Anxiety Disorders

We all experience anxiety. It’s a normal reaction to a stressful, dangerous or difficult situation. If you have an anxiety disorder though, the fear and worry you experience on a daily basis is out of proportion to the situations you encounter – and your anxiety is interfering with your ability to live a happy and healthy life.

If you think you may have an anxiety disorder, know first that you are not alone. Anxiety disorders are the most common type of mental health disorder in America. In any given year, 40 million Americans over the age of 18 will experience an anxiety disorder (18.1% of the total population).

Know also that although many people do not get appropriate anxiety treatments; most that do receive appropriate anxiety treatments make substantial recoveries and lead much happier lives (90%, according to the APA). The most common treatments for anxiety disorders include different psychotherapies, like cognitive behavioral therapy or exposure therapy, and/or medications like beta blockers, anti depressants or anti anxiety medications like Xanax and others.

Although treatment almost always makes things better, self medication very rarely does - and usually, it makes things much worse. Although certain drugs and alcohol can sometimes temporarily reduce anxiety symptoms, the abuse of such substances almost always worsen the severity of an anxiety disorder and can lead to a co-occurring substance abuse problem as well.

Anxiety Statistics

40 million Americans experience an anxiety disorder in any given year.

How that number breaks down into the many different  types of anxiety disorders, according to the National Institute of Mental Health (NIMH), in any given year:¹

• 6 million Americans over the age of 18 (2.7% of the total age-group population) experience panic disorder

• 7.7 million Americans over the age of 18 experience PTSD (3.5% of the total age-group population)

• 6.8 million Americans over the age of 18 have Generalized Anxiety Disorder (GAD) – (3.1% of the total age-group population)

• Obsessive Compulsive Disorder (OCD) is experienced by 2.2 million Americans over the age of 18 (1% of the total age group population)

• 19.2 million Americans over the age of 18 have a specific phobia

• 1.8 million Americans over the age of 18 have agoraphobia
  

Anxiety causes the release of stress hormones that put the body on alert and ready for a quick response. While this can be a beneficial physiological process for moments of real danger, when the body is always or often on alert and at the ready, the physical symptoms can be unpleasant.

Some physical symptoms of anxiety include:²

• Butterflies in your stomach
• A quickened heartbeat
• Tremor
• Dry mouth and difficulty in swallowing
• Needing to urinate
• Diarrhea
• Feeling dizzy
• Feeling chest pain

Other symptoms include

• Insomnia
• Fatigue
• Feeling irritable
• Having trouble concentrating
• Feeling a sense of detachment
• Worrying that you’re going ‘crazy’

Generalized Anxiety Disorder (GAD) is a lingering anxiety that lasts for most of the day, each day, for longer than 6 months in a row.³

People with GAD experience nagging fear and worry throughout the day that is not associated with any reasonable external cause. In moderate cases, people with GAD can live ‘normal’ but less fulfilling lives, but in extreme cases, people with GAD are unable to function normally.

To meet a diagnosis of GAD, a person must have excessive fear and worry that lingers for longer than 6 months. Symptoms of GAD can include insomnia, an inability to concentrate and feeling tense and easily startled. Physical symptoms related to GAD can include headache, muscle pain, tiredness, sweating, nausea, twitching and many more.

Twice as many women as men experience GAD. GAD often co-occurs with other anxiety disorders, substance abuse and depression.³

People with panic disorder experience panic attacks - sudden occurrences of extreme fear that aren’t associated to any real or reasonable cause, and these attacks can be so severe that a person enduring a panic attack can truly believe that they are dying.³

A person with panic disorder will experience re-occurring panic attacks and likely symptoms such as chest pain or a pounding heart, dizziness, difficulty breathing, a feeling of choking or of being smothered, chills and or hot flashes and other physical symptoms.

Panic attacks can strike without warning but are typically short-lived, subsiding mostly within about 10 minutes. Women are twice as likely as men to have panic attacks, and most people with panic disorder start having panic attacks in late adolescence or early adulthood.

A person who suffers re-occurring panic attacks may start to avoid situations that have previously triggered an attack, and this can affect quality of life as the ability to work or socialize is compromised by fears of a future attack. In extreme situations, a person with panic disorder can become housebound (agoraphobic) as a way of coping with panic attacks.

Panic disorder is among the most treatable of anxiety disorders. Medication and/or cognitive behavioral therapy (CBT) are both effective in reducing symptoms.

Agoraphobia is a fear of being in a place where help or escape may be hard to find. Some agoraphobics become housebound as they increasingly avoid public spaces, while some agoraphobics will only avoid certain public spaces, for example, bridges, elevators or airplanes, or very crowded public spaces, like stadiums or shopping malls.³

People with agoraphobia frequently have experienced or continue to experience panic attacks. A fear of having a panic attack in a public place is the most common cause of agoraphobia. Additional symptoms of the disorder include:

• An excessive reliance on others/fear of being alone
• A fear of public places
• A fear of being in a public place and losing control
• Becoming housebound
• Others

Women are more likely than men to experience agoraphobia. The age of onset is most commonly in the 20s, and most people with agoraphobia experience at least one additional co-occurring panic disorder.

Treatments for agoraphobia include medications like anti-depressants and psychotherapy, particularly desensitization therapy.

Phobias are the most common type of anxiety disorder. A specific phobia as a powerful fear of something that is not actually dangerous.³

If you come face-to-face with a poisonous snake, it is normal to feel fear. If you experience great fear when safe at home and you see a snake on TV or in a book, then you have an irrational fear – a phobia.

Some common specific phobias include a fear of:

• Flying
• Heights
• Public speaking
• Dogs
• Escalators
• Enclosed spaces
• Tunnels
• Blood
• Others

Psychotherapy is the most common treatment for specific phobia.

Experiencing a traumatic event, especially one that puts you or someone close to you in great danger, can lead to an after the fact disorder called Post Traumatic Stress Disorder.

If you experience a very traumatic event, during which you feel that you or those close to you are at risk of serious injury or death, you are at risk of an anxiety disorder called PTSD in the months after the fact. Although PTSD is popularly associated with combat, PTSD can strike people who experience any form of traumatic event, such as sexual or violent assault, car accident, natural disaster and others.

Some people seem more at risk of PTSD, and some types of events are more likely to lead to this anxiety disorder. Events that are more likely to cause PTSD, include:

• Events that felt beyond your control
• Events that happened very close to you
• Events that were very traumatic and/or long lasting
• Events that caused you to get seriously injured or to lose someone close to you

For a diagnosis of PTSD, anxiety symptoms must endure for a month or longer and must cause you significant distress in life. Some symptoms of PTSD anxiety include:

• Avoidance symptoms – avoiding people, places or things that remind of the event
• Reliving symptoms – nightmares, flashbacks and traumatic daydreams
• Numbness symptoms – feeling emotionally numb, finding little pleasure in life and or forgetting details of the traumatic event
• Hyperarousal symptoms – feeling irritable, easily startled, tense, jittery

About 1 in 3 who experience PTSD will find that without treatment, symptoms do not improve or may even get worse over time. Fortunately, effective treatments for PTSD are available.

Cognitive behavioral therapy, desensitization therapy and medications like SSRI anti depressants are all effective treatments for PTSD.

While most people will sometimes feel a little nervous at the thought of a public speech or a cocktail party full of strangers, people with social anxiety disorder experience an extreme and irrational fear social situations.

Some of the symptoms of social phobia include:

• Worrying about others judging you in social situations
• Feeling worried about how you will act when in a social situation, and worrying about feeling embarrassed in such situations – worrying that others will notice your discomfort
• Feeling anxiety during any kind of social situation
• Feeling anxiety during the period leading up to a social event
• Avoiding social situations, especially social situations with strangers
• Having few friends
• Sweating, flushing or feeling nauseous when in a social situation

For a person with social phobia, examples of situations that can provoke anxiety include:

• Eating in a restaurant (ordering food)
• Writing in front of other people
• Public speaking
• Using a public bathroom
• Talking with strangers, or getting introduced to strangers
• Talking class or in a meeting
• Dating

A diagnosis of social phobia can made if symptoms endure for longer than 6 months. This disorder usually begins in adolescence, although it can begin earlier. Without treatment, social phobia can last a lifetime.

If symptoms of social phobia endure for longer than a couple of months and affect your quality of life, or you worry about these symptoms, then you should make contact with a mental health professional to talk about treatment options.

Treatments often include medications, which can help you feel less anxious when in public and therapeutic techniques that can help you overcome your fear when in public. If your fears and worries are interfering with your ability to live a full, happy and social life, you will benefit from treatment!

People with OCD feel compulsions to perform certain ritualized behaviors. as a way to control irrational but intrusive thoughts.

OCD is a disorder that is characterized by:

1. Obsessive and intrusive thoughts that are beyond your control
2. Compulsions to perform certain acts – often done as a way to control the obsessive thoughts

Although the ritualized compulsive behaviors are done to control the intrusive obsessive thoughts, these behaviors provide only temporary relief, and need frequent repeating – for some people, these rituals can take hours each day. In some severe cases, the compulsive need to act out certain behaviors for hours on end makes working or otherwise living a normal life, impossible.

• Someone with obsessive worries about fire may develop rituals that involve checking the stove a set number of times, many times a day
• Someone with obsessive thoughts about germs may develop compulsive hand washing behaviors, as a way to cope, at least temporarily

Most people with OCD know that their behaviors are irrational, but they feel powerless to change their entrenched compulsions.

OCD can strike in childhood, and usually appears by early adulthood. Men and women are about equally affected, and there is likely a genetic component to the disease.

The normal treatments for OCD include medications and desensitization forms of therapy.³

Anxiety is a very treatable condition - and most people who get appropriate anxiety treatments will experience a reduction in their anxiety. The most common treatments are psychotherapy and/or certain medications.

Therapy and/or medications are the most commonly offered treatments for anxiety.

Therapies commonly used to treat anxiety include:⁴

Cognitive Behavioral Therapy – CBT is one of the most effective therapies in the treatment of most types of anxiety disorders. In an anxiety disorder, the mind is ‘overreacting’ to threats and worries that do not warrant such an anxiety reaction. CBT training teaches anxiety sufferers to change thought processes away from worry-provoking rumination before such thinking can cause an emotional and behavioral response. According to CBT, that voice in your head isn’t always right…and you don’t have to listen to it!

Exposure therapy – Exposure therapy is a type of CBT in which you gradually increase your exposure to anxiety provoking stimuli – and as you practice ‘confronting’ your fears, you also learn techniques to help manage them.

Medications often used to treat anxiety include: ⁵

• Antidepressants – Antidepressants, particularly those of the SSRI category (Prozac, Zoloft etc.) can also be used effectively in the treatment of many anxiety disorders. These medications are far less addictive than benzodiazepine type anti anxiety medications and are well tolerated by most people. These medications can take several weeks to become effective, and so are used as an ongoing treatment for a chronic condition – and not on an as needed basis.

• Benzodiazepines – These medications, like Xanax, Ativan and Klonopin, can start working very quickly to relieve symptoms of anxiety. They are however quite addictive and can also be sedating.

• Beta Blockers – these are high blood pressure medications that can block the physical symptoms of anxiety. These medications can be used on an as needed basis.

Although there is no substitute for a professional diagnosis and appropriate care, in addition to psychotherapies and certain medications, people can often help control their own symptoms of anxiety through a few learned techniques, the avoidance of certain substances and through the maintenance of general good health.

Home-remedy methods for controlling symptoms of anxiety include:

• Learning relaxation techniques like deep breathing exercises or yoga to reduce some of the anxiety you feel
• Use exercise as a way to fight symptoms of anxiety
• Avoid caffeine and alcohol***!!!
• Make sure to get enough sleep each night
• Avoid a diet high in processed foods and sugars