Dissociation

Dissociation is when our brain (and rest of our nervous system) feel overwhelmed and unable to deal with what’s going on in the moment and they pull us away. I have always talked about dissociation as our brain pulling the ripcord on reality because it’s just too much! When it comes to the DSM they call any dissociation DPDR or depersonalization/ derealization disorder.

Now depersonalization is when we feel out of our body like we are watching ourselves from above or in a haze and derealization is when we feel separated from our environment and it can feel like we are in a dream or like everything around us isn’t real. These experiences are really common, it’s estimated that half of all adults have had at least one episode of DPDR! 50%! That’s a lot of people, so know that you are not alone!

Anxiety: Can Diet Make a Difference

Anxiety symptoms can make you feel unwell. Coping with anxiety can be a challenge and often requires making lifestyle changes. There aren’t any diet changes that can cure anxiety, but watching what you eat may help.

Try these steps:

Eat a breakfast that includes some protein. Eating protein at breakfast can help you feel fuller longer and help keep your blood sugar steady so that you have more energy as you start your day.

Eat complex carbohydrates. Carbohydrates are thought to increase the amount of serotonin in your brain, which has a calming effect. Eat foods rich in complex carbohydrates, such as whole grains — for example, oatmeal, quinoa, whole-grain breads and whole-grain cereals. Steer clear of foods that contain simple carbohydrates, such as sugary foods and drinks.

Drink plenty of water. Even mild dehydration can affect your mood.

Limit or avoid alcohol. The immediate effect of alcohol may be calming. But as alcohol is processed by your body, it can make you edgy. Alcohol can also interfere with sleep.

• Limit or avoid caffeine. Avoid caffeinated beverages. They can make you feel jittery and nervous and can interfere with sleep.

Pay attention to food sensitivities. In some people, certain foods or food additives can cause unpleasant physical reactions. In certain people, these physical reactions may lead to shifts in mood, including irritability or anxiety.

Try to eat healthy, balanced meals. Healthy eating is important for overall physical and mental health. Eat lots of fresh fruits and vegetables, and don’t overeat. It may also help to eat fish high in omega-3 fatty acids, such as salmon, on a regular basis.

Changes to your diet may make some difference to your general mood or sense of well-being, but they’re not a substitute for treatment. Lifestyle changes, such as improving sleep habits, increasing social support, using stress-reduction techniques and getting regular exercise, also may help. Be patient, as it may take some time before these changes have an effect on your anxiety.

If your anxiety is severe or interferes with your day-to-day activities or enjoyment of life, you may need counseling (psychotherapy), medication or other treatment.

Sources: Mayo Clinic, Craig N. Sawchuk, Ph.D., L.P.

Managing Your Anxiety

Imagine a situation that makes you nervous. Maybe it’s getting on a plane or giving a presentation to colleagues.

Your pulse quickens. Your face flushes. Your breath speeds up and becomes uneven as adrenaline pumps through your veins.

For some, the fear and anxiety becomes strong enough that they avoid the situation. Avoidance, however, affects how you live by limiting how you engage life.

By practicing a few techniques, you can learn how fear affects your body and how you can control your stress response.

Listen to your body to change your emotions

Fear has a physical response — rapid heart rate, quicker breaths and other physiological responses. Stressful situations produce these physical responses, which your mind interprets as, “You are afraid.”

When you physically feel fear, take a moment to listen to your body and gain back control. Are you breathing quickly or hard? Take a few deep breaths and slow your breathing.

Controlling your physical response to fear can influence your emotional response.

Get past your own thoughts

Fear is largely caused by your thoughts. Your body gives you a fear stimulus and your mind takes off, giving you all kinds of irrational reasons you should be scared.

Of course the reasons aren’t always logical — you aren’t going to make a complete fool of yourself if you have to make a speech — but these irrational thoughts fill your mind and intensify your fear.

Don’t believe them!

Instead, identify those thoughts that are causing you fear. Challenge them. What evidence is there you’ll make a complete fool of yourself? None. You might not receive a standing ovation, but that is OK, your goal is to give a professional presentation where your audience can learn from you. Reappraise the situation and distance yourself from overly critical thoughts.

How you think about a circumstance impacts how you feel about it. Approaching your fear rationally, realistically and changing how you think will help you overcome its strong irrational stimuli.

Use your imagination to lessen your fears

As vividly as you can, imagine a situation that causes you fear. Feel your anxiety grow, but then add new information. Ask yourself, what are you worried about? What are the likeliest outcomes? Then imagine what you want to happen.

