First Responders and PTSD:

First Responders and PTSD:

First responders — including Deputy Sheriffs, police officers, firefighters, paramedics, emergency medical technicians (EMTs), and other emergency personnel — are at a significantly higher risk for developing PTSD (Post-Traumatic Stress Disorder) due to their routine exposure to traumatic and life-threatening events.

Why First Responders Are Vulnerable to PTSD

Frequent Exposure to Trauma

Car accidents, violent crimes, suicides, child abuse, fires, natural disasters, etc.

Repeated exposure can lead to cumulative trauma — a build-up of smaller traumas over time.

High-Stress Environment

Pressure to make quick, life-or-death decisions.

Often work in chaotic, unpredictable, and dangerous settings.

Cultural Expectations

A “tough it out” or “suck it up” mentality can prevent seeking help.

Stigma around mental health in these professions.

Lack of Closure

Many emergency workers do not get to see the outcome of their efforts, which can leave psychological wounds open.

Common Symptoms of PTSD in First Responders

Intrusive memories or flashbacks

Nightmares and insomnia

Emotional numbness or detachment

Hypervigilance and irritability

Avoidance of people, places, or reminders of trauma

Depression and anxiety

Substance misuse (often as a coping mechanism)

Relationship problems or social withdrawal

Protective Factors

Strong peer and family support

Regular mental health check-ins

Training on trauma resilience

Encouraging open discussions about emotional struggles

Access to counseling or peer-support groups

Treatment and Support Options

Evidence-Based Therapies

Cognitive Behavioral Therapy (CBT) for PTSD

EMDR (Eye Movement Desensitization and Reprocessing)

Prolonged Exposure Therapy

Peer Support Programs

Peer-led groups where responders can share without judgment

Critical Incident Stress Debriefing (CISD)

Immediate intervention post-trauma (though its effectiveness is debated)

Medication CONSULT A Psychiatrist

medications when appropriate

Mindfulness and Stress Reduction

Meditation, yoga, breathing techniques can help with emotional regulation.

Important Considerations

Early intervention is key to preventing long-term mental health issues.

PTSD does not always develop immediately; it may appear months or even years after the trauma.

Moral injury — the psychological damage from actions that go against one’s ethics — can accompany PTSD and complicate treatment.

Shervan K Shahhian

Soldiers and PTSD:

Soldiers and PTSD:

Post-Traumatic Stress Disorder (PTSD) is a significant mental health issue that affects many soldiers and veterans due to the extreme and often life-threatening situations they experience during military service.

Here’s an overview of the relationship between soldiers and PTSD:

What Is PTSD?

PTSD is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event. For soldiers, this can include:

Combat exposure

Witnessing death or injury

Experiencing personal injury

Dealing with the stress of survival and constant danger

Moral injury (conflicts between personal morals and actions taken during war)

Symptoms in Soldiers

PTSD symptoms may appear soon after trauma or months/years later, and can include:

Intrusive memories (flashbacks, nightmares, distressing thoughts)

Avoidance (of places, people, or conversations related to the trauma)

Negative mood and thoughts (guilt, shame, numbness, detachment, hopelessness)

Hyperarousal (irritability, aggression, hypervigilance, trouble sleeping, exaggerated startle response)

Why Are Soldiers Vulnerable?

Chronic exposure to trauma: Unlike single-incident trauma (e.g., car accident), soldiers may face repeated or ongoing traumatic events.

Military culture: Often discourages emotional expression, making it harder to seek help.

Survivor’s guilt: Can occur when a soldier lives while comrades do not.

Moral injury: Feeling responsible for actions that go against one’s values (e.g., killing civilians, following questionable orders).

Treatment and Support

Effective treatments for PTSD in soldiers include:

Psychotherapy:

Cognitive Processing Therapy (CPT)

Prolonged Exposure Therapy (PE)

Eye Movement Desensitization and Reprocessing (EMDR)

Medications:

CONSULT A Psychiatrist

Support groups and peer counseling

Service dogs and alternative therapies (e.g., equine therapy, mindfulness, art therapy)

Challenges

Stigma: Soldiers often fear being seen as weak or being passed over for promotions.

Underreporting: Many suffer in silence or don’t realize what they’re experiencing is PTSD.

Access to care: Especially difficult for veterans living in rural or underserved areas.

