Mental Health has taken so much of my life from me

Emma Blezard, 18, says her mental health problems have robbed her of her teenage years.

She started experiencing difficulties when she was 13, suffering from anxiety and panic attacks before developing an eating disorder, depression and obsessive compulsive disorder.

Emma feels more money needs to be spent on mental health services, so fewer young people are kept waiting for help.

A new NHS report has found nearly one in four young women have a mental illness.

Young women aged 17 to 19 are twice as likely as young men to have problems, with 23.9% reporting a disorder.

NHS England says the new figures confirm the importance of the action being taken to “ramp up” access and a long-term plan will be published soon.

Video Journalist: Laura Foster

If you, or someone you know, have been affected by mental health issues, please visit the BBC Actionline for more advice.

As Rita Simons opens up about OCD diagnosis – what is the …

I’m A Celebrity star Rita Simons recently opened up about her battle with Obsessive Compulsive Disorder (OCD) – and her improvement from the condition.

During a conversation with Anne Hegerty during the show, Simons, who played Roxy Mitchell in EastEnders, discussed her experience with the mental health disorder and how it affects her life.

“I’m much better now. I’m not too bad with cleanliness and all of that,” she said of the common-yet-debilitating disorder. “I don’t do any of the rituals anymore.”

However, although improvement is possible, OCD symptoms can remain throughout one’s life.

What is OCD?

OCD is a “common, chronic, and long-lasting disorder” in which a person has “uncontrollable, recurring thoughts and behaviours” that they feel the urge to repeat over and over, according to the National Institute of Mental Health (HIMH).

The main characteristics of OCD are obsessions and compulsions – and some people can have both.

Obsessions are thoughts or urges that cause anxiety – and can be anything from a fear of germs to a need to have things in a perfect or symmetrical order.

Compulsions are repetitive behaviours that people suffering with OCD may feel obligated to do – such as cleaning excessively or repeatedly checking things, like a locked door.

The difference between regular urges or compulsions and obsessive-compulsive ones is that people with OCD may be unable to control their thoughts or behaviours.

According to the NIMH, people with OCD typically spend “at least one hour on these thoughts or behaviours” and do not get pleasure from performing the rituals – although they may feel slight relief from anxiety. 

The disorder also affects overall quality of life – as those living with OCD often find themselves unable to participate in aspects of life such as work, school, and personal relationships.

Who develops OCD?

OCD can develop at any age, in men, women, and children, according to the NHS.

Although it occasionally develops around puberty, many people develop the disorder during early adulthood.

According to the NHS, a number of factors may result in a diagnosis of the condition, including family history, brain differences, life events, and personality.

Is there a cure for OCD?

While there is no cure for OCD, there are certain treatments that can be effective in improving the condition.

According to the NHS, those suffering with OCD should seek a psychological therapist, who can help a patient navigate the disorder through psychological therapy, a type of cognitive behaviour therapy that allows patients to face their fears and compulsions.

Medication is also a possible treatment for the disorder.

People with OCD are typically prescribed a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) that alter chemicals in the brain.

For Simons, the disorder has improved – however, she revealed that she used to a “real light switcher, tap checker” and would “spend hours” doing it.

Case Report: When ‘Earworm’ Becomes Musical Obsession

So-called earworms are very common – an estimated 98% of people have experienced this phenomenon of having a tune circling persistently through their minds at some time in their lives. But earworms can reach a clinical level of severity to be recurring, distressing, unwanted, and intrusive, and give rise to compulsive behavior, at which point they qualify for classification as musical obsessions (a.k.a. “stuck song syndrome”).1

Although the condition is rare and under-recognized by various diagnostic procedures for obsessive compulsive disorder (OCD),2 most patients with musical obsessions are ultimately diagnosed with OCD. Young adults in their mid-30s are most likely to be affected. Only about 100 cases have been reported worldwide.1 The following report describes the diagnostic and treatment challenges of one such case.3

The Case

A 32-year-old female psychology student presents to your office troubled by marked anxiety, distress, and a recent history of difficulty getting to sleep. She is troubled by hearing a series of songs that play repeatedly in her head, continuously throughout her waking hours. She explains that the constant loop of musical fragments she hears is interfering with her focus and concentration, to the extent that she cannot have a normal conversation or read without losing her train of thought.

She is single and lives with her mother, is a student, but otherwise has been unemployed for the past 3 years. Her symptoms are having a significant negative impact on her academic performance, and her apparent lack of attention is a detriment to her personal relationships at college and at home.

She is fully aware that the music is coming from inside her mind – although she knows some of the songs she is hearing and they are true to the original in melody and rhythm, the songs are not being triggered by music in her environment.

The stuck songs include songs she is fond of and songs she dislikes, choruses from television commercial jingles, and fragments of instrumental as well as vocal pieces. She notes that she first experienced this phenomenon 12 years ago; episodes were intermittent, lasting for a week or two and recurring monthly. Initially, the symptoms were mild, but they worsened gradually over the course of the following 6 years to become moderate to severe and to be associated with compulsive behaviors.

Her family has no history of mental health or neurological conditions. Her only mental health issue prior to this developed during adolescence, when she was affected by anorexia nervosa. This was resolved successfully with psychotherapy, an experience that may have actually inspired her to study psychology.

Her compulsive attempts to control these musical obsessions over the years have brought no lasting relief. She tried using headphones at high volume to listen to other music in an effort to distract herself from the songs looping in her head, and says that the resulting cacophony caused her intense anxiety and mental discomfort.

On the other hand, she found that matching her choice of music to the song in her head and listening at a very high volume offered some short-lived relief. Ultimately, her failure to control the musical obsessions left her feeling frustrated, defeated, sad, and powerless.

Case Challenge 1

Symptoms and Differential Diagnosis

As part of a clinical spectrum that ranges from normal to pathological, musical obsessions are distinct from “sticky tunes,” or earworms.

