What a worry
Everyone experiences some anxiety. It's a natural response to situations that are stressful or frightening. Up to a point, anxiety can help people prepare for a crisis and function better.
Anxiety disorders, however, are psychological conditions that carry the feelings of anxiety to extremes. Symptoms persist and disrupt life. Sleeplessness, emotional exhaustion, trembling, difficulty concentrating, and an increase in stress-related illnesses all indicate that anxiety is adversely affecting your daily life.
Subtypes of anxiety disorders such as generalized anxiety, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and specific phobias each have particular qualities or sources of anxiety. Doctors can treat all forms of anxiety with combinations of medication, psychotherapy, and self-help techniques.
Anxiety is a general term that has many connotations in our culture. Anxiety is sometimes associated with fear. Some anxiety in response to life's stress is normal and may even be productive. Anxiety becomes a medical issue, however, when it persists and interferes with daily living, becomes overwhelming, and emerges without connection to clear sources. When this happen, doctors classify the anxiety as a psychiatric disorder. Varieties of anxiety include:
- Generalized anxiety disorder. Anxious mood and underlying anxiety with symptoms of tension, hyperactivity, and being overly vigilant.
- Panic disorder. Recurring panic attacks usually last several minutes and occur without an obvious trigger. They can include a wide array of physical symptoms, including heavy sweating, shortness of breath, trembling, and rapid heartbeat. The attack usually causes concerns about additional attacks, and significant changes in behavior.
- Post-traumatic stress disorder. Frequent flashbacks or nightmares of catastrophic or traumatic events by survivors of trauma.
- Specific phobias. Intense frequent fear of an object or situation that causes extreme anxiety. People with phobias will try hard to avoid these situations or objects.
- Obsessive-compulsive disorder. Behavioral patterns that interfere with daily life, due to persistent unwanted and disturbing thoughts.
Periods of normalcy often follow periods of high anxiety. Because the condition is different in each person, doctor cannot predict its course in a generalized way.
How Common Are Anxiety Disorders?
Up to 20 million people in the United States each year have an anxiety disorder, making the disorders the country's most common category of mental illness. Anxiety disorders primarily affect adults, mostly between ages 20 and 45, and affect women more than men.
Goals of Treatment
The goal of treatment for all anxiety disorders is to reduce the anxiety to a point where it no longer interferes with your daily life. Drug therapy's goal is not to cure the disorder, but to reduce the symptoms; psychotherapy and lifestyle changes are important to effectively treat anxiety.
Doctors commonly use psychotherapy, anti-anxiety drugs, and antidepressants to treat anxiety disorders. They should base treatment on carefully considered identification of your anxiety disorder, including the subtype, the specific cause, and your history. Usually you won't need to stay in the hospital for treatment. If you have a history of substance abuse, you should tell your doctor; you will need to avoid treatment with benzodiazepine medications.
Drug therapies can successfully treat many people. Treatments also include nonpharmaceutical approaches such as:
- Education from health professionals, support groups, and self-help materials
- Relaxation techniques including progressive relaxation, biofeedback, and hypnotherapy
- Desensitization and behavioral therapy
- Cognitive therapy
For short-term anxiety disorders, such as panic disorder, changing your lifestyle and taking care of yourself are the first steps in treatment. Medication and psychotherapy may also help you work through the issues connected to the disorder. Active treatment can usually overcome these disorders.
Anxiety disorders that have longer-term symptoms, such as obsessive-compulsive disorder and post-traumatic stress disorder, are harder to treat. Treatment may involve long-term medication, psychotherapy and attention to lifestyle stresses.
If you are on drug therapy, do not suddenly stop taking the drug; ease off by slowly decreasing the dosage. Otherwise you may have significant side effects, such as stomach upset, insomnia, headaches, or seizures, in addition to potential return of symptoms of the anxiety disorder.
The benzodiazepine class of drugs is very addictive; doctors should administer them with caution. If you suspect that you have developed dependency on the drug, notify your physician.
|Drugs most commonly prescribed|
|For generalized anxiety disorder:|
|For panic attacks:|
|Tricyclic antidepressants (TCAs)|
|Selective serotonin reuptake inhibitors (SSRIs)|
|For post-traumatic stress disorder:|
Healthcare Professionals Who May Be Involved in Treatment
Healthcare professionals who may treat anxiety include:
- Family medicine physicians
Activity & Diet Recommendations
Doctors not only allow you full activity, they recommend it as part of the treatment. Reducing connections to people or normal life activities is counterproductive in overcoming anxiety disorders. Physical exertion and regular exercise helps to reduce anxiety in people of all ages.
To keep from hyperventilating a common experience during panic attacks hold a paper bag to your mouth and breath in and out of it. This helps restore a normal balance of oxygen and carbon dioxide, relieving the symptoms of dizziness and palpitations that hyperventilation can cause.
Since caffeine is itself a stimulant, consume less of it. Also, avoid alcohol, especially when using medication.
Monitoring the Condition
Since treatment may involve highly addictive drugs, your doctor must monitor your medications closely to avoid dependency. Other recommendations include:
- Regular follow-up visits
- Monitoring blood pressure and heart rate when using tricyclic medications
- Knowing and understanding the side effects from your medications
Unattended anxiety disorder could lead to complications such as social/work impairment and panic attacks. Medication use may lead to drug dependency and heart problems (associated with tricyclic medications).
Quality of Life
People with anxiety suffer great distress that may interfere with their daily lives. Moreover, external sources can trigger anxiety. Take a step back and identify the cause of your anxiety. If anxiety is greatly affecting your normal life, seek treatment promptly. Anxiety and problems with daily life can reinforce each other and cause a downward spiral.
Considerations for Women
Do not take benzodiazepines medications commonly prescribed for anxiety management during the first trimester of pregnancy, and use them with caution later in pregnancy.
There is some evidence of fetal risk with tricyclic antidepressants (TCAs), especially during the first trimester.
Taper off and discontinue selective serotonin reuptake inhibitors (SSRIs) during the first trimester of pregnancy. You may continue them later in the pregnancy.
Use benzodiazepines with caution. If you take benzodiazepines regularly or in high doses, avoid breastfeeding since the drugs may cause lethargy and weight loss in nursing infants.
Considerations for Older People
When diagnosing older people, doctors must consider that emotional highs and lows can be greater in later years, and that some fluctuation in mood is normal. Deaths of friends and family members may cause anxiety; doctor should consider this when examining the elderly person's emotional state. Older people usually receive a reduced dosage of medications for anxiety.
Self care & Prevention
Because anxiety is a symptom of severe stress, one of the primary ways you can avoid anxiety is to manage stress in your daily life. Take precautions so that you don't overburden yourself with more than is healthy or feasible. Set aside "just-for-me" time every day. Some other strategies for reducing stress include:
- Breathe deeply. Deep breathing is fundamental to meditation and many stress-relieving regimens.
- Take a hot bath or shower. When you feel stressed, warmth can sooth and relax you.
- Work up a sweat. Any vigorous exercise releases endorphins, the body's own mood-elevating stress relievers. Relaxing forms of exercise include walking, dancing, gardening, swimming, yoga, and tai chi.
- Limit your intake of caffeine. Coffee and other caffeinated items increase irritability and anxiety.
- Have a good laugh. Laughter is a great antidote to anxiety, reducing levels of the stress hormone, cortisol. Watch a comedy video or movie, or read a funny book.
- Talk to a friend. Social isolation is stressful, and social ties are relaxing, so don't forget to reach out to others.
- Care for a pet. Many studies show that pets help reduce stress. Dogs provide unconditional love. Cats purr on your lap. Even non-cuddly pets for example, fish can help calm you.
Last updated 27 May 2012
- Hyperventilation syndrome
No one knows the exact causes of anxiety, though researchers have studied biochemical and behavioral components.
Theoretical causes of anxiety disorders include:
- Genetics. Anxiety conditions often run in families.
- Biochemistry. Certain chemicals in the brain that relay signals neurotransmitters such as serotonin or gamma amino butyric acid (GABA) are expressed differently in anxiety states.
- Learning. Certain responses may be "conditioned" so that certain stimuli will provoke an anxiety response.
- Stressful triggers. Certainly in post-traumatic stress disorder, extremely stressful events are a major factor.
Some researchers have a combination view: that genetic/biochemical factors make you more vulnerable to anxiety, and that individual experiences then tip the balance.
Risk factors for anxiety disorders include:
- Any stress-inducing events
- Social and financial problems
- Medical illness
- Family history of anxiety, depression, or related disorder
- Lack of social support
- Perfectionistic tendencies
- Drug withdrawal
Symptoms & Diagnosis
Both psychological and physical symptoms characterize anxiety disorders. Since anxiety is a very general description of many psychiatric disorders, symptoms vary with each disorder:
Generalized anxiety disorder
This disorder is marked by excessive, almost daily anxiety and worry about a variety of activities and events. Symptoms fall into three categories:
- Muscular tension (trembling, easy fatigue)
- Hyperactive autonomic activity (shortness of breath, rapid heartbeat, sweating, dry mouth)
- Vigilance and scanning (exaggerated startle response, difficulty sleeping, irritability, difficulty concentrating)
A disorder of recurring, unexpected panic attacks. You can identify panic attacks by at least four of the following signs and symptoms:
- Shortness of breath
- Dizziness, unsteadiness, or faintness
- Increased heart rate (palpitations)
- Trembling and shaking
- Profuse sweating
- Chest pains or discomfort
- Nausea or upset stomach
- Gagging or choking sensation
- Hot and cold flashes
- Numbness or tingling sensations in the hands or feet
- Dizziness or vertigo
- Fear of losing control
- Intense fear of dying
These include specific phobias such as fear of large animals, rodents, heights, blood, or being trapped. There is a persistent, unrealistic anxiety in response to external situations. Social phobias are marked by a fear of humiliation or rejection in situations where others are observing, such as giving a speech or playing a musical instrument.
Post-traumatic stress disorder
This refers to nightmares and flashbacks of traumatic events by survivors of those events. Traumatic events include accidents, abuse, and violence (especially rape). Secondary depression and panic attacks often accompany this disorder.
OCD is marked by an obsession (persistently disturbing, irrational, and uncontrollable thoughts) and/or a compulsion (the strong urge to repeatedly perform a ritual such as hand washing, counting, and organizing). This compulsive behavior greatly affects daily life. When people with OCD cannot perform the ritual, the obsessive thoughts cause them great anxiety.
Conditions That May Be Mistaken for an Anxiety Disorder
Before your doctor makes a diagnosis, he or she must rule out physical disorders, which can cause similar signs and symptoms as anxiety disorders. The following conditions often mimic anxiety disorders:
- Various cardiovascular conditions (valvular heart disease, cardiomyopathies, myocarditis, arrhythmias, mitral valve disease)
- Various respiratory conditions (asthma, emphysema, pulmonary embolism, scleroderma)
- Dysfunction of the central nervous system (transient cerebral insufficiency, psychomotor epilepsy, essential tremor)
- Metabolic and hormonal conditions such as abnormalities of thyroid function
- Nutritional deficiencies (thiamine, pyridoxine, folate, and iron)
- Intoxication or withdrawal (from use of illicit drugs, caffeine, and alcohol)
- Other psychiatric disorders (for example, schizophrenia)
How Anxiety Disorders Are Diagnosed
- Your doctor reviews your medical history and performs a physical examination
- Based on your medical history and signs, your doctor excludes possible physical causes and may use laboratory tests to further verify the absence of physical conditions
- You take tests to evaluate your psychological state (such as Zung's anxiety self-assessment and Hamilton's anxiety scale)
- Your doctor considers criteria from Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)
Your Medical History
Since there appears to be a biological component to many anxiety states, your doctor may use information about psychiatric or neurological disease among your family members. Past traumatic events may also contribute, as well as your environment such as work, family, financial status, and social class. In addition, certain stimulants in your diet may also trigger anxiety.
Your physician will review your medical history to verify that you don't have any pre-existing conditions such as hyperglycemia or diabetes, which may cause anxiety. He or she will also rule out other physical and psychiatric conditions.
Doctors use laboratory tests mainly to exclude other physical disorders that may contribute to the signs and symptoms. If you are suffering from "true" anxiety disorder, these tests should have normal results.
More specific and sophisticated tests aim to exclude other possible physical disorders:
- Electroencephalogram (EEG): measures brain waves to diagnose brain abnormalities
- Electrocardiogram (ECG): measures electrical activity of the heart to diagnose heart diseases
None usually, possibly a chest X-ray to exclude respiratory conditions.
Meditation is a practice of concentrated thought that may involve breathing and/or visualization. The focus is on complete relaxation. At the University of Massachusetts Medical School in Worcester, researchers used psychological tests to measure the stress levels in 22 people plagued by anxiety or panic attacks. Then the participants were taught to meditate, and practiced meditation daily at home. After 12 weeks, tests showed a 50% drop in the average participant's stress level
Close your eyes, breathe deeply, and imagine a relaxing scene: a walk along a tropical beach, a picnic with a great view anything you enjoy. Imagine the scene in detail its sights, sounds, smells for five minutes. When you open your eyes, chance are you'll feel more relaxed. Several companies market stress-relieving visualization tapes that combine imagery, soothing music, and reminders to breathe deeply.
Many studies show that massage helps reduce anxiety. Like exercise, massage increases the release of endorphins, the body's own feel-good chemicals.
Try drinking chamomile tea, a mild tranquilizer. Other calming herbs include catnip, passionflower, and kava. Use one teaspoon of herb per cup of boiling water, steep, and enjoy.
Several studies show that fragrant plant oils help relieve anxiety. Aromatherapists consider lavender among the most relaxing fragrances. They recommend carrying a small vial of lavender oil. When you feel stressed or anxious, uncap it and take a whiff.