Anxiety and Related Disorders

If you’re sitting in a tornado shelter feeling apprehension about a tornado warning on the radio, then you probably have a normal fear response to your circumstances. If you’re sitting in there on a clear day, trembling, sweating and feeling doomed, then you probably have an anxiety disorder. Webster’s Dictionary defines anxiety as "An abnormal and overwhelming sense of apprehension and fear with physiological signs such as shortness of breath, a rapid pulse, or chest pain." Anxiety Disorders are one of the most common psychiatric conditions, affecting fifteen to twenty per cent of the general population.

The first order of business for a physician evaluating anxiety is to determine as accurately as possible the patient’s complete state of health. At least one-third of patients with an underlying organic disorder present with anxiety symptoms. These could include too much thyroid hormone, problems with the adrenal glands, an unrecognized heart disorder, or diabetes. Treatment of the underlying medical problem thereby becomes the primary treatment for the anxiety.

The second order of business is to determine if a patient is putting something into their body which is causing the anxiety. This could include alcohol, which is a frequent cause of a cycle of anxiety. Other substances which could cause anxiety would be stimulants like diet pills, amphetamines or cocaine. Finally, some prescription drugs do not mix well together, especially when they are broken down by the same enzymes in the liver, and may cause severe anxiety. There are certain herbal remedies such as yohimbine (a purported male enhancer), which in some individuals, can cause anxiety. Elimination of these substances is the treatment for this type of anxiety, so a patient needs to be forthright about all substances and prescriptions which he is taking.

A type of primary anxiety disorder is the panic attack. This is usually unexpected, peaks in about ten minutes and usually lasts less than an hour. It is characterized by a feeling of losing control or going crazy, trembling or shaking, profuse sweating or chills or hot flashes, rapid heart rate, and a sense of not being able to catch one’s breath. It may be associated with agoraphobia, which is a fear of being trapped or unable to escape. (Agoraphobia can occur by itself, and thus be considered as another form of primary anxiety.)

There is another form of anxiety which most often begins in childhood. It is the fear of separation from an important attachment figure, for example a parent. This leads to a form of anxiety called separation anxiety which can occur at later times in life when one is faced with losing another attachment figure.

Some anxiety sufferers have an inordinate fear of humiliation in social or performance situations. Once again it is the physical symptoms which define the condition. One could be tormented by flushing (or blushing), rapid heart rate, shortness of breath, and/or a sense of doom. If it is a fear of social situations it is called Social Anxiety or phobia; fear of performance humiliation is called Performance Anxiety.

Some anxiety sufferers can have symptoms brought on by a specific object or situation. These are called the various and sundry phobias. It might be the fear of heights, fear of crossing a bridge, fear of spiders or germs. Again it is the intense emotional and physical symptoms which make this form of anxiety so disabling.

Another form of anxiety is the Obsessive-Compulsive Disorder. A person suffering from this may perform certain rituals to allay the anxiety. This could include excessive hand-washing, not stepping on cracks in the sidewalk, or repetitively locking and relocking a door. Jack Nicholson played an Obsessive-Compulsive in a movie a few years ago (Melvin Udall in "As Good As It Gets"), which very poignantly portrayed the interpersonal difficulties which can occur secondary to this condition. Dustin Hoffman’s "Rain Man" portrayed a Tourette’s Syndrome/Autistic patient’s extreme dependence on rituals to alleviate mounting anxiety.

If a person has six months or more of constant generalized anxiety and excessive worry with the physical and emotional repercussions of anxiety, this is called Generalized Anxiety Disorder. Sometimes this particular spectrum of symptoms can be secondary to a mood disorder such as depression or manic-depression. In this latter case treatment would be for the mood disorder.

There is an anxiety disorder which occurs after a person has endured a shocking situation in which he has faced the possibility of his own death. We see this in soldiers who have been traumatized on the battlefield. It can occur after a terrible accident or a natural disaster. The person has panic attacks and vivid nightmares. This type of anxiety is called Post-Traumatic Stress Disorder. The VA Hospital system has developed an extensive body of knowledge about this disorder and various specific techniques for treating it. Adjustment Disorder is a much less intense form of anxiety than PTSD. In this situation, an individual develops anxiety secondary to a new situation such as a new job or a different family arrangement.

Treatment of anxiety usually involves both psychological and medical treatment. Identifying sources of anxiety and likewise identifying physical symptoms can eliminate some of the dread one has for intermittent anxiety. Sometimes with phobias there can be a supportive desensitization which can help alleviate symptoms. Medications can include anti-anxiety agents such as diazepam or clonazepam, but care has to be taken to avoid medication dependency. The SSRI antidepressants like fluoxetine have anti-anxiety properties as well. Tricyclic antidepressants like clomipramine can be used to treat anxiety but have a greater incidence of side-effects.

John Drew Laurusonis

Doctors Medical Center

www.doctorsmedicalctr.com