When Post-Traumatic Stress Disorder is in the news, it is mostly because of the number of veterans suffering as a result of combat-related trauma. Victims of other kinds of trauma can also suffer from PTSD, though, and often do without realizing it. PTSD mirrors other mental illnesses such as depression and anxiety, and can also present as, “I feel fine,” when really the “feeling fine” rooted in numbness and avoidance.
Are you anxious or are you depressed? In the world of mental health care, where exact diagnosis dictates treatment, anxiety and depression are regarded as two distinct disorders. But in the world of real people, many suffer from both conditions. In fact, most mood disorders present as a combination of anxiety and depression. Surveys show that 60-70% of those with depression also have anxiety. And half of those with chronic anxiety also have clinically significant symptoms of depression.
The coexistence of anxiety and depression-called comorbidity in the psych biz-carries some serious repercussions. It makes the course of disorder more chronic, it impairs functioning at work and in relationships more, and it substantially raises suicide risk.
Over the past couple of years, clinicians and researchers alike have been moving towards a new conclusion: Depression and anxiety are not two disorders that coexist. They are two faces of one disorder.
“They’re probably two sides of the same coin,” says David Barlow, Ph.D., director of the Center for Anxiety and Related Disorders at Boston University. “The genetics seem to be the same. The neurobiology seems to overlap. The psychological and biological nature of the vulnerability are the same. It just seems that some people with the vulnerability react with anxiety to life stressors. And some people, in addition, go beyond that to become depressed.”
They close down. “Depression seems to be a shutdown,” explains Barlow. “Anxiety is a kind of looking to the future, seeing dangerous things that might happen in the next hour, day or weeks. Depression is all that with the addition of ‘I really don’t think I’m going to be able to cope with this, maybe I’ll just give up.’ It’s shutdown marked by mental, cognitive or behavioral slowing.”
At the core of the double disorder is some shared mechanism gone awry. Research points to overreactivity of the stress response system, which sends into overdrive emotional centers of the brain, including the “fear center” in the amygdala. Negative stimuli make a disproportionate impact and hijack response systems.
Mental health professionals often have difficulty distinguishing anxiety from depression, and to some degree they’re off the hook. The treatments that work best for depression also combat anxiety. Cognitive-behavioral therapy (CBT) gets at response patterns central to both conditions. And the drugs most commonly used against depression, the SSRIs, or selective serotonin reuptake inhibitors, have also been proved effective against an array of anxiety disorders, from social phobia to panic and post-traumatic stress disorder (PTSD). Which drug a patient should get is based more on what he or she can tolerate rather than on symptoms.
And therein lies a problem. According to physicians Edward Shorter of Canada and Peter Tyrer of England, the prevailing view of anxiety and depression as two distinct disorders, with multiple flavors of anxiety, is a “wrong classification” that has led the pharmaceutical industry down a “blind alley.” It’s bad enough that the separation of anxiety and depression lacks clinical relevance. But it’s also “one reason for the big slowdown in drug discovery in psychiatric drugs,” the two contend in a recent article published in the British Medical Journal. It’s difficult to create effective drugs for marketing-driven disease “niches.”
Who is at risk for combined anxiety and depression? There’s definitely a family component. “Looking at [what disorders populate] the family history of a person who presents with either primary anxiety or depression provides a clue to whether he or she will end up with both,” says Joseph Himle, Ph.D., associate director of the anxiety disorders unit at University of Michigan.
Age plays a role, too. A person who develops an anxiety disorder for the first time after age 40 is likely also to have depression, observes Himle. “Someone who develops panic attacks for the first time at age 50 often has a history of depression or is experiencing depression at the same time.”
Usually, anxiety precedes depression, typically by several years. Currently, the average age of onset of any anxiety disorder is late childhood/early adolescence. Psychologist Michael Yapko, Ph.D., contends that presents a huge opportunity for the prevention of depression, as the average age of first onset is now mid-20s. “A young person is not likely to outgrow anxiety unless treated and taught cognitive skills,” he says. “But aggressive treatment of the anxiety when it appears can prevent the subsequent development of depression.”
“The shared cornerstone of anxiety and depression is the perceptual process of overestimating the risk in a situation and underestimating personal resources for coping.” Those vulnerable see lots of risk in everyday things-applying for a job, asking for a favor, asking for a date.
