2 Out of 3 People See Depression at Work. Here’s How to Keep Your Team Well

When Arun Gupta, founder of the New York City health care company Quartet Health, couldn’t find satisfactory mental health insurance for his team, he came up with a creative solution: confidentially reimbursing employees for out-of-­pocket expenses through a third-party vendor. “A lot of times, people might have to pay cash or have high co-pays attached to getting therapy. Now they can see anybody they want to see, as often as they need,” he says. “We’re pushing the envelope here, but it’s good for business.”

That’s because roughly 18 percent of American adults suffer from some form of mental illness, according to the National Institute of Mental Health. And that makes it a particular problem for smaller businesses, where every employee plays a crucial, often nonduplicated role. In the United States, the total economic burden of major depression alone is now estimated to be $210.5 billion per year, according to the consulting firm the Analysis Group. Even if you don’t go as far as Gupta, there are many measures you can take to ensure your workers are at their best.

1. Fight the stigma.

Build employee well-being into your culture. Once a month at social-media company Buffer, “we gather online and discuss topics like self-care,” says Courtney Seiter, the company’s director of people. At those times, Seiter says, employees share their struggles with anxiety, obsessive-compulsive dis­order, and depression. Boston-based clothier Ministry of Supply matches every employee with a company veteran who can provide emotional support. Co-founder and CEO Aman Advani attributes the company’s “incredibly low voluntary exit rate” to this approach.

Even offering unpaid leave for mental health crises can help, says Lauren Steiner, president of Cleveland-based consultancy Grants Plus, which was awarded a Psychologically Healthy Workplace Award from the American Psychological Association in 2016. “We had someone struggling with a mental health issue who needed time, and that’s really hard for a small company to handle,” she says. “When she came back to work, initially it was just for a few hours per day until she was ready to come back full time. I know she was very grateful for the flexi­bility.” In addition to building employee loyalty, the company avoided the costs of hiring and training a replacement.

2. Insure wellness.

Comprehensive mental health coverage is expensive, but some employers believe it pays for itself. Lisa Hannum, CEO of St. Paul-based Beehive Strategic Communication, provides her employees a choice of insurance policies with different mental health coverage options. She says this policy has played a role in the company’s 60 percent reduction in sick days over the past two years.

“My product is people,” Hannum says. “If they’re not energized and healthy, we don’t have a product.” Carrie Espinosa, owner of Waukegan, Illinois-based insurance agency Horizon Benefit Services, encourages employers to provide a number of plans and have their workers contact her directly for advice on benefits packages. “Employees can call us and say, ‘Here’s my scenario–help me pick the best plan,’ ” she says, pointing out that federal law ensures the conversation is confidential.

3. Work the program.

One popular supplement to standard mental health coverage is an employee-assistance program. EAPs, which can be added to insurance policies or purchased singly, are pack­ages of mental health services, such as limited-duration crisis counseling. But EAPs vary widely in their cost. If you can’t afford one, get together with other businesses to purchase an EAP as a group, advises Jodi Jacobson Frey, an associate professor at the University of Maryland’s School of Social Work. Then make sure your employees know about it.

Most employers have an EAP, but not all do what they should to publicize them. I’ve always aggressively promoted the EAP, ” says Dan Mendelson of consulting firm Avalere Health. “Employees need to see the leaders of the company acknowledge the importance of engaging with mental health professionals when it’s needed.”

Know the law.

“It’s illegal under the Americans With Disabilities Act to discipline or fire employees just because they’re alcoholics. Current illegal drug use is not protected. Drug testing is regulated by state law, and the rules vary drastically. It’s a good idea to talk to a lawyer before staging an intervention.” — Sachi Barreiro, employment law editor, Nolo.com

Few Effective Treatments For Hair Picking (Trichotillomania) Or Skin …

Trichotillomania and skin-picking disorders result in repetitive self-grooming behaviors that result in damage to the body.

I feel the urge again. My fingertips run along my face, feeling for imperfections, and I slip into the bathroom to be alone. After a glance in the mirror, I stalk back out, my nails digging into my palms. Not today.

Since my adolescence, I’ve had a tumultuous relationship with my reflection. That’s because I suffered from trichotillomania, or hair pulling, and currently struggle with its cousin excoriation disorder, dermatillomania, or skin picking.

Trichotillomania and skin-picking disorder are referred to as body-focused repetitive behaviors, an umbrella term for self-grooming behaviors that result in damage to the body.

But the difference between everyday fidgeting — say, occasionally playing with a hangnail when you’re antsy — and BFRBs, is that the behaviors cause clinically significant distress or interfere with daily functioning. A day at the spa, or on the beach, for instance, would only lead me to wonder how I’d hide my scarring.

Despite attempts to stop, people can pull or pick for long periods of time and even miss school, work, or outings.

And there is no long-term cure for either disorder.

One study suggests that around 13 percent of adults in the U.S. engage in at least one BFRB. But a non-profit organization dedicated to the cause gave me more conservative figures. Per their research, an estimated 1 to 2 percent of the population has trichotillomania and about 1.4 percent has skin picking disorder.

That still makes them two of the most common BFRBs, which may affect more than 10 million people in the U.S. alone.

Since these disorders are sometimes comorbid, meaning a person can have both at the same time, figuring out how many people have them it isn’t quite as simple as adding the two statistics together, says Jennifer Raikes, executive director the TLC Foundation, the BFRB focused non-profit.

There’s also a range of severity of these disorders. “For some people, they’re relatively minor, and for some people, they’re really life-warping and potentially dangerous,” Raikes adds.

Search Of DNA In Dogs, Mice And People Finds 4 Genes Linked To OCD

Skin pickers can run the risk of infection. There’s also a subset of individuals who swallow pulled hairs, which can potentially cause gastrointestinal injuries from undigested hairballs that can require surgery to remove.

Some people, myself included, experience feelings of isolation and confusion. Many of us believe, falsely, that the behavior is uncommon.

Finding others

That’s why, when I first found other women who shared my afflictions, I was astounded to hear them talk about the same feelings I’ve harbored in silence since I was a teen. We aren’t using their last names to protect their privacy.

“The shame with this is excruciating,” says Mary, who is in her 50s.

“It’s not just a bad habit, something you could stop if you just tried hard enough,” she says. “I almost feel like there is some kind of electrical buzz in me that it helps discharge. And living with that buzz is intolerable.”

I, too, feel that buzz.

For others, like Nina, who is in her 40s, picking can strain relationships. “When I was younger, it really upset all the people around me,” she says. “Nobody could understand that it was not something that I had a lot of control over.”

Mary says she has felt similar pressure. “My husband is frustrated beyond belief that I can’t just stop, and constantly nags me to ‘let it heal.’ It is a source of constant tension.”

Who suffers

Though body-focused repetitive behaviors tend to begin during adolescence, they can start at any time, including childhood. It’s not entirely clear why some people develop BFRBs, though research suggests that people may have an inherited predisposition for the disorders.

Women tend to be more likely to be sufferers, though it’s possible that men under-report their afflictions.

And from an evolutionary standpoint, we’re not the only species that exhibits these problems: Mice will pull their fur out. Birds pull their feathers. Dogs lick their paws to the point of irritating them.

A number of internal and external triggers can spur BFRBs, such as anxiety, stress and boredom. Some are driven by personal beliefs, like the thought that pulling or picking may make an area smoother.

Others do it in specific circumstances, like when they’re lying in bed, driving their cars or working at a computer. Many, like myself, rely on solitude and mirrors.

The comprehensive behavioral model of treatment helps patients identify triggers and then tailor an intervention. If smooth skin is the goal, for example, a therapist may advise carrying around a smooth stone to touch to mimic the sensation. If you require a mirror, like the author does, you may be advised to cover it or keep your lights dim.

The comprehensive behavioral model of treatment helps patients identify triggers and then tailor an intervention. If smooth skin is the goal, for example, a therapist may advise carrying around a smooth stone to touch to mimic the sensation. If you require a mirror, like the author does, you may be advised to cover it or keep your lights dim.

And sometimes when sufferers pull or pick, they don’t even notice that they’re doing it. The behaviors can also become more focused and routine because of the immense satisfaction or relief that they bring.

The more I spoke to people with these disorders, the more it became apparent that it’s a different experience for everyone.

Mary tells me she didn’t leave the house without concealer. Nina tells me manicures help her picking and that her urge dissipated over time once her life settled down.

But we all have one big thing in common: Despite our best efforts, we cannot completely stop. These women tried everything from wearing hats and gloves to cognitive behavioral therapy to deter pulling and picking.

A neurological condition

“This is a neuropsychological condition, really a neuropsychiatric condition, much the same as obsessive-compulsive disorder,” says Dr. Ira Halper, psychiatrist and director of the Cognitive Therapy Center at Rush University Medical Center in Chicago.

That leads me to perhaps one of the more contentious aspects of hair pulling and skin picking: their classification in the Diagnostic and Statistical Manual of Mental Disorders, the standard reference of mental health diagnoses.

Trichotillomania and skin picking were only recently recognized under Obsessive Compulsive and Related Disorders when the American Psychiatric Association published the DSM-5 in 2013. Up until that point, trichotillomania had been considered an impulse-control disorder along with kleptomania, pathological gambling and pyromania.

“I don’t think that the classification as a related disorder is entirely off-base, but I do think it’s confusing,” Raikes says. Though trichotillomania and skin picking disorder are related to OCD, she says, that doesn’t mean that the disorders are a form of it.

“The distinction is important because if they are too closely equated, it can result in receiving ineffective treatment,” she adds, meaning people will seek help for OCD rather than BFRBs.

“I always use the analogy, it’s like a distant cousin,” says psychologist Charles Mansueto, founder and director of the Behavior Therapy Center of Greater Washington. Mansueto is also on the TLC Foundation’s scientific advisory board. “It’s not unrelated. It just is not identical with or even a close sibling of it. It has its own characteristics. It requires its own treatment.”

