Why Therapy Is Broken

Photo collage of a face that's blurred gesturing hands and psychology books on a shelfPhoto-illustration: WIRED staff; Getty Images

Everyone is telling one another to “get help,” but few acknowledge that the practice is often flawed.To revist this article, visit My Profile, then View saved stories.

An hour a week in a shrink’s office is increasingly treated as a prerequisite for a healthy, happy life. There, we imagine, friends learn new coping skills and enemies realize the errors of their ways. Everyone is “healed.” Therapy has been marketed as a panacea for all kinds of issues, from fixing a bad personality to ending racism.

Refusing to seek treatment becomes a red flag, while fluency in “therapy-speak” is all but mandatory. Professional help has even infiltrated our leisure hours: Reality TV shows like Couples Therapy, podcasts from This Is Dating to Where Should We Begin?, and “therapy in a box” card games, some actually designed by psychoanalysts, abound.

Unfortunately, as anyone who’s actually tried it can tell you, therapy often sucks.Anywhere from 50 to 75 percent of people who go to therapy repo rt some benefit—but at least 5 percent of clients get worse as a result of treatment. (For people from marginalized groups, harmful outcomes may be even more common.) The remainder report no clear benefit at all. Plenty of would-be clients go once and, feeling alienated, never return.

Others keep trying, even as it becomes clear they aren’t really getting what they need, whatever that is. But the American mental health care system has hardly acknowledged the existence of bad therapy, let alone taken steps to fix the problem. Instead, in the wake of the Covid-19 pandemic, which sent the demand for therapy soaring, the American Psychological Association and other organizations seemed to prioritize the quantity of available appointments over the quality of any resulting therapy. The rise of app-based mental health care, like BetterHelp and Talkspace, has only made this landscape harder to navigate.

The result is that everyone is telling everyone else to go to therapy, but “nobody really creates space to have dialog about, ‘OK, if it doesn’t work, let’s talk about why,’” says psychotherapist Ben Fineman, cohost of the Very Bad Therapy podcast with Carrie Wiita. That’s partly out of fear of uncertainty, which therapists dislike as much as anyone, and partly because reforming mental health care is complicated. But ignoring these shortcomings is only perpetuating the suffering therapy promises to heal.

The obstacles to good therapy start when clients form expectations of what therapy will entail—which usually happens well before the first session. People often come in with their own “secret agendas,” says Jeffrey Kottler, author of On Being a Therapist. “They’re being blackmailed, or they want leverage, or they’re seeking reassurance.” Even for those that have reasonable expectations and feel eager to put in the work, the process by which transformation unfolds is murky, and therapists aren’t always the best at explaining what is to come.

All psychic healers strive to “clarify symptoms and problems, inspire hope, facilitate experiences of success or mastery, and stir the patient’s emotions,” as Jerome Frank wrote in his 1961 classic Persuasion and Healing. But the fault lines between professional and public conceptions of therapy are numerous. For example, research suggests that about half of therapy-goers will experience improvement in 15 to 20 sessions.

But one study found that the majority of people incorrectly assume they need just six sessions to resolve their issue. Similar gaps in understanding emerge in views on self-disclosure by therapists, the value of negative feedback to therapists, and the purpose of therapy itself. And while therapy is commonly discussed as if it were a single entity, there are hundreds of distinct theoretical models currently used, from EMDR to Gestalt to CBT. Depending on whom you ask, at least 20 orientations fly under the banner of psychoanalysis alone.

Each provides its own model of the brain or mind, the nature of distress, and the path to healing—in other words, its own value system. Even so, therapists commonly mix and match a number of techniques learned in graduate school, from early mentors, and at weekend workshops. This is done mostly for pragmatic reasons, as every client needs a slightly different form of support.

The practice has also been supported by the “Dodo bird verdict” of psychotherapeutic models—named for the Lewis Carroll line, “Everybody has won, and all must have prizes”—which claims that all models are equally helpful or unhelpful. But it’s unclear if the verdict holds up, says Alex Williams, program director of psychology at the University of Kansas. In fact, very little about contemporary psychotherapy is actually backed by credible evidence. In a meta-review of 70 purported empirically supported treatments, Williams and his colleagues found only 20 percent of the interventions are based on reliable studies.

An additional 30 percent were in the “murky middle,” and fully half of the treatments under review didn’t have the evidence their boosters thought they did. For Williams, contemporary therapy is resting on more of a “don’t-know bird verdict.”

Some therapies do appear to be better than others for specific conditions, like exposure therapy for phobias. Others, from conversion therapy to attachment therapy, appear to be dangerous in any context. But even when the underlying method is credible, “most therapists don’t follow a manualized treatment protocol,” says psychotherapist Kirk Honda, host of the podcast and YouTube channel Psychology in Seattle. That makes the line from a controlled trial (where evidence is developed) to the therapist’s couch (where evidence is acted upon) squiggly at best.

To save themselves from analysis paralysis, many therapists fall back on the “common factors,” which suggest that good therapy can be distilled down to empathy, a clear shared goal, positive regard and affirmation, and the like. To date, the so-called “therapeutic alliance” between patient and provider appears to be one of the most important components of successful therapy. Therapy is indeed a “relational art,” and the success (or failure) happens in the unreplicable dynamic between two people. Unfortunately, that insight hasn’t made these alliances any easier to foster.

In the US, finding a therapist—any therapist—can feel as difficult as the problem that drove you to therapy in the first place. Many communities have only one or a handful of mental health professionals to choose from, and some American counties have no psychiatrist (who can prescribe medication) at all. What’s more, private-practice therapists rarely if ever accept insurance, so many clients pay out of pocket—a luxury few can afford.

Even for people who have the time and money to choose, it’s hard to know what to look for. In the absence of a referral or personal recommendation, many people turn to “Find a Therapist” databases from their insurance, ZocDoc, or Psychology Today. But current systems are, understandably, designed to prioritize things like cost, proximity, and availability of services—not expertise in a particular problem or a good fit between patient and provider.

Consider a person who is seeking help for time-consuming rituals. They are likely to end up talking to the next-available therapist about more obvious issues, like the depression or anxiety their rituals cause. Even if this person has a hunch that a label like OCD might apply, and searches for the condition by “issue” for OCD on the Psychology Today site, they will receive dozens of results for therapists who have tagged OCD on their provider pages but don’t actually employ the gold-standard treatment, exposure response prevention.

To find a provider with expertise in ERP, the client would have to know what condition they have and what intervention they require, then deliberately search for providers by “type” of therapy offered instead. Even then, they may find that the therapist they’re paired with has all the right training but is untrustworthy, unprofessional, or unlikable.

When time is segmented into 50-minute billable increments, clients can’t afford to waste a second. But building an alliance with a therapist—or failing to do so—is often slow going. Some individuals seem supremely skilled at this work: In a 2003 study, psychologist John Okiishi found that, in a sample of 91 therapists, the top performers enabled their clients to improve 10 times faster than everyone else. But even a supershrink would, inevitably, struggle to help certain people.

When a client isn’t making progress, the therapist should be the one to point out the problems and offer a back-up plan. In situations where the alliance cannot be repaired (or never formed in the first place), a therapist will typically refer their client out to a colleague who might be a better fit. But in the US, financial incentives can get in the way. Kottler says therapists may be loath to let a source of revenue walk out the door; after all, their malpractice insurance, rent, and other payments are due.

“There have been times in my life, honestly, when my income stream has gone down, and I really need to keep clients and I’m not getting many new referrals,” Kottler says. “And I won’t easily let a client go.” Often, that leaves clients in the position of calling the whole thing off. Some end up ghosting. Others tell their therapist that they’re doing better even when they aren’t. Rare is the client who’s able to speak the truth: “You just aren’t helping me.”

Eliminating bad therapy entirely, whether in person or online, is a quixotic goal. But improvement starts with freeing both clients and therapists from getting trapped in the current “first come, first serve” model. Even in the absence of universal health care, government support for mental health could help people access therapy at no cost to them. Without the burden of out-of-pocket fees, patients would be able to experiment. If a therapeutic alliance doesn’t form on the first try, they’re able to find another.

“I joke with patients, it’s kind of like speed-dating,” says Jessi Gold, an assistant professor in the Department of Psychiatry at Washington University in St. Louis. Put another way: “We’re the medicine,” Gold says. And what do you do if your medicine isn’t working? You try a new one. Instead of leaving people to navigate mental health care themselves, Honda thinks government funding could also be used to create a system for pairing clients and therapists—perhaps a combination of algorithmic sorting and trained professionals who serve as a resource to both parties.

That way, everyone would have a first, second, and third option for therapy already lined up, with a point person to turn to should problems arise. Funding could also make a difference further upstream, by subsidizing psychotherapeutic education. Aspiring therapists of color, LGBTQ therapists, therapists from low-income backgrounds, and others with marginalized identities in particular should be supported as they enter a field that is predominantly white and relatively wealthy.

When coupled with proactive efforts to decolonize psychotherapy, intentional investment in diversity could help to satisfy clients’ growing desire for cultural competence in all its forms. Regulation may also be in order. Right now, American therapists are primarily accountable to their state licensing board, but these organizations tend to respond only to ethical violations in the strictest sense. At the same time, there is no federal agency responsible for regulating specific treatments, even those that consistently do real harm.

Funding research, putting evidence-based regulations in place, and curtailing misleading marketing practices could save many clients unnecessary frustration. In the interim, better technical education for therapists could help them navigate a post-pandemic, late-capitalist, and climate-changed country. Many of the most common “presenting problems” are grief and trauma, yet these topics are not currently a core part of many school’s curriculum, Honda says. At the same time, many therapists are reluctant to adopt new innovations as they try (and often fail) to balance the art and science inherent to their work.

For example, a 2018 trial showed that routine outcome surveys for clients led to better outcomes, yet the vast majority of therapists remain skeptical of the value of collecting such data. For now, it’s important to know that there probably aren’t many truly terrible therapists—just therapists who are bad for you. So while the world waits for a revolution in mental health care, consider getting your break-up speech ready.

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Spot The Signs: 7 Signs You’re In An Abusive Relationship

One third of women worldwide have experienced some form of physical violence by an intimate partner. And in England and Wales, two women are killed by their current or former partner every week. The rates of abuse are alarming, and due to the current cost of living crisis, they are expected to get worse, with concerns that financial difficulty and economic abuse will further trap victims in abusive relationships.

When we think of the signs of an abusive relationship, bruised skin and broken bones often come to mind, but that isn’t always the case as Sandra Horley, CEO of Refuge explained in her book Power and Control: why charming men can make dangerous lovers. Horley identifies the “Charm Man Syndrome”, where a partner’s pattern of abusive behaviour can be so subtle that many women do not even realise they are being abused. Yet, as she states: “the vast majority who come to Refuge are subjected to relentless controlling and demeaning behaviour, whether physical or not”.

“Abuse is Not Love” – a campaign launched by YSL Beauty in partnership with Women’s Aid highlights the warning signs and empowers victims to escape toxic relationships. Marie Claire is working with the partnership to spotlight the red flags of intimate partner abuse.

Here are seven signs to look out for…

1. Abusive relationships often begin with a pattern of control

An abusive man tries to dominate every aspect of his partner’s life. This could mean constantly checking up on his partner through texts, cutting her off in the middle of a telephone conversation, or having clear rules about what can take up space where in the house. Often the incidents will seem trivial, but they can build up into an oppressive, suffocating atmosphere. If the saying “walking on eggshells” rings any bells, it’s likely that the abuser is the one in control.

2. Jealousy is a tell-tale sign of an abusive relationship

Whether he is jealous of your job, friends or social life it really isn’t normal. A partner is meant to say how proud they say they are of your achievements, not make you feel guilty for them.  You may think his jealousy is cute at first. He may call or text you several times a day, and may accuse you of cheating if you don’t respond as quickly as he wants. He might start tracking your every move.  If you are worried that you, or a friend, is becoming increasingly isolated because of their relationship, it’s time for them to get out.

3. An abuser will make you feel the abuse is your fault

One woman told Sandra “looking back I can see it was a sort of suffocation”, another said: “I was cut off from the outside world and from all of my friends, the only logic seemed to be to believe that it was all my fault”. Another’s partner told her that she would be a “failure” if she left. One woman whose husband had abused her for 15 years, who frequently held knives to her throat and threatened her with his gun, told Horley, a whole ten years after she had escaped “actually, I think I was partly to blame”.

