UNDERSTANDING EMOTIONAL & PSYCHOLOG1CAL STATES
PSYCHOLOGICAL & CLINICAL SYMPTOMS
M. Mala Cunningham, Ph.D.
1. Dysthymia: symptoms include poor appetite or overeating, insomnia or hypersomnia, low energy or
fatigue, low seif esteem, poor concentration or difficulty making decision, feelings of hopelessness.
2. Depression: chronic depressed mood, diminished interest in pleasure or other activities, weight loss or
gain, insomnia or hypersomnia, psychomotor agitation, fatigue or loss of energy, feelings of
worthlessness, diminished ability to think or concentrate, suicidal ideation.
3. Generalized Anxiety: keyed up or an edge, exaggerated startle response, difficulty concentrating or
mind going blank, trouble falling asleep, irritability, muscle tension; autonomic hyperactivity - sweating,
dry mouth, flushes, trouble swallowing, dizziness.
4. Overanxious Disorder: excessive or unrealistic worry about future, worries about appropriateness of
behavior and competence; marked self-consciousness, excessive need for reassurance, inability to relax,
somatic complaints: headaches, stomachaches, etc.
5. Dissociated States: essential feature is a disturbance or alteration in the normally integrative functions
of identity, memory, or consciousness. An experience of feeling detached from and an observer to one’s
mental processes or body; feels like automaton, as if in dream.
6. Anorexia Nervosa: Refusal to maintain body weight to minimal for age / height; intense fear of gaining
weight or becoming fat; absence of 3 consecutive menstrual cycles.
7. Bulimia Nervosa: Recurrent episodes of binge eating - rapid consumption of food in short time; lack of
control during binges; regularly engages in self-induced vomiting, uses laxatives or diuretics; strict dieting
or fasting; vigorous exercise in order to prevent weight gain; persistent over concern with body shape and
weight.
8. Obsessive-Compulsive Disorder: Recurrent obsessions or compulsions severe enough to cause
distress; these usually are time consuming and can interfere with normal routine. Obsessions are
persistent ideas, thoughts, impulses or images which are experienced as intrusive. Compulsions are
repetitive, purposeful and intentional behaviors performed in response to an obsession to neutralize or
prevent discomfort.
9. Post-traumatic Stress: the result of a traumatic experience that is outside the range of usual human
experience; can experience recurrent and intrusive dreams, avoids exposure to events that symbolize the
trauma; avoids recollections of the event; concerted efforts to avoid thoughts and feelings associated with
trauma, feelings of detachment or estrangement from others, restricted range of affect, unable to have
loving feelings, sense of foreshortened future, i.e., does not expect to have a career, marriage, children
etc.; difficulty falling asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance,
exaggerated startle response.
BASIS FOR PSYCHOLOGICAL REFERRAL
1. Immediate referral if suicide is alluded to
2. Evidence of depression or withdrawing behaviors
3. Sudden loss or transition in client’s life
4. Psychosomatic or stress reactions
5. Excessive worrying or anxiety
6. Nightmares, frequent crying, loss of appetite, insomnia
7. Evidence of angry or hostile behaviors and attitude
8. Explosive personality or aggressive reactions
9. Alcohol or drug abuse
10. Phobic reactions
11. Anti-social behaviors
12. Obsessive or compulsive behaviors
13. Paranoid or dissociative behaviors
14. Eating Disorders
15. Relationship difficulties
16. Sexual difficulties
17. Overly concerned with health or somatic complaints
Warning signs or danger signals for suicide: 1) previous attempts, 2) threats, 3) extreme
depression - sad, anxious, disinterested, 4) changes in personality / behavior, such as
sleeplessness, weight loss, appetite and/or withdrawal, 5) preparation for death making
a will, giving away personal possessions, acquiring means to commit suicide, 6) a
sudden lift in spirit.
Recommendations for how to make a referral:
1. Have a list of mental health therapists that you feel comfortable referring people to.
2. Establish a rapport with local therapists - either directly or over the phone,
3. Have their business cards available to give to people.
4. Call the therapist and let them know you are making a referral to them. Teil them who the
person is and a brief description of why the referral is being made. Leave your phone
number so that the therapist can call you back.
5. Monitor the student in class (if they are in a yoga class); periodically check in with the
student on how they are doing.
6. Discuss with the therapist continuation of yoga classes or whether this would be
contraindicated. Also discuss meditation and whether this is contraindicated based on what
is happening with the individual. Individuals who are psychotic should not practice
meditation; individuals who are dissociative on a mild level shouldn’t have a problem with
meditation, but moderate or severe dissociative problems are contraindicated. Individuals
with full blown OCD might not do well
in a yoga class. Milder - moderate form of cyclothymia should be okay for yoga -
especially the breathing practices.
7. If a student approaches you to discuss a problem or issue before or after class,
be aware of confidentiality and talk where others won’t approach or hear your
conversation. Don’t discuss the issues with others in a random fashion; use your
mental health support system for advice and guidance on how to proceed if you
are uncertain what to do.