Less than a quarter of American youths previously treated for anxiety disorders stay anxiety-free

Pediatric anxiety disorders are common psychiatric illnesses, affecting approximately 10 percent of children. In one of the largest comparative treatment studies, researchers found that 12 weeks of sertraline and/or cognitive behavioral therapy (CBT) were effective in reducing anxiety and improving functioning. In the newly released follow-up study, researchers re-contacted these youths an average of six years later and then re-assessed them annually for up to four additional years.

Researchers found that 22 percent of youth who received 12 weeks of treatment for an anxiety disorder stayed in remission over the long term, meaning they did not meet diagnostic criteria for any anxiety disorder (defined as any DSM-IV TR anxiety disorder, including post-traumatic stress disorder and obsessive-compulsive disorder). 30 percent of youth who had received treatment remained chronically ill, meeting diagnostic criteria for an anxiety disorder during each year of follow-up, and 48 percent relapsed, meaning they met diagnostic criteria for an anxiety disorder at some, but not all follow-ups.

“When you see so few kids stay non-symptomatic after receiving the best treatments we have, that’s discouraging,” said one of the study’s principal investigators, Dr. Golda Ginsburg, Professor of Psychiatry at the University of Connecticut School of Medicine, Hartford, CT, USA. “However, we found no difference in outcomes by treatment type. Children were just as likely to stay in remission after treatment with medication as they were after treatment with CBT,” Dr. Ginsburg added.

Specifically, 319 youth and young-adults (the mean age at first follow-up assessment was 17 years) were followed from 2011 through 2015 (65 percent of the 488 youth included in the original treatment study). The researchers conducted annual evaluations that assessed, among other factors, diagnoses, school and social functioning, and service use. Findings indicated that at each follow-up year, approximately half of the youth remained in remission. When examined across all years of the follow-up, that number dropped to 22 percent, while 30 percent continued to meet criteria for an anxiety disorder at every annual evaluation.

The researchers found several factors that predicted which anxious youth were most likely to be in stable remission over the follow-up period. These factors included those who showed clinical improvement after 12 weeks of treatment; males; youth without a social phobia diagnosis; youth who had better family functioning; and those who experienced fewer negative life events.

The researchers concluded that while it may be optimistic to expect that 12 weeks of treatment resulted in long-term remission, it is now clear that more needs to be done to help anxious youth — including treatments that are more durable and a better mental health wellness model that includes regular check-ups to prevent relapse and improve outcomes over time.

Orthorexia: Do you have an unhealthy obsession with healthy eating?

SALT LAKE CITY — Healthy eating is a worthwhile endeavor. It’s definitely common to put at least some emphasis on meal planning, making nutritious choices and fueling your body. But for some, healthy eating gets taken to extremes causing fixation, preoccupation and obsession.

The term orthorexia nervosa was coined by Dr. Steven Bratman in 1996 to mean an unhealthy obsession with healthy food. It is not currently recognized as a diagnosable eating disorder, however, awareness and research on this condition are on the rise.

It’s difficult to quantify how many people struggle with orthorexia since to date, no formal diagnostic criteria have been developed, nor any validated tools for diagnosis. However, that’s only because it’s relatively new — not because it isn’t a serious condition that warrants careful attention.

So how do you know if your concern with healthy eating has crossed a dangerous line? The National Eating Disorders Association lists warning signs to be:

  • Compulsive checking of ingredient lists and nutritional labels
  • An increase in concern about the health of ingredients
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An inability to eat anything but a narrow group of foods that are deemed “healthy” or “pure”
  • Unusual interest in the health of what others are eating
  • Spending hours per day thinking about what food might be served at upcoming events
  • Showing high levels of distress when “safe” or “healthy” foods aren’t available
  • Obsessive following of food and “healthy lifestyle” blogs on Twitter and Instagram
  • Body image concerns may or may not be present

Orthorexia differs from other eating disorders in that the concern tends to be more about the purity of the food rather than its effect on weight. However, symptoms do overlap with anorexia nervosa as well as obsessive-compulsive disorder.

Orthorexia also resembles symptoms and anxieties seen in somatic symptom disorder and illness anxiety disorder, including excessive fear about bodily sensations and the potential for undiagnosed illness. This preoccupation with illness is positively correlated with problematic changes in eating behaviors.

5 common myths about eating disorders

Eating disorders are serious life-threatening mental illnesses. Here are five common myths and misconceptions and how you can get help.

As you may assume, orthorexia occurs on a spectrum ranging from more or less severe, but not less problematic. It has the potential to negatively affect relationships, health and well-being at any point and is likely to result in malnutrition.

Those working in health-related fields, dietitians, physical therapists, athletes, trainers, doctors, etc., may be more prone to developing orthorexia given the pressure to be a “good” example. In addition, the healthy living community found on Instagram (more than any other social media outlet) shows a high prevalence of orthorexia symptoms and Instagram use is positively correlated with increased symptoms.

Treatment for orthorexia, like any other eating disorder, is most effective when utilizing a team of professionals including a physician, therapist and dietitian. While there is no specific treatment protocol yet developed for orthorexia, eating disorder experts would most likely treat it as a combination of anorexia nervosa and obsessive-compulsive disorder. Some treatment strategies and goals would include:

  • Decrease obsessive thoughts about good vs. bad foods
  • Disrupt habitual patterns, rituals and routines around food
  • Challenge false food beliefs while managing the anxiety that would naturally result
  • Increase variety and amounts of foods eaten to improve nutritional status
  • Diversify how a patient’s time is spent to include things outside of food, exercise and health

If you find yourself struggling with any symptoms of orthorexia, I would encourage you to seek professional help. While this isn’t intended to replace individualized treatment, I would offer a few suggestions for challenging rigid and worrisome food behaviors:

  • Don’t eat the same foods over and over. Challenge yourself to eat a different meal for breakfast, lunch and dinner each day to avoid falling into ritualistic eating patterns.
  • Use meal times to connect with others rather than eating by yourself. Eating disorders and their behaviors are isolating; be intentional about making food and meal times social and interactive.
  • Make a list of all the things you enjoy doing. Set a goal to spend time each day doing something you find meaningful and valuable, particularly replacing time spent in researching, planning or preparing food.
  • Set a boundary for researching nutrition — avoid Google, don’t read labels or track food intake.
  • Detox your social media feeds from anything food and body image obsessive.

Eating disorders are serious and life-threatening. Our current nutrition culture tends to glamorize and applaud disciplined eating, but I would encourage you to assess your intentions around healthy eating and avoid the temptation to take it to extremes.

Help for those with eating disorders can be found on the National Association of Anorexia Nervosa and Associated Disorders website or by calling their hotline at 630-577-1330, available Monday-Friday, 8 a.m.-4 p.m. MST.


Emily Fonnesbeck


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Living With OCD: A Day In My Life

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You’ve probably heard “OCD” tossed around in conversation recently. You may have even used the term yourself. Colloquially, it’s become synonymous with wanting things to be neat, tidy and orderly but, really, it’s so much more than that.

Obsessive Compulsive Disorder, or OCD, is an actual anxiety disorder affecting 2.2 million adults in America and varies in severity. The biggest sign of this condition is obsessing over something, usually “contamination, cleanliness, aggressive impulses, or the need for symmetry,” and then being compelled to perform an act to relieve the anxiety.

As a result, many develop rituals that must be done in certain situations in order to feel “safe.” The symptoms can be mild or debilitating. I like to think I fall somewhere in the middle but, if I’m honest, I’m probably closer to the more extreme end of the spectrum.

I have spent most of my 40 years trying to hide it. Whenever I’ve opened up, I usually have regretted it. I’ve been mocked and publicly shamed which is why dedicating an entire post to my experience is so scary, but we need to stop letting the “monsters in our closets” win. We have to start talking about mental illness.

A Bit of Background

I was very young, 7 years old, I believe, when I realized that something wasn’t quite right. While sitting in the back of a car for a long road trip, I noticed a piece of gum stuck to the carpet. I couldn’t stop looking at it. My whole body was tense. It didn’t belong there. It was gross. I’d try to focus on the scenery outside my window but for the next ten hours, the gum in the carpet was all I could think about.

As I got older, it was clear that I had medical problems. My immune system wasn’t great, and I missed a lot of school. Years later, it was discovered that I had a heart condition and a degenerative condition that paralyzed areas of my digestive tract. For four years, I basically lived in the hospital. Every time I caught a cold, which happened often with two small children, I was back in the hospital. I realized that, if my body was going to recover, I’d have to stop getting sick so often.

I started carrying a bottle of rubbing alcohol with me everywhere, sprayed my body with bleach in the shower and asked people who were sick to stay away. Pretty soon, my trips to the hospital became less frequent. This sudden improvement in my health provided validation that the rituals I was performing were necessary. Unfortunately, this fed right into the obsessions I had been trying to suppress ever since that car ride in my childhood. My OCD was official.

Grabbing Groceries

With my paranoia at its peak and my health at risk, I started paying more attention to what was going into my body. I’d look around and see someone sneezing straight onto the bin of apples or coughing directly into their hand before reaching for a box of cereal. Suddenly, I was seeing things I had never paid attention to before.

I started noticing articles about mice droppings in grocery warehouses and how they could spread the deadly Hantavirus. I saw a dog peeing onto a crate of soda that had been placed on a sidewalk while being loaded into the store. I began to wonder how I could possibly survive these perceived threats to my health.

For several long months, I tried to ignore these things while feeling utterly powerless — and then disinfectant wipes became a thing. I read a CDC report that suggested wiping down groceries after purchase and started doing just that.

Every time we buy groceries, we dutifully wipe everything down before putting it in our pantry. If we don’t, my OCD tells me that I’ve basically doomed myself to death. It’s a daily challenge.

Going to the Movies

I’m a huge nerd and love everything about nerd culture. When they announced a Star Trek movie reboot, I was incredibly excited, especially because it was going to be right around my birthday. Unfortunately, that was the year H1N1 exploded and, instead of heading to the theater, I stayed safely within my home, unwilling to be surrounded by crowds.

While that year was particularly terrifying, I still tend to avoid going to the movies during cold and flu season. I spend a lot of time weighing whether the film is worth the risk and, if I choose to go, when the safest times would be.

