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Understanding Anxiety Disorders

Millions of individuals live each day in fear – not of an actual physical threat, but imaginary dangers, remembered trauma, inanimate objects, or something as simple as walking outside their front door.

The most common psychiatric illnesses today are anxiety disorders.  Estimates place the number of affected Americans at up to 40 million. At least 18% of adults and 13% of children suffer from some type of anxiety disorder in a given year.

The Nature of Anxiety Disorders

We all experience brief moments of anxiety during stress.  In order to be considered an actual disorder, anxiety symptoms must be intense and frequent.

Mental health professionals recognize six different types of anxiety disorders:

  • Obsessive-compulsive disorder – continual disturbing thoughts and/or the need to perform ritualistic behaviors;
  • Generalized anxiety disorder – excessive, unrealistic worry or tension without apparent cause;
  • Post-traumatic stress disorder – frightening thoughts and memories after a traumatic event, often with emotional numbing;
  • Social anxiety disorder – overwhelming self-consciousness or phobia about being in social situations;
  • Panic disorder – sudden feelings of terror, often with incapacitating physical symptoms;
  • Specific phobias – intense fears of specific situations or objects.

Excessive fears or feelings of dread are common to all types of anxiety disorders.

Common Symptoms

While clusters of symptoms vary with the type of anxiety disorder, individuals with severe anxiety may experience:

  • Persistent feelings of panic, fear, or dread;
  • Obsessive thoughts;
  • Ritualistic, compulsive behaviors;
  • Flashbacks to traumatic experiences;
  • Feelings of losing control;
  • Frequent nightmares;
    • Intense fears in public situation;
    • Intense fears of certain objects or activities;
    • Physical symptoms such as shortness of breath, heart palpitations, nausea, muscle tension, dizziness, or dry mouth.

Causes and Risk Factors

Many factors may influence the development of an anxiety disorder.  They include genetic tendencies as well as such environmental factors as repeated exposure to stressful events or one major traumatic event. Even certain medications, including antihistamines, oral contraceptives, and insulin, have been found to trigger anxiety.  As with most mental illnesses, anxiety disorders appear to develop from an interaction of many medical, genetic, psychological, and environmental factors.

Anxiety disorders can affect anyone and often occur in conjunction with other physical and mental illnesses. Women are diagnosed with anxiety disorders more frequently than men.  No differences in prevalence have been noted across races or cultures.

Anxiety Treatment

Treatment of anxiety can greatly reduce or eliminate symptoms in most individuals.  Primary treatments for most anxiety disorders include medication and psychotherapy.  Treatment can usually be provided on an outpatient basis, although brief residential or inpatient treatment is sometimes needed, depending upon the individual’s unique needs.

Medications used to treat anxiety disorders include a variety of antidepressants and anti-anxiety drugs.

Cognitive-behavioral therapy is the preferred type of psychotherapy for severe anxiety.  Through therapy, patients learn to recognize unhealthy thought patterns and behaviors associated with their anxiety and to change both faulty thinking patterns and their reactions to “trigger” situations.

In addition to medication and psychotherapy, treatment may include relaxation therapy, changes in diet and lifestyle, and education on the illness for both patients and their families.

While anxiety disorders cannot be prevented, people can often reduce symptoms by limiting caffeine consumption, avoiding over-stimulating medications or supplements, and seeking immediate support or counseling after a traumatic experience.

Through proper treatment and symptom management, millions of individuals affected by anxiety disorders can lead fulfilling lives again.

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Treating Obsessive-Compulsive Disorder with Cognitive-Behavioral Therapy

Patients with obsessive-compulsive disorder (OCD) frequently experience problems with disturbing, intrusive thoughts, as well as overwhelming impulses to perform ritualistic behaviors that reduce the anxiety associated with such thoughts. Traditional psychotherapy has not been found to be helpful for most individuals with OCD.  However, one modern form of treatment is particularly successful in overcoming symptoms of the disorder.

The nature of cognitive-behavioral therapy

OCD patients typically become distressed about negative thoughts or obsessions, because they see them as warnings of potentially dangerous events. Cognitive –behavioral therapy (CBT) helps patients identify such unrealistic thoughts and reinterpret them, thereby reducing anxiety.  Fewer anxious thoughts lead to decreased compulsive behavior.

How does CBT work?  Treatment focuses on helping patients examine the relationship between their feelings, thoughts, and behaviors. Using a collaborative and structured approach, therapists guide patients to explore and expose themselves to their fears and anxieties in a controlled and safe environment.  The beliefs surrounding those fears are also identified, challenged, and ultimately changed.

