Psychological symptoms, what now?
How do I know that I have psychological symptoms?
Everyone sometimes feels sad or anxious. That is normal. However, have you been unable to get out of bed for days? Do you have no appetite, sleeping problems or recurring intrusive negative thoughts? Are you overly anxious about specific situations, things in your past or the future and are you unable to function properly due to these symptoms? Do you have nightmares or flashbacks of events that you have experienced? Maybe you suffer from a psychiatric disorder. But how do you recognize that?
The most common mental disorders are depression, anxiety disorders, ADHD, autism, personality disorders and somatization disorders. A diagnosis of these disorders in the Netherlands is usually made based on a standard book, called the Diagnostic and Statistical Manual for Psychiatric Diseases (DSM-5), which lists the symptoms associated with each disorder.
A depressive disorder is characterized by five or more of the following symptoms, of which at least one must be a sad mood or loss of interest and pleasure. The symptoms must last for at least two weeks.
- Weight loss or increase
- Sleep problems (too little or too much)
- Fatigue, loss of energy
- Worthlessness or guilt
- Difficulty concentrating, indecisiveness
- Recurring thoughts of death
Post-traumatic stress disorder (PTSD) can arise when an experience, in which you are (repeatedly) exposed to an actual or imminent death, cannot be properly processed. The symptoms are a natural response to a serious threat, but they persist after the threat ends. Typical symptoms are:
- Increased irritability
- Nightmares and flashbacks related to the traumatic experience
- Avoid incentives associated with the trauma
- Negative thoughts and mood
Personality disorders are described as a lasting pattern of thoughts, feelings and behaviours that clearly deviate from the expectations within the culture of those involved. The patterns are sustainable in a sense that they usually have been present since childhood.
Somatisation is the experience of psychosocial discomfort that manifests itself in physical symptoms. There is no medical cause for physical symptoms. While body and mind are usually seen as two separate things in the Netherlands, there is often more overlap between them in Eastern cultures. In these cultures, psychological symptoms are therefore often expressed physically.
How do I deal with a psychological diagnosis?
In the intake phase (the first sessions) questions are asked and possibly tests and questionnaires are taken to see if you meet the DSM-5 criteria for a certain disorder. If this is the case, you will receive a diagnosis of one or more disorders. This means that your treatment can be reimbursed by health insurances (once your own risk budget is used up). Then, a treatment that has scientifically proven to be effective for this disorder can be offered.
During the diagnostic phase, often difficult life experiences are discussed. It can be difficult to be confronted with this. Acceptance of life events and a diagnosis is a process. You can compare it to learning how to deal with loss. Acceptance is hard work. Receiving a diagnosis has an impact on your life. It can also happen that you are alone in the process of acceptance. It can then be useful to take family members or other important people with you to your therapist. This way they can get information about your diagnosis and can better understand what you are going through. Ideas that you have about what the diagnosis entails and about the treatment can hinder its acceptance. For example, if you think that use of medication or psychological treatments are a sign of weakness.
Elisabeth Kübler-Ross distinguishes several steps in the acceptance process:
- Anger and/or resistance
- Negotiating with yourself
This process of acceptance is not static. You do not have to start with denial and finish with acceptance. It often happens that people go forth and back between the several steps of acceptance. There is no “standard” to be given for the duration of the acceptance process and when you should “finish” accepting.
Acceptance is important, it helps you to change and get better. For example, if you have the idea “Nothing is wrong with me, others have a problem with me”, you will have less motivation to get started. As a result, things stay as they are. Acceptance can also give rest. Everyone has strengths and weaknesses. You can try to use your strengths as much as possible and learn to deal with your weaknesses.
Movie of the WHO “Living with a black dog called depression”:
There is still a lot of stigma on psychological complaints. While mental disorders, including depression, for example, are common in the Netherlands and are often accepted, there is often still a taboo about mental disorders in other cultures. In collectivist cultures, for example, both the person who has a mental disorder and his/her family members can be excluded. In addition, different cultures deal with mental disorders in different ways. For example, in Western cultures (such as the Netherlands), depression is generally attributed to internal disturbances in a person, while depression in Eastern cultures is seen more as an interpersonal disturbance. There are psychological institutions that specifically take cultural factors into account (for example, i-psy in Arnhem/Nijmegen).
Mental health in the Netherlands – What steps should I take if I want to request psychological help?
If you suspect that you have a mental illness you first have to go to the doctor. Here you can be referred to the “mental health practice support” (POH-GGZ) or directly to a psychologist’s practice. The POH-GGZ is in the same building of the general practitioner. He or she is usually a psychologist who will have some supportive conversations with you to get you back on track. If it turns out that more help is needed, you can still be referred to a psychologist’s practice. In psychologist practices, a distinction is made between basic and specialist mental health care. Mental health care in the Netherlands is usually offered ambulant. This means that you continue to live at home and usually have an appointment with your practitioner once a week.
In basic mental health care, you come across relatively simple, mild symptoms that can be relieved within a few (usually eight) sessions. You will end up in specialist mental healthcare if you suffer from a combination of different symptoms. Often basic and specialist mental healthcare are also put together in a psychologist’s practice. During the intake procedure, it is determined how serious your symptoms are and how many sessions with your therapist you will need.
