Disability insurance urged for dental hygienists

Identify Depression Among ‘Perfect’ Colleagues


The dental hygiene job market is saturated in some areas and soon to be saturated in more areas. There are fewer full-time positions, and the part-time positions usually have no health insurance benefits. For many, this means paying for their own health insurance, and what is affordable has a high deductible and probably little or no prescription coverage.

Dental hygienists who are not practicing are working odd jobs in unrelated fields or are simply unemployed. Some have given up on the profession entirely, and are becoming educated in other professions. The financial strain and frustration can lead to anxiety and situational depression, even in those people who have never before experienced depression.

This article is dedicated to a dental hygienist who practiced for over 25 years, and due to the recent scarcity of jobs, could find only a part-time position. She had no benefits and only catastrophic medical insurance because that’s all she could afford. She suffered from depression, and the only treatment that seemed to help was a “specialty drug” (medical insurance term for brand name top tier) she could not afford, and her insurance would not pay for it. She described her severe anxiety and emotional pain as “unbearable.” Sadly, she took her own life.

In order to protect her identity, details about her are not included in this article. The personality trait that was a contributing factor to her severe anxiety and depression was called elevated perfectionism. Another factor that contributed to her depression was stress.

The objectives of this article are to promote an awareness of these factors and their association with general anxiety disorder (GAD) and major depressive disorder (MDD); discuss how the combination of anxiety and depression increases the chances of suicidal ideation; and to promote awareness and suicide prevention.


Striving for excellence is a healthy goal, but when people have unrealistic expectations of themselves and others, they create unhappiness in themselves and their relationships. Continuously functioning in this self-deprecating manner often leads to severe anxiety and depression. With perfectionism of this magnitude, there is often procrastination due to fear of failure, or even difficulty with decision making, as the choice may result in failure.1

Adjustment to life changes that do not align with lofty pursuits can result in extreme anxiety and profound sadness. For the elevated perfectionist, coping with day-to-day life is a challenge, but when a traumatic event occurs, coping can become nonexistent.1

Research has shown that elevated perfectionism not only makes certain individuals vulnerable to depression; it also makes them vulnerable to a variety of anxiety disorders, eating disorders, and obsessive-compulsive disorders. Many psychotherapists now use assessment scales to diagnose and treat perfectionism to reduce anxiety, depression, and associated disorders.3

Here is a link to the free electronic Multidimensional Perfectionism Scale: http://www.bbc.co.uk/science/humanbody/mind/surveys/perfectionism/


The accuracy and attention to detail required of dental hygienists make perfectionists ideal candidates for the profession.4 Ask any dental hygiene instructor about their daily dealings with students, and they’ll tell you that many insist on getting an “A” in every class or on every clinical exam. Perhaps we’ve recruited many perfectionists into the profession. You may remember being in dental hygiene school and hearing your instructors say, “Dental hygiene is not an exact science. Therefore, we call it ‘practice’ because we never get it perfect!”

Unfortunately, that expression falls on deaf ears of people with elevated perfectionism. She or he is the one who becomes anxious at patient checkout for fear the dentist will discover some minor omission in the dental hygiene patient exam. Then one day that hygienist may find something the dentist missed in his or her patient exam, and hopefully the hygienist will learn that “Perfection is unattainable.”


Fear of failure, or just plain trying to survive, when there is insufficient income for living expenses is a daunting situation. The uncertainty of survival and lack of adequate medical care can keep someone in fight or flight mode. This is anxiety on a continuous level, the type that causes insomnia and physical symptoms common to general anxiety disorder (GAD).

Anxiety disorders include:

  • Panic attacks — occur due to a sense of doom and lack of control.
  • Obsessive compulsive disorders — obsessive thoughts or repeated behaviors of checking, counting, or hoarding, often paired with eating disorders, over-exercising, and a variety of routines that relieve anxiety.
  • Posttraumatic stress disorder — anxiety and depression that occur within three months of a traumatic incident. Flashbacks replay the trauma as if it were occurring again.5

The following link includes a free anxiety assessment scale: Taylor Manifest Anxiety Scale (http://personality-testing.info/tests/TMA.php).

