The symptoms of PTSD may in fact be more appropriately called Accute Stress Disorder.
This diagnosis was brought around due to the amounts of people suffering many of the symptoms of PTSD but possibly not having met all of the criteria for such a diagnosis. As with all issues you're not alone
Acute Stress Disorder SYMPTOMS Acute Stress Disorder is characterized by the development of severe anxiety, dissociative, and other symptoms that occurs within one month after exposure to an extreme traumatic stressor (e.g., witnessing a death or serious accident).
As a response to the traumatic event, the individual develops dissociative symptoms. Individuals with Acute Stress Disorder have a decrease in emotional responsiveness, often finding it difficult or impossible to experience pleasure in previously enjoyable activities, and frequently feel guilty about pursuing usual life tasks.
A person with Acute Stress Disorder may experience difficulty concentrating, feel detached from their bodies, experience the world as unreal or dreamlike, or have increasing difficulty recalling specific details of the traumatic event (dissociative amnesia).
In addition, at least one symptom from each of the symptom clusters required for Posttraumatic Stress Disorder is present. First, the traumatic event is persistently reexperienced (e.g., recurrent recollections, images, thoughts, dreams, illusions, flashback episodes, a sense of reliving the event, or distress on exposure to reminders of the event). Second, reminders of the trauma (e.g., places, people, activities) are avoided.
Finally, hyperarousal in response to stimuli reminiscent of the trauma is present (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, an exaggerated startle response, and motor restlessness).
Specific Symptoms of Acute Stress Disorder:
Acute stress disorder is most often diagnosed when an individual has been exposed to a traumatic event in which both of the following were present:
The person 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 self or others
The person's response involved intense fear, helplessness, or horror Either while experiencing or after experiencing the distressing event, the individual has 3 or more of the following dissociative symptoms:
A subjective sense of numbing, detachment, or absence of emotional responsiveness A reduction in awareness of his or her surroundings (e.g., "being in a daze") Derealization Depersonalization Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)
The traumatic event is persistently re-experienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.
Acute stress disorder is also characterized by significant avoidance of stimuli that arouse recollections of the trauma (e.g., avoiding thoughts, feelings, conversations, activities, places, people).
The person experiencing acute stress disorder also has significant symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).
For acute stress disorder to be diagnosed, the problems noted above must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.
The disturbance in an acute stress disorder must last for a minimum of 2 days and a maximum of 4 weeks, and must occur within 4 weeks of the traumatic event. Symptoms also can not be the result of substance use or abuse (e.g., alcohol, drugs, medications), caused by or an exacerbation of a general or preexisting medical condition, and can not be better explained by a a Brief Psychotic Disorder.
Criteria summarized from: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Showing posts with label Stress. Show all posts
Showing posts with label Stress. Show all posts
Stress and Stomach Problems
Posted by a member of our Voluntary Emergency Services:
It may not be known to you, but your recent stomach ache may be because you are under a lot of stress. Butterflies in your stomach may not be just a figure of speech any more. If you have been under a lot of stress, chances are that you might also suffer from some stomach problems caused by stress.
But one can't help asking the question: How does stress cause stomach problems?
Stress Stomach Problems
The various stomach problems caused due to stress are given below. Irritable Bowel Syndrome (IBS) One of the most common stomach problems caused by stress is the irritable bowel syndrome. Irritable bowel syndrome is an umbrella condition which comprises a variety of illnesses under its purview. Scientists say that when a person is stressed, the brain is programmed to release some hormones and chemicals. When these hormones enter the digestive tract of a person, they cause trouble. Irritable bowel syndrome maybe characterized by either an increase or decrease in the contractions of the intestines.
In case there is an increase in the contractions of the intestine, you might suffer from diarrhea or cramping. On the other hand, if there is a decrease in the contractions of the intestines, it may lead to constipation. The increase or decrease in the motility of the intestines affect the digestive system causing stomach trouble. Thus we see that IBS may cause an increase in the speed of passage of waste matter along the intestines or a decrease in the speed of passage of waste matter.
Read on to know more about symptoms and treatment of irritable bowel syndrome and irritable bowel syndrome medication.
Nervous Stomach
Normally when diagnostic tests fail to identify a particular cause for a stomach related illness, the condition is known as a nervous stomach. When there is no plausible cause for a stomach-related illness, it is generally assumed that the cause for it is a nervous stomach. Nervous stomach is the source of stomach problems from stress. A nervous stomach, like irritable bowel syndrome, is caused due to stress. It may be caused because the brain releases a lot more acids into the stomach when you are stressed.
A nervous stomach may be the cause of any stomach-related illnesses such as abdominal fullness, bloating, belching and flatulence, acid reflux, nausea and heartburn. More on stomach pain and bloating. Read on for more about: Nervous Stomach Ache Nervous Stomach in Children Other Stomach Problems Due to Stress
Along with irritable bowel syndrome and nervous stomach, there may also be a number of other stomach-related illnesses that are caused due to anxiety. One of the most common conditions caused due to stress include stomach ulcers.
Stomach ulcers are inflammation of the stomach due to excessive release of hydrochloric acid in the body. While hydrochloric acid is otherwise present in the body in very small amounts, even the slightest increase can cause trouble.
It is said that although inflammatory bowel disease (IBD) is not directly caused by stress, a preexisting case of IBD may be worsened due to stress.
How to Prevent Stomach Problems Caused by Stress
If your stomach problems are indeed caused by stress, I guess the most logical thing to do would be to reduce stress. So how does one reduce stress? Stress can be effectively managed in several ways. The most common way is to participate in some de-stressing activities which will make you feel less stressed. Find some hobbies which will help you reduce stress.
Other things you can do is to get corrective cognitive therapy that will help you deal with the stress better. You should also learn to prioritize your responsibilities and take up only so much work that you can handle. If nothing worse, try to get counseling, which will surely help you deal with your problems better. Read on for stress relief activities and stress relief techniques.
So now you know about the stomach problems caused by stress and how to cure them. After reading this article you probably know that there may be something else causing your stomach upset rather than a bit of extra pizza!
It may not be known to you, but your recent stomach ache may be because you are under a lot of stress. Butterflies in your stomach may not be just a figure of speech any more. If you have been under a lot of stress, chances are that you might also suffer from some stomach problems caused by stress.
But one can't help asking the question: How does stress cause stomach problems?
Stress Stomach Problems
The various stomach problems caused due to stress are given below. Irritable Bowel Syndrome (IBS) One of the most common stomach problems caused by stress is the irritable bowel syndrome. Irritable bowel syndrome is an umbrella condition which comprises a variety of illnesses under its purview. Scientists say that when a person is stressed, the brain is programmed to release some hormones and chemicals. When these hormones enter the digestive tract of a person, they cause trouble. Irritable bowel syndrome maybe characterized by either an increase or decrease in the contractions of the intestines.
In case there is an increase in the contractions of the intestine, you might suffer from diarrhea or cramping. On the other hand, if there is a decrease in the contractions of the intestines, it may lead to constipation. The increase or decrease in the motility of the intestines affect the digestive system causing stomach trouble. Thus we see that IBS may cause an increase in the speed of passage of waste matter along the intestines or a decrease in the speed of passage of waste matter.
Read on to know more about symptoms and treatment of irritable bowel syndrome and irritable bowel syndrome medication.
Nervous Stomach
Normally when diagnostic tests fail to identify a particular cause for a stomach related illness, the condition is known as a nervous stomach. When there is no plausible cause for a stomach-related illness, it is generally assumed that the cause for it is a nervous stomach. Nervous stomach is the source of stomach problems from stress. A nervous stomach, like irritable bowel syndrome, is caused due to stress. It may be caused because the brain releases a lot more acids into the stomach when you are stressed.
A nervous stomach may be the cause of any stomach-related illnesses such as abdominal fullness, bloating, belching and flatulence, acid reflux, nausea and heartburn. More on stomach pain and bloating. Read on for more about: Nervous Stomach Ache Nervous Stomach in Children Other Stomach Problems Due to Stress
Along with irritable bowel syndrome and nervous stomach, there may also be a number of other stomach-related illnesses that are caused due to anxiety. One of the most common conditions caused due to stress include stomach ulcers.
Stomach ulcers are inflammation of the stomach due to excessive release of hydrochloric acid in the body. While hydrochloric acid is otherwise present in the body in very small amounts, even the slightest increase can cause trouble.
It is said that although inflammatory bowel disease (IBD) is not directly caused by stress, a preexisting case of IBD may be worsened due to stress.
How to Prevent Stomach Problems Caused by Stress
If your stomach problems are indeed caused by stress, I guess the most logical thing to do would be to reduce stress. So how does one reduce stress? Stress can be effectively managed in several ways. The most common way is to participate in some de-stressing activities which will make you feel less stressed. Find some hobbies which will help you reduce stress.
Other things you can do is to get corrective cognitive therapy that will help you deal with the stress better. You should also learn to prioritize your responsibilities and take up only so much work that you can handle. If nothing worse, try to get counseling, which will surely help you deal with your problems better. Read on for stress relief activities and stress relief techniques.
So now you know about the stomach problems caused by stress and how to cure them. After reading this article you probably know that there may be something else causing your stomach upset rather than a bit of extra pizza!
Tips On Managing Stress.
Stress is a part of life, a normal response to demands either emotional, intellectual, or physical. It can be positive if it keeps us alert, motivated, and ready to avoid danger. It can be negative if it becomes chronic, increasing the risk of diseases like depression, heart disease and a variety of other problems.
Managing stress is key to your health. And it isn't so very difficult to do. How Does Stress Affect Health? The body's autonomic nervous system has a built-in stress response that causes physiological changes to allow the body to combat stressful situations. This stress response, also known as the "fight or flight response," is activated in case of an emergency.
However, this response can become chronically activated during prolonged periods of stress, which can cause wear and tear on the body -- both physical and emotional. Stress that continues without relief can lead to a condition called distress -- a negative stress reaction.
Distress can disturb the body's internal balance or equilibrium, leading to physical symptoms such as headaches, an upset stomach, elevated blood pressure, chest pain, sexual dysfunction, and problems sleeping.
Emotional problems can also result from distress. These problems include depression, panic attacks, or other forms of anxiety and worry. Research suggests that stress also can bring on or worsen certain symptoms or diseases. Stress is linked to six of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. Stress also becomes harmful when people engage in the compulsive use of substances or behaviors to try to relieve their stress.
