"Breathe In, Breathe Out..." Acknowledging and Facing Anxiety

Fabiha Atiq
Sophomore
School of Life Sciences
Independent University, Bangladesh

October 13th, 2017

A dear friend once described the following incident to me:

It was a Saturday night, which turned into a Sunday morning as she studied for a quiz. Her alarm went off, and she realized she hadn’t slept at all. “It’s okay. It’s fine. I’ll just go to class with a mug of coffee,” she said to herself. But then all of a sudden, without warning, this intense and hitherto unfamiliar feeling came crashing down on her. She felt weak, and even thought that she might die (her words not mine). Her head had started hurting, and she felt as if an earthquake was taking place inside her skull. She tried to get up from her bed but fell back, collapsing into what felt like an abyss.

Over the next few weeks, she skipped classes, quizzes, meals, and going out, paralyzed by the fear of another attack. All the blood tests in the next two weeks couldn’t help her or her family figure out what was wrong with her. Everything showed normal in the test results. Until, that is, one doctor recommended a psychologist.

The psychologist, after a lot of assessment and tests, diagnosed her with an anxiety disorder. What she had experienced was a panic attack. Note that panic disorder (which results in panic attacks) is a type of anxiety disorder, and anxiety attacks (characterized by a momentary fear and shortness of breath) tend to be milder and more short-lived than panic attacks.

Art by Gemma Correll

Now, in our culture, a psychologist is usually referred to as a “pagol-er-daktar” (translated – a doctor for crazy people). But in actuality, a psychologist is a mental health professional who analyzes behavior and mental processes, and recommends strategies for overcoming behavioral impediments to proper functioning. Psychiatrists are similar to psychologists, with one of the main distinctions being that psychiatrists can prescribe drugs.

Let us refresh our memory a little by recalling what mental health is, maybe? Mental health refers to one’s emotional, psychological and social well-being, and affects how one thinks, feels and hence, acts. Mental health disorders may or may not have clear biochemical bases.

The dictionary defines anxiety as a feeling of worry, nervousness or unease, typically about an imminent event. Science adds that it may not necessarily be about an imminent event or an identifiable trigger. Regardless of how it occurs, anxiety can rob a person of their appetite, their social skills, and their ability to function properly or study. There are different levels of anxiety, like any other illness out there; from mild cases to very severe ones.

A person with anxiety overthinks often and to an extent that they feel nauseous and faint. Breathing becomes difficult, and the person loses strength in their limbs, feels terribly weak, which can lead to to them thinking that they will collapse any second, which some actually do.

Several factors may contribute to triggering anxiety. Environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these. Biologically speaking, anxiety appears to be tied to our fight-or-flight response, which involves the secretion of adrenaline and the priming of the body to respond to danger. But the problem is never the fight-or-flight system itself. The problem is the fight-or-flight response getting activated from a falsely heightened perception of danger, or when there is no danger at all.

Having said that, social factors also have a huge role to play here. Society tends to stress people out. Society often expects something from a person which they feel obliged to do even when they don’t want to (for instance, choose a subject they don’t want to study), which then stresses them out when they don’t like doing it, and thus cannot perform to live up to expectations. This can lead to anxiety. But there are can be a variety of reasons.

It is very easy to confuse anxiety with other similar mental illnesses, for example, depression. One might actually have questions as to how one differentiates between depression and anxiety. Depression is characterized by frustration, sadness and irritability amongst others whereas anxiety is associated with trembling, increased breathing rate and incredible sweating. They do, however, have some traits in common: restlessness, having trouble thinking/concentrating, having trouble with making decisions, excessive worrying, agitation and more.  Many people with depression do suffer from anxiety. Truth be told, there is no differentiating between them on your own, and it is best to leave it to one’s psychiatrist or psychologist, who will prescribe the appropriate drug, therapy, or course of action.

I have close friends, and immediate family who suffer from anxiety. I myself suffer from anxiety. Anxiety which is so bad I shamelessly admit that I have to take medication (prescribed of course) to function properly on a regular basis.

