Observations on Mental Health Epidemiology

By Jayson Blair
Certified Life Coach
The Washington Post examines a report from the government called the National Survey on Drug Use and Health that says that we love in an America where mental illness is common and the demand for treatment is high.  Some of the most interesting data comes from mental health statistics and epidemiology that has been so eloquently written by S. Nasser Ghaemi in his laymans guide to the topics.

The article offers this interesting observation about mental illness epidemology:
About 20 percent of American adults suffer some sort of mental illness each year, and about 5 percent experience a serious disorder that disrupts work, family or social life, according to a government report released Thursday.
And some interesting observations on the demographic profile of those who are diagnosed with mental health problems:

Mental illness is most prevalent in women, young adults, the unemployed and people with low incomes. Drug and alcohol abuse is more than twice as common in people with mental illness than those without it. About 4 percent of adults contemplate suicide each year. According to the study, slightly less than half the people with any mental illness —  and only 60 percent of those with serious, disabling ones — get treatment each year. Whites and Native Americans are more likely to get treatment than blacks, Hispanics or Asians.In all, about 14 percent of American adults receive some sort of behavioral care each year — and one in five said he or she wanted more, the survey found. Of the people reporting an “unmet need” for mental-health care, about 40 percent said they couldn’t afford it.

Prescription medicine has played an increasing role in treatment:

Prescription medicine was the most common treatment, used by 12 percent of adults. Between 2002 and 2010, the percentage of adults getting outpatient counseling fell slightly (to 7 percent), while the fraction of adults using a prescription drug went up.
The findings were drawn from interviews with about 68,500 randomly selected Americans living at homes, dormitories or shelters in 2010. It did not include people living on the street, active-duty members of the military, prisoners or hospital patients.
“This is a good picture of what the households in the country really look like,” said Pete Delany, an official of the Substance Abuse and Mental Health Services Administration, the agency that oversees the survey.

Daniel J. Carlat, a Massachusetts psychiatrist whose 2010 book “Unhinged: The Trouble With Psychiatry” criticized the profession’s overreliance on prescription drugs,“that there is a kind of alarmist quality to these reports.” The Post gives examples of the disorders found could include spider-phobia and staying upset for a long time after arguing with one’s spouse.

“There is a stigma about ‘mental illness’ that as soon as you hear the term people assume that it’s something quite severe. The nuances of this type of data tend to be lost on people,” he said. He added, however, that he doesn’t doubt that 5 percent of the population has a serious mental disorder. 
 Allen Frances, a professor of psychiatry at Duke University, makes an interesting observation about the survey. "I am skeptical that rates this high make sense,": he says. Frances oversaw the revisions of the Diagnostic and Statistical Manual of Mental Disorders from 1987 to 1994.  It echoes some of the thoughts of others.

Jayson Blair is a certified life coach and he can be reached here.

Now that the Elf on the Shelf is Gone…

By Valerie Tunks, Board Certified Coach


You made it through the holiday season.  Remember back in October when you had a strange mix of excitement and dread about all the work ahead of you preparing, shopping, wrapping, cooking, gifts and parties?  Well, now that there’s no elf on a shelf keeping the kids in line, the glitter and lights are boxed up and in the attic and the kids are back at school, you kind of miss it don’t you?  Your neighborhood no longer twinkles and glows at night when you drive home from work. The holiday magic is gone and it’s back to business as usual.  While there are a lot of stresses involved with the holidays, it is a magical time of year and when it’s over, we miss it; now it’s just plain old winter.   

Although we tend to have a love-hate relationship with the holiday season, when it’s over we’re left with somewhat of an empty feeling.  So, what can you do to spice up the rest of the season while we wait for Mr. Groundhog to tell us how long we have to wait for spring?
Get Out of the House

It is important to get out of the house during the winter months to avoid cabin fever.  It is easy to fall into a winter depression, so do your best to get out and be active.  Look around – sometimes it’s nice to walk in a winter wonderland.

Make the Best of it

While colder and shorter days can be tough to get through, they will go faster and be more enjoyable if you try to embrace them.  If you have a fireplace, use it; sit by the fire and enjoy the warmth and glow.  When it snows, get out there and make a snowman or go sledding with some friends.  If that isn’t your thing (or you live someplace where it doesn’t snow or you hate snow), get out your camera and take some scenery photos; you may just come to appreciate the winter landscape.

