Anxiety disorder

Anxiety disorder
Specialty	Psychiatry, clinical psychology

Anxiety disorder is a blanket term covering several different forms of abnormal, pathological anxieties, fears, and phobias.

In clinical usage, "fear", "anxiety" and "phobia" have distinct meanings, though the words are often used interchangeably in casual discourse to describe ubiquitous emotions. Clinically, a phobia is defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) as a "persistent or irrational fear." Clinically, fear is defined as an emotional and physiological response to a recognized external threat. Anxiety is an unpleasant emotional state, the sources of which are less readily identified. Distinguishing among different anxiety disorders is important, since accurate diagnosis is more likely to result in effective treatment and a better prognosis. Surveys have shown as many as 18% of Americans may be affected by anxiety disorders.

Anxiety disorders are frequently accompanied by physiological symptoms that may lead to fatigue or even exhaustion. Clinical depression is frequently comorbid with anxiety disorders.

Diagnosis

Anxiety disorders are often debilitating chronic conditions, which can be present from an early age or begin suddenly after a triggering event. They are prone to flare up at times of high stress.

A good assessment is essential for the initial diagnosis of an anxiety disorder, preferably using a standardized interview or questionnaire procedure alongside expert evaluation and the views of the affected person. There should be a medical examination in order to identify possible medical conditions that can cause the symptoms of anxiety. A family history of anxiety disorders is often suggestive of the possibility of an anxiety disorder.

Anxiety can be accompanied by headache, sweating, palpitations, and hypertension.

It is important to note that a patient with an anxiety disorder will often exhibit symptoms of Clinical Depression and vice-versa. Rarely does a patient exhibit symptoms of only one or the other.

Causes and contributing factors

Clinical and animal studies suggest a correlation between anxiety disorders and difficulty in maintaining balance. A possible mechanism is malfunction in the parabrachial nucleus, a structure in the brain, that among other functions, coordinates signals from the amygdala with input concerning balance. The amygdala is involved in the emotion of fear.

Biochemical factors come into play. Low levels of GABA, a neurotransmitter that reduces overactivity in the central nervous system, contributes to anxiety. A number of anxiolytics achieve their effect by modulating the GABA receptors.

Types

Generalized anxiety disorder

Main article: Generalized anxiety disorder

Generalized anxiety disorder is a common chronic disorder that affects twice as many women as men and can lead to considerable impairment (Brawman-Mintzer & Lydiard, 1996, 1997). As the name implies, generalized anxiety disorder is characterized by long-lasting anxiety that is not focused on any particular object or situation. In other words it is unspecific or free-floating. People with this disorder feel afraid of something but are unable to articulate the specific fear. They fret constantly and have a hard time controlling their worries. Because of persistent muscle tension and autonomic fear reactions, they may develop headaches, heart palpitations, dizziness, insomnia and chest pain. These physical symptoms, combined with the intense, long-term anxiety, make it difficult to cope with normal daily activities.

Panic disorder

Main article: Panic disorder

In panic disorder, a person suffers from brief attacks of intense terror and apprehension that cause trembling and shaking, confusion, dizziness, nausea, difficulty breathing, and feelings of impending doom or a situation that would be embarrassing. One who is often plagued by sudden bouts of intense anxiety might be said to be afflicted by this disorder. The American Psychiatric Association (2000) defines a panic attack as fear or discomfort that arises abruptly and peaks in 10 minutes or less, and can last for several hours.

Although panic attacks sometimes seem to occur out of nowhere, they generally happen after frightening experiences, prolonged stress, or even exercise. Many people who have panic attacks (especially their first one) think they are having a heart attack and often end up at the doctor or emergency room. Even if the tests all come back normal the person will still worry, with the physical manifestations of anxiety only reinforcing their fear that something is wrong with their body. Heightened awareness (hypervigilance) of any change in the normal function of the human body will be noticed and interpreted as a possible life threatening illness by an individual suffering from panic attacks.

Normal changes in heartbeat, such as when climbing a flight of stairs will be noticed by a panic sufferer and lead them to think something is wrong with their heart or they are about to have another panic attack. Some begin to worry excessively and even quit jobs or refuse to leave home to avoid future attacks. Panic disorder can be diagnosed when several apparently spontaneous attacks lead to a persistent concern about future attacks.

Agoraphobia

Main article: Agoraphobia

A common complication of panic disorder is agoraphobia, anxiety about being in a place or situation where escape is difficult or embarrassing (Craske, 2000; Gorman, 2000). It seems that the definition of the word has expanded to refer to avoidance behaviors that sufferers often develop. If a sufferer of panic attacks seems to have them while driving, for example, then he or she may avoid driving, which relieves the anxiety, and subsequently makes future driving more difficult, as a result of behavioral reinforcement.

Phobias

Main article: Phobia

This category involves a strong, irrational fear and avoidance of an object or situation. The person knows the fear is irrational, yet the anxiety remains. Phobic disorders differ from generalized anxiety disorders and panic disorders because there is a specific stimulus or situation that elicits a strong fear response. A person suffering from a phobia of spiders might feel so frightened by a spider that he or she would try to jump out of a speeding car to get away from one.

People with phobias have especially powerful imaginations, so they vividly anticipate terrifying consequences from encountering such feared objects as knives, bridges, blood, enclosed places, certain animals or situations. These individuals generally recognize that their fears are excessive and unreasonable but are generally unable to control their anxiety.

Social anxiety disorder

Main article: Social Anxiety Disorder

Social anxiety disorder is also known as social phobia. Individuals with this disorder experience intense fear of being negatively evaluated by others or of being publicly embarrassed because of impulsive acts. Almost everyone experiences "stage fright" when speaking or performing in front of a group. Since occasionally there are artists or performers with social anxiety disorder who are able to perform publicly without significant anxiety, their love of performing and practicing their art may be diminishing their anxiety. Although some high-functioning phobics such as Glenn Gould are able to perform despite anxiety, most people with social phobias become so anxious that performance is out of the question. In fact, their fear of public scrutiny and potential humiliation becomes so pervasive that normal life can become impossible (den Boer 2000; Margolis & Swartz, 2001). Another social phobia is fear of intimacy, or "love-shyness", which most adversely affects certain men. Those afflicted find themselves unable to initiate intimate adult relationships (Gilmartin 1987).

Obsessive-compulsive disorder

Main article: Obsessive-compulsive disorder

Obsessive compulsive disorder is a type of anxiety disorder primarily characterized by obsessions and/or compulsions. Obsessions are distressing, repetitive, intrusive thoughts or images that the individual often realizes are senseless. Compulsions are repetitive behaviors that the person feels forced or compelled into doing, sometimes, in order to relieve anxiety. The OCD thought pattern may be likened to superstitions: if X is done, Y won't happen—in spite of how unlikely it may be that doing X will actually prevent Y, if Y is even a real threat to begin with. A common example of this behavior would be obsessing that one's door is unlocked, which may lead to compulsive constant checking and rechecking of doors. Another example is obsession with the state of one's personal items, such as eyeglasses, leading to their excessive cleaning or adjustment. Often the process seems much less logical. For example, the compulsion of walking in a certain pattern may be employed to alleviate the obsession that something bad is about to happen. More often, though, the compulsion is inexplicable, simply an urge to complete a ritual triggered by nervousness. Light switches and other household items are also common objects of obsession.

Post-traumatic stress disorder

Main article: Post-traumatic stress disorder

Post-traumatic stress disorder or PTSD is an anxiety disorder which results from a traumatic experience. Post-traumatic stress can result from an extreme situation, such as being involved in warfare, rape, hostage situations, or involvement in a serious accident. It can also result from long term (chronic) exposure to a severe stressor, for example soldiers who endure individual battles but cannot cope with an unceasing sequence of battles. The sufferer may experience flashbacks, avoidant behavior, and other symptoms.

Separation anxiety

Main article: Separation anxiety disorder

Separation anxiety disorder is the feeling of excessive and inappropriate levels of anxiety over being separated from an attachment figure or from a person or place that gives a feeling of safety. While it is seen mostly in children (for example on being left at school) it is also seen in adolescents and adults.

Separation anxiety itself is a normal part of development in babies or children. It is only when this feeling is excessive or inappropriate that it can be considered a disorder.

Treatment

The choices of treatment include psychotherapy (such as cognitive behavioral therapy); lifestyle changes; or pharmaceutical therapy (medications). Mainstream treatment for anxiety consists of the prescription of anxiolytic agents or antidepressants or referral to a psychologist. Treatment controversy arises because some studies indicate that a combination of the medications and behavioral therapy can be more effective than either one alone; however, others studies suggest pharmacological interventions are largely just palliative, and can actually interfere with the mechanisms of successful therapy.

Meta-analysis indicates that psychotherapeutic interventions have superior long-term efficacy when compared to pharmacotherapy. The right treatment may depend very much on the individual's genetics and environmental factors. Therefore it is important to work closely with a psychologist and medication provider who is familiar with anxiety disorders and current treatments.

A number of drugs can be prescribed to treat these disorders. These include benzodiazepines (such as Xanax), antidepressants of most of the main classes (SSRI, TCAs, MAOIs), and possibly Quetiapine.

See also

• Somatosensory Amplification
• Psychologist
• Psychotherapy

External links

• Anxiety Disorders Association of America Information for families, clinicians and researchers
• Anxiety Disorder Affecting Large Population Of Men a large population of men being affected by it
• The Point of Exit Methodology (POEM System)
• Anxiety Support Group

Further reading

• Vanin, John; Helsley, James (2007), Anxiety Disorders: A Pocket Guide For Primary Care, Humana Press, ISBN 978-1-58829-923-9