To most people, anxiety is basically nothing. They will tell you to not worry about it. But it can quickly turn into a severe illness. It is better to pay attention, and address the symptoms early on, before it becomes severe and leads to loss of functioning, self-harm etc.

In our culture, people may be afraid to seek help because of social stigma.
“Are they going to call me crazy?”
“What will society say?”
“Will people look at me differently?” and on and on it goes.

It doesn’t matter. Seek help, for it can get bad. Talk to your friends, talk to your family, and if you don’t feel comfortable enough, then don’t. For there is a place called the internet. There are so many people out there, going through what you are going through, and they will come through and help you, if you only reach out and ask.

Take a long, slow breath in through your nose, first filling your lower lungs, then your upper lungs. Hold your breath to the count of "three." Then release.

It isn’t a myth. It works.

Go online, make a blog, drink, eat, breathe, live.
Take one step at a time. But live.

Fabiha is in her second year at IUB. She is a bookworm, a shutterbug, and loves to write.

Shedding in Pounds, Gaining in Control: Exploring the Determinants of Anorexia Nervosa Through a Personal Perspective

Nuzhat Faizah

Sophomore

School of Life Sciences

Independent University, Bangladesh

September 15th, 2017

Apshara stood up from her bed and stretched in the direction of the sun just shining its warm golden light on the balcony. Her eyes barely open, she could see the sharp shadows cast by the neon street lamps gradually disappearing with the onset of daylight. As she went towards the balcony, the dew-laden Jasmine tree embraced her with its fragrance even as she felt the tightening grip of the immense expectations she was carrying within herself. The vibrant summer rays kissed the outline of her curves, and tinted her brownish hair orange while she was standing in front of her mirror and pounding on her abdomen with her wrists. She was standing at the edge of her teenage years and was disgusted to see her belly. Eventually she thought to make it disappear.

Apshara's elder sister had eloped with her boyfriend and gotten married five years ago, and since then her relatives have been taunting her and her parents about upbringing and moral values. On top of that, her parents regularly taunted her, predicting that she was going to follow her sister's footsteps and tarnish the remaining reputation her family has in society. Her relationship of seven years with her boyfriend had ended with betrayal and heartbreak which shattered all her hopes of having a perfect family with the man she loved in the future. Moreover, disturbing fights and daily quarrels between her parents had her convinced that she could never have a harmonious environment at home. Ultimately, all these experiences had a negative impact on her professional life. Her friends and colleagues, while fully aware of her circumstances, had still taken advantage of her emotional disturbances and eventually boycotted her instead of standing beside her and supporting her through these ups and downs. Apshara realized that she was losing everything, and little did she know that she was going to get addicted to losing soon.

She could not believe in God anymore, not even in her own worth. As days passed by, she began to be under the impression that she was cursed, flawed, and worthless. She was fed up while coping with the taunts, expectations and decisions her parents had imposed on her, losing her job and friends, heartbreak, and betrayal. She was surrounded by the daily hustle and bustle, clustering of known and unknown people but at the end of the day, she was completely alone, concealed by the shadows of her agony and depression.

In response, she began to take control of her body and mind, and began losing calories. She did not care much about her health, as she did not want to live anymore. Her body amazed her when she woke up every day and went to coaching centers to teach children after she lost her job. She did feel uncomfortable and exhausted as she had very little body fat and almost no energy. The skinnier she became, the harder it was to keep the people around her from noticing, though she did everything to hide her body. She stopped caring about what everyone thought and focused on living up to her own standards of starvation.

What remained of her social life took a toll. Visiting Burger Lab, Pizza Inn or any other fast-food shops became a nightmare. "You are fat! You have to lose calories again! You are a failure! A disappointment to your family! You should die!" -an inner voice recited to her, conflating her feelings of loss and alienation with self-esteem issues regarding her physical appearance.

By April of this year, her physical conditions had worsened so much that she could not cover it up with clothes. Her hands and feet were completely emaciated and she tended to lose her balance whenever she tried to walk. One day at the coaching center, she collapsed. Once taken to the hospital, the doctor told her that her right leg was paralyzed and gradually the most important organs of her body would give up if she kept going this way. Apshara was scared but she was unsure if she wanted to go back to the days before she had started starving herself. Sitting emotionally numb at the doctor's chamber, she got to know that she was a serious patient of Anorexia Nervosa and if she had the will to get better and live a normal life, she would definitely attain success one day.

What could cause a normal person like Apshara to intentionally starve herself to this extent? What external factors and influences contributed to trigger this behavior? Could she recover?

There are two sub-types of anorexia: the restricting type, which typically involves severe reduction of food intake but no purging (self-induced vomiting or misuse of laxatives and diuretics);  and the binge-eating/purging type, which involves relatively frequent episodes of excessive eating followed by compensatory purging. The latter is distinct from bulimia nervosa, which also involves binge-eating and purging, but affected individuals are usually of normal or above average body weight.

Eating disorders like anorexia are products of many risk factors which might be cultural, biological or psychological, and these can add to the probability of developing anorexia, especially during late adolescence or early adulthood.

Anorexia’s general physical symptoms include rapid weight loss, irregular menstrual cycles in women, decreased libido in men, dizziness, bowel problems, swelling of face, hands and feet, anaemia, osteoporosis (thinning of the bones), dental problems, feeling cold most of the time even in warm weather, and feeling bloated and constipated. Furthermore, anorexia can result in lethargy, low energy and insomnia. But anorexia nervosa, at its root, is a mental health disorder. Anorexic individuals exhibit obsessive behavior such as excessive fasting and counting of calories. They often isolate themselves, and can become suicida.

Anorexia Nervosa, according to American Psychiatric Association Practice Guidelines can be treated by nutritional rehabilitation, psychosocial therapy, and medication such as anti-depressants and antipsychotics.

Nutritional rehabilitation simply refers to attempts to reverse the starvation-associated symptoms of anorexia through feeding of energy-rich foods. It is important to note, however, that overly rapid intake of nutrients in malnourished patients can result in refeeding syndrome, which is characterized by metabolic disruption and electrolytic imbalance. Patients are often resistant to change, so nutritional rehabilitation is often coupled with psychosocial therapies, which can include education, individual and family psychotherapy, and counseling. Interestingly, studies have shown that family therapy works best for adolescents while adults respond best to individual therapy. The Maudsley approach, developed for the treatment of anorexic patients, is a family-based therapy where parents play an active role to help their children start eating again and gain weight according to their age and weight. At such a vulnerable stage in their development, it appears that adolescents need encouragement and positive reinforcement to properly recover. It can take up to years to fully recover, and relapses can occur. But those are no reasons to give up trying.

It is undeniable that women are more susceptible to anorexia than men (the ratio is roughly 10:1). As girls grow up, they are complimented more on their physical appearances than on any other qualities they have. A majority of them follow diets and become conscious of their bodies from a young age. It is hardly surprising, then, that girls respond to feelings of inadequacy through enforcing harsh control over their bodies. Low self-worth combines with society’s ideals of beauty. While short-term measures must involve accurate assessment of each individual patient’s experiences and mental health, society’s attitudes toward women must change to truly break the cycle.

Name of character has been changed to maintain anonymity.

Nuzhat is a Biochemistry second-year with a neverending passion for photography and birds. She likes to study about mental disorders.

Casual Yet Special Strings Attached: My Experience Growing Up with Hypothyroidism

Nuzhat Faizah

Freshman

School of Life Sciences

Independent University, Bangladesh

May 18th, 2017

"Here I come!", exclaimed the throbbing neck pain with an evil smirk, as it came alongside the other overpowering symptoms of hypothyroidism. I was just three years old when this disorder decided to invade my life, overshadow my entire childhood, and profoundly affect me till now.

