Untangling the Web of Comorbid Obsessive-Compulsive Disorder and Medical Illness

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Some with OCD, anxiety disorders are struggling amid coronavirus epidemic.

Anxiety disorders affect some 40 million adults in the United States, according to the Anxiety and Depression Association of America. The International OCD Foundation estimates that about 2 million to 3 million adults nationwide have some form of OCD, a particular anxiety disorder characterized by a cycle of distressing obsessions and compulsions. One OCD subtype centers on contamination fears, which often spur compulsive hand-washing, disinfecting, avoiding contact with perceived contaminants, and other unhealthy coping mechanisms.

Now wash your hands… again: why coronavirus is different when you have obsessive compulsive disorder

When it comes to the threat of coronavirus, the British are supposedly among the most relaxed people in the world, and the least likely to take precautions, according to new research last week. Just five per cent in this country said they were “very scared” by the illness, a YouGov survey found.

But if the majority of the population is (so far) keeping calm and carrying on, not everyone is able to remain so tranquil about the impending doom we keep hearing about. For those who already suffer from mental health conditions such as obsessive compulsive disorder (OCD), the perceived panic surrounding the global spread of the virus is far harder to deal with serenely.

When Telegraph columnist and mental health campaigner Bryony Gordon posted a message on Twitter last week to ask “how many people with contamination OCD are suffering miserably at the moment?” the replies were revealing.

“The whole Coronavirus thing is really triggering,” wrote Rachel Allen, while Julia Bladen-Blake replied: “It’s really taking a lot in me not to succumb to old health anxiety habits that I had to go to therapy for.” A third woman, Jacqueline Strawbridge, said it was “off the scale, just like when those terrifying AIDS adverts came out in the 80s, this is a nightmare for people with OCD.”

At the most severe end of the scale, and illustrating the effect the coronavirus situation is having not only on adults but also on young children with mental health conditions, was the daughter of a woman called Jo who, she says, is “suffering terribly with this. 11 years old and feels like she’s going to die if she touches anything. Doesn’t want to go to school. Terrified from what she picks up on the media.”

OCD, a potentially debilitating condition characterised by obsessive thoughts and compulsive behaviours, affects 1.2 per cent of the UK population, according to the charity Rethink Mental Illness. But a far larger proportion is affected by a variety of anxiety disorders. The NHS says generalised anxiety disorder is estimated to affect up to five per cent of the UK population, while one in six people in the UK will experience a common mental health issue every year.

Many of these will experience fears around matters other than germs, contamination and illness. But for some of those who find it difficult to control their worries around these areas, the rapidly escalating coronavirus crisis is triggering unhelpful thought patterns and behaviours. About 50 per cent of people with OCD have “a fear of contamination from dirt or disease that causes them to wash and clean compulsively,” wrote David A. Clark, a clinical psychologist at the University of New Brunswick, Canada, in an article last week.

Coronavirus: how to stop the anxiety spiralling out of control

As the novel coronavirus proliferates on a global scale, worry and panic is on the rise. And it is no wonder when we are constantly being told how to best protect ourselves from being infected. But how do you stay safe in this climate and simultaneously make sure that the fear doesn’t take over your life, developing into obsessive compulsive disorder or panic?

Fear is a normal, necessary evolutionary response to threat – ultimately designed to keep us safe. Whether the threat is emotional, social or physical, this response is dependent on a complex interaction between our primitive “animal brain” (the limbic system) and our sophisticated cognitive brain (the neo-cortex). These work busily in concert to assess and respond to threats to survival.

Once a threat has been identified, a “fight or flight” response can be triggered. This is the body’s biological response to fear and involves flooding us with adrenaline in a bid to ensure that we are able to escape or defeat any threat, such as a dangerous animal attacking. The response produces a range of intense physical symptoms – palpitations, perspiration, dizziness and difficulty breathing – which are designed to make us run faster and fight harder.

However, this system can be prone to glitches, sometimes responding disproportionately to threats that aren’t actually that serious or imminent. Worrying about health conditions such as heart attacks, stroke and even COVID-19 (the disease caused by the coronavirus) can therefore also trigger a fight-or-flight response.

That’s despite the fact that there is no role for a primitive biological response to COVID-19 – no running or fighting is necessary. Instead, it is our high-level, cognitive neocortex that is required here, a rational and measured approach to infectious disease, without the messy complications of panic.

Sadly, this is easier said than done. Once the fear has kicked in, it can be hard to stop it.

Vulnerable groups

It is highly unlikely that a viral outbreak, even at pandemic levels, will trigger mental health problems in people who don’t already have them or are in the process of developing them. Research shows that most mental health problems start between early adolescence and the mid-20s, with complex factors being involved. Around 10% of the global population experience clinical levels of anxiety at any one time, although some estimates are higher.

People who are chronically and physically unwell – the ones who are the most vulnerable to the coronavirus – are at particular risk of spiralling anxiety. This should not be ignored. Their concern is warranted and is vital in motivating them to take up precautionary measures. But it is important that these individuals have the support they need in dealing with their emotions.

People with health anxiety, preoccupied with health-related information or physical symptoms, are also at risk of worsening mental health as the virus spreads. So are individuals who are prone to frequent or increased “checking”, such as constantly making sure that the oven is off or that the front door is locked. Those at the extreme end of the scale when it comes to such behaviour may be displaying signs of obsessive compulsive disorder.

People who have a lot of background anxiety, and are not easily reassured, may also benefit from assessment and support in the shadow of the coronavirus outbreak. This may include people with generalised anxiety disorder or panic disorder, which have strong physiological features.

Ways to manage the stress

If you find yourself excessively worrying about the coronavirus, this doens’t necessarily mean that you have a psychological disorder. But high levels of emotional distress, whatever the source, should be appropriately and compassionately attended to, particularly if it is interfering with normal day to day activities.

At times of stress and anxiety, we are often prone to using strategies that are designed to help but prove counter-productive. For example, you may Google symptoms to try to calm yourself down, even though it is unlikely to ever make you feel better. When our strategies for de-stressing instead increase our anxiety, it is time to take a step back and ask if there is anything more helpful we can do.

Stop checking.

There are actually ways to dampen down the physical and emotional symptoms associated with anxiety. One is to stop checking. For example, avoid looking for signs of illness. You are likely to find unfamiliar physical sensations that are harmless but make you feel anxious. Normal physical changes and sensations pass in time, so if you feel your chest tighten, shift your focus onto pleasurable activities and adopt “watchful waiting” in the meantime.

In the case of COVID-19, checking may also include constant monitoring of news updates and social media feeds, which significantly increases anxiety – only serving to reassure us momentarily, if at all. So if you are feeling anxious, consider tuning off automatic notifications and updates on COVID-19.

Instead, do less frequent checks of reliable, impartial sources of information updates on COVID-19. This might include national health websites rather than alarmist news or social media feeds that exacerbate worry unnecessarily. Information can be reassuring if it is rooted in facts. It is often the intolerance of uncertainty that perpetuates anxiety rather than fear of illness itself.

At times of stress and anxiety, hyperventilation and shallow breathing is common. Purposeful, regular breathing can therefore work to reset the fight or flight response and prevent the onset of panic and the unpleasant physical symptoms associated with anxiety. This is also true for exercise, which can help reduce the excess adrenaline build-up associated with anxiety. It can also give much needed perspective.

Perhaps most importantly, don’t isolate yourself. Personal relationships are crucial in maintaining perspective, elevating mood and allowing distraction away from concerns that trouble us. Even in imposed isolation, it is important to combat loneliness and keep talking – for example, via video chats.

We are globally united in living with a very real yet uncertain health threat. Vigilance and precautionary measures are essential. But psychological distress and widespread panic does not have to be part of this experience. Continuing normal daily activities, maintaining perspective and reducing unnecessary stress is key to psychological survival. In other words, where possible, keep calm and carry on.

If you continue to feel anxious or distressed despite trying these techniques, do talk to your GP or refer to a psychologist for evidence-based treatment such as cognitive behavioural therapy.

Coronavirus Is Wreaking Havoc On Our Mental Health

Earlier this week, on a New York subway train, a woman did something that caused me to descend into nothing short of sheer panic: She dropped a melon. It rolled down the car thunderously, careening past the ankles of passengers, until it landed right in front of my feet. My first instinct was to be a good citizen and to pick it up and deliver it to its owner. But a small, nagging voice in the back of my mind that’s grown louder and louder as of late advised me not to. So, instead of actually handing it over to her, I gingerly kicked it over to her. To her credit, she didn’t seem fazed: She picked it up and gave me a thumbs-up.

