Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how we feel and behave, and they can manifest real physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can be extremely debilitating, having a serious impact on daily life.
People often experience a general state of worry or fear before confronting something challenging such as a test, examination, recital, or interview. These feelings are easily justified and considered normal. Anxiety is considered a problem when symptoms interfere with a person's ability to sleep or otherwise function. Generally speaking, anxiety occurs when a reaction is out of proportion with what might be normally expected in a situation.
What is Generalized Anxiety Disorder (GAD)?
Generalized Anxiety Disorder (GAD) is a chronic disorder characterized by excessive, long-lasting anxiety and worry about nonspecific life events, objects, and situations. GAD sufferers often feel afraid and worry about health, money, family, work, or school, but they have trouble both identifying the specific fear and controlling the worries. Their fear is usually unrealistic or out of proportion with what may be expected in their situation. Sufferers expect failure and disaster to the point that it interferes with daily functions like work, school, social activities, and relationships.
What is Panic Disorder?
Panic Disorder is a type of anxiety characterized by brief or sudden attacks of intense terror and apprehension that leads to shaking, confusion, dizziness, nausea, and difficulty breathing. Panic attacks tend to arise abruptly and peak after 10 minutes, but they then may last for hours. Panic disorders usually occur after frightening experiences or prolonged stress, but they can be spontaneous as well. A panic attack may lead an individual to be acutely aware of any change in normal body function, interpreting it as a life threatening illness - hypervigiliance followed by hypochondriasis. In addition, panic attacks lead a sufferer to expect future attacks, which may cause drastic behavioral changes in order to avoid these attacks.
What is a Phobia?
A Phobia is an irrational fear and avoidance of an object or situation. Phobias are different from generalized anxiety disorders because a phobia has a fear response identified with a specific cause. The fear may be acknowledged as irrational or unnecessary, but the person is still unable to control the anxiety that results. Stimuli for phobia may be as varied as situations, animals, or everyday objects. For example, agoraphobia occurs when one avoids a place or situation to avoid an anxiety or panic attack. Agoraphobics will situate themselves so that escape will not be difficult or embarrassing, and they will change their behavior to reduce anxiety about being able to escape.
What is Social Anxiety Disorder?
Social Anxiety Disorder is a type of social phobia characterized by a fear of being negatively judged by others or a fear of public embarrassment due to impulsive actions. This includes feelings such as stage fright, a fear of intimacy, and a fear of humiliation. This disorder can cause people to avoid public situations and human contact to the point that normal life is rendered impossible.
What is Obsessive-Compulsive Disorder (OCD)?
Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by thoughts or actions that are repetitive, distressing, and intrusive. OCD suffers usually know that their compulsions are unreasonable or irrational, but they serve to alleviate their anxiety. Often, the logic of someone with OCD will appear superstitious, such as an insistence in walking in a certain pattern. OCD sufferers may obsessively clean personal items or hands or constantly check locks, stoves, or light switches.
What is Post-Traumatic Stress Disorder (PTSD)?
Post-traumatic Stress Disorder (PTSD) is anxiety that results from previous trauma such as military combat, rape, hostage situations, or a serious accident. PTSD often leads to flashbacks and behavioral changes in order to avoid certain stimuli.
What are common symptoms of anxiety?
People with anxiety disorders present a variety of physical symptoms in addition to non-physical symptoms that characterize the disorders such as excessive, unrealistic worrying. Many of these symptoms are similar to those exhibited by a person suffering general illness, heart attack, or stroke, and this tends to further increase anxiety. The following is a list of physical symptoms associated with GAD:
- Trembling
- Churning stomach
- Nausea
- Diarrhea
- Headache
- Backache
- Heart palpitations
- Numbness or "pins and needles" in arms, hands or legs
- Sweating/flushing
- Restlessness
- Easily tired
- Trouble concentrating
- Irritability
- Muscle tension
- Frequent urination
- Trouble falling or staying asleep
- Being easily startled
Those suffering from panic disorders may experience similar physical symptoms to those with GAD. They also may experience chest pains, a sense of choking, shortness of breath, and dizziness.
Post-traumatic stress disorders have a range of symptoms that are unique to this form of anxiety. Frequent symptomatic behaviors include:
- Flashbacks or nightmares of re-experiencing the trauma
- Avoidance of people, places, and things that are associated with the original event
- Difficulty concentrating or sleeping
- Closely watching surroundings (hypervigilance)
- Irritability and diminished feelings or aspirations for the future
What Causes Anxiety?
Anxiety disorders may be caused by environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these. It is most commonly triggered by the stress in our lives. Usually anxiety is a response to outside forces, but it is possible that we make ourselves anxious with "negative self-talk" - a habit of always telling ourselves the worst will happen.
Environmental and external factors
Environmental factors that are known to cause several types of anxiety include:
- Trauma from events such as abuse, victimization, or the death of a loved one
- Stress in a personal relationship, marriage, friendship, and divorce
- Stress at work
- Stress from school
- Stress about finances and money
- Stress from a natural disaster
- Lack of oxygen in high altitude areas
Medical factors
Anxiety is associated with medical factors such as anemia, asthma, infections, and several heart conditions. Some medically-related causes of anxiety include:
- Stress from a serious medical illness
- Side effects of medication
- Symptoms of a medical illness
- Lack of oxygen from emphysema, or pulmonary embolism (a blood clot in the lung)
Substance use and abuse
It is estimated that about half of patients who utilize mental health services for anxiety disorders such as GAD, panic disorder, or social phobia are doing so because of alcohol or benzodiazepine dependence. More generally, anxiety is also know to result from:
- Intoxication from an illicit drug, such as cocaine or amphetamines
- Withdrawal from an illicit drug, such as heroin, or from prescription drugs like Vicodin, benzodiazepines, or barbiturates
Genetics
It has been suggested by some researchers that a family history of anxiety increases the likelihood that a person will develop it. That is, some people may have a genetic predisposition that gives them a greater chance of suffering from anxiety disorders.
Brain chemistry
Research has shown that people with abnormal levels of certain neurotransmitters in the brain are more likely to suffer from generalized anxiety disorder. When neurotransmitters are not working properly, the brain's internal communication network breaks down, and the brain may react in an inappropriate way in some situations. This can lead to anxiety.
How is anxiety diagnosed?
A psychiatrist, clinical psychologist, or other mental-health professional is usually enlisted to diagnose anxiety and identify the causes of it. The physician will take a careful medical and personal history, perform a physical examination, and order laboratory tests as needed. There is no one laboratory test that can be used to diagnose anxiety, but tests may provide useful information about a medical condition that may be causing physical illness or other anxiety symptoms.
To be diagnosed with generalized anxiety disorder (GAD), a person must:
- Excessively worry and be anxious about several different events or activities on more days than not for at least six months
- Find it difficult to control the worrying
- Have at least three of the following six symptoms associated with the anxiety on more days than not in the last six months: restlessness, fatigue, irritability, muscle tension, difficulty sleeping, difficulty concentrating
Generally, to be diagnosed with GAD, symptoms must be present more often than not for six months and they must interfere with daily living, causing the sufferer to miss work or school.
If the focus of the anxiety and worry is confined to a particular anxiety disorder, GAD will not be the diagnosis. For example, a physician may diagnose panic disorder if the anxiety is focused on worrying about having a panic attack, social phobia if worrying about being embarrassed in public, separation anxiety disorder if worrying about being away from home or relatives, anorexia nervosa if worrying about gaining weight, or hypochondriasis if worrying about having a serious illness.
Patients with anxiety disorder often present symptoms similar to clinical depression and vice-versa. It is rare for a patient to exhibit symptoms of only one of these.
How is anxiety treated?
Anxiety can be treated medically, with psychological counseling, or independently. Ultimately, the treatment path depends on the cause of the anxiety and the patient's preferences. Often treatments will consist of a combination of psychotherapy, behavioral therapy, and medications.
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.
Self treatment
In some cases, anxiety may be treated at home, without a doctor's supervision. However, this may be limited to situations in which the duration of the anxiety is short and the cause is identified and can be eliminated or avoided. There are several exercises and actions that are recommended to cope with this type of anxiety:
- Learn to manage stress in your life. Keep an eye on pressures and deadlines, and commit to taking time away from study or work.
- Learn a variety of relaxation techniques. Information about physical relaxation methods and meditation techniques can be found in book stores and health food shops.
