Mental Health Conditions

Mental health conditions

 

A mental health condition describes/categorises various mental and behavioural patterns or changes that cause distress or interferes with one’s ability to function in daily life. Mental health disorders vary in their symptom profile and severity. The Diagnostic and Statistical Manual (DSM) is a commonly used manual by mental health professionals and researchers to help classify and diagnose mental health conditions. The fifth edition of the DSM was published by the American Psychiatric Association (APA) in 2013. We have used the diagnostic criteria set out in the DSM-5 when writing the sections in the toggle boxes below.

Anorexia Nervosa

 

Eating disorders involve significant psychological distress, as well as being associated with serious physical health complications. One of the three major forms of eating disorders is Anorexia Nervosa. Anorexia Nervosa is characterised by a low weight, fear of gaining weight, a powerful desire to be thin, and food restriction. Many people with anorexia see themselves as being overweight even though they are considerable underweight.

 

Signs & Symptoms

To be diagnosed with Anorexia Nervosa there are 3 core criteria that must be met:

 

  • A restrictive diet resulting in significantly low body weight.
  • The person has a strong fear of gaining weight, or becoming fat. They may also engage in behaviour that prevents weight gain, such as excessive exercise.
  • Distorted body image, body weight or shape is over emphasised in self-evaluation, or there is a strong lack of understanding in the seriousness of the low body weight.

Prevalence

Approximately one in 20 Australians has an eating disorder. It affects more females than males, although this difference is less in binge eating disorder. Unfortunately less is known about eating disorders among males.

Main Treatments

The primary approach is psychological, the person centred approach that is tailored to the individual is suggested as an effective model for specific treatment to be tailored. This treatment focuses on recovery and looks at the illness in a wide context (e.g., physical and psychological). It involves the person with the eating disorder in all treatment decisions.

Due to the medical implications of the anorexia nervosa, treatment typically involves a team approach with involving both doctors and mental health specialists.

Agoraphobia

 

This is extreme fear or anxiety associated with certain situations and places and these situations are actively avoided. This means that the person deliberately plans to avoid agoraphobia places, such as not using public transport, avoiding certain stores or shopping centres. Typically, anxiety in agoraphobic situations will take the form of a panic attack.

 

Signs & Symptoms

To have a diagnosis of agoraphobia a person must experience significant fear or anxiety about 2 or more of the following situations:

 

  • Using public transport (e.g. buses, trains, trams, ferry, plane)
  • Being in open spaces (e.g. in the country, in a parking lot, bridges, markets)
  • Being in enclosed places (e.g. shops, cinemas, theatres)
  • Being in crowded situations, or standing in a queue
  • Being outside of the home alone

Prevalence

Around about 1.7% of adults and adolescents are diagnosed annually. Females have twice the rate of agoraphobia in comparison to males. Onset occurs most frequently in adolescence and early adulthood.

Main Treatments

Treatment for agoraphobia is very similar as for panic disorder.

 

  • The psychological approach most frequently used is Cognitive Behavioural Therapy. Relaxation and thinking strategies, to get some control over anxious feelings and thoughts (including realising that fears are likely not to come true) are used in the initial approach, along with education to understand the body’s anxiety response to feared situations. Graduated exposure is used to gradually overcome the feared situation. For example, in overcoming a fear of using buses, exposure might begin with just standing at a bus stop, then getting on a bus (at the depot) but not going anywhere, to eventually taking increasingly longer bus routes. This is done in conjunction with relaxation and cognitive (thinking) strategies.
  • Medication may also be used if symptoms are severe, in particular some types of antidepressants are also useful in treating anxiety. This type of medication is preferred over the short acting and addictive drugs such as benzodiazepines. These types of medications are only used for brief periods of time.

 

Binge Eating Disorder

 

Eating disorders involve significant psychological distress, as well as being associated with serious physical health complications. One of the three major forms of eating disorders is binge eating disorder. Binge eating disorder involves binge eating but without subsequent purging episodes.

 

Signs & Symptoms

This disorder has some similarities with Bulimia Nervosa, and has the same aspects to binge eating, namely eating a large quantity of food in a certain time period, being more than what most people would eat in a similar situation, and a feeling of not having control over the binge eating. However they also experience at least 3 of the following with binge eating episodes:

 

  • Eating much faster than normal.
  • Continue to eat until feeling uncomfortably full.
  • Eating large amounts of food even though they are not feeling hungry.
  • Eating alone because of embarrassment regarding how much they are eating.
  • Feeling disgusted with themselves, guilty and depressed.
  • The binge-eating causes considerable distress, and occurs around once a week for 3 months. It is not however associated with behaviour to try and prevent weight gain.

Prevalence

Approximately one in 20 Australians has an eating disorder. It affects more females than males, although this difference is less in binge eating disorder. Unfortunately less is known about eating disorders among males.

Main Treatments

The primary approach is psychological, the person centred approach that is tailored to the individual is suggested as an effective model for specific treatment to be tailored. This treatment focuses on recovery and looks at the illness in a wide context (e.g., physical and psychological). It involves the person with the eating disorder in all treatment decisions.

Bipolar Disorders

 

Bipolar disorder is characterised by periods of extremes of mood. There are a number of types of bipolar disorder, with the most prevalent being bipolar I and bipolar II.

  • Bipolar I involves extreme mood elevation (mania), and for the majority of people with bipolar I they will also experience depression, although not everyone will experience low moods as well.
  • Bipolar II encompasses hypomania, a less extreme level of mood elevation in comparison to the mania of bipolar I. Bipolar II always involves periods of major depression.

 

Signs & Symptoms

The defining feature of bipolar disorder is elevated mood. It involves elevated, expansive or irritable mood. This is combined with an increased in goal-driven activity or energy. For mania, these symptoms must last for a week (unless hospitalised), and for hypomania, it must last for 4 days. Other symptoms include:

 

 

  • Exaggerated self-esteem or grandiosity
  • A reduced need to sleep – feeling rested after only 3 hours sleep
  • Talkative or pressure to keep talking
  • Racing thoughts or ideas jumping from one topic to another
  • Easily distracted
  • Pursuing many goals at once
  • Over involvement in activities that could have distressing consequences such as spending sprees, sexual indiscretions, poor business investments.

 

Prevalence

The 12-month prevalence rate for bipolar disorders is around 1.8%. There are equal numbers of men and women who experience bipolar I, however more females than males experience bipolar II. The onset of bipolar II is around the mid 20’s, which is a little later than the onset for bipolar I, whose onset is around 18 years.

Main Treatments

Bipolar disorder is very much a biological disorder, and as such the first line treatment approach is medication, specifically with mood stabilizers.

 

 

  • Antipsychotics may be used at times, however there is some controversy regarding the use of antidepressant medication with a risk they could switch a lowered mood into mania/hypomania. The efficacy-effectiveness gap that sees a high percentage of people with bipolar disorder experiencing relapses, even when taking medication as prescribed, has seen the increasing use of adjunctive psychosocial interventions. These are used in conjunction with medication and not as a replacement. Again there are a number of approaches used, with psycho-education (providing information about the disorder with some coping strategies), cognitive behaviour therapy, interpersonal social rhythm therapy (sticking to a flexible routine), some of the approaches of note.

 

Bulimia Nervosa

 

Eating disorders involve significant psychological distress, as well as being associated with serious physical health complications. One of the three major forms of eating disorders is Bulimia Nervosa. Bulimia nervosa is characterised by eating large amounts of food in a short time period, followed often by purging behaviours.

 

Signs & Symptoms

This eating disorder is characterised by binge eating. Specifically it refers to both of the following points:

 

  • Eating in a certain period of time (such as within a 2 hour period) a quantity of food that is larger than what most other people would eat in similar circumstances.
  • There is a feeling of having a lack of control over eating during the binging (e.g., sense that they cannot stop eating or have control over what or how much is being consumed).
  • There is also the pursuit of behaviours to prevent weight gain such as causing themselves to vomit, misuse of laxatives, diuretics, fasting or excessive exercise.
  • The binges and behaviours to prevent weight gain occur at least once a week for 3 months. Body shape and weight also overly influence self-evaluation.

Prevalence

Approximately one in 20 Australians has an eating disorder. It affects more females than males, although this difference is less in binge eating disorder. Unfortunately less is known about eating disorders among males.

Main Treatments

The primary approach is psychological, the person centred approach that is tailored to the individual is suggested as an effective model for specific treatment to be tailored. This treatment focuses on recovery and looks at the illness in a wide context (e.g., physical and psychological). It involves the person with the eating disorder in all treatment decisions.

Generalised Anxiety Disorder

 

There are some situations for most people where they feel anxious. It might be going for a driving test, sitting an exam, giving a presentation, or going for a job interview. Anxiety in these situations is normal, and can actually help a person feel alert and focused on the task. For people with GAD however, they feel worried and anxious on most days, not just at specific times during high stress situations.

 

Signs & Symptoms

For a person with GAD they experience excessive anxiety and worry on most days for at least 6 months. The focus of this worry can vary around a number of aspects of daily life, such as work, study, family, health, finances and fearing the worst will happen. This worry is difficult to control and occur without a particular reason and can impact upon a person’s social life, work or study. To be diagnosed with GAD, using the DSM-5 (2013), a person also has to have three or more of following symptoms, for most days, for at least six months:

 

  • Feelings of restlessness, agitation, or on edge
  • Tire easily
  • Finding it difficult to concentrate or experiencing mind going blank
  • Irritability
  • Tense muscles
  • Difficulty getting or staying asleep, or having restless sleep and waking tired

Prevalence

Around 0.9% of adolescents and 2.9% of adults will experience GAD in a 12 month period. Females are twice as likely as males to develop GAD. The prevalence of GAD spikes at middle age and then reduces in later life.

Main Treatments

 

  • Psychological approaches have been found to be effective in treating GAD. In particular Cognitive Behavioural Therapy (CBT) is used, which addresses issues around worrying thoughts and puts in place some behavioural strategies such as relaxation techniques to reduce tension and level of anxiety. CBT challenges the worry thoughts, or develops strategies of letting them go, or to stop them from dominating ones thoughts. Using exposure therapy, if avoidance of situations occurs, this involves gradually confronting the situation or place that is being avoided. Psycho-education, which provides information about anxiety and gives an understanding as to why a person feels the physical symptoms caused by high anxiety, is also provided.
  • If symptoms are very severe medication may also be used. Some types of antidepressants are also useful in treating anxiety. This type of medication is preferred over the short acting and addictive drugs such as benzodiazepines.

Gambling Disorder

 

How problem gambling has been defined has changed over the years. Most recently has been the name change from gambling addiction to gambling disorder. Another shift has been the re-classification of problem gambling from an impulse control disorder, to an addictive disorder. This acknowledges gambling disorder in much the same way as alcohol and drug addictions.

 

Signs & Symptoms

To be diagnosed with a gambling disorder, using the DSM-5 (2013), a person must have engaged in problem gambling behaviour that resulted in significant distress and experience of four or more of the following symptoms in a 12 month period.

 

  • Requiring increasing amounts of money to attain the same level of excitement when gambling
  • Attempts to reduce to cease gambling result in the person becoming restless or irritable
  • There have been numerous unsuccessful attempts to stop or reduce gambling behaviour
  • Frequently distracted with thoughts related to gambling, such as reliving past gains, planning the next gambling activity , thinking of how to get more money to fund gambling
  • Tends to gamble when experiencing distressing feelings (guilt, anxious, depressed)
  • Tries to make up losses by gambling further (“chasing” the losses)
  • Is deceitful in order to hide the degree of gambling behaviour
  • Has experienced, or threatened losses around relationships, employment, education or other carrier opportunities due to gambling
  • Dependent on others for money to alleviate perilous financial issues caused by gambling

Prevalence

In 2009, 0.7% of Victorians were problem gamblers. With the recent changes to the classification system, it is likely that this figure is actually higher. US data suggests that there are higher prevalence rates for males (around 0.9%), in comparison to females (0.2%).

Main Treatments

Psychological treatments are primary approaches used in gambling disorder. In particular forms of Cognitive Behavioural Therapy (CBT) looks at challenging the unhelpful behaviours and thoughts, such as rationalisation, belief that losses can be recovered through gambling more, managing urges and managing with feelings of distress in ways other than gambling.

Insomnia

 

Insomnia refers to a disturbance in sleep. It might be a difficulty in getting to sleep (sleep initiation) or in staying asleep. Difficulties with sleep resulting in poor sleep quality can have an impact on feelings of fatigue, concentration and mood.

 

Signs & Symptoms

Insomnia relates to discontentment with either sleep quality or quantity, despite having the opportunity to sleep. It includes having one or more of the following symptoms:

 

 

  • Difficulty in getting off to sleep
  • Difficulty staying asleep, and experiencing waking during the night. There might also be difficulty returning to sleep following waking
  • Waking early in the morning and unable to return to sleep

 

To be diagnosed with insomnia the disturbance must cause significant distress and impact on daily life. The sleep problems must also occur at least three nights a week and have persisted for at least three months.

 

Prevalence

Older people and those in poor health are at greatest risk of insomnia. Shift workers are also considered as having a higher risk as well. Women have twice the rate of insomnia in comparison to men. It is thought that this might be linked to women’s higher rates of anxiety and depression. US estimates put the prevalence at 6-10% of the population.

 

Main Treatments

 

  • Initial treatment ensures there are good sleep habits are in place. Cognitive Behavioural Therapy (CBT) has been shown to be better in the medium and long term than sleeping medication. CBT approach to sleep involves a number of elements, including establishing a good sleep routine, removing things that can impede sleep, and also deals with anxiety about not sleeping.
  • Medication may be used in conjunction with support from a medical practitioner.

Major Depressive Disorder

 

We can all feel sad and low at times. For most people, experiencing these things is transient, and they are relatively mild. For someone who experiences depression these symptoms are severe in their intensity and last for at least two weeks – but usually are longer.

 

Signs & Symptoms

Someone who is depressed will experience changes in emotions, they can be teary, more self critical and feel pessimistic and hopeless. They lose interest in things they usually do, have a lack of energy and can find it hard to go to work or school, even get out of bed or shower. To be diagnosed with major depression using the DSM-5 (2013) a person must experience 5 of the following symptoms for 2 weeks, and it must have a significant impact on a persons life. One of these symptoms must be either depressed mood, or a loss of interest or pleasure in things.

 

  • Low (depressed mood) for the majority of the day, on most days
  • Loss of interest or enjoyment in things
  • Difficulty or changes in sleeping. This might be sleeping a lot (hypersomnia), or having difficulty in being able to sleep (insomnia)
  • Feeling keyed up, uneasy, might find it difficult to sit still, or quite the opposite, like limbs are heavy and difficult to move
  • Tired and having no energy
  • Feeling they are pointless, or feeling responsible and guilt ridden for things that are not their fault
  • Significant loss of weight that is not due to dieting, or there can be a significant gain in weight
  • Difficulty in thinking or focusing, or being undecided and unable to make decisions easily
  • Thoughts or plans of suicide

Prevalence

Depression has a high prevalence in Australia. One in seven Australians will have depression in their lifetime. Women experience depression at slightly higher rates than men (one in six women, compared to one in ten for men). There is a great deal of variability in depression rates across age groups, with US data indicating that 18-29 year olds having 3 times higher the rate of depression than for those above 60 years of age.

Main Treatments

There are a number of different psychological and medical treatments available for depression. Often a combination of these treatments are used.

 

  • A number of different psychological approaches have found to be helpful for depression. In particular the research evidence to date is most supportive of Cognitive Behaviour Therapy (CBT), Behaviour Therapy (BT), Interpersonal Therapy (IPT) and Mindfulness based cognitive therapy (MBCT). CBT explores patterns of thinking and behaving that might be impeding becoming well. When unhelpful patterns are identified they are modified to a more healthy alternative. Behavioural therapy is an element of CBT, but purely focuses on behaviour. This is usually around increasing pleasurable or achievement based activities. Mindfulness based cognitive therapy also uses some behavioural techniques, specifically around meditation and learning to be ‘in the moment’ rather than allowing the mind drift off to negative thoughts. A different approach is taken by Interpersonal Therapy as it focuses on relationships and improving skills in this area.
  • Medical treatments are provided by a doctor or psychiatrist and involve medication, as well as treatments such as electroconvulsive treatment (ECT). Antidepressants are the main type of medication used to treat depression. There are many different types of antidepressants that act in slightly different ways. All antidepressants however target brain chemicals (neurotransmitters) concerned with emotion and motivation. It can take time to find the one that works best, and this always needs to be done in conjunction with your general practitioner or psychiatrist. Electroconvulsive Therapy (ECT) is used for very severe depression that has not responded to other treatments, or where there is a high risk of suicide. ECT involves electrical currents to stimulate parts of the brain. It is given under a general anesthetic.

Panic Disorder

 

Panic disorder refers to the repeated experience of relatively brief, but distressing periods of extreme anxiety symptoms. These are referred to as panic attacks. Essentially a panic attack is a sudden experience of intense fear or extreme discomfort that peaks within about 10 minutes and can last for around 30 minutes, although the after effects of anxiety can take some time to settle. These attacks are very unpleasant, and often a person will think they are going to die, and panic attacks are typically unexpected. They even occur during sleep, causing the person to wake. Around 40% of people will experience a panic attack over their life time, however the occurrence of one attack is not frequent enough for it to be considered as panic disorder.

 

Signs & Symptoms

During a panic attack a person can experience a number of symptoms. To be diagnosed with panic disorder, using the DSM-5 (2013), four or more of the following panic symptoms need to occur:

 

  • Palpitations, and heart racing
  • Sweating
  • Shaking or trembling
  • Feeling short of breath or like being smothered
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, and faint
  • Chills or heat sensations
  • Feelings of unreality or detachment
  • Fear of losing control or ‘going crazy’
  • Fear of dying

After these panic attacks there also needs to be at least 1 of month of either constant concern or worry about having another attack, or changing behaviour to try and avoid the attacks (e.g., avoiding exercise, or unfamiliar situations).

Prevalence

Estimates suggest that 5% of Australians will experience panic disorder at some time in their life, with around 2.6% of people experiencing it in a 12 month period. Panic disorder typically starts in early to mid 20’s, but also can begin around middle age. It is slightly more common in women than in men.

Main Treatments

 

  • There is strong evidence for the use of psychological treatment of panic disorder. The most frequently used approach is Cognitive Behavioural Therapy (CBT) that targets thoughts, feelings and behaviours. This approach also provides education (called psycho-education) about anxiety and helping people understand the physiological response in their body, and the interplay between the mind and body in panic disorder. The cognitive approach of this strategy helps calm the worrying thoughts, and challenge those ones that are unrealistic and driven by anxiety. The approach also uses behavioural techniques such as relaxation strategies to help gain control over the body symptoms and anxious thoughts. It also can involved what is called graduated exposure. Where someone may be avoiding a place where they have had a panic attack before, a person is gradually given tasks to overcome this fear and avoidance. There is a high association also between panic disorder and agoraphobia.
  • Some antidepressant medication can also be used to help with very severe symptoms. Using medication must be taken in consultation with your doctor. Antidepressants are used for longer periods of time, in contrast to drugs such as benzodiazepines, which are used only in the short term (two to three weeks), or intermittently as part of an overall treatment plan. Caution is taken in the use of benzodiazepine because of their addictive nature.

 

Peripartum Onset Depression

 

Women are at increased risk of depression during pregnancy and in the first year after the baby is born. As 50% of postpartum depressive episodes actually begin before the baby’s birth, this prompted the name change (peripartum onset depression) to encompass it more broadly. The signs and symptoms are the same as those for depression.

 

Signs & Symptoms

The symptoms of major depression, using the DSM-5 (2013), must include the experience of five of the following symptoms for two weeks or more, and it must have a significant impact on a persons life. One of these symptoms must be either depressed mood, or a loss of interest or pleasure in things.

 

  • Low (depressed mood) for the majority of the day, on most days
  • Loss of interest or enjoyment in things
  • Difficulty or changes in sleeping. This might be sleeping a lot (hypersomnia), or having difficulty in being able to sleep (insomnia)
  • Feeling keyed up, uneasy, might find it difficult to sit still, or quite the opposite, like limbs are heavy and difficult to move
  • Tired and having no energy
  • Feeling they are pointless, or feeling responsible and guilt ridden for things that are not their fault
  • Significant loss of weight that is not due to dieting, or there can be a significant gain in weight
  • Difficulty in thinking or focusing, or being undecided and unable to make decisions easily
  • Thoughts or plans of suicide

Prevalence

Many women experience the baby blues, this is common and is related to hormonal changes. This is very different to depression which is more severe and longer lasting. It is estimated that around 10% of women will experience depression during pregnancy and 16% will experience depression in the first 3 months after delivery.