These are manifestations of involuntary musical imagery in which music that has usually been recently heard repeats on an involuntary loop within the “mind’s ear.” This very common phenomenon may cause some distress, but does not reach the level of an obsession.4

When considering a patient reporting musical obsessions, common physiology may be distinguished from potential pathology by the extent of distress the stuck song causes in the patient, often signaled by a negative impact on sleep and daily functioning, active avoidance behaviors, and coexisting symptoms suggestive of OCD.5

Two key differential diagnoses include musical hallucinations and palinacousis. Musical hallucinations are a form of complex auditory hallucination in which individuals “hear” music they perceive as tunes or melodies coming from their surroundings, despite the absence of a corresponding external sound.6

Palinacousis is an illusory phenomenon thought to involve temporal lobe dysfunction, that involves persistent or recurrent echoing replication of music and/or environmental and vocal sounds after they have stopped.7

Assessments and Initial Treatment

A structured interview and evaluation reveals symptoms that meet the diagnostic criteria for OCD, as described in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Assessment using the Spanish version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) indicates that the patient has severe OCD, with scores of 17 for obsessions and 16 for compulsions, for a total of 33 out of a possible 40 (severe OCD).

Her score of 8 on the Beck Depression Inventory is negative for depression; however, she does have moderate to severe anxiety (Hamilton Anxiety Rating Scale score of 31). Results of laboratory tests are within normal limits, and no abnormalities are noted on brain magnetic resonance imaging and electroencephalogram.

When the patient’s symptoms escalate to become severe about 7 years after onset, she is treated with fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) medication. The dose is progressively escalated to 200 mg/day over 12 weeks. This decreases the frequency of her symptoms but not their intensity. A few years later, she receives treatment for sleep onset insomnia, which responds to eszopiclone 3 mg.

Case Challenge 2

Which medications would be appropriate to treat this patient’s symptoms?

Case Follow-up and Outcome

The following year, she is treated with paroxetine controlled-release tablets 50 mg/day for persistent and severe symptoms (total Y-BOCS score=33). However, that SSRI is later discontinued due to causing intolerable drowsiness and dizziness.

A subsequent trial of fluoxetine 60 mg/day partially reduces the symptoms after 12 weeks of treatment. The dose of fluoxetine is increased to 80 mg/day, but she is unable to continue taking it due to headache.

However, her Y-BOCS score drops to 13 (10 for obsessions and 3 for compulsions — i.e., mild OCD), a 60% reduction in symptoms from baseline. The Hamilton Anxiety Rating Scale yields a score of 16 (mild).

She refuses to start cognitive behavioral therapy (CBT) or other forms of psychotherapy as recommended. In particular, one form of CBT — exposure and response prevention8 — is effective in OCD and often combined with SSRI treatment.9

Medications in OCD

Although the effects of SSRI in adults with OCD appear to be of similar magnitude,9 they do have different pharmacodynamic properties. In contrast to paroxetine and fluvoxamine, fluoxetine not only inhibits serotonin reuptake, but also has norepinephrine reuptake inhibition and serotonin 2C (5HT2C) antagonist actions. Early research suggests that the 5HT2C receptor may have a role in OCD, which may help account for its effectiveness in this case.10

Importantly, musical obsessions may be misinterpreted as a psychotic symptom, which can result in erroneous use of antipsychotics such as chlorpromazine in these patients.2

The anesthetic ketamine is theorized to have a potential role in OCD — likely by increasing glutamate levels — and is currently being studied in the treatment of OCD.

Discussion

Musical obsessions are largely accepted as a rare variant of OCD, given that the vast majority of these patients have met the diagnostic criteria. This case also presents an unusual form of compulsion that accompanied musical obsessions, in which the patient sought to complete the obsessive content by listening to real music.

Compulsive efforts to dispel obsession-related anxiety — which can be described as a form of active harm avoidance — have the paradoxical effect of intensifying anxiety over time. In fact, these compulsive behaviors have been proposed as a cause of OCD since they trigger further intrusive thoughts, in a vicious cycle. This avoidance behavioral trait has a neuroanatomical basis in the striatum, an area known to be involved in OCD and targeted by deep-brain stimulation therapies for OCD.11

Conclusion

An often overlooked condition, musical obsessions can cause significant impairment of quality of life. This case was not complicated with comorbid illness, and the patient had a good level of self-awareness and understanding of her illness, and despite adverse effects, her symptoms proved to respond reasonably well to treatment. It is expected that psychotherapeutic measures would have further resolved her musical obsessions.

References

1. Taylor S, et al “Musical obsessions: A comprehensive review of neglected clinical phenomena” J Anxiety Disord 2014; 28: 580-589.

2. Saha A “Musical obsessions” Ind Psychiatry J 2012; 21: 64.

3. Orjuela-Rojas JM, Rodríguez ILL ” The Stuck Song Syndrome: A Case of Musical Obsessions” Am J Case Rep 2018; 19: 1329-1333.

4. Williamson VJ, et al “Sticky tunes: How do people react to involuntary musical imagery?” PLoS One 2014; 9: e86170.

5. Euser AM, et al “Stuck song syndrome: musical obsessions – when to look for OCD” Br J Gen Pract 2016; 66: 90.

6. Golden EC, Josephs KA “Minds on replay: Musical hallucinations and their relationship to neurological disease” Brain 2015; 138: 3793-3802.

7. Patterson MC, et al “Palinacousis: A case report” Neurosurgery 1988; 22: 1088-1090.

8. Rafin ZY “A 19-year-old with intrusive loops of music in his mind” Psychiatric Annals 2016: 46: 12.

9. Skapinakis P, et al “Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: A systematic review and network meta-analysis” Lancet Psychiatry 2016; 3: 730-739.

10. Papakosta V-M et al “5-HT2C receptor involvement in the control of persistence in the reinforced spatial alternation animal model of obsessive – compulsive disorder” Behav Brain Res 2013; 243:176-183.

11. Hauser TU et al “Neural mechanisms of harm-avoidance learning: A model for obsessive-compulsive disorder?” JAMA Psychiatry 2016; 73(11): 1196-1197.

The case study authors had no conflicts to disclose.

last updated 11.19.2018

Promentis Pharmaceuticals Announces Successful Completion of Phase 1 Studies for SXC-2023 Targeting Novel …

MILWAUKEE, Nov. 16, 2018 /PRNewswire/ — Promentis Pharmaceuticals, Inc., a privately-held biopharmaceutical company developing innovative therapies for neuropsychiatric disorders, today announced it has completed Phase 1 single ascending dose and multiple ascending dose studies for its lead compound, SXC-2023.  SXC-2023 has demonstrated a compelling profile across a range of non-clinical studies. Promentis is developing SXC-2023 and other compounds that engage System xc-, a central nervous system (CNS) target addressing glutamatergic imbalance and oxidative stress, to treat impulse control disorders, obsessive-compulsive disorder and other neuropsychiatric diseases.

