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”:
- An on-going sense of tension and apprehension. The majority of individuals reporting “Bad Nerves” also report a near-constant sense of tension, anxiety, and apprehension. As though waiting for something bad to happen, they report a sense of anxious expectation. There is also a feeling and attitude that they are not safe or secure, both emotionally and socially. There’s a sense of living in a combat zone where a situation that creates sheer terror can occur at any time. This apprehensive expectation is a characteristic of anxiety and becomes part of “Bad Nerves” when it becomes a daily emotional state that is not triggered by the presence of a real threat or danger. When in a safe and protected environment, individuals with “Bad Nerves” remain anxious and upset.
- The presence of a difficult, traumatic, or stressful upbringing. Patients reporting “Bad Nerves” frequently describe stressful, traumatic or difficult childhoods. They are frequently the product of very stressful family backgrounds where a positive or healthy role model was not available. Many patients with “Bad Nerves” describe how threats, yelling, screaming, and other anxiety-producing situations were part of their daily childhood routine. From descriptions, their families had little in the way of coping or problem-solving skills. Their history may include episodes of abuse or neglect, divorce, or severe family problems. Most individuals who feel they have “Bad Nerves” can also list members of their family who experience the same condition.
- The presence of a period of severe stress or turmoil. In almost every case of “Bad Nerves” there is a period of time in the patient history of severe stress, anxiety, threat, or emotional trauma. Military combat, an abusive marriage/relationship, abuse/assault, environmental trauma (tornado, flood, etc.), a severe injury, or other significant social situation is often identified. The patient with “Bad Nerves” may feel they have never fully recovered from that experience, reporting the sense that the experience still haunts or torments them. They often use the event as a dividing timeline, discussing how their life was different before and after the stressful experience. The changes produced by the event are often extensive and overwhelming, describing the changes with “I haven’t been the same since…”. Patients also describe themselves as having two different social and emotional states – before and after the period of stress. I’ve often heard “Before the accident I was…” as well as “Since that happened I’ve not been able to…”.
- Presence of an active mental health concern. Every individual with “Bad Nerves” has clinical depression and/or anxiety to some extent. As “Bad Nerves” is used to suggest a condition that has been present for several years, a clinical depression is often found. The depression or anxiety disorder brings multiple physical and body symptoms to the stressful social situation. Individuals with “Bad Nerves” have sleep and appetite problems, low energy levels, excessive worry, fretfulness, and bodily signs of stress and/or agitation such as bowel/bladder problems, chest pain, choking sensations, muscle twitches, hand tremors, and a sense of being on-edge or “wired”. Poor concentration and memory are also present and complicate the recovery process. The physical signs of anxiety and depression add to the feeling that “nerves” are involved in their situation.
- Low Self-Esteem. While “Bad Nerves” is used to describe their emotional status, “Bad Nerves” is also part of their self-description and personal identity. In the way that medical patients may describe themselves as “diabetic” or “asthmatic”, individuals who report “Bad Nerves” typically view themselves as less competent than their peers, especially in areas of emotional stability and social judgment. The may view their emotional status as a form of disability or hindrance in their life. Even when they find themselves in times of calm or low-stress, their self-perception of having “Bad Nerves” suggests that if a difficult situation arises – they won’t be capable of handling it. This chronic low self-esteem and self-defeating attitude often prompts individuals to apply for disability, listing “Bad Nerves” as their reason for disability. It may also prevent them from engaging in positive activities such as additional schooling, relocations, better jobs, and other changes in their life – feeling their “Bad Nerves” would surface and prevent their success. A self-description of “Bad Nerves” tells us that self-defeating attitudes and opinions are present. The low self-esteem present in Bad Nerves may have originated in childhood, related to upbringing or family dysfunction, or it may be linked to years of depression.
- A weak or dysfunctional support system. Most individuals seek emotional support, advice, and encouragement from trusted others in their environment. Patients reporting “Bad Nerves” rarely have a good support system where they can obtain positive, useful, and mature information. Often, their support system contains individuals with similar backgrounds or social difficulties. The inappropriate advice from the poor support system often complicates the difficulties of the individual with “Bad Nerves”. Bad advice is typically more damaging than receiving no advice at all. Seeking support from relatives who were also involved in the high-stress childhood and/or upbringing typically adds problems. Confronted with a social issue, for example, advice to “Go out and get drunk” is clearly not effective problem solving. It may be a common family reaction to stress however.
- Impaired or Dysfunctional Coping Skills and Techniques. Individuals reporting “Bad Nerves” typically have inadequate or weak skills when it comes to coping with problems, reducing stress, evaluating situations, and/or knowing what to do in difficult times. Usually related to the lack of a positive or mature role model in their past, their coping strategies range from ineffective to actually making their situation worse. It’s like playing tennis with a broom – your heart’s in the right place but your technique is terrible. When confronted with stressful or complex situations, those with “Bad Nerves” often attempt to cope by using alcohol or drug use/abuse, physical violence, threats, escape behaviors (“I’ll just quit the job!”), or even bizarre reactions. Confronted with a marital separation, they may use partying and sexual promiscuity in an attempt to improve their mood, only to be disappointed when they notice they feel worse. Due to their poor support system, they may follow inappropriate, immature, or even ridiculous advice or recommendations such as “To get out of this depression, you just need to buy a new car!” Poor problem solving and coping skills always keep the solution to most problems out of reach.
- Presence of a high stress lifestyle. Individuals with “Bad Nerves” report stress or emotional turmoil in almost every aspect of their daily life. Problems with finances, jobs, children, spouses and ex-spouses, friends, extended family, medical problems, and life-in-general are reported. One patient added to his list with “Even my dog hates me!” Ineffective problem solving often adds stress to the lifestyle by adding the complications of alcohol/drug use, gambling, illegal behavior, or impulsive actions. When a parent is dealing with Bad Nerves, their ability to parent and guide their children may be impaired, creating behavior problems in the children. This high-stress lifestyle acts to maintain a high level of tension in the individual, making it difficult to address single or specific sources of stress.
- Unstable Friends. Individuals with Bad Nerves typically have relationships with unstable friends and/or family. These friends may be emotionally unstable, needing support at all hours of the day and night, or they may be socially unstable in the sense of needing money, emergency shelter, and help with various complex situations. Instead of being part of a support system, these friends become an additional stressor in the lifestyle of someone with Bad Nerves. There’s a big difference between a friend-in-need and a friend-in-constant-need. When struggling emotionally, these unstable friends add significantly to the level of stress and obligation.
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”.
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