Try Something New Every Week

Cooking is great way to try something new every week.  Search for recipes online and invite a friend over to cook with you.  Your inner Julia Child will thank you.  Plus, having friends and loved ones over is fun – it makes us feel less cold and lonely.  It’s a great way to pass the time and doesn’t require going outside when it is too cold.

Plan Something to Look Forward To

If your budget allows now is a good time to plan that vacation you’ve been dreaming of.  It will give you something to look forward to and something to plan for a while.  You can book the trip now and spend the next couple of months planning your itinerary.  If a vacation isn’t a possibility, map out some day trips or outings you would like to do once the warmer weather reappears. Or, plan a winter trip if you can.  Go skiing, head someplace tropical, wherever you feel good – just give yourself something to look forward to.

Whether the Groundhog says we have 6 more weeks of winter or an early spring, don’t worry – you can beat the post-holiday blues by keeping yourself busy.  Who knows, winter may become your favorite season!

Valerie Tunks is a board certified life coach and can be reached here.

DiffDx: Anxiety About Anxiety

By Jayson Blair, Certified Life Coach

It’s a jungle out there.

And one of the hardest forests to untangle your way through is the differences between stress and anxiety, and the differences between the many anxiety disorders. It’s enough to make you anxious. But no worries, we’ve put together a little guide.

Anxiety disorders have one of the longest differential diagnosis lists of all psychiatric disorders.

One of the biggest problems is that clients with anxiety disorders also have anxiety about their disorders, and anxiety about treatment, making self-reports and diagnosis a difficult thing to work your way through. No worries, though. It might take time, but a careful clinician can often differentiate for you, and help improve your quality of life.

The importance of these differences is a key to selecting the most effective therapeutic and medical treatments.

One of the most important issues is the difference between anxiety and plan old stress.

Stress vs. Anxiety

Wikipedia puts it this way: “Stress is a term that is commonly used today but has become increasingly difficult to define.”

How true.

The Mayo Clinic puts it better than I ever could: “Its normal to feel anxious from time to time, especially if your life is stressful. However, severe, ongoing anxiety that interferes with day-today activities may be a sign of” anxiety disorders.

The key differences: severe, ongoing and inferring with living a healthy day to day life.

The same goes for fear. Gavin de Becker pines about the gift of fear in his excellent book by the same name. Fear and institution go hand and glove and as de Becker puts it, “Intuition is always right in at least two important ways: It is always in response to something. It always has your best interest at heart … Denial is a save now, pay later scheme.”

But when fear becomes irrational it can interfere with functioning and its safe bet you should be checked out for anxiety.

It’s true that many of the things that help with managing day-to-day stress – mindfulness, exercise, cognitive behavioral techniques, deep breathing, guided imagery and meditation – can be beneficial for some people who have anxiety disorders. But the reality is that therapy, coping skills and medications are key parts of addressing anxiety disorders that are not usually needed in managing stress.

Some good questions to ask yourself before you write off your anxiety as a not needing intervention are: do you feel tense and wound up for a significant amount of the time? Do you feel numbness or tingling? Do you feel hot when stressed? Are you unable to relax? Do you feel a sense of dread? Dizziness? Is your heart racing? Do you have to do routines that interfere with your function or drive those around you batty? Do you feel fear of losing control or death when the possibility does not seem realistic? Do you feel ridicule, rejection or abandonment when there is not real evidence that its coming? If you answer yes to an of those, I would suggest you see a therapist, a coach, a psychiatrist or your primary care physician and ask them to administer the Beck Anxiety Inventory (treatment providers should try to rule out the impacts of drug abuse, other mental health conditions, migraines, folic acid deficiency, seizures, caffeine-related disorders, CND-based sleep disorders, pregnancy and diabetes mellitus, among other potential disorders) .

The scores on the inventory not only guide clinicians on the question of whether you have anxiety but also what’s the best treatment. Being unable to relax suggests cognitive issues while feeling hot suggests autonomic symptoms. Feeling dizzy or lightheaded suggests nueromotor issues, while feeling like you are choking suggests a panic attack. These facts help clinicians design the most effective treatment for you.

