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What do I need to know about hoarding disorder?

This is the persistent difficulty in parting with possessions regardless of their actual value.

How would I know I have a hoarding disorder?
The following are symptoms of hoarding disorder;

  • Difficulty in discarding possessions; the main reasons for this difficulty are the perceived or delusional value of such possessions accompanied by the strong attachment to such items. Feeling responsible for the fate of possessions and going to great lengths to avoid being wasteful or losing important information. These possessions can be magazines, newspapers. Old clothing bag, books mail, and paperwork but virtually any item can be saved. Do these people come back for these items with the sole purpose of searching for information? Probably not but there is always that nagging “you never know” voice. 
  • Do you have those old school papers you can’t get rid of, why are you still keeping them?
Not all of these things are considered useless by other people some are very valuable but can be found mixed in piles with less valuable items.

  • Accumulation of a large number of items; may tend to fill up the place to the point of inconvenience. An individual may not be able to cook in the kitchen sleep in his or her bed or sit on the chair because or of these places are occupied by items due to cluttering. Clutter is defined as a large group of usually unrelated or marginally related objects piled together in a disorganized fashion for other purposes tabletops, floor hallway. If an individual with hoarding disorder is found without clutter is due to the intervening of a third party e.g. family member, the spouse who forces them to clear it and put it in appropriate places e.g. basement or a store.
  •  Animal hoarding; accumulation of large numbers of animals while failure to provide minimal standards of nutrition, sanitation, and veterinary care. the animals live in very deteriorating conditions while suffering from diseases starvation and poor living conditions. Animal hoarding maybe be a special manifestation of hoarding disorder
Other symptoms include indecisiveness, perfectionism, procrastination, difficulty in planning and organizing tasks, distractibility, and living in unsanitary conditions due to cluttering due to poor planning and organizing.

The major difference between animal hoarding and object hoarding is the extent of unsanitary conditions and the poorer insight into animal hoarding.

 Who is mostly affected by hoarding disorder? 

Symptoms of hoarding disorder first emerge as early as 11-15 years and start interfering with individual everyday activities around the mid-20s.

Pathological; hoarding in children can be easily distinguished from saving and collecting behaviors. However, this is hard in making a diagnosis because children do not control their living environments and discarding behaviors in the presence of parents and guardians.

Factors causing hoarding disorder

Genetic and physiological causes:
Hoarding behaviors is familial, about 50% of individual with hoards have reported having a family relative with hoarding disorder.

Environmental reasons; individuals with hoarding disorder have been through stressful and traumatic life events before the beginning of the disorder.

Temperamental reasons; indecisiveness is a prominent feature of individuals with hoarding disorder.

Other diagnoses with similar symptoms; 

Neurodevelopmental disorder hoarding disorder is not diagnosed if the symptoms are of a direct consequence of a neurodevelopmental disorder such as autism spectrum disorder or  intellectual disability 

Major depressive episode; if the accumulation of objects is due to the result of psychomotor retardation, fatigue, or loss of energy due to major depressive episode then hoarding disorder cannot be diagnosed.

Schizophrenia spectrum and other psychotic disorder hoarding disorder is not judged if the acquisition of objects in large quantities is due to delusions or negative symptoms of schizophrenia spectrum and other psychotic disorders.

Obsessive-compulsive disorder in OCD; the accumulation of objects is due to avoidance of onerous rituals (not getting rid of objects so as to avoid endless washing or checking rituals; however  OCD the behavior is distressing and the individual experiences no pleasure from it, unlike the hoarding disorder who feels a sense of accomplishment.

For OCD the excessive desire to acquire certain items is due to a certain obsession (the need to buy items that have been accidentally touched to avoid contaminating other people and not the genuine need to possess the items.

Imagine having both; when a person who hoards in the context of OCD while possessing bizarre items such as feces, urine, trash, nails, hair, used diapers, and rotten food though the accumulation of such items is very unusual for hoarding disorder alone. Although when hoarding disorder symptoms are diagnosed independently from  OCD both can be diagnosed.

Neurocognitive disorder; if the accumulation is judged based on the consequence of degenerative disorder such as neurocognitive disorder. The accumulation may be accompanied by self-neglect and severe domestic squalor along with other neuropsychiatric symptoms such as gambling and self-injurious behavior.

