Anger is a completely normal, usually healthy, human emotion. But when it gets out of control and turns destructive, it can lead to problems—problems at work, in your personal relationships, and in the overall quality of your life. Like other emotions, it is accompanied by physiological and biological changes; when you get angry, your heart rate and blood pressure go up, as do the levels of your energy hormones, adrenaline, and noradrenaline.

Anger can be caused by both external and internal events. You could be angry at a specific person (such as a coworker or supervisor) or event (a traffic jam, a cancelled flight), or your anger could be caused by worrying or brooding about your personal problems. Memories of traumatic or enraging events can also trigger angry feelings.

The instinctive, natural way to express anger is to respond aggressively. Anger is a natural, adaptive response to threats; it inspires powerful, often aggressive, feelings and behaviours, which allow us to fight and to defend ourselves when we are attacked. A certain amount of anger, therefore, is necessary to our survival.

Approaches of anger

The three main approaches are expressing, suppressing, and calming.

1. Expressing your angry feelings in an assertive—not aggressive—manner is the healthiest way to express anger. To do this, you have to learn how to make clear what your needs are, and how to get them met, without hurting others. Being assertive doesn’t mean being pushy or demanding; it means being respectful of yourself and others.
2. Anger can be suppressed, and then converted or redirected. This happens when you hold in your anger, stop thinking about it, and focus on something positive. The aim is to inhibit or suppress your anger and convert it into more constructive behaviour. The danger in this type of response is that if it isn’t allowed outward expression, your anger can turn inward—on yourself. Anger turned inward may cause hypertension, high blood pressure, or depression.
3. you can calm down inside. This means not just controlling your outward behaviour, but also controlling your internal responses, taking steps to lower your heart rate, calm yourself down, and let the feelings subside.

Management

The goal of anger management is to reduce both your emotional feelings and the physiological arousal that anger causes. Strategies that are used to control anger are relaxation, cognitive restructuring, problem-solving, better communication, using humour, change environment, timing, avoidance, finding alternatives etc…

 

 

Psychoactive drugs act on the nervous system to alter our state of consciousness, modify our perceptions and change our mood. Human beings are attracted to psychoactive substances because they help them adapt to an ever-changing environment. Smoking, drinking and taking drugs reduce tension and frustration, relieve boredom and fatigue and in some cases help us escape from the harsh realities of the world. The use of psychoactive drugs for such personal gratification and temporary adaptation, however, can carry a high price tag: drug dependence, personal and social disorganization and a predisposition to serious and sometimes fatal diseases.

Commonly abused psychoactive substances are: –

 

Alcohol

Alcohol is the most widely drug used in our society. Alcohol acts upon the body primarily as a depressant and slows down the brain’s activities. As people drink more, their inhibitions become even further reduced and their judgements become increasingly impaired. Activities such as driving become impaired as more alcohol is consumed. Eventually, the drinker becomes drowsy and falls asleep. With extreme intoxication, a person may even lapse into a coma and die.

Alcoholism is a disorder that involves long-term, repeated, uncontrolled, compulsive and excessive use of alcoholic beverages that impairs the drinker’s health and social relationships. Alcohol intoxication can cause irritability, violent behaviour, feelings of depression and in rare cases hallucinations and delusions. Long-term escalating levels of alcohol consumption can produce tolerance as well as such intense adaptation of the body that cessation of use can precipitate a withdrawal syndrome marked by insomnia, feelings of anxiety and evidence of hyperactivity of the autonomic nervous system.

 

Nicotine

Nicotine is both a stimulant and sedative. It gives an immediate kick due to the discharge of epinephrine from the adrenal cortex. Stimulation is followed by depression and fatigue. Type of smoking whether, from a cigarette, pipe or cigar, chewing tobacco has the same effect. In chronic smokers nicotine levels tend to persist overnight, thus they are exposed to the effects of smoking for 24 hours. Stress and anxiety reduce the effect of smoking due to increased secretion of cortisol. Withdrawal symptoms begin within 24 hours and consists of craving, irritability, anger, anxiety, poor concentration, increased appetite, impairment in psychomotor and cognitive functions.

 

Cannabis

Cannabis commonly called as Charas, Hashish, Ganja and Marijuana. It is usually taken by smoking with tobacco or by eating it by mixing in food or drink. The clinical effects seen depend on the underlying mood. It exaggerates the preexisting mood whether of anxiety or happiness. The patient also has increased enjoyment or visual sensations and a sensation of time passing slowly. Long-term use impairs memory and learning. However, it does not cause dependence.

 

Opioids

Opioids such as morphine, pethidine are used to relieve pain. The drugs produce euphoria or a sense of joy. Following this, there is a sense of relaxation with the user being alternately drowsy or awake. Thinking becomes slow due to depression of the brain. In high doses, opioids may cause death by stopping respiration. The drug is taken by injection or by chasing it i.e. by burning over a silver foil and inhaling the fumes. The drugs are very addicting and once dependent the patients are difficult to cure. Addicts taking the drug by injection route often share needles and syringes which are not sterile. Thus they are prone to get infections such as HIV, septicemia and endocarditis.

 

Solvents & Gases

Solvents & Gases include

1. Industrial solvents such as paint thinners, degreasing fluids, gasoline and glues.
2. Art or office supply solvents such as correction fluids, marker pen fluids and electronic contact cleaners.
3. Gases such as butane and propane lighters, aerosols, deodorant sprays and fabric protector sprays.
4. Medical gases such as ether, chloroform, halothane and nitrous oxide.

These are inhaled from containers and produce short-lasting intoxication and loss of inhibition. Repeated inhalations can cause organ damage. Inhalation of high concentrations can be fatal.

Treatment

Individual therapy, family therapy, group therapy, relapse prevention, pharmacotherapy and rehabilitation are used to reduce the usage of addictive substances.

 

Personality disorders are deeply ingrained maladaptive patterns of behaviour manifested by the time of adolescence or earlier, which continue throughout adult life. The personality is abnormal either in the balance of its components, their quality and expression or in its total aspect. Because of this, the individual suffers or others have to suffer and there is an adverse effect on the individual or society.

Types of Personality disorders

• Paranoid personality disorder: persons with paranoid personality disorder are characterized by long-standing suspiciousness and mistrust of persons in general. They refuse responsibility for their own feelings and assign responsibility to others. They are often hostile, irritable and angry.
• Schizoid personality disorder: a pattern of detachment from social relationships and a limited range of emotional expression. A person with schizoid personality disorder typically does not seek close relationships, chooses solitary activities and appears indifferent to praise or criticism from others. These persons are often seen by others as eccentric, isolated or lonely
• Schizotypal personality disorder:  there is a pervasive pattern of acute discomfort in close relationships, distortions in thinking or perception, and eccentric behaviour. A person with a schizotypal personality disorder may have odd beliefs or magical thinking, odd or peculiar behaviour or speech, or may incorrectly attribute meanings to events.
• Antisocial personality disorder: this disorder is more common in men. A pattern of disregarding or violating the rights of others. A person with an antisocial personality disorder may not conform to social norms, may repeatedly lie or deceive others, or may act impulsively.
• Borderline personality disorder: a pattern of instability in personal borderline personality disorder may go to great lengths to avoid abandonment (real or perceived), have recurrent suicidal behaviour, display inappropriate intense anger or have chronic feelings of emptiness.
• Histrionic personality disorder: a pattern of excessive emotion and attention seeking. A person with a histrionic personality disorder may be uncomfortable when he/she is not the centre of attention, consistently use physical appearance to draw attention or show rapidly shifting or exaggerated emotions.
• Narcissistic personality disorder: a pattern of need for admiration and lack of empathy for others. A person with a narcissistic personality disorder may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others or lack empathy.
• Avoidant personality disorder: a pattern of social inhibition, feelings of inadequacy and extreme sensitivity to criticism. A person with an avoidant personality disorder may be unwilling to get involved with people unless he/she is certain of being liked, be preoccupied with being criticized or rejected, or may view himself/herself as being inferior or socially inept.
• Dependent personality disorder: a pattern of needing to be taken care of and submissive and clingy behaviour. A person with a dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of himself or herself.
• Obsessive-compulsive personality disorder: a pattern of preoccupation with orderliness, perfectionism and control. A person with an obsessive-compulsive personality disorder may be preoccupied with details or schedules, may work excessively to the exclusion of leisure or friendships, or maybe inflexible in morality and values.

Treatment

Psychotherapy and behaviour therapy are the main modes of treatment. Drugs are given only to treat short-acting mental illnesses which occur in between.

A psychosomatic disorder is an illness that connects the mind and body. This occurs in such a way that the physiological functioning of the body is affected by the psychological tensions that either causes a disease or worsen the pre-existing disease in a person.

It is also known as a Psycho-physiologic disorder. An improper stimulation of the autonomic nervous system, which regulates the functions of the internal organs, is responsible for the evolution of this disorder and leads to impairment of the functional organs. A broad range of physical diseases and conditions may be especially prone to be made worse by mental factors. These include skin conditions such as eczema and psoriasis; high blood pressure; heart problems and more. Psychosomatic disorders frequently affect the respiratory and gastrointestinal systems as well as the cardiovascular system.

Psychosomatic disorders can have mild to severe effects on one’s quality of life, from interfering with the normal ability to function to cause physical or mental disability.

Types of psychosomatic disorder

There are three general categories of psychosomatic illness. In the first one, a person has both mental and physical illness, whose symptoms and management complicate each other. The second category involves a person who experiences mental issues due to the medical condition and its treatment. For example, patients feeling depressed because they have cancer and are taking treatment for it. The third kind is called somatoform disorder. It is a condition in which a person with mental illness experiences one or more physical symptoms, even if he does not have any associated medical condition. Somatoform illness is further classified as follows:

• Hypochondriasis: This is a condition in which the individual has a pervasive fear of illness and disease.  Persons with this disorder overreact to a missed heartbeat, shortness of breath and a slight chest pain. They often change doctors, moving from one to another searching for a diagnosis that matches their own.
• Conversion disorder: When a person who does not have any medical illness experiences neurological symptoms such as seizures, which have an effect on movement and senses, it is a conversion disorder.
• Somatization disorder: Here, an individual feels frequent headaches and has diarrhoea, which does not have any relation to a serious medical condition.
• Body dysmorphic disorder: A person gets stressed about the appearance of their bodies such as wrinkles and obesity. Here the person severely gets affected by anorexia.
• Pain disorder: Here, a person senses severe pain over any part of the body, which might last for six months to one year, without any physical cause. For example, migraines, tension headaches, back pain, etc.

Treatment

Cognitive behaviour therapy  (CBT) is often the treatment of choice for a psychosomatic disorder. This therapy helps patients learn new ways to cope with and solve their problems as they gain a deeper understanding of their condition or circumstances. Patients will also learn to set realistic life goals and identify and change behaviours or thoughts that have negative effects on their lives.

 

Depression is a common mental disorder involving persistent sadness and  loss of interest or pleasure accompanied by several of the following symptoms:  a loss of energy, a change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt, or hopelessness, and thoughts of self-harm or suicide. A person with depression considerable difficulty with daily functioning at home, school and work.

Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.

Symptoms

• Depressed mood most of the day
• Loss of  interest and pleasure
• Decreased activity
• Weight loss
• Loss of confidence or self-esteem
• Unreasonable guilt
• Recurrent thoughts of death and suicide
• Diminished ability to think or concentrate
• Change in psychomotor activity
• Fatigue or loss of energy
• Feelings of worthlessness
• Sleep disturbances (insomnia/hypersomnia)

Treatment

Interpersonal therapy, cognitive behavioural therapy and problem-solving treatment should be considered as a psychological treatment of depressive episode. Relaxation training and physical activities are also used to treat depressive episode/ disorder. In moderate and severe depression, problem-solving treatment should be considered as an adjunct to antidepressants.

Tips to manage depression

• Talk to someone you trust about your feelings. Most people feel better after talking to someone who cares about them.
• Seek professional help. Your local health-care worker or doctor is a good place to start.
• Remember that with the right help, you can get better.
• Keep up with activities that you used to enjoy when you were well.
• Stay connected. Keep in contact with family and friends.
• Exercise regularly, even if it’s just a short walk.
• Stick to regular eating and sleeping habits.
• Accept that you might have depression and adjust your expectations. You may not be able to accomplish as much as you do usually.
• Avoid or restrict alcohol intake and refrain from using illicit drugs; they can worsen depression.
• If you feel suicidal, contact someone for help immediately.

Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.

Symptoms of Anxiety:

• Sweating
• Dizziness, light-headedness, or feeling faint
• Trembling
• Increased or irregular heartbeat
• Back pain
• Nausea or gastrointestinal problems
• Restlessness and fatigue
• Muscle tension
• Being easily startled
• Recurring and ongoing feelings of worry, with or without known stressors
• Avoidance of certain situations that may cause worry, often affecting the quality of life

 

Major Anxiety Disorders

• Generalized anxiety disorder (GAD): This is a chronic disorder involving excessive anxiety and worries about several events or activities for most days during at least a six month period. Symptoms of GAD are restlessness, easily fatigued, difficulty in concentrating, irritability, muscle tension, sleep disturbances and impairment in social, occupational and other daily functioning.
• Panic disorder: Brief or sudden attacks of intense terror and apprehension characterize the panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. Panic attacks tend to occur and escalate rapidly and peak after 10 minutes. However, they may last for hours. Symptoms of panic disorder are severe palpitations, pounding heart, sweating, trembling or shaking, extreme shortness of breath, feeling of choking, chest pain or discomfort, nausea or abdominal distress, feeling faint, derealization or depersonalization, fear of losing control, fear of dying, numbness etc…

• Phobia: This is an irrational fear and avoidance of an object or situation. Phobias differ from other anxiety disorders, as they relate to a specific cause. The fear may be acknowledged as irrational or unnecessary, but the person is still unable to control the anxiety. Phobia comes in many forms. Some of the most common phobias are height, darkness, insects, animals blood, strangers etc…
• Social anxiety disorder: This is a fear of being negatively judged by others in social situations or a fear of public embarrassment. This includes a range of feelings, such as stage fright, a fear of intimacy, and a fear of humiliation. This disorder can cause people to avoid public situations and human contact to the point that everyday living is rendered extremely difficult.
• Obsessive-compulsive disorder (OCD): This is an anxiety disorder in which the individual has anxiety-provoking thoughts that will not go away (obsession) and urges to perform repetitive, ritualistic behaviours to prevent or produce some future situation  (compulsion). Individuals with OCD repeat and rehearse normal doubts and daily routines, sometimes hundreds of times a day.

