Symptoms

National Institute of Mental Health (NIMH) lists down a few symptoms of GAD on their official website. These include excessive worrying, nervousness, difficulty in concentration, troubled sleep schedules, etc. People with anxiety tend to overthink situations more than the average person and worry about future scenarios that may seem implausible to other people. They may sometimes experience anxiety attacks which aren’t the same as panic attacks, although the terms are used interchangeably. Anxiety attacks are usually caused by a particular event and have a cause and origin. During anxiety attacks, people with anxiety may be extra sensitive to stimuli such as repetitive sounds, actions, etc. Trouble going to sleep or staying asleep is another symptom of anxiety if the person is being kept awake by their thoughts. They find it tough to relax or fully immerse themselves in any activity. But anxiety isn’t simply a feeling, anxiety triggers the body’s fight or flight response which results in the manifestation of physical symptoms such as shortness of breath, muscle pain or tightening of muscles, teeth grinding, sweating, nauseousness, etc. This causes people to sometimes confuse it for a physical ailment and not consider a mental aspect to it.

Social Anxiety

Social Anxiety Disorder is a medically diagnosable condition that is one step further than introversion and shyness. It is extremely common and causes people to have trouble going on dates, talking to new people, public speaking, attending parties, etc. These issues originate from a fear of being publicly humiliated or snubbed or being judged for any of their actions. Social anxiety can be dealt with by self-soothing methods but it causes a person to be crippled when it comes to socialising. Thus naturally, people with social anxiety tend to avoid large gatherings or even any places where they might meet new people. They choose to stay home and decline invitations as soon as they come in. This behaviour may sound familiar as is stereotypically assumed for introverts. So it is not a surprise that introversion and social anxiety are used interchangeably, but that isn’t correct.

Introverts are basically people who are more concerned with their inner world than the outside world. Unlike extroverts, who get energized and feel connected to people while socialising, it is only a tedious task to introverts, who would if given the choice, choose to stay at home alone. But contrary to popular belief, being an introvert does not equate shyness or a lack of social skills. Introverts could be master people pleasers and could charm their way around a room whole wishing they were at home watching a movie instead. So while some introverts may have social anxiety and some people with social anxiety may be introverted, these two qualities do not necessarily go hand in hand.

Extroverts and Social Anxiety

On a completely opposite note, extroverts are seen as loud, funny and dynamic personalities who cannot possibly know how to stay quiet. So the idea of an extrovert having social anxiety seems entirely impossible. And even if it does seem possible, it is assumed that it would be very easy to observe.  But as definitely as they exist, it is also extra tough for them to handle both extraversion and social anxiety at the same time. While some of them may simply choose to stay home and avoid putting themselves in positions where they would have to socialize, others try to force themselves to get out there and end up making themselves miserable. The ones who stay at home, end up convincing themselves and people around them that they’re an introvert when in reality they have much more fun going outside and hanging out with people. The ones who do force themselves to go outside, live in constant fear where they question every single step they take or every sentence they speak. They might replay conversations and try to figure out if they did something wrong and overthink themselves into a frenzy of worry and nervousness over future interactions.

Thus, extroverts with social anxiety find themselves in a unique conundrum. While they need social interactions to thrive, those very interactions also cause them immense amounts of worry.

Tips to Work Through Social Anxiety

Be mindful. Anxiety makes you worry about the future or the past so it is important to keep reminding yourself that the present is all that matters.

Give yourself time. Allow yourself space to get comfortable with the idea of a situation before putting yourself in it. For example, do not immediately force yourself to go for tryouts in a huge club without some time to wrap your mind around the idea.

Start small. Take small steps towards what you want to achieve while constantly showing your inner critic that you’re doing well. For example, instead of going to a huge party full of strangers, go to a small lunch with friends and maybe 1 or 2 mutual friends that you have never talked to.

Remember that you’re not alone and chances are there may be a lot more people around you who are dealing with social anxiety that isn’t obvious to you.

