Wasted: Eating Disorders are Worse Than Ever

Think anorexia went out with big hair and legwarmers? Think again. Not only are anorexia and other eating disorders still around, they’re worse than ever.

They seemed to come from nowhere. Descriptions of “wasting disease” appear as far back as the 12th century, but it wasn’t until the 1970s that, trickling through the cracks between huge news stories about Roe v. Wade, Patty Hearst and Pol Pot, we started to hear about a small number of girls—young,well-to-do girls from good families who had everything to live for, yet seemed determined to starve themselves to death.

And then they seemed to be everywhere. In the 1980s, television specials covered eating disorders—primarily anorexia—with intense and morbid interest. New Haven native Karen Carpenter’s death from heart failure brought on by anorexia in 1983 fanned the flames.

But then, like a successful virus, eating disorders mutated. They diversified by age, gender, method, geographic location and class, spreading from the small original pool of rich, educated, adolescent girls living in the First World to males, very young children, athletes, middle-aged mothers, island populations. And ironically, with that loss of focus came the misperception that eating disorders were on the wane.

Not so.

“Eating disorders are still a big problem—much more of a problem than they were in the ’80s, for sure,” says Jennifer Smith, who was the director of the Walden Behavioral Care clinic in South Windsor for its first six months and is now a consultant. “It continues to be startling to me that it’s not more in the forefront of people’s minds.”

According to research by the National Eating Disorders Association, nearly 30 million people in the United States suffer from eating disorders. “These are not rare conditions,” says Margo Maine, a clinical psychologist who started the eating disorders program at Newington Children’s Hospital in the early 1980s, ran the eating disorders program at Hartford Hospital’s Institute of Living (IOL) for eight years and is now in private practice in West Hartford. “But despite the fact that eating disorders have grown in numbers and have started to affect people we thought were immune,we still don’t pay much attention to them. That, to me, is the mystery: How we have decided to accept that eating disorders just are, instead of realizing that they are a major public health problem.”

Despite their prevalence, in many cases those suffering from eating disorders have limited treatment options. In Hartford, until last year the only local choice was the IOL program. Though long-lived—opened in 1987, it was one of the first programs in the country—it is small, offering no residential component and serving only females and adolescent boys.

Center for Discovery New England, a residential home for adolescents with eating disorders, opened in Southport in September. Center for Discovery has 10 other facilities in California and Washington. All, like the Southport location, are housed in an actual home in a residential setting rather than in a hospital or clinic. The center has a small number of beds, and is open exclusively to girls and boys ages 11 to 17.

Closer to home, September also brought the opening of the Walden Behavioral Care eating disorders treatment center in South Windsor. Walden has four eating disorder clinics in Massachusetts, one of which offers residential treatment. The South Windsor facility, located in the Eastern Connecticut Health Network building, offers partial hospitalization and intensive outpatient programs for adolescents and adults.

Like most centers, Walden treats all types of eating disorders, both the classics—anorexia and bulimia— and the ones that fall, in medical parlance, under the term EDNOS, or “eating disorder not otherwise specified.” That includes anorexic and bulimic behaviors that don’t reach the established thresholds for official diagnosis—an anorexic who is severely underweight but has not lost her period, for example, or a bulimic who purges less than two days out of the week. One of the most common EDNOS is binge or night eating, which Smith says is “completely underdiagnosed and undertreated.”

Fortunately, binge eating disorder became a recognized specific diagnosis with the March release of the DSM-5, the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. “That creates a higher level of recognition and the need for treatment, especially with the insurance companies,” says Stuart Koman, president and CEO of Walden. “But we’ve been treating this disorder for at least the last five years.”

Most people who are bingers or night eaters are over 40, and have been struggling with the disorder as long as they can remember. Some have gotten bariatric surgery,which is a dangerous procedure on its own, but much more so if the underlying psychiatric issue remains untreated and the patient continues to binge. “You can’t cure a psychiatric condition by surgery,” says SaraNiego, medical director of
the eating disorders program at IOL.

And then there is the “fat” stigma. While the frail frame of an anorexic incites concern and alarm, binge eaters are often dismissed as people with no self-control who “just haven’t tried the right diet,” Smith says. Because of that, binge eaters, like bulimics, often hide their disorders, eating in secret, often late at night after everyone is in bed.

But while the compulsive eating might be kept secret, the shame is all too public. Smith recalls one woman who “had literally been the poster girl for bariatric surgery.” She was an employee of the hospital that performed the surgery, and the hospital made up posters of her to show her dramatic weight loss. Then she gained the weight back. “Every day, she had to walk in and pass by those photos of herself,” Smith says. “Can you imagine? The daily humiliation she experienced was just intense.”

Up to 50 percent of people who are pursuing bariatric surgery and 20 to 40 percent of people who are overweight have binge eating disorder, yet treatment options are few.

To address this need, Walden recently added 1,000 additional square feet to the Connecticut facility, which will house a center for binge and night eating.

While some psychological disorders can be measured and medicated, eating disorders are a mysterious, multifaceted combination. Niego calls them a “bio-psycho-social condition.”

Though scientists have not established a causal link between any one genetic factor and the appearance of an eating disorder, there’s usually some kind of predisposition in the family, such as obsessive-compulsive disorder, anxiety, depression or bipolar disorder. Many have experienced some sort of trauma, from bullying to sexual abuse. And then there is the social aspect, which is illustrated most glaringly in the fact that in the last 40 years, eating disorders have proliferated to more than 40 countries worldwide. “It’s not a First World problem anymore,” says Maine. “It has totally globalized.” And that globalization has a lot to do with the globalization of media influence.

