Definition of the dysphoria
Dysphoria It is a very familiar term in specialist language so much that among workers when we refer to it we understand each other without having to add a lot.
Despite this, if we focus on grasping the deepest meaning it remains a term with non -univocal and consensual definitions. The etymology of the term – of Greek derivation – is explanatory. If Eu-Forìa refers to feeling well, dysphoria has that “dis” preceding “forìa” that refers to feeling bad, an anguish and a difficult penalty to bring.
We immediately guess that dysphoria is equivalent to feeling of bad mood. The etymological clarification provides us with an idea of the mood, however, does not specifically explain what the typical peculiarity of the dysphoric bad mood is.
Definitions
The most shared definition considers the dysphoria a emotional state complex and disorganized, with a protein phenomenal. It is characterized by a multitude of symptoms including irritability, discontent, interpersonal resentment And sensation of defeat (On this last point the writer does not fully agree).
The definition attempts are further complicated when we find the word dysphoria or the dysphoric adjective next to other terms that give rise to other paintings. Premenstrual dysphoric disorder, gender dysphoria, somatic dysphoria, neuroleptic dysphoria, post -coatary dysphoria, hysteroid dysphoria.
We will limit ourselves to examining the dysphoria as an emotional state.
DISFORIA AND BIPOLARISM
If we consider the dysphoria from an emotional point of view, we must necessarily examine its presence within the bipolar spectrum.
For many years there has been a bipartition in the field of emotional disorders that considered two poles of the dimension prevalent. On the one hand the euphoria and the depression on the other.
These two opposite poles have monopolized the attention of the researchers, leaving that range of emotional states in the middle in the middle or that take some elements from one extreme and on the other.
In particular those feelings of unpleasant tension characterized by a irritable moodgrumpy, which in extreme cases leads to aggressive agitates.
In bipolar disorder it is possible to detect elements of irritability in the “non -pure” states – defined by Kraepelin as mixed states. In these we do not find elements of euphoria or depressive, distinct from each other, but we witness a situation in which elements of the two polarities simultaneously coexist.
The dysphoria can present itself with a certain frequency in mixed states, even if it is not to be considered a pathognomonic. Feelings of malaise, anxiety, bad mood, irritability, anguished suffering, inconsolation, restlessness and oscillating sadness can in fact find themselves transversely in different psychopathological paintings.
Other frames of the phenomenon
He tried to define the dysphoria in itself, regardless of the diagnosis in which it manifests itself. Dayer (2000) identifies a phenomenologically distinguishable profile in the dysphoria, characterized by Subjective tension, irritability/hostility, aggressive conduct and suspiciousness.
According to Startevic (2007) for dysphoria We must understand an emotional state characterized by discomfort, despair and irritability.
An element that seems to characterize the term dysphoria is one affective state characterized by irritability. In this perspective, Dayer hypothesizes that the dysphoria behaves like a third dimension of bipolar disorder. In fact, it describes two types of mixed state that are respectively the shape with symptoms maniacal + dysphoria and the one with symptoms depressive + dysphoria.
Clinical implications of the presence of dysphoria
In the context of emotional disorders, it is known that when the disorder has dysphorical elements we witness a worse prognosis, with a greater number of relapses and greater functional impairment.
In the relationship between depression and dysphoria It has been seen that depressed subjects with dysphoria have much more intense levels of anger and present greater difficulty in making decisions.
Depresses-Day subjects have a very intense emotional reactivity in the face of negative stimuli. Depressed unipolar elderly subjects without antecedent of psychiatric pathologies can present relaxation symptoms weeks or months before all the other symptoms that will then outline the acclaimed framework.
The relationship with mood disorders
With regard to the mood disorders report – dysphoria there are many open issues.
Can we think of dysphoria as a predictor of bipolarity? Do we have to think about dysphoria as a third dimension of bipolarity? Does bipolar dysphoria have specific characteristic elements that differentiate it from other mental disorders? And would I add: what is the pathological dysphoria from the “physiological” one differs? For example, what we can warn in the periods when everything goes wrong or at certain meteorological moments. Is it a simply quantitative or qualitative question? The answers that will be provided will be interesting.
We are trying to define what the dysphoria itself is and we understand that it is not easy to isolate it from the context in which it presents itself.
Differences with other psychopathological paintings
Let’s examine the specificities that would make it distinguishable from other psychopathological paintings. Let’s take for example the differences with a depressive picture by analyzing the coping mode.
In depression, coping styles are internalizing, prevailing the tendency to blame themselves and have to experience guilt and shame. In the dysphoria The coping mode is outsourcing. The fault of one’s moods is attributed to external factors, exposing feelings of anger more than fault or shame.
In the dysphoria we try to relieve malaise with intentional conduct – such only apparently since the dysphoric cannot do differently – which are considered socially unacceptable (eg aggressive acted). In depressed subjects there are fewer intentional conduct, with a basic liabilities and activities without a precise intent (see the Afinal agitation).
Evaluating the relationship between experiences and coping methods, the dysphoria seems to be characterized by:
- negative emotions mainly concerning the interpersonal sphere;
- sense of defeat and feeling overwhelmed;
- hostility towards others;
- tendency to blame others.
Dysphoria and personality disorders
It immediately catches us that we can observe these elements in other psychopathological situations ranging from personality disorders to the most defined clinical paintings.
We think of the irritability of the mood that characterizes a borderline disorder when abandonment lives, the narcissist who does not feel confirmed, to the obsessive that is hindered in his rituals, to the anti -sensocial when he is prevented from satisfying his needs immediately.
Lately there is a flourishing reflection on the differences between borderline personality disorder and bipolar spectrum disorders. The recent theorizations of the interpersonal model of the dysphoria speculate that the dysphoria can represent a psychopathological organizer of the borderline disorder. In bipolar disorder is considered Just a symptomatic aspect and not fundamental of the symptoms that characterizes bipolar disorder, especially in mixed states.
But dysphoric elements can be detected in paranoid states, in intoxication/abstinence from substances, in some phases of cognitive deterioration or in neurodegenerative disorders, in childhood (often indicator of problems of the family area more than personal), in intellectual disability and much more.
Induced dysphorical states
Even sometimes a dysphoric state can be induced by psychopharmacological prescriptions. In fact, in some situations the component dysphoric It would not be the direct expression of the basic diagnostic framework but could be induced by the treatment with antidepressant drugs.
Sometimes antidepressant drugs are used with too much lightness by figures who despite having prescriptive securities have no psychopathological and clinical experience. A frame called ACID-Antidepressant-Agliadocated Chronic Irritable Dysphoria-(El Mallakh et al, 2008) was identified in which the dysphoric worsening makes antidepressant therapies.
In these subjects, the care of depressive states requires more complex pharmacological therapies and managed by specialists, I would also add very experienced!
The care of the dysphoria
We have no specific treatments for dysphoria. We try to treat primary disorder with adequate psychopharmacological care and with a psychotherapy mainly with a cognitive behavioral address. This can help to recognize the dysphorical states early and to implement valid strategies of mastering these states.
It is certainly one of the symptoms that, when present, does not go absolutely underestimated and must be treated first because it can compromise the therapeutic relationship and adherence to the treatment. It can also lead to aggressive self-eteriretti aggressive or creating situations of great difficult management later.