Anxiety disorders: Generalized Anxiety Disorder (GAD), Panic Attacks, Panic Disorder, Phobias, Body Dysmorphic Disorder

 

Anxiety disorders have 12 relatively distinct subtypes: Acute Stress Disorder, Generalized Anxiety Disorder (GAD), Anxiety Disorder Due to a General Medical Condition, Substance-Induced Anxiety Disorder, Panic Disorder (+/- Agoraphobia), Agoraphobia without a history of Panic Disorder, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Anxiety Disorder not otherwise specified.

 

Generalized Anxiety Disorder (GAD) is characterized by excessive and unrealistic worrying about family, money, health, work, etc. The sufferer is over-concerned about almost anything, anticipates disasters, expects the worst, and is sometimes anxious at the mere thought of getting through the day.

 

Panic attacks (or anxiety attacks) are represented by periods (usually peak at 10 min, last to 20-30 min) of intense fear or discomfort that consist of 4 or more specific symptoms. The sufferer’s impression is that he/she is having a heart attack. The onset of a panic attack is sudden, with no apparent trigger. Isolated episodes usually do not require treatment

 

Panic Disorder is represented by the occurrence of repeated panic attacks and the fear of future panic attacks. This disorder usually begins in late adolescence or early adulthood. It is often associated with Agoraphobia (fear of wide, open spaces, where immediate escape seems impossible) because the panic attacks are frequently linked to certain places. This leads to an avoidant behavior (of the “triggering” surroundings) and a restricted lifestyle.

 

Phobias consist in excessive and irrational fears that are usually the result of a traumatic event. The most common phobias include closed spaces, public speaking, heights, spiders, mice, snakes, needles, germs, flying, but in essence people can develop phobias regarding almost anything.

 

Body dysmorphic disorder is defined as an exaggerated preoccupation with one or more defects in one’s appearance. People affected by this disorder tend to view their “defect” excessively disproportionate.

Causes

Generalized Anxiety Disorder (GAD):

The exact cause of GAD is unknown, but genetics, family background and traumatic or stressful life experiences are believed to have a major influence on the development of the disorder

 

Panic attacks (anxiety attacks) and Panic Disorder:

Panic attacks usually strike “out-of-the-blue”, with no clear trigger or reason (if there is no underlying medical condition) – they can occur even while sleeping

 

Recurrent panic attacks are triggered by specific situations or places

 

Feeling endangered or unable to escape, severe stress or traumatic experiences can induce a panic attack

 

Although panic attacks and panic disorder have no clear cause, they seem to be inherited from a family medical history

 

Medical conditions that can be causing panic attacks: mitral valve prolapsed (minor heart problem – one of the valves does not close properly), hyperthyroidism (the thyroid gland is overactive), hypoglycemia (low blood sugar); also stimulants (cocaine, amphetamines, caffeine overdose) and medication withdrawal

 

Phobias:

Caused by genetic aspects (family member with an anxiety disorder) and environmental factors – traumas: nearly drowning, being kept in a closed space, being bitten, etc

 

Body dysmorphic disorder:

Possible explanations regarding the disorder’s development consist of biological and/or psychological factors

 

Genetically, a person can have a predisposition for Body dysmorphia

 

Psychological aspects are linked to low self-esteem and an unrealistic way of judging oneself only by appearance; demanding perfection and setting absurd ideals are also factors that fuel the disorder

Symptoms and signs

Generalized Anxiety Disorder:

 

Psychological:

Exaggerated, constant worrying about family, money, health, work

Inability to relax, to disconnect from all the concern

Finding it difficult to concentrate (because of all the worrying)

Inability to make a decision (because it may be the wrong one)

Over-thinking an option until you reach its most negative outcome

 

Physical:

Irritability

Fatigue

Muscle tension and aches

Sleeping problems

Headaches

Nausea

 

Panic attacks:

Symptoms develop abruptly and include a combination of the following:

Heart palpitations, the impression of a “racing” heart

Hyperventilation or shortness of breath

Chest pain

Sweating

Trembling

Choking sensation

Nausea

Dizziness, feeling faint

Hot/cold flashes

Feeling detached from the surroundings

Fear of dying, losing control

 

Panic Disorder:

Frequent, unexpected, unrelated panic attacks

Constantly worrying about future episodes

Behavioral change caused by panic attacks (avoiding places or situations that caused previous attacks)

 

Phobias:

Uncontrollable anxiety when the person is exposed to the source of his/her fear

Despite being aware that most fears are irrational, sufferers still cannot control themselves; feeling anxious only thinking about their source of fear

The feeling that the object/situation has to be avoided no matter what

Sweating

Abnormal breathing

Accelerated heartbeat

Dry mouth, nausea

Headaches

Trembling

Choking sensation

Dizziness, feeling faint

 

Body dysmorphic disorder:

Excessive preoccupation with appearance

Self-consciousness

Mirror checking or complete avoidance of mirrors

Constant impression of ugliness

Self-isolation, avoidance of social events

Frequent cosmetic procedures, excessive make-up, grooming

Seeking reassurance from others regarding aspect

Demoralization, depression

Depending on how severe the disorder is, it can affect relationships, social and family life and work

Advice

Generalized Anxiety Disorder:

 

Your doctor will do a physical examination and request lab tests in order to determine whether your anxiety is due to an underlying medical condition and assess your overall health

 

A psychological evaluation will be made in order to diagnose the disorder (following criteria from the Diagnostic and Statistical Manual of Mental Disorders – American Psychiatric Association)

 

The two courses of treatment are represented by psychotherapy and medication

 

Medication: antidepressants and in special circumstances (to relieve anxiety, for short periods) benzodiazepines (sedatives)

 

Usual, go-to quick-fixes such as smoking, drinking alcohol, coffee should be avoided

 

Physical activity and healthy eating are important during the treatment process

 

Panic Attacks and Panic Disorder:

 

Both conditions are treatable and manageable

 

Cognitive-Behavioral Therapy is recommended and highly efficient. It implies informing and educating the patient regarding anxiety, relaxation and breathing techniques, cognitive therapy, gradual exposure to panic triggers, interoceptive exposure (provoking bodily symptoms that are associated to panic attacks – for example, to simulate the “racing heart” – running up and down stairs)

 

Medication for Panic Disorder: antidepressants and/or benzodiazepines

 

Phobias:

 

In diagnosing a phobia, the doctor will determine if and what situation, creature, object or place triggers an irrational fear in the patient

 

Also, it is needed to know whether the fear is persistent, appears instantly when in contact with the source, and if the patient is aware that his/her fear is unreasonable but still cannot do anything about it

 

Other possible factors must be ruled out (side-effects of medication, another disorder, an underlying medical condition)

 

A treatment plan has to be established based on the needs of every individual patient

 

Medication: beta-blockers (used to keep blood pressure under control and reduce palpitations), antidepressants (SSRIs – serotonin reuptake inhibitors), tricyclic antidepressants, benzodiazepines (sedatives)

 

Cognitive-Behavioral therapy is recommended and efficient – learning about and understanding the phobia, perspective change

 

Exposure therapy – gradually being put in contact with the source of fear until it is conquered

 

Body Dysmorphic Disorder:

 

A series of physical and psychological tests will be run by your doctor in order to determine your disorder and associated symptoms

 

A physical examination and lab tests will help evaluate your overall health

 

A psychological evaluation will imply talking about your thoughts, feelings and behavioral patterns and also whether you have or had thoughts regarding self-harm

 

Avoiding to go to the doctor, being embarrassed to talk about your situation, revealing the true feelings and motivation behind an action or not even being aware of a harmful behavior delay and complicate the process of giving an accurate diagnosis and future treatment

 

After being diagnosed, there are two successful courses of treatment: cognitive behavioral therapy and medication

 

The cognitive behavioral therapy’s role is to help you understand your thoughts and feelings and develop new and positive patterns of thinking; negative actions/rituals (frequently checking oneself in the mirror, face picking or excessive grooming) are progressively kept under control and, in time, positive interactions replace them (developing social skills)

