Anxiety Disorders & Panic Attacks
By Thomas C. Weiss
Approximately forty-million adults in the United States, or about eighteen percent of the population, experience a form of Anxiety disorder each year.
Anxiety disorders may last at least six months and can worsen if left untreated. Anxiety disorders are not the same as the kind of anxiety a person may feel when they are under stress from an event such as speaking in public or attempting to meet a deadline at work. Anxiety disorders often accompany another form of physical or mental illness, or substance or alcohol abuse. Illness, substance or alcohol abuse can hide symptoms of an Anxiety disorder and make the disorder worse. Each Anxiety disorder presents different symptoms, yet all of the symptoms involve irrational fears which are excessive. The person experiencing an Anxiety disorder may need to receive treatment for another illness before they are able to respond to treatment for an Anxiety disorder. There are therapies available for the treatment of Anxiety disorders which are effective. Medical research continues to discover additional methods of treatment that can aid persons with Anxiety disorders to live fulfilling and productive lives.
Persons with Panic Disorder have described feelings of a disconnection from reality, extreme loss of control, and like, and 'things are crashing in,' on them. They have described fears of going places because they may have another panic attack. They feel as if they cannot breath, and state that their heart pounds very hard. Some have felt as if they were dying.
Panic Disorder is a form of Anxiety disorder that can be treated successfully. The characteristics of Panic Disorder include sudden attacks of terror, sweatiness, faintness, dizziness, weakness, and a pounding heart. Persons with Panic Disorder can feel either chilled or flushed during panic attacks, and their hands might either feel numb or tingle. During a panic attack the person may experience a smothering sensation, as well as chest pains, and nausea, accompanied by fears of impending doom, and loss of control. People with Panic Disorder commonly experience a sense of unreality during panic attacks.
Panic Disorder produces fears of the person's own physical symptoms, which seem to be unexplained - this is another symptom in itself of the disorder. At times, persons with Panic Disorder will think that they are losing their minds, having a heart attack, or are near death. The inability to predict when a panic attack will occur finds many persons with Panic Disorder worrying greatly; dreading another attack.
Panic attacks are very unpredictable, able to happen at any time; even when the person is sleeping. Attacks usually peak within ten minutes; although the symptoms can last far longer. Panic Disorder affects twice as many women as men, and many times begins in a person's late teenage years or in young adulthood. There is some evidence that Panic Disorder may be inherited; not everyone who experiences a panic attack will then go on to develop Panic Disorder. A number of people may experience a panic attack, and then never experience another one.
Persons who experience repeated panic attacks can find them disabling, and are advised to seek treatment. There is a potential that they may begin to avoid situations and places where panic attacks have occurred, and treatment can help. An example of this might be if a person experiences a panic attack in an elevator, and begins avoiding elevators because of it - they may find their choice of apartments or jobs limited by the disorder. A fear of elevators in association with panic attacks could substantially limit the person's ability to go any number of places where an elevator is required to access services, such as medical care or entertainment.
Untreated, some persons with Panic Disorder find their lives have become so restricted that they cannot pursue common activities like grocery shopping or driving their car. Approximately one-third of untreated persons with Panic Disorder are unable to leave their homes, or may fear going to places or entering situations without the accompaniment of their spouse or a person they trust. Panic Disorder that has reached this point is referred to as, 'Agoraphobia.'
Agoraphobia is sometimes called the, 'fear of open places.' There is treatment available for Agoraphobia, and early treatment can prevent it. Too often, persons with Panic Disorder wander from doctor to doctor in search of appropriate medical care for years, visiting the emergency room repeatedly before they find someone who diagnoses their disorder. Of all the Anxiety Disorder, Panic Disorder is one of the most treatable. Medications and Cognitive Psychotherapy can help change thought patterns in persons with Panic Disorder which lead to anxiety and fear.
There are some problems that often accompany Panic Disorder, including alcoholism, depression, and drug abuse, which need to be treated separately. Changes in the person's appetite, low-energy, sadness, hopelessness, and difficulty concentrating are all symptoms of depression. Depression is a condition that can be treated effectively with medications, psychotherapy, or both.
Obsessive-Compulsive Disorder (OCD)
Persons with Obsessive-Compulsive Disorder describe a life of rituals woven throughout their daily routine, such as washing their hair several times a day, or counting repeatedly. They may have a, 'lucky,' number associated with tasks, or one that is not. They may count the number of times they perform tasks, or items. They may feel a sense of shame because of these rituals, yet cannot seem to overcome them. Specific routines are something that persons with Obsessive-Compulsive Disorder develop, and if they do not follow the routine they have created they may become anxious. The routines disrupt regular activities during the day.
Rituals and persistent, upsetting thoughts and obsessions are a part of persons with Obsessive-Compulsive Disorder's day. The rituals are used to help control the anxiety produced by thoughts, but the majority of the time it is the rituals that wind up controlling the person. A person with Obsessive-Compulsive Disorder who is obsessed with dirt or germs might compulsively wash their hands repeatedly, for example. Another person with the disorder obsessed with the potential for someone who may break into their home might repeatedly check the locks on their doors before going to bed. Others may be obsessed with their appearance, and comb their hair or adjust their make-up repeatedly. The rituals persons with Obsessive-Compulsive Disorder perform are not a pleasure for them; it only provides a sense of very temporary relief from anxiety produced by obsessive thoughts.
There are any number of rituals that persons with Obsessive-Compulsive Disorder create. Some persons with the disorder need to touch things in a particular sequence repeatedly, or check them repeatedly, or count things repeatedly. Other persons with the disorder obsess over fears of violence, thoughts which are prohibited by religious belief, or of performing un-liked tasks. Persons with Obsessive-Compulsive Disorder may be hoard things, or have trouble throwing things out, or have a preoccupation with order and symmetry. Persons with this disorder pursue their rituals despite the fact that they interfere with their daily lives, or that their rituals are personally distressing. They may understand that their rituals make no sense, but may not realize that it is un-ordinary.
Approximately 2.2 million adults in the United States are affected by Obsessive-Compulsive Disorder. The symptoms vary from individual to individual, and may come and go, ease over time, or worsen. Severe Obsessive-Compulsive Disorder has the potential to keep a person from their responsibilities at home, or working. Sometimes, persons with Obsessive-Compulsive Disorder attempt to help themselves through avoidance of situations which trigger their obsessions. They may also attempt to use drugs or alcohol to calm themselves.
Medications or Exposure-based Psychotherapy usually brings a good response in treatment of Obsessive-Compulsive Disorder. Exposure Psychotherapy involves exposing the person to situations which cause anxiety or fear in them with the intention of desensitizing the person to these situations. The National Institute of Mental Health (NIMH) is promoting research into treatment for persons with Obsessive-Compulsive Disorder who do not respond well to usual therapies, including augmentation treatments and deep brain stimulation.
Post-Traumatic Stress Disorder (PTSD)
Persons with Post-Traumatic Stress Disorder describe traumatic experiences, followed by, 'flashbacks,' terror, anxiety, fear, inability to sleep or relax, and not wanting to be around others. PTSD is a disorder that starts after a person experiences a terrifying ordeal which involves either actual physical harm or the threat of it. The harm may have happened to the person them self, or to someone the person loves; it may have happened during an event the person witnessed as well.
War veterans brought PTSD to the public's attention, although PTSD can occur as a result of a number of incidents involving trauma. Floods, earthquakes, torture, rape, kidnapping, child abuse, being held captive, mugging, train wrecks, car accidents, bombings, and plane crashes are all examples of the kinds of incidents that can cause PTSD in people.
PTSD affects those with it in some different ways. Persons with it may become emotionally, 'numb,' towards people they used to be close to or others, or startle easily. They may lose interest in things they used to enjoy, or become irritable, or have trouble feeling affectionate. They may become aggressive, or even violent in some cases. Persons with PTSD avoid situations that remind them of their trauma, with anniversaries being particularly difficult.
If the event that triggered the trauma was deliberately begun by another person, it may make PTSD symptoms worse for the person affected; in a kidnapping or mugging, for example. Persons with PTSD have, 'flashbacks,' where they repeatedly re-live the trauma they have experienced in their thoughts during the day, and at night while they sleep. Flashbacks are complex, and can involve smells, sounds, feelings, and images that can be triggered by everyday things like a car backfiring, or a door slamming. Persons with PTSD who are experiencing a flashback may believe that the traumatic event is happening again, and lost touch with reality.
The symptoms of PTSD, and their affect on individuals, vary from person-to-person. Symptoms of PTSD commonly begin within three months of the original trauma, although they can appear even years afterward. The symptoms need to last for more than one month in order to be considered Post-Traumatic Stress Disorder, and the course of the illness varies. For some people, recovery occurs within a six-month period of time; others experience symptoms for much longer. Other persons with PTSD are described as, 'chronic.' Not all persons who have experienced trauma will develop PTSD.
Approximately 7.7 million adults in the United States have Post-Traumatic Stress Disorder, although PTSD can happen to children as well. Women are more likely than men to develop PTSD, and there is some evidence that the disorder may run in families. There are medications which have proven effective in the treatment of Post-Traumatic Stress Disorder. Psychotherapeutic techniques are affective as well.
Social Phobia (SAD)
Persons with Social Phobia, also referred to as, 'Social Anxiety Disorder, ' or, 'SAD,' describe feelings of anxiety in social situations, not wanting to leave their homes, pounding heart, sweaty palms, and embarrassment. They may feel clumsy around others, want to leave social situations as quickly as possible, or like they don't have anything to say. They may even feel physically ill around others.
A diagnosis of SAD is reached when a person experiences overwhelming anxiety in social situations, and is excessively self-conscious in them. Persons with SAD are intensely, chronically fearful of being judged and watched by others, and of doing things that might embarrass them in social situations. They may worry for days, or even weeks about a social situation and the fear can become so serious that it can interfere with everything in the person's life. School, work, and other daily activities can become extremely difficult, and so can either making or keeping friends.
