Lessening anxiety: A key to unlocking greater health

LEFT unchecked, anxiety can spiral into an uncontrollable monster.

The disorder presents symptoms that may range from heart palpitations and difficulty breathing, to a sudden breakout in perspiration, feelings of dread, and mental confusion.

While anxiety describes a feeling of nervousness or worry, when those feelings persist even in the absence of the thing causing the anxiety, then anxiety may lead to a disorder.

Dr Julian Walters, a leading adult and child psychiatrist at the Fairview Medical Centre in Montego Bay, St James, reports that approximately 40 per cent of Jamaican children struggle with depression and anxiety, triggered by abuse. It is not difficult to see these young ones maturing into adults, carrying with them a bigger baggage as they deal with another round of anxiety challenges.

The figures are spiking on the world scene, because according to the US National Institute of Mental Health (NIMH), “anxiety disorders affect about 40 million American adults age 18 years and older…in a given year”.

When one member suffers an anxiety disorder, the entire family is affected. Due to leading research in the field, NIMH affirms that “effective therapies for anxiety disorders are available, and research is uncovering new treatments that can help most people with anxiety disorders lead productive, fulfilling lives”.

One should get a proper diagnosis in order to access correct treatment and advice, since, at the end of the day, lesser anxiety unleashes the potential to greater health.

Could one of the following anxiety disorders affect you?

Understanding anxiety disorders is vital, especially when the people involved are immediate family members or close friends. How much do you know? Consider five types of such disorders, and what some have done to cope.

Panic disorders

Not only do anxiety attacks cripple, but in-between the attacks, there is the constant dread that an attack is going to happen again.

True, sufferers tend to avoid places where the attack was triggered, even becoming so restricted they remain housebound with many times a fear to confront the place triggering the anxiety, unless accompanied by a trusted family member or friend.

Some sufferers explain that merely being alone can trigger an attack, and have attested to the fact that a close family member or friend does provide security — even helping them to face the situation or the place causing the anxiety.

Obsessive-compulsive disorder (OCD)

Individuals obsessed with germs or dirt could become victims to a compulsion to wash their hands on a repeated basis.

One OCD sufferer describes his mind as being in a state of constant turmoil, rehashing past mistakes, dissecting them, reanalysing them, and looking at them from every possible angle imaginable. He constantly wants to confess past mistakes to others, and as such, mentions that he is in constant need of reassurance.

Medication has also been of help in controlling his obsession.

Post-traumatic stress disorders (PTSD)

In recent times, this term has come to capture a host of psychological symptoms people suffer after an event of extreme traumatic proportions, usually occasioning physical harm or such, like threat. PTSD sufferers tend to be easily frightened, become irritable, numb emotionally, lack interest in the things they once considered enjoyable, even having trouble expressing or feeling affection for others with whom they were once close.

Not to be overlooked is the violence or aggression some develop, often tending to avoid situations that bring to mind the original traumatic incident. Many sufferers have benefited from cognitive behavioural therapy (CBT), which focuses on changing the thought patterns and processes responsible for disturbing the mind.

Just talking about the trauma or verbalising where your fears come from with a therapist may provide relief. For anxiety on the whole, never underestimate the power of breathing and relaxing techniques, while endeavouring to get proper rest and moderate exercise.

You may just be surprised, too, how powerful regularly drinking water is for general well-being.

Social phobia or social anxiety disorder

This term describes the feelings of those who undergo overwhelming anxiety, coupled with being overly self-conscious in day-to-day social situations. Some sufferers mention a strong and persistent fear that others looking on are doing so with watching and judging eyes.

The thought of attending an event may occasion great worry, days or weeks leading up to the event. The severity of social phobia disorder or social anxiety disorder is such that it may interfere with work, school or normal day-to-day activities — easily causing them to strain relationships with friends.

CBT has proven an effective treatment, and some doctors recommend antidepressants. Bear in mind though, that your body may take some time to respond to such medication, and since there may be side effects, it may take a little time to find the medication that gives the right fit for your body.

Generalised anxiety disorder

Those who suffer with this disorder tend to be on the lookout for disasters, even when there is no need to, and express an over preoccupation with health issues, money, family problems, or difficulties at work.

It takes something as simple as the thought of getting through the day to produce anxiety. Worries tend to be exaggerated even, as mentioned, with little or nothing to provoke them. Psychotherapy and talk therapy have yielded good results as worry-managing techniques, again with a balance of medication.

While following up with medical treatment is advised after the diagnosis, do not underestimate how critical it is to get family and friends on board whose understanding touch may enhanced coping skills. A listening ear may make a world of a difference and, for sure, kind words and a gentle, understanding tone show deep care while averting hurtful insinuations.

Since anxiety attacks from the level of the mind, it is of utmost importance to constantly train the mind, or have it trained with positive thoughts, while endeavouring to come to terms with or purging oneself of negativity.

Even if you do not suffer from severe anxiety disorder, do remember that it is your responsibility to try to keep your anxiety levels in check since, if left unmonitored, it can escalate into a disorder. And, having a working knowledge of anxiety and its disorders is crucial in case we or a family member fall victim.

Remember, even if we do not suffer with such disorders and a family member does, that in itself may be a source of increased anxiety for us if we do not endeavour to help the person access the needed assistance.

Many have suffered from different levels of anxiety, yet are determined to live and are living healthy, normal lives. So can you!

 

Warrick Lattibeaudiere (PhD), a minister of religion for the past 22 years, lectures full-time in the School of Humanities and Social Sciences at the University of Technology, Jamaica.

Lots of Americans have a fear of flying. There are ways to overcome the anxiety disorder.

Tami Augen Rhodes needed to fly to Washington. An invitation to a black-tie event at the Supreme Court was an opportunity the 49-year-old lawyer in Tampa did not want to miss. But Rhodes had not flown since she was 35, when an escalating dislike of flying grew into a firm phobia.

Desperate to get to Washington without resorting to a long train ride, Rhodes called into a weekly group-telephone chat run by Tom Bunn, a former Air Force and commercial airline pilot and licensed clinical social worker who runs a program for fearful fliers.

Bunn asked her what she was afraid of.

“I started crying,” Rhodes recalled. She told the group what worried her. “I am afraid of dying.”

Fear of flying, or aviophobia, is an anxiety disorder. About 40 percent of the general population reports some fear of flying, and 2.5 percent have what is classified as a clinical phobia, one in which a person avoids flying or does so with significant distress.

As with other situational phobias, the fear is disproportionate to the danger posed. Commercial air travel in the United States is extremely safe. A person who took a 500-mile flight every day for a year would have a fatality risk of 1 in 85,000, according to an analysis by Ian Savage, associate chair of the Economics Department at Northwestern University. In contrast, highway travel accounts for 94.4 percent of national transportation fatalities.


Tom Bunn is a former Air Force and commercial airline pilot and licensed clinical social worker who runs a program for fearful fliers. (Elisa Narsu)

But for many, statistics are not enough to quell phobias.

The Anxiety and Depression Association of America suggests eight steps to help identify triggers and defuse them. Martin Seif, a clinical psychologist who wrote the steps, identifies the variety of conditions that may comprise the phobia — panic disorder, social anxiety disorder, obsessive compulsive disorder and panic disorder, among them.

For some, breathing exercises, anti-anxiety medication and cognitive behavioral therapy work. But the strategies do not work for everyone.

Bunn has worked with fearful fliers since 1980 after becoming curious about the psychological and physical components that produced anxiety and panic in situations that he as a pilot knew to be safe. He developed a set of mental exercises for fearful fliers. One, called the “strengthening exercise,” links specific phases of air travel with a joyful personal memory, a visualization technique meant to trigger a sense of calm.

Rhodes had two months to prepare. She delved deeply into written exercises, videos, phone sessions. The day of her flight, she felt anxiety. But she was organized, equipped with magazines, memorized mental exercises and had an understanding of the expected noises and sensations of flight.

It worked.

“The panic never came,” she said, describing her flight. Since then, she has flown several more times, including a trip to Seattle to surprise her best friend.

Fear of flying, according to one overview, is far less studied than other conditions that can be detrimental to relationships and careers such as social anxiety, obsessive compulsive and post-traumatic stress disorders. Little is known about what keeps people afraid even after exposure to successful flights. And there are few experts in the field who are trained as both pilots and clinical social workers.

Stacey Chance, a pilot who flew with American Airlines for 30 years, runs a free online Fear of Flying Help Course, a one-hour overview of each aspect of flight. He includes video clips from therapists and pilots and printable checklists for managing anxiety. He was surprised to learn that many passengers fear they will “lose control and open a door in flight,” a scenario he said is impossible.

The door is pressurized.

Tonya McDaniel, a licensed clinical social worker at the Center for Growth in Philadelphia, uses a virtual-reality program designed for psychologists: While patients navigate stages of air travel with an avatar — from packing, boarding, takeoff and even weather — McDaniel monitors their heart rates and self-assessed level of distress, measured as SUDS (subjective units of distress scale.)

The goal of the exposure therapy is to recalibrate a person’s response, eventually teaching the body that the experiences are “not dangerous and this is okay,” she said.

After patients complete the sessions, McDaniel encourages them to keep practicing, even if it is simply going to the airport to watch planes.

“Phobias breed on avoidance,” she said.

Untreated, the phobia takes a toll. Rhodes did not go to her grandmother’s funeral or her best friend’s wedding.

Bunn trained as a fighter pilot, a vocation he chose because growing up in a small town in North Carolina after World War II, “the ones who got all the attention were ex-pilots,” he said. He finished top of his class in flight school and got assigned to the F-100 Super Sabre, a supersonic fighter.

While based in Germany in the early 1960s, sitting around on “nuclear alert,” he delved into books on psychology, an interest spurred by his mother’s mental illness. Later, as a commercial pilot for Pan Am, he helped a fellow pilot with a graduation class for fearful fliers run by the airline.

“People were sitting on the plane doing breathing exercises, doing exactly what we told them, and they still had panic,” he said. It was awful to be so helpless, he thought.

By 1982, Bunn started his own course, and eventually earned a master’s degree in social work at Fordham University. He did shifts at a Veterans Affairs hospital, and in 1996 retired from flying to work full time as a licensed clinical social worker in Bridgeport, Conn.

His program for fearful fliers, SOAR, continued to grow until it became his sole focus. Clients, me among them, call him “Captain Tom.”

He found that home study helped.

“[People] were in control,” he said. “They didn’t have to show up in an airport and fly in two days,” Bunn said.

Lisa Hauptner, a former client, quit her job in the corporate world to help run the business. Her own fear began as many do, with work-related stress and a sense of impending change.

“There are usually stressors, good or bad, happening at the time,” Hauptner said. “The average age of onset is 27. Think about what’s going on when you are 27 years old. You may be getting married, or may be moving, or may be engaged or having a child.”

