Anxiety and Anxiety Disorders

Anxiety (ang-ZY-e-tee) is a feeling of fear, worry, or nervousness that occurs for no apparent reason. Anxiety disorders are conditions in which anxiety becomes so intense and long-lasting that it causes serious distress, and may lead to problems at home, school or work.

On the first day of ninth grade, when Michelle started high school, she suddenly felt dizzy, sweaty, and short of breath when she walked down the hall toward her locker. For a few minutes, everything around her seemed strangely unreal. At first, Michelle thought it was just a little case of nerves. However, when the feelings returned the next day and the next, Michelle began to fear that she was losing control of her mind or that she had some terrible physical illness. In fact, Michelle was suffering from an anxiety disorder.

What Are Anxiety Disorders?

Everybody feels a little nervous now and then. Their palms may get sweaty when they take an important test, their heart may pound as they wait for the opening kickoff of a big game, or they may have butterflies in their stomach as they get ready for a first date. These feelings are perfectly normal. People with anxiety disorders, however, feel afraid, worried, or nervous even when there is no clear reason. Their feelings are intense and long lasting, and they may get worse over time. The feelings are very distressing to a person experiencing them, and can be so over-whelming that they can cause serious problems at home, school, or work.

Anxiety disorders are the most common of all mental disorders. All told, some type of anxiety disorder affects more than 19 million people in the United States. There are several different types of anxiety disorders.

Generalized anxiety disorder

Generalized anxiety is a term for constant, intense worry and stress over a variety of everyday events and situations. People who experience generalized anxiety always expect the worst to happen, even when there is no real reason for thinking this way. For example, they may worry all the time about their grades or sports performance, even when they are successful students or athletes. They may worry about loved ones, about the future, school, health, safety, or upsetting things they imagine could happen. These feelings may be accompanied by physical symptoms, such as tiredness, chest pain, trembling, tight muscles, headache, or upset stomach. When someone has experienced these symptoms for 6 months or longer, a mental health professional uses the diagnosis generalized anxiety disorder to describe their condition.

Separation anxiety disorder

Separation anxiety is the normal fear that babies and young children feel when they are separated from their parents or approached by strangers. It is not uncommon for children to have mild separation anxiety on the first day of school in kindergarten or first grade, or the first day of overnight camp. Usually, this feeling goes away after a few days as a child gets used to a new situation, new friends, and new adults in charge. For most children, separation anxiety lessens with age and experience. In some children, however, this normal fear turns into separation anxiety disorder, which is extreme fearfulness anytime the children are away from their parents or home. Children with this disorder may call their parents at work often, be afraid to sleep over at friends' houses, or suffer extreme homesickness at camp. Separation anxiety disorder can result in frequent absences from school and avoidance of participation in normal social activities of childhood that involve being without their parents. Children with separation anxiety disorder tend to worry and they may be very afraid that their parents will get sick or be injured, or they may have frequent nightmares about getting lost.

Separation anxiety can carry over into the teenage years as well. Teenagers with separation anxiety may be uneasy about leaving home, and they sometimes start refusing to go to school. Extreme separation anxiety may be triggered by a change in school, or it may occur after a stressful event at home, such as a divorce, illness, or death in the family.

Panic disorder

Panic disorder is a disorder that involves repeated attacks of intense fear that strike often and without warning. People having a panic attack may feel as if things are unreal, or they may fear that they are going to die. Along with the fear, they may have physical symptoms, such as chest pain, a pounding heart, shortness of breath, dizziness, or an upset stomach.

Obsessive-compulsive disorder

Obsessive-compulsive (ub-SES-iv-kum-PUL-siv) disorder (OCD) is a condition in which people become trapped in a pattern of repeated, unwanted, upsetting thoughts, called obsessions (ob-SESH-unz), and behaviors, called compulsions (kom-PUL-shunz). The thoughts or behaviors seem impossible to control or stop. Examples of common obsessions include worrying constantly about germs, whether the house is locked, and if a loved one is safe. Examples of common compulsions include washing the hands repeatedly, checking the door lock over and over again, and saying something over and over to "keep a person safe."

Phobias

Phobias (FO-bee-uhz) are unrealistic, long-lasting fears of some object or situation. The fear can be so intense that people go to great lengths to avoid the object of their dread. There are three types of phobia problems that mental health professionals may diagnose. They are specific phobias, social phobia (also called social anxiety disorder), and agoraphobia (AG-or-uh-FO-bee-uh). People with specific phobias have an intense fear of specific objects or situations that pose little real threat, such as dogs, spiders, storms, water, or heights. People with social phobia have an extreme fear of being judged harshly, embarrassed, or criticized by others, which leads them to avoid social situations. People with agoraphobia are terrified of having a panic attack in a public situation from which it would be hard to escape, such as standing in a crowd. If left untreated, the anxiety can become so severe that people might refuse to leave the house.

Post-traumatic stress disorder

Post-traumatic stress disorder involves long-lasting symptoms that occur after people have been through an extremely stressful, life-threatening event, such as a rape, mugging, child abuse, tornado, or car crash. People with the disorder may relive the traumatic event again and again in strong memories or nightmares. They may have other symptoms such as depression ^* , anger, crankiness, and a lack of normal emotions, and they may be easily startled, unusually fearful, and have trouble paying attention.

What Causes Anxiety Disorders?

Genetics

There are probably several causes for anxiety disorders. Genetics may play a role in some cases. For example, research has shown that a twin is more likely to have obsessive-compulsive disorder if the other twin has it and if they are identical twins (twins that have identical genes ^* ) rather than if they are fraternal twins (twins that do not have identical genes). Other twin studies have found a genetic component to panic disorder and social anxiety disorder.

Brain circuits

Some research has focused on pinpointing the exact brain areas and circuits involved in anxiety and fear, which are at the root of anxiety disorders. Scientists have shown that, when faced with danger, the body sends two sets of signals to different parts of the brain. One set goes straight to the amygdala (uh-MIG-duh-luh), a small structure deep inside the brain, which sets the body's automatic fear response in motion. This response readies the body to react to the threat. The heart starts to pound and send more blood to the muscles for quick action, while stress hormones and extra blood sugar are sent into the blood-stream to provide extra energy. The other set of signals takes a round-about route to the cerebral cortex (suh-REE-brul KOR-teks), the thinking part of the brain. Thus, the body response is set in motion before the brain understands just what is wrong. As a built-in safety measure, this learned response is etched on the amygdala so the response will be quickly available for the next dangerous situation.

In people with anxiety disorders, an experience that feels scary, even one involving a normally safe object or situation, can create a deeply etched memory of fear. This memory can lead to the automatic physical symptoms of anxiety when the object or situation is experienced again. These symptoms, in turn, can make it hard to focus on anything else. Over time, people may start to feel anxiety in many situations. Studies have shown that memories stored in the amygdala may be hard to erase. However, people can gain control over their responses with experience and sometimes with psychotherapy ^* .

Temperament

Another factor to take into account is a personality quality called temperament. Temperament refers to a person's inborn nature that consists of certain behavioral traits. To some extent, people's tendency to be shy or nervous may be inborn, simply part of their nature. Some research suggests that babies who are easily upset never fully learn how to soothe themselves early in life the way other children with calmer temperaments do. They may react more strongly to stressful or anxiety-provoking situations than people whose temperament makes them more adaptable. Some experts believe that people with an inhibited, cautious temperament may be more likely to have problems with anxiety.

Life experiences

Yet another factor that plays a role in some anxiety disorders is stress, especially when it occurs early in life. Scientists have found that when rat pups are separated from their mothers at an early age they have a much greater startle response to later stressful situations than rat pups that were not separated. In addition to separation from a parent, human children may be affected by stressful situations such as child abuse, family violence, or growing up in an unsafe neighborhood. Unsafe conditions or frightening experiences may teach children to be overcautious, to expect bad things, or to worry excessively about possible dangers. People with low self-esteem ^* also may be prone to developing anxiety disorders.

What Are the Symptoms of Anxiety Disorders?

The fear response associated with all of the anxiety disorders can involve a number of physical symptoms. These include:

• pounding or racing heart
• sweating
• trembling
• shortness of breath
• choking feeling
• chest pain
• upset stomach
• stomachache
• dizziness
• faintness
• numbness
• tingling
• chills

Anxiety disorders also can lead to changes in the way a person feels, thinks, or behaves. For example, people with anxiety disorders might:

• feel afraid and nervous
• fear they are losing control or going crazy
• fear they will die or get hurt
• worry about a parent's injury or illness
• worry about being away from home
• worry about things before they happen
• worry constantly about school or sports
• refuse to go to school
• be afraid to meet or talk to new people
• avoid new situations
• have trouble sleeping due to worry or fear

Without treatment, people may be driven to take extreme measures to avoid situations that trigger these unpleasant symptoms. They may refuse to join in many activities. Relationships with family and friends may suffer as a result. In addition, people who are always thinking about fears and worries are unable to concentrate on school, work, or sports. They may fail to do as well as they could in these areas.

How Are Anxiety Disorders Diagnosed
and Treated?

Anxiety disorders often occur along with other mental disorders, such as depression, eating disorders ^* , or substance abuse ^* . They also may accompany physical illnesses. In such cases, these other disorders also must be treated. People with the symptoms of an anxiety disorder need a complete medical checkup to rule out other illnesses. They also need a

thorough psychological evaluation. The mental health professional will ask about symptoms and the problems that they cause. With children and teenagers, the professional generally will also talk to parents or even teachers.

Medications

Medications cannot cure anxiety disorders, but they can be very helpful for relieving symptoms. Several kinds of medications are used to treat anxiety. Although these medications work well, they can be very dangerous if mixed with alcohol, and some can be habit forming. Increasingly, antidepressant medications originally developed to treat depression are becoming the more commonly prescribed anti-anxiety medicines as well. Finding the right medication and dose for a given person can take some time. Fortunately, though, if one medication does not work, there are several others that can be prescribed.

Psychotherapy

Medications often are combined with psychotherapy, in which people talk about their feelings, experiences, and beliefs with a mental health professional. In therapy, a person can learn how to change the thoughts, actions, or relationships that play a part in their problems. There are many kinds of psychotherapy, but two kinds have been shown to work particularly well in treating anxiety disorders: cognitive (COG-nih-tiv) therapy and behavioral (be-HAY-vyor-ul) therapy. Often techniques from these two types of therapy are combined.

Behavioral techniques help people replace specific, unwanted behaviors with healthier behaviors. Behavioral approaches that may be used to treat anxiety include relaxation training and deep breathing, for example. People are taught to take slow, deep breaths to relax, because people with anxiety often take fast, shallow breaths that can trigger other physical symptoms, such as a racing heart and dizziness. Another behavioral technique, called exposure (ek-SPO-zhur) therapy, gradually brings people into contact with a feared object or situation so they can learn to control their fear response to what frightens them.

Cognitive-behavioral therapy helps people understand and change their thinking patterns so they can learn to react differently to situations that cause anxiety. This awareness of thinking patterns is combined with behavioral techniques. For example, someone who becomes dizzy during panic attacks and fears he is going to die may be asked to spin in a circle until he gets dizzy. When he becomes alarmed and starts thinking, "I'm going to die," he learns to replace that thought with another one, such as "It's just dizziness. I can handle it." Though anxiety disorders can be extremely distressing to those experiencing them, the good news is that these disorders respond very well to treatment.