September 03, 2010
Anxiety DisordersKathryn J. Zerbe, M.D., is Jack Aron Professor in Psychiatric Education and Women's Mental Health, The Menninger Clinic, Topeka, Kansas.
Anxiety disorders are the most prevalent of the psychiatric disorders. They are two to three times more frequent in women than in men, negatively influence the quality of a person's life, lead to costly medical workups and cause general deterioration in overall health and well-being. The impact of these disorders is enormous. The economic cost, for example, of anxiety disorders has been estimated at $47 billion dollars.(1) Fortunately, anxiety disorders are highly treatable conditions for the majority of sufferers. Anxiety is the unpleasant emotional affect, usually accompanied by physiological sensation, that is characterized by worry, doubt and painful awareness that one is powerless to control situations. In contrast to fear, anxiety is irrational. The anxious person is hypervigilant, tense and insecure in most situations. Their heightened negative state leads to some of the bodily complaints that can be particularly prominent. These include excess sweating, trembling, dizziness, heart palpitations, shortness of breath, gastrointestinal upset, hot flashes, dry mouth, increased urination, fatigue and restlessness. The anxiety episodes can become so intense that individuals believe they are actually "going crazy" or will die. There are a number of different anxiety disorders, the common types of which are listed below in Table 1. Table 1.
Common Anxiety Disorders
Based on the American Psychiatric Association Diagnostic and Statistical Manual, DSMIV, 1994, Washington, DC, American Psychiatric Press.
Generalized anxiety disorder (GAD)
As its name implies, this anxiety disorder is characterized by a general sense of excessive worry and tension. It often begins in childhood or early adulthood. It is chronic, or ongoing, and highly treatable. Panic disorder
Key symptom is a paroxysm of sudden fear together with physiological symptoms that may seem to resemble a heart attack (palpitations, chest pain, choking, vertigo, trembling, shaking); distorted perceptions in light/sound intensity are also common. Panic attacks, as they are called, usually last only a few seconds or a few minutes. They may lead to agoraphobia (see below). Posttraumatic stress disorder (PTSD)
Anxiety that results from severe stress. It is characterized by unwanted and recurring flashbacks to the traumatic event. Battlefield experiences, rape and childhood sexual abuse are often implicated. Phobia
Distinguished by a person's avoidance of specific objects or places (such as avoiding snakes or bridges) because they arouse intense fear or panic; common phobias are fear of animals and heights. Social phobia
Profound shyness, including a fear of humiliation or embarrassment producing avoidance of social situations. Agoraphobia
Fear associated with being away from a safe person or safe place, such as home. It is frequently seen in those with panic disorder as they seek to avoid having a panic attack in public. It often occurs in people who experience panic attacks because they come to fear leaving the house lest they have a panic attack and embarrass themselves. Obsessive-compulsive disorder (OCD)
Characterized by repetitive intrusive, unwanted and disturbing thoughts (obsessions), such as thinking one's hands are dirty or that one's home will catch on fire, combined with rituals and behaviors such as compulsively needing to return home to check the stove or washing one's hands hundreds of times a day to reduce the anxiety provoked by the obsessions. There are many variations, including eating disorders and compulsive shopping. What Causes Anxiety?
The precise cause of anxiety is not known for sure and is most often today viewed as the result of a mix of influences - situational, biological and psychological - that varies from person to person. Anxiety disorder frequently occurs after a major life event (such as the loss of a spouse or parent or physiological stress resulting from physical illness) but a third of individuals with diagnosed panic disorder, for example, will have some recurrent panic attacks in their sleep, and about 4% will have more attacks while they are sleeping than when awake.(2) In fact, some people first experience the illness with a panic attack that interrupts their sleep, sometimes resulting in extensive cardiovascular testing because the individual awakens believing he or she is having a heart attack. All of this suggests that there is some underlying physical basis to at least certain anxiety disorders.
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