4. In an abusive relationship a partner often uses “playful” force during sex

He enjoys throwing you around or holding you down against your will; the idea of rape is a turn on for him. He intimidates, manipulates or forces you to engage in unwanted sex acts with no care for your consent. Horley met many women who put up with sexual abuse because they were afraid of getting hit, their husbands would tell them that they had a “right” to sex. Some were unable to sleep for fear of being attacked in their bed. One woman even said that she was scared to go back to hospital because she was ashamed that her husband had raped her and caused her birthing stitches to burst.

5. Unrealistic expectations emerge quickly in an abusive relationship

An abusive partner expects perfection and for you to meet their every need.  The littlest thing that you do “wrong” will result in endless physical and verbal abuse, making you feel worthless. He will likely have strict rules about gender roles. Horley found this was very common with the domestic abuse survivors that she interviewed, one woman described how whenever she was too busy with the children to cook, she would put a pot to boil on the stove when her husband came home, to give the illusion that dinner was on the way and avoid a row.genesis-768x148-2-1-2-1-1-1-1-1-2-1-1-2-1-2-1-1-2

6. An abusive partner will make threats if you leave

Horley met women whose partners had killed their pets, ripped up their clothes or played with knives in front of them, to ensure that the women always knew who was in control. He could be trapping you into staying in the abusive relationship by telling you that no one else will want you, or threaten to kill himself if you leave. He may threaten to kill you or your children (incidentally, an abused woman is most vulnerable when pregnant).

7. Abusers often have a “Jekyll and Hyde” personality

To the outside world he will appear the perfect partner. He will buy you flowers or your favourite perfume. Maybe he is the most romantic man you have ever known. Obviously, just being romantic is not necessarily a sign of abuse, but an abuser will often use romance to distract from unacceptable behaviours, or even use gifts as a blackmailing tool, particularly following outbursts of abuse or violence.

He will make you believe that if you just did something differently, he would be the loving man you first fell for all the time. It may feel as though you are with two different people – you will stay because of your hope for the man you fell in love with, but you will spend most of your time being controlled by the man who hurts you. Eventually, you won’t be able to tell the difference.

By:

Source: Spot the signs: 7 signs you’re in an abusive relationship

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The Effects of Self-Centered Parenting on Children

Many children suffer grave emotional problems from living with a self-absorbed parent. The child is disregarded and used as an extension of the parent. Often, this means the child’s physical wants and needs, points of view, and emotional needs go unmet.

The Role-Reversal Relationship

Everything revolves around the self-absorbed parent. The relationship is one-sided and directed by the parent. Such a parent enlists the child in caring for and catering to him or her. This creates a role-reversal relationship that is inappropriate for the child’s growth, development, and welfare.

Self-absorbed parents have many characteristics in the ways they relate with their children These relationship traits are well summarized by both Nina W. Brown, EdD, LPC, in Children of the Self-Absorbed and by Lindsay C. Gibson, PsyD. in Adult Children of Emotionally Immature Parents. Such parents manipulate the child to ensure the spotlight of admiration stays on the parent. They lack empathy for the child’s emotional needs. They may show jealousy with any steps the child takes toward individuation––being his or her own person.

Children’s Emotional Responses

Children are affected by growing up with a self-focused parent. When a child is not related to as an individual, a separate person from a parent, there are many emotional and psychological consequences for the child. When a child’s individuality is disregarded, it affects self-esteem and confidence. Low self-esteem in turn can create anxieties and depressions, suicidal thoughts, substance abuse, and runaway behaviors.

There are a wide variety of consequences children suffer in growing up with a selfish parent. Are there discernible patterns to their suffering? Homer B. Martin. M.D., and I found that there are. Children respond to self-centered parents differently based on the child’s personality style. This style is created by how a child is emotionally conditioned within the family. We discovered personality styles form into two types––omnipotent and impotent.

Effects on Omnipotent Children

Omnipotent children try hard to satisfy selfish parents. The omnipotent label comes from the child’s unconscious belief that he or she is psychologically strong and able to fulfill the parent’s needs and requests, no matter how inappropriate. Such children are trained to be emotionally attuned to what the parent needs and wants. It’s a tall order and an impossible job for adults, much less a small child.

