In this section you will find:
What Is Anxiety?
"Out of nowhere, my heart would start racing -
I'd start sweating and my stomach would cinch up."
Anxiety is your mind and body's natural response to events that are threatening. The right amount of anxiety can help you, but too much anxiety can interfere with your life.
Some worry and anxiety is normal for everyone. But when anxiety is severe, lasts for several weeks and includes symptoms that keep you from doing things you usually would, it may be something to discuss with your health care professional.
Anxiety symptoms are real. They are not just in your head. They can be treated, and they are nothing to be ashamed of. (DBSA)
Anxiety occurs when thought patterns are disturbed in a variety of ways, including obsessive thinking, excessive worrying, or experiencing either fear in general or fear of a specific thing or event.
Click here for links to videos about Anxiety from the MADI Resource Center at Massachusetts General Hospital
Anxiety Disorders
While everyone may have occasional moments of feeling anxious or worried, an anxiety disorder is a treatable medical condition that causes people to feel persistently, uncontrollably anxious, fearful or worried over an extended period of time. The disorder may result in significant distress in a number of settings, such as work, social settings, and home life, and it may dramatically affect people's lives by limiting their ability to engage in a variety of activities. The tendency to develop an anxiety disorder involves complex genetic and environmental factors, and it is possible for a person to have more than one anxiety disorder.
Anxiety disorders are the most common of emotional disorders and affect more than 25 million Americans. Anxiety disorders differ from normal feelings of nervousness. Untreated anxiety disorders can push people into avoiding situations that trigger or worsen their symptoms. People with anxiety disorders are likely to suffer from depression, and they also may abuse alcohol and other drugs in an effort to gain relief from their symptoms. Job performance, school work, and personal relationships can also suffer.
Fight or Flight
As long as humans have been on earth, when they have been confronted with threatening situations, their bodies have had automatic responses to prepare them to fight the threat or run away from it.
For example:
- Increased alertness
- Increased heart rate
- More blood flowing in the muscles of the arms and legs, possibly causing shaking or jitters
- Less blood flowing in the digestive system so more blood is available to the arms and legs, possibly causing dry mouth or abdominal discomfort
- Dilated pupils (for better vision)
- Constricted blood vessels in the skin and open sweat glands, leading to paleness or clamminess
In our brains, the hypothalamus, when stimulated, directs nerve cells to fire and starts a chemical release increasing adrenaline, noradrenaline and cortisol in the blood and causing the reactions listed above.
In people with depression, bipolar disorder and/or anxiety disorders, the fight or flight response may be stimulated more often and for longer periods of time than in people without these illnesses. This means that more things are perceived as threatening. An out-of-balance fight or flight response can cause a person to:
- Have a real physical reaction to everyday people, places or things
- Believe danger is around every corner
- Be convinced something terrible will happen if certain things aren't done a certain way
- Feel constantly keyed-up and on-edge
- Avoid everyday people, places or things in an effort to avoid the anxiety response
All of these things can interfere with people's lives so much that they aren't able to do things they would like to do and their relationships are strained or lost. (DBSA)
What Causes Anxiety Disorders?
Although the exact causes are unclear, scientists believe that several factors, alone or in combination, may contribute to the development of an anxiety disorder. As is the case with depression, inherited characteristics, brain chemistry, and environmental factors such as stressful life events may all play a role in bringing about an episode of anxiety.
Types of Anxiety Disorders
Doctors have classified a number of anxiety disorders, which include a wide range of symptoms:
Generalized Anxiety Disorder
People with GAD also often experience associated symptoms such as: restlessness, feeling keyed up or on edge, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. The anxiety and worry is considered a disorder if it is severe enough to cause significant distress or interferes with social or occupational functioning.
