Generalized anxiety disorder (GAD): Symptoms, causes, and treatments

Generalized anxiety disorder (GAD): Symptoms, causes, and treatments


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Generalized anxiety disorder (GAD) causes feelings of intense anxiety, worry, or nervousness about everyday life. People with GAD struggle to control these feelings, and the condition tends to interfere with daily activities and personal relationships.

GAD, a type of anxiety disorder, is very common. It affects 3.1% of the population (or 6.8 million adults) in the United States in any given year. It is more common in women.

Living with anxiety can be challenging. However, like other anxiety disorders, GAD is highly treatable. Some of the most effective treatments include psychotherapy, medication, and making lifestyle changes.

In this article, we provide an overview of GAD, including its symptoms and causes. We also list some potential treatment options.

Symptoms

A person with GAD may experience uncontrollable and persistent worries, fears, and concerns.

The symptoms of GAD can vary from one individual to another.

Symptoms may get better or worse at different times. Periods of high stress or physical illness, for example, often cause symptoms to worsen for a while.

Emotional and cognitive symptoms of GAD include:

  • uncontrollable and persistent worries, fears, and concerns
  • an inability to deal with uncertainty about the future
  • intrusive thoughts
  • excessive planning and troubleshooting
  • difficulty making decisions
  • fear of making the “wrong” decision
  • problems concentrating
  • an inability to relax

Physical symptoms include:

  • tense or tight muscles
  • aches and pains
  • difficulty sleeping
  • fatigue
  • feeling restless, jumpy, or twitchy
  • digestive problems, such as nausea or diarrhea
  • being easily startled
  • excessive sweating
  • needing to urinate more frequently than usual

Behavioral symptoms include:

  • being unable to relax or spend “quiet” time alone
  • switching between tasks or not finishing tasks due to finding it difficult to concentrate
  • spending excessive amounts of time completing simple tasks
  • redoing tasks because they are not “perfect”
  • avoiding situations that trigger anxiety, including socializing with others and speaking in public
  • missing school or work due to fatigue, fear, or other symptoms
  • requiring reassurance and approval from others

The presence of other conditions

People with GAD often have co-occurring conditions. These may include:

  • other anxiety disorders, such as phobias, obsessive-compulsive disorder, or social anxiety
  • depression
  • drug or alcohol misuse


Diagnosis

A doctor may use a psychological questionnaire to diagnose GAD.

A doctor or mental health professional may diagnose GAD according to the criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

To receive a diagnosis of GAD, a person must have:

  • excessive anxiety and worry in several areas of their life on more days than not for at least 6 months
  • difficulty controlling these worries
  • at least three of the following symptoms (or just one symptom in the case of children):
    • restlessness
    • fatigue
    • difficulty concentrating
    • irritability
    • tense muscles
    • sleep problems
  • significant distress or problems functioning in social settings or at work

Also, these symptoms must not result from substance use or another medical condition.

To confirm a diagnosis or rule out physical conditions that may be causing symptoms, a doctor may:

  • perform a physical examination
  • take a detailed medical and family history
  • use a psychological questionnaire
  • order blood or urine tests

Causes and risk factors

The exact cause of GAD is unknown. However, it most likely occurs as a result of a combination of several factors, including:

Genetics

Having a family history of GAD increases the risk of developing it, according to some research. For example, children of people with GAD are more likely to develop the condition themselves than those whose parents do not have it.

Brain chemistry and structure

Differences in brain functioning may increase the risk of developing an anxiety disorder. People with GAD also show differences in brain structure on neuroimaging studies using functional MRI scans.

An imbalance of serotonin and other brain chemicals are also present in people with GAD and other anxiety disorders.

Personality

People who are timid or pessimistic may be more likely to develop GAD.

Some research also suggests a link between anxiety disorders and neuroticism, a personality trait wherein people view the world as unsafe and threatening.

Life experiences and environmental factors

Having a history of trauma, such as abuse or bereavement, may also contribute to GAD. In addition, having a chronic illness can increase the chance of developing an anxiety disorder, as can misusing addictive substances.

Sex

Estimates suggest that females are twice as likely as males to have GAD.

Age

GAD can affect anyone of any age. However, the chance of developing it seems to be highest “between childhood and middle age.”


Treatments

Treatment options for GAD depend on the severity of a person’s symptoms and the presence of any other conditions.

Many people require a combination of treatments, such as attending psychotherapy and making lifestyle changes. Medications may also be necessary.

Treatment options include:

Psychotherapy

Working with a therapist can help people effectively manage their symptoms. Doctors and mental health professionals with often recommend cognitive behavioral therapy (CBT) for anxiety, as it is both safe and effective.

Studies suggest that CBT reduces worry in people with GAD, with the effects being equal to those of medications and more effective 6 months after treatment completion.

Other types of therapy that show promise in treating GAD include mindfulness based therapies and acceptance and commitment therapy. This is a type of therapy that uses both acceptable and mindfulness techniques.

Medication

In some cases, a healthcare professional may recommend medication to help with the symptoms of GAD.

Several types of medication can treat GAD, including:

  • Antidepressants. Most commonly, doctors will prescribe selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors for GAD. These drugs can take several weeks to work.
  • Buspirone. This is an antianxiety medication that reduces the physical symptoms of anxiety. Buspirone can take several weeks to take effect.
  • Benzodiazepines. Occasionally, doctors may prescribe a benzodiazepine for short term anxiety relief. These medications are fast acting, but they are highly addictive and may not be suitable for people with a history of addiction.