Could A Zap To The Brain Derail Destructive Impulses?

“In the history of psychiatry, this is nothing,” he adds. Schizophrenia, for example, has been studied for over a hundred years, whereas hair pulling and skin picking are just now being recognized, “This is so new.”

“A lot of people misdiagnose [skin picking] as OCD,” says Suzanne Mouton-Odum, a psychologist who helped create StopPicking.com, an interactive program for excoriation disorder that helps identify a sufferer’s internal and external cues and shares coping strategies. Mouton-Odum is also on the TLC Foundation scientific board.

“What’s so different about treating these behaviors is you really have to get to know the person, and you have to understand what their triggers are for the behavior and really work with that,” she says.


Though treatments exist, they have shown to only be moderately successful.

The current treatment of choice is called cognitive behavior therapy, an approach that hones in on problematic thoughts, feelings and behaviors. Some of the most successful approaches train patients to recognize what prompts them to pull or pick and replace it with something else, like balling hands into fists.

There’s also the comprehensive behavioral model, developed by Charles Mansueto and his colleagues. The ComB model helps patients self-monitor to pinpoint triggers in five areas (sensory, cognitive, affective, motor and place) and then tailor an intervention. If smooth skin is the goal, for example, a therapist may advise carrying around a smooth stone to touch to mimic the sensation. If you require a mirror, like me, you may be advised to cover it or keep your lights dim. This model also uses barriers like medical tape and Band-Aids to make patients more conscious of when they pull or pick.

And, even though selective serotonin reuptake inhibitors are commonly prescribed to combat hair pulling and skin picking, there’s increasing interest in an amino acid called N-acetylcysteine. One study showed that NAC helped lessen urges for more than half of participants. “That’s the closest thing we have to a magic bullet,” says Mouton-Odum.

Though the fight to understand and treat these disorders feels Sisyphean, especially because little federal funds have been devoted to them, the TLC Foundation has a huge research study underway.

The BFRB Precision Medicine Initiative is being led by investigators from UCLA, the University of Chicago, and Massachusetts General Hospital. The study will investigate the clinical, biological and genetic underpinnings of body-focused repetitive behaviors and collect data that will form the basis for more effective treatments.

“To understand these problems is to understand being human and that we all are in the same boat,” says Dr. Mansueto. “Join the club of humanity.”

I step back into the bathroom, this time a little more confident in my ability to reckon with my disorder because I know that I am not alone.

Kasia Galazka is a freelance science writer who has written for BuzzFeed, Psychology Today, Pitchfork and Paste. Follow her on Twitter: @supergalaxy.

Maine Voices: Media mislead, stigmatize by broadly linking mental illness to violence

The students in my undergraduate Community Partnership course – Brent Chandler, Marta Conant, Jacqueline Cormier, John Durham, Levi Krajewski, Jenna Libby, Nick Tolbert and Kate Wypyski – and I have been heatedly discussing the broad use of the term “mental illness” of late, and here are our thoughts.

“Mental illness” is currently a media buzzword, especially with regard to recent tragedies that have rattled the nation. Countless articles make not just an association between mental illness and violent acts, but also suggest it as the root cause. We consider such generalizations to be irresponsible and unproductive.


Marcia Goldenberg, MS, R.N., is a member of the faculty at the University of Southern Maine School of Nursing.

The media encourage us to think in generalizations by using this term as a catch-all phrase to describe a broad range of disorders, which castigates the many people living with mental health diagnoses and can distort society’s view of them, essentially making them into boogeymen. Readers can fall prey to human nature, to “err on the side of caution” and walk away with a general association between mental illness and violence. Thus, stigma is born.

Imagine a successful executive whose extreme mood swings are now well managed by medication; a nursing student with a history of chronic depression who was named to the dean’s list for the fourth consecutive term; and a young man with a history of hallucinations and delusions who is not receiving treatment and hears voices telling him that he is a worthless person. What do these individuals have in common? Each is living with a mental health condition, but that does not mean that each poses a threat to the community.

Very few people with severe mental illness are dangerous to others. Using this umbrella term does a disservice to those in recovery or struggling to reach out for help, and does not address the root of the recent school shootings and other tragedies.

Research has shown that the best predictor of violence among those with schizophrenia is the same as it is in the general population: a history of experiencing or perpetrating violence. Similarly, just as with the general population, substance abuse plays a significant role. Environment and context are just as important, if not more so, than “mental illness” in determining a person’s likelihood to perpetrate violence.

The average reader may not distinguish between depression, anxiety, schizophrenia, obsessive-compulsive disorder, personality disorders or sociopathy. Often, several different diagnoses can be made within the overarching category of any particular disorder. Additionally, people with a given condition fall on a spectrum with regard to the severity of that condition.

Instead of glibly explaining away a person’s behavior by labeling them “mentally ill,” why not instead look into the specific behaviors or traits of the individual? When an individual dies in a single-car crash and it’s reported that the individual suffered a “medical event,” we rarely consider that a sufficient explanation. Was it cardiac, neurological or suicide? Were there drugs and/or alcohol involved?