Effects of hoarding disorder

  • Clutter makes it difficult for basic activities such as e.g. cooking, cleaning personal hygiene, and even sleeping .when appliances are broken or utilities such as access to water broken repairing may prove difficult.
  • Risk of accidents  such as fire and falling especially for the elderly, poor sanitation  and other health risks which physical health
  • Social conflicts family relationships are frequently under strain. Conflicts with neighbors and local authorities  and some of the individuals are involved in the legal eviction 
  • Bankruptcy when they become shopaholics while everything ends up as clutter inside the house and due to difficulty in discarding possessions they can’t sell them.

Dsm v- American psychiatric association 

All you need to know about body dysmorphic disorder.

Mirror mirror on the wall, who is the fairest of them all? I think the evil queen had body dysmorphic disorder.

What is it?
This is the disorder where someone has perceived idea that they look ugly, unattractive or deformed and no one else around them sees that.

Signs that a person has body dysmorphic disorder.

  • Worries of perceived defects; people with body dysmorphic disorder believe they look ugly or unattractive abnormal or deformed. The individual observations may look very slight on completely unnoticed by other people. These concerns range from looking unattractive/ not right to ugly to hideous or monster. Preoccupations can focus on one or many body areas like skin; stuff like acne, paleness or scars can make this individual very concerned. Facial hair (excessive or lack of thereof ) and body organs like nose (size and shape).

Quick question; do you have that body part that makes you lose confidence to the point of actually hating it.

  • Excessive comparing themselves with other people-; in response to this worries to being imperfect and low self-esteem, one may end up comparing themselves to others in terms of appearances. “am I uglier than”. Is my nose bogger than hers. “do I look fat in these jeans? how fat? Father than Mellissa?

  • Excessive grooming; this involves styling, combing(always), shaving, plucking, or pulling hair due to the desire to always look perfect.

  • Camouflaging; This is the covering areas with defects with makeup or hats, clothing to cover disliked areas. Some individuals are excessively tan to look less pale. This is always accompanied by compulsive shopping of beauty products. Some individuals excessively tan to darken “pale” skin or diminish perceived acne.

  • Compulsive skin picking ( pimples and whiteheads); intended to improve perceived skin defects. This is common and can cause skin damage, infections and ruptured blood vessels.

  • Repeated checking for flaws or defects on mirrors and other reflecting surfaces and examining them directly. One might even pause where they are going to check their jaws on a reflecting window

  • Social anxiety, low self-esteem, depressed mood, perfectionism; people with body dysmorphic disorder have delusions that people will take special notice on them and mock them because of how they look. Since they are ashamed of how they look, they are reluctant to share their concerns with others. Some may try cosmetic improvements and surgeries to improve how they look

  • Bias for negative/threatening interpretations- this is because it has been associated with executive dysfunction and visual process abnormalities. Every look or act they get from other people may lead to them overthinking that it concerns with how they look.

Muscle dysmorphia; this is a form of body dysmorphic disorder occurring almost exclusively in males, consists of the preoccupation that one’s body is too small or insufficiently lean or muscular. Individuals with this form of the disorder have a normal looking body or even muscular. They may also be occupied with other body areas like skin and hair. Majority of their diet or even exercise excessively and this often leads to body damage.

Some reach a point of using potentially dangerous anabolic-androgenic steroids and other substances to try to make their body bigger and more muscular.

Body dysmorphic disorder by proxy is a body dysmorphic disorder in which individuals are worried about defects they perceive in another personal appearance.

What makes someone to have body dysmorphic disorder?

Environmental factor; body dysmorphic disorder has been linked with high rates or childhood neglect and abuse. Parents and guardians are the first teachers of the child. They are also the first people the child completely trusts and believes. The scars or pain they cause to the child can last for ages.

Throwing reckless comments like “ look at big fat nose” “distorted jaws” “you are fat/ugly”. These comments last in a child lifeway longer after the parents has even forgotten that they mentioned them.

Genetic and physiological- if you have a relative especially first degree like father or mother who had obsessive-compulsive disorder(OCD); the body dysmorphic disorder can be elevated.

Although body dysmorphic disorders are similar clinical features in body dysmorphic disorder; males are likely to have genital worries and muscle dimorphic while women have a comorbid eating disorder.

Another diagnosis with similar signs that can easily be mixed up with body dysmorphic disorder are;

Normal appearance concerns; the difference between the normal appearance concerns and body dysmorphic disorder; firstly for normal appearance cancers the defects are visible not just slightly and not only to the individual also other people
Also, body dysmorphic disorder is being characterized by excessive appearance-related preoccupations that are time-consuming and cause distress or impairment function.

Eating disorder; Fears of becoming fat are considered symptoms of an eating disorder rather than body dysmorphic disorder. However weight concerns are set, symptoms of both and in that case, both can be diagnosed.

