How to Tell if You Have Body Dysmorphia—and How to Get Help

Do I have body dysmorphia?

It’s 2015, and that question is rattling around my head. I’m a sophomore in college, and I’m skipping class today because I can’t find anything to wear.

I’d also be skipping my friend’s birthday dinner that night and calling in sick to work the next morning. I’d spend the day contemplating whether or not to break up with my then-boyfriend so I’d have one less reason to go out and do things.

My distorted body image was affecting my school, my job, my relationships, and my health. I was suffering from a horrific restrict-binge-purge-restrict eating cycle that stemmed from my body image issues. I often skipped social activities to hit the gym instead or simply because I was scared of the food that would be there.

I missed class because I felt so uncomfortable in my body that I couldn’t stomach the idea of walking through campus. I’d ignore phone calls and texts because I was too preoccupied trying on last summer’s swimsuits and analyzing every last detail on my body, particularly the ones I hated.

Eventually, I asked the internet if I had BDD. Body dysmorphic disorder (BDD), also called body dysmorphia, is a mental health condition that involves an unhealthy and excessive preoccupation with one’s physical appearance. It’s estimated that as many as 10 million people in the U.S. struggle with BDD, according to the International OCD Foundation. BDD is technically a sub-classification of obsessive-compulsive disorder, and research suggests that many people with BDD also have an anxiety disorder.

But I didn’t fit the BDD bill. Because my obsession was with my whole body—not one specific trait—I didn’t “qualify” for BDD. Currently, the diagnostic criteria for BDD involves a preoccupation with singular features, such as the nose, hands, or mouth. Whole-body dissatisfaction is technically not considered BDD, so when I was researching, I thought, “Well, that’s not what I have.” And because my dysfunctional eating habits didn’t warrant an eating disorder diagnosis, that was out too. Without a “real” issue to solve, I didn’t think that getting help would, well, help. It wasn’t until 2017 that I sought help.

RELATED: 10 Body-Positivity Moments of 2018 That Were Major Wins for All Women

Who experiences body dysmorphic disorder?

Scenarios like mine occur all too often, Elyse Resch, RDN, an eating disorder therapist and one of the originators of intuitive eating, tells Health.

According to the American Psychiatric Association, BDD is thought to affect 2.5% of women and 2.2% of men, and the disorder can show up at any age, though most people begin to exhibit symptoms during adolescence. The undiagnosed and misdiagnosed population probably skyrockets above those estimates, Resch says.

No single cause for BDD has been identified yet, but some research suggests that genetics might influence a person’s risk for BDD, and brain structure may also make a difference.

Exposure to “perfect” bodies on social media, television, movies, ads, and magazines is known to contribute to body image issues and may also be linked to BDD, Resch says. Constant media consumption puts people at risk of an altered sense of what’s real, and she encourages people to “cleanse” their social media feeds of body-negative accounts.

I traced my body image issues back to the innate perfectionist within me. With the help of my therapist, I was able to find correlations between my eating and exercise habits and other behaviors, like my desire to earn perfect straight As in school.

RELATED: 7 Things You Shouldn’t Say to Someone Who’s Had an Eating Disorder

How do you know if you have body dysmorphia?

Anyone can experience body dissatisfaction. But not everyone who experiences that dissatisfaction has body dysmorphic disorder. It’s important to note that BDD is a mental health diagnosis that involves an obsessive preoccupation with one or more specific body parts, usually around the head.

Common BDD focus areas include the ears, nose, skin, hair, and mouth or teeth. But people with BDD may obsess over other areas of the body, such as the knees, hands, or thighs, as well. Over the course of their suffering, most people with BDD will focus on five to seven different areas, says Jennifer Greenberg, PsyD, a Harvard Medical School assistant professor and director of translational research for the OCD and Related Disorders Program.

Up to 30% of people with BDD have concerns with their body shape or weight as well, Greenberg adds. And while someone with BDD can have coexisting preoccupations—i.e., their nose and their arms—as clinicians, she says, when they see someone who is obsessed with their stomach, thighs, hips, and other weight- or shape-related features, they need to check for eating disorder symptoms as well.

RELATED: 4 Women Share How Being in a Relationship Changed the Way They Eat

Symptoms of body dysmorphia

BDD causes an unbearable amount of distress for people with the disorder, which can lead to avoidance of social interaction, skipping class or work, and ignoring other obligations. Sometimes BDD makes it difficult to even leave the house or get out of bed, which is part of the reason it’s often misdiagnosed as depression or anxiety.

People with BDD often exhibit the following signs and symptoms:

  • Skin picking
  • Hair pulling
  • Excessive use of makeup or other cosmetics, like self-tanner
  • Wearing large or baggy clothes to hide certain features
  • Wearing only pants and long sleeves to hide features
  • Changing body positions frequently
  • Excessive grooming
  • Checking their appearance in the mirror repetitively
  • Over-emphasizing other body parts in an attempt to draw attention away from the features they don’t like

A telltale symptom of BDD is that people with the disorder seek excessive reassurance from the people around them about the trait or body part they don’t like. For example, someone who struggles with BDD about their nose might say things like:

  • “I hate my nose.”
  • “Can’t you see how big my nose is?”
  • “I wish I could change my nose.”

If you think someone you know may be suffering from BDD, it’s important not to agree or disagree if you find yourself in this situation, Resch says. You shouldn’t reinforce their beliefs one way or another. Instead, gently let them know that maybe their nose isn’t the problem after all, and they should consider finding someone safe to talk to about their self-image.

When I spoke to Resch, I mentioned that I look nearly the same as I did two years ago. Neither then nor now was my body outside of society’s definition of attractive. I would constantly say things like, “Ugh, I feel so fluffy,” and “I hate my cellulite” when, in fact, I was not fluffy and had very little cellulite (which is normal, by the way).

I still say those things sometimes, but the difference is that now—after a few bouts of therapy—I understand the underlying reasons behind my body image issues and can silence my inner mean girl.

RELATED: 9 Ways to Help a Friend With an Eating Disorder

Diagnosing BDD

Mental health professionals use these three criteria to officially diagnose someone with body dysmorphia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5).

Preoccupation with appearance. The focus of your attention is on a slight imperfection, which is either barely noticeable by others or fabricated. To be considered “preoccupied” with the trait, you must spend at least one hour each day thinking about the trait.

Repetitive attempts to “fix” the trait. For example, constantly picking at the skin, pulling hair, changing body positions, and checking the mirror are all repetitive behaviors that someone with BDD might engage in.

The obsessive thoughts and repetitive behaviors must be clinically significant. The perceived flaw must result in so much distress that your quality of life is impaired. Relationships, obligations, and other areas of life are significantly impacted because of the preoccupation.

RELATED: The Common Habit That Could Totally Warp Your Body Image

Body image vs. body dysmorphia

Whereas a person with BDD has an unhealthy fixation on particular body parts, a person with distorted or poor body image tends to be unhappy with their whole body.

Feeling uncomfortable in a swimsuit is “normal,” though everyone should work on self-acceptance, Resch says. Feeling so uncomfortable in a swimsuit that you refuse to wear one and avoid going to the beach with friends might warrant some deeper self-questioning. Feeling uncomfortable in everyday clothes and experiencing apprehension toward leaving your house warrants professional help.

Personal dissatisfaction is present in both conditions, and this type of thinking exists on a spectrum, says Carla Korn, an eating disorder therapist in Conejo Valley, California. “Oftentimes, the progression from ‘normal’ to ‘disordered’ can occur so quickly that one might not even be aware of the problem,” she says.

The question shouldn’t be, “Do I have body dysmorphia?” Resch says. Instead, she wants people to ask themselves, “Do I need help?”

“We place too much emphasis on whether or not someone actually falls into the clinical definition of this diagnosis, and that leaves so many people without proper help,” she says.

I eventually sought help because my life was so impacted by intrusive thoughts. Skipping class and losing friends wasn’t OK with me—I knew I needed help, even if I didn’t meet all of the diagnostic criteria for BDD.

Because my body image issues and dysfunctional eating habits were so closely related, I was eventually officially diagnosed with OSFED, which stands for other specified feeding and eating disorders. OSFED is a catch-all for eating, food, and body image concerns that are serious but don’t meet the criteria for another disorder.

Everyone who has a difficult or dysfunctional relationship with their body should have an opportunity for introspection and reflection around their patterns and behaviors. Social comparison is a significant challenge for many, if not most, of us, and it can be even more challenging when you are suffering from BDD.

“There is damage to the mind, body, and soul when you’re living your life obsessed with these behaviors or with your body,” Resch says. “The behaviors are just the tip of the iceberg, and underneath there is pain and discomfort and anguish.”

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Can some children outgrow autism?

Meds may not cause autism. Meds may not cause autism.
In some cases autism might be ‘outgrown’.  ~ 

Some toddlers thought to have mild autism “outgrow” the diagnosis, but most continue to struggle with language and behaviour, new research suggests.

The study is not the first to document cases of autism “recovery”. Doctors have known for decades that a small number of young children diagnosed with an autism spectrum disorder (ASD) seem to outgrow it.

Initial diagnosis may be wrong

But what does that mean for those kids? The findings suggest that the vast majority continue to face challenges and need support, said lead researcher Dr Lisa Shulman.

Her team found that of the 38 children who “lost” their autism diagnosis, most were found to have other conditions – including learning disabilities, attention deficit hyperactivity disorder (ADHD) and anxiety disorders.

Why did the picture change for those children?

That’s the “million-dollar question”, said Shulman, a professor of paediatrics at Albert Einstein College of Medicine/Montefiore Health System in New York City.

One possibility is that the initial diagnosis was wrong. But it’s also possible some children responded to early therapy aimed at supporting their development.

Shulman suspects both scenarios are true.

The 569 children in the study were diagnosed before the age of three. And what looks like an autism in a two-year-old may start manifesting differently as the child grows, Shulman explained. For example, that two-year-old may actually have an anxiety disorder, but children that age simply can’t express what they’re feeling. It only becomes clearer when the child is a little older.

On the other hand, early behavioural therapy can help children with autism build their social and language skills, and ease behaviour issues. So young kids who respond may no longer meet the criteria for autism at a certain point.

Intensive services can be very helpful

“I do think there is a group of children who were probably never going to have autism,” Shulman said. “And there are some who respond to early intervention.”

James Connell is clinical core director of the A.J. Drexel Autism Institute in Philadelphia. He agreed that in toddlers, it can be “difficult to pin down” whether it’s autism or something else.

“Global developmental delays, language delays and separation anxiety in 18- to 24-month-old children can look like an ASD,” said Connell, who was not involved in the study.

In fact, he said, “I would argue that most, if not all of these kids, did not have an ASD.”

But that’s not to say that kids mistakenly given an autism label did not benefit from therapy. Connell said that early and intensive services can be very helpful not only for children with an ASD, but for those with developmental delays.

And in fact, Connell said, young children with developmental difficulties may specifically be given an ASD diagnosis so that they qualify for such intensive therapy.

‘Evolution’ of diagnoses

“A diagnosis of autism gets services – services these children do need,” he said. “Doctors know that. Parents know that.”

The latest findings, published recently in the Journal of Child Neurology, were based on records for 569 children who were diagnosed with autism at the researchers’ centre between 2003 and 2013. Four years later, 38 of those kids no longer met the diagnostic criteria.

They all had one thing in common, according to Shulman. They had what initially appeared to be milder symptoms; they were not on the more severe end of the spectrum.

And nearly all saw their diagnoses evolve. A full 68% still had language or learning disabilities. Half were diagnosed with “externalising” behavior disorders – such as ADHD and oppositional defiant disorder – while one-quarter had “internalsing” mental health conditions, including anxiety disorders and obsessive compulsive disorder. Two children had more severe mental illnesses involving psychosis.

There were three children, the researchers added, who did not “warrant” any alternative diagnosis.

Those kids, Connell said, probably never had autism. “Most researchers would agree that children are never ‘cured’ of autism – it just becomes less apparent,” he said.

Image credit: iStock

    Is it stress or anxiety? A psychologist explains the difference — and why it matters

    If ruminating thoughts, heart palpitations and freak-outs are becoming commonplace, you might be wondering whether you’re suffering stress or more serious anxiety.

    Stress and anxiety can have similar symptoms and the words are often used interchangeably, however psychologists say it’s worth distinguishing between the two so you can help yourself fare better.

    “Stress usually occurs in response to some stressful event or threat – it’s situational and there’s usually something causing it,” Dr Grant Blashki, Beyond Blue Lead Clinical Advisor, tells Coach.

    So that’s the stomach-churning, thought-racing response to an insurmountable work deadline, first date nerves or exam worries that disappear after the worrying event.

    “We don’t need to medicalise natural everyday stress – it can be quite useful [in terms of] helping us get motivated and giving us a sense of energy about doing something,” Dr Blashki says.

    “Everyday stress is not a bad thing.”

    Anxiety, on the other hand, can have similar symptoms when there are no obvious threats or stressors about.

    “Anxiety conditions usually persist in a chronic way, even when the external stressor has gone away … they are still feeling worried about something even when they are away from the triggering situation,” Dr Blashki explains.

    There are a number of types of diagnosable anxiety conditions, including social anxiety, obsessive compulsive disorder, generalised anxiety disorder and post-traumatic stress disorder.

    Related

    When it comes to distinguishing between stress and anxiety, Dr Blashki, who is a practicing GP, says he talks to his patients about the broader effects on their lives.

    “The symptoms of stress and anxiety are pretty similar – racing heart, upset stomach, skin problems and period pain,” he explains.

    “The sort of questions I look at to decide whether someone has an anxiety disorder is: how is it affecting their life, their relationships, their ability to work, and their capacity to participate in things they want to do like catching up with friends or travelling.”

    Health psychologist Dr Marny Lishman says stress can turn into anxiety for some people.

    “Anxiety is a long-term reaction – there’s lots of thinking and ruminating, and it manifests into physical symptoms,” Dr Lishman explains.

    “For example, you might have financial stressors and constantly ruminate about it and you start feeling sick and nauseous and get irritable bowel symptoms.”

    RELATED: How psychology can help you cope with financial stress

    Dr Lishman says a good way to think about the difference is to imagine being approached by a vicious dog.

    “If a dog runs up to you bearing it’s teeth, you’d have a stress response because it’s a threat but when you get away, the stress response goes off,” she says.

    “But [in] anxiety, you would be constantly fearful of the dog, thinking about it a lot and experiencing ongoing distress that interrupts your life, so much so that you can’t do the things you normally do.”

    Dr Lishman says that stress can drive us to achieve while anxiety can hold us back.

    “Anxiety will often affect your work life, your sleep, your relationships and how far you push yourself … it wants you to stay in your comfort zone,” she explains.

    RELATED: Good stress vs. bad stress: do you know the difference?

    How to calm down

    Whether you suffer stress or anxiety, the first-line treatment suggestions are quite similar.

    “There’s a whole raft of things people can do that will help them, regardless of whether it’s stress or an anxiety disorder,” Dr Blashki says.

    “There’s good research evidence that regular exercise helps reduce stress and anxiety symptoms. [We also suggest] trying to reduce stress at work and home; reducing stimulants like caffeine; quitting smoking; trying to get enough sleep; and eating a healthy diet.”

    The good news is that Dr Blashki says people with anxiety disorders often respond really well to working with a psychologist.

    “If someone thinks they have an anxiety disorder, it’s good to get professional diagnosis,” he says.

    “GPs can do a Mental Health Plan for six Medicare-subsidised sessions with a psychologist.”

    There’s lots of evidence for the psychological technique called cognitive behavioural therapy (CBT) working well for anxiety sufferers.

    “It’s focused on challenging negative thinking patterns – people get caught up with catastrophising or black-and-white thinking or guessing what other people are thinking about them, so we challenge that,” Dr Blashki says.

    “We see patients who have had years of panic attacks [learn] what is going on and use slow breathing [techniques] and helpful thinking patterns [and] they start to get better and regain their confidence.”

    In severe cases, anxiety sufferers can be put on medication.

    If you’re prone to stress or anxiety, Dr Blashki suggests taking some time to proactively look after yourself.

    “Monitor your stress levels, schedule some time off where you put away your phone and contact with work,” he says.

    “Plan some relaxing activities like exercising or listening to music or taking a walk in nature.”

    READ NEXT: Three powerful ways to stopping stress waking you up at 3am

    Depression, Obsessive-Compulsive Disorder Symptoms May Predict Increased Postpartum Anxiety

    Women reporting greater depression, intolerance of uncertainty, and obsessive-compulsive disorder (OCD) symptoms during pregnancy may experience increased anxiety in the postpartum period, according to a longitudinal study published by Journal of Affective Disorders.

    The study included 35 pregnant women recruited primarily from the Women’s Health Concerns Clinic at St. Joseph’s Healthcare Hamilton in Ontario, Canada. Participants were age 18 to 41 with pre-existing diagnoses of anxiety disorders meeting Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria.

    At baseline (≥27 weeks gestation) and 6 months postpartum, investigators measured anxiety symptom severity using the Hamilton Anxiety Rating Scale (HAM-A). Patients completed questionnaires evaluating generalized anxiety, depressive symptom severity, intolerance of certainty, insomnia, childhood trauma, and obsessive-compulsive symptoms at baseline and follow-up. To compare baseline predictors between individuals who met HAM-A criteria for worsening anxiety and individuals who did not, investigators performed independent samples t-tests.

    At 6 weeks postpartum, 17 women (48.6%) met the criteria for worsening anxiety, defined as an increase of ≥50% on HAM-A scores from baseline to follow-up. Investigators found that key predictors of increased anxiety in the postpartum period were depressive symptom severity, intolerance of uncertainty, and OCD symptoms occurring during the third trimester of pregnancy. Self-reported anxiety severity, subjective maternal sleep, and childhood trauma history were not associated with anxiety worsening at 6 weeks postpartum (all P .05).

    Investigators suggested that through early and accurate identification of anxiety symptoms, women could be more closely monitored throughout pregnancy and the early postpartum period for signs of worsening anxiety. Subsequently, they could be introduced to preventative strategies, such as psychotherapeutic or psychopharmacologic treatments.

    Investigators concluded, “Continued research is necessary in this field with larger and more diverse sample sizes to replicate our findings, as well as identify other potential predictors which may then be targeted through preventive treatment.”

    References

    Furtado M, Van Lieshout RJ, Van Ameringen M, Green SM, Frey BN. Biological and psychosocial predictors of anxiety worsening in the postpartum period: a longitudinal study. J Affect Disord. 2019;250:218-225.

    People With Obsessive Compulsive Disorder More Likely To Have Money Problems


    A new analysis revealed that people with mental health problems are more likely to fall into deep debt compared to those without mental health conditions.

    In particular, the link between spiralling debt and mental health issues was strong among those with bipolar disorder, depression, or obsessive compulsive disorder, the study said.

    In fact, people with obsessive compulsive disorder were six times more likely to have money problems, as explained by the Money and Mental Health Policy Institute.

    As a result, the Money and Mental Health Policy Institute, which is an independent charity in the United Kingdom that conducts research on such matters, is calling for greater protection for people in these situations.

    About 1.5 million people in the UK are struggling with mental health and debt issues at the same time, the institute claimed.

    “We’re here to change that,” the institute said in its website.

    The Link Between Crippling Debt And Mental Health Problems

    In a study, the Money and Mental Health Policy Institute analyzed data from the Adult Psychiatric Morbidity Survey, which recorded responses from 7,500 people in England.

    Someone who was suffering from debt and mental health problems was Debbie who lived in the West Midlands.

    According to Debbie, when she developed depression after the death of her father, her debt spiralled. When she felt low due to depression, she would use her credit card to go out and buy something. Often she bought items she didn’t really need.

    Eventually, her debt incurred into a total of £70,000 (more than $92,000), which was a result of credit card, store card, catalogue debt as well as travelling expenses for a low-paying job.

    The survey analyzed by the institute said that one in every four people in England like Debbie were suffering from “problem debt,” compared to one in every 20 people who did not have mental health conditions.

    Symptoms of depressions, such as poor concentration and low moods, often affect how people manage their finances.

    Helen Undy, chief executive of the Money and Mental Health Policy Institute, said when a person is struggling with mental health issues, it will be harder to stay at work or manage spending.

    At the same time, being in debt causes stress and anxiety, so these issues feed off of each other. This creates a vicious cycle which can destroy lives, she said.

    How To Help Those In Debt

    Despite all these interconnected problems, Undy said financial services rarely think about people’s mental health, while mental health services rarely consider what is happening to patients’ finances.

    With that being said, the institute believes there is a way to change that. In fact, the institute says service providers have the power to improve both the emotional and financial well-being of customers. This can happen by introducing new tools, settings, and process that help people with mental health problems manage their finances well.

    Undy called on the government to create policies that dictate the standards for providers of services, ranging from banks and energy suppliers to debt collectors. This should be offered to those with mental health difficulties.

    According to Huffington Post, the government is already consulting on changes to improve protection of consumers across the country. The institute says it plans to boost support for customers with mental health problems, which includes helping them avoid debt from banks and energy suppliers.

    Photo: Mario Sánchez Prada | Flickr

    Crippling debt ‘linked to depression’

    Woman with empty purseImage copyright
    Getty Images

    People with mental health issues are three-and-a-half times more likely to be in problem debt than those without such conditions, analysis suggests.

    This link was even stronger for certain conditions such as bipolar disorder and depression, the Money and Mental Health Policy Institute said.

    It said those with Obsessive Compulsive Disorder (OCD) were six times more likely to have serious money troubles.

    It is leading calls for greater protection for those in this situation.

    The institute analysed data from the Adult Psychiatric Morbidity Survey, which had responses from 7,500 people in England.

    This revealed an estimated 1.5 million people were struggling with mental health and debt issues at the same time.

    Someone who had such difficulties was Debbie, from the West Midlands. During periods of depression – resulting, in part, from her father’s death – her spending spiralled.

    She said that, in the past, if she was feeling low owing to depression, she would go out to buy something and pay on credit. They were often items she did not need.

    Credit card, store card and catalogue debt, as well as extra travelling costs for a new, lower-paid job, led her to build up debt which, at its height, totalled £70,000. Eventually she decided the only route out was bankruptcy.

    Image copyright
    Getty Images

    The institute’s analysis suggested that one in four people affected by depression, such as Debbie, were in problem debt, compared with one in 20 people who did not have mental health problems.

    It said symptoms of depression, such as low moods and poor concentration, could affect people’s ability to manage their finances.

    Helen Undy, the institute’s chief executive, said: “When you’re struggling with your mental health it can be much harder to stay in work or manage your spending, while being in debt can cause huge stress and anxiety – so the two issues feed off each other, creating a vicious cycle which can destroy lives.

    “Yet despite how connected these problems are, financial services rarely think about our mental health, and mental health services rarely consider what is happening with our money.”

    She called on the government to dictate minimum standards that providers of services, ranging from banks and energy suppliers to debt collectors, offered to those with mental health difficulties to ensure they got a fair deal.

    Can Technology Cause Anxiety and Depression?

    Can technology cause anxiety and depression? You probably have your own view on this, but let’s have a look.

    To answer this question we first need to understand what anxiety actually is. 

    The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

    Whilst most people will have these feelings from time to time, it can lead to anxiety disorder which can be crippling to sufferers. This usually requires medical intervention to treat the condition, but not always.

    It is estimated that around 40 Million Americans currently suffer from some form of anxiety disorder today. This makes it, by far, the most common mental disorder in the U.S. 

    [see-also]

    Of these, it is estimated that only 37% of them have sought active treatment. 

    Technology might cause anxiety

    Anxiety is actually a very natural emotion and is, in part, hardwired into our brains. “Fight-or-flight” triggers helped keep our ancestors alive during encounters with predators and other dangers.

    Whilst mankind has alleviated many of these threats, thanks to our grasp of technology, the wiring is still there but modern triggers are very different indeed. 

    Today “fight or flight” responses can be triggered by work, money-worries (this is a huge one), health, family life, and a myriad other factors out of the scope of this summary. 

    For sufferers of anxiety disorder, this perfectly natural response can be out of proportion to the perceived threat, or trigger. 

    According to the APA “People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.”

    Once anxiety reaches the stage of a disorder, it can interfere with daily function.

    But is technology contributing to the apparent growth in anxiety problems seen in the modern world?

    What types of technology are affecting people’s mental health?

    Technology has made our lives inexorably more efficient and easier compared to generations past. It has freed us from many mundane tasks and given us more free time to, in theory, partake in more leisure activities outside of working to live.

    Yet despite this, some technologies might be making us less happy than our ancestors. Whilst many political ideologies will have their view on why it can be argued that some technologies are not exactly helping the situation.

    This would make technology a double-edged sword of types. It has made us more efficient and more time-rich than any generation before use, but it might have come at a cost. 

    Many occupations today require at least a fundamental grasp of technologies like computers. Their use may be responsible for an increased rate of depression in the population, especially those how to use them for many hours a day.

    Whilst correlation does not mean causation, technology may, in part, be contributing to anxiety and depression. Here are three ways in which technology can affect your mental health.

    technology causes depression pain
    Source: U.S. Air Force photo/Staff Sgt. Jonathon Fowler

    1. The internet is a very real double-edged sword

    Not since the rise of the printing press has any-one technology had such an enormous impact or human civilization. Never before have people had access to so much information, so easily. 

    Its impact has been, more or less, all-pervasive destroying old jobs but creating many, many more in their wake. This has led many to believe we are on the brink of a new industrial revolution with all the creative destruction that brings. 

    Yet, our brains might not be up to the task of being bathed in so much information, all the time. The constant influx of information we are exposed to today might be literally changing our brains.

    The human brain is an incredible piece of wetware and it can adapt to this, to a certain extent. Yet in doing so, much like a drug addict, the brain grows to expect constant stimulation.

