Learning to Recognize Symptoms of Stress

The nagging headache starts at the office. You feel tired. You’re having trouble concentrating. Your productivity starts to suffer, and you begin to wonder if you’re coming down with the flu. By the time you get home you’re ready to tuck yourself into bed. The chills and fever never materialize but your symptoms don’t go away.

While persistent headaches, fatigue, frequent forgetfulness and decreased productivity can be signs of illness, stress is often the culprit. Stress can affect your body physically, can impair thoughts and emotions, and can impact behavior.

• Physically, excessive or long-term stress can cause headache, back pain, chest pain, high blood pressure, erratic heart beat, stomach and intestinal problems, and sleep problems. Persistent stress can decrease your immunity to disease and cause heart disease.
• Emotionally, persistent stress can cause anxiety, restlessness, excessive worry, irritability, sadness, anger, feelings of insecurity, inability to concentrate and forgetfulness. Left untreated, stress can lead to serious depression.
• Behavior changes associated with constant stress include overeating or undereating, problems managing and controlling anger, drug or alcohol abuse, increased smoking, social withdrawal, crying spells and relationship conflicts.

If you are experiencing any of these symptoms of excessive or chronic stress, it is important to seek medical help. Naturally, a trip to your primary care physician to rule out and address any physical illness that may be responsible for your symptoms is in order. However, if chronic stress is the source of your symptoms, you will have to go beyond your primary care physician to cure what ails you. 

Chronic stress can be treated and overcome and you can learn to live a happier, more balanced, relatively stress-free life. With the help and guidance of a psychiatrist experienced in stress management, you can learn to recognize your personal stressors and how they impact your life and health. Through cognitive-behavioral therapy, an experienced psychiatrist can help you learn to recognize and control your reaction to stress. With expert guidance, you can learn new techniques for responding to stressful situations and people. You don’t have to let control your life. With help, you can learn to control stress and regain control of your life.

Sense of Fatalism Encourages Risky Behavior in Teens

A surprising number of teens expect to die young. In a seven-year study of 20,000 teens in grades 7 through 12, 15% felt it was highly likely that they would die before they reached their 35th birthday. Published in the July issue of Pediatrics, the unexpected results have caused researchers at the University of Minnesota to wonder if it is a feeling of hopeless fatalism rather than a sense of invulnerability that leads teens to engage in risky behavior.

The magnitude of teen-aged pessimism took researchers by surprise. University of Minnesota researcher Dr. Iris Borowsky told the Associated Press, Adolescence is “a time of great opportunity and for such a large minority of youth to feel like they don’t have a long life ahead of them was surprising.”

Males (15%) were slightly more likely than females (13%) to think they would die young. Living in a more stable family situation appeared to decrease the feeling of risk. Only 10% of teens who lived with both biological parents felt at risk, while 18% of those who lived with only one or neither of their biological parents felt they would die early. Lack of financial stability significantly increased the feeling of risk. Twenty-four percent of teens with a parent receiving public aid believed they would die at an early age. Racially and ethnically, the breakdown of perceived risk of early death was highest for groups exposed to the greatest deprivation and violence:

• 30% Native American
• 26% Black
• 21% Hispanic
• 15% Asian/Pacific Islander
• 10% White

While fatalistic teens did not die more often than their more optimistic peers (only 94 of the 20,000 teens participating died during the seven-year study), they were more likely to engage in unsafe behavior, including drug and alcohol abuse, unprotected sex, attempted suicide, and getting into fights that resulted in serious injury. Teens who believed they would die young were seven times more likely to contract AIDS than their positive-thinking peers. The perception that life was hopeless appears to have encouraged greater risk taking.

Psychiatrists are looking at the study in hopes of developing better methods for identifying at risk teens. It is hoped that the detection of fatalistic attitudes and thinking will help the medical community identify and treat at risk teens before they engage in dangerous behavior.

Is Your Child Addicted to Computer Games?

School is out and the long summer stretches ahead. It should be a time for outdoor fun, playing with friends, baseball games, reading, craft projects and lemonade stands; but many children spend their summers glued to the computer, playing games on the Internet for hours on end. Gaming, which seems to be particularly appealing to males, can be addictive. While the subject is still under study, gaming seems to trigger compulsive behaviors in some people.

It can be difficult to tell whether a child’s competitive interest in gaming has crossed the line into internet addiction. The following warning signs can indicate a problem:

• Your child loses track of time while on the computer.
• He’d rather play computer games than play with friends or engage in other activities that have interested him in the past.
• You child neglects chores and other responsibilities.
• Your child lies to you about his computer use, changes the screen quickly when you walk into the room or sneaks computer time.
• He talks constantly about games, game personas and strategies.
• Your child becomes irritable or rebellious when told to turn off the computer.

Gaming and overuse of computers has been cited as contributing to feelings of social isolation and loneliness, particularly in teens. It can exacerbate anxiety and depression and may trigger obsessive compulsive behaviors. Experts fear that the sedentary aspect of gaming is contributing to an increasing array of physical health problems, like obesity, among U.S. children.

If you feel your child has a problem with computer gaming, you will have to help him modify his behavior:

• Monitor computer use. Keep the computer in a common area so you can keep track of Internet activity.
• Set clear limits for realistic computer use; for instance, allowing gaming for a set period of time each day.
• Talk to your child. Gaming can mask underlying issues like an inability to fit in at school, bullying, depression or other emotional problems.
• Help your child replace gaming with healthy activities such as team sports, scouts, hobbies and clubs. Encourage social interaction with peers.

If you don’t see improvement, your child may need professional psychiatric help to end his dependence on computer games. Cognitive-behavioral therapy can helping children successfully stop compulsive Internet behaviors and learn to live a happy, well-balanced life.

Hypereaters Can’t Stop Craving Bad Foods

America’s love affair with unhealthy food may be more disturbing than we realized. According to research conducted by the former chief of the U.S. Food and Drug Administration, as many as 70 million Americans probably suffer from some degree of “conditioned hypereating.”  Dr. David Kessler defines hypereating as a willpower-sapping compulsion to eat high-fat, high-sugar foods, even when you’re not hungry. Kessler says the phenomenon accounts for the unhealthy food cravings that plague most Americans.

Hypereaters aren’t lured by carrots and celery sticks. Analysis of numerous brain studies led Kessler to conclude that foods loaded with sugar, fat and salt override the brain’s normal hunger cues and trigger the desire to overindulge. Neuroscientists have found that fat and sugar combinations activate the brain’s dopamine pathway — the pleasure-sensing center — in the same way as addictive drugs and alcohol. Kessler says that, like addiction, hypereating is a conditioned response. Each pleasurable experience encourages repetition. The more sugary, fatty foods you eat, the harder they are to resist.

Kessler says it’s a vicious cycle, but one that provides a new way of looking at America’s obesity epidemic. Calling obesity America’s “next great public-health campaign,” Kessler hopes a new perspective will lead to new methods that will help people fight obesity and tame their food cravings. While the problem is multi-fold, Kessler says the food industry must share the blame for America’s widening waistline. “The food industry has figured out what works. They know what drives people to keep on eating,” Kessler told the Associated Press in an interview earlier this year.

Overeaters must also take responsibility for their actions, Kessler said, and retrain their brains to resist the lure of sugar and fat. Just like alcoholics and drug addicts need help leaving their addictions behind, hypereaters may need help from psychiatrists or addiction specialists to retrain their brains before they can successfully resist the fat and sugary foods they’ve been conditioned to crave.

Of course, physical activity, metabolism and hormones all play a role in obesity, and any campaign to fight obesity in America will have to address these contributory issues. But to successfully fight obesity, Kessler believes that America will first have to change its love affair with unhealthy food and recognize the deadliness of the health danger obesity presents.

What is Heavy Drinking?

Clinically, health care providers consider heavy drinking to be more than 2 drinks a day totaling 14 or more drinks per week. But what is a drink? In general one drink is one 5oz glass of wine 1oz of liquor or 12oz of beer. Heavy alcohol use can have serious health consequences.

Let’s look at Larry

Larry comes to see me because he has been depressed and wants to take medication. As usual, I get new patient bloodwork and see that Larry has elevated liver enzymes indicating liver inflammation. When I see this, I usually think alcohol or overuse of Tylenol products.

When I first saw Larry he told me he drank 1-2 glasses of wine with dinner. With further questioning, he admits that he consistently drinks 2 glasses of wine each night. When I ask for details, he tells me his “glass” is a 10oz beverage glass that his wife calls his chalice.

So Larry was really having the equivalent of 4 drinks a night. Larry did not want to switch to a smaller glass as he felt the use of his special glass was part of his evening ritual. He reluctantly cut back to one glass that he filled to the lip, then he slurped down to a level that allowed him to pick it up without spilling. Clearly Larry is trying to maximize his one glass, but at least it’s one.

Larry was also concerned about a chronic cough he has had for months and was afraid it was cancer. I suggested he see his internist for a medical work up.

Months later…
Larry’s liver enzymes return to normal. His chronic cough turned out to be a combination of gastric reflux and allergies. He was told to reduce his alcohol intake to help with the reflux. He cut back by filling the chalice to ¾ full and skipping a night here and there. After several weeks his cough nearly diminished.

Larry does not refer to a specific person, but real situations I have seen many times. He illustrates how people can unknowingly consume heavy quantities of alcohol putting themselves at risk to develop medical problems.

Marijuana Use Can Make You Crazy

Theresa H. M. Moore of the University of Bristol in England and her colleagues have conducted research which concluded that having used marijuana at any point in your life increases the risk of having a psychotic episode by 40%. This was more than twice the risk of those who have never smoked marijuana. The heavier the use, greater the chance of developing psychosis. Heavy use was defined as smoking more than 100 times in a lifetime or currently smoking marijuana weekly.There study does not definitively establish a causal relationship between marijuana and psychosis, but it’s about the best that it gets because the only way to establish causality would be to do a randomized, controlled study having some people smoke marijuana to see what happens later in life. This type of study would be unethical.

I found this study interesting because I often hear people say “there’s nothing wrong with marijuana” or “marijuana should be legal.” These findings illustrate the fact that marijuana is a drug that can have very negative effects on your life, for the rest of your life.

Internet Addiction Part 2

Some researchers still question whether problematic Internet use should be considered a disease. An argument against this is that the internet can be a means to satisfy other compulsive behaviors such as gambling, shopping, pornography use, etc. So it’s a medium of exchange to fuel other addictions and is not the source of the addiction. That is, if a person has a shopping compulsion and spends hours shopping on the Internet, they are “addicted” to shopping and not the Internet. Others will say that the Internet itself provides its own level of rewarding experience such that those addicted to the Internet use the internet simply for the experience of being online.

So, what’s wrong with enjoying being online? After all, there is a vast amount of information available over the Internet and it is easy to spend loads of time reading and surfing. How is this different from watching television? Although theoretically, the Internet could be seen as a better use of time than television because it can be a research tool providing useful information, it is the interactive nature of the Internet and the sheer volume of information available that makes it more dangerous to some than sitting in front of the television.

Unfortunately, we haven’t definitively established how much is too much. In a review article on problematic Internet use (source: Liu T, Potenza MN, CNS Spectr. Vol 12, No. 6, 2007), the author cites several studies where they used time as a measure of social and occupational impairment. In one study those considered to have an Internet addiction spent 38.5 hours/wk on the Internet for non-work related activities compared to 4.9 hours/wk for the non-problematic user.

How does one find 38 extra hours in the week to spend on the internet?

So how do you know if you spend too much time on the internet? Diagnostic criteria aside, I think the most practical way is to examine how much of an impact it has on your personal and work life. Are you less efficient at work, missing deadlines, being warned not to surf, being distracted in meetings because you’re thinking of what you’re going to surf next? Are you spending less time with friends, losing sleep because you’re up late on the Internet? Is your spouse or significant other threatening to throw away your Blackberry? Are you getting more headaches, neck pain or finger cramps because of too much time at your keyboard?

As for treatment, the Center for Internet Addiction Recovery is a web-based treatment that some have found to be very helpful (despite that it uses the Internet to treat an Internet problem). There are also some more traditional treatment centers that use an addiction model and 12 step recovery program. Some research has suggested antidepressants may be helpful.

Do You Have an Internet Addiction? Part 1

In Psychiatry we define addictions as habitual usage of something that creates physical and psychological dependence. Furthermore, when the activity is discontinued, the individual experiences withdrawal. Substances such as alcohol and drugs fall under this addiction model. When considering behaviors such as sexual activity, shopping, eating and more recently internet use, these behaviors don’t quite meet the biological model of addiction, but researchers have recognized that people can fall into a similar pattern of escalating the behavior while having trouble discontinuing it despite experiencing negative consequences. These behaviors can more broadly fall under impulse-control disorders.

The idea of a computer addiction first emerged in the 70’s and 80’s, however with the introduction of Broadband, it is now estimated that over 200 million people in the US use the internet. This equates to almost 70% of the population (source: Liu T, Potenza MN, CNS Spectr. Vol 12, No. 6, 2007). A few people have proposed criteria for diagnosing Internet Addiction as a disease entity.

The following is diagnostic criteria proposed by KS Young in an article published in Cyberpsychol Behav 1998; 11:237-244. A person must have 5 or more of these 8 criteria:

1. Is preoccupied with the internet (thinks about previous online activity or anticipates the next online session)
2. Needs to use the Internet with increased amounts of time in order to achieve satisfaction
3. Has made unsuccessful efforts to control, cut back or stop Internet use
4. Is restless, moody, depressed, or irritable when attempting to cut down or stop Internet use
5. Has stayed online longer than originally intended
6. Has jeopardized or risked the loss of significant relationship, job, educational, or career opportunity because of the internet
7. Has lied to family members, therapists, or others to conceal the extent of involvement with the Internet
8. Uses the Internet as a way to escape problems or to relieve a dysphoric mood (such as feelings of helplessness, guilt, anxiety, depression).

Young used the criteria for substance dependence as a model with some criticism as the behavior does not involve the physiological dependence I previously mentioned. Other researchers have developed more broad criteria, but Internet Addiction or Problematic Internet Use still has not been accepted into standard practice.

To be continued: