Depression is a chemical mood disorder that affects our Physiology. It impacts our ability to function properly at work, in education, family life and the environment. It damages lives and its tentacles are far reaching.

An abundance of evidence shows clearly that three main areas cause depression. This is not within our genes, but rather stems from biology, psychology and social factors. These social factors are contagious, as we interact with depressives, we pick up and incorporate the negative feelings of their energy. It can leave us with feelings of heaviness within ourselves.

From the study of epidemiology revealing factors indicate, according to the World Health Organisation (WHO), in 2004 depression was the 4th biggest cause of human suffering and disability after cancer, heart disease and traffic accidents. They predicted that by 2020 depression numbers would rise to becoming the second biggest factor of human suffering. By the end of 2013 it was declared the number one factor of suffering throughout the global demographic group and was showing no signs of decreasing whatsoever.

The largest group of suffering was found among the ages of 25- to 44-year-olds. Frighteningly, the fastest growing group is children due to social media mobile phones being the number one culprit.

How does depression leave people feeling?

Fatigue, tiredness and brain fog.

Feeling isolated.

Shame of not feeling able to cope.

Feelings of failure and inadequacy.

Reluctance to reach out for help and fearing you may be told to pull yourself together.

Chronic feelings of overriding negativity, leading to apathy and loss of positivity.

Rumination of whether you’ll to return to your normal self.

Fearing moments of uncontrollable overwhelming emotions, whilst being in company.

Concern of being unable of control of mood swings.

Frightening feelings of wondering if life is worth continuing with.

The way forward

Antidepressants will not cure depression but can kick start the way to recovery. There isn’t a best approach for depression as it is a very individual thing as each of us are uniquely different. Recovery, therefore, needs to be based on how we deal with our vulnerabilities and in the way we self-manage our depression. This determines the best way forward for us. Undeniably, self-care must be the order of the day for each and every one of us to maintain a comprehensive healthy life and lifestyle.

 With each of us waging war on negative thinking or trash can thinking as I call it, we aim to combat being a prisoner stuck in our own head of internal negative thoughts instead of living in the real world out of our own heads among others – with rational external thinking patterns.

Bipolar I Disorder

People with Bipolar I disorder have full-blown manic attacks and deep, paralyzing depressions. A World Health Organization survey found the prevalence rate of bipolar I disorder to be 0.6 percent. Bipolar I disorder usually starts in late adolescence or early adulthood, with the peak onset during the third decade of life.

Bipolar I is often a relapsing and remitting illness, meaning that its symptoms come and go. This feature of bipolar I—it is a feature of all mood disorders—makes it challenging to diagnose, challenging to treat, and fiendishly difficult to study.

Bipolar I: What to Expect

Many excellent clinical studies about Bi-polar disorder were done in the years before effective treatments were available. How many episodes of illness did patients have in the days before treatment was available? How long did their episodes last? What was the length of time between episodes?

In a 1942 study, researchers looked at the medical records of 66 patients with “manic-depressive psychosis.” A few patients had only one episode of illness in the study period. About one-third had 2 to 3 episodes, about one-third had 4 to 6 episodes, and about one-third had more than 7. A few had 20 or more episodes. Unfortunately, there is no way to know whether the individual will have another 2 or 3 episodes during his lifetime or more than 20.

Subsequent studies have shown that, if untreated, episodes of bipolar disorder often occur more frequently as patients age, and episodes seemed to be triggered more easily.

Many patients with bipolar I disorder have nearly complete remission of their symptoms between episodes. This illness pattern often predicts that an individual will have an excellent response to treatment with lithium.

Bipolar 2 Disorder

People with bipolar II disorder have fully developed depressive episodes and episodes of hypomania.  These patients never develop full-blown mania, although they often have mild mixed states.

The World Health Organization estimates that the lifetime prevalence of bipolar 2 disorder is 0.4 percent.

Initially, some researchers suspected that patients with a history of hypomania and depression but not mania were in the early stages of “manic depression.” But several observational studies in the 1970s and 80s showed that this was not the case. One of these, written by Dr. William Coryell and his colleagues, followed patients with recurrent depressions and hypomania for some years and found that fewer than 5 percent of them ever became manic. Bipolar II is not merely a prelude to “full-blown” manic-depressive illness; bipolar II patients are not in the early stages of bipolar I.

Bipolar 2: What to Expect

Bipolar 2 is sometimes erroneously referred to as a milder form of bipolar I. But although patients with bipolar II do not develop the most severe symptoms of full-blown mania, they tend to have symptoms more of the time. Long periods of depression are typical of bipolar II disorder and can be even more debilitating than the dramatic but shorter-lived episodes of bipolar I illness.

Persons with bipolar 2 are more likely to have a seasonal variation in their symptoms, meaning that they tend to get depressed in the fall and winter and feel better—or even develop hypomania—in the spring and summer. Whereas patients with bipolar I frequently have irritable manic symptoms, the hypomanic periods of bipolar II patients are characterized by an elated mood.

Concerning depressive symptoms, patients with bipolar II disorder more often suffer from psychomotor agitation, guilty feelings, and thoughts of suicide.  Bipolar 2 patients also have a higher incidence of phobias and eating disorders. Typically, hypomanic episodes taper off as the bipolar 2 patient ages. When they reach middle age, depression is usually the predominant mood.

