5,

Attitude towards mental disorders in Ethiopia

Delving into mental health in Ethiopia through psychological lenses exposes the intricate
balance of biological, psychological, and social factors. Although concrete evidence specific
to Ethiopia may be lacking, adopting psychological frameworks such as the biopsychosocial
approach offers a comprehensive understanding of mental health dynamics.
A research study conducted in rural areas of Ethiopia showed that the burden of mental
illness encompasses about 11% of the total burden of disease, with depression and
schizophrenia counted among the top 10 priorities of troublesome circumstances which
indicates that mental illness is still being neglected as a core health priority in Ethiopia.
The prevalence of mental health conditions in the general population was high in low
resource settings like Ethiopia, as a report from different settings indicates, and this includes
common mental illnesses (ranging from 21.6–27.9%) in 2018 , major depression (6.8%),
Khat use disorder (5%) , childhood psychiatric illness (12.5–22%) and schizophrenia (0.5%)
2012–2016.
Understanding how Ethiopian culture influences views on mental health reveals a complex
interplay of traditional beliefs, societal norms, and resource accessibility. While specific
scientific data on Ethiopia's stance is limited, broader research on mental health stigma
suggests that cultural attitudes play a significant role in shaping help-seeking behaviors and
treatment efficacy.
Types and Causes of Mental Disorders:
Mental health disorders in Ethiopia, like elsewhere, encompass a diverse spectrum influenced
by genetic predispositions, environmental stressors, and psychological susceptibilities.
Anxiety disorders, mood disorders, psychotic disorders, and personality disorders represent
common categories, each with distinct diagnostic criteria and treatment avenues.
Types of mood disorders
1. Major Depressive Disorder (MDD)
2. Persistent Depressive Disorder (Dysthymia)
3. Bipolar Disorder
4. Cyclothymic Disorder
5. Seasonal Affective Disorder (SAD)
6. Premenstrual Dysphoric Disorder (PMDD)
7. Disruptive Mood Dysregulation Disorder (DMDD)
8. Substance/Medication-Induced Mood Disorder
9. Mood Disorder Due to a General Medical Condition
10. Other Specified and Unspecified Mood Disorders

Page | 1
Explain the types and causes of treatment modalities for mood disorders

Mood disorders are mental health conditions characterized by disturbances in a person's

mood, such as depression, bipolar disorder, and seasonal affective disorder. These disorders
can have a significant impact on a person's emotional well-being, behaviour, and overall
quality of life. There are various causes of mood disorders, including biological factors (such
as genetics, brain chemistry, and hormonal imbalances), psychological factors (such as
trauma, stress, and negative thought patterns), and environmental factors (such as life events,
social support, and lifestyle habits).

Treatment modalities for mood disorders aim to address these underlying causes and help
individuals manage their symptoms effectively. Here are some common types of treatment
modalities for mood disorders:
1. Medication: Antidepressants, mood stabilizers, and antipsychotic medications are often
prescribed to help regulate neurotransmitters in the brain and alleviate symptoms of mood
disorders. These medications can be used alone or in combination with other treatment
modalities.
2. Psychotherapy: Different forms of therapy, such as cognitive-behavioural therapy (CBT),
interpersonal therapy, dialectical behaviour therapy (DBT), and psychodynamic therapy, can
help individuals identify and change negative thought patterns, improve coping skills, and
address underlying emotional issues contributing to their mood disorder.
3. Lifestyle changes: Making healthy lifestyle choices, such as regular exercise, a balanced
diet, sufficient sleep, and stress management techniques, can have a positive impact on mood
disorders. Engaging in activities that promote relaxation, mindfulness, and social connection
can also help improve symptoms.
4. Brain stimulation therapies: Electroconvulsive therapy (ECT) and transcranial magnetic
stimulation (TMS) are forms of brain stimulation therapy that can be effective in treating
severe or treatment-resistant mood disorders. These therapies work by modulating brain
activity to alleviate symptoms.
5. Light therapy: Light therapy involves exposure to bright light to regulate the body's
internal clock and improve symptoms of seasonal affective disorder (SAD) and other mood
disorders related to light exposure.
6. Support groups: Joining a support group for individuals with mood disorders can provide
emotional support, validation, and practical advice for managing symptoms. Peer support can
be invaluable in coping with the challenges of living with a mood disorder.
It's important for individuals with mood disorders to work closely with mental health
professionals to determine the most appropriate treatment modalities for their specific needs.
A comprehensive treatment plan that addresses biological, psychological, and social factors is
often the most effective approach to managing mood disorders.

Page | 2
ANXIETY DISORDERS
What is anxiety?
Anxiety is a feeling of fear, dread, and uneasiness. It might cause you to sweat, feel restless
and tense, and have a rapid heartbeat. It can be a normal reaction to stress.

