Therapies – Behavior and Psychological Issues

Behavioral Therapy

When we are born, we only have a basic instinct. We know how to eat, how to excrete, and how to get attention (e.g. crying). All other behaviors are learned. Some we learn as a baby, others in the various life stages: toddler, kid, teen, young adult, adult, middle age, or senior. All of our behavior is learned by example, by watching others, by modelling our actions on the actions of others. Our primary teachers for this modelling are our parents, but we also imitate other sources – especially where there is association (pain/pleasure) or repetition (monkey see, monkey do). When our behavior is congruent with society we experience less external conflict (you are seen as ‘normal’) but as a result we can experience inner conflict (not being able to express yourself leads to suppressed emotions). Alternatively we are congruent with self (express ourselves and damn the consequences) and this may cause external conflict (family/friends/others/establishment). Wrong modelling, and suppressed emotions, can lead to non-desirable behaviors. Hypnosis is very successful in correcting this to more desirable behavior.


Please click on any of the issues below to find out about it in more detail.


Self Confidence

Self-belief has been directly connected to an individual's social network, the activities they participate in, and what they hear about themselves from others. Positive self-esteem has been linked to factors such as psychological health, mattering to others, and both body image and physical health. Low self-esteem in adolescents has been shown to be an important predictor of unhealthy behaviors and psychological problems such as suicidal ideation later in life.

During adolescence, self-esteem is affected by age, race, ethnicity, puberty, health, body height, body weight, body image, involvement in physical activities, gender presentation, gender identity, and awakening or discovery of sexuality. Self-confidence can vary and be observed in a variety of dimensions. Components of one's social and academic life affect self-esteem. An individual's self-confidence can vary in different environments, such as at home or in school.


Motivation is a theoretical construct used to explain behavior. It represents the reasons for people's actions, desires, and needs. Motivation can also be defined as one's direction to behavior or what causes a person to want to repeat a behavior and vice versa.[1] A motive is what prompts the person to act in a certain way or at least develop an inclination for specific behavior.[2] For example, when someone eats food to satisfy the need of hunger, or when a student does his/her work in school because he/she wants a good grade. Both show a similar connection between what we do and why we do it. According to Maehr and Meyer, "Motivation is a word that is part of the popular culture as few other psychological concepts are"

Self Image

A person's self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to objective investigation by others (height, weight, hair color, gender, I.Q. score, etc.), but also items that have been learned by that person about himself or herself, either from personal experiences or by internalizing the judgments of others. A simple definition of a person's self-image is their answer to the question "What do you believe people think about you?".
Self-image may consist of three types:

• Self-image resulting from how the individual sees himself or herself.
• Self-image resulting from how others see the individual.
• Self-image resulting from how the individual perceives others see him or her.

These three types may or may not be an accurate representation of the person. All, some or none of them may be true.


Physiological or biological stress is an organism's response to a stressor such as an environmental condition or a stimulus. Stress is a body's method of reacting to a challenge. According to the stressful event, the body's way to respond to stress is by sympathetic nervous system activation which results in the fight-or-flight response. Because the body cannot keep this state for long periods of time, the parasympathetic system returns the body's physiological conditions to normal (homeostasis). In humans, stress typically describes a negative condition or a positive condition that can have an impact on a person's mental and physical well-being.


Anger or wrath is an intense emotional response. Often it indicates when one's basic boundaries are violated. Some have a learned tendency to react to anger through retaliation. Anger may be utilized effectively by setting boundaries or escaping from dangerous situations. Sheila Videbeck describes anger as a normal emotion that involves a strong uncomfortable and emotional response to a perceived provocation.[1] Raymond Novaco of UC Irvine, who since 1975 has published a plethora of literature on the subject, stratified anger into three modalities: cognitive (appraisals), somatic-affective (tension and agitations), and behavioral (withdrawal and antagonism).[2] William DeFoore, an anger-management writer, described anger as a pressure cooker: we can only apply pressure against our anger for a certain amount of time until it explodes.[3]

Anger may have physical correlates such as increased heart rate, blood pressure, and levels of adrenaline and noradrenaline.[4] Some view anger as an emotion which triggers part of the fight or flight brain response.[5] Anger becomes the predominant feeling behaviorally, cognitively, and physiologically when a person makes the conscious choice to take action to immediately stop the threatening behavior of another outside force.[6] The English term originally comes from the term anger of Old Norse language.[7] Anger can have many physical and mental consequences.

The external expression of anger can be found in facial expressions, body language, physiological responses, and at times in public acts of aggression.[8] Animals, for example, make loud sounds, attempt to look physically larger, bare their teeth, and stare.[9] The behaviors associated with anger are designed to warn aggressors to stop their threatening behavior. Rarely does a physical altercation occur without the prior expression of anger by at least one of the participants.[9] While most of those who experience anger explain its arousal as a result of "what has happened to them," psychologists point out that an angry person can very well be mistaken because anger causes a loss in self-monitoring capacity and objective observability.[10]

Modern psychologists view anger as a primary, natural, and mature emotion experienced by virtually all humans at times, and as something that has functional value for survival. Anger can mobilize psychological resources for corrective action. Uncontrolled anger can, however, negatively affect personal or social well-being.[10][11] While many philosophers and writers have warned against the spontaneous and uncontrolled fits of anger, there has been disagreement over the intrinsic value of anger.[12] The issue of dealing with anger has been written about since the times of the earliest philosophers, but modern psychologists, in contrast to earlier writers, have also pointed out the possible harmful effects of suppressing anger.[12] Displays of anger can be used as a manipulation strategy for social influence.[13][14]


In psychology, frustration is a common emotional response to opposition. Related to anger and disappointment, it arises from the perceived resistance to the fulfillment of individual will. The greater the obstruction, and the greater the will, the more the frustration is likely to be. Causes of frustration may be internal or external. In people, internal frustration may arise from challenges in fulfilling personal goals and desires, instinctual drives and needs, or dealing with perceived deficiencies, such as a lack of confidence or fear of social situations. Conflict can also be an internal source of frustration; when one has competing goals that interfere with one another, it can create cognitive dissonance. External causes of frustration involve conditions outside an individual, such as a blocked road or a difficult task. While coping with frustration, some individuals may engage in passive–aggressive behavior, making it difficult to identify the original cause(s) of their frustration, as the responses are indirect. A more direct, and common response, is a propensity towards aggression.


Worry refers to the thoughts, images and emotions of a negative nature in which mental attempts are made[vague] to avoid anticipated potential threats. As an emotion it is experienced as anxiety or concern about a real or imagined issue, often personal issues such as health or finances, or broader issues such as environmental pollution and social or technological change. Most people experience short-lived periods of worry in their lives without incident; indeed, a moderate amount of worrying may even have positive effects, if it prompts people to take precautions (e.g., fastening their seat belt or buying fire insurance) or avoid risky behaviors (e.g., angering dangerous animals, or binge drinking).


Guilt is a cognitive or an emotional experience that occurs when a person realizes or believes—accurately or not—that he or she has compromised his or her own standards of conduct or has violated a moral standard and bears significant responsibility for that violation. It is closely related to the concept of remorse

Nail Biting

Nail biting is considered an impulse control disorder in the DSM-IV-R, and is classified under obsessive-compulsive and related disorders in the DSM-5. The ICD-10 classifies it as "other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence." Nevertheless, the frontier between normal and a pathological nail biting is not clear.

Nail biting usually leads to deleterious effects in fingers, but also mouth and more generally the digestive system. These consequences are directly derived from the physical damage of biting or from the hands becoming an infection vector. Moreover, it can also have a social impact.

The ten fingernails are usually equally bitten to approximately the same degree. Biting nails can lead to broken skin on the cuticle. When cuticles are improperly removed, they are susceptible to microbial and viral infections such as paronychia. Saliva may then redden and infect the skin. In rare cases, fingernails may become severely deformed after years of nail biting due to the destruction of the nail bed.

Nail biting is also related to oral problems, such as gingival injury, and malocclusion of the anterior teeth. It can also transfer pinworms or bacteria buried under the surface of the nail to the mouth. When the bitten-off nails are swallowed, stomach problems can develop.

Nail-biting is also associated to guilt and shame feelings in the nail biter, a reduced quality of life, and increased stigmatization in the inner family circles or at a more societal level.


Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behavior, such as pacing back and forth, somatic complaints and rumination. It is the subjectively unpleasant feelings of dread over anticipated events, such as the feeling of imminent death. Anxiety is not the same as fear, which is a response to a real or perceived immediate threat; whereas anxiety is the expectation of future threat. Anxiety is a feeling of fear, worry, and uneasiness, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing. It is often accompanied by muscular tension, restlessness, fatigue and problems in concentration. Anxiety can be appropriate, but when experienced regularly the individual may suffer from an anxiety disorder.

People facing anxiety may withdraw from situations which have provoked anxiety in the past. There are different types of anxiety. Existential anxiety can occur when a person faces angst, an existential crisis, or nihilistic feelings. People can also face test anxiety, mathematical anxiety, stage fright or somatic anxiety. Another type of anxiety, stranger anxiety and social anxiety are caused when people are apprehensive around strangers or other people in general. Anxiety can be either a short term 'state' or a long term "trait". Anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear, whereas trait anxiety is a worry about future events, close to the concept of neuroticism. Anxiety disorders are partly genetic but may also be due to drug use including alcohol and caffeine, as well as withdrawal from certain drugs. They often occur with other mental disorders, particularly major depressive disorder, bipolar disorder, certain personality disorders, and eating disorders. Common treatment options include lifestyle changes, therapy, and medications.


Assertiveness is the quality of being self-assured and confident without being aggressive. In the field of psychology and psychotherapy, it is a learnable skill and mode of communication. Dorland's Medical Dictionary defines assertiveness as: "a form of behavior characterized by a confident declaration or affirmation of a statement without need of proof; this affirms the person's rights or point of view without either aggressively threatening the rights of another (assuming a position of dominance) or submissively permitting another to ignore or deny one's rights or point of view".

During the second half of the 20th century, assertiveness was increasingly singled out as a behavioral skill taught by many personal development experts, behavior therapists, and cognitive behavioral therapists. Assertiveness is often linked to self-esteem. The term and concept was popularized to the general public by books such as Your Perfect Right: A Guide to Assertive Behavior (1970) by Robert E. Alberti, and When I Say No, I Feel Guilty: How To Cope Using the Skills of Systematic Assertiveness Therapy (1975) by Manuel J. Smith.


Procrastination is the practice of carrying out less urgent tasks in preference to more urgent ones, or doing more pleasurable things in place of less pleasurable ones, and thus putting off impending tasks to a later time, sometimes to the "last minute" before a deadline. People may procrastinate personal issues (raising a stressful issue with a partner), health issues (seeing a doctor or dentist), home care issues (patching a leak in a roof), or academic/work obligations (completing a report).

In recent years, procrastination has had a strong relation with social media. Office workers and students working on computers may find that checking and re-checking for updates on social media sites interferes with their work.

The pleasure principle may be responsible for procrastination; one may prefer to avoid negative emotions, and to delay stressful tasks. The belief that one works best under pressure provides an additional incentive to the postponement of tasks. Some psychologists cite such behavior as a mechanism for coping with the anxiety associated with starting or completing any task or decision. Piers Steel indicated in 2010 that anxiety is just as likely to get people to start working early as late and the focus should be impulsiveness. That is, anxiety will cause people to delay only if they are impulsive.

Procrastination may result in stress, anxiety, a sense of guilt and crisis, health problems, and severe loss of personal productivity, as well as social disapproval for not meeting responsibilities or commitments. These feelings combined may promote further procrastination. While it is regarded as normal for people to procrastinate to some degree, it becomes a problem when it impedes normal functioning. Chronic procrastination may be a sign of an underlying psychological disorder. Such procrastinators may have difficulty seeking support due to social stigma and the belief that task-aversion is caused by laziness, low willpower, or low ambition. On the other hand many regard procrastination as a useful way of identifying what is important to us personally as it is rare to procrastinate when one truly values the task at hand.

Attitude Adjustment

An attitude is an evaluation of an attitude object, ranging from extremely negative to extremely positive. Most contemporary perspectives on attitudes also permit that people can also be conflicted or ambivalent toward an object by simultaneously holding both positive and negative attitudes toward the same object. This has led to some discussion of whether individual can hold multiple attitudes toward the same object.

An attitude can be as a positive or negative evaluation of people, objects, events, activities, and ideas. It could be concrete, abstract or just about anything in your environment, but there is a debate about precise definitions. Eagly and Chaiken, for example, define an attitude as "a psychological tendency that is expressed by evaluating a particular entity with some degree of favor or disfavor." Though it is sometimes common to define an attitude as affect toward an object, affect (i.e., discrete emotions or overall arousal) is generally understood to be distinct from attitude as a measure of favorability. Attitude may influence the attention to attitude objects, the use of categories for encoding information and the interpretation, judgement and recall of attitude-relevant information. These influences tend to be more powerful for strong attitudes which are easily accessible and based an elaborate knowledge structure. Attitudes may guide attention and encoding automatically, even if the individual is pursing unrelated goals.

Self-Defeating Behaviors (Irrationality)

Irrationality is cognition, thinking, talking or acting without inclusion of rationality. It is more specifically described as an action or opinion given through inadequate use of reason, emotional distress, or cognitive deficiency. The term is used, usually pejoratively, to describe thinking and actions that are, or appear to be, less useful, or more illogical than other more rational alternatives.

Irrational behaviors of individuals include taking offense or becoming angry about a situation that has not yet occurred, expressing emotions exaggeratedly (such as crying hysterically), maintaining unrealistic expectations, engaging in irresponsible conduct such as problem intoxication, disorganization, or extravagance, and falling victim to confidence tricks. People with a mental illness like schizophrenia may exhibit irrational paranoia.

These more contemporary "normative conceptions" of what constitutes a manifestation of irrationality are difficult to demonstrate empirically because it is not clear by whose standards we are to judge the behavior rational or irrational. Irrationality, historically speaking, is an outcome of the ancient Greek separation of rationality (logos) from emotion and sensuality as the sources of "false" assumptions and statements.


Criticism is the practice of judging the merits and faults of something. Criticism as an evaluative or corrective exercise can occur in any area of human life. Criticism can therefore take many different forms (see below). How exactly people go about criticizing, can vary a great deal. In specific areas of human endeavor, the form of criticism can be highly specialized and technical; it often requires professional knowledge to understand the criticism. This article provides only general information about criticism. To criticize does not necessarily imply "to find fault", but the word is often taken to mean the simple expression of an objection against prejudice, or a disapproval of something. Often criticism involves active disagreement, but it may only mean "taking sides". It could just be an exploration of the different sides of an issue. Fighting is not necessarily involved.

Criticism is often presented as something unpleasant, but it need not be. It could be friendly criticism, amicably discussed, and some people find great pleasure in criticism ("keeping people sharp", "providing the critical edge").

Normally criticism involves a dialogue of some kind, direct or indirect, and in that sense criticism is an intrinsically social activity. Even if one is only criticizing a book or an idea in private, it is usually assumed there is someone who will be made aware of the criticism being expressed at some point, although who exactly will hear it, may also remain unknown. One is still engaging with the ideas of others, even if only indirectly. One can of course also keep a criticism to oneself, rather than express or communicate it, but in general the intention is, that someone else ought to be aware of it, however that may occur. Self-criticism, even if wholly private, still mentally takes the concerns of others into account.


Irritability is an excitation response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli. It is usually used to refer to anger or frustration. Irritability can be a growing response to the objective stimuli of hunger or thirst in animals or humans which then reaches some level of awareness of that need.

Irritability may be demonstrated in behavioral responses to both physiological and behavioral stimuli including environmental, situational, sociological, and emotional stimuli.


Pessimism is a state of mind in which one anticipates undesirable outcomes or believes that the evil or hardships in life outweigh the good or luxuries. Value judgments may vary dramatically between individuals, even when judgments of fact are undisputed. The most common example of this phenomenon is the "Is the glass half empty or half full?" situation. The degree in which situations like these are evaluated as something good or something bad can be described in terms of one's optimism or pessimism respectively. Throughout history, the pessimistic disposition has had effects on all major areas of thinking.


