Link found between unique brain cells and OCD, anxiety – News

According to the National Institute of Mental Health, 1 in 3 people experience debilitating anxiety-;the kind that prevents someone from going about their normal life. Women are also more at risk to suffer from anxiety. Yet the roots of anxiety and other anxiety-related diseases, such as Obsessive Compulsive Disorder (OCD), are still unclear. In a new study, University of Utah scientists discovered a new lineage of specialized brain cells, called Hoxb8-lineage microglia, and established a link between the lineage and OCD and anxiety in mice.

Mice with disabled Hoxb8-lineage microglia exhibited excessive overgrooming behavior. The symptom resembles behavior in humans with a type of OCD called trichotillomania, a disorder that causes people to obsessively pluck out their own hair. Their experiments proved that Hoxb8-lineage microglia prevent mice from displaying OCD behaviors. Additionally, they found that female sex hormones caused more severe OCD behaviors and induced added anxiety in the mice.

More women than men experience debilitating anxiety at some point in their lives. Scientists want help these people to get their lives back. In this study were able to link anxiety to a dysfunction in a type of microglia, and to female sex hormones. It opens up a new avenue for thinking about anxiety. Since we have this model, we have a way to test new drugs to help these mice and hopefully at some point, this will help people.”

Dimitri Traenkner, research assistant professor in the School of Biological Sciences at the University of Utah and lead author

The study published today in Cell Reports.

Discovery of a new microglia lineage

Microglia are crucial during brain development in the womb-;they ensure that brain structures and neural circuitry all wire together correctly. Traenkner and colleagues showed that microglia belong to least two distinct sub-lineages of cells. One lineage called Hoxb8-lineage microglia makes up about 30% of all microglia in the brain but until now, no one knew whether they had any unique function.

Mario Capecchi, Nobel laureate and senior author of the study, had long suspected that Hoxb8-microglia were special. In previous research, he disabled Hoxb8-lineage microglia expecting some impact on development. But the mice seemed fine.

‘We didn’t really know what to make of the fact that mice without Hoxb8 appear so normal, until we noticed that they groom significantly more and longer than what would be considered healthy. And that’s how the whole thing started,” said Capecchi, who is also a distinguished professor of human genetics at the University of Utah Health.

This is the first study to describe microglia’s role in OCD and anxiety behaviors in mice.

Researchers have long suspected that microglia have a role in anxiety and neuropsychological disorders in humans because this cell type can release substances that may harm neurons. So, we were surprised to find that microglia actually protect from anxiety, they don’t cause it,” added Traenkner.

Female sex hormones drive symptom severity

The mice showed sex-linked severity in their symptoms; female mice’s OCD symptoms were consistently more dramatic than in the males. Females also exhibited an additional anxiety symptom that was lacking in male mice-;the researchers designed and validated a new test showing that the pupils of female mice dilated dramatically, triggered by a fight-or-flight stress response.

To test whether sex hormones drove OCD and anxiety symptoms, Traenkner and colleagues manipulated estrogen and progesterone levels in the mice. They found that at male-levels, female mice’s OCD and anxiety behaviors resembled the male response, and at female hormone levels, male mice’s OCD behaviors looked more like the female’s severe symptoms, and showed signs of anxiety.

“Our findings strongly argue for a mechanistic link between biological sex and genetic family history in the risk to develop an anxiety disorders,” said Traenkner.

What does this mean for humans?

For many, anxiety drastically impacts their work, friends, family and lifestyle. Scientists and health care professionals are always looking for ways to help people get their lives back. This study of mouse models links anxiety to dysfunctional microglia. Down the line, the findings could spark new microglia-focused studies in patients with anxiety and, eventually, help to better treat this debilitating disorder.

“It’s not that we discovered how to fix anxiety in humans, but we constructed a platform for the discovery of new drugs against anxiety,” Traenkner said.

University of Utah

Tränkner, D., et al. (2019) A Microglia Sublineage Protects from Sex-Linked Anxiety Symptoms and Obsessive Compulsion. Cell Reports. doi.org/10.1016/j.celrep.2019.09.045.

Ontario program helps treat anxiety disorders during and after pregnancy that largely go unrecognized


Open this photo in gallery

Lacey Kempinski with her two sons, Pete, 4 and Zack, 2, taken in Paris, Ont., on Oct. 29, 2019.

Glenn Lowson/The Globe and Mail/The Globe and Mail

Lacey Kempinski’s first six months of motherhood were a blur of anxiety. She was terrified of dropping her first-born son down the stairs. She put signs up around the house to remind visitors to wash their hands before touching him and had trouble breathing when he was taken out of her sight. “There weren’t a lot of joyful moments,” said Ms. Kempinski, of Paris, Ont.

While pregnant with her second son, she was diagnosed with perinatal anxiety and enrolled in an experimental therapy program in Hamilton – one of the few in Canada for a condition that goes largely unrecognized, even though it is estimated that one in five women meet the diagnostic criteria for an anxiety disorder during pregnancy and the first year after delivery.

Now, after two years of monitoring participants and their outcomes, the program’s creators are sharing their findings in the hope that more women will get help.

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Clinical and health psychologist Sheryl Green said she created the program at the Women’s Health Concerns Clinic at St. Joseph’s Healthcare because she found no existing guidelines, recommendations or treatment protocols for women with perinatal anxiety – even though her clinic receives more referrals for this condition than for any other.

“Postpartum depression is on everybody’s radar, and that’s fantastic,” Dr. Green said. But since perinatal anxiety can also negatively affect everything from labour and delivery to the child’s development, “it is so incredibly important to have this effectively identified and treated.”