I spent hours obsessing over this interaction. That’s in part because, a few minutes after this interaction, I thought I spotted the woman who’d dropped the melon surreptitiously coughing, and in a news cycle drenched in constant updates about COVID-19, I was delirious with panic: Had I touched my foot that had touched the melon? Was I outside of the range of six feet required for coronavirus transmission, per the CDC, of the woman who had dropped it? Did I brush past her when I got off the train? Had I washed my hands thoroughly enough when I got off the subway? Had I Purell’ed them thoroughly enough? Would I run out of Purell soon and be unable to afford it now that resellers on Amazon had jacked up the price?

But mostly I just felt guilty about it. I’m not the most socially adept person on the planet, but I still am not in the habit of kicking other people’s personal items when they’re in my line of vision. Had COVID-19 and the ensuing panic fucked with my mind to the degree that basic social morés were just flying out the window?

Truthfully, prior to the advent of COVID-19, I probably would’ve gone through this thought process. I have diagnosed obsessive-compulsive disorder (OCD), an anxiety disorder that manifests itself in obsessive, unwanted thoughts and compulsive behaviors; for me, as is the case for many people with OCD, mine manifests itself in obsessive fears of myself or my family members getting sick, with a healthy dose of germophobia thrown in for good measure.

When the CDC announced its list of best practices for preventing COVID-19, my first thought was that years of engaging in obsessive behaviors such as ruminating on protective measures or washing my hands till they cracked and bled would better equip me for the impending apocalypse. But as the weeks have passed and the virus has spread, with deniers on one side of the spectrum and alarmists on the other, it’s been difficult to ignore just how much the symptoms of my OCD have been exacerbated by the intense media coverage. This is likely true for many people who struggle with anxiety disorders, an umbrella term that describes everything from generalized anxiety disorder to panic disorder to obsessive-compulsive disorder (OCD).

“It’s coming up a lot. In fact, I had a session on it this morning,” says Dr. Nicole Naggar, a psychiatrist in New York. “For those of us who may be more slanted in an anxious way, we can be really vulnerable to the news, especially if we happen to be germophobes too.” Angelina, an immunocompromised person struggling with OCD, whose last name has been withheld at her request, concurs. Angelina lives in Washington state, where an estimated nine people have died from a COVID-19 outbreak, which has exacerbated her fears. “I’ve been trying to stay optimistic but it’s so hard to do when the media is creating this hysteria,” she says.

People with anxiety disorders comprise a sizable percentage of the population. According to the Anxiety and Depression Association of America, nearly 18 percent of the population, or 40 million adults, struggle with some form of anxiety disorder.

Of course, even for those who don’t have a formal diagnosis, the wall-to-wall news coverage of the virus now known as COVID-19 is immensely concerning — and there’s some data to indicate that pandemics can wreak havoc on the general population’s mental health. In the past, depression and anxiety rates have soared following terrorist attacks, even among those who were not directly impacted.

Yet for those predisposed to anxiety, it could prove immensely triggering, says Dr. Robert Schachter, assistant clinical professor at the Icahn School of Medicine at Mount Sinai. “Think of anxiety as this underground river that’s flowing all the time,” he says. “If you have a ‘What if?’ thought” — a fear-inducing hypothetical scenario prompted by headlines about price-jacking on hand sanitizer or photos of abandoned grocery stores in Milan — “then that pokes a hole and gives a reason for the anxiety to come out.”

A trader passes a hand sanitizing station on the floor of the New York Stock Exchange, . Federal Reserve Chairman Jerome Powell noted that the coronavirus poses evolving risks to economic activityVirus Outbreak Economy, New York, USA - 03 Mar 2020

A trader passes a hand-sanitizing station on the floor of the New York Stock Exchange. Photo credit: Richard Drew/AP/Shutterstock

Because there’s relatively little known about COVID-19, there’s a great deal of uncertainty surrounding the virus — and uncertainty, if nothing else, breeds “What ifs.” Even those who don’t necessarily have an anxiety disorder may find themselves felled by such thoughts, says Naggar, who says it is “absolutely possible” that news of coronavirus “could be an exposure or a trauma of sorts that could trigger” them.

