Personality Disorders

Does Upbringing Influence the Development of Narcissism?

Every loving parent wants what’s best for their child. Whether that’s sending them to prestigious schools or making sure that the neighborhood is safe and supportive, every parent just wants their child on the best path possible. However, there is a myriad of factors that go into raising a child and that is typically what makes parenthood appear so intimidating and daunting. For many parents, deciphering the amount of praise they should give their child can be challenging. They want their children to have a high self-esteem but don’t want them to become arrogant. They want their children to feel beautiful without boasting, be smart without being snarky and be kind without feeling entitled for something in return.

Therefore, balancing the accolades becomes quite difficult. In some cases, the more praise parents give the better, but this type of upbringing can sometimes have adverse effects on a child.

In instances where a parent overvalues their child, the child can establish narcissistic traits which could possibly develop into Narcissistic Personality Disorder (NPD). The Mayo Clinic defines Narcissistic Personality Disorder as “… a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others.” Narcissistic Personality Disorder is usually attributed to both genetic and environmental factors, with environmental factors heavily influencing the development of this disorder (Mayo Clinic, 2017). For example, environmental factors can include situations in which the child has a parent with NPD or some variation of the disorder.  

According to Dr. Elinor Greenberg, a renowned Gestalt therapy trainer with a specialization in NPD, there are 7 signs of a parent with NPD. These signs include: the need to be the center of attention, having low emotional empathy, devaluing others to get their way, maintaining selfish behavior, having an expectation for the child to be perfect, being moody and inappropriately intrusive (Greenberg, 2017)). The aforementioned list provides several scenarios that can foster an environment for a child to develop Narcissistic Personality Disorder. However, there are four common types of scenarios that enhance the likelihood of a child developing NPD. These situations typically arise in situations where the head of household has NPD.

The “Golden Child” scenario describes an environment where the parents, who have narcissistic traits, idolize their child excessively causing the child to only value themselves for being “perfect” (Greenberg, 2017). However, this scenario can cause the child to have stunted self-growth and an unhealthy fixation on their flaws (Greenberg, 2017). A study found that young adults with narcissism may be “predisposed to greater anxiety after failure, over-reliance on and false perceptions of social support, and experiences of guilt” which could result in lower self-esteem (Muratori et al., 2018). It is important to note the distinction between having a high self-esteem and narcissism. Self-esteem is the idea that you are worthy of who you are as a person while narcissism is the idea that other people are inferior to you and you are superior (Pogosyan, 2018).

The second scenario is the “Narcissistic Parental Values” scenario. This environment is described as very competitive and stressful because of external pressures. A common mentality would be the parent reprimanding the child mentioning that ”If you can’t be the best, why bother?” (Greenberg, 2017). This situation creates a highly competitive atmosphere that can cause stress and an obsession with being the absolute best (Greenberg, 2017). This type of environment doesn’t allow the child to feel adequately loved and can set in “motion a lifelong pattern of chasing success and confusing it with happiness” (Greenberg, 2017).

The “Devaluing Narcissistic Parent” is the third scenario. Quite self-explanatory, this scenario is characterized by a situation in which a parent devalues and belittles the child resulting in constant feelings of inadequacy, humiliation, and anger (Greenberg, 2017). To combat this, children may develop a “mask model”. The “mask model” is a defense mechanism whereby low self-esteem is masked by a grandiose and inflated sense of self to create an outer appearance of high, albeit fragile, self-esteem” (Derry et al., 2018). This scenario can also affect siblings where the parent may switch which sibling to praise and which to belittle, in a frequent and unpredictable manner (Greenberg, 2017).

The last scenario is the “Exhibitionists Nightmare”.  This scenario contains an exhibitionist parent that usually possesses the seven qualities discussed previously. This environment details where an exhibitionist, narcissistic parent teaches the child to serve and praise their parent while devaluing themselves (Greenberg, 2017). They are taught to not surpass their parent and as adults feel exposed and vulnerable (Greenberg, 2017). As said by Elinor Greenberg, “all their value in the family comes from acting as a support to the ego of the exhibitionist parent.”

It is important to remember that people living with Narcissistic Personality Disorder are in fact, people just living with a disorder. It’s important to not dehumanize individuals with Narcissistic Personality Disorder. More often than not, they were caught in the cycle of these 4 types of environments, where their childhoods may have related one or more of the four scenarios. Therefore, it is important to get help so that the cycle can stop and people can achieve their full potential and personal growth.


Derry, K. L., Bayliss, D. M., & Ohan, J. L. (2018). Measuring Grandiose and Vulnerable Narcissism in Children and Adolescents: The Narcissism Scale for Children. Assessment. Retrieved from

Greenberg, E. (2017). How Do Children Become Narcissists? (n.d.). Retrieved from

Greenberg, E. (13 July 2017). Is Your Mother an Exhibitionist Narcissist? Retrieved from

Mayo Clinic. Narcissistic personality disorder. (2017, November 18). Retrieved from

Muratori, P., Milone, A., Brovedani, P., Levantini, V., Melli, G., Pisano, S., . . . Masi, G. (2018). Narcissistic traits and self-esteem in children: Results from a community and a clinical sample of patients with oppositional defiant disorder. Journal of Affective Disorders,241, 275-281. doi:10.1016/j.jad.2018.08.043

Pogosyan, M. (2018). Self-Esteem and Narcissism in Children. (n.d.). Retrieved from

Obsessive Compulsive Disorder

OCD: More Than A Hand-Washing Disease

The running water. The soap and the suds. The porcelain sink and the metal faucet. They all greet you, as you wash your hands, whether that is after using the bathroom or before having a meal. It is ingrained into our minds to wash our hands, in order to prevent spreading germs, which may ultimately lead to an illness. It is nothing out of the ordinary. Now, add unrelenting fear and anxiety to the equation. These factors are not tangible like the aforementioned objects, however they do shift the situation in a certain direction. Those who make grand efforts to escape germs tend to have a fear of contamination, either with contaminating themselves or others. As a result of this fear, individuals with washing obsessive-compulsive disorder wash their hands so often that it goes beyond physical cleanliness.

This very common form of OCD involves obsessions, which are mental processes, as well as compulsions, which are physical processes. It is difficult to detect one’s obsessions unless it is communicated to another person or reflected through the compulsions of the individual. In this case of washing OCD, “obsessions have to do with becoming contaminated or in some way dirty from sources such as bodily fluids or chemicals” (Weg, 2011). This worry can result in ritualistic behavior that relieves the anxiety caused by the obsession. These behaviors can include avoiding someone or something, in addition to compulsive washing. However, this form of OCD can present itself in an alternative way.  For example, someone “may be perceived as contaminated, not because of the sweat, urine, or microbes that might be on that person, but because that person is just who they are” (Weg 2011). It is very reminiscent of mothers refusing to allow their children to have certain friends, fearing that their behavior will rub off on their own children, or in other words contaminate them. The idea holds true with OCD, although it is much more extreme, due to the fear that consumes the individual on a daily basis.

Furthermore, those with washing OCD can be categorized into two groups. The first is concerned with harm in addition to contamination, while the second only feels discomfort due to contamination (New England OCD Institute, 2018). The first group is worried about harming themselves and others, as a result of having illnesses and potentially spreading them. It is as though they feel a sense of responsibility for those around them. “Washing rituals are performed in an attempt to prevent this perceived danger” (New England OCD Institute, 2018). These washing rituals can extend beyond the hands and into the entire body with shower rituals and rituals involving brushing one’s teeth; it is not restricted to hands only. The second group however, “tend to have fewer identifiable obsessions and engage in cleaning compulsions merely to relieve the discomfort associated with feeling dirty” (New England OCD Institute, 2018). In both cases, their fear seems to be rooted in their lack of control and their compulsions create a momentary sense of control, although it is not effective most of the time.

Melanie, the participant of an online forum speaks on her experience with OCD. She said, “we decided to fly to London and Gran Canaria instead and it was pure horror for me. I couldn’t enjoy one second of our trip. I was constantly counting or crying and I feared everything and everyone” (Carafa, 2015). Melanie’s mental illness ruined this experience for her. The trip was supposed to be a vacation, however Melanie could not escape her fear and anxiety. After some time though, she found a psychologist that was able to help her reduce her compulsions. Washing OCD, as well as other forms of OCD, can easily be overlooked because their symptoms are not entirely physical. This statement holds true for most, if not all, mental illnesses. The idea behind this however, is invalid because the individual still suffers from these symptoms, regardless of whether others can see it or not. Therefore, it is imperative that awareness be raised in order to reduce stigmas and to ensure that individuals no longer suffer silently with these unseen illnesses.


Carafa, M. (n.d.). OCD and Emetophobia: Gaining My Life Back. Retrieved from

OCD Types. (2018). About OCD. Retrieved from

Weg, A. H. (2011, July 16 ). The Many Flavors of OCD. Retrieved from


Personality Disorders

An Overview of Avoidant Personality Disorder: The Unnoted Anxiety Disorder

Avoidant Personality Disorder (APD/AvPD) is a lesser-known anxiety disorder that is more commonly known for being related to Social Phobia. There are debates on whether it is a subgroup of Social Phobia or belongs in its own category. Avoidant Personality Disorder is “characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and a hypersensitivity to negative evaluation” (DSM-5).  Social Phobia is a condition of “a person with social anxiety disorder [who] feels symptoms of anxiety or fear in certain or all social situations. He or she may be afraid of being humiliated, judged, and rejected” (Social). Since their definitions are very similar, it is easy to see why those debates are happening. They both deal with being uncomfortable in social situations, feeling an intense fear of rejection, and desire interactions. Although people living with Social Phobia may want social interactions, they don’t yearn for it to the extent that people with Avoidant Personality Disorder do. However, as much as people with AvPD desire it, they also reject it. Since there is a lot of overlap between these two disorders and anxiety disorders in general, we will dive into what AvPD is.

There are many causes of Avoidant Personality Disorder, with a few studies attempting to pin causes down to heritability. There was a study done with female Norwegian twins to determine whether environment and heritability were factors in their Dependent Personality Disorder (DPD) and Avoidant Personality Disorder. The results for the experiment was that environmental effects weren’t as significant as heritability was. APD got .64 for the heritability results and DPD has .66(Gjerde et al., 2012).  These results suggest that there is the statistical significance of heritability being a cause of Avoidant Personality Disorder more so than environmental factors. Another potential cause of Avoidant Personality Disorder is a negative childhood and, more specifically, childhood neglect. There was a study on childhood neglect and the significance it had on Social Phobia and Avoidant Personality Disorder. The results were that childhood neglect affected “that the experiences of physical and emotional neglect in childhood are risk factors for adult AvPD and SP, most pronounced for AvPD though”(Turner et al., 1986).

The most successful and used treatment for Avoidant Personality Disorder is psychotherapy and, more specifically, cognitive therapy. Since APD is a result of engrained repeated behaviors and ways of thinking, it is a bit tricky to treat. The therapy that would be done, described by the Cleveland Clinic, as focuses on overcoming fears, changing thought processes and behaviors, and helping the person better cope with social situations. The Cleveland Clinic also advises that medication may help as well for the anxiety aspect, but the best treatment is a mix of both medication and psychotherapy.

