Category Archives: Unclassified Disorders

Psychological problems or Social/familial/educational issues?

I’ve had quite some worried parents approaching me, telling me about the behaviour of their children – how these youngsters stay at home, not working/studying, not contributing to the family/society, simply playing games or spending all their time online browsing or social-media-ing.

I used to think this is some psychological problems that I can do something to help. But as I progressed and when I looked at those generations before us, I see that it’s becoming a “trend”, that arises due to the development of our society.

Such problems never occur in our grandparents and parents’ generations. Why?

If they didn’t work hard, they were likely to starve to death, they probably wouldn’t survive. The big environment and society are in such a position that “you have no choice, you work, or you die.” (slightly exaggerated – but if you really approach them and ask them, this was indeed how they felt). So many of them worked hard, come up with great ideas and achieved great things.

What about the children of those parents that approached me?

Their parents are generally well-to-do, white collars, giving the best to these kids, best education, best material life, best experience etc. The kids get what they want, without much effort or any hard work. Why would they want to work (hard)? Why would they not just enjoy life? Why wake up at 6am, stuck in the traffic, do things that he might not enjoy for 8 hours every day? – while he can sleep in all he wants, do what he wants, while still get everything he needs to survive and also everything he wants?

I know this saying is rather simplified. But really, if you think I’m pointing finger to their parents, no I’m not. It’s how the society has developed into, of course more importantly there are problems with our education, when children think all they need is doing well in exams and nothing else. This is worse in the Eastern, Asian, Chinese societies, because parents, as long as they are still alive and capable, look after and even pay for their children, including adult children.

What can we do about this? What can parents do about this? How can I help the children of these worried parents? Or instead how can I help these worried parents to simply stop worrying about their adult children? And perhaps then the problem is solved? Because sometimes we care too much that this love does more harm than good.


Disclaimer: I surely ain’t talking about every youngster out there are like that, there are many that work hard (or not) and have great achievements…

Problem-Focused & Emotion-Focused Copings

She didn’t think that she would need any professional mental help. That’s why she only came after quite a few months her colleague introducing our clinic to her. She realised that she is talking to herself, cursing, mumbling, and in this persistent low yet agitated mood.

It’s not difficult to understand why she’s in such state. She has a job herself and has four children, the second child is epileptic and can’t tolerate western medication, so she suffers from recurrent and unprovoked seizures. She lives with the husband and his family, including the mother in law, who doesn’t get along with her and is always criticising her. The husband’s brother works for the husband, and has recently moved in to their house with the wife and two dogs. She wasn’t happy that nobody sought her opinion regarding this. What’s worse is the brother in law and wife who never take proper care of the dogs’ hygiene. They live there for free, and never help out in any house chores. Sometimes they even use her car to take the dogs out, leaving the car seats with fur without cleaning. The mother in law would get in the way if she tried to say anything to the brother in law.

How about the husband? She’s been married to the husband for over a decade. The husband doesn’t care about all this. He usually comes home late, and is often drunk. She said he has been found to have mistress many times, some lasted for few months, some years. So this has left her in such paranoid state, is consistently suspicious that husband has another mistress yet again, and is always trying to track and check everything. So she lives in this house with her children, with almost no support and help, and with people who seem to always make life difficult for her.

What do you think? …? …?

My first reaction was fairly direct, “Why is she still there?” Yes she did mention that when outsiders look at her, most would think that she seems to lead such a happy and complete life. Is she?

Has she recognised what her problems are? Is she able to solve these problems effectively? Perhaps she can solve some of these, how about the remaining issues? Can she cope with them? Can she see the way out at all?

I do not think medication is going to do her much good, if any. I’d say this is why everyone should learn problem-focused coping strategies and emotion-focused strategies. Have you heard the famous inspirational by Reinhold Niebuhr,

Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

For me, it is telling us to solve the problems that are within our control (effective problem solving!), and for those stressors that we can do nothing about, we accept it (building psychological resilience, mindfulness, thought defusion, acceptance of negative emotions etc). And of course, what comes before, is the insight, the wisdom to identify the problems in your life and know to which category they belong to!

Psychosis to Depression?

It all started in December last year. She presented some elementary hallucination, poor sleep at night, poor concentration and drowsiness in the day. She wasn’t hearing voices, but some knocking sounds (similar to when one is knocking the doors).

So she sought psychiatric help, was put on antipsychotic and stimulant (Ritalin, normally prescribed for ADD, ADHD or narcolepsy). Her symptoms soon got much worse, seeing ghosts(?)., talking irrationally and was then brought to general hospital, where she was put on more antipsychotic drugs.

Few weeks later, her family took her to see another private psychiatrist doctor after she was discharged. The consultant diagnosed her with bipolar disorder, based on the fact that she was once an outgoing and independent person, and prescribed her with Lithium.

Throughout the few months under the care of the psychiatrists, she took and tried many medication including antipsychotic pills, she gained over 20 kgs. She gets really depressed about her weight. For when before the first episode end of last year, she bought some slimming pills online, which acted as appetite suppressant. That was when she was 20 kilograms lighter than what she is now. She wouldn’t even want to look at herself in the mirror, when she thinks about her weight, she thinks life is meaningless. She doesn’t know how she has got here and how to find the old self. She has been unable to work for 10 months now.

It all started mild. She has no family history of mental illness. The team can’t help suspecting those slimming pills that she took, which could affect and alter her brain and nervous system. Of course we wouldn’t know whether there is a cause effect relationship for definite here (and we would never know), but it is important that you know what pills and medicine you are taking, those that you buy online, and those that you are prescribed by professional doctors. I am not saying that everyone should question his/her doctors and the diagnosis and prescription, but when in doubt or think that something is not right, seek a second opinion. Also, do not believe everything that’s said on the internet, but sometimes online resources might provide us with some basic and guidance.

Online Dating Addiction

He said at first he was just going on online dating sites as he was feeling a bit lonely (though he didn’t use the word “lonely”, that’s just how I interpreted it). He is in his 30s, works in bank, bought a house last year and living on his own. He has rather limited social life as his work occupies almost all his time (13-14 hours a day, sometimes more, weekend too!) 

He went on multiple dating sites to increase the chance of meeting “the one”, some popular sites and some not so, but he’d make sure there’re at least some [female] users in the country (well, it’s still not so common a thing in Malaysia). He said some dating sites had literally no female users in his area.

Over the months he chatted with so many girls. At any one time he could be chatting with 3-4 girls on 2-3 different dating sites. “As long as they responded. But I do filter – religions, ethnicity mainly. The rest, it doesn’t matter, but I do check their pictures. I don’t talk to those without pictures. Who knows you may be talking to an old man or…”

But to my surprise, when I asked how many he had met in person. “None. We’d always mention about meeting in the future, or doing something together. But I never do it. Initially I thought it was due to my work. Well, at least that was the excuse I gave myself and them girls. But slowly I realized I had no intention to meet any of them.” ??!!

“I only enjoy talking to them, flirting with them, perhaps imagining how things would go with this particular girl in the future (then with another girl in “another future”). They fill my time, which isn’t much, anyway, due to my commitment to work and house loan”

“I feel good. I laughed genuinely, and I’m sure I made them happy, and they’re also laughing, giggling in front of the phone. It uses up my leisure time and I constantly feel accompanied, day or night. This one stops writing back? Fine, there’ll always be next and next, next one. So my problems of being alone and not having much social life are solved. Why still bothered to meet up? Especially it probably would often lead to disappointments anyway.”

“I know I’m not the only one being this way. Some people met up and found someone that they’d regularly see, but they continued to surf the dating sites and flirt with others. Why stayed committed when you have so many more constantly waiting for you [in your phone]? They said this more often happen in guys, but I think the girls are doing it, too, but perhaps in a more discrete way.”

I didn’t bring up the word “addiction”. I’m not even sure whether this is ordinary or unhealthy or… At the time of writing he’s still on dating sites, happily. Hopefully I get to come back to update this post as of what happens to him in the future…

Here are some of the interesting experiments done on online dating sites:

Pretty woman with ‘worst dating profile ever’ still got dates

Cruel Intentions: How I Hacked Tinder And Got 2015 Matches In Under 17 hours

OKCupid: We Experiment on Human Beings!  (The site did various experiments on its users!)

Paranoia? Anorexia? Body Dysmorphic Disorder?

It was first suspected that she has Othello Syndrome (morbid jealousy, case study here). When she came, she just split from her boyfriend and was having suicidal thoughts. The mother said she was constantly checking on the boyfriend, his phones, his whereabouts, his friends etc (similar to the case here). She was also hearing voices, very bad-tempered, having very unstable mood and insomnia.

Few days after she started taking anti-depressant and anti-psychotic medicine, she called up and asked if she could take weight loss pill “L*** B***”, she said it helps to lose body fat only, will not lead to diarrhea. So she was told ok to take this weight loss pill along with her medicine.

Few weeks later, the mother called and questioned us, why we allowed patient to take weight loss pills. Mother said patient has been taking the pills, along with laxative pills (for constipation) excessively, she could take over 20 tablets a day, and purging herself (to vomit). She’s in fact only 43 kgs when she first came to see us, she doesn’t need to lose any weight. But our position is to tell patient that the weight loss pill is safe to be taken with our medicine, but that’s obviously based on the fact that patient is taking it accordingly. It’s not our position to advice patient regarding her weight (we can do so, but we can’t stop her). It also important to note here that if the pill will cause diarrhea or vomit then it won’t be suitable to take with medicine.

So mentally she’s got much worse, as she wasn’t regular with the medication, plus all those means that she’s using to lose weight, her body probably couldn’t take in any of those medicine. She got more sensitive and paranoid, always thinks that people are talking about her, especially when she is out. At one point they had to admit her into hospital for drips as she was taking too much of those pills. After the discharge she finally realized what harms those pills are doing to her body and brain.

So she stopped purging and trying to lose weight. She’s given up on the idea of losing weight. But few days ago she came back for review, now she’s considering rhinoplasty (plastic surgery on the nose)! Almost obsessed about going for it…

Paranoia, anorexia nervosa and body dysmorphic disorder are undeniably inter-related and co-morbid, but does one move from one to another?

Body Integrity Identity Disorder (BIID)

If you were a surgeon and someone came to you asking you to amputate his leg, for how much he is suffering deeply due to this leg and for no physical health reason, what would you do?

The thing is if you don’t do it, they may DIY. One practiced first, he got rid of part of his finger as a prelude to amputating his leg. Another one laid on the train track and let the train run over his limbs. One more shot his legs off with a gun, etc.

Just like Gender Identity Disorder (GID), “body integrity identity disorder hypothesises that a normal function, which is your comfort in how your body fits together, has gone wrong.” When they envision themselves, the image is without the limb, the limb makes them feel “incomplete”.

Do they all desire an amputation due to BIID or a sexual fetish? An obsession with amputees and amputations?

Here was a perfectly healthy man with a perfectly healthy leg. Yet he went under the knife voluntarily, in a foreign country. He trusted a surgical team that worked under a cloak of deception. How much must a man suffer to come to this: lying by himself on an operating table, attended only by strangers, in a small, obscure hospital thousands of miles from his home in America?

Is amputation the only way out? Is it ethical?

Look at some case studies and the history of BIID here (a long read): This is what it is like to be at war with your body – the compulsion to be free of a limb is no imagery illness

Related study: Modular cognitive-behavioral therapy for body dysmorphic disorder: A randomized controlled trial