You know what its like to feel anxious--the butterflies in your stomach before a first job interview, the tension you feel when your spouse is angry, the way your heart pounds when you find yourself walking through a dangerous neighbourhood at night. Anxiety alerts you to the need for action. It gears you up to face a threatening situation. It makes you work harder on that presentation, and keeps you focused on studing for those exams. Without anxiety to arouse us we would be unprepared for those extraordinary situations when greater than usual effort is required.
But anxiety disorders are forms of this helpful emotion run amok. It is like a false alarm bell that seldom stops, that alerts you to a danger that is not present. It isn't the same as stress, an anxiety disorder may make you feel anxious most of the time, without any apparent reason. They can be so uncomfortable that to avoid them you may stop some everyday activities. Or you may have occasional bouts of anxiety so intense they terrify and immobilize you. These are illnesses, often related to the biological makeup and life experiences of the individual, and they frequently run in families. While depression, for example, tends to be backward looking, anxiety is often focused on a concern about the future. Depression is measured in degrees of severity, as is anxiety; but, unlike depression, anxiety disorders take several distinct forms. and are the most common of all the mental disorders.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is what people usually mean when they talk about anxiety. GAD is constant and severe worry and stress, without there being anything in the person's life serious enough to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about yourself, your intimate relatiionships, your family, or your work. Although there are always problems in life, with GAD the source of the worry is hard to pinpoint and it is not unusual for those with GAD to be anxious about being anxious.
People with GAD can't seem to shake their fears, even though they usually realize that their anxiety is more intense than the situation warrants. They have a hard time relaxing, falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded, out of breath and fear the social embarrassment of fainting. They may feel nauseated or have to go to the bathroom frequently. Or they might feel as though they have a lump in the throat. They startle easily, tend to feel tired and have trouble concentrating. It is not unusual for them to also suffer depression.
Usually the social impairment associated with GAD is mild and people with the disorder often continue to work and have active social lives. Unlike many other anxiety disorders, people with GAD don't characteristically avoid certain situations as a result of their disorder. However, it can be severe and very debilitating, making everyday activites impossible. GAD comes on gradually and most often hits people in childhood or adolescence, but can begin in adulthood, too. It's more common in women than in men and often occurs in relatives of affected persons. It's diagnosed when someone spends at least 6 months worried excessively about a number of everyday problems.
The symptoms of GAD often seem to seem to diminish with age. Successful treatment may include medication such as buspirone. Research into the effectiveness of other medications, such as benzodiazepines and antidepressants, is ongoing. Also useful are cognitive-behavioral therapy, relaxation techniques, and biofeedback to control muscle tension.
Panic Disorder
Panic disorder is a feeling of terror that strikes suddenly and with no warning. Those suffering from Panic Attacks can develop intense anxiety between episodes, worrying when and where the next one will strike. In between times there is a persistent, all pervasive fear that another attack could come any minute.
Symptoms of a panic attack include heart pounding, feeling sweaty, weak, faint, or dizzy, hands tingling or feeling numb, being flushed or chilled. They often include chest pain or smothering sensations. Many panic attack sufferers end up at hospital emergency wards believing they are having a heart attack or stroke, losing their mind, or are on the verge of death. Attacks can occur any time, even during nondream sleep. Attacks usually last only several minutes but can go on for an hour or more.
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&emdash;in children or in the elderly--but most often it begins in young adults. Not everyone who experiences panic attacks will develop panic disorder--for example, many people have one 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. Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you're riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.
Fearing panic attacks can lead many people fo severly restrict their lives--avoiding normal, everyday activities such as going to work, socializing, or even leaving the house. They may be able to confront a feared situation only if accompanied by a spouse or other trusted person. Essentially, they avoid any situation they fear would make them feel helpless if a panic attack occurs. Taking such severe restrictions to avoid panic attacks is known as agoraphobia. A tendency toward panic disorder and agoraphobia runs in families. Nevertheless, early treatment of panic disorder can often stop the progression to agoraphobia.
Studies have shown that proper treatment--cognitive-behavioral therapy, for example, medications, or possibly a combination of the two--helps 70 to 90 percent of people with panic disorder. Significant improvement is usually seen within 6 to 8 weeks.
Obsessive-Compulsive Disorder
MacBeth' wife releatedly attempting to wash out that "damn'd spot" from her hands is the paradime of Obsessive Compulsive behaviour. Disturbing thoughts or images are called obsessions, the rituals performed to try to prevent or dispel them are called compulsions. Performing such the rituals brings only temporary relief from the discomfort caused by the obsession. Obsessive-compulsive disorder is characterized by anxious thoughts or rituals over which you have no control. If you have OCD you may be plagued by persistent, and often frightening thoughts or images, or by the urgent need to engage in certain rituals.
As with Lady MacBeth, you may be obsessed with hands that are impossible to clean, washing them over and over again. You may be filled with doubt and feel the need to check things repeatedly (did you really turn off the stove?). You might be preoccupied by thoughts of violence and fear that you will harm people close to you. You may spend long periods of time touching things or counting; you may be preoccupied by order or symmetry. Sometimes there is a form of rebelliousness to OCD such as thoughts of performing sexual acts in which you would never engage; or thoughts that are against your religious beliefs--as if, in Freudian terms, your libedo had declared war on your superego.
