Anxiety Disorders

What is Anxiety?

Anxiety is a normal human reaction to stress that we all experience.  It helps us deal with tense situations.  However, when anxiety becomes an excessive, irrational fear of everyday situations, or an unremitting constant state of stress, it has become a disabling problem that interferes with a person’s ability to lead a normal life.  While there are many kinds of anxiety disorders, the five major ones include:  Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD) and Social Anxiety Disorder (Social Phobia).

What Kinds of Anxiety are There?

Let’s take a look at them more closely:  Generalized Anxiety Disorder involves excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.  In Obsessive-Compulsive Disorder (OCD) people are plagued with constant thoughts or fears that lead them to perform certain rituals or routines in hopes of making these thoughts or fears go away. The disturbing thoughts are called obsessions, and the rituals are called compulsions. A well known example is a person with an unreasonable fear of germs who constantly washes his or her hands, but some can be as subtle as a doubt about whether someone is upset with you to the point you repeatedly have to check with them whether they are or not.  People with Panic Disorder have feelings of terror that strike suddenly and repeatedly with no warning, to the point that they can otherwise be very happy individuals without a care in the world.  However, when they suddenly start getting symptoms such as sweating, chest pain, palpitations (irregular heartbeats), and choking feelings, they may feel like they are having a heart attack or “going crazy.”  Those with Post-Traumatic Stress Disorder (PTSD) can develop their symptoms following a traumatic and/or terrifying event, such as a physical or sexual assault, the unexpected death of a friend/loved one, or a natural disaster. Following this they often have lasting and frightening thoughts and memories of the event, and tend to be emotionally numb.  Lastly, Social Anxiety Disorder (previously called Social Phobia), involves an overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule.  Aside from these main ones are others such as Specific Phobias.   A specific phobia is an intense fear of a specific object or situation, such as heights, flying, snakes or spiders.  The level of fear experienced is often out of proportion to the situation, to the point that it may cause the person to avoid common, everyday situations.

How Common are Anxiety Disorders?

Most anxiety disorders begin in childhood, adolescence, and early adulthood. They occur more often in women than in men, and occur with equal frequency in all races.  Anxiety disorders affect about 20 million Americans.

What Causes Anxiety Disorders?

While the exact cause of anxiety disorders is unknown, research on mental illness has made it clear that many of these disorders are caused by a combination of factors, including genetics, changes in the brain and environmental stress.  Most importantly, like other forms of mental illness, they are not the result of a personal weakness, a character flaw, or poor upbringing.  Similar to other chronic illness such as high blood pressure or diabetes, they may be caused by chemical imbalances in the body.   In fact, studies have shown that severe or long-lasting stress can change the balance of chemicals in the brain that control how we think and feel.  Other studies have shown that people with certain anxiety disorders have changes in certain brain structures that control memory or mood.   Studies have also shown that anxiety disorders run in families, which means that they can be inherited from one or both parents, like skin tone, eye or hair color.  Lastly, certain environmental factors (such as a trauma or significant event) may trigger an anxiety disorder in a person who has an inherited susceptibility to developing the disorder.  In other words, a person can carry a dormant gene for anxiety, which is essentially in the “off” position, until one of these life events turns it “on”.

What are the Symptoms of an Anxiety Disorder?

The symptoms vary depending on the type of anxiety disorder, but in general they can include:  feelings of panic, fear, and uneasiness; uncontrollable, obsessive thoughts; repeated thoughts or flashbacks of traumatic experiences; nightmares; ritualistic behaviors, such as repeated hand washing; problems sleeping; cold or sweaty hands and/or feet; shortness of breath; palpitations; an inability to be calm and still; dry mouth; numbness or tingling in the hands or feet; nausea; muscle tension and dizziness.

How Is Anxiety Diagnosed?

The appropriate diagnosis of Anxiety should involve several steps, including a medical exam, a psychological interview, assessment tools and an evaluation for coexisting conditions.    A medical doctor, such as a primary care doctor or a Psychiatrist, will review your medical history and may use several tests to look for physical illness as the cause of the symptoms.  Keep in mind that there are no specific lab tests to diagnose anxiety disorder. However, chemical imbalances found in lab results could point to a medical condition that can lead to anxiety and should be corrected.  Certain studies such as a cardiac evaluation, radiological studies, etc. may be performed.  Then if no illness is found, the person may be referred to a Psychiatrist, Psychologist, or mental health professionals who are specially trained to diagnose and treat mental illnesses.  These professionals use specially designed interview techniques and assessment tools to evaluate a person for an anxiety disorder.

How Do Stress and Anxiety Affect Your Health?

Constant and unremitting stress or anxiety can lead to distress and has profound effects on our body.   For this reason, keeping stress under control is extremely important to our health.   If not it can result in some of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and even suicide.  I’ll explain why later, but for now suffice it to say that stress is the body’s reaction to any change that requires a physical, mental, or emotional adjustment or response, particularly sudden ones.  Stress is all around us and to a certain extent is a normal part of life.  Our bodies require stress to deal with events that happen around us and to us.   For instance, stress keeps us awake, alert, motivated, and ready to avoid sudden danger.  It is part of the so called:  flight or fight response.  The problem is that our body is only equipped to deal with that kind of state for a short period of time.  The assumption is that you only need that kind of a reaction to avoid imminent danger and then you are free to go back to a “normal” – non-stressed state.   However, what if that doesn’t happen and we stay in a state of stress?  If this occurs it can make us sick.

Stress that continues without relief can lead to a negative stress reaction, disturbing the body’s internal balance or equilibrium.  It can then lead to a variety of symptoms such as headaches, upset stomach, irritable bowls, high blood pressure, chest pain, acid reflux, sexual problems and sleeping problems (like problems falling or staying asleep).  It can also lead to emotional problems, such as other forms of anxiety, panic attacks and even depression.  In fact, research has found that stress can bring on or worsen certain symptoms or diseases and it lowers your immune response making “getting sick” easier.  Stress can also be a problem in that it can lead to people engaging in compulsive use of substances or behaviors to try to relieve their stress. These can include alcohol, drugs, food, gambling, sex, shopping, tobacco and the Internet. Rather than relieving the stress and returning the body to a non-stressed state, these substances and compulsive behaviors tend to keep the body in a stressed state causing more problems.   So the stressed person becomes trapped in a vicious circle.

How are Anxiety Disorders Treated?  

While the exact treatment approach depends on the type of disorder, one or a combination of either medication or therapy may be used for most anxiety disorders.  Medicines are used to reduce the symptoms of anxiety disorders and make other treatments more effective.  Sometimes they can be effective alone, but they are best used in combination with therapy.  Medicines include anti-depressants and anxiety-reducing drugs and must be used with great care by highly trained professionals.  These medications can be very safe in the hands of a medical doctor who knows how they affect the whole body, but they can be highly dangerous in the hands of those who are not familiar with their affects on the whole body.  It is for this reason that most of these medications are prescribed by only the most highly medically trained of all mental health professionals, a psychiatrist.  Moving beyond medications, environmental structure is also important, as is Psychotherapy.  Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people by talking through strategies for understanding and dealing with their disorder.  It also can help in uncovering the emotional triggers that are causing the anxiety to begin with and working to eliminate these as triggers.  Like a tool for the right job, there is no best therapy (or best tool).  However, there is the best therapy or therapies for specific types of anxiety disorders.  The ideal treatment will match the correct therapy for the type of anxiety that it is best used to deal with.  In addition to these treatments it is important to keep in mind that our dietary consumption, level of exercise and amount of sleep can affect our level of anxiety.  Much like a car cannot run without gas and proper maintenance the human body is the same and must be cared for.

Can Anxiety Disorders Be Prevented?

Anxiety disorders cannot be prevented; however, there are things that can be done to control or lessen symptoms.  Much like a mobile construction crane has four legs for stability, we can think of ourselves as having four areas that must be kept strong and in balance for us to be able to carry the “heavy loads” of life.  They are our emotional, mental, physical and spiritual selves.  Our emotional self is nourished by our interpersonal relationships with friends or family, the more and the greater the better.  As one of my many female patients recovering from cancer once said well “I am a very rich woman when it comes to friends”.  This is priceless.   Regarding our mental health, this often requires the aid of a professional through counseling, therapy, and medications if needed.  Our physical health is maintained through taking care of our body.  Exercising, getting enough sleep, eating healthy and avoiding the consumption of products that contain caffeine, such as coffee, tea, cola, and surprisingly chocolate can help as well.  Check with your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies, since many “natural” products contain chemicals that can increase anxiety symptoms.  Lastly, but equally as important is your spiritual health.  If you are not spiritual, meditation and Yoga are great for this.  If you are, or have been spiritual, remember that despite what your family may have told you growing up, the real reason you attend religious ceremonies and events is to enrich yourself at an extremely deep level.  Not to mention, people often surround you at these events, so you don’t feel alone and this adds to strengthening your emotional self.