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Incorporating any of these mindfulness and relaxation techniques into your daily routine can be a powerful way to manage stress and promote mental well-being. However, it's important to remember that these are practices that require regular engagement. The benefits often come over time, rather than immediately, so be patient with yourself as you explore these techniques.

Peer Support Groups: These are groups where individuals facing similar issues come together to support one another. For example, Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are well-known peer support groups for individuals dealing with substance abuse. Other groups might focus on grief, cancer, mental health conditions, parenting, and more. While these groups may sometimes be facilitated by a professional, they often are not.

Online Support Groups and Forums: With the rise of the internet, many individuals find comfort and advice in online communities. These can be especially beneficial for individuals with less common conditions or those in remote locations. It's important to remember that while valuable, the advice given in such forums is not typically monitored by professionals. Neurodevelopmental disorders can cause difficulties with learning, communication, behavior, social interactions, and motor skills. They can also cause problems with emotions, memory, and self-control. Neurodevelopmental disorders often begin in childhood and frequently persist throughout a person's life. They are thought to be caused by genetic, environmental, or biological factors and most often by a combination of these. Just imagine: you're a young child whose slightly younger brother beats you at several important kid motor milestones. (In truth, you still haven't accomplished all of the normally expected developmental motor tasks mentioned in the next sentence.) He learned to use a knife and fork before you, rode a bicycle sooner, used buttons and zippers before you, and a little later was much better at team play which you avoid.

If you are an individual with developmental coordination disorder (DCD) and a slightly younger brother, the above paragraph likely explains part of your experience as a young child. DCD is one of several mental health disorders that can negatively alter how the brain develops in young children. In this condition, the rhythmic coordination of fine and gross movements are affected. (Fine motor movements involve the small muscles, especially of the hands and wrists. Gross movements involve the large muscles.)

The diagnosis of DCD is made by putting together information concerning the individual's developmental and medical history, physical exam, school reports, and assessment by a professional (e.g., a psychologist, pediatrician, or neurologist) which requires the child to do a range of physical activities. The evaluators may use their own assessments or alternatively there are commercially available tests such as the Movement Assessment Battery for Children which may be used.

According to the Diagnostic And Statistical Manual Manual Of Mental Disorders Fifth Edition Text Revision (DSM-5-TR), which is the manual used to diagnose mental health disorders in the United States, the diagnostic criteria for DCD are, in brief: A) the acquisition and execution of coordinated motor skills are substantially below what is expected based on age; B) the deficits of motor skills and coordination significantly and persistently interfere with daily life in the areas of self-care, school, work, leisure, and play; C) the symptoms began in early childhood; and D) the deficits cannot be better explained by intellectual developmental disorder or by visual impairment and are not caused by a neurological condition affecting movement (e.g., cerebral palsy or muscular dystrophy). In DCD, the impaired skills of motor coordination vary with age. Young children may be delayed in sitting, walking, and crawling; however, many achieve normal early motor milestones. They may also be delayed in walking up stairs, pedaling, using buttons and zippers, and putting together puzzles. And even when any of the aforementioned skills are acquired they may appear ackward, slow, or lacking the precision of their peers. Adolescents and adults may have problems assembling puzzles and models, and additionally, they may face difficulties with typing, handwriting, driving, and self-care skills.

As per the above criteria, DCD is only diagnosed if the impaired motor skills hinder self-care and interfere with school, work, leisure, and play. Examples of these activities include: getting dressed, eating with utinsles in age-appropriate fashion, joining physical games, and using rulers, pencils, and scizzors. Impairment can include such things as clumsiness and slowness. Legibility and speed of handwriting may also be affected in all age groups.

According to the above diagnostic criteria, the diagnosis of DCD is made only if the motor coordination difficulties cannot be better explained by visual impairment or a neurological disorder such as cerebral palsy. Thus a vision and neurological exam are part of the workup for this disorder. And furthermore, if the person has intellectual developmental disorder, the diagnosis is only made if the lack of coordinated motor skills are in excess of what would be expected based on mental age.

Dysfunction of several brain regions have been proposed to contribute to the movement and coordination difficulties seen in DCD. These suspected regional brain malfunctions are many, extremely complex, and apparently cause other symptoms besides coordinated motor movement problems in persons who suffer from DCD. In the next two paragraphs, I will briefly mention a few of these other difficulties. Some children with DCD demonstrate abnormal involuntary motor movements of unsupported limbs. Another phenomenon sometimes seen is that voluntary gestures of one hand cause involuntary motions of the relaxed hand that mimic or "mirror" the type of movement done by the voluntarily moving hand. Both of these findings are referred to as neurological soft signs.

Another difficulty seen in DCD affected persons are problems with "executive function." Executive function involves conscious mental skills that assist a person with planning, monitoring, and executing their goals. Some of these "executive function" abilities include attentional control, problem-solving actions, inhibition, emotional and motivational regulation, and verbal working memory (which is the short-term memory used when we hear something and have to do something with it--like hearing a phone number and then dialing it. In one study from 2015, many adults with suspected DCD said that problems with executive function bothered them alot. The prevalence of DCD in young youths is commonly stated to be around 5%. However, some more recent studies have around 10% of children affected in the US and 24% in Brazil. The prevalence rate in adults is unknown, but between 30% - 70% of childhood cases are estimated to go on until adulthood.

DCD co-occurs (is comorbid with in medical speak) many other mental health disorders that first show their face in childhood--the so-called neurodevelopmental disorders (meaning problems with early brain development). Some of these include communication disorders , specific learning disorder (especially reading and writing) , attention-deficit/hyperactivity disorder (ADHD) (ADHD co-occurs with DCD about 50% of the time), autism spectrum disorder , and disruptive and emotional behavior problems.

Now, as the previous sentence alluded to, it is vignette time. When Alec, along with both parents, first came to see me he was a six-year-old first grader. His teacher had suggested to his parents that he be evaluated for ADHD. While in the waiting room, Alec couldn't stay seated. And in my office he displayed several ADHD symptoms. I gave Alec's parents some ADHD rating scales to be filled out by them and his teacher. They came back positive.

In our next session, I gave Alec's parents some medication for his ADHD symptoms. Then his mother mentioned that he was having trouble holding a pencil and eating his food in age appropriate fashion. This, along with knowing about the 50% co-occurrence of ADHD and DCD, made me suspicious of him also having DCD. I then took a more detailed developmental and medical history and referred him for vision testing, a neurological exam, and formal screening for DCD. The end result was that he had DCD.

I then referred Alec for treatment with an occupational therapist to help him with his fine motor difficulties. Over time, the treatment became successful. While he was not cured, his symptoms were improved. I also informed both Alec's parents and him what to look for as he grew older. So, along with getting treatment for both his DCD and ADHD symptoms and giving Alec and his parents some education, his life hopefully will be significantly altered for the better.

