Anxiety is a normal reaction to a threatening situation and results from an increase in the amount of adrenaline from the sympathetic nervous system. This increased adrenaline speeds the heart and respiration rate, raises blood pressure, and diverts blood flow to the muscles. These physical reactions are appropriate for escaping from danger but when they cause anxiety in many situations throughout the day, they may be detrimental to a normal lifestyle.
An anxiety disorder is a disorder where feelings of fear, apprehension, or anxiety are disruptive or cause distortions in behavior, (Coon, 526); they are psychiatric illnesses that are not useful for normal functioning. At times, an underlying illness or disease can cause persistent anxiety.
Anxiety illnesses affect more than 23 million Americans with about 10 million Americans suffering from the most common, general anxiety disorder (Harvard, 1). Common anxiety disorders are panic attacks (panic disorder), phobias, and general anxiety disorder (GAD).
Panic attacks can begin with a feeling of intense terror followed by physical symptoms of anxiety. A panic attack is characterized by unpredictable attacks of severe anxiety with symptoms not related to any particular situation. (Hale, 1886). The person experiencing the attack may not be aware of the cause. Symptoms include four or more of the following: pounding heart, difficulty breathing, dizziness, chest pain, shaking, sweating, choking, nausea, depersonalization, numbness, fear of dying, flushes, fear of going crazy.
Heredity, metabolic factors, hyperventilation, and psychological factors may contribute to anxiety causing panic attacks. (Hale, 1886) Panic disorder tends to run in families with first degree relatives of patients having four to seven times greater risk than the general population.
Metabolically, the levels of three neurotransmitters, nor-epinephrine, gamma-aminobutyric acid (GABA), and serotonin, may play a role in anxiety. These neurotransmitters act as signals between brain cells. Drugs that change the levels of these neurotransmitters are useful in the treatment of anxiety.
Hyperventilation (rapid shallow breathing) can cause a decrease in carbon dioxide in the blood. This decrease in carbon dioxide has been associated with anxiety.
Anxiety can be caused by psychological factors as well. One theory is that there is an unconscious conflict between certain wishes and desires, and guilt associated with these desires. Another theory is that certain fearful childhood situations provoke anxiety later. This later theory has been associated with agoraphobia in that the fear of being abandoned in the past may lead to fear of public places.
Panic disorder is treated with drugs, cognitive- behavior therapy and other forms of psychotherapy, and/or a combination of the two. Relaxation therapy is also used in combination with other treatments.
Phobias are extreme and disabling fear of something that poses little or no danger and leads to avoidance of objects or situations. There are three types of phobias: agoraphobia, social phobia, and specific phobias (Public Health, 293).
People with agoraphobia fear that something extremely embarrassing will happen to them (Coon, 533). This phobia tends to start between the ages of 15 and 35 and is twice as common in women as in men. Anxiety occurs when the person is in or thinks about being in a place where escape may be difficult or help may not be available. The condition is managed with behavioral techniques such as exposure therapy and it is believed that these techniques may be more effective than drug therapy.
Social phobia is a fear of being the focus of attention or scrutiny or of doing something extremely humiliating. Patients are afraid that others will think they are stupid, weak or crazy. Anxiety can occur from exposure to a particular situation or the mere thought of being in the situation. People with social phobias realize that their fears are irrational but they still experience the dread and anxiety. Treatment consists of cognitive-behavior therapy or medication or a combination of the two. (Pamphlet, 5-6).
Many people experience specific phobias - intense, irrational fears of certain things. Some of the more common specific phobias are dogs, closed-in places, heights, tunnels, bridges, and flying. Specific phobias tend to run in families and are more common in women. They strike more than one in ten people and no one knows just what causes them. Important career or personal decisions may be affected by a persons specific phobia but many of the feared things are easily avoidable and help is not sought. Treatment employs desensitization or exposure therapy and is beneficial in three-fourths of patients. There are currently no drugs recommended for specific phobias however, certain medications may be prescribed to help relieve anxiety symptoms. Relaxation and breathing exercises are also helpful.
General anxiety disorder (GAD)
GAD affects two to five percent of the general population, but it accounts for almost 30% of "psychiatric" consultations in general practice. GAD is chronic or exaggerated worry and tension. Worrying is often accompanied by physical symptoms like trembling, muscle tension, headache and nausea. People with GAD cannot seem to shake their concerns, seem unable to relax, have trouble falling or staying asleep, or feel lightheaded or out of breath. Some individuals startle more easily than other people, tend to feel tired, have trouble concentrating, and sometimes suffer depression. (Pamphlet, 2).
Although GAD is the most common anxiety disorder, it is the least understood. It affects people of both sexes and all ages but is diagnosed more frequently in women than in men. The diagnosis of GAD is chronic, exaggerated worry and tension that has lasted for more than six months, although most people with the disorder can trace it back to childhood or adolescence. (Harvard, 2). Only 25% of people with the disorder seek professional care leaving millions of sufferers to go without simple treatments which can make a great difference. (Wickelgren, 56). Treatment consists of a mixture of medication and counseling, finding the most useful combination for each patient.
Anxiety disorders can be confused with stress reactions. Stress reactions may have anxiety as a primary feature and include rapid response to sudden stressful life events, leading to disorientation, and adjustment reactions - slower responses to life events that occur days or weeks later as symptoms of anxiety, irritability, and depression. These are usually limited and helped by reassurance, ventilation, and problem solving. Anxiety disorders oftentimes cannot be linked to specific life events and persist for months if not years at a time.
Many people with anxiety disorders can be helped with treatment. Prescribed medications are started at low doses and tapered off when treatment is near an end. Side effects generally become tolerated or diminished with time.
Behavioral therapy and cognitive-behavioral therapy can be effective for treating several of the anxiety disorders. Behavioral therapy focuses on changing specific actions and uses different techniques to alter unwanted behavior. Techniques include special breathing exercises and exposure therapy - gradually exposing patients to what frightens them and helps them cope with their fears.
Cognitive-behavioral therapy teaches patients to react differently to the situations and bodily sensations that trigger panic attacks and other anxiety symptoms. Patients also learn to understand how to change their thoughts so that symptoms are less likely to occur. These techniques are designed to help people confront their fears. Without treatment, anxiety disorders can be extremely disabling and disrupt family, work and social relationships.
1. Coon, D., Essentials of Psychology, Seventh Edition, 1997, Brooks/Cole Publishing, Pacific Grove, California, 526.
2. Harvard Health Letter, July 1998 v23 i9 p1-2, Chronic Anxiety: How to Stop Living on the Edge.
3. British Medical Journal, June 28, 1997 v314 n7098 p1886.
4. Public Health Reports, July-August 1996, v111 n4 p293, Anxiety disorders lead mental ills in the United States.
5. Wickelgren, I., When Worry Rules Your Life Health, November-December 1997, v11 p56.
6. MonsterPapers, 2003
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The information presented here is not meant to be medical advice nor to act as a substitute for medical advice. Serious side-effects, including death, could result if one were to take any prescription medicine without the supervision of a physician.
Copyright 2003, Thomas Manaugh, PhD