Generalized Anxiety vs. OCD

Obsessive-compulsive disorder is an illness that is defined by intrusive thoughts that produce uneasiness, apprehension, fear or worry, that are most commonly demonstrated through repetitive behaviors aimed at reducing the driving wave of anxiety.

It often works. But it often, also, screws up the lives of people who suffer from the disease. As one client puts it, “It’s a monkey on my back, one that I can’t survive with and I cannot survive without.”

One of the common misconceptions about OCD is that those who suffer from it are ridiculously clean. In fact, may people who are OCD are hoarders – the behaviors are repetitive and are designed to help them manage their fears and anxiety. Others have trouble doing things like walking on cracks in the sidewalks or other strange behaviors that sooth them but can interfere with their lives (think, Mr. Monk). Often, like Mr. Monk, the symptoms come on or come on stronger after a severe emotional or financial crisis. It can border on paranoia and even psychotic in its presentation, if not its true symptomology.

Despite people with OCD being out of the norm, it’s not as rare as it might seem. It is the fourth most common mental disorder, diagnosed nearly as often as asthma and diabetes. 

Luckily, there are some excellent medical treatments for OCD.

OCD vs. OCPD and Autism Spectrum Disorders

Not everyone who presents with the symptoms of OCD have the illness. Many actually have autism spectrum disorders or the perhaps even more tortuous illness of obsessive compulsive personality disorder or, frankly, no pervasive or persistent disorder at all.

 Autism spectrums disorders are illnesses of executive functioning. The resulting social skills problem, difficulties with nonverbal cues, time management problems, organization problems and prioritizing problems often lead to a lot of anxiety. People with autism spectrum disorder also often have restricted and repetitive symptoms.

OCPD is, frankly, the same nightmare as OCD with the added twist built on top. As one National Institutes of Mental Health publication puts it, “OCPD has some of the same symptoms as [OCD]. However, people with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct.”

This belief complicates relationships, often leading to significant outbursts and serious  disinterest in seeking help. These often leads to painful battles with friends and family, who walk on eggshells with people who have OCPD. People with OCPD are more likely than people with OCD to have an obsessive need for cleanliness and over-attention to details. Thing to get black-and-white really fast and there is often little room for other opinions.

Several other disorders, including bipolar and avoidant personality disorder and dependent personality disorder, have significant symptoms of anxiety, but in bipolar it tends to be affective – mood related – and avoidant anxiety tends to play out in, well, obviously, avoidance, and dependence tends to be focused on fears of being abandoned.

It’s worth checking out other anxiety disorders, such phobic disorders (specific fears of spiders, water, wholes, or anything else), panic disorders (focused on full-blown panic attacks), agoraphobia (fear of panic attacks that are so great that people avoid people, places and things). Personality disorders should also be examined, such as paranoid personality disorder (delusional anxiety) and borderline personality disorder (fears of abandonment).

If there is a point here, if you are feeling that stress is impacting your functioning, and it’s a jungle out there for you it is worth it to find an expert to guide you through the vines and the trees.

Jayson Blair is a certified life coach and can be reached here.

DiffDx: The Importance of An Accurate Diagnosis

By Jayson Blair, Certified Life Coach

The importance of a good diagnosis has become even clearer as pharmaceutical companies have further refined their biological silver bullets for mental illness. Medicines like, for example, serotonin reuptake inhibitors can be targeted to treat depression, obsessive compulsive disorder and a variety of other illness. But they can have dramatically harmful effects on those with bipolar disorder. All things considered, its amazing that doctors are not more attentive to the symptoms faced by their clients. But increasing demands of the economy and insurance companies have made it harder, to potentially devastating consequences, for psychiatrists and psychologists to effectively diagnosis.

Increasingly it is fallen on clients to rapidly self-report symptoms in 15-minute to 30-minute initial evaluations and then the question of diagnosis never return. In the best practices of the profession, diagnosis is thoroughly evaluated and constantly re-evaluated. Clients, for better are worse, have become their now diagnosticians. 

Gregory House, the fictional doctor on the show House MD, is in some ways a joke about the trend that doctors rarely have time for accurate diagnosis (his fictional Department of Diagnostic Medicine makes no money and runs up huge bills for the hospital). This article is designed to help clients identify and self-report their symptoms.

