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Do I Have
Anxiety
Needing Treatment?
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--Do people say you worry
too much?
- Are you overly sensitive to others people's feelings?
- Are you usually shy, self-conscious and embarrass easily?
- Are very nervous in social situations?
--Do you feel anxious at least one thing every day?
--Have you been through a crisis or trauma recently?
--Do you ever get a sudden rush of fearfulness without any apparent
reason?
About five percent of Americans experience severe anxiety
at one time or another in their lives. Only one out of four of
them has sought treatment for their disorder. Whether or not
you can answer "Yes" to any of the above questions
at this point in time, it is a good idea to be aware of the symptoms
and causes of anxiety disorders so that you can recognize any
future symptoms that you may want to have professionally diagnosed.
We All Worry
From time to time we all worry about things that are important
to us.
Students worry about their grades, some passengers are nervous
when they are boarding an airplane, and even a first date can
be nerve-wracking. What job applicant isn't anxious about whether
he or she will get the job? Usually, when the anxiety-producing
circumstance is over, we are no longer concerned and stop thinking
about it. We may experience a sense of calm or satisfaction about
the event.
But for some people, the resolution of a problem does not
end their mental and emotional distress. They immediately start
fretting about something else, and then something else. Their
fear becomes the focal point of their daily experience. For these
individuals, fear becomes a pervasive force that disrupts their
lives or, in some cases, prevents them from functioning normally.
Examples are people who take trains or buses to their business
meetings across the country because they are afraid to fly. Or
persons become so terrified of the "dangers" outside,
they cannot leave their houses.
Being afraid is a healthy, normal response. It is a survival
mechanism we share with the animal kingdom that keeps us out
of threatening situations and preserves our lives. But when fear
becomes so intense, so relentless and so overwhelming that it
causes great distress and on-going disruption of normal functioning,
it is a serious problem that needs to be remedied.
A Wide Range of Causes
Anxiety can be caused by substance abuse or even prescription
medications. Sometimes genetics plays a hand. Increased stress
is a common cause because most people don't know how to cope
with stress effectively. Many anxiety problems are mood disorders
can be easily brought under control. Other causes range from
childhood trauma, physical illness, witnessing a crime or violence
to brain chemical imbalances. Thankfully, today there is an abundance
of research to help mental health professionals understand and
treat the various manifestations of anxiety disorders.
Following in this article are general description, symptoms,
possible causes, and treatment options for each of these five
types of anxiety problems.
Five main categories of anxiety disorders
Generalized Anxiety
Panic Disorder (Panic Attacks)
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder (PTSD
Social Anxiety Disorder (Social Phobia)
GENERALIZED ANXIETY
Generalized Anxiety Disorder, or GAD, is not "butterflies
in the stomach" but
a serious disorder characterized by extreme worry -- and about
more than one thing. A person with GAD would have persistent
thoughts such as "What if my husband gets hit by a car on
his way to the store?" or "What if I get sick and can't
take care of my family?" These thoughts might cross anyone's
mind, but a GAD sufferer is not able to "shake them off"
as others can. They are fixated on the feelings of worry and
dread. For these individuals normal anxiety has escalated into
a serious problem that needs treatment.
Anxiety disorders affect every aspect of the sufferers' lives
-- their activities, their decisions, their health, their businesses
or jobs, the thoughts and their family life. When these people
are in a stressful situation their anxieties become acute and
erupt into symptoms.
Symptoms
Constant worrying, uneasiness, restlessness, a sense of dread,
always "keyed-up", fret about health when there are
no apparent problems. When faced with a stressful situation,
irrational fear. Forgetful or confused. Negative interpretation
of other peoples action, feel unsafe.
Physical Symptoms:
-- clenching teeth or jaw
-- tightened muscles
-- holding one's breath
-- sleeping problems
-- racing heart beat
-- breathing difficulties
-- chest pain
-- hyperventilation
-- irritability
Emotional Symptoms:
-- irritability
-- sadness
-- depression
-- low self-esteem
-- loneliness
-- "numb" emotions
-- explosive emotions
-- feeling guilty
Causes
An Anxiety Disorder can be brought on by a major life trauma,
such as being a witness to or a victim of a crime, physical or
sexual abuse, a major illness, or a life threatening experience.
