The hypothalamic pituitary adrenal (HPA) axis is our central stress response system. The HPA axis is an eloquent and every-dynamic intertwining of the central nervous system and endocrine system.
This system works in a fairly straightforward manner. The HPA axis is responsible for the neuroendocrine adaptation component of the stress response. This response is characterized by hypothalamic release of corticotropin-releasing factor (CRF). CRF is also known as CRH or corticotropin-releasing hormone. When CRF binds to CRF receptors on the anterior pituitary gland, adrenocorticotropic hormone (ACTH) is released. ACTH binds to receptors on the adrenal cortex and stimulates adrenal release of cortisol. In response to stressors, cortisol will be released for several hours after encountering the stressor. At a certain blood concentration of cortisol this protection is ostensibly achieved and the cortisol exerts negative feedback to the hypothalamic release of CRF and the pituitary release of ACTH (negative feedback). At this point, systemic homeostasis returns.
With repeated exposure to stressors, the organism habituates to the stressor with repeated and sustained HPA axis activation. Therefore, it is important to support healthy cortisol levels in order to ensure the hypothalamus and pituitary glands maintain the appropriate level of sensitivity to the negative feedback of cortisol. Secretion of alarm chemicals such as epinephrine and norepinephrine from the adrenal medulla, as well as HPA axis activation persists along with the secretion of CRF, ACTH, and cortisol. Interestingly, with aging, the hypothalamus and pituitary are less sensitive to negative feedback from cortisol and both ACTH and cortisol levels rise as we age.1 Older women secrete more cortisol in response to stress than do older men. Young women, however, produce lower levels of cortisol in response to stress than do young men.
Under conditions of normal exposure to cortisol, our tissues only experience fleeting glimpses of the alarm catecholamines and cortisol. As we are addressing the various health consequences of stress, it is imperative to also address the axis of response itself. Restoring homeostasis to the HPA axis is the primary goal of integrative care.
Although the term “Stress” is generally claimed as something negative, it is in reality also a positive driver. In order to perform well, a certain degree of positive stress (called EUSTRESS) is needed. Positive Stress can be experienced when someone is well focused on a specific task, motivated, feeling confident and also excited about the result he/she is hoping to achieve. It is a typical short term feeling.
Negative stress (called DISTRESS) occurs when a person feels unable to perform or to cope with situation. This feeling can be short or long term. It causes anxiety or concern and can lead to mental and physical problems. The causes (called STRESSORS) for the negative feelings of stress do not always lie with external situations. Internal feelings (i.e. fear of doing something), thoughts (i.e. continuous worrying) and certain behaviours (i.e. procrastination) can also lead to negative stress.
The underneath chart shows the relation between stress (positive and negative) and performance efficiency:The physiological stress can be measured by combining physiological variables whilst the perceived stress can be indicated using questionnaires. Whether the stress in negative or positive, the physiological process in your body is the same. In order to deal with the stressor, the body goes in the‘fight’ mode and biochemical reactions are taking place. These reactions can ask a lot of metabolic energy from the body. BioRICS continuously measures key variables in the individual energy equation.By using real-time algorithms, the metabolic energy that the body consumes for mental tasks iscalculated.
Firstly, let’s debunk one myth: stress is not necessarily a ‘bad’ thing. Without this brilliant ability to feel stress, humankind wouldn’t have survived. Our cavemen ancestors, for example, used the onset of stress to alert them to a potential danger, such as a sabre-toothed tiger.
Stress isn’t always bad. In small doses, it can help you perform under pressure and motivate you to do your best. But when you’re constantly running in emergency mode, your mind and body pay the price. If you frequently find yourself feeling frazzled and overwhelmed, it’s time to take action to bring your nervous system back into balance. You can protect yourself — and improve how you think and feel — by learning how to recognize the signs and symptoms of chronic stress and taking steps to reduce its harmful effects.
What is stress?
Stress is your body’s way of responding to any kind of demand or threat. When you sense danger—whether it’s real or imagined—the body’s defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction or the “stress response.”The stress response is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can save your life—giving you extra strength to defend yourself, for example, or spurring you to slam on the brakes to avoid an accident.
