Kevin Stevenson, LMHC, MCAP

Anxiety

It’s normal to worry and feel tense or scared when under pressure or facing a stressful situation.  Anxiety is the body’s natural response to danger, an automatic alarm that goes off when you feel threatened.
In moderation, anxiety isn’t always a bad thing.  In fact, anxiety can help you stay alert and focused spur you to action, and motivate you to solve problems.  But when anxiety is constant or overwhelming, when it interferes with your relationships and activities, it stops being functional – that’s when you’ve crossed the line from normal, productive anxiety into the territory of anxiety disorders.
Because anxiety disorders are a group of related conditions rather than a single disorder, they can look very different from person to person.  One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky a the thought of mingling at a party.  Someone else may struggle with a disabling fear of driving, or uncontrollable, intrusive thoughts.  Yet another may life in a constant state of tension, worrying about anything and everything.
Despite their different forms, all anxiety disorders share one major symptom: persistent or severe fear or worry in situations where most people wouldn’t feel threatened.
Emotional symptoms of anxiety
In addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include:
  • Feelings of apprehension or dread
  • Trouble concentrating
  • Feeling tense or jumpy
  • Anticipating the worst
  • Irritability
  • Restlessness
  • Watching for sings of danger
  • Feeling like your mind’s gone blank
Physical symptoms of anxiety
Anxiety is more than just a feeling.  As a product of the body’s flight-or-flight response, anxiety invoices a wide range of physical symptoms.  Because of the numerous physical symptoms, anxiety suffers often mistake their disorder for a medical illness.  They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.
Common physical  symptoms of anxiety include:
  • Pounding heart
  • Sweating
  • Stomach upset or dizziness
  • Frequent urination or diarrhea
  • Shortness of breath
  • Tremors and twitches
  • Muscle tension
  • Headaches
  • Fatigue Insomnia
Types of anxiety disorders
  • Generalized Anxiety Disorder (GAD)
  • Obsessive – Compulsive Disorder (OCD)
  • Panic Disorder & Agoraphobia
  • Posttraumatic Stress Disorder (PTSD)
  • Social Anxiety Disorder
  • Specific Phobias
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things.  People with this disorder, which is also referred to as GAD, experience exaggerated worry and tension, often expecting the worst, even when there is no apparent reason for concern.  They anticipate disaster and are overly concerned about money, health, family, work, or other issues.  GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months.
Sometimes just the thought of getting through the day produces anxiety.  They don’t know how to stop the worry cycle and feel it is beyond their control, even though they usually realize that their anxiety is more intense than the situation warrants.
GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year.  Women are twice as likely as men to be affected with GAD.
GAD comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age.  Although the exact cause of GAD is unknown, there is evidence that biological factors, family background and life experiences, particularly stressful ones, play a role.
When their anxiety level is mild, people with GAD can function socially and be gainfully employed.  Although they may avoid some situations because they have the disorder, some people can have difficulty carrying out the simplest daily activities when their anxiety is severe.
People with generalized anxiety disorder (GAD) experience constant, chronic, and unsubstantiated worry, often about health, family, money, or work.  This worrying goes on every day, possibly all day.  It disrupts social activites and interferes with work, school, or family.
Physical symptoms of GAD include the following:
  • Muscle tension
  • Fatigue
  • Restlessness
  • Difficulty sleeping
  • Irritability
  • Edginess
  • Gastrointestinal discomfort
Obsessive – Compulsive Disorder (OCD)
People with obsessive-compulsive disorder (OCD) suffer from unwanted intrusive thoughts that they can’t seem to get out of their heads (obsessions), often compelling them to repeatedly perform ritualistic behaviors and routines (compulsions) to try and ease their anxiety.
Most people who have OCD are aware that their obsessions and compulsions are irrational, yet they feel powerless to stop them.
Some spend hours at a time performing complicated rituals involving hand-washing, counting, or checking to ward off persistent, unwelcome thoughts, feelings, or images.
These can interfere with a person’s normal routine, schoolwork, job, family, or social activities.  Several hours every day may be spent focusing on obsessive thoughts and performing seemingly senseless rituals.  Trying to concentrate on daily activities may be difficult.  Left untreated, OCD can interfere with all aspects of life.
Obsessions – unwanted intrusive thoughts:
  • Constant, irrational worry about dirt, germs, or contamination
  • Excessive concern with order, arrangement, or symmetry
  • Fear that negative or aggressive thoughts or impulses will cause personal harm or harm to a loved one
  • Preoccupation with losing or throwing away objects with little or no value
  • Excessive concern about accidentally or purposefully injuring another person
  • Feeling overly responsible for the safety of others
  • Distasteful religious and sexual thoughts or images
  • Doubting that is irrational or excessive
Compulsions – ritualistic behaviors and routines to ease anxiety or distress
  • Cleaning – Repeatedly washing one’s hands, bathing, or cleaning household items, often for hours at a time
  • Checking – Checking and re-checking several to hundreds of times a day that the doors are locked, the stove is turned off, the hairdryer is unplugged, etc.
