Module-3

Neurotic disorders’ is a global term used to cover minor psychiatric conditions such as anxiety,
depression, obsessional and phobic neuroses. They are mental disorders without an organic basis and
where the patient does not lose touch with reality.

GAD, worry uncontrollably about common occurrences and situations. It’s also sometimes known as
chronic anxiety neurosis.

GAD is different from normal feelings of anxiousness. It’s common to feel anxious every once in a while
about things happening in your life, such as your finances.

Symptoms of generalized anxiety disorder

 Physical and mental symptoms of GAD include:

 Perceiving situations as more threatening than they are
 Difficulty in letting go of worries
 Difficulty concentrating
 Difficulty sleeping
 Difficulty with uncertain situations
 Irritability, nervousness, overthinking, and difficulty relaxing
 Fatigue and exhaustion
 Muscle tension
 Repeated stomachaches, diarrhea, or other gastrointestinal issues
 Sweaty palms
 Feeling shaky or weak
 Rapid heartbeat
 Dry mouth

What are the causes and risk factors for GAD?

 Environmental and genetic factors, such as:

 A family history of anxiety
 Recent or prolonged exposure to stressful situations, including personal or family illnesses
 Excessive use of caffeine or tobacco, which can make existing anxiety worse
 Childhood abuse or bullying
 Certain health conditions such as thyroid problems or heart arrhythmias

How is generalized anxiety disorder diagnosed?

GAD is diagnosed with a mental health screening that your doctor can perform. They will ask you
questions about your symptoms and how long you’ve had them. They can also refer you to a mental
health specialist, such as a psychologist or psychiatrist.

Your doctor may also do medical tests to determine whether there is an underlying illness or substance
abuse problem causing your symptoms. Anxiety has been linked toTrusted Source:

Gastroesophageal reflux disease (GERD)

Thyroid disorders

Heart disease

Epilepsy

Bipolar disorder

Pheochromocytoma

The use of caffeine, decongestants, or albuterol

How is generalized anxiety disorder treated?

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) involves meeting regularly to talk with a mental health professional.

The goal of CBT for general anxiety is to change your thinking and behaviors. This approach has been
associatedTrusted Source with lower anxiety symptoms within 12 months after treatment.

It may be even more effective for GADTrusted Source than for other types of conditions, such as post-
traumatic stress disorder (PTSD) or social anxiety disorder (SAD).

In therapy sessions, you will learn how to recognize and manage your anxious thoughts. Your therapist
will also teach you how to calm yourself when upsetting thoughts arise.

Doctors often prescribe medication along with therapy to treat GAD.

Medication

If your doctor recommends medication, they will most likely create a short-term medication plan and a
long-term medication plan.

Short-term medications relax some of the physical symptoms of anxiety, such as muscle tension and
stomach cramping. These are called anti-anxiety medications. Some common anti-anxiety medications
are:

 Alprazolam (Xanax)
 Clonazepam (Klonopin)
 Lorazepam (Ativan)

Anti-anxiety drugs are not meant to be taken for long periods of time, as they have a high risk of
dependence and abuse.

Medications called antidepressants can work well for long-term treatment. Some common
antidepressants are:

 Buspirone (Buspar)
 Citalopram (Celexa)
 Escitalopram (Lexapro)

Lifestyle changes to help ease symptoms of GAD

Many people can find relief by adopting certain lifestyle or behavioral changes. These may include:

 Getting regular exercise if possible

 Eating a balanced and nutrient-dense diet
 Getting enough sleep
 Doing yoga and meditation
 Avoiding stimulants, such as coffee and some over-the-counter medications, such as diet pills
and caffeine pills
 Talking with a trusted friend, spouse, or family member about fears and worries

What Is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is a mental illness that causes repeated unwanted thoughts or
sensations (obsessions) or the urge to do something over and over again (compulsions). Some people
can have both obsessions and compulsions.

OCD comes in many forms, but most cases fall into at least one of four general categories:

 Checking, such as locks, alarm systems, ovens, or light switches, or thinking you have a medical
condition like pregnancy or schizophrenia
 Contamination, a fear of things that might be dirty or a compulsion to clean. Mental
contamination involves feeling like you’ve been treated like dirt.
 Symmetry and ordering, the need to have things lined up in a certain way
 Ruminations and intrusive thoughts, an obsession with a line of thought. Some of these
thoughts might be violent or disturbing.

