To reap the comfort that you seek, you will need to persist in practicing various skills using concentrated effort over several months. Certain characteristics of social anxieties, when combined, require that you use this degree of thoroughness. Here are seven of the most important distinctions regarding recovery from social phobias.

1. You will need to work on several skills at once.

You enhance your progress in mastering anxiety when you follow several principles regarding facing your fears. One principle is to break down your skills into manageable chunks of activities. As you accomplish early tasks, you can add complexity to your practices. A person with social anxieties, who worries predominantly about the critical judgments of others, will not typically have the chance to practice simple skills before he faces more complex situations.

A person learning to face social fears must master the same type of tasks as someone with panic attacks. However, he often must cope with them while simultaneously interacting with others. The skills needed to manage social interactions are inherently more sophisticated than those needed to sit in a crowded church, shop for groceries or tolerate an elevator ride to the fifth floor. It is this social interaction that adds significant complexity and therefore stress to the event. For instance, when giving a speech, he must practice tolerating uncomfortable physical symptoms, quieting his fearful thoughts, stopping himself from analyzing his every move, reducing his preoccupation with the reactions of his audience AND performing the complex skills needed to deliver a logical presentation.

2. You may participate in some anxiety-provoking events before you feel ready.

A similar principle for overcoming anxiety is to gradually face your feared situations as you are learning your coping skills. It is best to begin with lower grade fears and work your way to the more difficult events.

When you have social anxiety, events that are high up on your list of threatening situations may take place before you have mastered your lower level tasks. There are two primary ways that this occurs.

First, you may need to participate in some events simply because of your current responsibilities. For example, you are invited to a party for your close friend. Or you must meet with three managers about a new project. Or you are assigned an intern who must observe your work at the office. Any of these encounters can place you in an uncomfortable scene before you feel ready.

Second, distressing social encounters can pop up spontaneously and catch you unaware. Your boss may request a last-minute office meeting, you could be called on to give an informal report, an acquaintance might bump into you while you are eating lunch and ask to sit down. Suddenly you are thrust into a highly stressful event without planning your coping responses.

3. It's not so easy to schedule practice sessions.

Frequent practice of your skills within a limited time period is another important principle for learning new behaviors. Some socially uncomfortable situations, however, don't occur on a routine schedule. If you want to practice formal presentations, job interviews or taking exams, you may have to wait weeks or months for opportunities. Finding creative ways to simulate these events will be important additions to your practice. (I'll offer some suggestions later.)

4. Some socially uncomfortable events are brief contacts.

One of the goals of practice is to develop habituation: by remaining in anxiety-provoking situations for prolonged periods, your intense anxiety reaction gradually decreases. As you become less anxious, you can think more clearly and perform more comfortably. That's why I encouraged you to create practices that last from forty-five to ninety minutes.

However, a number of uncomfortable social contacts are brief, lasting seconds or a few minutes at most. Looking someone in the eye as you pass, saying hello in the hall at work, shaking hands, signing a credit card slip, answering a question in class, bumping into someone you know, asking someone for a date -- all these events can instantly generate high distress, but then end just as quickly.

Again, you may need to create simulations to practice these skills. For example, if you have difficulty writing in public, you can ask several friends to look over your shoulder while you sign your name fifty times.

5. Facing and tolerating the fearful event is not enough.

Phillip was a 53 year old engineer who came into treatment for his severe social phobia. His grave fears of writing and drawing in front of his colleagues cost him his job. He was sure that all who observed him would ridicule his shaking hands and "illegible" writing. By the time I saw him, he was on disability and couldn't publicly sign his name or lift a spoon, fork or glass to his mouth unless he had previously taken two shot glasses of bourbon. One afternoon in treatment, he took a giant step. I prearranged an agreement with the clerks in six stores, then Phillip entered each store, approached the clerk, asked if he could sign his name as the clerk watched, and then proceeded to do so. Relative to Phillip's severe limitations, this was a monumental task. I waited in the parking lot, and as he approached I asked if he accomplished his goal. Phillip nodded, and when he reached my side, as he held out the writing tablet, his first sentence was, "Look how shaky my writing was!"

This example illustrates that confronting the feared situation is necessary, but insufficient. Many people with social anxieties force themselves to interact with others in their feared situations. They will eat at restaurants, speak in a small group discussion, or answer questions when called on. But, like Phillip, they leave the scene and worry incessantly that they made a fool of themselves or will suffer dire consequences because of their humiliating actions. Along with entering your fearful arenas, you must specifically address your fear of others' judgments and your own harsh self-criticism.

6. You may also need to develop certain social skills.

Some people, in addition to feeling anxious about social interactions, are not confident of what behaviors are most socially appropriate. This is understandable if you have been socially withdrawn most of your life, or if your parents were also inhibited and failed to model interactional skills, or were critical of your social behaviors without instructing you in the correct actions. Such needed skills may include: how to initiate conversation and pastime with others; body posture, facial expressions, and eye contact; formal presentation skills; grooming; and assertive communication.

7. Other problems may get in your way.

Studies of people with social phobia indicate that seventy percent also suffer from at least one other psychological problem. Sixty percent have another phobia and forty-five percent have agoraphobia or panic disorder. Almost forty percent experience some form of depression. One study found that seventy percent meet the criteria for avoidant personality disorder. (Avoidant traits include pervasive social anxiety, loneliness, low self-esteem and the belief that others dislike you or will take advantage of you.) In addition, people sometimes use alcohol as a means of coping with the problem. Approximately twenty percent of those with social anxieties turn to alcohol in an attempt to self-medicate.

There are many ways in which you can help yourself overcome your social discomfort. In the following pages I will outline a positive approach based on the principles of this book. However, if you think that your difficulties are more than you can manage while using the support of your family and friends, then turn to a mental health professional who specializes in the treatment of social phobias using cognitive-behavioral therapy. There is now a growing number of caring and competent specialists who treat these problems.

Also, specialists sometimes recommend medications to assist you during treatment.

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All In Her Head

Anorexia - the most deadly mental illness - is definitely not just about looking thin.

