What Is It?
An anxiety disorder is an excessive or inappropriate response to stress that leaves you with feelings of apprehension, uncertainty and fear.
An anxiety disorder is an excessive or inappropriate response to stress that leaves you with feelings of apprehension, uncertainty and fear. It can paralyze you into inaction or withdrawal. An anxiety disorder isn't just a case of "nerves." According to the National Institute of Mental Health, an estimated 40 million Americans, or 18 percent of the population, experience this illness.
Anxiety is expressed physically through a series of responses such as:
* a rise in blood pressure
* a fast heart rate
* rapid breathing
* an increase in muscle tension
* a decrease in intestinal blood flow, sometimes resulting in nausea or diarrhea
Without treatment, an anxiety disorder can significantly disrupt your life because symptoms usually become progressively worse. Tormented by panic attacks, irrational thoughts and fears, compulsive behaviors or rituals, flashbacks, nightmares or countless frightening physical symptoms, people with anxiety disorders rely heavily on emergency departments and other medical services to address their symptoms.
Their work, family and social lives are disrupted, and some even become housebound. Many individuals who suffer from this disorder have other mental disorders such as depression or substance abuse.
Fortunately, treatment for anxiety disorders is, in general, very effective. Early diagnosis may aid early recovery, prevent the disorder from becoming worse and possibly prevent the disorder from developing into depression. Yet, because of a widespread lack of understanding and the stigma associated with anxiety disorders, only about one-third of those who experience them are diagnosed and receive treatment.
In recent years, a number of different anxiety disorders have been categorized:
* Generalized anxiety disorder (GAD) affects about 6.8 million Americans and affects twice as many women as men. GAD is characterized by at least six months of a more-or-less constant state of tension or worry not related to any event. If you suffer from GAD, you may always expect a catastrophe to happen. Though you may know your feelings are unrealistic, you cannot control them. The worries that accompany GAD are nonspecific and are not as obsessive as the thoughts and worries experienced with obsessive-compulsive disorder. However, more than half the people who suffer from GAD also have another anxiety disorder or depression.
* Panic attacks develop abruptly and generally reach a peak within 10 minutes. They develop without warning and are not necessarily related to any specific event. The word anxiety is derived from the Latin angere, which means to choke or strangle, and many women who suffer from panic attacks report the physical sensation of their throat tightening, cutting off their breath. This physical sensation can lead to additional anxious feelings.
* Panic disorder, defined as repeated panic attacks or worry about such attacks, affects about six million Americans. It typically strikes in late adolescence or early adulthood. Women are twice as likely as men to develop panic disorder. People with panic disorder may also suffer from depression, abuse alcohol or abuse drugs such as marijuana. About one-third of people with panic disorder develop agoraphobia, the fear of having a panic attack in public. It may lead a person to avoid public spaces for fear that escape might be difficult or help unavailable if they have a panic attack. Often they won't leave their homes.
* Phobias are irrational and involuntary and include overwhelming fears that lead a person to avoid common objects, events or situations, or become excessively anxious as they approach them. While they vary in severity, in some cases the anxiety associated with the feared object or situation can be incapacitating. Most people who suffer from phobias are aware of the irrationality of their fear, and many avoid certain objects or situations or endure intense anxiety. Specific phobias are among the most common mental health disorders.
Specific phobias include fear of animals, heights (acrophobia), air travel (pterygophobia), water, confined spaces (claustrophobia), bridges or other things. About 19.2 million Americans suffer from specific phobias, and they are twice as common in women as men.
* Social phobia, or social anxiety disorder, is caused by a fear of being embarrassed in a social situation or publicly scrutinized and humiliated. Social phobia is often accompanied by depression and may lead to alcohol or other drug abuse. About 15 million people have social phobia, which is equally common among women and men. The disorder typically beings in childhood or early adolescence and rarely develops after age 25.
* Obsessive-compulsive disorder (OCD) is characterized by recurrent, persistent and intrusive thoughts, images or impulses that cause anxiety. These mental images or ideas are called obsessions. The person tries to control these obsessions or keep her fears from being realized by performing repetitive behaviors called compulsions.
The compulsions are often rigid and must be performed in a certain time-consuming order. Although adults with OCD often know these rituals are excessive, they cannot stop doing them in spite of strenuous efforts to ignore or suppress the thoughts or actions. Repeated hand washing, reordering of belongings, rechecking objects in one's house, or silently repeating words, numbers or prayers are examples of compulsions. More than half of OCD sufferers have obsessive thoughts without ritualistic behavior. About 2.2 million Americans have OCD. One-third of adults affected with OCD had their first symptoms in childhood. OCD affects men and women with equal frequency.
OCD should not be confused with obsessive-compulsive personality disorder, which defines certain character traits such as being a perfectionist, excessively conscientious, morally rigid and preoccupied with rules and order. These traits do not necessarily occur in people with OCD.
* Post-traumatic stress disorder (PTSD) develops after exposure to an extremely stressful event that involved serious physical harm or the threat of harm to one's physical integrity. About 7.7 million people suffer from PTSD. Trauma such as a rape, childhood sexual abuse, military combat or war-related incidents and natural disasters during which you experienced intense fear, helplessness and horror are common causes of PTSD.
Although anxiety is a normal human response to stress, health care professionals and researchers don't know why some people have severe anxiety or panic in response to everyday situations. They do have several theories, however. Among the possible causes of anxiety disorders:
* A biological tendency toward anxiety, including greater sensitivity to the effects of hormones released during anxiety, such as adrenaline; or an imbalance of certain substances called neurotransmitters (chemical messengers in the brain)
* Differences in activity in certain areas of the brain in people with GAD
* Genetic or familial factors. About 30 percent of close relatives with generalized anxiety disorder suffer from the disorder themselves; 18 to 41 percent of people with relatives with panic disorder also suffer from panic attacks; and first- degree relatives of people with phobias are three times more likely to suffer from phobias themselves.
* Changes in certain areas of the brain in people with anxiety disorders
* Family background, such as an early childhood conflict or trauma, or "learned" fears or phobias
* Stressful events and an exaggerated negative interpretation of them
* Other illnesses or medications can cause symptoms of an anxiety disorder
While anxiety disorders can strike anyone of any age, gender or socioeconomic background, they most often begin in young adulthood. They often start mildly and progress, although GAD appears to be the most common form of anxiety in older ages. In addition, except for OCD, anxiety disorders strike women at twice the rate of men.
The first step to properly diagnosing an anxiety disorder is to rule out another medical condition. Because anxiety accompanies so many medical conditions, some serious, it is extremely important for your health care professional to uncover any physiological medical problems or medications that might underlie or be masked by an anxiety attack.
Thus, a physical examination and medical and personal history is essential. You should describe any history of anxiety disorders or depression in your family and mention any other contributing factors, such as excessive caffeine use, recent life changes or stressful events. It is very important to be honest with your health care professional about all conditions, including substance abuse or other psychological or mood states that might contribute to or result from the anxiety disorder.
Anxiety attacks can mimic or accompany nearly every acute disorder of the heart or lungs, including heart attacks and angina. Asthma attacks and panic attacks have similar symptoms and can also coexist. In addition, anxiety-like symptoms are seen in many other medical problems, including epilepsy, hypoglycemia, adrenal-gland tumors and hyperthyroidism. Women can also experience intense anxiety attacks with hot flashes during menopause. Many drugs, including some for high blood pressure, diabetes and thyroid disorders, can produce symptoms of anxiety, as can withdrawing from certain drugs like those used to treat sleep disorders or anxiety.
Panic disorder often coexists with depression, and sometimes the two conditions are difficult to distinguish because anxious feelings, agitation, insomnia and problems with concentration often accompany depression.
Thus, your health care professional will use a medical evaluation to rule out alternative explanations of anxiety symptoms.
Health care professionals can use various tests from the American Psychiatric Association and other professional organizations to determine the causes, type, severity and frequency of your anxiety. Most are written, multiple-choice tests that can be administered on paper or verbally and are centered on defining the kinds of symptoms you experience as part of your anxiety.
Specific anxiety disorders are diagnosed based on the severity and duration of symptoms and on additional behavioral characteristics that accompany the symptoms of anxiety. Specifically:
* Generalized anxiety disorder (GAD) is confirmed if you meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. These criteria include:
** excessive anxiety and worry about several events and activities most days of the week, for at least six months
** anxiety that isn't related to other mental health issues, such as post-traumatic stress disorder (PTSD), substance abuse or panic attacks
** difficulty controlling feelings of worry
** at least three of the following symptoms in adults and one in children: fatigue, restlessness, trouble concentrating, muscle tension, sleep problems or irritability
** inability to relax
** being easily startled
** feeling tired for no reason
** muscle tension and aches
** feeling lightheaded or out of breath
** frequent urge to go to the bathroom
** hot flashes
In addition, generalized anxiety disorder may cause the following symptoms:
Symptoms should cause significant distress and impair normal functioning.
* Panic disorder is diagnosed if you meet the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. These criteria include:
** frequent, unexpected panic attacks
** worry about having another panic attack or losing control
** avoidance of situations you think may trigger a panic attack
** panic attacks that aren't caused by substance abuse or another mental health condition such as social phobia or agoraphobia
* Panic attacks may also include the following symptoms:
** feelings of unreality
** either hot flashes or chills
** chest pain
** fear of dying
** fear of going insane
Agoraphobia occurs in about one-third of people with panic disorder. In its severest form, it is characterized by a paralyzing terror of being in places or situations from which you feel there is no escape or accessible help in case of a panic attack. As a result, you might confine yourself to places in which you feel safe, usually at home. You may often make complicated plans to avoid confronting feared situations and places.
* Specific phobias. If you have a specific phobia, you may experience the following symptoms around the phobic object or situation:
** panicky feelings
** rapid heartbeat
** avoidance behavior
* difficulty breathing
* Social phobia, also known as social anxiety disorder, is a fear of being embarrassed in social situations. Symptoms vary in intensity, ranging from mild and tolerable anxiety to a full-blown panic attack. Sometimes social phobia is manifested by extreme shyness and discomfort in social settings. Frequent blushing, trembling, sweating, palpitations, diarrhea and confusion are typical symptoms. It is often accompanied by depression and may lead to substance abuse.
* Obsessive-compulsive disorder (OCD) is diagnosed if obsessions and compulsions interfere with your normal activities or cause emotional distress or anxiety, especially if the ritualistic behavior cannot be carried out. Adults with this condition usually recognize their obsessions or compulsions as excessive and unreasonable, yet feel compelled to engage in them. The obsessive thoughts or images can range from mundane worries about whether one has locked a door to bizarre and frightening fantasies of behaving violently toward a loved one. The compulsive acts triggered by such obsessions might include repetitive checking for locked doors or unlit stove burners or calls to loved ones at frequent intervals to be sure they are safe. Some people are compelled to wash their hands every few minutes or spend inordinate amounts of time cleaning their surroundings to subdue the fear of contagion.
Certain other obsessive disorders, including body dysmorphic disorder (BDD), trichotillomania and Tourette's syndrome, may be part of the OCD spectrum. In BDD, people are obsessively preoccupied with an imagined defect in their appearance. People with trichotillomania continually pull out their hair, leaving bald patches. Symptoms of Tourette's syndrome include jerky movements, tics and uncontrollably uttering obscene words.
* Post-traumatic stress disorder (PTSD) symptoms can occur weeks, months or even years after the traumatic event. If you suffer from PTSD, you may have the following symptoms:
** recurrent and distressing memories or dreams during which you feel you are reliving the event and feel separated from your surroundings or body
** feelings of being "on alert" at all times
** emotional withdrawal
** mood swings
** guilt over surviving the event
** inability to concentrate
** an excessive startle response to noise
* Acute stress disorder (ASD) is similar to PTSD, except it can be diagnosed within the first month after a traumatic event and the symptoms generally go away after a few weeks. Like PTSD, it is triggered by a traumatic event such as witnessing a car accident or natural disaster or being violently assaulted. ASD symptoms overlap with those of PTSD but there are more dissociative symptoms with ASD, such as not knowing where you are or feeling like you are outside of your body. Some people who suffer ASD may have previously had PTSD, and many who get ASD go on to develop PTSD.
Because of widespread lack of understanding and the stigma associated with anxiety disorders, many people with these disorders--an estimated one-third--don't receive a diagnosis and so don't receive treatments proven effective through research. Yet anxiety disorders, like other mental illnesses, reflect specific dysfunctions within the brain and should not be faced with shame or fear. Enormous progress has been made in the scientific understanding of the underlying causes and mechanisms of anxiety disorders.
To be a smart health care consumer, you need to ensure that the health care professional you see is able to recognize an anxiety disorder. While mental health treatment can be received from a wide range of professionals, including primary care physicians, psychiatrists, psychologists and social workers, you may want to consider seeking out an anxiety specialist, particularly someone who can offer the treatments found to be most successful, such as cognitive behavioral therapy and medications.
You can contact the Anxiety Disorders Association of America (www.adaa.org) or the Association for Behavioral and Cognitive Therapies (www.abct.org) to find professionals specializing in anxiety. Make sure you follow the steps for seeking treatment as outlined in your health insurance plan. You may be required, for example, to see a primary care physician first. Some health insurance plans cover mental health services; some don't. Check your policy or ask your plan administrator so you can determine what your out-of pocket expenses might be. Don't overlook the simple fact that you should like your treating professional. If you can't develop a rapport within the first or second session, your therapy won't be successful, so keep searching for someone with whom you're comfortable.
Anxiety disorders require professional treatment; simply trying to talk yourself out of anxiety is as futile as trying to talk yourself out of a heart or stomach problem. Fortunately, the vast majority of people with an anxiety disorder can be helped with the right professional care. While obsessive-compulsive disorder and post-traumatic stress disorder can be more difficult to treat, most anxiety disorders, especially the phobias, respond well to treatment. There are no guarantees, however, and success rates vary with circumstances.
Treatment periods also vary, with some requiring only a few months of treatment and others needing a year or more. People with anxiety disorders often have more than one disorder or suffer from substance abuse or clinical depression. When more than one mental health-related condition is present, each must be accurately diagnosed and treated.
Treatments for anxiety disorders vary, with both therapy, particularly cognitive behavioral therapy (CBT), and medication, used. Often, the most effective approach for anxiety disorders is a combination of the two. With OCD, a specific type of CBT called exposure and response prevention should be used, usually in combination with medication.
