Mock Debate: For-profit organisations should have no place in the delivery of human services and healthcare

In recent years, opponents of our view have subjected us to an organized campaign designed to weaken confidence in the current health care system. The motto of this campaign is heard daily: Medicare is not working and cannot work.

Promoters of this position have steadily escalated their use of scare tactics in the health care debate. The public is told that waiting lists have grown out of control, the system is becoming unaffordable, and that in the future, care for the elderly will bankrupt the health system.

We are told the “solution” to this crisis is to turn allegedly wasteful and inefficient health care services over to the “more efficient” private sector, to increase the role of for-profit providers and to experiment with the creation of for-profit hospitals.

Our group affirms that for-profit organisations should have no place in the delivery of human services and healthcare. As reputable Australian resources are scarce, I have argued my position using some information from our commonwealth friends of Canada as their healthcare system and government is very similar to our own.

Opponents of my argument suggest that private or for-profit healthcare will lower waiting lists. However, health policy analyst Steven Lewis stated that available data contradicts the prevailing opinion that waiting lists are out of control. That data reveals that more procedures are being performed than ever before. And that, on average, data shows stable or declining waiting times (Lewis 2000).

That is not to say that waiting lists are not a problem for people in pain or in deteriorating health. But, says health economist Robert Evans, when efforts are made to find out more about the problem, to determine who is waiting, how long, and why, and to determine what might be the best solution to the problem,

“… it turns out there is little or no hard data behind the clamorous rhetoric.” The data tends to be anecdotal, and efforts to systemize it, and to target a response, are as likely to be attacked as welcomed (Evans 2000).”

Evans also notes that waiting lists have become an argument for those who promote two-tier health care, that is, letting those with the means buy services privately. He warns against such an approach.

“One of the clearest lessons from the U.K. National Health Service is that once you open up private market opportunities for specialists, no amount of public money will ever clear the public waiting lists. If there were no waiting in the public sector, who would ever pay extra for private care (Evans 2000)?”

Two examples that show that channelling public money to the less-efficient private system is a wasteful way to address waiting lists comes from the provinces or Alberta and Manitoba of Canada. Waiting lists are longest and costs are highest for cataract surgery in Alberta in centres where the proportion of private clinics is highest. Similarly, in Manitoba, waiting lists for cataract surgery were twice as long with surgeons who operated in both the private and public systems, in comparison to surgeons who did all their operations in the public system. Surgeons typically billed $1,000 extra per patient if the surgery was done in a private facility (Evans 2000).

Proponents of two-tier health care often point to the large number of aging baby boomers in our society and warn that the health needs of this aging population will bankrupt Medicare.

While health costs do rise as people age, particularly when people reach their seventies and beyond, the impact of aging baby boomers on the health care system is predictable and there is time to prepare. The peak of the baby boom will hit their early seventies in about 2030 (Catholic Health Alliance of Canada).

Careful analysis of health spending shows that our aging population will add more costs to health care, but it need not create a threat to Medicare. The challenge is to ensure that our health care responses to aging are appropriate and effective. For example, we have tended to emphasize institutional care over home care for the elderly, though home care is less expensive and often more appropriate (Catholic Health Alliance of Canada).

Furthermore, proponents of two-tier health care often argue for the contracting out of clinical services to for-profit corporations and maintain that increasing free markets and competition in the health care system would bring market benefits, most notably, lower costs.

This is the position presented by David Gratzer in his book Code Blue. Gratzer and other advocates of private, for-profit health care argue that competitive markets have produced an abundance of inexpensive, high-quality, and widely available food, shelter, and clothing, and that competitive markets would do the same for the health care system, if only the constraints of Medicare were lifted (Gratzer 1999).

But, what evidence is there that this is the case? Is private, for-profit health care cheaper and more efficient than public health care? Does for-profit health care serve more people better at a lower cost? All the evidence says no.

The presumption that there are significant savings to be gained by promoting for-profit health care is evident in Canadian province of Alberta’s recent decision to increase the role of for-profit health care providers in the area. Furthermore, after analyzing the evidence from the American experience, Robert Evans says:

“In effect, the Alberta government’s hopes for increased efficiency through increased for-profit provision of health care have no empirical support, and face extensive counter-evidence (Evans 2000).”

In fact there is strong evidence that the growth of for-profit health care will increase, not decrease costs. More than 20 studies have compared for-profit with not-for-profit acute care. Almost all showed higher costs with for-profit care. Michael Rachis (2000)  highlights the fact that the four most recent studies, which he says are methodically very strong, all favour not-for profit delivery.

In a 1997 article in the New England Journal of Medicine, Harvard physicians Woolhandler and Himmelstein analyzed 1994 data from all 5,201 acute care hospitals in the U.S. They found that for-profit hospitals were 25 per cent more expen-sive per case than public facilities. Fifty-three percent of the difference in cost between public and for-profit hospital care was due to higher adminis-trative charges in commercial facilities (Rachlis 2000).

A 1999 study by Dartmouth University researchers published in the New England Journal of Medicine concluded that introducing for-profit hospitals increased community health costs. Using data from the entire American Medicare program, the authors found that health spending was higher and increased faster in communities where all beds were for-profit compared to com- munities where all beds were not-for-profit (Rachlis 2000).

Why for-profit health care is more expensive:

  • Investors expect profits of 15% annually.
  • Significant time and money must be devoted to investor relations, take-over strategies and defences, marketing, insurance administration, and bill collections — all of which drive up costs.
  • The necessity to compete with every other hospital and clinic results in costly duplication of equipment and facilities in for-profit hospitals.
  • The prevalence of fraud among for-profit providers in the U.S. has become a major cost factor. The cost of monitoring, suppressing and prosecuting such behaviour has become part of the administrative overhead associated with for-profit provision.

One of the principal justifications for extending for-profit provision of health care rests on the assumption that contracting with private, for-profit providers is a more efficient way of meeting health care needs than simply restoring some of the funding previously cut from the public system.

Canadian province of Alberta’s decision to allow private, for-profit facilities to be the site of overnight care covered under the Canada Health Act provides a good example. “The Premier would appear to believe that his proposal is a more efficient approach to expanding the supply of needed services, that private sector organizations, operating under the incentive of profit opportunities, can provide as good or better quality care at lower cost.”

While no one questions the need to find ways to improve the efficiency and effectiveness of the health care delivery system, most sources of “efficiency” in the for-profit provision of care are more illusion than reality. When it comes to measuring quality, research solidly shows that the Canada’s single-payer, and similarly, Australia’s healthcare system works more efficiently than a for-profit system and protects against the deterioration of quality that is evident in for-profit organizations because of pressures to reduce operation costs and to protect larger operating margins (Catholic Health Alliance of Canada).

In fact an overview of studies prepared by Michael Rachlis indicates that the available data on quality of care supports a not-for-profit approach.

“Drs. Himmelstein and Woolhandler concluded in a 1999 article in the Journal of the American Medical Association that for-profit US health maintenance organizations (HMOs) rated lower than not-for-profit HMOs on all 14 quality indicators measured by the National Committee for Quality Assurance… The authors estimated that there would be an extra 5,925 breast cancer deaths annually in the United States if all HMOs were for-profit (Rachilis 2000).”

Another 1999 New England Journal of Medicine report, by Johns Hopkins researchers, investigated all dialysis centres in the United States. It concluded that patients receiving care at for-profit facilities had 20 percent higher death rates and were 26 percent less likely to be placed on a waiting list for renal transplantation than those attending not-for-profit centres (Rachilis 2000).

Advocates of for-profit health care and services argue that, in the case of health care, government has corrupted the market through the implementation of the entitlements established by Medicare. David Gratzer sets out this argument very clearly in his 1999 book, Code Blue.

“Consider that in a normal market, problems are solved by consumers and producers pursuing their own self-interests. Consumers tend to avoid waste and inefficiency because they usually result in higher prices. Instead, consumers seek good products at attractive prices offered by efficient suppliers. Producers search for less costly ways of delivering wanted goods. … Pursuit of self-interest by consumers rewards efficient producers, and pursuit of self-interest by producers rewards cost-conscious consumers (Gratzer 1999).”

So this argument suggests that Medicare is bad for business because it disrupts normal market processes. However, a study by the Conference Board of Canada shows that Canada’s health care system has been a central determinant of the costs of doing business in that country. The study revealed that the lower costs of employer-paid statutory benefits and taxes in Canada, which reflected the existence of a publicly funded health care system, created a significant cost advantage for employers located in Canada (Catholic Health Alliance of Canada).

In fact the strengths of Canada’s Medicare system and its comparative efficiency is good for their whole economy and represents a bargain for Canadian business.

  • Health insurance premiums paid by Canadian employers amount to only 1 per cent of gross pay compared with 8.2 per cent in the U.S., giving them a big leg up on U.S. businesses.
  • In 1999, Ontario accounted for 17% of the North American vehicle production market, up from about 13.5% in 1994. Roughly 90% of Canadian-made vehicles are exported to the U.S. Those exports are valued at $100 billion a year. Automakers building in Canada gain from a number of benefit costs.

“Health care is one of the big advantages. Savings amount to between $1,200 and $1,500 for every vehicle assembled here. In terms of overall production, auto makers that manufacture vehicles in Canada save $3.5 billion to $4 billion a year (Rachilis 2000).”

In Canada’s health care system, it is the combination of public administration and not-for-profit care that helps keep costs under control and lower than those in the United States. A survey of the cash and stock received by senior executives of for-profit hospitals, HMOs, and the like, when a corporate takeover occurs, provides an example of why costs are higher in a for-profit system. To take an extreme example from 1996:

“Leonard Abramson, CEO of U.S. Healthcare, will get more than $967 million in cash and stock, plus a $25 million corporate jet and a $10 million consulting contract, from the firm’s purchase of Aetna. Two of U.S. Healthcare’s co-presidents will receive an extra $11.62 million in cash and stock for joining Aetna (Catholic Health Alliance of Canada).”

Works Cited

Armstrong, Pat, Hugh Armstrong, and Claudia Fegan. Universal health care: what the United States can learn from the Canadian experience. New York: New Press :, 1998. Print.

Evans, Robert G.. The role of private and public health care delivery in Alberta: Health Forum sponsored by the Alberta Congress Board, Edmonton, Alberta, February 5, 2000 : notes from a keynote address by Robert G. Evans.. Vancouver: University of British Columbia, Centre for Health Services and Policy Research, 2000. Print.

“For-Profit Health Care Facts.” Catholic Health Alliance of Canada / Alliance catholique canadienne de la santa. Web. 22 Apr. 2013. <http://www.chac.ca/advocacy/issues_e.php&gt;.

Gratzer, David. Code blue: reviving Canada’s health care system. Toronto: ECW Press, 1999. Print.

Rachlis, Michael. A review of the Alberta private hospital proposal. Ottawa: Caledon Institute of Social Policy, 2000. Print.

Taylor, Christine L.. The corporate response to rising health care costs. Ottawa: Conference Board of Canada, 1996. Print.

Lewis, Steven. “The Myths and Agendas Behind the “Unsustainability Chorus.” BCMA Forum. NA. NA, Vancouver. 11 May 2000.

What is Aversion Therapy?

Similar to other types of behavior therapy, aversion therapy is based on the principles of learning (conditioning) and is done to eliminate the presence of some maladaptive behavior. This is done by pairing the maladaptive behavior (which is in some way rewarding to the person who engages in it — like smoking) with a stimulus that is unpleasant. What happens then is that the pleasant behavior becomes less pleasant and decreases over time until it is gone completely.

Aversion therapy is used when there are stimulus situations and associated behavior patterns that are attractive to the client, but which the therapist and the client both regard as undesirable.

For example, alcoholics enjoy going to pubs and consuming large amounts of alcohol

Aversion therapy involves associating such stimuli and behavior with a very unpleasant unconditioned stimulus, such as an electric shock.

The client thus learns to associate the undesirable behavior with the electric shock, and a link is formed between the undesirable behavior and the reflex response to an electric shock.

In the case of alcoholism, what is often done is to require the client to take a sip of alcohol while under the effect of a nausea-inducing drug.  Sipping the drink is followed almost at once by vomiting. In future the smell of alcohol produces a memory of vomiting and should stop the patient wanting a drink.

More controversially, aversion therapy has been used to “cure” homosexuals by electrocuting them if they become aroused to specific stimuli.

Evaluation of Therapy

Apart from ethical considerations, there are two other issues relating to the use of aversion therapy.

First, it is not very clear how the shocks or drugs have their effects.  It may be that they make the previously attractive stimulus (e.g. sight/smell/taste of alcohol) aversive, or it may be that they inhibit (i.e. reduce) the behavior of drinking.

Second, there are doubts about the long-term effectiveness of aversion therapy.  It can have dramatic effects in the therapist’s office.  However, it is often much less effective in the outside world, where no nausea-inducing drug has been taken and it is obvious that no shocks will be given.