Since news of COVID-19 first broke in the United States in December, media coverage has essentially been wall-to-wall. The vast majority of such coverage has centered on what we know about the virus, as well as the administration’s questionable handling of the ensuing health crisis, with President Trump most recently telling pharmaceutical executives to come up with a cure and vaccine all in one. (The World Health Organization (WHO) has said that it will take at least 18 months to develop a vaccine to COVID-19.) Yet very little has focused on the mental health effects of the omnipresent threat of coronavirus, which, combined with the administration’s response to COVID-19, creates “a perfect cocktail” of fear, says Dr. Chloe Carmichael, a clinical psychologist in New York. With previous health crises like SARS and the Ebola virus, the response was not highly politicized. Now, with COVID-19 being touted by right-wing media figures as a call to close borders, “it does seem like the administration’s handling of it has become a political football, which almost kinda supercharges the anxiety about it, says Carmichael.

That’s to say nothing of how little coverage has been afforded to the day-to-day experiences of those in countries where the crisis is more acute, such as China, Japan, Iran, and Italy, where the psychological impact of living with the threat — not to mention the isolation of quarantine — is immense. And there is evidence to suggest that the fallout could linger long after panic over the virus (hopefully! fingers crossed!) recedes. Studies of survivors, health care professionals, and members of surrounding communities impacted by the SARS crisis in Asia and Canada found that people were struggling with mental health issues up to four years after the epidemic had passed. Other studies post-9/11 found that watching news coverage of the attacks produced “substantial stress symptoms,” even in those who were watching from hundreds of miles away.

For those who struggle with anxiety disorders, part of the difficulty of dealing with coverage of COVID-19 stems from being unable to discern between the genuine threat posed by the illness and the inflated threat perpetuated by hysterical media coverage. Schachter refers to these two types of anxiety as “Anxiety One” and “Anxiety Two.” “With the virus there’s a lot of Anxiety One because it is dangerous in some cases,” particularly for the elderly or immunocompromised, says Schachter. “But we really don’t know the extent of it.” Such uncertainty creates prime conditions for the development of Anxiety Two, allowing people to “jump into the void” and make negative assumptions that are unrelated to the actual probability of contracting or dying from the virus, says Schachter. And this is likely especially true for marginalized people such as low-income people or people of color, who are often more likely than members of the general population to have anxiety disorders and less likely to have access to treatment like cognitive behavioral therapy or medication.

To complicate matters, many people with anxiety disorders adopt compulsive behaviors as a way to alleviate their own obsessive concerns, such as hand-washing or rigorously applying Purell an inordinate number of times a day to avoid contracting illness. Because these are the exact same behaviors recommended by the CDC to avoid contracting COVID-19, that can be confusing and disorienting for people with anxiety to discern between rationally and irrationally motivated behaviors. There’s a distinction between adhering to CDC guidelines as a way to keep yourself safe and doing so in a problematic way, says Carmichael. “If you keep excusing yourself to wash your hands on a date and it starts to interfere with your ability to focus on things, that’s a sign it’s starting to get a little bit overboard,” she says. It’s also a sign you may want to talk to a mental health care professional.

For those who are already finding themselves crippled by anxiety related to coronavirus, however, the question is: How can they alleviate some of that concern, without burying their head in the sand regarding the actual risk? The answer, says Schacter, is not to avoid media coverage of the virus (not that that would really be possible for those of us with access to WiFi, anyway). “Avoiding the media doesn’t help,” he says. “If you get anxious looking at the media, say, ‘Time out, I’m uncomfortable and anxious, let’s look at how realistic my fears are,’ and go through the steps of assessing that.”

That said, it’s probably more helpful to rely on trustworthy outlets (think the actual CDC and WHO websites, not something your uncle posts on Facebook) and steer clear of the types of headlines that are engineered specifically for the purposes of generating clicks, not to help you assess your actual risk level. For me, identifying such content is like identifying pornography: I know it when I see it. “The best coverage I’ve seen is from scientists that actually explain the virus and what it does in our bodies so we can identify it quickly — thus resulting in preventing its spread through proper education and awareness,” says Angelina. “Not stories scaring the shit out of everyone and urging them to clear out their grocery stores.” 

