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Anxiety Disorder

Anxiety disorder, anxiety illness, anxiety and phobia, social anxiety, panic attacks, anxiety and depression

Obsessive Compulsive Disorder – OCD

Collecting, Organizing, Checking, Washing…. Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder.

OCD - Bug ObsessionIt is composed of two parts: Obsession and Compulsion.  Obsession is the portion of OCD that occupies your thoughts such as excessive concerns about cleanliness (my kids call this germophobia), extreme social fear, fear of harming someone, preoccupation with organization or other intrusive thoughts that create anxiety.  Compulsion is the physical manifestation of needing to do something about the obsessionsCompulsion results in behaviors such as ritualistic behaviors like excessive hand washing, repeatedly checking to make sure the stove is off, counting steps and other extreme behaviors such as hoarding.

OCD the Good
Once I while participating in a wedding, I was attending the rehearsal dinner at the home of the bride whose mother made the appetizers for over 200 people.  I was amazed at her management skills that made her capable of preparing appetizers from a single kitchen – right up until the time that when looking for the restroom adjacent to the laundry, I opened the pantry door.

There, staring at me were over 100 spice containers, of all the same brand, all the same size and all angled at a precise 45-degree angle so that the labels were all pointed exactly at my head.  I was so dumbfounded that I continued to stare and found that on the other shelves there were precise pyramids of 5 cans each of various vegetables – all the same brand, all the same size, with all the labels facing exactly the same direction.

Lining the floor were plastic bins, spaced 2 inches apart…exactly, containing 3 bags each of a variety of pasta, flour, rice…. all of course the same brand, carefully placed in the bin, with the label in exactly the same location.

This is OCD at its best – at least for others.  She had an obsession and a compulsion that created this superbly organized pantry.  Likely though, even this “good” OCD manifestation took up a lot of her time – and had a negative impact on her daily life and that of her family’s.

OCD is not always at its best however and can result in the opposite – hoarding.  I don’t have to go into this but if you haven’t seen it, you should watch “Hoarders” or “Hoarding, Buried Alive” for some insight.

OCD the Bad
In addition to situations like hoarding, OCD can also interfere with life in other ways.  I have a cousin with OCD, who before he was medicated, found himself unable to leave his driveway due to fears that he would back over a child with his car.  This caused him to spend hours – literally hours every morning starting the car, looking in the rear view mirror, getting out of the car to look behind it, getting back in the car, looking in the rear view mirror, getting out of the car….  He eventually found himself unable to work.

Obsessive Compulsive Disorder - OCD Confused MindOthers have found that OCD has limited their lives in similar ways.  Howie Mandel, a well-known comic, has talked about his Obsessive Compulsive Disorder.  It prevented him from appearing in public for many years, in part due to social fear but also due to fear of infection.  Even today, while his disease is “under control,” he does not ever shake hands or allow others to touch him.

How do I know if I have OCD?
A lot of people have rituals – such as specific routines before bed.  A lot of people have extreme concerns which may consume thoughts for a while – such as excessive concerns over money.  The difference in “normal” rituals and “normal” concerns is that they don’t typically impair normal life and they don’t become paralyzing.

Thoughts and behaviors that might indicate OCD:
•    Repeated thoughts or mental pictures about things such as
o    Germs
o    Dirt
o    Intruders
o    Violence
o    Hurting others
o    Embarrassment
o    Disorganization
o    Religious beliefs
•    Repeated behaviors such as:
o    Washing hands
o    Disinfecting surfaces
o    Locking and unlocking doors
o    Counting
o    Repeating steps over and over
o    Keeping unneeded things
o    Excessive grooming
•    Lack of ability to control or stop unwanted thoughts and behaviors
•    Repeated behaviors provide temporary relief from anxiety that is caused by obsessive thoughts
•    Repeated behaviors don’t provide any pleasure other than temporary relief
•    Spending at least 1 hour a day on thoughts and behaviors, creating a negative impact on daily life

The International OCD foundation reports that it takes around 15 years for most people to be diagnosed.  This may be due to hiding of symptoms – but it may also be due to lack of awareness of both the public and health professionals.

What can be done about OCD?
OCD can be treated – it usually cannot be cured but can be controlled.  First line treatment for OCD includes working with a properly trained therapist – most beneficially, one who is trained in cognitive behavioral therapy (CBT).  CBT uses “exposure to” unpleasant stimuli, carried on to the “what if” stage.  “What if” I touch that faucet without disinfecting it?  “What if” I get into the elevator without opening the door 10 times?  The “exposure” period is followed by “response prevention” where the patient chooses NOT to perform the behavior that the “exposure” usually causes.  Over time, the obsession and compulsive thoughts and behaviors become more manageable.
In other cases, medication may be needed – usually given in combination with CBT.  Some antidepressants (not all) will help with OCD.  Anti-depressants that have been shown to help include:
o    Luvox (fluvoxamine)
o    Prozac (fluoxetine)
o    Zoloft (sertraline)
o    Paxil (paroxetine)
o    Celexa (citalopram)
o    Lexapro (escitalopram)
o    Effexor (venlafaxine)

Other medications may also help but have not been “approved” to treat OCD.  Doctors who have found them helpful may use them regardless of whether they are officially approved to treat OCDMedications such as Cymbalta (duloxetine) have been reported to be helpful – and some patients may benefit from short-term use of anti-anxiety agents.

It is important to know that all medications may cause side effects and you should tell your doctor about any other medications you are taking.

Melissa Lind

Obsessive Compulsive Disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety and by repetitive behaviors aimed at reducing that anxiety.

Obsessive Compulsive Disorder can be treated!

Anxiety Treatment Method – Mental Imaging

Use of mental imaging as an anxiety treatment method

While there are many wonderful medications that aid in the treatment of anxiety symptoms, there are other methods for controlling anxiety as well. Mental imaging is one such treatment.

Mental ImagingMental imaging is used in many instances and professions. Professional sports players, speakers, and actors use mental imaging. For the purpose of anxiety, mental imaging works as a relaxation technique. It can be used to negate negative thoughts, and replace those negative thoughts with positive images that help one to face or get through a situation that makes them feel anxious.

To practice mental imaging, you must predetermine what your image will be. Will you see yourself handling a tough situation? Will you see yourself doing something that you didn’t think you could do? Again, you need to have your mental image ready to go before you need it.

The hardest part of mental imaging remembers to use it when you need it. This is not always easy to do when you are feeling anxious, and worries are clouding your mind. You may also need mental imaging aids at the beginning, such as cassette tapes to get you into the state of mental imaging. You may need to close your eyes to practice mental imaging in the beginning as well.

Mental imaging can also be used outside of anxious situations — when you are calm — to help build confidence in yourself.

In fact, people who suffer from anxiety disorders who practice mental imaging outside of anxious situations find that the anxiety episodes that they do have are fewer and far between — and that they don’t last as long.

While mental imaging is very easy, and can be done by anyone, it should not be used to replace medical treatment for anxiety. You still need treatment from a doctor, and you can discuss mental imaging with your doctor.

Mental Imaging and Anxiety

Depression in Young Children

Child’s may become depressed because of several different things

Today, we are more aware of teenage depression, but there still isn’t enough said about depression in younger children. Depression in young children is not as common as teenage depression, but it does still exist, and it is still a significant problem. Did you realize that even babies can suffer from depression?

Depression in ChildrenIn children, depression shows itself through developmental delays, failure to thrive, sleeping and eating problems, social withdrawal or anxiety, separation anxiety, and dangerous behavior. Unfortunately, children are not yet equipped to express depressed feelings in simple words. They may not even be old enough to know what those feelings are. So, for the most part, a child’s depression is expressed in other ways and actions.