Medical anthropologist Ann Becker conducted a study in Fiji in the mid-’90s, just as satellite television was becoming available there. In 1994, when Becker initiated the study,which focused on how women responded to TV, “food was celebrated, a big body was seen as an advantage, and there was no talk of diets,” says Maine. In 1997, after three years of 90210, “all of a sudden there were eating disorders and dieting—women were not liking their bodies anymore. It was just amazing. As a culture, we have just become crazy about what a woman’s body should look like.”

Eating disorders have not only globalized, they have also infiltrated demographics previously considered “safe.” It used to be thought that if a girl made it though her teen years without an eating disorder, she would never develop one. But an increasing number of women who ate normally throughout adolescence are being diagnosed in middle age.

And those are just the ones that come forward—plenty of others fly under the radar. “Adult women with eating disorders don’t get identified in the health care system whatsoever,” Maine says. “Physicians are so immersed in the war on obesity that if a woman comes in and has lost weight, it’s only seen as positive.”

And eating disorders are less often a single diagnosis. “It used to be clean,”with kids diagnosed with just anorexia or just bulimia, says Paula Holmes, clinical program director at IOL. Now, she says, as much as 60 to 70 percent of people who are admitted to the program with an eating disorder also have a substance abuse issue, which makes them even more difficult to treat. And then there are the “drunkorexics”—kids who skimp on calories during the day so they can drink at night.

Eating disorders are not only varied, they’re also stubborn. “Eating disorders take some time to recover from, and you need a system of support that goes beyond any single level of care,” says Koman. “It may take three, four, five years, and they may go into lots of different programs in that time before they are able to extricate themselves from the series of things that are causing the eating disorder.”

Because of the dearth of nearby treatment centers, most of those multiple programs have been far from home, in Florida, California, Arizona, Oklahoma. Now, with more local options, for some, recovery is that much closer.

Anxiety disorders in children – Eco Child’s Play

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English: A child studying


Anxiety disorders in children


A certain amount of anxiety is a normal part of childhood, and every child will go through different phases, which are usually only temporary and quite harmless.  Sometimes, however, when a child cannot get past his or her anxiety or the shyness, fear, and nervousness that is commonly associated with anxiety, there may be something more serious going on.


Research has shown that anxiety disorders actually affect one in eight children, and often go untreated.  Children suffering from anxiety are at a higher risk of performing badly in school, missing out on normal social experiences, and may even engage in detrimental behavior such as substance abuse.


When a child suffers from an anxiety disorder, it generally means that the problem is significant enough to require intervention; when the condition lasts several weeks or months at a time it is essential.  It is common for anxiety disorders in children to occur alongside other disorders such as depression, ADHD, and eating disorders.  Fortunately, there are a number of treatments and support options that can help children learn how to successfully manage the symptoms and enjoy a normal childhood.


Types of anxiety disorders in children


As with adults, there are many different types of anxiety disorders that children may suffer from.  One of the most common is Separation Anxiety Disorder, in which children have excessive anxiety and stress when they are separated from an important figure, such as a parent, or from the home.  Children suffering from this disorder may cry, refuse to go to bed, eat, or attend school during an episode.  Social Anxiety Disorder is also fairly common in children.  Those suffering from it usually have an intense fear of performance situations as well as social situations, such as parties and other gatherings, and express an extreme concern about humiliation.


Many parents are surprised to learn that Obsessive Compulsive Disorder, or OCD, is also fairly common in kids.  This disorder involves obsessions, or unwanted unpleasant thoughts that make children anxious, and may prompt compulsive behavior in an attempt to reduce those feelings.  Some children may engage in repeated hand washing, tapping, or checking objects.  Like OCD, depression is also common in children, though most parents are under the assumption that it only affects adults.  As in adults, children suffering from depression are persistently sad, withdrawn, and irritable.


There is hope for parents and kids


Like other medical conditions, children’s anxiety disorders can become chronic if not properly treated.  There are a number of treatment methods, ranging from medication and therapy to diet and exercise, to help manage anxiety in kids.  Before parents simply buy Plavix, or any other medication, they should discuss the possible side effects with their pediatrician.  Often, doctors will prescribe a combination of medication, therapy, and home remedies that will be most successful. Children suffering from anxiety should be given a well-balanced diet and avoid foods rich in sugar and caffeine.


Just because a child becomes worried or has a bout of anxiety one day doesn’t mean that he or she is suffering from an anxiety disorder, however, parents do need to pay attention and look for the signs that something may be wrong.  When a child is diagnosed with such a disorder, Mom and Dad must pay attention to their child’s feelings and stay calm when he or she becomes anxious about a particular event or situation.  Parents that recognize and praise small accomplishments, avoid punishing for mistakes, and exhibit flexibility usually have the most success in helping their kids cope with anxiety.


Obsessive-Compulsive Disorder in the Media

Obsessive-Compulsive Disorder in the MediaSometimes, I overhear people casually using the term “OCD” (obsessive-compulsive disorder). They’re ‘OCD with being clean’ or ‘OCD with organizational skills.’

In fact, however, a real struggle with OCD is a manifestation of anxiety that creates an actual disturbance in one’s life.

Lena Dunham, creator/ writer/ producer/ star of the HBO award-winning series “Girls,” showcased the leading character, Hannah, (played by Dunham herself) in very raw and honest encounters with the illness toward the end of this past season. Hannah had dealt with OCD in high school. It resurfaced when she was faced with two significant stressors: trying to write an e-book in a short time frame, and dealing with the rocky aftermath of a breakup.

Whether the scenes illustrated episodes of relentless tics, counting, or a compulsive habit that brought her to the emergency room, “Girls” took on authentic territory that invited other OCD sufferers to feel less alone.

An article here on Psych Central characterizes obsessive-compulsive disorder as “recurrent and disturbing thoughts (called obsessions) or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions).”

Unwanted impulses and bothersome images may also invade the psyche of a person with OCD. While compulsions are usually served to neutralize the excessive thoughts or obsessions, those acts may spark further anxiety since they become very demanding to maintain.

Allison Dotson’s recent article featured on the Huffington Post discusses how the OCD storyline on the series allows other people, dealing with the disorder, to relate.

“As someone with OCD, I find it refreshing to see this often-misunderstood illness portrayed in a realistic way on an acclaimed television show,” Dotson said. She remarks how OCD may be presented as a “charming slapstick character trait,” but “Girls” definitely wasn’t gunning for easy laughs.

“In the real world, OCD symptoms can rear their persistent head just as Hannah’s did under the pressure of a book deadline,” Dotson noted. “Mine certainly did – new obsessions would pop up at bedtime and stick around for months.”

Lena Dunham talks about her own experiences with OCD to Rolling Stone in their cover story, “Lena Dunham: Girl on Top.” She was diagnosed at age 9, after displaying recurring symptoms.

“I was obsessed with the number eight. I’d count eight times … I’d look on both sides of me eight times. I’d make sure nobody was following me down the street, I touched different parts of my bed before I went to sleep, I’d imagine a murder, and I’d imagine that same murder eight times.”

While she tapered off her medication toward the end of college (which produced unpleasant side effects, including extreme exhaustion and night sweats), she still takes a small dose of an antidepressant to alleviate her anxiety.

I have nothing but respect for Dunham, who shared her private (and sometimes dark) history with OCD to the public via “Girls.” A disorder that may be portrayed in the media as humorous or lighthearted now is receiving a bit more attention and awareness. Others who are faced with OCD’s symptoms may be able to connect to Dunham’s character, identifying right alongside her.

“These episodes of ‘Girls’ appear promising,” Kent Sepkowitz wrote in his article in the Daily Beast. “They are ready to show, I hope, that real mental illness is not eradicated by a pill or a better diet, by three visits to a shrink, or by a thoughtful walk along the beach.”


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    Last reviewed: By John M. Grohol, Psy.D. on 27 Apr 2013
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OCD Treatment | How “OCD Rescue Program” Helps People Reduce Obsessive …

Seattle, WA (PRWEB) April 27, 2013

OCD Rescue Program is the newly updated OCD treatment method created by Rich Presta that promises to enable users to reduce Obsessive Compulsive Disorder (OCD). The natural method is based on the combination of new advances and psychological strategies, which can help users deal with anxiety, compulsion and obsessions. Additionally, the program will offer some essential ways that help users identify some OCD symptoms. Thanks to this new method, users will treat their OCD without using medicines, drugs or supplements. After the creator released the new guide, he received a lot of ideas from customers regarding their success with OCD Rescue Program. As a result, the website Vkool.com tested the guide and has completed a full review.

A full review of OCD Rescue Program on the site Vkool.com figures out that OCD Rescue Program is a safe and effective method that helps people decrease OCD quickly. When people purchase the guide, they will receive useful tips that help them lower this condition. In addition, users will get audio supplement series that are formatted in MP3 that they can listen to anywhere they want. Additionally, users will receive many Audios of the anxiety-free masterminds that they can listen to a lot of interviews with the creator about advice for lowering OCD fast. Moreover, people will discover the OCD Triad Audio system that is divided into three parts, which can help users overcome the problem quickly. Furthermore, users will receive some bonuses that are the anxiety helix report, some anxiety-free mastermind transcripts and the OCD Rescue triad audio system volume II, which support them to reduce OCD forever. Indeed, this is a safe and natural method treatment that enables users to decrease OCD permanently.

Sarah Arrow from the website V kool says that: “OCD Rescue Program is the new method that helps users reduce OCD naturally. The helpful method can help users save their time and efforts because they can do it at their own home. In addition, the program will give a 60-day money back guarantee if users are not happy with the result”.

If people wish to view advantages and disadvantages from OCD Rescue Program, they could visit the website: http://vkool.com/ocd-treatment-with-ocd-rescue-program/

To access the complete OCD Rescue Program review, visit the official site.


About the website: Vkool.com is the site built by Tony Nguyen. The site supplies people with tips, ways, programs, methods and e-books about many topics including business, health, entertainment, and lifestyle. People could send their feedback to Tony Nguyen on any digital products via email.

Read the full story at http://www.prweb.com/releases/ocd-treatment/ocd-rescue-program/prweb10674614.htm

Truckee dog trainer discusses obsessive-compulsive disorder

TAHOE/TRUCKEE, Calif. — Dear Carla,

We rescued our Lab, Harry, two years ago. Our vet thinks he’s about 4 years old. The problem is he compulsively chases shadows. We noticed the problem shortly after adopting him, but it seems to be getting worse. It’s especially bad when other dogs are around. Should we be concerned and if so what can we do to stop him?

Harry’s family

Dear Family,

I think you are right to be concerned. Dogs are subject to obsessive-compulsive disorder (OCD) just like humans. OCD is a medical condition where a dog engages in normal canine activities in an abnormally repetitive, frantic and self-destructive manner. There are many OCD type behaviors in dogs including, but not limited to, self-mutilation, compulsive shadow chasing and laser-pointer chasing. Fortunately, this condition can usually be controlled through behavior modification and possibly medication. You should consult with your veterinarian about the best course of treatment.

