Information

Is there a mental health disorder related to a harmful lack of anxiety and stress?

Is there a mental health disorder related to a harmful lack of anxiety and stress?

Ataraxia is the freedom from distress or worry in ancient Greek philosophy. However, emotions play a vital role in motivation and decision making. Many disorders relate to having excessive emotional reactions or inappropriate triggers for them. There are also a few concerning a lack of or dulled emotional responses. While high levels of stress and anxiety are seen as harmful, the same concern is rarely shown for the opposite end of the spectrum.

I have been unable to find any information about disorders related to dulled or absent anxiety or stress reactions. I assume this is due to the lower perceived harm, or conflation with depression disorders, but I find it hard to believe no one has done any work in this area. Clinical apathy is not what I'm looking for, since that seems to be typified by acute lack of response or interest in immediate stimulus or short time spans.


Sociopaths (people with Antisocial Personality Disorder) report lower levels of anxiety and stress than the general population. Psychopathic traits tend to foster resiliency and are protective against anxiety.

I'm a board-certified psychiatrist. There is ample evidence in the literature (and basic psych textbooks) that sociopathy have low levels of harm avoidance, decreased physiological responses to stress, and lower overall reported anxiety and fear. There is evidence supporting this.

In fairness, this association has come into question and there are some newer studies that are reevaluating the association between anxiety and sociopathy. Anecdotally, I have never encountered an ASPD patient with comorbid anxiety. I'm sure they exist: I've just never seen it, and suspect that it's rare.

Hofmann, S. G., Korte, K. J., & Suvak, M. K. (2009). The upside of being socially anxious: Psychopathic attributes and social anxiety are negatively associated. Journal of social and clinical psychology, 28(6), 714-727.
Dinn, W. M., & Harris, C. L. (2000). Neurocognitive function in antisocial personality disorder. Psychiatry research, 97(2-3), 173-190.
Dolan, M. C., & Rennie, C. E. (2007). Is juvenile psychopathy associated with low anxiety and fear in conduct-disordered male offenders? Journal of anxiety disorders, 21(8), 1028-1038.


Anxiety Disorders

Anxiety is a normal emotion. It’s your brain’s way of reacting to stress and alerting you of potential danger ahead.

Everyone feels anxious now and then. For example, you may worry when faced with a problem at work, before taking a test, or before making an important decision.

Occasional anxiety is OK. But anxiety disorders are different. They’re a group of mental illnesses that cause constant and overwhelming anxiety and fear. The excessive anxiety can make you avoid work, school, family get-togethers, and other social situations that might trigger or worsen your symptoms.

With treatment, many people with anxiety disorders can manage their feelings.


Health changes and mood disturbances

Changes in your physical health at the time of menopause may also drive mood changes. For example, anxiety may be triggered by an overactive thyroid gland, which becomes more common with age. In addition, anxiety and depression may be triggered by a lack of sleep, which also becomes more common at the time of menopause, as hormone shifts cause nighttime hot flashes or other sleep disruptions that make it more difficult for women to get the rest they need.

So, what can you do to protect your mental health as you go through menopause?

Be aware that mood changes may accompany other menopausal symptoms.

Monitor your mood and make note of patterns in other factors such as sleep and stress levels. Seek professional help if symptoms become severe and interfere with daily life.

Make lifestyle changes such as increasing exercise, getting adequate sleep, and controlling stress to reduce potential symptoms.

Reach out to others. Don't struggle alone.

Know that it's temporary. Typically, the mood changes that accompany female hormonal changes during the menopausal transition won't last. "Data show that these hormone-related risks ease with increasing time after menopause," says Dr. Joffe. People who opt to treat their condition using antidepressants or other methods won't necessarily have to continue treatment forever, potentially just through this time period, she says. "I see a lot of women who are really fearful that they are descending into a dismal aging experience," says Dr. Joffe. This is not the case, and help is available.

Image: Victor_69/Getty Images


What to know about anxiety

Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it might become a medical disorder.

Anxiety disorders form a category of mental health diagnoses that lead to excessive nervousness, fear, apprehension, and worry

These disorders alter how a person processes emotions and behave, also causing physical symptoms. Mild anxiety might be vague and unsettling, while severe anxiety may seriously affect day-to-day living.

Anxiety disorders affect 40 million people in the United States. It is the most common group of mental illnesses in the country. However, only 36.9 percent of people with an anxiety disorder receive treatment.

Share on Pinterest Disproportionate reactions of tension and worry characterize anxiety.

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

Knowing the difference between normal feelings of anxiety and an anxiety disorder requiring medical attention can help a person identify and treat the condition.

In this article, we look at the differences between anxiety and anxiety disorder, the different types of anxiety, and the available treatment options.

When does anxiety need treatment?

While anxiety can cause distress, it is not always a medical condition.

When an individual faces potentially harmful or worrying triggers, feelings of anxiety are not only normal but necessary for survival.

Since the earliest days of humanity, the approach of predators and incoming danger sets off alarms in the body and allows evasive action. These alarms become noticeable in the form of a raised heartbeat, sweating, and increased sensitivity to surroundings.

The danger causes a rush of adrenalin, a hormone and chemical messenger in the brain, which in turn triggers these anxious reactions in a process called the “fight-or-flight’ response. This prepares humans to physically confront or flee any potential threats to safety.

For many people, running from larger animals and imminent danger is a less pressing concern than it would have been for early humans. Anxieties now revolve around work, money, family life, health, and other crucial issues that demand a person’s attention without necessarily requiring the ‘fight-or-flight’ reaction.

The nervous feeling before an important life event or during a difficult situation is a natural echo of the original ‘fight-or-flight’ reaction. It can still be essential to survival – anxiety about being hit by a car when crossing the street, for example, means that a person will instinctively look both ways to avoid danger.

Anxiety disorders

The duration or severity of an anxious feeling can sometimes be out of proportion to the original trigger, or stressor. Physical symptoms, such as increased blood pressure and nausea, may also develop. These responses move beyond anxiety into an anxiety disorder.

The APA describes a person with anxiety disorder as “having recurring intrusive thoughts or concerns.” Once anxiety reaches the stage of a disorder, it can interfere with daily function.

While a number of different diagnoses constitute anxiety disorders, the symptoms of generalized anxiety disorder (GAD) will often include the following:

  • restlessness, and a feeling of being “on-edge”
  • uncontrollable feelings of worry
  • increased irritability
  • concentration difficulties
  • sleep difficulties, such as problems in falling or staying asleep

While these symptoms might be normal to experience in daily life, people with GAD will experience them to persistent or extreme levels. GAD may present as vague, unsettling worry or a more severe anxiety that disrupts day-to-day living.

For information on the symptoms of other diagnoses under the umbrella of anxiety disorders, follow the links in the “Types” section below.

The Diagnostic and Statistical Manual of Mental Health Disorders: Fifth Edition (DSM-V) classifies anxiety disorders into several main types.

In previous editions of DSM, anxiety disorders included obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), as well as acute stress disorder. However, the manual now no longer groups these mental health difficulties under anxiety.

Anxiety disorders now include the following diagnoses.

Generalized anxiety disorder: This is a chronic disorder involving excessive, long-lasting anxiety and worries about nonspecific life events, objects, and situations. GAD is the most common anxiety disorder, and people with the disorder are not always able to identify the cause of their anxiety.

Panic disorder: Brief or sudden attacks of intense terror and apprehension characterize panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. Panic attacks tend to occur and escalate rapidly, peaking after 10 minutes. However, a panic attack might last for hours.

Panic disorders usually occur after frightening experiences or prolonged stress but may also occur without a trigger. An individual experiencing a panic attack may misinterpret it as a life-threatening illness, and may make drastic changes in behavior to avoid future attacks.

Click here to learn more about panic disorder and panic attacks.

Specific phobia: This is an irrational fear and avoidance of a particular object or situation. Phobias are not like other anxiety disorders, as they relate to a specific cause.

A person with a phobia might acknowledge a fear as illogical or extreme but remain unable to control feelings anxiety around the trigger. Triggers for a phobia range from situations and animals to everyday objects.

Click here to learn more about phobias and how they develop.

Agoraphobia: This is a fear and avoidance of places, events, or situations from which it may be difficult to escape or in which help would not be available if a person becomes trapped. People often misunderstand this condition as a phobia of open spaces and the outdoors, but it is not so simple. A person with agoraphobia may have a fear of leaving home or using elevators and public transport.

Click here to learn about agoraphobia, an often-misunderstood psychological disorder.

Selective mutism: This is a form of anxiety that some children experience, in which they are not able to speak in certain places or contexts, such as school, even though they may have excellent verbal communication skills around familiar people. It may be an extreme form of social phobia.

Social anxiety disorder, or social phobia: This is a fear of negative judgment from others in social situations or of public embarrassment. Social anxiety disorder includes a range of feelings, such as stage fright, a fear of intimacy, and anxiety around humiliation and rejection.

This disorder can cause people to avoid public situations and human contact to the point that everyday living is rendered extremely difficult.

Click here to learn all you need to know about social anxiety disorder.

Separation anxiety disorder: High levels of anxiety after separation from a person or place that provides feelings of security or safety characterize separation anxiety disorder. Separation might sometimes result in panic symptoms.

Learn all about separation anxiety by clicking here.

The causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present.

  • environmental stressors, such as difficulties at work, relationship problems, or family issues
  • genetics, as people who have family members with an anxiety disorder are more likely to experience one themselves
  • medical factors, such as the symptoms of a different disease, the effects of a medication, or the stress of an intensive surgery or prolonged recovery
  • brain chemistry, as psychologists define many anxiety disorders as misalignments of hormones and electrical signals in the brain
  • withdrawal from an illicit substance, the effects of which might intensify the impact of other possible causes

To learn more about the causes and diagnosis of anxiety disorders, click here.