Cyclothymic Disorder

People with cyclothymic disorder have frequent short periods of depressive symptoms and hypomania separated by only brief periods of normal mood. By definition, the patient does not have either fully developed major depressive episodes or fully developed manic episodes. These patients essentially cycle almost continuously between mild depression and mild elation.

Modern studies on community populations have come up with an estimate of between 0.4 and 2.4 percent.

Cyclothymia is now considered a subtype of bipolar disorder, a classification supported by family-history studies. Patients with cyclothymia often have relatives with bipolar disorder but rarely have relatives suffering from depression only. Treatment experiences seem to confirm this relationship: The mood swings of cyclothymic disorder often respond to many of the same treatment approaches as other bipolar disorders.

Cyclothymic Disorder: What to Expect

Individuals with cyclothymic disorder have frequent ups and downs of mood, with only comparatively few periods of “normal” mood.

Cyclothymic disorder tends to begin very early in life. A study of 894 young patients (aged 5 to 17 years) found that nearly three-quarters of the patients with cyclothymic disorder had first experienced symptoms before age ten.

“Soft” Bipolar Disorders

“Soft” bipolar disorders are mood disorders with some features of bipolar disorder, but that doesn’t fit the pattern of better-defined subtypes.

Unspecified Bipolar and Related Disorder

This diagnosis is similar to specified bipolar and related disorder. It’s used when a doctor doesn’t have enough information to make a specific diagnosis, such as in an emergency room.

How Common Is Bipolar Disorder?

Studies suggest there is a lifetime prevalence rate of about 0.6% for bipolar type I and 0.4% for bipolar type II. The overall prevalence for all types of bipolar disorders is 2.4%.

Misdiagnosis Is Common

Of all the mental health disorders, bipolar is perhaps one of the most commonly misdiagnosed. Sometimes it’s not clear which one of the types of bipolar disorder a person’s symptoms align with.

Bipolar disorders can also be difficult to diagnose because they share symptoms with so many other conditions. These mental health conditions often get mistaken for bipolar disorder:

• Attention-deficit hyperactivity disorder (ADHD): both disorders come with overlapping symptoms.  However, while ADHD is a chronic condition present since childhood, bipolar disorders are episodic. Additionally, bipolar disorders primarily affect mood, whereas ADHD impacts attention and behaviour.
• Borderline personality disorder (BPD): A main difference between these conditions is the length of the mood swings. Bipolar mood cycles are persistent and can last for weeks or months, whereas BPD mood swings may last a few hours or days and are generally reactive to interpersonal situation. 
• Clinical depression: While bipolar disorders can include symptoms of depression, major depressive disorder is unipolar, meaning there is no mania or “high.” Doctors may initially misdiagnose bipolar disorder as clinical depression because hypomanic or manic episodes have yet to emerge or have gone unnoticed.
• Schizoaffective disorder: Psychotic symptoms can be part of manic and depressive episodes in bipolar disorder. In schizoaffective disorder, psychotic symptoms are also present independent of a clear mood episode.

Being correctly diagnosed is an important step toward getting the right treatment. The most important thing you can do to increase your chances of receiving an accurate diagnosis is to tell a doctor about all the symptoms you’ve been experiencing.

Sign of Bipolar Disorder in Men

Causes and Risk Factors

The exact causes of different types of bipolar disorders are not entirely understood, but genetic factors are believed to play a significant role. Research suggests that certain risk factors can increase the likelihood that a person will develop bipolar disorder, including:

• Genetics
• Childhood trauma
• Perinatal infections
• Difficult life events
• Cannabis use
• Substance use disorders
• Other mental health conditions
• Traumatic brain injury (TBI)

Treatment for Different Types of Bipolar Disorder

Treatment for any bipolar disorder generally involves medications and some form of psychotherapy. The specific treatment your doctor recommends may vary depending on the type of bipolar disorder you are diagnosed with.

Medications

Medication is the key to stabilizing most bipolar disorders. However, the type of medication a doctor prescribes depends on your symptoms and their severity.

Psychotherapy

Depending on your situation, psychotherapy might also be necessary. In fact, research shows that psychotherapy combined with medication can be more beneficial than medication alone.

Psychotherapy can help you better understand and cope with your illness. It can also help you improve your ability to manage relationships with others.

For about a half-century, psychiatry divided mood disorders into cases of unipolar depression, an illness characterized by only depressive symptoms, and bipolar disorders, in which patients suffer depressive episodes but also manic, hypomanic, or mixed states.

“Soft” bipolar disorders seem to challenge this way of thinking; many of these patients have an illness dominated by depressive symptoms with only the slightest colourings of mania. Sometimes, a family history of bipolar disorder is the only hint. More frequently, they have brief periods of elevated mood that they don’t feel are particularly abnormal but that, when examined more closely, bear the hallmarks of hypomania: the decreased need for sleep, increased energy, uncharacteristic overconfidence, and loss of inhibitions. They can have periods of agitation and irritability that last only a few hours and possibly represent mild mixed states. Below psychiatrist Tracy Marks explains how the spectrum of diagnosis came about.

Bipolar is an organic illness, of mood dysregulation and neuro-chemical. It can also be genetic but this is not a given.

Bipolar Disorder is a complex condition characterized by distinct periods of abnormally elevated, expansive, or irritable moods, often alternating with depressive moods. Contrary to popular belief, there is more than one type of bipolar disorder. How these mood episodes present determines which type of bipolar disorder a person will be diagnosed with. A lot of medical and drug aspects need to be eliminated in order to diagnosis bi-polar, which can take several months.

