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Major Characteristics

HealthyPlace.com Radio

Dr. Edward Hallowell on what makes us worry and the best strategies for coping. Dr. Hallowell is a former President, Anxiety Disorder Association of America and author of Worry: Hope and Help for a Common Condition

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Anxiety disorders are the most common problem seen by psychologists and psychiatrists. Recent national surveys have indicated that a startling 25% of the population reported having symptoms severe enough to warranty the diagnosis for an anxiety disorder at some point in their lives. The demands of stressful situations or even everyday life will cause most of us to feel anxious at different points in our life. What makes these feelings an "anxiety disorder" is that the problem persists for weeks and begins to interfere with occupational and/or social functioning. Symptoms can vary from mild, to severe in which case almost total disability can occur. Anxiety disorders are actually a group of separate but sometimes overlapping disorders, they include: phobias (social phobia, agoraphobia, simple phobia), panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder and separation anxiety disorder(a common childhood problem). These separate disorders will be discussed as a group since they share so many of the same symptoms.

Physical and Emotional Symptoms

One of the primary characteristics of all anxiety problems is of course fear. While the experience of fear under certain situations is a part of life, fear that significantly interferes with our daily functioning doesn't have to be. Emotionally, fear can vary from experiencing anticipation and tension, to at worst, acute panic attacks. Physical symptoms can include difficulties sleeping, loss of appetite, stomach upset, diarrhea, restlessness, muscle aches and tension headaches. Acute fear otherwise known as a panic attack can include a sudden feeling of terror accompanied by: trembling/shaking, sweating, hot/cold flashes, faintness, unsteadiness, dizziness, difficulty concentrating, disorientation, racing heart, chest discomfort, difficulty breathing, dry mouth, numbness in body parts, etc.

Cognitive Characteristics

Cognitions are simply thoughts. These include the ideas or images that come to mind while a person is feeling anxious. Anxious thoughts are generally characterized by the belief that you or someone you know is in some type of danger that something dangerous is about to happen. One of the main definitions of a phobia is believing that something is dangerous when it really is not, the fear is irrational or excessive. Most anxiety sufferers can see that their thoughts are unrealistic, distorted or excessive but find it very difficult to stop thinking these thoughts. For social phobia, fears are centered around social situations in which one focuses on not getting approval, failing, or being embarrassed. Thoughts during panic attacks include ideas about losing control, going crazy, or dying. Agoraphobic thoughts are often connected to believing that certain sensations or situations are going to lead to another full panic attack, and that without someone else around this cannot be stopped or may even be dangerous. Obsessive-compulsive thoughts often include the inability to stop thinking about, contamination, germs, illness, death, sex, religion, personal responsibility, loosing control and getting violent with oneself or others. Post-traumatic stress disorder includes flashbacks from some traumatic event, which may also be present in nightmares, and often thoughts about being responsible for the event. Generalized anxiety disorder produces almost constant worry about what might happen in a wide variety of areas in a person's life (e.g. health, financial, etc.). Younger children may be less able to express their fears clearly, or may report more primitive fears of harm such as monsters, eyes in the dark, or something bad happening to themselves or parents if they are separated.

Behavioral Characteristics

Behavioral characteristics are primarily different forms of avoidance. Avoidance can take a variety of forms, often it's as simple as giving in to the urge not to go to a certain place, or to quickly escape if the discomfort gets to powerful. Sometimes avoidance can take on more complicated forms such as compulsions or rituals in which certain actions may be excessively repeated even though it doesn't make sense to repeat them. Examples would include excessive cleanliness, ordering, or checking. Avoidance is a natural, almost automatic way that people try to reduce anxiety, physical distress and panic attacks. Unfortunately avoidance never helps a person to learn how to cope and instead worsens the problem.

Complications

Without proper treatment, a variety of possible complications may arise in conjunction with simple anxiety. Left untreated anxiety may begin to interfere with social functioning, resulting in difficulties in professional and/or personal relations. Often, after a prolonged period of suffering from an anxiety disorder, a person may become frustrated, hopeless and eventually depressed. Estimates vary, but as many as 59% of anxiety sufferers may at some point also simultaneously suffer from clinical depression (see anxiety and depression). Another common complication is the use of alcohol or other drugs as a way to feel calmer. Of course, this only worsens the condition in the long run. This is commonly referred to as "self-medicating".

Treatment

Behavior and cognitive-behavior therapies are among the treatments which have been most extensively evaluated and have repeatedly proven their effectiveness for treating anxiety disorders. Behavior Therapy (BT) is often confused with behavior modification, they are not the same.

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Behavior modification is using a plan of rewards and punishments to change behavior, this may help with children but IS NOT what is meant by BT for adult anxiety disorders. Behavior therapy emphasizes unlearning avoidant and compulsive behavior, and re-learning new alternative behaviors. These behavioral alternatives may include deep muscle relaxation, breathing retraining, assertiveness training, conflict resolution, etc. The primary purpose is to gradually replace escaping, avoiding and compulsions, which only worsen the problem, with other new behaviors. Learning alternative coping skills gradually allows a person to start confronting or exposing themselves to the triggers for the anxiety. This gradual exposure is an important but difficult part of behavior therapy. Done in a planned systematic way, exposure eventually desensitizes a person and the triggers no longer cause anxiety, or at least not as intensely.