Treatments will consist of a combination of psychotherapy, behavioral therapy, and medication.

Alcohol dependence, depression, or other conditions can sometimes have such a strong effect on mental well-being that treating an anxiety disorder must wait until any underlying conditions are brought under control.

Self-treatment

In some cases, a person can treat an anxiety disorder at home without clinical supervision. However, this may not be effective for severe or long-term anxiety disorders.

There are several exercises and actions to help a person cope with milder, more focused, or shorter-term anxiety disorders, including:

  • Stress management: Learning to manage stress can help limit potential triggers. Organize any upcoming pressures and deadlines, compile lists to make daunting tasks more manageable, and commit to taking time off from study or work.
  • Relaxation techniques: Simple activities can help soothe the mental and physical signs of anxiety. These techniques include meditation, deep breathing exercises, long baths, resting in the dark, and yoga.
  • Exercises to replace negative thoughts with positive ones: Make a list of the negative thoughts that might be cycling as a result of anxiety, and write down another list next to it containing positive, believable thoughts to replace them. Creating a mental image of successfully facing and conquering a specific fear can also provide benefits if anxiety symptoms relate to a specific cause, such as in a phobia.
  • Support network: Talk with familiar people who are supportive, such as a family member or friend. Support group services may also be available in the local area and online.
  • Exercise: Physical exertion can improve self-image and release chemicals in the brain that trigger positive feelings.

Counseling

A standard way of treating anxiety is psychological counseling. This can include cognitive-behavioral therapy (CBT), psychotherapy, or a combination of therapies.

This type of psychotherapy aims to recognize and change harmful thought patterns that form the foundation of anxious and troublesome feelings. In the process, practitioners of CBT hope to limit distorted thinking and change the way people react to objects or situations that trigger anxiety.

For example, a psychotherapist providing CBT for panic disorder will try to reinforce the fact that panic attacks are not really heart attacks. Exposure to fears and triggers can be a part of CBT. This encourages people to confront their fears and helps reduce sensitivity to their usual triggers of anxiety.

Medications

A person can support anxiety management with several types of medication.

Medicines that might control some of the physical and mental symptoms include antidepressants, benzodiazepines, tricyclics, and beta-blockers.

Benzodiazepines

A doctor may prescribe these for certain people with anxiety, but they can be highly addictive. These drugs tend to have few side effects except for drowsiness and possible dependence. Diazepam, or Valium, is an example of a commonly prescribed benzodiazepine.

Antidepressants

These commonly help with anxiety, even though they also target depression. People often use serotonin reuptake inhibitors (SSRI), which have fewer side effects than older antidepressants but are likely to cause jitters, nausea, and sexual dysfunction when treatment begins.

Other antidepressants include fluoxetine, or Prozac, and citalopram, or Celexa.

This is a class of drugs older than SSRIs that provide benefits for most anxiety disorders other than OCD. These drugs might cause side effects, including dizziness, drowsiness, dry mouth, and weight gain. Imipramine and clomipramine are two examples of tricyclics.

Additional drugs a person might use to treat anxiety include:

Seek medical advice if the adverse effects of any prescribed medications become severe.


Mental Health in the Workplace

Mental health disorders are among the most burdensome health concerns in the United States. Nearly 1 in 5 US adults aged 18 or older (18.3% or 44.7 million people) reported any mental illness in 2016.2 In addition, 71% of adults reported at least one symptom of stress, such as a headache or feeling overwhelmed or anxious. 4

Many people with mental health disorders also need care for other physical health conditions, including heart disease, diabetes, respiratory illness, and disorders that affect muscles, bones, and joints. 5&ndash8 The costs for treating people with both mental health disorders and other physical conditions are 2 to 3 times higher than for those without co-occurring illnesses. 9 By combining medical and behavioral health care services, the United States could save $37.6 billion to $67.8 billion a year. 9

About 63% of Americans are part of the US labor force.10 The workplace can be a key location for activities designed to improve well-being among adults. Workplace wellness programs can identify those at risk and connect them to treatment and put in place supports to help people reduce and manage stress. By addressing mental health issues in the workplace, employers can reduce health care costs for their businesses and employees.

Mental Health Issues Affect Businesses and Their Employees

Poor mental health and stress can negatively affect employee:

  • Job performance and productivity.
  • Engagement with one&rsquos work.
  • Communication with coworkers.
  • Physical capability and daily functioning.

Mental illnesses such as depression are associated with higher rates of disability and unemployment.

  • Depression interferes with a person&rsquos ability to complete physical job tasks about 20% of the time and reduces cognitive performance about 35% of the time. 11
  • Only 57% of employees who report moderate depression and 40% of those who report severe depression receive treatment to control depression symptoms. 12

Even after taking other health risks&mdashlike smoking and obesity&mdashinto account, employees at high risk of depression had the highest health care costs during the 3 years after an initial health risk assessment. 13,14

Employers Can PROMOTE Awareness About the Importance of Mental Health and Stress Management

Workplace health promotion programs have proven to be successful, especially when they combine mental and physical health interventions.

The workplace is an optimal setting to create a culture of health because:

  • Communication structures are already in place.
  • Programs and policies come from one central team.
  • Social support networks are available.
  • Employers can offer incentives to reinforce healthy behaviors.
  • Employers can use data to track progress and measure the effects.

Action steps employers can take include:

  • Make mental health self-assessment tools available to all employees.
  • Offer free or subsidized clinical screenings for depression from a qualified mental health professional, followed by directed feedback and clinical referral when appropriate.
  • Offer health insurance with no or low out-of-pocket costs for depression medications and mental health counseling.
  • Provide free or subsidized lifestyle coaching, counseling, or self-management programs.
  • Distribute materials, such as brochures, fliers, and videos, to all employees about the signs and symptoms of poor mental health and opportunities for treatment.
  • Host seminars or workshops that address depression and stress management techniques, like mindfulness, breathing exercises, and meditation, to help employees reduce anxiety and stress and improve focus and motivation.
  • Create and maintain dedicated, quiet spaces for relaxation activities.
  • Provide managers with training to help them recognize the signs and symptoms of stress and depression in team members and encourage them to seek help from qualified mental health professionals.
  • Give employees opportunities to participate in decisions about issues that affect job stress.

Many Businesses PROVIDE Employees With Resources to Improve Mental Health and Stress Management

  • Monitors the effect of supervisors on worker well-being, especially when supervisors change.
  • Conducts ongoing, anonymous surveys to learn about attitudes toward managers, senior executives, and the company as a whole.
  • Normalizes discussion of mental health by having senior leadership share personal stories in video messages.

TiER1 Performance Solutions 16

  • Focuses on six key health issues: depression, anxiety, obsessive-compulsive disorder, schizophrenia, bipolar disorder, and addictions as part of its Start the Conversation about Mental Illness awareness campaign.
  • Provides resources to assess risk, find information, and get help or support using multiple formats to increase visibility and engagement. For example, information is provided as infographics, e-mails, weekly table tents with reflections and challenges, and videos (educational and storytelling).
  • Maintains the &ldquoInZone,&rdquo a dedicated quiet room that is not connected to a wireless internet signal, which gives employees a place to recharge.
  • Combines professional and personal growth opportunities through goal-setting, one-on-one coaching, development sessions, and biannual retreats.

Tripler Army Medical Center 18

  • Requires resiliency training to reduce burnout and increase skills in empathy and compassion for staff members who are in caregiver roles. Training sessions mix classroom-style lectures, role-playing, yoga, and improvisational comedy to touch on multiple learning styles.
  • Provides free wellness consultations by an on-site clinical psychologist. Employees do not have to take leave to access these services.
  • Holds lunchtime learning sessions to reduce stigma about mental health and the services available to employees.
  • Offers quarterly guided imagery relaxation sessions to teach stress management strategies.

  • Provides comprehensive and integrated physical, mental, and behavioral health insurance coverage, including round-the-clock access to employee assistance program (EAP) services.
  • Extends EAP access to anyone living in an employee&rsquos home, with dedicated programming for those who are caring for children or elderly parents.

Strategies for Managing Mental Health and Stress in the Workplace

Health care providers can:

  • Ask patients about any depression or anxiety and recommend screenings, treatment, and services as appropriate.
  • Include clinical psychologists, social workers, physical and occupational therapists, and other allied health professionals as part of core treatment teams to provide comprehensive, holistic care.

Public health researchers can:

  • Develop a &ldquohow-to&rdquo guide to help in the design, implementation, and evaluation of workplace health programs that address mental health and stress issues.
  • Create a mental health scorecard that employers can use to assess their workplace environment and identify areas for intervention.
  • Develop a recognition program that rewards employers who demonstrate evidence-based improvements in metrics of mental health and well-being and measurable business results.
  • Establish training programs in partnership with business schools to teach leaders how to build and sustain a mentally healthy workforce.

Community leaders and businesses can:

  • Promote mental health and stress management educational programs to working adults through public health departments, parks and recreational agencies, and community centers.
  • Support community programs that indirectly reduce risks, for example, by increasing access to affordable housing, opportunities for physical activity (like sidewalks and trails), tools to promote financial well-being, and safe and tobacco-free neighborhoods.
  • Create a system that employees, employers, and health care providers can use to find community-based programs (for example, at churches and community centers) that address mental health and stress management.

Federal and state governments can:

  • Provide tool kits and materials for organizations and employers delivering mental health and stress management education.
  • Provide courses, guidance, and decision-making tools to help people manage their mental health and well-being.
  • Collect data on workers&rsquo well-being and conduct prevention and biomedical research to guide ongoing public health innovations.
  • Promote strategies designed to reach people in underserved communities, such as the use of community health workers to help patients access mental health and substance abuse prevention services from local community groups (for example, churches and community centers).

