Worried that you worry too much? Everyone worries or gets scared sometimes. But feeling extremely worried or afraid much of the time, or repeatedly feel panicky, may be signs of an anxiety disorder.
Anxiety disorders include panic attacks, post-traumatic stress disorder, and obsessive-compulsive disorder. They are among the most common mental illnesses, affecting roughly 40 million American adults. A person has an anxiety disorder if she or he has persistent worry for more days than not, for at least several months. Some people with anxiety feel they have always been worriers, even since childhood or adolescence. In other people, anxiety comes on suddenly, triggered by a crisis or a period of stress, such as the loss of a job, a family illness, the death of a relative, or other tragedy.
Numerous therapies can help control anxiety. These include psychotherapy and medication, ideally supported by good nutrition, sleep, and regular exercise. People who are anxious tend to reach for unhealthy "comfort" food—and then worry about it. Or they completely avoid food, skipping meals or even fasting—and worry that something is wrong, such as an undiagnosed cancer. Healthy eating can avoid these anxiety triggers.
Not getting enough sleep can boost a person's anxiety level. On the flip side, getting enough sleep can help control stress and anxiety. So can getting regular exercise—aim for 30 minutes of moderate-intensity exercise five days a week.
Panic disorder is a type of anxiety disorder. A person with panic disorder has panic attacks. These are repeated, unexpected episodes of intense fear and anxiety accompanied by physical symptoms that are similar to the body's normal response to danger.
If you are truly in danger (for example, if you are confronted by a criminal with a gun), your body readies itself for "fight or flight." Heart rate increases. Blood rushes to arm and leg muscles, causing a trembling or tingling sensation. You may sweat and become flushed. You become intensely fearful, aroused and very alert. For people having a panic attack, these changes occur even though there is no danger. At the height of a panic attack, there may be a frightening feeling that the environment has somehow become unreal or detached. The person may worry about dying, having a heart attack, losing control or "going crazy."
In obsessive-compulsive disorder (OCD), a person is troubled by intrusive, distressing thoughts (obsessions) and feels the pressure to carry out repetitive behaviors (compulsions).
Neuroscientists believe that the brain pathways involved with judgment, planning and body movement are altered in OCD. Environmental influences, such as family relationships or stressful events, can trigger or worsen OCD symptoms.
OCD affects an estimated 2% to 3% of people in the United States. The percentage is about the same in Canada, Korea, New Zealand and parts of Europe. About two-thirds of people with OCD have the first symptoms before they are 25 years old. Only 15% develop their first symptoms after age 35. There is strong evidence that the illness has a genetic (inherited) basis, since about 35% of people with OCD have a close relative who also has the condition. Although 50% to 70% of patients first develop OCD after a stressful life event – such as a pregnancy, a job loss or a death in the family – experts still do not understand exactly how stress triggers the symptoms of this illness.
Sometimes people with OCD manage their obsessions without giving any external sign that they are suffering. Usually, however, they try to relieve their obsessions by performing some type of compulsion: a repeated ritual that is aimed at soothing their fears. For example, a woman who has the obsession that her hands are dirty may develop the compulsion to wash them 50 times a day. A man who fears that his front door is unlocked may feel compelled to check the lock 10 or 20 times each night.
A phobia is a persistent, excessive, unrealistic fear of an object, person, animal, activity or situation. It is a type of anxiety disorder. A person with a phobia either tries to avoid the thing that triggers the fear, or endures it with great anxiety and distress.
There are three major types of phobia:
Specific phobia (simple phobia). With this most common form of phobia, people may fear specific animals (such as dogs, cats, spiders, snakes), people (such as clowns, dentists, doctors), environments (such as dark places, thunderstorms, high places) or situations (such as flying in a plane, riding on a train, being in a confined space). These conditions are at least partly genetic (inherited) and seem to run in families.
Social phobia (social anxiety disorder). People with social phobia fear social situations where they may be humiliated, embarrassed or judged by others. They become particularly anxious when unfamiliar people are involved.
Agoraphobia. Agoraphobia is a fear of being in public places where it would be difficult or embarrassing to make a sudden exit.
Childhood phobias occur most commonly between the ages of 5 and 9, and tend to last a short while. Most longer-lasting phobias begin later in life, especially in people in their 20s. Adult phobias tend to last for many years, and they are less likely to go away on their own. Without proper treatment, phobia can increase an adult's risk of other types of psychiatric illness, especially other anxiety disorders, depression and substance abuse.
Several studies have shown that about a quarter of people with cardiovascular disease have some kind of anxiety problem and, in some cases, the anxiety seems to make the heart condition worse. Researchers have reported, for example, that heart patients who have generalized anxiety disorder — constant, pervasive worrying, even about mundane matters — are more likely to have heart attacks and serious heart problems than heart patients who don't.