Above all else, now is the time to rely on facts and hard data, both of which are far more reassuring than most media coverage would otherwise suggest. “The fantasy versus the reality of COVID-19 are very different,” says Naggar. For me, it’s been helpful to memorize these statistics the way old white men do 1950s baseball team starting lineups: Thus far, the fatality rate of the virus is two percent, higher than that of the flu but lower than that of, say, SARS (10 percent) or MERS (30 percent). More than 80 percent of coronavirus cases are mild, which has made it easier to spread, but also may potentially render the carrier immune to developing it again in the future. Only 1.2 percent of the overall number of cases in China were among people between the ages of 10 and 19, indicating children are largely protected (a huge relief to parents such as myself); and the elderly and infirm are far more at risk of developing more serious cases, though falling into just one of those categories is not a death sentence in and of itself. (“A healthy 72-year-old is not at as great a risk as an unhealthy 72-year-old,” the health officer for Sacramento County told the Los Angeles Times.)

In short, there is real risk, but for the vast majority of us, the risk is not commensurate with the degree of obsession and panic coverage of the virus has bred, both in people who are panic-prone and those who are not. Is this to say I’ll start licking melons the next time one rolls across a subway car floor? Probably not, but it is a case for looking someone in the eye and handing it back to them like an actual human being — even if you do apply Purell right after.

If you are struggling with mental health conditions, please reach out to a mental health care professional or contact the National Association of Mental Illness (NAMI) Monday through Friday from 10 a.m. to 6 p.m. EST at 800-950-NAMI (6264).

How distrust of the past shapes obsessive-compulsive disorder

Pinpointing an exact cause of OCD can be difficult. As Doidge writes, one particularly afflicted college student put a gun in his mouth and pulled the trigger. Miraculously, he survived, giving himself a lobotomy in the process. Upon recovering, his OCD was cured. He soon returned to college. The damage to his frontal lobes fixed his suffering, so it appears such obsessive checking and worrying is a human trait.

Not that we should ever contemplate such an extreme path. A new study, published in PLOS Computational Biology by researchers at The Hebrew University of Jerusalem, adds to the literature by speculating that OCD sufferers place less trust in their past, creating a negative feedback loop as they age.

There’s a parallel with anxiety disorder. When sufferers experience a panic attack in a certain location, they imprint that environment as a place that causes attacks. When they return, the environment—more accurately, their nervous system responding to the environment—triggers a panic response. Likewise, those with OCD create a mental image of distrust from past habits. When triggered, symptoms of their disorder manifest. They leave the house, walk into the hallway or front yard, and are triggered to check that the lights are off—again, and again, and again.

For this study, lead author Isaac Fradkin and his colleagues studied 58 people with varying degrees of obsessive-compulsive symptoms. The subjects were asked to judge past experiences with recent observations. The more symptoms they expressed, the more likely they were to distrust their past. This caused them to believe that new environments are unpredictable, and therefore should be avoided or distrusted. They were actually more surprised by predictable outcomes than unpredictable ones.

Giving a face to OCD: Young author writes book about disorder

Surrounded by family and friends, 16-year-old Maggie Grace and her mother, Jennifer Watkins, on Wednesday celebrated the launch of their children’s book, “Maggie’s Friend Otis.”

This book allowed a younger Maggie to personify her obsessive-compulsive disorder (OCD), which separated herself from her illness and made the disorder more tolerable.

The hope is that this book can be used as a tool to aid children in coping with OCD and alleviate some of the stigma associated with mental disorders. Maggie and her mother will present at the S.C. Council for Exceptional Children Professional Development Conference later this month in Myrtle Beach. They will share their experiences and talk about how the book can help parents, teachers, counselors and students understand and manage OCD and other anxiety disorders.

Maggie’s anxiety, and later being diagnosed with severe OCD, resulted in her being homeschooled as a rising sixth-grader. One day, Maggie’s assignment was to draw what OCD looks like – and the colorful Otis was created.

“This is how we started referring to Maggie’s OCD,” Watkins said. “Maggie would say, ‘Otis is really bothering me today.’ Or I would say, “I’m not talking to Otis anymore right now.’ Giving it a name made it a whole lot easier to talk about it with her.”