Obsessive thoughts can include:

 Worries about yourself or other people getting hurt

 Constant awareness of blinking, breathing, or other body sensations
 Suspicion that a partner is unfaithful, with no reason to believe it

Compulsive habits can include:

 Doing tasks in a specific order every time or a certain “good” number of times
 Needing to count things, like steps or bottles
 Fear of touching doorknobs, using public toilets, or shaking hands

OCD risk factors include:

 A parent, sibling, or child with OCD

 Physical differences in certain parts of your brain
 Depression, anxiety, or tics
 Experience with trauma
 A history of physical or sexual abuse as a child

OCD Diagnosis

Your doctor may do a physical exam and blood tests to make sure something else isn’t causing your
symptoms. They will also talk with you about your feelings, thoughts, and habits.
 Treatments include:

 Psychotherapy. Cognitive behavioral therapy can help change your thinking patterns. In a
form called exposure and response prevention, your doctor will put you in a situation
designed to create anxiety or set off compulsions. You’ll learn to lessen and then stop your
OCD thoughts or actions.
 Relaxation. Simple things like meditation, yoga, and massage can help with stressful OCD
symptoms.
 Medication. Psychiatric drugs called selective serotonin reuptake inhibitors help many
people control obsessions and compulsions. They might take 2 to 4 months to start working.
Common ones include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac),
fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft). If you still have symptoms, your
doctor might give you antipsychotic drugs like aripiprazole (Abilify) or risperidone
(Risperdal).
 Neuromodulation. In rare cases, when therapy and medication aren’t making enough of a
difference, your doctor might talk to you about devices that change the electrical activity in
a certain area of your brain. One kind, transcranial magnetic stimulation, is FDA-approved
for OCD treatment. It uses magnetic fields to stimulate nerve cells. A more complicated
procedure, deep brain stimulation, uses electrodes that are implanted in your head.
 TMS (transcranial magnetic stimulation). The TMS unit is a non-invasive device that is held
above the head to induce the magnetic field. It targets a specific part of the brain that
regulates OCD symptoms.

OCD-Related Conditions

Some separate conditions are similar to OCD. They involve obsessions with things like:

 Your looks (body dysmorphic disorder)

 Collecting, arranging, or ordering things (hoarding disorder)
 Pulling out/eating your hair(trichotillomania)
 Picking at your skin (excoriation)
 Physical illness (hypochondriasis)
 Body odor or how you smell (olfactory reference syndrome)

Phobia

Phobia is a type of anxiety disorder that causes an individual to experience extreme, irrational fear
about a situation, living creature, place, or object. When a person has a phobia, they will often shape
their lives to avoid what they consider to be dangerous. The imagined threat is greater than any actual
threat posed by the cause of terror. Phobias are diagnosable mental disorders. The person will
experience intense distress when faced with the source of their phobia. This can prevent them from
functioning normally and sometimes leads to panic attacks.

A phobia is an exaggerated and irrational fear.The term ‘phobia’ is often used to refer to a fear of one
particular trigger. However, there are three types of phobia recognized by the American Psychiatric
Association (APA). These include:

Specific phobia: This is an intense, irrational fear of a specific trigger.

 Social phobia, or social anxiety: This is a profound fear of public humiliation and being singled out
or judged by others in a social situation. The idea of large social gatherings is terrifying for someone
with social anxiety. It is not the same as shyness.

Agoraphobia: This is a fear of situations from which it would be difficult to escape if a person were
to experience extreme panic, such being in a lift or being outside of the home. It is commonly
misunderstood as a fear of open spaces but could also apply to being confined in a small space, such
as an elevator, or being on public transport. People with agoraphobia have an increased risk of panic
disorder.

Symptoms

A person with a phobia will experience the following symptoms. They are common across the
majority of phobias:

 A sensation of uncontrollable anxiety when exposed to the source of fear

 A feeling that the source of that fear must be avoided at all costs
 Not being able to function properly when exposed to the trigger
 Acknowledgment that the fear is irrational, unreasonable, and exaggerated, combined with
an inability to control the feelings

The physical effects of these sensations can include:

 Sweating
 Abnormal breathing
 Accelerated heartbeat
 Trembling
 Hot flushes or chills
 A choking sensation
 Chest pains or tightness
 Butterflies in the stomach
 Pins and needles
 Dry mouth

Complex phobias

A complex phobia is much more likely to affect a person’s wellbeing than a specific phobia.

For example, those who experience agoraphobia may also have a number of other phobias that are
connected. These can include monophobia, or a fear of being left alone, and claustrophobia, a fear
of feeling trapped in closed spaces.

In severe cases, a person with agoraphobia will rarely leave their home.

How the brain works during a phobia

Some areas of the brain store and recall dangerous or potentially deadly events.

