1. About Anxiety Disorders
When one is faced with danger, threat or stress, anxiety is a natural reaction that everyone experiences.
Anxiety is part of our fight or flight response, which helps us to be on the alert for potentially dangerous or scary situations such as crossing a busy road or approaching a big black spider in the bathtub.
However for one out of ten people anxiety prevents them from living their life the way they want.
Problem anxiety can take various forms - panic attacks that occur out of the blue; incredible fear about situations or objects that are not actually dangerous or usually scary (like going to the shops), uncontrollable concerns and worry about almost everything, or compulsive repetition of a ritual due to an idea that it will reduce anxiety, i.e. washing hands repeatedly to get rid of germs.
Anxiety has similar physical and emotional symptoms to fear. Fear, however, is always based on something. With anxiety disorders a person feels the fear, but cannot necessarily name the reason they feel anxious.
During a panic attack, the fear you experience may be so intense that you feel like you are about to die, lose control, have a heart attack or stroke, or go crazy.
Some of the physical symptoms of a panic attack include sweating, feelings of choking, trembling or pounding of the heart. Panic attacks occur as part of different anxiety disorders.
If you suffer from an anxiety disorder, you may suffer from a wide variety of symptoms:
Emotional: You are likely to feel irritable, uneasy and find you excessively worry about things. You may also often feel that something dreadful is about to happen. You may feel highly strung.
Physical: You may have heart palpitations or chest pain, muscle tension, sweating, breathing difficulties, faintness, headaches and nausea. You may find it hard to relax, hard to concentrate and difficult to sleep.
Behavioural: You may go to great lengths and develop elaborate plans to avoid certain places, situations or objects.
2. What is anxiety?
Anxiety is a normal response in a scary, dangerous or unknown situation. Anxiety involves the physical and psychological reaction that is necessary to prepare a body for either running away or fighting if necessary - known as the flight or fight response.
This was certainly how we were able to equip ourselves to deal with danger in our distant past. The autonomic nervous system prepares the body to cope with danger by releasing adrenaline, which in turn increases blood pressure and puts the body and senses into a state of intense awareness, increased sensitivity and hyper-alertness. When the body triggers off this response, the person essentially feels nervous.
You would have felt this when you had an exam coming up, or had to give a talk, or found yourself having to cross a very busy road. The nervous system puts your body in an alert state, so that you can be at your best to deal with what it interprets as a dangerous or life-threatening situation.
3.When does it become a problem?
These days, however, events that trigger the flight or fight response are not usually life threatening or physically dangerous. Our stresses are more likely to involve meeting a deadline at work, being stuck in traffic, or finding our bills are piling up. The flight or fight response doesnt help us with these modern-day stresses. Anxiety becomes a problem when it is so constant, so pervasive, that it interferes with our lives. If a person is always feeling nervous, then they are constantly getting the internal message that something is wrong. They have difficulty relaxing enough to get on with day-to-day responsibilities and commitments. If anxiety is constant it has a detrimental effect on a persons physical health. It is physically stressful for a body to feel anxious all the time. The flight or fight response decreases the effectiveness of the immune system thus a person is more vulnerable to becoming sick.
4. Different types of anxiety disorders
Panic disorder is an illness where a person experiences panic attacks in situations where most people would not be afraid. Panic disorder is a dysfunction of the normal panic/anxiety reaction that would occur if you were in actual danger.
Panic attacks occur when the body gives off the same distress signals, as when a person is faced with a life-threatening or dangerous event, yet no such trigger is present. This means that a person may be sleeping, relaxing or just going about their daily business, when they suddenly feel some or all of the symptoms of a panic attack. These include: chest pain, trembling legs, the person feeling they are going crazy or that they are about to have a heart attack.
Physical symptoms of panic attack include:
Feelings of choking
Fear of dying, losing control or going crazy
Shortness of breath
Hot and cold flushes
Feelings of unreality
Panic attacks are described as a terrifying experience. Feelings of apprehension, fear that something really terrible is happening may also be present. Individuals with panic disorder often display characteristic concerns about the implication or consequences of the panic attacks. For example, that a panic attack may signify a major illness, or that the person is losing control or going crazy.
Panic disorder typically begins between late adolescence and the mid-thirties. The frequency and duration of panic attacks vary widely. Some individuals have moderately frequent attacks (e.g. once a week) that occur regularly for months at a time. Others experience short bursts of more frequent attacks (e.g. daily for a week) separated by weeks or months without any attacks. Panic disorder may also co-exist with depression, generalised anxiety disorder and personality disorders.
Panic disorder can occur with or without agoraphobia. Some people with agoraphobia do not have panic attacks, and many people with panic disorder do not develop agoraphobia. But large numbers suffer from both. Certain illegal drugs, such as marijuana, and other substances, such as caffeine, can trigger panic attacks as can fear of a specific object or social situation.
Agoraphobia is an anxiety disorder characterised by an uneasiness, fear or dread about leaving familiar surroundings. This may include a reluctance to travel, particularly on public transport, or to be in crowded places. It is associated with severe physical symptoms of anxiety and panic attacks. It is a condition related to anxiety, depression, panic and other phobias.
The word agoraphobia is derived from the Greek agora which means market place and phobia meaning fear of. It was first considered to be simply a fear of being in a public place (e.g. the market place). However the fear and dread about leaving home (or other O.K. place) is considered not to be associated with fear of the public place in itself, nor of lots of people, but actually the learnt fear from a previous experience of a panic attack in such a location.
First, a person may have a panic attack (for any number of reasons, including stress). Then a real fear develops that it may happen again, and situations are avoided which remind a person of the previous panic attacks. Panic attacks are frightening and embarrassing, so it is a natural reaction to do things to avoid what is perceived to have caused the panic attack.
A fear can be developed for almost anywhere. It can be open public places such as shopping centres, railway stations, airports or closed places like churches, theatres, buses, trains, aircraft or quiet places such as empty streets or a store at closing time. The situation can become very generalised from a fear of one place to the point where a person cannot leave home at all.
The onset of agoraphobia can be sudden and unexpected or it can take months or years for the condition to develop - from a mild phobic anxiety to a feeling of dread of many public situations. The fear of leaving the house may literally extend even to collecting the milk, mail or newspaper from the front step or gate.
There may be many factors playing a part in the development of agoraphobia - such as loss, separation or the death of a family member or close friend. Sudden life changes may bring emotional stress. Long-term emotional stress, which builds up gradually, often without its seriousness being recognised, can trigger panic attacks, which can gradually develop into agoraphobia.
Once a person develops agoraphobia, it is further reinforced by feelings of hopelessness, anger, frustration and guilt about the agoraphobia itself.
While the symptoms of agoraphobia may fluctuate, they may include:
Feelings of depression
Abuse of tranquillising drugs and alcohol for relief of symptoms
Fear of loss of control
Loss of self-esteem and self- confidence
Frustration and anger with oneself
Anxiety and panic attacks
The physical symptoms of anxiety and panic attacks may include:
Feeling of light-headedness
Feeling of being detached or distant from surroundings or even from ones own body
Buzzing in the ears, blurred vision, a dry mouth, tingling in the face and arms
Difficulty in breathing - perhaps breathlessness without apparent cause
Sudden feeling of extreme panic
Severe backache without apparent cause
Headaches and other muscle aches and pains
Weakness of the legs
Hands which shake
Fear of fainting
Fear of heart attack.
Generalised Anxiety Disorder (GAD)
You may worry constantly about being harmed, about financial disaster, your health, work and/or personal relationships. General anxiety disorder is marked by unrealistic and excessive worry, accompanied by constant and often unnecessary concern about anything or everything. People with Generalised Anxiety Disorder are excessively worried about two or more life situations most of the time. This may be extreme concern about their health and perhaps their finances, despite both being in reasonable condition.
