Anxiety

Definition:

Anxiety is a normal response to stress that everyone experiences throughout their life.  When this anxiety becomes excessive then it becomes a disorder.  Anxiety disorders may develop from various risk factors, including personality, life events and genetics.  Although anxiety is highly treatable, many sufferers do not seek treatment.

Symptoms of Anxiety:
Symptoms of anxiety often vary depending on the type of anxiety the person is diagnosed with.  These symptoms often interfere with the individual's ability to perform daily tasks, and may interfere with work or social settings. 

Generally, symptoms include:

• Need to escape
• Feelings of imminent danger 
• Palpitations
• Sweating
• Trembling
• Shortness of breath
• Choking feeling
• Chest pain
• Nausea or abdominal pain
• Dizziness
• Sense of things being unreal
• Fear of losing control
• Fear of dying
• Tingling sensation
• Hot flushes or chills

Types of anxiety:
Anxiety has many different forms however they all share one thing in common: a persistent and overwhelming fear or worry.  The rate and the strength of the anxiety attacks can be immobilizing, distressing and disruptive.

• Agoraphobia
• This often (but not always) coincides with Panic Disorder.  Agoraphobia is characterized by a fear of experiencing a panic attack while in a situation or place where escape is perceived as difficult.  This often results in sufferers refusing to leave their home; however some sufferers are able to develop a routine from which deviation is impossible.  This routine often involves taking the same route to the same places on a regular basis.  Deviating from this route often causes severe anxiety for the sufferer.  This disorder is uncommon in children, however may be diagnosed in late adolescence or adulthood.   
• Generalized anxiety disorder (GAD)
• GAD is characterized by excessive, idealistic worry that endures for a minimum of six months.  In adults, the anxiety may concern issues such as health, money, or work, however can also include more mundane issues.  Physical symptoms of GAD include trembling, muscular aches, insomnia, nausea, dizziness, sweating and irritability.  Patients also often report difficulties in concentrating and sleep patterns can also be disturbed during times of heightened worry.  The worry effects daily functioning and can occur with other anxiety disorders, depressive disorders or substance-related problems, thus making diagnosis difficult in some patients.
• Obsessive-compulsive disorder (OCD)
• OCD is characterized by persistent, recurring thoughts or obsessions that reflect exaggerated anxiety or fears.  Some of the most common compulsions include excessive cleaning of self or home; repetitive checking that things are done (for example, checking the iron is turned off, checking doors are locked); repetition of words or phrases; taking an excessively slow time to complete certain activities; violent or aggressive thoughts; and hoarding.  These obsessions may lead to ritualistic or routine compulsions such as repeated hand-washing, repetition of phrases or hoarding, however the compulsions may not always relate directly to the obsession (for example, a person with violent thoughts may count objects to alleviate the thoughts and stop themselves from acting upon such thoughts).  These obsessions tend to temporarily relieve the anxiety associated with the obsessive thoughts.  This disorder usually begins during adolescence or early adulthood, and may result in the sufferer’s refusal to do certain things (for example, they may refuse to use public toilets).  A diagnosis of OCD requires the obsessions and or compulsions take a significant amount of time (usually at least one hour per day), and interfere with the person’s daily functioning in social and professional activities or in relationships. 
• Panic attack
• A panic attack is an abrupt episode of intense fear or discomfort that lasts for approximately ten minutes, and includes a minimum of four of the following symptoms:
• Feelings of imminent danger
• Need to escape
• Palpitations
• Sweating
• Trembling
• Shortness of breath
• Choking feeling
• Chest pain
• Nausea or abdominal pain
• Dizziness
• Sense of things being unreal
• Fear of losing control
• Fear of dying
• Tingling sensation
• Hot flushes or chills

There are three different types of panic attacks, unexpected, situational or situationally predisposed.  The unexpected panic attack appears without warning and for no apparent reason.  The situation panic attack occurs when the individual experiences an attack when in the same situation (for example, every time they drive a car).  The situationally predisposed panic attack is similar to the situational panic attack, however the person does not always experience an attack when in the same situation (for example, they only sometimes have a panic attack while driving rather than every time they drive).

• Panic disorder
• Panic disorder is diagnosed when a person experiences a panic attack and then shows concern for at least one month that they will have another panic attack, usually this concern is about the physical or emotional consequences of experiencing another attack.  Many people become concerned that the panic attacks are underlying symptoms of another illness and thus undergo multiple medical examinations.  This behavior may continue for some time, even when medical tests show no underlying medical condition is present.  People with panic disorder may also experience situationally predisposed attacks and thus try to avoid placing themselves in similar situations to those in which they have previously experienced panic attacks.  The frequency and intensity of panic attacks tends to vary from person to person, some people may suffer from repeated attacks for weeks whereas others may have a short burst of severe attacks. 
• Post-traumatic stress disorder (PTSD)
• PTSD is associated with exposure to a traumatic event (for example, witnessing a death, the unexpected death of a loved one, natural disaster or being threatened with death or serious injury).  The main symptoms of PTSD include reliving the incident through flashbacks or nightmares, avoiding certain situations associated with the event physical arousal (including sleep difficulties, hypervigilance, overactive startle response. irritability or lack of concentration) or emotional numbing such as distancing oneself from others or emotional detachment.  Such symptoms must be present for more than one month and need to be accompanied by a reduction in the ability to socialize, work or participate in other areas of daily living that the individual was previously able to do. 

PTSD can occur at any age however is less common in the elderly.  PTSD in children is often displayed through the child’s play whereby the child will reenact the traumatic event.  Physical symptoms in children include headaches and stomachaches. 

• Social anxiety disorder (SAD)
• SAD is diagnosed when an individual experiences intense fear of social or performance situations in which embarrassment may occur.  The person often believes they are being perceived by others as behaving in a socially inappropriate manner.  This intense anxiety often leads to the person avoiding certain situations or extreme anxiety when anticipating certain situations.  The person may experience a panic attack when participating in such an activity.  Physical symptoms may include heart palpitations, excessive sweating, faintness, blushing or confusion.  People with social phobia tend to be sensitive to criticism or rejection and offer suffer from low self-esteem.  This disorder is usually diagnosed in mid to late adolescence, although it can be diagnosed in childhood.  Children with this disorder of exhibit extreme shyness, tantrums or mutism.  Some children will avoid going to school or group activities with their peers. 
• Specific phobia
• As the name suggests, this form of anxiety is caused by an intense fear of a specific object or situation (for example, fear of spiders or heights).  This fear is usually inappropriate to the situation and the sufferer views the fear as irrational.  Specific phobia may also lead to avoidance behaviors.  Specific phobia is diagnosed when the symptoms interfere with the person’s daily routing, work or social life.

Treatment for Anxiety:

Anxiety disorders are often treated with therapy, medication or a combination of the two.  Treatment for anxiety needs to be tailored to the individual as this disorder often coincides with depression or substance abuse.  The sufferer may also be diagnosed with multiple forms of anxiety.  The most common forms of therapy used to treat anxiety disorder are cognitive-behavioral therapy (CBT), exposure therapy, relaxation therapy or psychotherapy.  Medication is often used in conjunction with therapy.  Medications such as anti-depressants or anti-anxiety medications are used to alleviate symptoms rather than cure them, which is the reason for combined therapy and medicinal treatment.