  • Repeating – Inability to stop repeating a name, phrase, or simple activity (such as going through a doorway over and over).
  • Hoarding – Difficulty throwing away useless items such as old newspapers or magazines, bottle caps, or rubber bands.
  • Touching and arranging
  • Mental rituals – Endless reviewing of conversations, counting, repetitively calling up “good” thoughts to neutralize “bad” thoughts or obsessions; or excessive praying and using special words or phrases to neutralize obsessions.
Panic Disorder & Agoraphobia
Panic disorder is diagnosed in people who experience spontaneous seemingly out-of-the-blue panic attacks and are preoccupied with the fear of a recurring attack.  Panic attacks occur unexpectedly, sometimes even during sleep.
Panic Disorder affects approximately 6 million adults, or 2.7% of the U.S. population.  Women are twice as likely to be affected as men.
Many people don’t know that their disorder is real and highly responsive to treatment.  Some are afraid or embarrassed to tell anyone, including their doctors and loved ones, about what they experience for fear of being considered a hypochondriac.  Instead they suffer in silence, distancing themselves from friends, family, and others who could be helpful or supportive.
Panic Disorder often occurs with other mental and physical disorders, including other anxiety disorders, depression, irritable bowel syndrome, asthma, or substance abuse.
A panic attack is defined as the abrupt onset of intense fear that reaches a peak within a few minutes and includes at least four of the following symptoms:
  • A feeling of imminent danger or doom
  • The need to escape
  • Heart Palpitations
  • Sweating
  • Trembling
  • Shortness of breath or a smothering feeling
  • A feeling of chocking
  • Chest pain or discomfort
  • Nausea or abdominal discomfort
  • Dizziness or lightheadedness
  • A sense of thing being unreal, depersonalization
  • A fear of losing control or “going crazy”
  • A fear of dying
  • Tingling sensation
  • Chills or heat flush
Since many of the symptoms of panic disorder mimic those of illnesses such as heart disease, thyroid problems, and breathing disorders, people with panic disorder often make many visits to emergency rooms or doctors offices, convinced they have a life-threatening illness.  It can take months or years and a great deal of frustration before receiving the correct diagnosis.
Agoraphobia
Some people stop going into situations or places in which they’ve previously had a panic attack in anticipation of it happening again.
These people have agoraphobia, and they typically avoid public places where they feel immediate escape might be difficult, such as shopping malls, public transportation, or large sports arenas.  About one in three people with panic disorder develops agoraphobia.  Their world may become smaller as they are constantly on guard, waiting for the next panic attack.  Some people develop a fixed route or territory, and it may become impossible for then to travel beyond their safety zones without suffering sever anxiety.
Posttraumatic Stress Disorder (PTSD)
Posttraumatic stress disorder, or PTSD, is a serious potentially debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, terrorist incident, sudden death of a loved one, war, violent personal assault such as rape, or other life-threatening events.
Most people who experience such events recover from them, but people with PTSD continue to be severely depressed and anxious for months or even years following the event.
Posttraumatic Stress Disorder affects approximately 7.7 million Americans age 18 and older, or 3.5% of the U.S. population.  Women are twice as likely to develop posttraumatic stress disorder as men, and children can also develop it.  PTSD often occurs with depression, substance abuse, or other anxiety disorders.
PTSD is diagnosed after a person experiences symptoms for at least one month following a traumatic event.  However symptoms may not appear until several months or even years later.  The disorder is characterized by three main types of symptoms:
  • Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares.
  • Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma
  • Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered.
Diagnosis criteria that apply to adults, adolescents, and children older than six include: Exposure to actual or threatened death, serious injury, or sexual violation:
  • Directly experiencing the traumatic events
  • Witnessing, in person, the traumatic events
  • Learning that the traumatic events occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental
  • Experiencing repeated or extreme exposure to aversive details of the traumatic events
The presence of one or more of the following:
  • Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events
  • Recurrent distressing dreams in which the content or affect (i.e. feeling) of the dream is related to the events
  • Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring
  • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events
  • Physiological reactions to reminders of the traumatic events
Two or more of the following:
  • Inability to remember an important aspect of the traumatic events
  • Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
  • Persistent, distorted blame of self or others about the cause or consequences of the traumatic events
  • Feelings of detachment or estrangement from others
  • Persistent fear, horror, anger, guilt, or shame
  • Markedly diminished interest or participation in significant activities
  • Persistent inability to experience positive emotions
Two of more of the following marked changes in arousal and reactivity:
  • Irritable or aggressive behavior
  • Reckless or self-destructive behavior
  • Hypervigilance
  • Exaggerated startle response
  • Problems with concentration
  • Difficulty falling or staying asleep or restless sleep
Also, clinically significant distress or impairment in social, occupational, or other important areas of functioning not attributed to the direct physiological effects of medication, drugs, or alcohol or another medical condition, such as traumatic brain injury.
Social Anxiety Disorder
Social anxiety disorder is the extreme fear of being scrutinized and judged by others in social or performance situations and can wreak havoc on the lives of those who suffer from it.
Social anxiety disorder effects approximately 15 million or 6.8% of the U.S. population and is equally common among men and women, typically beginning around age 13.  One third of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help.
Symptoms may be so extreme that they disrupt daily life.  People with this disorder, also called social phobia, may have few or no social or romantic relationships, making them feel powerless, alone, or even ashamed.
Although they recognize that the fear is excessive and unreasonable, people with social anxiety disorder feel powerless against their anxiety.  They are terrified they will humiliate or embarrass themselves.
The anxiety can interfere significantly with daily routines, occupational performance, or social life, making it difficult to complete school, interview and get a job, and have friendships and romantic relationships.
Social anxiety disorder usually begins in childhood or adolescence, and children are prone to clinging behavior, tantrums, and even mutism.
Physical symptoms of social anxiety disorder may include:
  • Blushing
  • Profuse sweating
  • Trembling
  • Nausea or other abdominal distress
  • Rapid heartbeat
  • Shortness of breath
  • Dizziness or lightheadedness
  • Headaches
  • Feelings of detachment and loss of self-control
Those with social anxiety disorder experience an intense fear of being scrutinized and negatively evaluated by others in social or performance situations.  Some literally feel sick from fear in seemingly nonthreatening situations.
The disorder is often selective.  Some people may have an intense fear of talking to a salesperson or giving a speech, but the may be comfortable in other similar settings.  Others may become anxious during routine activities such as starting a conversation with a stranger or a person in authority, participating in meetings or classes, or dating and attending parties.
Specific Phobias
People with specific phobias or strong irrational fear reactions, work hard to avoid common places, situations, or objects even though they know there;s no threat or danger.  The fear may not make any sense, but they feel powerless to stop it.  People who experience these seemingly excessive and unreasonable fears in the presence of or in anticipation of a specific object, place, or situation have a specific phobia.
Having phobias can disrupt daily routines, limit work efficiency, reduce self-esteem, and place a strain on relationships because people will do whatever they can to avoid the uncomfortable and often-terrifying feelings of phobic anxiety.
While some phobias develop in childhood, most seem to arise unexpectedly, usually during adolescence or early adulthood.  Their onset is usually sudden, and they may occur in situations that previously did not cause any discomfort or anxiety.
Specific phobias commonly focus on animals, insects, heights, thunder, driving, public transportation, flying, dental or medical procedures, and elevators.
Although people with phobias realize that their fear is irrational, even thinking about it can often cause extreme anxiety.
Specific phobias effect approximately 19 million Americans or 8.7% of the U.S. population and are twice as likely to affect women as they do men.
Symptoms of having a specific phobia often include uncomfortable and terrifying feelings of anxiety along with:
  • A feeling of imminent danger or doom
  • The need to escape
  • Heart Palpitations
  • Sweating
  • Trembling
  • Shortness of breath or a smothering feeling
  • Chest pain or discomfort
  • Feeling faint, dizzy or lightheaded
  • A sense of things being unreal, depersonalization
  • Nausea or abdominal discomfort
  • A fear of losing control or “going crazy”
  • Tingling sensation
  • A fear of dying
  • Chills or heat flush
Treatment for anxiety disorders
Anxiety disorders are treatable, and the vast majority of people with an anxiety disorder can be helped with professional care.
Success of treatment varies and some may respond to treatment after a few weeks or months, while others may need more than a year.  Treatment may be complicated if people have more than one anxiety disorder or if they suffer from depression, substance abuse, or other co-existing conditions.  This is why treatment must be tailored specifically for each individual.
Although treatment is individualized, several standard approaches have proved effective.  Therapy along with medication and complementary & alternative practices may be used to treat anxiety.
Cognitive-Behavioral Therapy (CBT) is a well-established, highly effective, and lasting treatment for anxiety which focuses on identifying, understanding, and changing thinking and behavior patterns.  In CBT the person is actively involved in their own recovery, has a sense of control, and learns skills that are useful throughout life.  CBT typically involves reading about the problem, keeping records between appointments, and completing homework assignments in which the treatment procedures are practiced.
Treatment for anxiety disorders consists of the following:
  • Therapy
  • Medication
  • Stress and relaxation techniques
  • Acupuncture
  • Aromatherapy
  • Yoga

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                    Kevin Stevenson, LMHC,CAP