 

Medication: selective serotonin reuptake inhibitors (SSRIs) help control obsessive and repetitive behaviors

 

Antipsychotic medication is recommended along SSRIs if the patient also has delusions regarding appearance

 

Joining a support group and avoiding isolation is very important in such cases

 

Keeping a journal, learning relaxation techniques and stress management is also helpful in your treatment course

MISCONCEPTIONS
  • Generalized Anxiety Disorder:

     

    It means that a person is weak and incapable of dealing with anything

     

    Avoiding the anxiety-triggering situations will make the disorder go away

     

    When it is observed in children, the disorder should be quickly “treated” by forcing the child to do exactly what he/she is afraid of

     

    Panic attacks and Panic disorder:

     

    Panic attacks are just overreactions to stress

     

    Panic disorder is an untreatable, lifelong condition

     

    Panic attacks are just the first signs of a debilitating mental illness

     

    You must avoid anything you think might cause a panic attack

     

    Severe and repeated panic attacks will eventually lead to a heart attack

     

    Phobias:

     

    People with phobias are mentally ill

     

    Phobias cannot be overcome

     

    Phobias appear suddenly and start for no reason

     

    Phobias are self-induced

     

    Body Dysmophic Disorder:

     

    It is not a real, serious disorder that can have a great impact on a person’s life

     

    It only affects women; men are “immune” to such non-sense

     

    It is an eating disorder

     

    It is about major body issues

     

    There is nothing to do about it

Statistics

Anxiety disorders (National Institute of Mental Health)

 

Affect 1 in 8 children

 

Are the most common mental illnesses: 40 million adults in the US

 

Generalized Anxiety Disorder: Anxiety and Depression Association of America

 

This disorder affects 6.8 million adults in the US

 

Twice as many women are affected by GAD

 

Usually begins between childhood and middle age

 

Panic attacks:

 

7% of the people in the US experience at least one panic attack in their lifetime

 

Women tend to be more affected than men

 

Panic Disorder:

 

Affects 6 million people of the US population

 

Twice as many cases reported in women

 

Phobias:

 

Specific phobias affect 19 million people in the US

 

Prevalence is much higher in women

 

Average onset age is 7 years old

 

Body dysmorphic disorder:

 

The disorder has been reported in cases as young as 5 years old to 80 years old

 

It seems to have a higher prevalence in women

 

It occurs in 39% of the cases that are diagnosed with anorexia nervosa

 

Body dysmorphic disorder affects about 1% of the US population

Did you know?

Anxiety disorders are usually associated with other disorders: depression, eating disorders, ADHD

 

A very popular behavioral intervention was to snap a rubber band on your wrist whenever dark thoughts/anxiety crept up on you. The idea was to “help” suppress certain thoughts, but as studies have shown, resisting or ignoring some urges and thoughts only makes them much stronger, persistent.

 

Panic Attacks and Panic Disorder:

 

In the case of Nocturnal Panic Attacks you might have the feeling of watching yourself from a distance (derealization, depersonalization)

 

Panic Disorder and major depression is a common combination

 

Having a panic attack does not mean you will definitely develop panic disorder

 

Phobias:

 

Glossophobia is the fear of speaking in public, to an audience. It is also called performance anxiety

 

Acrophobia is the fear of heights: mountains, bridges or even the higher floors of buildings. Sufferers experience dizziness, sweating and the sensation that they will pass out at any moment

 

Claustrophobia is the fear of tight spaces and can even prevent a person from riding a car or getting in an elevator

 

Other phobias: Aviatophobia (fear of flying), Dentophobia (fear of the dentist or dental procedures), Hemophobia (fear of blood or injury), Cynophobia (fear of dogs), Ophidiophobia (fear of snakes)

 

Body Dysmorphic Disorder:

 

Body Dysmorphic Disorder has grave implications if it is left untreated (around 80% of the persons in case had or still have suicidal thoughts)

 

Body Dysmorphic Disorder is also called “The Imagined Ugliness Syndrome”