Anxiety Disorders

Anxiety disorders are the most common psychiatric illnesses affecting both children and adults.

• Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.
• An estimated 19 million adult Americans suffer from anxiety disorders.
• Anxiety disorders are highly treatable, yet only about one-third of those suffering from an anxiety disorder receive treatment.

Anxiety disorders are categorized as:

• Generalized Anxiety Disorder (GAD) . GAD is characterized by excessive, unrealistic worry that lasts six months or more; in adults, the anxiety may focus on issues such as health, money, or career. In addition to chronic worry, GAD symptoms include trembling, muscular aches, insomnia, abdominal upsets, dizziness, and irritability.
• Obsessive-Compulsive Disorder (OCD) . In OCD, individuals are plagued by persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fears; typical obsessions include worry about being contaminated or fears of behaving improperly or acting violently. The obsessions may lead an individual to perform a ritual or routine (compulsions)-such as washing hands, repeating phrases or hoarding-to relieve the anxiety caused by the obsession.
• Panic Disorder . People with panic disorder suffer severe attacks of panic-which may make them feel like they are having a heart attack or are going crazy-for no apparent reason. Symptoms include heart palpitations, chest pain or discomfort, sweating, trembling, tingling sensations, feeling of choking, fear of dying, fear of losing control, and feelings of unreality. Panic disorder often occurs with agoraphobia, in which people are afraid of having a panic attack in a place from which escape would be difficult, so they avoid these places.
• Post-Traumatic Stress Disorder (PTSD) . PTSD can follow an exposure to a traumatic event such as a sexual or physical assault, witnessing a death, the unexpected death of a loved one, or natural disaster. There are three main symptoms associated with PTSD: "reliving" of the traumatic event (such as flashbacks and nightmares); avoidance behaviors (such as avoiding places related to the trauma) and emotional numbing (detachment from others); and physiological arousal such difficulty sleeping, irritability or poor concentration.
• Social Anxiety Disorder (Social Phobia) . Social Anxiety Disorder (SAD) is characterized by extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule. This intense anxiety may lead to avoidance behavior. Physical symptoms associated with this disorder include heart palpitations, faintness, blushing and profuse sweating.
• Specific phobias . People with specific phobias suffer from an intense fear reaction to a specific object or situation (such as spiders, dogs, or heights); the level of fear is usually inappropriate to the situation, and is recognized by the sufferer as being irrational. This inordinate fear can lead to the avoidance of common, everyday situations.

Anxiety disorders are highly treatable with psychosocial therapies, medication, or both.

• Psycho-social treatments used in the treatment of anxiety disorders include cognitive behavioral therapy (CBT), exposure therapy, anxiety management and relaxation therapies, and psychotherapy.
• Drugs used to treat anxiety disorders include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, benzodiazepines, beta blockers, and monoamine oxidase inhibitors (MAOIs).
• Combination therapies are often utilized.

Misdiagnosis and undertreatment of anxiety disorders costs the nation billions of dollars annually.

• Anxiety disorders cost the U.S. more than $42 billion a year, according to "The Economic Burden of Anxiety Disorders," a study commissioned by the ADAA and based on data gathered by the association and published in the Journal of Clinical Psychiatry .
• More than $22.84 billion is associated with the repeated use of healthcare services, as those with anxiety disorders seek relief for symptoms that mimic physical illnesses.
• People with an anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers.

Panic Disorder

Panic Disorder is diagnosed when an individual suffers at least two unexpected Panic Attacks, followed by at least 1 month of concern over having another attack. Sufferers are also prone to situationally predisposed attacks. The frequency and severity of the attacks varies from person to person, an individual might suffer from repeated attacks for weeks, while another will have short bursts of very severe attacks. The sufferer often worries about the physical and emotional consequences of the Panic Attacks. Many become convinced that the attacks indicate an undiagnosed illness and will submit to frequent medical tests. Even after tests come back negative, a person with Panic Disorder will remain worried that they have a physical illness. Some individuals will change their behavioral patterns, avoiding the scene of a previous attack for example, in the hopes of preventing having another attack.

Agoraphobia

Agoraphobia often, but not always, coincides with Panic Disorder. Agoraphobia is characterized by a fear of having a panic attack in a place from which escape is difficult. Many sufferers refuse to leave their homes, often for years at a time. Others develop a fixed route, or territory, from which they cannot deviate, for example the route between home and work. It becomes impossible for these people to travel beyond what they consider to be their safety zones without suffering severe anxiety.

The age of onset of Panic Disorder varies from late adolescence to mid-thirties. Relatively few suffer from the disorder in childhood.

Obsessive-Compulsive Disorder
(OCD)

Obsessive-Compulsive Disorder is characterized by uncontrollable obsessions and compulsions which the sufferer usually recognizes as being excessive or unreasonable. Obsessions are recurring thoughts or impulses that are intrusive or inappropriate and cause the sufferer anxiety. Some common obsessions are:

• Thoughts about contamination, for example, when an individual fears coming into contact with dirt, germs or "unclean" objects;
• Persistent doubts, for example, whether or not one has turned off the iron or stove, locked the door or turned on the answering machine;
• Extreme need for orderliness;
• Aggressive impulses or thoughts, for example, being overcome with the urge to yell 'fire' in a crowded theater
  

Compulsions are repetitive behaviors or rituals performed by the OCD sufferer, performance of these rituals neutralize the anxiety caused by obsessive thoughts, relief is only temporary. Compulsions are incorporated into the person's daily routine and are not always directly related to the obsessive thought, for example, a person who has aggressive thoughts may count floor tiles in an effort to control the thought. Some of the most common compulsions are:

• Cleaning . Sufferers concerned with germs and contamination tend to clean constantly, either repeatedly washing their hands, showering, or constantly cleaning their home;
• Checking . Individuals may check several or even hundreds of times to make sure that stoves are turned off and doors are locked;
• Repeating . Some repeat a name, phrase or action over and over;
• Slowness . Some individuals may take an excessively slow and methodical approach to daily activities, they may spend hours organizing and arranging objects;
• Hoarding . Hoarders are unable to throw away useless items, such as old newspapers, junk mail, even broken appliances; sometimes the hoarding reaches the point that whole rooms are filled with saved items.
  

In order for OCD to be diagnosed, the obsessions and/or compulsions must take up a considerable amount of the sufferers time, at least one hour every day, and interfere with normal routines (a person, for example, who cannot make left turns when driving), occupational functioning, social activities, or relationships. OCD can interfere with one's ability to concentrate, and it is not uncommon for a sufferer to avoid certain situations, for example, someone who is obsessed with cleanliness may be unable to use public restrooms.

Onset of OCD is usually gradual and most often begins in adolescence or early adulthood. Unlike adults, children with OCD do not realize that their obsessions and compulsions, which are most often of the washing, checking, and ordering variety, are excessive.

Social Anxiety Disorder

Social Phobia is characterized by an intense fear of situations, usually social or performance situations, where embarrassment may occur. Individuals with the disorder are acutely aware of the physical signs of their anxiety and fear that others will notice, judge them, and think poorly of them. This fear often results in extreme anxiety in anticipation of an activity, a Panic Attack when faced with an activity, or in the avoidance of an activity altogether. Adults usually recognize that their fears are unfounded or excessive, but suffer them nonetheless.

Blushing when in social situations is particularly common and often causes the sufferer further embarrassment.

People with Social Phobia tend to be sensitive to criticism and rejection, have difficulty asserting themselves, and suffer from low self-esteem. The most common fears associated with the disorder are a fear of speaking in public or to strangers, a fear of meeting new people, and performance fears (activities that may potentially be embarrassing), such as writing, eating or drinking in public. Sufferers usually fear more than one type of social setting.

Onset of the disorder is usually in mid to late adolescence, but children have also been diagnosed with Social Phobia. Children with the disorder are prone to excessive shyness, clinging behavior, tantrums and even mutism. There is usually a marked decline in school performance and the child will often try to avoid going to school or taking part in age appropriate social activities. Their fears are centered on peer settings rather than social activities involving adults, with whom they may feel more comfortable. For a child to be diagnosed with Social Phobia, symptoms must persist for at least six months.

Specific Phobia

Specific Phobia is characterized by the excessive fear of an object or a situation, exposure to which causes an anxious response, such as a Panic Attack. Adults with phobias recognize that their fear is excessive and unreasonable, but they are unable to control it. The feared object or situation is usually avoided or anticipated with dread.

Specific Phobia is diagnosed when an individual's fear interferes with their daily routine, employment (e.g., missing out on a promotion because of a fear of flying), social life (e.g., inability to go to crowded places), or if having the phobia is significantly distressful. The level of fear felt by the sufferer varies and can depend on the proximity of the feared object or chances of escape from the feared situation. If a fear is reasonable it cannot be classed as a phobia.

Specific Phobia may have its onset in childhood, and is often brought on by a traumatic event; being bitten by a dog, for example, may bring about a fear of dogs. Phobias that begin in childhood may disappear as the individual grows older. Fear of certain types of animals is the most common Specific Phobia. The disorder can be comorbid with Panic Disorder and Agoraphobia.