Anxiety Archives

The Difference Between OCD and Perfectionism

Written by W. Nate Upshaw M.D. on April 15, 2021. Posted in Anxiety, Depression, Mental Health Maintenance.

Everyone’s heard the expression “I’m a little OCD” or has used the term “perfectionist” as a compliment. While these are common terms and phrases that get plenty of use both in daily life and in the media, Obsessive-Compulsive Disorder (OCD) and perfectionism are serious conditions that cause lasting, significant problems for millions. OCD and perfectionism may influence one another, with one condition potentially driving the other, but they’re not the same.

What is Obsessive-Compulsive Disorder?

OCD is a psychological disorder that causes a person to have both compulsions and obsessions. Obsessions and compulsions involve thoughts (obsessions) and ritualistic behaviors (compulsions). Obsessions are recurring unwanted, intrusive or distressing thoughts that come out of nowhere and interrupt a person’s normal flow of thinking. These obsessive thoughts are both caused by anxiety and generate greater levels of anxiety that compel a person to perform repetitive actions. These repetitive, ritualistic behaviors reduce or briefly eliminate the anxiety. If a person doesn’t carry out their compulsions, their anxiety will increase dramatically.

For example, a person may check the locks on their doors before leaving a particular number of times. If they don’t check the precise number of times, their levels of anxiety will rise dramatically.

For OCD to be diagnosed, it must rise to the level of such severity that a person’s ability to live a satisfying, fulfilling life is impaired.

Is Perfectionism a Psychological Disorder?

Anyone, with or without a mental illness, can be a perfectionist, but it is not by itself a psychological disorder. Perfectionism is a personality trait that’s a mental health risk. It results from experiences and beliefs that start to become ingrained in a person during their childhood years. Perfectionism is a maladaptive (harmful) characteristic of faulty self-esteem and has many problems associated with it.

Characteristics of Perfectionism

Perfectionists strive for perfection and feel bad about themselves when they aren’t flawless in their performance. They equate their performance in life (high grades, flawless work performance, being the ideal parent, etc) as being the measure of their worth as a human being. For example, a perfectionist may find earning a 95 on an exam to be worthless in comparison to getting a 100 percent. Not being the top salesperson at work every quarter might be, for a perfectionist, a sign of being totally worthless—and not just as a salesperson. Perfectionists interpret being less than 100 perfect flawless in all types of measures as a sign of being an inferior person. A perfectionist’s self-worth is tied up in their ability to achieve flawless performance.

Perfectionism sees the world in a polarized light—things are either 100 percent of what the perfectionist aims for, and thus good, or less than the goal, and thus worthless. Naturally, no one is always flawless.

OCD and Obsessive-Compulsive Personality Disorder (OCD-P)

Although the terms are similar, Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder are not the same things at all. Obsessive-Compulsive Disorder is a psychological disorder in which a person has both obsessions and compulsions. These compulsions are ritualistic behaviors; for example, a person who must check their doors to make sure they’re locked exactly 5 times, or otherwise suffers a panic attack. Checking less or more than 5 times would cause the individual as much anxiety as not checking at all. Compulsions in OCD are highly precise and will be performed exactly the same way every time they’re triggered.

Obsessive-Compulsive Personality Disorder (OCD-P) refers to a person who is psychologically characterized by perfectionism, orderliness, tidiness, and structure. They are completely devoted to observing precise schedules, rule-following, and timeliness. They also often are prone to hoarding behaviors. People with Obsessive-Compulsive Personality Disorder do not have a psychological disorder per se and enjoy their lifestyle as it is. They often find employment where their personality traits are highly valued, although their personal and intimate relationships may suffer from unrealistically high expectations of others.

Although people with Obsessive-Compulsive Personality Disorder (OCD-P) are prone to frequent tidying, cleaning, and straightening items in their environment, these behaviors do not rise to the level of pathological compulsiveness. Typically, people with OCD-P enjoy their lifestyle and find it beneficial.

Perfectionism and OCD

Perfectionism is not the result of OCD or OCD-P and may exist completely independently of either condition. There is no cause-effect relationship among the three conditions. However, people with OCD tend to be slightly more perfectionistic than those without it. Researchers believe OCD and perfectionism tend to reinforce each other when they occur together, but not as strongly as anecdotal evidence would suggest.

In the final analysis, perfectionism and OCD may influence each other, but one doesn’t cause the other and they may exist independently.

Treatments for OCD

If you’ve had problems with OCD and are looking for a modern, effective solution, consider Transcranial Magnetic Stimulation (TMS). It’s an FDA-approved treatment for OCD that uses projected magnetic fields to stimulate under-active areas of the brain thought to be involved in Obsessive-Compulsive Disorder. TMS is non-invasive, requires no sedation, and each session lasts less than an hour in a doctor’s office.

Works Cited

Bieling, P., Israeli, A., & Antony, M. (2003, November 24). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Retrieved April 19, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0191886903002356

Frost, R., & Steketee, G. (1998, June 15). Perfectionism in obsessive-compulsive disorder patients. Retrieved April 19, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0005796796001088

Halmi, K. A., Tozzi, F., & Thornton, L. M. (n.d.). The Relation among Perfectionism, Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive Disorder in Individuals with Eating Disorders. International Journal of Eating Disorders, 2005, vol 38: 371-374. Retrieved April 19, 2021

Obsessive-compulsive disorder. (n.d.). Retrieved April 19, 2021, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

What is obsessive-compulsive disorder? (n.d.). Retrieved April 13, 2021, from https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder

What You Need to Know About Insurance Coverage for TMS Therapy

Written by W. Nate Upshaw M.D. on March 16, 2021. Posted in Anxiety, Depression, Mental Health Maintenance, Step-By-Step Guides.

Depression affects more than 16 million adults in the USA every year. Typical treatments for depression include psychotherapy and antidepressant medications, however, people often need to try several different medications before finding one that works reliably for them. Like therapy, this process takes time and antidepressant medications often come along with significant side effects. However, there’s a newer and more convenient treatment for relief from depression.

Transcranial Magnetic Stimulation (TMS) is a treatment for depression that uses a powerful electromagnetic coil to stimulate tissues of the brain which are known to contribute to depression. TMS therapy, which is conducted in a clinician’s office, has been FDA-approved for the treatment of depression since 2008 and requires no sedation. During a TMS session, an electromagnetic coil is placed on the patient’s forehead and a series of repetitive, focused magnetic pulses stimulate nerves in the brain, particularly those responsible for one’s mood.

What Insurance Companies Cover TMS Treatment?

TMS therapy is covered by most insurance companies. Many insurance companies pay for TMS therapy for depression because it’s effective and FDA-approved for the treatment of major depressive disorder.

The following insurance companies cover TMS therapy as long as the treatment is medically necessary and company-specific guidelines are observed. Even though an insurance company may pay for a particular procedure like TMS, it’s vital for a potential recipient of these services to check their policy for specifics, including plan limitations. Each insurance company has its own benefits schedule, eligibility requirements, and coverage policies for TMS therapy.

The criteria most insurance companies require to be met include:

A diagnosis of depression
Attempts at resolving depression with antidepressant medications with no significant lasting improvement
A history of therapy or counseling carried out by licensed professionals
No history of seizures or seizure disorder

Each of these conditions must be met for insurance to cover TMS therapy.

The following insurance companies provide coverage for TMS used for the treatment of depression:

Aetna. Aetna requires a person to have been on 2 antidepressants in the past without significant improvement.
BCBS. Blue Cross and Blue Shield varies by state and policy. Anthem BCBS requires a person to have tried at least 2 antidepressants before covering TMS.
Beacon. Beacon requires several criteria to be met, including but not limited to resistance to treatment with psychopharmacologic agents.
Cigna. Cigna requires a prospective TMS client to have tried two antidepressants, each of a different class.
Humana. Humana requires several criteria to be met, including but not limited to a confirmed diagnosis of severe major depressive disorder.
Medicare. Medicare typically covers 80 percent of the cost of TMS, with 20 percent billed to the patient. Medicare requires a person to have attempted at least one antidepressant in the past.
Medicaid. Medicaid covers TMS only in Washington state at this time.
Meritain Health
Tricare. TMS is covered on an outpatient basis.
United Healthcare. A client must have tried four antidepressants in the past with no lasting improvement.

No insurance provider can deny treatment, however they can refuse to pay for treatment if their policy rules are not followed.

TMS for Conditions Other than Depression

Although the FDA approved TMS for treatment of Obsessive-Compulsive Disorder (OCD) in 2018, many insurance companies still do not cover it yet. Furthermore, even though PTSD and anxiety also benefit from TMS, the FDA has yet to approve its use for these disorders. Consequently, insurance companies will not cover TMS treatment for them. If you’re seeking TMS for conditions other than depression, reach out to your insurance company directly to learn if their policy rules offer reimbursement for treatment.

Benefits of TMS

If you have depression, TMS has advantages other treatment options don’t. Consider these numerous benefits in comparison with traditional approaches:

TMS is completely noninvasive. No pills to remember, no surgery, no inconvenience.
Side effects are minimal, including lightheadedness and mild headaches
TMS is particularly effective for treatment-resistant depression
TMS is effective. Over 50 percent of TMS patients achieve remission from depression within 6 weeks.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

Brain stimulation therapies. (n.d.). Retrieved March 27, 2021, from https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml

Challen, R., Brooks-Pollock, E., Read, J., Dyson, L., Tsaneva-Atanasova, K., & Danon, L. (2021, March 10). Risk of mortality in patients infected with sars-cov-2 variant of concern 202012/1: Matched cohort study. Retrieved March 24, 2021, from https://www.bmj.com/content/372/bmj.n579

Commissioner, O. (2008). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Retrieved March 27, 2021, from https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder

Risio, L., Borgi, M., Pettorruso, M., Miuli, A., Ottomana, A., & Sociali, A. (2020, November 10). Recovering from depression with repetitive transcranial magnetic stimulation (rtms): A systematic review and meta-analysis of preclinical studies. Retrieved March 29, 2021, from https://www.nature.com/articles/s41398-020-01055-2?utm_medium=affiliate&utm_source=commission_junction&utm_campaign=3_nsn6445_deeplink_PID100090071&utm_content=deeplink

close up photo of a man's eye looking into the camera

Everything You Need to Know About the PHQ-9 Test

Written by W. Nate Upshaw M.D. on February 9, 2021. Posted in Anxiety, Depression, Mental Health Maintenance.

Depression is a common mental illness that is both mentally and physically draining. Sometimes the signs and symptoms of depression may be obvious. However, sometimes it can be quite difficult to pick up on, especially in ourselves. Fortunately, there is a quick and simple questionnaire to help assess symptoms of depression. You may have heard of it or may have even taken it before; it’s called the PHQ-9.

What Is a PHQ-9 Form?

The PHQ-9 form is a brief, self-administered questionnaire that assesses depression symptoms. This shorter test is derived from the original and longer PHQ assessment that addresses multiple mental health concerns including depression, panic disorder, anxiety, sleep disorders, and others.

The PHQ was derived from an assessment tool utilized by medical professionals called the PRIME-MD that addresses multiple mental health diagnoses. The PHQ-9 was developed and copyrighted by Drs. R.L. Spitzer, J.B.W. Williams, and K. Kroenke in 1999 with an educational grant from Pfizer, Inc. Pfizer holds the copyright to the PHQ-9, but is available for use and replication without needing permission to be granted.

Since this assessment only addresses depression, the number 9 in the title is a reference to the nine questions to assess each criterion of depression according to the Diagnostic and Statistical Manual of Mental Disorders (or DSM). A self-administered test means that you can answer the questions and tally your result on your own, or by a health or mental healthcare professional. The PHQ-9 is commonly administered in doctor’s or therapist’s offices as a part of routine checkups, or as a way to monitor and evaluate your mental health.

What Does PHQ-9 Stand For?

PHQ-9 stands for Patient Health Questionnaire.

PHQ-9 Score

Your PHQ-9 score determines the severity of the depression according to the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders. Once again, there are 9 questions in this assessment; 8 questions directly assessing symptoms of depression and 1 question that assesses how any depressive symptoms have been impacting your ability to function. For each question, there are 4 choices to choose from in regard to how often you have been experiencing symptoms:

“Not At All”
“Several Days”
“More Than Half of the Days”
“Nearly Every Day”

Selecting “Not At All” will give you 0 points, “Several Days” is 1 point, “More Than Half of the Days” is 2 points, and “Nearly Every Day” is 3 points. Adding up each score will then give you your total score.

Take PHQ-9 Assessment

PHQ-9 Score Interpretation

Once you’ve taken the PHQ-9 questionnaire, your score will then be interpreted by a mental health professional to find out how severe your depression may be. A PHQ-9 score total of 0-4 points equals “normal” or minimal depression. Scoring between 5-9 points indicates mild depression, 10-14 points indicates moderate depression, 15-19 points indicates moderately severe depression, and 20 or more points indicates severe depression. The higher your score, the more symptoms of depression you experience, and the more severe your depression is.

According to the DSM, Major Depressive Disorder is diagnosed if 5 of 9 symptoms or more, have been present for “more than half the days” of the last 2 weeks, and one of those symptoms being depressed mood or anhedonia. If this criteria is not met, other unspecified depression can still be diagnosed if 2 to 4 symptoms have been present for “more than half the days” in the last 2 weeks, and one of those symptoms being depressed mood or anhedonia. Since each question in the PHQ-9 translates to a criterion of Major Depressive Disorder, it can be a good guide as to what level of depression you would be diagnosed with. Also, it is important to note that if your depression does not meet severe criteria, it does not make your symptoms any less valid.

One of the last questions in the PHQ-9, and a criteria for Major Depressive Disorder, (“thoughts that you would be better off dead or of hurting yourself in some way”) counts if given any score other than a zero, regardless of the duration of the symptom. The final question, found at the end of the symptom assessment portion of the PHQ-9, asks about the test taker’s functionality: “How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?” In order to accurately diagnose and treat depression, taking into consideration how symptoms impact you, not merely symptoms alone, give a better understanding of the severity.

PHQ-9 Validity and Reliability

The PHQ-9 test is widely used because of its high validity and reliability. Validity studies showed that those who scored a 10 or higher on the PHQ-9 were between 7% and 13.6% more likely to be diagnosed with depression by a mental health professional. Since it is also incredibly easy to administer, it can be given in many health and mental health care settings. This accessibility helps to give us quick and accurate information about the symptoms and severity of someone’s depression. It continues to be an accessible and reliable way to assess depression as it is free to use and is interpreted in over 30 languages. The PHQ-9 can be found in print form, such as this example of a PHQ-9, as well as digital versions, such as found on this website.

Your scores can be used as a way for you to individually monitor where your depression is at, or as a part of your treatment plan with a mental health professional. Since the test is so simple and quick to use, monitoring the severity of your symptoms has never been easier. The PHQ-9 is a fantastic tool to help assess and interpret the symptoms and severity of our depression, but these numbers alone will not provide treatment. It is still necessary to treat depression via therapy, medication, brain-stimulation therapies, self-reflection, or whatever treatment modality is right for you. Insight into our depression is vital, but that alone will not improve the depression. Knowledge is power, and the PHQ-9 helps you and your team to start that process of healing from depression.

Take PHQ-9 Assessment

Works Cited

American Psychological Association. (2020, June). Patient Health Questionnaire (PHQ-9 & PHQ-2). Retrieved February 2, 2021, from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Pfizer. (n.d.). phqscreeners. Retrieved February 2, 2021, from https://www.phqscreeners.com/

PHQ-9 Depression Test Questionnaire. (n.d.). Retrieved February 2, 2021, from https://patient.info/doctor/patient-health-questionnaire-phq-9

Psychiatric Times. (n.d.). Patient Health questionnaire, including PHQ, PHQ-9, PHQ-Brief, and PHQ-SADS. Retrieved February 2, 2021, from https://www.psychiatrictimes.com/view/patient-health-questionnaire-including-phq-phq-9-phq-brief-and-phq-sads

Stanford Medical. (n.d.). Patient Health Questionnaire (PHQ-9). Retrieved February 2, 2021, from https://med.stanford.edu/fastlab/research/imapp/msrs/_jcr_content/main/accordion/accordion_content3/download_256324296/file.res/PHQ9%20id%20date%2008.03.pdf

OCD and Depression: Are They Related

Written by W. Nate Upshaw M.D. on December 15, 2020. Posted in Anxiety, Depression.

Obsessive-Compulsive Disorder and Major Depressive Disorder are both common, and left untreated, potentially debilitating mental illnesses. While Obsessive-Compulsive Disorder (OCD) is widely categorized as an anxiety disorder, depression is a mood disorder. However, due to their biochemistry and most popular treatment recommendations, OCD and depression do share some relation to each other.

https://www.youtube.com/watch?v=LcLu3lKzxEU

Difference Between Obsessions and Compulsions

Obsessive-compulsive disorder (OCD) presents primarily as patterns of unwanted and intrusive thoughts or fears that lead someone to perform repetitive or frequent behaviors. The thoughts and fears are considered the “obsessions” part of the namesake, and the repetitive behaviors are the “compulsions”. These obsessions and compulsions have the ability to interfere with daily activities and cause significant distress. Examples of common obsessions include:

Becoming ill or dying
Disturbing sexual thoughts, urges, images
Doubts about having done something right or forgetting things
Germs or contamination
Harming or having harmed someone
Anticipating something bad happening

Following experiencing the obsessions, compulsive behaviors can emerge. Examples of common compulsions can include:

Counting
Excessive checking that tasks were completed
Doing something over until it’s “right”
Excessive washing or cleaning
Repeatedly putting things in a certain order
Replicating routine behaviors
Seeking reassurance from others.

Breaking the OCD Cycle

Prior to seeking treatment, people often try to ignore or stop these obsessions or thoughts, but in a clinical case of OCD, ignoring them only increases distress and anxiety. As a result, there is often an overwhelming urge to perform the subsequent compulsive acts in an attempt to ease the distress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behaviors, which is ultimately the vicious cycle of OCD.

Depression

Major Depressive Disorder (MDD), on the other hand, is a common mood disorder that presents as any combination of the following symptoms that are present for at least a two week period of time:

Persistent sadness, anxiousness, “emptiness”, hopelessness, or pessimism
Irritability
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies and activities
Decreased energy or fatigue
Moving or talking more slowly
Feeling restless or having trouble sitting still
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Aches or pains, headaches, cramps, or digestive problems

MDD can exist in one episode or as multiple episodes, lasting for periods of time up to months in length. There are a variety of other mood disorders that include varying degrees of depression as a symptom, such as Dysthymia or Postpartum Depression. The main difference between OCD and depression is that OCD is rooted in anxiety, and Major Depressive Disorder is a mood disorder. Although mood and anxiety are not the same, we know there is a link between the two conditions.

How Are OCD and Depression Connected?

It’s believed that up to two-thirds of people diagnosed with OCD will experience a depressive episode throughout the course of their mental illness. Up to 40% will also be diagnosed with Major Depressive Disorder, according to some studies. It is important to recognize how distressing intrusive and unwanted thoughts or obsessions are. Depression has been found to be mostly related to the obsessions rather than the compulsive behaviors. Compulsions tend to bring immediate relief to anxiety, which is why they are performed, but overall perpetuate the cycle of OCD. Other potential triggers for a depressive episode include stress and biochemical changes that can alter moods and behavior. Depression can also be especially serious in people with OCD because the presence of a depressive episode can negatively impact their ability to treat their OCD symptoms.

A similar chemical imbalance that can cause OCD, also impacts depression. OCD and depression are both impacted by activity of serotonin, a neurotransmitter that impacts processes such as mood, memory, and digestion. Since they are both characterized by disruptions of serotonin, a common medication that targets it can help both OCD and Major Depressive Disorder. Selective Serotonin Reuptake Inhibitors (more commonly known as SSRIs) are a common form of medication treatment for both OCD and depression. In addition, other non-medication related therapies, such as Cognitive-Behavioral Therapy and TMS therapy, can be highly effective in the treatment of both conditions.

While their initial symptom presentation may not be similar, the presence of OCD puts someone at higher risk of having a depressive episode or a diagnosis of Major Depressive Disorder. Each mental illness can cause significant distress in someone’s life. Untreated, they can negatively impact personal relationships, work, and family dynamics. Luckily, treatments such as SSRIs, talk therapy and TMS therapy can be helpful for both OCD and depression. These are often covered by insurance companies and accessible as referrals from your primary care provider. Taking the time and energy to heal from either or both OCD and depression are an investment, but absolutely worth the effort.

Works Cited

Kelly, O. (2020, September 22). How Depression Complicates the Treatment of OCD. Retrieved November 12, 2020, from https://www.verywellmind.com/ocd-and-depression-2510591

Mayo Clinic. (2020, March 11). Obsessive-compulsive disorder (OCD) – Symptoms and causes. Retrieved November 12, 2020, from https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432

National Institute of Mental Health. (n.d.-e). NIMH » Depression. Retrieved November 11, 2020, from https://www.nimh.nih.gov/health/topics/depression/index.shtml

Rivier University. (2019, November 13). OCD and Depression. Retrieved November 12, 2020, from https://www.rivier.edu/academics/blog-posts/ocd-and-depression/

Salters-Pedneault, K. (2020, June 19). What Serotonin Is and How It Regulates Body Functions. Retrieved November 12, 2020, from https://www.verywellmind.com/what-is-serotonin-425327

girl with anxiety looking out the window

The Most Common Myths About Anxiety

Written by W. Nate Upshaw M.D. on November 22, 2020. Posted in Anxiety.

“Just stop worrying!”

“Calm down”

“There’s nothing to worry about”

“It could always be worse!”

These are phrases that we have all heard and likely been told at some point in our lives. We may have been the ones to say these mantras to our loved ones, too. If you are someone who experiences anxiety, you may know how unhelpful these phrases actually are. These statements allude to anxiety being easy to dismiss or ignore, and that we have control over it. These myths about anxiety, unfortunately, contribute to further stigma around anxiety and mental illness in general. Let’s review some of the most common myths about anxiety, and identify how we can start to perpetuate more truth around anxiety.

Myth #1: Anxiety can be easily brushed off

Anxiety disorders don’t just impact your cognitive functioning; there are numerous physical and biological symptoms as well. The autonomic nervous system (ANS) is the system in your body that regulates functions such as heart rate, breathing, urination, sexual function, etc. It’s also the system that produces the “fight-or-flight” response when there is a physical or logical threat. Our bodies are biologically designed to help defend ourselves or run away from danger. Therefore, when someone says to just “relax”, “chill”, or “calm down”, this can often be very difficult, or nearly impossible to do initially if the body perceives a threat. Luckily, anxiety is treatable. There are numerous skills that are helpful in managing anxiety, such as deep breathing to slow the autonomic nervous system and grounding skills to center thoughts into the present versus in the anxiety. To simply tell someone to “stop” feeling the anxiety they are feeling isn’t just harmful and dismissive – it’s also inaccurate.

Myth #2: Anxiety is just another word for “worried”

One of the most common myths is that anxiety is simply feeling “stressed” or “worried”. People often use the word and definition of anxiety as interchangeable with the other two emotions. While this is not necessarily wrong, it is far too simplified. Stress and worry are common symptoms of anxiety, but usually not the only signs present. Anxiety disorders include the following diagnoses: Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, and various Phobias. Some practitioners also consider Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder as anxiety disorders. All of these diagnoses require more than worry or stress symptoms to qualify. Other symptoms of these diagnoses include fatigue, irritability, panic attacks, physical ailments such as headaches or gastrointestinal issues, difficulty concentrating, and sleep disruption. To consider any of these mental illnesses or conditions as simply worry or stress, is misguided.

Myth #3: Simply avoid your trigger

Naturally, we will want to avoid events, people, or situations that cause us anxiety. Our minds and body will signal us to avoidance or dismiss these thoughts or events as a protective mechanism. However, this is not a long term solution. Common myths of anxiety disorders include avoiding the trigger will lead to avoiding feeling anxious. While this may work in the short term, the longer you avoid exposure to the stressor, the larger and more fearful that situation then becomes. While it is uncomfortable or overwhelming to experience the stressor, teaching yourself you can experience it and learn to cope with it, is what can help manage and decrease the anxiety.