Sometimes financial difficulties, grief from a death
in one's family or a divorce can trigger anxiety symptoms. These
type of "life stressors" are inevitable in life. But
for many people, they are the root cause of their anxiety disorders.
Often it is a combination of these stressors that are just
too much for some people to handle. Just think how overwhelming
it would be to have more than one of these major stresses happen
in a short period of time -- the death of a loved one, losing
your job and finding out you have a serious illness.
In addition to external stressors, there are internal forces
at work that sabotage our sense of peace and well-being. The
number one culprit here is negative self image. When a
person is highly self-critical and doesn't allow themselves to
be simply "a human being being human" it can
spell trouble in terms of emotional health. This is tantamount
to holding yourself hostage -- without a ransom demand -- because
you don't deserve to be rescued! Obviously, these types of destructive
self-thoughts are a vicious cycle of misery that need to be treated
by a professional counselor.
Treatment Options
Fortunately, there are many avenues of successful treatment
for the full spectrum of anxiety disorders. Behavior Therapy
and Cognative Behavior Therapy are very helpful treatment methods.For
some people sessions of psychotherapy can help a person understand
the root causes of their disorder.Relaxation methods such as
meditation, breathing techniques and visualization can help relieve
symptoms.
Anti-anxiety drugs Xanax are non-addictive and can bring relief
of anxiety symptoms.
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PANIC DISORDER (PANIC ATTACKS)
Most people feel panic over something at least once in their
lives. But when it happens frequently and with extreme intensity
it may indicate a serious problem that needs attention. Panic
Disorder, or panic attacks, often begin in the teenage years
or in early adulthood.
A key characteristic of Panic Disorder, is that it usually
comes without warning and without any apparent cause. The unpredictable
nature of panic attacks adds to the distress of having to deal
with this disorder. After a period of time of having attacks,
the sufferer so dreads a repeat of this very unpleasant experience,
that they often develop a fear of having another attack in addition
to the initial disorder.
If attacks persist, it can become so distressful to the person
that he or she may not want to leave their house. This is a primary
cause of Agoraphobia, the extreme fear of going outside of one's
"safety zone," usually their home. For reasons not
yet known, women are twice as likely as men to suffer from
panic attacks.
Symptoms
A Panic Attack, or Panic Disorder, is an unexpected experience
of intense fear accompanied by physical symptoms of accelerated
heart rate, rapid or difficult breathing, shaking, dizziness,
sweating, hot or cold flashes, nausea , choking or smothering
sensation. A person having a Panic Attack may think they are
having a heart attack, since there is usually no apparent reason
for the physical symptoms.
There is a mental or psychological aspect of panic attack
which sufferers describe as a "sense of unreality,"
of feeling completely out of control or as though they are "going
to die" or will "go insane."
"Fight or Flight" Response
Human beings have a built-in "fight or flight" response
to a threatening situation. When perceived danger occurs, fear
triggers a physical response where the pituitary glad excretes
adrenaline into the bloodstream. The adrenaline enhances our
ability to "fight" in our defense, or run ("flight")
to save our lives. But when fear is triggered internally instead
of by some actual physical danger, our bodies still experience
the symptoms and physical readiness created by the adrenaline.
Panic Attacks are a serious disorder and can become disabling.
The symptoms alone can be very frightening, especially when they
come on without warning. People having Panic attacks often show
up in Emergency Rooms thinking they have a serious or life-threatening
medical condition.
Possible Causes
Scientists do not know exactly why the body's natural "warning
system" gets triggered when there is no actual danger. First
attacks can be triggered by physical illness or major stress
in a person's life. The causes may involve an interaction of
mental, or psychological and physical events. When stress is
severe, as with the loss of one's job or a death in the family,
it may stimulate
the part of the brain that controls fear response. Several very
stressful events happening within a short period of time, can
also set off panic attacks. In addition, panic attacks can accompany
other types of anxiety disorders.
