Nevertheless, when anxiety becomes extreme or when an attack of anxiety strikes suddenly, without an apparent external cause, it can be both debilitating and destructive. Its symptoms may include nervousness, fear, a "knot" in the stomach, rapid heartbeat, or increased blood pressure. If the anxiety is severe and long lasting, more serious problems may develop. People suffering from anxiety over an extended period may have headaches, ulcers, irritable bowel syndrome, insomnia, and depression. Because anxiety tends to create various other emotional and physical symptoms, a "snowball" effect can occur in which these problems produce even more anxiety.
Chronic anxiety can interfere with an individual's ability to lead a normal life. Mental health professionals consider a person who has prolonged anxiety as having an anxiety disorder. The U.S. Surgeon General's report estimated that more than 16 percent of Americans suffered from anxiety disorders. (See Table 8.1 for the prevalence of anxiety disorders among people eighteen to fifty-four years old.)
Panic Disorder
Extremely high levels of anxiety may produce panic attacks that are both unanticipated and seemingly without cause. In one type of panic attack, termed "unexpected," the sufferer is unable to predict when an attack will occur. Other types of panic attacks are linked to a particular location, circumstance, or event and are called "situationally bound" or "situationally predisposed" panic attacks. These panic episodes can last as long as thirty minutes and are marked by an overwhelming sense of impending doom while the person's heart races and breathing quickens to the point of gasping for air. Sweating, weakness, dizziness, terror, and feelings of unreality are also typical. Individuals undergoing a panic attack fear they are going to die; "lose their mind"; or, at the very least, lose control.
Repeated panic attacks may be termed a panic disorder; however, panic attacks do not necessarily indicate a mental disorder—as many as 10 percent of people with no other problems experience a single panic attack each year. According to the American Psychiatric Association, panic disorder occurs twice as much in women as men, can run in families, and most often begins between the ages of fifteen and nineteen years.
These symptoms often mimic those of a heart attack so the diagnosis of panic disorder often is not made until extensive and costly medical procedures fail to provide a diagnosis or relief. These patients then may turn to neurologists and other specialists to seek answers. Research has found that of the patients who make the most visits to doctors, spend the most time in the hospital, and use the most prescription medications, approximately 12 percent suffer from undiagnosed panic disorders.
The usual treatment for panic disorder is cognitive/behavioral therapy combined with antianxiety drugs to treat the fear of the attacks. Sometimes antidepressant medications are used, although the patient is not clinically depressed. Relaxation therapy also has proved beneficial.
Phobias
Phobias are defined as unreasonable fears associated with a particular situation or object. The most common of the many varieties of phobias are specific phobias. Fear of bees, snakes, rodents, heights, odors, blood, injections, and storms are examples of common specific phobias. Specific phobias, especially animal phobias, are common in children, but they can occur at any age. About 8 percent of American adults suffer from specific phobias. (See Table 8.1.) Most people with a phobia understand that their fears are unreasonable, but that awareness does not make them feel any less anxious.
Some specific phobias, such as a fear of heights, usually do not interfere with daily life or cause as much distress as more severe forms, such as agoraphobia (see later in this chapter). People suffering from severe phobias may rearrange their lives drastically to avoid the situations they fear will trigger panic attacks.
SOCIAL PHOBIAS.
Social phobias (also called social anxiety disorders) can be more serious than specific phobias. The person with a social phobia is intensely afraid of being judged by others. At social gatherings, the person with social phobia expects to be singled out, scrutinized, judged, and found lacking. People with social phobias are usually very anxious about feeling humiliated or embarrassed. They are often so crippled by their own fears that they may have a hard time thinking clearly, remembering facts, or carrying on normal conversations. The individual with social phobia may tremble, sweat, or blush and often fears fainting or losing bladder or bowel control in social settings. In response to these overwhelming fears, the person with social phobia tries to avoid public situations and gatherings of people. Social phobias tend to start between the ages of fifteen and twenty years and, if not treated, can continue throughout life.
AGORAPHOBIA.
Many people who experience panic attacks go on to develop agoraphobia—the fear of crowds and open spaces. The term comes from the Greek word agora, which means marketplace. This type of phobia is a severely disabling disorder that often traps its victims, rendering them virtual prisoners in their own homes, unable to work, shop, or attend social activities.
Agoraphobia normally develops slowly, following an initial unexpected panic attack. For example, on an ordinary day, while shopping, driving to work, or doing errands, the individual is suddenly struck by a wave of terror characterized by symptoms such as trembling, a pounding heart, profuse sweating, and difficulty in breathing normally. The person desperately seeks safety, reassurance from friends and family, or a physician. The panic subsides and all is well—until another panic attack occurs.
The person with agoraphobia begins to avoid all places and situations where an attack occurred and then begins to avoid places where an attack could possibly occur or where it might be difficult to escape and get help. Gradually, the victim becomes more and more limited in the choice of places that are "safe." Eventually, the person with agoraphobia cannot venture outside the immediate neighborhood or leave the house. The fear ultimately expands to touch every aspect of life.
Agoraphobia usually begins during the late teens or twenties, and about 5 percent of the adult population has it. (See Table 8.1.) Women tend to be affected two times more often than men.
PHOBIA TREATMENT PROGRAMS.
Phobia treatment centers now exist throughout the United States. The programs use a wide variety of cognitive/behavioral therapy techniques to help patients face and overcome their fears. In addition, drugs may be used to ease the symptoms of anxiety, fear, and depression and to help the person return to a normal life more quickly. Antidepressants have been shown to help people who suffer from panic attacks and agoraphobia. In addition, antianxiety drugs are useful in treating the generalized anxiety that frequently accompanies phobias.
Obsessive-Compulsive Disorder
People with obsessive-compulsive disorder (OCD) cannot control their thoughts or behaviors. OCD is an anxiety disorder marked by unwanted, often unpleasant recurring thoughts (obsessions) and repetitive, often mechanical behaviors (compulsions). The repetitive behaviors, such as continually checking to be certain windows and doors are locked or repeated hand washing, are intended to dispel the obsessive thoughts that trigger them—that an intruder will enter the house through an unlocked door or window or that disease will be prevented by hand washing. The vicious cycle of obsessions and compulsions only serves to heighten anxiety; the OCD can debilitate those who have the disorder.
The NIMH estimates that about 2.3 percent of adults between the ages of eighteen and fifty-four suffer from OCD annually. OCD strikes men and women equally; it sometimes coexists with other disorders such as substance abuse, eating disorders, or depression; and its symptoms generally appear during childhood or adolescence. Imaging studies using positron emission tomography (PET) reveal that people with OCD have different patterns of brain activity than those without the disorder. Further, the PET scans show that the part of the brain most affected by OCD (the striatum) changes and responds to both medication and behavioral therapy.
Many of the medications used to treat other anxiety disorders appear effective for patients with OCD along with a behavioral type of therapy called "exposure and response prevention," during which patients with OCD learn new ways to manage their obsessive thoughts without resorting to compulsive behaviors.
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