Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older (18% of U.S. population). Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment. People with an anxiety disorder are three to five times more likely to go to the doctor because they seek relief for symptoms that mimic physical illnesses. (The Anxiety Disorders Association of America)
The term “anxiety disorders” encompasses several clinical conditions:
- panic disorder, in which feelings of extreme fear and dread strike unexpectedly and repeatedly for no apparent reason, accompanied by intense physical symptoms
- obsessive-compulsive disorder (OCD), characterized by intrusive, unwanted, repetitive thoughts and rituals performed out of a feeling of urgent need
- post-traumatic stress disorder (PTSD), a reaction to a terrifying event that keeps returning in the form of frightening, intrusive memories and brings on hypervigilance and deadening of normal emotions
- phobias, including specific phobia a fear of an object or situation and social phobia a fear of extreme embarrassment
- generalized anxiety disorder (GAD), exaggerated worry and tension over everyday events and decisions
Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which underlie anxiety disorders. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body’s fear response is coordinated by a small structure deep inside the brain, called the amygdala.
Neuroscientists have shown that when confronted with danger, the body’s senses launch two sets of signals to different parts of the brain. One set of signals, which takes a more roundabout route, relays information to the cerebral cortex, the cognitive part of the brain that explains in detail the threatening object or situation such as a big black car heading for you as you cross the street. The other set of signals shoots straight to the amygdala, which sets the fear response in motion, readying the body for quick action before the cognitive part of the brain comprehends just what is wrong. The heart starts to pound and diverts blood from the digestive system to the muscles for quick action. Stress hormones and glucose flood the blood stream to provide the energy to fight or flee. The immune system and the pain response are suppressed to prevent swelling and discomfort, which could interfere with a quick escape. And, as a preventive measure for similar confrontations in the future, the learned fear response is etched on the amygdala.
One or more fearful experiences can prime a person to respond excessively to situations where most people would experience no fear-such as in the supermarket-or only moderate nervousnesss-such as giving a speech. In anxiety disorders, the deeply etched memory can result in hypervigilance, making it hard to focus on other things, and leading to feelings of anxiety in many situations. In people who have survived overwhelming trauma and developed PTSD, for example, even mild reminders of the trauma may initiate the fear response. People with specific or social phobia often completely avoid their feared situation. In panic disorder the chronic worry about having another attack may lead to stress-related conditions such as heart problems and irritable bowel syndrome. In people with generalized anxiety disorder, the chronic anxiety may prevent them from focusing on even the simplest tasks. The amygdala, although relatively small, is a very complicated structure, and recent research with animals suggests that different anxiety disorders may be associated with activation in different parts of the amygdala.
In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person’s preference. Before treatment begins, a doctor must conduct a careful diagnostic evaluation to determine whether a person’s symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.
Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations of treatment before they find the one that works for them.
Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not a substitute for care from a mental health professional.
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. Check with your physician or pharmacist before taking any additional medications.
(The National Institute of Mental Health (NIMH), a part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services)