All posts by Dr. Andrew Rosen

Does Breast Cancer Awareness Month Increase Health Anxiety?

It’s October and pink ribbons are popping up everywhere. While this time of year is good for reminding women to do their breast self-exams or get an annual mammogram, it also can be a month of great concern for women who suffer from health anxiety.

The Anxiety and Depression Association of America defines health anxiety as “the misinterpretation of normal bodily sensations as dangerous.” It is the excessive fear of physical illness and women who have the disorder often find it difficult to cope with Breast Cancer Awareness Month. For these women, every new twinge or tiny pain in their breasts likely signals cancer.

People with health anxiety may be so overwhelmed by their fears that they find it hard to live a normal life. They can spend hours online researching a symptom, convinced that a minor symptom is a sign of a serious illness. When October rolls around, the stories of breast cancer survivors may drive a woman with health anxiety to compulsively examine her breasts, positive that every small bump is a tumor just waiting to kill her. Or, she might feel something as innocent as an itch in her breast and suffer severe anxiety because she’s surrounded by breast cancer images on the news and on social media. And, like too many people with health anxiety, she may beg her doctor for unnecessary tests and spend an exorbitant amount of time and money visiting doctors in the quest for a diagnosis that will never come.

What are the Symptoms of Health Anxiety?

Health Anxiety Disorder is also known as hypochondria. Roughly 1-5% of the population suffers from health anxiety. It’s estimated that those with hypochondria use about 10-13 times the health resources that the average person does.

People who suffer from health anxiety:

  • Frequently check their bodies for new pains, blemishes, lumps, or lesions
  • Live in terror that any new physical symptom is a sign of a serious or life-threatening disease
  • Research health problems obsessively
  • Compulsively check their vital signs, take their temperature, or monitor their blood pressure and pulse rate
  • Switch doctors frequently because their current physician can’t find anything wrong with them
  • Either avoid doctors altogether or go to numerous medical consultations
  • May have strained relationships with friends or family
  • Are reluctant to consider that anxiety and other psychosocial factors may be causing their symptoms

Who is at Risk of Developing Health Anxiety?

While there are no easy answers, the people who are most at risk of becoming hypochondriacs tend to be worriers. They may strongly believe that being in good health means you have no physical symptoms or sensations. Frequently, they know someone with a serious disease or they went through a serious illness themselves during their childhood. Additionally, health anxiety can be triggered by the death of a loved one.

Overcoming Health Anxiety

Often, patients with hypochondria are so resistant to the idea of having an anxiety disorder that it may take intervention from their loved ones to help them understand they need treatment.

Cognitive behavioral therapy (CBT) is very effective for the treatment of health anxiety disorders. This type of therapy focuses on recognizing and understanding the false beliefs, thoughts, and actions that bring on the anxiety. Because people with hypochondria assign meanings to certain symptoms or sensations (“My breast is tender and that definitely means I have breast cancer”), CBT helps patients realize that it isn’t the symptom that causes the anxiety, it’s their reaction to the symptom that does.

By changing their mindset, a person with health anxiety learns to see a worrisome situation in a different way. Cognitive behavioral therapy teaches them how to stop the negative behaviors that reinforce the disorder.

It’s Important to Get Help for Health Anxiety

If you or someone you care about is overly worried about health concerns, it could be caused by health anxiety. Delaying treatment for hypochondria can cause complications such as depression and substance abuse, not to mention financial difficulties due to excessive medical costs or health risks from undergoing unnecessary procedures. Our compassionate mental health professionals are here to help. Contact the Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida for more information or call us today at 561-496-1094.

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On Being A Physician by Dr. Gross

Looking back on my many years as a physician I thought it appropriate to comment on this profession especially in a time when the core values of physician-hood are being tested.

