Dysphoria

In different situations in life, each person reacts in his own way to stimuli and, accordingly, expresses emotions that characterize his attitude to what is happening. With prolonged stressful situations, diseases of the central nervous system, affective experiences are intensified and can reach a pathological height. In psychology, dysphoria is a type of emotion disorder with an unmotivated, clearly lowered background of mood, characterized by intense gloom, gloom, and comprehensive discontent. This state is the opposite of euphoria. They both belong to disorders with increased emotionality. The sensitivity of a person is exacerbated, he is capable of a sudden explosion of anger and aggressive behavior that is not comparable in strength to external stimuli, often directed against himself.

[1], [2], [3], [4], [5], [6], [7], [8]

Epidemiology

The prevalence of dysphoria is very wide. It can cause many reasons, ranging from the banal overwork and ending with organic psycho-syndrome.

Statistics highlights only certain types of dysphoria, for example, premenstrual dysphoric disorder occurs in 5–8% of women of childbearing age, and patients of 25–35 years are most susceptible to it.

According to the US medical statistics, one of hundreds of women wants to change their gender to the male. One woman from four hundred wants to become a woman. The behavior characteristic of the opposite sex, demonstrates approximately 4% of the population of the planet. However, it is not known who of them has dissatisfaction on this basis reaches the height of dysphoria.

Dysphoria is observed in many epileptics of different ages, more often in male patients, and correlates with an increase in the frequency of attacks.

[9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]

Causes of the diskform

Painful dissatisfaction in combination with melancholy, depressed mood, bursting out anger, evil tricks directed both at others and at oneself can develop amid many mental disorders - neurosis, psychopathy, depression, phobias and more serious mental diseases - schizophrenia, epilepsy. In the latter, dysphoria can be observed in the prodrome of the seizure and after its completion, as well as in its place.

Unmotivated irritability and nastiness are characteristic of the withdrawal syndrome in alcoholics and drug addicts.

The dysphoric state is observed in the structure of organic brain lesions of various origins (trauma, intoxication, tumor, hypoxia, hemorrhage).

Decompensated diabetes and thyroid dysfunction can also cause this condition to develop.

Monthly hormonal fluctuations in some women of fertile age can cause a pathological response of the central nervous system in the form of the development of dysphoric disorder.

Sexual dissatisfaction, sexual incapacity, chronic pain, insomnia or stress, prolonged anxiety, heredity, obesity, general health and certain personality traits are risk factors for developing dysphoria.

The pathogenesis of a painful decrease in mood is triggered by many of the reasons described above, and more often their combination. At the present level, the neurobiological vulnerability of the brain to hormonal fluctuations has been proven - the development of dysphoric disorder in the premenstrual period or against the background of a surplus (deficit) of thyroid hormones; metabolic disorders, in particular, hypoglycemia; intoxication. Many causal factors can influence the chemical interaction of neurotransmitters with receptor proteins on the presynaptic and postsynaptic membranes, changing their concentration in synapses.

A disturbance in dopamine transmission affects mood and behavior. The weakening of the activity of norepinephrine leads to the formation of a melancholy mood, disorder of the sleep-wake cycle. Reduced serotonin levels, an imbalance of neuropeptides, in particular endorphins, and other substances cause a pathological response from the central nervous system in the form of a sharp decrease in mood while maintaining physical activity and explosive emotional stress.

The role of heredity in the pathogenesis of mental illness has also been established. In addition, certain personal characteristics (increased anxiety, suspiciousness), tendencies to somatic diseases, such as diabetes, drug addiction, alcoholism, other antisocial acts, and even the occurrence of premenstrual dysphoria, are inherited.

Hereditary aspects are involved in the formation of sexual identity. The brain of men and women has neuroanatomical differences, which affects the psychological characteristics and behavior of people of different sexes. Mutations of genes in case of gender dysphoria, or more precisely, those responsible for atypical sexual identity and the associated dissatisfaction, have so far been little studied, but studies show that they do occur.

In general, the mechanism of development of dysphoria in any mental disorders and organic pathologies is under study, the possibility of intravital neuroimaging, successes of neuroscience and genetics have not yet revealed all the secrets of the interaction of brain structures.

[23], [24], [25], [26]

Symptoms of the diskform

The first signs that draw attention to themselves are expressed in the fact that the emotional state of the subject is clearly with a minus sign. Moreover, there are no obvious reasons for this, or they do not correspond to gloomy displeased facial expression, caustic and caustic remarks, rude answers to questions, and irritation often goes off scale and results in a surge of unmotivated aggression.

A person can gloomily remain silent, however, tension is felt in everything. Dysphoria refers to disorders with increased emotionality, the patient does not have motor and speech inhibition, which is typical of typical depression. He easily moves from sullen silence to battle, threats, brutal behavior and even illegal actions in the form of a sudden attack or injury to himself.

An attack of bad mood occurs for no apparent reason, often right in the morning. The expression: “got off the wrong foot” is just about it: total discontent, grumbling, nagging in combination with hypersensitivity and sensitivity, easily turning into acute severity, are characterized by dysphoria syndrome, as some users call it, although in psychiatry it is not a condition for syndromes relate to.

Sometimes, in the presence of a previous negative stressful situation, others have the impression that this is a natural reaction to events, however, repeated and fairly frequent reactions of this type, sometimes for no apparent reason, should make us think about the presence of a mental disorder.

Episodes of dysphoria occur suddenly, last for two to three days, sometimes for several weeks (this is an obvious pathology). Fits of bad mood stop just as unexpectedly as they arise.

If the condition is delayed, the vegetative symptoms join in a very bad mood: blood pressure jumps, limb tremor, headache, increased heart rate, worsening of sleep and appetite.

Euphoria and dysphoria are two diametrically opposed emotional disorders. The euphoric state is composed of complacency, a serene and nonchalant mental state, and is accompanied by pleasant somatic symptoms. The toxic effects of opiates are associated with the emergence of a state of rest and satisfaction, sensations of blissful heat, spreading waves from the lower abdomen up to the neck. Opiate euphoria causes lightness in the head, a feeling of joy and glee. The world around us is perceived as bright, people are kind and friendly. Then the sensations are smoothed out and acquire the features of satisfaction, sweet languor, good-natured laziness - a state of nirvana.

Caffeine, cocaine, lysergid euphoria is combined more with sensations of a clarified mind, an intellectual upsurge.

Alcohol intoxication, barbiturate poisoning makes the subject complacent, boastful, self-confident and disinhibited. However, there is no true increase in mental and physical productivity in artificially induced euphoric states.

Sometimes a dysphoric disorder may be accompanied by inadequate enthusiasm, logorea, exaltation, and delusional statements about one's own greatness, somewhat reminiscent of euphoria, however, it doesn’t "smell" at the same time.

Dysphoria in children occurs less frequently, however, may develop for the same reasons as in adults. More often, epileptic children, oligophrenic, and future excitable epileptoid psychopaths suffer from bouts of bad mood with increased irritability.

The condition may develop against the background of a severe infectious disease. Domestic violence against a child, or a situation where he becomes a witness to violent acts, becomes an additional risk factor for the development of dysphoric disorder.

More and more children and adolescents in the world, according to Western studies, are not satisfied with their gender, complain of imaginary physical defects. Experts believe that in case of dysphoria in a child that is not associated with mental retardation, trauma, epilepsy, psychotherapeutic help is also required for his parents.

Dysphoria in a mild form looks and is perceived by others as a very bad mood - a person grumbles in the morning, displeased everyone, criticizes the domestic people bitterly, finds fault with trifles, however, is very offended at criticism. The patient can flare up, quarreling, slam the door. Such attacks usually last several hours, then suddenly pass.

With a longer course (up to several days), the state reaches a more severe stage. The vegetative symptoms join the manifestations of bad mood and irritability, the person behaves too inadequately, the emotional state is unstable, his consciousness is narrowed, the critical attitude to his behavior is reduced or absent. Sometimes after the end of a dysphoric episode, the patient remembers very briefly what was happening. A state of severe dysphoria can be a danger to the health and life of the person himself and his environment.

[27], [28], [29]

Forms

Experts identify some types of this mood disorder, which are quite common and therefore attract close attention. For example, in the last, fifth, edition of the Diagnostic and Statistical Manual on Mental Disorders DSM-5, such nosological units appeared as “gender dysphoria” instead of sexual identity disorder, emphasizing the deep dissatisfaction with their sexual status at the level of psychological distress, as well as premenstrual dysphoric disorder.

