Thursday, July 29, 2010

DocBlog: The Difference between Normal and Abnormal in Psychiatry

Introducing DocBlog – a relevant and educational blog post written by EaseMyHealth doctors to simplify medical conditions and issues.

Here’s the 1st DocBlog post by Psychiatrist Dr. Sujay Prabhugaonkar demystifying basic concepts of normal & abnormal in Psychiatry.

Dr. Prabhugaonkar, M.D., D.P.M. is a qualified Psychiatrist and practices in Mumbai.

Sadness-Depression, Mood swings-Bipolar Disorder, Anxiety-Panic…are all conceptually very similar – so how does Psychiatry differentiate between Normal and Abnormal? The actual difference is in the degree - Specifically in severity and duration as well as the quality of socio-occupational functioning. Here are some simple examples to tell the differences.

What is the difference between normal sadness and depression?

In normal sadness the person is sad for a while, but in depression sadness lasts for at least 2 weeks along with loss of interest in activities, vegetative symptoms like sleep, sex and appetite disturbances, cognitive symptoms like loss of concentration, worthlessness and if severe - suicidal ideation.

What is the difference between normal mood swings and manic depressive psychosis or bipolar disorder?

In normal mood swings, the person alternates between happiness and sadness during the course of the day or week.

In bipolar mood disorder, there are severe mood fluctuations which lead to extreme happiness on one hand and extreme sadness on the other. During the phase of extreme happiness the person not only thinks that he is god or he has some special ability or talent, but also starts spending excessively, eats voraciously, drinks, gambles, shops till he drops or till he becomes bankrupt, changes jobs frequently, has sex with numerous partners, or generally talks excessively not only with family members but also strangers.

During the phase of extreme sadness, he/she becomes lethargic, does not want to go out of the house and sometimes becomes suicidal.

What is the difference between normal concern and anxiety?

During normal concern, the person worries about finance, home, family, job etc. but in Anxiety disorder, these worries not only become the predominant focus of person’s attention but they also spill over the physiological and cognitive functions. Thus he/she breathes heavily, has palpitations, sweating etc along with distractibility, crowding of thoughts respectively. Also one has secondary anxiety i.e. anxiety about the effects of anxiety like having bleeding ulcers or hypertension

What is the difference between anxiety and panic?

Normal anxiety is fear without a definite cause.

Panic disorder is like having severe anxiety in which the person fears he may die or go crazy, lasting for maximum half hour but so severely debilitating that young individuals in their 20s or 30s land up in hospital emergency rooms with chest pains which come out of the blue and their cardiograms turn out to be normal. One eventually has a fear of having further attacks in public because of which he/she restricts going out of the house.

What is the difference between fear and phobia?

Fear is due to the threat of a real danger e.g. when car races towards you, you may sense fear.

Phobia is an irrational fear of object or situation e.g. if one has social phobia, one not only is afraid of public speaking which is normal but also afraid to urinate in public urinals or even eat in restaurants in public.

What is the difference between normal concern about illness and hypochondriasis?

During normal concern about illness, one visits doctors, do the tests if advised, take the prescribed course of treatment and be reassured that our health is in safe hands.

In Hypochondriasis, the concern about the illness is exaggerated e.g. if the concern is about having a heart attack, one would check pulse and be alarmed at missed beats, heart beating heavily or slowly, do multiple tests: ECG, 2D Echo, cardiac angiography, wont be reassured by the doctors sometimes even accusing them that they missed something, doctor shopping, resorting to miracle cures, reading various health magazines and looking out for new invention of a technique or a machine by which finally their disease can be diagnosed and treated.

What is the difference between having repetitive thoughts and Obsessive compulsive disorder?

Repetitive thoughts like a song lyric, or the story we reading the newspaper come to our mind and pass away as we go about our routine activities.

But obsessions are thoughts that don’t pass away. In fact they intrude into our consciousness that we still have to clean our hands, that door was not locked while leaving the house, that things are not in a particular order, that we did not pray sincerely.

These obsessions lead to compulsions like washing, cleaning, checking, counting, praying etc. Compulsions reduce the anxiety caused by obsessions e.g. cleaning compulsions reduce the anxiety caused by fear of contamination, checking compulsions reduce the anxiety caused by fear of harm to loved ones

Dr. Sujay Prabhugaonkar will soon be available for online/tele consultation on

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