Nonpsychotic Disorders

The highest frequency of occurrence among nonpsychotic mental disorders is found in substance abuse and alcoholism, which affect over 16% of the general U.S. population (Regier & Burke, 1989). Although alcoholism is at its peak in middle age, many older adults turn to alcohol as a means of coping with grief, loneliness, and pain. Alcoholism in early and middle adulthood occurs more often in men than in women, but, because of loneliness and depression, many women also start drinking in later life (LaRue et al., 1985). Older alcoholics are more likely to manifest impairments in memory and thinking.

Because alcohol is rich in carbohydrates but low in proteins and vitamins, long-term users can develop cirrhosis of the liver due to protein deficiency or Korsakoff's syndrome due to vitamin B deficiency. The symptoms of Korsakoff's syndrome, a chronic brain disorder occurring most often in chronic alcoholics in their fifties and sixties, include disorientation, impulsiveness, memory loss, confabulation,1 and inflammation of the peripheral nerves of the body.

Less common than alcoholics and other substance abusers are antisocial

1 Confabulation is filling in a memory gap with details or a falsification that the individual believes to be true.

personalities, individuals who possess little conscience or regard for other people. Antisocial personalities become less numerous with age, seeming to "burn out" by the fifth decade of life.

Other serious, nonpsychotic mental health problems includegeneralized anxiety, phobias, panic disorders, obsessive-compulsive behavior, and hypochondriasis. If untreated, these conditions can persist throughout life, often becoming more intense as the individual is confronted with the physical and psychological stresses of aging.

Phobias are irrational, persisting fears of some object, person, or situation. One of the most common phobias is agoraphobia, an abnormal fear of being alone or in open, public places, where escape might be difficult in case of a panic attack. Recurring panic attacks triggered by specific stimuli or situations are usually diagnosed as panic disorder. The role ofgeneralized anxiety in neurotic conditions is particularly apparent in phobias and panic attacks, but it is also important in obsessive-compulsive behavior. In this disorder, obsessions — recurring thoughts or ideas—and compulsions —specific behaviors performed in a rigid, repetitive manner-serve the function of controlling anxiety.

Another nonpsychotic disorder that presumably helps to control anxiety is hypochondriasis, an excessive preoccupation with health in the absence of significant physical pathology. Hypochondriacs are preoccupied with their bodily processes and irrationally afraid of disease. Hypochondriasis may occur at any age,but older adulthood, in particular, is often accompanied by an increase in hypochondriacal behavior. This disorder ranks third among nonorganic disorders in older adults, depression being first and delusional disorders second (LaRue et al., 1985). Hypochondriacs tend to shift from system to system within the body, complaining one week of kidney problems, the next week of stomach problems, and the week after of a respiratory disorder. Hypochondriasis has sometimes been associated with "dependency neurosis," in that it provides a way of escaping from stress by assuming the role of an invalid.

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