Hypothyroidism is a condition that results from an under-active thyroid gland, which means that the gland is not producing sufficient thyroid hormones for the body's vital needs on a daily basis. The thyroid monitors and regulates how the body's cells use energy from food, which is broadly referred to as metabolism. Our metabolism includes regulation of internal temperature, blood pressure, and heartbeat, and how well we can burn our calories. If someone does not have enough thyroid hormones, the processes taking place inside the body decelerate, the body makes less energy and the metabolism becomes sluggish.

Coming back to my story, after conducting blood tests to examine my thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels, the endocrinologist suggested that I undergo a thyroid scan. During a thyroid scan, a very small dose of radioactive iodine is taken orally or intravenously to then detect uptake of the iodine by the thyroid gland (which uses it to make different thyroid hormones), and thereby assess the functioning of the gland. Although the dosage used in this scan is thought to be miniscule and safe, my parents knew that radiation can damage the cells in the thyroid gland, and did not want to risk worsening my health conditions back then. Based on my thyroid hormone levels, it was ultimately concluded that I have hypothyroidism. Surprisingly, there was no history of thyroid disorders in my family and I always felt like I am the odd one out. As I gradually grew up, I experienced the most common symptoms such as extreme sensitivity to varying temperatures, dry and thinning hair, hoarse voice, muscle weakness and camps, heavier and longer periods, puffy eyes, severe mood swings (ranging from extremely hyped to depressed), slow movements and thoughts, difficulty in concentration. Lastly, my slow growth was one of the reasons my parents were always tensed.

At that crucial time of decision-making, the best available treatment was levothyroxine. It is a synthetic version of the thyroxine produced by the thyroid gland. According to physicians, this synthetic drug is very specific and has negligible side-effects if taken in the correct doses. Levothyroxine doses are dependent upon the person's body weight.

Now imagine my plight! Every morning, while looking at the anxious faces of my loved ones, I have to swallow three tablets of levothyroxine (50 mcg) with water on an empty stomach before breakfast, and wait for it to work so that I can function like a normal human being. A series of the worst consequences of the disorder start if I accidentally skip my doses: my body starts throwing tantrums when I move in and out of an air-conditioned room, feel hungry, socialize with people, try to stay awake in classes, and do some household chores.

As far back as I can remember, the best and worst memories of my life are intertwined with the effects of hypothyroidism. I was the jolly and playful child in my family, and used to eat a lot without any hesitation and fearing the gain of calories. I would play with my friends in the afternoon as well. I got a first taste of the consequences of skipping medication when I intentionally skipped my doses for nearly a week back then in childhood. I cried all day just because of the deadly neck pain, got tired without any activities and the idea of food never succeeded to amaze me at that painful phase. It must have been really tough, beyond my imagination for my parents to watch me suffer like that. My sense of temperature was and is always at odds with the external temperature! For instance, I still feel cold sometimes and sleep under a blanket when the season of heat-strokes is going on in the summer. Adding more element to contrast, I would say that I feel terribly hot during winter and often tell my parents that I crave for ice-cream and cold coffees which I never get eventually because the fear of sore throat and tonsillitis conquer their mind. The hardest part is that my mood and appetite keep on changing within the blink of an eye, which often adds to my stress level.

Sometimes, hypothyroidism feels like an ascribed status. Even though my symptoms can be controlled with medication, it is sometimes disheartening when people are dismissive of the condition, or in the other extreme, think that it makes me very different from them. It is undeniably true that I do share a casual yet special relationship with this condition, levothyroxine and my childhood friend named “lethargy” and I am sure that there are many other people who might relate to my story but may feel shy to talk about it. I feel that people should be aware of the disorder and how it affects individuals in order to be more sensitive to needs and demands that may seem strange, but are in fact quite beyond their control.

Nuzhat Faizah is a Biochemistry first-year with a never-ending passion for photography and birds. She likes to study about mental disorders.