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Anxiety Disorders
There are many different types of anxiety disorder, such as generalized anxiety disorder, panic disorder, agoraphobia, social phobia, specific phobia, obsession-compulsion disorder and posttraumatic stress disorder. All of these show different symptoms and require different types of treatments to manage.
Generalized Anxiety Disorder (GAD) is characterized by extensive worry or anxiety about different events. These feelings are hard to control, often causing distress and may even impair normal activity. Affected people are overcome by these intense emotions for more than six months. Many times, GAD starts during puberty and occurs equally in boys and girls, affecting about 2.4% of adolescents. Symptoms: In order to be diagnosed with GAD, three of the following symptoms must be present: restlessness or feeling on edge, tiredness, difficulty concentrating, irritability, feeling of weakness and difficulty sleeping. Treatment: There are many different ways to treat GAD. These include both psychiatric therapy and drug therapy or a combination of both. Cognitive behavior therapy is a type of counseling where the patient focuses on trying to change their misinterpretations that cause the anxiety. Psychotherapy may also help these people cope with stressors that may cause the disorder. There are also drugs that may help the symptoms of GAD such as benzodiazepines and antidepressants.
Panic Disorder and panic attacks usually appear as separate events of intense fear that begin without warning and can last up to an hour. These episodes are recurrent. Panic disorder usually begins during adolescence at the ages of 15 and 19 years. About 2 to 4% of the population has been diagnosed with panic disorder, but it is probably more common than this because it often goes undiagnosed. In many cases, panic disorder can lead to agoraphobia. In agoraphobia the fear of having a panic attack in public or in a situation where there is no escape causes severe anxiety. Because of this fear, people with agoraphobia avoid situations like these and it can interrupt normal activities. Symptoms: Panic attacks are the sudden feelings of intense worry or fear and some other physical symptoms. Some of these are chest pain, increased heart rate, headaches, dizziness, feeling lightheaded, and shortness of breath. Although everyone is different, panic attacks often occur during times of stress or after illnesses, accidents, rape or assault. Treatment: Treatment of panic disorder, depending on how bad it is, may use psychiatric counseling, drug therapy or both. Cognitive behavior therapy is a type of counseling where the patient focuses on trying to change their misinterpretations that may trigger the attacks. Counseling may also help people deal with the stresses that cause panic disorder. Drugs have also been shown to try to prevent panic attacks.
Phobias are irrational, constant fears of a specific situation, activity or object that are avoided and cause intense anxiety. There are many common phobias that are specific to things such as snakes or closed spaces. This is probably the most common anxiety disorder. Social anxiety disorder (SAD) is a phobia to certain social situations, such as eating or speaking in public, and a fear of embarrassment or failure in front of other people. Usually, these situations are avoided. SAD usually begins between ages 11 and 19, and girls are two times as likely as boys to have it. Many people without SAD may be nervous before entering a new situation, but people with SAD have a much more intense reaction that does not go away. Symptoms: SAD is a more intense than normal fear of embarrassment and judgment by other people in social situations such as speaking in public or eating in public. Specific phobias are intense fear of something specific. Treatment: Treatment of SAD, depending on how bad it is, may use psychiatric counseling, drug therapy or both. Specific phobias can be treated with psychiatric counseling where the affected person is put in the situation that they fear. For example, someone with a snake phobia may first be shown a picture of a snake. Once the pictures stop causing anxiety, a real snake may be brought into the room. After that, the patient may be asked to hold the snake. After showing that the snake does not cause him or her harm, the phobia may be cured.
Posttraumatic stress disorder (PTSD) often happens after a traumatic event where the person experiences or sees a serious injury. It causes extreme fear, horror or helplessness. Afterwards, they may have nightmares or flashbacks, where the affected person feels like they are experiencing the event again. They also usually avoid certain things that remind them of the event. Symptoms: PTSD is a result of re-experience (flashbacks, nightmares, or reenactment), avoidance of reminders of the incident and hyperarousal, such as difficulty concentrating or problems sleeping. Treatment: Treatment for PTSD is usually counseling.
Symptoms: Obsessions and compulsions to the point where they occupy increasing amounts of time and thought. Treatment: There are two medications that have been approved to treat OCD. Also, cognitive-behavioral therapy can be used to help change the thoughts that may lead someone to obsess.
Sources Bruce, Timothy J et al. “Social anxiety disorder”, UpToDate, 2005. www.uptodate.com. Ciechanowski, Paul and Wayne Katon. “Overview of generalized anxiety disorder”. UpToDate, 2005. www.uptodate.com. Ciechanowski, Paul and Wayne Katon. “Overview of panic disorder”. UpToDate, 2005. www.uptodate.com. Feldman, Mitchel, John Christensen. Behavioral Medicine in Primary Care: A Practical Guide. Stamford, CT: Appleton and Lange, 1997. Moore and Jefferson, Handbook of Medical Psychiatry, 2nd Ed. Mosby, 2004. (Accessed through MD Consult). Noble, Textbook of Primary Care Medicine, 3rd Ed. Mosby, Inc. 2001. (Accessed through MD Consult). Stafford, Brian, et al. Behrman: Nelsons Textbook of Pediatrics, 17thed. Elsevier, 2004.
Information Provided By Women in Medicine at the UConn Health Center, a group of first, second and third year female medical students at the University of Connecticut School of Medicine. |
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Featured Question of the Month © University of Connecticut Health Center. All rights reserved. |
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Anxiety is a necessary, normal emotion that many people experience throughout their lifetimes. They may feel fear or nervousness in all different types of situations. In fact, without this
emotion, our ancestors probably would not have survived. However, for some people, these feelings of fear and impending doom or even panic can get so bad that they impact all other aspects of
their lives. Relationships may suffer and certain situations may begin to be avoided. When anxiety reaches this level of intensity, it is called anxiety disorder. This is one of the most common
disorders in the United States, affecting 20% of women and 8% of men sometime in their lives.
Obsessions are thoughts, feelings or ideas that occur over and over again to the point where they interfere with someone’s normal activities. Compulsions are repetitive rituals such as hand
washing, checking and counting. When these start to cause distress and take up a large amount of time and thought, it is called obsessive-compulsive disorder (OCD). In OCD, these obsessions cause
feelings of anxiety and compulsions are attempts to decreased these feelings. One common example is that of cleanliness. Some patients with OCD are constantly thinking about germs and they think
about it so much that it causes them to wash their hands over and over again. About 1 to 3% of the population develops OCD during their life.