What are examples of decompensation?

Having a diagnosis in mental health, such as, Borderline Personality Disorder, a person would be aware of the areas in which their response to stress is weaker, areas such as a sensitivity to rejection and perceived abandonment. Likewise, for someone diagnosed with Panic Disorder, perhaps being in a crowded place would be a trigger.  Knowing this about oneself ahead of time allows one the opportunity to compensate, by making use of helpful coping mechanisms.

Decompensation, is what happens when your usual ways of coping are no longer working, and your symptoms worsen, indicating a decline in your mental wellness. When we reach the point of relapse or crises, there have usually been many signs or clues along the way beforehand.  These clues can be specific behaviours, physical body sensations and/or emotions. These things are unique to you, that only you would know or someone who knows you well, would be able to recognize and would indicate that you may be decompensating.

Below are a few ways in which we may be trying to regulate our emotional distress that are NOT the most helpful – even harmful, to ourselves.  This may indicate a healthier alternative to self-regulate is needed.

Behaviours:

• Excess skin rubbing or picking (until skin abrasions or sores/bleeding is present).
• Jaw clenching and/or teeth grinding (causing damage to teeth, headaches, sore jaw).
• Self medicating behaviours: Drinking more coffee/alcohol than usual, or eating larger amounts of sweets.
• Excess nail biting or chewing around cuticle area (causing damage/deformity/abrasions and pain).
• Insomnia or over sleeping.
• Hyper vigilance (Enhanced state of sensory sensitivity) also may be startled easily.
• Isolation/withdrawn.
• Taking prescription drugs in order to self medicate.
• Spending an excess amount of time on social media or electronic devices.

Emotional and physical responses:

• Increased Irritability, shortness, impatience and anger.
• Restlessness: Feeling as if you have to move constantly, i.e. Pacing, cleaning, fidgeting.
• Lack of motivation; lethargy.
• Frequent crying spells.
• Loss of joy/interest in usual things.
• Increase anxiety.
• Exhaustion – i.e. burnout

Physical Symptoms:

• Muscle tightness and tension.
• Headaches/migraines.
• Ulcers, upset stomach, Irritable bowl syndrome.
• Loss of appetite or increased appetite.
• Excess tiredness.
• Lack of self-care and grooming – i.e. showering, shaving, hair cut, laundry, dressing up/makeup.
• Any other unpleasant symptoms which may result from medications side effects and that should be explained to your doctor.

Every person, diagnosed or not, has ways in which they self-regulate and cope with day to day stresses.  For individuals with a mental health diagnosis, self-care is especially important in prevention of a relapse into harmful coping strategies.  There are many healthier coping alternatives. If you find yourself doing any of the above and anything else that only you would know that may not be as functional for you, find something else with which to replace those behaviours.

A helpful practice by which to identify physical body sensations is called bio-feedback.  This can be a self-guided body checkup, identifying the physical things happening in your body, then turning those sensations into emotions – giving it a name.  Once you have named the emotions that are creating the physical sensations, sit with the feeling – even If it feels uncomfortable or you are unsure as to what is causing the feeling.  Work with your body instead of against it – i.e., not pushing the feelings away.

A lot of the behaviours and symptoms noted above, can indicate that we are not attending to ourselves.  It is important to attend to ourselves with intention; to gain a superior awareness and recognition of decompensation.  This is a crucial process in maintaining mental wellness.

Something to try:

Make your own personal list of indictors that reveal your decompensation symptoms. Then make another list of alternate things you can do to replace them.  This can be part of a powerful self- awareness/self-care tool kit!

Warm Regards

Oriana

xo

Keep healing, keep growing. keep finding your truth.

The term “episodes of decompensation” is a crucial concept to understand if you’re applying for Social Security Disability (SSD) and/or Supplemental Security Income (SSI) benefits based on a diagnosed mental illness.

Decompensation is a clinical term used to describe a mentally ill individual’s state of mental health when he or she was previously managing the illness well but suffered a downturn at a certain stage. That stage is considered a decompensation or decline in overall condition.

Episodes are periods of decline that occur. Each period during which a patient’s mental health declines, even if for a very limited time, is considered an episode.

Episodes may occur frequently and last for a short duration or may happen less often and last for a longer period of time. Regardless of how common or uncommon they may be, and no matter how long they may last, episodes of decompensation must be clearly detailed in your medical records if you’re pursuing SSD benefits based on a psychiatric condition or mental illness.

Episodes of decompensation are a crucial component of meeting eligibility requirements for SSD benefits for those disabled by a mental illness, and like all other medical documentation, the SSA defines what documentation is acceptable for meeting the burden of proof in a claim. With episodes of decompensation, the SSA requires documentation showing:

• The applicant’s symptoms worsened for a period of time.
• The claimant was unable to adapt or appropriately respond to stress and/or normal changes.
• The applicant was severely limited during the episode and was therefore unable to perform normal activities of daily living like completing tasks, concentrating, remaining social or communicative, etc.

In other words, the documentation that is contained within your mental health records and your SSD application must show that during episodes of decompensation your symptoms got worse and you were unable to function because of them.

In addition to proving the existence of episodes and documenting what affect they have on your ability to maintain employment, you must also attribute episodes to specific causes. Your application must contain explanations for what triggers episodes and your medical records must communicate the reason for the episode, as well as the length and duration of each episode.

