The difference between healthy anxiety and anxiety disorders is that the anxiety is out of all proportion to the situation and interferes with normal daily activity, so that rather than helping you to cope, this normally helpful emotion can disrupt your daily life. People who get anxious are often dismissed, being told they are weak or lack moral fibre. This type of attitude is outmoded and inappropriate. We know from research that anxiety disorders are extremely unpleasant and can lead to very persistent distress, causing people to become housebound, unable to work and in more severe cases, going on to develop alcohol problems, drug addiction or even severe depression.
Q. What different types of anxiety are there?
A. Psychiatrists and psychologists classify different sorts of anxiety as follows.
Generalised anxiety disorder: With this anxiety there is exaggerated tension without apparent cause. It can be severe but doesn't usually cause people to avoid certain situations. People with general anxiety disorder often find it difficult to relax or fall asleep and may experience light-headedness, shortness of breath, nausea, trembling, muscle tension, headaches, irritability or sweating.
Agoraphobia: This is one of the most disabling anxiety disorders and is diagnosed when panic attacks cause people to avoid normal activities. As such people avoid situations where they fear a panic attack may occur, in crowds or stores, on bridges and on public transport. They often become so restricted that they can't work and may even not feel confident enough to leave their homes.
Panic disorder causes people to feel terror suddenly and unpredictably. It can become disabling and as noted above, lead to avoidance of situations that people fear may bring on an attack. Panic attack symptoms include rapid pulse, chest pains, shortness of breath, dizziness, nausea, numbness, trembling and a fear of going crazy or dying. Depression or alcohol problems often complicate panic disorder. During a particularly intense panic attack people sometimes become so frightened they think they are going to die, and end up going to the casualty department because they are frightened they are having a heart attack.
Post-traumatic stress disorder (PTSD) can occur after terrifying events. Sufferers often have very frightening thoughts and memories, which they can't control. Anniversaries of the incident can be very difficult and ordinary events trigger flashbacks or intrusive images. Sufferers from PTSD may become easily irritated or even have violent outbursts. Depression, anxiety and alcohol dependence may complicate PTSD.
Q. How would I know whether I'm suffering from clinical anxiety or not?
A. The difference between clinical anxiety and normal anxiety is that in clinical anxiety the anxiety takes over the patient, whilst in normal anxiety the unpleasant symptoms fade once the frightening or stressful event has gone away. The most common symptom of anxiety is fear. The patient may know that the fear is irrational and yet not be able to do anything about it. Anxious patients are typically frightened of losing control, suffering from severe illness, feeling exposed or vulnerable when out in public or being frightened that they might collapse or embarrass themselves.
Alongside the intense feelings of fear there are often physical symptoms such as rapid pulse rate, tingling in the hands and feet, light-headedness, dizziness, dry mouth, muscular tension, exhaustion, insomnia, vision disturbance, pins and needles, numbness and diarrhoea. Most people are familiar with the emotional symptoms that go with anxiety such as fear, worry and panic. There are other symptoms like derealisation where the world feels unreal, or depersonalisation where you feel unreal, which are less well known and can be very frightening.
Q. What causes anxiety?
A. Anxiety is usually caused by a combination of physical and environmental triggers. Scientists and researchers have recently found that biochemical imbalances can cause anxiety, while psychologists have shown that anxiety is a learned behaviour that can be unlearned. Personality also plays a role, with research showing that people who have low self-esteem and poor coping skills may be more prone to anxiety than others. Unpleasant life experiences are also very important. Exposure to abuse, violence or poverty undoubtedly makes people more susceptible to anxiety disorders and the complications of them, particularly depression and alcohol dependence.
Q. What sort of treatments are there for anxiety?
A. There are a number of different approaches.
Talking about the problem: This is particularly helpful where the anxiety occurs after an unpleasant life event such as someone you love leaving, a relative becoming ill, or losing a job. Talk to somebody you trust, someone who is a good listener and someone who you know has common sense. Talking like this reduces isolation and may also give the opportunity to learn from other people about how they have coped with similar problems. Learning to relax: Many people with anxiety have never been taught how to relax, and this can be learnt through a self-help group, through seeing a specialist or through buying a book or audiotape, so that you can teach yourself.
Self-help groups: Self-help organisations are usually run by other patients who are suffering from anxiety themselves this makes them a good place to go for help. A lot of support and kindness is available in these groups, where you will find people who have been through similar problems to yourself and may be able to give you a lot of advice and support about what to do. Some groups are run specifically for anxious patients, like Triumph Over Phobia, whilst other groups are run for people who become anxious as part of another problem such as bereavement or a group for abuse survivors.
Psychotherapy: For some people, particularly those with very severe disabling anxiety, seeing a specialist is helpful. Because anxiety can sometimes be associated with physical illnesses, it is probably a good idea to be checked up by your GP first. Your GP will then be able to refer you on to a psychologist, psychiatrist or nurse specialising in cognitive behaviour therapy. Cognitive behaviour therapy is a treatment that can take place individually or in groups, and usually takes about 10 weeks. Treatment usually means gradually facing up to your anxiety. Provided you are willing to try to do this, psychotherapy is very effective. Remember, anxiety can be very demoralising. It is important not to allow the anxiety to take over completely but to retain some hope and keep on trying.
Medication: Drugs can play a part in the treatment of anxiety, particularly where it is severe. Your GP may offer you a tranquilliser like Valium (drugs of this type are called benzodiazepines ) or a modern antidepressant (these are called SSRI's). Benzodaizepines (e.g. Valium) are very effective at relieving anxiety but we know that if you take them for more than 2 or 3 weeks they can be very addictive and cause unpleasant withdrawal symptoms when you try and stop them. These drugs should only be used for short periods. Antidepressants on the other hand are not addictive. One of the drawbacks of antidepressants is that they can take up to 6-8 weeks to work.
Q. My doctor started me on antidepressants and they made me feel worse. What should I do?
A. We know from research that antidepressants such as those known as SSRIs are very effective in treating anxiety, provided they are taken for at least 6 to 8 weeks. The problem with these drugs is that they often cause side effects first before they lead to improvement, particularly in anxious patients who tend to be rather sensitive about bodily symptoms. With antidepressants it is important to discuss with your doctor the type of side effects you might get and also to talk about how long it might take for the medicine to work. In the most severe forms of anxiety it may be necessary to combine the antidepressant with one of the benzodiazepine tranquillisers mentioned above in order to get over the very difficult period of increased anxiety during the first 2 to 3 weeks after starting the antidepressant.
You may have read scare stories in the press about using medication for anxiety. All drugs do have side effects and a very few patients will react badly to antidepressants. It is important not to forget that what you don't read in the press very often is about the many patients whose lives have been transformed by the correct use of either modern antidepressants, psychotherapy or both.
