Anxiety Disorders

Discuss all medical advice, diagnosis, and treatment with your healthcare practitioner.

advertisement

Sign up to receive our weekly newsletter featuring a digest of women's health-related news.

Anxiety Resources

The Basics

What is an anxiety disorder?

Anxiety is a normal human reaction to stress. Some degree of anxiety can be a good thing because it allows us to focus on the things that are important. For example, getting anxiety before a big exam will help us to study. However, when anxiety becomes so intense that it is disabling and causes disruption to an individual's life, it becomes a disorder.

Anxiety disorders affect about 40 million American adults, or about 18% of adults every year. Anxiety disorders are characterized as lasting at least 6 months. They can get worse if left untreated. Anxiety disorders often occur alongside other mental or physical illnesses. For example, people who suffer from substance abuse problems often experience anxiety disorders as well. In situations in which anxiety is a result of another disorder, the other disorder may need to be treated before the anxiety will abate.

Return to Top

What are the different types of anxiety disorders?

Anxiety disorders involve a group of conditions that include the following:

Panic Disorder: This illness is characterized by sudden attacks of panic. Symptoms often include a pounding heart, sweating, weakness, faintness, or dizziness. People suffering from a panic attack may feel flushed or chilled, nauseated, their hands may tingle or become numb, and they may experience chest pains or a smothering sensation. Panic attacks usually make a person lose all sense of reality, have a great fear of impending doom, or have a fear of losing control.

As a result of the confusing feelings that accompany a panic attack, the sufferer may feel that he or she is having a heart attack, losing his or her mind, or about to die. Since these attacks often occur without warning, people who suffer from panic attacks may live in a permanent state of fear that a panic attack will occur.

Panic attacks can occur at any time. Attacks usually reach their peak in about 10 minutes, but symptoms may persist for hours. Panic attacks usually begin in late adolescence or early adulthood. It is possible to experience a panic attack and to never develop a panic disorder. A tendency toward panic attacks seems to be hereditary.

Panic disorder is one of the most easily treated anxiety disorders, but many people are not correctly diagnosed for so long that their disorder has developed further into phobias, like agoraphobia, or the fear of open spaces.

Panic disorder often occurs alongside other problems, like depression, alcoholism, or drug abuse. These conditions need to be treated separately.

Obsessive-Compulsive Disorder (OCD): People with OCD are haunted by obsessions that are persistent, recurrent, and upsetting. They use compulsions, or rituals as a means to control their thoughts, which produce intense anxiety. Most of the time, the rituals that they develop eventually disrupt their lives.

Healthy people develop rituals too, but the difference is that people with obsessive-compulsive disorder perform these rituals even if they interfere with their everyday lives and even if the rituals are quite upsetting to the person.  Performing the rituals is not pleasurable, but the process may give some relief from the anxiety of obsessive thoughts.

Some common rituals that people with obsessive-compulsive disorder practice are:

• Washing: People become obsessed with germs and dirt and find themselves constantly washing their hands.
• Checking: People become obsessed with making sure something is locked or turned off and will check again and again, even when they know they just checked.
• Counting: People feel the need to count things over and over.
• Touching: People feel the need to touch things in a particular order.

Other common obsessions are frequent thoughts of violence or harm toward loved ones, persistently thinking about sexual acts that are not pleasurable to the person, or having thoughts that are prohibited by religious belief.  People may also have a difficult time throwing out things, and may become hoarders of meaningless possessions.

Posttraumatic Stress Disorder (PTSD): PTSD develops as a result of a terrifying event that involves physical harm or the threat of physical harm. A person may develop PTSD if he or she was the victim of physical harm, if he or she witnessed physical harm, or physical harm occurred to a loved one. It is also possible to develop PTSD if you witness something horrible happening to strangers, as in war. Traumatic incidents like rape, mugging, torture, kidnapping, being held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters are all triggers for this disorder.

Symptoms of posttraumatic stress disorder include:

• Startling easily
• Becoming emotionally numb (especially in relation to those the person used to love)
• Losing interest in the things that were once enjoyable
• Feeling unable to feel affection
• Feeling irritable
• Becoming aggressive
• Becoming violent
• Insomnia
• Nightmares
• Flashbacks
• Associated psychiatric conditions, incuding clinical depression

People with posttraumatic stress disorder will often relive the traumatizing incident throughout the day, and again in nightmares during sleep. These are called flashbacks. Flashbacks may consist of sounds, images, feelings, or smells and may be triggered by such normal events as a door slamming or an alarm sounding. A person having a flashback may lose touch with reality and believe that the traumatizing event is happening again. Posttraumatic stress disorder symptoms seem to be worse when the traumatic event was the result of someone else deliberately trying to harm them, as in a rape or kidnapping.