Further, anxiety and depression share an avoidant coping style. Sufferers avoid what they fear instead of developing the skills to handle the kinds of situations that make them uncomfortable. Often enough a lack of social skills is at the root.
In fact, says Jerilyn Ross, LICSW, president of the Anxiety Disorders Association of America, the link between social phobia and depression is “dramatic. It often affects young people who can’t go out, can’t date, don’t have friends. They’re very isolated, all alone, and feel cut off.”
Sometimes anxiety is dispositional, and sometimes it’s transmitted to children by parental overconcern. “The largest group of depression/anxiety sufferers is Baby Boomers,” says Yapko. “The fastest growing group is their children. They can’t teach kids what they don’t know. Plus their desire to raise perfect children puts tremendous pressures on the kids. They’re creating a bumper crop of anxious/depressed children.”
Treatment seldom hinges on which disorder came first. “In many cases,” says Ross, “the depression exists because the anxiety is so draining. Once you treat the anxiety, the depression lifts.”
In practice, treatment is targeted at depression and anxiety simultaneously. “There’s increasing interest in treating both disorders at the same time,” reports Himle. “Cognitive behavioral therapy is particularly attractive because it has applications to both.”
Studies show that it is effective against both. But sometimes the depression is so incapacitating that it has to be tackled first. Depression, for example, typically interferes with exposure therapy for anxiety, in which people confront in a graduated way situations they avoid because they give rise to overwhelming fear.
“Exposure therapy requires substantial effort,” explains Himle. “That’s effort that depressed people often do not have available to them.” Antidepressants can make a difference. Most SSRIs are approved for use in anxiety disorders and are the first line of drug therapy. But which drug works best for whom can not be predicted in advance. It takes some trial and error.
Ross finds CBT 80-90% successful in getting people functioning well, “provided it’s done correctly.” Not all psychotherapy is CBT, which has a very specific set of procedures, nor is every mental health professional trained in CBT. “Patients have to make sure that is what they are really getting.”
Medication and CBT are equally effective in reducing anxiety/depression. But CBT is better at preventing relapse, and it creates greater patient satisfaction. “It’s more empowering,” says Yapko. “Patients like feeling responsible for their own success.” Further, new data suggests that the active coping CBT encourages creates new brain circuits that circumvent the dysfunctional response pathways.
Treatment averages 12 to 15 weeks, and patients can expect to see significant improvement by six weeks. “CBT doesn’t involve years and years of talk therapy,” says Ross. “There’s homework, practice and development of lifestyle changes. Once patients learn how to identify the trigger thoughts or feelings, or events or people, they need to keep doing that. CBT gives people the tools they need.”
Obsessive-compulsive disorder (OCD) is characterized by repetitive thoughts, impulses, or images that are intrusive and inappropriate and cause anxiety or distress, or repetitive behaviors that the person feels driven to perform in response to an obsession or rigid rules that must be applied. Those suffering from this condition recognize that the obsessions are a product of their own mind. The obsessions or compulsions are time consuming or interfere with role functioning.
Click here for the original article: http://scitechconnect.elsevier.com/ocd-explained/
Written by Ann Pietrangelo
OCD: Symptoms, Signs & Risk Factors
We all double or triple check something on occasion. We forget if we’ve locked the door or wonder if we’ve left the water running, and we want to be certain. Some of us are perfectionists, so we go over our work several times to make sure it’s right. That’s not abnormal behavior. But if you have obsessive-compulsive disorder (OCD), you feel compelled to act out certain rituals repeatedly, even if you don’t want to — and even if it complicates your life unnecessarily.
Obsessions are the worrisome thoughts that cause anxiety. Compulsions are the behaviors you use to relieve that anxiety.
Signs and Symptoms of OCD
Signs of OCD usually become apparent in childhood or early adulthood. It tends to begin slowly and become more intense as you mature. For many people, symptoms come and go, but it’s usually a lifelong problem. In severe cases, it has a profound impact on quality of life. Without treatment, it can become quite disabling.
Some common obsessions associated with OCD include:
- anxiety about germs and dirt, or fear of contamination
- need for symmetry and order
- concern that your thoughts or compulsions will harm others, feeling you can keep other people safe by performing certain rituals
- worry about discarding things of little or no value
- disturbing thoughts or images about yourself or others
Some of the behaviors that stem from these obsessive thoughts include:
- excessive hand washing, repetitive showering, unnecessary household cleaning
- continually arranging and reordering things to get them just right
- checking the same things over and over even though you know you’ve already checked them
- hoarding unnecessary material possessions like old newspapers and used wrapping paper rather than throwing them away
- counting or repeating a particular word or phrase. Performing a ritual like having to touch something a certain number of times or take a particular number of steps
- focusing on positive thoughts to combat the bad thoughts
Social Signs: What to Look For
Some people with OCD manage to mask their behaviors so they’re less obvious. For others, social situations trigger compulsions. Some things you might notice in a person with OCD:
- raw hands from too much hand washing
- fear of shaking hands or touching things in public
- avoidance of certain situations that trigger obsessive thoughts
- intense anxiety when things are not orderly or symmetrical
- need to check the same things over and over
- constant need for reassurance
- inability to break routine
- counting for no reason or repeating the same word, phrase, or action
- at least an hour each day is spent on unwanted thoughts or rituals
- having trouble getting to work on time or keeping to a schedule due to rituals
Since OCD often begins in childhood, teachers may be the first to notice signs in school. A child who is compelled to count, for instance, may not be able to complete the ritual. The stress can cause angry outbursts and other misbehaviors. One who is afraid of germs may be fearful of playing with other children. A child with OCD may fear they are crazy. Obsessions and compulsions can interfere with schoolwork and lead to poor academic performance.
Children with OCD may have trouble expressing themselves. They may be inflexible and upset when plans change. Their discomfort in social situations can make it difficult to make friends and maintain friendships. In an attempt to mask their compulsions, children with OCD may withdraw socially. Isolation increases the risk for depression.
Risk Factors and Complications
The cause of OCD is not known. It seems to run in families, but there may be environmental factors involved. Most of the time, symptoms of OCD occur before age 25.
If you have OCD, you’re also at increased risk of other anxiety disorders, including major depression and social phobias.
Just because you like things a certain way or arrange your spice rack in alphabetical order, it doesn’t mean you have OCD. However, if obsessive thoughts or ritualistic behavior feels out of your control or are interfering with your life, it’s time to seek treatment.
Treatment usually involves psychotherapy, behavioral modification therapy, or psychiatric medications, alone or in combination. According to Harvard Medical School, with treatment, approximately 10 percent of patients fully recover and about half of patients show some improvement.
Original post: http://www.healthline.com/health/ocd/social-signs
by Jennifer Zimmerman, Demand Media
Behavioral problems have many causes. They can stem from neurological disorders such as attention-deficit/hyperactivity disorder, emotional issues such as abuse or family issues such as divorce. Regardless of the cause, though, some activities can help children with behavioral problems. Parents and teachers will need to determine which activities are most appropriate for a specific child.
No activities can eliminate behavior problems, but some can reduce the likelihood of them occurring. Exercise is recommended by both Kids Health and the American Academy of Pediatrics for help with behavioral problems. For children whose behavior problems have to do with anger, Kids Health recommends martial arts, wrestling and running as especially helpful forms of exercise.
Lack of self-control is often a cause of behavior problems, so the National Association of School Psychologists has suggested activities to help teach self-control. One idea is to use puppets to role-play wanting something that you can’t have. The organization suggests having your child write or draw something he’d like to do, then discussing it and sharing something you’d like to do, but can’t. Next, you and your child can use puppets to role-play scenarios that are typically frustrating for children such as wanting a toy that another child has or wanting to play with a friend who isn’t available. After acting out the scenarios, you and your child should discuss how he felt and what choices he made during the exercise.
Reading to your children is more than just an opportunity to settle down at bedtime and increase literacy skills; it can also be an opportunity to practice identifying feelings. Children who struggle to identify feelings, whether their own or others can have behavior problems. The National Association of School Psychologists suggests parents discuss character’s feelings with their children while they read and encourage children to draw pictures to illustrate those feelings.
Sometimes children misbehave because they don’t know how to handle a circumstance or a feeling correctly, according to the American Academy of Pediatrics. The National Association of School Psychologists suggests teaching children to deal with feeling angry. Have them recognize that they are angry by identifying characteristics such as clenched hands, then have them count to 10, then have them think about their choices. Discuss choices such as walking away, taking deep breaths or telling the person how you feel in a calm voice. Finally, children should act on their best choice.
Click here for original article: http://everydaylife.globalpost.com/activities-children-behavioral-problems-5099.html
Video created by New Zealand Psychologist Dr Alice Boyes. This video is an experiment in making some basic videos.