Lifestyle changes

Regular exercise may help a person keep their symptoms under control.

Making lifestyle modifications can help people keep their worries and concerns under better control. Some examples of helpful changes to make include:

  • exercising regularly
  • eating a healthful diet
  • reducing exposure to stressors
  • prioritizing issues and events
  • practicing mindfulness, meditation, or yoga
  • keeping a journal to help identify anxiety triggers and coping strategies
  • avoiding alcohol and drugs, and limiting or avoiding nicotine or caffeine
  • setting a sleep schedule to ensure 7–9 hours sleep per night

Summary

Anxiousness is a normal part of life, but excessive anxiety or worry — especially if it interferes with everyday functioning or relationships with others — can indicate an anxiety disorder.

GAD is common and highly treatable. Individuals who have concerns about their mental health should see a doctor or psychotherapist for treatment. The earlier a person seeks treatment, the better the outlook.


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    Article last reviewed by Mon 23 September 2019.

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Could You be Suffering from Anxiety? | Best Indian American Magazine | San Jose CA

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Over the last two weeks, how often have you felt nervous, anxious or on edge? How often have you felt that you weren’t able to stop or control worrying?

If your answer to these questions is half or more than half the days, it’s possible that you may be troubled by, or contending with, some anxiety. These simple questions, as benign as they sound, are adapted from an anxiety screen (GAD-2) that should be administered to patients at each primary care physician visit. The purpose of this screen, far from labeling someone as mentally unwell or ascribing a diagnosis, is to identify patients who are possibly having trouble dealing with day-to-day stressors, life events, or are suffering from a mental illness and could be helped in feeling and functioning better through therapy.

As a nurse, and now a medical student, I have often encountered patients who are extremely apprehensive about labels: depressed, anxious, obsessive, manic. The stigma around these labels and fear of being labelled as someone who has mental illness limits patients’ answers to clinician questions. “No! I am not depressed”, “I don’t have those problems” or “I can deal with it”. This patient perspective often leads to the patient continuing to silently suffer with symptoms of anxiety: constant worry about work, poor sleep, irritability, difficulty focusing or concentrating or feeling fatigued. 

According to the National Institute of Health (NIH) more than 1/5th (19.1%) of the American population above the age of 18 has had some form of anxiety disorder in the past year. While research on the South Asian community is limited, the prevalence of anxiety in the South Asian community mirrors that of the general American population, 20.8% of South Asians meet criteria for having an incident of anxiety, substance abuse, or affective disorder in their lifetime. Importantly research specific to South Asians has identified that, as a group, they are less likely to seek and utilize mental health services and that stigma around mental illness in the community may be a reason for this phenomenon.

    Admitting to anxiety, worry, or feelings of dread is not a sign of weakness. Similar to having a fever, pain in your knee from arthritis, or trouble swallowing, anxiety is a real medical condition for which you should be able to seek and receive care and help. Treatment for anxiety starts with a visit to your doctor. In collaboration with your doctor, and based on screening questionnaires and conversations with him/her, you can chart a plan for yourself. Anxiety comes in many forms; Social anxiety, Generalized Anxiety Disorder, Panic Disorder, Post Traumatic Stress Disorder, and Obsessive-Compulsive Disorder. However, a plan of care for all of them can begin simply: a referral to Cognitive Behavioral Therapy with a qualified healthcare professional and/or picking from possible drugs that modulate the amount of neurotransmitters in your brain (aka SSRIs or SNRIs).

Kultaj Kaleka is a third-year medical student at Central Michigan University’s College of Medicine, and a student delegate to the AMA. He aspires to pursue Psychiatry. Prior to medical school, Mr. Kaleka worked as a registered nurse at Mt. Sinai Hospital.

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Treatment options and anxiety disorders

Sir, – I note with regret the renewed pressure being applied by the Medical Council to general practitioners regarding their prescribing practices for patients with anxiety (“Doctors warned to reduce prescribing of sedatives”, News, September 19th).

The treatment options for patients suffering from anxiety disorders must be informed by the needs of the individual patient, rather than being judged by abstract prescribing statistics.

The unfortunate reality is that there is no “one size fits all” treatment that is effective for all patients with anxiety disorders, which span a wide range of conditions from obsessive compulsive disorder (OCD) to panic disorder. There is no doubting the effectiveness of the class of drugs known as benzodiazepines or minor tranquillisers, which act to rebalance brain chemicals by increasing the GABA neurotransmitter, producing an anxiolytic (calming) effect. These positive effects create a very real risk of abuse and addiction, which are the main dangers associated with the medication, and therefore it is vital that other treatment options, such as anti-depressants and cognitive behavioural therapy (CBT) are considered.

However, there must be scope for a physician to do so taking a patient’s individual circumstances into account, including the fact that the patient may not be able to afford expensive CBT sessions.

The fact that anxiety disorders are at such a high level reflects a society ill at ease with itself. This is what should be addressed, rather than scapegoating doctors left picking up the pieces. – Yours, etc,

LEOPOLD SMITH,

Balbriggan,

Co Dublin.

Surprising Mechanism Behind Sertraline’s Short-Term Benefit



When there is clinical uncertainty about whether antidepressants should be prescribed in primary care settings, the presence of anxiety symptoms may indicate an increased chance of benefit, a randomized trial found.

In a group of 550 primary care patients with mild to severe depressive symptoms, sertraline (Zoloft) did not reduce depressive symptoms at six weeks compared to placebo as measured through the 9-Item Patient Health Questionnaire (adjusted proportional difference 0.95, 95% CI 0.85-1.07, P=0.41), reported Gemma Lewis, PhD, of University College London in England, and colleagues.

However, there were mild improvements in depressive symptoms at 12 weeks, with a 13% reduction in PHQ-9 scores (difference 0.87, 95% CI 0.79-0.97) as a secondary outcome, the authors wrote in Lancet Psychiatry.

Secondary analyses also found that sertraline was associated with reduced anxiety symptoms at 6 weeks and 12 weeks compared to placebo, as well as improved functioning and self-reported mental health, they noted.

“Our findings support the prescription of SSRI antidepressants in a wider group of participants than previously thought, including those with mild to moderate symptoms who do not meet diagnostic criteria for depression or [generalized] anxiety disorder, especially when anxiety symptoms such as worry and restlessness are present,” Lewis told MedPage Today in an email.

Zoloft, or sertraline hydrochloride, is a selective serotonin reuptake inhibitor (SSRI), approved by the FDA in the 1990s to treat depression, obsessive-compulsive disorder, and social anxiety disorder, among other conditions. However, the majority of studies supporting its use involve patients in outpatient — and not primary care — settings.

This trial, which takes a “scattergun approach,” suggests a broader and more vaguely defined primary care population could benefit from antidepressants, which is important considering primary care is the largest treatment setting for depression and anxiety, wrote Brenda Penninx, PhD, of Vrije Universiteit in Amsterdam, in an accompanying editorial.

Penninx cautioned against overprescribing antidepressants, however, particularly since the overall effect sizes found in this trial were small and researchers did not examine the long-term effects of sertraline. The findings do not mean clinicians should bypass alternatives to pharmacological treatment like psychotherapy either, she added.

Long-term use of antidepressants, which many patients continue for several months or even years after remission, has been associated with “disturbing side-effects,” like sexual dysfunction, weight gain, and metabolic dysregulation, which providers should take into account when considering prescribing SSRIs, she noted.

“In the process of pharmacotherapy, antidepressant discontinuation deserves as much clinical attention as antidepressant initiation,” Penninx wrote.

The so-called “PANDA trial” by Lewis and colleagues enrolled adult patients from 179 primary care centers across four cities in England who had any level of depressive symptoms within the past two years, and who had been uncertain (along with their providers) about the potential benefit of using antidepressants. Notably, some participants were recruited through clinical record reviews and were not therefore current patients or treatment seekers. The remainder were referred through their general practitioners.

The PHQ-9 was the primary measure for depression, the 7-Item Generalized Anxiety Disorder Assessment was used for anxiety, and functionality and mental health were self-reported through the 12-Item Short-Form Health Survey.

Patients were assigned to either 50 mg oral sertraline or placebo administered daily for one week and then twice daily for up to 11 weeks. Patients could increase doses to three times daily after six weeks if they had consulted with their clinicians, though more than 90% of patients remained on 100 mg doses, Lewis said.

Overall, patients were a mean age of 40 and 59% were women. Within the cohort, 54% met criteria for depression, 46% met criteria for anxiety, and 30% met criteria for both. Some patients (15%) did not meet criteria for any condition. The vast majority (80%) of patients self-reported prior depression.

There was no association between baseline depression duration and depressive symptoms at six weeks (difference 1.08, 95% CI 0.96-1.22, P=0.19), and there was no evidence indicating responses to treatment were affected by depression severity or duration, although these analyses lacked statistical power, the authors reported.

There were two adverse events in the placebo group and three in the sertraline arm, one of which involved suicidal ideation and was classified as “possibly related to the study medication,” Lewis said.

Although using clinical uncertainty as an entry criterion creates a population similar to the one currently receiving antidepressants, it’s also possible that patients with few depressive symptoms were less likely to respond to antidepressants, reducing the treatment effect, the authors reported. It may also mean patients with severe depression are underrepresented in the trial, they added. They also used self-reported measures for mental health symptoms instead of observer-rated scales like the Hamilton Depression Scale. Finally, sertraline may have had an effect on depression too small to be detected in a trial of this size.

Lewis received personal fees from Fortitude Law outside this work.

Penninx reported receiving grants from the Dutch Ministry of Health/NWO, Boehringer Ingelheim, and Jansen Research regarding this editorial.

The study was funded by the National Institute for Health Research.

Primary Source

Lancet Psychiatry

Source Reference: Lewis G, et al “The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial” Lancet Psychiatry 2019; DOI: 10.1016/S2215-0366(19)30366-9.

Secondary Source

Lancet Psychiatry

Source Reference: Penninx B “Examining the antidepressant scattergun approach” Lancet Psychiatry 2019; DOI: 10.1016/S2215-0366(19)30366-9.

Hoarding disorder: Treatments, symptoms, causes, and definition

Hoarding disorder is a condition that makes it difficult for people to throw things away, regardless of their value. There are a range of treatment options available.

Hoarding disorder can have a significant negative emotional, social, financial, and legal impact.

This article provides important information about hoarding disorder, including the symptoms, causes, and treatment options.