Medications used to treat anxiety disorders include:
* Selective serotonin reuptake inhibitors (SSRIs) are first-line medicines used to treat anxiety disorders. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), fluvoxamine (Luvox) and escitalopram oxalate (Lexapro). They work by affecting the concentration of serotonin, a chemical in the brain thought to be linked to anxiety disorders, and have traditionally been used to treat depression.
The most common side effects are nausea and gastrointestinal problems, drowsiness, sweating, headache, difficulty sleeping and mild tremor, all of which usually wear off as your body adjusts to the medication. Weight gain and sexual dysfunction can also be side effects of this category of medications.
* Tricyclic antidepressants (TCA), which were first used for treating depression, are also effective in blocking panic attacks and PTSD because they regulate serotonin and/or noradrenaline in the brain. The most common TCAs used for the treatment of panic disorder are imipramine (Tofranil, Janimine), desipramine (Norpramin) and nortriptyline (Pamelor). TCAs are also effective in treating agoraphobia.
Clomipramine (Anafranil), which is the only TCA approved for obsessive-compulsive disorder (OCD), significantly reduces symptoms for patients who can tolerate it. Clomipramine has more adverse side effects than the SSRIs, but both appear to be equally effective over time. Tricyclics usually take two or three weeks to take effect. Side effects include dry mouth, blurred vision, sexual dysfunction, weight gain, difficulty urinating, disturbances in heart rhythm, drowsiness and dizziness. Blood pressure may drop slightly when sitting up or standing, causing dizziness. Tricyclics also can have serious, although rare, side effects and can be potentially fatal in overdose. Elderly patients and those with a history of seizures, cardiac problems, closedangle glaucoma and urinary retention or obstruction should be closely supervised when taking tricyclics.
* Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also frequently used for treatment of anxiety disorders. These include venlafaxine (Effexor) and duloxetine (Cymbalta). Venlafaxine is approved to treat GAD, panic disorder and social anxiety disorder, while duloxetine is approved thus far only for GAD. Desvenlafaxine (Pristiq) is the newest drug in this category and so far is not approved to treat anxiety disorders but is sometimes used off-label for treatment. The side effects of SNRIs are similar to those of the SSRIs although they appear to have more pronounced withdrawal symptoms when the medication is stopped.
* Other antidepressants target specific neurotransmitters in the brain that regulate depression, like the SSRIs do.
These drugs include bupropion (Wellbutrin, Wellbutrin SR, Zyban), trazodone (Desyrel), maprotiline (Ludiomil) and mirtazapine (Remeron).
Note: All antidepressants may lead to an increased suicide risk in adolescents and children, according to the U.S. Food and Drug Administration. Anyone taking antidepressants should be carefully watched for any signs of suicidal behavior.
These drugs tend to have fewer adverse effects on sexual function than SSRIs, and some may even enhance sexuality. Common side effects may include: drowsiness, agitation, nervousness, insomnia, nausea, headache, dizziness and dry mouth.
Mirtazapine (Remeron) may be an effective treatment for some anxiety disorders such as panic disorder, generalized anxiety disorder and post-traumatic stress disorder.
* Monoamine oxidase inhibitors (MAOI), typically phenelzine (Nardil) or tranylcypromine (Parnate), are antidepressants used for panic disorder, social anxiety disorder or PTSD that does not respond to other treatments. They work by blocking the effect of a brain chemical that breaks down serotonin and noradrenaline. Common side effects include a sudden drop in blood pressure upon standing, drowsiness, dizziness, sexual dysfunction and insomnia. The most serious side effect is severe hypertension, which can be brought on by eating certain foods with high tyramine content, such as aged cheeses, red wines, sauerkraut, vermouth, chicken livers, dried meats and fish, canned figs, fava beans and concentrated yeast products. They can also interact with other medications, such as over-the-counter decongestants and prescription stimulants. You shouldn't take MAOIs if you're pregnant or taking other SSRIs and should have at least a two-week break between ending one antidepressant and starting on MAOIs.
* Benzodiazepines like alprazolam (Xanax) and clonazepam (Klonopin) have been the treatment of choice for anxiety disorders for years. Benzodiazepines are mild sedatives that belong to a group of medications called central nervous system depressants. These drugs may be habit-forming, especially when taken in high doses or for an extended time.
Benzodiazepines work relatively quickly. Their principal side effects are drowsiness, possible weight gain, impaired concentration and short-term memory loss, but they have the potential for dependency after only a few weeks. Thus, if you stop taking them after taking them for a long period, you may experience rebound symptoms, sleep disturbance and anxiety within a few days. Make sure you discuss these risks with your health care professional, and if you are taking benzodiazepines, talk to your health care provider before you stop taking them.
* Buspirone (Buspar) is the only drug available in the class called azapirones. It works via one of the serotonin receptors. Buspirone is approved for generalized anxiety disorder. It usually takes several days to weeks for the drug to become effective, and it is not useful against panic attacks. Unlike the benzodiazepines, buspirone is not addictive, even with long-term use, and it seems to have less pronounced side effects and no withdrawal effects, even when the drug is discontinued quickly. Because the drug does not produce any immediate euphoria or change in sensation, those who have taken benzodiazepines may believe it's not working. Common side effects include dizziness, drowsiness and nausea. BuSpar should not be used with MAOIs.
* Beta-blockers, including propranolol (Inderal) and atenolol (Tenormin), reduce the effects of adrenaline by blocking cellular receptors for adrenaline. They affect only the physical symptoms of anxiety and are most helpful for phobias, particularly performance anxiety, but are less helpful for other forms of anxiety. They work quickly and aren't habit forming but shouldn't be used with certain pre-existing medical conditions such as asthma, congestive heart failure, diabetes, vascular disease, hyperthyroidism and angina pectoris.
Researchers are currently working on developing drugs that target specific brain cells involved in anxiety disorders.
* Behavioral techniques focus on changing negative thinking and behaviors that can contribute to anxiety disorders. Talking to a mental health therapist can provide relief, lead to new insights and help replace unhealthy behaviors with more effective ways of coping. Most mental health professionals tailor their approaches to the needs, problems and personalities of the people seeking help and may combine different techniques in the course of therapy. The various types of behavioral techniques used to treat anxiety disorders include:
** Cognitive-behavioral therapy focuses on identifying and modifying the faulty thoughts and assumptions that keep a person stuck in the anxiety pattern. There are two parts to this therapy. First, a therapist helps you identify and modify the thoughts and behaviors keeping you stuck in the anxious mode. This is done by challenging false assumptions and negative thinking. The second part of the therapy is to expose you to situations that cause the anxiety to help you desensitize yourself to these thoughts and feelings. Another part of the therapy is to help you understand what's happening to your body: it's misfiring like a false alarm. As you begin to understand the underlying falseness of the assumptions that cause anxiety, you can begin substituting new ways of coping.
** Systematic desensitization requires a woman to gradually confront the object of fear with a goal of breaking the link between the anxiety-provoking stimulus and the anxiety response. First, you undergo relaxation training and compose a list that prioritizes anxiety-inducing situations by the degree of fear they invoke. Next, you undergo the desensitization procedure, confronting each item on the list, starting with the least stressful. This treatment is especially effective for simple phobias, social phobias, agoraphobia and post-traumatic stress disorder.
** Breathing retraining helps women with panic disorder practice measured, controlled breathing. Because many people with panic disorder hyperventilate, breathing rapidly and tensely and expelling too much carbon dioxide, they suffer from chest pain, dizziness, tingling of the mouth and fingers and muscle cramps. One helpful breathing retraining approach is to practice controlling respiration rate and volume with slow deep breaths. By controlling your breathing at the onset of a panic attack, you may be able to prevent full attacks. This technique is frequently used in conjunction with other treatments for anxiety disorders.
* Other forms of psychotherapy, commonly called "talk" therapies, deal more with childhood roots of anxiety and usually, although not always, require longer treatments. They include interpersonal therapy, supportive psychotherapy, attention intervention and psychoanalysis. Some experts believe that such therapies might be more useful for generalized anxiety, which may require more sustained work to process and recover from early traumas and fears.
* Hypnotherapy, which uses the technique of hypnosis, may also be an appropriate treatment option. Hypnosis is a form of intense receptive concentration. Accordingly, hypnosis often is used to modify behavior and overcome phobias and bad habits--it can help you make changes that you've been unable to make otherwise. Often hypnotherapy is combined with other relaxation techniques.
People with anxiety disorders often are known as "worriers," concerned about control and perfectionism. These can be good traits to have. But when the need for perfectionism or control interferes with your life, you may have an anxiety disorder. The first step in prevention is to look at how you can respond differently to situations that make you anxious, modify the physiological response to those situations and master negative thinking.
A healthy lifestyle that includes regular aerobic exercise, relaxation techniques such as yoga, adequate rest and good nutrition can help reduce the impact of anxiety attacks.
To prevent your normal anxious feelings from going too far, try these suggestions:
* Identify situations that make you anxious, consider actions that will reduce the threat and try them out (for example, attend childbirth preparation classes to deal with the stress of labor and delivery; eliminate or reduce caffeine intake if nervousness alone is the problem).
* Avoid potentially dangerous ways of coping with anxiety, like smoking, alcohol, drug dependence or abnormal eating patterns.
* Express your feelings to someone you trust and can talk with comfortably. This often leads to a relief of anxious feelings.
* Try relaxation techniques or meditation such as yoga or stress reduction classes.
* Try walking, jogging, swimming or any aerobic exercise.
* Avoid unnecessary stress by eliminating as many nonessential activities as possible from your daily routine.
