Download WELCOME Identifying Key Symptoms of Vision Loss across the

Presenter: Margo Siegel, MA, LMSW, PLLC
MAER Annual Conference: Livonia, Michigan
April 28th, 2017
All presentations are subject to bias and/or
selective process. This presentation included
• No matter how much I think I know; someone
always knows more.
• This presentation respects confidentiality and
generalities; (not all people……)
• This presentation was derived from research
findings, years of work experience, academic
training and personal observations.
(Richard Harris, LICSW, NASW: Rhode Island)
•







The AGE at which vision loss occurred
The DEGREE of vision loss** (Spectrum)
The COPING strategies learned and utilized
Preconceived NOTIONS of blindness
The individual’s PERSONALITY before the loss
ATTITUDES of family/friends/medical staff
Societal values or MISCONCEPTIONS
(Tuttle & Tuttle, 2004)
Clarification:
• Those born blind (congenital)
• Those who lost vision after early childhood
• Those having some residual vision (low-vision);
perhaps (e.g., progressive eye disease )
• Those who have additional exceptionalities
besides blindness (e.g., DHH)
• Those who lost vision due to trauma (e.g., car
accident, war injury)
(Tuttle & Tuttle, 2004)
Concerns:
 Socialization (e.g., eye contact, social cues, facial
expression; development of peer
relationships/acceptance)
 Emotional (e.g., attachment, frustration, anger,
behaviors)
 Educational growth/developmental (e.g., slower
pace with developmental milestones in early
childhood; lower academic expectations not
appropriate, but present at times)
(Fox, 2012)
Concerns:
 Loss of: (e.g., employment/income, reading
printed materials, driving ability,
independence, change in daily activities,
decrease in social life)
 Older adults/Seniors (e.g., additional health
issues, death of spouse, cognitive changes,
dependence on others)
 Military (e.g., ocular injury, traumatic brain
injury, war trauma)
(Fox, 2012)
Found in both children and adults; however
they sometimes present differently.





Depression
Anxiety
PTSD
Grief/Loss
Social Withdrawal
(Fox, 2012)
“People suffering from vision loss are twice as
likely to suffer from depression as the general
population.”
(Ascher, 2014)
“By far the most common psychological
comorbidity of vision loss is depression.
Depression interferes with a person’s ability to
function; and yet in too many cases, depression
related to vision loss goes untreated.”
(Fox, 2012)
“Anxiety related to the anticipation of future
vision loss/blindness in addition to phobic
anxieties, such as fear of open spaces,
traveling in crowded areas, and being left
alone.” (Fox, 2012)
“Loss of vision is one of the most feared results
of aging.” (www.uniteforsight.org)
Diagnostic and Statistical Manual of Mental Disorders
(Located under Trauma and Stressor-Related Disorders
section)
Adjustment disorder is a stress-related, short-term,
nonpsychotic disturbance. The discomfort, distress,
turmoil, and anguish to the patient are significant, and
the consequences (e.g., suicidal potential) are
extremely important.
(Frank, 2016)
The specific DSM-5 diagnostic criteria for adjustment disorder are as follows:
•
Emotional or behavioral symptoms develop in response to an identifiable stressor
or stressors within 3 months of the onset of the stressor(s) plus either or both of
(1) marked distress that is out of proportion to the severity or intensity of the
stressor, even when external context and cultural factors that might influence
symptom severity and presentation are taken into account and/or (2) significant
impairment in social, occupational, or other areas of functioning.
•
The stress-related disturbance does not meet criteria for another mental disorder
and is not merely an exacerbation of a preexisting mental disorder.
•
The symptoms do not represent normal bereavement
•
After the termination of the stressor (or its consequences), the symptoms persist
for no longer than an additional 6 months.
•
The following 6 specifiers are used to identify subtypes of adjustment disorder:
•
•
•
•
•
•
With depressed mood
With anxious mood
With mixed anxiety and depressed mood
With disturbance of conduct
With mixed disturbance or emotions and conduct
Unspecified
(American Psychiatric Association, DSM-5, 2013)
As the term adjustment disorder implies, symptoms develop
when the person is responding to a particular event or
situation, for example a loss, a problem in a close
relationship, an unwanted move, a disappointment, or a
failure. Characteristic symptoms include the following:

Low mood

Sadness/Tearfulness

Worry

Anxiety

Insomnia

Poor concentration

Anger, disruptive behavior

Other typical manifestations - Loss of self esteem,
hopelessness, feeling trapped, having no good options,
and feeling isolated or cut off from others (Frank, 2016)
Additionally, children and adolescents with
adjustment disorder commonly exhibit the
following:





Depressed/irritable mood
Sleep disturbances
Poor performance in school
Challenging behaviors **
Isolation/withdrawal /suicidal ideation (especially
with teenagers)
(Frank, 2016)
Clarification:
 Examples: ongoing, daily temper tantrums;
yelling, screaming, hitting, throwing objects,
disrespect of authority figures
 Interferes with learning/academics
 Disrupts daily life at home and in the community
(at least 2 environments)
 Sometimes causes harm to others or self
 Sometimes causes damage to materials or
belongings
(AFB, Brooks, 2017)
5-YEAR OLD CHILD
Additional Considerations:
 Vision loss highest among those >65 yrs. and
increasing; expected to double in next 25 yrs.
 Diagnosis of the following eye conditions: AMD
(age-related macular degeneration), glaucoma,
diabetic retinopathy **
 Comorbidity-two or more health conditions
present simultaneously (e.g., sensory: DHH;
cognitive: Alzheimer’s; physical: Diabetes,
hip/bone fractures)
(Fox, 2012)


Age-related Macular Degeneration (AMD):
30% of people with AMD will experience
depression within a few months of their
second eye becoming affected; and anxiety
related to the anticipation of this progressive
vision loss (Fox, 2012)
Glaucoma: no symptoms occur initially until
significant damage to vision has occurred
causing people to suffer shock/trauma with
the reality of the situation; then possibly
leading to adjustment disorders (CNIB)

Diabetic Mellitus: Adjustment Disorder with
depressive mood in this disease presents with
an increase in hyperglycemic episodes and
increased vascular complications
(retinopathy); patients not motivated to
continue with ongoing laser treatments or
follow-up care due to their depressed
symptoms which may contribute to the
increase in vision loss/blindness.
(Fox, 2012)




At times normal age-related changes in vision and
hearing may be confused with abnormal sensory
changes which may lead to misdiagnosis or
misunderstanding of a person’s level of functioning.
An older individual with vision problems may act
timid, hesitant or confused especially in a new
situation/surroundings.
Just as an older person with hearing loss may miss
the nuances of conversations and appear confused.
Both of these experiences if misunderstood may lead
to feelings of isolation, disappointment and
frustration for the individual. (Crews & Campbell,
2003)
Approaches that may be helpful include the
following:




Psychodynamic psychotherapy (Talk Therapy)
Cognitive-behavioral therapy (CBT)
Family and group therapies (SolutionFocused)
Support groups specific to the stressor
(Frank, 2016)
Learning to adapt and cope with new and uninvited
circumstances
 Working with a professional in a safe, trusting and
non-judgmental therapeutic environment
 Working through challenges and grasping the idea
that there is a balance between continuing to be
independent and being able to ask for assistance
when necessary
 Being in a relationship where a psychotherapist
encourages the “person-centered” approach which
gives the individual responsibility for exploring
his/her own inner wisdom and potential for positive
change
(Delany, 2017)

Because adjustment disorder tends to be time-limited, brief rather
than long-term psychotherapy is often sufficient. The goals of brief
therapy typically include:







