What You Need to Know About Anxiety Disorders
Anxiety disorders are a cluster of syndromes where anxiety or fear is a key component. They include generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder, social anxiety disorder (also known as social phobia) and other phobias, separation disorder and post traumatic stress disorder.
They have all been categorised by the 'Diagnostic and Statistical Manual of Mental Disorders' which is in its fourth edition and known as DSM-IV. The manual is followed by American and British doctors and psychiatrists.
Making a diagnosis of one of the anxiety disorders isn't an exact science partly because there is some overlap in the symptoms. A doctor will also need to rule out other medical conditions such as an overactive thyroid, which could cause similar symptoms. Diagnosis is complicated further if the individual is abusing substances such as drugs or alcohol.
What you need to know about anxiety disorders is that they are treatable and that if you or a loved one are suffering from one you are not alone.
A revealing first hand experience of living with OCD.
DSM IV for OCD
According to the DSM IV obsessions are recurrent, persistent thoughts, impulses or images that are intrusive and not appropriate. These thoughts cause notable anxiety or distress. An example of an obsession would be a caring father who felt convinced that he was going to harm his child in some way or a person having thoughts that the whole house is tainted with dangerous germs. Obsessions may be, but are not always, accompanied by compulsions.
Compulsions are repetitive behaviours that the person performs to ward off the perceived dangers or because they feel they have to follow complicated internal rules. Examples are hand washing repeatedly or having to switch the light switch of a set number of times before leaving a room. The individual will recognise that their behaviour is excessive some of the time, but still be unable to stop doing it.
To be diagnosed with OCD the thoughts or actions must cause marked distress, they will be time consuming taking at least 1 hour a day or interfere significantly with the individual’s ability to function. A doctor will rule out OCD if the patient has a disorder such as anorexia and the obsessions and compulsions are all related to that.
Complex Post Traumatic Stress Disorder and PTSD
The DSM IV for PTSD in summary require the individual to have been involved in or witnessed an incident where there was a threat of death or serious injury to themselves or others or where there was actual death or injury.
Resulting symptoms may include: recurrent distressing memories or dreams replaying the event, feeling as though the event was occurring and intense distress when exposed to a cue which symbolises the event for them. They will also avoid things which recall the trauma to mind and may feel detached from feelings and people. They will show evidence of being very on edge e.g. with an exaggerated startle response or angry outbursts.
Traditional PTSD is focussed on the premise of a one off event which has caused the symptoms for example a terrorist attack, whereas the more recently described ‘complex PTSD’ acknowledges that some people will have endured trauma, such as domestic violence, over a considerable period of time.
Separation Anxiety Disorder
Also known as separation disorder this used to be considered a childhood anxiety disorder, but psychiatrists now recognise that it can occur in adults as well. It is normal for children between the ages of 8 – 15 months to show separation anxiety. Separation disorder would only be diagnosed if they meet the DSMIV criteria.
A study by Katherine Shear (2006) estimates that 4% of Americans suffer from separation disorder at some time during childhood and 6% of adults will suffer from adult separation disorder in their lifetime. Adult separation disorder is too newly recognised to have been given DSM criteria, but for children a summary of the criteria is:
The child shows excessive anxiety about separation from home or from someone to whom they are attached. Symptoms could include: recurrent excessive distress when separated or when they anticipate being separated, persistent reluctance or refusal to go to places because fear of separation, repeated nightmares involving the theme of separation.
This must happen over a minimum of a month and the child must either show clinically significant distress or be functioning significantly less well e.g. at school, because of it.
DSM IV for GAD
In a summary of the DSM IV for generalised anxiety disorder, for a diagnosis of GAD to be made an individual will have been excessively anxious and apprehensive about a wide range of situations or issues, such as work, health and going shopping, nearly everyday for at least six months. Their symptoms could include restlessness, feeling tired a lot and muscle tension. They find the worrying is uncontrollable and their condition must cause them significant distress or reduced ability to function.
In the UK GAD affects about 1 in 20 adults i.e. 5% of the population, so is quite a common condition. Patients with GAD are often diagnosed with depression as well. Sometimes the anxiety is present first and then the patient becomes depressed or sometimes the depression occurs first followed by anxiety. (Depression and generalized anxiety disorder, Moffitt et al June 2007)
DSM IV for Social Phobia
According to the DSM IV social phobia, also known as social anxiety disorder is diagnosed if the individual shows a marked and persistent fear in social or performance situations particularly in front of unfamiliar people or if they feel watched. The individual is afraid they will embarrass themselves or that the symptoms of anxiety will be humiliating, but they also recognise that the fear is disproportionate. They may try to avoid these situations or endure them but with anxiety and distress.
All of this interferes significantly with the person’s functioning or social activities or causes them a lot of distress. It is likely to have been going on for several months at least in order for a diagnosis to be made.
Avoidant personality disorder (AVPD) is a condition with some similarities to social phobia, but studies have shown that people with AVPD don’t all have social phobia so there is a clear distinction between the two conditions. ('Social Anxiety Disorder' Boden et al 2010)
DSM IV for Panic Disorder
Panic disorder is comparatively rare affecting 1 in 75 people (American Psychological Association) Panic disorder is characterised by panic attacks, however, panic attacks are not limited to individuals with panic disorder for example, they may occur as a symptom of PTSD or if someone with a specific phobia such as arachnophobia sees whatever triggers their phobia.
To be diagnosed with panic disorder the panic attacks must occur in a range of situations and although the individual may start to avoid situations because they fear getting a panic attack.it is the panic attacks which they fear rather than the situation. Panic disorder is quite often seen alongside agoraphobia, because the individual may feel that the only way to avoid triggering the panic attacks is to stay at home.
According to DSM IV a panic attack is characterized by four or more of these symptoms: heart palpitations, sweating, trembling, feeling short of breath, feeling of choking, chest pain, upset stomach or feeling sick, feeling dizzy or faint, feelings of being detached from oneself, fear of losing control, fearing of dying, numbness or tingling, chills or hot flushes.
Anxiety Disorder Treatment
Anxiety disorders can be treated with either medication, psychotherapy or a combination of the two. It isn’t always possible to completely cure an anxiety disorder, but it is usually possible to relieve the symptoms enough to improve the individual’s quality of life significantly.
Medication used to treat anxiety disorders includes antidepressants such as fluoxetine and citalopram and for very short term treatment benzodiazepines or buspirone. These must be prescribed by a doctor and the doctor should advise you to attend regular appointments to monitor the effectiveness of the medication and discuss any side effects which occur.
Cognitive behaviour therapy (CBT) is the most commonly used ‘talking therapy’ for anxiety disorders. It helps patients identify triggers for the anxiety and to understand the nature of panic attacks or anxious feelings. The therapist will look at ways in which the patient can cope with the feelings for example by teaching them relaxation techniques. They will often accompany the patient to some situations where they would expect to feel anxious or have a panic attack so that they can work through the learnt techniques for real.
The crucial thing with any psychotherapeutic treatment for an anxiety disorder is that the patient really engages with the therapy and makes an effort to use the techniques given and to gradually challenge themselves by going in to situations that they are afraid of. It does take a leap of faith to commit to the therapy especially if results aren’t immediately seen. Be reassured that the therapist isn’t expecting an overnight cure but rather a process of small incremental improvements, with perhaps the odd set back along the way. A good therapist will modify their treatment plan in response to each of their clients’ needs and progress. Most therapies for treating anxiety will last 10 – 20 weeks with one session per week.