Social Impacts on Depression and Bi-Polar Disorder

The concept of abnormal behavior is hard to define, yet very often one’s inability to possess qualities to function normally in society, is labelled as a mental disorder (Afifi, 2007). The paper examines the case of Disco Di, also known as Diana Miller, a 25-year old Toronto female, who was diagnosed with Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD). Although Diana’s behavioral problems started during childhood, it was during her early teenage years that her depression and mood significantly changed. In addition to multiple issues with substance abuse, using marijuana, alcohol and hallucinogens, she has also been promiscuous during this period, running away with her boyfriend when she was only 15 years old. She remained unemployed after dropping out of high school and has not made any significant effort to continue with her studies nor find a job (First, Skodol, Spitzer & Williams, 2016). In this paper, the writer will draw on published literature to discuss the impacts of cultural, gender and environmental factors in Diana Miller`s case summary and further support personal perspective on treatment recommendations.

Diagnostic features and differential diagnosis

A) Diagnostic features accompanying Major Depressive Disorder (MDD) that are evident in Diana’s case summary include the feelings of guilt, sadness, hopelessness and despair as she spends a lot of time alone at home, and makes no meaningful effort to be socially active or economically productive. She feels depressed most of the day and her moods fluctuate from euphoria to depression within short periods of time. Also, she exhibits a markedly diminished interest in almost all activities, and her promiscuous behaviour further suggest she feels worthless and self-hatred. Furthermore, on more than one occasion in the case summary, Diana mentions that she suffers from intense boredom, which suggests restlessness and diminished ability to think or concentrate. Diagnostic features of MDD that are not covered in the case summary include sleep disturbances, as Diana’s fatigue levels were not mentioned and whether she suffers from insomnia or hypersomnia (Blatt el al., 2007). In regards to diagnostic features accompanying Borderline Personality Disorder (BPD), the feature of unstable relationships is evident as she has no close friends, and her romantic relationships are characterized by violent arguments and the fear abandonment is manifested in her insisting to be accompanied by one of her parents to her therapy sessions. Furthermore, recurrent suicidal behaviors are clear through the multiple attempts during the course of her life; once when she was 17 and was kicked out for refusing the sexual advances of her host and more recently when her parents were on vacation.

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Lastly, the feature of impulsivity and ultimately self-damaging behaviour is evident when Dian’s food is not cut into certain shapes that she prefers or is not presented as she likes, triggering violent outburst and binge eating activities. Diagnostic features that are noted mentioned for BPD in the case summary include dissociation and a warped sense of identity, as Diana did not mention feeling disconnected from her-self or the world (Allen el at., 2008).

B) Diana is also suffering from a Panic Disorder and the main diagnostic features indicating so are her continues substance abuse, increased stress levels and increasingly worsening agoraphobia, or the intense fear of being in uncontrolled and hard to escape environments. Furthermore, during her therapy sessions, she suffers from intense anxiety, exhibiting sweaty palms, increased heart rate and shaky hands which are also indicative of the development of a panic disorder. Diana’s binge eating may have been frequent enough to warrant the additional diagnosis of binge-eating disorder as she is always preoccupied with food (Comer, 2015d).

Cultural and gender factors

A) The range of possible interactions between culture and diagnostic features of mental disorders such as MDD and BPD is broad and multifaceted, as each society establishes norms for proper behaviour and judgments about what constitutes abnormality vary (Alarcon, 2009). What may be considered as perfectly acceptable behaviour in one culture may be seen as abnormal in another (Comer, 2015a). Cultures also vary with respect to the meaning they impart to illnesses and distress, which consequently related to how people cope with everyday problems and more extreme types of adversity. Cultures also have a big influence on whether individuals will seek help from health care professionals based on the level of stigma associated with mental disorders (Hashimoto, Kim & Mojaverian, 2013). Therefore, in order to reach a comprehensive perspective of one’s experience, so that the most appropriate treatment can be offered, the cultural background of individuals suffering from mental disorders must be thoroughly understood as it reflects one`s self-observation, self-image, self-esteem, interaction styles and social disposition and skills (Alarcon, 2009).

B) Gender stereotypes regarding proneness to emotional problems, anxiety and depressive disorders in women and alcoholism and substance abuse disorder in men shape the diagnostic features of mental disorders such as MDD and BPD (Afifi, 2007). The reinforcement of the above within society constrains help seeking as men are less socially acceptable to admit feeling depressed and mask their depression behind traditionally “masculine” symptoms. Furthermore, important social and life events that occur at puberty, pregnancy, and menopause could likewise have an effect on the high prevalence among women to suffer from depression and eating disorders and men to engage in high risk behaviours and commit suicide more frequently. Also, women are subject to more stress than men and face more poverty, more menial jobs, less adequate housing, and discrimination than men and in many homes, women bear a disproportionate share of responsibility for child care and housework. For too many women, experiences of self-worth, competence, autonomy, adequate income and a sense of physical, sexual and psychological safety and security, so essential to good mental health, are systematically denied (Comer, 2015c).

C) The social environment impacts the level support that societies offer those suffering from mental disorders. A supportive environment can protect against the onset of mental disorders, as it affects the likelihood of help seeking and the probability of a positive outcome from the care received (Hashimoto, Kim & Mojaverian, 2013). On the other hand, an environment marked by severe marital discord, overcrowding, and social disadvantage and conditions such as child abuse, neglect, and sexual abuse certainly increases the chance of individuals for mental disorders and suicide (Afifi, 2007).

Paradigm and treatment methods

A) The cognitive behavioural paradigm can be used to examine the nature of Diana’s behavior. This approach suggests that abnormal behaviours could occur when people make assumptions and adopt attitudes that are disturbing and inaccurate. An individual becomes distressed and attempts to eliminate intrusions to prevent his/her comprehended consequences. This intrusion reflects on the persons mind as a threat for which he/she feels personally responsible and later on which can build up into a clinical obsession, and this intrusion is then maintained through compulsions by the patient. In addition, within the cognitive behavioural paradigm the motivation of individuals is said to be measured by self-efficiency and expectations (Munira, 2013). Thus, this paradigm looks into the causative factors in the sufferer’s environment that leads to the health problems that Diana is facing. As she continues to arrive at self-defeating conclusions she eventually hit rock bottom and engaged in self-harm behaviours to cope with her feelings and tried to end her life (Comer, 2015b).

B) Currently, Diana is undergoing psychodynamic psychotherapy, which aims to help her unravel past and current problems, feelings and experiences and make sense of them through reflection. However, although she initially responded well to this form of treatment, it has not been effective in terms of addressing her mental health status as she became too anxious during her therapy sessions. Therefore, to address Diana’s MDD and BPD diagnoses, the cognitive behavioral theory (CBT) should be the chosen treatment. While psychodynamic psychotherapy deals with the underlying factors on a subconscious level, CBT focuses on the relationship between thoughts, feelings and behaviors and explores the patterns of thinking of a patient, which will ensures that Diana is cognizant of the factors that are being addressed by the therapist. In CBT, using collaborative therapeutic relationships, in which the therapist tries to be an inspiring and imaginative trainer in self-help skills, Diana will be encouraged to analyze her behaviour and become a scientific observer of himself and his or her thoughts, which will motivate her to achieve conscious healthy behavioral change (Asnaani, Fang, Hofmann, Sawyer & Vonk, 2012). CBT also allows for group sessions, which might come in useful later in her treatment plan, when her family members can be incorporated in the treatment process.

It is human nature to wonder why we act the way we do and when addressing abnormal behaviours, it is important to remember that human beings are changeable and that the causes of human functioning are both complex and dynamic (Afifi, 2007). Although research constantly adds to our understanding of mental disorders, the manner in which society passes judgement on others who clearly behave differently based on cultural, gender and social environmental factors has significant ramifications on research and treatment (Comer, 2015a). With no doubt there is something frightening about things we do not understand like with mental disorders, thus Diana might find it understandably hard to make sense of what is happening to her and it is important to promote and protect her health by addressing the barriers she might face. Helping a person with a mental illness might not change the world, but it will definitely change the world for that person.

References

Afifi, M. (2007). Gender differences in mental health. Singapore Med J, 48(5), 385-391. Retrieved from https://sites.oxy.edu/clint/physio/article/Genderdifferencesin mentalhealth.pdf

Asnaani, A., Fang, A., Hofmann, G. S., Sawyer, T. A. & Vonk, J. J. I. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. National institute of health, 36(5), 427-440. doi: 10.1007/s10608-012-9476-1

Alarcon, D. R. (2009). Culture, cultural factors and psychiatric diagnosis: review and projections. World Psychiatry, 8(3), 131-139. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755270/

Allen R. P., Eaton, W. W., Earley, C. J.,  Henning, W. A., Kalaydjian, A. E., Lee, H. B. & Lyketsos, C. G. (2008).  Restless legs syndrome is associated with DSM-IV major depressive disorder and panic disorder in the community. The Journal of Neuropsychiatry and clinical neurosciences, 20(1), 101-105. doi: 10.1176/jnp.2008.20.1.101.

Blatt, S. J., Corveleyn, J., De Grave, C., Jansen, B., Luyten, P., Meganck, S. & Sabbe, B., (2007). Dependency and self-criticism: Relationship with major depressive disorder, severity of depression, and clinical presentation. Depression and anxiety, 24(8), 586-596. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17143851

Comer, R. J. (2015a).  Chapter 1: abnormal psychology past and present. (9th ed.). In Abnormal psychology (1-24). New York, NY: Worth Publisher.

Comer, R. J. (2015b).  Chapter 3: models of abnormality. (9th ed.). In Abnormal psychology (55- 95). New York, NY: Worth Publisher.

Comer, R. J. (2015c).  Chapter 5: anxiety, obsessive- compulsive and related disorders. (9th ed.). In Abnormal psychology (129- 179). New York, NY: Worth Publisher.

Comer, R. J. (2015d).  Chapter 7: digressive and bipolar disorders. (9th ed.). In Abnormal psychology (216- 265). New York, NY: Worth Publisher.

First, B. M., Skodol, E. A., Spitzer, L. R. & Williams, B. W. J. (2016). Learning DSM-5 by Case Example. Retrieved from https://books.google.ca/books?id=c7cEDgAAQBAJ& pg=PA372&lpg=PA372&dq=diana+miller+disco+di+case&source=bl&ots=LwLKZMv_Ck&sig=pS8dquKFCkieuLLkTZ-tyUP5ktQ&hl=en&sa=X&ved=0ahUKEwi8o_2t9e7 SAhUC7oMKHTUGAzAQ6AEIPzAJ#v=onepage&q=diana%20miller%20disco%20di%20case&f=false

Hashimoto, T., Kim, S. H. & Mojaverian, T. (2013). Cultural differences in professional help seeking: a comparison of Japan and the U.S. Frontiers in Psychology, 3(615), 1-8. doi: 10.3389/fpsyg.2012.00615

Munira, S. (2013). Cognitive Behavioral Paradigm: The Best Way to Address Obsessive-Compulsive Disorder. Retrieved from https://sites.google.com/site/anthologyauw/non-fiction/selected/cognitive-behavioral-paradigm-the-best-way-to-address-obsessive-compulsive-disorder