Abstract:
Any curable disease may be cured by any potency, when the indicated remedy is administered, but the cure is much accelerated by selecting the potency or dose most appropriate to the individual case. Psychological disorders very common in the present era and anxiety disorders are one of the most prevalent psychological disorders in the world. They include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Excessive fear or anxiety concerning separation from those to whom the individual is attached, is called separation anxiety. Homoeopathy is a system of medicine which has proved its efficiency in various psychological disorders. Here is a case of ‘separation anxiety disorder’ which was effectively managed using homoeopathic constitutional remedy in high potency.
Keywords:
Homoeopathy, constitutional treatment, high potency, anxiety disorders, separation anxiety.
Abbreviations: COVID -19 – coronavirus disease 2019, DASS 21 – depression anxiety and stress scale-21, HAM A – Hamilton anxiety rating scale
Introduction
“In my experience, the 10 M potency is the most effective in bringing about lasting psychological improvement, and I give it in most cases of psychological pathology unless the body is too frail to take it, or there is a danger of serious physical aggravation”, as quoted in the work, ‘Homoeopathic Psychology, personality profiles of the major constitutional remedies’, by Philip M. Bailey. The following case report will throw light upon the above view.
Anxiety has become a regular part of every individual’s life in this busy world. But for some, it is a bigger issue, interfering with their daily routine. It is more common in females than in males. According to diagnostic and statistical manual of mental disorders, fifth edition (DSM-5), anxiety disorders include separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalised anxiety disorder, medication induced anxiety disorder and anxiety disorder due to other medical conditions.
In separation anxiety disorder, the individual is fearful or anxious of being separated from a person to whom he/she is attached. There is persistent fear or anxiety on harm coming to the attachment figures or may be having nightmares .Physical symptoms of distress may be exhibited by many. Usually separation anxiety begins in childhood, but can persist throughout adulthood.
In selective mutism, the individual fails to speak in social situations where they are expected to speak, even though the individual speaks in other situations. The failure to speak leads to negative consequences on achievement in academic or occupational settings.
Individuals with specific phobia are fearful or anxious about certain objects or situations, and often avoid them, for example, animals, blood, injection, etc. The fear, anxiety, or avoidance is almost always immediately induced by the phobic situation. In social anxiety disorder (social phobia), the individual is fearful or anxious about social interactions and situations that involve the possibility of being scrutinized, and try to avoid them. The individual fears being negatively evaluated, humiliated or rejected by others in such situations.
Panic attacks are abrupt surges of intense fear or intense discomfort that reach a peak within minutes, accompanied by physical and/or cognitive symptoms. Panic attacks may occur either in response to a feared object or situation or without any reason. Panic attacks may also occur in many disorders including substance use, depressive and psychotic disorders.
People with agoraphobia have fear and anxiety on two or more of the following
situations: using public transportation; being in open spaces; being in enclosed places;
standing in line or being in a crowd; or being alone, outside home. These situations are often avoided or they need a companion. Generalised anxiety disorders present with persistent and excessive anxiety and worry about various domains, including work and school performance, that the individual finds difficult to control. The individual experiences physical symptoms,
including restlessness, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbances.
Substance/medication-induced anxiety disorder involves anxiety due to substance intoxication or withdrawal or to a medication treatment. In anxiety disorder due to another
medical condition, anxiety symptoms are the physiological consequence of another medical
condition.(1)
Case report:
A 32 year old man presented with headache with pressing sensation over whole head, palpitation<lying down ,chest pain, trembling of hands, difficulty sleeping and tight feeling of whole body. He had difficult concentration and had lost interest in everything. His speech was found to be hurried. On enquiry, it was found that he was having these problems since the last 8 months, since he was separated from his wife. Both he and his wife had been working abroad and he returned to his hometown in February 2020.His wife was expected to return a few months afterwards, but due to COVID 19 situation, she could not come and unite with her husband.
Mental generals-He felt that he is not loved by anyone (forsaken feeling) and had disappointed feeling. He also had dreams of dead people.
Physical generals-His appetite was normal, thirst was absent with dryness of mouth .His urine and stool were normal. He had normal perspiration. He had a desire for pungent things.
