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You are here: ABOUT PSYCHOANALYSIS  COMMON DIAGNOSES
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Psychoanalytic Perspectives
Psychoanalytic diagnosis differs from psychiatric diagnosis. Like other members of the mental health professions, psychoanalysts consult the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) when arriving at a diagnosis for purposes of insurance reimbursement or research. A psychiatric diagnosis, however, is limited to a list of symptoms that describes what’s wrong but that don't’t explain how the patient acquired those symptoms or offer any guidelines for relieving the patient’s suffering.
Not all DSM-IV diagnoses lend themselves exclusively to a psychoanalytic approach (severe mental retardation, for instance, or schizophrenia), but a psychoanalytic diagnosis is always a useful part of an overall treatment plan. For the psychoanalyst, diagnosis involves an investigation into how patients acquire their symptoms and what their symptoms mean. A new manual, The Psychodynamic Diagnostic Manual, offers a diagnostic framework that describes both the deeper and surface levels of an individual's personality, emotional and social functioning, and symptom patterns.
A psychoanalyst's investigation would include an understanding of the confluence of psychological issues from both the past (childhood environment, for instance) and the present (sources of stress such as family, employment, relationships).
In particular, the psychoanalyst and patient working together will try to explore how and why those influences are emerging in the present and causing the patient’s symptoms. This process of exploration is central to psychoanalysis and psychoanalytic psychotherapy, and can sometimes provide dramatic relief from symptoms, or at the very least help patients find better ways to cope.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Anxiety
Bipolar Disorder
Children's Mental Health
Depression
DSM-IV Diagnoses
Eating Disorders
Obsessive Compulsive Disorder (OCD)
Panic Disorder
Resistance
Sexual Dysfunction
Stress
Substance Abuse
Trauma
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Attention Deficit/Hyperactivity Disorder (ADHD)
Although many adults suffer from attention-deficit/hyperactivity disorder, or AD/HD, symptoms begin in childhood, and therefore diagnosis and treatment usually do, too.
Children with AD/HD often tend to extremes in their responses to the outside world. They might be both oversensitive and undersensitive to stimuli--completely unable to tolerate certain clothing fabrics, for instance, yet able to sleep through prolonged periods of loud noises. They’ll find it impossible either to stay with one activity for any length of time or to endure sudden changes. In the face of anxiety, they might exhibit extreme, even violent agitation, or an otherworldly calm.
The triggers for these symptoms are biological, and medication is almost always part of the AD/HD treatment. And because AD/HD manifests itself primarily through behavior, behavior modification (the use of a “shadow” teacher, for instance) is also often part of the AD/HD regimen. What psychoanalytic technique can provide, however, is a therapeutic outlet for the sufferer. The psychoanalytic emphasis on finding a narrative where at first none appears to exist can help instill some coherence--a sense that, despite appearances, the world isn’t entirely out of the child’s control.
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Anxiety
Freud originally thought anxiety was a result of an accumulation of psychic energy--a sort of stoppage of sexual or aggressive drives, bottled up by repression. He later refined his concept to thinking of anxiety as a warning signal of a threatening catastrophe brought on by a conflict of forces in the individual’s mind.
A trigger for anxiety might be specific, such as the loss of a job, a terrorist attack or, more personally, an encounter with a certain person or involvement in a particular situation. Or the anxiety might be global--an ongoing sense of doom. Whatever the apparent cause, the person suffering from anxiety responds as if under a severe threat. When treating anxiety, the psychoanalyst’s task is to investigate whether an unconscious conflict is triggering this deeper fear.
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Bipolar Disorder
Bipolar disorder is another name for manic-depressive illness, and as the name suggests, it is an illness of opposites. Although sufferers can experience prolonged periods of stability, they also go through episodes where their moods will swing from one extreme emotional state to the other, sometimes to the point of psychosis.
Toward one end of the spectrum is hypomania, which can be characterized by feelings of euphoria and a pronounced increase in activity and productivity, while depression is usually marked by listlessness and hopelessness. Even more extreme are mania, which can lead to a loss of coherent thought, delusions and hallucinations, and severe depression, which can lead to thoughts of suicide. The onset of bipolar disorder occurs most frequently in young adulthood.
