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ANXIETY
DISORDERS
Following in this article are general descriptions,
symptoms, possible causes, and treatment options for each of the
five main categories of anxiety disorders.
We All Worry
From time to time we all worry about things that are important to
us. But for some people, the resolution of a problem does not end
their mental and emotional distress. They immediately start fretting
about something else, and then something else. Their fear becomes
the focal point of their daily experience. For these individuals,
fear becomes a pervasive force that disrupts their lives or, in
some cases, prevents them from functioning normally.
Being afraid is a healthy, normal response. It
is a survival mechanism we share with the animal kingdom that keeps
us out of threatening situations and preserves our lives. But when
fear becomes so intense, so relentless and so overwhelming that
it causes great distress and ongoing disruption of normal functioning,
it is a serious problem that needs to be remedied.
A Wide Range of Causes
Increased stress is a common cause because most people don't know
how to cope with stress effectively. Sometimes genetics plays a
hand. Prescription medications or substance abuse. Many anxiety
problems are mood disorders which can be easily brought under control.
Other causes range from childhood trauma, physical illness, witnessing
a crime or violence………… to chemical imbalances.
Thankfully, today there is an abundance of research to help mental
health professionals understand and treat the various manifestations
of anxiety disorders.
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GENERALIZED
ANXIETY
Generalized Anxiety Disorder, or GAD, is not "butterflies
in the stomach" but a serious disorder characterized by extreme
worry -- and about more than one thing. A person with GAD would
have persistent thoughts such as "What if my husband gets hit
by a car on his way to the store?" or "What if I get sick
and can't take care of my family?" These thoughts might cross
anyone's mind, but a GAD sufferer is not able to "shake them
off" as others can. They are fixated on the feelings of worry
and dread. For these individuals normal anxiety has escalated into
a serious problem that needs treatment.
Anxiety disorders affect every aspect of the sufferers'
lives -- their activities, their decisions, their health, their
businesses or jobs, the thoughts and their family life. When these
people are in a stressful situation their anxieties become acute
and erupt into symptoms.
Symptoms
Constant worrying, uneasiness, restlessness, a sense of dread, always
"keyed-up", fret about health when there are no apparent
problems. When faced with a stressful situation, irrational fear.
Forgetful or confused. Negative interpretation of other peoples
action, feel unsafe.
Physical Symptoms:
- clenching teeth or jaw
- tightened muscles
- holding one's breath
- sleeping problems
- racing heart beat
- breathing difficulties
- chest pain
- hyperventilation
- irritability
Emotional Symptoms:
- irritability
- sadness
- depression
- low self-esteem
- loneliness
- "numb" emotions
- explosive emotions
- feeling guilty
Causes
An Anxiety Disorder can be brought on by a major life trauma, physical
or sexual abuse, a major illness, or a life threatening experience.
Sometimes financial difficulties, grief from a death in one's family
or a divorce can trigger anxiety symptoms. These type of "life
stressors" are inevitable in life. But for many people, they
are the root cause of their anxiety disorders.
Often it is a combination of these stressors that
are just too much for some people to handle. Just think how overwhelming
it would be to have more than one of these major stresses happen
in a short period of time -- the death of a loved one, losing your
job and finding out you have a serious illness.
In addition to external stressors, there are internal
forces at work that sabotage our sense of peace and well-being.
The number one culprit here is negative self image. When a person
is highly self-critical and doesn't allow themselves to be simply
"a human being being human" it can spell trouble in terms
of emotional health. This is tantamount to holding yourself hostage
-- without a ransom demand -- because you don't deserve to be rescued!
Obviously, these types of destructive self-thoughts are a vicious
cycle of misery that need to be treated by a professional counselor.
Treatment Options
Fortunately, there are many avenues of successful treatment for
the full spectrum of anxiety disorders. Behavior Therapy and Cognitive
Behavior Therapy are very helpful treatment methods. For some people,
sessions of psychotherapy can help a person understand the root
causes of their disorder. Relaxation methods such as meditation,
breathing techniques and visualization can help relieve symptoms.
Anti-anxiety drugs can bring relief of anxiety symptoms.
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PANIC
DISORDER (PANIC ATTACKS)
Most people feel panic over something at least once
in their lives. But when it happens frequently and with extreme
intensity it may indicate a serious problem that needs attention.
Panic Disorder, or panic attacks, often begin in the teenage years
or in early adulthood.
A key characteristic of Panic Disorder, is that
it usually comes without warning and without any apparent cause.
The unpredictable nature of panic attacks adds to the distress of
having to deal with this disorder. After a period of time of having
attacks, the sufferer so dreads a repeat of this very unpleasant
experience, that they often develop a fear of having another attack
in addition to the initial disorder.
If attacks persist, it can become so distressful
to the person that he or she may not want to leave their house.
This is a primary cause of Agoraphobia, the extreme fear of going
outside of one's "safety zone," usually their home. For
reasons not yet known, women are twice as likely as men to suffer
from panic attacks.
Symptoms
A Panic Attack, or Panic Disorder, is an unexpected experience of
intense fear accompanied by physical symptoms of accelerated heart
rate, rapid or difficult breathing, shaking, dizziness, sweating,
hot or cold flashes, nausea , choking or smothering sensation. A
person having a Panic Attack may think they are having a heart attack,
since there is usually no apparent reason for the physical symptoms.
There is a mental or psychological aspect of panic
attack which sufferers describe as a "sense of unreality,"
of feeling completely out of control or as though they are "going
to die" or will "go insane."
"Fight or Flight" Response
Human beings have a built-in "fight or flight" response
to a threatening situation. When perceived danger occurs, fear triggers
a physical response where the pituitary glad excretes adrenaline
into the bloodstream. The adrenaline enhances our ability to "fight"
in our defense, or run ("flight") to save our lives. But
when fear is triggered internally instead of by some actual physical
danger, our bodies still experience the symptoms and physical readiness
created by the adrenaline.
Panic Attacks are a serious disorder and can become
disabling. The symptoms alone can be very frightening, especially
when they come on without warning. People having Panic attacks often
show up in Emergency Rooms thinking they have a serious or life-threatening
medical condition.
Possible Causes
Scientists do not know exactly why the body's natural "warning
system" gets triggered when there is no actual danger. First
attacks can be triggered by physical illness or major stress in
a person's life. The causes may involve an interaction of mental,
or psychological and physical events. When stress is severe, as
with the loss of one's job or a death in the family, it may stimulate
the part of the brain that controls fear response. Several very
stressful events happening within a short period of time, can also
set off panic attacks. In addition, panic attacks can accompany
other types of anxiety disorders.
Stresses that may contribute
to the onset of panic attacks are:
- Serious relationship problems
- Concerns about one's health
- Physical illness
- Tensions at the workplace
- Poor self-esteem or self-hatred
- Emotional problems
- Worrying about finances
- Legal problems
- Physical or emotional abuse
- A traumatic situation
- Witnessing or being a victim
of a crime
There is not yet a consensus among professionals
about the exact nature of the causes. There are biological theories,
behavioral theories and psychodynamic theories. There is also a
brain-dysfunction theory and an inner-ear-dysfunction theory. But
as yet, none of them has been proven to be the correct theory. Perhaps
the true cause lies in a combination or synergy of factors. Researchers
do know that panic attacks are connected to major life transitions
that are inherently stressful, such as marriage, divorce, a first
child, school graduation, a new job, etc.
Often Undiagnosed
Unfortunately, Panic Disorder frequently goes undiagnosed and, therefore,
untreated. Some sufferers may rationalize their attacks for a long
time as normal or "no big deal." Other people may call
them nervous or "high strung." Sufferers may think that
what's bothering them is not important because it is from a long
time ago and try to shake it off. They may try to hide their attacks
from family, friends or co-workers. They may lose their jobs due
to their attacks. However, if Panic Disorder goes untreated for
months or years, it may worsen to the degree of seriously interfering
with the normal daily life of the person affected. Sometimes the
sufferer actually helps bring on an attack by responding to the
physical symptoms with more fear. They may be so anxious about the
onset of an attack that they will actually cause an attack themselves.
Or, they may mistakenly think that a symptom is from anxiety when
it is really a flu symptom or simply from physical exertion.
Treatment Options
Cognitive Behavioral Therapy is often helpful to treat anxiety .
This treatment helps the sufferer to be prepared for the situations
that might trigger panic attacks.
How Cognitive Behavioral
Therapy helps patients with panic disorders:
- Explains anxiety and how
to identify symptoms; designs a treatment plan.
- The patient learns to monitor
panic attacks and keeps a record of anxiety inducing situations.
- Relaxation and breathing
techniques are taught.
- Teaches other skills to
help block automatic reaction to fearful situations.
- Shows how to recognize thoughts
and beliefs that trigger anxiety and change their interpretation
from catastrophic to realistic.
- Develops gradual steps for
exposing the patient to situations that cause anxiety.
- Homework to help practice
in everyday life what is being learned in therapy.
- Often a combination of medication
and Cognitive Behavioral Therapy is an effective method of treating
panic disorder.
- Medications that interact
with brain chemicals can reduce or prevent attacks and lessen
anxiety.
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POST TRAUMATIC
STRESS DISORDER (PTSD)
A person with PTSD has experienced an event involving
actual or threatened death or injury to themselves or others. They
have experienced intense fear, a sense of helplessness and horror.
Trauma can be a one-time experience such as rape,
assault, mugging, robbery, fire, accident or a natural disaster
such as a flood or an earthquake, or it can be a prolonged trauma
as in the case of physical or sexual abuse, living in a prison or
concentration camp, or being a refugee.
Our brains and nervous systems are intended to handle
stress and trauma - to a point. When our system is overwhelmed by
traumatic stimuli, it goes into an overload situation. The result
is that the anxiety of these traumatic events stays "locked"
in our nervous system, waiting to be released.
Possible Causes
PTSD can develop after a major traumatic event, either emotional
or physical. This disorder is characterized by flashbacks and nightmares,
and is commonly found in returning military personnel and in people
who have experienced natural disasters or been victims crimes. Other
causes can be serious accidents, violent attacks such as rape or
torture, or witnessing violence in which they or other people are
seriously injured.
It is estimated that about ten percent of the U.S.
population has or has had symptoms of PTSD. It affects people of
all ages who have experienced a trauma. More females than males
suffer from this anxiety disorder. Some people can recover from
a traumatic event with brief therapy and the support of loved ones.
But for others, it persists, often for years.
Symptoms
Symptoms can appear within a few months of a traumatic event or
much later, after an event that triggers symptoms. Typical symptoms
of PTSD are:
- reliving the trauma event
as if it were happening - flashbacks
- intrusive thoughts, images,
feelings and illusions
- re-experiencing the traumatic
even in dreams or nightmares
- intense anxiety and physical
distress when remembering the event
- attempts to avoid the situation,
feelings or activities related to the event
- hypervigilance and scanning;
being on guard
- easily startled, jumpiness
- anger, resentment, irritability
or explosive outbursts
- feeling "numb"
emotionally
- a sense of detachment; "spacing
out"
- overwhelmed by normal situations
- trouble concentrating; poor
memory
- pessimism; a sense of doom
and dread of the future
- survivor guilt
It is important to diagnose and treat Post Traumatic
Stress Disorder. If it is not treated, it could lead to more serious
psychological illnesses, such as clinical depression or drug dependency.
Treatment for PTSD
There are a number of treatments available to mental health professionals
that have good track records with helping PTSD sufferers deal successfully
with their traumatic experiences. Treatment usually focuses on anxiety
reduction and stress-coping techniques. Self-hypnosis can help,
as can relaxation exercises. In many cases, behavioral psychotherapy
is effective. By bringing their experience into the therapy setting,
the trauma survivor usually finds it easier to discuss their trauma,
and learn new ways of reacting to their memories.
Another effective therapy for PTSD is a relatively
new but powerful technique called Eye Movement Desensitization and
Reprocessing, or EMDR.
Drug therapy can be helpful if there is notable
depression, panic attacks or debilitating stress symptoms. There
are also peer-counseling and other groups which can help sufferers
deal with their symptoms.
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SOCIAL
ANXIETY (SOCIAL PHOBIA)
Phobias are common in our society and are characterized
by intense, irrational fears of things, situations, people or activities.
Having high anxiety in social settings to the degree that it interferes
with ordinary social interaction is called a Social Phobia.
Social Phobia is a major mental health disorder
in the United States, affecting about eight percent of the population.
However, it has only been taken seriously for about ten years. Fortunately,
the body of research developed in that time has fostered numerous
treatment modalities.
Symptoms
People with Social Anxiety Disorder or Social Phobia, or, are very
fearful and anxious that other people will criticize them. In fact,
they will go to any extreme to avoid a social gathering at which
they might be stared at, and, in their mind, evaluated negatively.
They are intimidated by every stranger they come across. They avoid
eye contact with nearly everyone and feel that they will embarrass
themselves if they do anything at all in public. Other typical symptoms
are embarrassing easily, blushing, frequent swallowing and twitching.
"Trigger" Situations for Social Phobia
- having to speak in front
of other people
- being the center of attention
- dealing with people of authority
- looking other people in
the eye
- being introduced to strangers
- being teased or confronted
- being in a public place
- interviews and meetings
Social Phobia is very distressing emotionally because
it adversely affects a very important aspect of life - social interaction.
To make matters worse, other people often perceive those with Social
Phobia as being unfriendly, aloof, withdrawn or inhibited.
Causes
Social Anxiety is very prevalent in our society probably partly
because of social pressure to live up to idealized social expectations
and partly due to the emotional and psychological insecurity of
the individual with this disorder.
Add to this the tendency to analyze and evaluate
everything. People with this disorder realize their negative thoughts
and feeling are irrational, yet they cannot stop them. A cycle of
negative thoughts and negative actions is set into play that can
only be stopped with appropriate psychotherapy.
Cognitive-behavioral therapy is highly effective
in treating social anxiety. Behavioral Therapy in a Group setting
is also helpful because they allow opportunities for reestablishing
healthy relating skills.
WHAT YOU CAN DO TO HELP
YOURSELF
- Educate yourself about what
you suspect is your disorder so that you can communicate more
effectively with your medical doctor or your potential therapist.
- Physical exercise is often
an excellent temporary antidote for mild or moderate anxiety.
- Be aware of what you eat
and drink. Caffeine, Aspartame, or a high intake of sugar can
trigger anxiety symptoms in some people, as can alcohol and certain
unprescribed drugs.
- Begin with a thorough physical
exam by a physician to rule out a physical condition or allergies.
- Learn relaxation techniques
via yoga classes, video tapes, meditation etc.
- Be confident that you will
find relief for your symptoms. Many other people have suffered
with the same unpleasant or uncomfortable conditions and have
found relief -- often permanently.
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