Living with a mental health condition is more common than some know. Nearly one in five Americans is living with a mental health condition, the National Institute of Mental Health has found. According to the World Health Organization, the average American has a 50 percent chance of having a mental health disorder, not including eating disorders, personality disorders or schizophrenia. Furthermore, in any given year, nearly one in 10 adults will suffer from a mood disorder (such as depression or bipolar disorder), according to NIMH, while almost one in five will suffer from an anxiety disorder.

Many people who are affected by mental health disorders live successful lives and manage their diagnosis well. Yet more than 60 percent do not receive treatment, whether it’s from a lack of resources or an unwillingness to seek treatment for fear of stigmatization.

We need to talk more about whether or not there were warning signs when we discuss those few within a community who do commit acts of violence. And we need better treatment opportunities. People need to feel safe when seeking out resources, and we need to foster that environment. We need to support all people across the continuum of mental illness and recovery who read this seemingly constant stream of stigmatizing language that fails to explain the conditions in question.

As student nurses and working nurses, we have a unique opportunity to see people living every facet of the human condition, and we are hoping that we can destigmatize through our care, but we are only part of the equation. The media have a responsibility to present accurate information about mental health diagnoses to foster understanding, reduce ignorance and minimize fear by explaining the unknown, rather than further deepening it.





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Parents of slain DNC staffer sue Fox News for alleged distress caused by retracted WikiLeaks story

Fox News

SlayStorm / Shutterstock.com

The parents of a murdered staffer for the Democratic National Committee have filed a suit against Fox News that claims a false story about their son intentionally exploited their tragedy and caused them significant emotional distress.

Joel and Mary Rich filed suit Tuesday over the retracted story that had claimed their son, Seth Rich, had leaked DNC emails to WikiLeaks. Intelligence officials have concluded Russia hacked and leaked the emails, while law enforcement has attributed Rich’s July 2016 murder to a botched robbery. The Washington Post and the New York Law Journal have coverage.

The suit claims intentional infliction of emotional distress, negligent supervision of Fox News reporter Malia Zimmerman and paid investigator Rod Wheeler, and tortious interference with a contract between Wheeler and the Riches.

“Joel and Mary Rich, grieving parents of a murdered child, seek justice for having become collateral damage in a political war to which they are innocent bystanders,” the suit says. The Fox News story stemmed from a “fringe conspiracy theory” that was a “fiction” and a “sham,” according to the suit.

The Riches are experiencing symptoms of post-traumatic stress disorder and obsessive compulsive disorder, and Mary Rich has symptoms of social anxiety disorder, the suit says. The symptoms are triggered “by the constant stream of news coverage making false accusations and maligning their son.”

Wheeler sued Fox News last year, claiming he misquoted in the discredited story. Wheeler had alleged the story was concocted with the help of a wealthy supporter of President Donald Trump, Ed Butowsky, to discredit intelligence reports that Russians had hacked Democratic National Committee emails.

Fox News said it couldn’t comment on pending litigation. Zimmerman and Butowsky are also defendants.

Butowsky told the National Law Journal he didn’t write the article and it was frivolous to sue him over it. He said he was merely trying to help the Riches, and Joel Rich was initially happy with the story.

Updated on March 15 to report Fox News statement that it can’t comment on pending litigation.

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Khloe Kardashian’s OCD Reference Is Seriously Not OK & Fans Are Calling It Out

The glamorization of serious mental health issues might be a pet peeve of all of ours — especially when people joke about being bipolar when they aren’t, or say they suffer from Obsessive Compulsive Disorder (OCD) without any kind of diagnosis by a doctor. So when I logged online on March 13 to see Khloé Kardashian’s OCD reference front and center on my Twitter timeline, I was thoroughly disappointed in the reality star. And clearly, so are her fans because they’re totally calling her out over it.

Kardashian took to her Twitter page to advertise the latest quiz on her app, “How Khlo-C-D Are You?” The title seems to be a spin on the mental health disorder OCD, which is described by the International OCD Foundation as “a cycle of obsessions and compulsions” that cause “intrusive thoughts” and “intensely distressing feelings.” But, unfortunately, the name of the disorder has taken on a new meaning: some use it to describe how tidy or organized they are while downplaying the intense effects of OCD.

So of course, when Kardashian shared the “Khlo-C-D” quiz with her followers, many immediately criticized her for branding and glamorizing a mental illness. Kardashian’s team did not immediately respond to Elite Daily’s request for comment on her choice of phrase.

Fans are not happy.

Some were highly disappointed that Kardashian, who has “such a massive following” shared something so offensive.

Sadly, it’s not the first time she’s used the phrase, either. Kardashian’s been running “Khlo-C-D” posts around cleaning since at least 2017.

It’s one thing to be a neat freak, but to joke about OCD is just straight-up wrong.

