Anxiety Disorders

[A.J. Mahari]

Anxiety Disorders
(Stress, Tension)

In this factsheet:

    * The Facts on Anxiety Disorders
    * Causes of Anxiety Disorders
    * Symptoms and Complications of Anxiety Disorders
    * Diagnosing Anxiety Disorders
    * Treating and Preventing Anxiety Disorders

The Facts on Anxiety Disorders

Anxiety disorders are a group of conditions with exaggerated anxiousness and worry about a number of concerns persists for an extended period of time. They are not the same as the common anxiety that we feel as a result of a situation that we perceive as threatening, such as having to do an oral presentation, having a near-miss with a car, or waiting for the results of a lab test.

Some level of anxiety can be helpful. Anxiety can help people deal with a threatening situation, study harder for an exam, and perform better in sports.

When anxiety becomes persistent and interferes with the ability to cope and disrupts daily life, the person may have an anxiety disorder. Anxiety disorders are illnesses that may make people feel anxious most of the time without an obvious reason. In addition to persistent, general anxiety, people may also get occasional, intense moments of anxiety that immobilize them.

Anxiety disorders are the most common of all mental disorders. Many people misunderstand these disorders and think they can get over them on their own (i.e., without treatment). This is usually not the case. Fortunately, there are many treatments available today to help.
Causes of Anxiety Disorders

Anxiety disorders are often related to chemical imbalances in the nervous system, life experiences, or both.

Keep the following in mind:

    * Some medical conditions such as anemia and thyroid problems can cause symptoms of anxiety.
    * Coping with a serious physical illness like cancer can make you anxious.
    * Concern over diagnosis and treatments can lead to excessive and overwhelming anxiety.
    * Certain drugs such as caffeine, alcohol, diet pills, and stimulants can cause anxiety.
    * Constant negative stress in life (such as worries about one's job) can lead to general chronic worry and anxiety.
    * Many anxiety disorders run in families and likely have a genetic predisposition.

Different Types of Anxiety Disorders

Doctors divide anxiety into several different categories to help in creating guidelines for treatment. These are the main types:

Generalized anxiety disorder (GAD) affects about 4% of the population every year. GAD is twice as common in women as in men. GAD usually appears in childhood or adolescence. Worries tend to be about normal things (work, money, chores, etc.), but to an exaggerated degree. It's called "generalized" because there's no particular source of fear. The cause isn't known, but children of people with GAD are more likely to develop anxiety problems.

Panic attacks and panic disorder: Panic attacks are extremely common - 10% to 20% of the population experience a panic attack at some point in their life. People with phobias may have a panic attack if they encounter the object of their fear. Panic disorder is much less common. It's recognized as recurring feelings of terror and fear, which often come on unpredictably, without any clear trigger. Most panic attacks last a couple of minutes, but can continue for up to 10 minutes. After a while, fear of panicking becomes a sort of phobia in itself, as the person tries to avoid situations that might provoke one. Panic attacks can begin at any age, but most often begin in young adults.

Phobic disorders are irrational, intense fears about a particular object or situation. Phobias are common, affecting more than 1 in 10 people. Some phobias begin in childhood, such as fear of animals, the dark, or of strangers, while others usually appear in adulthood, as in phobias of weather, water, heights, flying, or enclosed places. The inconvenience of a specific phobia depends on how likely you are to encounter the object of your fear. The most debilitating types are agoraphobia and social phobia. Agoraphobia (literally, "fear of the marketplace") is anxiety about being caught in public situations when panic develops. It can develop after an embarrassing public panic attack. Social phobia may be a general shyness or fear of particular situations like public speaking. It tends to be more common in women but more severe in men.

Obsessive-compulsive disorder (OCD) is equally common among men and women, and affects about 1.6% of the population every year. These people are bothered by recurring images or ideas that are unpleasant (obsessions), or they develop repetitive habits or rituals (compulsions). The images and ideas may be connected to the repetitive habits. For example, people who fear infection may wash their hands constantly, or those who fear burglars may repeatedly check that the door is locked. Sometimes there's no connection at all between the thoughts and the rituals.

Post-traumatic stress disorder (PTSD) and acute stress disorder are the only types of anxiety with a clear cause. Extreme anxiety often appears after a frightening or horrible experience, particularly if injuries or deaths were witnessed. Acute stress disorder comes on quickly after a traumatic event and lasts less than a month. Feelings are often complicated by feelings of guilt, unworthiness, and betrayal in those who have survived a stressful experience but lost loved ones to it. PTSD, a longer-lasting, more severe form of acute stress disorder, is particularly common among war veterans.

Symptoms and Complications of Anxiety Disorders

Some symptoms of anxiety are common to all types of anxiety disorders. Other symptoms are more specific to a certain type of anxiety disorder. A person may have an anxiety disorder if any of the symptoms listed below interfere with their daily life in any way. Anyone who suspects they may have an anxiety disorder should talk to their doctor.

The common symptoms of anxiety disorders can include:

    * chest pain or discomfort
    * choking
    * chronic and exaggerated worry and tension
    * dizziness or faintness (actual fainting is extremely rare)
    * fear of dying
    * fear of going crazy or losing control
    * feeling a lump in your throat
    * feelings of unreality, strangeness, or detachment from the environment
    * feeling tired
    * flushes or chills
    * inability to relax
    * headaches
    * hot flashes
    * irritability
    * muscle tension
    * muscle tension
    * nausea or diarrhea
    * numbness or tingling sensations
    * palpitations ("fluttering" in the chest) or accelerated heart rate
    * recurring unpleasant thoughts
    * repetitive habits (e.g., washing hands)
    * shortness of breath or smothering sensation
    * startling easily
    * sweating
    * trembling
    * trouble concentrating
    * trouble falling asleep or staying asleep

Complications of anxiety disorders are mostly linked to feelings of inadequacy or depression, because people with these conditions know their behaviour is irrational and damaging to their lives. Depression is particularly common with obsessive-compulsive disorder. People with social phobia often rely on alcohol to reduce their inhibitions. Unfortunately, this can lead to alcohol dependency.

Diagnosing Anxiety Disorders

A person who thinks he or she might have an anxiety disorder should see a doctor. A doctor may perform some tests to make sure that the anxiety does not have a physical cause and will ask questions about the anxiety to determine whether it is an anxiety disorder or may be related to a type of depression.

Treating and Preventing Anxiety Disorders

Doctors use a two-pronged approach to manage anxiety disorders, based on the belief that the condition is part physical and part psychological in nature. Certain medications can help control anxiety, including some types of antidepressants (the serotonin reuptake inhibitors, in particular) and anti-anxiety agents (benzodiazepines). For a small number of people, benzodiazepines can be habit-forming. An alternative treatment is psychological interventions, including specific effective psychotherapies such as cognitive therapy or exposure therapy.

With cognitive therapy, irrational fears are challenged in a logical fashion. Exposure therapy involves confronting the object of the fear. This may need to be done slowly. Exposure therapy works best for specific phobias (like fear of spiders or flying) which often don't respond to medications.

Many people with anxiety benefit from lifestyle modifications, including the following approaches:

    * Determine the cause of the anxiety and confront it (for example, if money is a worry, develop a budget).
    * Reduce caffeine consumption.
    * Reduce alcohol consumption.
    * Reduce or stop smoking.
    * Practice relaxation techniques.
    * Exercise regularly.
    * Gain perspective by talking about your feelings with someone close or a professional counsellor.

Source: http://bodyandhealth.canada.com

[A.J. Mahari]

The Fear of Fear Itself
Are you feeling tightness in the chest, shortness of breath or a galloping heartbeat? Don't panic, it's not a heart attack.

By: Darby Saxbe

It can come out of nowhere. You're shopping for groceries or buckling your seat belt when suddenly your muscles contract and your heart begins to pound.

Panic attacks can be both bewildering and terrifying, but they're not unusual. An estimated 2.4 million people experience one every year. It may begin as tightness in the chest, shortness of breath or a galloping heartbeat. Many sufferers believe they are having a heart attack and rush to the emergency room.

The cause of an attack can be unclear, but they often arise in the face of major life changes, such as childbirth or a new job. Attacks may also follow trauma.

Prevalence rates have been on the upswing since the 1950s, although many experts believe what seems like a trend is simply better diagnosis.

What is a panic attack?

More than a feeling of anxiety, a panic attack produces distinctive physical symptoms. Each person experiences panic differently, but most people report intense fear accompanied by bodily sensations that can range from a racing heart to nausea and dizziness. Panic can come on suddenly or slowly and usually lasts no more than 20 minutes at its peak.

What causes a panic attack?

Scientists believe panic attacks stem from the brain's "fight or flight" system gone awry, often ignited by stress or a traumatic event. In our high-octane society, that response can kick in with no real threat in sight or after the source of stress is long gone.

Research suggests that chronic panic sufferers may be easily flummoxed by their bodily sensations. Someone vulnerable to panic might interpret a rapid heartbeat as a heart attack. If fear overwhelms her, the symptoms intensify in a vicious cycle.

Does it run in families?

Vulnerability to anxiety may have a biological basis. If a parent or sibling has panic attacks, a person's risk increases by about sixfold. A Yale study found that panic attack sufferers had fewer serotonin receptors in their brains, while other studies suggest those with anxiety may have overly sensitive "suffocation alarm systems," which detect a shortage of oxygen even under normal conditions.

What is panic disorder?

Panic attacks are so frightening that sufferers will do just about anything to avoid another. That may mean staying away from situations associated with anxiety. Someone who once panicked on an airplane might decide not to fly. But the fear often extends to other settings; the plane phobic might start to dread cars and buses as well.

People with full-blown panic disorder, in which attacks are a frequent problem, feel constantly vulnerable, which forces them to be vigilant.

Only about a third of people who get occasional panic attacks will go on to develop panic disorder. Even though men and women report the attacks with equal frequency, women are twice as likely to get the disorder.

Some scientists think Irritable Bowel Syndrome (IBS) may be linked to panic disorder. Because IBS can be uncomfortable and embarrassing, sufferers dread their next IBS attack and become highly sensitive to their digestive system. When something feels awry, their agitation mounts, causing real stomach upset and pain. Since both panic and IBS symptoms are highly stress-sensitive, sufferers of either condition might find themselves trapped in a feedback loop.

How can I cope?

Antidepressant medication may help alleviate panic. However, cognitive-behavioral therapy may work even better; researchers estimate that up to 80 percent of panic sufferers can be helped by psychotherapy alone.

Therapists often treat panic by exposing the patient to feared settings of increasing intensity. Exposure therapy can also include exposure to the physical sensations of panic—spinning clients in circles to make them dizzy, having them inhale carbon dioxide or breathe through a straw or jog to raise their heart rates. Once clients learn that those feelings do not signal impending doom, they can better withstand panic—and eventually prevent it altogether.

Source: Psychology Today Magazine, Nov/Dec 2005