Because bipolar disorder is a biological illness, stabilizing medications are essential for treatment. And as is often the case with such illnesses, psychoanalysis can’t offer a cure. But once a patient is stabilized, psychoanalysis can help a sufferer come to terms with the illness itself as well as the difficulties the illness has caused in his or her life and, as with any other analysis, to work through individual conflicts.
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Children's Mental Health
Children and adolescents often behave in troubling ways that puzzle and worry their parents, teachers and friends. Sometimes this behavior is symptomatic of passing problems or temporary stresses and it eventually disappears. But sometimes the troubles do not go away by themselves. Rather than feeling guilty or helpless when faced with a child whose behavior cannot be explained or modified, parents and guardians can turn to psychoanalysis for assistance.
- Times to Consider Child Psychoanalysis
- Parental Involvement is Crucial to Success
A valuable tool regarding children's mental health is the publication "All About Psychoanalysis for Children and Adolescents". Times to Consider Child Psychoanalysis
The goal of analysis is the modification of psychological roadblocks so children and adolescents can achieve their full potential, becoming happier, more caring, productive in school, and creative in their endeavors. Psychoanalysis is the best treatment when:
- The problems primarily stem from within the child or teen
- Children or adolescents have complex emotional disturbances
- Other therapies and attempted solutions have failed to deliver deep, long-lasting change
Psychoanalysis is a form of psychotherapy conducted four or five times a week in appointments usually lasting 45-50 minutes. The child or adolescent has time and space to use words, play, or action in the relationship with the analyst to express problems, which can then be understood and solved together. Rather than a “quick fix,” psychoanalysis helps a child or adolescent overcome troubles and developmental delays while building strength and resilience.
Parental Involvement is Crucial to Success
Parents play a key role in the success of child and adolescent psychoanalysis. Parents are the most important adults in a child’s or adolescent’s lives. Psychoanalysis helps people of all ages be more active and engaged in their own lives, teaching them to recognize and manage their feelings and develop their strengths and adaptations for their weaknesses.
Regular communication regarding the progress of analysis is shared between the psychoanalyst and parent(s) or guardian(s) and is provided for in every treatment plan.
“To another parent, I would say: Choosing analysis for your child is giving him/her a gift – the gift of self-knowledge, confidence, and the ability to be happily present in this world. It is also giving the gift of resilience and security so that the child can face the challenges ahead in life with a strong sense of self. Having a child in analysis is not easy for anyone involved, but it is worth it – absolutely, without a doubt.”
-Parent of a child in psychoanalytic treatment
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Depression
Freud was the first to differentiate between mourning and depression. Mourning is the set of feelings and behaviors that follow the loss of a loved one or some other profound disappointment in life. Depression does indeed feel and look somewhat like mourning but carries a crucial extra component: lowered self-regard.
Depression in general is anger turned inward, but anger in a depressed person is specifically directed at the sense of self-worth and manifests itself through feelings of helplessness, shame, and humiliation. As a result, sufferers distance themselves from their closest relationships, find no satisfaction in work, and don’t see the point in normally pleasurable activities such as food or sex. Sometimes this withdrawal makes the depressed person want to do nothing but sleep; sometimes a litany of self-loathing thoughts keeps the sufferer awake at all hours. And in some cases the depression leads to a suicidal wish.
Psychoanalysts believe that such extreme emotions might echo a response to a particular trauma from childhood--an early separation from a parent through death or divorce, for instance, or a mental illness in the family. Psychoanalysis holds that by recognizing and examining that earlier trauma, a patient can experience relief from the current bout of depression and perhaps even break a lifelong cycle.
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DSM-IV
The standard psychiatric diagnosis is a DSM-IV diagnosis (DSM-IV being the fourth edition of the psychiatric reference tool Diagnostic and Statistical Manual of Mental Disorders), and is purely descriptive (i.e., describes a group of symptoms). This type of diagnosis says nothing about the causes or etiology of a person's behavior or feelings, nor does it say anything about what mode of treatment is indicated.