According to the American Psychiatric Association, OCD is an anxiety disorder in which people have recurring intrusive and unwanted thoughts which drive them to do something repetitively. The disorder can manifest in ways such as excessive cleaning, ritualized hand washing patterns, and checking on things multiple times — all of which “can significantly interfere with a person’s daily activities and social interactions,” according to the Association’s webpage. When speaking about the realities of living with the disorder, Dr. Danielle Forshee, LLC, explained to Elite Daily just how severe it is. She says,

So Kardashian using a distressing mental disorder to try to illustrate how adorkably tidy she is clearly felt like a bit of a slap in the face toward the people who struggle with the real thing on a daily basis.

Jerod Harris/Getty Images Entertainment/Getty Images

It’s not the first time Kardashian’s posts have caused drama.

On March 9, Kardashian shared another post from her app, “5 Hacks To Look Thin AF In Pics” to the 26 million fans who follow her on Twitter. And the excerpt of the message was super cringeworthy, if you ask me. It read, “There are even more stealth ways to look like you have a sick bod in pics,” which kind of pushed the whole ideology of needing to be perfect on social media; a message that is more unhealthy than being “thin AF.” (IMO, at least.) While it’s one thing to advocate for healthy eating habits and lifestyles, many felt that the mom-to-be was promoting unhealthy eating habits and body-shaming through her post.

The best thing about all of this, though, is that when troubling things like this happen, one can always rely on social media to get them in check. That said, I’m sure Kardashian will get it right the next time. Hopefully.

I hope my son will develop his speech – Mother of child battling ADHD & OCD

Roselyne Boyani with her son Glen [Photo: Courtesy]

Roselyne Boyani is a mother living in hope that her son Glen, 6 diagnosed with autism, ADHD and OCD will develop his speech after therapy.

Glen was born a normal baby. He had no issues at birth. He even had normal developmental milestones. However, at two, Glen seemed to be regressing. Despite showing signs of speech earlier, and even responding to his name, the development suddenly stopped.

I thought taking him to a play school would enhance his power of speech but that didn’t happen. He still couldn’t speak and wouldn’t interact with the other kids. You could often find him huddled in a corner playing with his shoes.

He also does not listen when spoken to. And is rather impatient with the other children. He has trouble staying focused and is easily distracted or gets bored with a task before it is completed.

Glen was diagnosed just after he turned three. This was done at the Gertrude Child Development Centre after his nursery school teacher suggested that I get him accessed. The experts did a hearing a test, and Glen was found to be normal. But his paediatrician determined that he was autistic, had attention deficit hyperactivity disorder and obsessive compulsive disorder.

It seems as though Glen’s developmental milestones froze at age three. He is one month shy of six years, but he is still using his feeding bottle.

Glenice, his four-year-old sister does not display any neurological or autistic patterns.

Sometime back I joined a support group for mothers of special needs children. I learnt about stem cell therapy from one of the mothers who shared that there was a neurosurgeon from India called Dr Alok Sharma flying in to address us and follow-up on other children who had previously undergone stem cell therapy.

Being a clinical researcher and a trained nurse, I understand how we need to approach curative therapies that have, for the most part, been experimental. When I saw the neurosurgeon scans on cases previously done, and after hearing parents’ testimonies, I was in. I know a 15-year-old who was totally nonverbal, but has started speaking after the therapy.  

This corrective treatment, which is a form of stem cell bone marrow transplant using the child’s own purified and isolated stem cells, is not available in Kenya. It holds promise to enable Glen to be independent (diaper-free), to speak, to interact with other children, to learn and be free of other debilitating symptoms of autism such as seizures. 

Dr. Alok does the procedure at the NeuroGen Brain and Spine Institute in India. Thereafter, there is a follow-up visit after six months where he does scans to confirm that there has been progress and the damaged areas of the brain that received the new stem cell transplant have regenerated, renewed and improved. Glen is scheduled for his treatment in April and I am awaiting for response from NHIF to know if they will support his treatment.


 Obsessive Compulsive Disorder (OCD) is an anxiety disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them to feel driven to do something repetitively (compulsions). The repetitive behaviours, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.


One effective treatment of OCD is a type of cognitive-behavioural therapy known as exposure and response prevention. During treatment sessions, patients are exposed to the situations that create anxiety and provoke compulsive behaviour or mental rituals.

A class of medications known as selective serotonin reuptake inhibitors (SSRIs) is effective in the treatment of OCDs. Other psychiatric medications can also be effective.

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. ADHD also affects many adults.

Symptoms of ADHD include inattention, hyperactivity and impulsivity. ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork.

Scientists have not yet identified the specific causes of ADHD. There is evidence that genetics contribute to ADHD.

Behavioural therapy and medication can improve the symptoms of ADHD.

There are two main types of medication for ADHD: stimulants and non-stimulants. Stimulant medications are highly effective treatments, and include methylphenidate and amphetamines. Two non-stimulants, atomoxetine and guanfacine, have also been shown to be effective in treating ADHD symptoms.

Source: American psychiatric association

Eleven Types of Anxiety Disorders: What Are They?

I have been reviewing the psychology of fear and anxiety in my last few posts, discussing their similarities and differences.