Smartphones and tablet computers are making it easier to get health care information, advice, and reminders on an anywhere-and-anytime basis. Hundreds of health and medical apps for smartphones like the iPhone became available this year. Some are just for fun. Others provide useful information (calorie counters, first aid and CPR instructions) or perform calculations. Even the federal government is getting into the act: the app store it opened this summer has several free health-related apps, including one called My Dietary Supplements for keeping track of vitamins and supplements and another one from the Environmental Protection Agency that allows you to check the UV index and air quality wherever you are. Smartphones are also being used with at-home monitoring devices; for example, glucose meters have been developed thatsend blood sugar readings wirelessly to an app on a smartphone. The number of doctors using apps and mobile devices is increasing, a trend that is likely to accelerate as electronic health records become more common. Check out iMedicalapps if you want to see the apps your doctor might be using or talking about. It has become a popular Web site for commentary and critiques of medical apps for doctors and medical students. Meanwhile, the FDA is wrestling with the issue of how tightly it should regulate medical apps. Some adverse events resulting from programming errors have been reported to the agency. Medical apps are part of a larger "e-health" trend toward delivering health care reminders and advice remotely with the help of computers and phones of all types. These phone services are being used in combination with increasingly sophisticated at-home monitoring devices. Research results have been mixed. Simple, low-cost text messages have been shown to be effective in getting people wear sunscreen. But one study published this year found that regular telephone contact and at-home monitoring of heart failure patients had no effect on hospitalizations of death from any cause over a six-month period. Another study found that remote monitoring did lower hospital readmission rates among heart failure patients, although the difference between remote monitoring and regular care didn't reach statistical significance.
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A growing number of studies indicate that yoga may be a beneficial treatment for mental health issues such as anxiety, depression, and post-traumatic stress disorder.
Persistent anxiety can contribute to respiratory disorders, gastrointestinal problems, and heart disease. Treating anxiety with psychotherapy, medications, or a combination can reduce or relieve physiological distress.
A study found that people who maintained a positive approach to
life in their thoughts and feelings, referred to as high
emotional vitality, had a lower risk of heart disease.
A child's world is full of dangers, real and imaginary, that many adults forget they ever experienced. Most childhood fears are normal, temporary, and eventually outgrown, but studies still show that anxiety disorders are among the most common childhood psychiatric conditions. In a high proportion of cases, it turns out that the symptoms of an adult anxiety disorder first appeared in childhood, so treatment of abnormal childhood anxiety is not only important for its own sake but may help prevent adult disorders.
Children's minds and emotions are constantly changing and developing, and they do not all develop at the same rate, so it is not always easy to distinguish normal fears from those that require special attention. Newborns typically fear falling and loud noises. Fear of strangers begins as early as six months and persists until the age of two or three. Preschool children usually fear being separated from their parents; they may also be afraid of large animals, dark places, masks, and supernatural creatures. Older children may worry about death in the family, failure in school, and events in the news such as wars, terrorist attacks, and kidnappings. Adolescents have sexual and social anxieties and concerns about their own and the world's future. These anxieties become a problem only if they persist and cause serious distress, destroy family harmony, or interfere with a child's development or education.
Generalized anxiety disorder. Formerly called overanxious disorder of childhood, these days generalized anxiety in children is recognized as the same disorder of uncontrolled worry that occurs in adults. Children with this disorder are self-conscious, self-doubting, and excessively concerned about meeting other people's expectations. They need constant reassurance and approval from adults. They may worry about school grades, storms, burglary, hurting themselves while playing, or the amount of gas in the tank. They often feel restless and tense and complain of headaches, stomachaches, and other physical symptoms.
In the United States, more than 2 million adults suffer from bipolar manic depressive disorder, an illness of extreme moods. It is characterized by deep depression followed by periods of hyperactivity and elation, referred to as mania, with periods of normal mood in between. Bipolar disorder often leads to substance abuse and one in four people with the condition attempt suicide.In a recent study published in the American Journal of Psychiatry, researchers set out to determine how often major childhood depression turns into bipolar disorder. The researchers followed up on 72 subjects who, at an average age of 10.3 years, had been treated for major depressive disorder with the tricyclic antidepressant drug nortriptyline. They also studied 28 normal subjects.At the time of follow-up, the average age of the subjects who had had prepubertal major depressive disorder was 20.7 years. Of these subjects, 33.3% now had bipolar disorder, compared to none of the normal comparison subjects.These results may, in part, be due to heredity. A large portion of the prepubertal children who had been diagnosed with a major depressive disorder had family histories of bipolar disorder. Because bipolar disorder tends to run in families, these children may have been more vulnerable to developing the condition. Another possibility is that the children who were originally treated with nortriptyline already had bipolar disorder, but had not yet experienced their first manic episode.Clinicians treating children with antidepressants should be aware of the risk that children with major depressive disorder may develop adult bipolar manic depressive disease.
Another study, published in Psychology and Medicine, sought to determine the long-term prognosis of women with postpartum psychiatric disorders. 50-80% of women experience some degree of postpartum depression within one month of delivering a child. Postpartum psychiatric disorders are more extreme.The study authors used standardized questionnaires to determine the long-term outcome of 64 women who had been hospitalized with postpartum psychiatric disorders 23 years earlier, and who had been interviewed for a 1982 study of women with diagnoses of schizophrenia, schizo-affective, bipolar, or unipolar affective disorders.The researchers found that 75% of the women had recurrent psychiatric illness, and 37% of the women had at least three subsequent episodes. However, only 29% of the 34 women who gave birth after the initial postpartum psychiatric disorder had additional episodes of maternal psychiatric illness. In addition, a majority of the 64 women were functioning well in society; 71-73% were employed and in stable relationships.The women with the best outcomes were those who had an initial diagnosis of unipolar disorder, those who experienced psychiatric illness after a first pregnancy, and those whose psychiatric illness started within one month of delivery.July 2001 Update