What are Anxiety Disorders?

Q: A lot of my friends talk about having anxiety problems. Are they all the same thing?

A: No. Although they are all grouped into a category called Anxiety disorders, and have a common theme of anxiety attached to them, these anxieties affect people and their behaviors in different ways.

Anxiety disorders are the most common of all mental health problems. They are more prevalent among women than among men, and they affect children as well as adults. Anxiety disorders are illnesses. They can be diagnosed and they can be treated. But all too often, they are mistaken for mental weakness or instability, and the resulting social stigma can discourage people with anxiety disorders from seeking help. It is common for people to suffer from more than one anxiety disorder; and for an anxiety disorder to be accompanied by depression, eating disorders or substance abuse.

What is anxiety?

Anxiety is a natural response to a stressful or dangerous situation. The body reacts to a situation with a racing heart, sweaty palms and shortness of breath. For those with an anxiety disorder, this reaction is more intense, occurs frequently and can last hours, even days.

Anxiety may coexist with depression or bipolar disorder and make coping more difficult. It is important that symptoms of anxiety and a mood disorder be treated.

What causes anxiety disorders?

There are no clear-cut answers as to why some people develop an anxiety disorder, although research suggests that a number of factors may be involved. Like most mental health problems, anxiety disorders appear to be caused by a combination of biological factors, psychological factors and challenging life experiences, including:

•        stressful or traumatic life events

•        a family history of anxiety disorders

•        childhood development issues

•        alcohol, medications or illicit substances

•        other medical or psychiatric problems.   

Anxiety disorders include: Panic Disorder with or without Agoraphobia, Social and Specific phobias, PSTG or Post Traumatic Stress Disorder, OCD or Obsessive Compulsive Disorder and GAD or General Anxiety Disorder. 

 I will talk briefly about a few of them here.

Types of Anxiety

Panic Disorder and Agoraphobia

Panic disorder is a real illness that is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.

The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. Most panic attacks end within 20 to 30 minutes, and they rarely last more than an hour. Panic disorder is twice as common in women as men often beginning in late adolescence or early adulthood but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another.

The cause of panic disorder is unclear but it does tend to run in families. There also appears to be a connection with major life transitions or from severe stress.

A full-blown panic attack includes a combination of the following signs and symptoms:

Shortness of breath or hyperventilation Heart palpitations or a racing heart Chest pain or discomfort Trembling or shaking Choking feeling Feeling unreal or detached from your surroundings

Sweating Nausea or upset stomach Feeling dizzy, light-headed, or faint Numbness or tingling sensations Hot or cold flashes Fear of dying, losing control, or going crazy

While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life

Panic attacks may progress into Agoraphobia which is being afraid of having a panic attack in a situation where escape would be difficult or embarrassing or where you wouldn’t be able to get help. It may cause you to avoid many situations like crowded places such as shopping malls cars, airplanes or subways. In severe cases, you might only feel safe at home and be scared to leave the house at all.

Panic disorder is often accompanied by other serious problems, such as depression, drug abuse, or alcoholism.

Phobias - Phobias are divided into two categories: Social phobia, which involves fear of social situations, and Specific phobias, such as fear of flying, blood and heights.

Social phobia is the diagnoses of a person being excessively anxious and self-conscious in everyday social situations. People with social phobia have an intense, persistent, and chronic fear of being observed and judged by others doing something that will embarrass them. They may worry long before the situation occurs and may become so severe that it interferes with your daily activities. Many people with social phobia understand that their fears are excessive or unreasonable but they are unable to overcome them. Even if they manage to confront their fears and be around others, they are usually very anxious beforehand, they are intensely uncomfortable throughout the encounter, and they worry about how they may have been judged for hours after the situation or event has passed.

Physical symptoms that often accompany social phobia include blushing, profuse sweating, trembling, nausea, and difficulty talking. When these symptoms occur people with social phobia feel as though all eyes are focused on them and they are the center of everyone’s attention.

Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. Social phobia is often accompanied by other anxiety disorders or depression, and substance abuse may develop if people try to self-medicate their anxiety.

Specific Phobias - People suffering from a specific phobia are overwhelmed by unreasonable, irrational fears, which they are unable to control. Exposure to feared situations can cause them extreme anxiety and panic, even if they recognize that their fears are illogical. A specific phobia is an intense, irrational fear of something that poses little or no actual danger such as heights, escalators, tunnels, highway driving, water, flying or dog. Facing them or even thinking about them, result in bring on a panic attack or severe anxiety. Symptoms can include sweating, muscle tension, dizziness, or a need to escape.

Generalized Anxiety Disorder - GAD is characterized by excessive and uncontrollable anxiety and worry about events or activities, experienced most days for a period of at least six months. The person will anticipate the worst possible outcomes, even if there is no reason to expect such an outcome.

Worries, doubts, and fears are a normal part of life and it’s natural to be anxious about things sometimes but the difference for those suffering with generalized anxiety disorder (GAD) is that the worrying is excessive, intrusive, persistent and disabling.

People with GAD can’t seem to dispose of their concerns, even though they realize that their anxiety level is higher than the situation calls for. Their day is filled with exaggerated worry and tension with little or nothing to provoke it. They anticipate disaster and are excessively worried about any number of issues like, health, money, family work.

Psychological symptoms:

·         Your worrying significantly disrupts your job, activities, or social life.

·         Worrying is uncontrollable.

·         Worries are exceptionally distressing and stressful.

·         Worry about a variety of things, and seem to expect the worst.

·         Worrying almost every day for at least six months.

·         Can’t seem to relax,

·         Startle easily,

·         Have difficulty concentrating

·         Have trouble falling asleep or staying asleep.

Physical symptoms:

·         Feeling exhausted and tired all the time

·         headaches

·         Muscle aches or muscle tension

·         Trembling or twitching,

·          Irritable

·         Sweating,

·         nausea,

·         Lightheadedness,

·         Frequently having to go to the bathroom

·         Feeling out of breath,

·         Hot flashes.

GAD affects about twice as many women as men. The disorder develops gradually and can begin at any point in life but the years of highest risk are between childhood and middle age. GAD rarely occurs alone and is often accompanied by other anxiety disorders, such as depression, or substance abuse.

Treatments

When to seek professional help for anxiety disorders

While self-help coping strategies for anxiety can be very effective, if your worries, fears, or anxiety attacks have become so great that they’re causing extreme distress or disrupting your daily routine, it is important to seek professional help.

However, most experts agree that the most effective form of treatment for the anxiety disorders include medication, Cognitive Behavioral Therapy (CBT), along with exposure therapy. Many people with anxiety disorders also benefit from the addition of supportive counseling or family therapy.

Once you start to recover it is important to be proactive and work on things to prevent a relapse. Anxiety is not an illness that has a specific cure. Medication and therapy can help to keep symptoms under control, while the person receives therapy, but many symptoms of anxiety, like worrying and fear, occur for almost everyone during everyday life. Therefore it is important to be ready with a plan to manage symptoms as they appear.

What is Cognitive Behavioral Therapy: CBT has been found to be effective for all the anxiety disorders and is the first-choice psychological treatment for anxiety disorders.

CBT is a problem-focused treatment that allows the individual to change unproductive thought patterns and gain control over unwanted behaviours. An important part of CBT is helping people with anxiety disorders to identify, question and correct their tendencies to overestimate danger and their perceived inability to cope with danger. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.

With therapy and repeated practice, people can develop skills that enable them to identify anxiety-related thoughts and beliefs, identify common distortion in their thinking, examine the evidence that supports and does not support their fearful appraisals, and develop less-threatening alternative responses to the feared object or situation.

Specific CBT techniques for people with panic disorder, for instance, can benefit from breathing retraining, which shows them how to slow their breathing and use meditation when they're feeling anxious.

Exposure therapy: 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. Exposure therapy is also known as desensitization treatment, is a systematic process wherein an individual with a fear or phobia is taught relaxation techniques and is then gradually exposed to the object of fear in a controlled situation until it can be tolerated. This is done either directly or through the person’s imagination, to his or her feared situation that triggers anxiety. Over time, the fear reaction is neutralized.  

The theory of exposure therapy is that by practicing exposure to their fears, people have the opportunity to learn that their fears are excessive and irrational, and that the anxiety decreases with more and more practice.

Additional therapies

Support groups and educational resources can also be included in treatment. Anxiety disorders place a great burden on the individuals affected, their families and their friends. Learning all you can about the particular condition touching your life can help you develop tools for living with an anxiety disorder, or living with someone who has an anxiety disorder.

Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Talking with a trusted friend or member of the clergy can also provide support, but it is not a substitute for care from a mental health professional.

Other things you can do

• Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.
• Pay attention to the warning signs. Find out what triggers your anxiety. Make a plan so that you know what to do if your symptoms get worse.
• Get exercise because physical activity can help reduce anxiety whether it is walking, swimming, gardening, or other physical activities.
• Make sure you are eating a healthy diet.
• Avoid alcohol and illicit drugs. It may seem like it may help your worries, but they generally just make things worse.
• Get your sleep, especially if you’re having trouble sleeping.