People with bipolar disorder experience mood episodes that may include manic, hypomanic, and depressive periods. How these episodes present determines which type of bipolar disorder a person has. Bipolar I and 2 are the most common types. Bipolar I is characterized by manic episodes, and bipolar II is characterized by hypomanic and depressive episodes. Cyclothymic disorder is another type marked by alternating hypomanic and depressive symptoms.

No matter the type, the condition is often misdiagnosed for other conditions, including ADHD, borderline personality disorder (BPD), or depression. Treatments for bipolar disorder usually involve medications, therapy, and lifestyle modifications, but your doctor will make recommendations specific to the type you have.

What Exactly Are Mood Episodes?

People with bipolar disorder may experience periods of unusually intense emotion, changes in energy and activity levels, and uncharacteristic behaviours. These distinct periods are called mood episodes. During a mood episode, a person might feel extremely energetic or very depressed.

There are three main mood episodes that characterize bipolar disorders:

1. Manic: During a manic episode, you may feel extremely energized and happy, or sometimes even unusually angry or irritable. You feel like you have extra energy to burn. This period generally needs to last at least one week to be diagnosed.
2. Hypomanic: Less severe manic episodes are called hypomania. Hypomanic episodes only need to be present for four days for the diagnosis to be made.
3. Depressive: A major depressive episode is a period of at least two weeks during which you experience five or more depressive symptoms nearly every day and they impact your functioning.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) is a form of depression that manifests at specific times of the year, predominantly during the winter months when daylight hours are significantly reduced. This condition is primarily attributed to a decrease in sunlight exposure, which can disrupt the body’s internal clock, or circadian rhythm, leading to depressive symptoms.

One of the main causes of SAD is reduced sunlight exposure. During the shorter days of autumn and winter, the lack of sunlight can interfere with the body’s circadian rhythm, causing feelings of depression. Additionally, less sunlight can result in a drop in serotonin levels, a neurotransmitter that plays a crucial role in mood regulation. Lower serotonin levels are closely linked to depression. The seasonal change also affects melatonin levels, a hormone that regulates sleep and mood, further contributing to the symptoms of SAD. Moreover, reduced sunlight can lead to a deficiency in vitamin D, which is believed to influence serotonin activity.

The symptoms of SAD are varied and can significantly impact daily life. Individuals may experience a persistent low mood, a loss of interest in everyday activities, and increased irritability. Feelings of despair, guilt, and worthlessness are common, along with lethargy and excessive sleepiness during the day. Many people with SAD find themselves sleeping longer than usual and struggling to get up in the morning. There is also a tendency to crave carbohydrates, which can lead to weight gain.

Several risk factors can increase the likelihood of developing SAD. Geographic location plays a significant role; those living far from the equator, where daylight hours are shorter in winter, are more susceptible. A family history of SAD or other forms of depression can also increase risk. Women are more likely to be diagnosed with SAD than men, and younger adults are at a higher risk compared to older adults.

Treatment for SAD often involves light therapy, where exposure to bright light from a light therapy box can help alleviate symptoms. Medications, particularly antidepressants, can be effective, especially in severe cases. Psychotherapy, such as cognitive-behavioural therapy (CBT), is another valuable treatment option, helping individuals manage symptoms by altering negative thought patterns.

In addition to professional treatment, several self-care strategies can help manage SAD. Maximizing exposure to natural sunlight, exercising regularly to boost mood, maintaining a healthy diet, and managing stress through relaxation techniques like yoga or meditation are all beneficial practices.

If you suspect you might have SAD, it is important to consult a healthcare provider for a proper diagnosis and treatment plan.

Reactive Depression

This is a type of depression that most of us encounter at some points in our lives.  It generally occurs when we are overwhelmed and carrying too many burdens.  We begin to sink down low in our spirits and become very fatigued.

The trick here is to prioritise and tackle one problem at a time, a process of elimination if you like.  Below is a guide to help you which you can keep on the PC to help you tackle your issues when needed. 

Mental Housekeeping.

Belief’s, Blocks & Directions

A Multi-Therapeutic design, for Integrated Talking Therapies;  including Person Centred  Counselling, REBT (CBT), Psychoanalytical, EMDR, Hypnotherapy & Hypno-Analysis between the various stages of this technique, with little influence or transference from therapists.

Lifestyle Scale of Human Functioning

Frustration versus Satisfaction

Using percentages out of 100% advise how you would divide the below categories of your lifestyle

                                                                                % frustration                  %Satisfaction

Your level of self-care.

Your overall mood levels.

 Overall health.

Family & Relationships.

Work.

Social Networks/friendships.

Activities and Interests.

Finances.

Think about the why, what and who are the influences of your frustrations and the positives of your satisfactions

Situational Depression (Reactive Depression)

• Cause: Triggered by a specific external event or situation, such as a major life change, trauma, or significant stressor.
• Duration: Symptoms typically appear within three months of the triggering event and often improve as the individual adapts to the situation.
• Symptoms: Similar to those of major depression but directly linked to the stressful event. These can include sadness, hopelessness, fatigue, changes in sleep and appetite, and difficulty concentrating.
• Treatment: Often involves therapy, such as, psychotherapy combined with cognitive-behavioural therapy (CBT), and sometimes medication.

