ocd – Page 2 – Effects of Anxiety

What It’s Like To Live With Chronic Anxiety

Writer and journalist Sarah Wilson knows anxiety. She was 12 when she was first diagnosed with childhood anxiety. In the more than three decades since, she has been diagnosed with insomnia, bulimia, obsessive-compulsive disorder, depression, hypomania, and bipolar disorder. All of which, as she writes in her memoir about her journey through anxiety, First, We Make The Beast Beautiful, are “just different flavors” of the same thing.Anxiety is one of the most common mental health disorders in the United States, affecting about 18% of the population each year. Wilson shares with the Cut in the video above how the condition has profoundly affected her life, and how she has managed to make it, as she says, “beautiful.”Buy FIRST, WE MAKE THE BEAST BEAUTIFUL here: https://www.amazon.com/First-We-Make-Beast-Beautiful/dp/0062836781/ref=sr_1_1?ie=UTF8&qid=1544111959&sr=8-1&keywords=first+we+make+the+beast+beautiful+book

OCD and Anxiety Disorders: Crash Course Psychology #29

Want more videos about psychology every Monday and Thursday? Check out our sister channel SciShow Psych at https://www.youtube.com/scishowpsych!***Ever call someone OCD because they like to have a clean apartment? Ever tell someone you have a phobia of spiders when, in fact, they just creep you out a little? In this episode of Crash Course psychology, Hank talks about OCD and Anxiety Disorders in the hope we’ll understand what people with actual OCD have to deal with as well as how torturous Anxiety Disorders and Panic Attacks can actually be. — Table of Contents:What Defines an Anxiety Disorder 01:55:20 Symptoms of Obsessive Compulsive Disorder 02:35:07 Generalized Anxiety Disorder 04:05:18 Panic Disorder and Phobias 04:47:20 The Learning Perspective 07:38:20 The Biological Perspective 09:13:14 Don’t Use OCD as a Punch Line 00:00:00— Want to find Crash Course elsewhere on the internet? Facebook – http://www.facebook.com/YouTubeCrashCourse Twitter – http://www.twitter.com/TheCrashCourse Tumblr – http://thecrashcourse.tumblr.com Support CrashCourse on Subbable: http://subbable.com/crashcourse

VA Disability Benefits for Anxiety

Okay. And Alyse, what are some common symptoms that characterize these anxiety disorders? Sure So there's some of those like invisible symptoms like excessive worry or difficulty concentrating but then there's also symptoms that physically manifest so you can Feel jumpy or you might be dizzy, have difficulty sleeping have mental have muscle tension feel nauseous or even lightheaded. So these are all manifestations of an underlying anxiety condition and I think that it's really important. I think a lot of times veterans Think that they can only give service-connected for PTSD because I think that you know often PTSD is goes in hand-in-hand with a lot of experiences the veterans experience in service but Even though anxiety disorders are a little bit different if you go to your doctor, and they don't diagnose you with PTSD But they do diagnose you with any of these symptoms or any of the anxiety disorders that Nick mentioned And you can still claim service-connection for that specific condition. So What do veterans need in order to show service connection for this condition? So the first and most important thing that you want to be able to demonstrate is in service incurrence And that can take a number of different forms either the veterans specifically treats for and is diagnosed with an anxiety disorder in service They might just check that they were experiencing depression or excessive worry on their discharge Examination or there might have been some specific incident that they remember that caused their anxiety, and it's continued to persist since then You don't need to be diagnosed with anxiety.

Sure. Okay, you just have to have some sort of notation. Alyse, what else? What after an in-service occurrence, what else do you need? First thing that you need is a Nexus so, that's what's gonna Connect both your in service condition to what's going on with you now Typically that's gonna require some type of medical opinion because lay persons are not competent typically to make that connection so It's a medical opinion Usually that's gonna draw that nexus. And we have a Facebook live All about what you need to show all three elements of service connection, so we'll link that In our notes, and if you want more information just on general service connection. You can check us out there So Alyse you had mentioned that you need a nexus and that generally requires an examination or medical determination so, how do C&P exams which is what we also call them which stands for compensation and pension exam How do those work in relation to anxiety conditions? What would happen in a service connection for anxiety claim? Sure So typically with a C&P exam you're going to be meeting with a VA physician Who it's gonna be somebody that you've never met before most likely they will ask you about your experiences during service They'll also ask you about experiences that you have now.

They may also ask you about Any medical history any family medical history It's gonna be a lot of questions that are all gonna be what they're gonna use to Support an opinion on as to whether what's what you have now is related to service or not So it's gonna be a lot of those background questions family medical questions And they'll also ask you about what your current symptoms are. Mm-hmm And I think we also have a Facebook live all about C&P examinations Which has a lot of great information kind of explaining what's gonna happen in these exams and what you should and shouldn't you do. I think the biggest thing is you have to always show up for your examinations and then if you get an unfavorable opinion Nick, what are some remedies that the veteran can pursue? Sure Well oftentimes a veteran won't necessarily know that the opinion was negative until they get the next decision from VA denying their claim so first and foremost They need to make sure that they're requesting a copy of their VA examination which they're entitled to do And then once they have the exam they should go through it at length making sure to identify any specific problems that they noticed or things that they think Conflict with other evidence they've submitted before one of the things that VA examiner's are supposed to do is review the claims file and make sure that they're looking at Everything the veterans submitted including lay evidence and then considering all of those things in light of the examination itself Great.

Um, I think you know the one important thing that I heard you saying that is lay evidence So, you know, we've talked about medical evidence and why we need that usually for a nexus But can you talk a little bit about what other kind of evidence including lay evidence You might need to support a claim for anxiety? Sure lay evidence is often one of the things we go to most often if only because a lot of the time veterans don't feel comfortable seeking treatment for their condition during service or even afterward because it's something that you know, It's kind of stigmatized and people don't necessarily like to talk about it so it could be many years before they actually go get to the point where they feel they need to seek treatment and Lay evidence from the veteran him or herself and all their family members can help fill in some of those gaps But whenever possible it's also a good idea to submit treatment information from either your VA doctors or any private psychologists that you see.

So Let's kind of take a step back and talk about The Appeals Modernization Act. So we have a whole Facebook live on the AMA as we call it essentially back in February VA totally revamped their appeal system and so now There are several different Avenues that a veteran can pursue after they receive a unfavorable rating decision. So if A veteran, you know wants to file an appeal. What should they kind of know about the AMA? After they receive a rating decision from VA? Sure So the most important thing is that if their claim was previously denied and they're filing a supplemental claim Which is one of the new options under the appeals modernization system. They need to make sure that they're submitting new and relevant evidence That's meant to be a relatively relaxed evidentiary standard So it could be something as simple as providing a lay statement talking about how their symptoms are related to service Um, it could be submitting medical evidence establishing that they have a current diagnosis.

But whatever it is, it needs to be something that is relevant to their claim And then they can also pursue taking their case to the board with or without submitting additional evidence if they really do think That it's a situation where the regional office is just getting it wrong. But all of those options are still available to them They just need to be conscious of the 1-year time frames. Great. Yeah, I think You know, the AMA is a pretty new system and it's pretty complicated Although it is supposed to provide veterans with more choices, and it's supposed to clarify a lot of things I think it's still unclear kind of how it's going to work for veterans so we would really encourage you if you're seeking to initiate an appeal under the AMA to Consult your veteran service organization or an attorney. Someone who has some expertise in this area of law And as I mentioned, we'll link some more information to the AMA in the case notes or in the in the comments below so we're talking about service connection and we mentioned in-service incurrence a Nexus and a current, you know disability What if a veteran doesn't have an in-service occurrence can the veteran get service connection another way Alyse? Yes.

So an alternative way to get service connection is called secondary service connection This happens when you have an already service-connected disability, that is either causing or aggravating Your anxiety or a second condition So say that you have just for example you have a knee condition and your knee condition causes you a lot of pain and It makes you anxious to to get out of bed. It makes you anxious to walk down the street or to walk to work You could potentially show that you have secondary service connection for your anxiety because your knee conditions already service-connected whether it's either causing or Aggravating an already, you know existing anxiety condition Yeah, I think that anxiety is something that a lot of veterans probably have secondary to their service connected disabilities, especially physical disabilities I think In your example for example If the veteran had a lot of instability in their knee and they were never sure whether or not they were gonna fall You know I can imagine that causing a lot of anxiety And so just the same way that you would need a nexus opinion for direct service connection You would still want to get a doctor to make an opinion about whether or not that knee causes or aggravates anxiety.

Really good So let's assume that a veteran has received service connection, you know, they've met that first threshold Either secondary or direct. Let's talk about how VA rates anxiety. So Let's take a step back a little bit and talk about kind of how VA rates things in general and I think that we do Have some information on that in our past Facebook lives Alyse you want to talk a little bit about what Diagnostic codes are? And what the diagnostic code for anxiety is? Sure So if you think about the diagnostic code the best way think of it is it's this rubric Where they where the VA has established certain Disabilities and under those disabilities are certain rubrics.

If you meet certain criteria under the rubric then you're granted You should be granted or certain rating specifically anxiety is rated under the general formula for medical or mental rather disorders So that's gonna also include other Mental disorders which could be schizophrenia. It could also be PTSD the very many different types of anxiety there are and probably any other type of Mental condition that you can think of are all rated under the same Diagnostic code that's going to be diagnostic 4.130 That diagnostic code goes up to 100% It starts at a non-compensable rating of 0% And it lists specific symptoms and overall functional impairment that you would have to meet to Get a specific rating So Nick, Alyse mentioned that kind of several different Psychiatric conditions are all rated under this one general formula. So what Happens if the veteran has for example, both anxiety and PTSD or anxiety and depression? Does that affect your rating at all? Sure, so like Alyse mentioned, you know, even though individual psychiatric conditions do have their own diagnostic codes they're all rated under this general formula and Because of that and because they're all rated based off of the same criteria of factoring it in the same symptoms You're not going to receive separate ratings for each individual mental health condition.

They're going to figure out which symptoms are imposed by each of those conditions and then give you one overall rating using the general formula. Good and I think it's important to kind of keep that in mind when you're looking at your rating code sheet, you know, every rating decision comes with the code sheet that lists out all of your disabilities and over the course of your life and your different appeals your rating for your psych condition can change and the Characterization of your psych condition can change based on what VA determines– kind of what the diagnosis you have so for example you know veterans who were service-connected a long time ago for psychiatric conditions might be originally rated under something called like a nervous condition and then as you know medical information has kind of evolved that could get re-characterized as PTSD or anxiety and then sometimes You know a veteran could be service connected for one thing and then later on claim service connection for another psychiatric condition As Nick said you're not gonna get a separate rating for that second condition But they might recharacterize what it's called on your code sheet and so that's important to keep in mind and just to make sure that you know, if There are symptoms that weren't originally Compensated under your original characterization, but you feel are now Encompassed in that in that characterization you might want to make a claim for an increase rating.

So, you know Alyse you mentioned the different possible rating levels and you mentioned that The diagnostic code and the rating formula provides different symptoms and different criteria that you need to meet in order to get to a higher rating so Do veterans have to meet every single criteria in that rating in order to get to the higher rating? No. So technically you don't even have to meet a single one of the criteria What you have to do is show that your functional loss is similar and what's called severity frequency and duration To the type of symptoms and functional loss listed in this diagnostic code.

So if you receive a board decision that says, "The veteran is not entitled to a higher rating because he does because although he has certain symptoms in the seventy Criteria, he does not have them all that would be error" You don't have to meet all of their criteria What you have to do is show that your functional loss is overall similar in severity duration and frequency To these types of symptoms that they're listing it's a list.

It's a non exhaustive list and it's really just supposed to be examples And there are two cases that kind of go to that point about this, Claudio and Mauer. Yes, so For those of you who kind of want to take a little deeper into the case law The court has made clear that these symptoms are not required. So Nick what happens if a veteran's condition is so severe that they actually have to get hospitalized? Sure so periods of Hospitalization are considered to be totally disabling So in a situation where a veteran's hospitalized due to their mental health disability for more than 21 days They're entitled to a 100% rating for the period of the hospitalization But if the veteran is hospitalized for an extended stay of more than six months They're not only assigned the 100% rating for the entire length of the hospitalization But as well as six additional months after the date of their discharge I think that makes sense.

If you think about how VA rates disabilities and that the ratings are supposed to be based on Impairment in earning capacity. So obviously if a veteran is hospitalized they can't be working and so, you know It's really important if you do get hospitalized you want to make sure that you Tell VA and make sure the VA is appropriately compensating you so that's really important to keep that in mind and then you know I think that a lot of times when the veterans are going to seek treatment or they're seeking a VA examination They get something called GAF scores GAF So Alyse, do you want to talk about a little bit about GAF scores and whether or not they're even still relevant or what? What's going on with GAFscores? Sure so a GAF score is a somewhat or outdated way that Practitioners used to measure how severe a person's psychiatric disorder was it is from a previous version of the DSM a VA has since come out with a court decision called golden which says that those GAF scores are No longer in the dsm-5 and therefore they're they're outdated and they shouldn't be used by the board So in some circumstances, you might still see them mentioned your board decisions But the board really shouldn't be relying on them to deny you a higher rating Yeah, and if you see the board talk about gaps scores in relation to what rating you should be receiving That should be a red flag and and you can talk to you know An attorney or a VSO about potentially appealing that decision to the board Or to the court, excuse me, And Alyse mentioned the DSM.

So the DSM stands for Diagnostic Statistical Manual it's the manual that all Mental health professionals use in diagnosing mental health conditions. So we have a question from Stephen can you explain the difference between occupational and social impairment with reduced reliability and productivity and occupational and social impairment with deficiencies in most areas So these are the criteria for the 50 and the 70% ratings and this is actually an excellent question so. I'm smiling stephen Because it is a very good question and it's one that the board has not yet answered for us Yeah the court or the court, rather.

So They haven't provided exact definitions of what those things mean But if you look to the diagnostic code, you can try and get a sense of what types of symptoms fall under each of those But unfortunately they don't have like, a You know a straight answer for you because the court and the board– VA have not defined it further than what we already see In the code, you can look at some of the symptoms for example in the 50% What is contemplated by occupational and social impairment with reduced reliability and productivity include flattened effect Panic attacks more than once a week impaired judgment impaired abstract thinking difficulty in establishing and maintaining social Relationships in the step higher you're seeing it involve more areas of your life Other than just the occupation and some of your relationships.

You're also seeing suicidal ideation obsessive rituals Near-continuous panic rather than panic attacks once a week. You're seeing an inability to establish and maintain Effective relationships now what we were saying before you do not need to show all of these symptoms It's just meant to be a list of examples to give you an idea of what that level of functional loss is. Precisely Become the different ratings are so vague. Right. What is the difference between reduce reduced reliability and Deficiencies in most areas? And so you use the symptoms in order to kind of parse that out but as Alyse said, you know, the court hasn't really given us a lot of guidance on this and that results in a lot of wildly, inconsistent board decisions And that's –sorry Nope, go ahead. That's what makes the board's Requirement to provide adequate reasons and bases so important because they don't have a strict definition of what these things mean They're really supposed to be properly explaining to you As the veteran why you're not entitled to a higher rating With what we call adequate reasons and basis.

Yeah and it's especially important in the Context of anxiety disorders because often times it's the type of mental health illness that might only really manifest itself in two or three specific Symptoms where it's the overwhelming anxiety and frequent panic attacks that are causing you to be unable to function in these areas But because VA tends to rely on the number of symptoms that you have rather than how severe they are It can get complicated especially when they're not really Defining the concepts that they're using. Right, sure that goes back to what Alyse was saying about It's really focusing on the frequency severity and duration of these symptoms And so if you see VA kind of using this rating criteria as a checklist that should you know You know raise a red flag that it's probably not a very good decision and that you could potentially appeal it yeah, I think that's a really good point Nick, especially because we are talking about anxiety, which is not a condition that Typically actually manifests itself into a lot of the symptoms that you see in the highest 100% rating like hallucination But if you for example have such severe agoraphobia that you can't leave your house or can't leave your room Then you might have total occupational social impairment.

So even though a Agoraphobia isn't a symptom listed under the 100% the overall functional loss might be enough to get you there. Mm-hmm so it's a really great question and I think it's just it really highlights why this area of law is so Unclear and why it's important to You know consult with your VSO or consult with an attorney because they can kind of navigate this and figure out what the best solution or argument to make in your case is. Great so We talked about GAF scores And the DSM, so I think the next thing that we want to talk about is what happens if a mental health condition Overlaps a non psychiatric condition Nick. Do you want to talk about that? I mean It's a concept we talk about a lot called pyramiding and I think we have our own Facebook live sessions on that topic So, please refer to that if you have any more detailed questions but the basic idea is that VA is only going to compensate each symptom that a veteran experiences once so if the veteran Experiences or suffers from an orthopedic disability that causes sleep impairment and then a psychiatric disability that causes sleep impairment They're gonna generally rate that symptom under one of those diagnostic codes one of those conditions and then not rate it under the other one just to make sure that they're not overcompensating the veteran for the symptom.

Then I think that the kind of reverse of that is what Alyse was mentioning earlier as if your psychiatric condition results in non psychiatric symptoms then you can potentially get It's like the opposite of pyramiding it's when pyramiding isn't a problem is when there are distinct manifestations of Your condition and you can get separate ratings for that. So, um, we talked a little bit about this in terms of total occupational and social impairment But what happens if a veteran's anxiety prevents them from working? Sure, so there is an avenue to receive a 100% rating called tdiu this is what you may be entitled for if your Disabilities could be your anxiety alone or your anxiety combined with all of your other service-connected disabilities prevent you from obtaining securing what's called substantial gainful employment So this is actually a lower standard than total occupational impairment substantially gainful employment is another one of those terms that we're working on having, you know, getting a really good definition for But basically it is something that is more than just a marginal employment something that is more than what we call protected work environment and If somebody if somebody's anxiety or somebody's anxiety combined with their other disabilities prevent them from really obtaining Secure employment then they might be entitled to to TDIU we have Absolutely have a lot of information on their website about tdiu.

That is a very large area of veterans law But it so if you have any questions about that Absolutely advise you to look at our website as well as well our other– I'm sure there's a Facebook you're live on that as well. Definitely So what other kinds of evidence? Should veterans be kind of collecting and submitting in order to support their increased rating claims, Nick? we've mentioned it a few times in the context of service connection, but it applies equally well to Increased ratings and that's lay evidence Obviously the veteran will only see their treating provider or a VA doctor every so often There are going to be months or even years where they don't seek treatment But the people who know them who live with them who experience their symptoms on the day to day basis are often in the best Position to provide a description of you know, what those symptoms are and how they affect them I'm so getting statements from yourself getting statements from family members can go a long way And I think you know one of the most common mistakes I see in that situation is at the board or VA Provides or assigned more value to those treatment records as opposed to the lay statements and as Nick said I think it's really important to kind of highlight that they are both equally valuable and that they are probably complementary in most situations so even though a veteran You know might go to treatment and might not be super-severe on that one day he goes to treatment if he has all these lay statements filling in the gaps between treatment you can kind of get a bigger picture so That's kind of one of the more common mistakes that I see VA making Just to kind of wrap things up Do you guys have any other? thoughts on common mistakes VA makes in adjudicating anxiety claims or things that you think letter and should remember when they're making these claims? One thing actually it's along the lines of lay statements if you are submitting lay statements and this is kind of a new one Make sure that what you're submitting is legible because you'll want to make it easy for VA to agree with you So if they can't really read your handwriting then it's very difficult for them to understand what symptoms or what your story is.

So I just suggest whether you're typing it or in very neat handwriting lay statements should be Legible easy to understand make it easy for them to want to give you an increased rating. That's really good advice It's better for us too Another common example we see in the case of service connection is VA improperly requiring a verified stressor Which is something that's only really in place for post-traumatic stress disorder So most veterans are probably most familiar with PTSD.

So that tends to be the condition that they claim But VA is supposed to construe that Claim broadly and liberally so the veteran might end up being diagnosed with a different mental health disability But because they claimed PTSD initially VA will often get stuck on trying to adjudicate the claim at way But at the end of the day like we talked about before it's really just all about establishing Anxiety in service or reports of anxiety and then symptoms afterward. That's really good Great. Um Thank you for joining us today.

We will be back next week and we hope that you check out all the information we provided.

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Guided Imagery for School Anxiety-Social Anxiety Treatment-Anxiety Skills #15

