Anxiety (ang-ZY-e-tee) is a feeling of fear, worry, or nervousness that a person experiences for no apparent reason. Anxiety disorders are conditions in which the patient's anxiety becomes so intense and long-lasting that it causes serious distress and may lead to problems at home, school, or work.
On the first day of ninth grade, when Michelle started high school, she suddenly felt dizzy, sweaty, and short of breath as she walked down the hall toward her locker. For a few minutes, everything around her seemed strangely unreal. At first, Michelle thought it was just a mild case of nerves. When the scary feelings returned the next day and the next, Michelle began to fear that she was losing control of her mind or that she had some terrible physical illness. In fact, Michelle was suffering from an anxiety disorder, namely panic disorder.
Everybody feels a little nervous now and then. People's palms may get sweaty when they take an important test, their heart may pound as they wait for the opening kickoff of a big game, or they may have butterflies in their stomach as they get ready for a first date. These common feelings are normal. People with anxiety disorders feel afraid, worried, or nervous even when there is no clear reason for concern. The feelings associated with anxiety disorders are intense and long-lasting, and they may get worse over time. These emotions are very distressing to a person experiencing them, and they can be so overwhelming that they can cause serious problems at home, school, or work.
Anxiety disorders are the most common of all mental health disorders. In fact, some type of anxiety disorder affects more than 40 million people in the United States 18 years of age and over, or 18 percent of the adult population. There are several different types of anxiety disorders, and some individuals suffer from more than one at the same time.
Generalized anxiety disorder (GAD) is the term for constant, intense worry and stress over a variety of everyday events and situations. People who experience generalized anxiety typically expect something bad to happen, even when there is no real reason for thinking this way. For example, they may worry all the time about their grades or sports performance, even when they are successful students or athletes. They may worry about the well-being of loved ones, about school, their own health and safety, or upsetting experiences they imagine could happen in the future. These feelings may be accompanied by such physical symptoms as tiredness, chest pain, trembling, tense muscles, headache, or upset stomach. When individuals have experienced these symptoms for six months or longer, a mental health professional may diagnose them as having generalized anxiety disorder (GAD). GAD affects about 7 million Americans, with women twice as likely to have it as men. Some people with GAD or other anxiety disorders have test anxiety (a type of performance anxiety). This anxiety is strong and can persist from the time before a test, during the test, and until after the student has taken the test.
Separation anxiety is the normal fear that babies and young children feel when they are separated from their parents or approached by strangers. It is not unusual for children to have mild separation anxiety on the first day of school in kindergarten or first grade, or the first day of overnight camp. In most cases, this anxious feeling goes away after a few days as a child gets used to a new situation, new friends, and new adults in charge. For most children, separation anxiety lessens with age and experience.
Separation anxiety can carry over into the teenage years. Teenagers with separation anxiety may be uneasy about leaving home, and they sometimes start refusing to go to school. Separation anxiety may be triggered by a change in schools or by a stressful event at home, such as a divorce, illness, or death in the family.
Panic disorder involves repeated attacks of intense fear that strike often and without warning. People having a panic attack may feel as if their surroundings are unreal, or they may fear that they are going to die. In addition to the fear, they may have such physical symptoms as chest pain, a pounding heart, shortness of breath, dizziness, or an upset stomach. Panic disorder affects about 6 million adults in the United States, two-thirds of whom are women.
A panic disorder may be caused by genetics, a flaw in the nervous system cell structures, or psychological factors. Panic disorder tends to get worse over time if it is not properly treated with either medication or cognitive-behavioral (COG-ni-tiv-bee-HAY-vyor-al) therapy.
The first signs of OCD typically appear between the ages of 10 and 24. An obsession, or intrusive thought, creates constant worry and fear that the person tries to hold in check with a repeated behavior or compulsion. OCD is treated with medication and behavioral (be-HAY-vyor-al) therapy.
Phobias (FO-bee-uhz) are unrealistic long-lasting fears of some object or situation. The fear can be so intense that people go to great lengths to avoid the object of their dread. There are three types of phobia problems that mental health professionals may diagnose: specific phobias; social phobia (also called social anxiety disorder); and agoraphobia (AG-or-uh-FO-bee-uh).
People with specific phobias have an intense fear of specific objects or situations that pose little real threat, such as dogs, spiders, storms, water, heights, and flying in planes. Specific phobias are common in the U.S. population, affecting about 19 million adults.
People with social phobia have an extreme fear of being judged harshly, embarrassed, or criticized by others, which leads them to avoid social situations. Test anxiety can also be a form of social phobia, especially if the person fears how others might react to test results. Social phobia is diagnosed in 7 percent of the adult U.S. population, or about 15 million persons. It is equally common in men and women.
People with agoraphobia are terrified of having a panic attack in a public situation from which it would be hard to escape, such as being in a crowded store or stadium or in a form of public transportation such as a bus or train. If left untreated, the anxiety can become so severe that the affected person may refuse to leave the house.
Post-traumatic stress disorder (PTSD) is marked by long-lasting symptoms that occur after someone has been through an extremely stressful, life-threatening event, such as a rape or mugging, tornado, aviation disaster, or car crash, or after engaging in combat during military service. People with the disorder may relive the traumatic event repeatedly in painful memories or nightmares. They may have such other symptoms as depression * , anger, crankiness, and a lack of normal emotions, and they may be easily startled, unusually fearful, and have trouble paying attention. A person with PTSD may also have such symptoms as depersonalization * and derealization * . About 7.7 million Americans have PTSD.
Research has focused on pinpointing the exact brain areas and circuits involved in the emotions of anxiety and fear, which lie at the root of anxiety disorders. Scientists have shown that when faced with danger, the body sends two sets of signals to different parts of the brain. One group of signals goes straight to the amygdala (uh-MIG-duhluh), a small almond-shaped structure deep inside the brain that sets the body's automatic fear response in motion. This response readies the body to react to the threat. The heart starts to pound and send more blood to the muscles for quick action, while stress hormones and extra blood sugar are released into the bloodstream to provide extra energy. The other set of signals takes a roundabout route to the cerebral cortex (suh-REEbrul KOR-teks), the thinking part of the brain. The physical response to danger or stress is set in motion before the brain understands just what is wrong. As a built-in safety measure, this learned response is stored in the amygdala so the response will be quickly available for the next dangerous situation.
In people with anxiety disorders, an experience that feels scary, even one involving a normally safe object or situation, can create a deeply etched memory of fear. This memory can lead to the automatic physical symptoms of anxiety when the object or situation is experienced again. These symptoms in turn can make it hard for the individual to focus on anything else. Over time, people may start to feel anxiety in many situations that do not resemble the original fear-producing event. Studies have shown that memories stored in the amygdala may be hard to erase. This condition can change because people can gain control over their responses with experience and sometimes with psychotherapy * .
Another factor to take into account is a personality quality called temperament. Temperament refers to a person's inborn nature that includes certain behavioral traits. To some extent, people's tendency to be shy or nervous may be inborn or simply part of their nature. Some research suggests that babies who are easily upset never fully learn early in life how to soothe themselves the way other children with calmer temperaments do. Those with a high-strung temperament may react more strongly to stressful or anxiety-provoking situations than people whose temperament makes them more adaptable. Experts believe that people with an inhibited or cautious temperament may be more likely to have problems with anxiety.
The fear response associated with all of the anxiety disorders can involve a number of physical symptoms, including the following:
Anxiety disorders can also lead to changes in the way a person feels, thinks, or behaves. People with anxiety disorders might experience the following:
Anxiety disorders often occur along with other mental health disorders, such as depression, eating disorders * , or substance abuse * . Anxiety disorders may accompany physical illnesses. In such cases, these other problems must also be treated. People with the symptoms of an anxiety disorder need a complete medical checkup to rule out other illnesses. They will need a thorough psychological evaluation by a mental health professional who will ask about symptoms and the problems that they cause. With children and teenagers, the professional generally talks to parents and involved teachers.
Medications cannot cure anxiety disorders, but they can help to relieve symptoms. Several kinds of medications are used to treat anxiety. Although these medications work well, they can be dangerous if mixed with alcohol, and some can be habit-forming. Antidepressant medications * , originally developed to treat depression, have increasingly been prescribed to treat anxiety. Finding the right medication and dose for a given person can take some time. Fortunately, if one medication does not work well for a given patient, several other medications can be tried.
Medications often are combined with psychotherapy, a treatment in which people talk about their feelings, experiences, and beliefs with a mental health professional. In therapy, a person can learn how to change the thoughts, actions, or relationships that play a part in their problems. There are many kinds of psychotherapy; however, two kinds have been shown to work particularly well in treating anxiety disorders: cognitive (COG-nih-tiv) therapy and behavioral (be-HAY-vyor-ul) therapy. Often techniques from these two types of therapy are combined.
Cognitive-behavioral therapy helps people understand and change their thinking patterns so they can learn to react differently to situations that cause anxiety. This awareness of thinking patterns is combined with behavioral techniques. For example, someone who becomes dizzy during panic attacks and fears he is going to die may be asked to spin in a circle until he gets dizzy. When he becomes alarmed and starts thinking, “I'm going to die,” he learns to replace that thought with another one, such as “It's just dizziness. I can handle it.” Although anxiety disorders can be extremely distressing to those experiencing them, the good news is that these disorders respond well to treatment.
See also Cutting and Self-Harm • Fears and Phobias • Obsessive-Compulsive Disorder • Panic Disorder • Post-Traumatic Stress Disorder (PTSD) • School Avoidance • Stress and Stress-Related Illness
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* depression (de-PRESH-un) is a mental health state characterized by feelings of sadness, despair, and discouragement.
* depersonalization (de-per-sonal-i-ZAY-shun) is a mental condition in which people feel that they are living in a dream or are removed from their body and are watching themselves from the outside.
* derealization (de-reel-i-ZAY-shun) is a mental condition in which people feel that the external world is strange or unreal.
* genes (JEENS) are chemical structures composed of deoxyribonucleic acid (DNA) that help determine a person's body structure and physical characteristics. Inherited from a person's parents, genes are contained in the chromosomes found in the body's cells.
* psychotherapy (sy-ko-THER-apea) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.
* self-esteem is the value that people put on the mental image that they have of themselves.
* eating disorders are conditions in which a person's eating behaviors and food habits are so unbalanced that they cause physical and emotional problems.
* substance abuse is the misuse of alcohol, tobacco, illegal drugs, prescription drugs, and other substances such as paint thinners or aerosol gases that change how the mind and body work.
* antidepressant medications are used for the treatment and prevention of depression.