As a result, I see a lot of matinees, heading all the way in the back so that no one can sit behind and breathe on me. If someone nearby seems sick, I move to a different seat silently fuming if I can’t hear the dialogue because someone decided to come out with a cough (seriously, though, stay home — it’s selfish on so many levels). I’ve even left before the end of a movie because my OCD was telling me that I wasn’t safe.

Oh, and there’s zero chance of me snacking on popcorn. It isn’t the healthiest choice, it doesn’t seem sanitary, and I’ve gotten sick every time I’ve given into the craving.

Eating Out

Eating at a restaurant with OCD is a huge, major deal. Typically, I scope out a place and watch from afar before I even consider placing an order. This can including watching for how food is being prepared and whether someone is touching money and then handling orders without cleaning their hands.

Once I trust a place, I work on developing a rapport with the workers in hopes that this means they will treat my food with more respect. Another benefit of being a regular is that I feel more comfortable asking them to do things that make me feel more comfortable. I also don’t hide the fact that I travel with a pump of sanitizer so that I can clean the utensils, appetizer plates and my hands after touching things like a bottle of ketchup.

In order to feel safe, I never want a server to put the straw in my drink since I don’t know where their hands have been and, suddenly, whatever they’ve touched is living in my water. I also don’t want someone putting their dirty hands into a bag before putting my croissant or fresh chips into it — either open the bag in a more sanitary way or clean your hands.

Sometimes, it rubs people the wrong way and I leave with my tail between my legs, embarrassed that my requests were considered ridiculous. Other times, I hit the drive-thru to avoid scanning for problems in an attempt to rely on the “what you don’t know won’t hurt you” mentality. It still makes me nervous, but at least I get to eat.

Cold and Flu Season

As previously mentioned, I avoid going to movie theaters from late October to May but, really, the same applies to restaurants, traveling and anything involving large crowds. That means that, even though I still feel stressed in the summer months, I only really feel some level of freedom from June to September. It’s kind of sad, when you think about it.

Once the sniffling season rolls around, I get the flu shot and buy even more sanitizer than I normally do. Unless I know it won’t be crowded, I skip the mall or the grocery store and if I come in contact with someone who has been coughing or sneezing, I worry about having been contaminated for a full day.

It’s especially difficult to go to the gym, of course. All of the equipment is shared with other people and it’s hard to tell if someone is coughing due to illness or overexertion. Traditionally, I’ve chosen to forego working out but I’ve fallen in love with Orangetheory Fitness. Fortunately, they have members wipe everything down between rotations so that it’s fresh for the next person (I still wipe it down myself, though).

Health Issues Complicate Things

As I explained, back when I suffered a major health crisis, I’d end up in the hospital almost every time I caught a cold. While things aren’t quite as dire, I still don’t recover from even minor illnesses as quickly as most people. The common cold can sideline me for weeks and, unfortunately, one of my six children has inherited some of my medical problems.

On top of this, there are two other things that are frustrating. All the time, I encounter people who tell me I need to do this or that to strengthen my body. Some will argue that getting sick will build my system back up to optimal levels. While this may be true for many people, and I definitely believe in the benefit of a holistic lifestyle, even health gurus get sick — not everything can be cured.

Meanwhile, the fact that my rituals seem to have drastically reduce how often I’m sick reinforces my OCD. This mental illness is already difficult to treat because sufferers believe that giving up the safeguards could cost them their lives. It’s not true for most people but, in my situation, it just might be.

The Future for Me

When I think back to 20 years ago when I’d scrub my body raw with bleach, I’m able to see how far I’ve come. At that time, I couldn’t see how things would ever improve. I spent hours cleaning my fridge with a Q-Tip, mopped my kitchen floor nightly and prayed that I’d never get sick again.

Over time, I’ve developed better coping strategies for getting through my day-to-day struggles. I still think about my OCD a lot but I’ve made progress and that’s all I can ask for. I’m comfortable with where I’m at right now, even though it adds a few extra steps to my day.

My goal is to continue to work toward living a freer, less anxious life without giving in to the feeling that I need to be something that I’m not. I have to love myself exactly as I am in this moment and continue focusing on improving every single day.

How You Can Help

While OCD, as a term, gets thrown around a lot in conversation, it’s really important to understand what it means and how it truly affects people’s lives. I’m not saying you have to stop calling your need for orderly kitchen cabinets “a little obsessive compulsive” but be sensitive about what you’re saying. For a long time, I kept my struggle a secret and people had no idea what I was going through.

Always be compassionate to the person who seems worried about hand-washing or catching the flu. Nothing feels more like a punch in the face than someone laughing and labeling me a “germaphobe.” We all have triggers, so don’t mock someone just because yours are different. This perpetuates a culture where a harmful, unnecessary stigma surrounds mental illness.

Instead of trying to convince someone that they are wrong or worrying over nothing, show them love and support. Respect their boundaries and also try to live a life that’s mindful of other people’s health issues. If you are healthy, be grateful.

Remember that, in addition to OCD, there are plenty of people living with compromised immune systems and other medical problems. Alternately, someone could be preparing for their wedding day or a vacation they’ve saved ten years to take. They don’t need to catch whatever virus you’re fighting just because you can’t be bothered to cover your cough.

At the end of the day, compassion and consideration for others helps us all, no matter what battle we are fighting. If we all spent just a little more time thinking about the needs of those around us, our world would be a better place.

For more information, visit the Anxiety and Depression Association of America. Get informed, get inspired and get in the trenches with your fellow human beings. We need you.

Analysis of a Million-Plus Genomes Points to Blurring Lines Among Brain Disorders

Is lower academic achievement in early life tied to the same gene changes as an increased risk for Alzheimer’s in older age? That is one of dozens of possible deductions to be drawn from the largest genomic study of brain conditions ever conducted, research that obscures what often have been considered clear diagnostic borders.

According to the findings, published June 22 in Science, conditions such as schizophrenia, major depressive disorder (MDD) and bipolar disorder share a suite of overlapping genetic variants rather than having distinct genetic signatures.

In addition to the genetic links between educational attainment and Alzheimer’s risk, the results link neuroticism to anorexia nervosa, anxiety disorders, MDD and obsessive-compulsive disorder (OCD). Neurological disorders like Parkinson’s and multiple sclerosis, however, have few variants in common with each other or with psychiatric conditions.

This mother lode of findings comes after a six-year delving into genomes representing more than a million people, a quest for unusual genetic signals that track with one or more of 42 disorders and traits.

Researchers from 600-plus institutions worldwide, grouped into 25 consortia, pooled their genomic data for the effort, dubbed the “Brainstorm Consortium.” Their goal was to probe the immense data set for links among gene variants, brain disorders and physical and cognitive traits.

And they found many, many links.

“One of the big messages is that psychiatric disorders turned out to be very connected on the genetic level,” says Verneri Anttila, the first author on the paper and a postdoctoral research fellow at the Broad Institute. The implication is that “current diagnostics don’t accurately separate the mechanisms” for the conditions, he says, which might be a factor in explaining the struggle to find new treatments.

But because the study was a “hypothesis-free approach,” as Anttila describes it, showing only statistical associations among genes, not proof of a common genetic basis, the findings are only a starting point for digging deeper “to better understand how these disorders arise,” he says.  

To deliver this treasure trove of starting points, the Brainstorm Consortium applied a statistical method that teases out truly distinct signals from noise in the genome and tracked how those signals—small changes in DNA sequences that represent gene variants—associated with psychiatric and neurological diagnoses of 265,218 patients compared to 784,643 unaffected people.

Then, they looked at how variants that tracked with brain disorders related to educational achievement and physical and cognitive measures. Ultimately, the analysis involved 25 conditions, including MDD, autism, epilepsy, schizophrenia, post-traumatic stress disorder (PTSD) and migraine.

To spice it up a bit, the investigators also looked at 13 behavioral traits, including cognitive and personality measures, and four physical factors—Crohn’s disease, vascular disease, height, and body mass index.

From this brew of inputs, the researchers extracted statistical links between genetic variants and different disorders and identified overlaps across almost all psychiatric conditions they examined. Schizophrenia, anxiety disorder, MDD, bipolar disorder and attention deficit hyperactivity disorder (ADHD) all shared variants. Tourette syndrome, OCD and MDD clustered together, as did anorexia nervosa, schizophrenia and OCD.

Standing out from this crowd at the end of the shared-variant spectrum was schizophrenia, which overlapped with all of the psychiatric disorders except anxiety. PTSD, meanwhile, showed no significant association with any of them.

Although neurological disorders tended to remain distinct, an exception was migraine, which had many variants in common with ADHD, Tourette syndrome and MDD. Migraine also was associated with the personality trait “neuroticism,” which in turn overlapped with several psychiatric conditions, including MDD, OCD and schizophrenia.

Crohn’s disease, intended to represent immune disorders, had no variants in common with any other condition assessed, but vascular disease, stroke and MDD had commonalities.

Some of these associations are surprising, and some are not, says John Hardy, chair of molecular biology of neurological disease at the University College London Institute of Neurology, who was not involved with the study. Hardy calls the study a “reliable and well-organized piece of work.” The overlap among psychiatric diseases isn’t a big shock, he says, because “they share symptoms and can sometimes be confused with each other.”

What stands out for him is a lack of overlap between Alzheimer’s and Parkinson’s, both neurodegenerative conditions. Based on these findings, he says, “they really do seem distinct, which probably means that the mechanisms of cell death are different.”

Anttila mentions a couple of other curveballs. “I was personally surprised by the lack of such correlations between neurological disorders and psychiatric ones,” he says, noting that he would have expected depression, for example, to show overlap with some neurological diseases.

The other unexpected result for Anttila and his colleagues was the link between cognitive factors and the psychiatric and neurological disorders. “Having the genetic variants that predispose someone to Alzheimer’s disease at age 70 to be significantly correlated with those predisposing them towards worse results in school at age 12 was definitely a surprise to us,” he says.

Some of the non-overlapping results were unanticipated, too. Even though about a third of people with autism also have seizures, this probe of genomic information turned up little in the way of common variants between autism and epilepsy. Anttila says that this analysis was “one of the smaller ones” in the work, which might explain the lack of a link.

In fact, having fewer than 10,000 cases in any one of the many analyses in the study could have yielded misleading results because of the small sample size, not because there is no association, says Cathryn Lewis, professor of genetic epidemiology and statistics at King’s College London. Lewis is a member of the U.K.’s Psychiatric Genomics Consortium and contributed samples to the study but was not involved in the analysis.

