HLTA 1100 Fad Diets and Weight Loss Discussion

  • Do a search on fad diets–meaning a diet that goes against standard recommendations and promises quick and/or extreme results.
  • Select one fad diet for this assignment.
  • With your description of the diet, answer the following questions.Who discovered or founded the diet?What is the premise of the diet?How does weight loss occur?Is the diet nutritious, allowing for intake from all food groups?What health improvements are expected to come from following this diet?How long does one have to follow the diet to see results?In your opinion, does this diet seem healthy and safe? Why or why not?Does this diet seem reasonable to follow for a lifetime? Why or why not?Have you or anyone you know ever tried the diet? Would you ever consider following it if you wanted to lose weight? Why or why not?
    Personal Health
    HLTA 1100
    Version 3 from: https://www.canyons.edu/Offices/DistanceLearning/OER/Documents/Health%20Science%20100%20V3.pdf
    (Some images and data updated May 2019)
    2
    Acknowledgements
    We would like to extend appreciation to the following people and
    organizations for allowing this textbook to be created:
    California Community Colleges Chancellor’s Office
    Chancellor Diane Van Hook
    Santa Clarita Community College District
    College of the Canyons Distance Learning Office
    Compiled by
    Garrett Rieck, MA, ACSM-CPT
    &
    Justin Lundin, MA
    Special Thank You to OER staff
    Alexa Johnson, Mitchell Norhiro, & Trudi Radtke
    for helping with formatting, editing, readability, and aesthetics.
    &
    COC Kinesiology Department for making it all possible.
    Cover Photo: Cougar Field PIO COC
    The contents of this textbook were developed under the Title V grant from the Department
    of Education (Award #P031S140092). However, those contents do not necessarily represent
    the policy of the Department of Education, and you should not assume endorsement by the
    Federal Government.
    Unless otherwise noted, the content in this textbook is licensed under CC BY 4.0
    3
    Table of Contents
    Acknowledgements ………………………………………………………………………………………………………………………… 2
    CHAPTER 1: Introduction to Health ……………………………………………………………………………………………. 6
    Section 1.1 Definition and Concepts of Health …………………………………………………………………………………….. 6
    Section 1.2 Narrow Perspectives of Health ………………………………………………………………………………………….. 6
    Section 1.3 Broader Perspectives of Health …………………………………………………………………………………………. 6
    Section 1.4 The Six Dimensions of Health …………………………………………………………………………………………….. 7
    Section 1.5 Life Expectancy at Birth ………………………………………………………………………………………………………. 8
    Section 1.6 Leading Causes of Death ……………………………………………………………………………………………………… 8
    Section 1.7 About Determinants of Health …………………………………………………………………………………………… 8
    Section 1.8 Health Disparities ……………………………………………………………………………………………………………….. 11
    Section 1.9 Risk Factors and Levels of Disease Prevention …………………………………………………………….. 13
    Section 1.10 Levels of Disease Prevention …………………………………………………………………………………………. 14
    Section 1.11 Behavior Change and Goal Setting ………………………………………………………………………………… 15
    Section 1.12 SMART Goal Setting …………………………………………………………………………………………………………. 17
    CHAPTER 2: Psychological Health …………………………………………………………………………………………….. 19
    Section 2.1 Physiological Needs ……………………………………………………………………………………………………………. 20
    Section 2.2 Safety Needs ………………………………………………………………………………………………………………………… 20
    Section 2.3 Social Belonging ………………………………………………………………………………………………………………….. 20
    Section 2.4 Esteem …………………………………………………………………………………………………………………………………… 21
    Section 2.5 Self-Actualization………………………………………………………………………………………………………………… 21
    Section 2.6 Self-Transcendence ……………………………………………………………………………………………………………. 22
    Section 2.7 Mental Health ………………………………………………………………………………………………………………………. 22
    Section 2.8 Emotional Health ………………………………………………………………………………………………………………… 23
    Section 2.9 Spiritual Health …………………………………………………………………………………………………………………… 24
    Section 2.10 Social Health ……………………………………………………………………………………………………………………… 24
    Section 2.11 Factors That Influence Psychological Well-Being ……………………………………………………… 24
    Section 2.12 Developing and protecting individual attributes ………………………………………………………. 27
    Section 2.13 Supporting families and communities …………………………………………………………………………. 27
    Section 2.14 Supporting vulnerable groups in society …………………………………………………………………….. 28
    Section 2.15 Mental Illness ……………………………………………………………………………………………………………………. 28
    Section 2.16 Mood Disorders ………………………………………………………………………………………………………………… 29
    Section 2.17 Depression …………………………………………………………………………………………………………………………. 29
    Section 2.18 Dysthymic Disorder …………………………………………………………………………………………………………. 29
    Section 2.19 Bipolar Disorder ……………………………………………………………………………………………………………….. 30
    Section 2.20 The Causes of Depression (depressive disorders)…………………………………………………….. 30
    Section 2.21 Treating depression…………………………………………………………………………………………………………. 30
    Section 2.22 Coping with Depression ………………………………………………………………………………………………….. 31
    Section 2.23 Anxiety Disorders …………………………………………………………………………………………………………….. 31
    Section 2.24 The Stigma of Mental Illness ………………………………………………………………………………………….. 42
    CHAPTER 3: Stress Management ……………………………………………………………………………………………….. 45
    Section 3.1 Chronic Stress ……………………………………………………………………………………………………………………… 45
    Section 3.2 The Effects of Stress on the Body…………………………………………………………………………………….. 45
    Section 3.3 Stress and the Brain …………………………………………………………………………………………………………… 45
    Section 3.4 Your Bodies Response to Stress ………………………………………………………………………………………. 47
    Section 3.5 General Adaptation Syndrome…………………………………………………………………………………………. 47
    4
    Section 3.6 Distress may be destructive to health…………………………………………………………………………….. 49
    Section 3.7 Eustress ………………………………………………………………………………………………………………………………… 49
    Section 3.8 Burnout and Stress Related Illness …………………………………………………………………………………. 49
    Section 3.9 Common Causes of Stress …………………………………………………………………………………………………. 51
    Section 3.10 Common signs and symptoms of stress ………………………………………………………………………. 52
    Section 3.11 Do women react to stress differently than men?……………………………………………………….. 52
    Section 3.12 Can Stress Affect My Health?………………………………………………………………………………………….. 52
    Section 3.13 The Effect of Stress on the Immune System ……………………………………………………………….. 52
    Section 3.14 Does stress cause ulcers? NO …………………………………………………………………………………………. 53
    Section 3.15 Post-traumatic stress disorder (PTSD)………………………………………………………………………… 53
    Section 3.16 Stress is in the Eye of the Beholder ………………………………………………………………………………. 54
    Section 3.17 Managing Stress ……………………………………………………………………………………………………………….. 56
    Section 3.18 Coping with Stress ……………………………………………………………………………………………………………. 58
    Section 3.19 Exercise and Stress ………………………………………………………………………………………………………….. 58
    Section 3.20 Meditation and Health …………………………………………………………………………………………………….. 59
    Section 3.21 Relaxation Techniques ……………………………………………………………………………………………………. 60
    Section 3.22 Resilience …………………………………………………………………………………………………………………………… 65
    CHAPTER 4: Relationships and Communication …………………………………………………………………….. 68
    Section 4.1 Theories of Love………………………………………………………………………………………………………………….. 68
    Section 4.2 THEORIES OF MATE SELECTION ……………………………………………………………………………………. 72
    Section 4.3 Marriage ……………………………………………………………………………………………………………………………….. 77
    Section 4.4 Cohabitation ………………………………………………………………………………………………………………………… 78
    Section 4.5 Marrieds and Non-Marrieds …………………………………………………………………………………………….. 79
    CHAPTER 5: Gender and Sexuality ……………………………………………………………………………………………. 92
    Section 5.1 Sexual Scripts ………………………………………………………………………………………………………………………. 92
    Section 5.2 Genital Development………………………………………………………………………………………………………….. 93
    Section 5.3 The Importance of Sexuality …………………………………………………………………………………………….. 94
    Section 5.4 Sexual Anatomy …………………………………………………………………………………………………………………… 95
    Section 5.5 The Sexual Response ………………………………………………………………………………………………………….. 96
    Section 5.6 The Sexual Experience ………………………………………………………………………………………………………. 99
    Section 5.7 Sex and Gender …………………………………………………………………………………………………………………. 100
    Section 5.6 Sexuality …………………………………………………………………………………………………………………………….. 102
    CHAPTER 6: Sexual Health………………………………………………………………………………………………………… 106
    Section 6.1 Sexual Health …………………………………………………………………………………………………………………….. 106
    Section 6.2 Sexuality …………………………………………………………………………………………………………………………….. 106
    Section 6.3 Public Health Approach to Sexual Health ……………………………………………………………………. 106
    Section 6.4 Stigma …………………………………………………………………………………………………………………………………. 106
    Section 6.5 Sexual Dysfunction…………………………………………………………………………………………………………… 106
    Section 6.6 Sexual Frequency……………………………………………………………………………………………………………… 107
    Section 6.7 Sex and Health ………………………………………………………………………………………………………………….. 107
    Section 6.8 Sexual Happiness ……………………………………………………………………………………………………………… 107
    Section 6.9 Sexual Bias and Misconceptions……………………………………………………………………………………. 107
    Section 6.10 Reproductive Health ……………………………………………………………………………………………………… 108
    CHAPTER 7: Infectious diseases and Sexually Transmitted Infections (STI’s)…………………. 131
    Section 7.1 Introduction ………………………………………………………………………………………………………………………. 131
    Section 7.2 What are infectious diseases? ……………………………………………………………………………………….. 131
    Section 7.3 Symptoms and signs of infection ………………………………………………………………………………….. 132
    Section 7.4 What causes infectious diseases? …………………………………………………………………………………. 132
    Section 7.5 Direct person-to-person transmission of pathogens………………………………………………… 133
    Section 7.6 Indirect person-to-person transmission of pathogens …………………………………………….. 134
    5
    Section 7.7 Animal-to-human transmission of pathogens ……………………………………………………………. 136
    Section 7.8 Immune Defenses Against Infectious Diseases ………………………………………………………….. 138
    Section 7.9 Risk Factors and Levels of Disease Prevention ………………………………………………………….. 147
    Section 7.10 Levels of Disease Prevention ………………………………………………………………………………………. 148
    Section 7.11 Sexually Transmitted Infections …………………………………………………………………………………. 149
    Section 7.12 STD/STI Treatments……………………………………………………………………………………………………… 155
    Section 7.13 STD/STI Prevention: How to Prevent STI’s ……………………………………………………………… 157
    Section 8.1 Understanding Drug Use and Addiction ……………………………………………………………………… 161
    Section 8.2 Types of Drugs ………………………………………………………………………………………………………………….. 161
    Section 8.3 Prescription Drugs …………………………………………………………………………………………………………… 172
    Section 8.4 Alcohol Abuse……………………………………………………………………………………………………………………. 176
    Section 8.5 Tobacco………………………………………………………………………………………………………………………………. 181
    Section 8.7 Drug Addiction………………………………………………………………………………………………………………….. 186
    Section 8. 7 Treatment Approaches for Drug Addiction ……………………………………………………………….. 189
    CHAPTER 9: Basic Nutrition and Healthy Eating …………………………………………………………………… 196
    Section 9.1 Nutrition and Health ……………………………………………………………………………………………………….. 196
    Section 9.2 Planning a Diet………………………………………………………………………………………………………………….. 208
    Section 9.3 Popular Diets …………………………………………………………………………………………………………………….. 217
    Section 9.4 Food Supplements and Food Replacements ………………………………………………………………. 222
    CHAPTER 10: Weight Management …………………………………………………………………………………………. 227
    Section 10.1 Assessing Body Weight and Body Composition ………………………………………………………. 230
    Section 10.2 Factors Contributing to Overweight and Obesity ……………………………………………………. 233
    Section 10.3 Balancing Calories and Eating Healthfully ……………………………………………………………….. 239
    Section 10.4 Body Image ……………………………………………………………………………………………………………………… 246
    CHAPTER 11: Physical Fitness………………………………………………………………………………………………….. 251
    Section 11.1 Health Benefits Associated with Regular Physical Activity…………………………………… 251
    Section 11.2 Health Related Components of Physical Fitness ……………………………………………………… 253
    Section 11.3 Adding Physical Activity to Your Life ………………………………………………………………………… 256
    Section 11.4 Implementing Your Fitness Plan ………………………………………………………………………………… 262
    CHAPTER 12: Cardiovascular Disease, Diabetes, and Cancer ……………………………………………… 271
    Section 12.1 Stroke ……………………………………………………………………………………………………………………………….. 277
    Section 12.2 Metabolic Syndrome ……………………………………………………………………………………………………… 279
    Section 12.3 Diabetes …………………………………………………………………………………………………………………………… 287
    Section 12.4 Cancer ………………………………………………………………………………………………………………………………. 292
    CHAPTER 13: Environmental Health ………………………………………………………………………………………. 305
    Section 13.1 Overpopulation ………………………………………………………………………………………………………………. 306
    Section 13.2 Air Pollution ……………………………………………………………………………………………………………………. 307
    Section 13.3 Climate Change ………………………………………………………………………………………………………………. 308
    Section 13.4 Water ……………………………………………………………………………………………………………………………….. 309
    Section 13.5 Waste Management……………………………………………………………………………………………………….. 310
    CHAPTER 14: Health Care Choices …………………………………………………………………………………………… 312
    Section 14.1 Understanding your Health Care Choices …………………………………………………………………. 312
    Section 14.3 Health Care Choices: The Affordable Health Care Act (ACA)………………………………… 319
    Section 14.4 Health Insurance: Key Terms ……………………………………………………………………………………… 321
    Section 14.5 Choices in Medical Care………………………………………………………………………………………………… 323
    Section 14.6 Alternative Medical Practices ……………………………………………………………………………………… 327
    Section 14.7 Health Disparity …………………………………………………………………………………………………………….. 332
    6
    CHAPTER 1: Introduction to Health
    In this section, readers will learn about the nature of health, health education, health
    promotion and related concepts. This will help to understand the social, psychological and
    physical components of health.
    Section 1.1 Definition and Concepts of Health
    In the Oxford English Dictionary health is defined as: ‘the state of being free from sickness,
    injury, disease, bodily conditions; something indicating good bodily condition.”
    Clearly, health is not quite as simple as the definition implies. The concept of health is wide
    and the way we define health also depends on individual perception, religious beliefs,
    cultural values, norms, and social class. Generally, there are two different perspectives
    concerning people’s own definitions of health: a narrow perspective and a broader
    perspective.
    Section 1.2 Narrow Perspectives of Health
    People with a narrow perspective consider health as the absence of disease or disability or
    biological dysfunction. According to this view (or model), to call someone unhealthy or sick
    means there should be evidence of a particular illness. Social, emotional and psychological
    factors are not believed to cause unhealthy conditions. This model is narrow and limits the
    definition of health to the physical and physiological capabilities that are necessary to
    perform routine tasks.
    According to this definition, the individual is healthy if all the body parts, cells, tissues and
    organ systems are functioning well and there is no apparent dysfunction of the body. Using
    this model people view the human body in the same terms as a computer, or mechanical
    device, when something is wrong you take it to experts who maintain it. Physicians, unlike
    behavioral experts, often focus on treatment and clinical interventions with medication
    rather than educational interventions to bring about behavior change.
    Section 1.3 Broader Perspectives of Health
    The most widely used of the broader definitions of health is that within the constitution of
    the World Health Organization (WHO), which defines health as: A state of complete
    physical, mental, and social well-being, and not merely the absence of disease or infirmity.
    This classic definition is important, as it identifies the vital components of health.
    Well-being includes the presence of positive emotions and moods (e.g., contentment,
    happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with
    life, fulfillment and positive functioning. In simple terms, well-being can be described as
    judging life positively and feeling good. Well-being is associated with numerous health-,
    job-, family-, and economically related benefits. For example, higher levels of well-being are
    associated with decreased risk of disease, illness, and injury; better immune functioning;
    7
    speedier recovery; and increased longevity. Individuals with high levels of well-being are
    more productive at work and are more likely to contribute to their communities.
    Many practitioners have expanded their focus to include wellness at the positive end of the
    health continuum. Wellness is being in good physical and mental health. Because mental
    health and physical health are linked, problems in one area can impact the other. At the
    same time, improving your physical health can also benefit your mental health, and vice
    versa. It is important to make healthy choices for both your physical and mental well-being.
    Remember that wellness is not just the absence of illness or stress. One can still strive for
    wellness even if he/she is experiencing these challenges in life.
    To more fully understand the meaning of health, it is important to understand each of its
    individual components.
    Section 1.4 The Six Dimensions of Health
    1.4.1 Physical
    Body size and functioning; recognizing the need for physical activity, healthy foods, and
    adequate sleep; avoiding unhealthy habits
    1.4.2 Social
    Developing a sense of connection, belonging, and sustained support system; having positive
    relationships
    1.4.3 Intellectual
    Recognizing creative abilities and finding ways to expand knowledge and skills; being
    open-minded
    1.4.4 Emotional
    Coping effectively with life and expressing emotions in an appropriate manner
    1.4.5 Spiritual
    Having a sense of purpose and meaning in life; establishing peace, harmony, and balance in
    our lives
    1.4.6 Environmental
    Occupying pleasant, healthy, and safe environments that support wellbeing; positively
    impacting the quality of our surroundings (including protecting and preserving nature)
    Learning about the Six Dimensions of Health can help a person choose how to make
    wellness a part of everyday life. Wellness strategies are practical ways to start developing
    healthy habits that can have a positive impact on physical and mental health.
    8
    Section 1.5 Life Expectancy at Birth
    Life expectancy is a measure often used to gauge the overall health of a population. Life
    expectancy at birth represents the average number of years that a group of infants would
    live if the group were to experience the age-specific death rates present in the year of birth.
    Differences in life expectancy among various demographic subpopulations, including racial
    and ethnic groups, may reflect differences in a range of factors such as socioeconomic
    status, access to medical care, and the prevalence of specific risk factors in a particular
    subpopulation.
    During 1975–2015, life expectancy at birth in the United States increased from 68.8 to 76.3
    years for males and from 76.6 to 81.2 years for females. During this period, life expectancy
    at birth for males and females was longer for white persons than for black persons. Racial
    disparities in life expectancy at birth persisted for both males and females in 2015, but
    continued to narrow.
    Section 1.6 Leading Causes of Death
    In 1975, the five leading causes of death were heart disease, cancer, stroke, unintentional
    injuries, and influenza and pneumonia. In 2015, the five leading causes of death were heart
    disease, cancer, chronic lower respiratory diseases, unintentional injuries, and stroke.
    Throughout 1975–2015, heart disease and cancer remained the top two leading causes of
    death.
    Section 1.7 About Determinants of Health
    The range of personal, social, economic, and environmental factors that influence health
    status are known as determinants of health.
    1.7.1 Determinants of Health
    What makes some people healthy and others unhealthy?
    How can we create a society in which everyone has a chance to live a long, healthy life?
    Determinants of health are factors that contribute to a person’s current state of health.
    These factors may be biological, socioeconomic, psychosocial, behavioral, or social in
    nature. Scientists generally recognize five determinants of health of a population:
    Healthy People 2020 is exploring these questions by:

    Developing objectives that address the relationship between health status and
    biology, individual behavior, health services, social factors, and policies.
    9

    Emphasizing an ecological approach to disease prevention and health promotion. An
    ecological approach focuses on both individual-level and population-level
    determinants of health and interventions.


    Genes and biology: for example, sex and age
    Health behaviors: for example, alcohol use, injection drug use (needles),
    unprotected sex, and smoking
    Social environment or social characteristics: for example, discrimination, income,
    and gender
    Physical environment or total ecology: for example, where a person lives and
    crowding conditions
    Health services or medical care: for example, access to quality health care and
    having or not having insurance
    Other factors that could be included are culture, social status, and healthy child
    development.




    Determinants of health fall under several broad categories:
    Policymaking
    Policies at the local, state, and federal level affect individual and population health.
    Increasing taxes on tobacco sales, for example, can improve population health by reducing
    the number of people using tobacco products.
    Some policies affect entire populations over extended periods of time while simultaneously
    helping to change individual behavior. For example, the 1966 Highway Safety Act and the
    National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and
    regulate standards for motor vehicles and highways. This led to an increase in safety
    standards for cars, including seat belts, which in turn reduced rates of injuries and deaths
    from motor vehicle accidents.
    Social Factors
    Social determinants of health reflect the social factors and physical conditions of the
    environment in which people are born, live, learn, play, work, and age. Also known as social
    and physical determinants of health, they impact a wide range of health, functioning, and
    quality-of-life outcomes. Examples of social determinants include:






    Availability of resources to meet daily needs, such as educational and job
    opportunities, living wages, or healthful foods
    Social norms and attitudes, such as discrimination
    Exposure to crime, violence, and social disorder, such as the presence of trash
    Social support and social interactions
    Exposure to mass media and emerging technologies, such as the Internet or cell
    phones
    Socioeconomic conditions, such as concentrated poverty
    10




    Quality schools
    Transportation options
    Public safety
    Residential segregation
    Examples of physical determinants include:
    • Natural environment, such as plants, weather, or climate change
    • Built environment, such as buildings or transportation
    • Worksites, schools, and recreational settings
    • Housing, homes, and neighborhoods
    • Exposure to toxic substances and other physical hazards
    • Physical barriers, especially for people with disabilities
    • Aesthetic elements, such as good lighting, trees, or benches
    Poor health outcomes are often made worse by the interaction between individuals and
    their social and physical environment. For example, millions of people in the United States
    live in places that have unhealthy levels of ozone or other air pollutants. In counties where
    ozone pollution is high, there is often a higher prevalence of asthma in both adults and
    children compared with state and national averages. Poor air quality can worsen asthma
    symptoms, especially in children.
    Health Services
    Both access to health services and the quality of health services can impact health. Healthy
    People 2020 directly addresses access to health services as a topic area and incorporates
    quality of health services throughout a number of topic areas.
    Lack of access, or limited access, to health services greatly impacts an individual’s health
    status. For example, when individuals do not have health insurance, they are less likely to
    participate in preventive care and are more likely to delay medical treatment.
    Barriers to accessing health services include:
    • Lack of availability
    • High cost
    • Lack of insurance coverage
    • Limited language access
    These barriers to accessing health services lead to:
    • Unmet health needs
    • Delays in receiving appropriate care
    • Inability to get preventive services
    • Hospitalizations that could have been prevented
    11
    Individual Behavior
    Individual behavior also plays a role in health outcomes. For example, if an individual quits
    smoking, his or her risk of developing heart disease is greatly reduced.
    Many public health and health care interventions focus on changing individual behaviors
    such as substance abuse, diet, and physical activity. Positive changes in individual behavior
    can reduce the rates of chronic disease in this country.
    Examples of individual behavior determinants of health include:
    • Diet
    • Physical activity
    • Alcohol, cigarette, and other drug use
    • Hand washing
    Biology and Genetics
    Some biological and genetic factors affect specific populations more than others. For
    example, older adults are biologically prone to being in poorer health then adolescents due
    to the physical and cognitive effects of aging.
    Sickle cell disease is a common example of a genetic determinant of health. Sickle cell is a
    condition that people inherit when both parents carry the gene for sickle cell. The gene is
    most common in people with ancestors from West African countries, Mediterranean
    countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia.
    Examples of biological and genetic social determinants of health include:
    • Age
    • Sex
    • HIV status
    • Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
    • Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian
    cancer
    • Family history of heart disease
    Section 1.8 Health Disparities
    Although the term disparities is often interpreted to mean racial or ethnic disparities, many
    dimensions of disparity exist in the United States, particularly in health. If a health outcome
    is seen to a greater or lesser extent between populations, there is disparity. Race or
    ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location
    all contribute to an individual’s ability to achieve good health. It is important to recognize
    the impact that social determinants have on health outcomes of specific populations.
    Healthy People strives to improve the health of all groups.
    To better understand the context of disparities, it is important to understand more about
    the U.S. population. In 2008, the U.S. population was estimated at 304 million people.
    12





    In 2008, approximately 33%, or more than 100 million people, identified
    themselves as belonging to a racial or ethnic minority population.
    In 2008, 51%, or 154 million people, were women.
    In 2008, approximately 12%, or 36 million people not living in nursing homes or
    other residential care facilities, had a disability.
    In 2008, an estimated 70.5 million people lived in rural areas (23% of the
    population), while roughly 233.5 million people lived in urban areas (77%).
    In 2002, an estimated 4% of the U.S. population ages 18 to 44 identified themselves
    as lesbian, gay, bisexual, or transgender.
    During the past 2 decades, one of Healthy People’s overarching goals has focused on
    disparities. In Healthy People 2000, it was to reduce health disparities among Americans. In
    Healthy People 2010, it was to eliminate, not just reduce, health disparities. In Healthy
    People 2020, that goal expanded even further: to achieve health equity, eliminate
    disparities, and improve the health of all groups.
    Healthy People 2020 defines health equity as the “attainment of the highest level of health
    for all people. Achieving health equity requires valuing everyone equally with focused and
    ongoing societal efforts to address avoidable inequalities, historical and contemporary
    injustices, and the elimination of health and health care disparities.”
    Healthy People 2020 defines a health disparity as “a particular type of health difference
    that is closely linked with social, economic, and/or environmental disadvantage. Health
    disparities adversely affect groups of people who have systematically experienced greater
    obstacles to health based on their racial or ethnic group; religion; socioeconomic status;
    gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or
    gender identity; geographic location; or other characteristics historically linked to
    discrimination or exclusion.”
    Over the years, efforts to eliminate disparities and achieve health equity have focused
    primarily on diseases or illnesses and on health care services. However, the absence of
    disease does not automatically equate to good health. Powerful, complex relationships exist
    between health and biology, genetics, and individual behavior, and between health and
    health services, socioeconomic status, the physical environment, discrimination, racism,
    literacy levels, and legislative policies. These factors, which influence an individual or
    population’s health, are known as determinants of health.
    For all Americans, other influences on health include the availability of and access to:
    • High-quality education
    • Culturally sensitive health care
    providers
    • Nutritious food
    • Health insurance
    • Decent and safe housing
    • Clean water and non-polluted air
    • Affordable, reliable public
    transportation
    13
    Throughout the next decade, Healthy People 2020 will assess health disparities in the U.S.
    population by tracking rates of illness, death, chronic conditions, behaviors, and other
    types of outcomes in relation to demographic factors including:



    Race and ethnicity
    Gender
    Sexual identity and orientation


    Disability status or special health
    care needs
    Geographic location (rural and
    urban)
    Section 1.9 Risk Factors and Levels of Disease Prevention
    What is a Risk Factor?
    Part of learning how to take charge of one’s health requires understanding risk factors for
    different diseases. Risk factors are things in life that increase your chances of getting a
    certain disease. Some risk factors are beyond your control. A person may be born with
    them or have exposure with no fault assigned.
    Some risk factors that you have little or no control over include:



    Family history of a disease
    Sex/gender — male or female
    Ancestry
    Some controllable risk factors include:





    What you eat
    How much physical activity you get
    Whether you use tobacco
    How much alcohol you drink
    Whether you misuse drugs
    In fact, it has been estimated that almost 35 percent of all U.S. early deaths in 2000
    could have been avoided by changing just three behaviors:



