The Producers Groups Alcohol Usage Questionnaire: Fill & Download for Free

Hi sweetie: This should really answer not only your question but about a million other questions that you didn’t ask. haha. This is from Wikipedia. It came out with a weird layout, but just keep scrolling down and reading, and you will be an expert by the end of this thing (Pleeeeeze an upvote? THANK you!!!):Anxiety disorderFrom Wikipedia, the free encyclopediaJump to navigation Jump to searchAnxiety disorderThe Scream (Norwegian: Skrik) a painting by Norwegian artist Edvard Munch[1]SpecialtyPsychiatrySymptomsWorrying, fast heart rate, shakiness[2]Usual onset15–35 years old[3]Duration> 6 months[2][3]CausesGenetic and environmental factors[4]Risk factorsChild abuse, family history, poverty[3]Differential diagnosisHyperthyroidism; heart disease; caffeine, alcohol, cannabis use; withdrawal from certain drugs[3][5]TreatmentLifestyle changes, counselling, medications[3]MedicationAntidepressants, anxiolytics, beta blockers[4]Frequency12% per year[3][6]Anxiety disorders are a group of mental disorders characterized by significant feelings of anxiety and fear.[2]Anxiety is a worry about future events, and fear is a reaction to current events.[2]These feelings may cause physical symptoms, such as a fast heart rate and shakiness.[2]There are a number of anxiety disorders including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism.[2]The disorder differs by what results in the symptoms.[2]People often have more than one anxiety disorder.[2]The cause of anxiety disorders is a combination of genetic and environmental factors.[4]Risk factors include a history of child abuse, family history of mental disorders, and poverty.[3]Anxiety disorders often occur with other mental disorders, particularly major depressive disorder, personality disorder, and substance use disorder.[3]To be diagnosed symptoms typically need to be present for at least 6 months, be more than what would be expected for the situation, and decrease functioning.[2][3]Other problems that may result in similar symptoms include hyperthyroidism; heart disease; caffeine, alcohol, or cannabis use; and withdrawal from certain drugs, among others.[3][5]Without treatment, anxiety disorders tend to remain.[2][4]Treatment may include lifestyle changes, counselling, and medications.[3]Counselling is typically with a type of cognitive behavioral therapy.[3]Medications, such as antidepressants, benzodiazepines, or beta blockers, may improve symptoms.[4]About 12% of people are affected by an anxiety disorder in a given year, and between 5% and 30% are affected at some point in their life.[3][6]They occur about twice as often in females as males and generally begin before the age of 25.[2][3]The most common are specific phobia which affects nearly 12% and social anxiety disorder which affects 10% at some point in their life.[3]They affect those between the ages 15 and 35 the most and become less common after the age of 55.[3]Rates appear to be higher in the United States and Europe.[3]Contents1 Classification 1.1 Generalized anxiety disorder 1.2 Specific phobias 1.3 Panic disorder 1.4 Agoraphobia 1.5 Social anxiety disorder 1.6 Post-traumatic stress disorder 1.7 Separation anxiety disorder 1.8 Situational anxiety 1.9 Obsessive–compulsive disorder 1.10 Selective mutism2 Causes 2.1 Drugs 2.2 Medical conditions 2.3 Stress 2.4 Genetics3 Mechanisms 3.1 Biological4 Diagnosis 4.1 Differential diagnosis5 Prevention6 Treatment 6.1 Lifestyle changes 6.2 Therapy 6.3 Medications 6.4 Alternative medicine 6.5 Children7 Prognosis8 Epidemiology9 Children10 References11 External linksClassificationFacial expression of someone with chronic anxietyGeneralized anxiety disorderMain article: Generalized anxiety disorderGeneralized anxiety disorder (GAD) is a common disorder, characterized by long-lasting anxiety that is not focused on any one object or situation. Those suffering from generalized anxiety disorder experience non-specific persistent fear and worry, and become overly concerned with everyday matters. Generalized anxiety disorder is "characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance".[7]Generalized anxiety disorder is the most common anxiety disorder to affect older adults.[8]Anxiety can be a symptom of a medical or substance abuse problem, and medical professionals must be aware of this. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more.[9]A person may find that they have problems making daily decisions and remembering commitments as a result of lack of concentration/preoccupation with worry.[10]Appearance looks strained, with increased sweating from the hands, feet, and axillae,[11]and they may be tearful, which can suggest depression.[12]Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.[13]In children GAD may be associated with headaches, restlessness, abdominal pain, and heart palpitations.[14]Typically it begins around 8 to 9 years of age.[14]Specific phobiasMain article: Specific phobiaThe single largest category of anxiety disorders is that of specific phobias which includes all cases in which fear and anxiety are triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide suffer from specific phobias.[9]Sufferers typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. Common phobias are flying, blood, water, highway driving, and tunnels. When people are exposed to their phobia, they may experience trembling, shortness of breath, or rapid heartbeat.[15]People understand that their fear is not proportional to the actual potential danger but still are overwhelmed by it.[16]Panic disorderMain article: Panic disorderWith panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and/or difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours.[17]Attacks can be triggered by stress, irrational thoughts, general fear or fear of the unknown, or even exercise. However sometimes the trigger is unclear and the attacks can arise without warning. To help prevent an attack one can avoid the trigger. This being said not all attacks can be prevented.In addition to recurrent unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. As such, those suffering from panic disorder experience symptoms even outside specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis).AgoraphobiaMain article: AgoraphobiaAgoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable.[18]Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that sufferers often develop.[19]For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can often have serious consequences and often reinforce the fear they are caused by.Social anxiety disorderMain article: Social anxiety disorderSocial anxiety disorder (SAD; also known as social phobia) describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. This fear can be specific to particular social situations (such as public speaking) or, more typically, is experienced in most (or all) social interactions. Social anxiety often manifests specific physical symptoms, including blushing, sweating, and difficulty speaking. As with all phobic disorders, those suffering from social anxiety often will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation.Social physique anxiety (SPA) is a subtype of social anxiety. It is concern over the evaluation of one's body by others.[20]SPA is common among adolescents, especially females.Post-traumatic stress disorderMain article: Post-traumatic stress disorderPost-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in DSM-V) that results from a traumatic experience. Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even a serious accident. It can also result from long-term (chronic) exposure to a severe stressor--[21]for example, soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger and depression.[22]In addition, individuals may experience sleep disturbances.[23]There are a number of treatments that form the basis of the care plan for those suffering with PTSD. Such treatments include cognitive behavioral therapy (CBT), psychotherapy and support from family and friends.[9]Posttraumatic stress disorder (PTSD) research began with Vietnam veterans, as well as natural and non natural disaster victims. Studies have found the degree of exposure to a disaster has been found to be the best predictor of PTSD.[24]Separation anxiety disorderMain article: Separation anxiety disorderSeparation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. Separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder.[25]Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the childhood cases tend to be more severe; in some instances, even a brief separation can produce panic.[26][27]Treating a child earlier may prevent problems. This may include training the parents and family on how to deal with it. Often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child. In addition to parent training and family therapy, medication, such as SSRIs, can be used to treat separation anxiety.[28]Situational anxietySituational anxiety is caused by new situations or changing events. It can also be caused by various events that make that particular individual uncomfortable. Its occurrence is very common. Often, an individual will experience panic attacks or extreme anxiety in specific situations. A situation that causes one individual to experience anxiety may not affect another individual at all. For example, some people become uneasy in crowds or tight spaces, so standing in a tightly packed line, say at the bank or a store register, may cause them to experience extreme anxiety, possibly a panic attack.[29]Others, however, may experience anxiety when major changes in life occur, such as entering college, getting married, having children, etc.Obsessive–compulsive disorderMain article: Obsessive–compulsive disorderObsessive–compulsive disorder (OCD) is not classified as an anxiety disorder by the DSM-5 but is by the ICD-10. It was previously classified as an anxiety disorder in the DSM-IV. It is a condition where the person has obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to repeatedly perform specific acts or rituals), that are not caused by drugs or physical order, and which cause distress or social dysfunction.[30][31]The compulsive rituals are personal rules followed to relieve the anxiety.[31]OCD affects roughly 1-2% of adults (somewhat more women than men), and under 3% of children and adolescents.[30][31]A person with OCD knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior.[30][32]Their symptoms could be related to external events they fear (such as their home burning down because they forget to turn off the stove) or worry that they will behave inappropriately.[32]It is not certain why some people have OCD, but behavioral, cognitive, genetic, and neurobiological factors may be involved.[31]Risk factors include family history, being single (although that may result from the disorder), and higher socioeconomic class or not being in paid employment.[31]Of those with OCD about 20% of people will overcome it, and symptoms will at least reduce over time for most people (a further 50%).[30]Selective mutismMain article: Selective mutismSelective mutism (SM) is a disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. Selective mutism usually co-exists with shyness or social anxiety.[33]People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism or even punishment.[34]Selective mutism affects about 0.8% of people at some point in their life.[3]CausesDrugsAnxiety and depression can be caused by alcohol abuse, which in most cases improves with prolonged abstinence. Even moderate, sustained alcohol use may increase anxiety levels in some individuals.[35]Caffeine, alcohol, and benzodiazepine dependence can worsen or cause anxiety and panic attacks.[36]Anxiety commonly occurs during the acute withdrawal phase of alcohol and can persist for up to 2 years as part of a post-acute withdrawal syndrome, in about a quarter of people recovering from alcoholism.[37]In one study in 1988–1990, illness in approximately half of patients attending mental health services at one British hospital psychiatric clinic, for conditions including anxiety disorders such as panic disorder or social phobia, was determined to be the result of alcohol or benzodiazepine dependence. In these patients, an initial increase in anxiety occurred during the withdrawal period followed by a cessation of their anxiety symptoms.[38]There is evidence that chronic exposure to organic solvents in the work environment can be associated with anxiety disorders. Painting, varnishing and carpet-laying are some of the jobs in which significant exposure to organic solvents may occur.[39]Taking caffeine may cause or worsen anxiety disorders,[40][41]including panic disorder.[42][43][44]Those with anxiety disorders can have high caffeine sensitivity.[45][46]Caffeine-induced anxiety disorder is a subclass of the DSM-5 diagnosis of substance/medication-induced anxiety disorder. Substance/medication-induced anxiety disorder falls under the category of anxiety disorders, and not the category of substance-related and addictive disorders, even though the symptoms are due to the effects of a substance.[47]Cannabis use is associated with anxiety disorders. However, the precise relationship between cannabis use and anxiety still needs to be established.[48][49]Medical conditionsOccasionally, an anxiety disorder may be a side-effect of an underlying endocrine disease that causes nervous system hyperactivity, such as pheochromocytoma[50][51]or hyperthyroidism.[52]StressAnxiety disorders can arise in response to life stresses such as financial worries or chronic physical illness. Anxiety among adolescents and young adults is common due to the stresses of social interaction, evaluation, and body image. Anxiety is also common among older people who have dementia. On the other hand, anxiety disorder is sometimes misdiagnosed among older adults when doctors misinterpret symptoms of a physical ailment (for instance, racing heartbeat due to cardiac arrhythmia) as signs of anxiety.[8]GeneticsGAD runs in families and is six times more common in the children of someone with the condition.[53]While anxiety arose as an adaptation, in modern times it is almost always thought of negatively in the context of anxiety disorders. People with these disorders have highly sensitive systems; hence, their systems tend to overreact to seemingly harmless stimuli. Sometimes anxiety disorders occur in those who have had traumatic youths, demonstrating an increased prevalence of anxiety when it appears a child will have a difficult future.