Friday, March 16, 2018

Brazil Has Nearly 60,000 Murders, And It May Relax Gun Laws

NPR: Brazil Has Nearly 60,000 Murders, And It May Relax Gun Laws

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental disorder characterized by intrusive thoughts (obsessions) that produce uneasiness, apprehension, fear, or worry, and by repetitive behaviors or rituals (compulsions) aimed at reducing the associated anxiety. People with OCD may have just the obsessions or a combination of obsessions and compulsions.

Obsessions are characterized as persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing (APA, 2013). Common obsessions include concerns about germs and contamination, doubts (“Did I turn the water off?”), order and symmetry (“I need all the spoons in the tray to be arranged a certain way”), and urges that are aggressive or lustful. Usually, the person knows that such thoughts and urges are irrational and thus tries to suppress or ignore them, but has an extremely difficult time doing so.

Compulsions are ritualistic behaviors that an individual performs in order to mitigate the anxiety that stems from obsessive thoughts. They often include such behaviors as repeated and extensive hand washing, cleaning, checking (e.g., making sure the oven is off), counting things, hoarding, or ordering (e.g., lining up all the pencils in a particular way). They may also include such mental acts as counting, praying, or reciting something to oneself, as well as nervous rituals like touching a doorknob or opening and closing a door a certain number of times before leaving a room. These compulsions can be alienating and time-consuming, often causing severe emotional, interpersonal, and even financial distress. The ability to relieve their stress is often temporary, and individuals may have a hard time switching from one task to another.

The acts of those who have OCD may appear paranoid and potentially psychotic, or disconnected from reality; however, OCD sufferers generally recognize their obsessions and compulsions as irrational. Roughly one-third to one-half of adults with OCD report a childhood onset of the disorder.

DSM-5 Diagnostic Criteria

To be diagnosed with OCD, a person must experience obsessions, compulsions, or both. Such obsessions must be to a degree that lies outside the normal range of worries about conventional problems. A person will tend to recognize the obsessions as idiosyncratic or irrational, but still must perform them. Additionally, the degree of obsessions and compulsions must impair some aspect of the individual’s social, occupational, or daily life functioning.

Other Obsessive-Compulsive Disorders
Obsessive-compulsive and related disorders are a group of overlapping disorders that generally involve intrusive, unpleasant thoughts and repetitive behaviors. Included in this category are body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.

1. Body Dysmorphic Disorder
An individual with body dysmorphic disorder is preoccupied with a perceived flaw in their physical appearance that is either nonexistent or barely noticeable to other people (APA, 2013). These perceived physical defects cause the person to think they are unattractive, ugly, hideous, or deformed. These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair. The preoccupation with imagined physical flaws drives the person to engage in repetitive and ritualistic behavioral and mental acts, such as constantly looking in the mirror, trying to hide the offending body part, comparisons with others, and, in some extreme cases, cosmetic surgery (Phillips, 2005). Severely impairing quality of life, body dysmorphic disorder can lead to social isolation and involves especially high rates of suicidal ideation. An estimated 2.4% of the adults in the United States meet the criteria for body dysmorphic disorder, with slightly higher rates in women than in men (APA, 2013).
2. Hoarding Disorder
Hoarding disorder is a pattern of behavior that is characterized by excessive acquisition and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment. Compulsive hoarding behavior has been associated with health risks, impaired functioning, economic burden, and adverse effects on friends and family members. When clinically significant enough to impair functioning, hoarding can prevent typical uses of space, enough so that it can limit activities such as cooking, cleaning, moving through the house, and sleeping. It could also potentially put the individual and others at risk of causing fires, falling, poor sanitation, and other health concerns. Compulsive hoarders may be conscious of their irrational behavior, but the emotional attachment to the hoarded objects far exceeds the motive to discard the items.

Prevalence rates have been estimated at 2-5% in adults, though the condition typically manifests in childhood with symptoms worsening in advanced age. Hoarding appears to be more common in people with psychological disorders such as depression, anxiety, and attention -deficit hyperactivity disorder (ADHD).