Clinical Depression (Major Depressive Disorder)

• Cause: Can develop without an obvious external cause. It may be influenced by genetic, biological, environmental, and psychological factors.
• Duration: Symptoms must be present for at least two weeks and can last for months or even years if untreated.
• Symptoms: More severe and persistent than situational depression. Symptoms include deep sadness, loss of interest in activities, significant weight changes, sleep disturbances, fatigue, feelings of worthlessness or guilt, difficulty concentrating, and recurrent thoughts of death or suicide.

What is obsessive compulsive disorder?

Whichever type of obsessive compulsive anxiety disorder you may have is based in unhealthy anxiety (fear) and can lead to depression..

Obsessive-Compulsive Disorder (OCD) is often considered a neurological disorder because it involves abnormalities in brain function and structure. Specifically, it affects areas of the brain related to serotonin regulation and certain neural pathways. However, it’s also classified as a mental health disorder due to its significant psychological and behavioural components, Obsessive Compulsive Personality Disorder (OCPD), personality disorder.

Obsessive-compulsive disorder (OCD) is a common anxiety disorder. It causes unreasonable thoughts, fears, or worries. A person with OCD tries to manage these thoughts through rituals.

Frequent disturbing thoughts or images are called obsessions. They are irrational and can cause great anxiety. Reasoning doesn’t help control the thoughts. Rituals or compulsions are actions that help stop or ease the obsessive thoughts.

60% of Those with OCD struggle with the negative intrusive overthinking, such as what if this or that happens etc. 40% indulge in constant repetitive movements and rituals. Some of these rituals can indeed be extremely bizarre and difficult for others to understand.

What causes OCD?

Experts aren’t sure of the exact cause of OCD. Genetics, brain abnormalities, and the environment are thought to play a role. It often starts in the teens or early adulthood. But it can also start in childhood. OCD affects men and women equally. It appears to run in families.

Other anxiety problems, depression, eating disorders, or substance use disorder may happen with OCD and OCPD.

What are the symptoms of OCD?

Obsessions are unfounded thoughts, fears, or worries. They happen often and cause great anxiety. Reasoning does not help control the obsessions. Common obsessions are:

• A strong fixation with dirt or germs
• Repeated doubts (for example, about having turned off the stove)
• A need to have things in a very specific order
• Thoughts about violence or hurting someone
• Spending long periods of time touching things or counting
• Fixation with order or symmetry
• Persistent thoughts of awful sexual acts
• Troubled by thoughts that are against personal religious beliefs

While you may know that the thoughts are unreasonable and not due to real-life problems, it’s not enough to make the unwanted thoughts go away.

Compulsions are repetitive, ritualized acts. They are meant to reduce anxiety caused by the obsession(s). Examples are:

• Repeated handwashing (often 100+ times a day)
• Checking and rechecking to make sure that a door is locked or that the oven is turned off for example
• Following rigid rules of order, such as, putting on clothes in the same order each day, or alphabetizing the spices, and getting upset if the order becomes disrupted

Compulsive acts can become excessive, disruptive, and time-consuming. They may interfere with daily life and relationships, leading to brain fog and fatigue.

People may avoid situations in which they might have to face their obsessions. Some try alcohol or drugs to calm themselves. Below is a video from psychiatrist Tracy Marks, who describes the difference between OCD and OCPD. It is quite possible for a person to have a combination of both.  This being the case of both, we would look for evidence of trauma in the background.

How are OCD and OCPD diagnosed?

Always see your healthcare provider for a diagnosis.

Treatment may include:

• Anti-anxiety or antidepressant medicines such as Venalflaxine are often used.
• Psychotherapy, Psychodynamic and Cognitive behavioural therapy can also help.
• With my clients I use a little trick called trash can thinking. This is where there are negative thought patterns getting in the way and based on absolutely no evidence.  Internally in your mind you can just say to yourself sending to trash can and not giving it anymore headspace. The healthier and more positive our thinking patterns are, the healthier the neurotransmitters in our brain and nervous systems, will become as they reproduced regularly. This useful little phrase does however require constant practising until it becomes automated thinking.

Persistent depressive disorder (dysthymia) is a form of depression. It may be less severe than major depression, but — as the name suggests — it lasts longer. Many people with this type of depression describe having been depressed as long as they can remember, or they feel they are going in and out of depression all the time.

The symptoms of persistent depressive disorder are similar to those of major depression. In this disorder, the long duration is the key to the diagnosis, not the intensity of symptoms. As with major depression, mood may be low (or irritable in children and adolescents). An individual with persistent depressive disorder may feel less pleasure and a lack of energy. He or she may feel relatively unmotivated and disengaged from life. Appetite and weight can increase or decrease. The person may sleep too much or have trouble sleeping. Indecisiveness, pessimism and poor self-image may also be present.

Symptoms can grow into a full-blown episode of major depression. People with persistent depressive disorder have a greater-than-average chance of developing major depression.

While major depression often occurs in episodes, persistent depressive disorder is defined as more constant, lasting for years. The disorder sometimes starts in childhood. As a result, a person with persistent depressive disorder tends to believe that depression is part of his or her character, and so self-defining that he or she may not even think to talk about this depression with doctors, family members or friends.

Persistent depressive disorder, like major depression, tends to run in families. It is more common in women than in men, but in men it may be underdiagnosed because men are less likely to talk to their doctors about their mood. Some people with persistent depressive disorder have experienced a major loss in childhood, such as the death of a parent. Others describe being under chronic stress. But it is often hard to know whether people with the disorder are under more stress than other people or if the disorder causes them to perceive more stress than others do.