Perinatal anxiety is believed to be more common than postpartum depression, but it receives relatively little attention. Many women mistake their symptoms for the expected jitters of new parenthood, and those who do recognize that they have anxiety have few treatment options, especially non-pharmacological ones.

Postpartum depression often includes feelings of hopelessness or inadequacy and an inability to experience pleasure, whereas perinatal anxiety can involve excessive worrying, intrusive anxious thoughts, panic attacks and avoiding people, places or activities out of fear. Some women can experience both conditions concurrently (singer Alanis Morissette recently opened up about her own experience with both depression and anxiety after the birth of her third child).

While some psychiatric medications are considered safe during pregnancy, they are not risk-free, Dr. Green said, so many women are reluctant to take them while pregnant or nursing. Moreover, medication does not always deliver adequate relief.

So, she gathered elements of existing cognitive-behavioural therapy (CBT) programs for treating various anxiety and mood disorders, and assembled them into her own perinatal program.

CBT, a form of therapy aimed at changing dysfunctional thoughts and behaviours, is effective for treating anxiety disorders, but women who are pregnant or postpartum have very specific needs, Dr. Green said. Given the demands of motherhood, she shortened the typical CBT protocol of 12 sessions to six weekly group sessions and allowed women to bring their babies. She also made the content applicable to the concerns new mothers commonly face, from finances and work to relationships and personal identity.

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She and her team recently finished a two-year randomized control trial to test the program and said the results are encouraging. Women who participated in the six-week program had significant improvements in their anxiety symptoms, regardless of whether they were symptoms of social anxiety, obsessive-compulsive disorder (OCD) or any other type of anxiety, said Eleanor Donegan, a clinical and health psychologist and research analyst at the clinic.

They also had reduced depression and stress and maintained these improvements in a three-month follow-up.

Identifying women with perinatal anxiety is nevertheless a challenge. Nichole Fairbrother, a clinical associate professor at University of British Columbia’s department of psychiatry, who was not involved in the trial, said women with OCD can be reluctant to reveal that they have unwanted thoughts of harming their babies.

Even though they are not at risk of acting on those thoughts, she said, “no one talks about it because it’s terrifying to people to talk about.”

She said it is unlikely pregnancy or childbirth actually trigger most types of anxiety. But even if a woman’s anxiety predates her pregnancy, it is important to address it during the perinatal period, as it can affect the developing fetus, the woman’s birth experience and her parenting, Dr. Fairbrother said.

In Hamilton, the clinic continues to offer the program, which is covered by the province, and the team expects to publish its findings soon and is sharing its CBT protocol with other experts.

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Ms. Kempinski said she still uses some of the things she learned from the program, even though her sons are now 4 and almost 2. For example, when she panics, she uses something called the “best friend” technique: She thinks about what she would tell her best friend in the same situation. Another strategy involves thinking through all the “what if” scenarios and considering the likelihood of the worst possible outcomes.

The techniques don’t work all the time, she said, but she has learned to be easier on herself when she recognizes that she is having an anxious moment.

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Lauv Opens Up About His Battle with Depression and OCD: ‘I Had Fallen Out of Love with Everything’

PEOPLE is launching a year-long initiative to encourage readers to have vital conversations about their mental health. Our Let’s Talk About It campaign will highlight the stories of both ordinary people and celebrities who have dealt with mental illness and provide resources about where to get help and how to offer support to others. 

As more stars are being candid about their struggles with mental health, Lauv has joined the conversation and continues to open up about his experience.

In a post he shared on Twitter, the “I Like Me Better” singer, 25, revealed that he was dealing with a “case of intense obsessive anxiety and depression.” With support and encouragement from loved ones, Lauv decided to see a psychiatrist. In a heartfelt essay written exclusively for PEOPLE, he details his journey dealing with obsessive compulsive disorder and depression. —Darlene Aderoju

Lauv

Why is it that our generation seems to be more depressed and anxious than ever before? Or is it just that we’re talking more about it now?

Whether the latter is the case or it’s truly a result of the life we’re living —  a life full of distractions, constant information overload, social media syndrome (constant self-comparison, heightened insecurity, an unquenchable need for approval, and the endless dopamine loop) — it’s clear that this topic is more top of mind than ever.

We see more and more people opening up about their own experiences and encouraging others to do the same.

I was extremely nervous to open up about my struggles, especially before I was diagnosed with OCD, or obsessive compulsive disorder, and depression. This was largely due to a voice in my head that constantly told me my experiences were invalid.

RELATED: 5 Things to Know About ‘I Like Me Better’ Singer Lauv

In reality, I had spent almost the entire month of January in bed, trapped by obsessive negative thoughts and the need to organize them. My anxiety was at an all-time high, perpetually making me feel like life was on the brink of imploding.

But in my head, I thought I just had to think my way out of it. In reality, I had fallen out of love with everything I used to care about, including the one thing that always brought me purpose: music.

I was living with a vague, haunting sense of disconnection from everyone else (almost as if a blanket had been placed between me and the world). But in my head, I just had to find the one fix (which, by the way, was an ever-changing, made-up idea I had created in my mind).

Distraught and exhausted, I decided to let my friends and family in. And that helped a lot. But after weeks of endlessly cycling conversations with my friends, family and team, I realized I was stuck.

The thing with OCD is that talking about your obsessions can feel really good — like really, really good — because that is the compulsion: the act of relief. But that relief only lasts for a moment. Then, it’s back to obsessing.

Lauv

RELATED: How to Recognize a Mental Health Crisis — and What You Can Do to Help

I kept trying to pinpoint the fix for my sadness, but one of my best friends, who had his own struggles with bipolar disorder, told me I might “just actually be depressed.”  I didn’t understand what he meant, and I shrugged it off. It got worse.

At that point, my sister, who also had her own stint with extreme anxiety, was begging me to go see a psychiatrist. I knew therapy would be part of it, but medication? Reluctantly, I made an appointment with a psychiatrist.

I was diagnosed with OCD and clinical depression and was urged to get on medication. I could write a whole other article about my struggles with the decision to get on medication and the ups and downs of it all, but for the sake of staying on topic I’ll just say: in combination with therapy and a consistent practice of meditation, they worked really well for me.

As I started finding clarity and stability, I decided to open up to the world about my story. Growing up in a family where drawing attention to yourself was not highly encouraged, I was really nervous.

I began beating myself up before I even did anything. But after going through what I went through and having reflected on how the people around me who shared their struggles really helped me, I felt like I had to tell my story.

Still, as I was posting the note on my Instagram, I found myself coming up with every possible negative comment in my head, every possible reason that I was actually a fake and that I should just shut up. Luckily, I didn’t.

Looking back, I wonder if this feeling is the very thing that has historically kept people guarded. Perhaps this is the reason why there is such a prevalence of depression and anxiety, why the male stereotype has sustained emotional stoicism, why there is an abundance of people who feel lost, out of touch with themselves, and at worst, maybe it’s part of the reason why there are so many cases of unexplained suicide.

Perhaps it’s because we’ve undervalued emotional vulnerability for too long. Perhaps we’re so used to being emotionally out of touch that, when we experience moments of being in touch, it’s frightening. Perhaps we’re so used to dealing with it all ourselves, that when the opportunity arises to open up, we feel shame. Or we simply don’t know how.

Lauv

So, while it might start to seem that the increasing conversations about anxiety and depression are becoming cliché, we have to remember what’s really happening here. We are creating a new world where speaking up about one’s own problems is a good thing. A world where we find synchronicity with ourselves and analyze our feelings and experiences openly before they become unmanageable and life-destroying.

Could it be said that, in opening up about our mental health, we are facing a universal fear — the fear of not being accepted — and training ourselves to become less afraid of vulnerability in the future? Is it possible that we are creating a roadmap for a stronger generation and even stronger generations to come? I think so.

If you or someone you know is considering suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), text “STRENGTH” to the Crisis Text Line at 741-741 or go to suicidepreventionlifeline.org.

Anxiety Disorders: Hope is a Major Factor To Help Recovery – E

Hope is closely related to other positive psychology constructs, such as self-efficacy optimism, that have also been shown to have clear relevance to promoting resilience to recovery from emotional disorders

Within the positive realms of psychotherapy: “hope represents the capacity of patients to identify strategies or pathways to achieve goals, and the motivation to effectively pursue those pathways”. This succinct statement holds very true, and if sufferers can get the care they need, and have a psychologist who they feel they have some form of rapport and trust with, they could be motivated to see light at the end of the tunnel, which can make remarkable transformations possible.

A Beacon of Light

Matthew Gallagher, an associate professor of clinical psychology, at the University of Houston, has stepped up, and taken a stand on an age-old debate, the importance of hope. Indeed, back in the 16th century: “Martin Luther celebrated its power, claiming “Everything that is done in this world is done by hope. [Yet], two centuries later, Benjamin Franklin warned that “He that lives upon hope will die fasting.” [But taking his informed stand], Gallagher reports that psychotherapy can result in clear increases in hope and that changes in hope are associated with changes in anxiety symptoms”.

memory
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So What Does the Research Say?

Writing in the journal, Behavior Therapy, Gallagher states that: “hope is a trait that predicts resilience and recovery from anxiety disorders”, and he has empirical evidence to prove it. – The clinical trial in which he is the first author, involves 223 adults, and puts a spotlight on how strong participants’ feeling of hope is, when it comes to anticipating recovery. The subjects received CBD (cognitive behavior therapy), for one of four well known anxiety disorders: obsessive-compulsive disorder; generalized anxiety disorder; panic disorder, and social anxiety disorder.

Gallagher, who noted that average-to-large rises in the participants’ feelings of hope, were uniform across the five detached cognitive behavioral treatment programs, remarked: “In reviewing recovery during CBT among the diverse clinical presentations, hope was a common element and a strong predictor of recovery”.

Of note, the conclusion drawn by the study authors, shows that at some point during the cognitive behavioral therapy protocol: “hope gradually increases during the course of CBT, and increases in hope were greater for those in active treatment than for those in the waitlist comparison”. – This is promising news indeed, and a wonderful accomplishment which was brought about by holistic therapy, as opposed to pharmaceuticals, with all their unwelcome side effects, and open ended use.

This very welcome study forms part of a bigger undertaking which examines CBD’s efficacy for the treatment of anxiety disorders. It is chaired by the founder and director emeritus of the Boston University Center for Anxiety and Related Disorders, David H. Barlow.

Excessive worrying? A psychologist sees a spike in anxiety and offers tips.

My patients worry about work, relationships, children, health and money. When worrying becomes persistent, long-lasting and difficult to control, it can seriously affect daily life. And if the unrelenting worry is accompanied by anxiety symptoms such as irritability, difficulty concentrating, muscle tension, fatigue and poor sleep, that person may be suffering from something called generalized anxiety disorder (GAD).

Investigators Suggest Better Predictors to Diagnosing Mental Illness

Claire Gillan, PhD

Claire Gillan, PhD

In a new study, investigators suggest a need for more individualized approaches to defining mental illnesses because of substantial overlap across different disorders.

