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Anxiety Disorders

Everybody knows what it’s like to feel anxious -- the butterflies in your stomach before a first date, the tension you feel when your boss is angry, and the way your heart pounds if you’re in danger. Anxiety rouses you to action. It gears you up to face a threatening situation. It makes you study harder for that exam, and keeps you on your toes when you’re making a speech. In general, it helps you cope. But if you have an anxiety disorder, this normally helpful emotion can do just the opposite — it can keep you from coping and can disrupt your daily life.

Anxiety disorders aren’t just a case of "nerves." They are illnesses, often related to the biological makeup and life experiences of the individual, and they frequently run in families.

Anxiety disorders are among the most common of all the mental disorders. Many people misunderstand these disorders and think individuals should be able to overcome the symptoms by sheer willpower. Wishing the symptoms away does not work -- but there are very effective treatments that can help.

Women are twice as likely to have an anxiety disorder as men; women who are pregnant and are planning to become pregnant are even more at risk for anxiety disorders.  From the time a girl reaches puberty until about the age of 50, she is twice as likely to have an anxiety disorder. Anxiety disorders also occur earlier in women than in men.

Women are also more likely to have multiple psychiatric disorders during their lifetime than men. The most common to co-occur with anxiety is depression.

Differences in brain chemistry may account for at least part of these differences. The brain system involved in the fight-or-flight response is activated more readily in women and stays activated longer than men, partly as a result of the action of estrogen and progesterone.

The neurotransmitter serotonin may also play a role in responsiveness to stress and anxiety. Some evidence suggests that the female brain does not process serotonin as quickly as the male brain. Recent research has found that women are more sensitive to low levels of corticotropin-releasing factor (CRF), a hormone that organizes stress responses in mammals, making them twice as vulnerable as men to stress-related disorders.

Premenstrual cycles, perimenopause, and menopause can amplify anxiety and stress levels. During a woman’s premenstrual cycle, estrogen and progesterone levels are low, causing mood and energy levels to also decline. As a result, women oftentimes feel anxious, depressed, and on edge. The combination of the two can cause serious issues that if prolonged can produce to anxiety and stress disorders.

Perimenopause and menopause do not necessarily cause anxiety and stress. However, these hormonal changes that women go through can simply amplify the anxiety that is already present. Women who are perimenopausal and menopausal will usually experience hot flashes (a common physical reaction) when encountering a less than desirable situation or in high state of anxiety onset by reasons unknown.

There are several types of anxiety disorders, each with distinct features. If you are troubled by anxiety, see your physician for help and resources to manage your anxiety.  Learn more about the most common anxiety disorders here.

  • Post-traumatic stress disorder

    Post-traumatic stress disorder (PTSD) is a debilitating condition that follows a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people to whom they were once close. War veterans first brought PTSD, once referred to as shell shock or battle fatigue, to public attention, but it can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train accidents, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, 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 her or him. Or it could be something witnessed, such as mass destruction after a plane crash.

    Causes of PTSD

    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.

    Symptoms of PTSD

    PTSD can occur at any age, including childhood. Depression, substance abuse, or anxiety can accompany the disorder. 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 a person triggered the event — such as rape, as opposed to "force of nature" event like 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.

    Treatment for PTSD

    Antidepressants and anxiety-reducing medications can ease the symptoms of depression and sleep problems associated with post-traumatic stress disorder; and psychotherapy, including cognitive-behavioral therapy, is an integral part of treatment as well. 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.

  • Obsessive-compulsive disorder (OCD)

    Regular, uncontrolled anxious thoughts or rituals are characteristic of obsessive-compulsive disorder (OCD). If you have OCD you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals.

    You may feel obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. 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; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs.

    The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent them are called compulsions. There is no pleasure in carrying out the rituals. There is only temporary relief from the discomfort caused by the obsession.

    Causes of OCD

    OCD strikes men and women in approximately equal numbers and afflicts roughly 1 in 50 people. It can appear in childhood, adolescence, or adulthood, but on the average, it first shows up in the teens or early adulthood. A third of adults with OCD experience 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 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 a job or from carrying out normal responsibilities at home, but more often, it doesn’t develop to these extremes.

    Symptoms of OCD

    A lot of healthy people can identify with having some of the symptoms of OCD 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. Most adults with this condition recognize that what they’re doing is senseless, but they can’t stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary.

    Treatments for OCD

    There are several medications and behavioral treatments that can benefit people with obsessive-compulsive disorder (OCD). A combination of the two treatments is often helpful for most patients. Some individuals respond best to one therapy, some to another. 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 not go through the usual ritual — for instance, having the person touch something dirty and then not wash her hands. This therapy is often successful in those who have completed a behavioral therapy program, though results have been less favorable in some people who have both OCD and depression.

  • Panic disorder

    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, 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.

    Causes of panic disorder

    Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may lead to phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you’re riding in an elevator, you may develop a fear of elevators and perhaps start avoiding them.

    Symptoms of panic disorder

    Some people’s lives become greatly restricted -- they avoid normal everyday activities such as grocery shopping, driving, or, in some cases, even leaving the house. Or they may be able to confront a feared situation only if accompanied by a spouse or other trusted person. Basically, they avoid any situation they fear would make them feel helpless if a panic attack occurs. When people’s lives become so restricted by the disorder, as happens in about one-third of all people with panic disorder, the condition is called agoraphobia. A tendency toward panic disorder and agoraphobia runs in families. Nevertheless, early treatment of panic disorder can often stop the progression of agoraphobia.

    Treatment for panic disorder

    Studies have shown that proper treatment — a type of psychotherapy called cognitive-behavioral therapy, medications, or possibly a combination of the two — helps 70-80 percent of people with panic disorder. Significant improvement is usually seen within 6-8 weeks.

    Cognitive-behavioral approaches teach patients how to view the panic situations differently and demonstrate ways to reduce anxiety, using breathing exercises or techniques to refocus attention, for example. Another technique used in cognitive-behavioral therapy, called exposure therapy, can often help alleviate the phobias that may result from panic disorder. In exposure therapy, people are very slowly exposed to the fearful situation until they become desensitized to it.

    Some people find the greatest relief from panic disorder symptoms when they take certain prescription medications. Such medications, like cognitive-behavioral therapy, can help to prevent panic attacks or reduce their frequency and severity. Medications shown to be safe and effective in the treatment of panic disorder include antidepressants and benzodiazepines.

  • Generalized anxiety disorder
    Causes of generalized anxiety disorder

    Generalized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. It's chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.

    Symptoms of generalized anxiety disorder

    People with GAD also seem unable to relax. They often have trouble 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 or out of breath. 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.

    Many individuals with GAD startle more easily. They tend to feel tired, have trouble concentrating, and sometimes suffer depression, too. Usually the impairment associated with GAD is mild and people with the disorder don't feel too restricted in social settings or on the job. Unlike many other anxiety disorders, people with GAD don't characteristically avoid certain situations as a result of their disorder. However, if severe, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities.

    Treatment for generalized anxiety disorder

    If you, or someone you know, have symptoms of anxiety, a visit to your physician is usually the best place to start. A physician can help you determine whether the symptoms are due to an anxiety disorder, some other medical condition, or both. Most often, the next step is to get treatment for an anxiety disorder from a mental health professional.

    Among the professionals who can help are psychiatrists, psychologists, social workers, and counselors. However, it’s best to look for a professional who has specialized training in cognitive-behavioral or behavioral therapy and who is open to the use of medications should they be needed.

    Psychologists, social workers, and counselors sometimes work closely with a psychiatrist or another physician, who will prescribe medications when they are required. For some people, group therapy or self-help groups are a helpful part of treatment. Many people do best with a combination of these therapies.

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