    You will only ever notice this if you are away from the internet for hours or days on end. You may feel that “real-life” is slow or even boring. 

    technology causes depression internet
    Lawrence ‘Larry’ Roberts was one of the founders of the internet. Source: History Computer

    This kind of feeling is dubbed novelty addiction (aka “popcorn brain”, and can lead to some more serious mental health issues like depression. In essence, thanks to the opportunities the internet provides, it leaves users constantly searching for new experiences to get a “hit” of dopamine.

    There are some studies, like that of Leeds University, that do seem to support a link between depression and internet use. 

    Our research indicates that excessive internet use is associated with depression, but what we don’t know is which comes first — are depressed people drawn to the internet or does the internet cause depression?”

    2. Smartphones are a big problem

     Smartphone addiction is, technically speaking, a subset of a wider internet, or novelty, addiction. But since it is so prevalent today it is worthy of its own distinction.

    Many users will be familiar with a special kind of separation anxiety that forgetting or losing your smartphone brings. This is not too dissimilar to who some dogs feel when their owners leave the house for a few hours – it can feel like the end of the world.

    The smartphone has given its users unfettered access to the internet and all the benefits, are pitfalls, that brings. You can keep in contact with friends and family around the world 24/7. 

    But, some studies have shown that heavy smartphone use could be seriously affecting your mental health. In 2012, The University of Gothenburg made some interesting findings. 

    “Heavy cell phone use showed an increase in sleep disorders in men and an increase in depressive symptoms in both men and women.

    A combination of both heavy computer use and heavy mobile use makes the associations even stronger.”

    It is widely known, for example, that exposure to blue light just before bed, or whilst asleep, can disrupt your REM sleep cycle. Needless to say, this will impact on your mood the following day.

    technology causes depression sleeping
    Source: Lilmonster Michi/Flickr

    Another study by Baylor University, in 2015, also seems to support this. According to their research, heavy smartphone users tend to be “more prone to moodiness, materialism and temperamental behavior, and are less able to focus their attention on the task at hand”.

    “Much like a variety of substance addictions, cell phone addiction may be an attempt at mood repair… Incessant checking of emails, sending texts, tweeting, and surfing the web may act as pacifiers for the unstable individual distracting him or herself from the worries of the day and providing solace, albeit temporarily, from such concerns.”

    Smartphones also come with other trappings like constant access to your emails. This can lead to compulsive obsessive checking of them day and night. 

    3. Social media could be a big cause for anxiety and depression

    This one is a biggy. Whilst social media has some great benefits for people, it can also lead to some serious mental health issues like anxiety and depression,

    After over a decade of widespread social media use by billions of users, it seems social media could be more harmful than beneficial. For example, many people who visit Facebook daily may see their mood’s shift into the negative.

    technology causes depression Facebook
    Source: Facebook/Wikimedia Commons

    A ‘keeping up with the Joneses‘ effect can result as you compare your life to those of your friends and peers. Jealousy and even envy are completely understandable and natural responses to this but constant exposure to this could affect your long-term mental health.

    For some, this can lead to feelings of inferiority and all the trappings that way of thinking leads. 

    Many have suspected this dark side of social media for years. But an interesting study in 2015, by the University of Missouri, seems to put some flesh on the bones.

    “If Facebook is used to see how well an acquaintance is doing financially or how happy an old friend is in his relationship — things that cause envy among users — use of the site can lead to feelings of depression.

    We found that if Facebook users experience envy of the activities and lifestyles of their friends on Facebook, they are much more likely to report feelings of depression.”

    But it should be born in mind that social media has also opened up many doors for making useful connections in your life. More professional-orientated sites like LinkedIn has made connection building easier than ever before. 

    But even here you might feel professional anxiety as your peers appear to be getting ahead whilst you are treading water. It’s a completely natural human emotion but one that must be kept in check.

    So in at least three areas highlighted above, technology might be seriously affecting our collective mental health. But this doesn’t mean that technology as a whole is bad for us in the long run. 

    But younger generations appear to be coming around the idea of “disconnecting from the grid”. Perhaps we are about to see a major blowback to social media and the internet by users as they realize that the real world isn’t that boring after all. 

    Perhaps we need to relearn the teachings from the past. “Everything in moderation” as the saying goes. 

    Ketamine: A Promising Novel Therapy for Anxiety and PTSD

    Ketamine was originally approved by the US Food and Drug Administration (FDA) as an anesthetic, but is increasingly being used to treat mood disorders, such as treatment-resistant depression, anxiety disorders, and post-traumatic stress disorder (PTSD).1,2 Several studies have also found it to be effective for treating suicidal ideation.3,4

    “Ketamine can play an important role in the treatment of anxiety disorders,” according to Prakash Masand, MD, co-founder, chairman, and CEO of Centers of Psychiatric Excellence (COPE) (https://www.copepsychiatry.com) and adjunct professor at the Academic Medicine Education Institute, Duke-National University of Singapore Medical School (Duke-NUS).

    “Nowadays, people with anxiety disorders are treated either with a generic antidepressant, such as an SSRI (selective serotonin reuptake inhibitor), an SNRI (selective norepinephrine reuptake inhibitor), or a benzodiazepine and if they don’t respond to one of these, they get a trial of another or several more,” Dr Masand said.

    However, between 30% and 40% of these patients will not achieve remission, despite 3 or 4 different traditional agents, and even with evidence-based nonpharmacologic therapies, such as cognitive behavioral therapy (CBT) or mentalization-based therapy (MBT), he noted.

    “No good current strategies are available for these non-responders, so novel agents are being studied — including ketamine, which is accumulating an evidence base as [being] rapidly effective for an array of anxiety disorders, including social anxiety disorder (SAD) and PTSD,” he said.

    How Does Ketamine Work?

    A growing body of evidence points to the role of glutamate, a widely distributed excitatory neurotransmitter, in mediating response to stress and the formation of traumatic memories.2 Ketamine is an ionotropic glutamatergic N-methyl-d-aspartate (NMDA) receptor antagonist. Its antidepressant and anti-anxiety effects are presumed to occur through activating synaptic plasticity by increasing brain-derived neutrophic factor translation and secretion and also by inhibiting glycogen synthase kinase-3 and activating mammalian target of rapamycin signaling.5

    Brain-derived neutrophic factor plays a role in behavioral responses to classical antidepressants, but the impact on synaptic plasticity may take several weeks to manifest. In contrast, ketamine-mediated synaptic plasticity changes appear to occur within a matter of hours after ketamine administration.5

    “The current thinking is that eventually, 6 to 12 weeks after initiating treatment with traditional antidepressants, dendritic growth and increased synaptic connections occur but with ketamine, these can occur within 24 hours of the infusion,” Dr Masand said.

    Ketamine and Anxiety: An Increasing Evidence Base

    “Ketamine has been studied and shown [to be] effective with an array of anxiety disorders, including SAD, general anxiety disorder (GAD), and PTSD, although the data on its effectiveness in obsessive compulsive disorder (OCD) are more mixed,” Dr Masand observed.

    GAD/SAD

    • A small study of patients with GAD and/or SAD (n=12) compared 3 ascending ketamine doses to midazolam. Each was given at 1-week intervals, with midazolam counterbalanced in dosing position across patients. Ketamine was found to dose-dependently improve scores on the Fear Questionnaire. Moreover, it’s impact on decreasing theta frequency in the right frontal sites assessed via  electroencelphalogram (EEG) was comparable to that of conventional anxiolytics.6
    • Glue et al evaluated the efficacy and safety of ketamine in 12 patients with refractory GAD and/or SAD who were not currently depressed using an ascending single-dose at weekly intervals study design. Within 1 hour of dosing, patients reported reduced anxiety, which persisted for up to 7 days.7
    • A continuation of that study evaluated the impact of maintenance treatment ketamine in patients with GAD and/or SAD (n=20) and found that 18 of the 20 patients reported ongoing improvements in social functioning and/or work functioning during maintenance treatment. The researchers concluded that maintenance therapy ”may be a therapeutic alternative for patients with treatment-refractory GAD/SAD.”8

    “What is interesting about this study is that the impact of just one infusion lasted for 14 weeks, suggesting that patient[s] with anxiety disorders might have longer maintenance of response than patients with major depression, where the response has been maintained for only one week,” Dr Masand commented.

    Anxious Depression

    • A study of patients with anxious and non-anxious bipolar depression (n=21 for both groups) found that both anxious and non-anxious patients with bipolar depression had significant antidepressant responses to ketamine, although the anxious depressed group did not show a clear antidepressant response disadvantage over the non-anxious group.9 “Given that anxiety has been shown to be a predictor of poor treatment response in bipolar depression when traditional treatments are used, our findings suggest the need for further investigations into ketamine’s novel role in the treatment of anxious bipolar depression.,” the investigators concluded.9

    OCD

    • An open-label trial of ketamine in 10 patients with treatment-refractory OCD found that ketamine’s effects on OCD symptoms, in contrast to depressive symptoms, did not seem to persist or progress after the acute effects of ketamine had dissipated.10
    • On the other hand, another randomized controlled trial (RCT) of 15 patients with OCD found that anti-OCD effects from a single intravenous dose of ketamine persisted for more than 1 week in some patients with OCD with constant intrusive thoughts, demonstrating that “a drug affecting glutamate neurotransmission can reduce OCD symptoms without the presence of an [SSRI].”11

    PTSD

    In PTSD, there is “mounting evidence for a role of the excitatory neurotransmitter glutamate in stress responsiveness, the formation of traumatic memories, and the pathophysiology of PTSD, raising the possibility of identifying novel glutamatergic interventions for this disorder.”12

    • One double-blind study demonstrated that infusion of ketamine rapidly and significantly reduces symptom severity in patients with  PTSD compared with midazolam.2
    • Another study found that administration of ketamine immediately after witnessing a traumatic event has been shown to prevent the enhancement of passive avoidance learning in mice.13 Ketamine may thus target the mechanisms involved in the consolidation of traumatic memory and may enable the brain to reconsolidate memory and release trauma.14
    • A case study of a child with PTSD reported remission from behavioral dysregulation after receiving procedural ketamine.15

    Drawbacks and Potential Adverse Effects

    The main concern regarding the use of ketamine for anxiety disorders is the lack of a road map regarding maintenance, Dr Masand noted.

    “At COPE, we have found that roughly 30% to 40% of our patients being treated with ketamine require maintenance infusions, and we highly personalize this approach so that patients can identify early signs of recurrence or relapse and we can devise a treatment schedule to prevent them,” he said.

    Some patients continue treatment with pharmacotherapy, including standard antidepressants, benzodiazepines, or a mood stabilizer such as valproate and some patients become more receptive to psychotherapies such as CBT,” he stated.

    However, “there is very little data regarding what happens long-term in this patient population.”

    “Most side effects are mild and transient,” Dr Masand reported. “Patients must be monitored because of potential increases in blood pressure and pulse.”

    Additional adverse events include nausea or vomiting, which are also mild and transient. Patients may be pre-treated with prophylactic anti-nausea medication, such as ondansetron, to pre-empt these symptoms, he said.

    Some patients experience dissociation, or an out-of-body experience, which is also usually transient but seen by some patients as “annoying,” he noted. “Dissociative experiences are sometimes seen as a biomarker for insufficient response and suggest that the dose should be increased.”

    Providers should be aware that cystitis and lower urinary tract pathologies (eg, detrusor over-activity) have been reported in long-term ketamine users, but typically only at high doses.16

    Ketamine’s psychedelic effects make it a” popular recreational drug.”16 At lower doses, the predominant effects are stimulating, and users experience mild dissociation with hallucinations and a distortion of time and space. However, higher doses can induce more severe, schizophrenia-like symptoms and perceptions.16 Although these effects resolve rapidly, long-term use “can cause more pronounced and persistent neuropsychiatric symptoms. For this reason, ketamine should be “used cautiously with other drugs that alter mood and perception, including alcohol, opioids, benzodiazepines and cannabis.”16

    Promising Role

    “Ketamine for treatment-resistant depression has a robust evidence base and a rapidly-growing evidence base for its use in anxiety disorders,” Dr Masand said.

    “Given the gaps in current treatment, this promising agent is occupying a more promising role in treatment of anxiety disorders, such as PTSD. Considering how common PTSD is, ketamine can make an important difference for a large number of people who suffer from this debilitating condition,” he concluded.

    First Person Account of Ketamine Therapy: An Interview with Kimberly Palmer

    To gain insight into the experience of ketamine treatment in a person with depression and anxiety, Psychiatry Advisor interviewed Kimberly Palmer of Los Angeles, California. Ms Palmer received treatment at the Ketamine Clinics of Los Angeles (https://www.ketamineclinics.com). Ms Palmer works as a program manager for a consulting company where she organizes and runs corporate events for small groups.

    Psychiatry Advisor: What made you decide to pursue ketamine treatment?

    Ms Palmer: I was raised in an abusive home, and as an adult I had severe major depression, as well as anxiety. I was treated with medications, such as antidepressants, but they had many adverse events and they ended up making me feel like a zombie, so I discontinued them. I managed okay for a while, but then I had another major depressive episode.

    I was receiving psychotherapy at the time and it was only moderately helpful — not enough to stop the episode. Fortunately, I knew someone who works at a ketamine clinic. She told me how many patients had been helped by ketamine and I was interested, mostly because the adverse events of ketamine seemed mild and are not long-term.

    Psychiatry Advisor: What were your experiences during your infusion?

    Ms Palmer: I felt incredible during the infusion. The best way I can describe it is by referring to the movie Avatar, specifically the scene in which the protagonist is walking through a jungle at night for the first time and touching all the plants, which light up with pretty colors—very vivid, colorful, and not linear. There was the sensation of being on a sort of roller coaster, riding through different scenes.

    At one point, it felt as though my chair was on a cloud. Then suddenly, the chair disappeared and I was floating on the cloud. It was a wonderful experience.

    Psychiatry Advisor: How did the ketamine treatment affect you afterwards?

    Ms Palmer: After only one treatment, it was as if a switch had flipped in my brain that allowed me to digest things and move beyond my trauma. Before the infusion, a lot of what was going on with me had to do with self-esteem issues and negative self-talk. These were behaviors learned over many years. After the infusion, the negative self-talk immediately disappeared. All of those thoughts — such as telling myself I am not good enough — that were preventing me from working through emotional issues, were resolved. I was able to start looking at things more objectively rather than taking them personally, and not take on responsibility for other people’s emotions and reactions.

    I am currently working with a therapist and a life coach to help me feel more comfortable with communication because I was raised not to ask for things and to put up with anything I’m asked to do. As a result, I have developed a much more positive outlook of myself and the world.

    Psychiatry Advisor: How many ketamine treatments have you had?

    Ms Palmer: Over a 6-month period I had 6 treatments, which were all very helpful. Then, 6 months after the conclusion of this first series of treatments, some new issues came up, so I received 2 more — one regular 60-minute treatment and one extended 90-minute treatment.

    Recently, with the holidays coming up, I decided to pre-empt the effect of some stressors and have another treatment. My most recent infusion took place the day after my father passed away. I noticed that during the infusion, I was able to steer myself away from negative thoughts about that issue. Although I cannot control what visions or experiences I might have, I do have some control over the direction of my thoughts and the after-effects have been positive and helpful.

    Psychiatry Advisor: Did you have any adverse events from the treatments?

    Ms Palmer: I had no negative physical effects. I had one mild bad reaction, when I came to the treatment session in an agitated state because I had gotten into a fight with someone right before. I was sad and crying  by the time I finished the infusion. But I was in a bad headspace before I even walked into the room. And my experience was not scary, only sad.

    Psychiatry Advisor: What impact has your treatment had on your day-to-day life?

    Ms Palmer: My depression had interrupted my schooling. I was in school for 3 and a half years and then I hit a roadblock. After the treatments, I was able to complete my studies and graduated with a BA in business administration and management.

    My job is stressful. I counterbalance the stress with hobbies like surfing and photography. But there are still stressors, and I have a dog who is reaching the end of life, which is affecting me. The ketamine treatments have helped me to manage those stressors.