Control freaks are often perfectionists defending themselves against their own inner vulnerabilities in the belief that if they are not in total control they risk exposing themselves once more to childhood angst. Such persons manipulate and pressure others to change so as to avoid having to change themselves, and use power over others to escape an inner emptiness. When a control freak's pattern is broken, “the Controller is left with a terrible feeling of powerlessness … But feeling their pain and fear brings them back to themselves”.

Control freaks appear to have some similarities to codependents, in the sense that the latter’s fear of abandonment leads to attempts to control those they are dependent on. Recovery for them entails recognizing that being a control freak helped paradoxically preserve codependency itself.

In terms of personality-type theory, control freaks are very much the Type A personality, driven by the need to dominate and control.

Panic Attacks

Panic attacks are periods of intense fear or apprehension of sudden onset accompanied by at least four or more bodily or cognitive symptoms (such as heart palpitations, dizziness, shortness of breath, or feelings of unreality) and of variable duration from minutes to hours. Panic attacks usually begin abruptly and may reach a peak within 10 to 20 minutes but may continue for hours in some cases. Panic attacks are not dangerous and should not cause any physical harm.

The effects of a panic attack vary. Some, notably first-time sufferers, may call for emergency services. Many who experience a panic attack, mostly for the first time, fear they are having a heart attack or a nervous breakdown. Common psychological themes associated with panic attacks include the fears of impending death or loss of sanity; depersonalization is relatively common.

Panic attacks are of acute onset, although acute debilitation (generally severe) may be followed by a period of residually impaired psychological functioning. Repeated panic attacks are considered a symptom of panic disorder. Screening tools such as the Panic Disorder Severity Scale can be used to detect possible cases of disorder and suggest the need for a formal diagnostic assessment.


Temptation is a fundamental desire to engage in short-term urges for enjoyment, that threatens long-term goals. In the context of some religions, temptation is the inclination to sin. Temptation also describes the coaxing or inducing a person into committing such an act, by manipulation or otherwise of curiosity, desire or fear of loss.

In the context of self-control and ego depletion, temptation is described as an immediate, pleasurable urge and/or impulse that disrupts an individual’s ability to wait for the long-term goals that individual hopes to attain.

More informally, temptation may be used to mean "the state of being attracted and enticed" without anything to do with moral, ethical, or ideological valuation; for example, one may say that a piece of food looks "tempting" even though eating it would result in no negative consequences.


Aggression is overt, often harmful, social interaction with the intention of inflicting damage or other unpleasantness upon another individual. It is a virtually universal behavior among animals. It may occur either in retaliation or without provocation. In humans, frustration due to blocked goals can cause aggression. Submissiveness may be viewed as the opposite of aggressiveness.

In definitions commonly employed in the social sciences and behavioral sciences, aggression is a response by an individual that delivers something unpleasant to another person. Some definitions include that the individual must intend to harm another person. Predatory or defensive behavior between members of different species may not be considered aggression in the same sense.

Aggression can take a variety of forms which may be expressed physically or communicated verbally or non-verbally: including anti-predator aggression, defensive aggression (fear-induced), predatory aggression, dominance aggression, inter-male aggression, resident-intruder aggression, maternal aggression, species-specific aggression, sex-related aggression, territorial aggression, isolation-induced aggression, irritable aggression, and brain-stimulation-induced aggression (hypothalamus). There are two subtypes of human aggression: controlled-instrumental subtype (purposeful or goal-oriented); and reactive-impulsive subtype (often elicits uncontrollable actions that are inappropriate or undesirable). Aggression differs from what is commonly called assertiveness, although the terms are often used interchangeably among laypeople (as in phrases such as "an aggressive salesperson").


Two main types of self-blame exist:

1. Behavioral self-blame – undeserved blame based on actions. Victims who experience behavioral self-blame feel that they should have done something differently, and therefore feel at fault.
2. Characterological self-blame – undeserved blame based on character. Victims who experience characterological self-blame feel there is something inherently wrong with them which has caused them to deserve to be victimized.

Behavioral self-blame is associated with feelings of guilt within the victim. While the belief that one had control during the abuse (past control) is associated with greater psychological distress, the belief that one has more control during the recovery process (present control) is associated with less distress, less withdrawal, and more cognitive reprocessing.

Counseling responses found helpful in reducing self-blame include:

•supportive responses
•psychoeducational responses (learning about rape trauma syndrome for example)
•responses addressing the issue of blame.

A helpful type of therapy for self-blame is cognitive restructuring or cognitive–behavioral therapy. Cognitive reprocessing is the process of taking the facts and forming a logical conclusion from them that is less influenced by shame or guilt.


Hostility is seen as form of emotionally charged angry behavior. In everyday speech it is more commonly used as a synonym for anger and aggression.

It appears in several psychological theories. For instance it is a facet of neuroticism in the NEO PI, and forms part of personal construct psychology, developed by George Kelly.

In psychological terms, Kelly considered hostility as the attempt to extort validating evidence to confirm types of social prediction, constructs that have failed. .[citation needed] Instead of reconstruing their constructs to meet disconfirmations with better predictions, the hostile person attempts to force or coerce the world to fit their view, even if this is a forlorn hope, and even if it entails emotional expenditure and/or harm to self or others. In this sense hostility is a form of psychological extortion - an attempt to force reality to produce the desired feedback, even by acting out in bullying by individuals and groups in various social contexts, in order that preconceptions become ever more widely validated. In this sense, hostility is an alternative response to cognitive dissonance.

While challenging reality can be a useful part of life, and persistence in the face of failure can be a valuable trait (for instance in invention or discovery[citation needed]), in the case of hostility it is argued that evidence is not being accurately assessed when the decision is made to repeat the same approach .[citation needed] Instead it is claimed that hostility shows evidence of suppression or denial, and is "deleted" from awareness - unfavorable evidence which might suggest that a prior belief is flawed is to various degrees ignored and willfully avoided[citation needed


Premenstrual syndrome (PMS) refers to physical and emotional symptoms that occur in the one to two weeks before a woman's period. Symptoms often vary between women and resolve around the start of bleeding. Common symptoms include acne, tender breasts, bloating, feeling tired, irritability, and mood changes. Often symptoms are present for around six days. A woman's pattern of symptoms may change over time. Symptoms do not occur during pregnancy or following menopause.

Diagnosis requires a consistent pattern of emotional and physical symptoms occurring after ovulation and before menstruation to a degree that interferes with normal life. Emotional symptoms must not be present during the initial part of the menstrual cycle.[3] A daily list of symptoms over a few months may help in diagnosis. Other disorders that cause similar symptoms need to be excluded before a diagnosis is made.

The cause of PMS is unknown. Some symptoms may be worsened by a high-salt diet, alcohol, or caffeine. The underlying mechanism is believed to involve changes in hormone levels. Reducing salt, caffeine, and stress along with increasing exercise is typically all that is recommended in those with mild symptoms. Calcium and vitamin D supplementation may be useful in some. Anti-inflammatory drugs such as naproxen may help with physical symptoms. In those with more significant symptoms birth control pills or the diuretic spironolactone may be useful.

Up to 80% women report having some symptoms prior to menstruation. These symptoms qualify as PMS in 20 to 30% of women and in three to eight percent are severe. Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that has greater psychological symptoms. Antidepressant medication of the selective serotonin reuptake inhibitors class may be used in addition to usual measures for in PMDD.

Irrational Thoughts

Irrationality is cognition, thinking, talking or acting without inclusion of rationality. It is more specifically described as an action or opinion given through inadequate use of reason, emotional distress, or cognitive deficiency. The term is used, usually pejoratively, to describe thinking and actions that are, or appear to be, less useful, or more illogical than other more rational alternatives.

Irrational behaviors of individuals include taking offense or becoming angry about a situation that has not yet occurred, expressing emotions exaggeratedly (such as crying hysterically), maintaining unrealistic expectations, engaging in irresponsible conduct such as problem intoxication, disorganization, or extravagance, and falling victim to confidence tricks. People with a mental illness like schizophrenia may exhibit irrational paranoia.

These more contemporary "normative conceptions" of what constitutes a manifestation of irrationality are difficult to demonstrate empirically because it is not clear by whose standards we are to judge the behavior rational or irrational.[citation needed] Irrationality, historically speaking, is an outcome of the ancient Greek separation of rationality (logos) from emotion and sensuality as the sources of "false" assumptions and statements.

Occupational Burnout

Occupational burnout or job burnout is characterized by exhaustion, lack of enthusiasm and motivation, feelings of ineffectiveness, and also may have the dimension of frustration or cynicism, and as a result reduced efficacy within the workplace. A growing body of evidence suggests that burnout is clinically and nosologically similar to depression. Burnout is caused by long-term high stress levels, and occupational burnout is a type of stress itself.

Occupational burnout is typically and particularly found within human service professions. Professions with high levels of burnout include social workers, nurses, teachers, lawyers, engineers, physicians, customer service representatives, and police officers. One reason why burnout is so prevalent within the human services field is due in part, to the high stress work environment and emotional demands of the job.

Burnout is caused by stressors that a person is unable to cope with fully. Occupational burnout often develops slowly and may not be recognized until it has become severe. When one's expectations about a job and its reality differ, burnout can begin.

Symptoms of burnout include dysfunctional attitudes towards work, exhaustion, loss of motivation, distress, and feelings of ineffectiveness. Poor coping mechanisms can contribute to or result from burnout.

Lack of Direction (Higher Purpose)

When you become bored or fatigued – more specifically mentally fatigued – you descend into a kind of torpor, perhaps a bit like a balloon that has been punctured in such a way that the air, or inner pressure, leaks away gradually but surely and then leaves you feeling deflated, purposeless, and lifeless. You become easy prey to negative thoughts, feelings and perceptions, which can in turn lead to stress, anxiety, depression and ultimately a total loss of any sense of meaning in your life.

“Meaning” is what life is all about. Without “meaning” life becomes unreal, seemingly pointless and futile. This is principally due to the narrowing of consciousness that invariably accompanies negative thoughts and feelings, the tunnel vision that’s experienced when you allow yourself to become preoccupied with being in a state of boredom or worry.

When you become mentally run down, perhaps as a result of overwork or lack of mental stimulus, nothing seems to be worthwhile or interesting. It’s as if you’re experiencing life “second hand”, as if only a small part of your consciousness is actually present, and that the real “you” is somewhere else far away. A feeling of ennui, of “why bother”, “what’s the point anyway” takes over and it seems as if all that you really want to do is sit and vegetate in front of the TV. Some people spend the most part of their lives in a state something similar to this.

The thought of attempting to do something useful and constructive seems to be somehow almost impossible. Not only because this lower form of consciousness would make any effort appear to be very hard, but also because in this reduced state of consciousness it seems that you can’t think of anything remotely interesting, useful and constructive to do anyway. In this frame of mind, you are experiencing life as your lower self.

Of course one individual can experience different “moods”. You can be happy and excited one day, and bored or anxious the next. However the “you” that is happy and excited and feeling mentally expansive is a profoundly different “you” to the one who is bored and depressed and seeing life as a meaningless farce. Obviously you could say that both of these selves are the same person, and of course in a sense they are, but the point to note is that you tend to alternate between them and view yourself and life in general through the very different prism of whichever “self” is currently in occupation.

The “higher” self is naturally and inevitably linked with a strong sense of meaning and purpose in life. When you fall in love, or succeed in fulfilling some difficult and strongly desired goal your “inner pressure” rises and you experience an intense feeling of being, of being truly alive guess what happens? You get a sense of boundless possibilities and opportunities and feel that you’re equal to anything that comes your way, which – in these moments – is exactly what you are.

The countless billions of cells that make up your body exist independently of “you”. There is not one cell or atom in your entire biological make-up that does not die off and be renewed – partially at least – every 7 or 8 years. On the purely conscious level, you have no awareness of cellular changes taking place in your body, or of your heart continuing to beat while you sleep, or of a broken leg gradually healing in a cast. Some “higher” power or version of yourself oversees and controls all of these processes.

And the higher self does not only control all aspects of bodily function, it is also the self that imparts meaning and purpose into your life and the sheer intensity of living that true meaning and purpose brings. However when you become tired, bored, depressed or fearful, the higher self becomes hidden. Because of your negative feelings and outlook you lose touch with the higher self and forget or doubt that it exists and everything seems to become futile or perhaps in some way threatening. But when – through meaningful and purposeful activity – you come into contact with your higher self, it instantly becomes apparent that the sense and feeling of negativity had been an illusion.

In moments of inspiration, creativity and purposeful and intense excitement the negative sense of boredom, futility, of defeat, is fully understood for what it was, a delusion and a pointless and somehow ridiculous waste of time and mental energy. You are seeing and experiencing yourself and life through the prism of your higher self.

Finding Meaning And Purpose Through Action

“I felt like a child on Christmas morning” is an excellent way of verbally encapsulating the sense of intensity, of heightened awareness and sheer excitement of being alive that comes when you are truly “in the zone”. From the adult perspective it may seem a bit overstated but the principle remains fundamentally the same. When you’re engaged in some meaningful and purposeful activity that aligns with your core values, especially for which you have some natural affinity and ability, you feel as if you’re somehow fulfilling your destiny, that you’re on the right track.

Everything becomes much more real and true, much more meaningful. One of the most important questions in life is how to bring meaning and purpose into your day to day life and activities, how to maximize and maintain your contact with your higher self so as to experience as much positivity and intensity of being as you can.

The answer to that question is to be found in action, whether mental or physical or both. When you’re feeling down, you have a choice as to whether you’re going to sit and brood over it or whether you decide that you’re going to rise above it. If you decide to take the latter, positive course then you must learn how to call on your hidden reserves of mental energy and creative imagination, in other words, call on your higher self. You could think of it like this: imagine a room full of military commanders and generals all arguing about how to deal with some event or situation.

There’s no clear consensus, and no clear direction is emerging from the argument. Then the commander in chief walks in and the argument subsides and is replaced by quiet expectation. The commander in chief then issues the final order and so direction, i.e. meaning and purpose, is found. The squabbling generals could be thought of as the lower self, and the commander in chief as the higher self.

To begin to access your own “commander in chief”, you must first remove your focus from whatever negative thoughts or feelings are in your mind, whether it’s boredom, anxiety or whatever. Do this by inducing physical and then mental relaxation, by getting comfortable, closing your eyes, regulating your breathing and then imagining yourself in some calm and tranquil situation. Then, after a few minutes, start to think about doing something. Banal and over-simplistic as it may seem, action is nevertheless an effective route map out of negativity and into a much stronger frame of mind. Do this by making a conscious effort to focus on something that you want to do or have been meaning to do.
It could be something as mundane as some boring job or task, however if you mentally focus your concentration on what you’re doing, you’ll find yourself coming out of yourself and clicking neatly into a much more positive and constructive gear. In this way, you start to come into contact with the lower reaches of your higher self. And of course you can build and expand on this through a process of:

a) vigilance, i.e. continual monitoring of your own conscious thought processes for signs of negativity and self-defeatism,
b) persistence, i.e. always being prepared to make the mental effort to overcome that delusional negativity by invoking the realization of your will to experience a more purposeful and intense state of being

Exam Anxiety (Test Anxiety)

Test anxiety is a combination of physiological over-arousal, tension and somatic symptoms, along with worry, dread, fear of failure, and catastrophizing, that occur before or during test situations. It is a physiological condition in which people experience extreme stress, anxiety, and discomfort during and/or before taking a test. This anxiety creates significant barriers to learning and performance. Research suggests that high levels of emotional distress have a direct correlation to reduced academic performance and higher overall student drop-out rates. Test anxiety can have broader consequences, negatively affecting a student's social, emotional and behavioral development, as well as their feelings about themselves and school.

Highly test-anxious students score about 12 percentile points below their low anxiety peers. Test anxiety is prevalent amongst the student populations of the world. It has been studied formally since the early 1950s beginning with researchers George Mandler and Seymour Sarason. Sarason's brother, Irwin G. Sarason, then contributed to early investigation of test anxiety, clarifying the relationship between the focused effects of test anxiety, other focused forms of anxiety, and generalized anxiety.

Test anxiety can also be labeled as anticipatory anxiety, situational anxiety or evaluation anxiety. Some anxiety is normal and often helpful to stay mentally and physically alert. When one experiences too much anxiety, however, it can result in emotional or physical distress, difficulty concentrating, and emotional worry. Inferior performance arises not because of intellectual problems or poor academic preparation, but because testing situations create a sense of threat for those experiencing test anxiety; anxiety resulting from the sense of threat then disrupts attention and memory function. Researchers suggest that between 25 to 40 percent of students experience test anxiety. Students with disabilities and students in gifted educations classes tend to experience high rates of test anxiety. Students who experience test anxiety tend to be easily distracted during a test, experience difficulty with comprehending relatively simple instructions, and have trouble organizing or recalling relevant information.

Hair Twisting (trichotillomania)

People who have trichotillomania have an irresistible urge to pull out their hair, usually from their scalp, eyelashes, and eyebrows.
Trichotillomania is a type of impulse control disorder. People with these disorders know that they can do damage by acting on the impulses, but they cannot stop themselves. They may pull out their hair when they're stressed as a way to try to soothe themselves.

Besides repeated hair pulling, other symptoms may include:

• Feeling tense before pulling hair or when trying to resist the urge to pull hair
• Feeling relieved, satisfied, or pleased after acting on the impulse to pull hair
• Distress or problems in work or social life due to hair pulling
• Bare patches where the hair has been pulled out
• Behaviors such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on hair, or eating hair

Many people who have trichotillomania try to deny they have a problem and may attempt to hide their hair loss by wearing hats, scarves, and false eyelashes and eyebrows.
The exact cause of trichotillomania isn't known. It may be related to abnormalities in brain pathways that link areas involved in emotional regulation, movement, habit formation, and impulse control.

Some people with trichotillomania may also have depression or anxiety. Trichotillomania is slightly more likely if it runs in your family.

Trichotillomania is diagnosed based on the presence of its signs and symptoms. There is no specific test for it.

A doctor might refer someone who has symptoms of trichotillomania to a psychiatrist or psychologist, who can interview the person and see if they might have an impulse control disorder.

The main treatment for trichotillomania is a type of behavior therapy called habit reversal training. Basically, this means replacing a bad habit with something else that's not harmful.

With this approach, people with trichotillomania first learn to identify when and where they have the urge to pull hair. They also learn to relax and do something else, that doesn't hurt them, as a way to help ease tension when they feel the urge to pull their hair.


Punctuality is the characteristic of being able to complete a required task or fulfill an obligation before or at a previously designated time. "Punctual" is often used synonymously with "on time". It is a common misconception that punctual can also, when talking about grammar, mean "to be accurate".

According to each culture, there is often an understanding about what is considered an acceptable degree of punctuality. Usually, a small amount of lateness is acceptable; this is commonly about ten or fifteen minutes in Western cultures, but this is not the case in such instances as doctor's appointments or school lessons. In some cultures, such as Japanese society, and settings, such as military ones, expectations may be much stricter.

Some cultures have an unspoken understanding that actual deadlines are different from stated deadlines, for example with Africa time. For example, it may be understood in a particular culture that people will turn up an hour later than advertised.[4] In this case, since everyone understands that a 9 pm party will actually start at around 10 pm, no-one is inconvenienced when everyone arrives at 10 pm.[5]

In cultures which value punctuality, being late is seen as disrespectful of others' time and may be considered insulting. In such cases, punctuality may be enforced by social penalties, for example by excluding low-status latecomers from meetings entirely. Such considerations can lead on to considering the value of punctuality in econometrics and to considering the effects of non-punctuality on others in queueing theory


Problem gambling (or ludomania, but usually referred to as gambling addiction) is an urge to continuously gamble despite harmful negative consequences or a desire to stop. Problem gambling is often defined by whether harm is experienced by the gambler or others, rather than by the gambler's behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria. Pathological gambling is a common disorder that is associated with both social and family costs. Dr Mark Griffiths, a long-time gambling researcher at Nottingham Trent University, believes that the media plays an unhelpful role in the image of gambling.

The DSM-5 has re-classified the condition as an addictive disorder, with sufferers exhibiting many similarities to those who have substance addictions. The term "gambling addiction" has long been used in the recovery movement. Pathological gambling was long considered by the American Psychiatric Association to be an impulse control disorder rather than an addiction. However, data suggest a closer relationship between pathological gambling and substance use disorders than exists between PG and obsessive-compulsive disorder.

Performance Anxiety

Sexual performance anxiety isn't diagnosed as often in women as it is in men, but it can affect arousal in women, too. Anxiety can prevent women from getting lubricated enough to have sex, and it can take away the physical desire to make love.

Anxiety can take both men and women out of the mind-set needed to have sex. When you're focused on whether you'll perform well, you can't concentrate on what you're doing in bed. A distracted lover is an inattentive lover, which can make you feel like even more of a failure. Even if you are able to get aroused, you may be too distracted to reach orgasm.

Sexual performance anxiety leads to a perpetual cycle. You become so anxious about sex that you can't perform, which leads to even more sexual performance anxiety.


Perfectionism, in psychology, is a personality trait characterized by a person's striving for flawlessness and setting excessively high performance standards, accompanied by overly critical self-evaluations and concerns regarding others' evaluations. It is best conceptualized as a multidimensional characteristic, as psychologists agree that there are many positive and negative aspects. In its maladaptive form, perfectionism drives people to attempt to achieve an unattainable ideal, and their adaptive perfectionism can sometimes motivate them to reach their goals. In the end, they derive pleasure from doing so. When perfectionists do not reach their goals, they often fall into depression.

Lack of Initiative/executive function

Executive function is a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the frontal lobe.
Executive function helps you:

• Manage time
• Pay attention
• Switch focus
• Plan and organize
• Remember details
• Avoid saying or doing the wrong thing
• Do things based on your experience

When executive function isn’t working as it should, your behavior is less controlled. This can affect your ability to:

• Work or go to school
• Do things independently
• Maintain relationships

Executive function can be divided into two groups:

• Organization: Gathering information and structuring it for evaluation
• Regulation: Taking stock of your surroundings and changing behavior in response to it

For example, seeing a piece of chocolate cake on a dessert cart at a restaurant may be tempting. That's where executive function can step in. The organizational part reminds you that the slice is likely to have hundreds of calories. Regulation tells you that eating the cake conflicts with goals you may have, like eating less sugar or losing weight.

Some people are born with weak executive function. And people with ADHD, depression, or learning disabilities often have weaknesses in it.

An injury to the front of the brain, where the frontal lobe is, can harm your ability to stay on task. Damage from Alzheimer's disease or strokes may also cause problems.
Problems with executive function can run in families. You may notice them when your child starts going to school. They can hurt the ability to start and finish schoolwork.
Warning signs that a child may be having problems with executive function include trouble in:

• Planning projects
• Estimating how much time a project will take to complete
• Telling stories (verbally or in writing)
• Memorizing
• Starting activities or tasks
• Remembering

There's no single test to identify problems with it. Instead, experts rely on different tests to measure specific skills.

Problems seen on these tests can't predict how well adults or children will do in real life. Sometimes, watching them and trying different things are better ways to improve weak executive function.

Treating problems with executive function early can help children outgrow it. The brain continues to develop well into adulthood, and experiences can shape executive function as the brain grows.


Despair and Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being. People with depressed mood can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, ashamed or restless. They may lose interest in activities that were once pleasurable, experience overeating or loss of appetite, have problems concentrating, remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present.

Depressed mood is a feature of some psychiatric syndromes such as major depressive disorder, but it may also be a normal reaction to life events such as bereavement, a symptom of some bodily ailments or a side effect of some drugs and medical treatments.

Overly Critical

Criticism is the practice of judging the merits and faults of something.

• The judger is called "the critic".
• To engage in criticism is "to criticize".
• One specific item of criticism is called "a criticism" or a "critique".

Criticism as an evaluative or corrective exercise can occur in any area of human life. Criticism can therefore take many different forms (see below). How exactly people go about criticizing, can vary a great deal. In specific areas of human endeavor, the form of criticism can be highly specialized and technical; it often requires professional knowledge to understand the criticism. This article provides only general information about criticism. For subject-specific information, see the Varieties of criticism page.
To criticize does not necessarily imply "to find fault", but the word is often taken to mean the simple expression of an objection against prejudice, or a disapproval of something. Often criticism involves active disagreement, but it may only mean "taking sides". It could just be an exploration of the different sides of an issue. Fighting is not necessarily involved.

Criticism is often presented as something unpleasant, but it need not be. It could be friendly criticism, amicably discussed, and some people find great pleasure in criticism ("keeping people sharp", "providing the critical edge"). The Pulitzer Prize for Criticism has been presented since 1970 to a newspaper writer who has demonstrated 'distinguished criticism'.

Normally criticism involves a dialogue of some kind, direct or indirect, and in that sense criticism is an intrinsically social activity. Even if one is only criticizing a book or an idea in private, it is usually assumed there is someone who will be made aware of the criticism being expressed at some point, although who exactly will hear it, may also remain unknown. One is still engaging with the ideas of others, even if only indirectly. One can of course also keep a criticism to oneself, rather than express or communicate it, but in general the intention is, that someone else ought to be aware of it, however that may occur. Self-criticism, even if wholly private, still mentally takes the concerns of others into account.


Pessimism is a state of mind in which one anticipates undesirable outcomes or believes that the evil or hardships in life outweigh the good or luxuries. Value judgments may vary dramatically between individuals, even when judgments of fact are undisputed. The most common example of this phenomenon is the "Is the glass half empty or half full?" situation. The degree in which situations like these are evaluated as something good or something bad can be described in terms of one's optimism or pessimism respectively. Throughout history, the pessimistic disposition has had effects on all major areas of thinking.

Death or Loss

Loss is one of the most common experiences that brings about grieving, and although this is often viewed as normal, there are times when it is disqualified. Some examples of when grieving over a loss is disenfranchised include: the loss of a grandchild, of an ex-spouse, or of a child through adoption.

Loss of a grandchild can be extremely difficult for a grandparent, but the grandparent’s grief is often disenfranchised because they are not part of the immediate family. Attention and support is given to the child’s parents and siblings, but the grandparent’s grief is two-fold as they have not only grieving the loss of their grandchild, but are also grieving for their adult children who have lost the child. This phenomenon is termed “double-grief” and this makes bereavement even more difficult.

Loss of an ex-spouse is disenfranchised due to the lack of a current or ongoing personal relationship between the former couple. Although the marriage has ended, the relationship has not, and there are ties between the two people that will forever be there including: shared children, mutual friendships, and financial connections. Research has shown that those couples who never resolved conflicts and had closure after the relationship ended experienced much more grief than those who had. The grievers experience guilt and thoughts of “what might have been”, similar to those of widows.

Loss of a child by adoption is often disenfranchised because the decision to give a child up for adoption is voluntary, and therefore it is not acceptable by society to grieve. Birth mothers lack support, and are expected to just move on and pretend the child doesn't exist. Many birth mothers experience regret and have thoughts of what might have been or of reuniting with the child. See Grief for more details.


Insomnia, or sleeplessness, is a sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired. While the term is sometimes used to describe a disorder demonstrated by polysomnographic or actigraphic evidence of disturbed sleep, this sleep disorder is often practically defined as a positive response to either of two questions: "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?"

Insomnia is most often thought of as both a medical sign and a symptom that can accompany several sleep, medical, and psychiatric disorders characterized by a persistent difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia is typically followed by functional impairment while awake. Insomnia can occur at any age, but it is particularly common in the elderly.[4] Insomnia can be short term (up to three weeks) or long term (above 3–4 weeks); it can lead to memory problems, depression, irritability and an increased risk of heart disease and automobile related accidents.[5]

Insomnia can be grouped into primary and secondary, or comorbid, insomnia. Primary insomnia is a sleep disorder not attributable to a medical, psychiatric, or environmental cause. It is described as a complaint of prolonged sleep onset latency, disturbance of sleep maintenance, or the experience of non-refreshing sleep.[10] A complete diagnosis will differentiate between free-standing primary insomnia, insomnia as secondary to another condition, and primary insomnia co-morbid with one or more conditions.

Cognitive behavioral therapy is useful in insomnia that is present for a long duration. Those who are having trouble sleeping sometimes turn to sleeping pills, which may help, but also may lead to substance dependency or addiction if used regularly for an extended period.


Stuttering is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds. The term stuttering is most commonly associated with involuntary sound repetition, but it also encompasses the abnormal hesitation or pausing before speech, referred to by people who stutter as blocks, and the prolongation of certain sounds, usually vowels or semivowels. According to Watkins et al. stuttering is a disorder of “selection, initiation, and execution of motor sequences necessary for fluent speech production.” For many people who stutter, repetition is the primary problem. The term "stuttering" covers a wide range of severity, encompassing barely perceptible impediments that are largely cosmetic to severe symptoms that effectively prevent oral communication. In the world, approximately four times as many men as women stutter, encompassing 70 million people worldwide. To put that in perspective, about 1% of the world’s population stutters. The impact of stuttering on a person's functioning and emotional state can be severe. This may include fears of having to enunciate specific vowels or consonants, fears of being caught stuttering in social situations, self-imposed isolation, anxiety, stress, shame, being a possible target of bullying (especially in children), having to use word substitution and rearrange words in a sentence to hide stuttering, or a feeling of "loss of control" during speech. Stuttering is sometimes popularly seen as a symptom of anxiety, but there is actually no direct correlation in that direction (though as mentioned the inverse can be true, as social anxiety may actually develop in individuals as a result of their stuttering).

Stuttering is generally not a problem with the physical production of speech sounds or putting thoughts into words. Acute nervousness and stress do not cause stuttering, but they can trigger stuttering in people who have the speech disorder, and living with a highly stigmatized disability can result in anxiety and high allostatic stress load (i.e., chronic nervousness and stress) that reduce the amount of acute stress necessary to trigger stuttering in any given person who stutters, exacerbating the problem in the manner of a positive feedback system; the name 'stuttered speech syndrome' has been proposed for this condition. Neither acute nor chronic stress, however, itself creates any predisposition to stuttering.

The disorder is also variable, which means that in certain situations, such as talking on the telephone or in a large group, the stuttering might be more severe or less, depending on whether or not the stutterer is self-conscious about their stuttering. Stutterers often find that their stuttering fluctuates and that they have "good" days, "bad" days and "stutter-free" days. The times in which their stuttering fluctuates can be random. Although the exact etiology, or cause, of stuttering is unknown, both genetics and neurophysiology are thought to contribute. There are many treatments and speech therapy techniques available that may help increase fluency in some people who stutter to the point where an untrained ear cannot identify a problem; however, there is essentially no cure for the disorder at present. The severity of the person's stuttering would correspond to the amount of speech therapy needed to increase fluency. For severe stuttering, long-term therapy and hard work will be required to increase fluency


A tic is a sudden, repetitive, non-rhythmic motor movement or vocalization involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and phonic tics are, respectively, eye blinking and throat clearing.

Tics must be distinguished from movements of other movement disorders such as chorea, dystonia, myoclonus; movements exhibited in stereotypic movement disorder or some autistic people, and the compulsions of obsessive-compulsive disorder (OCD) and seizure activity

Tic disorders occur along a spectrum, ranging from mild (transient or chronic tics) to more severe; Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe. The treatment for the spectrum of tic disorders is similar to the treatment of Tourette syndrome.


Emotional abandonment is a subjective emotional state in which people feel undesired, left behind, insecure, or discarded. People experiencing emotional abandonment may feel at loss, cut off from a crucial source of sustenance that has been withdrawn either suddenly or through a process of erosion. In a classic abandonment scenario, the severance of the emotional bond is unilateral, that is, it is the object of one’s attachment that has chosen to break the connection. Feeling rejected, a significant component of emotional abandonment, has a biological impact in that it activates the physical pain centers in the brain and can leave an emotional imprint in the brain’s warning system. Abandonment has been a staple of poetry and literature since ancient times.


The duration that cravings last after discontinuation varies substantially between different addictive drugs. For instance, in smoking cessation, a substantial relief is achieved after approximately 6–12 months, but feelings of craving may temporarily appear even after many years following cessation.
Cravings may be triggered by seeing objects or experiencing moments that are associated with the drug or usage of it, and this phenomenon, termed post-acute withdrawal syndrome, may linger the rest of the life for some drugs. For the alcohol withdrawal syndrome, the condition gradually improves over a period of months or in severe cases years.

