Anxiety and Its Disorders: Types and Treatment

Introduction

Anxiety disorder is a broad term that encompasses many different types of abnormal or psychological fear, anxiety, and phobias. Illogical worry which is not based on factual or rational thinking comes falls under this category. Anxiety and fear are present everywhere all around us, and both are often used interchangeably because of their common usage even though they mean different things. The Diagnostic and Statistical Manual of Mental Disorders describes a phobia as a “persistent or irrational fear” and fear itself is defined as the psychological and emotional response generated as a result of the recognition of an external threat. Anxiety, which is often felt in combination with other bodily symptoms that may lead to fatigue, is defined as an unwanted or unpleasant emotional condition but the sources of anxiety are more difficult to identify. However, since recognition of external threats often leads to the same kind of mental and physical responses, anxiety and fear are often used synonymously. Nevertheless, for the purpose of treatment and prognosis, it is important that the various types of anxiety disorders are differentiated because inaccurate diagnosis would lead to ineffective treatment (Barlow, 2002).

Causes and Diagnosis

Anxiety disorders can afflict a person suddenly after a particular event that triggers them or can be present from a young age. These are chronic conditions that hinder the person from routine regular life and get more aggravated in highly stressful incidences or periods. It is necessary that expert evaluation is carried out with the participation of the affected person, along with an interview or questionnaire administered so that the anxiety disorder is correctly diagnosed. A medical examination and an assessment of family history should be done. This is because headaches, hypertension, palpitation are often conditions associated with anxiety disorder and family history would also point towards the possibility of this condition. Medical exams and interviews are also essential because it is mostly found that patients suffering from anxiety disorders also suffer from clinical depression (Barlow, 2002).

As far as the causes of anxiety disorders are concerned, one possible cause is the failure of the parabrachial nucleus, which is a component of the brain with many functions, one of which is to coordinate responses from the amygdala (that has a major role in the processing and memory of responses to emotional events). The parabrachial nucleus, therefore, fails to coordinate signals from the amygdala related to balance. Clinical research, as well as animal studies, have all shown there to be a correlation between the occurrence of anxiety disorders and problems in maintaining balance. There are also other factors involved such as biochemical reasons: if levels of Gamma-aminobutyric acid (GABA), which is a neurotransmitter working to lessen higher than normal activity in the central nervous system, are low this will lead to anxiety. Anxiolytics, which are drugs prescribed to treat the symptoms of anxiety, work by moderating GABA (Barlow, 2002).

Types

One of the types of anxiety disorder is a generalized anxiety disorder. This is a chronic condition that affects more women than men and can be a serious impediment to normal daily life. The ‘generalized’ refers to the fact that this is a condition where patients feel anxious for long periods of time but without regard to a specific object, event, or situation. People who suffer from this disorder are afraid but can not put this fear into words or express exactly what the source of this fear is. They are constantly worried, can not control their vexations, are always anticipating the next catastrophe, and are much more concerned about issues pertaining to daily life (such as work, family, personal problems, health) than is required. Due to this, they suffer from constant muscle tension and autonomic fear responses which lead to headaches, muscle pain, fatigue, irritability, insomnia, palpitation, chest ache, and hot flashes. However, for this to qualify as GAD, these symptoms must be regular and present for at least six months. The physical symptoms coupled with the constant anxiety make GAD a debilitating condition, one which 1-5% of the general population suffers from (Buck, 2008).

Another type of anxiety disorder is a panic disorder, in which a person goes through short attacks of feelings of extreme fear and apprehension, which cause him to tremble, shake, feel dizzy, nauseous, face breathing problems, and feel a sense of confusion and impending doom. People afflicted by panic disorder often go through brief attacks of serious anxiety and panic which happen all of a sudden and become very intense in 10 minutes or so and then go on to last for a few hours (Barlow, 2002). While they may happen all of a sudden, seemingly without reason, as a general rule panic attacks take place after the afflicted person has been through a traumatic experience, or undergone a highly stressful period. People who have a panic attack for the very first time might think it is a heart attack, and even when proved wrong, they will still worry and become extra sensitive to physiological changes, which will trap them in a vicious cycle of anxiety and panic. Panic attacks become a disorder when the patient becomes overly concerned as a result of seemingly spontaneous panic attacks, about the possibility of future attacks (Buck, 2008).

Agoraphobia is a type of anxiety disorder, which is a more intense form of a panic disorder because it occurs in a place or setting from which the person feels it would be difficult or embarrassing to getaway. For example, a person may suffer from agoraphobia if he gets a panic attack while he is driving, and then for the future, he would avoid driving which would make him less anxious, and in the future make him less likely to choose to drive (Perugi, Frare & Toni, 2007).

Phobia is also a type of anxiety disorder where the afflicted person feels irrationally afraid and wants to avoid a situation or an object, which is different from the generalized and panic disorders described above because there is a particular condition or stimulus which leads to this intense anxiety. Afflicted people have very vivid imaginations as they associate very extreme consequences as a result of coming into contact with the object or situation that makes them uncomfortable (Barlow, 2002).

Another type of anxiety disorder is social anxiety disorder individuals afflicted with which go through feelings of extreme fear of being negatively judged by others in a social setting or getting embarrassed in front of other people. Some people are able to overcome their social anxiety disorder if their love for publicly performing for example overpowers this anxiety. Others however become so overwhelmed with anxiety that this fear of public evaluation and the prospect of humiliation renders them unable to lead a normal life (Barlow, 2002).

Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder where the individual repeatedly thinks about disturbing and intrusive thoughts or images or feels forced to indulge in patterns of repetitive behavior to relieve himself of anxiety. People with OCD might obsess that their doors are unlocked or their hands are unclean, causing them to compulsively check and recheck their locks, or wash their hands; or they might be obsessed with the condition of their personal possessions. The thinking behind some obsessive-compulsive patterns might be explicable while some might be completely devoid of logical thinking (Deacon & Abramowitz, 2008).

An anxiety disorder that develops in an individual as a result of a traumatizing incident is called post-traumatic stress disorder, for example, as a result of a serious accident, rape, or being held, hostage. Soldiers who return home after the war might go through it if they experience flashbacks or severe anxiety. Another disorder is known as a separation anxiety disorder which is when individual experiences seriously and is overly anxious about being separated from another person or place that he considers safe. Children most often suffer from separation anxiety disorder but adolescents and adults may also suffer from this. Separation anxiety becomes a disorder only when this feeling is inappropriate or more intense than in normal conditions (Barlow, 2002).

Treatment

Individuals suffering from anxiety disorders can undergo cognitive behavioral therapy (which attempts to influence distressing emotions by way of altering cognitions, assumptions, beliefs, thoughts, and behaviors), changes in their lifestyle, or medications. Generally, anxiety disorders are treated by a combination of anxiolytics and/or antidepressant drugs and/or cognitive therapy or psychotherapy. There are mixed opinions on treatment because some schools of thought believe that medications coupled with behavioral therapy work better than in isolation, while others insist that therapy alone is most powerful, as pharmaceuticals work only temporarily and actually hinder the effects of therapy. However, it is largely believed that while psychotherapeutic treatments are more effective in the long run, the optimal treatment is also determined by the genetics and environment of the individual himself (Vanin & Helsley, 2007).

References

Barlow, D. H. (2002). Anxiety and its Disorders. New York: Guilford Press.

Buck, A. (2008). Dealing with anxiety. Practice Nurse, 35 (2), 34-37.

Deacon, B., & Abramowitz, J. S. (2008). Is Hypochondriasis Related to Obsessive-Compulsive Disorder, Panic Disorder, or Both? An Empirical Evaluation. Journal of Cognitive Psychotherapy: An International Quarterly, 22 (2), 115-127.

Perugi, G., Frare, F., & Toni, C. (2007). Diagnosis and Treatment of Agoraphobia with Panic Disorder. CNS Drugs, 21 (9), 741-764.

Vanin, J. & Helsley, J. (2007). Anxiety Disorders: A Pocket Guide For Primary Care. Humana Press.