Introduction
Most of us know at least one person who has been afflicted with an anxietyârelated disorder. In many cases, itâs the person staring back at us in the mirror. Approximately 3 out of every 10 people in the United States will suffer from one of these disorders at some point in their lives. Because these problems cause so much distress in so many people, it is imperative that we have a correct understanding of their nature and treatments.
Anxiety disorders are characterized by expectations that distressing or dangerous events may occur in certain situations, even when there is little or no chance they will. These expectations are often associated with pronounced physiological arousal and strong tendencies to avoid the feared situations. Anxiety is also part of the symptom picture of several anxietyârelated disorders including posttraumatic stress disorder (PTSD), obsessiveâcompulsive disorder (OCD), and hoarding disorder.
The fifth edition of the American Psychiatric Associationâs diagnostic manual (DSMâ5), published in 2013, lists several anxiety disorders including specific phobias; social phobia; panic disorder; agoraphobia; and generalized anxiety disorder.
People with specific phobias usually experience anxiety about one particular situation (e.g., driving on freeways), object (e.g., needles), or living creatures (e.g., snakes). Often, phobias are given names derived from Greek. One of our favorites is hexakosioihexekontahexaphobia, which refers to a fear of the number 666, biblically associated with Satan. Try pronouncing that! Social anxiety disorder is an intense and often paralyzing fear of situations involving scrutiny by others, as in having a conversation or giving a speech in public. A diagnosis of panic disorder requires recurrent panic attacks with a fear of having more in the future. The name of this disorder also owes its origins to ancient Greece, in this case the mythical Greek god Pan, whose main diversion was scaring travelers in the forest, preferably at night. Apparently, Pan was good at his job. Panic attacks are terrifying experiences involving an abrupt surge of intense fear accompanied by physical symptoms that include accelerated heart rate, chest pain, shortness of breath, and trembling, as well as mental symptoms like a fear of losing control, going crazy, or dying. People diagnosed with agoraphobia become anxious in and avoid situations perceived as difficult to escape, embarrassing, or in which help would be unavailable in case of panicâlike symptoms. Examples are crowded places, movie theaters, or being alone and away from home. Generalized anxiety disorder is characterized by excessive and pervasive worry, usually in several areas such as work, school, finances, and the safety of oneself or loved ones.
Several anxietyârelated disorders appear in other sections of the DSM. These include PTSD, OCD, and hoarding disorder. In order to receive a diagnosis of PTSD, a person must experience exposure to traumas such as actual or threatened death, serious injury, or sexual violence. Exposure to trauma can be direct, as in the case of a victim of torture, or indirect, as in observing a fatal automobile crash. Common symptoms include traumaârelated distressing and intrusive memories, flashbacks, or dreams; distress at exposure to cues relating to the trauma (e.g., media depictions of similar events); sleep disturbances; inability to experience positive emotions; and irritability and anger. Recently, researchers have found that this disorder is even more prevalent than previously thought, with rates of at least 7%.
A diagnosis of OCD requires the presence of either obsessions, which are persistent and intrusive thoughts, urges, or images recalled that cause anxiety, or compulsions, which are maladaptive attempts to reduce that anxiety. In most cases, both obsessions and compulsions are present. A common example of OCD is when a person engages in excessive and frequent hand washing to reduce the anxiety caused by obsessions about dirt and contamination. In some cases, people with this disorder wash their hands so much that they rub off several layers of skin. A particularly good portrayal of a person with OCD was by Jack Nicholson in the 1997 movie As Good as It Gets. In contrast, people with hoarding disorder experience excessive anxiety about parting with possessions regardless of their value or utility. They retain them in an attempt to reduce anxiety. Some keep so much that it may be difficult for them to move around comfortably in their living quarters. A 2004 movie entitled The Aviator portrayed Howard Hughes, who was one of the wealthiest people in the world, and who developed a severe hoarding disorder.
There are a number of treatments that have been employed to treat anxiety. While the one that has shown the most success involves a number of methods that fall under the rubric of cognitiveâbehavior therapy, and to some extent psychoanalytically oriented psychotherapy. Others have also been used. They include antiâanxiety medication, herbal remedies, a form of meditation known as mindfulness, and a recently developed treatment known as eye movement desensitization and processing (EMDR). In the latter, the therapist asks clients to think of memories of anxietyâprovoking events while tracing the therapistâs backâandâforth finger movements with their eyes.
A number of questions have been raised about the nature and treatment of anxietyârelated disorders. In this section, we will examine some of them, including:
- Do panic attacks come out of the blue?
- Do most people who experience trauma develop PTSD?
- Is trauma involving physical threat necessary to trigger PTSD?
- In DSMâ5, is hoarding a symptom of obsessiveâcompulsive disorder?
- Are there any down sides to using antiâanxiety medications?
- How effective are herbal remedies, mindfulness meditation, and EMDR in the treatment of anxietyârelated disorders?
