Anxiety is a normal experience for all of us.  We experience anxiety every day.  Mild anxiety is of benefit as it motivates us to work and to provide security for ourselves.  Sometimes normal anxiety can be intense and not always helpful, as the feelings before an exam or public speaking.  Sometimes normal anxiety can be intense to the point of panic, but it is still protective in nature, as in the "fight or flight" reaction.  It occurs in response to great danger and mobilizes all the body's reserves to protect itself.  occasionally this type of fear can be so great it becomes paralyzing.

Types of Anxiety Disorders

There are two broad categories of anxiety states that often require treatment.
They are:
Esogenous - an anxiety reaction due to outside causes
Endogenous - an anxiety disorder within the central nervous system

Anxiety Disorders include the following:
     - Panic Disorders
     - Panic Disorder with Agoraphobia 
     - Agoraphobia in the absence of Panic Attaacks
     - Social Phobia
     - Simple Phobias
     - Post Traumatic Stress Disorder

What is the Cause of Anxiety?

Recent research has revealed that anxiety is due to a disturbance within the central nervous system.  This disorder affects specific parts of the brain that normally control anxiety, creating a biochemical or physiological disturbance.  Why some people are affected by this disturbance and others are not is not known.  Genetic factors may play a role by making individuals more predisposed to developing an anxiety state.  Anxiety Disorders can spontaneously go away.  However, unfortunately it can continue for years and for this reason psychiatric treatment is required.

Signs and Symptoms

Generalized Anxiety Disorder usually begins slowly and gets progressively worse.  There are not usually apparent triggers or stresses that bring it on.  The symptoms wax and wane, but are almost always preset to some degree. 
The symptoms of anxiety can affect almost any organ in the body and include the following:
     - a subjective feeling of tension, uneasinness, fear, 
        apprehension, restlessness
     - sweaty palms
     - dry mouth
     - rapid pulse, palpitations, chest pains
     - breathlessness
     - dizziness
     - a subjective feeling of unreality, of beeing in a dream
     - difficulty concentrating
     - difficulty swallowing, a "lump" in the tthroat'
     - episodes of diarrhea, urgency to urinatee
     - chronic fatigue
     - muscle soreness, especially in the head region, neck and 
       shoulders
     - headaches - "tight band" of pressure
     - a butterfly feeling in the pit of the sttomach
     - insomnia

Because so many organ systems are involved, anxiety can mimic many other diseases.

Panic Disorder sometimes is proceeded by generalized anxiety.  Quite often it occurs out of the blue, although sometimes the first panic attack can be triggered by a stressful event.  Once established, the attacks can occur at any time and any frequency.  Some people have several a day, others only once a week.  Panic attacks are much different from generalized anxiety, although there are similarities.  Panic attacks come on suddenly, without warning, and are frightening and overwhelming.

the primary symptoms of an attack are:
     - shortness of breath, over breathing
     - palpitations, rapid pulse, chest pain
     - a choking or smothering feeling
     - a feeling of unreality, of losing controol
     - pins and needles
     - dizziness
     - sweating
     - trembling

People suffering a panic attack frequently fear that they are having a heart attack, are going crazy, or even dying.  The first few panic attacks often bring a person to an Emergency Department.

Untreated, both generalized anxiety and panic attacks can lead to considerable social and psychological handicaps.  Depression and preoccupation with illness (hypochondriasis) can be a consequence.

Other Types of Anxiety Disorders

Agoraphobia - is the fear of open spaces, crowds, places where a ready exit is not available (theaters, airplanes, buses). Panic attacks usually begin first and become associated with various situations that are available.  This disorder can be very severe and disabling.

Social Phobia - these are learned fears that develop in response to a frightening experience such as being trapped in an elevator or being bitten by a dog.  Often basic fears that all humans have as children (fear of snakes) become reactivated in adult life.

Post Traumatic Stress Disorder - this occurs following an experience that was perceived to be life threatening, such as an accident. Severe anxiety symptoms can develop including avoidance of a similar situation, nightmares, flashbacks of the experience during the day and so on.
 

What can be done?

Fortunately there are very effective treatments for these conditions.

1. To begin with, the correct diagnosis must be established.
    Other conditions that can mimic anxiety, such as an over-
    active thyroid or a heart condition must be ruled out.
2. Next, it is very important to gain control of the
    physiological aspects of the disorder.  This is done with
    medication.  Patients with anxiety frequently resist taking
    medications for fear of becoming addicted or of 
    experiencing further loss of control.  Medication therapy
     however, is usually essential.  It is important to note that 
     once symptoms are controlled, medications may have
     to be taken for several months, up to several years.  This is
     no different than drugs used for high blood pressure, 
     diabetes or many other medical conditions.

     It is important for people on the medications to report
     any side effects to their doctors.  The medication regime 
     for each person must be individualized.  Common side
     effects include dizziness, drowsiness, dry mouth, 
     constipation and occasional weight gain.
3. Psychological therapists are also important during treatment,
    once physiological symptoms are controlled.  A person may
    need to help to overcome learned avoidance and fears and 
    to make some life style changes.  Psychological therapies 
    are particularly helpful for agoraphobia, social phobia and 
    simple phobias.

What can People with Anxiety do for Themselves?
     - listen to their doctors advice
     - take the prescribed medications regularlly
     - be prepared to take a close look at theiir life-style and 
        try to correct or avoid stresses as much as possible.
     - learn to relax. Take time for themselvess, for holidays,
        hobbies.
     - regular habits such as a balanced diet, adequate sleep 
       and regular exercise are important.
     - avoid excessive caffeine (found in coffeee, tea, cocoa) 
       which can enhance symptoms.  Also avoid alcohol and 
       cannabis which are harmful in the long run, even though 
       they may seem helpful in the short term.

By Dr. L. Warneke