Tag: Emotional Distress

What is Emotionality?

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Introduction

Emotionality is the observable behavioural and physiological component of emotion. It is a measure of a person’s emotional reactivity to a stimulus.

Most of these responses can be observed by other people, while some emotional responses can only be observed by the person experiencing them. Observable responses to emotion (i.e. smiling) do not have a single meaning. A smile can be used to express happiness or anxiety, while a frown can communicate sadness or anger. Emotionality is often used by experimental psychology researchers to operationalise emotion in research studies.

Early Theories

By the late 1800s, many high-quality contributions became interested in analysing emotion because of the works of psychologists and scientists such as Wilhelm Wundt, George Stout, William McDougall, William James, and George Herbert Mead. William James preferred to focus on the physiological aspects of emotional response, although he did not disregard the perceptual or cognitive components. William McDougall thought of emotion as the articulation of a natural response built on instinct. Other psychologists reasoned that although gestures express emotion, this is not the entirety of their function. Wundt analysed that emotion portrays both expression and communication.

As Irrational

One of the oldest views of emotion is that emotion indicates inferiority. In early psychology, it was believed that passion (emotion) was a part of the soul inherited from the animals and that it must be controlled. Solomon identified that in the Romantic movement of the eighteenth and nineteenth centuries, reason and emotion were discovered to be opposites.

As Physiological

Physiological responses to emotion originate in the central nervous system, the autonomic nervous system, and the endocrine system. Some of the responses include: heart rate, sweating, rate and depth of respiration, and electrical activity in the brain. Many researchers have attempted to find a connection between specific emotions and a corresponding pattern of physiological responses, but the results have been inconclusive.

Later Theories

The significant theories of emotion can be divided into three primary categories: physiological, neurological, and cognitive. Physiological theories imply that activity within the body can be accountable for emotions. Neurological theories suggest that activity within the brain leads to emotional responses. Lastly, cognitive theories reason that thoughts and other mental activity have a vital role in the stimulation of emotions. Common sense suggests that people first become consciously aware of their emotions and that the physiological responses follow shortly after. Theories by James-Lange, Cannon-Bard, and Schachter-Singer contradict the common-sense theory.

James-Lange

The James-Lange theory of emotion was proposed by psychologist William James and physiologist Carl Lange. This theory suggests that emotions occur as a result of physiological responses to outside stimuli or events. For example, this theory suggests that if someone is driving down the road and sees the headlights of another car heading toward them in their lane, their heart begins to race (a physiological response) and then they become afraid (fear being the emotion).

Cannon-Bard

The Cannon-Bard theory, which was conceptualized by Walter Cannon and Phillip Bard, suggests that emotions and their corresponding physiological responses are experienced simultaneously. Using the previous example, when someone sees the car coming toward them in their lane, their heart starts to race and they feel afraid at the same time.

Schachter-Singer

Stanley Schachter and Jerome Singer proposed a theory also known as the two-factor theory of emotion, which implies emotion have two factors: physical arousal and cognitive label. This suggests that if the physiological activity occurs first, then it must cognitively be distinguished as the cause of the arousal and labelled as an emotion. Using the example of someone seeing a car coming towards them in their lane, their heart would start to race and they would identify that they must be afraid if their heart is racing, and from there they would begin to feel fear.

Gender Differences

The opposition of rational thought and emotion is believed to be paralleled by the similar opposition between male and female. A traditional view is that “men are seen as rational and women as emotional, lacking rationality.” However, in spite of these ideas, and in spite of gender differences in the prevalence of mood disorders, the empirical evidence on gender differences in emotional responding is mixed.

When engaging in social interaction, studies show that women smile significantly more than men do. It is difficult to determine the exact difference between males and females to explain this disparity. It is possible that this difference in expression of emotions is due to societal influences and conformity to gender roles. However, this may not fully explain why men smile less than women do.

The male gender role involves characteristics such as strength, expert knowledge, and a competitive nature. Smiling may be stereotypically associated with weakness. Men may feel that if they engage in this perceived weakness, it may contradict their attempts to show strength and other traits of the male gender role. Another broad explanation for the contrast in male and female gender expression is that women have reported to experience greater levels of emotional intensity than men, in both positive and negative aspects, which could naturally lead to greater emotional response. It has also been reported that men are more likely to confide in female companions, revealing their emotions and intimacy, while females are typically comfortable confiding in both genders. This suggests that men are more particular about how they express the emotions they feel, potentially relating back to gender roles.