Symptoms

The main symptom of persistent depressive disorder is a long-lasting low or sad mood. Children and adolescents with persistent depressive disorder may be irritable. Other symptoms include:

• increased or decreased appetite or weight
• lack of sleep or sleeping too much
• fatigue or low energy
• low self-esteem
• difficulty concentrating
• indecisiveness
• hopelessness or pessimism.

Causes

Persistent depressive disorder appears to have its roots in a combination of genetic, biochemical, environmental, and psychological factors. In addition, chronic stress and trauma can provoke PDD.

Stress is believed to impair one’s ability to regulate mood and prevent mild sadness from deepening and persisting. Social circumstances, particularly isolation and the unavailability of social support, also contribute to the development of PDD. This cause can be especially debilitating given that depression often alienates those who are in a position to provide support, resulting in increased isolation and worsening symptoms. In addition, trauma, loss of a loved one, a difficult relationship, or any  stressful  situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger. In old age, PDD is more likely to be the result of medical illness, cognitive decline, bereavement and physical disability.

Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging, have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite, and behaviour appear to function abnormally. In addition, important neurotransmitters—chemicals that brain cells use to communicate—appear to be out of balance. But these images do not reveal why the depression has occurred.

Are dysthymia and cyclothymia similar?

Dysthymia, or persistent depressive disorder, is mild chronic depression. Cyclothymia is a mild case of bipolar disorder.  A person with cyclothymia might be mildly depressed at one moment, then mildly manic at another moment.

Treatment

Psychotherapy

Many people with persistent depressive disorder do not get the treatment they need; in many cases because they only see their family doctors, who often fail to diagnose the disorder. Part of the problem is that people suffering from PDD believe their symptoms are an inevitable part of life. In older people, dementia , apathy, or irritability can disguise PDD. Open-ended questions are helpful: “How has your mood been recently?”

There are several types of depression, each with distinct characteristics. Let’s explore them:

1. Reactive Depression:
   • Triggered by specific life events, such as divorce, loss, or financial difficulties.
2. Seasonal Affective Disorder (SAD):
   • SAD occurs during specific seasons, often in winter due to reduced sunlight exposure. Symptoms include fatigue, low energy, and changes in sleep patterns.
3. Major Depressive Disorder (MDD):
   • Also known as clinical depression, MDD is the most common type. It involves persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in daily activities. Symptoms can be severe and impact daily functioning.
4. Dysthymia (Persistent Depressive Disorder):
   • A chronic form of depression lasting for at least 2 years. It is characterized by milder symptoms but persistent low mood.
5. Cyclothymia:
   • Involves unstable moods, including periods of depression and elation. Not severe enough to be diagnosed as bipolar disorder.
   • Psychotic Depression:
     • Severe depression accompanied by psychotic symptoms such as hallucinations or delusions.
6. Prenatal or Antenatal Depression:
   • Occurs during pregnancy and can affect both expectant mothers and fathers.
7. Postpartum Depression:
   • Occurs after childbirth and affects both mothers and fathers. Symptoms include sadness, anxiety, and difficulty bonding with the baby.
8. Bipolar Disorder (Manic Depression):
   • People with bipolar disorder experience extreme mood swings. These include depressive episodes (similar to MDD) and manic or hypomanic episodes characterized by elevated mood, increased energy, and impulsive behavior.

Crossover Symptoms of Anxieties.

In part one we looked at the DMS-5 Guidelines for recognising the differences between Panic Anxiety Disorder and Panic Disorder. In Part Two, we look at people’s experiences from panic attacks of both types and question if there is a link to health anxiety disorder, based on patient experiences.

The Guideline Symptoms:

raised heart rate                                                  shortness of breath.

Feeling queasy                                                    stomach tightening

Throat restrictions                                              hands clammy.

Depersonalisation

The Symptoms according to people’s actual experiences of panic attacks:

Heart rate

It felt like a sledgehammer in my chest, and it felt loud. My chest felt like it was being crushed and I thought I was having a heart attack. I felt like my chest is caving in on itself from so much pressure.

Shortness of breath

 For no reason I felt myself struggling to breathe, my breathing was rapid and in explainable I do not recall having problems with breathing before, but this is weird and restricted.

 I found my stomach feeling queasy.

 I felt like it was rolling like a ship in stormy waters not at all like the usual butterflies when I am nervous.

My stomach

It felt very tight and hard, as if it were suddenly clenched and had become restricted, very painful.

Throat restrictions.

 I just could not speak my throat was all closed down, it was like my throat was not capable of an uttering a word and had completely left me.

Clammy / sweaty

 I felt clammy and sweaty all over but particularly my hands, my face, and my body.

 Depersonalization

 It all felt so surreal, one minute I was walking along and the next, I was having a panic attack and everything around me felt surreal. It was like I was not in reality anymore. I felt totally confused and out of it, like I had gone somewhere else entirely but not somewhere I know. I was so scared and I still am. Since my panic attack I am reluctant to leave the house, and this is the crux of the matter. If asked why? No explanation can be found.

The jigsaw pieces have not been found and this is where therapy can be helpful, joining the dots, so as to speak of a trigger, which relates to the past – let’s not forget the older part of the brain has no concept of time, but keeps a record of experiences and sometimes similar modern experience can trigger a past experience as if it were recent. It all stems from the past experience playing out in the present. The problem or block is that the old experience is not recognised and dealt with (processed).