Hope and Recovery

Recovery is possible. With appropriate treatment and support, many soldiers with PTSD can regain quality of life, purpose, and meaningful relationships. Programs offered through the VA, non-profits, and military hospitals have increasingly recognized the need for comprehensive PTSD care.

Shervan K Shahhian

Can Exercise protect the Brain:

Can Exercise protect the Brain:

It’s important to consult with your medical doctor before starting an exercise routine.

Yes, exercise can protect the brain — this is well-supported by scientific research across neuroscience, psychology, and aging studies.

Here’s how:

Exercise Promotes Brain Plasticity

Neurogenesis: Aerobic exercise (like walking, running, cycling) stimulates the growth of new neurons, especially in the hippocampus, a brain region vital for memory and learning.

Synaptogenesis: Exercise increases the number and strength of connections between neurons.

Increases Blood Flow and Oxygen

Physical activity improves cerebral blood flow, delivering more oxygen and nutrients to the brain.

This helps prevent neurodegeneration and maintains cognitive function, especially with aging.

Boosts Brain-Protective Chemicals

Exercise elevates levels of Brain-Derived Neurotrophic Factor (BDNF) — a key molecule that supports neuron survival and growth.

Also increases dopamine, serotonin, and endorphins, which contribute to mood regulation and mental clarity.

Reduces Inflammation and Oxidative Stress

Chronic inflammation is linked to conditions like Alzheimer’s, Parkinson’s, and depression.

Regular exercise lowers inflammatory markers and oxidative damage, reducing risk of neurodegenerative disease.

Improves Sleep and Stress Regulation

Better sleep = better memory consolidation and emotional resilience.

Exercise helps regulate cortisol, the stress hormone, which in excess can damage the brain.

Slows Cognitive Aging and Dementia Risk

Long-term physical activity is linked to:

Reduced risk of Alzheimer’s and vascular dementia

Slower progression of mild cognitive impairment

Better executive functioning and memory in older adults

Best Types of Exercise for Brain Health

Aerobic (e.g., brisk walking, swimming): most evidence-based

Resistance training (e.g., weights, yoga): improves executive function

Mind-body practices (e.g., Tai Chi, Qigong): support mental focus and mood

Shervan K Shahhian

Psychology of Addiction:

Psychology of Addiction:

Addiction is a complex psychological and physiological condition that involves compulsive engagement in behaviors or consumption of substances, despite the negative consequences. It typically involves both mental and physical dependence, and its psychology can be explored from several perspectives:

1. Biological Basis of Addiction:

Neurotransmitters and the Reward System: The brain’s reward system, particularly the dopaminergic pathways (such as the mesolimbic pathway), plays a key role in addiction. When individuals engage in addictive behaviors (e.g., drug use, gambling), the brain releases dopamine, which creates feelings of pleasure and reinforces the behavior.
Tolerance and Withdrawal: Over time, the brain adapts to the heightened dopamine levels, leading to tolerance (where more of the substance or behavior is needed to achieve the same effect). When the addictive behavior is stopped, withdrawal symptoms arise as the brain struggles to regulate dopamine levels without the substance or activity.

2. Psychological Factors:

Coping Mechanism: Many people turn to addictive behaviors as a way to cope with stress, anxiety, depression, or trauma. The addiction may serve as a temporary escape from negative emotions, creating a reinforcing loop where the individual seeks relief from their emotional pain.
Cognitive Distortions: People struggling with addiction often exhibit cognitive distortions, such as denial (“I can quit anytime”), rationalization (“I deserve this”), or catastrophizing (“If I don’t use this now, something bad will happen”).
Conditioned Responses: Addictive behaviors are often learned through classical conditioning, where certain cues (e.g., places, people, emotions) trigger the desire to engage in the addictive behavior. These associations can be so strong that they drive relapse even after long periods of abstinence.

3. Social and Environmental Influences:

Peer Pressure and Social Environment: The social environment can have a profound influence on addiction. Peer pressure, social acceptance, or exposure to environments where substance use or addictive behaviors are normalized can increase the likelihood of engaging in these behaviors.
Family Dynamics: Dysfunctional family relationships, including enmeshment, neglect, or abuse, can contribute to the development of addiction. Family members may also enable addictive behaviors, which complicates recovery.

