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Pituitary Disorders and the Role of the Family Therapist

Linda M. Rio, M.A.
(First appeared in newsletter for the American Association for Marriage and Family Therapy, California Division 2006)

Throughout my more than twenty year career as a marriage and family therapist, I have had to continually broaden my understanding of the clinical issues I was originally trained to treat. Like most professions, mine has become more complicated over the years. In recent years it seems that understanding the brain-body connection is one of those issues very few of us therapists were properly trained to deal with originally, but one we can no longer ignore. I see developments that have been made in such areas of medicine as those supported by The Pituitary Network Association as deepening the ever-growing link between medicine and mental health. I believe the training and expertise of mental health professionals who are trained in family therapy is ideal for the kind of team effort pituitary disorders require. This article is intended to bring to light the need for family therapists and other mental health professionals to learn to assess all mental health symptoms for potential medical etiology, and refer clients to physicians when we may be the first to spot symptoms. This article is also intended to educate the lay public on the unique skills a family therapist has to offer pituitary patients and their families.

Family therapy is a separate and unique field within the mental health field. The lay public often becomes confused because of the number of choices for a practitioner. Psychology and psychiatry have the longest history and most name recognition. Licensed clinical social workers sometimes practice clinical psychotherapy as do some nurses with special training. Marriage and family therapists are sometimes called MFT (marriage and family therapist), or LMFT (licensed marriage & family therapist), or even use the more generic term psychotherapist, or counselor. In most states all these are licensed or regulated by a state governing body to assure quality education, training, and safety for the public. Any of the mental health professionals may practice from a family therapy, or "family systems" perspective. No matter what a mental health professional is called, having specific training in "systems theory", or having a "family systems approach" will assure they are capable of working with and understanding the dynamics of the family (or even larger in cases of working within companies or other large groups). Often, a family systems therapist will recommend the inclusion of family members or others that may be helpful to the treatment process. Even if family members are not actually included in treatment, a family therapist will view treatment with the patient's entire system in mind.

Pituitary and other endocrine disorders encompass a range and symptoms.. The pituitary gland is often called the "master gland" because it controls the secretions of hormones that have dramatic wide range effects on metabolism, growth and maturation, sexuality and reproduction, and other important bodily functions (Kelly & Cohan, 2004). Symptoms of pituitary disease may appear months to years prior to proper diagnosis and may cause patients to seek mental health treatment first due to the feelings of depression and fatigue. This is not to say that patients cannot also develop clinical depression as a result of any disease, but not everything that looks like depression is, in fact, depression (2004, Weitzner). Prevalence rates for benign pituitary tumors (adenomas) in the general population were found in one meta-analytic study to be approximately 17% (Ezzat et. al, 2004). Non-cancerous tumors may even be as high as 25% since benign tumors are much more prevalent (Khandwala, H., McCutcheon, I., & Friend, K., 2004). Thankfully, most pituitary tumors are benign, but may still cause life-disrupting symptoms. Emotional, relationship and psychiatric symptoms often accompany hormonal disturbances. These symptoms can range from mildly uncomfortable to life threatening. Family system's medicine has much to offer toward treatment of medical pituitary disorders that are accompanied so frequently by emotional and relationship disturbances as well. Family therapists can learn to work more closely with primary care physicians and endocrinologists in the management and sensitive treatment of such patients and their families. Unfortunately, many physicians may be insensitive to the emotional impact of pituitary tumors. Patients may have difficulty finding properly trained, experienced doctors. This may also lead to emotional responses of frustration, anger, depression that affects the stability of the family system.

Pituitary patients may recognize that the first signals of something being wrong with their system and/or body is when they find their sexual health and/or mental health deteriorating. For example, Cushing's Disease is a complex endocrine condition that results from abnormally high levels of cortisol. This is characterized by such symptoms as truncal obesity, diabetes, hypertension, muscle weakness, and emotional lability. Major depression is noted as a prominent feature as well. Since women are effected five times more often than men, and are often misdiagnosed as obese or depressed (Stewart, D, 2004) they may first find themselves in a therapist's office searching for help. Cushing, himself, acknowledged that 'psychic traumas' may play an important role in the pathogenesis of pituitary disease (Cushing,1913). Acromegaly is also a serious and often undiagnosed and unrecognized condition that may be characterized psychologically with changes in personality and increased irritability, anxiety and agitation. An increase in anger, with outbursts at the slightest provocation is possible. Acromegaly is a chronic and debilitating condition that usually results from a growth hormone (GH)-secreting pituitary tumor (Furman &Ezzat, 1998). Recent treatment recommendations for Acromegaliac patients and their families include the need to assess for possible posttraumatic stress disorder (PTSD), and Adjustment Disorders due to the above mentioned symptoms (Furman & Ezzat, 1998). Another disorder, thyroid hormone deficiency (hypothyroidism) is marked by such mental and emotional symptoms as mood changes, decreased cognitive abilities and mental slowness, decreased libido, hair loss, loss of energy, menstrual irregularities, erectile difficulties, and possibly infertility. All of these symptoms are commonly seen within the clinical setting. Unfortunately, such symptoms may go improperly diagnosed unless observed by a professional eye looking beyond merely the psychological symptoms. Proper referral to qualified physicians is necessary to complete the clinical picture and develop a good treatment team.