To analyze the stressors affecting the patient and determine
whether they can be eliminated or minimized (problem solving)
To clarify and interpret the meaning the patient gives to the
stressor
To reframe the meaning of the stressor(e.g., negative to positive)
To illuminate the concerns and conflicts the patient experiences
To identify a means of reducing the stressor
To maximize the patient’s coping skills (emotional selfregulation, avoidance of maladaptive coping, especially
substance misuse)
To help patients gain perspective on the stressor, establish
relationships, mobilize support, and manage themselves and the
stressor (Frank, 2016)
YOUNG ADULT
Phase One: Trauma
 Hearing initial news of vision loss from medical
staff
 “What hit me?”
Phase Two: Shock and Denial
 “This is not happening to me, or Why Me?”
 “Mental numbness”
 Belief of unrealistic miracle will bring vision back
Phase Three: Mourning and Withdrawal
 Sadness, anger, outbursts, isolation from others
 Feelings of inadequacy; low self-esteem
Phase Four: Succumbing and Depression
 “I can’t”
 Resentment, frustration, hostility, negativism
 Despair, discouragement, disinterest,
distress, disenchantment
Phase Five: Reassessment and Reaffirmation
 “Life is not over”
 The “turning point” in coping
 “I am the same person as before my vision
loss. I may have to do things differently. I
can do it.”
Phase Six: Coping and Mobilization
 Emphasis on strengths, abilities, etc.
 Positive attitude, more confident
 Open to trying new skills/techniques/adaptations
Phase Seven: Self-Acceptance and Self-Esteem
 “I like me.”
 Accepting strengths with limitations, assets, selfapproval
 No longer questioning, “IF ONLY”
(Tuttle & Tuttle, 2004)
SENIOR ADULT
CHILD, ADULT ?
HOPE
“Sometimes life can be unfair. We
cannot stop bad things from
happening; we can only choose how we
will respond to them.”
(Delaney, 2017)
WHAT DID YOU LEARN TODAY?
Ascher, M. (2014 May 3). Vision Loss and
Mental Health: The Hidden Connection.
Retrieved from
https://www.pennmedicine.org/news
American Psychiatric Association. (2013).
Diagnostic and Statistical Manual of Mental
Disorders, 5th Ed. Arlington, VA: APA.
Brooks, C. (2017). Behavioral Issues in Children
with Visual Impairments and Blindness: A
Guide for Parents. Retrieved from
https://www.afb.org
Chronic Illness and Disability. Retrieved from
http://www.goodtherapy.org
Crews, J. & Campbell, V. (2004). Vision
Impairment and Hearing Loss Among
Community-Dwelling Older Americans:
Implications for Health and Functioning.
American Journal of Public Health,
94 (45), 823-829.
Delany, J. (2017). The Benefits of
Psychotherapy. Retrieved from
https://www.fightingblindness.ie/support/
Eger, E. (2004 Nov. 1). Helping Patients Cope
with Vision Loss. Retrieved from
http://www.optometricmanagment.com
Fox, S. (2012 Oct. 29). Visual Impairment:
Understanding the Psychosocial Impact.
Retrieved from
http://www.medscape.com
Frank, J. (2016 Nov. 1). Adjustment Disorders.
Retrieved from
http://emedicine.medscape.com
Module 10: Eye Disease and Mental Health.
Retrieved from:
http://www.uniteforsight.org/community
Sacks, S., Kekelis, L., & Gaylord-Ross, R. (1997)
The Development of Social Skills by Blind
and Visually Impaired Students. New York,
NY: AFB Press.
Sullivan, G. (2000). Helen Keller. New York, NY:
Scholastic Inc. Publisher.
Tuttle, D. & Tuttle, N. (2004). Self-Esteem and
Adjusting with Blindness, 3rd. Ed.
Springfield, IL: Charles C. Thomas Publish.
Wahl, H. (2013). The Psychological Challenge o
of Late-Life Vision Impairment: Concepts,
Findings, and Practical Implications.
Journal of Ophthalmology, Vol. 2013,
Article ID 278135, 11 pages.