[54]In these cases, the disorder arises as a way to predict that the individual’s environment will continue to pose threats.Persistence of anxietyAt a low level, anxiety is not a bad thing. In fact, the hormonal response to anxiety has evolved as a benefit, as it helps humans react to dangers. Researchers in evolutionary medicine believe this adaptation allows humans to realize there is a potential threat and to act accordingly in order to ensure greatest possibility of protection. It has actually been shown that those with low levels of anxiety have a greater risk of death than those with average levels. This is because the absence of fear can lead to injury or death.[54]Additionally, patients with both anxiety and depression were found to have lower morbidity than those with depression alone.[55]The functional significance of the symptoms associated with anxiety includes: greater alertness, quicker preparation for action, and reduced probability of missing threats.[55]In the wild, vulnerable individuals, for example those who are hurt or pregnant, have a lower threshold for anxiety response, making them more alert.[55]This demonstrates a lengthy evolutionary history of the anxiety response.Evolutionary mismatchIt has been theorized that high rates of anxiety are a reaction to how the social environment has changed from the Paleolithic era. For example, in the Stone Age there was greater skin-to-skin contact and more handling of babies by their mothers, both of which are strategies that reduce anxiety.[54]Additionally, there is greater interaction with strangers in present times as opposed to interactions solely between close-knit tribes. Researchers posit that the lack of constant social interaction, especially in the formative years, is a driving cause of high rates of anxiety.Many current cases are likely to have resulted from an evolutionary mismatch, which has been specifically termed a "psychopathogical mismatch". In evolutionary terms, a mismatch occurs when an individual possesses traits that were adapted for an environment that differs from the individual’s current environment. For example, even though an anxiety reaction may have been evolved to help with life-threatening situations, for highly sensitized individuals in Westernized cultures simply hearing bad news can elicit a strong reaction.[56]An evolutionary perspective may provide insight into alternatives to current clinical treatment methods for anxiety disorders. Simply knowing some anxiety is beneficial may alleviate some of the panic associated with mild conditions. Some researchers believe that, in theory, anxiety can be mediated by reducing a patient’s feeling of vulnerability and then changing their appraisal of the situation.[56]MechanismsBiologicalLow levels of GABA, a neurotransmitter that reduces activity in the central nervous system, contribute to anxiety. A number of anxiolytics achieve their effect by modulating the GABA receptors.[57][58][59]Selective serotonin reuptake inhibitors, the drugs most commonly used to treat depression, are frequently considered as a first line treatment for anxiety disorders.[60]AmygdalaThe amygdala is central to the processing of fear and anxiety, and its function may be disrupted in anxiety disorders.[61]Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal, and accessory basal nuclei). The basolateral complex processes sensory-related fear memories and communicates their threat importance to memory and sensory processing elsewhere in the brain, such as the medial prefrontal cortex and sensory cortices.Another important area is the adjacent central nucleus of the amygdala, which controls species-specific fear responses, via connections to the brainstem, hypothalamus, and cerebellum areas. In those with general anxiety disorder, these connections functionally seem to be less distinct, with greater gray matter in the central nucleus. Another difference is that the amygdala areas have decreased connectivity with the insula and cingulate areas that control general stimulus salience, while having greater connectivity with the parietal cortex and prefrontal cortex circuits that underlie executive functions.[61]The latter suggests a compensation strategy for dysfunctional amygdala processing of anxiety. Researchers have noted "Amygdalofrontoparietal coupling in generalized anxiety disorder patients may ... reflect the habitual engagement of a cognitive control system to regulate excessive anxiety."[61]This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.Clinical and animal studies suggest a correlation between anxiety disorders and difficulty in maintaining balance.[62][63][64][65]A possible mechanism is malfunction in the parabrachial area, a brain structure that, among other functions, coordinates signals from the amygdala with input concerning balance.[66]Anxiety processing in the basolateral amygdala has been implicated with dendritic arborization of the amygdaloid neurons. SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization. By overexpressing SK2 in the basolateral amygdala, anxiety in experimental animals can be reduced together with general levels of stress-induced corticosterone secretion.[67]DiagnosisAnxiety disorders are often severe chronic conditions, which can be present from an early age or begin suddenly after a triggering event. They are prone to flare up at times of high stress and are frequently accompanied by physiological symptoms such as headache, sweating, muscle spasms, tachycardia, palpitations, and hypertension, which in some cases lead to fatigue.In casual discourse the words "anxiety" and "fear" are often used interchangeably; in clinical usage, they have distinct meanings: "anxiety" is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas "fear" is an emotional and physiological response to a recognized external threat.[68]The term "anxiety disorder" includes fears (phobias) as well as anxieties.[medical citation needed]The diagnosis of anxiety disorders is difficult because there are no objective biomarkers, it is based on symptoms,[69]which typically need to be present at least six months, be more than would be expected for the situation, and decrease functioning.[2][3]Several generic anxiety questionnaires can be used to detect anxiety symptoms, such as the State-Trait Anxiety Inventory (STAI), the Generalized Anxiety Disorder 7 (GAD-7), the Beck Anxiety Inventory (BAI), the Zung Self-Rating Anxiety Scale, and the Taylor Manifest Anxiety Scale.[70]Other questionnaires combine anxiety and depression measurement, such as the Hamilton Anxiety Rating Scale, the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), and the Patient-Reported Outcomes Measurement Information System (PROMIS).[70]Examples of specific anxiety questionnaires include the Liebowitz Social Anxiety Scale (LSAS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Inventory (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30).