Trichotillomania (also known as trichotillosis or hair pulling disorder) is an obsessive compulsive disorder characterized by the compulsive urge to pull out one’s hair, leading to hair loss and balding, distress, and social or functional impairment. Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. Owing to social implications the disorder is often unreported and it is difficult to accurately predict its prevalence; the lifetime prevalence is estimated to be between 0.6% and 4.0% of the overall population. Common areas for hair to be pulled out are the scalp, eyelashes, eyebrows, legs, arms, hands, nose and the pubic areas.

Excoriation Disorder
Excoriation disorder is an obsessive compulsive disorder characterized by the repeated urge to pick at one’s own skin, often to the extent that damage is caused. Episodes of skin picking are often preceded or accompanied by tension, anxiety, or stress. During these moments, there is commonly a compulsive urge to pick, squeeze, or scratch at a surface or region of the body, often at the location of a perceived skin defect. The region most commonly picked is the face, but other frequent locations include the arms, legs, back, gums, lips, shoulders, scalp, stomach, chest, and extremities such as the fingernails, cuticles, and toenails. Most patients with excoriation disorder report having a primary area of the body that they focus their picking on, but they will often move to other areas of the body to allow their primary picking area to heal.

Excoriation disorder can cause feeling of intense helplessness, guilt, shame, and embarrassment in individuals, and this greatly increases the risk of self-harm. Studies have shown that excoriation disorder presented suicidal ideation in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and psychiatric hospitalizations in 15% of individuals with this condition.

Lumen: Boundless Psychology: Obsessive-Compulsive Disorders

Wednesday, March 14, 2018

Heather Mac Donald: How Much More Delusional Can University Students Get?

Anxiety Disorders

Defining Anxiety
The difference between normal anxiety and an anxiety disorder is that anxiety disorders cause such severe distress as to interfere with someone’s ability to lead a normal life. “Anxiety disorder” refers to any of a number of specific disorders, including generalized anxiety disorder, phobia, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and social anxiety disorder.

Anxiety disorders are defined by excessive worry, apprehension, and fear about future events or situations, either real or imagined. Specifically, symptoms may include:
  • feelings of panic, fear, or uneasiness
  • uncontrollable and obsessive thoughts
  • flashbacks to traumatic events
  • problems sleeping
  • nightmares
  • shortness of breath
  • nausea
  • muscle tension
  • dizziness
  • heart palpitations
  • dry mouth
  • cold or sweaty hands
Anxiety disorders are diagnosed in between 4% and 10% of older adults; however, this figure is likely an underestimate of the true incidence due to the tendency of adults to minimize psychiatric problems and to focus on physical symptoms.

Anxiety in and of itself is not a bad thing. In fact, the hormonal response involved in anxiety evolved to help humans react to danger—it better prepares them to recognize threats and to act accordingly to ensure their safety. Such sensory information is processed by the amygdala, which communicates information about potential threats to the rest of the brain. However, anxiety becomes counterproductive and thus is deemed “disordered” when it is experienced with such intensity that it impedes social functioning.

Anxiety disorders develop as the result of the interaction of genetic (inherited) and environmental factors. Neurologically speaking, increased amygdala reactivity is correlated with increased fear and anxiety responses. Low levels of GABA (a neurotransmitter in the brain that reduces central nervous system activity) can contribute to anxiety, and serotonin, glutamate, and the 5-Ht2A receptor have also all been implicated in the development of anxiety disorders.

In addition to biological factors, anxiety disorders can also be caused by various life stresses, such as financial worries or chronic physical illness. Severe anxiety and depression can also be induced by sustained alcohol abuse; with prolonged sobriety these symptoms usually decrease. Even moderate sustained alcohol use may increase anxiety and depression levels in some individuals. Caffeine, alcohol, and benzodiazepine dependence can worsen or cause anxiety and panic attacks.

Treatment options for anxiety disorders include lifestyle changes, therapy, and medication. The most common intervention is cognitive behavioral therapy (CBT), which aims to help the person identify and challenge their negative thoughts (cognitions) and change their reactions to anxiety-provoking situations (behaviors).

In terms of medication, SSRIs are most commonly recommended. Benzodiazepines are also sometimes indicated for short-term or “as-needed” use. MAOIs such as phenelzine and tranylcypromine are also considered effective and are especially useful in treatment-resistant cases, but dietary restrictions and medical interactions may limit their use.

I. Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is characterized by chronic anxiety that is excessive, uncontrollable, often irrational, and disproportionate to the actual object of concern. People with GAD often characterize it as a feeling of “free-floating anxiety”—a term that Sigmund Freud used in his early work. Typically, the anxiety has no definite trigger or starting point, and as soon as the individual resolves one issue or source of worry another worry arises. People with GAD also tend to catastrophize, meaning they may assume the absolute worst in anxiety-inducing situations. Racing thoughts, inability to concentrate, and inability to focus are also characteristic of GAD.

GAD is a particularly difficult disorder to live with; because the individual’s anxiety is not tied to a specific situation or event, they experience little relief. This disorder can contribute to problems with sleep, work, and daily responsibilities and often impacts close relationships.

DSM-5 Diagnostic Criteria

In order for GAD to be diagnosed, a person must experience excessive anxiety and worry—more days than not—for at least 6 months and about a number of events or activities (such as work or school performance). This excessive worry must interfere with some aspect of life, such as social, occupational, or daily functioning, and the person must have trouble controlling the anxiety. The disturbance must not be attributed to the physiological effects of a substance (e.g., a drug or medication) or another medical condition, and must not be better explained by another medical disorder. At least 3 of the following symptoms must be experienced: restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or mind going blank; irritability; muscle tension; and/or sleep disturbance.

In any given year, approximately 2.3% of American adults and 2% of European adults experience GAD. Although there have been few investigations into the disorder’s heritability, a summary of available family and twin studies suggests that genetic factors play a moderate role in its development (Hettema et al., 2001). Specifically, about 30% of the variance for generalized anxiety disorder can been attributed to genes. Individuals with a genetic predisposition for GAD are more likely to develop the disorder, especially in response to a life stressor.

Cognitive theories of GAD suggest that worry represents a mental strategy to avoid more powerful negative emotions (Aikins & Craske, 2001), perhaps stemming from earlier unpleasant or traumatic experiences. Indeed, one longitudinal study found that childhood maltreatment was strongly related to the development of this disorder during adulthood (Moffitt et al., 2007). According to these theories, generalized anxiety may serve as a distraction from remembering painful childhood experiences.

Long-term use of benzodiazepines can worsen underlying anxiety, with evidence that reduction in benzodiazepine use can in turn lead to a lessening of anxiety symptoms. Similarly, long-term alcohol use is associated with the development of anxiety disorders, with evidence that prolonged abstinence can in turn result in the remission of anxiety symptoms.

GAD is generally chronic, but it can be managed, or even eliminated, with the proper treatment. While there are many options for treating GAD, full recovery is only seen about 50% of the time, which indicates the need for further research into more effective treatment options.

Pharmaceutical treatments for GAD include selective serotonin reuptake inhibitors (SSRIs), which are more commonly used as antidepressants. SSRIs block the reabsorption of serotonin in the brain so that it can keep activating serotonin receptors, improving the individual’s mood.

II. Panic Disorder and Panic Attacks
A panic attack is defined as a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes. Its symptoms include accelerated heart rate, sweating, trembling, choking sensations, hot flashes or chills, dizziness or lightheadedness, fears of losing control or going crazy, and fears of dying (APA, 2013). Sometimes panic attacks are expected, occurring in response to specific environmental triggers (such as being in a tunnel); other times, these episodes are unexpected and emerge randomly (such as when relaxing).

People with panic disorder experience recurrent (more than one) and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks (such as withdrawing from social activities out of fear of having an attack) (APA, 2013). Since panic attacks can occur unexpectedly, they can become a cause of ongoing worry and avoidance. People with panic disorder may become so afraid of having panic attacks that they experience what are known as anticipatory attacks—essentially panicking about potential panic attacks and entering a cycle of living in fear of fear.

Panic disorder is very treatable; however, left untreated, it can significantly reduce quality of life. People with untreated panic disorder are at an increased risk for specific phobias, such as agoraphobia (a fear of leaving the house), and they often suffer from one or more additional mental-health conditions, such as depression or substance abuse.

DSM-5 Diagnostic Criteria
In the DSM-5, panic attacks themselves are not mental disorders; instead, they are listed as specifiers for other mental disorders, such as anxiety disorders. Panic attacks are differentiated as being either expected or unexpected; the categories from the previous DSM-IV-TR (situationally bound/cued, situationally predisposed, or unexpected/uncued) have been removed.

