Dr Thomas M J

What are personality disorders?

Disorders of personality are abnormal exaggerations of normal traits, though some of these disorders also show symptoms not seen in normal people. Differences in personality between people depend on their genetic make-up and on their life experiences, and these differences show up in relative strength of emotions and behaviours. Maladaptive personality traits can improve with intervention and over time, although residual effects remain. The following table illustrates some of these personality traits and their maladjusted extensions.

SOCIAL PHOBIAS

Social phobias start in adolescence and are centered on a fear of scrutiny by other people, leading to avoidance of social situations. Social phobias are equally common in men and women. Social phobias can be discreet, for example for public speaking, eating in public or meeting with the opposite sex r diffuse, involving all situations outside family circles. Direct eye to eye contact may be particularly bothersome in some cases. Social phobias are usually associated with low self esteem and a fear of criticism. The person with social phobia anticipates and ruminates over the problems that can occur in a social contact, resulting in avoidance of the situation and in extreme cases social isolation. They experience rapidheartbeats, trembling, sweating, upset stomach, diarrhoea, muscle tension,blushing and confusion. In some cases these symptoms may be severe enough to take the form of panic attack. Some people with social phobia may use alcohol or drugs as a way to self-medicate to help them get through social situations. Althoughalcohol or drugs may seem to help initially, they eventually become another problem in the life of the person with social phobia. The consequence of social phobia can be socially and economically devastating. It can result in a person dropping out of school, chronic unemployment and financial dependence, alcohol abuse, suicidal thoughts, and not getting married or having children. Social phobia is related to an imbalance of a chemical that transports signals between nerve cells in the brain. It also runs in families, especially among close relatives like parents and their children. It can be precipitated by an embarrassing social event in the past. Both medication and cognitive behaviour therapy have proven successful in treating social phobias. Some find that a combination of medication and behavioural therapy is most effective. Cognitive behaviour therapy teaches people with social phobia to react differently to the situations that trigger their anxiety symptoms. Patients learn how to change their negative feelings about social situations so the symptoms begin to lessen. Gradual exposure to an anxiety-provoking situation until the patient learns to identify and modify behaviour that contributes to his or her social phobia is helpful. Social skills training involve rehearsal of problematic social situations, such as making eye contact, talking louder

Gender Identity Disorder

Gender identity disorder is used to describe a male or female who
feels a strong identification with the opposite sex and feels distressed
because of his or her actual sex. They are uncomfortable with their present sexual
role and desire to alter their bodies. Cross-gender behavior is tolerated in
girls to a far greater degree than it is in boys. Social tolerance of
"tomboys" is more than "sissies." Causes of gender identity
disorder are not fully known.

Treatment for people with gender identity disorder focuses on treating
depression and anxiety, and improving self-esteem. Many people do not see their
gender identity disorder symptoms as requiring treatment. People with gender
identity disorder request hormone and surgical treatments to suppress their
biological sex and acquire those characteristics of opposite sex. Because of
the irreversible nature of the surgery, candidates for sex-change surgery are
evaluated extensively and are often required to spend a period of time
integrating themselves into the cross-gender role before the procedure begins. Significant
social, personal, and occupational issues may result from surgical sex changes,
and the patient may require psychotherapy or counseling after the change too.

Many people feel attracted to people of the same
sex. For some people these feelings can be very intense. Some people find that
these feelings change over time. Some of them are bisexual, meaning they are
attracted to both men and women, and have relationships with both. Some people
are not attracted to anyone. With time, someone who is homosexual will realize
that not only are they sexually attracted to members of the same sex, but that
this attraction is not transitional. However, for some people homosexual
experiences are part of a transitional or experimental phase in their youth.

There
is now growing support for the belief that sexuality is pre-determined, though
may change over time. Some people believe homosexuality is an illness and
believe it can and should be cured. Available information seems to indicate
that reparative therapy is ineffective. Available evidence suggests that the
success of these techniques is restricted to three areas:

• Convincing bisexuals to limit
  their sexual activities to members of the opposite sex.
• Convincing homosexuals to
  become celibate.
• Convincing homosexual men and women
  to attempt to maintain heterosexual relationships, whilst retaining their
  homosexual orientation.

