Obsessions and Compulsions - How Social Workers Help
By William Shryer, LCSW, BCD
Clearly one of the most misunderstood disorders in the field of neuroscience is the diagnosis of “Obsessive-Compulsive Disorder.” It occurs from early childhood all the way throughout the life span.
It is actually a spectrum of disorders generally seen when one cannot get a particular thought out of their conscience mind. They may think they are contaminated, that something horrible will befall someone they love. They may think that they may utter something blasphemous. They may feel convinced that there is something about their body that is misshapen or looks ugly. They may look endlessly in mirrors and ask others of they notice the defect. They may avoid going out, certain that others will notice their defect. The public is generally unaware of the suffering that so many go through dealing with their “stuck thinking.”
Obsessive-Compulsive Disorder has more symptoms than just about any other diagnosis. From the better known symptoms such as those seen in the movie, “As Good as it Gets” with Jack Nicholson, where hand washing and certain rituals were present, to the lesser known symptoms such as “hoarding”, stuck thoughts, and many believe that even anorexia may be a symptom on this wide and unusual spectrum. Clearly one of the most disturbing for some is the, “distress of perceived ugliness,” known as Body Dysmorphic Disorder or BDD.
About Post Traumatic Stress Disorder (PTSD) and Brain Injury in Iraq’s War Veterans
By Katherine van Wormer, PhD, MSSW
Introduction
In 1980, in response to the veterans of the Vietnam War and the militancy of the antiwar movement, the American Psychiatric Association (APA) acknowledged the symptoms of Post Traumatic Stress Disorder (PTSD). The diagnosis of PTSD was then included in the DSM (Diagnostic and Statistical Manual of Mental Disorders). The feminist movement was influential in this development as well due to their advocacy for a diagnosis in recognition of the trauma of rape.
The DSM IV-R (2000) describes PTSD, in short, as the “re-experiencing of an extremely traumatic event that the person has experienced or witnessed, accompanied by symptoms of increased arousal (such as sleep disturbance, irritability, hypervigilance, difficulty concentrating) and by avoidance of stimuli associated with the trauma and numbing.”
Post Traumatic Stress Disorder Related to Combat
After the war in Vietnam was over, some 30 percent of Vietnam combat veterans suffered from PTSD; flashbacks to horrible near-death situations were common. A study conducted in 2003 involved 6,200 soldiers who had served in Iraq and Afghanistan several months before. Research was conducted by a team of social scientists at the Walter Reed Army Institute of Research.
Results showed that one in six of the veterans displayed symptoms of PTSD, major depression, or anxiety; 12 percent had symptoms of PTSD alone. (These figures are an underestimate as the study was done before the far more brutal urban combat efforts got underway.) The risk of developing trauma rose in proportion to the number of instances of combat in which the soldier had engaged.
According to a more recent Post-Deployment Health Reassessment, which is administered to all service members, 38 percent of regular soldiers and 31 percent of Marines report psychological symptoms. Among members of the National Guard, the figure rises to 49 percent. Those who had served repeated deployments were at extremely high risk of problems and the toll on their family members was great.
The exact rate of PTSD in women veterans is unknown. Studies conducted after the Gulf War concluded that female service members were more likely than their male counterparts to develop PTSD. This is consistent with the 2 to 1 ratio of female to male PTSD sufferers in the general population.
Males with psychological symptoms from battle, however, are three times more likely to be given a diagnosis of PTSD than females, according to the Pentagon Task Force report.
One explanation for this may be cultural expectations that make it difficult for society and mental health providers to recognize women as combatants. Additionally, there is a tendency to diagnose women as having depression, anxiety and borderline personality disorder instead of combat-related PTSD.
For several reasons, the impact of the Iraq and Afghanistan wars is expected to be more severe than the impact of previous wars. (1) The experience of combat, engagement in gun battles, and handling the bodies of dead comrades is a constant in these wars, (2) the experience of killing people at close range is a frequent occurrence, (3) extended lengths of service with only short periods of rest and recuperation in between are taking a psychological toll on soldiers; and (3) many of the injuries in this war are to the brain.
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Black History Month Celebration! Profiles of African American Social Workers
New on HelpStartsHere.org - A Celebration of African American Social Workers who tell us why they joined the profession and what they believe are the greatest challenges in the African American community.
Also on HelpStartsHere…
About Domestic Homicide and Murder-Suicide
Introduction
Intimate partner violence is all too common throughout the world and takes many forms. The most serious of these is homicide by an intimate partner. The fear of being killed, in fact, is a major dynamic in male-on-female violence and sometimes in motivating women to kill the perpetrator of abuse out of fear or desperation.
Facts on Domestic Homicide
In the U.S., estimates from the Bureau of Justice Statistics (BJS) are that more than three women a day are killed by their intimate partners. Women are killed by intimate partners more often than by another acquaintance of stranger. Most of these murders involved were preceded by physical and psychological abuse.
Outside the domestic realm, males are killed much more often than females; they are killed most often in fights with other men.
According to the FBI’s Uniform Crime Reports, 1,055 women and 287 men were murdered by their intimate partners in 2005. These figures are striking, because in the past, in the 1970s and earlier, the numbers of men and women so victimized were about even. In other words, there has been a significant decline in the numbers of men killed by their partners but not for women.
The number of men who were murdered by intimates dropped by 75% between 1976 and 2005 (BJS). The number of black females murdered in this time has declined but the number of white females murdered has dropped only by 6%. Statistics Canada (1998, 2005), similarly, reveals a sharp decline in the numbers of male domestic homicide victims but not of female victims of homicide.
The reason that women are resorting less to murder of their partners is most likely because many of these women were battered women who felt trapped in a dangerous situation. Today, the presence of violence prevention programming and the availability of shelters are paving the way to other options. The fact that domestic violence services apparently are saving the lives of more men than women is a positive, though unintended consequence of the women’s shelter movement (see van Wormer and Bartollas, 2007).
Situations of Domestic Murder Suicide
The National Violent Death Reporting System (NVDRS) is a recently developed state-based surveillance system that includes data from 17 states as of 2007. Now for the first time, a national data base exists that reveals the numbers of homicides that end in suicide. The goal is to collect data on homicide for all 50 states. Results so far reveal that over 90% of the perpetrators of murder-suicide are male. About one third of these male perpetuated homicides end in suicide. (Data available at www.nvdrs.com.)
These results are consistent with those of the Violence Policy Center (VPC). The VPC bases their findings on an Internet search of media accounts of deaths by murder-suicide. VPC reports that a total of 591 murder-suicide deaths took place nationwide in the six months between Jan. 1 and June 30, 2005.
As reported by the Violence Policy Center (2005), the pattern of the murder-suicide is predictable: the pattern involves a male perpetrator, female victim, a decision by the woman to leave the man, and a gun. A handgun was used in 92% of the incidents. The offender was 6.3 years older on average than the victim. Texas had the highest number of cases; the typical Florida pattern involved an elderly male caregiver overwhelmed by his inability to care for an infirmed wife.
Some researchers argue that murder is the primary motive in such cases; others point to the double and multiple killings as a form of extended suicide (van Wormer and Bartollas, 2007). The urge to kill can be described as an urge toward total self-destruction including the destruction of the person who rejected him.
The pattern that emerges in these cases involves intimate partners in the 20 to 35-year-old range: The man is abusive, psychologically and/or physically. Obsessed with the woman to the extent that he feels he can’t live without her, he is fiercely jealous and determined to isolate her.
Characteristically, suicidal murderers have little regard for the lives of other people; they would be considered, in mental health jargon, to be antisocial. Yet they are so emotionally dependent on their wives or girlfriends that they would sooner be dead than to live without them. When the girlfriend/wife makes a move to leave, her partner is absolutely distraught in the belief that he can’t live without her.
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Top Reasons Why Some Long-Term Marriages End in Divorce
Ever since the 1970’s, divorce has become commonplace. In fact, the definition of family has changed dramatically. Less than fifty percent of families are intact families with the original mother and father. Families now include single heads of households—with women as the head of household, couples living together and step-families that become “blended” through divorce and re-marriage.
Included in the rising divorce rates are long-term marriages. Why, we ask, would someone get divorced after more than twenty years of marriage? Before we take a look at the top reasons for why some long-term marriages end in divorce, let’s first see why some long-term marriages succeed or just “go along to get along.” “Success” means that BOTH partners report being happy.
Good Reasons Why Some People Stay in Long-Term Marriages—What Makes These Good, Happy Marriages Work?
Good, happy marriages consist of people who:
- Are both truly happy, optimistic people who know how to problem-solve.
- Tended to get married when older and more settled in their careers/education and more mature.
- Are financially comfortable.
- Have college degrees or technical training.
- Find ways to “renew” the marriage spark. Some couples do this by traveling, taking classes of some kind together, doing a large project together (building a dream house, etc.), volunteering together and basically finding a new shared interest etc.
- Are happily involved with their grandchildren and/or adult children.
- Have good health.
- Don’t criticize and reject each other.
- Respect and like each other.
- Have more than “weathered or gotten through” major stresses such as affairs, financial or emotional problems. Instead, they triumph over these issues and grow.
- Have a wildcard factor—a highly personalized reason for being happy and together!
Make a checklist of which ones are part of your marriage. Now let’s take a look at why some unhappy, long-term marriages continue.
Why Some Unhappy, Long-Term Marriages Continue
Continue reading ‘Top Reasons Why Some Long-Term Marriages End in Divorce’
Spinal Cord Injury (SCI)
There are an estimated 11,000 new cases of spinal cord injury (SCI) in the United States per year. Over the last several years, SCI has primarily affected persons aged 16 – 30, 78 percent of whom are males; and predominately Caucasian (78 percent).
Almost half of the spinal injuries occur as a result of motor vehicle injury, second are falls, and the remainder come from acts of violence such as gun shot wounds or knife injuries as well as war related injury.
SCI is defined as, damage or trauma to the spinal cord that results in loss of sensory and motor function. An SCI can result in either a “complete injury” (a loss of all voluntary movement) or an “incomplete injury” (a partial loss of voluntary movement).
An SCI is classified utilizing a scale developed by the American Spinal Injury Association (ASIA) that uses a system to describe the level of injury. For example, a person with an ASIA A complete injury describes a person who has no voluntary movement or sensation below the level of injury.
Dealing with the Diagnosis
Spinal cord injury (SCI) is a devastating event that not only has physical but social and psychological ramifications for both the individual and the family. In one moment, a person’s world is monumentally changed forever with reverberations throughout the whole family system. The person who sustains an SCI is at high risk for many factors including: dependency, depression, drug addiction and, if married, divorce. They can also struggle with debilitating secondary medical complications and other factors such as the effects of perceived social discrimination, declining help and lack of social, family, and emotional support.
Family Implications
When something traumatic happens to one family member, the whole family feels the effects. Roles and responsibilities change. Marital strain occurs when one partner has to take on unfamiliar roles such as providing assistance with activities of daily living, financial responsibility and intimacy changes. This can put the person without the disability at high risk for depression.
Parents who have a young adult child that has an SCI will often reestablish the role or responsibility of parenting. If the person has left home, this may mean moving back in. This can affect self-esteem of the person with SCI and cause conflict with parents.
Interpersonal relationships are affected as well. Friends who may have had previous interests or activities they enjoyed doing together are now different. The person with SCI may withdraw or may feel embarrassed being seen post-injury. While having a young child sustain a spinal cord injury, brings a new dynamic to the entire family system and numerous challenges to the child who must face an SCI during times of dynamic growth and development. Continue reading ‘Spinal Cord Injury (SCI)’
How Do I Know If My Child Is Transgender?
By Stephanie Brill and Caitlin Ryan, PhD, ACSW
What Is Transgender?
