Why Do Youths Kill Themselves?

Youth suicide is a growing concern in Singapore, with increasing numbers of young people overwhelmed by pressures they struggle to cope with. Hopelessness plays a critical role, as many youths feel trapped in situations they perceive as unchangeable. To prevent these tragedies, it is crucial for families, schools, and communities to foster open communication, ensuring that young people feel supported and understood in their struggles.

Key takeaways

  • Hopelessness is a key predictor of youth suicide—young people often feel overwhelmed by life stressors and lack coping mechanisms, leading them to believe there is no escape.
  • The accumulation of pressures—such as academic stress, romantic rejection, family issues, and identity struggles—can push vulnerable youths toward suicidal thoughts.
  • Open communication and support from families, schools, and communities are critical to preventing youth suicide, helping young people feel seen, heard, and understood.

Posted on 4 Oct 2024

Written by
Dr Jared Ng, Connections MindHealth

The heartbreaking rise in youth suicides in Singapore is impossible to ignore. In 2023, nearly 30% of suicides involved individuals under the age of 29, with an alarming number – almost one-third – being children and youths between the ages of 10 and 19. Suicide has tragically become the leading cause of death among our youth, surpassing accidents and illnesses. This devastating reality forces us to confront the intense pressures that many of our young people face every day.

Though the media often refrains from reporting youth suicides, perhaps out of concern for contagion effects or protecting vulnerable individuals, those of us working in mental health witness this silent epidemic. These cases are not just confined to adolescents; even children in primary school are not immune. Behind every statistic is a young life lost, and with it, a family and community left grieving, searching for answers.

The youths who take their own lives often appear to be thriving—excelling academically, socially, and physically. Yet beneath this veneer of success can lie a deep, unnoticed despair that ultimately becomes too much to bear.

youth suicides in singapore
The interplay between hope and hopelessness is crucial in understanding youth suicides.
How Hope and Hopelessness Influence Youth Suicide

Hopelessness is a significant factor in suicide risk across all ages, representing a profound state of despair where individuals feel trapped in an unchangeable situation, with suffering that seems endless. This overwhelming sense of hopelessness can lead to the belief that death is the only escape, making it one of the strongest predictors of suicidal behavior. When hope is lost, the risk of suicide dramatically increases.

For young people, hopelessness often stems from life stressors they perceive as insurmountable. Unlike adults, children and youths typically have less experience dealing with complex emotional challenges and may lack the coping mechanisms needed to navigate their despair. Additionally, their natural impulsivity can exacerbate the situation. Young people are more prone to making rash decisions in moments of intense emotion, often without fully considering the consequences. This impulsivity, combined with feelings of hopelessness, can dangerously heighten the risk of suicide, as a young person may act on suicidal thoughts suddenly, leaving little opportunity for intervention.

The interplay between hope and hopelessness is crucial in understanding youth suicides. Hope is a vital psychological resource that begins to develop early in childhood. It starts to form in infancy when a child learns to trust their caregivers and becomes more established around ages 3 to 5, when children develop a sense of purpose and the ability to envision a positive future. However, as children grow older and face more complex social and academic pressures, their sense of hope can be threatened, especially if they encounter repeated failures or rejection. When these pressures become too great, and the child or youth sees no way out, hope can be replaced by hopelessness.

As a parent, it’s essential to understand that even the most successful children can struggle with feelings of inadequacy. Despite outward appearances of success, some youths battle intense internal pressures, setting impossibly high standards for themselves. When they fail to meet these expectations, the resulting feelings of hopelessness, compounded by impulsivity, can lead to a dangerous downward spiral.

Understanding the fragility of hope in our young people is then crucial to grasping the triggers behind youth suicides. But what are these pressures that push them beyond the brink?

academic pressure in Singaporean children
Academic pressure is another recurring theme when young people talk about their stressful situations.
Understanding the Triggers Behind Youth Suicide

Through my practice, I’ve encountered many young individuals overwhelmed by circumstances they don’t know how to navigate—circumstances that drive them to contemplate, or even attempt, suicide. One case that stands out is that of a 12-year-old girl whose parents discovered a suicide note hidden in her pencil case. She had poured out her feelings of profound loneliness, all stemming from the rejection of a crush whom she saw as her ‘true love.’ When she tried to talk to her parents about her heartache, they dismissed her emotions, telling her to focus on her studies instead since she was not doing well. For her, this response deepened her isolation. In her note, she expressed that she felt like a burden to her family and believed they would be happier without her. (For the record, this child is alive, and with the support of her parents, she is now receiving the care she needs and is on the path to healing.)

This case, like many others, reminds us that youth suicide is rarely the result of one factor. It’s often an accumulation of pressures—romantic rejection, academic stress, family dynamics, and more. And while romantic relationships are an important part of adolescence, young people’s sense of self-worth is often tied to many areas—be it friendships, peer acceptance, or family approval.

As a mental health professional, cases like this weigh heavily on me. They reinforce how critical it is to listen to our children, even when their struggles seem small to us. This experience, and countless others, have deeply influenced my approach to treating at-risk youths. I’ve learned that what we might dismiss as “typical teenage angst” or fleeting concerns can be the very thing pushing a young person to the edge. Every cry for help, no matter how subtle, deserves to be heard.

I often ask myself, “What can we do better?” or “What more can be done?” In my years of practice, the answer has always come down to fostering connections—helping young people feel seen and heard before their pain becomes too overwhelming to manage. These stories shape the way I approach my work and emphasise the importance of never underestimating the emotional lives of our youths.

Youth suicides are rarely caused by one isolated factor. It’s usually the accumulation of stressors—romantic rejection, academic pressure, and more—that can push a young person beyond their breaking point.

Family disputes causes emotional distress in children
Family issues, particularly parental disputes or divorce, can also contribute to emotional distress.

Romantic rejection, particularly a first heartbreak, is one of the most common and emotionally intense triggers for young people. Adolescents often experience their first romantic relationships with immense intensity, and when these relationships end, it can feel like the end of the world. Many young people’s sense of identity and self-worth becomes closely tied to their romantic relationships, and a breakup or rejection can lead to overwhelming feelings of worthlessness, despair, and hopelessness. For some, this emotional pain can feel unbearable, especially when combined with other stressors in their lives.

Academic pressure is another recurring theme when young people talk about their stressful situations. Students often feel that their worth is tied to their performance, leading to immense stress. When combined with other stressors like friendship or family issues, the result can be overwhelming despair. We must also consider how these pressures interact with individual vulnerabilities, such as a predisposition to anxiety or depression, to fully understand why some youths are more affected than others.

Identity confusion is also a significant factor. Adolescence is a time of exploration, especially concerning personal identity, gender identity, and sexual orientation. For some, navigating these aspects of themselves can lead to significant distress, particularly if they feel unsupported or misunderstood.

Child abuse—whether physical, emotional, or sexual—can create overwhelming feelings of worthlessness and despair. Studies have shown that children who experience abuse are significantly more likely to develop mental health issues, including depression and anxiety, which are risk factors for suicide. The trauma from abuse can worsen hopelessness, making it difficult for these youths to see a future free from pain.

Family issues, particularly parental disputes or divorce, can also contribute to emotional distress. While not all divorces lead to emotional distress, the instability or conflict surrounding a family breakdown can be deeply unsettling for young people, potentially leading to suicidal thoughts.

It is important to understand that children and youths often face more than one stressor at a time, and these stressors can accumulate, making the situation feel even more overwhelming and inescapable. By recognising the complex interplay of mental health disorders, environmental factors, stressors, and individual vulnerabilities, we can better appreciate the depth of the challenges that many young people face.

Social Media’s Impact on Youth Mental Health

In a world where young people already face immense pressure, social media often amplifies their challenges. It’s not just a space for connection—it’s a constant stream of comparison, where vulnerable youths measure their lives against the carefully curated, often unattainable standards set by their peers.

