Anxiety is a common mental health condition. However, while it is normal to feel anxious and worried sometimes, having high levels of anxiety that are more intense and occur more frequently over a long period can impact mental health, wellbeing, and functionality. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder and various phobia-related disorders.

Generalized anxiety disorder (GAD) involves the display of excessive anxiety or worry, restlessness, irritability, fatigue, difficulty concentrating, muscle tension, and sleep disturbance. These manifestations may occur most days for at least 6 months about a number of things such as personal health, work, social interactions, and everyday routine life circumstances.

Panic disorder displays as recurrent unexpected panic attacks, which are sudden periods of intense fear or discomfort that come on quickly and reach their peak within minutes. Symptoms might include a pounding heart, sweating, shaking, a sensation of shortness of breath, feeling of choking, chest pain, nausea, dizziness, numbness or tingling sensations, and fear of losing control, going crazy or dying.

Phobias are an intense fear of specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object. Usually, the phobic situation is actively avoided or endured with intense fear or anxiety. Some examples of specific phobias include the fear of flying, heights, blood, receiving injections, or specific animals such as spiders, dogs, or snakes.

Social anxiety disorder (previously called social phobia) involves a general intense fear of, or anxiety toward, social situations—such as conversations, meeting unfamiliar people, or being observed—or performance situations such as giving a speech.

Agoraphobia is an intense fear of two or more of the following situations: Using public transportation; being in open spaces; being in enclosed spaces; standing in line or being in a crowd; and being outside of the home alone. People with agoraphobia often avoid these situations, in part because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

Treatment:

Anxiety disorders are generally treated with talk therapy (psychotherapy, mainly CBT), medication, or both. There are many ways to treat anxiety and people should work with their doctor to choose the treatment that is best for them.

Bipolar disorder is a mental health condition that involves high (manic or hypomanic) episodes and can include low (depressive) episodes (similar to those related to depression). People with manic episodes have periods of abnormally, persistently high or irritable moods and increased energy and activity that is different from how they usually are and that last for at least one week. They may also be distractible, talkative, agitated, have feelings of inflated self-esteem or that they have special abilities and can engage in activities that have high potential for painful consequences. They can have many ideas flying thought their heads in quick succession and no need for sleep for days at a time. In many ways, mania can be thought of as the opposite of depression. While both are episodic, these mood states cause difficulties in functioning in life (work, school, relationships, and friendships, etc.).

Treatment:

Untreated, an episode of mania typically lasts around 3 to 6 months, but with treatment a manic episode can be contained within a matter of days or weeks. Given the risks involved with both bipolar mania and depression, in moderate/severe cases, hospitalization can be necessary for stabilization and initiation of treatment. Treatment includes medications (mood stabilizers and antipsychotics) and psychotherapy.

Depression is a period of two or more weeks of depressed mood and/or loss of interest and pleasure in activities accompanied with some of the following symptoms: oversleep or inability to sleep, decrease in appetite/weight loss/weight gain, restlessness or sluggishness, fatigue, feelings of worthlessness or guilt, diminished ability to think, and recurrent thoughts of death and/or suicide. These symptoms can lead to loss of functioning at work and/or disruptions in relations with friends or family and other important aspects in life.

Treatment:

Treatment depends on the severity of the case. Mild cases can start by self-help (i.e., self- help books, exercise, etc.) and/or psychological/talk therapy (CBT, supportive, etc.). Moderate to severe cases may need interventions with medications such as antidepressants and/or other groups of medications. More severe cases may need ECT.

Eating disorders are mental health disorders where people experience disturbances in their eating behaviours and related thoughts and emotions. There are three main types: anorexia nervosa, bulimia nervosa and binge eating disorder.

Anorexia nervosa

Anorexia nervosa is the restriction of food intake leading to a significantly low body weight, less than minimally accepted according to age, sex, height, and physical health. This along with an intense fear of becoming fat and persistent behaviours that interfere with weight gain, even though the individual is at significantly low weight. There is also significant disturbance in the way body image or weight is perceived with denial of seriousness of low body weight.