Psychoanalysis offers a deeper psychological explanation for the phenomenon (i.e., the person's behavior). In other words, psychoanalysis offers not only descriptions, but etiology/causes that includes the role of early environment, developmental factors, current stressors, and internal psychological factors.
Psychoanalysis can compliment the more descriptive approach of the psychiatric DSM-IV diagnosis. For information about a diagnostic framework that describes both the deeper and surface levels of an individual's personality, emotional and social functioning, and symptom patterns, see the Psychodynamic Diagnostic Manual.
Eating Disorders
You are how you eat: this is the mantra that guides the women (and they are almost all women) who suffer from eating disorders.
Bulimia is characterized by binge eating followed by purging, often through vomiting, excessive exercise or extreme fasting. Anorexics are so fearful of gaining weight that they put themselves on a starvation diet--sometimes literally. At the other extreme, the obese eat themselves into a life-threatening state. In general, eating disorders take one of the basic needs for human survival and turn it into a means for personal extinction.
Because these disorders tend to first surface in adolescence, and because the persons they affect are mostly female, they likely arise from anxiety about meeting society’s impossibly high standard of sexuality. The psychoanalytic perspective focuses on the particular form of the disorder and what it might mean for the individual. The purging part of bulimia, for instance, is more aggressive than the wasting-away of anorexia, which is primarily passive. Several studies have found that treatments relying on medication and behavioral therapy alone are effective for only 40 to 60 percent of patients; psychoanalysts hold that a deeper, personal understanding can lead to both mental and physical health.
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Obsessive-Compulsive Disorder
Although the term obsessive-compulsive has become so commonplace, the two words actually carry specific meanings.
“Obsessive” refers to a thought pattern where the same words or phrases recur, cycling endlessly. “Compulsive” describes equally repetitious, and often outwardly bizarre, actions. Obsessive-compulsives tend to be highly rational individuals (often male) who are so focused on the logical side of life that they have largely lost touch with the emotional side. When an especially unacceptable or intolerable emotion such as anger or anxiety threatens to overwhelm them, they unconsciously try to counteract it by trying to exert greater control over their minds, but their minds are so out of control that sufferers in fact wind up being more slave than master. In the end the conflict seeks a physical outlet in their behavior--checking the gas jets eight times and only eight times before leaving the house, for instance, or washing their hands whenever they touch anything foreign, or showering a dozen times a day.
Obsessive-compulsive disorder almost certainly has a strong biological component, but from a psychoanalytic perspective, repetitive gestures can’t be meaningless. In part because the obsessive-compulsive patient is usually highly rational, the psychoanalytic assumption that the seemingly meaningless has meaning can itself provide short-term relief, but the ultimate goal of psychoanalytic treatment would be the discovery of the underlying reason.
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Panic Disorder
If “panic attacks” take a certain form, and if they occur often enough and intensely enough, then a person probably has what’s called a panic disorder.
A person having a genuine panic attack (as opposed to a passing episode of confusion or fear or even extreme worry) would psychologically experience a high level of anxiety, even terror, while physically feeling any one or some combination of these symptoms: heart palpitations, coldness, excessive sweating, a clenched stomach, sleeplessness, nausea, diarrhea, shortness of breath, and a tightness around the chest so extreme that it can feel like a heart attack. Persons suffering a panic attack can feel as if they’re about to die.
A sufferer often feels that the attacks are coming out of nowhere, but from a psychoanalytic perspective, they must have deeper triggers and meanings. For someone with a panic disorder, this deeper trigger might be a separation or loss (more often imagined than real), and this trigger in turn would suggest a psychological meaning--a loss of control, or a fear of a loss of control. Although medication can certainly help, psychoanalysis holds that examining and understanding these deeper meanings will alleviate the psychological terror and the physical discomforts.
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Resistance
Resistance is one of the two cornerstones of psychoanalysis. (See also transference.) As uncomfortable thoughts and feelings begin to get close to the surface--that is, become conscious--a patient may resist the self-exploration that would bring them fully into the open.
These resistances can take the form of suddenly changing the topic, falling into silence, or trying to discontinue the treatment altogether. To the analyst, such behaviors would signal the possibility that a patient is unconsciously trying to avoid threatening thoughts and feelings, and the analyst would then encourage the patient to consider what these thoughts and feelings might be and how they continue to exert an important influence on the patient’s psychological life.