[71]Anxiety disorders often occur along with other mental disorders, in particular depression, which may occur in as many as 60% of people with anxiety disorders. The fact that there is considerable overlap between symptoms of anxiety and depression, and that the same environmental triggers can provoke symptoms in either condition, may help to explain this high rate of comorbidity.[72]Studies have also indicated that anxiety disorders are more likely among those with family history of anxiety disorders, especially certain types.[73]Sexual dysfunction often accompanies anxiety disorders, although it is difficult to determine whether anxiety causes the sexual dysfunction or whether they arise from a common cause. The most common manifestations in individuals with anxiety disorder are avoidance of intercourse, premature ejaculation or erectile dysfunction among men and pain during intercourse among women. Sexual dysfunction is particularly common among people affected by panic disorder (who may fear that a panic attack will occur during sexual arousal) and posttraumatic stress disorder.[74]Differential diagnosisThe diagnosis of an anxiety disorder requires first ruling out an underlying medical cause.[5][68]Diseases that may present similar to an anxiety disorder, including certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia),[3][5][68][75]metabolic disorders (diabetes),[5][76]deficiency states (low levels of vitamin D, B2, B12, folic acid),[5]gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[77][78][79]heart diseases,[3][5]blood diseases (anemia),[5]and brain degenerative diseases (Parkinson's disease, dementia, multiple sclerosis, Huntington's disease).[5][80][81][82]Also, several drugs can cause or worsen anxiety, whether in intoxication, withdrawal, or from chronic use. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants.[3][83]PreventionFocus is increasing on prevention of anxiety disorders.[84]There is tentative evidence to support the use of cognitive behavior therapy[84]and mindfulness therapy.[85][86]As of 2013, there are no effective measures to prevent GAD in adults.[87]TreatmentTreatment options include lifestyle changes, therapy, and medications. There is no good evidence as to whether therapy or medication is more effective; the choice of which is up to the person with the anxiety disorder and most choose therapy first.[88]The other may be offered in addition to the first choice or if the first choice fails to relieve symptoms.[88]Lifestyle changesLifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking.[88]Stopping smoking has benefits in anxiety as large as or larger than those of medications.[89]TherapyCognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first line treatment.[88][90][91][92][93]CBT appears to be equally effective when carried out via the internet.[93]While evidence for mental health apps is promising it is preliminary.[94]Self-help books can contribute to the treatment of people with anxiety disorders.[95]Mindfulness based programs also appear to be effective for managing anxiety disorders.[96][97]It is unclear if meditation has an effect on anxiety and transcendental meditation appears to be no different than other types of meditation.[98]MedicationsMedications include SSRIs or SNRIs are first line choices for generalized anxiety disorder.[88][99]There is no good evidence for any member of the class being better than another, so cost often drives drug choice.[88][99]If they are effective, it is recommend that they be continued for at least a year.[100]Stopping these medications results in a greater risk of relapse.[101]Buspirone, quetiapine and pregabalin are second line treatments for people who do not respond to SSRIs or SNRIs; there is also evidence that benzodiazepines including diazepam and clonazepam are effective but have fallen out of favor due to the risk of dependence and abuse.[88]Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical disorders. Adherence problems are more likely among older people, who may have difficulty understanding, seeing, or remembering instructions.[8]In general medications are not seen as helpful in specific phobia but a benzodiazepine is sometimes used to help resolve acute episodes; as 2007 data were sparse for efficacy of any drug.[102]Alternative medicineMany other remedies have been used for anxiety disorder. These include kava, where the potential for benefit seems greater than that for harm with short-term use in those with mild to moderate anxiety.[103][104]The American Academy of Family Physicians (AAFP) recommends use of kava for those with mild to moderate anxiety disorders who are not using alcohol or taking other medicines metabolized by the liver, and who wish to use "natural" remedies.[105]Side effects of kava in the clinical trials were rare and mild.Inositol has been found to have modest effects in people with panic disorder or obsessive-compulsive disorder.[106]There is insufficient evidence to support the use of St. John's wort, valerian or passionflower.[106]Aromatherapy has shown some tentative benefits for anxiety reduction in people with cancer when done with massages, although it not clear whether it could just enhance the effect of massage itself.[107]ChildrenBoth therapy and a number of medications have been found to be useful for treating childhood anxiety disorders.[108]Therapy is generally preferred to medication.[109]Cognitive behavioral therapy (CBT) is a good first therapy approach.[109]Studies have gathered substantial evidence for treatments that are not CBT based as being effective forms of treatment, expanding treatment options for those who do not respond to CBT.[109]Like adults, children may undergo psychotherapy, cognitive-behavioral therapy, or counseling. Family therapy is a form of treatment in which the child meets with a therapist together with the primary guardians and siblings.[110]Each family member may attend individual therapy, but family therapy is typically a form of group therapy. Art and play therapy are also used. Art therapy is most commonly used when the child will not or cannot verbally communicate, due to trauma or a disability in which they are nonverbal. Participating in art activities allows the child to express what they otherwise may not be able to communicate to others.[111]In play therapy, the child is allowed to play however they please as a therapist observes them. The therapist may intercede from time to time with a question, comment, or suggestion. This is often most effective when the family of the child plays a role in the treatment.[110][112]If a medication option is warranted, antidepressants such as SSRIs and SNRIs can be effective.[108]Minor side effects with medications, however, are common.[108]PrognosisThe prognosis varies on the severity of each case and utilization of treatment for each individual.[113]If these children are left untreated, they face risks such as poor results at school, avoidance of important social activities, and substance abuse. Children who have an anxiety disorder are likely to have other disorders such as depression, eating disorders, attention deficit disorders both hyperactive and inattentive.EpidemiologyGlobally as of 2010 approximately 273 million (4.5% of the population) had an anxiety disorder.[114]It is more common in females (5.2%) than males (2.8%).[114]In Europe, Africa and Asia, lifetime rates of anxiety disorders are between 9 and 16%, and yearly rates are between 4 and 7%.[115]In the United States, the lifetime prevalence of anxiety disorders is about 29%[116]and between 11 and 18% of adults have the condition in a given year.[115]This difference is affected by the range of ways in which different cultures interpret anxiety symptoms and what they consider to be normative behavior.[117][118]In general, anxiety disorders represent the most prevalent psychiatric condition in the United States, outside of substance use disorder.[119]ChildrenLike adults, children can experience anxiety disorders; between 10 and 20 percent of all children will develop a full-fledged anxiety disorder prior to the age of 18,[120]making anxiety the most common mental health issue in young people. Anxiety disorders in children are often more challenging to identify than their adult counterparts owing to the difficulty many parents face in discerning them from normal childhood fears. Likewise, anxiety in children is sometimes misdiagnosed as an attention deficit disorder or, due to the tendency of children to interpret their emotions physically (as stomach aches, head aches, etc.), anxiety disorders may initially be confused with physical ailments.[121]Anxiety in children has a variety of causes; sometimes anxiety is rooted in biology, and may be a product of another existing condition, such as autism or Asperger's disorder.[122]Gifted children are also often more prone to excessive anxiety than non-gifted children.[123]Other cases of anxiety arise from the child having experienced a traumatic event of some kind, and in some cases, the cause of the child's anxiety cannot be pinpointed.[124]Anxiety in children tends to manifest along age-appropriate themes, such as fear of going to school (not related to bullying) or not performing well enough at school, fear of social rejection, fear of something happening to loved ones, etc. What separates disordered anxiety from normal childhood anxiety is the duration and intensity of the fears involved.[121]A small child will usually experience separation anxiety, for example, but he or she will generally grow out of it by about the age of 6, whereas in an anxious child it may linger for years longer, hindering the child's development.[125]Similarly, most children will fear the dark or losing their parents at some point, but this fear will dissipate over time without interfering a great deal in that child's normal day-to-day activities. In a child with an anxiety disorder, fearing the dark or loss of loved ones may grow into a lasting obsession which the child tries to deal with in compulsive ways which erode his or her quality of life.[125]The presence of co- occurring depressive symptoms in anxiety disorders may mark the transition to a more severe and detrimental and impairing disorder in preschool and early school age.[126]Children, similar to adults, may suffer from a range of different anxiety disorders, including:Generalized anxiety disorder: The child experiences persistent anxiety regarding a wide variety of situations, and this anxiety may adapt to fit each new situation that arises or be based largely on imagined situations which have yet to occur. Reassurance often has little effect.[121][125]Separation anxiety disorder: A child who is older than 6 or 7 who has an extremely difficult time being away from his or her parents may be experiencing Separation Anxiety Disorder. Children with this disorder often fear that they will lose their loved ones during times of absence. As such, they frequently refuse to attend school.[127]Social anxiety disorder should not be confused with shyness or introversion; shyness is frequently normal, especially in very young children. Children with social anxiety disorder often wish to engage in social activity (unlike introverts) but find themselves held back by obsessive fears of being disliked. They often convince themselves they have made a poor impression on others, regardless of evidence to the contrary. Over time, they may develop a phobia of social situations.[128]This disorder affects older children and preteens more often than younger children. Social phobia in children may also be caused by some traumatic event, such as not knowing an answer when called on in class.[129]While uncommon in children, OCD can occur. Rates are between two and four percent.[130]Like adults, children rely on "magical thinking" in order to allay their anxiety, i.e., he or she must perform certain rituals (often based in counting, organizing, cleaning, etc.) in order to "prevent" the calamity he or she feels is imminent. Unlike normal children, who can leave their magical thinking-based activities behind when called upon to do so, children with OCD are literally unable to cease engaging in these activities, regardless of the consequences.[125][131]Panic disorder is more common in older children, though younger children sometimes also suffer from it. Panic disorder is frequently mistaken for a physical illness by children suffering from it, likely due to its strongly physical symptoms (a racing heartbeat, sweating, dizziness, nausea, etc.) These symptoms are, however, usually accompanied by extreme fear, particularly the fear of dying. Like adults with Panic Disorder, children may attempt to avoid any situation they feel is a "trigger" for their attacks.[125]

I can only answer this question in relation to internet gaming disorder (IGD), which I researched around this time last year. The short answer is yes and no. There are medical and psychological treatments available, which work for some people, and the addition can be uprooted, but not for others. There is still insufficient body of research to categorically confirm or invalidate such claims. If you’re interested in IGD, I’ve pasted a synthesis paper I wrote last year.Can psychological theories explain why some people develop an internet gaming disorder (IGD) and others don’t? What implications do those theories have for reducing the harm associated with IDG?Online gaming addiction remains the subject of academic debate focusing on the condition’s prevalence and diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies Internet Gaming Disorder (IGD) as a provisional disorder due to insufficient clinical research (APA, 2013). Whilst a neurologically evidenced link between substance and behavioural addictions has been identified, more systematic investigation is required. This essay critically evaluates psychological theories that explain why some people remain at greater risk of developing IGD and discusses implications for reducing the harm associated with online gaming addiction. Behavioural, cognitive and social theories are applied to explore IGD’s internal and external risk factors.IGD belongs within a wider compulsive-impulsive spectrum of online computer disorders, alongside social networking, messaging and online pornography addiction (Kuss & Griffiths, 2012; Ferguson & Ceranoglu, 2013). The disorders are characterised by excessive use, which leads to lost sense of time; withdrawal, with feelings of tension, anger, guilt or depression; tolerance, with