The most common compulsions are excessive handwashing or taking bath, checking and counting.

 

• Post-traumatic stress disorder (PTSD): This is anxiety that results from previous trauma such as military combat, sexual assault, natural disasters and accidents. Symptoms of PTSD are flashbacks, constricted ability to feel emotions, sleep disturbances, difficulties in memory and concentrations, feelings of apprehension and impulsive outbursts.

 

Treatment

Treating a person with anxiety depends on the causes of the anxiety and individual preferences. Often, treatments will consist of a combination of psychotherapy, behavioural therapy, yoga therapy and medication.

There are several exercises and actions that are recommended to cope with this type of anxiety:

• Stress management: Learning to manage stress can help limit potential triggers. Keep an eye on pressures and deadlines, compile lists to make daunting tasks more manageable, and commit to taking time off from study or work.
• Relaxation techniques: Simple activities can be used to relax mental and physical signs of anxiety. These include meditation, deep breathing exercises, long baths and yoga asanas.
• Exercises to replace negative thoughts with positive ones: Make a list of the negative thoughts you experience, and write down a list of positive, believable thoughts to replace them. Picturing yourself successfully facing and conquering a specific fear can also be beneficial if the anxiety symptoms are related to a specific cause.
• Support network: Talk with a person who is supportive, such as a family member or friend.
• Exercise: Physical exertion can improve self-image and release chemicals in the brain that trigger positive feelings.

Sexual dysfunctions prevent or reduce an individual’s enjoyment of normal sex and prevent or reduce the normal physiological changes brought on normally by sexual arousal. These dysfunctions can be classified by the phase of the sexual cycle in which they occur. It is important to keep in mind that the diagnosis of sexual dysfunction is made only when the disability persists. The common sexual disorders are:

 

• Hypoactive sexual disorder

 

A persistently reduced sexual drive or libido, not attributable to depression where there is a reduced desire, sexual activity and reduced sexual fantasy. It is more common in females. In males, there may be less desirable due to premature ejaculation or pain during intercourse.

 

• Sexual aversion disorder

 

An avoidance of or aversion to genital sexual contact or by masturbation. It is more seen in females usually with a history of childhood sexual abuse.

 

• Female sexual arousal disorder

 

A failure of arousal and lubrication/swelling response of sexual excitement until the completion of sexual activity.

 

• Male erectile disorder

 

Inability to gain an erection or inability to maintain an erection once it has occurred.

 

• Female orgasmic disorder

 

A lengthy delay or absence of orgasm following a satisfactory excitatory phase. The diagnosis must take into account the patient’s age, previous sexual experience and adequacy of sexual stimulation.

 

• Male orgasmic disorder

 

A lengthy delay or absence of orgasm following normal excitation, erection and adequate stimulation.it is also called erectile dysfunction and impotence. A man with the lifelong male erectile disorder has never been able to obtain an erection sufficient for vaginal insertion.

 

• Premature ejaculation

 

Ejaculation occurring with only minimal stimulation, either before penetration, or soon afterwards, in either case certainly before the patient wishes it.

 

• Dyspareunia

 

Recurrent pain associated with intercourse, but in women not due to vaginismus, poor lubrication and in women and men not due to drugs or other physical causes.

 

• Vaginismus

 

An involuntary or persistent spasm of the muscles of the outer third of the vagina that interferes with penile insertion and intercourse. Vaginismus may be either lifelong or recent generalized to all sexual encounters or specific to certain partners or situations.

 

• Secondary sexual dysfunction

 

Dysfunctions secondary to illness like hyperthyroidism, mental disorder, depression or drugs.

 

• Sexual Masochism and Sadism

 

A sadist is applied to those who derive sexual excitement from the pain of others. Masochist is applied to those who derive sexual excitement through their own pain.

 

• Gender identity disorder

 

Strong and persistent identification of the self with another gender is considered as gender identity disorder. The persistent dissatisfaction with own sex and desire to participate in stereotyped games and pastimes of opposite sex are common among them. These individuals have a preference for cross-dressing. It may occur in children, adolescents and adults.

Treatment

Usually treating both partners simultaneously. It involves three stages

1. Sex education
2. A behavioural component in which the partners are prescribed certain procedures or ways to go about the sexual act.
3. A psychotherapeutic component in which the partners are counselled if any difficulties arise in carrying out the instructions given. Emotional problems are also treated.