It's Like an Endless Hole of Despair! Quiz

Answer: Recent bereavement

A recent bereavement would usually lead to a diagnosis of Reactive Depression or an 'Adjustment Disorder with a depressed mood'. These people still suffer from the symptoms of depression but it occurs in response to a known stimuli. This form of depression should be able to be treated within six months of the event that caused it.

The symptoms of depression are wide and extremely varied and can be influenced by many other factors making its diagnosis quite difficult. It causes changes in the person's feelings, thinking patterns, behaviour and their physical health. It is also a frequent symptom in other psychiatric disorders. In major depression there are usually more symptoms of greater intensity.

A person can have one major depressive episode or a recurrent depression where it is treated with several years in-between episodes. The ICD-10 (World Health Organisation categorisation) defines a depressed mood, reduced energy and anhedonia (inability to experience pleasure in activities that were formally enjoyed) as the three typical symptoms and two of these must be present to make a diagnosis of Major Depressive Disorder.

Answer: Kleptomania

Impulse Control Disorders (ICD) are a class of disorders where the person is unable to resist an impulse or temptation that may be harmful to others or themselves. The five recognised stages are:
1. The impulse
2. Growing tension
3. Pleasure from acting on impulse
4. Relief
5. Guilt

Impulse control in itself is a symptom of many other psychological conditions particularly substance abuse related disorders, schizophrenia, mood disorders and antisocial personality disorder.

ICD basically fills the category of "impulse control disorders not elsewhere classified". 'Pathological gambling' and 'Intermittent Explosive Disorder" are also included in this category.

Kleptomania is characterized by an impulsive urge to steal purely for the sake of the gratification that it brings.

Pyromania is an impulsive and repetitive urge to start fires.

Dermatillomania is an uncontrollable urge to pick one's skin.

Trichotillomania is where the impulse is to pluck out bodily hair.

Answer: Dissociative Identity Disorder

Dissociative Identity Disorder (DID) was also referred to as a 'split personality' due to its characterisation of at least two separate identities alternatively controlling the persons behaviour - each unknown to the other and causing large gaps that neither identity can remember while the other was in 'possession.' These are now called 'disassociated personality states'.

Disassociation is a psychological term which means a detachment from ones surroundings - this can be as simple as daydreaming all the way up to a catatonic state. The important characteristic is that it is a 'detachment from reality' not a 'loss of reality.' People with dissociate disorders use this as an involuntary defence mechanism.

DID is an extremely controversial disorder. There are many conflicting theories about its cause, diagnosis and treatment. It is thought to be caused by psychological trauma; a common link is childhood sexual/physical abuse.

The number of 'alters' a person can have ranges dramatically but most patients report less than 10. These identities may or may not be aware of each other and may have different memories. In general the 'primary identity' is the more passive and depressed while their alters are much more active and aggressive - some are even quite hostile. The common theory is that these personalities were created to take care of the primary.

Cyclothemia is one of the chronic mood disorders similar to a mild bipolar disorder. Paranoid Personality Disorder leads sufferers to general distrust of other people and long standing paranoia which makes them extremely hypersensitive.

Answer: Bulimia Nervosa

EDNOS is a default category - its definition is made by what it is NOT. It is basically any eating disorder that does not meet the criteria for Anorexia Nervosa (AN) or Bulimia Nervosa (BN). They can be patients that have sub threshold symptoms of these disorders, mixed symptoms of both disorders or a completely different 'atypical' disorder. It is currently the most diagnosed eating disorder and can be a precursor to AN or BN. One study has shown that 40% of people with EDNOS develop either AN or BN within 2 years. Not all atypical disorders are officially classified into the ICD-10 or DSM-IV-TR (US Classification System) at this stage.

Orthorexia Nervosa is a deep obsession with avoiding foods that the person feels are unhealthy which can lead to severe malnutrition and death. Unlike the patient with AN, whose prime motivation is to be thin, the orthorexic wants to feel healthy.

Drunkorexia is a term given to people who restrict their food intake so they can drink alcohol without gaining weight. It is most common among females in their 20s. While seeming a rather 'silly' diagnosis the effects can be fatal. Alcohol intake in a state of malnutrition and taken on an empty stomach, which increases the speed of which ethanol enters the bloodstream, leads to much greater risks of blackouts, alcohol poisoning and all alcohol related illnesses and injuries.

Diabulimia is an eating disorder which affects people with Insulin Dependent Diabetes. Sufferers give themselves less insulin than they need in order to lose weight. Insulin breaks down the sugar in the body, if it has none then the sugar is not absorbed and is excreted in the urine. The body then has to use muscle and fat for its energy source. This can lead to a life threatening condition known as diabetic ketoacidosis.

I have included these examples for something a little bit different. Though they may not all be yet officially recognised it does not change the outcome of the correct answer - Bulimia Nervosa by the very definition of EDNOS is the only option that can be the correct answer.

Answer: Dissocial

Personality Disorders are the most frequently diagnosed of all psychiatric conditions. They involve people whose personalities are different from the expected social 'norms'. Their behaviour often shows problems with impulse control, interpersonal relationships and understanding. These behaviour patterns usually cause significant distress.

Dissocial Personality Disorder (DPD) is very similar to what the Americans call 'Antisocial Personality Disorder' but there are some differences in both definition and diagnostics. Both disorders include a total disregard for the feelings of others and a refusal to follow the rules of society. They are impulsive and have a low anger threshold which most often leads to violence. One of its most obvious traits is the complete inability to feel any guilt over their behaviour or to learn anything from the consequences which arise from it.

The very nature of these personality traits tends to bring them into conflict with the law and the rest of society. Many of them have criminal convictions and many die young as a result of their lifestyle.

Dependant Personality Disorder is a chronic condition where sufferers have a psychological dependence on other people to meet all their physical and emotional needs.

Narcissistic Personality Disorder is a disorder where the person has a preoccupation with power, prestige and vanity. They have an elevated sense of their own value but actually have a very fragile self esteem which leads to them trying to cut others down to continue to validate themselves. It was originally referred to as Megalomania.

Histrionic Personality Disorder sufferers are highly emotional with a need for constant approval and attention. They are highly functional people who appear vivacious, lively and dramatic. Unlike many other personality disorders they have very good social skills but these are usually used to manipulate other people into meeting their needs.

Answer: Psychotic

The term psychosis is derived from the word 'psyche' (Greek for mind or soul) and 'osis' (abnormal condition) meaning an abnormal condition of the mind. It is used for the more severe psychiatric disorders where there is a loss of contact with reality.

The term 'schizophrenia' also comes from Greek origins - 'skhizein' (to split) and 'phren' (the mind"). This has often led to confusion from the general public believing it to refer to a 'split personality' when it actually refers to the splitting of the mental functions in the brain.

The most common symptoms of Schizophrenia are auditory hallucinations, paranoid delusions and disorganised speech and thinking. Some of the most common delusions are those where they feel that they are being controlled by an outside force - they hear voices telling them what to do or they think thoughts are either being taken or inserted into their mind by others.

Most schizophrenics have an onset that appears in the late teenage years or early twenties. They usually have other psychiatric conditions as well; particularly anxiety disorders and depression, and nearly 50% of them also have a substance abuse condition.

There are many subcategories within the disorder. The DSM-IV-TR recognises the following five: Paranoid, Disorganized, Catatonic, Undifferentiated and Residual, while the ICD-10 recognises these five plus Post-schizophrenic depression and Simple schizophrenia

Answer: Münchhausen Syndrome

Münchhausen Syndrome is a disorder where the person creates or exaggerates an illness so that they can receive attention and sympathy. These people love medical tests and procedures - the more severe cases even enjoy having multiple surgeries. They have a huge amount of knowledge of the human body and the exact signs and symptoms to report that will enable them to receive treatment. These patients are not hypochondriacs who actually believe they have a disease - they are well aware that there is nothing wrong with them (physically at least).

There is an offshoot of this disorder known as Münchhausen by proxy. In this case it is a parent (or guardian) of a child that convinces the medical staff that there is something wrong with their child and the child then has to suffer the investigations. In severe cases the adult will introduce a disease or life threatening event into their life.

The syndrome was first recognised in 1951 by Richard Asher. He named the disorder after an 18th century German Baron who was infamous for his exaggerations and tall tales.

Da Costa's Syndrome is where the patient has all the symptoms of heart disease but there are no physical abnormalities found. This has also been known as soldier's heart, irritable heart and cardiac neurosis.

Ganser Syndrome is a dissociative disorder where the individual gives either deliberately wrong or nonsense answers to questions and does things the wrong way on purpose. It has also been called balderdash syndrome and hysterical pseudo-dementia.

