Anxiety & Depression

The following information is adapted from the Diagnostic and Statistical Manual IV. These are brief descriptions of disorders and the criteria for diagnosing are not identified. Clients should consult a professional mental health clinician if any of these symptoms are evident. Note the disorders are diagnosed based on duration, intensity and frequency of the symptoms. A full assessment should be done prior to any treatment.
Anxiety on certain levels is not only normal, but helps us to adapt to stressful situations, such as when taking a test and recognizing when we are in danger. However, when individuals experience recurrent psychological symptoms (e.g. worry, repetitive thoughts, nervousness, irritability, restlessness) and physical symptoms (e.g. sweaty palms, rapid heartbeat, difficulty breathing) while confronted with fearful situations or objects, that are real or imagined, produce the disorder. The building blocks of Anxiety disorder are panic attacks and phobias. 
Panic Attack - when an individual experiences intense sense of impending doom accompanied by cardiac symptoms (chest pain, palpitations) and has difficulty breathing. The symptoms begin suddenly and peak rapidly within a ten minute time span and cease within 30 minutes. The individual will often seek medical evaluation via visits to an emergency room. Multiple panic attacks are then classified into a disorder.
Phobia - this is an unwarranted fear of objects or situations. There are many types of phobias that individuals experience, resulting in persons avoiding the feared object or situation. There are external fears (e.g. storms, sight of blood, animals) and there are internal fears (e.g. feeling embarrassed to speak, and worrying about being clumsy, silly, or shameful). A person can also fear open spaces and closed in environments i.e. elevators, escalators, or heights. Individuals can develop specific phobias and experience feelings of choking, trembling, vertigo.
Below are brief descriptions of a few of the Disorders as identified in the DSM IV. Individuals should consult a professional mental health professional for a complete evaluation of their symptoms and best course for treatment.
Panic Disorder: An individual that experiences repeated Panic attacks and worries about having them recur. Panic attacks are often classified with Agoraphobia (fear of situations or places) or without Agoraphobia.
Agoraphobia without History of Panic Disorder:   Persons usually experience fear of open places, large gatherings and particular situations, and can develop panic like symptoms.
Specific Phobia: As stated earlier these are the external fears; for examples animals, blood, airplanes or elevators.  Individual can experience physical symptoms of vomiting chocking and difficulty breathing. The feared objects are avoided. A panic attack or general anxiety is induced at the exposure of the feared object.
Social Phobia: An individual imagines themselves embarrassed when they speak, write, or eat in public, using a public urinal (for men), and worry of having this behavior noticed by others. Individuals can exhibit choking, blushing, hoarseness, tremors or perspiration.
Obsessive-Compulsive Disorder: These persons are bothered by repeated thoughts or behaviors that appear senseless, even to them. Obsessions are recurrent thoughts/beliefs that invade a person's thought process and can also be unrealistic. Compulsions are the acts performed repeatedly; in a way that the person realizes it is neither appropriate nor useful.   This is seen with people with frequent hand washing, cleaning and checking.
Posttraumatic Stress Disorder (PTSD): A person repeatedly relives a severely traumatic event, such as combat or a natural disaster. Sometimes, car accidents or near death experiences can also give rise to the repetition of the traumatic event.
Acute Stress Disorder: This condition is much like PTSD, except that it begins during or immediately after the stressful event and lasts for a month or less. 
Generalized Anxiety Disorder (GAD): Although they experience no episodes of acute panic, these patients feel tense or anxious much of the time. Individuals with GAD have constant worry about everything and exhibit low-key, chronic nervousness.
Depressive disorders are complex and a full assessment is necessary prior to being diagnosed or treated. The severity is dependent on how the symptoms are experienced in duration, frequency and intensity. Note mood disorders are different and must have other symptoms present before being diagnosed.
Major Depressive Disorder: Within a two week time frame, an individual must have exhibited depressed mood or deceased interest or pleasure accompanied by at least five of the following:
§         Changes in mood
§         Change in appetite
§         Changes in sleep patterns
§         Deceased psychomotor activity
§         Sense of hopelessness
§         Suicidal thoughts/gestures
§         Deceased self-worth
§         Decreased energy and concentration
§         Fatigue
Dysthymic Disorder: An individual must have depressed mood for two years or more and have at least two of the following:
·        Changes in appetite
·        Change in sleep patterns
·        Fatigue or low energy
·        Poor self-image
·        Reduced concentration or indecisiveness
·        Hopeless feelings
During this two year period, the above symptoms are never absent longer than two consecutive months
During the first two years of this syndrome, the patient has not has a Major Depressive Episode.
Depressive Disorder Not otherwise Specified: Individuals have depressive symptoms that do not meet the criteria of the above disorders.
For more information on these disorders, please feel free to contact me.
Zarna Shah, LCSW
(516) 243-9480
Professional Psychotherapy Services