UNDERSTANDING ANXIETY
There are several types of anxiety. Anxiety can vary from general nervousness in new situations, to more severe, disabling anxiety. Below are some of the more serious types of anxiety and information about each.
Panic Disorder
Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief.
Many people with panic disorder develop intense anxiety between episodes, worrying when and where the next one will strike. Fortunately, effective treatments have been developed to help people with panic disorder.
How Common Is Panic Disorder?
In a given year, 1 to 2% of the U.S. population has panic disorder.
Women are twice as likely as men to develop panic disorder.
Panic disorder typically strikes in young adulthood. Roughly half of all people who have panic disorder develop the condition before age 24.
What Causes Panic Disorder?
The exact cause of panic disorder is unknown and is the subject of intense scientific investigation. Possible causes include heredity, other biological factors, stressful life events, and overreacting to normal bodily sensations. Some research suggests panic attacks occur when a “suffocation alarm mechanism” in the brain erroneously fires, falsely reporting that death is imminent.
What Treatments Are Available for Panic Disorder?
Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety. NIMH is conducting a large-scale study to evaluate the effectiveness of combining these treatments. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70% to 90% of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.
Obsessive-Compulsive Disorder (OCD)
People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals such as hand washing, counting, checking, or cleaning are often performed in hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person’s life. OCD is often a chronic, relapsing illness.
Fortunately, effective treatments have been developed to help people with OCD.
How Common Is OCD?
About 2% of the U.S. population has OCD in a given year.
OCD typically begins during adolescence or early childhood; at least one-third of the cases of adult OCD began in childhood.
OCD affects men and women equally.
OCD cost the U.S. $8.4 billion in 1990 in social and economic losses, nearly 6% of the total mental health bill of $148 billion.
What Causes OCD?
There is growing evidence that OCD has a neurobiological basis. OCD is no longer attributed to family problems or to attitudes learned in childhood - for example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Instead, the search for causes now focuses on the interaction of neurobiological factors and environmental influences. Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medication produce changes in the caudate nucleus, a part of the brain. This is graphic evidence that both psychotherapy and medication affect the brain.
What Treatments Are Available for OCD?
Treatments for OCD have been developed through research supported by the NIMH and other research institutions. These treatments, which combine medications and behavioral therapy (a specific type of psychotherapy), are often effective.
Several medications have been proven effective in helping people with OCD: clomipramine, fluoxetine, fluvoxamine and paroxetine. If one drug is not effective, others should be tried. A number of other medications are currently being studied.
A type of behavioral therapy known as “exposure and response prevention” is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and then, is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety.
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is an extremely debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm was threatened or occurred. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural or manmade disasters, car accidents, or military combat.
Most people with PTSD try to avoid any reminders or thoughts of the ordeal. Despite this avoidant behavior, many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. Symptoms of PTSD also include emotional numbness and sleep disturbances (including insomnia), depression, and irritability or outbursts of anger. Feelings of intense guilt are also common. PTSD is diagnosed only if these symptoms last more than one month. Fortunately, effective treatments have been developed to help people with PTSD.
How Common Is PTSD?
About 4% of the population will experience symptoms of PTSD in a given year.
When Does PTSD Strike?
PTSD can develop at any age, including childhood. Symptoms of PTSD typically begin within 3 months following a traumatic event, although occasionally symptoms do not begin until years later. Once PTSD develops, the duration of the illness varies. Some people recover within 6 months while others may suffer much longer.
What Treatments Are Available for PTSD?
Treatment for PTSD includes cognitive-behavioral therapy, group psychotherapy, and medications (including antidepressants). Various forms of exposure therapy (such as systemic desensitization and imaginal flooding) have all been used with PTSD patients. Exposure treatment for PTSD involves repeated reliving of the trauma, under controlled conditions, with the aim of facilitating the processing of the trauma.
Phobias
Phobias are persistent, irrational fears of certain objects or situations. Phobias occur in several forms; the fear associated with a phobia can focus on a particular object (specific phobia) or be a fear of embarrassment in a public setting (social phobia). People who have phobias are often so overwhelmed by their anxiety that they avoid the feared objects or situations. Specific phobias involve a fear of an object or situation, such as small animals, snakes, closed-in spaces, or flying in an airplane. Social phobia is the fear of being humiliated in a social setting, such as when meeting new people, giving a speech, or talking to the boss. Most people experience these fears with mild to moderate intensity, and the fear passes. For people with social phobia, however, the fear is extremely intrusive and can disrupt normal life, interfering with work or social relationships in varying degrees of severity. Fortunately, effective treatments have been developed to help people with phobias.
How Common Are Phobias?
Approximately 4 to 5% of the U.S. population has one or more clinically significant phobias in a given year.
Specific phobias occur in people of all ages. The average age of onset for social phobia is between 15 and 20 years of age, although it can often begin in childhood.
What Causes Phobias?
Traumatic events often trigger the development of specific phobias, which are slightly more prevalent in women than men. Research shows that social phobia may have a hereditary component and occurs in women and men in equal proportions. However, men may seek treatment for social phobia more frequently than women.
What Treatments Are Available for Phobias?
There is no proven drug treatment for specific phobias, but certain medications may help reduce symptoms of anxiety before one faces a phobic situation. A type of cognitive-behavioral therapy known as "exposure therapy" is also a very useful treatment for phobias. It involves helping patients become gradually more comfortable with situations that frighten them. Relaxation and breathing techniques are also helpful.
Generalized Anxiety Disorder (GAD)
Generalized Anxiety Disorder (GAD) is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with this disorder usually expect the worst; they worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia. Many people with GAD also have physical symptoms, such as fatigue, trembling, muscle tension, headaches, irritability, or hot flashes.
How Common is GAD?
About 3 to 4% of the U.S. population has GAD during the course of a year.
GAD most often strikes people in childhood or adolescence, but can begin in adulthood, too. It affects women more often than men.
What Causes GAD?
Some research suggests that GAD may run in families, and it may also grow worse during stress. GAD usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders.
What Treatments Are Available for GAD?
Treatments for GAD include medications, cognitive-behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Successful treatment may include a medication.
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