Tourette Syndrome is a neuropsychiatric disorder which is characterised by multiple physical tics and uncontrolled involuntary sounds. A small majority have uncontrollable spurts of either socially inappropriate or derogatory remarks.

Answer: Querulous Paranoia

Querulous Paranoia is classified as a delusional disorder. A person who is known as a querulant is someone who always feels that they have been wronged and seeks legal action based upon this - usually over petty or unfounded claims. Querulous Paranoia refers to a paranoid psychiatric condition which is manifested in querulant behaviour.

Anxiety Disorders cover a wide range of psychiatric conditions but their common denominator is anxiety which can range from a mild persistent worry to sheer terror. Their apprehension and fear can be based on real or imagined events and often leads to a deterioration in physical health. Apart from those already mentioned it includes all phobias, both social and separation anxiety disorders and generalised anxiety disorder. Many patients with anxiety disorders also suffer from depression as a result of their disease.

Agoraphobia is characterised by anxiety in situations where the sufferer believes that escape is not possible or where help is not available. Two of the most common examples are either a large complex, such as a shopping centre, where the exit is not visible or in a wide open space where there is no help or exit. Sufferers fear that these places will bring on a panic attack so will avoid them at all costs. The most severe agoraphobics become unable to leave the safe environment of their own home.

Post-Traumatic Stress Disorder develops after some form of deep psychological trauma has been experienced. Sufferers often have flashbacks to the original event and anything that is a trigger to the event can send them into an acute stress response. Hypervigilance is common which leads to sleep disturbances and often they have a deep unrelenting anger over the incident. All of these totally overwhelm the patient and leave them unable to cope with life's basic demands.

Obsessive-Compulsive Disorder (OCD) is characterised by obsessive thoughts that create apprehension or fear in the sufferer and by the compulsions that they perform to temporarily relieve this fear. Common compulsions are repetitive checking, excessive hand washing, extreme hoarding and rituals that they must complete in a certain order. Most of these obsessions and compulsions are very time consuming so they have a huge impact on their lives. Most OCD sufferers are aware that these actions are irrational and this causes even more distress in their lives.

Answer: Bipolar Affective Disorder

Bipolar Affective Disorder (BAD) is a condition where individuals suffer from mood swings between depression and mania. BAD is only diagnosed after at least one episode of mania so many people are originally diagnosed and treated for major depression. There are now different sub classifications of BAD depending on the severity of the manic episodes.

At a lower level (called hypomania) the person may just appear to have periods of high energy and optimism and can actually function extremely well, often being more productive than usual. At a higher level they are much more erratic and unable to function normally due to a very short attention span. They are also very impulsive and often have poor judgement which can lead to huge spending sprees and risky behaviour. At the most extreme level they can actually break away from reality and have a psychotic episode.

These periods of depression and mania are usually separated by a period of 'normal' behaviour but some sufferers experience what is known as rapid cycling where they alternate directly from one extreme to the other repeatedly.

'Manic-Depressive Illness' was a term that began in the nineteenth century and referred to any mood disorder. The term bipolar was introduced in 1957 by Karl Leonhard, a German psychiatrist, who divided the illness into two categories - unipolar disorder for major depression and bipolar disorder for those that cycled between the 'high and low poles'.

Schizoid Personality Disorder (SPD) is a condition where the person has no interest in developing social relationships. They are emotionally cold, secretive and apathetic. They prefer a solitary lifestyle but often have an active internal fantasy world.

Oppositional Defiant Disorder (ODD) is classified as a behavioural and emotional disorder of childhood. These children exhibit symptoms of extreme stubbornness, disobedience, anger and hostility which is directed at authority figures in their lives.

Answer: Females aged 20 - 40

Puerperal Psychosis (also known as Postpartum Psychosis) is a severe mental illness following childbirth where the mother has psychotic symptoms. This is not the same as postnatal depression which is a depressive state caused by the birth of a child.

The condition is very similar to bipolar disorder in that sufferers have either extreme manic symptoms or those of psychotic depression or can experience both within the same episode. The important differentiation is that this disorder is a psychosis which means that there is a loss of contact with reality with patients showing either delusions or hallucinations.

It has a sudden onset and escalates rapidly - manic cases begin within a fortnight of the birth but it can be much later for the depressive form. It can be resolved within a few weeks of treatment but can last for months without any. The chance of recurrence following future births is between 20 - 50% depending on the original severity.