The differences between a shared natural traumatic disastrous event and a personal traumatic event:

Let us just suppose, a natural traumatic event takes place when you least expect it too. Shock, heartache, misery, confusion and bewilderment are the likely feelings we experience. There is here however a difference, in the way that we process trauma. When it is a shared tragic experience amongst many people at the same time, a shared bonding develops to help the processing with multiple support. We are able to come back online to our nervous system and brain again because the processing of the trauma has been completed. This is where the difference lies, a collective bonding between a catastrophic event which effects so many people at the same time versus a singular incident or catastrophe/trauma in which the individual feels shut down and isolated. With no support, understanding or compassion from other people, the sufferer can be feeling a hidden despair and dysregulation of the nervous and brain systems (not fully online together). Carrying the trauma alone with not enough support or any at all.  Many times, I have seen the symptoms of panic disorder and anxiety, amalgamate into health anxiety disorder (HAD). Hence, it is always wise to look at what else in going on currently and from the past. Clients and patients are the first to then tell you as they have all the information.

DSM-5 Definition of panic attacks or panic anxiety disorder.

The DSM-5 Diagnostics, has simplified the approach to panic anxiety disorder into two very clear differences: expected panic attacks and unexpected panic attacks.

Expected panic attacks are associated with a specific fear like that of flying and any type of phobia which interferes with day-to-day life or planned activities. It’s quite common for expected panic attacks to be linked to phobias, which is one of the most common causes of expected panic attacks.

Panic anxiety disorder is the opposite and is a completely unexpected panic attack. This type of anxiety disorder where panic attacks can suddenly occur without warning and be followed by increased heart rate, shortness of breath, feeling queasy, stomach tightening, throat restriction, hands clammy. They occur suddenly without any warning catching you completely unawares and leaving you in a dreadful and terrified state, feeling quite shocked. Some people can also experience feeling detached from their reality (depersonalisation) or a feeling of internal numbness.

This type of panic attack is very often triggered unknown to us and at any time any place anywhere. What’s happening here is the information that the brain is receiving is being compared to any previous experiences similar. If there is a strong previous experience, then flight or fight kicks in instantly to aid human survival. These kinds of panic attacks are often linked to PTSD, which can involve ongoing repetitive trauma in the past but also a singular traumatic experience from the past as well. Let’s not forget the area of the brain that is triggered into panic/anxiety mode, is the area of the brain has absolutely no concept of what time is and when trigger experience suddenly occurs and creates a panic attack, it can be related to an incident that occurred in the past and yet, as if it was 5 minutes ago.

What other presenting issues can bring on panic attacks?

Certain drugs or substances alcohol combinations. Other underlying medical conditions and mental health disorders. The majority of people with underlying conditions would be aware of these and realise hopefully that panic attacks can be the result of these things.

If, however panic attacks are a complete mystery to you and causing you such misery because you can’t understand why they’re happening, then it’s a question of looking to environmental root causes and for the answers and the best treatment plans are found to be within talking psychologies, such as psychotherapy, hypnotherapy and EMDR. Talking therapies can help to bring about the missing jigsaw pieces which complete the picture that results in panic attacks. The results are good because it gives you a much clearer picture of the underlying causes and can help you to self-manage the condition of anxiety freeing up your life to reach whatever potential you choose.

Agoraphobia can start as a mild form of avoidance and if not treated can escalate into full blown agoraphobia.  It is an anxiety disorder in which a person is distressed by settings in which there is no easily perceived means of escape. An agoraphobic avoids certain social situations, large or open areas and public places where it would be difficult to hide. In some case’s agoraphobia debilitates someone to a point at which he or they cannot leave home. Any situation unfamiliar to the agoraphobic becomes a potential source of fear or anxiety arising from panic attacks, which some believe stems from traumatic early life experiences. Traumatic events can disrupt learning and memories, causing depersonalisation and other methods of blocking out anxiety.  Hypnotherapy combined with psychotherapy has been proven to produce long-acting beneficial results when the root cause is to be found in the yearly developing years.

How does Agoraphobia develop?

The causes of agoraphobia, like most mental disorders, are not definitive. Still, some experts have theorised that besides stressful and traumatic events, sudden shock, other anxiety disorders and substance abuse may also contribute. Along with agoraphobia, many patients have also been diagnosed with obsessive compulsive disorder (OCD), posttraumatic stress disorder and separation anxiety disorder. Women may suffer from this condition more than men because of social-cultural factors that encourage avoidant coping strategies. Other theories have posited that more women may seemingly suffer from the condition simply because more of them are willing to seek help.

Venture towards anybody undertaking some sort of activity or job at a desk with a computer and notice the telltale signs of health anxiety disorder (HAD).

For one thing you’ll notice everything on the desk is reasonably tidy and easy to find, there’s a distinct lack of coffee or tea stains from cups on the table and there may be a little bag of wipes for cleaning around the desk area nearby somewhere. If you look on the desktop you see Google is open on the NHS site or similar containing advice on a medical condition of sorts.

People living with health anxiety disorder very often do a body scan to check in with how they’re feeling, tracking in to make sure they’re OK physically and mentally. They’re looking for self-assurance that they are in control and by keeping on top of things all will be well. They just need to find the answers to their questions. Briefly people will health anxiety disorder just don’t feel safe; they need to protect themselves and are indeed in protective mode.

The exact cause of health anxiety is not yet known, but researchers believe that it may be due to a combination of factors. According to medical journals people who experience severe illness during childhood, have parents or siblings with a serious medical condition, or have other outside conditions such as general anxiety disorder and social anxiety are at risk of developing health anxiety.

