What is the difference between General Anxiety Disorder and Trump Anxiety Disorder?

Source: Time Magazine

More people than are commonly thought to suffer from some degree of anxiety disorder.  You may be wondering what is the operational (psychiatric) definition of anxiety.  No worries, I will get to that shortly.  Recently, as in the past two years, research has shown that politics has played a major part in increased anxiety.  How?  A scientific study published in the Journal 'Science' titled "The effect of partisanship and political advertising on close family ties" showed that on average, families spend fewer number of hours together as a result of the division based upon differing political views in the current political climate.  Remember, the study was conducted after the election.  The current political climate has caused noticeable adverse changes in family dynamics.  How does one differentiate between anxiety based on events (politics) and anxiety which is inherent to each of us to some degree.

What is Anxiety?

Anxiety is commonly viewed as a sharpening tool to keep us alert to any threats -- a survival mode.   For a large percentage of people, anxiety is anything but a 'sharpening tool' and more often associated with feeling of 'excessive nervousness'.   Further, a certain amount of people suffer to a large degree from anxiety on a daily basis from carrying out their normal daily lives.  Which is concerning to say the least.  In order to understand the disorder which inflicts so many people without notice, an operational definition of General Anxiety Disorder is needed.



I just finished a book titled "The Dangerous Case of Donald Trump," (organized and edited by Dr. Bandy X. Lee) -- a compilation of written works describing the symptoms which contribute to the informal diagnosis of President Donald J. Trump.  By discussing possible attributes/qualities of different personality and other mental health disorders, the contributors discuss the problems facing the United States along with President Trump.  Without violating the 'Goldwater Rule', the contributors focus on what electing a person with disorders says about the electorate (you and I).



As I just mentioned, the book had a number of mental health professionals contributing to the book.  The author who I would like to highlight wrote a chapter titled "Trump Anxiety Disorder" whose name is Jennifer Contarino Panning.  She is a licensed psycotherapist in Clarkston, Michigan.  The excerpts below are shown to help introduce an operation definition of General Anxiety Disorder along with distinguishing the newly emerging Trump Anxiety Disorder.  First, lets start with a definition of General Anxiety Disorder:

It is important to differentiate generalized anxiety disorder and Trump anxiety disorder.  The "Diagnostic and Statistical Manual of Mental Disorders" (5th ed.) (commonly referred to as DSM-V), is widely used among mental health professionals (American Psychiatric Association 2013).  It describes generalized anxiety disorder (GAD) as characterized by excessive, uncontrollable, and often irrational worry--that is, apprehensive expectation about events or activities.  This excessive worry often interferes with daily functioning, as individuals with GAD typically anticipate disaster and are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties. Individuals often exhibit a variety of physical symptoms, including fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, difficulty swallowing, excessive stomach acid buildup, stomach pain, vomiting, diarrhea, bouts of breathing difficulty, difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, rashes, and an inability to fully control the anxiety. 

The author goes onto state that these symptoms must be consistent and ongoing to be formally diagnosed by a physician for at least 6 months.  Moreover, that according to the National Institute of Mental Health, over 7 million Americans suffer from General Anxiety Disorder within a year....Wow!  Each of us have felt a sense of anxiety at some point in our life.  Whether that be preparing a work project or presenting a speaking event to a large audience.  That is typically normal anxiety associated with stress of planning.  Some people often have difficulty distinguishing between stress and anxiety.  Regardless, understanding the causes of anxiety or stress are important.



Which is why after certain events in time, new anxiety can be sourced to a different cause.  Although, the phenomenon on a larger scale calls for a different type of analysis.  Further, the type of anxiety causing issue at a national scale has been traced to a certain number of events.  These events have been surrounding the campaign/election of President Donald J. Trump.  Below, the differences along with the definition of Trump Anxiety Disorder will be highlighted.

What is Trump Anxiety Disorder?

As I mentioned above, suffering from General Anxiety Disorder is terrible enough on a daily basis.  Now, add in the unknown quantity of Trump Anxiety Disorder.  What is the difference between the two anxiety disorders.  Let's define it.  The author of the above excerpt, Dr. Jennifer Panning, goes onto describe Trump Anxiety Disorder in the same chapter as:

Symptoms associated with Trump Anxiety Disorder include: feeling a loss of control; helplessness; ruminations/worries, especially about the uncertain sociopolitical climate while Trump is in office; and a tendency toward excessive social media consumption.  In fact, the polarization that this has created has caused a deep divide between families and friends of differing political beliefs.  Trump's specific personality characteristics, and his use of psychological manipulation tools such as gaslighting, lying, and blaming, are described as contributing factors to Trump Anxiety Disorder. 

