Stress

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Q. Glen, I am Stressed Out What Can I Do?

A. Being stressed out is no fun. Everyone knows that. But what a lot of people don't know is that in addition to making you feel anxious and irritable, stress can also cause physical issues such as headaches, muscle aches, back pain and sleeping problems—things you might not immediately think of as being caused by stress.
The good news is, there are plenty of easy, healthy ways to help you reduce stress and feel better.

Exercise. Go for a run. Take a hike. Swim some laps. Pretty much any type of physical exercise can help bring down your stress levels and improve your overall sense of well-being. And, of course, exercise is just plain good for you. Remember to talk to your doctor before beginning or changing an exercise routine.

Massage. Shiatsu. Deep tissue. Swedish. Or a good old-fashioned back rub. Whatever kind of massage you prefer, it's one of the more enjoyable ways to reduce anxiety.


Yoga. Hitting the yoga mat is another great way to help manage stress. It can also help you tone your muscles, lose weight, increase flexibility and improve balance.

What it means to feel better.
Feeling better is not just about the pills we take. It's about the choices we make every day—whether it's exercising to reduce stress, getting an extra hour of sleep or making healthier food choices.

Any personal health questions or problems mental or physical or before starting any diet or exercise program.

Please consult your physician !

My mission is to provide you with "Trusted Advice for a Healthier Life."

Yours in good health

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Male depression: Don't ignore the symptoms

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Q. Glen, Do men get depressed ? And how do I know if I am?

A. Yes! Male depression is a serious medical condition. Many men try to tough it out on their own, but depression symptoms can make them chronically miserable. Effective treatment helps.

Are you irritable, isolated and withdrawn? Do you find yourself working all the time, drinking too much alcohol, using street drugs or seeking thrills from risky activities?

If so, perhaps you're being chased by what Winston Churchill called his "black dog" — male depression. Churchill attempted to ward off his black dog with compulsive overwork and large amounts of brandy. For male depression, the coping strategy may be reckless driving, risky sex or shutting yourself off from the world.

But none of these can keep male depression at bay for long. Even worse: Men with depression are at an increased risk of suicide.

Male depression often undiagnosed

Each year, depression affects about 6 million American men and 12 million American women. But these numbers may not tell the whole story. Because men may be reluctant to discuss male depression with a health care professional, many men with depression may go undiagnosed, and consequently untreated.

Some men learn to overvalue independence and self-control during childhood. They're taught that it's "unmanly" to express common feelings and emotions often associated with depression, such as sadness, uncertainty or a sense of hopelessness. They tend to see illness — especially mental illness — as a threat to their masculinity. So men may deny or hide their problems until a partner's insistence or a catastrophic event, such as job loss or arrest, forces them to seek treatment.

When they visit their health care professional, men are more likely to focus on physical complaints — headaches, digestive problems or chronic pain, for example — than on emotional issues. As a result, the connection between such symptoms and male depression may be overlooked. And even if they're diagnosed with depression, men may resist mental health treatment. They may worry about stigma damaging their careers or about losing the respect of family and friends.

Symptoms of male depression

In both men and women, common signs and symptoms of depression include feeling down in the dumps, sleeping poorly, and feeling sad, guilty and worthless. Men with depression, however, have bouts of crying less often than do women with depression.

Other symptoms of male depression often include:

• Anger and frustration
• Violent behavior
• Losing weight without trying
• Taking risks, such as reckless driving and extramarital sex
• Loss of concentration
• Isolation from family and friends
• Avoiding pleasurable activities
• Fatigue
• Loss of interest in work, hobbies and sex
• Alcohol or substance abuse
• Misuse of prescription medication
• Thoughts of suicide

In addition, men often aren't aware that physical symptoms, such as headaches, digestive disorders and chronic pain, can be symptoms of male depression.

Job stress a common trigger of male depression

Whether in men or in women, the precise cause of depression isn't known. Researchers believe depression is the result of a combination of genetics, your thought processes and your social environment. Everyone, for instance, is susceptible to depression in the wake of a major life stress, such as the end of an important relationship, the death of a loved one, moving or financial problems.

Some research suggests that for men, job-related stress may also play an important role in male depression. Some job characteristics that may be associated with male depression include:

• Lack of control over your responsibilities
• Unreasonable demands for performance
• Conflicts with supervisors or co-workers
• Lack of job security
• Night-shift work
• Excessive overtime
• More time than you'd like spent away from home
• Wages that don't reflect the level of responsibility

When male depression goes untreated

Like other men, you may feel that your depression symptoms aren't severe. You may believe that you should be able to just get over them or tough them out. You may try to deny them, ignore them or blunt them by drinking too much alcohol or working longer hours. But left untreated, male depression symptoms can disrupt your life in many ways and leave you chronically unhappy and miserable.

Depression can also affect your health. For instance, it can keep your stress response continually activated, a state that can damage many organs, including the heart. Depression may even shorten your life. In a given year, men with depression are more than twice as likely as men without depression to die of any cause. Women with depression also have an increased risk of dying, compared with women without depression, but the difference is not as great as it is in men. Although the reasons for this difference are unclear, men with depression may be more likely to engage in self-destructive behavior — from excessive drinking to reckless driving to suicide — that may contribute to it.

Depression also increases your risk of divorce and your children's risk of developing depression themselves. At work, male depression makes you less productive, limits your earning potential and increases your risk of losing your job.

Suicide and male depression

Although women are twice as likely to have depression, men are four times as likely to suffer its worst consequence: suicide. Starting in adolescence, men are far more likely than women to take their own lives. Older men, particularly white men over age 85, have the highest suicide rate. Although women attempt suicide more often than men do, men are more likely to complete suicide.

Men are more likely to use more lethal means in suicide attempts, such as guns, which partly accounts for their higher rate of suicide. But other factors also are involved. One such factor may be their tendency to move from suicidal thoughts to suicidal actions faster than women. Men take an average of just 12 months to go from contemplating suicide to attempting suicide. In contrast, it takes women about 42 months. During this time, men are less likely than women to show warning signs, such as talk of suicide. Because this window of opportunity is so short, family and mental health professionals may have little chance to recognize a man's depression and intervene.

Treatment and self-care for male depression

If you or someone close to you is considering suicide, seek help immediately from your doctor, the nearest hospital emergency room or emergency services (911).

If you suspect you have depression, schedule a physical examination with your family doctor or primary health care professional. Conditions such as a viral infection, thyroid disorder and low testosterone levels can produce symptoms similar to male depression. If your doctor rules out such conditions as a cause of your symptoms, the next step may be a depression screening. Treatment for male depression may include antidepressant medications, psychotherapy or both.

Self-care strategies also may help. These include:

• Setting realistic goals and prioritizing tasks
• Spending time with supportive family and friends
• Engaging in activities you enjoy, such as exercise, movies, ball games or fishing
• Delaying important decisions, such as changing jobs or getting married or divorced, until your depression symptoms improve

Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !

Wishing You A Healthy Life Style!

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Stress in Sheep's Clothing

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Q. Glen, I am stress out all the time is there any hidden stress that I don't know about?

A. Yes there are !Here are 5 hidden stressors and how to take the bite out of all of them

Hidden Stressor #1 - Using your computer

Here's what happens when you flick on your iMac: "Your breathing rate goes up 30 percent, your blinking rate goes way down, and you tend to tighten your arms and shoulders without knowing it," says Erik Peper, Ph.D., director of the Institute for Holistic Healing at San Francisco State University.

Slash the stress: Change your body position every half hour or so--simply standing while talking on the phone can improve bloodflow and ease muscle strain. Visit cheqsoft.com for free software that will tell you to also take microbreaks--quick pauses to close your eyes and flex your wrists.

Hidden Stressor #2 - Surviving a layoff

The ax fell and missed you. Good news, right? Maybe not. A Finnish study found that those who remain employed after a corporate downsizing are twice as likely to die of heart disease triggered by job stress.

Slash the stress: If you weren't told why the layoff happened and what will happen next, ask. "Information is a great calming force," says Harry Dahlstrom, author of Surviving a Layoff or Downsizing. "You should ask your boss questions about your job security and what new duties you have."

Hidden Stressor #3 - Living with a newly pregnant wife

She's glowing--but you're sweating. A study in Australia found that the first months of a pregnancy are the most stressful for first-time fathers, many of whom don't feel prepared for the responsibilities that lie ahead.

Slash the stress: Develop a financial strategy--draw up a new will, start a college account, get your insurance in order. "It gives men a sense of satisfaction and well-being to take care of the people who depend on them," says Glade Curtis, M.D., author of Your Pregnancy for the Father to Be.

Hidden Stressor #4 - Trying to relax

Forget those bills you have to pay. Forget the six projects waiting on your desk. Forget that noise your car is making. Just breathe deeply. Feel better? Maybe in the short term, but even the most effective relaxation technique is no substitute for getting to--and dealing with--the root cause of your stress.

Slash the stress: Use some of your downtime to address what's worrying you. "You have to think, What can I do? How can I fix it?" says Allen Elkin, Ph.D., author of Stress Management for Dummies. Make a list with two columns--stressors you can eliminate and those out of your control--and then start working on the first item in the first column.

Hidden Stressor #5 - Driving

Even after the engine cools down, you haven't. Scientists in Canada found that men who reported the most irritation while commuting were most likely to act stressed and hostile throughout the day.

Slash the stress: If your daily commute ties you up in traffic that's more stop than go, accept that you may need to wake up a half hour earlier. You can also explain your situation to your supervisor and try to adjust your morning schedule (that is, unless you just survived a layoff).

"People who have more flexibility in their work environment have less stress when they drive, because the time emergency isn't such a big concern," says Dwight Hennessy, Ph.D., author of the Canadian study.

Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !

Wishing You Great Health!

Any questions? Ask Glen

Antisocial Personality Disorder ( treatment )

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Q. Glen, What type of treatment is available for APD ?

A. Many types of psychotherapy techniques have been used to treat antisocial personality disorder. In younger people, family or group psychotherapy may help to change destructive patterns of behavior, teach new vocational and relationship skills, and reinforce a person's social support. Psychotherapy also may help a person with this disorder learn to be more sensitive to the feelings of others and encourage new, socially acceptable and productive ways of thinking about one's goals and aims. Cognitive therapy attempts to change sociopathic ways of thinking. Behavior therapy uses reward and punishment to promote good behavior.

In some cases, symptoms can be treated with medication. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), may decrease aggressiveness and irritability. They are useful if anxiety or depression is present, or if either is contributing to substance abuse.

There are many questions about how helpful any of these interventions can be. Treatment is more likely to be successful if it is started earlier in life, but long-entrenched patterns of thinking and behavior are difficult to change. Also, the longer a person lives with this personality style, the less he or she may be interested in taking responsibility for change. For some people, the tendency toward aggression and irritability decreases with age, but some personality characteristics may persist.

Often the only thing that can protect victims of antisocial behavior is the criminal justice system. In rare instances, corrections systems (jails and prisons) provide opportunities for treatment or rehabilitation, but often these environments, with their abundance of antisocial individuals, only promote antisocial behavior.

Any personal health questions or problems mental or physical or before starting any diet or exercise program.Please consult your physician !

Wishing You Great Health!

Glen Edward Mitchell

Any questions? Ask Glen

Antisocial Personality Disorder ( Expected Duration )

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Q. Glen, What is the duration of the disease (APD) ?

A. All personality disorders are lifelong patterns.

Any personal health questions or problems mental or physical or before starting any diet or exercise program.Please consult your physician !

Wishing You Great Health!

Glen Edward Mitchell

Any questions? Ask Glen

Antisocial Personality Disorder

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Q. Glen, What is Antisocial Personality Disorder?

A. Antisocial personality disorder, like other personality disorders, is a longstanding pattern of behavior and experience that impairs functioning and causes distress.

People with antisocial personality disorder don't follow society's norms, are deceitful and intimidating in relationships, and don't consider the rights of others. People with this type of personality sometimes have a history of criminal activity but are not sorry for their hurtful deeds. They can be impulsive, reckless and sometimes violent. This disorder is far more common and more apparent in men than women.

People with antisocial personality disorder may believe that only threats of punishment, rather than personal values, cause people to play by the rules. The belief leads to a tendency to exploit others, take advantage of their fairness or soft-heartedness, and feel indifferent toward or even contemptuous of their victims. A person with this disorder has little, if any, ability to be intimate with another person. Any lasting relationships involve abuse or neglect. Yet people with this disorder are sometimes charming and can be good actors who use lies and distortion to keep relationships going. Some with antisocial personality disorder have no goal beyond the pleasure of deceiving or harming others.

People with antisocial personality disorder appear to care for no one but themselves. They may be able to understand the emotions of others, but they don't suffer any shame or guilt about the pain they may be causing. Instead, they use their knowledge of others' weaknesses to gain favors or to manipulate. A person with this disorder usually does not take responsibility for any of his or her own suffering. He or she will blame others when things go badly. Many with this disorder are self-defeating and live lives without the many pleasures that come to people who are better able to have mutual and satisfying relationships.

People with this personality disorder can have related problems, such as chronic boredom or irritability, psychosomatic symptoms, pathological gambling, alcohol and substance abuse, and a variety of mood or anxiety disorders. They have a higher risk of suicide. A significant number have had behavior problems or attention deficit disorder as children.

Antisocial personality disorder is probably caused by a combination of factors.

• Influences from the environment. A chaotic family life with a lack of supervision may be involved in the development of this personality disorder. The disorder also may be more common where the community is unsupportive and provides little opportunity to be rewarded for positive behavior.

• Genetic (inherited) or biological factors. Researchers have found certain physiological responses that may be specific to people with antisocial personality disorder. For example, they have a comparatively flat response to stress -- they seem to get less anxious than the average person. They seem to have a harder time maintaining daytime arousal. They also have a weak "startle reflex," the involuntary response to loud noises. This relative insensitivity may affect their ability to learn from reward and punishment.

  The frontal lobe, the area of the brain that governs judgment and planning, also appears to be different in people with antisocial personality disorder. Some researchers have found changes in the volume of brain structures that mediate violent behavior. They may thus have more difficulty restraining their impulses, which may account for the tendency toward more aggressive behavior.

Any personal health questions or problems mental or physical or before starting any diet or exercise program.Please consult your physician !

Wishing You Great Health!

Glen Edward Mitchell

Any questions? Ask Glen

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Antisocial Personality Disorder ( Symptoms )

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Q.Glen What are the symptoms of Antisocial Personality Disorder?

A. A person with antisocial personality disorder tends to have few symptoms, but causes discomfort or distress to others through socially unacceptable behavior and by being:Any personal health questions or problems mental or physical or before starting any diet or exercise program.Please consult your physician !

Wishing You Great Health!

Glen Edward Mitchell

Any questions? Ask Glen

Antisocial Personality Disorder ( Diagnosis )

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Q. Glen, How are you diagnosed with APD?

A.The diagnosis is made on the basis of a person's history, usually by a mental health professional. There are no laboratory tests to assist in diagnosing this disorder. Other psychiatric disorders, such as a mood or anxiety disorder, attention deficit disorder, or substance abuse, may also be present.


Any personal health questions or problems mental or physical or before starting any diet or exercise program.Please consult your physician !

Wishing You Great Health!

Glen Edward Mitchell

Any questions? Ask Glen

Depression

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Q. What is Depression? Pronunciation (dĕ-presh′ŭn)

A. Reduction of the level of functioning. Syn: excavation (1) Displacement of a part downward or inward.

1. A mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia. Syn: dejection (1) , depressive reaction, depressive syndrome

[L. depressio, fr. deprimo, to press down]

Depression

Sometimes physical problems can cause depression. But other times, symptoms of depression are part of a more complex psychiatric problem. There are several different types of depression, including:

• Major depressive disorder
• Dysthymia
• Seasonal affective disorder
• Psychotic depression
• Bipolar depression

Major Depression

An individual with major depression, or major depressive disorder, feels a profound and constant sense of hopelessness and despair.

Major depression is marked by a combination of symptoms that interfere with the person's ability to work, study, sleep, eat, and enjoy once pleasurable activities. Major depression may occur only once but more commonly occurs several times in a lifetime.

What Are the Symptoms of Major Depression?

Symptoms of depression include:

• Sadness
• Irritability
• Loss of interest in activities once enjoyed
• Withdrawal from social activities
• Inability to concentrate

Psychotic Depression

Roughly 25% of people who are admitted to the hospital for depression suffer from what is called psychotic depression. In addition to the symptoms of depression, psychotic depression includes some features of psychosis, such as hallucinations (seeing or hearing things that aren't really there) or delusions (irrational thoughts and fears).

How Is Psychotic Depression Different Than Other Mental Disorders?

While people with other mental disorders, like schizophrenia, also experience these symptoms, those with psychotic depression are usually aware that these thoughts aren't true. They may be ashamed or embarrassed and try to hide them, which can make diagnosing this condition difficult.

What Are the Symptoms of Psychotic Depression?

• Anxiety (fear and nervousness)
• Agitation
• Paranoia
• Insomnia (difficulty falling and staying asleep)
• Physical immobility
• Intellectual impairment
• Psychosis

Dysthymia

Dysthymia, sometimes referred to as chronic depression, is a less severe form of depression but the depression symptoms linger for a long period of time, perhaps years. Those who suffer from dysthymia are usually able to function normally, but seem consistently unhappy.

It is common for a person with dysthymia to also experience major depression at the same time - swinging into a major depressive episode and then back to a more mild state of dysthymia. This is called double depression.

Symptoms of dysthymia include:

• Difficulty sleeping
• Loss of interest or the ability to enjoy oneself
• Excessive feelings of guilt or worthlessness
• Loss of energy or fatigue
• Difficulty concentrating, thinking or making decisions
• Changes in appetite
• Thoughts of death or suicide

Seasonal Affective Disorder

Seasonal depression, called seasonal affective disorder (SAD), is a depression that occurs each year at the same time, usually starting in fall or winter and ending in spring or early summer. It is more than just "the winter blues" or "cabin fever." A rare form of SAD known as "summer depression," begins in late spring or early summer and ends in fall.

What Are the Symptoms of Seasonal Affective Disorder?

People who suffer from SAD have many of the common signs of depression: Sadness, irritability, loss of interest in their usual activities, withdrawal from social activities, and inability to concentrate. But symptoms of winter SAD may differ from symptoms of summer SAD.

Symptoms of winter SAD may include the seasonal occurrence of:

• Fatigue
• Increased need for sleep
• Decreased levels of energy
• Weight gain
• Increase in appetite
• Difficulty concentrating
• Increased desire to be alone

Symptoms of summer SAD include the seasonal occurrence of:

• Weight loss
• Trouble sleeping
• Decreased appetite

What Causes Depression?

There is not just one cause of depression. It is a complex disease that can occur as a result of a multitude of different factors, including biology, emotional and environmental influences. For some, depression occurs due to a loss of a loved one, a change in one's life, or after being diagnosed with a serious medical disease. For others, depression just happened, possibly due to a family history of the disorder.

How Is Depression Diagnosed?

