Anxiety Disorders

Some fears and worries are justified, but anxiety disorder symptoms compromise daily life functions.

• Anxiety is a feeling of nervousness, apprehension, fear, or worry. Some fears and worries are justified, such as worry about a loved one or in anticipation of taking a quiz, test, or other examination. Problem anxiety interferes with the sufferer's ability to sleep or otherwise function.
• It is noteworthy that teenagers are particularly susceptible to having irritability as a symptom of a number of emotional problems, including anxiety.
• Anxiety may occur without a cause, or it may occur based on a real situation but may be out of proportion to what would normally be expected. Severe anxiety can have a serious impact on daily life.
• Anxiety can be accompanied by a variety of physical symptoms. Most commonly, these symptoms are related to the heart, lungs, nervous, and gastrointestinal systems. You may have upset stomach, diarrhea, trouble breathing, or feel as if you may faint or are having a heart attack.

Problem anxiety may be caused by a mental condition, a physical condition, the effects of drugs, or from a combination of these. The doctor's initial task is to see if your anxiety is caused by a medical condition. Conditions as varied as anemia, asthma attack, infection, drug intoxication or withdrawal, or a number of heart conditions are just a few examples of medical problems that can be associated with anxiety.

Common types of anxiety are classified as a number of distinct mental conditions.

Panic disorder: In addition to attacks of anxiety, called panic attacks, common symptoms of panic disorders are stomach upset, palpitations (feeling your heart beat), dizziness, and shortness of breath. These same symptoms also can be caused by caffeine consumption, amphetamines ("speed" is the street slang for amphetamines when they are not prescribed by a doctor), an overactive thyroid, abnormal heart rhythms, and other heart abnormalities (such as mitral valve prolapse). The panic attack sufferers may experience their mind going blank or that they somehow do not feel real, in that they feel as if they are looking at themselves from outside of themselves. In order to qualify for the diagnosis of panic disorder, the individual would experience repeated panic attacks rather than just one episode.

Generalized anxiety disorder: Those who endure this condition experience numerous worries that are more often on the mind of the sufferer than not. Those worries interfere with the person's ability to sleep, frequently affect appetite, energy level, concentration, and other aspects of daily functioning.

Phobic disorders: People with phobias experience irrational fear that may rise to the level of panic attacks in response to a specific thing or situation. Examples of phobias include fears of spiders, insects in general, open spaces, closed-in spaces, air travel, heights, and social anxiety.

Obsessive compulsive disorder: Individuals with this condition either suffer from intrusive and distressing thoughts (obsessions) or engage in irresistible, often repetitive behaviors (compulsions). Examples of obsessions include worries about germs or having items in a particular order. Examples of compulsions include counting items or activities, avoiding walking on cracks, or avoiding touching doorknobs.

Separation anxiety disorder: Considered a disorder of children, separation anxiety disorder can be diagnosed when a child becomes extremely anxious in response to anticipating or being separated from one or more caregiving adults (usually a parent). The separation may come with the child's going to school each day or going to bed each evening, for example.

Stress disorders

These common external factors can cause anxiety:

• Stress at work
• Stress from school
• Stress in a personal relationship such as marriage or friendships
• Financial stress
• Stress from an emotional trauma such as the death of a loved one, a natural disaster, victimization by crime, physical abuse or sexual abuse (for example, acute stress disorder or posttraumatic stress disorder)
• Stress from a serious medical illness
• Side effects of medication
• Intoxication (being "high" on) with an illicit drug, such as cocaine or amphetamines
• Withdrawal from an illicit drug, such as opiates (for example, heroin) or from prescription drugs like Vicodin, benzodiazepines, or barbiturates
• Symptoms of a medical illness
• Lack of oxygen: In circumstances as diverse as high altitude sickness, emphysema, or pulmonary embolism (a blood clot with the vessels of the lung)
• The doctor has the often difficult task of determining which symptoms come from which causes. For example, in a study of people with chest pain that could be heart disease but turned out not to be heart related, 43% were found to have a panic disorder -- a common form of anxiety.

Panic disorder: recurrent episodes of panic attacks, worry about having an attack, about what it means, or changing the way one behaves because of the panic attacks for at least a month. Panic attacks are separate and intense periods of fear or feelings of doom developing over a very short time frame-10 minutes-and they're associated with at least four of the following:

• Palpitations
• Sweating
• Trembling
• Shortness of breath
• Sense of choking
• Chest pain
• Nausea or other stomach upset
• Dizziness
• A feeling of being detached from the world (derealization)
• Being unable to think, feeling as if the mind has gone blank
• Irrational fear of dying
• Numbness or tingling
• Chills or hot flashes

Generalized anxiety disorder: excessive, unrealistic, and difficult to control worry over a period of at least six months. It's associated with three of the following:

• Restlessness
• Easily tired
• Trouble concentrating
• Irritability
• Muscle tension
• Sleep problems

Phobic disorders: intense, persistent, and recurring fear of certain objects (such as snakes, spiders, or blood) or situations (such as heights, speaking in front of a group, or public places). These exposures may trigger a panic attack.

Stress disorders: anxiety (also known as posttraumatic stress disorder) caused by the exposure to either death or near-death circumstances such as fires, floods, earthquakes, shootings, automobile accidents, or wars, for example. Other traumatic events may not have had the threat of death or near-death but resulted in the severe injury or threat thereof. Examples of such trauma include victimization through physical or sexual abuse, witnessing the abuse of another or over-exposure to inappropriate material (for example, exposure of children to pornographic images or acts). The traumatic event is re-experienced in thoughts and dreams. Common behaviors include the following:

• Re-experiencing the trauma, either when awake (flashbacks) or when asleep (nightmares)
• Avoiding activities, places, or people associated with the triggering event
• Difficulty concentrating
• Difficulty sleeping
• Being hypervigilant (you closely watch your surroundings)
• Feeling a general sense of depression, irritability, doom and gloom with diminished emotions such as loving feelings or aspirations for the future

Symptoms such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness generally should not be attributed to anxiety and require evaluation by a doctor.

Call your doctor when the signs and symptoms of anxiety are not easily, quickly, and clearly diagnosed and treated.

• If the symptoms are so severe that you believe medication may be needed
• If the symptoms are interfering with your personal, social, or professional life
• If you have chest pain, shortness of breath, headaches, palpitations, dizziness, fainting spells, or unexplained weakness
• If you are depressed and feel suicidal or homicidal

When the signs and symptoms suggest that anxiety may have been present for a prolonged period (more than a few days) and appear to be stable (not getting worse rapidly), you may be able to make an appointment with your doctor for evaluation. But when the signs and symptoms are severe and come on suddenly, they may represent a serious medical illness that needs immediate evaluation and treatment in a hospital's emergency department.

The doctor will take a careful history, perform a physical examination, and order laboratory tests as needed.

• If you have another medical condition that you know about, there may be an overlap of signs and symptoms between what is old and what is new.
• Just determining that anxiety is psychological does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, or other mental health professional.

In certain cases, anxiety gets better on its own. These are limited to anxiety attacks of short duration in which you know the cause, the anxiety is short, it goes away by itself, and the cause can be eliminated. For example, you may be anxious over an upcoming public performance, a final exam, or a pending job interview. In such circumstances, stress may be relieved by such actions as these:

• Picturing yourself successfully facing and conquering the specific fear
• Talking with a supportive person
• Meditation
• Watching TV
• Taking a long, warm bath
• Resting in a dark room
• Deep-breathing exercises

Treatment depends on the cause of the anxiety.

When the cause of anxiety is a physical ailment, treatment is directed toward eliminating that ailment. For example, if your thyroid gland were overactive and causing anxiety, the treatment might involve surgery and various thyroid-regulating medications.

When the cause is psychological, the underlying cause needs to be discovered and, if possible, eliminated or controlled. For example, if the cause is difficulty in a marriage, the doctor may suggest marital counseling. Withdrawal from a substance of abuse is often addressed with drug-abuse treatment.

Sometimes, the cause cannot be identified. In such cases, the only treatment option is control of symptoms.

In the past, anxiety was treated with drugs in a class known as benzodiazepines. This class of medications is currently used much less often to treat anxiety due to the possibility of addiction.

Examples of medications from this group include:

• Diazepam (Valium)
• Alprazolam (Xanax)
• Lorazepam (Ativan)
• Clonazepam (Klonopin)

Another anti-anxiety drug that is not a benzodiazepine is buspirone (BuSpar).

Neurontin is an antiseizure medication that has been found to be helpful in treating anxiety for some people, but little organized research has indicated whether or not it is effective in addressing anxiety disorders.

Drugs of the SSRI and SNRI classes (selective serotonin reuptake inhibitors and serotonin norepiniphrine reuptake inhibitors) that are also used to treat depression are the first-line treatment. They include the following:

• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluoxetine (Prozac)
• Escitalopram (Lexapro)
• Citalopram (Celexa)
• Venlafaxine (Effexor): This medication has chemical properties of the SSRI class as well as blocking the reuptake of norepinephrine, another neurotransmitter.

In addition, psychotherapy may be useful. Helping the anxiety sufferer combat whatever unrealistic beliefs that may underlie the anxiety (cognitive therapy) or developing ways to manage worries (behavioral therapy) are psychotherapeutic approaches that are often used.

Anxiety should be addressed and treated with your doctor. Establish an ongoing relationship. By encouraging your doctor's familiarity with you and by having a follow-up on a regular basis, you may cope with your problems and resolve them more effectively. These steps may also help you deal with medical conditions that might otherwise go undiagnosed and untreated.

Prevention of anxiety essentially involves an awareness of life's stresses and your own ability to cope with them. This can often be a difficult task in our busy and hectic 21st century.

In essence, you might develop coping mechanisms for all of life's stresses. Strategies might include these:

• Physical well-being through exercise, healthy eating habits, and adequate rest
• Avoiding the use of caffeine, illicit drugs, or the inappropriate use of stimulants or other prescription medications
• Meditation
• Relaxation exercises including deep breathing
• Visualization
• Interpersonal skills in dealing with difficult people and situations or parenting skills training in dealing with your children

When the cause of anxiety is identified and treated, complete recovery is often possible. Where no cause can be readily identified, you may feel anxiety for a long time, perhaps your entire life, unless the symptoms are treated. Treatment can result in anxiety being successfully managed if not cured. Excellent medications are available to help many of the symptoms. Counseling with mental-health professionals can be highly effective.