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What is Anxiety?
The word anxiety is derived from the Latin word angere, which means to choke or strangle. Anxiety is an uncomfortable feeling of worry, dread, fear or apprehension. Often physical symptoms, such as a racing heart, shaking, or shortness of breath, occur with anxiety. Anxiety can be perfectly normal and can be useful as it alerts one to avoid dangerous situations. This is called situational anxiety and does not last longer than 3 weeks. When anxiety occurs for no apparent reason, is excessive for the situation or interferes with normal functions, anxiety is not beneficial and is considered to be an anxiety disorder, or pathological anxiety.
There are different types of anxiety disorders: generalized anxiety disorder (GAD), panic disorder, phobic disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Each of these disorders is associated with anxiety, but the specific symptoms and treatments are different.
Generalized anxiety disorder (GAD) is the most common of the anxiety disorders. People with GAD constantly feel anxious and worry excessively. It is common for people with GAD to also have another anxiety disorder or clinical depression. GAD is associated with physical symptoms, such as restlessness, tiring easily, and stomach problems, in addition to the feelings of anxiety and worry.
Panic disorder involves recurrent panic attacks that occur unpredictably and lead the person to worry about the occurrence and complications of future attacks. Panic attacks can last from several seconds up to 30 minutes. They can be frightening and lead the person to believe he or she is having a heart attack. The frequency of panic attacks is variable; they can occur daily, weekly or even monthly.
Phobic disorder is a common psychiatric illness. Phobias are extreme fears of objects or activities such as a fear of animals or fear of flying (called "specific phobias") or social situations (called "social phobias"). These fears lead people to alter their behavior in order to avoid the source of their fear. This avoidance may impair the ability to perform daily functions. People with phobic disorders realize that their fears and behaviors are unreasonable.
Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring obsessions and compulsions. Obsessions and compulsions cause feelings of anxiety, are time consuming and interfere with normal functioning. An obsession is an intrusive, persistent thought or image. Common obsessions involve contamination or aggressive or sexual thoughts. A compulsion is a repetitive, ritualistic act, which the person does in order to decrease the anxiety associated with the obsession. Common compulsive acts are washing, cleaning and checking. The person with OCD knows that the obsessions and compulsions are not beneficial.
People with post-traumatic stress disorder (PTSD) re-experience a traumatic event such as war, a natural disaster, a violent crime, or abuse. People can have "acute" PTSD, which means that symptoms occur immediately or "delayed" PTSD when symptoms do not appear for at least six months after the event. The length and seriousness of the traumatic event play an important role in the development of PTSD.
What Causes Anxiety?
There are many theories as to what causes anxiety disorders. It appears that people with anxiety may be more vulnerable to the effects of stress. The exact cause in each type of anxiety is not fully understood; however, there are certain factors that may be associated with the development of an anxiety disorder. Some medical illnesses, particularly those that are serious and life-threatening, and psychiatric disorders cause anxiety. Anxiety can also be caused by medications such as amphetamines, caffeine, pseudoephedrine, antipsychotics and antidepressants. Other factors include major life changes or traumatic events.
Additional factors that may predispose a person to developing an anxiety disorder are of several types:
Genetic: having a family member with an anxiety disorder or genetic defect
Biochemical: imbalances in neurotransmitters (the brain’s chemical messengers)
Who Gets Anxiety?
Anxiety disorders are among the most common of all psychiatric disorders. Approximately 25 million Americans will develop an anxiety disorder at some time during their lives. Only about 25% of people with an anxiety disorder will seek professional help. This is unfortunate as there is effective treatment available for these disorders.
People with a chronic medical illness such as lung disease or heart disease are more likely to suffer from anxiety (and depression) than people who are healthy.
There are some differences between the anxiety disorders with respect to gender and age of onset. GAD affects women and men equally and typically appears when people are in their twenties. Panic disorder affects approximately 2-3 times more women than men and most commonly occurs anytime from early childhood to the late teens. People generally develop phobias early in life, typically before they reach their teens. OCD affects men and women equally and often develops around the twenties.
Signs and Symptoms
There are many symptoms associated with anxiety disorders, both psychological and physical. While all people with anxiety exhibit some of the classic symptoms, they may experience additional symptoms that differ depending upon the specific anxiety disorder.
The classic symptoms associated with anxiety are:
Heart palpitations, fast heart rate
Trembling or shaking
Shortness of breath
Sensation of choking
Nausea or diarrhea
Dizziness, faintness or lightheadedness
Numbness or tingling
Chills or hot flashes
Feeling detached from oneself
Fear of losing control, going crazy, or dying
In addition to the classic symptoms, people with generalized anxiety disorder may also experience:
Restlessness or edginess
People with a social phobia may also experience:
Additional symptoms of post-traumatic stress syndrome (PTSD) are:
The Diagnosis of Anxiety
A physician should diagnose an anxiety disorder. The physician will conduct a through physical and psychiatric exam and may take blood and urine samples for laboratory analysis. The physician will ask many questions to complete a medical and psychiatric history. The physician may ask about medication, substance and alcohol use. The physician will exclude other causes of anxiety such as medical and psychiatric conditions.
How Serious is Anxiety?
Complications of Anxiety
While everyone experiences anxiety at some time, those who suffer from an anxiety disorder can have significant complications and a greatly diminished quality of life. Complications can include social isolation, dependence upon social assistance, alcohol or substance abuse, eating disorders, depression or other psychiatric illnesses. People with an anxiety disorder have a higher rate of sudden death from heart disease, and are more likely to develop high blood pressure. Anxiety disorders have also been associated with chronic headaches and inflammatory bowel disease.
Some complications are specific to the type of anxiety disorder. For example, approximately 25–30% of people with panic disorders have suicidal thoughts. People with social phobias may isolate themselves so severely that they do not complete educational training, or do not hold long-term employment or form healthy interpersonal relationships.
In the last decade, researchers have made great strides in understanding potential causes and treatment of anxiety disorders. Because of the significant negative impact on quality of life, people with anxiety disorders must be encouraged to seek professional help to receive the appropriate treatment. People with untreated anxiety disorders are at risk for suffering from depression and developing alcohol or substance abuse problems.
Typically, anxiety disorders are chronic conditions. While most types respond favorably to treatment, many people may experience a relapse after treatment has been discontinued. Thus, it is important to maintain open and honest communication with a health care provider.
What are the Complementary and Alternative Treatments for Anxiety?
What are the Conventional Treatments for Anxiety?
There are many effective treatments for anxiety disorders. Usually treatment involves non-drug approaches and/or medication. Non-drug approaches include cognitive or behavioral therapy. Examples include supportive psychotherapy, interpersonal therapy, stress management, biofeedback, desensitization techniques, hypnosis and group therapy.
There are several different types of medication that are effective for anxiety disorders.
Benzodiazepines are among the most common anti-anxiety medications prescribed, as they are quite effective. They are particularly useful for GAD, panic disorders and phobic disorders. Common examples are alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), and chlordiazepoxide (Librium).
Serotonin-reuptake inhibitors (SSRIs) are used for panic disorders, phobic disorders, OCD and PTSD. Examples are fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).
Tricyclic antidepressants (TCAs) are effective for GAD and panic disorders. Examples include imipramine (Tofranil), amitriptyline (Elavil) and clomipramine (Anafranil).
Monoamine oxidase inhibitors (MAOIs) are used to treat panic disorders and OCD. Examples are phenelzine (Nardil) and tranylcypromine (Parnate).
Beta-blockers are used to treat phobic disorders. Beta-blockers used for this purpose are propranolol (Inderal) and atenolol (Tenormin).
Buspirone (Buspar) is used to treat GAD.
The specific treatment will differ slightly based upon the cause of or the type of anxiety disorder. For people with situational anxiety, a short course (several weeks) of an anti-anxiety medication is appropriate. If the physician determines that the anxiety is caused by a medical or psychiatric condition, the best way to treat the anxiety is to treat the condition causing it. Many of the anxiety disorders will require long-term treatment. The physician will determine when treatment can be discontinued and whether or not it needs to be restarted if symptoms return.
The goals of treatment include:
Increasing quality of life
Decreasing the disability associated with the anxiety
Minimizing the impact on daily activities
Reducing the physical and psychological symptoms associated with anxiety
Avoiding complications associated with anxiety disorders
Thorough education regarding anxiety disorders and their management
How Can Anxiety Be Minimized?
There are a number of steps one can take to minimize feelings of anxiety:
Perform some type of relaxation regularly (biofeedback, muscle relaxation, meditation, yoga or deep breathing exercises).
Use positive imagery to prepare for a situation that may provoke anxiety.
Attempt to deal with the source of stress.
Avoid excessive stress.
Decrease exposure to objects or situations that cause anxiety.
Maintain a healthy lifestyle (healthy diet, exercise and rest).
Avoid excessive caffeine, alcohol and cigarette consumption.