Symptoms

A person with hoarding disorder may also experience disorganization, indecisiveness, and distractibility.

People with hoarding disorder may find it difficult or stressful to throw away items that others view as worthless or of little value.

Unlike collectors — who choose to collect a specific type of item — people with hoarding disorder tend to acquire various items. These may include piles of clothes, old magazines, food wrappers, and childhood trinkets.

Over time, they may run out of room to store these things, so they may have to display their belongings chaotically.

Some people with hoarding disorder might even start to acquire living things, including companion or farm animals. This can endanger both human and animal welfare due to factors such as overcrowding, unhygienic conditions, and a possible lack of veterinary care.

Other symptoms that people with hoarding disorder may experience include:

  • emotional distress, such as being overwhelmed or embarrassed by their possessions or living situation
  • suspicion or fear of other people touching their items
  • obsessive fears and actions, such as checking trashcans for discarded items or a fear of needing an item in the future
  • feeling responsible for objects, and sometimes thinking of inanimate objects as having feelings

People with hoarding disorder also tend to experience associated issues with:

  • indecisiveness
  • disorganization
  • distractibility
  • procrastination

Typically, the symptoms of hoarding disorder will begin during a person’s early teenage years, with the average age of onset being 13 years old.

Complications

Hoarding disorder can result in a range of negative emotional, social, physical, financial, and even legal complications.

For example, clutter may overrun someone’s home, blocking access to important living, cooking, and working spaces.

Other common complications or consequences associated with hoarding disorder include:

  • difficulty functioning in daily activities
  • poor hygiene
  • poor diet or nutrition
  • living in unsafe environments, with factors such as tripping hazards, fire hazards, or large piles of items that may collapse
  • strained or severed marital, family, or friend relationships
  • social isolation and loneliness
  • lost work or employment
  • debt
  • reluctance to let others into their home
  • financial difficulties
  • legal problems, such as those involving child custody and animal welfare
  • lost property value or eviction

As well as these complications and consequences, people with hoarding disorder may also experience mental health conditions such as:


Treatments

CBT is one possible treatment for hoarding disorder.

With the right treatment, most people with hoarding disorder can reduce their major symptoms and the risk of complications.

Healthcare professionals tend to treat hoarding disorder using a type of therapy called cognitive behavioral therapy (CBT).

During CBT sessions for hoarding disorder, a mental health professional will gradually teach people how to part with unnecessary items less stressfully.

CBT can also help a person improve relaxation, organization, and decision making skills. This can help with future management of hoarding behaviors.

In some cases, medication may also play a role in treatment. This is particularly the case when hoarding disorder is related to other conditions that respond well to medication, such as severe anxiety or depression.

Causes and risk factors

Researchers do not yet know why people develop hoarding disorder.

Usually, people with hoarding disorder are driven to obtain and keep items that:

  • they believe may become useful or valuable in the future
  • are free or are more affordable than usual
  • have perceived sentimental value
  • seem irreplaceable, unique, or perfect (often only to them)
  • are a reminder of an important memory of a person, place, time, or event that the person fears they will forget

Surrounding themselves with these items may also comfort the person.

Although researchers are not certain what causes people to develop hoarding disorder, several risk factors seem capable of triggering or worsening the symptoms. These include:

  • a family history of the condition
  • brain injuries
  • very stressful events, such as severe illness or the loss of a loved one
  • differences in brain function and neuropsychological performance unique from people with other conditions, such as obsessive-compulsive disorder (OCD)

Hoarding disorder can also be a symptom of another condition, most commonly:

  • OCD and obsessive-compulsive personality disorder
  • ADHD
  • depression

Less commonly, hoarding disorder is also associated with:


Diagnosis

Diagnosing hoarding disorder can be difficult, as many people with the condition are not willing to admit that they have it or are unwilling to seek treatment, often for fear of losing their belongings.

To diagnose someone with hoarding disorder, a psychiatrist will usually ask the person some questions about themselves, their belongings, and their homes. Common questions include:

  • How hard or stressful is it to get rid of (sell, give away, recycle) things that other people seem to discard easily?
  • How hard is it to use rooms and surfaces at home because of clutter?
  • How hard is it to organize things or decide where they should go?
  • To what extent do items or clutter impact overall daily functioning?
  • Does clutter impact work, school, social, or family obligations or relationships?
  • How common are fears about other people touching, using, or destroying belongings?

The doctor may also ask to see pictures of the person’s major living areas or ask to visit it themselves to better assess the extent or impact of their symptoms.

For a diagnosis of hoarding disorder, someone will need to display:

  • long term problems with getting rid of possessions, regardless of their value
  • significant distress tied to losing items
  • items that block, fill, or clutter primary living spaces and prevent proper use

For an accurate diagnosis, a psychiatrist will also need to make sure that hoarding disorder is not a symptom of another condition.

How common is it?

According to the American Psychiatric Association, around 2–6% of the population of the United States has hoarding disorder.

Some research suggests that hoarding disorder is more common among males than females.

When to see a doctor

People with symptoms of hoarding disorder should try to talk to a doctor, particularly if these symptoms:

  • are severe, chronic, or accompanied by other symptoms
  • interfere with everyday activities, such as cleaning, cooking, bathing, working, or attending school
  • cause significant interpersonal problems
  • cause severe anxiety or embarrassment
  • have made living environments unsafe or unhealthful


How to help someone with hoarding disorder

It may be beneficial to have a loved one accompany a person to their first mental health meeting.

