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Minggu, 09 Juli 2017

Perfectionism is manifestation of personality disorder



Case vignette

Mr. R., working as pharmacist in a Government hospital, experiences ‘mental tension’ whenever he sees things at home or at the pharmacy in a disorderly fashion. He wants everything in orderly way and neat and tidy condition. He often scolds his only son studying in the higher secondary class for not keeping his books in neat and tidy manner. He did his daily exercise to keep himself fit but his son never bothered to do exercise. He couldn’t gather why he is all the time worried and dissatisfied. He was constantly disappointed with his wife and son who, according to him, never rose to his standards. He has been pointing out their faults, lecturing them about their duties and warning them about how their future would be doomed unless they changed their easygoing nature. His wife and son are becoming more and more detached and irresponsible, quite contrary to what he wanted. They seemed to be purposely not following his instructions. They avoided him even to the extent of refusing to sit together to have a meal. Obviously, they found his constant blaming and advising unacceptable.  He concluded: “Doctor, I am a perfectionist. But my wife and son are not. That is why I am worried about them. What should I do to correct them?”

Perfectionism is a personality disorder

Mr. R. was absolutely correct when he said that he was a perfectionist. But perfectionist is, as William Shakespeare said in King Lear, “striving to be better, oft mar what's well”. Perfectionism is the manifestation of a personality disorder called obsessive-compulsive personality disorder. In the international classification of diseases it is designated as ‘anancastic personality disorder.’ It is characterized by the following:
  1. feelings of excessive doubt and caution;
  2. preoccupation with details, rules, lists, order, organization or schedule;
  3. perfectionism that interferes with task completion;
  4. excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
  5. excessive pedantry and adherence to social conventions;
  6. rigidity and stubbornness;
  7. unreasonable insistence by the patient that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things;
  8. intrusion of insistent and unwelcome thoughts or impulses.


Perfectionists may be mistaken for high achievers, but there are some key differences between them. How to identify a perfectionist? Following are the telltale traits of perfectionist:

All-or-nothing thinking:

Perfectionists, like high achievers, tend to set high goals and work hard toward them. However, a high achiever becomes satisfied with doing a great job and achieving excellence or something close to it. They are not tense even if their very high goals aren’t completely met. Perfectionists will accept nothing less than perfection. Even “almost perfect” is considered as failure by perfectionists. This kind of evaluation of achievements is due to their “all-or-nothing thinking’. This type of thinking is a cognitive distortion. They see everything in black or white. Therefore this type of thinking is also called black-and-white thinking.

Harsh self-criticism:

Perfectionists are far more critical of themselves than are high achievers. While high achievers take pride in their accomplishments and tend to be supportive of others, perfectionists tend to spot tiny mistakes and imperfections in their own work, as well as in others work.

Perfectionists are pushed by fear:

High achievers tend to be pulled toward their goals by a desire to achieve them, and are happy with any steps made in the right direction. Perfectionists, on the other hand, tend to be pushed toward their goals by a fear of not reaching them. They see anything less than a perfectly met goal as a failure.

Unrealistic goals:

A perfectionist’s goals aren’t always reasonable. While high achievers can set their goals high, perhaps enjoying the fun of going a little further once goals are reached, perfectionists often set their initial goals out of reach. Because of this, high achievers tend to be not only happier, but more successful than perfectionists in the pursuit of their goals.

No result orientation:

High achievers can enjoy the process of chasing a goal. Perfectionists see the goal and nothing else. They’re so concerned about meeting the goal and avoiding the dreaded failure that they can’t enjoy the process of growing and striving.

Depressed by unmet goals:

While high achievers are able to bounce back fairly easily from disappointment, perfectionists tend to beat themselves up much more and wallow in negative feelings when their high expectations go unmet. This leads to depression.

Afraid to fail:

Perfectionists are also much more afraid to fail than are high achievers. Failure becomes a very scary prospect. And, since anything less than perfection is seen as ‘failure’, this can lead to procrastination.

Procrastination:

Procrastination is deferring an action to a later time. Perfectionism and procrastination do tend to go hand in hand. This is because, fearing failure as they do, perfectionists will sometimes worry so much about doing something imperfectly that they become immobilized and fail to do anything at all! This leads to more feelings of failure, and a vicious cycle is thus perpetuated.