    References

    1. Sanacora G, Frye MA, McDonald W, et al. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry. 2017;74(4):399-405.
    2. Feder A, Parides M, Murrough JW, et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71(6):681-688.
    3. Murrough JW, Soleimani L, DeWilde KE, et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med. 2015;45(16):3571-3580.
    4. Wilkinson ST, Ballard ED, Bloch MH, et al. The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis. Am J Psychiatry. 2018;175(2):150-158.
    5. Schwartz J, Murrough JW, Iosifescu DV. Ketamine for treatment-resistant depression: recent developments and clinical applications. Evid Based Ment Health. 2016;19(2):35-38.
    6. Shadli SM, Kawe T, Martin D, McNaughton N, Neehoff S, Glue P. Ketamine effects on EEG during therapy of treatment-resistant generalized anxiety and social anxiety [published online April 24,2018]. Int J Neuropsychopharmacology. doi:10.1093/ijnp/pyy032
    7. Glue P, Medlicott NJ, Harland S, et al. Ketamine’s dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders. J Psychopharmacol. 2017;31(10):1302-1305.
    8. Glue P, Neehoff SM, Medlicott NJ, Gray A, Kibby G, McNaughton N. Safety and efficacy of maintenance ketamine treatment in patients with treatment-refractory generalised anxiety and social anxiety disorders. J Psychopharmacol. 2018;32(6):663-667.
    9. Ionescu DF, Luckenbaugh DA, Niciu MJ, Richards EM, Zarate CA. A single infusion of ketamine improves depression scores in patients with anxious bipolar depression. Bipolar Disord. 2014;17(4):438-443.
    10. Bloch MH, Wasylink S, Landeros-Weisenberger A, et al. Effects of ketamine in treatment-refractory obsessive-compulsive disorder. Biol Psychiatry. 2012;72(11):964-970.
    11. Rodriguez CI, Kegeles LS, Levinson A, et al. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology. 2013;38(12):2475-2483.
    12. Girgenti MJ, Ghosal S, LoPresto D, Taylor JR, Duman RS. Ketamine accelerates fear extinction via mTORC1 signaling. Neurobiol Dis. 2016;100:1-8.
    13. Ito W, Erisir A, Morozov A. Observation of distressed conspecific as a model of emotional trauma generates silent synapses in the prefrontal-amygdala pathway and enhances fear learning, but ketamine abolishes those effects. Neuropsychopharmacology. 2015; 40(11):2536-2545.
    14. Fattore L, Piva A, Zanda MT, Fumagalli G, Chiamulera C. Psychedelics and reconsolidation of traumatic and appetitive maladaptive memories: focus on cannabinoids and ketamine. Psychopharmacology (Berl). 2018;235(2):433-445.
    15. Donoghue AC, Roback MG, Cullen KR. Remission from behavioral dysregulation in a child with PTSD after receiving procedural ketamine. Pediatrics. 2015;136(3):e694-e696.
    16. Li L, Vlisides PE. Ketamine: 50 years of modulating the mind. Front Hum Neurosci. 2016;10:612.

    One of the Most Effective Treatments for Obsessive-Compulsive Disorder: Part 1/2

    Obsessive-compulsive disorder is a psychological disorder associated with obsessions (recurrent thoughts, such as about germs) and compulsions (repetitive actions, like cleaning).¹

    In previous posts, I discussed the nature of OCD, consequences of obsessions and compulsions, the need for control, potential reasons compulsions appear to work, and why we need compulsions to work. Then, in my last article, I began discussing an effective treatment for OCD called exposure and response prevention (ERP).

    Though other interventions (e.g., psychodynamic therapy, antidepressants) are also used in managing obsessive-compulsive disorder, research shows that ERP is one of the most effective treatments for OCD.²

    What is exposure and response prevention?

    Exposure and response prevention is essentially a behavioral technique (some versions also contain cognitive exercises which help identify thinking errors).

    ERP has two components. The first component requires exposure to a feared situation that an individual with, say, germ worries, has been avoiding (e.g., shaking hands with strangers); the second component requires refraining from engaging in compulsive behavior during or after exposure (e.g., washing thoroughly after shaking hands).

    Exposure and response prevention in practice

    To explain how ERP works in practice, I use the example of a fictional person named Charlie.  Charlie is a young man who has germ-related obsessions. He is highly disgust prone. So he often dreads doing anything that might trigger his intense disgust reaction. One such activity is taking out the trash.

    His therapist suggests that Charlie begins with some cognitive activities which help identify his cognitive distortions. After a week of completing these exercises, it becomes clear to Charlie that he often commits a cognitive distortion called thought-action fusion.

    Common in people with OCD, thought-action fusion refers to the mistaken belief that merely thinking about something increases its occurrence.

    For instance, one night as Charlie is carefully taking out the trash, his right hand touches a piece of garbage that is very sticky, and he suddenly thinks he might catch a deadly virus. Something about the thought is so powerful that he engages in a lot of washing afterwards.

    By doing cognitive exercises addressing thought-action fusion and other errors, Charlie slowly begins to think differently, learning that intrusive thoughts—as real as they might feel—are only thoughts.

    As mentioned earlier, the first behavioral component of ERP is exposure. To do exposure, Charlie first needs to create a hierarchy of his fears (see picture), by ranking a list of relevant situations from least to most anxiety-provoking. Then, he will begin ERP with a situation that provokes moderate levels of anxiety and discomfort.

    Key is starting with situations which provoke enough anxiety to engage us emotionally but not so much to make us feel powerless, reinforcing fear and avoidance behaviors. Choosing an activity associated with moderate levels of anxiety increases the likelihood of success, which then teaches us that anxiety can be managed. After completing that step, we feel more confident to move up the ladder and face more difficult challenges.

    A few weeks later, Charlie is ready to move up his ladder of fears and touch a garbage can in a public place, like in the mall. As with previous rungs of the ladder, Charlie needs to remain in this anxiety-provoking situation (i.e. keep his hand on the bin) until his intense fear dissipates.

    The second major component of ERP is response prevention. Having learned to identify compulsions and avoidance behaviors associated with his germ-related obsessions, Charlie now tries to apply his knowledge to identify and prevent his usual avoidance behaviors during his exposure sessions.

    Identifying compulsions can be difficult since some avoidance strategies are very subtle. For instance, while Charlie has his hands on the garbage can, he constantly worries about his back pain. These distractions prevent him from being fully exposed to fearful thoughts and sensations about catching an illness from touching the bin.

    If this step is too anxiety-provoking, Charlie may not be able to do without constant distraction and avoidance; if so, he may need to repeat the previous step before trying this again.

    The same applies to you and your fears. As we come to the end of this post, I would like you to consider creating a hierarchy of your fears.

    Some of you may have obsessions for which real life exposure does not exist. For instance, you may fear accidentally running over an animal while driving. I address how ERP works for these types of obsessions in my next post.

     

    **Please note the information provided is meant only for educational purposes and is not intended to be a substitute for professional medical advice or treatment.

    References

    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

    2. Strauss, C., Rosten, C., Hayward, M., Lea, L., Forrester, E., Jones, A. M. (2015). Mindfulness-based exposure and response prevention for obsessive compulsive disorder: study protocol for a pilot randomised controlled trial. Trials, 16, 167.

    Can Some Kids Outgrow Autism?

    Assessment: How Could You Live Better With Multiple Sclerosis?

    By Amy Norton

    HealthDay Reporter

    TUESDAY, March 19, 2019 (HealthDay News) — Some toddlers thought to have mild autism “outgrow” the diagnosis, but most continue to struggle with language and behavior, new research suggests.

    The study is not the first to document cases of autism “recovery.” Doctors have known for decades that a small number of young children diagnosed with an autism spectrum disorder (ASD) seem to outgrow it.

    But what does that mean for those kids? The findings suggest that the vast majority continue to face challenges and need support, said lead researcher Dr. Lisa Shulman.

    Her team found that of the 38 children who “lost” their autism diagnosis, most were found to have other conditions — including learning disabilities, attention deficit hyperactivity disorder (ADHD) and anxiety disorders.

    Why did the picture change for those children?

    That’s the “million-dollar question,” said Shulman, a professor of pediatrics at Albert Einstein College of Medicine/Montefiore Health System in New York City.

    One possibility is that the initial diagnosis was wrong. But it’s also possible some children responded to early therapy aimed at supporting their development.

    Shulman suspects both scenarios are true.

    The 569 children in the study were diagnosed before the age of 3. And what looks like an autism in a 2-year-old may start manifesting differently as the child grows, Shulman explained. For example, that 2-year-old may actually have an anxiety disorder, but children that age simply can’t express what they’re feeling. It only becomes clearer when the child is a little older.

    On the other hand, early behavioral therapy can help children with autism build their social and language skills, and ease behavior issues. So young kids who respond may no longer meet the criteria for autism at a certain point.

    “I do think there is a group of children who were probably never going to have autism,” Shulman said. “And there are some who respond to early intervention.”

    James Connell is clinical core director of the A.J. Drexel Autism Institute in Philadelphia. He agreed that in toddlers, it can be “difficult to pin down” whether it’s autism or something else.

    Continued

    “Global developmental delays, language delays and separation anxiety in 18- to 24-month-old children can look like an ASD,” said Connell, who was not involved in the study.

    In fact, he said, “I would argue that most, if not all of these kids, did not have an ASD.”

    But that’s not to say that kids mistakenly given an autism label did not benefit from therapy. Connell said that early and intensive services can be very helpful not only for children with an ASD, but for those with developmental delays.

    And in fact, Connell said, young children with developmental difficulties may specifically be given an ASD diagnosis so that they qualify for such intensive therapy.

    “A diagnosis of autism gets services — services these children do need,” he said. “Doctors know that. Parents know that.”

    The latest findings, published recently in the Journal of Child Neurology, were based on records for 569 children who were diagnosed with autism at the researchers’ center between 2003 and 2013. Four years later, 38 of those kids no longer met the diagnostic criteria.

    They all had one thing in common, according to Shulman. They had what initially appeared to be milder symptoms; they were not on the more severe end of the spectrum.

    And nearly all saw their diagnoses evolve. A full 68 percent still had language or learning disabilities. Half were diagnosed with “externalizing” behavior disorders — such as ADHD and oppositional defiant disorder — while one-quarter had “internalizing” mental health conditions, including anxiety disorders and obsessive compulsive disorder. Two children had more severe mental illnesses involving psychosis.

    There were three children, the researchers added, who did not “warrant” any alternative diagnosis.

    Those kids, Connell said, probably never had autism. “Most researchers would agree that children are never ‘cured’ of autism — it just becomes less apparent,” he said.

    Sources

    SOURCES: Lisa Shulman, M.D., professor, pediatrics, Albert Einstein College of Medicine/Montefiore Health System, New York City; James Connell, Ph.D., associate professor and clinical core director, A.J. Drexel Autism Institute, Drexel University, Philadelphia; March 12, 2019, Journal of Child Neurology, online



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    Pagination

    Donna Missal Shares Vulnerable Selfie to Show Skin Picking and Anxiety

    If you’ve ever struggled with picking your skin due to anxiety, you’re not alone.

    On Monday, singer Donna Missal posted a selfie on Instagram, showing noticeable red spots between her eyebrows. She captioned the photo:

    got very anxious last night and picked my skin. feeling pretty depressed. 12th show in a row tonight in dallas but still gonna give everything i got because what else is there to do? forgive myself + get a coffee + keep it moving #tour

    got very anxious last night and picked my skin. feeling pretty depressed. 12th show in a row tonight in dallas but still gonna give everything i got because what else is there to do? forgive myself + get a coffee + keep it moving #tour

    A post shared by Donna Missal (@donnamissal) on Mar 18, 2019 at 8:32am PDT

    Though few of us have experienced the anxiety that comes from performing in multiple back-to-back shows on tour, the struggle of skin picking because of anxiety is something many may relate to.

    According to WebMD, some people use repetitive actions like picking at a scab or the skin around their nails because it relieves stress. This might be especially true for folks with anxiety who may feel high levels of stress frequently.

    It’s important to note that while some folks may occasionally turn to skin picking in moments of anxiety, for others, compulsive skin picking can be debilitating and disrupt their quality of life. According to Mental Health America, dermatillomania, or excoriation disorder, is characterized by chronic skin picking and is a mental illness related to obsessive-compulsive disorder (OCD).

    This is something Mighty contributor Rosie Forbes wrote about in her piece, “How I Discovered My Skin Picking Was Actually a Disorder.” She said:

    I Googled it, finding out it was an actual thing recognized in the medical community as dermatillomania or excoriation disorder… It was so strange to me that my lifetime “habit” was considered a disorder, said to be triggered by anxiety.

    Even though I knew that, I just viewed it as something I did, not that it would have a name. I now talk about it as part of my anxiety and how it affects me in a physical way, whereas I might not have before since I only saw it as a habit. This has been helpful, but I don’t do it any less. I do it when I am thinking, when I am anxious, when I am lonely and when I am trying to sleep, just to name a few times. I get nervous about social events, pick my skin, and then I am nervous that people will notice the scabs on my face so I do it even more. It is a horrible cycle.

    If you struggle with skin picking, you’re not alone. You can find resources for coping with dermatillomania at The TLC Foundation for Body-Focused Repetitive Behaviors. For more about skin picking, check out the following stories:

    Can you relate?

    How Do I Find a Mental Health Rehab Near Me?

    Are There Rehabs for Mental Health?

    Many who struggle with substance use disorders also meet the diagnostic criteria for one or more psychiatric disorders. Those struggling with drug or alcohol addiction, or an eating disorder are also commonly found to face an anxiety disorder, bipolar disorder, depression, personality disorder or schizophrenia.

    The Correlation Between Mental Illness and Substance Misuse

    The coexistence of mental illness alongside an addiction or chemical dependency is known as a co-occurring disorder or a dual diagnosis. Co-occurring disorders require a specialized approach to therapy and a highly individualized plan that can evaluate and treat both problems. Unless clients receive treatment that target both their mental illness and addiction, they will more than likely leave treatment prematurely or relapse quickly.

    Co-occurring disorders are more common than you might think. The Substance Abuse and Mental Health Services Administration (SAMSHA) recently found that just under eight million adults in the United States had co-occurring disorders.

    According to the National Alliance on Mental Illness, the problem is extremely common. About 33 percent of individuals with a mental health illness also struggle with substance abuse. Nearly half of those with a severe psychiatric disorder like bipolar disorder or schizophrenia also struggle with addiction. Over 33 percent of alcoholics also exhibit signs of a mental illness.

    Depending on the degree and severity of multiple symptoms, clients with co-occurring disorders often suffer for a long period time without an accurate diagnosis. It’s very common for only one disorder to be treated, which decreases the changes of long term, lasting recovery.

    Someone suffering from dual diagnosis has two separate co-occurring disorders but they can be related and intertwined. No one person suffers from co-occurring disorders in the same way. A mental or mood disorder can precede an addiction and vice versa.

    The most important thing to keep in mind is that for an accurate dual diagnosis, both conditions have to be present at the same time and a plan is formulated to treat both simultaneously.

    Dual Diagnosis Treatment

    Up until the 1980s, addictions to drugs and alcohol were considered separate problems from mental health disorders. Clients who exhibited both had to first detox at a rehab facility before being treated for their mental health illnesses. For the last 30 years, substance abuse treatment counselors and psychiatric professionals have worked together to better understand and treat co-occurring disorders and integrate treatment plans.

    Dual Diagnosis Symptoms

    Different combinations of substances and mental health conditions impact the presence of symptoms that can lead to an accurate dual diagnosis. Symptoms of a mental illness are often very similar to the symptoms of addiction and drug withdrawal. Drug or alcohol use can temporarily hide the effects of certain mental health disorders. Substance abuse can trigger a psychiatric relapse in patients with severe conditions like schizophrenia or schizoaffective disorder. An undiagnosed mental health disorder can precipitate an episode of heavy drug abuse.

    Most co-occurring disorders emerge when a client self medicates with a substance to escape from the symptoms of a mood disorder. Common symptoms and behaviors of a co-occurring disorder can include:

    • Using drugs, alcohol or compulsive behaviors to relieve intense anxiety, depression or mood swings
    • Psychiatric symptoms like depressive episodes, flashbacks or panic attacks after drinking heavily or using drugs
    • Withdrawing from friends, family and social activities
    • Experiencing problems with employment, housing or relationships
    • Using emergency services for acute intoxication, self-injury or suicide attempts
    • Legal difficulties, homelessness or incarceration as a result of behavioral problems and substance abuse
    • Drug or alcohol withdrawal symptoms
    • Extreme changes in behavior
    • High tolerance to substances being abused
    • Perceived inability to function without alcohol or drugs

    Self-medicating is the use of a substance, drugs, alcohol or food, for the purpose of cessation or escape from a mood disorder. An example of self-medication who drinks to excess or abuses drugs to escape the pains of anxiety or depression. A dual diagnosis plan treats the underlying cause of the mood disorder while also treating the addiction or dependence that has developed with ongoing substance abuse. As a substance is abused over a long period of time, a resistance to it is built up which requires an increase in frequency of use which leads to addiction. Self medicating can mask root symptoms of a mood disorder which leads to misdiagnosis .

    Dual Diagnosis Programs

    Dual diagnosis recovery programs integrate mental health treatment with addiction therapy to promote equal healing on both levels. These program can include:

    • Medically supervised detox
    • Psychological testing
    • Individually tailored recovery program
    • One-on-one psychotherapy
    • Peer support groups
    • Behavioral modification courses
    • Life skills
    • Holistic therapies like acupuncture, yoga, meditation
    • Aftercare services

    Dual diagnosis treatment should be customized to meet the needs of the individual, giving you the very best chance at success. If you or someone you love is struggling with both mental illness and addiction, you can find the help you need from a rehab facility that specializes in co-occurring disorders.

    Residential Rehab

    Treating patients with a Dual Diagnosis, a mental health condition combined with an addictive disorder requires a highly individualized, integrated approach to therapy. Residential rehab facilities provide a structured environment for clients who face special challenges in their journey to recovery. At a residential treatment center, where the stressors and distractions are removed, clients can devote all their time and attention to learning new coping skills and building a stronger sense of self-worth.

