Health Conditions

Anxiety

Almost everyone feels anxious from time to time. When there is a threat of some kind, anxiety is normal—bound up with the way the body prepares to deal with danger: Adrenaline and cortisone are released in the bloodstream; heart rate quickens; breathing becomes shallow and rapid; muscles tense; sugar is released by the liver; and the mind goes on full alert. But when anxiety is not tied to an identifiable threat or is more severe and long-lasting than warranted, it is a clinical disorder, debilitating and disruptive.

Many different anxiety disorders are recognized. Among them are phobias (fear of certain situations, such as confining spaces, or of particular things, such as insects); panic attacks (a sudden onset of extreme fear or tension, for no evident reason); obsessive-compulsive disorder (persistent, irrational thoughts, such as a dread of infection, or repetitive behavior, such as checking that doors are locked); posttraumatic stress disorder (prolonged anxiety after a traumatic event); and generalized—or "free-floating"—anxiety (an inexplicable feeling of apprehension that may last for months).

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Anxiety disorders can vary greatly in their severity; they may be mild orcompletely immobilizing. The incidence of the different disorders also varies:
Phobias, panic attacks, and obsessive-compulsive disorder, for example, occur less frequently than generalized anxiety (which afflicts twice as many women as men). The disorders usually become noticeable during the teen years or early adulthood and are considerably more common among adults than children.

Some anxieties are very difficult to treat; others respond well to medications, psychotherapy, and alternative therapies. What   does not work is self-treatment with alcohol or recreational drugs to alleviate the symptoms. Many sufferers choose this path, but ultimately it will only make the condition worse.

SYMPTOMS OF ANXIETY

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For school-age children:

CAUSES OF ANXIETY

Anxiety can be caused by a recognizable stress—such as an accident, a death in the family, or the loss of a job; in such cases, adjustments to the situation, along with the passage of time, will have an ameliorating effect. In other cases, the stress is invisible—a buried memory of some unhappy or frightening facet of childhood, lurking below the surface of the conscious mind and revealing its presence in anxiety.

Genetic inheritance may predispose some individuals to anxiety: Studies of identical twins show that if one member of an identical pair suffers from anxiety, there is at least a 50 percent chance that the other will, as well. Food sensitivities may also contribute to anxiety, although more research must be done to certify this connection. Certainly, caffeine has been implicated in increasing anxiety levels, especially in individuals predisposed to anxiety. In addition, anxiety frequently follows a sudden withdrawal from alcohol,
tobacco, or other drugs.

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DIAGNOSTIC AND TEST PROCEDURES

The first step is to rule out the possibility that the symptoms are being caused by an organic disease. Among the conditions that produce symptoms similar to those of anxiety are hyperthyroidism; hyper- or hypocalcemia (too much or too little calcium); and certain heart problems. A thorough evaluation by your doctor will determine if any of these conditions are the cause.

If no organic culprit can be found and the symptoms seem out of proportion to any situation you are facing, the condition will be classified as an anxiety disorder.

TREATMENT

Anxiety can be treated with conventional medications, psychotherapy and many alternative approaches.  A combination of conventional and alternative methods is often effective.

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CONVENTIONAL MEDICINE

Psychotherapy and psychoanalysis aim at identifying conflicts and other stresses—perhaps long buried—that may lie at the roots of anxiety. Behavior modification—a therapy that concentrates on changing patterns of behavior—can help the patient avert anxiety or better cope with it, as can cognitive therapy, which concentrates on changing ways of thinking.

Medication is useful for alleviating the symptoms of anxiety and is often prescribed in conjunction with other therapies. The most prominent of antianxiety drugs are those known as benzodiazepines; among them are lorazepam, diazepam, alprazolam and clonazepam. They have drawbacks: Benzodiazepines sometimes cause drowsiness, irritability, dizziness and dependency. Nonetheless, in recent decades they have largely replaced barbiturates, which not only pose a clear danger of addiction but also can be a threat with suicidal patients. Another antianxiety drug is buspirone. It has fewer side effects than the benzodiazepines and is not associated with dependence. Buspirone has its own side effects and may not always be as effective when a person has taken benzodiazepines in the past.

Antidepressants, particularly the serotonin reuptake inhibitors (SSRIs), are now also widely used for a variety of anxiety disorders and can be as helpful in managing longterm anxiety problems. Examples of SSRIs that are sometimes used to treat chronic anxiety include Prozac, Zoloft, and Paxil. The antidepressants Effexor and Serzone and the tricyclic antidepressant imipramine may also help. Finally, antihistamines (such as hydroxyzine) and beta blockers (such as Inderal) can help more mild cases of anxiety as well as performance anxiety (such as public speaking).

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A wide variety of mind/body treatments and practices can relieve anxiety. The key is to find the one or two that you prefer and to use them consistently. Among the useful meditation and relaxation techniques are progressive muscle relaxation, autogenic training, the relaxation response, transcendental meditation (TM), mindfulness meditation techniques, and Oriental exercise techniques such as yoga, tai chi and qigong. For best results, meditation and relaxation practices should be undertaken daily or even twice a day.

Since anxiety is almost always accompanied by shallow breathing, deep breathing exercises are very helpful; it is impossible to be anxious when breathing deeply and slowly. Try the following form of yoga breathing: Lie on your back in a comfortable place. Breathe in slowly through your nose, using your diaphragm to suck air into your lungs while allowing your abdomen to expand. (Put your hand on your abdomen just below the navel to make sure the abdomen is being pushed up and out by the diaphragm.) After the abdomen is expanded, continue to inhale as deeply as possible. When you breathe out, reverse the process: Contract the abdomen while exhaling slowly and completely. Repeat several times.

EEG biofeedback, used to retrain thought patterns, is another helpful tool for conditions that combine both physical and mental symptoms—as is the case with anxiety. In a series of sessions with a therapist, the patient watches his or her own brain-wave patterns on an electroencephalograph and gradually learns to control the waves. Practitioners estimate that after about a dozen sessions, the patient will be able to exert the control over mental activity without the help of the therapist or monitoring instrument.

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Hypnotherapy is recommended for specific phobias such as fear of flying, stage fright or fear of exams and sports contests. It also helps with general anxiety. Children and adolescents learn self-hypnosis far more quickly than adults, perhaps because they are so accustomed to using their imaginations. Hypnosis is not a magical or sinister process in which you are under the control of the hypnotist; instead, it is a form of concentration. All hypnosis is self-hypnosis; the hypnotist is there simply to teach you how to use the technique to best advantage.

AT-HOME REMEDIES

Daily exercise can be one of the most potent treatments for anxiety symptoms. If you find that exercise works for you, push yourself to go for brisk walks, or undertake an active sport that you enjoy. Take care of your body by eating a well-balanced diet. Include a multivitamin when you can't always eat right.  Avoid alcohol, and reduce or eliminate your consumption of sugar and caffeine.  Take time out for yourself every day. Even 20 minutes of relaxation or doing something pleasurable for yourself can be restorative and decrease your overall anxiety level.  Trim a hectic schedule to its most essential items, and do your best to avoid activities you don't find relaxing. If you begin to hyperventilate, exhale into a paper bag and inhale the air within the bag. This increases the amount of carbon dioxide you are inhaling, which can reduce the urge to hyperventilate. Inhaling from a bag will help relieve any dizziness or tingling you might feel.

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CALL YOUR DOCTOR IF:

Your anxiety seems irrational or more extreme than the situation warrants. Your anxiety inhibits normal activities. low-level anxiety persists for many weeks. your symptoms suddenly become severe or uncontrollable. You may be experiencing a panic attack. anxiety is accompanied by weight loss and bulging of the eyes; you may have thyroid problems.

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Panic Attack

If you have recurrent panic attacks and persistent fear of subsequent attacks or change your behavior significantly because of such attacks, you have panic disorder.

You are engaged in some ordinary aspect of life when suddenly your heart begins to pound, and you hyperventilate, sweat, and tremble. You fear you are having a heart attack, going crazy, or even dying. Then, 10 or so minutes later, it's gone. Where did that feeling come from?

Unfortunately, there is no clear answer. You have had a panic attack, and for a small minority of sufferers, they recur again and again in a pattern known as panic disorder. Between attacks, sufferers live in dread of the next one.

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Many people with panic disorder relate an attack to what they were doing when it occurred. They may assume that the restaurant, elevator, or classroom caused the attack, and decide to avoid that situation. In this case, panic disorder may lead to agoraphobia — the fear of leaving home or being in public places — though the relationship between the two conditions is unclear.

Panic attacks are fairly common, afflicting about 35 percent of the population each year. About 1 to 2 percent will develop panic disorder.  Attacks usually begin between ages 15 and 25.

SYMPTOMS OF PANIC ATTACK

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Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is not the ordinary "double-checking" that all of us do from time to time — making sure the doors are locked or the oven is off. For OCD patients these thoughts and behaviors are so magnified that they interfere with everyday routines, jobs and relationships. Sufferers have been known to wash their hands for eight hours or to reorganize their entire household daily. Obsessive-compulsive disorder is chronic and cannot be controlled voluntarily. Even after long periods of relative normality, sufferers may have another attack without apparent cause.

Because obsession and compulsions may take hold gradually, people often fail to recognize that they are suffering from a disorder. When OCD eventually produces symptoms that interfere with daily life, patients may try to hide their compulsions from others and attempt to deal with them by using will power. Often, patients feel embarrassed about their obsessive thoughts or compulsions or feel like they're crazy and so will avoid revealing symptoms, even to their health care provider.

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Although OCD can appear in childhood, onset most often occurs in adolescence; half of adult sufferers show some symptoms by the age of 15. In the United States, between 2 percent and 3 percent of the population experiences some form of OCD during their lives. Obsessive-compulsive features are also found in Tourette's syndrome , depression and schizophrenia.

SYMPTOMS

You may have obsessive thoughts or compulsive behavior or both.

For obsession:

Involuntary and persistent thoughts that appear to be senseless (such as an overwhelming fear of dirt or persistent worry about a past event) and cause marked anxiety or distress.  Attempts to suppress such thoughts.  Recognition that these thoughts come from one's own imagination, not from outside factors (not true for children).

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For compulsions:

Repetitive acts such as hand washing, checking and rechecking locks, tidying, repeating words.  Recognition that the repetitive behavior is excessive or unreasonable (may not be true for children).   Depression and distress as attempts to deal with compulsions fail.

For children:

Mute behavior with agitated depression.
Gradual decline in school work, secondary to impaired
concentration.
Withdrawal and social isolation accompanied by delusional thinking.
Mood swings from anxiety to despair.
Ritualistic or compulsive behaviors as noted above.

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Insomnia

After infancy, humans function the way the world turns — on a natural cycle that repeats itself about every 24 hours. During this daily cycle — known as the circadian rhythm — most adults sleep between six and eight hours, usually at night and without interruption. A few nights of poor sleep do us no harm, but prolonged insomnia can have serious consequences. Insomnia is one of the most commonly reported health problems: About one in three people encounters sleep problems in a given year, and twice as many women as men. Because sleep patterns change as we age, most sleep disorders are reported by the elderly.

Insomnia can be described in terms of both duration and severity. Transient insomnia is associated with a temporary disturbance of one's normal sleeping pattern — caused, perhaps, by travel or relocation — and usually lasts no more than several nights. Short-term insomnia, lasting two or three weeks, can accompany worry or stress and typically disappears when the apparent cause is resolved. Chronic insomnia is a more complex disorder with potentially serious effects, including immune disorders: When people are deprived of sleep over long periods, the body's production of natural killer cells — an important part of the immune system — becomes depressed, potentially lowering resistance to disease.  The rare disorder called narcolepsy is characterized by attacks of irresistible drowsiness during the day, disrupting the pattern of a person's normal activity. A narcoleptic may not sleep well at night but suffer sleep attacks during the day, while talking, working, eating and even when driving a vehicle — a potentially life-threatening event.

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SYMPTOMS

Persistent trouble falling asleep.
Failure to sleep through the night.
Waking up earlier than usual.

Stress

Stress is the reaction of our bodies and minds to something that upsets their normal balance. The human response to stressful events is an ancient one, dating back to a time when life was a constant struggle for survival. A good example of stress in action is the way you react when you are frightened or threatened. Your adrenal glands release epinephrine — or adrenaline — a hormone that activates your body's defensive mechanisms: Your heart pounds, your blood pressure rises, your muscles tense, the pupils of your eyes open wide. This cluster of reactions — the fight-or-flight response — concentrates all your body systems on the apparent danger and helps you take the next step, which is either to resist or to retreat.  

Of course, not all stressful events are so sudden or so obvious as the threat of bodily harm. Any challenge that overwhelms us — a serious illness, the death of a family member, the loss of a job or a lover — can be stressful to the point of physical and psychological dysfunction. Some of us are especially vulnerable to stressful situations or events, responding in extreme ways to everyday decisions — what to buy at the supermarket, what to wear to the wedding or how to ask for a raise. But while some people fall to pieces if they are pressed too hard, others are highly productive under pressure. The difference may lie partly in our constitutions, and partly in how we manage our lives.

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Continued stress can eventually deplete the body's resources and produce chronic fatigue, loss of appetite or overeating and other reactions. Coping ability may diminish, causing feelings of insecurity and inadequacy, and possibly leading to depression. At the same time, the body's immune system becomes disrupted, increasing vulnerability to illness and disease.  Unrelieved stress — from real or imagined causes — may bring on hypertension in predisposed individuals, a recognized factor in heart disease or may worsen migraine headaches and peptic ulcers in others. Post-traumatic stress disorder, in which symptoms appear immediately or months after a stressful event, can be a protracted and difficult problem. 

SYMPTOMS

Physical symptoms may include headache, fatigue, insomnia, digestive changes, neck pain or backache, loss of appetite or overeating.  Psychological symptoms may include tension or anxiety, anger, reclusiveness, pessimism, resentment, increased irritability, feelings of cynicism and inability to concentrate or perform at usual levels.

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CAUSES

Stress occurs when there is an imbalance between the demands of life and our ability to cope with them. Certain work is highly stress producing, especially assembly-line jobs or jobs requiring repetitive tasks with dangerous equipment. Events and situations that are difficult to manage typically bring on stress: burnout on the job, financial problems, the loss of or a threat to your security, bereavement or divorce. A positive experience, such as marriage or a job promotion, can also be stressful. Other causes are internal: illness, loneliness, pain or emotional conflict. The effects of such changes, big and little, are cumulative. We can tolerate only so much stress in a given period of time.

THE TYPE A PERSONALITY

DIAGNOSTIC AND TEST PROCEDURES

Diagnosing stress is largely a matter of recognizing and understanding the symptoms — both physical and psychological — in yourself or others. Some researchers have developed more objective diagnostic tools. For example, the Holmes-Rahe questionnaire is helpful in identifying potentially stressful events. The questionnaire scale ranks 43 important life events according to their potential stress value. Not all events are considered "bad," but all involve some kind of change, including a new job, a new home and the birth of a child.

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TREATMENT

You don't have to deal with stress by yourself. A counselor, psychologist, psychiatrist, member of the clergy or friend can often help you define or resolve a problem that seems unsolvable to you. Developing a stress-abatement routine you trust will help you prepare for an event you know may be stressful.

CONVENTIONAL MEDICINE

If you have symptoms of stress from a specific event, such as a death in the family, your doctor may prescribe an antianxiety drug, such as diazepam. While such medications are highly effective if taken for brief periods, they can be addictive if taken for more than a few weeks.

Your doctor may suggest psychotherapy to pinpoint events or conditions that are stressful to you, and to devise ways of reducing the stress they cause. Group therapy is often valuable for people who share a stressful life situation. Cognitive and behavioral therapies can also be helpful in challenging irrational thoughts that may intensify your reaction to stress and in devisiong alternative behaviors to cope with stressful situations. Treatment of posttraumatic stress disorder usually includes counseling and may require antianxiety or antidepressant medications.

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CALL YOUR DOCTOR IF:

You have prolonged or acute symptoms. Excessive stress puts you at risk of other serious disorders, including immune problems, digestive disorders, diabetes, asthma, high blood pressure, migraine headaches and possibly cancer.  You have symptoms of stress and any of the following: unusual patterns of sleep, appetite and moods; physical movement that is unusually agitated or abnormally slow. You may have clinical depression.

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