Cognitive behavioral therapy, often used to treat anxiety and panic with measurable results, was helping people on the ground, they found, but left them vulnerable to feelings of panic in flight. Once panic starts, “cognitive ability is fried,” Bunn said. Stress hormones and a fight or flight response take over.

Bunn said that people can “retune” their ability to calm themselves before panic escalates, relying on unconscious or procedural memory, the kind used to ride a bike. He offers exercises that are simple, but require practice, conditioning the body to respond to triggers (turbulence, for example) with less alarm.

He was influenced by the work of Stephen Porges, Distinguished University Scientist at Indiana University and Professor of Psychiatry at the University of North Carolina University, whose Polyvagal theory examines how our nervous system detects and responds to threat.

Porges described Bunn’s exercises as using “visualization to help people deal with fear of flying, or deal with anxiety.” The images send the body cues that it is safe and not in a state of defense.

At age 83, Bunn is busy. He responds to 30 to 40 emails a day from anxious fliers and conducts up to eight private phone sessions. His weekly email goes to more than 17,000 subscribers. Last April, he released a book, “Panic Free: The 10-Day Program to End Panic, Anxiety, and Claustrophobia,” which uses the system developed for fearful fliers. Since the Boeing 737 Max crashes, activity has increased, he said.

Not everyone responds to his system. Hauptner, who is also a mental health counselor, said fliers who are in the middle of another big event, such as a divorce or quitting smoking, may not respond. “Or, they want perfection, and there is no perfection,” she said.

No one strategy may work for everyone. Porges said some people find breathing exercises, a common coping strategy for panic, effective if done with a slow exhale.

Joe Spatola sought help shortly after he got engaged, setting his sights on a honeymoon in Italy.

Spatola said Bunn helped him break down his feelings, recognize his heartbeat and employ a technique for calming himself that transfers anxiety to a cartoon character.

“I use Popeye,” he said. His biggest annoyance with turbulence now is not being able to get up to use the lavatory.

I found “Captain Tom” on the Internet 18 years ago, back when his program arrived in the mail on audiocassettes. My fear of flying hit at age 26 when I started a new job at CBS News — the age and phase of young adulthood when it typically manifests. I listened to the tapes. I read the typed material. I flew to my destination and worked on an assistant producing assignment.

On the return trip, I was delayed, first in Tallahassee and then in Atlanta because of mechanical problems. As the night wore on, my confidence waned, and I did not want to board the plane. I decided to try the phone session that came with my course.

Bunn picked up right away. His voice reflected his North Carolina upbringing and a calm demeanor, my idealized version of a pilot and therapist rolled into one. I flew home to New York and arrived late that evening, Sept. 10, 2001.

There was no good place to be the following day, tragedy hit families across the country and stranded travelers for days. My own anxieties shifted and grew, and it would take another concerted effort years later to work on flying again.

But I always look back on that night and the indecision I had waiting alone in the Atlanta airport. And I thank Captain Tom for picking up the phone.

Investigators Suggest Better Predictors to Diagnosis Mental Illness

Claire Gillan, PhD

Claire Gillan, PhD

In a new study, investigators suggest a need for more individualized approaches to defining mental illnesses because of substantial overlap across different disorders.

A team of investigators, led by Claire M. Gillan, PhD, School of Psychology, Trinity College Institute of Neuroscience and Global Brain Health Institute, recently completed a 285-patient cross-sectional study in the US for individuals diagnosed with obsessive-compulsive disorder (OCD) and/or generalized anxiety disorder (GAD).

The investigators found self-reported compulsivity was more strongly linked with goal-directed deficits than a diagnosis of OCD compared with GAD.

The results could have implications for research assessing the association between brain mechanisms and clinical manifestations, as well as for understanding the structure of mental illness.

The aim of the study was to identify if deficits in goal-directed planning better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder. Each patient completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments between 2015-2017.

The investigators collected follow-up data as well to test for replicability.

Performance was measured on a test of goal-directed planning and cognitive flexibility using the Wisconsin Card Sorting Test (WCST), as well as a test for abstract reasoning.

Clinical variables included a DSM-5 diagnosis of OCD and GAD, as well as 3 psychiatric symptom dimensions—general distress, compulsivity, and obsessionality—derived from a factor analysis.

Overall, deficits in goal-directed planning in OCD was strongly tied with a compulsivity dimension than with a OCD diagnosis.

The mean age of the 285 patients was 32, with a range of 18-77 years old. The patient population included 219 females, 111 individuals with OCD, 82 patients with GAD, and 92 patients with both disorders.

“A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (P = .18),” the authors wrote. “In contrast, a compulsivity dimension was negatively associated with goal-directed performance (P = .003).”

This pattern was also found with abstract reasoning tasks as well as WCST.

“The compulsivity dimension was associated with abstract reasoning (P  .001) and several indicators of WCST performance (P  .001), whereas OCD diagnosis was not (abstract reasoning: P = .56; categories completed: P = .38),” the authors wrote.

However, other symptom dimensions related to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning.

Obsessionality also had a positive association with requiring more trials to reach the first category on the WCST at baseline (P = .04), while general distress was linked to impaired goal-directed performance at baseline (P = .01).

Despite this, neither survived correction for multiple comparisons or was replicated at follow-up testing.
 
In the past, dimensional definitions of transdiagnostic mental health problems has been recommended as an alternative to a categorical diagnosis. Using this technique allows clinicians to capture heterogeneity within diagnostic categories and similarity across them to bridge more naturally psychological and neural substrates.

“This study suggests that transdiagnostic compulsivity symptoms may have greater biological validity than a diagnosis of obsessive-compulsive disorder,” the authors wrote.

