§4.4. Noögenic neuroses: A person can be emotionally disabled by serious conflicts between opposing personal, ethical, or religious values. This problem has not gained widespread recognition among psychiatrists and therapists. It is a focus of logotherapy (see Chapter 11): G §4.5. Psychosomatic disorders, hypochondria: Physical disorders caused by emotional problems are psychosomatic. Examples include some cases of colitis, stomach cramps, diarrhea, constipation, ulcers, cardiac arrhythmias, impotence, back and neck spasms, and migraines. Hypochondria involves an exaggerated concern over potential and imagined symptoms of disease. Physical examination followed by: P, C, N, W, X §4.6. Sexual disorders: These include impotence, frigidity, vaginismus (vaginal muscle spasm), premature ejaculation, and sexual role disturbances when accompanied by emotional disorders or poor social functioning (some cases of homosexuality, transsexualism): P, E, O, N, W; sometimes with Y If you are willing to work on this within a wider focus: A §4.7. Impulse control disorders: e.g., pathological gambling, kleptomania, pyromania: O, M, E, Q §_5 Mood Disturbances (Affective Disorders)_ There are three primary mood disorders: depression, mania, and manic depression. They may be neurotic, or they may be psychotic, in which you experience hallucinations, delusions, and withdrawal from reality. Each disorder may be situational or nonsituational, depending on the role of precipitating events, such as the death of a loved one, loss of a job, diagnosis of terminal illness, etc. Situational mood disorders usually disappear with time. All three disorders may appear as isolated episodes, or they may be recurrent. §5.1. Depression: Clinical depression is not simple sadness or grief. Severely depressed people speak slowly, laboriously. It is difficult for you to maintain attention and concentration. You may have feelings of hopelessness, despair, heaviness, self-blame, heightened self-criticism, great pessimism about the future, inability to make decisions, tendencies to think of suicide and sometimes to commit it. Dependence on loved ones increases as you feel helpless. Interests diminish in work, hobbies, and friends. You may cry frequently; you may be irritable and {74} inclined to have angry outbursts. You probably sleep poorly and awaken frequently, particularly in early morning. Anxiety is common in about 50 percent of patients. There is frequently little appetite for food or for sex: Y, E, P, U, T, W, X As a sense of deep discouragement with life: H Depressed as a result of a conflict in personal values: G If you are willing to work on your problems within a wider focus (also see §1.1): A