A team of investigators, led by Claire M. Gillan, PhD, School of Psychology, Trinity College Institute of Neuroscience and Global Brain Health Institute, recently completed a 285-patient cross-sectional study in the US for individuals diagnosed with obsessive-compulsive disorder (OCD) and/or generalized anxiety disorder (GAD).

The investigators found self-reported compulsivity was more strongly linked with goal-directed deficits than a diagnosis of OCD compared with GAD.

The results could have implications for research assessing the association between brain mechanisms and clinical manifestations, as well as for understanding the structure of mental illness.

The aim of the study was to identify if deficits in goal-directed planning better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder. Each patient completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments between 2015-2017.

The investigators collected follow-up data as well to test for replicability.

Performance was measured on a test of goal-directed planning and cognitive flexibility using the Wisconsin Card Sorting Test (WCST), as well as a test for abstract reasoning.

Clinical variables included a DSM-5 diagnosis of OCD and GAD, as well as 3 psychiatric symptom dimensions—general distress, compulsivity, and obsessionality—derived from a factor analysis.

Overall, deficits in goal-directed planning in OCD was strongly tied with a compulsivity dimension than with a OCD diagnosis.

The mean age of the 285 patients was 32, with a range of 18-77 years old. The patient population included 219 females, 111 individuals with OCD, 82 patients with GAD, and 92 patients with both disorders.

“A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (P = .18),” the authors wrote. “In contrast, a compulsivity dimension was negatively associated with goal-directed performance (P = .003).”

This pattern was also found with abstract reasoning tasks as well as WCST.

“The compulsivity dimension was associated with abstract reasoning (P  .001) and several indicators of WCST performance (P  .001), whereas OCD diagnosis was not (abstract reasoning: P = .56; categories completed: P = .38),” the authors wrote.

However, other symptom dimensions related to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning.

Obsessionality also had a positive association with requiring more trials to reach the first category on the WCST at baseline (P = .04), while general distress was linked to impaired goal-directed performance at baseline (P = .01).

Despite this, neither survived correction for multiple comparisons or was replicated at follow-up testing.
 
In the past, dimensional definitions of transdiagnostic mental health problems has been recommended as an alternative to a categorical diagnosis. Using this technique allows clinicians to capture heterogeneity within diagnostic categories and similarity across them to bridge more naturally psychological and neural substrates.

“This study suggests that transdiagnostic compulsivity symptoms may have greater biological validity than a diagnosis of obsessive-compulsive disorder,” the authors wrote.

There are fundamental issues with using popular international categories for neurobiological research such as the DSM-5 and International Classification of Mental and Behavioural Disorders, 10th Revision.

While diagnostic groups are highly heterogeneous, patients often have the same diagnosis with vastly different symptom profiles.

Individuals without a psychiatric diagnosis usually differ from patients with a diagnosis in several ways beyond the diagnosis under investigation, including anxiety, depression, physical illness, and early-life adversity.

As a result, potential biomarkers, intermediate phenotypes, and etiologic substrates often can only show a modest association with a categorical clinical phenotype, but is unlikely to be specific to that phenotype.

The study, “Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis,” was published online in JAMA Psychiatry.

What Is Trypophobia?

If you’ve ever experienced strong aversion, fear or disgust while looking at objects or photos of objects with lots of little holes, you might have a condition called trypophobia. This strange word describes a type of phobia in which people have a fear of, and therefore avoid, patterns or clusters of small holes or bumps, says Ashwini Nadkarni, M.D., a Boston-based associate psychiatrist and instructor at Harvard Medical School.

While the medical community does have some uncertainty about the official classification of trypophobia and what causes it, there’s no doubt that it manifests in very real ways for individuals who experience it.

So, What Is Trypophobia?

There’s little known about this condition and its causes. A simple Google search of the term will bring up loads of potentially triggering trypophobia pictures, and there are even online support groups for trypophobics to warn each other of things like movies and websites to avoid. Yet, psychologists remain skeptical of what, exactly, trypophobia is and why some people have such adverse reactions to specific images.

“In my 40-plus years in the field of anxiety disorders, no one has ever come in for treatment of such a problem,” says Dianne Chambless, Ph.D., a psychology professor at the University of Pennsylvania in Philadelphia.

While, Martin Antony, Ph.D., a professor of psychology at Ryerson University in Toronto and author of The Anti-Anxiety Workbook, says he did get an email once from someone who was struggling with trypophobia, he has never personally seen anyone for the condition.

Dr. Nadkarni, on the other hand, says she treats a fair number of patients in her practice who present with trypophobia. Although it’s not named in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), an official manual compiled by the American Psychiatric Association used as a means for practitioners to assess and diagnose mental disorders, it is recognized under the umbrella of specific phobias, says Dr. Nadkarni.

Why Trypophobia Isn’t Officially Considered a Phobia

There are three official diagnoses for phobias: agoraphobia, social phobia (also referred to as social anxiety) and specific phobia, says Stephanie Woodrow, a Maryland-based licensed clinical professional counselor and nationally certified counselor specializing in the treatment of adults with anxiety, obsessive-compulsive disorder, and related conditions. Each of these is in the DSM-5. Basically, the specific phobias category is the catch-all for every phobia from animals from needles to heights, says Woodrow.

It’s important to note that phobias are about fear or anxiety, and not disgust, says Woodrow; however, obsessive-compulsive disorder, which is a close friend to anxiety disorder, can include disgust.