The aim of the Phase 1 studies was to evaluate the safety, tolerability and pharmacokinetics of single and multiple ascending oral doses of SXC-2023.  In the first study, single ascending doses were evaluated in six cohorts, with a total of 48 subjects. In the second study, SXC-2023 was administered daily for 14 days within four different dose groups. SXC-2023 proved to be safe and well-tolerated over a wide dose range in healthy volunteers in both the SAD and MAD studies, and demonstrated a very consistent PK profile. There were no significant adverse events and no treatment-related discontinuations in either study. 

“We are very pleased with these results, which show SXC-2023 to be very safe and well-tolerated, and to possess a very well-behaved PK profile,” said Dr. Tom Beck, CMO of Promentis. “We believe that the mechanism and excellent safety profile of the drug are consistent with potential applications in a wide variety of impulse control disorders, both as monotherapy and in combination with other treatments. These results reinforce our interest and enthusiasm in SXC-2023 as we look to the near-term commencement of our Phase 2 program.”

Glutamatergic dysfunction is a hallmark feature of many neuropsychiatric indications, including a broad range of impulse control disorders (ICDs), which is Promentis’ initial therapeutic focus.

Promentis’ first ICD monotherapy indication is trichotillomania, a disabling and underrecognized condition characterized by recurrent hair pulling, leading to noticeable hair loss and substantial adverse impact on quality of life. Trichotillomania is more common in women than men and has been estimated to affect approximately 1% of the US population. No medications are approved by the US Food and Drug Administration for the treatment of this chronic disorder. Obsessive-compulsive disorder is the company’s first add-on indication, and the company is also exploring additional CNS indications where glutamatergic imbalance and oxidative stress contribute to impaired functioning.

About Promentis Pharmaceuticals

Promentis Pharmaceuticals, Inc. is a privately-held biopharmaceutical company developing innovative therapies for neuropsychiatric disorders. Promentis’ drug development efforts are focused on a unique approach to addressing glutamatergic imbalance and oxidative stress. The Company’s first indication is trichotillomania, a highly prevalent disorder for which there is no approved therapy, and for which there are no other known treatments in development.

Promentis is led by Klaus Veitinger, M.D., Ph.D. (CEO, Chairman of the Board for Promentis and OrbiMed Venture Partner). The team also includes Tom Beck, M.D. (Chief Medical Officer and Board Member for Promentis and F-Prime Capital Executive Partner), Daniel Lawton (President and Board Member) and Chad Beyer, Ph.D. (Senior VP RD).

About Trichotillomania and Other Obsessive-Compulsive and Addictive Disorders

Obsessive-compulsive and related disorders, as defined by DSM-5, represents a broad category of neuropsychiatric disease, including OCD, excoriation (skin-picking) disorder and trichotillomania. Trichotillomania is a disabling and underrecognized condition characterized by recurrent hair pulling despite repeated attempts to stop the behavior, leading to noticeable hair loss. Trichotillomania is associated with a range of psychosocial problems, including low self-esteem, social anxiety, avoidance of intimacy, occupational impairment and an overall decrease in quality of life. In addition, a significant number of trichotillomania patients ingest their hair after pulling, which can lead to life-threatening gastrointestinal blockages requiring surgery. 

Alterations in glutamate signaling within brain regions implicated in urge control and executive function have been proposed to contribute to the underlying pathology of trichotillomania, as well as other obsessive-compulsive disorders, addictive disorders and other CNS conditions. No medications are approved by the US Food and Drug Administration for the treatment of trichotillomania, nor are there any other known treatments in development. For more information regarding trichotillomania, see: https://promentispharma.com/technology/trichotillomania.

Contact: Tiberend Strategic Advisors, Inc.

Janine McCargo, 646-604-5150,  jmccargo@tiberend.com

SOURCE Promentis Pharmaceuticals, Inc.

Fearless: Breaking Anxiety Down

Today I discuss six common thinking errors (or maladaptive beliefs) in obsessive-compulsive disorder. These are different from the ten cognitive thinking errors I have discussed previously. I divide these OCD-related thinking errors into three groups:

  1. Control of intrusive thoughts
  2. Exaggerated threat and responsibility
  3. Intolerance of uncertainty and perfectionism

To explain these patterns of maladaptive beliefs, I use the example of an individual who has checking compulsions regarding his family’s safety. He worries that strangers will break into his house and harm his wife and his little son. So he tries to reassure himself not only through walks around the house before leaving for work, but by calling home many times a day, calling the neighbors, checking the local news for reports of break-ins, etc.

Important uncontrollable intrusions

To explain these first two thinking errors, let us consider the individual in our example, who despite reassuring himself that everything is okay, is tormented by thoughts such as: Am I certain there was nothing suspicious around the house?

Why do these thoughts cause him such anguish? Because to many with obsessive-compulsive disorder, intrusive thoughts are important. It is as though such intrusive obsessions increase the likelihood of bad things happening. Therefore, people with obsessive-compulsive disorder try to suppress threatening worries.

However, it is very difficult to control one’s thoughts. To see for yourself, try this exercise: For five minutes, do not think of a purple kite, in the shape of a pig with wings. It is crucial that you don’t!

Set the timer for five minutes.

Okay, how did you do?

Compared to thoughts regarding a purple kite, obsessions are even more difficult to control because they are threatening. It is difficult to ignore thoughts like: What if I have AIDS and don’t know it? What if there was a rare virus on my hand when I put a band-aid on my daughter’s injury? What if I did not do my prayers right and go to Hell? Etc.

The more one tries to suppress such obsessions, the more powerful they seem to become.

Exaggerated threat and responsibility

To examine the next two thinking errors, let us return to the person in our example. He now obsesses about the possibility that this morning he failed to notice two strangers standing next to a tree, a block away. To him, such an error would be costly. Why?