Another possible explanation for the lack of shared variants between autism and epilepsy is that the study focused on commonly occurring, but not on rare, candidates. “The methods are definitely sound, well-respected, and widely used,” she says, but because they involve looking only at common variants, they won’t capture rare ones.

With dozens of new investigative starting points involving these common variants in-hand, what’s next? “The immediate takeaway from this study is that now that we have identified these connections, we can better understand how these disorders arise,” says Anttila. “There may be some deeper genetic mechanisms at play here [that] predispose individuals to multiple disorders, rather than just a single one.”

Adult Child & Adolescent Psychiatric Services now open in McKinney

Adult Child Adolescent Psychiatric Services, or ACAPS, opened March 1 at 1740 W. Virginia St., Ste. 100, McKinney. Dr. M. Sarfaraz Khan is a Board Certified adult psychiatrist and child and adolescent psychiatrist, according to the company’s website. ACAPS treats adults, children and teens suffering from a variety of psychiatric issues, including anger management, anxiety disorder, behavioral disorder, bipolar disorder, depression, eating disorders, schizophrenia, paranoia, Obsessive Compulsive Disorder, substance abuse, a computerized ADHD program and more. ACAPS also has a location in Plano at 5501 Independence Parkway, Ste. 302. 972- 709-7556. www.acapstx.com

If You Have These 7 Habits, You Might Have High-Functioning Anxiety

Anxiety can affect people in many different ways. Some find that their daily habits are compromised, while others continue to go on with their routine, so much so that they may not even realize they have anxiety disorder. There are a number of habits that can be signs of high-functioning anxiety, and although it might seem fine to just keep going about your business while struggling with the disorder, managing your anxiety is just as important, even if you are still able to check everything off your to-do list.

High-Functioning Anxiety has become [a] … pop-psychology term used by people who experience more than moderate levels of anxiety symptoms, but have either not attempted to seek treatment or have not been properly diagnosed by a mental health professional as having a diagnosable anxiety disorder,” psychotherapist Dr. Gin Love Thompson, Ph.D, M.A., M. Msc, tells Bustle. “The danger here is that just because you are ‘functioning,’ even with a high level of success, while experiencing moderate to high levels of anxiety does not mean it is a healthy state of living. And beyond potentially endangering your health, it is most probably reducing the quality of your daily life, work and relationships.”

Sometimes, it can be hard to decipher between what’s a common amount of anxiety and what could be considered anxiety disorder, especially if you’re managing to continue on with your life. But if you have these seven habits, it’s possible you may have high-functioning anxiety disorder, and may want to speak with a professional.

1You Can’t Sleep

Andrew Zaeh for Bustle

Worrying all the time can lead to physical and mental exhaustion. “These constant racing thoughts, along with the overbooked schedules, lead to another trait: insomnia,” says Dr. Thompson. “This leads to a lessened ability to perform during the day, which makes the entire cycle of anxiety more toxic. The fatigue affects the body and mind.” Although there can be many causes for exhaustion, speak with a doctor or psychologist if you believe anxiety is to blame.

2You Pay Close Attention To Details

Andrew Zaeh for Bustle

“High-functioning anxiety individuals are often extremely detail-oriented,” says Dr. Thompson. “Although this in moderation is a valuable trait, in excess it leads to extreme agitation and is a classic symptom of perfectionism. This can also be a symptom of Obsessive-Compulsive Disorder [OCD] and lead to an unhealthy need to repeat tasks.”

3You Can’t Relax

Hannah Burton/Bustle

If you have high-functioning anxiety, you might find that you can’t relax and that you are often exhausted, as a result. “Your mind doesn’t shut off, and you always feel like you should be doing something,” psychotherapist Kelly Bos, MSW, RSW tells Bustle. “When you do finally stop, it is through distracting or shutting down.”

4You Engage In “Numbing” Behaviors

Hannah Burton/Bustle

When people experience chronic distress, they often have an urge to numb their feelings. “Numbing refers to behaviors that help us dull our emotional experience, but not actually deal with it,” Laurie Sharp-Page MS, LPCC-S, NCC, CWC. “Drinking, eating, shopping, watching TV and sleeping are all examples of coping skills, which when used in excess actually numb us to our emotional experience.” While many of these activities are common to do, take note if you tend to do them in excess when a particularly difficult situation or thought crops up — when engaging in these activities to avoid or mask feelings that could be bothering you, it may considered a “numbing” behavior. If you think you may be doing this, seeking the help of a therapist can help equip you with other tools to cope with your anxiety.

5You Focus On Control

Ashley Batz/Bustle

Since anxiety makes us feel helpless and out of control, many people with high-functioning anxiety disorder engage in habits where they feel like they have the power. “You may try to counter that by focusing on controlling something else, like diet and exercise, cleaning, or achieving career goals,” licensed clinical psychologist Liz Gustafson, Ph.D. tells Bustle.

6You Push Yourself To Your Limits

Ashley Batz/Bustle

“You might push yourself, a little too much,” says Bos. “[People with high-functioning anxiety] are high achievers, but they feel they have to be for acceptance from others and themselves. They are hard on themselves, having difficulty showing themselves self compassion and often criticizing themselves for what they didn’t do.”

7You Plan Everything

Andrew Zaeh for Bustle

If you are someone who is overly early to appointments for fear of being late, while anxious to “get started” on whatever event, appointment, or task awaits, you may have high-functioning anxiety. “You may find it difficult to go with the flow,” says Dr. Thompson. “You may also plan ahead in ways that are beyond being proactive. This leads to wasted time and high levels of stress.”

Some anxiety is common, but if you feel like you are constantly in a state of worry, you might have high-functioning anxiety disorder and could benefit from seeking the help of a loved one or therapist.

Northern Psychiatric Associates

Casey spent his childhood in the Brainerd Lakes Area and has lived in several places since then, including California, Thailand, Malaysia, and Duluth, MN. He moved back to the Brainerd Lakes Area with his wife and child to be closer to family. Casey enjoys spending time with family, reading, traveling, and being outdoors.

His services are covered by most insurances and he is currently accepting new patients.

Northern Psychiatric Associates is a full service mental health clinic that provides psychological and psychiatric services to patients of all ages. More information can be found at www.npamn.com or call 218.454.0090.

Sofia Andres admits having anxiety disorder. Here’s how it can affect anyone

Sofia Andres recently admitted that she’s going to “lie low” for a month to deal with her anxiety issues, hence her withdrawal from the Kapamilya drama-fantaserye, “Bagani.” (Pang-masa/File photo)

Sofia Andres recently shared that she will not appear in showbiz-related projects for a month to deal with her anxiety disorder, raising awareness on how anxiety affects an individual.

The Kapamilya actress previously admitted that she was seeing a therapist for her anxiety.

In May 30, she shared on Twitter: “I have been struggling and don’t know how (I will) prevent it. Started going to a therapist and go counseling for a couple of times.”

“Anxiety is anxiety, we don’t know when is it going to attack you. Yes, I am always worried with everything. Literally everything.”

She also shared a more detailed account on her Instagram, noting that she supports anyone who is facing similar struggles.

Andres has openly admitted that she will “lie low for a month” to deal with her anxiety.

Andres was part of ABS-CBN’s drama-fantasy series “Bagani,” where she played the role of Mayari.

How anxiety disorder affects actors 

According to the Anxiety and Depression Association of America, anxiety disorder can be further broken down:

  • Specific psychiatric disorders that involve extreme fear and worrying; 
  • Generalized anxiety disorder (GAD); 
  • Panic disorder and panic attacks; 
  • Agoraphobia;
  • Social anxiety disorder; 
  • Selective mutism; 
  • Separation anxiety;
  • Other specific phobias 

Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are also closely linked with anxiety disorder. Individuals are most likely to suffer from depression as well.

General symptoms of anxiety disorder include sweating, trembling, feeling nervous or tense all the time, having a sense of danger, increased heartbeat, rapid breathing (hyperventilation), having trouble concentrating and feeling weak and tired, among others.

In her Instagram post, Andres shared that she has been having anxiety attacks and that she has the tendency to overthink and worry all the time.

She added, “These past few days, I haven’t been replying to my friends. The reason behind it is that my brain’s a little messed up sometimes.”

“What that means in the simplest possible terms, is that a lot of time I feel very, very low. (I) think about bad thoughts and just spend time in bed.”

Andres shared through her social media accounts that she is prone to overthink and feel “very, very low.” Research indicates that anxiety is closely linked with depression. (Pang-masa/File photo)

Drama therapist and actress Leith Taylor noted that acting can place a “mental strain on performers,” saying that they can suffer from performance anxiety and high levels of stress.

“Research over many years has acknowledged that those drawn to working in the arts tend to be highly vulnerable to depression and anxiety,” Taylor said.

She noted that it could be attributed to the fact that actors are supposed to feel “deep emotions” whenever they are playing a certain role and how they can identify themselves with the character.

“Actors frequently tap into their personal histories to evoke the emotions required to play a role. This can be traumatic if it triggers deep issues or elicits difficult experiences and memories,” Taylor said.

Andres has previously shared that she was bullied in school, with classmates calling her “mayabang.” This made her fear rejection, in turn making her feel inadequate and suffer anxiety. She also admitted that she was looked down as a “starlet.”

3 Questions To Ask Your Partner To Help Them Understand Your Anxiety, According To An Expert

Dealing with anxiety on your own can be challenging. And often, having a supportive partner around to help you through it can be a real source of strength. But occasionally, you might find that your new love is amazingly rad, thinks you’re cool, too, and also seems not to know very much about anxiety at all — or, worse, has some beliefs about mental health that aren’t based in fact, or are even stigmatizing. Many people simply don’t have a vocabulary around mental health, thanks to decades of stigma, and unfortunately, sometimes it’s up to those of us with mental illness to help people who don’t understand, well, get it. If you aren’t sure about how to start a discussion about mental health, it can help to ask your partner questions to help them understand your anxiety through some serious empathy.

Anxiety disorders come in many forms, from generalized anxiety to PTSD and obsessive-compulsive disorder, and there are many preconceptions about each — preconceptions that can be broken down with a little bit of empathy. And of course, if your partner isn’t willing to try to empathize with you about your mental health, then, heck, that’s a sign they probably won’t empathize about much else, either (and yes, that’s a red flag). You’re in this as a team, after all.

If you’re in need of a general framework to start the conversation, counselor Heidi McBain suggests these three questions as ways to help your partner get a bigger, more accurate picture of anxiety and how it impacts your life. Here are three things to ask your partner if you want them to better understand your mental health.

2.“Do You Know The Difference Between Anxiety And Stress?”

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“The term anxiety gets used in society a lot of today to simply mean “worried” or “stressed”,” says McBain. “But a true anxiety diagnosis goes so much deeper than this.” And that’s an important thing to discuss. Sometimes terminology can be misleading. Feeling worried about something isn’t the same as having anxiety about it, and anxiety disorders aren’t just slightly more intense concern. Understanding this difference can help your partner avoid trivializing your anxiety, and understand when you need help.

3.“What Do You Notice About Anxiety In My Life?”

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Anxiety, McBain says, “is pervasive in the person’s life, and if left untreated, can be debilitating in that people change their behavior and where they go, who they see, how they act, etc. In extreme cases, people may even stop leaving their house and interacting with others.” If your partner has noticed this behavior, helping them understand that it’s a product of anxiety may clear some things up for them; if they haven’t noticed anything, this may nudge them to make some connections.

Once your new partner has got a clear picture of what your anxiety is, this is a chance for them to articulate how it affects them and what they’ve noticed about your mood. And then you can start working, together, on how to help manage your anxiety, improve awareness of it, and facilitate your treatment.

The problem with wanting to seem perfect



The news of celebrated designer Kate Spade’s death by suicide last week was shocking.

The “Kate Spade brand” was known for its cheery, sweet, sunshiny colors and ease, and whenever Spade was out in public, whether alone or with her husband and business partner, Andy, she projected that same image. Buoyant, smiling, impeccably put together, perfect.

“She made us feel that the perfect life was eminently achievable,” Guardian columnist Hadley Freeman writes.

Who doesn’t want to have a perfect life?

Perhaps we should reconsider.

Now, of course, we heartachingly know that Spade’s life was anything but perfect. Her husband admits that they had been living apart for the past 10 months, and that she had been battling mental illness and anxiety for the past few years; her older sister says Spade was “definitely worried about what people would say if they found out” about her struggles.

So she kept them to herself. Cue the perfection.

Spade had evidently been deeply affected by the suicide of Marin’s Robin Williams in 2014. Williams, too, we find out from Dave Itzkoff’s new biography, “Robin,” kept much of his struggles to himself.

By all appearances, Spade was a woman who had it all, a life many of us would consider enviable — balancing a successful family-friendly business with being a wife and mom, and a loving, supportive equal partner. But appearances are deceptive.

Just look on Instagram, Pinterest and Facebook, where many of us are guilty of presenting a super-curated image of our lives that generally just shows our best moments, never the full spectrum of what’s going on — the joys, the pains, the hardships, the ambivalence, the fears and the grief along with the transcendent moments.

Researchers say it’s taking a toll on all of us. A recent study found that, between 1989 to 2016, there’s been a huge jump in perfectionism among recent undergraduates here and abroad, as well as an increasing need to “measure up” to peers and more harsh judgments of them — a trend the researchers called “worrying.”

It is worrisome. A friend’s 30-something daughter, a mom of two, shared that some of her friends can’t be on Instagram on Mother’s Day because they’ll compare their “special day” to how other moms spent it or the gifts they got, causing spousal conflict, envy and sadness instead of feeling joy for their friends’ good fortunes.

Perfectionistic leanings have been linked to a veritable laundry list of health problems, from depression to anxiety, obsessive compulsive disorder to eating disorders to suicide. At a QA after a recent San Rafael screening of “Angst: Raising Awareness Around Anxiety,” a documentary co-produced by Marin filmmaker Karin Gornick that features numerous Marin kids living with anxiety disorders, Gornick said many teens in the audience said they wished their parents knew just how much pressure they feel to be “perfect.”

That’s OK, kids; your parents are feeling the same pressure.

There’s a veneer of perfectionism in Marin — the perfect kids, the perfect homes, the perfect bodies, the perfect car, the perfect stuff. “There is kind of a self-delusional myth that I find that people have here, that everything is perfect and everything’s great and they live in a bubble,” Rebecca Foust, Marin’s former poet laureate told me when she published her award-winning book “Paradise Drive.” Foust had been rattled by the suicides of three Marin women, one of whom she knew, within a short span. “It’s very easy to live in a bubble and not see the rest of the world. I wanted to puncture that bubble and set it straight.”

Just a few days after Spade’s death came the suicide of celebrated chef, author and television personality Anthony Bourdain, a man who was transparent about his flaws and demons, but who seemingly had a insatiable lust for life. So many of us wanted his adventurous, high-energy life; it seemed so perfect.

No life is perfect. Puncturing the bubble sounds about right.

Vicki Larson’s So It Goes runs every other week. Contact her at vlarson@marinij.com and follow her on Twitter at OMG Chronicles

How to talk to someone who is struggling with depression

When someone is struggling with depression, even daily tasks can feel insurmountable. But there are steps you can take to help a loved one.

Fashion designer Kate Spade was found dead in her New York apartment on Tuesday, after an apparent suicide. Before her death, Spade, 55, suffered from depression, but had not received treatment, according to her sister, who spoke with the Kansas City Star.

