Anxiety
What Are Anxiety Disorders?
– 7/7/2001
Arousal and stress reactions are essential for human survival; they enable people to pursue important goals and to respond appropriately to danger. In a healthy individual, the stress response (fight, fright, or flight) is provoked by a genuine threat or challenge and is used as a spur for appropriate action. Anxiety, however, is excessive or inappropriate arousal characterized by feelings of apprehension, uncertainty, and fear. The word is derived from the Latin, angere, which means to choke or strangle. It is often not attributable to a real or appropriate threat and can paralyze the individual into inaction or withdrawal. Anxiety can also be a symptom of other psychologic or medical problems, such as depression, substance abuse, or thyroid disease.
Anxiety disorders are the most common psychiatric condition in the United States. About 25 million Americans experience anxiety disorders at some time during their lives; the lifetime risk for an anxiety disorder is nearly 25%. Nevertheless, only about a quarter of those who experience this problem seek help. In recent years, a number of different anxiety disorders have been classified; the two primary ones are generalized anxiety disorder (GAD), which is long-lasting and low-grade, and panic disorder, which has more dramatic symptoms. Other anxiety disorders include phobias, performance anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Anxiety disorders are usually caused by a combination of psychological, physical, and genetic conditions, and treatment is, in general, very effective.
What Are the Symptoms of Anxiety Disorders?
Physically, anxiety is usually expressed through a series of responses that include a rise in blood pressure, a fast heart rate, rapid breathing, and an increase in muscle tension; intestinal blood flow decreases, sometimes resulting in nausea or diarrhea. Specific anxiety disorders are diagnosed based on the severity and duration of symptoms and on additional behavioral characteristics that accompany the symptoms of anxiety.
Generalized Anxiety Disorder Symptoms
Generalized anxiety disorder (GAD), which affects about 10 million Americans, is characterized by a more-or-less constant state of tension and anxiety over various situations; this state lasts more than six months despite the lack of an obvious or specific stressor. It is very difficult to control worry. (For a clear diagnosis of GAD, the worries are not those of other anxiety disorders, such as fear of panic attacks or appearing in public, nor are they obsessive as in obsessive-compulsive disorder. It should be noted, however, that over half of those with GAD also have another anxiety disorder or depression.) Given these conditions, a diagnosis of GAD is confirmed if three or more of the following symptoms are present (only one for children): feeling on edge or very restless; feeling tired; having difficulty with concentration; feeling irritable; having muscle tension; experiencing sleep disturbances. Some of these symptoms occur on most days for six months. Symptoms should cause significant distress and impair normal functioning and not be due to a medical condition or other mood disorder or psychosis.
Panic Disorder Symptoms
Panic disorder is characterized by periodic attacks of anxiety or terror, which usually last 15 to 30 minutes, although residual effects can persist much longer. The frequency and severity of acute states of anxiety determine the diagnosis. During a panic attack a person feels intense fear or discomfort with at least four or more of the following symptoms: rapid heart beat, sweating, shakiness, shortness of breath, a choking feeling, dizziness, nausea, feelings of unreality, numbness, either hot flashes or chills, chest pain, fear of dying, and fear of going insane. A diagnosis of panic disorder is made when a person experiences at least two recurrent, unexpected panic attacks followed by at least one month of fear that another will occur. Frequency of attacks can vary widely. Some people have frequent attacks (for example, every week) that occur for months; others may have clusters of daily attacks followed by week or months of remission. Panic attacks may occur spontaneously or in response to a particular situation. If the patient associates fear with harmless circumstances surrounding the original attack, similar circumstances later on may recall the anxiety and trigger additional panic attacks. Panic attacks that include only one or two symptoms, such as dizziness and heart pounding, are known as limited-symptom attacks; these may be either residual symptoms after a major panic attack or precursors to full-blown attacks. (It should be noted that panic attacks occur with other anxiety disorders, including phobias and posttraumatic stress disorder.)
Phobic Disorders Symptoms
Phobias — overwhelming and irrational fears — are common, but they vary in severity. In most cases, people can avoid or at least endure phobic situations, but in some cases, as with agoraphobia, the anxiety associated with the feared object or situation can be incapacitating.
Agoraphobia. About half of people with panic disorders develop agoraphobia, which has been somewhat misleadingly described as fear of open spaces — the term having been derived from the Greek word agora meaning marketplace. In its severest form, agoraphobia is characterized by a paralyzing terror of being in places or situations from which the patient feels there is no escape or accessible help in case of an attack. (One patient described the terror of going outside as opening a door onto a landscape filled with snakes.) Consequently, agoraphobes confine themselves to places in which they feel safe, usually at home. The patient with agoraphobia often makes complicated plans in order to avoid confronting feared situations and places.
Social Phobia and Performance Anxiety. Social phobia is the fear of being publicly scrutinized and humiliated. The associated symptoms vary in intensity, ranging from mild and tolerable anxiety to a full-blown panic attack. Usually, the fear is directed at a particular activity, such as writing in the presence of others or urinating in a public bathroom. Sometimes social phobia is manifested by extreme shyness and discomfort in social settings; frequent blushing, trembling, and sweating are typical symptoms. Performance anxiety, or stage fright, is a subset of social phobia that occurs when a person must perform in public; symptoms include pounding heart, dry mouth, and tremor.
Simple Phobias. A simple phobia is an irrational fear of specific objects or situations. The most common phobias are fear of animals (usually spiders, snakes, or mice), flying (pterygophobia), heights (acrophobia), water, public transportation, confined spaces (claustrophobia), dentists (odontiatophobia), storms, tunnels, and bridges. When confronting the object or situation, the phobic person experiences panicky feelings, sweating, rapid heart beat, avoidance behavior, and difficulty breathing. Most phobic individuals are aware of the irrationality of their fear, and many endure intense anxiety rather than disclose their disorder. Simple phobias are among the most common medical disorders; in many mild cases, however, they are not significant enough to require treatment.
Obsessive-Compulsive Disorder Symptoms
Obsessive-compulsive disorder (OCD) has been described as hiccups of the mind. Obsessions are recurrent or persistent mental images, thoughts, or ideas, which may result in compulsive behaviors — repetitive, rigid, and self-prescribed routines that are intended to prevent the manifestation of the obsession. Although individuals recognize that the obsessive thoughts and ritualized behavior patterns are senseless and excessive, they cannot stop them in spite of strenuous efforts to ignore or suppress the thoughts or actions. Obsessions and compulsions do not always coexist; however, over half of OCD sufferers have obsessive thoughts without ritualistic behavior.
OCD is time-consuming, distressing, and can disrupt normal functioning. The obsessive thoughts or images can range from mundane worries about whether one has locked a door to bizarre and frightening fantasies of behaving violently toward a loved one. The compulsive acts triggered by such obsessions might include repetitive checking for locked doors or unlit stove burners or calls to loved ones at frequent intervals to be sure they are safe. Some people are compelled to wash their hands every few minutes or spend inordinate amounts of time cleaning their surroundings in order to subdue the fear of contagion. Certain other obsessive disorders, including body dysmorphic disorder (BDD), trichotillomania, and Tourette’s syndrome, may be part of the OCD spectrum. In BDD, people are obsessed with the belief that they are extremely ugly. People with trichotillomania continually pull their hair, leaving bald patches. Symptoms of Tourette’s syndrome include jerky movements, tics, and uncontrollably uttering obscene words. OCD should not be confused with obsessive-compulsive personality, which defines certain character traits (e.g., being a perfectionist, excessively consciousness, morally rigid, and preoccupied with rules and order). These traits do not necessarily occur in people with obsessive-compulsive disorder, which is a psychiatric condition.
Post-Traumatic Stress Disorder Symptoms
Although post-traumatic stress disorder (PTSD) is primarily a reaction to a traumatic event, it is classified as an anxiety disorder because of the similarity of symptoms. The event that precipitates PTSD is usually thought to be outside the norm of human experience, such as sexual assault or combat. Studies indicate, however, that the condition may be very common. It may develop in people who witness accidents, who or are involved with rescues, or who lose loved ones suddenly. It may also occur in people who have serious illness and receive aggressive treatments or who have close family members or friends with such conditions. Symptoms can occur weeks, months, or even years after the traumatic event. The patient struggles to forget the traumatic event and frequently develops emotional numbness and event-related amnesia. Often, however, the PTSD patient suffers a mental flashback and re-experiences the painful circumstance in the form of intrusive dreams or disturbing thoughts and memories, which resemble or recall the trauma. They are often quick to startle or be angry, even from minor matters. Other symptoms may include emotional withdrawal, hopelessness, mood swings, sleep disorders, guilt over surviving the event, inability to concentrate, and an excessive startle response to noise.