Untreated AvPD can truly inhibit a person’s life and, in some cases, may even be fatal. By avoiding social interactions, it becomes very difficult to excel in relationships and work environments. Because of this, it also likely that a person with Avoidant Personality Disorder is not able to reach their full potential. In the case of violence and more specifically domestic abuse, a study found that 12% of domestic abuse survivors had comorbid AvPD. Even more alarming, the researchers also found that 35% of wife batterers scored above a statistical range for APD (Lynn et al., 2002).

It is important that people with Avoidant Personality Disorder receive help, as it is highly devitalizing to live with. It is also important to distinguish between Social Phobia and Avoidant Personality Disorder, as arduous as that may be. Avoidant Personality Disorder has different causes and can lead to a much more hindered life. This stems from an intense fear of rejection but yearning for interaction. By receiving treatment, someone living with AvPD might be able to reach their full potential and live the lives that they deserve.


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Lynn E. Alden, Judith M. Laposa, Charles T. Taylor, Andrew G. Ryder, (2002). Avoidant Personality Disorder: Current Status and Future Directions. Journal of Personality Disorders: Vol. 16, No. 1, pp. 1-29.

Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K., … Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457.

Avoidant Personality Disorder Management and Treatment | Cleveland Clinic. (n.d.). Retrieved October 1, 2018, from

Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology,95(4), 389-394. http://doi:10.1037//0021-843x.95.4.389

Anxiety and Anxiety Disorders

Through Her Mind: Generalized Anxiety Disorder

“But a caged bird stands on the grave of dreams

his shadow shouts on a nightmare scream

his wings are clipped and his feet are tied

so he opens his throat to sing.”

-Maya Angelou

It is difficult to grasp the true weight of experiencing an Anxiety Disorder. My roommate this semester has been diagnosed with Generalized Anxiety Disorder and Major Depressive Disorder. With her permission, I conducted an interview to understand what her experiences with anxiety have been like. Being so close to the source and helping her through this rough time, I have also made my own observations, and experiences which will be discussed below.

Question: Are there any questions that you find people ask you too often?

Response: I think the question I get the most often is “How are you?”. It is not a bad question but asking it over and over again does not change my response nor does it make me feel better. Other common questions are “Have you been better lately?”, “Is there anything I can do for you?”, “Are you feeling any better?”. I always appreciate the concern but the circumstances don’t change. It’s like being set on fire and someone asking the same question, the circumstance is horrendous, it hasn’t changed and the question doesn’t help to smother the flame.

Q: What coping mechanisms have you found most beneficial?

R: Checking the facts, distraction, exercising and holding ice cubes have helped. The three I mentioned first are Dialectical Behavioral Therapy skills. Checking the facts is a great skill because it allows me to realize how justifiable my emotions are in a situation. Distraction is great because when you are drowning in stress and misery this skill allows you to step away, gather yourself and then conquer it later. For me exercising and holding ice cubes are the blurred line between self-harm and coping. While they do distract me from my current situation, the physical pain from the workout or from the ice cube that slowly numbs my hand fuels me to keep going. As I reach my threshold for pain tolerance it helps me feel like I am in control of what happens and takes my mind off of the emotional and mental pain.

Q: Have your interactions changed since sharing your diagnosis with others? If so, how?

R: Everything changed. While I had a few trusted people that saw the signs of my illness and accepted it, they become more worried about me than I would have wished. I have begun to feel very alone and mute since I was “labeled”. Everyone is so eager to help me get better that they are literally throwing themselves at me. While there is a sense of support, I feel pressure because they all want to see results that I don’t think I am capable of giving them. Too much of a good thing is never good and sadly that applies to good intentions too. It is hard to explain to people who “check up” on me every day that I am not getting better and that even though I am in a crowd of caring voices I feel alone, mute, and lost.

Q: What does Anxiety feel like for you?

R: Anxiety is like having my phone constantly buzzing with reminders but not being able to turn it off because some part of me needs it. I may wish to decrease the amount of reminders or silence the volume. But, I can not distinguish which reminders are valuable and which ones are not.

Q: What does depression feel like for you?

R: It is more than the feeling the world is over because you failed a test. It is the constant assurance of being a failure and a burden to others just by existing.

Q: What advice would you give or have you given to your friends that are still in the hospital?

R: I would tell them that even though today is awful, you have to just get through it in hopes that tomorrow will be a better day even if you truly believe that it won’t be. We may not have chosen this mental illness, but it chose us. All we can do it try to take back control one day at a time…if that’s even possible.

My roommate has come a far distance but definitely has further to go. Each day is a battle of life falling apart quicker than she can pick up the pieces and before she realizes the pieces turn to dust unable to be mended back to its original form. Yet, she has to proceed with everyday activities while managing anxiety and battling depression. Many days turn out well, but each still feels as bad as the last.  Although she may not believe the next day will be better, she has the courage to proceed, refusing to allow these illnesses to control her. This journey of my roommate has been tough to witness and seems to encounter a new phase every week. Yet, I am constantly reminded of the analogy of being a caged bird. In the midst of all this darkness and difficulty she still sings hoping that this season will soon pass. Longing to be freed from the shackles of anxiety and depression, she shall not be defeated.