Also, relapse rates are very high – the success of the therapy depends of whether the patient can avoid the stimulus they have been conditioned against.  Aversion therapy also has many ethical problems.

Above: an example from the tv series King of the Hill

 

Resources:

McLeod, S. A. (2010). Aversion Therapy. Retrieved from http://www.simplypsychology.org/aversion-therapy.html

http://www.alleydog.com/glossary/definition.php?term=Aversion%20Therapy

Eating Disorders – Anorexia Nervosa

Right now, 1 percent of all American women — our sisters, mothers and daughters — are starving themselves; some literally starving and exercising themselves to death. Eating disorders are becoming an epidemic, especially among our most promising young women. These women and girls, whom we admire and adore, feel a deep sense of inadequacy and ineffectiveness. Anorexia nervosa is a confusing, complex disease that many people know too little about.

There is no blame in anorexia nervosa. Anorexia is not an indication that parents have gone wrong in raising their children. Cultural, genetic and personality factors interact with life events to initiate and maintain eating disorders.

Anorexia is not fun. Many people who strive to lose weight state, “I wish I were anorexic.” They fail to recognize the wretchedness of the disease. Anorexia is not about feeling thin, proud and beautiful; if you take the time to listen to an anorexic you will hear that they feel fat, unattractive and inadequate. They are scared and trapped.

Anorexia is not something sufferers can just “snap out of.” Anorexics’ minds are not their own; they are possessed by thoughts of weight, body image, food and calories. Many sufferers are not even free of the disease in their sleep, troubled by dreams of food, eating and exercise. Anorexia is an awful, lonely experience that often takes years to conquer.

Anorexia is hard on everyone involved. Living with someone with anorexia nervosa can be exasperating and confusing. To those who do not understand the complexity of the disorder, the sufferer’s behavior seems selfish and manipulative. It is often hard to remember that eating disorders are a manifestation of profound unhappiness and distress.

Anorexia can be deadly. It has one of the highest fatality rates of any mental illness. If you or someone you know shows the signs or symptoms of an eating disorder, take action, get educated and seek help.

Specific Symptoms of Anorexia Nervosa:

A person who suffers from this disorder is typically characterized by their refusal to maintain a body weight which is consistent with their build, age and height. Specifically, a person’s body weight needs to be 85% or less than that which is considered typical for someone of similar build, age and height.

The individual usually experiences an intense and overwhelming fear of gaining weight or becoming fat. This fear is regardless of the person’s actual weight, and will often continue even when the person is near death from starvation. It is related to a person’s poor self-image, which is also a symptom of this disorder. The individual suffering from this disorder believes that their body weight, shape and size is directly related to how good they feel about themselves and their worth as a human being. Persons with this disorder often deny the seriousness of their condition and can not objectively evaluate their own weight.

At least three consecutive menstrual cycles must be missed, if the woman was menstruating previously before the onset of the disorder. Specifically, a woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.

There are two types of anorexia nervosa:

  • Restricting type — The person restricts their food intake on their own and does not engage in binge-eating or purging behavior.
  • Binge eating/purging type — The person self-induces vomiting or misuses laxatives, diuretics, or enemas.

The Body Mass Calculator is one simple way to calculate your healthy weight.

Resources:
PsychCentral

The key features of Panic Disorder

More than three million Americans will experience panic disorder during their lifetime, and there is no typical victim. According to the American Academy of Child and Adolescent Psychiatry, panic disorder can begin during childhood or before age 25.

While it is not clear what causes the disorder, there is a strong suggestion that the tendency is inherited and runs in families. At one time, researchers believed panic disorder was due primarily to psychological problems. Experts now believe that genetic factors or changes in body chemistry, in combination with stressful circumstances or events, play a pivotal role.

According to the American Psychological Association, each panic attack peaks within about 10 minutes. Sometimes attacks repeat in clusters for up to an hour after the initial attack, with associated fear over the possibility of another attack. Subsequent attacks may occur days and even weeks later.

This element of fearfulness is called anticipatory anxiety. People fear having another attack while performing the same activity or being in the same situation as when a previous attack occurred. Anticipatory anxiety can be so extreme that people turn away from the outside world for fear that another attack will be set off.

For example, if an attack occurred while driving on the freeway, a person may fear that repeating this type of driving will cause panic again. He will, then, limit himself to driving only on secondary roads. If panic was experienced while sleeping in bed in the dark, a person might sleep on the couch with the light on to try to prevent another attack.

