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Anxiety is a complex combination of the feeling of fear, apprehension and worry often accompanied by physical sensations such as palpitations, chest pain and/or shortness of breath. It may exist as a primary brain disorder or may be associated with other medical problems including other psychiatric disorders.
A chronically recurring case of anxiety that has a serious affect on your life may be clinically diagnosed as an anxiety disorder. The most common are Generalized anxiety disorder, Panic disorder, Social anxiety disorder, phobias, Obsessive-compulsive disorder, and posttraumatic stress disorder (PTSD).
A good medical history and physical examination are essential for the initial diagnosis of any of the anxiety disorders in order to exclude any other significant, treatable medical conditions that could be causing the symptoms of anxiety. A family history of anxiety disorders or other psychiatric illnesses present strenghtens the case for an anxiety disorder.
As there is a high association for anxiety for other psychiatric problems including drug abuse and depression, the physical examination should include checking for evidence of intravenous drug use or previous episodes of self-harm.
Generalized anxiety disorder
Main article: General anxiety disorder
Generalized anxiety disorder is a common chronic disorder that affects twice as many women as men and leads to considerable impairment (Brawman-Mintzer & Lydiard, 1996, 1997). As the name implies, generalized anxiety disorder is characterized by long-lasting anxiety that is not focused on any particular object or situation. In other words it is unspecific or free-floating. People with this disorder feel afraid of something but are unable to articulate the specific fear. They fret constantly and have a hard time controlling their worries. Because of persistent muscle tension and autonomic fear reactions, they may develop headaches, heart palpitations, dizziness, and insomnia. These physical complaints, combined with the intense, long term anxiety, make it difficult to cope with normal daily activities.
Main article: Panic disorder
This disorder is even more distressing than generalized anxiety disorder. In panic disorder, the person suffers brief attacks of intense terror and apprehension that cause trembling and shaking, dizziness, and difficulty breathing. One who is often plagued by sudden bouts of intense anxiety might be said to be afflicted by this disorder. The American Psychiatric Association (2000) defines a panic attack as fear or discomfort that arises abrubtly and peaks in 10 minutes or less. Although panic attacks sometimes seem to occur out of nowhere, they generally happen after frightening experiences, prolonged stress, or even exercise. Many people who have panic attacks interpret them correctly--as a result of a passing crisis or stress. Unfortunately, others begin to worry excessively and some may even quit jobs or refuse to leave home to avoid future attacks. It is labeled panic disorder when several apparently spontaneous attacks lead to a persistent concern about future attacks. A common complication of panic disorder is agoraphobia--anxiety about being in a place or situation where escape is difficult or embarrassing (Craske, 2000; Gorman, 2000).
This category involves a strong, irrational fear and avoidance of an object or situation. The person knows the fear is irrational, yet the anxiety remains. Phobic disorders differ from generalized anxiety disorders and panic disorders because there is a specific stimulus or situation that elicits a strong fear response. Imagine how it would feel to be so frightened by a spider that you would try to jump out of a speeding car to get away from it. This is how a person suffering from phobia might feel.
People with phobias have especially powerful imaginations, so they vividly anticipate terrifying consequences from encountering such feared objects as knives, bridges, blood, enclosed places, or certain animals. These individuals recognize that their fears are excessive and unreasonable but are generally unable to control their anxiety.
In addition to specific phobias, such as fears of knives, rats or spiders, there is another category of phobias known as social phobias. Individuals with this disorder experience intense fear of being negatively evaluated by others or of being publicly embarrassed because of impulsive acts. Almost everyone experiences "stage fright" when speaking or performing in front of a group. But people with social phobias become so anxious that performance is out of the question. In fact, their fear of public scrutiny and potential humiliaton becomes so pervasive that normal life is impossible (den Boer 2000; Margolis & Swartz, 2001).
Obsessive compulsive disorder is a type of anxiety disorder characterized by obsessions and/or compulsions. Obsessions are distressing, repetitive thoughts or images that the individual often realizes are senseless. Compulsions are repetitive behaviors that the person feels forced or compelled into doing, in order to relieve anxiety. One example would be the obsession of extreme cleanliness and fear of contamination, which may lead to the compulsion of having to wash one's hands hundreds of times a day.
The acute symptoms of anxiety are often controlled with anxiolytic agents such as the benzodiazepines. Valium (diazepam) was one of the first such drugs. SSRIs (selective serotonin reuptake inhibitors) have been successfully used to treat patients with chronic anxiety. Beta blockers are also sometimes used to treat the somatic symptoms associated with anxiety. The serotonin agonist, buspirone, is also sometimes prescribed. Behavioral and cognitive therapy are the most popular and most effective forms of psychotherapy used to treat anxiety. Exercise and other physical activities are thought to relieve stress and anxiety as well. Alcohol is probably the most widely used substance for the alleviation of anxiety, though it is much less effective than the benzodiazepines. Kava Kava is a popular herbal treatment, small doses (e.g. 200mg) either taken regularly through the day, or when early symptoms are noticed by the patient.
Many scientists believe that the benzodiazepenes and other antianxiety drugs are greatly overprescribed and potentially addictive. See, for example, Fred Leavitt (2003) The REAL Drug Abusers. Rowman & Littlefield.
Anxiety in palliative care
Some research has strongly suggested that treating anxiety in cancer patients improves their quality of life.
Anxiety and alternative medicine
- eMedicine article on anxiety
- An excellent website that offers help, support and information on anxiety
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