Goodbye to the DSM-V

By Matthew McKay, PhD, New Harbinger Publications co-founder and publisher

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is here, and it’s dead on arrival. A few weeks ago, the National Institute of Mental Health (NIMH) announced it will no longer fund research based on DSM symptom clusters — for the simple reason that the DSM is irrelevant to determining the cause and treatment of psychological problems. Here’s why:

A huge disconnect exists between DSM categories and treatment.
Some diagnoses have no viable treatments, some have the same treatment (for example, David Barlow’s unified treatment for emotional disorders), and some have multiple evidence-based treatments. If DSM diagnosis doesn’t inform treatment, what good is it? The answer is one, to facilitate the exchange of money between payers and providers, and two, to create silos for focused research. With the NIMH announcement, scratch number two.

The DSM is a topographical symptom map that doesn’t point to the actual causes — underlying mechanisms — that drive and maintain disorders.
These mechanisms, sometimes called transdiagnostic factors and/or vulnerabilities, are how we now formulate and explain psychological pain. Transdiagnostic factors like experiential avoidance, rumination, and cognitive misappraisal, along with vulnerabilities like intolerance of uncertainty, hyperarousal, and negative schemas create psychological disorders. Our treatments must be aimed at these causative mechanisms rather than outdated symptom clusters.

DSM categories are not discrete.
In other words, the same symptom can show up in many different diagnoses. Sadness/dysphoria is listed as a criterion symptom in more than a dozen disorders. If the DSM categories were useful and distinct, this smearing of symptoms across diagnoses wouldn’t happen. It forces clinicians, who observe anger symptoms for example, to rule out attention deficit hyperactivity disorder, bipolar disorder, borderline personality disorder, narcissistic personality disorder, post-traumatic stress disorder, substance use disorder, grief, intermittent explosive disorder, and six other DSM categories. And if one successfully wades through all these choices, there is still no understanding of why the disorder exists or what to do about it.

The DSM fails to account for comorbidity.
If you have obsessive-compulsive disorder, you’re likely to struggle with other anxiety disorders as well. And depression co-occurs with anxiety 60 percent of the time. All this is unexplained by the DSM. The only way to account for high rates of comorbidity is that many disorders are driven by the same underlying (transdiagnostic) mechanisms. Rumination, for example, is a major driver for both depression and anxiety — that’s why they are so often seen together. Though rumination may focus on different things (e.g., personal failures in depression vs. future catastrophes in anxiety) it is a required target of treatment across both diagnoses.

In light of its failures, one might reasonably ask: why a new DSM? In truth, this fifth edition is just moving a few deck chairs on a sinking ship. Dumping the multiaxial system and Asperger’s disorder while adding binge eating, hoarding, and excoriation disorder (skin picking) has brought us no closer to a classification system that explains what’s wrong and guides evidence-based treatment decisions. Soon we’ll need to finish what the NIMH started — lower the lid, hammer it down, and bury the Diagnostic and Statistical Manual of Mental Disorders.


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How To Set Qualifications For Massage Practitioners

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Skin picking classified as distinct disorder

“I went through years, I just felt so embarrassed and had so much shame,” says Hartlin, 26, who began digging at her skin at about age 13. “I thought I was the only one for years, and I think that is the worst part, that disorders such as this feed into that isolation and make it worse.”

What Is Depression

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Local teen hopes to increase awareness of service dogs

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Becca Hart and Mike have been companions for two years now, and Mike has done wonders toward helping Becca with her heart condition, lupus and OCD.

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Becca Hart, shown here with her service dog Mike, created Harts 2 Paws to help educate the public about service dogs.



An otherwise normal teenager, Becca Hart sends a text with one hand while holding Mike’s paw with the other.