The diagnosis of depression begins with a physical exam by a doctor. Although there are no laboratory tests to specifically diagnose depression, the doctor may use various tests to look for physical illness as the cause of the symptoms. If a physical cause for the depression is ruled out, your doctor will likely refer you to a psychiatrist or psychologist for evaluation.

The doctor bases his or her diagnosis of depression on the patient's report of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the patient's symptoms and degree of dysfunction point to depression.

How Is Depression Treated?

The most common treatment for depression includes the combination of antidepressant medicine, including selective-serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, and psychotherapy (called "therapy" for short, or "counseling"). Electroconvulsive therapy, also called ECT, may be used when severe depression is unresponsive to other forms of therapy.

What Is the Outlook for People With Depression?

The outlook for depressed people who seek treatment is very promising. By working with a qualified and experienced mental health care professional, you can regain control of your life.

Any personal health questions or problems mental or physical or before starting any diet or exercise program.Please consult your physician !

Wishing You Great Health!

Glen Edward Mitchell

Any questions? Ask Glen

Stress

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Q. What is Stress? Pronunciation (stres)

A. Reactions of the body to forces of a deleterious nature, infections, and various abnormal states that tend to disturb its normal physiologic equilibrium (homeostasis).

1. In dentistry, the forces set up in teeth, their supporting structures, and structures restoring or replacing teeth as a result of the force of mastication.
2. The force or pressure applied or exerted between portions of a body or bodies, generally expressed in pounds per square inch.
3. In rheology, the force in a material transmitted per unit area to adjacent layers.
4. In psychiatry and psychology, the abnormal mental and emotional state in response to a physical or physiologic stressor.
5. Stressor, in the sense that psychological stress can be a stressor to a person physically and the physical stress of illness can also be a psychological stressor.
6. In endocrinology, state of threatened homeostasis in which stressors are the threatening forces and adaptive responses are the forces of the organism that reestablish homeostasis.

[L. strictus, tight, fr. stringo, to draw together]

Evaluating Stress

Feeling the effects of stress is a normal part of life, especially when you are facing major challenges. However, each person responds to stress differently. What causes a lot of stress for one person may not cause stress for someone else. That's because a large part of stress is a matter of perception-how you view a situation determines how much stress it causes you. Therefore, only you can best evaluate the amount of stress in your life and learn better ways to cope with it.

Ask yourself the following questions to learn what is causing you stress and how you respond:

What job, family, or personal stress do I have?

Chronic stress can be caused by an ongoing stressful situation such as:

• Family or relationship problems.
• Caring for a family member who is elderly, has chronic health problems, or is disabled. Caregiving is a major source of stress. For more information, see the topic Caregiver Tips.
• Job stress.
• A family member who is under stress.

Do I have recent major changes in my life?

Stress is an unavoidable part of life and can be good or bad. We routinely experience both types of stress when we go through life changes such as getting married, having a baby, or having a child move away from home.

To estimate your current stress level based on recent changes in your life, use this Interactive Tool: What Is Your Stress Level?

How am I coping with stress?

Some behaviors and lifestyle choices can interfere with the ways your body seeks relief from stress. For example, as you sleep, your body recovers from the stresses of the day. If you are not getting enough sleep or your sleep is frequently interrupted, you are losing a chance to recover from stress.

Your actions and behavior can be a sign of stress. Some people who face a lot of stress respond by smoking, drinking alcohol, or eating poorly. The health risks posed by these behaviors are made even worse by stress. Your body experiences stress-related wear and tear from two sources: the stress itself and the unhealthy habits you've developed to respond to stress. Evaluate how you respond to stress by identifying your positive and negative coping strategies. Use this coping strategies evaluation form(What is a PDF document?) to see how you respond to stress.

Do my beliefs cause me stress?

Some people feel stressed because their beliefs conflict with the way they are living their life. Examine your beliefs to see if conflict between what you believe and what your life is like causes you stress.

If you are not sure that you are stressed or are not sure what is making you feel the way you do, you need to discover what is causing stress. One way to do this is to keep a stress journal, a written record that can help you identify stressors so you can find better ways to cope with them.

Any personal health questions or problems mental or physical or before starting any diet or exercise program.Please consult your physician !

Wishing You Great Health!

Glen Edward Mitchell

Any questions? Ask Glen

Anxiety

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Q. What is Anxiety? Pronunciation (ang-zī′ĕ-tē)

A. Experience of fear or apprehension in response to anticipated internal or external danger accompanied by some or all of the following signs: muscle tension, restlessness, sympathetic (automonic) hyperactivity (e.g., diarrhea, palpitation, rapid breathing or jitteriness), or cognitive signs and symptoms (e.g., hypervigilance, confusion, decreased concentration, or fear of losing control). It may be transient and adaptive or pathologic in intensity and duration.

1. In experimental psychology, a drive or motivational state learned from and thereafter associated with previously neutral cues.

[L. anxietas, anxiety, fr. anxius, distressed, fr. ango, to press tight, to torment]

Mental Health: Anxiety Disorders

There many types of anxiety disorders that include panic disorder, obsessive compulsive disorder, post traumatic stress syndrome, social anxiety disorder, specific phobias, and generalized anxiety disorder.

Anxiety is a normal human emotion that everyone experiences at times. Many people feel anxious, or nervous, when faced with a problem at work, or before taking a test or making an important decision. Anxiety disorders, however, are different. They can cause such distress that it interferes with a person's ability to lead a normal life.

An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling.

What Are the Types of Anxiety Disorders?

There are several recognized anxiety disorders, including:

• Panic disorder : People with this condition have feelings of terror that strike suddenly and repeatedly with no warning. Other symptoms of a panic attack include sweating, chest pain, palpitations (irregular heartbeats) and a feeling of choking, which may make the person feel like he or she is having a heart attack or "going crazy."
• Obsessive-compulsive disorder (OCD) : People with OCD are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands.
• Post-traumatic stress disorder (PTSD) : PTSD is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event, and tend to be emotionally numb.
• Social anxiety disorder : Also called social phobia, social anxiety disorder involves overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule.
• Specific phobias : A specific phobia is an intense fear of a specific object or situation, such as snakes, heights or flying. The level of fear usually is inappropriate to the situation and may cause the person to avoid common, everyday situations.
• Generalized anxiety disorder : This disorder involves excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.

What Are the Symptoms of an Anxiety Disorder?

Symptoms vary depending on the type of anxiety disorder, but general symptoms include:

• Feelings of panic, fear and uneasiness
• Uncontrollable, obsessive thoughts
• Repeated thoughts or flashbacks of traumatic experiences
• Nightmares
• Ritualistic behaviors, such as repeated hand washing
• Problems sleeping
• Cold or sweaty hands
• Shortness of breath
• Palpitations
• An inability to be still and calm
• Dry mouth
• Numbness or tingling in the hands or feet
• Nausea
• Muscle tension

What Causes Anxiety Disorders?

The exact cause of anxiety disorders is unknown; but anxiety disorders -- like other forms of mental illness -- are not the result of personal weakness, a character flaw or poor upbringing. As scientists continue their research on mental illness, it is becoming clear that many of these disorders are caused by a combination of factors, including changes in the brain and environmental stresses.

Like certain illnesses, such as diabetes, anxiety disorders may be caused by chemical imbalances in the body. Studies have shown that severe or long-lasting stress can change the balance of chemicals in the brain that control mood. Other studies have shown that people with certain anxiety disorders have changes in certain brain structures that control memory or mood. In addition, studies have shown that anxiety disorders run in families, which means that they can be inherited from one or both parents, like hair or eye color. Moreover, certain environmental factors -- such as a trauma or significant event -- may trigger an anxiety disorder in people who have an inherited susceptibility to developing the disorder.

How Common Are Anxiety Disorders?

Anxiety disorders affect about 19 million adult Americans. Most anxiety disorders begin in childhood, adolescence and early adulthood. They occur slightly more often in women than in men, and occur with equal frequency in Caucasians, blacks and Hispanics.

How Are Anxiety Disorders Diagnosed?

If symptoms are present, the doctor will begin an evaluation by asking you questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms.

If no physical illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for an anxiety disorder.

The doctor bases his or her diagnosis on the patient's report of the intensity and duration of symptoms -- including any problems with daily functioning caused by the symptoms -- and the doctor's observation of the patient's attitude and behavior. The doctor then determines if the patient's symptoms and degree of dysfunction indicate a specific anxiety disorder.

How Are Anxiety Disorders Treated?

Fortunately, much progress has been made in the last two decades in the treatment of people with mental illnesses, including anxiety disorders. Although the exact treatment approach depends on the type of disorder, one or a combination of the following therapies may be used for most anxiety disorders:

• Medication : Medicines used to reduce the symptoms of anxiety disorders include anti-depressants and anxiety-reducing medications.
• Psychotherapy : Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people by talking through strategies for understanding and dealing with their disorder.
• Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of psychotherapy in which the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings.

Can Anxiety Disorders Be Prevented?

Anxiety disorders cannot be prevented; however, there are some things you can do to control or lessen symptoms:

• Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
• Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
• Seek counseling and support after a traumatic or disturbing experience.

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.

Any personal health questions or problems mental or physical or before starting any diet or exercise program.Please consult your physician !

Wishing You Great Health!

Glen Edward Mitchell

Any questions? Ask Glen

Is Guilt Getting the Best of You?

Ask Glen!

Q. Can you let go of the burden of guilt?

A. Psychology experts give tips for easing the burden of groundless guilt.

Does your guilty conscience follow your every move, making you wonder how you could have done something more or better -- for your partner, your kids, your community, or your career? Where does such crippling guilt come from? What toll does it take on you? And, most importantly, how can you shake it? Keep reading to find out. And don't feel too guilty about taking the time for yourself to do so.

Clearly, the spectrum of guilt that burdens folks runs the gamut. "Some people don't have the positive guilt that keeps you on the straight and narrow. Others have guilt that eats away at their soul; they rarely have a moment of peace," says Michael McKee, PhD, vice chairman of The Cleveland Clinic's psychiatry and psychology department.

Why do some people let guilt tear them apart inside? Personality is partly to blame, say the experts.

"Timid, insecure individuals may be victims of excessive guilt and constant 'second guessing' of themselves and their actions," says Patricia Farrell, PhD, clinical psychologist and author of How to be Your Own Therapist, A Step-by-Step Guide to Building a Competent, Confident Life.

"People with an obsessive-compulsive or obsessive-personality disorder or with these traits in their personalities are also prone to excessive ruminating about their actions and driving up their guilt quotient," she adds.

Social Forces Behind Guilt

While personality can predispose people to guilt, social expectations play a part, too.

From an early age, both males and females receive strong signals about "gender-specific" expectations that, when not fulfilled, can provoke guilt.

"Women build self-esteem through relationships," explains Mary Ann Bauman, MD, director of Women's Health for INTEGRIS, a nonprofit health system in Oklahoma. She is also author of Fight Fatigue: Six Simple Steps to Maximize Your Energy. "As women, we have to make sure no one thinks we're being selfish," Bauman says.

The result? "It causes us to absolutely overextend ourselves," she tells WebMD.

Men and Guilt

Men, on the other hand, grow up with a different set of expectations. "Men learn to build self-esteem through their accomplishments," Bauman says. So a man who doesn't become the athlete or the scholar that he, or his parents, expected him to be is often plagued by guilt. That's particularly true for children who, even as adults, live to please their parents.

"I have patients who are students in college and want to major in x, y, or z but tell me, 'My father is a doctor and wants me to follow in his footsteps," says Kiki Weingarten, executive director of DailyLifeConsulting.com.

Parenthood also opens up opportunities for guilt. "It's not just working parents; it's parents across the board. I think they feel like they should be doing more. They're looking over their shoulders at their neighbors, thinking they're doing more," says Naomi Drew, a New Jersey-based parentingparenting expert and author.

Even as we face our twilight years, the tendency toward guilt can remain strong.

Take, for instance, parents who enter a nursing home. "They often feel very guilty about the cost of it, knowing they have to sell everything to pay for the cost of the nursing home instead of passing it on to their children," says Barbara Ensor, PhD, a psychologist with Stella Maris, a long-term care facility in Baltimore.

Meanwhile, the children of these parents often suffer from guilt too. "Many family members feel guilty that they've had to put their mother in a nursing home, and that they can't provide for her," says Ensor.

Side Effects of Guilt

The crushing sense of guilt that so many of us feel isn't just bad for the psyche; it's bad for our health.

"If you're guilty, you're probably getting stressed. If your body releases stressstress chemicals, it puts you at risk for minor stuff like headaches and backaches," McKee tells WebMD. And that's not all."It [guilt] also contributes to cardiovascular disease and gastrointestinal disorders. It can even have a negative impact on the immune system over time," McKee says.

Guilt also takes a toll on an already fragile mental state. "It contributes significantly to depressiondepression, as it is very often involves a negative view of self, and to anxiety," McKee explains.

Letting Go of Excessive Guilt

If you feel guilty as an adult, chances are the bad feelings have been building since childhood, so it may take some time to unravel all the suffocating layers of the stuff. But it can be done. Here's how.

Practice saying no. "There will be discomfort, as with any change," Weingarten says. But it can and should be done, particularly if you're constantly putting yourself last.

But what if you're having trouble saying no? "Ask yourself why you fear saying 'no,'" Weingarten says. "Are you afraid you won't be popular? That people will talk behind your back?" That should help you put your fear in perspective.

Remember to take care of yourself. "Ask yourself 'What is good enough? How can I handle all these responsibilities and not fall apart?' Because when you fall apart, you're not good for anybody," Weingarten tells WebMD. "You simply have to take care of yourself."

Building on Success

Change your behavior by starting with small steps. "When you first say 'no,' you will still have insecurities about it. After you build a portfolio of successes, it gets easier," Bauman says.

Re-evaluate your expectations. "Assess your accomplishments, or lack thereof, and ask yourself if they're the right ones for you," Bauman suggests. "Sometimes, we are moved to do things because it was right for our parents. But your parents' situation was not your own," she reminds us.

"Identify where that guilty voice comes from," McKee suggests. "If it's your mother's or your fathers', I ask people to let go of it," he says.

"Keep things in perspective," urges Natalie Gahrmann, a life coach and founder of N-R-G Coaching Associates. For instance, if you're trying to get to a meeting on time and feel terribly guilty about showing up a few minutes late, consider the alternative: you speed and get a ticket, or cause an accident. Being a little late is not unforgivable.

Stop feeling guilty about making mistakes. "View mistakes as a learning experience, not because you're a sinful, slothful person," McKee says


Any personal health questions,Mental or Physical. Please consult your physician !

Wishing You Great Health,

Glen Edward Mitchell

Got a question? Ask Glen!

Shame: Secret Ally of Illness

Ask Glen!

Q. Can shame affect my health?

A. Experts tell Glen Edward Mitchell how shame can have an impact on health.

Think positive. Eat good foods. Be healthy. It's good advice. Sadly, it has a dark side.

"You can be healthy!" shout the covers of magazines and health books. The promise is that all it takes for good health is good exercise, good diet, and good hygiene.

But what does it mean if we aren't like those good people on the covers of health magazines? What if we aren't slim or young or fit? What if we're at risk of illness -- or actually ill?

We all have an ideal self we feel we should live up to, says psychologist Lawrence Josephs, PhD, a professor at Adelphi University. And we feel ashamed when we don't live up to this ideal.

"Everybody believes they should be healthy and fit and youthful and live to a ripe old age," Josephs tells Glen Edward Mitchell. "But people do get weak and vulnerable and depend on others and need help. So that ideal of being a strong, healthy person who can do everything on their own, that is shattered. And people get shamed and don't want to admit they are ill."

Shame: A Major Health Issue

In the experience of shame, one's whole being seems diminished or lessened. … The expression of shame … is not just the desire to hide, or to hide my face, but the desire to disappear, not to be there. It is not even the wish, as people say, to sink through the floor, but rather the wish that the space occupied by me should be instantaneously empty. -- Bernard Williams, British philosopher

The effects of shame and stigma can be devastating to a person's health, experts tell Glen Edward Mitchell. They're seen not only in people with life-altering medical problems but also in relatively healthy people with risk factors (such as a family history of cancer) for future illness.

Examples include:

• AIDS patients not taking their lifesaving drugs.
• People with diabetes becoming discouraged over difficulties with blood-sugar control.
• Obese people ashamed to go out of doors and get the exercise they desperately need.
• People with urinary incontinence afraid to leave their homes.
• Unnecessary suffering in people with treatable mental illnesses.

Duke University researcher Laura Smart Richman, PhD, studies emotional influences on health.

"Shame is one reason why people don't seek care," Richman tells WebMD. "There tends to be this perspective that people should have a lot of control over their health -- even with an illness like cancer. We're told, 'You should think positive, you should eat the right foods.' So when people aren't healthy there is self-blame and the perception of societal blame."

Taking personal responsibility for one's life is a good thing. We all want to be independent and in control of our lives. But illness isn't something we fully control. That can be scary -- and shaming.

"People want to think, 'I am in control,' so if you have alcoholism, addiction, eating disorders, incontinence, whatever, there is shame in lack of self-control," Josephs says. "Shame can be dangerous if it keeps you from seeking help for anything serious. It is very upsetting to have a heart attack scare or a cancer scare. It is tempting to deny it -- because that is a big assault on our self-image."

This isn't merely a matter of vanity, or even of being a control freak. Shame is hardwired into our mental makeup, says psychiatrist Michelle E. Friedman, MD, director of pastoral counseling at Yeshivat Chovevei Torah rabbinical seminary and assistant clinical professor at Mount Sinai School of Medicine, New York.

"This is an issue and a struggle for every ill person," Friedman tells Glen Edward Mitchell. "Shame comes from an ancient, primitive way of thinking. It is really powerful."

We feel guilty for what we do. We feel shame for what we are. A person feels guilt because he did something wrong. A person feels shame because he is something wrong. We may feel guilty because we lied to our mother. We may feel shame because we are not the person our mother wanted us to be. -- Lewis B. Smedes, U.S. psychologist

Why is shame such a problem? It has to do with the nature of this mixed emotion. Like its sister emotion, guilt, shame is what psychologists call a negative emotion.

Negative emotions such as sadness, anger, and fear -- alone or in any of their many combinations -- aren't bad in and of themselves. It's how we handle them that makes them harmful. In this regard, shame is particularly tricky. It strikes at the core of our being, says psychologist June Tangney, PhD, a professor at George Mason University in Fairfax, Va. Tangney is co-author of the book Shame and Guilt.

When we feel bad about having failed or about having done something we think is wrong, we feel guilt or shame.

"Guilty people feel bad about their behavior. Shamed people feel bad about themselves," Tangney tells Glen Edward Mitchell. "Guilt is a less overwhelming feeling. It is less self-esteem related, and doesn't affect our sense of who we are."

Guilt motivates a person to repair the damage done by bad behavior and to make positive changes in their lives. Shame works in the other direction. It makes us want to disappear.

"When people are ashamed, the defense mechanism is hiding," Joseph says. "We become like little kids who are ashamed and hide their faces in their mothers' aprons. It is hard to get past that."

As adults, we don't have our mothers' skirts to hide behind. But our reaction to shame often isn't any more mature.