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Separation Anxiety Disorder is experienced by children when they have intense anxiety concerning separation from their home or caregivers. It is natural for a young child to feel anxious when they are separated from their parents. It usually starts from a child’s first birthday and can last up to their fourth birthday. Parents can ease their child’s anxiety by being patient and by setting some limits. However, some kid’s anxiety does not go away and it becomes a sign of a larger problem that is separation anxiety disorder. It is not a normal stage of development. Children with this disorder avoid situations in which they will be parted from their caregivers. Even the thought of separation causes extreme anxiety. Situations like when their caregivers are going to work or before going to sleep at night they become anxious. They ask one of their parents to stay with them and leave them after they sleep because they get nightmares regarding separation. Adults avoid going out and staying with others for example going to a friend’s house for a night out.

When they are separated from their caregivers they develop intense fear. They think something terrible will happen to their caregivers or themselves. The fear gets intense that they feel they will get kidnapped.  To avoid this situation they complain about physical symptoms such as stomach ache, fever etc. They become panicky, miserable, homesick, socially withdrawn and sad. They also demand constant attention and sometimes become so clingy that they will not allow one of their caregiver to go out of sight. People with separation anxiety disorder are also at greater risk of subsequently developing other anxiety disorder such as panic disorder.

SYMPTOMS

The symptoms of separation anxiety disorder include:

1. Fear and worry that something will happen to their caregivers
2. Children refuse to go to school
3. Insomnia
4. Complains about headache and stomachache
5. Clinging to the caregiver
6. Nightmares about separation
7. Fear of being alone
8. Bedwetting
9. Temper tantrums

Children and adolescents should show at least three symptoms from the above mentioned symptoms. The symptoms should last for at least four weeks and cause significant distress.

CAUSES

It occurs because of the fear a child has in some ways. If we can know the actual cause we will be one step closer to help the child through their struggles. A strong genetic component was used as evidenced by analyses based on twin data. Important environmental factors such as low-income environment, new house or school can trigger symptoms. They can also develop it because of natural or manmade disasters such as losing a loved one in an attack or tsunami etc. An overprotective parent or insecure attachment can also be a problem because they manifest their own anxiety about separation on the kid. 

DIAGNOSIS

Separation Anxiety Disorder is diagnosed on the basis of the signs and symptoms shown by the person. It varies from age to age. Children in the range of 5 to 8 show more symptoms than the 9 to 12 age group. Young children report more nightmares. Adolescents are more likely to report physical symptoms. Parents and child symptoms differ from each other. Clinicians are more likely to diagnose children with the disorder when parents report their symptoms. There are no laboratory tests for this disorder but the clinicians can ask for a blood test. If no physical illness is found, the child is sent to a psychologist to diagnose and treat them.

TREATMENT

The majority of children diagnosed with the disorder are completely free of symptoms within 18 months. However, people those who need help get the proper treatment from the clinicians. Behavioural techniques such as Systematic Desensitization, Exposure Therapy and Modeling is used for treating fear and anxieties. Contingency management and self management are also useful in teaching child to react positively to their fear-provoking situations. The therapies can be given individually or in combination. Cognitive Behavioral Therapy seems to be the most promising. It helps to reshape the child’s thinking and behaviour. Other therapies include Talk Therapy and Family Counseling to help the child to fight from their fears of separation.  There are no specific medications but in severe cases, antidepressant or anti-anxiety pills can be given to the person. Parents can also help their children at home by making proper plans for them and replacing their anxiety provoking thoughts into positive thoughts and also by setting some limits. They should also allow the child to stay or go to some place alone and should give up on their insecurities regarding their children.

CONCLUSION

Most children with the disorder get better and healthy with time. They need family support and love and when this thing combines with the treatment the chances of recovery improves. There is no way of preventing it but acting and recognizing it at the right time is important. They should live at a better place and should adapt with the changes and should give away their fears and accept the challenges with a positive attitude.