Family members or friends may want to meet with a doctor or mental health professional to learn how to broach the topic of diagnosis and treatment with someone they suspect has hoarding disorder.

Loved ones may also want to accompany someone to their first mental health meeting to make them feel more comfortable.

Having someone else attend early mental health appointments may also help give the doctor a better perspective of the person’s habits, home, and interpersonal relationships.

It is also worth noting that community public health agencies may have programs and services dedicated to helping people with hoarding disorder.

In extreme cases, local state or governmental authorities and agencies may need to become involved in someone’s treatment, such as to provide child or animal welfare services.

Outlook

Early recognition, diagnosis, and treatment usually increase the likelihood that someone with hoarding disorder can reduce the severity of their symptoms.

Untreated hoarding disorder is likely to become chronic, often getting more severe over time.

People with signs of hoarding disorder should try to speak to a doctor or mental health professional as soon as possible.

People who think that someone they know may have hoarding disorder should consider contacting a mental health professional to learn how to help the person seek treatment.

Children can suffer from anxiety too

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Bookbag: Young adult authors tackle anxiety in moving stories

Author John Green’s meteoric rise in Young Adult literature has come despite his ofttimes debilitating Obsessive Compulsive Disorder (OCD), a topic he has been openly discussing since the release of his 2017 novel entitled, “Turtles All the Way Down” (2017, Dutton, $19.99, ages 14 and up).

After Green’s huge success of “Fault in Our Stars” in 2014, writing the next novel proved difficult. He abandoned several starts, then relapsed into a monthslong OCD bout. Green found that the only thing he could write about was OCD and, thus, the protagonist of “Turtles,” Aza, also an OCD sufferer, was born.

Those unfamiliar with OCD might only associate it with compulsive hand washing or being a “neat freak,” but as in Green’s case and the case of his protagonist, Aza, it is usually manifested as a combination of obsessive thoughts, along with repeated compulsive behaviors.

In “Turtles All the Way Down,” 16-year-old Aza Holmes, dubbed “Holmesy” by her best friend, Daisy, is consumed with obsessive thoughts of bacteria entering her body that will lead to her death, yet ironically, for years she has been reopening a self-inflicted wound on her finger. This habit feeds her anxiety, forming a vicious loop. Her thought-spirals coincide with intense grief from the death of her father and begin to affect her friendship with Daisy, as well as a budding romantic relationship with Davis, a boy she went to camp with many years ago whose wealthy father has just gone missing the night before he was to be arrested for bribery. With a reward of $100,000 for the missing Mr. Pickett, Aza and Daisy fashion themselves as detectives.

Green does an excellent job conveying the imprisoned echoes in the mind of an obsessive-compulsive person through story, showing us how alienating, lonely, and painful it can be and how the intense self-focus interferes with being a good friend to others. Yet Green himself remains a positive example that an afflicted person can still achieve success and happiness, despite occasional relapses, thereby further endearing him to millions of readers as genuinely human.

The Weight of Our Sky

There are books with tongue-in-cheek warnings, but rarely does the author strike a plea to the reader that her novel is not an “easy read,” and that its contents could be an anxiety trigger for someone with OCD. In Hanna Alkaf’s debut novel, “The Weight of Our Sky” (2019, Salaam Reads, $18.99, ages 14 and up), she says, “If this will hurt you, please don’t read my book.”

This historical novel, set around the events of May 13, 1969, when Malay and Chinese residents clashed in the streets of Alkaf’s hometown of Kuala Lumpur, Malaysia, up to 600 residents were killed in a racially-fueled civil war.

The protagonist, 16-year-old Melati who is a Malay Muslim, also suffers from obsessive-compulsive thoughts. Her thoughts stem from the loss of her father. She believes her mind is controlled by a djinn, a genie-like creature.

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The djinn lurks within her mind as a negative, taunting force that is cruel, critical and paralysis-inducing.

On this May day, Melati and her best friend, Saf, are at the movies when the civil war erupts. Had it not been for a kind and brave Chinese “auntie,” who notices Melati’s skin tone and insists that she is an Indian and not Malay, thus saving her life, Melati would’ve suffered the same fate as her best friend, Saf, who is killed.

Amid the warlike chaos, Auntie Bee takes her home and takes in many neighbors whether they be Malay, Chinese, or Indian. Worrying about the fate of her mother, Melati is compelled to do her “magic” via the complex counting rituals designed to keep her mother safe. Eventually, Auntie Bee’s kind son, Vincent, notices and, for the first time, she admits her illness to someone besides her mother. With help from Indian and Chinese alike, Melati finds a way to stave off her mental anguish by helping others.

This suspenseful novel, written with a sophistication not always seen in Young Adult literature, is worth reading and provides valuable insight into the struggles one with OCD bears.

Wendy Henrichs is a children’s author living in Iowa City.

Cannabis and Mental Health: Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is a mental health condition that is often misunderstood and misrepresented by the public to some degree. Such misunderstandings may stem from the media’s frequent inaccurate depictions of the disorder and similar conditions like it. Other causes may be due to its similar symptoms to other medical conditions. 

Whatever the case may be, it is time we better understand OCD and other mental health conditions like it. 