Many mental health professionals have believed for years in the importance of a holistic approach, one that looks at the mind, emotions, spirit, and body. Increasingly, the more traditional medical field is also recognizing the need for treatment approaches that incorporate the mental health needs of patients as well as their physical care. Research on families and health suggests that marriage and family therapists have an important, but unmet role in the treatment of physical illness (Campbell,2002). The role of the family and other supportive relationships are also becoming recognized in medicine as necessary aspects to a patient's healing process.

Families operate as a unit, one that strives to maintain its stability. When a family member begins to demonstrate behavior outside of the usual and familiar, as with a hormonal disorder, this disturbs the status quo and is a threat to the whole family, not just the patient with the illness. Whether it be the onset of sudden and angry outbursts, or loss of sexual interest, or withdrawal and isolation, or memory or mood changes, these all affect most the family surrounding the person with such symptoms. Nichols ((2005) uses the analogy of a home heating/cooling system to understand how families attempt to deal with such changes in a member. When the thermostat drops below a certain point, the thermostat triggers the furnace to heat the house back to the pre-arranged temperature. It is this self-correcting feedback loop that is the system's response to change and restore its previous state. With small changes or stressors most families can adjust with ease, like the thermostat, and bring things back to their original stability. When the temperature drop too far, like discovering a pituitary adenoma in a family member, getting back to the comfortable state may be quite difficult. Families try many things to restore their house to its desired temperature. Often families will keep trying things that were used in the past and develop "vicious cycles" that may actually make things worse.

Mental Health Professionals are needed as essential members of a well-formed treatment team. Research on families and health suggests that marriage and family therapists do have an important role in the treatment of physical illness (Campbell, 2003). Medical family therapy, or family systems medicine (Block, 1984) provides us in the mental health field with skills to work within, and with the medical field (McDaniel et al., 1992). Family therapists and other psychological professionals need to become more familiar with pituitary and hormonal disorders in order to more quickly identify potential symptoms, refer to qualified physicians, and assist patients and their families in relationship difficulties that often accompany such disorders. Family therapy can be an important component in the early identification and subsequent treatment of pituitary and hormone disorders.

Linda Rio is a marriage and family therapist in practice at New Beginnings Counseling Center, Camarillo, CA, and is on the adjunct faculty at California Lutheran University. She can be contacted at linrio@earthlink.net.

References:

Block, D. A. (1984). The family as a psychosocial system. Family Systems Medicine, 2, 387-396.
Campbell, T.L. (2002). The effectiveness of family interventions for physical disorders. Journal of Marital & Family Therapy, 29 (2), 263-281.
Cushing, H. (1913). Psychic disturbances associated with disorders of the ductless glands. American Journal of Insanity, 965-990.
Ezzat, S. et. al (2004). The prevalence of pituitary adenomas: A systematic review. American Cancer Society, published online in Wiley InterScience (www.interscience.wiley.com), 613-619.
Furman, K.; Ezzat, S. Psychological features of acromegaly. Psychotherapy and Psychosomatics (67) 3, 146-153.
Kelly, D, Pejman, C. (2003). Introduction to pituitary disorders. In S. Ezzat & R. Knutzen (Eds.), The Pituitary Patient Resource Guide, (pp. 22-32 ), Thousand Oaks, CA: Pituitary Network Association.
Khandwala, H., McCutcheon, I., Friend, K. (2004). Pituitary cancer. In S. Ezzat & R. Knutzen (Eds.), The Pituitary Patient Resource Guide, (pp. 22-32 ), Thousand Oaks, CA: Pituitary Network Association.
Nichols, M. (2005). The essentials of family therapy. Boston: Pearson.
Sonino, N.; Fava, G. (1998). Psychosomatic aspects of Cushing's disease. Psychotherapy and Psychosomatics (67) 3, 141-146.
Stewart, D. (2004). Psychosocial aspects of pituitary disease in women. In S. Ezzat & R. Knutzen (Eds.), The Pituitary Patient Resource Guide, (pp. 137), Thousand Oaks, CA: Pituitary Network Association.
Weitzner, M. (2004). Sick of being sick and tired: When depression is not depression. In S. Ezzat & R. Knutzen (Eds.), The Pituitary Patient Resource Guide, (pp. 22-32 ), Thousand Oaks, CA: Pituitary Network Association.

 

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