Defensiveness:

Because a less-than-perfect performance is so painful and scary to perfectionists, they tend to take constructive criticism defensively, while high achievers can see criticism as valuable information to help their future performance.

Low self esteem:

High achievers tend to have high esteem of themselves; not so with perfectionists. They tend to be very self-critical and unhappy, and suffer from low self-esteem. They can also be lonely or isolated, as their critical nature and rigidity can push others away as well. This can lead to lower self-esteem.

Get rid of perfectionism

Perfectionism can rob you of your peace of mind, enjoyment of life, and self esteem. Though it’s a process that may take a little time, shedding the burden of perfectionism can greatly decrease the level of stress you feel on a daily basis.

Recognizing that a change may be needed is a very important first step toward creating a more easygoing nature and achieving the inner peace and real success that comes from overcoming perfectionism and being able to say that ‘almost perfect’ or ‘less than perfect’ is also a job well done.
A restructuring of cognition or mindset and personality is needed to get rid of perfectionism; here are some important steps you can take to maintain a healthier attitude:

Make a cost-benefit analysis:

Take a closer look at your perfectionist traits. You may think you’re more effective because of them. Many researchers have proved that this isn’t true. Perfectionism has many negative consequences, and you may be experiencing several of them right now. Make a list of all the ways perfectionism is hurting you (and those around you), and you’ll be more motivated to shed these tendencies.

Self-awareness of your tendencies:

By becoming more aware of your patterns, you’re in a better position to alter them. It is better to record your perfectionist thoughts as they pop into your mind. If it is impractical for you to write down thoughts as they come, try to go over your day each night and remember the times when you felt you’d failed, and write down what you thought at the time. This will help you become more aware of perfectionist thoughts as they come to you in the future.

See the positive:

Try to stop spotting mistakes. It may be difficult to just stop. But you can soften your tendency to notice the bad by making a conscious effort to notice all that is good with your work and the achievements of others. If you notice something you don’t like about yourself or your work, for example, look for five other qualities that you do like. This will balance out your critical focus and become a positive new habit.

Change your self-talk:

A perfectionist always engages in negative self-talk like ‘my work isn’t good enough’, ‘I am not trying hard enough’, and ‘they are not good enough’. Negative self talk can perpetuate unhealthy behaviors and wreak havoc on your self esteem; by altering your self-talk, you can go a long way toward enjoying life more and gaining an increased appreciation for yourself and your work. 

Set realistic goal

Perfectionists tend to set goals of unreasonable excellence. These goals tend to be unrealistic and cause problems by being so rigidly demanding and leaving little room for error. Instead, you can reduce a lot of stress by changing your goals.

Enjoy the process:

You may be used to focusing on results, and getting depressed if your results are less than perfect. One important way to recover from perfectionism is to begin focusing more on the process of reaching toward a goal, rather than just focusing on the goal itself. You can also enjoy the process of reaching a goal by getting involved with a group who is also trying to achieve the same goal you’re after. If you find you don’t achieve perfection, you can then reflect back and see all that you’ve gained in just working toward a worthy goal, assessing and appreciating the gains you did make in the process.

Learn to handle criticism:

Do not look at criticism as an attack and react defensively. Constructive criticism can give you important clues on how to improve your performance, making your less-than-perfect performances into useful stepping stones that lead to excellence. If the criticism you’re receiving is harsh, just remind others and yourself that mistakes are a great way to learn.

Senin, 03 Juli 2017

Christ is All We Need


I would like to thank Crosswalk.com for their kind permission in letting me reprint the below devotional written by Selwyn Hughes.

The desire for God
For reading & meditation: Psalms 42:1-11

"My soul thirsts for God, for the living God '" (v.2)

Yesterday we looked at the words: "Whom have I in heaven but you?" Now we examine the second part of that text: "And earth has nothing I desire besides you" (Psa. 73:25b). Personally, I find these some of the most enchanting words in the whole of the Old Testament. The first part of the verse is put in a negative, and the second in a positive form. Having looked around and seen that there is no satisfying substitute for the Almighty, the psalmist goes on to make the positive assertion that from the bottom of his heart he desires to know God. He has come to see (so I believe) that it is more important to desire God for who He is than for what He does or what He gives. In a sense, the psalmist's entire problem arose out of the fact that he had put what God gives in the place of God Himself. The ungodly were having a good time while he was having a bad time. Why was he having to suffer like this? His trouble was that he had become more interested in the things God gives than in God Himself, and when he didn't have the things he wanted, he began to doubt God's love. Now, however, he has come to the place where he desires God for Himself. The ultimate test of the Christian life is whether we desire God for Himself or for what He gives. Each one of us must ask ourselves: "Do I desire God more than forgiveness? More than release from my problems? More than healing of my condition? More than gifts and abilities?" How tragic that our prayers can be full of pleadings that show, when they are examined, that we are more interested in enjoying God's blessings than we are in enjoying God.

Prayer:
O Father, forgive me that so often I am concerned more with Your gifts than I am with You - the Giver. Help me to long after You, not because of what You give me, but because of who You are. In Jesus' Name I ask it Amen.


If you would like to read more of Selwyn Hughes devotionals, Every day Light, they are uploaded every day on Crosswalk's website. You can also subscribe to receive the devotionals by email.

From my diary, 10th April 1990, during my first major depressive disorder episode
I see others who live and prosper,
and yet here I am, stuck in this dark prison cell.
Jesus, where are You?
Please see my circumstances and hear my prayer.
Why do You remain silent?
It makes it look like You don’t care,

I have noticed that when Christians undergo trials and tribulations, such as depression, they may become caught up on the issue that God does not appear to hear or answer their fervent prayers for help. As a result, they may become frustrated and disappointed, or even bitter and angry with God, and in some cases, lose faith in Him and believe He no longer loves them. They may even become depressed as a result.

In the above devotional by Selwyn Hughes, he shows us the underlying problem in our thinking that causes such harmful reactions in us when our prayers for relief from suffering are not answered. Selwyn writes this about the Psalmist - ‘His trouble was that he had become more interested in the things God gives than in God Himself, and when he didn't have the things he wanted, began to doubt God's love.’ Finally, the Psalmist ‘came to the place where he desires God for Himself.’

Even if we had nothing else, even if all our prayers went unanswered, even if we suffered until the day we died, to have Jesus - to have the incomparable riches and wonder of knowing Him, our loving Lord and God, is enough. Selwyn Hughes writes - ‘The ultimate test of the Christian life is whether we desire God for Himself or for what He gives.’ And when we desire God for Himself instead of for what He gives, our perspective on life changes completely. Rather than getting frustrated, angry, bitter and disillusioned when prayers are not being answered, we still have inner peace and joy because we have God Himself, and He will never leave us. 'Be strong and courageous. Do not be terrified; do not be discouraged, for the LORD your God will be with you wherever you go.' Joshua 1:9

I would like to encourage every Christian to ask themselves in which category they fall, and if in the latter, to hunger and thirst for Jesus and make knowing Him their greatest desire.

I consider everything a loss compared to the surpassing greatness of knowing Christ Jesus my Lord, for whose sake I have lost all things. I consider them rubbish, that I may gain Christ. Philippians 3:8



Minggu, 26 Februari 2017

Boredom is an anagram of Bedroom which is ironic because I am bored in my bedroom


I am bored. I have been bored for 4 hours. And a bit. I am sitting on a chair in my room, which squeaks every time I move. I am wearing a pyjama top, hoody, and shorts. It is raining. Which is quite nice. I like the rain. My windowsills are soaking wet because I can't be bothered to shut my windows. I need a wee, and have needed one for quite a while. My right index finger aches from endlessly scrolling and refreshing, with minimal positive outcomes. My left hand is getting that pre-pins and needles thing because I've had a tissue pressed to my face for a good 10 minutes as I've picked a scab and now it's bleeding like frickin' Niagara Falls. My room is engulfed in a strong stench of nail varnish remover, which is probably quite dangerous, but I've left the top to the bottle in mum's room and can't be arsed to get it. I also can't be arsed to remove the rest of my nail varnish so have a green stained thing going on with my nails.

(I couldn't hold my wee any longer)

Can't believe I'm so bored I've resorted to talking about my need for wee. C'est la vie. STOP RHYMING.

Jesus.













It worries me that in my second week of the summer holidays (technically speaking, seeing as the first full week was Kos week) I'm bored already. I've done nothing today. Nothing. N o t h i n g. I should be used to doing nothing, seeing as that's what we did in Kos. We lay in the sun all day, doing nothing. Although to be fair, lying on the sofa while my little brother runs around the house with friends screaming, while my mum is screaming at them, and my dad has the football on the TV at maximum volume because of said screaming...isn't really the same. I'd do a whole blog post dedicated to mine and Clare's gallivanting around Kos, but it wouldn't be worth it because we did, er, nothing. So have some photos here instead.

Things I have managed to achieve today:

  • Get up before midday.
  • Finally persuade the 'rents to let me have an 18th birthday party at home. (ooooohyeeeeeeah)
  • Make a Facebook event for said party, and continually refresh it to see if people like me and 'attend'.
  • Eat a roast dinner. Achievement, I know. It's succeeding through battles like this that spur me on for greater future success, and make me proud to be a human being.
  • Watch 3 cat youtube videos.
  • Watch 1 adorable child youtube video.
  • Watch 1 freaky youtube video.
  • See 3 twitter fights unfold.
  • Carry on writing my book. The document is open.
  • Take off and reapply my nail varnish. (work in progress)
*le sigh*

Today IS special, though, because I have a new baby cousin. Zachary.


































So combing these photos, with the new one of Beckham and Baby...















...I now feel like my fallopian tubes are flapping around my face, while my brooding heart bleeds out my eyes with every new photo. I want a baby. Now.*

WELL, that's about it. I'm gonna goooo aaaannnddd....oh let's not kid ourselves I'll still be sitting here until midnight. But know that I am going in the Big Brother house for a day on Thursday with the likes of EMMA KENNEDY (yeah you heard right) so my boredom will be severely diminished. Ciao. X

(* I am, of course, totally lying, but I've always held a small hope that one day a baby will be left on our doorstep, or I find one abandoned on the side of the road.)

THE BELOW WHITE SPACE WON'T GO AWAY. IT'S IRRITATING, AND EVEN MORE SO THAT I CAN'T FIND A DOWN ARROW ON MY KEYBOARD TO DISPLAY IT. DAMN YOU, WHITE SPACE, AND YOUR LINGERING WAYS.





Jumat, 20 Januari 2017

Depression is a Symptom Not a Psychiatric Disorder




Lately there have been a slew of articles about "depression" that seem to go out of their way to avoid discussing any specific psychiatric diagnosis listed in the DSM - instead strongly implying that "depression" is itself a disorder. These articles appear in the popular press, but, frighteningly, also in newsletters and newspapers for psychiatrists and psychologists. They explore such questions as "Do antidepressants work?" and "What is better for depression, drugs or cognitive behavioral therapy?"

These types of questions are completely meaningless. Depression is discussed as if it were a single phenomenon that, at best, exists on a continuum from "mild" to "moderate" to "severe." This type of wording is in fact completely ignorant, but does not necessarily reflect real ignorance. In many cases, different entities such as big Pharma have a vested interest in conflating several different psychiatric conditions.

In truth, "depression" is just a mood state, and as a symptom, it can be part of many different psychiatric disorders that are, despite some overlap in symptomatology, as different as night and day when it comes to their clinical presentations as well as their response to various treatments.

To name but a few actual diagnoses, there is major depression (both as part of unipolar and bipolar disorder), dysthymia, adjustment disorder with depression, depression due to a medical condition, and depression due to a substance. Medical conditions that can lead to depressive symptoms include hypothyroidism and some strokes. Substances that can do that include some steroids like prednisone and the "crash" that results when an acute cocaine high wears off.

Furthermore, "depression" as discussed in every day conversation can be a normal mood that is part of chronic unhappiness, or that occurs in response to grief at someone's death or due to any other loss or misfortune.

The most important diagnostic distinction for this discussion is between major or clinical depression and dysthymia. Although we don't know enough about the brain to know the exact causes of either one, and there is some overlap in symptomatology, they appear for the most part with very distinct clinical presentations, especially in their classic forms.

Dysthymia appears to be more of a psychological reaction, while major depression probably involves the more primitive part of the brain called the limbic system. The latter, unlike the former, is accompanied by a whole array of chronic, persistent (lasting all day every day for at least two weeks), and pervasive (coloring all aspects of the patient's mental life) physical symptoms - all at the same time - involving sleep, appetite, ability to experience pleasure, energy level and motivation, and concentration. Sufferers may have an unrelenting and constant sense of foreboding accompanied by inexplicable hopelessness and helplessness. We used to refer to these types of symptoms as vegetative symptoms.

Furthermore, someone in a major depressive disorder episode reacts completely differently to life's every day ups and downs than they do when they are not in the middle of such an episode. It's almost Jeckyl and Hyde territory.

These people stay depressed no matter what life events occur around them. They could literally win the lottery and would not really feel a whole lot better for more than a few minutes.

The most severe form of major depression is called melancholic depression. Most people who have never worked in a mental hospital have never seen a case, but the anti-psychiatry types who have not seen it blather on about depression incessantly as if they knew what they were talking about.

People with melancholic depression exhibit something called psychomotor retardation. People with this symptom move and think at a snail's pace.  It takes them longer to respond to any verbal interactions. They can even appear to have significantly impaired memory, although it is actually a more severe form of concentration impairment. That clinical picture is sometimes referred to as pseudodementia. 

You cannot spend more than an hour with such people without realizing that this condition has next to nothing in common with the type of "depression" people see in their everyday interactions with others, and that there is something seriously wrong with their brain functioning.

In severe major depression, doing any kind of psychotherapy (short of telling them, "take these pills") is a complete and utter waste of time. Sufferers literally do not have the mental wherewithal to deal with any kind of problem solving or other interactions with a therapist. And I say that as a major advocate of psychotherapy.

The symptom of depression in dysthymic disorder, on the other hand, rarely responds to antidepressant medication at all (although the drugs can be useful for other symptoms seen in patients with dysthymia such as panic attacks, obsessive ruminations, and the affective instability characteristic of borderline personality disorder). For these folks, psychotherapy is essential.

In my experience a very high percentage of the people who do drug and psychotherapy outcome studies, at least in adults, make almost no meaningful effort to differentiate dysthymia from major depression by: 1) Not spending any time making certain that patients understand the pervasiveness and persistence criteria that differentiate the symptoms of the two disorders; and by 2) Not taking a complete biopsychosocial history to distinguish psychological from limbic system factors.

All of the fancy biological research is not being complemented by good old fashioned clinical typing.

Furthermore, with the private Contract Research Organizations that do a lot of the studies, experimenters get paid only if they recruit a subject, and subjects get paid only if they get recruited - giving a financial incentive for everyone to exaggerate symptoms in order to qualify.

And people with suicidal ideation, comorbid (other, co-occurring) conditions, and significant personality pathology are excluded from studies. Those "exclusions" eliminate the vast major of subjects that have any of the psychiatric disorders in which depression is a symptom.

Garbage in, garbage out.

By the way, you can also have something called double depression. Such people are generally dysthymic but every so often can have a superimposed episode of major depression. So they have both conditions.

Once a major depressive episode starts to occur, it takes on a life of its own. However, being chronically unhappy, anxious, or stressed out may be risk factors for triggering a major depressive episode to begin with.  If you are genetically vulnerable to an episode of major depression, being chronically unhappy might make an episode more likely.

This is another reason why the question, "Should you treat these people with medications or therapy" is a really stupid question. It's a bit like asking, "Which treatment should people who have extensive, severe, cardiovascular disease get, bypass surgery or high blood pressure medication?" 

These treatments address completely different aspects of the disorder. In major depressive disorder, drugs should be used during the acute disorder, but psychotherapy should be given later to address personality  and relationship risk factors - in order to reduce the likelihood of subsequent episodes.

Selasa, 17 Januari 2017