There are multiple causes of episodes of decompensation with mental illnesses. The specific cause doesn’t typically affect eligibility for SSD other than that it must be defined and clearly documented in order to prove episodes occurred at all. Potential causes can include:

• Treatments that become ineffective over time,
• Situation-based stressors,
• Increases in patient-specific drivers that fuel condition decline,

There are a number of conditions that require the clear documentation of episodes of decompensation. These include, but are not limited to: Anxiety, Autism, Bipolar Disorder, Depression, Mental Retardation, and Schizophrenia.

Decompensation is defined by the American Psychological Association as a breakdown in an individual's defense mechanisms resulting in progressive loss of functioning or worsening of psychiatric symptoms. The symptoms are unique to each person and their diagnosis, but may include sensory, perceptual, emotional, or cognitive changes.

What causes decompensation? Who may be affected? Are there any warning signs?

We answer these questions and more in our article!

The term "decompensation" refers to when a bodily structure or system, previously in balance (compensated), becomes unbalanced (decompensated), causing symptoms to appear. The term implies a structural fragility, a potential imbalance, which was previously compensated and then suddenly is no longer so, following destabilizing circumstances. 

In medicine, decompensation is a general term used to describe a variety of situations. Decompensation can be, for example, cardiac, metabolic, respiratory, or psychological in nature. In each case, it is a question of the breakdown or functional deterioration of an organ, an organism or a psychological structure.  

Mental decompensation is therefore a breakdown of the psychic balance in a person following an emotional crisis, traumatic event, etc. It can imply a break with reality and most often occurs after the fact, once the "danger" has been averted.    

Decompensation can occur in mental illnesses such as schizophrenia, bipolar disorder, or chronic hallucinatory psychosis and can also affect people with neurosis and/or depression. However, it can also occur in people without any mental health conditions. 

The patient may not be aware that he or she is decompensating.

What are the causes and symptoms of mental decompensation? How is it diagnosed?

Mental decompensation is marked by serious and debilitating symptoms. It can manifest both physically and psychologically. These symptoms may fade or persist depending on how the new psychic balance is established. 

Physically, there are symptoms of sweating, chest pain, cardiac arrhythmia, and insomnia.  

Psychologically, this sudden imbalance triggers powerful and unusual symptoms, such as:

• Delusions: Their onset is sudden, and they typically fade within a few days or weeks. The person may describe persecution (conspiracies, possession), grandeur (power, discoveries), or mystical themes. Mood can be variable.
• Mental (thoughts) or sensory (auditory, visual, olfactory, and/or sensory) illusions or hallucinations
• Confusion
• Phobias
• Addictions
• Anxiety attacks
• OCD
• Depression

Frequently, the first episode of decompensation occurs in people who may already experience psychosis, such as those with schizophrenia or borderline personality disorder.

The causes of mental decompensation are still poorly understood. Mental disorders are thought to be due to a combination of biological, psychological, and social factors. It can, therefore, be caused by an external factor, such as drugs and/or alcohol abuse, overwork, lack of sleep, etc. Lockdowns and isolation can also encourage these manifestations. 

Adolescence may also be a triggering factor, which would explain why the first psychotic episodes are often triggered between the ages of 15 and 25

The diagnostic criteria for mental decompensation are listed in the two main classification systems used in mental health care: the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

How is mental decompensation treated?

When faced with an episode of mental decompensation, the first reaction should be to accompany the person to hospital. Often, hospitalization in a psychiatric unit is necessary, to allow the patient to regain his or her psychological balance. 

As a first step, therapists will often prescribe medication. These may include anxiolytics, antidepressants and/or antipsychotics (neuroleptics). The latter aim to reduce the excess of dopamine in the body that is involved during a delusional episode. A balanced dosage is important to maintain the patient's emotional and social life.

Antipsychotic drugs can cause dyskinesia, or the occurrence of abnormal muscle movements or discomfort in voluntary movements, which must be corrected. 

Next a psychological approach will be undertaken, which is essential in the care of a patient experiencing psychosis. It is important in this situation to establish a dialogue and active listening with the patient, as well as with relatives and professionals. Family and friends play a crucial role in supporting a person affected by mental decompensation.

It is advisable to treat the psychotic episode as soon as possible, to avoid endangering the life of the person or their family. 

There are other forms of care aimed at helping the patient regain his or her psychological balance. This may include sports, meditation, sophrology, cardiac coherence and also music, art, and theatre. 

It can take several years to find a lasting balance, but it is attainable. Regular psychotherapeutic follow-up helps to work on oneself, to regain confidence and to reclaim one's environment. The establishment of rituals, mentalization and the anticipation of tasks and activities are methods that help to lead an almost normal life.

How to prevent mental decompensation?

Prevention of decompensation is a public health issue. To reduce the risks, we need to inform and support those the most at risk.

The current pandemic has shown that a stressful or sudden change can lead a large number of people to decompensate. The COVID-19 lockdowns were a triggering factor for many, as they disrupted our routines and habits. A new balance and way of living had to be established. Then, later, the end of lockdown was another significant change requiring us to readapt and restore our balance once again.

To prevent a possible decompensation, it is necessary to maintain one's habits and environment, avoid boredom, continue to have a social life, be aware of current events without focusing on the negative, and be able to connect with others. 

For people who have already experienced one or more mental decompensations, it is important to work on managing the triggering factors in order to better avoid or control them. 

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