Anxiety Disorders

An anxiety disorder is an excessive or inappropriate response to stress that leaves you with feelings of apprehension, uncertainty and fear. It can paralyze you into inaction or withdrawal. An anxiety disorder isn't just a case of "nerves." According to the Anxiety Disorders Association of America (ADAA), an estimated 40 million Americans, or 18 percent of the population, experience this illness. It is the most common psychiatric condition in the U.S. and costs an estimated $42 billion per year.

Anxiety is expressed physically through a series of responses such as:

a rise in blood pressure

a fast heart rate

rapid breathing

an increase in muscle tension

a decrease in intestinal blood flow, sometimes resulting in nausea or diarrhea

Without treatment, an anxiety disorder can significantly disrupt your life because symptoms usually become progressively worse. Tormented by panic attacks, irrational thoughts and fears, compulsive behaviors or rituals, flashbacks, nightmares or countless frightening physical symptoms, people with anxiety disorders rely heavily on emergency departments and other medical services to address their symptoms.

Their work, family and social lives are disrupted, and some even become housebound. Many individuals who suffer from this disorder have other mental disorders such as depression or substance abuse.

Fortunately, treatment for anxiety disorders is, in general, very effective. Early diagnosis may aid early recovery, prevent the disorder from becoming worse and possibly prevent the disorder from developing into depression. Yet, because of a widespread lack of understanding and the stigma associated with anxiety disorders, only about one third of those who experience them are diagnosed and receive treatment.

In recent years, a number of different anxiety disorders have been categorized:

Generalized anxiety disorder (GAD), which affects about 6.8 million Americans (3.1 percent), and it affects twice as many women as men. GAD is characterized by at least six months of a more-or-less constant state of tension or worry not related to any event. If you suffer from GAD, you may always expect a catastrophe to happen. Though you may know your feelings are unrealistic, you cannot control them. The worries that accompany GAD are non-specific and are not as obsessive as the thoughts and worries experienced with obsessive-compulsive disorder. However, more than half the people who suffer from GAD also have another anxiety disorder or depression.

Panic attacks. While GAD is long-lasting and low-grade, panic attacks develop abruptly and generally reach a peak within 10 minutes. They develop without warning and are not necessarily related to any specific event. The word anxiety is derived from the Latin angere, which means to choke or strangle, and many women who suffer from panic attacks report the physical sensation of their throat tightening, cutting off their breath. This physical sensation can lead to additional anxious feelings.

Panic disorder, defined as repeated panic attacks or worry about such attacks, affects about six million Americans (2.7 percent). It typically strikes in young adulthood—before age 24 in roughly half of cases. Women are twice as likely as men to develop panic disorder. People with panic disorder may also suffer from depression; in addition, 30 percent of those with panic disorder abuse alcohol and 17 percent abuse drugs such as cocaine and marijuana. About one-third of people with panic disorder develop agoraphobia, an illness in which they become afraid of being in any place or situation where escape might be difficult or help unavailable if they have a panic attack. So they often won't leave their home.

Phobias are irrational, involuntary and include overwhelming fears that lead a person to avoid common objects, events or situations, or become excessively anxious as they approach them. While they vary in severity, in some cases the anxiety associated with the feared object or situation can be incapacitating. Most people who suffer from phobias are aware of the irrationality of their fear, and many avoid certain objects or situations or endure intense anxiety. Specific phobias are among the most common medical disorders.

There are three types of phobias: specific, social and agoraphobia. Specific phobias include fear of animals, heights (acrophobia), air travel (pterygophobia), water, confined spaces (claustrophobia), bridges or other things.

Social phobias, also known as Social Anxiety Disorder (SAD), is caused by a fear of being embarrassed in a social situation, or publicly scrutinized and humiliated. Social phobia is often accompanied by depression and may lead to alcohol or other drug abuse. About 6.8 percent of Americans or 15 million people, have social phobia. Social phobia is equally common among women and men. The disorder typically begins in childhood or early adolescence and rarely develops after age 25.

Agoraphobia is caused by a fear of having a panic attack in public. This fear is so great that it may lead a person to avoid public spaces. About one-third of people with panic disorder develop agoraphobia, which has been somewhat misleadingly described as fear of open spaces—the term having been derived from the Greek word agora, meaning marketplace.

Obsessive-compulsive disorder (OCD) is characterized by recurrent, persistent and intrusive thoughts, images or impulses that cause anxiety. These mental images or ideas are called obsessions. The person tries to control these obsessions or keep her fears from being realized by performing repetitive behaviors called compulsions.

The compulsions are often rigid and must be performed in a certain time-consuming order. Although adults with OCD know these rituals are excessive, they cannot stop doing them in spite of strenuous efforts to ignore or suppress the thoughts or actions. Repeated hand washing, re-ordering of belongings, re-checking objects in one's house, or silently repeating words, numbers or prayers are examples of compulsions. More than half of OCD sufferers have obsessive thoughts without ritualistic behavior. About one percent of the U.S. population, approximately 2.2 million Americans, has OCD. One third of adults affected with OCD had their first symptoms in childhood. OCD affects men and women with equal frequency.

OCD should not be confused with obsessive-compulsive personality, which defines certain character traits such as being a perfectionist, excessively conscientious, morally rigid and preoccupied with rules and order. These traits do not necessarily occur in people with OCD.

Post-traumatic stress disorder (PTSD) involves exposure to an extremely stressful event. About 3.5 percent of the population, or seven million people, suffer from PTSD. Trauma such as a rape, childhood sexual abuse, military combat or war-related incidents and natural disasters during which you experienced intense fear, helplessness and horror are common causes of PTSD. Rape is the most common trigger of PTSD—65 percent of men and 45.9 percent of women who are raped develop the disorder.

Although anxiety is a normal human response to stress, health care professionals and researchers don't know why some people have severe anxiety or panic in response to everyday situations. They do have several theories, however. Among the possible causes of anxiety disorders:

A biological tendency toward anxiety, including greater sensitivity to the effects of hormones released during anxiety, such as adrenaline; or an imbalance of certain substances called neurotransmitters (chemical messengers in the brain)

A chemical hypersensitivity that triggers a panic attack after exposure to caffeine

Genetic factors. About 20 to 25 percent of close relatives of people with panic disorder or obsessive-compulsive disorder experience these disorders themselves. Researchers have identified a gene associated with people with certain personality traits, such as anxiety, anger, hostility, impulsiveness, pessimism and depression; the gene produces reduced amounts of a protein that transports serotonin, an important neurotransmitter for maintaining positive emotions

Family background, such as an early childhood conflict or trauma, or "learned" fears or phobias

Stressful events and an exaggerated negative interpretation of them

Other illnesses or medications can cause symptoms of an anxiety disorder

While anxiety disorders can strike anyone of any age, gender or socioeconomic background, they most often begin in young adulthood. They often start mildly and progress, although GAD appears to be the most common form of anxiety in older ages. In addition, except for OCD, anxiety disorders strike women at twice the rate of men.