Adults with GAD often worry excessively about everyday, routine life circumstances such as job responsibilities, finances, or the health of themselves or their family members. Children with generalized anxiety disorder are often preoccupied with worries about their success in school and social activities and their ability to obtain the approval of others. They may appear inflexible or excessively worried about conforming to rules and may not be able to enjoy hobbies or other recreational activities. Back to Types of Anxiety Disorders
Panic Disorder
Panic disorder is characterized by repeated panic attacks, at least some of which are "out of the blue." Panic disorder differs from GAD in that the anxiety in panic disorder comes and goes and is of varying intensity, whereas the anxiety of GAD is continuous. In addition, a person with panic disorder experiences at least a month of: persistent concern about having more attacks, worry about the implications of having an attack (for example, "is there something wrong with my heart?"), or a change in behavior related to the attacks (for example, avoiding a place or situation).
Panic attacks are periods of intense fear or anxiety that tend to come on quickly and usually end within 10 minutes. These attacks are accompanied by at least four of the following symptoms of arousal: palpitations (heart racing); sweating; trembling or shaking; shortness of breath or choking; chest pain; feeling dizzy, lightheaded or "woozy"; nausea or upset stomach; face or skin flushing or hot or cold flushes; tingling in hands, feet or other parts of the body; "spaciness" or feeling unreal or cut off from one's surroundings; or feeling as if one may be dying, going crazy, or losing control. Many people with panic disorder develop agoraphobia .
Panic disorder may look different in young people than in adults, because children may tend to focus to an even greater extent on the physical rather than psychological symptoms that accompany panic attacks. Children having a panic attack may appear to be suddenly frightened or upset with no easily identified explanation. Sometimes children having a panic attack incorrectly explain their symptoms as a response to an external trigger. Back to Types of Anxiety Disorders
Agoraphobia
Agoraphobia is anxiety about, or avoidance of, places or situations where previous panic attacks have occurred, or where help or easy escape may not be available in the event of a future panic attack. Some people with agoraphobia avoid the feared situations or require a companion to accompany them, while others endure the feared situations with a great deal of distress. Panic disorder can cause significant difficulties, including marked distress, social and job-related dysfunction, repeated visits to doctors and emergency rooms, and increased rates of depression and alcohol abuse. Back to Types of Anxiety Disorders
Social Anxiety Disorder
Social anxiety disorder (SAD), also known as social phobia, causes significant, often impairing, anxiety about being in situations where an individual perceives him or herself to be the center of attention, as well as fear of embarrassing oneself in social situations. It is characterized by marked and persistent anxiety about performance situations such as public speaking or may be generalized to a variety of social situations including interacting in small groups or with people in authority, where they may be exposed to unfamiliar people or to the possible scrutiny of others. People with SAD often recognize that their fear is excessive or unreasonable, but they avoid such situations or endure them with great difficulty. This avoidance or distress can significantly interfere with a person's normal routine. SAD differs from panic disorder in that the anxiety is focused on social and/or performance situations.
Social phobia may look different in young people than in adults. While adults recognize the excessiveness of their discomfort in social situations, children may not have that understanding. Younger children with social phobia may protest when forced to leave a parent's side, have a tantrum when facing a social encounter, refuse to play with friends, or complain about physical illness at the time of a social event. Adolescents may simply avoid group gatherings or describe little interest in friendships. Back to Types of Anxiety Disorders
Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) produces uncontrollable, recurring thoughts and fears that are often accompanied by repetitive behaviors intended to prevent the fears from being realized. People with OCD typically experience the persistent thoughts, impulses, and images of the disorder as intrusive, unwanted, or inappropriate, and the symptoms may cause them marked anxiety.
Obsessions are preoccupations with certain thoughts or impulses that are not simply excessive worries about everyday problems. Individuals suffering from obsessions might count things out multiple times, worry about potential contamination, or constantly evaluate the symmetry of their surroundings. People with OCD often attempt to suppress, ignore or neutralize their obsessions with another thought or action, without success.
Compulsions are repetitive actions a person feels he or she must carry out. The repetitive actions are aimed at preventing or reducing distress or a dreaded event or situation. Compulsions may include cleaning (such as frequent hand washing) and checking behaviors (such as repeatedly checking whether the stove is off, or if the house is locked).
OCD is commonly diagnosed when a person's obsessions or compulsions cause significant distress, take a substantial period of time each day, and are recognized by the person, at least some of the time, as being unreasonable. Back to Types of Anxiety Disorders
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) may develop after a person experiences or witnesses a highly traumatic event. PTSD produces persistent re-experiencing of the event and intrusive psychological and physical symptoms. In general the traumatic event involves a significant threat of, or experience of, severe bodily harm or loss of life. Some examples of traumatic events that could lead to the development of PTSD are: car accidents; natural disasters such as hurricanes or earthquakes; physical or sexual assault; emotional, physical, or sexual abuse; combat exposure; or learning about the unexpected death or injury of a loved one.
Although not all individuals exposed to a trauma develop PTSD, some individuals experience a number of distressing psychological and physical symptoms including re-experiencing the event, avoidance or numbing, and hyperarousal (difficulty falling or staying sleep, irritability, angry outbursts, difficulty concentrating, being easily startled, or feeling always "on guard").
PTSD is diagnosed when symptoms persist for at least one month and cause significant distress, interference, or impairment at work, school, or in social functioning. Symptoms may last for several months, or become even more chronic. For some people, PTSD symptoms emerge six months or more after the traumatic event. One way PTSD differs from OCD is that in PTSD intrusive thoughts pertain to the traumatic experience. Back to Types of Anxiety Disorders
Treatment of Anxiety Disorders
Effective therapies for anxiety disorders are available, and research is uncovering new treatments that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment right away.
In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person's preference. Before treatment begins, a doctor must conduct a careful diagnostic evaluation to determine whether a person's symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. 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.
People with anxiety disorders who have already received treatment should tell their current doctor about that treatment in detail. If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether the dosage was increased or decreased while they were under treatment, what side effects occurred, and whether the treatment helped them become less anxious. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions, and whether the therapy was useful.
Often people believe that they have "failed" at treatment or that the treatment didn't work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations of treatment before they find the one that works for them.
Medication
The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.
Antidepressants
Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires a series of changes to occur; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.
SSRIs
Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.
Fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. Venlafaxine (Effexor®), a drug closely related to the SSRIs, is used to treat GAD. These medications are started at low doses and gradually increased until they have a beneficial effect.
SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when people first start to take them. These symptoms fade with time. Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another SSRI.
Tricyclics
Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased. They sometimes cause dizziness, drowsiness, dry mouth, and weight gain, which can usually be corrected by changing the dosage or switching to another tricyclic medication.
Tricyclics include imipramine (Tofranil®), which is prescribed for panic disorder and GAD, and clomipramine (Anafranil®), which is the only tricyclic antidepressant useful for treating OCD.
MAOIs
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil®), followed by tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are useful in treating panic disorder and social phobia. People who take MAOIs cannot eat a variety of foods and beverages (including cheese and red wine) that contain tyramine or take certain medications, including some types of birth control pills, pain relievers (such as Advil®, Motrin®, or Tylenol®), cold and allergy medications, and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help lessen these risks. MAOIs can also react with SSRIs to produce a serious condition called "serotonin syndrome," which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions.
Anti-Anxiety Drugs
High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol and who become dependent on medication easily. Clonazepam (Klonopin®) is used for social phobia and GAD, lorazepam (Ativan®) is helpful for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD.
Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.
Buspirone (Buspar®), an azapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.
Beta-Blockers
Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. When a feared situation can be predicted (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety under control.
Taking Medications
Before taking medication for an anxiety disorder:
- Ask your doctor to tell you about the effects and side effects of the drug.
- Tell your doctor about any alternative therapies or over-the-counter medications you are using.
- Ask your doctor when and how the medication should be stopped. Some drugs can't be stopped abruptly but must be tapered off slowly under a doctor's supervision.
- Work with your doctor to determine which medication is right for you and what dosage is best.
- Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
Psychotherapy
Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms.
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. 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.
For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. 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.
People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes. People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened. People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.
Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Often the therapist will accompany the person to a feared situation to provide support and guidance.
CBT is undertaken when people decide they are ready for it and with their permission and cooperation. To be effective, the therapy must be directed at the person's specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.
CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. Often "homework" is assigned for participants to complete between sessions. There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.
Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people. (NIMH)
Sources
The content for Anxiety was provided by the following NNDC sites unless otherwise specified above: