This is an excellent article, more up to date about anxiety disorders which it seems many of us suffer from. I fit the GAD category, and I really am very depressed a good bit of the time.
The trend in current research is to note that depression and anxiety (and I would then say DP/DR) come hand in hand in many circumstances.
I'm pinning this topic at the top of the board for now. I suppose it could be moved to the links section, but I feel it has some valuable information.
This tends to be my take on my own illness, and others may not agree with everything here, but I think this is a valuable resource in terms of definint various types of anxiety, and their link to depression. Very frustrating that nothing is directly mentioned about DP/DR. But this does discuss the presense of multiple symptoms that many of us seem to share.
Best,
D
University of Michigan Depression Center
Understanding Depression
Anxiety Disorders
The Anxiety Disorders
Anxiety disorders only infrequently occur in isolated, pure form. They
can vary in their presentation and are extensively co-morbid, with
other anxiety disorders and with depression and substance abuse. All
patients with depression and substance abuse should be screened for
anxiety disorders. A significant portion of female alcoholism may be
associated with panic and agoraphobia.
Patients will not present complaining of panic attacks, obsessions or
compulsions, or social phobia. When anxiety, obsessional traits, any
type of behavioral rituals, significant shyness, depressive symptoms,
or substance abuse are detected or suspected, then specific questions,
probing for the key features described below, should be asked.
Anxiety disorders cannot be "cured." Full, functional recovery is an
achievable goal, but complete resolution of symptoms and
invulnerability to relapse are not expected outcomes. Lingering
symptoms, vulnerability to "normal" anxiety, and stress-related
intensification of symptoms and anxiety contribute to a continuous risk
of relapse. These factors are directly addressed in CBT, which is
probably why it improves long-term outcomes.
Panic Disorder
Rapid onset, discrete, episodes of anxiety/distress/discomfort,
accompanied by physical symptoms that are often suggestive of cardiac,
endocrine or neurologic disorder. Panic patients become frightened of
fear itself and its symptoms. Associated with fear/avoidance of crowds,
driving, being closed in, being far from home alone, etc.
(agoraphobia). Temporal course of symptoms (sudden onset, rapid
progression to a peak, and recovery over 5 to 30 minutes) is as
important as enumeration of specific symptoms in diagnosing panic
attacks. Agoraphobic fears and avoidance help confirm the diagnosis.
Must always be evaluated for depression, substance abuse, and
suicidality.
First line treatment: CBT and/or medication (SSRIs). New data and APA
guidelines now support CBT as a first line treatment for Panic
Disorder.
Screening questions: Have you ever had a spell or attack when all of a sudden you felt frightened, anxious or very uneasy in situations when
most people would not be afraid or anxious? In the past 6 months, have
you had a spell or attack when for no reason your heart suddenly began
to race, you felt faint, or you couldn't catch your breath? Some people
have such an unreasonably strong fear of being in a crowd, leaving home
alone, traveling on buses, cars or trains, crossing a bridge that they
always get very upset in such situation or avoid it altogether. Did you
ever go through a period when being in any of these situations
frightened you?
Social Phobia
Generalized: Excessive anxiety/distress in nearly all situations in
which subject to attention, social scrutiny or evaluation
Specific: Anxiety and avoidance of a specific, social performance
situation (public speaking, using public restrooms...)
Extremely common, can be severely debilitating, and is often minimized
or ignored because social anxiety is "normal". Patients are also
generally embarrassed and avoidant, so they often won't disclose their
symptoms unless specifically asked. May have panic attacks but they are
confined to situations in which the patient may be the center of
attention.
First line treatment: CBT. Group CBT is our preferred treatment for
those who are candidates for it. Medication is used for patients who
are not likely to do well with CBT, such as those with extensively
generalized or severe symptoms or co-morbid depression. Try standard SSRIs or Effexor first; MAOIs may be more effective. Beta-blockers havelittle direct impact on anxiety but can be helpful in performance situations where physical manifestations of anxiety (e.g., sweating, tremor) undermine the performance or become distractions. Some patients need social skills training.
Screening question: Some people have an unreasonably strong fear of doing things in front of other people - like speaking in public, using
public rest rooms, eating in public, or even talking to people. Have
you had any of these kinds of fears?
Obsessive-Compulsive Disorder (OCD)
Obsessions are recurrent, intrusive thoughts, disturbing to the
patient, but experienced as uncontrollable, often involving fears of
harm coming to self or others. Typical examples include obsessive
thoughts about germ contamination leading to illness, obsessive
thoughts about making mistakes that will lead to harm. Violent, sexual,
or blasphemous content is common.