Illness anxiety disorder; people with body dysmorphic disorder are not worried about having a serious illness and do not have elevated levels of somatization

Psychotic disorders; the majority of people with body dysmorphic disorder have delusional appearance beliefs. appearance-related ideas or delusions are common in body dysmorphic disorder. Although delusions even appearance delusion is a psychotic symptom, a person is diagnosed with body dimorphic disorder because other psychotic disorder symptoms are absent.

Anxiety disorders; social anxiety and avoidance are common in body dysmorphic disorder. however unlike social phobia, agoraphobia and personality avoidant disorder, body dysmorphic disorder focuses worry on perceived appearance flaws.

Major depressive disorder; major depressive disorder and depressive symptoms are common in individuals with body dysmorphic disorder. body dysmorphic disorder should be diagnosed in in depressed people only if the criteria for body dimorphic disorder are met.

Obsessive-compulsive and related disorders; the worries of obsessive-compulsive disorder differ from those of body dysmorphic disorder because the latter focuses only on appearance. when skin picking is intended to improve the appearance of perceived skin defects body dysmorphic disorder is diagnosed and not skin picking disorder. When hair plucking is intended to improve perceived defects in the appearance of facial or body hair body dysmorphic disorder is diagnosed instead of trichotillomania(hair-pulling disorder).

Shubo-you is the Japanese diagnostic systems similar to body dysmorphic disorder meaning “ the phobia of a deformed body”.Body dysmorphic disorder is international and it appears all races and cultures have more similarities than differences.

What are the consequences of body dysmorphic disorder?

Poor functioning on the quality of life; people experience in their job (missing work), academic(missing school), or role function (as apparent or guardian). About 20% of youth with body dysmorphic disorder are dropping out of school.

Housebound; to avoid social activities and functions people be I housebound 9staying indoors0 even for years in severe cases avoiding all kinds of relationships and intimacies.

Suicide risk; rates of suicidal attempts are high in both adults and adolescents with body dimorphic disorder

On severe cases, individuals may perform cosmetic treatments or surgeries on themselves dermatological are most common though others like ental may be performed. the bad thing is body dysmorphic disorder responds poorly to such treatments and often make stuff worse. Individuals may take legal or violent action to the clinician because they are dissatisfied with the outcome.

Piece of advice, no one is perfect it's what makes us humans and not gods. The cover girls/ men and social media girls/ gents shouldn't pressure to be that way; because believe me even they don't look like that. Live a healthy life and enjoy it. It's the best we can do for our bodies and mind.

Child stuttering; should I be worried?

Child onset fluency disorder(stuttering)- This refers to the occasional disturbances in the normal fluency and time patterning of speech that are inappropriate to the individual’s age and language skills persist over time. The onset range from 2-7 years. Most of the time they start gradually but it can occur suddenly as well.

  • The child may not be aware of these dysfluencies initially but as the disorder progresses the disturbances become more frequent and interfering occurring in most meaningful words or phrases in the utterances.
  • As the child grows up and becomes more aware of the frequencies help she may avoid occasions that involve public speaking, telephoning and instead use short and simple words to avoid stuttering. The speaker may also adjust the rate of speech ( slower or faster, avoiding certain words
  • The child onset fluency disorder is accompanied by motor movements like eye blinks tics, lips tremors and face tremors, jerking of the head, increase in breathing movements, and fist-clenching.
  • The magnitude of disturbance varies from situation to situation. It is extreme in situations where there is pressure to communicate. E.g class speech, interviews, reporting to school. dysfluency is absent during oral reading, singing, talking to pets and inanimate objects
  • Children with fluency disorder show arrange of language abilities so the relationship between fluency disorders and language abilities is unclear
  • Most of the children recover from stuttering and the age of eight or just at the beginning of adolescence.

Childhood fluency disorder characterized by ;

  1. Words are pronounced with excess physical tension
  2. Monosyllabic words repetitions (e.g. I-I-I-I-I don’t want.)
  3. Circumlocutions( using alternative words to avoid problematic words)
  4. Silent or audible blocking(filled and unfilled pauses in speech)
  5. Broken words (e.g. pauses within a word)
  6. Sound prolongations of consonants as well as vowels e.g. (you ca-a-a-a-not)
  7. Sound and syllable repetitions

Effects of stuttering.

  • Stress and anxiety can worsen this condition leading to social impairment.
  • This stuttering interferes with academic or occupational achievements or with social communication.
My little brother used to stutter a lot when he was a kid but now can't seem to shut up. Do you know any kid who stuttered or still is having problems with speech fluency?

