Anxiety, and Anxiety Disorders: Definition

Anxiety is a state of physiological arousal involving feelings of apprehension and fear and physical symptoms such as palpitations, sweating, and feelings of stress.

Anxiety disorders: These are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people’s lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

Common Anxiety Disorders

GAD – Generalized Anxiety Disorder: Excessive anxiety and worry for more than 6 months, often associated with symptoms of restlessness, feeling on edge, fatigue, poor concentration, irritability, stomach and bowel cramps, muscle tension, and sleep disturbance, often causing significant distress and impairment in social and occupational function.

Panic Disorder: A discrete period of intense fear and discomfort, peaking within 10 minutes, often associated with palpitations, trembling, shaking, sweating, shortness of breath, choking feeling, chest pain, nausea, dizziness, derealisation, depersonalisation, fear of dying, fear of loosing control, numbness, tingling, chills and hot flushes. May mimic a heart attack.

 Post-Traumatic Stress Disorder: A person who was exposed to an event that caused or threatened death or injury to self or other persons, causing a response of intense fear, helplessness or horror. The person experiences distressing recollections, images ,thoughts, dreams, physical sensations. The person avoids situations which give rise to the distressing symptoms, may have diminished interest in events, activities, social interaction and work. Symptoms may include Insomnia, irritability, poor concentration, hyper vigilance, startle response.

Phobia: A marked persistent fear that is excessive and unreasonable. It is activated by exposure to the feared circumstance or object. Subtypes of phobia include Simple Phobia, Social Phobia, Agoraphobia, Claustrophobia, Flying Phobia.

Obsessive-Compulsive Disorder: Obsessions: Recurrent and persistent thoughts, impulses and images which cause anxiety and distress. Compulsions: Repetitive unreasonable behaviors and actions that are aimed at reducing distress.

Causes of Anxiety Disorders

A number of factors, including genetics, brain chemistry and environmental stressors, appear to contribute to its development.

Genetics: Anxiety Disorders often run in families. They may be associated with or obscured by other disorders such as depression or alcoholism. Specific genes such as the Serotonin Transporter Gene have been identified to predispose a person to Anxiety Disorders.

Brain chemistry: Anxiety Disorders have been associated with abnormal levels of certain neurotransmitters in the brain especially Serotonin. This can alter the way the brain reacts in certain situations, leading to anxiety.

Environmental factors: Stress is often a major factor that may lead to an Anxiety Disorders and may include: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools. Withdrawal from addictive substances, including alcohol, caffeine and nicotine, may also worsen anxiety.

The Role of Stress: Stress is a normal part of life related to external or internal events impinging on the individual. Stress can be manageable and help us learn and grow or too much stress can cause us significant problems. Stress releases neurotransmitters and hormones in particular the adrenal glands secrete epinephrine and norepinephrine. The release of these neurotransmitters and hormones leads to the physiologic effects seen in the fight or flight response, for example, a rapid heart rate, increased alertness.

Research studies show that repeated or prolonged stress responses also activate toxic immune system responses, which can cause psychiatric disorders such as anxiety disorders and depression, and medical conditions such as hypertension, and cardiovascular disease, gastrointestinal diseases, cancers, and accelerate aging. This also may worsen migraine headaches, asthma, diabetes, colds and infections.

Treatment of Anxiety Disorders

 Medial Conditions: People should have a screening examination including blood screen, urinalysis and EKG to exclude medical illness. Exclude Other Conditions: Alcohol and Substance abuse is a common co-existing problem. Treatment of existing Alcohol and Substance abuse usually necessary before other therapies can be effective.

 Medications : tranquillizers, antidepressants, mood stabilizers modulate neurotransmitters and reduce the intensity of anxiety symptoms. The most commonly used medications are antidepressants, that are effective but usually have some undesirable side effects. Some selected vitamin, mineral and herbal supplements can be useful.

 Cognitive behavioral therapy: The most common type of behavior therapy. Usually provided in group of 12 sessions. People learn to recognize and change thought patterns and behaviors that lead to troublesome feelings. This helps limit distorted thinking by looking at worries more realistically.

 Relaxation Therapy: Relaxation training, deep breathing and biofeedback helps to control the muscle tension that accompanies Anxiety Disorders.

Mindfulness Training: Meditation and Yoga modulate brain wave activity such as gamma waves and can work well for some people.

 Lifestyle Management: This can be useful in balancing people’s routines to achieve a healthy balance between work, relaxation and sleep cycles. Exercise and Diet: Regular exercise reduces stress, alleviates anxiety and depression. All people can benefit from this modality.

Acupuncture and Low Level Laser Therapy: Traditional Chinese and a novel treatment modality that works by stimulating stimulate acupoints and results in the release of natural endorphins that reduce and control anxiety.

Resources and References:

1. CAMH Anxiety Disorders Guide:   General Overview by CAMH

2. Generalized Anxiety CCI:   Brief Illustrated Graphical Overview

3. Panic Disorder CCI:  Brief Illustrated Graphical Overview

4. OCD & Procrastination CCI:   Brief Illustrated Graphical Overview

5. Sleep Facts CCI:  Brief Illustrated Graphical Overview

6. Self Esteem CCI: Brief Illustrated Graphical Overview

7. Thinking and Feeling CCI:  Brief Illustrated Graphical Overview

8. Acupuncture for Anxiety: Psychology Today, by James Lake MD

9. CognitiveBehaviouralTherapy CARMA: Center for Applied Research in Mental Health and Addiction Simon Fraser University, BC