Mental Illness Comes In Many Forms

Anxiety disorders: People with anxiety disorders respond to certain objects or situations with fear and dread, as well as with physical signs of anxiety or panic, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if the person’s response is not appropriate for the situation, if the person cannot control the response, or if the anxiety interferes with normal functioning. Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias.

Mood disorders: These disorders, also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common mood disorders are depression, bipolar disorder, and cyclothymic disorder.

Psychotic disorders: Psychotic disorders involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations — the experience of images or sounds that are not real, such as hearing voices — and delusions, which are false fixed beliefs that the ill person accepts as true, despite evidence to the contrary. Schizophrenia is an example of a psychotic disorder.

Eating disorders: Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the most common eating disorders.

Impulse control and addiction disorders: People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders. Alcohol and drug are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships.

Personality disorders: People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school, or social relationships. In addition, the person’s patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the person’s normal functioning. Examples include antisocial personality disorder, obsessive-compulsive personality disorder, and paranoid personality disorder.

Obsessive-compulsive disorder (OCD): People with OCD are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands.

Post-traumatic stress disorder (PTSD): PTSD is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event, and tend to be emotionally numb.

Other diseases or conditions, including various sleep-related problems and many forms of dementia, including Alzheimer’s disease, are sometimes classified as mental illnesses, because they involve the brain.

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Other, less common types of mental illnesses include:

Stress response syndromes (formerly called adjustment disorders): Stress response syndromes occur when a person develops emotional or behavioral symptoms in response to a stressful event or situation. The stressors may include natural disasters, such as an earthquake or tornado; events or crises, such as a car accident or the diagnosis of a major illness; or interpersonal problems, such as a divorce, death of a loved one, loss of a job, or a problem with substance abuse. Stress response syndromes usually begin within three months of the event or situation and ends within six months after the stressor stops or is eliminated.

Dissociative disorders: People with these disorders suffer severe disturbances or changes in memory, consciousness, identity, and general awareness of themselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents, or disasters that may be experienced or witnessed by the individual. Dissociative identity disorder, formerly called multiple personality disorder, or “split personality,” and depersonalization disorder are examples of dissociative disorders.

Factitious disorders: Factitious disorders are conditions in which a person knowingly and intentionally creates or complains of physical and/or emotional symptoms in order to place the individual in the role of a patient or a person in need of help.

Sexual and gender disorders: These include disorders that affect sexual desire, performance, and behavior. Sexual dysfunction, gender identity disorder, and the paraphilias are examples of sexual and gender disorders.

Somatic symptom disorders: A person with a somatic symptom disorder, formerly known as a psychosomatic disorder or somatoform disorder, experiences physical symptoms of an illness or of pain with an excessive and disproportionate level of distress, regardless of whether or not a doctor can find a medical cause for the symptoms.

Tic disorders: People with tic disorders make sounds or display nonpurposeful body movements that are repeated, quick, sudden, and/or uncontrollable. (Sounds that are made involuntarily are called vocal tics.) Tourette’s syndrome is an example of a tic disorder.

Other diseases or conditions, including various sleep-related problems and many forms of dementia, including Alzheimer’s disease, are sometimes classified as mental illnesses, because they involve the brain.


Contact Johann Calhoun at or call at (215) 893-5739

Is sex addiction a real condition?

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The American author Mark Twain is often, possibly apocryphally, quoted as saying that quitting smoking was easy – he’d done it 100 times. The writer later died of lung cancer.

As a society we accept the existence of addictions to substances, such as nicotine, alcohol and other drugs – and the harm they can cause. But when it comes to sex, some experts still disagree over whether addiction is real or a myth.

Sex addiction is currently not a clinical diagnosis, which means we don’t have official figures on how many people have sought help for related concerns through the NHS.

A self-help website for people who feel they are struggling with sex or porn addiction surveyed 21,000 people in the UK who have visited the site for help since 2013.

Of these, 91% were male and only 10% had sought help from a GP.

  • ‘Having sex five times a day wasn’t enough’
  • Scientists probe ‘sex addict’ brains

Sex addiction was considered for inclusion in the latest 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a key diagnostic tool in both the US and the UK, but was rejected because of lack of evidence.

But “compulsive sexual behaviour” is now being proposed as an entry in the International Classification of Disease (ICD) manual produced by the World Health Organization.

Gambling was previously considered in the category of compulsive behaviours, but was given formal diagnostic status as an addiction in 2013, along with binge-eating disorder, after new evidence emerged.

Therapists believe sex addiction could follow a similar route.

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Science Photo Library

Image caption

Researchers found watching porn activated the same reward pathways in the brain as those activated by taking drugs.

A study published in 2014 suggested brain activity in “sex addicts” watching porn is similar to that of drug addicts when shown their drug of choice.

At the time, its lead researcher Dr Valerie Voon, from the University of Cambridge, told the BBC: “This is the first study to look at people suffering from these disorders and look at their brain activity, but I don’t think we understand enough right now to say it is clearly an addiction.”

Whether you believe someone can be addicted to sex will depend largely on what you think makes something an addiction – and there’s no one officially accepted definition.

If it’s purely something on which someone becomes physiologically reliant – that withdrawing from would cause physical harm – then sex “can’t be an addiction,” according to Dr Frederick Toates, an emeritus professor at the Open University.

But he believes a broader definition is more useful.


Dr Toates says there are two key features that mark out an addiction: the seeking of reward or pleasure, and the existence of conflict around this behaviour. The seeking of reward is what many experts believe distinguishes addiction from obsessive compulsive behaviour, although there are striking similarities.

People with an addiction are seeking a short-term gain, even if this may be outweighed by the long-term loss. In contrast, people with obsessive compulsive disorder engage in behaviours from which they derive no pleasure, he says.

But we all seek out pleasure, so what separates regular reward-seeking behaviour from addiction?

Psychologist Dr Harriet Garrod thinks a behaviour becomes an addiction when it reaches a level of intensity such that it causes harm to the individual and those around them.

Addictions to food and gambling have been recognised as diagnosable conditions while sex addiction hasn’t, because they have been in the public consciousness for longer, she says.

This means more people have come forward seeking clinical help, providing more evidence to support their existence as a condition, according to Dr Garrod.

Media captionRebecca Barker said sex addiction took over her life and ruined her relationship

Dr Abigael San is a clinical psychologist who believes that sexual behaviours could be addictive, but for people struggling with feeling out of control, the sex itself is secondary to the underlying problems – whether that’s depression, anxiety or trauma – that leads them to use it as a coping mechanism.

“Different activities and substances activate reward pathways in different ways but they still activate those reward pathways,” she says.

“There’s no reason to believe sex doesn’t work in the same way – it’s just we don’t have enough evidence for it yet.”

But she’s not convinced labelling it as an addiction would necessarily help people, especially those using sex to cope with other issues – and it could lead to over-diagnosis.

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Sex addiction ‘myth’?

Not everyone agrees that sex addiction is a real condition, however.

David Ley, a sex therapist who wrote The Myth of Sex Addiction, says behaviours commonly labelled as sex addiction are in fact the symptoms of untreated mood and anxiety disorders and that evidence for its treatment was lacking.

“Equating sex or masturbation to alcohol and drugs is ludicrous. People addicted to alcohol can die from withdrawal,” he said.

He adds that “the concepts of sex addiction are based on moral values of what healthy sex is”.

“You’re a sex addict if you have more sex, or different sex, than the therapist diagnosing you.”

In a research paper on the inclusion of compulsive sexual behaviour in the next edition of the International Classification of Disease, a group of researchers, including Dr Voon, is keen to avoid this trap.

They say the diagnosis should not be used “to describe high levels of sexual interest and behaviour” or based on “psychological distress related to moral judgments or disapproval about sexual impulses”.

But for them, and others who want the condition to be formally recognised, having a clinical label is about ensuring people in distress can receive help – whether the addictive behaviour is the problem in itself or the symptom of another deeper issue.

6 Signs of OCD—Because There’s More to It Than Constant Hand-Washing

For most people, there will be times where we’ll get angry or upset and might have a fleeting image of hurting ourselves or hurting the person who caused that emotion. But for the majority of us, we see these thoughts as just that: thoughts. We recognize them as being fleeting and unrepresentative of our character, and we don’t have the urge to actually do the harm we imagine. For people with OCD, they worry that they might actually act on those thoughts.

These are called aggressive compulsions. They can present as you thinking about jumping in front of a subway train or out of a window, for example. Or, you might think about pushing someone else in front of that subway train or out of that window.

“One of the things that’s important to understand with OCD is it knows just what to exploit in the particular individual,” says Carrie Holl, PsyD, a Washington, DC-based clinical psychologist who specializes in OCD treatment. So for someone who’s normally gentle, OCD might present itself in aggressive thoughts, which causes incredible distress for that person.

“It’s like if you’re on a bike, if you start pedaling, it moves the bike along,” says Holl. “Compulsions are what keep the OCD moving along.”

What Is Obsessive-Compulsive Disorder? Camila Cabello Talks Living With Condition

Singer Camila Cabello opened up Monday about how she’s managed to live life with obsessive-compulsive disorder.

“OCD is weird. I laugh about it now,” Cabello, 21, exclusively told Cosmopolitan UK.  “Everybody has different ways of handling stress. For me, if I get really stressed thinking about something, I’ll start to have the same thought over and over again, and no matter how many times I get to the resolution, I feel like something bad is about to happen if I don’t keep thinking about it.”

OCD is an anxiety disorder that causes sufferers to experience excessive thoughts (obsessions), which lead the person to engage in repetitive behaviors (compulsions). It affects 2.2 million adults—or one percent—of the U.S. population, according to the Anxiety and Depression Association of America (ADAA). On average, an individual will first experience OCD symptoms at 19, but nearly 25 percent of sufferers first encounter the disorder at 14. 

“What’s really important for people with OCD is that they know that they have an illness and the thoughts that they’re having are not their own wishes,” Helen Blair Simpson, M.D., Ph.D. and vice chair for research and professor of psychiatry at Columbia University, told Newsweek. “OCD has many different flavors…and there are different treatments.”


“One way you handle it is by knowing and being able to name it when you have the OCD thought or you have the OCD behavior. You’re able to say, ‘That’s my OCD talking,'” Simpson added.

The International OCD Foundation said affected individuals encounter excessive thoughts over contamination, perfectionism, harm, sex, religion and loss of control, among other areas. Famed aviator Howard Hughes battled a phobia of germs that progressed throughout his life, for instance. Hughes subsequently acquired obsessive-compulsive symptoms to prevent him from encountering germs, including requiring his staffers to wash their hands several times and cover them before serving him meals, according to the American Psychological Association (APA).    

OCD is a treatable and manageable condition. Patients with the disorder can use medication, therapy or a combination of both remedies, according to the National Institute of Mental Health (NIMH).

“OCD is one of those illnesses where if you’re alone [and] you’re not talking to people, it’ll just fill the space,” Simpson told Newsweek. “Having a social network and people around you to help you is also really important…People who love what they do and get focused on what they’re doing, they [patients] tell me that’s when they can push the OCD away the easiest.”

While Cabello didn’t reveal her treatment process, the singer says she’s doing “much better.”

“I feel so much more in control of it now,” Cabello told Cosmopolitan UK. “To the point where I’m just like, ‘Aha! OK, this is just my OCD.’ I’ll ask my mom a question for the fourth time, and she’ll be like, ‘That’s OCD. You’ve got to let it go.'”

Since leaving Fifth Harmony in December 2016, Cabello has achieved major success with Camila, her debut solo album. After its January release, Camila topped the iTunes albums charts in more than 100 countries. The critically acclaimed album also debuted number one on Billboard’s Top 200 Albums list.

Cabello is set to join singer Charli XCX in opening up for Taylor Swift on her forthcoming Reputation Stadium Tour May 8.

“It’s a dream come true. When I first met her four years ago, I was like, ‘I really love you,'” Cabello told Entertainment Tonight in March. “I was like, ‘Man, I really look up to you. You really inspire me.’ She was one of the people that made me wanna start songwriting, so it’s really amazing.”

Camila cabello Singer Camila Cabello opened up about battle with obsessive-compulsive disorder. Here, Cabello is pictured performing on stage during her “Never Be the Same Tour” at Orpheum on April 9 in Vancouver, Canada. Andrew Chin/Getty Images

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These New Dads Love Their Babies. So Why Can’t They Stop Thinking About Hurting Them?

  • While most people think of postpartum mood disorders as a women’s issue, nearly 10 percent of men have postpartum anxiety (PPA) or postpartum depression (PPD)
  • Obsessive-compulsive disorder, or OCD, is a common form of postpartum anxiety
  • For parents, postpartum OCD can manifest itself in terrifying, intrusive thoughts about being violent or even sexually abusive toward their own children
  • Parents with postpartum OCD are not at risk of acting on those thoughts, but that doesn’t change how difficult it is for men to live with them

    Most new dads know how tough it is to get a baby to fall asleep. Usually, when they finally start to nod off, it’s cause for celebration. But when Ashley Curry’s first child was born, bedtime was nothing less than terrifying.

    “I’d get up to make sure that the blankets hadn’t gone across the baby’s face once, then go back to bed,” Curry, now 49, recalls. “Then I’d go back and check again, then again. Then I’d just spend most of the night checking.”

    Curry’s normal parental concern became a profound, constant terror. He would insist on bathing the baby himself, in case his wife “drowned him accidentally.” He constantly wondered whether he was his child’s biological father, even though he trusted his wife completely and had no reason to suspect otherwise. Worst of all, he’d spend hours obsessing over the possibility that he had inadvertently physically or sexually abused his son — even though the idea of hurting his child in any way was abhorrent to him.

    For years, Ashley struggled with these thoughts alone, without seeking counseling or treatment. When his daughter was born a few years later, his symptoms worsened. He started having severe panic attacks. He couldn’t sleep. He lost more than 25 pounds. “I was really, really unwell,” he says.

    Convinced he was on the verge of a nervous breakdown, Curry went to the emergency room. When he told doctors his symptoms started after his first child was born, he was retroactively diagnosed with postpartum Obsessive Compulsive Disorder (OCD), a form of OCD that affects new parents. It most often manifests itself in intrusive, disturbing thoughts about the baby — even though the parent has no desire whatsoever to act on those thoughts.

    Curry was relieved. He had struggled with these terrifying thoughts for so long without knowing why, or telling anyone about them. “Knowing what was wrong was half the battle for me,” he says.

    Most people have disturbing thoughts from time to time. The most common example cited by OCD scholars is someone standing in front of a subway platform and suddenly thinking, “What if I just pushed the man next to me in front of the train?” But most people tend to forget about these intrusive thoughts, the images drifting out of their brains just as quickly as they entered them.

    For people with OCD, however, such violent intrusive thoughts are more than fleeting. They are constant, unrelenting, and often extremely disturbing. While most people would just laugh off the sudden urge to commit a violent crime on a subway platform, dismissing it as a brain fart, someone with OCD could comb their memory for hours afterwards to “check” that they didn’t act on that thought, then go back to the station later to look for evidence.

    Approximately one in 10 new dads has PPA or PPD.

    When people exhibit OCD symptoms after becoming a parent, it’s known as postpartum OCD. Postpartum OCD falls under the umbrella of postpartum anxiety (PPA), one of many mental health issues that can afflict new parents.

    Postpartum mental health issues are relatively common among new moms: according to the American Psychological Association, approximately one in seven women struggle with postpartum depression (PPD) or PPA, and celebrities like Hayden Panettiere and Chrissy Teigen have spoken openly about their struggles with the condition. But we don’t often hear about new dads struggling with postpartum mental health issues — even though one study estimates that approximately one in 10 new dads has PPA or PPD.

    “When we think postpartum, we think of moms and we assume it’s a result of pregnancy hormones,” says Dr. Jonathan Abramowitz, a clinical psychologist and professor at UNC Chapel Hill who studies anxiety disorders, including postpartum OCD. “[But they are] often related to this huge increase in responsibility that comes with having a baby.”

    Abramowitz has been studying postpartum OCD for years. In fact, it was his own intrusive thoughts after his first child was born that prompted him to study postpartum OCD in the first place.

    “One night, I got up when the kid was a week old,” he recalls. “I’m feeding her, it’s like 2:00 in the morning and my wife is asleep. I’m patting the baby on the back and I’m thinking, ‘Oh, my god, what’s stopping me from beating the shit out of this kid?’” When Dr. Abramowitz spoke to a colleague who was also a new parent, he was surprised to find that she too had experienced thoughts about driving a pencil into her baby’s soft spot.

    In 2007, Abramowitz authored a study assessing whether new parenthood was a risk factor for OCD. Shockingly, he found that 60 to 90 percent of new parents had experienced such intrusive thoughts. “We found that almost everybody reports having unwanted thoughts about a newborn baby, because they look so vulnerable and they’re so cherished,” he said.

    Of course, not every parent who experiences such thoughts has postpartum OCD. It’s the frequency and intensity of the thoughts that differentiates normal behavior from postpartum OCD, as well as engaging in compulsions, or “safety” behaviors, that serve to alleviate their anxiety — for instance, checking their child over and over again for signs of harm, as Curry did.

    People with postpartum OCD might also try to avoid their children, causing them to “not change diapers or not spend time with the baby,” says Dr. Carolyn Rodriguez, assistant professor of psychiatry and behavioral sciences at Stanford University. They also might try to over-correct by spending all of their time with the baby, fearing that someone else might hurt them.

    “I became very protective of the baby, so I took over quite a bit,” Curry says. “People would say, ‘Oh, he’s a fantastic father!’ But actually, I was being over-responsible.”

    It’s also not uncommon for new dads with postpartum OCD to obsess over the prospect of sexually abusing their children, even though the thought of causing them harm is anathema to them. “I worked with a dad who was afraid to be left alone with his baby: ‘What if I molest the baby? What if I touch the baby on the genitals when my wife isn’t around to stop me?’,” Abramowitz says.

    But it’s crucial to note that however dark their thoughts may be, men with postpartum OCD are not at risk of acting on them. “These intrusive images are unwanted, so they cause a lot of distress,” says Rodriguez. “They go against what they actually feel in their heart.”

    In this sense, postpartum OCD is very different from postpartum psychosis, a rare and severe postpartum condition that causes new parents to suffer from delusions that compel them to harm their babies. (The condition allegedly caused a 32-year-old new mom in St. Louis, Mo. to kill her newborn daughter and husband before taking her own life last month.) “People [with psychosis] don’t recognize that their thoughts are actually harmful,” explains Rodriguez. By contrast, people with OCD are fully aware of the disturbing nature of their thoughts, which only makes them feel even more guilty for having them.

    It’s also crucial to note that while people with a history of anxiety or depression may be at increased risk, anyone can develop a postpartum mood disorder, regardless of their mental health history. Before becoming a father, Curry had never been diagnosed with a mental illness, though he had occasionally struggled with intrusive thoughts. After becoming a parent, however, these thoughts became constant and unmanageable. He constantly checked his children for injuries, frequently asking other people if they looked “normal.”

    “The images flash up and it’s like they’re actually real memories, so you have this urge to keep going over and over them and work out whether you have done these things or not, but you can’t get a solution,” he explains. “It’s like playing Whack-A-Mole: you knock one down and another one pops up.”

    “You sort of have this man thing that you’re supposed to be the strong person. So you just carry on as best as you can.”

    “You have this man thing that you’re supposed to be the strong person. So you just carry on as best you can.”

    Of course, when new fathers have troubling thoughts — especially thoughts about sexually abusing their own children —, they may fear being judged or deemed a threat to their children’s safety. This fear of judgment, combined with the societal pressure on fathers to appear masculine and “strong,” leads many men with postpartum OCD to suffer in silence.

    But ignoring the symptoms of OCD just isn’t an option, says Fred Penzel, PhD, a psychologist with 35 years of experience treating OCD. “You’re not going to wake up one morning and find that it’s gone away,” he told “This is a chronic problem that requires serious treatment.”

    According to Penzel and Abramowitz, the best way for dads to make sure they get the help they need is to contact a therapist who specialises in OCD (the International OCD Foundation keeps a list of OCD specialists).

    The most common form of treatment for postpartum OCD patients is exposure and response prevention (ERP), in which patients rank the things that scare them (for example, holding their baby, or changing their baby’s diaper) from least to most distressing. They gradually work through the list, performing each action with the support of a therapist.

    ERP is not a cure for OCD, nor does it get rid of the intrusive thoughts entirely. The point is to prove to patients that they are not at risk of harming their children, says Penzel. “We get people to read stories about people who harm their children as a way of confronting their thoughts,” Dr Penzel explains. “We try to list all of the things that can set a person’s anxiety off. It’s all about building tolerance.”

    Following Curry’s trip to the emergency room, he underwent nine months of ERP to treat his OCD. He emerged from the treatment symptom-free. “Eventually, life got back to normal again,” he says.

    But he urges new dads grappling with these thoughts to seek treatment immediately. “You sort of have this man thing that you’re supposed to be the strong person,” he adds. “So you just carry on as best as you can. But really, until you get help, you’re just going down a slippery slope.”

    For OCD support and advice, contact the International OCD Foundation. If you or someone you know is having suicidal thoughts, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Mental Health First Aid Training Offered in Westfield May 15 and …

Caring Contact, a crisis hotline that serves Northern and Central New Jersey, will be offering Mental Health First Aid Training in Westfield May 15 and May 22. Attendees will learn the risk factors, warning signs and symptoms for a range of mental health problems and what to do when they encounter a person in mental health crisis.

The training is ideal for first responders, educators, clergy, leaders of community groups and business professionals as well as for families with loved ones suffering from mental illness or mental health issues.

The eight-hour course is being offered in two four-hour sessions, Tuesday, May 15 and Tuesday, May 22 from 6 p.m. to 10 p.m. at  the Presbyterian Church of Westfield located at 140 Mountain Avenue.

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The value for the course is $150. Caring Contact is offering the training for just $75. To learn more or register, visit or call 908-301-1899.

According to the National Institute of Mental Health, one in four Americans experience some form of diagnosable mental disorder in a given year. Mental illnesses include depression, bipolar disorder, generalized anxiety disorder, panic attacks, obsessive-compulsive disorder, post-traumatic stress syndrome, schizophrenia and substance abuse addictions.

“Too often we think mental illness applies only to those with serious issues, for example someone who is exhibiting easily recognizable symptoms or someone under a physician’s care,” said Janet Sarkos, Caring Contact executive director. “But people experiencing mental health issues are all around us, perhaps among our friends and neighbors, co-workers, classmates or even within our own family. Yet too many of us are not trained to recognize the signs and offer help. This training enables you to do that.”

Mental Health First Aid is listed on the National Suicide Prevention Registry of Evidence-Based Programs. Successful completion of the course includes a three-year Mental Health First Aid Certification.

Caring Contact is an award-winning, volunteer-staffed crisis hotline and listening community serving North and Central New Jersey, an area with 3 million inhabitants in Union, Essex, Middlesex, Morris and Somerset counties. More than 100 listeners attentively and compassionately serve those in emotional distress and educate communities about the power of personal connection. Caring Contact responded to more than 10,200 calls in 2017.

Caring Contact is a member agency of the National Suicide Prevention Lifeline network and its hotline services are available to anyone, anonymously and confidentially.

About Caring Contact

Caring Contact is an award-winning, volunteer-staffed caring and crisis hotline providing active listening support and best-in-class education to the Central and Northern New Jersey community. We attentively and compassionately serve those in emotional distress and educate our communities about the power of personal connection. We are affiliated with CONTACT USA, the National Suicide Prevention Lifeline and the American Association of Suicidology. If you are in crisis and need someone to listen, call us at 908-232-2880.To learn more, visit


Michigan considering expanding conditions covered under medical marijuana law

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(WXYZ) – The State of Michigan’s Department of Licensing and Regulatory Affairs and the Bureau of Medical Marihuana Regulation has opened public comment on a number of medical conditions and treatments that are being considered for addition to the state’s medical marijuana policy.

Public comment will remain open and can be emailed up to 5:00 p.m. on May 3, 2018. You must put “Medical Marihuana Review Panel” in the subject line.

The conditions under consideration are: Anxiety, Depression, Obsessive Compulsive Disorder, Panic attacks, Schizophrenia, Social Anxiety Disorder, Arthritis, Rheumatoid Arthritis, Brain injury, Spinal cord injury, Asthma, Diabetes, Colitis, Gastric Ulcer, Inflammatory Bowel Disease, Ulcerative Colitis, Organ transplant, non-severe and non-chronic pain, Parkinson’s, Tourette’s Syndrome, Autism and Chronic pain.

A public hearing will be held on May 4, during which the Review Panel will make recommendations to the Department Director. It will be held at 9:00 a.m. in the Williams Building 1st Floor Auditorium at 525 W Ottawa St, Lansing, MI 48933.

The current list of debilitating medical conditions covered under Michigan’s Medical Marijuana law include:

  • Post-Traumatic Stress Disorder
  • Positive status for Human Immunodeficiency Virus
  • Acquired Immune Deficiency Syndrome
  • Hepatitis C
  • Amyotrophic Lateral Sclerosis
  • Crohn’s Disease
  • Agitation of Alzheimer’s disease
  • Nail Patella, or the treatment of these conditions.
  • A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following:
    • Cachexia or Wasting Syndrome
    • Severe and chronic pain
    • Severe nausea
    • Seizures, including but not limited to those characteristic of epilepsy
    • Severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis

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Comorbid Autism Spectrum Disorder and OCD: Challenges in Diagnosis and Treatment

It can be challenging to distinguish between symptoms of anxiety and symptoms of autism.

Interventions shown to be highly effective in treating symptoms of autism are already limited, but the options shrink even further in the presence of anxiety comorbidities, particularly obsessive compulsive disorder (OCD). Research has been focused not only on identifying a specific anxiety disorder in children and adolescents with autism, but also in distinguishing between the symptoms of each disorder and how to treat each disorder. Although cognitive behavioral therapy (CBT) with various modifications has been shown to be beneficial, the research evaluating CBT includes small populations and a variety of nonstandard modifications.

Prevalence and Symptom Differentiation

Estimates of the prevalence of anxiety, specifically of OCD, among children and adolescents with autism spectrum disorder (ASD) vary widely, from 11% to 84% for any anxiety disorder and from 2.6% to 37.2% for OCD, reported Valentina Postorino, PhD, of Emory University Department of Pediatrics and of the Marcus Autism Center in Atlanta and colleagues.1 They draw particular attention to one meta-analysis of 31 studies, which found a 39.6% prevalence of “clinically elevated levels of anxiety or at least one anxiety disorder” in young individuals with autism.2

“The range of prevalence rates reported for anxiety disorders and OCD in ASD is likely influenced by the clinical heterogeneity of individuals with ASD, including the broad spectrum of intellectual and verbal abilities,” they wrote.