However, it's not wise to assume that very difficult in fluency is a childhood-onset fluent disorder; some other different diagnosis may be;

Sensory deficits; dysfluencies may be associated with hearing impairment or other sensory deficits. When the speech dysfluencies are in excess to those that normally accompany sensory deficit then childhood-onset fluency disorder can be diagnosed.

Normal speech dysfluencies; the disorder should be distinguished from the normal dysfluencies that normally occur in children especially toddlers involving word –a word or phrase repetition e.g I want, I want ice cream Incomplete phrases, interjections unfilled pauses, and parenthetical remarks. However, if these difficulties increase even as the child gets older then the diagnosis for child stuttering can be made.

Medication side effects; stuttering can also be a result of medication and this can be seen with a temporal relationship in exposure to medication
Adult-onset dysfluencies-if stuttering occurs to a person during or after adolescence it is then referred to as adult-onset dysfluency. Adult stuttering is associated with neurological insults and a variety of medical conditions and medical disorders and may be specified with them.

Touretter disorder-vocal tics ants and repetitive vocalizations of Tourette's disorder should be distinguishable from repetitive sounds of childhood-onset fluency disorder by their nature and timing

What to do?
Encourage the individual to speak more without any pressure to avoid any stress or anxiety as this can worsen the stuttering. The more relaxed they feel the less they stutter. That is why the dysfluencies cannot be observed when an individual is in a comfortable environment e.g singing and talking to pets.

Dsm v- psychiatric association.

Why do self-harming people harm themselves?

Non-suicidal self-injury– this is when a person deliberately inflicts shallow yet painful injury on his / her skin with no aim to kill him/herself.

It might get you wondering why would anyone want to cause themselves pain?; pain is bad; one of the reasons I hated school? The painful strokes you get when you are in trouble, a slight headache, toothache, or stomach ache can make one rushes to get pain killers.

So why would anyone deliberately cause themselves pain?

Two theories of psychopathology explain function behavioral analysis.
Non-suicidal self-injury may be due to negative reinforcement and positive reinforcement.

The negative reinforcement include;
  • The purpose of this self-inflicting injuries is to cause relief or reduce negative emotions such as tension, anxiety and self-reproach or as a result os solving interpersonal conflict.
  • Reduction of unpleasant thoughts including suicide, self-injury works as a distraction.
The positive reinforcement include;
  • Another reason could be a result of self-punishment. An act someone might have done in the past that makes them disgust or hates themselves and can’t seem to forgive nor forget it. Victims confess there a sense of relief they feel during this process.
  • Gaining attention or help from a significant other, maybe spouse or lover.
  • An expression of anger.

Differential diagnosis

Borderline personality disorder-Individuals with a borderline personality disorder often manifest disturbed or aggressive and hostile behaviours. Nonsuicidal self-injury disorder can be a symptom of borderline personality disorder historically.

Although they have been associated together these disorders differ because while other borderline disorders show aggressive and hostile behaviour non-suicidal self-injury shows closeness, collaborative snd positive relationships both are involved in different neurotransmitter systems though they are not apparent on clinical examination.

Suicidal behaviour disorder- the major difference between suicidal and non-suicidal is suicidal the individual has the intention of dying. However, reports show that many victims of suicide have a history of no suicidal self-injury. The same is suicide intent can be associated with the use of various methods of self-harm. The caretaker or guardian should be careful with suicide may happen.
  • The injury is normally caused by a very sharp object like a knife, needle, thorns, razorblade (just to mention a few.

Who is likely to be a victim of non-suicidal injury?

According to admissions of hospital reports, self-injury normally starts in the early teen years and may continue to the late twenties.

However, these statistics may not be with absolute accuracy because most of the victims on non-suicidal self-injury do not seek clinical attention and tend to stigmatize themselves from everyone.

It is not known if this affects the frequency of their self inflicting incidents. Young children may try this but end up not feeling a sense of relief but pain and distress so stop immediately.

Some report shows that when a self-injury individual is being hospitalized in the inpatient unit, another individual may begin the same behaviour.
Is self-harm addictive?

Yes, most of these self-inflicting injuries actors repeatedly,  mostly with a sense of urgency or craving like an alcohol  or drug addict 

Other kinds of non-suicidal injury include;

Stereotype self-injury.

This is a type of self-injury that includes headbanging( I've seen some toddlers do this); self-biting or self hitting and is usually associated with intense concentration or under conditions of low external stimuli or developmental delay.

Excoriation (skin-picking disorder)

It occurs mainly in females, which involves picking an area of the skin that an individual feels blemish (with ananflw0 and is usually on the face or scalp (top of the head). The picking is done due to the urge and the experience of pleasure even the individual know that they are causing harm to themselves. There is no use of any tool.

Hair-pulling disorder (trichotillomania)

This is self-harm behaviour involving pulling out one’s hair from the scalp, eyebrows, or eyelashes. The behaviour occurs in certain periods and can sometimes last for hours and many who do this are sometimes in a relaxed mood or distraction. (I had a friend who used to pull out her hair while studying).

  • The act of cutting performed by tools (implements ) may raise the possibility of blood-borne disease.
  • Things might go wrong, and one may end up dying even if it wasn’t the initial plan.

Have you ever done self-harm? What was the reason?  What did you feel after?
Concise textbook of clinical psychiatry.

Gender identity disorder in children

Gender identity

Gender identity simply means a sense that one has of being male or female and most of the time it matches the anatomical sex. Note that most are the keyword in the previous text. 
Gender identity disorders mean a very strong preference of being the other gender ( the one opposite to the individual's birth sex) either to have a body of the other sex or to be considered as the other gender socially. 
What if I told you you can detect gender disorder from a child as early as 3-4 years?
As a parent, guardian, or concerned relative I believe it's crucial to know all these things.

Signs that a child has gender identity disorder.
For girls, before you get alarmed some prefer gender-neutral clothing ( unisex) they are occasionally called tomboys and this is not a gender identity disorder.  A girl with this disorder strictly refuses to dress up on girls' clothes or gender-neutral, they want boys' clothes.
They keep insisting on wanting to be a boy( and are very serious about it) and how they will grow up to become a man. They strongly despise and avoid all feminine acts. In those childhood games we used to enjoy mother-father games, they would always play the role of a man.

Girls with the disorder may refuse to urinate from a sitting position and claim that they have a penis or it will grow someday. And absolute hate the idea of growing breasts and menstruating.
They often have male companions and they love rough games and sports. They show no interest in dolls.

For a boy, it's a bit tricky, parents shouldn’t rush to conclude that the child has this disorder, some boys just don’t like sports like a ball or any athletic activities and instead prefer staying indoors having a tea party with dolls. Some might even dress up in female costumes and all this can still be normal, just a kid being a kid.

For a  boy with gender identity disorder, it might be difficult for them at school being stigmatized and bullied by their peers for their feminine acts or choice of costume.

They have a very strong preference of being a girl and growing up someday into a woman can be one of the signs crucial signs for gender identity disorder, they have female peer friends, preferring female activities, Playing as a woman(mother, sister) in the house (mother-father games).

Boys with the disorder might declare that their penises are disgusting and may prefer not having one, their gestures can be seen as feminine(body motion and postures)

According to research young children with gender identity disorder rarely tend to become homosexuals when they but it can happen especially if they don’t undergo psychological intervention.

Note; this diagnosis excludes children with anatomical intersex, hermaphroditism( having both female testes and ovaries) because in such cases hormones, confusion of their actual sex can lead to a showing of such symptoms.

Why do children get gender identity disorder? 
Children always develop a  gender identity according to the assigned sex. The formations of gender identity are influenced by children's temperament and parents' qualities and reactions. The first people a child grows to trust are his parents and the same goes for the first few years of his life. Therefore the parents play a big role in a child gender identity 

  • Mother's role
Gender identity

In the first few years, a mother-child relationship is important; a mother should teach the child to be proud of their genders, to love themselves as they are valued and loved just how they are. Children need to be constantly assured that they are loved and proud of to avoid separation-individuation can cause gender process. Separation individuation is when a child begins to develop a sense of self and separate from the mother.  

  • When a child gets a message that the parents expected a different gender, or they would more love if they were opposite sex it can cause them to act like the opposite gender, so you can love them. If by any chance you wanted a girl and got a boy, keep it to yourself. Also treat siblings especially of the opposite sex, with much equality so one doesn’t feel unloved and devalued than the other.
  • A parent’s absence, a mother’s for example either by death or extended absence can cause depression, especially for a young boy. Depression to a kid as a result making him identifying with a mother gender to replace her.

Gender roles exist even for kids, there are games a male child is s supposed to play (robots and cars) and some for girls (doll). Boys are expected to be masculine are tough and energized girls are expected to be feminine. Investigators say that this may not be the case for all children, some boys are delicate and feminine and girls are tough and energized. Parents should know this and let just kids be kids

  • Psychiatric intervention for children with gender identity disorder does not the direction of subsequent sexual orientation
  • This treatment of gender identity disorder for a young child is mainly focused on developing social skills and being comfortable in the sex role expected at birth anatomy. This treatment is successful to some extent though transsexual development may be interrupted.
  • No hormonal or psychopharmacological treatments for gender identity disorder in childhood have been identified.

To sum up, gender roles exist even for kids, there are games a male child is s supposed to play (robots and cars) and some for girls (doll). Boys are expected to be masculine are tough and energized girls are expected to be feminine. Investigators say that this may not be the case for all children, some boys are delicate and feminine and girls are tough and energized. Parents should know this and try to direct kids in a loving way rather than using force, harsh way or commanding as this might make a child detach from the parents and become a loner, And I can say this, no parents want this.

Concise textbook for clinical psychology, third edition

Sexual Dysfunction Psychology

It's true without reasonable doubt that sexual dysfunction is sometimes a psychological issue than organic. Sexual dysfunction includes low sexual desire(female hypoactive sexual desires), orgasmic abnormalities( premature ejaculation ) and of course erectile dysfunction. It shouldn’t be quoted wrongly nutrition, physical exercises and conditions like diabetes and heart diseases play a big role on the whole sexual activity (biogenic), but so does psychology(pyogenic, intrapsychic, interpersonal), hence the importance.

One individual may have more than one disorder like one can have male erectile dysfunction as well as premature ejaculation.

The function/ disoders include;

Sexual desire disorders- it has two categories; one means a very low or complete absence of sexual fantasies or yearnings for sexual activities ( no horniness) this is hypoactive sexual desire disorder. Another category is sexual aversion disorder where one avoids genital sexual contact, sometimes by masturbation. Hypoactive sexual desire disorder is more common than the other and even more common among women. However, if the desire is triggered during sex this not a disorder. Factors that can lead to inhibition of sexual desires are;

  • Unconscious fears of sex- vagina-dentate as stated by Sigmund Freud is a condition where men unconsciously believe that a vagina has teeth and they can be castrated if they approach it, therefore avoid it any cost. 
  • Unresolved developmental and oedipal conflicts(complex sexual desires by a child to a parent of the opposite sex) can also inhibit sexual desire
  • Celibacy; abstaining from sex for a very long period can lead to inhibition of sexual desires and impulses
  • Hostility/ hate from a partner- many dying relationships have this hypoactive sexual desires and slowly leads to no sex at all. however, this is not a rule some people have normal sexual desires than others and can have sex as minimal as once in two months yet they are in happy relationships. So unless this lack of desire causes distress, clinicians cannot diagnose hypoactive sexual desires.
  • Other causes include stress, depression and anxiety

Female sexual arousal disorder; it can be both normal and dysfunctional to women. Hormonal pattern may contribute to women who have excitement phase dysfunction. Some women have reported feeling sexual excitement before or after menses while others during ovulation. Shifts of testosterone, estrogen, prolactin and thyroxin levels are factors causing female arousal disorder

Male erectile disorder (erectile dysfunction and impotence)-this means failure to obtain an erection sufficient for vaginal insertion, this is called a lifelong erectile disorder. Situational erectile disorder is when a man can have an adequate erection in some circumstances while failing in others ( can have coitus with a mistress or prostitute but fail to do so with his wife or can do it his home but not unfamiliar environment). Acquired erectile dysfunction is when a man had successful sexual intercourse at appoint in his life but currently unable to do so. Erectile dysfunction is very wide effects from 10- 20 percent of all men. The psychological causes include;

  • Anxiety – erectile dysfunction can be caused when a man is anxious before sexual intercourse. Thoughts like will I be good enough to do anyone any good.
  • Difficulties between partners- failure of a man to communicate due to anger, anxiety, stress at work of life in general with his partner can lead to erectile dysfunction. Communication is the key.
It should be noted that Freud identified one of impotence due failure to reconcile feelings of affection towards a woman he has feelings for. This is known as Madonna- putana complex where men can only function with women they see degraded.
  • Other factors include failure to have sexual impulse are punitive superego, lack of trust, inadequate feelings, feeling undesirable ass a partner.
Female orgasmic disorders. Refers to the continuous inhibition or absence of female orgasm. This is a failure to achieve orgasm by either masturbation or sexual intercourse. Those who can attain orgasm by one of these methods is not considered anorgasmic, many women achieve coitus by a combination of clitoral(manual) and vaginal orgasm. According to feud theory women must give up clitoral orgasm to attain vaginal orgasm for sexual maturity; however, this theory was found to be inaccurate.
A woman with who has never had an orgasm all her life is has a life long female orgasmic disorder while a woman who has experienced at least one orgasm in her life has acquired orgasmic disorder regardless the measure either masturbation or dreaming during sleep.

Male orgasmic disorder, the chances of a man with this disorder achieving an ejaculation are slim to none. A man with life long male orgasmic disorder has never been able to ejaculate all his life, while for acquired is termed when he was ejaculating normally. Some researchers say ejaculation and orgasm should be differentiated especially since there have been some complaints from men who ejaculated and yet didn’t feel pleasure. Patients having this order are fewer compared to those of erectile dysfunction premature ejaculation. 
Reasons may be;
  •  For life long orgasmic disorder it shows  a man is from a  difficult background that  perceives sex sinful and genitals dirty(disgusting)
  • Unconscious or conscious wishes to incest and guilt
  • Attention deficit disorder can worsen the situation
Premature ejaculation-this is when a man achieves orgasm or ejaculation before they wish to ( before or immediately after entering the vagina). A man is considered a premature ejaculator if he can not retain ejaculation long enough in the vagina to satisfy his partner at least half their. episodes with coitus.
A strange fact is premature ejaculation is more common in college-educated men than among men with less education. Some argue because of their concern to satisfy their partners though this cause inst proved. This (premature ejaculation is the chief complaint (35 to 40 percent of men are being treated). Psychogenic causes include
  •  Unconscious fears about vaginas
  •  Men who were initially used to a sexual encounter with prostitutes who demanded it to be quicky, or in an unfriendly environment where they had to have sex quickly because being caught would be embarrassing ( public toilets near the road, parental home.
  • Stressful marriage or relationship influences the disorder, a partner can influence this there its crucial to choose wisely
Young inexperienced men are likely to suffer from this but it goes away with time.
 Individuals especially men are not that open to talk to sexual dysfunction to specialists and at times even their partners. There is no shame in it, talk to your partner or specialist, and enjoy the best in sex.
Some treatments don't need medications rather advice and communication.

References: Concise textbook of clinical psychiatry; Third edition

15 Weeks Pregnant: Body Changes, What to Eat & More

15 weeks is around the second trimester of the whole gestation period.

Body changes in the expectant mother’s body.

  • Weight gain-this is completely normal as the baby is going a lot more than the first trimester. Measure your weight regularly and it should be about 0.5 kg a week on average.
  • Enlargement of the rib cage around 2 to 3 inches to accommodate the widening of the lungs to carry more oxygen to the baby since the capacity increases.
  • Body pains and aches- unless they are unbearable this is completely normal. The uncomfortable pain may be a result of the growing belly that put excess pressure on the muscles and skeleton. All this to accommodate the growing fetus accompanied by the weakening of abdominal walls and increasing strain of muscles. In addition to that, hormonal levels are heightened (especially relaxin hormone) causing stretching of joints and ligaments in the body and this change correlates with back pain.
  • Nipples become darker and bumpier; the hormones cause the skin cell to produce more pigment. there also is the secretion of oily substance so that the nipples can become oily and soft during breastfeeding the secretion of this oil substance is due to the gland called Montgomery tubercles that are only visible during pregnancy. they are found around the nipples on the areola, they re-raised white bumps around the areola(the dark area surrounding the nipple, just like goosebumps).
  • Numbing, tingling Hands and feet- you’ve ever slept on your arm for a long time or sit on your leg and had that tingling feeling? That is the body’s way of telling you a particular area is not getting enough blood or you are compressing a nerve. However, this is just temporary during the second trimester and very common in the last trimester caused by carpal tunnel syndrome.
  • Sexual arousal(increased libido)- estrogen whose level rises during the second-trimester causes an increase of blood flow in the vulva and vagina lubrication hence heightened arousal and pleasure. The genital blood flow makes the clitoris hypersensitive. there is no harm in enjoying sex in this period is advised until the very late stages of your pregnancy.
  • Sensitive teeth and gums-it may be accompanied by bleeding gums especially during brushing teeth, it’s the pregnancy hormones making your gums swell hence likely to bleed. these same hormones make your sinuses to clog. If the symptoms of sinusitis are brutal seek medical help to get relieved.
  • Nose bleed; same thing hormonal changes cause a nose bleeds and if you are not losing a lot of blood do not be terrified as this is completely normal.
The good news is by this time nausea and vomiting symptoms are fading, unlike the first trimester, so the expectant mother is likely to get her appetite back. this is not a privilege for all women some women experience hyperemesis gravidarum which is an intense morning sickness accompanied by extreme vomiting and may require hospitalization, this may lead to complications like premature detachment of the placenta from the uterus(womb), which causes deprivation of the nutrients and oxygen to the baby. So go see the doctor!

