Anxiety Disorders (General, Panic and Social)

What are Anxiety Disorders?

Anxiety is a normal reaction to stress – your mind and body's natural response to events that are threatening. A certain amount of worry and anxiety is normal for everyone – in fact, it can help you focus on an upcoming deadline or presentation, or cope with a tense situation. But when anxiety is severe, symptoms continue for several weeks, and it leads to an excessive, irrational dread of everyday situations that interferes with normal activities, it crosses the line to crippling disorder.

Anxiety disorders are serious illnesses of the brain. When they are not treated, anxiety disorders can negatively affect a person’s personal relationships or ability to work or study. In the most severe cases, they can make even regular and daily activities such as shopping, cooking or going outside incredibly difficult. Further, anxiety disorders can lead to low self-esteem, substance abuse, and isolation from one’s friends and family.

People with anxiety disorders perceive more threats, which sends their bodies’ natural “fight or flight” mechanism into overdrive. This response can prompt a genuine physical reaction to everyday people, places or things. They believe danger lurks around every corner, and that something terrible will happen if certain things aren't done a certain way. This leaves them in a constant state of feeling keyed-up and on edge.

Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least six months and can get worse if they are not treated. Anxiety symptoms are real and nothing to be ashamed of. What’s more, they can be treated effectively.

Signs and Symptoms

Individuals who suffer from anxiety disorders frequently experience severe symptoms that make them feel extremely uncomfortable, helpless and out-of-control. Symptoms include: 

• Constant worry
• Fear or confusion
• Thoughts that don’t go away
• Avoidance of people, places or things
• Muscle tension
• Physical weakness
• Poor memory
• Sweating
• Trembling
• Restlessness, inability to relax
• Difficulty concentrating
• Shortness of breath
• Lightheadedness
• Rapid or irregular heartbeat
• Upset stomach
• Aches and pains 

There are three major types of anxiety disorders:

Generalized Anxiety Disorder (GAD)

Panic Disorder

Social Anxiety Disorder / Social Phobia

Each anxiety disorder has different symptoms, but they all revolve around excessive, irrational fear and dread. Other recognized anxiety disorders include separation anxiety, specific phobias, and substance/medication-induced anxiety disorder.  

How Common are Anxiety Disorders? Approximately 40 million American adults – about 18 percent of the population age 18 and older – are affected by anxiety disorders in a given year. Anxiety disorders also affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse. 

Diagnosis

An anxiety disorder may be diagnosed if a person has an inappropriate response to a situation, cannot control their response, and the anxiety inhibits their ability to function for more than six months. As with all types of illness, a physician must be seen to provide a proper diagnosis. After ruling out other illnesses, the doctor may recommend seeing a mental health professional, such as a psychiatrist.

Treatment

Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help people with anxiety disorders lead productive, fulfilling lives. In general, individuals are treated with medication, specific types of psychotherapy or a combination of the two. Some people may respond to treatment after a few weeks or months, while others may need more than a year. Treatment may be complicated if people have more than one anxiety disorder or if they suffer from other co-existing conditions. This is why treatment must be tailored specifically for each individual. 

Co-occurring Conditions

Anxiety disorders commonly occur along with other mental or physical illnesses, including depression and alcohol or substance abuse. Even though some drugs make people feel less anxious when they are high, anxiety becomes even worse when the drugs wear off. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.

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Sources:

National Institute of Mental Health

National Alliance on Mental Illness

The Kim Foundation

Anxiety Disorders Association of America

Helpful links:

http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

http://www.nimh.nih.gov/health/publications/anxiety-disorders-listing.shtml

http://www.nami.org/Template.cfm?Section=By_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=142543

http://www.nami.org/factsheets/anxietydisorders_factsheet.pdf

http://www.psychologytoday.com/basics/anxiety

http://psychcentral.com/disorders/anxiety/

http://www.adaa.org/living-with-anxiety

http://www.adaa.org/living-with-anxiety/children

Anxiety Disorders Association of America – http://www.adaa.org/

 

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by persistent, excessive and unrealistic worry about everyday things. People with the disorder experience chronic, exaggerated worry and tension. They often expect the worst, even when there is no apparent reason for concern. They anticipate disaster and are overly concerned about money, health, family, work or other issues. Other times, the source of the worry is hard to pinpoint.

