Other Disorders that i treat

Other disorders that i treat are:

• Insomnia
• Sexuality and couples therapy
• Obsessive compulsive Disorder

When we talk about Sleep Disorders we refer to a wide category of problems, such as, for example, sleep apnea, sleepwalking, narcolepsy, rhythm disturbances.

Among all sleep disorders, insomnia is certainly the most widespread, as it is estimated that it is occasionally experienced by more than half of the population and that it seriously affects at least one Italian in 10.

Causes

Sometimes the problems of insomnia last only a few days and go away by themselves, especially if insomnia is linked to obvious and specific causes such as stress before a public presentation, physical trauma or jet lag. In other cases, insomnia is persistent. Chronic insomnia is usually related to problems of a physical or psychological nature.

• Psychological problems: depression, anxiety, chronic stress, bipolar disorder, post-traumatic stress disorder.
• Drugs / substances: antidepressants; cold or flu medications containing alcohol; painkillers containing caffeine (Midol, Excedrin); diuretics, corticosteroids, thyroid hormones, drugs for high blood pressure, coffee, alcohol.
• Medical problems: asthma, allergies, Parkinson's disease, hyperthyroidism, gastric reflux, cancer, chronic pain.
• Sleep disorders: apnea, narcolepsy.
• Poor sleep hygiene.

Symptoms

Insomnia can be defined as a repeated difficulty in starting and / or maintaining sleep, such that it results in unsatisfactory duration and / or quality.

In particular, those suffering from insomnia, report one or more of the following sleep-related disorders:

Overnight:

• Difficulty falling asleep despite fatigue
• Use of sleeping pills or alcohol to sleep
• Frequent and brief awakenings or stay awake for extended periods
• Early awakenings in the morning without feeling rested

 During the day:

• Daytime sleepiness, fatigue or irritability
• Difficulty concentrating, poor performance at work at school
• Slow reaction times and reduced mental alertness: increase in the percentage of risk of accidents
• Weakening of the immune system
• Increased risk of depression, anxiety and substance abuse

The good news is that in most cases, insomnia can be treated with changes that each of us can do even alone and without resorting to drugs.

Treatment

Today, the most accredited drug-free therapy is the Cognitive-Behavioral Treatment of Insomnia (CBTi - Cognitive-Behavior Therapy for Insomnia). TCC is a psychological intervention, individual or group, based on techniques that have shown significant efficacy for the treatment of insomnia in numerous experimental researches. In recent years, several studies have shown that Mindfulness, in particular the Mindfulness Based Stress Reduction (MBSR) program, can be effective in the treatment of insomnia if integrated with CBTi.

Sexual disorders are commonly divided into three distinct categories:

• Sexual dysfunctions (disorders that hinder or prevent sexual intercourse);
• Paraphilias or recurrent and intense impulses, fantasies or sexual behaviors that involve uncommon objects, activities or situations (objects or non-human beings, receive and / or inflict genuine physical suffering, humiliate oneself or one's partner), children or other non-consenting persons;
• Gender identity disorders (intense and constant identification with the opposite sex and malaise with respect to one's biological sex).

Sexual dysfunctions

Sexual dysfunctions can have a physical cause (hormonal imbalances, diabetes, alcohol abuse, neurological disorders or side effects of drugs) or psychological (performance anxiety, fear of pregnancy or transmission of diseases, depression, distorted ideas about sex, religious prejudices or moral, relationship problems). In most cases the origin is psychological, but it is always advisable to exclude any organic derivation by contacting specialists: gynecologist, andrologist, urologist.

The person who suffers from disorders of the sexual life experiences anxiety, frustration and depression with symptoms such as insomnia, difficulty concentrating, irritability, etc. Sentimental and family life is directly affected by this situation.

It is possible to divide the main dysfunctions according to the phase of the sexual response that is disturbed. (DSM 5, Diagnostic and Statistical Manual of mental disorders)

PHASE 1 - DESIRE

• Male hypoactive sexual desire disorder. Persistent or recurrent insufficiency (or absence) of sexual thoughts or fantasies and desire for sexual activity not attributable to depression or other physical or psychological condition.

PHASE 2 - EXCITATION

• Sexual desire disorder and female sexual arousal. Lack or significant reduction of sexual desire / arousal in response to sexual and erotic stimuli. In some cases associated with pain felt during current or past sexual activity.
• Erectile disorder. In all or almost all (75-100%) sexual relations marked difficulty in getting an erection during sexual activity or until it is completed.