Symptoms usually emerge within 3 months of the traumatizing incident but may take years to develop. They must last for more than a month to be considered posttraumatic. Some people recover within 6 months, but for some, the situation becomes chronic.

Social Phobia (Social Anxiety Disorder): This disorder is characterized by people feeling overwhelmingly self-conscious and anxious about everyday situations. People who suffer from this disorder have an intense feeling that they are being watched and judged. They tend to worry for days or weeks about an upcoming situation, and the fear can become so strong that they give up ordinary activities and fall behind at school or work.

Social phobia may be limited to one type of situation, like writing on the chalkboard or talking to people at cocktail parties. Or it may be a more generalized social phobia that limits the person from talking to anyone except close family members.

Symptoms include blushing, sweating, shaking, nausea, and difficulty talking. When these symptoms appear, the person’s anxiety intensifies because there is a feeling that everyone knows something he or she doesn't and is focused on him or her.

Specific Phobias: A specific phobia is an intense fear of something that poses no actual threat. Although most adults with phobias realize that there is no actual danger, they may find that facing their phobia brings on intense anxiety or panic attacks. Some common, specific phobias include fears of:

• Closed-in places
• Heights
• Escalators
• Tunnels
• Highway driving
• Water
• Flying
• Dogs
• Injuries involving blood

Generalized Anxiety Disorder (GAD): People with GAD go through the day worrying intensely, even if there is nothing specific or concrete to provoke the worry. They anticipate the worst, and are very worried about health, money, family problems, or difficulties at work. Generalized anxiety disorder is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. Even though people with generalized anxiety disorder usually realize that their worry is disproportionate to the problem, they cannot get rid of the feeling.

Symptoms of generalized anxiety disorder:

• Unable to relax
• Unable to concentrate
• Feeling jumpy
• Difficulty falling asleep
• Physical tension
• Muscle aches
• Difficulty swallowing
• Shaking or trembling
• Twitching
• Irritability
• Sweating
• Nausea
• Lightheadedness
• Frequent urination
• Hot flashes
• Shortness of breath

Anxiety disorder due to a general medical condition: An anxiety disorder casued by, for example, asthma, thyroid disease, Cushing's syndrome, and cardiovascular disease.

Anxiety disorder not otherwise specified: An anxiety disorder that does not meet the criteria for another category.

Return to Top

What causes anxiety?

• Heredity: There is evidence that anxiety disorders run in families. If one identical twin has an anxiety disorder, it is more likely that the other twin will have anxiety disorder. This connection is less likely in a fraternal twin, which shows the genetic link.
• Brain chemistry: Because anxiety symptoms are often alleviated by medications that alter levels of chemicals in the brain, scientists believe that brain chemistry is a factor.
• Personality:  Researchers believe that sometimes people with low self-esteem and poor coping skills may be more likely to develop anxiety disorders. At the same time, anxiety disorders that appear in childhood may cause low self-esteem and poor coping skills.
• Difficult life experiences: Long-term exposure to abuse, violence, or poverty is thought to play a role in the development of anxiety disorders. Street drugs like ecstasy, acid, and amphetamines may also be a cause.
• Environmental factors: Problems such as separation from loved ones, family dysfunction, anxious parents, and lack of social support can lead to anxiety.

Return to Top

Anxiety disorders and women: the statistics

• Panic disorder affects about 6 million American adults, and it is twice as common in women as in men.
• About one third of people who suffer from panic disorders become agoraphobic, or afraid of open spaces. This means they are afraid to confront certain situations where a panic attack may occur.
• Obsessive-compulsive disorders affect 2.2 million American adults; it strikes men and women equally.
• One third of adults with obsessive-compulsive disorder develop symptoms as children
• Posttraumatic stress disorder affects about 7.7 million American adults
• More women than men are likely to develop posttraumatic stress disorder
• Social phobia affects about 15 million American adults
• Women and men are equally as likely to develop social phobia
• Specific phobias affect an estimated 19.2 million adult Americans and are twice as common in women as in men
• 6.8 Million adult Americans suffer from generalized anxiety disorder, and about twice as many women as men suffer from it

Return to Top

How do anxiety disorders affect women differently?

Because of the many demands placed on modern women to fulfill various roles, from wife to mother to businesswoman to housekeeper, women are more likely than men to suffer from many anxiety disorders. In addition, there is evidence that hormonal fluctuations may trigger (though don’t necessarily cause) symptoms of anxiety. In other words, the onset of menstruation alone would not trigger an anxiety disorder. But, if you are predisposed to anxiety because of genetics, brain chemistry, or another cause, then the hormonal fluctuations that occur with menstruation may intensify your symptoms.

Return to Top

advertisement

Diagnosis and Treatment

Diagnosis

Your healthcare professional will take a full medical history and conduct a physical examination to see whether there is any history of anxiety in the family or if you have suffered from other illnesses that are linked with anxiety. Your pulse, breathing rate, and blood pressure will be measured because abnormal levels could be a sign of anxiety or another medical condition. Your healthcare professional will probably ask some of the following questions:

• When did your feelings of stress, tension, or anxiety begin? Do you attribute the feelings to anything in particular, like an event in your life or a circumstance that scares you?
• Do you have physical symptoms along with your feelings of anxiety? If so, what are they?
• Does anything make your anxiety better?
• Does anything make your anxiety worse?
• What medications are you taking?

Your healthcare professional may also conduct several diagnostic tests such as blood tests and an electrocardiogram. These tests are done primarily to exclude other conditions that may be causing a person's symptoms.

Return to Top

Prevention

The prevention of anxiety disorders is complex and is an area of ongoing research. Much of the research in anxiety disorders has focused on treatment, rather than causes and prevention. Research on prevention has primarily focused on children because it is during childhood that personality can be influenced through upbringing and parenting, which are factors in the development of anxiety disorders. In order to understand how to prevent anxiety disorders, it is important to first know the risk factors (why people may get it) and the protective factors (why people do not get it).

Risk factors:

• Young age (anxiety disorders are one of the most common mental health problems in children)
• Having a family history of anxiety disorders
• Personality traits (such as having low self-esteem)
• Brain chemistry (for example, reduced levels of serotonin in the central nervous system)
• Life experiences (for example, stressful life events)

Protective factors:

• Social support (such as good family support)

• Good coping skills (effective ways that people have learned to deal with adversity)

Usually the reason for developing an anxiety disorder is complex, as it is a combination of physical, psychological, and environmental factors. However, prevention is crucial in anxiety disorders because they can have a very disruptive effect on a person’s life.

Substantial research shows that anxiety disorders may be prevented by educating children in certain behaviors. The following approaches can reduce the risk of developing anxiety disorders in childhood:

• Teaching children coping strategies such as relaxation, breathing exercises, and positive self-talk
• Role playing and practice runs of stressful situations and how to deal with them
• Teaching children about potentially stressful and fearful situations, so they are prepared to face them
• Ensuring that children have good social support and a good learning environment at school and at home

It is worthwhile for parents to talk to a healthcare provider about available programs and sources for further information about how to prevent anxiety disorders in children.
Furthermore, since people who are experiencing stressful events in their daily lives are at risk of developing an anxiety disorder, it is worthwhile to seek advice and support from a healthcare professional about how to reduce and better cope with stress.

Accepted Treatment

A healthcare professional can assess symptoms of anxiety to determine the diagnosis and what treatments options are available. Anxiety disorders can be treated with psychological therapies, medications, or both, combined with certain lifestyle changes and learning about better ways to cope with the condition. In fact, psychological therapies may complement therapy with medication to improve symptoms of anxiety disorders. However, more research is needed to determine if medication and psychological therapies used in combination are more effective for reducing symptoms of anxiety disorders than either therapy used alone.

A healthcare professional will be able to recommend a combination of treatments tailored to individual symptoms, health needs, and goals. Referral to a psychiatrist for a specialized assessment of symptoms is also helpful. The decision as to the best treatment for a particular anxiety disorder depends on:

• The severity of the anxiety disorder, which entails the extent of the symptoms and their effect on a person’s life and how long the symptoms have lasted
• The type of anxiety disorder (generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, or a specific phobia or anxiety disorder not otherwise specified)
• Individual perspectives on different types of treatments
• A person’s past history: for example, whether certain treatments were used before and were effective or resulted in any side effects
• Any comorbid conditions, which are other medical conditions that tend to coexist with anxiety such as depression and drug addictions (such as addiction to alcohol, nicotine/cigarettes, and prescription medicines)
• Any physical conditions that cause symptoms, for example, thyroid hormone problems or a heart condition
• Life situation or life stressors like personal, relationship, or financial problems

Other accepted treatment options for anxiety disorders include the following:

Self-care and lifestyle changes

Taking care of yourself and making some lifestyle changes may be effective in reducing anxiety symptoms and recovery. Some suggested lifestyle and self-care approaches include:

• Eating a balanced diet
• Exercising daily
• Meditation
• Breathing exercises to reduce stress
• Getting enough sleep
• Avoidance of smoking, drugs, and excessive alcohol
• Surrounding yourself with supportive friends and family

Psychological therapies

Common psychological therapies include:

• Cognitive behavioral therapy
• Supportive therapy
• Psychotherapy
• Systematic desensitization
• Biofeedback

Psychological therapy is usually the initial treatment for mild anxiety symptoms. These are worries and fears that only have a mild impact on daily life. Specific therapies focus on particular symptoms in anxiety disorders. For example, cognitive behavioral therapy helps to teach people who have unrealistic worrying, avoidance, and procrastination tendencies better coping strategies and problem-solving skills by changing patterns in their thinking.

A healthcare professional can offer advice on the form of therapy best suited to an individual’s need and can provide a referral to an appropriate therapist.

The following are brief descriptions of the different types of psychological therapies:

Cognitive behavioral therapy
This form of counseling analyzes how people’s thoughts contribute to the symptoms of the anxiety disorder and helps people learn how to change their thinking and behaviors linked to their thoughts.

Supportive therapy
A form of counseling that provides support so that people can cope better with their anxiety and/or stressful life circumstances

Psychotherapy
Psychotherapy is a form of counseling performed by trained psychotherapists. It involves communication and dialogue with a therapist, understanding and learning about one’s self, and how to change behaviors that may cause problems that contribute to an anxiety disorder or other mental health conditions.

Systematic desensitization
A process of repeated exposure to a feared object, which helps to reduce fear and cause desensitization.

Biofeedback
Anxiety symptoms cause people to be hyperaroused. Biofeedback is a technique that involves assessing physical factors such as blood pressure, temperature, and heart rate to increase a person’s awareness of his or her physical state in the hope of exerting more conscious control over certain stress responses.

Medication for anxiety disorders

1. Antidepressants
2. Antianxiety medication
3. Beta blockers
4. Atypical antipsychotics

Treatment with medication is used for people whose symptoms of anxiety disorders have a significant impact on their day-to-day function, including having moderate or severe physical symptoms such as restlessness, sweating, palpitations, fatigue, and muscle tension. A healthcare professional can determine if symptoms require medication in order to alleviate them. Reduction of symptoms and restoring the ability to live a normal life is the usual goal of treatment in anxiety disorders, and often psychological therapies used alone are inadequate in achieving this goal for many sufferers. Medication for anxiety is generally taken each day. The duration of treatment will depend on individual symptoms and the medication itself. Relapse is common after stopping anxiety treatment, especially if it is stopped too early. For example, in generalized anxiety disorders, 60% to 80% of people can relapse if they stop therapy after 1 year. A healthcare professional can monitor the response to medications and offer advice on the appropriate duration of therapy.

Types of medication used for treating anxiety disorders include:

1. Antidepressants

Antidepressants were developed to treat depression but they are also effective for anxiety disorders. Antidepressants help reduce anxiety symptoms because they can alter certain chemicals in the brain related to stress. These chemicals are called neurotransmitters. Different types of antidepressants will affect different neurotransmitters; therefore, some will be better for certain symptoms of anxiety than others. Each type also has different side effects. Antidepressants usually take 4 to 6 weeks to start improving anxiety symptoms and need to be taken every day. People are advised not to suddenly stop taking antidepressants because sudden withdrawal may cause physical symptoms, such as dizziness and headaches.

Selective serotonin reuptake inhibitors

• Fluoxetine (Prozac®)
• Sertraline (Zoloft®)
• Escitalopram (Lexapro®)
• Paroxetine (Paxil®)
• Citalopram (Celexa®)

Selective serotonin reuptake inhibitors are the most commonly prescribed antidepressants and are usually the first medication option for treatment of anxiety disorders. Side effects include nausea, abdominal discomfort, and increased anxiety.

Serotonin norepinephrine reuptake inhibitors

• Venlafaxine (Effexor® or Effexor XR®)
• Duloxetine (Cymbalta®)

Tricyclic antidepressants

• Doxepin (Adapin®)
• Clomiprimine (Anafranil®)
• Nortriptyline (Aventyl®)
• Amitriptyline (Elavil®)
• Maprotiline (Ludiomil®)
• Desipramine (Norpramin®)
• Trimipramine (Surmontil®)
• Imipramine (Tofranil®)
• Protriptyline (Vivactil®)

Since tricyclic antidepressants have more side effects than selective serotonin reuptake inhibitors, they are not prescribed as much.  Side effects include dizziness, drowsiness, dry mouth, and weight gain.

Monoamine oxidase inhibitors

• Phenelzine (Nardil®)
• Tranylcypromine (Parnate®)
•  Isocarboxazid (Marplan®)
• Selegiline (Emsam®)

Monoamine oxidase inhibitors are less frequently prescribed than either selective serotonin reuptake inhibitors and tricyclic antidepressants because of possible severe side effects and drug interactions. People who take monoamine oxidase inhibitors cannot eat foods and beverages (including cheese and red wine) that contain tyramine. Also they must avoid certain medications including some types of birth control pills, pain relievers (such as Advil®, Motrin®, or Tylenol®), cold and allergy medications, and herbal supplements. These antidepressants are often used to treat anxiety that has not responded to other medications.

2. Antianxiety medications

• Mirtazapine (Remeron®)

Benzodiazepines

• Alprazolam (Xanax®)
• Chlordiazepoxide (Librium®)
• Clonazepam (Klonopin®)
• Clorazepate (Tranxene®)
• Diazepam (Valium®)
• Lorazepam (Ativan®)
• Oxazepam (Serax®)

Benzodiazepines lower anxiety symptoms through sedation and reducing physical symptoms like muscle tension. However, since they have some severe side effects and can be psychologically and physically addictive, they need to be prescribed and used carefully. They are usually prescribed for a very short period of time. In cases of  benzodiazepine dependence or addiction, withdrawal symptoms can occur once the medication is stopped. Withdrawal symptoms include anxiety, irritability, and insomnia.

Norepinephrine and dopamine reuptake inhibitors: Buspirone (Buspar®)

3. Beta blockers

• Propranolol (Inderal®)

Beta blockers can reduce a person’s heart rate and, if taken intermittently, they can prevent the physical symptoms (such as palpitations) that accompany certain anxiety disorders, particularly social phobia.

4. Atypical antipsychotics

• Aripiprazole (Abilify®)
• Ziprasidone (Geodon®)
• Risperidone (Risperdal®)
• Quetiepine (Seroquel®)
• Olanzapine (Zyprexa®)

These medications are usually only used in combination with other medications when a single medication only partially improves anxiety symptoms.

Alternative Therapies

Herbal medicines are popular for the treatment of a variety of conditions. However, they should only be used if scientific research has shown that they are safe and effective. Passionflower extract (Passiflora) and valerian have been used by some people to reduce anxiety symptoms. However, there is inadequate research to support their benefit or safety.

Dealing with chronic and long-term anxiety
Once a person has developed an anxiety disorder, there are a variety of factors that increase the risk of their symptoms becoming more chronic and not as responsive to available treatments. These factors include:

• Persistent stressful life circumstances
• Using certain medicines that can cause anxiety, for example, steroids, thyroid hormone replacement medication (L-thyroxine ), theophylline, digoxin, some over-the-counter cold and flu medications (decongestants, such as pseudoephedrine (Sudafed)  and certain herbal products and vitamins)
• Personality type—being a “worrier” by nature
• Severe symptoms at initial diagnosis
• Delay in getting treatment for an anxiety disorder
• Symptoms that are only partially treated and do not fully resolve
• Having a comorbid condition like depression or drug addiction

Many people with anxiety disorders will need long-term medication to prevent their symptoms from relapsing. If you have been diagnosed with an anxiety disorder, make certain that you have regular checkups with a healthcare professional who can monitor your symptoms and the prescribed treatment. He or she can offer guidance on whether you need to increase, reduce, or change your treatment.

Return to Top

Emerging Treatments

Research into new medications and genetic advances for anxiety disorders looks promising.

New medications for anxiety disorders

New medications are needed for the treatment of anxiety disorders because many people do not respond adequately to the current treatments that are available. Much research surrounds new medicines that target GABA (gamma-amino butyric acid) receptors in the central nervous system. A gamma-amino butyric acid, such as serotonin, is a type of neurotransmitter in the nervous system that acts like a messenger between nerve cells.

Pregabalin (Lyrica®) is already licensed in Europe for the treatment of generalized anxiety disorder and is currently being considered by the US FDA as treatment for adults with generalized anxiety disorder or social anxiety disorder.

Tiagabine (Gabitril®) is another medication currently being investigated for use in the treatment of anxiety disorders. So far tiagabine is only approved in the US for treatment of seizures.

Genetic advances

Research is being conducted on genes that are linked to the development of anxiety disorders. One of these genes is the BDNF gene that produces a protein linked to stress and the production of new nerve cells. The BDNF gene is also linked to the risk of resistance to some common medications for anxiety.

Return to Top

advertisement

Empower Yourself

Dealing with anxiety

The best way to address your anxiety is to find the source of what worries you and deal with it. Unfortunately, this is much harder than it sounds. One way to get to the source of your anxiety is to take an inventory of what situations stress you. Ask yourself:

• What do I worry about most?
• Is something constantly on my mind?
• Does anything in particular make me sad or depressed?

Once you have answered these questions, find someone you trust: a friend, family member, teacher, mentor, counselor, etc. Tell this person that you need to talk and share with them what you’re feeling. Sometimes, all you really need to do is to talk about the things that are troubling you: to vent. Talking can relieve anxiety. If you feel that you've been unloading yourself on friends and family too much, then maybe it's time to talk to a professional. Most communities offer support groups or hotlines that you can consult for help. You could also look into one of the various forms of therapists: social workers, psychologists, art therapists, and energy healers all deal with stress relief. Research some treatments you think would work best.

Also, find healthy ways to cope with stress. For example:

• Eat a well-balanced, healthy diet. Don’t overeat.
• Get enough sleep.
• Exercise regularly.
• Limit caffeine and alcohol.
• Don’t use cocaine, nicotine, or other recreational drugs.
• Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation. Try biofeedback, using a certified professional to get you started.
• Take breaks from work. Make sure to balance fun activities with your responsibilities. Spend time with people you love and whose company you enjoy.

Return to Top

Frequently asked questions

What is the difference between anxiety and panic?
Panic is a sudden intense response to normal thoughts or sensations. This is often accompanied by a feeling of impending doom and physical symptoms, such as increased heart rate, palpitations, and pins and needles. Anxiety is a psychological condition, prolonged by thought processes and rituals that cause the person affected to avoid certain situations which, he or she believes, will exacerbate his or her anxiety. This avoidance behavior affects the quality of their life. In some forms of anxiety disorders, individuals will experience panic and/or panic attacks.

Can people with panic disorder lead normal lives?
Absolutely!  Most people with anxiety or panic disorder can lead normal panic-free lives.  The key is finding the treatment option that works best for you.  Unfortunately, it can take trial and error to find the best medication or treatment that fits your needs.

How do I explain my panic disorder to others?
Most people have experienced the kind of frightening situations in which their hearts pound, their minds race, their palms and brows sweat, their breathing quickens, and they feel a need to escape. Having a near accident or facing the threat of harm or injury will produce just such a reaction. If you get panic attacks, you know that they produce the same response. The difference is that during a panic attack there is no true danger. Help your family to understand what you go through by having them recall an intensely uncomfortable and overwhelming moment of danger, pointing out to them that they would do almost anything to avoid that feeling may help them understand.

Will I have a heart attack or stroke during a panic attack?
No.  This is one of the most commonly asked questions.  Even though during a panic attack you may feel as if you are going to have a heart attack or stroke, statistics show that no one has ever died from a panic attack.

Are there different types of anxiety disorders?
Yes. Anxiety disorders differ from normal feelings of nervousness because the symptoms often occur for no apparent reason and do not go away. Rather than functioning as a call to action, these alarming reactions can make everyday experiences sources of potential terror.  Below you will find a list of the most common anxiety disorders:

• Panic Disorder
• Social Phobia
• Specific Phobia
• Agoraphobia
• Obsessive-Compulsive Disorder (OCD)
• Posttraumatic Stress Disorder (PTSD)
• Generalized Anxiety Disorder (GAD)

One day when I was driving home from work I had a panic attack. Now I'm reluctant to drive. Will this fear of driving go away on its own?
What you experienced is a classic panic attack, which can come seemingly out of the blue. Now, you are experiencing avoidance by being reluctant to get behind the wheel again. You can’t will away your panic attack. Instead of suffering alone, seek treatment from a healthcare professional who has experience in treating these disorders. Don’t let embarrassment stop you from returning to an active lifestyle.

A close friend has just been diagnosed with a phobia. What can I do to help?
Support from family and friends is an important part of the recovery process, but ultimately the person who is suffering from the phobia will have to do most of the work. However, you can lend support by learning about the disorder, praising small milestones achieved, and being flexible and realistic in your expectations. Your patience will be invaluable.

I was previously treated for an anxiety disorder, and now I've been experiencing the same feelings again. Can I get more treatment?
When you undergo treatment for an anxiety disorder, you and your doctor or therapist work as a team to find the best approach to treat your anxiety. That will include a detailed history of the previous treatment, as well as your overall health. When treatment begins, some people feel much better after a single session, whereas others require weeks of care. Most people are treated with a speciific therapy whereas others benefit from medication. If one treatment doesn’t work, the odds are good that another one will. Don’t give up hope.

What is agoraphobia?
Agoraphobia is a condition that develops when a person begins to avoid spaces or situations associated with anxiety. Typical phobic situations might include driving, shopping, crowded places, traveling, standing in line, being alone, meetings, and social gatherings.

If I have been diagnosed with an anxiety disorder, will I need medication?
If you have been diagnosed with an anxiety disorder your healthcare professional will advise you that treatment options include medication, psychotherapy, and other types of psychological therapies such as stress reduction management. The recommended treatment will depend on factors such as what type of anxiety you suffer from, how disruptive your anxiety is to your life, whether you have associated conditions, such as depression, and whether you have already tried certain treatments that may not have worked.

If I have been diagnosed with an anxiety disorder, am I likely to suffer any other medical conditions?
It is common for an anxiety disorder to be accompanied by another medical illness that can even include a second type of anxiety disorder. For example, often people who have an anxiety disorder also can experience the intense sadness, hopelessness, and worthlessness associated with clinical depression. People with an anxiety disorder can also suffer from eating disorders and drug abuse problems, including excessive drinking of alcohol.

Return to Top

Glossary of anxiety disorder terms

Anxiety: A feeling of apprehension and fear characterized by physical symptoms such as palpitations, sweating, and feelings of stress. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people's lives with overwhelming worry and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

Anxiety disorder: A chronic condition characterized by an excessive and persistent sense of apprehension with physical symptoms such as sweating, palpitations, and feelings of stress. Anxiety disorders have biological and environmental causes.

Balance: A biological system that enables us to know where our bodies are in the environment and to maintain a desired position. Normal balance depends on information from the inner ear, other senses (such as sight and touch), and muscle movement.

Benzodiazepines: A class of drugs that acts as tranquilizers or sedatives. Sometimes prescribed for anxiety, benzodiazepines can cause drowsiness, and are addictive.

Biofeedback: A method of treatment that uses monitors to feed back to patients physiological information of which they are normally unaware. By watching the monitor, patients can learn by trial and error to adjust their thinking and other mental processes in order to control “involuntary” bodily processes such as blood pressure, temperature, gastrointestinal functioning, and brain wave activity.

Cardiovascular disease: A disease of the heart and blood vessels including the arteries and veins; for example, coronary heart disease, stroke, and hypertension (high blood pressure).

Cognitive behavioral therapy: A relatively short-term form of psychotherapy based on the concept that the way we think about things affects how we feel emotionally. Cognitive therapy focuses on present thinking, behavior, and communication rather than on past experiences and is oriented toward problem solving.

Comorbid conditions: Conditions of an illness that tend to coexist with another illness in the same person.

Cushing's syndrome: Cushing's syndrome is a hormonal condition characterized by abnormally high levels of the hormone cortisol in the body, which causes various symptoms like weight gain, fatigue, and easy bruising. There are various causes of Cushing's syndrome, including certain adrenal gland and brain tumors.

Depression: A medical illness characterized by long-lasting low mood associated with feelings of intense sadness, hopelessness, and loss of interest in activities that usually bring pleasure.

Digoxin: A medication classified as a cardiac glycoside and used in the treatment of various heart conditions such as cardiac arrhythmias (abnormal heart rhythms).

Family history: The family structure and relationships within the family, including information about diseases in family members.

Fraternal twins: Twins are a form of multiple birth. Fraternal twins, otherwise known as "nonidentical twins," usually occur when two fertilized eggs are implanted in the uterine wall (wall of the womb) at the same time, producing two nonidentical embryos.

Generalized anxiety disorder (GAD): A condition characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with GAD usually expect the worst. They worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia.

Genetics: The scientific study of heredity. Genetics pertains to humans and all other organisms. For example, there are human genetics, mouse genetics, fruitfly genetics, etc.

Neurotransmitter: A chemical substance in the body that enables information to be relayed from neurons or nerve cells to other cells in the body.

Obsessive-compulsive disorder (OCD): A psychiatric disorder characterized by obsessive thoughts and compulsive actions such as cleaning, checking, counting, or hoarding. OCD, one of the anxiety disorders, is a potentially disabling condition that can persist throughout a person’s life. The sufferer becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if it is severe and left untreated, OCD can destroy a person’s capacity to function at work, at school, or even in the home.

Panic: A sudden strong feeling of fear that prevents reasonable thought or action.

Panic disorder: A disorder characterized by sudden attacks of fear and panic. The episodes may resemble a heart attack. They may strike at any time and occur without reason, but more frequently are triggered by specific events or thoughts such as taking an elevator or driving. The attacks may be so terrifying that some people associate their attacks with the place they occurred and will refuse to go there again.

Pharmacist: A professional who fills prescriptions, and in the case of a compounding pharmacist, assembles the ingredients. Pharmacists are familiar with medication ingredients, interactions, cautions, and hints.

Psychiatrist: A physician (MD) who specializes in the prevention, diagnosis, and treatment of mental illness. Psychiatrists must receive additional training and serve a supervised residency in their specialty. They may also have additional training in a psychiatric specialty such as child psychiatry or neuropsychiatry. They can prescribe medication, whereas psychologists cannot.

Psychiatry: The medical specialty concerned with the prevention, diagnosis, and treatment of mental illness.

Psychology: The study of the mind and mental processes, especially in relation to behavior. There are several fields of psychology. Clinical psychology diagnoses and treats disorders of the brain, emotional disturbances, and behavior problems. Child psychology is the study of the mental and emotional development of children and is part of developmental psychology, the study of changes in behavior that occur through the life span. Cognitive psychology deals with how the human mind receives and interprets impressions and ideas. Social psychology looks at how the actions of others influence the behavior of an individual.

Self-talk: Refers to an internal dialogue consisting of a person's thoughts, emotions, and beliefs.

Serotonin: A hormone or neurotransmitter, also called 5-hydroxytryptamine, in the pineal gland, blood platelets, the digestive tract, and the brain. Serotonin acts both as a chemical messenger that transmits nerve signals between nerve cells and causes blood vessels to narrow.

Side effects: Problems that occur when treatment exceeds the desired effect or occur in addition to the desired therapeutic effect.

Stress: Forces from the outside world impinging on the individual. Stress is a normal part of life that can help us learn and grow. Conversely, stress can cause us significant problems.

Theophylline: A medication used in treating lung conditions such as asthma.

Therapy: The treatment of disease.

Trauma: Any injury, whether physically or emotionally inflicted. Trauma has both a medical and a psychiatric definition. Medically, trauma refers to a serious or critical bodily injury, wound, or shock. This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. In psychiatry, trauma has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects.

Return to Top

Anxiety disorder resources

Government Agencies

*Accepts Spanish calls

* National Women’s Health Information Center, OWH, HHS
8270 Willow Oaks Corporate Drive
Fairfax, VA 22031
Phone: (800) 994-9662
TDD: (888) 220-5446
Fax: (703) 663-6942
http://www.4woman.gov/faq/depress.htm#e

National Institute of Neurological Disorders and Stroke (NINDS), NIH, HHS
NIH Neurological Institute
PO Box 5801
Bethesda, MD 20824
Phone: (800) 352-9424
http://www.ninds.nih.gov

* National Center for Complementary and Alternative Medicine, NIH, HHS
PO Box 7923
Gaithersburg, MD 20898
Phone: (888) 644-6226
TTY: (866) 464-3615
Fax: (866) 464-3616
http://nccam.nih.gov



Private Organizations

National Mental Health Association
Mental Health America
2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
Phone: (800) 969-6MHA (6642)
TTY: (800) 433-5959
Fax: (703) 684-5968
http://www.nmha.org

Mayo Clinic
4500 San Pablo Road
Jacksonville, FL 32224
Phone: (904) 953-2000
http://www.mayoclinic.org


Newsletters, Magazines, Reports

Healthy Women Today
The National Women's Health Information Center
http://www.womenshealth.gov/newsletter

National Institute of Neurological Disorders and Stroke
Subscribe to the newsletter to get up-to-date news on research and breakthroughs.
http://www.ninds.nih.gov/funding/nindsnotes/nindsnoteslistserv.htm

Living With Anxiety
Subscribe to the newsletter.
http://www.livingwithanxiety.com/newsletter.htm


Tools

The Anxiety Panic Internet Resource
Join a chat room, read other people's stories, and get up-to-date information on anxiety.
http://www.algy.com/anxiety/

Anxiety.com
Find out about free self-help groups and take a free self-diagnostic test.
http://www.anxieties.com/self.php

Return to Top

References

1. Leichsenring F. Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-anyalytic approach. Clin Psychol Rev. 2001;21:401.

2. Craighead WE, Craighead LW. The role of psychotherapy in treating psychiatric disorders. Med Clin North AM. 2001;85:617.

3. Roy-Byrne PP, Craske MG, Stein MB. Pain disorder. Lancet. 2006;368:1023.

Return to Top