There are fundamental issues with using popular international categories for neurobiological research such as the DSM-5 and International Classification of Mental and Behavioural Disorders, 10th Revision.

While diagnostic groups are highly heterogeneous, patients often have the same diagnosis with vastly different symptom profiles.

Individuals without a psychiatric diagnosis usually differ from patients with a diagnosis in several ways beyond the diagnosis under investigation, including anxiety, depression, physical illness, and early-life adversity.

As a result, potential biomarkers, intermediate phenotypes, and etiologic substrates often can only show a modest association with a categorical clinical phenotype, but is unlikely to be specific to that phenotype.

The study, “Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis,” was published online in JAMA Psychiatry.

Anxiety disorders top mental health issues in UAE

One of the triggers for suicides in society is unattended or poorly managed anxiety and depression. Speaking at a two-day suicide prevention workshop at the Zayed University Dubai, Dr Justine Thomas, professor of psychology at the university, said, “Globally, 300 million people suffer from depression. Depression varies in severity, but at the sharp end, it can lead to suicide. Around 800,000 people die due to suicide each year, the second leading cause of death among those between the ages of 15 and 29.”

For Patients with Eating Disorders, Cannabis May be the Right Medicine

It’s morning in New York City, and Jessica Mellow is preparing for a long day. She pours her first of many cups of coffee and steels herself for another day of work — and another day of anorexia treatment. Not only does the body-paint model have a long session booked, she also has an appointment with her psychiatrist, and dinner with a meal-support specialist. She takes some cannabidiol (CBD) oil to help calm her nerves. Her anxiety is ever-present. 

“I’ve found that when I use a bit of pot or take some CBD oil, it helps with anxiety and pain, and helps me get to sleep, sans side effects,” Mellow said. “Treatment for anorexia is trickier than for a lot of mental illnesses, largely because it requires doing the exact opposite of what feels safe and instinctual. If the brain perceives food as a threat, but the only way to get better is to continuously eat, the anxiety increases drastically, and as treatment goes on, often gets worse instead of better.”

Anorexia isn’t a qualifying condition for a medical marijuana certification in New York, even though a review of studies has shown cannabinoids can decrease anxiety and promote weight gain in anorexic patients.

Mellow, for one, is eager for more anorexia treatment protocols. “I think it would be really helpful to have [legal] cannabis as an option,” she said.

Eating Disorders’ Origins

Despite what TV movies depict, eating disorders don’t just stem from a drive to be thin. Some people are born with a genetic predisposition to anorexia, bulimia, and binge-eating disorder. Further, the intrusive thoughts that often plague sufferers are similar to those of obsessive-compulsive disorder (OCD)

According to the National Eating Disorders Association (NEDA), “two-thirds of those with anorexia [show] signs of an anxiety disorder (including generalized anxiety, social phobia, and obsessive-compulsive disorder) before the onset of their eating disorder.” These comorbid conditions are only part of the reason anorexia is notoriously hard to treat.

Restrictive eating disorders such as anorexia and avoidant/restrictive food intake disorder (ARFID) can lead to progressive starvation that affects the brain, and therefore the intellect, making treatment for these patients even more challenging. Critically ill anorexic patients may want to eat, and want to recover, but may feel trapped in ritualistic thoughts and behaviors.

Bulimia and binge-eating disorder present a different but similar set of challenges, and symptoms of these disorders often overlap with anorexia symptoms. Binges can last for hours and result in the consumption of tens of thousands of calories. People with bulimia or binge-eating disorder can be of a normal weight or very overweight. Body weight doesn’t change the severity of the disease, but due to the risk of starvation or heart failure, anorexia remains the deadliest of all psychiatric disorders, with an estimated mortality rate of 10%. 

Eating Disorders and the Endocannabinoid System

The endocannabinoid system (ECS) is a network of receptors, enzymes, and endocannabinoid molecules that maintains homeostasis, or a range of healthy functions in the body. The CB1 receptors, found in the central nervous system, transmit a “calm down” signal to overactive neurons. Because these receptors are plentiful in brain regions that control food intake, clinical evidence suggests that there may be a link between a defective ECS and the development of an eating disorder.

The ECS is involved in the regulation of eating and energy balance, and CB1 receptors — one of the two kinds of cannabinoid receptors in our brains, the other being the CB2 receptors — are plentiful in the brain regions that regulate hunger and control eating behaviors. Because of the way they bind to CB1 receptors, ingested cannabinoids can help reduce patients’ anxiety and increase (or decrease, in the case of high-CBD strains) the amount of food they consume. What stoners have long known to be true turns out to be backed by science: Cannabis can chill you out and give you the munchies.

“Cannabis helps me in two ways. First, it helps with hunger cues,” Cassidy said. “When you’ve been restricting for a while, your body stops asking for food when it needs to. The munchies help with that. Second, [cannabis] helps with the anxiety. It kind of quiets the wave of negative self-talk that often comes with eating.”

Anorexia sufferer Cassidy, whose name has been changed agrees. “Cannabis helps me in two ways. First, it helps with hunger cues,” Cassidy said. “When you’ve been restricting for a while, your body stops asking for food when it needs to. The munchies help with that. Second, [cannabis] helps with the anxiety. It kind of quiets the wave of negative self-talk that often comes with eating.”

The OCD Connection 

The American Psychiatric Association’s “Practice Guideline for the Treatment of Patients with Eating Disorders” states that eating disorders are often comorbid with other psychiatric conditions, particularly OCD, anxiety disorders, and personality disorders. And according to the International OCD Foundation, 64% of people with eating disorders also have an anxiety disorder, and 41% of those have OCD.  

