The Zung Self-rating Anxiety Scale (SAS) is a tool that provides a general measure of the person’s anxiety level. For each of the twenty questions for the Zung Self-rating Scale for anxiety disorders, the person taking the test marks whether the statement applies to them a little of the time, some of the time, a good part of the time, or most of the time.

The twenty statements are:

1. I feel more nervous and anxious than usual.
2. I feel afraid for no reason at all.
3. I get upset easily or feel panicky.
4. I feel like I’m falling apart and going to pieces.
5. I feel that everything is alright and nothing bad will happen.
6. My arms and legs shake and tremble.
7. I am bothered by headaches, neck and back pain.
8. I feel weak and get tired easily.
9. I feel calm and can sit still easily.
10. I can feel my heart beating fast.
11. I am bothered by dizzy spells.
12. I have fainting spells or feel like it.
13. I can breathe in and out easily.
14. I get feelings of numbness and tingling in my fingers and toes.
15. I am bothered by stomachaches or indigestion.
16. I have to empty my bladder often.
17. My hands are usually dry and warm.
18. My face gets hot and blushes.
19. I fall asleep easily and get a good night’s rest.
20. I have nightmares.

For statements 5, 9, 13, 17, and 19: Add 4 points to the score if you answered “a little of the time.” Add 3 points for “some of the time.” Add 2 points for “a good part of the time,” and 1 point for “most of the time.”

For all the other statements: Add 1 point for “a little of the time,” and 2 points for “some of the time.” Add 3 points for “a good part of the time,” and 4 points for “most of the time.”

Then total all the number to get the score. The score should be between twenty and eighty.

The Zung Self-rating Scale for anxiety score describes the level of anxiety the person has.
• 20-44 Normal Range
• 45-59 Mild to Moderate Anxiety Levels
• 60-74 Marked to Severe Anxiety Levels
• 75-80 Extreme Anxiety Levels

If the person has a score within the moderate, severe, or extreme levels, the person should be evaluated by a physician or psychiatric professional. High levels of anxiety can be a sign of several illnesses and can also cause physical problems. The good news is that anxiety is often very treatable. Seeking professional help can be the first step towards living without elevated anxiety.

Reference:
Zung, W.K. A rating scale for anxiety disorders. Psychosematics. 1971.

While obsessive-compulsive disorder most commonly begins in adolescence or adulthood, OCD in children is possible. However, many psychiatric conditions associated with childhood can have symptoms that look like OCD symptoms. Autism, attention deficit disorder (ADD), and Tourette’s syndrome can cause symptoms that could be mistaken for OCD.

Symptoms of OCD in children include excessive worrying about danger, being wrong, or things being dirty. The obsessive thoughts can make it difficult for the child to concentrate in school and while doing other things that require concentration. The child may have a compulsive need to be clean and want to take excessively long showers and insist their clothing be washed frequently and a certain way. Some children may spend hours every day washing their hands and showering.

Children with OCD may be obsessed with being perfect or having the items in their environment perfectly clean or perfectly ordered. Children with obsessive-compulsive disorder may perform rituals or repetitive behaviors. A child may feel the need to perform rituals in the morning to ensure that they will have a good day. If the child with OCD is prevented from doing morning rituals, the child is likely to believe that the day will go badly.

About one percent of children in the United States have obsessive-compulsive disorder. Children diagnosed with obsessive-compulsive disorder are usually between the ages of seven and twelve. Many children with obsessive-compulsive disorder have a family history of OCD.

Children with OCD may have a greater risk of some other psychiatric conditions. Trichotillomania, a condition of pulling out one’s hair, and Tourette’s disorder may be more common in children with obsessive compulsive disorder. Depression, learning disorders, and other anxiety disorders can be more common. The child may also have a greater risk of conditions that affect their behavior such as oppositional defiant disorder.

Even if a child is officially diagnosed with OCD, it does not mean that the child will necessarily have OCD in adulthood. OCD in children is often treated with a combination of therapy and medication. A therapist can help the child learn to cope with anxiety and teach parents how to reduce the child’s anxiety. Prescription drugs that treat obsessive-compulsive disorder in children are also anti-depressants.

Obsessive compulsive disorder is a condition that causes repetitive thoughts and compulsive behavior. The repetitive, obsessive thoughts often cause an increase in anxiety. The person may have repetitive, disturbing images such as of a fictitious murder or violence. Performing the compulsive behavior often alleviates some of the anxiety for the individual.

The unwanted, intrusive thoughts or images of OCD cause significant anxiety. The thoughts can impair the person’s ability to concentrate on other things. The person with obsessive thoughts often has compulsive behavior that is related to the obsessions. For example, someone who has obsessive thoughts of contracting an illness from germs may be a compulsive hand-washer.

Signs of obsessive compulsive disorder include ritualistic behavior. The compulsive behavior can be checking objects such as the locks on doors or knobs on the stove. Excessive hand-washing can be a compulsive behavior. One of the signs of OCD can be a tendency to repeat certain words.

Another of the common signs of obsessive compulsive disorder is worrying about things being perfect or in order. The person may spend abnormal amounts of time and energy fixing things, cleaning, straightening objects, and putting things in order. People with OCD may become preoccupied with numbers or a specific number. They may feel compelled to check things a specific number of times or count things.

Excessively checking on the wellbeing of family can be a sign of obsessive-compulsive disorder. A person with OCD may call loved ones numerous times a day just to make sure that they are safe. A sign of obsessive compulsive disorder can be extreme religious activities, prayer, or rituals fueled by fear of sinning or not being perfect.

A form of obsessive compulsive disorder is hoarding. Signs of obsessive compulsive disorder in the form of hoarding is collecting objects and refusal to throw away possessions. A person with hoarding behavior may be driven by feelings of emptiness or a fear of not having the things they need. This is not the same as someone with poor housekeeping skills who has just been neglectful of cleaning and throwing away garbage. For the hoarder, the objects fulfill some emotional need and are therefore difficult to part with.

PTSD treatment can include different types of therapy and medication. There is no set duration of posttraumatic stress disorder treatment. Treatment for PTSD can take months or years. The first part of treatment for posttraumatic stress disorder often includes educating the person about what PTSD is and an explanation of the common symptoms.

Individual cognitive therapy and family therapy can be the foundation of PTSD treatment. The individual with PTSD needs therapeutic support when coping with the symptoms. The role of the therapist may be to teach the person ways to cope with flashbacks, nightmares, and other symptoms. The person often needs to learn how to cope with the symptoms before therapy can even begin to address the traumatic cause of the PTSD.

Exposure therapy is a therapeutic approach to the traumatic cause of PTSD. Gradually, the individual is to recount the memories that the person has of the traumatic event. It is not uncommon for the person to have blanks in the memory of the trauma. The therapist may gently push the person to remember and tell more of the events of the trauma in each desensitization session. In some cases, the location of the trauma may be revisited.

Cognitive-behavioral therapy is a type of therapy that looks at how thoughts, feelings, and behaviors are interconnected. The therapist may assist the individual in challenging negative thoughts that stem from the trauma or were reinforced by the trauma. The individual’s interpretations of the traumatic event may be explored.

Eye movement Desensitization and Reprocessing (EMDR) addresses the cause of PTSD more effectively than many other therapeutic approaches. It is believed that for people with PTSD, the memory of the trauma becomes stuck in intense, fractured segments. An example of how this shows in people with PTSD is the emotionally-charged flashbacks which are stuck memories of portions of the event while the person with PTSD may be unable to recall other parts of the trauma. EMDR uses clicking or repetitive eye movement while the person is retelling the traumatic event. The goal of EMDR therapy is to unfreeze the stuck memories and help the individual integrate the memory of the trauma as a whole with less emotional intensity attached to it.

Group therapy and support groups are often helpful for people with PTSD. An individual with PTSD may feel alone or isolated. They may feel that no one understands the trauma and how it has affected them. By meeting with a group of people with similar trauma or PTSD, the person gets a sense that there are people who understand what they are going through. It can also be helpful when members of the group share things that have been helpful for them.

Family therapy is often used as part of the treatment for posttraumatic stress disorder. The family as a whole often suffers the effects of PTSD due to the individual’s symptoms. Family therapy is also helpful to show the person with PTSD that they have support and to educate the family about PTSD and its effects.

Medication may be used to treat anxiety, depression, and sleep problems caused by the PTSD. Antidepressants that are in the SSRI category like Paxil or Zoloft are most commonly used to treat PTSD.

People who suffer from panic attacks, also called anxiety attacks, can be desperate to learn how to stop them. Panic attacks can be a debilitating condition. People with panic attacks often avoid social situations or situations that may trigger panic attacks.

Panic attacks cause an emotional and physical response to intense fear that is not based on a real danger. The person may experience heart pain or palpitations, sweating, dizziness, shortness of breath, and nausea. A panic attack often causes feelings of being disconnected from reality and a fear of dying.

Positive self-talk is one method of breaking the panic response. Therefore, it can be an effective way to stop panic attacks. How to stop a panic attack with positive self-talk is to begin replacing the distressful messages of danger with internal messages based on reality.

The intense fear is often a beginning symptom of a panic attack. The person may have a fear of dying, fear of losing control, or fear that someone they love is going to die. The fear may be a sense of impending doom like something horribly bad is going to happen.

Fear is sometimes appropriate. Fear can save us from dangerous situations. For example, a person may not speed because the person has a fear of being in a car accident. That would be a healthy fear. People with panic attacks may have had reasons to have this fear at one time. However, as with many anxiety disorders, the fear has somehow become stuck and returns when there is no longer any real threat or danger.

Immediately when the fear begins during a panic attack, the person should remind themselves that there is no actual, real danger. Recognizing that what is happening is a panic attack and nothing more can help reduce the fear response and empower the person to control the panic attack.

Negative thinking is a common problem for people with panic attacks and other anxiety disorders. During a panic attack, negative thinking can be combated with positive self-talk. Assuring yourself that there is no real danger is just one example of how positive self-talk can be used during a panic attack.

People can use statements like:
I am safe and strong.
I was feeling anxious which caused the physical symptoms. I am fine and the symptoms will go away shortly.
I am able to cope with the anxiety. The anxiety cannot control me unless I allow it to.

These are only examples. Someone can write down their own positive statements that may help them in this situation. Writing them down and carrying them with you is helpful. During a panic attack is not an ideal time to try to figure out how to cope with them. Having a plan ahead of time is empowering.

Having personalized statements can be helpful. For example, if during a panic attack, a person often feels they are in danger of being attacked, the person may want to write several statements that focus on their safety. The person may want to start by repeating “I am safe and strong” and add other statements that they wrote such as “No one is going to hurt me” and “The anxiety is lying to me and telling me that I am in danger, but there is no real danger.”

Coping with panic attacks can take practice. If the person tries these methods and the methods do not help, the person may be tempted to feel that the situation is hopeless. Often, all that is needed is more practice to gain control of the anxiety. A therapist can be very helpful in developing effective coping skills or personalizing these methods for more control over panic attacks.

People who are feeling anxious, overwhelmed, or nervous may wonder if they are having an anxiety attack. Anxiety attacks cause physical and emotional symptoms. How can I tell if I’m having an anxiety attack?

What happens during an anxiety attack? Emotionally, a person may feel threatened or in danger during a panic attack. They may have a strong urge to leave the area immediately even though there are no real signs of danger. The person may feel nervous and scan the area for signs of danger. Feeling more alert than usual and gathering in details from the environment is not uncommon during an anxiety attack.

There is a sense of impending doom during an anxiety attack. The person may feel that they are going to die or someone they know is going to die. The person may experience a fear of dying, losing control, or going crazy.

During an anxiety attack, the person often feels a sense of being unreal or detached from reality. Their environment may feel unreal as if the person is dreaming or otherwise disconnected from reality. People having anxiety attacks may feel disconnected from their bodies.

The physical symptoms of anxiety attacks can be shallow breathing, sweaty palms, hot flashes, or chills. The person may have a feeling of choking, dizziness, and nausea. Heart symptoms of anxiety attacks can include a racing heart rate, pounding heart, chest tightness, chest pain, or heart palpitations. Other physical symptoms of anxiety attacks include shortness of breath, numbness, tingling sensations, trembling or shaking.

The physical symptoms of anxiety attacks can be prominent and very noticeable or minor. Instead of having these anxiety attack symptoms, a person may have the emotional symptoms and uncontrollable crying.

A person is not likely to have every symptom of anxiety attacks. So, if I am having some symptoms of anxiety at once, how can I tell if I’m having an anxiety attack? The Diagnostic and Statistical Manual (DSM) which is the manual used to diagnose psychiatric conditions states that in order for a person’s anxiety symptoms to be considered an anxiety attack, the person must have at least four symptoms during the time of intense fear or discomfort. The symptoms must have developed suddenly and typically hit their peak approximately ten minutes after onset.

A phobia is an irrational fear. For people suffering from a phobia, the object that triggers the fear produces an intense feeling of being threatened. Though a phobia can be a very serious matter, many people want to know about weird phobias. It is important to remember that even though it may be difficult to imagine being afraid of these objects, it is a very real and distressful experience for the individual who has the weird phobia.

Here is a weird phobia list:

Animals:
Chickens- alektorophobia
Fish – ichthyophobia
Fog- homichlophobia
Frogs- ranidaphobia
Moths- mottephobia

Atmosphere and Weather Phobias:
Clouds- nephophobia
Gravity- barophobia
Ice or frost- pagophobia
Rain- pluviophobia
Snow- chionophobia
Sun- heliophobia

Body Parts and Bodily Function Phobias:
Belly button phobia- omphalophobia
Blood – hemophobia
Blushing- ereuthrophobia
Chins- geniophobia
Knees- genuphobia
Memories- mnemophobia
Menstruation- menophobia
Painful bowel movements- defecaloesiophobia
Sitting down- kathisophobia
Sleep- somniphobia
Urinating- urophobia
Walking- ambulophobia

Colors:
Fear of colors- chromophobia
Black- melanophobia
Purple- porphyrophobia
White- leukophobia
Yellow- xanthophobia

Other Weird Phobias:
Bald people- peladophobia
Button phobia- koumpounophobia
Clown phobia- coulrophobia
Dust- amathophobia
Feeling pleasure- hedonophobia
Ferns- pteridophobia
Garlic- alliumphobia
Light- photophobia
Metal- metallophobia
Mirror phobia- eisoptrophobia
Mushrooms- Mycophobia
Paper- papyrophobia
Peanut butter sticking to the roof of the mouth — arachibutyrophobia
String — linonophobia
Tickled by feathers or feathers — pteronophobia
Vegetables – lachanophobia

Answers to Common Phobia Name Questions:

What is a phobia of toilet seats or public bathrooms? A toilet seat phobia may be called mysophobia if the fear is of being contaminated by germs.

What is the name for a phobia of sponges? Trypophobia may be used as the name of the phobia of sponges. Trypophobia is a phobia of holes. People with trypophobia often have phobias of many objects with holes. Some also have phobias of clusters or clustered objects.

What phobia or fear of turkeys? I do not know the name of a phobia for turkeys specifically, but the phobia of birds is ornithophobia. This could be used to describe a phobia of any or all birds.

If you have a question about phobia names, leave a comment with your question and I will try to find the answer for you.

The invasive thoughts and ritualistic behaviors of obsessive-compulsive disorder (OCD) can interrupt a person’s life to the extent that the person’s ability to function is impaired. People with obsessive-compulsive disorder may spend a substantial amount of time everyday worrying about imagined, catastrophic consequences and performing ritualistic behaviors to avoid these consequences.

Work, relationships, and personal activities and achievements can suffer. OCD is considered one of the most debilitating medical conditions by the world Health Organization.

Research studies are being conducted at the Silvio O. Conte Center to judge the safety and effectiveness of a new OCD treatment. Deep brain stimulation (DBS) has been approved by The Food and Drug Administration (FDA) for the treatment of OCD.

Thin wires are implanted in the parts of the brain that have been associated with obsessive-compulsive disorder. A battery-powered stimulating device is connected to the wires and implanted in the chest of the patient. The stimulating device is sometimes referred to as a “brain pacemaker.”

The effects of deep brain stimulation and OCD have been tested in previous studies. It was found that deep brain stimulation for OCD treatment reduced OCD symptoms.

While many cases of obsessive-compulsive disorder can be effectively treated with medication and cognitive-behavioral therapy, severe OCD may be resistant to these treatments. Very few alternatives other than different medications or different therapeutic approaches are available for people with obsessive-compulsive disorder that has been resistant to treatment.

The deep brain stimulation treatment for OCD may offer hope to those whose OCD symptoms have not been alleviated with therapy or medication. People whose quality of life has suffered due to severe OCD symptoms despite attempted obsessive-compulsive disorder treatment may be eligible to participate in the study.

Deep brain stimulation has been used in the treatment of Parkinson’s and other neurological conditions. Another study on the genetics of OCD is being conducted as well.

People with OCD who are not interested in participating in the deep brain stimulation OCD clinical trial may want to participate in the genetics study. The genetics study does not require surgery like the deep brain stimulation clinical trial does. People interested in either of these OCD clinical trials can contact the Butler Hospital OCD Research Clinic in Providence, Rhode Island at (401) 455-6366.

What is OCD? Obsessive-compulsive disorder, commonly referred to as OCD, is an anxiety disorder that causes unwanted, invasive thoughts and ritualistic behaviors. The person may feel powerless to control these thoughts and behaviors.

Common ritualistic behaviors associated with obsessive-compulsive disorder include excessive hand-washing and checking and rechecking items. while someone who does not have OCD may wonder if they forgot to turn off the stove, someone with OCD may check twelve times to make sure they turned it off, They may also worry about forgetting to turn it off and the harm it could cause between checking the stove.

When a person with OCD has an urge to do the ritualistic behavior, the person’s anxiety may increase until the person does the behavior. Then, the person may experience some temporary relief from the anxiety.

Often, the person’s obsessive thoughts are related to the compulsive behavior. As in the example of checking and rechecking the stove, the checking of the stove is the compulsive behavior, while the obsessive thought may be the threat of fire if the stove is left turned on. People with compulsions to wash their hands excessively often fear the contamination of germs

Other people with obsessive-compulsive disorder have preoccupations with order, perfection, or symmetry. A person may need to have items lined up a certain way or in a certain order. If items are violating the person’s perception of order, the person experiences anxiety and an urge to “fix” it.

Hoarders are receiving more media attention and have been described as having OCD. A hoarder often experiences fear or anxiety about throwing things away or not having something when it is needed. Therefore, a person who is hoarding will resist throwing things away and may collect items in case the things are ever needed. Hoarders may have difficulty letting go of items for which the objects represent their emotions or memories.

Hoarders may also be driven by fear of not having money or food which may have stemmed from having a deprived past. Ironically, hoarders often waste money since they store much more food than they can possibly use before the expiration dates of the food. This can become a health concern if the person hoarding is eating food that has expired and is no longer healthy to eat because they can’t throw it away.

People with OCD often need professional counseling to overcome the fear and anxiety that is driving the compulsive behavior. Some medications are also used to treat the anxiety associated with obsessive compulsive disorder. Sometimes, exposure therapy is used to help the person with OCD see that the disastrous consequences that the person worries will occur if the person does not perform the compulsive behavior is imagined and not based on reality.

Anxiety attacks can occur with different levels of severity. A person may have a severe anxiety attack when under higher stress levels, but experience mild anxiety attacks at other times. Some people may only experience mild anxiety attacks.

Even mild anxiety attacks are uncomfortable and stressful. The symptoms of mild anxiety attack make it difficult to concentrate and cause distressful feelings. People with social anxiety may experience symptoms of mild anxiety attacks whenever they are among people or in certain social situations in which they feel scrutinized.

Mild anxiety attack symptoms can include uneasiness, disturbing thoughts of being judged or threatened, racing thoughts, and difficulty concentrating. A person may feel the need to avoid or leave certain situations that tend to trigger these uncomfortable feelings.

Symptoms of a mild anxiety attack can include irritability, muscle tension, sweating, and restlessness. A person experiencing a mild anxiety attack may be more alert and watchful as if looking for signs of danger. Nervousness and feeling jumpy are common symptoms of anxiety attacks of any level of severity.

A person who is experiencing symptoms of an anxiety attack may be able to use positive self-talk to cope with the distressful symptoms. Positive self-talk is silently talking to yourself in a self-assuring way. The person may be able to remind themselves that the symptoms are caused by anxiety and they are not in any true danger.

It may take practice to overcome anxiety symptoms with positive self-talk. The person may want to think about ways of replacing distressful thoughts of impending doom or judgment that may occur during a panic attack with more realistic thoughts before entering situations that tend to make the person feel anxious. Preparing in this way can equip the person with the necessary coping skills to deal with the anxiety attack when it occurs.

It is easy to fall into a counter-productive habit of berating yourself for having anxiety symptoms. Reminding yourself that anxiety symptoms are not a personal weakness or flaw, but may be part of a physical illness such as a psychiatric condition of panic attacks may be helpful. Think of anxiety attacks as similar to other physical ailments such as diabetes. A person with diabetes would not criticize themselves for having diabetes and neither should someone with panic attacks.

There has been more and more hype about a fictional category of PTSD called “complex PTSD.” “Complex” PTSD supposedly differs from regular (simple?) PTSD in its causes and symptoms. Complex PTSD is not an official diagnosis recognized by the American Psychiatric Association. In my opinion, it should not be.

Complex PTSD is described as PTSD occurring from recurrent or ritualized abuse. For a “diagnosis” of complex PTSD, the person has to have been under the control of another person for a significant amount of time. Up until this point, and still officially, PTSD has been considered to be caused by any trauma, whether the trauma was a single event or recurrent.

Complex PTSD symptoms include alterations in emotional regulation, alterations in consciousness such as forgetting part of the trauma and flashbacks, changes in self-esteem and the person’s self-concept, altering perception of the perpetrator, changes in personal relationships, and a sense of hopelessness or despair or a loss of faith. Any of that sound familiar? If not, you probably do not have PTSD.

Three more possible symptoms of complex PTSD include self-harm, numbing behavior such as drinking, and avoiding discussing the trauma. I’m still waiting to see how complex PTSD is different from PTSD in general…

Is anyone else with PTSD outraged about this? I experience every single one of those complex PTSD symptoms, but because I was not under someone’s control for a consistent, prolonged period of time, my PTSD is not as severe or complicated as complex PTSD? Are they saying that I and anyone else who has all of these symptoms but was not in a concentration camp or a victim of child sexual abuse have SIMPLE PTSD?

As anyone who has PTSD can attest to, there is no SIMPLE PTSD. All PTSD is complex in and of itself.
So, what would be the purpose of having a separate diagnosis of complex PTSD? Will it lead to better treatment? If so, why and how? How many categories of PTSD do we need? I could make the same claims for PTSD from rape or sexual assault. There have been claims associated that the victim of complex PTSD is often viewed as having a character weakness. How is that different from a rape victim being blamed for the rape?

Some people may feel that there needs to be a separate category for combat PTSD. If we are going to start separating PTSD, why not include categories for domestic violence PTSD, child abuse PTSD, media-induced PTSD, natural disaster PTSD, etc? My question is why? How will it help develop better treatment when people with PTSD who would not be considered as having complex PTSD can have the exact same symptoms? I can see this separation as being more divisive among people with PTSD than helpful. There should NOT be a separation of this already complex disorder. Professionals should be focused on finding treatments to benefit ALL people with PTSD, not a fictitious, arbitrary division of it!

When having an anxiety attack, a person may become intensely worried about whether the chest tightness or shortness of breath are signs of a heart attack or anxiety attack. The short of breath anxiety can cause someone to fear that they will hyperventilate and pass out. Since anxiety attacks cause physical symptoms that seem to be leading to a heart attack or fainting, these symptoms can cause even more anxiety for the person.

In addition to the physical symptoms that can cause fear of a heart attack or hyperventilation, anxiety attacks cause feelings of dread or feelings of being in danger. These feelings of impending doom can cause the person to interpret physical panic heart attack symptoms as life-threatening which in turn can cause even more anxiety. This increased anxiety can cause even worse physical symptoms, so this cause a horrifying cycle.

Someone who suffers from chest pain and anxiety or short of breath anxiety should be examined by a physician to be properly diagnosed with panic attacks. Panic heart attack symptoms such as tightness in the chest and difficulty breathing need to be medically evaluated to determine if the person is experiencing signs of heart disease or having anxiety attacks. After being diagnosed with panic attacks, knowing that the physical anxiety symptoms are due to anxiety and not heart disease can help alleviate some of the anxiety that one may feel while having the symptoms.

The physician may give the patient information on how to distinguish physical symptoms of anxiety attacks from heart attack symptoms. During an anxiety attack, it may help the person to remind themselves that these are anxiety symptoms that will pass. Reassuring self-talk is one of the best things to do during an anxiety attack.