Trypophobia, on the other hand, is a bit more convoluted. There is a question of whether it might be better classified as a generalized fear or disgust toward dangerous things, or whether it can be considered an extension of other disorders such as a generalized anxiety disorder, says Dr. Nadkarni.

She adds that existing studies on trypophobia indicate that it does involve some sort of visual discomfort, particularly toward imagery with a certain spatial frequency.

If trypophobia conclusively fell under the classification of a phobia, then the diagnostic criteria would include an excessive and persistent fear of the trigger; a fear response out of proportion to the actual danger; avoidance or extreme distress related to the trigger; a significant impact on the person’s personal, social or occupational life; and at least six months of duration in symptoms, she adds.

Trypophobia Pictures

Triggers are often biological clusters, such as lotus-seed pods or wasps’ nests that occur naturally, though they can be other types of non-organic items. For example, the Washington Post reported the three camera holes on Apple’s new iPhone were triggering for some, and the new Mac Pro computer processor tower (dubbed the “cheese grater” among the tech community) sparked conversation around trypophobia triggers on some Reddit communities.

A few studies have linked the emotional response of trypophobia to the triggering visual stimuli as part of an aversion response rather than a fear response, says Dr. Nadkarni. “If disgust or aversion is the primary physiological response, this may suggest the disorder is less of a phobia since phobias trigger the fear response, or ‘fight or flight’,” she says.

What It’s Like to Live with Trypophobia

Regardless of where science stands, for people like Krista Wignall, trypophobia is a very real thing. It only takes a glimpse of a honeycomb—in real life or on a screen—to send her into a tailspin. The 36-year-old Minnesota-based publicist is a self-diagnosed trypophobic with a fear of multiple, small holes. She says her symptoms began in her 20s when she noticed a strong aversion to items (or photos of items) with holes. But more physical symptoms began to manifest as she entered her 30s, she explains.

“I would see certain things, and it felt like my skin was crawling,” she recalls. “I would get nervous ticks, like my shoulders would shrug or my head would turn—that body-convulsion type of feeling.” (Related: Why You Should Stop Saying You Have Anxiety If You Really Don’t)

Wignall dealt with her symptoms the best she could with little understanding of what was causing them. Then, one day, she read an article that mentioned trypophobia, and although she had never heard the word before, she says she immediately knew this is what she had been experiencing.

It’s a little hard for her to even talk about the incidents, as sometimes just describing things that have triggered her can make the convulsions come back. The reaction is nearly instantaneous, she says.

While Wignall says she wouldn’t call her trypophobia “debilitating”, there’s no doubt it’s impacted her life. For example, her phobia forced her to get out of the water two different times when she spotted a brain coral while snorkeling on vacation. She also admits to feeling alone in her phobia because everyone she opens up to about brushes it off, saying they’ve never heard of it before. However, there now seem to be more people speaking out about their experience with trypophobia and connecting with others who have it via social media.

Another trypophobia sufferer, 35-year-old Mink Anthea Perez from Boulder Creek, California says she was first triggered while dining at a Mexican restaurant with a friend. “When we sat down to eat, I noticed her burrito had been cut down the side,” she explains. “I noticed her whole beans were in a cluster with perfect little holes between them. I was so grossed out and horrified, I started itching my scalp really hard and just freaked out.”

Perez says she’s had other frightening occurrences, too. The sight of three holes in a wall at a hotel pool sent her into a cold sweat, and she froze on the spot. Another time, a triggering image on Facebook led her to break her phone, throwing it across the room when she couldn’t stand to look at the image. Even Perez’s husband didn’t understand the seriousness of her trypophobia until he witnessed an episode, she says. A doctor prescribed Xanax to help ease her symptoms—she can sometimes scratch herself to the point she brakes the skin.

Trypophobia Treatments

Antony says exposure-based treatments used to treat other phobias that are done in a controlled way, where the sufferer is in charge and not forced into anything, may help people learn to overcome their symptoms. For example, gradual exposure to spiders can help ease fear for arachnophobes.

Dr. Nadkarni echoes the sentiment that cognitive-behavioral therapy, involving consistent exposure to the feared stimuli, is an essential component of treatment to phobias because it desensitizes people to their feared stimuli. So in the case of trypophobia, treatment would involve exposure to small holes or clusters of these holes, she says. Yet, since the blurred line between fear and disgust is present in people with trypophobia, this treatment plan is just a cautious suggestion.

For some trypophobia sufferers, getting over a trigger may just require looking away from the offending image, or focusing their attention on other things. For others like Perez, who are more deeply affected by trypophobia, treatment with anxiety medication may be needed to better control symptoms.

If you know someone who’s trypophobic, it’s key to not judge how they react or how triggering images make them feel. Often, it’s beyond their control. “I’m not afraid [of holes]; I know what they are,” says Wignall. “It’s just a mental reaction that goes into a body reaction.”

For patients with eating disorders, cannabis may be the right medicine | Grow

This article was republished from Weedmaps News under a syndication agreement. Read the original article here.

It’s morning in New York City, and Jessica Mellow is preparing for a long day. She pours her first of many cups of coffee and steels herself for another day of work — and another day of anorexia treatment. Not only does the body-paint model have a long session booked, she also has an appointment with her psychiatrist, and dinner with a meal-support specialist. She takes some cannabidiol (CBD) oil to help calm her nerves. Her anxiety is ever-present.

“I’ve found that when I use a bit of pot or take some CBD oil, it helps with anxiety and pain, and helps me get to sleep, sans side effects,” Mellow said. “Treatment for anorexia is trickier than for a lot of mental illnesses, largely because it requires doing the exact opposite of what feels safe and instinctual. If the brain perceives food as a threat, but the only way to get better is to continuously eat, the anxiety increases drastically, and as treatment goes on, often gets worse instead of better.”