Compulsions are repetitive behaviors
(e.g., washing, counting, repeating, checking...) that are performed
according to certain rules or in a stereotyped fashion. Some patients
may resist their compulsions, but usually cannot control them. OCD is
the most hidden of the anxiety disorders. Patients must specifically be
asked about counting, checking, washing rituals and intrusive,
disturbing thoughts.
First line treatment: CBT and medication (SSRIs, often in high doses).
Some patients do well without medication. Recovery is often incomplete,
but substantial gains are usually possible.
Screening questions: Have you ever been bothered by thoughts that didn't make any sense, and kept coming back to you even when you tried not to have them? Was there ever anything you had to do over and over again and couldn't resist doing, like washing your hands again and
again, counting up to a certain number, or checking something several
times to make sure that you'd done it right?
Specific Phobia
Marked fear of specific, circumscribed objects or situations associated
with severe distress upon exposure. Nearly all patients experience
impairing avoidance. Impairment is often not evident to the patient, as
they have incorporated accommodation to the phobia into their lives.
Height phobias and claustrophobia are among our most commonly treated
phobias. Snake and spider phobias are among the most common in the
community but few people with these seek treatment. Blood, illness, and
injury phobias are common, impede medical care, and should be treated,
though they sometimes keep patients from even visiting the doctor's
office.
Treatment - CBT for phobias is simple, quick, and extremely effective.
These patients need help overcoming their reluctance to seek treatment.
Screening question: Are there things that you have been especially
afraid of, like flying, seeing blood, getting a shot, heights, closed
places, or certain kinds of insects or animals?
Generalized Anxiety Disorder
The hallmark of this disorder is chronic, excessive worry. Patients
often recognize that their worry is excessive and struggle with their
inability to control it. Additional symptoms include restlessness,
insomnia, poor concentration, fatigue and irritability. Though GAD can
occur in isolation, it is far more common to see it in association with
depressive symptoms, or other anxiety disorders. Many patients referred
to us with suspected GAD turn out to have major depression with
intense, ruminative anxiety.
First line treatment: antidepressant medication (SSRIs).
Screening questions: Are you a particularly nervous or anxious person?
Do you or people who know you well think of you as a "worry wort"?
Last updated on:
Wednesday, 05-May-2004 10:36:56 EDT
-----------------------------------------
This site developed and maintained by: John Bennett
University of Michigan Health System
1500 E. Medical Center Dr.
Ann Arbor, MI 48109
734-936-4000
http://www.med.umich.edu/
(c) copyright 2001 University of Michigan Health System
The trend in current research is to note that depression and anxiety (and I would then say DP/DR) come hand in hand in many circumstances.
I'm pinning this topic at the top of the board for now. I suppose it could be moved to the links section, but I feel it has some valuable information.
This tends to be my take on my own illness, and others may not agree with everything here, but I think this is a valuable resource in terms of definint various types of anxiety, and their link to depression. Very frustrating that nothing is directly mentioned about DP/DR. But this does discuss the presense of multiple symptoms that many of us seem to share.
Best,
D
University of Michigan Depression Center
Understanding Depression
Anxiety Disorders
The Anxiety Disorders
Anxiety disorders only infrequently occur in isolated, pure form. They
can vary in their presentation and are extensively co-morbid, with
other anxiety disorders and with depression and substance abuse. All
patients with depression and substance abuse should be screened for
anxiety disorders. A significant portion of female alcoholism may be
associated with panic and agoraphobia.
Patients will not present complaining of panic attacks, obsessions or
compulsions, or social phobia. When anxiety, obsessional traits, any
type of behavioral rituals, significant shyness, depressive symptoms,
or substance abuse are detected or suspected, then specific questions,
probing for the key features described below, should be asked.
Anxiety disorders cannot be "cured." Full, functional recovery is an
achievable goal, but complete resolution of symptoms and
invulnerability to relapse are not expected outcomes. Lingering
symptoms, vulnerability to "normal" anxiety, and stress-related
intensification of symptoms and anxiety contribute to a continuous risk
of relapse. These factors are directly addressed in CBT, which is
probably why it improves long-term outcomes.
Panic Disorder
Rapid onset, discrete, episodes of anxiety/distress/discomfort,
accompanied by physical symptoms that are often suggestive of cardiac,
endocrine or neurologic disorder. Panic patients become frightened of
fear itself and its symptoms. Associated with fear/avoidance of crowds,
driving, being closed in, being far from home alone, etc.
(agoraphobia). Temporal course of symptoms (sudden onset, rapid
progression to a peak, and recovery over 5 to 30 minutes) is as
important as enumeration of specific symptoms in diagnosing panic
attacks. Agoraphobic fears and avoidance help confirm the diagnosis.
Must always be evaluated for depression, substance abuse, and
suicidality.
First line treatment: CBT and/or medication (SSRIs). New data and APA
guidelines now support CBT as a first line treatment for Panic
Disorder.