Major Depressive Disorder (MDD)

Major depressive disorder includes a variety of depressions that may or may not include all of the symptoms in the syndrome of generalized depression:

  • Inability to function
  • Inability to concentrate
  • Fatigue
  • Lack of energy
  • Feeling immobilized
  • Sleeping too much
  • Insomnia or sleep disturbance
  • Loss of interest in daily activities
  • Loss of interest in sex
  • Overeating or lack of appetite
  • Nervousness and agitation
  • Persistent sadness, crying
  • Anxiety and hopelessness
  • Guilt and worthlessness
  • Thoughts of death or suicide

Physical symptoms such as headaches, pain, and gastrointestinal disturbances that become chronic and resist treatment are often associated with major depression.6

Comorbid Anxiety and Depression

Current reviews of the literature show evidence of high risk of suicide in people with a combination of anxiety and depression.7 The largest percentage of people presenting with this combination are middle-aged women.8 There is an overlap in the symptoms of the two disorders, making it difficult to discern whether the anxiety is a symptom of the depression, or a separate disease entity that will not be relieved by antidepressants.

Comorbid anxiety and depression often require a combination of antidepressants such as selective serotonin reuptake inhibitors (SSRIs), or selective serotonin-norepinephrine inhibitors (SNRIs) and antianxiety drugs such as benzodiazepines. Examples of common antidepressants are fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), and desvenlafaxine (Pristiq). Common antianxiety drugs are alprazolam (Xanax), diazepam (Valium), and clonazepam (Klonopin). If the patient’s condition still resists treatment, antidepressant augmentation with aripiprazole (Abilify) has shown complete remission in some patients with comorbid anxiety and depression, and pramipexole (Mirapex, Mirapexin, Sifrol) has shown complete remission in some patients with depression not combined with anxiety.9,10,11,12

Patients may not be diagnosed with comorbid anxiety and depression, but may be treated on symptoms. Most antidepressants do not relieve every symptom on the MDD list.13 The physician may treat various symptoms with additional drugs, e.g., benzodiazepines for anxiety, sedative-hypnotics for insomnia, and proton pump inhibitors for acid reflux. A patient may be on an array of medications for various symptoms and still not be in complete remission from depression. Could the profile of comorbid anxiety and depression be masked by the regimen? Does failure to diagnose comorbid anxiety and depression present a greater risk for suicide ideation? More research is needed to answer these questions.

Comorbid anxiety and depression require a multimodal therapy carefully planned by the physician who has conducted a comprehensive evaluation of the patient using all assessment scales and diagnostic methods to arrive at the accurate diagnosis. Psychotherapy as well as pharmacotherapy must be included in the treatment plan.13

Suicide Awareness

Not everyone exhibits classic signs of depression or suicidal ideation. If they did, more lives would be spared. But if someone you know is depressed, it’s a good idea to ask that person if he or she is having thoughts of suicide. Suicide websites and training kits contain information stating that asking does not provoke someone who is not suicidal into becoming suicidal, and asking may be the key to getting someone to accept help.

NOW, you the reader — Do you have thoughts of suicide? If you answered yes, call the National Suicide Prevention Lifeline 800-273-TALK (8255).

For a complete guide to suicide awareness, go to www.suicide.org/index.html.

Local hotlines are also helpful for those with suicide ideation. Here is the National Suicide Prevention hotline link for finding a center categorized by country or state — http://www.suicide.org/suicide-hotlines.html.

Our fallen colleague was an elevated perfectionist, but out of the darkness of her quest for perfection, there was a crack of bright light filled with her love for friends and animals. She was an excellent caregiver to others. One could say she truly served the greater good, except she lacked self-love. She was perfect in many of her accomplishments, but not in her pursuit of happiness.

She is greatly missed and loved by many.