Manifestations of anxiety are likewise highly variable, they noted, “encompassing both classic and unconventional presentations, such as fears of change or novelty, worries surrounding circumscribed or specialist interests, and unusual phobias.”1

Therein lies the challenge: distinguishing between symptoms of anxiety and symptoms of autism because social withdrawal and “ritualistic behaviors” from anxiety can resemble the difficulty with social interaction and the stimming seen in autism. Although it is already challenging to differentiate between these behaviors in nonverbal children with autism, learned attention-seeking or communicative behaviors may confound the differential diagnosis even in children who are verbally adept, Postorino et al pointed out.1

“Behaviors such as screaming, which might reflect manifestations of anxiety in a nonverbal child or a child with limited emotion recognition, might also reflect learned patterns of behaviors aimed at escaping demands, obtaining attention, or other instrumental purposes that are not accompanied by anxious feelings,” they wrote. “In this way, anxiety symptoms may be both altered in presentation and obscured by their co-occurrence with ASD.”

Assessment and Diagnostic Tools

“Many of the currently available measures to evaluate anxiety and OCD were initially developed and standardized for typically developing children,” Postorino et al wrote. “Therefore, it is possible that these measures may not adequately differentiate between autism and anxiety or obsessive-compulsive symptoms.”

The authors include a list of assessments that practitioners can consider, but they urge caution in interpreting them and emphasize the need to gather and consider information from multiple sources, including caregivers and from direct observation.

Evidence favors the following assessments:

  • Child and Adolescent Symptom Inventory (CASI) — designed to exclude symptoms that co-occur with anxiety and ASD
  • Autism Spectrum Disorders-Comorbidity for Adults scale (ASD-CA)
  • Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD)
  • Anxiety Disorders Interview Schedule with Autism Spectrum Addendum (ADIS/ASA) — more comprehensive in differentiating anxiety symptoms from those of ASD
  • Autism Comorbidities Interview’s (ACI) adaptation of the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) for youth with ASD — currently validated only for depression, attention-deficit/hyperactivity disorder (ADHD), and OCD sections
  • Children’s Inventory for Psychiatric Syndromes-Parent Version — has high interrater reliability for specific phobias and generalized, separation, and social anxiety; lower agreement for OCD, ADHD, mood disorders, and generalized anxiety disorder  in youth with IQs below 70
  • The possible development of a parent-reported inventory of anxiety symptoms based on 52 items identified in a study published in Autism3

The following tools measure repetitive behaviors reliably, Postorino et al reported:

  • Children’s Yale-Brown Obsessive Compulsive Scales for ASD (CYBOCS- ASD)
  • Autism Diagnostic Interview-Revised (ADI-R)
  • Repetitive Behavior Questionnaire (RBQ)
  • Repetitive Behavior Interview (RBI)
  • Repetitive Behavior Scale-Revised (RRB-R)

Other anxiety questionnaires were not designed for use in children and adolescents with autism and lack consistent evidence in this population:

  • Multidimensional Anxiety Scale for Children (MASC-C)
  • Revised Children’s Anxiety and Depression Scale (RCADS)
  • Screen for Child Anxiety and Related Emotional Disorders (SCARED)
  • Spence Child Anxiety Scale (SCAS)

Analysis of Treatment Interventions

A systematic review published in the Journal of Developmental and Physical Disabilities by Leman Kaniturk Kose, Lise Fox, and Eric A. Storch from the University of South Florida in St. Petersburg analyzed the effectiveness of CBT based on 11 studies, including 3 randomized controlled trials, 1 case controlled study, 2 single subject experimental designs, and 5 case studies.4

Results from all of the studies showed at least some treatment gains, but they included only 170 participants total with substantial variation in age and severity of conditions. All participants with autism had “high-functioning” autism and an IQ above 69. Further, the studies were very heterogenous in terms of procedures, therapy modifications, and outcome measures.

“In all studies, a multicomponent CBT treatment was implemented,” the authors wrote. “The components of CBT typically involved mapping, cognitive restructuring, fear hierarchy development, [exposure and response prevention], and relapse prevention.” There were also 2 studies with emotional literacy education. The number of CBT sessions ranged from 6 to 17.4 sessions over 9 to 21 weeks, with each session lasting from 35 minutes to 2 hours.4

Further, all of the studies used at least 1 and up to 8 of the following 10 modifications, starting with the 5 most common:

  • Parental involvement
  • Increased use of visuals
  • Incorporation of child interests
  • Personalized treatment metaphors and coping statements
  • Self-monitoring
  • Nonverbal and concrete examples
  • Positive reinforcement
  • Use of clear language and instructions
  • Functional Behavioral Assessment Intervention (FBAI)
  • Narratives

Glen Elliott, PhD, MD, chief psychiatrist and medical director of Children’s Health Council in Palo Alto, California, was not persuaded by the review that CBT is very effective for comorbid autism and OCD, given the small population in this review, its substantial limitations, his own limited clinical success with CBT, and the need for the patient’s willing participation in therapy.

“One of the requirements for diagnosis [of] OCD in non-autistic individuals is that the behavior they engage in [is] behavior they don’t want to engage in,” Dr Elliott told Psychiatry Advisor. “They [are] compelled to do it even though they don’t want to do it.”

Autistic repetitive behaviors are different, however. Children and adolescents with autism who have verbal skills often say they feel content with their repetitive behaviors and have no interest in stopping them.

“What they get upset about is when those behaviors are disrupted,” Dr Elliot said. He noted that their responses can range from annoyance to complete meltdowns.

“I think the motivation to do CBT would be much lower with autistic than [with] non-autistic individuals,” he said. “Most of them think, ‘Why should I give this up? It’s fun, it’s who I am, it’s what I do.’ CBT would be a hard sell since all therapy requires some agreement of ‘I have a problem I’d like to see changed.’”

If they do have repetitive behaviors they don’t enjoy, however, CBT may help them reduce those behaviors, Dr Elliott told Psychiatry Advisor. He described the case of a boy who had such elaborate rituals that it took 3 hours to get through a meal and 20 minutes simply to enter his office. After treatment with fluoxetine and haloperidol, those behaviors decreased, freeing up 6 to 8 hours a day for him to be more socially engaged and participate in behavior he actually enjoyed.

In addition, neither of these reports address the distinction between obsessive and perseverative behaviors, Dr Elliott said.

“With perseverative behaviors, it’s not the behavior that’s important but the fact that they started doing it and can’t stop,” he told Psychiatry Advisor. “Both occur, and they both can be responsive to medications, but they’re different.” Perseverative behaviors typically respond better to antipsychotics while [selective serotonin reuptake inhibitors] more effectively treat obsessive behaviors, he said.

Dr Elliott agreed, however, that there is a strong need for evidence-based interventions for comorbid ASD and OCD.

Currently, CBT is at least somewhat effective, Kose et al noted, when “enhanced with modifications such as increased structure in the sessions, visual aids and cues, and considerable parental involvement.”


  1. Postorino V, Kerns CM, Vivanti G, Bradshaw J, Siracusano M, Mazzone L. Anxiety disorders and obsessive-compulsive disorder in individuals with autism spectrum disorder. Curr Psychiatry Rep. 2017;19:92.
  2. van Steensel FJ, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302-317.
  3. Bearss K, Taylor CA, Aman MG, et al. Using qualitative methods to guide scale development for anxiety in youth with autism spectrum disorder. Autism. 2016;20:663-672.
  4. Kose LK, Fox L, Storch EA. Effectiveness of cognitive behavioral therapy for individuals with autism spectrum disorders and comorbid obsessive-compulsive disorder: a review of the research. J Dev Phys Disabil. 2018;30:69-87.

11 Cymbalta Side Effects You Should Know About

People 24 and younger may experience thoughts of suicide on Cymbalta. According to the FDA, the risk is greatest in those under the age of 18 and elevated in people ages 18 to 24.

This may be because Cymbalta can worse or cause symptoms including anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, hypomania, and mania.

At the same time, suicide risk actually decreases in people 25 and over, particularly among people over the age of 65.

“Any of these drugs may increase suicidal thoughts in periods of time when there’s a big shift—when you’re starting or raising a dose,” says Saltz. “The numbers aren’t big, so we don’t know who will be affected.”

HealthWatch: Anxiety is Treatable! – WEAREGREENBAY

SAN ANTONIO, Texas (Ivanhoe Newswire) — Forty million adults suffer from anxiety disorders; yet, only a small percentage seek professional help. It is highly treatable…so, why do so many continue to suffer? 
Monica Reveley is finally loving life after being haunted for years by anxious and unwanted thoughts. 
“The violent intrusive thoughts…the sexual intrusive thoughts, especially. They were really uncomfortable, you know. You’re not supposed to have those kinds of thoughts. On the outside, I was straight A, involved in all the clubs, had all the friends. But on the inside, I was really miserable,” explained Monica. 
If an anxiety lasts for two weeks or longer, depression may be right around the corner. And that combination is not something you can think your way out of. 
Harry A. Croft, MD, Psychiatrist, says, “Despite your efforts at self-talk and whatever else you do, you can’t get rid of it.”
Prescriptions like Xanax and Klonopin help, but…  
Dr. Croft continues, “Far and away, the best treatments for anxiety disorders are therapies like cognitive behavioral therapy or desensitization therapy.”
Cognitive behavioral therapy  that means facing anxieties head on. 
“It’s like the bear. The bear comes to get us and how do we respond? We respond with rapid heartbeat and all these other things. It’s simply a way to help us get away from the bear…to stay alive. I’m a big believer that if you change the thought, the feeling will follow. So, I put a lot of emphasis on again the cognitive part of it,” Randy Pollock, MA, Licensed Counselor, told Ivanhoe.
If it’s been two weeks or more and anxiety is still tormenting you, here are a few quick tips: 
Avoid caffeine which amps you up even more, exercise will help drain away anxiety, and every day, breathe deeply.
“I wish that a lot of people had a lot more awareness about mental illnesses, so that people could be more open about it,” Monica shared. 
Alleviating stress and addressing any childhood trauma with a professional can go a long way toward keeping anxiety at bay.
Contributors to this news report include: Donna Parker, Producer; Bob Walko, Editor and Gary Boyer, Videographer.

REPORT #2522

BACKGROUND: Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults age 18 and older every year. Anxiety disorders are highly treatable, yet only 36.9 percent of those suffering receive treatment. People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer. Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events. It’s not uncommon for someone with an anxiety disorder to also suffer from depression. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder. Many people with an anxiety disorder also have a co-occurring disorder or physical illness, which can make their symptoms worse and recovery more difficult. It’s essential to be treated for both disorders. Obsessive-compulsive disorder and post-traumatic stress disorder are closely related to anxiety disorders, which some may experience at the same time, along with depression.

CURRENT TREATMENTS: Depression and anxiety disorders can often be treated similarly. In many cases, therapy can be tailored to an individual so that it works to reduce the symptoms of both disorders. Several forms of psychotherapy are effective. Of these, cognitive behavioral therapy works to replace negative and unproductive thought patterns with more realistic and useful ones. Treatment often involves facing one’s fears as part of the pathway to recovery. Interpersonal therapy and problem-solving therapy are also effective, as well as prescribed medications. Symptoms of depression and anxiety disorders often occur together, and research shows that both respond to treatment with selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI) medications. For people with severe symptoms, or functional limitations, psychotherapy and medication treatment may be combined. More than one in 10 Americans take antidepressants, the number one type of medication used by people ages 18 to 44. Joining a support group is always encouraged along with trying relaxation techniques, meditation, and breathing exercises. 

RESEARCH BREAKTHROUGH FOR MENTAL HEALTH: Pioneered by researchers at Monash University in Australia, a promising new “whole person” approach to the treatment of anxiety and depression has been developed in an effort to improve the effectiveness and efficiency of current treatments, and further improve the lives of those who are living with these mental health disorders. Following the discovery of considerable genetic, neurological, developmental, behavioral and cognitive data, which suggested commonalities across anxiety and related disorders, transdiagnostic cognitive-behavioral therapy interventions have been developed to form a new approach to treatment. This new disorder-independent approach considers the biological, physical and psychological symptoms, targeting the person and their emotional difficulties as a whole to deliver tailored treatment. “As well as providing better treatment for those experiencing anxiety and other emotional disorders, transdiagnostic treatments offer a number of appealing advantages to the mental health field,” shared Professor Peter Norton, Director of Translational Research at the Monash Institute of Cognitive and Clinical Neurosciences. The FEAR Clinic, housed within the Monash Psychology Centre, is adopting the transdiagnostic approach, so those who attend are first in line to benefit from this new ground-breaking approach to treatment.

? For More Information, Contact:

Harry A. Croft, MD                        Randy Pollock, MA     
(210) 602-9418                        (210) 558-8200

Free weekly e-mail on Medical Breakthroughs from Ivanhoe. To sign up:

How Much Watching Time Do You Have This Weekend?

No matter how much free time you have this weekend, we have TV recommendations for you. Come back every Friday for new suggestions from our TV critic on what to watch.

This Weekend I Have … an Hour, and Anything Goes

‘Live From Lincoln Center: Sutton Foster in Concert
When to watch: Friday, 9 p.m., on PBS. (Check local listings.)

“Younger” doesn’t come back until June, but luckily there’s this terrific special to keep its star, Sutton Foster, in our minds and hearts this spring. In this special, she is by turns perky and salty and wistful. The highlight is the goofy, almost variety-show schtick between Ms. Foster and Jonathan Groff, which eventually leads to a fantastic tap duet to the song “Fit as a Fiddle (and Ready for Love).”

… a Few Hours, and I Like the Human Condition

This two-season series, which began in 2009, is for obsessive-compulsive and anxiety disorders what “Intervention” is for addiction: a frank, intimate, sometimes shocking snapshot of a person in crisis. Here, though, we also stay with the subjects through effective therapy and coaching. Pop culture tends to position O.C.D. as cutesy germaphobia, but “Obsessed” makes it clear that the disorder is isolating and debilitating — and, mercifully, also treatable.

… 4 Hours, and I Like Gentle Comedy

The brainy and self-effacing British comedian James Acaster released four stand-up specials at once: three individual chapters and a fourth that synthesizes material from the previous three. The wrinkled backdrops and Mr. Acaster’s unassuming demeanor give off a laid-back vibe, but the material is precisely written and tightly constructed, with elegant moments of poetry and fantasy. The third hour, “Reset,” is the best of the bunch, but the episodes build on one another and should be watched in order.

Niall Horan Said He Has "Mild" Obsessive Compulsive Disorder

Niall Horan has previously shared how anxiety and mental health issues have been a factor in his on-stage performances. In 2017, the former One Direction member said he gets “a little anxious,” and in a new interview he said that he has been diagnosed with another form of mental illness — obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is estimated to affect 2.2 million people in the United States, and as the Anxiety and Depression Association of America explains, the disorder can cause a person to experience unwanted compulsions and obsessions, ranging from behavior to thoughts. As pointed out by Just Jared Jr., Niall explained in an interview with German magazine ZEIT LEO that doctors call his OCD “mild.”

The performer explained how his OCD causes “tics,” or the need to complete behaviors in a particular way. “I feel like I have to do things in a certain way,” he said in the interview. “For example, if I have a burger with chips on my plate, I always have to eat the chips first and only pick up the burger at the very end.” Niall went on to share how OCD has impacted his performance.

“There are other tics in my life. Even when I go on stage, I only have one fixed sequence. I always have to sing in the same order, move and so on,” he said.

He also previously explained that he practices a breathing technique before he goes on stage to cope with anxiety. It’s called”box breathing,” which is process where you take a deep breath in for four seconds, breathe out for four seconds, and then hold your breath for four seconds, and repeat as necessary.

Niall said he’s learned to not be ashamed of his tics, and he shouldn’t be. Mental illness is nothing to be ashamed of, just as someone with a physical illness shouldn’t be ashamed.

“I live with them and they’re mine no matter what others think about it,” he said. “I’m just like — what the hell! Fortunately, I now have enough people around me who understand me.”

As mental health experts have previously explained, there are many people with OCD out there, and you’re not alone in this mental health struggle. Niall’s opening up about his OCD proves that. There are ways to treat and cope with the disorder, and you can always reach out to a trusted adult for help on finding what may work for you.

Related: Stress, Obsess, Repeat: What It’s Like to Have OCD

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