Stresses that may contribute to the onset of panic attacks
are:
-- Serious relationship problems
-- Concerns about one's health
-- Physical illness
-- Tensions at the workplace
-- Poor self-esteem or self-hatred
-- Emotional problems
-- Worrying about finances
-- Legal problems
-- Physical or emotional abuse
-- A traumatic situation
-- Witnessing or being a victim of a crime
There is not yet a consensus among professionals about the
exact nature of the causes. There are biological theories, behavioral
theories and psychodynamic theories. There is also a brain-dysfunction
theory and an inner-ear-dysfunction theory. But as yet, none
of them has been proven to be the correct theory. Perhaps the
true cause lies in a combination or synergy of factors. Researchers
do know that panic attacks are connected to major life transitions
that are inherently stressful, such as marriage, divorce, a first
child, school graduation,
a new job, etc.
There may also be a heredity factor involved, since scientists
have found that Panic Disorder can run in families.
Often Undiagnosed
Unfortunately, Panic Disorder frequently goes undiagnosed
and, therefore, untreated. Some sufferers may rationalize their
attacks for a long time as normal or "no big deal."
Other people may call them nervous or "high strung."
Sufferers may think that what's bothering them is not
important because it is from a long time ago and try to shake
it off. They may try to hide their attacks from family, friends
or co-workers. They may lose their jobs due to their attacks.
However, if Panic Disorder goes untreated for months or years,
it may worsen to the degree of seriously interfering with the
normal daily life of the person affected.
Sometimes the sufferer actually helps bring on an attack by
responding to the physical symptoms with more fear. They may
be so anxious about the onset of an attack that they will actually
cause an attack themselves. Or, they may mistakenly think that
a symptom is from anxiety when it is really a flu symptom or
simply from physical exertion.
Treatment Options
Cognitive Behavioral Therapy is often helpful to treat anxiety
. This treatment helps the sufferer to be prepared for the situations
that might trigger panic attacks.
How Cognitive Behavioral Therapy helps patients with panic
disorders:
Explains anxiety and how to identify symptoms; designs a treatment
plan.
The patient learns to monitor panic attacks and keeps a record
of anxiety inducing situations.
Relaxation and breathing techniques are taught.
Teaches other skills to help block automatic reaction to fearful
situations.
Shows how to recognize thoughts and beliefs that trigger anxiety
and change their interpretation from catastrophic to realistic.
Develops gradual steps for exposing the patient to situations
that cause anxiety.
Homework to help practice in everyday life what is being learned
in therapy.
Often a combination of medication and Cognitive Behavioral
Therapy is an effective method of treating panic disorder.
Medications that interact with brain chemicals can reduce
or prevent attacks and lessen anxiety.
The main types for treating panic disorder are benzodiazepines
and antidepressants. These must be taken on a regular basis,
from six months to a year.
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OBSESSIVE-COMPULSIVE DISORDER (OCD)
It is estimated that five million Americans are affected by
OCD. This disorder exists when a person's compulsions and obsessive
thoughts overpower their life to the point that they are unable
to function normally. Unwanted, disturbing or distracting thoughts,
and out-of-control behaviors are typical of OCD. These thoughts
may be accompanied by a personality disorder, an eating disorder,
attention deficit disorder, anxiety or depression.
A compulsion, which is an irresistible impulse or urge, usually
includes elaborate and repetitive rituals and often interferes
with the person's normal functioning. An obsession is the preoccupation
with, and repetition of, a persistent thought or behavior. The
person with an obsession usually finds them disturbing and intrusive,
but cannot stop doing whatever they are obsessive about.
The reason these conditions are components of the same disorder
is because most people with this problem suffer from both obsessions
and compulsions.
A smaller percentage has only one or the other. In most cases,
OCD develops in early childhood, but may not be diagnosed until
adulthood.
Some common compulsions are:
-- organizing and arranging things
-- checking the same thing over and over
-- counting and repeating
-- cleaning something over and over
-- shopping
-- gambling
-- lying
Some common obsessions are:
-- symmetry and order
-- talking, asking questions, confessing
-- germs and dirt
-- fear of making mistakes
-- working
-- sex
-- exercise
The Cause of OCD
Research indicates that OCD is a biology-based disorder involving
the brain chemical, serotonin. Serotonin carries impulses to
and from nerves for functions such as walking, eating and thinking.
It is believed that very stressful events can cause an imbalance
of this chemical in the brain of certain individuals and bring
on OCD symptoms.
Treatment Options for OCD
If untreated, Obsessive-Compulsive Disorder is usually a lifelong
illness.
OCD has usually been treated with a tricyclic antidepressant.
Recently, though, additional drugs that selectively act on the
neurotransmitter serotonin, called SSRIs, or selective serotonin
reuptake inhibitors, are now available for treating OCD.
Behavior therapy has also helped OCD patients, as has a combination
of therapy and drugs.
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POST TRAUMATIC STRESS DISORDER (PTSD)
A person with PTSD has experienced an event involving actual
or threatened death or injury to themselves or others. They have
experienced intense fear, a sense of helplessness and horror.
Trauma can be a one-time experience such as rape, assault,
mugging, robbery, fire, accident or a natural disaster such as
a flood or an earthquake, or it can be a prolonged trauma as
in the case of physical or sexual abuse, living in a prison or
concentration camp, or being a refugee.
Our brains and nervous systems are intended to handle stress
and trauma - to a point. When our system is overwhelmed by traumatic
stimuli, it goes into an overload situation. The result is that
the anxiety of these traumatic events stays "locked"
in our nervous system, waiting to be released.
Possible Causes
PTSD can develop after a major traumatic event, either emotional
or physical. This disorder is characterized by flashbacks and
nightmares, and is commonly found in returning military personnel
and in people who have experienced natural disasters or been
victims crimes. Other causes can be serious accidents, violent
attacks such as rape or torture, or witnessing violence in which
they or other people are seriously injured.
It is estimated that about ten percent of the U.S. population
has or has had symptoms of PTSD. It affects people of all ages
who have experienced a trauma. More females than males suffer
from this anxiety disorder. Some people can recover from a traumatic
event with brief therapy and the support of loved ones. But for
others, it persists, often for years.
Symptoms
Symptoms can appear within a few months of a traumatic event
or much later, after an event that triggers symptoms. Typical
symptoms of PTSD are:
-- reliving the trauma event as if it were happening - flashbacks
-- intrusive thoughts, images, feelings and illusions
-- re-experiencing the traumatic even in dreams or nightmares
-- intense anxiety and physical distress when remembering the
event
-- attempts to avoid the situation, feelings or activities related
to the event
-- avoids conversations connected to the trauma
-- changes in appetite
-- feeling sadness, depression, hopelessness, and despair
-- difficulty falling asleep or staying asleep
-- anger, resentment, irritability or explosive outbursts
-- feeling "numb" emotionally
-- a sense of detachment; "spacing out"
-- overwhelmed by normal situations
-- love, sexuality or intimacy become restrictive
-- frequent and excessive crying; moodiness
-- trouble concentrating; poor memory
-- Hypervigilance and scanning; being on guard
-- easily startled, jumpiness
-- pessimism; a sense of doom and dread of the future
-- survivor guilt
It is important to diagnose and treat Post Traumatic Stress
Disorder because if
it is not treated, it could lead to more serious psychological
illnesses, such as clinical depression or drug dependency.
Treatment for PTSD
There are a number of treatments available to mental health
professionals that have good track records with helping PTSD
sufferers deal successfully with their traumatic experiences.
Treatment usually focuses on anxiety reduction and stress-coping
techniques.
Self-hypnosis can help, as can be relaxation exercises. In
many cases, behavioral psychotherapy is effective. By
bringing their experience into the therapy setting, the trauma
survivor usually finds it easier to discuss their trauma, and
learn new ways of reacting to their memories.