Sara Biljana Gaon. (2015 June 25). Caged Bird [image]. Retrieved from

Maya Angelou. (1969). I know why the caged bird sings [poem]. Retrieved from

Anxiety and Anxiety Disorders

The Unspoken: Anxiety and the Church

“The Bible says it, I believe it, that settles it” 

-Kenneth Hagin

“Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your request to God. And the peace of God which transcends all understanding will guard your hearts and your minds in Christ Jesus”

Philippians 4:6-7

Often times with good intentions, mature Christians may sometimes give this verse to individuals suffering with anxiety. But overcoming an issue can sometimes be more difficult than a simple phrase can solve. Usually, miscommunications can occur because the signs are not visually obvious. Similar to a headache, there may not always be external indicators to make anxiety appear as a problem. Therefore, because anxiety is not tangible we may not believe that it actually exists or we simply don’t know the best strategy to combat it. But, to the individual experiencing it, it is real and it is difficult to get through. In this case, though intentions are pure, simply quoting a bible verse may not always be the best way to approach the situation when someone confides in you with their mental health struggle.

Despite technological advances in the health field, the exact cause of anxiety is unknown. Anxiety disorders go beyond everyday stress and may sometimes involve feelings of excessive fear or worry that interfere with progress and functionality. With anxiety disorders, the body reacts as if danger is present when there is no actual threat. The body sounds all the alarms to the sympathetic nervous system to prepare for fight or flight, when in truth no harm is present. This overactivity of the bodily systems could result in fatigue or have other damaging effects. Many people with anxiety may have difficulty concentrating, trouble sleeping, experience irritability, or have racing thoughts. Though the struggle with this mental illness may seem endless, there is hope because anxiety disorders are highly treatable. Nevertheless, while approximately 44 million adults in the United States suffer from anxiety disorders, only one-third of those struggling actually seek and receive treatment. Professor and clinical psychologist Ryan Howes believes that many people do not seek out therapy or other forms of treatment because they feel ashamed or embarrassed. Society has placed a negative connotation on seeking help in general as it may be perceived as a sign of weakness, and even more so as it relates to mental illnesses. This concept could become especially damaging to individuals who feel as though they have to live up to a certain reputation to fit into their cultural, racial or religious group.

According to Focus On The Family, a Christian faith-based website, stigmas within the Christian community is a major factor why individuals may not seek help or even admit that they are suffering with an anxiety disorder. Some Christians may feel hopeless and begin to believe that this battle is a sign of spiritual failure. Yet there are many biblical figures that have faced their own battles with spiritual and mental health.

Mental illness is not always the result of a spiritual struggle. However, religious ideologies and criticism from fellow believers could negatively impact one’s mental health. Though there is limited research on the topic of religion and Christianity, a study performed by Kenneth Kendler and colleagues, revealed that different religious aspects could dictate someone’s relationship with a mental illness. Internalizing disorders include depression, generalized anxiety disorder, and panic disorder. On the other hand, externalizing disorders involved issue relating to substance abuse or dependence. According to Agorastos et al, negative religious perceptions could include beliefs that God has abandoned that individual or is punishing them, and worsen internalizing disorders such as anxiety. On the other hand, positive religious behavior including worship, fellowship, thankfulness, prayer and reading the bible was associated with better mental health, thereby reducing (not eradicating) both externalizing and internalizing disorders. This reveals, that even with a positive and devoted Christ following lifestyle, that individuals may still suffer from mental health issues.

Upon acknowledging that religious and spiritual resources do not make Christians absolutely immune to mental health issues, some may accept mental health as a serious issue worthy of taking note of. However, the response for ‘acceptable’ treatment could be burdensome. In her testimony, Christian singer, songwriter and inspirational speaker, Sheila Walsh, mentioned that she talked to a mother whose child was battling with mental health. She said, “My daughter has struggled for years with depression but she started to work with a church that doesn’t believe Christians should take medication. My daughter took her own life.” Though truly heartbreaking and painful to admit, more situations like this need to be brought to light. Everyone is different, and what works for one individual may not work so well for another. While there have been testimonies where through prayer and petition individuals have claimed receive instant healing from God, this may not always be the case. For example, Walsh mentions that medication has helped and she thanks God each day that He has made this resource available and possible for her.

Many are wary of using secular methods versus spiritual ones in the treatment of illnesses such as anxiety. However, psychologists are now beginning to understand the benefit of spirituality. For example, Kenneth Pargament an expert in the psychology of religion and spirituality mentions that psychologists are currently developing and evaluating spiritual integration into their treatment approaches (typically Cognitive Behavioral Therapy). Therefore, this once secular method of treating mental illnesses is now incorporating mantras from the Bible and utilizing other spiritual resources.

Nevertheless, regardless of the method of treatment whether it be medication or prayer for healing from anxiety, individuals should not be criticized for their choice. As aforementioned, many biblical figures have struggled with issues that did not arise from a lack of faith. For example, in the New Testament, Paul mentions that he had a “thorn in his flesh” (not a literal one). After pleading with God for its removal, God did not take it away but rather said, “My Grace is sufficient”. God lovingly denied this request so that in weakness, through Him believers could be made strong. Mental health is not an issue of faith. But, in the church, it may be an issue of perspective. We forget that many in the Bible have struggled and that God is not a magical fairy that grants our every wish.

The church may sometimes alienate and criticize fellow believers because of their battles. In doing so judgment takes root and makes people feel as though they have strayed away and that God is no longer willing to help them. However, that is not truly the case. The book of Romans mentions that nothing can separate anyone from God’s love. Through anxiety, depression or any other mental health battle, God’s love never ceases. Church can no longer be a place where individuals quietly suffer from their mental illness. We need to band together and permit these tough and awkward conversations. We need to listen, be respectful and offer a helping hand. We cannot solve issues if they remain to be hidden and unspoken.


