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Jelena Dokic's candid admission on weight loss

Jelena Dokic has opened up on her 20kg weight loss and her previous struggles with depression and an eating disorder. The former tennis player took to Instagram on Sunday to share before and after shots from her weight loss, taken seven years apart, and her past battles with self-worth. She explained to her followers that her current weight loss was a result of her prioritising her mental health. "This is not about body size but feeling that I am not worthy enough to even live!!! On the left 7 years ago," she said. "Even though I have a bit less weight now on the right, this is not about weight. Because even if I was half the size on the left, I would still feel the same. And how is that? Not worthy enough to even live!!" She explained that in the first photo she was afraid to leave the house and was "broken" from her battle with depression and PTSD. "My face, body language and even clothing on the left says it all. This is how low my self worth was. I was afraid to get out of the house," she shared. "I was not able to look people in the eye, I just wanted to wear black or dark grey and cover myself up. I even remember wishing to somehow fully cover my face and head and could I possibly not even need to go out of the house for the rest of my life." "This was anxiety, depression, debilitating effect of trauma that made me feel I was worthless and not even worthy of living. "This was the result of being put down my whole life especially by people close to me." "The person on the left was broken, shattered, battling anxiety, depression, PTSD, BPD and an eating disorder. At times I hoped I wouldn't wake up so that I don't have to feel like this anymore," she continued. She then explained that she wasn't asking for pity as she didn't want to victimise herself. "I wanted to survive and thrive and I got there." She then shared a few motivating words on courage and resilience, saying: "Fight hard. Every single day, don't give up and no matter how scary it is get outside of your comfort zone. It will get easier and more comfortable to do so." "Keep going after it even when it's scary. Be brave and never give up. The way to start feeling good in your own skin and life is to be who you really are and embrace and love yourself." "Don't be afraid of mistakes and failures, they make you learn and as long as you get back up, that's all that matters." "Don't you ever give up on yourself and your goals. Don't ever be defined by someone else's judgement and comments." She encouraged her followers to stay true to themselves and remember their self-worth. "Be yourself. Being authentic, real and vulnerable is the way to being happy and thriving. You are worthy and never allow anyone to tell you otherwise." Images: Instagram

Body

What’s the difference between autism and Asperger’s disorder?

<a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Swedish climate activist Greta Thunberg describes herself as having <a href="https://www.theguardian.com/environment/2019/sep/02/greta-thunberg-responds-to-aspergers-critics-its-a-superpower">Asperger’s</a> while others on the autism spectrum, such as Australian comedian Hannah Gatsby, <a href="https://www.theguardian.com/stage/2022/mar/19/hannah-gadsby-autism-diagnosis-little-out-of-whack">describe</a> themselves as “autistic”. But what’s the difference? Today, the previous diagnoses of “Asperger’s disorder” and “autistic disorder” both fall within the diagnosis of autism spectrum disorder, or ASD. Autism describes a “neurotype” – a person’s thinking and information-processing style. Autism is one of the forms of diversity in human thinking, which comes with strengths and challenges. When these challenges become overwhelming and impact how a person learns, plays, works or socialises, a diagnosis of <a href="https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder">autism spectrum disorder</a> is made. <h2>Where do the definitions come from?</h2> The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the criteria clinicians use to diagnose mental illnesses and behavioural disorders. Between 1994 and 2013, autistic disorder and Asperger’s disorder were the two primary diagnoses related to autism in the fourth edition of the manual, the DSM-4. In 2013, the DSM-5 collapsed both diagnoses into one <a href="https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">autism spectrum disorder</a>. <h2>How did we used to think about autism?</h2> The two thinkers behind the DSM-4 diagnostic categories were Baltimore psychiatrist Leo Kanner and Viennese paediatrician Hans Asperger. They described the challenges faced by people who were later diagnosed with autistic disorder and Asperger’s disorder. Kanner and Asperger observed patterns of behaviour that differed to typical thinkers in the domains of communication, social interaction and flexibility of behaviour and thinking. The variance was associated with challenges in adaptation and distress. Between the 1940s and 1994, the majority of those diagnosed with autism also had an intellectual disability. Clinicians became focused on the accompanying intellectual disability as a necessary part of autism. The introduction of Asperger’s disorder shifted this focus and acknowledged the diversity in autism. In the DSM-4 it superficially looked like autistic disorder and Asperger’s disorder were different things, with the Asperger’s criteria stating there could be no intellectual disability or delay in the development of speech. Today, as a legacy of the recognition of the autism itself, the <a href="https://www.aihw.gov.au/reports/disability/autism-in-australia/contents/autism">majority of people</a> diagnosed with autism spectrum disorder – the new term from the DSM-5 – don’t a have an accompanying intellectual disability. <h2>What changed with ‘autism spectrum disorder’?</h2> The move to autism spectrum disorder brought the previously diagnosed autistic disorder and Asperger’s disorder under the one new diagnostic umbrella term. It made clear that other diagnostic groups – such as intellectual disability – can co-exist with autism, but are separate things. The other major change was acknowledging communication and social skills are intimately linked and not separable. Rather than separating “impaired communication” and “impaired social skills”, the diagnostic criteria changed to “impaired social communication”. The introduction of the spectrum in the diagnostic term further clarified that people have varied capabilities in the flexibility of their thinking, behaviour and social communication – and this can change in response to the context the person is in. <h2>Why do some people prefer the old terminology?</h2> Some people feel the clinical label of Asperger’s allowed a much more refined understanding of autism. This included recognising the achievements and great societal contributions of people with known or presumed autism. The contraction “Aspie” played an enormous part in the shift to positive identity formation. In the time up to the release of the DSM-5, <a href="https://xminds.org/resources/Documents/Web%20files/Aspie%20Criteria%20by%20Attwood.pdf">Tony Attwood and Carol Gray</a>, two well known thinkers in the area of autism, highlighted the strengths associated with “being Aspie” as something to be proud of. But they also raised awareness of the challenges. <h2>What about identity-based language?</h2> A more recent shift in language has been the reclamation of what was once viewed as a slur – “autistic”. This was a shift from person-first language to identity-based language, from “person with autism spectrum disorder” to “autistic”. The neurodiversity rights movement describes its aim to <a href="https://researchonline.jcu.edu.au/71531/1/JCU_71531_AAM.pdf">push back</a> against a breach of human rights resulting from the wish to cure, or fundamentally change, people with autism. The movement uses a “social model of disability”. This views disability as arising from societies’ response to individuals and the failure to adjust to enable full participation. The inherent challenges in autism are seen as only a problem if not accommodated through reasonable adjustments. However the social model contrasts itself against a very outdated medical or clinical model. Current clinical thinking and practice focuses on <a href="https://www.collegianjournal.com/article/S1322-7696(22)00122-6/fulltext">targeted</a> supports to reduce distress, promote thriving and enable optimum individual participation in school, work, community and social activities. It doesn’t aim to cure or fundamentally change people with autism. A diagnosis of autism spectrum disorder signals there are challenges beyond what will be solved by adjustments alone; individual supports are also needed. So it’s important to combine the best of the social model and contemporary clinical model.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223643/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrew-cashin-458270">Andrew Cashin</a>, Professor of Nursing, School of Health and Human Sciences, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-autism-and-aspergers-disorder-223643">original article</a>.

Mind

How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

<a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life. However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals. Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>. <h2>Weight loss and eating disorders</h2> Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting. Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>. As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms. <h2>Eating disorders and ‘weight suppression’</h2> In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy). Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa. <a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain. There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa. <h2>Ozempic and other semaglutide drugs</h2> Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake. Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>. Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As. Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication. <h2>Risks of dieting and weight-loss drugs</h2> The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders. Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>. Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>. The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain. Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>. People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221514/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, PhD Candidate, Clinical Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders-221514">original article</a>.

Body

Why do people with hoarding disorder hoard, and how can we help?

<a href="https://theconversation.com/profiles/jessica-grisham-37825">Jessica Grisham</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>; <a href="https://theconversation.com/profiles/keong-yap-1468967">Keong Yap</a>, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a>, and <a href="https://theconversation.com/profiles/melissa-norberg-493004">Melissa Norberg</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Hoarding disorder is an under-recognised serious mental illness that <a href="https://pubmed.ncbi.nlm.nih.gov/25909628/">worsens with age</a>. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/31200169/">2.5% of the working-age population</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27939851/">7% of older adults</a>. That’s about 715,000 Australians. People who hoard and their families often feel ashamed and don’t get the support they need. Clutter can make it hard to do things most of us take for granted, such as eating at the table or sleeping in bed. In the gravest cases, homes are completely unsanitary, either because it has become impossible to clean or because the person <a href="https://pubmed.ncbi.nlm.nih.gov/23482436/">saves garbage</a>. The <a href="https://pubmed.ncbi.nlm.nih.gov/18275935/">strain on the family</a> can be extreme – couples get divorced, and children grow up feeling unloved. So why do people with hoarding disorder hoard? And how can we help? <h2>What causes hoarding disorder?</h2> Saving millions of objects, many worthless by objective standards, often makes little sense to those unfamiliar with the condition. However, most of us<a href="https://www.sciencedirect.com/science/article/pii/S2352250X21000282?via%3Dihub"> become attached to at least a few possessions</a>. Perhaps we love the way they look, or they trigger fond memories. Hoarding involves this same type of object attachment, as well over-reliance on possessions and <a href="https://pubmed.ncbi.nlm.nih.gov/32402421/">difficulty being away from them</a>. Research has shown genetic factors play a role but there is no one <a href="https://pubmed.ncbi.nlm.nih.gov/27445875/">single gene that causes hoarding disorder</a>. Instead, a range of psychological, neurobiological, and social factors can be at play. Although some who hoard report being deprived of material things in childhood, emotional deprivation may play a <a href="https://pubmed.ncbi.nlm.nih.gov/20934847/">stronger role</a>. People with hoarding problems often report excessively cold parenting, difficulty connecting with others, and more <a href="https://pubmed.ncbi.nlm.nih.gov/34717158/">traumatic experiences</a>. They may end up believing people are unreliable and untrustworthy, and that it’s better to rely on objects for comfort and safety. People with hoarding disorder are often as attached or perhaps <a href="https://akjournals.com/view/journals/2006/11/3/article-p941.xml">more attached to possessions</a> than to the people in their life. Their experiences have taught them their self-identity is tangled up in what they own; that if they part with their possessions, they will lose themselves. Research shows <a href="https://www.sciencedirect.com/science/article/pii/S0005789421000253?via%3Dihub">interpersonal problems</a>, such as loneliness, are linked to greater <a href="https://pubmed.ncbi.nlm.nih.gov/32853881/">attachment to objects</a>. Hoarding disorder is also associated with high rates of <a href="https://pubmed.ncbi.nlm.nih.gov/34923357/">attention deficit and hyperactivity disorder</a>. Difficulties with <a href="https://pubmed.ncbi.nlm.nih.gov/30907337/">decision-making</a>, planning, <a href="https://akjournals.com/view/journals/2006/12/3/article-p827.xml">attention</a> and categorising can make it hard to organise and <a href="https://pubmed.ncbi.nlm.nih.gov/20542489/">discard possessions</a>. The person ends up avoiding these tasks, which leads to unmanageable levels of clutter. <h2>Not everyone takes the same path to hoarding</h2> Most people with hoarding disorder also have strong beliefs about their possessions. For example, they are more likely to see beauty or usefulness in things and believe objects possess <a href="https://link.springer.com/article/10.1023/A:1025428631552">human-like qualities</a> such as intentions, emotions, or free will. Many also feel responsible for objects and for the environment. While others may not think twice about discarding broken or disposable things, people with hoarding disorder can <a href="https://pubmed.ncbi.nlm.nih.gov/30041077/">anguish over their fate</a>. This need to control, rescue, and protect objects is often at odds with the beliefs of friends and family, which can lead to conflict and <a href="https://pubmed.ncbi.nlm.nih.gov/32853881/">social isolation</a>. Not everyone with hoarding disorder describes the same pathway to overwhelming clutter. Some report more cognitive difficulties while others may have experienced more emotional deprivation. So it’s important to take an individualised approach to treatment. <h2>How can we treat hoarding disorder?</h2> There is specialised cognitive-behavioural therapy (CBT) tailored for hoarding disorder. <a href="https://academic.oup.com/edited-volume/46862/chapter-abstract/413932715?redirectedFrom=fulltext">Different strategies</a> are used to address the different factors contributing to a person’s hoarding. Cognitive-behavioural therapy can also help people understand and gradually challenge their beliefs about possessions. They may begin to consider how to remember, connect, feel safe, or express their identity in ways other via inanimate objects. Treatment can also help people learn the skills needed to organise, plan, and discard. Regardless of their path to hoarding, most people with hoarding disorder will benefit from a degree of exposure therapy. This helps people gradually learn to let go of possessions and resist acquiring more. Exposure to triggering situations (such as visiting shopping centres, op-shops or mounds of clutter without collecting new items) can help people learn to tolerate their urges and distress. Treatment can happen in an individual or group setting, and/or via <a href="https://pubmed.ncbi.nlm.nih.gov/35640322/">telehealth</a>. Research is underway on ways to <a href="https://pubmed.ncbi.nlm.nih.gov/34409679/">improve</a> the <a href="https://www.sciencedirect.com/science/article/pii/S2666915322001421">treatment</a> options further through, for example, learning different emotional regulation strategies. <h2>Sometimes, a harm-avoidance approach is best</h2> Addressing the emotional and behavioural drivers of hoarding through cognitive behavioural therapy is crucial. But hoarding is different to most other psychological disorders. Complex cases may require lots of different agencies to work together. For example, health-care workers may work with fire and housing officers to ensure the person can <a href="https://pubmed.ncbi.nlm.nih.gov/31984612/">live safely at home</a>. When people have severe hoarding problems but are reluctant to engage in treatment, a <a href="https://pubmed.ncbi.nlm.nih.gov/21360706/">harm-avoidance approach</a> may be best. This means working with the person with hoarding disorder to identify the most pressing safety hazards and come up with a practical plan to address them. We must continue to improve our understanding and treatment of this complex disorder and address barriers to accessing help. This will ultimately help reduce the devastating impact of hoarding disorder on individuals, their families, and the community.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208102/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jessica-grisham-37825">Jessica Grisham</a>, Professor in Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>; <a href="https://theconversation.com/profiles/keong-yap-1468967">Keong Yap</a>, Associate Professor of Psychology, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a>, and <a href="https://theconversation.com/profiles/melissa-norberg-493004">Melissa Norberg</a>, Professor in Psychology, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-people-with-hoarding-disorder-hoard-and-how-can-we-help-208102">original article</a>.

Mind

Obsessive compulsive disorder is more common than you think. But it can take 9 years for an OCD diagnosis

Obsessive compulsive disorder, or OCD, is a <a href="https://www.sciencedirect.com/science/article/abs/pii/S2211364916301579">misunderstood </a>mental illness despite affecting <a href="https://pubmed.ncbi.nlm.nih.gov/18725912">about one in 50 people</a> – that’s about half a million Australians. Our <a href="https://www.tandfonline.com/doi/full/10.1080/00050067.2023.2189003">new research</a> shows how long and fraught the path to diagnosis and treatment can be. This initial study showed it takes an average of almost nine years to receive a diagnosis of OCD and about four months to get some form of help. <h2>What is OCD?</h2> OCD affects children, adolescents and adults. <a href="https://www.nature.com/articles/mp200894">About 60%</a> report symptoms before the age of 20. One misconception is that OCD is mild: someone who is extra tidy or likes cleaning. You might have even heard someone say they are “<a href="https://theconversation.com/you-cant-be-a-little-bit-ocd-but-your-everyday-obsessions-can-help-end-the-conditions-stigma-49265">a little bit OCD</a>” while joking about having beautiful stationery. But OCD is not enjoyable. Obsessions are highly distressing and there are repetitive, intrusive thoughts a person with OCD can’t control. They might believe, for instance, they or their loved ones are in grave danger. <a href="https://iocdf.org/about-ocd/">Compulsions</a> are actions that temporarily alleviate, but ultimately exacerbate, this distress, such as checking the door is locked. People with OCD spend hours each day consumed by this cycle, instead of their normal activities, such as school, work or having a social life. It can also be very distressing for <a href="https://www.tandfonline.com/doi/abs/10.1586/ern.11.200">family members</a> who often end up completing rituals or providing excessive reassurance to the person with OCD. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/Cl7ElJqBg4f/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/Cl7ElJqBg4f/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by ABC Health (@abchealth)</a> </div> </blockquote> <h2>How is it diagnosed?</h2> People with OCD often don’t tell others about their disturbing thoughts or repetitive rituals. They often feel <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/%28SICI%291099-0879%28199905%296%3A2%3C80%3A%3AAID-CPP188%3E3.0.CO%3B2-C">ashamed or worried</a> that by telling someone their disturbing thoughts, they might become true. Doctors <a href="https://www.ncbi.nlm.nih.gov/books/NBK56470/#ch2">don’t always ask about</a> OCD symptoms when people first seek treatment. Both lead to delays getting correctly diagnosed. When people do feel comfortable talking about their OCD symptoms, a diagnosis might be made by a GP, psychologist or other health-care professional, such as a psychiatrist. Sometimes OCD can be <a href="https://link.springer.com/article/10.1007/s10566-009-9092-8">tricky to differentiate</a> from other conditions, such as eating disorders, anxiety disorders or autism. Having an additional mental health diagnosis <a href="https://www.nature.com/articles/s41572-019-0102-3">is common</a> in people with OCD. In those cases, a health-care provider experienced in OCD is helpful. To diagnose OCD, the health professional asks people and/or their families questions about the presence of obsessions and/or compulsions, and how this impacts their life and family. <h2>How is it treated?</h2> After someone receives a diagnosis, it helps to learn more about OCD and what treatment involves. Great places to start are the <a href="https://iocdf.org/">International OCD Foundation</a> and <a href="https://www.ocduk.org/">OCD UK</a>. Next, they will need to find a health-care provider, usually a psychologist, who offers a special type of psychological therapy called “exposure and response prevention” or ERP. This is a type of <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive-behavioural therapy</a> that is a <a href="https://doi.org/10.1016/j.jocrd.2021.100684">powerful, effective treatment</a> for OCD. It’s recommended people with OCD try this first. It involves therapists helping people to understand the cycle of OCD and how to break that cycle. They support people to deliberately enter anxiety-provoking situations while resisting completing a compulsion. Importantly, people and their ERP therapist <a href="https://pubmed.ncbi.nlm.nih.gov/18005936/">decide together</a>what steps to take to truly tackle their fears. People with OCD learn new thoughts, for example, “germs don’t always lead to illness” rather than “germs are dangerous”. There are a range of medications that also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967667/">effectively</a> <a href="https://pubmed.ncbi.nlm.nih.gov/27663940/">treat</a> OCD. But more research is needed to know more about when a medication should be added. For most people these are best considered a “boost” to help ERP. <h2>But not everything goes to plan</h2> Delays in being diagnosed is only the start: <ul> <li> treatment is challenging to access. Only <a href="https://www.sciencedirect.com/science/article/abs/pii/S0887618518301038?via%3Dihub">30% of clinicians</a> in the United States offer ERP therapy. There is likely a similar situation in Australia </li> <li> many people receive therapies that appear credible, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12337?casa_token=Wn3bgnvINSsAAAAA%3A2sqam0BKtCzFA680_f6ln4scp1SKVpN_cOB6Tg8vQyEiNDZPwS-Z-NNveLelKYF6iz4PFqQSXyHKZYJS">but lack evidence</a>, such as general cognitive therapy that is not tailored to the mechanisms maintaining OCD. Inappropriate treatments waste valuable time and effort that the person could use to recover. Ineffective treatments can make OCD symptoms worse </li> <li> even when someone receives first-line, evidence-based treatments, <a href="https://www.sciencedirect.com/science/article/pii/S0005796722001413?via%3Dihub">about 40-60%</a> of people don’t get better </li> <li> there are no Australian clinical treatment guidelines, nor state or national clinical service plans for OCD. This makes it hard for health-care providers to know how to treat it </li> <li> there has been <a href="https://journals.sagepub.com/doi/full/10.1177/00048674221125595">relatively little research funding</a> spent on OCD in the past ten years, compared with, for example, psychosis or dementia. </li> </ul> <h2>What can we do?</h2> Real change demands collaboration between health-care professionals, researchers, government, people with OCD and their families to advocate for proportionate funding for research and clinical services to: <ul> <li> deliver public health messaging to improve general knowledge about OCD and reduce the stigma so people feel more comfortable disclosing their worries </li> <li> upskill and support health professionals to speed up diagnosis so people can receive targeted early intervention </li> <li> support health-care professionals to offer evidence-based treatment for OCD, so more people can access these treatments </li> <li> develop state and national service plans and clinical guidelines. For example, the Australian government funds the <a href="https://nedc.com.au/">National Eating Disorders Collaboration</a> to develop and implement a nationally consistent approach to preventing and treating eating disorders </li> <li> research to discover new, and enhance existing, treatments. These include ones for people who don’t get better after “exposure and response prevention” therapy. </li> </ul> <h2>What if I think I have OCD?</h2> The most common barrier to getting help is not knowing who to see or where to go. Start with your GP: tell them you think you might have OCD and ask to discuss treatment options. These might include therapy and/or medication and a referral to a psychologist or psychiatrist. If you choose therapy, it’s important to find a clinician that offers specific and effective treatment for OCD. To help, we’ve started <a href="https://ocd.org.au/directory">a directory</a> of clinicians with a special interest in treating OCD. You <a href="https://iocdf.org/ocd-finding-help/how-to-find-the-right-therapist/#:%7E:text=Tips%20for%20Finding%20the%20Right%20Therapist&text=Also%2C%20remember%20that%20some%20therapists,the%20phone%20or%20in%20person">can ask</a> any potential health professional if they offer “exposure and response prevention”. If they don’t, it’s a sign this isn’t their area of expertise. But you still can ask them if they know of a colleague who does. You might need to call around, so hang in there. Good treatment can be life changing. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/obsessive-compulsive-disorder-is-more-common-than-you-think-but-it-can-take-9-years-for-an-ocd-diagnosis-196651" target="_blank" rel="noopener">The Conversation</a>.

Caring

Global review shows link between social media use, body image and eating disorders

Body image has remains a <a href="https://www.missionaustralia.com.au/what-we-do/research-impact-policy-advocacy/youth-survey" target="_blank" rel="noopener">top personal concern</a> for young people in Australia, with 76% concerned about the issue. Social media use by teens is rising at the same time – with <a href="https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Social-Media-and-Teens-100.aspx" target="_blank" rel="noopener">more than 90% on platforms</a> like Facebook, YouTube, Instagram, Snapchat, WeChat and TikTok. While there have long been concerns about the association between social media, body image and eating disorders the connection remains relatively unexplored as a public health issue. Now, researchers from University College London in the UK have undertaken a systematic review of 50 scientific studies across 17 countries showing clear links between social media use and body image concerns. The paper, <a href="https://doi.org/10.1371/journal.pgph.0001091" target="_blank" rel="noopener">published</a> in PLOS Global Public Health, analyses the relationship between body image or eating disorders in young people and social media use. The researchers identify specific aspects of social media – platforms with an emphasis on photos, and engaging with “fitspiration” and “thinspiration” trends – as the factors most closely linked to body image concerns, disordered eating and poor mental health. Other key risk factors included female gender, high body-mass-index and pre-existing body image concerns. The researchers note further studies are needed into the direction of causality. “For example, do body image dissatisfaction and disordered eating occur because of social media usage, or do these pre-exist, encourage engagement in certain online activities, and result in unfavourable clinically significant outcomes?” they ask. Eating disorders involve disturbed attitudes to body image, pre-occupation with weight and body shape and are associated with significant negative outcomes such as cardiovascular disease, reduced bone density, and psychiatric conditions. In Australia, the <a href="https://butterfly.org.au/" target="_blank" rel="noopener">Butterfly Foundation</a> reports eating disorders affect around one million people, with the conditions causing more people die each year than the road toll. Image credits: Getty Images This article was originally published on <a href="https://cosmosmagazine.com/health/social-media-use-body-image/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Petra Stock.

Technology

We studied how COVID affects mental health and brain disorders up to two years after infection – here’s what we found

The occurrence of mental health conditions and neurological disorders among people recovering from COVID has been a concern since early in the pandemic. Several studies have shown that a <a href="https://www.sciencedirect.com/science/article/pii/S2215036621000845" target="_blank" rel="noopener">significant proportion</a> of adults <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00042-1/fulltext" target="_blank" rel="noopener">face problems</a> of this kind, and that the risks are greater than following other infections. However, several questions remain. Do the risks of psychiatric and neurological problems dissipate, and if so, when? Are the risks similar in children as in adults? Are there differences between COVID variants? Our new study, published in <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext" target="_blank" rel="noopener">The Lancet Psychiatry</a>, explored these issues. In analyses led by my colleague Maxime Taquet, we used the electronic health records of about 1.25 million people diagnosed with COVID, mostly from the US. We tracked the occurrence of 14 major neurological and psychiatric diagnoses in these patients for up to two years. We compared these risks with a closely matched control group of people who had been diagnosed with a respiratory infection other than COVID. We examined children (aged under 18), adults (18-65) and older adults (over 65) separately. We also compared people who contracted COVID just after the emergence of a new variant (notably omicron, but earlier variants too) with those who did so just beforehand. Our findings are a mixture of good and bad news. Reassuringly, although we observed a greater risk of common psychiatric disorders (anxiety and depression) after COVID infection, this heightened risk rapidly subsided. The rates of these disorders among people who had COVID were no different from those who had other respiratory infections within a couple of months, and there was no overall excess of these disorders over the two years. It was also good news that children were not at greater risk of these disorders at any stage after COVID infection. We also found that people who had had COVID were not at higher risk of getting Parkinson’s disease, which had been a concern early in the pandemic. Other findings were more worrying. The risks of being diagnosed with some disorders, such as psychosis, seizures or epilepsy, brain fog and dementia, though mostly still low, remained elevated throughout the two years after COVID infection. For example, the risk of dementia in older adults was 4.5% in the two years after COVID compared with 3.3% in those with another respiratory infection. We also saw an ongoing risk of psychosis and seizures in children. <figure class="align-center "><img src="https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479705/original/file-20220817-11701-ygfp4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" alt="A woman sits by a window, hiding her head." /><figcaption>Rates of depression and anxiety were higher after COVID, but only for a short time. <a class="source" href="https://www.shutterstock.com/image-photo/beautiful-young-blonde-caucasian-female-feeling-2057071157" target="_blank" rel="noopener">Stock Unit/Shutterstock</a></figcaption></figure> In terms of variants, although our data confirms that omicron is a much milder illness than the previous delta variant, survivors remained at similar risk of the neurological and psychiatric conditions we looked at. However, given how recently omicron emerged, the data we have for people who were infected with this variant only goes up to about five months after infection. So the picture may change. Mixed results Overall, our study reveals a mixed picture, with some disorders showing a transient excess risk after COVID, while other disorders have a sustained risk. For the most part, the findings are reassuring in children, but with some concerning exceptions. The results on omicron, the variant currently dominant around the world, indicate that the burden of these disorders is likely to continue, even though this variant is milder in other respects. The study has important caveats. Our findings don’t capture people who may have had COVID but it wasn’t documented in their health records – perhaps because they didn’t have symptoms. And we cannot fully account for the effect of vaccination, because we didn’t have complete information about vaccination status, and some people in our study caught COVID before vaccines became available. That said, in <a href="https://pubmed.ncbi.nlm.nih.gov/35447302/" target="_blank" rel="noopener">a previous study</a> we showed the risks of these outcomes were pretty similar in people who caught COVID after being vaccinated, so this might not have significantly affected the results. Also, the risks observed in our study are relative to people who had had other respiratory infections. We don’t know how they compare to people without any infection. We also don’t know how severe or long lasting the disorders were. Finally, our study is observational and so cannot explain how or why COVID is associated with these risks. Current theories include persistence of the virus in the nervous system, the immune reaction to the infection, or problems with blood vessels. These are being investigated in <a href="https://academic.oup.com/braincomms/advance-article/doi/10.1093/braincomms/fcac206/6668727?searchresult=1" target="_blank" rel="noopener">separate research</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/188918/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-harrison-1371295" target="_blank" rel="noopener">Paul Harrison</a>, Professor of Psychiatry, <a href="https://theconversation.com/institutions/university-of-oxford-1260" target="_blank" rel="noopener">University of Oxford</a> This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-studied-how-covid-affects-mental-health-and-brain-disorders-up-to-two-years-after-infection-heres-what-we-found-188918" target="_blank" rel="noopener">original article</a>. Image: Getty Images