Patients learn to recognize their worries as being obsessions and to see their rituals as compulsions. Treatment includes a variety of structured techniques and strategies.

Homework

Working on assignments between therapy sessions is an important part of the treatment process.  Patients are usually asked to keep a journal or “thought record” of their obsessions, in which they write down each one when it occurs, as well as their interpretation of its meaning.  The therapist reviews the journal with the patient and helps challenge any unrealistic beliefs or “magical thinking” that surrounds the obsessive thoughts.

Behavioral Experiments

Once a patient understands the relationships between thoughts and behaviors, therapy may progress to the use of behavioral “experiments,” in which the patient practices what has been learned.  An individual who believes that touching a doorknob three times will prevent her house from burning down may be asked by her therapist to touch it only once, then leave the house.  She will then see that nothing catastrophic happens.

One effective type of behavioral experiment is the use of exposure and ritual prevention.  This technique involves a patient’s prolonged exposure to a distressing situation or object, along with strict prevention of any associated ritualistic behavior.

First the patient is exposed to a situation or cue that stimulates obsessive thoughts. For example, a patient with a germ obsession may find that touching a faucet in a public restroom triggers thoughts of contracting a fatal disease. These thoughts, in turn, lead to compulsive hand washing. During exposure, the patient may actually touch the restroom faucet, while imagining the possible horrible consequences associated with this action.

Following exposure to the triggering obsessive thought, the patient is asked to abstain from performing the behavior believed to prevent the feared consequence; e.g., ritual hand washing. After several exposures, followed by no performance of the compulsive act, the patient realizes that the feared consequence does not occur if the compulsive act is not performed.  More importantly, the patient realizes that distress and anxiety can lesson even without performance of the ritualized behaviors.

Finally, the patient and therapist process the patient’s experience during or after the experiment and discuss how the experience affects the patient’s beliefs and fears.

CBT is generally successful as a short-term therapy, and it has achieved very positive results with a variety of patients.

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Obsessive Compulsive Disorder Treatment Methods

Constant hand washing, repetitive touching of doorways, checking ten times to make sure the stove is turned off:  these are all examples of behaviors we frequently associate with obsessive compulsive disorder, or OCD.

The nature of obsessive compulsive disorder

OCD is a type of anxiety disorder, characterized by unwanted, uncontrollable thoughts as well as repetitive or ritualized behaviors.  While the thoughts and actions are irrational and unproductive, the affected individual is unable to resist the urge to express them.

An obsession is a frequent and uncontrollable impulse, thought, or mental image that an individual experiences.  They are often quite disturbing or unpleasant, as well as distracting.

A compulsion is a behavior or ritual that an individual repeatedly completes as a way of trying to make an obsessive thought go away.  Individuals with obsessive thoughts about being unclean may wash their hands until they are raw.  However, compulsive behavior not only does not reduce an obsession; these frustrating and time-consuming acts usually increase anxiety.

Treatment of obsessive compulsive disorder

OCD is a mental disorder that responds successfully to treatment.  The two most effective types of OCD treatment are cognitive-behavioral therapy and medication, often used in combination.

Cognitive-behavioral therapy, or CBT, is a type of psychotherapy that involves retraining one’s thought patterns so that compulsive behaviors no longer feel necessary.

Two CBT components are most effective in treatment of obsessive compulsive disorder:

  1. Exposure and response prevention, or ERP, is a treatment that involves repeated exposure to a source or common cue for an obsession, while the individual refrains from the associated compulsive behavior.  Using the previous example of compulsive hand washing, an individual might be asked to repeatedly touch a public restroom’s door handle and then be prevented from hand washing.   Gradually the individual learns that nothing catastrophic occurs when the behavior is not performed. The more an individual is exposed to an anxiety-provoking trigger without incident, the more the association weakens. ERP is a therapy based upon literally facing one’s fears.
  2. Cognitive therapy focuses on the obsessive thoughts themselves.  Individuals with OCD often think of “worse-case” scenarios or experience an exaggerated sense of personal responsibility for things they cannot really control; e.g., a plane crash. Through “cognitive restructuring,” harmful thought patterns can be challenged and healthier, alternative ways of thinking can be developed. For example, the hand-washing individual may explore the underlying belief prompting this behavior, such as “I am unclean.” Once an unrealistic belief is discovered and challenged, the need to engage in the anxiety-reducing behavior may disappear over time.