    Stopping smoking
    Eating a healthy diet (for example, eating more fruits and vegetables and less red
    meat)
    Getting more physical activity
    A person can have one risk factor for a disease or he/she can have many. The more risk
    factors a person has, the more likely he/she will get the disease. For example, if people eat
    healthy, exercise on a regular basis, and control blood pressure, their chances of getting
    heart disease are less than those of diabetics, smokers, and sedentary people. To lower
    14
    your risks, take small steps toward engaging in a healthy lifestyle, and you’ll see big
    rewards.
    People with a family health history of chronic disease may have the most to gain from
    making lifestyle changes. You can’t change your genes, but you can change behaviors that
    affect your health, such as smoking, inactivity, and poor eating habits. In many cases,
    making these changes can reduce your risk of disease even if the disease runs in your
    family. Another change you can make is to have screening tests, such as mammograms and
    colorectal cancer screening. These screening tests help detect disease early. People who
    have a family health history of a chronic disease may benefit the most from screening tests
    that look for risk factors or early signs of disease. Finding disease early, before symptoms
    appear, can mean better health in the long run.
    Section 1.10 Levels of Disease Prevention
    Prevention includes a wide range of activities — known as “interventions” — aimed at
    reducing risks or threats to health. You may have heard researchers and health experts talk
    about three categories of prevention: primary, secondary and tertiary. What do they mean
    by these terms?
    Primary prevention aims to prevent disease or injury before it ever occurs. This is done by
    preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe
    behaviors that can lead to disease or injury, and increasing resistance to disease or injury
    should exposure occur. Examples include:



    Legislation and enforcement to ban or control the use of hazardous products (e.g.
    asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike
    helmets)
    Education about healthy and safe habits (e.g. eating well, exercising regularly, not
    smoking)
    Immunization against infectious diseases.
    Secondary prevention aims to reduce the impact of a disease or injury that has already
    occurred. This is done by detecting and treating disease or injury as soon as possible to halt
    or slow its progress, encouraging personal strategies to prevent re-injury or recurrence,
    and implementing programs to return people to their original health and function to
    prevent long-term problems.
    Examples include:



    Regular exams and screening tests to detect disease in its earliest stages (e.g.
    mammograms to detect breast cancer)
    Daily, low-dose aspirins and/or diet and exercise programs to prevent further heart
    attacks or strokes
    Suitably modified work so injured or ill workers can return safely to their jobs.
    15
    Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting
    effects. This is done by helping people manage long-term, often-complex health problems
    and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much
    as possible their ability to function, their quality of life and their life expectancy. Examples
    include:



    Cardiac or stroke rehabilitation programs, chronic disease management programs
    (e.g. for diabetes, arthritis, depression, etc.)
    Support groups that allow members to share strategies for living well
    Vocational rehabilitation programs to retrain workers for new jobs when they have
    recovered as much as possible.
    Section 1.11 Behavior Change and Goal Setting
    Transtheoretical Model (Stages of Change)
    The transtheoretical model of behavior change, developed by Prochaska and DiClemente,
    assesses an individual’s readiness to implement a healthier behavior and provides insight
    into the decision making process that leads to action. For many people, changing or
    modifying a behavior that is unhealthy or potentially harmful can be quite challenging.
    Here are the stages that lead to behavior change:





    Precontemplation (Not Ready) – You are not intending to take action in the
    foreseeable future, and can be unaware that your behavior is problematic
    Contemplation (Getting Ready) – You are beginning to recognize that your behavior
    is problematic, and start to look at the pros and cons of your continued actions
    Preparation (Ready) – You are intending to take action in the immediate future, and
    may begin taking small steps toward behavior change
    Action – You are making actual changes to your problem behavior by incorporating
    healthy choices/behaviors into your life
    Maintenance – You have been able to sustain action for at least six months and are
    working to prevent relapse into previous unhealthy behaviors
    Stage 1: Precontemplation (not ready)
    People at this stage do not intend to start the healthy behavior in the near future (within 6
    months), and may be unaware of the need to change. People here learn more about healthy
    behavior: they are encouraged to think about the pros of changing their behavior and to
    feel emotions about the effects of their negative behavior on others.
    Precontemplators typically underestimate the pros of changing, overestimate the cons, and
    often are not aware of making such mistakes.
    16
    One of the most effective steps that others can help with at this stage is to encourage them
    to become more mindful of their decision-making and more conscious of the multiple
    benefits of changing an unhealthy behavior.
    Stage 2: Contemplation (getting ready)
    At this stage, participants are intending to start the healthy behavior within the next 6
    months. While they are usually now more aware of the pros of changing, their cons are
    about equal to their Pros. This ambivalence about changing can cause them to keep putting
    off taking action. People here learn about the kind of person they could be if they changed
    their behavior and learn more from people who behave in healthy ways.
    Others can influence and help effectively at this stage by encouraging them to work at
    reducing the cons of changing their behavior.
    Stage 3: Preparation (ready)
    People at this stage are ready to start taking action within the next 30 days. They take small
    steps that they believe can help them make the healthy behavior a part of their lives. For
    example, they tell their friends and family that they want to change their behavior.
    People in this stage should be encouraged to seek support from friends they trust, tell
    people about their plan to change the way they act, and think about how they would feel if
    they behaved in a healthier way. Their number one concern is: when they act, will they fail?
    They learn that the better prepared they are, the more likely they are to keep progressing.
    Stage 4: Action (current action)
    People at this stage have changed their behavior within the last 6 months and need to work
    hard to keep moving ahead. These participants need to learn how to strengthen their
    commitments to change and to fight urges to slip back. People in this stage progress by
    being taught techniques for keeping up their commitments such as substituting activities
    related to the unhealthy behavior with positive ones, rewarding themselves for taking
    steps toward changing, and avoiding people and situations that tempt them to behave in
    unhealthy ways.
    Stage 5: Maintenance (monitoring)
    People at this stage changed their behavior more than 6 months ago. It is important for
    people in this stage to be aware of situations that may tempt them to slip back into doing
    the unhealthy behavior—particularly stressful situations. It is recommended that people in
    this stage seek support from and talk with people whom they trust, spend time with people
    who behave in healthy ways, and remember to engage in healthy activities to cope with
    stress instead of relying on unhealthy behavior.
    Relapse (recycling): Relapse in the TTM specifically applies to individuals who
    successfully quit smoking or using drugs or alcohol, only to resume these unhealthy
    17
    behaviors. Individuals who attempt to quit highly addictive behaviors such as drug, alcohol,
    and tobacco use are at particularly high risk of a relapse. Achieving a long-term behavior
    change often requires ongoing support from family members, a health coach, a physician,
    or another motivational source. Supportive literature and other resources can also be
    helpful to avoid a relapse from happening.
    Section 1.12 SMART Goal Setting
    Figure 1. SMART Acronym
    Have you ever said to yourself that you need to “eat healthier” or “exercise more” to
    improve your overall health? How well did that work for you? In most cases, probably not
    very well. That’s because these statements are too vague and do not give us any direction
    for what truly needs to be done to achieve such goals. To have a better chance at being
    successful, try using the SMART acronym for setting your goals (S= Specific, M=
    Measurable, A=Attainable, R= Realistic, T= Time-oriented):
    Specific – Create a goal that has a focused and clear path for what you actually need to do.
    Examples:



    I will drink 8 ounces of water 3 times per day
    I will walk briskly for 30 minutes, 5 times per week
    I will reduce my soda intake to no more than 2 cans of soda per week
    Do you see how that is more helpful than just saying you will eat healthier or exercise
    more? It gives you direction.
    Measurable – This enables you to track your progress, and ties in with the “specific”
    component. The above examples all have actual numbers associated with the behavior
    change that let you know whether or not it has been met.
    18
    Attainable – Make sure that your goal is within your capabilities and not too far out of
    reach. For example, if you have not been physically active for a number of years, it would
    be highly unlikely that you would be able to achieve a goal of running a marathon within
    the next month.
    Realistic – Try to ensure that your goal is something you will be able to continue doing and
    incorporate as part of your regular routine/lifestyle. For example, if you made a goal to
    kayak 2 times each week, but don’t have the financial resources to purchase or rent the
    equipment, no way to transport it, or are not close enough to a body of water in which to
    partake in kayaking, then this is not going to be feasible.
    Time-oriented – Give yourself a target date or deadline in which the goal needs to be met.
    This will keep you on track and motivated to reach the goal, while also evaluating your
    progress.
    References
    Behavior Change and Goal Setting
    https://courses.lumenlearning.com/suny-monroecc-hed110/chapter/three-levels-ofhealth-promotiondisease-prevention/ CC BY SA
    Centers for Disease Control
    https://www.cdc.gov/nchs/data/hus/hus16.pdf%23019 CC BY SA
    Contemporary Health Issues
    http://hlth21fall2012.wikispaces.com/home CC BY SA
    Healthy People
    https://www.healthypeople.gov CC BY SA
    Transtheoretical Model
    https://en.wikipedia.org/wiki/Transtheoretical_model CC BY SA
    19
    CHAPTER 2: Psychological Health
    Figure 2. Maslow’s Motivation Model
    Maslow’s hierarchy of needs is a theory in psychology proposed by Abraham Maslow in his
    1943 paper “A Theory of Human Motivation” in Psychological Review. Maslow used the
    terms “physiological”, “safety”, “belonging” and “love”, “esteem”, “self-actualization”, and
    “self-transcendence” to describe the pattern that human motivations generally move
    through. The goal of Maslow’s Theory is to attain the sixth level of stage: self-transcendent
    needs.
    Maslow’s hierarchy of needs is often portrayed in the shape of a pyramid with the largest,
    most fundamental needs at the bottom and the need for self-actualization and selftranscendence at the top.
    The most fundamental and basic four layers of the pyramid contain what Maslow called
    “deficiency needs” or “d-needs”: esteem, friendship and love, security, and physical needs.
    If these “deficiency needs” are not met – with the exception of the most fundamental
    (physiological) need – there may not be a physical indication, but the individual will feel
    anxious and tense. Maslow’s theory suggests that the most basic level of needs must be met
    before the individual will strongly desire (or focus motivation upon) the secondary or
    higher level needs.
    The human brain is a complex system and has parallel processes running at the same time,
    thus many different motivations from various levels of Maslow’s hierarchy can occur at the
    same time. Maslow spoke clearly about these levels and their satisfaction in terms such as
    “relative”, “general”, and “primarily”. Instead of stating that the individual focuses on a
    certain need at any given time, Maslow stated that a certain need “dominates” the human
    organism. Thus Maslow acknowledged the likelihood that the different levels of motivation
    could occur at any time in the human mind, but he focused on identifying the basic types of
    motivation and the order in which they should be met.
    20
    Section 2.1 Physiological Needs
    Physiological needs are the physical requirements for human survival. If these
    requirements are not met, the human body cannot function properly and will ultimately
    fail. Physiological needs are thought to be the most important; they should be met first.
    Air, water, and food are metabolic requirements for survival in all animals, including
    humans. Clothing and shelter provide necessary protection from the elements. While
    maintaining an adequate birth rate shapes the intensity of the human sexual instinct, sexual
    competition may also shape said instinct.
    Section 2.2 Safety Needs
    Once a person’s physiological needs are relatively satisfied, his/her safety needs take
    precedence and dominate behavior. In the absence of physical safety – due to war, natural
    disaster, family violence, childhood abuse, etc. – people may (re-)experience post-traumatic
    stress disorder or transgenerational trauma. In the absence of economic safety – due to
    economic crisis and lack of work opportunities – these safety needs manifest themselves in
    ways such as a preference for job security, grievance procedures for protecting the
    individual from unilateral authority, savings accounts, insurance policies, disability
    accommodations, etc. This level is more likely to be found in children as they generally
    have a greater need to feel safe.
    Safety and Security needs include:




    Personal security
    Financial security
    Health and well-being
    Safety net against accidents/illness and their adverse impacts
    Section 2.3 Social Belonging
    After physiological and safety needs are fulfilled, the third level of human needs is
    interpersonal and involves feelings of belongingness. This need is especially strong in
    childhood and it can override the need for safety as witnessed in children who cling to
    abusive parents. Deficiencies within this level of Maslow’s hierarchy – due to hospitalism,
    neglect, shunning, ostracism, etc. – can adversely affect the individual’s ability to form and
    maintain emotionally significant relationships in general, such as:



    Friendships
    Intimacy
    Family
    According to Maslow, humans need to feel a sense of belonging and acceptance among their
    social groups, regardless whether these groups are large or small. For example, some large
    21
    social groups may include clubs, co-workers, religious groups, professional organizations,
    sports teams, and gangs. Some examples of small social connections include family
    members, intimate partners, mentors, colleagues, and confidants. Humans need to love and
    be loved – both sexually and non-sexually – by others. Many people become susceptible to
    loneliness, social anxiety, and clinical depression in the absence of this love or belonging
    element. This need for belonging may overcome the physiological and security needs,
    depending on the strength of the peer pressure.
    Section 2.4 Esteem
    All humans have a need to feel respected; this includes the need to have self-esteem and
    self-respect. Esteem presents the typical human desire to be accepted and valued by others.
    People often engage in a profession or hobby to gain recognition. These activities give the
    person a sense of contribution or value. Low self-esteem or an inferiority complex may
    result from imbalances during this level in the hierarchy. People with low self-esteem often
    need respect from others; they may feel the need to seek fame or glory. However, fame or
    glory will not help the person to build their self-esteem until they accept who they are
    internally. Psychological imbalances such as depression can hinder the person from
    obtaining a higher level of self-esteem or self-respect. Most people have a need for stable
    self-respect and self-esteem. Maslow noted two versions of esteem needs: a “lower”
    version and a “higher” version. The “lower” version of esteem is the need for respect from
    others. This may include a need for status, recognition, fame, prestige, and attention. The
    “higher” version manifests itself as the need for self-respect. For example, the person may
    have a need for strength, competence, mastery, self-confidence, independence, and
    freedom. This “higher” version takes precedence over the “lower” version because it relies
    on an inner competence established through experience. Deprivation of these needs may
    lead to an inferiority complex, weakness, and helplessness.
    Maslow states that while he originally thought the needs of humans had strict guidelines,
    the “hierarchies are interrelated rather than sharply separated”. This means that esteem
    and the subsequent levels are not strictly separated; instead, the levels are closely related.
    Section 2.5 Self-Actualization
    “What a man can be, he must be.”[ This quotation forms the basis of the perceived need for
    self-actualization. This level of need refers to what a person’s full potential is and the
    realization of that potential. Maslow describes this level as the desire to accomplish
    everything that one can, to become the most that one can be. Individuals may perceive or
    focus on this need very specifically. For example, one individual may have the strong desire
    to become an ideal parent. In another, the desire may be expressed athletically. For others,
    it may be expressed in paintings, pictures, or inventions. As previously mentioned, Maslow
    believed that to understand this level of need, the person must not only achieve the
    previous needs, but master them.
    22
    Section 2.6 Self-Transcendence
    In his later years, Abraham Maslow explored a further dimension of needs, while criticizing
    his own vision on self-actualization. The self only finds its actualization in giving itself to
    some higher goal outside oneself, in altruism and spirituality, which is essentially the desire
    to reach infinite. “Transcendence refers to the very highest and most inclusive or holistic
    levels of human consciousness, behaving and relating, as ends rather than means, to
    oneself, to significant others, to human beings in general, to other species, to nature, and to
    the cosmos” (Farther Reaches of Human Nature, New York 1971, p. 269).
    Section 2.7 Mental Health
    According to the World Health Organization (WHO), mental health includes “subjective
    wellbeing, perceived self-efficacy, autonomy, competence, inter-generational dependence,
    and self-actualization of one’s intellectual and emotional potential, among others.” The
    WHO further states that the well-being of an individual is encompassed in the realization of
    their abilities, coping with normal stresses of life, productive work and contribution to
    their community. Cultural differences, subjective assessments, and competing professional
    theories all affect how “mental health” is defined. A widely accepted definition of health by
    mental health specialists is psychoanalyst Sigmund Freud’s definition: the capacity “to
    work and to love”.
    Mental Health Issues Are Prevalent Among College Students
    Mental health issues are a leading impediment to academic success among college students.
    Untreated mental illness in the college student population — including depression, anxiety
    and eating disorders — is associated with lower GPA and higher probability of dropping
    out of school. Treatment is effective and available yet because of an unnecessary shame
    surrounding these issues, mental health is not discussed and too many students are
    suffering in silence



    An estimated 26 percent of Americans ages 18 and older – or about 1 in 4 adults
    – live with a diagnosable mental health disorder.
    Half of all serious adult psychiatric illnesses – including major depression,
    anxiety disorders, and substance abuse – start by 14 years of age. Three-fourths
    of them are present by 25 years of age.
    Compared to older adults, the 18-24 year old age group shows the lowest rate of
    help-seeking.
    Mental Health Issues Impact Students’ Ability To Succeed:

    Almost one third of all college students report having felt so depressed that they
    had trouble functioning.
    23


    Mental health issues in the college student population, such as depression,
    anxiety, and eating disorders, are associated with lower GPA and higher
    probability of dropping out of college.
    More than 80 percent of college students felt overwhelmed by all they had to do
    in the past year and 45 percent have felt things were hopeless.
    Mental health issues can be deadly:




    Suicide is the 2nd leading cause of death among college students, claiming the
    lives of 1,100 students each year.
    67% of college students tell a friend they are feeling suicidal before telling
    anyone else.
    More than half of college students have had suicidal thoughts and 1 in 10
    students seriously consider attempting suicide. Half of students who have
    suicidal thoughts never seek counseling or treatment.
    80-90% of college students who die by suicide were not receiving help from
    their college counseling centers
    Section 2.8 Emotional Health
    Emotional well-being is a term that has been used increasingly in recent decades. The
    implications of decreased emotional well-being are related to mental health concerns such
    as stress, depression, and anxiety. These in turn can contribute to physical ill-health such as
    digestive disorders, sleep disturbances, and general lack of energy.[1] The profile of a
    person prone to emotional distress is usually someone with low self-esteem, pessimistic,
    very self-critical, etc. and people who need to constantly assert themselves through their
    behavior. They also tend to be afraid, overly worried about the future, and focused on the
    past.
    On the positive side, enhanced emotional well-being is seen to contribute to upward spirals
    in increasing coping ability, self-esteem, performance and productivity at work, and even
    longevity. Thoughts determine feelings, and thoughts are nothing more than firings of
    neurons. And those feelings that thoughts generate make the body release extremely
    addicting substances like adrenaline and cortisol. Like with any other addiction, the need to
    continually feed off these addicting substances tends to make the body think and feel in a
    certain way. When someone decides to disengage from these emotional addictions, he/she
    must learn to think differently.
    Emotions and feelings are part of every step a person takes. A person must learn how to
    manage himself/herself in order to reach the maximum potential in all aspects of life. Good
    emotional health leads to better physical health, prevents diseases, and makes it possible to
    enjoy life and be happier. In this way you can become a “medicine person” through mirror
    neurons, those that lead to empathy and fire to imitate the emotions of others. Mirror
    neurons are what make you feel good when you’re with someone who is positive, cheerful
    24
    and motivational. At the other extreme are the so-called “toxic people”, who make others
    around them feel bad.
    Section 2.9 Spiritual Health
    The spiritual dimension is understood to imply a phenomenon that is not material in
    nature, but belongs to the realm of ideas, beliefs, values and ethics that have arisen in the
    minds and conscience of human beings, particularly ennobling ideas. Ennobling ideas have
    given rise to health ideals, which have led to a practical strategy for Health for All that aims
    at attaining a goal that has both a material and non-material component. If the material
    component of the strategy can be provided to people, the non-material or spiritual one is
    something that has to arise within people and communities in keeping with their social and
    cultural patterns. The spiritual dimension plays a great role in motivating people’s
    achievement in all aspects of life. [7]
    Section 2.10 Social Health
    The capacity for an individual to develop and flourish is deeply influenced by immediate
    social surroundings – including their opportunity to engage positively with family
    members, friends or colleagues, and earn a living for themselves and their families – and
    also by the socioeconomic circumstances in which said individual find himself/herself.
    Restricted or lost opportunities to gain an education and income are especially pertinent
    socio-economic factors.
    Psychoneuroimmunology is defined as the examination of the interactions among
    psychological, behavioral, and social factors with immunological and neuroendocrine
    outcomes. It is now well established that psychological factors, especially chronic stress,
    can lead to impairments in immune system function in both the young and older adults. In
    several studies of older adults, those who are providing care for a relative with dementia
    report high levels of stress and exhibit significant impairments in immune system
    functioning when compared with non-caregivers. Stress-induced changes in the immune
    system may affect a number of outcomes, including slowing the wound healing process and
    increasing susceptibility to infections.
    Section 2.11 Factors That Influence Psychological Well-Being
    Infancy and Early Childhood
    There is a strong body of evidence to show the importance of attachment by neonates to
    their mothers or other primary caregivers for subsequent social and emotional
    development. Separation from the primary caregiver – due for example to parental absence
    or rejection – leads to anxiety, stress and insecurity. Post-natal depression among new
    mothers can likewise contribute to sub-optimal attachment and development. Parents who
    have difficulties in bonding, have limited skills or exhibit negative attitudes place their
    children at increased risk of exposure to stress and behavioral problems. Other important
    25
    risks to physical and cognitive development in infancy and early childhood include
    maltreatment and neglect (by parents and other caregivers), malnutrition and infectious or
    parasitic diseases.
    Individual attributes and behaviors
    These relate to a person’s innate and learned ability to deal with thoughts and feelings and
    to manage him/herself in daily life (’emotional intelligence’). It is also the capacity to deal
    with the social world around by partaking in social activities, taking responsibilities or
    respecting the views of others (‘social intelligence’). An individual’s mental health state can
    also be influenced by genetic and biological factors; that is, determinants that persons are
    born or endowed with, including chromosomal abnormalities (e.g. Down’s syndrome) and
    intellectual disability caused by prenatal exposure to alcohol or oxygen deprivation at
    birth.
    Social and economic circumstances
    The capacity for people to develop and flourish is deeply influenced by their immediate
    social surroundings – including their opportunity to engage positively with family
    members, friends or colleagues, and earn a living for themselves and their families – and
    also by the socioeconomic circumstances in which they find themselves. Restricted or lost
    opportunities to gain an education and income are especially pertinent socio-economic
    factors.
    Environmental factors
    The wider sociocultural and geopolitical environment in which people live can also affect
    an individual’s, household’s or community’s mental health status, including levels of access
    to basic commodities and services (water, essential health services, the rule of law),
    exposure to predominating cultural beliefs, attitudes or practices, as well as by social and
    economic policies formed at the national level; for example, the on-going global financial
    crisis is expected to have significant mental health consequences, including increased rates
    of suicide and harmful alcohol use. Discrimination, social or gender inequality and conflict
    are examples of adverse structural determinants of mental well-being.
    Personality
    Personality measures turn out to be good predictors of your health, your sexual
    promiscuity, your likelihood of divorce, how happy you typically are—even your taste in
    paintings. Personality is a much better predictor of these things than social class or age.
    The origin of these differences is in part innate. That is to say, when people are adopted at
    birth and brought up by new families, their personalities are more similar to their blood
    relatives than to the ones they grew up with. The differences begin to emerge early in life
    and are surprisingly stable across the decades. This is not to say that people cannot change,
    but major change is the exception rather than the rule. Personality differences tend to
    manifest themselves through the quick, gut-feeling, intuitive, and emotional systems of the
    26
    human mind. The slower, rational, deliberate systems show less variation in output from
    person to person. Deliberate rational strategies can be used to over-ride intuitive patterns
    of response, and this is how people wishing to change their personalities or feelings have to
    go about it.
    So what are the major ways personalities can differ? The dominant approach is to think of
    the space of possible personalities as being defined by a number of dimensions. Each
    person can be given a location in the space by their scores on all the different dimensions.
    Virtually all theories agree on two of the main dimensions, though they differ on how many
    additional ones they recognize.
    Five factors




    Openness to experience: (inventive/curious vs. consistent/cautious). Appreciation
    for art, emotion, adventure, unusual ideas, curiosity, and variety of experience.
    Openness reflects the degree of intellectual curiosity, creativity and a preference for
    novelty and variety a person has. It is also described as the extent to which a person
    is imaginative or independent and depicts a personal preference for a variety of
    activities over a strict routine. High openness can be perceived as unpredictability
    or lack of focus. Moreover, individuals with high openness are said to pursue selfactualization specifically by seeking out in tense, euphoric experiences. Conversely,
    those with low openness seek to gain fulfillment through perseverance and are
    characterized as pragmatic and data-driven—sometimes even perceived to be
    dogmatic and closed-minded. Some disagreement remains about how to interpret
    and contextualize the openness factor.
    Conscientiousness: (efficient/organized vs. easy-going/careless). A tendency to be
    organized and dependable, show self-discipline, act dutifully, aim for achievement,
    and prefer planned rather than spontaneous behavior. High conscientiousness is
    often perceived as stubbornness and obsession. Low conscientiousness is associated
    with flexibility and spontaneity, but can also appear as sloppiness and lack of
    reliability.
    Extraversion: (outgoing/energetic vs. solitary/reserved). Energy, positive emotions,
    surgency, assertiveness, sociability and the tendency to seek stimulation in the
    company of others, and talkativeness. High extraversion is often perceived as
    attention-seeking, and domineering. Low extraversion causes a reserved, reflective
    personality, which can be perceived as aloof or self-absorbed.
    Agreeableness: (friendly/compassionate vs. challenging/detached). A tendency to
    be compassionate and cooperative rather than suspicious and antagonistic towards
    others. It is also a measure of one’s trusting and helpful nature, and whether a
    person is generally well-tempered or not. High agreeableness is often seen as naive
    or submissive. Low agreeableness personalities are often competitive or challenging
    people, which can be seen as argumentativeness or untrustworthiness.
    27

    Neuroticism: (sensitive/nervous vs. secure/confident). The tendency to experience
    unpleasant emotions easily, such as anger, anxiety, depression, and vulnerability.
    Neuroticism also refers to the degree of emotional stability and impulse control and
    is sometimes referred to by its low pole, “emotional stability”. A high need for
    stability manifests itself as a stable and calm personality, but can be seen as
    uninspiring and unconcerned. A low need for stability causes a reactive and
    excitable personality, often very dynamic individuals, but they can be perceived as
    unstable or insecure.
    Assess yourself! This is an interactive version of the IPIP Big-Five Factor Markers, a
    measure of the big five personality traits: Big 5 Personality Test
    Section 2.12 Developing and protecting individual attributes
    At its core, mental health and well-being rests on the capacity of individuals to manage
    their thoughts, feelings and behavior, as well as their interactions with others. It is essential
    that these core attributes of self-control, resilience and confidence be allowed to develop
    and solidify in the formative stages of life, so that individuals are equipped to deal with the
    complex choices and potential adversities they will face as they grow older.
    Alcohol, tobacco and drug use pose risks to mental and physical health, particularly among
    pregnant women and adolescents. Raising awareness about the health risks of substance
    use can be accompanied by implementation of a number of proven strategies for reducing
    their use, including fiscal measures (namely, increased excise taxes) and regulatory
    instruments (such as comprehensive restrictions on advertising, minimum age of use and
    restrictions on smoking in public places).
    Maintaining a healthy diet and regular physical exercise are also protective factors for
    mental health and can be considered as part of a holistic approach to health promotion and
    protection in the population.
    Section 2.13 Supporting families and communities
    Individual-level mental health and well-being is strongly mediated by the immediate social
    context in which people live, work and carry out their day-to-day activities. The focus of
    family- and community-level attention is therefore to foster living and working conditions
    that enable psychosocial development (particularly among vulnerable persons) and
    promote positive interactions within and between families and social groups. Certain
    mental health promotion and protection strategies are targeted at specific groups,
    including: home-based interventions for socioeconomically disadvantaged families and for
    children with a mentally ill parent; prevention of intimate partner violence; school-based
    interventions for children and adolescents exhibiting emotional or behavioral problems;
    work-based interventions for adults looking for employment or struggling to cope at work;
    community-based interventions aimed at enhanced social participation of older adults; and
    psychosocial support for persons affected by conflict or disaster.
    28
    Section 2.14 Supporting vulnerable groups in society
    At the level of social and environmental determinants, key predictors of – and also
    consequences of – mental ill-health include lack of access to basic amenities and services,
    social exclusion, discrimination and exposure to violence, conflict or disasters. State-wide
    policy instruments that can address these failings and contribute towards social equality,
    inclusion and security include: anti-discrimination laws and campaigns; social protection
    for the poor; and elaboration of peaceful relations within and across national or ethnic
    boundaries.
    Section 2.15 Mental Illness
    We have all had some exposure to mental illness, but do we really understand it or know
    what it is? Many of our preconceptions are incorrect. A mental illness can be defined as a
    health condition that changes a person’s thinking, feelings, or behavior (or all three) and
    that causes the person distress and difficulty in functioning. As with many diseases, mental
    illness is severe in some cases and mild in others. Individuals who have a mental illness
    don’t necessarily look like they are sick, especially if their illness is mild. Other individuals
    may show more explicit symptoms such as confusion, agitation, or withdrawal.
    Even if you or a family member has not experienced mental illness directly, it is very likely
    that you have known someone who has. Estimates are that at least one in four people is
    affected by mental illness either directly or indirectly.
    Consider the following statistics to get an idea of just how widespread the effects of mental
    illness are in society:






    According to recent estimates, approximately 20 percent of Americans, or about one
    in five people over the age of 18, suffer from a diagnosable mental disorder in a
    given year.
    Four of the 10 leading causes of disability—major depression, bipolar disorder,
    schizophrenia, and obsessive-compulsive disorder—are mental illnesses.
    About 3 percent of the population have more than one mental illness at a time.
    About 5 percent of adults are affected so seriously by mental illness that it interferes
    with their ability to function in society. These severe and persistent mental illnesses
    include schizophrenia, bipolar disorder, other severe forms of depression, panic
    disorder, and obsessive-compulsive disorder.
    Approximately 20 percent of doctors’ appointments are related to anxiety disorders
    such as panic attacks. Eight million people have depression each year.
    Two million Americans have schizophrenia disorders, and 300,000 new cases are
    diagnosed each year.
    29
    Section 2.16 Mood Disorders
    Major mood disorders are depression, bipolar disorder, and dysthymic disorder. Like
    anxiety, depression might seem like something that everyone experiences at some point,
    and it is true that most people feel sad or “blue” at times in their lives. A true depressive
    episode, however, is more than just feeling sad for a short period. It is a long-term,
    debilitating illness that usually needs treatment to cure. And bipolar disorder is
    characterized by dramatic shifts in energy and mood, often affecting the individual’s ability
    to carry out day-to-day tasks. Bipolar disorder used to be called manic depression because
    of the way that people would swing between manic and depressive episodes.
    Section 2.17 Depression
    Depression, or depressive disorders, is a leading cause of disability in the United States as
    well as worldwide. It affects an estimated 9.5 percent of American adults in a given year.
    Nearly twice as many women as men have depression. Depression is more than just being
    in a bad mood or feeling sad. Everyone experiences these feelings on occasion, but that
    does not constitute depression. Depression is actually not a single disease; there are three
    main types of depressive disorders. They are major depressive disorder, dysthymia, and
    bipolar disorder (manic-depression).
    While some of the symptoms of depression are common during a passing “blue mood,”
    major depressive disorder is diagnosed when a person has five or more of the symptoms
    nearly every day during a two-week period. Symptoms of depression include a sad mood, a
    loss of interest in activities that one used to enjoy, a change in appetite or weight,
    oversleeping or difficulty sleeping, physical slowing or agitation, energy loss, feelings of
    worthlessness or inappropriate guilt, difficulty concentrating, and recurrent thoughts of
    death or suicide.
    When people have depression, their lives are affected severely: they have trouble
    performing at work or school, and they aren’t interested in normal family and social
    activities. In adults, an untreated major depressive episode lasts an average of nine months.
    At least half of the people who experience an episode of major depression will have another
    episode of depression at some point.
    Section 2.18 Dysthymic Disorder
    Dysthymia is less severe than major depressive disorder, but it is more chronic. In
    dysthymia, a depressed mood along with at least two other symptoms of depression persist
    for at least two years in adults, or one year in children or adolescents. These symptoms
    may not be as disabling, but they do keep affected people from functioning well or feeling
    good. Dysthymia often begins in childhood, adolescence, or early adulthood. On average,
    untreated dysthymia lasts four years in children and adolescents.
    30
    Section 2.19 Bipolar Disorder
    A third type of depressive disorder is bipolar disorder, also called manic-depression. A
    person who has bipolar disorder alternates between episodes of major depression and
    mania (periods of abnormally and persistently elevated mood or irritability). During manic
    periods, the person will also have three or more of the following symptoms: overly inflated
    self-esteem, decreased need for sleep, increased talkativeness, racing thoughts,
    distractibility, increased goal-directed activity or physical agitation, and excessive
    involvement in pleasurable activities that have a high potential for painful consequences.
    While in a manic phase, adolescents may engage in risky or reckless behaviors such as fast
    driving and unsafe sex. Bipolar disorder frequently begins during adolescence or young
    adulthood. Adults with bipolar disorder often have clearly defined episodes of mania and
    depression, with periods of mania every two to four years.
    Section 2.20 The Causes of Depression (depressive disorders)
    Depression, like other mental illnesses, is probably caused by a combination of biological,
    environmental, and social factors, but the exact causes are not yet known. For years,
    scientists thought that low levels of certain neurotransmitters (such as serotonin,
    dopamine, or norepinephrine) in the brain caused depression. However, scientists now
    believe that the interplay of factors leading to depression is much more complex. Genetic
    causes have been suggested from family studies that have shown that between 20 and 50
    percent of children and adolescents with depression have a family history of depression
    and that children of depressed parents are more than three times as likely as children with
    nondepressed parents to experience a depressive disorder. Abnormal endocrine function,
    specifically of the hypothalamus or pituitary, may play a role in causing depression. Other
    risk factors for depressive disorders in youths include stress, cigarette smoking, loss of a
    parent, the breakup of a romantic relationship, attention disorders, learning disorders,
    abuse, neglect, and other trauma including experiencing a natural disaster.
    Section 2.21 Treating depression
    A variety of antidepressant medications and psychotherapies are used to treat depression.
    The most effective treatment for most people is a combination of medication and
    psychotherapy. Many of us are aware that medications are available to treat depressive
    disorders—we see the ads on television and in magazines. Up to 70 percent of people with
    depression can be treated effectively with medication.
    Medications used to treat depressive disorders usually act on the neurotransmission
    pathway. For example, some medications affect the activity of certain neurotransmitters,
    such as serotonin or norepinephrine. Different depressive disorders require different
    medication therapies. For example, individuals who have bipolar disorder are often treated
    with a mood-stabilizing drug, such as lithium, during their manic phase and a combination
    of mood-stabilizer and antidepressant medications during their depressive phase.
    31
    Medications usually lead to relief from the symptoms of depression within six to eight
    weeks. If one drug doesn’t relieve symptoms, doctors can prescribe a different
    antidepressant drug. As with drugs to treat other mental illnesses, patients are monitored
    closely by their doctor for symptoms of depression and for side effects. Patients who
    continue to take their medication for at least six months after recovery from major
    depression are 70 percent less likely to experience a relapse. Psychotherapy helps patients
    learn more effective ways to deal with the problems in their lives. These therapies usually
    involve 6 to 20 weekly meetings. These treatment plans should be revised if there is no
    improvement of symptoms within three or four months.
    Section 2.22 Coping with Depression
    People who have depression (or another depressive disorder) feel exhausted, worthless,
    helpless, and hopeless. These negative thoughts and feelings that are part of depression
    make some people feel like giving up. As treatment takes effect, these thoughts begin to go
    away.
    Some strategies that can help a person waiting for treatment to take effect include setting
    realistic goals in light of the depression and assuming a reasonable amount of
    responsibility; breaking large tasks into small ones, setting some priorities, and doing what
    one can as one can; trying to be with other people and to confide in someone—it is usually
    better than being alone and secretive; participating in activities that may make one feel
    better; getting some mild exercise, going to a movie or a ball game, or participating in
    religious, social, or other activities; expecting one’s mood to improve gradually, not
    immediately (feeling better takes time); postponing important decisions until the
    depression has lifted and discussing big decisions with family or friends who have a more
    objective view of the situation; remembering that positive thinking will replace the
    negative thinking that is part of the depression as one’s depression responds to treatment;
    and letting one’s family and friends help.
    Section 2.23 Anxiety Disorders
    Anxiety Disorders affect about 40 million American adults age 18 years and older (about
    18%) in a given year, causing them to be filled with fearfulness and uncertainty. Unlike the
    relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a
    first date), anxiety disorders last at least 6 months and can get worse if they are not treated.
    Anxiety disorders commonly occur along with other mental or physical illnesses, including
    alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In
    some cases, these other illnesses need to be treated before a person will respond to
    treatment for the anxiety disorder.
    Panic Disorders
    “For me, a panic attack is almost a violent experience. I feel disconnected from reality.
    I feel like I’m losing control in a very extreme way. My heart pounds really hard, I feel
    32
    like I can’t get my breath, and there’s an overwhelming feeling that things are
    crashing in on me.”
    “It started 10 years ago, when I had just graduated from college and started a new job.
    I was sitting in a business seminar in a hotel and this thing came out of the blue. I felt
    like I was dying.”
    “In between attacks there is this dread and anxiety that it’s going to happen again. I’m
    afraid to go back to places where I’ve had an attack. Unless I get help, there soon won’t
    be anyplace where I can go and feel safe from panic.”
    Panic disorder is a real illness that can be successfully treated. It is characterized by sudden
    attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness,
    faintness, or dizziness. During these attacks, people with panic disorder may flush or feel
    chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain,
    or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of
    impending doom, or a fear of losing control.
    A fear of one’s own unexplained physical symptoms is also a symptom of panic disorder.
    People having panic attacks sometimes believe they are having heart attacks, losing their
    minds, or on the verge of death. They can’t predict when or where an attack will occur, and
    between episodes many worry intensely and dread the next attack.
    Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10
    minutes, but some symptoms may last much longer. Panic disorder affects about 6 million
    American adults and is twice as common in women as men. Panic attacks often begin in late
    adolescence or early adulthood, but not everyone who experiences panic attacks will
    develop panic disorder. Many people have just one attack and never have another. The
    tendency to develop panic attacks appears to be inherited.
    Obsessive-Compulsive Disorder
    “I couldn’t do anything without rituals. They invaded every aspect of my life. Counting
    really bogged me down. I would wash my hair three times as opposed to once because
    three was a good luck number and one wasn’t. It took me longer to read because I’d
    count the lines in a paragraph. When I set my alarm at night, I had to set it to a
    number that wouldn’t add up to a ’bad’ number.”
    “I knew the rituals didn’t make sense, and I was deeply ashamed of them, but I couldn’t
    seem to overcome them until I had therapy.”
    “Getting dressed in the morning was tough, because I had a routine, and if I didn’t
    follow the routine, I’d get anxious and would have to get dressed again. I always
    worried that if I didn’t do something, my parents were going to die. I’d have these
    terrible thoughts of harming my parents. That was completely irrational, but the
    33
    thoughts triggered more anxiety and more senseless behavior. Because of the time I
    spent on rituals, I was unable to do a lot of things that were important to me.”
    People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts
    (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce.
    Most of the time, the rituals end up controlling them.
    For example, if people are obsessed with germs or dirt, they may develop a compulsion to
    wash their hands over and over again. If they develop an obsession with intruders, they
    may lock and relock their doors many times before going to bed. Being afraid of social
    embarrassment may prompt people with OCD to comb their hair compulsively in front of a
    mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing
    such rituals is not pleasurable. At best, it produces temporary relief from the anxiety
    created by obsessive thoughts.
    Healthy people also have rituals, such as checking to see if the stove is off several times
    before leaving the house. The difference is that people with OCD perform their rituals even
    though doing so interferes with daily life and they find the repetition distressing. Although
    most adults with OCD recognize that what they are doing is senseless, some adults and
    most children may not realize that their behavior is out of the ordinary.
    OCD affects about 2.2 million American adults, and the problem can be accompanied by
    eating disorders, other anxiety disorders, or depression. It strikes men and women in
    roughly equal numbers and usually appears in childhood, adolescence, or early adulthood.
    One-third of adults with OCD develop symptoms as children, and research indicates that
    OCD might run in families.
    Post-Traumatic Stress Disorder
    “I was raped when I was 25 years old. For a long time, I spoke about the rape as
    though it was something that happened to someone else. I was very aware that it had
    happened to me, but there was just no feeling.”
    “Then I started having flashbacks. They kind of came over me like a splash of water. I
    would be terrified. Suddenly I was reliving the rape. Every instant was startling. I
    wasn’t aware of anything around me, I was in a bubble, just kind of floating. And it was
    scary. Having a flashback can wring you out.”
    “The rape happened the week before Thanksgiving, and I can’t believe the anxiety and
    fear I feel every year around the anniversary date. It’s as though I’ve seen a werewolf. I
    can’t relax, can’t sleep, don’t want to be with anyone. I wonder whether I’ll ever be free
    of this terrible problem.”
    Post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that involved
    physical harm or the threat of physical harm. The person who develops PTSD may have
    34
    been the one who was harmed, the harm may have happened to a loved one, or the person
    may have witnessed a harmful event that happened to loved ones or strangers.
    PTSD was first brought to public attention in relation to war veterans, but it can result from
    a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held
    captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural
    disasters such as floods or earthquakes.
    People with PTSD may startle easily, become emotionally numb (especially in relation to
    people with whom they used to be close), lose interest in things they used to enjoy, have
    trouble feeling affectionate, be irritable, become more aggressive, or even become violent.
    They avoid situations that remind them of the original incident, and anniversaries of the
    incident are often very difficult. PTSD symptoms seem to be worse if the event that
    triggered them was deliberately initiated by another person, as in a mugging or a
    kidnapping.
    Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in
    nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images,
    sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door
    slamming or a car backfiring on the street. A person having a flashback may lose touch with
    reality and believe that the traumatic incident is happening all over again.
    Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually
    begin within 3 months of the incident but occasionally emerge years afterward. They must
    last more than a month to be considered PTSD. The course of the illness varies. Some
    people recover within 6 months, while others have symptoms that last much longer. In
    some people, the condition becomes chronic.
    PTSD affects about 7.7 million American adults, but it can occur at any age, including
    childhood. Women are more likely to develop PTSD than men, and there is some evidence
    that susceptibility to the disorder may run in families. PTSD is often accompanied by
    depression, substance abuse, or one or more of the other anxiety disorders.
    Social Phobia (Social Anxiety Disorder)
    “In any social situation, I felt fear. I would be anxious before I even left the house, and
    it would escalate as I got closer to a college class, a party, or whatever. I would feel
    sick in my stomach-it almost felt like I had the flu. My heart would pound, my palms
    would get sweaty, and I would get this feeling of being removed from myself and from
    everybody else.”
    “When I would walk into a room full of people, I’d turn red and it would feel like
    everybody’s eyes were on me. I was embarrassed to stand off in a corner by myself, but
    I couldn’t think of anything to say to anybody. It was humiliating. I felt so clumsy, I
    couldn’t wait to get out.”
    35
    Social phobia, also called social anxiety disorder, is diagnosed when people become
    overwhelmingly anxious and excessively self-conscious in everyday social situations.
    People with social phobia have an intense, persistent, and chronic fear of being watched
    and judged by others and of doing things that will embarrass them. They can worry for
    days or weeks before a dreaded situation. This fear may become so severe that it interferes
    with work, school, and other ordinary activities, and can make it hard to make and keep
    friends.
    While many people with social phobia realize that their fears about being with people are
    excessive or unreasonable, they are unable to overcome them. Even if they manage to
    confront their fears and be around others, they are usually very anxious beforehand, are
    intensely uncomfortable throughout the encounter, and worry about how they were judged
    for hours afterward.
    Social phobia can be limited to one situation (such as talking to people, eating or drinking,
    or writing on a blackboard in front of others) or may be so broad (such as in generalized
    social phobia) that the person experiences anxiety around almost anyone other than the
    family.
    Physical symptoms that often accompany social phobia include blushing, profuse sweating,
    trembling, nausea, and difficulty talking. When these symptoms occur, people with social
    phobia feel as though all eyes are focused on them.
    Social phobia affects about 15 million American adults. Women and men are equally likely
    to develop the disorder, which usually begins in childhood or early adolescence.2 There is
    some evidence that genetic factors are involved. Social phobia is often accompanied by
    other anxiety disorders or depression, and substance abuse may develop if people try to
    self-medicate their anxiety.
    A specific phobia is an intense, irrational fear of something that poses little or no actual
    danger. Some of the more common specific phobias are centered around closed-in places,
    heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving
    blood. Such phobias aren’t just extreme fear; they are irrational fear of a particular thing.
    You may be able to ski the world’s tallest mountains with ease but be unable to go above
    the 5th floor of an office building. While adults with phobias realize that these fears are
    irrational, they often find that facing, or even thinking about facing, the feared object or
    situation brings on a panic attack or severe anxiety.
    Specific phobias affect an estimated 19.2 million adult Americans and are twice as common
    in women as men. They usually appear in childhood or adolescence and tend to persist into
    adulthood. The causes of specific phobias are not well understood, but there is some
    evidence that the tendency to develop them may run in families.
    36
    Generalized Anxiety Disorder (GAD)
    “I always thought I was just a worrier. I’d feel keyed up and unable to relax. At times it
    would come and go, and at times it would be constant. It could go on for days. I’d
    worry about what I was going to fix for a dinner party, or what would be a great
    present for somebody. I just couldn’t let something go.”
    “When my problems were at their worst, I’d miss work and feel just terrible about it.
    Then I worried that I’d lose my job. My life was miserable until I got treatment.
    “I’d have terrible sleeping problems. There were times I’d wake up wired in the middle
    of the night. I had trouble concentrating, even reading the newspaper or a novel.
    Sometimes I’d feel a little lightheaded. My heart would race or pound. And that would
    make me worry more. I was always imagining things were worse than they really
    were. When I got a stomachache, I’d think it was an ulcer.”
    People with generalized…

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