What are Anxiety Disorders?
Anxiety Disorders are conditions in which extreme, often disabling, anxiety is the shared principal symptom. Such anxiety can be understood as a pathological version of normal fear, and is characterized by disturbances of mood, thinking, behavior and physiology. The most common of all the mental disorders, about one in nine, or more then 20 million Americans, are affected with an anxiety disorder annually. It is thought that genetic makeup, brain chemistry, personality and life experience contribute to the development of these disorders. There are several types of anxiety disorders, each with its own distinct features, highlighted below.
What are the Symptoms and Courses of Anxiety Disorders?
- Panic disorder consists of having had at least two panic attacks, worrying persistently about a reoccurrence and changing behaviors to try to avoid another attack. Panic attacks involve an overwhelming fear of being in danger for no apparent reason, and physiological symptoms such as pounding heart or chest pain; sweating, trembling or shaking; shortness of breath or choking sensation; nausea, dizziness; feelings of unreality or depersonalization; fear of going crazy or dying.
- Phobia is an uncontrollable, irrational and persistent fear of a specific object, situation or activity to the extent that the individual experiences marked distress or interference with functioning. The three types of phobias include social phobia (fear of embarrassment or scorn in social or performance situations); specific phobia (persistent, excessive or unreasonable fear of an object or situation); and agoraphobia (fear of having a panic attack in situations from which escape may be difficult or embarrassing).
- Obsessive-Compulsive Disorder involves recurring unwanted thoughts or excessive worries (obsessions) and/or activities or rituals the person feels driven to perform to reduce anxiety (compulsions). Common obsessions include preoccupation with dirt and germs, nagging doubts and putting things in a particular order. Corresponding compulsions may include excessive hand washing, checking, and following rigid rules of order. Compulsive behavior may take up over an hour a day, interfering with functioning.
- Posttraumatic Stress Disorder is a debilitating condition that follows a terrifying event. People with PTSD keep experiencing the ordeal through recurrent nightmares or memories of the event, flashbacks, and extreme emotional, mental, and physical distress when exposed to situations that remind them of the trauma. Additional symptoms include feeling numb or detached, sleep difficulties, feeling jittery or on guard, and feeling irritable or depressed. Symptoms seem to be worse when caused by human violence, such as rape or war, rather than natural disasters, such as floods.
- Generalized Anxiety Disorder is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. It may be accompanied by trembling, twitching, muscle tension, headaches, irritability, hot flashes, nausea, frequent urination and fatigue.
While anxiety disorders can occur at any age, they typically have relatively early ages of onset, and are chronic with relapsing or recurrent periods of illness and periods of disability. Individuals with anxiety disorders may have co-occurring substance abuse and/or mood disorders as well. Panic disorder and agoraphobia are particularly associated with increased risk of attempted suicide.
What are Effective Treatments?
Most anxiety disorders respond well to psychotherapy, medication, or a combination of both. There is extensive evidence that cognitive-behavioral therapy is a useful treatment for a majority of patients with anxiety disorders. This type of therapy helps patients understand and change their patterns of thinking regarding situations that cause anxiety, and uses relaxation techniques and carefully planned exposure to the feared object or situation to gradually lessen anxious responses. Medications for more severe and persistent symptoms include benzodiazepines, antidepressants, and buspirone.
Sources:
Mental Health: A Report of the Surgeon General, DHHS, 1999, Chapter 4
Let’s Talk Facts About Anxiety Disorders, American Psychiatric Association
Helping Children and Teens With Panic and Anxiety
- Closely listen and observe the student. True panic attacks include shortness of breath, heart palpitations, dizzinees, dry mouth, nausea, or diarrhea, high levels of muscle tension, and possibly an irrational fear that he or she will die.
- For true panic encourage slow deep breaths, be reassuring and non-judgmental. Sit with the student and be present, refer to the nurse or seek medical attention if the situation worsens.
- Be present and soothing. Use consistent eye contact, active listening, and a warm accepting demeanor.
- Listen for irrational cognitive messages (e.g., "My future is ruined", "I can never get anyone to like me", "No one ever takes me seriously", "I suck in everything I do", "Everyone in the school is going to talk about this all the time for the next ten years."). For young children puppets and drawings may help in uncovering anxiety-related thoughts.
- Help the student to see that irrational self-talk raises anxiety off the charts.
- Specifically, explain how OVER-EXAGGERATIONS, OVER-ESTIMATIONS, AWFULIZING, CATASTROPHISIZING, lead to anxiety. Obviously, adjust the level of explanation to the level of the student. E.g., for younger students use puppets, and drawings and even a half empty/half full glass so they can SEE how perception affects reality.
- Help student to realize the lack of evidence for irrational (unhelpful) thoughts and help him or her find evidence for more rational (helpful) thoughts. So, for example, point out how the student is not a total failure or total loser or totally unpopular. Go back in time and point out times when the problem did not exist and when the current problem does not exist. Finding such exceptions to the rule is very helpful.
- Along these lines, ask, "What is the worst that can happen?"
- When appropriate, educate the student's parents about nature and causes of anxiety.
- For persistent and more serious anxiety concerns, refer to a qualified mental health professional.
Sources and further information:
The chapter Understanding Anxiety from The Feeling Good Handbook (David Burns)
American Psychological Association (www.apa.org)
Anxiety Disorders in Children And Adolescents (John March, 1995)
Treatments That Work With Children (Chrisopherson & Mortweet, 2001)