Sometimes just the thought of getting through the day triggers anxiety. Individuals affected don’t know how to stop the worry cycle and feel it is beyond their control, even though they usually realize that their anxiety is more intense than the situation warrants – that it’s irrational. Yet the anxiety is frequently sufficient to also cause fatigue, headaches, nausea and other physical symptoms.

In contrast to those with other anxiety disorders, people with GAD don’t typically avoid certain situations as a result of their disorder. When their anxiety level is mild, they can function in social settings and the workforce. However, if severe, GAD can be debilitating, making even the most routine daily activities seem overwhelming.

How Common is Generalized Anxiety Disorder?

GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year. The disorder comes on gradually and can begin anytime within the life cycle. Most often, it appears in childhood or adolescence, but can begin in adulthood, too. According to the Anxiety and Depression Association of America, women are twice as likely to be affected. In addition, GAD often occurs in the relatives of affected individuals. Evidence suggests that biological factors, family background and life experiences, particularly stressful ones, all play a role.

Signs and Symptoms

People with generalized anxiety disorder are consumed with worry every day, potentially all day. This disrupts social activities and interferes with work, school or family. What’s more, they seem irritable, on-edge and unable to relax. They frequently have trouble falling or staying asleep, so they’re tired all the time. They have a hard time concentrating – or their mind goes blank.

The emotional pain is compounded by physical symptoms, notably trembling, twitching, headaches, muscle tension or unexplained pains. Those afflicted with GAD are prone to sweating or hot flashes, upset stomachs and frequent trips to the bathroom. They may feel lightheaded or out-of-breath, or as though they have a lump in their throat. Many individuals with GAD even startle more easily than other people. 

Treatment

Like other anxiety disorders, GAD is treatable. Cognitive-behavioral therapy is effective for many people, helping them to identify, understand and modify faulty thinking and behavior patterns. This enables people with GAD learn to control their worry. They may also take medication. Anti-anxiety medications and antidepressants are commonly prescribed to treat GAD. In addition, a GAD treatment plan may incorporate relaxation techniques, meditation, yoga, exercise and other alternative treatments

Co-occurring Conditions

Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone; co-occurring conditions must also be treated with appropriate therapies.

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Helpful links:

http://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml

http://psychcentral.com/disorders/generalized-anxiety-disorder-symptoms/

 

Panic Disorder

Characterized by “panic attacks,” panic disorder results in sudden feelings of terror that can strike anytime, anywhere, repeatedly and often without warning – even while asleep. While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes. In rare cases, they may last an hour or more. These episodes of intense fear are accompanied by physical symptoms such as chest pain, heart palpitations, breathlessness, dizziness or intestinal distress. Panic disorder drives more people to seek medical attention than any other anxiety disorder.

Some people with this disorder experience unrealistic worry and live in fear of having more panic attacks. They become very ashamed and self-conscious, and avoid places where they have previously had an attack. They may be unable to work, drive, go to school, shop for groceries, see friends, or conduct activities of daily living. Approximately one-third of individuals who suffer from panic disorder become so consumed with fear that they cannot leave their homes or other safe surroundings, a condition known as agoraphobia. The good news is that early treatment of panic disorder can often stop the progression to agoraphobia. In fact, most people with panic disorder get better with treatment.

How Common is Panic Disorder?

Panic disorder strikes between 3 and 6 million Americans, and is twice as common in women as in men. It can appear at any age – in children or in the elderly – but most often it begins in young adults. Sometimes it starts when a person is under a lot of stress. Not everyone who experiences panic attacks will develop panic disorder; many people have a single panic attack but never have another. For those who do have panic disorder, though, it’s important to seek treatment. Untreated, the disorder can become very disabling.

Signs and Symptoms

Panic attacks are characterized by the following symptoms:

• A racing or pounding heart, or palpitations
• Chest pain or discomfort
• Trembling or shaking
• Shortness of breath or a sensation of being smothered
• A choking feeling
• Chills, hot flashes or sweating
• Nausea or abdominal distress
• Feeling faint, unsteady or woozy
• Numbness or a tingling sensation
• A sense of being detached from oneself or unreality
• Fears of losing control or impending doom
• Fear of dying

Diagnosis

Panic disorder may be diagnosed in people who experience panic attacks, fixate on the fear of having another attack, and who significantly change their behavior as a result. Not surprisingly, the symptoms of panic disorder, such as elevated heart rate, feeling faint, shortness of breath, and sweating, are often mistaken for signs of a heart attack or other life-threatening medical conditions. Therefore, someone with panic disorder may not be diagnosed until medical tests are conducted to rule out other serious illnesses.

Co-occurring Conditions

Panic disorder is often accompanied by other conditions such as depression or substance abuse. Individuals with panic disorder may self-medicate with drugs or alcohol in hopes of coping with or preventing symptoms. The disorder can also trigger phobias – such as fears of places or situations where panic attacks have occurred. If a panic attack struck while someone was on an airplane, he or she may develop a flying phobia.

Treatment

Typically, panic disorder is treated with medication, psychotherapy or a combination of the two. Cognitive-behavioral therapy (CBT) has proven particularly useful for treating panic disorder. It teaches patients to see their panic attacks in a different way and shows them how to reduce their anxiety. Most patients show significant progress after just a few weeks of therapy. Relapses may occur, but they can be treated effectively.

Physicians may also prescribe medication to help relieve symptoms. Anti-anxiety medications and antidepressants are most commonly prescribed for panic disorder. 

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Helpful links

http://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml

http://www.psychologytoday.com/conditions/panic-disorder?tab=Treatments

 

Social Anxiety Disorder (Social Phobia)

Social Anxiety Disorder (also known as social phobia) is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of work, school or doing other everyday things. People with social anxiety disorder often have an irrational fear of being humiliated in public for “saying something stupid,” or “not knowing what to say.”

Everyone has felt anxious or embarrassed at one time or another. Meeting new people or giving a public speech can make anyone nervous. But people with social anxiety disorder worry about these and other things for weeks before they happen.

Those affected are afraid of doing common things in front of other people. For example, they might be afraid to sign a check in front of a cashier at the grocery store; eat or drink in front of other people; or use a public restroom. Most of these individuals know that their fear is excessive, but they can't control it. So they avoid going to places or events where they think they might have to do something that will embarrass them.

For some, social anxiety is a problem only in specific situations. For example, they may be extremely fearful of talking to a salesperson or speaking in public. Others can have symptoms in almost any social setting, and around anyone except their own family. They can literally feel sick from fear where most people see no threat. Children with social anxiety are prone to clinging behavior, tantrums and even mutism.

How Common is Social Anxiety Disorder?

Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence.

Signs and Symptoms

People with social phobia tend to:

• Be very anxious about being with other people and have a hard time talking to them, even though they wish they could
• Be very self-conscious in front of other people and feel embarrassed
• Be very afraid that other people will judge them
• Worry for days or weeks before an event where other people will be
• Stay away from places where there are other people
• Have a hard time making and keeping friends 

Physical symptoms of social anxiety disorder may mirror panic attacks. These can include blushing, sweating profusely, trembling, nausea or other abdominal distress, rapid heartbeat, shortness of breath, dizziness and headaches. Afflicted adults may experience feelings of detachment and loss of self-control in social situations. As a result, individuals struggling with this disorder may have few or no social or romantic relationships, making them feel powerless, alone or even ashamed.

Co-Occurring Conditions

Social phobia is often accompanied by other anxiety disorders or depression. Substance abuse may develop if people try to self-medicate their anxiety.

Treatment

Most people with a diagnosed social phobia condition require professional treatment to overcome it.

Social phobia is generally treated with psychotherapy, medication or a combination of the two. Cognitive behavior therapy (CBT) is especially useful for treating social phobia. It teaches individuals different ways of thinking, behaving and reacting to situations that help them feel less anxious and fearful. It can also help people learn and practice social skills. The most commonly prescribed medications for social phobia are anti-anxiety medications and antidepressants.

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Helpful links

http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml

http://www.adaa.org/understanding-anxiety/social-anxiety-disorder

http://www.nami.org/Template.cfm?Section=By_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=142543