She didn't choose anorexia. I know that now, but that doesn't make it any easier to watch her starve herself, and fade away into nothing.

It's like a nightmare where you see the boogeyman and you know it's going to kill her so you warn her, but she can't see it, so she doesn't believe you, and then she dies.

But anorexia is a slow suicide. And although anorexia accounts for more deaths than any other type of mental illness, she says she's okay, she says she's healthy. Her brain has shrunk and she's losing her cognitive skills.

She's says she's not like other anorexics. She's in denial. She's moody and angry and depressed a lot of the time. She thinks her mind and body are just fine. But her heart has shrunk, too, and its resting rate has fallen to 49 beats per minute (60 to 80 beats per minute is considered healthy) and she's seen doctors for problems with her kidneys, stomach and other organs.

When she's sleeping, her heart rate will fall well below the "critical" rate of 45 beats per minute, and she may not wake up again.

It's difficult not to feel angry with her because she's hurting herself and all of the people who love her. But she's not just a skinny, stubborn, vain girl who won't eat. She's sick, with a mental illness, and she didn't choose this any more than someone chooses cancer.

A few days after Christmas, she is hospitalized. She's in treatment now, although most of the time she doesn't want to be there and she insists she can get better on her own. I try to tell her that no one looks forward to chemo, either. I don't know if she hears me or not. There are millions of other women - and men - like her in the US, walking skeletons, dying to be thin.

"Why won't she just eat the sandwich?" asks Dr. Cecily FitzGerald, an emergency physician who also treats patients with eating disorders. "She can no more eat that sandwich than you can eat that shoe.

"It's important to stress that it's not about the food, because parents, spouses, loved ones - they always feel it's just about the food. It's really not about the food."

The National Association of Anorexia and Associated Disorders says the problem has reached epidemic levels in America, and affects everyone - young and old, rich and poor, women and men of all races and ethnicities. Their statistics say seven million women and one million men are sick with an eating disorder. More than 85 percent of victims report the onset of their illness by age 20.

There are still a lot of misunderstandings about the disease, however, even among health professionals. Treatment is hard to find - few states have adequate programs or services to combat anorexia nervosa and bulimia - and it's also very expensive.

Inpatient treatment can cost about $30,000 a month, and outpatient treatment, including therapy and medical monitoring, can reach $100,000 per year or more.

"The treatment should be multi-disciplinary," FitzGerald says. "Therapy, a nutritionist, and a physician. Those are the minimum requirements - you can add to that physical therapy or art therapy. You can add as much as you see fit. But the bare-bones is the therapist/psychologist, a physician and a nutritionist."

Anorexia - as all eating disorders - is a complex disease. There's not one single, simple cause, although new research has revealed that anorexia and bulimia are inherited conditions - one needs to have a genetic predisposition for them.

"But that doesn't mean that everybody who has that gene does have, or will develop, an eating disorder," says Kirstin Lyon, a marriage and family therapist in Carmel Valley who is also a certified eating disorder specialist.

So-called environmental factors can also trigger, and worsen, the disease: our society's obsession with thinness, puberty, dieting, going away to college, a traumatic world event or a more personal one, like a breakup.

"There are usually about 10 other reasons why people get eating disorders," Lyon says, "and they all come together: control issues, perfection issues, also addiction. When all these things come together, it forms this way of coping. It's not about the food."

While most people who develop anorexia do so when they hit puberty, both Lyon and FitzGerald say they see patients of all ages. They say they treat 10 girls for every one boy.

First, it looks like body dissatisfaction. "I want to go on a diet," Lyon quotes her patients. "Or food pickiness - I want to be a vegetarian."

Sometimes it's even encouraged - "dieting and exercising are good for you; thin is beautiful," or so we are told every day.

"We live in a culture where we look at anorexically thin models and call that normal, call that attractive," FitzGerald says. "We have lost our high level of suspicion for someone who is at low weight."

By the time the disease is discovered, much damage has already been done. Hair falls out. Skin turns orange, or yellow. Teeth and gums erode. Menstruation stops. Bones become weak and brittle. The heart, kidney, liver, stomach and other organs become seriously damaged and start to shut down. The brain shrinks.

And those are only the physical repercussions. Words don't adequately describe what the disease does to her self-esteem, how badly it damages her relationships and how much it hurts the people who love her.

"Weight restoration will return most everything to normal," FitzGerald says.

About one third of anorexics recover, Lyon says. Another third may relapse and remain symptomatic. The final third are chronic.

"Their life expectancy is shorter, or they will die," Lyon says.

The ones who recover can't do it overnight. It usually takes between two and nine years. Both Lyon and FitzGerald had eating problems. Both recovered from eating disorders, and want to help other people become well.

"There were so many times when I didn't want to go [to treatment]," Lyon says, "but I just had faith that things can change. If they can for me, they can for anybody."

And both Lyon and Fitzgerald rail against the unrealistic body images on TV, in magazines and on the runways.

"It's very important for all of us - parents, teachers, men and women - to be accepting of our bodies," FitzGerald says. "I think this whole obesity epidemic is really dangerous; the amount of press that obesity is getting is leading to so much press for diets and it's such a dangerous, dangerous place to go. People need to eat what they want, when they want, and stop when they are satisfied."

It's also extremely important for parents to model body acceptance for their kids, she says. "Then they aren't so susceptible to the media, to diets. It's important for parents to point out all the ways that our culture gets women to be unhappy with themselves. Don't say, 'Do these jeans make me look fat?' or, 'I can't have dessert; it will go straight to my hips.' It's that kind of stuff that children just can't hear. They need to know that they don't need thin thighs or a flat stomach to love their body."

FitzGerald talks to her daughter about airbrushing; in fact, the two have made a game out of it.

"We go through magazines and pick out where we think the model has been airbrushed. You take a woman who is already beautiful, and even the model can't achieve this level of perfection.

"Parents, teachers, babysitters, sisters, we need to all stand up and say, 'We are happy with ourselves, our bodies, the way they are.'"

I hope she makes it to that point, and someday, will be able to say she's happy with her body and really mean it. She's begun to take the first steps, at least. But right now she's angry much of the time. She's angry at her doctors and her parents because they are forcing her to eat and attend therapy sessions. I hope someday she will be able to realize that they saved her life.

Source: Monterrey Weekly

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The nature of social anxieties requires that you focus primary attention on your evaluations -- of yourself, your behaviors, how you perceive that others judge you, and your imagined consequences of those judgments. The first steps toward change include recognizing and confronting the destructive patterns of self-talk that I label the Negative Observer. You will then need to develop a new way of rationally and respectfully addressing your intentions through the voice I call the Supportive Observer. As I will discuss later, you cannot improve by only facing your feared events. (I am sure you already know this from experience.) You must also focus your resources on mentally vocalizing support for your desire to fit comfortably into your community. This will require that you first challenge your current way of negative thinking.

Listening for the negative thoughts

Worried, self-critical and hopeless comments for the Negative Observer flourish within the mind of the socially anxious person. Some statements are a combination of worried and hopeless comments. Instead of the typical "what if...?" question of the person who fears panic attacks, your comments sound more like a statement of hopelessness. "What if I won't be able to answer their questions?" becomes "I'm sure I won't be able to aworried and hopeless commentsnswer their questions." "What if everyone notices that I'm sweaty and nervous?" becomes "I'm sure everyone will notice that I'm sweaty and nervous." Instead of being uncertain about the outcome, you declare that the negative outcome will, in fact, occur. This becomes a much stronger negative voice. You are certain it is reflective of the truth, and you then worry about the inevitable consequences. If you forge ahead into the feared situation, you are likely to be more frightened than others. This is because you are already predicting the dreaded failure and even calculating the dire costs you will pay in humiliation and rejection. Because you combine your worried thoughts with your hopeless comments, you are also more likely to avoid these situations instead of face them.

Here are more examples of the worried/hopeless combination of Negative Observer thoughts:

• I've got to quit this position, because I'll certainly keep failing.
• This will never work. Everyone will notice.
• I'll look like a fool.
• I won't be able to think of anything to say.
• I'll humiliate myself.
• I can't do it! I'm too nervous.
• I won't be able to get my point across.
• It'll be awful.
• I'll never find another job.
• I'll go blank. We'll just stand there and stare at each other.
• I'll be so nervous I won't be able to express myself.
• I'll never get better.
• I'm so anxious. I know I must be coming across wrong.

Many of your Critical Observer comments are typical, such as:

• I was so stupid.
• I stumbled over that word; I looked like a complete fool up there.
• I always get anxious!
• What's wrong with me? I'm just worthless.

Your Negative Observer comments can be quite self-critical. They have two basic distinctions. First, you criticize yourself indirectly by fantasizing that other people are critical of you. If you are like many socially anxious people, this is a ruthless attack on your self-esteem because it goes to the core of your fears: that others will demean you or reject you. Here are some examples:

• He's yawning. The entire audience is bored.
• He saw my hands shake when I was drinking. He knows how incompetent I am.
• He didn't like me because I didn't know what to talk about.
• He thinks I'm boring, stupid, obviously incapable.

In a second distinction, your Negative Observer operates through a set of rules and expectations that are either impossible to meet or entirely unnecessary to adequate social performance. These often come in the form of "should" and "shouldn't" statements, and they place an inordinate amount of pressure on you to perform:

• I should have done that perfectly.
• I should be able to figure out what to say.
• Remember, never let them see you sweat!
• There are rules for how I should behave. I shouldn't be inappropriate.
• I shouldn't blink.
• I should always look people in the eye when I'm talking.
• I should be able to make a statement without mispronouncing my words.

To improve your comfort level in social situations you must first change your thoughts. There is little point of you entering fearful encounters and simply tolerating them. There is no learning in such an approach. So start with your thinking process -- before, during and after any anxiety-producing social events. To take control of your thoughts, you need to identify your Negative Observer comments and to challenge them. The central focus of your attention will be on your distorted evaluation of your performance.

Listen for your self-talk in these four major areas.

1. That you are likely to perform poorly:

• I'll never think of anything to say. My mind always goes blank.
• I'm sure my hands will shake, and they'll notice.
• I'm so nervous. I just know I'm going to mess up.
• I'm going to talk too much.

2. That others will disapprove of your performance and their disapproval will be harsh.

• If I raise my hand and she calls on me, then everyone will know how nervous I am and they will reject me.
• I can't just start talking. He'll think I'm superficial.
• He'll never like me after he sees how I act.
• They will think I'm obviously incapable.

3. That the consequences of their disapproval will be severe.

• He won't want to go out with me again.
• I'll never get this job.
• I'll never meet anyone, go on a date, get married.
• He'll fire me if I do that again.
• I'll be alone for the rest of my life.

4. That your performance reflects your basic inadequacy and worthlessness.

• This proves that I'm a social incompetent.
• I'm so stupid!
• Who'd want to be with someone like me, anyway?
• I'm a born loser, a jerk, so boring.
• No one would ever want to go out with me.

Handling negative thoughts

We do not yet know to what degree social anxieties are biologically based problems. But let's assume that your social inhibitions are genetic -- that you are preprogrammed to automatically think in this negative fashion. If this is true, it's not bad news. Please understand that most people suffering from any anxiety disorder -- who get the proper cognitive-behavioral treatment -- are able to improve. Thousands have recovered fully. So even though you may be biologically vulnerable to anxiety, you can change your future using psychological techniques. You don't have to live your life in pain and with the fear of humiliation.

If it is the nature of your disorder that your mind automatically generates fearful thoughts -- without the benefits of logic or conscious reasoning -- should you believe those thoughts? Certainly not! But when your initial, spontaneous thought is negative, your body tends to react to it instinctually, by generating symptoms of anxiety. As your anxious symptoms arise, you use them as a sign of how poorly you are going to perform. In essence, you say, "This proves that I'm going to fail."

It is very hard to perform while simultaneously listening to that critic or that hopeless worrier: that you are going to fail, that others will be harshly disapproving, that the consequences of their disapproval will be severe, and that all this shows how worthless you are. Your challenge is to stop taking those thoughts at face value. Recognize them as your automatic and impulsive Negative Observer comments. Even think of them as genetically preprogrammed if you want. Just stop viewing them as reflective of reality!

The most powerful question

You must listen for your negative thoughts, and you must disrupt them. However the last thing you want to do is to start arguing with yourself mentally, because your fearful thoughts will tend to win out, since they involve the strongest emotions. The most straightforward way to disrupt these thoughts is to say to yourself, "This is just my Negative Observer talking; I'm not going to listen." Then let those thoughts go and return to your Task. In Step 8 of the Panic Attack Self-Help Program I described this skill, called "Stopping the Negative Observer":

1. Listen for your worried, self-critical, or hopeless thoughts.

2. Decide that you want to stop them. ("Are these thoughts helping me?")

3. Reinforce your decision through supportive comments ("I can let go of these thoughts.")

4. Mentally yell "stop!" (Snap rubber band on wrist.)

5. Begin the Calming Counts.

Of all these steps, the most important for you will be: "Are these thoughts helping me?" Keep in mind the goals of your practice: to learn to perform while you are anxious, to actively engage in your coping skills, to disrupt negative thoughts, and to participate in activities that you have been avoiding. When you question your thoughts, ask if they are helping you reach these specific goals.

Let's see how this works through an example. Let's say your goal is to support yourself as you give one of your first presentations to your office staff.

You say to yourself: "This will never work. Everyone will notice." Is this thought helpful?

You say to yourself: "I won't be able to get my point across." Is this thought helpful?

You say to yourself: "What's wrong with me? I'm just worthless." Is this thought helpful?

You say to yourself: "He's yawning. The entire audience is bored." Is this thought helpful?

You say to yourself: "I should be able to make a statement without mispronouncing words." Is this thought helpful?

Here is the central strategy that makes this intervention so powerful: you are not disputing the accuracy of your thought. You are declaring that, regardless of its accuracy, it isn't helping you. It's hurting you. Some of these thoughts may be partly true. Perhaps a few people will see your hands shake or hear your voice crack. Maybe some audience members won't understand your point. A few others might have little interest in your topic and will feel bored. But if your goal is to support yourself before, during and after your presentation, none of these negative comments further your goal. Don't analyze them, don't embellish them, don't argue with them. Notice them and let them go!

Once you let them go, offer yourself a supportive comment to keep you on track with your Task. The chart below offers a few suggestions.

EXAMPLES OF SUPPORTIVE STATEMENTS

• I'll survive this.
• Remember to breathe.
• Most people will accept it if I make mistakes.
• I can handle disapproval.
• My self-esteem is not based on other people.
• It's OK to be nervous.
• I can handle these symptoms.
• There's no proof I'll fail.
• This is good practice.
• I've done this before.
• I know this topic.
• These people want me to succeed.
• There are many reasons for their behavior

Sometimes your negative thoughts seem so powerful that you feel as though you can't disrupt them with a simple dismissal such as, "This thought isn't helpful." Don't be surprised if you have such trouble for awhile. I encourage you to persist in your efforts to master this skill even when you feel resistant to it. Don't give up on it! You are working to overcome a long-standing pattern, so repetition and a certain degree of tenacity will be important. This particular intervention will be your most powerful ally.

The second level of challenge

There may be times when you need a different challenge to your negative thoughts. As I suggested earlier, your Negative Observer leads you to feel certain about your inadequacies, and about how bad things are or will become. This second level of challenge is just as simple as the first. Its purpose is to confront your certainty. If you are like most socially anxious people, you have a great deal of conviction about negative assessments. Your mind quickly chooses some negative evaluation without considering any other options. That is what to question: your mind's automatic and rapid decision regarding a negative evaluation. The goal, minimally, is to open your mind to the possibility that you are not absolutely, incontestably, 100 percent, beyond doubt, sure of your conclusion.

It is not necessary that you take on a positive, optimistic view of yourself or your interaction. It is only important that you let yourself consider that there are other points of view. It's possible that something else could occur. It is conceivable that they are thinking something else about you. (Or not thinking about you at all!) Here are some examples of this challenge:

"No one would ever want to go out with me." --> "What evidence do I have?"

"If I raise my hand and she calls on me, then everyone will know how nervous I am, and they will reject me." -->

"Do I know for certain that will happen?"

"He saw my hands shake when I was eating. He knows how incompetent I am." --> "Do I know that for certain?"

"I was so stupid." --> "Does labeling myself improve my performance?"

"I stumbled over that word; I looked like a complete fool up there." --> "Could there be a less harsh way

to describe my behavior? Would I treat a friend this way?"

"I'll never find another job." --> "Am I 100 percent sure?"

"It'll be awful." --> "What is the worst that could happen? How bad is that?"

"He's yawning. The entire audience is bored." --> "Could there be any other explanation?"

Challenging Negative Thoughts

Here are some questions to confront your negative comments:

• Am I positive that this is true? What evidence do I have?
• Do I know for certain that will happen? Am I 100 percent sure?
• Does labeling myself improve my performance?
• Could there be a less harsh way of describing my behavior? Would I treat a friend this way?
• What is the worst that could happen? How bad is that?
• Could there be any other explanations?
• Is this my only opportunity?

By challenging your automatic negative thoughts, by loosening up your grip of certainty, you open the door to tell yourself, "This thought isn't helpful." You can then remind yourself of your positive goals: to learn to perform while you are anxious, to actively engage in your coping skills, to disrupt negative thoughts, and to engage in activities that you have been avoiding.

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Parents are usually the first to recognize that their child has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a parent. The first step is to gently try to talk to the child. An honest open talk about feelings can often help. Parents may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the child well. These steps may resolve the problems for the child and family.

Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful.

Younger Children

• Marked fall in school performance.
• Poor grades in school despite trying very hard.
• A lot of worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child's age.
• Hyperactivity; fidgeting; constant movement beyond regular playing.
• Persistent nightmares.
• Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures.
• Frequent, unexplainable temper tantrums.

Pre-Adolescents and Adolescents

• Marked change in school performance.
• Inability to cope with problems and daily activities.
• Marked changes in sleeping and/or eating habits.
• Many physical complaints.
• Sexual acting out.
• Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death.
• Abuse of alcohol and/or drugs.
• Intense fear of becoming obese with no relationship to actual body weight, purging food or restricting eating.
• Persistent nightmares.
• Threats of self-harm or harm to others.
• Self-injury or self destructive behavior.
• Frequent outbursts of anger, aggression.
• Threats to run away.
• Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism.
• Strange thoughts and feelings; and unusual behaviors.

If problems persist over an extended period of time and especially if others involved in the child's life are concerned, consultation with a child and adolescent psychiatrist or other clinician specifically trained to work with children may be helpful.

Extensive information on parenting children with special needs at the HealthyPlace.com Parenting Community Center.

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Doubt is thought's despair; despair is personality's doubt. . .;
Doubt and despair . . . belong to completely different spheres; different sides of the soul are set in motion. . .
Despair is an expression of the total personality, doubt only of thought. -
Søren Kierkegaard

doubt 1 a : uncertainty of belief or opinion that often interferes with decision-making b : a deliberate suspension of judgment 2 : a state of affairs giving rise to uncertainty, hesitation, or suspense 3 a : a lack of confidence : DISTRUST b : an inclination not to believe or accept dis·or·der 1 : to disturb the order of 2 : to disturb the regular or normal functions of Definitions from Merriam-Webster Dictionary

"Lisa"

Hi

I'm not sure where to begin. It all began in 1997 when we moved. I had my first "attack" of anxiety. It came on so quickly I didn't even know what it was. I suddenly was very afraid of dying and would imagine a funeral (my own) which would just make the anxiety worse. It felt like an impending doom sort of thing...like something really bad was going to happen and I would die as a result. They subsided quickly and I never gave them another thought. I just figured it was due to having a baby and a move and a job change. (The move was from Ohio to Florida) I began to build my life.

We built a house. I found a good job teaching at a private school. As I was driving to work on Jan. 21, 2000, I had a terrifying intrusive thought of suffocating my son with a pillow as he slept. This sent me into the worst panic attack I've ever had. I got to work and couldn't pull myself together. I just kept thinking, "where did this horrible thought come from, and why can't I stop thinking about it?" "What is wrong with me?" I was so embarrassed and terrified. I went to the dr. and was diagnosed with anxiety/depression. Before the attack my husband even noted something was wrong...I was moody, unpredictable. I didn't tell a soul about the thought b/c I was sure they would lock me up and throw away the key. I then began to fear going to jail and obsessing about life in prison. I didn't even tell the dr. until my follow-up visit. I went 3 days before telling anyone and lived in my own silent hell of anxiety and panic. I missed work. I couldn't sleep. I couldn't eat. I was afraid that the thought would be carried out by myself--that somehow I would lose control and actually do it. This terrified me even more--and then I began obsessing about it and trying to get it to go away.

I am on a long road to recovery and discovery about myself. I am involved with a self help program called "Attacking Anxiety and Depression" by Lucinda Bassett. It has changed me--literally. I am not the person I was before the attack. I am getting better, but I still struggle sometimes. Some nights are ok, others are not, as tonight I am writing this at midnight. My husband works 3rd so I'm here alone with my son at night. This is when the anxiety is the worst. I have to do deep breathing and talk to myself. I am not a violent person. I love my son more than life. Why does this thought have so much control over me and why can't I just make it go away....it's almost as if you are dreaming except you are awake. You have no control over the thought process--just like you don't have control over your dreams while you sleep.

I wanted to share my story b/c I am still learning more about myself. I have been told that I may have a form of OCD (Obsessive-Compulsive Disorder), but I have not been officially diagnosed with the disorder. I find that telling people, even if they don't understand or think I'm nuts is a very freeing experience. The more I talk about it, the less control the thought has in provoking the panic. I know that I would never harm my son--that's what makes this so annoying. Why would I have the thought, and then why would I let it scare me so?

I hope this is of some help to anyone. I would love to have feedback of anyone in a similar situation, struggling with similar intrusive scary thoughts. I am happy to share, now knowing that I won't go to jail b/c I have a disorder, and more importantly that people never act on these intrusive thoughts.

Thank you for allowing me to share, and please don't judge me--this is not something that I chose to think about and now plagues me as I strive to become well.
Lisa

I am not a doctor, therapist or professional in the treatment of OCD. This site reflects my experience and my opinions only, unless otherwise stated. I am not responsible for the content of links I may point to or any content or advertising in HealthyPlace.com other then my own.

Always consult a trained mental health professional before making any decision regarding treatment choice or changes in your treatment. Never discontinue treatment or medication without first consulting your physician, clinician or therapist.

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Doubt is thought's despair; despair is personality's doubt. . .;
Doubt and despair . . . belong to completely different spheres; different sides of the soul are set in motion. . .
Despair is an expression of the total personality, doubt only of thought. -
Søren Kierkegaard

doubt 1 a : uncertainty of belief or opinion that often interferes with decision-making b : a deliberate suspension of judgment 2 : a state of affairs giving rise to uncertainty, hesitation, or suspense 3 a : a lack of confidence : DISTRUST b : an inclination not to believe or accept dis·or·der 1 : to disturb the order of 2 : to disturb the regular or normal functions of Definitions from Merriam-Webster Dictionary

"Heather"

My name is Heather, and I suffer from OCD. My story is much like the ones I read. My OCD revolves around UNWANTED thoughts. I have had it all my life, in many different manifestations. I am 23.

It reached its worst point around 20-21. I was obsessed about diseases. HIV was a huge deal and at times still is, though I have been tested and am fine. I was bed ridded with this disorder. I could not touch certain colors. If I touched a dark color it would make the evil thoughts worse, but a light color was too good to touch. That happened one day when I was trying to put on socks. It grew into a fear of knives and the thoughts that what if I went crazy and hurt somebody. I hated it . A brown handled knife. A black handled knife. I was convinced I was dying from AIDS, and multiple sclerosis. I had my head buried in a medical book for I don't know how many months. I lay down for so long that getting up made my legs tingle. I looked up the symptom and came up with MS. And on And on. I spent hours terrified. I kept a religious candle lit by my bed ready to die. I started reading the bible to save my soul. I was dying. If not in true body than my mind was killing me.

My mother showed me strength and we learned together. I have had very supportive friends too. I went for help. I was put on Luvox after Serzone and Paxil. I have also struggled with eating disorders. I went off my medication and therapy one year ago this month. (Feb) and this month I had an attack. All bad thoughts came back. I was paralyzed with fear. I felt like I was spiraling back down into that bad dark place my mind sheltered. I went for an appointment today and am currently back on the Luvox I never finished taking. (they have not expired.)

This disease is scary. I hate it. I want it to go away. I am not looking forward to restarting therapy . My old psychologist has moved and I am scared the new one will want to put me away or something. I know I'm not alone, but at the same time support is hard to find. Your family goes through so much. You feel guilty for the way you are. You cant run away from your own mind. It's there. I'm ok. I'm struggling but I'm trying.

People with OCD don't want to be like this. You always fight to convince yourself that its ok, and that it will pass, but it comes back. I didn't think it would. I thought I could keep it away, but I just found out I was wrong. If you have this keep going. Don't turn back. Don't look away. Always look forward. I'm going through it too. My old psychologist told me something that helped pull me out the first time," think of your mind like a river . Let the thoughts flow by you'll never step in the same river twice." It was just a little something that stuck with me. I have much more to say about this, but for now I'll just wait to see if someone gets it. Don't stop trying. Its not your fault.

Heather

I am not a doctor, therapist or professional in the treatment of OCD. This site reflects my experience and my opinions only, unless otherwise stated. I am not responsible for the content of links I may point to or any content or advertising in HealthyPlace.com other then my own.

Always consult a trained mental health professional before making any decision regarding treatment choice or changes in your treatment. Never discontinue treatment or medication without first consulting your physician, clinician or therapist.

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Doubt is thought's despair; despair is personality's doubt. . .;
Doubt and despair . . . belong to completely different spheres; different sides of the soul are set in motion. . .
Despair is an expression of the total personality, doubt only of thought. -
Søren Kierkegaard

doubt 1 a : uncertainty of belief or opinion that often interferes with decision-making b : a deliberate suspension of judgment 2 : a state of affairs giving rise to uncertainty, hesitation, or suspense 3 a : a lack of confidence : DISTRUST b : an inclination not to believe or accept dis·or·der 1 : to disturb the order of 2 : to disturb the regular or normal functions of Definitions from Merriam-Webster Dictionary

"Cara"

My Perfect OCD

As a child I didn't know I had OCD and didn't know that the way I behaved was not normal. I always used to have a little spot in my dresser where I kept my disaster kit in case there was a tornado. I lived in NH and they don't even have tornadoes there so I don't know where I got the idea for that (Wizard of Oz maybe?). Anyway - I had to be prepared in case there were some sort of a sudden emergency!

At around 35 years of age I began to question why I had to check things all the time - are the car lights really turned off, did I make a mistake in the work I did today (better recheck it), etc... Then things grew worse and it wasn't just checking anymore. Then it was fear of a lack of control. I couldn't drive over bridges because I felt to uncertain about it. The "what if" scenario. What if someone in the other lane drives to close to my car and I'm forced off the road and off the bridge.

Eventually, I felt I could no longer drive over bridges. The problem with that was that I had to drive over a bridge to get to work. Even the alternative routes had bridges. So.... how to get to work and how to keep my job? That wasn't too hard. I just became OC about my work. You know how it is - people call you a perfectionist and a master at whatever you set your mind to. So, once I 'proved' myself at work I convinced them to let me work from home. No more confronting the bridge!

My OCD also took form in fits of anger - intense, unexplainable rage over nothing! I hated that I acted this way and I hated that my husband suffered for it too. But - I just thought that was me - my personality - and what a horrible person I am. Why couldn't I be kinder, less of a perfectionist - ease up a bit...

Then one day I saw a book cover in the bookstore that described a disease. I was stunned and delighted because it perfectly described me. It was a book about OCD. That's when I realized it's a disorder and not just a matter of me being a horrible person. Armed with this new info I went to my Dr. and told her I'm OCD and I have to have medicine. (I had a long list with me and I was prepared to argue if I had to).

I told her my symptoms as fast as I could, so she couldn't stop my momentary courage, and I ended with an exasperated demand: "if you don't give me medicine I'll go to the streets and self-medicate!" She said - "OK, well I've thought that you might be OCD but I wanted to wait and see if you came to that conclusion as well and I'm glad you recognize it and do want help". (why she never discussed this with me before I don't know).

Anyway, I now take Zoloft and it works very well for me. It has changed my life dramatically. I still have moments of doubt from time to time, but I can behaviorally handle it much better than previously. I sleep better, I live better, I'm not stressed out anymore and the people around me enjoy my happiness. There's also a physical benefit. I used to suffer sever Spastic Colitis. The minute I'd get too stressed out I'd be doubled over with intense abdominal pain. I also used to suffer crippling migraines that would send me to the ER in the middle of the night! I no longer suffer from these things since relieving my OCD.

Finally, I personally think there's a genetic and heredity component to OCD. My Dad (who died of a heart attack) was very OCD. I think I learned how to be OCD from him, but I also think he passed it on to me genetically. My 4 year old niece was also diagnosed with OCD which I thought interesting because no one in my family yet knew of my OCD - or even what it was.

Thanks to the owner of this website for providing a forum where we can hear the personal side of OCD - not just the clinical side of it.

Good luck to all of you,

Cara

Write to Cara

I am not a doctor, therapist or professional in the treatment of CD. This site reflects my experience and my opinions only, unless otherwise stated. I am not responsible for the content of links I may point to or any content or advertising in HealthyPlace.com other then my own.

Always consult a trained mental health professional before making any decision regarding treatment choice or changes in your treatment. Never discontinue treatment or medication without first consulting your physician, clinician or therapist.

Content of Doubt and Other Disorders
copyright ©1996-2009 All Rights Reserved

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Doubt is thought's despair; despair is personality's doubt. . .;
Doubt and despair . . . belong to completely different spheres; different sides of the soul are set in motion. . .
Despair is an expression of the total personality, doubt only of thought. -
Søren Kierkegaard

doubt 1 a : uncertainty of belief or opinion that often interferes with decision-making b : a deliberate suspension of judgment 2 : a state of affairs giving rise to uncertainty, hesitation, or suspense 3 a : a lack of confidence : DISTRUST b : an inclination not to believe or accept dis·or·der 1 : to disturb the order of 2 : to disturb the regular or normal functions of Definitions from Merriam-Webster Dictionary

"Brenda"

my earliest memory of an ocd obsession was around 4-5 years of age. i noticed a neighbor's cat with a dead mouse in its mouth, and i was fascinated. i remember telling my mother about the sight, and her response was, "oh, you didn't touch it did you? that dead mouse will have germs and i hope you didn't touch it." nothing more, nothing less. for more than two weeks i went to bed every night crying my eyes out, scared sick that "what if i had touched the mouse?" in my young mind, i could not remember. maybe i did touch the mouse. maybe i did stoop a little too close and it touched me. i didn't know. but if i did, surly i would get very sick from the germs of a dead creature, and i too would die. i cried before going to sleep every night for a long time. my mother could not comfort me, because even though i did express my worry, she caused the worry, and i think, in her mind, she couldn't ease it because she honestly couldn't tell me i did not touch that mouse. the obsession of "what if?" i had touched it was in my mind, and nothing she said now would take away the doubt.

many other things happened as the years went on. at the age of 12-13 (this would have been in 1970), i felt i was different, and did ask my mother if i could see a psychologist. but of course, the answer was no. "decent, normal" people did not tell their troubles to anyone else. everyone had troubles, and you were expected to deal with your own problems, not air them out in public. after reading articles on ocd, it probably wouldn't have mattered if i had seen someone, because from what i've now read, a lot of therapists did not know much about ocd in the early 70's.

another problem with me and the ocd was when i finally got my license. every time i hit a bump, i would circle the block, 3, 4, even 5 times looking for a dead or injured body. i would even get out of the car and look for signs of blood, anything that would show that i had hit a living being. of course, i didn't, but even now, at the age of 40, i wonder when i hit bumps, and i still circle and inspect the area and the car, just to make sure everything is all right. i have even gone so far as to check news articles, or have called the police station to inquire if anyone had been injured by a hit and run driver.

i asked my daughter the other day if she counts when she washes her hands. she looked at me like i was nuts. i just assumed everyone counted while washing, or bathing, brushing their teeth, putting on deodorant, ect. i know now how lonely and alone i am with this disease.

i am going for therapy, specifically for the ocd. i finally grew tired of living with such an odd, troublesome problem. in fact, my therapist pointed out that i was dual diagnosed, using alcohol as a way of "self medicating" for the ocd symptoms. i have since entered into a rehab to help treat the alcoholism, and along with group therapy through the rehab and meeting with my psychologist once a week, i am coming to terms with the ocd. i am not "cured" or anywhere near that, but i have been directed to a psychiatrist to help get on the right medication. hopefully through behavior therapy and medication, and ridding my body of the alcohol is was so used to, i will be able to overcome this crippling, doubting, disease.

thanks for letting me share.

---brenda

I am not a doctor, therapist or professional in the treatment of CD. This site reflects my experience and my opinions only, unless otherwise stated. I am not responsible for the content of links I may point to or any content or advertising in HealthyPlace.com other then my own.

Always consult a trained mental health professional before making any decision regarding treatment choice or changes in your treatment. Never discontinue treatment or medication without first consulting your physician, clinician or therapist.

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copyright ©1996-2009 All Rights Reserved

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Change #7

"I must be certain (that there is no risk.)" to "I can tolerate uncertainty."

Most problems with anxiety relate to a fear of uncertainty.

My educated guess is that the brains of about twenty percent of the population have a more difficult time than the average person in tolerating uncertainty regarding risk. This, of course, can put them at a serious disadvantage, since living demands risk. It is no wonder, then, that so many people develop anxiety problems. They worry because their brain is demanding closure on a specific issue. Their mind says, "This is how it must turn out for me to feel secure. And I must feel secure. Do I know for certain it will turn out this way?" It is as though they require a 100% guarantee that they will encounter zero risk. That is simply too much to ask of life. If you intend to go up against one of the most powerful forces of the natural world -- that is, continual change -- you will have a tough time winning. Listen to these expectations of life and you will see what I mean. The person with panic attacks, phobias or social anxieties asks such questions as:

• "Can I know for certain that I won't have any symptoms?"
• "Can I know for certain that I won't have to leave?"
• "Can I know for certain that I won't feel trapped?"
• "Can I know for certain that this isn't a heart attack?"
• "Can I know for certain that I won't die on that plane?"
• "Can I know for certain that I won't cause an embarrassing scene?"
• "Can I know for certain that people won't stare at me?"
• "Can I know for certain that I won't have a panic attack?"

If we look at a different anxiety problem -- obsessive-compulsive disorder -- we find the same kinds of questions:

• "Can I know for certain that this object is clean?"
• "Can I know for certain that I won't get contaminated if I touch the ground?"
• "Can I know for certain that my family will be safe?"
• "Can I know for certain that I didn't run someone over?"
• "Can I know for certain that I unplugged that iron?"
• "Can I know for certain that I won't kill my child?"

If it is true that some people's brains cause them to feel a strong yet inappropriate need for certainty, then confronting that problem involves disrupting those demanding thoughts. It involves confronting them consistently and directly everyday to produce the change we want. This is where your new attitude comes in. You must find ways to accept risk and tolerate uncertainty.

Stay with me as I explain how this works, because this stance doesn't seem very attractive at first glance. Whatever outcome you fear, work to find a way to accept that outcome as a possibility. For example, imagine that sometimes when you begin to have panicky symptoms you feel a pain in your chest that runs down one arm. Each time it happens, your first thought is, "This could be a heart attack!" Of course you have had one or more medical evaluations by a specialist. Let's also say that all physicians you consult declare you have a strong heart, take good care of yourself and are not at risk of a heart attack.

Nonetheless, as soon as that pain shoots down your arm, you say, "This time it really could be my heart! How do I know? There's no guarantee that this is only panic. And if it is a heart attack, I need help now!"

Further, let's say that you've been learning to reassure yourself as a way to get some perspective on panic. "Look, guy, you've been to the emergency room twelve times in the last two years. One hundred percent of those visits have been false alarms. You know you suffer from panic attacks, and this is what they feel like, too. Take a few Calming Breaths, relax, wait a few minutes. You'll begin to feel better."

The reassurance lasts all of five seconds. Then you're back in the saddle. "But I don't know. I don't know for certain. If this is a heart attack I could die! Right now! There's always a chance."

It's the same with people's fear of dying on a plane. Commercial flight is the safest mode of transportation we have. On average, about one hundred people die on a plane per year, while 47,000 motorists die on the highways and 8,000 pedestrians die each year. If you are looking for a risk-free environment, don't stay at home; 22,000 people die of accidents a year without even leaving their house!

Even though your odds of dying on a plane are one in 7.5 million, the dialogue goes like this, "There's still a chance I might die. And if I do, that will be the most horrible, terrifying death I can imagine." You reassure, "Planes are safe. You'll be fine. The pilot has gray hair; he has twenty-five years' experience."

"Yes, but how do I know? How can I be certain?"

This is what you do to yourself, in your own unique way. You ask, "how can I be certain someone won't criticize me?", or "how can I be certain I won't have to leave the concert?" You might as well give it up, because you can never satisfy the demand for absolute confidence. No amount of reassurance will ever be enough.

Here, instead, is the attitude to strive for: "I accept the possibility of that (negative event) happening."

For fear of heart attacks: "I accept the possibility that this time could actually be a heart attack. I'm going to respond to it as though it is a panic attack. I accept the risk that I might be wrong."

For fear of dying on a plane: "I accept the possibility that this plane could crash. I'm going to think and feel and act as though this plane is 100% safe. I accept the risk that I might be wrong."

For fear of having to leave an event: "I accept the possibility that I might have to leave the restaurant. I imagine I'd feel embarrassed, but I'm willing to tolerate that now."

By making this decision -- to accept the possibility of a negative outcome -- you circumvent the requirement for absolute certainty of your future comfort and safety. There's always a chance you will have a heart attack, regardless of your health. There's always a chance you could die in a plane crash, regardless of the relative safety of air travel. There's always a chance you will leave the restaurant and become embarrassed.

If you want to lower your chances of panicking and raise your chances of flying comfortably or feeling more at ease at the restaurant, you have work to do. Your job is to lower your risk of problems as much as makes common sense, then accept the remaining risk that is not under your control. You only have two other basic options. You can keep worrying about the risk while you continue with these behaviors. That leads to anxiety and the increased likelihood of panic. Or, you can withdraw from these activities. The world can get by with you never flying again. The world can get by if you never enter another restaurant. There are consequences to these behaviors, of course. (It may take longer to travel to your friends or relatives, and so forth.) But it's your choice.

I encourage you, instead, to practice this idea of accepting uncertainty.

There is an interesting thing about many therapeutic interventions designed to help you control anxiety. Most actually make you more anxious at first. This one -- giving up the requirement for complete confidence in the outcome -- is a good example. For instance, you begin to feel that pain in your chest that shoots down you arm. Now you are saying, "I'm going to apply all my skills as though this is a panic attack. I'm not going to act as though this is a heart attack." Do you think 100% of you is going to agree to this plan? No way! Some part of your mind is still going to feel scared, because, try as you might, some part of you will still be worried about a heart attack..

If worrying, or fearful monitoring, is one of our most common ways to stay in control, then if you practice letting go of your worries, your mind and body will feel out of control. That will make you anxious. This anxiety is the distress of positive experimentation and change. It's a good kind of anxiety. Remember what Goleman said: "A person prevails over anxiety by sacrificing attention." But expect to be uncomfortable at first anyway! Have faith that over time, this anxiety will diminish.

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If you're concerned about your child's weight, you're in good company. Since the 1960s, the number of overweight kids in the United States has nearly doubled and the number of overweight adolescents has nearly tripled. Today, 10% of 2- to 5-year-olds and more than 15% of children between the ages of 6 and 19 are overweight, which puts them at risk for disease and low self-esteem. Eating disorders are on the rise among young people as well. Keep reading to learn more about weight and kids, and healthy ways to manage weight for the entire family.

Underweight Kids

Be aware of the teen who gains too little weight, especially the teenage girl who begins to lose weight rapidly yet still complains she is fat. Young girls may worry about the physical changes that puberty brings, partly in response to society's emphasis on thinness. Full hips and breasts may make them feel "fat," and they can get caught up in behavior patterns known as eating disorders.

Some girls become obsessed with body weight and image. They will eat very small amounts of food - inadequate amounts to support normal growth and health. Some refuse to eat at all. This condition is known as anorexia nervosa. Other teens, again mostly girls, practice binge-and-purge behavior, known as bulimia. Both conditions are potentially life threatening. If you suspect either condition, talk to your child and seek medical treatment from a doctor or registered dietitian.

Teenage boys are prone to nutritional problems as well. Many adolescent boys yearn to be bigger or heavier. Beware of nutritional supplements that promise more muscles. If a teen is eating properly and consuming the right amount of a variety of foods, nutritional supplements are just a waste of money. If you are concerned about your teenager's eating habits, talk with your child's doctor. Counseling is often an effective way to get kids back on track.

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