* If your anxiety persists or becomes chronic, seek out a competent mental health professional. You can ask for help or a referral from your primary health care professional, a community mental health center, a mental health association or your local health department.
Facts to Know
1. According to the National Institute of Mental Health, an estimated 40 million Americans experience anxiety disorders.
2. Without treatment, an anxiety disorder can significantly disrupt your life. You may be tormented by panic attacks, irrational thoughts and fears, compulsive behaviors or rituals, flashbacks, nightmares or countless frightening physical symptoms. Yet, because of widespread lack of understanding and the stigma associated with these disorders, only about one-third of those who experience this problem are diagnosed and receive treatment.
3. Generalized anxiety disorder affects about 6.8 million Americans and is characterized by at least six months of a more or less constant state of tension or worry not related to any event.
4. Panic disorder affects about six million Americans. It typically strikes in late adolescence or early adulthood. Women are twice as likely as men to develop panic disorder. People with panic disorder may also suffer from depression; in addition, those with panic disorder are more likely to abuse alcohol and drugs such as cocaine and marijuana. About one-third of people with panic disorder develop agoraphobia, an illness in which they become afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.
5. About 15 million people have social phobia. Social phobia occurs in women twice as often as in men. The disorder typically begins in childhood or early adolescence and rarely develops after age 25.
6. About 2.2 million Americans have obsessive-compulsive disorder (OCD). OCD affects men and women with equal frequency.
7. About 7.7 million Americans suffer from Post Traumatic Stress Disorder (PTSD). Trauma such as a rape, childhood sexual abuse, military combat or war-related incidents, and natural disasters during which a person experienced intense fear, helplessness and horror are common causes. PTSD can develop at any age, including childhood. Depression, alcohol or other substance abuse or another anxiety disorder often accompanies PTSD.
8. Anxiety disorders most often begin in young adulthood, starting mildly and progressing. Generalized anxiety disorder appears to be the most common form of anxiety at older ages. In addition, except for OCD, anxiety disorders strike women at twice the rate of men. A woman's hormonal cycle may affect her anxiety disorder, with symptoms getting worse premenstrually.
9. Anxiety attacks can mimic or accompany nearly every acute disorder of the heart or lungs, including heart attacks and angina. Asthma attacks and panic attacks have similar symptoms and can also coexist. In addition, anxiety-like symptoms are seen in many other medical problems, including epilepsy, hypoglycemia, adrenal-gland tumors and hyperthyroidism. Women can also experience intense anxiety attacks with hot flashes during menopause. Many drugs, including some for high blood pressure, diabetes and thyroid disorders, can produce symptoms of anxiety.
10. Fortunately, treatment for anxiety disorders is, in general, very effective. Early identification and treatment of an anxiety disorder may help you recover more easily and prevent depression. Treatments for anxiety disorders vary, with therapy, particularly cognitive behavioral therapy, and medication, used. Often the most effective approach for most anxiety disorders is a combination of the two.
Questions to Ask
Review the following Questions to Ask about anxiety disorders so you're prepared to discuss this important health issue with your health care professional.
1. Could my anxiety be caused by an underlying medical condition or medications I'm taking?
2. Can anxiety be treated? What treatments are available?
3. How can I use relaxation techniques or biofeedback to ease my anxiety?
4. Will counseling or therapy help my anxiety? What kind of counseling or therapy do you recommend?
5. Are there any substances I should avoid, or lifestyle habits I should change, to help overcome my anxiety?
6. I need to involve my partner or family member in my treatment. Will you help educate them about my problem and how to help me manage it?
If medication is prescribed
7. How do you expect this medication to help me? When and how should I take it?
8. What are the possible side effects of the medication?
9. How long will it take the medication to work?
10. Should I avoid other medications, alcohol or certain foods while I take this medication?
11. What if this medication doesn't work? Is it safe to stop taking it?
12. How long should I take this medication? How can I avoid becoming dependent on it?
1. What is an anxiety disorder?
An anxiety disorder is an excessive or inappropriate stress response that leaves you with feelings of apprehension, uncertainty and fear, and can inappropriately paralyze you into inaction or withdrawal. While an anxiety disorder may provoke feelings similar to a case of "nerves," it is the severity and duration of symptoms that distinguish the two. Without treatment, an anxiety disorder can significantly disrupt your life as you become tormented by panic attacks, irrational thoughts and fears, compulsive behaviors or rituals, flashbacks, nightmares or countless frightening physical symptoms.
2. Who gets this illness and why?
Anxiety disorders strike men and women of all races, ages and social status, but (except for OCD) they are twice as common in women and they tend to strike more often in young adulthood. Anxiety disorders can be caused by biological, chemical or genetic factors; can be brought about by family background; or can be attributed to certain medical conditions or medications.
3. Are there different types of anxiety disorders?
Yes, there are several types of anxiety disorders, including:
** Generalized anxiety disorder is characterized by at least six months of a more-or-less constant state of tension and worry not related to any event.
