Anxiety Disorders

Unreasonable fears. . . uncontrolled repetitive behavior. . . trouble concentrating. . . racing heartbeat. . . these are some of the symptoms of anxiety disorders. Characterized by overwhelming fear and unrealistic worries that appear for no apparent reason, anxiety disorders can dramatically impair a person's ability to function and perform everyday activities.

The nation's most common mental health problem, anxiety disorders affect more than 28 million Americans each year. While anxiety disorders are highly treatable with successful results, only 25% of those suffering get help. Many people are simply unaware of what their symptoms mean and that recent treatment advances can improve their condition.

Anxiety disorders are a group of illnesses that include generalized anxiety disorder, panic disorders, phobias, obsessive-compulsive disorder and post-traumatic stress disorder.

Generalized Anxiety Disorder

Generalized Anxiety Disorder is characterized by chronic, exaggerated, unrealistic worry about everyday life occurrences and activities. Normally, these everyday problems would cause little or no concern. A person with Generalized Anxiety Disorder may have feelings of impending disaster and be unable to relax. Despite the realization that he/she is worrying excessively, the individual may be unable to stop.



The onset of Generalized Anxiety Disorder can begin quite gradually, usually in childhood or adolescence, but can also appear in adulthood.

Treatment

Treatment for Generalized Anxiety Disorder often includes a combination of medication and therapy. Busipirone is frequently prescribed although other drugs are being researched. Therapeutic techniques can include cognitive or behavior therapy (see box), relaxation techniques, and biofeedback to alleviate muscle tension.

Panic Disorder

A person suffering from panic disorder experiences sudden feelings of intense, uncontrollable fear -- for no apparent reason. Accompanying the fear are physical symptoms so intense that the person may feel as if he/she is having a heart attack or a stroke. Panic "attacks" often occur without any warning, lasting two to ten minutes, or, more rarely, up to an hour.

Panic disorder affects up to 1.6 percent of the population and is twice as prevalent among women. This condition typically begins when individuals are in their twenties. Panic disorder has a tendency to run in families.

Left untreated, panic disorder can affect the ability to lead a normal life because sufferers begin to restrict their activities in an attempt to avoid situations or places where episodes have occurred. It may become difficult or impossible to go to the grocery store, drive a car, or simply leave the house. In about one-third of cases, panic disorder can lead to agoraphobia, an intense unreasonable fear of being alone in a public place and the feeling that escape from the situation is difficult or impossible.

Treatment

The physical symptoms associated with panic disorder can make diagnosis more difficult. Often, it is mistaken for heart disease, thyroid problems, respiratory disease or hypochondria.

Recent research has shown that the roots of panic disorder are both physical and psychological. The most successful treatment approach for panic disorder combines medication with cognitive and behavior therapy. In particular, medications, such as antidepressants and benzodiazepines, have proven effective for 75 to 90 percent of sufferers.

Phobias

Affecting 12 percent of Americans, phobias are a group of symptoms that are brought on by intense irrational fears of objects or situations. Coupled with the physical reactions associated with extreme fear, phobic reactions are automatic, and pervasive, consuming the person's thoughts with imagined dangers and threats. Phobias fall into three categories:

1. Agoraphobia - the fear of being alone in a public place from which escape would be difficult or impossible, such as a bus, crowded stores, busy streets, etc. Left untreated, this disorder becomes more disabling and often results in making the sufferer housebound. Symptoms typically develop between the ages of 18 and 35.
2. Social - an irrational fear of being in situations where a person's activities can be watched by others, such as dating. The person may fear being humiliated or embarrassed by doing everyday activities in public, such as eating, writing a check, buttoning a coat. Occurring equally among men and women, social phobias usually develop after puberty and peak after the age of 30.
3. Simple - an irrational fear of a specific object. Examples include snakes, insects, closed spaces, heights, escalators, water, flying, blood, etc. Simple phobias tend to develop during childhood and disappear over time. Those that persist into adulthood usually require treatment.

Treatment

Treatment usually involves desensitization or exposure therapy through which the sufferer is exposed to the source of the phobia and gradually learns to overcome the fear. Exposure therapy can significantly reduce or end phobic reactions for at least seven years. Therapy is often combined with medication, such as antianxiety drugs, antidepressants and, in some cases, tranquilizers.

Obsessive-Compulsive Disorder (OCD)

People with obsessive-compulsive disorder have repeated, intrusive, unwanted thoughts (obsessions) that they attempt to control with rituals that are repeated over and over (compulsions). These obsessive thoughts may involve, for example, fear of harming themselves or others, making inappropriate sexual advances, worrying over infections, and unresolved religious issues. In an attempt to ease the anxiety caused by obsessions, individuals may engage in the painful, constant repetition of rituals, such as cleaning, repeating names/phrases, checking and rechecking their behavior, hoarding useless items, or performing tasks very slowly.

Adding to the anxiety caused by this disorder is that sufferers of OCD are aware that their compulsions are irrational. They are ashamed of their actions and take care to hide them from loved ones. Years may pass before anyone notices their problem and encourages them to seek help.

OCD occurs equally in men and women, affecting approximately one out of every 50 people. It can appear at any age but often begins in childhood.

Treatment

Behavior therapy is used to expose individuals to situations that provoke their compulsions and help them learn how to decrease and eventually refrain from performing the rituals. This treatment approach has been successful for 50 to 90 percent of those suffering from OCD. Because OCD may be accompanied by depression, it is important to identify whether this illness is present and treat it concurrently. For some individuals medications, such as chlomipramine or fluoxetine, are effective in alleviating obsessions.

Post-Traumatic Stress Disorder (PTSD)

Survivors of severe physical or mental trauma may develop post-traumatic stress disorder, a condition characterized by repeated episodes of re-experiencing a traumatic event. The event responsible for the onset of PTSD could be an airplane crash, an earthquake, domestic abuse, rape, war, etc. The symptoms of PTSD rarely appear during the traumatic experience; usually it is months or even years before they occur.

Survivors may re-experience the event through nightmares or disturbing thoughts while awake. Others have such vivid flashbacks that the event seems to be happening all over again. Relationships with loved ones can be affected because survivors may have diminished emotions and are unable to express their feelings. The severity of symptoms increases when the trauma was unanticipated.

Treatment

Post-traumatic stress disorder can be successfully treated. Individual psychotherapy helps survivors work through their pain and grief. Support groups or peer counseling groups enable survivors of similar traumatic events to share their experiences and reactions. Family therapy may also be an important component of the treatment process. Medications, such as antidepressants, lithium, benzodiazepines, and beta-blockers, can help control the symptoms of PTSD.

We can help

Help for anxiety disorders begins with excellent diagnosis and treatment. At Dominion Hospital, our mental health professionals have extensive experience in the treatment of anxiety disorders in children, adolescents and adults. Through careful evaluation of medical and psychological history, our experts can determine the most effective treatment approach and identify the appropriate treatment resources, both at Dominion and in the community. In most cases anxiety disorders can be treated on an outpatient basis.

Dominion offers a complete spectrum of care with varying levels of treatment intensity to meet individual needs. Dominion Hospital also hosts a free weekly support group for sufferers of anxiety disorders and their families that is led by a licensed mental health professional specializing in this area.

To learn more about how we can help, call Dominion Hospital's FirstStep, a free, 24-hour information, assessment and referral service, at (703) 538-2872.