These substances or behaviors may include food, alcohol, tobacco, drugs, gambling, sex, shopping, and the Internet. Rather than relieving the stress and returning the body to a relaxed state, these substances and compulsive behaviors tend to keep the body in a stressed state causing more problems. The distressed person becomes trapped in a vicious circle. What Are the Warning Signs of Stress?
Chronic stress can wear down the body's natural defenses, leading to a variety of physical symptoms, including: Dizziness or a general feeling of "being out of it" General aches and pains Grinding teeth, clenched jaw Headaches Indigestion or acid reflux symptoms Increase in or loss of appetite Muscle tension in neck, face or shoulders Problems sleeping Racing heart Cold and sweaty palms Tiredness, exhaustion Trembling/shaking Weight gain or loss Upset stomach, diarrhea Sexual difficulties Irritability, impatience, forgetfulness
Tips for Reducing Stress
People can learn to manage stress and lead happier, healthier lives. Here are some tips to help you keep stress at bay:
Keep a positive attitude. Accept that there are events that you cannot control. Be assertive instead of aggressive.
Assert your feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.
Learn and practice relaxation techniques; try meditation, yoga, or tai-chi. Exercise regularly. Your body can fight stress better when it is fit. Eat healthy, well-balanced meals.
Learn to manage your time more effectively. Set limits appropriately and say no to requests that would create excessive stress in your life. Make time for hobbies and interests.
Get enough rest and sleep. Your body needs time to recover from stressful events.
Don't rely on alcohol, drugs, or food to reduce stress. Ease up on caffeine, too. Seek out social support.
Spend enough time with those you love.
Seek treatment with a psychologist or other mental health professional trained in stress management or biofeedback techniques to learn more healthy ways of dealing with the stress in your life
Managing stress is key to your health. And it isn't so very difficult to do. How Does Stress Affect Health? The body's autonomic nervous system has a built-in stress response that causes physiological changes to allow the body to combat stressful situations. This stress response, also known as the "fight or flight response," is activated in case of an emergency.
However, this response can become chronically activated during prolonged periods of stress, which can cause wear and tear on the body -- both physical and emotional. Stress that continues without relief can lead to a condition called distress -- a negative stress reaction.
Distress can disturb the body's internal balance or equilibrium, leading to physical symptoms such as headaches, an upset stomach, elevated blood pressure, chest pain, sexual dysfunction, and problems sleeping.
Emotional problems can also result from distress. These problems include depression, panic attacks, or other forms of anxiety and worry. Research suggests that stress also can bring on or worsen certain symptoms or diseases. Stress is linked to six of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. Stress also becomes harmful when people engage in the compulsive use of substances or behaviors to try to relieve their stress.
These substances or behaviors may include food, alcohol, tobacco, drugs, gambling, sex, shopping, and the Internet. Rather than relieving the stress and returning the body to a relaxed state, these substances and compulsive behaviors tend to keep the body in a stressed state causing more problems. The distressed person becomes trapped in a vicious circle. What Are the Warning Signs of Stress?
Chronic stress can wear down the body's natural defenses, leading to a variety of physical symptoms, including: Dizziness or a general feeling of "being out of it" General aches and pains Grinding teeth, clenched jaw Headaches Indigestion or acid reflux symptoms Increase in or loss of appetite Muscle tension in neck, face or shoulders Problems sleeping Racing heart Cold and sweaty palms Tiredness, exhaustion Trembling/shaking Weight gain or loss Upset stomach, diarrhea Sexual difficulties Irritability, impatience, forgetfulness
Tips for Reducing Stress
People can learn to manage stress and lead happier, healthier lives. Here are some tips to help you keep stress at bay:
Keep a positive attitude. Accept that there are events that you cannot control. Be assertive instead of aggressive.
Assert your feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.
Learn and practice relaxation techniques; try meditation, yoga, or tai-chi. Exercise regularly. Your body can fight stress better when it is fit. Eat healthy, well-balanced meals.
Learn to manage your time more effectively. Set limits appropriately and say no to requests that would create excessive stress in your life. Make time for hobbies and interests.
Get enough rest and sleep. Your body needs time to recover from stressful events.
Don't rely on alcohol, drugs, or food to reduce stress. Ease up on caffeine, too. Seek out social support.
Spend enough time with those you love.
Seek treatment with a psychologist or other mental health professional trained in stress management or biofeedback techniques to learn more healthy ways of dealing with the stress in your life
Stress: Can We Cope?
As modern pressures take their toll doctors preach relaxation
"Rule No. 1 is, don't sweat the small stuff. Rule No. 2 is, it's all small stuff. And if you can't fight and you can't flee, flow."
—University of Nebraska Cardiologist Robert Eliot, on how to cope with stress
It is the dawn of human history, and Homo sapiens steps out from his cave to watch the rising sun paint the horizon. Suddenly he hears a rustling in the forest. His muscles tense, his heart pounds, his breath comes rapidly as he locks eyes with a saber-toothed tiger. Should he fight or run for his life? He reaches down, picks up a sharp rock and hurls it. The animal snarls but disappears into the trees. The man feels his body go limp, his breathing ease. He returns to his darkened den to rest.
It is the start of another working day, and Homo sapiens steps out of his apartment building into the roar of rush hour. He picks his way through the traffic and arrives at the corner just in time to watch his bus pull away. Late for work, he opens his office door and finds the boss pacing inside. His report was due an hour ago, he is told; the client is furious. If he values his job, he had better have a good explanation. And, by the way, he can forget about taking a vacation this summer. The man eyes a paperweight on his desk and longs to throw it at his oppressor. Instead, he sits down, his stomach churning, his back muscles knotting, his blood pressure climbing. He reaches for a Maalox and an aspirin and has a sudden yearning for a dry martini, straight up.
The saber-toothed tiger is long gone, but the modern jungle is no less perilous. The sense of panic over a deadline, a tight plane connection, a reckless driver on one's tail are the new beasts that can set the heart racing, the teeth on edge, the sweat streaming. These responses may have served our ancestors well; that extra burst of adrenaline got their muscles primed, their attention focused and their nerves ready for a sudden "fight or flight." But try doing either one in today's traffic jams or boardrooms. "The fight-or-flight emergency response is inappropriate to today's social stresses," says Harvard Cardiologist Herbert Benson, an expert on the subject. It is also dangerous. Says Psychiatrist Peter Knapp of Boston University: "When you get a Wall Street broker using the responses a cave man used to fight the elements, you've got a problem."
Indeed we have.
In the past 30 years, doctors and health officials have come to realize how heavy a toll stress is taking on the nation's well being. According to the American Academy of Family Physicians, two-thirds of office visits to family doctors are prompted by stress-related symptoms. At the same time, leaders of industry have become alarmed by the huge cost of such symptoms in absenteeism, company medical expenses and lost productivity. Based on national samples, these costs have been estimated at $50 billion to $75 billion a year, more than $750 for every U.S. worker. Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide—six of the leading causes of death in the U.S. Stress also plays a role in aggravating such diverse conditions as multiple
"Rule No. 1 is, don't sweat the small stuff. Rule No. 2 is, it's all small stuff. And if you can't fight and you can't flee, flow."
—University of Nebraska Cardiologist Robert Eliot, on how to cope with stress
It is the dawn of human history, and Homo sapiens steps out from his cave to watch the rising sun paint the horizon. Suddenly he hears a rustling in the forest. His muscles tense, his heart pounds, his breath comes rapidly as he locks eyes with a saber-toothed tiger. Should he fight or run for his life? He reaches down, picks up a sharp rock and hurls it. The animal snarls but disappears into the trees. The man feels his body go limp, his breathing ease. He returns to his darkened den to rest.
It is the start of another working day, and Homo sapiens steps out of his apartment building into the roar of rush hour. He picks his way through the traffic and arrives at the corner just in time to watch his bus pull away. Late for work, he opens his office door and finds the boss pacing inside. His report was due an hour ago, he is told; the client is furious. If he values his job, he had better have a good explanation. And, by the way, he can forget about taking a vacation this summer. The man eyes a paperweight on his desk and longs to throw it at his oppressor. Instead, he sits down, his stomach churning, his back muscles knotting, his blood pressure climbing. He reaches for a Maalox and an aspirin and has a sudden yearning for a dry martini, straight up.
The saber-toothed tiger is long gone, but the modern jungle is no less perilous. The sense of panic over a deadline, a tight plane connection, a reckless driver on one's tail are the new beasts that can set the heart racing, the teeth on edge, the sweat streaming. These responses may have served our ancestors well; that extra burst of adrenaline got their muscles primed, their attention focused and their nerves ready for a sudden "fight or flight." But try doing either one in today's traffic jams or boardrooms. "The fight-or-flight emergency response is inappropriate to today's social stresses," says Harvard Cardiologist Herbert Benson, an expert on the subject. It is also dangerous. Says Psychiatrist Peter Knapp of Boston University: "When you get a Wall Street broker using the responses a cave man used to fight the elements, you've got a problem."
Indeed we have.
In the past 30 years, doctors and health officials have come to realize how heavy a toll stress is taking on the nation's well being. According to the American Academy of Family Physicians, two-thirds of office visits to family doctors are prompted by stress-related symptoms. At the same time, leaders of industry have become alarmed by the huge cost of such symptoms in absenteeism, company medical expenses and lost productivity. Based on national samples, these costs have been estimated at $50 billion to $75 billion a year, more than $750 for every U.S. worker. Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide—six of the leading causes of death in the U.S. Stress also plays a role in aggravating such diverse conditions as multiple
Staying Sane May Be Easier Than You Think
As modern pressures take their toll doctors preach relaxation
"Rule No. 1 is, don't sweat the small stuff. Rule No. 2 is, it's all small stuff. And if you can't fight and you can't flee, flow."
—University of Nebraska Cardiologist Robert Eliot, on how to cope with stress
It is the dawn of human history, and Homo sapiens steps out from his cave to watch the rising sun paint the horizon. Suddenly he hears a rustling in the forest. His muscles tense, his heart pounds, his breath comes rapidly as he locks eyes with a saber-toothed tiger. Should he fight or run for his life? He reaches down, picks up a sharp rock and hurls it. The animal snarls but disappears into the trees. The man feels his body go limp, his breathing ease. He returns to his darkened den to rest.