Myth #4: Exercise and healthy eating will cure your anxiety

Mental and physical wellness is a popular movement that has roots in a lot of great intentions. However, a common myth that is perpetuated time and time again is that exercise and “eating right” will cure your anxiety and depression. This is, once again, overly simplified. Exercise does help to increase endorphins and regulate mood, which can have an impact on anxiety, but does not fully treat it. Exercise can be a great tool to manage anxiety, but only if you find it to be a helpful tool for you to utilize. The same concept applies to food; there are no magic foods that will give you less anxiety. Eating consistently, eating foods you like, eating foods that taste good, eating to feel satisfied, and having reliable access to food absolutely helps with stability of mood and lower stress levels, but cannot cure your anxiety or depression.

Myth #5: It’s just a personality trait

Some people have personality traits or temperaments that may look a lot like anxiety, such as neuroticism or perfectionism. If you have these traits, you may be at a higher risk of developing an anxiety disorder, but someone with these traits are not inherently anxious. When someone’s anxiety is so high that it interferes with their job, their relationships, their ability to attend to daily tasks, that is no longer a “personality trait” – that is a mental illness. Whether it be biological or environmental anxiety, being neurotic or a perfectionist may largely play into a diagnosis of anxiety, but you can have these traits without having clinically diagnosed anxiety.

Through therapy, medication, or other alternative methods of treatment, you can help manage symptoms of anxiety despite having a temperament that may be predisposed to anxiety. When we can understand how true anxiety presents itself for our friends and loved ones, we can continue to decrease the stigma around experiencing it, and ultimately become more successful in our management of anxiety disorders.

If you have depression induced anxiety, a great treatment method you can explore is TMS therapy. TMS therapy is a non-invasive treatment that works by transmitting electromagnetic stimulation into the portion of your brain that controls your mood. It’s been successfully used as a treatment for depression for many years, and has been associated with also effectively reducing the symptoms of anxiety that arise from depression. TMS therapy is FDA cleared, medication-free, painless, side-effect-free, and is covered by most major insurance companies, Medicare and Tricare.

Works Cited

Anxiety and Depression Association of America. (n.d.-a). Myths and Misconceptions About Anxiety | Anxiety and Depression Association of America, ADAA. Retrieved November 9, 2020, from https://adaa.org/understanding-anxiety/myth-conceptions.

Harvard Health Publishing. (2020, August). Recognizing and easing the physical symptoms of anxiety. Retrieved November 6, 2020, from https://www.health.harvard.edu/mind-and-mood/recognizing-and-easing-the-physical-symptoms-of-anxiety

National Institute of Mental Health. (n.d.-a). NIMH » Anxiety Disorders. Retrieved November 9, 2020, from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145336

dictionary with word anxiety highlighted

How to Understand Your Anxiety and Explain It To Others

Written by W. Nate Upshaw M.D. on November 15, 2020. Posted in Anxiety, Step-By-Step Guides.

Anxiety can show up in many different ways for each of us. While anxiety may be a familiar companion for some, the current world, environmental, and financial stressors may be contributing to an emergence of anxiety as a new presence for others. Anxiety tends to manifest as a result of the unknown, which is why it’s so common in this day and age. To start doing the work to manage our anxiety, it can be helpful to learn how to understand more about anxiety and depression itself. It can be a necessary step to protect and care for ourselves more effectively from the stress of the world around us. Especially when those stressors may be present for an unknown length of time.

What Are the Feelings of Anxiety

Those who suffer from anxiety may have thoughts of “people don’t understand me”, or feeling very different than others due to the anxiety, or any other mental health concern for that matter. Learning what your anxiety is and why it happens can be helpful to starting to manage it. Your autonomic nervous system (more commonly known by its initials, ANS) is a system in your body that regulates functions such as your heart rate, breathing, urination, sexual function, etc. It’s also the system that reacts when you are under a physical threat. The ANS produces the “fight-or-flight” response, which is biologically designed to help you defend yourself or run away from danger. However, we now know that anxiety is often triggered under less physically dangerous triggers, such as emotional pain or stress. Knowing the biological origins of anxiety can help us to have more self-compassion for ourselves, and reduce blaming for experiencing anxiety.

Leaning into discomfort is never easy or fun. It’s also not our natural state of being. As mentioned earlier, our mind and body is created to turn away from threats and discomfort out of safety and survival. Learning to override this initial reaction is hard, but can lead to more long term relief. A good, albeit difficult, first step is to work on noticing our emotions versus reacting to our emotions. When we feel irritable, angry, sad, frustrated, scared, worried, or any other uncomfortable feeling, we may naturally want to find ways to fix or get rid of it. We have a tendency to do this for others’ discomfort, as well. Unintentionally, we may be prolonging our own or others’ suffering. Sitting in and validating our feelings instead of pushing them away or playing along with them, can be far more beneficial.

If we can allow ourselves some space to explore and sit in our discomfort, we can potentially learn some things about ourselves. Knowing how our anxiety manifests can be vital in learning how to manage it. There are a variety of symptoms of anxiety, both physical and emotional. Cognitive and emotional symptoms include: difficulty concentrating, mind going blank, restlessness, irritability, worry, and fear. Physical symptoms include being easily fatigued, muscle tension, nausea, diarrhea, sleep difficulties, physical restlessness, stomachache, and headache. Taking our time to notice how we are feeling, physically and mentally, will help us to learn how our anxiety presents itself.

Once we have a better idea of how our anxiety presents, we can start to take note of potential stressors, no matter how big or small, that may be influencing our emotions. Finding patterns between our emotions and environmental stressors is the next step, in order to anticipate and manage anxiety symptoms. When we can draw connections between stressors and the manifestation of anxiety, we can prepare ourselves for future discomfort. Sometimes, there may be such small triggers for anxiety that they are seemingly non-existent. If your anxiety tends to appear without a clear trigger, it’s important to still treat our anxiety with the same compassion as we would when the trigger is obvious.

Sharing How You Feel With Others

Understanding anxiety can take time and may be a difficult process for some. Even more so, sharing and educating our family, friends, and co-workers can be an overwhelming task. We are allowed to be selective with who we share our most vulnerable moments. Confiding in our closest friends or family members, particularly those we trust the most, can be the best people to share what we’re feeling. Telling them about what to look for when you are anxious and what situations could be potential triggers tends to be the most helpful. If you are able to provide them more information as to what helps you manage your anxiety, they can assist you in practicing those skills, and help you to avoid or navigate triggers.

You are also allowed to set boundaries with people that may make your anxiety worse or do not take the time to understand or acknowledge it. Protecting our mental health is a critical part of anxiety management. When people “don’t understand you”, and don’t take the time to learn, that can take a substantial toll on your well being. Setting time, physical distance, and emotional energy limits with those people can be necessary practices to protect the work you’ve done on managing your anxiety.

Works Cited

National Institute of Mental Health. (n.d.-a). NIMH Anxiety Disorders. Retrieved November 9, 2020, from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145336

How Common is PTSD in Veterans and How to Deal With It

Written by W. Nate Upshaw M.D. on November 2, 2020. Posted in Anxiety, Depression, Step-By-Step Guides.

Post-Traumatic Stress Disorder (PTSD) is a long-standing, debilitating mental health disruption that occurs after experiencing or witnessing a traumatic event. Having a trauma response to an event that is potentially life threatening, or has caused harm to you or others, is a normal physiological reaction – there’s no need to feel ashamed! If you’ve ever wondered how common PTSD is among veterans and how to deal with this disorder, keep reading as we have all of those answers below.

https://www.youtube.com/watch?v=BQHyWwYY-P0

The events that can lead to the development of PTSD vary. What someone may consider trauma and have a significant reaction to, others may recover from more easily. Examples of trauma, outside of war and combat, can include: accidents, sudden deaths, physical violence, sexual violence, childhood abuse, genocide, natural disaster, terrorism, and generally anything that may put someone’s physical and emotional safety at risk. Signs and symptoms of PTSD include:

Intrusive thoughts or flashbacks of the traumatic event
Avoiding reminders of the traumatic event
Negative thoughts and feelings about self or others
Arousal and reactive symptoms such as irritability, anger, reckless or self-destructive behaviors, startle response, difficulty concentrating or sleeping.

While we know PTSD can happen to anyone experiencing a traumatic event, PTSD is a common diagnosis among veterans. How common is PTSD in veterans? The number of veterans diagnosed with PTSD varies by service era:

Operations Iraqi Freedom and Enduring Freedom = between 11-20% experience PTSD in a given year.
Gulf War (Desert Storm) = approximately 12% experience PTSD in a given year.
Vietnam War = approximately 15% of Vietnam veterans were diagnosed with PTSD at the time of the most recent study in the late 1980s, the National Vietnam Veterans Readjustment Study (NVVRS), however it is estimated that about closer to 30% have had PTSD in their lifetime.

Also, there are other considerable environmental and social factors that play into how many veterans suffer from post-traumatic stress disorder. These factors include one’s own actions and behaviors during combat, the politics around the war, where the war is fought, and the type of enemy you face. One very common cause of PTSD in the military is military sexual trauma (MST). MST is any sexual harassment or sexual assault that occurs while you are in the military. Sexual assault happens to both men and women, and occurs during peacetime, training, or war. Among Veterans who use VA health care, about:

23% reported sexual assault when in the military.
55% of women, and 38% of men have experienced sexual harassment during their time in the military.

Unfortunately, it’s quite likely that if you are or know a veteran in your life, they may have experienced some level of PTSD. In most cases, PTSD is treatable, if you have access and resources available to you. More traditional talk therapy and trauma-focused types of therapy are the most highly recommended type of treatment for PTSD. “Trauma-focused” means that the treatment focuses on the memory of the traumatic event or its meaning to the individual. These methods utilize a variety of different techniques that help you process the traumatic memories and experience. Specific trauma treatment modalities include:

Prolonged Exposure (PE): PE teaches you how to gain control by facing your negative feelings. It involves talking about your trauma with a licensed and trauma-trained therapist, and facing some of the things you have avoided since the trauma.
Cognitive Processing Therapy (CPT): CPT helps you to reframe negative thoughts you have about the trauma. It involves talking with your therapist about the negative thoughts, as well as doing short writing assignments.
Eye Movement Desensitization and Reprocessing (EMDR): EMDR helps you process and make sense of your trauma. It involves calling the trauma to mind while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone).

All of these therapies can help someone who suffers from PTSD work through the trauma, identify and practice skills to help ground them if they’re experiencing flashbacks, maintain relationships, and move forward in their life with less fear.

For some, finding treatment without medication is important. That’s when alternative treatments, such as TMS therapy, can generate a positive outcome if the patient has PTSD that stems from depression. However, medications are also a helpful treatment tool that you can discuss with your medical or psychiatry physician. Oftentimes, SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), antidepressant and anti-anxiety medications, can be prescribed to help someone cope with PTSD. These generally help with symptoms and can help increase the efficacy of therapy. It’s definitely helpful and reassuring to know that there are numerous treatment options available for PTSD and that you are not alone in this journey.

Works Cited

American Psychiatric Association. (n.d.-e). What Is Posttraumatic Stress Disorder? Retrieved September 3, 2020, from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

Posttraumatic stress disorder. (2018, August 28). Retrieved September 3, 2020, from https://www.womenshealth.gov/mental-health/mental-health-conditions/post-traumatic-stress-disorder.

U.S. Department of Veterans Affairs. (n.d.). VA.gov | Veterans Affairs. Retrieved September 3, 2020, from https://www.ptsd.va.gov/understand/what/ptsd_basics.asp.

U.S. Department of Veterans Affairs. (n.d.-c). VA.gov | Veterans Affairs. Retrieved September 3, 2020, from https://www.ptsd.va.gov/understand/common/common_veterans.asp

U.S. Department of Veterans Affairs. (n.d.-a). Medications for PTSD. Retrieved September 3, 2020, from https://www.ptsd.va.gov/understand_tx/meds_for_ptsd.asp

Living With Bipolar Disorder

Written by W. Nate Upshaw M.D. on August 25, 2020. Posted in Anxiety, Depression, Mental Health Maintenance.

Living with bipolar disorder is very challenging. It’s a serious, chronic mental illness characterized by intense and unpredictable mood swings. Each mood swing has the potential for turning a person’s life upside down. People with bipolar disorder have the same kind of depression as those with major depression, but occasionally experience an unusually euphoric mood called mania. In between the profound highs and lows, people with bipolar disorder experience normal moods called euthymia.

Living with bipolar disorder can be very challenging. The long periods of normal moods can fool a person into thinking that their depression and manic episodes have gone away. But depression or mania will always re-occur until a person is on a steady treatment regimen.

https://www.youtube.com/watch?v=a5lGyDNxOgg

Living with bipolar disorder presents challenges that must be met in order to live a fulfilling and productive life. One of these challenges is living with medication.

Medication and Bipolar Disorder

Living with bipolar disorder typically requires daily medication to eliminate mood swings. Mood stabilizers, like lithium, lamotrigine, valproate, or carbamazepine are common treatments. Antipsychotic medications can also keep mania under control if it’s persistent. Without medication, a person will suffer the depths of profound depression and often psychotic highs of unrestrained mania. Many people are at first resistant to medication, however. Because their behavior is so at odds with their normal behavior during mania, people tend to discount the chances that it will recur. Unfortunately, left untreated, bipolar episodes occur more and more frequently.

Myths about Living with Bipolar Disorder

Living with bipolar disorder means dealing with myths about it. Some common myths are:

Myth 1: You can’t have a normal life if you have bipolar disorder.

Fact: With consistent medication and therapy, a person with bipolar disorder can have as much of a normal, ordinary (or extraordinary) life as anyone else.

Myth 2: Willpower is what you need to be in control of bipolar.

Fact: Bipolar disorder cannot be controlled by sheer willpower. You can’t tough it out. Medication, therapy, and awareness of the facts about bipolar disorder are what allow a person to keep it managed.

Myth 3: All medication for bipolar is worse than the disease itself.

Fact: The right medication will allow you to feel and behave like yourself. People often talk about how a psychiatric medication made them feel like a zombie or “just not like themselves,” which is often a sign that in reality, the person is on the wrong medication or on too high a dose. It’s true that it can take several weeks for a person to adjust completely to medication, and there’s no way to rush that adjustment period.

Myth 4: There’s no way to predict bipolar phases.

Fact: There are known triggers for bipolar phases. For example, insomnia can trigger manic phases. A lack of restful sleep is one of the hallmark signs of an impending mood shift. As with all psychological disorders, changes in a person’s routine can also trigger mood shifts.

Myth 5: There’s only one form of bipolar disorder.

Fact: There are several varieties of bipolar disorder. Bipolar I is the most common and involves periods of depression, normal moods, and mania. Bipolar II has the same degree of depression that bipolar I does, but a less intense form of mania called hypomania. Cyclothymia is a disorder similar to bipolar I, but the highs and lows are much less intense.

Myth 6: Bipolar disorder is cyclical.

Fact: Mood swings in bipolar disorder may be very irregular. A person may have far more depressive episodes than manic. There isn’t a one to one relationship between extremes of mood in bipolar disorder.

Myth 7: Bipolar disorder is most often found in geniuses.

Fact: People of all kinds get bipolar disorder. The myth of the “bipolar genius mind” is common in the media and is often used to dramatize the condition, but there’s no consistent association between bipolar disorder and high levels of intellectual achievement.

Treatment for Bipolar Disorder

All types and intensities of bipolar disorder benefit from regular psychotherapy, and most people with type I bipolar disorder require medication. Bipolar disorder responds well when people are proactive; that is, they monitor their symptoms and take action immediately if their condition worsens. A holistic approach to bipolar disorder is one of the most useful ways to keep it in check. This includes psychotherapy, medication, good nutrition, and healthy amounts of exercise and leisure.

TMS Therapy as an effective alternative for depression

In 2008, the FDA approved the treatment of depression with transcranial magnetic stimulation (TMS). TMS therapy uses a powerful and precise magnetic field applied to an area of the brain that regulates mood. It is completely non-invasive, is done on an outpatient basis and provides significant relief from the symptoms of depression. TMS therapy is covered by major insurance companies, Medicare and TRICARE.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

Bipolar disorder. (2018, January 31). https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961.

Keck, P. E., McElroy, S. L., Havens, J. R., Altshuler, L. L., Nolen, W. A., Frye, M. A., … Post, R. M. (2003, June 28). Psychosis in bipolar disorder: phenomenology and impact on morbidity and course of illness. https://www.sciencedirect.com/science/article/abs/pii/S0010440X03000890.

Lewis, K. S., Gordon-Smith, K., Forty, L., & Florio, A. D. (2018, January 2). Sleep loss as a trigger of mood episodes in bipolar disorder: Individual differences based on diagnostic subtype and gender: The British Journal of Psychiatry. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/sleep-loss-as-a-trigger-of-mood-episodes-in-bipolar-disorder-individual-differences-based-on-diagnostic-subtype-and-gender/41F07BA90B95312BF9CB73CD941DA645.

U.S. Department of Health and Human Services. Bipolar Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml.

https://youtu.be/HRIbYrrRvVE

How to Help Someone with Anxiety

Written by W. Nate Upshaw M.D. on August 3, 2020. Posted in Anxiety, Step-By-Step Guides.

Anyone can experience anxiety when faced with situations that generate worry or fear. While we’re all capable of having feelings of anxiety at certain moments during our lifetimes, it can become serious when it interferes with a person’s day-to-day routine for long periods of time. Approximately 18% of Americans suffer from anxiety disorder, making anxiety the most common mental illness in the United States. Women experience anxiety more frequently than men, but anyone can develop anxiety regardless of sex, age, race, or genetics. Depending on the type and severity, anxiety may significantly affect everyday life for those experiencing the symptoms as well as those around them. Read on to learn more about how you can help someone with anxiety.

https://www.youtube.com/watch?v=nW6GQCv9R30

Support a person who needs help

Your approach matters. Think about who you are approaching and what your relationship is to that person. The way you approach a family member may be different than a friend or coworker. It will determine how receptive they may be and how empathetic you can be for them. Be sure to recognize their feelings and whether they’re being open or defensive.

Ask questions and listen. Ask how they are feeling. Most of the time people will try to make you believe they are fine even when they are not because they are afraid of getting help. Ask again and comfort them. Let them know you are there for them by being a good listener.

Share resources. Refer them to a medical professional who specializes in treating patients with signs of anxiety. A physician or therapist can help. Alternative methods, such as TMS (transcranial Magnetic Stimulation) therapy, may also be an option for your loved one looking to treat anxiety caused by depression.

Follow up. After you sit down and talk, follow up on the conversation to see if they have used the medical resources or any advice received. If not, remind them that you are there for them and encourage them to seek treatment and get the help they need.

The importance of seeking professional help

Knowing how to help someone with anxiety is important for initiating proper care and ultimately reducing anxiety symptoms. The most important first step in dealing with anxiety is to seek professional help. Without a systematic clinical evaluation by a mental health professional, it can be challenging to identify the best strategy for overcoming someone’s unique experience with anxiety. Proper diagnosis and exploration of therapeutic options is vital to effectively combat the disorder.

A therapist can help determine what types of treatment is most appropriate and most likely to help the patient achieve specific desired outcomes. Pharmaceutical drugs are often used for anxiety. While these medications can often help minimize one’s anxiety, there potentially are some downsides. For instance, any effectiveness may be short-lived. More importantly, drugs for anxiety are plagued by safety issues and unwanted side effects.

Identifying a therapist who is knowledgeable about the latest research and relevant innovations in anxiety treatment methods can help improve the chances of overcoming some of anxiety’s debilitating symptoms. Not all treatments work the same way for everyone, so finding the right treatment for someone with anxiety is a task that can only be accomplished with the help of a medical professional.

https://www.youtube.com/watch?v=GOcrDcXO31s

TMS therapy to treat depression-induced anxiety

Some patients who suffer from depression also have significant anxiety symptoms. TMS therapy is an excellent treatment option for these patients. It works by non-invasively transmitting electromagnetic stimulation into the portion of your brain that controls your mood. TMS therapy has been successfully used as a treatment for depression for years, and has been associated to also reduce the symptoms of anxiety that arise from depression. What’s so great about TMS is the fact that it’s FDA cleared, medication-free, painless and leaves no side effects. Plus, it’s covered by most major insurance companies, Medicare and Tricare.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

John Hopkins Medicine. (n.d.). How to Help Someone With Anxiety. Retrieved July 28, 2020, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/how-to-help-someone-with-anxiety

Jovanovic, T. (2019, November 12). Anxiety ” What Is Anxiety? Signs, Causes, Symptoms. Retrieved from https://www.anxiety.org/what-is-anxiety

NIH Medline Plus. (2019, November 20). How to Help Someone With Anxiety. Retrieved July 28, 2020, from https://magazine.medlineplus.gov/article/how-to-help-someone-with-anxiety

Living with Someone with Bipolar Disorder

Written by W. Nate Upshaw M.D. on June 30, 2020. Posted in Anxiety, Depression, Step-By-Step Guides.

Bipolar disorder is a difficult condition to live with, but when it’s well-managed it presents no barriers to good relationships. Uncontrolled bipolar disorder is another story. The extreme highs and lows associated with bipolar disorder can prove disruptive to even the strongest of bonds. The lack of stability in a person’s mood and the significant alterations in a person’s behavior can be devastating to a relationship.

https://www.youtube.com/watch?v=V-P1YmHEA4EBipolar disorder consists of periods of normal functioning, divided by phases of depression, mania, or mixed episodes.

Mania. Manic episodes lead to a bipolar spouse or partner becoming easily irritable and quickly angered. The false euphoria may boost risk-taking behaviors, wildly excessive spending, binge drinking and more dangerous behaviors with long-lasting consequences. For example, a person experiencing a manic episode can easily blow a family’s savings.
Depression. In the depressed phase, a person will feel intensely sad and may become very withdrawn and uncommunicative. They’ll usually lose interest in spending time with their spouse and their sex drive will decrease. This is easy to misinterpret as rejection.
Mixed Episodes. During a mixed episode, a person with bipolar disorder may have symptoms of mania or hypomania and depression at the same time. This may be confusing or stressful for their partner, who may not know what kind of reaction to expect.

Typically, a person with bipolar will spend weeks to months in a fairly stable mood, with depressive episodes interspersed throughout. Some people however are “rapid cyclers” and will go through at least 4 full phases of mania and depression a year.

How to Live With a Bipolar Spouse

When a bipolar person is in an average mood, everything goes along normally. When a person’s bipolar disorder is well-managed with medicine and therapy, their moods are much the same as anyone else’s. If your bipolar husband or wife stops taking their medication, the disorder will show up as a rapid, severe mood shift. Your loved one may seem like a stranger during a severe depressed or manic phase.

It takes a structured and methodical approach to prevent a bipolar marriage breakdown, but it’s possible. Consider the following steps to keeping your sanity when living with someone with bipolar disorder.

Get the facts about bipolar disorder. Bipolar disorder is a complex illness. The more you know about it, the less frightening and confusing it’ll be.
Get into therapy. You need professional support when living with a bipolar spouse. People typically experience many powerful emotions, like anger toward a bipolar spouse, frustration, sadness and disappointment.
Take care of yourself. The very first step in living with a bipolar spouse or partner is to take care of yourself. Don’t neglect yourself for one moment. The disorder is exhausting for everyone, and too many spouses of bipolar people run themselves into the ground. Remember, you’re not responsible for your spouse’s mental health. You’re a partner in their psychological well-being, but you cannot be responsible for anyone’s mental health but your own.
Establish healthy separation. Avoid codependency. Your bipolar husband or bipolar wife has a mental illness. Many people compound the problem by making their own happiness dependent on how happy or stable their partner is. When you’re living with a bipolar spouse, you must learn to enjoy life on your own terms.
Set boundaries. Bipolar people may invade boundaries and push limits, primarily in their manic phase. You have to keep all boundaries firm. People in manic phases will challenge them.
Be proactive when setting safeguards. It’s important to do things like establishing separate bank accounts
Develop a support system. Your family and friends can provide you with essential support. Don’t cut yourself off from others. It’s important that you feel supported, too.
Insist on medication compliance. It’s likely your spouse will need medications to control their bipolar disorder. Insist that they take them exactly as their physician prescribed, with no changes, every day. Getting the benefit from psychiatric medication requires taking it regularly, without skipping doses.
Keep the lines of communication open. Keep talking to your partner. Ask them what they need from you and let them know your needs.
Be kind to yourself. Living with a bipolar partner is challenging. You deserve good treatment, too.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

https://www.youtube.com/watch?v=HRIbYrrRvVE

Works Cited

Barrios, C., Chaudhry, T. A., & Goodnick, P. J. (2001, December). Rapid cycling bipolar disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11825328

Bipolar Disorder. (n.d.). Retrieved April 8, 2020, from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

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