The inability to overcome these fears of social situations makes SAD even more difficult for persons affected by it. Many persons with this disorder are aware that their fears are unreasonable and excessive, but are unable to overcome them. If they manage to face their fears and be around other people they may still be extremely anxious beforehand, during the social situation, and may worry about the opinions of the other people involved in the social situation in relation to them for hours afterward. Seemingly simple social situation, such as talking to one person or eating lunch with one person, may be difficult for a person affected by SAD. Getting up in front of a group of people may be incredibly difficult. Persons with SAD may experience anxiety in the presence of anyone other than immediate family members. SAD may affect a person in smaller ways as well, so that it is limited to only a specific situation.
Approximately 15 million adults are affected by SAD in the United States. Women are more likely to be affected by SAD than men. SAD usually presents symptoms in either childhood or in early adolescence, and there is evidence that it may run in families. SAD is treatable with either medications, or with Psychotherapy.
Persons with specific phobias express fears and anxiety related to specific situations or things. For example, a person may be afraid of flying in a plane, experiencing a pounding heart, sweating, a sense of loss of control, fear of crashing, and anxiety. Specific Phobias involve intense fears of things that present little or no actual danger. Fear of things such as escalators, tunnels, heights, closed-in places, dogs, and highway driving are specific phobias. These phobias are not just a fear of the things mentioned and others; they have become irrational fears. A person may be able to ski down a mountain, but find themselves unable to take an elevator to the sixth floor. Persons with these Specific Phobias may realize that their phobia is irrational, and discover that facing their phobia or even thinking about it can cause severe anxiety or a panic attack.
Approximately 19.2 million adults in the United States have some form of Specific Phobia. Women are more likely to experience a specific phobia than men. Symptoms of a specific phobia commonly appear in either childhood or in adolescence, and then continue into adulthood. There is evidence that a tendency towards specific phobias runs in families, although the causes of specific phobias are not clearly understood. Psychotherapy is used to treat Specific Phobias, often with good results.
Generalized Anxiety Disorder (GAD)
Persons with GAD express feelings of being wound up and unable to relax, as well as having difficulty sleeping. They describe being,' unable to let something go,' having trouble concentrating, feeling lightheaded, a pounding heart, worrying, and anxiety. Persons with GAD often live through days which are filled with exaggerated tension and worry, although there is nothing really wrong. They live in anticipation of a disaster; concerns over money, family, health, and work run through their mind. Worries about daily living can even produce anxiety in persons with GAD.
A diagnosis of GAD is reached when a person is worrying excessively over a number of daily issues over a period of six months or more. Persons with GAD may realize that their anxiety is more intense than the situations they face deserves, but are unable to rid themselves of the concern and anxiety. They have difficulty with staying asleep, or even falling asleep in the first place. They can have a number of physical symptoms in association with GAD, including muscle tension, muscle aches, fatigue, headaches, trembling, and twitching. They may also experience sweating, irritability, nausea, lightheadedness, hot flashes, and having to go to the bathroom repeatedly. If a person with GAD's anxiety level is low, they may be able to keep a job and function socially. If their anxiety level is high, a person with GAD may find them self unable to do even the simplest daily activities.
Approximately 6.8 million adults are affected by GAD in the United States. Almost twice as many women as men are affected by GAD. The risk of developing GAD is highest between the ages of childhood and middle-age, although the disorder can begin throughout the life-cycle, and begins gradually. There is some evidence that genetic factors play a modest role in GAD. Treatment for GAD involves either medication, or Cognitive-Behavioral Therapy.
Treatment of Anxiety Disorders
As a general rule, medications and psychotherapy are used to treat anxiety disorders, or both. Every person is an individual, and their treatment depends on their specific disorder and preferences. Prior to treatment, a physician conducts a diagnostic evaluation with the goal of determining if the person's symptoms are being caused by an anxiety disorder, of if they are being caused by a physical problem. If the symptoms are being caused by an anxiety disorder it is important to identify the form or forms of disorders that are present. If there are any co-existing conditions that the person is experiencing, like depression, alcoholism, or drug abuse, the have to be treated before the anxiety disorder can be treated.
Persons with anxiety disorders who have received prior treatment for the disorders need to inform their doctor, and describe the kind of treatment they have received including any medications they have taken and the dosages. If the medications were increased in dosage over the course of treatment, the doctor needs to know, as well as any side-effects the person may have experienced, and how the medications worked for them. If the person received psychotherapy, the doctor needs to know what kind of therapy was involved, how often the person attended sessions, and how well the therapy worked for the person.
Sometimes people with anxiety disorders think they have not done well with forms of treatment, or that they did not work, when in actuality the treatment was not given for an adequate period of time or administered correctly. It is important to find the right treatment for the person, and their particular anxiety disorder; this can take some patience and different attempts.
Medications do not, 'cure,' anxiety disorders. Medications do keep symptoms of anxiety disorder under control while a person receives psychotherapy. A physician or psychiatrist can prescribe medications to help control the symptoms of an anxiety disorder, and work with other healthcare professionals. Psychologists, psychiatrists, social workers, and counselors can provide psychotherapy to relieve anxiety disorders. Medications used for anxiety disorders include antidepressants, beta-blockers, and anti-anxiety medications.
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