A child with an omnipotent personality acts as a complement to a self-focused parent. The omnipotent child will attempt to care for and meet a selfish parent’s needs and desires. Since omnipotent children strive to do what Dad wants or be what Mom demands, they fall short. Selfish parents ask too much and are capricious, readily changing their demands. When these children fail to please selfish parents, they feel guilty, berate themselves, and lose self-esteem and confidence.

Omnipotent-role children feel anxious, get depressed, and believe they are of little value for failing the selfish parent’s demands. This puts them at risk for emotional illnesses of depression, academic failure, social withdrawal from friends, suicidal thoughts, substance abuse, and eating disorders.

Effects on Impotent Children

The other emotionally conditioned role for children in families is the impotent role. These children are raised differently from omnipotent children. Impotent refers to their unaware belief and actions of helplessness in their relationships. They are raised to be self-absorbed, like the self-centered parent. In this situation there are two peas in a pod. Parent and child are alike in personality.

An impotent parent and impotent child robustly compete with one another. Each wants to be the top dog in the relationship. Each wants his or her way. Young impotent children are often bullied by their selfish parent with put-downs and name-calling. At other times they may be favored children, regarded by selfish parents as special. This happens because the parents project their own specialness and self-centered view onto the child. It is like looking in a mirror.

Older impotent children and teenagers bully and fight back with their impotent parent. This can create verbal and even physical conflict, as they both erupt with demands to gain their way in the relationship. Impotent personality teens may run away from home, self-mutilate, abuse substances, or become involved in legal troubles. They are more likely to be outwardly volatile in their reactions to a self-absorbed parent than are omnipotent personality children, who curtail their emotional reactions.

Difficulties Follow into Adult Life

Unfortunately, the effects of living with a self-absorbed parent do not vanish at the end of childhood. As children grow to adulthood, they continue to relate to other selfish people the same way they were emotionally conditioned to do as a child. We discovered that omnipotent personality children often marry self-focused mates. They focus on pleasing and caring for their partner. They neglect themselves in the relationship. Often, they walk on emotional eggshells, striving to never upset their mates.

Impotent children may form the same high-conflict relationships with other selfish people. They will always be in a contest to get their way in the relationship. They may have frequent emotional blowups and even physical altercations.

A Way Out

Hopefully, self-absorbed people will want to improve themselves before they become parents. They can do this by taking honest stock of their own emotional conditioning style.How were you raised? Were you indulged and allowed to have your way a great deal? Did other family members give in to your requests, demands, or tantrums, no matter how unreasonable they were? Do you expect others to meet your desires and never thwart you?

If answers to these questions are positive for you, then you were likely raised in an impotent role. Your job before becoming a parent is to undo some of your emotional conditioning. Seek out psychotherapy and work with a therapist. By so doing you can be prepared to raise your children in a reasonable way, listening to their needs and viewpoints and imposing judicious guidance and discipline. By undertaking the job of changing yourself, their childhoods will not be all about you.

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Coping with Grief During a Pandemic

Since the arrival of the coronavirus pandemic, many of us have experienced loss, sadness, anxiety, and grief. You will often hear how losing a loved one changes you for the rest of your life.

You learn to move forward in life carrying with you the cherished memories of this person and the love they brought into this world, into their relationship with you. For many, this is one of the hardest things they will ever experience in their life. It’s never easy, whether you have experienced a sudden loss of a loved one or losing a loved one due to an illness or cancer, that may have included stays in a hospital or hospice setting.

Pre-pandemic, one vital aspect of this process that helped us grieve was being surrounded by our loved ones and friends. Being present with your loved ones as they were in the hospital, being present with loved ones at a viewing or mass, being present with your family and friends at a luncheon after the funeral, just being physically present with others helped us to cope.

Currently, we are almost a year into the isolating effects of the COVID-19 pandemic and unfortunately, like everyone, I have felt loss. Like others worldwide, I missed casual visits with friends and family, holiday gatherings, having my children’s education interrupted, struggling to adapt to zoom and other online video tools, fear of contracting COVID-19, etc.