Adding new information and associations to your fears will help lessen their effects when you feel them in real life. This can be challenging to accomplish without professional guidance, so if needed, see a licensed mental health professional with expertise in anxiety management.

Sources: Mayo Clinic, NAMI, NIMH

Antisocial Personality Disorder: Symptoms

Antisocial personality disorder, sometimes called sociopathy, is a mental disorder in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others. People with antisocial personality disorder tend to antagonize, manipulate or treat others harshly or with callous indifference. They show no guilt or remorse for their behavior.

Individuals with antisocial personality disorder often violate the law, becoming criminals. They may lie, behave violently or impulsively, and have problems with drug and alcohol use. Because of these characteristics, people with this disorder typically can’t fulfill responsibilities related to family, work or school.

Symptoms

Antisocial personality disorder signs and symptoms may include:

• Disregard for right and wrong

• Persistent lying or deceit to exploit others

• Being callous, cynical and disrespectful of others

• Using charm or wit to manipulate others for personal gain or personal pleasure

• Arrogance, a sense of superiority and being extremely opinionated

• Recurring problems with the law, including criminal behavior

• Repeatedly violating the rights of others through intimidation and dishonesty

• Impulsiveness or failure to plan ahead

• Hostility, significant irritability, agitation, aggression or violence

• Lack of empathy for others and lack of remorse about harming others

• Unnecessary risk-taking or dangerous behavior with no regard for the safety of self or others

• Poor or abusive relationships

• Failure to consider the negative consequences of behavior or learn from them

• Being consistently irresponsible and repeatedly failing to fulfill work or financial obligations

Adults with antisocial personality disorder typically show symptoms of conduct disorder before the age of 15. Signs and symptoms of conduct disorder include serious, persistent behavior problems, such as:

• Aggression toward people and animals

• Destruction of property

• Deceitfulness

• Theft

• Serious violation of rules

Although antisocial personality disorder is considered lifelong, in some people, certain symptoms — particularly destructive and criminal behavior — may decrease over time. But it’s not clear whether this decrease is a result of aging or an increased awareness of the consequences of antisocial behavior.

Causes

Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It’s the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood, shaped through an interaction of inherited tendencies and environmental factors.

The exact cause of antisocial personality disorder isn’t known, but:

• Genes may make you vulnerable to developing antisocial personality disorder — and life situations may trigger its development

• Changes in the way the brain functions may have resulted during brain development

Risk factors

Certain factors seem to increase the risk of developing antisocial personality disorder, such as:

• Diagnosis of childhood conduct disorder

• Family history of antisocial personality disorder or other personality disorders or mental health disorders

• Being subjected to abuse or neglect during childhood

• Unstable, violent or chaotic family life during childhood

Men are at greater risk of having antisocial personality disorder than women are.

Complications

Complications, consequences and problems of antisocial personality disorder may include, for example:

• Spouse abuse or child abuse or neglect

• Problems with alcohol or substance use

• Being in jail or prison

• Homicidal or suicidal behaviors

• Having other mental health disorders such as depression or anxiety

• Low social and economic status and homelessness

• Premature death, usually as a result of violence

Prevention

There’s no sure way to prevent antisocial personality disorder from developing in those at risk. Because antisocial behavior is thought to have its roots in childhood, parents, teachers and pediatricians may be able to spot early warning signs. It may help to try to identify those most at risk, such as children who show signs of conduct disorder, and then offer early intervention.

Agoraphobia: Symptoms

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.

The anxiety is caused by fear that there’s no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.

Agoraphobia treatment can be challenging because it usually means confronting your fears. But with psychotherapy and medications, you can escape the trap of agoraphobia and live a more enjoyable life.

Symptoms

Typical agoraphobia symptoms include fear of:

• Leaving home alone

• Crowds or waiting in line

• Enclosed spaces, such as movie theaters, elevators or small stores

• Open spaces, such as parking lots, bridges or malls

• Using public transportation, such as a bus, plane or train

These situations cause anxiety because you fear you won’t be able to escape or find help if you start to feel panicked or have other disabling or embarrassing symptoms.

In addition:

• Fear or anxiety almost always results from exposure to the situation

• Your fear or anxiety is out of proportion to the actual danger of the situation

• You avoid the situation, you need a companion to go with you, or you endure the situation but are extremely distressed

• You experience significant distress or problems with social situations, work or other areas in your life because of the fear, anxiety or avoidance

• Your phobia and avoidance usually lasts six months or longer

Panic disorder and agoraphobia

Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). You might think that you’re totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.

Signs and symptoms of a panic attack can include:

• Rapid heart rate

• Trouble breathing or a feeling of choking

• Chest pain or pressure

• Lightheadedness or dizziness

• Feeling shaky, numb or tingling

• Excessive sweating

• Sudden flushing or chills

• Upset stomach or diarrhea

• Feeling a loss of control

• Fear of dying

Causes

Biology — including health conditions and genetics — temperament, environmental stress and learning experiences may all play a role in the development of agoraphobia.

Risk factors

Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years — usually before age 35 — but older adults can also develop it. Women are diagnosed with agoraphobia more often than men are.

Risk factors for agoraphobia include:

• Having panic disorder or other phobias

• Responding to panic attacks with excessive fear and avoidance

• Experiencing stressful life events, such as abuse, the death of a parent or being attacked

• Having an anxious or nervous temperament

• Having a blood relative with agoraphobia

Complications

Agoraphobia can greatly limit your life’s activities. If your agoraphobia is severe, you may not even be able to leave your home. Without treatment, some people become housebound for years. You may not be able to visit with family and friends, go to school or work, run errands, or take part in other normal daily activities. You may become dependent on others for help.

Agoraphobia can also lead to or be associated with:

• Depression

• Alcohol or drug abuse

• Other mental health disorders, including other anxiety disorders or personality disorders

Prevention

There’s no sure way to prevent agoraphobia. However, anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places over and over again before your fear becomes overwhelming. If this is too hard to do on your own, ask a family member or friend to go with you, or seek professional help.

If you experience anxiety going places or have panic attacks, get treatment as soon as possible. Get help early to keep symptoms from getting worse. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

COVID-19 and your mental health

The COVID-19 pandemic has likely brought many changes to how you live your life, and with it uncertainty, altered daily routines, financial pressures and social isolation. You may worry about getting sick, how long the pandemic will last, whether you’ll lose your job, and what the future will bring. Information overload, rumors and misinformation can make your life feel out of control and make it unclear what to do.

During the COVID-19 pandemic, you may experience stress, anxiety, fear, sadness and loneliness. And mental health disorders, including anxiety and depression, can worsen.

Surveys show a major increase in the number of U.S. adults who report symptoms of stress, anxiety and depression during the pandemic, compared with surveys before the pandemic. Some people have increased their use of alcohol or drugs, thinking that can help them cope with their fears about the pandemic. In reality, using these substances can worsen anxiety and depression.

People with substance use disorders, notably those addicted to tobacco or opioids, are likely to have worse outcomes if they get COVID-19. That’s because these addictions can harm lung function and weaken the immune system, causing chronic conditions such as heart disease and lung disease, which increase the risk of serious complications from COVID-19.

For all of these reasons, it’s important to learn self-care strategies and get the care you need to help you cope.

Self-care strategies

Self-care strategies are good for your mental and physical health and can help you take charge of your life. Take care of your body and your mind and connect with others to benefit your mental health.

Take care of your body

Be mindful about your physical health:

Get enough sleep. Go to bed and get up at the same times each day. Stick close to your typical schedule, even if you’re staying at home.

Participate in regular physical activity. Regular physical activity and exercise can help reduce anxiety and improve mood. Find an activity that includes movement, such as dance or exercise apps. Get outside in an area that makes it easy to maintain distance from people, such as a nature trail or your own backyard.

Eat healthy. Choose a well-balanced diet. Avoid loading up on junk food and refined sugar. Limit caffeine as it can aggravate stress and anxiety.

Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you’re already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to try to cope can make matters worse and reduce your coping skills. Avoid taking drugs to cope, unless your doctor prescribed medications for you.

Limit screen time. Turn off electronic devices for some time each day, including 30 minutes before bedtime. Make a conscious effort to spend less time in front of a screen — television, tablet, computer and phone.

Relax and recharge. Set aside time for yourself. Even a few minutes of quiet time can be refreshing and help to quiet your mind and reduce anxiety. Many people benefit from practices such as deep breathing, tai chi, yoga or meditation. Soak in a bubble bath, listen to music, or read or listen to a book — whatever helps you relax. Select a technique that works for you and practice it regularly.

Take care of your mind

Reduce stress triggers:

• Keep your regular routine. Maintaining a regular schedule is important to your mental health. In addition to sticking to a regular bedtime routine, keep consistent times for meals, bathing and getting dressed, work or study schedules, and exercise. Also set aside time for activities you enjoy. This predictability can make you feel more in control.

• Limit exposure to news media. Constant news about COVID-19 from all types of media can heighten fears about the disease. Limit social media that may expose you to rumors and false information. Also limit reading, hearing or watching other news, but keep up to date on national and local recommendations. Look for reliable sources, such as the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Stay busy. A distraction can get you away from the cycle of negative thoughts that feed anxiety and depression. Enjoy hobbies that you can do at home, identify a new project or clean out that closet you promised you’d get to. Doing something positive to manage anxiety is a healthy coping strategy.

Focus on positive thoughts. Choose to focus on the positive things in your life, instead of dwelling on how bad you feel. Consider starting each day by listing things you are thankful for. Maintain a sense of hope, work to accept changes as they occur and try to keep problems in perspective.

Use your moral compass or spiritual life for support. If you draw strength from a belief system, it can bring you comfort during difficult times.

Set priorities. Don’t become overwhelmed by creating a life-changing list of things to achieve while you’re home. Set reasonable goals each day and outline steps you can take to reach those goals. Give yourself credit for every step in the right direction, no matter how small. And recognize that some days will be better than others.

Connect with others

Build support and strengthen relationships:

Make connections. If you need to stay at home and distance yourself from others, avoid social isolation. Find time each day to make virtual connections by email, texts, phone, or FaceTime or similar apps. If you’re working remotely from home, ask your co-workers how they’re doing and share coping tips. Enjoy virtual socializing and talking to those in your home.

Do something for others. Find purpose in helping the people around you. For example, email, text or call to check on your friends, family members and neighbors — especially those who are elderly. If you know someone who can’t get out, ask if there’s something needed, such as groceries or a prescription picked up, for instance. But be sure to follow CDC, WHO and your government recommendations on social distancing and group meetings.

Support a family member or friend. If a family member or friend needs to be isolated for safety reasons or gets sick and needs to be quarantined at home or in the hospital, come up with ways to stay in contact. This could be through electronic devices or the telephone or by sending a note to brighten the day, for example.

Recognizing what’s typical and what’s not

Stress is a normal psychological and physical reaction to the demands of life. Everyone reacts differently to difficult situations, and it’s normal to feel stress and worry during a crisis. But multiple challenges daily, such as the effects of the COVID-19pandemic, can push you beyond your ability to cope.

Many people may have mental health concerns, such as symptoms of anxiety and depression during this time. And feelings may change over time.

Despite your best efforts, you may find yourself feeling helpless, sad, angry, irritable, hopeless, anxious or afraid. You may have trouble concentrating on typical tasks, changes in appetite, body aches and pains, or difficulty sleeping or you may struggle to face routine chores.

When these signs and symptoms last for several days in a row, make you miserable and cause problems in your daily life so that you find it hard to carry out normal responsibilities, it’s time to ask for help.

Get help when you need it

Hoping mental health problems such as anxiety or depression will go away on their own can lead to worsening symptoms. If you have concerns or if you experience worsening of mental health symptoms, ask for help when you need it, and be upfront about how you’re doing. To get help you may want to:

• Call or use social media to contact a close friend or loved one — even though it may be hard to talk about your feelings.

• Contact a minister, spiritual leader or someone in your faith community.

• Contact your employee assistance program, if your employer has one, and get counseling or ask for a referral to a mental health professional.

• Call your primary care provider or mental health professional to ask about appointment options to talk about your anxiety or depression and get advice and guidance. Some may provide the option of phone, video or online appointments.

• Contact organizations such as the National Alliance on Mental Illness (NAMI) or the Substance Abuse and Mental Health Services Administration (SAMHSA) for help and guidance.

If you’re feeling suicidal or thinking of hurting yourself, seek help. Contact your primary care provider or a mental health professional. Or call a suicide hotline. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use its webchat at suicidepreventionlifeline.org/chat.

Continue your self-care strategies

You can expect your current strong feelings to fade when the pandemic is over, but stress won’t disappear from your life when the health crisis of COVID-19 ends. Continue these self-care practices to take care of your mental health and increase your ability to cope with life’s ongoing challenges.

Sources: McLean Hospital, The Mayo Clinic, NAMI

Does caffeine make depression worse?

Does caffeine make depression worse?

There’s no clear link between caffeine intake and depression. However, caffeine intake and depression may be linked indirectly for people who are particularly sensitive to the effects of caffeine or who have too much caffeine.

Caffeine can cause sleep problems that affect mood.Caffeine can make it harder to fall asleep and stay asleep. Lack of sleep can worsen depression. If you have trouble sleeping, don’t drink caffeinated beverages late in the day. Some people need to limit caffeine to the morning or quit drinking caffeinated beverages completely to avoid sleep problems.