Agorastos, A., Demiralay, C., & Huber, C. (2014). Influence of religious aspect and personal beliefs on psychological behavior: focus on anxiety disorders. PMC journals. 7, 93-101. doi: 10.2147/PRBM.S43666

American Psychiatric Association. (2017). What are anxiety disorders? Retrieved from 

American Psychological Association. (2013). What role do religion and spirituality play in mental health? Retrieved from 

Anxiety and Depression Association of America. (2016). Understanding the facts of anxiety disorders and depression is the first step. Retrieved from

Graber, D. (2014). Anxiety Disorders- Frequently Asked Questions. Retrieved from 

Kendler, K., Liu, X., Gardner, C., McCullough, M., Larsen, D., & Prescott, C. (2013). Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. The American Journal of Psychiatry. 160(3),  496-503.

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Tartakovksy, Margarita. (2013). What prevents people from seeking mental health treatment? Retrieved from

Anxiety and Anxiety Disorders

Foreseeing the Unforeseen: Anxiety and Romance

You were not expecting this. Your life has come to a standstill. Other people dismiss it as “teenage drama” and expect you to get over it. It’s frivolous and temporary, they think. It’s a transient phase in every teenagers’ life. Is that why you underestimate and dismiss your own feelings? You shove them away somewhere deep inside, plaster a smile on your face and hold your shoulders high, ready to face the world, as if it doesn’t affect you at all. But because of the termination of a romantic relationship in your life panic, fear and anxiety have set in. You’re not the same person anymore, but nobody can see it. The damage is not physical– there are no fractures or bruises, it is intangible.

Romantic relationships during adolescence are not uncommon. Dr. Wyndol Furman, an editor of the book ‘The Development of Romantic Relationships in Adolescence’ described adolescence as, ”a roiling emotional caldron whose major fuel — more than parents, peers or school and almost as much as those things combined”– is romance (Gallagher Nov 2001). While romantic relationships can provide companionship and joy, the termination of such a relationship, whether expected or unexpected, can cause emotional tribulations in the lives of the affected. Feelings of sadness and depression may be expected to occur in such a scenario, but feelings of panic or anxiety, especially when a person has never experienced it before, can be surprising and scary (Robboy).

An example of an who individual who expressed their surprise to the anxiety they experienced after their breakup on a relationship-anxiety forum, gives us insight into what it could feel like: “I also think I’ve been experiencing mini-anxiety attacks but I don’t really know. The only other time I’ve had an anxiety/panic attack was during a rough patch in my life. I don’t know how to control this especially since I’m a student who is fairly busy all day long” (upsided0wnn, 2017). Their words delineate confusion and doubt regarding the reality of her anxiety. Adolescents may experience this confusion because they are not informed about the symptoms and prevalence of different forms of anxiety disorders. Another crucial factor that may cause this confusion could be the assumption that symptoms are normal and what is expected after ending a romantic relationship. They may feel that being sad after a breakup is typical, but since anxiety after a breakup is less heard of or anticipated, they could be hindered from recognizing it.

Perhaps recognizing the cause of anxiety after a breakup could facilitate adolescents to anticipate it, and thus seek help or treatment. Sadness post-breakup can sometimes be an awaited emotion, and root cause of sadness may not impossible to decipher either. However, since the cause of anxiety may not be that easy to pinpoint, it could overwhelm them. Caroline Robboy, founder and executive director of a counseling organization in Philadelphia called Center for Growth Inc, explained why anxiety might be experienced after a breakup. She explained that since the discontinuation of a significant relationship engenders a major transition in a person’s life, they are bound to move into at least “some degree of unknown territory.” She further elaborated that anxiety is an “extremely normal feeling to have when facing the unknown.” This unknown territory could be in the form of not being able to rely on their partner for “social engagement, financial support or even life advice”, which was previously a major constant in our lives (Robboy). When such familiar feelings and habits are abruptly taken away from us, anxiety could set in.  

Adolescents may be in vulnerable phases– they are fascinated with experimenting and romance. Some fall in love with the idea of love and want to be swept away in a whirlwind of movie-like romance, while some fall prey to popular culture that focuses on just having a good time. Either way, mental health should always be given importance. It is easy, especially at this age, for emotions to feel blurry and overwhelming, but being aware of mental health issues that might arise in certain situations could help get intervention and prevention at early stages.


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Gallagher, W. (2001, November 12). Young Love: The Good, the Bad and the Educational. Retrieved October 24, 2017, from

Obsessive Compulsive Disorder

Game of Thoughts

We have all heard about Obsessive Compulsive Disorder (OCD) in one form or another. Even if we don’t know much about the symptoms or the common types of OCD, we have still used the term or heard someone use it before. In general, it is a psychological anxiety disorder which is characterized by repetitive, uncontrollable and unwanted thoughts followed by rituals performed by the person in order to alleviate the resulting anxiety.

Most of the OCDs discussed or depicted, are those that result in common physically visible actions/rituals (compulsions). Such compulsions are the ones related to washing your hands too many times or having things kept extremely tidy and in order. Hoarding is also another form of OCD, although less discussed, it has surfaced more often in the mainstream media and amongst the public. The types of OCD that usually emerge in movies and shows are those that result in compulsions. The OCDs with obsessions alone are rarely shown.

“I was obsessed with the number eight. I’d count eight times … I’d look on both sides of me eight times. I’d make sure nobody was following me down the street, I touched different parts of my bed before I went to sleep, I’d imagine a murder, and I’d imagine that same murder eight times.”

Lena Dunham, someone diagnosed with OCD, had directed and acted in the HBO series, “Girls” showcasing her condition. In her interview with the Rolling Stone, she stated the aforementioned to help place a mental picture of her suffering. These forms of OCD are usually referred to as rumination or intrusive thoughts. It is also referred to as “Pure-Obsessions” or “Pure-O”.

“I’ve had maybe ten obsessive thoughts since we arrived at the green. Would I push her pram into the traffic as we crossed from the car park? What if I hit her with a cricket bat, there all out propped on the porch. I open the broadsheet newspaper we bought to peruse and the story of a poisoned Russian spy escalates thoughts that I might have Münchhausen by Proxy and be on the verge of making my child sick with salt. The word ‘Poison’ is repeating in My head like my own mind is torturing me with the word and it kinda is.” 

To further illustrate this condition, the above mentioned is the thoughts of an anonymous woman, on the OCD UK platform, who has been dealing with postpartum OCD for several years. OCD can take on numerous forms and, excluding the ones currently diagnosed, many other forms exist as well. Within OCD, ruminations may take the form of ideas, mental images, or impulses. Ruminations by itself also have many of its own forms as well; ranging from intrusive thoughts about symmetry/orderliness, relationships, body-focused obsessions, sexual thoughts, magical thinking, religious to those that are related to avoidance, trigger, and violence.

Due to unfamiliarity and improper diagnosis, these impulses exhibited within an individual are not immediately recognized under OCD and they could easily be misdiagnosed for a completely different mental illness. One thing that’s a given with OCD is that it causes distress for the individual. Individuals struggling with OCD find their thoughts unnecessary and with that, we can try to distinguish OCD from Obsessive Compulsive Personality Disorder (OCPD) since those with OCPD don’t actually think that their behaviors and/actions are unnecessary. However, in comparison to the symptoms of other mental illnesses, it may not be as clearly distinguishable.

These seemingly never-ending thoughts consume a person’s time, energy, control, and disrupt their day-to-day activities. In essence, the person is forced to enter long battles multiple times during the day and face their worst fears that are manifested by their own mind.


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Anxiety and Anxiety Disorders

Ensuring the Best for Your Baby by Putting Yourself First

The nine months of pregnancy are romanticized as the happiest and most blissful period in a woman’s life. It marks the birth of another soul and the transformation of a woman into a mother: where she learns to put her baby before herself, always. These nine months are spent planning every detail of the baby. Knowing that as a parent, you have the power to create and shape another human can be scary and beautiful in equal parts.

Due to the high stakes involved in this nine-month period, pre-existing anxiety disorders are prone to exacerbation (Rubinchik, 2005). There are psychological and physiological changes happening in the mother-to-be’s life such as increased heart rate, increased blood flow and increased activity in the kidneys may be some (Brown). According to DSM-V, anxiety is defined as the “anticipation of future threat” or “cautious or avoidant behaviors to avoid future danger” During a stressful period such as pregnancy, new mothers can develop protective instincts and worry about providing for their child, thus stress and caution running high. In addition, there are 100 to 1000-fold hormonal variations occurring, which may also exacerbate such emotional difficulties (Rubinchik, 2005). This brings us to a pertinent question: How do mothers deal with anxiety disorders during pregnancy, which is supposedly the epitome of womanhood?

Everything the mother experiences, within herself and her surroundings, affects the fetus (Murphy, 2011) . Hence parents-to-be tend to be extremely careful of what they are exposed to, particularly medication. Everything the mother consumes is absorbed into her blood, and that blood goes into the fetus (Children’s Hospital of Philadelphia). Thus many clinicians admit that they prefer not to prescribe pregnant women medications during these prime nine months. Although there’s no definite information about the effect of anti-anxiety drugs on a fetus, women affected with anxiety do not have access to medication. There are very few studies on expecting women (What to Expect, 2015); Dr. Stephanie Ho, a reproductive psychiatrist, states that FDA’s warning on the SSRI paroxetine (Paxil) risk of increasing cardiovascular defects in a fetus was based on three unpublished studies. This insufficient amount of researched data has caused most women to discontinue their medication for the safety of their child, thus disrupting the blissful period that they are supposed to have during her pregnancy.

On ‘BabyCenter Community’ many women discuss whether taking anxiety medication would be safe for their babies. A user said: “When I was pregnant my doctor stopped my medication and I relapsed. My panic attacks, that had once been under control, were now worse than ever. I developed a new fear of leaving my house and began to feel like a prisoner in my own home. I couldn’t drive either. What bothered me the most though is that there were meds to treat this but my obstetrician thought it was best for me to stay away from them.” Another user said, “I started having panic attacks when I was 11 years old. I am 24 years old now and 19 weeks pregnant. I started suffering from panic attacks again probably after the first trimester. I have one almost every time I leave my house. I talked to my care provider about this and she suggested I stay at home and limit what I do. She said, “I know that doesn’t sound fun, but if it can keep you off meds then do it.” However, she did mention that she would prescribe me meds if my panic attacks did not get any better. I want to be able to do normal things without freaking out so I know I need to get on something. I went so many years without a panic attack and now that I’m pregnant it’s triggering them again. Good luck to you all! I wouldn’t wish panic attacks on anyone.”

Discontinuing medication or not having resources available during a pregnancy can be extremely emotionally taxing for the mother and those around her. Most of the mothers on this “Baby Center Community”  wish that they could continue taking their medication: pregnancy without panic attacks can be exhausting in itself. Constraints like not being able to step out of your house along with additional mental difficulties may leave the mother with unpleasant memories, and perhaps even less willing to bear another child. A mother’s physical health has always been given utmost importance during her pregnancy, such as yoga and nutrition. Adequate research has been done about the physical needs of mothers and the baby’s, however, not enough research has been done regarding medications that are safe to use while pregnant.

