How I overcame OCD

My mind was my own worst nightmare.

It was telling me I was going to die if I didn’t perform the tasks it told me to do with acute detail.

I didn’t understand. My parents didn’t either. I was lost, confused. I needed help.

I was diagnosed with Obsessive-Compulsive Disorder at the age of 9 — a time when I was going through countless changes in my life.

It became apparent I needed help after a family trip to Sault Ste. Marie, Ontario, had to be cut short because my compulsions were virtually taking over my life. Minutes, even hours, of my days were being spent performing repetitive tasks as I succumbed to my mind’s every demand.

Birgit Amann, medical director at the Behavioral Medical Center in Troy, said there is a certain point when an individual should come in to receive help for the disorder. I was at that point.

“In general, the biggest reason is it’s gotten to a point where they (people with OCD) are unable to function,” she said. “Clinically, it’s when it gets to the point where you’re missing out on things, you’re not getting to school or getting to work and that type of stuff.”

Luckily, I was able to receive the therapy I needed and realized I am not the only one with this disorder.

Others just like me

That was the hardest part in the early stages of my OCD. I felt like I was completely different than everybody else. I felt like I was being punished for some reason. I felt like I was the only one that was wasting away hours in a day, so engulfed in my rituals that everything in the outside world was oblivious to me.

But as it turns out, there were plenty others just like me, with about half a million children in the United States suffering from OCD, according to ocfoundation.org.

Understanding that OCD was a relatively common disorder was a big first step in my battle against my brain.

However, I still didn’t understand why my mind was telling me to turn the lights on and off a certain amount of times, why I had to keep closing and opening drawers until I did it just right, why I had to put the dishes away in a certain order.

I knew it was stupid. I knew it was pointless. I knew there was no sane rationale to why I was doing these tasks. All I did know was that if I didn’t perform these tasks exactly how my mind told me, then my anxiety level would increase drastically.

And it wasn’t just the compulsions. The obsessions were equally destructive. I was so afraid of germs and getting sick that I would wash my hands so many times in a day my hands would turn raw.

Ugh. I hated myself.

Therapy

When I first began therapy, my psychiatrist tried to explain to me what was causing these symptoms.

She said it was because of an imbalance of a chemical in my brain called serotonin, and that parts of my brain were overactive. In order to increase the serotonin levels in my brain, I was prescribed Prozac right when I began therapy.

Being so young, I didn’t really understand the clinical part of it, I just wanted to feel normal—not just for my sake, but for my family’s as well. As hard as the disorder was on me, it was equally as hard on them.

“As a family, you’re a team as much as possible, but this (OCD) gets in the way,” Amann said. “Not only does it (OCD) make you late for things, but it can make your family late for things.”

And, boy, did it ever. I can’t even count how many times we were late to places because I had to finish performing my compulsions. I hated it, but there was nothing they or I could do about it.

Tamar Chansky writes in his book, “Freeing Your Child from Obsessive-Compulsive Disorder,” that punishment does not help anxiety—it makes it worse, so that was not an option for them.

All they could do is support me as much as possible as this malicious monster attacked my mind.

The only places I felt safe

As much pain and anxiety this disorder brought me as a child, there were always two places I could escape my symptoms.

When I was in that room, I could put my mind to rest. My psychiatrist made me realize this disorder was all in my head and if I didn’t perform one of my compulsions, nothing bad would happen to me.

The other place was at school. As I walked among my peers, I was afraid of them thinking I was different. I didn’t want to be thought of as the “weird kid,” and I didn’t want people avoiding me because they felt uncomfortable in my presence.

So, I fought as hard as I could to hide my disorder from my classmates.

Why I had it

OCD is interesting because there is still no definitive answer as to what causes it.

Most research suggests that people that have close relatives with the disorder are much more likely to develop OCD. Also, according to Chansky, an estimated 25 percent to 30 percent of children with OCD is said to be triggered by strep infections. This subtype of OCD is called Pediatric Autoimmune Neurological Diseases Associated with Strep (PANDAS).

“It’s not like everyone with strep is going to end up with OCD, but there are definitely cases of it,” Amann said.

However, I most likely developed the disorder because of my grandpa.  Although he was never officially diagnosed with it, my family said there was a good chance he had it.

Outgrowing the disorder

I am now 21 years old and have been off medicine for three years and have not needed to see a psychiatrist in four. My symptoms have digressed to the point where I feel like I don’t even have the disorder anymore.

Sure, I still have to set the timer on the microwave as an even number, along with other little rituals, but that is even common in people without OCD.

I am curious now to see how many of my peers suspected me of having OCD. For so long, I was so afraid of people finding out, because I felt like I would be treated differently. I only told a handful of my friends, and I don’t think any of them understood how severe it was. But after my battle with OCD, I am able to understand what people have to go through, not just with OCD, but with other disorders as well. I know it’s not easy, but there are always people out there to support you.

I don’t really have a definitive answer as to how I outgrew it. I think a major factor was my therapy and the support system from my family. I still don’t know how my parents and brother handled my situation so well, because, looking back now, I know there were times I was absolutely unbearable to be around.

I also think I just became old enough to realize that the voice inside my head wasn’t real and nothing bad would happen if I just stopped doing what it said.

I was sick of it. Sick of it.

I just wanted to live my life, and finally, that is what I have been able to do the past four years.

Eating disorders are not confined to teens


Posted: Tuesday, May 28, 2013 2:00 am


Eating disorders are not confined to teens


1 comment

DEAR DOCTOR K: I’m a woman in my 50s. Ever since my divorce last year, I’ve developed an unhealthy pattern of eating and purging. A friend suggested I might have an eating disorder. Could she be right?


DEAR READER: I understand why you ask the question, as most people think of eating disorders as a teenager’s disease. But eating disorders also affect middle-aged and older women, and even some men.

Experts disagree about what causes eating disorders. There is probably no single, simple answer. Genes seem to play a role. Identical twins are more likely to have eating disorders than non-identical twins, for example.

Eating disorders appear to be more common in people who have dieted frequently in the past and in people who needed to be lean at one point in their lives — because they were competing in certain sports, for example, or dancing.

People with eating disorders appear to be more likely to have psychiatric disorders, particularly obsessive-compulsive disorder, anxiety disorder and substance abuse.

I’m not a psychiatrist, but I’ve always been struck by the parallels between obsessive-compulsive disorder and eating disorders. Both involve irrational behaviors that people cannot control. Eating disorders may be a way of responding to stressful events in life.

There are many reasons why eating disorders may develop or reappear during middle age. With age, for example, you are increasingly likely to lose people you care about. Restricting food or purging can be a way to deal with distressing feelings.

Divorce is another common reason. In addition to grief and loss, the breakup of a marriage can spur a person to view their body unfavorably.

The type of disordered eating you’ve described sounds like bulimia nervosa. People with bulimia go through cycles of binge eating followed by purging. While on a binge, a person with bulimia may eat an entire cake rather than one or two slices, or a gallon of ice cream rather than a bowl. This is followed by a purge: making oneself vomit or using laxatives or diuretics.

Talk to your doctor about your eating patterns.

If you do have bulimia, treatment can help you achieve a healthy weight and eating pattern, eliminate binge eating and purging and address any stressful issues in your life:

n Psychotherapy is the cornerstone of treatment for eating disorders. Cognitive behavioral therapy challenges unrealistic thoughts about food and appearance. It can help you develop more productive thought patterns. Interpersonal and psychodynamic therapy can help you gain insight into issues that may underlie your disordered eating.

n Through nutritional rehabilitation, a dietitian or nutritional counselor can help you learn (or relearn) the components of a healthy diet. He or she can help motivate you to make the needed changes.

n Fluoxetine (Prozac) is the only medication approved to treat an eating disorder. At high doses, it reduces binge eating and vomiting, particularly in combination with psychotherapy. Other antidepressants and the seizure medication topiramate (Topamax) may also be prescribed for bulimia.

With the help of these treatments, you can overcome your eating disorder.

Dr. Komaroff is a physician and professor at Harvard Medical School. Send questions and get additional information at www.AskDoctorK.com.

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Quelling Anxiety Across the Chesapeake

Driving over the Chesapeake Bay Bridge stirs fear in the hearts of no small number of Baltimore and Washington residents, an anxiety that resumed its seasonal peak over the Memorial Day weekend and the start of the annual pilgrimage to the beach towns and quaint sailing harbors of the Eastern Shore.