What all these statistics mean is that people with eating disorders — especially the restrictive type – often operate according to a strict set of rules that may not make sense to  people without eating disorders. For example, a person with anorexia may deem foods “safe” and “unsafe” based on reasons other than calories or nutrient content, or develop rituals around how they cut food and where they place it on the plate. It’s not so different from having to turn the lights on and off a certain number of times before leaving the house, or having to wash one’s hands a certain number of times before going to bed, behaviors typically associated with OCD. 

In a 2019 study published in Cannabis and Cannabinoid Research, researchers from the New York State Psychiatric Institute at the Columbia University Department of Psychiatry found preliminary evidence that suggests the body’s endocannabinoid system may play a role in OCD, and cited case reports from three patients for whom the cannabinoid drug dronabinol reduced compulsive behaviors. One patient, who displayed treatment-resistant OCD symptoms following a thalamic stroke, was able to participate in cognitive behavioral therapy (CBT) after using dronabinol. While more research is needed, this preliminary evidence suggests that cannabis-based treatments may allow patients struggling with compulsive behaviors to more effectively participate in talk therapy. In addition, a 2005 study showed that rates of the endocannabinoid anandamide are increased in patients with anorexia and binge-eating disorder, but not in patients with bulimia. The possibility of modulating the endocannabinoid system to treat certain eating disorders deserves more research.

Future of Eating Disorder Treatment

Scientific studies of patients with HIV and cancer show that cannabis increases appetite and can lead to significant, life-saving weight gain. However, established eating-disorders treatment programs have been slow to accept the medical efficacy of cannabis. 

Fortunately, clinicians such as Dr. Ziv Cohen, a psychiatrist in New York City licensed to certify patients to the state medical-marijuana program, think it could be a helpful addition to eating disorder treatment protocols.

“I think that there is a lot of promise in cannabis-based products for restrictive eating disorders in the same way that cannabis products are very helpful for cancer patients who have problems with their nutrition,” Cohen said. “Anxiety is reduced and appetite is increased, and that combination can kind of push patients over the hump and get them to eat things that they wouldn’t normally eat, or that they’re phobic about.”

There is a lot of promise in cannabis-based products for restrictive eating disorders in the same way that cannabis products are very helpful for cancer patients who have problems with their nutrition. Click To Tweet

Cohen stressed that not all patients with eating disorders are good candidates for cannabis medicine; comorbidity is an important consideration. Inducing uncontrollable munchies in patients who purge has obvious consequences, but for patients with trauma histories who restrict or binge in response to post-traumatic stress disorder (PTSD) triggers, Cohen said cannabis could be helpful. 

“We want to make sure we’re not conditioning the patient to only be able to eat when they’re using a cannabis product; just like with other medications, we would want [cannabis] to facilitate developing regular eating habits, not to become a ritual that is necessary [in order] to eat,” Cohen said. “Cannabis treatment could be very helpful, as long as it’s within the context of a good multidisciplinary team.”

Mellow agreed, and stressed the importance of her treatment team and the need for alternatives to psychiatric medications.

“Malnutrition can prevent psychiatric medications from being effective, so having [cannabis] to help with the anxiety could potentially make a treatment that often feels punitive much more tolerable and effective,” Mellow said.

“I don’t believe there’s any miracle cure,” Mellow said, “but if cannabis can reduce some of the biggest barriers to treatment — exhaustion, anxiety, physical discomfort — that leaves more room to focus directly on recovery, and I don’t see how that could be anything but positive.”

OCD Awareness Week | Lifestyles

Shawn’s mother brought him to therapy because she noticed he began to squeeze his head in the mornings before school. He was trying to “squeeze out the thoughts.” Shawn (a 5-year old) was experiencing ruminating thoughts that “would not go away.” He was having unwanted intrusive thoughts.

Kate (a 9-year old) developed an irrational fear that certain foods would harm or poison her. She read food labels; refused to eat school lunches; and experienced extreme anxiety around family meals. Her parents brought her to therapy when she began to lose weight.

Rita (a 13-year old) was buying and stockpiling household cleaners whenever she could. Her fear of germs was so overwhelming and compelling that she would sneak out of her house and walk to a nearby store to purchase more cleaning products.

Many children with OCD develop it between the ages of 8–12, although OCD can occur in children as young as 4.

According to Nationwide Children’s Hospital-Behavioral Health Services in Ohio, The Anxiety and Depression Association of America, reports OCD affects about 1 in 100 children in the U.S. The disorder can begin in childhood or during the teen years. Boys often develop symptoms at an earlier age than girls.

What is OCD? “Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.” Learn more about OCD at www.iocdf.org.

What kinds of obsessions do children and teenagers have? Children may have worries about germs, getting sick, dying, bad things happening, or doing something wrong. Feelings that things have to be “just right” are common in children. Some children have very disturbing thoughts or images of hurting others, or improper thoughts or images of sex.

What compulsions or rituals do children and teenagers have? There are many different rituals such as washing and cleaning, repeating actions until they are just right, starting things over again, doing things evenly, erasing, rewriting, asking the same question over and over again, confessing or apologizing, saying lucky words or numbers, checking, touching, tapping, counting, praying, ordering, arranging and hoarding.

According to The American Academy of Child and Adolescent Psychiatry, “Research shows that OCD is a brain disorder and tends to run in families, although this doesn’t mean the child will definitely develop symptoms if a parent has the disorder. A child may also develop OCD with no previous family history.” www.aacap.org.

Can OCD in children and teenagers be treated? Yes, OCD in children can be effectively treated. Although there is no cure for OCD, cognitive-behavioral therapy (CBT) and medicines are effective in managing the symptoms. Experts agree that CBT is the treatment of choice for children with OCD. Whenever possible, CBT should be tried before medicine with children.

Resources

For more information about OCD in kids and teens, including helpful information for family members, your child’s pediatrician, and your child’s school, visit: www.ocdinkids.org.

A recommend book, “Talking Back to OCD” by Dr. John March for parents to use with children and teens diagnosed with OCD.

“Being Me with OCD: How I Learned to Obsess Less and Live My Life” by Alison Dotson is highly recommended. Dotson was diagnosed with OCD at age twenty-six, after suffering from “taboo” obsessions for more than a decade. www.freespirit.com.

OCD Awareness Week goes from Sunday to Saturday, Oct. 13–19. Each year during the second full week of October, community groups, service organizations, and clinics across the US and around the world celebrate OCD Awareness Week with events such as educational lecture series, OCD-inspired art exhibits, grassroots fundraisers, and more.

As a kick-off to #OCDweek, on Saturday, Oct. 12, the International OCD Foundation (IOCDF) will co-host the Mental Health Advocacy Capital Walk at the National Mall in Washington, DC.

Body Dysmorphic Disorder, Major Depressive Episode, and Suicidality

Major depressive episodes (MDEs) are associated with
suicidal ideation and suicidal behaviors, and comparably, body dysmorphic
disorder (BDD) is significantly associated with suicidal ideation and suicidal
behaviors, according to a study published in the Journal of Affective Disorders. Furthermore, although bipolar
depression was associated with suicidal ideation and marginally associated with
suicidal behaviors, unipolar depression was only associated with suicidal
ideation.

This study examined the possible associations between anxiety,
mood, and obsessive-compulsive spectrum disorders and suicidal ideation and
behaviors in a sample of patients from the Behavioral Health Partial Program at
McLean Hospital (N=498; 55.2% women; 88% white, 3% black, 8% Asian, 4% other
races; average age 34.8 years [SD=14.4, range=18-74]). Data on current
diagnosis and past-month suicidal ideation and behaviors were assessed by
semi-structured interviews.

After adjustments were made for sex, age, and other psychiatric disorders, multivariant analysis demonstrated that body dysmorphic disorder was significantly associated with suicidal ideation (OR, 6.62; 95% CI, 1.92-22.79; P =.003) and suicidal behaviors (OR, 2.45; 95% CI, 1.05-5.71; P =.038). Similarly, episodes of major depression were associated with suicidal ideation and suicidal behaviors. While bipolar depression was associated with suicidal ideation (OR, 2.71; 95% CI, 1.36-5.40; P =.005) and was marginally associated with suicidal behaviors (OR, 2.02; 95% CI, 0.99-4.13; P =.054), unipolar depression was only associated with suicidal ideation (OR, 1.82; 95% CI, 1.20–2.74; P =.005). After controlling for comorbid disorders, no association was found between suicidality and obsessive-compulsive disorder, anxiety disorders, or post-traumatic stress disorder.

Although there were limitations to the study, such as the
cross-sectional design and the low base rates of certain disorders, which led
to a relatively small sample size, study investigators concluded that, “MDE and
BDD have unique relationships with suicidality in a partial hospital setting
that is independent of other internalizing disorders. BDD is a common and often
underrecognized disorder (Zimmerman and Mattia, 1998), and clinicians should be
aware of elevated risk of suicidality in this population. Further research is
needed to better understand the nature of the relationship between BDD and
suicidality, and whether the results generalize to other clinical settings.”

Reference

Snorrason I, Beard C, Christensen K, Bjornsson AS, Björgvinsson T. Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting [published online August 19, 2019]. J Affect Disord. doi: 10.1016/j.jad.2019.08.059

Melissa Martin: Obsessive Compulsive Disorder in children is a mental health issue and it can be treated – User

Shawn’s mother brought him to therapy because she noticed he began to squeeze his head in the mornings before school. He was trying to “squeeze out the thoughts.” Shawn (a 5-year old) was experiencing ruminating thoughts that “would not go away.” He was having unwanted intrusive thoughts.

Kate (a 9-year old) developed an irrational fear that certain foods would harm or poison her. She read food labels; refused to eat school lunches; and experienced extreme anxiety around family meals. Her parents brought her to therapy when she began to lose weight.

Rita (a 13-year old) was buying and stockpiling household cleaners whenever she could. Her fear of germs was so overwhelming and compelling that she would sneak out of her house and walk to a nearby store to purchase more cleaning products.

Many children with OCD develop it between the ages of 8–12, although OCD can occur in children as young as 4.

According to Nationwide Children’s Hospital-Behavioral Health Services in Ohio, The Anxiety and Depression Association of America reports OCD affects about 1 in 100 children in the U.S. The disorder can begin in childhood or during the teen years. Boys often develop symptoms at an earlier age than girls.

What is OCD? “Obsessive-compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.” Learn more about OCD at the website.

What kinds of obsessions do children and teenagers have? Children may have worries about germs, getting sick, dying, bad things happening, or doing something wrong. Feelings that things have to be “just right” are common in children. Some children have very disturbing thoughts or images of hurting others, or improper thoughts or images of sex.

What compulsions or rituals do children and teenagers have? There are many different rituals such as washing and cleaning, repeating actions until they are just right, starting things over again, doing things evenly, erasing, rewriting, asking the same question over and over again, confessing or apologizing, saying lucky words or numbers, checking, touching, tapping, counting, praying, ordering, arranging and hoarding.

According to The American Academy of Child and Adolescent Psychiatry, “Research shows that OCD is a brain disorder and tends to run in families, although this doesn’t mean the child will definitely develop symptoms if a parent has the disorder. A child may also develop OCD with no previous family history.”

Can OCD in children and teenagers be treated? Yes, OCD in children can be effectively treated. Although there is no cure for OCD, cognitive-behavioral therapy (CBT) and medicines are effective in managing the symptoms. Experts agree that CBT is the treatment of choice for children with OCD. Whenever possible, CBT should be tried before medicine with children.

Resources

For more information about OCD in kids and teens, including helpful information for family members, your child’s pediatrician, and your child’s school, click here.

A recommended book, “Talking Back to OCD” by Dr. John March for parents to use with children and teens diagnosed with OCD.

“Being Me with OCD: How I Learned to Obsess Less and Live My Life” by Alison Dotson is highly recommended. Dotson was diagnosed with OCD at age twenty-six, after suffering from “taboo” obsessions for more than a decade.

OCD Awareness Week goes from Sunday to Saturday, October 13–19. Each year during the second full week of October, community groups, service organizations, and clinics across the US and around the world celebrate OCD Awareness Week with events such as educational lecture series, OCD-inspired art exhibits, grassroots fundraisers, and more.

As a kick-off to #OCDweek, on Saturday, October 12th, the International OCD Foundation (IOCDF) will co-host the Mental Health Advocacy Capital Walk at the National Mall in Washington, DC.

Melissa Martin, Ph.D., is an author, columnist, educator, and therapist. She lives in Ohio.

Intrusive, unwanted thoughts

By Haneen Mas’oud

Clinical Psychologist

 

Do you find yourself constantly going back to check if you locked your front door or the car? People with obsessive thoughts and compulsive behaviours that interfere with daily life have Obsessive Compulsive Disorder (OCD). 

 

What is OCD?

 

OCD is an anxiety disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions), which interfere with a person’s daily activities and social interactions, according to the American Psychiatric Association. These obsessions and compulsions can be time consuming and very exhausting to the person experiencing them. Rituals like checking, washing and cleaning are most common types of OCD, and are done to relieve the anxiety resulted by the obsessive thoughts.

 

Causes of OCD

 

Causes of OCD have not been identified but genetics and having a predisposition to develop OCD symptoms may be a factor along with environmental factors, such as childhood abuse, neglect, psychological and physical trauma, big life events like marriage, divorce and moving out.

 

Basic types of OCD

 

OCD patients may experience more than one type of OCD:

 

• Checkers: Those who feel compelled to repeatedly check objects; doors, locks, ovens and other appliances at home, or even checking in on their loved ones

• Washers and cleaners: Obsessions about contamination by germs, dirt and viruses 

• Orders and repeaters: Those who keep repeating particular actions or thoughts like prayers or arranging items in a specific perfect way

• Pure obsessionals: Some people experience sexual or aggressive obsessions that involve causing harm to others. They are mortified by such thoughts and, as a result, work very hard to suppress or push them away

• Hoarders: Those who collect unimportant items and face difficulties throwing them away, developing a strong attachment to these items while having the fear of needing them if thrown away

• People with scrupulosity: Those who have religious or ethical obsessions, being preoccupied with doing the right thing

 

Treatment options for OCD

 

The most effective treatment is Exposure and Response Prevention, a cognitive behavioural therapy that focuses on cognition and behaviour:

• The cognitive part is mainly focused on the faulty beliefs (the obsessions) the individual is experiencing

• The behaviour part includes exposing the individual to experience anxiety, provoking situations in a gradual process under the supervision of a psychologist

Medication can be prescribed to OCD patients to reduce the stress resulted by obsessions. However, a combination of both medication and cognitive behavioural therapy can be very helpful in breaking free from OCD symptoms.

Don’t hesitate to seek professional help if you have obsessions or compulsions that affect your daily life. Seeking professional help and enlisting the support of loved ones is very important to getting better.

 

Reprinted with permission from Family Flavours magazine

A Special Episode for Kids: The Fear Facer

Donna De La Cruz contributed reporting. Alex Overington contributed music and sound design.

“The Daily” is made by Theo Balcomb, Andy Mills, Lisa Tobin, Rachel Quester, Lynsea Garrison, Annie Brown, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Larissa Anderson, Wendy Dorr, Chris Wood, Jessica Cheung, Alexandra Leigh Young, Jonathan Wolfe, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, Adizah Eghan, Kelly Prime, Julia Longoria, Sindhu Gnanasambandan, Jazmín Aguilera, M.J. Davis Lin and Dan Powell. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Mikayla Bouchard, Stella Tan and Julia Simon.

Man with OCD films himself nearly 24/7 because he thinks he killed someone

A 27-year-old British man with obsessive-compulsive disorder (OCD) recently revealed the extremes he must go through to manage his mental illness. 

In an interview with BBC, the man, identified as Connor, said he constantly struggles with dark thoughts and films himself throughout the day in order to make sure he hasn’t done anything out of place. 

“I get these thoughts every minute of every day,” he said. “They primarily revolve around death or it could be sexual or it could be violence. It’s about me being a bad persona and how much I don’t want to be a bad person.”

Connor, who lives with his parents and has reportedly lost a girlfriend due to his disorder, added that he often experiences anxiety. 

