Social Isolation, Not Just Feeling Lonely, May Shorten Lives

2013-03-28

Feeling lonely seems to go hand in hand with being isolated, but there’s a difference, according to a growing body of research.

It’s no secret that people who are socially isolated tend to be at greater risk of health issues, from mood disorders like depression to stress-related chronic conditions like heart disease. But what is really responsible for these negative outcomes — the emotional toll of feeling alone or the physical and social lack of contact with others?

Now a new study suggests that being socially isolated may have a greater effect on risk of early death, especially among the elderly. The research, which was led by Andrew Steptoe, a professor of epidemiology and public health at University College London, followed 6,500 British people over 52 from 2004 until 2012. The most socially isolated in this group were 26% more likely to die during the study period than those with the most active social lives, even after controlling for factors that also affect mortality, like age and illness.

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What Really Causes Violence in Psychosis?

2013-03-19

A new study investigates how anger associated with delusions — not simply being out of touch with reality — is critical in determining whether psychosis turns violent.

The research, published in JAMA Psychiatry, included 458 participants around age 31 who experienced a first episode of psychosis in East London, an inner-city neighborhood with a history of poverty and social stress, between 1996 and 2000. They were diagnosed with some sort of psychosis either through local mental-health services and hospitals or via the criminal-justice system.

Schizophrenia and schizoaffective disorder — a condition that includes the delusions and social withdrawal of schizophrenia, along with a mood conditions like depression or bipolar disorder— together accounted for more than half of the participants’ diagnoses. However, 14% suffered from psychotic depression, a condition in which delusions develop as part of a severe depression, and 10% had bipolar disorder in which a manic episode included psychotic delusions. The rest were diagnosed with a variety of less common psychotic conditions.

Nearly two-thirds of the participants were not involved in any violence at all in the year before their first psychotic episode. But 26% had committed what the authors defined as minor violent acts, including assaults that did not lead to injuries or involve weapons. Another 12% were seriously violent, engaging in crimes like injurious assaults, use of lethal weapons or sexual attacks.

The researchers, led by Dr. Jeremy Coid, a professor of psychiatry at Queen Mary University in London, interviewed participants about the content of their delusions and their emotional experiences. Anger related to delusions was strongly linked with attempting to harm others. After adjusting for other factors, 31% of the minor violence could be attributed to anger connected with delusions. In the seriously violent patients, anger accounted for 56% of the incidents. Elation, anxiety and fear were not associated with violence.

Those who engaged in violence also tended to be younger and were more than twice as likely to have taken drugs in the past year, although alcohol use did not matter. The seriously violent were far more likely to be male, but there was no difference in risk by gender for minor violence.

None of the delusions were dangerous in and of themselves. But three types, all of which involved a sense of personal threat, were linked to serious violence if they provoked anger. One delusion centered on the idea that the person was being spied on or was under surveillance by some type of threatening authority, group or person.  Another focused on the misguided belief that people with hostile intent were targeting the victim. Finally, there was the fantasy of some sort of conspiracy against the delusional person.

Any anger generated from feeling threatened under these situations could make the patients lash out. “Anger due to delusions appeared to constitute the main drive to serious violence,” the study authors write. On the other hand, a more depressive response to the threats seemed to thwart violence so that a “depressive affect had a protective effect,” according to the research.

“If patients are not angry, the delusions themselves don’t cause a problem,” Coid told the New York Times. What causes delusions to result in angry responses in some people and not in others? Researchers aren’t sure, but they believe that a better understanding of this connection, as well as a greater appreciation for how this anger response is related to the delusions of psychosis, could lead to treatments that prevent violent behavior and its potentially tragic consequences.

What to do after an affair

2013-03-18

By Ian Kerner, CNN Contributor

• Infidelity is much more complicated than our culture admits, expert says
• Couples can find their way to a deeper and more intimate bond after an affair
• You can’t heal from infidelity overnight — take time to rebuild the relationship slowly

Editor’s note: Ian Kerner, a sexuality counselor and New York Times best-selling author, writes about sex and relationships for CNN Health. Read more from him on his website, GoodInBed.

We’ve all heard the adage: “Once a cheater, always a cheater.” If your partner has been unfaithful, you’re likely getting all sorts of advice from well-meaning friends and family.

Much of that advice may involve ending your relationship. Yet it’s possible — and perhaps even beneficial — to stay in a marriage or long-term relationship when one partner cheats. That’s the idea of two new books from noted experts on the topic: a newly revised edition of the best-selling “After the Affair” by Janis Abrahms Spring and “The New Monogamy: Redefining Your Relationship After Infidelity” by Tammy Nelson.

But should you really forgive and move on after infidelity?

“Most of us are totally unprepared for what lies ahead in a relationship, and ignorant of what’s required to last the course,” Spring writes. “An affair shocks us into reality. Fortunately, it also invites us to try again.”

Adds Nelson, “Many couples instinctively know that infidelity is much more complicated than our culture sometimes admits.”

Couples can, and do, often find their way to an ultimately deeper, more intimate bond — but it can take time and effort.

“In the wake of infidelity, most betrayed partners feel surprised and caught off guard,” says marriage and family therapist James Walkup. “But even though the hurt person may have assumed they would not stay married to a straying spouse, they may realize they still love their partner and want to work on the relationship.”

Today, not all committed relationships follow the traditional definition of monogamy. For example, both partners may decide together what constitutes cheating going forward — whether that means flirting with a particular friend, visiting a strip club or even having sex outside the relationship.

“I have seen a growing number (of) straight and same-sex couples thrive on the infamous ‘monogamish’ agreement,” psychotherapist Jean Malpas says. “They realize that long-term relationships might need to include the reality of attractions to other people. They carefully define trust and craft guidelines for acceptable behavior based on their level of comfort with risk and fluidity.”

Such a “monogamish” approach tends to be more common among gays, lesbians, bisexuals and transgendered people, notes sex therapist Margie Nichols.

“The issue is commonly on the table for consideration or discussion when LGBTQ partners get together, and when a transgression is purely sexual (as opposed to emotional), it may be less likely to end the relationship,” she says.

That’s not to say that monogamish couples are safe from infidelity, however.

“Just because a couple is monogamish does not mean that they will be any more forgiving of a partner who breaks the rules and violates their trust,” says social psychologist Justin Lehmiller. “Deciding whether to work things out has less to do with the gender of the partners and more to do with whether it was a good quality relationship to begin with.”

Nelson adds, “Ideally, your relationship will continue to grow and change as each of you grows and changes, and it may change position on the (monogamy) continuum throughout the years.”

You can’t heal from infidelity overnight. Instead, take time to rebuild your relationship slowly. Rather than ignoring the affair, be willing to share your pain, listen to each other and provide comfort when one partner is remembering the betrayal — all can help lessen the pain while re-creating the original bond that joined the two of you together.

“Turning your back on a damaged relationship may be the simplest or most sensible solution, one that frees you from the tyranny of hope,” Spring writes. “But it also may be a way to escape growing up, facing bitter truths about life, love and yourself, and assuming the terrible responsibility for making your relationship work.”

Some couples undoubtedly view an infidelity as the end of their relationship — and in some cases, going your separate ways may be the best decision. But for partners who are willing to recommit themselves to each other, an affair can be a turning point.

“Sometimes my clients acknowledge that coping with infidelity was the worst and yet the best thing to happen to their relationship,” Walkup says. “The distance between them has been bridged, and a deeper level of sharing and intimacy can bring joy and hope in the long run.”