Generalised Anxiety Disorder is one of the anxiety disorders. A person with GAD is in a state of constant anxiety over many aspects of their life relationships, work, health, family and/or finances. Just about anything that a person can think about they worry about. The concerns are ongoing, extreme and unrealistic. The person feels worried and anxious most of the time.
Symptoms associated with generalised anxiety disorder include:
Mind becomes alert
Heart rate increases, blood pressure rises
Mouth gets dry, increased thirst
Breathing rate increases
Immune response decreases
Feelings of fear and apprehension
Feeling sick or nauseous
Trembling and shaking
Butterflies in the stomach
Feeling out of control
Feeling as if you are going crazy
It is difficult coping with constant anxiety some people smoke, drink or use other recreational or non-prescription drugs however these drugs only exacerbate the problem. Cigarettes, coffee and other stimulants decrease the anxiety for short periods, but the stimulant nature of these drugs actually puts more strain on the nervous system as it increases the alert mode. Alcohol and other depressants are other short-term fixes anxiety often couples with depression so alcohol only leads a person to increased anxiety when they are not drinking, and depression when they are.
Obsessive Compulsive Disorder (OCD)
If you are experiencing OCD, you may have constant and unwanted thoughts which often result in the performance of elaborate rituals in an attempt to control or banish those persistent thoughts. You will feel you have no control over your actions. You may be so embarrassed about your obsessive behaviour that you have kept it a secret, even from your family. Some people may be obsessed with order and cleanliness. One ritual associated with this can be washing hands hundreds of times a day.
Obsessive Compulsive Disorder is an Anxiety Disorder that is mainly characterised by intrusive thoughts (obsessions) and behaviours (compulsions). Individuals with OCD are besieged by patterns of unwanted, repetitive thoughts and repetitious behaviours that are distressing and difficult to ignore or overcome completely.
OCD is the fourth most commonly occurring psychiatric disorder after substance abuse, major depression and phobias. OCD can affect anyone regardless of class, culture, sex, status or level of intelligence. On average OCD affects 2-3% of the Australian population (Robins et al., 1984). That means that about 450, 000 Australians will suffer from OCD during some stage of their lives.
Obsessive Compulsive Disorder can affect people in many different ways. Not all people experience the same symptoms or the same degree of intensity of symptoms, although all people who suffer from OCD experience obsessions and/or compulsions.
Obsessions are intrusive, unwanted and often disturbing thoughts that the person cannot control. Persistent fears of contamination, that they are to blame for something or an overwhelming need to do things perfectly, are common. Time after time, the individual will experience a distressing and anxiety- provoking thought, such as, Have I left the iron on?, have I injured somebody else? or Do I have something physically wrong with me?
Compulsions are repetitive, distressing and purposeful physical behaviours that may relate to the obsessive thoughts. Examples of compulsive behaviours include the need of the individual to repeatedly wash their hands due to the fear of contamination, the constant need to check that things have been done, like whether doors or windows have been locked, or even avoidance of certain objects and situations (holes in the road, cracks or lines in pavement).
All of these compulsive behaviours are a way for the person to try to reduce their feelings of anxiety. This repetitive behaviour can interfere with a persons life to the extent that the individual cannot leave home or function at school or at work, because of the many hours spent performing these rituals.
The exact causes of OCD are not fully understood. There are, however, a number of possible theories which suggest that it could be genetic, a result of the interaction between behaviour and environment, beliefs and attitudes, or even chemical changes in the brain, usually related to the brain chemical serotonin.
Post-traumatic Stress Disorder (PTSD)
If you have experienced a major trauma like war, torture, abuse in childhood, car accidents, fires or violence you may continue to feel terror long after the event is over. You may experience nightmares or flashbacks for many years after the event.
Post Traumatic Stress Disorder (PTSD) was introduced into the American Psychiatric Associations official manual in 1980. PTSD is a label for the range of symptoms that may be experienced days, weeks, months or even years after being exposed to a traumatic event or series of events. These traumatic events range from experience of war, child abuse, domestic violence, rape, robbery, assault or car accidents.
