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Psychological difficulties

• Depression
  
  Most of us experience periods of unhappiness from time to time.
  
  Depression however is a persistent feeling of sadness, emptiness and hopelessness. Some of you don’t realize you are depressed and try to ‘pull yourself together’. If you suffer from depression your interest in activities you previously enjoyed, energy, ability to concentrate and think are considerably reduced. You may have insomnia, early morning awakening or oversleeping. Your appetite may increase or decrease with significant weight gain or loss. You may experience yourself as worthless person and have feelings of anger and/or guilt. In some circumstances you may even feel like killing yourself in which case it is important to talk to your GP immediately.
  
  Anxiety
  Most of us have felt anxious or tense at some point in our life. Anxiety is a normal reaction and moderate levels can motivate us to work harder or protect ourselves from dangerous situations. Generalised anxiety disorder refers to an excessive and persistent worry that is not necessarily triggered by a stressful situation. We usually experience symptoms such as sweating, palpitations, chest pains, muscle tension and stomach upsets. We also may have difficulties with our sleep and ability to concentrate. Sometimes fear, anxiety and worry take other forms. The most common diagnoses are: panic disorder, agoraphobia, social anxiety, phobias, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD) and hypochondriasis.
  
  Panic disorder
  Panic disorder refers to what people know as panic attack. Panic attack is a period of intense fear accompanied with an extreme physical reaction that includes palpitations, difficulty to breathe, sweating, trembling, chest pains, nausea, dizziness and a feeling of being detached from oneself. Panic attacks can be very frightening as individuals feel like they are dying. Panic attacks usually have an abrupt onset and people often experience them as ‘coming out of the blue’.
  
  Agoraphobia
  Agoraphobia refers to a fear of being in open spaces, outside the house alone or in a crowd. Sometimes people who suffer from agoraphobia find it extremely difficult to leave the house even with a family member or a friend. They usually think that if they go out something terrible will happen to them. Some people with agoraphobia also suffer from panic attacks.
  
  Social anxiety
  Social anxiety refers to a persistent fear of social situations. Individuals worry that they will be humiliated or embarrassed. Individuals with social anxiety usually believe that others will judge them negatively and tend to avoid a range of social situations, such as public speaking or eating out.
  
  Phobias
  Phobias refer to a fear that is excessive and persistent, triggered by a specific object or situation. Some examples of phobias include: fear of heights, fear of flying, fear of receiving injections, fear of seeing blood, fear of vomiting, fear of animals, fear of snakes and others.
  
  Obsessive-compulsive disorder (OCD)
  Obsessive-compulsive disorder (OCD) refers to recurrent obsessional thoughts or compulsive acts. Obsessional thoughts are ideas or images that are recurrent, time consuming and cause distress. For example some individuals may have obsessive thoughts about being contaminated. Compulsions are repetitive acts or rituals, such as hand washing, checking or tidiness. Individuals with OCD may also suffer from depression.
  
  Posttraumatic stress disorder (PTSD)
  Posttraumatic stress disorder is a condition that may develop following the individual’s exposure to a traumatic event. Not everyone who is exposed to a terrifying event will suffer from PTSD. Hence it is not just the event; it is the subjective response that defines the trauma. Some of the symptoms include persistent and re-experiencing memories, thoughts, images, feelings or nightmares triggered by ordinary events. Some of you may also feel detached, numb or avoid situations that trigger the traumatic memories. Sometimes PTSD is accompanied by depression, anxiety or substance abuse.
  
  Health anxiety
  Health anxiety refers to the anxiety related to a perceived physical illness. Individuals with hypochondriasis usually fear that they will develop a serious disease and interpret bodily discomforts as indications that they are ill. They also seek constant reassurance and keep checking for signs of the illness.
  
  Work related stress
  Most of us have experienced stress at some point in our working life. However some of you may be under excessive stress when you perceive your self as no longer able to meet the demands of the job. You may experience changes in the organisation that affect your work. You may have a difficult relationship with your boss or just be bored and frustrated. Sometimes you also feel depressed and find it difficult to relax when you leave work. You may drink more to cope or feel that other relationships are affected by your mood. Your response to stress depends on a number of factors such as personal characteristics, family history, support networks, whether you have experienced other difficulties in the past.
  
  Substance abuse
  Substance abuse refers to the problematic use of alcohol, any illicit substances or prescribed medication. There are varying degrees of misuse, sometimes leading to tolerance and a state of withdrawal including physical and psychological symptoms. Although some of you may not experience withdrawal symptoms you may still feel your life and/or mood is affected. You may want to ask for help from a health professional who specializes in this field. Together you will identify the extent of your alcohol or drug abuse, the ways it affects you and your life and the best treatment that suits your needs.
  
  Eating disorders
  Anorexia and bulimia are the two major eating disorders.
  
  Anorexia usually involves extreme weight loss as a result of rigid diet or starvation. A person with anorexia may also become compulsive with exercise. Some of you may also engage in binge eating and self-induced vomiting, or the misuse of laxatives. Females with anorexia will suffer from amenorrhea, the absence of menstrual cycles. People with anorexia have an intense fear of becoming fat and a disturbed perception of their body weight. People with anorexia are usually preoccupied with food and may become picky eaters.
  
  People with bulimia binge on food over a short period of time followed by episodes of dieting, self-induced vomiting or laxative abuse. This cycle may be repeated several times during one day or week. People with bulimia are afraid of becoming fat. Some of them manage to maintain their weight within the normal range. The behaviour of a person with bulimia is characterised by high impulsivity. Some of you may also show poor impulse control in other areas such as drug abuse, self-harm and stealing. Both anorexia and bulimia are more commonly found in teenage girls and women. People with eating disorders may also have other difficulties such as anxiety, depression, low self-esteem, which can complicate their recovery.
  
  Relationship difficulties
  Most relationships experience problems in one form or another. This may be related to changes depending on the developmental stage of the relationship. Past experiences that each individual brings into the relationship may cause conflict. Therapy can help you explore these difficulties and gain a further understanding of yourself in order to enable the relationship to move forward.
  
  Bereavement
  Bereavement is one of the most painful experiences most of us will go through sooner or later. Any loss can cause sadness, however pain and grief is usually experienced following the death of someone we love. Each one of us experiences the process of grieving in a different way and for some of us it may last for a long time. Initially we may be in shock. Attending the funeral is an important part of the mourning process. After the first few days we may experience a variety of emotional responses such as sadness, anxiety, relief if the person had suffered from a terminal illness, guilt, anger and others. It is important to remember that these are part of coming to terms with the loss and that being with friends and family usually helps. Some of you may want to ask for professional help especially if the death has triggered unresolved feelings, if you have many experiences of bereavement, if you feel suicidal or if you just want to talk to someone.
  
  Coping with transitions
  We all go through changes throughout our life (for example getting married, getting divorced, deciding to become parents, redundancy, change of career, and others). For some people coping with change may be difficult and talking to someone could help you make sense of your experiences. You may be confused about what you want and would like help to clarify your thoughts.
  
  Postnatal depression
  
  Postnatal depression refers to the depression that develops after having a baby. Sometimes you can suffer even months after giving birth. You may feel low, irritable and anxious. You may feel very tired and unable to cope with the baby. You may experience feelings of anger, guilt or failure. Some of you may even have thoughts about harming the baby, although you have no plans to act on your thoughts. On some occasions postnatal depression develops as a reaction to the changes that a new baby brings into the life of the family. However for some mothers having a new baby may trigger issues from the relationship with their own mother. Receiving treatment is important for you, your baby and the family.
  
  
  Coping with an illness
  When someone becomes ill their thoughts, feelings, concerns, preoccupations and worries change dramatically. You may focus on how your daily activities will have to change. You may be diagnosed with a terminal illness and worry how you and your family are going to cope. You may be depressed or anxious. You may need support to go through all the different phases of your illness. You may need to make certain decisions over your treatent and would like to talk to someone.