Anxiety Disorders: Just What Are They? – Part 1

by Mike Nichols – Posted in: Anxiety

The subject of this blog are the Anxiety Disorders, obviously.

But I just realized that, aside from the reference information listed on the sidebar, I have never given a succinct list of what the primary Anxiety Disorders are.

This is the first of a two-part series that describes the main Anxiety Disorders. Note that every heading has a hyperlink to the full Reference article. Today’s post will cover the following:

General characteristics of Anxiety Disorders
Agoraphobia
Generalized Anxiety Disorder (GAD)
Obsessive-Compulsive Disorder (OCD)

The National Institute of Mental Health (NIMH) estimates that about 18.1 percent of the American people age 18 and older suffer from some sort of Anxiety Disorder. That’s 55 million people! According to the Anxiety Disorders Association of America (ADAA), the US economy loses over 42 billion dollars yearly due to undiagnosed, misdiagnosed and under-treated Anxiety Disorders. Less than one-third of those affected with Anxiety Disorder are treated, the ADAA found in a 1999 study.

General characteristics of Anxiety Disorders

Everybody has anxiety

Everybody has anxiety. It is a normal reaction to stress, a threat, or an emergency. The “fight or flight” response is built into humans as a way to prepare the body and mind to take on a situation that requires the ultimate of preparedness. It helps us do better on a test, run faster in races, and escape from a burning house.

However, when the “fight or flight” response does not turn off, or is too easily triggered, the human body becomes continually ready for action. This results in a serious imbalance in the body and brain’s chemistry, and leads to real trouble, both physically and mentally.

Anxiety Disorder: locked in a prison

The person with an Anxiety Disorder is locked in a prison, seemingly without any control of their own actions or environment. Untreated Anxiety Disorders cause people to avoid situations that trigger or worsen their symptoms. They are much more likely to suffer from depression. Many turn to alcohol or drugs to gain some sort of temporary relief. It is common for people with Anxiety Disorders to suffer family problems, poor job or school performance, and a crippling lack of self-esteem and self-confidence. Anxiety Disorder disrupts your life in many ways, all negative.

Although the symptoms of the various types of Anxiety Disorder vary, generally they may include:

Uncontrollable or obsessive thoughts
Overwhelming feelings of panic and fear
Painful, intrusive memories
Recurring nightmares
Stomach disturbances such as feeling sick or “butterflies”
Heart pounding and disturbed breathing
Muscle tension
Startling easily or overreacting to mundane situations

Agoraphobia

Agoraphobics typically are house-bound

People with Agoraphobia typically are house-bound, or find it extremely difficult to leave their homes, even when accompanied by another person. The NIMH estimates that there are 1.8 American adults with a history of Agoraphobia without Panic Disorder. About one in three of those with Panic Disorder develop Agoraphobia, as well — another 2 million.

Agoraphobics’ fears come in clusters, or groups rather than a single fear, which is characteristic of Social Phobia. Common symptoms of Agoraphobia are the fear of:

Being outside of home alone
Being in a crowd such as a meeting, a department store, or a waiting room
Standing in line
Being on a bridge, either on foot or in a vehicle
Traveling in a bus, train, or automobile
Being in a large open space, such as a parking lot

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association defines Agoraphobia as:

Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available
The situations are avoided or else are endured with marked distress or with anxiety, or require the presence of a companion.

Generalized Anxiety Disorder (GAD)

Worry defines Generalized Anxiety Disorder

Worry is the defining characteristic of GAD. Excessive worry and anxiety that are unrelieved often develop into GAD. Sufferers find that their normal daily life is impaired by their worrying, and in extreme cases, they cannot hold a job, they have serious relationship difficulties, and sometimes they are confined to their home. The NIMH states that about 6.8 million American adults have GAD. GAD can begin across the life cycle, though the median age of onset is 31 years.

GAD symptoms can include nausea, vomiting, and chronic stomach aches. Symptoms used in the diagnosis of GAD are:

Restlessness or feeling keyed up or on edge
Being easily fatigued
Irritability
Muscle tension
Difficulty falling or staying asleep, or restless unsatisfying sleep
Difficulty concentrating or the mind going blank

The DSM-IV has quite stringent requirements for diagnosing someone as having GAD in order to separate it from “normal” anxiety and worry. The criteria are:

Excessive anxiety and worry … occurring more days than not for at least six months…
The person finds it difficult to control the worry.
The anxiety and worry are associated with three (or more) of the following six diagnosable symptoms listed above (with at least some symptoms present for more days than not in the past 6 months).

Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder: recurring and disturbing thoughts

OCD is a psychiatric Anxiety Disorder characterized by recurring and disturbing thoughts (called “obsessions”). Most people with OCD — about eighty percent — also engage in repetitive, ritualized behaviors that the person feels driven to perform (called “compulsions”). The NIMH states that about 2.2 million adults in the US have OCD.

An important distinction with OCD is that the person recognizes that their thoughts or behaviors are senseless or excessive. However, the drive to actively dismiss the obsessions or neutralize them by engaging in compulsions is overpowering. Most people with OCD have multiple types of obsession and compulsion. OCD can be accompanied with other mental illnesses, such as eating disorders, Anxiety Disorders, or Depression.

The DSM-IV states that to be diagnosed with OCD, the individual can have either obsessions or compulsions alone, or both obsessions and compulsions. Obsessions and compulsions are described as:

Obsessions

Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress.
The thoughts, impulses, or images are not simply excessive worries about real-life problems.
The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.

Compulsions

Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not actually connected to the issue, or they are excessive.

In addition to these criteria, at some point during the course of the disorder, the individual must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning.

Common OCD obsessions include:

Fear of contamination
Doubts that tasks or rituals have been completed satisfactorily
Excessive concern with order, arrangement, or symmetry
Intrusive thoughts and fears that are difficult or impossible to control.
Physical symptoms may include tics, tremors, jerking arm movements, involuntary movements of the limbs and other Parkinson’s Disease-like movements.

Every OCD sufferer has a different set of tasks and rituals. Common OCD compulsions include:

Frequent hand washing, leading to dermatitis
Picking at the skin, causing skin lesions
Pulling the hair, causing hair loss or bald spots
Impulses to shout obscenities in inappropriate situations
Avoidance of situations that can trigger obsessions
Replaying pornographic images in the mind
Not shaking hands or touching objects others have touched, such as doorknobs and public phones
Repeatedly checking whether something was done, such as locking the door, shutting off the stove, or turning off a light
Counting steps, tiles, words in a book; counting objects in certain patterns or order
Repeatedly touching an object, ones self, or another
Intense distress when objects aren’t orderly, lined up properly or facing the right way
Excessive concern about accidentally or purposefully injuring another person. Ex. Repeated thoughts that you’ve hurt somebody in a traffic accident, images of hurting your child or another person
Fear that negative or aggressive thoughts or impulses will cause personal harm or harm to a loved one
Feeling overly responsible for the safety of others
Distasteful and inappropriate religious thoughts, such as blasphemous images
Distasteful and inappropriate sexual thoughts or images
Endless reviewing of conversations
Repetitively calling up “good” thoughts to neutralize “bad” thoughts or obsessions
Excessive praying and using special words or phrases to neutralize obsessions
Difficulty throwing away useless items such as old newspapers or magazines, bottle caps, or rubber bands; hoarding
Inability to stop repeating a name, phrase, or simple activity
Mental repetition of words, real or nonsense, to vanquish a horrific image or thought

Tomorrow’s installment will cover:

What do you think?

This is the shortest summary I could make without leaving out important information you should know. Note that each of the Anxiety Disorders is hyperlinked to the full discussion in the Reference section.

Have you ever experienced one of these Anxiety Disorders?
Do you have “medical school disease” where you think that every symptom you read applies to you?
Are my “short” synopses too long?

As always, your comments are welcome!

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Resources used in this post:

American Psychiatric Association. (2007). Anxiety — Let’s Talk Facts. Retrieved June 22, 2008, from American Psychiatric Association Web site (PDF): http://www.healthyminds.org/multimedia/anxietydisorders.pdf

Anxiety Disorders Association of America. (2008). Statistics and Facts About Anxiety Disorders. Retrieved June 26, 2008 from Anxiety Disorders Association of America Web site: http://adaa.org/AboutADAA/PressRoom/Stats&Facts.asp

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Arlington, VA: American Psychiatric Association. 1994.

National Institute of Mental Health. (2006). Anxiety Disorders Introduction. Retrieved June 23, 2008, from National Institute of Mental Health. Web site: http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml

National Institute of Mental Health. (2008, June 26). The Numbers Count: Mental Disorders in America. Retrieved August 28, 2008 from National Institute of Mental Health Web site: http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml

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