Bulimia nervosa

Bulimia nervosa is the recurrence of episodes of binge eating (see below) along with recurrent inappropriate compensatory behaviours to try to prevent weight gain. These can range from induced vomiting, misuse of laxatives and diuretics, fasting, or excessive exercise.

Binge eating

This involves episodes of eating large amounts of food (can be high-caloric foods) in a short period of time, along with a feeling that one cannot stop eating (lack of control). This is associated with three of the following: eating more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of feelings of embarrassment at the high amounts of food consumed, and feeling disgusted with oneself, depressed or very guilty after binging.

Treatment:

Treatment is multidisciplinary involving psychiatrists, psychologist, nutritionists, and in some cases internists. The following are some of the treatment guidelines used:

• Physical and laboratory assessments for the general medical condition.
• Nutritional assessment and meal plans to regain a healthy body weight.
• Psychotherapy to help sufferers understand the thoughts, emotions and behaviours that trigger these disorders.
• Family therapy, which can be paramount to treatment especially in younger individuals.
• Psychiatric medications maybe used to treat comorbid anxiety or depression or other conditions, if present.

Gender identity means the sex we most feel we are. For most people this is the sex they were assigned at birth. However, for some people there is a mismatch between the sex they feel they are and the sex they appear to be to other people.

Gender dysphoria is the term used by health professionals for the distress people experience when the sex they were assigned when they were born doesn’t match the sex they feel they are. Problems associated with gender dysphoria include feelings of unhappiness, difficulties in relationships with family and friends, stress, anxiety, or depression.

Treatment:

Treatment involves psychological support such as talk therapy. Professionals can help you explore your feelings and understand yourself better. You will be able to talk through the implications of changing sex on your life. Medications may be used if there is any comorbid condition such as depression and/or anxiety.

Obsessive-compulsive disorder (OCD) is characterized by the onset of obsessions and/or compulsions. Obsessions are intrusive, recurrent, and persistent. They induce unwanted thoughts, urges or images that cause marked distress for the individual. The person often attempts to ignore and suppress these thoughts with little success. Obsessive thoughts and themes can range from contamination, symmetry, aggression, harm, and religious, or sexual issues.

Compulsions are the repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession. These compulsions, clearly excessive, are aimed at preventing or reducing anxiety or distress. The individual can feel driven to perform actions in response to an obsession. Examples of compulsions may be handwashing, organizing, checking, and rechecking, mental acts such as praying, counting, and silently repeating words.

Body dysmorphic disorder

This is characterized by preoccupation with one or more flaws in physical appearance that appear only slight to others or are not observable. Symptoms are in the form of repetitive behaviours of: Mirror checking, skin picking, excessive grooming, reassurance seeking , and comparing one’s appearance with that of other people in response to these concerns. This preoccupation causes significant distress or impairment in areas of functioning.

Treatment:

Treatment options are various and may include medications and psychotherapy. Medications can be antidepressants which work with both obsessions and compulsions. In more severe cases, an addition of an antipsychotic can help ease the symptoms. Talk therapy (Psychotherapy—specifically CBT, exposure, and response prevention) can help provide tools that allow changes in thought and behaviour patterns. Milder cases can start with psychotherapy. More distressing cases can use a combination of both medications and therapy, which can be the most effective.

A person with a personality disorder can have patterns of behaviour, feelings, and thinking that is quite different from the average individual around them. These patterns manifest in cognition (ways of perceiving and interpreting things), affective (appropriateness of emotional response), and impulsivity. As a result, they can have significant distress in important areas of functioning such as relationships, work, activities, etc. Personality disorders usually begin in adolescence or early adulthood but may show signs in childhood as well. The following are examples of personality disorders with their accompanying manifestations:

Paranoid personality disorder

• Pervasive distrust and suspicion of others and their motives and unjustified belief that others are trying to harm or deceive you including recurrent suspicion that spouse or sexual partner is unfaithful.
• Unjustified suspicion of the loyalty or trustworthiness of others and hesitancy to confide in them due to unreasonable fear that they will use the information against you.
• Perception of innocent remarks or nonthreatening situations as personal insults or attacks.
• Angry or hostile reaction to perceived slights or insults and tendency to hold grudges.