In order to be diagnosed with panic disorder, a person must experience unexpected, recurrent panic attacks. These panic attacks must also be accompanied by at least one month of a significant and related behavior change in relation to the attacks, a persistent concern or fear of more attacks, or a worry about the attacks’ consequences. As is the case with other anxiety disorders, the panic attacks cannot result from the physiological effects of drugs and other substances, a medical condition, or another mental disorder. While the previous version of the DSM defined panic disorder as occurring either with or without agoraphobia, the new DSM-5 lists panic disorder and agoraphobia as two distinct disorders.
III. Social Anxiety Disorder (Social Phobia)
Social anxiety disorder (formerly called social phobia) is characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others (APA, 2013). As with specific phobias, social anxiety disorder is common in the United States; a little over 12% of all Americans experience social anxiety disorder during their lifetime (Kessler et al., 2005).

The heart of the anxiety in social anxiety disorder is the person’s concern that they may act in a humiliating or embarrassing way, such as appearing foolish, showing symptoms of anxiety (such as blushing), or doing or saying something that might lead to rejection (such as offending others). The kinds of social situations that may cause distress include public speaking, having a conversation, meeting strangers, eating in restaurants, or using public restrooms. Although many people become anxious in social situations like public speaking, the fear, anxiety, and avoidance experienced in social anxiety disorder are highly distressing and lead to serious impairments in life.

Physical symptoms often accompanying social anxiety disorder include excessive blushing, excessive sweating, trembling, palpitations, and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. Adults with this disorder are more likely to experience lower educational attainment and lower earnings (Katzelnick et al., 2001); more likely to perform poorly at work and to be unemployed (Moitra, Beard, Weisberg, & Keller, 2011); and report greater dissatisfaction with their family lives, friends, leisure activities, and income (Stein & Kean, 2000).

When people with social anxiety disorder are unable to avoid situations that provoke anxiety, they typically perform safety behaviors: mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes. Safety behaviors can include avoiding eye contact, rehearsing sentences before speaking, talking only briefly, and not talking about oneself (Alden & Bieling, 1998). Although these behaviors are intended to prevent the person with social anxiety disorder from doing something awkward that might draw criticism, these actions often exacerbate the problem because they do not allow the individual to disconfirm their negative beliefs, often eliciting rejection and other negative reactions from others (Alden & Bieling, 1998).

One of the most well-established risk factors for developing social anxiety disorder is behavioral inhibition (Clauss & Blackford, 2012). Behavioral inhibition is thought to be an inherited trait, and it is characterized by a consistent tendency to show fear and restraint when presented with unfamiliar people or situations (Kagan, Reznick, & Snidman, 1988). A recent statistical review of studies demonstrated that behavioral inhibition was associated with a greater-than sevenfold increase in the risk of development of social anxiety disorder, indicating that behavioral inhibition is a major risk factor for the disorder (Clauss & Blackford, 2012).

IV. Specific PhobiaA person diagnosed with a specific phobia (formerly known as a “simple phobia”) experiences excessive, distressing, and persistent fear or anxiety about a specific object or situation (such as animals, enclosed spaces, elevators, or flying) (APA, 2013). Even though people realize their level of fear and anxiety in relation to the phobic stimulus is irrational, some people with a specific phobia may go to great lengths to avoid the phobic stimulus (the object or situation that triggers the fear and anxiety). 

When confronted with the object of their phobia, a person will generally enter a state of panic and experience a wide variety of physical symptoms, such as nausea, increased heartbeat, dizziness, and sweaty palms. For this reason, many people with phobias simply avoid the object of their phobia. Such avoidance can range from not wanting to be outside in a lightning storm to being unable to even look at a picture of lightning.

There are five general categories of phobias:
  • Environment phobias (e.g., fear of lightning, fear of tornadoes)
  • Animal phobias (e.g., fear of snakes, fear of bears)
  • Blood-injury phobias, (e.g., fear of getting a shot, fear of the sight of blood)
  • Situational phobias (e.g., fear of heights, fear of public speaking)
  • Other phobias not otherwise specified (e.g., fear of vomiting)

Tuesday, March 13, 2018

Heaven on Earth: The Rise and Fall of Socialism

Heaven on Earth: The Rise and Fall of Socialism (2005) is a three-hour PBS documentary film.

Wednesday, March 7, 2018

TOXO A Conversation with Robert Sapolsky

Edge Video: TOXO A Conversation with Robert Sapolsky

Depressive Disorders

Depressive Disorders
Clinical depression is characterized by pervasive and persistent low mood that is accompanied by low self-esteem and a loss of interest.

Major Depressive Disorder

Defining Depression
Everyone occasionally feels sad and may even characterize their mood as depressed every once in a while; however, these feelings are usually short-lived and pass within a couple of days. When you have clinical depression, it interferes with daily life and causes significant pain for both you and those who care about you. Major depressive disorder (also called major depression and clinical depression) is a mood disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities. The symptoms interfere with a person’s ability to work, sleep, study, eat, and enjoy pleasurable activities.

DSM-5 Diagnostic Criteria
In order to be diagnosed with major depressive disorder (MDD) in the DSM-5, a person must experience at least five listed symptoms over a two-week period. One of the symptoms must either be a depressed mood or an inability to experience pleasure in activities that were formerly enjoyed. The symptoms must significantly interfere with one or more areas of an individual’s life (such as work, relationships, school, etc.) and must not be directly caused by a medical condition or the use of substances.

People with depressive illnesses do not all experience the same symptoms, and the severity, frequency, and duration of symptoms vary. Common symptoms include the following:
persistent sad, anxious, or empty feelings;
feelings of hopelessness or pessimism;
feelings of guilt, worthlessness, helplessness, or self-hatred;
irritability, restlessness;
loss of interest in activities or hobbies once pleasurable, including sex;
difficulty concentrating;
insomnia, or excessive sleeping;
overeating, or appetite loss;
thoughts of suicide, suicide attempts;
aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

In 2013, the DSM-5 removed the bereavement clause from the diagnostic criteria of MDD. This controversial decision means those who were previously exempt from a diagnosis of MDD due to bereavement (mourning the loss of a loved one) are now candidates for the MDD diagnosis.

Clinical depression is one of the most common mental disorders in the United States. Each year about 6.7% of U.S. adults experience major depressive disorder. Women are 70% more likely than men to experience depression during their lifetime, and non-Hispanic blacks are 40% less likely than non-Hispanic whites. The average age of onset is 32 years old. Additionally, 3.3% of 13 to 18 year olds have experienced a seriously debilitating depressive disorder.

Causes of depression can be broken up into three categories: precipitating causes, perpetuating causes, and predisposing causes.
  • A precipitating cause describes an immediate trigger that instigates a person’s action or behavior. This includes acute physical stresses such as diseases or infections, psychological stresses such as bereavement, and social stresses such as work problems or a significant change in social status or living conditions.
  • A perpetuating cause is one that worsens an individual’s current condition and can be said to push someone “over the edge” into depression. This may include physical inactivity, emotional disorders, ongoing psychological or social stresses, and abnormalities of sleep.
  • A predisposing cause typically describes an individual’s history, both genetic and environmental. For instance, being female and growing up in a lower socioeconomic status are both predisposing factors for depression. The preexisting vulnerability can be either genetic, implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.

The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy. Currently, the most effective form of psychotherapy for depression is cognitive-behavioral therapy (CBT), which teaches clients to challenge self-defeating but enduring ways of thinking (cognitions) and change counter-productive behaviors. Antidepressants (usually SSRIs) have been shown to cause significant improvement in the mood of those with very severe depression. Electroconvulsive therapy (ECT) is a procedure whereby pulses of electricity are sent through the brain via two electrodes; studies have found it to be very effective in treating severe forms of depression that have not responded to medication or therapy.

Persistent Depressive Disorder
Diagnosis requires that a person experience depressed moods most of the day nearly every day for at least two years, as well as at least two of the other symptoms of major depressive disorder. People with persistent depressive disorder are chronically sad and melancholy but do not meet all the criteria for major depression. However, episodes of full-blown major depressive disorder can occur during persistent depressive disorder (APA, 2013). The etiology and treatment of persistent depressive disorders is much the same as that of MDD.