If a person faces a similar event later on in life, those areas of the brain retrieve the stressful
memory, sometimes more than once. This causes the body to experience the same reaction.
 In a phobia, the areas of the brain that deal with fear and stress keep retrieving the frightening
event inappropriately.

Researchers have found that phobias are often linked to the amygdala trusted Source, which lies
behind the pituitary gland in the brain. The amygdala can trigger the release of “fight-or-flight”
hormones. These put the body and mind in a highly alert and stressed state.

Treatment-

Medications

The following medications are effective for the treatment of phobias.

Beta blockers- These can help reduce the physical signs of anxiety that can accompany a phobia.

Side effects may include an upset stomach, fatigue, insomnia, and cold fingers.

Antidepressants

Serotonin reuptake inhibitors (SSRIs) are commonly prescribed for people with phobias. They affect
serotonin levels in the brain, and this can result in better moods. SSRIs may initially cause nausea,
sleeping problems, and headaches.

If the SSRI does not work, the doctor may prescribe a monoamine oxidase inhibitor (MAOI) for social
phobia. Individuals on an MAOI may have to avoid certain types of food. Side effects may initially
include dizziness, an upset stomach, restlessness, headaches, and insomnia.

Taking a tricyclic antidepressant (TCA), such as clomipramine, or Anafranil, has also been found to
help phobia symptoms. Initial side effects can include sleepiness, blurred vision, constipation,
urination difficulties, irregular heartbeat, dry mouth, and tremors.

Tranquilizers- Benzodiazepines are an example of a tranquilizer that might be prescribed for a

phobia. These may help reduce anxiety symptoms

Therapies-

Behavioral therapy

There are a number of therapeutic options for treating a phobia.

Desensitization, or exposure therapy

This can help people with a phobia alter their response to the source of fear. They are gradually
exposed to the cause of their phobia over a series of escalating steps. For example, a person with
aerophobia, or a fear of flying on a plane, may take the following steps under guidance:

 They will first think about flying.

 The therapist will have them look at pictures of planes.
 The person will go to an airport.
 They will escalate further by sitting in a practice simulated airplane cabin.
 Finally, they will board a plane.
Cognitive behavioral therapy (CBT) The doctor, therapist, or counselor helps the person with a
phobia learn different ways of understanding and reacting to the source of their phobia. This can
make coping easier. Most importantly, CBT can teach a person experiencing phobia to control their
own feelings and thoughts.

Eating disorders

Eating disorders are serious conditions related to persistent eating behaviors that negatively impact
your health, your emotions and your ability to function in important areas of life. The most common
eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.

Symptoms

Symptoms vary, depending on the type of eating disorder. Anorexia nervosa, bulimia nervosa and
binge-eating disorder are the most common eating disorders. Other eating disorders include
rumination disorder and avoidant/restrictive food intake disorder.

Anorexia nervosa

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is a potentially life-

threatening eating disorder characterized by an abnormally low body weight, intense fear of gaining
weight, and a distorted perception of weight or shape. People with anorexia use extreme efforts to
control their weight and shape, which often significantly interferes with their health and life
activities.

When you have anorexia, you excessively limit calories or use other methods to lose weight, such as
excessive exercise, using laxatives or diet aids, or vomiting after eating. Efforts to reduce your
weight, even when underweight, can cause severe health problems, sometimes to the point of
deadly self-starvation.

Bulimia nervosa

Bulimia (boo-LEE-me-uh) nervosa — commonly called bulimia — is a serious, potentially life-

threatening eating disorder. When you have bulimia, you have episodes of bingeing and purging
that involve feeling a lack of control over your eating. Many people with bulimia also restrict their
eating during the day, which often leads to more binge eating and purging.

During these episodes, you typically eat a large amount of food in a short time, and then try to rid
yourself of the extra calories in an unhealthy way. Because of guilt, shame and an intense fear of
weight gain from overeating, you may force vomiting or you may exercise too much or use other
methods, such as laxatives, to get rid of the calories.

If you have bulimia, you’re probably preoccupied with your weight and body shape, and may judge
yourself severely and harshly for your self-perceived flaws. You may be at a normal weight or even a
bit overweight.

Binge-eating disorder
When you have binge-eating disorder, you regularly eat too much food (binge) and feel a lack of
control over your eating. You may eat quickly or eat more food than intended, even when you’re not
hungry, and you may continue eating even long after you’re uncomfortably full.

After a binge, you may feel guilty, disgusted or ashamed by your behavior and the amount of food
eaten. But you don’t try to compensate for this behavior with excessive exercise or purging, as
someone with bulimia or anorexia might. Embarrassment can lead to eating alone to hide your
bingeing.

A new round of bingeing usually occurs at least once a week. You may be normal weight, overweight
or obese.

Rumination disorder

Rumination disorder is repeatedly and persistently regurgitating food after eating, but it’s not due to
a medical condition or another eating disorder such as anorexia, bulimia or binge-eating disorder.
Food is brought back up into the mouth without nausea or gagging, and regurgitation may not be
intentional. Sometimes regurgitated food is rechewed and re swallowed or spit out.

The disorder may result in malnutrition if the food is spit out or if the person eats significantly less to
prevent the behavior. The occurrence of rumination disorder may be more common in infancy or in
people who have an intellectual disability.

Avoidant/restrictive food intake disorder

This disorder is characterized by failing to meet your minimum daily nutrition requirements because
you don’t have an interest in eating; you avoid food with certain sensory characteristics, such as
color, texture, smell or taste; or you’re concerned about the consequences of eating, such as fear of
choking. Food is not avoided because of fear of gaining weight.

The disorder can result in significant weight loss or failure to gain weight in childhood, as well as
nutritional deficiencies that can cause health problems.

Red flags that may indicate an eating disorder include:

 Skipping meals or making excuses for not eating

 Adopting an overly restrictive vegetarian diet
 Excessive focus on healthy eating
 Making own meals rather than eating what the family eats
 Withdrawing from normal social activities
 Persistent worry or complaining about being fat and talk of losing weight
 Frequent checking in the mirror for perceived flaws
 Repeatedly eating large amounts of sweets or high-fat foods
 Use of dietary supplements, laxatives or herbal products for weight loss
 Excessive exercise
 Calluses on the knuckles from inducing vomiting
 Problems with loss of tooth enamel that may be a sign of repeated vomiting
 Leaving during meals to use the toilet
  Eating much more food in a meal or snack than is considered normal
 Expressing depression, disgust, shame or guilt about eating habits
 Eating in secret

Causes

The exact cause of eating disorders is unknown. As with other mental illnesses, there may be many
causes, such as:

Genetics and biology. Certain people may have genes that increase their risk of developing eating
disorders. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.

Psychological and emotional health. People with eating disorders may have psychological and
emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism,
impulsive behavior and troubled relationships.

Certain factors may increase the risk of developing an eating disorder, including:

Family history. Eating disorders are significantly more likely to occur in people who have parents or
siblings who’ve had an eating disorder.

Other mental health disorders. People with an eating disorder often have a history of an anxiety
disorder, depression or obsessive-compulsive disorder.

Dieting and starvation. Dieting is a risk factor for developing an eating disorder. Starvation affects
the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. There
is strong evidence that many of the symptoms of an eating disorder are actually symptoms of
starvation. Starvation and weight loss may change the way the brain works in vulnerable individuals,
which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating
habits.

Stress. Whether it’s heading off to college, moving, landing a new job, or a family or relationship
issue, change can bring stress, which may increase your risk of an eating disorder.

Assessments and tests generally include:

Physical exam. Your doctor will likely examine you to rule out other medical causes for your eating
issues. He or she may also order lab tests.

Psychological evaluation. A doctor or mental health professional will likely ask about your thoughts,
feelings and eating habits. You may also be asked to complete psychological self-assessment
questionnaires.

Psychotherapy

Psychotherapy, also called talk therapy, can help you learn how to replace unhealthy habits with
healthy ones. This may include:

Family-based therapy (FBT). FBT is an evidence-based treatment for children and teenagers with
eating disorders. The family is involved in making sure that the child or other family member follows
healthy-eating patterns and maintains a healthy weight.
Cognitive behavioral therapy (CBT). CBT is commonly used in eating disorder treatment, especially
for bulimia and binge-eating disorder. You learn how to monitor and improve your eating habits and
your moods, develop problem-solving skills, and explore healthy ways to cope with stressful
situations.

Lifestyle and home remedies

 To improve your chances of success in overcoming your eating disorder, try to make these
steps a part of your daily routine:
 Stick to your treatment plan — don’t skip therapy sessions and try not to stray from meal
plans. Follow your doctor’s recommendations on physical activity and exercise.
 Talk to your doctor about appropriate vitamin and mineral supplements. If you’re not eating
well, chances are your body isn’t getting all of the nutrients it needs, such as vitamin D or
iron. However, getting most of your vitamins and minerals from food is typically
recommended.
 Resist urges to weigh yourself or check yourself in the mirror frequently. This may simply
fuel your drive to maintain unhealthy habits.
 Don’t isolate yourself from caring family members and friends who want to see you get
healthy and have your best interests at heart.