“The anxiety makes me panic,” he said. “I’ll get headaches. I’ll get dizzy.”

The 27-year-old said his main compulsion is recording his every move with his phone. He also has a separate camera that he uses when he’s on his phone — just to confirm that he hasn’t done anything with his free hand.

Connor’s OCD is so severe that he has allegedly gone to great lengths to retrace his steps when he doesn’t have a camera.

In one instance, Connor’s brother, Cameron, recalled a time when the family went on a holiday trip to Spain about three years ago and they were all sitting outside a nightclub. One of the nightclub’s patrons jokingly told Connor that he had done something sexual to him in the bathroom. 

“After that, once we had flown home, and my [then] girlfriend came to me, she could tell something wasn’t right,” Connor recalled. “Ten, 20 minutes later, I started crying.”

Connor said he flew back to Spain just to confirm that he hadn’t done anything wrong. He revisited the nightclub, which unfortunately didn’t have any security cameras that could have proved his innocence. The Briton said he then visited the hotel where the patron stayed and was told that nothing had happened that night. He ended up sleeping on an outdoor bench before flying back home. 

The disorder has purportedly prevented Connor from holding a steady job. It’s also made him think that he’s murdered someone. 

“I’ll be driving and then I’ll think I’ve hit someone, hit a pothole,” he told BBC. “My mind will think that’s a person. I’ll have to drive back to the pothole to check. I’ll just be doing that for two, three hours.” 

For years, Connor said he has taken medication, received cognitive behavioral therapy and gone through an eye movement desensitization and reprocessing trial. Now, he hopes to ease his condition through an innovative technique called Transcranial Magnetic Stimulation (TMS) — a noninvasive brain procedure that stimulates nerve cells in the brain via magnetic fields. According to the BBC, at least 30 percent of OCD patients have experienced remission through TMS.

“I feel like this is the only option I’ve got left,” Connor said. ” I’m just living in existence, it’s not a life to live.”

Why you’re likely not ‘so OCD’: an underlying look at the mental disorder

How many times have you heard “I like things organized! I’m so OCD!” as if the acronym is a cute trait to flaunt around? Actually, Obsessive-Compulsive Disorder is a serious mental illness in which one obsesses over their thoughts while carrying out ‘compulsions’ to quell their anxiety. Currently, 2 percent of Americans suffer from it — including me.

So, what is OCD exactly? “Beyond OCD” states “obsessions are persistent and uncontrollable thoughts … that are intrusive.”  One will carry out an action, called a ‘compulsion,’ to feel relieved. As a personal example, my OCD theme is integrity, based on a religious fear of not being honest enough before God.

I’ll obsess over my honesty, followed by compulsions to ‘confess’ to others to ensure I have done the right thing and receive disciplinary action if needed. As a result, my social, academic and professional lives have been seriously affected by OCD.

Riley Mott, a transfer junior majoring in environmental science, opened up to his reality with the illness. “My version of OCD makes simple, everyday things very challenging to get through … Anxieties can pop up out of nowhere, putting them in anxious situations.”

Dr. Charles Pittenger, Associate Professor of Psychiatry and the Director of the Yale OCD Clinic, studies the disorder extensively at Yale University and explained his research and insight about the disorder. He explained that the short-term goal is to use existing treatments to aid sufferers.

As for the long-term goal, “We seek to develop new insights into the fundamental causes, brain biology and psychological imbalances that underlie OCD because we believe that such insights will pave the way to new strategies,” Pittenger said.

Through the aid of brain scans, Pittenger explains how brains with OCD work differently than ones without the disorder. “There’s a specific circuitry in the brain involving regions of the cortex and of the basal ganglia that are more active in individuals with OCD than in control individuals,” he said. When symptoms flare, these structures become hyperactive. With treatment, however, these brain areas can be calmed down.

Pittenger mentioned strategies to keep the OCD at bay including taking care of your physical and mental health, keeping yourself busy and not giving in to your compulsions. “When the obsessive thoughts come, the goal should be to accept their existence and let them pass,” Pittenger said. “Fighting them is natural, but it perversely gives them more strength.”

So how do you know if you suffer from this disorder? If you’re obsessing over thoughts for a good chunk of time while carrying out an action that relieves anxiety, then it might be OCD. Meanwhile, if you’re arranging desk items because you like things neat and have no anxiety over the desk’s organization, then you’re likely not OCD. Of course, if you’re not entirely sure, it’s a good idea to make an appointment with a counselor so they can diagnose you.

If you do have the disorder, medication is an option to balance your brain chemistry, which reduces anxiety. For example, I’ve noticed a dramatic improvement in my thought processes to the point where some days I forget I have OCD. Just remember that different medications work differently for everyone, so be patient in finding the right drug and dosage. According to the International OCD Foundation, it takes 10-12 weeks of medication to notice improvement.

After careful consideration, you may realize you don’t have OCD and that you should stop using the acronym because it stigmatizes sufferers. However, you can be a great support system for those who have the illness. Pittenger encourages people to “be a friend; accept that the sufferer is having difficulties, and support them.” At the same time, Pittenger warns that supporters do not accommodate their compulsions, which strengthens the OCD.

The Counseling Center at UMBC is a great resource for anyone going through a mental storm. Just remember, your mental health does not define you and it does get better. Since being diagnosed with OCD in 2018, I’ve come far with my mental health. With counseling, medication and a support system, I’ve made great improvements. Even with flare-ups, these elements of treatment have made me felt like anxiety doesn’t bother me.