Gender, sexual dysphoria

In the world, the number of calls to clinics for gender reassignment is growing every year, as people feel inconsistent with their internal self and appearance. At present, Western psychiatry recognizes sexual incongruence as a birth defect, although there are still multiple debates on this issue. In addition to the presence of certain and still not established genes responsible for sexual identification, scientists consider endocrine theory, suggesting the occurrence of pathological processes in the nuclei of the hypothalamus and other brain structures that disrupt the transmission, conduction, and regulation of neuropulses.

Social theory blames the impact on the psyche of any adverse factors, and most of these factors are present in the life of a child from early childhood.

In addition, the term “sexual” has been replaced by “gender”, since the concept of sex (“sex”) is not applicable to people with impaired sexual development. Gender implies clear biological signs of gender. But in reality there are a number of patients with ambiguous gender characteristics. The term “gender” is more general and reflects social and psychological identification as a person of a certain gender.

“Gender dysphoria” accentuates, first of all, as a clinical problem, namely an emotional disorder, a discrepancy between experiences and sensations of the sex being defined.

Symptoms of gender dysphoria often manifest themselves in childhood - the child begins to behave as a member of the opposite sex, to dress in stressed out inappropriate clothes, makes a request to change his name. However, such a violation of self-perception does not always persist in adulthood.

Gender dysphoria in women is more common than in men. Among those who want to change the sex to the opposite, the fair sex is four times more (at least in the USA).

They classify individuals with a cross-gender behavior on the Benjamin scale, which helps determine the severity of symptoms and determine the direction of care.

Pseudo-transvestites - people who are seen in dressing up in clothing that is specific to the opposite sex and a variety of sexual preferences, however, who do not exhibit their own characteristics, often do so out of curiosity to gain sharp sexual sensations and new interesting experience. In fact, their sexual identity uniquely corresponds to biological. They often acquire a traditional family, do not intend to change anything in their lives and do not consider the possibility of hormone therapy or sex change surgery.

Transvestite-fetishists self-identify themselves exclusively with their gender. In sexual life, heterosexual contacts are more often preferred, bisexuality is possible, but is rare. Toilets are regularly worn for the opposite sex, underwear can be worn constantly, and also call themselves by both masculine and feminine names. The goal - the achievement of sexual arousal. About any types of treatment it does not go. Sometimes it is recommended behavior correction using psychotherapy sessions.

True transvestites are determined in cases where sexual self-identification on biological grounds is difficult, and their gender is recognized with great reservations. With a mild degree, people try to wear as often as possible all items of clothing of the opposite sex and copy the behavior and lifestyle that is inherent to them. Sexual orientation is directly related to clothing that is worn on a person (psychologically heterosexual). In periods of disguise, feeling like a member of the opposite sex, chooses a partner of one with a biological sex. He does not actively seek sex change surgery, but does not reject the idea itself. Psychotherapeutic treatment usually does not help in such cases, sometimes hormonal treatment is helpful.

A more severe form is transsexualism non-op. Sexual self-identification is difficult, however, there is no activity on the issue of prompt sex change, although there is some interest in this. Uses every opportunity to dress and maintain the lifestyle of a person of the opposite sex. However, it does not feel complete satisfaction, complains that this is not enough. These people often have reduced sexual desire, they are mostly bisexual. In this case, shown hormone therapy, which helps to adapt to society. The choice of a gender role often occurs under the influence of external factors.

True transsexuals with moderate disorders do not doubt that they are of the opposite sex. In sex, they choose partners of their biological sex with a heterosexual orientation, while imagining the classic sexual contact between a man and a woman. They constantly wear clothes and lead the lifestyle of the opposite sex, however, this does not bring them satisfaction. Hormonal treatment is not effective, although they also do not refuse it. Actively seek surgical intervention for changing sex. They are more positive thinking than the next group.

Severe transsexualism is expressed in the complete rejection of their biological sexual characteristics until the commission of suicide. It is in this group that severe transgender dysphoria develops. Social and sexual behavior is similar to the previous group. It is for them, according to vital indications, that surgical correction of the sex is necessary, followed by hormone therapy.

The discrepancy between the external sexual characteristics (body) and the inner self-awareness of one’s own gender is also called bodily dysphoria, which is mainly associated with the desire to change the sex. However, mood disorders can occur with any manifestations of dysmorphophobia. A person may be overly concerned about any part of his body, be willing to change it, be upset to such an extent that the ability to work, self-care and other social responsibilities are impaired. Such mental pathologies occur among men and women equally, manifesting in adolescence or adolescence, there is a risk of committing suicide against the background of the inability to change an imaginary defect.

Another continuation of physical dysphoria is the species. A person is also dissatisfied with his body, feels himself to belong to another species of creatures, sometimes mythical - for example, a dragon, sometimes real, often predators - a wolf, a leopard. Patients feel the presence of phantom parts of the body (wings, clawed paws, tail), upset due to the lack of hair or mane. Species dysphoria essentially includes gender: a woman in a man’s body is a particular case of her. Nevertheless, people with species dysphoria are aware of their biological identity, although they are not satisfied with this even to the heights of dysphoric disorder.

Premenstrual dysphoria

A pronounced regular decrease in mood, the appearance of despondency, irritability is experienced by about a quarter of menstruating women in the late luteal phase (the week before menstruation), and with the onset of menstruation, these symptoms subside and disappear afterwards. No more than a third of this cohort of patients experience premenstrual syndrome in a very severe form. Modern medicine regards it as a complex psycho-neuroendocrine disorder that reduces the quality of life of a woman in certain periods.

Moreover, it is not even necessary to observe the symptoms described below every menstrual cycle, however, most of them must be accompanied by at least five signs. Among them, the obligatory presence of at least one of the first four is required.

An authoritative organization such as the American Psychiatric Association identified the following main symptoms:

• repressed gloomy mood, fixing attention only on negative events, a feeling of hopelessness or one's own low significance (“just give up”);
• anxiety, anxiety, increased emotionality at the limit of constant exertion;
• emotional state instability: sudden tearfulness, hypersensitivity;
• outbursts of anger, evil tricks, conflict.

In addition, there may be additional complaints about the inability to concentrate on any activity, scattered attention, lack of strength and energy, fatigue, a constant desire to lie down, a change in appetite or eating habits, sleep disturbances (difficulty falling asleep or pathological drowsiness), subjective feeling the inability to lead their actions, navigate the situation, the lack of criticism of their actions.

Some somatic symptoms are expected: swelling and / or tenderness of the mammary glands, abdominal pain, flatulence, migraine, arthralgia, myalgia, weight gain, swelling of the extremities.

Risk factors for the development of premenstrual dysphoria include heredity (close female relatives suffered), obesity, chronic somatic pathologies, physical (sexual) violence, and depressive episodes in history.

The mechanism of development of premenstrual syndrome and its most severe form, dysphoria, is still under study.

Its following forms are distinguished:

• neuropsychic, in which affective symptoms prevail, and, at a young age - depressive episodes, and in more mature - severe dysphoria;
• Edema - the name speaks for itself, except for this there is weakness, irritability, sweating and itching of the skin;
• cephalgic - with a predominance of hypersensitivity to sounds (headache), to smells (nausea, vomiting, dizziness), cardialgia, paresthesias of extremities, hyperhidrosis;
• crisis - panic states or sympathoadrenal attacks (more severe stage of decompensated first three forms);
• atypical - cyclic allergic or hyperthermic reactions, unrestrained vomiting, and others.

Premenstrual dysphoric disorder suggests the absence of other mental disorders (although they could have been in the past). Symptoms should appear only in the late luteal phase and disappear completely after menstruation.

Postcoital dysphoria

Not only women, but also men face a bad mood, feelings of emptiness and dissatisfaction after sex, to the quality of which the individual usually has no complaints.

It is expressed in different ways. Women feel sadness, inexplicable longing, some violently crying.

Men want to be left alone for some time, do not touch, do not talk to them, otherwise - they feel a strong irritation. Sometimes sad to tears and the stronger sex.

Studies and surveys have shown that about a fifth of the population experiences this condition after sex from time to time, and about 4% of men and women constantly experience a decrease in mood.

The causes of this phenomenon are unknown, one of the hypotheses suggests that the depressed mood background after love joys is associated with a decrease in dopamine levels during intercourse. Then the body regains balance for some time, it takes from a quarter of an hour to three hours, in which melancholy, displeasure, tearfulness, irritability manifest themselves.