From the lyrics of the song “Anthem” by Leonard Cohen:

Ring the bells that still can ring
Forget your perfect offering
There is a crack in everything
That’s how the light gets in

Top 10 Signs Your a Perfectionist

  1. You cannot stop thinking about a mistake you made.
  2. You are intensely competitive and can’t stand doing worse than others.
  3. You either want to do something “just right” or not at all.
  4. You demand perfection from others.
  5. You will not ask for help if asking can be perceived as a flaw or weakness.
  6. You will persist at a task long after other people have quit.
  7. You are a fault-finder who must correct other people when they are wrong.
  8. You are highly aware of other people’s demands and expectations.
  9. You are very self-conscious about making mistakes in front of other people.
  10. You noticed the error in the title of this list3

Source: Gordon Flett, PhD


1. Flett GL, Stainton M, Hewitt PL, Sherry SB, Lay C. (in press) Procrastination automatic thoughts as a personality construct: An analysis of the Procrastinatory Cognitions Inventory. Journal of Rational-Emotive and Cognitive-Behavior Therapy.
2. Flett G. “York researcher finds that perfectionism can lead to imperfect health” York’s Daily Bulletin, York University, Toronto, Canada, June 2004.
3. Egan SJ, Wade TD, Shafran R. “Perfectionism as a transdiagnostic process: a clinical review. Clin Psychol Rev. 2011 Mar; 31(2):203-12. Epub 2010 May 5. Source: School of Psychology and Speech Pathology Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia. s.egan@curtin.edu.au.
4. Henning K, Ey S, Shaw D. “Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students” Medical Education article first published online 4 Jan 2002 DOI: 10.1046/j.1365-2923.1998.00234.x.
5. Stein MB. Attending to anxiety disorders in primary care. J Clin Psychiatry 2003;64 (suppl 15):35-39.
6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR) Washington DC, American Psychiatric Publishing, Inc. 2000.
7. Cyranowski JM, Schott LL, Kravitz HM, et al. Depress Anxiety. 2012 Aug 28. doi: 10.1002/da.21990. Psychosocial features associated with lifetime comorbidity of major depression and anxiety disorders among a community sample of midlife women: The Swan Mental Health Study. Source: Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
8. Joffe H, Chang Y, Dhaliwal S, et al. Arch Gen Psychiatry. 2012 May;69(5):484-92. Lifetime history of depression and anxiety disorders as a predictor of quality of life in midlife women in the absence of current illness episodes. Source: Department of Psychiatry, Center for Women’s Mental Health, Massachusetts General Hospital, Harvard Medical School, Simches Research Bldg, 185 Cambridge St, Ste 2000, Boston, MA 02114, USA.
9. Hori H, Kunugi H. The efficacy of pramipexole, a dopamine receptor agonist, as an adjunctive treatment in treatment-resistant depression: an open-label trial. ScientificWorldJournal. 2012;2012:372474. Epub 2012 Aug 1.
10. Dold M, Aigner M, Lanzenberger R, Kasper S. Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a meta-analysis of double-blind, randomized, placebo-controlled trials. Int J Neuropsychopharmacol. 2012 Aug 29:1-18.
11. Yoshimura R, Kishi T, Hori H, Ikenouchi-Sugita A, Katsuki A, Umene-Nakano W, Iwata N, Nakamura J. Comparison of the efficacy between paroxetine and sertraline augmented with aripiprazole in patients with refractory major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2012 Jul 17.
12. Maher AR, Theodore G. Summary of the comparative effectiveness review on off-label use of atypical antipsychotics. J Manag Care Pharm. 2012 Jun;18(5 Suppl B):1-20.
13. Dunlop BW, Davis PG. Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression: a review. Prim Care Companion J Clin Psychiatry. 2008;10(3):222-8.
14. Pychyl TA. Words of Healing for Perfectionists: Forget Your Perfect Offering. Psychology Today 2010 Nov 19.

CYNTHIA BIRON LEISECA is president of DH Methods of Education, Inc., Home of Boot Camp for Dental Hygiene Educators. She is also the producer of two DVDs, “Precision in Periodontal Instrumentation,” and “A Focus on Fulcrums.” Cynthia is the distributor of “The Sharpening Horse Kit,” www.DHmethEd.com.

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Rockets to meet with White about his anxiety disorder

The Houston Rockets will meet with rookie forward Royce White on Monday to work out issues regarding his anxiety disorder

Jamie Grace Is Holding On


Jamie Grace Harper may be the world’s only musician with Tourette syndrome, ADHD, obsessive-compulsive disorder, echolalia, anxiety disorder—and a Grammy nod. Nominated for Best Contemporary Christian Music Song (for her breakout hit “Hold Me”), Harper, 20, attended February’s Grammy ceremony with her family; the rest of the year, she lives in Atlanta with her parents, James and Mona Harper, cofounders and pastors of Kingdom City Church.

