Adult onset diabetes is less serious than juvenile diabetes; it occurs more often in the elderly and especially in people who are overweight. Diabetes can appear in a person after a traumatic event: great stress, a physical accident, surgery, infection, or a severe emotional disturbance. It may also appear after a person has gone through a long period of fatigue, depression, indecision, or sense of hopelessness. Those who become diabetic may be individuals who felt strong resentment toward their parents while growing up or who were "spoiled children." Diabetic men often were dominated by their mothers while being excessively dependent on them. Adult onset diabetes is usually controlled without insulin injections, particularly during the early stages of the disease. Treatment in about one-third of noninsulin-dependent diabetics is possible by diet alone; in others, it is necessary to take oral hypoglycemic drugs that stimulate the release of insulin. The emotional symptoms of both forms of diabetes may include apathy, depression, personality disorders, or even psychosis as a result of undersecretion of insulin. Physical symptoms include the need to urinate frequently, day and night, unusual fatigue and weakness, tingling in hands and feet, reduced resistance to infections (especially of the urinary tract), blurred vision, impotence in men, and lack of menstrual periods in women. HYPOGLYCEMIA Hypoglycemia, or hyperinsulism, which affects perhaps as many as five million Americans, is caused by overproduction of insulin. Excess insulin leads to low blood sugar (literally, _hypoglycemia_). Sometimes this overproduction of insulin is caused by a tumor of the pancreas; the growth can often be removed surgically to correct the condition. The emotional symptoms of hypoglycemia include depression and anxiety. Physical symptoms include fast pulse, palpitations, dizziness, general weakness, faintness, stomach pain, blurred vision, and sweating. These symptoms often occur a few hours after eating and disappear after eating again. {105} Hypoglycemia has become almost a fad disease among "psychonutritionists." The condition is believed by most physicians, however, to be confined mainly to diabetics who have not kept to a prescribed routine and have allowed their levels of insulin to become too high. Sometimes stomach surgery, liver disease, pregnancy, and periods of high fever can cause attacks of hypoglycemia. DISORDERS AND DISEASES AFFECTING THE BRAIN AND NERVOUS SYSTEM EPILEPSY The second most common physical cause of emotionally distressing symptoms, after the metabolic disorders we have just discussed, is epilepsy. Approximately 7 percent of mentally disturbed patients have some form of epilepsy.