Almost half of menopausal women are “depressed”

One in four women find it difficult to cope during the menopause, with almost half (43%) feeling depressed, and about a third (36%) experiencing anxiety, according to recent research as reported in The Scotsman.  As the article states,  the menopause is commonly accepted to be just  ‘a fact of life’ meaning that distressing symptoms experienced around this time are often dismissed as ‘to be expected’.  A staggering amount of women (70%) feel that they are not being adequately supported at this difficult time of their lives. This is a subject I feel passionately about, so I was pleased to read this article and learn about the study, as I feel it is a hugely overlooked issue that affects every woman to some degree.

The menopause, in biological terms, is the end of menstruation, signalling the natural end of a woman’s ability to reproduce. It usually occurs during the 40s or 50s though it can strike earlier or later – the average age is 51.  In medical terms it is a straightforward process of gradual change in a woman’s menstrual cycle before it ends altogether. Menopause is triggered by hormonal changes  – principally a reduction in progesterone and estradiol, ultimately causing the ovaries to pack up and retire.  So in textbook terms the menopause is quite simple really. However the degree of variation in women’s experience of the menopause is seemingly immense. From working with and talking to many menopausal and post-menopausal women, I have concluded that no two women appear to experience the menopause in the same way.

For some women the menopause seems to come and go fairly quickly or without much trouble; indeed some seem to be completely unaware of the changes their bodies are undergoing until they realise they haven’t had a period for over 12 months – which officially puts them into the post-menopausal category. They are the lucky ones.  For other women the process can drag on for  years and cause considerable physical and psychological difficulties.

Let’s look firstly at the physical symptoms.  As well as the commonly known symptoms such as menstrual changes, night sweats and hot flushes, the menopause can be associated with a whole range of other physical symptoms. These include joint or muscle pain, migraine or headaches, rapid heartbeat, dizziness, urinary incontinence or urgency, the list goes on. And on. Many women find themselves repeatedly attending their GP surgery but not getting answers to what is causing their pain or problems.  Medical tests are often undergone but repeatedly show up nothing. Some women have been referred for tests for serious conditions such as Multiple Sclerosis, diabetes, rheumatoid arthritis, even cancer, when in fact their symptoms have later been found to be menopause related. And the fittest of women can suddenly be struck down with debilitating physical pain or dysfunction.  Some of the physical effects may be temporary and recede post-menopause, but other physical effects can be permanent, such as changes to the skin condition or body weight, arthritic damage and reduction in bone mass.

However I am more interested in the effect that the menopause can have on the mood and emotions, indeed the mental health of women. The often dramatic fluctuations in hormone levels as well as coping with the physical effects can have an enormous impact on a woman’s life – often at a time when she is still busy and active, and in most cases working.  And then there’s the psychological impact of the menopause and of what it represents – an end to fertility,  the start of a new phase leading inexorably to old age, made all the more real with accompanying physical effects that can – simply put – make one feel one has suddenly aged by years. For some women this can dramatically affect the way that they think and feel about themselves.  In addition, it can put an enormous strain on relationships and on family, work or social life.

Although medical textbooks, and even health professionals may play down – or simply ignore – the psychological effects of the menopause,  I can testify from my own client work and from talking to friends and family that women often find it difficult to cope during the menopause. Many feel completely overwhelmed by what they are experiencing. Some of the psychological effects include dramatic mood swings, increased anxiety – sometimes the onset of panic attacks, which can be very frightening, onset or increase in depression or depressive episodes, confusion, memory problems, extreme fatigue and loss of libido. While undergoing all of this, many women feel they have little support. Many family doctors seem to downplay the role of the menopause – and if a hormone test comes back within the ‘non-menopausal’ ranges then the possibility of it can be quickly discounted, even though specialists confirm that blood tests can be poor indicators of menopause due to hormone level fluctuations. As a result women can find themselves in pain or discomfort, concerned about what may be wrong with them, not getting any answers, and extremely anxious, depressed or confused.  In extreme cases women are sometimes prescribed psychiatric medications or labelled with mental health diagnoses.

Many women do seek talking therapy for help and support at this time, and indeed it can help them to cope with what they’re going through.  I strongly recommend anyone who feels that they may be experiencing psychological symptoms linked to the menopause to seek support in the form of counselling or similar.  Also speak up and ask your GP or other medical practitioner if your problems could be menopause related.  It’s surprising how many don’t even consider it.

 

https://www.ucl.ac.uk/news/2024/may/women-are-40-more-likely-experience-depression-during-perimenopause#:~:text=The%20researchers%20found%20that%20perimenopausal,to%20those%20who%20were%20premenopausal.

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The O and the C of OCD

OCD has become a bit of a joke – in that it’s common for people to state flippantly that they’re “a bit OCD” about something – when what they really  mean is that they like things to be neat and tidy or they pay particular attention to details.  However, the reality of OCD can be extremely debilitating for sufferers.  Those who deal with the condition daily can find it exhausting, overwhelming, confusing and increasingly difficult to manage as it literally takes over their life.

The O of OCD stands for Obsessive – and it relates to the obsession behind the condition. Frequently an OCD sufferer comes to believe – often at a subconscious level – that unless they carry out some act or behaviour, there will be a disastrous negative consequence.  They become preoccupied by the idea that they must do one thing to prevent something else from occurring.  Sometimes sufferers find it difficult to state what the feared negative consequence might actually be – they just have an overwhelming feeling that something bad will happen. Sometimes the fear is very specific, for example that someone will die or that they themselves will harm someone.  Many sufferers feel ashamed of their obsession(s), particularly if they are of a sexual nature, or they fear that they themselves might do something violent or harmful. Sufferers are often afraid to talk about their obsession(s), some fearing that they must be going crazy.  If not addressed, over time the obsession can become extreme and can make life very difficult for the sufferer.

The C of OCD stands for Compulsive and relates to the compulsion to do something in order to prevent the feared negative consequence from happening.  Sometimes the compulsion can seem completely unrelated to the obsession to anyone other than the sufferer.  An example is a case I heard about where a woman felt compelled to give away all of her money to charity otherwise something dreadful would happen to her family. The more a sufferer carries out their compulsion, the more it reaffirms their belief in the obsessive idea, and this can set in motion a vicious cycle that can be very difficult to break.  The OCD sufferer believes that he/she is controlling their behaviour and their environment by sticking to their rituals, but the opposite is true.

Whilst cleaning, tidying and checking compulsions are the most easily recognised manifestations of OCD, it also presents in various other forms, including:

•Aggressive obsessions – the sufferer believes that they will carry out violent or aggressive acts (this frequently presents in people who may not seem capable of doing any harm)
•Contamination obsessions – fear of germs or dirt or of becoming ill
•Hoarding and Saving – fear of getting rid of or losing things, or an overwhelming need to collect items going far beyond a hobby to the point where it can cause the sufferer financial difficulties
•Religious obsessions – a fear of damnation, blasphemy or the consequences of ‘sinning’ or an obsession with morality
•Sexual obsessions – obsessive sexual thoughts and/or compulsions to carry out acts largely considered to be lewd or obscene, sometimes with aggression
•Symmetry and Order – a preoccupation with order and ritual
•Counting compulsions- the need to count arbitrary or specific items, often over and over again
•Repeating rituals – the overwhelming need to carry out the same rituals over and over, with no flexibility, often ‘safety’ or ‘superstition’ routines – for example the need to always take the same route to get somewhere without any deviation or to always wear the same outfit for ‘luck’
•Checking compulsions – similar to repeating rituals, but involves repeatedly checking things such as door locks or electrical sockets
•Cleaning compulsions – constantly cleaning, often to extremes, and frequently linked to a contamination obsession

All of these subgroups feature irrational or exaggerated fears that the sufferer often realises are irrational but that does not seem to lessen their impact.  OCD is classed as an Anxiety Disorder and anxiety is the mechanism that fuels it. Indeed it has been classed as the fourth most common anxiety disorder internationally¹ and is thought to be on the increase.  The way to relieve or reduce OCD is therefore to address the underlying anxiety.  It is the control of anxiety that is crucial in learning to manage and conquer OCD.  OCD patterns follow a typical anxiety curve – the anxiety increases while the sufferer is preoccupied with their obsession or fear, and decreases temporarily when they start to carry out their compulsion.  However, the act of performing their compulsion reinforces their belief in the obsession, which causes their anxiety levels to increase again and so the cycle continues. It is also possible to experience obsessive thinking without compulsions and vice versa.

When OCD becomes debilitating, sufferers often seek help to regain control of their lives.  I have experience in helping many clients to reduce their OCD symptoms, typically using an educational, CBT-based² approach where they learn to recognise and understand their anxiety cycles and then learn the skills to manage and reduce their effects.  I help clients to effectively become their own therapist so that they can cope better and develop the strengths and skills to make the changes necessary to free themselves from the debilitating effects of anxiety.

Call me for a no obligation chat if you or someone you know is suffering from OCD or other anxiety-related problems.

Bad Thoughts (c) Frances Cacnio 2012, source Flickr Creative Commons

1. Textbook of Anxiety Disorders, second edition;  Stein, Hollander et al;  American Psychiatric Publishing, inc.; Washington, 2009

2. Cognitive Behavioural Therapy

 

 

 

 

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Is Oscar Pistorius a narcissist?

Oscar Pistorius in 2012

Cold blooded killer? Pistorius when I met him in 2012
photo (c) Amanda Hart 2012

I’ve been following the Oscar Pistorius trial with interest.  Not only because it is the celebrity sensation du jour, not even because I met Oscar when he was competing in the London 2012 Paralympics, but because as someone who works in the mental health sector I find the unfolding of the trial fascinating for what it tells us about this unique individual, and about human nature.

Yesterday, news reports jumped on Prosector Gerrie Nel’s condemnation of Pistorius as a “bully” and a self-obsessed “narcissist” who was only interested in “Oscar”.  To call someone a narcissist is contentious, and Nel most likely used the term knowingly.  Was he implying that Pistorius may suffer from Narcissistic Personality Disorder (NPD), which could have far-reaching implications not only for the trial but for Pistorius’s future. So what is NPD and what does it mean for this trial?

Personality disorder diagnoses are controversial, as the implication is that a person does not have a mental health condition – which may be treatable – but rather has a flawed personality.  The label is often seen as stigmatising and unhelpful. The personality is the very essence of who we are – and cannot easily be changed.  Common signs of a personality disorder include demonstrating less flexibility than most,  having limited ranges of emotions and behaviours and difficulties in relationships with others. A person with a personality disorder may feel different or that he/she doesn’t fit in. Personality Disorders typically manifest in teens or early adulthood and affect all areas of an individual’s life. There is no medication that can specifically treat personality disorders, though drugs may be prescribed for associated problems, such as depression and talking therapies can be helpful.  Personality disorders fall into three categories: Suspicious, Emotional/Impulsive and Anxious.  NPD is in the Emotional/Impulsive category.

NPD is one of the most complex of the personality disorders, and often very difficult to diagnose or treat.  During my training one of my tutors told me that the last person to acknowledge that he/she has a problem will be the narcissist as he/she will always believe that everyone else has the problem, not them.  Narcissists can appear selfish; they may seem to have a belief that they are in some ways superior, or more deserving.  They often crave attention or deference  – resenting the popularity or success of others. Narcissists need to be in control and can become adept at manipulating others to get what they desire or feel they deserve.  They are often the epitome of charisma and charm to some, whilst being controlling and unpleasant – even to the point of abuse – to those close to them. Narcissists can be terrible bullies, but underlying the controlling and seemingly confident exterior is a fragile ego, a poorly formed sense of identity and frequently low self esteem.  Is this Oscar Pistorius?

When I met Pistorius in 2012 he came across as extremely charming, not at all the big celeb:  he seemingly had time for everyone, he told me that I didn’t need to apologise to him when I said sorry for giving him a pen that didn’t work to sign his autograph. Like most, I was stunned and shocked to the core to hear the news that unfolded on February 14 last year.  But when I consider the traits of NPD and look for the evidence in Pistorius, there is a compelling case. Firstly, I am reminded of his behaviour at London 2012 Paralympic games when beaten in the 200m final by Brazilian Alan Oliveira.  His reaction was one of indignation and disbelief – someone had snatched away the crown that was rightfully his.  He accused the victor of cheating. He later apologised for his ungracious reaction, but the apology itself could be part of the narcissist’s game play.  This is what some are saying about his public apology to the Steenkamps in court this week – as Gerrie Nel put to him, why not do it in private?  Another sign of NPD is a lack of empathy for others. So does Pistorius feel genuine regret for killing Reeva?  This seems to be one of Nel’s main angles in court this week.

The origins of NPD, as all personality disorders, are unclear, however childhood experiences are believed to be a factor in some cases; Pistorius’s upbringing was far from typical.  Disabled from birth and having both lower legs amputated at a young age, he was never going to be an ordinary child.  Yet the mother he still idolises – who was his sole parent for much of his childhood and who died when he was 15 – allegedly refused to allow him any special treatment.  His subsequent successes as an athlete have often been credited to the strength and determination he needed to develop in order to survive alongside – and ultimately compete against – the able-bodied. It’s quite significant that Pistorius felt driven to compete against able-bodied athletes as well as other disabled athletes.  One theory behind NPD is that an exaggerated sense of self-belief develops in order to compensate for vulnerability or feelings of worthlessness beneath. Was the young Oscar not allowed to feel or express any self-pity, or anger at his condition? Is the cost of this now being played out for all to see, and the violent death of a talented young woman?   Pistorius’s feelings of vulnerability may contribute to his apparently extreme paranoia, and the reason he allegedly kept a gun to hand at all times.  Could the circumstances of Pistorius’s upbringing and disability explain the self-absorption of which he stands accused in court?  If so, then should not his disability be taken into account? Should his defense not plead diminished responsibility, if that is an acceptable defence in South Africa?  But in order to do so, perhaps he would have to admit first to shooting Reeva in rage?

Pistorius’s vulnerability seems to be on display in court for all to see, but is his behaviour genuine, or as some suggest, merely an act?  Are his extreme emotions in the dock caused by the weight of responsibility for the death of Reeva, or by the narcissist’s self pity and regret?  Some of the text messages between himself and Reeva have been damning; Nel has used them to paint a picture of a cruel and manipulative bully, a man who was unable to reciprocate his girlfriend’s declarations of love but who would torment and intimidate her instead. But I believe Pistorius when he says that he was besotted by Reeva; he probably had a far greater need for her than she had for him.  Narcissists need the adoration of others in order to bolster their inadequate self worth, yet they continue to put their own needs above those of others. A relationship with a narcissist can be like a one-way street, and perhaps Reeva was starting to realise this.  If the text messages are anything to go by, their relationship seems to have been tempestuous, a fact that Pistorius is trying to play down in court.

Whilst Pistorius has too much to lose by changing his plea now – there’s still a chance he will not be convicted of premeditated murder – the truth is that the narcissist is just as likely to fire a gun recklessly upon a partner with whom he is fighting as upon an intruder.  For the narcissist will always put himself first. Narcissists can be risk taking and reactive, they often do not stop to think  – which is Pistorius’s own defence of firing the fatal shots.  If Pistorius is convicted of premeditated murder, or even of the lesser charge of culpable homicide,  perhaps it would help him to undergo detailed psychological analysis (if such a thing is available in the South African prison system), because if he does have narcissistic personality disorder, he really needs to talk…..

Further reading:
Information about Personality Disorders from Mind

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