On 13 September 2017, Dr. Yonkers at Yale University released the results of a study about the true implications of benzodiazepines and serotonin reuptake inhibitors, which are common medications for Generalized Anxiety Disorder and panic disorder, on pregnant women and their babies. The study recruited women at 137 obstetric practices in Connecticut and Massachusetts before 17 weeks of pregnancy, reassessed them at 28 (±4) weeks of pregnancy, and at 8 (±4) weeks postpartum. The diagnoses of anxiety disorders were determined by the World Mental Health Composite International Diagnostic Interview and other information such as treatment with medications, substance use, previous adverse birth outcomes, and demographic factors were also assessed (Yonkers, 2017).

Dr. Yonkers’ study concluded that with maternal benzodiazepine treatment, 61 out of 1000 newborn babies required ventilatory support and the duration of gestation was shortened by only 3.6 days. On the other hand, mothers who used serotonin reuptake inhibitor to treat their anxiety disorder, gestation was shortened by 1.8 days and 152 of 1000 additional newborns required minor respiratory interventions. What this means is that although there was an increase in some adverse effects, the rates were very modest. It is up to the parents and doctors to decide if continuation of these medications is the best option for the pregnancy, but this study opened an avenue for pregnant women by empowering them with the knowledge of consequences and allowing them to make a more informed rather than cautionary decision.

Every expecting parent’s primary concern is to give their child the very best. To do so, it is vital for them to ensure their own well-being, both mental and physical. Based on Dr. Yonkers’ study, expecting females who struggle with anxiety disorders can consider staying on or starting anxiety medication such as serotonin reuptake inhibitor and benzodiazepines, after consulting their physician, because if they are mentally healthy and eased, their baby gets a healthier mother. Hence, mothers: by putting yourself first you’re actually putting your babies first.


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Rubinchik, S. M., Kablinger, A. S., & Gardner, J. S. (2005). Medications for Panic Disorder and Generalized Anxiety Disorder During Pregnancy. Primary Care Companion to The Journal of Clinical Psychiatry, 7(3), 100–105.

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Yonkers, K. A., Gilstad-Hayden, K., Forray, A., & Lipkind, H. S. (2017). Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.2733

Anxiety and Anxiety Disorders Bipolar Disorder

Bipolar Vs. Anxiety: The Unlikely Relatives

Imagine being on a euphoric mental high so powerful, it makes you dangerous to yourself and others. It makes quickly spending your life savings and engaging in risky sexual behaviors seem like a natural course of action for the intense euphoria you’re experiencing.  After this “high,” your mental state quickly takes a downturn. You crash, you hit the proverbial wall. It becomes hard to function, even though everything was so effortless just days before.  As one patient, comparing her mental state during highs and lows to a sprinting race, puts it,Life, everyone and everything in life, me included, are exquisitely and fabulously beautiful. But then the sprint and marathon race inside my brain finishes. My brain becomes completely exhausted — depleted of everything it had.” By definition, you are experiencing the manic and depressive episodes shared by all sufferers of this disorder, commonly known as bipolar.  

Now, imagine you are fearfully anticipating an upcoming event. Your anticipation is so pervasive it makes it hard to think about anything else or to focus on things that need to be accomplished for school or for work. In fact, it’s even affecting you physically, in the form of muscle tension and lightheadedness. “It feels like a constant heaviness in your mind; like something isn’t quite right, although oftentimes you don’t know exactly what that something is.” You would be experiencing generalized anxiety.  

Now put the two together, the manic highs and depressive lows, the heavy thoughts and the fearful anticipation. This combination of bipolar and anxiety disorders, something psychologists refer to as comorbidity, is in fact what many bipolar patients experience regularly.  According to a study performed on bipolar patients who were part of the National Epidemiologic Survey on Alcohol and Related Conditions, an estimated 60% of people diagnosed with bipolar have also suffered from an accompanying anxiety disorder. This is in contrast to the 2.9% of the population of American adults that suffer from anxiety disorders who may or may not have an accompanying mental illness. Although anxiety may be hard to distinguish from the highly aroused mental state that comes with bipolar manic highs, Dr. Naiomi M. Simon, Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Assistant Professor in psychiatry at Harvard Medical School, says that several key factors can help in making a diagnosis. The presence of anxious mood, general worry, panic attacks, or related anxiety symptoms, extended periods of sleeplessness when not in a manic state, and even the time frame during which anxiety symptoms develop, all aid in making a proper diagnosis for an accompanying anxiety disorder.

The fact that these two diseases are so closely tied together is problematic for several reasons. First, some studies show that individuals diagnosed with both disorders were twice as likely to be hospitalized during a depressive episode than those strictly diagnosed with bipolar. The study also correlated stronger bipolar symptoms, such as more manic and depressive episodes and a higher likelihood of suicidal behavior, with a co-occurrence of an anxiety-related diagnosis. Second, just as bipolar is tied to a higher likelihood of experiencing anxiety, the reverse is true as well; those experiencing symptoms solely related to an anxiety diagnosis are nine times more likely to develop bipolar disorder at some point in their lifetime.  Third, treatment for comorbid anxiety and bipolar may be more difficult, as some of the medications prescribed for anxiety may trigger manic episodes even when the patient is taking medicine to control the effects of their bipolar. In addition, antidepressants are sometimes addictive, which may be especially problematic for those more prone to substance abuse as a result of their bipolar.