There are also psychological practices that are specifically aimed at intercultural target groups. They have practitioners who speak different languages and can often treat patients in their mother tongue. The practitioners often have a migration background themselves. I-psy, for example, is an organization with various branches throughout the Netherlands (including Arnhem and Nijmegen) that offers psychological help for refugees and migrants. It is therefore often the case that you are referred there by your doctor. However, there are other organizations that take cultural differences into account in the treatment of mental disorders.
The process: from registration to treatment
If you are registered with a psychologist’s practice (such as i-psy for example) you will be invited for an intake interview within a few weeks. This is a conversation in which as much information as possible about your symptoms, you as a person and your environment are retrieved. The more you dare to share, the better the picture of your situation can be estimated. A diagnosis is made based on this in consultation with the team. This diagnosis is explained to you during a second appointment.
During this second session, the form of treatment that you will receive will also be briefly explained and it will be discussed whether you also need appointments with the psychiatrist. A psychiatrist is not the same as a psychologist. The psychiatrist’s job is to prescribe medication, while the psychologist provides conversational therapy and may not prescribe medication.
After the consultation, you will be placed on the waiting list. If you prefer a therapist who speaks your native language, this may mean that you will have to wait a few months for a place at this practitioner. If you do not have a language preference, you will be treated faster. The practitioners all speak Dutch and a translator can always be called who translates the conversation live into your native language.
The next session is an introduction to your therapist. The main goal of this session is that you get to know your therapist and the treatment plan will be discussed. There will be room for any questions and doubts from your side. After this session, treatment can start, provided that both you and your therapist agree. The therapy sessions can take place weekly or every other week. The sessions usually last between 45 minutes and 1.5 hours. If both you and your practitioner think that the treatment has had sufficient effect, an evaluation session will follow at the end and the treatment can be finished.
What forms of therapy are there?
The most common form of therapy in the Netherlands is Cognitive Behavioural Therapy (CBT). This therapy is based on the view that our thoughts, feelings, and behavior are all interrelated and that if you change one, the others automatically change. In this therapy, negative thoughts are automatically challenged and behavior is changed, for example through exposure to frightening situations and experiencing that the feared outcome does not occur. Different forms of CBT have been found to be effective in scientific research for various disorders.
Eye Movement Desensitization and Reprocessing (EMDR) is a widely-used form of therapy for Post-Traumatic Stress Disorder (PTSD; see the heading “How do I notice that I have psychological symptoms?”). With this form of treatment, you are asked to think of a specific moment of the traumatic event and then your working memory is derived. This can be done, for example, by a dot that you follow with your eyes from left to right or by a sound that you hear through headphones. As a result, the memory will be newly recorded and the emotional charge will decrease or disappear.
Schema therapy is often used for personality disorders. If there are problems in the family or at school, systemic therapy can be effective. This can be a treatment where you and your partner or children go to the treatment sessions and the interaction in the family will be the focus. Relatively new are forms of therapy based on mindfulness. Mindfulness is about being in the moment, being aware of your body and accepting negative sensations, thoughts, or feelings. On YouTube, there are numerous videos with mindfulness meditations or “body scans” that you could try out. The treatment methods described here are not exhaustive and new treatment methods are constantly being added.
What is psychotherapy (not) and what is the goal?
Against the expectations of many, therapy is not meant for you to relieve your dissatisfaction with your life or to help with problems with authorities. It is also not a possibility to network and certainly not a magic tool. Therapy requires a lot of effort; especially your effort. The therapist can support you and offer you tools for change. However, the change must come from within yourself.
Therapy is a safe place based on trust where you can tell and explore without judgment why you got stuck in your life. You receive advice and practice new behaviour to overcome these problems. It is hard work. It is sometimes necessary to discuss sensitive topics and feelings. It is important that you work together with the therapist. Furthermore, it is good for the progress of the treatment if you give the therapist feedback about how you experience the treatment. That way you can collaborate optimally with your therapist to get better.
What is needed for successful treatment?
In successful therapy, there is room for change. Both patient and therapist are open to this. Openness and trust are important basic conditions. It is important that a cooperative relationship develops between you and your therapist. Change costs a lot of energy and it is possible that sometimes resistance to change occurs. This resistance needs to be overcome to be open to treatment again. In successful treatment, there is also a great deal of practice with new behaviour. It requires active commitment from the patient. Homework assignments are an important part of the treatment. After all, the purpose of the treatment is that you become better in your everyday life situation and not only in the treatment room. This requires that you practice new behaviour in your home environment. The homework assignments will also be discussed with your practitioner. Whenever possible, the patient’s family will also be involved in the treatment. This can be nice both for the family because they will get more understanding for your situation and how they can best support you as well as for yourself because you are better understood and supported.
Anxiety disorders are characterized by excessive anxiety and concerns that are present for six months and relate to events or activities. Further symptoms are:
- Difficulty in controlling anxiety
- Restlessness, tiredness, difficulty concentrating, irritability, muscle tension and / or sleeping disorder
- Restrictions in (e.g. social or professional) functioning
written by: Linda Blaesing