Stress can also help you rise to meet challenges. It’s what keeps you on your toes during a presentation at work, sharpens your concentration when you’re attempting the game-winning free throw, or drives you to study for an exam when you’d rather be watching TV. But beyond a certain point, stress stops being helpful and starts causing major damage to your health, your mood, your productivity, your relationships, and your quality of life.Fight-or-flight response: what happens in the body.
Stress is primarily a physical response. When stressed, the body thinks it is under attack and switches to ‘fight or flight’ mode, releasing a complex mix of hormones and chemicals such as adrenaline, cortisol and norepinephrine to prepare the body for physical action. This causes a number of reactions, from blood being diverted to muscles to shutting down unnecessary bodily functions such as digestion.Through the release of hormones such as adrenaline, cortisol and norepinephrine, the caveman gained a rush of energy, which prepared him to either fight the tiger or run away. That heart pounding, fast breathing sensation is the adrenaline; as well as a boost of energy, it enables us to focus our attention so we can quickly respond to the situation.
In the modern world, the ‘fight or flight’ mode can still help us survive dangerous situations, such as reacting swiftly to a person running in front of our car by slamming on the brakes.The challenge is when our body goes into a state of stress in inappropriate situations. When blood flow is going only to the most important muscles needed to fight or flee, brain function is minimised. This can lead to an inability to ‘think straight’; a state that is a great hindrance in both our work and home lives. If we are kept in a state of stress for long periods, it can be detrimental to our health. The results of having elevated cortisol levels can be an increase in sugar and blood pressure levels, and a decrease in libido.
Signs and symptoms of stress overload
The most dangerous thing about stress is how easily it can creep up on you. You get used to it. It starts to feel familiar — even normal. You don’t notice how much it’s affecting you, even as it takes a heavy toll. That’s why it’s important to be aware of the common warning signs and symptoms of stress overload.
Causes of stress
The situations and pressures that cause stress are known as stressors. We usually think of stressors as being negative, such as an exhausting work schedule or a rocky relationship. However, anything that puts high demands on you can be stressful. This includes positive events such as getting married, buying a house, going to college, or receiving a promotion.
Of course, not all stress is caused by external factors. Stress can also be internal or self-generated, when you worry excessively about something that may or may not happen, or have irrational, pessimistic thoughts about life.
Finally, what causes stress depends, at least in part, on your perception of it. Something that’s stressful to you may not faze someone else; they may even enjoy it. While some of us are terrified of getting up in front of people to perform or speak, for example, others live for the spotlight. Where one person thrives under pressure and performs best in the face of a tight deadline, another will shut down when work demands escalate. And while you may enjoy helping care for your elderly parents, your siblings may find the demands of caretaking overwhelming stressful.
A phobia is a type of anxiety disorder.Phobic disorders (phobias) involve persistent, irrational fears and avoidance of the situations or objects that induce these fears.If you have one, you’ll do almost anything to avoid what you’re afraid of. Someone with a phobia understands that their fear is not logical. Still, if they try to squelch it, it only makes them more anxious. Women are more likely to experience phobias than men.
Three Main Categories of Phobias
Social phobia : Social phobia is characterized by the fear of being judged by others. Individuals affected by social phobia usually avoid social functions and other gatherings due to the irrational fear of being judged by other attendees. The victim feels that he will be singled out and scrutinized in the crowd, thereby leading to an embarrassing situation. For instance, a person with social phobia will avoid parties fearing that people around him will start laughing at his clothes, or confront him with questions that would make him feel awkward.
Agoraphobia: Agoraphobia is a type of phobia wherein a person fears open spaces. These individuals are more prone to suffer from panic attacks. More than often, the victims try to avoid crowded and public places to cope up with their fear. An agoraphobia victim would usually shy away from visiting airport, gymnasium, clubs, busy stores, restaurants and other prominent places, thereby killing loads of joyful moments in his life.
Specific phobia : Specific phobia is a type of phobia which gets triggered due to a specific stimulus. For instance, an individual can experience panic attack while driving, taking an elevator or by merely viewing an insect. It could also be a fear of being trapped in a closed room. Specific phobia can disrupt one’s day to day activities because of the nature of the phobia. For example, a person with a driving phobia will try his best to avoid being seated in the driver’s seat. He would prefer staying dependent on others for his travelling needs to avoid confronting his phobia.
Types of Specific Phobia
Specific Phobias are categorized into 5 types:
Animal Phobias (e.g., dogs, snakes, or spiders)
Natural Environment Phobias (e.g., heights, storms, water)
Blood-Injection-Injury Phobias (e.g., fear of seeing blood, receiving a blood test or shot, watching television shows that display medical procedures)
Other Phobias (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds like balloons popping or costumed characters like clowns)
Some common specific phobias
A person with a phobia will experience the following symptoms. They are common across the majority of phobias:
a sensation of uncontrollable anxiety when exposed to the source of fear
a feeling that the source of that fear must be avoided at all costs
not being able to function properly when exposed to the trigger
acknowledgment that the fear is irrational, unreasonable, and exaggerated, combined with an inability to control the feelings
A person is likely to experience feelings of panic and intense anxiety when exposed to the object of their phobia. The physical effects of these sensations can include:
hot flushes or chills
a choking sensation
chest pains or tightness
butterflies in the stomach
pins and needles
confusion and disorientation
A feeling of anxiety can be produced simply by thinking about the object of the phobia. In younger children, parents may observe that they cry, become very clingy, or attempt to hide behind the legs of a parent or an object. They may also throw tantrums to show their distress.
Phobia Vs Fear
biological factors: The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels. Serotonin and dopamine are two important neurotransmitters that, when “out of whack,” can cause feelings of anxiety.
family factors: Anxiety and fear can be inherited. Just as a child can inherit a parent’s brown hair, green eyes and nearsightedness, a child can also inherit that parent’s tendency toward excessive anxiety. In addition, anxiety may be learned from family members and others who are noticeably stressed or anxious around a child. For example, a child whose parent shows immense fear of spiders may learn to fear spiders, too.
environmental factors: A traumatic experience (such as a divorce, illness or death in the family) or even just a major life event .
How the brain works during a phobia
Some areas of the brain store and recall dangerous or potentially deadly events.If a person faces a similar event later on in life, those areas of the brain retrieve the stressful memory, sometimes more than once. This causes the body to experience the same reaction.
In a phobia, the areas of the brain that deal with fear and stress keep retrieving the frightening event inappropriately.Researchers have found that phobias are often linked to the amygdala, which lies behind the pituitary gland in the brain. The amygdala can trigger the release of “fight-or-flight” hormones. These put the body and mind in a highly alert and stressed state.
Behavior therapy sets up phobic treatment involving exposure to the phobic stimulus in a safe and controlled setting.
Foa and Kozak (1986) call this exposure treatment, , so called because the patient is exposed to the phobic stimulus as part of the therapeutic process. One simple form of exposure treatment is that of flooding, where the person is immersed in the fear reflex until the fear itself fades away. Some phobic reactions are so strong that flooding must be done through one’s imagining the phobic stimulus, rather than engaging the phobic stimulus itself.
Some patients cannot handle flooding in any form, so an alternative classical conditioning technique is used called counter-conditioning (Watson, 1924). In this form, one is trained to substitute a relaxation response for the fear response in the presence of the phobic stimulus. Relaxation is incompatible with feeling fearful or having anxiety, so it is said that the relaxation response counters the fear response. This counter-conditioning is most often used in a systematic way to very gradually introduce the feared stimulus in a step-by-step fashion known as systematic desensitization, first used by Joseph Wolpe (1958). This desensitization involves three steps:
training the patient to physically relax,
establishing an anxiety hierarchy of the stimuli involved, and
counter-conditioning relaxation as a response to each feared stimulus beginning first with the least anxiety-provoking stimulus and moving then to the next least anxiety-provoking stimulus until all of the items listed in the anxiety hierarchy have been dealt with successfully.
Biofeedback instrumentation has often been used to ensure that the patient is truly well-relaxed before going the next higher item in the anxiety hierarchy. Several indexes have been used in this adjunctive approach, including pulse rate, respiration rate, and electrodermal responses.