Main Treatments

As with depression at other times, treatment can involve both psychological and medical treatment. Psychological interventions, in particular cognitive behavioural therapy, which also involves the partner, is used. Many approaches also look at issues around bonding with the baby including time at a mother-baby unit. Medication in severe cases can also be useful and is done in conjunction with a general practitioner or medical specialist.

 

Post Traumatic Stress Disorder

 

This disorder emerges from having witnessed or experienced a traumatic event that threatened the persons life or safety or that of others. This could be a car accident, sexual assault, natural disasters such as bush fire or flood.

 

Signs & Symptoms

To be diagnosed with PTSD, using the DSM-5 (2013), a person has to experience or be a witness to a traumatic event, or be aware of violent or accidental death or threatened death of a close friend or family member. It can also relate to experiencing repeated or contact with repelling details of a traumatic event such in the case of first responders, or police officers.

There also needs to be one of more of the following intrusive symptoms, beginning after the traumatic event:

 

  • Repeated, involuntary and intrusive upsetting memories of the trauma
  • Repeated frightening dreams related to the traumatic event
  • Dissociative responses such as flashback, where the person feels, or behaves as if they are back in the traumatic situation
  • Significant distress when exposed to any reminder of the traumatic event
  • Continued avoidance of things associated with the traumatic event. This might be avoiding memories related to the event, or of specific places and people. This is in an attempt to avoid distressing emotions.

 

Prevalence

It is estimated that 800,000 to 1 million Australians will experience PTSD in a 12 month period, and 12% will experience PTSD in their lifetime.

Main Treatments

 

  • Psychological treatment of PTSD targets confronting the traumatic memory, via the thoughts and beliefs that have developed around it. Trauma-focused therapy has been found to reduce symptoms including depression that can also occur with PTSD.
  • Medication might be used if symptoms are severe.

 

Obsessive Compulsive Disorder

 

This disorder is defined by the presence of obsessions, compulsions or both. Obsessive thoughts are recurring OCD thoughts that are distressing and also lead to repetitive behaviours. For example, obsessive thoughts that you didn’t lock the front door, could lead to repeated checking of the locks (compulsions). A person with OCD can also experience what is termed intrusive thoughts. These can be distressing thoughts or images that are out of character for the person, such as “what if I hurt my parents”. It seems that for someone with OCD thinking it is parallel with doing it.

 

Signs & Symptoms

To receive a diagnosis of OCD a person must experience obsessions or compulsions or both.

 

 

Obsessions are:

  • Recurrent and persistent thoughts, images, or urges that are intrusive and unwanted. These obsessions cause significant anxiety or distress.
  • Attempts are made to suppress the obsessions with either some other thought or behaviour (compulsion)

 

Compulsions are:

  • Behaviours that are repeated excessively (e.g., hand washing, checking) or mental acts (e.g., praying, counting, repeating words quietly). The person feels driven to engage in the behaviour as a consequence to and obsession, or according to rigid rules they have.
  • The compulsions are designed to prevent or to decrease anxiety, or to prevent a terrible event or situation. These behaviours are not realistically linked with what they are suppose to neutralise and are clearly excessive.

 

The obsessions or compulsions must also take a lot of time (e.g., more than an hour a day) and cause significant distress and impede the persons ability to function day to day. If you would like to read more about what are the more common types of obsessions and compulsions experienced by people with OCD, please open the toggle box below.

Common Obsessions & Compulsions

Some of the more common obsessions and compulsions that are experienced by people with OCD are:

 

 

  • Counting – repeatedly counting items such as lines in footpath
  • Hoarding – items such as newspapers, junk mail
  • Cleanliness – obsessive hand washing or cleaning to reduce unrealistic fear of germs
  • Order – over concern with symmetry of items such as glasses, books
  • Safety/checking – concern about possible harm, so constant checking of locks, or that electrical items are turned off
  • Sexual issues – having a level of revulsion that is irrational concerning sexual activity
  • Religious/moral issues – having to pray a certain number of times a day

 

Prevalence

Around 3% of Australians will be diagnosed with OCD in their lifetime, and approximately 2% will experience OCD in a 12 month period. OCD occurs at any time of life, although symptoms tend to develop during adolescence.

 

Main Treatments

 

  • Psychological treatments, in particular Cognitive Behaviour Therapy (CBT) has been found to be effective in treating OCD. CBT explores a persons cognitions (thinking) and their actions (behaviour) and how it is impacting on how they are feeling. Psycho-education is also a part of this approach, which helps the person understand what they are experiencing and to see how the pattern of their thinking and behaviour is contributing to their anxiety (rather than reducing it). CBT treatment for OCD looks at identifying the distorted thinking patterns and challenging them and replacing them with more constructive thoughts. Behaviourally, the compulsions are targeted by gradually reducing the behaviour, such as, only gradually reducing the amount of checking a person does.
  • Medication may also be used in the treatment of OCD, in particular some antidepressants can be useful in reducing anxiety. Benzodiazepines are only used in the very short term, and as only a part of a specific treatment plan. Their use is closely monitored because of their addictive nature.

 

 

Specific Phobia

 

Feeling anxious in certain situations, or with some animals, or things that are unfamiliar, is not unusual. Most people feel anxious when they see a snake. This is a natural protective response. For some people however, their response to situations or things is greatly exaggerated. People with a specific phobia are aware that their fear is irrational (such as the fear of going to the dentist), but they feel they have little to no control over their reaction. This type of phobia can also be associated with panic attacks.

 

Signs & Symptoms

A person may be diagnosed with a specific phobia if they meet the following criteria:

 

 

  • Significant fear or anxiety about a certain objection or situation (such as seeing a dog, plane travel, being on water, heights, receiving an injection, seeing blood)
  • Situations where a person might encounter the phobic object are avoided (e.g., not going to parks where dogs are allowed)
  • The fear is disproportionate to the actual danger
  • The anxiety and avoidance makes day to day life difficult

 

Specific phobias are broken up into 5 types:

 

  • Animal phobias (e.g., spiders, insects, dogs)
  • Natural environment (e.g., heights, rain, thunder)
  • Blood-injection-injury (e.g., needles, invasive medical procedures), or with seeing blood
  • Specific situation (e.g., bridges, elevators, airplanes, enclosed places)
  • Other – any other specific phobia (e.g., fear of choking, fear of vomiting)

 

Prevalence

It is not known how many Australians experience specific phobias. In the United States and Europe around 6% of adults will be diagnosed with a specific phobia in a 12 month period. Females tend to experience more specific phobias than males, although rates are approximately equal for the blood-injection-injury type of phobia.

Main Treatments

  • Psychological treatments have been found to be effective, and are the treatment of first choice. Cognitive Behavioural Therapy (CBT) is the most common approach used and explores and challenges the fearful cognitions (thoughts) to more realistic thinking. It also includes education, so a person can understand what is happening. Behavioural strategies such as breathing relaxation, is used to get some control over anxiety symptoms. Graduated exposure, gradual contact with the fear situation, is also part of this treatment. For example, in the fear of dogs, a person might start to look at pictures of puppies, and then dogs, then video of dogs, observing a real life dog at a safe distance and gradually getting closer to being able to touch it.
  • In severe situations medication may be used, however their use in the treatment of specific phobias is not clear. Benzodiazepines might be used very briefly as part of a comprehensive treatment plan. However due to the addictive nature of these medications they are use with care.

 

 

Social Anxiety Disorder

 

Feeling anxious in situations where we can be the focus of attention is understandable and normal. This might be giving a talk or a speech, or a presentation to work colleagues. For those with social anxiety however, being in situations where they feel they are under the scrutiny of others causes extreme anxiety. This fear of social situations can also include eating in front of others or making conversation at a party. Underpinning this fear is a fear that others are thinking negatively of them, and/or fear possible criticism or being humiliated. The intensity of this fear results in the person avoiding situations where they will feel socially anxious.

 

Signs & Symptoms

The major signs and symptoms of social anxiety disorder, according to the DSM-5 (2013) include:

 

 

  • Intense fear or anxiety about one or more social situations where a person feels they may be under scrutiny by others. For example, meeting new people, eating or drinking socially, having a conversation, giving a speech.
  • The person fears that others will notice their anxiety symptoms and/or that others will think of them negatively.
  • That they will feel humiliated, embarrassed and rejected by others.
  • The social situation is avoided or experienced with significant anxiety.

 

Some of the anxious symptoms a person might experience include:

 

  • Blushing
  • Finding it difficult to speak (e.g., stammering)
  • Sweating
  • Trembling and shaking
  • Gastrointestinal symptoms such as nausea, and diarrhoea

 

Prevalence

Some 10% of Australians will experience social anxiety in their lifetime. In any 12 months 4.7% of Australians will be diagnosed. Social anxiety is more common in women than men. It tends to develop in later childhood with the average age of onset around 13 years of age.

Main Treatments

 

  • Psychological treatment, most frequently Cognitive Behavioural Therapy (CBT) has been found to be effective in the treatment of social anxiety. This approach looks at how a person thinks (their cognitions), what they do (their behaviour) and how this affects how they feel. This approach also includes education about the anxiety so a person has some understanding of what they are feeling and why. The cognitive (thinking) aspect of CBT will look at fear generating thoughts and challenging these and developing more helpful, encouraging thoughts. Behaviour aspects of this approach include relaxation strategies to reduce anxiety and graduated exposure, a gradual introduction to those feared situations. In severe anxiety medication may be used.
  • Some antidepressants are also useful in treating anxiety. This type of medication is preferred over the short acting and addictive drugs such as benzodiazepines. These types of medications are only used for brief periods of time.

 

Substance Use Disorder

 

In the latest DSM-5 (2013) edition, there has been a major change in how alcohol and other drug addictions are classified. The terms abuse and dependence have been removed and they are now all defined in terms of ‘use’ disorders.

 

Signs & Symptoms

There are a number of use disorders that have been classified as disorders, they all share a broad classification criteria noted below. The problem “pattern” of use results in “significant impairment or distress”, and includes at least 2 of the following within a 12 month period.

 

 

  • The substance is regularly consumed in larger amounts, or over a longer period than was planned
  • There is a wish to reduce or to be able to control substance use, or there have been failed attempts to do so
  • Considerable time is spent in obtaining, using or recovering from the effects of the substance
  • Experiences cravings, or has a strong urge to use the substance
  • Repeated substance use causes significant impact on work, home or school as responsibilities in these areas are not able to be fulfilled
  • Regardless of the personal or social difficulties caused or worsened by its effects, the substance use continues
  • The substance use takes priority over important social, work, or leisure activities that are either cut down or stopped completely
  • Substance use persists even when physically unsafe to do so
  • Despite the awareness of ongoing or recurrent physical or psychological problems that are likely to be caused or worsened due to the substance, its use is continued
  • The development of tolerance that can EITHER:1) require “markedly” increased amounts of the substance to obtain “desired effect’ or to become intoxicated OR 2) reduced effect with use of the same amount of the substance.
  • Withdrawal as indicated by EITHER: a) the substance-specific withdrawal symptoms OR b) The substance or a related substance is taken to reduce or avert withdrawal symptoms.

 

Prevalence

The Australian Department of Health reports that 7.7% of Australian adults have a substance use disorder with males at 11.1% were twice as likely as females at 4.5% to have a disorder. Alcohol use disorders were approximately three times as common as drug use disorders.

Main Treatments

Treatment of substance use disorders usually involves both psychological and medical approaches.

 

 

There are a number of health issues around withdrawal that require medical involvement and medication can lessen the risk and unpleasant physiological withdrawal symptoms. The combined approach of medical and psychological treatments has been found to be most effective. The psychological treatments take a number of different approaches, but there is also some evidence that suggests including broader aspects beyond the substance use and also dealing with issues such as relationships, social and community connectedness is also important. Research has also supported the 12-step treatment program used for example in Alcoholics Anonymous.