Schizoid personality disorder

• Lack of interest in social or personal relationships, preferring to be alone, and little or no interest in having sex with another person.
• Limited range of emotional expression, inability to pick up normal social cues, and appearance of being cold or indifferent to others.
• Inability to take pleasure in most activities.

Schizotypal personality disorder

• Peculiar dress, thinking, beliefs, speech, or behaviour.
• Odd perceptual experiences, such as hearing a voice whisper your name or belief that certain casual incidents or events have hidden messages meant only for you.
• Flat emotions or inappropriate/indifferent emotional responses to others as well as social anxiety and a lack of or discomfort with close relationships.
• ‘Magical thinking’ — believing you can influence people and events with your thoughts.

Antisocial personality disorder

• Disregard for others’ needs or feelings and lack of remorse.
• Consistent irresponsibility and persistent lying, stealing, using aliases, conning others.
• Recurring problems with the law and repeated violation of the rights of others.
• Aggressive, impulsive, often violent behaviour and disregard for the safety of self or others

Borderline personality disorder

• Impulsive and risky behaviour, such as having unsafe sex, gambling, or binge eating.
• Unstable or fragile self-image, ongoing feelings of emptiness, and suicidal behaviour or threats of self-injury.
• Unstable and intense relationships with fluctuating moods, often as a reaction to interpersonal stress and a fear of being alone or abandoned.
• Frequent, intense displays of anger and intermittent stress-related paranoia.

Histrionic personality disorder

• Constant attention-seeking using excessive emotions, drama, or sexual provocativeness.
• Opinionated and forceful with few facts or details to back up strong opinions.
• Shallow, rapidly changing emotions easily influenced by others.
• Excessive concern with physical appearance and thinks relationships with others are closer than they really are.

Narcissistic personality disorder

• Belief of superiority to others with fantasies about power, success, and attractiveness.
• Arrogance, failure to recognize others’ needs and feelings, and envy of others or belief that others envy you.
• Exaggeration of achievements or talents and expectation of constant praise and admiration.
• Unreasonable expectations of favours, often taking advantage of others.

Avoidant personality disorder

• Excessive sensitivity to criticism, rejection, or embarrassment with feelings of inadequacy, inferiority, or unattractiveness.
• Socially inhibited, timid and isolated, avoiding new activities or meeting strangers including for work purposes.
• Extreme shyness in social situations and personal relationships.

Dependent personality disorder

• Excessive dependence on others and fear of having to provide self-care or fend for yourself if left alone.
• Submissive or clingy behaviour toward others with lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions.
• Difficulty in starting or undertaking projects alone due to lack of self-confidence.
• Fear of disapproval leading to inability to disagree with others and a tolerance for poor or abusive treatment, even when other options are available.

Obsessive-compulsive personality disorder

• Preoccupation with details, orderliness, and rules and inability to discard broken or worthless objects.
• Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don’t meet your own strict standards.
• Desire to be in control of people, tasks and situations, and inability to delegate tasks.
• Neglect of friends and enjoyable activities because of excessive commitment to work or a project.
• General rigidity and stubbornness as well as inflexibility about morality, ethics, or values.
• Tight, miserly control over budgeting and spending money.

Treatment:

Treatment includes mainly psychological therapies and social rehabilitation. Medication can also be used.

Post-traumatic stress disorder (PTSD) may be experienced after being directly being exposed or witnessing a traumatic event happening to others (or learning that it happened to a loved one). This traumatic event can be an actual or threatened death, serious injury, or sexual violence. Each person’s experience to trauma is unique. You may have experienced the same traumatic event as someone else but become affected differently.

Symptoms associated with PTSD may include intrusive symptoms, avoidance of stimuli related to events, negative alterations in mood and cognitions, and marked alterations in arousal. Intrusive symptoms can be in the form of nightmares, vivid flashbacks or the intrusive reliving of memories related to the incident. Avoidance of stimuli related to the event can be efforts to avoid reminders such as people or places. Negative alterations in cognitions and mood associated to the traumatic event can be an inability to remember an important aspect of the event, negative emotions and thinking, feelings of detachment or numbness, or diminished interest in participation in significant activities. Marked alterations in arousal and reactivity can manifest as angry outbursts, exaggerated responses, problems with concentration, or sleep disturbances.

Treatment:

After a traumatic event, symptoms may improve within a few weeks with good self-care and support including identifying triggers, confiding in someone, and seeking peer support, giving oneself time, and looking after one’s physical health. A diagnosis of PTSD may be given if symptoms worsen, persist for longer than a month, or interfere with daily functioning. In this case, talk therapy (trauma-focused CBT) may be used. Other modalities may be Eye Movement Desensitization and Reprocessing (EMDR). In addition, medications (most commonly antidepressants) may be used as well.

Schizophrenia is a serious mental illness which may involve an abnormal interpretation of reality. Symptoms may include a combination of hearing, seeing, or feeling things that are not there in reality (hallucinations), abnormal false fixed beliefs (delusions), and disorganization (where there is an inability to organize thoughts in a clear way leading to odd or seemingly purposeless speech or  behaviour). In addition, a person may have negative symptoms in the form of an inexpressive face, monotonous speech, few gestures, lack of interest in the world and other people, and the inability to act spontaneously. This combination of distorted thinking, behaviour and negative symptoms may impair daily functioning and can be disabling.

Treatment:

People with schizophrenia may require lifelong treatment. Treatment consists of medications (mainly antipsychotics) which can be taken as tablets or long-term injections. Individual and group psychotherapy sessions can help too. Treatment mainly aims to reduce symptoms,  improve overall quality of life, and enhance the ability to live independently.

These are experienced bodily symptoms that are distressing or cause disruption of day-to-day activity. Excessive thoughts, feelings or  behaviours relating to those symptoms lead to anxiety about one’s health or the seriousness of the illness they might be experiencing. Excessive time and energy are devoted to these symptoms or health concerns. Somatic symptom disorder maybe primarily in the form of pain but other symptoms may also predominate. A common misconception is that individuals suffering from Somatic Symptom Disorder do not actually experience the symptoms they describe.

Illness anxiety disorder

This is the preoccupation with having or acquiring a serious illness despite having no or mild bodily complaints. There is usually a high level of anxiety about one’s health, and the person is easily alarmed about their wellbeing being at risk. The individual may repeatedly check their body for signs of illness. This disorder may also be characterized by excessive seeking of medical care.

Conversion disorder

This is an altered ability to move or feel a body part to an extent that causes significant distress or impairment in important areas of life (such as work or daily living) or requires medical attention. Symptoms may vary and be in the form of weakness, paralysis, abnormal movement, swallowing difficulty, talking difficulty, seizures, sensory loss, and sometimes disturbed hearing, smell, or sight.

Treatment:

Treatment includes psychological therapies and medications when needed.

Sleep disorders are conditions that result in changes in sleep patterns. A sleep disorder can affect overall health, safety, and quality of life and increase the risk of other health problems. There are five types of sleep-wake disorders:

Insomnia is a common disorder that includes having difficulties in falling or staying asleep, waking up too early and not being able to get back to sleep, or still feeling tired when you wake up.

Hypersomnolence includes excessive sleepiness despite having at least 7 hours or more of quality sleep.

Narcolepsy is a rare condition that causes a person to suddenly fall asleep at inappropriate times.

Breathing-related disorders include sleep apnoea, which is a disorder in which breathing repeatedly stops and starts. Specific signs may include snoring loudly and feeling tired even after a full night’s sleep.

Parasomnia may involve unwanted experiences or events that occur during sleep. These may include abnormal movements, behaviours, emotions, perceptions or dreams. Examples include sleep walking, sleep terrors, and nightmares.

Treatment:

Treatments mainly depend on the cause of the sleep disorder. The Behman’s doctors evaluate each patient and design a tailored treatment plan according to individual needs.