There is no single explanation for food cravings, and explanations range from low serotonin levels affecting the brain centers for appetite to production of endorphins as a result of consuming fats and carbohydrates. Foods with high levels of sugar glucose, such as chocolate, are more frequently craved than foods with lower sugar glucose, such as broccoli, because when glucose interacts with the opioid system in the brain an addictive triggering effect occurs. The consumer of the glucose feels the urge to consume more glucose, much like an alcoholic, because the brain has become conditioned to release "happy hormones" every time glucose is present. There is evidence that addiction and food craving activate some of the same brain areas. Specifically, when smokers look at pictures of people smoking it activates the same areas of the brain as when obese people look at pictures of food.

The cravings for certain types of food are linked to their ingredients. Chocolate for example, contains the amino acid phenylethylamine, which is important for the regulation of the body’s release of endorphins. Endorphins are released following a stressor and result in a sense of relaxation. Exercise and sleep are two alternative ways to help facilitate the release of endorphins.

Chocolate also contains large quantities of iron, which can be depleted during the menstrual cycle. Another common craving is salt. Craving salt may be partly due to being dehydrated. When dehydrated the body loses water, electrolytes, and salt, and by ingesting salt, water retention can be increased. Craving salt can also be a sign of diabetes, heart disease, and sickle cell anemia.

Carbohydrates, or particularly sugars, are yet another common craving. These cravings occur often in the middle of the afternoon when energy is at its lowest.
The craving of non-food items as food is called pica.


In physical medicine, trauma (injury) is damage to a biological organism caused by physical harm from an external source. The term is sometimes used to refer to trauma centers and other medical units that deal with trauma. Major trauma is injury that can potentially lead to serious outcomes.

In psychology, psychological trauma is a type of damage to the psyche that occurs as a result of a severely distressing event.

In sociology, sociological trauma is a type of damage to the social life of an individual as a result of stigma.

Chronic Pain

Chronic pain is pain that lasts a long time. In medicine, the distinction between acute and chronic pain is sometimes determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 months and 6 months since onset, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed duration, is "pain that extends beyond the expected period of healing".

Problem Solving

The term problem-solving is used in many disciplines, sometimes with different perspectives, and often with different terminologies. For instance, it is a mental process in psychology and a computerized process in computer science. Problems can also be classified into two different types (ill-defined and well-defined) from which appropriate solutions are to be made. Ill-defined problems are those that do not have clear goals, solution paths, or expected solution. Well-defined problems have specific goals, clearly defined solution paths, and clear expected solutions. These problems also allow for more initial planning than ill-defined problems.[1] Being able to solve problems sometimes involves dealing with pragmatics (logic) and semantics (interpretation of the problem). The ability to understand what the goal of the problem is and what rules could be applied represent the key to solving the problem. Sometimes the problem requires some abstract thinking and coming up with a creative solution.


Emotional resistance is the force that drives you to keep your unhealthy habits firmly in place. This force is often hidden and goes undetected, for example:

• Avoidance of feelings (e.g., drink alcohol to reduce social anxiety)
• Unconscious emotions (e.g., overeat in self-destructive ways to suppress anger, to avoid interpersonal conflicts and to comfort oneself)

You can be motivated to change and emotionally resist it at the same time, without being fully aware of the full impact of this statement; "I think that I should change but I really don't feel like it". If you do not understand and lower your resistance, you'll stand still, even though you are trying to move forward.

On the other hand, when your resistance overwhelms your motivation, you will not even think about change and go backwards, even though you know that you should be moving forwards. So what causes resistance to change? Change can be threatening, involve risks and creates emotional dis-ease.

Resistance is expected and normal even when change is in your best interests. Your resistance protects and keeps you in your comfort zone rather than risk change (the unknown). Remember a time when someone told you to change when you did not want to. How did you respond outwardly? And inwardly?

How does it feel when someone threatens your comfort zone, even when the advice was the right thing to do? Did you resist or embrace change when others pressured you to change? Did it bring out the rebellious teenager within you? If not, have you seen the rebellious teenager come out in any of your family, friends or colleagues?

The theory of reactance helps to understand the inner, rebellious teenager. This theory emphasizes that individuals value the freedom to choose, without control, coercion, force or threats to their autonomy. Any perceived loss of that freedom can provoke you or your loved ones to protect or restore that freedom, even if it is in your best interest to change.

The real challenge is whether you can recognize and understand your resistance and explore how you view your comfort zone versus the risk of change.
As a general principle, it is essential to understand and lower your emotional resistance to change before trying to motivate yourself to change.


Having responsibility is the duty or obligation to act. But responsibility can be a great burden. Taking responsibility is acknowledging and accepting the choices you have made, the actions you have taken, and the results they have led to. True autonomy leads to both having responsibility and taking responsibility. Taking responsibly is fulfilling your role in life. Responsibility is an essential element of integrity; it is the congruence of what you think, what you say, and what you do. Responsibility is essential for reciprocity, trust, and for maintaining symmetric relationships.

• Having a duty or obligation to act
• Acknowledging and accepting the choices you have made, the actions you have taken, and the results they have led to.
• Able to meet commitments made to yourself and others
• Keeping the promises you make.
• Doing everything you say you will do, or have lead others to expect from you. Do what you say!
• Responsibility is a Choice

Responsibility without choice is torment. This is the tragic curse suffered by scapegoats and other innocent people falsely accused and wrongly blamed. Choice without responsibility is greed. This is the selfish attempt to get something for nothing that is the wasteful and harmful excess of cheaters, playboys, egotists, and tyrants. Escaping responsibility is at the root of the tragedy of the commons. Taking responsibility for our choices provides the symmetry of reciprocal exchange and the basis for trust. Responsibility is a congruence between the actions we choose and our values.

Responsibility unleashes choice. Whenever we think, decide, choose, and act we are exercising our personal responsibility. Deciding to accept responsibility for our choices increases the range of choices considered acceptable by others. It allows autonomy to increase without decreasing relatedness.


Forgiveness is the intentional and voluntary process by which a victim undergoes a change in feelings and attitude regarding an offense, let’s go of negative emotions such as vengefulness, with an increased ability to wish the offender well. Forgiveness is different from condoning (failing to see the action as wrong and in need of forgiveness), excusing (not holding the offender as responsible for the action), pardoning (granted by a representative of society, such as a judge), forgetting (removing awareness of the offense from consciousness), and reconciliation (restoration of a relationship).

In certain contexts, forgiveness is a legal term for absolving or giving up all claims on account of debt, loan, obligation or other claims.

As a psychological concept and virtue, the benefits of forgiveness have been explored in religious thought, the social sciences and medicine. Forgiveness may be considered simply in terms of the person who forgives including forgiving themselves, in terms of the person forgiven or in terms of the relationship between the forgiver and the person forgiven. In most contexts, forgiveness is granted without any expectation of restorative justice, and without any response on the part of the offender (for example, one may forgive a person who is incommunicado or dead). In practical terms, it may be necessary for the offender to offer some form of acknowledgment, an apology, or even just ask for forgiveness, in order for the wronged person to believe himself able to forgive.

Thumb Sucking

Thumb sucking is a behavior found in humans, chimpanzees, captive Ring-tailed Lemurs, and other primates. It usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration. It can also be accomplished with any piece of skin within reach (such as the big toe) and is considered to be soothing and therapeutic for the person. As a child develops the habit, it will usually develop a "favorite" finger to suck on.

At birth, a baby will reflexively suck any object placed in its mouth; this is the sucking reflex responsible for breastfeeding. From the very first time they engage in nutritive feeding, infants learn that the habit can not only provide valuable nourishment, but also a great deal of pleasure, comfort, and warmth. Whether from a mother, bottle, or pacifier, this behavior, over time, begins to become associated with a very strong, self-soothing, and pleasurable oral sensation. As the child grows older, and is eventually weaned off the nutritional sucking, they can either develop alternative means for receiving those same feelings of physical and emotional fulfillment, or they can continue experiencing those pleasantly soothing experiences by beginning to suck their thumbs or fingers. This reflex disappears at about 4 months of age; thumb sucking is not purely an instinctive behavior and therefore can last much longer. Moreover, ultrasound scans have revealed that thumb sucking can start before birth, as early as 15 weeks from conception; whether this behavior is voluntary or due to random movements of the fetus in the womb is not conclusively known.

Thumb sucking generally stops by the age of 5 years. Some older children will retain the habit, which can cause severe dental problems. While most Dentists would recommend breaking the habit as early as possible, it has been shown that as long as the habit is broken before the onset of permanent teeth, at around 5 years old, the damage is reversible. Thumb sucking is sometimes retained into adulthood and may be due to stereotypic movement disorder, another psychiatric disorder, or simply habit continuation.


Standing up for yourself is one thing, but having a stubborn personality is quite another thing. Many people find dealing with stubborn people very draining. Do you have to have your way all the time? Do you find it difficult to compromise with others? Stubbornness can lead to an air of superiority, may lead to confrontation, and generally creates conflict. Hypnosis can help.

Lack of Ambition

Many clients come to therapy because they have a hard time completing their goals. They begin a new project with enthusiasm and then, after a while, they find "reasons" why they can't find the time to do it. There are times when you need to re-evaluate or change a goal.
Lacking Determination and Perseverance.

There are many reasons why people lack determination and perseverance to see their goals to completion. Sometimes, people allow self-doubt to get in the way and they have a hard time seeing themselves as a success.

Anxiety and depression can also get in the way of people completing their goals. If you're feeling anxious and depressed, it might be all that you can do to just get through the day--let alone have long term goals.

For many people, what gets in the way of completing their goals and achieving success is an inability to stay focused on the benefits they will derive if they persevere. They get bored and allow their boredom to distract them. They also have difficulty sacrificing short term pleasure for long term goals.

Self Control

Self-control is the ability to control one's emotions, behavior, and desires in the face of external demands in order to function in society. In psychology it is sometimes called self-regulation. Self-control is essential in behavior to achieve goals and to avoid impulses and/or emotions that could prove to be negative. In behavior analysis self-control represents the locus of two conflicting contingencies of reinforcement, which then make a controlling response reinforcing when it causes changes in the controlled response.

Desire is an affectively charged motivation toward a certain object, person, or activity, but not limited to, that is associated with pleasure or relief from displeasure. Desires vary in strength and duration. A desire becomes a temptation, entering the area of self-control, if the behavior resulting from the desire conflicts with an individual’s values or other self-regulatory goals. A limitation to research on desire is the issue of individuals desiring different things. New research looked at what people desire in real world settings. Over one week, 7,827 self-reports of desires were collected and indicated significant differences in desire frequency and strength, degree of conflict between desires and other goals, and the likelihood of resisting desire and success of the resistance. The most common and strongly experienced desires related to bodily needs like eating, drinking, and sleeping. This study has many implications related to self-control and the everyday things that interfere with people’s ability to stay on task.

Desires that conflict with overarching goals or values are known as temptations. Self-control dilemmas occur when long-term goals and values clash with short-term temptations. Counteractive Self-Control Theory states that when presented with such a dilemma, we lessen the significance of the instant rewards while momentarily increasing the importance of our overall values. When asked to rate the perceived appeal of different snacks before making a decision, people valued health bars over chocolate bars. However, when asked to do the rankings after having chosen a snack, there was no significant difference of appeal. Further, when college students completed a questionnaire prior to their course registration deadline, they ranked leisure activities as less important and enjoyable than when they filled out the survey after the deadline passed. The stronger and more available the temptation is, the harsher the devaluation will be.

One of the most common self-control dilemmas involves the desire for unhealthy or unneeded food consumption versus the desire to maintain long-term health concerns. Experiment participants rated a new snack as significantly less healthy when it was described as very tasty compared to when they heard it was just slightly tasty. Without knowing anything else about a food, the mere suggestion of good taste triggers counteractive self-control and prompts us to devalue the temptation in the name of health. Further, when presented with the strong temptation of one large bowl of chips, participants both perceived the chips to be higher in calories and ate less of them than did participants who faced the weak temptation of three smaller chip bowls, even though both conditions represented the same amount of chips overall. Weak temptations are falsely perceived to be less unhealthy, so self-control is not triggered and desirable actions are more often engaged in, supporting the counteractive self-control theory. Weak temptations present more of a challenge to overcome than strong temptations, because they appear less likely to compromise long-term values


An inferiority complex is a lack of self-worth, a doubt and uncertainty, and feelings of not measuring up to standards. It is often subconscious, and is thought to drive afflicted individuals to overcompensate, resulting either in spectacular achievement or extreme asocial behavior. In modern literature, the preferred terminology is "lack of covert self-esteem". For many, it is developed through a combination of genetic personality characteristics and personal experiences.

An inferiority complex occurs when the feelings of inferiority are intensified in the individual through discouragement or failure. Those who are at risk for developing a complex include people who: show signs of low self-esteem or self-worth, have low socioeconomic status, or have a history of depression symptoms. Children reared in households who were constantly criticized or did not live up to parents' expectations may also develop this. Many times there are warning signs to someone who may be more prone to developing an inferiority complex. For example, someone who is prone to attention and approval seeking behaviors may be more susceptible. Also, children raised in families where everything is done for them, who have developed what Adler called a "pampered lifestyle". These individuals have developed a form of learned helplessness and are unable to overcome the problems of life without assistance. According to Adler "Everyone (...) has a feeling of inferiority. But the feeling of inferiority is not a disease; it is rather a stimulant to healthy, normal striving and development. It becomes a pathological condition only when the sense of inadequacy overwhelms the individual and, far from stimulating him to useful activity, makes him depressed and incapable of development."

When an inferiority complex is in full effect, it may impact the performance of the individual as well as impact the individual's self-esteem. Unconscious psychological and emotional processes can disrupt students’ cognitive learning, and negatively “charged” feeling-toned memory associations can derail the learning process. Hutt found that math can become associated with a psychological inferiority complex, low motivation and self-efficacy, poor self-directed learning strategies, and feeling unsafe or anxious.
Widely researched, but often not talked about specifically in this area is the concept of self-esteem and that people can feel good about their abilities and have self-esteem in areas where they feel competent and might not hold such personal esteem in other areas of their life. In essence, self-esteem can also be context-driven. Thus, the theory that someone has an overarching inferiority complex is a bit outdated,

In the mental health treatment population, this characteristic is shown in patients with many disorders such as certain types of schizophrenia, mood disorders, and personality disorders. Moritz found the people suffering from paranoid schizophrenia used their delusions as a defense mechanism against low implicit self-esteem. Alfred Adler identified an inferiority complex as one of the contributing factors to problem child behaviors


"The superiority complex is one of the ways that a person with an inferiority complex may use as a method of escape from her or his difficulties. She or he assumes that she or he is superior when she or he is not, and this false success compensates her or him for the state of inferiority which she or he cannot bear. The normal person does not have a superiority complex, she or he does not even have a sense of superiority. She or he has the striving to be superior in the sense that we all have ambition to be successful; but so long as this striving is expressed in work it does not lead to false valuations, which are at the root of mental disease."

An individual faced with a task wants to overcome or master the task. This is known as striving for superiority. For a well-adapted individual, this striving is not for personal superiority over others, but an overcoming of the task, or finding useful answers to questions in life. When faced with the task, the individual will experience a feeling of inferiority or a sense that the current situation is not as good as it could be. This feeling is similar to stress. If the individual has not been properly trained, the task may seem too much to overcome and lead to an exaggerated feeling of inferiority, or intense anxiety. The individual may, after several unsuccessful attempts to accomplish the task, give up on mastering the task, experiencing the inferiority complex, or a depressed state. The individual may also make several attempts at solving the problem and find a solution to the problem that causes problems in other areas. An individual who answers the question "How can I be thin?" by not eating will become thin, but at the cost over their overall health.

An individual who is not properly trained to answer life's problems may turn from striving for superiority in useful ways to that of a personal superiority at all cost. If an individual cannot be better than another on their own merit, they will attempt to tear down another person or group to maintain their superior position.


Jealousy is an emotion, and the word typically refers to the thoughts and feelings of insecurity, fear, concern and anxiety over an anticipated loss or status of something of great personal value, particularly in reference to a human connection. Jealousy often consists of a combination of emotions such as anger, resentment, inadequacy, helplessness and disgust. In its original meaning, jealousy is distinct from envy, though the two terms have popularly become synonymous in the English language, with jealousy now also taking on the definition originally used for envy alone. Jealousy is a typical experience in human relationships. It has been observed in infants five months and older. Some claim that jealousy is seen in every culture; however, others claim jealousy is a culture-specific phenomenon.

Jealousy is often reinforced as a series of particularly strong emotions and constructed as a universal human experience; it has been a theme of many artistic works. Psychologists have proposed several models of the processes underlying jealousy and have identified factors that result in jealousy. Sociologists have demonstrated that cultural beliefs and values play an important role in determining what triggers jealousy and what constitutes socially acceptable expressions of jealousy. Biologists have identified factors that may unconsciously influence the expression of jealousy.

Romantic jealousy can be expressed in five antecedent factors:

1. Sociobiological factors
2. Cultural and historical factors
3. Personality factors
4. Relational factors
5. Situational factors and strategic factors.

Sociobiological factors deal with reproductive strategies. For males they can only ensure paternity by restricting the access or involvement of other males. Females are more inclined to find resources in a male to be more important than actual reproductive opportunities. Males used the following tactics more than females: a. resource display b. mate concealment c. submission and debasement d. inter sexual threats and violence. For cultural and historical factors males and females have similar states of emotions of jealousy as sociobiological factors. Personality factors include a third-party threat that stores jealousy in both males and females. Personality factors also vary based on love styles. Relational factors as well as emotional factors have been found to vary on comparison levels of commitment to the relationship as well as investment and the level of alternatives in the relationship. Situational factors include critical events that may induce jealousy in both males and females. Situational factors are very common and can be easily stimulated. Last is strategic factors which includes were "individuals are rarely aware of the sociobiological or cultural factors that promote a particular communication behavior."

Sexual jealousy in humans may be triggered when a person's significant other displays sexual interest in another person. The feeling of jealousy may be just as powerful if one partner suspects the other is guilty of Infidelity. Fearing that their partner will experience sexual jealousy the person who has been unfaithful may lie about their actions in order to protect their partner. Experts often believe that sexual jealousy is in fact a biological imperative. It may be part of a mechanism by which humans and other animals ensure access to the best reproductive partners.


Social rejection occurs when an individual is deliberately excluded from a social relationship or social interaction for social rather than practical reasons. The topic includes interpersonal rejection (or peer rejection), romantic rejection and familial estrangement. A person can be rejected on an individual basis or by an entire group of people. Furthermore, rejection can be either active, by bullying, teasing, or ridiculing, or passive, by ignoring a person, or giving the "silent treatment." The experience of being rejected is subjective for the recipient, and it can be perceived when it is not actually present. The word ostracism is often used for the process (in Ancient Greece ostracism was voting into temporary exile).

Although humans are social beings, some level of rejection is an inevitable part of life. Nevertheless, rejection can become a problem when it is prolonged or consistent, when the relationship is important, or when the individual is highly sensitive to rejection. Rejection by an entire group of people can have especially negative effects, particularly when it results in social isolation.

The experience of rejection can lead to a number of adverse psychological consequences such as loneliness, low self-esteem, aggression, and depression. It can also lead to feelings of insecurity and a heightened sensitivity to future rejection.

Rejection may be emotionally painful because of the social nature of human beings and the need of social interaction between other humans is essential. Abraham Maslow and other theorists have suggested that the need for love and belongingness is a fundamental human motivation. According to Maslow, all humans, even introverts, need to be able to give and receive affection to be psychologically healthy.

Psychologists believe that simple contact or social interaction with others is not enough to fulfill this need. Instead, people have a strong motivational drive to form and maintain caring interpersonal relationships. People need both stable relationships and satisfying interactions with the people in those relationships. If either of these two ingredients is missing, people will begin to feel lonely and unhappy. Thus, rejection is a significant threat. In fact, the majority of human anxieties appear to reflect concerns over social exclusion.

Being a member of a group is also important for social identity, which is a key component of the self-concept. Mark Leary of Duke University has suggested that the main purpose of self-esteem is to monitor social relations and detect social rejection. In this view, self-esteem is a sociometer which activates negative emotions when signs of exclusion appear.

Social psychological research confirms the motivational basis of the need for acceptance. Specifically, fear of rejection leads to conformity to peer pressure (sometimes called normative influence), and compliance to the demands of others. Our need for affiliation and social interaction appears to be particularly strong when we are under stress.


Shame is a negative, painful, social emotion that can be seen as resulting "...from comparison of the self's action with the self's standards...", but which may equally stem from comparison of the self's state of being with the ideal social context's standard. Thus, shame may stem from volitional action or simply self-regard; no action by the shamed being is required: simply existing is enough. Both the comparison and standards are enabled by socialization. Though usually considered an emotion, shame may also variously be considered an affect, cognition, state, or condition.

The roots of the word shame are thought to derive from an older word meaning "to cover"; as such, covering oneself, literally or figuratively, is a natural expression of shame. Nineteenth century scientist Charles Darwin, in his book The Expression of the Emotions in Man and Animals, described shame affect as consisting of blushing, confusion of mind, downward cast eyes, slack posture, and lowered head, and he noted observations of shame affect in human populations worldwide. He also noted the sense of warmth or heat (associated with the vasodilation of the face and skin) occurring in intense shame.

A "sense of shame" is the consciousness or awareness of shame as a state or condition. Such shame cognition may occur as a result of the experience of shame affect or, more generally, in any situation of embarrassment, dishonor, disgrace, inadequacy, humiliation, or chagrin.

A condition or state of shame may also be assigned externally, by others, regardless of one's own experience or awareness. "To shame" generally means to actively assign or communicate a state of shame to another. Behaviors designed to "uncover" or "expose" others are sometimes used for this purpose, as are utterances like "Shame!" or "Shame on you!" Finally, to "have shame" means to maintain a sense of restraint against offending others (as with modesty, humility, and deference) while to "have no shame" is to behave without such restraint (as with excessive pride or hubris).


Major decisions often are referred to as ‘reaching a crossroads in one’s life,’ which is a poor motoring analogy.

They would be better considered as life’s roundabouts — merry-go-rounds of approaching exits, panicking, flapping maps, shouting at sat-navs, and finally passing them by until the next miserable orbit.

Most of us will, at some point, find ourselves on the roundabout of indecision.

From my work as an existential therapist, I’ve come upon the following unnerving thoughts about indecision, which may help your own battles with indecision.

1.Indecision is an Illusion.
Well, not so much an illusion as very badly labeled. Indecision implies that we are unable to decide. Jean-Paul Sartre decreed that ‘Man is condemned to be free.’ What he means is that no matter how much you might like to think otherwise, you are constantly, unrelentingly forced to make choices. You have a choice right now – read the next sentence, or leave it. Are you still with me? Whichever way, you had to make that choice. Even when you are not making a decision, you are deciding not to decide.

2. Decisions Don’t Save Us from Decisions.
When we are making a tough decision, we often think ‘I hope I don’t look back and regret this.’ This very thought is an attempt to deny our freedom from ourselves, as if, should events turn out poorly, our future self couldn’t subsequently make further decisions to improve the situation. It is often more comforting for us to think that if we could just get this one, single decision right, we won’t have to make any more. Sorry, I refer you back to Sartre’s point – you’re condemned to always have to make them.

3. Don’t be an Ass.
A hungry ass walks into a barn. In the barn are two equally large and inviting bales of straw. They are both equally visible and accessible. The ass dies of starvation.
As jokes go, it’s dreadful. The ass, known as Buridan’s ass, was conceived in response to the French philosopher’s thoughts on decision-making.
One of the pragmatic implications of Buridan’s ass is that when you find yourself caught between equally attractive positions, the worst course of action is to do neither.

4. Don’t Get Squish like Grape.
Perhaps my favorite quote on decision-making comes from The Karate Kid‘s Mr. Miyagi:
‘Walk on road, hmmm? Walk left side, safe. Walk right side, safe. Walk middle, sooner or later… you get squish just like grape.’
Mr. Miyagi’s point is that if you are going to make a decision, then make it 100 percent. An attractive prospect, sometimes one we’re unaware of, is to take action, but only halfheartedly. You might decide to take the plunge and start a new business venture, but while away precious and potentially profitable hours looking for other work just in case it doesn’t work out. It’s almost guaranteed in this situation you will get squish like grape.

5. Your Brain Lies to You.
Much of the theory here I’m going to let you look into yourself; have a peep at Dan Gilbert’s talks on TED or read his excellent Stumbling upon Happiness.
Gilbert’s overriding point is that what you think will ruin your life, be it illness, disability, being single, not having children, probably won’t. Conversely, what you think will make you happy, probably won’t. Our ability to predict how we’ll feel in the future is typically skewed in favor of survival. Consequently, it’s actually very unhelpful in situations where we have two equally ‘survivable’ options. Whether you are happy or sad given this or that turn of events in your life will largely be decided by your future self, not by your present self.

6. You’ll Regret Inaction More than Action.
Regret is a funny ol’ thought that doesn’t make a lot of sense in itself. Many writers, including the likes of Kafka, have commented on how easy it is to regret inaction over action. We are much more prone to thinking ‘I wish I’d done such and such’ than we are to thinking ‘I wish I’d not done such and such.’Much of this comes down to the previous thought. If we leave it to our brains to ‘guess’ how we would have felt had we gone down another route in life, we’ll most likely get wildly inaccurate data. By trying all avenues we can rely on our experiences to describe these various scenarios.

7. Indecision isn’t a Talisman against Death.
A common thought I’ve met in the counseling room is that once we have made a decision then we will be left on a collision course with death. Our fear of death has an immeasurable effect on us and we can fool ourselves into thinking that we can postpone or outwit it in all sorts of different ways, this thought being one of them.
The theory here is that if I never chose a direction in life, I won’t be ultimately led to my death. If I become a lawyer, I’ll probably have to do that till I die; if I become a storekeeper it’ll be much the same – however, if I choose neither, maybe I’ll dodge the reaper. As if not choosing a direction in life leaves us somehow unidentifiable, unreal and, just maybe, immortal. I’ll leave your rational minds to weigh up the logic here.

Indecision most likely is a ploy you are using for some other purpose: be it to deny your own freedom, your own death, perhaps an attempt to get a 2-for-1 deal on life or just as a means to stay comfortable at the expense of your happiness. There are all manner of tools to help you drag out decisions; the reality is that if two bales of hay appear equally attractive, remember that either one is better than starvation. Take a chance, roll a dice, phone a friend. Just get off the roundabout.

Resistance to Change

The wiring of your brain makes you a learning-being by nature, however, when you do not feel safe, your brain switches ‘learning mode’ off and ‘protective mode’ on.
This has to do with the fact that your brain is always either in one state or the other. (Note: A type of ‘learning’ takes place is ‘protection’ mode as well, however, this is a radically different type of learning that involves ‘either-or’ behavior patterns, protective ‘fight or flee’ strategies, and the like.)

What, however, turns on your body’s survival response in situations where there are absolutely no threats present to your physical survival (no lions, tigers or bears!)? Certain emotional relational drives are as real as and perhaps even more powerful in driving behaviors than drives for sustenance and physical survival.

• For human beings, learning is inherently connected to deep inner strivings to matter, to meaningfully connect to life, and contribute value, and so on.
• Thus, learning situations can activate core existential fears, such as fear of inadequacy or rejection, and your brain has a built-in tendency to push away what causes discomfort or anxiety, and to draw nearer to what causes pleasurable feelings of safety and love.

You cannot control the body’s survival response. The primary directive of your subconscious mind, after all, is to ensure your survival. This is automatic.
There is something you can do, however!

Your sense of safety in the moment is what determines whether or not your subconscious mind will activate your body’s survival response that, like a dictator, performs a coup d’état of all the systems of your body.

You can control your sense of safety in a given situation. How?
• For one, by identifying and replacing reactive thinking (belief) patterns that are associated with your early survival-love map with life-enriching new ones (that do not automatically activate certain core emotional-command circuits associated with certain early survival fears).
• Recognizing that, unless you do, your subconscious can act like an over-protective parent to block any new behaviors, in particular, ones that activate the core fears imprinted in your own early survival-love map memory.

Learning means opening yourself up to a wide array of information to include information that is not pleasant.

If you stubbornly resist your own attempts to implement new changes, it may be that you attempting to make simple adjustments to old subconscious patterns when the situation calls for some new learning instead.

Not knowing something when someone else does may not sound threatening to the conscious thinking brain, however, if your body holds a belief that continually compares and demands proof of your worth in relation to others on the basis that knowing more means you are smart versus dumb, this will automatically fire the body’s survival response!
A deeper healing, the kind that breaks this and similar strongholds of fear, makes conscious any limiting subconscious beliefs, and brings about transformative change may be necessary

Sexual Problems

There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes. Emotional factors include interpersonal or psychological problems, which can be the result of depression, sexual fears or guilt, past sexual trauma, and sexual disorders, among others.

Sexual dysfunction is especially common among people who have anxiety disorders. Ordinary anxiousness can obviously cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as panic disorder commonly cause avoidance of intercourse and premature ejaculation. Pain during intercourse is often a comorbidity of anxiety disorders among women.

Physical factors that can lead to sexual dysfunctions include the use of drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, and some psychotherapeutic drugs. For women, almost any physiological change that affects the reproductive system—premenstrual syndrome, pregnancy and the postpartum period, menopause—can have an adverse effect on libido. Injuries to the back may also impact sexual activity, as can problems with an enlarged prostate gland, problems with blood supply, or nerve damage (as in spinal cord injuries). Diseases such as diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis may also impact the activity, as could the failure of various organ systems (such as the heart and lungs), endocrine disorders (thyroid, pituitary, or adrenal gland problems), hormonal deficiencies (low testosterone, other androgens, or estrogen) and some birth defects.

In the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction. This can be very distressing for the male partner, causing poor body image, and it can also be a major source of low desire for these men. In aging women, it is natural for the vagina to narrow and become atrophied. If a woman has not been participating in sexual activity regularly (in particular, activities involving vaginal penetration) with her partner, if she does decide to engage in penetrative intercourse, she will not be able to immediately accommodate a penis without risking pain or injury. This can turn into a vicious cycle, often leading to female sexual dysfunction.


When an obsession dominates us, it steals our will and saps all the pleasure out of life. We become numb to people and events, while our mind replays the same dialogue, images or words. In a conversation, we have little interest in what the other person is saying and soon talk about our obsession, oblivious to the impact on our listener.
Obsessions vary in their power. When they’re mild, we’re able to work and distract ourselves. When intense, our thoughts are laser-focused on our obsession. As with compulsions, they operate outside our conscious control and rarely abate with reasoning.

Obsessions can possess our mind. Our thoughts race or run in circles, feeding incessant worry, fantasy or a search for answers. They can take over our life, so that we lose hours, sleep, or even days or weeks of enjoyment and productive activity.

Obsessions can paralyze us. Other times, they can lead to compulsive behavior such as repeatedly checking our email, our weight or whether the doors are locked. We lose touch with ourselves, our feelings and our ability to reason and solve problems. Obsessions like this are usually driven by fear.
Codependents (including addicts) focus on the external. Addicts obsess about the object of their addiction. Our thinking and behavior revolves around the object of our addiction, while our true self is cloaked with shame. But we can obsess about anyone or anything.

Obsessive worry frequently occurs. Because of shame, we’re preoccupied with how others perceive us. This leads to anxiety and obsessions concerning what other people think about us. We especially worry before or after any type of performance or behavior where others are watching, and during dating or after a breakup.

Shame also creates insecurity, doubt, self-criticism, indecision and irrational guilt. Normal guilt can turn into an obsession that leads to self-shaming that can last for days or months. Normal guilt is alleviated by making amends or by taking corrective action, but shame endures because it is “we” who are bad, not our actions.

Codependents typically obsess about people for whom they love and care. They might worry about an alcoholic’s behavior, not realizing they have become as preoccupied with him or her as the alcoholic is with alcohol.

Obsessions can feed compulsive attempts to control others, such as following someone, reading another person’s diary, emails, or texts, diluting bottles of liquor, hiding keys, or searching for drugs. None of this helps but only causes more chaos and conflict. The more we’re obsessed with someone else, the more of ourselves we lose. When asked how we are, we may quickly change the subject to the person we’re obsessed with.

In a new romantic relationship, it’s normal to think about our loved one to a degree, but for codependents, it often doesn’t stop there. When not worrying about the relationship, we may become obsessed with our partner’s whereabouts or create jealous scripts that damage the relationship.

Our obsessions may also be pleasurable, such as fantasies about romance, sex, or power. We may imagine how we’d like our relationship to be or how we want someone to act. A big discrepancy between our fantasy and reality may reveal what we’re missing in our life.

Some codependents are consumed by obsessive love. They might call their loved one many times a day, demand attention and responses, and feel easily hurt, rejected, or abandoned. Actually, this isn’t really love at all, but an expression of a desperate need to bond and escape loneliness and inner emptiness. It usually pushes the other person away. Real love accepts the other person and respects their needs.

Denial is a major symptom of codependency: denial of painful realities, of addiction (ours and others’), and denial of our needs and feelings. A great many codependents are unable to identify their feelings. They may be able to name them, but not feel them.

This inability to tolerate painful emotions is another reason why codependents tend to obsess. Obsession serves the function of protecting us from painful feelings. Thus, it can be looked at as a defense to pain.

As uncomfortable as an obsession can be, it keeps at bay underlying emotions, such as grief, loneliness, anger, emptiness, shame and fear. It may be the fear of rejection or the fear of losing a loved one to a drug addiction.

Passive Aggressive

Passive aggressive behavior stems from an inability to express anger in a healthy way.

A person's feelings may be so repressed that they don't even realize they are angry or feeling resentment. A passive aggressive can drive people around him/her crazy and seem sincerely dismayed when confronted with their behavior. Due to their own lack of insight into their feelings the passive aggressive often feels that others misunderstand them or, are holding them to unreasonable standards if they are confronted about their behavior.

Common Passive Aggressive Behaviors:

• Ambiguity: I think of the proverb, "Actions speak louder than words" when it comes to the passive aggressive and how ambiguous they can be. They rarely mean what they say or say what they mean. The best judge of how a passive aggressive feels about an issue is how they act. Normally they don't act until after they've caused some kind of stress by their ambiguous way of communicating.
• Forgetfulness: The passive aggressive avoids responsibility by "forgetting." How convenient is that? There is no easier way to punish someone than forgetting that lunch date or your birthday or, better yet, an anniversary.
• Blaming: They are never responsible for their actions. If you aren't to blame then it is something that happened at work, the traffic on the way home or the slow clerk at the convenience store. The passive aggressive has no faults, it is everyone around him/her who has faults and they must be punished for those faults.
• Lack of Anger: He/she may never express anger. There are some who are happy with whatever you want. On the outside anyway! The passive aggressive person may have been taught, as a child, that anger is unacceptable. Hence they go through life stuffing their anger, being accommodating and then sticking it to you in an under-handed way.
• Fear of Dependency: From Scott Weltzer, author of Living With The Passive Aggressive Man. "Unsure of his autonomy and afraid of being alone, he fights his dependency needs, usually by trying to control you. He wants you to think he doesn't depend on you, but he binds himself closer than he cares to admit. Relationships can become battle grounds, where he can only claim victory if he denies his need for your support."
• Fear of Intimacy: The passive aggressive often can't trust. Because of this, they guard themselves against becoming intimately attached to someone. A passive aggressive will have sex with you but they rarely make love to you. If they feel themselves becoming attached, they may punish you by withholding sex.
• Obstructionism: Do you want something from your passive aggressive spouse? If so, get ready to wait for it or maybe even never get it. It is important to him/her that you don,t get your way. He/she will act as if giving you what you want is important to them but, rarely will he/she follow through with giving it. It is very confusing to have someone appear to want to give to you but never follow through. You can begin to feel as if you are asking too much which is exactly what he/she wants to you to feel.
• Victimization: The passive aggressive feels they are treated unfairly. If you get upset because he or she is constantly late, they take offense because; in their mind, it was someone else's fault that they were late. He/she is always the innocent victim of your unreasonable expectations, an over-bearing boss or that slow clerk at the convenience store.
• Procrastination: The passive aggressive person believes that deadlines are for everyone but them. They do things on their own time schedule and be damned anyone who expects differently from them.

Obsessive-Compulsive Disorder (OCD)

Obsessive–compulsive disorder (OCD) is a mental disorder where people feel the need to check things repeatedly, have certain thoughts repeatedly, or feel they need to perform certain routines repeatedly. People are unable to control either the thoughts or the activities. Common activities include hand washing, counting of things, and checking to see if a door is locked. Some may have difficulty throwing things out. These activities occur to such a degree that the person's daily life is negatively affected. Often they take up more than an hour a day. Most adults realize that the behaviors do not make sense. The condition is associated with tics, anxiety disorder, and an increased risk of suicide.

The cause is unknown. There appears to be some genetic components with identical twins more often affected than non-identical twins. Risk factors include a history of child abuse or other stress inducing event. Some cases have been documented to occur following infections. The diagnosis is based on the symptoms and requires ruling out other drug related or medical causes. Rating scales such as Yale–Brown Obsessive Compulsive Scale can be used to assess the severity. Other disorders with similar symptoms include: anxiety disorder, major depressive disorder, eating disorders, tic disorders, and obsessive–compulsive personality disorder.

Treatment for OCD involves the use of behavioral therapy and sometimes selective serotonin reuptake inhibitors (SSRIs). The type of behavior therapy used involves increasing exposure to what causes the problems while not allowing the repetitive behavior to occur. Atypical antipsychotics such as quetiapine may be useful when used in addition to an SSRI in treatment-resistant cases but are associated with an increased risk of side effects. Without treatment the condition often lasts decades.

Obsessive–compulsive disorder affects about 2.3% of people at some point in their life. Rates during a given year are about 1.2% and it occurs worldwide. It is unusual for symptoms to begin after the age of thirty five and half of people develop problems before twenty. Males and females are affected about equally. In English the phrase obsessive–compulsive is often used in an informal manner unrelated to OCD to describe someone who is excessively meticulous, perfectionistic, absorbed, or otherwise fixated.


Addiction is a state characterized by compulsive engagement in rewarding stimuli, despite adverse consequences. It can be thought of as a disease or biological process leading to such behaviors. The two properties that characterize all addictive stimuli are that they are reinforcing (i.e., they increase the likelihood that a person will seek repeated exposure to them) and intrinsically rewarding (i.e., something perceived as being positive or desirable).
Addiction is a disorder of the brain's reward system which arises through transcriptional and epigenetic mechanisms and occurs over time from chronically high levels of exposure to an addictive stimulus (e.g., morphine, cocaine, sexual intercourse, gambling, etc.). Addiction exacts an astoundingly high toll on individuals and society as a whole through the direct adverse effects of drugs, associated healthcare costs, long-term complications (e.g., lung cancer with smoking tobacco, liver cirrhosis with drinking alcohol, or meth mouth from intravenous methamphetamine), the functional consequences of altered neural plasticity in the brain, and the consequent loss of productivity. Classic hallmarks of addiction include impaired control over substances or behavior, preoccupation with substance or behavior, and continued use despite consequences. Habits and patterns associated with addiction are typically characterized by immediate gratification (short-term reward), coupled with delayed deleterious effects (long-term costs).
Examples of drug and behavioral addictions include: alcoholism, amphetamine addiction, cocaine addiction, nicotine addiction, opiate addiction, exercise addiction, food addiction, gambling addiction, and sexual addiction. The term addiction is misused frequently to refer to other compulsive behaviors or disorders, particularly dependence, in news media.

Bed Wetting (Enuresis)

Nocturnal enuresis or nighttime urinary incontinence, commonly called bedwetting or sleepwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Nocturnal enuresis is considered primary (PNE) when a child has not yet had a prolonged period of being dry. Secondary nocturnal enuresis (SNE) is when a child or adult begins wetting again after having stayed dry.
Some people sleep so deeply (somnambulists) that they can dream they are physically on the toilet at time of release.
Some bedwetting is a developmental delay—not an emotional problem or physical illness. Only a small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations. Bedwetting is frequently associated with a family history of the condition.
Treatments range from behavioral-based options such as bedwetting alarms, to medication such as hormone replacement, and even surgery such as urethral enlargement. Since most bedwetting is simply a developmental delay, most treatment plans aim to protect or improve self-esteem. Bedwetting children and adults can suffer emotional stress or psychological injury if they feel shamed by the condition. Treatment guidelines recommend that the physician counsel the parents, warning about psychological damage caused by pressure, shaming, or punishment for a condition children cannot control.
Bedwetting is the most common childhood complaint. Most girls stay dry by age six and most boys stay dry by age seven. By ten years old, 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% to 2.3%

Sleep Disorders

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for some sleep disorders.

Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism) to night terrors. When a person suffers from difficulty falling asleep and/or staying asleep with no obvious cause, it is referred to as insomnia.

Sleep disorders are broadly classified into dysomnias, parasomnias, circadian rhythm sleep disorders involving the timing of sleep, and other disorders including ones caused by medical or psychological conditions and sleeping sickness. Some common sleep disorders include sleep apnea (stops in breathing during sleep), narcolepsy and hypersomnia (excessive sleepiness at inappropriate times), cataplexy (sudden and transient loss of muscle tone while awake), and sleeping sickness (disruption of sleep cycle due to infection). Other disorders include sleepwalking, night terrors and bed wetting. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

The most common sleep disorders include:

• Bruxism, involuntarily grinding or clenching of the teeth while sleeping
• Delayed sleep phase disorder (DSPD), inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythms. Other such disorders are advanced sleep phase disorder (ASPD), non-24-hour sleep–wake disorder (non-24) in the sighted or in the blind, and irregular sleep wake rhythm, all much less common than DSPD, as well as the situational shift work sleep disorder
• Hypopnea syndrome, abnormally shallow breathing or slow respiratory rate while sleeping
• Idiopathic hypersomnia, a primary, neurologic cause of long-sleeping, sharing many similarities with narcolepsy
• Insomnia disorder (primary insomnia), chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these symptoms
• Kleine–Levin syndrome, characterized by persistent episodic hypersomnia and cognitive or mood changes (rare)
• Narcolepsy, including excessive daytime sleepiness (EDS), often culminating in falling asleep spontaneously but unwillingly at inappropriate times. Also often associated with cataplexy, a sudden weakness in the motor muscles that can result in collapse to the floor.
• Night terror, Pavor nocturnus, sleep terror disorder, an abrupt awakening from sleep with behavior consistent with terror
• Nocturia, a frequent need to get up and urinate at night. It differs from enuresis, or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties.
• Parasomnias, disruptive sleep-related events involving inappropriate actions during sleep, for example sleep walking and night-terrors
• Periodic limb movement disorder (PLMD), sudden involuntary movement of arms and/or legs during sleep, for example kicking the legs. Also known as nocturnal myoclonus. See also Hypnic jerk, which is not a disorder.
• Rapid eye movement sleep behavior disorder (RBD), acting out violent or dramatic dreams while in REM sleep, sometimes injuring bed partner or self (REM sleep disorder or RSD)
• Restless legs syndrome (RLS), an irresistible urge to move legs. RLS sufferers often also have PLMD.
• Shift work sleep disorder (SWSD), a situational circadian rhythm sleep disorder. Jet lag was previously included, but it doesn't appear in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).
• Sleep apnea, obstructive sleep apnea, obstruction of the airway during sleep, causing lack of sufficient deep sleep, often accompanied by snoring. Other forms of sleep apnea are less common. When air is blocked from entering into the lungs, the individual unconsciously gasps for air and sleep is disturbed. Stops of breathing of at least ten seconds, 30 times within seven hours of sleep, classifies as apnea. Other forms of sleep apnea include central sleep apnea and sleep-related hypoventilation.
• Sleep paralysis, characterized by temporary paralysis of the body shortly before or after sleep. Sleep paralysis may be accompanied by visual, auditory or tactile hallucinations. Not a disorder unless severe. Often seen as part of narcolepsy.
• Sleepwalking or somnambulism, engaging in activities normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject
• Somniphobia, one cause of sleep deprivation, a dread/ fear of falling asleep or going to bed. Signs of the illness include anxiety and panic attacks before and during attempts to sleep.

Premature Ejaculation

Premature ejaculation (PE) occurs when a man experiences orgasm and expels semen soon after sexual activity and with minimal penile stimulation. There is no uniform cut-off defining "premature," but a consensus of experts at the International Society for Sexual Medicine endorsed a definition including "ejaculation which always or nearly always occurs prior to or within about one minute." The International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse.
Although men with premature ejaculation describe feeling that they have less control over ejaculating, it is not clear if that is true, and many or most average men also report that they wish they could last longer. Men's typical ejaculatory latency is approximately 4–8 minutes.

Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment. Compared with men, women consider PE less of a problem, but several studies show that the condition also causes female partners distress.


Social inhibition is a conscious or subconscious avoidance of a situation or social interaction. With a high level of social inhibition, situations are avoided because of the possibility of others disapproving of their feelings or expressions. Social inhibition is related to behavior, appearance, social interactions, or a subject matter for discussion. Related processes that deal with social inhibition are social evaluation concerns, anxiety in social interaction, social avoidance, and withdrawal. Also related are components such as cognitive brain patterns, anxious apprehension during social interactions, and internalizing problems. It also describes those who suppress anger, restrict social behavior, withdraw in the face of novelty, and have a long latency to interact with strangers. Individuals can also have a low level of social inhibition, but certain situations may generally cause people to be more or less inhibited. Social inhibition can be reduced by the use of drugs including alcohol. Major signs of social inhibition in children are cessation of play, long latencies to approaching the unfamiliar person, signs of fear and negative affect, and security seeking. Also in high level cases of social inhibition, other social disorders can emerge through development, such as social anxiety disorder and social phobia.

A sexual inhibition is a conscious or subconscious constraint or curtailment by a person of behavior relating to specific sexual matters or practices or of a discussion of sexual matters.

Though a person can be regarded as being sexually inhibited if he or she irrationally fears of or is excessively averse to any sexual practice or discourse, the term is normally not applied to a person who refrains from certain sexual activities on moral and rational grounds or due to a psychological disorder. On the other hand, a person can be regarded as having low sexual inhibitions when he or she welcomes a variety of non-conventional erotic practices. Hypersexuality is typically associated with lowered sexual inhibitions, and alcohol and some drugs can affect a person's social and sexual inhibitions. Hypersexuality is at times viewed in terms of sexual addiction.


Grief is a multifaceted response to loss, particularly to the loss of someone or something that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, spiritual, and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to loss.

Grief is a natural response to loss. It is the emotional suffering one feels when something or someone the individual loves is taken away. Grief is also a reaction to any loss. The grief associated with death is familiar to most people, but individuals grieve in connection with a variety of losses throughout their lives, such as unemployment, ill health or the end of a relationship. Loss can be categorized as either physical or abstract, the physical loss being related to something that the individual can touch or measure, such as losing a spouse through death, while other types of loss are abstract, and relate to aspects of a person’s social interactions.

The Kübler-Ross model postulates a series of emotional stages experienced by survivors of an intimate's death, wherein the five stages are denial, anger, bargaining, depression and acceptance.

The model was first introduced by Swiss psychiatrist Elisabeth Kübler-Ross in her 1969 book, On Death and Dying, and was inspired by her work with terminally ill patients. Motivated by the lack of curriculum in medical schools on the subject of death and dying, Kübler-Ross examined death and those faced with it at the University of Chicago medical school. Kübler-Ross' project evolved into a series of seminars which, along with patient interviews and previous research, became the foundation for her book. Since the publication of "On Death and Dying", the Kübler-Ross model has become accepted by the general public; however, its validity is not consistently supported by the majority of research.

Kübler-Ross noted that the stages are not a complete list of all possible emotions, and can occur in any order, and that not everyone who experiences a life-threatening or life-altering event feels all five of the responses.

The stages, popularly known by the acronym DABDA, include:

1. Denial — one of the first reactions is denial, wherein the survivor imagines a false, preferable reality.
2. Anger — when the individual recognizes that denial cannot continue, it becomes frustrated, especially at proximate individuals. Certain psychological responses of a person undergoing this phase would be: "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"; "Why would God let this happen?".
3. Bargaining — the third stage involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Other times, they will use anything valuable against another human agency to extend or prolong the life. People facing less serious trauma can bargain or seek compromise.
4. Depression — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point?"; "I miss my loved one, why go on?" During the fourth stage, the individual becomes saddened by the certainty of death. In this state, the individual may become silent, refuse visitors and spend much of the time mournful and sullen.
5. Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it."

In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or other tragic event. People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the individual, and a stable condition of emotions.

Kübler-Ross later expanded her model to include any form of personal loss, such as the death of a loved one, the loss of a job or income, major rejection, the end of a relationship or divorce, drug addiction, incarceration, the onset of a disease or chronic illness, an infertility diagnosis, and even minor losses.


