Anxiety Disorders

Anxiety is a reaction to stress that can affect both one’s physical and psychological health. Many experience anxiety as feeling an excessive range of emotions at once, characterized by prolonged worrying, mental uneasiness, physical tension, apprehension and fear. A wide variety of anxiety disorders exist within the health community, as they are among the most common mental disorders experienced by Americans.

Types of Anxiety Disorders

Generalized Anxiety Disorder (GAD)

A very common chronic disorder often characterized by long-lasting anxiety. Often, the nervous feeling is not focused on any one object or situation. Those suffering from generalized anxiety disorder experience non-specific persistent fear and worry, and become overly concerned with everyday matters. Generalized anxiety disorder is the most common anxiety disorder to affect older adults.

Obsessive-Compulsive Disorder (OCD)

An anxiety disorder primarily characterized by repetitive obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to perform specific acts or rituals). It affects roughly around 3% of the population worldwide. The OCD thought pattern is often likened to superstitions insofar as it involves a belief in a cause-and-effect relationship that may or may not exist. For example, the compulsion of walking in a certain pattern may be employed to alleviate the inexplicable obsession of (perceived) impending harm.

Anxiety disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year.

Panic Disorder

Another chronic disorder, but with symptoms that include brief attacks of intense terror and apprehension. These are often marked by trembling, confusion, dizziness, nausea, and/or difficulty breathing. Panic attacks abruptly arise and peak in less than ten minutes, but can last for several hours.

Post-Traumatic Stress Disorder (PTSD)

One of the more well known anxiety disorders, PTSD is often the result of a traumatic experience. Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying or even a serious accident. It can also result from long term exposure to a severe stressor, the most common example being soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidance, anxiety, anger and depression.

Social Anxiety Disorder

Social Anxiety Disorder often describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. This fear is typically experienced in most (or all) social interactions, although it can be specific to particular social situations. Social anxiety often manifests specific physical symptoms, including blushing, sweating, and difficulty speaking.

Phobic Disorder

Perhaps the single largest category of anxiety disorders, affecting 5% and 12% of the worldwide population. Victims of Phobic Disorder often anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal or location to a bodily fluid or particular situation. Sufferers understand that their fear is not proportional to the actual potential danger, but feel overwhelmed regardless.

Causes of Anxiety Disorders

Women are 60% more likely than men to experience an anxiety disorder over their lifetime.

Research into the causes, diagnosis, prevention and treatment of anxiety disorders continues to expand as an ongoing endeavor. Scientists look at what role genes play in the development of these disorders and are also investigating the effects of environmental factors such as pollution, physical and psychological stress, and diet.

Current evidence suggests that, like heart disease or diabetes, the complexity of mental illnesses most likely results from a combination of genetic, environmental, psychological, and developmental factors. In addition, several parts of the brain act as key factors in the production of fear and anxiety: the amygdala, which triggers fear and anxiety, and the hippocampus, which stores traumatic memories. By discovering more on the brain’s relationship with fear and anxiety, scientists may be able to create better treatments for anxiety disorders.

Other current research on anxiety disorders includes studies that address how well medication and behavioral therapies work, and the safety and effectiveness of medications for children and adolescents who have a combination of anxiety disorders and attention deficit hyperactivity disorder.

Symptoms and Diagnosis

Anxiety disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year, causing multiple feelings of fear and uncertainty.

Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders are often debilitating chronic conditions, which can be present from an early age or begin suddenly after a triggering event. Each anxiety disorder has different symptoms, but the symptoms cluster around excessive and irrational fear and dread. Often occurring at times of high stress, anxiety disorders are frequently accompanied by physiological symptoms such as a headache, sweating, muscle spasms, tachycardia, palpitations, and hypertension. This can lead to fatigue or even exhaustion.

When children suffer from a severe anxiety disorder, their thinking, decision-making ability, perceptions of the environment, learning, and concentration may be affected. They not only experience fear, nervousness, and shyness but also may start avoiding places and activities. If these children are left untreated, they face risks such as poor results at school, avoidance of important social activities, and substance abuse. Children who suffer from an anxiety disorder are likely to suffer other disorders such as depression, eating disorders, attention deficit disorders (both hyperactive and inattentive), and obsessive compulsive disorders.

A doctor must conduct a thorough diagnostic evaluation to determine whether a person’s symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.

Facts and Statistics

• Anxiety disorders commonly occur with other mental illnesses, including alcohol or substance abuse. This has the unfortunate effect of temporarily masking anxiety symptoms and often making them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.
• Women are 60% more likely than men to experience an anxiety disorder over their lifetime.
• Non-Hispanic blacks are 20% less likely, and Hispanics are 30% less likely than non-Hispanic whites to experience an anxiety disorder during their lifetime.
• A large, national survey of adolescent mental health reported that about 8 percent of teens ages 13–18 have an anxiety disorder, with symptoms commonly emerging around age 6. However, of these teens, only 18 percent received mental health care.

Treatment

In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both: treatment choices depend on the problem and the person’s preference.

Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy. Medication must be prescribed by physicians, usually psychiatrists, who can either offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.

Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations of treatment before they find the one that works for them.

Medications

Antidepressants were developed to treat depression but are also effective for anxiety disorders.

The principal medications used for anxiety disorders include antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms.

• Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires a series of changes to occur; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.
  • Selective serotonin reuptake inhibitors (SSRIs) are some of the newest antidepressants, which alter the levels of the neurotransmitter serotonin in the brain. Like other neurotransmitters, SSRIs help brain cells communicate with one another. Fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobias.
  • Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil®), followed by tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are useful in treating panic disorder and social phobia. People prescribed MAOIs cannot eat a variety of foods and beverages or take certain medications, including some types of birth control pills, pain relievers, cold and allergy medications, and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure.

• Anti-Anxiety Drugs, or benzodiazepines, have sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties, and are generally effective in controlling negative effects of anxiety disorders. Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.
  • High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Although benzodiazepines are still sometimes prescribed for long-term everyday use (most commonly for people with panic disorder), there is concern over the development of drug tolerance, dependency and recreational abuse. It has been recommended that benzodiazepines only be considered for individuals who fail to respond to safer medications. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time. Clonazepam (Klonopin®) is used for social phobia and GAD, lorazepam (Ativan®) is helpful for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD.
• Beta-blockers can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. When a feared situation can be predicted (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety under control.

Psychotherapy

You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere.

Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms. You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a mental health professional with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.

Cognitive-behavioral therapy (CBT) has also shown effectiveness in treating anxiety disorders. The cognitive aspect helps people change the thinking patterns that support their fears, while the behavioral aspect helps people change the way they react to anxiety-provoking situations. CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.

For example, a CBT therapist may encourage a person with a social phobia to spend time in feared social situations without giving in to the temptation to flee or to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened. People with PTSD may be supported by recalling their traumatic event to a therapist in a safe situation, which helps reduce the fear it induces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.

CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.