Becca Hart is young, smart, kind and pretty — all qualities that are easy to see. On the surface, she’s exactly what you would expect the reigning Miss High Point Teen USA to be.
What you don’t immediately see when you meet this amiable 17-year-old, though, are the bumps in the road that have shaped — and continue to shape — so much of her life:
• Heart surgery at age 12, and residual heart issues that continue to this day.
• Lupus, an unpredictable, often misdiagnosed and misunderstood autoimmune disease.
• Obsessive-compulsive disorder, or OCD, an anxiety disorder that can be characterized by irrational fears and, in some cases, repetitive behaviors such as hand-washing to avoid contamination from germs. Becca, for example, takes a daily two-hour shower. She knows it’s irrational, but she can’t help it — that’s what OCD is.
“My OCD is so severe that just getting through a day can be nearly impossible,” she says.
Bridging the gap between what you see in Becca and what you don’t see is her constant companion, Mike, a 9-year-old brindled greyhound that acts as her service dog.
Mike can sense when Becca’s heart rhythm changes, when she’s experiencing — or about to experience — a panic attack, and when she’s in pain. If she needs assistance, he can provide it or go get someone who can.
“He really is an amazing dog,” Becca says, glancing over at Mike as he rests on his dog bed in a corner of the Hart living room.
Like many greyhounds you see around here, Mike is a rescue, retired from a career of racing in Florida. Truth be told, though, Becca’s family didn’t just rescue Mike.
He’s rescued them, too.

* * * *

Becca’s journey with Mike began a couple of years ago, when she was diagnosed with lupus and OCD, which is considered a byproduct of the lupus.
In addition to irregular heart rhythms she’s had since her surgery at age 12, and the joint pain and fatigue associated with her lupus, Becca struggles mightily with the symptoms of her OCD. Obsession with germs is only one facet of the disease for her; she also experiences irrational anxiety triggered by certain types of floor textures, extreme cold, and even the touch of paper.
“You don’t realize how much a day that you touch paper,” Becca says. “Even something as simple as going to get the mail is an issue. OCD is a very real thing — it’s the 10th most debilitating disease in the world. A lot of people discount it, but it’s definitely real.”
Becca’s OCD doctor, who owns greyhounds, suggested their calm, gentle demeanor might them a complementary companion that could help ease some of her anxiety.
“She suggested a greyhound for distraction techniques and to kind of be therapeutic for me,” Becca explains. “We got Mike, and he was learning everything we needed, but what we didn’t realize when we got him was that he can actually detect when my heart doesn’t beat correctly.”
At first, Becca’s cardiologist didn’t believe Mike could sense her irregular heart rhythm, but he’s seen it happen enough times now that he’s a believer, according to Becca’s mom, Tonya Hart.
Now, Mike is also learning to get help for Becca when she’s on the verge of a panic attack.
“When I feel panic coming on,” she explains, “I’ll say a certain word to him, and he will be trained to either go find my parents or push a button to call them, and then if they don’t answer, it will call 911.”
The Harts say Mike can also sense Becca’s pain and will touch the source of her pain — for example, her leg or her stomach — when he senses it.
Trained by Elite Canine of Winston-Salem, Mike is a certified service dog, which is unusual for greyhounds. He’s registered with the N.C. Department of Health and Human Services, and he wears a vest indicating he’s a service dog.
Still, there were skeptics.
“Some people didn’t believe he was a service dog, because I wasn’t in a wheelchair or wasn’t blind or didn’t have any kind of physical symptoms that they could see,” Becca says. “That’s why we started Harts 2 Paws.”

* * * *

Harts 2 Paws is a nonprofit foundation, established by Becca and her family, “to change the perception of what somebody’s service dog should look like, and to educate about the laws related to service dogs,” Becca says.
Tonya Hart says the foundation grew out of their frustration.
“Because (Becca’s) challenges are not as visible as someone that may be sight-impaired, she has encountered many situations in public that have led to her — and us — being very frustrated,” Tonya says.
“So we had two choices — get angry, and nothing would change, or we could educate the public on seeing people’s challenges and service animals from a different perspective.”
To that end, Becca has begun speaking at schools, churches, civic group meetings and other gatherings to talk about the Americans with Disabilities Act as it relates to service dogs, and the importance of the proper etiquette when encountering a service dog.
Becca’s also writing a children’s book about service dogs, and she has chosen Harts 2 Paws as her official platform when she competes in the Miss North Carolina Teen USA Pageant in High Point this fall.
Despite her anxiety issues, Becca says she’s not nervous about competing in the pageant.
“I’m more nervous about doing well to get my cause out there, because it’s something I have a real heart for,” she says. “So I guess I’m nervous only because I care so much about Harts 2 Paws.” | 888-3579


For more information about the Harts 2 Paws nonprofit foundation, visit the website at or on Facebook at Harts2Paws.
To book a speaking engagement for Becca Hart (and her service dog, Mike), call Tonya Hart at (336) 995-3138 or send an email to

Gradual Reduction Of Addictive Behavior Can Lead To More Sustainable

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Mental illness alliance planning walk at MCCC

If you’re looking for a reason to get outside and moving, May 18 will bring five chapters of a national organization together for a good cause.

