Anxiety Disorders
Anxiety
is the most common of all psychological disorders. Generalized anxiety,
phobias, panic attacks and obsessive-compulsive behaviors affect 7.3%
of all adult Americans. 8.3 million women and 4.2 million men suffer
from anxiety disorders. The disorders are treatable. During the course
of our lifetime, 14.6% of us will suffer from one or more anxiety
disorders. During any month, 6% of us experience a phobia.
Close
to 2% of us will suffer from a panic disorder during the course of our
lifetime (and if the disorder develops), 15-20% of our first degree
relatives will have the disorder. Women are twice as likely to have
anxiety disorders, and the peak occurrence is between 18-44 years
We
see anxiety create work related injuries, we see anxiety disorders
result from personal injury, and we diagnose physical disorders when
what we are seeing is anxiety disorders. Of all the emotional
responses that we have to our world, this thing we call anxiety is the
most pervasive. None of us are free from the effects of anxiety upon
our lives.
The
term "neurosis", often used in association with the anxiety
disorders, literally means weakness of the nerves and is a misnomer.
An operating definition of neurosis would more likely be that it
results from a conflict between opposing emotions. For example, it
would be "neurotic" to feel both love and resentment for the
same individual or rage and guilt. Anxiety based upon the conflict of
emotions is often called neurotic anxiety.
Although
anxiety symptoms can present in a wide variety of forms, all are
organized around the central components of "nervousness"
and/or reactions to being so agitated. The person, when anxious, has
begun to substitute maladaptive approaches for more reality-based
responses to problems.
The
anxiety may be be based on present, past, or future (even imagined)
events. That is why we are able to be anxious over things that have
never and may not even be likely to happen. We create these events in
our fantasy and then become frightened over their
"potential" for occurrence.
In
an acute panic attack the fear is so great that the individual feels
total loss of control, impending doom and intense terror. Anxiety is,
therefore, essentially a free-floating fear. Sometimes it is attached
to a specific object such as confrontation with one's supervisor;
sometimes it is attached to specific activities such as the
performance of a work-related task.
Anxiety
is a physical as well as a psychological reality. The person becomes
intensely activated with an increase in heart rate, breathing, blood
pressure, muscle tension, digestive processes and other autonomic
activity. Thus, anxiety is a response of the person's nervous system.
When
we recognize the source of the anxiety we refer to it as: "I am
nervous about" some problem, task or interaction. Often, however,
we are aware of the physical symptoms of anxiety rather than the
source. The person may feel abdominal distress, muscle contraction
headache, stiff back, the heart palpitations...and the individual
believes that they are ill. The symptoms rather than the event become
the target of concern.
Rather
than tell the doctor that they are anxious, they tell the doctor that
they have chest pain, and the process of "chasing down" the
source begins. Would it not be an ideal situation if the patient would
only say: "I am so concerned about my job performance and losing
this job that my muscles are tense and my back is killing me."
The symptoms of Generalized Anxiety Disorder vary, but may include any
or all of the following presentations: The patient may report the
sensation of trembling muscles, feeling "shaky" inside,
muscle tension, restlessness and rapid fatigue. Complaints may include
being short of breath or the feeling that one is smothering,
palpitations, cold clammy hands, dizziness, nausea, diarrhea, hot
flashes, frequent urination or a "lump in the throat".
An
exaggerated startle response may be present, as well as difficulty in
concentrating, trouble in falling or staying asleep, and irritability.
Importantly, the symptoms of anxiety can look like many, many organic
disease processes. Anxiety is often called the great imposter, and
there are a "gallery of aliases" for anxiety disorders
dependent upon which bodily system is most affected by this
free-floating fear.
These
symptoms may be accompanied by phobia or physical complaints for which
there is little or no physical basis. These individuals frequently
display overconcern with their health and will develop physical
symptoms in direct response and proportion to stress or emotional
difficulties.
There
is much research regarding the relationship of alcohol abuse to
anxiety disorders. While the presence of one problem does not insure
the coexistence of the other, it is fair to state that a large
percentage (perhaps as much as 40%) of those individuals suffering
from anxiety turn to alcohol as a form of self-medication.
Over
a period of time, a cycle emerges in which repeated alcohol intake
effectively undermines the individual's capacity to cope with daily
problems, which in turn leads to increased anxiety, to excessive
drinking...
In
addition to the subjective reporting of symptoms, prolonged anxiety
may also manifest in physical disorders which seem, at a glance,
unrelated to emotional stressors. Diseases such as gastric ulcers,
tension and migraine headaches, ulcerative colitis and Raynaud's
disease all have in common the component of anxiety.
The
physical complaints displayed by overly anxious individuals have at
their core an intense emotional component. Until the psychological
core is addressed, treatment at best will be circumstantial and
symptom-, rather than cause-oriented. The analogy may be made to
taking aspirin for a fever and gaining temporary relief from
discomfort, without seeking and discovering the source of infection.
Panic
Attack - A panic attack is a discrete period, not just part of a
continuum, in which you feel a sudden onset of anguishing anxiety
characterized by emotions ranging from apprehension to fear to actual
terror. The person may have shortness of breath (SOB), chest pain,
chest constriction, fear of losing control, fear of impending heart
attack (MI) and palpitations. It occurs in the context of several
anxiety disorders. It builds into its peak within 10 minutes. Among
the following 13 symptoms, the individual may have four or more of the
following: sweating, palpitations, trembling, SOB, choking, dear of
dying, numbness/tingling, chills/hot flashes, chest constriction, GI
distress, dizziness/unsteadiness, feeling of unreality or detachment,
etc.
A
social phobia can, in some cases, precipitate the panic attack
discussed last week. The individual develops a pattern of avoidance to
prevent the occurrence of extreme feelings of discomfort, anxiety, and
dread. While such individuals can often force themselves to act in
these social situations, they do so with extreme dread if at all.
This, not uncommonly, disrupts their relationships and their
occupational advancement. They are often tremulous as a result of
their fear of ridicule or criticism and concurrently fear that the
tremulousness will be noted. These symptoms do not spontaneously remit
(simply cease) and the pattern of anticipatory anxiety and avoidance
can, and often does, generalize and include more and more of the
environment to be avoided. The person is aware of the problem but
feels powerless to do anything about it.
Agoraphobia
involves the fear of being away from the home, being alone, being
alone or in a line of people, traveling or any situation in which the
individual believes they be overwhelmed by their fears and no help
readily available. Obviously, they then avoid such settings. There is
the fear of having an anxiety attack, and if the outings are
attempted, they are executed with great fear and loathing. The often
cited concept is "fear of the marketplace." People can have
panic attacks with or without agoraphobia. Agoraphobia often
represents more the avoidant pattern that emerges when the fear of
impending panic is tied to specific events or potential events. The
person creates for themselves, based often upon minimal past
experiences, a series of anticipatory states in which they
contemplate, obsess over potential outcome and, often, thereby, assure
that outcome. Desensitization procedures and psychotherapy with and
without medication if often very helpful to these patients who need to
amass a series of successful experiences to offset the fears that they
are developing while isolating themselves.
Acute
Stress Disorder occurs within four weeks of an event in which a person
felt at risk for survival, intense fear and/or helplessness. The
Disorder can be characterized by a sense of detachment, feeling as
though things are unreal, forgetting parts of the event, and reduced
awareness of daily activities. The patient can have recurrent
thoughts, dreams and sense of reliving the event. Many patients begin
to avoid settings similar to that in which the traumatic even
occurred. They concentrate poorly, are restless and may startle
easily. If the symptoms persist longer than four weeks, it may be
posttraumatic stress disorder which we can discuss next week. The
symptoms can be distressing, may persist, and the prudent thing to do
would be to seek consultation to determine if care is needed.
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