Everyone has a gender identity. Gender identity is our internal sense of being male or female. For most people, our basic awareness that we are male or female matches our physical body. When we’re born, people decide if we’re male or female based on our genitals. But for children and adults who are transgender, their basic sense of being male or female – their gender identity – does not match their body. So a transgender person may have a male body, but feel inside that they are female. Or a transgender person may have a female body, but feel inside that they are truly male.
Can a Child Be Transgender?
Children and adolescents can be transgender, just like adults. In fact, a small percentage of all children are transgender. Children understand gender differences from a very early age. And transgender children strongly identify with the other gender, often from age two or three. Because we don’t talk about transgender people with children, adolescents or even adults, children who are transgender lack basic information about who they are, and struggle with feeling like they were born in the wrong body. And adults typically react as if there were something wrong with these children, as well.
In truth, there is nothing wrong with these children. But since very few people understand that it is natural for a small percentage of the population to be transgender, people don’t know that you can have male genitals and still be female or have female genitals and be male.
Transgender children who express their “real” gender identity can become extremely unhappy and depressed when adults try to prevent them being their true selves. Being transgender is not the cause of their distress. Instead, not being understood and feeling like there is something wrong with them causes them to suffer. And pressure to change their core sense of who they are causes emotional suffering, as well.
What Makes a Child Transgender?
Many parents are concerned that something they did made their child become transgender. This is not true. Nothing that a parent or anyone else does can change a child’s gender identity. Being transgender is not caused by divorce, neglect, wishing you had given birth to the other sex, using fertility drugs to conceive, encouraging your child to play sports too often or not enough, or other parental thoughts, behaviors or experiences. We don’t know exactly why some people are transgender. But science is showing that transgender children are most likely born that way, right from the start. Even before children can verbalize their sense of gender, they start to tell us who they are through their play and choices for clothing, hair styles, and toys. Once they are old enough to talk, transgender children strongly insist that they are “really” a boy, or “really” a girl. Continue reading ‘How Do I Know If My Child Is Transgender?’
Genetic Testing Tools for HIV/AIDS
Introduction
In recent years, medical advances have produced revolutionary treatments for people with HIV that slow the progression of the disease and prolong life. Unfortunately, various strains of the HIV virus are also evolving, becoming increasingly resistant to drug treatments, which may lead to the drugs or medication therapies failing. Genetic testing is now used for people with HIV to help identify drug-resistant HIV strains so that physicians can prescribe the most effective treatment options.
HIV (human immunodeficiency virus) is a disease that destroys or damages a type of white blood cell (CD4 T-cells) in the immune system and progressively decreases the body’s ability to fight infections and certain cancers. The virus causes AIDS (acquired immune deficiency syndrome).
People with AIDS have a significantly reduced number of healthy white blood cells, and therefore become more susceptible to life-threatening infections caused by microbes that rarely cause illness in healthy people.
Although there is no cure, treatment for HIV has advanced with highly active antiretroviral therapy (HAART), which suppresses the virus. However, HIV is constantly replicating and can mutate so that antiretroviral medications designed to treat a certain strain of virus are no longer effective.
Drug resistance is the most common reason why medication therapies fail. People with HIV may have several different strains of the virus, so determining the optimal treatment option becomes more difficult.
Types of Genetic Tests
Two types of genetic tests are available to determine if a resistant strain of HIV is present in a person using HAART: phenotype and genotype testing. Phenotype testing measures the amount of drug required to completely stop HIV replication in a blood sample. In contrast, genotype testing identifies the mutations in the genetic structure of the virus that have been linked with drug resistance.
Genetic analysis of HIV/AIDS helps researchers to better track the patterns of disease transmission, and to better understand how the virus affects the human body. No one test is sufficient for making treatment decisions.
People with HIV/AIDS work with a variety of professionals who diagnose and treat the disease and help manage the physical and mental health and social issues related to the disease. Social work professionals play an important role in the disease management team.
Social workers employed in community human services agencies, hospitals, and in private practice help people with HIV/AIDS to decide whether or not to have genetic testing and to understand the implications of test results. Additionally, social workers coordinate community services and help their clients address the life changes that often accompany a diagnosis of this life-threatening disease.
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Preparing for In Vitro Fertilization: Emotional Considerations
Infertility is an experience that strikes at the very core of one’s life. Reproduction is considered the most basic of human needs, propelled by powerful biological and psychological drives. When the ability to reproduce is thwarted, a crisis ensues and impacts relationships with others, life goals, social roles, and sense of self. A host of emotions emerge in a somewhat predictable and repetitive process as one moves through medical diagnosis and treatment. Feelings of disbelief, anger, sadness, guilt, blame, anxiety and depression can be overwhelming and finding appropriate avenues to express these emotions is important.
For most people, in vitro fertilization (IVF) is not the first course of treatment for their infertility—it is the last, best option for having a child. It occurs after long months and sometimes years of treatment failure, often at tremendous emotional, physical and financial cost. Couples beginning IVF usually do so with the burden of grief and disappointment from infertility, and may feel depressed, angry, tired, and anxious. Although emotionally depleted, couples are attracted to a technology that offers hope where none may have existed. They find themselves drawn into new emotional turbulence of contrasting feelings of hope and despair, which seems to be generated in part by the experience of the technology itself.
The opportunities that IVF creates brings with it significant challenges. IVF is considered by patients to be the most stressful of all infertility treatments. Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as a death of a family member and separation and divorce. While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique—each patient will experience the stress differently based upon his or her own personality and life experiences.
The aspects of IVF that are perceived stressful to patients are multifaceted and affect all parts of their life: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress impacts the marital relationship with an emotionally laden experience and, by removing the conjugal act of procreation, sexual intimacy is lost. Couples, also, are stretched financially paying for the high cost of IVF treatment with a relatively low probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, shots, sonograms, future health concerns, and decision making about embryos and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third party reproduction, when these values are in conflict with the choice of treatment.
The first treatment cycle has been found to be the most stressful for patients, with high levels of confusion, bewilderment, and anxiety. This may be due to inexperience with the process or possibly inadequate preparation of the patient by staff in terms of information and discussion of care. While experience seems to help the stress level in the next cycle, if it is unsuccessful the stress level rises again with the third cycle as the “stakes” have been raised. For many couples, IVF can feel like gambling where the stakes are high and the chance of success unknown. Like gamblers, some IVF patients may have unrealistically high expectations of success or feel compelled to try “just one more time” finding it difficult to end treatment after having already invested so much physically, emotionally, and financially to have a child.
Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving onto the next phase of treatment: monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation raises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization had occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process and the uncertainty of the outcome is highly distressing.
Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients are well adjusted. Further, there seems to be no long-term impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit.
IVF has the potential to be an emotionally, physically, and financially exhausting experience due to the “high stakes” and “end of the line” nature of this treatment. Thus, patients need to consider thoughtful preparation before beginning the process. If you are a patient about to begin a cycle, here are some tips to help get ready for IVF. Continue reading ‘Preparing for In Vitro Fertilization: Emotional Considerations’
Adult Day Care Centers
Excerpt from the U.S. Department of Eldercare Locator
Reviewed by NASW Office of Social Work Specialty Practice Staff
Today, family caregivers have options to choose from when they need assistance or respite. And, highly trained and experienced social workers are available to help caregivers sort through the range of available options. Below is a brief description of some of the caregiving services commonly available.
Adult Day Care
The goals of these programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: Adult social day care provides social activities, meals, recreation, and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.
How Do Adult Day Care Centers Operate?
These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.
Assisted Living
Assistive Technology
Assistive technology is any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently. These tools are also sometimes called “adaptive devices.”
Such technology may be something as simple as a walker to make moving around easier or an amplification device to make sounds easier to hear (for talking on the telephone or watching television, for instance). It could also include a magnifying glass that helps someone who has poor vision read the newspaper or a small motor scooter that makes it possible to travel over distances that are too far to walk. In short, anything that helps the elderly continue to participate in daily activities is considered assistive technology.
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