| Anxiety
Anxiety disorders are
among the most common mental health problems. Many people struggle with anxiety disorders,
hiding their discomfort as best they can and avoiding situations that provoke their fears.
They often do not seek treatment, but their lives are unnecessarily limited as result, and
they tolerate a lifetime of discomfort.
Some people who have
undiagnosed anxiety disorders self-medicate with alcohol or other drugs. Often, as time
goes by, they need more of the drug to control the anxiety, and they are at risk of
developing substance abuse problems as a result (including excessive use of prescription
medications).
There are a variety of
anxiety disorders. The most common are described below, along with specific information
about anxiety in children. We also discuss the role of psychologists in diagnosing and
treating anxiety disorders.
Panic Disorder
Panic Disorder is
characterized by panic attacks, although having a panic attack does not necessarily mean
you have panic disorder.
Panic attacks are sudden, intense episodes of fear or discomfort,
accompanied by symptoms such as a racing heart, difficulty breathing, fear of dying, chest
pain or tightness, feeling like you are choking, feeling dizzy or lightheaded, shaking or
trembling, abdominal distress or nausea, chills or hot flushes, sweating, numbness or
tingling, fear of losing control or going crazy, feeling like things are not real, or
feeling like you are outside yourself.
Panic attacks are very scary, and often make the person think he is
having a heart attack. As a result, people with undiagnosed panic disorder often have
multiple visits to hospital emergency rooms and medical tests, which are both costly and
unpleasant. Worst of all, the person often leaves the hospital without having the panic
disorder diagnosed, no better off than when he went in there. It is, of course, a good
idea to get emergency medical care if you think you are having a heart attack. But, once
you have been medically cleared, it is worth having the possibility of panic disorder
evaluated, too. It could save you a lot of grief and money.
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Phobias
Phobias are
characterized by intense anxiety or fear related to particular situations or objects. The
situation/object is avoided or is tolerated with extreme discomfort.
Common phobic situations might include:
- Fear of social situations or situations where you have to perform while others observe.
This fear is excessive and hinders performance.
- Fear of being in public places, crowds, or situations where escape could be difficult or
embarrassing (e.g., being in a car, going to the mall, standing in a line). This type of
fear often develops in conjunction with panic disorder, but can exist separately, too.
- Fear of needles, flying, heights, elevators, enclosed spaces, etc.
- Fear of snakes, bugs, rodents, etc.
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Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive
Disorder is marked by one or both of the following:
- Persistent, recurrent thoughts, ideas, impulses, or images that are distressing and
intrusive. For example, one of the most distressing obsessive thoughts is having the
sudden idea of killing a loved one, when this is actually the last thing you would ever
do.
- Feeling compelled to perform certain actions over and over. You experience anxiety,
dread, and distress if you are unable to do so. These actions can include physical acts
like hand-washing, bathing, putting things in order, checking (e.g., going back more than
once to see if the stove is off), etc. Or they can be mental acts like counting, repeating
certain words, or praying.
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Generalized Anxiety Disorder
A person with
Generalized Anxiety Disorder experiences a lot of anxiety and tends to worry a great deal
more than most other people would in the same situation. He can't just "turn
off" the anxiety and it is difficult to ignore it or reduce it. The worry tends to
interfere with effectively coping with the situation, making things worse instead of
better. The person often feels on edge, tense, or restless. Irritability is common, along
with difficulty concentrating. Sometimes, the person's mind will simply go blank. Problems
with sleep, fatigue, and muscle tension also can occur.
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Posttraumatic Stress Disorder (PTSD)
PTSD can occur after a
person has experienced or witnessed a severely traumatic or horrific event, which involved
(real or threatened) serious injury, violation, or death. These situations typically are
marked by feelings of terror, immobilization, and helplessness.
PTSD is marked by involuntarily reliving the trauma through flashbacks,
persistent nightmares, or intrusive thoughts, images, or perceptions that recall the
event. The person tends to experience intense emotional and physical reactions to things
that remind him of the trauma. Often attempts are made to insulate oneself from things
that can provoke those memories, which can lead to withdrawal, isolation, and giving up
important activities.
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Anxiety in Children
Children can experience
all of the anxiety disorders listed above, and exhibit similar symptoms. However, there
are some symptoms that are child-specific, as well.
An anxious child is often "clingy" and has trouble separating
from his parents. He might resist going to school, and even bedtime can be difficult.
Sometimes, the child wants to sleep with his parents nearly every night.
Anxiety also can
manifest as whining, being excessively demanding, and attention-seeking. Sometimes, temper
tantrums are seen. An anxious child also might have trouble adapting to changes in his
familiar routine.
In the case of PTSD, in
particular, you can see separation anxiety, trouble sleeping, tantrums, and regression to
more childlike behaviors (e.g., thumb-sucking, bedwetting).
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The Role of the Psychologist
Diagnosis:
Psychologists can
identify the particular type of anxiety disorder the person has. They also can clarify the
specific situations that might contribute to the problem. Usually, the history and
clinical interview will allow a diagnosis, but sometimes psychological testing can shed
light on more difficult cases.
Treatment:
Psychologists use a
variety of methods to treat anxiety. Treatment can be relatively brief, although this is
affected by the severity of the problem, how long it has existed, the presence of other
(comorbid) disorders, and other factors.
Often, anxiety disorders can be controlled by learning specific skills
that allow the person to reduce their discomfort, tolerate anxiety-provoking situations,
and gain mastery over their fears. When these skills are learned, many people who
previously relied on medications, alcohol, or illicit drugs to control their anxiety find
they no longer need this chemical control.
One of the skills that people find beneficial is relaxation training,
in which the person learns to manage their physical response to a feared situation. This
is often the foundation for other coping responses, since this mastery of physical
discomfort allows the person to face the anxiety-provoking situation and use other new
skills they learn in treatment.
One of these other skills is learning to recognize and control
unhelpful, automatic thoughts that can contribute to anxiety. For example, learning to
coach yourself through a panic attack and challenge the fear that you are having a heart
attack and dying can be a very effective tool.
Psychologists also teach people how to manage their day-to-day
responses to their anxiety disorder. For example, someone who engages in ritualistic,
compulsive behaviors needs to learn how to eliminate/avoid those behaviors while managing
their discomfort.
For trauma-based anxiety responses, treatment can be more involved, and
it often is necessary to process the traumatic memories. In some cases, this can mean
longer-term therapy is needed.
In general, the skilled psychologist will tailor the treatment to the
specific needs of the client.
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