4. Addiction as a Disease:

Chronic Nature: Addiction is often viewed as a chronic disease that can be managed but not “cured.” This perspective emphasizes the need for ongoing treatment and support, including therapy, medication, and lifestyle changes.
Genetic Predisposition: There is evidence to suggest that genetic factors may make some individuals more vulnerable to addiction. Family history of addiction increases the likelihood of developing similar issues.

5. Psychological Theories of Addiction:

Behaviorism: Addiction is seen as a learned behavior, reinforced through the reward system. Operant conditioning, where positive reinforcement (pleasure) strengthens the addictive behavior, plays a key role in the maintenance of addiction.
Cognitive-Behavioral Theory (CBT): CBT focuses on identifying and changing the distorted thinking patterns and behaviors that contribute to addiction. It helps individuals recognize triggers and develop healthier coping strategies.
Psychodynamic Theory: From this perspective, addiction is viewed as an expression of unconscious conflicts, often linked to unresolved trauma or emotional issues. Psychoanalysis or psychodynamic therapy may focus on exploring these deeper emotional causes.

6. Stages of Addiction:

Initiation: The first stage of addiction typically involves experimentation or use in social settings. This phase is driven by curiosity, peer pressure, or the desire to escape reality.
Reinforcement: As the individual experiences pleasurable effects, they continue engaging in the behavior. Positive reinforcement encourages repetition, and negative reinforcement (relief from negative emotions) strengthens the habit.
Escalation: Over time, the behavior becomes more frequent and intense, leading to greater tolerance and dependence.
Dependence: This stage is characterized by the individual’s need for the substance or behavior to feel normal. Withdrawal symptoms become a prominent feature.
Addiction: Full addiction is marked by the inability to control the behavior despite harmful consequences. This is when the behavior starts to interfere with daily life, relationships, and work.

7. Treatment of Addiction:

Psychotherapy: Various types of therapy can be helpful, including Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and Dialectical Behavioral Therapy (DBT), which aim to change thought patterns and emotional responses that fuel the addiction.
Support Groups: Programs like 12-step groups (e.g., Alcoholics Anonymous, Narcotics Anonymous) or other peer-support groups provide social support and accountability.
Medication: For certain types of addiction (e.g., alcohol, opioids), medications can be used to manage cravings and withdrawal symptoms, such as methadone, naltrexone, or buprenorphine.
Mindfulness and Stress Management: Techniques such as mindfulness meditation and stress management strategies can help individuals manage triggers and cravings in healthier ways.

Understanding addiction from a psychological perspective involves a blend of factors, including genetic predisposition, environmental influences, emotional regulation, and cognitive patterns. Treatment approaches typically aim at addressing both the mind and body to break the cycle of addiction and promote long-term recovery.

Shervan K Shahhian

Overcoming Anxiety, Grief, Loss and Stress, how:

Overcoming Anxiety, Grief, Loss and Stress, how:
Overcoming anxiety, grief, loss, and stress is a deeply personal journey, but there are core approaches that consistently help people regain emotional balance and strength.
Here’s a structured yet compassionate guide:
Acknowledge and Accept Your Emotions

Feel without judgment: Suppressing grief or anxiety only extends suffering.
Name what you’re feeling: “This is grief.” “This is fear.” Naming brings awareness and grounding.
Accept that healing is nonlinear - good and bad days may alternate.
Regulate Your Nervous System

Breathing exercises: 4–7–8 breathing or box breathing calms the autonomic nervous system.
Mindfulness meditation: Trains attention, reduces stress, and promotes acceptance.
Grounding techniques: Focus on your five senses to pull yourself out of overwhelming thoughts.
Reframe Thoughts (Cognitive Tools)

Challenge catastrophic thinking: Anxiety often feeds on worst-case scenarios.
Write it down: Journaling helps process emotions and uncover hidden beliefs.
Use compassionate self-talk: Replace “I can’t do this” with “I’m doing my best, and that’s enough.”
Connect with Others

Talk to trusted friends or family. Grief and stress shrink when shared.
Support groups: For grief or anxiety, connection with others going through similar struggles is powerful.
Therapy: Cognitive Behavioral Therapy (CBT), EMDR (for trauma), and grief counseling can be transformative.
Take Care of the Body

Sleep: Non-negotiable for emotional regulation.
Nutrition: Avoid excessive sugar, caffeine, and alcohol during emotional lows.
Movement: Gentle exercise like walking, yoga, or tai chi releases endorphins and relieves stress.
Purpose and Meaning

Grief often awakens deep existential questions. Ask:
What values can guide me now?
What do I want to create or give, even in this pain?
Spiritual practices (prayer, meditation, ritual) often bring solace and strength.
Create Safe Routines

Structure helps stabilize a chaotic inner world.
Simple routines like morning tea, evening walks, or regular journaling bring predictability and peace.
Give Yourself Time

Don’t rush healing. The goal isn’t to “get over” grief or anxiety - it’s to integrate the experience and grow stronger.
Personalized routine:
Great - let’s create a personalized emotional healing routine to help you overcome anxiety, grief, loss, and stress. I’ll structure it around morning, midday, and evening, with options you can adjust based on your energy levels or emotional state.
Morning Routine: Grounding & Intentional Start (30–60 min)
Mindful Awakening (5–10 min)

Sit up in bed or in a chair.
Do box breathing: Inhale 4 sec, hold 4, exhale 4, hold 4 - repeat x4.
Say silently: “I’m safe. I’m here. I will face this day with gentleness.”
Journaling (10–15 min)

Prompt: “Today I feel…” or “What do I need right now?”
Optional: Write 3 things you’re grateful for - helps shift from pain to presence.
Body Activation (15–30 min)

Gentle yoga, stretching, tai chi, or a walk.
Move while focusing on how your body feels - not performance.
Midday Reset: Emotional Check-in & Release (15–30 min)
5-Minute Breath or Nature Break

Step outside, or sit near a window.
Breathe deeply and observe without trying to change anything.
Thought Release (Optional CBT practice)

Ask: “Is what I’m thinking true, or is it fear speaking?”
Replace with: “Even if this is hard, I am not alone. I can handle one moment at a time.”
Supportive Input

Listen to calming music, an uplifting podcast, or a spiritual reflection (e.g. Tara Brach, Eckhart Tolle, Thich Nhat Hanh).
Evening Routine: Emotional Integration & Rest (30–60 min)

Reflective Journaling (10–20 min)

Prompt: “What emotions visited me today?”
Follow with: “What do I forgive myself for today?”
Meditation or Guided Practice (10–20 min)

Use Insight Timer, Calm, or YouTube for grief or anxiety meditations.
Focus: Acceptance, letting go, inner calm.
Wind-Down Ritual

Herbal tea, warm bath, or reading a calming book (avoid screens 1 hr before sleep).
Light a candle or use aromatherapy (lavender, frankincense, sandalwood).
Weekly Anchor (Once a Week)

Talk to someone you trust (friend, therapist, group).
Creative expression: Paint, write poetry, sing - express the unspeakable parts of grief and stress.
Shervan K Shahhian

If your experiencing Narcissistic Abuse, how can you survive it:

If your experience involves Narcissistic Abuse, how can you survive it:
Surviving narcissistic abuse can be incredibly difficult, but it is possible - and many people not only survive, but grow stronger and more self-aware afterward.
Here’s a grounded, practical guide to surviving narcissistic abuse, emotionally and psychologically:
Recognize the Abuse

Narcissistic abuse often involves:
Gaslighting (making you doubt your reality)
Emotional manipulation (guilt-tripping, silent treatment, love bombing)
Chronic criticism or devaluation
Control and isolation
Intermittent reinforcement (hot-cold behavior that confuses you)
Why it matters: Naming it is the first step toward healing.
Detach Emotionally

Even if you can’t leave right away, begin to emotionally detach:
Stop seeking their approval.
Understand their tactics are about control, not love.
See them as emotionally limited, not powerful.
Tip: Journaling or keeping a reality-check notebook helps you stay clear-headed when they try to confuse you.
Set Boundaries

Learn to say no without guilt.
Stop explaining or justifying yourself.
Use the Gray Rock Method (be boring and unreactive around them).
Boundaries may trigger more manipulation at first - but persist.
Break Contact (If Possible)

No Contact is the most effective strategy when safe and possible.
If you must stay in touch (e.g., co-parenting), practice Low Contact with firm boundaries and minimal emotional engagement.
Rebuild Your Identity

Narcissists often erode your self-worth. Reclaim it by:
Reconnecting with hobbies, friends, and passions.
Affirming your values and needs.
Working with a therapist - preferably trauma-informed and familiar with narcissistic abuse.
Seek Support

Trusted friends, online communities, or support groups can validate your experience.
You’re not alone - even if they made you feel that way.
Focus on Healing

Recovery isn’t linear. You may grieve the illusion of who you thought they were.
Learn about C-PTSD (Complex PTSD), a common outcome of narcissistic abuse.
Practice self-compassion. You didn’t “let” this happen - you were targeted.
Educate Yourself

Knowledge is power. Learn about:
Narcissistic Personality Disorder (NPD)
Trauma bonding
Inner child healing
Emotional flashbacks
The more you understand, the less control they have over you.

