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- What is Anxiety?
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What is Anxiety?
Everyone has felt a little anxious at some time point in their lives. In fact, some degree of anxiety is perfectly normal! Both children and adults may suffer from routine anxiety which is often brought on by physical situations. These situations can range from the first day of school to job interviews, flying on an airplane or common anxiety felt on your wedding day.
There are many different types of anxiety disorders, including Generalized Anxiety Disorder (GAD), Panic Disorders, Phobias, Obsessive Compulsive Disorder - OCD in Adults and OCD in Children, Stress Disorders like Post Traumatic Stress Disorder (PTSD) and Anxiety Disorders due to known physical causes.
There are no laboratory tests that can diagnose anxiety disorders, although some specific tests may be performed by a health care professional to rule out disease or serious illness. It is very difficult to diagnosis anxiety as it involves a wide variety of symptoms that often differ from person to person.
A person may display physical signs of anxiety – such as profuse sweating, or they may appear completely normal. A personal history may be reviewed and tests may be run to rule out the following factors that may be causing the symptoms of anxiety:
- Physical disorders (e.g. thyroid problems)
- Prescription drugs
- Alcohol abuse
- Mood-altering drugs
- Caffeine consumption in large amounts
- Work environment (overly noisy or dangerous)
In most cases, the most important information is the patient's psychological and social history. Anyone with chronic anxiety for no apparent reason should see a healthcare professional.
Signs of Anxiety Disorder
Signs of anxiety disorders include:
- Endless checking or rechecking actions
- A constant and unrealistic worry about everyday occurrences and activities
- Fear and anxiety that appear for no apparent reason
These symptoms must be severe enough to seriously affect social and occupational functioning to a significant degree.
Below is a short overview of anxiety disorders and their related symptoms. For more detailed information on these anxiety disorders, click on the links provided.
The main characteristic of panic disorder is the occurrence of panic attacks along with fear of them happening again. People suffering from panic disorder may also experience symptoms of agoraphobia (fear of public places) or situations in which they might have a panic attack and be unable to leave or to find help. This can create a cycle of anxiety and apprehension with the impending fear of the anxiety bringing on a panic attack, and so forth. About 25% of patients with panic disorder develop obsessive-compulsive disorder (OCD). Symptoms of panic disorder include:
- A sudden, uncontrollable attack of terror
- Heart palpitations
- Shortness of breath
- The feeling of being out of control or a terribly frightening feeling, with a strong desire to flee or avoid the situation altogether
Generalized Anxiety Disorder (GAD)
GAD is the most commonly diagnosed anxiety disorder and occurs most frequently in young adults. People with this anxiety disorder find themselves worrying excessively for a period of at least six months accompanied by three or more of the following physical symptoms (only one of the following symptoms is needed in children to diagnose GAD):
- Trembling, twitching
- Difficulty concentrating
- Difficulty breathing
- Sweating, hot flashes Change in appetite
- Frequent need to use bathroom
- Easily startled
- Lump in throat, difficulty swallowing
- Restlessness or feeling on edge
- Muscle tension
If you've ever been described as "painfully shy," you know it's no exaggeration! Extreme shyness (also known as social anxiety disorder or social phobia) can be agonizing. It keeps you from living a normal life, trying new things, making friends and having healthy self-esteem.
People with this anxiety disorder have a deep rooted fear of situations in which they may be exposed to possible scrutiny of others. It involves a fear of being humiliated or judged. It can appear as a fear of performing certain functions in the presence of others, such as public speaking, eating in public or using public lavatories. About 3.7% of the U.S. population ages 18 to 54 - approximately 5.3 million Americans – will suffer from social phobia in any given year! Social phobia occurs in women twice as often as in men, although a higher proportion of men seek help for this disorder. The disorder typically begins in adolescence and rarely develops after age 25. Social phobia can be debilitating. Many people with this illness have a hard time making and keeping friends.
Symptoms can include:
- Canceling social events at the last minute
- Fearing new activities
- Avoiding contact and interaction with others
- Becoming easily embarrassed
- Frequently feeling down or lonely
- Using alcohol or drugs to help relax in social situations
- Worrying for days or weeks about an upcoming social event
- Fearing others may be judgmental
- Feeling self-conscious in everyday situations
- Having an extreme fear of being in an embarrassing situation
- Going to great lengths to avoid social situations
While almost everyone finds some social situation uncomfortable, those suffering with social phobia, may avoid social situations completely. Some people feel extreme shyness in certain situations, but not in others.
These situations may include:
- Public speaking
- Meeting new people, especially members of the opposite sex and authority figures
- Making phone calls
- Eating or drinking in front of others
Physical symptoms often accompany the intense anxiety of social phobia and may include:
- Profuse sweating
- Difficulty talking
Other phobias concern activities or situations (e.g. fear of flying), while many are focused on harmless animals or other objects. Some of the more common specific phobias focus on small enclosed places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood. Phobias are more than just extreme fear - they are irrational fear of a particular thing or situation. You may feel fine flying in airplanes 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.
Obsessive Compulsive Disorder (OCD)
People suffering from obsessive compulsive disorder are constantly occupied with intrusive and unwanted thoughts – often, although not always, accompanied with un-controlled ritualized behavior that eases the anxiety. This affects between 2-3% of the population and is much more common than was previously thought. OCD affects males and females equally. The symptoms of OCD, which are the obsessions and compulsions, may vary.
Common obsessions include:
- Fear of dirt or contamination by germs
- Fear of causing harm to another
- Fear of making a mistake
- Fear of being embarrassed or behaving in a socially unacceptable manner
- Fear of thinking evil or sinful thoughts
- Need for order, excessive neatness or exactness
- Excessive doubt and the need for constant reassurance
Common compulsions include:
- Repeatedly bathing, showering or washing hands
- Refusing to shake hands or touch doorknobs
- Repeatedly checking things, such as locks or stoves
- Constant counting, mentally or aloud, while performing routine tasks
- Constantly arranging things in a certain way
- Eating foods in a specific order
- Being stuck on words, images or thoughts, usually disturbing, that won't go away and can interfere with sleep
- Repeating specific words, phrases or prayers
- Needing to perform tasks a certain number of times
- Collecting or hoarding items with no apparent value
Post Traumatic Stress Disorder (PTSD)
This disorder can arise as a result of a severely distressing or traumatic event. Signs and symptoms of post-traumatic stress disorder typically appear within three months of the traumatic event. However, in some instances, they may not occur until years after the event and may include:
- Flashbacks and distressing dreams associated with the traumatic event
- Distress at anniversaries of the trauma
- Efforts to avoid thoughts, feelings and activities associated with the trauma
- Feelings of detachment or from others and an inability to have loving feelings
- Markedly diminished interest or participation in activities that once were an important source of satisfaction
- Hopelessness about the future — no hope of a family life, career or living
- Physical and psychological hypersensitivity (after the trauma) with at least two of the following reactions: trouble sleeping, anger, difficulty concentrating, exaggerated startle response to noise, and physiological reaction to situations that remind you of the traumatic event. These physiological reactions may include an increase in blood pressure, a rapid heart rate, rapid breathing, muscle tension, nausea and diarrhea.
What Causes Anxiety?
The human body is programmed to sense and respond to danger and threats. When presented with a new situation, the brain searches for a stored memory of the event – so that it can reference how it should react.
If you have not experienced the situation before, and you have no stored memory for it, you are suddenly faced with the unknown and your body reacts chemically, by changing to what is known as flight or fight mode.
This is when a person most often experiences physical symptoms like a racing heart, sweaty palms and a dry mouth. There is often a change in breathing as well as a desire to run away or avoid the situation somehow.
If you have a stored memory for the event – and it was a negative memory (such as being bitten by a snake for example) then, upon entering a snake park, your brain will reference this memory and react accordingly, producing the physical signs of anxiety.
These physical symptoms are the body’s healthy response to a feared event, object or situation. They are caused by an increase in stress hormones which prepare the body physically to deal with a dangerous situation – to either escape it or to fight against it. The stress hormones (e.g. adrenalin) increase the heart rate to provide more oxygen to the muscles and the brain and cause breathing to become faster to get the oxygen into the lungs.
When there is an actual dangerous situation, these symptoms are adaptive and can mean the difference between life and death! The problem arises when this flight or fight reaction of the body takes place when there is no actual danger – or when it is out of proportion to the actual situation that is occurring.
It is important to remember that fear and anxiety are not the same.
Fear is a direct, focused response to a specific event or object, and the person is consciously aware of it. Most people will feel fear if someone points a loaded gun at them or if they see a tornado forming on the horizon. They also will recognize that they are afraid.
Anxiety, on the other hand, is often unfocused, vague, and hard to pin down to a specific cause. This may be because the anxious individual is not consciously aware of the original source of the feeling. In this form it is called free-floating anxiety. An individual observing the anxious person from the outside may be truly puzzled as to the reason for the person's anxiety. Anxiety is difficult to describe concretely because it has so many different potential causes and degrees of intensity.
It is also important to distinguish between anxiety as a feeling or experience, and an anxiety disorder as a diagnosed condition. A person may feel anxious without having an anxiety disorder. Similarly, a person facing a clear and present danger or a realistic fear is not usually considered to be in a state of anxiety.
Other Factors Associated with Anxiety
Learned Associations vs Inherited Conditions
Anxiety disorders often run in families possibly indicating that children may learn unhealthy attitudes and behaviors from parents, as well as healthy ones. Also, recurrent disorders in families may indicate that there is a genetic or inherited factor in some anxiety disorders.
For example, identical twins have a higher rate of panic disorders than in fraternal (non-identical) twins. A review of the available studies on Anxiety Disorders suggests that a combination of environmental (learned) and inherited (genetic) factors exist in the manifestation of Anxiety Disorders. This makes some people more susceptible to developing an Anxiety Disorder than others – and environmental triggers (e.g. stress) can therefore more easily result in anxiety symptoms.
Medications and Substance Use
Anxiety symptoms may occur as a side effect of certain medications. These include birth control pills; some thyroid or asthma drugs; some psychotropic agents; occasionally, local anesthetics; corticosteroids; antihypertensive drugs; and nonsteroidal anti-inflammatory drugs.
Although people do not usually think of caffeine as a drug, it can cause anxiety-like symptoms when consumed in sufficient quantity. Patients who consume caffeine rich foods and beverages, (such as chocolate, cocoa, coffee, tea, or carbonated soft drinks - especially cola beverages) can sometimes lower their anxiety symptoms by simply reducing their intake of these substances.
Withdrawal from certain prescription drugs, primarily beta blockers and corticosteroids, as well as withdrawal from drugs of abuse, including LSD, cocaine, alcohol, and opiates, can also cause anxiety. Many people who try to stop benzodiazepines (originally prescribed for anxiety) begin to experience anxiety symptoms when they stop their medication. This is often interpreted as meaning that they ‘need’ the medication rather than as the withdrawal process from the drug itself.
Disease and Illness
Anxiety often occurs as a symptom in other medical conditions. Some of these diseases are disorders of the endocrine system, (such as Cushing's syndrome) and include over- or under activity of the thyroid gland. Other medical conditions that can produce anxiety include respiratory distress syndrome, mitral valve disorders and chest pain caused by inadequate blood supply to the heart. Certain symptoms (e.g. vertigo) may even be caused by problems in the balance center of the inner ear. Anxiety may also be a symptom of other psychiatric disorders such as schizophrenia.
When anxiety symptoms accompany the diagnosis of another disorder, then treatment usually focuses on the primary diagnosis rather than the anxiety itself – which is why it is important that a proper differential diagnosis be done. It makes no sense, for example, to treat anxiety caused by an overactive thyroid. While some minor relief may be experienced, the underlying cause remains untreated – meaning the problem will not resolve.
Social and Environmental Stress
People frequently report feelings of high anxiety when they anticipate and fear the loss of social approval or love. Another social stressor is prejudice. People who belong to groups that are targets of bias are at higher risk for developing anxiety disorders. Some experts believe, for example, that the higher rates of phobias and panic disorders among women, reflects their greater social and economic vulnerability.
Some controversial studies indicate that the increase in violent or upsetting pictures and stories in news reports and entertainment may raise the anxiety level of many people. Stress and anxiety management programs often suggest that patients cut down their exposure to upsetting people, programs and events. This may be particularly relevant in the case of young children who develop problems with anxiety.
Anxiety may also be caused by environmental or occupational factors. People who must live or work around sudden or loud noises, bright or flashing lights, chemical vapors, or similar nuisances, which they cannot avoid or control, may develop heightened anxiety levels. This is because the stimuli they receive from their environment (e.g. loud noises) can put their system into a state of constant alert.
Help for Anxiety
Not all patients with anxiety require treatment, but for more severe cases, treatment is recommended. The important thing to remember is that anxiety disorders do respond to treatment and therefore everyone can be helped.
There are several reasons why it is important for patients with severe anxiety symptoms to get help. Anxiety doesn't always go away by itself! It often progresses and if left untreated, anxiety disorders may eventually lead to a diagnosis of major depression, or interfere with the patient's education or ability to keep a job.
In addition, many anxious patients develop addictions to drugs or alcohol when they try to medicate their symptoms. Moreover, since children learn ways of coping with anxiety from their parents, adults who get help for anxiety disorders are in a better position to help their families cope with factors that lead to anxiety than those who remain untreated.
Because anxiety often has more than one cause and is experienced in highly individual ways, its treatment usually requires more than one type of therapy. In addition, there is no way to tell in advance how patients will respond to a specific medication, remedy or therapy.
Sometimes health care professionals will need to try different methods of treatment before finding the best combination for the particular patient. It usually takes about six to eight weeks to evaluate the effectiveness of a treatment regimen.
Psychological Treatments for Anxiety
By contacting a psychologist, those who suffer from an anxiety disorder can take the first step on the road to recovery. Different psychologists use different approaches to the treatment of anxiety and, as mentioned above, it may take some time before the most appropriate treatment or combination of treatments is found for the individual.
- Cognitive-Behavioral Therapy (CBT): Cognitive-behavioral therapy (CBT) helps in changing the behaviors and thought processes of people with anxiety disorders. The cognitive part of CBT involves changing the thinking patterns that keep the person from overcoming the fear. Someone with panic disorder can learn to understand that they are not having a heart attack when they are having heart palpitations. People are taught to identify the thoughts and situations that stimulate their anxiety, and to view them more realistically. Over time, the individual is helped to change maladaptive thought patterns which contribute to the feelings of anxiety. The behavioral part is meant to change the person's behavior by exposing that person to very thing they fear in manageable, gradual stages until they are desensitized to it. For instance, someone with obsessive compulsive disorder with a fear of germs may be encouraged by a therapist to go a certain amount of time without washing. Doing this repeatedly along with counseling from the therapist eventually helps decrease the anxiety. Sometimes behavioral therapy is used without the component of cognitive therapy. This involves exposing the person to the object or situation that is feared. For these approaches to work, the patient must be ready. (A therapist can help them decide if they are.)
- Psychotherapy: Most people with anxiety disorders will be given some form of psychotherapy, sometimes accompanied by medication. Many people benefit from insight-oriented therapies, which are designed to help them uncover unconscious battles in order to understand how their symptoms developed in the first place. People who are extremely anxious may benefit from supportive psychotherapy, which aims at reducing the symptoms. It centers on the developmental aspects of anxiety disorders solely through talk therapy
- Behavioral Therapies: Behavioral therapies focus on using techniques such as guided imagery, relaxation training, progressive desensitization or flooding as means to reduce anxiety responses or eliminate specific phobias.
- Relaxation training, sometimes called anxiety management training, includes breathing exercises and similar techniques intended to help the patient prevent hyperventilation and relieve the muscle tension associated with the fight-or-flight reaction. The person may also be given a CD to continue the relaxation training at home. Both CBT and relaxation training can be used in group therapy as well as individual treatment. In addition to CBT, support groups are often helpful to anxious patients, because they provide a social network and lessen the embarrassment that often accompanies anxiety symptoms.
- Psychopharmacological Treatments: Medications are often prescribed to relieve the physical and psychological symptoms of anxiety. Most drugs work by counteracting the biochemical and muscular changes involved in the fight-or-flight reaction. Some work directly on the chemicals in the brain that are thought to underlie the anxiety.
- Benzodiazepines: (e.g. Klonopin, Ativan, Valium, Librium, Serax) can help to reduce the symptoms of an anxiety disorder. However, if used long term, dependency may develop, along with tolerance to the drug. With some benzodiazepines, dependency can develop very quickly – even after two or three weeks of use. Because of the development of tolerance to the drug, dosage might have to be increased over time in order to achieve the same effect. Once the person has become dependent on benzodiazepines, it can be difficult for them to stop taking it due to severe withdrawal symptoms. Benzodiazepine dependency is a major problem in the Western World and the use of benzodiazepines for more than a week or two should be considered as a last resort only – after all other interventions have failed. Remember that these drugs also increase the effects of alcohol and the two should never be taken in combination.
- Serotonergic Agents: newer antidepressants act as anti-anxiety agents as well. Unlike benzodiazepines which are faster acting, these drugs can take 4 to 6 weeks for full response. Examples are Luvox, Prozac, Zoloft and Paxil. Although manufacturers claim that they are not dependency forming, withdrawal symptoms when discontinuing these medications are widely reported, along with other side effects like weight gain and loss of libido.
- Tricyclic Antidepressants (TCAs): These are older antidepressants with more side effects typically than the serotonergic agents. They may also take 4 to 6 weeks for full response. Examples include Tofranil, Elavil, Pamelor and Sinequan.
- Combination Serotonin/Norepinephrine Agents: These include medications such as Effexor, Serzone, and Remeron. Response time is also 4 to 6 weeks.
- Antihistamines: Antihistamines, usually prescribed for allergies, were also used for mild to moderate anxiety for many years. These, like the benzodiazepines, work fairly quickly (Atarax, Vistaril), but may also cause drowsiness and other side effects.
- Buspirone (BuSpar): A new serotonergic combination agonist/antagonist. This medication claims to be non-addicting, but may take 2 to 4 weeks for full effect.
- Major Tranquilizers (also called neuroleptics): These are medications that act on a variety of neurotransmitter systems (acetylcholine, dopamine, histamine, adrenergic). Most are somewhat sedating, and have been used in situations where anxiety is severe enough to cause disorganization of thoughts and abnormal physical and mental sensations, such as the sense that things around you aren't real or that you are disconnected with your body (derealization). Commonly used neuroleptics include: Zyprexa, Risperdal, Seroquel, Mellaril, Thorazine, Stelazine, Moban, Navane, Prolixin, and Haldol.
If you have been diagnosed with an anxiety disorder, your healthcare professional may give you a beta-blocker for going into a situation where an attack may happen. The beta-blocker can keep your heart from pounding, your hands from shaking and other physical symptoms from developing.
Before taking medication for an anxiety disorder:
- Ask your healthcare professional to tell you about the effects and side effects, as well as the risk of dependency. Do not allow yourself to be brushed off with simple reassurances that there will be no problems. If you do not receive the information you need from your doctor, seek a second opinion, do your own research on the internet, or ask your pharmacist for a package insert. While drug therapy can be helpful, especially in the short term, many people later regret that they ever started it, finding themselves dependent on their medication as well as having to use a range of drugs to cope with the side effects that may develop.
- Tell your healthcare professional about any alternative therapies or over-the-counter medications you are using.
- Ask your healthcare professional when and how the medication will be stopped. Some drugs have to be tapered slowly under a doctor's care.
Environmental Treatments for Anxiety
- Avoidance or minimization of stimulants. No caffeine, minimize use of asthma medications if possible (bronchodilators, theophylline), avoid use of nasal decongestants, some cough medications, and diet pills
- Avoid or decrease alcohol consumption. While alcohol can help to relax you, it increases anxiety levels when it wears off.
- Good sleep habits. Getting adequate, restful sleep improves response to interventions to treat anxiety disorders. Many people with anxiety disorders who cultivate good sleep habits find that their symptoms diminish significantly.
- Reduction of stressors. Identify and remove or reduce stressful tasks or situations at home, school and work
- Regular exercise helps tremendously with stress and anxiety management and also increases the body’s production of ‘feelgood’ hormones, while reducing stress hormones such as adrenalin.
Learning to Manage Anxiety
Talking with friends or someone from your religious or spiritual community also can help, although this is not a substitute for mental health care. The family is very important in the recovery of an anxiety disorder. Families should be supportive. If family members tend to trivialize the disorder or demand improvement without treatment, individuals suffering from anxiety and the related disorders may experience worse anxiety attack symptoms.
Managing stress and practicing meditation may help calm you and enhance treatment. Early research says heart-pumping exercise such as brisk walking or running may help. Caffeine, illegal drugs and even some over-the-counter cold medications can worsen an anxiety disorder.
Recovery depends on a number of factors such as:
• The specific disorder
• The severity of anxiety attack symptoms
• The specific causes of the anxiety
• The person's degree of control over these causes
• The patient's age, sex, general health, living situation, belief system, social support network, and responses to different medications and forms of therapy
Remember! According to the National Institutes of Mental Health, 90 percent of people with emotional illnesses will improve or recover if they get adequate treatment.
How to Avoid Feeling Anxious
A number of techniques may help manage anxiety attack symptoms, such as:
- Relaxation techniques (meditation, listening to soothing music or having a hot aromatherapy foam bath)
- Breathing exercises
- Distraction (putting the anxiety out of one's mind by focusing thoughts on something else)
As humans, we have significant control over thoughts, and therefore, we can try to re-program our minds and learn ways of preventing anxiety by changing irrational ideas and beliefs.
- Picture yourself confronting your fears. Figure out what scares you and learn to respond differently.
- Change your attitude. Remind yourself that you are in control.
- Learn calming techniques.
- Practice. Place yourself in smaller, more manageable social situations.
- Tell people that you're nervous. This can help put you and others at ease.
- Read as much as you can about anxiety and ways of helping yourself. There are many excellent books written by professionals containing a wealth of information that can help you. Knowledge is power!
More Information on Anxiety
Different Types of Anxiety Disorders
There are many types of anxiety disorders in the adult population. They can be sorted under the following headings:
- Panic Disorders
- Phobias (and social phobia)
- Obsessive-compulsive disorder (OCD)
- Stress disorders, e.g. Post Traumatic Stress Disorder (PTSD)
- Generalized anxiety disorder (GAD)
- Anxiety disorders due to known physical causes (general medical conditions or substance abuse)
Supporting an Anxious Family Member
Family support is important to the recovery process. Like any other illness, anxiety disorders can take a toll on the family and friends of the sufferer.
Sufferers of anxiety disorders and their families may spend months, even years, without knowing what is wrong or how they can help the family member suffering from anxiety.
Household routines are disrupted, sometimes special plans or allowances need to be made, and the person with the disorder may be reluctant to participate in typical social activities. This can be very frustrating and can put an enormous amount of strain on relationships.
These factors can all have a negative impact on family dynamics. Family members should learn as much as they can about the disorder, which will help them know what to expect from the illness and from the sometimes long recovery process.
Family members should also learn when to be patient with the sufferer and when to push or encourage them to do things that they may be avoiding due to the anxiety.
Family members often want to help the sufferer, but do not know how. Here are some important things to keep in mind:
- Anxiety disorders are real, serious, but treatable medical conditions
- Having one is not a sign of weakness or lack of moral character
- There is reliable evidence linking Panic Disorder, Obsessive Compulsive Disorder, and other anxiety disorders to brain chemistry
- Life events can trigger the onset of an anxiety disorder in a person who is genetically predisposed
Some things family members can do to help a loved one diagnosed with an anxiety disorder are:
- Learn about the disorder
- Recognize and praise small accomplishments
- Modify expectations during stressful periods
- Measure progress on the basis of individual improvement, not against some absolute standard
- Be flexible and try to maintain a normal routine
It is also important for family members to keep in mind that the recovery process is stressful for them too. They should build a support network of relatives and friends for themselves. Remember that with proper treatment most anxiety disorders can be overcome!
Anxiety can also affect children. Childhood anxiety may arise for different reasons, but should never be viewed lightly. A child or teen may not know how to put feelings of anxiety or inner turmoil into words.
They may be scared of the dark, being bullied at school or it could have a more serious origin. The root cause should be found as soon as possible and appropriate treatment implemented.