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Anxiety Disorders

Anxiety disorders are the most common mental illness, affecting more than 19 million Americans each year, with over 30% of the national mental health bill being spent to treat the effects of the disorders. Before any mental illness treatment begins, however, a full medical examination is required to rule out possible physical problems that may be causing the resulting anxiety.

Normal anxiety is experienced by almost everyone before an important event, but Anxiety disorders overwhelm people’s lives, tormenting them with panic attacks, obsessive thoughts, flashbacks, nightmares, or countless other frightening physical symptoms. Some people even become housebound.

Treatments vary according to the specific disorder or combination of disorders. Psychotherapy, specifically Behavioral and Cognitive-Behavioral Therapy, has been clinically proven to be the most effective way to treat Anxiety disorders. Medications, such as antidepressants and benzodiazepines, are sometimes prescribed to enhance treatment and don’t work as well when not used in conjunction with psychotherapy.

It’s common for an anxiety disorder to be accompanied by depression, eating disorders, substance abuse, physical problems, or other anxiety disorders. In these instances, all the disorders need to be treated.

Panic Disorders

Panic disorder is the most common mental illness in the United States. More than 2.4 million adult Americans are affected each year. Panic disorder is twice as common in women as men and often begins during late adolescence or early adulthood. Panic disorder also appears to be inherited. If left untreated, Panic disorders can be extremely disabling and can lead to agoraphobia.

The average person has at least one panic attack during their lifetime, and most never experience more than one. Panic disorder is characterized by episodes of terror that strikes suddenly, repeatedly, and without warning. The average episode peaks after ten minutes, but the symptoms that accompany these episodes can linger for hours.

palpitating heart, chest pain, or smothering sensation
profuse sweating
weakness
faintness
dizziness
tingling or numbness in hands
flushed or chilled skin
nausea
sense of unreality
fear of impending doom or loss of control
belief in having a heart attack, loosing sanity, or being on the verge of death

Panic attacks can occur anytime, even during sleep. Heightened anxiety between episodes contributes to the helpless feeling most suffers experience. This helplessness can lead to a pattern of avoidance of places or situations where attacks have occurred, as well as the development of phobias. Suffers may become housebound and withdrawn to avoid situations where they would feel helpless or embarrassed if they had an attack. The extreme form of this behavior is known as agoraphobia.

Agoraphobia is intense anxiety about being in a place or situation from which escape could be difficult or embarrassing, or in which help may not be available in the event a panic attack or panic-like symptoms occur. Fears typically involve characteristic clusters of situations that might include leaving the home alone, being in a crowded situation, standing in a line, being on a bridge, or traveling in any public or private conveyance, be it an automobile, bus, train, or plane.

Bipolar Disorder

Overview
Bipolar depression disorder is characterized by extreme emotional states of either high euphoria and recklessness, to low depression and listlessness. Bipolar depression disorder, also known as manic-depressive illness, can be a serious and disabling mental illness affecting more than 2 million American adults. Often beginning in adolescence or early adulthood, bipolar disorder can persist for a lifetime. Its causes are elusive and there is no cure, but it can be managed. Left untreated, it invariably gets worse, flaring up for weeks or months at a time and disrupting the lives of those affected, as well as their family and friends.

Bipolar disorder tends to run in families. Family history appears to exist in 60% of cases. Researchers are attempting to identify specific genes in DNA that may make people susceptible to bipolar disorder.

Signs and Symptoms
People with bipolar depression disorder often don’t recognize how impaired they are while experiencing an episode or how great their disorder is affecting their lives and the people around them. Often friends, family, and primary care physicians are factors in urging the person to seek professional help from a trained psychiatrist. Diagnosis screening includes asking friends and family what symptoms the person is exhibiting during the episodes, as well as ruling out other health conditions such as mood disorders, possible schizophrenia, ADHD, borderline personality disorder, substance abuse, or thyroid disorders.

Bipolar disorder is characterized by an alternating pattern of emotional highs (mania) and lows (depression). The intensity of signs and symptoms varies from mild to severe.
Signs and symptoms are divided into the mania and depression categories and are listed below.