Also, systematic desensitization can be paired with modeling, an application suggested by social learning theorists. In modeling, the patient observes others (the “models”) in the presence of the phobic stimulus who are responding with relaxation rather than fear. In this way, the patient is encouraged to imitate the model(s) and thereby relieve their phobia. Combining live modeling with personal imitation is sometimes called participant modeling (Bernstein, 1997).
It’s normal to feel anxious from time to time, especially if your life is stressful. However, excessive, ongoing anxiety and worry that are difficult to control and interfere with day-to-day activities may be a sign of generalized anxiety disorder. It’s also sometimes known as chronic anxiety neurosis.
Generalized anxiety disorder (GAD) is more than the normal anxiety people experience day to day. It’s chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint.
People with GAD can’t seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants — that it’s irrational. People with GAD also seem unable to relax. They often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded or out of breath. They may feel nauseated or have to go to the bathroom frequently. Or they might feel as though they have a lump in the throat.Many individuals with GAD startle more easily than other people. They tend to feel tired, have trouble concentrating, and sometimes suffer depression, too.
GAD comes on gradually and most often hits people in childhood or adolescence, but can begin in adulthood, too. It’s more common in women than in men and often occurs in relatives of affected persons. It’s diagnosed when someone spends at least 6 months worried excessively about a number of everyday problems.
The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months; children do not need to meet as many criteria–only 1 is needed).
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
The exact cause of GAD isn’t fully understood, although it’s likely that a combination of several factors plays a role. Research has suggested that these may include:
overactivity in areas of the brain involved in emotions and behaviour
an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
the genes you inherit from your parents – you’re estimated to be 5 times more likely to develop GAD if you have a close relative with the condition
having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
having a painful long-term health condition.
having a history of drug or alcohol misuse
However, many people develop GAD for no apparent reason.
Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.
Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you’ve avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.
Progressive Muscle Relaxation
Progressive muscle relaxation (PMR) is a non-pharmacological method of deep muscle relaxation, based on the premise that muscle tension is the body’s psychological response to anxiety-provoking thoughts and that muscle relaxation blocks anxiety. Progressive Muscle Relaxation teaches you how to relax your muscles through a two-step process. First, you systematically tense particular muscle groups in your body, such as your neck and shoulders. Next, you release the tension and notice how your muscles feel when you relax them.This tension is then released, as attention is directed towards the differences felt during tension and relaxation. This exercise will help you to lower your overall tension and stress levels, and help you relax when you are feeling anxious. It can also help reduce physical problems such as stomachaches and headaches, as well as improve your sleep.
Panic disorder is a type of anxiety disorder. It causes panic attacks, which are sudden feelings of terror when there is no real danger. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. It may feel like having a heart attack. Panic attacks can happen anytime, anywhere, and without warning. You may live in fear of another attack and may avoid places where you have had an attack. For some people, fear takes over their lives and they cannot leave their homes.A person with panic disorder may become discouraged and feel ashamed because he or she cannot carry out normal routines like going to school or work, going to the grocery store, or driving.
Most panic attacks last for between 5 and 20 minutes. Some panic attacks have been reported to last up to an hour.The number of attacks you have will depend on how severe your condition is. Some people have attacks once or twice a month, while others have them several times a week.Although panic attacks are frightening, they’re not dangerous. An attack won’t cause you any physical harm, and it’s unlikely that you’ll be admitted to hospital if you have one.
Panic disorder often begins in the late teens or early adulthood. More women than men have panic disorder. But not everyone who experiences panic attacks will develop panic disorder.Even though the symptoms of this disorder can be quite overwhelming and frightening, they can be managed and improved with treatment. Seeking treatment is the most important part of reducing symptoms and improving your quality of life.
Pounding or fast heartbeat
Trembling or shaking
Shortness of breath or a feeling of being smothered
A choking feeling
Nausea or stomach pains
Feeling dizzy or faint
Chills or hot flashes
Numbness or tingling in the body
Feeling unreal or detached
A fear of losing control or going crazy
A fear of dying
Be aware that most of these symptoms can also be symptoms of other conditions or problems, so you may not always be experiencing a panic attack.For example, you may have a racing heartbeat if you have very low blood pressure.
It is Misinterpretation and Catastrophization that cause us to panic and become locked in the cycle.
It’s not known what causes panic attacks or panic disorder, but these factors may play a role:
Temperament that is more sensitive to stress or prone to negative emotions
Certain changes in the way parts of your brain function
Panic attacks may come on suddenly and without warning at first, but over time, they’re usually triggered by certain situations.Some research suggests that your body’s natural fight-or-flight response to danger is involved in panic attacks. For example, if a grizzly bear came after you, your body would react instinctively. Your heart rate and breathing would speed up as your body prepared for a life-threatening situation. Many of the same reactions occur in a panic attack. But it’s unknown why a panic attack occurs when there’s no obvious danger present.
Education about the disorder : Following assessment, a therapist will teach you about anxiety in general, and panic disorder specifically. This will involve talking about the ‘fight or flight’ response and details of how this affects the body. Education will involve dispelling fears that people commonly have about this disorder such as that they are going crazy or will die as a result of the symptoms.
Relaxation and breathing techniques : Panic can be made worse by over breathing. Slowing one’s breathing rate can be effective for some people to help deal with a panic attack and also to prevent a full-blown attack from occurring. Relaxation is probably more useful as a general strategy for dealing with anxiety but has been shown to be helpful for some people with panic disorder. Relaxation and slow-breathing alone have not generally been shown to effectively treat panic disorder, although there is some evidence that a form of relaxation called ‘applied relaxation’ can be helpful.
Cognitive Behavioural Therapy:CBT for panic disorder involves treatments that change the behavior (exposure and anxiety management such as slow-breathing) and those that change anxiety-provoking and worrying thoughts (i.e. cognitive therapy). The goal is to help you develop a less upsetting understanding of physical changes that occur when you are anxious. There is evidence that CBT is more effective than medication in both the short and long term. One advantage of CBT over medication is that it has been shown to be helpful in the long-term, i.e. several months to several years after short-term treatment has finished.
Cognitive therapy : This part of treatment involves identifying triggers for panic attacks and understanding the fears you have about the symptoms of panic. Triggers might be a thought or situation or a slight physical change such as faster heartbeat. People are taught to be more realistic in their interpretation of panic symptoms and feared situations.
Interoceptive exposure and In vivo exposure(graded exposure) : Interoceptive exposure involves becoming less frightened of the symptoms of panic in a controlled manner. For instance, it might involve jogging on the spot in the therapist’s office to become more familiar with the meaning of certain symptoms such as rapid heartbeat and shortness of breath. Alternatively, it may involve drinking cups of coffee or sitting in a hot room. For those who avoid situations for fear of having a panic attack it will be important to face feared places. In vivo exposure involves breaking a fearful situation down into achievable steps and doing them one at a time until the most difficult step is achieved. For example, if a person is fearful of train journeys, the treatment may include going on trains, then going on trains with an increasing number of stops and with increasingly large crowds and so on.
In simple terms, anxiety is a feeling of fear or apprehension which occupies your mind. Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. You may avoid places or situations to prevent these feelings. Symptoms may start during childhood or the teen years and continue into adulthood.
Examples of anxiety disorders include generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. You can have more than one anxiety disorder. Sometimes anxiety results from a medical condition that needs treatment.Whatever form of anxiety you have, treatment can help.
Anxiety disorders are a group of related conditions, each having unique symptoms. However, all anxiety disorders have one thing in common: persistent, excessive fear or worry in situations that are not threatening. People typically experience one or more of the following symptoms:
Feelings of apprehension or dread
Feeling tense or jumpy
Restlessness or irritability
Anticipating the worst and being watchful for signs of danger
Pounding or racing heart and shortness of breath
Sweating, tremors and twitches
Headaches, fatigue and insomnia
Upset stomach, frequent urination or diarrhea
Types Of Anxiety Disorders
There are many types of anxiety disorders, each with different symptoms. The most common types of anxiety disorders include:
Generalized Anxiety Disorder (GAD)
GAD produces chronic, exaggerated worrying about everyday life. This worrying can consume hours each day, making it hard to concentrate or finish daily tasks. A person with GAD may become exhausted by worry and experience headaches, tension or nausea.
Social Anxiety Disorder
More than shyness, this disorder causes intense fear about social interaction, often driven by irrational worries about humiliation (e.g. saying something stupid or not knowing what to say). Someone with social anxiety disorder may not take part in conversations, contribute to class discussions or offer their ideas, and may become isolated. Panic attacks are a common reaction to anticipated or forced social interaction.
This disorder is characterized by panic attacks and sudden feelings of terror sometimes striking repeatedly and without warning. Often mistaken for a heart attack, a panic attack causes powerful physical symptoms including chest pain, heart palpitations, dizziness, shortness of breath and stomach upset. Many people will go to desperate measures to avoid an attack, including social isolation.
We all tend to avoid certain things or situations that make us uncomfortable or even fearful. But for someone with a phobia, certain places, events or objects create powerful reactions of strong, irrational fear. Most people with specific phobias have several things that can trigger those reactions; to avoid panic, they will work hard to avoid their triggers. Depending on the type and number of triggers, attempts to control fear can take over a person’s life.
Other anxiety disorders include:
Agoraphobia : Agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable. Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that sufferers often develop.
Selective mutism : Selective mutism (SM) is a disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. Selective mutism usually co-exists with shyness or social anxiety.People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism or even punishment.
Separation anxiety disorder : Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. Separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder.
Substance/medication-induced anxiety disorder, involving intoxication or withdrawal or medication treatment
Please Note :
Obsessive–compulsive disorder (OCD) is not classified as an anxiety disorder by the DSM-5 but is by the ICD-10. It was previously classified as an anxiety disorder in the DSM-IV. It is a condition where the person has obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to repeatedly perform specific acts or rituals), that are not caused by drugs or physical order, and which cause distress or social dysfunction. The compulsive rituals are personal rules followed to relieve the anxiety.
Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in DSM-V) that results from a traumatic experience. Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even a serious accident. It can also result from long-term (chronic) exposure to a severe stressor.
Scientists believe that many factors combine to cause anxiety disorders:
Genetics. Studies support the evidence that anxiety disorders “run in families,” as some families have a higher-than-average amount of anxiety disorders among relatives.
Environment. A stressful or traumatic event such as abuse, death of a loved one, violence or prolonged illness is often linked to the development of an anxiety disorder.
Physical symptoms of an anxiety disorder can be easily confused with other medical conditions, like heart disease or hyperthyroidism. Therefore, a doctor will likely perform an evaluation involving a physical examination, an interview and lab tests. After ruling out an underlying physical illness, a doctor may refer a person to a mental health professional for evaluation.
Using the Diagnostic and Statistical Manual of Mental Disorders (DSM) a mental health professional is able to identify the specific type of anxiety disorder causing symptoms as well as any other possible disorders that may be involved. Tackling all disorders through comprehensive treatment is the best recovery strategy.
Different anxiety disorders have their own distinct sets of symptoms. This means that each type of anxiety disorder also has its own treatment plan. But there are common types of treatment that are used.
Psychotherapy, including cognitive behavioral therapy
Complementary health approaches, including stress and relaxation techniques
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.
Scientists have not yet discovered a single cause of bipolar disorder. Currently, they believe several factors may contribute, including:
Genetics. The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not so absolute. Studies of identical twins have found that, even if one twin develops the disorder, the other may not.
Stress. A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. Thus, a person’s handling of stress may also play a role in the development of the illness.
Brain structureand function. Brain scans cannot diagnose bipolar disorder, yet researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder.
Manic and Depressive Episodes
People with bipolar disorder have periods or episodes of:
depression – feeling very low and lethargic
mania – feeling very high and overactive (less severe mania is known as hypomania)
Types of Bipolar Disorder
Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person’s manic episodes must last at least seven days or be so severe that hospitalization is required.
Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a “full” manic episode.
Cyclothymic Disorder or Cyclothymia is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.
Bipolar Disorder, “other specified” and “unspecified” is when a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.
Treatments and Therapies
Right now, there is no cure for bipolar disorder, but treatment can help control symptoms. Most people can get help for mood changes and behavior problems. Steady, dependable treatment works better than treatment that starts and stops. Treatment options include:
Different kinds of psychotherapy, or “talk” therapy, can help people with bipolar disorder. Therapy can help them change their behavior and manage their lives. It can also help patients get along better with family and friends. Sometimes therapy includes family members.
Cognitive Behavioral Therapy (CBT), as individual or family-focused therapy, can help prevent relapses.
Interpersonal and Social Rhythm Therapy, combined with CBT, can also help with depressive symptoms.
2. Other treatments.
Some people do not get better with medication and therapy. These people may try ElectroConvulsive Therapy (ECT).This is sometimes called “shock” therapy. ECT provides a quick electric current that can sometimes correct problems in the brain.
ElectroConvulsive Therapy (ECT)
Electroconvulsive therapy, also known as ECT or electroshock therapy, is a short-term treatment for severe manic or depressive episodes, particularly when symptoms involve serious suicidal or psychotic symptoms, or when medicines seem to be ineffective. It can be effective in nearly 75% of patients.
In electroconvulsive therapy, an electric current is passed through the scalp to cause a brief seizure in the brain. ECT is one of the fastest ways to relieve symptoms in people who suffer from mania or severe depression. ECT is generally used only when medicines or other less invasive treatments prove to be unhelpful. It is also used when mood or psychotic symptoms are so severe that it may be unsafe to wait until drugs can take effect. ECT is also often thought to be the treatment of choice for severe mood episodes during pregnancy.
Prior to ECT treatment, a person is given a muscle relaxant and put under general anesthesia. Electrodes are placed on the patient’s scalp, and an electric current is applied that causes a brief seizure. Because the muscles are relaxed, the seizure will usually be limited to slight movement of the hands and feet. The patient is carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding the treatment, and may be briefly confused.
ECT is usually given up to three times a week, typically for two to four weeks.
The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure was developed to aid clinicians with a dimensional assessment of psychopathology; however, this measure resembles a screening tool for several symptomatic domains. The objective of the current study was to examine the basic parameters of sensitivity, specificity, positive and negative predictive power of the measure as a screening tool. One hundred and fifty patients in a correctional community center filled out the measure prior to a psychiatric evaluation, including the Mini International Neuropsychiatric Interview screen. The above parameters were calculated for the domains of depression, mania, anxiety, and psychosis. The results showed that the sensitivity and positive predictive power of the studied domains was poor because of a high rate of false positive answers on the measure. However, when the lowest threshold on the Cross-Cutting Symptom Measure was used, the sensitivity of the anxiety and psychosis domains and the negative predictive values for mania, anxiety and psychosis were good. In conclusion, while it is foreseeable that some clinicians may use the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure as a screening tool, it should not be relied on to identify positive findings. It functioned well in the negative prediction of mania, anxiety and psychosis symptoms.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and offers a common language and standard criteria for the classification of mental disorders. It is used, or relied upon, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, the legal system, and policy makers together with alternatives such as the ICD-10 Classification of Mental and Behavioural Disorders, produced by the WHO.The manual is non-theoretical and focused mostly on describing symptoms as well as statistics concerning which gender is most affected by the illness, the typical age of onset, the effects of treatment and common treatment approaches.
The Diagnostic and Statistical Manual has been revised a number of times in its history.
1952: The DSM-I
1968: The DSM-II
1974: The DSM-II Reprint
1984: The DSM-III
1987: The DSM-III-R
1994: The DSM-IV
2000: The DSM-IV-TR
2013: The DSM-5
DSM – 5
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance.
The DSM-5 was published on May 18, 2013, superseding the DSM-IV-TR, which was published in 2000. The development of the new edition began with a conference in 1999 and proceeded with the formation of a Task Force in 2007, which developed and field-tested a variety of new classifications. In most respects, the DSM-5 is not greatly modified from the DSM-IV-TR; however, some significant differences exist between them. Notable changes in the DSM-5 include the reconceptualization of Asperger syndrome from a distinct disorder to an autism spectrum disorder; the elimination of subtypes of schizophrenia; the deletion of the “bereavement exclusion” for depressive disorders; the renaming of gender identity disorder to gender dysphoria, along with a revised treatment plan; the inclusion of binge eating disorder as a discrete eating disorder; the renaming and reconceptualization of paraphilias to paraphilic disorders; the removal of the axis system; and the splitting of disorders not otherwise specified into other specified disorders and unspecified disorders. In addition, the DSM-5 is the first DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the first “living document” version of a DSM.