Despite an increase in public awareness, portrayals of OCD are often incorrect. The often hyperbolic, comedic depiction of an OCD patient that includes hoarding of niche items and excessive cleaning may play a part in some symptoms. However, it does not accurately summarize what diagnoses OCD.

In fact, OCD symptoms vary by person. Furthermore, the condition equally affects men and women of all ethnic backgrounds at a rather frequent rate. One in 40 adults, and one in 100 children in the United States have OCD.  

Symptoms of the disorder include spending an hour or more each day obsessing over thoughts, images, impulses and/or compulsions. These thoughts become a seemingly unstoppable force, rapidly looping in a person’s mind over and over. Anxiety builds as the person tries to find ways to cope or relieve the internal tension. Compulsions, commonly known as rituals, are employed in an attempt to control these obsessions. Over time, the process tends to disrupt or derail the person’s quality of life over time. 

OCD is often incorrectly associated with the similarly named Obsessive Compulsive Personality Disorder (OCPD). People with OCPD believe in their own routines despite it resulting in possibly detrimental results. Patients often seek control of situations and other aspects of their lives to maintain their habits. With OCPD, a person is focused on perfection, which may lead them to repeat tasks numerous times.

In some cases, OCD has been miscategorized as being on the autism spectrum. This is likely due to both patients often having a preoccupied focus on specific interests. The confusion can be compounded as the two conditions can coexist together. Coexisting conditions are common in OCD. Possible conditions include anxiety and depression as well as bipolar disorder, ADHD, eating disorders and Tourette’s syndrome, among others. 

OCD can also lead to the development of related disorders. These include body dysmorphia, hoarding, hair pulling, skin picking and other conditions focused on picking or chewing certain parts of the body.

At this point, no definitive causes for OCD have been identified. It is thought that a combination of factors, including genetics and a person’s environment, can have a role. 

Studies have shown cannabis may help address OCD symptoms. A 2008 analysis of two patients noted a “significant symptom improvement” when they used medical cannabis or the man-made cannabis-derived drug Dronabinol. 

In 2015, an analysis of 49 studies found that CBD reduced anxiety behaviors in OCD as well as several other conditions. They included generalized anxiety disorder (GAD), panic disorder (PD), post-traumatic stress disorder (PTSD) and social anxiety disorder (SAD). The analysis noted another 2015 study which found that CBD reduced subjects’ behavior to bury a marble for up to seven days. 

In recent news, a 2019 pilot research study of 14 patients aims to understand if smoked THC or CBD can reduce OCD symptoms. The research completed in March of 2019. It has not published its results as of this article’s filing.

Like lab studies, some medical professionals believe cannabis could be a treatment option as well. 

Mitchell Sadar is a clinical psychologist with a specialty in measuring brain waves using biofeedback activity. He believes cannabis may help some OCD patients. 

The 30-plus year medical professional explained that OCD symptoms may stem from “deviant brainwave patterns.” A lack of normal alpha activity may make a person vulnerable to OCD and other anxiety symptoms, according to Sadar. He believes cannabis may help resolve the issue. 

“Cannabis typically increases alpha activity…in the case of OCD associated with a lack of alpha activity, cannabis would be expected to have a beneficial effect,” Sadar elaborated. 

He added that cannabis could be detrimental in other cases, such as when a patient has increased alpha activity. “The bottom line is that cannabis may or may not be helpful depending on the underlying EEG endophenotype.”

While High Times attempted to contact those affected by OCD, none were able to provide us with their personal accounts by the time of this article’s submission. To better understand the patient perspective, we turned to anecdotal evidence supplied over the past few years. Several discussions can be found in online forums. An assortment of responses supports Sadar’s assessment. 

A 2017 Quora thread offered both pros and cons on the issue. One person claimed that cannabis lowered their inhibitions while lessening anxiety. They added that cannabis use made them a more affable person. Another said using cannabis helped them notice when they fall into thought loops. On the other hand, a respondent in the thread claimed that their symptoms were worse when consuming THC. They did not elaborate further. 

The same mixed results were found on Reddit. In one thread, a person claimed cannabis helped them focus, while another reported feeling intense fear and a state of panic.

Few anecdotes about minors could be readily found online. However, a July 2010 ABC News report profiled a California mother Judy Mendoza and her son, Ryan. She claimed that cannabis helped her then 12-year-old son cope with severe OCD brought on by pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, or PANDAS. 

Ryan’s symptoms were so bad that violent meltdowns could be triggered by everyday occurrences like the wind and the number six. The condition intensified to a point that Ryan asked his mother to kill him to relieve the pain. Judy tried cannabis after using numerous opiate medications. A positive early response prompted the family to continue Ryan on a once-daily cannabis pill with additional liquid drops for when his anxiety became severe. 

Now nearly a decade old, the Mendoza’s story is one many continue to face. Some studies, coupled with stories like the Mendozas, paint a positive picture for cannabis treatments. That said, uncertainty remains over THC as a treatment. With its ability to work for some, it may appear to be the wonder drug many see it as. However, for others, THC can prove to be detrimental. 

As such, it is highly recommended that you or your loved ones speak with a physician before incorporating cannabis into any OCD treatments.

Direct link from brain’s emotion circuit to movement circuit

“This finding is very exciting as it is the first time that a comprehensive circuit mechanism has been found showing how emotional states can influence movement through connections in an area of the brain called the basal ganglia, a region involved in guiding behavior,” says Associate Professor Xin Jin, senior author on the paper. “We did not previously know much about this pathway, so it brings about a whole new paradigm for examining psychiatric disorders as well as spinal cord injury.”