Here are therapy recommendations tailored to healing from narcissistic abuse, grounded in current trauma and abuse recovery practices:
Trauma-Informed Therapy

Look for therapists who specialize in trauma and narcissistic abuse recovery. Key modalities include:
Cognitive Behavioral Therapy (CBT)

Helps reframe negative self-beliefs implanted by the abuser.
Effective for regaining confidence and stability.
Eye Movement Desensitization and Reprocessing (EMDR)

Highly effective for processing trauma and emotional flashbacks.
Can help with lingering effects of gaslighting, fear, and identity confusion.
Internal Family Systems (IFS)

Helps heal the “inner parts” of you wounded by the abuse.
Very effective for restoring self-leadership after identity erosion.
Somatic Experiencing (SE)

Trauma is stored in the body - this therapy gently releases it.
Ideal for survivors with anxiety, panic, or dissociation.
Narcissistic Abuse Specialists

When searching for a therapist:
Look for key phrases like: narcissistic abuse, emotional abuse, toxic relationships, or trauma bonding.
Ask if they’re familiar with Cluster B disorders or personality disorders, especially NPD.
Use platforms like:
PsychologyToday.com
TherapyDen.com
Better Help (some therapists specialize in abuse recovery)
Group Therapy or Support Groups

Consider:
Group therapy for survivors of narcissistic or emotional abuse.
Online support communities such as:
Reddit’s r/Narcissistic Abuse
Facebook groups like “Narcissistic Abuse Recovery” or “Daughters of Narcissistic Mothers”
Psychoeducation and Self-Help Tools Books:

In tandem with therapy, these resources can help:
Books:

“The Body Keeps the Score” by Bessel van der Kolk (trauma healing)
“Healing from Hidden Abuse” by Shannon Thomas (specifically on narcissistic abuse)
“Complex PTSD: From Surviving to Thriving” by Pete Walker (C-PTSD recovery)
Apps:

Insight Timer - free meditations for trauma
MindDoc - track emotional health
Moodnotes - CBT-based mood tracking
Shervan K Shahhian

Understanding Elderly Persons Mental Health Disorders:

Understanding Elderly Persons Mental Health Disorders:

Understanding mental health disorders in elderly persons is crucial for providing appropriate care, improving quality of life, and ensuring early detection and treatment.

Here’s a clear overview of the key aspects:

Common Mental Health Disorders in the Elderly:

Depression

Often underdiagnosed in older adults.

Symptoms: persistent sadness, fatigue, sleep disturbances, loss of interest, weight changes.

May be triggered by isolation, loss, illness, or medication side effects.

Anxiety Disorders

Includes generalized anxiety disorder, phobias, panic disorder.

Often co-occurs with depression.

Symptoms: excessive worry, restlessness, tension, sleep issues.

Dementia

Includes Alzheimer’s disease and other types (vascular, Lewy body, etc.).

Progressive cognitive decline: memory loss, confusion, personality changes, impaired judgment.

Early detection is key for care planning.

Delirium

Acute and sudden onset of confusion.

Often caused by medical illness, medications, or surgery.

Reversible with timely treatment.

Substance Use Disorders (“Please Seek Medical Advice”)

Includes alcohol or prescription drug misuse (especially benzodiazepines or opioids).

May be overlooked due to stigma or misattributed to aging.

Late-Onset Psychosis

Can include schizophrenia-like symptoms or delusional disorder.

May be related to neurodegenerative diseases or underlying medical conditions. (“Please Seek Medical Advice”)

Contributing Factors to Mental Health Issues in the Elderly:

Biological: Chronic illness, pain, neurodegenerative conditions, medication side effects.

Psychological: Grief, trauma, fear of death, loss of autonomy.

Social: Isolation, loneliness, lack of social support, elder abuse.

Environmental: Institutionalization, poor housing, or inadequate caregiving.