Because those with obsessive-compulsive disorder overestimate both the likelihood and severity of something terrible happening. So two strangers a block away could not be tourists, photographers, people considering buying a house, someone’s guests…but criminals. And not thieves or swindlers, but unstoppable murderers who will break into this individual’s home and kill his powerless and defenseless wife and child.  This is a horrifying possibility. But a rare one.

Many things in life are possible but not probable. Just as it is possible that today, as you drive to work, you have an accident and become paralyzed from the neck down. Again, horrifying, but rare possibility.

Of course, it is rational to prevent harmful things from happening when their likelihood multiplies. For instance, it would not be a good idea to drive drunk, when the weather is terrible, or when your car’s brake is malfunctioning.

Let us talk about the other thinking error, that of responsibility. Our individual’s pseudo-prophetic vision of his family getting murdered is too powerful to ignore, so in a sense it becomes his responsibility to prevent their murder. Only he—not his wife, the neighbors, the police, etc—can anticipate or stop this tragedy. So he checks and checks and checks….

Uncertainty and “not just right” feelings

The last two thinking errors in obsessive-compulsive disorder are intolerance of uncertainty and “not just right” feelings. I start with the first.

Life is filled with uncertainties. Awful things could happen to anyone. Usually, we do not worry about such events because we can tolerate uncertainties.

But low probabilities are no source of comfort to one who can not tolerate uncertainty; for instance, for a person who needs to feel absolutely certain about the safety of his family, and for whom “good enough” is not good enough. Nothing short of perfect certainty will do.

Perhaps related to this is the maladaptive pattern of “not just right experiences.” People with obsessive-compulsive disorder have difficulty tolerating feelings of incompleteness and imperfection.

Being told that a negative event is unlikely provides no comfort when things do not feel right.

Case in point, the individual in our example needs to examine his surroundings until it feels right; until he feels a sense of balance, of things being just right. Only then can he stop obsessing.

Summary of thinking errors in OCD

People with obsessive-compulsive disorder

  1. Often consider intrusive thoughts to be important, and they try to control them.
  2. Exaggerate a threat’s likelihood and severity, and feel responsible for stopping the dreaded event from occurring.
  3. Have trouble tolerating uncertainty and “not just right” feelings.

Inflammatory Th17 Cells Seen to Trigger Obsessive Compulsive Disorder in MS Mouse Model

The pro-inflammatory Th17 cells that characterize multiple sclerosis (MS) may also underlie symptoms of obsessive-compulsive disorder (OCD), results of a mouse study show.

The study, “Auto-Reactive Th17-Cells Trigger Obsessive-Compulsive-Disorder Like Behavior in Mice With Experimental Autoimmune Encephalomyelitis,” was published in the journal Frontiers in Immunology.

“For the first time, we are reporting a likely link between OCD and an important arm of cell-mediated immunity,” Avadhesha Surolia, the study’s senior author, and an honorary professor at the Indian Institute of Science in Bengaluru, India, said in a press release.

“Until now, we have looked at neuropsychiatric diseases as purely a neurological problem, ignoring rather completely the immunologic contribution,” Surolia added.

Patients with autoimmune diseases like multiple sclerosis can develop OCD, an anxiety disorder. But central mechanisms linking these disorders remain elusive.

Researchers at the institute used the chronic experimental autoimmune encephalomyelitis (EAE) model, an established MS mouse model, to characterize the psychological abnormalities associated with MS.

Ten days after the induction of MS-like symptoms, they saw that mice developed a repetitive behavior similar to OCD — the animals spent an excessive amount of time, 60 to 70 percent more than a healthy control group of mice, grooming themselves Excessive behavior was also seen in compulsive nestlet shredding and marble burying.

Researchers then focused on a group of cells, called Th17 lymphocytes, known for their pro-inflammatory properties. Th17 cells play a key role in the destruction of the nerve cells’ protective myelin layer, a hallmark of MS.

To determine the relative contribution of Th17 cells to the OCD-like symptoms, they infused Th17 cells into the EAE mice. They also infused mice with Th1 cells, another group of autoreactive immune cells also linked with MS.

Although both groups of animals developed signs of MS, only mice given Th17 cells showed a significant increase in grooming activity, as well as marble burying and nestlet shredding behavior.

“We observed unexpectedly high grooming activities in diseased mice which in some cases manifested as hair-less patches and/or injuries,” the researchers wrote. “The repetitive behavior was noted to be quite similar to OCD in human subjects … firstly, diseased mice devoted unusually greater time in grooming themselves which can be viewed as over-grooming; second, the grooming behavior was rigid in pattern and rigidity is a characteristic feature of OCD; thirdly, the behavior had a[n] anxiety component.”

Brain analysis of Th17-infused mice with excessive grooming behavior showed that these cells lodged primarily in two brain areas known to regulate grooming in mice — the brainstem (the region that connects the cerebrum with the spinal cord) and the brain cortex.

EAE mice treated with digoxin, a selective inhibitor (blocker) of Th17 differentiation, reduced by half the animals’ grooming activity.

Neurotransmitters, like serotonin, were previously linked with OCD, and researchers saw a considerable reduction in serotonin levels in the brain stem and cortex of the EAE mice. Mice treated with an antidepressant that boosts the uptake of serotonin, like fluoxetine (sold as Prozac), reduced their obsessive grooming behavior.

These results suggest that the infiltrating Th17 cells eventually may disrupt serotonin signaling, triggering the OCD-like symptoms. Additional neurotransmitters, like glutamate, may also play a role in the compulsive behavior — perturbed glutamate signaling is known to underly several neuropsychiatric disorders, including OCD.

“[I]t could be proposed that autoimmunity due to Th17-cells or any condition leading to a persistent increase in this particular repertoire of immune cells is a risk factor for neuropsychiatric illnesses,” the study concluded.

Its researchers suggest that therapies targeting the pro-inflammatory Th17 cells may help to halt the development of OCD in people with MS and possibly other autoimmune diseases.

“In this way we will be able to treat the root cause of the malady rather than targeting its manifestation and the symptoms,” Surolia said.

Are you afraid of fear?

Fear. What is your response when you think about the following words that describe the fear feeling? Shock, distressed, anxious, alarm, panic, frightened, terror.

The emotion called “fear” is the most researched of all human emotions. Fear is a survival mechanism. Pick up a poisonous snake and what might happen after it bites you? Learning to fear something dangerous helped our ancestors to survive. Try to pet a T-Rex and you would be eaten for dinner?