On that morning, the National Alliance on Mental Illness will host its annual Greater Philadelphia NAMIWalk on and around the campus of Montgomery County Community College in Whitpain.

This year’s NAMIWalk 5K will begin with registration at 8 a.m. and the walking itself kicks off at 10 a.m., and will bring together five local chapters of the national program meant to raise awareness of mental illnesses: NAMI chapters from North Philadelphia, Northwest Philadelphia, Montgomery County, Bucks County, and the Main Line will all take part.

The Montgomery County chapter is headquartered inside the Centennial Plaza building at 100 West Main Street, and is one of more than 80 chapters nationwide established to help those with mental illnesses along with their families and friends.

There’s no registration fee, and the walk route and all walk facilities are accessible to those with disabilities – and a “Walking in place” section will have activities for those unable to walk the entire distance. Donations and sponsorships collected by those who walk will help support NAMI programs in the greater Philadelphia area, which include peer support and education for families and individuals suffering from mental illnesses, and advocacy and research for illnesses including schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorder, anxiety disorders, post traumatic stress disorder and attention deficit hyperactivity disorder.

Walkers are encouraged to recruit teams of family members, friends, organizations or agencies that would like to take part, and those teams can register online or that morning. As of press time, teams had raised a combined total of more than $61,000 to help support NAMI and its activities, with the top individual and team fundraisers recognized on the walk’s website.

Walkers who raise $100 or more for NAMI through sponsorships or donations will receive official NAMIWalks event t-shirts, and companies, businesses or organizations who’d like to learn more about sponsorships – or volunteers who would like to help out – can do so by contacting NAMI-MC Executive Director Carol Caruso at or calling (215) 361-7784.

What Is Penikese

As perhaps you have heard, the Becket Family of Services, working with the Family Support Collaborative, has been asked to create a new vision for the former Penikese Island School. This new program, Penikese, will be a small, non-profit, residential treatment program for young men (ages 14 to17) with substance abuse issues – and will be located on Penikese Island in Massachusetts’s Buzzards Bay. We plan to open on July 1.

The following is the profile of whom we serve.

Penikese is designed to address the specific, co-occurring treatment needs of older adolsecents and young men, ages 14-17, suffering from Substance Use Disorders and “internalizing” mental health conditions (i.e., disorders of anxiety, mood, attachment and trauma).

Substance Use Disorders at Penikese

Substance Use Disorders range across a spectrum of severity. One common assumption about a SUD is that one must hit rock bottom in order to be ready for treatment. At Penikese we believe quite the opposite. Our goal is to catch a young person at the earliest possible recognition of a SUD and to simultaneously treat the underlying internalizing mental health condition. We seek to prevent problematic use that is recurrent and already resulting in significant adverse consequences from becoming chronic, habitual and compulsive.
While there are a range of SUDs, the most common ones associated with the young me we serve include:

  • Cannabis Abuse Cannabis Dependence
  • Alcohol Abuse; Alcohol Intoxication
  • Inhalant Related Abuse
  • Sedative and Anxiolytic Abuse (Sleep Medication and Anti-Anxiety Medication)
  • Amphetamine Abuse (ADHD stimulant Medication Misuse and Abuse)

Treatment is possibly indicated and Penikese may be an appropriate setting when parents, teachers and friends of the young person begin to observe and witness substance abuse and some the following significant adverse behavioral changes:

  • Sudden personality changes that include abrupt changes in work or school attendance, quality of work, work output, grades, discipline
  • Unusual flare-ups or outbreaks of temper
  • Withdrawal from responsibility
  • General changes in overall attitude
  • Loss of interest in what were once favorite hobbies and pursuits
  • Changes in friends and reluctance to have friends visit or talk about them
  • Greater difficulty in concentration, paying attention
  • Sudden jitteriness, nervousness, or aggression
  • Increased secretiveness
  • Deterioration of physical appearance and grooming
  • Association with known substance abusers
  • Unusual borrowing of money from friends, co-workers or parents
  • Secretive behavior regarding actions and possessions; poorly concealed attempts to avoid attention and suspicion.