This also helped Maggie realize she had an identity separate from Otis, that her disorder did not define her. In time, when she would have irrational thoughts, Maggie would tell herself, “That’s just Otis. That’s not real.”

“This is a great book for children who feel alone in their struggles with mental health issues,” said Maggie’s therapist, Jeanna Smith. “It is also a good resource to help children identify their own Otis.”

Mackenzie Hall, an elementary school counselor in Lexington County School District 1, said when she met Maggie at a school counseling conference earlier this year, “It was one of the best moments in my life.”

“I will forever cherish this book,” Hall said. “It actually led me to create a school counseling kiosk in our library. Thank you again for writing a book about OCD. It changed my life and inspired me to share my story with others.”

“Maggie’s Friend Otis,” published by Palladian Publications, is available to purchase at A Boutique, 1425 Boiling Springs Road, at Facebook.com/MaggieAndFriend, and at maggieandfriend.com.

For more information, contact maggieandfriend@yahoo.com.

Obsessive-Compulsive Disorder May Be Fueled by a Distrust of the Past

Both Kasper and Vitko may benefit from new research published today in PLOS Computational Biology by Isaac Fradkin, PhD, of The Hebrew University of Jerusalem in Israel, and his colleagues.

Fradkin, who has dedicated his career to studying OCD and treatment outcomes, found via his study that rather than being characterized by inflexible behavior, OCD may manifest in a person as a result of a mistrust of past experiences.

In other words, there could be an underlying reason for the development of OCD.

Fradkin says he was motivated to dive into the study after noticing, time after time, that people with OCD spoke of what he calls the “not just right experience.”

“They can do an action that allegedly reaches a goal, but they just don’t feel quite right about it,” he told Healthline. “The vagueness of this experience and yet the dramatic impact on function made me want to dig deeper.”

His surprise moment?

When the outcome of the study matched his hypothesis exactly.

Fradkin and team used mathematical equations to assess how people with OCD performed on a multiple choice test, and then dug into what made them make the choices they did.

The outcome, he believes, could in time “inform new treatments and therapeutics” for people living with OCD.

Research study examines brain development among adolescents for potential predictors of anxiety

Approximately 40 million adults in the United States are affected by an anxiety disorder, according to the Anxiety and Depression Association of America. Anxiety disorders — including generalized anxiety, social anxiety, obsessive-compulsive disorder, posttraumatic stress disorder (PTSD) and others — are the most common mental illness in the country. Although anxiety disorders are manageable, many go undiagnosed or unrecognized — and they frequently begin during adolescence.

A research study led by Hilary Marusak, assistant professor of psychiatry and behavioral neurosciences in Wayne State University’s School of Medicine, will examine adolescent brain development to better understand how the brain regulates fear. The five-year study, funded by the National Institute of Mental Health (Endocannabinoids and the Development of Extinction Recall Neural Circuitry in Adolescents), will monitor the brain development of adolescents between the ages of 10 and 17 by measuring blood samples and brain imaging.

While experiencing fear is natural and may be helpful in the face of imminent danger, it can be detrimental when fear interferes with daily life. For example, individuals with anxiety or PTSD can powerfully re-experience past memories of trauma, or experience symptoms of fear or anxiety — for example,  an elevated heart rate — to people, places or situations that only resemble past traumas.

Marusak’s team has previously shown that the brain systems that regulate fear are immature during childhood, and their current study will focus on adolescence. Adolescence is a critical time for brain development because it is the period where anxiety disorders begin to emerge.

Marusak’s team is especially interested in the development of the endocannabinoid system, a recently discovered system in the body that is of great medical interest. Interestingly, scientists discovered the compound that binds to the system in the body before they actually discovered the system. In the 1960s, scientists discovered the molecule THC — the primary psychoactive compound in cannabis (marijuana) — and, years later, the system in the body that THC binds to — the endocannabinoid system — was discovered. Scientists have only recently found that the body creates its own THC-like molecules, or “endocannabinoids,” and these molecules have receptors throughout the brain and are essential for controlling how the body responds to fear and anxiety.  

“The endocannabinoid system changes very dynamically during adolescence, before stabilizing into adulthood,” Marusak said. “Identifying a relationship between this system and potential indicators of anxiety would enable earlier treatment and possibly prevention.”  For example, this study may provide new ways to prevent anxiety in youth who are at high risk. “We know that childhood trauma is a huge risk factor for anxiety, which is influenced by fear regulation and tends to be chronic into adulthood,” Marusak said. “Previous studies indicate that the endocannabinoid system is critical in fear regulation, which is a skill developed between childhood and adolescence. Mapping out how this system develops during that critical stage can provide significant insight into treatment and prevention of adolescent anxiety.” 

In addition to helping find new ways to prevent and treat anxiety disorders, Marusak’s study has future implications related to the effects of cannabis on adolescent brain development.

“There’s still a lot of research to be done about the effect of cannabis on the developing brain, but we do know that THC can change signaling within the brain’s endocannabinoid system, which could have lasting effects on brain development and the ability to regulate fear and anxiety,” she said.

To learn more about Marusak’s work and additional research related to childhood brain development and the impact of stress and trauma, visit Wayne State’s THINK Lab.

Mental disorders in kids – Empowering kids

It seems every time we turn on the television or read the news headlines there is mention of another teenager who died by suicide or committed a crime while under the influence of drugs or was involved in a school shooting. 

Mental illness and suicide in children and teenagers are increasing rapidly, which begs the question: Why?

Decades of research and studies have determined that there is no one single definitive reason for developing a mental illness, rather it is a combination of factors that influence brain growth and development: genetics, early environment (in utero) and current environment. For example, genetics play a significant role in the development of schizophrenia, alcohol intake during pregnancy increases the risk of a child having fetal alcohol syndrome. However, it is the current environment that the child/teenager lives in that appears to have the most impact on a child/teenager’s mental health and brain development and increases the likelihood of mental illness.

A child/teenager’s identity is shaped by environment, relationships, experiences and natural abilities. The way a child is parented and the relationship with parents, guardians, and other adults has a significant impact not only on brain development but also on how the child attains milestones, develops healthy relationships, and copes with stressful and challenging situations. Kids learn by example, and a mentally healthy child will be confident, have self esteem and positive self worth, quality of life and function well at home, in school and in the community. 

Unfortunately, many children live in, and are exposed to unsafe, abusive, and scary environments. Back in the 1990s, research revealed that when a child/teenager encounters stressful situations over and over again, the stress response shifts into overdrive and resets on high creating more inflammation in the brain, which predisposes him/her to developing health problems in later life, e.g. mental illness, obesity, chronic health conditions, etc. 

There are three types of Adverse Childhood Experiences (ACEs): 

  1. Abuse: physical, emotional, sexual
  2. Neglect: physical, emotional
  3. Household Dysfunction: divorce, substance abuse, mental illness, mother treated violently, incarcerated relative

In the early 2000s, the National Scientific Council on the Developing Child coined the term “toxic stress”  to describe extensive, scientific knowledge about the effects of excessive activation of stress response systems on a child’s developing brain, as well as the immune system, metabolic regulatory systems, and cardiovascular system. 

Experiencing ACEs triggers all these interacting stress response systems. Specifically, the chronically stressed brain releases a hormone that shrinks the size of the brain directly affecting the amygdala (fear processing) and the hippocampus (stress, memory, emotions). Also, brain cells which are part of the immune system start producing neurochemicals that lead to neuro inflammation. In the child/teenager who has experienced mental and physical suffering, these inflammatory chemicals continually flood the body from head to toe. Consequently, when a child experiences multiple ACEs over time, especially without supportive relationships with adults to provide buffering protection, these experiences trigger an excessive and long-lasting stress response, which can have a wear-and-tear effect on the body, like revving a car engine for days or weeks at a time.

So, after reading all this information, let’s look at the world today, the world our children and teenagers live in. The world is ravaged by wars, poverty, natural disasters, unemployment, fake news, threat of global warming, migration, anti-Semitism. Crime is escalating, homelessness and economic hardship is increasing, sex/human trafficking is widespread. Then, add in the opioid crisis, gangs, the constraints of school work, the impact of bullying – especially cyberbullying, and the influence of social media, and we have a world full of confusion, hatred and very little regard for the health and wellbeing of others. As adults, many of us feel frustrated, uncertain and concerned. No wonder our children and teenagers feel that they have little control over their lives and their future. 

Our children and teenagers are being exposed to life situations and stressors their parents never experienced. Even bullying in school has become more widespread and more dangerous. Furthermore, bullying is no longer confined to school, because cyberbullying is an ever present, constant and predatorial threat in kids’ lives. Research is beginning to show not only a connection between bullying and mental illness, but also that students who are bullied have smaller and less developed brains. Children and teenagers are being bullied and victimized at an alarming rate. Every seven seconds a child or teenager is bullied. Make no mistake, bullying is a very real and harmful threat, and it increases a child/teenager’s risk of developing a mental illness significantly. 

Many kids I have spoken to say they feel lost; they have no clear direction and purpose in life. I believe adult expectations, the competitive need to be bigger – better – the best, and the constant need to live stress-free and to be happy is a major problem. We have become a world where entitlement, popularity, good looks and acquiring material goods is the norm. We expose children and teenagers to life problems, the horrors of the world, and yet we rarely sit down with them and explain right from wrong, good from bad. Practically every child and teenager owns a phone or tablet and social media has become the surrogate parent, the teacher, and the babysitter. We seem to think that giving our kids whatever he/she wants, treating them as if they are our best friends and confidantes, will make them happier and feel loved. Sadly, this is not true. 

The only way we can truly help support our children and teenagers is by listening to them, hearing what they say, be understanding, non-judgmental, and compassionate. Help them to problem solve, to be assertive and to be kind. Be there for them, tell them how loved they are, show them. Our kids need help now. In the words of John Fitzgerald Kennedy: “Children are the world’s most valuable resource and it’s best hope for the future.”

If you want to take the ACEs quiz, please check out this site.

Medical Marijuana Available for Anxiety – Observer

Do you suffer from anxiety?

According to the National Institute of Mental Health, roughly 19% of adults have some form of anxiety disorder. Medical marijuana is now available as a treatment option for patients in Pennsylvania. Since it became an approved condition July 20, many are already seeking anxiety relief with this new plant-based choice also known as cannabis.

“I have already seen a lot of positive results in patients who have been coming to The Healing Center and using medical marijuana to treat their anxiety,” Jill Zimbicki Pharmacist at The Healing Center says. “This has been life changing for some patients.”

“Anxiety is one of the only approved conditions that most can relate,” says Chris Kohan, co-founder of The Healing Center, the Pittsburgh area’s premier dispensary group with a location in Washington.

“There is no doubt that cannabis can help treat anxiety, but it may take a little trial and error. The important part is to consult with your medical professional at the dispensary to determine proper strain, delivery method, and dosage to start.”

Dr. Bryan Doner, co-founder of Compassionate Certification Centers says, “I feel that the addition of anxiety to the qualifying conditions in Pennsylvania’s Medical Marijuana Program has the potential to help a tremendous amount of patients.”


The five major types of anxiety disorders are Generalized Anxiety Disorder, Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD) and Social Phobia (or Social Anxiety Disorder). PTSD has been an approved condition since the program was implemented.

“We have already seen wonderful clinical results with so many PTSD patients and the anxiety component of their disorder,” Doner says. “This will also help provide a focus on medical cannabis research in the area of anxiety, which is a common symptom of so many disease entities.”


Dr. Michael S. Butler, Pharmacist and General Manager at The Healing Center sees a lot of potential for patients to find relief without the use of pharmaceuticals that have been traditionally prescribed before cannabis became an option for them. “I believe that high CBD forms of medical marijuana have the potential to replace the majority of benzodiazepine drugs prescribed for anxiety in the US within the next 10 years. It is that effective” CBD is short for cannabidiol, an active ingredient found in the cannabis plant that communicates with receptors in the human body. THC is short for tetrahydrocannabinol, the psychoactive ingredient of the plant which also communicates with receptors.


  • Severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain: 45.02%
  • Anxiety Disorders: 14.94%
  • Post-traumatic stress disorder: 12.33%


  • Feeling restless and irritable
  • Difficulty concentrating
  • Muscle pain, tightness or soreness
  • Trouble falling asleep or staying asleep
  • Feeling exhausted even after a full night’s sleep
  • Going out of your way to avoid situations that make you
  • anxious
  • Unwanted thoughts or worries that won’t go away

Do You Suffer from Anxiety?

Contact medical marijuana experts in Washington



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