Medication has also been found to be effective in obsessive compulsive disorder treatment for many individuals.  Some psychiatric or psychotropic medications help control obsessions and compulsions.  These include antidepressants that increase serotonin levels in the brain, which may be low in individuals with OCD.  Medication, if indicated, is normally used in conjunction with psychotherapy.

Professional treatment for OCD is highly effective, with research findings of long-term recovery rates of up to 75% or more.  With proper intervention, individuals struggling with the anxiety and frustration of obsessive compulsive disorder can resume productive lives.

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Mood Disorders and Personality Disorders among the Most Common Mental Illnesses

 Mental health problems are the leading cause of disability in the U.S., costing our society countless hours of productivity each year.

The types of mental illnesses are wide-ranging and are classified according to symptoms and characteristics.  It is not always easy to pinpoint a specific mental disorder. This is in part due to similarities between some of the symptoms of various illnesses. Although many established treatment methods have proven to be effective, approaches to treatment are continuously evolving and depend upon circumstances and contributing factors that are unique to each individual.

The Most Prevalent Types of Mental Disorders

Nearly nine percent of Americans suffer from some form of depression, according to the Centers for Disease Control and Prevention (CDC). Depression falls into the “mood disorders” category and can range from relatively mild depression to potentially debilitating “major depression.”

Other mood disorders include manias and manic disorders — which are indicated by abnormally elevated moods and elation — and bipolar disorders, which carry symptoms such as fluctuations between mania and depression or “mood swings.”

Personality disorders are another common category of mental illness. These are indicated by unstable and socially abnormal behavior patterns and include disorders such as schizophrenia and obsessive compulsive disorder (OCD). Mental illnesses such as OCD and various phobias are often also categorized as anxiety disorders.

The statistics on mental illness in our society are sobering. But the good news is that expertise in the areas of OCD treatment, depression treatment and overall mental health treatment continues to advance. Innovations in research, medications, psychotherapy, behavior modification techniques and the advent of technology such as transcranial magnetic stimulation (TMS treatment) are resulting in increasingly positive results in the treatment of a wide spectrum of mental disorders.

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Help Available for Compulsive Hoarders

Compulsive hoarding is by no means a new phenomenon. However, it has recently moved into the spotlight courtesy of several documentaries and television shows such as A&E’s “Hoarders” and TLC’s “Hoarding: Buried Alive.”

The exposure compulsive hoarding has gained as a result has been an eye-opener to many hoarders as well as to those around them. It has brought awareness to the fact that treatment is available to help people begin to unclutter their lives.

The Characteristics of a Hoarder

Compulsive hoarding affects roughly two million Americans, according to Psychology Today Magazine. Although it is argued in some circles that hoarding is a stand-alone disorder, it is most often placed within the category of obsessive compulsive disorders (OCD).

Generally, hoarders fear that throwing anything away will have negative repercussions on their lives. As a result, they collect and accumulate things that might have little or no real use.

Although the scene inside their dwelling might appear chaotic to others, many hoarders feel hanging onto items provides them with a certain amount of control and sense of organization. Hoarders feel a personal responsibility and connection to their possessions. If an item is lost or discarded, the fragile balance in their lives can be disrupted.

Getting Help

In treating compulsive hoarding, mental health professionals use an approach similar to that of OCD treatment. The foundation of treatment focuses on a combination of medication and psychotherapy. Specifically, behavioral therapies such as cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are employed.

Some of the goals within behavioral therapy include diminishing the hoarder’s urge to save, and redirecting the distorted view of the importance they place on the items in question. Therapy also helps at decreasing a hoarder’s anxiety over discarding items and improving their judgment and decision-making capabilities.

Mental health centers across the country are home to experienced professionals who have successfully treated compulsive hoarders. Though treatment can be lengthy and at times difficult, it can provide a new lease on life for those struggling with this all-consuming disorder.

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Stigma Surrounding Mental Illness Slowly Decreasing

There is an overriding tendency within human nature to fear what we don’t understand. Throughout history, this “fear of the unknown” has shaped our perception in regard to those who suffer from mental illness.

Assumptions and judgments are formed about people with mental health issues often without any understanding of the causes, symptoms and treatment of a particular disorder. Moreover, people tend to believe that those who are mentally ill have a greater propensity toward displaying violent behavior.