Excessive fear and anxiety, however, can be a sign of an anxiety disorder. In today’s post, I will explain what an anxiety disorder is and then briefly describe the variety of anxiety disorders, all eleven of them.


To understand anxiety disorders, we need to learn a little about the Diagnostic and Statistical Manual (DSM), which is published by the American Psychiatric Association. Mental health professionals use this manual, which lists the diagnostic criteria for several hundred mental disorders, to diagnose disorders in their clients.

The DSM is updated every few years. What changes in a new edition? Some disorders are eliminated, new ones are created, and the criteria for some disorders are modified. The latest edition of the manual, DSM-5, was published in 2013.

What is an anxiety disorder?

So what is an anxiety disorder, according to DSM-5?

Anxiety disorders differ from developmentally normative fear or anxiety by being excessive or persisting beyond developmentally appropriate periods [my emphasis]. They differ from transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting 6 months or more), although the criterion for duration is intended as a general guide….Since individuals with anxiety disorders typically overestimate the danger in situations they fear or avoid, the primary determination of whether the fear or anxiety is excessive or out of proportion is made by the clinician, taking cultural contextual factors into account….Each anxiety disorder is diagnosed only when the symptoms are not attributable to the physiological effects of a substance/medication or to another medical condition or are not better explained by another mental disorder.¹

The difference between the various anxiety disorders has to do with the “types of objects or situations that induce fear, anxiety, or avoidance behavior, and the associated cognitive ideation.”¹

Eleven anxiety disorders

So what are the major types of anxiety disorders? While anxiety can be a feature of many disorders, including obsessive-compulsive disorder and post-traumatic stress disorder (both were listed under anxiety disorders, in the previous edition of the DSM), DSM-5 lists only the following eleven types of disorders in the anxiety category:

  1. Separation anxiety disorder: Being overly fearful of separating from attachment figures (e.g., one’s parents).
  2. Selective mutism: Failing to speak in some situations though capable of speaking in others.
  3. Specific phobia: Being excessively fearful of certain objects or situations (e.g., animals, blood, etc).
  4. Social phobia: Being overly fearful of interacting with others in social situations.
  5. Panic disorder: Experiencing unexpected panic attacks and as a result constantly worrying about the occurrence of more attacks in the future.
  6. Agoraphobia: Being excessively fearful of certain situations (e.g., crowds), worrying that, should a panic attack or other similar distressing events occur, escape will be difficult.
  7. Generalized anxiety disorder: Being overly anxious in various domains (e.g., personal relationships, work, school).
  8. Substance/medication-induced anxiety disorder: Intense anxiety that results from substance withdrawal or medication use.
  9. Anxiety disorder due to another medical condition: Here the anxiety symptoms are the physiological consequence of a medical condition (e.g., an overactive thyroid).
  10. Other specified anxiety disorder: This is a category for anxiety symptoms that do not meet the full criteria for any of the above disorders.
  11. Unspecified anxiety disorder: Same as above, but this category is used in cases that the health provider can not (or chooses not to) specify the reason the full criteria are not met.

In case that you have concerns about yourself meeting the criteria for a particular disorder, I recommend you refrain from searching for a disorder’s detailed criteria online and self-diagnosing, and instead make an appointment with your mental health provider. A good health provider will obtain full history and rule out a number of other conditions before providing you with a diagnosis. You may want to also obtain a second opinion, just to be sure.

But what then? What treatment options are there?

Starting next week, I will begin a series of posts on treatments for fear and anxiety. I will discuss how various therapies work, and will also talk about medications.


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

Kevin Love ‘brave’ voice for those living with mental illness, panic disorders

CLEVELAND, Ohio – The Cleveland Cavaliers forward Kevin Love took a brave step Tuesday when he publicly shared how a panic attack drove him from a game and began his exploration of mental health, those in the local mental health community say.

“It’s a brave thing to do,” said Dr. Eric Berko, a psychologist and the director of behavioral science at MetroHealth. “It’s a sign of strength, being comfortable in your truth.”

Love revealed his experiences with mental health in a contributed piece “Everyone is Going Through Something” for The Players’ Tribune, in which he detailed how a panic attack led him to start giving his mental health the kind of attention his physical health gets.

“Partly, I want to do it for me, but mostly, I want to do it because people don’t talk about mental health enough. And men and boys are probably the farthest behind,” Love wrote. “Mental health isn’t just an athlete thing. What you do for a living doesn’t have to define who you are. This is an everyone thing. No matter what our circumstances, we’re all carrying around things that hurt — and they can hurt us if we keep them buried inside.”

In the U.S., 18 percent of adults have anxiety disorders, under which category panic attacks fall, yet only 37 percent of those affected seek treatment, according to the Anxiety and Depression Association of America

Scott Osiecki, CEO of the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County, said the stigma associated with mental illness can keep those in need of help from getting it, and he credits Love for helping change the conversation surrounding mental health.  

“We really want to thank Kevin Love. We are so proud of him, not only for his contributions to basketball, but also in speaking out,” Osiecki said. “It really has a great impact when Kevin and other people who are folks people look up to say it’s OK to have a mental illness. That really helps to break down that stigma and the barriers people have.”

