By Alan Koenigsberg, M.D.
Last week I gave a high level overview of the difference between everyday experiences of anxiety as distinguished from having an anxiety disorder and listed the common anxiety disorders.
In this and subsequent articles, I’ll discuss each anxiety disorder in more detail, their natural courses and treatments. As I have mentioned before, it’s fairly common for people to ask about what is the best kind of treatment for these conditions, before getting a thorough evaluation to determine a specific diagnosis, as well as to check for other general medical conditions. I want to stress a thorough evaluation is essential.
It is important to also understand that many people experience anxiety due to medications they are taking, such as some asthma medicines; some general medical conditions may cause anxiety symptoms, such as high thyroid; withdrawal from some medications or drugs can mimic anxiety disorders; other psychiatric conditions may exhibit anxiety, such as bipolar disorder and ADHD. While these conditions are usually known, sometimes they are not recognized or considered as the cause of anxiety, or perhaps a part of the cause.
Generalized anxiety disorder (GAD) may affect around 3% of the population in any given year. Women are affected a bit more than men. The common symptoms are a high baseline level of anxiety and worry. Some people feel anxious all or most of the time, even when they acknowledge there doesn’t seem to be anything external to cause the level of worry they are experiencing. It also doesn’t abate, but rather exists constantly.
They may experience a constant feeling of dread; catastrophize that something terrible is imminent; and/or have excessive worry about work, school, finances, relationships or their health. They can feel restless and not be able to relax. They may have difficulty concentrating and startle easily. They can have headaches, stomach aches, neck pains, feel tired all the time, feel irritable and have digestive problems.
There are no laboratory tests, no scans, no biopsies or other external objective tests to diagnose these conditions. A thorough clinical exam is required, which takes an experienced clinician’s time and expertise to be able to accurately diagnose a specific condition, as well as rule out what other conditions it isn’t. There are many paper and pencil screening tests that are available that tend to be used by primary care physicians to screen for these situations. The actual diagnosis, however, is done face to face in a private, safe environment.
Left untreated, life can be miserable for someone who is constantly on edge, nervous, worried, irritable, has trouble sleeping and fears the worst.
Panic Disorder is another common anxiety condition which affects about another 3% of the adult population. Unlike GAD, Panic Disorder is not a constant anxiety condition, but rather sporadic and unexpected. The person is doing fine, when out of the blue, an anxiety attack occurs. The person feels their heart racing, may experience pain in their chest, begin to hyperventilate and sweat. They may feel tremendous anxiety, like they will jump out of their skin.
This may last minutes, or sometimes, longer, but eventually subsides. During this panic episode, the person cannot be talked into relaxing. They are conscious and aware that something is terribly wrong but cannot calm down. It is very different from stage fright, where there is anxiety, but not this terrifying panic.
Often, if the person is out and about, they have an extremely intense need to return home, where they feel safe.
Generally, there is no clear precipitant that brings on these attacks, which only makes the person doubt their sanity. They may regularly rush to the hospital, fearing a heart attack, in spite of having receiving multiple ECG’s and reassurances that their heart is fine.
Continued panic attacks may lead to agoraphobia, which is the situation in which a person is gradually confined to their home, for fear of a panic attack happening anytime they leave.
Next time, I’ll cover the other phobias, including obsessive compulsive disorder, along with the difference between obsessive compulsive personality disorder, social anxiety disorder and phobias.
Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.