If an attack was experienced outside while walking through a park or shopping at a mall, a fear of having a future attack in public can occur. This can lead to complete avoidance of any outside activity, which can result in a condition called agoraphobia-the inability to go beyond known and safe surroundings because of intense fear and anxiety.

While a great deal of research has been conducted on panic disorder, the exact cause is unclear. Research does suggest that panic disorder is more prevalent in women than in men.

According to the National Institute of Mental Health (NIMH), panic disorder can also happen with other disorders. Depression and substance abuse commonly occur simultaneously with panic disorder. About 30 percent of people with panic disorder abuse alcohol and 17 percent abuse drugs, such as cocaine and marijuana. This drug abuse can be attributed to unsuccessful attempts by a person with panic disorder to alleviate the anguish and distress caused by his condition.

Major advances have been made through research funded by the NIMH to produce effective treatments to help people with panic disorder. Treatment includes medication and a type of psychotherapy known as cognitive-behavioral therapy.

Appropriate treatment by an experienced professional can reduce or prevent attacks in 70 to 90 percent of people with panic disorder. Most people show significant progress after a few weeks of treatment. Relapses can occur, but they can often be treated effectively.

Symptoms of Panic Disorder

There are more than a dozen physical or emotional sensations that a person can experience during a panic attack. Not everyone experiences all of them, and people with panic disorder may report different feelings when having an attack.

If not recognized and treated, panic disorder can be devastating because it can interfere with relationships, schoolwork, employment and normal development. It is not uncommon for a person with panic disorder to experience an anxious feeling even between attacks. People with panic disorder will begin to avoid situations where they fear an attack may occur or situations where help might not be available. This happens with both adults and children with panic disorder.

For example, a child may be reluctant to go to school or be separated from her parents. Not all children who express separation anxiety do so because they have panic disorder, and it can be very difficult to diagnose. But when properly evaluated and treated with a combination of medication and cognitive-behavioral therapy, children with panic disorder usually respond well. It is recommended that a family physician or pediatrician first evaluate children and adolescents with suspected panic. If no other physical illness or condition is found as a cause for symptoms, a comprehensive evaluation by a child and adolescent psychiatrist should be obtained.

Brain scans and blood tests are not effective in diagnosing panic disorder.

Questions formulated by The Anxiety Disorders Association of America can help an individual determine whether he is experiencing panic disorder. These include:

  1. Are you troubled by repeated and unexpected “attacks” of intense fear or discomfort for no apparent reason?
  2. During such attacks, do you experience at least four of the following symptoms?
    • pounding heart
    • sweating
    • trembling or shaking
    • shortness of breath
    • choking
    • chest pain
    • nausea or abdominal discomfort
    • “jelly” legs
    • dizziness
    • a feeling of unreality or being detached from yourself
    • fear of losing control
    • going crazy
    • fear of dying
    • numbness or tingling sensations or chills or hot flashes
  3. Do you have a fear of places or situations where escape or getting help might be difficult, such as a crowded room or traffic jam?
  4. Do you have a fear of being unable to travel without a companion?
  5. For at least one month following an attack, have you felt persistent:
    • concern about having another attack?
    • worry about going crazy?
    • need to change your behavior to accommodate the attack?

In summary, panic disorder results from having panic attacks. Panic attacks are episodes that come “out of the blue.” They peak within a few minutes and cause feelings of terror and alarming physical symptoms.

People often are convinced during the attack that they are dying and describe a panic attack as the most distressing experience that they have ever had. As a natural response, people dread the next attack and often avoid places or situations where they have had panic attacks.

 

Learn more at: PsychCentral

What is Psychology?

While browsing my collection of followed blogs I came across the Blog what is psychology. The blog has a short yet detailed explanation of what psychology is!

What is psychology? That question is commonly asked by interested persons and/or students who are somewhat puzzled as to how to capture all that the discipline entails in a few short words. To perfectly define psychology is no easy task and the confusion is understandable considering the myriad of applications the science of psychology has across even the most diverse of fields. Visit a hospital, a coffee factory, a police station or even a weight loss and dietary club and sooner or later, if you’re very quiet, you just might see a psychologist skulking somewhere in the bushes.