Humans need to be able to experience healthy fear for safety and to stay away from danger. Fear serves a purpose.

Fear and the Brain

Fear is created in both the brain and the body. The amygdala, an almond-shaped structure in the limbic system, is considered the seat of fear in the brain. Our “thinking brain” gives feedback to our “emotional brain” and perceives the environment as dangerous or safe.

Fear is a neuro-physiological response to a perceived or actual threat. Fear activates our fight, flight, or freeze response by stimulating the hypothalamus, which directs the sympathetic nervous system and the adrenal-cortical system to prepare our bodies for danger.

Anxious: Using the Brain to Understand and Treat Fear and Anxiety is a book by neuroscientist Joseph LeDoux (Publisher: Penguin, 2015). “Together, fear and anxiety disorders are the most prevalent of all psychiatric problems in the United States…”

Disorders of anxiety and fear include phobias, social phobia, generalized anxiety disorder, panic disorder, separation anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

Common phobias include the following: fear of public speaking, flying, spiders, needles, heights, enclosed or open spaces, storms, snakes. A specific phobia is an intense, irrational fear of something that poses little or no actual danger.

Is Fear Holding You Back?

Humans fear loss, risk, and failure. A doctor who fails to pass the licensure test cannot practice medicine, so he/she procrastinates on signing up to take it. Fear of bodily harm prevents some humans from skydiving—the risk is not worth the temporary pleasure. A fear of snakes may prevent camping trips. Do you like stability and security or change and risk?

Fear can stop someone from following his/her dreams and achieving goals. Fear can stop someone from socializing in public. Fear can stop someone from leaving his/her home. Fear of what? Fear of failure, being judged, being harmed.

Have you felt so afraid of failing at something that you decided not to try it at all? Some people fear success. What if I lose it all after I get it?

Adolescents fear being embarrassed in front of peers or being judged as less than. Children fear the dark, monsters, and being picked last for a game at recess. Both youth and adults fear rejection and betrayal.

Entering a haunted house during Halloween is different from being chased down a dark alley by a stranger. Do you like to watch scary movies or not?

Others have a fear that they cannot control the terrifying unknown (their perception of what is horrifying).

Zach William’s song is called Fear is a Liar. The chorus is the following:

“Fear, he is a liar

He will take your breath

Stop you in your steps

Fear he is a liar

He will rob your rest

Steal your happiness

Cast your fear in the fire

‘Cause fear he is a liar”

Fear is a universal emotion. Every person on planet Earth has experienced fear.

“This song is my anthem, and I pray it encourages others to break up with fear too.” Francesca Battistelli sings the Breakup Song:

“Fear, you don’t own me

There ain’t no room in this story

And I ain’t got time for you

Telling me what I’m not

Like you know me well guess what?”

Managing Fear

“No one is immune to fear. Even courageous people experience fear. Courage is not the absence of fear, but the management of fear,” according to a 2015 article in The Washington Post.

Information about fear can bring awareness, curiosity, and questioning to promote understanding about why humans experience certain reactions to perceived or real threats. Acknowledge the fear and take action.

Seek out a mental health therapist if needed to address debilitating fear that impairs daily functioning.

“Faith is a place of mystery, where we find the courage to believe in what we cannot see and the strength to let go of our fear of uncertainty.”—Brene Brown

By Melissa Martin

Reach:Melissa Martin, Ph.D, is an author, columnist, educator, and therapist www.melissamartinchildrensauthor.com. Contact her at melissamcolumnist@gmail.com.

Reach:Melissa Martin, Ph.D, is an author, columnist, educator, and therapist www.melissamartinchildrensauthor.com. Contact her at melissamcolumnist@gmail.com.

In Search of the Ultimate High

The world offers up an enticing smorgasbord of pastimes – all claiming to offer you an endorphin rush not to be missed. These thrill-seeking activities such as drug and alcohol use, casual sex, and escapism though non-stop entertainment, promise much but deliver little in terms of long-lasting satisfaction.

It seems our relentless search to be high is because we feel so consistently low. Look around you and you will see that joy is notably absent. It is ironic that America is ravaged by misery though widely recognised as a land of plenty. This fact alone lends resonance to Jesus’ statement that, “…life is not measured by how much you own” (Luke 12:15, NLT).

Statistics show that, “Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year.” These disorders range from general anxiety disorder, to panic disorder, social phobias, obsessive compulsive disorder and post-traumatic stress disorder.

In this article, we will consider three types of highs in particular. They all carry health warnings, or risks to life, limb, and well-being.

Thrill-Seeking High

A 2018 study revealed that between 2011 and 2017, 259 people died in pursuit of extreme selfies. Two people forming a couple, aged 29 and 30 years old, respectively, recently fell to their deaths whilst taking a photo of themselves on a granite ledge with no railings in the Yosemite National Park in California. They flirted with death for the temporary adrenalin rush of taking an extraordinary selfie, but they will never live to see how many “likes” they would have gained on Instagram or other social media sites; nor will they be able to share with friends and family what it felt like to experience that moment before their tragic accident.

There is something about getting up high, scaling physical heights or defying gravity which induces a spike of endorphins, such as when riding on a Ferris wheel at a carnival, riding in a helicopter or experiencing the view from the Empire State building. These times signify rising above our mundane problems and the tedium of everyday life, and savoring the sublime – if only for a fleeting moment. But to what lengths are we willing to go to achieve this high, and is it all worth it?

Drug-Induced High

Drug-taking is a popular means of escape, and the stigma surrounding marijuana is being replaced by mainstream approval. For example, on October 17, 2018, cannabis use was legalised in Canada – second only to Uruguay in achieving this historic feat. But pro-marijuana advocates do not want to stop there, they desire a global trend in legalizing marijuana for recreational use. Apart from medical marijuana, is this drug as harmless as many claim it to be? According to research from the Canadian Centre on Substance Use and Addiction (CCSA), “Teens who start smoking marijuana early and do so frequently risk lowering their IQ scores.”

As well as the potential to lower IQ, marijuana use tends to lower motivation, breed addiction and its smoke contains many of the same irritants and toxins as tobacco smoke which increases the user’s chances of developing chronic bronchitis, emphysema and cancer. Apart from deciding whether the money spent on buying marijuana is worth it, users will need to assess whether the high it yields from the psychoactive tetrahydrocannabinol or THC ingredient is worth the risk to their life and physical and mental health. Furthermore, marijuana is known to be a gateway drug, no doubt because over time it will deliver diminishing returns. This means that users will need stronger doses to get the same effect, and so many will move to stronger drugs.

Alcohol-Induced High

A recent report from the World Health Organisation reveals that one in 20 deaths worldwide are linked to alcohol. This number spans deaths resulting from road traffic accidents, digestive diseases and suicide. Research from the Washington School of Medicine confirms that daily consumption, even if it is light, increases your chances of premature death by 20%. Current health guidelines on safe levels of social drinking are now being revised. Scientists now hold to the view that whatever benefits are gained by light drinking, are outweighed by the risks.

A Supernatural High

This high cannot be granted by another human being, and there is no amount of money which can buy it. It won’t cost you anything monetarily, yet it costs everything – a lifetime of trusting and following Jesus. This yields a guaranteed high from knowing that your sins are forgiven, you will spend eternity with God, and that God will be your faithful companion and provide for all your needs. Life will not always be a blissful road, but it is possible to experience a high that does not result in premature death, an impaired mind or physical disease. By choosing the path of life found in a relationship with Jesus Christ and by casting all your cares on his supernatural shoulders, “…then you will experience God’s peace, which exceeds anything we can understand” (Philippians 4:7, NLT). This is the only high from which there are no withdrawal symptoms – because it lasts from now until eternity.

—Carla Cornelius, ph.D., gained her doctorate from Trinity School of the Bible and Theological Seminary in Newburgh, Indiana. Her dissertation proposed a biblical model of counseling the suicidal based on the book of Ecclesiastes. Because the causes of suicide are multifactorial, she endeavors to bring a psycho-spiritual perspective to this complex and ever-pressing issue. She is the author of five books including “Culture Detox: Cleansing our minds from toxic thinking,” “Captive Daughters: Breaking the chains” and “No Way Out: Keys to avoiding suicide.”

Chronically anxious? Deep sleep may take the edge off

Extreme angst is on the rise nationally and globally, especially among teens and millennials. Among other factors, preliminary findings from UC Berkeley sleep researchers point to a chronic lack of deep restorative sleep.

Investigating the neural link between sleep and anxiety, UC Berkeley neuroscientists Matthew Walker and Eti Ben Simon are finding that non-Rapid Eye Movement (NREM) sleep plays a key role in calming the overactive brain, especially in the brain regions that process and regulate emotions.

“The more time you spend in deep non-REM sleep, the less anxious you are in the morning,” said Ben Simon in reporting her preliminary findings at the Society for Neuroscience annual meeting this week in San Diego.

Using functional Magnetic Resonance Imaging (fMRI), among other measures, Ben Simon and Walker tracked the anxiety levels and brain activity of 18 healthy young adults, first during and after each participant enjoyed a regular night of sleep, and next after the same study participants stayed awake for 24 hours.

Each morning, study participants viewed emotionally evocative video clips while inside a brain scanner so that researchers could observe changes in their emotional brain activity after a night of no sleep.

Chronically anxious? Deep sleep may take the edge offChronically anxious? Deep sleep may take the edge offIn the evenings, researchers found nearly identical anxiety levels across all the participants. However, after a night of no sleep, study participants reported a 30 percent increase in anxiety compared to the way they felt after a good night’s sleep.

Moreover, brain scans taken as sleep-deprived participants watched video clips in the morning showed increased activity in such emotion centers as the amygdala “fight-or-flight” reflex, while the medial frontal cortex, which helps temper emotional responses, was virtually shut down.

As for study participants who benefitted from a full night of sleep, those who enjoyed longer periods of non-REM deep sleep reported the lowest levels of anxiety the next morning and showed the least emotional reactivity.

“A good night of deep non-REM sleep can benefit us in terms of anxiety and emotional regulation,” said Ben Simon, a postdoctoral fellow in Walker’s Center for Human Sleep Science at UC Berkeley.

One U.S. adult in five is estimated to have been diagnosed with an anxiety disorder, a mental health category that includes panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder and generalized anxiety disorder, and up to 80 percent of anxiety patients complain about poor or disturbed sleep.

Add to that an epidemic in which one U.S. adult in three fails to get the recommended nightly eight hours of sleep, and a connection between sleep and anxiety emerges, Walker points out.

On a positive note, Walker says, “Deep sleep provides a nocturnal soothing balm, taking the sharp edges off our lives and lowering our anxiety. It’s a form of nocturnal therapy that many of us shortchange in this modern era of insufficient sleep.”

Final results of a study by Ben Simon and Walker on the neural link between sleep and anxiety disorders are forthcoming.

Americans: Get ready for the post-millennial generation. They have a lot to say.


Alex Sayres, 12, speaks during an Oct. 29 rally in Seattle by youth activists and others demanding action by the federal government on climate change. (Elaine Thompson/AP)
Valerie Strauss

The U.S. Supreme Court has refused to stop a lawsuit filed by young Americans who want to force the federal government to take action on climate change. The Trump administration had asked the court to stop the suit, which was filed in 2015, but it did not.

The suit was filed in Oregon by 21 young people, many of them minors, who are arguing that the federal government’s refusal to take action to fight climate change violates their constitutional right to a clean environment.

Whatever ultimately happens with the suit, it remains a reflection of the activism of young people, which, the author of the following post says, is in some ways unique. Sarah Vander Schaaff, a freelance writer, looks at what she calls the postmillennial generation, people born after 1996, and describes what she found.

Vander Schaaff has written some extraordinary pieces for The Washington Post, including one about her struggle with obsessive-compulsive disorder and generalized anxiety disorder, and another about how obsessive-compulsive disorder affected the life of one young man and his struggles to get through school. In another post for this blog, she wrote about a mother who realized that her young son — who threw a computer at his teacher in second grade — was mentally ill, and the help she got him and other children. And she wrote why the only charter school in Princeton, N.J., had become a flash point. Here’s her latest piece.

