Tag Archives: Mental disorder

Health

Prolonged Grief Disorder Is Now an Officially Recognized Mental Illness

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Photo: Eliano Imperato/AFP (Getty Images)

The latest update to the Diagnostic and Statistical Manual of Mental Disorders, the codebook used by mental health professionals, includes a new officially recognized condition: prolonged grief disorder. People with prolonged grief are considered to have intense feelings and preoccupied thoughts that distress them or impede their daily functioning beyond the normal grieving process.

The DSM was created by the American Psychiatry Association and is often called the bible of psychiatry. It’s not only a guidebook for clinicians, though, since insurance providers typically rely on the DSM to approve coverage of treatments for these various disorders. So validation in the DSM carries important financial weight as well.

According to the APA, people with prolonged grief may experience “intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death.” These reactions to grief would further affect them most of the day, nearly every day, for at least a month. In children, the DSM criteria notes, the condition can be diagnosed six months after the loss, while it can be diagnosed in adults after a year. And the APA also reminds clinicians that people’s symptoms shouldn’t be better explained by other conditions.

Since at least 2010, some psychiatrists have been trying to add prolonged grief disorder to the DSM, which routinely goes through new editions and smaller revisions. Advocates have argued that people with prolonged grief are distinctly identifiable from those afflicted by typical grief, as well as conditions possibly related to loss, such as post-traumatic stress disorder and depression. But a fair share of critics have opposed its addition, including former members of the DSM task force, who have argued that the diagnosis would pathologize normal behavior. It’s a criticism that’s been lodged against other recently added conditions to the DSM, such as gaming addiction.

Changes to the DSM are approved through a collaborative process, though, and by the fall of 2021, prolonged grief disorder was cleared for inclusion. This week, the American Psychiatric Association formally released the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), with prolonged grief disorder the latest and only new condition to be added onto it.

“Including prolonged grief disorder in the DSM-5-TR will mean that mental health clinicians and patients and families alike share an understanding of what normal grief looks like and what might indicate a long-term problem,” said Saul Levin, CEO and medical director of the APA, in September 2021 when the condition was first announced for inclusion. “Especially now, sharing information and increasing awareness about prolonged grief disorder is essential.”

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Health

You’re Probably Using These Psychological Terms Wrong on Social Media

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Photo: OlgaOtto (Shutterstock)

When I first joined TikTok in 2020, I couldn’t go a day without seeing videos about abusive narcissists, whether in the form of “toxic” exes, or emotionally absent parents. While narcissists obviously do exist, the content was so prevalent that you’d be forgiven for thinking narcissists were as common as people named Bob. Narcissism had become the new “OCD”—that is, another clinical term people often misuse to mean “I keep my office really organized, and I like to match my paper clips to my push pins.”

Two years later, it’s nearly impossible to go on social media without seeing one of the following: ADHD, gaslight, trauma, anxiety, neuro-divergent, or trigger (a descendant of trigger warning).

Mental health awareness matters, but with more digital creators making therapy-adjacent mental health content, clinical psychological terms are being thrown around so casually as to obfuscate their actual meanings. And while speaking openly about mental health issues can be a clear positive, as Australian publisher Zee Feed writes, “the overuse of clinical terms on social media risks pathologizing behavior and turning lived experience into content trends.”

On the Sci Show, science communicator Hank Green agreed, “Mental health professionals point out that using diagnostic terms as misplaced metaphors for odd behavior, personality traits, or even changes in the stock market ultimately minimizes serious conditions and the people who have them.”

Here’s a look at some of the most commonly—and wrongly—used psychological terms, and what they do—and more importantly do not—mean.

ADHD: According to the National Institute of Mental Health, ADHD is “an ongoing pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development.” It is not simply being absentminded, forgetting to call people back, or having a perpetually messy car.

Gaslighting: Gaslighting is a form of emotional abuse that causes the victim to question their own sanity. In gaslighting, the abuser convinces the victim their version of events never happened, and manipulates them into believing they’re overly sensitive or mentally unstable. Gaslighting is not when someone doesn’t agree with your opinion and tries to convince you of theirs, thinks you’re upset when you’re really not, or a girlboss.

Narcissistic abuser: According to Insider, narcissistic personality disorder is a diagnosable condition that affects 0.5 to 1% of the population. It’s characterized by controlling, invading privacy, socially isolating, verbally abusing, and instilling fear in the victim. A narcissist is not someone who hurt your feelings or ghosted you on Tinder.

OCD: Obsessive-compulsive disorder is “a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions)…that can significantly interfere with a person’s daily activities.” It is not vacuuming a lot, moving your bedroom furniture around, or re-organizing your fridge on a whim because you can’t stand the sight of it.

Trigger: A trigger is something that reminds a person of a traumatic experience, whether it be abuse, an eating disorder, substance use, an accident, or some other form of trauma. Saying “I’m triggered” is often used tongue-in-cheek; as in “this picture of a woman’s perfect boyfriend bringing her breakfast in bed is triggering me.” But triggers are reminders of traumatic experiences, not something that just makes you feel uncomfortable, anxious, angry, or inadequate.

Anxiety: Per the Mayo Clinic, anxiety disorder is characterized by “intense, excessive and persistent worry and fear about everyday situations.” Often they involve sudden feeling of fear or terror (panic attacks). Do we all experience anxiety sometimes? Yes. But there’s no need to chalk up how you’re feeling before a presentation, party, or waiting in line to “anxiety.” What you’re experiencing is nerves and impatience.

Trauma: Perhaps there is no word more overused online than “trauma.” As psychology professor Nick Haslam wrote for the Chicago Tribune, people are “traumatized” by high-profile jury verdicts, “Trump 2016 slogans,” even their curly, frizzy hair. (I once posted a TikTok video about pouring water over my child’s head during a bath and received numerous comments from people who were “traumatized” by water on their face as a child.)

Trauma is, according to the American Psychological Association, “an emotional response to a terrible event like an accident, rape or natural disaster” characterized by shock, denial, “unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea.” Trauma is not being made to eat vegetables when you were little, or getting water in your eyes while being bathed.

 

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Doctors Say Mild Covid-19 Likely Triggered Psychiatric Illness in Two Teen Patients

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A MRI scan of one of the patients, with the arrow pointing to a suspected lesion.
Photo: Bartley CM, et al/JAMA Neurology

Researchers in California suspect that covid-19 triggered sudden mental illness in at least two of their teenage patients. Though they caution that a causative link remains uncertain, they say they’ve found evidence of antibodies attacking the brain of their patients post-infection, which could help explain the psychiatric symptoms.

Since the very start of the pandemic, some researchers have warned that covid-19 could contribute to a wave of neurological illness, based on the history of previous pandemics. Since then, studies have shown that covid-19 survivors do seem to be at higher risk for ailments like depression and anxiety. Some researchers and patient advocates have also argued that long covid—the constellation of chronic symptoms reported by some survivors—can include neurological impairments.

The stress of simply having covid-19 could certainly influence a person’s mental health, as could the aftereffects of a severe infection and hospitalization. But it’s possible that the virus itself could directly impact the nervous system and brain, even in mild cases, and these interactions could then lead to a higher risk of neurological and psychiatric disorders. Because mental illness is unfortunately common and often linked to a variety of influences, it can be difficult to show cause and effect from any one thing, including a viral infection.

But doctors at the University of California, San Francisco (UCSF) Benioff Children’s Hospital say they’ve come across a few cases in the past year where covid-19 does seem to have been a primary trigger for a patient’s sudden mental illness. In a new paper published Monday in JAMA Neurology, they describe teen patients who developed newly documented psychiatric symptoms, including extreme mood swings, paranoid delusions, and suicidal ideation, after a confirmed but mild or asymptomatic case of covid-19. It’s the timing of these events that suggests the symptoms were connected to the infection, study author Sam Pleasure, a UCSF neurologist, told Gizmodo.

In the spinal fluid of two patients, the team also found antibodies to the coronavirus, known as SARS-COV-2, as well as autoantibodies to the nervous system. In one patient, these traitor antibodies seemed to target a gene responsible for making a protein called transcription factor 4 (TCF4), which is notable because variations of the gene have been linked to psychiatric disorders including schizophrenia. The patients had a history of some mental health problems, such as anxiety and tics, but not to the extent documented by the doctors.

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A third teenage patient had neither kind of antibody in their nervous system, and it was determined that the most likely cause of their symptoms was an unknown drug they had taken days earlier.

But with the other two, those antibodies indicate that the coronavirus can reach the nervous system and stir up trouble there. It may be that the virus isn’t directly causing these symptoms, but rather that it helps generate a self-destructive immune response.

“We know that covid-19 is a potent stimulus for increased inflammatory responses, and one possible cause of these symptoms is that they are associated with this ‘generic’ increase in inflammation,” Pleasure explained in an email.

In the two patients where covid-19 was seen as a likely trigger, the doctors chose to treat them with immunotherapy, including steroids to tamp down inflammation. One patient seemed to respond well and by a month later had stopped reporting delusions and twitching. The second patient seemed to respond modestly to the immunotherapy, and by the six-month mark they were still improved but continued to have memory problems and trouble concentrating.

The authors found other reports of similarly timed cases among hospitalized adult covid-19 patients. Pleasure noted that immune-related problems after an infection have been documented well before covid-19, often linked to viral infections. These post-infection cases in general seem to be rare, but there are still many unknowns.

“We don’t at this point know how common this is with covid-19 infection and may be seeing patients primarily because of the very large numbers of infected people at about the same time,” Pleasure said.

To better understand these cases and definitively establish a link between sudden psychiatric illness and covid-19 would require more research, which the authors say they’re conducting now.

“We are working on studying larger numbers of prospectively followed patients with post-covid neurologic and psychiatric symptoms,” Pleasure said. “We are also able to compare such patients to ‘controls,’ i.e. patients after covid without neuropsychiatric symptoms.”

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