Anxiety disorders

There are a number of anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive compulsive disorder and bipolar disorder, among others. While many people may experience the symptoms of some of these disorders, those symptoms only translate into disorders when they become disruptive, Osiecki said.

“Anybody at any point in their life is going to feel anxious about something,” Osiecki said. “Generalized anxiety disorder is when people worry all of the time, and it interferes with their life. It’s a chronic condition; it’s that feeling of heightened anxiety all day long.”

The same is true of panic disorder. Many people can feel the symptoms: heart pounding, hearing more acute, a need to get more air.

“It’s the basic fight or flight mechanism that we all have. That’s only a panic disorder when it starts to happen when you don’t want it to,” MetroHealth’s Berko said. “Your brain’s not doing anything bad; it’s trying to help you out. The problem is you don’t need the help; you don’t need to outrun a woolly mammoth or a cheetah.”

The same thing that makes these disorders relatable, however, also makes many dismiss them. Because people are familiar with the symptoms of panic attacks or of anxiety, it is common for those without the disorders to think others should also be able to get over them.

“A person who doesn’t have the disorder would say, ‘I got over that in a matter of minutes,'” ADAMHS’ Osiecki said.

He likens it to migraines. People without migraines think others are just getting headaches because that is what they’re familiar with. But migraines are actually “a crippling disease,” Osiecki said.

Athletes sharing their truth

Love, an NBA All-Star, said he was encouraged to talk about mental health by Toronto Raptor and fellow All-Star DeMar DeRozan’s decision to open up about his own depression last month.

“I’ve played against DeMar for years, but I never could’ve guessed that he was struggling with anything,” Love wrote. “Because just by sharing what he shared, DeMar probably helped some people – and maybe a lot more people than we know – feel like they aren’t crazy or weird to be struggling with depression. His comments helped take some power away from that stigma, and I think that’s where the hope is.”

DeMar first revealed his experiences with depression through a tweet and later elaborated on his personal battles in an interview with The Toronto Star.

“It’s one of them things that no matter how indestructible we look like we are, we’re all human at the end of the day,” DeRozan told The Star. “We all got feelings . . . all of that. Sometimes . . . it gets the best of you, where times everything in the whole world’s on top of you.”

Love isn’t the first Cavs player to start a conversation about mental health. A few years ago, Delonte West revealed he was diagnosed with bipolar disorder after he was arrested for speeding, cutting off a police cruiser and carrying loaded weapons on his motorcycle. West, who is no longer in the NBA, has since distanced himself from that diagnosis and questioned whether public perception of his clinical illness affected his professional career.

Bipolar diagnosis eludes many who suffer from the disorder

Tips and resources for getting health

For those who think they may have a mental illness, mental health experts recommend first seeing a primary care doctor for a physical evaluation to ensure the symptoms present aren’t indicative of a physical illness. A primary care doctor can then refer patients to a counselor or therapist.

  • ADAMHS’s partner agency, FrontLine Service, offers a 24-hour suicide prevention, mental health crisis, information and referral hotline at 216-623-6888, as well as an online chat service 3 p.m. to 9 p.m. Monday through Friday at www.frontlineservice.org.
  • Through the national Crisis Text Line, the Ohio Department of Mental Health and Addiction Services offers a 24/7 texting service for those in crisis. Those in Ohio can text “4hope” to 741741 to be connected with a crisis counselor.

Crisis texting hotline has been successful in Ohio, officials say

4 Tips for Living with Obsessive-Compulsive Personality Disorder

An estimated 7.9 percent of Americans suffer from this anxiety disorder.


Living with Obsessive-Compulsive Personality Disorder (OCPD) is challenging. It can frustrate loved ones, make everyday tasks seem arduous, and can effect overall well being. OCPD is considered an anxiety disorder and is often confused with Obsessive Compulsive Disorder (OCD). Although the two disorders have similar names, they are actually quite different.

OCD is a disorder in which a person has uncontrollable, recurring thoughts and behaviors, which he feels the need to constantly repeat. OCPD is generally characterized by needs for orderliness, perfectionism, excessive attention to detail, a need to control the surrounding environment and emotions, being overly conscientious and excessively devoted to work and productivity.

Those with OCPD put themselves under constant pressure to keep order, stick to a prescribed schedule, meet unrealistic expectations, and are often inflexible and self-critical when things don’t go as planned. Studies have found that 7.9 percent of Americans suffer from OCPD, making it the most common personality disorder.

4 Tips for Dealing with OCPD:

  1. Cultivate self-compassion. Try not to be self-critical when having obsessive thoughts, as this can make obsessive thoughts more powerful. Instead, work on practicing acceptance to reduce negative emotions.
  2. Meditate. Studies show that regularly meditation helps reduce anxiety and obsessive thoughts.
  3. Identify self-soothing techniques. Anxiety is a major component of OCPD. Learning ways to calm down intense emotions, like anger, frustration, anxiety and sadness, helps reduce emotional reactivity. Listening to music, going for a walk, or watching TV may help.
  4. Seek professional help. OCPD is a complex disorder and being able to make changes may require therapy and/or medication. Exploring the underlying causes of OCPD combined with cognitive-behavioral therapy and proper medications can bring about lasting change. 