Sometimes PTSD arises from witnessing the trauma of another person, particularly a friend or relative. The events usually involve threat to the persons life or physical integrity. The immediate feelings are helplessness, horror and/or intense fear. PTSD is unique amongst mental disorders because the person has to have been exposed to a previous event that is considered traumatic in order to be diagnosed with PTSD.
The symptoms that commonly occur in people suffering from PTSD have been divided into three categories: Intrusions, Hyper-alertness and Avoidance.
Intrusions: Re-experiencing the events as flashbacks or nightmares that occur suddenly, without conscious control. These are very distressing, disrupting sleep and normal activities of life.
Hyper-alertness: A state of hyper-vigilance or increased sensitivity to things such as a phone ringing or the sudden appearance of a person which leads to a physical reaction (e.g. jumping with fear; feeling nauseous) which is out of proportion to the stimulus. The person is edgy, agitated and appears to be on the lookout for a perceived danger.
Avoidance: The person tends to avoid anything (e.g. certain places, going out at night, being alone) that may result in a memory of, or a feeling from, the original traumatic experience. This symptom particularly impacts upon interpersonal relationships. The person may report feeling emotionally numb; unable to experience their usual feelings for people and things, and will often act very impersonally to people with whom they are closest.
Often the person finds it difficult to trust others or to feel safe and secure anywhere. As this continues the person becomes detached from friends, colleagues and family, thus adding to his/her isolation. The person may experience physical signs such as rapid breathing, sweating and becoming agitated. Poor sleep patterns (due to insomnia and nightmares) affect concentration and memory, and thus can lead to a deterioration of work and study performance.
Post-Traumatic Stress Disorder is rarely diagnosed on its own. It is often accompanied by depression, anxiety, panic attacks, social phobia, agoraphobia or other psychiatric illnesses. Many people recovering from the after-effects of trauma abuse alcohol, nicotine and other drugs, thus complicating the situation further. Substance abuse is addressed within PTSD treatment.
Is a fear that others will judge everything you do in a negative way. You may cope either by trying to do everything perfectly, limiting the amount you do (like writing, eating, speaking) in front of others or you may withdraw gradually from contact with others.
Social Phobia, also know as Social Anxiety Disorder, is the third most common psychiatric condition after depression and alcoholism. Its central feature is a persistent fear of scrutiny from others. It includes a fear of social situations and interactions with other people that automatically bring on feelings of self-consciousness, judgement and negative evaluation. A specific social phobia may be a fear of public speaking; a generalised social phobia occurs when a person is anxious, nervous and uncomfortable in almost all social situations.
What are the symptoms?
People with this disorder experience significant emotional distress in the following situations:
Being introduced to other people
Being teased or criticised
Being the centre of attention
Being watched while doing something
Meeting people in authority
Most social encounters
Making small talk at parties
Speaking in a group
The physical symptoms that occur include:
Dry mouth and throat
Franz Kafka once said, But if I am in an unfamiliar place with a number of strange people...then the whole room presses on my chest. My whole personality seems to get under their skins and everything gets hopeless.
Phobias usually involve fear about particular objects or situations. They cause major disruptions in your daily living. You may go to great lengths to avoid confronting the particular object or situation. Having a fear is not so unusual, but when it interferes with getting on with responsibilities in your life, then it can become a problem. For example, having a fear of flying is not a problem until you find yourself planning a holiday overseas or find you need to travel for your job.
5. Causes of anxiety disorder?
An absolute cause for anxiety disorders is not known. Some ideas that researchers have include:
a) An imbalance of certain brain chemicals/hormones. Neurotransmitters could be at the source of anxiety disorders. Certain chemicals control the fight or fight response in times of a real emergency. A change in the balance of these chemicals could lead to someone always being in a state of readiness for an emergency even when none exists. Some researchers think people can inherit a predisposition to chemical imbalances.
b) Certain personality traits, such as being sensitive and emotional can make people more vulnerable to anxiety. Being a sensitive person often leads the caring, empathic person to over-concern and worry about lots of things beyond their control and/or responsibility.
c) Anxiety may onset particularly during periods of high-level stress; in some cases the body may not be able to stop the physiological response after the stress has gone. Having to deal with a lot of stress all at once, or in seemingly endless succession, can stretch the mind and bodys ability to cope, and make a person vulnerable to developing an anxiety disorder.
6. Long term problems with continuing anxiety disorders
If anxiety levels remain high over an extended period of time then it can have a detrimental effect on the body. Physical problems can arise because there is a decrease in immune response to illness and infection, increased chance of heart trouble due to increased blood pressure and intestinal problems such as irritable bowel syndrome. Without treatment, anxiety can become quite severe and the following symptoms may become more troublesome:
Jumping at sudden noises
Muscle aches and pains from persistent tension
Losing interest in activities usually enjoyed socialising for instance
Digestion and stomach problems
Ongoing difficulties with relationships.
7. Treatments for Anxiety
There are a number of therapies that have proven effective in the treatment of anxiety disorders. A psychologist or other mental health professional is able to make an assessment regarding your anxiety and /or panic disorder, and either treat it, or inform you regarding the options available for treatment. Panic disorder is highly treatable and most people who seek treatment will resume normal activities within a couple of months although for some it may take longer. Medication is also available and this is best used in conjunction with therapy.
This type of therapy is a step-by-step structured technique tailored by therapists to suit individual clients. Essentially behaviour therapy is about unlearning disruptive patterns and replacing them with new behaviours.
Cognitive Behaviour Therapy (CBT)
Cognitive behaviour therapy challenges the persons thought patterns and behaviour. Cognitive therapists focus their treatment on assisting the person to modify thoughts causing their unwanted behaviour. In the case of OCD, Cognitive Behaviour Therapy can prepare the ground for the use of behaviour therapy and can also help to prevent any future return of the symptoms after the treatment has finished.
This is a form of talking therapy. It can help the individual to understand and contemplate their feelings and the difficulties they experience directly as a result of the disorder.
Self-help support groups can play a helpful role in the recovery process, enabling you to meet other people who know what it is like to live with this illness. Support groups provide support, friendship, education, understanding and information for the individual with this disorder and to their friends and family.
In this therapy a person is taught relaxation techniques, and through combining a relaxed body state with thought of the feared situation, a person gradually overcomes their fears.
A person is immersed in their feared situation with the idea that they have faced their worst fear and survived.
Anti-depressant drugs, which specifically affect the serotonergic neurotransmitter system, are the most useful of pharmacological interventions. These drugs are not addictive substances and work on correcting chemical imbalances within the brain. This is thought to reduce patterns of compulsive behaviour. Unfortunately, medications are not equally effective for all sufferers.
Medications are often prescribed, but have not been found to be effective without some additional therapy. Medication can play a useful role to overcome some of the distressing symptoms in order for a person to get to work or simply get out of the house. However to prevent recurrence it is best used in conjunction with therapy.
8. Reluctance to seek treatment
Almost all people with anxiety disorders can be assisted to some extent by treatment. However, often people are reluctant to ask for help. Reasons that a person may not want to seek help my include:
Fear that instead of helping them, therapy will only make them feel worse about themselves
Feelings that if they forget about things that the feelings will just go away
Beliefs that nothing will help, that nothing could possibly work
Beliefs that they ought to be able to handle it themselves, without any help.
9. What can I do for myself?
To help relieve mild anxiety and assist in the long term management of feelings of anxiety:
Talk to a friend, a relative or your partner or a counsellor about your feelings.
Eat a balanced diet especially more vegetables and less fast food.
Exercise Regular (including light exercise like walking) can help reduce feelings of depression and anxiety. Exercise can keep you grounded
Relaxation this is different for everybody you may watch TV or read a book, go for a walk, see a movie or have a bath. Others find slow breathing or progressive muscle relaxation beneficial.
10. How to be a good helper to someone with an anxiety disorder
Listen when the person talks of his/her feelings: dont judge
Offer support, not pity.
Accept your own limits, and communicate this. Encourage him/her to find professional help
Take care of yourself; maintain a life of your own
Seek emotional support for yourself from other sources
You cannot fix a person. You can listen - that is good enough.
11. Where to get help
Mental Health Information Service (for services in your area) (02) 9816 5688 toll free 1800 674 200
Your local GP
Community Health Centre (see the White Pages)
Anxiety Disorders Alliance on 02 9570 4126
There are specialist Anxiety clinics in most major hospitals and Universities. See your GP or Community Health Centre for a referral
Sexual Health Hotline (Family Planning Australia): 1800 188 171
Sydney Rape Crisis Centre: (02) 9819 6565 - 24 hr crisis intervention counselling for women experiencing trauma related to sexual assault (including from childhood)
STARTTS (Service for Treatment & Rehabilitation for Trauma & Torture Survivors): (02) 9726 1033 (Fairfield) or (02) 9794 1900 (Carramar) - counselling & various rehabilitation programs available.
Clinic for Anxiety & Traumatic Stress: (02) 9722 8992 (Bankstown)
Lifeline: 13 1114 - for 24 hour counselling/support
Victims of Crime: 1800 633 063 - telephone counselling for emotional trauma resulting from any crime
Vietnam Veterans Counselling Service: (02) 9635 9733 or 1800 043 503 (Sydney & country NSW)
The Anxiety Disorders Unit, St Vincents Hospital, Phone: (02) 9332 1188
Anxiety Disorders Clinic, Westmead Hospital, Phone: (02) 9845 6686
Australian Psychological Society (APS) 1800 333 497 for a referral to a psychologist in your area.
12. Reading List
Benson, H. (1975), The relaxation response, New York: Morrow
Montgomery, B and Evans, L. You and Stress. Ringwood, Viking O'Neil.
Page, A. (1993) Don't Panic: Overcoming Anxiety, Phobias, and Tension. Sydney: Gore and Osment.
Panic Disorder and Agoraphobia
Barlow, D.H., & Craske, M.G. (1994). Mastery of your anxiety and panic II. San Antonio TX: The Psychological Corporation. In Canada, 1-800-387-7278.
Silove, D., & Manicavasagar, V. (1997). Overcoming panic: A self-help guide using cognitive behavioral techniques. London: Robinson Publishing.
Wilson, R.R. (1996). Don't panic: Taking control of anxiety attacks (revised edition). New York: Harper Perennial.
Zuercher-White, E. (1997). An end to panic: Breakthrough techniques for overcoming panic disorder, 2nd Edition. Oakland, CA: New Harbinger Publications.
Franks, H. (1996). Hidden fears: Self help for anxiety and phobias. London: Headline Book Publishing.
Markway, B.G., Carmin, C.N., Pollard, C.A., & Flynn, T. (1992). Dying of embarrassment: Help for social anxiety and phobia. Oakland, CA: New Harbinger Publications.
Baer, L. (1991). Getting control: Overcoming your obsessions and compulsions. Boston, MA: Little, Brown and Company.
Foa, E.B. & Wilson, R. (1991). Stop obsessing! How to overcome your obsessions and compulsions. New York: Bantam Books.
Schwartz J.M. (1996). Brainlock: Free yourself from obsessive-compulsive behavior. New York: ReganBooks.
13. FURTHER INFORMATION
Tel: (02) 9816 5688
Tel: 1800 674 200
(Outside Sydney Metropolitan Areas)
Weekdays: 9.30pm - 4.30pm
Largest information data base of government and non-government mental health services in NSW
Extensive range of mental health publications & videos
Mutual support & self help groups
Referral for a wide range of mental health services
Friendship House, Library & Resource Centre (open to the public 9.30am - 4.30pm Monday-Friday, closed Wednesday 9.00am 12.00 am)
Mental Health Information Service
Mental Health Association NSW
60-62 Victoria Rd
Gladesville NSW 2111
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