientists predict that by the year 2050 seventeen percent of Bangladesh may be underwater (Davenport, 2015).

Impact of Climate Change in the Great Plains

I live in South Dakota, which is a part of the great plains of the United States. The great plains stretch across the United States from the border of Canada to the border of Texas and consists of a variety of environments and ecosystems. The effects of climate change on the great plains is many and varied (Environmental Protection Agency, 2015). As winters get warmer, crop cycles will alter requiring new techniques for farmers to grow their crops. The increase in global temperatures will increase the chance of droughts stressing the High Plains Aquifer, where most of the great plains get their water. With droughts will come changes in the water availability, causing challenges to crop irrigation and threatening wetlands (Environmental Protection Agency, 2015). Wetlands help to purify water naturally and are important in many respects. Climate change will impact the great plains in many ways, most of those ways will affect the United States food chain, to include the production of meat, and dairy (Environmental Protection Agency, 2015).

 

 

References

Botkin, K. a. (2013). Environmental Science: Earth as a Living Planet (Nineth ed.). Retrieved from https://phoenix.vitalsource.com/#/books/9781119168959/cfi/6/6!/4/4/2/2/1:0

Davenport, C. (2015, December 2). The Marshall Islands Are Disappearing. Retrieved from New York Times : http://www.nytimes.com/interactive/2015/12/02/world/The-Marshall-Islands-Are-Disappearing.html?_r=0

Environmental Protection Agency. (2015). Great Plains. Retrieved from United States Environmental Protection Agency: http://www3.epa.gov/climatechange/impacts/greatplains.html

NASA . (2015, November ). Sea Level. Retrieved from NASA : http://climate.nasa.gov/vital-signs/sea-level/

Oosthoek, K. J. (2015, June 5). Reconstructing Past Climates. Retrieved from Enviromental History Resources : https://www.eh-resources.org/reconstructing-past-climates/

Autism Spectrum Disorder (ASD)

This week in class, I read something I had never heard before; that Autism is a consciousness disorder. I have a nine-year-old with Autism, and had never heard or read that before; strange huh? I’ve heard autism be called a spectrum disorder, a neurophysiological disorder, and a sensory disorder. I’ve always explained it as, “his senses do not work the same way ours do.” That description is right, and wrong. Let’s take a closer look at autism.

Autism does not have one known cause, and the disorder can range from severe to high functioning, leading scientists to believe that there are probably many causes. (Autism is NOT caused by vaccines, and that is all I will say about that in this paper.) Because of the complexity of the disorder, researchers believe that the cause of Autism may be both environmental and genetic (Mayo Clinic, 2016). Post mortem examinations have brought about many discoveries in how autism effects the genes, and the brain.

Several different genes appear to be involved in Autism Spectrum Disorder. Some children have mutations in their genes, that may be the involved in Autism. Some children who have Autism also have a genetic disorder, such as fragile X syndrome or Rhett’s Disease. Some mutations may be on the genes that affect communication, or determine the severity of symptoms. Some mutations may occur spontaneously, while others may be inherited (Mayo Clinic, 2016). One’s chances of having autism increase if one has a sibling or other blood relative with autism, however, scientists believe that many environmental factors may be involved in autism as well.

Environmental factors are currently being explored, and some causes that have been considered are; viral infections, medications or complications during pregnancy, air pollutants, and GMO’s (Mayo Clinic, 2016). All of these factors are considered to effect the baby in utero, evidence shows that around thirty-two weeks in utero, the baby’s brain stops developing normally.

The cerebellum, limbic system, and cortex appears to be affected by Autism. The cerebellum controls fine motor skills, balance, and coordination of the body, as well as, receiving sensory information from muscles, joints, and visual and audio input. Post mortem examinations of the brains of people with Autism has shown an under developed prefrontal cortex and a decrease of purkinje cells in the cerebellum, and that this mutation occurs around thirty-two weeks in vitro. This cell deficient in the cerebellum appears to increase the risk of seizures, and the risk of Autism (Blatt,2012). Many autistic patients also suffer from severe epilepsy.

Many neurotransmitters are affected in the autistic patient including dopamine, serotonin, GABA, and Acetylcholine. Dopamine plays a large role in regulating sensitivity and processing of information, perception of change, relying information, cognition, motivation, emotional responses, attention and focus, movement, and posture (Autism Couch, 2017). A decrease in dopamine levels can impair attention and focus, while an increase can cause the mind to race, and increase sensory processing causing an overload on the brain’s ability to process information. Studies have shown that individuals with autism have increased dopamine receptors on the mRNA expression (Autism Couch, 2017).

GABA is a neurotransmitter that contributes to calming a person down; prohibiting neurons from firing. Research has shown that individuals with autism have an imbalance of glutamate to the GABA receptors, causing over excitement, explaining why so many individuals with autism also have a co-morbid diagnosis of ADHD.

Acetylcholine is an excitatory neurotransmitter that contributes to the contraction of muscles, and stimulates the release of certain hormones. It is involved in wakefulness, attentiveness, anger, aggression, sexuality, and thirst, among other things. A decrease in acetylcholine may explain why so many on the spectrum suffer from issues with aggression.

Autism spectrum Disorder is an extremely complicated disorder, and individuals can range from low functioning to high functioning. What may affect one autistic person may not affect another. However, there are common characteristics that all patients with autism will share to one degree or another.

Social interaction and communication are issues for almost all individuals on the spectrum. They may fail to respond to their own name, after someone has called it many times. They may resist hugging and may not want to play with other kids, often times they will appear to be “in their own world.” They may lack eye contact when having conversations, and they may lack facial expression as well. Delayed speaking, or never speaking at all are common, as well as the inability to use words correctly, and some may lose the ability to speak. Conversations are hard for people on the spectrum, and often they may appear to be uninterested in what the other person is saying. They may speak in an abnormal tone, either sing songy, or robotic is common. Social interactions are complicated for autistic people, and they may approach a situation inappropriately by being passive, or aggressive.

As well as communication and social problems, people on the spectrum may have behavioral problems as well. Common behaviors found in ASD individuals include rocking of the body or flapping of the hands. They may self-harm, but not because they are emotionally damaged. They may bite themselves or hit their head against things. Autistic patients are very fixed in their routines and do not like change or surprises. They may be clumsy or have exaggerated body movements, as often they have a hard time with body coordination. (We know that this is due to the damage in the cerebellum.) Most autistic patients are unusually sensitive to light, and sound, but are indifferent to pain and temperature. Children on the spectrum tend to fixate on certain things, have very real food preferences (and that “let them get hungry” philosophy, does not work with autistic kids – they WILL starve before eating something they do not like). They participate in what is called “parallel play.” This means that, yes, they play with other kids, but only alongside them, not interacting or exchanging ideas with them – Jacob still does this.

Treatment for autism is nonexistent. I hate that some people do not care about a cure. I would love a cure for my son. Autism makes his life so hard, and he gets bullied every year because he has a hard time in social situations. Right now, he is in elementary school, and has a student aid that helps him; I’m scared for when he goes to middle school.  I hope they keep doing the research and find something, someday to cure autism. Many on the spectrum suffer from co-morbid diagnosis of epilepsy, ADHD, anxiety disorders, and sometimes OCD. Since the core symptoms of autism cannot be treated; treatment is focused on the symptoms, or what symptoms can be treated.

Jacob suffers from generalized anxiety disorder, and he takes an adult dose of Prozac to combat that. He’s been in behavioral therapy since he was diagnosed at age three. Behavioral therapy teaches him how to interact with his peers, and how to react in social situations. Jacob is high functioning, but when he was younger, and first diagnosed, the doctors told me that he would never communicate, and never have a life outside of my home. Well, he sure showed them! Jacob has many friends, and talks up a storm – he never stops, he even talks in his sleep! While I know that there is no cure for autism, some patients can be brought out of their shell, and can go from low functioning to high functioning. Jacob use to be non-verbal, and non-communicative (meaning no outward signs of communication, not even grunting and pointing), his IQ use to be a 70, now it’s a 92, and Jacob has come so far in his abilities to interact socially.  Jacob use to be in physical therapy, occupational therapy, and speech therapy (all common therapies for autism), and now he is only in speech and behavioral therapy. I have no complaints.

Autism spectrum disorder is complicated and can take many different paths. This is not a complete list of all signs and symptoms. If you feel like your child may be autistic, please see your primary care provider.

 

 

 

References

Gene J. Blatt, “The Neuropathology of Autism,” Scientific, vol. 2012, Article ID 703675, 16

pages, 2012. doi:10.6064/2012/703675

Autism Couch, Neurotransmitters and Autism. Retrieved from:

http://autismcoach.com/neurotransmitters-and-autism/

Dissociative Identity Disorder

Part of this paper discusses James McAvoy’s character from the recent blockbuster Split. 

 James McAvoy plays a character names Kevin who has twenty-three distinct personalities “trapped” inside his mind. Everyone goes into the movie knowing it is about a man with a “split” personality, but “Kevin” displays these different personalities in very different manners. As the movie develops Kevin’s personalities manifest physically by changing his clothes, changing his personality (for instance, one personality is an agoraphobia, can cannot even stand a smudge on the mirror, one is a small child, who is excited to have a new person to talk to, one is a nurturing woman, one is a tough guy, who protects and guards, one is a gay man and fashion designer, and one has Type I Diabetes and needs medication), changing his medical needs, and changing his emotional state, as well as his physical appearance. Kevin also attends therapy. (I will not discuss the validity of DID in this paper, as I believe that DID is a real disorder.)

A psychologist uses, what is called, the four “D’s” to determine if a person has a psychological disorder. The four D’s include: deviance, dysfunction, distress, and danger (some consider a fifth D to be relevant in diagnosing psychological disorders; duration) (Davis, 2009). “Kevin” would certainly be diagnosed with DID if he was a real patient.

Deviance can best be described as a disruptive behavior that deviates from society’s norms, or standards of conduct (Davis, 2009). A person’s behavior can be described as deviant when it goes against societies norms, such as when Kevin kidnaps a person, and holds her prisoner, or when Kevin commits murder, multiple times.