** Panic disorder is characterized by repeated, unprovoked attacks of anxiety or terror generally lasting about 10 minutes.
** Phobias are irrational, involuntary and overwhelming fears that lead a person to avoid, or endure with great anxiety, common objects, events or situations.
** Social phobia, or social anxiety disorder, is characterized by a persistent fear of humiliation in social or performance situations which often leads to avoidance of these situations.
** Obsessive-compulsive disorder is characterized by recurrent, persistent and intrusive thoughts or impulses that the person feels can be controlled by performing repetitive behaviors.
** Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents or military combat.
** Acute stress disorder (ASD) is similar to PTSD, except it can be diagnosed within the first month after a traumatic event and the symptoms generally go away after a few weeks. Like PTSD, it is triggered by a traumatic event such as witnessing a car accident or natural disaster or being violently assaulted.
4. How can I tell if I have an anxiety disorder?
If you feel "on edge" most of the time; if you experience panicky feelings, sweating, rapid heartbeat and difficulty breathing around specific objects or situations; if you feel compulsions to perform specific and time-consuming rituals; if you have recurrent disturbing thoughts; if you regularly experience distressing sleeplessness, irritability or difficulty concentrating; and if these feelings persist or impair normal functioning, you should discuss them with your health care professional.
5. How are anxiety disorders treated?
Most anxiety disorders respond well to treatment, usually medication and/or cognitive-behavior therapy. Specific medications have been developed to combat anxiety, with antidepressant medications such as SSRIs particularly useful. Behavioral therapies help patients regain control of their reactions to stress and feared objects or situations.
6. Do anti-anxiety medications have side effects? How long will I have to take this medication?
The newer antidepressants, including serotonin reuptake inhibitors, cause fewer side effects than the older types of drugs used to treat anxiety. Both types of medication can cause side effects such as nausea, drowsiness, gastrointestinal upset, anxiety and insomnia, which may subside after about a month. Most people make the mistake of stopping the medication when they first start to experience side effects or without speaking to their health care professional about the side effects. Sexual dysfunction (impotence, loss of desire, inability to reach orgasm) is a common side effect of some medications. Because many types of antianxiety medications are available, it is likely that one can be identified that produces the fewest side effects with best results. Most people don't have to take anti-anxiety medications forever. Once your anxiety subsides, you can determine with your health care team what the best course is for you. Short-term treatment, from six months to one year, is common. But longer treatment may be necessary to prevent a recurrence. People who have recurrent anxiety disorder may need to take medication for the rest of their lives.
7. Can anti-anxiety medications be taken during pregnancy or breastfeeding?
If you are nursing, pregnant, plan to become pregnant or could possibly become pregnant, you should discuss with your health care professional the possible effects of any medications. If the mental health of an expectant mother depends on taking antidepressants during pregnancy, many health care professionals recommend that she continue taking the drugs, so she can care for herself and her family. Research is unclear about how antidepressants may affect a nursing baby though it is known that these drugs pass through to breast milk. Most health care professionals suggest that a woman who is taking anti-anxiety medication and is concerned about breastfeeding options consider the risks of taking medication along with the potential benefits that nursing could provide.
8. What's the first step in getting treatment?
If you think you may have an anxiety disorder, talk to your primary care physician about your symptoms and ask for a referral to a medical professional who can diagnose and treat anxiety. There are many good sources of information about anxiety and other types of mental illness on the Web, through libraries and from mental health organizations. Many organizations have hotlines to help get you started talking about symptoms. If you feel suicidal, seek help immediately.
Organizations and Support
For information and support on coping with Anxiety Disorders, please see the recommended organizations, books and Spanishlanguage resources listed below.
American Academy of Child and Adolescent Psychiatry (AACAP)
Address: 3615 Wisconsin Ave., NW
Washington, DC 20016
American Psychological Association
Address: 750 First St., NE
Washington, DC 20002
Hotline: 1 -800-374-2721
Anxiety Disorders Association of America (ADAA)
Address: 8730 Georgia Avenue, Suite 600
Silver Spring, MD 20910
Association for Behavioral and Cognitive Therapies (ABCT)
Address: 305 7th Avenue, 16th Floor
New York, NY 10001
Address: The Bazelon Center for Mental Health Law
1101 15th Street NW, Suite 1212
Washington, DC 20005
Federation of Families for Children's Mental Health
Address: 9605 Medical Center Drive, Suite 280
Rockville, MD 20850
Freedom From Fear
Address: 308 Seaview Avenue
Staten Island, NY 10305
Geriatric Mental Health Foundation
Address: 7910 Woodmont Ave, Suite 1050
Bethesda, MD 20814
Mental Health America
Address: 2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
National Alliance on Mental Illness (NAMI)
Address: Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201
Hotline: 1-800-950-NAMI (1-800-950-6264)
National Anxiety Foundation
Address: 3135 Custer Drive
Lexington, KY 40517
National Institute of Mental Health
Address: Science Writing, Press and Dissemination Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892
National Mental Health Consumers' Self-Help Clearinghouse
Address: 1211 Chestnut St., Suite 1207
Philadelphia, PA 19107
Obsessive Compulsive Foundation
Address: 112 Water Street Suite 501
Boston, MA 02109
SAMHSA's National Mental Health Information Center
Address: P.O. Box 2345
Rockville, MD 20847
Screening for Mental Health (SMH)
Address: One Washington Street, Suite 304
Wellesley Hills, MA 02481
10 Steps to Take Charge of Your Emotional Life: Overcoming Anxiety, Distress, and Depression Through Whole-Person
by Eve A. Wood
Anxiety, Phobias and Panic Attacks: Your Questions Answered
by Elaine Sheehan
Complete Idiot's Guide to Conquering Fear and Anxiety
by Sharon Heller
An End to Panic--Breakthrough Techniques for Overcoming Panic Disorder
by Elke Zuercher-White
From Panic to Power: Proven Techniques to Calm Your Anxieties, Conquer Your Fears, and Put You in Control of Your Life
by Lucinda Bassett
Mastering Your Moods--Understanding Your Emotional Highs and Lows
by Paul D. Meier, Stephen Arterburn, and Frank B. Minirth
Overcoming Panic Disorder--A Woman's Guide
by Lorna Weinstock, Eleanor Gilman
Seven Keys to Calm
by A.M. Matthews
The Therapy Sourcebook
by Francine M. Roberts
Women & Anxiety: A Step-by-Step Program for Managing Anxiety and Depression
by Helen DeRosis
US National Library of Medicine
National Institutes of Health
Address: 8600 Rockville Pike
Bethesda, MD 20894
National Association of School Psychologists
Address: 4340 East West Highway, Suite 402
Bethesda, MD 20814
Address: National Institute of Mental Health
Office of Communications and Public Liaison
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892
"Anxiety Disorders." National Institute of Mental Health. July 2009. http://www.nimh.nih.gov/health/publications/anxietydisorders/introduction.shtml. Accessed November 2009.
"Generalized anxiety disorder: Tests and diagnosis." The Mayo Clinic. June 2009. http://www.mayoclinic.com/health/generalizedanxiety-disorder/DS00502/DSECTION=tests-and-diagnosis. Accessed November 2009.
"Generalized anxiety disorder." The National Institute of Mental Health. February 2009. http://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder/index.shtml#Generalized-Anxiety- Disorder. Accessed November 2009.
"Panic attack and panic disorder treatments and drugs." The Mayo Clinic. March 2008. http://www.mayoclinic.com/health/panicattacks/DS00338/DSECTION=treatments-and-drugs. Accessed November 2009.
"Panic disorder: Tests and diagnosis." The Mayo Clinic. March 2008. http://www.mayoclinic.com/health/panicattacks/DS00338/DSECTION=tests-and-diagnosis. Accessed November 2009.
"Overview of panic disorder." Uptodate.com. May 2009. Subscription necessary to view text. Accessed November 2009.
"Overview of obsessive compulsive disorder." Uptodate.com. May 2009. Subscription necessary to view text. Accessed November 2009.
"Cells May Provide Target for New Anxiety Medications." The National Institute of Mental Health Science Update. November 2008. http://www.nimh.nih.gov/science-news/2008/cells-may-provide-target-for-new-anxiety-medications.shtml. Accessed November 2009
"Acute Stress Disorder: A Brief Description." National Center for PTSD. U.S. Department for Veterans Affairs. Updated November 9, 2009. http://www.ptsd.va.gov/public/pages/acute-stress-disorder.asp. Accessed December 2009.
Kent J. "Treating Anxiety Disorders with Medications." Anxiety Disorders Association of America. 2009. http://www.adaa.org/GettingHelp/newsletter/2008/TreatingAnxietyDisordersWithMedications.asp. Accessed December 2009.
"Anxiety Disorders." National Institute of Mental Health, http://www.nimh.nih.gov. Reprinted 2002. Accessed Nov. 2003.
"Anxiety Disorders Information." Anxiety Disorders Association of America. Copyright 2003. http://www.adaa.org. Accessed Nov. 2003.
"Anxiety Disorders & Treatments" Mental Health Net, http://anxiety.mentalhelp.net. Accessed Sept. 2001.
"Brief overview of anxiety disorders." Anxiety Disorders Association of America. http://www.adaa.org/. Accessed August 2006.
"Statistics and Facts About Anxiety Disorders." The Anxiety Disorders Association of America. http://www.adaa.org/. Accessed August 2006.
"Medications." The Anxiety Disorders Association of America. October 2004. http://www.adaa.org/. Accessed August 2006.
"Facts about panic disorder." The National Institute of Mental Health. February 2006. http://www.google.com/. Accessed August 2006.