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Since then, the world news has been dominated by the rapid spread and far-reaching impacts of COVID-19. However, the pandemic is much more than a global health crisis. The novel Coronavirus has the potential to create crippling and devastating social, economic and political effects on each of the country it touches and leave deep and long-enduring scars. 

MULTIFACETED CHALLENGES IMPOSED BY COVID-19

Creating a monumental challenge on the public healthcare system, the pandemic brought turmoil on the global market, livelihood, trade, economies, different institutions and the like and integrating all, affecting human life. 

The lockdowns confined millions of citizens to their houses shut down, businesses left large groups of migrant workers jobless and homeless and ceased almost all economic activities. Consequently, the recent days witnessed the sharpest economic pullback and a huge spike in unemployment all across the globe. According to the International Monetary Fund (IMF), the global economy is expected to shrink by over 3 per cent in 2020 – the steepest slowdown since the Great Depression of the 1930s. This global economic downturn, coupled with the financial crisis, is bound to have a negative impact on the behavioural and mental health of the society. 

Quite a few start-ups came to a temporary or permanent halt and the organisations that could operate had to identify and overcome several challenges for ensuring business continuity. One such challenge was quickly adapting to the work culture change and instigating remote working practices that reflected this new environment in order to maintain business continuity. With this shift in working cultures, people not only lost a routine and structured daily schedule, but also social interactions with the wide variety of supportive, friendly, casual relationships at work and in public that make for a rich social texture. Moreover, middle-aged working individuals experienced greater levels of stress due to overlapping family and work responsibilities. These factors compounded with the responsibilities they have towards their children and/or ageing parents as caregivers might have triggered feelings of despair, frustration and loneliness. 

With the shutting down of schools and playgrounds, lack of outdoor activity, aberrant eating and sleeping habits, children have also been exposed to great psychological sufferings because of COVID-19. Although children have been largely spared from the direct health effects of COVID-19, the crisis is having a profound effect on their mental well-being, their social development, their safety, their privacy, their economic security, and most importantly, their education. This disruption of lifestyle has given rise to feelings of distress, monotony, impatience, annoyance and various other neuropsychological manifestations. There is an even greater threat of domestic violence and child abuse now. The children from marginalized communities are particularly susceptible to the infection and may suffer from extended ill-consequences of this pandemic, such as child labour, child trafficking, child marriage, sexual exploitation and death.

Campus closings and the overall response to the Coronavirus fundamentally brought a shift in how college students think about their sense of belonging. In addition to depression and loneliness, college students were also likely to face increased rates of anxiety, fuelled by the uncertainties surrounding the virus. 

The elderly, however, face special challenges because of this pandemic and constitute an especially vulnerable group. Firstly, their age is a predisposing factor to mental and physical health issues and the presence of comorbid conditions make them even more susceptible to infections and accompanying mental distress. The elderly are always advised for maintaining social interactions for their mental and emotional wellbeing, but this has seen a drastic disruption because of the current situational demands of social distancing. Nowadays, not visiting ageing relatives, with the intention of not exposing them to the virus, has become a symbol of love. Thus, the lack of social interactions can precipitate and worsen anxiety, loneliness, feelings of being a burden on their children and various other psychological issues. Thirdly, the lockdowns have aggravated the issues of access to basic medications and healthcare facilities which the elderly face owing to their physical health problems. If they are unable to obtain a sustained supply of medication, they are bound to experience deterioration in their mental state. The constant streaming of news related to the pandemic may become a source of their stress and anxiety because most news outlets highlight the increased mortality rates of COVID-19 in older people. Thus, the regular exposure to such disturbing information can trigger episodes of anxiety, depressive moods and eating and sleeping disturbances. This, in turn, can have a detrimental effect on their quality of life.

Besides these age-related problems, the collateral damage of COVID-19 has been suffered by relationships. These times have witnessed a tsunami of divorces, the dating scene is on its knees and thousands of couples have consulted therapists after months of staying indoors together during the lockdown. All of this has triggered feelings of isolation, loneliness, anxiety and depression. 

Thus, with the spread of COVID-19, the world has been witnessing and experiencing the parallel spread of anxiety, worry, stress and frustration because of the instability and ambiguity of the current situation. Having little idea about what the post COVID scenario looks like and experiencing a lack of control has been a major stressor in recent times. Indeed, in a crisis like this, our mental state seems to deteriorate and it becomes very essential for each one of us to learn ways of staying mentally healthy and be able to cope with the surrounding negativity and stress. 

RESILIENCE: THE KEY TO OVERCOME HARDSHIPS

Remaining calm at a time when we are all in high alert due to COVID-19 can be a challenging task and people exhibit varied responses to the outbreak.  However, during these challenging times, building psychological resilience is vital for the ability to cope effectively with hardship, uncertainty, and change. The ability to withstand setbacks, adapt positively, and bounce back from adversity is described as “resilience” (Luthar and Cicchetti, 2001). Very simply explained, mental resilience means managing our minds in a way that increases our ability to face the situation and prevent psychological distress from affecting our daily functioning. Resilience is the skill which starts with noticing our own thoughts, then unhooking them from the non-constructive ones, and rebalancing quickly. This is a skill that can be built internally, nurtured and trained. 

In research by Marin Seligman, the former president of the American Psychological Association (APA) and the father of the positive psychology movement, seven habits of the happiest people had been identified – 

1. Relationships— Consistent with all the other happiness research, relationships are absolutely vital to a sense of joy and meaning in life. This is why regularly investing in, and carefully working on close relationships is very important, especially during such uncertain times. Connecting with close ones over a phone call or social media can help reduce stress and depressive moods. 

The present climate of fear can also create stigmas and judgments about who is to be avoided or who is to be kept at a distance. Thus, forming and maintaining compassionate, meaningful bonds and relationships has become even more important. 

2. Kindness— Seligman found that people, who volunteer or regularly care for others, are happier and less depressed than other people. Not surprisingly, research shows that giving and receiving kindness can protect one from disease, and may even help the person live longer. 

In the COVID times, where people are translating social distancing into physical distancing and mistreating people affected by the virus, little acts of kindness can not only help others but the society overall. 

3. Physical Exercise— Exercise and a good diet are primary factors for lifting depression. Keeping the body healthy by moving every day is a basic building block of happiness and can also act as a form of healthy engagement during these times. 

4. Purpose, meaning, and spirituality— Studies demonstrate a close link between spiritual practices and happiness. Spiritual thinking can also help people cultivate hope, compassion, and self-reflection. Spiritual engagement can also keep one’s mind off the surrounding negativity and help the person stay calm and relaxed. 

5. Identify and use greatest strengths— People who identify what they are great at and try to do more of it every day—are much happier. Developing strengths and concentrating on positive qualities can also boost mental wellbeing. 

6. Gratitude, mindfulness and hope— Happy people focus on what they have, not on what they don’t have and live in the present as much as possible. Hope has been linked to a better immune system and less chronic disease. How we explain bad events to ourselves also plays a large role in how we move forward. These attributes are deeply linked to happiness, and they are skills that can be learnt, practised and deliberately cultivated. 

7. Flow States— A fascinating work of Mihaly Csikszentmihalyi, “flow” activities are those in which people become so engrossed and absorbed in that space and time seem to not exist. Research shows that people are happier when they regularly engage in “flow” activities. These are activities that people simply enjoy doing voluntarily. They are moderately challenging, but not so challenging that they produce stress. 

With the gift of time, we have received due to COVID-19, we can rediscover our long-lost talents and spend productive time behind cultivating them.

This calm and present state is crucial. It helps keep the mind from wandering and getting hooked, and it prevents us from being susceptible to stress and worry. Moreover, taking some time off from work and family commitments and engaging in self-care and introspection can help us think clearly. More importantly, the continued practice of calming our minds builds a muscle of resilience. When we practice bringing ourselves back to the present moment, we deepen our capacity to cope and weather all sorts of crises, whether global or personal. 

Resonating well with Seligman’s research, a recent study by Killgore, W. D. S., Taylor, E. C., Cloonan, S. A., and Dailey, N. S. (2020) on Psychological resilience during the COVID-19 lockdown proved that social support from family, friends, and a special caring loved one were each independently associated with greater resilience and during periods of shelter-in-place orders, it is important to foster these relationships and to find creative ways to stay emotionally connected with those we care about. Their research also highlighted the importance of daily activities. Exposure to the outdoors and sunlight for a few minutes each day and getting a bit more exercise were both also associated with greater resilience. Finally, spiritual health was another facet of well-being to consider, as more frequent prayer was independently associated with greater resilience. It was thus found that those who actively engaged in these vital activities and nurtured their relationships tended to be the most resilient to the challenges to mental health imposed by the COVID-19 pandemic. 

In addition to these, World Health Organization (WHO) also published a document on “mental health and psychosocial considerations during the COVID-19 outbreak” which addressed age-specific concerns and highlighted similar points related to building resilience. The World Health Organization (WHO) and Disease Control and Prevention (CDC) also highlighted the significance of enhancing community resilience to curb the COVID-19 outbreak.

Thus, individuals building internal reliance can definitely contribute to the building of community resilience and create a better situation for all, because the overall resilience of a community rests on the extent to which community members practice healthy lifestyles and are aware of the community’s health-related functional needs. 

CONCLUSION

Looking through the lens of positivity and optimism, one can see a silver lining on the dark COVID cloud. Despite all the obvious hardships, most of the people are learning to adapt well to these challenging circumstances and deal with all the ordeals. We’ve started engaging in healthy habits, connected with long lost friends, rediscovered old talents and understood the value of time. We’ve become more aware of our emotional needs, we’re understanding people better and we’re bonding with each other like never before. It’s true that the current times are uncertain and we have a very hazy idea about what the future looks like, but in spite of all this, humans are known to be resilient beings and this innate human capacity of resilience has always helped us overcome the hard times. After all, when life gives us lemons, we’ve got to make good lemonade and enjoy the drink! 

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Symptoms

Conditions such as anxiety, depression, panic attacks, lucid dreams, phobia, insomnia affect our mental health. Overthinking plays a very huge part when we talk about mental health. Many people tend to think too much about the situations which will probably never happen. People don’t have control over how much they overthink. There are many solutions to overthinking if you search it up on the internet but, in reality, it’s not very elementary. You can experience these conditions at any point of your life, no matter the age, sex or ethnicity. Some people can be more prone to depression than others because of well, life situations, peer pressure, sexual identity and whatnot.

According to a study by WHO, half of all mental health conditions start by 14 years of age. Adolescents are at greater risk of mental health conditions due to their stigma, discrimination or exclusion, or lack of support from their parents/friends. As per the same study by WHO, suicide is the third leading cause of death in older adolescents because of mental illness and lack of access to help/therapy. There is a growing consensus that healthy development during childhood contributes to good mental health.

Lancet’s Study

Lancet has found the efficacy of “brief lay counsellor delivered, problem-solving intervention’’ for mental health problems in adolescents from government schools in Delhi. This is for adolescents who can’t afford to pay for therapy sessions. The premium for Adolescents (PRIDE) is a six-year research programme dedicated to making psychosocial interventions for improving the mental health of adolescents in India. “The study established that with limited resources and counselling intervention, we can give practical tools to adolescents to manage and deal with their mental health issues. This also makes mental health treatment accessible to those from underprivileged sections of society,” says Dr Kanika Malik, a clinical psychologist. The programme is going really well and is pretty successful. More than 250 adolescents were enrolled for the programme between August and December in 2018. For the treatment, they made a problem-solving booklet in a comic format to keep up with the interest of the adolescents. The book has many chapters which teach the kids to deal with domestic problems. This is very important because domestic life can be a major source of stress for the students and they don’t have the resources to tackle these situations but the comic book gives them tools to work through them. Not only did they distribute the booklets but also hired and trained the members of the community to counsel students.

