The Nightingale Center

What are Anxiety Disorders?

By Dr. Lois Nightingale

Anxiety disorders are the most common class of psychiatric illness in America. More than 23 million are affected by these debilitating illnesses each year. Left untreated, these disorders can dramatically reduce productivity and significantly diminish a person's quality of life. If you or someone you know is suffering from an anxiety disorder you may have first hand experience at seeing how relationships, work, school, hobbies and home life can be negatively affected by this emotionally painful illness.

As National Anxiety Screening Day approaches (May 6), I am asked more often about the different types of anxiety disorders that may disrupt a person's life. The following is a brief description of the most common types of anxiety disorders.

Generalized Anxiety Disorder:

People with generalized anxiety disorder worry excessively about money, health, family, work or other routine life events and activities, even when there are no real signs of trouble. They expect the worst and constantly think about how things could take a negative turn. They are unable to relax and often suffer from insomnia. These people may also experience some physical symptoms, such as fatigue, trembling, muscle tension, headaches, nausea, irritability, or hot flashes.

Many modes of psychotherapy have been effective in treating Generalized Anxiety Disorders. Some of these include visualization and guided imagery, assertion training, self-talk techniques, progressive muscle relaxation, cognitive-behavioral therapy and breathing techniques. No matter how long someone has suffered from Generalized Anxiety Disorder there is treatment available and it can be conquered.

Panic Disorder:

Panic Disorder is characterized by panic attacks, sudden feelings of terror or impending doom that strike repeatedly and without warning. A panic attack reaches its peak in about 10 minutes, but leaves the person emotionally drained and frightened. The physical symptoms that accompany panic attacks include; chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, choking sensations, feelings of unreality, and fears of dying or "going crazy". After someone has experienced a panic attack they usually have concern and apprehension over the possibility of having a panic attack in the future. Because there is no way to predict when another panic attack may occur a person may start avoiding the place or situation where the first one occurred, or become afraid to go out in public at all. Many of these people also suffer from depression.

Panic disorders are often very treatable with psychotherapy. Breathing and relaxation techniques, self-talk exercises, nutritional information and bio-feedback can give a person tools that allow them to feel safe and stop worrying about future panic attacks.

Agoraphobia:

People with this disorder suffer from anxiety about being in places or situations from which it might be difficult or embarrassing to escape, such as being in a room full of people or in an elevator. It is common for people with a panic disorder to develop agoraphobia because they fear help might not be available if an attack occurs. In extreme cases people with agoraphobia may even be afraid to leave their homes.

Agoraphobia is also a very treatable anxiety disorder. Progressive Systematic Desensitization techniques to help a person feel progressively more comfortable in previously frightening situations can be very helpful. Learning relaxation techniques and breathing methods that help stop the anxiety are also very useful. Cognitive restructuring and Rational Emotive Therapy can address the thoughts that may be facilitating the fears.

Obsessive-Compulsive Disorder:

People with OCD suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. They may repeatedly do rituals such as hand washing, counting, constantly requesting or demanding assurances, checking door locks, light switches paperwork etc., precisely arranging items in a particular order for no useful reason, or cleaning. People with OCD repeat these rituals in order to reduce their fear and in hopes of making the obsessive thoughts go away. But performing these repeated behaviors provides only temporary relief, and not performing them makes the anxiety increase. Left untreated, obsessive thoughts and the need to perform the accompanying rituals can take over a person's life. OCD is often a chronic and relapsing illness.

There is growing evidence that OCD has a neurobiological basis. Research is providing evidence that an interaction of neurobiological factors and early environmental influences (family problems or attitudes learned in childhood) play a significant roll in the development of OCD. Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medication produce changes in the caudate nucleus, a part of the brain. This is graphic evidence that both psychotherapy and medication affect the brain and can help alleviate symptoms of OCD. Behavioral therapy focuses on interrupting the rituals and finding techniques to help a person feel increasingly safe in the absence of participation in their rituals. Many sufferers of OCD have found complete release from their symptoms.

Post-Traumatic Stress Disorder:

People with PTSD develop symptoms after experiencing an extremely traumatic event that involved actual or threatened death or serious injury to themselves or another person. These may include; war, rape, child abuse, natural disasters, severe car accidents, having life threatened or being taken hostage. These symptoms persist and include nightmares, flashbacks, reliving the event, numbing of emotions, depression, feeling angry, irritable, distracted, being easily startled and intense distress when exposed to an object or situation that was related to the event. This leads PTSD sufferers to avoid thoughts, conversations or activities that may remind them of the trauma.

A new treatment called EMDR (Eye Movement Desensitization Reprogramming) has proven to be very helpful in the treatment of PTSD. It is a very simple procedure administered by a trained therapist and usually consists of one to four sessions with the patient. The treatment involves repeated eye-movement by the patient directed by a focus point moved by the therapist. The repeated eye movement appears to create neurological changes in stored memories and is often very effective at reducing or alleviating symptoms of PTSD. Even though the administration of this treatment is very simple substantial research verifies remarkable results in numerous clinical settings.

Phobias:

Phobias are persistent, irrational fears about certain objects or situations. Phobias can occur in several forms; fear about a particular object (specific phobia) or a fear of embarrassment in a public setting (social phobia). People who have phobias are often so overwhelmed by their anxiety that they avoid the feared objects or situations. Specific phobias involve a fear of an object or situation, such as small animals, snakes, closed-in spaces, or flying in an airplane. Social phobia is the fear of being humiliated in a social setting, such as meeting new people, giving a speech, or talking to the boss. Most people experience these fears with mild to moderate intensity, and the fear passes. But for people with social phobia the fear is extremely intrusive and can disrupt normal life, interfering with work or social relationships in varying degrees of severity.

A type of cognitive-behavioral therapy called "exposure therapy" is very useful in the treatment for phobias. It involves helping the patient become gradually more comfortable with situations that frighten them. Relaxation and breathing techniques are also helpful.

The Nightingale Center would like to help. We are providing free anxiety screenings at our center beginning on May 6, National Anxiety Screening Day. We will be providing a free program with written screening test, lecture with video and slides and a confidential meeting with a mental health professional. We are giving away free relaxation tapes that teach you how to relax and learn to quiet anxiety on your own. We are also available to answer any questions you may have for yourself or someone you care about. Thank you for taking the time to educate yourself about this very real and important subject.

For further information on this topic you can read:

The Anxiety & Phobia Workbook
By Ph.D. Edmund J. Bourne, K Edmund J. Bourne

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