Penikese Focuses on Internalizing Mental Health Conditions

Mental health conditions are often characterized as being externalized or internalized. Words commonly associated with young persons with externalized behavior include extroverted, under-controlled and acting out. Conversely, those with internalized conditions are often characterized as being introverted, depressed and disinterested. Persons suffering from internalized conditions often experience a diminished or lost interest in their previous patterns of activities of life, including social activities, work, school and activities of daily living.

Based on our focus on treating SUDs and co-occurring internalizing mental health conditions, we typically work with young persons diagnosed with one or more of the following diagnosis:

  • The Mood Disorders: Major Depressive Disorder, Bi-Polar Disorders, Dysthymic Disorder.
  • The Anxiety Disorders: Generalized Anxiety Disorder, Social Anxiety Disorders, Panic Disorder, Separation Anxiety, Obsessive Compulsive Disorder, PTSD, and Specific Phobias.
  • Autistic spectrum disorders: Aspergers Disorder, Non Verbal Learning Disorder, Childhood disintegrative disorder, Pervasive developmental disorder not otherwise specified.

Whom We Do Not Serve

At Penikese, we do not seek to focus on the entire spectrum of co-occurring mental health conditions. Penikese is a small and highly integrated community. We do not have the ability to “divide and conquer” populations that research indicates should either not be mixed during treatment or could require a different treatment regimen that is not available at Penikese. In addition, severe addictions are best treated in alternative environments where symptoms of withdrawal can be better monitored and addressed. Accordingly, Penikese has developed exclusionary criteria that include the following:

  • Primary diagnosis of Oppositional Defiant Disorder, ADHD or Conduct Disorder
  • Need for medical detoxification
  • Requirement for opiate replacement therapy
  • Current or recent history of suicidal ideation
  • History of requiring a highly restrictive setting as the result of acting out or anti-social behaviors.

Most adolescents who present with a SUD also suffer from another mental health disorder. In order to maximize the likelihood of recovery both disorders should be treated at the same time. Adolescents with co-occurring disorders are less likely to recover from SUD when the mental health condition is left untreated. They are also more likely to be treatment resistant and more greatly inclined to drop out of treatment.

Many adolescents presenting with SUD begin using and drinking as a way to self-medicate untreated mental health disorders. In some cases mental health symptoms do not appear until the young person begins to use and drink. This may point to the fact that the drugs and alcohol either accelerate or cause the mental illness to manifest. In any event, the research points to the fact that if one of the co-occurring disorders is not treated there is a high risk that they will both get worse and even open the possibility for further complications to surface.

Over the past several decades there have been many studies highlighting the prevalence of both internalized (e.g., anxiety and mood) and externalized (e.g., conduct or oppositional defiance) disorders co-occurring with SUD. Adolescents presenting with SUD and co-occurring externalizing behaviors have received significant attention and much of the resources allocated for co-occurring disorders. Perhaps because of the internalized nature of the behaviors, there has been less focus on the treatment of internalizing disorders and SUD. Penikese seeks to respond to this need.
Of further note, adolescents with mood disorders, anxiety disorders and disorders related to trauma and attachment have particularly poor outcomes when their SUD is not treated simultaneously with their mental health disorder. A 2007 study (Buckner, et al.) found that Social Anxiety Disorder serves as a unique risk factor for the onset of cannabis and alcohol dependence. The prevalence of co-occurrence of SUD and internalizing disorders has been suggested by the empirical data as being as high as 47.9% (O’Neil, et al. 2011). The relationship between these disorders relative to which came first is unclear. What is clear is that early intervention in treating both disorders simultaneously gives the greatest chance that the adolescent will avoid the devastating implications of a bottom and begin to develop skills and discover strengths that will help protect him from relapse.

Penikese stands alone in its commitment to treating co-occurring internalizing disorders (disorders of mood, anxiety and trauma) simultaneously with SUD.

Best tips to overcome anxiety disorders naturally! – Zee News

Best tips to overcome anxiety disorders naturally!Most of us experience the feelings of anxiety and nervousness prior to an important occasion- it could be exams, interviews, meetings, first date, etc, which is quite normal. But, anxiety disorders are serious mental illnesses that fill people’s lives with overwhelming worry and fear that are chronic. In the long run, it can cause such misery that it interferes with a person’s ability to lead a normal life.

Several types of anxiety disorders are there– panic attacks, social anxiety disorders, obsessive compulsive disorders, post-traumatic stress disorders, generalized anxiety disorders, and phobias.
First of all one needs to identify what type of anxiety he/she is suffering from in order to get rid of it. While a combination of therapy, medicines and self-care can heal all of these disorders, here are some of the tips to help you in dealing with problems naturally:

Meditation: Using the right form of meditation can be useful for many people. Since lots of people dealing with anxiety problems are always in a dream-like state, the connective properties between mind and body that are used in meditation can do wonders.

Exercise: Daily exercise can drastically reduce your anxiety. Studies have shown that there is an incredibly strong link between anxiety and exercise.

Yoga/deep breathing: People who practice yoga regularly can keep themselves calmer and are often at peace. Deep breathing, which is very useful in dealing with panic attacks, is frequently taught in yoga. Doing yoga every day can help you relax from anxiety disorder besides toning your body.

Caffeine elimination: Anxiety may be reduced for some people by eliminating caffeine consumption.

Healthy diets: Eating a healthy diet is the key in combating anxiety disorders. Taking lots of fruits and vegetables and a diet rich in vitamins B, C, D and E as well as zinc, calcium and magnesium will be of great help in combating this disorder.

Compiled by: Salome Phelamei

Not Otherwise Specified: Anxiety & the Work of Dr. Robert Hudak

Not Otherwise Specified: Anxiety  the Work of Dr. Robert HudakSouthwest Pennsylvania National Alliance on Mental Illness (NAMI) held its annual conference at the beginning of April, and one of their afternoon breakout workshop presenters was Dr. Robert Hudak, assistant professor of psychiatry at Western Psychiatric Institute Clinic, University of Pittsburgh. “Pathways to Hope: Shaping a Positive Future in Uncertain Times” was the conference topic; Dr. Hudak’s contribution was “Coping with Anxiety and Panic Attacks.”

I communicated with Dr. Hudak recently, to clarify some questions, get his take on some extrapolations of anxiety and even to inquire about an interesting diagnostic title he proposed in his presentation.

Conference breakout workshops, be they NAMI or just about any organization, can never do justice to a topic in the short time allotted, but it is always good to get a small group together to at least begin a dialogue.

In his session, Dr. Hudak defined anxiety, reviewed the disorders as classified by the old and up-and-coming Diagnostic and Statistical Manual (DSM), discussed when and how to treat anxiety, and addressed referral concerns. Most of the content described herein is directly from his slide presentation, combined with quotes from my interview with him.

Interestingly, anxiety is “the only psychiatric symptom that is also experienced by individuals with no psychopathology.” Think about what that means. It can be found in normal emotion, or in psychiatric illness. But it can show up as “secondary to a medical or psychiatric illness, or as a primary symptom of a medical illness.” There are two states– not just psychological but also physiological — and four components — somatic, emotional, cognitive, and behavioral.

It is hardly a secret that even mild anxiety can show up in our bodies. The onset of hives for me during teen years, personally, was definitely emotionally-based, no matter how physically those deep red welts marred my arms. And as the emotional and behavioral components of anxiety are “givens,” in a sense, I asked Dr. Hudak to elaborate a bit on some of the cognitive components that might surface.

“The main one is an inability to concentrate or an inability to focus or pay attention,” he replied. “People sometimes complain to me that they feel like they have ADHD because their concentration is so bad.”

Due to internal family conversations that I have witnessed and been a part of at NAMI groups, though, I was thinking along the lines of more severe cognitive impairment even if acutely, as in stress-induced psychotic symptoms, disorganized thinking in how one presents to others, disassociation, or any manipulative behavior.

Given a chance to respond further, Dr. Hudak explained that “diistorted thoughts absolutely occur secondary to anxiety.” He gave the example of a mother who may not let ever her kids leave the house due to fear that they might get into a car accident and die.

“If they do leave, they may be required to check in every few minutes to ensure her they have not died, which most people would consider very extreme.” He goes on to say that “cognitive restructuring (in order to get her to realize that the chances of this happening are extremely unlikely and her reactions are extreme) is a part of the treatment, but only part. Simply doing that alone won’t work. Other behavioral methods are needed as well.”

