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ANXIETY DISORDERS

Anxiety disorders are the most common of emotional disorders, annually affecting more than 20 million Americans (approximately one in nine). Symptoms of anxiety disorders can include:

• Overwhelming feelings of panic and fear
• Uncontrollable obsessive thoughts
• Painful, intrusive memories; recurring nightmares
• Nausea, sweating, muscle tension, and other uncomfortable physical reactions

Anxiety disorders differ from normal feelings of nervousness, as the symptoms often occur for no apparent reason and do not go away. Rather than functioning as a call to action, these alarming reactions can make everyday experiences sources of potential terror. If left untreated, anxiety disorders can propel people to take extreme measures (such as refusing to leave the house) to avoid situations that may trigger or worsen their anxiety. Job performance and personal relationships inevitably suffer as a result.

Fortunately, these illnesses generally respond well to treatment, and the majority of patients receiving treatment experience significant relief from their symptoms. Unfortunately, many people with anxiety disorders do not seek treatment because they do not recognize their symptoms as a sign of illness or they fear the reactions of co-workers, family, or friends.

Types of Anxiety Disorders

Panic Disorder
The core symptom of panic disorder is the panic attack, an overwhelming fear of being in danger, during which the individual may experience:

• Pounding heart or chest pain
• Sweating, trembling, or shaking
• Shortness of breath or sensation of choking
• Nausea or abdominal pain
• Dizziness or lightheadedness
• Feeling unreal or disconnected
• Fear of losing control, "going crazy," or dying
• Numbness
• Chills or hot flashes

Because these attacks occur unexpectedly and seemingly without reason, people with panic disorder often first believe that they are having a heart attack.

Phobias
A phobia is an uncontrollable, irrational, and persistent fear of a specific object, situation, or activity. The fear experienced by people with phobias can be so great that some individuals go to extreme lengths to avoid the source of their dread. There are three types of phobias:

1.) Specific phobia - An extreme or excessive fear of an object or situation that is not harmful under general conditions. People with specific phobias know that their fear is excessive, but they are unable to overcome the emotion.

2.) Social phobia (also called social anxiety disorder) - Significant anxiety and discomfort related to fear of being embarrassed or scorned in social or performance situations (e.g., public speaking, meeting people, or using public restrooms). Most people experiencing social phobia try to avoid situations that provoke the dread, or endure them with much distress.

3.) Agoraphobia - The fear of experiencing a panic attack in situations from which escape may be difficult or embarrassing. The anxiety of agoraphobia is so severe that individuals typically seek to avoid the situations altogether. Untreated, agoraphobia can become so debilitating that a person may refuse to leave the house.

Phobias are diagnosed only when the specific fear is excessively upsetting or significantly interferes with normal daily activities.

Obsessive-Compulsive Disorder
Obsessions are frequently occurring irrational thoughts that cause great anxiety but that cannot be controlled through reasoning. Common obsessions include preoccupations with dirt or germs, nagging doubts (e.g., "Did I turn off the oven?" or "Did I lock the house?"), and a need to have things in a very particular order. Although an individual with an obsession realizes that the thoughts are unreasonable and not related to real-life problems, this knowledge is not enough to make the unwanted thoughts go away. Instead, to get rid of the obsessive thoughts, people with obsessive-compulsive disorder (OCD) often engage in repetitive rituals, or compulsions, to reduce their anxiety. Examples of compulsions include repeated hand washing (to avoid contamination), constant checking and rechecking to satisfy doubts (e.g., the oven is off; the house is locked), and following rigid rules of order (putting on clothes in exactly the same sequence every day). Compulsive behaviors can sometimes take up more than an hour a day, thus becoming excessively disruptive of normal daily routines and social relationships.

Posttraumatic Stress Disorder
Posttraumatic stress disorder (PTSD) occurs in individuals who have survived a severe or terrifying physical or emotional event. People with PTSD keep experiencing the ordeal through recurrent nightmares or memories of the event, flashbacks, and extreme emotional, mental, and physical distress when exposed to situations that remind them of the trauma. Additional symptoms include:

• Feeling numb or detached
• Trouble sleeping
• Feeling jittery or on guard
• Depression

Events that can trigger PTSD include military combat, violent personal attack (e.g., rape), natural disasters (e.g., earthquake), tragedies (e.g., bombing, plane crash), physical or sexual abuse during childhood, or witnessing another person’s serious injury.

Generalized Anxiety Disorder
People with generalized anxiety disorder (GAD) experience ongoing, exaggerated tension that interferes with daily functioning. Individuals with GAD worry constantly, even when there is no apparent reason for doing so. The focus of these excessive concerns can be health, family, work, or money. In addition, those with GAD are unable to relax, are easily tired and irritable, have difficulty concentrating, and may experience insonia, muscle tension, trembling, fatigue, and headaches. Although people with GAD usually do not seek to avoid specific objects or situations, they are highly likely to have additional mental health difficulties, such as depression, substance abuse, or another anxiety disorder.

What Causes Anxiety Disorders?
Anxiety disorders run in families. For example, if one identical twin has an anxiety disorder, the second twin is likely to have an anxiety disorder as well, which suggests that genetics—possibly in combination with life experiences—makes some people more susceptible to these illnesses. Brain chemistry, too, appears to play a role in the onset of anxiety disorders, since symptoms of anxiety disorders are often relieved by medications that alter levels of chemicals in the brain. Personality also may play a role, as people who have low self-esteem and poor coping skills may be prone to anxiety disorders. Finally, life experiences such as long-term exposure to abuse, violence, or poverty may affect individuals’ susceptibility to these illnesses.

Treatment
Although each anxiety disorder has its own unique characteristics, most anxiety disorders respond well to two types of treatment: medication and psychotherapy. These treatments can be prescribed alone or in combination. Although not cures, both treatments are effective in relieving the symptoms of anxiety disorders, thus enabling individuals to live healthier lives.

Several effective medications are available; therefore, if one does not provide expected results, another can be prescribed. Because medications often require several weeks to achieve their full effect, progress should be monitored by a psychiatrist to determine whether a change is needed in either the type or the amount of medication given.

Three types of psychotherapy have been used successfully to address the symptoms of anxiety disorders. Behavior therapy uses relaxation techniques and exposure to the feared object or situation in a carefully planned, gradual manner so that the individual can learn to control the anxious responses. Cognitive-behavioral therapy helps patients understand their patterns of thinking so that they can react differently to situations that cause anxiety. Psychodynamic psychotherapy is based on the concept that symptoms result from unconscious mental conflict, and that to experience relief from the symptoms their meaning must be uncovered.

People with an anxiety disorder can feel optimistic about overcoming the illness. Effective treatments are available, so it is important, if you or someone you know is experiencing symptoms described in this pamphlet, to visit a psychiatrist, physician, or other mental health professional for a thorough examination.

Other Sources of Information

American Psychiatric Association
1400 K Street, N.W.
Washington, DC 20005
202 682-6000
http://www.psych.org

Anxiety Disorders Association of America
11900 Parklawn Drive, Suite 100
Rockville, MD 20852-2624
(301) 231-9350
http://www.adaa.org

Freedom From Fear
308 Seaview Avenue
Staten Island, NY 10305
(718) 351-1717

National Alliance for the Mentally Ill (NAMI)
200 North Glebe Road
Suite 1015
Arlington, VA 22203-3754
(800) 950-NAMI
http://www.nami.org

© Copyright 1999 American Psychiatric Association ISBN 0-89042-360-1

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National Institute of Mental Health (NIMH)
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National Mental Health Association
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(800) 969-NMHA
http://www.nmha.org

National Self-Help Clearinghouse
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http://www.selfhelpweb.org