Anorexia isn’t a qualifying condition for a medical marijuana certification in New York, even though a review of studies has shown cannabinoids can decrease anxiety and promote weight gain in anorexic patients.

Mellow, for one, is eager for more anorexia treatment protocols. “I think it would be really helpful to have [legal] cannabis as an option,” she said.

Eating Disorders’ Origins

Despite what TV movies depict, eating disorders don’t just stem from a drive to be thin. Some people are born with a genetic predisposition to anorexia, bulimia, and binge-eating disorder. Further, the intrusive thoughts that often plague sufferers are similar to those of obsessive-compulsive disorder (OCD).

According to the National Eating Disorders Association (NEDA), “two-thirds of those with anorexia [show] signs of an anxiety disorder (including generalized anxiety, social phobia, and obsessive-compulsive disorder) before the onset of their eating disorder.” These comorbid conditions are only part of the reason anorexia is notoriously hard to treat.

Restrictive eating disorders such as anorexia and avoidant/restrictive food intake disorder (ARFID) can lead to progressive starvation that affects the brain, and therefore the intellect, making treatment for these patients even more challenging. Critically ill anorexic patients may want to eat, and want to recover, but may feel trapped in ritualistic thoughts and behaviours.

Bulimia and binge-eating disorder present a different but similar set of challenges, and symptoms of these disorders often overlap with anorexia symptoms. Binges can last for hours and result in the consumption of tens of thousands of calories. People with bulimia or binge-eating disorder can be of a normal weight or very overweight. Bodyweight doesn’t change the severity of the disease, but due to the risk of starvation or heart failure, anorexia remains the deadliest of all psychiatric disorders, with an estimated mortality rate of 10%. 

Eating disorders and the endocannabinoid system

The endocannabinoid system (ECS) is a network of receptors, enzymes, and endocannabinoid molecules that maintains homeostasis, or a range of healthy functions in the body. The CB1 receptors, found in the central nervous system, transmit a “calm down” signal to overactive neurons. Because these receptors are plentiful in brain regions that control food intake, clinical evidence suggests that there may be a link between a defective ECS and the development of an eating disorder.

The ECS is involved in the regulation of eating and energy balance, and CB1 receptors — one of the two kinds of cannabinoid receptors in our brains, the other being the CB2 receptors — are plentiful in the brain regions that regulate hunger and control eating behaviours. Because of the way they bind to CB1 receptors, ingested cannabinoids can help reduce patients’ anxiety and increase (or decrease, in the case of high-CBD strains) the amount of food they consume. What stoners have long known to be true turns out to be backed by science: Cannabis can chill you out and give you the munchies.

“Cannabis helps me in two ways. First, it helps with hunger cues,” Cassidy said. “When you’ve been restricting for a while, your body stops asking for food when it needs to. The munchies help with that. Second, [cannabis] helps with the anxiety. It kind of quiets the wave of negative self-talk that often comes with eating.”

Anorexia sufferer Cassidy, whose name has been changed agrees. “Cannabis helps me in two ways. First, it helps with hunger cues,” Cassidy said. “When you’ve been restricting for a while, your body stops asking for food when it needs to. The munchies help with that. Second, [cannabis] helps with the anxiety. It kind of quiets the wave of negative self-talk that often comes with eating.”

The OCD connection 

The American Psychiatric Association’s “Practice Guideline for the Treatment of Patients with Eating Disorders” states that eating disorders are often comorbid with other psychiatric conditions, particularly OCD, anxiety disorders, and personality disorders. And according to the International OCD Foundation, 64% of people with eating disorders also have an anxiety disorder, and 41% of those have OCD.

What all these statistics mean is that people with eating disorders — especially the restrictive type — often operate according to a strict set of rules that may not make sense to people without eating disorders. For example, a person with anorexia may deem foods “safe” and “unsafe” based on reasons other than calories or nutrient content, or develop rituals around how they cut food and where they place it on the plate. It’s not so different from having to turn the lights on and off a certain number of times before leaving the house, or having to wash one’s hands a certain number of times before going to bed, behaviours typically associated with OCD.

In a 2019 study published in Cannabis and Cannabinoid Research, researchers from the New York State Psychiatric Institute at the Columbia University Department of Psychiatry found preliminary evidence that suggests the body’s endocannabinoid system may play a role in OCD, and cited case reports from three patients for whom the cannabinoid drug dronabinol reduced compulsive behaviours. One patient, who displayed treatment-resistant OCD symptoms following a thalamic stroke, was able to participate in cognitive behavioural therapy (CBT) after using dronabinol. While more research is needed, this preliminary evidence suggests that cannabis-based treatments may allow patients struggling with compulsive behaviours to more effectively participate in talk therapy. In addition, a 2005 study showed that rates of the endocannabinoid anandamide are increased in patients with anorexia and binge-eating disorder, but not in patients with bulimia. The possibility of modulating the endocannabinoid system to treat certain eating disorders deserves more research.

Future of eating disorder treatment

Scientific studies of patients with HIV and cancer show that cannabis increases appetite and can lead to significant, life-saving weight gain. However, established eating-disorders treatment programs have been slow to accept the medical efficacy of cannabis.

Fortunately, clinicians such as Dr. Ziv Cohen, a psychiatrist in New York City licensed to certify patients to the state medical-marijuana program, think it could be a helpful addition to eating disorder treatment protocols.