As for stress induced psychotic-like symptoms, Dr. Hudak felt them “extremely rare” (but I know many family members through NAMI who might disagree!) Most important, as stressed in his workshop, “anxiety is expressed in a wide variety of ways by different individuals.”

The outgoing DSM has obsessive-compulsive disorder (OCD) as an anxiety disorder, but it will apparently be given its own weighted place elsewhere in the new one. Anxiety Disorder NOS (Not Otherwise Specified) will still be there, though, and Dr. Hudak curiously had it labeled “Hudak’s Syndrome.”

“This is a joke I tell to drive home a point. Every major psychiatric category has a NOS category which is generally used as a wastebasket term, for symptoms that don’t appear to be a diagnosable psychiatric condition…. I don’t feel it is a wastebasket term but is an actual separate illness that people can have, and to emphasize that it is different from generalized anxiety disorder.”

He goes on to say that he has certainly heard others comment, as well, that anxiety NOS is an actual illness and not just an NOS category.

His presentation gives an integrated approach for the treatment of all anxiety disorders, with consideration of medications and behavioral therapy, yet he definitely feels, as most, that “cognitive-behavioral therapies are the only ones shown to be effective for anxiety disorders.” These include specific physical techniques to help people cope with anxiety, as well as cognitive ones, such as self-record keeping and progress-tracking. “Thinking skills” also help individuals face situations that cause anxiety.

In his presentation, Dr. Hudak covered panic attacks in depth. I found it interesting to note that he included explaining the harmlessness of panic attacks as a specific, disarming therapeutic technique to be included in treatment.

A thorough look at the latest medications, and the symptoms they best treat, was given via his slide lecture. Some interesting points definitely stood out. He mentions FLAMS (Frontal Lobe Amotivational Syndrome) as a potential severe side effect of SSRI meds. Individuals being treated with these may “feel apathetic and emotionless…. very difficult to treat.”

“Exposure with Response Prevention” was one of Dr. Hudak’s slides and topics. This “teaches people that the physical symptoms of anxiety are normal and OK.” In treatment, a careful attempt to try to raise the heart rate will take place (by doing triggering behaviors and mechanisms).

Dual diagnosis — mental illness and co-occurring substance abuse — is a problem for many. Whether attending AA or NA, or on a treatment with an agonist like suboxone, it has been documented that acute anxiety is one of the most common co-occurring conditions with these patients.

Dr. Hudak feels that the the best way to determine the cause of the anxiety in these circumstances is to get patients sober. Nevertheless, anxiety can and will present in myriad forms, for myriad people, as is clearly pointed by his research and effective presentation.

An effective workbook is referenced in Dr. Hudak’s material — Mastery of Your Anxiety and Worry, by Zinbarg, Craske and Barlow, as well as some local resources for OCD, one of Dr. Hudak’s specialties.


Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 11 May 2013
    Published on All rights reserved.


Chronic pain sufferers often experience anxiety as well – Zee News

Chronic pain sufferers often experience anxiety as wellWashington: Researchers have suggested that patients coping with chronic pain should also be evaluated for anxiety disorders.

Lead author Kurt Kroenke, M.D., professor of medicine at Indiana University in Indianapolis, noted that health care providers are more aware of the common occurrence of depression in patients with chronic pain, and there has been less of an emphasis on anxiety.

In the new study, researchers evaluated 250 primary care patients who were being treated at a Veterans Medical Center in the Midwest. All patients had moderate to severe chronic joint or back pain that had lasted at least 3 months despite trying pain medications.

The participants were screened for five common anxiety disorders: generalized anxiety, characterized by persistent worry; panic, or sudden, repeated attacks of fear; social anxiety, characterized by overwhelming anxiety in everyday social interactions; post-traumatic stress, or a repeated feeling of danger after a stressful event; and obsessive-compulsive disorder, characterized by repeated thoughts or rituals that interfere with daily life.

They were also screened for health-related quality of life issues, such as fatigue, sleep habits, and work productivity.

The study found that 45 percent of the pain patients screened positive for at least one or more of the common anxiety disorders. And those who had an anxiety disorder also reported significantly worse pain and health-related quality of life than patients without a disorder.

“It is important to note that patients in our study screened positive for an anxiety disorder but not all would have a full-blown anxiety disorder if they had a diagnostic psychiatric interview,” said Kroenke.

