A doctor holding red stethoscope.

Understanding Unspecified Depression Type Diagnosis

The last seven years of my medical history have been confusing. When I looked over my medical summaries, I noticed I was diagnosed with depression, in some way, shape, or form for these years. I guess since I declined to take prescription medicines for my depression, the doctor(s) may have just decided to not look further into my issues. Maybe they just thought I was resistant, or crazy.

Lately, I’ve been getting stressed at work. In most cases, I think I can manage, but sometimes things are beyond my control. For instance, there are times we are required to work overtime- 12 days straight. Also, the expectations of my company keep changing. More is demanded at times, at other times, I feel bored, unchallenged and unappreciated.

In any event, I knew my previous medical practice wasn’t good for me. I felt like I needed a doctor with good reviews. I researched the doctors in my insurance directory and discovered one in town that was a D.O., instead of an M.D. The difference is an M.D. is a Doctor of Medicine, while a D.O. is a Doctor of Osteopathic Medicine. From my understanding, there is very little difference as far as certification and training:

“While osteopathic programs tend to be less competitive than allopathic medical schools, students in both programs receive similar training. However, osteopathic schools have a stronger focus on alternative therapies, holistic medicine, and disease prevention.” (www.gulfbend.org)

  • This factor appealed to me since I am one that has been resistant to taking prescription medications.
  • I went to the new doctor for convenience (he is located in town, as opposed to my previous doctor, who was about 12 miles from my home).

I went to establish a new doctor, but I discovered I have ectopic heartbeats, or, extra heartbeats. Soon, I will have to wear a Holter monitor to find out more information.

Also, my diagnosis included:

  • Anxiety
  • Depression, unspecified depression type
  • Fatigue, unspecified type.

Depression, unspecified depression type is often used at the beginning of medical diagnosis and treatment. This category is used when there is not yet enough information. Once the doctor has my information, he or she may proceed to choose a more specific condition.

As far as the other conditions are concerned, I suppose I could worry. I’ve read that PVC’s- Premature Ventricular Contractions, can be induced by anxiety. Sometimes the PVCs are nothing to worry about if all else is normal. It could also be a sign of underlying heart disease.

My new doctor asked me if I felt any fluttering in my chest, to which I replied that I hadn’t noticed. I’ve been so consumed about mood disorders, I took for granted the fact that just because I have had a long history of anxiety and depression, doesn’t mean that I can’t have other problems. I’ve been accustomed to “invisible” problems for so long that I ignored my “visible” problems.

Such is the case for me. I become blinded by my own thought patterns. I really wanted my doctor to look into this aspect of my health too.

References:

  1.  https://medschool.ucla.edu/body.cfm?id=1158&action=detail&ref=1019
  2. https://www.nchmd.org/education/mayo-health-library/details/CON-20376741
  3. https://www.gulfbend.org/poc/view_doc.php?type=doc&id=12992&cn=5

3 Important People in Your Anxiety Treatment

“People tend to dwell more on negative things than on good things. So the mind then becomes obsessed with negative things, with judgments, guilt, and anxiety produced by thoughts about the future and so on.” -Eckhart Tolle

In the US, over 40 million people are affected by an anxiety disorder. Although it is highly-treatable, it’s reported that only about 37% of affected individuals receive treatment. (ADAA).

6 Types of Anxiety Disorders

  • Generalized Anxiety Disorder
  • Panic Disorder
  • Social Anxiety Disorder
  • Specific Phobias
  • Obsessive-Compulsive Disorder (OCD)
  • Posttraumatic Stress Disorder (PTSD)

When you consider the various sub-categories listed under “specific phobias”, one can conclude there is a multitude of anxiety types. These subtypes are broadly-defined:

3 Types of Phobias

    1. Agoraphobia– A fear, anxiety, or avoidance of non-specific situations where one may not be able to escape or get help if a panic attack occurs.
    2. Specific Phobia– A fear, anxiety, or avoidance of specific situations or object (i.e, a fear of flying, a fear of needles, or the fear of spiders qualify as specific phobias).
  • Social Anxiety Disorder– A fear, anxiety, or avoidance of social situations. Intense fear in social situations includes the fear of appearing foolish, which can physically by way of blushing, shaking, sweating, etc.

Scientists believe there are a complex variety of factors that cause anxiety disorders, but they can be simplified into two broad categories.

  1. Genetics– A family history of anxiety disorders is a significant indicator of being predisposed.
  2. Environment– Traumatic, stressful, or exposure to violence can cause individuals to develop anxiety disorders. (NAMI).

Identifying the sources of anxiety disorders can be complex and confusing, hence why it is especially important to first see your doctor to eliminate the possible physical cause that mimics anxiety disorders.

It is also important to do whatever you can to reduce or eliminate sources that cause you to feel more anxious or nervous. For instance, you can opt to drink decaffeinated coffee instead of regular coffee. Some dietary choices can improve the physical aspects of anxiety. Simple choices are only the beginning of managing anxiety disorders.

Anxiety Disorders Originate In The Recesses Of Our Brains

“According to the National Institute of Mental Health, there are two parts of the brain that are key players in the production and processing of anxiety – the amygdala and the hippocampus.” (Neurocore Brain Performance Centers).

Our brains- and our specific human experiences- are complex and vast, but the good news is that only you fully understand yourself! Conversely, others on your mental health “team” (i.e., your family doctor, your nutritionist, your spiritual advisor, therapists, counselors, and other qualified mental health professionals).

The Family Doctor

You may opt to schedule an appointment with your family doctor before or after you’ve had time to reflect and write down information on your anxiety disorder. You may have learned from school or work that you don’t like public speaking or crowds. It will be most beneficial of you to have notes and information to offer your doctor when attending your appointments.

Don’t be discouraged if your family doctor seems to focus on the “externals” more than the “internals”. The doctor may offer you unwanted advice, such as losing weight, getting more exercise, or reducing the amount of caffeine or alcohol you consume. These are important steps in the management of your anxiety, although, they are often not the only steps to pursue.

Therapists

As I mentioned earlier, each individual has their own unique and complex brain and set of experiences. There isn’t a “one size fits all” approach to anxiety. Medications may work for one person but may be ineffective for another. Many individuals prefer to manage their anxiety through therapy. Therapy types are as varied as the individuals seeking treatment, so be sure to have a solid good understanding of each type.

Traditional  Psychotherapy

  • Interpersonal therapy
  • CBT (Cognitive/Behavioral Therapy)
  • Psychodynamic Therapy

Non-Traditional Therapies

  • Mindfulness-Based Stress Reduction model (Jon Kabat-Zinn)
  • EMDR- Eye Movement Desensitization Resolution (Often for individuals suffering from PTSD).
  • Interpersonal and Social Rhythm Therapy (IPSRT)- Developed to understand and improve moods, based on biological and social rhythms. (“Taking Charge”, University of Minnesota).

There are other therapies, which include group therapy, family therapy, and emotion-focused therapy. (Types of Therapy).

Help Yourself (And Others) Treat Your Anxiety Disorders

You may be limited in your choices of family doctors, based on where you live or the type of medical insurance you carry. Additionally, your medical insurance may limit the type of therapy or mental health services you can receive. Be sure to obtain a provider directory and handbook from your insurer to ensure you choose providers your insurance will cover, or you may end up paying more than you can afford for your treatment.

Consider what your own preferences are along with what your insurance will offer. Is your local family doctor in your network? If not, you may have to choose another or decide if it’s worth it to pay out-of-pocket.

In addition to receiving medical care and therapy, be sure to consider your own interests, and how they can be applied to help you manage and treat your anxiety.

“To know thyself is the beginning of wisdom.” -Socrates.

  • Are you artistic? Why not try painting when you need to calm down?
  • Are you a kinetic person? Do you have lots of energy? Why not try jogging to release some negative energy?
  • Are you an emotional or sensitive person? Why not channel your inner-poet and write something expressive?

When you know yourself, you have insight and wisdom about yourself, and thus, can make better decisions on how to treat yourself. You will not be able to treat anxiety effectively- at least, not in most circumstances, without the help of others. For some, that includes doctors and therapists. Many people wish to augment treatment by using their faith and spirituality. The most important thing to realize is that you can get the most out of managing anxiety if A) you understand yourself and B) you allow others to help.

References:

  1. https://www.nami.org/Learn-More/Mental-Health-Conditions/Anxiety-Disorders
  2. https://www.mentalhelp.net/articles/specific-phobias-and-social-anxiety-disorder-social-phobia/
  3. https://www.neurocorecenters.com/blog/depression-anxiety-stresseffects-of-stress-anxiety-on-brain
  4. https://keltymentalhealth.ca/types-of-therapy
  5. https://www.takingcharge.csh.umn.edu/what-types-psychotherapy-are-helpful-anxiety-and-depression
  6. https://www.2knowmyself.com/The_kinesthetic_personality_type
  7. https://sciencing.com/kinetic-energy-potential-energy-apply-everyday-life-15430.html
  8. https://www.psychologytoday.com/us/blog/changepower/201603/know-yourself-6-specific-ways-know-who-you-are

How Early Trauma Caused Much of My Anxiety

I am inclined to believe that living in a stressful environment triggers OCD. As a new mother who suffered from depression and anxiety, the compounding factor of being in a dysfunctional relationship seemed to be the trigger in the development of my OCD.

My husband was an alcoholic and often abused me, verbally, physically, emotionally and financially. I became consumed with the compulsion to discard things in my home. I look back with regret when I realize the importance of things I threw or gave away. Sometimes, I even re-purchased similar items to replace things I threw out or donated.

The process of getting rid of purging became cyclic. I recall, getting rid of items I had stored in plastic boxes, then I got rid of the boxes. I would feel “better”, or just get a desire to purchase something. Then I had to move other things around to “purge” myself when I became overwhelmed by the ritual of shopping.

 

Other times, I got rid of “things” when I was overwhelmed with emotions and did not realize I was not finding a proper outlet for my emotions. My husband only made my condition worse by calling me “crazy” or “unstable.” Sometimes I purged items when I was experiencing symptoms of PMS. He called me “hormonal” when he discussed such issues to my in-laws (who also called me “crazy” and “unstable”).

I was diagnosed with OCD and GAD several years ago. At the time when I was diagnosed, the two disorders were listed in the same category in the DSM. In 2013, the fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders), GAD (Generalized Anxiety Disorder) remains under the section under anxiety disorders, OCD is under a section labeled as “Obsessive-Compulsive and Related Disorders. Included under this category are hoarding disorder, trichotillomania (hair-pulling disorder), and body dysmorphic disorder. Though individuals suffering from GAD and OCD tend to spend much time worrying, the difference is that people with OCD rely on physical or mental rituals (compulsions) to relieve stress caused by an obsession. Those with GAD tend to worry about “real” problems, while those with OCD are plagued by intrusive thoughts that are somewhat illogical or unrealistic, such as unnecessary counting, or a preoccupation with symmetry.

Though my GAD may have progressed into OCD during my marriage, I recall other stages in my life where I have been afflicted by one or both of these disorders. In my twenties, I attended college despite my impairing social anxiety disorder. I rarely made any social connections during my academic pursuits. I managed to take several drawing classes as part of my graphic design course load. I became repulsed by using pencils in my drawing classes. I was unable to pick up the charcoal sticks to complete my work because I was focused on the trail of dust left behind from the materials. The dust was attached to my artist’s toolbox and my portfolio. I spent a great deal of effort obsessing about the dust and eraser crumbs in my tools and supplies. Years after I dropped out of my classes, I tried to save the pieces I had labored over, but like everything else that had some sentimental value, I discarded them too (OCD Almost Destroyed My Creativity!).

Exposed To Adult Life

As children, my sister and I became fixtures at the local bars. From ages 10 until about 12, we were dragged along to a number of bars near our house so my mom could drink and be with my dad. The bar was a dive and quite disgusting. My mom bought us pop and Slim Jims, and I sat at the booth with my sister. Sometimes we were allowed to pick songs on the jukebox (I played, “Don’t Stop” by Fleetwood Mac and “Rapture” by Blondie on a loop!).

At times, it felt glamorous to hang out in bars. Other times, it was unsettling to see adults become less inhibited, argumentative, and repulsive. I could get a sense when people were getting too “loose”…almost an innate vide to warn of impending danger (in my adult life, this “sense” was clouded by my own self-doubt and afflictions).

My mom got annoyed when I sat on the barstool next to her, spinning around, so she sent me off with a constant supply of quarters to play arcade games and the pinball machine. When I 12, I was old enough to not have to sit at the bar. At some point, it was decided that I was old enough to take care of everybody else.

I was appointed the neighborhood babysitter- my mom offered my babysitting services to her friend so they could go out drinking. I was given no instructions on how to feed, entertain, or comfort the kids. The house in which I cared for them didn’t appear to show signs of toys, books or anything that could help me occupy the kids while they left us for hours on end. We sat in front of the TV, bored, tired and hungry until they returned after the bars closed at 2:30 AM. Sadly, when I became a mother, I was haunted feelings of inadequacies due to these experiences.

Help! I’m Starving Myself (To Get Control And Acceptance!)

At age 14 I developed an eating disorder. When I stood in front of the mirror, I would section off the parts of my body I deemed too fat. Within six months I had dropped down to size 2 in jeans. I survived by drinking soda and eating just one item per day, usually a school lunch item, as to not draw too much attention to my disorder.

At dinner time, I covered food in napkins, moved food around on my plate, or I simply gave the food to the dog. Eventually, my mom realized my tactics and I had to eat more of my dinner. I still rationed my food, or only ate half servings. This went on for four years. When I overcame one element of my disorder, it manifested in some other way, as in discarding things. Sometimes I purged the food I ingested, but mostly I purged “things”.

My compulsion to discard things is more manageable now. I have limited contact with people that may provoke or trigger anxiety and OCD symptoms. I try to be more mindful by writing in a journal and meditating on my faith. I also keep a few empty boxes out of sight for those times when I feel compelled to purge. My rule is that I must wait a few days before deciding the permanent home for all the “things”. This time allows me to sort my thoughts, gain clarity and determine the reasons why I feel the intrusive thoughts.

 

References:

Glasofer, Deborah R., Ph.D., “What Is the Difference Between GAD and OCD?”

www.verywell.com, July 28, 2016, accessed August 21, 2016.