“I think that there is a lot of promise in cannabis-based products for restrictive eating disorders in the same way that cannabis products are very helpful for cancer patients who have problems with their nutrition,” Cohen said. “Anxiety is reduced and appetite is increased, and that combination can kind of push patients over the hump and get them to eat things that they wouldn’t normally eat, or that they’re phobic about.”

Cohen stressed that not all patients with eating disorders are good candidates for cannabis medicine; comorbidity is an important consideration. Inducing uncontrollable munchies in patients who purge has obvious consequences, but for patients with trauma histories who restrict or binge in response to post-traumatic stress disorder (PTSD) triggers, Cohen said cannabis could be helpful.

“We want to make sure we’re not conditioning the patient to only be able to eat when they’re using a cannabis product; just like with other medications, we would want [cannabis] to facilitate developing regular eating habits, not to become a ritual that is necessary [in order] to eat,” Cohen said. “Cannabis treatment could be very helpful, as long as it’s within the context of a good multidisciplinary team.”

Mellow agreed, and stressed the importance of her treatment team and the need for alternatives to psychiatric medications.

“Malnutrition can prevent psychiatric medications from being effective, so having [cannabis] to help with the anxiety could potentially make a treatment that often feels punitive much more tolerable and effective,” Mellow said.

“I don’t believe there’s any miracle cure,” Mellow said, “but if cannabis can reduce some of the biggest barriers to treatment — exhaustion, anxiety, physical discomfort — that leaves more room to focus directly on recovery, and I don’t see how that could be anything but positive.”

Brain immune cells may protect against OCD, anxiety

Over the last decade, scientists have been discovering that microglia, a type of immune cell that resides in the brain, do more than respond to illness and infection.

New research suggests a novel treatment for OCD and anxiety.

Now, new research in mice has linked the dysfunction of microglia of a particular genetic lineage to anxiety and obsessive-compulsive disorder (OCD).

The recent Cell Reports study also shows that female sex hormones can worsen the anxiety symptoms that arise when this subset of microglia do not function correctly.

The discovery sheds light on the brain biology of anxiety and conditions that relate to it, such as OCD, whose root causes have remained unclear.

“More women than men experience debilitating anxiety at some point in their lives,” says lead study author Dimitri Traenkner, Ph.D., a research assistant professor in biological sciences at the University of Utah in Salt Lake City.

“In this study,” Traenkner adds, “[we] were able to link anxiety to a dysfunction in a type of microglia and to female sex hormones.”

Microglia have many functions

Since their discovery in the 1920s, scientists have come to appreciate the important roles that microglia play in the brain following injury, infection, and illness.

They have shown that these innate immune cells play a part in conditions ranging from Alzheimer’s disease and multiple sclerosis to brain cancer.

More recently, however, a wealth of research has revealed that microglia have a large repertoire of functions.

Studies have shown, for instance, that microglia contribute to many aspects of brain development, including the generation of the myelin sheath that protects nerve fibers and the stimulation and pruning of connections between brain cells.

In addition, scientists are starting to appreciate that the influence of microglia extends into behavior.

‘At least two different lineages’

In their study paper, Traenkner and colleagues cite studies that have suggested that under conditions of prolonged stress, abnormal microglia activity may cause depression or anxiety.

They also explain that not all microglia are the same. For example, in their own research, they “recently demonstrated that there are at least two different lineages of microglia” and that it is possible to program them to do different things.

In that earlier work, the team identified a specific subset of microglia whose precursors express the protein Hoxb8 during embryonic development.

Hoxb8 is a transcription factor, which is a protein that can alter cell behavior by switching genes on and off.

It appears that about one-third of all microglia in the adult mouse brain descend from Hoxb8 precursors.

Other researchers have also shown that mice that have no Hoxb8 tend to overgroom, a behavior similar to the human disorder trichotillomania, a type of OCD that causes individuals to pull out their hair. However, they did not establish which cells are involved.

Hoxb8-lineage microglia

What Traenkner and colleagues did in the new study was to identify the cells responsible for this behavior as microglia that have descended from precursors with a Hoxb8 lineage.

Their experiments showed that inactivating Hoxb8-lineage microglia in mice caused overgrooming and that active Hoxb8-lineage microglia can stop the compulsive behavior.

“Researchers have long suspected,” notes Traenkner, “that microglia have a role in anxiety and neuropsychological disorders in humans because this cell type can release substances that may harm neurons.”

So, the fact that microglia can protect against anxiety surprised them, he adds.

In their experiments, the researchers also saw how female sex hormones can worsen the OCD and anxiety that arises from dysfunctional Hoxb8-lineage microglia. The symptoms were consistently more severe in the female mice than in the male mice.

In addition, female mice displayed anxiety that was not present in the males. The team saw evidence of this in a new test that they developed and validated, in which the animals’ pupils dilated markedly under stress conditions.

To confirm that female sex hormones were driving the symptoms of OCD and anxiety, the researchers varied the animals’ levels of two female sex hormones: estrogen and progesterone.

When the team manipulated these hormone levels in the female mice to resemble those typically present in males, the OCD and anxiety symptoms in the female mice were like those of males.

Conversely, when the hormones in males were at the levels typically present in females, the OCD and anxiety symptoms in the male mice were like those of females.

New direction for drug research

Traenkner suggests that these findings make a strong case for the existence of a mechanism that links biological sex and genetic family history in the risk of developing anxiety-related disorders.

The team does not claim to have found a cure for anxiety but suggests that the findings point to a new direction in which to look for new drugs to treat the condition.

Nearly one-third of adults in the United States will experience an anxiety disorder at some point in their lives, according to estimates from the National Institute of Mental Health, which is one of the National Institutes of Health (NIH).

The symptoms of anxiety can be so severe that they disrupt people’s relationships and their ability to work, study, and carry out their daily activities.

[This study] opens up a new avenue for thinking about anxiety. Since we have this model, we have a way to test new drugs to help these mice, and hopefully, at some point, this will help people.”

Dimitri Traenkner, Ph.D.

Obsessive-Compulsive Disorder and Secrecy

A critically important clinical feature of obsessive-compulsive disorder (OCD) is the pervasive secrecy of patients suffering from the condition. OCD involves recurrent, disturbing thoughts and recurrent and excessive behaviors, including rituals and constant checking. Secrecy about OCD symptoms has been responsible for a long-standing, marked underestimation of the true incidence of the illness. Although clinical recognition has increased, patients’ secrecy, shame and denial continue to have an impact on assessment, treatment, and the validity of research results.

More than with many other psychiatric disorders, OCD patients do not spontaneously or voluntarily report their symptoms to health providers or even intimate family members. OCD patients fear that revealing their symptoms will lead to severe censure and disapproval because the symptoms are often ego-dystonic and seemingly antisocial or bizarre in nature: repetitive obscene or blasphemous phrases, for example, or thoughts of attacking children or loved ones or removing one’s clothes in public. Also, there is reason to believe that secrecy has its own function in both the formation and perpetuation of OCD symptoms, which serve to protect against painful anxiety.

The feelings of shame and desire for secrecy strongly influence patients’ open acknowledgment of the senselessness of symptoms. OCD patients are characteristically highly concerned with approval from other people, and their acknowledgment or denial of symptom senselessness is often determined by assumptions about the expectations of interviewers, raters or administrators of self-report measures, rather than provisions of truthful accounts. There is very likely somewhat more acknowledgment of senselessness in those indulging in checking or else cleanliness behaviors, the latter being more congruent with the values of middle-class culture and therefore more individually and socially acceptable.

Attempts at diagnostic measurement, including studies of accompanying personality disorder symptoms, have been extensively confounded by the problem of shame and secrecy. These studies have shown markedly variable results. Such wide variation in itself suggests unreliability of diagnostic instruments, but less shameful-feeling obsessive-compulsive personality disorder (OCPD) patients are also secretive about reporting certain behaviors and characteristics—in this case, irrational control, hoarding, rigidity, miserliness, and meticulous perfectionism.

Sensitive extended clinical evaluations, because of trust and familiarity developed, reveal a full range of OCD patterns. Patients will readily supply answers when asked simple questions in an unthreatening manner. The questions must rely on voluntary report and in each case, the patient should be asked to evaluate the excessiveness and inappropriateness of behaviors stipulated.

How much is “excessive”? It is up to the trained clinician together with the patient to determine the answer. This orientation is also necessary for ongoing treatment and the following of specific features of the illness. In order to determine whether the patient engages in excessive checking behavior, information is gathered about job histories, including whether one repeats tasks. If so, how often?

At home, how many times is the lock on the door tested when the patient goes out, how often are the stove burners checked, how long does it take to dress in the morning? In order to assess cleanliness, the patient is asked about patterns of housekeeping, showering and handwashing. Are particular places avoided because of possible contamination or dirt? For symmetry and order, questions are directed toward preferred placement of objects in the home, pictures on the wall, and preferences about physical work environments.

For assessment of obsessional thinking, information is effectively evoked by identifying everyday difficulties in living and performing. Commonly reported problems in sleeping are followed by questions about the possibility of bothersome or repetitive thoughts that keep the patient awake. Similarly, if a patient reports distractions and inability to concentrate at work or at school, questions are asked about mental preoccupations.

Obsessive-compulsive disorder has long been hidden and difficult for both sufferers and therapists. Currently, various treatments are available with varying degrees of promise. A number of SSRI medications have shown beneficial effects, including clomipramine, fluoxetine, paroxetine, sertraline, and fluvoxamine—and psychotherapy is an absolute must.

A specialized brain cell could be a root cause of OCD and anxiety, especially in women

Anxiety disorders affect more than 40 million adults in the United States, making them the most common mental illness in the country.

Women, in particular, are at greater risk for anxiety and associated conditions such as Obsessive Compulsive Disorder.

The underlying causes of these disorders are still not very well understood, but new research suggests a specific type of brain cell may be responsible for certain behaviors common, Medical Xpress reported.

Scientists from the University of Utah have identified a potentially linked type of cell that plays a critical role during development in the womb. Lower levels of this cell type may play a role in the eventual onset of anxiety disorders.

The researchers looked specifically at a subset of microglia, a cell that helps wire together brain structures and neural circuitry. This subset, called Hoxb8-lineage microglia, accounts for about 30% of all microglia in the brain.

In a series of tests on mice, it was found that those who had Hoxb8-lineage microglia disabled showed excessive grooming behavior. The authors noted the similarity to trichotillomania, a condition that causes people to compulsively pull out their hair.

The findings were not only more noticeable in female mice, but ebbed and flowed when scientists adjusted the female sex hormones in both the female and male mice.

Curiously, the results of the study were not necessarily what the research team expected.

“Researchers have long suspected that microglia have a role in anxiety and neuropsychological disorders in humans because this cell type can release substances that may harm neurons,” lead author Dimitri Traenkner said. “So, we were surprised to find that microglia actually protect from anxiety, they don’t cause it.”

The study published in Cell Reports may form the basis of a new approach to developing drugs for those with anxiety disorders.