HotmailEveryday anxiety or anxiety disorder?
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Everyday anxiety or anxiety disorder?
So what exactly is an anxiety disorder? It’s an umbrella term for a group of conditions that involve chronic, excessive, inexplicable anxiety that interferes with the way a person conducts his or her daily life. Under the umbrella are generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Each of these conditions has a different constellation of symptoms, although some symptoms are common to several disorders. For instance, the pounding heart, shallow breathing, and excessive perspiration associated with panic disorder may also be familiar to someone who suffers from a specific phobia or social phobia. It is also common for a person to have more than one anxiety disorder, the varieties of which are as follows:
• As we established, Melissa is suffering from generalized anxiety disorder (GAD). People who suffer from GAD are beset by persistent, excessive, and unrealistic worry that they are unable to control and that focuses on everyday things such as health, career, fifinances, relationships, and the security and well-being of their loved ones. GAD symptoms differ from those of the garden-variety worrier in that the worry associated with GAD is relentless and ongoing, feels impossible to control, and occurs on more days than not for a minimum of six months. The worries of GAD are accompanied by physical symptoms, especially restlessness, difficulty falling asleep and staying asleep, becoming easily fatigued, headaches, difficulty concentrating, irritability, muscle tension with resulting pain, abdominal upsets, and dizziness. Nearly seven million American adults, or 2 percent of the U.S. population, suffer from GAD, with women twice as likely as men to develop it. Women with GAD tend to develop the disorder younger than men and are more likely than men to have other mental health problems, such as depression.
• Panic disorder is characterized by recurrent, spontaneous, seemingly out-of-the-blue panic attacks, whose symptoms may include heart palpitations, sweating, trembling, shortness of breath or a feeling of choking, dizziness, chills, and hot flushes as well as fears of losing control, “going crazy” or dying, and feelings of imminent doom. Panic attacks manifest as abrupt onsets of intense terror that reach a peak within a few minutes. What differentiates someone with panic disorder from someone who experiences occasional panic attacks is the person’s state of mind between the attacks: with panic disorder, an attack is typically followed by at least one month of persistent concern about having another attack, worry about the consequences of an attack (such as losing control or having a heart attack), and/or a major change in behavior related to the attacks. Panic disorder affects twice as many women as men and is often accompanied by major depression. More than six million Americans — 2.7 percent of the adult population — suffer from panic disorder.
• Panic disorder with agoraphobia About one out of three people with panic disorder develops agoraphobia, an avoidance of places, typically open or public spaces, where one fears having a panic attack and being unable to immediately get to safety — for instance, when entering a theater or sports arena, waiting in line at the grocery store, or riding on public transportation. People with agoraphobia often start eliminating places they are willing to go as they relentlessly anticipate having a panic attack. In extreme cases, an agoraphobic’s world gradually shrinks until he or she is too fearful to leave the house. Women with panic disorder are more likely than men to develop agoraphobia.
• Specific or simple phobias are characterized by irrational, involuntary fear reactions to particular objects, places, or situations. As with the example of the kindergarten teacher and the accountant with a fear of elevators, people who suffer from a specific phobia dread encountering ordinary, everyday situations or objects even though they know the dread is irrational. Someone with a phobia may even have a panic attack when confronted with a dreaded object or situation and thereafter be loath to go back for fear of having another panic attack. Oftentimes, it is anticipatory anxiety — the anxiety you feel when anticipating an event rather than the anxiety you feel when experiencing the event — that keeps a person from confronting something she has no realistic fear of (driving through a tunnel, petting her neighbor’s kitten, riding on an escalator).
How can you tell the difference between a fear and a phobia? As stated earlier, if the aversion makes sense, it’s probably a fear. If the aversion and accompanying feelings are irrational, it’s probably a phobia. A person with a phobia fears the fear itself rather than the object of the fear and typically has difficulty exactly what he or she is afraid of. For example, if you ask someone with a fear of flying what she is afraid of, she will probably say “I’m afraid of crashing” or “I can’t stand turbulence” or “I’m terrified we’ll be hijacked by terrorists.” Ask someone with a true flying phobia the same question, however, and she will probably say, “I don’t know what I’m afraid of. What if I want to get off after we’re airborne?” or “What if I have a panic attack on the plane and lose control and start running up and down the aisle like a madwoman?” or “What if I have a heart attack and die on the plane?” The “what if?” questions and fear of the feelings or the fear itself are characteristic of a phobia.
• Social anxiety disorder, also known as social phobia, is characterized by an intense fear of one or several social or performance situations in which the person is exposed to unfamiliar people and/or to possible scrutiny and judgment by others. Physical symptoms may include blushing, nausea, trembling, profuse sweating, and difficulty talking. Some people with social phobia are terrified of and make every effort to avoid specific situations requiring contact with others, such as speaking before an audience, making or receiving telephone calls, or signing their name in public. Others have a more generalized form of the disorder where they attempt to avoid or endure with great distress common, everyday social situations such as talking to authority figures (teachers, doctors, supervisors, police officers), being the center of attention at a meeting or social gathering, expressing disapproval of or disagreement with people they don’t know well, or working while others are watching them. One of my patients, a twenty- year-old college freshman with the generalized type of social phobia, described his anxiety as affecting every aspect of his life and said, “The first thing I think about every morning when I first wake up is ‘Who am I going to have to say hello to today?’ ”
Social phobia is the most common anxiety disorder, affecting fifteen million American adults. It’s the third most common psychiatric disorder in the country after depression and substance abuse, and, interestingly, it is one of the few psychiatric disorders where men are more likely to seek treatment than women. We don’t know for certain why this is the case, but one theory is that because it is less acceptable for men to be socially reticent than women, social anxiety poses more professional and personal difficulties for men, motivating them more to seek treatment.
• Obsessive-compulsive disorder (OCD) People who suffer from OCD are plagued by unwanted thoughts (obsessions) that intrude into their thinking. To ease the anxiety caused by these thoughts, they feel compelled to do certain things or perform ritualized acts (compulsions), all the while recognizing both the irrationality of their behavior and their inability to stop it. Common obsessions include constant, irrational worry about dirt, germs, or contamination; feelings that chaos will descend unless objects are positioned or a situation managed in a certain way; and apprehensiveness about disposing of items of little intrinsic value but that the person inexplicably feels she may someday need. Common compulsions include rituals associated with cleaning (repeated washing of hands or dusting and vacuuming); checking and rechecking (repeatedly making sure the door is locked, the iron unplugged, and the oven turned off before leaving the house); and hoarding (amassing excessive numbers of useful items such as dozens of bottles of shampoo or cases of soup or stockpiling useless items such as old newspapers and magazines or empty bottles and jars).
• Post-traumatic stress disorder (PTSD) is the one anxiety disorder that is rooted not in irrational fear but rather in an actual life-threatening event that the sufferer has either endured or witnessed. Once known as shell shock and used in reference to soldiers returning from battle with psychological disturbances, PTSD is diagnosed when a person is unable to recover from a traumatic experience (such as rape, physical abuse, or surviving a hurricane, tsunami, or earthquake) and continues to suffer from significant anxiety and depression for months and sometimes years afterward. People with PTSD often relive the traumatic event through nightmares and flashbacks and find it difficult if not impossible to concentrate, relax, or sleep undisturbed.
Excerpted from “One Less Thing to Worry About” by Jerilyn Ross. Copyright (c) 2009. Reprinted with permission from Random House.
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