Hi, I’m Emma McAdam, a licensed therapist, in this little Nugget of Help we’re going to apply some tools from adoption and commitment regiman to help with school and social anxiety. This activity is meant to help build an increased ability to face anxiety eliciting status like institution or social locates The purpose of this activity is not relaxation but resilience meaning the ability to experience uncomfortable perceptions with strong empathy and pacify. So during this activity You may feel a couple of spirits, some comfortable and some unpleasant Please stick with the activity through the end and I predict you’ll develop a greater ability to experience your excitements without them limiting you So first check in with yourself, a be engaged in a comfortable locate close your eyes and Take a depth breath Let it out gradually Take a moment and notice your feet wiggle them Now, press them against the floor.Just feel what the flooring feels like pressing back up against your feet Now move your awareness up your legs clench your calves and then soften those muscles Then clench the big-hearted muscles in your thighs for a moment Now relax them and breathe in and breathe out Now move your awareness up to your belly You may feel some hostility here and that’s okay Pretend you’re scientist who has never noticed what that feeling is like Explore that feeling in your stomach and describe it in your psyche. What does it definitely sounds like? Allow it happening there while clenching your stomach muscles as tightly as you can Now breathe out and then take a big inhale Expand your stomach out as far as it becomes Hold that gulp and notice what that feels like Let that air out and move your awareness up to your chest and back Tense, those muscles attract your shoulders up to your ears and hamper them there tightly, clenched hard Then softened those muscles and breathe out gradually Now clench your biceps your upper arms and then liberate Now clench your fists and liberate Move your awareness up to your face and seize your face muscles tightly And now lightened those muscles in your face Now we’re going to do a speedy check of your bodily awareness, what do you notice in your figure? There might be some places in your organization that feel warm soft and comfortable notice those And there might be some residence that feel tighten or pain notice these areas You don’t need to label these even worse or be discouraged, but merely notice them Notice yourself breathing what does it feel like to breathe? Take one more deep breath in and give away very slowly What feelings or sensations are you knowing right now? Some of them may be painful and that’s okay Just notice them, be curious.What does it feel like to feel those sentiments without needing to escape them? Send each of your feelings a bit mental hug. It’s okay to have feelings. Notice if there are any more spirits, perhaps quieter emotions that “youre gonna” feeling too what else are you noticing? Be puzzled. You don’t need them “re going away”. You can treat feeling them. How would you describe each of these sentiments? Take one more deep breath and notice yourself breathing Now let’s envisage yourself going to the first day of clas The bus pushes up to the front of the school and as you get off the bus you feel your gut tighten a bit Perhaps you feel a lot of energy coursing through your torso You may feel a little tense or jumpy and that’s okay It’s perfectly normal to be having these feelings and superstars Most of the other adolescents are feeling a little anxious and aroused extremely You can administer feeling this action Anxiety and fervor are the same physiological response in our body Both of them prepping us for action to perform well, and it’s okay to have this feeling in your person Your old-time habitual suppose is I need to escape or I can’t handle feeling this way But now you remind yourself I can administer feeling this course and be okay.I Don’t need my agitations to go away for me to be alright, I can feel them and notice them and While they are uncomfortable, they can’t trauma me. I is in fact safe in this moment You look around and remember that probably most of the other children are also feeling a little watchful or stimulated right now It’s perfectly natural to feel this way, and it’s not going to harm you You alter your attention back to your breathing and as you step toward the school you notice something beautiful What is it? Perhaps the clear sky or the light-green grass Take a time and notice that one pretty thing You hear lots of adolescents are running noisily toward the school some are meeting up with their friends some are alone suddenly you were supposed to meditated What if no one will be my friend? or You worry that people are looking at you in a funny way.For a moment You have visions of a catastrophe run through your psyche. You’re afraid of being rejected being alone being a loser But you rapidly notice those remembers they are distressing and loudly judges, but they are just supposes Just as you can notice yourself listening to my expression at this moment. You can notice yourself having those designs They aren’t truthful They don’t help you be the person that you appreciate Because you appraise being style, you be concerned about connecting with people You want to be a good friend. You can act on those qualities and good things will happen People will want to be friends with you when they get to know you because of who you are You notice those frightening thoughts and you imagine them written on the side of the bus and the bus begins to pull away You remember that you’re okay You have some inner endowments to share with the world. Even if you are quiet or observant instead of a thundering idiot. Take a time and think of one of the talents that you have One thing that you are good at like has become a good listener or noticing others needs for example You remember some of the people who love you and looks just like you, your friends your parents You remember that you are safe right now.It may feel uncomfortable But you can handle that You may feel a bit of distres But you can open up some opening for that suspicion inside of you. You don’t need to represent that nervousnes go away to be okay. Imagine that your anxiety is a little child saying What if no one likes me? and you say Come now little tension. I want to give you a hug See it’s awkward, but you can experience it and it doesn’t trauma you. You walk through the figurehead entrances of the school and there’s a lot of noise and commotion Not your favorite So you thoughts over to your locker, You previously know where it is because you went to the open live And you open your locker and a gentle float of your favorite flavor comes out of it You waste a minute.Just bask that fragrance Breathe in deeply Now you walk to your first class, you know Right where it is and you arrive a few minutes early you take your seat and look around There’s a few other adolescents sitting down and you say hi to the girl sitting next to you She says hi back, and then suddenly you feel so awkward You start worrying that you should have said more or maybe you shouldn’t have said anything or that maybe you didn’t determine fairly nose contact and unexpectedly you’re hyper aware of how you’re sitting in your chair and you can feel Your heart thrashing a little faster and your hands sweating a little bit and then you notice yourself Tensing up a little and you can notice your thoughts Now in this moment notice what’s going on in your person and in your mind.You retain what your mentor said you don’t actually act tricky you only feel clumsy No one else has even paying attention to you. They’re all anxious and elicited about their first day of school And they’re too busy worrying about what parties “ve been thinking about” them to notice you You can still feel that tight feeling in your tummy and your sweaty palms and you tell yourself.That’s ok It’s ok to have uncomfortable perceptions sometimes. I can let myself feel this experience without needing to escape it or make it go away You know that it never helps to beat yourself up so instead you precisely testify yourself a little compassion You going to go to noticing for a while and you sifted through your experience in this moment. So Sift is an acronym S is for agitations Notice your physical perceptions precisely notice them both cozy and disagreeable. I is for epitomes What do you envisage in this moment? Can you notice those portraits and then bring yourself back to center with the wheeze? Can you notice those portraits in your manager And then bring yourself back to center by acknowledge your wheeze F is for feelings, what ardours are you knowledge? Are you having more than one? What is one thing you’re elicited about And the T is thoughts Notice, what are you thinking? You don’t need to duel or change your thoughts. Just notice yourself having them You take another deep gulp and you’re feeling kind of proud That right now you’re experiencing a little anxiety But you’re okay with it It’s a little embarrassing But you’re beginning to develop the skill of letting yourself feel it You give yourself a little imaginary pat on the back for being indomitable For letting yourself do hard things and feel hard things and stick with it The bell sounds and the coach starts class he goes through the roll.You Pay close attention waiting for him to call your name.And then when he does you say here and Maybe you wonder a little if you did, okay, but no one even looks at you They’re all exactly paying attention to their own stuff right now You remind yourself that you can do hard things You take another deep gulp and tell it out gradually Then the teacher extends out a sheet of paper to everyone on it is an icebreaker activity You detest these. you have to go around the room and find someone who has broken their arm and someone who’s lived in another state and someone who Has a baby reptile Maybe you’re afraid that you’ll be awkward You might worry that no one will ask you questions or that you’re afraid that people will ask you questions You press your feet into the floor feeling the flooring pulping back up at you You notice your panic It’s telling you to run away, to avoid, to hide to be silent and you notice that fear You be recognized, you say hello fear.I’ve noticed you’re trying to hang out with me today I know I can’t meet you go away But you’re not the boss of me and I still get to decide what matters to me so fear You can restrain constructing suggestions, but I know what’s more important You is a well-known fact that you don’t like these icebreaker works But you also know that you wishes to be oblige some friends and you don’t want to isolate yourself on the first day So you look around and consider another minor who seems kind of hushed and is standing by himself You walk over to him and you feel a little awkward, but you don’t actually seem touchy from the outside. You look perfectly normal When you get to his desk, you look down at your article and you ask him.What’s your favorite notebook? He seems a little shy so you been listening while he says you about the book series that he likes then he looks at his paper and asks you What’s your favorite journal? You tell him about your favorite work and what you like about it and you can see in his smile that he’s speak that one And he likes it extremely. He must be a special type of nerd like you You stand around and other adolescents comes down to you and ask their questions you ask yours and pretty soon your newspapers all filled out The teacher gets back up. He seems nice and also a little funny and you think you’ll like his class The rest of that class leads somewhat smoothly you only sit in your chair and predict the syllabus while the educator tells you the class Rules and talks about what you’re going to learn so far so good You feel proud of yourself after your first day of clas There were hours “thats been” awkward, but that’s okay and there were experiences that were good You learned more about what to expect and although you felt some anxiety.You didn’t let it boss you around You were gentle with yourself Patient with your sentiments and whizs and you two are heroic to show up and feel lots of things today Excitement beauty anxiety hope for new friends and a sense of confidence in your ability to do hard-bitten things Now come back to the present moment Notice your feet on the floor notice your wheeze Think back over this exercise Was it unpleasant at times? But you fastened with it.You chose to do something challenging because something else mattered more than avoidance Take a deep breath and give yourself a little pat on the back for letting yourself experience your passions You are on the pathway to growth an emotional strong Keep up the good work.

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Why Are You Anxious?

Many of us experienced symptoms of anxiety Whether it is from testing or applying for a new job But some people find it difficult to stop worrying Even in seemingly normal situations, this has a lasting effect on me Their quality of life, so what happens? And why do they get so anxious? Nearly seven million people Have general disorder which means That they are exposed to excessive anxiety most days, for a period of not less than six months This includes sleep disturbance, agitation and muscle strain Panic attacks may also occur, but their nature varies as they come In sudden and short periods of excessive fear that leads to Violent physical reaction such as tachycardia, shortness of breath and dizziness In fact, anyone can suffer from a panic attack, whether or not they have the disorder There may be no specific cause for this panic attack Although we do not fully understand it, anxiety is partly caused by the amygdala "glory" and the hypothalamus, which are responsible for circulating cortisol and adrenaline in the body. Genetically, 40 percent of people with general disorder have a relative with the same disease Which means I levels of these hormones you have linked to your genes The environment around you may be another factor Some diseases of the disorder are associated with traumatic experiences in childhood Levels of neutron transmitters such as GABA, serotonin, and dopamine may change Be another reason.

Serotonin hormone is responsible About the feeling of luxury and happiness It works by moving between Neuron and another in the brain via a difference called "synapses" Any unused Serotonin returns to the original neuron by a special carrier But those with certain anxiety disorders like OCD It has been suggested that a mutation in these vectors multiply the amount of Serotonin returned Before it gets to the receiving neuron This results in a decrease in the amount of the difference, "Synapse", leading to the effect of the feelings This was the reason for using drugs such as SSRIs In these anxiety states, Serotonin is prevented from returning to the original Neuron Also, many anxiety diseases show an excessive reaction in the amygdala and the gray area "periaqueductal gray area". This results in negative effects not only on the brain Even on our bodies.

In a study of nearly 300 people for a period of five years Those who had an amygdala tonsil with an overactive reaction showed higher rates of heart disease. Because the amygdala stimulates the production of white blood cells In the bone marrow leading Inflorescence affects Artery heart artery If you have a fear of a cause (phobia), this is one of the forms of anxiety diseases But since many fears help us to survive Like fear of spiders or heights, it has been suggested that These concerns may be stored in the DNA and inherited When mice are electrocuted after being exposed to a fruit smell They quickly learn to fear that smell But interestingly, the new generations of mice Also, you are afraid of these same fruit scents. Although generations of new mice did not experience electric shocks, it turned out to be Because of the strong reaction of the electrocution in the brain aromatherapy receptors Make new generations more sensitive to the same smells In such a way that the receivers are turned on for those odors These smells are associated with some cases of phobia.

For treatment, cognitive behavior therapy helps Get to know the thoughts that stimulate feelings Affecting behavior and aims to Change these thoughts to fight anxiety diseases On the other hand, medicines like SRIs and SNRIS It is used to prevent the absorption of serotonin or noreprivin But it may result in side effects and sometimes It negatively affects long use Benzodiazepines are also used to aid sleep Muscle relaxation, but it is also associated with dementia in older generations It is important to know that the basis of nervous and chemical anxiety is very complex And telling someone who is infected to calm down will not produce any result So we decided to make another video and show us what we're doing In order to overcome anxiety with some tips and tricks that We think it works. You can see it by clicking here. Subscribe for weekly science videos every Thursday .

What is Illness Anxiety Disorder?

Hello, this is Dr Grande Today.’s, question is what is Illness Anxiety Disorder If you find this video to be interesting or helpful, please like it and subscribe to my channel That way, you won’t miss any new videos. Now, when we talk about illness, anxiety disorder, we talk about a mental disorder where an individual is preoccupied with concern about having a serious illness, and this is an interesting disorder because it’s fairly, similar to Obsessive Compulsive Disorder. And there’s even a debate. In a mental health community About whether or not Illness, Anxiety disorder is really just a variant of OCD. So when we look at the criteria for Illness, Anxiety Disorder, there’s, another interesting feature. A lot of mental disorders in the DSM have a symptom criteria section and Then other criteria. So there may be Nine symptoms in the symptom criteria section and somebody might have to meet four or five of those symptoms to qualify For that criterion. And then there are other criteria that have to qualify for as well With illness, anxiety disorder. All of the different criteria are required. There is no section in the DSM with illness, anxiety disorder That has a number of symptoms where somebody only has to meet a certain Number less than that for the diagnosis. For example, if we consider Borderline Personality Disorder, that disorder has nine symptoms in the symptom criteria, But an individual only needs to have five of those to qualify for that diagnosis. So again with Illness, Anxiety, Disorder, all the symptoms are required. So the first symptom is a preoccupation with having or acquiring a serious illness. Now the DSM doesn’t specifically say that this would be a mental disorder or a medical disorder, but most of the time we interpret this as relating to a possible medical disorder, a concern over having or getting a medical disorder, because we usually conceptualize this first Criterion as being related to medical disorders, this brings up an important point in terms of the distinction between a talk therapist and a physician. For example, I have a PhD in counselor education and supervision and I’m a licensed counselor. I’m, not a physician and most talk. Therapists are not physicians either. So with this particular diagnosis of illness, anxiety disorder. As a talk therapist, you would be working with somebody who has complaints or concerns about a medical disorder. So it’s important to make the referral to a physician so that you know if they in fact have the disorder or don’t That’s an important element in terms of the mental health treatment to know if that medical disorder is really there Or not Now, of course, a lot of times when we treat individuals with Illness, Anxiety Disorder, they have been referred by a physician and we already have the information that shows that they did not qualify for a diagnosis of any type of medical disorder, at least not The medical disorder that they’re worried about. The second criterion is that there are little or no somatic symptoms, So there’s another disorder, which is difficult to differentiate from Illness, Anxiety, Disorder, called Somatic Symptom Disorder, and I have another video that discusses these two disorders. Together With Illness, Anxiety Disorder, there can be mild somatic symptoms, but that’s really not the emphasis as the symptom criterion suggests. The anxiety is not coming primarily from physical, sensations of the person’s having, but rather the meaning or significance of having the illness. That they’re worried about having The third symptom criterion is the individual is experiencing a high level anxiety about health related concerns? The fourth is that there’s excessive health related behavior, like checking or maladaptive avoidance, so a lot of times we think of this disorder and compare it to OCD. It’s, this particular symptom criterion. That makes it difficult to distinguish the two, because that health related behavior, as I mentioned oftentimes, involves checking and, of course, OCD oftentimes involves checking The fifth symptom criteria is that the disturbance has been present for six months, but the illness that the person is worried about. Can change in that time So a lot of times we think of Illness, Anxiety Disorder, we think of one particular illness that the person is worried about having or acquiring, But sometimes with this disorder. If they have evidence that shows that they don’t have a particular medical disorder, they were worried about. Then they might develop a fear about another potential medical disorder, So the illness can change, but the disturbance would be present for at least six months, and The sixth symptom criterion is that this disturbance is not better explained by another mental disorder and there’s a Number of mental disorders listed in the DSM as examples. One of them is OCD Again, emphasizing this difficult differentiation between illness, anxiety disorder and OCD. It’s important to note here as well that somebody can have Obsessive Compulsive Disorder and Illness Anxiety Disorder. At the same time, These can be comorbid and oftentimes. They are comorbid This six symptom criterion that not better explained by another mental disorder criterion. Doesn’t mean that the two can’t co occur. It just means that if you’re looking at a presentation that you think is Illness, Anxiety, Disorder and the symptoms are in fact better explained by OCD, then you would consider OCD over illness anxiety disorder. This can certainly become confusing, but the term not better explained doesn’t mean that the two are mutually exclusive, that the two disorders cannot co occur. Now it’s also important to note that, with illness anxiety disorder, There are two subtypes. These are not specifiers, but rather subtypes, So an individual would have to have one, and only one of these subtypes There’s the care seeking type and the care avoiding type. So an individual with Illness. Anxiety Disorder would have to be categorized as one of these two types they could not be assigned both types. Some other interesting associated characteristics with Illness. Anxiety Disorder include that there’s, usually not a desire for perfectionism. With this disorder like we would see with OCD and also in terms of what medical disorder or serious illness somebody’s worried about it:’s, oftentimes, not a communicable illness, so the concern would more likely be over a medical disorder like cancer or heart disease. As opposed to influenza, Now in terms of the treatment for Illness, Anxiety Disorder, we don’t have a lot of research on the treatment effectiveness for illness, anxiety disorder specifically, but generally, we believe that mental health talk therapy is somewhat effective in relieving the symptoms of Illness, Anxiety Disorder. I hope you found this description of Illness Anxiety Disorder to be interesting Thanks for watching

VA Disability Benefits for Anxiety

Good afternoon and welcome to CCK live. My name is Jenna Zellmer and joining me today are Alyse Galoski and Nick Briggs We all work on Veterans Benefits appeals here at CCK And today we're gonna be talking about anxiety. Now before we get into it I just wanted to remind you all that if you have any questions or comments during our conversation You can go ahead and leave them in the comment box below You will also be posting links to blogs and more information on our website at CCK-LAW.com So let's get into it.

So Nick, why don't you start us off? We're gonna be talking about both service connection and increased rating for anxiety today Let's start with talking about service connection So Nick what are some common anxiety disorders that veterans can claim service connection for? Sure So one of the more common types that we see are generalized anxiety disorders But there are also other specific types of anxiety disorders like social anxiety, Panic disorders, and then specific phobias like agoraphobia. Okay.

And Alyse, what are some common symptoms that characterize these anxiety disorders? Sure So there's some of those like invisible symptoms like excessive worry or difficulty concentrating but then there's also symptoms that physically manifest so you can Feel jumpy or you might be dizzy, have difficulty sleeping have mental have muscle tension feel nauseous or even lightheaded. So these are all manifestations of an underlying anxiety condition and I think that it's really important. I think a lot of times veterans Think that they can only give service-connected for PTSD because I think that you know often PTSD is goes in hand-in-hand with a lot of experiences the veterans experience in service but Even though anxiety disorders are a little bit different if you go to your doctor, and they don't diagnose you with PTSD But they do diagnose you with any of these symptoms or any of the anxiety disorders that Nick mentioned And you can still claim service-connection for that specific condition.

So What do veterans need in order to show service connection for this condition? So the first and most important thing that you want to be able to demonstrate is in service incurrence And that can take a number of different forms either the veterans specifically treats for and is diagnosed with an anxiety disorder in service They might just check that they were experiencing depression or excessive worry on their discharge Examination or there might have been some specific incident that they remember that caused their anxiety, and it's continued to persist since then You don't need to be diagnosed with anxiety. Sure. Okay, you just have to have some sort of notation. Alyse, what else? What after an in-service occurrence, what else do you need? First thing that you need is a Nexus so, that's what's gonna Connect both your in service condition to what's going on with you now Typically that's gonna require some type of medical opinion because lay persons are not competent typically to make that connection so It's a medical opinion Usually that's gonna draw that nexus.

And we have a Facebook live All about what you need to show all three elements of service connection, so we'll link that In our notes, and if you want more information just on general service connection. You can check us out there So Alyse you had mentioned that you need a nexus and that generally requires an examination or medical determination so, how do C&P exams which is what we also call them which stands for compensation and pension exam How do those work in relation to anxiety conditions? What would happen in a service connection for anxiety claim? Sure So typically with a C&P exam you're going to be meeting with a VA physician Who it's gonna be somebody that you've never met before most likely they will ask you about your experiences during service They'll also ask you about experiences that you have now.

They may also ask you about Any medical history any family medical history It's gonna be a lot of questions that are all gonna be what they're gonna use to Support an opinion on as to whether what's what you have now is related to service or not So it's gonna be a lot of those background questions family medical questions And they'll also ask you about what your current symptoms are. Mm-hmm And I think we also have a Facebook live all about C&P examinations Which has a lot of great information kind of explaining what's gonna happen in these exams and what you should and shouldn't you do. I think the biggest thing is you have to always show up for your examinations and then if you get an unfavorable opinion Nick, what are some remedies that the veteran can pursue? Sure Well oftentimes a veteran won't necessarily know that the opinion was negative until they get the next decision from VA denying their claim so first and foremost They need to make sure that they're requesting a copy of their VA examination which they're entitled to do And then once they have the exam they should go through it at length making sure to identify any specific problems that they noticed or things that they think Conflict with other evidence they've submitted before one of the things that VA examiner's are supposed to do is review the claims file and make sure that they're looking at Everything the veterans submitted including lay evidence and then considering all of those things in light of the examination itself Great.

Um, I think you know the one important thing that I heard you saying that is lay evidence So, you know, we've talked about medical evidence and why we need that usually for a nexus But can you talk a little bit about what other kind of evidence including lay evidence You might need to support a claim for anxiety? Sure lay evidence is often one of the things we go to most often if only because a lot of the time veterans don't feel comfortable seeking treatment for their condition during service or even afterward because it's something that you know, It's kind of stigmatized and people don't necessarily like to talk about it so it could be many years before they actually go get to the point where they feel they need to seek treatment and Lay evidence from the veteran him or herself and all their family members can help fill in some of those gaps But whenever possible it's also a good idea to submit treatment information from either your VA doctors or any private psychologists that you see.

So Let's kind of take a step back and talk about The Appeals Modernization Act. So we have a whole Facebook live on the AMA as we call it essentially back in February VA totally revamped their appeal system and so now There are several different Avenues that a veteran can pursue after they receive a unfavorable rating decision. So if A veteran, you know wants to file an appeal. What should they kind of know about the AMA? After they receive a rating decision from VA? Sure So the most important thing is that if their claim was previously denied and they're filing a supplemental claim Which is one of the new options under the appeals modernization system. They need to make sure that they're submitting new and relevant evidence That's meant to be a relatively relaxed evidentiary standard So it could be something as simple as providing a lay statement talking about how their symptoms are related to service Um, it could be submitting medical evidence establishing that they have a current diagnosis.

But whatever it is, it needs to be something that is relevant to their claim And then they can also pursue taking their case to the board with or without submitting additional evidence if they really do think That it's a situation where the regional office is just getting it wrong. But all of those options are still available to them They just need to be conscious of the 1-year time frames. Great. Yeah, I think You know, the AMA is a pretty new system and it's pretty complicated Although it is supposed to provide veterans with more choices, and it's supposed to clarify a lot of things I think it's still unclear kind of how it's going to work for veterans so we would really encourage you if you're seeking to initiate an appeal under the AMA to Consult your veteran service organization or an attorney.

Someone who has some expertise in this area of law And as I mentioned, we'll link some more information to the AMA in the case notes or in the in the comments below so we're talking about service connection and we mentioned in-service incurrence a Nexus and a current, you know disability What if a veteran doesn't have an in-service occurrence can the veteran get service connection another way Alyse? Yes. So an alternative way to get service connection is called secondary service connection This happens when you have an already service-connected disability, that is either causing or aggravating Your anxiety or a second condition So say that you have just for example you have a knee condition and your knee condition causes you a lot of pain and It makes you anxious to to get out of bed. It makes you anxious to walk down the street or to walk to work You could potentially show that you have secondary service connection for your anxiety because your knee conditions already service-connected whether it's either causing or Aggravating an already, you know existing anxiety condition Yeah, I think that anxiety is something that a lot of veterans probably have secondary to their service connected disabilities, especially physical disabilities I think In your example for example If the veteran had a lot of instability in their knee and they were never sure whether or not they were gonna fall You know I can imagine that causing a lot of anxiety And so just the same way that you would need a nexus opinion for direct service connection You would still want to get a doctor to make an opinion about whether or not that knee causes or aggravates anxiety.

Really good So let's assume that a veteran has received service connection, you know, they've met that first threshold Either secondary or direct. Let's talk about how VA rates anxiety. So Let's take a step back a little bit and talk about kind of how VA rates things in general and I think that we do Have some information on that in our past Facebook lives Alyse you want to talk a little bit about what Diagnostic codes are? And what the diagnostic code for anxiety is? Sure So if you think about the diagnostic code the best way think of it is it's this rubric Where they where the VA has established certain Disabilities and under those disabilities are certain rubrics.

If you meet certain criteria under the rubric then you're granted You should be granted or certain rating specifically anxiety is rated under the general formula for medical or mental rather disorders So that's gonna also include other Mental disorders which could be schizophrenia. It could also be PTSD the very many different types of anxiety there are and probably any other type of Mental condition that you can think of are all rated under the same Diagnostic code that's going to be diagnostic 4.130 That diagnostic code goes up to 100% It starts at a non-compensable rating of 0% And it lists specific symptoms and overall functional impairment that you would have to meet to Get a specific rating So Nick, Alyse mentioned that kind of several different Psychiatric conditions are all rated under this one general formula.