Another effective therapy for PTSD is a relatively new but
powerful technique called Eye Movement Desensitization and Reprocessing,
or EMDR. Drug therapy can be helpful if there is notable depression,
panic attacks or debilitating stress symptoms. There are also
peer-counseling and other groups which can help sufferers deal
with their symptoms.
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SOCIAL ANXIETY (SOCIAL PHOBIA)
Phobias are common in our society and are characterized by
intense, irrational fears of things, situations, people or activities.
Having high anxiety in social settings to the degree that it
interferes with ordinary social interaction is called a Social
Phobia.
Social Phobia is a major mental health disorder in the United
States, affecting about eight percent of the population. However,
it has only been taken seriously for about ten years. Fortunately,
the body of research developed in that time has fostered numerous
treatment modalities.
Symptoms
People with Social Anxiety Disorder or Social Phobia, or,
are very fearful and anxious that other people will criticize
them. In fact, they will go to any extreme to avoid a social
gathering at which they might be stared at, and, in their mind,
evaluated negatively. They are intimidated by every stranger
they come across. They avoid eye contact with nearly everyone
and feel that they will embarrass themselves if they do anything
at all in public. Other typical symptoms are embarrassing easily,
blushing, frequent swallowing and twitching.
"Trigger" Situations for Social Phobia
-- having to speak in front of other people
-- being the center of attention
-- dealing with people of authority
-- looking other people in the eye
-- being introduced to strangers
-- being teased or confronted
-- being in a public place
-- interviews and meetings
Social Phobia is very distressing emotionally because it adversely
affects a very important aspect of life - social interaction.
To make matters worse, other people often perceive those with
Social Phobia as being unfriendly, aloof, withdrawn or inhibited.
Causes
Social Anxiety is very prevalent in our society probably partly
because of social pressure to live up to idealized social expectations
and partly due to the emotional and psychological insecurity
of the individual with this disorder.
Add to this the tendency to analyze and evaluate everything.
People with this disorder realize their negative thoughts and
feeling are irrational, yet they cannot stop them. A cycle of
negative thoughts and negative actions is set into play that
can only be stopped with appropriate psychotherapy.
Cognitive-behavioral therapy is highly effective in treating
social anxiety. Behavioral Therapy in a Group setting is also
helpful because they allow opportunities for reestablishing healthy
relating skills.
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WHAT YOU CAN DO TO HELP YOURSELF
Educate yourself about what you suspect is your disorder so
that you can communicate more effectively with your medical doctor
or your potential therapist.
Physical exercise is often an excellent temporary antidote for
mild or moderate anxiety.
Be aware of what you eat and drink. Food additives such as Aspartame,
the sugar substitute, or caffeine, can be toxic to some people
and cause anxiety symptoms. Packaged meats contain preservatives
and other chemicals.
A high intake of sugar can also trigger anxiety symptoms.
Eliminate alcohol and unprescribed drugs from your system.
It is a good idea to begin with a thorough physical exam by a
physician. Many times symptoms are caused by a physical condition
or illness, such as allergies.
Learn relaxation techniques. They are available everywhere -
yoga classes, video tapes, meditation, etc.
Be confident that you will find relief for your symptoms. Many
other people have suffered with the same unpleasant or uncomfortable
conditions and have successfully gotten relief -- often permanently.
© Copyright 1999 by Carol Boulware, Ph.D.
For information about making an appointment
CLICK HERE
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CALL (310) 395-3351
Day & Evening/Weekend Appointments
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Email : carolphd@psychotherapist.net
Carol Boulware, Ph.D.
Licensed Marriage, Family Therapist- #MFCT11632
Board Certified Expert in Traumatic Stress
ABS Certified Sex Therapist
EMDR - Level 2 - 1994
626 Santa Monica Blvd., Suite 275
Los Angeles, California 90401
(310) 395-3351
Additional offices in Santa Monica & Redondo Beach
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