Anxiety

Read more about anxiety disorders and how to navigate anxiety on mental-md website

Anxiety, what is it? Is it not part of normal life to be anxious?

Many people experience anxiety in the context of daily stressors of life, however, if anxiety continues to worsen and starts to affect job performance, schoolwork, and relationships then it is considered an anxiety disorder. Many people are suffering from anxiety disorders but they have no insight into their mental illness and they are either too embarrassed to seek treatment or they are not aware of their options for treatment.

Here are some examples of how anxiety, especially if left untreated, can affect your life:
– anxiety takes a physical toll on our bodies. It can cause a higher blood pressure, headaches, and stomach problems. Chronic Anxiety could even change the structure of the brain!
– Children also suffer when their parents are suffering from anxiety. It is partly due to genetics, but it is also that children learn what they observe. Anxiety could cause children to be shy and not be able to focus in school.
– Anxiety can affect your fitness as well. Some people binge eat or stop eating when anxious. Stress also increases the hormone known as cortisol which causes fat storage in the abdomen. This can also increase the risk of heart disease and stroke.
– Anxiety can manifest in different ways and cause different kinds of physical symptoms, which overall causes a person to be constantly worried about their health.
– Anxiety can cause relationship problems. People suffering from anxiety are usually irritable and they sometimes withdraw emotionally or excessively cling to their partners.
– Anxiety can interfere with daily activities such as going to work, exercising, or simply leaving the house.

Generalized anxiety disorder is the most common type of anxiety disorder. The symptoms include being worried about everything such as finances, health, relationships, job, school, and so on. Anxiety can affect sleep as well. Patients with generalized anxiety disorder will experience insomnia, which is defined as the persistent problem of falling and staying asleep. Here are some examples of the different types of anxiety disorders: panic disorder, social anxiety disorder, performance anxiety, separation anxiety, agoraphobia and selective mutism.

What is panic disorder?

Panic disorders are defined by panic attacks which are sudden periods of intense anxiety that can last from minutes to Hours. Patient can feel extreme fear and a sense of impending death which can be accompanied with physical symptoms such as heart palpitations and sweating. These attacks could happen due to a trigger or without a trigger. Triggers can be things such as alcohol, caffeine, nicotine, emotional stressors, sexual activity, or even physical exertion.

Treatments of panic attacks:

non-pharmacological treatments of panic attacks include breathing exercises and cognitive behavior therapy. One simple technique is square breathing in which you inhale for 4 seconds, then hold your breath for 4 seconds, and then exhale for 4 seconds. This technique will help you reach a calm moment and could help during a panic attack as well.
Patients who are experiencing a panic attack can misinterpret minor bodily sensations as doom or death. Cognitive behavior therapy will focus on these false beliefs about panic attacks and these misinterpretation of bodily sensations so that the patient can distinguish the difference.
It is important for you to be informed that panic attacks are time limited and they are not life threatening.
Pharmacological treatments of panic attacks include several medications that are used as treatment.
Selective serotonin reuptake inhibitors are effective for panic attacks, however, it takes several weeks for it to build up in the system and show its effect.
Rescue agents or other as needed medications are also available which can be taken when you are experiencing symptoms of a panic attack.

What is Social anxiety disorder?

Social anxiety or social phobia involves the fear of social situations. People who suffer from social anxiety are fearful of embarrassing themselves in social gatherings, presentations, or while meeting new people. This fear/phobia could be specific to a certain act or it could be a non-specific and vague fear of some sort of embarrassment.
Social anxiety disorder tends to have an onset in late childhood or early adolescence. This disorder can severely disrupt a person’s daily life such as disruption in school, job performance, and social development.
The symptoms in adults are demonstrated as persistent fear,anxiety, or avoidance of social situations. In children, such fears are expressed by crying, tantrums, shrinking, clinging, or failing to speak in social situations.
Psychotherapy and pharmacotherapy are both used as treatment options for social anxiety disorder. Psychotherapy usually involves a combination of behavioral and cognitive therapy methods such as cognitive retraining, desensitization, rehearsals, and homework assignments. Some effective drugs used as treatment for social anxiety disorder include SSRIs, benzodiazepines, venlafaxine, and buspirone.
Performance anxiety fits into the category of social anxiety, but it is specific to experiencing severe anxiety related to performing in public or being in front of a crowd. The symptoms are the same as experiencing social anxiety, and can be so severe that an individual feels like their heart is beating out of their chest, they cannot speak or gather their thoughts, excessive sweating, and feeling hot. People experiencing this type of anxiety tend to avoid such situations all together, but there are treatment options available for this specific condition as well.
Separation anxiety is also in the same category, and the trigger is the feeling of abandonment, being left alone by someone, or generally being alone. Symptoms can be very similar to other forms of anxiety disorders but with the excessive fear towards loneliness and abandonment. People experiencing separation anxiety can feel anxious constantly, and assume that they are going to be left alone so causing the trigger for themselves even if not true. Such anxiety disorders can start interfering with a person’s life, daily tasks, and relationships which is when seeking treatment becomes very vital.

What are phobias?

Phobias are defined as an irrational fear of something. That something might even be very typical to others but people who experience phobia, cannot explain or control their fear of it. There are many different kinds of phobias, and new ones are being discovered everyday. Agoraphobia is an extreme representation of social anxiety. Agoraphobia is referred to a fear or anxiety regarding places which escape might be difficult or help might not be available. This condition can significantly interfere with a person’s ability to function in any social situation outside of the home. There are 5 different diagnostic criteria for agoraphobia, and if two or more of the following criteria cause persistent fear or anxiety then there could be a diagnosis of agoraphobia. The five situations are 1) using public transportation, 2) being in an open space, 3) being in an enclosed space, 4) being in a crowd or in a line, or 5) being alone outside of the home.
Most cases of agoraphobia are thought to be developed as a complication of panic disorders. If the panic disorder is treated, the agoraphobia often improves as time goes by.
Pharmacotherapy for agoraphobia include benzodiazepines, SSRIs, Tricyclic and Tetracyclic drugs. The most rapid effects come from benzodiazepines which are sometimes used right when a phobic stimulus is presented. SSRIs have shown to help reduce or prevent relapse from different forms of anxiety, including agoraphobia. These two drugs are considered first-line agents for treatment of panic disorders but tricyclic and tetracyclic drugs are the most effective for such disorders. Tricyclic and tetracyclic drug dosages much be titrated up slowly to avoid overstimulation.
There are also multiple methods of psychotherapy available as treatment. Supportive psychotherapy uses psychodynamic concepts and therapies to promote adaptive coping. In such therapy, reality testing is done and behavioral changes are encouraged.
Insight-oriented psychotherapy is focused on increasing the patient’s development of insight into psychological conflicts. If such conflicts are left untreated, they can show up as symptomatic behavior.
Behavioral therapy is based on change in behavior without the need to determine underlying causes. Techniques include hypnosis, positive and negative reinforcement, graded exposure, response prevention, and many more.
Cognitive therapy is a short term and interactive treatment, which focuses on correcting distorted assumptions and cognitions. It emphasizes on confronting and examining situation that manifest anxiety.
Lastly, virtual therapy is the use of computer programs that allow patients to see themselves as avatars who can be placed in crowded/open spaces. This method helps the patient identify with the avatar and get repeated exposure through the sessions, which helps them overcome their anxiety through de-conditioning.

There are also certain stress disorders which is caused by exceeding our coping mechanism after an event or series of events cause trauma. The two main types of stress disorders include Post-traumatic stress disorder (PTSD) and Obsessive compulsive disorder (OCD).
Post-traumatic stress disorder (PTSD) is a result of experiencing life traumas. Some people recover from such traumas, while others might suffer after their tragedy. Such life traumas that could cause PTSD include war, crashes, sexual assault, torture, and natural disasters. Emotional and/or physical reactions to trauma are normal, and they might show up right after a tragedy or emerge years later. Some signs and symptoms of PTSD include:
-reliving the event
-avoiding anything that is a reminder of the trauma
– feeling on edge and on guard
Diagnosing PTSD is complex and requires professional help such as a psychiatrist.
Experiencing some of these symptoms but not fully meeting the diagnosis is possible as well. Mild symptoms that do not interfere with your daily life could be a normal reaction to trauma and working through it could also be helpful.

Obsessive-compulsive disorder (OCD) may present itself as behaviors that include an obsession, a compulsion, or both. People who suffer from OCD usually experience havoc in their lives and if left untreated, it could last for a lifetime.
What are obsessions? They are impulses, images, or thoughts that are unwelcome, disturbing, and repetitive. Most people who suffer from OCD are aware that these obsessions are not always realistic but they can’t seem to rid of them.
What are compulsions? These are repetitive actions or thoughts that are carried out to reduce anxiety or distress for a short amount of time. Certain events or situations might cause anxiety which could trigger such compulsions.
If OCD symptoms are taking too much time, interfere with life, relationships, and work, then that is a serious problem which requires the help of a professional.

Anxiety and stress disorders sometimes come with other company. It is important to be able to differentiate between anxiety disorder and other emotional disorders. When anxiety disorder is left untreated, 50% of people develop depression as well. Since the treatment for these disorders may differ, it is important to know the differences.

– Depression can cause the loss of interest in activities to used to bring pleasure and slow life down. Symptoms of depression include feeling sad, tired, bad sleeping, change in appetite, and decrease or loss of sex drive. Anxiety and depression both cause a loss of focus, but depression also takes away your drive and motivation.
– Bipolar disorder causes a seesaw between up and down mood. At times you feel on top of the world, more special than others, reckless, impulsive, extra energetic, barely sleep, and lose good judgment. Then you suddenly crash and depression sets in causing a complete change in mood.
– Psychosis mixes hallucinations into everyday life. Psychosis might cause anxiety while the symptoms extremely interfere with life. Delusions are a symptom of psychosis which distorts reality. Examples of such delusion and symptoms include exaggerated beliefs, grandiose, paranoia, hearing voices or seeing shadows