- Practice deep abdominal breathing. This consists of breathing in deeply and slowly through your nose, taking the air right down to your abdomen, and then breathing out slowly and gently through your mouth. Breathing deeply for too long may lead to dizziness from the extra oxygen.
- Learn to replace "negative self talk" with "coping self talk." Make a list of the negative thoughts you have, and write a list of positive, believable thoughts to replace them. Replace negative thoughts with positive ones.
- Picture yourself successfully facing and conquering a specific fear.
- Talk with a person who is supportive.
- Meditate.
- Exercise.
- Take a long, warm bath.
- Rest in a dark room.
Counseling
A standard method of treating anxiety is with psychological counseling. This can include cognitive-behavioral therapy, psychotherapy, or a combination of therapies.
Cognitive-behavioral therapy (CBT) aims to recognize and change the patient's thinking patterns that are associated with the anxiety and troublesome feelings. This type of therapy has two main parts: a cognitive part designed to limit distorted thinking and a behavioral part designed to change the way people react to the objects or situations that trigger anxiety.
For example, a patient undergoing cognitive-behavioral therapy for panic disorder might work on learning that panic attacks are not really heart attacks. Those receiving this treatment for obsessive-compulsive disorder for cleanliness may work with a therapist to get their hands dirty and wait increasingly longer amounts of time before washing them. Post-traumatic stress disorder sufferers will work with a therapist to recall the traumatic event in a safe situation to alleviate the fear it produces. Exposure-based therapies such as CBT essentially have people confront their fears and try to help them become desensitized to anxiety-triggering situations
Psychotherapy is another type of counseling treatment for anxiety disorders. It consists of talking with a trained mental health professional, psychiatrist, psychologist, social worker, or other counselor. Sessions may be used to explore the causes of anxiety and possible ways to cope with symptoms.
Medicine
Medical treatments for anxiety utilize several types of drugs. If the cause of the anxiety is a physical ailment, treatment will be designed to eliminate the particular ailment. This might involve surgery or other medication to regulate a physical anxiety trigger. Often, however, medicines such as antidepressants, benzodiazepines, tricyclics, and beta-blockers are used to control some of the physical and mental symptoms.
Anxiety historically has been treated with a class of drugs called benzodiazepines. Their use has declined, however, due to their addictive nature. These drugs tend to have few side-effects except for drowsiness and possible dependency. Some common benzodiazepines include:
- Diazepam (Valium)
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
Anti-depressants - especially those in the class of serotonin reuptake inhibitors (SSRI) - are also commonly used to treat anxiety even though they were designed to treat depression. SSRIs have fewer side effects than older anti-depressants, but they are still likely to cause jitters, nausea, and sexual dysfunction when treatment begins. Some anti-depressants include:
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Escitalopram (Lexapro)
- Citalopram (Celexa)
- Venlafaxine (Effexor)
Tricyclics are a class of drugs that are older than SSRIs and have been shown to work well for most anxiety disorders other than obsessive-compulsive disorder. These drugs are known to cause side-effects such as dizziness, drowsiness, dry mouth, and weight gain. Two types of tricyclics include:
- Imipramine (Tofranil)
- Clomipramine (Anafranil)
Additional drugs used to treat anxiety include monoamine oxidase inhibitors (MAOIs), beta-blockers, and buspirone. MAOIs, such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan), are an older type of anti-depressant that is used to treat some anxiety disorders. These drugs carry with them several restrictions on diet and prevent one from taking other medications such as pain relievers. Beat-blockers, such as propranolol (Inderal), are usually used to treat heart conditions, but they can also treat physical symptoms that accompany some anxiety disorders. Buspirone (Buspar) is another type of medication that affects neurotransmitters to control anxiety but lacks the side effects of sleepiness and dependency. However, it has been associated with dizziness, headaches, and nausea.
How is anxiety prevented?
Although anxiety disorders cannot be prevented, there are ways to reduce your risk and methods to control or lessen symptoms. Recommendations include:
- Reducing caffeine, tea, cola, and chocolate consumption.
- Checking with a doctor or pharmacist before using over-the-counter or herbal remedies to see if they contain chemicals that may contribute to anxiety.
- Exercising regularly.
- Eating healthy foods.
- Keeping a regular sleep pattern.
- Seeking counseling and support after a traumatic or disturbing experience.
- Avoiding alcohol, cannabis.
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