Across Cultures

There are six universal emotions which expand across all cultures. These emotions are happiness, sadness, anger, fear, surprise, and disgust. Debate exists about whether contempt should be combined with disgust. According to Ekman (1992), each of these emotions have universally corresponding facial expressions as well.

In addition to the facial expressions that are said to accompany each emotion, there is also evidence to suggest that certain autonomic nervous system (ANS) activity is associated with the three emotions of fear, anger, and disgust. Ekman theorizes that these specific emotions are associated with the universal physiological responses due to evolution. It would not be expected to observe the same physiological responses for emotions not specifically linked to survival, such as happiness or sadness.

Ekman’s theories were early challenged by James A. Russell, and have since been tested by a variety of researchers, with ambiguous results. This seems to reflect methodological problems relating to both display rules and to the components of emotion. Current thinking favours a mix of underlying universality combined with significant cultural differences in the articulation and expression of emotion. Emotions serve different functions in different cultures.

Positive

Positive emotionality is the ability to control positive mood and emotions, people with positive emotions seek for social reward. Positive emotionality can be a preventive factor in blocking out certain types of mental illness. In a study of a sample of 1,655 youth (54% girls; 7-16 years), it found that the higher their positive emotionality was, the lower their depression would be. Depression was considered by its definition of the inability to receive positive emotions or pleasure. The youth’s temperament, adaptive emotion regulation (ER) strategies, and depressive symptoms were determined through a questionnaire. The study also reported that depressive symptoms could be reduced through emotion regulation of positive mood. A study by Charles T. Taylor et al. linked being exposed to positive emotions before a surgery to less anxiety and a decrease in having symptoms after treatment.

Negative

Negative emotionality is the opposite of positive emotionality. People are unable to control their positive mood and emotions. Everyone experiences negative emotionality in different levels, there are different factors that effect each individual in a different way. Negative emotionality effects many aspects of our lives in terms of coping and the relationship that people share with one another. Neuroticism is one of the biggest factors found in negative emotionality. Someone on the higher spectrum of neuroticism is often more anxious and enjoy the feelings of their negative emotion. Some research suggests that obese children compared to children who are not obese have higher levels of negative emotionality and the ability to control emotions.

What is Trichotillomania?

Published on by Andrew Marshall11 Comments

Introduction

Trichotillomania (TTM), also known as hair pulling disorder or compulsive hair pulling, is a mental disorder characterised by a long-term urge that results in the pulling out of one’s hair. This occurs to such a degree that hair loss can be seen. A brief positive feeling may occur as hair is removed. Efforts to stop pulling hair typically fail. Hair removal may occur anywhere; however, the head and around the eyes are most common. The hair pulling is to such a degree that it results in distress.

The disorder may run in families. It occurs more commonly in those with obsessive compulsive disorder. Episodes of pulling may be triggered by anxiety. People usually acknowledge that they pull their hair. On examination broken hairs may be seen. Other conditions that may present similarly include body dysmorphic disorder, however in that condition people remove hair to try to improve what they see as a problem in how they look.

Treatment is typically with cognitive behavioural therapy (CBT). The medication clomipramine may also be helpful, as will clipping fingernails. Trichotillomania is estimated to affect one to four percent of people. Trichotillomania most commonly begins in childhood or adolescence. Women are affected about 10 times more often than men. The name was created by François Henri Hallopeau in 1889, from the Greek θριξ/τριχ; thrix (meaning “hair”), along with τίλλειν; tíllein (meaning “to pull”), and μανία; mania (meaning “madness”).

Brief History

Hair pulling was first mentioned by Aristotle in the fourth century B.C., was first described in modern literature in 1885, and the term trichotillomania was coined by the French dermatologist François Henri Hallopeau in 1889.

In 1987, trichotillomania was recognised in the Diagnostic and Statistical Manual of the American Psychiatric Association, third edition-revised (DSM-III-R).

Epidemiology

Although no broad-based population epidemiologic studies had been conducted as of 2009, the lifetime prevalence of trichotillomania is estimated to be between 0.6% and 4.0% of the overall population. With a 1% prevalence rate, 2.5 million people in the US may have trichotillomania at some time during their lifetimes.

