As a psychologist, I typically ask patients to describe the emotional state or social situation that brings them to my office. In 34 years of clinical experience, I've heard a variety of descriptions. Some individuals have researched their symptoms and may describe themselves as depressed, anxious, phobic, obsessive-compulsive, or anorexic. Others use common words or descriptions such as "I'm sad", "I worry too much", or "I'm paranoid!" Some are quite articulate and offer symbolic interpretations such as "My heart's been eclipsed" or "I've lost the wind in my sails".
Some patients describe family, social, or cultural circumstances as part of their emotional status and condition. I've heard "My family put the 'D' in dysfunctional" or "We have to use rent-a-cop at the Christmas Dinner". Some focus on a specific event or situation of concern such as "I'm going through a divorce" or "I'm worried about a surgery".
It's also common to encounter a description of their difficulties from a social or competency standpoint. Common interpretations of their condition might be "I'm not running on all cylinders" or "My light's gone out".
One label is often used to describe all the above – the presence of years of stress, a mental health condition, social problems, and an impairment in their ability to function effectively in the home or community. The description for this condition is often "Bad Nerves". "Bad Nerves" is patient's diagnosis - a description of several impairments and/or problems that are generally more complicated than any single clinical issue such as a phobia or depression. The term "Bad Nerves" doesn't suggest that the physical nerves, neurons, or nervous-system structure of the body is impaired. Shaking and tremors in the hands may be the most visual and observable symptom of "Bad Nerves" but the self-diagnosis suggests more than anxiety or tremors.
The term "Bad Nerves" is almost never used to describe situational depression, grief, or an emotional reaction to a specific stressor. Instead, the term "Bad Nerves" often suggests several different emotional, personal and social problems that have been active for many years. In some cases, it's difficult to identify when "Bad Nerves" started or what stressful events are involved. In other cases, an incident in the past may be identified as the starting point, suggesting the Bad Nerves began after a divorce, work injury, death of a loved one, or other significant trauma.
Psychologists use the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) to describe mental health conditions. To be given a diagnosis of depression for example, a patient must have a depressed mood, reduction in interest/pleasure, weight loss or gain, sleep disturbance, physical agitation or chronic fatigue, feelings of worthlessness, impaired concentration, and recurrent thoughts of death or suicide. As I thought about what conditions, symptoms, and situations combine to produce "Bad Nerves", a list of criteria came to mind.
In my experience, the condition of "Bad Nerves" is actually a group of several factors that are present in the same individual. When these "Bad Nerves" factors are combined, they tend to be overwhelming and often make it very difficult for the individual to function effectively in their life. The following diagnostic criteria might be considered for a diagnosis of "Bad Nerves":
The individual with Bad Nerves feels overwhelmed. They often summarize their situation with "I don't know what to do…or where to start!" They also voice a sense of hopelessness and helplessness with "I've always been this way" or "Nothing I've ever done has helped".
Treatment for Bad Nerves involves several approaches that include mental health care, improving social skills, and reorganizing the lifestyle. Here are some guidelines:
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