More than one in five mums struggle to bond with their baby and are ‘crippled by emotional and mental problems’

MORE than one in five new mums struggles to bond with their newborn.

Many are crippled by emotional and mental health problems around the birth.

 More than one in five new mums struggles to bond with their newborn (stock image)
More than one in five new mums struggles to bond with their newborn (stock image)

Experts say up to a third of mums claim the baby blues have left them feeling unable to care for tots.

But the NHS is letting down thousands.

Two in five women admitted mental strains damaged their relationship with their partner.

The National Childbirth Trust questioned 1,000 mums.

 Libby Binks, 37, suffered postnatal depression
Libby Binks, 37, suffered postnatal depression
 NCT head of knowledge Sarah McMullen
NCT head of knowledge Sarah McMullen

About 700,000 tots are born each year.

The charity estimates half of new mums suffer an emotional or mental health problem during pregnancy or within a year of birth.

This can include postnatal depression, post-traumatic stress, anxiety or obsessive compulsive disorder.

Some feel suicidal and only half get help.

Sarah McMullen, of the NCT said: “There are still whole areas of the country with no specialist mental health services for mums.”

Libby Binks, 37, of Yorkshire, said postnatal depression meant she could not wait to hand over daughter Chloe to her husband.

She said: “I felt the best thing would be for me to disappear.”

She paid for private therapy.

Yorkshire mum-of-one Libby Binks, 37, said postnatal depression meant she could not wait to hand her baby daughter Chloe over to her husband.

She said: “I would find any excuse and I felt a huge sense of relief when he was responsible for her.
“But the more I pushed her away the worse I felt.

“I struggled to cope from the day she was born.”

After a traumatic birth, Libby struggled to breastfeed Chloe, now three.

Things got so bad she admits: “I felt the best thing would be for me to ‘disappear’ and leave them both to it.

“They would be better off without me.”

After health visitors failed to get Libby the help she needed on the NHS, she paid for private counselling.

“I am finally feeling better.

“But I wish I’d had that help two and a half years ago.”

GOT a news story? RING us on 0207 782 4104 or WHATSAPP on 07423720250 or EMAIL exclusive@the-sun.co.uk


Westfield Public Schools host comprehensive PD sessions for staff


Why you need the MyCentralJersey mobile app.
Joe Martino | Wochit

Whether delving into the Next Generation Science Standards (NGSS), non-fiction reading strategies, dyslexia training, or the ever critical issue of student and staff mental health, teachers and paraprofessionals in the Westfield Public School District participated in wide-ranging professional development sessions on Feb. 15 and 16.

“It was a really dynamic two days. We had a great blend of in-district facilitators and out-of- district consultants addressing the professional learning needs of our staff,” said Paul Pineiro, assistant superintendent for curriculum, instruction and programs, whose office organized the multi-building staff inservice days.

READ: Westfield’s Wilson School participates in Month of Hope

Depending on their specific positions, staff members were assigned to various inservice courses.  Among the comprehensive offerings were break-out science sessions for teachers in grades K-5 who are rolling out the new science curriculum. Teachers explored investigative planning, engineering practices, science notebooks and other lessons, while participating in grade level training aimed at helping them to best implement the NGSS in their classrooms.  

“The goal is to make teaching science easier for you and more engaging for your students,” said K-12 Supervisor of Science Tom Paterson before teachers moved on to the individual NGSS sessions. 

Pineiro said one of the aspects he liked most about this full-day of science training was its hybrid approach.

“The best people to deliver two of the three modules were right here in district,” he said. “But we also needed an expert in how to use the program materials that accompany the new science curriculum. For that we brought in training staff from the vendor.”

READ: Student news: Hands-on learning focus of Westfield school’s STEAM event

There was curriculum mapping for world language teachers, moot court simulations for intermediate social studies instructors, a review of new standards for the visual and performing arts, movement education for high school physical education teachers and much more.

Psychologist Rob Zambrano of the Stress and Anxiety Services of New Jersey, talked about how to spot signs of panic disorder, anxiety, obsessive-compulsive disorder and other stresses on a child’s mental health, while his colleague, psychologist Charity Truong, addressed the issue of cognitive behavioral therapy and anxiety.

On the second day of the inservice, all staff members gathered in the WHS auditorium to hear sobering statistics yet empowering strategies from Phyllis Alongi, clinical director of the Society for the Prevention of Teen Suicide.  Assistant Superintendent for Pupil Services Michael Weissman called the presentation “relevant, timely and significant.”

That afternoon, teachers returned to their schools to receive individualized training on the soon-to-be new teacher webpages.

“The district is committed to providing opportunities for our staff members to grow professionally,” Superintendent Margaret Dolan said. “I commend all our staff for their dedication and continued commitment as educators.”

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