Dysfunction can best be described as a behavior or multiple behaviors that interfere with a person’s life in a significant way (Davis, 2009). Kevin’s diagnosis of DID interferes with multiple faucets of his life. It is hard for him to interact with people socially, he has an Obsessive Compulsive disorder, and it affects his ability to maintain employment, friendships, and even his relationship with his therapist suffers over the course of the movie. Keven can be described as very dysfunctional.

Distress can best be described as the related stress the behaviors and dysfunctions have on the individual. A person can be very dysfunctional and not very distressed over those dysfunctions, or a person can have very little dysfunctions in life, and be very distressed over them anyway (Davis, 2009). It depends on the person, and the diagnosis one is looking at. Kevin experiences a high deal of distress, or at least some of his personalities do. The more dominant personalities have taken over Kevin’s physical body, the person who is normally in charge, a separate personality named Barry, has little control. Barry is very distressed by the actions of the other personalities, and he begins to call and email the therapist when he is in charge, trying to get assistance. Barry believes the other personalities will cause trouble or be dangerous, and he is right.

Danger is the fourth D, and it can best be described as the person’s ability or inclination, to harm either oneself or another person (Davis, 2009). The, normally, non-dominate personalities that have taken over Kevin’s physical body present a great deal of danger to others and to Kevin. They even run the risk of getting Kevin killed because of their actions; kidnapping, and murder.

Kevin has suffered from DID for many years, and has been, up until his non-dominate personalities decided to get revenge, a quiet, unobtrusive person who lives and works in the basement of some factory. The fifth D that psychologists look at is duration; how long has the person been suffering from these symptoms (Davis, 2009)?  For Kevin, the answer is probably since child hood, as DID is a disorder usually brought about by severe childhood abuse and trauma.

Dissociative identity Disorder (DID) is a “…complex type of dissociation in which individuals are from time to time dominated by distinctly different, complex, highly integrated personalities (LeFrancois, 2016. Sec. 10.6, para. 23).  The causes of DID are prolonged, severe, childhood abuse, with seventy-six percent of patients reporting a combination of mental, physical and sexual abuse; usually by a parent, or other close relative. Occasionally, the stressor of war can bring on a dissociative identity, as the identity of a person is still developing during childhood. Kevin has twenty-three distinct and separate personalities with their own psychological disorders to include OCD, and Generalized anxiety disorder. They have their own medical needs, and their own interests, and sexual preferences. Kevin has gone to many years of therapy to counter-react the effects of DID.

Treatment for DID mainly consists of talk therapy, but drug treatment may be necessary as well, especially if the patient presents with other psychological disorders, such as OCD, or anxiety.

Another form of treatment therapist may choose to employ for patients with DID is Cognitive Behavioral Therapy. Cognitive Behavioral Therapy is an approach to therapy that attempts to change behaviors and attitudes by changing the reward for these attitudes and behaviors (LeFrancois, 2016).  Cognitive Behavioral Therapists believe that negative behavior can be unlearned and that acceptable behaviors can then replace those negative behaviors.

A more humanistic approach to therapy, one that has proven to be affective with treating DID, is Roger’s Client Centered Therapy (LeFrancois, 2016).  Roger’s client centered therapy is perhaps the most well-known approach to therapy aside from Fraud’s psychoanalyst approach. Client centered therapy is built upon the premises that all people have a desire to self-actualize; to improve oneself. Client centered therapy focuses on providing the client with a safe environment in which to explore past trauma, and their feelings without a sense of judgment (LeFrancois, 2016).  These are the therapists that asks such questions as, “how do you feel about that?” In this sense, the therapist helps the client to self-actualize, or improve upon oneself, by providing an environment where the client can grow and become of aware of their own coping mechanisms.

Because of the severe childhood trauma that accompanies a diagnosis of DID, often family therapy is recommended, if the patient is still in touch with their family. Family therapy aims to help families communicate better, as well as teach family members how to better understand the diagnosis (American Psychological Association:  Society of Clinical Psychology, 2013).

DID, like all mental health diagnosis, can be complicated and hard to understand. However, treatment has been proven to be successful in that it has allowed most patients to carry on with their lives without too much dysfunction. Patients with DID often suffer from a variety of comorbid disorders, as well as severe mental trauma from the abuse that they suffered. Because of the comorbidity of DID, a diagnosis is often not made until later in life, often after many years of suffering by the patient at the hands of psychologists who are doubtful the disorder exists. Some attribute the symptoms to Schizophrenia, however, schizophrenia and dissociative identity disorder are completely different, in that in DID, patients have two or more distinct personalities, whereas, in schizophrenia, patients have paranoid episodes where they may behave like a different person.

 

References

T Davis. Conceptualizing Psychiatric Disorders Using “Four D’s” of Diagnoses. The Internet

Journal of Psychiatry. 2009 Volume 1 Number 1.

LeFrancois, G. (2016). Psychology: The human puzzle (2nd ed.). [Electronic version]. Retrieved

from https://content.ashford.edu/

American Psychological Association:  Society of Clinical Psychology. (2013). Research-

            Supported Psychological Treatments. [Website]. Retrieved from

https://www.psychologicaltreatments.org/