Trump Anxiety Disorder, albeit not a formal diagnosis, differs from GAD in regard to several measures. One difference is in the furation of time for the symptoms to develop.  The volatile events leading up to the 2016 election (i.e., false news reports, Comey's report questioning Clinton's ethics) were challenging in themselves, but many Americans were reassured by multiple polls (e.g., Silver 2016) predicting that Hillary Clinton would win the election in a landslide.  This led to a sense of shock and disbelief after Trump was announced as president of the United States. 

An additional symptom of Trump Anxiety Disorder is that symptoms are directly related to the uncertain sociopolitical climate.  An elevated stress level when reading articles about numerous topics--the Muslim ban, the threat/promise of disbanding the Affordable Care Act, tensions between the United States and North Korea, the possibility of Russia's having interfered in the 2016 election and Russia's financial connection to Trump, the US/Mexican wall, immigration issues, the defunding of environmental groups such as the National Park Service and the Environmental Protection Agency, and the defunding of medical research--is strong.  An individual impacted by Trump Anxiety Disorder may be directly impacted by one of these singular issues, have multiple concerns, or worry about the future democratic state in America given these issues.  Therefore, the ruminative worry associated with an anxiety disorder is specific to these events (Clarridge 2017).

Wow! After reading the above excerpt have you ever suffered from a small amount of Trump Anxiety Disorder?  I can easily see myself suffering from a fair amount of the same underlying attributes/sources defined under the Trump Anxiety Disorder.  Have you?  Many of the students from our university are showing signs of suffering from symptoms of Trump Anxiety Disorder.  On a larger scale, people around us are showing signs of symptoms too -- which is completely concerning.

Conclusion...

If you have ever had an anxiety attack or even felt a moderate amount of anxiety, I feel for you.  The symptoms above are real and have been felt by me at one point or another in my graduate career.  To have the added stress or symptoms associated with Trump Anxiety Disorder are even more concerning.  Especially since the latter anxiety is controllable -- he could have been not elected into office.  Instead, we have what we have and have to deal with what we have.



The first step in dealing with anxiety without any outside influences is to identify triggers and find solutions.  Once the triggers are known, then solutions can be found.  But with the added anxiety associated with Donald Trump is unfair.  Although, now with the election over and two years into the administration, the least we can do is to either ignore television and the online world all together.  Or, we can try to understand and move onto find solutions to deal with the current situation.  We might not be in control of other's actions, but we are in control of our own.  Distinguishing between normal anxiety and anxiety associated with Donald Trump will be beneficial in the future.




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What is the next big step in Mental Health Research?

Source: Texas Public Radio

Today is Veterans Day and I would like to reach out to all of my brothers and sisters who have donned a U.S. Military uniform and SERVED OUR COUNTRY to say a Big THANK YOU FOR YOUR SERVICE.  Your service does not go unnoticed in the Kaiser family household and is greatly appreciated.  The opportunity to wear a U.S. Military uniform and serve our country is not afforded to each resident of the United States.  I have had the opportunity and respect every other person who has had the chance to as well.  Unfortunately, each of us have varied experiences during our time in the service.  There are those who serve and leave the service to lead a somewhat normal life with memories which are unshakable.  While there are others who leave the service is an unfortunate state of mind -- which is tragic and needs to be dealt with -- especially given the sacrifice to our country offered by soldiers. No one gets out for free without memories of their service.



Last week on Wednesday night in Thousand Oaks (California), a 28 year old veteran entered a bar named "...." and released terror by shooting up the place to leave 11 killed and untold number of people with mental scars with which they will live for years to come.  How did this happen?  Why did this happen?  Especially, as early reports suggest that Ian David Long was visited by law enforcement earlier (in April) in 2018 which included a deployment of mental health services to clear him (as no current threat).



Now 13 people are dead and the rest of us are wondering what is going on in the world?  The shooter was a student at California State University at Northridge (up to 2016) -- which directly impacts myself and others who are employed here.  Released the next day was a press release from the National Institute of Mental Health titled "NIMH Explores the “Next Big Thing” in Mental Health Services Research" with the following updates on Mental Health Research from a conference held earlier in the year (in August).  With the tragedy that just unfolded, what is the "next big thing" which will address/mitigate these terrible occurrences from recurring.  According the the NIMH, a whole range of issues confront the Mental Health Research system which mainly stem around patient treatment:

NIMH Explores the “Next Big Thing” in Mental Health Services Research

November 8, 2018 • Institute Update

What’s the “next big thing” that could help people with mental illnesses get the treatment and services they need? This important question was the theme of the National Institute of Mental Health (NIMH)’s 24th biennial Mental Health Services Research (MHSR 2018) conference held August 1-2, in Rockville, MD.

“This conference brings together mental health researchers and other experts, trainees, consumers, advocates, and mental health care providers to learn about current research findings and discuss new research that might close the gap between what science shows is most effective and what services people actually receive in real-world settings,” explained Michael Freed, Ph.D., EMT-B., a conference co-chair. “We are thrilled that this year the conference had more presentation proposals, more sessions, and more attendees than ever before. There is clearly a lot of interest in this research.”

Health services research is a multidisciplinary scientific field that examines how to improve people’s access to health care providers and services; how to improve the quality, continuity, and equity of the care they receive; how to most efficiently pay for needed health care; and ultimately, how to improve the symptoms and functioning of people with health conditions. The research considers individual and provider preferences and behavior, innovations in technology, and community, organizational, and systems-level factors to understand how to implement effective practices in care-delivery settings.

In his opening address, Dr. Freed acknowledged the participants’ passion and ongoing contributions to mental health services research and challenged them to use the meeting to generate new research ideas. In a pre-recorded welcoming address, NIMH Director Joshua Gordon, M.D., Ph.D., noted that, “Research doesn’t stop with the discovery of a new treatment, because even the best treatment won’t work if people can’t or won’t use it. We also need research to figure out how best to deliver effective therapies and services to those who need it now.”

The wide range of conference topics reflected the realities of mental health delivery today. Judge Steve Leifman, J.D., Administrative Judge for the Eleventh Circuit Court of Florida, delivered a compelling keynote address, noting that people with mental illnesses are more likely to be in jail—where mental health treatment is typically not available—than in a mental health facility. The key to addressing this problem is to make mental health care more easily available to those who have difficulty obtaining it, and he described his long-time efforts to do just that. Judge Leifman’s advocacy work in Miami-Dade County created an opportunity for the criminal justice system there to divert low-level offenders with mental illnesses to treatment and social services rather than to incarceration. The goal is to reduce psychiatric symptoms in order to break the cycle of repeat arrests and to provide services that lead to community reintegration and stability. This approach has significantly decreased the number of arrests and repeat incarcerations of people with mental illnesses, as well as the overall jail population in the county.

Jürgen Unützer, M.D., M.P.A., M.A., professor and chair of the Department of Psychiatry and Behavioral Health at the University of Washington, delivered the inaugural Wayne Katon Memorial Lecture.Dr. Katon was an accomplished mental health services researcher, teacher, and mentor whose research established the collaborative care approach as an effective intervention in psychiatry).

In his address, Dr. Unützer described the robust body of research supporting the effectiveness of collaborative care, in which primary care physicians actively collaborate with mental health care managers and psychiatric treatment specialists to provide comprehensive patient care. With provider training, he explained, treatment for less severe mental health concerns can be delivered in the primary care setting while patients needing more intensive treatment can be referred to contacts working in mental health specialty settings. He discussed how this approach could address provider shortages and reduce the long wait-times often faced by people seeking mental health care. Dr. Unützer also reviewed the possible—but addressable—challenges to wide-spread adoption of collaborative care and underscored the approach’s potential for broadly improving mental health treatment outcomes.

Two plenary sessions of the conference were directly focused on this year’s theme—what are our visions of “The Next Big Thing” in mental health services and research. Talks in these sessions focused on a wide range of topics including how electronic health records and health information exchanges can be used advantageously in both research and care delivery; research and practice considerations in the use of telehealth platforms; the promise of practice-based research networks; and, the use of learning health networks for improving services for those with severe mental illnesses.

As in prior years, the conference also provided career development opportunities for a competitively selected group of Early Stage Investigators (ESIs). Thirty ESIs presented posters at the main conference and attended a post-conference New Investigators Workshop. During the workshop, experts from NIMH and academia gave presentations on developing a career in mental health services research and on navigating the process of NIMH grant submissions. ESIs also met with these experts to receive feedback to refine their ideas for future grant applications.

“Thanks to the presenters and attendees, the meeting exceeded our expectations in exploring ideas for new research directions,” stated Denise Juliano-Bult, M.S.W., a meeting co-chair. “The quality of the presentations and panels was outstanding, and it was not only the biggest conference to date but included some of the most visionary sessions we’ve heard. Ultimately, we hope that MHSR 2018 will enable the synthesis of ideas from a broad range of perspectives that can inform the development of future NIMH services research priorities.”

The meeting agenda with links to the video recordings of the presentations are available on the NIMH website.

With the above press release being stated, hopefully the result will be mental health services which are offered to more people and effective.  There are too many people who are suffering from mental illness in the United States -- who go untreated.  Additionally, there is such a large change needed across the entire nation that a solution seems out of sight.  Although, if each local government tries to make changes which are accessible, then large scale changes across the nation will be noticeable. 



Conclusion...



Mental illnesses impact each of us either directly or indirectly.  If you know of someone in need of mental health services, please don't hesitate to contact the right services to help them.  Each of have a responsibility to say something if a danger is present.  Furthermore, each of us can contribute to society to urge elected leaders to take action and find a solution -- i.e. direct money toward services along with other accessible solutions -- policy making, community discussions, outreach to other government officials.  All of these combined actions will hopefully result in a more efficient and effective system which provides treatment to all of those in need.




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