The list can go on! My family also experienced two personal losses within a very short time frame. Both were my uncles; both were my mother’s brothers. One uncle contracted COVID-19 and passed away in under a month, and my other uncle lost his lengthy battle with cancer.

How the Pandemic Impacts the Grieving Process

In any time period, losing a loved one is a very difficult experience. You will hear individuals experience stages of grief and loss, denial, anger, bargaining, depression, and acceptance. Maneuvering through these stages is often supported in part by aspects that we are missing because of the pandemic. One of the elements that are different is not being able to hug someone, to give or receive a simple embrace!

People often say that you might not remember what people say, but you will remember how they made you feel. An embrace of love, support, and I am here for you without saying a word is missing these days. Further, visitation limitations in hospitals and nursing homes due to the pandemic have strongly impacted the grieving process.

This deepens the void felt in the time with a loved one who is sick leading up to their passing. This may cause us to feel like we missed out on being there, caring for, and helping our sick loved ones feel like they are not alone. Also, some people are nervous about attending the viewing and funerals. Constraints on large gatherings impact how many people can attend, and even those who attend are spaced far apart.

The purposeful distancing helps to keep it safe in the pandemic but takes away some of the comfort in gathering together to mourn. Some wanted to attend but also wanted to make sure they were safe. In regards to my uncle, one family friend explained, “I really wanted to go, have closure, pay my respects and love to him and all of his loved ones,” but due to COVID-19 and his physical health concerns, was not able to attend.

Recommendations to Help with Loss During a Pandemic

This pandemic has had a huge impact on how we cope with grief, and it may lead us to use some new methods to help us through the tough times. If you or someone you know is dealing with a loss, the recommendations below may help to ease the pain and additional loneliness felt when losing a loved one.

Therapy. Seeing a therapist can help you process your grief and sadness.

Group Therapy (Bereavement groups). Attending a bereavement group can help you connect with others who have lost loved ones. It also may help with feeling like you are not alone and learn coping strategies from others that may better support this extremely difficult time for you.

NAMI or other support groups. Joining a group like the National Alliance on Mental Illness (NAMI) or other support groups such as those offered on social media platforms. This will help you broaden your scope of supportive networks. These groups and support networks are often at zero cost and can be extremely beneficial.

Support and Time. There is no specific way to mourn a loved one. For some, it may take a long time to pass through the stages of grief (denial, anger, bargaining, depression, and acceptance). For those supporting someone who lost a loved one, just being present with them (virtually or physically distanced) and encouraging them to talk about their loved one is extremely beneficial.

They may not remember what you said, but surely will remember how you made them feel. This is especially true with grief – just knowing that you are there, listening, and offering comfort means so much!

Talk. Continue to talk about your thoughts and feelings related to the frustrations, anxiety, sadness, and grief due to the loss of the loved one. Shutting down, avoiding, and isolating can be an instinctual response with grief and understandable due to the significant loss.

Talk about the good times you had with the person, talk about the anger you have related to your situation, talk about the sadness that you have about the loss. The most important thing is to express yourself.

Pictures of your loved one. Looking through pictures of my uncles really helped me and my family. Remembering good times, funny moments, and speaking about their character, values, and personality was extremely beneficial to my family.

Memorialize the loved one. There are various ways you can memorialize your loved one. Some ideas are dedicating and planting a tree, flower, or garden for your loved one, contributing to a local charity, creating an online memorial, or creating a picture box.

Engage in Self-Care. Take care of yourself. Yoga, meditation, walks, music, exercise, gym, and eating right are a few things that can help you during a time of grieving.

Be kind to yourself. Losing a loved one is one of the hardest situations a person can experience. Self-compassion throughout this experience is one aspect that may help you process your grief. This is also easier said than done.

A beautiful quote by Rick Hanson from his book Just One Thing is “you can have compassion for yourself- which is not self-pity. You’re simply recognizing that ‘this is tough, this hurts,’ and bringing the same warmhearted wish for suffering to lessen or end that you would bring to any dear friend grappling with the same pain, upset, or challenges as you.”

By: Patrick McElwaine Psy.D.

Patrick McElwaine is a Licensed Clinical Psychologist and also Licensed Professional Counselor (LPC). He is an Assistant Professor of Counseling Psychology at Holy Family University and a faculty member at the Beck Institute.

Source: Coping with Grief During a Pandemic | Psychology Today

More contents:

Symptoms of Dementia and Early Warning Signs

From age 50 on, it’s not unusual to have occasional trouble finding the right word or remembering where you put things.

Dementia Symptoms at a Glance

  • Difficulty with everyday tasks
  • Repetition
  • Communication problems
  • Getting lost
  • Personality changes
  • Confusion about time and place
  • Troubling behavior

But persistent difficulty with memory, cognition and ability to perform everyday tasks might be signs that something more serious is happening to a loved one’s brain.

Dementia isn’t actually a disease, according to the Mayo Clinic. It’s a catch-all term for changes in the brain that cause a loss of functioning that interferes with daily life. Dementia can diminish focus, the ability to pay attention, language skills, problem-solving and visual perception. It also can make it difficult for a person to control his or her emotions and lead to personality changes.

Roughly 6.5 million Americans are living with Alzheimer’s dementia, according to the “2022 Alzheimer’s Disease Facts and Figures” report from the Alzheimer’s Association. Alzheimer’s disease is the leading cause of dementia, accounting for 60 percent to 70 percent of cases, but a range of brain illnesses can lead to the condition (see sidebar, “Diseases that cause dementia”).

Diseases that cause dementia

These conditions are the leading causes of dementia. Many patients have mixed dementia, a combination of two or more types, such as Alzheimer’s and vascular dementia.

Alzheimer’s disease. Alzheimer’s is characterized by amyloid plaques and tangled fibers in the brain and by a loss of connections between nerve cells. Damage initially appears in the hippocampus, an area of the brain involved in memory formation, and gradually spreads.

Vascular dementia. The second most common type of dementia results from damage to the vessels that supply blood to the brain. It tends to affect focus, organization, problem-solving and speed of thinking more noticeably than memory.

Lewy body dementia. Abnormal protein deposits in the brain, called Lewy bodies, affect brain chemistry and lead to problems with behavior, mood, movement and thinking.

Frontotemporal disorders. Degenerative damage to the brain’s frontal and temporal lobes is the most common cause of dementia in people age 65 and younger. Symptoms might include apathy; difficulty communicating, walking or working; emotional changes; and impulsive or inappropriate behaviors.

A loved one showing symptoms of dementia needs to see a medical expert who can conduct tests and come up with a diagnosis. If a loved one has dementia, you’ll want to plan how you will manage that care, especially as the condition progresses.

But it’s also important to rule out other medical conditions with dementia-like symptoms that may disappear with treatment such as infections and side effects of medications.

Dementia symptoms to watch for

Here are some of the warning signs identified by dementia experts and mental health organizations:

• Difficulty with everyday tasks. Everyone makes mistakes, but people with dementia may find it increasingly difficult to do things like keep track of monthly bills or follow a recipe while cooking, the Alzheimer’s Association says. They also may find it hard to concentrate on tasks, take much longer to do them or have trouble finishing them.

• Repetition. Asking a question over and over or telling the same story about a recent event multiple times are common indicators of mild or moderate Alzheimer’s, according to the Cleveland Clinic.

• Communication problems. Observe if a loved one has trouble joining in conversations or following along with them, stops abruptly in the middle of a thought or struggles to think of words or the name of objects.

• Getting lost. People with dementia may have difficulty with visual and spatial abilities. That can manifest itself in problems like getting lost while driving, according to the Mayo Clinic.

• Personality changes. A loved one who begins acting unusually anxious, confused, fearful or suspicious; becomes upset easily; or loses interest in activities and seems depressed is cause for concern.

• Confusion about time and place. Loved ones who forget where they are or can’t remember how they got there should raise alarms. Another worrisome sign is disorientation about time — for example, routinely forgetting what day of the week it is, says Jason Karlawish, M.D., a professor at the University of Pennsylvania’s Perelman School of Medicine and co-director of the Penn Memory Center.
• Troubling behavior. If your family member seems to have increasingly poor judgment when handling money or neglects grooming and cleanliness, pay attention.