“Everyone talks about the fear of crossing the bridge,” said Carolyn Casey, who lives in Washington with her family and has a second home near St. Michaels, Md., across the bridge.

On Friday, she pulled her silver Lexus S.U.V. to the side of the road before the western end of the bridge, which stretches more than four miles. The passenger seat was piled with Whole Foods bags, and two Labrador retrievers were curled in the cargo area. As Ms. Casey climbed into the back seat with her 3-year-old daughter and a nanny, Alex Robinson got in behind the wheel.

“When I told people I’d found someone to drive me over the bridge, they laughed,” said Ms. Casey, 41, a homemaker whose husband is a consultant. “But it all came out — everyone is afraid of the bridge.”

Mr. Robinson, 27, runs Kent Island Express, which charges $25 each way to shuttle people in their own vehicles across a bridge that Travel Leisure magazine ranks as one of the world’s scariest.

As he drove to pick up one customer, he fielded the kind of telephone call he receives all day. “Do you have a lot of people you drive because they’re afraid?” a woman asked, with uneasiness in her voice.

“About 5,800 people use our service,” Mr. Robinson told her.

“Whoa,” the woman said. “That makes me feel better.”

Mr. Robinson’s business, which he took over last year from his mother and stepfather after they had run it for five years, has made him an amateur psychologist. He hires only upbeat drivers so as not to further alarm clients. “Their stress and anxieties feed off of your mood,” he tells employees.

He knows to talk about anything but the bridge during the 10 to 15 minutes it takes to cross: first, a disconcerting dogleg curve, then a precipitous climb over the initial suspension span; then downhill and over a second span, a cantilever whose boxy sides and roof feel like a suffocating tunnel.

“Most people, when they’re nervous, they babble,” Mr. Robinson said. “They talk about their first boyfriend. Their kids. People will tell you about their entire life story.”

But not everyone. Construction workers have been known to ride in the back seat of their pickup trucks, hats pulled over their eyes and their ears plugged. A woman once rode with a blanket over her head. A man asked to be put in his trunk, an offer that was refused.

The fear of bridges has a name, gephyrophobia. Psychotherapists say it is common and often traces back to a panic attack during a particular crossing, even after years of driving over the same bridge without incident.

Kathleen Busch, who retired from the human resources department of a Baltimore company, said she could cross carefree “when I could wear a bikini.” Her fear began after she was stuck in the Baltimore Harbor Tunnel for hours. (Experts say the fear of bridges and tunnels are sometimes linked.)

Trying to drive through the tunnel later, “everything went white,” Ms. Busch recalled. “I had a full-blown panic attack,” with racing heart and shortness of breath. “I thought I was going to pass out.”

In the two years since she and her husband bought a retirement home on the Eastern Shore, she has not tried to drive on the Bay Bridge for fear of causing an accident.

The bridge, officially the William Preston Lane Jr. Memorial Bridge, is not the only one with a service to help anxious drivers. The five-mile-long Mackinac Bridge in Michigan, one of the world’s longest suspension bridges, offers a free drivers’ assistance program. In the Florida Keys, enterprising college students have been known to wait at either end of the Seven Mile Bridge to drive tourists.

School mental health services stretch to meet increased need, staff says

With increasingly severe emotional disorders seen among students, resources for mental health services in public schools do not adequately address the county’s needs, according to one school official.


Symptoms of mental illness have grown more intense in recent years and are seen at much younger ages, said Ann Hammond, the county’s supervisor of psychological services and school therapists. But Frederick County Public Schools’ budget restrictions have kept school mental health staff from increasing to accommodate the growing demand.

Nineteen full-time school psychologists served in the county’s 51 public schools during the 2000-2001 school year, Hammond said. Though the county has gained 13 public schools since 2001, only one part-time psychologist position has been added.

“Schools often are the biggest mental health providers for children because they are with us for such a large part of the day,” Hammond said. “We’re not keeping up, and that’s just the honest truth.”

More than 3,000 children in the county have some form of mental illness, Hammond said. The school system does not keep statistics of the number of its students with mental illnesses.

School psychologists and counselors deal most often with students who have anxiety issues such as obsessive-compulsive disorder or separation anxiety; mood disorders such as depression; attention-deficit (hyperactivity) disorder and trauma from abuse, neglect or loss of a loved one, Hammond said.

The increase in mental health problems, particularly anxiety and depression, can be linked to the stresses children face as a result of a shaky economy, she said.

“As people lose jobs and have less money, families become less stable,” Hammond said. “Everybody is more stressed. Families are losing homes, families are moving in together, so there’s a lot of people living together in less space.”

Job stress can cause parents to have less patience with or pay less attention to their children, Hammond said. When families lose health insurance, they are less likely to be able to afford medicine or therapy for children.

The school system provides a number of services to help students cope with mental illness, including in-school psychological consultations, counseling sessions, and group or one-on-one teaching. Outside health care professionals are also brought into schools through partnerships with the county’s departments of social and health services.

School system staff conducted 1,369 student psychological evaluations, 51 student threat assessments and 320 suicide interventions during the 2011-2012 school year, according to school records.

About 240 students in Frederick County have emotional disabilities that require special education services, Hammond said.

However, there are other students with mental disabilities who do not need special education because of adequate medication and support by family and schools, she said.

Janet Shipman, who oversees the county’s school counselors, said her staff has tried to “fine-tune” the counseling process by educating teachers and students on the importance of reporting unusual changes in their peers’ personalities.

This helps school counselors reach out to students who may consider suicide, whether or not they have expressed the desire to harm themselves.

The number of elementary students who say they intend to hurt themselves has increased from 53 during the 2011-2012 school year to 64 to date in the current school year, Shipman said. The number of such cases among middle and high school students in the current school year has dropped from 118 to 113 and 149 to 108, respectively.

Despite the decline of suicide threats in middle schools and high schools so far this school year, Shipman said she has observed a general increase in serious mental health issues.

The current ratio of counselors to students varies based on the school, Shipman said. One counselor may be placed in a school with 500 students, while another works in a school of more than 900.

The school system’s fiscal 2013 budget allocated about $6.4 million for student health services, accounting for slightly more than 1.2 percent of the overall budget.

The fiscal 2014 budget request asks for more than $6.7 million, an increase of 6.1 percent in student health funding.

Stretching resources and personnel to meet the county’s needs can be a struggle, Hammond said.

“It’s been very, very hard because we as a system haven’t seen a lot of increases in funding,” she said. “Working within what we have, we do support kids amazingly. We have good people doing their jobs really well.”

School counselors are only a short-term solution, Shipman said, and schools are fortunate to have connections with community resources.

“I know in working with the health department and working with different agencies, there’s a lot of groups of people who are trying to increase awareness, trying to think outside of the box,” Shipman said. “I don’t foresee things getting worse.”

Follow Rachel S. Karas on Twitter: @rachelkaras.

BY THE NUMBERS

240 students in special education for emotional disabilities

Fiscal 2013 FCPS budget: $6.37 million for student health services

Fiscal 2014 request: $6.76 million

Increase of 6.1 percent

2000-2001 51 schools, 19 psychologists2012-2013 64 schools, 19 full time, 1 part time

2011-12 school year:

1,369 student psychological evaluations51 student threat assessments320 suicide interventions

More than 3,000 children in the county have some form of mental illness

Goodbye to the DSM-V

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

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

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

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

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

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

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

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Skin picking classified as distinct disorder

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

Local teen hopes to increase awareness of service dogs

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SPECIAL | HPE

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


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SPECIAL | HPE

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


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SPECIAL | HPE

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


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

* * * *

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

* * * *

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

jtomlin@hpe.com | 888-3579

Interested?

For more information about the Harts 2 Paws nonprofit foundation, visit the website at www.harts2paws.org or on Facebook at Harts2Paws.
To book a speaking engagement for Becca Hart (and her service dog, Mike), call Tonya Hart at (336) 995-3138 or send an email to harts2paws@yahoo.com.
 

Mental illness alliance planning walk at MCCC

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

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

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

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

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

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

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

What Is Penikese

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

The following is the profile of whom we serve.

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

Substance Use Disorders at Penikese

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

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

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

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

Penikese Focuses on Internalizing Mental Health Conditions

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

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

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

Whom We Do Not Serve

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

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

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

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

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

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

Best tips to overcome anxiety disorders naturally! – Zee News

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

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

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

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

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

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

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

Compiled by: Salome Phelamei

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


 

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