However, her husband, Andy Spade, said in a statement that she was “actively seeking help and working closely with her doctors to treat her disease.” She suffered from anxiety and depression, he said, and was taking medication.

“We were in touch with her the night before and she sounded happy,” he said. “There was no indication and no warning that she would do this. It was a complete shock. And it clearly wasn’t her. There were personal demons she was battling.”

He added, “She was actively seeking help for depression and anxiety over the last 5 years, seeing a doctor on a regular basis and taking medication for both depression and anxiety. There was no substance or alcohol abuse.”

Spade is not alone. More than 16 million American adults, or 6.7% of the adult population, have experienced at least one major depressive episode in the last year, according to the Anxiety and Depression Association of America.

“There is hope and there is recovery,” said Dan Reidenberg, the executive director of Suicide Awareness Voices of Education, a nonprofit based in Minnesota. “Treatment does work. By far, most people who experience depression live and function successfully and go about their lives.”

Major depression — defined as a mood disorder that causes a persistent feeling of sadness and loss of interest — is more common in women than in men, and the median age of onset is 32.5 years old, although it can occur at any age, the ADAA said.

Other causes of suicide

Some 37% of adults with major depressive episodes do not receive any treatment at all. More adults suffer from other types of mental illnesses, including anxiety disorders and obsessive compulsive disorder, which can also make life difficult without treatment.

Some people hide their depression from others, making it very hard to detect. What’s more, depression and suicidality aren’t always linked, Winston said. “There are people who die of suicide where there’s no evidence they were previously depressed, or no one can find evidence they were depressed,” she said.

Or, someone may die of suicide because they feel immense shame, or they have been diagnosed with a terminal illness, she said. “It’s not always depression.”

What to look out for

Feelings of emptiness, hopelessness and guilt are common for those experiencing depression. It helps to know the signs, recognize them and then encourage treatment, according to the Mayo Clinic, a nonprofit academic medical center based in Rochester, Minn.

Common symptoms of depression include feelings of sadness, tearfulness, loss of interest or pleasure in activities. But symptoms also include tiredness, or even sleeping too much, feelings of worthlessness or guilt, changes in appetite and unexplained physical problems.

In some people, especially children and teens, depression may show up as irritability or crankiness rather than sadness. That symptom is often misunderstood, said Sally Winston, co-director of the Anxiety and Stress Disorders Institute of Maryland. Friends and family members may “get mad at them because they’re not their usual self,” she said.

Those at risk might actually talk about suicide or watch television shows and movies about it, or read books or online articles about it, Reidenberg said. He or she may mention death, suicidal thoughts or make statements like “I wish I hadn’t been born,” or, “I feel like I have no future,” or, “I feel hopeless.”

If you think someone is suffering, “ask them directly and clearly,” Reidenberg said. Withdrawing from social contact and wanting to be left alone, increasing use of alcohol or drugs, saying they feel trapped or hopeless and giving away belongings or getting affairs in order can also be signs.

How to offer help

One of the best ways to help: Assist in setting up a doctor’s appointment for someone who is struggling — including helping finding someone who accepts their insurance, if possible. Go with them if needed, help with transportation and continue to follow up, the Mayo Clinic says.

Prepare a list of questions to ask the doctor or mental health provider. Think about a team of loved ones who can reach out to the person at risk at different times, and at different ways. It may be just as uplifting to hear from a friend who lives far away as it is to hear from a close confidante.

Finances should not be a barrier, Reidenberg said. Even for someone who is uninsured, there are free resources, including suicide hotlines and texting lines, and mental health professionals who allow patients to pay on a sliding scale. That scale may even go down to zero, he said.

The nonprofit organization United Way is another affordable mental-health resource, he said. The emergency room is another option if needed, because patients can go there for an evaluation and be treated, even without showing proof of insurance.

When to intervene

The days following a high-profile death may be an even more important time to do this: Exposure to someone else who has died by suicide, even if that person is a celebrity, is one of the risk factors for suicide and can lead to copycat suicides, according to the NIMH.

Someone who is already considering suicide might be more at risk after Spade’s death. In fact, after actor Robin Williams died of suicide, there was a 10% increase in suicides in the U.S., with a particular uptick among people ages 30 to 44, according to researchers at Columbia University.

“They start to identify with the person who has died,” Reidenberg said. “They might think, ‘Here is someone who had fame and fortune and access to good care and was married and had a child. If she can’t make it, how can I make it?’ But you can lead a functioning, successful life.”

How to talk about it

Broach the subject carefully. Ask directly if your friend or loved one has considered suicide, Reidenberg said. Research suggests that talking to someone about suicide isn’t going to lead them to taking their life, nor will it put the thought into their head, he said.

“If they are, in fact, really thinking about it, talking might give them a sense of relief,” he added. “Then, you can form a connection, which will be helpful in getting them the help they need.” It also allows you to let family members and friends know what’s going on.

Make sure the person is supervised and in a safe environment and eliminate anything that they might use to harm themselves, such as weapons. Call a suicide hotline, like the National Suicide Prevention Lifeline at 1-800-273-8255. And, if there is immediate danger, call 911.

Maria LaMagna covers personal finance for MarketWatch in New York.

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