Screening questions: Have you ever had a spell or attack when all of a sudden you felt frightened, anxious or very uneasy in situations when
most people would not be afraid or anxious? In the past 6 months, have
you had a spell or attack when for no reason your heart suddenly began
to race, you felt faint, or you couldn't catch your breath? Some people
have such an unreasonably strong fear of being in a crowd, leaving home
alone, traveling on buses, cars or trains, crossing a bridge that they
always get very upset in such situation or avoid it altogether. Did you
ever go through a period when being in any of these situations
frightened you?
Social Phobia
Generalized: Excessive anxiety/distress in nearly all situations in
which subject to attention, social scrutiny or evaluation
Specific: Anxiety and avoidance of a specific, social performance
situation (public speaking, using public restrooms...)
Extremely common, can be severely debilitating, and is often minimized
or ignored because social anxiety is "normal". Patients are also
generally embarrassed and avoidant, so they often won't disclose their
symptoms unless specifically asked. May have panic attacks but they are
confined to situations in which the patient may be the center of
attention.
First line treatment: CBT. Group CBT is our preferred treatment for
those who are candidates for it. Medication is used for patients who
are not likely to do well with CBT, such as those with extensively
generalized or severe symptoms or co-morbid depression. Try standard SSRIs or Effexor first; MAOIs may be more effective. Beta-blockers havelittle direct impact on anxiety but can be helpful in performance situations where physical manifestations of anxiety (e.g., sweating, tremor) undermine the performance or become distractions. Some patients need social skills training.
Screening question: Some people have an unreasonably strong fear of doing things in front of other people - like speaking in public, using
public rest rooms, eating in public, or even talking to people. Have
you had any of these kinds of fears?
Obsessive-Compulsive Disorder (OCD)
Obsessions are recurrent, intrusive thoughts, disturbing to the
patient, but experienced as uncontrollable, often involving fears of
harm coming to self or others. Typical examples include obsessive
thoughts about germ contamination leading to illness, obsessive
thoughts about making mistakes that will lead to harm. Violent, sexual,
or blasphemous content is common.
Compulsions are repetitive behaviors
(e.g., washing, counting, repeating, checking...) that are performed
according to certain rules or in a stereotyped fashion. Some patients
may resist their compulsions, but usually cannot control them. OCD is
the most hidden of the anxiety disorders. Patients must specifically be
asked about counting, checking, washing rituals and intrusive,
disturbing thoughts.
First line treatment: CBT and medication (SSRIs, often in high doses).
Some patients do well without medication. Recovery is often incomplete,
but substantial gains are usually possible.
Screening questions: Have you ever been bothered by thoughts that didn't make any sense, and kept coming back to you even when you tried not to have them? Was there ever anything you had to do over and over again and couldn't resist doing, like washing your hands again and
again, counting up to a certain number, or checking something several
times to make sure that you'd done it right?
Specific Phobia
Marked fear of specific, circumscribed objects or situations associated
with severe distress upon exposure. Nearly all patients experience
impairing avoidance. Impairment is often not evident to the patient, as
they have incorporated accommodation to the phobia into their lives.
Height phobias and claustrophobia are among our most commonly treated
phobias. Snake and spider phobias are among the most common in the
community but few people with these seek treatment. Blood, illness, and
injury phobias are common, impede medical care, and should be treated,
though they sometimes keep patients from even visiting the doctor's
office.
Treatment - CBT for phobias is simple, quick, and extremely effective.
These patients need help overcoming their reluctance to seek treatment.
Screening question: Are there things that you have been especially
afraid of, like flying, seeing blood, getting a shot, heights, closed
places, or certain kinds of insects or animals?
Generalized Anxiety Disorder
The hallmark of this disorder is chronic, excessive worry. Patients
often recognize that their worry is excessive and struggle with their
inability to control it. Additional symptoms include restlessness,
insomnia, poor concentration, fatigue and irritability. Though GAD can
occur in isolation, it is far more common to see it in association with
depressive symptoms, or other anxiety disorders. Many patients referred
to us with suspected GAD turn out to have major depression with
intense, ruminative anxiety.
First line treatment: antidepressant medication (SSRIs).
Screening questions: Are you a particularly nervous or anxious person?
Do you or people who know you well think of you as a "worry wort"?
Last updated on:
Wednesday, 05-May-2004 10:36:56 EDT
-----------------------------------------
This site developed and maintained by: John Bennett
University of Michigan Health System
1500 E. Medical Center Dr.
Ann Arbor, MI 48109
734-936-4000
http://www.med.umich.edu/
(c) copyright 2001 University of Michigan Health System
that's so funny, avaya! i just read the top and was like "oh my gosh, maybe i have ocd..." and then i got down to your post and realized that it was just some good ole' hypochondria.