Harper is open about her struggles with Tourette syndrome, which started when she was about 8 years old in the form of tics—involuntary movements and sounds—and an obsession to repeat certain behaviors and phrases. “It took our lives for a spin,” she says of the diagnosis. “I learned early on that Tourette’s is not life-threatening, but it is life-altering.”

Harper has been crazy busy since releasing her debut album, One Song at a Time, in September 2011. In addition to more than 100 shows, she’s been working on a new album, writing a novel, recording a Christmas song (with older sister Morgan) for a holiday project, speaking on the Revolve Tour (for teen girls), acting in a movie (Grace Unplugged, due in 2013), and, incredibly, graduating from college, with a degree in children’s ministry from Point University (formerly Atlanta Christian College). All before her 21st birthday.

Question Answer

Your Facebook page includes your phone number. Why?

It’s a public number anybody can call if they just want to say hey or leave a voice mail. A couple times a month I’ll reply to a few of them, and sometimes I’ll just answer it myself, and we’ll chat about life and stuff. It’s fun to connect with people.

Why is that important to you?

As a kid, I was always on message boards for my favorite singers. I once sent ZOEgirl a message about something I was struggling with, and when [they] replied, it was like the kindest thing ever. I just want to do the same thing.

How does Tourette syndrome affect you today?

Mostly I repeat things I hear, sometimes obscure and random things, over and over. Lately, I’ve been saying one line from a movie, The Master of Disguise. I’ll start saying, “I’m going to be the master of disguise,” and I don’t even realize it. My friends will say, “Jamie, you’re quoting The Master of Disguise again.” Sometimes you just have to laugh at yourself! But I’ve been able to train myself out of it a little bit. I’ll cover it up by singing it instead of saying it, or saying it under my breath. Or I’ll do something to distract myself, like play my drums or go for a run.

You became an overnight sensation when “Hold Me” exploded. How has sudden fame affected you?

It was a little overwhelming. “Hold Me” was just a very personal song between me and Jesus. I was thinking it was like the worst song ever; I didn’t even want it on the album! I’ve always prayed that God [could] use my story to touch other people, but I never thought he’d use that song. But my mom encouraged it—which just goes to show you that, one, moms know everything, and, two, God can take your dreams and do more than you can ever imagine.

More: JamieGrace.com

Hometown: Atlanta

Church: Kingdom City Church

Reading now: Books by Lisa Harper; The Hunger Games, by Suzanne Collins

On your iPod: Johnnyswim, Natalie Grant, Reba McEntire

Favorite movie: Princess Diaries 2

Favorite Bible verse: Psalm 30:5

Favorite website: YouTube

Your hero My parents

What makes you laugh? When 2-year-olds sing my songs

Best meal you cook? Ham, cheese, and spinach omelet

Richard Russo’s ‘Elsewhere’: unraveling the mystery of a troubled mother

‘Elsewhere: A Memoir’

by Richard Russo

Knopf, 243 pp., $25.95

Richard Russo has mined his childhood with enormous energy, humor and craftsmanship. He’s populated most of his stories and novels (one, “Empire Falls,” a Pulitzer Prize winner) with wonderfully believable characters found in fading mill towns nestled in upper New York State.

These towns, once vibrant, clattering, stinking centers where animal hides were turned into famously excellent gloves and other leather goods, were dying by the 1950s when Russo was growing up just north of the Adirondacks foothills. His hometown was Gloversville, in what was later labeled the Central Leatherstocking District — two names so simultaneously sad and absurd that Russo might have made them up . (A place proudly named after an extinct industry not once, but twice, is the sort of stuff Russo appreciates.)

It isn’t unusual for a novelist to tell her or his own story over and over, of course. Russo has been more transparently autobiographical and skilled than many of his peers. In fact, Russo has done such a good job of capturing his characters that “Elsewhere: A Memoir,” seems almost redundant. Or to put it another way, this book may have been written more for the author than for his longtime readers.

For Russo, the distinction between novel and memoir makes for an important journey. “My fictional hometowns are no better or worse than the real one. They’re just mine, mostly because I’m free to see them with my own eyes, whereas the real Gloversville I still see with my mother’s,” he writes.

Jean Russo was a fiercely independent woman who struggled with the many financial and social strikes against a single mother of her era, as well as what her son later discovers was obsessive-compulsive disorder. Her anxiety, odd rituals and rules, and periodic unhinged fury in which she would scream things like “Don’t I deserve a life?” in rhetorical hysteria, came to make posthumous sense as one of Russo’s daughters was successfully treated for OCD.

“From the time I was a boy I understood that my mother’s health, her well-being, was in my hands … My rock, as she was so fond of saying. My own experience, however, had yielded a different truth — that I could easily make things worse, but never better.”

He is likewise never free of his sense of duty. With the sort of painfully funny irony for which Russo is famous, even as his mother trumpets her independence, she is packing up to accompany him to college on the other side of the country. She never fully leaves. If half of what he writes about his mother’s later years is true, Russo’s wife, Barbara, should be canonized.

There is nothing wrong with memoir serving as a mature writer’s reflections on the effect of a demanding, complicated parent. One might even say that someone with Russo’s impressive bibliography of eight novels (and a successful career as a college English professor) has earned the right to work out childhood stuff, finally, without the protective tissue of fiction.

Yet at the same time, it seems to me that gifted writers who publish a memoir somewhat earlier in their career often give readers a braver, more revelatory gift — think Anne Lamott and Mary McCarthy, as well as “Poser” author Claire Dederer and Cheryl Strayed (“Wild”). I’m sure there are men lurking in this category, somewhere, but it does seem as if women are more willing to reveal themselves to their readers in this way, earlier.

Blaming a gifted writer for this may not be quite fair. Clearly Russo used his books and a lot of years to figure out his mother and their connection. He began to work the issue more pointedly in his last novel, “That Old Cape Magic,” which creates a mother every bit as exasperating, pitiful and wonderful as Russo’s own. When he was good and ready to write this memoir, he wrote it.

But those writers who fling themselves bravely into memoir earlier seem, to me, to do it better. There is an arresting rawness (think Mary Karr) and a willingness to examine oneself from every angle that is best done by the young (or at least, younger) and very flexible.

Following that logic, the upside here may be that readers discovering Russo through this memoir and then returning to his first few titles are embarking on a delightful voyage with a gifted writer about whom they now know a great deal.

Kimberly Marlowe Hartnett is a writer living in Portland, Ore.

Royce White Absent as He and Houston Rockets Remain at Odds

Royce White, Houston Rockets at Odds as White Remains Absent from Team

Thomas Campbell-US Presswire

Houston Rockets rookie power forward Royce White suffers from anxiety disorder, fear of flying and obsessive compulsive disorder which is why the team agreed to workout a plane for White to deal with his disorders and fears while also keeping him ready to go for games and practices.

The arrangement between the Rockets and White which was made was to have White fly only to certain games and then take a bus to the others that were close in distance to where the team would be. For instance to begin the season White flew with his team from Houston to Michigan to take on the Detroit Pistons because of the lengthy distance and then traveled by bus to the next few road games versus the Atlanta Hawks and Memphis Grizzlies.

Now the 16th overall selection in the 2012 NBA Draft has essentially gone AWOL after not appearing for the Rockets’ Monday night loss to the Miami Heat, the team’s Tuesday practice or their shoot around prior to Wednesday night’s game versus the New Orleans Hornets. There has been word as to when or if White will rejoin the team from either the Rockets or White himself but recently White tweeted on his verified Twitter account that the Rockets have been “inconsistent” with helping him.

White has yet to see any type of playing time this season and that could also be a partial factor in to him being absent from the team along with the 6’8″, 260 pound forward feeling that the team isn’t doing all they can to assist him with this situation. The Rockets organization will fine White for everyday that he remains away from the team or fails to meet with his therapist according to the Houston Chronicle.

Why Some of Us Fret More Over Moral Dilemmas

brain areas

CREDIT: Dreamstime

Imagine yourself in a time of war. You’re huddled in a cellar with your entire village, hiding from armed enemy soldiers outside. A baby starts to cry, threatening to expose the hideout. Do you cover the infant’s mouth tightly and risk suffocating it to save the others?