a need to increase the quality of gaming equipment or hours played; and negative repercussions, following social isolation and mental and physical exhaustion (Block, 2008).Excessive online gaming in itself is not a pathological behaviour. Many virtual hobbies are considered normal, even if initial excitement results in the loss of control, mood modification and longing for more of the same activity (Beranuy et al., 2013). Turner et al. (2012) give examples of previous generations’ preoccupations with comic books or television, which resulted in moral panics, yet did not develop into addictions. Decisively, it is the persistent nature of one’s inability to control the habit, despite the many associated problems, that makes internet gaming pathological (Lemmens et al., 2009).IGD’s pathological status is upheld when the syndrome model of addiction is applied and biochemical and neuronal factors are considered. First, IGD sufferers have the same genetic polymorphisms as alcohol addicts (Blum et al., 1990), cocaine addicts (Noble et al., 1993) and pathological gamblers (Comings et al., 1996). Second, Kalivas and Volkow (2005) demonstrated that brains of IGD addicts respond to rewards in exactly the same way as substance addicts’ brains. Brain functional imaging studies consistently show the same neurobiological mechanism behind urges and cravings in pathological gamers and substance addicts (Ko et al., 2009). Finally, the success of pharmacological treatment in alleviating IGD symptoms supports the disorder’s biochemical basis. Thus, substance and behavioural addictions might be one single addiction type with different opportunistic expressions.However, diagnostic analogies with substance addictions can produce spuriously high prevalence estimates, as they lack severity and time-based dimensions and do not consider the context of game use (Ferguson et al., 2011). In addition, pathological gamers usually have other underlying problems, combined with poor time management skills, which makes IGD appear as a symptom, rather than the cause of the problem (Wood, 2008). Finally, cultural differences exist between substance and behavioural addictions; whilst alcohol or drug addicts are aware of legal and social constraints on their usage, playing games is not likely to land someone in trouble (Christakis, 2010).Despite the problematic diagnostic criteria, certain demographic characteristics of IGD can be discerned. The mean age of UK and US gamers in 2004 was 27.9 years of age (Griffiths, Davies & Chappell, 2004) and 25 years of age in 2008 for Asian players (Yee, 2007). Gamers are usually male college graduates who live in urban areas (Achab et al., 2011). Although age in itself is not a risk factor, the age of onset of online gaming is, with earlier exposure increasing the IGD risk (Achab et al., 2011), particularly when already existing comorbidities can be identified. Kuss and Griffiths (2012) suggest that an IGD diagnosis process should start with screening for anxiety disorders, e.g. GAD, panic disorder and phobias; ADHD; and psychosomatic symptoms. This supports Huang et al.’s (2010) conviction that IGD meets diagnostic criteria for Axis I and II disorders, especially anxiety, ADHD and impulse control disorders, with additional correlation between pathological gaming and substance use disorders.However, overlapping diagnostic criteria create a risk of eliminating IGD, or explaining it purely in the light of existing labels (Young, 2009). For most people, computers are work and study tools, with occasional entertainment value; thus, clinicians diagnosing mental health disorders might fail to ask questions about computer use. Block (2008) reports that an average American mental health patient has 1.5 diagnoses, with 86% of all DSM-IV diagnoses comorbid with some form of internet addiction. As more than three quarters of mental health patients show some comorbidity with IGD, it is difficult to justify the status of IGD as a unique disorder.An important exemption, however, are attention disorders. Although Bioulac et al. (2008) found no relationship between frequency or duration of play between ADHD children and internet gamers, Yoo et al. (2004) demonstrated that teenagers with ADHD score highly on Internet addiction and vice versa. Significantly, Ferguson and Ceranoglu (2013) showed that in adolescents, pathological gaming is a result of attention difficulty, but not the other way round. Whilst those with impulse dysregulation difficulty find it easy to become immersed in video game play, pathological gamers do not typically develop impulse dysregulation as a consequence of their addiction. This shows IGD cannot be explained in the light of the attention disorder label.Similarly, lower psychosocial wellbeing and loneliness, risk factors for IGD, are due to a shift in social interactions from real to virtual life (Lemens et al., 2011). Positive correlations have been established between pathological gaming, social phobia and depression with somatic pain symptoms, although depression is typically specific to substance addictions (Walther et al., 2012). Likened to pathological gambling, online gaming is also described as “a silent epidemic” (Suisa, 2011, p.12), understood within the framework of sociocultural pathology that, nonetheless, must not be confused with mood disorders.A better way to explain IGD involves application of a theoretical framework based on combined behavioural, cognitive and social models, which present IGD as a continuum condition with risk factors acting as triggers relevant at any stage of online gaming development into a fully-brown addiction (Kuss & Griffiths, 2012). The specific risk factors can be broadly categorised into internal influences, e.g. personality traits, motivations for playing and pathophysiology factors; and external influences, e.g. structural game characteristics. The two main types of influences will be analysed in turn.A range of personality traits associated with IGD can be subsumed under three main traits: introversion, neuroticism and impulsivity (Kuss & Griffiths, 2012). Not unique to IGD, their etiological value is difficult to assess, especially, as the causality direction is not clear and a third variable might be at play, e.g. increased health-risk behaviours (Sublette & Mullan, 2012). In addition, experimentation with parts of one’s core personality leads to skewed personality tests’ results, e.g. after an introverted neurotic individual with emotional problems and low self-worth had successfully adopted vocal leadership roles in a game and their new identity’s personality comes to life during completion of a study questionnaire (Yee, 2007).Examples of the causality direction difficulty are studies into pathological gaming and aggressiveness and impulsivity. A broad link between IGD and aggressiveness was suggested by Anderson and Bushman (2001) without specifying the causality direction, or explaining the mechanisms involved. It was speculated that aggressive individuals are attracted to internet games to release negative emotions and to gain control over impulsivity. Later on, Desai et al. (2010) found positive correlation between teenage IGD and participation in