The word “Psychology” is derived from the Greek word psyche which means “soul” or “mind.” Psychology has its roots in Biology and Philosophy and discussions on these topics date all the way back to ancient Greece. However, it wasn’t until 1879 when Wilhelm Wundt established the first experimental psychology lab in Leipzig Germany that people began to perceive Psychology as a science in its own right.

What is psychology all about in today’s world? Psychology is essentially the study of the human mind and behaviour. It is both an applied and academic field, meaning that some concepts can be and have been used to solve practical problems in a physical environment (applied) while other concepts only exist in the realm of theory (academic) and contribute to the understanding of the phenomena we see around us.

Psychological research might find practical application in areas such as ergonomics, performance enhancement, self-help, mental health treatment, advertising and various other applications affecting day to day life. It can also deepen our appreciation as to how more intangible processes such as thought and emotion occur.

Throughout the history of Psychology there have been various “schools of thought” which endeavoured to explain human thought and behaviour. These schools of thought include structuralism, humanism, cognitivism, psychoanalysis, functionalism, behaviourism, among others. While some persons might view these different approaches as competing forces, each has contributed in its own way to our overall understanding of Psychology. Today, psychologists tend to use more objective, scientific methods to comprehend, explain and predict human behaviour. These methods include but are not limited to experiments, longitudinal research and correlation studies.

Such is the breadth and diversity of Psychology that numerous specialty areas and subfields have emerged. Some of these include abnormal psychology, biological psychology, clinical psychology, cognitive psychology, comparative psychology, developmental psychology, educational psychology, environmental psychology, evolutionary psychology, forensic psychology, health psychology, personality psychology, social psychology, etc.

Psychology is all around us. However it is only when you begin learning about this wonderful science that you really start to realize just how much there is left to learn.

Read more at: What is Psychology?

The key features of Generalized Anxiety Disorder (GAD)

The key feature of Generalized Anxiety Disorder (GAD) is excessive worry.

Everyone worries to some degree at some point about something in their lives. However, the worry experienced by individuals with GAD is clearly out of proportion to the actual likelihood or impact of the feared event. The worry is longstanding.

Themes of worry may include health, finances, job responsibilities, safety of one’s children or even being late for appointments. The worry is difficult to control and interferes with the task at hand. For example, students may find it difficult to get their schoolwork done and parents often describe difficulty letting their child get on the school bus. These feelings of worry and dread are accompanied by physical symptoms such as pain from muscle tension, headache, frequent urination, difficulty swallowing, “lump in the throat” or exaggerated startle response.

For some people this chronic anxiety and worry have become the standard approach taken to all situations and health experts recognize this condition as Generalized Anxiety Disorder. While the exact cause for GAD is uncertain, experts feel that it’s a combination of biological factors and life events. It’s not uncommon for some people with GAD to also have other medical disorders such as depression and/or panic disorder . These may be influenced by the activity certain chemicals systems in the brain.

Symptoms of Generalized Anxiety Disorder

The first sign is chronic, irrational worry that can’t be turned off. This can focus on a variety of topics from health to money to job responsibilities. The worry, while ever present, can peak to the point that it prevents functioning.

Worries can be accompanied by physical symptoms that include trembling, twitching, muscle tension, headaches, sweating or hot flashes. The person might feel lightheaded, out of breath, nauseated or have to go to the bathroom a lot. Some people might feel they have lumps in their throats. Others startle more easily.

GAD comes on gradually and often hits people in childhood or adolescence but can begin in adulthood. According to the Diagnostics Statistics Manual IV, this excessive anxiety occurs more days than not and for at least six months. The person finds it difficult to control the worry.

In addition, there are certain physical conditions associated with GAD. At least three of the following symptoms need to be present for six months:

  • feeling keyed up, restless or on edge
  • being easily fatigued
  • having difficulty concentrating, or having one mind go blank
  • experiencing irritability
  • experiencing muscle tension
  • having sleep disturbances (difficulty falling or staying asleep; or having restless, unsatisfying sleep)

In addition, the focus of the anxiety and worry is not directed to worrying about a particular occurrence, such as having a panic attack, as in panic disorder or being embarrassed in public as in social phobia or being contaminated as in obsessive-compulsive disorder.

The anxiety, worry and physical symptoms cause significant distress or impairment in social, occupational or other important areas of functioning. It also important to rule out that the anxiety is not due to drugs, prescription medication, alcohol or another medical condition, such as hyperthyroidism.

Learn more at: PsychCentral