Many of the young patients I’ve seen talk about how they feel ‘less than’ when scrolling through platforms like Instagram and TikTok. While these platforms can offer a sense of connection, they can also foster deep feelings of inadequacy. For youths already struggling with self-esteem or personal challenges, these comparisons can be devastating. The image of success, beauty, and happiness they see online becomes yet another unattainable goal—further driving feelings of worthlessness.

Cyberbullying is another significant issue that I have encountered in my practice. The anonymity of the internet allows bullies to harass others with little fear of consequences. Victims of cyberbullying often feel isolated and powerless, trapped in a cycle of psychological distress. The pressure to maintain a certain image online, combined with the fear of public humiliation, can push vulnerable youths toward suicidal thoughts as they see no way to escape the relentless negativity.

As a parent, it’s vital to engage in open conversations with your children about their online experiences. Rather than imposing strict bans on screen time, which may feel punitive, encourage your children to share what they see and how it makes them feel. Creating a safe space for these discussions can help them develop a healthy perspective on social media and reduce the impact of negative comparisons.

cyberbullying
In a world where young people already face immense pressure, social media often amplifies their challenges.
Supporting Those Affected: The Role of Postvention

Postvention, the support provided to those affected by a suicide, is a crucial yet often overlooked aspect of suicide prevention. The impact of a suicide extends far beyond immediate family members, affecting friends, classmates, teachers, and even acquaintances. In my own experience, I witnessed this firsthand when my daughter lost a friend after a fall from heights. I was heartened to see that the school had structured interventions in place to support classmates and teachers during this difficult time.

However, it’s important to remember that structured postvention processes often focus on those directly involved in formal settings, such as schools. Other social groups that are equally affected by the suicide may be overlooked. These include peers
from enrichment classes, playground friendships, virtual friend groups, and other less formal social circles. These groups can be just as devastated by the loss, and it is essential to extend postvention efforts to these communities as well.

Effective postvention can take many forms. Schools can start by providing immediate mental health support, such as on-site counselors, and creating spaces where students can talk openly about their grief. Peer support groups can also be invaluable in helping young people process their emotions together. Schools and communities should work to destigmatise conversations about suicide and loss, ensuring that students feel safe expressing their feelings without fear of judgment. Another critical step is offering long-term support—grief doesn’t disappear after a few weeks. Schools and community organisations should follow up with affected youths in the months after a suicide, helping them manage their ongoing emotions.

Just as important as support in schools is the involvement of families in the healing process. Parents and guardians are often a young person’s primary emotional support, and it is essential that they be part of the conversation. Family members should be prepared to discuss the loss in a way that is developmentally appropriate for their child’s age and emotional maturity. Younger children may not fully understand the permanence of death and might express their grief through behavior changes or play, while adolescents might need space to process their more complex emotions, often experiencing a heightened sense of vulnerability. Parents should create a safe, open environment where their child feels supported in sharing their feelings without fear of dismissal.

This is where age-appropriate conversations become so vital. Discussing suicide and loss with children and adolescents requires sensitivity, but it’s necessary to ensure they feel seen and understood. Younger children might need simple explanations, focusing on reassurance and security, while older youths may need a space to explore their feelings more deeply. It’s crucial for parents to acknowledge their child’s emotions, validate their pain, and provide ongoing support as grief evolves.

By providing compassionate and consistent postvention support, we can help those left behind heal from their grief and prevent further emotional distress. It’s vital to remember that postvention is not just about reacting to loss but about reinforcing the connections and resilience that can help prevent future tragedies. Families, schools, and communities must work together to provide a holistic, age-appropriate approach to support, ensuring no young person feels isolated in their grief.

preventing youth suicide together
Parents need to foster open communication, ensuring that their children feel safe to express their fears and anxieties.
Taking Action: Preventing Youth Suicide Together

Preventing youth suicide demands a collective effort. Families play a pivotal role in the well-being of young people. Parents need to foster open communication, ensuring that their children feel safe to express their fears and anxieties. This involves creating a home environment where emotional expression is encouraged and where children know they will be supported and not judged when they share their struggles. It’s equally important for parents to be aware of the signs of distress—such as changes in mood and behavior, withdrawal from social activities, or declining academic performance—and to be proactive in offering emotional support or seeking professional help when needed.

Schools must prioritise mental health by creating supportive environments that recognise the importance of emotional well-being alongside academic success. Schools should work to reduce the stigma of help-seeking and suicide prevention. Teachers and other staff need to be trained to identify signs of distress and intervene appropriately. Additionally, schools can incorporate programs that teach coping mechanisms and stress management skills, helping students build resilience in the face of challenges.

As a broader community, we must challenge the societal norms that contribute to the immense pressure on young people. This includes rethinking our definitions of success and ensuring that mental health resources are accessible and timely. Public awareness campaigns can play a significant role in changing perceptions about mental health and reducing stigma. Policymakers, too, have a crucial role to play in creating supportive frameworks that address the root causes of youth suicide—such as reducing academic pressure, combating child abuse, and regulating the impact of social media.

Addressing youth suicide is a daunting task, but by tackling the root causes, fostering communication, and creating supportive environments, we can help our young people find hope and resilience. Everyone has a role in this effort because, ultimately, it is the collective compassion and determination of the community that will make the difference.

Where to get help:
Mental Well-being
  • Institute of Mental Health’s Mental Health Helpline: 6389-2222 (24 hours)
  • Samaritans of Singapore: 1-767 (24 hours) / 9151-1767 (CareText via WhatsApp)
  • Singapore Association for Mental Health: 1800-283-7019
  • Silver Ribbon Singapore: 6386-1928
  • Tinkle Friend: 1800-274-4788
  • Community Health Assessment Team 6493-6500/1
Counselling
  • TOUCHline (Counselling): 1800-377-2252
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          • Obsessive Compulsive Disorder—Myths and Misconceptions

          Obsessive Compulsive Disorder—Myths and Misconceptions

          Obsessive-Compulsive Disorder (OCD) is a complex and often debilitating mental health condition that affects millions of people around the world.

          Posted on 25 Jun 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          Obsessive-Compulsive Disorder (OCD) is a complex and often debilitating mental health condition that affects millions of people around the world. The 2016 Singapore Mental Health Study (SMHS) highlighted OCD as one of the top three most common mental disorders in the country [1]. The findings revealed that approximately one in every 28 adults in Singapore has been impacted by OCD, sparking discussions that Singapore might be the “OCD capital” of the world.

          Characterised by persistent, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions), OCD can significantly interfere with a person’s daily activities and quality of life. These obsessions and compulsions are not simply excessive worries about real-life problems or personal quirks; they are intense, consuming, and distressingly intrusive.

          Despite its prevalence and severity, numerous myths and misconceptions about OCD persist, which can lead to stigma, misdiagnosis, and inadequate treatment. The 2016 SMHS suggested that the duration of untreated OCD was slightly more than 10 years, underscoring the critical need for awareness and timely intervention. Misconstruing OCD and its impacts trivialises the condition and obscures its true nature [2], preventing those affected from seeking help or receiving the empathy and support they desperately need.

          This article aims to debunk some of the biggest myths about OCD and provide a clearer picture of what the disorder is. By spreading accurate information and fostering a better understanding of OCD, we hope to create a more compassionate environment that encourages those affected to seek treatment and supports them on their road to recovery.

          Content 
          1. Understanding OCD; The relationship between Obsession and Compulsion 
          2. Dispelling Popular Myths: The Realities of OCD
          1. Treatment and Management of OCD
          2. Importance of Seeking Professional Help 
          3. Moving Beyond Misconceptions; Resources for Further Reading or Assistance:

          Understanding OCD; The relationship between Obsession and Compulsion 

          One of the core aspects of Obsessive-Compulsive Disorder (OCD) that is often misunderstood is the distinction and relationship between obsessions and compulsions. These two components are the hallmark features of OCD, but they manifest differently and serve different psychological purposes in the disorder. 