Reaction to heat and cold –He had intolerance to cold weather, preferred warm bathing and desired covering and had aversion to fanning.
The depression anxiety and stress scale-21(DASS 21) was used to assess the emotional state of the patient. It is a set of three self reported scales designed to measure the emotional states of depression, anxiety and stress.(2)
The symptoms of anxiety were more for the patient, than those of depression and stress.
Diagnosis
Separation anxiety disorder.(1)
To assess the severity of symptoms of the patient, Hamilton anxiety rating scale(HAM-A) was used. The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety(physical complaints related to anxiety).Each item is scored on a scale of 0(not present) to 4(severe),with a total score range of 0-56,where<17 indicates mild severity,18-24 mild to moderate severity and 25-30 moderate to severe.(3)
Here, the patient had a score of 24, which showed that he had mild to moderate severity.
Analysis and evaluation of symptoms with miasmatic analysis
| Symptoms | Intensity | Common/uncommon | Miasm |
| Mental Generals Forsaken feelingDisappointedDreams of dead people.Hasty speech | ++ ++ + ++ | Uncommon Uncommon Uncommon Uncommon | Psora(7) Psora(7) Syphilis(7) Psora(7) |
| Physical Generals Thirstlessness with dryness of mouthDesires pungent things | + ++ | Uncommon Uncommon | Psora(7) Sycotic(7) |
| Particulars Pressing pain in headPalpitation<lying down | ++ + | Uncommon Uncommon | Psora(7) Syphilis, Tubercular(7) |
Based on the totality of symptoms ,the patient was given a dose of Arsenicum album 10M,on 18/11/2020.
Justification for the remedy and potency:
On repertorisation using RADAR 10 Synthesis repertory(4), the remedies with maximum marks were Arsenicum album, Nux vomica and Phosphoricum acidum. Nux vomica is very irritable and sensitive. This patient is not as sensitive and irritable as Nux vomica. The patient is also not as indifferent as Phosphoricum acidum.(5) 10M potency was apt in this case of psychological condition. As the patient was physically healthy and could endure a high potency of the individualised constitutional remedy.(6)
Follow up
| DATE | SYMPTOMS | PRESCRIPTION |
| 25/11/2020 | Headache better Palpitation better Chest pain better Trembling of hands persists Sleep better Tight feeling better Concentration difficult Speech hurried | Placebo |
| 2/12/2020 | No headache Palpitation occasionally No chest pain Trembling better Sleep good Tight feeling better Better concentration Speech normal | Placebo |
HAM-A Score on 2/12/2020 was 11,which means mild severity.
Conclusion
Homoeopathic treatment acts internally and individualises each person by his/her constitution. It gives great importance to the patient’s psychological condition. The accurate remedy in the appropriate dose and potency speeds up the process of cure. The above case of separation anxiety disorder could be managed effectively by homoeopathic constitutional remedy in high potency, as proved by the improvement in HAM-A scores.
REFERENCES
- American Psychiatric Association; Anxiety Disorders; Diagnostic and Statistical Manual, 5th ed; Washington DC; American Psychiatric Publishing;p.189,190
- DASS 21;Available from: maic.qld.gov.au
- Hamilton Anxiety Rating Scale(HAM-A);Available from:dcf.psychiatry.ufl.edu
- Shroyens Frederich; RADAR Version 10
- Boericke William; New Manual of Homoeopathic Materia Medica &Repertory;9th ed; New Delhi; B. Jain Publishers;2000;p 464,492
- Bailey M Philip; Homeopathic Psychology; New Delhi; B. Jain Publishers;2008
- Banerjea K Subrata; Miasmatic Diagnosis; Revised ed; New Delhi; B. Jain Publishers;2003
About the author
Dr Dhanya G. Nair,BHMS,MD(Hom.)(Practice of Medicine)
Consultant Physician at Dr.Dhanya’s Homoeopathic Multispeciality Clinic, Thottakad, Kottayam, Kerala, South India
Author of articles in state wide, National and International journals in Homoeopathy. Has published articles titled “Managing pneumonia Homoeopathically based on the general symptoms: A case report” in the July 2019 issue and “Constitutional approach in Homoeopathy cured hypothyroidism: A case report” in the November 2020 issue of Homoeopathic Heritage.