Changes of the baby during 15 weeks of pregnancy’

From the size of kiwi fruit in week fourteen to the size of an orange or apple.fascinating right?  It is about 4.5 inches a nd weighs about 144 grams. 
  • The outer part of the baby ears can be recognizable through the inner year continues to develop, hearing though not yet it's happening and you can start singing or read to that baby.
  • The skin is still translucent and vessels and skeleton can be seen, some bones like collar bone have already the development process through the bones from the hands and feet harden and become stronger this week. 
  • Baby hair might appear on the scalp and eyebrows.
  • By 15  weeks the bay can make whole-body movements, their arms legs, stretch and breathing motions, they can go as far as sucking thumbs. When very still, focused and attentive some women can feel their baby moves as early as 15 weeks, they aren’t as strong as the “it kicked” during the 20- 22 weeks. these are first fetal movements and are known as “fluttering” and they are very subtle that some mothers don’t feel them at all.

Food a pregnant mother is advised to eat at 15 weeks

A pregnant mother should consume a balanced diet to avoid pregnancy difficulties like high blood pressure, premature birth, preeclampsia (rise of blood pressure, swelling of face, hands, and feet. Although a balanced diet should be  some nutrients are very essential including

  • Protein- this is essential for the growth of the abyss brain and other tissues to grow, it also helps the growth of the mother's uterus and breasts. for every 1kg of a mother, she should aim to eat 1.52g of protein every day. So if the expectant mother is 65 kg she should eat 98.8g of protein daily. The protein foods include lean meat(low-fat content), nuts, eggs (not undercooked to avoid the risk of salmonella), fish,  and beans.
  • Iron; supplies oxygen to the baby and voids anemia and complications such as premature birth and pots Partum depression (feeling down after giving birth) is a mental health condition. The foods containing iron are meat (lean), green vegetables, groundnuts, cashew nuts, bread, cereal foods. Iron from animal products is absorbed way faster than that from plants. For those who are vegans  foods rich in vitamin c like oranges are highly advisable
  • Fluids- pregnant women need to stay hydrated at all times (8-12glasses a day). Water is essential for the formation of amniotic fluid, carries nutrients and wastes to and fro respectively, produces extra blood, lack of water can cause premature labor, neural tube defects reduced milk production, and low amniotic fluid. Stay hydrated queens!
  • Calcium &folic acid- calcium helps to strengthen a baby's bones and teeth and improves its circulatory system. Folic acid prevents neural tube defects (birth defects of brain, spine, or spinal cord including spina bifida which is the failure of the baby’s spinal cord to develop properly and anencephaly which is a baby born with brain or incomplete skull and normally becomes stillborn or dies few hours after being born), reduces risks of premature labour.No expectant mother wants any of that to happen to her baby. So take these calcium foods which include dairy, eggs, sardines, and salmon (with bones), fruit juices and greens, and foods containing folic acid include oranges, grains, green vegetables, cereals, and legumes.  The folic acid increment is available as one may not get enough from foods.
  • Vitamin D and fatty acids – like calcium vitamin d  in building the baby’s bones and is not present in many foods but can be obtained from the morning sun even though the body generates it's own vitamin D. Cereal and milk, egg yolk, beef liver, cheese 9 just to mention a few the supplements can be obtained especially fr those who live in polar regions. Fatty acids support the heart, brain, and eyes, prevent premature labor, increase birth weight, and reduces the risk of the mother falling into depression. Vegetable oils, fruits, nuts animal fats, are some of the sources of fatty acids.
 N.B Alcohol in the first trimester can cause the baby to have abnormal facial features however alcohol deprives growth and cause harm to the central nervous system, refrain from it at all costs!

Do not smoke! It causes baby defects like the sudden death of infant syndrome or cleft lip or cleft palate( this is an opening on the baby's lip or in the roof of her mouth. Of course, it can be treated but if you can avoid it you should.
  • Working out is good as it helps reduces aches, bloating and constipation helps a woman to sleep better. It also helps one to have a normal delivery, without unnecessary complications. Avoid being idle unless strictly advised by the doctor to have a bed rest. Almost there queens, a new life is about to join yours!.