When we’re faced with tough choices like this, certain parts of our brain light up, helping us navigate morally sticky situations. New research finds that these brain regions are more active in individuals with obsessive-compulsive disorder (OCD), which suggests they tend to be more distressed by moral quandaries than people without the condition.

“Faced with a problem of this type, people suffering from this type of anxiety disorder show that they worry considerably more,” study researcher Carles Soriano, of the Hospital de Bellvitge in Barcelona, told Spanish news agency SINC.

Soriano and his team studied 73 patients with OCD and 73 control subjects, measuring their brain activity with an fMRI machine as they were faced with decisions, such as the classic crying baby dilemma.

Compared with the control subjects, the patients with OCD had a higher degree of activation in the orbitofrontal cortex, a region with ties to the decision making processes and the development of moral sentiment, the researchers found. The OCD patients did not have the same responses when making more trivial choices, such as choosing between going to the countryside or the beach for the weekend, the researchers note.

“The data allows us for the first time to objectify the existence of cerebral dysfunctions related to alterations in complex cognitions, such as experiencing morality,” Soriano said. “This allows us to expand further on the characterisation of altered cerebral mechanisms in OCD.”

OCD is thought to affect at least 1 percent of the population and is characterized by repetitive behaviors that aim to reduce anxiety.

While the majority of cases involve compulsions to clean and perform other rituals or routines, other forms of the disorder are marked by pathological sexual or religious guilt, suggesting OCD patients might be prone to moral hypersensitivity.

The new study appears in the journal Archives of General Psychiatry.

Follow LiveScience on Twitter @livescience. We’re also on Facebook  Google+.

OCD May Heighten Moral Sensitivity

OCD May Heighten Moral Sensitivity Individuals with obsessive-compulsive disorder (OCD) appear far more sensitive when it comes to moral dilemmas.

“Faced with a problem of this type, people suffering from this type of anxiety disorder show that they worry considerably more,” said Carles Soriano, Ph.D., researcher at Hospital de Bellvitge in Barcelona.

For the new study, scientists looked at the neurofunctional basis of this increased moral sensitivity. Using functional magnetic resonance imaging, they measured the brain activity of a group of 73 patients with OCD and 73 healthy patients.

All participants had to face a variety of moral problems in which they had to choose between two alternatives both leading to very negative consequences.

For example, they were asked to imagine themselves in a hypothetical war. Enemy soldiers lie in wait to attack and the entire village is hiding in a cellar. A baby starts to cry. If nobody makes the baby stop, the enemy soldiers will find them. Would it be justifiable to smother the baby’s cry, possibly suffocating it to save the others?

The results demonstrated that during situations of moral dilemma, the brains of those with OCD showed a higher degree of activation in the orbitofrontal cortex, especially in the medial part, which is associated with decision making and the development of moral sentiment.

“The majority [of people with OCD] are characterized by being obsessed with dirt and compulsive cleaning or by doubting that they have carried out important actions properly, like turning off the gas. Such behavior makes then repeatedly check whether they have performed such actions,” said Soriano.

There are other types of obsessions and compulsions as well, such as needing objects in the environment to be perfectly symmetrical and in order.   

There are also those that suffer from involuntary and unwanted thoughts of a sexual or religious kind.  They may feel unsure whether they have committed a sexual act that is unacceptable in their opinion or they worry that they have blasphemed God.

“The last group of patients is identified for precisely having a higher level of moral hypersensitivity,” said Soriano.

The research included help from experts at Barcelona’s Hospital del Mar and the University of Melbourne in Australia.

Source:  Archives of General Psychiatry

Very anxious woman photo by shutterstock.

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Brain and Behavior, General, Mental Health and Wellness, OCD, Psychology, Research


Biting Nails? You could be Insane!

Tense situations call for nail biting, be it the world cup, the board exam results or maybe the final seconds of a lottery showdown. But if you find yourself biting nails all the time you may be suffering from obsessive compulsive disorder.   

Nail-biting has been classified as a type of obsessive compulsive disorder (OCD) by the American Psychiatric Association (APA) in their upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

According to Wikipedia, People with obsessive compulsive disorder are known to produce repetitive behaviours aimed at reducing anxiety.

Other habits like hair-pulling and skin-picking — habits of “pathological grooming”– will also be included in the OCD classification, as reported by news.com.au

The DSM-V is the known ‘Bible of psychiatrists’ and is used by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and even policy makers.

A word of advice for the nail biters then — choose nail cutters over your teeth to stay in the sane category.  

Patients with obsessive-compulsive disorder worry considerably more than … – News

Patients with obsessive-compulsive disorder are characterised by persistent thoughts and repetitive behaviours. A new study reveals that sufferers worry considerably more than the general population in the face of morality problems.

Along with the help of experts from the Barcelona’s Hospital del Mar and the University of Melbourne (Australia), researchers at the Hospital de Bellvitge in Barcelona have proven that patients with obsessive-compulsive disorder, known as OCD, are more morally sensitive.

“Faced with a problem of this type, people suffering from this type of anxiety disorder show that they worry considerably more,” as explained to SINC by Carles Soriano, researcher at the Catalan hospital and one of the lead authors of the work published in the journal Archives of General Psychiatry.

Using functional magnetic resonance imaging, the experts studied the neurofunctional basis of this increased moral sensitivity. They measured the brain activity of a group of 73 patients with OCD and 73 healthy patients when faced with different moral problems in which they had to choose between two alternatives both leading to very negative consequences.

For example, they were faced the dilemma of the crying baby, a classic in philosophy classes. They were asked to imagine themselves in a hypothetical war. Enemy soldiers lie in wait to attack and the entire village hides in a cellar. A baby starts to cry. If nobody makes the baby stop, the soldiers will discover everyone. Would it be justifiable to smother the baby’s cry running the risk of suffocating it to save the others?

“The brain activations displayed by participants in the face of such a moral question were compared to those displayed for trivial choices, like choosing between going to the countryside or the beach for the weekend,” as Soriano points out.

The results verified that during situations of moral dilemma those subjects with OCD displayed a higher degree of activation in the orbitofrontal cortex, especially in the medial part, which is linked to decision making processes and the development of moral sentiment.

“The data allows us for the first time to objectify the existence of cerebral dysfunctions related to alterations in complex cognitions, such as experiencing morality,” adds the researcher from Catalonia. “This allows us to expand further on the characterisation of altered cerebral mechanisms in OCD.”

Anxiety compulsion

Parents’ Social Anxiety May Raise Kids’ Risk for Anxiety Disorder


Published: November 7, 2012 5:27 PM

 — Mary Elizabeth Dallas


Parental social anxiety should be considered a risk factor for childhood anxiety, according to researchers.

In a new study, researchers from Johns Hopkins Children’s Center found that kids with parents who have social anxiety disorder — the most common form of anxiety — are at greater risk for developing an anxiety disorder than kids whose parents have other forms of anxiety.

The study revealed that the parental behaviors that contributed to children’s anxiety included a lack of warmth and affection as well as high levels of criticism and doubt.

“There is a broad range of anxiety disorders, so what we did was home in on social anxiety, and we found that anxiety-promoting parental behaviors may be unique to the parent’s diagnosis and not necessarily common to all those with anxiety,” the study’s senior investigator, Golda Ginsburg, professor of child and adolescent psychiatry at the Johns Hopkins University School of Medicine, said in a university news release.

In conducting the study, Ginsburg’s team examined the interactions between 66 anxious parents and their children, whose ages ranged from 7 to 12 years. Of the parents, 21 had social anxiety; the rest were diagnosed with another form of anxiety, such as panic disorder or obsessive-compulsive disorder.

Each parent-child team was videotaped while working together to write speeches about themselves and also to copy designs on an Etch-a-Sketch. They were given five minutes to complete each task. On a scale of one to five, the researchers rated the affection and criticism the parents showed their children.

The study authors found that parents with social anxiety were less warm and affectionate toward their children. These parents also criticized their children more, and tended to doubt their child’s ability to complete each task.

Ginsburg, who also is a child anxiety expert at Johns Hopkins Children’s Center, added that doctors treating parents with social anxiety should discuss the risk their condition poses to their children. The researchers noted that controlling environmental factors that contribute to anxiety can help prevent these children from developing the disorder.