          Obsessions:

          Obsessions are involuntary, persistent thoughts, images, or impulses that intrude into a person’s mind and cause significant anxiety or distress. These are not simply excessive worries about real-life problems but are often irrational or exaggerated fears. People with OCD typically recognise that their obsessions are created in their minds but are unable to control or dismiss them.

          Examples of less visible obsessions include:

          • Fear of accidentally harming oneself or others, even in “absurd” or unlikely scenarios.
          • Intrusive sexual thoughts or images that are distressing.
          • Obsessions with symmetry or exactness, where a slight imperfection can trigger intense discomfort.
          • Fears of shouting obscenities or acting inappropriately in public which lead to social withdrawal.

          Compulsions:

          Compulsions are repetitive behaviours or mental acts that a person feels compelled to perform in response to an obsession or according to rigid rules. The primary purpose of these compulsions is to prevent or reduce the distress caused by the obsessions or to prevent a feared event or situation; however, these behaviours are either not connected logically to the feared event or are excessive.

          Examples of less visible compulsions include:

          • Mental rituals, such as repeating certain words or phrases in one’s mind to ward off harm or bad luck.
          • Counting objects or performing tasks in certain numbers to “neutralise” the anxiety associated with an obsession.
          • Rearranging or organising items until they feel “just right” to alleviate the distress of imperfection.
          • Silently praying or performing rituals that cannot be observed by others, which can often go unnoticed.

          The relationship between obsessions and compulsions in OCD is one of a problematic cycle. Obsessions fuel anxiety, which compels the individual to engage in compulsive behaviours. These compulsions temporarily reduce the anxiety but reinforce the obsession, which makes it even stronger. This creates a vicious cycle that can escalate and become more debilitating over time.

          OCD Cycle
          OCD can be understood as a looping cycle of obsession, anxiety, compulsion and relief. 
          Dispelling Popular Myths: The Realities of OCD
          Myth 1: OCD is just about being overly tidy and organised

          One of the most common misconceptions about Obsessive-Compulsive Disorder (OCD) is that it solely manifests as a preoccupation with cleanliness and a need for order. This stereotype is often perpetuated by media portrayals and casual references that equate being meticulous or neat with having OCD. However, this simplistic view fails to capture the complexity and distress that characterise the disorder.

          OCD Singapore
          Popular culture’s portrayal of OCD undermines the complex and debilitating nature of OCD

           

          Comparison with Normal Tidiness:

          While many people prefer a clean and organised environment, those with OCD experience severe anxiety if things are not “just right.” For example, a person without OCD might feel satisfied after tidying up their desk, but someone with OCD might spend hours arranging and rearranging items to achieve a sense of relief from their distressing thoughts.

          OCD is a clinical condition marked by severe and intrusive obsessions—unwanted thoughts, images, or urges that repeatedly enter the mind and cause significant anxiety [3]. These obsessions are coupled with compulsions, which are behaviours an individual feels compelled to perform in an attempt to reduce stress or prevent some dreaded event or situation, regardless of whether these outcomes are realistic.

          The manifestations of OCD can be extraordinarily diverse. Beyond the well-known compulsions related to cleanliness, such as hand-washing or sanitising, OCD can involve:

          Symptom Characteristics
          Hoarding Contrary to popular belief, hoarding is not just a problem of disorganisation or messiness. Hoarding OCD can be succinctly described as the difficulty of discarding items regardless of their actual value, driven by a fear of losing something important [4]. Hoarding involves the compulsive collecting or keeping of items to the extent that it impairs functioning. Individuals may fear that something bad will happen if they throw anything away, leading to severe clutter that can affect living condition
          Touch and movement The compulsion to count or perform tasks several times to prevent perceived danger [5]. This symptom involves an intense, irrational fear that not performing a particular ritual or compulsion will result in harm to oneself or others. This can manifest in less obvious ways, such as needing to touch things a specific number of times to prevent a loved one from getting hurt.
          Checking compulsion Repeated checking behaviour such as checking if the door is locked or the stove is off, is driven by a paralysing fear of harm or disaster. Patients of OCD may repeat these actions compulsively even if initials “checks” were done.
          Orderliness and symmetry A compulsion to arrange objects to meet a subjective sense of order, often accompanied by intense discomfort if items are perceived as misaligned or disorganised [6]. Some individuals with OCD are not just discomforted by lack of “order” but may even be plagued with anxiety that something terrible will happen if things are not just right.
          Ruminations and intrusive thoughts These are prolonged and unwanted thoughts about philosophical, metaphysical, or moral issues that do not have clear solutions or outcomes. Such ruminations can be highly distressing and time-consuming, often interfering with the person’s ability to engage in daily activities. Sometimes these can also include disturbing and unwanted thoughts or images about harming others, sexual content, or blasphemous themes that provoke intense distress [7].
          hoarding OCD
          OCD encompasses a wide range of symptoms beyond cleanliness obsessions, including behaviours like hoarding and compulsive checking.

           

          Myth 2: People with OCD just need to relax and stop worrying

          A common but harmful misconception about Obsessive-Compulsive Disorder (OCD) is the notion that individuals can simply choose to ‘relax’ or stop worrying to overcome their symptoms. This belief undermines the serious nature of OCD and suggests that it is within the individual’s control to stop their obsessive thoughts and compulsive behaviours. In reality, OCD is a deeply ingrained disorder with complex biological and psychological roots, and it is not about lacking willpower or personal strength.

          Biology of OCD Explained:

          OCD has a significant biological basis. Research has shown that genetic factors play a crucial role in the development of the disorder, with individuals having a higher risk of developing OCD if a close family member also has the condition [8]. Neuroimaging studies have revealed that people with OCD often have differences in certain areas of the brain, including the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia [9]. These brain regions are involved in decision-making, learning from mistakes, and controlling repetitive behaviours. Abnormalities in these areas can contribute to excessive doubts, compulsive checking, and the intense need to perform rituals that are characteristic of OCD.

          • Serotonin and Brain Function:

          The role of neurotransmitters, particularly serotonin, has also been highlighted in the pathology of OCD [10]. Serotonin is crucial for mood regulation and decision-making processes. Imbalances or disruptions in serotonin levels can exacerbate the symptoms of OCD, which can result in increased anxiety and the compulsion to perform certain rituals [11]. This is why medications that target serotonin levels, such as SSRIs (selective serotonin reuptake inhibitors), are often effective in managing OCD symptoms.

          • Psychological Factors:

          From a psychological perspective, OCD is believed to be influenced by behavioural, cognitive, and environmental factors. For example, behavioural theory suggests that compulsions are developed to reduce the anxiety caused by obsessions temporarily [12]. Cognitively, people with OCD may have maladaptive beliefs about responsibility and harm, overestimating the danger in certain situations and their role in preventing it. This can lead to excessive checking, hoarding, or other compulsive behaviours.

          • Why It’s Not About Willpower:

          Telling someone with OCD to stop worrying or to relax is akin to telling someone with asthma to breathe normally during an asthma attack—neither helpful nor feasible. OCD is not a disorder that can be controlled or willed away by the individual. It requires professional treatment, including therapy and sometimes medication, to manage effectively. 

          Understanding these biological and psychological underpinnings of OCD helps highlight why reducing it to an issue of willpower is not only incorrect but also detrimental. It diminishes the real struggles experienced by those with the disorder and can prevent individuals from seeking the appropriate, evidence-based treatments that they need.

          Myth 3: OCD is not a serious disorder

          Contrary to the dismissive views that label Obsessive-Compulsive Disorder (OCD) as a minor annoyance or a mere personality quirk, OCD is a serious psychiatric condition recognised for its serious impact on daily functioning and overall quality of life. The idea that OCD is not a significant health issue is not only inaccurate but also diminishes the real and sometimes severe challenges faced by those who live with the disorder.

          According to the World Bank and the World Health Organization, OCD is the tenth leading cause of disability globally, and for women aged 15 to 44 years, it ranks fifth. [13]. Studies have shown that individuals with OCD can experience a reduction in quality of life that is comparable to or even greater than those suffering from chronic physical conditions like diabetes [14]. The economic impact is also significant, with many individuals facing challenges in maintaining consistent employment and managing healthcare expenses related to their condition.

          The data and real-life impacts illustrate that OCD is undoubtedly a serious disorder, deserving of the same attention and medical care as any other significant health issue. 

          Impact of OCD on Daily Life:

          OCD can severely disrupt daily activities by making routine tasks extraordinarily difficult and time-consuming. For many individuals, the intense need to perform compulsive rituals—such as repeated hand washing, checking, or arranging items in a specific order—can take up several hours of their day, which severely disrupts their personal, professional, and social lives. The distressing nature of obsessive thoughts can also lead to heightened anxiety, pervasive feelings of disgust, or even a paralysing fear of harming others inadvertently. These experiences can restrict individuals’ ability to function in work settings, participate in social activities, and maintain relationships, which often leads to isolation and loneliness.

          Mental Health Consequences:

          The constant battle with obsessive thoughts and compulsive behaviours can lead to significant emotional distress. Many individuals with OCD experience co-occurring mental health conditions, such as depression and anxiety disorders. The relentless nature of OCD can contribute to feelings of hopelessness and helplessness, which are key risk factors for depressive symptoms and suicidal ideation. Furthermore, the stigma associated with mental health, particularly around a misunderstood condition like OCD, can exacerbate feelings of shame and inadequacy, hindering individuals from seeking help and support.

          Obsessive-Compulsive Disorder (OCD) is not only a complex disorder in its own right, but it is also frequently accompanied by other psychological conditions [15]. This coexistence of multiple disorders, known as comorbidity, can complicate diagnosis and treatment, and affect the overall prognosis of those affected. Understanding the relationship between OCD and its comorbid conditions is crucial for developing comprehensive treatment plans that address all aspects of a patient’s mental health.

          Common Comorbid Conditions with OCD:
          • Anxiety Disorders: OCD is often found alongside other anxiety disorders, such as Generalized Anxiety Disorder (GAD) [16], Panic Disorder [17], and Social Anxiety Disorder [18]. The overlap is understandable, given that both OCD and other anxiety disorders involve chronic worry and fear. However, OCD is distinct in that the anxiety typically stems from intrusive thoughts (obsessions) and is temporarily alleviated by specific actions (compulsions).
          • Depression: Depression is one of the most common comorbid conditions with OCD [19]. The relentless nature of OCD symptoms often leads to feelings of despair and hopelessness, which can evolve into clinical depression. The presence of depression in OCD patients can make symptoms worse and recovery more challenging, as it can sap motivation and increase feelings of worthlessness.
          • Eating Disorders: Eating disorders [20], particularly those involving ritualistic behaviour around food and body image, such as Anorexia Nervosa and Bulimia Nervosa, can also co-occur with OCD. The obsessive thoughts and compulsive behaviours seen in eating disorders can mirror the pattern of symptoms experienced in OCD, reflecting a shared foundation of anxiety and control issues.
          • Tic Disorders: Particularly in pediatric populations, there is a significant overlap between OCD and tic disorders, including Tourette Syndrome [21]. Both conditions involve repetitive behaviours, although the compulsions in OCD are typically linked to obsessional thoughts, whereas tics are often involuntary and not connected to obsessions.
          • Attention Deficit Hyperactivity Disorder (ADHD): Although seemingly counterintuitive due to ADHD’s association with impulsivity (opposite of OCD’s compulsivity), there is a noteworthy rate of comorbidity [22]. The shared features may include high levels of inattention, poor impulse control, and executive functioning problems.
          • Autism Spectrum Disorder (ASD): There is a considerable overlap between OCD and ASD. Individuals with ASD may engage in repetitive behaviours and routines similar to OCD compulsions, but the motivations behind these behaviours differ. Understanding the distinctions and overlaps is crucial for accurate diagnosis and treatment.
          • Autoimmune Conditions: Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a condition where streptococcal infections lead to the sudden onset or worsening of OCD symptoms in children. This condition highlights the complex interplay between infections and psychiatric symptoms, necessitating a multidisciplinary approach to treatment.
          Depression and OCD Singapore
          Depression is a common comorbidity for individuals with OCD, which often exacerbates the challenges they face.
          Treatment and Management of OCD

          The presence of comorbid conditions in individuals with OCD requires a more comprehensive treatment approach. For instance, a treatment strategy that only addresses OCD may not be effective if the patient is also experiencing major depressive disorder. In such cases, a combination of medications, along with therapy tailored to address both OCD and depression, may be necessary.

          Moreover, the treatment of one condition can sometimes improve the symptoms of the other. For example, the techniques used in CBT for managing anxiety can also be beneficial in controlling OCD symptoms. However, healthcare providers must monitor all conditions closely and adjust treatment plans as necessary to address the full scope of a patient’s mental health needs.

          Effective treatment and management of Obsessive-Compulsive Disorder (OCD) are critical for improving the quality of life for those affected by the disorder. Modern treatment methods, professional help, and support from loved ones form the cornerstone of successful management strategies for OCD. Understanding these elements can empower individuals and their families to seek the right kind of help and support needed.

          • Cognitive-Behavioral Therapy (CBT): CBT is one of the most effective treatment options for OCD, particularly a specialised form known as Exposure and Response Prevention (ERP) [23]. ERP involves exposing the person to the thoughts, images, objects, and situations that make them anxious or trigger their OCD symptoms. The key is to encourage the individual not to engage in the compulsive behaviour typically performed in response to anxiety. Over time, ERP can help reduce the compulsive behaviours associated with the triggers.
          • Medication: Medications, especially those that increase the brain’s serotonin levels, are often prescribed in conjunction with therapy. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly used medications for treating OCD, helping to manage symptoms by balancing neurotransmitters [24]. In some cases, other types of psychiatric medications may be recommended depending on the individual’s symptoms and response to SSRIs. These include:

          Tricyclic Antidepressants (TCAs): Clomipramine is a TCA that has been found to be effective in treating OCD. It works by affecting serotonin levels in the brain, similar to SSRIs, but can also influence other neurotransmitters. However, TCAs can have more pronounced side effects, such as dry mouth, constipation, and dizziness, which need to be carefully managed.

          Antipsychotics: In some cases, antipsychotic medications such as risperidone or aripiprazole may be prescribed as adjunctive therapy, particularly if the patient does not respond adequately to SSRIs alone. These medications can help reduce intrusive thoughts and compulsive behaviours but come with potential side effects like weight gain, sedation, and metabolic changes.

          Benzodiazepines: While not typically first-line treatments for OCD, benzodiazepines like clonazepam can be used short-term to help manage severe anxiety and agitation associated with the disorder. These medications are usually prescribed with caution due to their potential for dependence and tolerance.

          Other Antidepressants: Some other antidepressants, such as Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), may also be effective for treating OCD symptoms in patients who do not respond to SSRIs. These medications work by affecting multiple neurotransmitters, which can be beneficial but also require careful monitoring for side effects.

          Psychiatrists must balance the benefits of these medications against their possible side effects to achieve the best possible outcome for the patient. This involves careful monitoring and adjusting dosages or changing medications as needed to minimize side effects while effectively managing symptoms.

          • Combination Therapy: Often, a combination of CBT and medication provides the best results. This approach addresses both the behavioural and biochemical aspects of the disorder, providing a comprehensive management strategy.
          Importance of Seeking Professional Help

          Managing OCD typically requires more than just willpower or self-help strategies—it needs professional intervention. Mental health professionals can provide a diagnosis, recommend appropriate treatment modalities, and adjust therapies as needed based on how the patient responds over time. Professional guidance is crucial because it ensures that treatment is tailored to the individual’s specific symptoms and severity, which can significantly enhance the effectiveness of the treatment.

          OCD and Counseling Singapore
          Seeking professional help is crucial for OCD patients, as it provides specialised therapies and support essential for managing the disorder effectively.

          Encouraging Support from Family and Friends

          Support from family and friends is extremely valuable in the treatment of OCD. A supportive social network can help reduce the stigma and isolation often associated with this disorder. Family members and friends can also play a proactive role by encouraging adherence to treatment regimens, providing transportation to therapy sessions, or simply being there to listen in a non-judgmental manner.

          • Education: It’s helpful for family and friends to educate themselves about OCD to better understand the challenges and behaviours associated with the disorder. This knowledge can foster patience and empathy, key components of support.
          • Participating in Therapy: Sometimes, therapists may involve family members in sessions to improve understanding and communication around the behaviours and needs associated with OCD.
          • Advocacy: Loved ones can also serve as advocates for individuals with OCD, helping them navigate healthcare systems and advocating for necessary accommodations at school or work.

          In conclusion, the treatment and management of OCD involve a multifaceted approach that includes advanced therapeutic techniques, appropriate medication, and a strong support system. With the right combination of these elements, individuals with OCD can lead fulfilling lives despite the challenges posed by the disorder.

          Moving Beyond Misconceptions

          In this article, we have tackled some of the most persistent myths and misconceptions surrounding Obsessive-Compulsive Disorder (OCD). These myths not only skew public perception but also contribute to the stigma and misunderstandings that can significantly impact those living with OCD. By debunking these myths, we aim to foster a more accurate and compassionate understanding of the disorder, highlighting its complexity and the real challenges faced by those affected.

          Our society stands to benefit greatly from a deeper understanding and empathy towards mental health issues, particularly OCD. Empathy begins with education and awareness, which can break down the barriers of ignorance and fear that often surround mental health disorders. We encourage everyone to advocate for and promote mental health education in their communities, which can transform public attitudes and make a real difference in the lives of those affected.

          • Educate Yourself and Others: Continue learning about OCD beyond this article. Education is a powerful tool for changing perceptions and promoting an environment of support and understanding.
          • Support Mental Health Initiatives: Includes participating in community awareness events, supporting mental health non-profits, or advocating for policies that improve mental health care, your involvement can contribute to a larger change.
          • Show Compassion: If you know someone struggling with OCD, offer your understanding and support. Sometimes, simply being there to listen without judgment can make a significant difference.
          • Seek Professional Help if Needed: If you or someone you know is battling OCD, encourage seeking help from mental health professionals. Early intervention can lead to better outcomes.
          Resources for Further Reading or Assistance:

          By addressing these myths and supporting those affected by OCD, we can create a more inclusive and supportive community. Let’s commit to being part of the solution, promoting understanding, and providing educated support to transform how we deal with OCD in society.

          References 
          1. Subramaniam, M., Abdin, E., Vaingankar, J. A., Shafie, S., Chua, B. Y., Sambasivam, R., Zhang, Y. J., Shahwan, S., Chang, S., Chua, H. C., Verma, S., James, L., Kwok, K. W., Heng, D., & Chong, S. A. (2019). Tracking the mental health of a nation: Prevalence and correlates of mental disorders in the second Singapore mental health study. Epidemiology and Psychiatric Sciences, 29, e29. https://doi.org/10.1017/S2045796019000179
          2. Kaur, R., Garg, R., & Raj, R. (2023). Quality of life among patients with obsessive compulsive disorder: Impact of stigma, severity of illness, insight, and beliefs. Industrial Psychiatry Journal, 32(1), 130–135. https://doi.org/10.4103/ipj.ipj_22_22 
          3. Stein, D. J., Costa, D. L. C., Lochner, C., Miguel, E. C., Reddy, Y. C. J., Shavitt, R. G., van den Heuvel, O. A., & Simpson, H. B. (2019). Obsessive–compulsive disorder. Nature Reviews. Disease Primers, 5(1), 52. https://doi.org/10.1038/s41572-019-0102-3 
          4. Hoarding ocd: Symptoms, diagnosis, treatment, and more. (2023, December 21). Healthline. https://www.healthline.com/health/ocd/your-guide-to-hoarding-ocd-and-its-treatment 
          5. Compulsion to touch things in ocd cases – beyond ocd. (n.d.). Retrieved May 27, 2024, from https://beyondocd.org/expert-perspectives/articles/a-touching-story 
          6. Symmetry ocd: Compulsively orderly. (2024, January 22). https://www.simplypsychology.org/orderliness-and-symmetry-ocd.html 
          7. LPC, S. Q. (2023, August 16). OCD themes that can be hard to talk about. NOCD. https://www.treatmyocd.com/blog/ocd-themes-that-can-be-hard-to-talk-about 
          8. Strom, N. I., Soda, T., Mathews, C. A., & Davis, L. K. (2021). A dimensional perspective on the genetics of obsessive-compulsive disorder. Translational Psychiatry, 11(1), 1–11. https://doi.org/10.1038/s41398-021-01519-z 
          9. Parmar, A., & Sarkar, S. (2016). Neuroimaging studies in obsessive compulsive disorder: A narrative review. Indian Journal of Psychological Medicine, 38(5), 386–394. https://doi.org/10.4103/0253-7176.191395 
          10. Baumgarten, H. G., & Grozdanovic, Z. (1998). Role of serotonin in obsessive-compulsive disorder. The British Journal of Psychiatry. Supplement, 35, 13–20. 
          11. The links between ocd and serotonin deficiency. (n.d.). Retrieved May 27, 2024, from https://www.calmclinic.com/ocd/serotonin-deficiency 
          12. Foa, E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181959/ 
          13. World health organisation and ocd | ocd-uk. (n.d.). Retrieved May 27, 2024, from https://www.ocduk.org/ocd/world-health-organisation/ 
          14. Żerdziński, M., Burdzik, M., Żmuda, R., Witkowska-Berek, A., Dȩbski, P., Flajszok-Macierzyńska, N., Piegza, M., John-Ziaja, H., & Gorczyca, P. (2022). Sense of happiness and other aspects of quality of life in patients with obsessive-compulsive disorder. Frontiers in Psychiatry, 13, 1077337. https://doi.org/10.3389/fpsyt.2022.1077337 
          15. Ocd related disorders | baylor medicine. (n.d.). Retrieved May 23, 2024, from https://www.bcm.edu/healthcare/specialties/psychiatry-and-behavioral-sciences/obsessive-compulsive-disorder-program/related-disorders 
          16. Sharma, P., Rosário, M. C., Ferrão, Y. A., Albertella, L., Miguel, E. C., & Fontenelle, L. F. (2021). The impact of generalized anxiety disorder in obsessive-compulsive disorder patients. Psychiatry Research, 300, 113898. https://doi.org/10.1016/j.psychres.2021.113898 
          17. Comorbidity and ocd. (n.d.). Made of Millions Foundation. Retrieved May 23, 2024, from https://www.madeofmillions.com/ocd/comorbidity-and-ocd 
          18. Endrass, T., Riesel, A., Kathmann, N., & Buhlmann, U. (2014). Performance monitoring in obsessive–compulsive disorder and social anxiety disorder. Journal of Abnormal Psychology, 123(4), 705–714. https://doi.org/10.1037/abn0000012 
          19. Tibi, L., van Oppen, P., van Balkom, A. J. L. M., Eikelenboom, M., Rickelt, J., Schruers, K. R. J., & Anholt, G. E. (2017). The long-term association of OCD and depression and its moderators: A four-year follow up study in a large clinical sample. European Psychiatry, 44, 76–82. https://doi.org/10.1016/j.eurpsy.2017.03.009 
          20. The relationship between eating disorders and ocd part of the spectrum. (n.d.). International OCD Foundation. Retrieved May 23, 2024, from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/ 
          21. The relationship between ocd and tourette’s. (n.d.). NOCD. Retrieved May 23, 2024, from https://www.treatmyocd.com/what-is-ocd/info/related-symptoms-conditions/ocd-and-tourettes 
          22. Adhd and ocd: They can occur together. (2021, March 24). Healthline. https://www.healthline.com/health/mental-health/adhd-and-ocd 
          23. Foa, E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181959/ 
          24. Medications for ocd » department of psychiatry » college of medicine » university of florida. (n.d.). Retrieved May 23, 2024, from https://psychiatry.ufl.edu/patient-care-services/ocd-program/medications-for-ocd/ 
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          • Psychiatrist, Psychologist, or Therapist: Who Should I See?

