Diary – When tiredness favors chaos rather than structure


Exhaustion & Panic Disorder

118HIn October 2015, I was diagnosed with severe Exhaustion Disorder. I also suffer, depending on the day, from a mild Panic Disorder. The point of this post, however, is not to explain how I have gotten to that point – for I have written about it before – but rather to assess my situation as it is today. This is not an easy task mainly because I wish I could avoid thinking about it. Unfortunately, the healing process demands that I ponder on the matter more often than not.

According to the National Board of Health and Welfare in Sweden, there are five criteria to be evaluated – quote:

Table 1. Criteria for Exhaustion Disorder according to the National Board of Health and Welfare in Sweden
A. Physical and mental symptoms of exhaustion during at least two weeks. The symptoms have developed in response to one or more identifiable stressors present for at least six months.
B. The clinical picture is dominated by markedly reduced mental energy, as manifested by reduced initiative, lack of endurance, or increased time needed for recovery after mental effort.
C. At least four of the following symptoms have been present, nearly every day, during the same 2-week period:
1/ Concentration difficulties or impaired memory
2/ Markedly reduced capacity to tolerate demands or to work under time pressure
3/ Emotional instability or irritability
4/ Sleep disturbance
5/ Marked fatigability or physical weakness
6/ Physical symptoms such as aches and pains, palpitations, gastrointestinal problems, vertigo or increased sensitivity to sound
D. The symptoms cause clinically significant distress or impairment in occupational, social or other important respects.
E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a physical illness/injury (e.g., hypothyroidism, diabetes, infectious disease).

Source: Construction and evaluation of a self-rating scale for stress-induced Exhaustion Disorder, the Karolinska Exhaustion Disorder Scale

When rating the answers to the test on each criterium, all results above 20 points (54 being the maximum) place the patient in the risk zone for depression. Four months after I first took the test, I am still above 20 which proves one very important aspect of the illness: the healing process is extremely slow. I knew that of course, my doctor said so himself, but it was even more striking as I just took the test again a week ago.

Since it has happened, I am on full-time sick leave, have regular appointments with my doctor, as well as with a Cognitive Behavior Therapist and I also started (and as of now, stopped) a Mindfulness course at my healthcare center. I have an incredible support system with my husband, my friends and my parents. This helps to move forward at a pace that best suits my present situation and state of mind.

Therapy and Mindfulness

The therapy is giving me a lot to think about. Strangely, I do not think I have yet been actively thinking about the different points discussed in my sessions. I know, however, that it has helped immensely to re-focus solely on myself. The latest tool I should use is some kind of a barometer to measure the stages until I get exhausted. On the other side of the barometer, should coincide the tools to prevent each stage from excalating. Furthermore, each stage should be associated with pictures that talk to me… I chose Chihuahuas, since I love ’em. The pictures look like that: Exhaustion BarometerBarometer_back

I believe the tools are supposed to evolve with time, but so far, they are as accurate as I can make them.

Now, when it comes to mindfulness I have to admit that following a course once a week is not really my thing. The expectation – I surely put on myself – of feeling improvement every week after regular “training” is somewhat a structure that does not sit well with me at the moment. Structure and routine are a hinder to my feeling good. Furthermore, talking about how my training is going during the course, puts a lot of pressure on my mind. All this sound like an excuse but it is not. It is the way things are and it is ok; I don’t judge anymore, I just acknowledge the situation.

The tools that my therapist gave me are more efficient and useful than the mindfulness course, and yet she told me that mindfulness exercices are good and will help me. All I have to do now, is find the little something in between that will unlock my resistance to the routine everybody advise me to follow. I need to do what is best for me and I am the only person who can figure that out. When tiredness favors chaos rather than structure, it is already too late, so I’d better get a move on and listen better to what my body is telling me so I can heal better.

There is no hopelessness in my situation, only the will to be well again.

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