Anxiety disorders, like depressive disorders, are medical conditions that affect about 20 million American adults. These conditions disrupt people's lives by causing ongoing and often overwhelming fear and anxiety. Such continuous anxiety differs markedly from the manageable mild stress caused by an upcoming job interview, exam, or first date. Anxiety disorders are persistent, ongoing, distracting — and they can get worse if they are not treated. With proper professional attention, anxiety disorders can be effectively treated, for the long term.
There are several types of anxiety disorders. Each has particular symptoms and features, but they all share the common element of persistent and irrational fear. The paragraphs below describe these disorders and recommend courses of treatment.
Panic Disorder
Panic disorder is a condition in which a person experiences a sudden episode of acute anxiety, including feelings of terror, with frequent alarming physiologic sensations such as heart palpitations, shortness of breath, chest pains, and dizziness. People experiencing panic attacks also complain of feeling nauseous, weak, or faint. Panic attacks strike swiftly and hit hard without warning and often repeatedly. Due to their unpredictability, many people develop intense anxiety between attacks, worrying about when the next one will strike. It is not unusual for a person experiencing an anxiety attack to actually believe that he or she is having a heart attack or is on the verge of death. About 2.5 million adult Americans suffer from panic disorder; and the condition is twice as common in women as in men. Panic disorder, as may be expected, is often accompanied by serious conditions such as depression and substance abuse, and often leads to a pattern of avoidance of places and situations. Panic disorder is one of the most treatable of all the anxiety disorders, responding in most cases to medications and carefully focused psychotherapy. Research in the field suggests that panic disorder is a hereditary condition.
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder, or OCD afflicts about 3.5 million American adults. People suffering from OCD engage in ritual behaviors that they feel helpless to control, behaviors accompanied by persistent anxious thoughts. They become obsessed with any number of things: germs, dirt, fear of violence. Some sufferers feel the need to check and re-check things repeatedly (Did I lock the door? Is the oven off?). The troubling thoughts are referred to as the obsessions and the behavioral rituals that accompany them are the compulsions. Most people who have OCD recognize that what they are doing is irrational, but they are unable to stop the behavior. Men and women are just as likely to experience the condition, and about a third of people suffering from OCD report experiencing their first symptoms of the condition as children or adolescents.
The course of the condition is variable — symptoms can come and go or may disappear entirely for awhile — or they can become progressively worse, and typically do without treatment. Research suggests that symptoms of OCD run in families. Like sufferers from panic disorders, many people who have OCD also experience depression, and may also avoid situations that may stimulate symptoms. The abuse of substances to “self medicate” for this condition is common, and chemical abuse, therefore, should be included in an assessment of condition. Like panic disorder, OCD responds best to treatment that combines medications with targeted and task-oriented psychotherapy.
Generalized Anxiety Disorder
Generalized Anxiety Disorder, or GAD affects about 4 million American adults. Its symptoms include excessive anxiety experienced on a day to day basis. It is persistent and chronic and causes people to feel stress, fear and worry even though there are no clear events to stimulate these feelings. Sufferers always anticipate disaster, worrying about health, money, job, family, relationships. Some people report that they feel as though they are “walking on eggshells” all the time. People who experience GAD cannot seem to get over their concerns without some kind of structured assistance —notwithstanding their intellectual awareness that the anxiety is more severe than the situation warrants. Such perpetual anxiety is physically and emotionally draining, and is often accompanied by physical symptoms such as fatigue, headaches, muscle tension, difficulty swallowing or involuntary gagging, sweating and hot flashes.
GAD affects about twice as many women as men. The disorder tends to come on gradually in the individual, and can begin anytime during life, often during childhood. There is evidence that GAD may be hereditary. GAD rarely occurs by itself, and is usually accompanied by another anxiety disorder, although not always. As with other anxiety disorders, substance abuse as a method of self medication is common. Similarly, medications and focused psychotherapy have proven quite helpful.
Effective Treatment for Anxiety Disorders
Research has demonstrated that a combination of medications and cognitive-based, short-term, or intermittent psychotherapy is quite effective in containing symptoms of the anxiety disorders. However, given the physiologic symptoms that often accompany these conditions, it is particularly important for the individual to have a thorough medical workup as he or she initiates psychological care. For this reason, in the treatment of anxiety disorders, I often work very closely with the primary care physician in order to rule out various conditions and develop the most practical and constructive treatment plan. If there is a pattern of substance abuse as a method of containing the symptoms, I find it essential to address this issue first and foremost before implementing specific behavioral interventions or recommending psychiatric medicines. As the symptoms associated with the anxiety disorders tend to have an effect upon the sufferer’s family members and significant others, I believe it is important to involve these people in treatment, at least to educate them about the condition, and to evaluate whether their responses to the sufferer may inadvertently reinforce or exacerbate the situation. Treatment usually begins with weekly sessions and the assignment of tasks designed to “desensitize” the person from the symptoms, as well as reading books and articles on cognitive interventions, such as addressing “automatic thoughts.” In the initial evaluation session(s), I will outline the most effective and efficient course of treatment, so that the individual is aware of their responsibilities in their recovery, and there are no “surprises.”