Also, anxiety and depression often occur together, and caffeine can worsen anxiety.

Stopping abruptly can worsen depression. If you regularly drink caffeinated beverages, quitting can cause a depressed mood until your body adjusts. It can also cause other signs and symptoms, such as headaches, fatigue and irritability.

If you have depression, consider limiting or avoiding caffeine to see if it helps improve your mood. To lessen these withdrawal effects, gradually reduce the amount of caffeinated beverages you drink.

Is it possible to have depression and anxiety at the same time?

Is it possible to have depression and anxiety at the same time?

Depression and anxiety are different conditions, but they commonly occur together. They also have similar treatments.

Feeling down or having the blues now and then is normal. And everyone feels anxious from time to time — it’s a normal response to stressful situations. But severe or ongoing feelings of depression and anxiety can be a sign of an underlying mental health disorder.

Anxiety may occur as a symptom of clinical (major) depression. It’s also common to have depression that’s triggered by an anxiety disorder, such as generalized anxiety disorder, panic disorder or separation anxiety disorder. Many people have a diagnosis of both an anxiety disorder and clinical depression.

Symptoms of both conditions usually improve with psychological counseling (psychotherapy), medications, such as antidepressants, or both. Lifestyle changes, such as improving sleep habits, increasing social support, using stress-reduction techniques or getting regular exercise, also may help. If you have either condition, avoid alcohol, smoking and recreational drugs. They can make both conditions worse and interfere with treatment.

Sources: The Mayo Clinic, McLean Hospital, NAMI, NIMH

Adjustment Disorders: Symptoms

Adjustment disorders are stress-related conditions. You experience more stress than would normally be expected in response to a stressful or unexpected event, and the stress causes significant problems in your relationships, at work or at school.

Work problems, going away to school, an illness, death of a close family member or any number of life changes can cause stress. Most of the time, people adjust to such changes within a few months. But if you have an adjustment disorder, you continue to have emotional or behavioral reactions that can contribute to feeling anxious or depressed.

You don’t have to tough it out on your own, though. Treatment can be brief and it’s likely to help you regain your emotional footing.

Symptoms

Signs and symptoms depend on the type of adjustment disorder and can vary from person to person. You experience more stress than would normally be expected in response to a stressful event, and the stress causes significant problems in your life.

Adjustment disorders affect how you feel and think about yourself and the world and may also affect your actions or behavior. Some examples include:

• Feeling sad, hopeless or not enjoying things you used to enjoy

• Frequent crying

• Worrying or feeling anxious, nervous, jittery or stressed out

• Trouble sleeping

• Lack of appetite

• Difficulty concentrating

• Feeling overwhelmed

• Difficulty functioning in daily activities

• Withdrawing from social supports

• Avoiding important things such as going to work or paying bills

• Suicidal thoughts or behavior

Symptoms of an adjustment disorder start within three months of a stressful event and last no longer than 6 months after the end of the stressful event. However, persistent or chronic adjustment disorders can continue for more than 6 months, especially if the stressor is ongoing, such as unemployment.

Causes

Adjustment disorders are caused by significant changes or stressors in your life. Genetics, your life experiences, and your temperament may increase your likelihood of developing an adjustment disorder.

Risk factors

Some things may make you more likely to have an adjustment disorder.

Stressful events

Stressful life events — both positive and negative — may put you at risk of developing an adjustment disorder. For example:

• Divorce or marital problems

• Relationship or interpersonal problems

• Changes in situation, such as retirement, having a baby or going away to school

• Adverse situations, such as losing a job, loss of a loved one or having financial issues

• Problems in school or at work

• Life-threatening experiences, such as physical assault, combat or natural disaster

• Ongoing stressors, such as having a medical illness or living in a crime-ridden neighborhood

Your life experiences

Life experiences can impact how you cope with stress. For example, your risk of developing an adjustment disorder may be increased if you:

• Experienced significant stress in childhood

• Have other mental health problems

• Have a number of difficult life circumstances happening at the same time

Complications

If adjustment disorders do not resolve, they can eventually lead to more serious mental health problems such as anxiety disorders, depression or substance abuse.

Prevention

There are no guaranteed ways to prevent adjustment disorders. But developing healthy coping skills and learning to be resilient may help you during times of high stress.

If you know that a stressful situation is coming up — such as a move or retirement — call on your inner strength, increase your healthy habits and rally your social supports in advance. Remind yourself that this is usually time-limited and that you can get through it. Also consider checking in with your doctor or mental health professional to review healthy ways to manage your stress.

Sources: The Mayo Clinic, NAMI, NIH, NIMH