It is the start of another working day, and Homo sapiens steps out of his apartment building into the roar of rush hour. He picks his way through the traffic and arrives at the corner just in time to watch his bus pull away. Late for work, he opens his office door and finds the boss pacing inside. His report was due an hour ago, he is told; the client is furious. If he values his job, he had better have a good explanation. And, by the way, he can forget about taking a vacation this summer. The man eyes a paperweight on his desk and longs to throw it at his oppressor. Instead, he sits down, his stomach churning, his back muscles knotting, his blood pressure climbing. He reaches for a Maalox and an aspirin and has a sudden yearning for a dry martini, straight up.
The saber-toothed tiger is long gone, but the modern jungle is no less perilous. The sense of panic over a deadline, a tight plane connection, a reckless driver on one's tail are the new beasts that can set the heart racing, the teeth on edge, the sweat streaming. These responses may have served our ancestors well; that extra burst of adrenaline got their muscles primed, their attention focused and their nerves ready for a sudden "fight or flight." But try doing either one in today's traffic jams or boardrooms. "The fight-or-flight emergency response is inappropriate to today's social stresses," says Harvard Cardiologist Herbert Benson, an expert on the subject. It is also dangerous. Says Psychiatrist Peter Knapp of Boston University: "When you get a Wall Street broker using the responses a cave man used to fight the elements, you've got a problem."
Indeed we have. In the past 30 years, doctors and health officials have come to realize how heavy a toll stress is taking on the nation's well being. According to the American Academy of Family Physicians, two-thirds of office visits to family doctors are prompted by stress-related symptoms. At the same time, leaders of industry have become alarmed by the huge cost of such symptoms in absenteeism, company medical expenses and lost productivity. Based on national samples, these costs have been estimated at $50 billion to $75 billion a year, more than $750 for every U.S. worker. Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide—six of the leading causes of death in the U.S. Stress also plays a role in aggravating such diverse conditions as multiple
Studying such kids for more than a decade, the researchers discovered that those who became schizophrenic were most often from families that, when first interviewed, displayed "communication deviance" (unclear, unintelligible or fragmented speech) and highly critical and intrusive parenting. These weren't merely families that argued with difficult sons and daughters; they were families that had lost all ability to cope.
McFarlane and others began working with some of the families to address their interactions and teach them how to communicate better — more slowly, with less anger and intrusion. Even after they are on medication, people with schizophrenia have a difficult time tracking rapid, highly emotional speech, yet that's the kind they often hear from frustrated family members. These patients would improve in hospitals but relapse once they got home, even when they continued to take antipsychotics.
For several years, McFarlane developed and tested the Multi-Family Group approach, which brought several families together at a time to learn from one another how they sounded to outsiders. In twice-monthly sessions, the families modeled greater clarity and compassion and troubleshot daily-living problems like kids' marijuana use or sexual activity. It was a simple intervention that, when combined with antipsychotic drugs, worked to reduce schizophrenic relapse rates significantly more than the drugs alone.
McFarlane wondered if the treatment could work even earlier, to help prevent the illness in largely asymptomatic kids who were at risk for schizophrenia. Such prediagnosis would not be easy, but McFarlane knew that once a patient's perception of reality has cracked for the first time, it becomes exceedingly hard to walk back to normality. Indeed, a major study just published in the journal Neuropsychology shows that the signature cognitive problems of schizophrenia — deficits in verbal learning and memory along with processing speed — actually begin days or weeks before a first psychotic episode, making the earliest possible detection all the more urgent.
And so in the 1980s, McFarlane began canvassing schools in the New York City area to try to get the staffs excited about preventing schizophrenia among their students. A number of the superintendents "practically threw us out the window," he says. "They just kept saying, 'We don't have mental illness in our high school.'" It was dispiriting: based on the epidemiological data, McFarlane knew that each year about 12 in 10,000 young people suffered a first episode of psychosis. Some of the kids were clearly in those schools, but if he couldn't get through the door to screen them, he couldn't prevent any illness.
A Theory Goes WideEven as McFarlane was exploring his schizophrenia-prevention idea, other researchers were having similar what-if moments with respect to other, more routine conditions. Suppose irritable infants who become fearful toddlers who become shy children somehow could be stopped from becoming adults with anxiety disorders. Suppose men and women who go to war or become cops in inner cities could be helped before developing posttraumatic stress disorder. Could you, similarly, identify the children of depressed parents early and give them skills to prevent their own first depressive episode?
In any given year, approximately 17% of Americans under 25 have a mental, emotional or behavioral disorder. (Over our lifetime, 46% of us will receive such a diagnosis.) If we reduce the proportion of young people who become mentally ill by even one-quarter, that would mean about 3.8 million saved each year from what can turn into a lifelong struggle.
But if most mental illnesses have a genetic origin, isn't even that modest 25%-reduction goal unlikely? The science can get tricky here, but the simple answer is that genes aren't destiny. You can't do anything to change your genome, but your environment and experiences have powerful effects on the way those genes are expressed. A susceptibility to cancer may remain just a susceptibility — until you start smoking and kick the disease process into motion. Similarly, change a child's emotional experiences for the worse and you can trigger mental illness; change them for the better and you may hush the problem genes. One concrete example of this: in 2003, a study in Science found that the larger the number of copies an individual carries of a serotonin-transporter gene called 5-HTTLPR the greater the risk of developing major depressive disorder and suicidality — but only if the individual suffers stressful early-life experiences like abuse.
How long is the window between first symptoms and actual diagnosis? The National Academies report says that across several mental illnesses — including obsessive-compulsive disorder, depression and substance dependence — we have about two to three years to intervene and keep short-term symptoms from becoming long-term afflictions.
Depression offers particularly good evidence of this idea at work. Currently, about 5% of adolescents experience an episode of clinical depression in any given year. Rates of depression are three to four times as high among the children of depressed parents as among those whose parents aren't depressed. Dr. William Beardslee of Children's Hospital Boston, one of the authors of the National Academies report, has spent more than 25 years studying how some kids of depressed parents avoid the illness, and he has found that resilience is key. The kids who don't develop depression are "activists and doers," Beardslee says. Even growing up in the darkness of a depressed home, they muster the capacity to engage deeply in relationships. They also are likelier than other kids to understand that they aren't to blame for their parents' disorder — and that they are free to chart their own course.
How do you foster resilience in order to prevent depression? Over the past 17 years, Beardslee's team has developed an early intervention that targets kids from families in which at least one parent is depressed. Like McFarlane, he uses a family-based approach because a bad home environment tends to be more predictive of adolescent mental illness than dysfunctional peer relationships are. Beardslee's Family Talk Intervention includes both separate meetings with parents and kids as well as family meetings with social workers or psychologists that focus in part on demystifying depression — explaining that it is a treatable illness, not a beast that will necessarily crush a family. In a randomized trial, Beardslee found that just seven sessions of this intervention decreased predepression symptoms among the kids and improved the parents' behavior and attitudes. All this makes kids more resilient.
Tackling SchizophreniaMcFarlane hadn't gotten far with the New York City schools in the 1980s, and his prevention work waned for a few years as he taught at Columbia University and wrote articles on his Multi-Family Group approach to treating psychosis. Eventually, he moved to Portland, Maine, where he had been offered the chairmanship of Maine Medical Center's psychiatry department. There, he settled into quieter, less paradigm-changing work.
It wasn't until 1996 that his prevention work resumed. That year, a team of researchers in Norway — one that included Dr. Thomas McGlashan of Yale — approached McFarlane about training therapists to use the Multi-Family Group approach with patients who had just suffered a first psychotic episode. These patients already had the illness, so it was too late for prevention. But the Norwegians had succeeded where McFarlane had failed in New York: they had connected with schools and other local institutions to identify the first signs of psychosis and refer patients to the team immediately.
In October 1998, the picture grew still more promising when NATO sponsored a major psychotic-disorders conference in Prague, where McFarlane learned that several groups around the world, including one in Australia, had also been trying to prevent first episodes of psychosis. He returned from Prague and tried again to set up an early-detection system with schools, this time in Portland. By now, the stigma against mental illness had eased a bit; schools had seen a dramatic rise in emotional and behavioral problems during the '90s. Unlike their New York counterparts, Portland school superintendents welcomed McFarlane.
At about the same time, McGlashan's team at Yale was working on a screening interview that might distinguish kids who would become psychotic from those who wouldn't. McGlashan tested his questions at various sites in North America, including with teens who sought treatment in McFarlane's department in Portland. By 2001, McGlashan and his team had completed their "Structured Interview for Prodromal [pre-disease] Symptoms" (SIPS) — a two-hour assessment involving various oral tests and a family history. Those who meet SIPS criteria for risk are about 30 times as likely as the general population to develop a diagnosable psychotic disorder. SIPS allows for the careful scoring of warning signs, some of which are obvious (hearing mumbling that isn't there) and some of which are less so (changing your behavior because of a superstition).
McFarlane and his team connected with most of Portland's principals and pediatricians. The message was simple: If you encounter kids who seem slightly off — prone to jumbled thoughts, maybe even hearing voices — send them our way. Among those referred to him, McFarlane found that 80% of those who met SIPS criteria for prodromal psychosis would receive a diagnosis of schizophrenia within 30 months. He put kids who met a certain SIPS threshold into Multi-Family Group psychoeducation. At first, he intended not to use drugs with these prediagnosis kids, particularly since the meds can cause side effects like weight gain, acne and uncontrollably shaky legs. But McFarlane found that once symptoms like auditory hallucinations started, he couldn't correct them with only psychosocial interventions. (Today, virtually everyone enrolled in his Portland Identification and Early Referral prevention program is prescribed psychiatric medication.)
The combination of the family approach and drug support seems to be working well. The National Institute of Mental Health is funding a trial of McFarlane's work, and while he is still writing up his data for publication, his anecdotal results are promising: most of the kids are so far avoiding a first psychotic episode. Even those who have heard voices and nearly dropped out of high school are going to college and getting jobs.
But this approach doesn't come cheap. The kids who are enrolled are bombarded with care: social workers help them at school or work; therapists guide them and their families in individual and group sessions; a psychiatrist or nurse practitioner carefully calibrates their medication based on response rates and side effects.
When members of McFarlane's clinical team gather each day to discuss cases, they know virtually everything about their kids: they know about boyfriends, girlfriends and summer plans. They know the kids' grades in English class, how much pot they smoke, what they did on a recent trip to Disneyland. They know whether Dad just lost his job and if Mom's grandmother killed herself. This is what prevention of mental illness looks like: unwavering, sweeping, complicated. But it works.