Mind

How eye disorders may have influenced the work of famous painters

Vision is an important tool when creating a painted artwork. Vision is used to survey a scene, guide the artist’s movements over the canvas and provide feedback on the colour and form of the work. However, it’s possible for disease and disorders to alter an artist’s visual perception. There is a <a href="http://digicoll.library.wisc.edu/cgi-bin/HistSciTech/HistSciTech-idx?type=article&did=HISTSCITECH.NATURE18720321.I0007&id=HistSciTech.Nature18720321&isize=M">long history</a> of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1869328/">scientists and clinicians</a> arguing <a href="https://www.ncbi.nlm.nih.gov/pubmed/8510952">particular artists</a> were affected by <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">vision disorders</a>, based on signs in their works. Some argued the <a href="https://www.ncbi.nlm.nih.gov/pubmed/8510952">leaders of the Impressionist movement were short-sighted</a>, for instance, and that their blurry distance vision when not using spectacles may explain their broad, impetuous style. Supporting evidence of such disorders and their influence on artworks is often speculative, and hampered by a lack of clinical records to support the diagnosis. A particular challenge to verifying these speculations is that artists are, of course, free to represent the world in whatever fashion they like. So, is a particular style the result of impoverished vision, or rather a conscious artistic choice made by the artist? Here are three artists who it has been claimed suffered vision impairments. <h2>El Greco</h2> Architect, painter and sculptor of the Spanish Renaissance, El Greco (1541-1614) is known for vertically elongating certain figures in his paintings. In 1913, ophthalmologist <a href="https://pdfs.semanticscholar.org/5059/8e2c07220d1bb76b52f02508ee7f09ce0077.pdf">Germán Beritens argued</a> this elongation was due to astigmatism. Astigmatism typically results when the cornea – the front surface of the eye and the principal light-focusing element – is not spherical, but shaped more like a watermelon. This means the light bends in different amounts, depending on the direction in which it’s passing through the eye. Lines and contours in an image that are of a particular orientation will be less in focus than others. Beritens would demonstrate his astigmatism theory to house guests using a special lens that produced El Greco-like vertical elongations. But there are several problems with Beriten’s theory. A common objection is that any vertical stretching should have affected El Greco’s view of both the subject being painted and the canvas being painted on. This would mean the astigmatism effects <a href="https://www.ncbi.nlm.nih.gov/pubmed/24577418">should largely cancel out</a>. Possibly <a href="https://www.ncbi.nlm.nih.gov/pubmed/24577418">more problematic</a> is that uncorrected astigmatism mainly causes blurry vision, rather than a change in image size. Plus, <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">other evidence suggests</a> El Greco’s use of vertical elongation was a deliberate artistic choice. For example, in his 1610 painting, St Jerome as Scholar (above), the horizontally oriented hand of the saint is also elongated, just like the figure. If El Greco’s elongated figures were due to a simple vertical stretching in his visual perception, we would expect the hand to look comparatively stubby. <h2>Claude Monet</h2> Elsewhere, the influence of eye anomalies in artworks is more compelling. Cataracts are a progressive cloudiness of the lens inside the eye, producing blurred and dulled vision that can’t be corrected with spectacles. Cataracts are often brown, which filter the light passing through them, impairing colour discrimination. In severe cases, blue light is almost completely blocked. Claude Monet was <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">diagnosed with cataracts in 1912</a>, and recommended to undergo surgery. He refused. Over the subsequent decade, his ability to see critical detail reduced, as is documented in his medical records. Importantly, his colour vision also suffered. In 1914, he <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">noted how reds appeared dull and muddy</a>, and by 1918 he was reduced to selecting colours from the label on the paint tube. The visual impact of his cataracts is demonstrated in two paintings of the same scene: the Japanese footbridge over his garden’s lily pond. The first, painted ten years prior to his cataract diagnosis, is full of detail and subtle use of colour. In contrast, the second – painted the year prior to his eventually relenting to surgery – shows colours to be dark and murky, with a near absence of blue, and a dramatic reduction in the level of painted detail. There is good evidence such changes were not a conscious artistic choice. In a 1922 <a href="https://psyc.ucalgary.ca/PACE/VA-Lab/AVDE-Website/Monet.html">letter to author Marc Elder</a>, Monet confided he recognised his visual impairment was causing him to spoil paintings, and that his blindness was forcing him to abandon work despite his otherwise good health. One of <a href="https://www.ncbi.nlm.nih.gov/pubmed/26563659">Monet’s fears</a> was that surgery would alter his colour perception, and indeed after surgery he complained of the world appearing too yellow or sometimes too blue. It was two years before he felt his colour vision had returned to normal. Experimental work <a href="https://www.ncbi.nlm.nih.gov/pubmed/15518204">has confirmed</a> colour perception is measurably altered for months after cataract surgery, as the eye and brain adapt to the increased blue light previously blocked by the cataract. <h2>Clifton Pugh</h2> In addition to eye disease, colour vision can be altered by inherited deficiencies. Around <a href="http://www.colourblindawareness.org/colour-blindness/">8% of men and 0.5% of women</a> are born with abnormal colour vision – sometimes erroneously called “colour blindness”. In one of its most common severe forms, people see colours purely in terms of various levels of blue and yellow. They can’t distinguish colours that vary only in their redness or greenness, and so have trouble distinguishing ripe from unripe fruit, for example. It has been argued no major artist is known to have <a href="https://www.ncbi.nlm.nih.gov/pubmed/11274694">abnormal colour vision</a>. But <a href="https://www.ncbi.nlm.nih.gov/pubmed/19515095">subsequent research</a> argues against this. Australian artist <a href="https://www.portrait.gov.au/portraits/2006.56/kate-hattam/31931/">Clifton Pugh</a> can readily lay claim to the title of “major artist”: he was three-times winner of the Archibald Prize for Portraiture, is highly represented in national galleries, and even won a bronze medal for painting at the Olympics (back when such things were possible). His abnormal colour vision is <a href="https://www.ncbi.nlm.nih.gov/pubmed/19515095">well documented</a> in biographical information. Owing to the inherited nature of colour vision deficiencies, researchers were able to test the colour vision of surviving family members to support their case that Pugh almost certainly had a severe red-green colour deficiency. But an analysis of the colours used in Pugh’s paintings failed to reveal any signatures that would suggest a colour vision deficiency. This is consistent with <a href="https://academic.oup.com/bjaesthetics/article-abstract/7/2/132/117619?redirectedFrom=fulltext">previous work</a>, demonstrating it was not possible to reliably diagnose a colour vision deficiency based on an artist’s work. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/how-eye-disorders-may-have-influenced-the-work-of-famous-painters-92830" target="_blank" rel="noopener">The Conversation</a>.

Art

Why are more men diagnosed with schizophrenia?

New research has found a link between the genetic differences in men and women and their likelihood of developing certain psychotic and mood disorders. In a study <a href="https://www.biologicalpsychiatryjournal.com/article/S0006-3223(21)01139-2/fulltext">recently published</a> in Biological Psychiatry, researchers looked at the underlying genetic differences between the sexes for the reason why bipolar disorder, schizophrenia, and depression affect the two sexes in different ways and at different rates. After examining the genomes of 85,735 people with schizophrenia, bipolar disorder, or depression, and 109,946 people without any of those conditions, the researchers found almost a dozen single nucleotide polymorphisms (SNPs) that differed between men and women diagnosed with one of the three disorders. What are the impacts of SNPs? The four nucleotides - Adenine, Thymine, Cytosine, and Guanine - that are used to make DNA are compared in particular orders to make specific proteins. SNPs are a kind of mutation where a single nucleotide - either A, G, T, or C - is swapped for another in a specific spot in the genome. These substitutions can affect our risk of getting certain diseases. In the study of mental disorders in the different sexes, the team found that these mutations would have different impacts on the different sexes. Some SNPs were only linked to disease in one sex, while others decreased the likelihood of the disorder occurring in one sex but increased it in the other. The researchers also found that these mutations occurred in genes that are linked to vascular, immune, and neuronal development pathways, suggesting cardiovascular and neurological health are affected by each other in some way. “We found a SNP in the IDO2 gene,” Jill Goldstein, a clinical neuroscientist at Harvard Medical School and the senior author of the study, told <a href="https://www.the-scientist.com/news-opinion/genetic-variants-tied-to-sex-differences-in-psychiatric-disorders-68624">The Scientist</a>. This particular gene is associated with immune tolerance in humans, meaning it helps suppress the immune system so it doesn’t attack bodily tissues and other substances. The gene is also linked to and has different effects on different disorders. “The SNP [in the IDO2 gene] increased the risk of bipolar disorder in women and decreased the risk in men, but it also decreased the risk of major depression and schizophrenia,” she said. “With that same genetic SNP, we found a lower risk of depression and schizophrenia in women, but a higher risk in the men. “And what was even more exciting was that the pathways that were implicated - vascular pathways and immune pathways - fit with what has been found and mapped by neurobiology,” Goldstein said. In their studies of the shared abnormal changes between the brain and heart, Goldstein and her team found schizophrenia has a high comorbidity with cardiovascular disease. “I was thrilled to see we actually found these genes with shared sex differences in areas that we’ve been studying,” she said. Why this matters Though these differences are small, they can have implications for how treatment can be tailored to different patients. Gendered differences in the presentation and effectiveness of treatments have been previously identified in other diseases including cardiovascular disease and lung cancer. “There are real-life consequences if we do not develop sex-dependent therapeutics, and I think it is critical for precision medicine,” she said.

Mind

Are you a maladaptive daydreamer?

Most people daydream and can spend a lot of time doing it, with <a href="https://science.sciencemag.org/content/330/6006/932">research suggesting</a> that as adults, we spend over 50 percent of our time conjuring up fantasies in our heads. Some people can even experience daydreams that are so vivid they can feel like they are in the imaginary environment of their creation. Though this is a commonplace ability, depending on the severity, frequency and other factors, some daydreamers may be experiencing a psychiatric condition called maladaptive daydreaming, or MD. Maladaptive daydreamers will feel compelled to switch to daydreams during the day, leading experts to believe it is a behavioural addiction much like any other. Since it is still an evolving area of research, it is yet to be formally recognised as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">DSM-5</a>. But, some experts believe it is a real disorder that can have a significant effect on a person’s daily life. What is maladaptive daydreaming? Though daydreams are a common and enjoyable experience, when the daydreaming interferes with a person’s social, academic, or professional life this is considered to be maladaptive, especially when human interactions are replaced with fantasy. However, maladaptive daydreamers also usually know that their daydreams are not reality and are still in touch with the real world in some way. Why does it occur? Though experts are unsure what causes MD, Professor Eli Somer, who <a href="https://www.haifa.ac.il/index.php/en/2012-12-16-11-30-12/new-media/1754-our-researchers-discovered-a-new-psychological-disorder-maladaptive-daydreaming.html#:~:text=Our%20Researchers%20Discovered%20a%20New%20Psychological%20Disorder%3A%20Maladaptive%20Daydreaming,-A%20new%20psychological&text=%E2%80%9CDaydreaming%20usually%20starts%20as%20a,it%20takes%20over%20their%20lives.">first defined the phenomenon in 2002</a>, believed that it develops as a result of trauma, abuse or loneliness, acting as a coping mechanism that a person could use to escape from their reality. In his study, Somer identified six survivors of sexual assault who would regularly escape into an imaginary world they created and would fantasize about themselves in empowering storylines that were missing in their real lives. Symptoms In a 2011 review by Cynthia Schupak and Jayne Bigelson that <a href="https://pubmed.ncbi.nlm.nih.gov/21959201/">studied 90 self-identifying maladaptive daydreamers who fantasize excessively</a>, they found several common behaviours. The researchers found that 79 percent of subjects reported physically engaging with their fantasies, such as making faces or performing repetitive movements while daydreaming. They also found that participants struggled against the compulsion to daydream and were concerned that their fantasies interfered with their real-life relationships. Additional symptoms can include: <ul> <li style="font-weight: 400;" aria-level="1">Extremely vivid daydreams with an evolving or complex story, characters and other detailed story-like features</li> <li style="font-weight: 400;" aria-level="1">Daydreams triggered by real-life events</li> <li style="font-weight: 400;" aria-level="1">Daydreaming for lengthy periods, from many minutes to hours</li> </ul> Can I be diagnosed with maladaptive daydreaming? Since it is not currently recognised by the DSM, you cannot be formally diagnosed with maladaptive daydreaming. Experts have developed a diagnostic tool called the <a href="https://ars.els-cdn.com/content/image/1-s2.0-S1053810015300611-mmc1.doc">Maladaptive Daydreaming Scale (MDS)</a> to help people determine whether they are experiencing symptoms of it. But, this should be treated as an indication rather than a formal diagnosis. Can maladaptive daydreaming be treated? There is no official treatment for MD. <a href="https://www.ncbi.nlm.nih.gov/pubmed/19062309">One study</a> found that fluvoxamine, a common treatment for OCD, was effective in helping an individual control her daydreams. Experts believe cognitive behavioural therapy could help people manage their daily life and address their need to daydream. “Maladaptive daydreaming still isn’t an officially recognized condition, but it’s clear that people around the world are experiencing the same symptoms: the hypnotic movements, the plots and characters, and the crippling inability to focus on the real world. As a researcher, I hope to find out much more about this condition and help the medical profession learn to address it,” Bigelsen said.

Mind

5 signs you have body dysmorphic disorder

Signs of BDD 1. Your idea of a “flaw” isn’t realistic. The Diagnostic Manual differentiates between people who are actually obese and are worried or struggling with that, and BDD. With BDD you are concentrating on minute imperfections that are normal aspects of being human, rather than actual body issues that are visible to others. Samantha DeCaro, an assistant clinical director at an eating disorder clinic, says BDD is a fixation on “perceived” flaws. “These flaws are not detectable, or they are barely noticeable, to anyone else,” she says. “People with BDD commonly become obsessed with real or imagined imperfections on their face, their hair, or the size and shape of a particular body part.” 2. You avoid social situations Ever cancelled an event because you can’t find something that makes you look skinny enough to go out? This is a concerning sign that can indicate BDD. Psychotherapist Haley Neidich, a social worker with an online private practice, says those with BDD may “isolate themselves and avoid social situations.” Rosenbaum says the major distinction that helps her diagnose BDD is identifying “how much does this interfere with [a patient’s] life?” “How much of my thinking time does this take? Does my focus on my body keep me from doing things I enjoy, like going out with my friends?” All of these can indicate that you are moving from body dissatisfaction to a more concerning, obsessive disorder. 3. You spend a lot of time staring in the mirror When bodybuilder Greeley finally reached her lowest point and reached out to a therapist, she was diagnosed with BDD, as well as bulimia. “When you are in that world staring in the mirror taking thousands of [progression] photos for coaches, I’d say ‘I can’t see my abs, Oh God,’” she says. Greeley would spend hours “stalking” other people’s Instagram accounts, comparing her body to theirs. “I felt not skinny enough. It became sick and obsessive,” she says. 4. You can’t stand your face Rosenbaum says the pandemic has worsened BDD for many people who are sitting on Zoom calls for hours, staring at their own reflection. She jokes that even she has never “checked her hair” this much. “People are staring at their distorted image all day. For most of us, we are bodies from the chest up. We don’t even have bodies,” Rosenbaum explains. This unreasonable amount of time we can now spend staring at our own features is exacerbating the problem. It’s being called the “Zoom Boom” as plastic surgeons see more patients considering plastic surgery in 2020. DeCaro says we are living in a society obsessed with “fatphobia and ageism,” which causes everyone to be critical of their bodies from time to time, but those with BDD can be constantly concerned with “real or imagined imperfections on their face” or other body parts. 5. You see your body as parts, not a whole healthy being Finding yourself hating a specific body part? This can be one of the difficulties of BDD, as piecing out the body causes us to hyper analyse the flaws of each part, rather than looking at the body as a whole being, Rosenbaum explains. One of the strategies she’s found helpful with patients is helping them to see their bodies as a whole being that serves a function, and to focus on what your body can do. “Appreciate what your body does for you. Every aspect of your body. Learn to appreciate what it does and how it serves you so well… so we need to feed our bodies with fuel to give us energy so our brains work. So we can walk and love and engage in everything our bodies do. Often [people with BDD] only focus on the surface,” Rosenbaum says. That deep dive into our perspective on our bodies, and focus on the importance of certain parts being perfect, is what BDD patients work on in therapy. What to do if you think you have BDD First, determine the severity of the symptoms. Often BDD happens in conjunction with an eating disorder, which can be more dangerous than BDD by itself. Neidich says individuals with BDD are known to pursue or complete medical procedures in order to change their bodies in an effort to rid themselves of the obsession, which can be dangerous. “Given the high prevalence of disordered eating among individuals with BDD, it is important to point out that eating disorders are the most deadly mental health disorder,” she says. Behaviours Rosenbaum says can be more severe including binging and purging, restricting kilojoules, over-exercising, and other typical eating disorder symptoms. Seeking therapy is an important step towards overcoming BDD, and is a great place to start. Next steps People with co-morbid personality disorders may be referred to dialectical behaviour therapy (DBT) treatment, a type of cognitive behaviour therapy that helps teach skills to handle negative emotions. Those with co-morbid post-traumatic stress disorder (PTSD) may be referred to a trauma therapist. Anyone with obsessive-compulsive disorder (OCD) may be referred to a specialist for cognitive behaviour therapy (CBT) combined with Exposure and Response Prevention, a type of therapy that exposes people to their fears. Those with co-morbid substance use disorders will be encouraged to attend 12-step programs and focus on sobriety. Individuals with eating disorders should have a multidisciplinary treatment team. “Just like other mental health conditions, it is possible for people to reach a place in their recovery where they are no longer symptomatic (or minimally so),” Neidich says. “However, individuals with a history of BDD are at a high risk for a recurrence of the symptoms or other mental health conditions in the future, particularly around a time of transition or intense stress in their lives,” she explains. Greeley is finally able to manage, after years of therapy. She says you don’t just wake up and not have BDD anymore, and that sometimes she still has to check herself: “It’s OK to have one Oreo. You can have a cheeseburger and it won’t be the end of the world,” she says. She credits her care team’s support with helping her “learn to love herself all over again.” Written by Alex Frost. This article first appeared in <a href="https://www.readersdigest.com.au/healthsmart/what-is-body-dysmorphia-5-signs-you-have-body-dysmorphic-disorder">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.innovations.com.au/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRA93V">here’s our best subscription offer.</a>

Body

Why people with anxiety and other mood disorders struggle to manage their emotions

Regulating our emotions is something we all do, every day of our lives. This psychological process means that we can manage how we feel and express emotions in the face of whatever situation may arise. But some people cannot regulate their emotions effectively, and so experience difficult and intense feelings, often partaking in behaviours such as <a href="https://onlinelibrary.wiley.com/doi/full/10.1348/014466508X386027">self-harm</a>, <a href="https://www.tandfonline.com/doi/abs/10.3109/00952990.2013.877920">using alcohol</a>, and <a href="https://theconversation.com/how-difficulty-in-identifying-emotions-could-be-affecting-your-weight-105917">over-eating</a> to try to escape them. There are several strategies that <a href="https://theconversation.com/emotions-how-humans-regulate-them-and-why-some-people-cant-104713">we use to regulate emotions</a> – for example, reappraisal (changing how you feel about something) and attentional deployment (redirecting your attention away from something). Underlying <a href="https://tu-dresden.de/mn/psychologie/ifap/allgpsy/ressourcen/dateien/lehre/pruefungsliteratur_KN_2013/Ochsner-Gross-2005.pdf?lang=en">neural systems</a> in the brain’s prefrontal cortex are responsible for these strategies. However, dysfunction of these neural mechanisms can mean that a person is unable to manage their emotions effectively. <a href="http://psycnet.apa.org/record/2013-44085-004">Emotion dysregulation</a> does not simply occur when the brain neglects to use regulation strategies. It includes unsuccessful attempts by the brain to reduce unwanted emotions, as well as the counterproductive use of strategies that have a cost that outweighs the short term benefits of easing an intense emotion. For example, avoiding anxiety by not opening bills might make someone feel better in the short term, but comes with the long-term cost of ever increasing charges. These unsuccessful attempts at regulation and counterproductive use of strategies are a core feature of many <a href="https://journals.lww.com/co-psychiatry/Abstract/2012/03000/Emotion_regulation_and_mental_health___recent.11.aspx">mental health conditions</a>, including anxiety and mood disorders. But there is not one simple pathway that causes the dysregulation in these conditions. In fact research has found several causes. <h2>1. Dysfunctional neural systems</h2> In anxiety disorders, dysfunction of the brain’s emotional systems is related to emotional responses being of a much higher intensity than usual, along with an increased <a href="http://people.socsci.tau.ac.il/mu/anxietytrauma/files/2014/04/Pergamin-Height-et-al-2015-CPR.pdf">perception of threat</a> and a negative view of the world. These characteristics influence how effective emotion regulation strategies are, and result in an over-reliance on maladaptive strategies like avoiding or trying to suppress emotions. In the brains of those with anxiety disorders, the system supporting the reappraisal does not work as effectively. Parts of the prefrontal cortex show <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210184">less activation</a> when this strategy is used, compared to non-anxious people. In fact, the higher the levels of anxiety symptoms, the less activation is seen in these brain areas. This means that the more intense the symptoms, the less they are able to reappraise. <iframe width="440" height="260" src="https://www.youtube.com/embed/iALfvFpcItE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe> Similarly, those with <a href="https://www.researchgate.net/profile/David_Mohr3/publication/308172676_Major_depressive_disorder/links/59ce9dfaaca2721f434efc3d/Major-depressive-disorder.pdf">major depressive disorder (MDD)</a> – the inability to regulate or repair emotions, resulting in prolonged episodes of low mood – struggle to use <a href="http://sites.oxy.edu/clint/physio/article/EmotionRegulationinDepressionTheRoleofBiasedCognitionandReducedCognitiveControlClinicalPsychologicalScience-2014-Joormann.pdf">cognitive control</a> to manage negative emotions and decrease emotional intensity. This is due to <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2203837">neurobiological differences</a>, such as decreased <a href="https://www.sciencedirect.com/science/article/pii/S1053811910011857">density of grey matter</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S0006322301013361">reduced volume</a> in the brain’s prefrontal cortex. During emotion regulation tasks, people who have depression show less <a href="http://www.jneurosci.org/content/jneuro/27/33/8877.full.pdf">brain activation</a> and metabolism in this area. People with MDD sometimes show less effective function in the brain’s motivation systems – a network of neural connections from the <a href="https://www.sciencenewsforstudents.org/blog/scientists-say/scientists-say-ventral-striatum">ventral striatum</a>, located in the middle of the brain, and prefrontal cortex – too. This might explain their difficulty in regulating positive emotions (known as <a href="https://www.pnas.org/content/pnas/106/52/22445.full.pdf">anhedonia</a>) leading to a lack of pleasure and motivation for life. <h2>2. Less effective strategies</h2> There is little doubt that people have different abilities in using different regulation strategies. But for some they simply don’t work as well. It’s possible that people with anxiety disorders find reappraisal a <a href="https://s3.amazonaws.com/academia.edu.documents/43509779/Emotional_reactivity_and_cognitive_regul20160308-6583-1i7qqg3.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1544177061&Signature=wG2kJQEWhjSupMVDCGjIjeImecI%3D&response-content-disposition=inline%3B%20filename%3DEmotional_reactivity_and_cognitive_regul.pdf">less effective</a> strategy because their <a href="https://www.researchgate.net/profile/Dominique_Lamy/publication/6598643_Threat-related_attentional_bias_in_anxious_and_nonanxious_individuals_a_meta-analytic_study_Meta-Analysis_Research_Support_Non-US_Gov%27t/links/02bfe510acc10b0e3d000000/Threat-related-attentional-bias-in-anxious-and-nonanxious-individuals-a-meta-analytic-study-Meta-Analysis-Research-Support-Non-US-Govt.pdf">attentional bias</a> means they involuntarily pay more attention towards negative and threatening information. This can stop them from being able to come up with more positive meanings for a situation – a key aspect of reappraisal. It’s possible that reappraisal doesn’t work as well for people with mood disorders either. <a href="https://www.researchgate.net/profile/Lauren_Hallion/publication/51466532_A_Meta-Analysis_of_the_Effect_of_Cognitive_Bias_Modification_on_Anxiety_and_Depression/links/5642034608aeacfd8937f221/A-Meta-Analysis-of-the-Effect-of-Cognitive-Bias-Modification-on-Anxiety-and-Depression.pdf">Cognitive biases</a> can lead people with MDD to interpret situations as being more negative, and make it difficult to think more positive thoughts. <h2>3. Maladaptive strategies</h2> Although maladaptive strategies might make people feel better in the short term they come with long term costs of maintaining anxiety and mood disorders. Anxious people rely more on maladaptive strategies like <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.463.83&rep=rep1&type=pdf">suppression</a> (trying to inhibit or hide emotional responses), and less on adaptive strategies like reappraisal. Though research into this is ongoing, it’s thought that during <a href="https://academic.oup.com/scan/article/10/10/1329/1647887">intense emotional experiences</a> these people find it very difficult to disengage – a necessary first step in reappraisal – so they turn to maladaptaive suppression instead. The use of maladaptive strategies like suppression and <a href="https://www.sciencedirect.com/science/article/pii/S0272735809000907">rumination</a> (where people have repetitive negative and self-depreciating thoughts) is also a common feature of MDD. These, together with <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/bjc.12210">difficulties using adaptive strategies</a> like reappraisal, prolong and exacerbate depressed mood. It means that people who have MDD are even less able to use reappraisal during a depressed episode. It’s important to note that mood disorders don’t just come from neural abnormalities. The research suggests that a combination of brain physiology, psychological and environmental factors are what contributes to the disorders, and their maintenance. While researchers are pursing promising <a href="https://s3.amazonaws.com/academia.edu.documents/45245021/DA_Emotion_Dysregulation.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1544123102&Signature=CuwEuqpH%2B4c78EoNxnkA1i7gGmU%3D&response-content-disposition=inline%3B%20filename%3DEMOTION_DYSREGULATION_MODEL_OF_MOOD_AND.pdf">new treatments</a>, simple actions can help people loosen the influence of negative thoughts and emotions on mood. <a href="https://www.researchgate.net/profile/Tayyab_Rashid2/publication/299155510_Rashid_T_2015_Positive_Psychotherapy_A_Strengths-Based_Approach/links/570951f408aed09e916f9518.pdf">Positive activities</a> like expressing gratitude, sharing kindness, and reflecting on character strengths really do help.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/106865/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/leanne-rowlands-408353">Leanne Rowlands</a>, PhD Researcher in Neuropsychology, <a href="http://theconversation.com/institutions/bangor-university-1221">Bangor University</a> This article is republished from <a href="http://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-people-with-anxiety-and-other-mood-disorders-struggle-to-manage-their-emotions-106865">original article</a>.