Anxiety disorders are a cluster of mental disorders characterized by significant and

uncontrollable feelings of anxiety and fear such that a person's social, occupational, and
personal functions are significantly impaired.

Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy
fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a
variety of other symptoms that may vary based on the individual.

There are several types of anxiety disorders including

 Generalized anxiety disorder

Is severe, on going anxiety that interferes with daily activities.

This disorder can occur at any age, and the condition has symptoms similar to panic disorder,
obsessive compulsive disorder, and other types of anxiety.

These symptoms include constant worry, restlessness and trouble with concentration.

As with many mental health conditions, the cause of generalized anxiety disorder likely
arises from a complex interaction of biological and environmental factors which may include
differences in brain chemistry and function, genetics, differences in the way threats are
perceived, development and personality.

 Panic disorder

Is a mental and behavioral disorder, specifically an anxiety disorder characterized by

reoccurring unexpected panic attacks, which are sudden periods of intense fear that may
include palpitations, sweating, shaking, shortness of breath, numbness or a feeling that
something terrible is going to happen.

The cause of panic disorder is not certainly unknown but it does run in families. risk factors
include smoking, psychological stress and a history of child abuse.

 Social anxiety disorder

Is also known as social phobia. It is an anxiety disorder characterized by sentiments of fear

and anxiety in social situations, causing considerable distress and impairing ability to
function in at least some aspects of daily life. The physical symptoms often include excessive
blushing, excessive sweating, trembling, palpitations, rapid heartbeats, muscle tension,
shortness of breath and nausea. along intense fear and discomfort, panic attacks can also
occur.

Page | 3
As the cause of social anxiety, children who experience teasing, bullying, rejections, ridicule
or humiliation may be more prone. In addition, other negative events in life such as family
conflict, trauma or abuse may be associated with this disorder.

 Agoraphobia

Is a mental and behavioral disorder,. Specifically an anxiety disorder characterized by

symptoms of anxiety in situations where the person perceives their environment to be unsafe
with no easy way to escape, Situations can include public transit, shopping centers, crowds
and queues, or simply being outside their home on their own. being in these situations may
result in panic attack.

Psychological factors that increase the risk of developing agoraphobia include a traumatic
childhood experience such as the death of a parent or being sexually abused, experiencing a
stressful event such as bereavement, divorce or losing an important job.

 Separation anxiety disorder

Is an anxiety disorder in which an individual experiences excessive anxiety regarding

separation from home and or from people to whom the individual has a strong emotional
attachment. Normal separation anxiety indicates healthy advancements in a child’s cognitive
maturation and should not be considered a developing behavioral problem but if it is an
excessive display of fear and distrust when faced with situations of separation from home and
from specific attachment figure, it is termed as separation anxiety disorder.

It is believed that SAD is caused by both biological and environmental factors, it is an

imbalance of two chemicals in the brain that most likely plays a part but sometimes it can be
triggered by life stress that results in separation from a loved one. Genetics may also play a
role in developing the disorder.

 Specific phobias

Specific phobia is an anxiety disorder, characterized by extreme, unreasonable and irrational

fear associated with a specific object, situation or concept which poses little or no actual
danger. Fear discomfort or anxiety may be triggered both by the presence and anticipation of
the specific object, or situation. The main behavioral sign of specific phobia is avoidance. the
fear or anxiety associated with specific phobia can also manifest in physical symptoms such
as an increased heart rate, shortness of breath, muscle tension, sweating or a desire to escape
the situation.

The causes might be past incidents or traumas,learned responses from early life, reactions
and responses to panic or fear, experiencing long term stress and genetic factors.

 Selective mutism

Is an anxiety disorder in which a person who is otherwise capable of speech becomes unable
to speak when exposed to specific situations, specific places, or to specific people, one or
multiple of which serving as triggers. this is caused by the freeze response.

Page | 4
It Is believed that this disorder is related to extreme social anxiety and that genetic
predisposition is likely. It’s mostly an adaptive response and it’s due to behavioral inhibition.

 Diagnostic criteria and treatment modalities for anxiety disorders

As we tried to mention above the diagnostic criterias are taken regarding the mentioned
causes of each types of anxiety disorders.

Using psychological approaches, there are different types of therapy for anxiety. these could
be cognitive therapy, acceptance and commitment therapy, dialectical behavior therapy,
exposure therapy, interpersonal psychotherapy, psychodynamic therapy, applied relaxation,
eye movement desensitization and reprocessing, deep breathing, psychotherapy, mindfulness,
and medications such as benzodiazepine, selective serotonin reuptake inhibitors, tricyclic
antidepressant busprine, and other treatment options.

Coming to our case, the study conducted on major mental disorders in Ethiopia indicates that
phobia is one of the leading anxiety disorders, with a lifetime prevalence of 4.8% and other
anxiety disorders to be 2.7%.

Studies have shown that the majority of Ethiopians prefer traditional and alternative healing
methods like holy water, and are not mostly given serious attention because mental disorders
are not considered as life threatening in low income countries like Ethiopia.

Personality disorder
A personality disorder is a mental health condition that involves long-lasting, all-
encompassing, disruptive patterns of thinking, behavior, mood and relating to others. These
patterns cause a person significant distress and/or impair their ability to function.

Types of personality disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard
reference publication for recognized mental illnesses, organizes the 10 types of personality
disorders into three main clusters (categories)

Cluster A personality disorders involve unusual and odd thoughts and behaviors. It includes:

Paranoid personality disorder:in which a person has paranoia (an extreme fear and distrust of
others). They may think that someone is trying to harm them.

Schizoid personality disorder: in which a person prefers to be alone and is not interested in
having relationships with others.

Schizotypal personality disorder: in which a person has unusual thoughts and ways of
behaving and speaking. They are uncomfortable having close relationships with others.

Cluster B personality disorders involve dramatic and emotional thoughts and behaviors that
can keep changing. It includes:

Page | 5
Antisocial personality disorder: in which a person has a long-term pattern of manipulating,
exploiting, or violating the rights of others.

Borderline personality disorder: in which a person has lots of trouble managing their
emotions. This makes them impulsive and uncertain about how they see themselves. It can
cause a lot of trouble in their relationships.

Histrionic personality disorder :in which a person is dramatic, has strong emotions, and
always wants attention from others.

Narcissistic personality disorder: in which a person lacks empathy and wants to be admired
by others. They think that they are better than others and that they deserve special treatment.

Cluster C personality disorders involve anxious and fearful thoughts and behaviors. It
includes:

Avoidant personality disorder: in which a person is very shy and feels that they are not as
good as others. They often avoid people because they fear rejection.

Dependent personality disorder: in which a person depends too much on others and feels
that they need to be taken care of. They may let others treat them badly because they are
afraid of losing the relationship.

Obsessive-compulsive personality disorder: in which a person needs control and order.

They are perfectionists and can be inflexible. Although some of the symptoms are similar,
this is not the same thing as obsessive-compulsive disorder (OCD).

Causes of personality disorders

Personality disorders usually begin when someone is in their teens or early adult years. The
cause is unknown. However, genes and childhood experiences such as abuse and trauma
likely play a role.

Symptoms of personality disorders

People with personality disorders may have trouble realizing that they have a problem. To
them, their thoughts are normal. They may see others as the problem. So they may not seek
help when they need it. Or, if they seek help, it may be because of another reason. They may
be looking for help because of other mental health symptoms or problems with relationships
and work. Sometimes someone else, such as a family member or social agency, may ask them
to get help.

So far, they believe the following factors may contribute to the development of personality
disorders:

Genetics: Scientists have identified a malfunctioning gene that may be a factor in obsessive-
compulsive personality disorder. Researchers are also exploring genetic links to aggression,
anxiety and fear, which are traits that can play a role in personality disorders.

Page | 6
Brain changes: Researchers have identified subtle brain differences in people with certain
personality disorders. For example, findings in studies on paranoid personality disorder point
to altered amygdala functioning. The amygdala is the part of your brain that’s involved with
processing fearful and threatening stimuli. In a study on schizotypal personality disorder,
researchers found a volumetric decrease in the frontal lobe of their brain.

Childhood trauma: One study revealed a link between childhood traumas and the
development of personality disorders. People with borderline personality.

Diagnosis and Tests

Personality disorders can be difficult to diagnose since most people with a personality
disorder don’t think there’s a problem with their behavior or way of thinking.

Because of this, people with a personality disorder typically don’t seek help or a diagnosis for
their condition. Instead, their loved ones or a social agency may refer them to a mental health
professional because their behavior causes difficulty for others.

When they do seek help, it’s often due to conditions such as anxiety, depression or substance
use, or because of the problems created by their personality disorder, such as divorce or
unemployment, not the disorder itself.

Treatment Modalities:
Personality disorders, characterized by persistent patterns of behavior, thought, and emotion,
present unique diagnostic and therapeutic challenges. Referring to the DSM-5, clinicians
delineate specific criteria for each disorder, guiding treatment approaches such as
psychotherapy, medication, and, in severe instances, hospitalization.

Personality disorders are some of the most difficult disorders to treat in psychiatry. This is
mainly because people with personality disorders don’t think their behavior is problematic, so
they don’t often seek treatment.

psychotherapy (talk therapy) can help manage personality disorders. Psychotherapy is a term
for a variety of treatment techniques that aim to help you identify and change troubling
emotions, thoughts and behaviors.

Page | 7