One Family at a TimeThe Robert Wood Johnson foundation is so impressed with McFarlane's program that it has devoted $15 million to its national expansion. It is the foundation's single largest mental-health initiative. McFarlane's approach costs about $3,500 per patient per year, but compare that with the $150,000 a year to care for a hospitalized schizophrenic or severely bipolar patient.
Still, not all the kids McFarlane sees can be helped. Patti White is a plainspoken 47-year-old Mainer who works for McFarlane as an administrative coordinator. She has a son who began experiencing psychotic symptoms a few years ago, and he might have seemed like a perfect fit for her boss's program. He wasn't; prevention isn't that easy. Instead, White's son Tyler, who turns 20 this month, was too far along in his illness — eventually diagnosed as schizoaffective disorder, a relative of schizophrenia — to benefit from prevention therapy. A social worker on McFarlane's team helped Tyler get into treatment, and he is doing better and holding down a job in food service.
But White has another son, Jacob, who causes her to worry. A few months ago, Jacob, 10, started to withdraw. He was getting paranoid. At school, he started seeing complicated machinations where none existed. And even though White works for one of the world's leading prevention experts, she at first resisted having Jacob take the SIPS test. "If his brother had had diabetes, I wouldn't have thought twice about having Jacob screened for diabetes," she says. "But I just couldn't deal with the idea that another one of my kids would have" — she pauses — "this enormous thing."
Three weeks ago, Jacob took SIPS. The good news: he showed no red flags for psychosis. He does have depressive symptoms and is now taking a low dose of Prozac to help prevent a full-blown depression. But for Jacob — and millions of other Americans with all manner of mental ills — intervention can now come in time
"Rule No. 1 is, don't sweat the small stuff. Rule No. 2 is, it's all small stuff. And if you can't fight and you can't flee, flow."
—University of Nebraska Cardiologist Robert Eliot, on how to cope with stress
It is the dawn of human history, and Homo sapiens steps out from his cave to watch the rising sun paint the horizon. Suddenly he hears a rustling in the forest. His muscles tense, his heart pounds, his breath comes rapidly as he locks eyes with a saber-toothed tiger. Should he fight or run for his life? He reaches down, picks up a sharp rock and hurls it. The animal snarls but disappears into the trees. The man feels his body go limp, his breathing ease. He returns to his darkened den to rest.
It is the start of another working day, and Homo sapiens steps out of his apartment building into the roar of rush hour. He picks his way through the traffic and arrives at the corner just in time to watch his bus pull away. Late for work, he opens his office door and finds the boss pacing inside. His report was due an hour ago, he is told; the client is furious. If he values his job, he had better have a good explanation. And, by the way, he can forget about taking a vacation this summer. The man eyes a paperweight on his desk and longs to throw it at his oppressor. Instead, he sits down, his stomach churning, his back muscles knotting, his blood pressure climbing. He reaches for a Maalox and an aspirin and has a sudden yearning for a dry martini, straight up.
The saber-toothed tiger is long gone, but the modern jungle is no less perilous. The sense of panic over a deadline, a tight plane connection, a reckless driver on one's tail are the new beasts that can set the heart racing, the teeth on edge, the sweat streaming. These responses may have served our ancestors well; that extra burst of adrenaline got their muscles primed, their attention focused and their nerves ready for a sudden "fight or flight." But try doing either one in today's traffic jams or boardrooms. "The fight-or-flight emergency response is inappropriate to today's social stresses," says Harvard Cardiologist Herbert Benson, an expert on the subject. It is also dangerous. Says Psychiatrist Peter Knapp of Boston University: "When you get a Wall Street broker using the responses a cave man used to fight the elements, you've got a problem."
Indeed we have. In the past 30 years, doctors and health officials have come to realize how heavy a toll stress is taking on the nation's well being. According to the American Academy of Family Physicians, two-thirds of office visits to family doctors are prompted by stress-related symptoms. At the same time, leaders of industry have become alarmed by the huge cost of such symptoms in absenteeism, company medical expenses and lost productivity. Based on national samples, these costs have been estimated at $50 billion to $75 billion a year, more than $750 for every U.S. worker. Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide—six of the leading causes of death in the U.S. Stress also plays a role in aggravating such diverse conditions as multiple
Studying such kids for more than a decade, the researchers discovered that those who became schizophrenic were most often from families that, when first interviewed, displayed "communication deviance" (unclear, unintelligible or fragmented speech) and highly critical and intrusive parenting. These weren't merely families that argued with difficult sons and daughters; they were families that had lost all ability to cope.
McFarlane and others began working with some of the families to address their interactions and teach them how to communicate better — more slowly, with less anger and intrusion. Even after they are on medication, people with schizophrenia have a difficult time tracking rapid, highly emotional speech, yet that's the kind they often hear from frustrated family members. These patients would improve in hospitals but relapse once they got home, even when they continued to take antipsychotics.
For several years, McFarlane developed and tested the Multi-Family Group approach, which brought several families together at a time to learn from one another how they sounded to outsiders. In twice-monthly sessions, the families modeled greater clarity and compassion and troubleshot daily-living problems like kids' marijuana use or sexual activity. It was a simple intervention that, when combined with antipsychotic drugs, worked to reduce schizophrenic relapse rates significantly more than the drugs alone.
McFarlane wondered if the treatment could work even earlier, to help prevent the illness in largely asymptomatic kids who were at risk for schizophrenia. Such prediagnosis would not be easy, but McFarlane knew that once a patient's perception of reality has cracked for the first time, it becomes exceedingly hard to walk back to normality. Indeed, a major study just published in the journal Neuropsychology shows that the signature cognitive problems of schizophrenia — deficits in verbal learning and memory along with processing speed — actually begin days or weeks before a first psychotic episode, making the earliest possible detection all the more urgent.
And so in the 1980s, McFarlane began canvassing schools in the New York City area to try to get the staffs excited about preventing schizophrenia among their students. A number of the superintendents "practically threw us out the window," he says. "They just kept saying, 'We don't have mental illness in our high school.'" It was dispiriting: based on the epidemiological data, McFarlane knew that each year about 12 in 10,000 young people suffered a first episode of psychosis. Some of the kids were clearly in those schools, but if he couldn't get through the door to screen them, he couldn't prevent any illness.
A Theory Goes WideEven as McFarlane was exploring his schizophrenia-prevention idea, other researchers were having similar what-if moments with respect to other, more routine conditions. Suppose irritable infants who become fearful toddlers who become shy children somehow could be stopped from becoming adults with anxiety disorders. Suppose men and women who go to war or become cops in inner cities could be helped before developing posttraumatic stress disorder. Could you, similarly, identify the children of depressed parents early and give them skills to prevent their own first depressive episode?
In any given year, approximately 17% of Americans under 25 have a mental, emotional or behavioral disorder. (Over our lifetime, 46% of us will receive such a diagnosis.) If we reduce the proportion of young people who become mentally ill by even one-quarter, that would mean about 3.8 million saved each year from what can turn into a lifelong struggle.
But if most mental illnesses have a genetic origin, isn't even that modest 25%-reduction goal unlikely? The science can get tricky here, but the simple answer is that genes aren't destiny. You can't do anything to change your genome, but your environment and experiences have powerful effects on the way those genes are expressed. A susceptibility to cancer may remain just a susceptibility — until you start smoking and kick the disease process into motion. Similarly, change a child's emotional experiences for the worse and you can trigger mental illness; change them for the better and you may hush the problem genes. One concrete example of this: in 2003, a study in Science found that the larger the number of copies an individual carries of a serotonin-transporter gene called 5-HTTLPR the greater the risk of developing major depressive disorder and suicidality — but only if the individual suffers stressful early-life experiences like abuse.
How long is the window between first symptoms and actual diagnosis? The National Academies report says that across several mental illnesses — including obsessive-compulsive disorder, depression and substance dependence — we have about two to three years to intervene and keep short-term symptoms from becoming long-term afflictions.
Depression offers particularly good evidence of this idea at work. Currently, about 5% of adolescents experience an episode of clinical depression in any given year. Rates of depression are three to four times as high among the children of depressed parents as among those whose parents aren't depressed. Dr. William Beardslee of Children's Hospital Boston, one of the authors of the National Academies report, has spent more than 25 years studying how some kids of depressed parents avoid the illness, and he has found that resilience is key. The kids who don't develop depression are "activists and doers," Beardslee says. Even growing up in the darkness of a depressed home, they muster the capacity to engage deeply in relationships. They also are likelier than other kids to understand that they aren't to blame for their parents' disorder — and that they are free to chart their own course.
How do you foster resilience in order to prevent depression? Over the past 17 years, Beardslee's team has developed an early intervention that targets kids from families in which at least one parent is depressed. Like McFarlane, he uses a family-based approach because a bad home environment tends to be more predictive of adolescent mental illness than dysfunctional peer relationships are. Beardslee's Family Talk Intervention includes both separate meetings with parents and kids as well as family meetings with social workers or psychologists that focus in part on demystifying depression — explaining that it is a treatable illness, not a beast that will necessarily crush a family. In a randomized trial, Beardslee found that just seven sessions of this intervention decreased predepression symptoms among the kids and improved the parents' behavior and attitudes. All this makes kids more resilient.
Tackling SchizophreniaMcFarlane hadn't gotten far with the New York City schools in the 1980s, and his prevention work waned for a few years as he taught at Columbia University and wrote articles on his Multi-Family Group approach to treating psychosis. Eventually, he moved to Portland, Maine, where he had been offered the chairmanship of Maine Medical Center's psychiatry department. There, he settled into quieter, less paradigm-changing work.
It wasn't until 1996 that his prevention work resumed. That year, a team of researchers in Norway — one that included Dr. Thomas McGlashan of Yale — approached McFarlane about training therapists to use the Multi-Family Group approach with patients who had just suffered a first psychotic episode. These patients already had the illness, so it was too late for prevention. But the Norwegians had succeeded where McFarlane had failed in New York: they had connected with schools and other local institutions to identify the first signs of psychosis and refer patients to the team immediately.
In October 1998, the picture grew still more promising when NATO sponsored a major psychotic-disorders conference in Prague, where McFarlane learned that several groups around the world, including one in Australia, had also been trying to prevent first episodes of psychosis. He returned from Prague and tried again to set up an early-detection system with schools, this time in Portland. By now, the stigma against mental illness had eased a bit; schools had seen a dramatic rise in emotional and behavioral problems during the '90s. Unlike their New York counterparts, Portland school superintendents welcomed McFarlane.
