Category Archives: Anxiety Disorder

Post-Traumatic Stress following MVA

An oversea holiday is meant to be relaxing and pleasurable. Yet it doesn’t apply to this young boy and his family.

When he was 12 years old, he travelled to Hong Kong with his family. As they were in a minibus, the driver ignored the red traffic light, went ahead a junction and was crashed by a big bus. A few passengers were injured, one badly injured. This boy sat at the front so he didn’t see that bus coming from the right, he had his right arm fractured.

As the family was there only for holidays, they didn’t know what to do so they decided to travel back straightaway by air, and the boy had to suffer all the way till he got back to Malaysia.

Subsequently the boy’s right arm is ok with some physiotherapy. However, the boy is no longer able to ride in any bus or van. He used to go to school by school bus, now the family has to send him. They haven’t got much of a choice, as the boy can get so panic, worried and be in tears when asked to take any van or bus.

His auntie has later decided to sue the bus company in Hong Kong, knowing that the minibus driver who caused this accident did not receive any legal punishment (this sounds ridiculous, I thought HK is a lot more strict in executing their law). They aren’t a rich family, middle class but they had to do so as this incident has brought so much loss to the whole family, financially, psychologically, time spent and so, so much energy since the incident two years ago.

The boy has been suffering from Post Traumatic Stress Disorder (PTSD) following major motor vehicle accident (MVA) for over 2 years now. He sometimes still has nightmares about the accident, and can’t concentrate to study. He was a smart and happy child. The family thought it was just about avoiding to take bus and van, and he will get better by himself gradually, now they slowly learn about PTSD and is searching for help, as his condition doesn’t appear to be better after 2 years.

Part II: Social, Peer & Exam Phobias

Part I: Social, Peer & Exam Phobias

Few days later, I spoke to the mother again. They went to a Counselling centre in town. The patient opened up in the counselling session, saying that she was under great pressure and worried about various things especially her parents financial abilities.

She has always wanted to learn cooking and baking. So she’s chosen the school that she’s attending now, because this school has the course she wanted, and she can join it straightaway after Form 3, though it’s the most expensive course. The parents didn’t mind it, as they want their daughter to be happy.

The parents bought a new house earlier this year. They will be paying 3 times the house loan of what they’re currently paying. The parents are happy-go-lucky people, they know it’s going to be difficult but they were never too worried about it. Yet this eldest daughter of theirs is so concerned – whether they can afford paying for the new house and also for her expensive course. She still has younger siblings, she thinks, maybe she shouldn’t complete her Form 3 and go for such expensive course.

She also has a very traditional grandmother, who dislikes her furthering her study in cooking/baking. The grandmother always criticizes her mother in front of her, and scolding the mother for allowing her to study in this course which leads to a career that doesn’t earn money.

She listened to all these comments about her decision, is upset that her mother was scolded because of her. Somehow internally, she knows if she couldn’t pass her exams or doesn’t attend her exam she will not be able to proceed to the cooking course. And this is what she wants, or maybe not, but for her family.

We overlooked all these underlying concerns, worries and feelings. This is somehow true in psychiatric settings, especially outpatient settings. I’m not saying that medicine is not helping, obviously I’ve seen a lot of people benefit from it (especially when the condition is critical), but sometimes we easily overlook things that may not be solved by medication. Comparing to medication, in this particular case counselling and psychological treatment have shown a much better outcome.

Social, Peer & Exam Phobias

Her class teachers see no problem with her. Her school counsellor said that she can’t sit for exams. Not that she doesn’t do revision and gets herself prepared, but she just gets so anxious, palpitating, hands trembling, sweating… as if she’s going to pass out.

Yet if she gets to sit for the exam alone in a room, she can do it.

Ok, so it isn’t exam phobia.

It could be agoraphobia (a fear of being somewhere where there is a chance of having a panic attack that others may witness, and not being able to get away rapidly) then? But she never really experiences panic attack in her 15 years of life. Though she is definitely going through some very severe anxiety and fears in any exam hall. She’s supposed to be the last batch of students taking PMR this year, she is now missing it.

She seems a bit shy when she talks to us. But she’s having eye-contacts with me as I explained things to her (probably better than how I was when I was at her age, despite being call as an extrovert I used to avoid eye-contacts) and her mother. During waiting time she stays outside of the clinic with her mother. I wonder if there’re some degrees of social phobia in there.

The mother said that she doesn’t really make friends. Her friends laughed at her weight and body size. Well, based on the standard nowadays, everyone thinks that they are fat, everyone is on a constant diet, everyone has to lose weight all their lives (ok, this is “a bit extreme”). I see no problem with her weight (but she’s in fact overweight), but I understand peer influences very much. Because of this she avoids making friends…

So there could be some peer pressure leading to social anxiety and social phobia. But what about her problem with exam? Why is it exam only? She survives just fine in class, and she survives just fine sitting for exam alone.

Sitting for exams with peers phobia, it is then. I think this could be under the parent of Agoraphobia, but I think in mental illnesses, we sometimes don’t have to fit people into any available categories, everyone has their problems and symptoms, which can be very unique to them.

Part II: Social, Peer & Exam Phobias

Hypochondriasis or Illness Phobia?

This woman is married to a husband who has another family outside (with a one month old girl). She accepted it after a while, knowing that she can’t carry babies for her husband. Her husband was considerably “good” as he never abandon her, although most of the time he’s out there with the family, he calls her daily, gives her complete financial support, and comes back home quite often.

One day this woman visited our clinic, with a lot of somatic complaints (stomach wind? dizziness? chest discomfort? feeling weak and anxious? etc). She has been taking chinese herbs for over 20 years, but still turns out as a very ill-health person. Doctor advised her to stop taking chinese herbs completely (not that all chinese herbs are bad, but those that she had been taking apparently does not help her at all, could even be worsening her health problem).

She is sensitive, anti-western-med, with multiple somatic complaints. On the day she got home after the first consultation, she started to bombard us with phone calls, asking all kind of questions – Can I take ABC soup? Should I continue with med during periods? Why do I feel like losing balance? Can I eat oat? Can I take in some protein supplement? etc

Do you consider this as OCD (Obsessive Compulsive Disorder)? But she doesn’t repetitively asking the same/similar questions?! She has kind of wide different concerns…

Do you think she has illness phobia? Because she’s so health concerned that she wants to be so careful and watch out for any possible harm to her health?

Do you think she’s purely attention seeking? Or should I say she just needs some love, care and attention? So she pretends to be “problematic”, to be sick, to be unwell, so that her husband would be calling her and care about her? So she can call us non-stop to ask different questions?

Sometimes I find “attention-seeking” explains a lot of things…

Behavioural Experiment for Social Anxiety – Walking a Banana

I have long heard about behavioural experiment in the CBT. We used to have a guest lecturer in the uni who shared quite a lot different types of behavioural experiments she has done throughout her life as a therapist. One of them that I remember quite well was working with a woman with OCD (Obsessive Compulsive Disorder), who was very obsessed with hand washing. And in short what they did, was putting their hands into the toilet bowl, reaching the water in it! then what? Without washing hands, they used their hands to eat!!!! It was like OMG, REALLY?! But yes that’s what was done, the therapist was going it with the client, and really, nothing happened afterwards, and the client realized her obsession with hand washing really wasn’t rational (of course this is kind of simplified, you should assume that they have done a lot of work in identifying irrational/negative thoughts, doing relaxation techniques and also discussing the rationale of designing such experiment etc).

Guess what I did today? Hehehe, oh the title tells – I walked a banana in Croydon, London. YES I BLOODY DID IT. Me and Krishna did it together, initially we didn’t quite get into the state, and we were laughing and stuff. But after that we realized we really need to be so serious, so people know, yea we’re serious about it. Believe it or not, so many people looked at us! Some people asked Pei Man (she was following behind us and taking video). Some just stared, some tried to look covertly Haha. We went into the McDonalds, and obviously people were looking. I saw a guy taking pictures of us. I heard the staff saying “people coming with a banana on the string”. At the end a guy approached us and asked whether he could take a picture, even asked for their names and age. LOL. The staff in McD also asked us. We left, another black woman on the street was like “what’s this for?” Another two women walked past and we could overhear them saying “look at these stupid people”. Hahahahaha. Stupid, I kind of enjoy this stupidity!! There were also quite ignorant people, who walked past like nothing happened. In front of the hotel, there were 4-5 teenagers, some just stared at us, while one who was obviously more extrovert approached us, and patted on Bobo (Krish’s banana, and my banana is Nana), although another friend of his almost gave Bobo a big kick!

Okay up to this point you probably going to ask me, why were we doing this for? The idea came from Donald, our lecturer on the hypnotherapy course, who treats people with social anxiety. Oh yea this was one of this behavioural experiments with his clients. The idea is to do something and make people really look at you. In fact some people are often so self-conscious, being worried about what other people think about them, whether they look stupid, look anxious or too awkward etc etc. With experiment of this sort you probably find out the reaction could be quite different from what you think. But even if it was what you think (that “you look stupid”, “you look so anxious”, “you look like an idiot”). Those are just their thoughts! So what?? It’s nothing catastrophic. Let them think what they want.

It’s like people who are overly anxious doing public speaking, worrying they might make mistake. Well okay there are a lot of thing you could do to present your best, but what if you make mistakes? What if… you make a mistake deliberately?? Laugh it off? Chances are you are going to survive it anyway, why worry? This is my way of seeing it, though Don said people can test by making a mistake deliberately and see what happens, see what’s so catastrophic about it. Of course this doesn’t mean that I’m no longer anxious, and no longer worried in public speaking, but when you really analyze your reason of being nervous, rather than focusing on hiding your nerve/anxiety, the results are most likely going to turn up better.

I also forget to mention, at this very same day when Don realized we’re going to do his banana walking experiment, he was also interested in joining. So I gave him a string and he got himself an apple to walk, but that apple fell off. And what did he do?! – he went to a toy shop, got himself a pink piggy soft toy, which could fart if you sat on it – and he MADE the shop assistant showed him how the pig fart in front of a long queue / big crowd of shoppers. Then he put the string on the big pink pig and walked it back……. You probably going to say he’s such a weirdo. Hahaha well he is… not. I suppose it can get addictive, so additive. But to go to shop and ask for certain things to be done, is part of assertiveness training (and other things). And doing all those things can get quite addictive! Well, in fact at the same time you’re also helping your clients and being a problem-solver.

I just have got to say, I have really enjoyed it. And Krish did too – know what? She’s a mum of two, and she was as passionate as me if not more, in stuff like this. Hahahaha.

N.B. The content was first posted at huibee.blogspot.com by the same author.