Mind

Feeling down: When does a mood become a disorder?

We’ve all felt sad, anxious or down at one time or another, but where does the normal experience of emotion end and the clinical picture of a mood or anxiety disorder begin? Psychiatry has two widely used classificatory systems that provide definitions of “clinical” states of such emotions as differentiated from “normal” states – the World Health Organisation’s <a href="https://theconversation.com/two-visions-for-understanding-illness-dsm-and-the-international-classification-of-diseases-14167">International Classification of Diseases</a> and the American Psychiatric Association’s <a href="https://theconversation.com/explainer-what-is-the-dsm-14127">Diagnostic and Statistical Manual</a> (DSM). The boundaries are not absolute and, in recent decades, the DSM in particular has been criticised for expanding the boundary of clinical states into essentially normal domains. <h2>Degrees of depression</h2> Clinical depression is distinguished in such diagnostic manuals by a number of parameters including severity, duration, persistence, and recurrence. More severe depressive disorders are accompanied by the individual experiencing gravid depressive symptoms (such as suicidal preoccupations), by distinct impairment (such that it prevents them from going to work) and lasting more than two weeks. Although severity is an important thing to consider in depression, we prefer to distinguish by depression type, not just severity. Depressive disorders can be divided into two types – melancholic and non-melancholic conditions. The latter is a diverse group that could reflect the contribution of severe life events, such as being humiliated by a partner or a personality style that predisposes someone to depression. Such personality styles include being an anxious worrier, sensitive to judgement by others, being a perfectionist, having intrinsically low self-esteem, being profoundly shy or having a low sense of self-worth since childhood. In contrast, melancholic depression is better positioned as a disease, having rather specific clinical features, a strong genetic contribution, biological underpinnings and responding only partially to counselling or psychotherapy but well to antidepressant drugs. During melancholic depressive states, the individual lacks energy, experiences little pleasure in life, is physically slowed down, and tends to feel much worse in the morning. Extremely severe melancholic depression may even include psychosis, though importantly this is normally very responsive to appropriate medical treatment. <h2>Bipolar disorders</h2> The bipolar disorders are also better positioned as “diseases”. We now distinguish bipolar I (previously manic depressive illness) and bipolar II conditions – by the extremity of the highs. While both bipolar I and bipolar II are characterised by swings from high to low moods, in bipolar I the highs (mania) are more extreme and can include psychosis or hospitalisation. Highs (hypomania) in bipolar II are less extreme and will never include psychosis or a need for hospitalisation. While it’s normal for everyone to experience periods of happiness in their life, the highs experienced in bipolar are distinctly different. The individual loses day-to-day anxieties, feels bulletproof or invulnerable, is excessively talkative, grandiose, creative, needs little sleep without feeling tired, is indiscreet, spends money on things that subsequently cause financial difficulty and may become sexually indiscreet or possibly aggressive. <h2>Anxiety disorders</h2> It’s normal for everyone to feel anxious in a variety of situations. Some people might feel anxious going to a party where they don’t know many people, for instance, or giving a speech. The difference between normal anxiety and an anxiety disorder is when the anxiety is so persistent it stops you doing things you want to, or persists even when all logical reasons to be anxious are absent. Generalised anxiety disorder, for instance, involves chronic worry without a definitive cause and social phobia involves a fear of talking to or being around others. There are many different anxiety disorders, and it can be difficult to distinguish when normal anxiety starts to become a problem. <h2>Awareness and increase</h2> There are two possible reasons why there has been an increase in these conditions. First, more people are willing to talk about their experiences, as the stigma of these conditions is slowly decreasing. And changes to criteria in diagnostic manuals have effectively classified some “normal” states as clinical conditions. But being diagnosed with a mood or anxiety disorder can be a stressful experience itself. The reaction generally depends on how well the person relates to the diagnosis, whether or not the diagnosis was something anticipated and whether or not they expect a diagnosis and adequate treatment will improve their life. The vast majority of conditions can be treated either psychiatrically or psychologically, but finding the right treatment, while ultimately rewarding, can also at times be frustrating. It’s our opinion that Australia is ahead of many other western countries in having destigmatised mood disorders, and the stigma and negative consequences linked to seeking help has reduced considerably. Unfortunately, this doesn’t mean that stigma is completely eradicated. Some employers may take advantage of knowing that an individual has a psychiatric condition. And the declaration of any condition can prevent people obtaining income protection, and even travel insurance. But that shouldn’t stop people from seeking help when they feel their emotional health is at risk.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/14566/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Written by Gordon Parker, Scientia Professor, UNSW and Amelia Paterson, Research Assistant, UNSW. Republished with permission of <a rel="noopener" href="https://theconversation.com/feeling-down-when-does-a-mood-become-a-disorder-14566" target="_blank">The Conversation</a>.