Employees can:

  • Encourage employers to offer mental health and stress management education and programs that meet their needs and interests, if they are not already in place.
  • Participate in employer-sponsored programs and activities to learn skills and get the support they need to improve their mental health.
  • Serve as dedicated wellness champions and participate in trainings on topics such as financial planning and how to manage unacceptable behaviors and attitudes in the workplace as a way to help others, when appropriate.
  • Share personal experiences with others to help reduce stigma, when appropriate.
  • Be open-minded about the experiences and feelings of colleagues. Respond with empathy, offer peer support, and encourage others to seek help.
  • Adopt behaviors that promote stress management and mental health.
  • Eat healthy, well-balanced meals, exercise regularly, and get 7 to 8 hours of sleep a night.
  • Take part in activities that promote stress management and relaxation, such as yoga, meditation, mindfulness, or tai chi.
  • Build and nurture real-life, face-to-face social connections.
  • Take the time to reflect on positive experiences and express happiness and gratitude.
  • Set and work toward personal, wellness, and work-related goals and ask for help when it is needed.

Any mental illness is defined as having any mental, behavioral, or emotional disorder in the past year that met Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria (excluding developmental disorders and substance use disorders). Mental illness can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment.

Mindfulness is a psychological state of moment-to-moment awareness of your current state without feeling inward judgement about your situation. Mindfulness can be achieved through practices foster control and develop skills such as calmness and concentration.

Self-management is a collaborative, interactive, and ongoing process that involves educators and people with health problems. The educator provides program participants with the information, problem-solving skills, and tools they need to successfully manage their health problems, avoid complications, make informed decisions, and engage in healthy behaviors. These programs can be provided in person, over the phone, or online.


Schizophrenia is a brain disorder that is chronic and severe that has affected people throughout history. Schizophrenia distorts the way a person thinks, acts, perceives reality, expresses emotions and relates to others.

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition(DSM-III) listed BPD as a diagnosable illness for the first time.


Anxiety disorders

You are not alone other people have experienced what you are experiencing. Below you&rsquoll find some forums where you can learn from people with similar experiences.

What’s troubling you?

Overview

Feeling anxious and fearful is part of being human. These feelings help you be alert for and escape from threats, and help you make better decisions. If you have an anxiety disorder, you may feel anxious or fearful in situations where there are no threats.

Anxiety can cause you to experience a range of symptoms like shaking and trembling, sweating, nausea, and rapid heartbeat. You may also get pains in your stomach and tension in your neck and shoulders. It can cause sleep problems and make you irritable as well. If your anxiety builds, you may have a very real sense that something bad is going to happen to you. You may even feel like you are losing control and experience physical symptoms similar to a heart attack.

Anxiety and fear can be very intense feelings, and you may tend to avoid situations where you believe they may occur &ndash like social gatherings or particular places. This can lead you to limit your interactions with the wider world, and can greatly impact the way you live your life.

Learning relaxation techniques like controlled breathing can help you reduce the symptoms of anxiety when they first occur. Finding out more about anxiety and things you can do to control it is a positive step towards recovery. We have some resources below to help you get started.

Taking action for change

It’s important to maintain a healthy lifestyle

Learn controlled breathing

Keep a diary or use an app

Engage in activities that require focus

Psychological treatments can be effective

Helping someone with an anxiety disorder

A person with anxiety might tend to avoid particular places or situations and may withdraw socially for fear of an attack. This might make you feel frustrated and put additional strain on your relationship. Try not to take it personally when they refuse to do things they are afraid of, and consider relationship counselling to help develop mutual understandings.

Support them in getting out and about, and facilitate social interactions. It can also be useful to learn how to help someone through a panic attack. By showing patience, encouragement, and support, you can play a vital role in treatment.

It is important find out what you can about anxiety from the websites recommended below, and to look after yourself as well. Find out more about caring for someone with a mental health condition on the support for carers page.

Lived experience

Next steps

You might find online and phone-based mental health resources helpful. Some suggestions are below. You can find more with our Search tool.


How It Feels to Have Imposter Syndrome About a Mental Illness

"That seemed too easy," I thought to myself as I left my second appointment with a new psychiatrist. After years of suspecting that ADHD was the real reason I lived in a cloud of constant chaos, surrounded by literal and figurative mess, I finally decided to see a professional. When I got the diagnosis, my first feeling was validation. The second was doubt. Don&apost these symptoms kind of describe everyone? Did I exaggerate to get the answer I wanted? Was this just one of those doctors who diagnoses everyone who comes into his office?

I went back to work and spent the rest of the day clicking anxiously between my email and Twitter, wondering if maybe my generalized anxiety disorder (GAD) was just an affectation, too. Like a white lady Instagram influencer who has to apologize for a gaffe and immediately brings up "anxiety."

When I tell people I have an anxiety disorder and ADHD, I still often wonder if they believe me. While society as a whole has taken some important first steps toward destigmatizing mental health disorders, a greater willingness to speak openly about neurodivergence has also opened the door for critics who speculate that these disorders are over-diagnosed or that some people are self-diagnosing as a way to pathologize normal feelings of insecurity, angst, or lack of focus. And some have been accused of falsely claiming anxiety or some other mood or behavioral disorder as an identity or for attention, minimizing the reality of the condition felt by those who really have it. 

So when someone online or in your community complains about people "pretending" to have anxiety, when they have been having regular panic attacks since childhood, or are unable to leave their homes, or their hair is falling out, it can even make you doubt yourself — am I one of those pretenders?

In a word, it&aposs gatekeeping, which sometimes results in a game of one-upmanship to "prove" your right to claim your diagnosis. And if you fail — perhaps you&aposve been too successful in your career, you can&apost list enough physical manifestations of your anxiety, you&aposve never experienced suicidal ideation — if you&aposre made to feel like your neurodivergence has not been sufficiently devastating, you can feel invalidated, or even guilty.

When you&aposve been successful in your career, for example, you may question whether your ADHD diagnosis is legit, "because other people discount it or they don&apost see it," IngerShaye Colzie, MSW, LCSW, a coach and counselor focused on ADHD, says. "They don&apost know all the stuff you&aposre doing behind the scenes in your head, running around or working twice as hard."

She continues, "There&aposs so much misinformation about ADHD that most of the time people don&apost know what it is. And so even if they get diagnosed, sometimes you question it because you are able to do things some of the time." So one day you may be able to function perfectly and the next you can&apost get out of bed, which, Colzie says, can make you feel off-kilter. 

Without a trained, professional understanding of mood or mental health disorders — as in, one that follows the diagnostic model — criteria for these disorders can seem pretty nebulous and vague, and are therefore subject to a lot of self-doubt. So while you may feel all the symptoms of anxiety, and while these may be impacting your daily life, you can still second-guess your own assessment, or even a professional assessment, of how serious they really are. 

Don't these symptoms kind of describe everyone? Did I exaggerate to get the answer I wanted? Was this just one of those doctors who diagnoses everyone who comes into his office?

David Susman, PhD, clinical psychologist and advocate, names "limited awareness" as one reason people do not seek treatment at all. "A person may acknowledge some mental health concerns, but can lack full awareness of their significance," or fail to "understand they have an actual illness," Susman writes on his mental health awareness website. "They may dismiss or minimize their issues and say &aposeveryone gets stressed out&apos or &aposmy problems aren&apost that bad&apos or &aposyou&aposre making more out of this than you need to.&apos" 

On the r/Anxiety subreddit board, for example, it&aposs not uncommon to see posters describe their symptoms of anxiety and ask the community for perspective on whether it&aposs worth it to seek help or if they&aposre just being "dramatic" or "faking."

One poster wrote, "Feel like I&aposve been living in denial of my anxiety/depression for years now, but at the same time I feel that I&aposm being dramatic and actually fine." Another asked, "I have searched up the symptoms for anxiety and I feel like I have it but then immediately think I don&apost. I really don&apost know if I do have it and I&aposm afraid that I&aposm just faking it." And another, "In the community I grew up [in], mental illness is looked at as a weakness. So every time I talk to my parents about the things I feel, they keep on saying I am just overreacting, that I don&apost have anxiety."  

As Colzie notes, popular misconceptions and invalidation often leads people to internalize the mental health condition as a character flaw, creating a lot of shame and anxiety — which certainly rings true for me. 

Adam Mandel, PhD, clinical psychologist at NYU Langone Health, notes that without an accurate diagnosis, caregivers of children with ADHD who are failing to meet their full potential are "left to write their own stories as to why the child appears so inconsistent. These stories are not always kind." He explains, "Children may begin to form what we psychologists describe as &aposmaladaptive core beliefs&aposꂫout themselves and the world.  For example, children may come to believe that they are lazy or unreliable … Without intervention, these core beliefs may persist into adulthood and contribute to the higher rates of anxiety and depressive disorders observed in adults who meet criteria for ADHD."

Growing up, the symptoms of my anxiety and ADHD were treated simply as personality quirks or family jokes ("Katie always does her homework, she just leaves it in the bottom of her locker somewhere," or "Well, of course you&aposre crying, Kate, you&aposve always been a bit weepy"). I grew up believing that I, fundamentally, was a lazy and often histrionic person. The idea that any of the mess in my life could be in any way not my fault was utterly foreign and, to be honest, felt like a cheat.

Chronic invalidation and stigma does not affect people equally across gender, racial, or class lines, of course. Research suggests that the adult Black community in the United States is 20% more likely to experience major mental health problems. At the same time, powerful cultural stigma about mental health means that people in these communities are likewise less likely to seek mental healthcare — in addition to other barriers to access to care including cost and racism within the healthcare system. 

