Disorders in the adult population

DEPRESSIVE DISORDERS

Depression can be considered a major social problem. According to the World Health Organization (2015) depression is a common illness worldwide, affecting an estimated 350 million people.

We need to differentiate depression as a disorder from the usual variations in mood and from brief emotional responses to the problems of everyday life.

Depression is a serious health problem, especially when it is long-lasting, of considerable intensity, when it causes great suffering and when it ends up affecting work, school and family activities.

 The forecast for 2020 is that depression will become the second cause of disability and sick leave after cardiovascular disease.

Depression is one of the most disabling problems and one of the most painful for those who suffer from it.

Levels of depression:

• Symptom level, depression refers to a low, sad mood.

• Syndromic level, depression implies not only the existence of a certain mood but also a series of concomitant symptoms (changes in appetite, sleep problems, loss of pleasure, inactivity, etc.). It is called a “depressive episode” and it is a set of symptoms with a determined severity and duration that can be linked, in a non-specific way, to diverse mental disorders or to a specific circumstance (mourning, delirium, change in life, etc.).

• Nosological level, the existence of a depressive episode in which the symptoms are not exclusively due to another disorder or condition. It is called “depressive disorder”.

ANXIETY DISORDERS

The term anxiety refers to a “state of agitation, restlessness, or distress of the mind. It can be defined as the anticipation of future harm or misfortune, accompanied by a feeling of (unpleasant) dysphoria and/or somatic symptoms of stress.

It is an emotional reaction to the perception of danger or threat, manifesting itself through a set of responses that are grouped into three systems: cognitive, physiological and motor, and can act with some independence. It is an alert signal that warns of a future danger and allows the person to take the necessary measures to confront the threat.

Anxiety disorders as such are a group of illnesses characterized by the presence of excessive worry, fear or dread, tension or activation, and behavioral disturbances that result in significant distress or clinically significant impairment of the individual’s activity. Anxiety disorders tend to get worse if they are not treated properly.

ADJUSTMENT DISORDERS

Throughout our lives, we all face stressful or negative events and we have a wide range of responses to deal with the stress that these experiences cause. Most of these reactions are not serious or prolonged and do not allow a psychopathological diagnosis to be established, but on other occasions they can be the cause of intense discomfort and interfere with people’s lives.

Similarly, it is necessary to take into consideration that sometimes, despite the discomfort experienced, the experience of certain events could also constitute an opportunity for growth. Thus, psychotherapy helps to identify not only the individual differences in coping, but also the learning that comes with life changes (breakup or problems with a partner, loss of work, change of address, diagnosis of illness, etc.). 

Adjustment disorders are a psychological response to one or more stressful events that leads to the appearance of altered emotional or behavioral symptoms. They usually readjust in a short period of time, approximately six months. If the discomfort persists and no readjustment takes place, psychotherapy help becomes necessary.

A nervous breakdown is usually characterized by a deterioration in family, social or work activity. It usually presents itself with great personal discomfort and suffering, which affects one’s emotional state permanently.

SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

• Alcohol
• Nicotine
• Illegal Drugs
• Pathological play

Addictive disorders include pathological gambling, which despite not including the intake of substances, causes very similar reactions and deterioration in the body and in the subject’s daily life.

In recent decades, addictive disorders have become a major problem not only clinically but also socially because of their increasing prevalence and the negative consequences of their use.

The use of both legal (alcohol and tobacco) and some illegal drugs (e.g. cannabis, cocaine, synthetic drugs, etc.) have spread considerably in our society and in practically all developed countries. People usually seek help for the serious consequences at different levels such as health, work, family life, work, etc.

Addictive behavior is problematic when:

1. The action is performed more frequently or for a longer time than expected.
2. There is a persistent desire or unsuccessful effort to give up or control the urge to do it again.
3. A large amount of time is spent on the activities needed to do them again or to recover from the aftereffects.
4. There is a strong and constant desire or urge to do it again.
5. Failure to meet major obligations at work, school or home occurs.
6. The addictive action continues despite having social or interpersonal problems caused by it.
7. Stops or reduces important social, recreational or work activities.
8. Instead of reducing, there is an increase in the number of times the addictive activity is done .
9. The inabity to perform the adictiva behaviour leads to considerable discomfort  and has physically and psychologically affects (anger, sweating, tachycardia, anxiety, outbursts of rage, etc.)