According to a study by the lancet, more than 99% of adolescents and children with mental health problems remain undiagnosed in India. If these students receive proper treatment right now, they are less likely to suffer from serious mental health conditions in the later stage of their life. The initiative that lancet took for these adolescents is exceptional. 

Vulnerable Teens 

Another problem that students face while growing up is whether or not they should tell their parents about what they are going through. Adolescence is a very crucial period in our lives. Your decision-making power is not the best at this age. Parents are also requested to listen to their kids, to understand them, to tell them that it’s normal to feel this way. Many kids have abusive parents which makes it even more difficult for them to go through the illness. 

Look out for yourself and other people

 Mental illness is a very serious condition and it should not be neglected. Your brain is just as important as your heart and other body parts. It can only handle so much. Also, we should not forget the fact that we are in the middle of a pandemic right now and this COVID situation is not helping. This is for all the parents, if your kid is struggling, love him/her. This is for all the people who have friends with mental illness, support your friends.

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This article is about ‘Bella Clifton’ and her fight with BPD.

Bella Clifton was a 9-year-old girl when she saw her parents fighting every day and night. Little as she was, in that environment of hostile and distressful, her child-like mind started believing that people leave when we need them the most. Although her parents reconciled after years of arguments and fights but her subconscious mind was still lost in those years of her childhood. 

During her teenager days, she lost some of her closest friends and became more & more depressed. She had a feeling of insecurity & fear of rejection. So, she never made very close relationships. She was emotionally imbalanced, full of sadness and the cloud of self-worthlessness thoughts started following her. She even started questioning her existence. Those events made her lonelier. She was feeling empty inside her own. 

Borderline personality disorder or BPD is a serious Psychological Disorder, often confused with bipolar disorder. According to the most recent DSM-4-TR lists nine categorical criteria for BPD, five of which must be present for diagnosis. 

The nine Psychological criteria are as follows:-

1. Frantic efforts to avoid real or imagined abandonment.
2. Unstable and intense interpersonal relationships.
3. Lack of a clear sense of identity.
4. Impulsiveness in potentially self-damaging behaviours, such as substance abuse, sex, shoplifting, reckless driving, binge eating, etc.
5. Recurrent suicidal threats or gestures, or self-mutilating behaviours.
6. Severe mood shifts and extreme reactivity to situational stress.
7. Chronic feelings of emptiness.
8. Frequent and inappropriate displays of anger.
9. Transient, stress-related feelings of unreality or paranoia.

Discussion

Borderline personality disorder (BPD) is one of the group B-type of personality disorder. It is common in a psychiatric environment with a recorded prevalence of 20%. In BPD comorbid depression, anxiety spectrum disorders & bipolar illness occur more frequently & the lifetime risk of having at least one comorbid mental disorder approaches 100%. It is more common in women, higher in the urban population. It was originally used in psychodramatic circles to describe people with a marked instability. (source)

People suffering from borderline personality usually have a traumatic childhood experience such as separation of parents, sexual assault, or physical violence. The world of a borderline, like that of a child, is split into black and white. At any particular moment, one is either “good” or “evil”; there is no grey area. Splitting is an escaping mechanism from anxiety. A person suffering from BPD desperately seeks out new relationships; for solitude, even temporary aloneness is intolerable than mistreatment. 

BPD is often accompanied by- anxiety, anger, depression, panic attacks, sleep disturbance, episodes of frequent mood swings.

In Bella’s case, it was her traumatic childhood which made her a patient of BPD. At first, she wasn’t ready to go to a psychiatrist but after lots of convincing and arguments with her childhood best friend, she gave in. Bella was prescribed with some mood stabilizer, anti-depressant and sleep-improver. Her psychiatrist recommended her a clinical psychologist and the journey of her DBT session (therapy for BPD) begins.

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