“Some may just have anxiety symptoms and not all would warrant active treatment. However, probably at least 1 in 5 might have some type of anxiety disorder,” the researcher added.

The researchers also found that it was common for the five different types of anxiety conditions to occur in combination with each other and with depression.

“Psychological comorbidities are common in patients with chronic low back pain and other studies have also shown a high prevalence of depression, anxiety and other psychological conditions,” said pain expert Roger Chou, M.D., an assistant professor of medicine at Oregon Health and Science University.

Chou added that the guidelines on evaluating and managing lower back pain do recommend clinicians assess patients for psychological factors that may be contributing to a poorer prognosis and address them with appropriate treatments.

“Many patients benefit from cognitive behavioral therapy to help them in coping with the pain and related anxiety,” Chou continued.

The research was published in General Hospital Psychiatry.


Dunbar: Coping with obsessive-compulsive disorder

Dunbar: Coping with obsessive-compulsive disorder

May 9, 2013

During seventh grade, I was diagnosed with obsessive-compulsive disorder. For those who haven’t taken Intro to Psych, this disorder consists of two parts: obsessions and compulsions. Obsessions are persistent, anxiety-inducing thoughts, while the compulsions consist of certain acts or behaviors you carry out to alleviate the anxiety caused by the obsessions.

I tend to get obsessed with certain ideas. For example, when I was reading “Jane Eyre,” I was obsessed with why Jane decides to go back to Mr. Rochester. As a result, I repeated sentences in my head with the same meaning but different syntax: Jane left because she realized she needed Mr. Rochester. Realizing Jane needed Mr. Rochester, she went back to him. Jane realized she needed morality and love. Jane realized she needed both morality and love. Realizing she needed morality and love, she left her cousin John and went back to Mr. Rochester.

I also check things because I am always afraid I will forget something. I’ll be driving in the car and have to check my purse for my wallet. I also have to have things arranged in exact order. For example, books must be placed on a desk with perfect rectangles surrounding it.

I thought my OCD would improve as I grew older and moved away from my high school. At the very least, I believed I would learn to control it. But it turns out college just made me more stressed. So far, I haven’t really experienced the fun part of college, and I’m not the only one.

A couple weeks ago, my good friend suffered a psychotic break. She came down with mono and was prescribed a steroid to bring down the inflammation of her lymph nodes. Unfortunately, the steroid interacted with the Prozac she takes to reduce her anxiety. The result? She went a bit crazy — literally. Truth be told, however, I wasn’t entirely surprised. The stress and anxiety overload was bound to catch up with her.

Sometimes I look at my and my friends’ lives and think, “What’s with all the stress?” I don’t have to worry about money or paying for college. I go to a great school. I have friends and parents who love me. I even have a car, so I can go wherever I need to go. Nevertheless, the majority of the time I’m so consumed with anxiety that I can’t sleep.

But even with all of this, college isn’t what it was 30 years ago. Now it seems like nothing is ever enough. Education becomes a competition that never ends. Most of the students at Northwestern spent their four years of high school breaking their backs to take AP classes, get high grades and participate in numerous extracurricular activities. I thought I would finally be able to relax once I was accepted to college, but I was mistaken. In college, it all starts over – the grades, the extracurricular activities, the internships – and it starts from scratch. Everything is a resume builder, and one bad grade feels like the invariable downfall of your GPA. College is a never-ending flow of anxiety and exams and applications.

We’re trapped in a hot, cramped box with no way out. The contents are under pressure. It is no wonder people are suffering.

Since my friend’s psychotic break, I got to thinking. If our high school records get wiped clean, eventually won’t our college records be forgotten? Ten years down the road, no one is really going to care whether you graduated cum laude or magna cum laude, just like ACT scores stopped being important once you set foot on a college campus. We spend so much time worrying about the future that we forget we have no idea what’s actually going to happen. We forget that what the world revolves around today won’t matter much in the future.

I’m not saying college isn’t important. I’m just saying that the quiz you bombed when you were hungover or that interview you were late to isn’t going to determine your life in 20 years. Most likely, it will just get lost in a pile of memories.

Having fun shouldn’t have to be so hard. After all, we only have so much time to do it.

Blair Dunbar is a Weinberg sophomore. She can be reached at If you would like to respond publicly to this column, email a Letter to the Editor to