I truly am grateful and honored to continue to serve as a physician to my patients. Unlike other “jobs”, being a physician is a unique calling. Perhaps the best way for me to share with you the special nature of this profession is by relaying an experience from my first year at medical school at the University of Florida. The Chairman of Medicine, Dr. Lee Cluff facilitated a seminar entitled “What has modern medicine contributed to humankind?” Like good medical students we each chose a topic to present; infectious disease, heart disease, etc. Each week several of us presented an in-depth treatise on our topic that covered all the miraculous advances in medicine that aided our patients. When the last medical student presented their topic Dr. Cluff then proceeded with his contribution. He started by telling us that we were all correct in our summaries as to the contributions of modern medicine while at the same time we were also wrong. He went on to state that what has not changed in over one hundred years has been the role of the physician. Our responsibility is to our patients so that at “the end of the day” they can be assured they have someone to call in their time of need. He was emphasizing the critical importance of the physician-patient relationship; the trust, compassion and honesty of communication that must be developed.

I believe that if one replicated this seminar today focusing on the amazing scientific advances in all of medicine we would still fall back on Dr. Cluff’s core premise underlying the importance of the therapeutic alliance between physician and patient. As physicians we function as healer, friend, confidant and at times wise sage. This is quite a tall order which at times can be demanding. Nevertheless I believe that it is essential component of physician-hood. This brings me to the nature of medicine in this 21st century. The stunning advances in the science of medicine have unfortunately placed an undue focus on the science itself, placing the physician-patient covenant somewhere down the priority list. There are a whole host of factors responsible for this shift including the role that modern health insurance and the managed care industry have relegated physician providers to a subservient role. Health insurance in the previous century reimbursed the individual for covered expenses. The last two decades of that century saw the development of provider physician panels that essentially allowed the insurance companies to gain control of the marketplace. Provider physicians suddenly were faced with reduced controlled fee schedules resulting in higher volumes of patients. This then led to what we witness today, patient volume-related reduction in time spent with each patient. As one would imagine, relationships are based on time and experience and as a consequence the relationships of today's medical practice have suffered.

In Psychiatry, the advent of managed care has relegated the Psychiatrist to physician prescriber while non-psychiatrist provider panels provide the psychotherapy due to insurance cost issues. As I have indicated in the past, Psychiatry is no different from other fields of medicine in that the physician Psychiatrist core role is to be able to provide a diagnostic assessment after a comprehensive examination and data gathering. The treatment plan comes next which may include additional testing, psychotherapy and/or medication. I cannot over emphasize the importance of an evaluation that employs a comprehensive medical (bio-psycho-social) model.

Despite the misgivings outlined, I remain proud of my role a physician Psychiatrist and the honor of providing care to my patients. At the end of the day it is essential for all of us to know there is someone to call in our time of need.

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jBaby – An Educational Program Series from The Jewish Federation of South Palm Beach County

Introducing jBaby, an educational program series from The Jewish Federation of South Palm Beach County. This six part program series for parents focuses on important pre-natal topics presented by local topic experts. See below for the full schedule and be sure to RSVP to this program series here.

6-part program series for parents (pre-natal) – $118

For more information, please call Liana Konhauzer at 561.852.5015 or email lianak@bocafed.org.

October 9, 2018 – What to expect when you are expecting…a Jewish baby!

Moderated panel including the PJ Library Chair, J-screen representative, etc.

October, 30, 2018 – Raising a Jewish baby

What does having a baby mean for your Jewish life? What does your first Shabbat look like? Open discussion.

Presentation by Dr. Leon Weissberg

November 8, 2018 – Health & Wellness Seminar

Presentation by the New Leaf Life

November 28, 2018 – Preparing for Parenthood

Emotional aspects of becoming a family. What does fatherhood and motherhood mean? Navigating the relationship with your grandparents, Intentional parenting, etc.

Presentation by KC Charette, Psy.D

December 12, 2018 – Planning for the future

Planning for your child’s future, wills, trusts, insurance, etc.

December 18, 2018 – Welcome to the community

What does it mean to be a part of the South Palm Beach County Jewish community? Open Q&A.

RSVP for the Educational Program Series »

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Rapid Onset Gender Dysphoria: Does it Exist?

workshop on resiliency and overcoming traumaThe American Psychiatric Association (APA) defines a person as having gender dysphoria when they feel strongly that they don’t identify with the biological gender they were born with, when it causes them distress, and when they have felt this way for at least six months. Although children as young as age four may express gender nonconformity, often a person isn’t aware of their gender dysphoria until they reach puberty and recognize they are not comfortable with the new changes going on in their bodies. Because this realization may take their families by surprise, some researchers have been recently exploring a new subset of gender dysphoria called Rapid Onset Gender Dysphoria (ROGD). On the surface, ROGD seems to occur very suddenly and without the child having expressed any prior distress with their physical gender.

What is Rapid Onset Gender Dysphoria?

The term “Rapid Onset Gender Dysphoria” has only sprung up within the past decade or so. ROGD has not been established as a distinct syndrome and this type of dysphoria has only been casually – but not scientifically – observed.

In ROGD, an adolescent or young adult who has seemingly always identified as their physical (birth) gender abruptly starts to identify as another gender. It is important to note that the child would not have met the APA’s criteria for gender dysphoria prior to this, nor would they have shown any discomfort with their birth gender. Moreover, often multiple friends within the child’s same peer group simultaneously begin to identify with another gender and become gender dysphoric around the same time.

Why is ROGD Controversial?

A Brown University researcher recently published a study designed to empirically describe teens and young adults who did not have symptoms of gender dysphoria during childhood but who were observed by their parents to rapidly develop gender dysphoria symptoms over days, weeks or months during or after puberty.” The study author, Lisa Littman, is an assistant professor of the practice of behavioral and social sciences at Brown’s School of Public Health.

For the study, Littman surveyed more than 250 parents who had reported their children developing gender dysphoria within a very short time period. Of these parents, about 45 percent noticed that their child had increased their social media use before announcing their dysphoria. They also told Littman that the child had one or more friends who had become transgender-identified around the same time as their child.

These findings led to Littman’s hypothesis that gender dysphoria could be spread, at least partially, by social contagion. She proposed that a child’s peers, coupled with information obtained from social media, could cause the child to embrace certain beliefs, such as the idea that feeling uneasy with the gender you were born with meant you were gender dysphoric. Because many gender nonconforming teens also push for medical transition to the gender with which they identify, Littman went further and suggested that medical transition could be a harmful coping tool in much the same way that alcohol or substance abuse are negative coping mechanisms.

Her hypotheses set off a firestorm. Transgender advocates aggressively condemned Littman’s study saying, in part, that it was methodologically flawed because Littman only interviewed parents and did not get input from the transgender-identifying children. They also called the study “antitransgender” and a denial of transgender affirmation while citing the fact that a person who is questioning their gender would naturally read up on the subject and communicate with supportive friends who had similar thoughts and feelings. Advocates also pointed out that a true gender dysphoria diagnosis requires evaluation by specialists, but the Rapid Onset Gender Dysphoria study only required the parent’s perspective.

As a result of the criticism, Brown University withdrew their press release about the study. They also released a statement explaining their decision to conduct a post-publication re-review of Littman’s Rapid Onset Gender Dysphoria study. They worried that the study “could be used to discredit efforts to support transgender youth and invalidate the perspectives of members of the transgender community.”

Gender Dysphoria Treatment

We know that gender dysphoria exists, but clearly more research is needed in order to settle the question of whether Rapid Onset Gender Dysphoria is real.

For those with gender dysphoria, early diagnosis, gender-affirming approaches by parents and family, as well as individual and family counseling can help the transgender person and their loved ones deal with the emotional challenges of gender transition.

Often, transgender people take some type of action to outwardly embrace the person they feel they are. They may change their name to one more aligned with the gender they express or may dress as that gender. Other options may include taking puberty blockers, hormones to develop the physical traits of the gender they identify with, or completing sex-reassignment surgery.

We know that people with gender dysphoria have higher rates of mental health conditions like depersonalization disorder, anxiety, depression and mood disorders, and suffer from an increased rate of substance abuse. They also have higher suicide rates, therefore it is important for them to seek mental health treatment. The objective of this treatment is not to change the person’s feelings about their gender, rather it is to give them a way to deal with the emotional issues that come with their gender dysphoria.

Get Answers about Gender Dysphoria and Rapid Onset Gender Dysphoria

If you or a loved one are distressed, anxious, or depressed about your gender identity or worried about ROGD, we can help. Contact the Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida for more information or call us today at 561-496-1094.

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Can Virtual Reality Therapy Treat Eating Disorders?

Eating disorders affect a person’s physical and psychological functioning differently than any other mental health disorder. Once thought to be a problem of the wealthy, eating disorders are now known to impact various cultures, socioeconomic statuses, ages, and genders, and can be found worldwide.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) characterizes people with eating disorders as having “pathological eating habits and a tendency to overestimate their weight and body shape.” Eating disorders are not to be taken lightly: patients with an eating disorder faces a high risk of medical and psychological effects, along with the possibility of death if their condition becomes severe enough.

Eating disorders are also more common than you might think. In fact, a 2007 survey by Hudson, et al., noted that about 1.5% of American women (0.5% of men) experience bulimia nervosa, about 0.9% of women (0.3% of men) have been diagnosed with anorexia nervosa, and roughly 3.5% of women (2% of men) struggle with binge eating disorder.

Until recently, eating disorders have been treated mainly through cognitive behavioral therapy (CBT). New advances in the emerging field of virtual reality therapy (VRT), however, are being combined with traditional therapy and show promise for more effective treatment.

How Does VRT Work?

Virtual reality therapy is a high tech approach to helping people learn effective ways to cope with the fearful situations they dread. During VRT, you wear a virtual reality headset that looks similar to the type you’d use when playing video games. The therapist plays a simulation program that displays avatars in a variety of anxiety-provoking settings, such as in a restaurant or a store dressing room for those with an eating disorder. These settings are low stress to begin with, then stress levels are increased as you become more desensitized to the worrisome scenario.

You use a virtual “body” during VRT. Although this avatar isn’t really “you”, studies show that people feel a close enough association to the avatar that they emotionally respond as if they were in the actual setting. In this way, they can address their eating disorder and work through their body-image issues in a safe, controlled environment. The psychologist listens in during the session to coach, help with relaxation techniques and provide coping skills. They also can control the environment and either stop the program or lower the stress level if you become too upset.

How Effective is VRT for Eating Disorders?

Virtual reality exposure therapy gives people an experience that is just real enough to trigger an emotional response to their eating disorder, but is it effective?

In 2017, DeCarvalho, et. al., did a systematic review of several studies that used virtual reality therapy for binge eating and bulimia nervosa (BN) treatment. One of the studies they analyzed was done by Perpina, et. al., and focused on treatment with a combination of VRT and cognitive behavioral therapy (CBT) versus treatment with CBT alone. The study found that the “VR treatment group showed more BI [body image] improvement than CBT and greater improvement in the behavior clinical measures. At post-treatment, the VR group improved on body attitudes, frequency of negative automatic thoughts on BI, body satisfaction, discomfort caused by body-related situations and BN symptoms (measured by Bulimic Investigatory Test; BITE). These results were maintained or continued to improve (body attitudes, frequency of negative automatic thoughts on BI) at one-year follow-up.” All participants improved in the eating disorders measures and it was also maintained at follow-up.

In a different study, a body-swapping illusion was used in conjunction with virtual reality. Women with body image anxiety were asked to estimate their own body size before participating in two different body-swapping scenarios. In both illusions, the women were shown a virtual image of themselves with skinny stomachs.

The theory was that it may be possible to modify a person’s allocentric memory (a type of spatial memory in which the person mentally manipulates objects from a stationary point of view) for the positive. Indeed, after going through the virtual scenarios, the women in the study reported a decreased estimated body measurement and assessed their body size more accurately than before participating in the illusion.

Get Help for Eating Disorders

Eating disorders impact a person’s biological and psychological functioning in ways unlike other mental health disorders. If you are struggling, we can help through both traditional and virtual reality therapies. Talk to the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida today. For more information, contact us or call us today at 561-496-1094.

Reference:

Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 01;61(3):348–58. doi: 10.1016/j.biopsych.2006.03.040. http://europepmc.org/abstract/MED/16815322. [PMC free article] [PubMed] [Cross Ref]

De Carvalho, M. R., Dias, T. R. de S., Duchesne, M., Nardi, A. E., & Appolinario, J. C. (2017). Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review. Behavioral Sciences, 7(3), 43. http://doi.org/10.3390/bs7030043

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Midlife Anxiety

Patient in need of In Vivo Exposure Therapy.A 2014 study by the British government found that while most people of all age levels are generally content with their lives, those in the middle age years – between the ages of 45 and 59 – are the least happy. These respondents reported low ratings of overall happiness and life satisfaction and a sharp increase in midlife anxiety. Interestingly, even adults aged 90 and older reported being happier and more satisfied than the middle aged group.

What Causes Anxiety in Middle Age?

The U. K. study, done by the Office of National Statistics, analyzed data from more than 300,000 respondents during a three-year period from 2012 to 2015. It generated average scores for specific areas including happiness, life satisfaction, anxiety, and the feelings of being worthwhile. The scores showed that anxiety levels were highest for people between the ages of 40 and 60. The peak anxiety levels were noted in those in the 50 – 54 age group.

Many things can cause midlife anxiety, ranging from underlying health problems to financial concerns. In women, even the fluctuating hormones of menopause and perimenopause can change the chemistry in their brain and bring on anxiety and panic attacks.

For men, while many are aware that anxiety disorders exist, very few realize how often anxiety affects them. Men often refuse to admit to themselves or others that they might have a mental health issue and may seek out unhealthy ways to cope (example: alcohol use) rather than admit to the concern.

There is no one specific trigger that causes midlife anxiety. Instead, people who experience anxiety in middle age are often burdened with simultaneous stressors that other generations aren’t facing: the raising of children, while at the same time trying to hold down jobs and care for elderly parents. Top this off with the financial pressures of putting children through college, empty nest syndrome, and facing worries of possibly not having saved enough for a retirement that is drawing ever closer, and stress rises even higher.

Midlife Anxiety Treatment

Self-help:

One of the best ways to manage anxiety is to reduce your stress. There are several things you can do to accomplish this and a side benefit is that they are also good for your overall health:

  • Get daily exercise. The newest research recommends that we all do some type of aerobic exercise at least 30 minutes a day, a total of 5 days per week. Regular physical exercise causes the brain to release serotonin, the “feel-good” neurotransmitter. Serotonin helps to reduce stress, improve your mood, and gives you more energy. Low-impact exercise, such as swimming, yoga or walking are great examples of workouts that will help raise your serotonin levels.
  • Make time for relaxation. When your days are filled with rush, rush, rush – getting the kids to school, getting yourself to work, finishing projects, taking the kids to after-school activities – relaxation time can be hard to come by. Yet, relaxing is crucial to reducing anxiety and stress levels. Try to set aside time every day, just for yourself. Relaxation can come from simple activities that you look forward to, such as soaking in a warm bath at the end of your day or taking a few minutes to read, meditate or listen to some soothing music.
  • Silence your phone and put away your laptop or tablet (or at least turn off all but the most important alerts). Limit your use of social media and reduce the amount of time you spend reading the news. We’re so used to having our electronics with us at all times, but getting constant notifications and reading endless news reports about crime, wars, and world problems can keep you from truly relaxing. Give yourself an electronic break every day.
  • Visualize yourself in a peaceful setting. Your brain can’t distinguish between a real setting and one you visualize, so reduce your stress by imagining yourself on a tranquil beach or in a beautiful forest. Smell the salt air at the beach or the pine trees in the woods, imagine the sound of the waves on the sand or the birds singing in the forest. Being as specific as you can and really trying to imagine all the aspects of the setting can take you away from your stressors and help you unwind.

Professional help:

When you have anxiety, it’s easy to become overwhelmed by your emotions. When that happens, people tend to react to certain aspects of their lives in a more negative way. It is common to begin to avoid the situations or experience that make you anxious, but that avoidance can actually increase anxiety.

If self-help to reduce your midlife anxiety isn’t working any longer, consider seeing a mental health professional, particularly if your anxiety is causing you extreme distress or disrupting your daily life. Anxiety is treatable and the majority of people who seek help are able to improve, reduce or eliminate their anxiety symptoms after working with a psychologist to address their own, specific concerns.

Cognitive behavioral therapy (CBT) is a form of psychotherapy that is very effective for treating anxiety in middle age. CBT helps you understand how your own negative thoughts contribute to your anxiety symptoms. By learning to recognize these negative thought patterns, you can change them, which allows you to manage your symptoms. Additionally, cognitive behavioral therapy teaches you skills and techniques for coping with your midlife anxiety.

CBT is often used in conjunction with exposure therapy. Exposure therapy allows you to gradually confront your fears in a safe environment and in a way that gives you control. When you face your fears without harm, you reduce your anxiety by learning that the outcome you feared is unlikely to happen.

Get Help for Midlife Anxiety

If you’re feeling overwhelmed and facing midlife anxiety, we can help. Talk to the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida today. For more information, contact us or call us today at 561-496-1094.

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How Do You Know That You Have Received a Comprehensive Psychiatric Evaluation?

As I have discussed in previous blogs on this website, the practice of Psychiatry is challenging. Unlike other medical specialties there are a paucity of laboratory testing or radiologic imaging that will reveal the true nature of the problems being presented at the time of our appointment. Instead of relying on objective data I must process a wealth of subjective information; that is, the words that you use in describing your current emotional state. I view this challenge much like a good detective would tackle a mystery. To help you better understand the complexities of the evaluation I will try to outline the key components.

Firstly, I certainly recognize that a new patient coming into my office will be uneasy and not sure of what to expect. So it is important to reassure the individual that he evaluation process is straightforward and geared to better understanding what brings the individual to my office.

This brings us to what I call the “Chief Complaint”, best expressed by asking “How can I help you?” Quite commonly people present with concerns about being depressed or suffering from anxiety. The problem with the chief complaint is that what people mean by words like depression or anxiety differ tremendously among individuals. So the chief complaint must be clarified with more specific descriptions of what the person means by the words they are using. Often a perceived problem with anxiety represents a symptom of a depressive disorder. I commonly hear individuals come in concerned about “mood swings” with a fear that they could have bipolar disorder (manic depressive illness). However, after clarifying their concerns by getting a more comprehensive description, I often discover that what they are describing I a swing between feeling fine and feeling depressed, a symptom complex that can be part of a core depressive disorder.

Once the chief complaint is determined, the next step is to obtain a “History of Present Illness”. Specifically, this entails finding out how long the difficulties have been present, what does the development of emotional symptoms look like and what was the context in which the difficulties presented themselves. Since a major goal of assessment is to discover if there are underlying biological (that is, brain related) factors causing symptoms,  it is just as important to determine if there are situational factors present during symptom development. Then the challenge is to try to better understand whether there are psychological factors (coping style, attitude and belief systems) influencing or even responsible for producing the current problems bringing the person to my office.