    When a dual diagnosis is involved, it can be hard to distinguish between the symptoms of a psychiatric illness and the signs of drug or alcohol addiction. Recognizing the need for treatment is the first step in getting the help you need to restore balance and health to your life. If you see signs that indicate that it’s time for you or a loved one to reach out for help, it’s always best to be on the safe side. If you have any reason to believe that someone you care about needs treatment, contact a mental health specialist near you for an evaluation. Your decision to help someone in your life get into residential rehab may help prevent the serious consequences of substance abuse, such as incarceration, loss of key relationships or incarceration.

    Entering a residential rehab facility can be a scary prospect, especially for those with a co-occurring disorder. Depression, anxiety and emotional instability can create an intense fear of the unknown. Patients with social phobias may be terrified of group meetings, while those with obsessive-compulsive disorder may have difficulty living in an unfamiliar environment. At a residential facility that specializes in dual diagnosis treatment, they train staff members to expect these responses and to provide the most comfortable atmosphere possible.

    What to Expect at Mental Health Rehab

    Assessment and evaluation are the first stages of the rehab process. When you enter a facility, you’ll be evaluated by an addiction specialist (a psychiatrist, psychologist, counselor or social worker) who will gather information about your recent substance use, your current and past medical history, and your psychiatric symptoms. The assessment phase is crucial for developing an individualized treatment plan that addresses both your mental health condition and your substance use disorder

    Residential vs. Outpatient

    What makes residential treatment so effective for patients with a dual diagnosis? At a residential facility, fully integrated care may be easier to provide. Integrated care refers to combined treatment for an addiction and a psychiatric disorder. When both conditions are treated at the same time, the patient has a greater chance of making a full recovery, according to the National Alliance on Mental Illness (NAMI).

    Here are a few ways that integrated care lends itself to a residential environment:

    • Patients who need intensive monitoring for heavy substance abuse or acute psychiatric symptoms can receive clinical care 24 hours a day.
    • Clinical professionals and recovery resources are gathered in a single setting, where patients can focus exclusively on their rehabilitation.
    • In a residential setting, there’s more time to foster trust between caregivers and dual diagnosis patients.
    • Patients who have trouble with denial or low motivation can receive specialized attention and encouragement without the distractions of daily life.
    • Patients can go through rehabilitation at their own pace in a secure, supportive environment.
    • Peer group support is stronger in residential facilities, where dual diagnosis patients can share advice and hope with other clients who have similar concerns.

    Outpatient treatment programs are useful and effective for patients who require a lower level of supervision. Outpatient counseling and group meetings take place at rehab facilities, mental health centers and clinics in many communities. Services are generally provided during daytime or evening hours, and patients go home at night.

    While the cost of outpatient care is usually lower than the cost of residential services, the lack of structure and supervision places patients at a greater risk of relapse.

    In a study published in Drug and Alcohol Review, researchers at Dartmouth Psychiatric Research Center compared the effectiveness of residential treatment programs with outpatient programs for dual diagnosis patients. Their study showed that outpatient care was less effective than residential treatment in up to 50 percent of cases. Participating in outpatient rehab requires a higher level of motivation and compliance, which may not be present in a patient who has a severe mental illness. The structured setting of a residential community provides a sense of security and safety that isn’t available in an outpatient clinic or treatment center.

    Medication Management

    Pharmacological therapy is a vital component of residential dual diagnosis treatment. In a residential treatment program, patients undergo thorough evaluation to assess their recent history of substance abuse (if any), their psychiatric history and their current symptoms. Medications may be prescribed to relieve the symptoms of anxiety or depression, to control flashbacks, or to reduce cravings for drugs or alcohol. Prescription drugs used to support recovery from a dual diagnosis include:

    • SSRIs: Selective serotonin reuptake inhibitors, or SSRIs, are a class of antidepressants that help to restore healthy levels of serotonin, a neurotransmitter that influences mood, appetite and energy levels. SSRIs like fluoxetine (Prozac), citalopram (Celexa) and sertraline (Zoloft) are prescribed for the treatment of depression, obsessive-compulsive disorders, eating disorders and many other psychiatric conditions.
    • Anti-anxiety medications: Medications used to treat anxiety disorders include beta-blockers, which help to manage the physical symptoms of panic attacks, and buspirone, a medication used to treat generalized anxiety disorder. Benzodiazepines like lorazepam (Ativan) and alprazolam (Xanax) are sometimes prescribed for the short-term control of severe anxiety, but because these drugs can be addictive, they must be used with care in Dual Diagnosis individuals.
    • Antipsychotic medications: Antipsychotic medications like aripiprazole (Abilify), clozapine (Clozaril) and risperidone (Risperdal) are used to treat severe, persistent mental health disorders like bipolar disorder and schizophrenia.
    • Anti-addiction medications: For dual diagnosis patients who are addicted to alcohol or opiates, drugs like naltrexone (ReVia, Vivitrol) and buprenorphine (Suboxone) are prescribed to help reduce cravings and maintain long-term abstinence. Methadone may be prescribed to minimize withdrawal symptoms in patients who are addicted to heroin or other opiates.

    Therapy

    At a residential mental health rehab, individual therapy may be modeled on one or more of these therapeutic schools:

    • Cognitive Behavioral Therapy (CBT): The goal of CBT is to change destructive thought patterns and behaviors that interfere with the patient’s desire to lead a more productive, fulfilling life. CBT can be used in the treatment of mental disorders like depression or anxiety, as well as in the treatment of addictive behavior. The coping skills that patients learn in CBT can empower them to manage their moods, fears or flashbacks without the help of drugs or alcohol.
    • Motivational Interviewing (MI): Motivational interviewing arose from the need to provide a more supportive, compassionate form of therapy to dual diagnosis patients. According to Professional Counselor, MI is designed to help patients with low levels of motivation and compliance find a reason to recover. MI is a nonjudgmental school of therapy that accepts the client’s level of readiness to change instead of attempting to force recovery.
    • Dialectical behavior therapy (DBT): Originally developed for the treatment of chronically suicidal patients, the principles of DBT have been applied successfully to addiction treatment and rehabilitation. Dual Diagnosis patients can benefit from this innovative approach to therapy, which focuses on mindfulness, self-acceptance and the regulation of emotional responses.

    What to Bring to a Rehab Facility

    When you’re admitted to a rehabilitation facility, you’ll need to bring certain personal items and you may also be presented with a list of prohibited items.

    Below are some of the basics you’ll need:

    • Personal identification, such as a driver’s license or passport
    • A contact list of family members, friends and physicians
    • Comfortable clothing, footwear and workout gear
    • Personal toiletries, such as soap, shampoo. Products containing alcohol are prohibited.
    • Electronic devices, such as clocks, hair dryers and CD players
    • Reading material (pornography may be prohibited)

    Cameras, clothing that advertises drugs or alcohol, incense, candles and cigarette lighters are not allowed at some facilities. The use of cell phones and laptop computers may be limited, but most facilities will allow you to bring these items with you. Your admissions team will advise you on what to bring to the facility before you enroll.

    Mental Health Aftercare

    According to the U.S. Department of Health and Human Services, peer support is crucial to long-term recovery. Aftercare services can fulfill a number of functions: offering emotional strength, providing education or information about addiction, helping you connect with community resources (transportation, healthcare, affordable housing, etc.), or introducing you to social groups that can give you a sense of belonging.

    Aftercare services help you maintain the coping skills you learned in rehab, so you can continue to build the healthy, fulfilling life you want after you graduate from a recovery program. Even as you go through detox and rehab, your treatment team will work on identifying the tools and skills that you’ll need to be successful after you finish the program.

    Aftercare can continue for as long as you’re committed to a healthy, meaningful life. People who stay stable despite a mental illness diagnosis often attribute their success to participation in aftercare services like self-help groups, 12-step meetings, alumni organizations, or volunteer activities that support recovery. These activities can help you stay connected to other people who share your goals and values — people who can motivate and inspire you as you create the future you really want.

    The following services fulfill one or more of these functions:

    • Counseling and therapy
    • Family education and counseling
    • Case management
    • Relapse prevention therapy
    • Outpatient recovery services
    • Sober living homes

    Covering the Cost of Mental Health Rehab

    In 2014 the passage of the Affordable Care Act required both individual and group insurance policies to cover care for mental health issues or substance use disorders. However, the extent of what’s covered varies significantly depending on what type of plan you have. Some luxury-level rehab facilities don’t accept insurance but most psychiatric hospitals do since they obviously have a heavy medical component. In general, facilities that advertise as addiction rehabs that offer dual diagnosis support or detox also accept insurance since prescription medication, whether for drug withdrawal or treating mental illness, necessitates physicians on staff. Again though, this isn’t always the case to be sure to call each facility to confirm what their policy is.

    The good news is, there are so many different ways to get help now. If treatment isn’t available near you, changes are help isn’t very far. Sometimes it’s best to completely remove yourself from the environment you associate with active addiction or untreated mental health issues in order to begin the healing process.

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