It was previously believed that the brain’s emotion and movement loops worked like parallel closed circuits, operating independently to relay important information. However, researchers suspected that there could be some influence of emotion on movement due to the observation that, in neuropsychiatric conditions such as depression, decreased physical movement is a symptom and could be linked to disrupted emotional processing and reduced motivation. Yet, scientists did not know much about the connections within each circuit or how the circuits might interact.

“We wanted to explore how emotion information reaches the movement circuitry in the brain by using a combination of cutting-edge viral and optogenetic techniques,” says Sho Aoki, co-first author and postdoctoral fellow in the Jin lab.

The scientists sought to trace these circuits in rodent models to better understand each step of neuronal communication. They focused on the emotion and movement brain loops, starting from a region involved in emotion (the medial prefrontal cortex) and a region involved in movement (the primary motor cortex). They used multiple genetic and viral tracing tools, including a technique developed by Salk Professor Ed Callaway’s lab, to observe how each loop was organized in the brain.

To the researchers’ surprise, they found a one-way communication pathway from the emotion loop to the movement loop through an area located deep in the brain called the basal ganglia. The basal ganglia, which includes structures involved in guiding behavior, essentially acts as a crossroads for the emotion circuit to directly influence the movement circuit to control action. To confirm their results, the authors used optogenetics, a technique that uses light to control cells, to investigate the precise function of the neurons in this region. They also studied each neural circuit in isolation from the rest of the brain and confirmed the novel pathway.

“Psychiatric diseases such as depression and anxiety can alter actions in a dramatic way by either decreasing or increasing movement. This mechanism represents a likely way that emotional states are related to changes in action control in psychiatric diseases,” says Jin.

Additionally, this unidirectional communication may be relevant for recovery from spinal cord injury. Researchers previously focused on movement centers of the brain because spinal cord injury is a movement issue; however, since these results suggest emotional states can influence brain movement centers, experiencing positive emotions such as motivation may aid patients in the recovery process. Activating emotion centers could likewise stimulate movement centers and facilitate recovery, according to the Salk co-first authors Jared Smith, a postdoctoral fellow, and Hao Li, a senior research associate. Further, these results suggest that emotional states could directly influence sports performance. So, Jin advices, maybe the next time you feel anxious during a game, just calm down and let the action take care of itself.

OCD, PTSD symptoms overlap

Findings published in Psychiatry Research revealed significant overlap between self-reported PTSD and obsessive-compulsive disorder symptoms.

“Numerous case studies have documented the co-occurrence of these disorders following exposure to a traumatic event,” C. Laurel Franklin, PhD, and Amanda M. Raines, PhD, of the Southeast Louisiana Veterans Health Care System in New Orleans and the Tulane University School of Medicine, wrote. “One possibility for the high degree of co-occurrence between these two disorders is symptom similarity.”

Franklin and Raines examined symptom endorsement and overlap between OCD and PTSD in 117 trauma-exposed veterans.

At a VA hospital, participants were administered self-report assessments — such as the Dimensional Obsessive-Compulsive Scale (DOCS) and the PTSD Checklist for DSM-5 (PCL-5) — as part of a routine clinical care. For analysis, the researchers first examined rates of PTSD, OCD and co-occurring PTSD/OCD using clinical cut scores on self-report measures, then calculated a series of correlations for the PCL-5 total score, DOCS total score and DOCS subscale scores, and lastly paired DOCS and PCL-5 items for similarity in item content.

Based on self-report assessment of clinical cut scores, the results showed that 81% of veterans met for probable PTSD and 74% met for OCD. Chi square analyses also revealed frequent overlap of endorsement across items with similar content, according to the findings.

Using Pearson product-moment correlation, Franklin and Raines found a strong positive association between PCL-5 and DOCS total scores (r = 0.6; P .001), which remained significant after controlling for self-report depressive symptom severity (r = 0.48; P .001). In addition, they reported links between PCL-5 total scores and DOCS subscales scores: contamination concerns (r = 0.32; P = .002); responsibility for harm (r = 0.55; P .001); unacceptable thoughts (r = 0.71; P .001); and symmetry concerns (r = 0.42; P .001).

“To our knowledge, this study is the first to explore symptom overlap using an outpatient sample of veterans and self-report scales that more accurately assess the constructs of interest,” Franklin and Raines wrote. “Given the significant overlap, caution should be used when using self-report solely to assess PTSD and OCD particularly in traumatized samples.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.

Obsessive-compulsive disorder: All you need to know – symptoms of OCD, causes, treatment

Obsessive-compulsive disorder: All you need to know- symptoms of OCD, causes, treatment


New Delhi: Obsessive-compulsive disorder (OCD) is a common mental disorder that affects people of all ages and walks of life. Like a needle getting stuck on an old record, OCD causes the brain to get stuck on a thought or action. For example, the person may check the stove 20 times to make sure it’s really turned off, or wash hands until the skin peels off. The person doesn’t derive any pleasure from performing these repetitive behaviours and anxiety is generated by the obsessive thoughts. OCD consists of obsessions and compulsions.

OCD is seen in 2-3 per cent adult population and 1 per cent in children and adolescents. Obsessions are involuntary thoughts, images, or impulses that occur over and over again in the patients’ mind. They don’t want to have these ideas but they can’t stop them. These obsessive thoughts are disturbing and distracting. Compulsions are behaviours or rituals that the patient feels driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if the patient is afraid of contamination, he might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessions come back stronger and the compulsions often end up causing anxiety themselves as they become more demanding and time-consuming. This is the vicious cycle of OCD.

Signs and symptoms of obsessive-compulsive disorder

Scientists have classified the many symptoms of OCD into four major categories:

  • Washers: Repeated thoughts of dirt and contamination followed by repeated washing and cleaning
  • Doubters, Checkers and Counters: Repeated illogical doubts followed by repeated checking and counting
  • Arrangers: Repeated thoughts of symmetry and things being just right followed by repeatedly arranging things
  • Sinners: Repeated thoughts of sinning or taboo thoughts or sacrilegious thoughts or forbidden actions and in response repeated compulsive ritualistic behaviours

Causes of obsessive-compulsive disorder

The exact causes are not fully known. However, research suggests a combination of genetic, psychological and environmental factors can make a person more likely to develop the condition. A stressful childhood environment or an emotionally traumatic event might trigger a psychotic episode. The main theory is the severe decrease of the neurochemical serotonin in certain parts of the brain.

Treatment for obsessive-compulsive disorder

OCD is typically treated with medications, psychological counselling, family counselling to understand the illness and motivate family members to help.

No matter how overwhelming your OCD symptoms may seem, there are many ways in which you can help yourself. Some of the most powerful strategies are to eliminate the compulsions that keep your obsessions going. Here are some tips that can help you cope with OCD:

  • Relabel – don’t avoid your fears. Try to resist or delay the relief seeking compulsions. When the OCD thought arises, try to relabel it as just an OCD thought.
  • Reattribute – tell yourself it’s not me it’s my OCD.
  • Refocus – shift your attention and do something else when the OCD thought comes such as exercise, listening to music, reading, playing a video game, etc.
  • Revalue – do not believe your OCD thought. Tell yourself it has no meaning.
  • Write down your OCD thoughts and worries.
  • Exercise regularly.
  • Get enough sleep.
  • Avoid addictions.
  • Practice relaxation techniques like yoga and deep breathing.
  • Reach out for support – meet your nearest psychiatrist, counsellor or mental health professional.

Disclaimer: The author, Dr Shaunak Ajinkya, Consultant Psychiatrist, Kokilaben Dhirubhai Ambani Hospital, is a guest contributor and a part of our medical expert panel. Views expressed are personal)

"Euphoria" displays the real-world problems of teenagers

The first season of “Euphoria” on HBO was a whirlwind phenomenon. Despite only being eight episodes, the complex drama showed its viewers a different point of view of a not so typical teenager. Euphoria explores various situations, from losing their virginity before junior year to becoming more aggressive with a parent. All of “Euphoria’s”characters have a traumatic backstory that makes the show more intriguing. 

The music played during montages throughout the season expresses how characters are feeling, by themselves or in a group. For example, whenever rap music is played a character would be getting ready for a party, “getting hyped.” Alternative music is played when a character, Rue, is getting high.

At the beginning of each episode viewers get a look into the lives of different characters. This method is a nice introduction to the characters and builds up what’s to come for the rest of the episode.

At a young age, the show’s protagonist Rue, played by Zendaya, was diagnosed with several mental disorders, such as obsessive compulsive disorder, attention deficit disorder, general anxiety disorder and impulsive bipolar disorder. The only time she didn’t feel as if she were crazy was when a nurse put her on valium at the hospital. That was the beginning of her downward spiral. Rue’s drug abuse had gotten so out of hand that she almost dies of an overdose.

 Zendaya is known for playing Rocky and K.C on the Disney Channel programs “Shake it Up” and  “K.C Undercover” as well as for playing Anne in “The Greatest Showman” and M.J. in “Spider-Man: Homecoming” and “Spider-Man: Far From Home.” It is exciting to see her play this role. showing  she can be a serious actress. 

Jules, played by Hunter Schafer, is a transgender transfer student who befriends Rue, and their connection grows to unimaginable heights. Her presence helps Rue stay clean. Schafer is known for modeling, but she has skills in acting. To be playing a character like this must take a lot of studying, since she is not a transgender actress. She plays Jules as if she knew this character or someone who is like Jules. I wonder how Schafer feels in these intense scenes with Nate and his Father Cal. Jules had an awful childhood. Her mother didn’t accept her for who she is and tricked Jules into staying at a mental institution for years. Jules wanted someone to love her, so she would have sex with random guys. The last guy she slept with is the father of one of her classmates, Nate Jacobs, played by Jacob Elordi.

The cinematography of the show is superb. One scene in the first episode shows Rue snorting drugs in the bathroom. As she comes out, the hallway begins to spin. This gives the viewer an insight into how Rue feels: chaotic. “Euphoria” is a show whose writing doesn’t follow the stereotypes seen in “safe” teen stories. For instance, Nate is an overprotective boyfriend who likes to hold his girlfriend, Maddy, the head cheerleader, on a leash. Also, they like to get back at each other, meaning they will cheat. But they always seem to come back together even though their relationship is unhealthy. 

Overall, Euphoria is show for teens and about teens. It’s a raw perspective on a new reality, a new normal. It’s nice to see something controversial. Something that is truthful. It gives people something to talk about other than politics.