PHASE 3 - ORGASM

• Premature ejaculation. Persistent or recurrent mode of ejaculation that occurs during sexual intercourse, about one minute after vaginal penetration and before the individual desires.
• Delayed ejaculation. In all or almost all (75-100%) sexual intercourse and without the delay being intentional, marked delay in ejaculation, infrequency or absence of ejaculation.
• Female orgasmic disorder. In all or almost all (75-100%) marked sexual relations, marked infrequency or absence, of orgasm, markedly reduced intensity of orgasmic sensations.

IN EVERY PHASE

• Disorders of genito-pelvic pain and penetration (not due to a general medical condition). Persistent or recurrent difficulties and pain during vaginal penetration and intercourse, marked anxiety before and during penetration, contraction of the pelvic floor muscles.

Treatment

Generally, the prognosis of sexual dysfunctions is very good: with short sexual therapies, high success rates are achieved in less time. It has been shown that the best results derive from the application of cognitive behavioral therapy techniques to each specific disorder. These techniques consist of exercises aimed at obtaining a gradual re-training of compromised skills.

A couple therapy is certainly useful, where relevant.

Couples therapy

The Cognitive Behavioral Therapy for couples is born as a short-term intervention, as an active and directive process of educating the couple on specific aspects that can contribute to relational dysfunction.

The therapist will support the couple in their own change process, to build a positive and collaborative relationship.

Aspects will be evaluated:

• COGNITIVES (thoughts, beliefs, perceptions and expectations of the couple)
• BEHAVIORAL (communication skills, past interaction, strengths and weaknesses of the couple)
• EMOTIONALS (positive and negative emotions, such as anger, anxiety, jealousy)
• Behavioral interventions will be proposed, such as psychoeducation, communication training and problem solving as well as modifications and management of thoughts.

Obsessive-compulsive disorder (DOC) is a disorder characterized by the presence of obsessions and compulsions, which interfere with daily life, causing significant discomfort.

In Obsessive Compulsive Disorder, obsessions occur suddenly, frequently and against the will of the person, and often cause unpleasant and very intense emotions, such as reactions of anxiety, fear, shame or guilt.

Obsessions can take three forms:

• Thoughts
• Images
• Pulses

They are perceived as uncontrollable and their content is often very far from the values, moral beliefs or personality of the person experiencing them.

These fixed ideas are always accompanied by an attempt by the person to resist, ignoring them, trying to drive them out of his mind or neutralizing them with other ideas or actions.

Examples of obsessive thoughts:

• "I forgot to close the gas knob"
• "There are germs on my hands"
• "I killed someone with the car"

Examples of obsessive images:

• Blasphemous images with a religious background
• Sexual background images

Examples of obsessive impulses:

• Impulse to hurt a loved one
• Impulse to act inappropriate behavior in public

Compulsions or rituals are repetitive behaviors (such as checking, washing / washing, ordering, etc.) or mental actions (praying, repeating formulas, counting) that the person carries out in response to an obsession, aimed at containing emotional distress provoked by obsessions and to prevent some feared event.

A compulsion is intentional: although, in fact, it can become habitual or automatic, it is voluntary behavior. Compulsions are repeated several times throughout the day and often are always the same or follow specific rules.

People with OCD feel a strong impulse to implement compulsions and feel enslaved by them, as if they had no control over them.

Examples of compulsive behaviors:

• To wash hands
• reorder
• To check

Examples of compulsive mental actions:

• To count
• To pray
• Repeat formulas

Just having obsessive thoughts or ritualistic behaviors does not mean that you are suffering from DOC. Many people have minor obsessions or compulsions but are able to cope with life without major problems.

But with obsessive compulsive disorder these thoughts and behaviors cause considerable discomfort, occupy most of the time and interfere with the daily habits of life, work and relationships.

Types of DOC

An Obsessive Compulsive Disorder can take different forms.

The main types of DOC, classified according to obsessive and compulsive symptoms are:

• Obsessive compulsive washing and cleaning disorder (Washers and Cleaners)
  Terror of contracting a disease or being contaminated or infected with germs, bacteria, viruses or dangerous chemicals. There may also be a strong concern to infect other people.
  To eliminate any possibility of contamination, one or more rituals are performed, such as washing your hands or teeth excessively, taking long showers or cleaning your home or household items for many hours.
  The person suffering from an Obsessive Compulsive Disorder of washing and cleaning will do everything to avoid contact with contaminants. It could, for example, keep certain rooms in the house closed or refuse to touch things that fall to the ground.
• Obsessive compulsive control disorder (Checking)
  Those who suffer from Obsessive Compulsive Control Disorder are afraid of being responsible, for their own negligence, for terrible events (for example, fires or thefts), of being able to harm themselves or other people.
  Usually when these people check for the first time, immediately afterwards they are assailed by the doubt whether they have checked well and have to check again. Many control compulsions are not observable from the outside, because they take place only in the mind of the person who, for example, retraces all the actions performed in a certain period of time, to make sure that they have been carried out correctly.
• Repetitive and counting obsessive compulsive disorder
  The person feels compelled to repeat precise actions, in order to prevent an obsessive thought that frightens her from coming true. This type of thinking is called "magic thinking": an example is the fear that a family member may experience an accident if some activities or counts are not repeated.
  The repetition and counting compulsions can be directed to any type of object or action, such as counting tiles, red traffic lights, thinking of series of numbers or patterns. As for the control DOC, these people try to prevent or neutralize possible catastrophes but, unlike the former, it is not possible to identify a logical connection between obsession and compulsion, because a magical component is expressed in their thinking.
• Obsessive compulsive disorder of order and symmetry
  Who suffers from an obsessive compulsive disorder of order and symmetry, has thoughts, impulses or mental images that concern the positioning of objects or perform actions in a "symmetrical" or "perfect" way.
  With this type of DOC, the compulsive behaviors implemented can involve arranging objects in a certain order - for example by size, color or function -, re-reading or rewriting things excessively, repeating routine activities - such as going through and back a door or comb your hair - excessively.
• Obsessive compulsive accumulation / hoarding disorder
  In obsessive compulsive accumulation / hoarding (or hoarding) disorder, obsessions are characterized by the fear of throwing objects away, even if they are completely useless, by the discomfort caused by empty spaces in your home - and by the need to fill them - and pleasure in collecting used and unused objects.
  The accumulation compulsions vary from purchasing multiple pieces of the same object to storing purchased items without using them, to picking up used or unusable items from the ground, keeping them in your own home. People suffering from this type of DOC do not realize, if not partially, the excess in which they incur, and families are usually the ones to request therapeutic treatment.
• Obsessive compulsive disorder with obsessions as well
  In Obsessive Compulsive Disorder with pure obsessions, there are no mental rituals or compulsions, but only obsessive thoughts. These are thoughts or, more often, images or impulses, related to scenes in which unwanted and unacceptable behaviors for the person, meaningless, dangerous or socially inappropriate, are put in place. Most of these fears can be understandable and rational in their content, however the measures taken to counter them and their imagined consequences are not related to risk. The three areas in which these fears are mainly concentrated are superstition and counting (counting objects, seeing lucky or unlucky numbers or colors with particular meanings), religion or morality (fear of not respecting religious precepts, of being homosexual, pedophile, perverse or sexually violent), and obsessions related to the body (excessive controls of parts of one's body or functions - blood circulation, pressure - or on one's appearance).

Treatment

Numerous clinical studies, conducted over the past 15 years, have definitively confirmed that cognitive behavioral therapy, with or without drugs, is significantly superior to all other forms of treatment for OCD.

In fact, international guidelines indicate the psychotherapy treatment of choice for the treatment of obsessive disorders, in particular in the exposure procedure with prevention of response (ERP) in cognitive-behavioral therapy.

Most studies show that, on average, about 70% of patients with Obsessive Compulsive Disorder benefit from cognitive-behavioral therapy.

In the treatment of obsessive-compulsive disorder, the techniques of exposure and response control and cognitive therapy have both shown stable results over time and comparable to pharmacological intervention with antidepressants, with an average of 15.

Furthermore, mindfulness practice, integrated with cognitive-behavioral therapy, can offer a more global perspective, intervening on the symptoms and on the person.

• National Istitute for Health and Care Excellence guidelines Sleep Conditions
• American Psychological Association, Division 12 evidence-based treatment Insomia
• American Psychological Association, Division 12 treatment relationship Problems
• Guidelines Obstetrics and Gynecology Sexual Disorders
• National Istitute for Health and Care Excellence guidelines Obsessive Compulsive Disorder
• American Psychological Association, Division 12 treatment Obsessive Compulsive Disorder