From a behavior perspective, I would start by trying to determine if there are specific triggers that lead to the behavior and eliminate them. Being around some dogs may make him nervous, but with others he is fine. If you can determine what dogs cause the anxiety, avoid them. It will help to keep his environment calm and predictable. Next, redirect Harry when he begins to chase shadows. Carry a favorite squeaky toy or a ball in your pocket and engage him in a game. You could also ask him to do something he knows well like “sit” or “lay down.” You will need to consistently interrupt the shadow chasing so he can learn new behavior patterns. In addition, adequate daily exercise is very important to relieve stress and minimize anxiety.

The one thing you don’t want to do is punish a compulsive behavior. Punishment is not an effective form of treatment and can actually increase a dog’s level of arousal and anxiety, which in turn can make the symptoms worse. Punishment can also interfere with a dog’s ability to learn new, non-ritualistic behaviors successfully.

The behaviors associated with OCD almost always worsen without treatment, so the sooner you get started the better.

Carla Brown, CPDT is a Certified Professional Dog Trainer and owner of The Savvy Dog Training and Education Center in Truckee. If you have a pet topic/issue you would like to see covered in the Ask the Trainer column, please email her at savvydogtruckee@mac.com.

Obsessive-Compulsive Personality Common in Parkinson’s – GoodTherapy.org

April 22nd, 2013


TherapyNewsPic71Individuals with Parkinson’s disease (PD) often have personality features that mimic those found in depression, anxiety, and even obsessive compulsion (OC). Behaviors such as extreme punctuality, perfectionism, rigidity, harm avoidance, and unwillingness to seek out novel experiences are common in all of these illnesses. New research has begun to explore whether or not any of these personality types are common in people with PD and, if so, whether any of these traits act as predictors of PD, or merely comorbid symptoms. To look at the relationships between PD and personality traits further, Alessandra Nicoletti of the Department of Hygiene, Public Health, and Neuroscience at the University of Catania in Italy recently conducted a study involving 100 clients with PD and 100 without. She evaluated the personality traits of all of the participants and found that OC was present in 40% of the PD participants and 10% of the non-PD participants.

Nicoletti noted that OC personality and Parkinsonian personality both present with similar cognitive and behavioral traits. She believes that even though there is an overlap in symptoms, it has not been shown that OC personality predicts later Parkinson’s. However, some research has suggested a predictive quality in OC personality for future OC. Nicoletti believes the shared traits present in both personality types are the result of similar neurological circuitry, rather than genetic predisposition to Parkinson’s.

The second most common personality type was depressive, accounting for 14 PD participants and four control participants. This personality is characterized by avoidant behaviors and negative affect, which can also be present in individuals with PD alone. Nicoletti added, “Considering the well known high prevalence of depression among the PD patients, we are aware that in some case distinguishing between these two conditions can be difficult.” She hopes that future work will examine this personality type and others more thoroughly in order to establish whether they provide an early indication of Parkinson’s risk or they merely exist as comorbid conditions.

Nicoletti, A., Luca, A., Raciti, L., Contrafatto, D., Bruno, E., et al. (2013). Obsessive compulsive personality disorder and Parkinson’s disease. PLoS ONE 8(1): e54822. doi:10.1371/journal.pone.0054822

© Copyright 2013 by www.GoodTherapy.org Mountain View Bureau – All Rights Reserved.

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Gun mania is obsessive hoarding – Casper Star-Tribune – Casper Star

The recent attention locally at the Wyoming State Legislature and nationally on the extreme behavior of some gun owners left me scratching my head and wondering about their far-out behavior. On researching the questions raised by their behavior, I found some partial answers that I want to share with you.

I found that many of these bad behaving gun owners are suffering from a compulsive obsession with the gun hoarding. One of the symptoms of compulsive-obsession disorder is obsession hoarding. In this context, the hoarding of guns explains the passions and strong feelings of some gun owners. For example, hoarders, compelled by obsessive-compulsive behavior, treat what they hoard as having the same rights as living human beings. They often believe these inanimate objects have the same value as a human life. This kind of obsession also features a preoccupation, or paranoia, that someone “out there” will harm either them or the people or things they care about. The president of the United States could be, to many of these hoarders, the threatening menace.

Some hoarders perform rituals to mitigate the anxiety that stems from their particularly obsessive thoughts. These rituals, for a gun hoarder include buying more guns. The gun hoarder feels that, by doing this, it will somehow prevent a dreaded event from happening, like “Obama is coming for their guns.” The compulsive gun hoarders know that their thoughts and behaviors are not rational, but they feel bound to comply with them to fend off feelings of panic or dread.

Compulsive gun owners are not particularly delusional in other matters in their lives, but are unable to realize which dreaded events are reasonably possible and which are not. When the representatives of the gun industry, like the NRA, declare that “Obama is coming for your guns,” it boosts gun sales to unbelievable heights. These declarations work time and again and set off a maelstrom of irrational gun sales. Because obsessive gun hoarders are unable to rationally evaluate the gun industry’s representative’s claims, they fall for this marketing ploy over and over again.

This rush to buy more guns has led to some side effects that I have personally witnessed. Gun hoarders, compelled to buy guns, have an effect on their families, financially. I know one of these hoarders who, several times over, has rushed out to buy more guns, and has filled two gun safes with his acquisitions. At the same, he jeopardized his credit rating because of late payments and repossessed vehicles. These problems were greatly exacerbated by his uncontrolled gun purchases. There have to be many families who are financially stressed because of compulsive gun buying. His problems were not helped by his hanging out with other gun hoarders who reinforced each other’s obsessions.

Reflecting on the nature of obsessive-compulsive behavior, has explained a lot of the extreme attitudes of some gun owners. By the way, I have been a gun owner all my life and possess a Wyoming concealed weapon permit.

Anxiety and the Monkey Mind

Chimp with toy monkey
Our primordial fight-or-fight response goes haywire when we suffer an anxiety disorder (Lise Gagne/Vetta)

Anxiety is the most common psychiatric complaint, and has its causes in a malfunctioning of our prehistoric fight-or-flight response. Daniel Smith has written a book about the anxiety epidemic, after suffering for decades with a complaint that’s cruellest effect is shutting down our ability to love, writes Lynne Malcolm.

New Yorker Daniel Smith has lived with chronic anxiety for most of his life—well, at least since he was 16, after he lost his virginity to two older women. 

Yes—some young men may not think that was so bad, but it launched Mr Smith into his first period of acute, constant, ‘seize-you-by-the-shirt-lapels’ anxiety. The truth is, as Mr Smith writes in his book Monkey Mind: A Memoir of Anxiety, anxiety disorders can be triggered by just about anything.

Anxiety is by far the most common psychiatric complaint—with double the sufferers of depression. An anxiety disorder involves a degree of distress caused by unjustified, persistent worry: obsessive compulsive disorder, agoraphobia, social anxiety, hypochondria and panic attacks.

‘It feels when anxiety is really acute as if anything around you is a terrible threat to you, catastrophe is about to befall you,’ Mr Smith says.

‘Anxiety is a state of nervous vigilance. You look around for the source of it; it could be anything. It could be the sandwich you’re eating for lunch, it could be the person that you’re living with, it could be the job that you’re in the middle of trying to do.’

Some level of anxiety is normal in humans, Mr Smith says. ‘[I]f we hadn’t been anxious when we were evolving on the African plains lions would have eaten us. And if we weren’t anxious now we would get burned by the hot stove more often than we do, or get hit by cars more often than we do.’

But it’s important to distinguish between normal day-to-day worry and an anxiety disorder, in the same way that we distinguish between a diagnosis of depression and just feeling a bit down. When anxiety starts to control your thoughts rather than you controlling them, it’s a good idea to get help.

Dr Paul Morgan from Sane Australia says that for patients with anxiety disorders it’s often the case that chemical messengers associated with the flight-or-fight mechanism have gone haywire.

‘It’s as though there’s a big red button inside your brain that says “Panic, get the heck out of here,” and this button has somehow got stuck down when you have an anxiety disorder and your brain is going: “It’s an emergency!”’ Dr Morgan says. ‘It’s an emergency but it isn’t.’

Environmental stresses—including the pressures of everyday life—also play a role. And while our modern standard of living is better than ever, it can be argued that the super-abundance of choice in modern life is particularly anxiety inducing, Mr Smith says.

‘It seems comic, but we are met with so many choices now. The internet has broken this wide open; there are so many options and the result is very often a sense of paralysis and a kind of extended adolescence. If I choose one thing I am closing off a thousand other lives and that can be very terrifying.’

Even so, he doesn’t think we live in ‘The Age of Anxiety’.

‘I did a little reading up on the fourteenth century, which was a period in which people’s uneasiness spiked terribly for very good reason: there were roving hordes of mercenaries in the countryside; there was the black plague, which wiped out nearly 50 per cent of the population of Europe; there was a traumatic schism in the church; there were all sorts of terrifying things going on—war, famine. Now that produces anxiety.’

Mr Smith says that the worst thing about an anxiety disorder is the inability to love—the sense of being locked into oneself. Very often people experiencing anxiety are so distressed that they look for someone to blame, and that person is usually a family member or loved one. 

‘People often ask me, “What can I do for my brother, my wife, my husband, my child who is anxious?” And it pains me to have to say nothing. It’s that person’s responsibility or it’s up to that person to learn new ways.’

Dr Morgan has also had personal experience of an anxiety disorder. He says he’s always been a bit of a perfectionist and slightly obsessive from childhood—but he developed chronic anxiety many years ago, when he was working very hard on a project and put himself under a lot of pressure. He began to obsessively worry about anything and everything and felt strangely guilty for no rational reason. Eventually he realised he needed help and got a referral from a GP for some therapy. He says it changed his life.

Dr Morgan says that sometimes anti-anxiety medications, which are called anxiolytics, are prescribed if the person is so severely affected by anxiety that it causes them extreme distress, but caution should be taken because of potential side effects and the risk of developing a dependency. He says they should only be prescribed for short-term use and that psychotherapy is by far the best long-term treatment.

Despite having ‘as many therapists as King Henry VIII had wives,’ Mr Smith was finally able to find a therapist who helped him manage his anxiety: a practitioner of cognitive behavioural therapy, which teaches techniques to change unhelpful and destructive thought processes. 

‘[W]hat you have to do is find a way—find a discipline—to change that pathway, to carve out a new pathway, and to keep doing that practice probably—for someone like me—forever,’ Mr Smith says.

And when that fails, he falls back on the advice from his brother, who made a chance suggestion a few years ago which Mr Smith was at first sceptical about. 

It was to listen to the soundtrack of the beautiful Hollywood romance Singin’ in the Rain with Gene Kelly and Debbie Reynolds.

Listen to more on anxiety and its neurological and environmental causes with Lynne Malcolm on All In The Mind.