But while disorders are likely underdiagnosed in Black and brown people, there are real concerns that as a whole, certain mental health disorders are being overdiagnosed, and that we are in a "diagnosis epidemic," a term coined by Allen Frances, MD, psychiatrist and professor at Duke University. Joel Paris, a professor of psychology at McGill University, argues in his book Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life&aposs Misfortunes, that the boundaries between what we&aposd call normal and what we&aposd call a pathology are becoming fuzzier, and doctors, erring on the side of caution, are actually overdiagnosing and overprescribing. 

Taking all of this together, it&aposs not irrational to wonder if a diagnosis of GAD, ADHD, major depression, or bipolar disorder — all named as examples of overdiagnosis — is just a reflection of your own privilege or a failure to take responsibility for your own faults, thus restarting the cycle of internalized shame and inadequacy that led you to seek treatment in the first place. Ironically, a hyperfixation on whether or not you&aposre anxious enough to have anxiety could, in itself, be a sign of anxiety. 

And this self-doubt is often reflected on social media, within friend groups, or in pop culture, sometimes with legitimate reason and sometimes less so. Take Cazzie David, daughter of Larry David, who described her severe anxiety in an interview with LA Times promoting her new book of essays — and her irritation with those who falsely claim the disorder. 

"I give people this anxiety test as a joke, because anxiety has become such a trend, and it deeply annoys me. I ask them if they had anxiety when Clinton or Obama was president. Have you taken a nap in the last two years? Do you like roller coasters? Do you like scary movies? There&aposs a difference between having stress and having an anxiety disorder, and that&aposs never feeling safe or comfortable or like the rug is gonna be pulled out from under you at any second."

Ironically, a hyperfixation on whether or not you're anxious enough to have anxiety could, in itself, be a sign of anxiety.

But while no professional recommends self-diagnosis in a clinical way, most individuals are very good at describing and assessing their own feelings, according to experts. Meaning that while you may not be able to correctly identify which specific disorder, syndrome, or condition you have, if your instinct is that something is not right in your brain and it is impacting your life, you&aposre probably correct.

For instance, while I fail Cazzie David&aposs test (I love naps, roller coasters, and scary movies), and though this passage does continue to haunt me, I also know that my own panic attacks and neuroses and physical symptoms are both real and disruptive to my life. 

"I don&apost have too many biological assessments when people come into my office," says Mandel. "I don&apost put them in an fMRI study. I don&apost put electrodes on their head. I ask them how they&aposre thinking and how they&aposre feeling, and we figure it out together. So, if someone feels like something&aposs wrong, they&aposre usually going to be the expert in it."

The process, Mandel explains, is collaborative. The patient describes what they&aposre feeling and experiencing, and if it feels necessary, together the provider and patient figure out a diagnosis and find a professional practitioner to speak to regularly.

Whether or not you feel your disorder rises to the level that certain of your peers or community would deem adequately disruptive, the most important point, experts agree, is that you are the authority on what does and does not impact your life.

I don&apost talk about my GAD and ADHD for clout, and if you accused me of trying to make them my whole personality, well, in a lot of ways they are. I could list all of my symptoms, describe my daily internal pandemonium, and show you a lifetime of destruction left in their wake. But that would be boring and I don&apost have anything to prove. I really don&apost care if you call it a disorder, a syndrome, a condition, or just a normal variation in the human experience. At the end of the day, a diagnosis is just a way to describe how my brain works — and how to help it work in the world.


Medical Students Are Facing Serious Mental Health Issues

There appears to be a lack of support for medical students with mental health problems.

An online survey of 1,122 medical students was carried out recently by the Student BMJ. Of these, 30% had experienced or received treatment for a mental health condition. Nearly 15% had considered committing suicide while at medical school.

Among these respondents, 80% thought the level of support available to them was either poor or only moderately adequate.

One student said, &ldquoAs a postgraduate student studying undergraduate medicine, I worry for my younger colleagues. I know many of them suffer with depression, self-esteem issues, and various other problems, and I am stunned by the amount who take prescription medication during exam time.&rdquo

A second respondent reported, &ldquoThe stigma with mental health issues especially comes into focus when exposed to consultants and tutors who refer to it as a weakness.&rdquo This respondent had also encountered several consultants who believed that depression &ldquoisn&rsquot a real illness,&rdquo so the responded asked, &ldquois it any wonder that students struggle to come forward?&rdquo

Matthew Billingsley, editor of the Student BMJ, believes the reasons for these high rates of mental health problems in medical students are complex. &ldquoStudents often have a relentless timetable of exams as well as having to balance the emotional strain of seeing sick patients and uphold high professional standards,&rdquo he writes. &ldquoThe demands of the course can cause an over competitive environment that can have a detrimental effect on the health of students.&rdquo

Twishaa Sheth, chair of the British Medical Association&rsquos student&rsquos welfare committee, adds, &ldquoThe number of students reporting mental illness or considering suicide is shocking. What is more concerning is the lack of independent support available for students.&rdquo

The results are in line with previous research carried out by Dr. Deborah Cohen of Cardiff University, UK, in which 15% of 557 respondents from two large UK medical schools had substantial levels of depression. In this study, 52% reported substantial levels of anxiety.

Chair of the Medical Schools Council, Professor Iain Cameron, stated, &ldquoMedical schools take the mental well-being of their students seriously. The Student BMJ survey highlights key issues and similar concerns have been raised previously. It is crucial that students who have concerns about their health are able to make this known so that they can be provided with the necessary advice and support.&rdquo

The American Medical Student Association is well aware of the growing concern of mental health in medical students. They state, &ldquoThe cycle of stress, anxiety, and depression takes root during medical school since students frequently lack time for enough sleep, healthy eating, regular exercise, and smaller support systems.&rdquo

The AMSA quote a study published by Academic Medicine in 2014 on distress among matriculating medical students. Results showed that medical students had similar or better mental health than the rest of the population before they began training.

&ldquoTherefore, the high rates of distress reported in medical students and residents support concerns that the training process and environment contribute to the deterioration of mental health in developing doctors,&rdquo the authors state. &ldquoInterventions targeting physicians, therefore, should take place early in training during the first year of medical school.&rdquo

In terms of the changes medical schools can make, the AMSA suggests they try to provide opportunities to discuss mental health issues on campus &ldquoby promoting candid discussions and opening up to classmates about our own struggles.&rdquo

Others have suggested changing medical school curricula to pass or fail grading, reducing the volume of material covered in classes, and lowering the number of classroom hours to reduce stress and anxiety over grades.

New programs for promoting student wellness have increased over the past few years, including activities that focus on community building among medical students or courses to teach coping methods and stress management. In addition, colleges can target specific issues that medical students face, such as the challenges of individual clerkships during the third year of medical school.

Dr. Scott Rodgers, the associate dean of student affairs at Vanderbilt University School of Medicine, comments, &ldquoYou don&rsquot want to lose your humanity by becoming a doctor. Students should participate in activities outside of medicine, maintain personal connections, and make their own physical health a priority.&rdquo


How Does Lighting Affect Mental Health In The Workplace

Poor lighting often gets overlooked in the workplace, as we talk about mental health and well-being, and the focus is firmly on creating happier and healthier workplaces. But bad lighting is associated with a range of ill-health effects, both physical and mental, such as eye strain, headaches, fatigue and also stress and anxiety in more high-pressured work environments. As we spend much of the day in artificial lighting, there is evidence that the lack of natural sunlight has an adverse effect on the body and the mind, and can result in conditions such as seasonal affective disorder (SAD).

As we navigate the darkest (and shortest days) of the year, 40% of office workers are struggling to work in poor lighting every day. This has a negative effect on their productivity and wellbeing - according to a new research report, looking at the impact of lighting in the workplace. This is a recent research report by the UK company Staples, where an online survey of 7,000 office workers was conducted in October 2018. The research sample consisted of a sample of desk-based office workers from ten European countries including: United Kingdom (2,000, with 302 in London), Germany (1,000), France (500), Netherlands (500), Sweden (500), Norway (500), Spain (500), Italy (500), Portugal (500) and Finland (500).

80% of office workers, said that having good lighting in their workspace is important to them, and two-in-five (40%) are having to deal with uncomfortable lighting every day. A third (32%) said better lighting would make them happier at work. However, when access to natural sunlight is so limited in the winter, many are feeling stressed and suffering from seasonal affective disorder (SAD), and often spend long hours at their desks which is sometimes their only access to light during the day. The results have also shown that 25% of the surveyed are frustrated at having to deal with poor lighting in their workplaces.

Often just 13-15 mins of exposure to natural light are enough to trigger the release of endorphins or "happy hormones". Dr. Joe Taravella, a supervisor of pediatric psychology at NYU Lagone Medical center said that SAD “ affects anywhere from 5% to 10% of the population:, which is a huge proportion of the population suffering from clinical levels of depression for up to a quarter of the year.

Another research c oncludes that there is a strong relationship between workplace daylight exposure and office workers' sleep, activity, and quality of life.

There are no statutory workplace lighting levels in the UK. Regulation 8 of the Workplace Health, Safety and Welfare (WHSW) simply requires that lighting at work is "suitable and sufficient" and that, where possible workplaces are lit by natural light. The emphasis on natural lighting and other related research reflects the consensus that daylight is the best form of light. But, in parts of the northern hemisphere, daylight by itself will not provide sufficient illuminance throughout a working area. This means that "sufficient and suitable" lighting usually needs a combination of natural and artificial lighting, and especially artificial lighting that can be personalized as per the activity, function and individual requirements, and those that can imitate natural daylight.

The research by Staples recommends providing SAD lamps to employees, and to have cold-tone lighting with high illuminance in the mornings for maximum productivity. In this research report, 68% of the surveyed workforce admitted that they would feel more valued by their employers if they considered their health and well-being and invested in suitable lighting.

Personalized lighting options can help create more inclusive work environments. One such way is the use of biodynamic lighting which can then adjust the lighting during the day for the tone and illuminance as per natural daylight levels outside, and also the individual requirements of the user. This way the employees feel more in control of their work environments, which has been shown to increase their levels of happiness and productivity in the workplace.

Some lighting designers have recommended an emphasis on cooler, daylight temperatures, for example by adding more blue to the mix. A trial by the University of Surrey's sleep research center suggests that certain wavelengths of blue light suppress the sleep hormone that regulates sleep/wake cycles. The trial compared alertness levels among staff working in the blue-enriched light with those on a control floor. It found that first thing in the morning and at lunchtime, alertness levels were the same on both floors. But another measure just before staff left for home found significantly higher alertness on the trial floor. Staff also reported improved sleep patterns, and although not scientifically validated, indicated that visual acuity was better with the blue light, and after four weeks, 92% of people on the floor said they preferred it over the old lighting.

There is sufficient evidence now to show that well-being in the workplace can be hugely improved by providing lighting that mimics natural daylight, by bringing more natural light in with large windows, by providing suitable levels of illumination for visual acuity, and by providing personalized lighting that can be adjusted as per the individual biodynamics as well as the task on hand.


How It Feels to Have Imposter Syndrome About a Mental Illness

"That seemed too easy," I thought to myself as I left my second appointment with a new psychiatrist. After years of suspecting that ADHD was the real reason I lived in a cloud of constant chaos, surrounded by literal and figurative mess, I finally decided to see a professional. When I got the diagnosis, my first feeling was validation. The second was doubt. Don&apost these symptoms kind of describe everyone? Did I exaggerate to get the answer I wanted? Was this just one of those doctors who diagnoses everyone who comes into his office?

I went back to work and spent the rest of the day clicking anxiously between my email and Twitter, wondering if maybe my generalized anxiety disorder (GAD) was just an affectation, too. Like a white lady Instagram influencer who has to apologize for a gaffe and immediately brings up "anxiety."

When I tell people I have an anxiety disorder and ADHD, I still often wonder if they believe me. While society as a whole has taken some important first steps toward destigmatizing mental health disorders, a greater willingness to speak openly about neurodivergence has also opened the door for critics who speculate that these disorders are over-diagnosed or that some people are self-diagnosing as a way to pathologize normal feelings of insecurity, angst, or lack of focus. And some have been accused of falsely claiming anxiety or some other mood or behavioral disorder as an identity or for attention, minimizing the reality of the condition felt by those who really have it. 

So when someone online or in your community complains about people "pretending" to have anxiety, when they have been having regular panic attacks since childhood, or are unable to leave their homes, or their hair is falling out, it can even make you doubt yourself — am I one of those pretenders?

In a word, it&aposs gatekeeping, which sometimes results in a game of one-upmanship to "prove" your right to claim your diagnosis. And if you fail — perhaps you&aposve been too successful in your career, you can&apost list enough physical manifestations of your anxiety, you&aposve never experienced suicidal ideation — if you&aposre made to feel like your neurodivergence has not been sufficiently devastating, you can feel invalidated, or even guilty.

When you&aposve been successful in your career, for example, you may question whether your ADHD diagnosis is legit, "because other people discount it or they don&apost see it," IngerShaye Colzie, MSW, LCSW, a coach and counselor focused on ADHD, says. "They don&apost know all the stuff you&aposre doing behind the scenes in your head, running around or working twice as hard."

She continues, "There&aposs so much misinformation about ADHD that most of the time people don&apost know what it is. And so even if they get diagnosed, sometimes you question it because you are able to do things some of the time." So one day you may be able to function perfectly and the next you can&apost get out of bed, which, Colzie says, can make you feel off-kilter. 

Without a trained, professional understanding of mood or mental health disorders — as in, one that follows the diagnostic model — criteria for these disorders can seem pretty nebulous and vague, and are therefore subject to a lot of self-doubt. So while you may feel all the symptoms of anxiety, and while these may be impacting your daily life, you can still second-guess your own assessment, or even a professional assessment, of how serious they really are. 

Don't these symptoms kind of describe everyone? Did I exaggerate to get the answer I wanted? Was this just one of those doctors who diagnoses everyone who comes into his office?

David Susman, PhD, clinical psychologist and advocate, names "limited awareness" as one reason people do not seek treatment at all. "A person may acknowledge some mental health concerns, but can lack full awareness of their significance," or fail to "understand they have an actual illness," Susman writes on his mental health awareness website. "They may dismiss or minimize their issues and say &aposeveryone gets stressed out&apos or &aposmy problems aren&apost that bad&apos or &aposyou&aposre making more out of this than you need to.&apos" 

On the r/Anxiety subreddit board, for example, it&aposs not uncommon to see posters describe their symptoms of anxiety and ask the community for perspective on whether it&aposs worth it to seek help or if they&aposre just being "dramatic" or "faking."

One poster wrote, "Feel like I&aposve been living in denial of my anxiety/depression for years now, but at the same time I feel that I&aposm being dramatic and actually fine." Another asked, "I have searched up the symptoms for anxiety and I feel like I have it but then immediately think I don&apost. I really don&apost know if I do have it and I&aposm afraid that I&aposm just faking it." And another, "In the community I grew up [in], mental illness is looked at as a weakness. So every time I talk to my parents about the things I feel, they keep on saying I am just overreacting, that I don&apost have anxiety."  

As Colzie notes, popular misconceptions and invalidation often leads people to internalize the mental health condition as a character flaw, creating a lot of shame and anxiety — which certainly rings true for me. 

Adam Mandel, PhD, clinical psychologist at NYU Langone Health, notes that without an accurate diagnosis, caregivers of children with ADHD who are failing to meet their full potential are "left to write their own stories as to why the child appears so inconsistent. These stories are not always kind." He explains, "Children may begin to form what we psychologists describe as &aposmaladaptive core beliefs&aposꂫout themselves and the world.  For example, children may come to believe that they are lazy or unreliable … Without intervention, these core beliefs may persist into adulthood and contribute to the higher rates of anxiety and depressive disorders observed in adults who meet criteria for ADHD."

Growing up, the symptoms of my anxiety and ADHD were treated simply as personality quirks or family jokes ("Katie always does her homework, she just leaves it in the bottom of her locker somewhere," or "Well, of course you&aposre crying, Kate, you&aposve always been a bit weepy"). I grew up believing that I, fundamentally, was a lazy and often histrionic person. The idea that any of the mess in my life could be in any way not my fault was utterly foreign and, to be honest, felt like a cheat.

Chronic invalidation and stigma does not affect people equally across gender, racial, or class lines, of course. Research suggests that the adult Black community in the United States is 20% more likely to experience major mental health problems. At the same time, powerful cultural stigma about mental health means that people in these communities are likewise less likely to seek mental healthcare — in addition to other barriers to access to care including cost and racism within the healthcare system. 

But while disorders are likely underdiagnosed in Black and brown people, there are real concerns that as a whole, certain mental health disorders are being overdiagnosed, and that we are in a "diagnosis epidemic," a term coined by Allen Frances, MD, psychiatrist and professor at Duke University. Joel Paris, a professor of psychology at McGill University, argues in his book Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life&aposs Misfortunes, that the boundaries between what we&aposd call normal and what we&aposd call a pathology are becoming fuzzier, and doctors, erring on the side of caution, are actually overdiagnosing and overprescribing. 

Taking all of this together, it&aposs not irrational to wonder if a diagnosis of GAD, ADHD, major depression, or bipolar disorder — all named as examples of overdiagnosis — is just a reflection of your own privilege or a failure to take responsibility for your own faults, thus restarting the cycle of internalized shame and inadequacy that led you to seek treatment in the first place. Ironically, a hyperfixation on whether or not you&aposre anxious enough to have anxiety could, in itself, be a sign of anxiety. 

And this self-doubt is often reflected on social media, within friend groups, or in pop culture, sometimes with legitimate reason and sometimes less so. Take Cazzie David, daughter of Larry David, who described her severe anxiety in an interview with LA Times promoting her new book of essays — and her irritation with those who falsely claim the disorder. 

"I give people this anxiety test as a joke, because anxiety has become such a trend, and it deeply annoys me. I ask them if they had anxiety when Clinton or Obama was president. Have you taken a nap in the last two years? Do you like roller coasters? Do you like scary movies? There&aposs a difference between having stress and having an anxiety disorder, and that&aposs never feeling safe or comfortable or like the rug is gonna be pulled out from under you at any second."

Ironically, a hyperfixation on whether or not you're anxious enough to have anxiety could, in itself, be a sign of anxiety.

But while no professional recommends self-diagnosis in a clinical way, most individuals are very good at describing and assessing their own feelings, according to experts. Meaning that while you may not be able to correctly identify which specific disorder, syndrome, or condition you have, if your instinct is that something is not right in your brain and it is impacting your life, you&aposre probably correct.

For instance, while I fail Cazzie David&aposs test (I love naps, roller coasters, and scary movies), and though this passage does continue to haunt me, I also know that my own panic attacks and neuroses and physical symptoms are both real and disruptive to my life. 

"I don&apost have too many biological assessments when people come into my office," says Mandel. "I don&apost put them in an fMRI study. I don&apost put electrodes on their head. I ask them how they&aposre thinking and how they&aposre feeling, and we figure it out together. So, if someone feels like something&aposs wrong, they&aposre usually going to be the expert in it."

The process, Mandel explains, is collaborative. The patient describes what they&aposre feeling and experiencing, and if it feels necessary, together the provider and patient figure out a diagnosis and find a professional practitioner to speak to regularly.

Whether or not you feel your disorder rises to the level that certain of your peers or community would deem adequately disruptive, the most important point, experts agree, is that you are the authority on what does and does not impact your life.