          Psychiatrist, Psychologist, or Therapist: Who Should I See?

          The prevailing culture of silence around mental health, fueled by societal norms that equate vulnerability with weakness, exacerbates this issue.

          Posted on 3 Jan 2024

          Written by
          Dr Jared Ng, Connections MindHealth

          Recent data from the National Population Health Survey in Singapore reveals a concerning trend: the prevalence of poor mental health has risen from 13.4% in 2020 to 17% in 2022 [1]. This increase underscores the critical need for accessible and effective mental health care. As individuals face these growing challenges, a paradox becomes evident – despite the clear need, many find the act of seeking help daunting.

          The prevailing culture of silence around mental health, fueled by societal norms that equate vulnerability with weakness, exacerbates this issue. People are often hesitant to seek help due to the fear of judgement and the stigma associated with mental health issues. This paradox, where the need for support is evident, yet the pursuit of it is hindered by stigma, highlights a significant barrier in mental health care.

          Navigating the complexities of mental health services adds to the challenge. Choosing between a psychiatrist, psychologist, or counsellor can be overwhelming in Singapore, especially when understanding each professional’s distinct roles and specialisations. The struggle lies not just in recognising these distinctions but also in aligning them with personal mental health needs.

          mental health concerns
          Mental health issues require understanding, compassion, and accessible support.
          So, You Have Decided to Seek Help: A Guide for Approaching Mental Health Services

          Recognising the need for mental health support is a crucial first step. For those hesitant to seek help, understanding how to approach mental health services is vital. Here’s an expanded guide on how to navigate your way through seeking mental health services, incorporating important factors such as rapport, honesty, and practical considerations:

          1. Start with research

          Begin by exploring the different types of mental health professionals. Understand their areas of expertise and what they specialise in. This initial research will provide you with a solid foundation for making an informed decision about whom to approach for your mental health needs.

          2. Consultation as a first step

          An initial consultation is a great starting point. It’s an opportunity to discuss your concerns, understand the therapy process, and get a feel for how the therapist works. Remember, this first meeting is about gathering information and does not lock you into a specific treatment path.

          3. Choose based on rapport and therapeutic alliance

          Selecting a mental health professional can sometimes feel more daunting than choosing a life partner. The therapeutic alliance [2], or your rapport with your therapist, is crucial. You will share deep, personal aspects of your life, so feeling comfortable and connected with your therapist is paramount. Don’t hesitate to meet with different therapists to find the one with whom you feel most comfortable.

          4. Be open and honest

          Approach your sessions with openness and honesty. Being candid about your feelings, thoughts, and experiences is essential. Similarly, be open about practical considerations like the cost of sessions. Discussing fees upfront can help set clear expectations and ensure that the therapeutic process fits within your budget, an important aspect of maintaining a stress-free therapeutic relationship.

          5. Seek support

          Sharing your decision to seek therapy with a trusted friend or family can provide additional emotional support. You could ask someone to accompany you to your first session if it makes you more comfortable. Knowing you have the support of your loved ones can make a significant difference in your mental health journey.

          supporting friend
          Support from a friend or family member can provide extra emotional and mental support.
          6. Be prepared for a process

          Therapy [3] is a process that involves navigating through complex emotions and thoughts. It requires patience and commitment. Remember that progress in therapy often comes in small steps and requires time.

          7. Celebrate your progress

          Recognise and celebrate your progress, no matter how small it may seem. Acknowledging your efforts and the steps you’ve taken can be incredibly empowering and motivating as you continue your journey.

          8. You are not alone

          Finally, remind yourself that you are not alone. Many others have embarked on this journey before you; support is always available. Your decision to seek help is a brave and significant step towards a healthier life.

          For the rest of the article, we will first further explore and differentiate between the roles of psychologists [4], psychiatrists [5], counsellors [6], and therapists [7]. We will then shed some light on who you should choose concerning your situation. We hope this guide will empower you with the necessary insights and considerations for starting your mental health journey. With the right approach and support, seeking help can lead to profound personal growth and improved well-being.

          What We Do: A Closer Look at Mental Health Professionals’ Roles

          Having understood the initial steps in seeking help, it’s important to delve into the specific roles of mental health professionals. 

          1. Psychiatrists: Medical experts in mental health

          Psychiatrists are medical doctors in Singapore who specialises in diagnosing and treating mental illnesses, uniquely positioned to evaluate both the physical and psychological aspects of their patient’s health. Their role is multifaceted, encompassing a range of responsibilities:

          • Diagnostic assessments: psychiatrists are proficient in conducting comprehensive diagnostic evaluations. They use various assessment tools and techniques, including psychiatric interviews and psychological tests. As medical doctors, psychiatrists are particularly attentive to ensuring that psychiatric symptoms are not the manifestation of a medical illness. They often incorporate neuroimaging or lab tests into their assessments to rule out physical health conditions that could present with psychiatric symptoms.
          • Medical and psychological expertise: their training as medical doctors is fundamental to their practice. Psychiatrists consider the interplay of biological, psychological, and social factors in mental health, allowing them to offer a holistic approach to treatment.
          • Prescribing medication: being medical doctors, they are authorised to prescribe medication. They manage medication plans for a range of mental health conditions, from mood disorders to severe mental illnesses.
          • Psychotherapy provision: many psychiatrists are also trained in providing psychotherapy, enabling them to integrate therapeutic techniques into their treatment plans.
          • Treatment planning and management: psychiatrists develop and manage comprehensive treatment plans that often combine medication, psychotherapy, lifestyle changes, and other interventions.
          MRI brain mental health
          Psychiatrists are medical professionals who may use brain imaging to rule out neurological conditions that may cause psychiatric conditions.
          2. Psychologists: Specialists in behaviour and mental processes

          Psychologists are professionals specialising in understanding the intricacies of the human mind and behaviour. Their expertise is not limited to therapy but extends to a broad spectrum of activities that contribute significantly to mental health care and research. Here are key aspects of their role:

          • Deep dive into human behaviour: psychologists extensively study how individuals think, feel, behave, and interact. They are particularly focused on the patterns and motivations underlying human behaviour, making them adept at understanding complex emotional and cognitive processes.
          • Conducting psychological assessments: a crucial aspect of their work involves conducting detailed psychological assessments. This includes:
          • Personality tests: to evaluate personality traits and identify patterns that may impact mental health and behaviour.
          • Cognitive assessments and IQ testing: to measure cognitive abilities such as memory, problem-solving, and intellectual functioning. These assessments are essential in identifying learning disabilities, giftedness, and cognitive impairments.
          • ADHD assessments: using various tools and interviews to assess attention, impulsivity, and hyperactivity, which are key in diagnosing Attention-Deficit/Hyperactivity Disorder [8].
          • Autism evaluations: through observational assessments and structured interviews, psychologists play a vital role in diagnosing Autism Spectrum Disorder and understanding the individual’s social, communication, and behavioural challenges.
          • Diagnostic interviews: to identify specific mental health conditions and understand the individual’s mental health history and current symptoms.
          • Providing psychotherapy: psychologists are well-known for their role in providing psychotherapy. They employ various evidence-based therapeutic approaches like cognitive-behavioural therapy (CBT) [9], psychodynamic therapy [10], humanistic therapy [11], and more. Their therapy sessions are designed to help individuals understand and work through their problems, enhance self-awareness, and develop healthier coping mechanisms.
          • Specialised areas of focus: many psychologists specialise in areas such as clinical psychology, counselling psychology, child and adolescent psychology, health psychology, neuropsychology, and forensic psychology, providing targeted care and interventions.
          child psychologist
          Psychologists specialise in different areas, such as child and adolescent psychology.
          3. Counsellors: Advisors for specific life issues

          Counsellors are key figures in the mental health landscape, offering tailored support and guidance for various life challenges and transitions. Their role is multifaceted and client-centred, focusing on empowering individuals with the tools and insights needed for personal growth and problem resolution. Here are some key aspects of their role:

          • Personalised support: counsellors work closely with individuals to provide personalised support tailored to their unique circumstances. This involves understanding each person’s background, challenges, and goals to offer relevant and effective guidance.
          • Development of coping strategies: counsellors are adept at helping individuals develop coping strategies for managing stress, anxiety, and other emotional challenges. They provide tools and techniques for better emotional regulation and resilience.
          • Relationship and family counselling: in the realm of relationship and family counselling, they address issues such as communication problems, marital conflicts, and family dynamics, facilitating healthier relationships and improved interpersonal skills.
          • Life transitions and adjustments: counsellors often assist individuals navigating significant life transitions such as divorce, retirement, relocation, or losing a loved one, providing support and strategies to adjust to these changes.
          Collaborative Approach in Mental Health Care: A Unified Effort

          As we have seen, psychiatrists, psychologists and counsellors have different expertise. They bring together their diverse expertise to offer comprehensive care. This collaborative approach combines medical, psychological, and social perspectives to ensure holistic treatment for patients. Psychiatrists often lead in medical evaluations and medication management, while psychologists delve deep into in-depth therapy. Counsellors add a crucial dimension by supporting everyday life challenges and specific life issues.

          The success of this approach hinges on continuous communication among all professionals, ensuring that treatment plans are cohesive and adapt to the patient’s evolving needs. Additionally, family involvement is a key aspect, especially with children or adolescents, where family dynamics significantly impact treatment. Counsellors often engage with family members to enhance communication and understanding, while psychiatrists and psychologists guide the management of the patient’s condition in the familial setting. This unified effort ensures a well-rounded and effective approach to mental health care.

          psychiatrist
          Choosing between a psychiatrist and a psychologist depends on a number of factors.
          Case Example: Collaborating for Comprehensive Patient Care

          Jane, a 30-year-old woman, sought help from a psychiatrist due to her struggles with anxiety and mood swings. After a detailed diagnostic assessment, the psychiatrist diagnosed her with bipolar disorder and started a medication regimen to manage her symptoms. To complement the medical treatment, the psychiatrist referred Jane to a psychologist for psychotherapy.

          In her sessions with the psychologist, Jane engaged in cognitive-behavioural therapy, which helped her understand and manage her thought patterns and emotions. During therapy, it became evident that Jane was also facing significant challenges in her marriage, which were contributing to her stress.

          To address this aspect of Jane’s life, the psychologist coordinated with a counsellor specialising in marriage counselling. The counsellor worked with Jane and her husband, providing them with strategies to improve communication, understand each other’s perspectives, and strengthen their relationship. This counselling was crucial in helping them navigate the complexities of Jane’s mental health condition within the context of their marriage.

          Throughout her treatment journey, there was ongoing communication between the psychiatrist, psychologist, and counsellor. This was done with Jane’s consent, of course. This collaborative approach ensured that all aspects of Jane’s mental, emotional, and relational health were being addressed cohesively. The team adjusted their strategies based on Jane’s progress and the evolving dynamics of her personal life.

          The integrated efforts of the psychiatrist, psychologist, and marriage counsellor gave Jane a holistic treatment experience. This multi-pronged approach not only helped her manage her bipolar disorder but also supported her in building a healthier, more understanding relationship with her husband, significantly improving her overall quality of life.

          So…do I see a psychiatrist or psychologist first?

          When faced with whether to see a psychiatrist or psychologist, it’s important to consider the nature of your concerns and your preferred approach to treatment. This decision often hinges on the specifics of your mental health needs, the severity of your condition, and your openness to various forms of therapy.

          If you suspect that the issues are linked to an illness, such as in cases of severe depression, bipolar disorder, or schizophrenia, or if you’re experiencing symptoms that significantly impact your daily functioning, seeing a psychiatrist could be the right choice. Psychiatrists, as medical doctors, are adept at managing complex mental health conditions, particularly those requiring medication. Their medical training offers a comprehensive approach that may include medication, psychotherapy, and lifestyle changes.

          On the other hand, if you’re primarily seeking to understand your thoughts, emotions, and behaviours or grappling with life challenges, stress, anxiety, relationship issues, or mild to moderate mood disorders, a psychologist might be more suitable. Psychologists specialise in psychotherapy, offering a range of therapeutic approaches to help you explore and manage your mental health concerns. Their focus is on providing profound insights and coping strategies through talk therapy.

          Treatment preferences also play a crucial role in this decision. If you are open to the possibility of medication as part of your treatment, a psychiatrist with the authority to prescribe would be the suitable professional to consult. However, for those who prefer a treatment approach focused exclusively on psychotherapy without medication, a psychologist is often the better choice.

          psychiatrist
          A psychiatrist conducts proper diagnosis and prescribes medications to address mental health concerns.

          The journey of mental health care is sometimes a collaborative one. Psychiatrists and psychologists frequently work together, and it’s not uncommon to start with one and be referred to the other as your treatment progresses. This collaborative care approach ensures that all aspects of your mental health are being addressed.

          If you’re still uncertain about which professional to see, a consultation with a psychiatrist or psychologist can be a wise first step. They can assess your situation and, if needed, refer you to another professional for additional support.

          Ultimately, whether you see a psychiatrist or psychologist, the most important step is reaching out for help. Both are committed to helping you navigate your mental health journey and can guide you towards the path that best suits your individual needs.

          Do I need counselling or psychotherapy?

          Understanding whether you need counselling or psychotherapy [12] is an important step in seeking mental health care. While the terms are often used interchangeably, subtle differences in focus and approach might make one more suitable for you than the other.

          Counselling typically addresses specific, current issues or life challenges. It is often more short-term and goal-oriented, focusing on providing guidance, problem-solving strategies, and support. Counsellors work with individuals to develop coping mechanisms for managing stress, navigating life transitions like career changes or relationship difficulties, and handling day-to-day emotional challenges. If you need assistance with a particular life event, decision-making, or managing emotional responses to recent changes or stressors, counselling could be the right choice.

          Psychotherapy, on the other hand, tends to delve deeper. It is often more long-term and explores underlying patterns of thoughts, feelings, and behaviours. Psychotherapy aims to uncover the root causes of your challenges, providing a deeper understanding of yourself and your experiences. It can be particularly beneficial for individuals dealing with long-standing psychological issues, complex emotional difficulties, or mental health disorders. If you’re looking to explore your past, understand persistent negative patterns, or address more complex emotional or mental health issues, psychotherapy might be more appropriate.

          Both counselling and psychotherapy provide supportive environments where you can talk openly about your feelings and experiences. The key difference lies in the depth and scope of the work. Counselling often deals with the ‘here and now,’ helping you to navigate current life situations, while psychotherapy may involve a more extensive exploration into your psychological makeup and past experiences.

          In many cases, the decision doesn’t have to be one or the other. Some individuals might start with counselling to address immediate concerns and later transition into deeper psychotherapeutic work as they uncover more about themselves. Mental health professionals can guide you in choosing the most suitable approach based on your individual needs.

          Remember, the most important step is recognising when you need support and taking action to seek it. Whether through counselling or psychotherapy, reaching out for professional help is a commendable and significant step towards your mental health and well-being.

          Conclusion 

          In conclusion, understanding the diverse landscape of mental health care is crucial, particularly in the context of Singapore, where we’re witnessing a significant rise in mental health concerns. Whether it’s a psychiatrist, psychologist, or counsellor, each professional plays a unique role in providing care and support. It’s important to choose the right professional based on your individual needs while also considering factors like therapeutic rapport and practical considerations such as cost.

          Seeking help for mental health issues is a sign of strength and self-awareness, not a weakness. It’s a proactive step towards understanding yourself better and improving your overall quality of life. Remember, the mental health journey is not one you must walk alone. Help is available, and reaching out is the first step towards healing and growth.

          If you or someone you know is struggling with mental health issues, we encourage you to seek support. Consult a mental health professional for guidance, talk to friends and family for emotional support, and explore the various resources available in Singapore. Let’s break the silence and stigma surrounding mental health together. Your mental health matters, and taking the first step towards seeking help is a courageous move that can lead to transformative change.

          Remember, you are not alone, and support is available. Your mental health journey is important, and taking the first step today can lead you towards a healthier tomorrow.

          References
          1. Ganesan, N. (2023, September 27). Prevalence of poor mental health increasing in Singapore; young adults have highest proportion at 25.3%. Retrieved from CNA: Channel News Asia: https://www.channelnewsasia.com/singapore/poor-mental-health-young-adults-seek-help-moh-survey-3802531 
          2. Therapeutic Alliance – an Overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/psychology/therapeutic-alliance#:~:text=Therapeutic%20alliance%20(TA)%2C%20a,therapy%2Drelated%20tasks%20and%20goals.  Accessed 2 Jan. 2024.
          3. Therapy | Psychology Today. https://www.psychologytoday.com/us/basics/therapy.   Accessed 2 Jan. 2024.
          4. Contributors, WebMD Editorial. “What Is a Psychologist?” WebMD, https://www.webmd.com/a-to-z-guides/what-is-psychologist.  Accessed 2 Jan. 2024.
          5. “What Is A Psychiatrist? What They Do and When to See One.” Cleveland Clinic, https://my.clevelandclinic.org/health/articles/22702-psychiatrist.  Accessed 2 Jan. 2024.
          6. Services, Department of Health &. Human. Counsellors. http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/counsellors.   Accessed 2 Jan. 2024. 
          7. “What Therapists Do and When to See One.” Verywell Mind, https://www.verywellmind.com/what-is-a-therapist-2672019.  Accessed 2 Jan. 2024.
          8. CDC. “Attention-Deficit / Hyperactivity Disorder (ADHD).” Centers for Disease Control and Prevention, 16 Oct. 2023, https://go.usa.gov/xRAsU
          9. “What Is Cognitive Behavioral Therapy?” Https://Www.Apa.Org, https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.   Accessed 2 Jan. 2024.
          10. Treatment, Center for Substance Abuse. “Chapter 7—Brief Psychodynamic Therapy.” Brief Interventions and Brief Therapies for Substance Abuse, Substance Abuse and Mental Health Services Administration (US), 1999. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK64952/
          11. Contributors, WebMD Editorial. “What Is Humanistic Psychology and Humanistic Therapy?” WebMD, https://www.webmd.com/mental-health/humanistic-psychology-and-humanistic-therapy.  Accessed 2 Jan. 2024.
          12. Psychotherapies – National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/psychotherapies.  Accessed 2 Jan. 2024.
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          • Not Just a Label – Embracing Potential and Personal Triumphs in ADHD

          Not Just a Label – Embracing Potential and Personal Triumphs in ADHD

          The recognition of Attention Deficit Hyperactivity Disorder (ADHD) has evolved significantly over the years, shedding outdated stereotypes that once led to mislabeling children as naughty or unintelligent.

          Key takeaways

          • From being initially mislabeled, there has been a significant shift in understanding ADHD, emphasizing support over punishment.
          • The heightened awareness of ADHD has resulted in a surge in non-therapeutic diagnoses, necessitating comprehensive assessments and collaborative approaches for accurate diagnosis and effective management.
          • A holistic strategy is advocated, emphasizing the combination of medication with non-medication interventions, recognizing the complexity of ADHD and its co-existing conditions.

          Posted on 8 Dec 2023

          Written by
          Dr Jared Ng, Connections MindHealth

          The recognition of ADHD has expanded significantly in Singapore, yet this heightened awareness has its downsides. There’s a growing tendency to hastily ascribe various behaviours to ADHD, precipitating an upsurge in diagnoses and requests for medication. This is particularly noticeable in academic contexts where students may seek an ADHD diagnosis, not necessarily for managing symptoms but to secure special accommodations or get prescribed stimulant medications. Such a trend muddles the clarity of genuine ADHD cases and ignites ethical debates about the appropriateness of using ADHD medications as tools for cognitive enhancement rather than their intended therapeutic purpose.

          child running around in airport

          Diagnosing ADHD necessitates a comprehensive approach, incorporating detailed assessments and corroborative information from various sources like caregivers and educators, to accurately understand a child’s behaviour in different environments. Medications like Methylphenidate and Lisdexamfetamine have been pivotal in managing ADHD, enhancing brain neurotransmitter levels to improve focus and decrease impulsivity.

          While these stimulant medications can be transformative, improving school performance and interpersonal relationships, they require careful monitoring for side effects such as loss of appetite, sleep problems, and mood swings. Hence, it is crucial for psychiatrists to collaborate closely with parents and educators, fine-tuning treatment plans to ensure the best outcomes for the patient.

          Behavioural therapy is instrumental in teaching children organizational skills, focus enhancement techniques, and impulse control. Additionally, parental training provides caregivers with strategies to establish supportive home environments, fostering consistency and positive reinforcement.

          Yet, the narrative of success for individuals with ADHD should not be narrowly defined by occupational attainment or academic accolades. True success is about harnessing one’s potential and finding joy and fulfilment in life. Jamie’s story embodies this. I first saw Jamie because he was struggling in a “traditional” academic setting in Singapore. He eventually found his calling in the culinary arts, leveraging his ADHD traits of creativity and quick thinking to run a successful small restaurant. He recently told me that he is planning for a sister restaurant! Jamie’s contentment in his career choice and the sense of community he has built are his personal measures of success.

          It is important to note that ADHD’s complexity is often compounded by co-morbid conditions like learning disorders, depression, and anxiety, which require equal attention in diagnosis and treatment. The presence of learning difficulties such as dyslexia or dyscalculia can magnify the academic challenges faced by children with ADHD. Mental health conditions like depression and anxiety can stem from or exacerbate ADHD symptoms, creating an intricate cycle that demands a comprehensive treatment approach.

          The treatment for ADHD and its co-morbidities is not uniform but tailored to each individual. A child may benefit from stimulant medication for focus but may also need support for reading comprehension or managing social anxiety. Behavioural therapy and parental support play multifaceted roles in treatment, offering strategies to manage ADHD symptoms and cope with associated emotional and learning challenges.

          As we assist those with ADHD, we must be vigilant for signs of co-morbid conditions, providing a holistic support system that nurtures not only academic capabilities but also emotional well-being.

          In summary, success for those with ADHD is deeply personal, characterized by achieving well-being and happiness. It is about creating environments where their unique abilities are recognized and cultivated, ensuring that the true mark of success is living a life enriched by their experiences and talents, where they feel content and valued.

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