Twin studies were also carried out, which do not exclude hereditary predisposition.

The recommendations of specialists on postcoital dysphoria are as follows. If the deterioration of mood after sex does not bother you, then you can continue to live with it. If this worries you, contact a psychotherapist, in most cases he will be able to assist.

You can contact a sexologist, sometimes the problem lies in the field of its activities.

However, more serious causes are not excluded - diseases of the central nervous system, endocrine organs. Therefore, you should pay attention to the state of your health in general and its changes.

Dysphoria in epilepsy

Emil Kraepelin noted that intermittent dysphoric episodes in epileptics are the most common mental disorder for this category of patients. They are often accompanied by bright bursts of rage, although they can occur without them.

Classify such violations depending on the time of their occurrence in relation to an epileptic seizure.

Prodromal dysphoria precedes seizure. Dysphoric disorder is manifested by depressed mood, gloom and irritability. The condition develops within a few hours, and sometimes even a few days before an epileptic seizure, after which it regresses independently. Relatives of the patient note that the mood of the patient after a seizure is significantly improved. Studies confirm that in epileptics, prodromal dysphoria is characterized by more pronounced symptoms than in the interictal period. This is explained by the generality of neurobiological processes that initiate a dysphoric episode and seizure, that is, a reduced mood is a subclinical manifestation of increasing seizure activity.

Postictal dysphoria (postepristnaya) - the disturbance of affect, which lasts from several hours to several days. In isolated form almost does not occur. It is characteristic of patients with interictal episodes of dysphoria and epileptic seizures with impaired consciousness emanating from the focus in the temporal lobes of the right hemisphere. Posthumous dysphoria is associated with neurobiological processes that inhibit seizure activity.

Interdical (interictal) dysphoric episodes are more often short-term (not more than two three-days) and tend to self-restraint. Such conditions are characteristic of patients with refractory (resistant to therapy) epilepsy, especially with foci in the temporal region. Interictal dysphoria develops approximately two or more years after the onset of the disease. Its episodes are represented by various combinations of symptoms, the severity of which in one patient may vary. In patients with interictal dysphoria, psychopathological symptoms increase in the late luteal phase. It is this form of mental disorder in epileptics that is considered as a serious risk factor for suicide attempts and the development of psychosis between attacks.

Dysphoric depression

An atypical form of chronic mood disorder that, in most cases, starts at a young age as a reaction to the effects of persistent negative factors (psychological and physical discomfort, serious illness, substance use), changes in habitual conditions of existence or acute stress.

Against the background of depressed mood and pessimism, the patient does not have psychomotor retardation characteristic of classical depression, however, there is increased irritability, frequent bursts of negative emotions and aggressive behavior that do not correspond to the circumstances of the strength of the expression.

The patient finds fault with trifles, dissatisfied with everything and everyone - from served dinner to the behavior of home and even passers-by on the street. He is especially annoyed and brings to a state of rabies the expression of joy and contentment on the faces of others, their successes and achievements. How dare they rejoice when he feels so bad! With typical depression, the patient does not care, he simply does not notice anything.

In dysphoric depression, a person often becomes the initiator of quarrels, scandals and fights, his irritation is characterized by a pronounced heat. In a fit of rage, he becomes dangerous because he does not control his actions.

Beyond outbursts of anger, depressive features appear - inactivity and pessimism. The patient's performance decreases, he quickly gets tired and constantly feels empty and overwhelmed. The past years are perceived as fruitless, the patient feels frustration and dissatisfaction with what has been achieved, dissatisfaction with himself, and the future in his perception does not bode well for him either.

Begin problems with sleep, with pressure, with heart. A person seeks oblivion and tries to relax with the help of alcohol and drugs, however, such methods increasingly aggravate the situation and are fraught with committing illegal acts and / or suicidal attempts.

[30], [31], [32], [33]

Complications and consequences

Dysphoria dysphoria discord. The functional state of dissatisfaction that occurs in healthy people is reversible, usually short and not dangerous. Naturally, when a gloomy mood with irritability lasts for several hours, no one will have time to consult a doctor.

But if such states tend to repeat or are delayed in time, affecting activity and working capacity, making communication difficult, you should persuade a person to appear to a doctor. Dysphoria can be caused by a medical condition that requires treatment.

Protracted pathological affective disorders without appropriate therapy lead to undesirable consequences. The lack of productive activity, conflict and nastiness can result in the loss of work, family and loss of social status, which is often aggravated by antisocial behavior, unlawful actions or a decision to end the scores of life.

[34], [35], [36], [37], [38], [39], [40], [41]

Diagnostics of the diskform

Dysphoria is diagnosed during a conversation with a psychiatrist, who will ask a series of questions and, if necessary, conduct a test for dysphoria with the patient. Depending on the causative factor that caused the attack of pathological gloom and irritability, the subject of testing will be chosen (test for psychopathy, for gender dysphoria, etc.).

Analyzes and instrumental diagnostics may be needed if the doctor suspects that the cause of dysphoria lies in a chronic violation of general health. In this case, the treatment will be handled by specialists of the appropriate profile.

[42]

Differential diagnosis

Differential diagnosis is carried out between the diseases that provoked dysphoric disorder, and their absence. For example, a person suffering from gender dysphoria, dissatisfied with his body and requiring a sex change operation, must first of all be mentally healthy. A schizophrenic who imagines himself a transsexual will need a completely different treatment.

Species dysphoria is differentiated from lycanthropy, a woman complaining of premenstrual dysphoric disorder should also not suffer from epilepsy or schizophrenia. Postcoital dysphoria is also diagnosed to completely healthy people.

There is dysphoria in epileptics, individuals with organic brain lesions as a result of diseases, injuries, operations, alcoholism and drug addiction. This is necessary in order to choose the right tactics for the treatment of mental disorder.

[43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53]

Treatment of the diskform

How to deal with dysphoria? This condition occurs and passes suddenly, often within a few hours, even in epileptics. If this is a one-time situation, then treatment is not required. Frequent or prolonged attacks of pathologically depressed conditions with easily arising affects require diagnosis and treatment by a specialist.

If diabetes mellitus or thyroid dysfunction became the cause of the dysphoric disorder, then the endocrinologist will treat the patient and the symptoms of dysphoria will disappear if a compensated condition is reached.

Standards for the treatment of mood disorders in patients with epilepsy have not yet been developed. Such patients are treated symptomatically. Sometimes it is enough to correct the scheme of antiepileptic therapy, some patients, in particular with dysphoria, are prescribed antiepileptic drugs in combination with antidepressants.

In the treatment of dysphoric disorders psychotherapy, auto-training, meditation, breathing exercises, yoga, qigong are widely used. Such practices help well in cases of post-coital and post-stress dysphoria, when the disorder has occurred in a sensitive, however, practically healthy person.

Women diagnosed with premenstrual dysphoria are prescribed medications to alleviate the condition and arrest the prevailing symptoms. It may be analgesics, sedatives of plant origin, sleeping pills. In more severe cases, progesterone-based hormone correction may be prescribed. In cases of severe psychotic reactions, the doctor may prescribe antidepressants or tranquilizers.

True transsexuals can only be helped surgically against the background of hormonal therapy. At least, such a path of help has now been chosen. Although more and more gender reassignment operations are being done, it is far from always that a person finds himself after the operation and gets rid of suffering. More and more voices of scientists are being heard in defense of the opinion that when the soul and the body are suffering, the soul should be healed, and not the redrawing of the body, as is being done now.

[54], [55], [56]

Prevention

Preventing the appearance of dysphoric disorders should begin even before the birth of a child. Healthy parents, a normal pregnancy and natural childbirth without complications are the key to a healthy child who should be raised by a healthy and friendly family without pathological interactions between its members, and then a healthy society. How realistic is this? At the very least, you need to strive for this.

In adulthood - clear goals and objectives, positivism, the ability not only to work, but also to relax, commitment to a healthy lifestyle significantly reduces the risk of painful affects.

[57], [58], [59], [60], [61]

Forecast

Mild forms of dysphoria often go away on their own, and sometimes a psychotherapist can help to relieve a condition.

If dysphoria is complicated by alcoholism or drug addiction, then the prognosis is less rosy.

With the development of this condition on the background of diseases, the prognosis completely depends on the disease. Modern medicine has a large arsenal of means of help in almost any cases of dysphoric disorder.

[62], [63]