Current problems and symptoms must be understood in the context of any “Past Psychiatric History”. Have these problems and/or symptoms been present in the past? If so, has there been a pattern of episodes? Has there been previous psychiatric treatment and what was the outcome of such treatment? It is always helpful to know if an individual had previous depressive episodes and responded to a particular antidepressant. If there is a history of prior courses of psychotherapy, what type of therapy was it and what was the outcome?

The presence of “Substance Abuse” (another section of the comprehensive evaluation) must be discovered because of the complicating role it may play in the presentation of the individual’s symptoms and concerns. The drugs, amount used and duration of use must be clarified. When substance abuse has been extensive and long term, all bets are off in determining a non-substance abuse primary psychiatric disorder. It is only after months of a brain free of the substance(s) abused can one adequately determine the presence or absence of a core mood or anxiety disorder.

A most important section of this initial assessment consists of the “Family Psychiatric History”. Knowing what the individual’s genetic pedigree is can be very telling. If mood and/or anxiety disorders are prevalent in nuclear and extended family members the possibility of an underlying biological problem must be considered when treatment planning occurs. This does not mean that biological dysfunction is the sole problem. It is quite common to discover that there has been a stress-diathesis interaction; that is, the external situational stressors are interacting with an underlying biological predisposition.

A “Childhood History” is another critical component. To discover that there is a past history of traumatic life experiences raises questions about both the nature of the present problem and aspects of treatment planning. Bullying has unfortunately become recognized as a major factor in the development of future suffering and trauma syndromes. Determining if there was any birth injury, delay in developmental milestones or school related anxiety and avoidance or academic learning difficulties is part of this section. Although a very sensitive area of investigation, learning about a history of abuse, whether it be emotional, physical or sexual, represents important albeit painful information to gather.

The person’s “Past Medical History” cannot be ignored. This section includes the presence or absence of medical system problems (involving heart/vascular, lungs, kidney. Liver, thyroid, gastrointestinal, other hormonal, and brain) that may be impacting on the individual’s current complaints. An accurate and detailed list of current medications and dosages taken is essential for treatment planning due to the varied effects of medication on mental state as well as the risk of drug to drug interactions when psychiatric medications need to be prescribed. Obtaining a history of medication-related or other allergies, surgeries, head injuries or concussions rounds out this section.

The “Psychosocial History” explores childhood specifics, religious background, educational level, job history, marital status and special interests or hobbies. It helps to fill in the context of the present illness.

The “Mental Status Examination” is the psychiatrist’s equivalent of the internist’s physical examination. This examination evaluates the behavior and demeanor of the individual. Emotional experience and expression is assessed. Thinking content and process along with speech characteristics are components as well. A formal assessment of memory, attention/concentration, abstract language use, fund of knowledge and perceptual/sensory disturbances are an integral part of mental status.

Because severe mental disorders can lead to self or other destructive thoughts and urges, an evaluation of dangerousness risks is an important aspect of a comprehensive evaluation.

After all this information is obtained, a preliminary psychiatric assessment is provided. This diagnostic section utilizes the American Psychiatric Association Diagnostic and Statistical Manual, Edition V to aid in evidence-based diagnostic consistency.

The initial plan of treatment may include medication, lifestyle recommendations and psychotherapy. It is important to recognize that both diagnostic impressions and treatment recommendations need to be flexible because as the therapeutic relationship unfolds additional information becomes available which may alter treatment planning.  

 

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Signs You May be a Hypochondriac

A hypochondriac is someone who lives with the fear that they have a serious, but undiagnosed medical condition, even though diagnostic tests show there is nothing wrong with them. Hypochondriacs experience extreme anxiety from the bodily responses most people take for granted. For example, they may be convinced that something as simple as a sneeze is the sign they have a horrible disease.

Hypochondria accounts for about five percent of outpatient medical care annually. More than 200,000 people are diagnosed with health anxiety (also known as illness anxiety disorder) each year.