Diagnosis and Assessment:

Comprehensive assessments should include:

Medical history and current medications

Mental status exams (e.g., MMSE, MoCA)

Functional assessments (daily living skills)

Family and caregiver input

Treatment Approaches:

Psychotherapy

Cognitive Behavioral Therapy (CBT), reminiscence therapy, supportive counseling.

Medication (“Please Seek Medical Advice”)

Antidepressants, anxiolytics, antipsychotics — but with caution due to sensitivity and side effects.

Social Support

Day programs, community involvement, family therapy, support groups.

Lifestyle Modifications

Physical activity, good nutrition, sleep hygiene, cognitive stimulation.

Integrated Care

Collaboration between primary care, mental health professionals, and caregivers.

Prevention and Early Intervention:

Promote social engagement and meaningful activity.

Regular screenings during routine medical visits.

Educate families and caregivers on warning signs.

Encourage open conversations about mental health.

Shervan K Shahhian

Bipolar 1 & Bipolar 2, what is the difference:

Bipolar 1 & Bipolar 2, what is the difference:

ASK YOUR PSYCHIATRIST/MEDICAL DOCTOR

The main difference between Bipolar I and Bipolar II disorder lies in the severity and type of mood episodes experienced:

Bipolar I Disorder

Manic episodes are the hallmark. These are severe, often requiring hospitalization, and can include psychosis (delusions, hallucinations).
The person may also experience major depressive episodes, but depression is not required for a diagnosis.
Manic episodes Might last at least 7 days, or are so severe that immediate medical care is needed.

Example: A person may go days without sleep, have grandiose ideas, and engage in risky behaviors—followed (or preceded) by deep depression.

Bipolar II Disorder

Characterized by hypomanic episodes (a milder form of mania) and major depressive episodes.
No full manic episodes occur.
Hypomania Might lasts at least 4 days and doesn’t usually cause significant disruption or require hospitalization.

Example: A person may feel unusually energetic, talkative, and productive for a few days, but not out of control—then experience weeks or months of debilitating depression.

Summary Table:

Feature	Bipolar I	Bipolar II
Mania	Full mania (severe)	Hypomania (mild/moderate)
Depression	May occur, not required	Required for diagnosis
Hospitalization	Common during mania	Rare
Psychosis	Possible in mania	Absent

Here’s a comparison of Bipolar I vs Bipolar II including their core features and typical treatment options:

Bipolar I vs. Bipolar II: Full Comparison

Feature	Bipolar I	Bipolar II
Type of Elevated Mood	Full mania	Hypomania (less intense than mania)
Depressive Episodes	Common, but not required for diagnosis	Required for diagnosis
Mania Duration	≥ 7 days, or any duration if hospitalization needed	≥ 4 days, not severe enough for hospitalization
Psychosis	Can occur during manic episodes	Not typical
Functioning Impairment	Often severe, may lead to hospitalization	Impairment usually mild during hypomania
Diagnosis Requirement	At least 1 manic episode	At least 1 hypomanic + 1 major depressive episode
Suicide Risk	High (especially with mixed episodes or depression)	Higher than Bipolar I due to more time spent in depression
Course of Illness	May have rapid cycling or mixed episodes	Often more time spent depressed than elevated

Treatment Options

1. Mood Stabilizers

ASK YOUR PSYCHITRIAST/MEDICAL DOCTOR

2. Antipsychotics (especially for mania or psychosis)

ASK YOUR PSYCHITRIAST/MEDICAL DOCTOR

3. Antidepressants

ASK YOUR PSYCHITRIAST/MEDICAL DOCTOR.

4. Psychotherapy

Cognitive Behavioral Therapy (CBT) – For managing depressive symptoms and negative thinking patterns.
Psychoeducation – Teaching about the illness to improve treatment adherence.
Family-focused therapy – Helps stabilize the environment and support systems.

5. Lifestyle and Monitoring

Sleep regulation is critical — disturbed sleep can trigger episodes.
Mood tracking apps or journals help identify early warning signs.
Avoiding alcohol and drugs — these can destabilize mood.

Summary:

Bipolar I: More severe, needs stronger antimanic treatment, often antipsychotics. ASK YOUR PSYCHIATRIST/MEDICAL DOCTOR
Bipolar II: More chronic depression, focus often on lamotrigine and psychotherapy.
Shervan K Shahhian

Understanding Non-Suicidal Self-Injury or NSSI:

Understanding non-suicidal self-injury or NSSI:

Non-suicidal Self-Injury (NSSI) refers to the intentional, direct harm to one’s own body tissue without suicidal intent. It’s a psychological behavior often used as a coping mechanism, not an attempt to end life. Understanding it involves examining emotional, psychological, and social dimensions.

Key Aspects of NSSI:

1. Common Forms:

Cutting (most prevalent)

Burning

Scratching

Hitting or banging body parts

Interfering with wound healing

Hair pulling (can overlap with trichotillomania)

2. Psychological Function:

People may engage in NSSI for various emotional reasons, including:

Emotion regulation: Relief from intense emotions like anger, sadness, anxiety, or emptiness.

Self-punishment: Due to guilt, shame, or low self-esteem.

To feel something: Counteracting emotional numbness or dissociation.

Communication or expression: As a cry for help or a way to express internal pain non-verbally.

Control: Gaining a sense of control in chaotic situations.

3. Risk Factors:

Childhood trauma or abuse

Emotional dysregulation (often seen in borderline personality disorder)

Depression or anxiety disorders

Bullying, social rejection, or peer pressure

Lack of social support or emotional expression tools

4. Who Is Affected?

Most common among adolescents and young adults

Can occur in any gender, though females often report cutting more and males report hitting or burning more

Increasingly seen across cultural and socio-economic groups

5. Clinical Recognition:

Included in the DSM-5 as a condition requiring further study

Often co-occurs with other mental health issues like depression, PTSD, eating disorders, or BPD

6. Treatment Approaches:

Cognitive Behavioral Therapy (CBT): Helps restructure negative thought patterns and develop healthy coping skills.

Dialectical Behavior Therapy (DBT): Particularly effective for emotion regulation and interpersonal effectiveness.

Trauma-informed care: When history of abuse or trauma is involved.

Medication: If there’s a co-occurring mood or anxiety disorder.

Family therapy or support groups: To address relational dynamics and isolation.

Important Distinctions:

NSSI ≠ Suicide Attempt: NSSI is not intended to be fatal, though it can increase the risk of future suicide attempts if underlying issues remain untreated.

It is a signal of distress, not attention-seeking behavior — compassionate, nonjudgmental support is key to helping those who engage in it.

Supporting someone who engages in non-suicidal self-injury (NSSI) and understanding how it is assessed clinically are both critical for effective care and intervention. Here’s a breakdown of both:

How to Support Someone Engaging in NSSI

1. Respond with Empathy, Not Judgment

Avoid saying things like “Why would you do that?” or “You just want attention.”

Instead: “That must be really hard for you. I’m here if you want to talk.”

2. Stay Calm and Grounded

Seeing injuries can be shocking, but reacting with panic may make the person feel ashamed or retreat.

Keep your voice calm, and focus on understanding rather than controlling.

3. Open Non-Confrontational Conversations

Ask gently: “I noticed you’ve been hurting yourself. Do you want to talk about what’s been going on?”

Validate their pain even if you don’t understand the behavior: “I can’t imagine what you’re going through, but I want to help.”

4. Encourage Professional Help

Suggest they speak with a therapist or counselor trained in trauma, emotion regulation, or adolescent mental health.

Offer to help them find resources or go with them if they’re afraid.

5. Promote Safe Alternatives

Help them identify replacement behaviors like:

Snapping a rubber band on the wrist

Drawing on skin with red markers

Holding ice cubes

Journaling or art

Exercise or grounding techniques

These don’t solve the core issue but can reduce harm as they transition to healthier coping.

6. Be Patient

Stopping NSSI is a process, not a single decision.

Relapses can happen; continue offering nonjudgmental support.

How NSSI is Assessed Clinically

1. Clinical Interviews

Mental health professionals conduct structured or semi-structured interviews that cover:

Frequency, methods, and severity of self-injury

Triggers and emotional states before and after

Intent (e.g., suicidal vs. non-suicidal)

History of trauma, abuse, or neglect

Co-occurring symptoms: depression, anxiety, dissociation

2. Assessment Tools and Questionnaires

Some standardized tools used include:

Functional Assessment of Self-Mutilation (FASM)

Deliberate Self-Harm Inventory (DSHI)

Self-Injurious Thoughts and Behaviors Interview (SITBI)

3. Differential Diagnosis

Clinicians assess whether NSSI is:

A symptom of a broader condition (e.g., Borderline Personality Disorder, Depression, PTSD)

Occurring independently, possibly as a primary coping mechanism.

4. Risk Assessment

Even though NSSI isn’t suicidal, it’s linked to higher suicide risk over time.

Clinicians assess for suicidal ideation, hopelessness, and impulsivity.

5. Treatment Planning

Based on the assessment, the clinician develops a personalized care plan that may involve:

Therapy (DBT, CBT, EMDR)

Medication SEEK MEDICAL ADVICE FROM A MEDICAL DOCTOR.

Family involvement, if appropriate

Shervan K Shahhian

Cutters and those who Self-Harm, why:

Cutters and those who Self-Harm, why:

Self-harm, including cutting, is a complex and often misunderstood behavior. People who engage in self-harm are usually not trying to end their lives but are instead trying to cope with overwhelming emotional pain, regulate intense feelings, or feel something when feeling numb. It’s a maladaptive coping mechanism that can temporarily relieve distress but often leads to shame, isolation, and increased suffering.

Common Reasons People Self-Harm:

Emotional regulation: To release feelings of anger, sadness, or frustration.
Self-punishment: Due to feelings of guilt, shame, or self-hatred.
Numbness or dissociation: To feel real or break through emotional numbness.
A cry for help or communication: When words feel insufficient to express inner turmoil.
Sense of control: When life feels chaotic or out of their hands.

Important Points:

It affects people across all ages, genders, and backgrounds.
It is not necessarily linked to suicidal intent, though it does increase risk.
Shame and stigma often keep people from seeking help.
Therapy (especially Dialectical Behavior Therapy or Cognitive Behavioral Therapy) can be very effective.
Supportive relationships and environments are critical for healing.

Would you like insights on how to support someone who self-harms or explore psychological approaches to treatment?

Explore Psychological approaches to treatment:

Psychological approaches to treating self-harm focus on understanding the underlying emotional drivers and helping individuals build healthier coping strategies.

Here’s an overview of the most effective evidence-based treatments:

1. Dialectical Behavior Therapy (DBT)

Best for: Individuals with emotional dysregulation, especially those with Borderline Personality Disorder (BPD), though it’s helpful beyond that.

Core Skills Taught:

Mindfulness: Staying present and aware of emotions.

Distress Tolerance: Surviving emotional crises without self-harming.

Emotion Regulation: Identifying and managing intense emotions.

Interpersonal Effectiveness: Navigating relationships in a healthy way.

Why it works: DBT teaches concrete skills to replace self-harm with more adaptive behaviors.

2. Cognitive Behavioral Therapy (CBT)

Best for: Understanding and challenging the thoughts and beliefs that lead to self-harming behaviors.

Focuses on the cognitive distortions (e.g., “I deserve pain”) and maladaptive behavior patterns.

Encourages behavioral experiments to try safer alternatives.

Teaches problem-solving and coping skills.

3. Mentalization-Based Therapy (MBT)

Best for: People who struggle to understand their own and others’ mental states (common in BPD or attachment trauma).

Helps the person recognize the thoughts and feelings behind their actions.

Builds the capacity to reflect rather than react.

4. Compassion-Focused Therapy (CFT)

Best for: Individuals with high self-criticism or shame.

Aims to increase self-compassion and soothe the inner critic.

Replaces self-harm used as self-punishment with nurturing internal dialogues.

5. Psychodynamic Therapy

Best for: Exploring unresolved emotional conflicts, early attachment issues, or trauma.

Uncovers the root psychological causes behind the need to self-harm.

Can be helpful for those who want to understand the deeper meaning of their behavior.

6. Trauma-Informed Therapy (e.g., EMDR, Somatic Experiencing)

Best for: Those with a history of abuse, neglect, or PTSD.

Recognizes self-harm as a survival response to trauma.

Helps process traumatic memories and reduce dysregulation at the nervous system level.

Additional Support Approaches:

Art therapy or music therapy to express pain non-verbally.

Group therapy for peer support and skill-building.

Medication may be helpful for co-occurring depression, anxiety, or mood disorders.

Treatment is most effective when non-judgmental, empathetic, and collaborative, focusing on safety planning, trust, and empowerment.

Shervan K Shahhian