Anxiety

Anxiety is a feeling of being keyed up and extra alert. Your heart may race or you may get “butterflies” in your stomach. You may feel short of breath or generally jittery. You're likely to have a feeling of impending danger.

These reactions are the way our bodies prepare to cope with stress. All the senses become tuned up and on alert in the presence of a threat. These reactions derive from the primitive “fight or flight” response that enabled early humans to deal quickly with dangerous situations.

Everyone is likely to have that kind of anxiety response in urgent situations, such as a fire or other emergency. But we also get these feelings in the course of our daily routines. Time pressures, traffic tie­ups, social jitters, a new job, or waiting for test results can all produce anxious feelings; and these feelings are normal and healthy.

But anxiety ceases to be positive when it is painful or prolonged, or when the response is out of proportion to the cause. When anxiety interferes with your daily life or when it becomes incapacitating fear, it becomes an illness called an anxiety disorder.

Causes of Anxiety Disorder

The causes of anxiety disorder are not clear. Researchers are currently investigating a number of factors including chemical imbalances, enzyme deficiencies, hormones, the role of emotional traumas, and the interaction between emotions and brain chemistry.

Diagnosing Anxiety Disorder

There is no specific test for anxiety, but after ruling out medical causes, your doctor will compare the symptoms you are having with the definitions of anxiety disorders in the American Psychiatric Association Diagnostic and Statistical Manual (DSM). Anxiety disorders are divided into seven (sometimes overlapping) categories: generalized anxiety disorder; simple phobias; social phobias; agoraphobia; panic disorder; obsessive­compulsive disorder; and posttraumatic stress disorder.

Generalized Anxiety Disorder can typically leave you feeling constantly edgy or jumpy, and worrying excessively. You may suffer from shortness of breath, palpitations, dizziness, or nausea. For a diagnosis of generalized anxiety disorder, you must have the symptoms for more than six months, and in relation to at least two areas of your life (such as overwhelming concern about your health and your finances). The disorder can cause both psychological and physical complaints, ranging from edgy feelings to stomach trouble, sexual problems, and insomnia.

Phobias are involuntary fear reactions that are inappropriate to the situation. They produce a strong sense of dread, and those with the illness do everything possible to avoid the source of their fear. There are three (often overlapping) categories.

Simple phobias are based on a fear of a specific object or situation, such as heights, driving, or flying, even when the object of the fear poses no real threat or danger. Almost anything can become the object of a simple phobia.

Extreme anxiety about being judged by others or fears about behaving in a way that will lead to public embarrassment are signs of a social phobia. People with this disorder often dread speaking, eating or writing in public, or using public restrooms.

Agoraphobia is a complex set of fears about being alone or feeling trapped in a public place. It is often accompanied by panic disorder. Agoraphobia can be debilitating, even to the extent that some people with this disorder become completely housebound.

Panic Disorder. A panic attack is a period of intense fear or discomfort, when you feel confronted with immediate, mortal danger. It has been described as a feeling of life or death in a situation that is not truly dangerous. During a panic attack, you may have shortness of breath, dizziness, palpitations, feelings of unreality, hot flashes or chills. Some people believe they are losing control or even dying. People who have four or more panic attacks in a month, or one or more panic attacks followed by persistent fear of another attack are diagnosed with panic disorder.

Obsessive­Compulsive Disorder. Unpleasant and unwanted thoughts that preoccupy and intrude on one's daily life are a sign of obsessive­compulsive disorder. For example, a woman may have the thought that she could harm her children. These thoughts, while disturbing, are almost never acted upon. They are usually accompanied by repetitive routines and rituals that serve to make the person feel a bit more comfortable. For instance, some people with this disorder feel compelled to wash their hands repeatedly. Others check and re­check that the stove is off or a door is locked. Some hoard things or count things.

Posttraumatic Stress Disorder is a condition brought on by the experience of surviving a severe or unusual physical or mental trauma (such as war, rape, or kidnap), or disasters such as fire, flood, or plane crash. Symptoms range from reliving the traumatic event over and over to feeling emotionally numb. Victims of this disease often have trouble sleeping and suffer recurrent nightmares.

Treating Anxiety Disorders

Everyday anxiety responds to simple measures that you can take yourself, such as regular aerobic exercise, time management, learning to let your feelings out with a trusted friend, or relaxation training. But when anxiety is severe, professional treatment is necessary. The good news is that anxiety disorders are among the most treatable emotional illnesses, and while they are certainly distressing, they are rarely dangerous.

Treatment is usually two­pronged, combining drug therapy and psychotherapy. Drugs are useful for short­term relief, while long­term improvement usually requires some behavioral and life­style changes.

Psychotherapy, including cognitive and behavioral therapies, can be helpful in reducing anxiety. Behavioral therapy involves gradually exposing you to the object or situation that causes your anxiety. Cognitive therapy helps you learn to control unrealistic or negative thinking patterns that may be contributing to your anxiety.

Drugs are available to help treat and manage the symptoms of various anxiety disorders. Benzodiazepines such as diazepam (Valium), lorazepam (Ativan) and alprazolam (Xanax) are commonly used to treat generalized anxiety disorders.

Panic attacks are treated with drugs containing tricyclic antidepressants, such as Etrafon, Triavil, and Limbitrol. Also used for panic are certain benzodiazepines such as alprazolam (Xanax).

For obsessive­compulsive disorders, doctors can prescribe clomipramine (Anafranil). To control the physical symptoms of phobias such as severe stage­fright, beta­blocking drugs such as propanolol (Inderol) are sometimes prescribed.

Outlook

People with anxiety disorders do get better. With proper management, most people with an anxiety disorder can expect to live normal, fulfilling lives.

Next: Depression