Anxiety

by Amy Scholten, MPH

Definition

Anxiety is a normal state of apprehension, tension, and uneasiness in response to a real or perceived threat. Although anxiety is considered a normal response to temporary periods of stress or uncertain situations, prolonged, intense, or inappropriate periods of anxiety may indicate an anxiety disorder.

Other indicators of an anxiety disorder are anxiety that occurs without an external threat (“free-floating” anxiety) and anxiety that impairs daily functioning.

The most common types of anxiety disorders are: phobias, post-traumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder, social anxiety disorder, and generalized anxiety disorder. Anxiety and anxiety disorders are often complicated by the presence of alcohol/drug abuse and depression.

See also: Generalized Anxiety Disorder

Causes

Anxiety may result from many factors including:

• Appropriate response under stressful circumstances
• Drugs that affect the nervous system, such as:
  • Caffeine
  • Alcohol
  • Cocaine
  • Nicotine
  • Amphetamines (eg, “crystal meth”)
  • Some herbal medications
• Biological factors:
  • Brain chemistry imbalances (eg, serotonin and norepinephrine)
  • Personality traits
• Faulty perceptions and irrational beliefs (eg, phobias)
• Unresolved emotional conflicts

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for anxiety include:

• Sex: female
• Family member with anxiety disorders
• Stressful life events
• Ineffective coping strategies
• History of physical or psychological trauma

Symptoms

Anxiety has psychological and physical symptoms.

Psychological symptoms may include:

• Worry or dread
• Obsessive or intrusive thoughts
• Sense of imminent danger or catastrophe
• Fear or panic
• Restlessness
• Irritability
• Impatience
• Ambivalence
• Trouble concentrating

Physical symptoms may include:

• Rapid or irregular heartbeat
• Sweating, especially the palms
• Dry mouth
• Flushing or blushing
• Muscle tension
• Shortness of breath
• Lightheadedness or faintness
• Difficulty sleeping
• Shaking
• Choking sensation
• Frequent urination
• Nausea or vomiting
• Diarrhea
• Constipation
• Feeling of "butterflies" in the stomach
• Sexual difficulties
• Tingling sensations
• Nail biting or other habitual behavior

Diagnosis

Your doctor will ask about your symptoms and medical history. You will be given a psychiatric evaluation. Your doctor may also perform a physical exam and diagnostic tests. Usually the results of these tests are normal. You may be referred to a psychotherapist for further evaluation.

Treatment

Effective treatment usually involves a combination of interventions, including:

Lifestyle Changes

• Get sufficient rest and sleep
• Avoid tobacco
• Reduce or eliminated caffeinated beverages
• Drink alcohol in moderation
• Avoid illicit drugs
• Reduce exposure to stressful environments
• Exercise regularly

Relaxation Techniques

• Deep breathing
• Meditation
• Deep muscle relaxation
• Massage
• Engaging in pleasurable activities

Social Support

• Strong support system of family and friends
• Counseling to improve coping skills
• Support groups

Psychotherapy

• Psychotherapy addresses thoughts, feelings, and behaviors that play a role in anxiety
• Psychotherapy helps you work through unresolved psychological trauma and conflict

Medication

For severe anxiety or anxiety disorder, medications may include:

• Benzodiazepines
• Buspirone
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors (SSRIs)

  Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern ­- mostly SSRIs (Selective Serotonin Re-uptake Inhibitors) - are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.

Prevention

To help prevent anxiety, consider taking the following steps:

• Avoid situations, occupations, and people that cause you stress.
• If unavoidable, confront and overcome situations that provoke anxiety.
• Find a relaxation technique that works for you and use it regularly.
• Develop and maintain a strong social support system.
• Express your emotions when they happen.
• Challenge irrational beliefs and counterproductive thoughts.
• Correct misperceptions; ask others for their views.
• Work with a psychotherapist or marriage and family counselor.
• Avoid using nicotine or other drugs, and drink alcohol in moderation.

RESOURCES:

Anxiety Disorders Association of America
http://www.adaa.org

The Canadian Network for Mood and Anxiety Treatments
http://www.canmat.org

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

Current Medical Diagnosis and Treatment, 45th ed. McGraw-Hill; 2006.

National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/.

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