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Anxiety Disorders

What is anxiety?

All of us are prone to feel some anxiety in our lives. But when anxiety affects our day to day functioning and enjoyment of life, it becomes an illness. Many people with anxiety disorder do not recognize it. You may have an anxiety disorder if you worry too much on most days for at least six months. Your anxiety may make it hard for you to live life normally. You might find it difficult to get a job, go to classes or make friends.

What are the symptoms of an anxiety disorder?

The symptoms of an Anxiety Disorder can vary from person to person and can include the following:

• Excessive worry and anxiety on an almost daily basis for 6 months or more;
• An inability to control your worries;
• The anxiety can be associated with other symptoms,  including restlessness, fatigue, poor concentration, irritability, muscle tension, and sleep disturbances. Some people also experience headaches and body pain with no medical explanation.
• Panic attacks involving sweating, shaking, racing heart, shortness of breath,nausea, tightness in the stomach or jaw may also occur.
• These symptoms can cause significant impairment in your ability to function.

How is anxiety diagnosed?

Many people with anxiety are embarrassed to tell their clinician about it. An Anxiety disorder is commonly diagnosed by your care provider/clinician by asking you some questions about your symptoms, their severity, duration etc.. There are several rating scales or questionnaires (Hamilton Anxiety Scale or Beck Inventory, among others) that are used to diagnose anxiety.

What treatments are available for anxiety?

It is important to realize that the treatment of anxiety usually takes time. You may not be “cured” but your symptoms will subside and your quality of life will improve with treatment.

• Psychotherapy: A form of psychotherapy called cognitive behavioral therapy (CBT) is highly effective for treatment of anxiety. Cognitive therapy works by challenging and investigating false or self-defeating beliefs that cause anxiety.
• Medications: Various groups of medications have been found to be useful.  Anti-depressants (SSRI’s and non-SSRI’s), Beta-blockers and anti-psychotics have been used to treat anxiety. Anxiolytics (Benzodiazepines and non-benzodiazepines) are also used; however, Benzodiazepines are highly addictive, especially when used without medical supervision. Herbal remedies like Kava, Valerian and St. John’s wort have also been used to allay anxiety. 
• Meditation and Relaxation Training: We really do not know how these work, but they are effective in treating anxiety and have no known harmful effects. Mindfulness meditation is the oldest known technique to deal with anxiety. It teaches us to be aware of anxious thoughts as just thoughts passing through our awareness and we can learn to see them as mental events without having to react to them or try to get rid of them.

Are there other types of anxiety disorders?

Yes. There are other conditions that have similar symptoms:

• Panic Attacks: Characterized by a sudden intense fear or discomfort in the absence of real danger – as if something terrible is about to happen. It may be accompanied by sweating, difficulty breathing, feeling light headed, a pounding heart, shaky hands and can last 30-60 mins.
• Post-Traumatic Stress Disorder (PTSD):  PTSD occurs in people who have either witnessed or lived through a potentially life threatening event such as an accident, natural disaster, war, personal violence, etc. Symptoms may develop weeks, months or years later in some cases. PTSD is characterized by anxiety, with flashbacks of the threatening event, nightmares, jumpiness, irritability or physical symptoms like digestive problems, aches and pains.
• Obsessive-compulsive disorder (OCD): Obsessive-compulsive disorder was highlighted in the movie “As Good As It Gets”, by Jack Nicholson (Melvin Udall). People with OCD suffer from disturbing thoughts (obsessions) and images that are difficult to shake off and which they know are ridiculous. They may indulge in repetitive behaviors or rituals to ward off the accompanying anxiety. Such behaviors may take a lot of time to complete. Common examples are fear of germs or dirt, checking door locks, arranging and re-arranging objects for hours.
• Phobia: A Phobia is the circumscribed fear of something – an animal (spiders), a situation (riding in elevators), open places (agoraphobia). People with a phobia will do anything to avoid the fearful stimulus. This can make life very difficult for them.

For additional information about anxiety please visit the following sites:

Anxiety Disorders (National Institutes of Mental Health)

Anxiety Disorders (Anxiety Disorders Association of America)

Anxiety Disorders (Center for Mental Health Services (SAMHSA)

Authored by: Anil Coumar, MBBS, M.A. with Kathreen Gimbrere, MD
Last updated: 2/12/07
Last reviewed: 10/08