This article examines differential diagnosis of bipolar disorder and other illnesses. Subsequent articles will look at ADHD, anxiety disorders and personality disorders.

Bipolar Disorder and Depression

Bipolar disorder and depression are often the toughest differential diagnosis for the most seasoned mental health professional. Clients most often come in from the rain of depression to seek treatment and rarely seek a helping hand when they are manic or hypomanic. This means that those with bipolar, whose illness includes the symptoms of depression and mania, are often misdiagnosed with major depression.

This would hardly be a big deal if the front-line treatments for depression didn’t cause mania (often rapid cycling), which often includes high risk, life-changing behaviors that can be harmful and mentally painful to clients and their families.

Epidemiologists say that bipolar disorder effects 1% to 2% of the population and that about 10% of those with major depression will later develop mania. The first occurrence is often in childhood, teenage years or early adulthood. There is no gender difference when it comes to the prevalence of the illness.  

The symptoms of mania, which can used to differentiate from depression, vary from person to person. They can include eutrophia, irritability, agitation, inflated self-esteem, poor judgment, rapid and pressured speech, aggressive behavior, increased goal-directed activity, risky behaviors, spending degrees, delusions an increased drive to perform and frequent work and social problems.  A helpful Mayo Clinic article on mania can be found here.

ADHD and Bipolar

Steriods and stimulants can have the same effects, so it’s very careful for bipolar to be differentiated from bipolar and attention deficit hyperactivity disorder. Atypical antipsychotics that can be used to calm manic storms can exasperate inattention. A preteen or a teenager with mood swings may be going through a difficult but normal development stage. They could be suffering from actual bipolar disorder with periodic mood changes going from depression and mania.

In addition, symptoms of ADHD often mimic symptoms of bipolar disorder. With ADHD, an individual may have rapid or impulsive speech, physical restlessness, trouble focusing, irritability and, sometimes, defiant or oppositional behavior. There are some similarities.

While ADHD is characterized by inattention and most often some distractibility and hyperactivity, bipolar disorder is characterized by mood swings between high energy and activity and feelings of sadness. People with ADHD may feel sad or even depressed, but rarely with the persistence and cycling of bipolar. Another sign is that hyperactivity and inattention symptoms persist in people with ADHD while they don’t always in bipolar.

Borderline and Bipolar Disorder

Borderline personality disorder is a persistent and pervasive illness that causes emotional instability, leading to stress and other problems, including temper tantrums, self-mutalization, elevation and devaluation of people, fast and furious relationships that crash and burn, frequent feelings of inadequacy and fears of abandonment. 

From a medical perspective, differentiating between bipolar and borderline personality disorders is not relevant for medical treatment. The two diseases are often treated with the same medications to stabilize a person’s mood. It is helpful because atypical antipsychotics can have added effect with bipolar disorder and anti-depressants can be more readily utilized with borderline personality. But the medical consequences of a misdiagnose are not enormously negative. 

The differential is important, however, for therapeutic options. Bipolar disorder can be treated with a variety of psycho-therapeutic modalities, while borderline is most effectively treated with dialectic behavioral therapy and transference-focused therapies. These later treatments are some of my favorites; they focus on the relationship between the client and the therapist, helping clients understand emotions and the difficulties that develop in therapy. The relationship between the two often serve as a model for future relationships outside the safety of the therapeutic room.

Schizoaffective Disorder and Bipolar Disorder

I would be remiss if I did not address the difference between bipolar disorder and schizoaffective disorder. Despite the designs of some in the scientific community to eliminate schizoaffective disorder from the next Diagnostic and Statistical Manual of Mental Disorders, it is real, live and present. The essentially difference between bipolar and schioaffective disorder is that while people with bipolar can have psychotic symptoms, such as delusions and hallucenations, during mood swings, those symptoms don't usually persist when their mood is normal. People with schizoaffective disorder have mood swings and can have psychotic symptoms at anytime, whether their mood is good or not. The importance is the appropriate use of atypical antipsychotic medications and therapeutic treatments that recognize that the psychotic symptoms can emerge when the client's mood is fine. Take it out of the DSM, but it won't make it go away. It is also important to note that families with a loved one with schizoaffective disorder will face very different challenges and the outcomes are sharply different.

Jayson Blair is a certified life coach with Goose Creek Consulting and can be reached here.