Trichotillomania is diagnosed in all age groups; onset is more common during preadolescence and young adulthood, with mean age of onset between 9 and 13 years of age, and a notable peak at 12-13. Among preschool children the genders are equally represented; there appears to be a female predominance among preadolescents to young adults, with between 70% and 93% of patients being female. Among adults, females typically outnumber males by 3 to 1.

“Automatic” pulling occurs in approximately three-quarters of adult patients with trichotillomania.

Signs and Symptoms

Trichotillomania is usually confined to one or two sites, but can involve multiple sites. The scalp is the most common pulling site, followed by the eyebrows, eyelashes, face, arms, and legs. Some less common areas include the pubic area, underarms, beard, and chest. The classic presentation is the “Friar Tuck” form of vertex and crown alopecia. Children are less likely to pull from areas other than the scalp.

People who suffer from trichotillomania often pull only one hair at a time and these hair-pulling episodes can last for hours at a time. Trichotillomania can go into remission-like states where the individual may not experience the urge to “pull” for days, weeks, months, and even years.

Individuals with trichotillomania exhibit hair of differing lengths; some are broken hairs with blunt ends, some new growth with tapered ends, some broken mid-shaft, or some uneven stubble. Scaling on the scalp is not present, overall hair density is normal, and a hair pull test is negative (the hair does not pull out easily). Hair is often pulled out leaving an unusual shape. Individuals with trichotillomania may be secretive or shameful of the hair pulling behaviour.

An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socialising, due to appearance and negative attention they may receive. Some people with trichotillomania wear hats, wigs, false eyelashes, eyebrow pencil, or style their hair in an effort to avoid such attention. There seems to be a strong stress-related component. In low-stress environments, some exhibit no symptoms (known as “pulling”) whatsoever. This “pulling” often resumes upon leaving this environment. Some individuals with trichotillomania may feel they are the only person with this problem due to low rates of reporting.

For some people, trichotillomania is a mild problem, merely a frustration. But for many, shame and embarrassment about hair pulling causes painful isolation and results in a great deal of emotional distress, placing them at risk for a co-occurring psychiatric disorder, such as a mood or anxiety disorder. Hair pulling can lead to great tension and strained relationships with family members and friends. Family members may need professional help in coping with this problem.

Other medical complications include infection, permanent loss of hair, repetitive stress injury, carpal tunnel syndrome, and gastrointestinal obstruction as a result of trichophagia. In trichophagia, people with trichotillomania also ingest the hair that they pull; in extreme (and rare) cases this can lead to a hair ball (trichobezoar). Rapunzel syndrome, an extreme form of trichobezoar in which the “tail” of the hair ball extends into the intestines, can be fatal if misdiagnosed.

Environment is a large factor which affects hair pulling. Sedentary activities such as being in a relaxed environment are conducive to hair pulling. A common example of a sedentary activity promoting hair pulling is lying in a bed while trying to rest or fall asleep. An extreme example of automatic trichotillomania is found when some patients have been observed to pull their hair out while asleep. This is called sleep-isolated trichotillomania.

Causes

Anxiety, depression and obsessive-compulsive disorder (OCD) are more frequently encountered in people with trichotillomania. Trichotillomania has a high overlap with post traumatic stress disorder, and some cases of trichotillomania may be triggered by stress. Another school of thought emphasizes hair pulling as addictive or negatively reinforcing, as it is associated with rising tension beforehand and relief afterward. A neurocognitive model – the notion that the basal ganglia plays a role in habit formation and that the frontal lobes are critical for normally suppressing or inhibiting such habits – sees trichotillomania as a habit disorder.

Abnormalities in the caudate nucleus are noted in OCD, but there is no evidence to support that these abnormalities can also be linked to trichotillomania. One study has shown that individuals with trichotillomania have decreased cerebellar volume. These findings suggest some differences between OCD and trichotillomania. There is a lack of structural MRI studies on trichotillomania. In several MRI studies that have been conducted, it has been found that people with trichotillomania have more gray matter in their brains than those who do not suffer from the disorder.

It is likely that multiple genes confer vulnerability to trichotillomania. One study identified mutations in the SLITRK1 gene.