I don&apost talk about my GAD and ADHD for clout, and if you accused me of trying to make them my whole personality, well, in a lot of ways they are. I could list all of my symptoms, describe my daily internal pandemonium, and show you a lifetime of destruction left in their wake. But that would be boring and I don&apost have anything to prove. I really don&apost care if you call it a disorder, a syndrome, a condition, or just a normal variation in the human experience. At the end of the day, a diagnosis is just a way to describe how my brain works — and how to help it work in the world.


Schizophrenia is a brain disorder that is chronic and severe that has affected people throughout history. Schizophrenia distorts the way a person thinks, acts, perceives reality, expresses emotions and relates to others.

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition(DSM-III) listed BPD as a diagnosable illness for the first time.


Anxiety Disorders

Anxiety is a normal emotion. It’s your brain’s way of reacting to stress and alerting you of potential danger ahead.

Everyone feels anxious now and then. For example, you may worry when faced with a problem at work, before taking a test, or before making an important decision.

Occasional anxiety is OK. But anxiety disorders are different. They’re a group of mental illnesses that cause constant and overwhelming anxiety and fear. The excessive anxiety can make you avoid work, school, family get-togethers, and other social situations that might trigger or worsen your symptoms.

With treatment, many people with anxiety disorders can manage their feelings.


Mental Health in the Workplace

Mental health disorders are among the most burdensome health concerns in the United States. Nearly 1 in 5 US adults aged 18 or older (18.3% or 44.7 million people) reported any mental illness in 2016.2 In addition, 71% of adults reported at least one symptom of stress, such as a headache or feeling overwhelmed or anxious. 4

Many people with mental health disorders also need care for other physical health conditions, including heart disease, diabetes, respiratory illness, and disorders that affect muscles, bones, and joints. 5&ndash8 The costs for treating people with both mental health disorders and other physical conditions are 2 to 3 times higher than for those without co-occurring illnesses. 9 By combining medical and behavioral health care services, the United States could save $37.6 billion to $67.8 billion a year. 9

About 63% of Americans are part of the US labor force.10 The workplace can be a key location for activities designed to improve well-being among adults. Workplace wellness programs can identify those at risk and connect them to treatment and put in place supports to help people reduce and manage stress. By addressing mental health issues in the workplace, employers can reduce health care costs for their businesses and employees.

Mental Health Issues Affect Businesses and Their Employees

Poor mental health and stress can negatively affect employee:

  • Job performance and productivity.
  • Engagement with one&rsquos work.
  • Communication with coworkers.
  • Physical capability and daily functioning.

Mental illnesses such as depression are associated with higher rates of disability and unemployment.

  • Depression interferes with a person&rsquos ability to complete physical job tasks about 20% of the time and reduces cognitive performance about 35% of the time. 11
  • Only 57% of employees who report moderate depression and 40% of those who report severe depression receive treatment to control depression symptoms. 12

Even after taking other health risks&mdashlike smoking and obesity&mdashinto account, employees at high risk of depression had the highest health care costs during the 3 years after an initial health risk assessment. 13,14

Employers Can PROMOTE Awareness About the Importance of Mental Health and Stress Management

Workplace health promotion programs have proven to be successful, especially when they combine mental and physical health interventions.

The workplace is an optimal setting to create a culture of health because:

  • Communication structures are already in place.
  • Programs and policies come from one central team.
  • Social support networks are available.
  • Employers can offer incentives to reinforce healthy behaviors.
  • Employers can use data to track progress and measure the effects.

Action steps employers can take include:

  • Make mental health self-assessment tools available to all employees.
  • Offer free or subsidized clinical screenings for depression from a qualified mental health professional, followed by directed feedback and clinical referral when appropriate.
  • Offer health insurance with no or low out-of-pocket costs for depression medications and mental health counseling.
  • Provide free or subsidized lifestyle coaching, counseling, or self-management programs.
  • Distribute materials, such as brochures, fliers, and videos, to all employees about the signs and symptoms of poor mental health and opportunities for treatment.
  • Host seminars or workshops that address depression and stress management techniques, like mindfulness, breathing exercises, and meditation, to help employees reduce anxiety and stress and improve focus and motivation.
  • Create and maintain dedicated, quiet spaces for relaxation activities.
  • Provide managers with training to help them recognize the signs and symptoms of stress and depression in team members and encourage them to seek help from qualified mental health professionals.
  • Give employees opportunities to participate in decisions about issues that affect job stress.

Many Businesses PROVIDE Employees With Resources to Improve Mental Health and Stress Management

  • Monitors the effect of supervisors on worker well-being, especially when supervisors change.
  • Conducts ongoing, anonymous surveys to learn about attitudes toward managers, senior executives, and the company as a whole.
  • Normalizes discussion of mental health by having senior leadership share personal stories in video messages.

TiER1 Performance Solutions 16

  • Focuses on six key health issues: depression, anxiety, obsessive-compulsive disorder, schizophrenia, bipolar disorder, and addictions as part of its Start the Conversation about Mental Illness awareness campaign.
  • Provides resources to assess risk, find information, and get help or support using multiple formats to increase visibility and engagement. For example, information is provided as infographics, e-mails, weekly table tents with reflections and challenges, and videos (educational and storytelling).
  • Maintains the &ldquoInZone,&rdquo a dedicated quiet room that is not connected to a wireless internet signal, which gives employees a place to recharge.
  • Combines professional and personal growth opportunities through goal-setting, one-on-one coaching, development sessions, and biannual retreats.

Tripler Army Medical Center 18

  • Requires resiliency training to reduce burnout and increase skills in empathy and compassion for staff members who are in caregiver roles. Training sessions mix classroom-style lectures, role-playing, yoga, and improvisational comedy to touch on multiple learning styles.
  • Provides free wellness consultations by an on-site clinical psychologist. Employees do not have to take leave to access these services.
  • Holds lunchtime learning sessions to reduce stigma about mental health and the services available to employees.
  • Offers quarterly guided imagery relaxation sessions to teach stress management strategies.

  • Provides comprehensive and integrated physical, mental, and behavioral health insurance coverage, including round-the-clock access to employee assistance program (EAP) services.
  • Extends EAP access to anyone living in an employee&rsquos home, with dedicated programming for those who are caring for children or elderly parents.

Strategies for Managing Mental Health and Stress in the Workplace

Health care providers can:

  • Ask patients about any depression or anxiety and recommend screenings, treatment, and services as appropriate.
  • Include clinical psychologists, social workers, physical and occupational therapists, and other allied health professionals as part of core treatment teams to provide comprehensive, holistic care.

Public health researchers can:

  • Develop a &ldquohow-to&rdquo guide to help in the design, implementation, and evaluation of workplace health programs that address mental health and stress issues.
  • Create a mental health scorecard that employers can use to assess their workplace environment and identify areas for intervention.
  • Develop a recognition program that rewards employers who demonstrate evidence-based improvements in metrics of mental health and well-being and measurable business results.
  • Establish training programs in partnership with business schools to teach leaders how to build and sustain a mentally healthy workforce.

Community leaders and businesses can:

  • Promote mental health and stress management educational programs to working adults through public health departments, parks and recreational agencies, and community centers.
  • Support community programs that indirectly reduce risks, for example, by increasing access to affordable housing, opportunities for physical activity (like sidewalks and trails), tools to promote financial well-being, and safe and tobacco-free neighborhoods.
  • Create a system that employees, employers, and health care providers can use to find community-based programs (for example, at churches and community centers) that address mental health and stress management.

Federal and state governments can:

  • Provide tool kits and materials for organizations and employers delivering mental health and stress management education.
  • Provide courses, guidance, and decision-making tools to help people manage their mental health and well-being.
  • Collect data on workers&rsquo well-being and conduct prevention and biomedical research to guide ongoing public health innovations.
  • Promote strategies designed to reach people in underserved communities, such as the use of community health workers to help patients access mental health and substance abuse prevention services from local community groups (for example, churches and community centers).

Employees can:

  • Encourage employers to offer mental health and stress management education and programs that meet their needs and interests, if they are not already in place.
  • Participate in employer-sponsored programs and activities to learn skills and get the support they need to improve their mental health.
  • Serve as dedicated wellness champions and participate in trainings on topics such as financial planning and how to manage unacceptable behaviors and attitudes in the workplace as a way to help others, when appropriate.
  • Share personal experiences with others to help reduce stigma, when appropriate.
  • Be open-minded about the experiences and feelings of colleagues. Respond with empathy, offer peer support, and encourage others to seek help.
  • Adopt behaviors that promote stress management and mental health.
  • Eat healthy, well-balanced meals, exercise regularly, and get 7 to 8 hours of sleep a night.
  • Take part in activities that promote stress management and relaxation, such as yoga, meditation, mindfulness, or tai chi.
  • Build and nurture real-life, face-to-face social connections.
  • Take the time to reflect on positive experiences and express happiness and gratitude.
  • Set and work toward personal, wellness, and work-related goals and ask for help when it is needed.

Any mental illness is defined as having any mental, behavioral, or emotional disorder in the past year that met Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria (excluding developmental disorders and substance use disorders). Mental illness can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment.

Mindfulness is a psychological state of moment-to-moment awareness of your current state without feeling inward judgement about your situation. Mindfulness can be achieved through practices foster control and develop skills such as calmness and concentration.

Self-management is a collaborative, interactive, and ongoing process that involves educators and people with health problems. The educator provides program participants with the information, problem-solving skills, and tools they need to successfully manage their health problems, avoid complications, make informed decisions, and engage in healthy behaviors. These programs can be provided in person, over the phone, or online.


Health changes and mood disturbances

Changes in your physical health at the time of menopause may also drive mood changes. For example, anxiety may be triggered by an overactive thyroid gland, which becomes more common with age. In addition, anxiety and depression may be triggered by a lack of sleep, which also becomes more common at the time of menopause, as hormone shifts cause nighttime hot flashes or other sleep disruptions that make it more difficult for women to get the rest they need.

