Anxiety disorders are the commonest psychiatric illnesses globally. There is no test for anxiety disorders like panic disorder, PTSD,OCD or social anxiety disorder and the diagnosis is based on a good history and examination. The signs and symptoms of anxiety disorders are often missed or explained away. Anxiety disorders are also commonly comorbid with other psychiatric disorders particularly mood disorders.
There is no cure for anxiety disorders but very effective treatments are available with a good evidence base. The treatments for anxiety disorders include medications like benzodiazepines, SSRIs or SNRIs or other new generation antidepressants, atypical antipsychotics, as well as augmentation therapies. Several proven therapies are also efficacious in patients with anxiety disorders. These include cognitive behavior therapy, relaxation training, and prolonged exposure therapy. Yoga and meditation have also demonstrated benefits.
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What Are Anxiety Disorders?
Individuals with an anxiety disorder can experience psychological or physical symptoms, or both.
- Stressed out
- Burned out
- Disturbed sleep
- Chest tightness
- Stomach “twisted up in knots”
Anxiety Disorders are the most common psychiatric disorder in the U.U. with 19 million affected adults.
People with an anxiety disorder are six times more likely to be hospitalized for psychiatric disorders than non-sufferers.
The mean age of onset of anxiety disorders is a strikingly young age of 11 years old.
The lifetime prevalence of developing an anxiety disorder is an astonishingly high 28.8%.
Overall anxiety disorders are associated with a 3 fold increased risk for suicide attempts.
Anxiety Disorders Are Frequently Comorbid With Other Disorders
59.2% of all patients with major depression had an anxiety disorder.
Over four of 10 individuals with Bipolar I and II disorder have a diagnosable anxiety disorder.
In people who had a co-existing medical condition such as Hypertension, Diabetes and Arthritis… in over 70% of those cases, anxiety disorders actually came first!
In people who have had a “heart attack,” the presence of high anxiety increases the risk of reinfarction, ischemia, arrhythmia and even death.
Anxiety disorders are found to exist at much higher rates in people with the following conditions:
- Heart Disease
- Chronic Headaches
- Back and Neck Pain
There Are Several Types of Anxiety Disorders
Generalized Anxiety Disorder
Excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.
Feelings of terror that strike suddenly and repeatedly with no warning. Sweating, chest pain, irregular heartbeats, and a feeling of choking, which may make the person feel like he or she is having a heart attack or “going crazy.”
Constant thoughts or fears that cause them to perform certain rituals or routines. For example: Someone with unreasonable fear of germs who constantly washes their hands.
Post-Traumatic Stress Disorder
Can develop following a traumatic or terrifying event (like war combat). People experience lasting and frightening thoughts and memories of the event and tend to be emotionally numb.
Social Anxiety Disorder
Overwhelming worry and self-consciousness about everyday social situations. The worry often centers on fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule.
A specific phobia is an intense fear of a specific object or situation, such as spiders, heights, or flying. The level of fear is usually inappropriate to the situation and may cause the person to avoid common everyday situations.
The History of Anxiety Disorder
1866 – The Frenchman Benedict-Augustin Morel first suggested a dysfunction of the autonomic nervous system as the cause of anxiety.
Early 1900s – Sigmund Freud uses the term “anxiety neurosis” to describe mental illness or distress with extreme anxiety as a defining feature.
1952 – The first DSM-I is published and lists OCD as “Obsessive compulsive reaction.”
1968 – Anxiety neurosis is added to the (DSM-II) and OCD is referred to as “Obsessive compulsive neurosis” (OCN).
1980 – OCN is reclassified and called “Obsessive Compulsive Disorder.” Also, PTSD is added to DSM-III.
1980 – Anxiety neurosis classification in the DSM-III is changed by the American Psychiatric Association. Panic disorder, characterized by spontaneous episodes of intense anxiety, is added. The category was Generalized Anxiety Disorder.
2013 – The DSM-5 makes new changes to Anxiety Disorders.
Did You Know?
Hoarding and Skin-picking anxiety disorders have recently been added to the DSM-5.
Anxiety Disorders in the DSM-5
Changes in the DSM-5 criteria for anxiety and related disorders:
- Obsessive compulsive and related disorders and trauma and stress related disorders have separate categories.
- Body dysmorphic disorder now requires performance of repetitive behaviors.
- Social anxiety disorder and specific phobia no longer require that patient recognizes that fear is excessive or unreasonable-now clinician decides.
- Changes to PTS criteria include elimination of criterion A2 (response involves “fear, helplessness, or horror”), three new symptoms are added and separate diagnostic criteria for “preschool” PTSD.
- Generalized anxiety disorder occurring exclusively during major depression can be comorbid diagnosis.
How Is a Person Diagnosed With An Anxiety Disorder?
A health professional will perform a thorough mental status examination, medical evaluation, and ask an individual about their personal and family psychiatric history. Individuals may also have to complete a depression-screening test as part of the diagnostic process.
A thorough mental status and physical exam is necessary to confirm the diagnosis, and to rule out secondary causes (medical illnesses, medications, drugs, etc.) of the anxiety symptoms.
Laboratory test that may be indicated in the work-up of a anxious patient include: Thyroid function tests, B-12 and folate levels, sleep studies (if sleep apnea is suspected), EEG (if seizure disorder is suspected), drug screen, and EKG.
What Causes Anxiety Disorders?
The exact cause of anxiety disorders is not fully known, but a number of factors appear to contribute to its development.
Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.
Some research suggests that family history plays a part in increasing the likelihood that a person will develop an anxiety disorder. This means that the tendency to develop a disorder may be passed on in families.
Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to anxiety disorders. The use of and withdrawal from addictive substances, including alcohol, caffeine and nicotine, can also worsen anxiety.
How Do Doctors Treat Anxiety Disorders?
Anxiety is highly treatable (up to 90% of cases), but only one-third of those who suffer from it receive treatment.
Psychotherapy is often used in either alone or in combination with medications to treat anxiety disorders. Psychotherapy involves a variety of treatment techniques and helps him or her identify and work through the factors that may be triggering the anxiety.
Medication treatment of anxiety disorders is generally safe and effective and is often used in conjunction with therapy. Medication may be a short-term or long-term treatment option, depending on severity of symptoms. The four major classes of medications used for anxiety disorders are Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, Benzodiazepines, and Tricylic Antidepressants.
Complementary & Alternative Treatment
- Meditation Techniques
Can Someone With Anxiety Disorders Still Lead a Successful Life?
There are many successful people who have an anxiety disorder.
- Jessica Alba
- Heather Locklear
- Whoopi Goldberg
- David Beckham
- Vinny Guadagnino
- Howie Mandel
- John Mayer
- Johnny Depp
- Chalize Theron