At about the same time, McGlashan's team at Yale was working on a screening interview that might distinguish kids who would become psychotic from those who wouldn't. McGlashan tested his questions at various sites in North America, including with teens who sought treatment in McFarlane's department in Portland. By 2001, McGlashan and his team had completed their "Structured Interview for Prodromal [pre-disease] Symptoms" (SIPS) — a two-hour assessment involving various oral tests and a family history. Those who meet SIPS criteria for risk are about 30 times as likely as the general population to develop a diagnosable psychotic disorder. SIPS allows for the careful scoring of warning signs, some of which are obvious (hearing mumbling that isn't there) and some of which are less so (changing your behavior because of a superstition).
McFarlane and his team connected with most of Portland's principals and pediatricians. The message was simple: If you encounter kids who seem slightly off — prone to jumbled thoughts, maybe even hearing voices — send them our way. Among those referred to him, McFarlane found that 80% of those who met SIPS criteria for prodromal psychosis would receive a diagnosis of schizophrenia within 30 months. He put kids who met a certain SIPS threshold into Multi-Family Group psychoeducation. At first, he intended not to use drugs with these prediagnosis kids, particularly since the meds can cause side effects like weight gain, acne and uncontrollably shaky legs. But McFarlane found that once symptoms like auditory hallucinations started, he couldn't correct them with only psychosocial interventions. (Today, virtually everyone enrolled in his Portland Identification and Early Referral prevention program is prescribed psychiatric medication.)
The combination of the family approach and drug support seems to be working well. The National Institute of Mental Health is funding a trial of McFarlane's work, and while he is still writing up his data for publication, his anecdotal results are promising: most of the kids are so far avoiding a first psychotic episode. Even those who have heard voices and nearly dropped out of high school are going to college and getting jobs.
But this approach doesn't come cheap. The kids who are enrolled are bombarded with care: social workers help them at school or work; therapists guide them and their families in individual and group sessions; a psychiatrist or nurse practitioner carefully calibrates their medication based on response rates and side effects.
When members of McFarlane's clinical team gather each day to discuss cases, they know virtually everything about their kids: they know about boyfriends, girlfriends and summer plans. They know the kids' grades in English class, how much pot they smoke, what they did on a recent trip to Disneyland. They know whether Dad just lost his job and if Mom's grandmother killed herself. This is what prevention of mental illness looks like: unwavering, sweeping, complicated. But it works.
One Family at a TimeThe Robert Wood Johnson foundation is so impressed with McFarlane's program that it has devoted $15 million to its national expansion. It is the foundation's single largest mental-health initiative. McFarlane's approach costs about $3,500 per patient per year, but compare that with the $150,000 a year to care for a hospitalized schizophrenic or severely bipolar patient.
Still, not all the kids McFarlane sees can be helped. Patti White is a plainspoken 47-year-old Mainer who works for McFarlane as an administrative coordinator. She has a son who began experiencing psychotic symptoms a few years ago, and he might have seemed like a perfect fit for her boss's program. He wasn't; prevention isn't that easy. Instead, White's son Tyler, who turns 20 this month, was too far along in his illness — eventually diagnosed as schizoaffective disorder, a relative of schizophrenia — to benefit from prevention therapy. A social worker on McFarlane's team helped Tyler get into treatment, and he is doing better and holding down a job in food service.
But White has another son, Jacob, who causes her to worry. A few months ago, Jacob, 10, started to withdraw. He was getting paranoid. At school, he started seeing complicated machinations where none existed. And even though White works for one of the world's leading prevention experts, she at first resisted having Jacob take the SIPS test. "If his brother had had diabetes, I wouldn't have thought twice about having Jacob screened for diabetes," she says. "But I just couldn't deal with the idea that another one of my kids would have" — she pauses — "this enormous thing."
Three weeks ago, Jacob took SIPS. The good news: he showed no red flags for psychosis. He does have depressive symptoms and is now taking a low dose of Prozac to help prevent a full-blown depression. But for Jacob — and millions of other Americans with all manner of mental ills — intervention can now come in time
Acute Stress Disorder
By definition, acute stress disorder is a result of a traumatic event in which the person experienced or witnessed an event that involved threatened or actual serious injury or death and responded with intense fear and helplessness.
Symptoms
Symptoms include dissociative symptoms such as numbing, detachment, a reduction in awareness of the surroundings, derealization, or depersonalization; re-experiencing of the trauma, avoidance of associated stimuli, and significant anxiety, including irritability, poor concentration, difficulty sleeping, and restlessness. The symptoms must be present for a minimum of two days and a maximum of four weeks and must occur within four weeks of the traumatic event for a diagnosis to be made.
Treatment
The disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. Medication can be used for a very short duration (up to four weeks) or psychotherapy can be utilized to assist the victim in dealing with the fear and sense of helplessness.
Prognosis
Prognosis for this disorder is very good. If it should progress into another disorder, success rates can vary according to the specific of that disorder.
Symptoms
Symptoms include dissociative symptoms such as numbing, detachment, a reduction in awareness of the surroundings, derealization, or depersonalization; re-experiencing of the trauma, avoidance of associated stimuli, and significant anxiety, including irritability, poor concentration, difficulty sleeping, and restlessness. The symptoms must be present for a minimum of two days and a maximum of four weeks and must occur within four weeks of the traumatic event for a diagnosis to be made.
Treatment
The disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. Medication can be used for a very short duration (up to four weeks) or psychotherapy can be utilized to assist the victim in dealing with the fear and sense of helplessness.
Prognosis
Prognosis for this disorder is very good. If it should progress into another disorder, success rates can vary according to the specific of that disorder.
Anxiety Overview
IMPORTANT INFORMATION:
As with all articles on this site this article is a brief overview of Anxiety, Medication, and Interventions. It is meant as an insightful article giving further understanding and awareness of issues that might be affecting you. At all times medical advice and intervention should be sought if you are in need or just want to talk, medical interventions are always changing and the information in this article may need updating.
Anxiety Overview
Anxiety is a feeling of apprehension, fear, or worry. Some fears and worries are justified, such as worry about a loved one. Anxiety may occur without a cause, or it may occur based on a real situation, but may be out of proportion to what would normally be expected. Severe anxiety can have a serious impact on daily life.
Anxiety can be accompanied by a variety of physical symptoms. Most commonly, these symptoms are related to the heart, lungs, and nervous system. You may feel as if you are having a heart attack.
Anxiety Causes
Anxiety may be caused by a mental condition, a physical condition, the effects of drugs, or from a combination of these. The doctor’s initial task is to see if your anxiety is caused by a medical condition.
Common causes of anxiety include these mental conditions:
Panic disorder: In addition to anxiety, common symptoms of panic disorders are palpitations (feeling your heart beat), dizziness, and shortness of breath. These same symptoms also can be caused by coffee (caffeine), amphetamines ("speed" is the street slang for amphetamines when they are not prescribed by a doctor), an overactive thyroid, abnormal heart rhythms, and other heart abnormalities (such as mitral valve prolapse).
Generalized anxiety disorder
Phobic disorders
Stress disorders
These common external factors can cause anxiety:
Stress at work
Stress from school
Stress in a personal relationship such as marriage
Financial stress
Stress from an emotional trauma such as the death of a loved one
Stress from a serious medical illness
Side effect of medication
Use of an illicit drug, such as cocaine
Symptom of a medical illness
Lack of oxygen - In circumstances as diverse as high altitude sickness, emphysema, or pulmonary embolism (a blood clot with the vessels of the lung)
The doctor has the often-difficult task of determining which symptoms come from which causes. For example, in a study of people with chest pain that could be heart disease but turned out not to be heart related, 43% were found to have a panic disorder—a common form of anxiety.
Anxiety Symptoms
Panic disorders - Separate and intense periods of fear or feelings of doom developing over a very short time frame—10 minutes—and associated with at least 4 of the following:
Palpitations
Sweating
Trembling
Shortness of breath
Sense of choking
Chest pain
Nausea
Dizziness
A feeling of being detached from the world (derealization)
Fear of dying
Numbness or tingling
Chills or hot flushes
Generalized anxiety disorder - Excessive and unrealistic worry over a period of at least 6 months associated with 3 of the following:
Restlessness
Easy fatigue
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbances
Phobic disorders - Intense, persistent, and recurrent fear of certain objects (such as snakes, spiders, blood) or situations (such as heights, speaking in front of a group, public places). These exposures may trigger a panic attack.
Stress disorders - Anxiety (also known as post-traumatic stress disorder) caused by the exposure to either death or near-death circumstances such as fires, floods, earthquakes, shootings, automobile accidents, or wars, for example. The traumatic event is re-experienced in thoughts and dreams. Common behaviors include the following:
Avoiding activities, places, or people associated with the triggering event
Difficulty concentrating
Difficulty sleeping
Being hypervigilant (you closely watch your surroundings)
Feeling a general sense of doom and gloom with diminished emotions such as loving feelings or aspirations for the future
Symptoms such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness generally should not be attributed to anxiety and require evaluation by a doctor.
When to Seek Medical Care
Call your doctor when the signs and symptoms of anxiety are not easily, quickly, and clearly diagnosed and treated.
If the symptoms are so severe that you believe medication may be needed
If the symptoms are interfering with your personal, social, or professional life
If you have chest pain, shortness of breath, headaches, palpitations, dizziness, fainting spells, or unexplained weakness
If you are depressed and feel suicidal
When the signs and symptoms suggest that anxiety may have been present for a prolonged period (more than a few days) and appear to be stable (not getting worse rapidly), you may be able to make an appointment with your doctor for evaluation. But when the signs and symptoms are severe and come on suddenly, they may represent a serious medical illness that needs immediate evaluation and treatment in a hospital’s emergency department.
Exams and Tests
The doctor will take a careful history, perform a physical examination, and order laboratory tests as needed.
If you have another medical condition that you know about, there may be an overlap of signs and symptoms between what is old and what is new.
Just determining that anxiety is psychological does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, or other mental health professional.
Anxiety Treatment
Self-Care at Home
In certain cases, you may treat anxiety at home without the involvement of a doctor. These are limited to anxiety attacks of short duration in which you know the cause, the anxiety is short, it goes away by itself, and the cause can be eliminated. For example, you may be anxious over an upcoming public performance, a final exam, or a pending job interview. In such circumstances, stress may be relieved by such actions as these:
Talking with a supportive person
Meditation
Watching TV
Taking a long warm bath
Resting in a dark room
Deep breathing exercises
Medical Treatment
Treatment depends on the cause.
When the cause of anxiety is a physical ailment, treatment is directed toward eliminating that ailment. For example, if your thyroid gland were overactive and causing anxiety, the treatment might involve surgery and various thyroid-regulating medications.
When the cause is psychological, the underlying cause needs to be discovered, and, if possible, eliminated or controlled. For example, if the cause is difficulty in a marriage, the doctor may suggest marital counseling.
Sometimes, the cause cannot be identified. In such cases, the only treatment option is control of symptoms.
In the past, anxiety was treated with drugs in a class known as benzodiazepines. These include familiar names:
Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)
A newer anti-anxiety drug is buspirone (BuSpar).
More recently, drugs of the SSRI class (selective serotonin reuptake inhibitors, often also used to treat depression) are prescribed and include the following:
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Venlafaxine (Effexor)
In addition, psychotherapy may be useful. Combinations of medication and counseling are usually advisable.
Next Steps
Follow-up
Anxiety should be addressed and treated with your doctor. Establish an ongoing relationship. By knowing your own doctor and by having follow-up on a regular basis, you may cope with your problems and resolve them more effectively. These steps may also help you deal with medical conditions that might otherwise go undiagnosed and untreated.
Prevention
Prevention of anxiety essentially involves an awareness of life's stresses and your own ability to cope with them. This can often be a difficult task in our busy and hectic 21st century.
In essence, you might develop coping mechanisms for all of life's stresses.
Strategies might include these:
Exercise
Meditation
Relaxation exercises including deep breathing
Visualization
Interpersonal skills in dealing with difficult people and situations or parenting skills training in dealing with your children
Prevention also includes diet, regular exercise, rest, and the basics in terms of preventive health care maintenance. Diet is a large factor. Caffeine, stimulants, lack of rest, and lack of exercise all are factors that influence anxiety.
Outlook
When the cause of anxiety is identified and treated, complete recovery is often made. Where no cause can be readily identified, you may feel anxiety for a long time, perhaps your entire life. Excellent medications are available to help many of the symptoms. Counseling with mental health professionals can be highly successful.
As with all articles on this site this article is a brief overview of Anxiety, Medication, and Interventions. It is meant as an insightful article giving further understanding and awareness of issues that might be affecting you. At all times medical advice and intervention should be sought if you are in need or just want to talk, medical interventions are always changing and the information in this article may need updating.
Anxiety Overview
Anxiety is a feeling of apprehension, fear, or worry. Some fears and worries are justified, such as worry about a loved one. Anxiety may occur without a cause, or it may occur based on a real situation, but may be out of proportion to what would normally be expected. Severe anxiety can have a serious impact on daily life.
Anxiety can be accompanied by a variety of physical symptoms. Most commonly, these symptoms are related to the heart, lungs, and nervous system. You may feel as if you are having a heart attack.
Anxiety Causes
Anxiety may be caused by a mental condition, a physical condition, the effects of drugs, or from a combination of these. The doctor’s initial task is to see if your anxiety is caused by a medical condition.
Common causes of anxiety include these mental conditions:
Panic disorder: In addition to anxiety, common symptoms of panic disorders are palpitations (feeling your heart beat), dizziness, and shortness of breath. These same symptoms also can be caused by coffee (caffeine), amphetamines ("speed" is the street slang for amphetamines when they are not prescribed by a doctor), an overactive thyroid, abnormal heart rhythms, and other heart abnormalities (such as mitral valve prolapse).
Generalized anxiety disorder
Phobic disorders
Stress disorders
These common external factors can cause anxiety:
Stress at work
Stress from school
Stress in a personal relationship such as marriage
Financial stress
Stress from an emotional trauma such as the death of a loved one
Stress from a serious medical illness
Side effect of medication
Use of an illicit drug, such as cocaine
Symptom of a medical illness
Lack of oxygen - In circumstances as diverse as high altitude sickness, emphysema, or pulmonary embolism (a blood clot with the vessels of the lung)
The doctor has the often-difficult task of determining which symptoms come from which causes. For example, in a study of people with chest pain that could be heart disease but turned out not to be heart related, 43% were found to have a panic disorder—a common form of anxiety.
Anxiety Symptoms
Panic disorders - Separate and intense periods of fear or feelings of doom developing over a very short time frame—10 minutes—and associated with at least 4 of the following:
Palpitations
Sweating
Trembling
Shortness of breath
Sense of choking
Chest pain
Nausea
Dizziness
A feeling of being detached from the world (derealization)
Fear of dying
Numbness or tingling
Chills or hot flushes
Generalized anxiety disorder - Excessive and unrealistic worry over a period of at least 6 months associated with 3 of the following:
Restlessness
Easy fatigue
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbances
Phobic disorders - Intense, persistent, and recurrent fear of certain objects (such as snakes, spiders, blood) or situations (such as heights, speaking in front of a group, public places). These exposures may trigger a panic attack.
Stress disorders - Anxiety (also known as post-traumatic stress disorder) caused by the exposure to either death or near-death circumstances such as fires, floods, earthquakes, shootings, automobile accidents, or wars, for example. The traumatic event is re-experienced in thoughts and dreams. Common behaviors include the following:
Avoiding activities, places, or people associated with the triggering event
Difficulty concentrating
Difficulty sleeping
Being hypervigilant (you closely watch your surroundings)
Feeling a general sense of doom and gloom with diminished emotions such as loving feelings or aspirations for the future
Symptoms such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness generally should not be attributed to anxiety and require evaluation by a doctor.
When to Seek Medical Care
Call your doctor when the signs and symptoms of anxiety are not easily, quickly, and clearly diagnosed and treated.
If the symptoms are so severe that you believe medication may be needed
If the symptoms are interfering with your personal, social, or professional life
If you have chest pain, shortness of breath, headaches, palpitations, dizziness, fainting spells, or unexplained weakness
If you are depressed and feel suicidal
When the signs and symptoms suggest that anxiety may have been present for a prolonged period (more than a few days) and appear to be stable (not getting worse rapidly), you may be able to make an appointment with your doctor for evaluation. But when the signs and symptoms are severe and come on suddenly, they may represent a serious medical illness that needs immediate evaluation and treatment in a hospital’s emergency department.
Exams and Tests
The doctor will take a careful history, perform a physical examination, and order laboratory tests as needed.
If you have another medical condition that you know about, there may be an overlap of signs and symptoms between what is old and what is new.
Just determining that anxiety is psychological does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, or other mental health professional.
Anxiety Treatment
Self-Care at Home
In certain cases, you may treat anxiety at home without the involvement of a doctor. These are limited to anxiety attacks of short duration in which you know the cause, the anxiety is short, it goes away by itself, and the cause can be eliminated. For example, you may be anxious over an upcoming public performance, a final exam, or a pending job interview. In such circumstances, stress may be relieved by such actions as these:
Talking with a supportive person
Meditation
Watching TV
Taking a long warm bath
Resting in a dark room
Deep breathing exercises
Medical Treatment
Treatment depends on the cause.
When the cause of anxiety is a physical ailment, treatment is directed toward eliminating that ailment. For example, if your thyroid gland were overactive and causing anxiety, the treatment might involve surgery and various thyroid-regulating medications.
When the cause is psychological, the underlying cause needs to be discovered, and, if possible, eliminated or controlled. For example, if the cause is difficulty in a marriage, the doctor may suggest marital counseling.
Sometimes, the cause cannot be identified. In such cases, the only treatment option is control of symptoms.
In the past, anxiety was treated with drugs in a class known as benzodiazepines. These include familiar names:
Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)
A newer anti-anxiety drug is buspirone (BuSpar).
More recently, drugs of the SSRI class (selective serotonin reuptake inhibitors, often also used to treat depression) are prescribed and include the following:
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Venlafaxine (Effexor)
In addition, psychotherapy may be useful. Combinations of medication and counseling are usually advisable.
Next Steps
Follow-up
Anxiety should be addressed and treated with your doctor. Establish an ongoing relationship. By knowing your own doctor and by having follow-up on a regular basis, you may cope with your problems and resolve them more effectively. These steps may also help you deal with medical conditions that might otherwise go undiagnosed and untreated.
Prevention
Prevention of anxiety essentially involves an awareness of life's stresses and your own ability to cope with them. This can often be a difficult task in our busy and hectic 21st century.
In essence, you might develop coping mechanisms for all of life's stresses.
Strategies might include these:
Exercise
Meditation
Relaxation exercises including deep breathing
Visualization
Interpersonal skills in dealing with difficult people and situations or parenting skills training in dealing with your children
Prevention also includes diet, regular exercise, rest, and the basics in terms of preventive health care maintenance. Diet is a large factor. Caffeine, stimulants, lack of rest, and lack of exercise all are factors that influence anxiety.
Outlook
When the cause of anxiety is identified and treated, complete recovery is often made. Where no cause can be readily identified, you may feel anxiety for a long time, perhaps your entire life. Excellent medications are available to help many of the symptoms. Counseling with mental health professionals can be highly successful.
High Court Awards Stress Payments
High Court awards put spotlight on stress
A lot has changed since Professor Michiel Kompier found that Ireland was relatively untouched by stress in 1996. These days we are working harder and faster and many of us are feeling the pressure.
THERE HAVE been a fair number of stress-related court cases in Britain since the groundbreaking ‘Walker’ judgement in the mid-1990s, but little significant activity in the Irish Courts. That is until now.
The Walker case concluded with a £175,000 sterling award to a social worker for stress-related illness. Mr Walker suffered two nervous breakdowns and the UK court found his employer – Northumberland county council - liable because it was aware of the risk after his first breakdown but took no steps to address it.
Until last year, Irish legal activity on workplace stress cases was relatively insignificant. Few cases formally entered the legal arena, although it is believed that many as 25 stress-related claims were settled out of court. One case, Quinn -v- Servier Laboratories, is thought to have been settled for a six-figure sum.
In 1999, the Employment Appeals Tribunal made an award of over £26,000 to a supervisor in a sausage factory after it found she had been unfairly dismissed during a period when she was on sick leave as a result of high stress levels.
Concern about the legal implications of stress was growing among employers.
Then, at the end of 2000, the High Court made what are thought to be the first court awards in bullying and stress related cases. These will really concentrate minds.
In the first a welder was awarded £51,000, of which £50,000 was attributed to stress and health problems he suffered as a result of serious intimidation. The additional £1,000 was for loss of earnings. The key aspect in this award was the link between bullying and stress.
The second case concerned a Garda, who was awarded over £52,000, £40,000 of which was compensation for stress and anxiety.
Both cases arose as a result of complex employment relationships and both took a long time to come to court. The common element in the awards is that the judge compensated the plaintiffs for the stress they suffered and, in doing so, put a value on stress claims. But, of course, there is no ‘going rate’ for stress claims and each legal case would be judged – and compensated or otherwise – on its own merits
The law
Most of us experience stress in our lives and at work. A certain level of stress is acceptable – even positive - but it’s a serious matter when it crosses the line and threatens health problems.
The Health and Safety Authority (HSA) says workplace stress arises “when the demands on a person exceed the capacity to meet them.” And it says most stress and stress-related illness is preventable with good work design, safe work practices, and adequate resources.
Research shows that all workers can suffer from unacceptable stress levels. Although senior managers are under pressure, they also have control over resources and workplace organisation – and the power to deal with problems. It is often those further down the pile who suffer most because they have less control over work demands, work organisation and resources.
Employers are legally obliged to control workplace stress, just as they must control any other workplace health hazard. The 1989 Safety, Health and Welfare at Work Act obliges them to identify and safeguard against all risks to health and safety. All places of work must have a safety programme written down in a safety statement. The potential hazard of stress must be addressed when compiling a safety statement.
Under the legislation, your employer has a ‘duty of care’ to all employees and must consider whether stress is a risk when they identify health hazards and assess risks. If a risk is identified, your employer is obliged to adopt measures to eliminate or control it.
There is now a massive literature on the causes and effects of stress, including clear advice from the HSA on potential triggers. The Agency says stress can effects us at four levels: Emotional (causing fatigue and anxiety), cognitive (leading to mistakes and accidents), behavioural (possibly manifest in smoking, excessive drinking or over-eating) and physiological, with potentially serious symptoms like raised blood pressure, heart disease, reduced resistance to infection, digestive problems and bad skin.
The HSA says that safeguards and controls must be implemented primarily at organisation level - basically in the specific workplace. This may mean changes in working conditions, social support, career development and training, management support, communication, and control over workloads and work organisation. In some cases, these measures may need to be supported by a programme of individual coping strategies.
Many trade unionists and practitioners hope that stress and bullying will be specifically identified as occupational hazards in amendments due to the health and safety legislation. In any case, the recent hefty High Court awards are likely to drive many employers to seek legal advice.
Thanks to ©IMPACT Trade Union for this article published in 2000
A lot has changed since Professor Michiel Kompier found that Ireland was relatively untouched by stress in 1996. These days we are working harder and faster and many of us are feeling the pressure.
THERE HAVE been a fair number of stress-related court cases in Britain since the groundbreaking ‘Walker’ judgement in the mid-1990s, but little significant activity in the Irish Courts. That is until now.
The Walker case concluded with a £175,000 sterling award to a social worker for stress-related illness. Mr Walker suffered two nervous breakdowns and the UK court found his employer – Northumberland county council - liable because it was aware of the risk after his first breakdown but took no steps to address it.
Until last year, Irish legal activity on workplace stress cases was relatively insignificant. Few cases formally entered the legal arena, although it is believed that many as 25 stress-related claims were settled out of court. One case, Quinn -v- Servier Laboratories, is thought to have been settled for a six-figure sum.
In 1999, the Employment Appeals Tribunal made an award of over £26,000 to a supervisor in a sausage factory after it found she had been unfairly dismissed during a period when she was on sick leave as a result of high stress levels.
Concern about the legal implications of stress was growing among employers.
Then, at the end of 2000, the High Court made what are thought to be the first court awards in bullying and stress related cases. These will really concentrate minds.
In the first a welder was awarded £51,000, of which £50,000 was attributed to stress and health problems he suffered as a result of serious intimidation. The additional £1,000 was for loss of earnings. The key aspect in this award was the link between bullying and stress.
The second case concerned a Garda, who was awarded over £52,000, £40,000 of which was compensation for stress and anxiety.
Both cases arose as a result of complex employment relationships and both took a long time to come to court. The common element in the awards is that the judge compensated the plaintiffs for the stress they suffered and, in doing so, put a value on stress claims. But, of course, there is no ‘going rate’ for stress claims and each legal case would be judged – and compensated or otherwise – on its own merits
The law
Most of us experience stress in our lives and at work. A certain level of stress is acceptable – even positive - but it’s a serious matter when it crosses the line and threatens health problems.
The Health and Safety Authority (HSA) says workplace stress arises “when the demands on a person exceed the capacity to meet them.” And it says most stress and stress-related illness is preventable with good work design, safe work practices, and adequate resources.
Research shows that all workers can suffer from unacceptable stress levels. Although senior managers are under pressure, they also have control over resources and workplace organisation – and the power to deal with problems. It is often those further down the pile who suffer most because they have less control over work demands, work organisation and resources.
Employers are legally obliged to control workplace stress, just as they must control any other workplace health hazard. The 1989 Safety, Health and Welfare at Work Act obliges them to identify and safeguard against all risks to health and safety. All places of work must have a safety programme written down in a safety statement. The potential hazard of stress must be addressed when compiling a safety statement.
Under the legislation, your employer has a ‘duty of care’ to all employees and must consider whether stress is a risk when they identify health hazards and assess risks. If a risk is identified, your employer is obliged to adopt measures to eliminate or control it.
There is now a massive literature on the causes and effects of stress, including clear advice from the HSA on potential triggers. The Agency says stress can effects us at four levels: Emotional (causing fatigue and anxiety), cognitive (leading to mistakes and accidents), behavioural (possibly manifest in smoking, excessive drinking or over-eating) and physiological, with potentially serious symptoms like raised blood pressure, heart disease, reduced resistance to infection, digestive problems and bad skin.
The HSA says that safeguards and controls must be implemented primarily at organisation level - basically in the specific workplace. This may mean changes in working conditions, social support, career development and training, management support, communication, and control over workloads and work organisation. In some cases, these measures may need to be supported by a programme of individual coping strategies.
Many trade unionists and practitioners hope that stress and bullying will be specifically identified as occupational hazards in amendments due to the health and safety legislation. In any case, the recent hefty High Court awards are likely to drive many employers to seek legal advice.
Thanks to ©IMPACT Trade Union for this article published in 2000
ANXIETY DISORDERS
Anxiety Disorders
Anxiety is a common and normal occurrence. However, a chronic, high level of anxiety indicates an anxiety disorder.
Common Anxiety Disorders
Some of the more common anxiety disorders include:
Generalized Anxiety Disorder: A person with generalized anxiety disorder experiences persistent and excessive anxiety or worry that lasts at least six months.
Specific Phobia: A person who has specific phobia experiences intense anxiety when exposed to a particular object or situation. The person often avoids the feared object or situation because of a desire to escape the anxiety associated with it.
Social Phobia: A person who has social phobia experiences intense anxiety when exposed to certain kinds of social or performance situations. As a result, the person often avoids these types of situations.
Panic Disorder and Agoraphobia: A person with panic disorder experiences recurrent, unexpected panic attacks, which cause worry or anxiety. During a panic attack, a person has symptoms such as heart palpitations, sweating, trembling, dizziness, chest pain, and fear of losing control, going crazy, or dying. Panic disorder can occur with or without agoraphobia. Agoraphobia involves anxiety about losing control in public places, being in situations from which escape would be difficult or embarrassing, or being in places where there might be no one to help if a panic attack occurred.
Obsessive-compulsive Disorder: A person with obsessive-compulsive disorder experiences obsessions, compulsions, or both. Obsessions are ideas, thoughts, impulses, or images that are persistent and cause anxiety or distress. A person usually feels that the obsessions are inappropriate but uncontrollable. Compulsions are repetitive behaviors that help to prevent or relieve anxiety.
Post–traumatic Stress Disorder (PTSD): A person with this disorder persistently re-experiences a highly traumatic event and avoids stimuli associated with the trauma. Symptoms include increased arousal such as insomnia, irritability, difficulty concentrating, hypervigilance, or exaggerated startle response.
Roots of Anxiety Disorders
Many different interactive factors influence the development of anxiety disorders.
Biological Factors
Many biological factors can contribute to the onset of anxiety disorders:
Genetic predisposition: Twin studies suggest that there may be genetic predispositions to anxiety disorders. Researchers typically use concordance rates to describe the likelihood that a disorder might be inherited. A concordance rate indicates the percentage of twin pairs who share a particular disorder. Research has shown that identical twins have a higher concordance rate for anxiety disorders than fraternal twins.
Differing sensitivity: Some research suggests that people differ in sensitivity to anxiety. People who are highly sensitive to the physiological symptoms of anxiety react with even more anxiety to these symptoms, which sets off a worsening spiral of anxiety that can result in an anxiety disorder.
Neurotransmitters: Researchers believe there is a link between anxiety disorders and disturbances in neural circuits that use the neurotransmitters GABA and serotonin. GABA limits nerve cell activity in the part of the brain associated with anxiety. People who do not produce enough GABA or whose brains do not process it normally may feel increased anxiety. Inefficient processing of serotonin may also contribute to anxiety.
Brain damage: Some researchers have suggested that damage to the hippocampus can contribute to PTSD symptoms.
SSRIs and Anxiety Disorders
Selective serotonin reuptake inhibitors (SSRIs) are a class of drug commonly used to treat anxiety disorders. They raise the level of serotonin in the brain by preventing it from being reabsorbed back into cells that released it. Serotonin is a neurotransmitter that affects sleep, alertness, appetite, and other functions. Abnormal levels of serotonin can lead to mood disorders.
Conditioning and Learning
Research shows that conditioning and learning also play a role in anxiety disorders:
Classical conditioning: People can acquire anxiety responses, especially phobias, through classical conditioning and then maintain them through operant conditioning: A neutral stimulus becomes associated with anxiety by being paired with an anxiety-producing stimulus. After this classical conditioning process has occurred, a person may begin to avoid the conditioned anxiety-producing stimulus. This leads to a decrease in anxiety, which reinforces the avoidance through an operant conditioning process. For example, a near drowning experience might produce a phobia of water. Avoiding oceans, pools, and ponds decreases anxiety about water and reinforces the behavior of avoidance.
Evolutionary predisposition: Researchers such as Martin Seligman have proposed that people may be more likely to develop conditioned fears to certain objects and situations. According to this view, evolutionary history biologically prepares people to develop phobias about ancient dangers, such as snakes and heights.
Observational learning: People also may develop phobias through observational learning. For example, children may learn to be afraid of certain objects or situations by observing their parents’ behavior in the face of those objects or situations.
Cognitive Factors
Some researchers have suggested that people with certain styles of thinking are more susceptible to anxiety disorders than others. Such people have increased susceptibility for several reasons:
Anxiety is a common and normal occurrence. However, a chronic, high level of anxiety indicates an anxiety disorder.
Common Anxiety Disorders
Some of the more common anxiety disorders include:
Generalized Anxiety Disorder: A person with generalized anxiety disorder experiences persistent and excessive anxiety or worry that lasts at least six months.
Specific Phobia: A person who has specific phobia experiences intense anxiety when exposed to a particular object or situation. The person often avoids the feared object or situation because of a desire to escape the anxiety associated with it.
Social Phobia: A person who has social phobia experiences intense anxiety when exposed to certain kinds of social or performance situations. As a result, the person often avoids these types of situations.
Panic Disorder and Agoraphobia: A person with panic disorder experiences recurrent, unexpected panic attacks, which cause worry or anxiety. During a panic attack, a person has symptoms such as heart palpitations, sweating, trembling, dizziness, chest pain, and fear of losing control, going crazy, or dying. Panic disorder can occur with or without agoraphobia. Agoraphobia involves anxiety about losing control in public places, being in situations from which escape would be difficult or embarrassing, or being in places where there might be no one to help if a panic attack occurred.
Obsessive-compulsive Disorder: A person with obsessive-compulsive disorder experiences obsessions, compulsions, or both. Obsessions are ideas, thoughts, impulses, or images that are persistent and cause anxiety or distress. A person usually feels that the obsessions are inappropriate but uncontrollable. Compulsions are repetitive behaviors that help to prevent or relieve anxiety.
Post–traumatic Stress Disorder (PTSD): A person with this disorder persistently re-experiences a highly traumatic event and avoids stimuli associated with the trauma. Symptoms include increased arousal such as insomnia, irritability, difficulty concentrating, hypervigilance, or exaggerated startle response.
Roots of Anxiety Disorders
Many different interactive factors influence the development of anxiety disorders.
Biological Factors
Many biological factors can contribute to the onset of anxiety disorders:
Genetic predisposition: Twin studies suggest that there may be genetic predispositions to anxiety disorders. Researchers typically use concordance rates to describe the likelihood that a disorder might be inherited. A concordance rate indicates the percentage of twin pairs who share a particular disorder. Research has shown that identical twins have a higher concordance rate for anxiety disorders than fraternal twins.
Differing sensitivity: Some research suggests that people differ in sensitivity to anxiety. People who are highly sensitive to the physiological symptoms of anxiety react with even more anxiety to these symptoms, which sets off a worsening spiral of anxiety that can result in an anxiety disorder.
Neurotransmitters: Researchers believe there is a link between anxiety disorders and disturbances in neural circuits that use the neurotransmitters GABA and serotonin. GABA limits nerve cell activity in the part of the brain associated with anxiety. People who do not produce enough GABA or whose brains do not process it normally may feel increased anxiety. Inefficient processing of serotonin may also contribute to anxiety.
Brain damage: Some researchers have suggested that damage to the hippocampus can contribute to PTSD symptoms.
SSRIs and Anxiety Disorders
Selective serotonin reuptake inhibitors (SSRIs) are a class of drug commonly used to treat anxiety disorders. They raise the level of serotonin in the brain by preventing it from being reabsorbed back into cells that released it. Serotonin is a neurotransmitter that affects sleep, alertness, appetite, and other functions. Abnormal levels of serotonin can lead to mood disorders.
Conditioning and Learning
Research shows that conditioning and learning also play a role in anxiety disorders:
Classical conditioning: People can acquire anxiety responses, especially phobias, through classical conditioning and then maintain them through operant conditioning: A neutral stimulus becomes associated with anxiety by being paired with an anxiety-producing stimulus. After this classical conditioning process has occurred, a person may begin to avoid the conditioned anxiety-producing stimulus. This leads to a decrease in anxiety, which reinforces the avoidance through an operant conditioning process. For example, a near drowning experience might produce a phobia of water. Avoiding oceans, pools, and ponds decreases anxiety about water and reinforces the behavior of avoidance.
Evolutionary predisposition: Researchers such as Martin Seligman have proposed that people may be more likely to develop conditioned fears to certain objects and situations. According to this view, evolutionary history biologically prepares people to develop phobias about ancient dangers, such as snakes and heights.
Observational learning: People also may develop phobias through observational learning. For example, children may learn to be afraid of certain objects or situations by observing their parents’ behavior in the face of those objects or situations.
Cognitive Factors
Some researchers have suggested that people with certain styles of thinking are more susceptible to anxiety disorders than others. Such people have increased susceptibility for several reasons:
They tend to see threats in harmless situations.
They focus too much attention on situations that they perceive to be threatening.
They tend to recall threatening information better than nonthreatening information.
Personality Traits
The personality trait of neuroticism is associated with a higher likelihood of having an anxiety disord
Minister McDowell Shows Signs of Stress
23/03/2006
Published Irish Independent
By Mark Reddy
Mr Mc
Dowell’s recent public outburst appeared to show the signs of a man under
stress. .“Work related stress affects about one third of
the workforce in the EU”. (World Health Organisation 2004) and although clearly he is a very
strong, intelligent and clearly committed professional it showed that not even
a man in his position is safe from the possible adverse affects that can come
from carrying out a difficult and challenging career. Labour leader Pat
Rabbitte referred to this as an “intolerable tantrum”,
this outburst arose from a difference of opinion in regard to Garda numbers on
the streets of Dublin
Workplace Stress has
arisen as a key cause of absence from work and it is suggested that it now
replaces back pain as the most commonly cited problem on medical certificates.
Stress can lead to many issues such as a disruption in sleep patterns, mood
swings, outbursts difficulty in making decisions and faulty decision making to
name but a few. The World Federation for
Mental Health has predicted that by 2020, the primary cause of lost working
time will be due to stress.
Having continued to
campaign since 2002 for an internal support service made up of professional
therapists to be established to support members of An Garda Siochana in dealing
with such issues as workplace stress it continues to be my belief that a
service like the one I am proposing will help to counter act any adverse
affects caused by the very difficult and challenging duties carried out by our
police force on a daily basis. I establishing a voluntary support service
helping people who suffer stress, false
allegation, isolation and illness in the workplace and have continued to
keep the Minister and Commissioner aware of my findings and results raised as
to the need for such a service to be established to support the Gardai, clearly
the Ministers Job is a highly stressful one however so to is the work of the
Gardai. Police work in general is considered the most challenging and dangerous
professions one can work in, currently the Garda are serviced by a committed
and hard working team of seven welfare officers, one sergeant and one inspector
catering for the care needs of some twelve thousand officers.
Routinely Gardaí face the very real threat of violence, trauma and crisis on a
daily basis the resulting stress or more appropriately distress may cause some
to suffer from stress related symptoms. Symptoms that maybe similar to the
possible stress the Minister might be under at present, the constant and real
threat that is faced by members of the Gardai on a daily basis can prove to be
very difficult. The work of the Gardai can be perceived as times of quiet
boredom through to times of crisis and trauma. It’s the changes in environment
that results in the body having to adapt in order to meet these changes, these
changes in the demand on the body can be immediate and automatic and the
resulting stress can help the person experiencing them to perform and meet the
challenges presented - or it can be negative and present in the form of
distress which can make someone upset and unwell, symptoms that the Minister
may well of felt on Monday night.
‘The most widespread
negative effect of work on mental health is stress’ World health Organisation.
The reaction humans have to stress results
in chemical changes in the body, the stimulant hormone adrenaline increases
that pours into the blood stream with other hormones producing changes in our
bodies designed to protect us, this can be seen as the ‘fight or flight
response’ - it provides both the energy and strength needed to either stay and
fight or to run away from the perceived danger, in all fairness the Minister
stayed and fought his corner but he had that choice and could of walked away if
he wished, this is not a choice the Gardai have when dealing with such stress
inducing incidences.
Gardaí can face these reactions several
times throughout each working shift; which I believe can increase the negative
affects of stress. When we deal with the causes of stress we can help elevate
it, in the case of members of An
Garda Síochána, one way of helping is to provide a
service that allows the individuals a safe and secure place to work-through
their perceptions and difficulties. This in turn can help to relieve some of
the problems and symptoms and also help develop the understanding, awareness
and coping skills of the individual, helping them to be more readily able to
deal with the everyday and real stressors of the job. This is but one aspect of
supporting the members of the force the others are very clearly stated,,
documented and requested at every turn and they are simply increased numbers of
qualified Gardai to tackle the increasing level of crime resulting in members
feeling more secure and less vulnerable and hopefully reducing the effects of
distress, we need to provide them with proper working conditions and up to date
equipment this will allow them to carry out their duties of protecting life and
property with more effect and will allow for officers to feel appreciated by
those they are employed by thus increasing self esteem and job satisfaction, we
need to provide them with an internal support service like the one I am
recommending so that when a traumatic experience is dealt with or when assaulted
or experiencing difficulty they can seek help and support in confidence.
It
makes sense to have a healthy workforce, these seem like the basic
requirements and all will have only
positive benefits for the Gardai on the Beat, the organisation as a whole and
society who requires a supported, healthy and pro-active police service it will
also elevate the types of symptoms suffered by Minister McDowell.
(IMPORTANT POINT)
I would hope that this could be considered
by the Minister when he next reviews how best to support the Gardai, his
outburst was reported to be a meltdown and a tantrum and all of which was
visible to all and arose from a disagreement of words and numbers, how must it
be to be in the centre of a riot or to attend a scene of a violent murder, rape
or accident the likes of which the committed member of An Garda Siochana deal
with professionally everyday.
Hopefully the lesson can now be learned before
others have to continue to experience such difficulties as a result of doing
their jobs.
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