In its essence, specific learning disorder is a "brain disorder" that causes significant difficulties with reading, writing, and/or arithmetic in the presence of normal intelligence. According to the Diagnostic And Statistical Manual Of Mental Disorders Fifth Edition (DSM-5) (the manual used to diagnose mental health disorders in the United States) the criteria for specific learning disorder are as follows:

The skills affected by learning disorders are well below what is expected based on age and cause significant interference with academic performance. Learning difficulties begin during the early school-age years and can most often be seen then, but sometimes they may not become noticed until later when academic demands exceed the person's limited capacities. There are no lab or imaging tests that can be used to diagnose specific learning disorders. Instead, the diagnosis is based on a thorough understanding of the person's developmental, medical, family, and educational history, along with school reports, and a written psychological and educational assessment done by a psychologist. This diagnosis can only be given after formal education starts, but it can be made any time thereafter. Typically, specific learning disorder persists until adulthood; therefore, there is no need to reassess unless the symptoms significantly worsen or improve.

The learning difficulties here are termed "specific," because they are not attributable to intellectual disability (see link above), hearing or vision difficulties, neurological or motor problems, or global developmental delay which is the term used for a child younger than five who has missed several intellectual developmental milestones but cannot be tested due to age or other factors.

In contrast to talking and walking, which occur almost naturally in the presence of brain maturation, the academic skills of reading, writing, and mathematics have to be taught to and learned by a child. Specific learning disorder disrupts this normal process of learning academic skills in children of normal or even "gifted" intelligence.

Specific learning disorder is often, but not always, preceded in the preschool years by delays in attention, language, (e.g., difficulties in rhyming) and/or motor skills that may continue on and co-occur with the disorder being discussed. Commonly, in this disorder, an uneven profile of intellectual ability develops. For example, there may be above-average drawing ability in the presence of slow, inaccurate reading.

Learning to map letters with the sounds of one's language is important when learning to read. Problems in this arena are termed dyslexia. In the presence of dyslexia, it becomes difficult to accurately learn to make printed words come alive in your mind or with your voice. And it can cause all sorts of other problems in the academic (e.g., problems with spelling), emotional, and behavioral realms. One problem it doesn't cause, despite the myth to the contrary, is letter reversal. Young children commonly reverse some letters. However, if it's still occurring by the end of first grade it may indicate a problem. Of note: dyslexia is not a DSM-5 diagnosis. Instead, DSM-5 uses the terms with impairment in reading (subheadings: reading accurately and fluently) or with impairment in written expression (subheading: spelling accuracy) are used.

Specific learning disorders occur in about 5% - 15% of school-age children across different languages and cultures. Prevalence among adults isn't really known but a best guess is roughly 4%. Although there is some variation in the literature, several repatable sites state that specific learning disorders are equally common in males and females; however, these sites go on to say that males are referred for evaluation twice as often as females.

Specific learning disorders run in families, and it has genetic and environmental factors contributing to its origin. The relative risk of a learning disorder in mathematics is 5-10 times higher in first-degree relatives (parents, siblings, & offspring) of individuals with this disorder than in the general population. For reading, the risk is 4-8 times higher in first-degree relatives of affected individuals This indicates a genetic component in their origin. From an environmental viewpoint, prematurity or very low birth weight increases the risk of specific learning disorders as does prenatal nicotine exposure.

Specific learning disorders can have negative consequences across the lifespan. These include: higher rates of high school dropout, poorer overall mental health, higher rates of unemployment or underemployment, and lower income. It should also be known that specific learning disorders increases the rate of suicidal ideation in children, adolescents, and adults. According to one Canadian study, this is especially true for women.

Specific learning disorders commonly co-occur with many other mental health difficulties that are first seen in school-age youth. These include: attention-deficit/hyperactivity disorder , communication disorders [What Are Communication Disorders?], developmental coordination disorder [What Is Developmental Coordination Disorder?], and autistic spectrum disorder . It also co-occurs with other mental health disorders that can come to pass throughout the lifespan. They include: anxiety disorders [What Is Panic Disorder?] is given as an example of an anxiety disorder there are others, depressive disorders , and bipolar disorders . Early intervention is key for children with learning disabilities, and it can help avoid extended problems with schoolwork and related low self-esteem.The Individuals with Disabilities Education Act (IDEA) is a federal law in the United States which states that children with specific learning disorders are eligible for special education services. The law states that if an individual is suspected of having a learning disorder the school must provide an evaluation. (Alternatively, this evaluation can be done in the private sector, but it is expensive.) A team, including school personnel and the parents, will together develop an Individualized Education Plan (IEP) for the student. The law goes on to state that Free Appropriate Public Education (FAPE) will be offered to all students including those requiring special education.

Now it is vignette time: Alec came to see me along with his parents when he was in the middle of first grade. He wasn't able to sit still in his seat and he had other symptoms consistent with attention-deficit/hyperactivity disorder (ADHD). He was also having more difficulty learning to read than his peers. I started Alec on.Ritalin (generic: methylphenidate) which controlled his ADHD symptoms. However, his reading was still not up to snuff, so I suggested to his parents that they have him evaluated for a specific learning disorder.

It turned out that Alec had a mild case of specific learning disorder with impairment in reading. With early intervention by the school personnel, he was reading at grade level by the middle of third grade. So by treating Alec's ADHD and his specific learning disorder with impairment in reading his life was altered significantly for the better. For example, it became less likely that Alec would be a highschool dropout and more likely that he would be able to find decent, interesting employment as an adult.

Stereotypic movement disorder is a brain based illness that begins in early childhood and causes the affected person to make involuntary, repetitive, rhythmic-type movements that appear purposeless. (However, these movements may be used by the affected individual to ward off anxiety due to external stressors.) These movements can be divided in a couple of ways: First, there is the non-self-injurious type (e.g., body rocking/hand shaking) and the self-injurious type (e.g., hand or nail biting, lip biting, hitting oneself, and eye poking). These movements are not painful and not harmful unless they are of the self-injurious type. In fact, some people say they are pleasurable. And interestingly, they are absent during sleep.

Another way to divide stereotypic movements is into primary and secondary forms. Primary stereotypic movements occur in a child who is otherwise developing normally. Primary stereotypic movements can be further subdivided into common (e.g., pencil tapping and hair twisting which are not unusual in children and usually fade with age) and complex (e.g., hand flapping and wiggling fingers in front of the face).

Each person with SMD has their own stockpile of movements. That is, each person has their own "signature" behaviors. Sometimes persons with SMD display a type of self-restraint in the form of binding their arms or hands and fingers with cloth or take other protective measures in an effort to avoid self-injury. This self-restraint behavior is only temporararily effective, and it should be noted that self-restraint is not a common symptom of stereotypic movement disorder.

According to the Diagnostic And Statistical Manual Of Mental Disorders Fifth Edition Text Revision (DSM-5-TR), which is the manual used to diagnose mental illness in the United States, the diagnostic criteria for stereotypic movement disorder are, in short A) repetitive, seemingly driven, rhythmic-type movements that appear to be purposeless (e.g., hand shaking, hand waving, head banging, eye poking); B) the body movements interfere with (e.g., school, work, leisure, self-care, etc.) and may result in self-injury; C) the movements begin in early childhood (most often by three years of age); D) the repetitive behavior is not caused by a substance or a neurological condition and is not better explained by another early brain developmental disorder or mental illness.

The exact cause of SMD is not known. There are; however, several ideas along these lines. In a study of 100 typically developing children, one-fourth of them had a positive family history of SMD (indicating a possible genetic basis) and three-fourths of them did not (i.e., these later cases appeared to arise spontaneously). To date, no abnormal genes giving rise to stereotypic movements have been found, but studies are currently underway. There are several environmental/psychosocial stressors known to be associated with SMD. For example, a study of children in Romanian orphanages (where there was a lack of stimulation) found that greater than 80% of them had stereotypic movements (mostly body rocking). (Lack of stimulation was one of two factors hypothesized to be involved here.) And differing parts of the brain (both structural and functional) have been implicated in SMD without much agreement. There is; however, much complex evidence pointing to a biological basis for this illness.

Stereotypic movements usually persist until adulthood. In one study that followed 100 affected children for up to 10 years found that 94% of them continued to experience stereotypic movements. Over 50% of the participants reported no change in their stereotypic movements during the monitored time and 10% reported worsening of symptoms.

SMD commonly occurs with some other mental health disorders. In one study, participants had attention-deficit/hyperactivity disorder (ADHD) in 30% of studied cases; tics were present18% of the time; and obsessive-compulsive behaviors/obsessive-compulsive disorder (OCD) co-occurred 10% of the time. In another study, 73% of the participants with primary complex stereotypic movements had elevated anxiety. Now it is vignette time: Janet brought her daughter, Alicia, to see me when Alicia was seven years old. Janet wanted to know if there was anything I could do for her daughter who had been diagnosed with stereotypic movement disorder of the primary complex type at the age of three years by a pediatric neurologist. Through a combination of luck and skill I had successfully treated Janet for a complicated depressive disorder where another physician had failed, so she held me in some esteem. I told Janet that honestly I didn't know anything about stereotypic movement disorder, but I would look into it and see them back in two weeks. I spent a fair amount of time over the next week learning about SMD.and part of the following week trying to locate a psychologist with experience and know how when it came to treating persons that had SMD with behavioral therapy. Finally, I found one at the local medical school. In psychology and psychiatry, depressive disorders are conceived of as mood disorders. The term mood is elusive to define, but with a little explanation, it can be intuitively understood. Mood is a pervasive, ongoing feeling state that colors one's outlook. "My father just sits, stares, and says he's not worthy to be alive," is an example of a sad, or more correctly, a melancholic mood. The majority of the time people's moods remain within a so-called normal range--not too high; not too low. Significantly below the low end of normal are the found depressive disorders which are forms of mental illness. The essential feature of a major depressive episode is at least a two-week period of either a depressed mood (e.g. feeling sad, empty, or hopeless) or a loss of interest or pleasure in almost all activities. If both of these symptoms exist they must be accompanied by three of the following seven features listed below. When only one of these symptoms is present at least four of the following seven signs must exist.

Decreased energy, fatigue, and sleep disturbance are common. The smallest tasks may seem to require a major effort. "It's hard to even bend over and pick up a piece of trash on the floor." a patient named Bill told me one time. "It's like I'm moving through molasses." Many individuals report impaired ability to think, concentrate, or make even small decisions. "I may have four or five things to do, and I just can't decide which one to do first," a middle-aged woman named Mary told me. "When I think I've finally settled on one all of a sudden I just feel anxious, and I start trying to decide all over again." Loss of interest in or decreased ability to obtain pleasure from previously enjoyed activities is almost always present. "I just don't care about soccer anymore. Please don't make me play," a young girl, whose grades had recently fallen, told her parents in my office one day. "But you love soccer, honey," her mom said. "I hate soccer!" Another man said, "my wife doesn't understand why I'm not interested in sex anymore. I'm just not. It sounds more like work." A sense of worthlessness and excessive guilt may be present. "I told my daughter that she needed to live in the dorms at college because that's all we could afford. She never finished university, you know, and it's my fault. I should never have told her that." If my patient, Abigail, said that to me once she said it forty times. She couldn't get that thought out of her mind even though part of her knew it not to be true. She'd look so guilty each time she said it--head down with tears in her eyes.

Appetite changes can go either way. "I don't have much desire for food anymore," a man named Sam said. "It just almost turns my stomach." "Now I crave sweets all the time," one middle-aged woman told me. "I never used to be that way." Sleep changes are the same in that they too can go either way. "I wake up at two a.m. and can't go back to sleep to save my life," Ray, a young man in his 30s, answered when I asked him about his sleep during one of our sessions. He was in the midst of a major depressive episode. On the other hand, a high school girl, Sara, said, "I sleep all the time, and I still feel tired." Sometimes there are body movement changes. "He just sits and stares and never seems to move," Jim's wife said. On the other hand, John's wife noted, "he just can't seem to stand still. It seems like he's always pacing or rubbing his right thumb on the palm of his left hand."

Major Depressive Disorder (MDD) is associated with a high death rate. Much, but not all, of which is accounted for by suicide. Suicidal thinking is frequently present and attempted or completed suicide is often a risk during a major depressive episode. Suicidal thinking can go all the way from, "I think my wife and kids would be better off without me, but I'd never hurt myself," to, "it crosses my mind sometimes," to, "I bought a gun three days ago, and I'm going to shoot myself tonight in the bathroom after my wife and kids go to sleep. I'm going to do it this time. I'm tired of feeling this way." Epidemiologic research suggests that between 15-19% of people who experience a major depressive episode will have hallucinations and/or delusions . If a person's mind is having hallucinations and/or endorsing delusional beliefs, that places the individual in a psychotic state. (In a psychotic state, one has at least partially lost the ability to distinguish correctly between what other non-psychotic persons perceive as real or not real). So major depressive disorder contributes to psychiatric illnesses that can cause psychosis.

The psychotic symptoms of major depressive disorder may be termed mood congruent: "When I was born, I cast a backward shadow and caused the Great Depression." This utterance shows a depressive theme, so it is mood-congruent. The other type of psychosis in MDD is termed mood-incongruent psychotic features: "I'm guilty of kidnapping, but my dad is famous, and he will keep me out of prison. There's no way I'm going; God told me." These statements are examples of mood-incongruent psychotic features as they do not relate to a depressive theme. The first episode of a major depressive disorder may start at any age, but after puberty, it becomes more likely. In the United States, the peak age of onset is in the 20s, but it is not uncommon for the first episode to occur later in life. The course of major depressive disorder is variable. Some individuals seldom, if ever, see remission (a period of two or more months with few or no symptoms). Others have recurrent episodes with few to no symptoms in between. Two in five individuals began to see recovery within three months after the onset of a major depressive episode. Four in five began to feel better within a year without treatment. Depression has been with man for a long time. There are ancient texts over four thousand years old that describe depression and attribute it to demonic possession. Since that time it has been attributed to various causes with an off-and-on belief that it is a mental disease. Currently, I would say the dominant model for postulating the cause(s) of depression is the biopsychosocial model. This model looks at the biological, psychological, and social causes of an illness.

Current treatment for major depressive disorder centers around psychotherapy (mostly differing forms of cognitive-behavioral therapy--CBT) and medical treatments. For mild to moderate depression, treatment can be conducted by psychotherapy, biological treatment (mostly medications at this point), or both. It is believed that in this group of people using both psychotherapy and medication together leads to the best possible outcomes.

As depression worsens or worsens still and becomes psychotic, medical treatments predominate. There are numerous antidepressant medications to choose from [see link to: What Are The Different Classes Of Medications For Mental Health Disorders? antidepressants subheading.] In order to facilitate the desired efficacious effects, sometimes dosage adjustments need to be made or another medication needs to be tried. (It should be known that which medication is tried first is not a science.) Sometimes antidepressants need to be augmented (i.e. another medication is added on; (e.g. BuSpar (buspirone), thyroid hormone, lithium, or an atypical (second generation) antipsychotic, etc. (Atypical antipsychotics also work on biological mechanisms that affect mood.))[see link to: What Are The Different Classes Of Medications For Mental Health Disorders? antidepsychoticssubheading If MDD becomes "MDD with psychotic features" an antipsychotic medication is given alongside an antidepressant. Now we're going to shift gears and take a look at persistent depressive disorder (aka dysthymia). In order to be diagnosed with dysthymia there must have been at least a two year period in which a person has been depressed most of the time (one year in children and adolescents where the mood can be either depressed or irritable). Additionally, there must have been negative personal consequences that lead to distress accompanied by two or more of the following:

Major depression can occur during a persistent depressive disorder (so called"double depression"). Due to the chronicity of dysthymia, when there is an early onset (a typical beginning is in childhood, adolescence or early adulthood), it may be difficult to elicit the information needed for the diagnosis due to, "I've always been this way," type phenomenon.

The degree to which dysthymia impacts basic and/or occupational functioning is widely variable, but it can be worse than major depression. When compared to major depression, those with dysthymia have, on average, more co-occurring (comorbid in medical speak) disorders-- especially anxiety and substance use disorders. There appears to be a genetic component for persistent depressive disorder as the rates of dysthymia are thought to be higher in close relatives of individuals with this illness. The female to male gender ratio is greater than one, but the actual number varies depending on the source. Treatment, as with most other of the depressive disorders, is given with psychotherapy (mostly some form of CBT) and medications.

Finally, it should be noted that sometimes depressive symptoms can be due to a medical condition (e.g. hypothyroidism) or a medication or substance. Keeping this in mind when thinking about the origin of depression in a specific individual is important as the treatments for these forms of depression are very different than in a primary psychiatric manifestation. This category applies to situations in which depressive symptoms exist that cause significant distress but do not meet full criteria for any depressive disorder, and the clinician does not give the reason why a more definitive diagnosis is not given. This diagnosis might be given in, for example, in an emergency room setting where information for a more specific diagnosis cannot be elucidated.

In closing, I want to make it clear that treatment can be offered even if the suffering person does not meet full MDD criteria. What if a person has only three symptoms but they are ill and it is interfering with important aspects of their life (e.g. decreased school grades, work absenteeism, feelings of serious depression or emptiness, etc.) It's just common sense that these people are deserving of psychological and medical care. Alcohol-induced mental health conditions resemble independent mental health disorders as described in the Diagnostic And Statistical Manual Of Mental Disorders Fifth Edition (DSM-5) which was published in 2013 by the American Psychiatric Association. (The DSM-5 is the reference book currently used to diagnose mental illness in the United States.) These conditions include alcohol-induced psychotic disorders as an example of a psychotic disorder, alcohol-induced bipolar disorder , alcohol-induced depressive disorders , alcohol-induced anxiety disorders as an example of an anxiety disorder (there are several), alcohol induced sleep disorders (there are numerous ones), alcohol-induced sexual dysfunctions (there are several), and alcohol intoxication and withdrawal delirium.

Delirium is somewhat hard todefine, but once you see it the descriptions make sense. Delirium consists of a disturbance of attention and also, among other things, memory deficits, disorientation, and language difficulties. It tends to develop over hours to a few days and is prone to fluctuate in severity throughout the day. Please see the following link for a more detailed explanation. .

There is also a very serious problem termed alcohol-induced neurocognitive disorder. Alcohol induced neurocognitive disorder can be chronic. (Neurocognitive disorders come in many flavors. Alzeheimer's dementia is the best known example). Symptoms of an alcohol-induced neurocognitive disorder, include among other things: memory loss, trouble cooking a meal, and problems handling finances. Alcohol induced neurocognitive disorder can be chronic, but unlike Alzeheimers disease, alcohol related neurocognitive disorder can, with the right treatment and support, often stop getting worse and improve. If the person can stop drinking, take high doses of thiamine, and eat a balanced diet their prognosis greatly improves.

Alcohol-induced disorders must develop in the context of repeated severe intoxication and/or withdrawal from the drug alcohol. In other words, these disorders develop after alcohol intoxication and/or withdrawal begins and clears up without treatment within a short period of time from a few days to a month at most after severe intoxication and/or withdrawal ends. Other than that, they resemble primary mental disorders and have, for example, the same risk of suicide.

Rates of alcohol-induced mental disorders vary depending on the diagnostic category at issue. For example, the lifetime risk for major depressive episodes in persons with an alcohol use disorder is about 40%. However, only about one-third to one-half of them represent independent major depressive syndromes. The rest are then believed to be alcohol-induced. It is likely that there are similar rates of alcohol-induced sleep and anxiety problems. On the other hand, alcohol-induced psychotic disorders are fairly rare.

This category applies to circumstances in which symptoms of an alcohol-related disorder occur in a person and cause clinically significant distress, certain other problems, and/or impairment in social, occupational, or other important areas of functioning. However, these difficulties do not meet criteria for any specific alcohol-related disorder or, for that matter, they do not qualify for any specific substance-related or addictive disorder diagnosis. is the presence of significant problematic psychological and/or behavioral changes that develop during, or shortly after, stimulant use. Stimulant intoxication usually begins with a "high" feeling and includes one or more of the following: euphoria with enhanced vigor, gregariousness, hyperactivity, restlessness, hypervigilance, interpersonal sensitivity, talkativeness, anxiety, tension, alertness, grandiosity, anger, impaired judgment, and in the case of chronic intoxication, emotional blunting with fatigue or sadness and social withdrawal are possible.

Intoxication is not a criterion for stimulant use disorder, and just because a person is intoxicated on stimulants does not mean they have stimulant use disorder. Stimulant use disorder is defined as having two or more of the eleven symptoms of the disorder during twelve months. Please see the following link for the disorder's criteria .

Acute withdrawal symptoms (a crash) are often seen after periods of recurrent high-dose use (runs or binges). These withdrawal periods are characterized by extraordinarily unpleasant feelings of lethargy, depression, and increased appetite usually requiring several days of rest and experience stimulant withdrawal at some point, and the majority of these individuals experience tolerance. and recuperation. Depressive symptoms and suicidal thinking and behavior are generally the most serious problems seen during a crash. The lion's share of persons with stimulant use disorder

Stimulant-induced disorders include mental illnesses produced by amphetamines, cocaine, or other types of stimulants that resemble primary mental health issues. These illnesses include psychotic disorders (e.g., schizophrenia) , stimulant-induced bipolar disorder , stimulant-induced depressive disorders , stimulant-induced anxiety disorders of which there are around eight (e.g., Generalized anxiety disorder and panic disorder) . There are stimulant-induced obsessive-compulsive and related disorders . Other disorders include stimulant-induced sexual dysfunctions of which there are several (e.g. delayed ejaculation and female orgasmic disorder) [link; What Is Delayed Ejaculation Disorder?] . And then there are the sleep-wake disorders, (e.g., Insomnia disorder and hypersomnolence disorder [What Is Insomnia Disorder?] [What Is Hypersomnolence Disorder?]. And, in closing, there are neurocognitive disorders (e.g., delirium) . In short, delirium consists of a decreased awareness of the environment along with illusions and non-understandable speech and thought. It tends to wax and wane throughout the day and worsens with the onset of night, called "sundowning."

This category applies to times when symptoms characteristic of a stimulant-related disorder are present and cause significant distress and significantly interfere with social or occupational functioning but do not meet criteria for stimulant use disorder or any of the disorders in the substance-related and addictive disorders class. This diagnostic category is rarely utilized.

A tic is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization. Tics can be simple or complex. Simple motor tics are short lived (i.e., milliseconds) and can include such things as eye blinking, shoulder shrugging, and grimacing. Simple vocal tics include things like sniffing, grunting, and throat clearing. Complex tics are of longer duration (e.g., seconds), and frequently they include a combination of simple tics like shoulder shrugging along with grunting. At times, complex tics can appear purposeful. Examples of purposeful appearing complex tics include a tic-like obscene, sexual gesture (copropraxia) and repeating the last heard word or phrase heard (echolalia). Tourette's Disorder consists of multiple motor and one or more vocal tics which occur in one person but not necessarily at the same time. These tics may wax and wane in frequency but have persisted for more than one year and have their onset before age 18 years. It should be noted that these movements are not caused by a substance (e.g., cocaine or amphetamines) or another medical condition.

Persistent (Chronic) Motor Or Vocal Tic Disorder consists of single or multiple motor or vocal tics, but not both, that may wax and wane in frequency but have persisted for more than a year and begin by 18 years of age. These movements or vocalizations are not due to a substance or another medical condition. In addition, criteria has never been met for Tourette's Syndrome.

Provisional Tic Disorder consists of single or multiple motor and/or vocal tics that have been present for less than one year with an onset before 18 years. The condition is not caused by a substance or another medical condition. Additionally, criteria have never been met for Persistent (Chronic) Motor Or Vocal Tic Disorder or Tourette's Syndrome.

Other Specified Tic Disorder applies to times in which symptoms characteristic of a tic disorder predominate and cause distress or impairment but do not meet full criteria for any of the above tic disorders. Under this diagnostic category, the clinician communicates the reason why criteria for any of the above tic disorders are not met.

Unspecified Tic Disorder applies to times when symptoms characteristic of a tic disorder are present and cause distress or impairment and the clinician does not give the reason why criteria are not met for a tic disorder. This category is used when there is insufficient information to make a more definitive diagnosis (e.g., in the emergency room). Tic disorders have an average age of onset between 4 through 6 years with peak severity occurring between 10 and 12 years. The onset of new tic disorders decreases in the teen years. New onset of tics in adulthood is exceedingly rare and is often linked to drugs (e.g., excessive cocaine use) or to a post viral brain infection. Additionally, many adults with tic disorders experience decreased symptoms as they age. However, a small percentage of individuals will have persistently severe or worsening symptoms in adulthood.

Tics wax and wane in severity and the affected muscle groups and vocalizations change over time. As children age, they begin to perceive bodily sensations that precede the tic (referred to as a "premonitory urge") along with a feeling of tension reduction that follows the tic expression.Tics associated with a premonitory urge may be experienced as not completely involuntary as the urge and tic can be resisted for a time. Tics are worsened by anxiety, excitement, and exhaustion, and they are made better during calm, focused activities. Of interest, observing a gesture or sound in another person may result in a similar gesture or sound in a person with a tic disorder. These motor movements or vocalizations may be perceived by others to be purposeful which they are not. These echoed gestures or sounds can be especially problematic when interacting with authority figures such as supervisors, teachers, or the police.

Interestingly, many persons with mild to moderate tic disorders experience no distress or impairment related to their tics, and some individuals with severe tic disorders function well. On the other hand, persons with more severe symptoms often have daily living impairments. Less commonly, tics can result in social isolation and inability to work or go to school along with a lower quality of life and substantial psychological suffering. Borderline personality disorder is a mental health disorder that impacts how you think and feel about yourself and others. It begins by early adulthood and leads to extreme difficulties managing emotions, impulsive behavior, along with a long-standing pattern of unstable relationships. It is accompanied by an intense fear of abandoment. To learn more about this disorder see:

A diagnosis of BPD can be obtained from a psychiatrist (a physician who specializes in the diagnosis and treatment of mental disorders: M.D./D.O.), psychologist (Psy.D./Ph.D.), licensed clinical social worker (L.C.S.W.), a physician's assistant (P.A.) who specializes in psychiatry, a nurse practitioner (N.P.) who specializes in psychiatry, or a licensed professional therapist (L.P.C.) .

An in depth biopsychosocial interview is done by one of the above professionals in order to obtain the information needed to make a diagnosis. Please see for a discussion of the term biopsychosocial. And for completeness sake a physical exam along with routine lab tests can be conducted by a primary care physician in order to rule out medical conditions that could be causing the symptoms. (It should be noted there are no lab or x-ray/imaging tests specifically for BPD.)

The details from the diagnostic interview are compared to the diagnoses found in the Diagnostic And Statistical Manual Of Mental Disorders Fifth Edition Text Revision (DSM-5-TR). The DSM-5-TR was assembled with the backing of over ten years of research and is used to make mental health diagnoses in the United States. Over two hundred international experts were involved in its productioon. Many of these experts were also involved in the writing of the DSM-5 which came before the DSM-5-TR. Now moving on to the treatment of BPD. The first thing that needs saying is that BPD is not known to be curable, but it can now be treated and managed. It is no longer a hopeless state of affairs as was once thought. The mainstay of treatment is long-term psychotherapy or in other words "talking" therapy. (It should be noted that psychotherapy for BPD can last for a number of years.)

There are no specific medications that are F.D.A. approved for BPD; nevertheless, there are several medications to choose from which can help manage certain BPD symptoms such as impulsiveness along with other problems which are the result of BPD. Also, medicines can often help some of the frequently co-occurring disorders. These disorders include: depressive illness , anxiety disorders such as,panic disorder substance abuse , bipolar disorder , posttraumatic stress disorder (PTSD) , and eating disorders such as bulimia . It is very important to understand that these or any other coexisting disorders need to be effectively managed in order to facilitate a good outcome for BPD.

As was mentioned above, the main form of treatment for BPD is long-psychotherapy. Before I give some of the frequently used forms of therapy for BPD, I don't want to fail to mention that one of most important indicators of a good treatment outcome is the "fit" between the client and therapist. The client needs to believe more often than not that the therapist is invested in them and cares about whether they get better or not. "Can I trust my therapist," is a good question to ask yourself. Another important consideration to think about when seeking treatment for BPD is whether or not the professional you are considering has experience and skill in dealing with BPD. This is extremely important when looking for a good outcome as all mental health providers do not possess this expertise. Some may even believe that a good treatment outcome for BPD is unlikely.

