Category Archives: Anxiety Disorder

When you get old…

Anxiety Disorder, Clinical Case Studies, Depression

She usually calls me a few times a week, especially when she first came to see us.

This is a woman in her late 70s. She has 3 daughter, 2 married, one lives in Singapore and another in the UK. She lives with her youngest daughter who is still single. Although she does her best for her mother, her work is usually very busy and occupies most of her time during the week.

This woman has problems getting into sleep, so she used to take alcohol to aid sleeping. Then she had problems with her heart arteries and had to go for coronary angioplasty twice. Since the discharge her physical health deteriorated. She can no longer move around freely like she used to be, take alcohol the way she wanted it, do her daily chores like going to the market, cooking, visiting friends, walking around etc.

She spends most of the time alone in the house, not doing much. She can’t do much work as she feel her limbs have no strength (to even take up a pot filled with water). She isn’t interested in watching TV or reading papers. The elder daughter bought her an iPad and tried to teach her playing games and using Skype to connect with her grandchildren overseas, but she gave up learning half way. What’s worse, now that she isn’t allowed to take alcohol, she couldn’t sleep at all, could only sleep for few hours taking sleeping pills.

She sees no purpose of her life, and thinks very negatively. She can’t see hopes and meaning of her life. Whatever suggestions and advice made to her, she finds excuses to dispute them (symptoms of depression). When I told her how negatively she has been thinking, and all this negativity comes from her illness, not from herself; and when she’s well, she wouldn’t behave, think and feel this way at all, she doesn’t believe it – she sees no “negativity”, she thinks all these feelings and thinking are completely normal, anyone in her shoes would experience the same cognition and emotions.

In some countries the suicidal rates in the elderly are very high, I don’t have the statistics in Malaysia, but I’m sure there’re quite a number of them suffering in silence. Asian cultures place enormous value on filial piety which includes caring for the elderly (especially parents) when they can no longer look after themselves, but still, this is not always possible, so it’s important to have a plan in mind, whether it’s to have a partner with you (not necessary a spouse) and look after each other, to live in the old folks house with the others, or get a private carer.

But while you’re still young, look after your physical and mental health, be prepared for it before you get there, and take good care of your body now so that it’s fit for you to go a long way!

PTSD – MH370 incident

Anxiety Disorder, Clinical Case Studies

He is an engineer who travels a lot for his work, and was supposed to board the MH370 plane. On that very day he wasn’t feeling well so he cancelled the trip and somehow had very fortunately avoided to be one of the victims of the ill-fated aircraft.

Though he didn’t think that way. He didn’t see himself as “very lucky”. His mind keeps playing what happened if he boarded the plane, where he would be right now, and how his family and friends would feel. Everyone keeps telling him how thankful he should be.

But he had to come to see us few weeks later. Because of what’s playing in his mind, causing him so much anxiety and fear, couldn’t sleep, couldn’t work, and of course, couldn’t travel for work.

He has worked for this company for over 20 years, but now the company isn’t understanding of his situation, and would want him to leave if he couldn’t continue to do his work (including travelling around for the projects).

Quite often we thought PTSD attacks people who actually experienced the incident, it is also possible for people who had not experienced it, but merely observed it happen (like some who got PTSD following the 911 incident), or for some who almost experience it!

OCD or Body Dysmorphic Disorder

Anxiety Disorder, Clinical Case Studies, Depression, Obsession & Compulsion

“Why wasn’t I born pretty like some people?”

“What’ve I done in my past life to be born this ugly?”

“How am I going to live with this face?”

“I’m growing older and going to be even uglier. How do I live till then? Can I just kill myself?”

“Why can those people cope with their ugly look and live like nothing happens, but not me?”

This is a defaulted case who now follow up with General Hospital due to financial constraint.

She is in her late 40s, married with two teenage sons, having long standing mood disorder, very preoccupied and worried with her look, thinking about cosmetic surgery. She thinks she’s very, very ugly, and ugly people should kill themselves.

From the outsiders’, she’s actually quite tall and has a reasonably pretty face.

When she walks on the streets and see some women who’re less attractive, she’d be thinking, “how do they live with that look? Why didn’t they just kill themselves?”

She said people teased her. Telling her not to speak to them since she’s so ugly. She can’t bear people’s remarks about her look and appearance.

Her husband and two sons are very supportive, always trying to comfort her. So are her siblings. But she couldn’t get rid of this obsession from her mind. Whether she’s doing something or not, her mind consistently reminds her that she’s ugly. She also tries to do some meditation, but that doesn’t calm her down and release her stress at all.

In a conversation with her for about 30 minutes, she asked over 10 times of “Can ugly people live? Are you sure? Really? They can live till old being so ugly? They don’t have to kill themselves? They must be suffering isn’t it? Why do they bother to live?”

Then few minutes later, she’d be asking all of these questions over again. This suggests some level of OCD, but her obsessional is to do with her look. She also appears to see things very negatively, which may indicate her dysthymic mood, if not depression. In fact when I asked her a few questions, I realized she is almost completely incapable to see things positively, optimistically, and be grateful.

This was when I gave her a task – to write down a list of 30 items “Anything I have that others MAY be jealous with”, I easily gave her over 10 examples (you have healthy limbs; your husband loves you; your sons listen to you; you’re tall; you can see; you get to arrange your time; you can taste food; there’s electricity supply at home; I’m able to pay the bills etc etc).

When she started to ask those “ugly persons should kill themselves” kind of question, I reminded her about the task, and she told me, “there’s nothing anyone will be jealous about me”, couldn’t recall any of the examples I gave her few minutes ago.

So this is a severe obsession with her own definition of “ugly look” and some degree of depression. Before we help her, what  could be the diagnosis?

IPad Addiction

Anxiety Disorder, Clinical Case Studies, Developmental Disorder, Obsession & Compulsion

Came across this article and think it’s really worth sharing, also a very good case study reflecting the growing up environment of infants/toddlers nowadays:

‘The day I realised my toddler was addicted to the iPad’: Three-year-old William tugged at the duvet and woke his father demanding the tablet… at 4am

Some food for thought: How do we help the younger generations to develop healthy relationship with those advanced gadgets? How do we balance while using them as educational or entertaining tools (not iNanny!) but not overusing leading to obsession and/or addiction?

(To the educational psychologists and child experts: is this going to be a newly added and researched Developmental Disorder?!)

Illness Phobia

Anxiety Disorder, Clinical Case Studies

She has consulted many specialists, cardiologist, gastroenterologist, orthopedist… It all started with some pain in the arms, then the shoulders and later her back.

Other than the aching in her body, she also feels something stuck in her throat, chest discomfort, her stomach twitching, sometimes having light-headed, sometimes having red rashes on her skins… She even imagines that she’s got cancer and is suffering from it badly. She is worried so much about all these somatic symptoms and about getting more and more ill, she can’t eat properly, she doesn’t have any appetite.

In addition to those complaints, she’s also paranoid and may be hallucinating. She feels that the DJs on the radios are all talking about her (“Why do they know so much about me?” “Why do they talk about me non-stop?!”), she feels everyone on the train knows that she’s sick and is taking medicine for her sickness…

The problems were aggravated by a big row with her boyfriend, whom she found out to be getting back in touch with his ex-girlfriend. She’s becoming really sensitive and paranoid. She thinks the boyfriend is not being faithful, for contacting the ex. At the same time she was also having some massive pressure preparing for her professional paper.

She slowly moved away from her relationship and study problems (she passed the paper). But then she developed all those psychosomatic pains and problems. What’s worse is not the problems themselves, but the fact that she’s so overly worried about them – even the slightest rashes on her skin makes her think that she’s got skin cancer and is dying… When she started to take the medication, she did a table diary, noted down every small changes and symptoms in her body, whether she felt sleepy, had rashes, felt dizzy, could breath properly… She tried so hard to notice every little things in her body (perhaps it’s also an obsession?).

Illness phobia is not uncommon nowadays (see here for another case study on illness phobia), it’s under the anxiety categories, yet this appears to be some modern mental illnesses, as people nowadays know more and learn more as the technology gets advanced, at the same time people are also creating more problems for themselves as the world develops further (unhealthy processed food, overly urbanised cities, pollution…). But why, why get so worried when you’re not ill? Why are people losing the abilities to enjoy lives? Why worry before even knowing if the problem exists? It’s like people being worried about getting worried, now these people with illness phobia are getting ill mentally because of being worried about getting ill physically…

Separation Anxiety

Anxiety Disorder, Clinical Case Studies

When the boy first came to us, the parents were very anxious as the boy had already stopped going to school for almost a week. They begged for an earliest possible appointment as they can’t bear the boy missing even one extra day of absentee from school, despite advice that even if the boy came for consultation straightaway he won’t be able to recover immediately and be able to go to school the next day.

The mother told us that the boy has been refusing to go to school, tuition, and any classes. He can go out still, can see crowds (just like when he came to see us, there were a lot of other patients and patients’ family in the waiting room), but whenever it comes to classes and school he just wouldn’t go. It all started about two weeks ago.

When I spoke to the boy, I asked if he felt ok in the waiting room with the crowds, he nodded indicating ok. I asked whether he can accept it if the mother now goes to the washroom and leaves him there alone. He shook his head. “Not even for 5 minutes? 3 minutes?” Again he shook his head. The mother explained that he wasn’t like this before, he could go to school and tuition classes with peers.

With some prompts the mother recalled an incident about two weeks ago, where she was too busy at work and was late to pick him up from school. The boy was in tears when she got there. She now realized it was this incident that leads to her son’s subsequent behaviours. She thought he was just avoiding school, perhaps due to bullies, problems with friends or not completing homework. She thought her son was just being rebellious and never realized she was the reason of his problematic behaviour.

I’ve come across cases like this a number of times. Imagine if the mother didn’t seek help, and insisting, forcing the boy to go to school, what’s going to happen? They are likely to get into frequent rows and arguments, the mother thinks the son is disobedient and doesn’t like schooling, the son thinks the mother doesn’t understand him and love him.

Yet it’s important to look at the root of the problem, as a lot of childhood insecurity starts from small incident like this (“my mother is late for 1 hour to pick me up, I thought she doesn’t want me, she’s going to leave me there” – often depicted in TV as well!). If this conflict isn’t resolved, quite often the child brings the insecurity to adulthood and has trouble forming secure and trusted relationship.