Health anxiety can be due to a combination of factors including learned coping patterns, genetics, temperaments, personality traits, childhood and family history, chronic stress and traumatic events. People with health anxiety may also tend to misinterpret physical symptoms as a sign of serious illness, which can lead to further anxiety and worry. It’s worth noting that while HAD has been on the increase several years now it has increased even more post COVID-19.

Hypnotherapy is a gentle and relaxing therapy for the treatment of the differing anxiety groups. With the more pronounced types of anxiety, its effectiveness brings excellent results by helping patients into a nice dreamy relaxed altered state of mind or trance state as it was known for years. During hypnotherapy patients are able visit their fears in a variety of different scenarios feeling safe and relaxed in a gently exposed non-threatening way but sensitised manner. This helps them to realise that the fear can be rationally contained, and several solutions can be shown to counteract the fear.  Anchors can be embedded in hypnotherapy to allow the patients to use when their anxiety starts to take hold. Practicing an anchor can invoke clients with feelings of calmness and ease of mind, by using and practicing their anchor. A good follow on from hypnotherapy is the information retrieved and be explored in psychotherapy and exposure therapy. EMDR is also and successful therapy to reduce root causes of anxiety when used in conjunction with psychotherapy and hypnotherapy.

Exposure therapy is a type of behavioural therapy that helps people confront their fears and overcome anxiety. Graded exposure involves gradually exposing the patient to the source of their fear by going up the ladder one step at a time. Systematic desensitisation involves helping the patient relax and get comfortable with each step of the process. It’s important to note that exposure therapy is highly individualised and should only be done under the guidance of a healthcare professional.

Health anxiety disorder and obsessive-compulsive disorder (OCD) are two separate mental health conditions with a distinct symptom. Whilst there are some overlapping symptoms between the two disorders, they are defined as separate disorders. According to OCD-UK health anxiety is a condition that exists over preoccupation with having a serious illness or a fear of developing a serious illness. People with health anxiety may believe they already have an illness or are in imminent danger of developing one despite receiving reassurance from health professionals. People with health anxiety may continue to worry excessively about their health.

OCD, on the other hand, involves having repetitive upsetting intrusive thoughts (obsessions) I’m feeling the need to address those obsessions with rituals (compulsions), 40% of OCD sufferers use this as a coping mechanism. 60% of OCD sufferers on the other hand employ their obsession with Intrusive thinking.  It is mostly unlikely that the majority of people live with just one issue, as usually we have more than one which stems from a knock on effect, hence, it is possible for someone to be diagnosed with both OCD and mental anxiety however, they are defined as separate disorders with one significant difference worth noting. Those with OCD have better insight into their problems compared to those with health anxiety who honestly believe they have a serious illness.

Social anxiety disorder (SAD) has a different characteristic, hence its own label above. The difference with this type of anxiety is that we internalise our world and our place in it. When we internalise our anxiety, we view the cause of concern as being us ourselves, that we are in one way or another, different from other people. In other words, we have too much wrong with us to blend or fit in successfully. Hence, this is known as Social Anxiety Disorder. Our internal belief system about ourselves carries false/inaccurate information leaving us full of self-doubt messages about who and what we are.

The distinguishing threats of Social Anxiety Disorder (SAD) and its internal messages of self -criticism

People see me as stupid, not having much to say, not being educated as much as others. Quiet, boring, not a fun person.

Common issues felt by people living with this condition.

“I feel unable to say much in company and I’d rather listen to others. I feel dread if someone asks ne my opinion because I don’t know how to respond, my words get stuck in my throat and I feel embarrassed, I may even turn bright red in my face and neck. I just don’t have the confidence, that others have. I’d like to interview for a job because I know I would be really good at it but I feel I can’t because I just don’t have the confidence to come across in an interview properly and I’m afraid of going blank and not being able to speak, if asked questions and it’s the same when I meet people I’m attracted to, I just feel tongue tide and then I go bright red, I need to find an escape route quickly.  It takes me a while to get to know people before I feel comfortable in their presence but then I’m already worried that they think I’m a bit stupid before they get to know me.”

Social anxiety disorder is not to be confused with panic disorder. It is related to general anxiety disorder. It can sometimes also be known as social phobia. It stems from interaction with other people and the fear of being judged and criticised. For some young people they may have got involved with other childhood gangs of people and been teased consistently by other kids. Perhaps you had bright red hair awesome kind of affliction.  Vulnerable people who are the victims of some kind of abuse are also easy targets of ridicule by others. This anxiety has wide spreading ramifications and I’ve worked with a small hand full of clients, which have developed body dysmorphia, usually relating to how their face looks. This is where people will see their faces looking distorted. One thing is for sure social anxiety disorder needs to be taken a lot more seriously, with compassion and understanding.

Many an adult has come out with the unhelpful comment, regarding a sensitive or shy youngster by stating “don’t worry, they’ll grow out of it.” You have made the youngster feel that they are not normal!!!!

So, what can the root causes be, because that is where the answers to this awful type of anxiety often lies.

Imagine as a child growing up, you were always criticised or compared to other children who performed better than yourself in certain areas, this could be critical parenting, relatives, and teachers, after all the big grown-ups must be right when they make these judgments.