Some people who experience memory loss or have difficulty with attention, decision-making language or reasoning may have a condition known as mild cognitive impairment. The condition causes a noticeable decline, but the changes are less severe than with dementia and a person can still perform normal daily activities, according to the Cleveland Clinic.

People with mild cognitive impairment are at an increased risk of developing dementia.

Signs of dementia? Where to find help

When your loved one is displaying troubling symptoms, a trip to a primary care physician is often the first step. But to get a definitive diagnosis, you’ll need to see a specialist such as a neurologist, geriatrician or geriatric psychiatrist.

If you can’t find one, the National Institute on Aging recommends contacting the neurology department of a nearby medical school. Some hospitals also have clinics that focus on dementia.

Ailments can mimic dementia

Any number of treatable conditions can cause dementia-like symptoms. Some of the most common:

• Alcohol abuse
• Anxiety, depression or stress
• Blood clots, brain infections or tumors
• Delirium
• Head injuries
• Kidney, liver or thyroid problems
• Side effects of medication
• Vitamin deficiencies

Source: National Institute on Aging

Specialists will want to know about the patient’s personal and family medical history. A close relative or relatives having had Alzheimer’s is a major risk factor.

Recent research suggests that a prevalence among even members of your extended family can increase your dementia risk. Doctors also will conduct physical and neurological exams to rule out other treatable causes for dementia symptoms.

Some of the methods that doctors use to diagnose dementia:

• Cognitive and neuropsychological tests assess language and math skills, memory, problem-solving and other types of mental functioning.

• Lab tests of blood and other fluids, including checking levels of various chemicals, hormones and vitamins, can help rule out nondementia causes for the symptoms.

• Brain scans such as CT, MRI or PET imaging can spot changes in brain structure and function. These tests also can identify strokes, tumors and other problems that can cause dementia.

• Psychiatric evaluation can determine whether a mental health condition is causing or affecting the symptoms.

• Genetic tests are important, especially if someone is showing symptoms before age 60. The early onset form of Alzheimer’s is strongly linked to a person’s genes, according to the Mayo Clinic. Talk with a genetic counselor before and after getting tested.

Editor’s note: This article was published on October 22, 2019. It has been updated with more recent information.

By: Patrick J. Kiger

Patrick J. Kiger is a contributing writer for AARP. He has written for a wide variety of publications, including the Los Angeles Times Magazine, GQ and Mother Jones, as well as the websites of the Discovery Channel and National Geographic.​​

Source: Symptoms of Dementia and Early Warning Signs

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Critics:

Having trouble with memory can be an early symptom of dementia. The changes are often subtle and tend to involve short-term memory. A person with dementia may be able to remember events that took place years ago, but not what they had for breakfast.

Another early symptom of dementia is difficulty with communicating thoughts. A person with dementia may have a hard time explaining something or finding the right words to express themselves. They may also stop in the middle of a sentence and not know how to continue.

Having a conversation with a person who has dementia can be challenging, and it may take longer than usual for them to express their thoughts or feelings.

A change in mood is also common with dementia. If you have dementia, it may not be easy to recognize this in yourself, but you may notice this change in someone else. Depression, for instance, is common in the early stages of dementia.

Someone who has dementia may also seem more fearful or anxious than they were before. They could get easily upset if their usual daily routine is changed, or if they find themselves in unfamiliar situations.

Apathy, or listlessness, is a common sign in early dementia. A person with dementia may lose interest in hobbies or activities that they used to enjoy doing. They may not want to go out anymore or have fun.They may also lose interest in spending time with friends and family, and they may seem emotionally flat.

Someone in the early stages of dementia may often become confused. They may have trouble remembering faces, knowing what day or month it is, or figuring out where they are. Confusion can occur for a number of reasons and apply to different situations. For example, they may misplace their car keys, forget what comes next in the day, or have difficulty remembering someone they recently met.

But dementia is not one single condition. It’s essentially an umbrella term that covers a wide range of cognitive disorders. This includes Alzheimer’s disease, which accounts for 60 to 80 percent of cases, according to the Alzheimer’s Association…

More contents:

Caregiving for dementia: Helping your loved one stay connected

Healthy lifestyle, not supplements, prevent dementia

Staying Sharp: Take control of your brain health

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