The term dialectical refers to finding a balance between two opposing forces. The idea being that two seemingly opposite ideas can both be true at the same time which can be seen by joining them with the word and instead of but. To take an example from everyday life: I'm doing the best I can and I want to do better. In this example, it can easily be seen that both of apparently contradictory statements are true. The seemingly opposite forces at work in dialectical behavior therapy are acceptance and change. Acceptance is partly achieved through the practice of mindfulness.. One way in which this is practiced is by sitting quietly and paying attention to one's breathing. When emotions, thoughts, and other sensations arise no value is placed on them as either good or bad and they are let go by refocusing on one's breath. Without going into detail this partially explains the acceptance side of the coin. As referred to above, there are no F.D.A. approved medications for BPD. However, there are three kinds of medications which can be used to help control some of the symptoms of BPD such as impulsiveness and treat some of its co-occurring disorders. These classes include: antidepressants (e.g., Prozac generic fluoxetine and Paxil generic paroxetine), antipsychotics (especially the atypical antipsychotics e.g., Abilify generic aripiprazole and Seroquel generic quetiapine), and mood stabilizers (e.g., Tegretol generic carbamazepine and Lamictal generic lamotrigine). Please see the following link for a discussion of these medications

In summary, BPD is a personality disorder characterized by unstable moods, intense emotions, a lack of a stable sense of self, a strong fear of abandoment, a long-term pattern of unstable interpersonal relationships, and often recurrent suicidality. (Approximately 3 to 10% of persons with BPD die by their own hand and about 70% of them will attempt suicide at least once.) In the past, it was thought that BPD could not be successfully treated.

This changed in the 1980's with the development of dialectical behavior therapy. Since then other treatment strategies have been developed. Oftentimes medications need to be added along with the long-term psychotherapy which can last a number of years.The length of dialectical behavior therapy itself most often lasts between six months and a year.

Now it is vignette time. When Christine first came to see me she was twenty-two years old. She had previously been diagnosed with BPD and had averaged two or three hospitalizations a year for the past three years due to intense feelings of wanting to kill herself. I concurred with the diagnosis and also determined that she had panic disorder. I started her on Lamictal to help with her unstable moods along with anti-anxiety medication Klonopin for her panic disorder The Klonopin was added after two trials of antidepressants failed to effectively treat the panic disorder. After our first session together, I referred her to a psychologist I knew who was skillful in the use of dialectical behavior therapy. The only time thereafter that she needed to be hospitalized for intense suicidality was toward the end of her third month of dialectical behavior therapy. At that time, she spent a few days as an inpatient. After discharge, she continued to improve, and after a year of dialectical behavior therapy, her therapist switched her over to a supportive type of treatment. I continued to prescribe her medications.

Around three years after she first came to my office, Cristine began college. At first she went only part-time, but within less than a year she was attending full-time. After completing her bachelor's degree in psychology she moved away to attend graduate school. I believed I had lost contact with her, but five years later she wrote to me stating that she had obtained a Ph.D. in psychology.

In individuals who are not alcohol tolerant, evidence of mild intoxication often begins after about two drinks. (Note: One drink equals 12 oz. of beer; 12 oz. of a wine cooler; 1.5 oz. of 40% liquor like bourbon or vodka; 5 oz. of wine which is usually 12.9%; 10 oz. of 6% cider; and 8 or 9 oz. of 7% malt liquor.) Signs of mild intoxication include things like increased talkativeness, feelings of well-being, and a brightened mood. With increasing intoxication, problematic psychological or behavioral changes such as mood lability and impaired judgement possibly leading to inappropriate sexual and aggressive actions can occur. Later, when blood alcohol levels are falling, the symptoms often change to things like becoming more depressed and withdrawn along with impairments in thinking.

Diabetic ketoacidosis (This occurs when the body does not have enough insulin to utilize sugar [glucose] for energy production. Instead the body must make use of fats to generate energy. This leads to a breakdown product of fats [ketones] building up in the blood. The buildup of ketones causes several symptoms including confusion which can be mistaken for alcohol intoxication. Another symptom here includes a fruity-scented breath which does not smell like alcohol.

Next, I would like to discuss the phenomena of blackouts, which can occur with heavy alcohol consumption and are of concern and perhaps some confusion. Alcohol-related blackouts are gaps in a person's memory that can occur when a person is very intoxicated. These memory gaps occur when a person drinks enough alcohol to temporarily block the transfer of memory from short-term to long-term storage. This process is referred to as memory consolidation and it takes place in an area of the brain known as the hippocampus. There are two types of blackouts and they are known by their severity. The first and most common one is known as a gray out or brownout. It is characterized by spotty memories of events. Complete amnesia, also known as an "en bloc" blackout, happens when no long-term memory storage occurs for an event(s). It is as if the event(s) never occurred, and there are no memories to retrieve. During a blackout a person may behave normally and even do complex behaviors such as driving a car. In other words, there is no outward sign that a person is in a blackout. It is only known to the person who has the blackout when later they cannot remember certain events.

All total, alcohol intoxication contributes to more than 300,000 deaths annually, and there appears to be increased suicidal type behavior and completed suicide in persons intoxicated on the drug alcohol. Additionally, intoxication on this drug contributes to huge costs related to drunk driving, lost time from school and work, as well as interpersonal arguments and physical fights.

An individual with alcohol use disorder has problems brought on by their continued heavy consumption of alcohol (this can include binge drinking) that does not stop or moderate even in the face of difficulties that mount up as a result of ongoing alcohol abuse. Alcohol use disorder according to the Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-V), which is the book used to diagnose mental health disorders in the United States, comes in three flavors: mild, moderate, and severe. People can and do recover from all three levels. There, that's it in a nutshell. But, let's take a closer look.

I'm going to start by giving the DSM-V diagnostic criteria for alcohol use disorder. Remember it comes in three different levels of severity: mild (two through three symptoms); moderate (three through five symptoms); and severe (six or more symptoms). For completeness sake, note that these symptoms need to occur in the same twelve-month period:

Or it can be severe: In its severe form, it can lead to significant illness and even death in the drinker. I treated a man back in the 1990s who chugged so much bourbon that he said he had to have his esophagus replaced. (I'm still not sure what he meant by that, but he most likely had esphageal varices which are enlarged veins in the esophagus secondary to liver disease.) And I had a patient, later on--a really nice lady--who I'll call Wanda. She drank so much alcohol that she repeatedly urinated on herself while asleep. And then there was a man I was called to see while working as an intern on the internal medicine service. (He was middle-aged, I seem to recall.) My job, which I failed at, was to prevent him from bleeding to death from ruptured esophageal varices (ruptured enlarged esophageal veins) which were caused by liver cirrhosis which was in turn due to chronic, heavy alcohol consumption. Before going on, I want to reiterate my statement from above. People can and do recover from all three stages. However, if one can avoid the more severe stages that is definitely a good thing. If given some knowledge, served-up in an insightful manner, and heed is taken by the person doing the excessive drinking, the individual does not need to progress to more and more severe stages. Hopefully, that will happen to someone reading this article. That is, they will moderate their drinking, or if unable to do so: quit completely.

