TOPIC OF THIS ARTICLE:What does it mean to be emotionally unavailable
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What does it mean to be emotionally unavailable 01. understand emotional unavailability
The emotional unavailable (either active disorder or mod disorder) includes bi polar disorder and depression disorder. In bipolar disorder, bipolar I disorder is characterized by extreme depression to extreme mania, while type II prevents patients from experiencing from extreme depression to mania (extremely excited, energetic, with a lot of ideas, little sleep needs, vertigo or slight impatience, Other types include BP NOS (those that do not meet I and II but are obviously not in normal condition) and cyclothmic disorder (cyclothmia) (and a more mild symptom).
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Take the data of 2012 as an example, mental health accounts for the largest proportion (20.6%), higher than cancer (16.9%), cardiovascular disease (10.2%), etc. in the category of mental disease, emotion unavailable accounts for about 40-50% of the total. In the economic sense, in 2011 only, Europe has spent about £ 113.4 billion on emotional disorders, affecting 33.4 million people. So the research of emotional disorder is becoming more and more important.
So how to distinguish between bi-directional affective disorder (BD) and severe depression (MDD)?
As shown in the figure above, the key to distinguish between manic degree and depression degree is as follows: the highest point of type II BD line is on hypomanic (mild mania), while type I BD is on manic, while depression line does not exceed the euthymic (stable line) to show manic symptoms, while many depression emotions.
What does it mean to be emotionally unavailable 02. historical origin of mania and depression
Mania and depression have been recognized in the early stages of human history, such as in the 5th century BC, Greek famous doctor hippocarates had been used to treat these symptoms with drugs. He was also the first physician to describe these diseases as “brain disease” (marneros, 2000). In the second century, Galen, a famous Greek doctor, published “on the nature of man” and proposed that four kinds of body fluids shape personality.
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Kraepelin (1856-1926), a German medical scientist, proposed the linear state of emotion, which suggested that people not only fluctuate up and down emotions, but also change their thinking cognitive way and executive ability. This man has a position in the current psychology world to surpass Freud’s trend, and later has the opportunity to write in detail.
Freud published “learning and Melania” in 1917, which suggested that self blame is the key to distinguish depression from sadness.
In 1977, Bowlby published the famous attachment theory that reluctant separation can also lead to depression.
What does it mean to be emotionally unavailable 03. what leads to emotional unavailability?
Emotional disorders are mainly manifested in high emotions, mania or depression, or alternate, so it is difficult to be diagnosed correctly. The following figure shows the diagnostic accuracy rate of various mental / psychological diseases (Am J psychiantry. 2013; 170 (1): 1-5.intermediate reliability of diagnostics from the initial dsm-5 field trials: it is found that the correct diagnosis rate of BDI and BDII is acceptable, and the lowest is mixed anxiety depression
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The cause of the formation is not clear so far. Naturally, genes (as shown below) and environment are two factors. From the perspective of human nature, the way of doing things, the experience of childhood managers, parents or grandparents, the influence of major events, sensitivity to stress, health status, intestinal flora and so on will be one of the reasons for emotional disorders.
BD is usually pre-25 years old and chronic. The prevalence of BD I is 1.0%, BD II is 1.1%, and sub threshold is 2.4%. 75% of patients with bipolar disorder had mental complications. In 12 months, 68.8% of BD II patients and 74.5% of BD I patients described emotional disorder as a very serious clinical problem. Moreover, manic disorders increase substance abuse and depression can lead to severe functional defects (Merikangas et al, 2007). The following figure shows the study of the probability of complications of severe depression in gene Epidemiology (Kessler RC, et ak., 2003):
In addition, severe depression increased the suicide rate by about 20 percent, the highest in the weeks before onset and then gradually decreased after treatment (Harris et al, 1997)
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What does it mean to be emotionally unavailable 04. genetic epidemiology study of emotional unavailability (modified from Nick Graddock and Liz Fort)
(Note: the proband refers to the first person in a family who has been diagnosed when a genetic trait is investigated in a family). The incidence rate, incidence rate and genetic expectation of bipolar disorder are higher than those of one-way affective disorder. According to Baidu encyclopedia, the rate of the same disease among the first family is 30 times that of the general population, the expected incidence rate of the first degree relatives is 7.2-16%, the closer the blood relationship is, the higher the incidence rate is. The incidence of monozygote twin disease (69-95) was significantly higher than that of twin twins (12-38%), and the prevalence of the children was still high even if they were placed in normal families shortly after birth. ” That is also true.
What does it mean to be emotionally unavailable 05. is the cause / connection special?
In fact, there are many common diseases of anxiety, depression and two-way emotional disorder, and most of the factors are the same, so it is difficult to ensure the correctness of the initial diagnosis. It needs the patient and the doctor to cooperate with each other for several months to determine the most appropriate treatment according to the effect of the drug effect. The change of symptoms can determine the most appropriate treatment (so it is important to find a qualified and responsible psychologist).
The EEG above (wise et al, 2015) shows the difference in the brain activity areas of depression (left) and bipolar disorder (right). Both appeared in the corpus callosum part of the reduction (red arrow). Bipolar disorder (black arrow) shows a greater reduction in the posterior cingulate region, which is associated with human cognition.
When it comes to bipolar disorder, we have to mention marginal personality disorder. What is the difference between them? The following figure (yatham, et al, 2005) shows:
BDNF (brain derived neurotrophic factor) in our brain has a great influence on our emotions. According to Baidu Encyclopedia, “BDNF is a protein synthesized in the brain, widely distributed in the central nervous system. During the development of the central nervous system, it plays an important role in the survival, differentiation and growth of neurons, and can prevent the neuron from being injured and dying, improve the pathological state of the neurons, promote the regeneration and differentiation of injured neurons and other biological effects, It is also necessary for mature tree species and neurons of the peripheral nervous system to maintain their survival and normal physiological functions. “
What does it mean to be emotionally unavailable 06. when BDNF is in trouble
C is BDNF under normal operation, and the lower is functional missing. It can be seen that the following problems arise in the transmission of BDNF in cell analysis. The experimenters compared the BDNF functional deficient rats with the normal wild mice, and found that in forced swimming tasks, the two mice had similar stress response, but the anxiety behaviors of BDNF deficient mice increased and the strain ability decreased. Therefore, increasing BDNF secretion can have positive effects on anxiety, fear and other diseases.
What does it mean to be emotionally unavailable 07. what caused depression?
Depression is caused by the absence of brain chemicals, according to monoamine hypothesis.
The first antidepressant drug, iproniazid, was used in the 1950s to inhibit enzymes that destroy the neuroneurotransmitters.
Most drugs can change the nerve transmission immediately after taking, but the effect will take 2 to 6 weeks to achieve. There are other alternatives or additional possibilities:
· monoamine imbalance
· hypothalamic pituitary adrenal dysfunction (any environmental change, internal or external, affects internal and external balance, affects stability, and thus leads to stress)
? changes in nerve regeneration function
• inflammation or changes in cytokines
Neurodegenerative changes: urinary ammonia pathway / oxidative stress in dogs
? glutamate dysfunction
What does it mean to be emotionally unavailable 08. glucocorticoids and depression
Glucocorticoids affect about 20% of human dominant genes and almost all organs and tissues (chrousos & Kini, 2005). Glucocorticoids increase in depressed patients (Juruena et al, 2006). As shown in the following figure, as a healthy subject, and also in depressed patients, it is obvious that the glucocorticoids of depressed patients are much higher than those in normal patients.
Similarly, after comparing the inhibitory effect of dexamethasone on salivary cortisol in normal subjects and depressed patients, it is found that the effect of dexamethasone on patients with depression is not much different from placebo. As shown in the figure below, the upper is the normal subject icon, the lower depression patients, the black line is placebo, and the blue line is dexamethasone.
It is also said that physical diseases such as injury, infection, inflammation and other physiological diseases can also promote “disease behavior”. For example, after being infected, human beings will have behavioral changes, such as fever and vomiting, loss of appetite, loss of interest in external things, fatigue, falling sleep quality, changeable mood and decreased cognitive ability, If you think carefully, you will find that these symptoms are very similar to depression symptoms. Now it has become a new research hotspot.
What does it mean to be emotionally unavailable 09. current treatment
Drug therapy: combination of antidepressants and affiliated treatment
Non drug therapy: psychotherapy, including CBT, interpersonal therapy and psychodynamic therapy.
The change of life habits and thinking mode.
Deep brain stimulation.
Vagus nerve stimulation.
Repeat transcranial magnetic stimulation (rTMS).
What does it mean to be emotionally unavailable 10. anti treatment response
The current antidepressant therapy is only effective for 50% to 70% of patients, and 20% to 30% of patients have therapeutic depression (TRD) (sackeim, 2001). Most of the pain, disease, and expenses are related to TRD. The concept of resistance is a long, recurrent symptom.
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