“Children with an inherited propensity to anxiety do not just become anxious because of their genes, so what we need are ways to prevent the environmental catalysts — in this case, parental behaviors — from unlocking the underlying genetic mechanisms responsible for the disease,” Ginsburg explained.

The study authors noted that anxiety disorder affects one in five children in the United States. If left untreated, the condition can lead to depression, substance abuse and poor performance in school.

The study was released online in advance of print publication in an upcoming issue of the journal Child Psychiatry and Human Development.

More information

The U.S. National Institute of Mental Health has more about anxiety disorders.

Copyright © 2012 HealthDay. All rights reserved.

Nail biting doesn’t belong in psychiatry’s list of OCD symptoms

News that the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) may classify nail biting as a form of obsessive-compulsive disorder has confirmed the worst fears of the psychiatric handbook’s critics. The threshold of what is deemed a disorder is lowered with each successive edition, with nearly all forms of human behaviour now becoming pathologised. Of the 180 or so disorders one could have suffered from in the mid 1980s, there are now approaching 400.

Academics, GPs and psychiatrists have all spoken out against this trend. Petitions have been raised expressing grave doubts about DSM, and a stream of academic books and articles ridicule its scientific claims. Yet these critiques seem to be ignored. Most clinicians working in the NHS use the DSM, and a fitness-to-practise case has even been brought against a clinician who challenged the DSM categories she was supposed to be applying.

The proposed inclusion of nail biting in lists of OCD symptoms is a good example of the manual’s failures. Pre-DSM psychiatry emphasised the difference between symptom and underlying structure. Someone could bite their nails as a way of redirecting anger when they felt cross, or even because they had the delusional belief that their nail embodied some evil that had to be excised from the body. The symptom – nail biting – was simply the clue to what lay beneath it.

OCD itself is another case in point. The DSM treats it as a disorder, defined by symptoms such as compulsions, rituals and intrusive thoughts. Yet the actual category of OCD is suspect for a simple reason: the same surface symptoms can appear in two distinct underlying clinical groups – the neuroses and the psychoses.

In neurosis, obsessive symptoms can be a way of warding off anxiety, particularly about the proximity of love and hate. One of Freud’s patients worried that a stone in the road might cause an accident when his loved one’s carriage travelled along it later that day. He put it by the side of the road, only to then worry that this was absurd and then return it to its original place. Behind the repetitive ritual was a conflict of affection and aggression.

In psychosis, although the person may complain of the cleaning, checking or counting rituals they have to carry out, these activities may protect them from more acute terrors. It is well-known, for example, that the appearance of OCD-style phenomena in schizophrenia or manic-depressive psychosis is generally a good prognostic sign. By introducing an order, they can be less a problem than a way of treating a problem.

In the DSM approach, this distinction is all too often lost. The piece of behaviour becomes in itself transparent, simply one more item on a checklist of symptoms. You don’t need to know what the nail biting means to that individual patient, just whether they do it or not. Meaning has been stripped from the diagnostic enterprise, in favour of pure external classification.

Clinicians who want to pursue a dialogue here find that they are allocated less and less time with their patients by a bureaucratic and managerial healthcare system. The tragedy is that this deprives us of having any authentic understanding of the symptom, and it introduces a rigid, normative vision of human behaviour. We can know what is a disorder, and what isn’t, without listening to what the person has to say.

Yet nail biting might be a totally irrelevant detail for one person, a terrible curse or a pleasurable habit for another. Classifying such behaviour externally as a symptom, without taking into account what it means to that person, is profoundly inhuman. It is yet another vehicle for imperatives telling us how we should live and how we shouldn’t.

Nail-biting to be classified as type of obsessive compulsive disorder

The American Psychiatric Assiociation will classify nail-biting as a type of obessive compulsive disorder (OCD) in their upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Other “pathological grooming” habits like hair-pulling and skin-picking – collectively known as trichotillomania – will also be included in the OCD classification, News.com.au reported.

The DSM-V is known as the ‘bible of psychiatrists’ and is used by international clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers.

According to Wikipedia, obsessive compulsive disorder is characterised by intrusive thoughts that produce repetitive behaviours aimed at reducing anxiety.



Tags: nail biting, obsessive compulsive disorder, lifestyle news

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