When an adult becomes depressed, their first stop may be their medical doctor’s office, followed by an appointment with a therapist. With children, it does not necessarily work this way. Instead, you may need an appointment with a child psychologist so that an assessment for depression can be done, using the Children’s Depression Inventory.

If the child psychologist determines that the child is indeed depressed, he or she may want a physical workup done by the child’s pediatrician to determine whether the cause of the depression is physical. A child may be depressed because there is simply a family history of depression. (Genetically illness) Child’s become depressed because of things going on in their lives, or because of a medical problem.

In most cases of depression in children, the cause of the depression can be associated with more than one of these causes. So, if your child is found to be depressed, and medical reason for it is discovered, you should still seek out answers and determine if one of the other factors — problems in their lives or genetics — are also contributing.

The important thing is to watch your child closely. Is your child getting along with other children? Are they growing and developing as they should? If either of these things isn`t happening, you should seek help before the problem escalates.

Depression in children is not as common as depression in teenagers!

Getting Out of Depression

Some tips to get you out of depression

Major depression is the third most common mental disorder in the US.  Nearly 7 percent of the US population is affected in any one year.  Incidentally, if you are keeping track, the two most common mental disorders are Anxiety disorders and Phobia disorders, including Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder.

Major Depression, also called Major Depressive Disorder (MDD) has an average onset of 32 years of age and is more common in women than in men.  It is also called “unipolar depression” by those who are familiar with Bipolar disorder.  It may include a subset of depressive disorders such as Seasonal Affective Disorder (SAD), which affects people yearly – usually in the winter and Dysthymic Disorder, which is a less severe form of depression.

In order to be diagnosed with Major Depression, a person must meet the DSM criteria including at least five of the following for at least two weeks:
•    Depressed mood most of the day
•    Diminished interest in all or most activities
•    Significant, unintentional weight loss or gain
•    Insomnia or sleeping too much
•    Agitation or psychomotor retardation (slow movement) noticeable by others
•    Fatigue
•    Feelings of worthlessness or guilt
•    Diminished ability to think or indecisiveness
•    Suicidal thoughts

In some cases, depression can be relieved by changes in lifestyle or with psychotherapy, but in severe cases – medication may be warranted.  We are fortunate today in that there are a number of effective medications that have fewer side effects than previous treatments, and the category continues to evolve.

Even with medication – that may not begin working for at least several weeks – some lifestyle changes, and habits may help a person “emerge” from their depression and manage symptoms in the future.

Major DepressionLifestyle changes are difficult, particularly when depressed, but the effort it takes to “soldier through” is worth it in the end.  These tips for helping with depression are not easy – especially when you do not have any energy and don’t feel like getting up, but even though they may not provide a cure – they almost always provide some help.

  1. Get up and move – this is the hardest for most people to do.  It may take a tremendous amount of efforts but even simply getting off the couch or out of bed and walking around the house will help.  Getting up and moving around will increase your blood flow and heart rate will help increase blood flow to your brain and may convince your body that “hibernation” is over.
  2. Get dressed – you may have been wearing the same clothes for many days.  Changing into a “daytime” outfit can help regulate your time clock and may help you feel like you can accomplish something.  If you wear makeup or fix your hair, do so – and by all means, take a shower.
  3. Get out in the sun – don’t stay long enough to get a sunburn but studies have shown that bright light helps your brain wake up.  It resets your internal clock by adjusting your melatonin levels (a hormone responsible for inducing sleep).  It also triggers a “springtime” effect – that again tells your brain and body that winter is over, and it is time to come out of hibernation.
  4. Talk to a friend – making a phone call may not be tops on your mind, but even a wordless chat can help you feel like someone else is aware of your existence.
  5. Watch something enjoyable – even if you don’t want to enjoy anything, do something that would normally make you happy.  Just a little bit of happiness peeking through can go a long way.
  6. Go to bed and get out of bed at normal hours – sleep patterns are often destroyed by depression.  Reestablishing those normal patterns will help reset your internal clock to a natural level.
  7. Don’t take naps – again with both the normal sleeping hours and with the “getting up.”  Reinforcing physiologic habits will help establish normal brain functioning.
  8. Eat healthily – you may want to eat everything, nothing, or only certain foods.  Likely, no matter how much or how little you are eating, you are deficient in some of the necessary vitamins and nutrients – so eating a healthy diet and taking a multivitamin mineral supplement is a good idea.  B vitamins are especially helpful to restore nerve cell functioning, C and E are useful for combating inflammation that can cause sluggishness, D vitamins are useful to aid in the “sunlight” phenomenon discussed before, Calcium and Magnesium are good for the brain cells which are malfunctioning.