"When people feel ashamed they are more likely to hide, deny, escape, and externalize blame," Tangney says. "When people feel guilt they are motivated to face the music. When people feel shame they want to duck the heat."

Tangney lists five ways shame can be destructive:

• Lack of motivation to seek care.
• Lack of empathy. Shame, Tangney says, is very self-involved. People feeling shame cut themselves off from other people.
• Anger and aggression. Tangney says shame has a special link to anger. "In day-to-day life, when people are shamed and angry they tend to be motivated to get back at a person and get revenge," she says.
• Psychological problems. Tangney says shame is associated with eating disorders, substance abuse, anxiety, depression, and other mental disorders.
• Problematic moral behavior. Tangney's team tested fifth-grade students, and followed them until they were 18 years old. Shame-prone kids were prone to substance abuse, earlier sexual activity, less safe sexual activity, and involvement with the criminal justice system.

Because we tend to feel more shame about our bodies than about other aspects of ourselves, health issues are particularly likely to evoke shame. And no health issues evoke shame more than those involving sex, says Ilan Meyer, PhD, associate professor of clinical sociomedical sciences at Columbia University's Mailman School of Public Health.

"If people are embarrassed to talk about their sexuality, they are not going to be seeking out services, testing or counseling on the topic," Meyer tells Glen Edward Mitchell. "People often don't seek treatment for an STD [sexually transmitted disease]. Or when they do, they lie or pretend it is something else. I know of someone with an STD who called the doctor and said he had a cold, and wanted antibiotics. Of course this would be the wrong drug for both conditions, but this is a case of a person acting out of shame, trying to manipulate the situation to get care."

In the Bible, God often punishes people by making them ill -- often with humiliating diseases.

"That is very much lodged in people's minds," Friedman says. "When something goes wrong with our health we think, 'What did I do to deserve this?' People feel -- and this may be an unconscious feeling -- that if something befalls them, they somehow did wrong."

It's a pernicious feeling. If we feel bad because we are sick, we can be treated for the sickness and feel better. But if we feel sick because we are bad, we are powerless.

Religion isn't the problem here. If we feel that our fate is in God's hands, we aren't afraid to seek treatment. We become powerless only when we believe our illness stems from a moral flaw that we must hide from everyone, including God.

What do you regard as most humane? To spare someone shame. -- Friedrich Nietzsche, German philosopher

One of the oldest stories of healing shame is in the Old Testament, Friedman notes. God punishes Miriam by giving her leprosy. He answers Moses' prayer that she be healed, but insists that she must be shamed by being expelled from the Israelites' camp for seven days.

Even though they are in dire circumstances -- they are escaping Egypt for the Promised Land -- the Israelites do not move from camp until Miriam has served her sentence. Then they welcome her back from her shame.

"Miriam had to be marginalized so that her shame could be recognized. But then the whole camp waits for her to welcome her back from her shame," Friedman says. "But if you are marginalized, who is inviting you to dinner? If you are someone who has fallen through the cracks, who is thinking of you? A fact of modern cultural life is that there is a decreased attention to integrating marginal people into some kinds of communities."

One relatively recent positive change is that more and more celebrities are speaking out about their own shame-associated conditions.

"When celebrities come out with their stories -- like Brooke Shields talking about her postpartum depression -- that is a very big thing," Tangney says.

But often, simple human contact is the most important thing for a shamed person. Even this can be difficult to offer because shame makes people withdraw.

"The most important thing is to keep up contact with someone -- for example, the kid who drops out of college and is now a strung-out marijuana addict," Tangney says. "Marginalized people -- and nobody is more marginalized than the mentally ill -- need to have a place in society. That is a very powerful message that should be attended to by communities, whether they are religious or family or neighborhood communities."

Approaching a shamed person can be tricky, Josephs warns.

"If you see shame preventing someone from getting health care, you can confront it as irrational," he says. "You can say there is nothing to be ashamed of, and if people hear it, they hear it. But when you point out that they are ashamed, people can get touchy and angry. If you point out their shame, you could get into a fight. So bring it up, but in a tactful way, knowing this is a tough issue."

Tangney says that the best approach is to avoid further shaming. The first thing to offer is support and empathy. Rather than confront a person's shame, it's better to point out -- very, very gently -- how a person's behavior is harming areas of life that the person really values.

"There is a lot of evidence suggesting this is a good approach," Tangney says. "And to my ears it is all about shame reduction."

Any personal health questions,Mental or Physical. Please consult your physician !

Wishing You Great Health,

Glen Edward Mitchell

Got a question? Ask Glen!

Shame: The Quintessential Emotion

Ask Glen!


Q. Why do I feel inadequate some time?


A. Shame it’s the quintessential human emotion, says New Brunswick, N.J., psychologist Michael Lewis, Ph.D., in his writings.

All extravagant behaviors are reactions to it, says Philadelphia psychiatrist Donald I. Nathanson, M.D.

It’s the root of dysfunctions in families, says Montpelier, Vt.-based Jane Middelton-Moz, author of “Shame & Guilt: Masters of Disguise.”

After decades of obscurity — spent, Middelton-Moz says, confused with and overshadowed by guilt — shame is increasingly recognized as a powerful, painful and potentially dangerous emotion,- especially for those who don’t understand its origins or know how to manage it.

A Complex Response

According to Alen J. Salerian, M.D., psychiatrist and medical director of the Washington, D.C., Psychiatric Center Outpatient Clinic, shame is a complex emotional response that all humans acquire during early development. “It’s a normal feeling about ourselves and our behavior,” he said, “not necessarily a symptom of an illness or pathology. In many situations, it’s abnormal if we don’t experience it.”

Embarrassment and shyness, for example, are two forms of shame that seldom cause trouble — unless they’re extreme or long lasting. And humility, another of the forms shame can take, is generally considered socially desirable.

But there’s mounting evidence that problems occur when shame or humiliation becomes an integral part of a person’s self-image or sense of self-worth. Over the past two decades, psychologists, psychiatrists and other mental health professionals have reported that abnormal styles of handling shame play an important role in social phobias, eating disorders, domestic violence, substance abuse, road rage, schoolyard and workplace rampages, sexual offenses and a host of other personal and social problems.

The Importance of Feeling Adequate

Marilyn J. Sorensen, Ph.D., author of “Breaking the Chain of Low Self-Esteem” and clinical psychologist in Portland, Ore., explains how such disorders originate.

“Early in life, individuals develop an internalized view of themselves as adequate or inadequate within the world,” she said. “Children who are continually criticized, severely punished, neglected, abandoned, or in other ways abused or mistreated get the message that they do not ‘fit’ in the world — that they are inadequate, inferior or unworthy.”

These feelings of inferiority are the genesis of low self-esteem, Sorenson says.

“Individuals with low self-esteem become overly sensitive and fearful in many situations,” she said. “They are afraid they won’t know the rules or that they’ve blundered, misspoken or acted in ways others might consider inappropriate. Or they might perceive that others reject or are critical of them.”

Once low self-esteem is formed, the person becomes hypersensitive — they experience “self-esteem attacks” that take the form of embarrassment or shame, Sorenson adds.

“Unlike guilt, which is the feeling of doing something wrong,” she said, “shame is the feeling of being something wrong. When a person experiences shame, they feel ‘there is something basically wrong with me.’”

Middelton-Moz says this is a common emotional response in adult children of alcoholic parents, as well as those who grew up with depressed parents, abuse, religious fanaticism, war, cultural oppression, or adult or sibling death. All of these experiences cause an individual to feel vulnerable, helpless and shamed.

A Deep, Unproductive Well

Aaron Kipnis, Ph.D., author of “Angry Young Men: How Parents, Teachers and Counselors Can Help Bad Boys Become Good Men” and a clinical psychologist in private practice in Santa Barbara, Calif., agrees. He says that shame’s effects are more damaging than those of guilt.

“Guilt is positive,” he said. “It’s a response of psychologically healthy individuals who realize they have done something wrong. It helps them act more positively, more responsibly, often to correct what they’ve done.”

But shame is not productive, Kipnis says. “Shame tends to direct individuals into destructive behaviors. When we focus on what we did wrong, we can correct it; but when we’re convinced that we are wrong as a result of shame, our whole sense of self is eroded.”

That’s why guilt doesn’t produce the anger, rage or other irrational behaviors shame does, Kipnis adds. “Many violent behaviors lead back to a deep well of shame,” he said.

He’s Shamed, She’s Shamed

Do men and women respond similarly when shamed?

“It has been common in shame-based conditions to say that men ‘act out’ and women ‘act in,’” Kipnis said.

In his book, “Shame: The Exposed Self,” Lewis says that not only do women feel more shame than men, they tend to express it differently. Typically, females have dealt with shame through introversion and self-hate while males have been more likely to exhibit extreme anger and violence.

Lewis found the major causes of shame in women are feelings of unattractiveness or perceived failures in personal relationships. In contrast, he reported, the leading cause of shame in men is feelings of sexual inadequacy.

In a 1997 article in the Electronic Journal of Sociology, Thomas J. Scheff, Ph.D., professor emeritus at the University of California-Santa Barbara, and Suzanne M. Retzinger, family relations mediator in the Superior Court of Ventura, Calif., provide an explanation for the difference in how men and women manage the shame associated with sexuality — described as “quite prevalent” in modern society.

Scheff and Retzinger found that women typically experience shame-shame feedback loops, while males experience shame-anger feedback loops. In shame-shame loops, individuals are ashamed of being ashamed, which makes them more ashamed of being ashamed, which leads to more shame, and so on. This circular process often results in withdrawal or depression.

In shame-anger loops, individuals are angry that they are ashamed, and ashamed that they are angry, and so on. This creates another emotional loop that feeds on itself and often culminates in antisocial acts.

“Shame about sexuality helps to explain the direction sexuality often takes with women: lack of sexual interest, withdrawal, passivity or late-blooming interest,” Scheff and Retzinger say in the journal article. “But the same shame leads men in a different direction — to boldness, anger and aggression. When a man feels ashamed of his sexuality and rejected by or inadequate with women and does not acknowledge these feelings even to himself, a likely outcome is sexual assault.”

Nathanson uses an even broader stroke in characterizing the potential effects of shame: “There’s no record of a violent action other than as a reaction to shame or humiliation,” he said.

Compass of Shame: Pointing a Way to Treatment and Recovery

Nathanson, author of “The Many Faces of Shame” and “Shame and Pride: Affect, Sex, and the Birth of the Self,” has focused much of his attention on how to help both patients and their therapists deal with the emotion more effectively. After extensive study, he concluded nearly two decades ago that psychoanalytic therapy had treated almost everything but shame-based conditions — despite mounting evidence that not only was shame a prominent feature of many psychological disorders, but that many treatment approaches often created or exacerbated painful shame reactions.

“Conventional psychoanalysis had viewed silence as anxiety, which was interpreted as resistance to treatment,” he said. “But, more often, silence in therapy is actually a sign that the patient is ashamed to say what he’s thinking. The therapist’s silence only makes the shame worse, it doesn’t make it go away.”

Nathanson devised the Compass of Shame to provide a framework for better understanding of the dynamics of shame and humiliation, as well as for supporting more effective approaches to shame-based responses in treatment situations. In this compass, each of the four cardinal directions is represented by a reaction to an experience during which a shame trigger has occurred, a physiological effect has been experienced and a cognitive response has taken place.

“Imagine the points with ‘Withdrawal’ at the north pole, ‘Attack Self’ due east, ‘Avoidance’ at the south pole and ‘Attack Other’ due west,” he said. “Each of these is a library in which individuals store a huge number of scripts they use to respond to experiences of being shamed. These scripts are activated by the sequence of events that involves the trigger, the physiological effect and the cognitive response.”

This means there is not a single entity that can be called “shame,” but four separate entities, four patterns of response in reaction to life events, he says.

Nathanson adds that making patients aware that feelings of shame are a normal part of the treatment process is an important first step toward resolving the core psychological problems at all four points of the compass.

Medications for Shame

Nathanson, Salerian and other therapists agree the role of biology is increasingly evident in the development of shame. Low levels of serotonin, for example, are believed to contribute to an innate vulnerability to feeling shamed or humiliated.

Both experts say the class of medications known as selective serotonin reuptake inhibitors, or SSRIs, including Prozac, Zoloft, Luvox and Paxil, have been effective in shame treatment.

But not all authorities agree on the appropriateness of prescribing SSRIs or other drugs. Middelton-Moz, for instance, says that biology is unlikely to hold the key to the cause or the cure of shame. “Medications send yet another message that the individual is helpless; that they are not the one making the change,” she said. “The hope that we can achieve a better self through chemistry is inevitably a false one in shame-based conditions.”

Any personal health questions,Mental or Physical. Please consult your physician !

Wishing You Great Health,

Glen Edward Mitchell

Got a question? Ask Glen!