So, what can you do to protect your mental health as you go through menopause?

Be aware that mood changes may accompany other menopausal symptoms.

Monitor your mood and make note of patterns in other factors such as sleep and stress levels. Seek professional help if symptoms become severe and interfere with daily life.

Make lifestyle changes such as increasing exercise, getting adequate sleep, and controlling stress to reduce potential symptoms.

Reach out to others. Don't struggle alone.

Know that it's temporary. Typically, the mood changes that accompany female hormonal changes during the menopausal transition won't last. "Data show that these hormone-related risks ease with increasing time after menopause," says Dr. Joffe. People who opt to treat their condition using antidepressants or other methods won't necessarily have to continue treatment forever, potentially just through this time period, she says. "I see a lot of women who are really fearful that they are descending into a dismal aging experience," says Dr. Joffe. This is not the case, and help is available.

Image: Victor_69/Getty Images


How Does Lighting Affect Mental Health In The Workplace

Poor lighting often gets overlooked in the workplace, as we talk about mental health and well-being, and the focus is firmly on creating happier and healthier workplaces. But bad lighting is associated with a range of ill-health effects, both physical and mental, such as eye strain, headaches, fatigue and also stress and anxiety in more high-pressured work environments. As we spend much of the day in artificial lighting, there is evidence that the lack of natural sunlight has an adverse effect on the body and the mind, and can result in conditions such as seasonal affective disorder (SAD).

As we navigate the darkest (and shortest days) of the year, 40% of office workers are struggling to work in poor lighting every day. This has a negative effect on their productivity and wellbeing - according to a new research report, looking at the impact of lighting in the workplace. This is a recent research report by the UK company Staples, where an online survey of 7,000 office workers was conducted in October 2018. The research sample consisted of a sample of desk-based office workers from ten European countries including: United Kingdom (2,000, with 302 in London), Germany (1,000), France (500), Netherlands (500), Sweden (500), Norway (500), Spain (500), Italy (500), Portugal (500) and Finland (500).

80% of office workers, said that having good lighting in their workspace is important to them, and two-in-five (40%) are having to deal with uncomfortable lighting every day. A third (32%) said better lighting would make them happier at work. However, when access to natural sunlight is so limited in the winter, many are feeling stressed and suffering from seasonal affective disorder (SAD), and often spend long hours at their desks which is sometimes their only access to light during the day. The results have also shown that 25% of the surveyed are frustrated at having to deal with poor lighting in their workplaces.

Often just 13-15 mins of exposure to natural light are enough to trigger the release of endorphins or "happy hormones". Dr. Joe Taravella, a supervisor of pediatric psychology at NYU Lagone Medical center said that SAD “ affects anywhere from 5% to 10% of the population:, which is a huge proportion of the population suffering from clinical levels of depression for up to a quarter of the year.

Another research c oncludes that there is a strong relationship between workplace daylight exposure and office workers' sleep, activity, and quality of life.

There are no statutory workplace lighting levels in the UK. Regulation 8 of the Workplace Health, Safety and Welfare (WHSW) simply requires that lighting at work is "suitable and sufficient" and that, where possible workplaces are lit by natural light. The emphasis on natural lighting and other related research reflects the consensus that daylight is the best form of light. But, in parts of the northern hemisphere, daylight by itself will not provide sufficient illuminance throughout a working area. This means that "sufficient and suitable" lighting usually needs a combination of natural and artificial lighting, and especially artificial lighting that can be personalized as per the activity, function and individual requirements, and those that can imitate natural daylight.

The research by Staples recommends providing SAD lamps to employees, and to have cold-tone lighting with high illuminance in the mornings for maximum productivity. In this research report, 68% of the surveyed workforce admitted that they would feel more valued by their employers if they considered their health and well-being and invested in suitable lighting.

Personalized lighting options can help create more inclusive work environments. One such way is the use of biodynamic lighting which can then adjust the lighting during the day for the tone and illuminance as per natural daylight levels outside, and also the individual requirements of the user. This way the employees feel more in control of their work environments, which has been shown to increase their levels of happiness and productivity in the workplace.

Some lighting designers have recommended an emphasis on cooler, daylight temperatures, for example by adding more blue to the mix. A trial by the University of Surrey's sleep research center suggests that certain wavelengths of blue light suppress the sleep hormone that regulates sleep/wake cycles. The trial compared alertness levels among staff working in the blue-enriched light with those on a control floor. It found that first thing in the morning and at lunchtime, alertness levels were the same on both floors. But another measure just before staff left for home found significantly higher alertness on the trial floor. Staff also reported improved sleep patterns, and although not scientifically validated, indicated that visual acuity was better with the blue light, and after four weeks, 92% of people on the floor said they preferred it over the old lighting.

There is sufficient evidence now to show that well-being in the workplace can be hugely improved by providing lighting that mimics natural daylight, by bringing more natural light in with large windows, by providing suitable levels of illumination for visual acuity, and by providing personalized lighting that can be adjusted as per the individual biodynamics as well as the task on hand.


Anxiety disorders

You are not alone other people have experienced what you are experiencing. Below you&rsquoll find some forums where you can learn from people with similar experiences.

What’s troubling you?

Overview

Feeling anxious and fearful is part of being human. These feelings help you be alert for and escape from threats, and help you make better decisions. If you have an anxiety disorder, you may feel anxious or fearful in situations where there are no threats.

Anxiety can cause you to experience a range of symptoms like shaking and trembling, sweating, nausea, and rapid heartbeat. You may also get pains in your stomach and tension in your neck and shoulders. It can cause sleep problems and make you irritable as well. If your anxiety builds, you may have a very real sense that something bad is going to happen to you. You may even feel like you are losing control and experience physical symptoms similar to a heart attack.

Anxiety and fear can be very intense feelings, and you may tend to avoid situations where you believe they may occur &ndash like social gatherings or particular places. This can lead you to limit your interactions with the wider world, and can greatly impact the way you live your life.

Learning relaxation techniques like controlled breathing can help you reduce the symptoms of anxiety when they first occur. Finding out more about anxiety and things you can do to control it is a positive step towards recovery. We have some resources below to help you get started.

Taking action for change

It’s important to maintain a healthy lifestyle

Learn controlled breathing

Keep a diary or use an app

Engage in activities that require focus

Psychological treatments can be effective

Helping someone with an anxiety disorder

A person with anxiety might tend to avoid particular places or situations and may withdraw socially for fear of an attack. This might make you feel frustrated and put additional strain on your relationship. Try not to take it personally when they refuse to do things they are afraid of, and consider relationship counselling to help develop mutual understandings.

Support them in getting out and about, and facilitate social interactions. It can also be useful to learn how to help someone through a panic attack. By showing patience, encouragement, and support, you can play a vital role in treatment.

It is important find out what you can about anxiety from the websites recommended below, and to look after yourself as well. Find out more about caring for someone with a mental health condition on the support for carers page.

Lived experience

Next steps

You might find online and phone-based mental health resources helpful. Some suggestions are below. You can find more with our Search tool.


What to know about anxiety

Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it might become a medical disorder.

Anxiety disorders form a category of mental health diagnoses that lead to excessive nervousness, fear, apprehension, and worry

These disorders alter how a person processes emotions and behave, also causing physical symptoms. Mild anxiety might be vague and unsettling, while severe anxiety may seriously affect day-to-day living.

Anxiety disorders affect 40 million people in the United States. It is the most common group of mental illnesses in the country. However, only 36.9 percent of people with an anxiety disorder receive treatment.

Share on Pinterest Disproportionate reactions of tension and worry characterize anxiety.

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

Knowing the difference between normal feelings of anxiety and an anxiety disorder requiring medical attention can help a person identify and treat the condition.

In this article, we look at the differences between anxiety and anxiety disorder, the different types of anxiety, and the available treatment options.

When does anxiety need treatment?

While anxiety can cause distress, it is not always a medical condition.

When an individual faces potentially harmful or worrying triggers, feelings of anxiety are not only normal but necessary for survival.

Since the earliest days of humanity, the approach of predators and incoming danger sets off alarms in the body and allows evasive action. These alarms become noticeable in the form of a raised heartbeat, sweating, and increased sensitivity to surroundings.

The danger causes a rush of adrenalin, a hormone and chemical messenger in the brain, which in turn triggers these anxious reactions in a process called the “fight-or-flight’ response. This prepares humans to physically confront or flee any potential threats to safety.

For many people, running from larger animals and imminent danger is a less pressing concern than it would have been for early humans. Anxieties now revolve around work, money, family life, health, and other crucial issues that demand a person’s attention without necessarily requiring the ‘fight-or-flight’ reaction.

The nervous feeling before an important life event or during a difficult situation is a natural echo of the original ‘fight-or-flight’ reaction. It can still be essential to survival – anxiety about being hit by a car when crossing the street, for example, means that a person will instinctively look both ways to avoid danger.

Anxiety disorders

The duration or severity of an anxious feeling can sometimes be out of proportion to the original trigger, or stressor. Physical symptoms, such as increased blood pressure and nausea, may also develop. These responses move beyond anxiety into an anxiety disorder.

The APA describes a person with anxiety disorder as “having recurring intrusive thoughts or concerns.” Once anxiety reaches the stage of a disorder, it can interfere with daily function.

While a number of different diagnoses constitute anxiety disorders, the symptoms of generalized anxiety disorder (GAD) will often include the following:

  • restlessness, and a feeling of being “on-edge”
  • uncontrollable feelings of worry
  • increased irritability
  • concentration difficulties
  • sleep difficulties, such as problems in falling or staying asleep

While these symptoms might be normal to experience in daily life, people with GAD will experience them to persistent or extreme levels. GAD may present as vague, unsettling worry or a more severe anxiety that disrupts day-to-day living.

For information on the symptoms of other diagnoses under the umbrella of anxiety disorders, follow the links in the “Types” section below.

The Diagnostic and Statistical Manual of Mental Health Disorders: Fifth Edition (DSM-V) classifies anxiety disorders into several main types.

In previous editions of DSM, anxiety disorders included obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), as well as acute stress disorder. However, the manual now no longer groups these mental health difficulties under anxiety.

Anxiety disorders now include the following diagnoses.

Generalized anxiety disorder: This is a chronic disorder involving excessive, long-lasting anxiety and worries about nonspecific life events, objects, and situations. GAD is the most common anxiety disorder, and people with the disorder are not always able to identify the cause of their anxiety.

Panic disorder: Brief or sudden attacks of intense terror and apprehension characterize panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. Panic attacks tend to occur and escalate rapidly, peaking after 10 minutes. However, a panic attack might last for hours.

Panic disorders usually occur after frightening experiences or prolonged stress but may also occur without a trigger. An individual experiencing a panic attack may misinterpret it as a life-threatening illness, and may make drastic changes in behavior to avoid future attacks.

Click here to learn more about panic disorder and panic attacks.

Specific phobia: This is an irrational fear and avoidance of a particular object or situation. Phobias are not like other anxiety disorders, as they relate to a specific cause.

A person with a phobia might acknowledge a fear as illogical or extreme but remain unable to control feelings anxiety around the trigger. Triggers for a phobia range from situations and animals to everyday objects.

Click here to learn more about phobias and how they develop.

Agoraphobia: This is a fear and avoidance of places, events, or situations from which it may be difficult to escape or in which help would not be available if a person becomes trapped. People often misunderstand this condition as a phobia of open spaces and the outdoors, but it is not so simple. A person with agoraphobia may have a fear of leaving home or using elevators and public transport.

Click here to learn about agoraphobia, an often-misunderstood psychological disorder.

Selective mutism: This is a form of anxiety that some children experience, in which they are not able to speak in certain places or contexts, such as school, even though they may have excellent verbal communication skills around familiar people. It may be an extreme form of social phobia.

Social anxiety disorder, or social phobia: This is a fear of negative judgment from others in social situations or of public embarrassment. Social anxiety disorder includes a range of feelings, such as stage fright, a fear of intimacy, and anxiety around humiliation and rejection.

This disorder can cause people to avoid public situations and human contact to the point that everyday living is rendered extremely difficult.

Click here to learn all you need to know about social anxiety disorder.

Separation anxiety disorder: High levels of anxiety after separation from a person or place that provides feelings of security or safety characterize separation anxiety disorder. Separation might sometimes result in panic symptoms.

Learn all about separation anxiety by clicking here.

The causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present.

  • environmental stressors, such as difficulties at work, relationship problems, or family issues
  • genetics, as people who have family members with an anxiety disorder are more likely to experience one themselves
  • medical factors, such as the symptoms of a different disease, the effects of a medication, or the stress of an intensive surgery or prolonged recovery
  • brain chemistry, as psychologists define many anxiety disorders as misalignments of hormones and electrical signals in the brain
  • withdrawal from an illicit substance, the effects of which might intensify the impact of other possible causes

To learn more about the causes and diagnosis of anxiety disorders, click here.

Treatments will consist of a combination of psychotherapy, behavioral therapy, and medication.

Alcohol dependence, depression, or other conditions can sometimes have such a strong effect on mental well-being that treating an anxiety disorder must wait until any underlying conditions are brought under control.

Self-treatment

In some cases, a person can treat an anxiety disorder at home without clinical supervision. However, this may not be effective for severe or long-term anxiety disorders.

There are several exercises and actions to help a person cope with milder, more focused, or shorter-term anxiety disorders, including:

  • Stress management: Learning to manage stress can help limit potential triggers. Organize any upcoming pressures and deadlines, compile lists to make daunting tasks more manageable, and commit to taking time off from study or work.
  • Relaxation techniques: Simple activities can help soothe the mental and physical signs of anxiety. These techniques include meditation, deep breathing exercises, long baths, resting in the dark, and yoga.
  • Exercises to replace negative thoughts with positive ones: Make a list of the negative thoughts that might be cycling as a result of anxiety, and write down another list next to it containing positive, believable thoughts to replace them. Creating a mental image of successfully facing and conquering a specific fear can also provide benefits if anxiety symptoms relate to a specific cause, such as in a phobia.
  • Support network: Talk with familiar people who are supportive, such as a family member or friend. Support group services may also be available in the local area and online.
  • Exercise: Physical exertion can improve self-image and release chemicals in the brain that trigger positive feelings.

Counseling

A standard way of treating anxiety is psychological counseling. This can include cognitive-behavioral therapy (CBT), psychotherapy, or a combination of therapies.

This type of psychotherapy aims to recognize and change harmful thought patterns that form the foundation of anxious and troublesome feelings. In the process, practitioners of CBT hope to limit distorted thinking and change the way people react to objects or situations that trigger anxiety.

For example, a psychotherapist providing CBT for panic disorder will try to reinforce the fact that panic attacks are not really heart attacks. Exposure to fears and triggers can be a part of CBT. This encourages people to confront their fears and helps reduce sensitivity to their usual triggers of anxiety.

Medications

A person can support anxiety management with several types of medication.

Medicines that might control some of the physical and mental symptoms include antidepressants, benzodiazepines, tricyclics, and beta-blockers.

Benzodiazepines

A doctor may prescribe these for certain people with anxiety, but they can be highly addictive. These drugs tend to have few side effects except for drowsiness and possible dependence. Diazepam, or Valium, is an example of a commonly prescribed benzodiazepine.

Antidepressants

These commonly help with anxiety, even though they also target depression. People often use serotonin reuptake inhibitors (SSRI), which have fewer side effects than older antidepressants but are likely to cause jitters, nausea, and sexual dysfunction when treatment begins.

Other antidepressants include fluoxetine, or Prozac, and citalopram, or Celexa.

This is a class of drugs older than SSRIs that provide benefits for most anxiety disorders other than OCD. These drugs might cause side effects, including dizziness, drowsiness, dry mouth, and weight gain. Imipramine and clomipramine are two examples of tricyclics.

Additional drugs a person might use to treat anxiety include:

Seek medical advice if the adverse effects of any prescribed medications become severe.


Medical Students Are Facing Serious Mental Health Issues

There appears to be a lack of support for medical students with mental health problems.

An online survey of 1,122 medical students was carried out recently by the Student BMJ. Of these, 30% had experienced or received treatment for a mental health condition. Nearly 15% had considered committing suicide while at medical school.

Among these respondents, 80% thought the level of support available to them was either poor or only moderately adequate.

One student said, &ldquoAs a postgraduate student studying undergraduate medicine, I worry for my younger colleagues. I know many of them suffer with depression, self-esteem issues, and various other problems, and I am stunned by the amount who take prescription medication during exam time.&rdquo

A second respondent reported, &ldquoThe stigma with mental health issues especially comes into focus when exposed to consultants and tutors who refer to it as a weakness.&rdquo This respondent had also encountered several consultants who believed that depression &ldquoisn&rsquot a real illness,&rdquo so the responded asked, &ldquois it any wonder that students struggle to come forward?&rdquo

Matthew Billingsley, editor of the Student BMJ, believes the reasons for these high rates of mental health problems in medical students are complex. &ldquoStudents often have a relentless timetable of exams as well as having to balance the emotional strain of seeing sick patients and uphold high professional standards,&rdquo he writes. &ldquoThe demands of the course can cause an over competitive environment that can have a detrimental effect on the health of students.&rdquo

Twishaa Sheth, chair of the British Medical Association&rsquos student&rsquos welfare committee, adds, &ldquoThe number of students reporting mental illness or considering suicide is shocking. What is more concerning is the lack of independent support available for students.&rdquo

The results are in line with previous research carried out by Dr. Deborah Cohen of Cardiff University, UK, in which 15% of 557 respondents from two large UK medical schools had substantial levels of depression. In this study, 52% reported substantial levels of anxiety.

Chair of the Medical Schools Council, Professor Iain Cameron, stated, &ldquoMedical schools take the mental well-being of their students seriously. The Student BMJ survey highlights key issues and similar concerns have been raised previously. It is crucial that students who have concerns about their health are able to make this known so that they can be provided with the necessary advice and support.&rdquo

The American Medical Student Association is well aware of the growing concern of mental health in medical students. They state, &ldquoThe cycle of stress, anxiety, and depression takes root during medical school since students frequently lack time for enough sleep, healthy eating, regular exercise, and smaller support systems.&rdquo

The AMSA quote a study published by Academic Medicine in 2014 on distress among matriculating medical students. Results showed that medical students had similar or better mental health than the rest of the population before they began training.

&ldquoTherefore, the high rates of distress reported in medical students and residents support concerns that the training process and environment contribute to the deterioration of mental health in developing doctors,&rdquo the authors state. &ldquoInterventions targeting physicians, therefore, should take place early in training during the first year of medical school.&rdquo

In terms of the changes medical schools can make, the AMSA suggests they try to provide opportunities to discuss mental health issues on campus &ldquoby promoting candid discussions and opening up to classmates about our own struggles.&rdquo

Others have suggested changing medical school curricula to pass or fail grading, reducing the volume of material covered in classes, and lowering the number of classroom hours to reduce stress and anxiety over grades.

New programs for promoting student wellness have increased over the past few years, including activities that focus on community building among medical students or courses to teach coping methods and stress management. In addition, colleges can target specific issues that medical students face, such as the challenges of individual clerkships during the third year of medical school.

Dr. Scott Rodgers, the associate dean of student affairs at Vanderbilt University School of Medicine, comments, &ldquoYou don&rsquot want to lose your humanity by becoming a doctor. Students should participate in activities outside of medicine, maintain personal connections, and make their own physical health a priority.&rdquo