Psych Central

Archive for May, 2009

Memories, loss, and a game of cards

Tuesday, May 26th, 2009

The New York Times recently reported about an ongoing study on aging that began in 1981 and has included at least 14,000 people all over the age of 65. At least 1,000 members of the group were older than 90. The study, conducted by the University of California, is looking at what provides protection against dementia in some groups of elderly people. Like other studies, this one points to keeping mentally and socially active as variables that seem present in most people who stay sharp in old age. Many of the people who kept their mental sharpness played cards daily.

I witnessed these interactions of factors such as social support, and the benefit of keeping mentally busy, first hand over the past decade. When my father passed away 10 years ago, my mother moved to an active retirement community. She was in relatively good health. At 81, my mother enthusiastically enjoyed the various social activities; she joined clubs, got regular exercise, organized events, and helped to arrange expeditions to restaurants, concerts, and even an occasional road trip. Those first few years at the community, she occasionally played cards.

However, as she aged her outside activities began to decrease; she became frail, and she filled more of her time with card playing. There were two tables, mostly women, who met on the balcony at the center. The game was canasta. It was a serious game; played for the glory of winning or sometimes a few pennies. If a visitor dared to interrupt the play, the reaction of the group was quick and simple. Go away–we’re busy. I’d often just say hello, check to see if she needed anything and quietly leave, grateful that she was occupied.

Sometimes a player would vanish. A few never returned; others came back for a while. If you asked those at the table what happened, there would be comments such as, “Oh, he died,” or “She went to live with her daughter,” or “He’s in the hospital,” or “She had to go to the nursing home,” “She fell,” or “She’s not doing well today.”

Other players were auditioned to replace someone who left. Those who passed …


Obsessive Worries: Could You be a Killer?

Saturday, May 23rd, 2009

We want to discuss a widely reported news story that concluded yesterday. About a week ago a couple of kids were playing in an Albuquerque park. They spotted a tennis shoe sticking out in the sand. A 3 year old boy was found buried under the swing set. There were no reports of a missing child and no one came forth to claim him.

Help from the community, the police department, retired police officers, and other law enforcement professional all over the country swarmed in. After a frantic week of searching, they found the boy’s mother and she confessed to the crime. She was homeless and estranged from her family. After spending the night in a park, she decided that her son’s life should be taken. Apparently, she put her hand over his mouth until he stopped breathing. She then revived him using CPR she had learned as a student dental hygienist. His return to life was fleeting. She reported that she then suffocated him again. After waiting a few minutes, she dug his grave in the soft sand of a playground. The city responded with horror and broken hearts to the story of a little boy named Tyrus.

We ‘re writing about this gut wrenching news event because some people with OCD have obsessive thoughts about hurting a person they care about. Some parents with a specific type of OCD have horrible intrusive images of themselves hurting and yes even killing their kids. We want to repeat the message we have given before in our blog Baby Anxiety and throughout our OCD For Dummies book.

People with OCD are almost always highly moral, well controlled, and kind. They do not hurt others; especially when they have these obsessive thoughts. Their thoughts do not make them more susceptible to doing bad deeds. And having a “bad” thought is not the same as doing a “bad” deed. Thoughts are just thoughts.

But still, how do you know that you’re not in the category of a potential killer of your child? In other words, how do you know that’s it’s your OCD and not a true desire to kill …


Finding a Therapist for Obsessive Compulsive Disorder

Wednesday, May 20th, 2009

We recommend that people with OCD (obsessive compulsive disorder) get help from a therapist with experience and training in cognitive behavioral therapy. Specifically you want a therapist trained in a technique called exposure and response prevention. Many of our readers with OCD have asked for directions on finding a good, well trained therapist. Here are a few web sites that list therapists. Of course, we don’t know all of the names on these lists, but generally the therapists will have training in this area.

Association for Behavioral and Cognitive Therapies This site has listings of therapists all over the world. The Association encourages the study, practice, and development of scientifically validated treatments in the area of cognitive behavior therapy (which the specific technique, exposure and response prevention is based upon).

Academy of Cognitive Therapy This organization certifies therapists who have been trained in cognitive therapy. Many, if not most of these therapists are also well schooled in cognitive behavior therapy.

Obsessive Compulsive Foundation This nonprofit organization delivers education to the public and professionals about OCD. You can find lots of articles and information about books and workshops. A list of therapists trained in treating OCD is also available.

When therapists are on one or more of these lists, there is a greater likelihood that they have had experience and training in the treatment of OCD than those not on the lists. But you should still inquire about specific expertise in treating OCD. However, all therapists do not choose to be listed in this manner. Some may have full practices, or prefer to have referrals directly from a particular source. Professional associations at the state level (in social work, counseling, psychology, and psychiatry) also often provide referrals.

However, much as you want expertise in treating OCD, there are a few additional things to consider when working with a therapist. After you’ve made a selection and begun your work, you want to ask yourself a few questions such as:

  • Do you feel comfortable talking about everything with your therapist?
  • Does your therapist allow you to express your feelings about therapy?
  • Do you feel understood by your therapist?
  • Does your therapist seem nonjudgmental for the most part?
  • Does …

Lingering Depression

Friday, May 15th, 2009

I read a well written, moving article in the Sunday NYT magazine section about a woman with severe, unremitting depression. Although the ending offered a small bit of hope, the piece induced in me the feeling that depression has a life of its own, and that those of us who try to help people with depression are mostly powerless bystanders. Daphne Merkin, the author writes, “What’s more, after a lifetime of talk therapy and medication that never seemed to do more than patch over the holes in my self, I wasn’t sure that I still believed in the concept of professional intervention.”

At first, I thought that writing about that piece could be dangerous, that anything I wrote would be construed as me not understanding the depth and darkness of real depression. But then, I thought that stance would be cowardly and fighting depression takes courage. So here goes.

I find myself wondering why people who live in New York City (and write about depression) seem to have such poetic yet intractable depressions. Okay, some of my favorite people live in or come from NYC; but really, sometimes it seems to me that those that venture west appear more able to plod through life than those remaining in the dark canyons and gray skies of NYC.

On a more serious level, I also wonder why so many people persist in getting therapy that does not seem to be working. If you are in therapy for a “lifetime” and are not getting better, ask for a referral! Do so again if the new therapy doesn’t seem to be doing you any good after a few months. There are literally thousands of practitioners, especially in New York that offer empirically validated treatments for depression such as cognitive behavioral therapy. And finally, if you are getting medications that are not helping you, talk to, and yes, complain to your doctor (but please don’t abruptly discontinue without talking to your doctor).

I write this because I have studied many hundreds of research articles that show people who receive cognitive behavioral therapy for depression, whether mild or severe, can and usually do recover. Other …


Women, Anxiety, and Exercise

Tuesday, May 12th, 2009

The United States Department of Health and Human Services issued a report in conjunction with the beginning of Women’s Health Week. The report found that women may be almost twice as likely to suffer from major depression than men. Furthermore, the rates of anxiety disorders are two to three times greater in women than in men. Anxiety comes in many forms such as panic disorder, post traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), agoraphobia, specific phobias, and social phobias.

These high rates of distress in women not only affect women, but their families, friends, and coworkers as well. Anxiety or depression may cause mothers to be less able to take cheerful care of their children, women may have more trouble keeping their households organized, and women workers miss work due to emotional and physical manifestations of their mental disorders. The burden of mental illness on the society as a whole through loss of productivity, loss of wages, and cost of care has been well documented. However the personal loss of a child who yearns for a happy moment with a mother who is depressed, a woman who can’t enjoy the first few days of spring, or the woman who finds life a series of hurdles cannot be quantified.

So, what can we do to help? There are many ways to improve lives. Lots of help is available. But today, I want to share with you a simple solution that involves a commitment from women. This will cost next to nothing and no other treatment has been found to be as consistently successful. Get moving. That’s right, exercise. When I learned about the information about higher rates of anxiety and depression in women, I wanted to find a bit more information. So, I went to the US Dept of Health website: www.womenshealth.gov

While I was surfing for more information, I ran across a program called “woman activity tracker.” You can sign up for free (I did), then you set a modest goal of doing some amount of exercise. You don’t have to be public with your information. Starting this week and running through June …


When Anxiety isn't Anxiety

Saturday, May 9th, 2009

Though not typical, some people experience significant anxiety for the first time in their lives as adults. Other folks have had previous bouts with anxiety, but suddenly feel an intense new wave of anxious feelings for no clear reason. Is it possible, as an adult, to end up with an anxiety disorder, panic, or worry that you’ve never had before or that you can’t figure out where it’s coming from? Absolutely. And a good therapist may help you put your finger on what’s causing your problem.But, before you run to a shrink, we suggest you consider the possibility that medications (whether prescription or over the counter) as well as various medical conditions may be causing the problem. Here are just a few of the most widely prescribed types of medications that have side effects which can, at times, mimic anxiety:

  • Codeine (for pain relief): Can cause agitation, nausea, dizziness, flushing, and restlessness.
  • Calcium channel blockers (for high blood pressure): Can cause flushing, palpitations, dizziness, lightheadedness, and fatigue.
  • ACE inhibitors (for high blood pressure): Can cause dizziness, headaches, nausea, weakness, and impotence.
  • Statins (for high cholesterol): May cause dizziness, headaches, diarrhea, nausea.
  • Benzodiazepines (for treating anxiety!): May cause dizziness, anxiety, tremors, headaches, and stimulation.

Many more examples of medications causing anxiety like symptoms can be found, and as you can see, even medication for treating anxiety sometimes causes these symptoms. Over the counter medications can do the same thing. Bronchodilators, decongestants, caffeine, and cold remedies are some prime culprits. Even the astonishingly popular energy drinks crowding convenience store shelves can easily trigger a cascade of anxiety like symptoms such as flushing, palpitations, jitteriness, and dizziness.

In fact, though I sort of hate to admit it, a few years ago I began to experience an unusually rapid pulse and tightness in my chest while seeing a client in my office. For a moment I wondered if I was having a panic attack though I’d never had one before and I couldn’t for the life of me figure out what would have triggered such an attack right then. After I thought about it a little longer, I realized that I’d probably taken a little too …


Women and Financial Stress

Tuesday, May 5th, 2009

You can’t read a newspaper, click on an online news site, listen to the radio, or watch a television newscast without seeing or hearing something about the economy in a recession. Unemployment this month has reached over eight and a half percent with many areas on the country seeing more than 10 percent of its population out of work. Men and women are both faced with the mounting stress of feeding their families, looking for work, watching their houses go down in value, and looking at dwindling retirement savings.

A recent telephone survey sponsored by the American Psychiatric Association found that women are reporting significant increases in negative mental health symptoms in the past months. Women throughout the United States were interviewed along with a large sample of women in Clinton County, Ohio. The Ohio sample was included because the people of Clinton County have experienced a higher than average loss of employment due to DHL eliminating more than 5,000 jobs.

The results of this survey suggested that the higher rates of unemployment and wage cuts in Clinton County, Ohio have indeed increased the levels of stress, anxiety, irritability, sleep problems, and frustration in women. For the women in that area who have not experienced a job loss, the fear of losing a job and the stress of seeing friends and neighbors suffering raises their levels of anxiety. A smaller but still significant level of increased stress was also found in the country wide survey.

Women who experience anxiety tend to push their worries aside and focus on their families. They are likely to forgo their own needs in favor of making sure that their families are taken care of. At the same time, many of the women sampled said that they are spending more time with their families and friends and engaging in positive activities.

Women must take care of themselves in order to be strong for their families. If women are irritable, fatigued, and frustrated, caring for others may be more difficult. Therefore, women should strive for a balance between dealing with their own anxiety and helping their family members. Exercise and social support are critical in these times. So, …


More about OCD and Children

Saturday, May 2nd, 2009

If a child has OCD, getting an accurate diagnosis is critical. Unfortunately, the disorder can be hard to spot. Children with OCD may keep their symptoms secret because of shame, guilt, or fear. They often get in trouble in school or at home because they can’t complete assignments due to obsessive thoughts or compulsions. The following case examples illustrate what might happen to a child with OCD.

Julie, a 3rd grader student, believes that her letters must be perfectly formed or something bad will happen to her family. This thought repeats in her mind over and over again (an obsession). In order to protect her family, she must carefully draw each letter on all of her written assignments (a compulsion). If she is not satisfied with the result, she throws her paper away and starts over. Julie’s teacher becomes frustrated with her and tells her that her writing is fine, just turn in the paper. Julie, terrified that her family is in danger, can’t stop herself. Her teacher finds Julie’s behavior irritating and disrespectful. So instead of getting help, Julie’s grades begin to drop.

Sam’s mother notices that her son is taking longer and longer to get ready for school in the morning. He takes forever to get dressed. With two younger sisters needing help, she expects 10 year-old Sam to be independent. She explains to him that either he gets ready to leave for school by 8 in the morning or he’ll have to get up earlier. The next day, she finds Sam on the floor in his room putting a sock on and then taking it off. Sam has an intense need for his socks to be even. The thought of clothing being “wrong” makes Sam very anxious. When his mother asks him what is the world he is doing, Sam replies, “nothing”.

He doesn’t understand why these urges to make things “just so” are overwhelming him. He believes that if he tells anyone about his troubles, they’ll think he’s weird. So, Sam remains silent and continues his compulsive dressing. His mother sets the alarm earlier. Within days, Sam find himself arranging and rearranging …


Anxiety & OCD Exposed



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Laura L. Smith, Ph.D. and Charles H. Elliott, Ph.D. are authors of many books, including Overcoming Anxiety for Dummies and Child Psychology & Development for Dummies.

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