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Anxiety Disorders

How Prevalent Are
Psychiatric Problems?

In a recent national study of the general population, researchers found that 48% of the population has had a psychiatric disorder during their lifetime. The most common class of disorders was anxiety disorders, accounting for 25% of the population. Of all the people who reported a psychiatric disorder, 79% had more than one disorder. For example, many people who have anxiety disorders are also likely to have depression or substance abuse. The most common anxiety disorders are social phobia, simple phobia, generalized anxiety, panic, agoraphobia, and obsessive-compulsive disorder. Anxiety disorders tend to persist, with some people claiming that they have been anxious and worried all their lives.

Are There Different Kinds of Anxiety Disorders?

Yes. And it is possible to have more than one.

  • Social phobia – excessive concern about evaluation by others. Examples: anxious about using public bathrooms, apprehensive that others are evaluating or looking at you.
  • Simple phobia – fears of specific places or objects, such as fears of animals, heights, elevators, flying, snakes.
  • Generalized anxiety – worries, sweating, apprehension, restlessness, shortness of breath, irritability, palpitations.
  • Panic – experiences of intense anxiety, trembling, feeling like you are going insane, dying or losing control, feelings of irreality. Often, you avoid situations because of your fear that you will have a panic attack.
  • Agoraphobia without panic – avoidance or anxiety in open spaces, public places, or when looking at certain stimuli (such as horizons).
  • Obsessive-compulsive (OCD) – Recurring disturbing thoughts that you can’t seem to get out of your mind, which seem irrational to you, often followed by attempts to “neutralize” the thought by repeating actions (e.g., touching, counting, washing) or by hoarding. Many OCD people have thoughts that appear to them to be bizarre or dangerous–for example, obsessions about aggression, contamination, symmetry, disease, or sexual thoughts.

Many people who suffer from one anxiety disorder may also experience other anxiety disorders, depression, or substance abuse. There are a number of medical conditions that “mimic” anxiety, such as angina, cardiac arrhythmias, and severe pain and a number of drugs may increase anxiety, such as caffeine, decongestants and diet pills, MSG, alcohol (both increases and decreases anxiety), and withdrawal from drugs.

What Causes Anxiety Disorders?

There are many factors that may account for anxiety disorders. Between 30% to 50% of the cause may be genetic, but early childhood experiences (such as loss of a parent, demanding or inconsistent standards, overprotection, parental statements that the world is a dangerous place), recent stresses in life, unrealistic expectations about yourself and others, relationship conflicts, alcohol, caffeine, poor coping skills, and other factors all contribute to the experience of anxiety.

What Are the Typical Thoughts Associated with Anxiety?

The anxious person is plagued with a stream of irrational thoughts that further increase his/her anxiety:

  • “People can see I’m anxious.”
  • “They think less of me. I’m the only one with this problem.”
  • “I can’t stand to be disapproved of.”
  • “It’s awful that…or …What if ..(whatever you are worried about).”
  • “I’m losing control, going crazy, making a fool out of myself.”
  • “I need to get rid of this anxiety (obsession, behavior, etc.) immediately.”
  • “I am going to fail.”
  • “My worrying is out of control and I’ll go crazy.”
  • “I should never worry.”

In general, people who are anxious tend to predict the worst, expect that they will not be able to handle stress, and demand certainty in an uncertain world.

How Does Personality Affect Anxiety?

People are anxious about things that are personally relevant to their concerns. Depending on your personality, you may worry about being rejected, making mistakes, not achieving success, getting sick, or being abandoned. Furthermore, when you are anxious, you may avoid or leave situations that make you anxious or try to compensate by trying to be overly controlling, overly concerned about approval or by trying to be perfect. These individual concerns that you have and your style of coping with anxiety may actually make you more vulnerable to anxiety.

How Can Treatment be Helpful?

Cognitive-behavior therapy and/or medication are especially useful in treating these anxiety disorders. Both during therapy sessions and as part of the your self-help homework, you may be instructed in a number of techniques to decrease anxiety.

  • Controlling Arousal. You are more likely to feel anxious when you are physically aroused. You should examine how much caffeine (coffee, teas, sodas, chocolate) and alcohol you use. Your therapist may teach you breathing and relaxation exercises that can help you control your general arousal. In addition, regular exercise may be helpful.
  • Identify and Confront Your Fears. Your therapist will assist you in recognizing the specific situations, sensations, or thoughts that are disturbing to you. You may be asked to rank these fears from most to least feared and identify exactly what you are afraid will happen. Through gradual and guided exposure to these fears, with the help of your therapist, you may begin to modify the way you experience these situations.
  • Modify Thinking and Decrease Stress. Your therapist may help you in identifying your negative thinking in those situations, identifying and challenging your underlying “should” statements or maladaptive “rules”, examining your catastrophic interpretation of symptoms, assertion, conflict resolution training, exercise and diet modifications (where necessary), treatment for insomnia, assigning worry time, testing and challenging your negative thoughts, modifying compulsions by following a step-by-step program of response delay, response alteration, and response prevention, and assisting your spouse and you in understanding your treatment and managing marital conflict. In addition to the foregoing, your therapist may also help you in modifying interpersonal styles that contribute to your anxiety.
  • Medication. Depending on the specific anxiety disorder you have, and whether depression is also part of the problem, your doctor may prescribe any number of medications that have proven effective for your problem. Cognitive-behavior therapy may be augmented with medication for anxiety disorders. Medications that have been found useful for various anxiety disorders include anafranil, prozac, and zoloft (for obsessive-compulsive symptoms), tofranil, prozac and beta-blockers (for panic) and xanax, buspar, and antidepressants for generalized anxiety. Your doctor can assist you with medication.

How Effective Is Treatment?

Until ten years ago, treatments had limited success. However, today the outcome is very promising for most anxiety disorders. Depending on the anxiety disorder, between 70% and 80% of patients experience improvement with cognitive-behavior therapy and/or medication.

What We Expect From You As A Patient

The treatment of anxiety disorders requires your regular attendance in therapy and your willingness to carry out self-help homework assignments that can be very effective in helping you cope with your anxiety. Many patients also benefit from medication which should only be taken as prescribed by your doctor.

Further Reading

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