Emotional security is the measure of the stability of an individual's emotional state. Emotional insecurity or simply insecurity is a feeling of general unease or nervousness that may be triggered by perceiving of oneself to be vulnerable or inferior in some way, or a sense of vulnerability or instability which threatens one's self-image or ego.
The concept is related to that of psychological resilience in as far as both concern the effects which setbacks or difficult situations have on an individual. However, resilience concerns over-all coping, also with reference to the individual's socioeconomic situation, whereas the emotional security specifically characterizes the emotional impact. In this sense, emotional security can be understood as part of resilience.

The notion of emotional security of an individual is to be distinguished from that of emotional safety or security provided by a non-threatening, supportive environment. A person who is susceptible to bouts of depression being triggered by minor setbacks is said to be less "emotionally secure". A person whose general happiness is not very shaken even by major disturbances in the pattern or fabric of their life might be said to be extremely emotionally secure.

Abraham Maslow describes an insecure person as a person who "perceives the world as a threatening jungle and most human beings as dangerous and selfish; feels a rejected and isolated person, anxious and hostile; is generally pessimistic and unhappy; shows signs of tension and conflict, tends to turn inward; is troubled by guilt-feelings, has one or another disturbance of self-esteem; tends to be neurotic; and is generally selfish and egocentric." (Maslow, 1942, pp 35). He viewed in every insecure person a continual, never dying, longing for security. Alegre (2008).

A person who is insecure lacks confidence in their own value, and one or more of their capabilities, lacks trust in themselves or others, or has fears that a present positive state is temporary, and will let them down and cause them loss or distress by "going wrong" in the future. This is a common trait, which only differs in degree between people.
This is not to be confused with humility, which involves recognizing one's shortcomings but still maintaining a healthy dose of self-confidence. Insecurity is not an objective evaluation of one's ability but an emotional interpretation. Two people with the same capabilities may have entirely different levels of insecurity.

Insecurity may contribute to the development of shyness, paranoia and social withdrawal, or alternatively it may encourage compensatory behaviors such as arrogance, aggression, or bullying, in some cases.

The fact that the majority of human beings are emotionally vulnerable, and have the capacity to be hurt, implies that emotional insecurity could merely be a difference in awareness.

Insecurity has many effects in a person's life. There are several levels of it. It nearly always causes some degree of isolation as a typically insecure person withdraws from people to some extent. The greater the insecurity, the higher the degree of isolation becomes. Insecurity is often rooted in a person's childhood years. Like offense and bitterness, it grows in layered fashion, often becoming an immobilizing force that sets a limiting factor in the person's life. Insecurity robs by degrees; the degree to which it is entrenched equals the degree of power it has in the person's life. As insecurity can be distressing and feel threatening to the psyche, it can often be accompanied by a controlling personality type or avoidance, as psychological defense mechanisms.

To a certain extent, emotional security is a function of brain chemistry: some people are naturally predisposed to feel less happy, and to be more adversely affected by natural events, for example in the case of hypothyroidism. Certain medications, such as SSRI's or even stimulants, are often prescribed to address such natural deficiencies. The side-effects of these medications, however, in many cases can negate their positive effects, for example when certain anti-depressants make it difficult or impossible to experience orgasm by making the brain incapable of cutting off the flow of certain hormones usually associated with positive emotions but necessary to suddenly block for short periods of time in order for orgasm to occur. It is also said that such medications blunt both 'the highs and the lows,' sapping, for some people, a valuable, inspiring energy from life. However, weighing the pros against the cons of such situations is something different for each individual, and in many cases the dangers of naturally low emotional security may be worse than the side-effects of the appropriate medication, especially such as when a person is suicidal.


Distrust and mistrust are roughly the same. Both refer to (1) lack of trust, and (2) to regard without trust. But distrust is often based on experience or reliable information, while mistrust is often a general sense of unease toward someone or something. For example, you might distrust the advice of someone who has given you bad tips in the past, and you might mistrust advice from a stranger. This distinction is only a general tendency, though, and it is not always borne out in real-world usage.
Individuals with high levels of cynical distrust — the belief that other people are usually motivated by selfish desires — may be more likely to develop dementia, according to a new study published in the journal Neurology. Cynical distrust has been linked to other types of health problems, such as heart disease.
Distrust doesn’t happen overnight. It develops progressively through stages, and if we can recognize these stages when we’re in them, we have a chance of addressing the situation before distrust takes root.
1. Doubt – The first stage of distrust begins with doubt. You start to experience a slight uncertainty about someone’s trustworthiness that causes you to pause just a bit. It might be that nagging doubt in the back of your mind that you can’t seem to dismiss, or something just doesn’t feel right about the situation even though you can’t put your finger on it exactly.
2. Suspicion – Doubt, if unresolved, grows into suspicion over time. Suspicion is belief without proof. You’ve started to see a pattern of behavior that may indicate a lack of trust, but you don’t quite have enough proof to make a firm conclusion. Your trust radar is telling you that something is wrong.
3. Anxiety – The third stage of distrust is anxiety, a feeling of apprehension or uneasiness that is often manifested physically. When dealing with someone you don’t quite trust, you may experience nervousness, a rapid heartbeat, anger, a knotted stomach, or even disgust.
4. Fear – At this point in a relationship, distrust has risen to the point where you are afraid to show vulnerability. You have experienced repeated breaches of trust and have grown to distrust another person to the point you are afraid for your emotional well-being.
5. Self-protection – As a result of the fear you experienced, you move into a state of self-protection. You put up walls in your relationship to prevent the other person getting close to you. This act of self-preservation reduces your vulnerability, but also cements the state of distrust in the relationship.
Trust is the cord that holds two people together in relationship, and when it’s severed, disconnection occurs. When you can no longer be vulnerable with the other person, you begin to experience different things in your relationship:
Withdrawal – Instead of acting carefree, which is normal in a trusting relationship, you become more reserved in sharing personal information. You quit taking risks in the relationship because the safety net has been removed. Loneliness or feeling dead or frozen inside is common.
Movement to task – To compensate for the lack of trust in the relationship, you may over-invest yourself in tasks related to hobbies, work, school, church, or other activities. You stay active in other parts of your life because you find it easier to “do” than to “connect.” You shut down the personal part of your relationship with the other person.
Unbalanced “giver” relationships – It is common for a person to be the “giver” in all relationships and to avoid “receiving.” Being the giver allows you to remain safe from being vulnerable with another person. You will listen, help, and guide others, but withhold letting others help you. Being the giver also manifests itself in co-dependent relationships.
Bad habits – Trust issues can often lead to problematic behavioral patterns in your life. It’s easy to suppress our emotional feelings by over-eating, drinking too much, or other addictive behaviors.
Distrust can spread through a relationship like a wildfire. What starts as a small ember of doubt can mushroom into a full-on blaze of distrust if we don’t take steps to address it early. The best way to prevent distrust from taking root is to proactively focus on building trust. Trust must be continually developed and nurtured throughout the course of a relationship, not just when it’s been damaged.


Victimization (or victimization) is the process of being victimized or becoming a victim. Research that studies the process, rates, incidence, and prevalence of victimization falls under the body of victimology.

Peer victimization is the experience among children of being a target of the aggressive behavior of other children, who are not siblings and not necessarily age-mates.
Secondary victimization (also known as post crime victimization or double victimization) relates to further victimization following on from the original victimization. For example, victim blaming, inappropriate post-assault behavior or language by medical personnel or other organizations with which the victim has contact may further add to the victim's suffering. Victims may also experience secondary victimization by justice system personnel upon entering the criminal justice system. Victims will lose time, suffer reductions in income, often be ignored by bailiffs and other courthouse staff and will remain uninformed about updates in the case such as hearing postponements, to the extent that their frustration and confusion will turn to apathy and a declining willingness to further participate in system proceedings.

Rape is especially stigmatizing in cultures with strong customs and taboos regarding sex and sexuality. For example, a rape victim (especially one who was previously a virgin) may be viewed by society as being "damaged." Victims in these cultures may suffer isolation, be disowned by friends and family, be prohibited from marrying, or be divorced if already married.

The re-traumatization of the sexual assault, abuse, or rape victim through the responses of individuals and institutions is an example of secondary victimization. Secondary victimization is especially common in cases of drug-facilitated, acquaintance, and statutory rape.

The term revictimization refers to a pattern wherein the victim of abuse and/or crime has a statistically higher tendency to be victimized again, either shortly thereafter or much later in adulthood in the case of abuse as a child. This latter pattern is particularly notable in cases of sexual abuse. While an exact percentage is almost impossible to obtain, samples from many studies suggest the rate of revictimization for people with histories of sexual abuse is very high. The vulnerability to victimization experienced as an adult is also not limited to sexual assault, and may include physical abuse as well.

Reasons as to why revictimization occurs vary by event type, and some mechanisms are unknown. Revictimization in the short term is often the result of risk factors that were already present, which were not changed or mitigated after the first victimization; sometimes the victim cannot control these factors. Examples of these risk factors include living or working in dangerous areas, chaotic familial relations, having an aggressive temperament, drug or alcohol usage and unemployment.

Revictimization of adults who were previously sexually abused as children is more complex. Multiple theories exist as to how this functions. Some scientists propose a maladaptive form of learning; the initial abuse teaches inappropriate beliefs and behaviors that persist into adulthood. The victim believes that abusive behavior is "normal" and comes to expect it from others in the context of relationships, and thus may unconsciously seek out abusive partners or cling to abusive relationships. Another theory draws on the principle of learned helplessness. As children, they are put in situations that they have little to no hope of escaping, especially when the abuse comes from a caregiver. One theory goes that this state of being unable to fight back or flee the danger leaves the last primitive option: freeze, an off-shoot of death-feigning.

In adulthood, the freeze response can remain, and some professionals have noted that victimizers sometimes seem to pick up subtle clues of this when choosing a victim. This behavior can make the victim an easier target, as they sometimes make less effort to fight back or vocalize. Afterwards, they often make excuses and minimize what happened to them, sometimes never reporting the assault to the authorities.

Self-victimization (or victim playing) is the fabrication of victimhood for a variety of reasons such to justify abuse of others, to manipulate others, a coping strategy or attention seeking.

Victims of abuse and manipulation often get trapped into a self-image of victimization. The psychological profile of victimization includes a pervasive sense of helplessness, passivity, loss of control, pessimism, negative thinking, strong feelings of guilt, shame, self-blame and depression. This way of thinking can lead to hopelessness and despair.


Cramp is a sudden, severe, and involuntary muscle contraction or over-shortening; while generally temporary and non-damaging, they can cause mild-to-excruciating pain, and a paralysis-like immobility of the affected muscle(s). Onset is usually sudden, and it resolves on its own over a period of several seconds, minutes, or hours. Cramps may occur in a skeletal muscle or smooth muscle. Skeletal muscle cramps may be caused by any combination of muscle fatigue, a lack of electrolytes (e.g., low sodium, low potassium, or low magnesium)[citation needed]. Cramps of smooth muscle may be due to menstruation or gastroenteritis.

Causes of cramping include hyperflexion, hypoxia, exposure to large changes in temperature, dehydration, or low blood salt. Muscle cramps may also be a symptom or complication of pregnancy, kidney disease, thyroid disease, hypokalemia, hypomagnesemia or hypocalcemia (as conditions), restless-leg syndrome, varicose veins, and multiple sclerosis.

Electrolyte disturbance may cause cramping and muscle tetany, particularly hypokalemia and hypocalcaemia. This disturbance arises as the body loses large amounts of interstitial fluid through sweat. This interstitial fluid comprises mostly water and salt (sodium chloride). The loss of osmotically active particles outside of muscle cells leads to a disturbance of the osmotic balance and therefore shrinking of muscle cells, as these contain more osmotically active particles. This causes the calcium pump between the muscle sarcoplasm and sarcoplasmic reticulum to short circuit; the calcium ions remain bound to the troponin, continuing muscle contraction.

As early as 1965, researchers observed that leg cramps and restless-leg syndrome result from excess insulin, sometimes called hyperinsulinemia. Hypoglycemia and reactive hypoglycemia are associated with excess insulin (or insufficient glucagon), and avoidance of low blood glucose concentration may help to avoid cramps.


Retching (also known as dry heaving) is the reverse movement (peristalsis) of the stomach and esophagus without vomiting. It can be caused by bad smell or choking, or by withdrawal from some medications after vomiting stops. Retching can also be as a result of an emotional response or from stress which produces the same physical reaction. The function is thought to be mixing gastric contents with intestinal refluxate in order to buffer the former and give it momentum in preparation of vomiting. Treatments include medication and correction of the fluid and electrolyte balance.

The retching phase is characterized by a series of violent spasmodic abdomino-thoracic contractions with the glottis closed. During this time, the inspiratory (inhalatory) movements of the chest wall and diaphragm are opposed by the expiratory contractions of the abdominal musculature. At the same time, movements of the stomach and its contents take place. Whereas a patient will complain of disagreeable sensations during nausea, speech is not possible during retching. The characteristic movements furnish a ready diagnostic sign of the retching phase. Schindler (1937) studied retching on two occasions during gastroscopy and noted that longitudinal folds appeared in the previously smooth antrum, thickened quickly, came together and completely closed the antrum. Retching involves a deep inspiration against a closed glottis. This, along with contraction of the abdomen, leads to a pressure difference between the abdominal and thoracic cavities. As a result, the stomach and gastric contents are displaced upwards toward the thoracic cavity.

Retching comprises a rhythmically alternating (about once per second) elevation and descension of the entire pharyngolaryngoesophagogastric apparatus in synchrony with the movement of the diaphragm. The function of retching may be to mix gastric contents with intestinal refluxate to buffer gastric contents before gastroesophageal reflux and to impart a momentum to the gastric contents before vomiting. Airway protection during retching is accomplished by glottal closure during retches and constriction of the upper esophageal sphincter between retches.

Vomiting (the expulsion of gastric contents) is usually preceded by retching, but retching and vomiting can occur separately and involve different sets of muscles. During a retch, thoracic pressure is decreased and abdominal pressure is increased, which may serve to position gastric contents and overcome esophageal resistance. Conversely, a vomit occurs with increased thoracic and abdominal pressure. Retches and vomits are commonly lumped together in behavioral analyses and consequently the neural controls for these processes are not well delineated.


Repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. The awakenings generally occur during the second half of the sleep period.

On awakening from the frightening dreams, the person rapidly becomes oriented and alert (in contrast to the confusion and disorientation seen in Sleep Terror Disorder and some forms of epilepsy).

The dream experience, or the sleep disturbance resulting from the awakening, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The nightmares do not occur exclusively during the course of another mental disorder (e.g., a delirium, Posttraumatic Stress Disorder) or any coexisting (sleep or non-sleep) mental or medical disorder cannot adequately explain the predominant complaint of dysphoric dreams. These dreams are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication).

A clinician will add specifiers to the diagnosis according to its duration and severity.

• Acute: Duration of period of nightmares is 1 month or less.
• Subacute: Duration of period of nightmares is greater than 1 month but less than 6 months.
• Persistent: Duration of period of nightmares is 6 months or greater.
Severity is rated by the frequency with which the nightmares occur:
• Mild: Less than one episode per week on average.
• Moderate: One or more episodes per week but less than nightly.
• Severe: Episodes nightly.


A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck.

Headaches can result from a wide range of causes both benign and more serious. Brain tissue itself is not sensitive to pain as it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Nine areas of the head and neck have these pain-sensitive structures, which are the cranium (the periosteum of the skull), muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes. There are a number of different classification systems for headaches. The most well recognized is that of the International Headache Society. Headache is a non-specific symptom, which means that it has many possible causes, including fatigue and sleep deprivation, stress, the effects of medications and recreational drugs, viral infections and common colds, head injury, rapid ingestion of a very cold food or beverage, dental or sinus issues, and many more.

Treatment of a headache depends on the underlying cause, but commonly involves pain killers. Some form of headache is one of the most commonly experienced of all physical discomforts.

There are more than 200 types of headaches. Some are harmless and some are life-threatening. The description of the headache and findings on neurological examination, determine whether additional tests are needed and what treatment is best.

Headaches are broadly classified as "primary" or "secondary".[3] Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example, migraine is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous. Secondary headaches are caused by an underlying disease, like an infection, head injury, vascular disorders, brain bleed or tumors. Secondary headaches can be harmless or dangerous. Certain "red flags" or warning signs indicate a secondary headache may be dangerous.