Despite the potential complications in treatment, there is still hope for decreased symptoms for those struggling with both bipolar and anxiety. According to the Anxiety and Depression Association of America, therapy, in addition to taking prescribed medication, may play a crucial role in mitigating patients’ anxiety symptoms. Research is still being done to investigate the effectiveness of these techniques as they relate to anxiety and bipolar comorbidity.

Though bipolar and anxiety treatment together is still proving to be a challenge for healthcare providers, the combination of both disorders is certainly not uncommon or unique by any means. The comorbidity of these two disorders affects over half of the those diagnosed with bipolar, an important and startling statistic. According to this statistic, patients of both illnesses would actually be in the majority.  Dealing with this sort of mental illness is a complex battle, but with continued research and developments in this field of psychology, perhaps bipolar may one day feel a little less like an exhaustive marathon race and anxiety may feel a little less all-consuming. In the meantime, perhaps increased awareness for the complications of both these disorders can give those of us who do not have to suffer under the grip of manic and depressive episodes and generalized anxiety a better understanding of what sufferers of these disorders experience regularly, perhaps every day.


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Anxiety and Anxiety Disorders

Take A Breath

One of the 10 most influential therapists of the past quarter-century, John Gottman, states, “Empathy and understanding must precede advice.” Oftentimes, when people share their dilemmas, we try to give them quick-fixes and solutions when instead they are searching for compassion and empathy; we present them with solutions thinking we are helping them, when we may be giving them incorrect information. What seems like conventional wisdom could be scientifically incorrect, even when given with the best intentions. People look for understanding and caring, as Gottman suggests.

A generally underrated condition, ‘panic attack’ is a term that is thrown around loosely to describe a feeling of panic and distress a person experiences when something happens unexpectedly. We frequently hear people say, ‘If I forget to take my homework to class tomorrow I’ll have a panic attack,’ or, ‘If my favorite T-shirt shrinks I’ll have a panic attack.’ While these situations may be extremely distressing for some of us or even cause panic attacks, it eludes the true meaning of what a real panic attack may feel like.

Undervaluing panic attacks might prevent us from empathizing with people who actually suffer from them. A panic attack, as described by DSM-V, is an “abrupt surge of intense fear or intense discomfort,” accompanied by at least 4 of a given list of physical symptoms of which include accelerated heart rate, sweating, trembling, and sensations of shortness of breath. The Huffington Post attempted to bring to light some corporal aspects of panic attacks through descriptions of its  Facebook and Twitter communities:

“I can’t stand up, I can’t speak. All I feel is an intense amount of pain all over, like something is just squeezing me into this little ball. If it is really bad I can’t breathe, I start to hyperventilate and I throw up.”

“It feels like my throat is being choked. My arms start tingling because I’m breathing shallowly and not getting enough oxygen, which of course panics me more.”

When these panic attacks become recurrent and unexpected, a person may be suffering from a panic disorder.

People with panic disorders are usually tormented by the fear of these attacks repeating, which may wreck their peace of mind and inhibit them from certain activities (Mayo Clinic). Chores they take for granted may be interrupted by panic attacks, impeding their desire and capacity to carry them out. Sarah, a mother of three, described how panic disorder distressed and altered her life: “One day I was standing in a queue at the bank with a friend and suddenly everything went hazy. I can remember my friend shaking me and asking if I was okay. I felt like something was really wrong, I just needed to get home. My friend was crying with fear. That was my biggest mistake, as the only place I felt safe than was home and it became my prison for 5 years. I was forced by my family to seek medical help and my [general practitioner] made me feel I was overreacting. Asking for help every time I needed shopping was degrading. The worst day of my life came when my daughter fell and broke her wrist and she was terrified and crying and I had to watch her being taken to hospital by someone else as the panic had too big [a] hold on me.”

Panic attacks may affect people mentally, physically, or emotionally. Understanding, love, and care can make them feel like they have space to heal and someone to heal for. Sarah’s personal experience coincides with this:

“There is also nothing like the feeling of watching friends and family go on holiday and knowing I couldn’t take my children anywhere. My eldest son couldn’t bare to see me suffering and moved out at 16 to live with his girlfriend, but my other two children never once asked anything of me. We spent many hours having great times at home, playing games and watching movies. They were the reason I was determined to recover.”

It may not always be obvious when someone is experiencing a panic attack, but if they do share with you, you may be inclined to assist them in some way. It is crucial that legitimate guidance be given. About 6 million people suffer from panic disorder in America (ADAA), the majority of whom experience hyperventilation during their attacks. According to Mark Tyrrell, a therapist trainer for 15 years, 60% of panic attacks are accompanied by hyperventilation. Literally translating to ‘over-breathing’, they could be a cause or an effect of panic attacks. When it occurs, the person enduring it may feel like they are short of breath because there isn’t enough oxygen in the body. However, the contrary is true– hyperventilation is a symptom of too much oxygen in the body (Tyrell).

Panicking people are often told to “calm down” and “take deep breaths,” but for someone hyperventilating during a panic attack deep breathing is a bad idea. Symptoms like dizziness and numbness occur, making the person feel like they’re suffocating; thus “taking deep breathes” would further exacerbate the problem by increasing the oxygen in the body (Meuret). A new form of therapy called capnometry-assisted respiratory training (CART) therapy teaches patients to take shallow breaths and has been found efficient in assuaging panic symptoms. Thus, the fitting action in such a situation would be to take quick, shallow breaths to balance the carbon dioxide and oxygen contents in the body.

Panic disorder can be overwhelming and debilitating for the person who suffers from it. While adopting new breathing techniques and finding the right therapy style is essential, those with panic disorders need tenderness and support of family and friends in order to heal.


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