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.
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.
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.
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.
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
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.
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.
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:
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.
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.
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.
Everyone has moments of fear over their performance on things like college exams and projects or they worry whether they’ll please their boss or colleagues. For those who suffer from social anxiety, however, concerns like these may not only impact their ability to learn, they may also lead them to make different education or career choices than they would actually prefer.
Everyone looks forward to going off to college, right? High school graduates eagerly plan to meet new friends, enjoy parties, learn about their future degree field, and have the chance to live their own life without having to follow rigid rules at home. For most teens, college represents a rite of passage – it’s a symbol of adulthood and independence. For someone with social anxiety, though, the new world of being a college student is not so friendly. Instead, all they can see is an endless list of potential situations in which they will have to fight their physical anxiety symptoms and battle to manage their anxious thoughts.
Students with social anxiety often avoid or don’t participate in group projects or lectures in college due to embarrassment and self-consciousness, their fear of being criticized, or worrisome physical symptoms, such as sweating or stuttering. Research also indicates that socially anxious students judge their own competence poorly when participating in a seminar or presentation (Austin, 2004) and this worry continues regardless of whether or not the student performs well academically. In fact, social anxiety can make college life so terrifying that some studies have reported that students with social anxiety fail to complete school and drop out before they can graduate (Van Ameringen, et al, 2003).
When it comes to careers, social anxiety can negatively impact career choices and occupational functioning. According to a study by Himle, et al (2014), people with social anxiety “have significantly different career aspirations than job-seekers without social anxiety.” Carnevale, et al (2010), reported that job sectors requiring strong workplace-based social capabilities (for example: healthcare or hospitality) “are among the most active in the current economy, yet people with social anxiety routinely avoid jobs requiring social interaction”.
As far as occupational functioning, a study done by Stein and Kean (2000) suggests that approximately 20% of people with social anxiety disorder reported declining a job offer or a promotion due to social fears.
People with social anxiety who want to get past their fears in order to have a wider choice of jobs or to find jobs with a more social aspect can benefit from Cognitive Behavioral Therapy (CBT) and exposure therapy.
Additionally, a study by Beidel, et al (2014), suggests that people with social anxiety can be helped even more effectively through a combination of CBT/exposure therapy and social skills training.
During the Beidel, et al, study, participants used modeling, behavior rehearsal, and feedback to learn such things as basic conversational skills, assertiveness training, and effective public speaking. They also went through exposure sessions consisting of scenes designed to address each person’s unique fears. At the conclusion of the study, 67% of the people treated with the combination of social skills training and CBT no longer met the diagnostic criteria for social anxiety disorder.
The National Social Anxiety Center is a national association of regional clinics with certified cognitive therapists specializing in social anxiety and anxiety-related problems. We have compassionate therapists who can help you to reduce social anxiety. Currently, we have regional clinics in San Francisco, District of Columbia, Los Angeles, Pittsburgh, New York City, Chicago, Newport Beach / Orange County, Houston / Sugar Land, St. Louis, Phoenix, South Florida, Silicon Valley / Sacramento Valley, and Dallas. Contact our national headquarters at (202) 656-8566 or visit our Regional Clinics contact page to find help in your local area.
Article written by:
Austin, B.D. (2004). Social anxiety disorder, shyness, and perceived social self-efficacy in college students. Dissertation Abstracts International: Section B: The Sciences and Engineering, 64 (7-B), 31–83.
Beidel, Deborah C. et al. “The Impact of Social Skills Training For Social Anxiety Disorder: A Randomized Controlled Trial.” Journal of anxiety disorders 28.8 (2014): 908–918. PMC. Web. 28 June 2018.
Carnevale AP, Smith N, Strohl J. Help Wanted: Projections of Jobs and Education Requirement through 2018. Washington, DC.: Georgetown University Center on Education and the Workforce; 2010.
Himle, Joseph A et al. “A Comparison of Unemployed Job-Seekers with and without Social Anxiety.” Psychiatric services (Washington, D.C.) 65.7 (2014): 924–930. PMC. Web. 24 June 2018.
Stein MB, Kean YM. Disability and quality of life in social phobia: Epidemiologic findings. American Journal of Psychiatry. 2000;157:1606–3.
Van Ameringen, M., Mancini, C. & Farvolden, P. (2003). The impact of anxiety disorders on educational achievement. Journal of Anxiety Disorders, 17(5), 561–571.
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.
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.
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:
Professional treatments for hypochondria include:
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.
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.
The summer travel season is just kicking off. Scores of tourists are excitedly packing their luggage and consulting websites or glossy brochures as they anticipate their upcoming vacations. While the idea of seeing new places or relaxing in cozy, familiar locations is appealing to most people, there are those who find the whole idea of travel frightening. It’s hard to get excited about new adventures when the mere thought of taking a trip brings up travel anxiety.
For some, just being out of their home and familiar surroundings can be enough to bring on travel anxiety, especially if you suffer from panic attacks. Meeting new people or experiencing new foods can also make people feel insecure, plus worrying about how you’ll react emotionally may trigger anxiety.
If you have travel anxiety these tips should help you feel more in control:
If you’re scared of flying (also called aerophobia), these tips can help make your next flight the best you’ve ever taken:
If you’ve tried some of these tips on previous trips and they haven’t worked for you, consider seeking help from a mental health professional. They may prescribe medications to help ease your travel anxiety and often have programs that teach coping techniques you can use when you’re scared of flying. Some even offer virtual reality sessions that simulate the flying experience in manageable doses in a safe office setting, so you can conquer your fears before even setting foot on a plane.
If you’re still facing travel anxiety after trying our tips to reduce your stress over an upcoming trip, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida can help. For more information, contact us or call us today at 561-496-1094.
Following the Netflix release of 13 Reasons Why in 2017, many mental health, suicide prevention, and education experts from around the world expressed a common concern about the series’ graphic content and portrayal of difficult issues facing youth. Resources and tools to address these concerns were quickly and widely disseminated in an effort to help parents, educators, clinical professionals and other adults engage in conversations with youth about the themes found in the show.
In advance of the release of season 2, SAVE (Suicide Awareness Voices of Education) brought together a group of 75 leading experts in mental health, suicide prevention and education as well as healthcare professionals (see full list below) to develop tools to help encourage positive responses to the series. In just a few short months, this group has developed a toolkit providing practical guidance and reliable resources for parents, educators, clinicians, youth and media related to the content of the series (suicide, school violence, sexual assault, bullying, substance abuse, etc.).
Using the toolkit and resources developed will help to encourage conversations, identify those at risk and prevent unexpected tragedies. Hopefully, it will also help those in need get the appropriate level of support and professional care to ensure that youth are protected, nurtured and our communities are stronger.
Executive Director – SAVE
SAVE especially thanks the following sub-group leaders in this effort:
Katherine C. Cowan
The organizations listed below represent thousands of mental health and suicide prevention, education experts and healthcare professionals from around the world with decades of experience working with youth, parents, schools and communities.