Mind

Why shopping addiction is a real disorder

UK-based healthcare group the Priory is well-known for treating gambling, sex, drug, alcohol and computing addictions – especially of the <a href="https://www.thesun.co.uk/fabulous/7327125/the-priory-celebrity-guests-katie-price-rehab-centre-cost/">rich and famous</a>. Now it has added a new condition to its list: shopping addiction. Research suggests that as many as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13223">one in 20 people</a> in developed countries may suffer from shopping addiction (or compulsive buying disorder, as it’s more formally known), yet it is often not taken seriously. People don’t see the harm in indulging in a bit of “retail therapy” to cheer themselves up when they have had a bad day. Indulging in the occasional bit of frivolous spending is not a bad thing, if it is done in moderation and the person can afford it. But for some people compulsive shopping is a real problem. It takes over their lives and leads to genuine misery. Their urges to shop become uncontrollable and are often impulsive. They end up spending money they don’t have on things they don’t need. The worst part is that compulsive buyers continue to shop regardless of the negative impact it has on them. Their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMc1805733/">mental health gets worse</a>, they get into serious debt, their social network shrinks, and they may even contemplate suicide – but shopping still provides the brief dopamine rush they crave. There is no doubt that people who engage in this behaviour suffer, and often badly. But it is debatable whether compulsive buying disorder is a condition in its own right or a symptom of another condition. Often it is difficult to diagnose because people with compulsive buying disorder have symptoms of other disorders, such as <a href="https://psycnet.apa.org/record/1994-29953-001">eating disorders and substance abuse</a>. Formal criteria needed The most commonly used manuals for diagnosing mental disorders are the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">DSM</a> and <a href="https://icd.who.int/en">ICD</a>, and neither include diagnostic criteria for compulsive buying disorder. One reason may be that there are many theories about what kind of illness the disorder is. It has been likened to <a href="https://psycnet.apa.org/record/1995-01870-001">impulse control disorder</a>, mood disorders, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1987.tb00424.x">addiction</a> and <a href="https://www.sciencedirect.com/science/article/pii/S0005789402800259">obsessive-compulsive disorder</a>. How the disorder ought to be classified is an ongoing debate. What is also an <a href="https://www.macmillanihe.com/page/detail/Consumption-Matters/?K=9780230201170">ongoing debate</a> is what the disorder should be called. To the general public, it’s known as “shopping addiction”, but experts variously call it compulsive buying disorder, oniomania, acquisitive desire and impulse buying. Researchers also struggle to agree on a definition. Perhaps the lack of a clear definition stems from the fact that research shows that no single factor is sufficiently powerful to explain the causes of this compulsive behaviour. What most experts seem to agree on is that people with this condition find it difficult to stop and that it results in harm, showing that it is an involuntary and destructive kind of behaviour. People with the condition often try to hide it from friends and partners as they feel shame, thereby alienating themselves from the people who are best placed to support them. Although the disorder has not yet been clearly defined by name, symptoms or even category of mental health problem, most researchers agree on one thing: it is a real condition that people truly suffer from. The fact that the Priory, a well-established healthcare group, is treating people with compulsive buying disorder, may help to raise awareness of the condition. Hopefully, this will result in more research being conducted to help define diagnostic criteria. Without the criteria, it will be difficult for healthcare professionals to diagnose the illness and treat it. This is a condition that is crying out to be properly recognised and should not be trivialised.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/123813/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Written by Cathrine Jansson-Boyd, Reader in Consumer Psychology, Anglia Ruskin University. Republished with permission of <a rel="noopener" href="https://theconversation.com/shopping-addiction-is-a-real-disorder-123813" target="_blank">The Conversation</a>.

Retirement Income

The most common genetic kidney disorder you've probably never heard of

Autosomal-dominant polycystic kidney disease (<a href="https://pkdaustralia.org/adpkd/">ADPKD</a>) is the most common genetic kidney disorder, and the <a href="https://www.anzdata.org.au/report/anzdata-41st-annual-report-2018-anzdata/">fourth most common</a> cause of kidney failure in Australian adults. It affects about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">one in 1,000 Australians</a>. In people with ADPKD, a mutation in one or two genes leads to the development and progressive growth of cysts in the kidneys, causing a decline in kidney function. Labor senator Malarndirri McCarthy, a Yanyuwa woman, recently spoke publicly about having ADPKD after <a href="https://www.smh.com.au/politics/federal/senator-reveals-kidney-disease-that-saw-her-leave-question-time-for-hospital-20190802-p52d8w.html">she became unwell</a> with a kidney infection and had to leave the Senate. But a newly available treatment for ADPKD shows promise for people with the disease.<a href="http://theconversation.com/explainer-what-is-chronic-kidney-disease-and-why-are-one-in-three-at-risk-of-this-silent-killer-81942"></a> What is ADPKD? If one parent has ADPKD, the children have a 50 per cent chance of inheriting the gene (though <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">up to 10 per cent</a> of patients don’t have a family history). Where it is inherited, the age of diagnosis and rate of progression to kidney failure in the parent gives some indication of how the disease will develop in affected children. The cysts are like balloons filled with water, which start small in childhood and increase in size over time. Typically, the cysts don’t start to cause problems until later in life. The average age at diagnosis is <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1402685">27 years</a>. As the cysts grow, normal working tissue in the kidney is replaced with enlarging cysts. So with time, the kidneys don’t work as well. For about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">half of people with ADPKD</a>, their condition will eventually progress to kidney failure, which may be treated with dialysis or a transplant. While the loss of kidney function is paramount, the cysts may cause other symptoms and complications too. Symptoms can include high blood pressure and chronic pain or heaviness in the back, sides and abdomen. The growth of cysts means the kidneys can grow to as large as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2007.07229.x">5-6kg in size</a>. Blood in the urine, urinary tract infections, kidney stones and infections in the cysts are not uncommon in people with ADKPD, and can all impact quality of life. Other organs may also be affected. People with ADPKD can develop cysts in the liver, pancreas and bowel, and about 10 per cent will experience balloon dilations of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26260542">blood vessels in the brain</a>, called aneurysms. Treatment Until recently, treatment of ADPKD was directed towards early detection, control of blood pressure, lifestyle measures such as quitting smoking, weight control and diet, antibiotics for infections, analgesics for pain and the management of progressive kidney dysfunction via dialysis and transplantation. None of these therapies however directly slowed the growth of cysts. But on January 1, 2019, tolvaptan <a href="https://pkdaustralia.org/news/">was listed</a> on the Pharmaceutical Benefits Scheme. Australia now joins the United States, the European Union, and several other countries where this drug was already available. Tolvaptan, which is taken in tablet form, slows the growth of cysts by <a href="https://www.ncbi.nlm.nih.gov/pubmed/28379536">blocking a hormone called vasopressin</a>. Vasopressin is critical in triggering the formation of cysts. In this way, tolvaptan prolongs the time to kidney failure. In one study, three years of treatment with tolvaptan <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1205511">reduced the rate of cyst growth</a> by around 50 per cent in comparison to a placebo treatment. The authors suggested tolvaptan may delay dialysis or the need for a transplant for six to nine years for patients with ADPKD, particularly if started early. People who took tolvaptan in this study also had lower incidence of ADPKD-related complications including urinary tract infections and kidney pain. Kidney disease and Indigenous Australians ADPKD is not actually more common in Aboriginal and Torres Strait Islander communities, as other causes of <a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Diabetes_and_kidney_disease/Kidney/">chronic kidney disease</a> are. This may be because ADPKD is inherited. The majority of chronic kidney disease develops as a complication of diabetes, which affects Aboriginal and Torres Strait Islander populations more commonly and typically <a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Diabetes_and_kidney_disease/Diabetes/">at a younger age</a> than the overall Australian population. Kidney disease, whatever the cause, remains a significant issue for Aboriginal and Torres Strait Islander communities. People in remote Indigenous communities in particular face challenges around accessing treatments in large urban centres, and have poorer access to organ transplants. There are several nationally targeted activities and proposals aimed at reducing the burden of chronic kidney disease in Indigenous Australians. The <a href="https://www.menzies.edu.au/icms_docs/281923_Roundtable_Towards_Roadmap_For_Renal_Health_-_Media_Release.pdf">Renal Health RoadMap</a> is designed to support health systems in early detection and management of diabetes and chronic kidney disease. It also seeks to address the social determinants of poor health in Indigenous communities, including housing quality and availability, and health infrastructure. In 2018, Minister for Indigenous Australians Ken Wyatt commissioned <a href="https://www.tsanz.com.au/TSANZ%20Performance%20Report%20-%20Improving%20Indigenous%20Transplant%20Outcomes%20(Final%20edited)-1.pdf">a report</a> detailing how access to and outcomes of kidney transplants could be improved among Indigenous Australians. He also established a <a href="https://www.anzdata.org.au/anzdata/for-information-2/tsanz/">National Indigenous Kidney Transplantation Taskforce</a> to implement the recommendations from this report. Some key recommendations include improving the communication between health-care teams, patients and their families, addressing cultural bias in the delivery of health care, and improving the quality of data around transplant access and outcomes. Addressing transplant and treatment inequities will benefit Indigenous Australians with kidney failure sustained from ADPKD and chronic kidney disease more broadly. Written by Karen Dwyer, Deputy Head, School of Medicine, Deakin University and Jaquelyne Hughes, Senior Research Fellow, Menzies School of Health Research. Republished with permission of <a rel="noopener" href="https://theconversation.com/polycystic-kidney-disease-the-most-common-genetic-kidney-disorder-youve-probably-never-heard-of-121441" target="_blank">The Conversation</a>.

Body

Dissociative disorders: What are they and why haven’t we heard about them?

Dissociative disorders are often said to be <a href="http://www.teachtrauma.com/controversial-topics-trauma/myths-media-portrayals-dissociative-identity-disorder/">rare</a>. But our soon-to-be published analysis of <a href="https://www.researchgate.net/publication/334625332">international studies</a> suggest they affect 10-11% of the population at some point in their lives. This makes them nearly as common as <a href="https://journals.sagepub.com/doi/abs/10.1177/070674370404900208">mood disorders</a> (such as clinical depression). So what are dissociative disorders, why is diagnosis controversial and how can people be treated? What is dissociation? Dissociation occurs when a person experiences being disconnected from themselves, including their memories, feelings, actions, thoughts, body and even their identity. People with dissociative disorders have one or more of the following <a href="https://psycnet.apa.org/record/1995-98841-000">symptoms</a>: <ul> <li>amnesia and other memory problems</li> <li>a sense of detachment or disconnection from their self, familiar people or surroundings</li> <li>an inner struggle about their sense of self and identity</li> <li>acting like a different person (identity alteration).</li> </ul> For some people, symptoms can last days or weeks, but for others they can persist for months, years, or a lifetime. Dissociation allows the person to compartmentalise and disconnect from aspects of traumatic and challenging experiences that could otherwise overwhelm their capacity to cope. A person whose spouse has died may become emotionally numb, allowing them to focus on arranging the funeral; a man who has separated from his wife and lost his job soon afterwards may become so disconnected from his identity that he no longer recognises himself in the mirror and feels his life is happening to someone else; and a young woman who is sexually assaulted may remember her attacker moving too quickly towards her, recalls being safely back in her family home, but cannot remember the assault. If the traumatic and overwhelming experiences happen repeatedly over a long period of time, the person’s <a href="https://books.wwnorton.com/books/detail.aspx?id=9227">personality may become fragmented</a>. The traumatised part of the personality that contains the emotions, thoughts, sensations and experiences relating to the trauma becomes separated from the part of the personality that is trying to get on with daily life. This <a href="http://www.hup.harvard.edu/catalog.php?isbn=9780674068063&content=reviews">allows young children to be with frightening and abusive caregivers</a> they can neither fight nor flee from as they are dependent on them. The person may have no (or only some) conscious awareness of the compartmentalised memories, thoughts, feelings and experiences. These may, however, intrude into the person’s awareness. For example, the person may be aware of thoughts, feelings and internal voices that don’t “belong” to them, or may speak or act in ways that are completely out of character. The most extreme form of structural dissociation is <a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">dissociative identity disorder</a>, once known as multiple personality disorder. This is where the person has at least two separate personalities that exist independently of one another and that emerge at different times. These personality differences are not just psychological. <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/aiding-the-diagnosis-of-dissociative-identity-disorder-pattern-recognition-study-of-brain-biomarkers/DCF85A7D69652C06E61524593B266E8C">Neuroimaging confirms structural differences</a> in the brains of people with dissociative identity disorder. A controversial diagnosis There are two competing theories about what causes dissociation: trauma and fantasy. With the <a href="https://psycnet.apa.org/record/2012-06384-001">trauma model</a>, dissociative symptoms arise from physical, sexual and emotional abuse; neglect, particularly in childhood; attachment problems if a child fears the caregiver or the caregiver is not adequately attuned to the child’s emotional or safety needs; and other severe stress or trauma, such as experiencing or witnessing domestic violence. This trauma model is reflected in the <a href="https://icd.who.int/en/">World Health Organisation</a> and <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">American Psychiatric Association</a> past and present diagnostic criteria. However, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24773505">fantasy model</a> is based on the idea that dissociative disorders are not “real”. Instead, they are the delusion of people who are troubled (and often traumatised), suggestible, fantasy-prone and sleep-deprived. Fantasy model theorist <a href="https://www.cambridge.org/core/journals/bjpsych-advances/article/dissociative-identity-disorder-validity-and-use-in-the-criminal-justice-system/C1C27EE9731782570E1376A3EDA48CE4">Joel Paris</a> describes dissociative disorders as a North American “fad” that has nearly died out. Yet <a href="https://www.researchgate.net/publication/334625332">my analysis of 98 studies</a> found rates are not declining. In fact, I found dissociation is an international phenomenon far more common in countries that are comparatively unsafe. This is supported by other research which finds dissociation more common in people that have experienced trauma, such as <a href="https://www.tandfonline.com/doi/abs/10.3109/08039488.2014.977344?src=recsys&journalCode=ipsc20">refugees</a>. All up, the evidence indicates dissociative disorders are real (not imagined) and caused by trauma (not fantasy). Dissociative disorders are under-diagnosed and misdiagnosed Even though there are accurate ways of diagnosing dissociative disorders, most people will <a href="https://www.routledge.com/Humanising-Mental-Health-Care-in-Australia-A-Guide-to-Trauma-informed/Benjamin-Haliburn-King/p/book/9780367076603">never be diagnosed</a>. This is due to the lack of health professional education and training about dissociation, the symptoms being less obvious to observers, and scepticism that the disorder even exists. The person also may not realise they have dissociative symptoms. Even if they do, they may not reveal them due to fear or embarrassment, or may find them difficult to put into words. At least <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/assessment-of-the-prevalence-of-psychiatric-disorder-in-young-adults/5673B18071E22D850EF4E5F3241763FB">three-quarters of people with a dissociative disorder</a> will also have one or more other mental disorders. <a href="https://www.routledge.com/Humanising-Mental-Health-Care-in-Australia-A-Guide-to-Trauma-informed/Benjamin-Haliburn-King/p/book/9780367076603">They may be diagnosed with and treated for other mental health difficulties</a>, such as post-traumatic stress disorder, mood disorders, anxiety disorders, sleep disorders, borderline personality disorder, or psychosis. They may also be treated for addictions, self-harm, and/or suicidal thoughts (<a href="https://www.ncbi.nlm.nih.gov/pubmed/18195639">2% of those diagnosed complete suicide</a>). They may also be misdiagnosed with schizophrenia because <a href="https://www.ncbi.nlm.nih.gov/pubmed/27209638">hearing voices is common to both</a>. But their dissociative disorder usually remains undiagnosed. However, treatment for other mental health issues is not likely to be effective unless the underlying dissociation is addressed. How to treat? What does the evidence say works? The mental health and quality of life of people with a dissociative disorder <a href="https://psycnet.apa.org/record/2012-08580-001">improves </a>significantly with psychotherapy (a type of talk therapy) that recognises the impact of trauma <a href="https://besselvanderkolk.net/the-body-keeps-the-score.html">is physiological</a> (affecting the brain and body) as well as psychological. In therapy consistent with international treatment <a href="https://www.tandfonline.com/doi/abs/10.1080/15299732.2011.537247">guidelines</a>, people can learn skills to cope with unbearable emotions, thoughts and physical sensations. Once people are stable and have constructive coping strategies, therapists can then help people process traumatic and dissociated memories. Dissociative, post-traumatic, and depressive <a href="https://psycnet.apa.org/record/2012-08580-001">symptoms improve</a>. And hospitalisations, self-harm, drug use, and physical pain declines. There is no medication that specifically treats dissociation. Where to get help Dissociative disorders are one of the most common, yet most unrecognised, mental disorders. Symptoms are often debilitating, but significant improvements are possible if the dissociation is diagnosed and treated correctly. If you are concerned, you can speak to your GP and ask for a referral to a therapist knowledgeable about trauma and dissociation. A list of therapists with this expertise in Australia is available from the <a href="https://www.blueknot.org.au/Helpline">Blue Knot Foundation</a> and worldwide from the <a href="https://isstd.connectedcommunity.org/network/network-find-a-professional">International Society for the Study of Trauma and Dissociation</a>. Written by Mary-Anne Kate. Republished with permission of <a href="https://theconversation.com/dissociative-disorders-are-nearly-as-common-as-depression-so-why-havent-we-heard-about-them-116731">The Conversation</a>.

Body

How this rare sleep disorder forced a woman into debt

A UK mum has spoken out about a rare medical condition that resulted in a huge online shopping bill – all while she was sound asleep. Kelly Knipes, from Essex in England first discovered that something was wrong seven years ago, a little while after her first child was born. Speaking to <a href="https://www.mirror.co.uk/">The Mirror</a>, the 37-year-old said that every morning after she would wake up, she would find receipts for items that she had no recollection of purchasing. Now, years later, she believes she has spent over $A5,571 including hundreds of dollars on lollies, cookie jars costing $A107 and also a “full-size plastic basketball court” that was delivered to her home in a truck. “I bought a full-size basketball court from eBay, and when it turned up at my house the next day, I just refused delivery,” she said. “I would never actually have to put any credit card details when I was buying things online because it was all saved on my phone. “It was all on my phone, and everything that is on my phone is accessible by touch. I was racking up debt everywhere.” According to Ms Knipes, the transactions were made through her phone, which had her credit card details already saved. She was later forced to return the items to avoid falling into debt. Her condition, otherwise known as parasomnia, is a disorder caused by sleep apnoea – a dangerous condition that causes the person affected to stop breathing while they’re sleeping. The symptoms are similar to sleepwalking, which Ms Knipes was known to do as a child. And while shopping seems to not be the worst thing in the world, Ms Knipes has also overdosed on diabetes medication during her pregnancy due to the disorder. “I was having a dream that I was speaking to the doctors, and I kept saying that I didn’t want to take the medicine anymore — but when I woke up, I had taken all the tablets,” she told The Mirror. “Luckily everything was OK — but I was so worried that social services would get involved.” Countless doctors’ appointments later, she finally found the solution by using a continuous positive airway pressure (CPAP) device during the night, which helps her breathe while she sleeps. “When I had the CPAP machine, I felt rested and re-energised for the first time in ages,” she said. “It really has given me my life back. “Since starting CPAP, I have not had any abnormal sleep behaviours, have not shopped online at night, my headaches have ceased, and I am not depressed.” Ms Knipes is now opening up about her journey to raise awareness and help those who are currently facing the same issue.

Body

Sarah Harris reveals her husband Tom Ward suffers from neurological disorder

Sarah Harris has opened up about her husband Tom Ward's lifelong struggle with narcolepsy. The Studio 10 host revealed her husband’s neurological disorder on last night’s comedy show Hughesy, We Have A Problem. Although chronic sleep disorders are no laughter matter, the mum-of-two was happy to share an amusing anecdote about her husband’s narcolepsy. “My husband's actually a narcoleptic,” Sarah revealed, before going on to tell the true story of his forgettable helicopter flight over Las Vegas “Before they'd taken off, Tom had fallen asleep – so he'd paid $500 to see the sights of Las Vegas, landed and went: ‘Oh, that was a great sleep!’” she said to a laughing panel. “Totally slept through the entire thing.” Host Dave Hughes couldn't resist asking whether narcolepsy “ever affected your love life?” “To my advantage,” Sarah quipped back, “I don't have to fake a headache as much!”

Body

Sarah Duchess of York opens up about her struggle with eating disorders

Sarah, Duchess of York, has opened up about struggling with her addiction to food and how she once wished to be bulimic. The 57-year-old, who has been maliciously dubbed ‘The Duchess of Pork’, made the admission during a podcast with an ayurvedic doctor and naturopath Dr Vijay Murthy. “To wish you could have a mental illness to that level is a very serious place to get to,” she said. “I was a binge-eater. I never could get bulimia because I just didn’t have that mental state to go that far, but I always wished I could.” "But that just shows you how dangerous and what place I got to. To wish you could have a mental illness to that level is a very serious place to get to.” “My body and mind was in that place, but I couldn’t actually act out to make myself sick. I then grew and grew and grew.” Sarah, Prince Andrew’s former wife, revealed that her comparison with her then sister-in-law Princess Diana, made her want to be as “beautiful and thin”. "I tried, but of course it never went that way," she said. The Duchess focused on her recovery during the interview and hoped to be a “human bridge” for others who suffer from eating disorders. She also has plans to start a franchise of kindergartens to teach children around the world about healthy eating and develop a line of nutritional sauces. <img width="498" height="245" src="https://oversixtydev.blob.core.windows.net/media/37963/hero-sarah_498x245.jpg" alt="Hero Sarah"/> Sarah, mother of Princess Eugenie and Princess Beatrice, is expected to be going through an exciting time as speculation increases of her daughter Eugenie’s engagement to her boyfriend of seven years, Jack Brooksbank. Last year, Jack was invited to Queen Elizabeth’s Balmoral estate in Scotland, a positive sign that he’s been accepted by the royal family.

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Why shopping addiction is a real disorder

The most common genetic kidney disorder you've probably never heard of

Dissociative disorders: What are they and why haven’t we heard about them?

How this rare sleep disorder forced a woman into debt

Sarah Harris reveals her husband Tom Ward suffers from neurological disorder

Sarah Duchess of York opens up about her struggle with eating disorders

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