Anxiety Disorders: Excessive Fear, Worry and Panic Attacks

Fear is a safety valve that helps us recognize and avoid danger. It increases our reflexive responses and sharpens awareness.

But when a person's fear becomes an irrational, pervasive terror or a nagging worry or dread that interferes with daily life, he or she may be suffering from some form of anxiety disorder. This affliction affects about 30 million Americans, including 11 percent of the population who suffer serious anxiety symptoms related to physical illness. In fact, anxiety is thought to contribute to or cause 20 percent of all medical conditions among Americans seeking general health care.

There are many different expressions of excessive anxiety. Phobic disorders, for example, are irrational, terrifying fears about a specific object, social situations or public places. Psychiatrists divide phobic disorders into several different classifications, most notably specific phobias, social phobias and agoraphobia.

Specific phobias are a relatively common problem among Americans. As this category's name implies, people suffering from specific phobia generally have irrational fear of specific objects. If the feared object rarely appears in the person's life, the phobia may not create serious disability. If the object is common, however, the resulting disability can be severe. The most common specific phobia in the general population is fear of animals -- particularly dogs, snakes, insects and mice. Other specific phobias are claustrophobia (fear of enclosed spaces) and acrophobia (fear of heights). Most specific phobias develop during childhood and eventually disappear. But those that persist into adulthood rarely go away without treatment.

Social phobia is the irrational fear and avoidance of being in a situation in which a person's activities can be watched by others. In a sense, it is a form of "performance anxiety," but a social phobia causes symptoms that go well beyond the normal nervousness before an on-stage appearance. People suffering social phobias intensely fear being watched or humiliated while doing something--such as signing a personal check, drinking a cup of coffee, buttoning a coat or eating a meal--in front of others. Many patients suffer a generalized form of social phobia, in which they fear and avoid most interactions with other people. This makes it difficult for them to go to work or school, or to socialize at all. Social phobias occur equally among men and women, generally developing after puberty and peaking after age 30. A person can suffer from one or a cluster of social phobias.

Derived from the Greek, agoraphobia literally means "fear of the marketplace." This disorder, which afflicts twice as many women as men, is the most serious of the phobic disorders. It causes its victims to fear being alone in any place or situation from which he or she thinks escape would be difficult or help unavailable if he or she were incapacitated. People with agoraphobia avoid streets, crowded stores, churches, theaters and other crowded places. Normal activities are restricted by this avoidance, and people with the disorder often become so disabled they literally will not leave their homes. If people with agoraphobia do venture into phobic situations, they do so only with great distress or when accompanied by a friend or family member.

Most people with agoraphobia develop the disorder after first suffering a series of one or more spontaneous panic attacks. The attacks seem to occur randomly and without warning, making it impossible for a person to predict what situations will trigger the reaction. The unpredictability of the panic attacks "trains'' the victims to anticipate future panic attacks and, therefore, to fear any situation in which an attack may occur. As a result, they avoid going into any place or situation where previous panic attacks have occurred.

Agoraphobia victims also may develop depression, fatigue, tension, alcohol or drug abuse problems and obsessive disorders.

These conditions are treatable with psychotherapy and with medication. Psychiatrists and other mental health professionals use desensitization techniques to help people with phobic disorders. They teach patients deep muscle relaxation techniques, and work to understand what provoked the anxiety. They rely on relaxation techniques to quell patients' fear. As the sessions progress, the object or situation that provokes the fear no longer has its hold on the person.

Panic disorder, while it often accompanies phobias such as agoraphobia, can occur alone. People with panic disorder feel sudden, intense apprehension, fear or terror, that can be accompanied by heart palpitations, chest pain, choking or smothering sensations, dizziness, hot and cold flashes, trembling and faintness. These "panic attacks,'' which are the disorder's main feature, usually begin during adolescence or early adult life. Many people experience panic disorder's symptoms at some time in their lives as a "panic attack," in episodes that are limited to a single brief period and that may be connected to stressful life events. But psychiatrists diagnose panic disorder when the condition has become chronic.

People with generalized anxiety disorder suffer with unrealistic or excessive anxiety and worry about life circumstances. For example, they may feel anxious about financial matters when there's plenty of money in the bank and their debts are paid. Or they may be preoccupied constantly about the welfare of a child who's safe at school. People with generalized anxiety disorder may have stretches of time when they're not consumed by these worries, but they are anxious most of the time. Patients with this disorder often feel "shaky," reporting that they feel "keyed up" or "on edge" and that they sometimes "go blank" because of the tension they feel. They often suffer also with mild depression.

The behaviors that are a part of obsessive-compulsive disorder include obsessions (which are recurring, persistent and involuntary thoughts or images) which often occur with compulsions (repetitive, ritualistic behaviors -- such as hand washing or lock checking -- which a person performs according to certain "rules"). The individual doesn't get pleasure from such behavior, and, in fact, recognizes that it is excessive and has no real purpose. Still, a person with OCD will claim they "can't help" their ritualistic behavior, and will become very anxious if it is interrupted. Often beginning in adolescence or early adulthood, obsessive and compulsive behaviors frequently become chronic.

Increasing evidence supports the theory that the disorders arise at least partly from imbalances in the brain's chemistry. Some investigators believe these disorders result from a traumatic experience in childhood that has been consciously forgotten, but surfaces as a reaction to a feared object or stressful life situation, while others believe they arise from imbalances in brain chemistry. Several forms of medication and psychotherapy are highly effective in treating anxiety disorders, and research continues into their causes.

Learn more about anxiety disorders

continue: Schizophrenia: What Some Call the Worst Mental Illness