90% of all headaches are primary headaches. Primary headaches usually first start when people are between 20 and 40 years old. The most common types of primary headaches are migraines and tension-type headaches. They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms. Other very rare types of primary headaches include:

• cluster headaches: short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium.
• trigeminal neuralgia: shooting face pain
• hemicrania continua: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication indomethacin.
• primary stabbing headache: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with indomethacin.
• primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious etiologies(see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made.
• primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as indomethacin.
• primary sex headache: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as propranolol and diltiazem can also be helpful.
• hypnic headache: moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during night. Hypnic headaches are usually in older women. They may be treated with lithium.

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.

More serious causes of secondary headaches include:

• meningitis: inflammation of the meninges which presents with fever and meningismus, or stiff neck
• bleeding inside the brain (intracranial hemorrhage)
• subarachnoid hemorrhage (acute, severe headache, stiff neck WITHOUT fever)
• ruptured aneurysm, arteriovenous malformation, intraparenchymal hemorrhage (headache only)
• brain tumor: dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. Often, the person will have nausea and vomiting for weeks before the headache starts.
• temporal arteritis: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica
• acute closed angle glaucoma (increased pressure in the eyeball): headache that starts with eye pain, blurry vision, associated with nausea and vomiting. On physical exam, the person will have a red eye and a fixed, mid dilated pupil.

Immune System

The immune system is a system of many biological structures and processes within an organism that protects against disease. To function properly, an immune system must detect a wide variety of agents, known as pathogens, from viruses to parasitic worms, and distinguish them from the organism's own healthy tissue. In many species, the immune system can be classified into subsystems, such as the innate immune system versus the adaptive immune system, or humoral immunity versus cell-mediated immunity.

Pathogens can rapidly evolve and adapt, and thereby avoid detection and neutralization by the immune system; however, multiple defense mechanisms have also evolved to recognize and neutralize pathogens. Even simple unicellular organisms such as bacteria possess a rudimentary immune system, in the form of enzymes that protect against bacteriophage infections. Other basic immune mechanisms evolved in ancient eukaryotes and remain in their modern descendants, such as plants and insects. These mechanisms include phagocytosis, antimicrobial peptides called defensins, and the complement system. Jawed vertebrates, including humans, have even more sophisticated defense mechanisms, including the ability to adapt over time to recognize specific pathogens more efficiently. Adaptive (or acquired) immunity creates immunological memory after an initial response to a specific pathogen, leading to an enhanced response to subsequent encounters with that same pathogen. This process of acquired immunity is the basis of vaccination.

Disorders of the immune system can result in autoimmune diseases, inflammatory diseases and cancer. Immunodeficiency occurs when the immune system is less active than normal, resulting in recurring and life-threatening infections. In humans, immunodeficiency can either be the result of a genetic disease such as severe combined immunodeficiency, acquired conditions such as HIV/AIDS, or the use of immunosuppressive medication. In contrast, autoimmunity results from a hyperactive immune system attacking normal tissues as if they were foreign organisms. Common autoimmune diseases include Hashimoto's thyroiditis, rheumatoid arthritis, diabetes mellitus type 1, and systemic lupus erythematosus. Immunology covers the study of all aspects of the immune system.


Fatigue (also called exhaustion, tiredness, languidness, languor, lassitude, and listlessness) is a subjective feeling of tiredness which is distinct from weakness, and has a gradual onset. Unlike weakness, fatigue can be alleviated by periods of rest. Fatigue can have physical or mental causes. Physical fatigue is the transient inability of a muscle to maintain optimal physical performance, and is made more severe by intense physical exercise. Mental fatigue is a transient decrease in maximal cognitive performance resulting from prolonged periods of cognitive activity. It can manifest as somnolence, lethargy, or directed attention fatigue.

Medically, fatigue is a non-specific symptom, which means that it has many possible causes. Fatigue is considered a symptom, rather than a sign because it is a subjective feeling reported by the patient, rather than an objective one that can be observed by others. Fatigue and 'feelings of fatigue' are often confused.

Separation Anxiety

Separation anxiety, a substrate of emotional abandonment, is recognized as a primary source of human distress and dysfunction. When we experience a threat to or disconnection in a primary attachment, it triggers a fear response referred to as separation stress or separation anxiety. Separation stress has been the subject of extensive research in psychological and neurobiological fields, and has been shown to be a universal response to separation in the animal world of which human beings are a part. When laboratory rat pups are separated from their mothers for periods of time, researchers measure their distress vocalizations and stress hormones to determine varying conditions of the separation response. As the rats mature, their subsequent reactive behaviors and stress hormones are reexamined and are shown to bear a striking resemblance to the depression, anxiety, avoidance behaviors, and self defeated posturing displayed by human beings known to have suffered earlier separation traumas.

Owing to the neocortical component of human functioning, when human beings lose a primary relationship, they grasp its potential repercussions (i.e. they may feel uncertain about the future or fear being unable to climb out of an abyss), thus encumbering an additional layer of separation stress. To abandon is "to withdraw one's support or help from, especially in spite of duty, allegiance, or responsibility; desert: abandon a friend in trouble." When the loss is due to the object’s voluntary withdrawal, a common response is to feel unworthy of love. This indicates the tendency for people to blame the rejection on themselves. "Am I unworthy of love, destined to grow old and die all alone, bereft of human connection or caring?" Questioning one’s desirability as a mate and fearing eternal isolation are among the additional anxieties incurred in abandonment scenarios. The concurrence of self-devaluation and primal fear distinguish abandonment grief from most other types of bereavement.


Dyspraxia, a form of developmental coordination disorder (DCD) is a common disorder affecting fine and/or gross motor coordination in children and adults. It may also affect speech. DCD is a lifelong condition, formally recognized by international organizations including the World Health Organization. DCD is distinct from other motor disorders such as cerebral palsy and stroke, and occurs across the range of intellectual abilities. Individuals may vary in how their difficulties present: these may change over time depending on environmental demands and life experiences. An individual’s coordination difficulties may affect participation and functioning of everyday life skills in education, work and employment.

Children may present with difficulties with self-care, writing, typing, and riding a bike and play as well as other educational and recreational activities. In adulthood many of these difficulties will continue, as well as learning new skills at home, in education and work, such as driving a car and DIY.
There may be a range of co-occurring difficulties which can also have serious negative impacts on daily life. These include social and emotional difficulties as well as problems with time management, planning and personal organization, and these may also affect an adult’s education or employment experiences.
Many people with DCD also experience difficulties with memory, perception and processing. While DCD is often regarded as an umbrella term to cover motor coordination difficulties, dyspraxia refers to those people who have additional problems planning, organizing and carrying out movements in the right order in everyday situations. Dyspraxia can also affect articulation and speech, perception and thought.

Although the exact causes of dyspraxia are unknown, it is thought to be caused by a disruption in the way messages from the brain are transmitted to the body. This affects a person’s ability to perform movements in a smooth, coordinated way.


The essential features of sleepiness in narcolepsy is irresistible attacks of refreshing sleep that occur almost daily (at least 3x per week) over at least 3 months. Narcolepsy generally produces cataplexy, which most commonly presents as brief episodes (seconds to minutes) of sudden, bilateral loss of muscle tone precipitated by emotions, typically laughing and joking. Muscles affected may include those of the neck, jaw, arms, legs, or whole body, resulting in head bobbing, jaw dropping, or complete falls. Individuals are awake and aware during cataplexy.

Narcolepsy-cataplexy affects 0.02%–0.04% of the general population in most countries. Narcolepsy affects both genders, with possibly a slightly greater prevalence in males. In 90% of cases, the first symptom to manifest is sleepiness or increased sleep, followed by cataplexy (within 1 year in 50% of cases, within 3 years in 85%).

Onset is typically in children and adolescents/young adults but rarely in older adults. Two peaks of onset are generally seen, at ages 15–25 years and ages 30–35 years. Onset can be abrupt or progressive (over years). It is most severe when it occurs abruptly in children. Illustratively, sleep paralysis usually develops around puberty in children who have prepubertal onset. Since 2009, clinicians have observed greater rates of abrupt onset in young children who are obese and likely to experience and premature puberty. In adolescents, onset is more difficult to pinpoint. Onset in adults is often unclear, with some individuals reporting having had excessive sleepiness since birth. Once the disorder has manifested, the course is persistent and lifelong.

Sleepiness, vivid dreaming, and excessive movements during REM sleep are early symptoms. Excessive sleep rapidly progresses to an inability to stay awake during the day is indicative of its progression. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting is most common (often a precursor of later developing cataplexy). Exacerbation of symptoms suggest lack of compliance with medications or development of a concurrent sleep disorder, notably sleep apnea. Some medication treatments are helpful can lead to the disappearance of cataplexy.

The specific symptoms in the DSM-5 requires presence of recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day (3x per week over the past 3 months) (Criteria A) PLUS at least one of the following Criterion B symptoms:

• Cataplexy (i.e., brief episodes of sudden bilateral loss of muscle tone, most often in association with intense emotion)
• Hypocretin deficiency, as measured using cerebrospinal fluid (CSF)

Results of a formal sleep study (nocturnal sleep polysomnography) conducted by a medical professional showing abnormal rapid eye movement (REM) sleep latency (e.g., ≤ 15 minutes). This manifests as recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes

The severity of the disorder depends on the frequency of cataplexy or response to medication treatment. Mild narcolepsy indicates infrequent cataplexy (less than once per week), need for naps only once or twice per day, and less disturbed nocturnal sleep; Moderate as cataplexy once daily or every few days, disturbed nocturnal sleep, and need for multiple naps daily; and severe as drug-resistant cataplexy with multiple attacks daily, nearly constant sleepiness, and disturbed nocturnal sleep (i.e., movements, insomnia, and vivid dreaming).

Night Terrors

Sleep terror disorder is also known as night terrors. Sleep terror is characterized by the following symptoms that a professional looks for when making a diagnosis for this condition:

• Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream.
• Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode.
• Relative unresponsiveness to efforts of others to comfort the person during the episode.
• No detailed dream is recalled and there is amnesia for the episode.
• The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Anti-Depressant Side Effects

Like all medications, antidepressants may produce unwanted side effects. While various drugs have different side effect profiles, most individuals experience fewer side effects with the newer antidepressants (example: SSRIs, SNRIs).

Some symptoms will go away as the body adjusts to the medication. Other side effects are more troubling and may require a change in medication or the addition of other medications to treat the side effects. Some of these side effects include weight gain, sleep disturbances (either interrupted or excessive sleep) and sexual dysfunction.

The following is a summary of common side effects for the major classes of antidepressants. Remember, this list is not exhaustive and it is impossible to predict what side effects, if any, a person will experience. Patients should consult their physician about any side effects they think they may be experiencing.

SSRIs—paroxetine (Paxil); fluoxetine (Prozac); sertraline (Zoloft); fluvoxamine (Luvox); citalopram (Celexa)—are among the most widely prescribed medications in the world. It is useful to divide side effects into acute versus chronic.

The acute side effects occur early in treatment and for the most part tend to disappear over time. Acute side effects of SSRIs include stomach upset, nausea, fatigue, headache, fatigue, tremor, nervousness and dry mouth. Some of the more persistent, or chronic, side effects are daytime fatigue, insomnia, sexual problems (especially problems experiencing an orgasm) and weight gain.

Some patients, particularly those over 35 or with medical problems, may experience a change in EKG (electrocardiogram) readings that measure certain heart function. For this reason, it is important to consult a physician before taking these medications. Those over 35, or with medical problems, should have an EKG prior to starting a tricyclic antidepressant.

The greater side effects and lesser safety of tricyclic antidepressants are the main reasons they are no longer the first line of treatment. Side effects of tricyclics include dry mouth, postural blood pressure changes (drop in blood pressure when getting up quickly, resulting in dizziness), constipation, difficulty urinating, blurred vision, weight gain and drowsiness.

An overdose of a tricyclic medication is serious and potentially lethal. It requires immediate medical attention. Symptoms of an overdose usually develop within an hour of ingestion and may start with rapid heartbeat, dilated pupils, flushed face and agitation, and progress to confusion, loss of consciousness, seizures, irregular heart rate, cardiorespiratory collapse and death.


People with paranoid personality disorder are generally characterized by having a long-standing pattern of pervasive distrust and suspiciousness of others. A person with paranoid personality disorder will nearly always believe that other people’s motives are suspect or even malevolent.

Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation. While it is fairly normal for everyone to have some degree of paranoia about certain situations in their lives (such as worry about an impending set of layoffs at work), people with paranoid personality disorder take this to an extreme — it pervades virtually every professional and personal relationship they have.

Individuals with Paranoid Personality Disorder are generally difficult to get along with and often have problems with close relationships. Their excessive suspiciousness and hostility may be expressed in overt argumentativeness, in recurrent complaining, or by quiet, apparently hostile aloofness. Because they are hyper vigilant for potential threats, they may act in a guarded, secretive, or devious manner and appear to be “cold” and lacking in tender feelings. Although they may appear to be objective, rational, and unemotional, they more often display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations.

Because individuals with Paranoid Personality Disorder lack trust in others, they have an excessive need to be self-sufficient and a strong sense of autonomy. They also need to have a high degree of control over those around them. They are often rigid, critical of others, and unable to collaborate, and they have great difficulty accepting criticism.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Paranoid personality disorder is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This usually begins in early adulthood and presents in a variety of contexts, as indicated by four (or more) of the following:

• Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
• Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
• Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
• Reads hidden demeaning or threatening meanings into benign remarks or events
• Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights)
• Perceives attacks on his or her character or reputation that are not apparent to others, and is quick to react angrily or to counterattack
• Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

Paranoid personality disorder generally isn’t diagnosed when another psychotic disorder, such as schizophrenia or a bipolar or depressive disorder with psychotic features, has already been diagnosed in the person.

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.


Tinnitus is the hearing of sound when no external sound is present. While often described as a ringing, it may also sound like a clicking, hiss or roaring. Rarely, unclear voices or music are heard. The sound may be soft or loud, low pitched or high pitched and appear to be coming from one ear or both. Most of the time, it comes on gradually. In some people, the sound causes depression, anxiety or interferes with concentration.

Tinnitus is not a disease but a symptom that can result from a number of underlying causes. One of the most common causes is noise-induced hearing loss. Other causes include: ear infections, disease of the heart or blood vessels, Meniere's disease, brain tumors, exposure to certain medications, a previous head injury and earwax. It is more common in those with depression.

The diagnosis is usually based on the person's description. Occasionally, the sound may be heard by someone else using a stethoscope: in which case, it is known as objective tinnitus. A number of questionnaires exist that assess how much tinnitus is interfering with a person's life. People should have an audiogram and neurological exam as part of the diagnosis. If certain problems are found, medical imaging such as with MRI may be recommended. Those who have tinnitus that occurs with the same rhythm as their heartbeat also need further testing.

Prevention involves avoiding loud noise. If there is an underlying cause, treating it may lead to improvements. Otherwise, typically, management involves talk therapy. Sound generators or hearing aids may help some. As of 2013, there are no effective medications. It is common, affecting about 10-15% of people. Most, however, tolerate it well with its being a significant problem in only 1-2% of people. The word tinnitus is from the Latin tinnīre which means "to ring".

Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise but, in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging or whistling sound or as ticking, clicking, roaring, "crickets" or "tree frogs" or "locusts (cicadas)", tunes, songs, beeping, sizzling, sounds that slightly resemble human voices or even a pure steady tone like that heard during a hearing test and, in some cases, pressure changes from the interior ear. It has also been described as a "whooshing" sound because of acute muscle spasms, as of wind or waves. Tinnitus can be intermittent or it can be continuous: in the latter case, it can be the cause of great distress. In some individuals, the intensity can be changed by shoulder, head, tongue, jaw or eye movements.

Most people with tinnitus have some degree of hearing loss:[8] they are often unable to clearly hear external sounds that occur within the same range of frequencies as their "phantom sounds". This has led to the suggestion that one cause of tinnitus might be a homeostatic response of central dorsal cochlear nucleus auditory neurons that makes them hyperactive in compensation to auditory input loss.

The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by hearing the sounds of one's own pulse or muscle contractions, which is typically a result of sounds that have been created from the movement of muscles near to one's ear, changes within the canal of one's ear or issues related to blood flow of the neck or face.