Anxiety Disorders: Overcoming the Fear

NOT MERELY NERVES, NOT SIMPLY STRESS

The feelings of panic, fear, or discomfort associated with anxiety disorders arise with no apparent cause in situations that are not normally considered stressful or dangerous. The individual recognizes that his or her reactions are inappropriate, but cannot control them. It is these inappropriate responses to non-threatening situations that distinguish anxiety disorders from an attack of “nerves” or everyday stress. These responses also make these disorders so debilitating. Since the symptoms of anxiety disorders can arise seemingly without warning, even everyday routines can become sources of unbearable dread. Unfortunately, lack of understanding about the disorders limit recognition of the symptoms, and the stigma attached to them too often results in anxiety disorders being ignored, trivialized, misdiagnosed or inappropriately treated.

FIVE TYPES OF ANXIETY DISORDERS

Anxiety disorders fall into five main categories. What connects each of them is that people with these disorders resort to often extreme measures to avoid or “white knuckle” their way through anxiety-provoking situations, even when they are quite aware that the reactions are irrational. It is this excessive need to maintain some sense of control---coupled with the fear of the consequences should control be lost---that impairs the individual’s ability to function.

Panic Disorder

Panic disorder is primarily defined by its core symptom, the panic attack, during which the body sends out various warning signals:

Pounding heart...chest pains...sweating...trembling...

shaking...nausea...shortness of breath...sensations of choking...chills... stomach pains...numbness...

dizziness...hot flashes...fear of losing control...feeling “unreal”...fear of dying...

Because these attacks occur “out of the blue” with no apparent cause, people experiencing the above symptoms may believe they are having a heart attack and proceed to the emergency room. They might also blame other causes,

such as a possible brain tumor. Or they may feel that they are simply “losing their mind.”

Unfortunately, because these attacks occur repeatedly, people with panic disorder might find themselves going from doctor to doctor seeking help. They begin to think that nobody understands them. They might even give up seeking help and continue to suffer so as not to be seen as a hypochondriac.

Phobias

The word “phobia” is commonly heard. In fact, its usage is so common that it may have lost some of its meaning and by extension, its seriousness. But people with a phobia have a fear that they know is irrational but yet is excessively distressing and that causes significant disruption in their lives. Phobias have three main classifications:

C Specific phobia --- An extreme or excessive fear of an object or situation that is not harmful under general conditions. This is the category under which many of the commonly known phobias reside, such as claustrophobia (fear of confined spaces) and acrophobia (fear of heights). People with specific phobias realize that their fears are excessive but are unable to overcome them.

C Social phobia --- Also known as social anxiety disorder, this describes the significant, excessive, and persistent fear of social or performance situations. The primary symptom is a feeling of anxiousness when around other people, which makes meeting people, eating in public, or writing in front of someone tasks of extreme difficulty and discomfort. Most people with social phobia either try to avoid dread-provoking situations or endure them with much distress.

C Agoraphobia --- literally a “fear of open areas,” agoraphobia describes the fear of experiencing a panic attack in situations from which escape may be difficult or help is not at hand. This fear of fear can become so severe that people avoid such situations altogether or in extreme cases, never leave their homes.

Obsessive-Compulsive Disorder (OCD)

A person with OCD finds that his or her life has become consumed by obsessions such as preoccupations with dirt or germs, nagging doubts, or a need to have things in a certain order. To combat these obsessions, the person with OCD engages in repetitive rituals (compulsions) to reduce the anxiety brought on by the obsessions. Examples of compulsions include:

C Constant hand washing --- A person might wash their hands until the skin is raw to combat perceived germs.

C Checking and rechecking --- A person might spend up to an hour or more each day in a worrying and checking cycle to satisfy nagging doubts.

C Following rigid procedural rules --- A person might engage in elaborate counting rituals to prevent harm from occurring to a family member, despite knowing that following such rules has no realistic connection to whether the unwanted event happens.

C Hoarding --- A person might resist throwing anything away, despite its readily apparent uselessness, because of unrealistic concerns that it might be needed later.

Everyone has thoughts that may nag at them (going back to make sure the house is locked is not cause for concern). What is indicative of the illness of OCD is spending up to an hour or more each day in addressing these obsessions --- obviously a significant disruption of normal routine and a signal of the need for treatment.

Post-traumatic Stress Disorder (PTSD)

It is a cruel fact that after surviving a harrowing catastrophe or experiencing an utterly terrifying event, many individuals will be unable to shake the images from their minds. They will have nightmares. They will lose sleep. They will have flashbacks. The event will replay over and over in their minds, and they may even find that they are experiencing the same physical symptoms that they felt at the time of the incident. It is normal to have anxiety after a traumatic event, but people with PTSD find that these symptoms still occur six months (and sometimes even years) after the event.

Individuals with PTSD will experience all of the above symptoms as well as extreme emotional and physical discomfort when exposed to situations that even remind them of the initial trauma. Stories reporting the horrors of military combat have brought this condition into the national consciousness, but other events also can trigger PTSD, including rape, witnessing a serious crime, natural disasters, accidents, and childhood physical or sexual abuse.

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. Individuals with generalized anxiety disorder can find themselves constantly worrying about their health, loved ones, finances, or jobs, even when there appears to be no reason to do so. They are unable to relax and often suffer from insomnia.

Many people with GAD also have physical symptoms, such as fatigue, trembling, muscle tension, headaches, irritability, or hot flashes.

Unlike what occurs with other anxiety disorders, individuals with GAD usually do not have specific objects or situations they try to avoid. But like people with the other disorders, there is a high likelihood that these individuals may have an additional mental health difficulty, such as depression, another anxiety disorder, or substance abuse.

Treatment of Anxiety Disorders

While the specifics for these disorders differ, there are two general treatment methods available that have proven effectiveness: medication and psychotherapy. Both methods are effective and can be chosen based on individual preference. A combination of the two treatments also can provide a successful outcome.

There are many promising medications from which a physician can choose, so if one does not deliver hoped-for results, another can be prescribed. It should be noted that medications often require several weeks before reaching full effectiveness. However, if no improvements are noted within 4-6 weeks, a change in medication is probably in order. In the meantime any reactions to medication should be reported so that a determination can be made as to whether to alter the type or amount of medication given.

Psychotherapy involves talking about problems with a trained mental health professional, from which a person learns about the causes and appropriate ways to handle his or her difficulties. An effective form of psychotherapy used to treat anxiety disorders, particularly social phobia and panic disorder, is called cognitive-behavioral therapy, which consists of two components. The cognitive component teaches patients to understand their thinking patterns so they can react differently to the situations that cause them anxiety. The behavioral component seeks to change individuals’ reactions to anxiety-provoking situations through techniques such as deep breathing exercises or gradual exposure to what is causing the anxiety or discomfort. OCD therapy relies primarily on this behavioral component.

How do I pay for treatment?

If you have a private insurance or a health maintenance organization (HMO) plan, your cost for treatment may be covered. In many cases, a portion of the cost is covered. If you do not have insurance or are unable to afford treatment, your community may have publicly-funded mental health centers and other mental health programs that calculate the cost of many services according to what you can afford to pay. If you or your family are on public assistance, you are most likely covered for treatment of anxiety disorders by your state Medicaid plan. Contact your local mental health association for help finding a mental health program in your community.

How else can I help with my treatment?

Talking to trusted confidantes can often give people the support they need when going through life’s difficult times. For example, your pastor, rabbi, or other church leaders and members can be a tremendous source of support and optimism, and may be able to refer you to a mental health professional in your community. Remember, though, that for those with anxiety disorders, such support is no substitute for the care of a trained mental health professional. Just like diabetes, high blood pressure, and depression, anxiety disorders are serious medical disorders that warrant attention from a trained mental health provider. See the list of organizations at the end of this brochure for more information on anxiety disorders and their treatment.

Life can be enjoyable again! With recognition and treatment, anxiety disorders can be overcome.

Other sources of information:

American Academy of Child and Adolescent Psychiatry

3615 Wisconsin Avenue, N.W.

Washington, DC 20016

Referrals: (800) 333-7636, ext. 124

www.aacap.org

American Psychiatric Association

1400 K Street, N.W.

Washington, DC 20005

Referrals: (888) 852-8330

www.psych.org

American Psychological Association

750 First Street, N.E.

Washington, DC 20002

(800) 964-2000

www.apa.org and http://helping.apa.org

Anxiety Disorders Association of America

11900 Parklawn Drive

Suite 100

Rockville, MD 20852-2624

(301) 231-9350

www.adaa.org

Freedom From Fear

308 Seaview Avenue

Staten Island, NY 10305

Screening Site locator line: (888) 442-2022

www.freedomfromfear.com

National Institute of Mental Health

Information and Inquiries Branch

6001 Executive Blvd.

Room 8184, MSC 9663

Bethesda, MD 20892-9663

(888) 8-ANXIETY

www.nimh.nih.gov/anxiety

Obsessive-Compulsive Foundation

9 Depot K Street

P.O.Box 70

Milford, Ct 06460

(203) 878-5669

http://ww.ocfoundation.org

For more information about Mental Illnesses -

Contact:

The National Alliance on Mental Illness

NAMI of Greater Chicago

1536 West Chicago Ave, Chicago, IL 60622

Phone: 312-563-0445