Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. This fact sheet briefly describes the different types of anxiety disorders. This fact sheet is not exhaustive, nor does it include the full range of symptoms and treatments. Keep in mind that new research can yield rapid and dramatic changes in our understanding of and approaches to mental disorders. If you believe you or a loved one has an anxiety disorder, seek competent, professional advice or another form of support.

Generalized Anxiety Disorder

Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder.

Anxiety Disorder Symptoms: Chronic, exaggerated worry, tension, and irritability that appear to have no cause or are more intense than the situation warrants. Physical signs, such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating, often accompany these psychological symptoms.

Anxiety Disorder Formal diagnosis: When someone spends at least six months worried excessively about everyday problems. However, incapacitating or troublesome symptoms warranting treatment may exist for shorter periods of time.

Anxiety Disorder Treatment: Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication, most commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also may be required in some cases. Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety medication buspirone can be helpful for some individuals.

Panic Disorder

People with panic disorder experience white-knuckled, heart-pounding terror that strikes suddenly and without warning. Since they cannot predict when a panic attack will seize them, many people live in persistent worry that another one could overcome them at any moment.

Panic Disorder Symptoms: Pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of breath, shaking or trembling, choking, fear of dying, sweating, feelings of unreality, numbness or tingling, hot flashes or chills, and a feeling of going out of control or going crazy.

Panic Disorder Formal Diagnosis: Either four attacks within four weeks or one or more attacks followed by at least a month of persistent fear of having another attack. A minimum of four of the symptoms listed above developed during at least one of the attacks. Most panic attacks last only a few minutes, but they occasionally go on for ten minutes, and, in rare cases, have been known to last for as long as an hour. They can occur at any time, even during sleep.

Panic Disorder Treatment: Cognitive behavioral therapy and medications such as high-potency anti-anxiety drugs like alprazolam. Several classes of antidepressants (such as paroxetine, one of the newer selective serotonin reuptake inhibitors) and the older tricyclics and monoamine oxidase inhibitors (MAO inhibitors) are considered “gold standards” for treating panic disorder. Sometimes a combination of therapy and medication is the most effective approach to helping people manage their symptoms. Proper treatment helps 70 to 90 percent of people with panic disorder, usually within six to eight weeks.

Phobias

Most of us steer clear of certain, hazardous things. Phobias however, are irrational fears that lead people to altogether avoid specific things or situations that trigger intense anxiety. Phobias occur in several forms, for example, agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult. Social phobia is a fear of being extremely embarrassed in front of other people. The most common social phobia is fear of public speaking.

Phobias Symptoms: Many of the physical symptoms that accompany panic attacks - such as sweating, racing heart, and trembling - also occur with phobias.

Phobias Formal Diagnosis: The person experiences extreme anxiety with exposure to the object or situation; recognizes that his or her fear is excessive or unreasonable; and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.

Phobias Treatment: Cognitive behavioral therapy has the best track record for helping people overcome most phobic disorders. The goals of this therapy are to desensitize a person to feared situations or to teach a person how to recognize, relax, and cope with anxious thoughts and feelings. Medications, such as anti-anxiety agents or antidepressants, can also help relieve symptoms. Sometimes therapy and medication are combined to treat phobias.

Post-traumatic Stress Disorder

Researchers now know that anyone, even children, can develop PTSD if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. PTSD can result from terrifying experiences such as rape, kidnapping, natural disasters, or war or serious accidents such as airplane crashes. The psychological damage such incidents cause can interfere with a person’s ability to hold a job or to develop intimate relationships with others.

Post-traumatic Stress Disorder Symptoms: The symptoms of PTSD can range from constantly reliving the event to a general emotional numbing. Persistent anxiety, exaggerated startle reactions, difficulty concentrating, nightmares, and insomnia are common. People with PTSD typically avoid situations that remind them of the traumatic event, because they provoke intense distress or even panic attacks.

Post-traumatic Stress Disorder Formal Diagnosis: Although the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond three months.

Post-traumatic Stress Disorder Treatment: Psychotherapy can help people who have PTSD regain a sense of control over their lives. They also may need cognitive behavior therapy to change painful and intrusive patterns of behavior and thought and to learn relaxation techniques. Support from family and friends can help speed recovery and healing. Medications, such as antidepressants and anti-anxiety agents to reduce anxiety, can ease the symptoms of depression and sleep problems. Treatment for PTSD often includes both psychotherapy and medication.

Source: Samhsa.gov

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What is anxiety?

Anxiety can be a normal “alarm system” alerting you to danger. Imagine coming home and finding a burglar in your living room. Your heart beats fast. Your palms get sweaty. Your mind races. In this situation, anxiety can provide an extra spark to help you get out of danger. In more normal but busy situations, anxiety can give you the energy to get things done.

But sometimes anxiety can be out of control, giving you a sense of dread and fear for no apparent reason. This kind of anxiety can disrupt your life.

Are there different types of anxiety?

Yes. Anxiety can be a general feeling of worry, a sudden attack of panicky feelings, or a fear of a certain situation or object.

What is generalized anxiety disorder?

Generalized anxiety disorder is ongoing worry or fear that isn’t related to a particular event or situation, or is out of proportion to what you would expect–for instance, constantly worrying about a child who is perfectly healthy.

Symptoms of generalized anxiety disorder include muscle tension, trembling, shortness of breath, fast heartbeat, dry mouth, dizziness, nausea, irritability, loss of sleep and not being able to concentrate.

What is panic disorder?

Panic disorder is another type of anxiety. It occurs when you have repeated periods of extreme panic, called panic attacks.

Suppose one day you’re getting out of your car to go to work. Suddenly, your chest feels tight. Your heart races. You begin to feel dizzy and faint. You start to choke. You feel as if the end is near. Was it all in your head? No. Most likely, you had a panic attack.

Panic attacks last about 5 to 30 minutes and may include any of the symptoms listed in the box below. Panic attacks can lead to phobias if they aren’t treated.

Panic attack symptoms

What is a phobia?

A phobia is an extreme, unreasonable fear in response to something specific. There are lots of different phobias, including fear of crowds, bridges, snakes, spiders, heights, open places or social embarrassment.
A phobia is only considered a problem when it keeps you from living a normal life. An example is being afraid to leave home because you are afraid of one of the things listed above.

What causes anxiety disorders?

Suppose the fire alarm goes off in your home. You race around frantically to find the fire. Instead, you find that there is no fire–the alarm just isn’t working properly.

It’s the same with anxiety disorders. Your body mistakenly triggers your alarm system when there is no danger. This may be due to a chemical imbalance in your body. It may also be related to an unconscious memory, to a side effect of a medicine or to an illness.

Can anxiety disorders be treated?

Yes. Talk to your family doctor if you think you have an anxiety disorder. He or she can help you form a plan to develop skills to cope with your anxiety. Your doctor may also suggest counseling and prescribe medicine if needed. The following are some tips on coping with anxiety:

Control your worry. Pick a place and time to do your worrying. Make it the same place and time every day. Spend 30 minutes thinking about your concerns and what you can do about them. Try not to dwell on what “might” happen. Focus more on what’s really happening. Then let go of the worry and go on with your day.

Steps to deep breathing

Learn ways to relax. These may include muscle relaxation, yoga, or deep breathing (see box to the right).

Muscle relaxation is simple. Start by choosing a muscle and holding it tight for a few seconds. Then relax the muscle. Do this with all of your muscles. Try starting with your feet muscles and working your way up your body.

Exercise regularly. People who have anxiety often quit exercising. But exercise can give you a sense of well-being and help decrease feelings of anxiety.

Get plenty of sleep.

Avoid alcohol and drug abuse. It may seem that alcohol or drugs relax you. But in the long run they make anxiety worse and cause more problems.

Avoid caffeine. Caffeine is found in coffee, tea, soft drinks and chocolate. Caffeine may increase your sense of anxiety because it stimulates your nervous system. Also avoid over-the-counter diet pills, and cough and cold medicines the contain a decongestant.

Confront the things that have made you anxious in the past. Begin by just picturing yourself confronting these things. By doing this, you can get used to the idea of confronting the things that make you anxious before you actually do it. After you feel more comfortable picturing yourself confronting these things, you can begin to actually face them.

If you feel yourself getting anxious, practice a relaxation technique or focus on a simple task, such as counting backward from 100 to 0.

Although feelings of anxiety are scary, they won’t hurt you. Label the level of your fear from 0 to 10 and keep track as it goes up and down. Notice that it doesn’t stay at a very high level for more than a few seconds. When the fear comes, accept it. Wait and give it time to pass without running away from it.

Use medicine if it helps. Your doctor may give you medicine to help reduce your anxiety while you learn new ways to respond to the things that make you anxious. Many types of medicine are available. Your doctor will decide which medicine is right for you.

Talk about your anxiety with your doctor. Your doctor can help you make a plan to cope with anxiety. Counseling can help you learn to express your needs and wants so you can feel more in control and hold in less of your anger and anxiety.

The most important thing is to take action. Any action you take will help you gain a sense of control over your anxiety.

Source: FamilyDoctor.org

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Chronic insomnia may predict the development of anxiety disorders and also indicate current depression.

That’s according to a Norwegian study published in the latest edition of the journal Sleep.

The study defines chronic insomnia as the subjective feeling of having trouble falling or staying asleep most nights for at least a month.

People with chronic insomnia should be screened to see if they have an anxiety disorder or depression, note the researchers. They included Dag Neckelmann, MD, PhD, of the psychiatry department at Haukeland University in Bergen, Norway.

Neckelmann’s team tracked depression, anxiety, and insomnia in more than 25,000 Norwegian adults.

Participants completed a health survey that included questions about chronic insomnia, anxiety disorders, and depression. They took the survey twice — once in the mid-1980s and again 11 years later.

Insomnia, Anxiety Disorders, and Depression

The researchers excluded participants who had anxiety disorders or depression at the time of the first survey.

People who reported chronic insomnia in the first survey were particularly likely to note anxiety disorders in the follow-up survey 11 years later.

Chronic insomnia didn’t predict depression’s development. People with chronic insomnia in the first survey weren’t especially likely to report depression 11 years later in the second survey.

But that doesn’t mean that insomnia and depression weren’t related.

People with chronic insomnia were more likely to have current anxiety or depression than people without insomnia.

The results held when the researchers considered other factors, including participants’ age, sex, and educational level.
Sound Sleep, Less Anxiety?

Easing chronic insomnia might help prevent the development of anxiety disorders, Neckelmann’s team notes.

However, they didn’t test that theory directly. Their study doesn’t prove that insomnia causes anxiety disorders, or that ending insomnia heads off anxiety.

SOURCES: Neckelmann, D. Sleep, July 1, 2007; vol 30: pp 873-880. News release, American Academy of Sleep Medicine.

?© 2007 WebMD Inc. All rights reserved.

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Older men who suffer from chronic anxiety substantially increase their risk of having a heart attack, a new study reports.

While stress has been linked to an increased risk of heart problems, this is the first time that chronic anxiety has been identified as a risk factor also.

“There is an independent contribution of anxiety that can predict the onset of a heart attack among healthy older men,” said lead researcher Biing-Jiun Shen, an assistant professor of psychology at the University of Southern California in Los Angeles.

Even after accounting for anger, hostility, depression and type A personality, anxiety still predicted the onset of a heart attack, Shen said. “The relationship between anxiety and heart attack cannot be explained by depression, hostility or type A personality,” he said.

In the study, Shen’s group collected data on 735 men who participated in the Normative Aging Study, which assesses medical and psychological changes associated with aging. Each of the men completed psychological testing in 1986 and had no heart problems at the time. The men were followed for an average of 12 years.

The report appears in the Jan. 15 issue of the Journal of the American College of Cardiology.

During follow-up, the researchers found men who had chronic anxiety had a 30 percent to 40 percent increased risk of heart attack. Those with the highest levels of anxiety on psychological testing had an even higher risk of heart attack.

The risk posed by anxiety remained even after the researchers adjusted their data to account for standard cardiovascular risk factors, health habits, and negative psychological and personality traits, Shen said.

Whether treating anxiety reduces the risk of heart attack isn’t known, Shen said. “But the implication is there,” he added. “It is something that doctors can look out for.”

Shen’s team is hoping to study that possibility. “Hopefully, that will reduce the risk for heart disease,” he said.

In addition, it isn’t known if women are also at risk for heart attack from chronic anxiety, Shen noted.

One expert agreed that psychological factors play a significant role in the risk for having a heart attack.

“Psychological characteristics including anxiety, anger, hostility and type A personalities have been associated with increased risk of heart attack in a number of prior studies, and this study again shows that chronic anxiety appears to raise an individual’s heart attack risk,” said Dr. Gregg C. Fonarow, a cardiology professor at the University of California, Los Angeles.

“An important finding of this study is that anxiety not only represents an independent risk factor for heart attack but may also explain the associations between heart attack risk with other psychosocial risk factors,” Fonarow said.

Exaggerated response to acute and chronic stress in anxious individuals may trigger a number of pathways which increase the risk of developing coronary artery disease and being stricken with a heart attack, Fonarow said.

“Highly anxious individuals should be aware they may face an increased risk of a heart attack and take proactive steps under physician supervision to control those cardiovascular risk factors which are modifiable including blood pressure, lipid levels, activity level and weight,” Fonarow added.

SOURCES: Biing-Jiun Shen, Ph.D., assistant professor, psychology, University of Southern California, Los Angeles; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Jan. 15, 2008, Journal of the American College of Cardiology

Copyright ?© 2008 ScoutNews, LLC. All rights reserved.

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It may be just as common, if not more common, for people to develop mental health problems as lung cancer, stroke, and cardiovascular disease, a new study shows.

The study, published in today’s advance online edition of Molecular Psychiatry, tracks new cases of substance abuse, mood disorders, and anxiety disorders among more than 34,000 U.S. adults.

The researchers interviewed participants and counted the number of people who had a specific mental disorder for the first time in their lives any time between 2004 and 2005. The figures don’t include people with longstanding conditions.

The results:

* 1.7% developed alcohol dependency
* 1.51% developed major depression
* 1.12% developed generalized anxiety disorder
* 1.02% developed alcohol abuse
* 0.62% developed any panic disorder
* 0.53% developed bipolar I disorder
* 0.44% developed a phobia
* 0.32% developed drug dependency
* 0.32% developed social phobia
* 0.28% developed drug abuse
* 0.21% developed bipolar II disorder

“Incidence rates of substance, mood, and anxiety disorders were comparable to or greater than rates of lung cancer, stroke, and cardiovascular disease,” write the researchers, who included Bridget Grant, PhD, of the National Institute on Alcohol Abuse and Alcoholism.

Men were more likely than women to report alcoholism and other substance use disorders. Women were more likely than men to report depression and anxiety. No gender trends were seen for bipolar disorder.

All of the disorders were most common in younger participants. That finding “underscores the need for increased vigilance in identifying and treating these disorders among young adults,” Grant and colleagues write.

SOURCES: Grant, B. Molecular Psychiatry, April 22, 2008; advance online edition. News release, National Institute on Alcohol Abuse and Alcoholism.

?© 2008 WebMD Inc. All rights reserved.

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Social anxiety disorder prevents some 15 million Americans from leading normal social and romantic lives, a new survey finds.

The disorder leaves many isolated, ashamed and often misdiagnosed. Thirty-six percent of those with social anxiety disorder have symptoms for 10 years or more before seeking help, the Anxiety Disorders Association of America reports.

“Social anxiety disorder is when somebody has an intense, persistent and irrational fear of social or performance situations,” Jerilyn Ross, the association’s president and CEO, said during a teleconference Wednesday.

“The condition causes people to avoid common, everyday situations and even other people for fear of being judged or criticized or humiliated or embarrassing themselves,” Ross said.

Social anxiety disorder can interfere with daily routines and job performance, Ross noted. “It also makes it very difficult for people to develop friends and romantic partnerships,” she said.

People with this disorder recognize their fear is excessive and irrational, Ross noted. “But they feel powerless to do anything about it,” she said.

Social anxiety disorder can start in the early teens, Dr. Mark H. Pollack, director of the Center for Anxiety and Traumatic Stress Disorders and a professor of psychiatry at Harvard Medical School, said during the teleconference.

“This is a disorder that starts affecting people early on,” Pollack said. “The typical age of onset is early adolescence, age 12 or 13, and many individuals report a history of anxiety dating back to earlier childhood.”

The disorder also has physical symptoms, including heart palpitations, feelings that their throat will close up, sweating, blushing, faintness, trembling and stammering, Ross said.

In the survey, pollsters questioned 578 people with anxiety, 276 people with obsessive-compulsive disorder, and 287 people with social anxiety disorder.

Among people with the disorder, 75 percent said the condition affected their ability to do normal activities. In addition, 69 percent said they didn’t want people to think they were crazy, and 58 percent said they were embarrassed by their condition, Ross said.

However, when the condition is diagnosed and treated, many reported improvement in their lives. In fact, 59 percent who were receiving treatment said treatment had a positive effect on their ability to have a romantic relationship. In addition, 39 percent who had received treatment said knowing that treatment can be successful aided their decision to get help, Ross noted.

The disorder can be effectively treated. Among the techniques that have been successful is cognitive behavior therapy, which helps people get a sense of control over their lives, Ross said.

In addition, relaxation techniques and medications have also been effective. Combination therapy that includes behavior therapy and medications has also been effective. Commonly prescribed medications include various types of antidepressants.

Among other key survey findings were:

* Thirty-four percent reported that their condition caused serious fights with their significant others.
* Seventy-seven percent said the disorder negatively impacted their romantic relationships.
* Thirty-five percent said having social anxiety disorder made them avoid intimacy.
* Twenty-four percent reported that the disorder resulted in their significant other not respecting them.
* Fifty-five percent said they had no close friends.
* Sixty-six percent reported having misunderstandings with friends, and 50 percent said they did not tell their friends about their symptoms.
* More than 60 percent didn’t keep in touch with friends or answer or return their phone calls.

SOURCES: April 9, 2008, teleconference with: Jerilyn Ross, president and CEO, Anxiety Disorders Association of America; Mark H. Pollack, M.D., director, Center for Anxiety and Traumatic Stress Disorders, and professor, psychiatry, Harvard Medical School, Boston

By Steven Reinberg
HealthDay Reporter

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Anxiety disorders are real, serious, and treatable. Experts believe that anxiety disorders are caused by a combination of biological and environmental factors, much like other disorders, such as heart disease and diabetes. The vast majority of people with an anxiety disorder can be helped with professional care. Success of treatment varies among people. Some may respond to treatment after a few months, while others may need more than a year. Treatment is sometimes complicated by the fact that people very often have more than one anxiety disorder or suffer from depression or substance abuse. This is why treatment must be tailored to the individual.Although treatment is individualized, several standard approaches have proved effective. Therapists will use one or a combination of these therapies.

Anxiety treatment options

1. Behavior Therapy

   The goal of behavior therapy is to modify and gain control over unwanted behavior. The individual learns to cope with difficult situations, often through controlled exposure to them. This kind of therapy gives a sense of having control over one’s life.

2. Cognitive Therapy

   The goal of cognitive therapy is to change unproductive or intrusive thought patterns. The individual examines his or her feelings and learns to separate realistic from unrealistic thoughts. As with behavior therapy, the individual is actively involved in his or her own recovery and has a sense of control.

3. Cognitive-Behavioral Therapy (CBT)

   Many therapists use a combination of cognitive and behavior therapies, which is often referred to as CBT. One of the benefits of these types therapies is that the patient learns recovery skills that are useful for a lifetime.

4. Relaxation Techniques

   Relaxation techniques help individuals develop the ability to cope more effectively with the stresses and physical symptoms contributing to anxiety. The techniques include breathing retraining and exercise.

Anxiety treatment medications Medication can be very useful in the treatment of anxiety disorders, and it is often used in conjunction with one or more of the therapies mentioned above. Sometimes antidepressants or anxiolytics (antianxiety medications) are prescribed to alleviate severe symptoms so that other forms of therapy can go forward. Effective for many people, medication can be either a short-term or long-term treatment option, depending on the individual.Most known anxiety treatment medications are

• Valium (generic name: Diazepam)
• Xanax (generic name: Alprazolam)
• Klonopin (generic name: Clonazepam)
• Ativan (generic name: Lorazepam)
• Buspar (generic name: Buspirone)

How to choose a therapist

Anxiety disorders can be treated by a wide range of mental health professionals, including, psychiatrists, psychologists, clinical social workers and psychiatric nurses. Primary care physicians are increasingly aware of the problems of anxiety disorders and depression, making these diagnoses more frequently. A primary care physician may prescribe medication or refer a patient to a mental health provider.Finding the right therapist can be tricky, because satisfactory credentials are not the only factors to take into consideration. It is important to feel comfortable with a therapist. Speak to the therapist, either on the phone or in the office, and do not be embarrassed if you feel uncomfortable and would rather see someone else.

Questions you should ask your therapist:

A therapist should be willing to answer any questions you may have about methods, training, and fees. Here are some questions you may want to ask a therapist during a consultation:

• What training and experience do you have in treating anxiety disorders?
• What is your basic approach to treatment?
• Can you prescribe medication or refer me to someone who can, if that proves necessary?
• How long is the course of treatment?
• How frequent are treatment sessions and how long do they last?
• Do you include family members in therapy?
• Will you or a staff member go to the home of a phobic person, if necessary?
• What is your fee schedule, and do you have a sliding scale for varying financial circumstances?
• What kinds of health insurance do you accept?

If a therapist is reluctant to answer your questions, or if you do not feel comfortable, see someone else.

Find more info about anxiety treatment at Anxiety Disorders Asociasion of America website.

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