Now your Self- belief evaluation of yourself is being corrupted when having suffered childhood criticism on a regular basis. It could also stem from sibling rivalry, having a very clever sibling can be a very tough act to follow especially where expectations are put upon us. On speaking of expectations very often the adults IE: our parents’ grandparent’s teachers often have higher expectations of us that we can deliver and therefore perhaps we feel slightly failing or lacking in some ways or not up to scratch, not quite as good as others. This is a disorder that can develop during the first 25 to 30 years of someone’s life, however most sufferers develop this at a much younger age.

Recommended Therapies

Psychotherapies, humanistic therapies such as Person-Centred Counselling and Gestalt therapy. Hypnotherapy and hypno-analysis can very often help with uncovering suppressed root causes. EMDR is also an excellent therapy for producing longer term lasting results when teamed with other major therapies.

My final thoughts on this debilitating type of anxiety are that if we were to compare our instinct deep down, to the inner tribal elders or the inner committee, what would the names of the members be called?

Self-belief, trust, compassion, acceptance, choices and courage with the chairperson sitting on the fence of doubt -known as avoidance.

General Anxiety Disorder & The importance of GABA nutrition?

If a person suffers with an inflamed sympathetic symptom (over-active radar) for six months or more, it is diagnosed as General Anxiety Disorder (GAD). This is because healthy anxiety has become unhealthy and requires intervention treatment. Anxiety can be triggered by a difficult situation that has become out of hand. Different symptoms of general anxiety disorder (GAD) can be negative over-thinking, fears or concern of what can go further wrong in our lives from the environment around us and feelings of being unsafe and insecure. When we live with this type of anxiety, we are externalizing (it normally comes from the outside towards us), the potential threats or actual threat that we have encountered. General anxiety disorder is easily treatable with medical hypnosis, counselling, psychotherapy (if the cause is deep rooted) eye movement desensitisation reprogramming (EMDR).

What are GABA levels and how can they calm anxiety?

Gamma-aminobutyric acid (GABA) is a neeurotransmitter that helps the body to relax after stress. Low GABA activity can lead to anxiety, depression, insomnia, and mood disorders. Research shows that people with anxiety and depression are more likely to have low levels of GABA and it is the most common inhibitory neurotransmitter in the human central nervous system. It reduces the ability to receive, create or send chemical messages to other nerve cells. GABA, when at normal levels, produces a calming effect, with a significant role in controlling anxiety, stress, excessive fear, and depression. GABA supplements have shown a very small amount of beneficial promise in treating anxiety and depression. However, it’s important to note that only very minimal amounts of GABA can cross the blood-brain barrier to have any effect on the brain. Research shows that supplements are poor performers. Better success however, is through diet with certain foods can help elevate and improve levels GABA far more effectively. 

So, what does help to maintain GABA at healthy levels

1. Almonds, walnuts, and other nuts
2. Whole wheat, barley, rice, and other grains
3. Beans, peas, and soybeans
4. Potatoes and sweet potatoes
5. Cruciferous vegetables, such as broccoli, kale, spinach, and cauliflower
6. Tomatoes and green tomatoes
7. Mushrooms, especially shiitake
8. Fermented foods, such as yogurt, kefir, tempeh, and kimchi
9. Tea, especially oolong and white tea

Anxiety is a protective process. It allows us to experience protection from what is unsafe to our well-being, such as, intense heat or cold. In pitch darkness it warns us to not put one foot in front of the other as we can’t see where we’re going. It gives us a feeling of disorientation; its too risky. It stems from one of two areas, the mid brain area (limbic/sympathetic area and the nervous system – sympathetic area). It’s an early warning system which detects anything that may be of threat to our survival. This can range from something small to something extremely threatening.

The scale of the threat, however, can’t always distinguished by the Brain. It often depends on what we can see, hear, sense, or feel. Sometimes anxiety is triggered by something in the present that is perceived to be a threat from past experience, which is similar. This is due to the fact that the older more primitive area of the brain, does not have any concept of time and play out past memories of potential threat from the past as if it were happening right here and now.

The front of the brain (cortex) can be pictured like the top part of an iceberg. This is responsible for what you’re doing, planning, thinking about, choosing, contemplating. Your everyday thoughts and behaviours. What remains of the iceberg beneath the water’s surface are the different functions for your physical being and automated learnt actions. This includes patterns of behaviour which stem from earlier belief systems, within the older area of the brain.

The brain interprets a potential threat that requires further action. It is sent via the brain stem whose job it is to alert the physical body and prepare the body for defence or action, within the nervous system as depicted in the photo. This occurs via the inflamed sympathetic system / heightened arousal (flight/fight).

A further explanation of fight/flight is the relationship that occurs between the physical body and brain. A dynamic at an unconscious awareness level occurs, and this is known as Neuroception. In other words, we’re unaware that anything is happening until we feel the physical symptoms. Our bodies carry automatic radar (An inflamed Sympathetic system) alerting us with its anxious feelings.

What occurs in the body to alert it to any kind of threat?

When the brain stem becomes involved with a potential threat it alerts the body by triggering the hormone cortisol and boosting the secretion of the adrenaline glands. The impact of this causes a larger flow of blood to the arms and legs in preparation for what we know as fight or flight. This can occur in various stages and fluctuate (Co-regulation). The result of these changes can cause us to start to breathe from higher up in the stomach and limiting the amount of oxygen to the visceral area off the body – our torso. Our heart rate can increase, our throat and mouth feel dry and sometimes our hands and other areas of our bodies feel sweaty.

The term for this is an inflamed Sympathetic system. The good news is that we have a Para-sympathetic system to balance the body again, once the threat has diminished.