Anxiety - July 20, 2010 Newsletter

Anxiety

EHE Newsletter, Volume 10, Number 29
July 20, 2010

Anxiety (and related disorders) is the most common mental illness in the United States, affecting 40 million adults age 18 and older. Almost everyone experiences anxiety to some degree at some point in life. It is a normal reaction to stress and is usually caused by stresses related to work, family, finances, social situations or illness. It is natural for new, unfamiliar or challenging situations to prompt feelings of anxiety or nervousness in an individual. When anxiety becomes an excessive, irrational dread of everyday situations, however, it can be a disabling disorder.

Anxiety Disorders

Normal anxiety can keep an individual alert, help him or her to perform at his or her best and avoid dangerous situations. Anxiety disorders, on the other hand, are mental health conditions that involve excessive amounts of anxiety, fear, nervousness, worry or dread. According to the National Institute of Mental Health (NIMH), anxiety disorders last for at least six months and can worsen if not treated. Such disorders often occur along with other mental or physical illnesses, such as alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.

There are different types of anxiety disorders, each with different symptoms. The common symptoms that all anxiety disorders share are that the anxiety occurs too often, is too strong, is out of proportion to the present situation and affects a person’s daily life and happiness. Five major types of anxiety disorders are:

Generalized Anxiety Disorder (GAD): Generalized Anxiety Disorder is characterized by persistent, excessive and unrealistic worry and tension about everyday things, even when there is little or no apparent reason for worry or tension. Individuals with GAD anticipate disaster and are overly concerned about health issues, money, family problems or difficulties at work. People with GAD often realize that their anxiety is more intense than the situation warrants, but do not know how to stop worrying and feel that it is beyond their control. They cannot relax, startle easily, have difficulty concentrating and often have difficulty falling or staying asleep. Physical symptoms that can accompany GAD include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, hot flashes, having to go to the bathroom frequently and feeling out of breath. GAD develops gradually and can begin at any age, though the years of highest risk are between childhood and middle age. In any given year, GAD affects 6.8 million adults, or 3.1 percent of the U.S. population. Women are two times more likely to be affected than men.

GAD is commonly treated with medication or cognitive–behavioral therapy (CBT) which helps change thinking patterns that lead to fear and anxiety.

Obsessive-Compulsive Disorder (OCD): Obsessive–Compulsive Disorder is characterized by persistent, intrusive and upsetting thoughts that cause anxiety and lead to an urgent need to perform certain rituals or routines (compulsions) to relieve the anxiety. Performing these rituals is not pleasurable, yet it produces temporary relief from the anxiety created by the obsessive thoughts. Additionally, while the ritual might relieve anxiety temporarily, the ritual must be performed again when the obsessive thoughts return. OCD can be so severe and time–consuming that it literally becomes disabling. Many individuals with OCD are aware that their obsessions and compulsions are irrational, yet feel powerless to stop them. Examples of obsessions are a fear of germs or a fear of being hurt. Compulsive behavior includes hand washing, counting, checking on things or cleaning. OCD affects approximately 2.2 million American adults and affects men and women equally. It usually appears in childhood (one–third of adults with OCD develop symptoms as children), adolescence or early adulthood. Research indicates that OCD may run in families.

OCD will not go away by itself, so it is important to seek treatment. The two main treatments for obsessive–compulsive disorder are psychotherapy and medication; a combination of the two is often most effective.

Panic Disorder: A panic attack is a sudden episode of intense fear that develops for no apparent reason and triggers severe physical reactions. Panic attacks typically begin suddenly and without warning. To be diagnosed as having panic disorder, a person must experience at least four of the following symptoms during a panic attack: shortness of breath, dizziness, accelerated heart rate, sweating, a choking sensation, nausea or abdominal distress, chest discomfort, tingling/numbness or a fear of dying, ‘going crazy’ or losing control. In addition to panic attacks themselves, a key symptom of panic disorder is the persistent fear of having future panic attacks. Panic attacks typically last about 10 minutes, but may be slightly shorter or longer. Panic disorder affects approximately six million American adults and is twice as common among women as men.

Panic disorder is one of the most treatable anxiety disorders. It responds in most cases to medication or cognitive behavioral therapy.

Post-Traumatic Stress Disorder (PTSD): Post–Traumatic Stress Disorder is a serious, potentially debilitating condition that can occur among individuals who have experienced or witnessed a traumatic or life–threatening event such as a natural disaster, serious accident, terrorist incident, the sudden death of a loved one, war or a violent act. Symptoms usually begin within three months of the incident and must last for more than one month to be considered PTSD. Occasionally, symptoms do not emerge until years later.

PTSD is characterized by the following three symptoms:

• Intrusion: Reliving the traumatic event through flashbacks or nightmares
• Avoidance: Emotional numbness and avoidance of people, places, thoughts or activities that may bring back memories of the trauma
• Hyperarousal: Feeling overly alert, easily startled, easily irritated, easily angered and having difficulty sleeping and concentrating

People with PTSD have trouble coping with, and recovering from, traumatic events and often feel the effects for months or even years afterwards. They often use alcohol or other drugs in an attempt to self–medicate. PTSD affects approximately 7.7 million U.S adults, but it can develop at any age.

Treatment often includes both medication and psychotherapy. This combined approach can help improve symptoms and teach individuals the skills needed to cope with the traumatic event and its aftermath.

Social Anxiety Disorder (SAD) or Social Phobia: Social Anxiety Disorder is a chronic and potentially disabling disorder. Affected individuals generally avoid specific social situations such as eating or speaking in public or, more commonly, avoid a variety of social situations due to a fear of being scrutinized and/or judged by others. This fear can be so strong that it interferes with going to work or school or performing other everyday activities. Approximately 15 million adults in the U.S. have SAD. It usually begins in childhood or early adolescence, with the typical age of onset being 13 years old.

SAD can be successfully treated through cognitive behavioral therapy and medication.

"Normal" Anxiety or Anxiety Disorder?

How can an individual determine if what he or she is feeling is "normal" anxiety or if it is an anxiety disorder? Some amount of anxiety and worrying is a normal and necessary part of life. There are many events in life that can cause anxiety at a normal level, provided the anxiety is short–lived and does not dramatically interfere with an individual’s daily life. However, feeling excessively anxious for most of the day or night for a prolonged period of time is not normal. When anxiety becomes so overwhelming that it interferes with day–to–day activities, or when it keeps an individual from going places or doing things that he or she needs to do, then help should be sought.

Anxiety disorders are highly treatable, yet only about one–third of those suffering receive treatment. Anyone who has concerns about anxiety or feels that anxiety is interfering with his or her daily life should speak with a healthcare provider.

MEDICAL DISCLAIMER: The information is not intended to constitute medical advice and is not a substitute for consultation with a physician or other healthcare provider. Individuals with specific complaints should seek immediate consultation from their personal physicians.