So what Happens if the veteran has for example, both anxiety and PTSD or anxiety and depression? Does that affect your rating at all? Sure, so like Alyse mentioned, you know, even though individual psychiatric conditions do have their own diagnostic codes they're all rated under this general formula and Because of that and because they're all rated based off of the same criteria of factoring it in the same symptoms You're not going to receive separate ratings for each individual mental health condition. They're going to figure out which symptoms are imposed by each of those conditions and then give you one overall rating using the general formula. Good and I think it's important to kind of keep that in mind when you're looking at your rating code sheet, you know, every rating decision comes with the code sheet that lists out all of your disabilities and over the course of your life and your different appeals your rating for your psych condition can change and the Characterization of your psych condition can change based on what VA determines– kind of what the diagnosis you have so for example you know veterans who were service-connected a long time ago for psychiatric conditions might be originally rated under something called like a nervous condition and then as you know medical information has kind of evolved that could get re-characterized as PTSD or anxiety and then sometimes You know a veteran could be service connected for one thing and then later on claim service connection for another psychiatric condition As Nick said you're not gonna get a separate rating for that second condition But they might recharacterize what it's called on your code sheet and so that's important to keep in mind and just to make sure that you know, if There are symptoms that weren't originally Compensated under your original characterization, but you feel are now Encompassed in that in that characterization you might want to make a claim for an increase rating.

So, you know Alyse you mentioned the different possible rating levels and you mentioned that The diagnostic code and the rating formula provides different symptoms and different criteria that you need to meet in order to get to a higher rating so Do veterans have to meet every single criteria in that rating in order to get to the higher rating? No. So technically you don't even have to meet a single one of the criteria What you have to do is show that your functional loss is similar and what's called severity frequency and duration To the type of symptoms and functional loss listed in this diagnostic code. So if you receive a board decision that says, "The veteran is not entitled to a higher rating because he does because although he has certain symptoms in the seventy Criteria, he does not have them all that would be error" You don't have to meet all of their criteria What you have to do is show that your functional loss is overall similar in severity duration and frequency To these types of symptoms that they're listing it's a list.

It's a non exhaustive list and it's really just supposed to be examples And there are two cases that kind of go to that point about this, Claudio and Mauer. Yes, so For those of you who kind of want to take a little deeper into the case law The court has made clear that these symptoms are not required. So Nick what happens if a veteran's condition is so severe that they actually have to get hospitalized? Sure so periods of Hospitalization are considered to be totally disabling So in a situation where a veteran's hospitalized due to their mental health disability for more than 21 days They're entitled to a 100% rating for the period of the hospitalization But if the veteran is hospitalized for an extended stay of more than six months They're not only assigned the 100% rating for the entire length of the hospitalization But as well as six additional months after the date of their discharge I think that makes sense.

If you think about how VA rates disabilities and that the ratings are supposed to be based on Impairment in earning capacity. So obviously if a veteran is hospitalized they can't be working and so, you know It's really important if you do get hospitalized you want to make sure that you Tell VA and make sure the VA is appropriately compensating you so that's really important to keep that in mind and then you know I think that a lot of times when the veterans are going to seek treatment or they're seeking a VA examination They get something called GAF scores GAF So Alyse, do you want to talk about a little bit about GAF scores and whether or not they're even still relevant or what? What's going on with GAFscores? Sure so a GAF score is a somewhat or outdated way that Practitioners used to measure how severe a person's psychiatric disorder was it is from a previous version of the DSM a VA has since come out with a court decision called golden which says that those GAF scores are No longer in the dsm-5 and therefore they're they're outdated and they shouldn't be used by the board So in some circumstances, you might still see them mentioned your board decisions But the board really shouldn't be relying on them to deny you a higher rating Yeah, and if you see the board talk about gaps scores in relation to what rating you should be receiving That should be a red flag and and you can talk to you know An attorney or a VSO about potentially appealing that decision to the board Or to the court, excuse me, And Alyse mentioned the DSM.

So the DSM stands for Diagnostic Statistical Manual it's the manual that all Mental health professionals use in diagnosing mental health conditions. So we have a question from Stephen can you explain the difference between occupational and social impairment with reduced reliability and productivity and occupational and social impairment with deficiencies in most areas So these are the criteria for the 50 and the 70% ratings and this is actually an excellent question so. I'm smiling stephen Because it is a very good question and it's one that the board has not yet answered for us Yeah the court or the court, rather. so They haven't provided exact definitions of what those things mean But if you look to the diagnostic code, you can try and get a sense of what types of symptoms fall under each of those But unfortunately they don't have like, a You know a straight answer for you because the court and the board– VA have not defined it further than what we already see In the code, you can look at some of the symptoms for example in the 50% What is contemplated by occupational and social impairment with reduced reliability and productivity include flattened effect Panic attacks more than once a week impaired judgment impaired abstract thinking difficulty in establishing and maintaining social Relationships in the step higher you're seeing it involve more areas of your life Other than just the occupation and some of your relationships.

You're also seeing suicidal ideation obsessive rituals Near-continuous panic rather than panic attacks once a week. You're seeing an inability to establish and maintain Effective relationships now what we were saying before you do not need to show all of these symptoms It's just meant to be a list of examples to give you an idea of what that level of functional loss is. Precisely Become the different ratings are so vague. Right. What is the difference between reduce reduced reliability and Deficiencies in most areas? And so you use the symptoms in order to kind of parse that out but as Alyse said, you know, the court hasn't really given us a lot of guidance on this and that results in a lot of wildly, inconsistent board decisions And that's –sorry Nope, go ahead. That's what makes the board's Requirement to provide adequate reasons and bases so important because they don't have a strict definition of what these things mean They're really supposed to be properly explaining to you As the veteran why you're not entitled to a higher rating With what we call adequate reasons and basis.

Yeah and it's especially important in the Context of anxiety disorders because often times it's the type of mental health illness that might only really manifest itself in two or three specific Symptoms where it's the overwhelming anxiety and frequent panic attacks that are causing you to be unable to function in these areas But because VA tends to rely on the number of symptoms that you have rather than how severe they are It can get complicated especially when they're not really Defining the concepts that they're using. Right, sure that goes back to what Alyse was saying about It's really focusing on the frequency severity and duration of these symptoms And so if you see VA kind of using this rating criteria as a checklist that should you know You know raise a red flag that it's probably not a very good decision and that you could potentially appeal it yeah, I think that's a really good point Nick, especially because we are talking about anxiety, which is not a condition that Typically actually manifests itself into a lot of the symptoms that you see in the highest 100% rating like hallucination But if you for example have such severe agoraphobia that you can't leave your house or can't leave your room Then you might have total occupational social impairment.

So even though a Agoraphobia isn't a symptom listed under the 100% the overall functional loss might be enough to get you there. Mm-hmm so it's a really great question and I think it's just it really highlights why this area of law is so Unclear and why it's important to You know consult with your VSO or consult with an attorney because they can kind of navigate this and figure out what the best solution or argument to make in your case is. Great so We talked about GAF scores And the DSM, so I think the next thing that we want to talk about is what happens if a mental health condition Overlaps a non psychiatric condition Nick. Do you want to talk about that? I mean It's a concept we talk about a lot called pyramiding and I think we have our own Facebook live sessions on that topic So, please refer to that if you have any more detailed questions but the basic idea is that VA is only going to compensate each symptom that a veteran experiences once so if the veteran Experiences or suffers from an orthopedic disability that causes sleep impairment and then a psychiatric disability that causes sleep impairment They're gonna generally rate that symptom under one of those diagnostic codes one of those conditions and then not rate it under the other one just to make sure that they're not overcompensating the veteran for the symptom.

