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Anxiety disorders, which include generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder
(PTSD), and phobias, are the most common of all mental disorders.
According to the National Institute of Mental Health (NIMH):
- More than 16 million adults ages 18 to 54 in the United States suffer from anxiety disorders.
- Anxiety disorders are frequently complicated by depression, eating disorders, or substance abuse.
- Many people have more than one anxiety disorder.
Anxiety is an emotion that can signal just the right response to a situation. It can spur you on, for example, to add the finishing touches that
elevate an essay, painting, or important work document from good to excellent. But if you have an anxiety disorder, exaggerated anxiety can stop
you cold and disrupt your life. Like many other illnesses, anxiety disorders often have an underlying biological cause and frequently run in families.
These disorders can be treated by several methods.
Anxiety disorders range from feelings of uneasiness most of the time to immobilizing bouts of terror. This fact sheet briefly describes generalized
anxiety disorder, panic disorder, phobias, and post-traumatic stress disorder. It is intended only as a starting point for gaining an understanding
of anxiety disorders. This fact sheet is not exhaustive, nor does it include the full range of symptoms and treatments. Keep in mind that new research
can yield rapid and dramatic changes in our understanding of and approaches to mental disorders.
If you believe you or a loved one has an anxiety disorder, seek competent professional advice or other forms of support.
Generalized Anxiety Disorder
Most people experience anxiety-that knot in the stomach over a backlog of bills or just before a job interview-at some point in their lives. Such
nervousness in anticipation of a real situation is normal. But if a person cannot shake unwarranted worries, or the feelings are jarring to the point
of avoiding everyday activities, he or she most likely has an anxiety disorder.
Chronic, exaggerated worry, tension, and irritability that appear to have no cause or are more intense than the situation warrants. These psychological
symptoms often are accompanied by physical signs such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating.
- Formal Diagnosis: When someone spends at least 6 months worried excessively about everyday problems. However, incapacitating or troublesome symptoms
warranting treatment may exist for shorter periods of time.
- Treatment: Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation
techniques, and biofeedback to control muscle tension. Medication, most commonly antianxiety drugs, such as benzodiazepines and its derivatives, also may be required
in some cases. Some commonly prescribed antianxiety medications are diazepam, alprazolam, and lorazepam. The nonbenzodiazepine antianxiety medication buspirone can be
helpful for some individuals.
People with panic disorder experience white-knuckled, heart-pounding terror that strikes with the force of a lightning bolt-suddenly and without warning. Some people
feel like they are being devoured by fear, going crazy, or that they are surely dying of a heart attack. And because they can not predict when a panic attack will
seize them, many people live in persistent worry that another one could overcome them at any minute.
Most panic attacks last only a few minutes, but they occasionally go on for 10 minutes and, in rare cases, have been known to last for as long as an hour. They can occur
at any time, even during sleep. The good news is that proper treatment helps 70 to 90 percent of people with panic disorder, usually within 6 to 8 weeks.
- Symptoms: Pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of breath, shaking or trembling, choking, fear of dying, sweating, feelings of unreality, numbness or tingling, hot flashes or chills, and a feeling of going out of control or going crazy.
- Formal Diagnosis: Either four attacks within 4 weeks or one or more attacks followed by at least a month of persistent fear of having another attack. A minimum of four of the symptoms listed above developed during at least one of the attacks.
- Treatment: Cognitive behavioral therapy and medications such as high-potency antianxiety drugs, for example, alprazolam. Several classes of antidepressants [such as paroxetine one of the newer selective serotonin reuptake inhibitors (SSRIs)] and the older tryicyclics and monoamine oxidase inhibitors (MAO inhibitors) are considered "gold standards" for treating panic disorder. Sometimes a combination of therapy and medication is the most effective approach to helping people manage their symptoms.
Most of us steer clear of certain things-for instance, stinging insects or hazardous situations. But phobias are irrational fears that lead people to avoid altogether specific things or situations that trigger intense anxiety.
Post-Traumatic Stress Disorder
- Symptoms: Phobias occur in several forms.
Specific phobia is an unfounded fear of a particular object or situation-such as being afraid of dogs yet loving to ride horses or avoiding highway driving yet being able to drive on city and country roads. Virtually an unlimited number of objects or situations-such as being afraid of flying, heights, or spiders-can be the target of a specific phobia.
Agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult. Many people who have agoraphobia become housebound. Others avoid open spaces, standing in line, or being in a crowd. Many of the physical symptoms that accompany panic attacks-such as sweating, racing heart, and trembling-also occur with phobias.
Social phobia is a fear of being extremely embarrassed in front of other people. The most common social phobia is fear of public speaking.
- Formal Diagnosis: The person experiences extreme anxiety with exposure to the object or situation; recognizes that his or her fear is excessive or unreasonable; and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.
- Treatment: Cognitive behavioral therapy has the best track record for helping people overcome most phobic disorders. The goals of this therapy are to desensitize a person to feared situations or to teach a person how to recognize, relax, and cope with anxious thoughts and feelings. Medications, such as antianxiety agents or antidepressants, can also help relieve symptoms. Sometimes therapy and medication are combined to treat phobias.
In the past, post-traumatic stress disorder (PTSD) was thought to affect only war veterans with heavy combat experience. Researchers now know that anyone, even children, can develop PTSD if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. PTSD can result from terrifying experiences such as rape, kidnapping, natural disasters, war, or serious accidents such as airplane crashes. The psychological damage such incidents cause can interfere with a person's ability to hold a job or develop intimate relationships with others.
- Symptoms: The symptoms of PTSD can range from constantly reliving the event to a general emotional numbing. Persistent anxiety, exaggerated startle reactions, difficulty concentrating, nightmares, and insomnia are common. In addition, people with PTSD typically avoid situations that remind them of the traumatic event because they provoke intense distress or even panic attacks. A rape victim with PTSD, for example, might avoid all contact with men and refuse to go out alone at night. Many people with PTSD also develop depression and may at times abuse alcohol or other drugs as "self-medication" to dull their emotional pain and to forget about the trauma.
- Formal Diagnosis: Although the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond 3 months.
- Treatment: Psychotherapy can help people who have PTSD regain a sense of control over their lives. Many people who have this disorder need to confront what has happened to them and, by repeating this confrontation, learn to accept the trauma as part of their past. They also may need cognitive behavior therapy to change painful and intrusive patterns of behavior and thought and to learn relaxation techniques. Another focus of psychotherapy is to help people who have PTSD resolve any conflicts that may have occurred as a result of the difference between their personal values and how behavior and experience during the traumatic event violated them. Support from family and friends can help speed recovery and healing. Medications, such as antidepressants and antianxiety agents to reduce anxiety, can ease the symptoms of depression and sleep problems. Treatment for PTSD often includes both psychotherapy and medication.
For more information, as well as referrals to specialists and self-help groups in your State, contact:
Anxiety Disorders Association of America
11900 Parklawn Drive, Suite 100
Rockville, MD 20852-2624
The National Institute of Mental Health's toll-free information line is 1-88-88-ANXIETY.
Source of above material on Anxiety Disorders:
National Institute of Mental Health
National Mental Health Services Knowledge Exchange Network (KEN)
Everyone experiences anxiety at one time or another "butterflies in the stomach" before giving a speech or sweaty palms during a job interview are common symptoms. Other symptoms of anxiety include irritability, uneasiness, jumpiness, feelings of apprehension, rapid or irregular heartbeat, stomach ache, nausea, faintness, and breathing problems.
Anxiety is often manageable and mild. But sometimes it can present serious problems. A high level or prolonged state of anxiety can be very incapacitating, making the activities of daily life difficult or impossible. Besides generalized anxiety, other anxiety disorders are panic, phobia, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder.
Phobias, which are persistent, irrational fears and are characterized by avoidance of certain objects, places, and things, sometimes accompany anxiety. A panic attack is a severe form of anxiety that may occur suddenly and is marked with symptoms of nervousness, breathlessness, pounding heart, and sweating. Sometimes the fear that one may die is present.
Antianxiety medications help to calm and relax the anxious person and remove the troubling symptoms. There are a number of antianxiety medications currently available. The preferred medications for most anxiety disorders are the benzodiazepines. In addition to the benzodiazepines, a non-benzodiazepine, buspirone (BuSpar), is used for generalized anxiety disorders. Antidepressants are also effective for panic attacks and some phobias and are often prescribed for these conditions. They are also sometimes used for more generalized forms of anxiety, especially when it is accompanied by depression. The medications approved by the FDA for use in OCD are all antidepressants clomipramine, fluoxetine, and fluvoxamine.
The most commonly used benzodiazepines are alprazolam (Xanax) and diazepam (Valium), followed by chlordiazepoxide (Librium, Librax, Libritabs). Benzodiazepines are relatively fast-acting medications; in contrast, buspirone must be taken daily for 2 or 3 weeks prior to exerting its antianxiety effect. Most benzodiazepines will begin to take effect within hours, some in even less time. Benzodiazepines differ in duration of action in different individuals; they may be taken two or three times a day, or sometimes only once a day. Dosage is generally started at a low level and gradually raised until symptoms are diminished or removed. The dosage will vary a great deal depending on the symptoms and the individual's body chemistry.
Benzodiazepines have few side effects. Drowsiness and loss of coordination are most common; fatigue and mental slowing or confusion can also occur. These effects make it dangerous to drive or operate some machinery when taking benzodiazepines especially when the patient is just beginning treatment. Other side effects are rare.
Benzodiazepines combined with other medications can present a problem, notably when taken together with commonly used substances such as alcohol. It is wise to abstain from alcohol when taking benzodiazepines, as the interaction between benzodiazepines and alcohol can lead to serious and possibly life-threatening complications. Following the doctor's instructions is important. The doctor should be informed of all other medications the patient is taking, including over-the-counter preparations. Benzodiazepines increase central nervous system depression when combined with alcohol, anesthetics, antihistamines, sedatives, muscle relaxants, and some prescription pain medications. Particular benzodiazepines may influence the action of some anticonvulsant and cardiac medications. Benzodiazepines have also been associated with abnormalities in babies born to mothers who were taking these medications during pregnancy.
With benzodiazepines, there is a potential for the development of tolerance and dependence as well as the possibility of abuse and withdrawal reactions. For these reasons, the medications are generally prescribed for brief periods of time days or weeks and sometimes intermittently, for stressful situations or anxiety attacks. For the same reason, ongoing or continuous treatment with benzodiazepines is not recommended for most people. Some patients may, however, need long-term treatment.
Consult with the doctor before discontinuing a benzodiazepine. A withdrawal reaction may occur if the treatment is abruptly stopped. Symptoms may include anxiety, shakiness, headache, dizziness, sleeplessness, loss of appetite, and, in more severe cases, fever, seizures, and psychosis. A withdrawal reaction may be mistaken for a return of the anxiety, since many of the symptoms are similar. Thus, after benzodiazepines are taken for an extended period, the dosage is gradually tapered off before being completely stopped.
Although benzodiazepines, buspirone, tricyclic antidepressants, or SSRIs are the preferred medications for most anxiety disorders, occasionally, for specific reasons, one of the following medications may be prescribed: antipsychotic medications; antihistamines (such as Atarax, Vistaril, and others); barbiturates such as phenobarbital; and beta-blockers such as propranolol (Inderal, Inderide). Propanediols such as meprobamate (Equanil) were commonly prescribed prior to the introduction of the benzodiazepines, but today rarely are used.
Source: NIMH -Medications for Mental Illnesses
Books on Anxiety Disorders
The Anxiety and Phobia Workbook
Edmund J. Bourne, PhD
New Harbinger / 2nd rev edition / 1995
The Anxiety Cure
Robert L. Dupont, MD, Elizabeth Dupont Spencer, MSW, Caroline M. Dupont, MD
John Wiley & Sons / 1998 / Paperback
Anxiety Disorders and Phobias: A Cognitive Perspective
Aaron T. Beck, MD, Gary Emery, PhD, Ruth Greenberg, PhD
Basic Books / Reprint edition / 1990
Anxiety, Phobias, and Panic: A Step-by-Step Program for Regaining Control of Your Life
Reneau Z. Peurifoy, MA, MFCC
Warner Books / 1995 / Paperback
Diagonally-Parked in a Parallel Universe: Working Through Social Anxiety
Signe A. Dayhoff, PhD
Effectiveness-Plus / 2000 / Paperback
Don't Panic : Taking Control of Anxiety Attacks
R. Reid Wilson, PhD
HarperCollins / Revised edition / 1996 / Paperback
Overcoming Shyness and Social Phobia : A Step-By-Step Guide
Ronald M. Rapee
Jason Aronson / 1998 / Paperback
Shy Children, Phobic Adults
Deborah C. Beidel, Samuel M. Turner
Amer Psychological Assoc / Hardcover / Published 1997
Triumph Over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks, and Phobias
Jerilyn Ross, MA, LICSW
Trade Paperback / 1995
National and State Resources
Anxiety Disorders Association of America
National Institute of Mental Health
National Mental Health Association
National Institute of Mentally Ill
State Self-Help Groups
State and Local Affiliates- NAMI
National Mental Illness Screening Project (Held each May)
Anxiety Newsletters from athealth.com