Ask the Sexpert: April 18, 2013

Dear Sexpert, 

I have been having a lot of sex lately. I go out often, and when I do, I have sex with different partners. My friends and roommates are concerned with my behavior, and one of them called me a nymphomaniac, which really hurt my feelings. I do not feel like I need to have sex, I just really enjoy it. Am I a sex addict?

—Girl Just Wants to Have Fun


Dear Girl,

Many individual factors, personal feelings and choices go into deciding how much sex is “enough” or “too much.”  You need to consider your own values, priorities and what you consider “too much” sex.  Unless your sexual behavior is interfering with your daily life or harming yourself or others (Do you always use condoms, dental dams, or other forms of barrier protection? Are you regularly tested for STIs? Do you communicate honestly with all of your partners?), you may be comfortable with your life as it is.

That said, some people do experience compulsive sexual behavior, sometimes referred to as hypersexuality or hypersexual disorder. This disorder is defined as an obsession with sexual thoughts, behaviors or feelings that can have a detrimental effect on multiple aspects of one’s life, such as health, occupation, and relationships. Symptoms of compulsive sexual behavior are varied and often case-specific.  Many researchers argue that hypersexuality is not really about sex itself. In these cases, frequent and potentially risky sexual behavior is not simply driven by a craving for sex, but often by an underlying issue. Stress, anxiety, depression and shame are all internal psychological issues that can be externalized through sexual behaviors. Such behaviors become an issue when they result in an obsession that is disruptive or harmful not only to the addict but also to those who surround them. Compulsive sex behavior may also be caused by physical health issues including an imbalance of natural mood-regulating brain chemicals, unusually high levels of androgens (sex hormones that play an important role in generating feelings of sexual desire), or other diseases and health conditions that affect the brain.

If you feel as though you have lost control of your sexual behavior or if you feel like you want to clarify your values around sex, you can speak with a counselor at UHS’s Counseing and Psychological Services office in McCosh. Even if you simply want to discuss your relationships with your friends and roommates, I recommend visiting a counselor. You should seek immediate treatment if you have a history of bipolar disorder or of problems with impulse control, or if you feel as though you are losing control of your sexual behavior.

While your friends clearly care about you, you need to decide for yourself how much sex you want to have and with whom.  There are many resources available to you on campus and many people willing to listen confidentially, starting with University Health Services, so you don’t have to make these decisions alone.

—The Sexpert


Information regarding Compulsive Sexual Behavior provided by The Mayo Clinic.


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Many of us occasionally have thoughts about avoiding germs from shaking hands, refraining from using drinking fountains or public bathrooms, or being fearful of getting too close to those who are sick. When we find ourselves constantly thinking about cleanliness or avoiding contagions and can’t get these thoughts out of our minds, when they consume our time or frequently cause us stress, we may have obsessive-compulsive disorder.

Obsessions are thoughts, ideas, images or impulses that we can’t seem to get out of our head and cause us to become anxious. They usually involve repeated doubts and worries, constant thoughts about contamination, distressing images (either horrific or sexually disturbing), and impulses that we fear we might act on or can’t control.

The typical way we try to deal with these obsessions is to push them down into the smallest nooks and crannies of our psyche, pretending they don’t exist, or to escape or avoid anything that creates tension. If we attempt to neutralize this internal tension by repetitive behavior, this could be considered compulsion.

Compulsions are behaviors or actions we continually repeat to relieve tension or discomfort. The most common types of compulsions are repetitive mental or physical behaviors, such as putting things in order, checking things repeatedly, washing hands, counting to oneself or saying certain words – all done with the intention of reducing stress and anxiety.

After unsuccessful attempts to turn off the negative, obsessive thoughts or compulsive acts, we give up trying to resist, letting them rule our day and dominate us. Most of us lack the time and energy to process the daily barrage of impressions, images, drama and problems that face us. Instead of trying to make meaning out of our day through reflection, we turn on the television, have a glass of wine or a beer, or get lost in Facebook.

Obsessive thoughts and compulsive actions, when allowed to run amok, possess us by causing us to think we are prisoners to them. We can instead try something different than ignoring or transferring the pain.

First, we can try getting out into nature. When we’re able to immerse ourselves in our sensations – at the beach, mountains, or in the desert – we start to become more mindful, grounded and relaxed. Another way would be to practice rhythmic, repetitive movements with our breathing, such as running or brisk walking while breathing deeply and swinging our arms.

Doing an evening review of your day through noting thoughts and feelings and letting go of anything upsetting is another way to deal with unresolved issues. Using journaling to write down your inner emotions and negative thoughts is ideal.

Substituting thoughts or actions with a prayer, mantra or positive image works well. Meditation, the quieting of the mind and turning off thoughts, achieves peace and calm. It is only through reflection that we gain insight into our lives.

Meeting with a psychologist to reveal the patterns that have created this anxiety can be helpful. If you feel acutely anxious above and beyond obsessive traits or compulsions, you may need to see a psychiatrist and augment these procedures with medications.

Thomas Conte Manheim is a clinical psychologist specializing in the treatment of anxiety and depression. He practices in Del Mar/Solana Beach and can be reached at tom@moneyandsoul.com

We now know that many disorders are physiological, not psychological

Exhaustion weighs her down until she gets out of bed. Trudging to the shower and going down the grocery store aisles feel like a long slog through dark molasses.

By the numbers

Who are the mentally ill? They are our neighbors, friends, family — and us. Put five people in a room and one has suffered from a mental illness in the past year.

One in five adults (46 million Americans) experiences mental illness each year.

One in 17 suffers serious mental illness such as schizophrenia, major depression or bipolar disorder.

One in 10 children lives with a serious mental or emotional disorder.

The rate of mental illness is more than twice as high among those aged 18 to 25 (29.9 percent) than among those 50 and older.

Less than one-third of adults and half of children with a diagnosable mental disorder receives mental health care in a given year.

Half of all lifetime cases of mental illness begins by age 14, three-quarters by 24.

More than 50 percent of students 14 and older with a mental disorder drop out of high school — the highest dropout rate of any disability group.

24 percent of state prisoners and 21 percent of local jail prisoners have a recent history of mental illness.

70 percent of children in juvenile justice systems have at least one mental disorder.

The annual economic, indirect cost of mental illness in the U.S. is about $79 billion, mostly in lost productivity.

Adults living with serious mental illness die 25 years earlier than other Americans, largely due to treatable medical conditions.

An estimated 8.7 million American adults had serious thoughts of suicide in the past year. Of them, 2.5 million made suicide plans, and 1.1 million attempted suicide.

Sources: Substance Abuse and Mental Health Services Administration, National Alliance on Mental Illness, National Institute of Health, U.S. Department of Health and Human Services, National Center for Mental Health and Juvenile Justice

The heaviness caused by major depression has come and gone throughout Lisa Livingston Baker’s life. And when her husband died in 2008, she could not even lift her body from her bed.

Major mental illnesses

Mental illness refers to a wide range of disorders that affect mood, thinking and behavior. More common ones include:

Attention-deficit/hyperactivity disorder: Characterized by inattention, hyperactivity and impulsivity. Strong scientific evidence indicates ADHD is a biologically based disorder. Research also suggests a strong genetic basis.

Bipolar disorder (formerly known as “manic-depressive disorder”): A major mood disorder in which a person experiences episodes of depression and mania (extreme irritability or euphoria). Likely caused by an imbalance of neurotransmitters or hormones. Trauma and major loss may play roles.

Major depression (known as clinical depression): A combination of depressed mood, poor concentration, insomnia, fatigue, appetite disturbances, excessive guilt and suicidal thoughts. Depression is twice as common in women for reasons not fully understood. Likely caused by biological differences in the brain along with trauma or major loss.

Post-traumatic stress disorder: Severe or repeated exposure to trauma can affect the brain in a way that makes a person feel like the event is happening again and again. Can induce anxiety, sleeplessness, anger or substance abuse. PTSD can affect everyone from survivors of sexual trauma and natural disasters to emergency and rescue personnel and military veterans.

Generalized anxiety disorder: A severe, chronic, exaggerated worrying about everyday events. Likely caused by genetics, brain chemistry and environmental stresses.

Obsessive-compulsive disorder: Obsessions are intrusive, irrational thoughts or impulses that repeatedly well up in a person’s mind. Compulsions are repetitive rituals such as handwashing, counting, checking, hoarding or arranging. Evidence suggests that OCD is caused by a chemical imbalance in the brain. People whose brains are injured also can develop OCD.

Panic disorder: Feelings of terror that strike suddenly and repeatedly with no warning. Symptoms include sweating, chest pain and irregular heartbeats. More common in women. Brain abnormalities, family history, major life stress and abuse of drugs and alcohol may play roles.

Schizophrenia: A group of severe brain disorders in which people interpret reality abnormally. May result in hallucinations, delusions and disordered thinking and behavior. Likely caused by differences in the brain, genetic vulnerability and environmental factors that occur during a person’s development.

Personality disorders

Borderline personality disorder: Characterized by unstable moods, interpersonal relationships, self-image and behavior.

Antisocial personality disorder: A person’s thinking and relating to others are abnormal and destructive, such as disregard for right and wrong, lying and behaving violently.

Narcissistic personality disorder: Characterized by an inflated sense of self-importance and a deep need for admiration.

Personality disorders are thought to be caused by genetic and environmental factors.

Sources: National Alliance on Mental Illness, Mayo Clinic, WebMD

She blamed herself.

First in a series

The mentally ill are under pressure and scrutiny like never before. Mental health budgets have been slashed. State inpatient beds are at historic lows. Emergency rooms and jails are the new front lines of care. In the wake of mass shootings — and would-be school shooters such as Alice Boland — some want registration of the severely ill.

But there is promise for change. State funding may increase. Research is showing these illnesses are based in flawed physiology, not character flaws. And many who suffer are challenging the stereotypes that affect them.

The Post and Courier is examining these issues in a series of stories over the next few months. We start with the stigma and its undercurrent of shame.
Join the discussion about this story and other mental health issues at Jennifer Berry Hawes’ Facebook group.

The master’s-educated teacher struggled to raise her three girls as she took medications and entered therapy. Books and tapes about coping amassed beneath her bed.

“I’ve done it all,” the Summerville mom sighed. “And how many more Lisas are out there?”

Millions. One in four adults experiences mental illness in a given year. One in 17 suffers serious mental illness such as schizophrenia, major depression or bipolar disorder, according to the U.S. Department of Health and Human Services.

And at perhaps no other time have they received more public attention than today.

Megachurch Pastor Rick Warren’s son committed suicide a week ago after a long battle with major depression.

Lawmakers are debating mental health care funding, gun control and registries of the mentally ill. And last week, 9th Circuit Solicitor Scarlett Wilson voiced doubt that the state can fully rehabilitate the violent mentally ill.

What does all this attention mean for the average person with a mental illness, suffering amid a public that stigmatizes them?

Baker can’t count how often she’s heard:

Buck up. Get over it. Just cheer up!

“People make you feel bad about yourself — and you make you feel bad about yourself,” Baker said. “I’m not a bad person. I’m not lazy or weak. I’m a good person. I’m trying.”

She recently joined a clinical trial at the Medical University of South Carolina that administers a brain stimulation treatment based on researchers’ improving knowledge of the brain as a highly complex electro-chemical organ, one that can malfunction just like any body part.

After receiving most of her treatments, Baker can laugh again. She even tackled her taxes.

And it’s not just the relief. The boost proves to her that the depression is caused not by personal failure, as stigma insinuates, but rather by malfunctioning brain circuitry.

It’s proof that the illness isn’t her fault.

Biology trumps

Dr. Mark George trained in psychiatry and neurology. He doesn’t see a distinction between the two.

Both deal with disorders caused by dysfunctional brain circuitry. So why are neurological disorders — Parkinson’s disease, for instance — viewed without the stigma that clouds others like depression and bipolar disorder?

“Stigma is really hard for me to deal with. I’ve trained across these disciplines, and to me it’s all the same,” said George, director of MUSC’s Center for Advanced Imaging Research and its Brain Stimulation Laboratory.

Stigma stems from historical misunderstandings, such as when people thought the mentally ill were inherently weak-minded or evil, or when George’s medical school professors taught that the brain was a fixed organ, incapable of changing and repairing itself.

Not true.

Modern imaging technology is allowing researchers to track the brain’s activity and to examine its wiring, structures and tissue micro-architecture to see exactly what is going on inside a living, thinking organ.

It has revolutionized knowledge of psychiatric disorders.

“The brain is really the last frontier in medicine,” George said.

What is now clear to researchers is that malfunctioning brain circuitry, and its interplay with genetics, trauma and environmental stress, plays a major role in many illnesses, including depression, anxiety and addictions. A new mantra rising among medical professionals calls mental illnesses “brain disorders.”

“We have these powerful imaging tools so we can see all of these things,” George said. “This new understanding should make people wake up to stigma.”

For instance, when imaging showed differences in the brains of people with attention deficit hyperactivity disorder, it indicated that the problem wasn’t bad parenting or a lack of discipline. It was based in physiology.

“That was huge. Imaging can add that legitimacy,” said Joseph A. Helpern, professor and vice chairman for research in radiology and endowed chair in brain imaging at MUSC.

Today, MUSC psychiatry is the largest research department in its College of Medicine, and is especially known for research of addictions and imaging techniques. And just this month President Barack Obama announced his BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative to map the brain’s activity in unprecedented detail.

So much research promises better understanding of this final frontier, and new treatments for when its circuits malfunction.

“In mental illness and addiction, the brain is different,” said Rhonda Faughender, clinical director for adult services at Palmetto Behavioral Health System. “But we can retrain our brains.”

Which means there is hope for people like Baker.

Biology of change

Baker sits in a small room in the Institute of Psychiatry lying on what resembles a dentist’s chair.

Dr. Baron Short, clinical director of MUSC’s Brain Stimulation Services, positions a plastic block containing an electromagnetic coil onto the upper left area of Baker’s forehead. She wears neon yellow earplugs to block out the rapid and fairly loud tapping of electrical pulses that penetrate her scalp and skull.

Brain tissue lacks pain receptors, so she can’t feel where the pulses penetrate into her prefrontal cortex, the upper front area of the brain.

Coils pulse for four seconds, then quiet for 20. The sensation on her skin is irritating but not painful, Baker said, like getting snapped by a rubber band.

Transcranial Magnetic Stimulation, recently approved by the FDA for the treatment of depression, aims to rouse the prefrontal cortex. It is considered the brain’s CEO, responsible for abstract thinking and regulating behavior and emotions, and it tends to be underactive in people with depression.

This underactivity, in turn, appears to affect the brain’s limbic system, a primitive area often called the “feeling and reacting brain” that is important in memory formation. This area tends to be overly active in people with depression.

“We’re helping the brain re-regulate itself,” Short explained.

Brain stimulation may hold promise in treating other illnesses, including addiction, which imaging indicates is another form of brain disorder. This also could change societal views of addiction — after all, when it comes to stigma, few disorders carry more shame than drug addiction, George said.

Yet it appears that some people are predisposed to addiction due to overly active brain regions that control craving and desire, while impulse-control areas are not as active. Researchers are testing ways to correct this circuitry just as they are with depression and other illnesses.

On Monday, George and a team of researchers will publish a study in the journal Biological Psychiatry that showed high-frequency TMS significantly reduced nicotine craving even in heavy smokers.

“People still think it’s about bad behavior and not an illness,” George said. “But it’s not you. It is a part of the brain that needs to exercise differently.”

Surviving stigma

Today, when someone is released from a psychiatric hospital, there are no sympathy cards in the mail, no meals provided by friends, no flowers or well-wishers eager to visit.

Often, there is only the suffocating silence of fear and rejection.

“We as a people don’t look at mental illness as an illness. If we just pull up our bootstraps and go, we can go. And it’s so untrue. It’s an illness just like heart disease or cancer,” said Wanda Brockmeyer, emergency services director for Roper St. Francis Healthcare.

When Baker turned 50 recently, she cried.

“This isn’t where I wanted to be,” she said. Then she reminded herself: I’m not a loser.

She wonders if others see her that way.

“Imagine if you said to a person, ‘If you had only been stronger, you wouldn’t have gotten cancer,’” Baker said.

She agreed to share her story here to challenge the stigma, to remind people that those with mental illness are parents, children, neighbors. And that their illnesses aren’t their fault.

Reach Jennifer Hawes at 937-5563, follow her on Twitter at @JenBerryHawes or subscribe to her at facebook.com/jennifer.b.hawes.