Chronic and unremitting
Anxiety disorders affect millions
by Randall A. Scott, M.D., General Adult Psychiatrist and Hospitalist, Adult Psychiatric Program, Virginia Baptist Hospital

It is easy to identify with the nervousness and anxiety that accompany stressful moments in our lives—our wedding day, a new job, speaking in public, moving to a new state. But more than 19 million Americans suffer from something far more serious—mental illnesses known as anxiety disorders, in which their lives are filled with overwhelming anxiety, fear and dread.

The most common type of mental illness in the United States, anxiety disorders are chronic and unremitting, and if left untreated, can become progressively worse. Symptoms often occur for no apparent reason and do not go away. More common than depression and extremely debilitating, anxiety disorders present in a variety of ways, either as a specific type or as a cluster of different symptoms which don't fall neatly into a single category.

Types of anxiety disorders

Panic disorder: Episodes or attacks of an intense fear that strike suddenly and repeatedly without warning. The unpredictability of panic attacks causes people to develop intense anxiety between episodes and to associate the attacks with activities, such as driving, riding an elevator or being outdoors, causing them to alter their lives. Symptoms include dizziness, numbness, nausea, a smothering sensation, intense heat, cold or a sense of impending doom. Many sufferers seek frequent emergency medical care for what appears to be a heart attack until they are properly diagnosed.

Obsessive-compulsive disorder: Repeated unwanted thoughts (obsessions) that create a great deal of fear and anxiety accompanied by uncontrollable behaviors/rituals (compulsions) to try to alleviate those fears. (See related story on page 2.)

Post-traumatic stress disorder: Persistent anxiety symptoms that occur after experiencing or witnessing a traumatic event or events, such as violent attacks, serious accidents or natural disasters. Symptoms of post-traumatic stress disorder include anxiety, flashbacks, mood changes, feelings of numbness and detachment, irritability, increased startled response to any reminder of the event.

Generalized anxiety disorder: Chronic and excessive worrisome thoughts and tension about routine everyday life events and activities. A person suffering from this disorder is constantly nervous, anxious and worried. Their worries are accompanied by physical symptoms, including fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating and hot flashes.

Phobias: Irrational fears that lead people to avoid specific things or situations that trigger intense anxiety. The two major types of phobias are social phobia—an overwhelming anxiety and excessive self-consciousness in daily social situations, and specific phobias—an intense fear of something that poses little or no actual danger. (See related story on page 5.)

Treatment

Many people with anxiety disorders do not seek treatment because they learn to work around the symptoms and live with them. Others are afraid that if they see a psychiatrist they will be diagnosed as mentally ill, and fear the reactions of their family, coworkers and friends.

Those who seek help are usually people who want to understand their symptoms or are so disabled by them that treatment is the only answer to leading a normal life. It is very common for an anxiety disorder to accompany other psychiatric conditions, including depression, eating disorders, other anxiety disorders and substance abuse.

Anxiety disorders generally respond well to treatment. The majority of patients receiving treatment in the form of medication and/or psychotherapy experience significant relief from their symptoms.

Many of the antidepressants, particularly newer agents, have been shown to be very effective in curbing and reducing anxiety symptoms. Psychotherapy, specifically cognitive behavioral or behavioral therapy, is equally if not more important for long-term treatment, especially for sufferers of panic disorder and obsessive-compulsive disorder. Cognitive behavioral therapy helps patients recognize what their brain is telling them, identify the fear and develop ways to cognitively think differently.

With appropriate treatment, many patients can be essentially "cured" of their condition.