As the analysis progresses, patients may begin to feel less threatened and more capable of facing the painful things that first led them to analysis. In other words, they may begin to overcome their resistance.
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Sexual Dysfunction
The term “sexual dysfunction” encompasses many specific disorders and issues--impotency, frigidity, promiscuity, and so on. What these problems have in common is a repeated difficulty or outright inability to experience the pleasure that ideally accompanies sexual relations.
Because sexual relations can involve extremes of exposure and physicality, it can easily raise issues of vulnerability and aggression. Frigidity, for instance, might signal a defense against emotional or physical closeness. An inability to perform--impotency--might reflect a feeling of genital inadequacy. Promiscuity may involve issues of dependency--a fear of being too dependent, a need to be dependent, or both. And any of these issues might be complicated by an aggression--or a fear of the aggression, or both--that fuels the physical act of sex.
The psychoanalytic approach to sexual dysfunction is to try to untangle the unconscious motives and fantasies in the hope of helping the patient achieve less conflicted, more satisfying sexual relations.
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Stress
As in physics, stress in psychoanalysis refers to external pressure. Bombarded by outside forces, a person will develop an equal and opposite reaction, so to speak, in an effort to achieve an internal sense of equilibrium.
Some stressful situations are of the once-in-a-lifetime variety. Others are lifelong--a chronic illness, for instance, or a learning disability. The response to stress typically includes worry and tension. The psychoanalytic approach consists of helping the patient: understand that these responses are normal, healthy and necessary; assess the extent of the pressure; develop a strategy for coping with the pressures. Sometimes a patient’s internal response to external pressures can seem disproportionate to the severity of the situation--either an under-reaction or an overreaction. In those cases, an analyst might encourage the patient to investigate whether the current stressful situation is reminiscent of earlier, formative stressful situations, such as a separation from a parent, an accident, an illness, and so on.
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Substance Abuse
Alcoholics Anonymous and similar organizations maintain that alcoholism, or any other form of substance abuse, is a disease, and psychoanalysis doesn’t disagree. But the psychoanalytic approach holds that substance abuse is also an attempt to self-medicate underlying emotional disturbances.
Alcohol and drugs allow users to lose their inhibitions. Sometimes that loosening serves a social or recreational purpose, and in certain circumstances society sanctions these indulgences. When the use of a substance turns chronic, however, it crosses the boundary and becomes abuse. That abuse itself can cause secondary problems by altering social or family relationships or affecting the ability to do work, and the life-changing complications that arise from those problems can in turn lead to a greater dependence on the addictive substance.
Addiction definitely involves a physical dependence on a substance, but the psychoanalytic point of view concerns the emotional source of the abuse itself. The choice of substance itself can reflect what sort of psychological pain an abuser is trying to soothe. Alcohol, for instance, is a form of sedation that can relieve anxiety and calm nerves, while cocaine is a stimulant that can serve as an anti-depressant. Because addicts share a tendency toward immediate gratification, they can be unlikely or difficult prospects for psychoanalysis, and they often don’t seek psychoanalytic help until after they’ve quit their substance of choice. But even if they do enter psychoanalysis while abusing a substance, their physical dependence will still need to be treated separately.
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Trauma
Trauma is a severe shock to the system. Sometimes the system that’s shocked is physical; the trauma is a bodily injury. Sometimes the system is psychical; the trauma is a deep emotional blow or wound (which itself might be connected to a physical trauma). It’s the aftereffects of the psychical trauma that psychoanalysis can attempt to counteract.
While many emotional wounds take a while to resolve, a psychic trauma may continue to linger. When the stimulus is powerful enough--a death, for instance, or an accident--the psyche isn’t able to respond sufficiently through regular emotional channels such as mourning or anger. Often this lack of resolution can foster a repetition compulsion--a chronic re-visiting of the trauma through rumination or dreams, or an impulse to place oneself in other traumatic situations. Psychoanalysis can help the victim to develop emotional and behavioral strategies to deal with the trauma.
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