Mania

Essential features (must be present)

Social or occupational impairment
Mood swings from elated to irritable or hostile

Core features (usually present)

Inflated self-esteem or grandiosity, extreme optimism, feelings of euphoria
Decreased need for sleep
Impulsive or reckless behavior (i.e. excessive involvement in pleasurable activities that have a high potential for painful consequences, like buying sprees, sexual indiscretions, or foolish business investments)
Over-talkative, rapid speech, racing thoughts, agitation
Hyperactivity or increase in goal-directed activity
Poor concentration (distractibility)

Severe symptoms

Suspiciousness or distrust
Economic problems
Poor personal self-care (may require hospitalization)
Increased impulsiveness
Criminal behavior
Physically violent
Increased additions to smoking, alcohol abuse, medication abuse
Euphoria is mixed with depressive thoughts of sadness, apathy, generalized anxiety, feelings of worthlessness or guilt, suicidal thoughts or tendencies
May progress to a catatonic stupor or psychosis with memory impairment, intellectual impairment, and/or an impaired ability to communicate using language or emotions
Impaired or slowed response to stimulus
Delusions or hallucinations
Grossly disorganized speech or behavior
Disorientation
Poor insight

Proven Treatments for Mania

Lithium
Carbamazepine
Valproate
Olanzapine
Risperidone
Haloperidol

Illness Course for Mania

Untreated pure manic episodes usually lasting six weeks
Untreated mixed episodes of mania and depression usually lasting 17 weeks
If left untreated, multiple episodes of mania occur
Mania usually returns within 5 months after stopping lithium treatments
Prognosis: 41% have a good overall outcome and 4% have died
Women with bipolar disorder lose an average of 9 years of life expectancy, 14 years of productivity, and 12 years of normal health

Depression

Essential Features (must be present)

Social or occupational impairment
Either sadness or depressed mood swings, apathy, irritability or hostility (if 18 or younger)

Core features (usually present)

Fatigue and loss of interest in everyday activities
Sleep disturbances
Eating or appetite problems
Feelings of worthlessness or guilt
Recurring suicidal thoughts or tendencies
Trouble concentrating or paying attention
Either hyperactivity, or slowing of response to stimuli

Severe symptoms

Pain or discomfort
Sexual problems
Poor overall physical functioning
Suspiciousness or distrust
Economic problems
Dependent behavior with poor personal self-care (may require hospitalization)
Increased use of smoking, alcohol abuse, medication abuse
Increased anxiety with phobias, panic attacks, anorexia nervosa, bulimia nervosa, or generalized anxiety
May progress to “pseudodementia”, psychosis, or stupor with memory impairment, intellectual impairment, impaired ability to communicate using language or emotions, delusions or hallucinations, disorientation, mutism, negativism, posturing, and poor insight

Proven Treatments for Depression

Lithium
Carbamazepine
Lamotrigine
Fluoxetine
Imipramine
Tranylcypromine

Illness Course for Depression

Untreated depression episodes usually lasting 11 weeks.
Multiple episodes of depression occur if untreated.
Suicide probability is 15-22 times above the national average.
Suicide probability in the first year off lithium therapy is 20 times the rate when on lithium.
Suicide risk is especially high for patients with psychosis, a history of previous suicide attempts, a family history of suicide, or concurrent substance abuse.

Depression

Depression, also known as Clinical Depression, is a serious medical illness that can interfere with an individual’s ability to function. Sadness, loss, or passing mood states are normal, but when the symptoms persist longer than two weeks and cannot be attributed to normal situations or to a medical condition, depression can be debilitating.

Depression annually affects nearly 10% of the American adult population aged 18 and over. Evidence shows a predisposition to depression is hereditary and women are twice as likely to be affected by a depressive illness in any given year.

Depression Disorder has several subtypes, including Unipolar Major Depression, Major Depression, and Dysthymia. Unipolar Major Depression is the leading cause of disability in the United States and worldwide, often beginning between ages 15 to 30, or even earlier.

Bipolar Depression, also known as Manic-Depression, may include periods of depression but must include at least some “manic” symptoms. Manic symptoms vary from mild mania (chronic irritability, restlessness, insomnia, excessive talking) to severe mania (reckless behavior, poor judgment, inappropriate social behavior, explosive anger, spending sprees, impulsiveness, sleep disturbance, and grandiose thinking). A chronic but less severe form of depression called Dysthymia (or Dysthymia Disorder) is diagnosed when a depressed mood persists for at least two years and is accompanied by at least two other symptoms of depression.

Individuals are diagnosed with Clinical Depression when five or more of the following symptoms are present nearly every day during the same two week period:

sadness
loss of interest or pleasure in activities once enjoyed
change in appetite or weight
difficulty sleeping or oversleeping
physical slowing or agitation
fatigue
feelings of worthlessness or inappropriate guilt
difficulty thinking or concentrating
recurrent morbid focus on death or suicide

Depression can be devastating to all areas of an individual’s everyday life, including relationships with family, friends, and co-workers. Many people believe the emotional symptoms of depression is all in their head and can be easily shaken off if they just put their minds to it. This inaccurate belief causes many people to fail to seek treatment for this curable illness because of denial, shame, and the stigma attached to it. Unfortunately, untreated or inadequately treated depression frequently leads to suicide.