Diagnosis

Patients may be ashamed or actively attempt to disguise their symptoms. This can make diagnosis difficult as symptoms are not always immediately obvious, or have been deliberately hidden to avoid disclosure. If the patient admits to hair pulling, diagnosis is not difficult; if patients deny hair pulling, a differential diagnosis must be pursued. The differential diagnosis will include evaluation for alopecia areata, iron deficiency, hypothyroidism, tinea capitis, traction alopecia, alopecia mucinosa, thallium poisoning, and loose anagen syndrome. In trichotillomania, a hair pull test is negative.

A biopsy can be performed and may be helpful; it reveals traumatised hair follicles with perifollicular haemorrhage, fragmented hair in the dermis, empty follicles, and deformed hair shafts. Multiple catagen hairs are typically seen. An alternative technique to biopsy, particularly for children, is to shave a part of the involved area and observe for regrowth of normal hairs.

Classification

Trichotillomania is defined as a self-induced and recurrent loss of hair. It includes the criterion of an increasing sense of tension before pulling the hair and gratification or relief when pulling the hair. However, some people with trichotillomania do not endorse the inclusion of “rising tension and subsequent pleasure, gratification, or relief” as part of the criteria because many individuals with trichotillomania may not realise they are pulling their hair, and patients presenting for diagnosis may deny the criteria for tension prior to hair pulling or a sense of gratification after hair is pulled.

Trichotillomania may lie on the obsessive-compulsive spectrum, also encompassing OCD, body dysmorphic disorder (BDD), nail biting (onychophagia) and skin picking (dermatillomania), tic disorders and eating disorders. These conditions may share clinical features, genetic contributions, and possibly treatment response; however, differences between trichotillomania and OCD are present in symptoms, neural function and cognitive profile. In the sense that it is associated with irresistible urges to perform unwanted repetitive behaviour, trichotillomania is akin to some of these conditions, and rates of trichotillomania among relatives of OCD patients is higher than expected by chance. However, differences between the disorder and OCD have been noted, including: differing peak ages at onset, rates of comorbidity, gender differences, and neural dysfunction and cognitive profile. When it occurs in early childhood, it can be regarded as a distinct clinical entity.

Because trichotillomania can be present in multiple age groups, it is helpful in terms of prognosis and treatment to approach three distinct subgroups by age: preschool age children, preadolescents to young adults, and adults.

In preschool age children, trichotillomania is considered benign. For these children, hair-pulling is considered either a means of exploration or something done subconsciously, similar to nail-biting and thumb-sucking, and almost never continues into further ages.

The most common age of onset of trichotillomania is between ages 9 and 13. In this age range, trichotillomania is usually chronic, and continues into adulthood. Trichiotillomania that begins in adulthood most commonly arises from underlying psychiatric causes.

Trichotillomania is often not a focused act, but rather hair pulling occurs in a “trance-like” state; hence, trichotillomania is subdivided into “automatic” versus “focused” hair pulling. Children are more often in the automatic, or unconscious, subtype and may not consciously remember pulling their hair. Other individuals may have focused, or conscious, rituals associated with hair pulling, including seeking specific types of hairs to pull, pulling until the hair feels “just right”, or pulling in response to a specific sensation. Knowledge of the subtype is helpful in determining treatment strategies.

Treatment

Treatment is based on a person’s age. Most pre-school age children outgrow the condition if it is managed conservatively. In young adults, establishing the diagnosis and raising awareness of the condition is an important reassurance for the family and patient. Non-pharmacological interventions, including behaviour modification programmes, may be considered; referrals to psychologists or psychiatrists may be considered when other interventions fail. When trichotillomania begins in adulthood, it is often associated with other mental disorders, and referral to a psychologist or psychiatrist for evaluation or treatment is considered best. The hair pulling may resolve when other conditions are treated.

Psychotherapy

Habit reversal training (HRT) has the highest rate of success in treating trichotillomania. HRT has also been shown to be a successful adjunct to medication as a way to treat trichotillomania. With HRT, the individual is trained to learn to recognise their impulse to pull and also teach them to redirect this impulse. In comparisons of behavioural versus pharmacologic treatment, cognitive behavioural therapy (CBT, including HRT) have shown significant improvement over medication alone. It has also proven effective in treating children. Biofeedback, cognitive-behavioural methods, and hypnosis may improve symptoms. Acceptance and commitment therapy (ACT) is also demonstrating promise in trichotillomania treatment. A systematic review from 2012 found tentative evidence for “movement decoupling”.

Medication

The United States Food and Drug Administration (FDA) has not approved any medications for trichotillomania treatment.

Medications can be used to treat trichotillomania. Treatment with clomipramine, a tricyclic antidepressant, was shown in a small double-blind study to improve symptoms, but results of other studies on clomipramine for treating trichotillomania have been inconsistent. Naltrexone may be a viable treatment. Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have limited usefulness in treating trichotillomania, and can often have significant side effects. Behavioural therapy has proven more effective when compared to fluoxetine. There is little research on the effectiveness of behavioural therapy combined with medication, and robust evidence from high-quality studies is lacking. Acetylcysteine treatment stemmed from an understanding of glutamate’s role in regulation of impulse control.

Different medications, depending on the individual, may increase hair pulling.

Devices

Technology can be used to augment habit reversal training or behavioural therapy. Several mobile apps exist to help log behaviour and focus on treatment strategies. There are also wearable devices that track the position of a user’s hands. They produce sound or vibrating notifications so that users can track rates of these events over time.

Prognosis

When it occurs in early childhood (before five years of age), the condition is typically self-limiting and intervention is not required. In adults, the onset of trichotillomania may be secondary to underlying psychiatric disturbances, and symptoms are generally more long-term.

Secondary infections may occur due to picking and scratching, but other complications are rare. Individuals with trichotillomania often find that support groups are helpful in living with and overcoming the disorder.

Society and Culture

Support groups and internet sites can provide recommended educational material and help persons with trichotillomania in maintaining a positive attitude and overcoming the fear of being alone with the disorder.

Media

A documentary film exploring trichotillomania, Bad Hair Life, was the 2003 winner of the International Health & Medical Media Award for best film in psychiatry and the winner of the 2004 Superfest Film Festival Merit Award.

Trichster is a 2016 documentary that follows seven individuals living with trichotillomania, as they navigate the complicated emotions surrounding the disorder, and the effect it has on their daily lives.

Book: The Mental Toughness Handbook

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Book Title:

The Mental Toughness Handbook: A Step-By-Step Guide to Facing Life’s Challenges, Managing Negative Emotions, and Overcoming Adversity with Courage and Poise.

Author(s): Damon Zahariades.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Bravely Endure Hardship, Perform Under Pressure, and Overcome Challenges More Easily Than You Ever Thought Possible!

Do you feel overwhelmed by your circumstances? Are you exhausted and overburdened with stress? Are you tempted to give up whenever you encounter obstacles and mishaps? If so, The Mental Toughness Handbook is for you.

Imagine boldly facing any challenge that comes your way. Imagine confronting any problem you run into and resolving it with confidence.

Imagine being 100% certain that you can handle any predicament or setback life throws at you.

Amazon bestselling author, Damon Zahariades, provides a step-by-step training program for toughening your mind against adversity. You will learn how to persevere when life become difficult and your circumstances deviate from your plans. You will discover how to handle pressure, control your impulses, and endure the emotional and psychological distress that accompany misfortune.

And best of all, you will learn how to achieve more than you thought possible through sheer tenacity and determination.

  • Hhow mental toughness differs from grit (most people mistakenly think they’re the same thing).
  • the top 7 traits mentally-tough people adopt to conquer any problem they encounter.
  • how mental toughness is closely entwined with emotional mastery (as well as the importance of self-awareness and empathy).
  • 5 daily habits you must embrace to strengthen your mind and harden your resolve.
  • why willpower and motivation are unreliable (and how mental toughness trumps both!).
  • 5 simple tips for controlling your impulses and delaying gratification
  • how Navy SEALs develop mental toughness (and 5 surprising tactics they employ to do so).

Plus, you will received 18 exercises that will help you to apply the advice and tactics you will learn throughout this book!

Book: Mental Health and Well-being in Animals

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Book Title:

Mental Health and Well-being in Animals.

Author(s): Dr Franklin D. McMillan (Editor).

Year: 2019.

Edition: Second (2nd).

Publisher: CABI Publishing.

Type(s): Hardcover and Kindle.

Synopsis:

The second edition is fully revised, expanded, and comprehensively updated with the most current knowledge about the full array of mental health issues seen in animals.

Written by key opinion leaders, internationally-recognized experts and specialists, it is comprehensive covering basic principles to mental wellness, emotional distress, suffering and mental illness, through to measurement and treatment.

With even more practical information and clinical pearls, this book remains invaluable to veterinary professionals, animal welfare researchers and advocates, and other animal caregivers.