Hypochondriac Symptoms

Hypochondria is a mental health disorder. It usually starts in early adulthood and may show up after the person or someone they know has gone through an illness or after they’ve lost someone to a serious medical condition. About two-thirds of hypochondriacs have a co-existing psychiatric disorder, such as panic disorder, obsessive compulsive disorder (OCD), or major depression. Hypochondria symptoms can vary, depending on factors such as stress, age, and whether the person is already an extreme worrier.

Hypochondriac symptoms may include:

·         Regularly checking themselves for any sign of illness

·         Fearing that anything from a runny nose to a gurgle in their gut is the sign of a serious illness

·         Making frequent visits to their doctor

·         Conversely, avoiding the doctor due to fear that the doctor will find they have a dreaded disease or serious illness

·         Talking excessively about their health

·         Spending a lot of time online, researching their symptoms

·         May focus on just one thing: a certain disease (example: cancer) or a certain body part (example: the lungs if they cough). Or, they may fear any disease or might become focused on a trending disease (example: during flu season, they may be convinced that a sniffle means they’re coming down with the flu)

·         Are unconvinced that their negative medical tests are correct, then worry that they have something undiagnosed and that no one will be able to find it and cure them

·         Avoiding people or places they fear may cause them to get sick

Health anxiety can actually have its own symptoms because it’s possible for the person to have stomachaches, dizziness, or pain as a result of their overwhelming anxiety. In fact, illness anxiety can take over a hypochondriac’s life to the point that worrying and living in fear are so stressful, the person can become debilitated.

You may be wondering what triggers hypochondria. Although there really isn’t an exact cause, we do know that people with illness anxiety are more likely to have a family member who is also a hypochondriac. The person with health anxiety may have gone through a serious illness and fear that their bad experience may be repeated. They may be going through major life stress or have had a serious illness during childhood. Or, they may already be suffering from a mental health condition and their hypochondria may be part of it.

Hypochondriac Treatment

Often, when a person repeatedly runs to their doctor at the first sign of a minor symptom, their doctor doesn’t take them seriously and may consider them to be a “difficult patient,” rather than a person who is honestly concerned about their health. Worse, some doctors will take advantage of the person’s fears and may run unnecessary tests just to appease the patient. In fact, it’s been estimated that more than $20 billion is spent annually on unnecessary procedures and examinations.

Self-help for hypochondria can include:

  • Learning stress management and relaxation techniques
  • Avoiding online searches for the possible meanings behind your symptoms
  • Focusing on outside activities such as a hobby you enjoy or volunteer work you feel passionate about
  • Avoiding alcohol and recreational drugs, which can increase anxiety
  • Working to recognize that the physical signs you experience are not a symptom of something ominous, but are actually normal bodily sensations
  • Setting up a schedule for regular appointments with your primary care doctor to discuss your health concerns. Work with them to set a realistic limit on medical tests and specialist referrals.

Professional treatments for hypochondria include:

  • Cognitive Behavioral Therapy (CBT), which is very helpful for reducing patient fears. In this type of therapy, the person learns to recognize and understand the false beliefs that set off their anxiety. Research has shown that CBT successfully teaches hypochondriacs to identify what triggers their behavior and gives them coping skills to help them manage it.
  • Behavioral stress management or exposure therapy may be helpful
  • Psychotropic medications, such as anti-depressants, are sometimes used to treat health anxiety disorder

It is worth noting that many sufferers are unwilling to acknowledge the role anxiety plays in their symptoms. This makes them less likely to seek help from a mental health professional. Often, hypochondriacs are so resistant to the idea that they have anxiety that it takes intervention from loved ones to help them understand that they need assistance.

Get Help for Health Anxiety Disorder

Being a hypochondriac and experiencing health anxiety can be debilitating. It can severely affect the lives of the people who suffer from it.  The mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida are experienced in helping those with illness anxiety. For more information, contact us or call us today at 561-496-1094.

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