By Sarah Vander Schaaff

It doesn’t take a social scientist to tell you change is coming. It only takes a parent. And the contrast is staggering — between the leaders in Congress (whose average age is among the oldest of any Congress in U.S. history, according to the Congressional Research Service) and the generation of young people we are raising in our homes and schools.

Stand in the hallway of a school when students are walking from class to class. Observe students. Read the headlines of the student newspaper. Go to a game or performance. Notice themes in the emails from school administrators. The issues that occupy our worries and ignite our grown-up debates, including climate change, gender identity, sexual misconduct, digital privacy, economic opportunity and the threat of gun violence, are palpable. These are not opportunities to wield political power; they are part of the complex foundation out of which these young people must grow. They are trying to figure it out.

They have to figure it out.

Some dismiss this young generation’s determination, calling it naive or predictable. But others, like me, sense that there is some special combination of opportunity and outrage that gives this diverse and collaborative cohort a quality we can’t quite define. Moral energy. Passion. Whatever it is, it seems to be less about youth and more about responsibility.

Gary Lundgren, associate director of the National Scholastic Press Association who runs the organization’s Pacemaker Award for outstanding student journalism, said this young generation realizes its voice matters. Student journalists in high school and middle school have shown great interest in covering national issues at the local level, looking at #MeToo, mass shootings, the opioid crisis, body awareness, and vaping, and in some cases educating their parents.

“They have communication tools that are immediate and by and large the same tools professionals have,” he said.

These kids, born after 1996, are a generation without an official name. What is known is that they come after millennials, the cohort defined by the Pew Research Center as born between 1981 and 1996. Post-millennials are the most racially and ethnically diverse generation in our country’s history. Unlike millennials, who are recognized for adapting to social media and constant connectivity, these young people have essentially never lived in a world without them.

But the uniqueness of this generation goes beyond technology. KJ Dell’Antonia, former lead editor of the New York Times’s Motherlode blog and author of the book, “How to be a Happier Parent,” said the current generation is growing up in a different terrain than many of its Generation X parents.

“We grew up in a climbing gym. There were handholds. If I do this, then that will follow. If I get a good grade, this will follow. If I ace the SAT, this will follow,” Dell’Antonia said. Now, she said, “It’s a bare wall. A cliff face.”

In the face of that uncertainty, some see the post-millennials taking heightened responsibility. It’s a “post-trust” world in which the sentiment is: If we don’t step up and try to take care of this, nobody else is going to take care of us.

It’s both heartening and heartbreaking to see young people fill the void. Three years ago, students at Walter Johnson High School in Montgomery County, Maryland, pushed for more mental health classes after a classmate died by suicide. Suicide is a growing concern for many young people, because it is the third leading cause of death for people ages 10 to 24, and rates have tripled since the 1940s, according to the Centers for Disease Control and Prevention.

Student survivors of the mass shooting at Marjory Stoneman Douglas High School in Parkland, Fla., energized a movement with March for Our Lives. Since the 1999 Columbine shooting, 219,000 children at 223 schools have been exposed to gun violence during school hours, according to figures tabulated by The Washington Post. The updated database indicates the date of the most recent shooting. As I type this, the update reads “five days ago.”

The editorial board of Chicago’s University High School’s student newspaper, whose piece, “Conservative Students Entitled to Safe Space, Too” was selected as a Pacemaker Award finalist this year, called for fellow students to stand by their school’s founding ideals, defending the need for “more spaces where students can learn from and even respectfully disagree with one another.”

Some efforts seamlessly link the personal with the global and the imperative of the present moment, such as the young student at my daughter’s school who held a bake sale to help her father’s family in Chennai, India, devastated by 10 days of heavy rains and government failure to the manage water supply.

In his recent story in the Harvard Graduate School of Education’s magazine Ed, “Student Activism 2.0,” Zachary Jason looks at an essential question about such activism: Does it make a difference? From the student strike at the Sorbonne in the year 1229 through the activism of Never Again, he cites variables that determine and sustain success. College students, for example, find more success when linking a world issue to a campus policy. Younger students generally do better with issues that are not a direct challenge to their school. And students of color face another challenge: prejudice.

But youthful generations, of course, become adults, and formative life experiences “such as world events and technology, economic and social shifts” interact with the “aging process to shape people’s views of the world,” according to the Pew Research Center. So how will the divisive tone of today’s politics shape the postmillennial mind-set for problem-solving and political engagement in their adulthood?

They could expand on the footprint of millennials, a generation that has the highest proportion of voters who identify as independent, and for whom, even among Republicans, a majority says that there is “solid evidence of global warming” and that “Americans’ openness to people from all over the world is essential to who we are as a nation,” as noted in the Pew Research Center’s report “The Generation Gap in American Politics.”

They could reject the premise that issues once considered taboo are still divisive. Pew’s report shows, for the first time, “a majority of baby boomers express support of same-sex marriage.” And multiple surveys show a majority of parents in both major political parties support comprehensive sex education in school.

“There’s no ambiguity there,” said Bonnie Rough, author of “Beyond Birds and Bees.” The idea that sex education is considered improper by Americans is an outmoded idea but one with lingering consequences not only for sexuality, she said, but for gender equality. The United States ranks 49th in a Global Gender Gap Report by the World Economic Forum.

The moment could be an opportunity for schools to rehabilitate the “disappearing center,” said one school administrator with 14 years of experience. He suspects the new generation will begin to find a new framework and norms to replace the ones that are outdated.

“Societies have been through watershed moments before when older ways of thinking begin to collapse or show signs of their age,” he said. “Inevitably, during this turbulent transition period, the old ways aren’t working, but we haven’t figured out what a new way will look like. Eventually something will emerge. It always does. I wouldn’t be surprised if the current generation of students are leaders in that.”

There are many ways to lead, of course. The oldest of these post-millennials are just reaching voting age, capturing 5 percent of the adult population.

They can run for Congress in 2022.

Anxiety In Kids: Parents Can Help Nervous Children Develop Coping Strategies

Every child experiences anxiety on occasion, but healthy children are fairly relaxed most of the time. So children who routinely experience fear and nervousness or demonstrate shyness may be suffering from an anxiety disorder. It is crucial that parents understand the warning signs of social anxiety in children and respond appropriately—which may require seeking medical assistance — rather than assuming that reticence is just a stage. That can be the case and separation anxiety, in particular, is fairly common. But it isn’t always so it’s important that parents be honest in their assessment of the issue.

Childhood mental health problems are surprisingly common. The Child Mind Institute estimates that 49.5 percent of American youth will be diagnosed with a mental health illness before age 18. Anxiety disorders are, by far, the most common and account for about half of these psychiatric conditions. Studies suggest up to 80 percent of children with anxiety disorders are not receiving treatment. Part of the problem may be the tender age at which anxiety first manifests. Unlike ADHD and mood disorders, conditions that usually show up in the early teen years, the median age of onset for anxiety disorders in children is a mere six years old.

Childhood anxiety disorders comprise a family of psychiatric conditions, and impact children’s lives in different ways. Generalized Anxiety Disorder, one of the most difficult to diagnose, is characterized by excessive worry about grades, family issues, relationships with peers, or performance in sports. It can be difficult to distinguish GAD from perfectionism, or simple conscientiousness but, as with most psychiatric disorders, the diagnosis comes down to a question of quality of life. If a child is suffering from the drive to succeed, GAD is a possibility.

More specifically, children may suffer from panic disorders (at least two unexpected panic or anxiety attacks, followed by at least one month of concern over having another attack), separation anxiety disorder (when a child is unable to leave a family member), and social anxiety disorder (intense fear of being called on in class, or starting a conversation with a peer). In extreme cases, children with anxiety disorders may suffer from selective mutism and intense phobias. Obsessive-compulsive disorder and posttraumatic stress disorder, while not traditionally considered anxiety disorders, are often associated with the more extreme cases.

Cognitive behavioral therapy is the preferred treatment method for anxiety disorders, because it is not particularly invasive and, in children, has particularly high rates of success. Therapy usually involves identifying and interrogating unhealthy patterns of thinking, and teaching children strategies to conjure more positive thoughts and feelings in their stead. If therapy is ineffective, or a child has a particularly severe case of anxiety, prescription medications (usually selective serotonin reuptake inhibitors, or SSRIs) are an option. Studies suggest that therapy and antidepressants, together, can be more effective than either treatment in isolation.

Awareness is the key to protecting your children, and ensuring that those who are suffering actually get help. “Parents should not dismiss their child’s fears,” according to a statement from the American Academy of Child Adolescent Psychiatry. “Because anxious children may also be quiet, compliant, and eager to please, their difficulties may be missed. Parents should be alert to the signs of severe anxiety so they can intervene early to prevent complications.”

6 Unexpected Differences Between OCD And Hypochondria

Although Obsessive Compulsive Disorder (OCD) and Illness Anxiety Disorder (hypochondria) are different disorders, they both can involve a person worrying excessively about their health. This can make the disorders seem similar, and although may have overlapping symptoms, there are quite a few differences between OCD and Hypochondria. Both OCD and hypochondria can involve anxiety about about illness, but in order to get the correct treatment, it’s important to differentiate between the two mental health issues.

“Hypochondria and Obsessive-Compulsive Disorder (OCD) can overlap in many ways, which may make the diagnoses difficult to tease apart even for a seasoned mental health professional,” Dr. Lindsay Henderson, PsyD, a psychologist who treats patients virtually via telehealth app, LiveHealth Online, tells Bustle “To an observer, both involve what seem to be an abundance of seemingly improbable concerns about one’s physical health.”

OCD involves a cycle of obsessions (or intrusive and uncomfortable thoughts) that the individual seeks to relieve by engaging in some sort of compulsion — health worries are just one type of obsession someone with OCD may have, says Henderson. Hypochondria, on the other hand, involves an excessive fear of having a serious illness.

Although both conditions can cause great distress and can impact someone’s ability to function and maintain healthy relationships, there are key differences between the two. Here are six unexpected differences between OCD and hypochondria, according to experts.

1Those With OCD Tend To Have Greater Insights Into Their Thoughts Behaviors

Natalia Lebedinskaia/shutterstock

“A person with OCD tends to have greater insight into their thoughts and behaviors as being problematic than someone with hypochondria has,” says Dr. Henderson. Those with hypochondria often do not have this insight and hold on very strongly to the belief that their medical issues are not psychological in nature at all.

2In OCD, There May Not Actually Be Symptoms Present

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With hypochondriacs, the presence of actual symptoms is what triggers a fear of a greater health issue. This leads to excessive worry about these physical symptoms, says licensed psychologist Laura Chackes, Psy.D. However, in OCD, there may or may not be actual physical symptoms present.

3OCD Fears Are More Future-Oriented

Ashley Batz/Bustle

“In OCD the fears related to illness are typically future-oriented, such as the fear that touching something contaminated will make the person or others sick,” says Dr. Dr. Chackes. On the flip side, people with hypochondria tend to focus on already having an illness.

4Those With Hypochondria Don’t Often Engage In Behaviors To Alleviate Their Anxieties

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“In OCD, there are always repetitive behaviors such as hand-washing, repeatedly asking others about symptoms, searching online for answers, and/or mental compulsions like reassuring themselves or trying to figure out whether they’re sick or not,” says Dr. Chackes. “In [hypochondria,] the individual does not exhibit compulsions aimed at reducing their anxiety as occurs in OCD.”

5Someone With OCD Is More Likely To Seek Psychological Help Than Medical Assistance

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Because those with OCD have more insight into their anxieties than someone with hypochondria, they tend to seek out different avenues of assistance. “Someone with OCD may be more likely to seek help from a mental health professional, whereas someone with hypochondriasis may be more likely to seek medical interventions,” says Dr. Henderson.

6Each Disorder Shows Different Brain Activity

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Single photon emission computed tomography (SPECT) scans show different brain activity between people with OCD and people with hypochondria. “OCD SPECT scans show a hyper-frontal pattern, which means the frontal lobes work too hard,” psychiatrist Dr. Daniel Amen tells Bustle. This area of the brain is concerned with behavior, learning, personality, and voluntary movement. But different areas of the brain are active in hypochondriacs. “Hypochondria SPECT scans show increased activity in the insular cortex, which is associated with feeling body sensations,” he says.

Although both disorders can involve worries about one’s physical health, OCD and hypochondria are separate conditions that may be managed and treated differently. If you have symptoms that fit into both categories, see a medical professional, who can help give you the proper diagnosis.