However this is simply not the case. Numerous studies have shown those with mental disorders are no more likely than anyone else to commit violent acts. In fact, the mentally ill are more likely to be the victims of violent crimes than the perpetrators.

The Stigma Softens

In the past, the portrayal of those with mental illness in books, film and television were major contributors to the negative reaction that terms such as “mental disorder” and “schizophrenia” often received from the general public.

However, in more recent years, a greater effort has taken place to educate the public about mental illness.  These positive developments include:

  • Mental health centers with educational programs that raise public awareness  about the truths of  mental disorders, as well as addressing successful treatment modalities for OCD, ADHD, depression,  and eating disorders.
  • Organizations such as the National Institute of Mental Health (NIMH) that work with media and news organizations to raise awareness about mental illnesses.
  • TV shows and documentaries focusing on the lives and struggles of people with bipolar disorders, obsessive compulsive disorders and other illnesses.
  • The emergence of celebrities who are beginning to discuss their mental health issues in public forums.

By increasing exposure to the facts and attaching names and faces to various disorders, the stigma and stereotypes surrounding mental illness are gradually fading. All these factors contribute to encouraging those with mental illness and other mental health concerns feel empowered to discuss their issues and seek help.

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Mental Illness Does Not Discriminate: Celebrity Struggles Well-Documented

In recent years, many high profile actors, politicians and athletes have opted to take the step of disclosing their battles with mental disorders to the general public.

In doing so, these people have elevated public awareness of conditions such as bipolar disorders, depression and attention deficit hyperactivity disorders (ADHD). In some cases, the decisions by these public figures to reveal their struggles have been the catalyst for everyday people to seek help for their own mental conditions.

Public Figures Reveal Mental Health Issues

After a stressful period in which she was caring for her cancer-stricken husband actor Michael Douglass, Catherine Zeta-Jones decided to check herself into a mental health treatment center. Zeta-Jones had reached a point where she was fluctuating between periods of joy and deep depression and knew she had to take additional action to address her condition. As a result of her decision to seek treatment, the famous actress discovered she had bipolar II disorder.

Not long ago, comedian and game show host Howie Mandel was officially diagnosed with obsessive compulsive disorder (OCD) and ADHD. After years of dealing with racing thoughts, an inability to sit still and obsessing over germs, Mandel decided to get help. After seeing improvements in his mental health with ADHD treatment and OCD treatment that included the use of psychotherapy and medication, Mandel is now a spokesman for these disorders and fights to diminish stigmas attached to them.

Mental health issues surrounding professional athletes have also come to the forefront. Reigning National League MVP Joey Votto of the Cincinnati Reds and boxer Mike Tyson both endured bouts of severe depression. Additionally, a Duke University study found that nearly half of all U.S. presidents have at some point battled mood disorders that include depression.

Mental illness is not something an individual should be embarrassed about or feel they have to keep secret. Numerous agencies and mental health centers offer treatment that allows individuals struggling with mental disorders to live normal and productive lives.

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Understanding Anxiety Disorders

Everyone experiences some level of worry or anxiety from time to time. But when that worry or anxiousness becomes overwhelming or subsists for long periods of time, there may be a deeper issue at hand.

In a given year, anxiety disorders affect roughly 18 percent of Americans over the age of 18, according to the National Institute of Mental Health (NIMH). Following are descriptions of some of the more prominent anxiety disorders:

Panic Disorder: A panic attack is a brief period of intense uneasiness, fear or distress. The duration of these attacks can range anywhere from minutes to a few hours. While the cause is not completely clear, it is thought that the tendency toward panic attacks could be genetic or linked to a traumatic occurrence in an individual’s life. Those suffering from panic disorders display an inability to properly process stressful situations and therefore react to them with a heightened sense of fear and apprehensiveness.

Obsessive-Compulsive Disorder (OCD): Those suffering with OCD are bombarded with persistent thoughts and fears usually focusing on one area. They develop repetitive behaviors in an attempt to “control” the things causing their fears, and end up becoming obsessed with their rituals.

Post-Traumatic Stress Disorder (PTSD): PTSD is the result of a terrifying or traumatic event in one’s life where they will re-experience the event and react with intense fear, anger, anxiety or even numbness. These episodes are usually brought about by exposure to a situation, thought or image reminding them of the original experience.

A combination of psychotherapy, behavior modification and medications are used for OCD treatment, PTSD treatment and the treatment of most other anxiety disorders. Mental health professionals continue to gain a better understanding of anxiety-related disorders, which has resulted in more effective methods of therapy.