Treatment
Antidepressant medications are widely used as effective treatments for depression but need to be monitored because of the unfortunate side effects they have. Psychotherapy is also effective for the treatment of depression, but a combination of psychotherapy and medication therapy is particularly successful in the treatment of the different types of depression.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is characterized by recurrent, unwanted thoughts (obsessions) or rituals (compulsions) that seem uncontrollable to the individual sufferer. About 2.3% of the United States adult population suffers from OCD each year, affecting men and women equally. OCD typically begins during adolescence or early childhood and costs the United States $8.4 billion to treat the social and economic losses incurred from this disorder.

Obsessions are defined in four ways:

recurrent and persistent thoughts, impulses, or images that the individual considers intrusive and inappropriate, resulting in anxiety or distress
thoughts, impulses, or images that go beyond normal worries about everyday problems
the individual attempts to counter those thoughts, impulses, or images by neutralizing them with some other action or thought
the individual realizes that these thoughts, impulses, or images are a product of their own mind and not based on reality

Compulsions are defined in one of two ways:

repetitive behaviors used to counter thoughts, impulses, or images the individual believes to be intrusive or inappropriate
behaviors or ritualistic mental exercises aimed at preventing or reducing distress from perceived consequences of thoughts, impulses, or images

Symptoms of obsessive-compulsive behavior are varied and can manifest themselves in many ways. Examples of these are:

repetitive hand-washing
ordering and re-ordering items in a drawer or cabinet or on a desktop
checking and rechecking lists
repeating rituals unnecessarily, such as checking for locked doors, stove settings, or lights multiple times before being personally assured that everything is as it should be
repeating a mantra, praying, or counting to keep thoughts, impulses, or images from materializing
recurrent intrusive thoughts of hurting oneself or one’s children

Symptoms of both obsessive and compulsive behavior are recognized by the individual as excessive or unreasonable, but they feel powerless to change the behavior for fear of the consequences of failing to counter the thoughts, impulses, or images. Many individuals feel heightened anxiety and a sense of doom and foreboding if they are unable to complete their rituals. They have to be helped to understand that no catastrophe will occur if their behaviors cease. The anxiety caused by obsessions and compulsions are time-consuming, taking more than one hour a day, and can significantly interfere with a person’s normal activities and relationships.

Treatment
Obsessive-Compulsive Disorder is believed to be caused by abnormal functioning of brain circuitry, probably involving the striatum area of the brain. It is not caused by environmental factors in childhood, such as family problems, inordinate emphasis on cleanliness, or belief that certain thoughts are unacceptable or dangerous. Proper medication with psychotherapy has been proven to actually produce changes in the striatum to correct this disorder. One of the most difficult problems in OCD is convincing family members that the individual is unable to simply stop the behaviors. Many OCD sufferers keep their symptoms hidden from doctors to avoid guilt, simply complaining of anxiety or depression, which sometimes accompany the disorder, along with eating disorders, substance abuse, ADHD, and other anxiety disorders. When other anxiety disorders are present, OCD is often difficult to diagnose and treat. Medical problems can coexist with OCD and must also be treated. Appropriate diagnosis and treatment of other disorders are extremely important to the successful treatment of OCD.

Phobias

Phobias are intense, irrational fears of certain things or situations that are debilitating and agonizing to the sufferer. Unlike extreme fear, a phobia is characterized by its irrational nature. While you may be perfectly comfortable scaling the side of a mountain, going above the 5th floor in a building may be terrifying. Teaching to a full classroom may seem natural, but giving a speech to a small group might trigger extreme anxiety. Other phobias might include talking with an authority figure, dating, attending parties, talking on the phone, using a public restroom, eating out, writing in the presence of other people, fear of specific types of animals or insects, flying, injuries involving blood, highway driving, tunnels, closed-in spaces, heights.

Phobias usually first appear in adolescence or early adulthood, starting suddenly, and are persistent for at least six months. Only about 20 percent of adult phobias vanish on their own, while childhood phobias tend to disappear as the child matures. Phobias have been found to run in families and are a little more prevalent in women than men.

Phobias are classified into two main types: Specific Phobia, and Social Phobia. Specific Phobia is cued by the presence or anticipation of a specific object or situation, whereas Social Phobia is an intense fear of social situations, specifically fear of embarrassment or humiliation in front of other people. Both phobias interfere with normal activities and affect social interaction and lifestyle.

Anticipation of exposure to or direct exposure to the phobic stimulus (whether specific or social) almost inevitably provokes an immediate anxiety response, which may take the form of a Panic Attack. In children, these reactions are expressed by crying, tantrums, freezing, or clinging. Adults usually recognize that their feelings are irrational but seem unable to control their anxiety and thus go out of their way to avoid contact or exposure to the stimulus. Children usually don’t recognize their fear as being excessive or unreasonable.

Psychotherapy, specifically behavioral treatments, are used, sometimes in addition to anti-depressant medications, to treat both Specific and Social Phobias.

Post-Traumatic Stress Disorder

Post-traumatic Stress Disorder (PTSD) is a debilitating condition that follows a traumatic incident. People with PTSD often have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. PTSD was first recognized in war veterans and is often referred to as shell shock or battle fatigue. Kidnappings, serious accidents, natural disasters, violent attacks, torture, and captivity can cause PTSD. The event that triggers it may be something that threatens the person’s life or the life of someone close to them, or it could be something witnessed, like the burned-out remains of a home where people died, or the aftermath of a destructive plane crash.

People with PTSD tend to relive the trauma in the form of nightmares and disturbing recollections and flashbacks during their waking hours. Flashbacks may make the person lose touch with reality and reenact the event for a period of seconds or hours or even days. Flashbacks can come in the form of images, sounds, smells, or feelings that seem so real that the person experiencing them believes that the traumatic event is happening all over again. PTSD sufferers may also experience sleep problems, depression, detachment, and hypersensitivity. They may lose interest in things they used to enjoy, have trouble with intimacy, feel irritable, aggressive, violent, anxious to the point of having anxiety attacks. Anniversaries of the event are often extremely difficult to get through.

PTSD can occur at any age and can be accompanied by depression, substance abuse, or anxiety. Symptoms vary from mild to severe. In severe cases, people may have trouble working or socializing. In general, PTSD symptoms seem to be worse if the event that triggered them was initiated by another human being, such as the case in rape versus a natural disaster like a flood.

Not every traumatized person gets full-blown PTSD or experiences PTSD at all. PTSD is diagnosed only if the symptoms last more than a month, with symptoms usually beginning within three months of the trauma. Some people recover within six months, while others may have symptoms that last much longer. Occasionally, the illness doesn’t show up until years after the event.

Specific Symptoms of PTSD
The person has been exposed to a traumatic event in which they experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of themselves or others and the person’s response involved intense fear, helplessness, or horror in one or more of the following ways:

distressing recurrent and intrusive recollections of the event, including images, thoughts, and perceptions
recurrent dreams of the event
flashbacks giving a sense of reliving the experience, possibly including illusions, hallucinations, and disassociation that occurs on awakening or when intoxicated
intense psychological distress at exposure to internal or external triggers that symbolize or resemble an aspect of the event
physiological reactions on exposure to internal or external triggers that symbolize or resemble an aspect of the event

Individuals with PTSD also have persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, as indicated by three or more of the following:

efforts to avoid thoughts, feelings, or conversations about the trauma
efforts to avoid activities, places or people that arouse recollections of the trauma
inability to recall important details of the trauma
markedly loss of interest and participation in significant activities
feelings of detachment or estrangement from others
restricted range of feelings (like intimacy)
sense of foreboding and doom (like not expecting to have a career, family, or normal life span)

PTSD causes persistent symptoms of increased arousal that were not present before the trauma, as indicated by two or more of the following:

sleep disorders
irritability or outbursts of anger
difficulty concentrating
hypervigilance
hypersensitivity (exaggerated startle response)

PTSD which has lasted for at least a month will cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. PTSD is best treated with psychotherapy and medication therapy.

Attention Deficit Hyperactivity Disorder

Today, it seems like more and more children are being informally diagnosed with ADHD by teachers and parents. The symptoms of ADHD can be difficult for adults to handle and can cause major disruptions in a child’s life. However, the symptoms that a child exhibits may reveal only part of a larger picture and it can be difficult to spot underlying issues because of symptom presentation. Symptoms that seem to fall into the ADHD category may actually be anxiety, depression, a learning disability, or another issue. Therefore, clarification is needed. This is why it is important to have a professional intervene to help educate you and your child about the options that are available.

Symptoms of Inattention

Overlooking details
Making careless mistakes
Inability to follow instructions
Inability to finish tasks
Unable to keep attention on tasks
Trouble organizing activities or belongings
Being easily distracted
Day dreaming
Difficulty listening when spoken to directly
Avoidance of things that require long periods of mental effort
Forgetting daily activities

Symptoms of Hyperactivity

Fidgeting with hands and feet
Inability to remain seated when expected
Difficulty with quiet activities (though may be able to focus intensely on video games or other stimulating activities)
Feeling restless
Feeling driven like a motor
Talking excessively

Symptoms of Impulsivity

Blurring out answers before question is finished
Unable to wait their turn
Interrupting other people’s conversations

Oppositional Defiant Disorder (in youth)

All youth can be difficult or go through a resistant phase, but for some kids, it is clearly more. Oppositional Defiant Disorder describes a collection of oppositional behaviors that have begun to cause significant problems at home and at school. These may include: