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PANIC DISORDER

A SPECIAL Sunday Times investigation has uncovered the shocking state of mental health in South Africa. One third of all South Africans have mental illnesses — and 75% of them will not get any kind of help as also revealed by statistics of the South African Depression and Anxiety Group (SADAG).

PANIC DISORDER

A person has panic attacks, which are intense, overwhelming and often uncontrollable feelings of anxiety combined with a range of physical symptoms. Someone having a panic attack may experience shortness of breath, chest pain, dizziness and excessive perspiration. Sometimes, people experiencing a panic attack think they are having a heart attack or are about to die. If a person has recurrent panic attacks or persistently fears having one for more than a month, they’re said to have panic disorder.

Panic disorder

Panic disorder is the term used to describe when panic attacks are recurrent and disabling. Panic disorder can be characterised by:

  • The presence of recurring and unexpected “out of the blue” panic attacks.
  • Worrying for at least a month after having a panic attack that you will have another one.
  • Worrying about the consequences or implications of a panic attack (such as thinking that the panic attack is a sign of an undiagnosed medical problem). It happens that some people have repeated medical tests due to these worries and, despite reassurance, still have fears of being unwell.
  • Significant changes in behaviour that relate to the panic attacks (such as avoiding activities like exercise because it increases the heart rate).

During a panic attack the person is suddenly overwhelmed by the physical sensations described above. Panic attacks reach a peak within about 10 minutes and usually last for up to half an hour. Following the attack it leaves the person feeling tired or exhausted. They can occur several times a day or may happen only once every few years. They can even occur while people are asleep, waking them up during the attack. Many people experience a panic attack once or twice in their lives which in such cases is common and is not panic disorder.

WHAT CUASES PANIC DISORDERS

There is no single cause for panic disorder. A number of factors are usually involved, including:

  • Family history – People with panic disorder tend to have a family history of anxiety disorders or depressive conditions, and some studies suggest a genetic component.
  • Biological factors – Some medical conditions (cardiac arrhythmias, hyperthyroidism, asthma, chronic obstructive pulmonary disease and irritable bowel syndrome) are associated with panic disorder.
  • Negative experiences – Extremely stressful life experiences, such as childhood sexual abuse, redundancy or bereavement, have been linked to panic attacks. Periods of ongoing, unrelenting stress are also a risk factor

Have you had a sudden surge of intense worry or fear during which you had four or more of the following symptoms:

  • sweating
  • trembling or shaking
  • increased heart rate
  • short of breath
  • feeling like you are choking
  • feeling nauseous or having butterflies or pain in the stomach
  • dizzy, lightheaded or faint
  • numb or tingly
  • derealisation (feelings of unreality) or depersonalisation (feeling detached from yourself or your surroundings)
  • hot or cold flushes
  • scared of losing control or going crazy, and
  • scared of dying?

If you have felt more than four of the above symptoms, have you also: felt persistently worried for one month or more, of experiencing these feelings again, or changed your behaviour to try to avoid having panic attacks again? If yes, you may be experiencing panic disorder.

OTHER CONDITIONS WHERE PANIC IS PRESENT

OBSESSIVE COMPULSIVE DISORDER (OCD)

A person has ongoing unwanted/intrusive thoughts and fears that cause panic or anxiety. Although the person may acknowledge these thoughts as silly, they often try to relieve their panic or anxiety by carrying out certain behaviours or rituals. For example, a fear of germs and contamination can lead to constant washing of hands and clothes.

What is obsessive compulsive disorder (OCD)?

Anxious thoughts can influence our behaviour, which is helpful at times. For example, thinking ‘I may have left the oven on’ leads to you checking the oven and keeping things safe.

However, if that thought becomes obsessive (recurring), it can influence unhealthy patterns of behaviour that can cause difficulties in daily functioning. Obsessively thinking ‘I’ve left the oven on’ can lead to repeated checking.

For someone with the anxiety disorder known as obsessive compulsive disorder (OCD), obsessions or compulsions (acts performed to alleviate the distress or neutralise the thought), or both, are present.

People with OCD often feel intense shame about their need to carry out these compulsions. These feelings of shame can exacerbate the problem and the shame, and consequent secrecy associated with OCD can lead to a delay in diagnosis and treatment. It can also result in social disability, such as children failing to attend school or adults becoming housebound.

What are the signs and symptoms of OCD

Issues that commonly concern people with OCD and result in compulsive behaviour include:

  • Cleanliness/order – obsessive hand-washing or household cleaning to reduce an exaggerated fear of contamination; obsession with order or symmetry, with an overwhelming need to perform tasks or place objects, such as books or cutlery, in a particular place and/or pattern
  • Counting/hoarding – repeatedly counting items or objects, such as their clothes or pavement blocks when they are walking; hoarding items such as junk mail and old newspapers
  • Safety/checking – obsessive fears about harm occurring to either themselves or others which can result in compulsive behaviours such as repeatedly checking whether the stove has been turned off or that windows and doors are locked
  • Sexual issues – having an irrational sense of disgust concerning sexual activity
  • Religious/moral issues – feeling a compulsion to pray a certain number of times a day or to such an extent that it interferes with their work and/or relationships.

People with OCD may also experience other mental health issues including depression, other anxiety disorders, an eating disorder and/or alcohol or substance-use problems.

Symptoms checklist

Have you:

  • had repetitive thoughts or concerns that are not simply about real life problems (e.g. thoughts that you or people close to you will be harmed)
  • Done the same activity repeatedly and in a very ordered, precise and similar way each time e.g.:
    • constantly washing your hands or clothes, showering or brushing your teeth
    • constantly cleaning, tidying or rearranging things at home, at work or in the car in a very particular way
    • constantly checking that doors and windows are locked and/or appliances are turned off
  • felt relieved in the short term by doing these things, but soon felt the need to repeat them
  • recognised that these feelings, thoughts and behaviours were unreasonable
  • found that these thoughts or behaviours take up more than one hour a day and/or interfered with your normal routine (e.g. working, studying or seeing friends and family)?

WHAT CAUSES OCD?

OCD is thought to develop from a combination of genetic and environmental factors. A number of factors may increase the risk of developing OCD, including family history, social factors and psychological factors. Other factors specific to OCD include:

  • Biological factors – OCD has been linked to several neurological factors and irregular levels of serotonin (a chemical that transmits messages between brain cells) in particular. Research into chemical, structural and functional changes or abnormalities in the brain continues.
  • Environmental / learned behaviours – Some experts suggest that OCD may develop as a result of learned behaviour, either by direct conditioning (e.g. developing a washing compulsion after contracting a disease from contact with an animal) or learning by watching the behaviour of others, e.g. parents.

ECD and panic disorder is serious and require professional assistance to alleviate the symptoms in order to have a meaningful life.

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