Of course healthy people also perform OCD like behaviours, such as checking the stove several times before leaving the house. But the disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life. Although most adults with this condition recognize that what they're doing is senseless, they still can't stop it. Children with OCD, may not even realize that their behavior is out of the ordinary. It is estimated that 1 out of 50 people have OCD. Although often it first shows up in the teens or early adulthood a third of adults with OCD experienced their first symptoms as children. The course of the disease is variable--symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence, again, suggests that OCD might run in families.
Depression or other anxiety disorders may accompany OCD. And some people with OCD have eating disorders. In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home, but more often it doesn't develop to those extremes.
Two medications that have been found effective in treating OCD are clomipramine and fluoxetine. A number of others are showing promise, however, and may soon be available. Behavioral therapy, specifically a type called exposure and response prevention, has also proven useful for treating OCD. It involves exposing the person to whatever triggers the problem and then helping him or her forego the usual ritual--for instance, having the patient touch something dirty and then not wash his hands. This therapy is often successful in patients who complete a behavioral therapy program, though results have been less favorable in some people who have both OCD and depression.
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is an externally generated emotional disorder, an extreme condition that follows a terrifying event in which lives are at risk or are actually lost. These critical incidents can leave people with persistent frightening thoughts and memories of their ordeal and feeling emotionally numb, especially with people they were once close to. PTSD, once referred to as shell shock or battle fatigue, was first brought to public attention by war veterans, but it can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, or torture, or being held captive. The event that triggers it may be something that threatened the person's life or the life of someone close to him or her. Or it could be something witnessed, such as mass destruction after a plane crash.
Whatever the source of the problem, some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience sleep problems, depression, feeling detached or numb, or being easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent. Seeing things that remind them of the incident may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event are often very difficult. PTSD can occur at any age, including childhood. The disorder can be accompanied by depression, substance abuse, or anxiety. Symptoms may be mild or severe--people may become easily irritated or have violent outbursts. In severe cases they may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was initiated by a person--such as a rape, as opposed to a flood. Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A flashback may make the person lose touch with reality and reenact the event for a period of seconds or hours or, very rarely, days. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, usually believes that the traumatic event is happening all over again.
Not every traumatized person gets full-blown PTSD, or experiences PTSD at all. PTSD is diagnosed only if the symptoms last more than a month. In those who do have PTSD, symptoms usually begin within 3 months of the trauma, and the course of the illness varies. Some people recover within 6 months, others have symptoms that last much longer. In some cases, the condition may be chronic. Occasionally, the illness doesn't show up until years after the traumatic event.
Antidepressants and anxiety-reducing medications can ease the symptoms of depression and sleep problems, and psychotherapy, including cognitive- behavioral therapy, is an integral part of treatment. Being exposed to a reminder of the trauma as part of therapy--such as returning to the scene of a rape-- sometimes helps. And, support from family and friends can help speed recovery.
Phobias
Phobias are fears of either objects or situations. Social phobia is a fear of being painfully embarrassed in a social setting; while specific phobias are intense, irrational fears of certain things or situations--dogs, spiders, closed-in places, heights, escalators, tunnels, lakes or rivers, flying, blood etc. Phobias aren't just extreme fear; they are irrational fear. You could be a police offier braving the most dangerous criminals on a daily basis, but paralized in the presence of a butterfly. Although adults with phobias usually realize their fears are irrational, even thinking about the feared object or situation can bring on a panic attack.
No one knows just what causes them, though they seem to run in families, are a little more prevalent in women and strike more than 1 in 10 people. Phobias usually first appear in adolescence or adulthood, start suddenly and are more persistent than childhood phobias; with only about 20 percent of adult phobias vanishing on their own. When children have specific phobias, for example, a fear of snakes, those fears usually disappear over time, though they may continue into adulthood. No one knows why they hang on in some people and disappear in others.
Under lying a social phobia is often the belief that other people are very competent in public and that you are not. Small mistakes you make may seem to you much more exaggerated than they really are. Blushing itself may seem painfully embarrassing, and you feel as though all eyes are focused on you. You may be afraid of being with people other than those closest to you. Or your fear may be more specific, such as feeling anxious about giving a speech, talking to a boss or other authority figure, or dating. The most common social phobia is a fear of public speaking. Sometimes social phobia involves a general fear of social situations such as parties. More rarely it may involve a fear of using a public restroom, eating out, talking on the phone, or writing in the presence of other people, such as when signing a check.
Most people with phobias first try to avoid the feared situation or object. Those who fear flying merely travel by train or boat. Sometimes, though, they may make important career or personal decisions to avoid a phobic situation. When phobias interfere with a person's life, treatment can help. Successful treatment usually involves a kind of cognitive-behavioral therapy called desensitization or exposure therapy, in which patients are gradually exposed to what frightens them until the fear begins to fade. Three-fourths of patients benefit significantly from this type of treatment. Relaxation and breathing exercises also help reduce anxiety symptoms.
A social phobia is an intense fear of becoming humiliated in social situations, specifically of embarrassing yourself in front of other people. It is the most common fear people face and often runs in families and can be accompanied by depression or alcoholism. Social phobia often begins around early adolescence or even younger. The medications that have proven effective include antidepressants called MAO inhibitors. People with a specific form of social phobia called performance phobia have been helped by drugs called beta-blockers. For example, musicians or others with this anxiety may be prescribed a beta-blocker for use on the day of a performance.
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(c) BER Fraser msw,rsw. (1998) Reprint only with attribution and, if on-line, with appropriate link..