Coming to terms with confusion about identity can
have both positive and negative effects on many aspects of a person's life,
including social relationships, work, and self-esteem. It can take a long time
too. Coming to terms is not a single action. It is a process that begins with a
feel of being 'different' to other people of the same sex. Sometimes they
recognize that they are not very interested in people of the opposite sex but
more often they feel they are not really interested in things which are
supposed to be appropriate for their sex. Different people cope with the
emotional upheaval of identity confusion in different ways. Some people deny it
to themselves and try to avoid thoughts and feelings which may confirm they are
homosexual. Others persevere with heterosexual relationships to try and
'convert' themselves. In some extreme cases people may try to avoid confronting
their feelings by expressing strong homophobia or turning to drink and drugs in order to find
temporary relief from them.

Making the decision to tell others that you are homosexual,
bisexual or transgender can relieve a great deal of stress and unhappiness and
build self-esteem, as well as help improve relationships. However, there are
also risks associated with telling others, and it is important to think
carefully about how you could cope with the potential consequences before
telling others. Friends and family may not react in an understanding way, and
relationships can be changed significantly. Having time to fully come to terms
before telling others can mean you are more prepared to deal with any
misunderstanding or prejudice you may face. Telling others does not mean that
you have to tell everybody. Many people chose to tell first to people who they
think are more likely to react positively. It not only helps them get an idea
of how people may react, but often means that they will have someone to support
them when they tell others. Some people may never be able to accept your true
gender identity. This is not something that you can change, and it can be very
hard to feel rejected by someone you are close to.

There are also many stereotypes surrounding homosexual
relationships. As with heterosexual couples, homosexual relationships can also be
short-lived or long-term.

MARRIAGE COUNSELLING

Marriage is a social and legal contract between people to create an institution in which interpersonal, emotional and sexual relationships, are acknowledged in a culturally appropriate manner. They 'marry' for legal, social, emotional, economical, spiritual, and religious 'reasons'. It includes arranged marriages, marriages out of family obligations, marriages to establish a legal nuclear family, marriages for legal protection of children or public declaration of commitment to each other and so on.

Individuals in relationship also come with different value systems. Hence societal factors like the social, religious, group and other factors that shape a person's behaviour are also considered while counselling. It is advantageous for all in relationships to interact with each other and their society at large with minimal amounts of conflicts. Many relationships get strained some time during life resulting in poor functioning producing self-reinforcing, maladaptive patterns. There are many possible reasons for this, including insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication or poor problem solving skills, ill health, third party influences and so on. Changes in situations like financial state, physical health, and the influence of other family members can also have a profound influence on the actions of the individuals in a relationship. Often it is the interaction between people, rather than the behaviour of just one of the person's that causes such maladaptive conflicts.

Relationship influences are reciprocal and it takes all people involved, to manage problems in a marriage. A solution to the problem and setting relationships back on track requires reorientation of perceptions and emotions of all people concerned. These need to be explored collaboratively and discussed openly. The core values they comprise can then be understood and respected or changed when no longer appropriate. This implies that each person takes equal responsibility for awareness of the problem as it arises, awareness of their own contribution to the problem and making some fundamental changes in thought and feelings. The next step is to adopt conscious structural changes to the inter-personal relationships and evaluate the effectiveness of those changes over time. Counselling focuses on clearing past issues that continue to affect your present situation while developing new skills to solve your current issues. It replaces resentment with respect and replace arguments with caring responses. New skills builds intimacy without sacrificing one's individual identity. Working individually and together, people can heal old wounds, gain the abilities to addresses conflicting priorities and betrayal of trust.

Common signs of relationship problems:
1.Feeling of having grown apart
2.Arguments, nagging or angry silence
3.Lack of intimacy and affection
4.Persistent and unresolved problems
5.Feeling unappreciated
6.One's needs are not appreciated by the partner
7.Communication becomes one sided, hostile, sarcastic, angry or absent.
8.Partners spend little or no time alone
9.Trust issues – dishonesty/lies, affairs, unexplained absences, secrecy regarding email, phone and text message.

Marriage counselling differ in duration, between 1 to 3 sessions usually, to 5 to 10 sessions. It is also more 'here and now' and deals with new coping strategies and about seemingly intractable problems within a relationship. Effective counselling requires careful review and planning. Each session is an opportunity to explore free-thinking, and therefore are not too structured. These sessions also encourage the client to make steady progress in a caring and supportive manner. During marriage counselling, regardless of the origin of the problem and whether the clients consider it an "individual" or "family" issue, involving all partners in solutions is often beneficial.