fights, alongside regular cigarette smoking, drug use, and depression. It would appear that aggression in gaming does play a normative function.Chumbley and Griffiths (2006) demonstrated that impulsivity does not predict nor lead to gaming addiction and, if it does, another contributing factor is responsible. More recently, Kim et al. (2008), Grant et al. (2010) and Mehroof and Griffiths (2010) documented that impulsivity and aggression are significantly associated with IGD, and any additional factor would be of phenomenological nature, i.e. to do with intentionality of the gaming experience, rather than its compulsivity.In a study by Walther et al. (2012) that looked at shared personality traits between gaming addiction, gambling addiction and substance abuse, aggression and irritability were only associated with problematic computer gaming, whilst high impulsivity with both substance and behavioural addictions. Shared personality traits are only one way of explaining etiology of gaming addiction. Scales used to measure addiction, substance-based and behavioural, are not without internal validity problems, as some only relate to substance use, or behaviour dependency.Another internal risk factor for IGD is motivation for playing, particularly if dysfunctional coping, socialisation and personal satisfaction reasons are considered. Escape from reality in order to cope with negative emotions is the most common incentive (Hussain & Griffiths, 2009). Escapism is positively correlated with the motivation of mechanics, i.e. high investment of time and energy to play as best as one can. Mechanics accurately predicts IGD development, alongside occupational and social problems due to wasted time (Kuss et al., 2012). Beranuy et al. (2013) show how escapism can end in dissociation and the gamer’s inability to sustain relationships with individuals other than virtual ones. Dissociation also serves as a motivational factor to continue gaming (Caplan et al., 2009). Thus, entertainment and playfulness value of early online gaming experience cannot be underestimated.Motivations behind pathological gaming can also be conceptualised using the Theory of Planned Behaviour (TPB). Behaviour is determined by intention, a function of attitude, subjective norm (SN) and perceived behavioural control (PBC) (Ajzen, 1991). Haagsma et al. (2013) undertook a six-month longitudinal study and found that PBC, i.e. one’s perception of the level of difficulty involved in stopping gaming, had the highest predicting power of IGD. Those who had positive attitudes towards gaming and low PBC reported an intention to continue excessive gaming. The SN, i.e. perceived expectations of others, only played a role in initial stages of addiction. These findings have practical implications for treatment, as the TPB can be used as a screening tool to determine excessive gamers’ intentions for future behaviour, before it becomes pathological.Little research exists into genetic predisposition to IGD. However, Grant et al. (2010) found that pathological internet users, including internet gamers, show higher frequencies of the long arm allele of the serotonin transporter gene 5HTTLPR. They explained their findings in terms of associated greater harm avoidance, i.e. excessive shyness, pessimism and fearfulness, linked to escapism in IGD. Caplan et al. (2009) demonstrated that poor social skills, introversion, shyness and social anxiety are positively correlated with IGD.In contrast to genetics, pathophysiology, i.e. the correlation between gaming addiction and physical changes in the brain, explains IGD risk factors more confidently. fMRI studies reveal the same brain activation processes in substance and behavioural addicts, including pathological gamers and gamblers. Significantly greater neural activation takes place in the left occipital lobe, parahippocampal gyrus, dorsolateral prefrontal cortex, nucleus accumbens, right orbitofrontal cortex, bilateral anterior cingulate, medial frontal cortex, and the caudate nucleus (Ko et al., 2009; Kuss & Griffiths, 2012). Ko et al. (2009) concluded that the urge in IGD and craving in substance dependence share the same neurobiological mechanism. Similarly, Han et al. (2007) reported higher occurrence of two polymorphisms in the dopaminergic system, the area linked to substance addictions.The specific neural activations in the brain cannot be denied potential etiological status; they show that risk factors can be physiological and biochemical in nature, not simply psychosocial. However, to date, it has not been established whether the changes in the brain are specific to IGD, substance addictions, or any activity that results in arousal. Furthermore, pathophysiological findings do not specify whether the changes are causes or effects of IGD.The second category of IGD risk factors are external influences. The highly addictive nature of internet games is due to their construction features that reinforce playing (Kuss & Griffiths, 2012). Offline games lack such structures, e.g. virtual alter-egos (avatars), superior to real-life physical characteristics and characters, adult content, finding rare items located in different online ‘worlds’, and watching games’ cut scenes (Lee & Shin, 2004). Playing online with others is a highly reinforcing activity. Positive reinforcement results in game perseverance, whilst negative reinforcement leads to frustration (Chumbley & Griffiths, 2006).The application of variable ratio reinforcement schedules (Skinner, 1953) gives strongest habitual and repetitive behaviour. Pathological gamers continue responding, even when immediate reinforcement is not offered, hoping that another reward is close-by – the effect of intermittent reinforcement schedules, as part of the partial reinforcement effect theory by Skinner, which particularly affects younger players (Wood, 2008) due to the reinforcing nature of newly found feelings of excitement (Solomon & Corbit, 1974). Behavioural addition can be better understood when the Hedonic Management Model of Addiction (HMMA) is applied (Brown, 1991). Arousal and mood are manipulated using specific activities to achieve pleasure, i.e. good hedonic tone. Addiction is a result of powerful manipulation of the hedonic tone to achieve euphoria. Although the HMMA explains the complex behavioural changes associated with addiction, the theory lacks empirical evidence and fails to explain why gamers might return to addiction after a long period of abstinence.A game genre is a better predictor of the extent of pathological gaming. Fantasy-themed Massively Multiplayer Online Role-Playing Games (MMORPGs), e.g. World of Warcraft or Skyrim, are especially problematic, as they require substantial personal commitment and time investment at the expense of work- or study-related activities (Kuss et al., 2012). Elliott et al. (2012) identified the following addictive elements of MMORPG games: never-ending nature; desirable items to collect and trade; social organisation of in-game groups, with notions of belonging and obligation; and membership based on monthly subscription that encourages excessive playing to secure best value for money. The elements powerfully resonate with Skinner’s reinforcement effect theory.Beranuy et al. (2013) explain why MMORPGs are more addictive than violent first-person shooter (FPS) games, e.g. Call of Duty, or Halo. The FPSs provide entertainment and temporary dissociation, but not more permanent escapism by means of virtual friendships. Through avatars, players interact, cooperate and compete in the game, which facilitates dissociation with real life and online identity formation (Smahel et al., 2008). MMORPG addiction is associated with gradually increased playing time, a loss of control over the behaviour and a narrow focus. The consequences resemble those in substance addictions: salience, mood modification via negative reinforcement, cravings and resultant serious adverse effects. Tolerance and relapse can additionally be present.Caplan’s (2005) Social Skill Model is particularly useful in making predictions about one’s pathological MMORPG gaming behaviour. Poor self-presentational skills result in preference of online interactions over face-to-face communication. Secondly, a media attendance model by Bandura’s (1986) Social Cognitive Theory allows analysis of uses and gratifications in IGD. LaRose and Easton (2002) applied the model and found that media exposure can be predicted from media gratification and that gratification goes beyond entertainment or ‘pass time’ factor. Habit, deficient self-regulation and internet self-efficacy are new gratification dimensions, previously overlooked by researchers.In 2006, 1.2 million South Korean children aged 6-19 were identified by the Korean government as being at risk of gaming addiction, with 80% needing psychotropic medication (Block, 2008). Lee and Shin (2004) refer to IGD in children as deviant behaviour understood in terms of the Self-Control Theory (Vazsonyi & Belliston, 2007). High pressure to achieve at school leaves Korean children stressed and can result in addictive avatar consumption. Parental socialisation is partly to blame, as early inability to satisfy the parents’ expectations of high grades in competitive schools frees children from social control. Once the forces of social control seize to operate, stressed Korean children escape to the virtual world, where their efforts and work pay off, where they find emotional fulfilment and where conformity becomes irrelevant (Vazsonyi & Belliston, 2007).Finally, the style of engagement in video gaming accurately predicts one’s risk of IGD. Using the Self-Determination Theory and the Dualistic Model of Passion, Przybylski et al. (2009) distinguished between harmonious vs. obsessive engagement in gaming. High levels of basic psychological need satisfaction lead to harmonious engagement, where the individual wants to play, whilst low levels foster obsessive passion and a feeling of having to play, which turns into addiction.Few studies have looked at pathological gamers in treatment (Beranuy et al., 2013). Application of pharmacological treatment follows reasoning that, as fMRI studies show the same neurobiological mechanism in pathological gaming and substance dependence (Ko et al., 2009; Huang et al., 2010), then pharmacology used in substance addiction treatment should be equally effective in IGD. For example, bupoprion used for treating drug abuse was shown to be effective in decreasing cravings and cue induced brain activity in pathological gamers (Han et al., 2011).Additional evidence comes from studies into the selective serotonin reuptake inhibitors and naltrexone in pathological gambling (Hung, et al., 2010). Grant et al. (2010) investigated the role of a mu opioid receptor antagonist used in treatment of alcoholism and opioid dependence in treatment of pathological gambling and internet addiction. Results of their study show promise for treatment of both behavioural addictions that share the same pattern of modulation of the dopaminergic mesolimbic pathway, whilst the very pathways were not found in sufferers of obsessive-compulsive disorder (Grant et al., 2010).As many IGD sufferers present Axis I and II disorders that need pharmacologic treatment, the goal is to optimise existing treatment whilst considering the additional symptoms of gaming addiction. Sattar and Ramaswamy (2004) studied an IGD patient who, after three months of receiving 30mg of escitalopram for anxiety and depression, stopped having urges to play online. Similarly, methylphenidate (MPH) appears to be effective in treatment of ADHD and IGD; Huang et al. (2010) reported significant reduction in impulsivity and cravings for excessive playing after 8 weeks of MPH treatment.Non-pharmacological treatment screening is based on the DSM symptoms checklist for substance dependence (Achab et al., 2011) followed by behavioural (BT) and cognitive-behavioural therapies (CBT) or online support groups (Griffiths & Meredith, 2009). CBT has been shown effective in treating compulsive disorders, substance abuse and emotional disorders (Young, 2009). Patients learn how to moderate and control their use of the internet, then use of games (behavioural stage) and how to address maladaptive thoughts (cognitive stage), e.g. distortions “Just a few minutes won’t hurt” (Young, 2007). CBT can be effective after only 8 weeks of treating IGD, where six-month follow-ups show sustained ability to control behaviour and cognitions management (Young, 2007; Du et al., 2010).Less research is available on the effects of psychoanalysis, gestalt or group counselling. Traditional substance addiction treatments combine the pharmacological and non-pharmacological approaches to maximise effects. However, Gooding and Tarrier (2009) call for more systematic review and meta-analyses of all types of interventions to avoid generalising of behavioural addictions’ treatment based on assumed links to substance addictions.An equally pressing matter is prevention of IGD. Despite calls to educate children with pre-existing psychosocial morbidities, Kim (2007) showed that, whilst prevention programmes in schools increase knowledge about online gaming, they do not result in a significant self-control change. This contradicts theoretical premises of the Self-Control and Self-Regulation models, which place IGD within a wider socio-cultural context. As the motivation to decrease playing must come from within the child, the behavioural theories appear more relevant.In summary, whilst internal and external risks are equally important in IGD development, psychological theories tend to explain them in isolation. Although online gaming addiction appears to be firmly fixed within the urban sociocultural context, social theories alone are insufficient in making predictions about one’s pathological gaming behaviour. In contrast, combined behavioural and cognitive approaches originating in Skinner’s and Bandura’s theoretical work show promise for treatment and prevention of IGD, with CBT remaining the most effective treatment for IGD at present.ReferencesAchab, S., Nicolier, M., Mauny, F., Monnin, J., Trojak, B., Vandel, P., Sechter, D., Gorwood, P., & Haffen, E. (2011). Massively multiplayer online role-playing games: comparing characteristics of addict vs. non-addict online recruited gamers in a French adult population. 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