When it comes to quitting completely, some can do it on their own accord, some join support groups such as Alcoholics Anonymous (AA) or Rational Recovery (RR), some need professional mental health assistance along the lines of specific medications and/or psychotherapy, ranging from Intensive Outpatient Programs to Partial Hospitalization to 30 day inpatient settings. Others need treatment of co-occurring mental health disorders, and some need both support groups and professional aid to make the transition to non drinking a reality. But before showing how treatment might look through a vignette, let's dive into the illness a little deeper. The majority of persons who drink alcohol can do so without encountering any problems. But, according to DSM-V statistics, the twelve month prevelance of alcohol use disorder (number of persons endorsing this malady during the past year) in the United States is about 4.6% among persons ages twelve through seventeen and 8.5% in adults ages eighteen and older. Rates of this disorder were found to be greatest among adult men at 12.4% as opposed to 4.9.% among adult females. Further breakdown shows that alcohol use disorder is highest in the eighteen through twenty-nine year old age group (16.2%) and lowest among adults ages sixty-five years and older (1.5%). Alcohol use disorder runs in families with 40-60% of the risk being explained by genetic influences. A significantly higher number of monozygotic (identical) twins are both affected than are dizygotic (fraternal) twins. A child of a parent with alcohol use disorder is three or four times more likely to be affected than are other persons. This is true even if the child is adopted and raised by parents without the disorder. It's important to note that there are many genetic influences at work here caused by a multitude of different genes. It's not just one or two. The first episode of intoxication is likely to occur in the mid-teens. Alcohol related problems that do not meet full criteria for an alcohol use disorder may occur prior to age twenty. The onset of alcohol use disorder with two or more symptoms peaks in the late teens or early to mid-twenties. The large majority of persons who develop alcohol use disorder do so by the late thirties. Onset after age forty occurs in only about 10% of cases. The first episode of withdrawal usually does not occur until after many years of meeting criteria for alcohol use disorder.

Alcohol use disorder has a variable course often with periods of remission and relapse. A desire to stop drinking due to this or that crisis may be accompanied by weeks of abstinence, followed by controlled use for a while, with the large majority of persons progressing rather rapidly to the development of severe problem drinking again.

Alcohol use disorder is sometimes perceived as an intractable condition. This may be based on certain people who come for treatment after having had many years of serious alcohol-related problems who nevertheless continue to drink compulsively. However, people so situated are only a small portion of persons with alcohol use disorder. Most affected persons do not have such long-standing, intractable histories, and statistically they have a much better prognosis. Regarding lab tests suggestive of this disorder, there are two I wish to highlight: The first is blood alcohol concentration which can sometimes be used to judge tolerance, for example, when normal behavior occurs in the presence of elevated blood alcohol concentrations, tolerance should be suspected. The next test is a blood test for the liver enzyme gamma-glutamyl transferase (GGT) which is often high normal or elevated in heavy drinkers. At least 70% of persons with a high GGT are persistent, heavy drinkers (i.e., consuming eight or more drinks in a day on a regular basis.) Note, one drink equals 12 oz. of 5% beer, 12 oz. of a wine cooler, 1.5 oz. of forty percent (or eighty proof) liquor, like vodka, gin, or bourbon, or 5 oz. of wine which is usually about 12.9% alcohol. Cider is approximately 6% alcohol and malt liquor is about 7% alcohol resulting in ten fluid ounce cider drinks and eight or nine ounce drinks for malt liquor.

Alcohol use disorder is associated with an increased risk of accidents, violence, and suicide. It is estimated that one in five hospital intensive care unit admissions in some U.S. urban hospitals is alcohol related. Alcohol is involved in approximately 55% of fatal driving events. And finally, severe repeated alcohol intoxication may suppress immune function predisposing individuals to more frequent infections and cancer.

Two shots of vodka to settle my nerves while I got ready this morning," she said. "That's all. In my bedroom this morning I saw a guy who looked kind of like a character I'd see on a TV cartoon. He was only three feet tall, and he looked at me all weird." (This was an alcohol withdrawal visual hallucination.) I took a few drinks; he went away, but it scared me."

Per Janice's history, her drinking began in earnest about ten years prior. It had started as a defense against her former husband's mental abusiveness. "As soon as I hit my neighborhood on the way home from work, my heart would start pounding just thinking about him. After a while, I learned that a few drinks would get me through." "After we split, my girlfriend got me into cocaine for a little bit. Then I'd use the alcohol to come down. The cocaine is long gone, but the longest I've made it without drinking is about three months. I always find a reason to start up again. I don't really know why." I thought it best to hospitalize Janice at least to get her through withdrawal. After a few days passed and she'd undergone withdrawals' worst, I transitioned her to a residential treatment setting for four weeks where she remained engaged in mostly small group therapy sessions during the day. Janice began to notice there were a few persons enrolled in the treatment program who were present for their second or even third admission. Relapse was common. She gradually began to tell herself she would not be one of them. Evenings included mandatory AA meetings. At week three, she began to perk up. "I think I can do this," she told me. "Like they say, 'one day at a time.'" Let's start out by giving a brief statement about what a personality disorder is in general. A personality disorder affects a person's inner experience and outer behavior causing their distinctive character to deviate markedly from the norms of an individual's culture. It is ongoing, inflexible, has its onset in late adolescence or early adulthood, is stable over time, and leads to distress or impairment.

Borderline personality disorder in its essence is a pervasive pattern of unstable interpersonal relationships, unstable self-image, (e.g. self respect, self-esteem), unstable moods, intense emotions, and serious problems with impulsivity that typically begins in early adulthood. It is not diagnosed in children and adolescents as difficulties that look like this disorder can clear up with maturing. These character problems are present in a variety of situations.

In individuals with borderline personality disorder, rejection by others or the loss of something outside of themselves can lead to profound changes in self-image, mood, thinking, and behavior. These individuals are very sensitive to environmental circumstances. They can experience excessive abandonment fears and inappropriate anger even when faced with realistic time-limited separation (e.g., sudden despair in reaction to a clinician's announcing the end of their session or fury when someone important to them must cancel an appointment.) They may believe that this "abandonment" means they are "bad." At their core, these separation fears are related to an intolerance of being alone.

Persons with borderline personality disorder have a pattern of unstable and intense interpersonal relationships which consists of idealizing new caregivers and lovers and wanting to spend a lot of time with them. However, this may switch to devaluing them, sometimes rather quickly, while complaining that the other person does not care enough or is not "there" enough for them. There may be an identity disturbance exemplified by an ongoing unstable self-image characterized by shifting-goals and valules. There may be frequent changes in opinions, career choices, sexual identity, values, and friends. Although they usually have a self-image based on being bad or evil, they may at times feel like they do not exist at all. These feelings of non existence most often occur when there is a lack of meaningful nurturance, relationship, and support. These individuals fare better in structured work and school settings.

Individuals with borderline personality disorder show impulsivity in at least two areas that can be self-damaging. They may gamble outside their means, spend money they do not have, abuse substances, engage in unsafe sex, or drive recklessly. Persons with this disorder can display frequent suicidal behavior, gestures, or threats, or self-mutalating behavior. Completed suicide occurs in about 8-10% of such individuals, and self-mutilative acts (cutting or burning), suicidal threats and attempts are frequently the reason these persons seek help. These self-destructive acts are usually precipitated by rejection, separation, or by an expectation that the person with this disorder assumes increased responsibility. .

Persons with borderline personality disorder may display intense, episodic sadness, irritability, or anxiety most often lasting a few hours and only rarely more than a few days. This basic sadness is often disrupted by periods of anger, or panic, and is rarely relieved by times of well-being or satisfaction. These episodes of irritability, and anxiety are most often brought on by the individual's extreme reactivity to interpersonal stress.

Individuals with this disorder are often troubled by chronic feelings of emptiness. They easily feel bored and often search for something to do. Persons with borderline personality disorder frequently express inappropriate, intense anger. They may display extreme sarcasm, enduring bitterness, or verbal outbursts. These displays of anger are often brought on when a caregiver or lover is seen as neglectful, withholding, or abandoning. Such expressions of anger are often followed by feelings of shame and guilt and contribute to the feelings they have of being evil. Persons with borderline personality may have the habit of undermining themselves at the moment a goal is about to be realized (e.g., quitting school during the last semester, regressing severely after a discussion about how well therapy is going, and destroying a good relationship just when it is clear that it could last.) Some individuals with this disorder develop hallucinations, body image distortions, and other such symptoms during times of stress. Some persons with borderline personality disorder feel more secure with a pet or an inanimate possession than with an interpersonal relationship. Premature death from suicide may occur in persons with this disorder especially in those with co-occurring depressive or substance abuse disorders. Physical handicaps may result from self-inflicted behaviors or failed suicide attempts. Recurrent job losses, interrupted education, and separation or divorce are common. Physical and sexual abuse, neglect, hostile conflict, and early parental loss are common in the childhood histories of children who later develop borderline personality disorder.

Common co-occurring disorders include: depressive disorders and bipolar disorder , substance use disorders [What Are Substance Related and Addictive Disorders?], eating disorders (especially bulimia nervosa) [What Is Bulimia Nervosa?], post traumatic stress disorder [What Is Post Traumatic Stress Disorder?], and attention-deficit/hyperactivity disorder [What Is Attention-Deficit/Hyperactivity Disorder?]. Borderline personality disorder also frequently co-occurs with other personality disorders.

The prevalence of borderline personality disorder at a point in time is estimated to be 1.6% with the lifetime prevelence being around 5.9% of the population at large. This number rises to about 6% in medical clinics and 10% in psychiatric outpatient clinics. It rises to around 20% in psychiatric inpatients. In older populations, its presence may decrease.

There is high variability in the course of borderline personality disorder. The most common pattern is one of chronic instability in young adulthood with high levels of usage of both general medical and mental health resources. The disorder's impairment and risk of suicide is greater in young adulthood and they both decrease with advancing age. During their 30s and 40s the majority of persons with this disorder obtain greater stability in relationships and vocational functioning. Follow-up studies reveal that after about 10 years roughly half of the individuals no longer meet full criteria for borderline personality disorder. Although the tendency to be prone to intense emotions, impulsivity, and intensity in relationships is often lifelong, persons who engage in therapeutic intervention often begin to demonstrate improvement sometime during their first year.

Before closing, I don't want to fail to mention that roughly 75% of persons who receive a diagnosis of borderline personality disorder are female. However, upon taking a closer look by giving structured interviews (a structured interview is given using a flowchart to take a look at an extensive array of psychiatric diagnosis) this female greater than male ratio is lost. The essential feature of dependent personality disorder is a pervasive and all consuming need to be taken care of by another person(s) which causes submissive and clinging behavior. This personality style is anxious and fearful in nature. It begins by early adulthood, is ongoing, not discreet, and is present in most areas of an individual's life. Dependent personality disorder is somewhat rare and occurs in approximately one half of one percent of the population. Females diagnosed with dependent personality disorder are more common than males, but it is thought, based on studies, that in the general population the ratios are more equal. It is less well studied than some of the other personality disorders. Even so, quite a bit is known about it. Decisions, even small ones, such as what to wear can often require input from another person. For example a woman named Sally with dependent personality disorder can never decide on her own what to wear to work. Everyday she will say to her husband, John, something like, "Should I wear the green outfit or the blue one today, or maybe another one altogether?"

Major decisions such as where to live, work, or who to associate with can often not be made alone. Other people, often a single other person, are looked to to assume responsibility for these areas of their life. As an example, Sally doesn't seem to want to have any input on which job she should take or even where to live. While house hunting with her husband, John, he asks, "Out of the houses we've seen today, which one do you like the best?" To which Sally replies, "Oh, I don't know, Honey. You decide." You know I'm not good at this kind of thing." And Sam, who is eighteen-years-old and has dependent personality disorder, looks to his parents to decide what he should wear, who he should associate with, and what university he should attend.

It is often important for the person with dependent personality disorder not to disagree with another person who is important to them out of fear of losing their support. For example, while Sally and John continue to look for a place to live, he decides there is a certain house he wants to buy. Sally, however, just can't stand the neighborhood. But what she says is, "If you like it, let's buy it." She just can't bring herself to disagree with John, because he might turn against her. When in reality, John's always kind to her.

Since persons with dependent personality disorder need so much nurturance and support, they will frequently volunteer to do things they find unpleasant out of fear of losing the backing of someone important to them. They are willing to submit to what others want even if it does not make sense. For example, they may make extraordinary self-sacrifice like submitting to verbal, physical, or sexual abuse when clearly other options are available to them.

Individuals with this disorder have difficulty starting projects on their own or working in an unaided fashion. They lack self-confidence and believe they cannot independently begin and complete tasks, even when they have the ability to do so. They present themselves as being incompetent-- requiring constant assistence. They do this even when in reality they possess the skills to function alone in the contemplated undertaking. They may fear that displaying competence could lead to abandoment. Often they do not learn the skills of independent living thus continuing dependency.

Oftentimes the person with dependent personality disorder feels uncomfortable or helpless when alone due to having excessive fears of being unable to care for himself or herself when they are in this situation. Sometimes they will do what others are doing, even when they are not interested, to avoid being alone.

The person with dependent personality disorder often continually worries about not being able to take care of themselves if left alone. And then if a close relationship actually ends they urgently seek a replacement due to fears of not being able fend for themselves in solo fashion. For example, even though Sally has a really good job along with two close friends, she continually worries about how she'll take care of herself if John were to leave. John is aware of this thinking on her part, and it bothers him. One day he actually leaves her, and Sally almost immediately takes up with a man at her work.

Individuals with dependent personality disorder are often characterized by negativity and self-doubt. They may continually call themselves "stupid." Criticism is taken as proof of their worthlessness. They have trouble making decisions and will thus often avoid positions of responsobility. There may be an increased risk of depressive disorders , anxiety disorders, for example, generalized anxiety disorder , and adjustment disorders . Certain other personality disorders may also co-occur. Chronic physical illness or separation anxiety disorder in childhood or adolescence may predispose a person to this disorder. Now for a vignette. When Danna first came to see me she complained of depressive symptoms. I started her on Paxil Her depressive symptoms started to improve after week two and she continued to get better. However, on taking a closer look, it became apparent that she had other mental health difficulties.

due to the frequency of her changing majors. She just couldn't seem to make a decision and stick with it. It made her anxious to think about it. It turned out that she had six yes answers to the criteria for dependent personality disorder. It was enough to count her in.