Know More about the Excesses of Phobias and Manias

When does Obsessive-Compulsive Disorder begin?
OCD can start at any time from preschool age to adulthood (usually by age 40). One third to one half of adults with OCD report that it started during childhood. Unfortunately, OCD often goes unrecognized.

On average, people with OCD see three to four doctors and spend over nine years seeking treatment before they receive a correct diagnosis. Studies have also found that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment.

OCD tends to be underdiagnosed and undertreated for a number of reasons. People with OCD may be secretive about their symptoms or lack insight about their illness. Many healthcare providers are not familiar with the symptoms or are not trained in providing the appropriate treatments. Some people may not have access to treatment resources.

This is unfortunate since earlier diagnosis and proper treatment, including finding the right medications, can help people avoid the suffering associated with OCD and lessen the risk of developing other problems; such as, depression or marital and work problems.

Is Obsessive-Compulsive Disorder Inherited?
No specific genes for OCD have yet been identified, but research suggests that genes do play a role in the development of the disorder in some cases. Childhood-onset OCD tends to run in families (sometimes in association with tic disorders). When a parent has OCD, there is a slightly increased risk that a child will develop OCD, although the risk is still low. When OCD runs in families, it is the general nature of OCD that seems to be inherited, not specific symptoms; for example, a child may have checking rituals, while his mother washes compulsively.

What causes Obsessive-Compulsive Disorder?
There is no single, proven cause of OCD. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia).

These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are prominently involved in OCD. Drugs that increase the brain concentration of serotonin often help improve OCD symptoms.

Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy.

Although it seems clear that reduced levels of serotonin play a role in OCD, there is no laboratory test for OCD. Rather, the diagnosis is made based on an assessment of the person's symptoms. When OCD starts suddenly in childhood in association with strep throat, an autoimmune mechanism may be involved, and treatment with an antibiotic may prove helpful.

If you or someone you care about has been diagnosed with Obsessive-Compulsive Disorder (OCD), you may feel that you are the only person facing the difficulties of this illness; but you are not alone. In the United States, it is estimated that 1 in 50 adults currently has OCD, and twice that many have had it at some point in their lives. Fortunately, very effective treatments for OCD are now available to help you regain a more satisfying life.

What Is Obsessive-Compulsive Disorder?
Worries, doubts, superstitious beliefs all are common in everyday life. However, when they become so excessive such as hours of hand washing or make no sense at all such as driving around and around the block to check that an accident didn't occur then a diagnosis of OCD is made. In OCD, it is as though the brain gets stuck on a particular thought or urge and just can't let go. People with OCD often say the symptoms feel like a case of mental hiccups that won't go away. OCD is a medical brain disorder that causes problems in information processing. It is not your fault or the result of a "weak" or unstable personality.

Before the arrival of modern medications and cognitive behavior therapy, OCD was generally thought to be untreatable. Most people with OCD continued to suffer, despite years of ineffective psychotherapy. Today, luckily, treatment can help most people with OCD. Although OCD is usually completely curable only in some individuals, most people achieve meaningful and long-term symptom relief with comprehensive treatment.

Symptoms of Obsessive-Compulsive Disorder
OCD usually involves having both obsessions and compulsions, although a person with OCD may sometimes have only one or the other.
OCD symptoms can occur in people of all ages. Not all Obsessive-Compulsive behaviors represent an illness. Some rituals (for example, religious practices; such as, prayer, Bible reading, etc.) are a welcome part of daily life. Normal worries, such as contamination fears, may increase during times of stress, such as when someone in the family is sick or dying. Only when symptoms persist, make no sense, cause much distress, or interfere with functioning do they need clinical attention.

1. Obsessions.

Obsessions are thoughts, images, or impulses that occur over and over again and feel out of your control. The person does not want to have these ideas, finds them disturbing and intrusive, and usually recognizes that they don't really make sense. People with OCD may worry excessively about dirt and germs and be obsessed with the idea that they are contaminated or may contaminate others. Or they may have obsessive fears of having inadvertently harmed someone else (perhaps while pulling the car out of the driveway), even though they usually know this is not realistic. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust, doubt, or a sensation that things have to be done in a way that is "just so."

2. Compulsions.

People with OCD typically try to make their obsessions go away by performing compulsions. Compulsions are acts the person performs over and over again, often according to certain "rules." People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. A person may repeatedly check that she has turned off the stove or iron because of an obsessive fear of burning the house down. She may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions.

3. Other features of Obsessive-Compulsive Disorder

OCD symptoms cause distress, take up a lot of time (more than an hour a day), or significantly interfere with the person's work, social life, or relationships.

Most individuals with OCD recognize at some point that their obsessions are coming from within their own minds and are not just excessive worries about real problems, and that the compulsions they perform are excessive or unreasonable. When someone with OCD does not recognize that their beliefs and actions are unreasonable, this is called OCD with poor insight.

OCD symptoms tend to wax and wane over time. Some may be little more than background noise; others may produce extremely severe distress.

Just like other emotions, fear is a package of reactions that tend to occur together simultaneously or sequentially. These include visible behavioral expression, an inner feeling, and accompanying physiological changes. In humans as well as in animals, two obvious behavioral expressions of fear present a striking contrast. One is the tendency to freeze and become mute, which reaches its extreme form in feigning death. The opposite is to be startled, to scream, and then to run away from the source of danger. Behavior may shift rapidly from one pattren to the other when a frightened person first freezes and then suddenly flees to find shelter.

With strong fear there are unpleasant feelings of terror, an urge to run and to hide, to cry, a pounding heart, tense muscles, trembling, the strong tendency to be easily startled, dryness of the throat and mouth, a sinking feeling in the stomach, nausea, perspiration, an urge to urinate and/or to defecate, irritability, anger, difficulty in breathing, tingling of the hands and feet, weakness or even paralysis of the limbs, a sense of faintness or falling, and a sense of unreality or of being distant from the event. Fear that continues for a long time leads to tiredness with difficulty in sleeping and bad dreams, restlessness, being easily startled, loss of appetite, aggression, and avoidance of further unusual or tension-producing situations.

Would you agree that this just about covers the expressions of fear?

French art addict on trial for museum thefts

STRASBOURG, Jan 6- Stephane Breitwieser, a 33 year-old French hotel-worker who stunned the art-world when he admitted stealing more than 200 treasures from European museums, went on trial in Strasbourg Thursday for offences committed in France.

Breitwieser, who describes himself as a passionate art collector, was extradited in July from Switzerland where he had served two years of a four year term for similar offences. He faces a maximum three year jail term if convicted at the end of the two-day hearing.

Also facing charges in France are his mother Mireille Stengel, 53, and former girlfriend Anne-Catherine Kleinklaus, 33.

At his Swiss trial in February, 2003, Breitweiser said he had taken 239 works, including masterpieces by Pieter Brueghel, Watteau, and Durer and other items worth tens of millions of euros, that vanished from museums and galleries in seven countries between 1995 and 2001.

He stored the articles at his home in the village of Gerstheim near the German border, but at his arrest in 2001 his mother destroyed much of the collection with an axe and dumped other pieces in the Rhine-Rhone canal. She apparently did this in an effort to get rid of any evidence when she heard that her son was caught and arrested while trying to steal an antique trumpet. Later, she said she destroyed the treasures "to punish my son for all the harm he has done me." She described him as infantile and narcissistic, and accused him of acts of violence against her.

Items subsequently recovered from the canal included baroque chalices, ivory carvings and a silver galleon; however, several highly valuable paintings, such as "The Princess of Cleves" by Lucas Crannach and "Cheating Benefits its master" by Peter Brueghel were lost for ever.

The mother, Stengel, is being tried for receiving and destroying some 200 stolen items; while Kleinklaus, his former girlfriend, is being tried for receiving some of them.

Breitwieser is suspected of taking some 70 works from French museums, but he is charged with just 20 thefts between 1999 and 2001; the rest of the items falling outside France's statute of limitations. Two thefts in Denmark and Austria also appear on the charge-sheet.

The Swiss court heard that he toured the continent posing as a collector and was surprised by the ease with which he could smuggle out works of art from poorly-guarded provincial museums, normally concealing them under his coat or in a back-pack.

Breitwieser's lawyer Thierry Moser said that he "feels very guilty. He says to himself; 'It was me who got my mother into this mess.' It is very hard for him."

Most people have met someone with a significant fear of a particular object or situation, such as closed spaces (claustrophobia), heights (acrophobia), water (aquaphobia), snakes (ophidiphobia), or lightning (astraphobia). When a person has a persistent, irrational fear of an object or situation and a strong urge to avoid that object or situation, he/she has a "simple phobia"; that is, an inappropriately intense reaction triggered by a single stimulus.

The most common phobias are of specific animals and insects, of the natural elements (storms or water), of heights, and of closed-in spaces.

The person with a specific phobia may react with mild anxiety or even with panic when confronted with the prospect of facing the fearful situation; however, his fear is not of his symptoms (as in panic disorder or agoraphobia) but of the situation itself, which he believes to be a dangerous one.

Some may fear that they will lose their senses and do something foolish. The person with a height phobia, for example, might fear that he will forget what he is doing and accidentally leap off the cliff on which he is standing. Others with phobias fear that something will go wrong with their circumstances. The individual with a flying phobia might imagine the tail falling off the aircraft, or the pilot losing consciousness with no one to take over, or the oxygen running out in mid-flight.

Such fears defy rational thinking. Most phobics know that they are being excessive and unreasonable in their thoughts, but this knowledge does not help them overcome the obvious irrationality of the situation. The fearful thoughts come automatically in spite of rational thoughts and therfore the phobic usually believes his/her only recourse is to avoid the terror-causing situation.

Fear is a vital evolutioinary legacy that leads an organism to avoid threat, and has obvious survival value. It is an emotion produced by the perception of the present or impending danger and is normal in appropriate situations. Without fear, few people would survive for very long under natural conditions. Fear "girds our loins" for rapid action in the face of danger and alerts us to perform quickly under stress. It helps us fight an enemy in war, drive carefully, parachute safely, take exams, do our best to speak well to a critical audience, make efforts to keep a safe foothold when climbing a mountain, and look to the left and right before crossing streets.

In its less extreme form, fear can be not only useful but also a thrilling experience. Many people actively seek out and enjoy the fearful thrill of mastering danger. Race car drivers, bull fighters, and mountaineers willingly expose themselves to extreme hazards. Thousands of spectators throng to take vicarious pleasure in the tension of dangerous sports. Millions of dollars are earned from the pleasure of the suspense of thriller films in theaters and on videos or on TV; and, now to a much lesser degree, in books.

There seems to be an optimal amount of fear for good performances; too little and we risk being careless, too much and we react clumsily. Trainee parachutists perform poorly if they are overly frightened, and even trained paratroopers may "lose their nerve" and "freeze" when it is time for them to jump.

Fear can follow rather than precede danger. In sudden dangerous situations, quick actions are needed to avoid disasters, and we may become aware of the fears only several hours after the worst dangers have passed. This is well documented in cases of people who have had to cope with bad accidents, fire, earthquakes; and more recently, a tsunami.

Fear is a vital evolutioinary legacy that leads an organism to avoid threat, and has obvious survival value. It is an emotion produced by the perception of the present or impending danger and is normal in appropriate situations. Without fear, few people would survive for very long under natural conditions. Fear "girds our loins" for rapid action in the face of danger and alerts us to perform quickly under stress. It helps us fight an enemy in war, drive carefully, parachute safely, take exams, do our best to speak well to a critical audience, make efforts to keep a safe foothold when climbing a mountain, and look to the left and right before crossing streets.

In its less extreme form, fear can be not only useful but also a thrilling experience. Many people actively seek out and enjoy the fearful thrill of mastering danger. Race car drivers, bull fighters, and mountaineers willingly expose themselves to extreme hazards. Thousands of spectators throng to take vicarious pleasure in the tension of dangerous sports. Millions of dollars are earned from the pleasure of the suspense of thriller films in theaters and on videos or on TV; and, now to a much lesser degree, in books.

There seems to be an optimal amount of fear for good performances; too little and we risk being careless, too much and we react clumsily. Trainee parachutists perform poorly if they are overly frightened, and even trained paratroopers may "lose their nerve" and "freeze" when it is time for them to jump.

Fear can follow rather than precede danger. In sudden dangerous situations, quick actions are needed to avoid disasters, and we may become aware of the fears only several hours after the worst dangers have passed. This is well documented in cases of people who have had to cope with bad accidents, fire, earthquakes; and more recently, a tsunami.

Information on these subjects has developed along with our knowledge of other areas of mental health. Just as our understanding of the human psyche is far from complete, so to is our incomplete understanding of the origins and management of phobias, fears, and anxieties.

There are experiences that we all have at times, but for some of us these have become persistent and sometimes devasting problems. Although we don't fully understand the causes of the problems, or why some people are more susceptible to them than others, our modern advances have been more fortunate in treating phobias, fears, and anxieties.

Behavioral therapies have been shown to be particularly effective, and self-help techniques are flourishing. Drugs have also been useful, but the biochemical and physiological mechanisms underlying phobias, fears, and anxieties are still only partially understood. It is clear that anxiety and related disorders are much more than a physical or even behavioral response alone. The complex nature of the problem confronts the clinician and researcher at every turn.

Psychiatrists define a phobia as a type of anxiety disorder that consists of a morbid and irrational fear of a specific object or situation associated with severe anxiety, and recognized by the subject to be unreasonable or unwarranted. It is more than fear, however, for the feared object or situation must be avoided, or can be endured only with marked distress, because of the anxiety response or panic attack that it almost invariably provokes. This condition is also known as angst.

Two major forms of phobias are recognized:

1. Specific phobia (also known as simple phobia or isolated phobia).

The essential feature of a specific phobia is a persistent, irrational fear of, and compelling desire to avoid, specific objects or situations. This kind of phobia is characterized by a relatively specific fear of an object or situation. The range of stimuli that may elicit a fearful response is narrower than in other phobic disorders and such phobias are sometimes also referred to as simple phobias.

Examples of specific phobias include the following groups of excessive fears:

Some animal dreads: entomophobia, apiphobia, arachneophobia, batrachophobia, equinophobia, ichthyophobia, musephobia, murophobia, ophidiophobia, ornithophobia, and zoophobia.

Samples of natural terrors: acluophobia, nyctophobia, acrophobia, hysophobia, anemophobia, astraphobia, aurophobia, brontophobia, keraunophoia, ombrophobia, potomophobia, and siderophobia.

Examples of blood-injury-illness panics: algophobia, odynophobia, belonephobia, dermatophobia, hematophobia, hemophobia, pyrexeophobia, febriphobia, molysmophobia, mysophobia, traumatophobia, and vaccinophobia.

A few miscellaneous anxieties: ballistophobia, barophobia, claustrophobia, dementophobia, dextrophobia, erythrophobia, harpaxophobia, levophobia, pediophobia, trichopathophobia, and trichophobia.

2. Social phobia (social anxiety disorder; although when it occurs in children, it is known as avoidant disorder).

Individuals who have social phobias have excessive anxieties in social situations; such as, parties, meetings, interviews, restaurants, making complaints, writing in public, eating in restaurants, and interacting with the opposite sex, strangers, and aggressive individuals. They often fear situations in which they believe they are being observed and evaluated, such as eating, drinking, speaking in public, driving, etc.

Unlike specific or simple phobias, which tend to diminish as the individual grows into puberty and young adulthood, social phobias persist as one gets older. Many such individuals have traits that interfere with social and marital adjustment. Some have ongoing problems with generalized anxiety, dependence, authority, and depression.

Samples of excessive-social anxieties: aphephobia, haptephobia, catagelophobia, ereuthophobia, graphophobia, scriptophobia, kakorrhaphiophobia, scopophobia, and xenophobia.

True fears present signals in the presence of dangers; whereas unwarranted fears, phobias, are a waste of time. True fears are based on perceptions from your environment.

Unwarranted fears, phobias, are based on your imaginations or memories. Your survival instincts are gifts from nature. Whatever causes true fears is probably based on legitimate reasons. Always listen to them; however, you should also strive to distinguish true fears from phobias (irrational terrors).

Some other words that are synonyms of the word phobia include: fear, hatred, dread, anxiety, aversion, panic, fright, terror, torment, scare, terrify, angst, disgust, abhorrence, antipathy, repulsion, and revulsion.

The various roles of anxiety in human behavior and in psychiatric disorders have long been recognized by psychologists, psychiatrists, and psychophysiologists. The instrumental survival value of anxiety must be acknowledged to be as essential in human experience as that of pain. Research attention to the biological, behavioral, and experiential components of anxiety has, however, waned in the past several decades. Much of the early impetus to examine the source and roles of anxiety in psychiatric disorders came from psychoanalytic writings, particularly those of Freud and his students based on case histories and clinical observations of individuals.

Significant contributions also were made by behavioral psychologists concerned primrily with the treatment of fears and phobias, particularly in children. World military conflicts and catastrophies have provided opportunity for field studies of stress and anxiety under naturalistic conditions, but these efforts were not, for the most part, systematic, broad gauged, or coordinated. Clearly, there is a pressing need to explore biological, psychologicl, and behavioral components of anxiety; to develop valid models that can bring these phenomena under laboratory control; and to consturct theories that accommodate and summarize existing knowledge while simultaneously serving a heuristic function.

A few of the fundamental questions that need to be answered are: What constitutes an anxiety response? Whar are its neurological, psychological, and behavioral components? Is this response expressed differently at different stages of human development? How is it modified by cognitive, neuroendocrine, and social environmental influences? Are there basic individual differences in vulnerability to pathological forms of anxiety? What are the critical factors that contribute to these individual differences, and what are the biological and psychological mechanisms that may be involved in causing such differences? Can the emergence of pathological anxiety response be prevented or modified; by what mechanisms and under what circumstances? What role, if any, does anxiety play in such other psychiatric disorders as depression, schizophrenia, schizoaffective disorders, anorexia nervosa, sleep pathologies, and sexual dysfunctions. These and similar questions that flood this area of research represent the concerns of the community of researchers whose work is reported in this blog.


From Anxiety and the Anxiety Disorders published by
the National Institute of Mental Health