Then I think that the kind of reverse of that is what Alyse was mentioning earlier as if your psychiatric condition results in non psychiatric symptoms then you can potentially get It's like the opposite of pyramiding it's when pyramiding isn't a problem is when there are distinct manifestations of Your condition and you can get separate ratings for that. So, um, we talked a little bit about this in terms of total occupational and social impairment But what happens if a veteran's anxiety prevents them from working? Sure, so there is an avenue to receive a 100% rating called tdiu this is what you may be entitled for if your Disabilities could be your anxiety alone or your anxiety combined with all of your other service-connected disabilities prevent you from obtaining securing what's called substantial gainful employment So this is actually a lower standard than total occupational impairment substantially gainful employment is another one of those terms that we're working on having, you know, getting a really good definition for But basically it is something that is more than just a marginal employment something that is more than what we call protected work environment and If somebody if somebody's anxiety or somebody's anxiety combined with their other disabilities prevent them from really obtaining Secure employment then they might be entitled to to TDIU we have Absolutely have a lot of information on their website about tdiu.

That is a very large area of veterans law But it so if you have any questions about that Absolutely advise you to look at our website as well as well our other– I'm sure there's a Facebook you're live on that as well. Definitely So what other kinds of evidence? Should veterans be kind of collecting and submitting in order to support their increased rating claims, Nick? we've mentioned it a few times in the context of service connection, but it applies equally well to Increased ratings and that's lay evidence Obviously the veteran will only see their treating provider or a VA doctor every so often There are going to be months or even years where they don't seek treatment But the people who know them who live with them who experience their symptoms on the day to day basis are often in the best Position to provide a description of you know, what those symptoms are and how they affect them I'm so getting statements from yourself getting statements from family members can go a long way And I think you know one of the most common mistakes I see in that situation is at the board or VA Provides or assigned more value to those treatment records as opposed to the lay statements and as Nick said I think it's really important to kind of highlight that they are both equally valuable and that they are probably complementary in most situations so even though a veteran You know might go to treatment and might not be super-severe on that one day he goes to treatment if he has all these lay statements filling in the gaps between treatment you can kind of get a bigger picture so That's kind of one of the more common mistakes that I see VA making Just to kind of wrap things up Do you guys have any other? thoughts on common mistakes VA makes in adjudicating anxiety claims or things that you think letter and should remember when they're making these claims? One thing actually it's along the lines of lay statements if you are submitting lay statements and this is kind of a new one Make sure that what you're submitting is legible because you'll want to make it easy for VA to agree with you So if they can't really read your handwriting then it's very difficult for them to understand what symptoms or what your story is.

So I just suggest whether you're typing it or in very neat handwriting lay statements should be Legible easy to understand make it easy for them to want to give you an increased rating. That's really good advice It's better for us too Another common example we see in the case of service connection is VA improperly requiring a verified stressor Which is something that's only really in place for post-traumatic stress disorder So most veterans are probably most familiar with PTSD.

So that tends to be the condition that they claim But VA is supposed to construe that Claim broadly and liberally so the veteran might end up being diagnosed with a different mental health disability But because they claimed PTSD initially VA will often get stuck on trying to adjudicate the claim at way But at the end of the day like we talked about before it's really just all about establishing Anxiety in service or reports of anxiety and then symptoms afterward. That's really good Great.

Um Thank you for joining us today. We will be back next week and we hope that you check out all the information we provided.

Demystifying the Anxiety Disorders

Free public talk presented by Dr. Rami Nader, Registered Psychologist on October 19, 2017. The talk highlights the characteristics of various anxiety disorders and the mechanisms that underlie anxiety conditions. Dr. Nader reviews how avoidance, safety behaviors and beliefs about anxiety all maintain and perpetuate various anxiety disorders. For more information, visit www.raminader.com.

Anxiety Disorders: OCD, PTSD, Panic Attack, Agoraphobia, Phobias, GAD Generalized

http://www.stomponstep1.com/anxiety-disorders-ocd-ptsd-panic-attack-agoraphobia-phobias-gad-generalized/ SKIP AHEAD: 0:25 – Anxiety Definition & Symptoms 1:13 – Anxiety Differential Diagnosis 2:12 – Generalized Anxiety (GAD) 3:05 – Panic Attacks, Panic Disorder & Agoraphobia 5:01 – Specific Phobia & Social Anxiety Disorder (Social Phobia) 7:55 – Obsessive-Compulsive Disorder (OCD) 9:29 – Posttraumatic Stress Disorder (PTSD)Anxiety is uncontrolled fear, nervousness and/or worry about trivial or non-existent things. It is an unpleasant fear of future events that are unlikely to occur. Some patients have insight and realize that their uneasiness is illogical, but that does not alleviate symptoms. A certain level of anxiety is considered normal in many situations, but frequent anxiety or anxiety that inhibits function is pathologic.During anxiety sympathetic nervous system activation can result in physical symptoms such as Palpitations, Tachycardia, Shortness of breath, Muscle tension, Restlessness, Lack of focus, Sweating or chills and Changes in sleeping pattern.In order to make a diagnosis of anxiety, one must rule out other potential causes of these symptoms. The differential diagnosis for anxiety includes other psychiatric disorders, cardiac abnormalities (such as myocardial infarction or valvular disease), endocrine disorders (like hyperthyroidism) and respiratory disease (such as asthma or Pulmonary Embolism). Substances such as street drugs and prescribed medications must also be ruled out as a potential cause of the symptoms. We are going to hold off on discussing most of the different treatment options for anxiety until a later video that will cover all of pharmacology for the psychiatry section. That video will cover things like SSRIs, anxiolytics and cognitive behavioral therapy which can be used to treat anxiety disorders. However, during this video I will mention a couple treatment options that are used for specific anxiety disorders.We will start our discussion with Generalized Anxiety Disorder or GAD. You can see here in the top right corner I give GAD a high yield rating of 2. For those of you who aren’t familiar with the High Yield Rating it is a scale from 0 to 10 that gives you an estimate for how important each topic is for the USMLE Step 1 Medical Board Exam. GAD is a prolonged period of near constant anxiety. Their anxiety is not linked to a specific item, person, or situation (AKA it isn’t a phobia).They usually worry about a wide variety of things including school/work performance, finances, health, friends and/or family members. Their anxiety is “generalized” across many situations. Their anxiety frequently presents with “physical” symptoms and may be severe enough to impair function.A Panic Attack is sudden onset period of extremely intense anxiety accompanied by numerous signs and symptoms of anxiety. The attack is often associated with a sense of impending doom. These “episodes” usually last 10 to 30 minutes and are disabling. The patient returns to their normal level of function soon after the panic attack. They may be brought on by an inciting event or be completely unprovoked. I’d like to stop here for a moment to clarify the difference between generalized anxiety disorder and a panic attack. GAD can be thought of as a constant moderate level of anxiety while panic attacks are short periods of severe anxiety.Panic Disorder is recurrent panic attacks that are unprovoked and have no identifiable trigger. The onset of these anxiety episodes is unpredictable. Patients may be relatively asymptomatic between attacks, but often have anxiety about having more attacks. Their fear is related to the panic attacks themselves rather than a particular external stimuli. This differentiates Panic Disorder from Panic Attacks that are caused by things like phobias.The text for this video is too long and exceeds the maximum allowed by youtube. For the rest of it please click here http://www.stomponstep1.com/anxiety-disorders-ocd-ptsd-panic-attack-agoraphobia-phobias-gad-generalized/

MY STRUGGLE WITH SEVERE BLUSHING & SOCIAL ANXIETY

Today I’m sharing my personal struggle with erythrophobia/severe blushing. Warning: I talk about some sensitive topics that may be triggering for some.CONNECT WITH ME: ☾Instagram: https://www.instagram.com/aliceoliviawonder ☾Tees: https://teespring.com/stores/aliceoliviadesigns ☾Facebook: https://www.facebook.com/RecoverwithabundanceDisclaimer: The views expressed in this video are based off my own research and experience and do not constitute professional advice.Why vegan? ☾Forks over Knives: https://www.youtube.com/watch?v=O7iju… http://www.forksoverknives.com/☾Cowspiracy: https://www.youtube.com/watch?v=nV04z… http://www.cowspiracy.com/facts/☾Earthlings: https://www.youtube.com/watch?v☾101 Reasons To Go Vegan: https://www.youtube.com/watch?v=W4HJcq8qHAY&t=4s

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