Most people who are depressed will find a lot of these activities difficult – and you may only be able to do one or two a day.  None of this is meant to be insulting, but there is science behind all of it – and others have been through it before.
With the help from the medication and the lifestyle adjustments – you will feel like you are coming out of the fog – and be able to do all of them – or sometimes, choose not to.  Choosing not to do something is different than feeling like you are unable to do something – and you want to have control of your life.

- Melissa Lind

Diagnosis and Symptoms of Bipolar Disorder

Bipolar disorder is difficult to diagnose.

The average bipolar patient will see three mental health professionals before getting the right diagnosis. In fact, one-third of bipolar patients will not be diagnosed with the disorder until more than 10 years after they first seek treatment.

There is a lot of similarity between the symptoms of bipolar disorder and other psychiatric conditions, but that isn’t the only reason why it is so difficult to diagnose. Here are some of the complicating factors:

Bipolar Disorder PatientThe patient only talks about depression – as bipolar disorder is a condition that has periods of depression alternating with manic episodes, many patients present when they are depressed. This is particularly true when a patient seeks treatment for themselves. Manic patients feel good or at least energized and are unlikely to believe that anything is wrong. Either they feel terrific, or they are in a heightened “bad” mood – and likely to blame that on other people or life circumstances. Consequently when they first seek treatment – they only profess to the depression as that is most bothersome.

Bipolar disorder looks like anxiety – in actuality, many, if not most bipolar patients also have some type of anxiety disorder. Consequently it may be very difficult for mental health professional to root out bipolar disorder. If patients are seen as agitated, hyperactive or fidgety, they may be only asked about anxiety or given a self-rating scale for anxiety. This would immediately lead the practitioner to diagnose an anxiety disorder – unless careful investigations were done.

Substance abuse can be complicating the issue – many bipolar patients spend years self-treating with substances of abuse. This includes prescription medications, recreational drugs and alcohol. There is not any particular drug that is more often abused by bipolar people as a whole – some will choose alcohol, some will prefer stimulants, some will choose pain medications – all of which will mask the symptoms to some extent. In some cases, the substance abuse appears to be more problematic than anything else and in cases of addiction; the substance abuse must be treated before an accurate evaluation can occur.

Denial is very common – Denial is a nice way of saying dishonesty. That would be lying. This sounds very harsh but in many cases, bipolar patients will not be honest about difficulties that they have had. It may be subconscious dishonesty in that they, themselves do not really know what the problem is. Lack of awareness is common but outright denial is also common. Many bipolar patients absolutely refuse to accept the diagnosis when it is first presented – even after years of not being treated properly. Oddly, this may make it more likely that the practitioner believes that the patient has bipolar disorder but such outright denial delays treatment.

These are just a few of the reasons why bipolar disorder is so difficult to pin down and, unfortunately, delayed treatment can have huge life implicationsBipolar disorder is one of the riskiest psychiatric illnesses to have and can have severe consequences for the patient who is not properly diagnosed and medicated – including job losses, family disturbance, institutionalization, jail and even death.

Bipolar disorder affects not only the patient himself – but family and loved ones as well.

Why is it so difficult to diagnose bipolar disorder?