EATING DISORDERS

Eating disorders have great socio-health relevance due to their peculiarity, their seriousness, their social interest, their complexity and their diagnostic and treatment difficulties. These disorders group together a set of problems that are characterized by abnormal behaviors, beliefs and emotions about eating, weight and body shape. They can be:

➢ Pica. Ingestion of non-nutritive substances (e.g. paper, hair, ashes, etc.) in a persistent manner. Not usually accompanied by general aversion to food. This pattern of intake presents physical complications that can be serious, such as intestinal obstructions or poisoning.

➢ Rumination disorder. Repeated regurgitation of food is considered characteristic. Once the food has been partially digested it is returned to the mouth without disgust or nausea. Malnutrition is often present in this disorder and eating out is sometimes refused in order not to exhibit these episodes of regurgitation in public.

➢ Food avoidance/restriction disorder. It should be noted that the essential characteristic is to avoid or restrict food, which can have important weight loss and nutritional consequences. Although significant physical deterioration can occur, as in anorexia nervosa, it does not occur in a context of excessive concern about body weight or shape.

➢ Anorexia nervosa. The main feature revolves around the person losing weight of their own free will. Leading to unhealthy body mass ranges.  People who suffer from this disorder are afraid of gaining weight even if they are underweight. All this is accompanied by an alteration of the body image characterized by an excessive assessment of the concept of self in terms of achieving a certain appearance, in this case a more than thin, emaciated aspect. It should also be noted that in this particular disorder or in eating disorders in general there is a significant motivation to control intake, and thus also body shape.

➢ Bulimia nervosa. It is characterized by episodes of binge eating (voracious and uncontrolled intake), in which a large amount of food is ingested in a short period of time and usually in secret. Affected individuals try to compensate for the effects of over-eating by self-induced vomiting and/or other purging maneuvers (laxative abuse, use of diuretics, etc.) and physical hyperactivity. They show an unhealthy concern for their weight and figure, but do not necessarily produce alterations in their weight. The three essential characteristics of this table can be summarized as the subjective loss of control over intake, behaviours aimed at body weight control, and extreme concern for body shape and weight.

MOURNING

The word “mourning” comes from Old English murnan “to feel or express sorrow, grief, or regret; bemoan, and from Proto-Germanic *murnan “to remember sorrowfully”. For thousands of years people have been mourning, using the means available to them at the time to help them resolve their loss.  However, the passage of time and changes in our society have been reflected in a new approach, since we often lack that sense of community and extended family that provided support in earlier times, and this is causing more and more people who have suffered a loss to seek help from mental health professionals.

To understand the experience of loss, it is often helpful to recognize its pervasiveness in human life; we lose something with every step we take on the journey of life, from the most concrete things, such as people, places or objects, to the most immaterial, but no less significant. Each of these inevitable losses is accompanied by its own pain and affects us in a particular way.

Mourning could be defined as the natural response to the loss of any person, thing of value with which an affective bond has been built, and as such, it is a natural and human process and not a disease to be avoided or cured. The expression of grief includes reactions, which very often resemble those that accompany physical, mental or emotional disorders. It is important to be very cautious in interpreting certain expressions of grief that may appear as pathological and are, in fact, entirely natural and appropriate manifestations, given the particular circumstances of the loss: feelings of intense sadness, rumination about the loss, insomnia, loss of appetite and weight loss.

In some cases, the grieving process may not follow a normal course, becoming complicated and leading to major disruptions in the lives of the people who experience it. This is known as complicated, pathological, abnormal or traumatic grief.

Sometimes, the grieving person may be aware that the grief is following an abnormal course, since it interferes with the general functioning of the grieving person, and this leads them to seek specialized help. However, the discomfort experienced is not always related to unresolved grief, and in these cases, the grieving person will seek help for a medical or psychiatric problem.

The warning signs of grief that can become pathological are:

• intrusive thoughts about the deceased
• constant worry
• inability to enjoy or disconnect from loss
• search for the deceased
• social isolation
• lack of goals and/or uselessness regarding the future
• contempt for life
• lack of emotional response to positive events
• difficulties in accepting death or guilt towards it
• excessive irritability, bitterness and/or anger in relation to death.