What are Anxiety Disorders?

Anxiety is a part of our everyday lives. Who is not nervous on the first day of school or a new job, speaking in public or walking down a dark street alone at night? In such situations, anxiety is helpful. It can make us more alert, and help us prepare – it can work for us. On the other hand, anxiety can also become overwhelming and interfere with our lives. It can cut down on productivity and damage relationships with family, friends and co-workers. When anxiety reaches this level, it may be a symptom of an anxiety disorder.

What are the different types of Anxiety Disorders?

  • General Anxiety Disorder:  Is characterized by recurring fears or worries that keep us from concentrating on tasks.
  • Panic Disorder:  Is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control. A fear of one’s own unexplained physical symptoms is also a symptom of panic disorder. People having panic attacks sometimes believe they are having heart attacks, losing their minds, or on the verge of death. They can’t predict when or where an attack will occur, and between episodes many worry intensely and dread the next attack. Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer. Panic disorder is one of the most treatable of all the anxiety disorders, responding in most cases to certain kinds of medication or certain kinds of cognitive psychotherapy, which help change thinking patterns that lead to fear and anxiety.
  • Obsessive-Compulsive Disorder:  Is characterized by an on-going, out of control and unwanted feelings or thoughts (obsessions) and routines or rituals used to try to rid ourselves of these thoughts (compulsions). People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them. At best, it produces temporary relief from the anxiety created by obsessive thoughts. OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them. 
  • Post-Traumatic Stress Disorder (PTSD):  Is characterized by a re-experiencing trauma, crime or natural disaster through nightmares, flashbacks or other reminders months or even years after the event. Post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that involved physical harm or the threat of physical harm. People with PTSD may startle easily, become emotionally numb, lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, or become more aggressive. They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. 
  • Social Anxiety Disorder:  Is diagnosed when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. People with social anxiety disorder have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends. Even if they manage to confront their fears and be around others, they are usually very anxious beforehand, are intensely uncomfortable throughout the encounter, and worry about how they were judged for hours afterward. Social anxiety disorder can be limited to one situation (such as talking to people, eating or drinking, or writing on a blackboard in front of others) or may be so broad that the person experiences anxiety around almost anyone other than the family. Physical symptoms that often accompany social anxiety disorder include blushing, profuse sweating, trembling, nausea, and difficulty talking. When these symptoms occur, people with social phobia feel as though all eyes are focused on them. 
  • Specific Phobia:  Is characterized by an intense, irrational fear of something that poses little or no actual danger. Some of the more common specific phobias are centered around closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood. If the feared situation or feared object is easy to avoid, people with specific phobias may not seek help; but if avoidance interferes with their careers or their personal lives, it can become disabling and treatment is usually pursued.
  • Generalized Anxiety Disorder (GAD):   A person with GAD may go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety. GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.

What is the Treatment for Anxiety Disorders?  

Anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person’s preference. Before treatment begins, a Psychologist must conduct a careful diagnostic evaluation to determine whether a person’s symptoms are caused by an anxiety disorder. 

  • Psychotherapy:  Psychotherapy involves talking with a Psychologist to discover what caused the anxiety and how to deal with the symptoms.
  • Cognitive-Behavioral Therapy:  Cognitive-Behavioral Therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations. For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties. People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The Psychologist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes. People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened. People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.  
  • Exposure-Based Behavioral Therapy:  With EBT the person gradually encounters the object or situation that is feared, perhaps at first only through pictures, then later face-to-face.  
  • Medication:  Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy. The principal medications used for anxiety disorders are antidepressants and anti-anxiety drugs.  
  • Antidepressants:  Although antidepressants begin to alter brain chemistry after the very first dose; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work. 
  • SSRI’s:  Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRI’s.  SSRI’s alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another. These medications are started at low doses and gradually increased until they have a beneficial effect.  
  • Anti-Anxiety Drugs:  Benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, Benzodiazepines are generally prescribed for short periods of time. Some people experience withdrawal symptoms if they stop taking Benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped.  
  • FDA Warning on Antidepressants:  Before taking medication for an anxiety disorder you should consult with your doctor and report any unusual side effects to a doctor immediately. Patients of all ages taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations.