ANXIETY DISORDERS
After investigating the biology and
life events that can cause stress and anxiety, we now turn our attention to the
instances when the anxiety becomes an interference in the clients’ daily
living. We will use the NIMH brochure on
Anxiety disorders and the Surgeon General reports throughout this section to
better understand these complex but highly treatable disorders.
Please
review the DSM IV Characteristics of Anxiety Disorders and screening tools
for their assessment, please visit click
here to go to the ADAA resource page on this topicScreening
tools http://www.adaa.org/Public/ScreeningTool.cfm
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ANXIETY DISORDERS NIH Publication No. 00-3879 |
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Introduction
Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.1 These disorders fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.
Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment.
This brochure will
- help you identify the symptoms of anxiety disorders,
- explain the role of research in understanding the causes of these conditions,
- describe effective treatments,
- help you learn how to obtain treatment and work with a doctor or therapist, and
- suggest ways to make treatment more effective.
The anxiety disorders discussed in this brochure are
- panic disorder,
- obsessive-compulsive disorder,
- post-traumatic stress disorder,
- social phobia (or social anxiety disorder),
- specific phobias, and
- generalized anxiety disorder.
Each anxiety disorder has its own distinct features, but they are all bound together by the common theme of excessive, irrational fear and dread.
The National Institute of Mental Health (NIMH) supports scientific investigation into the causes, diagnosis, treatment, and prevention of anxiety disorders and other mental illnesses. The NIMH mission is to reduce the burden of mental illness through research on mind, brain, and behavior. NIMH is a component of the National Institutes of Health, which is part of the U.S. Department of Health and Human Services.
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Post Traumatic Stress |
Before we can truly mourn our losses
and deal with grief in traumatic situations we must first address the stress
response. Not everyone will
develop Post Traumatic Stress Disorder (PTSD) in response to a traumatic
event, but the response to the event may be somewhat predictable and should be
viewed as a normal response. Education and understanding of the body and the mind's
response to traumatic stress can be quite helpful to many people. In an incident of mass destruction and
violence we are now seeing the image through various media sources several
times over. These images become a collective part of our psyche and
without directly being in that place we can begin to experience symptoms of
PTSD. We need to be aware of attentive to the signs of ongoing
problems. In this course you have links to sources for information on
initial responses and ongoing treatment issues.
PTSD is seen as having three
components: an inability to stop thinking about the incident and replay the
events, numbing and avoiding reminders of the incident, heightened anxiety and
startle response. (Frank Ochberg,
MD ON PTSD video, Gift From Within) I have often heard this explained as a
feeling of ongoing noise or static in the space around the client.
A history of PTSD, depression or
anxiety can impact the reoccurrence of the PTSD symptoms. Additionally proximity to the incident and direct
contact will impact the stress and grief response. If you have lost
a loved one in New York your grief is likely to be far deeper and longer than
those of us who have experienced the loss via media. If you are living in
a violent situation, it is not until you are separated from that situation and
feel a distance of safety that your grief process and healing can begin.
Those recovering from a traumatic incidence will most likely show symptoms of
Post Traumatic Stress. Dr. Frank Ochberg repeatedly refers to this as a
"normal response to an abnormal situation" Although this diagnosis
was initially developed for survivors of war we as clinicians recognize its
broad applicability to the victims of violence. How do we deal with
these situations in the clinical situation? We will approach healing the wounds of violence as a
multidisciplinary effort. The victims may
first encounter a medical professional; the first line of intervention may be a
primary care facility. There is likely to be a physical, emotional,
legal and spiritual response required in many of these cases. Let us
first define Sudden Traumatic Loss
What
is a sudden, traumatic loss?
Few
things in life are as painful as the sudden, traumatic death of a loved one. Sudden, traumatic deaths include (a) deaths that
occur suddenly or without warning, providing no opportunity to say good-bye;
(b) deaths that are untimely, including the death of one's child at any age;
(C) deaths involving violence, mutilation, or destruction; (d) situations
involving multiple deaths; and (e) deaths that occur as a result of the
carelessness, negligence, or willful misconduct of others. Major causes of such
losses include unintentional deaths resulting from motor vehicle crashes or
firearms, as well as deaths from homicide or suicide. Sixty percent of all
individuals experience the sudden, traumatic loss of a loved one at some point
in their lives.
What
symptoms are typical following a sudden, traumatic loss?
The
range of people's reactions can vary a great deal from person to person and
from culture to culture. Survivors often
experience two different kinds of symptoms - trauma symptoms and grief symptoms
- which sometimes can overwhelm their capacity to cope.
Trauma
symptoms may include feelings of horror and anxiety on the one hand and
emotional numbness and a sense of disconnection on the other. Some people cannot remember significant parts of
what happened, while others are plagued by memories or feel as if they are
re-experiencing or reliving the event through painful flashbacks. Because
sudden, traumatic deaths represent such an assault to the system, many people
develop a psychological condition called post-traumatic stress disorder (or
PTSD) following the loss. There are three kinds of symptoms that indicate PTSD. These include (1)
re-experiencing of the traumatic event as indicated by painful, intrusive
thoughts or nightmares about the death; (2) avoidance and emotional numbing as
indicated by feeling detached from others, loss of interest in others, and
marked avoidance of activities, places, or things related to the loved one's
death; and (3) increased arousal, as indicated by difficulty sleeping,
irritability, and difficulty concentrating.
Signs
of grief include strong feelings of yearning or longing for the loved one and feeling empty or like a part
of the survivor has died.
Survivors often speak
of a generalized pain or heaviness in their chest, feeling depressed and hopeless about the future,
and having things that were once important not seem to matter so much any more.
They may cry easily, lose interest in eating, or experience stomach upset,
headaches, and feelings of restlessness.
How
long will the feelings last?
Because survivors
must come to terms with the loss of their loved one, as well as the manner in
which it occurred, it can take time for the painful feelings and thoughts to diminish.
It may take longer if (1) it involved the loss of a child, (2) the survivor has
experienced previous traumatic events, such as other traumatic losses, rape or
sexual abuse, (3) friends and relatives are unsupportive, (4) the survivor is
simultaneously coping with other serious problems, such as major health
problems, or (5) the survivor witnessed the death or was also threatened with
death.
After the initial
shock of the death wears off, most people experience distress that may be quite
intense. At first, the pain may seem constant. Over time, there may be
intervals when the survivor is able to focus on other issues and not feel the
intense pain of the loss.
Gradually, these intervals will
become longer, and there will be good days and bad days. However, people can
experience setbacks during the process. On a relatively good day, they may
encounter a reminder of their loved one - for example, a favorite song may be
played on the radio, and this may cause the reemergence of painful feelings of
loss. People often have difficulty dealing with occasions such as holidays,
birthdays, and the anniversary date of the death.
When
is it a good idea to seek professional help?
One sign that
professional help may be warranted is if the survivor continues to experience frequent or severe
trauma symptoms, as described above, for more than a few months after the
death. This is especially true if these symptoms are interfering with other
parts of normal life such as relationships, work, or leisure activity.
In addition, any
of the following experiences suggest that professional help may be warranted:
continuing to experience intense yearning for the deceased that does not
diminish over time
struggling with substantial
feelings of guilt or uncontrolled rage
becoming
severely depressed and feeling completely hopeless about the future
harboring
persistent suicidal thoughts
abusing
alcohol or other drugs or greatly increasing tobacco use
being
unable to accomplish the tasks required for daily living, or to hold a job
What
can survivors do to help themselves?
The
immune system and the cardiovascular system may be affected by grief, so it is important for survivors to eat well and
to stay in contact with their primary physician, so that any chronic health
problems, such as heart disease can be monitored. Survivors are prone to other
sorts of mishaps, such as automobile accidents, because they are often
preoccupied by their grief. It may be unwise to make major decisions during the
first several months after a loss since they may bring on additional stress.
Most experts
recommend that survivors try to confide in someone about the loss. This can be
a friend, a clergy person, or another person who has experienced a similar loss.
It may take some trial and error to identify friends who can be good listeners.
Since many people do not know what to say or do to be helpful, they may say the
"wrong" thing. Some survivors withdraw from social contact because of
the possibility of such hurtful comments. This is unfortunate, because it cuts
people off from interactions that could be healing.
Grieving
is a difficult process because it involves remembering what happened. These memories may be so upsetting that it is
almost more than the survivor can bear. Hence, it is important for survivors to
learn strategies for calming themselves down. These might include such things
as taking a walk, taking a warm bath, exercising, surfing the Internet, or
watching a movie. Some survivors find it useful to keep a journal of their
feelings. There is some research to suggest that recording thoughts and
feelings about a traumatic event in written form promotes greater understanding
and even better physical health.
Treatment
can help
No
matter how long someone has been suffering from the impact of a sudden,
traumatic loss, it is important not to give up hope. Healing is a long, slow and sometimes painful
process. It is also important to remember that effective treatments are
available for the symptoms that are usually most troubling following a
traumatic loss - post-traumatic stress symptoms and symptoms of depression.
These treatments require effort and commitment - survivors may have to review
painful thoughts about their loved ones and the circumstances surrounding the
death - but treatment can be successful.
A family doctor, clergy person, local mental
health association, state psychiatric, psychological, or social work
association, or health insurer may be helpful in providing a referral to a
counselor or therapist with experience in treating people affected by sudden
traumatic loss. For more information about traumatic stress or the
International Society of Traumatic Stress Studies, call 1-877-507-PTSD
Reprinted with permission from the International
Society for Traumatic Stress Studies (ISTSS)
For more information about ISTSS and its work,
visit http://www.istss.org
© 2000 International Society for Traumatic Stress
Studies
Generalized Anxiety Disorder
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John was referred by his EAP for emotional outbursts his anger
always seemed right beneath if not on top of the surface.
“The house, the kids the job the parents, the roof.... I just can’t get to sleep anymore.” Upon Review of His case John was given the
GAD diagnosis and referred to a brief cognitive therapist to help him develop
tools for stress and anger management.
In the course of treatment a tendency towards substance abuse was
explored and treatment for this was begun as well.
From the NIMH Brochure on Anxiety Disorders
"I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go.
"I'd have terrible sleeping problems. There were times I'd wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were: when I got a stomachache, I'd think it was an ulcer.
"When my problems were at their worst, I'd miss work and feel just terrible about it. Then I worried that I'd lose my job. My life was miserable until I got treatment."
Generalized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. It's chronic and fills one's day with exaggerated worry and tension, even though there is little or nothing to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.
People with GAD can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. Their worries are accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. People with GAD may feel lightheaded or out of breath. They also may feel nauseated or have to go to the bathroom frequently.
Individuals with GAD seem unable to relax, and they may startle more easily than other people. They tend to have difficulty concentrating, too. Often, they have trouble falling or staying asleep.
Unlike people with several other anxiety disorders, people with GAD don't characteristically avoid certain situations as a result of their disorder. When impairment associated with GAD is mild, people with the disorder may be able to function in social settings or on the job. If severe, however, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities.
GAD affects about 4 million adult Americans1 and about twice as many women as men.2 The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age.2 It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. There is evidence that genes play a modest role in GAD.13
GAD is commonly treated with medications. GAD rarely occurs alone, however; it is usually accompanied by another anxiety disorder, depression, or substance abuse.2,4 These other conditions must be treated along with GAD.
GENERALIZED ANXIETY
DISORDER SELF-TEST
How
much anxiety is too much? If you suspect that you might suffer from generalized
anxiety disorder, complete the following self-test by clicking the "yes"
or "no" boxes next to each question, print out the test and show the
results to your health care professional.
HOW
CAN I TELL IF IT'S GAD?
Yes or No? Are you troubled by:
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Yes No
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Excessive worry,
occurring more days than not, for a least six months? |
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Yes No
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Unreasonable worry
about a number of events or activities, such as work or school and/or health? |
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Yes No
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The inability to
control the worry? |
Are
you bothered by a least three of the following?
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Yes No
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Restlessness, feeling
keyed-up or on edge? |
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Yes No
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Being easily tired? |
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Yes No
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Problems concentrating? |
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Yes No
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Irritability? |
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Yes No
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Muscle tension? |
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Yes No
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Trouble falling asleep
or staying asleep, or restless and unsatisfying sleep? |
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Yes No
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Does your anxiety
interfere with your daily life? |
Having
more than one illness at the same time can make it difficult to diagnose and
treat the different conditions. Illnesses that sometimes complicate anxiety disorders
include depression and substance abuse. With this in mind, please take a minute
to answer the following questions
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Yes No
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Have you experienced
changes in sleeping or eating habits? |
More
days than not, do you feel:
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Yes No
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Sad or depressed? |
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Yes No
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Disinterested in life? |
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Yes No
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Worthless or guilty? |
During
the last year, has the use of alcohol or drugs:
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Yes No
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Resulted in your
failure to fulfill responsibilities with work, school, or family? |
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Yes No
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Placed you in a
dangerous situation, such as driving a car under the influence? |
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Yes No
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Gotten you arrested? |
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Yes No
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Continued despite
causing problems for you and/or your loved ones |
Reference:
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
Washington, DC, American Psychiatric Association, 1994.
If you or someone you know would like more information on generalized anxiety disorders, please click here to go to the ADAA resource page on this topic
Panic Disorder
"It started 10 years ago, when I had just graduated from college and started a new job. I was sitting in a business seminar in a hotel and this thing came out of the blue. I felt like I was dying.
"For me, a panic attack is almost a violent experience. I feel disconnected from reality. I feel like I'm losing control in a very extreme way. My heart pounds really hard, I feel like I can't get my breath, and there's an overwhelming feeling that things are crashing in on me.
"In between attacks there is this dread and anxiety that it's going to happen again. I'm afraid to go back to places where I've had an attack. Unless I get help, there soon won't be anyplace where I can go and feel safe from panic."
People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They can't predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike.
If you are having a panic attack, most likely your heart will pound and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have nausea, chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control. You may genuinely believe you're having a heart attack or losing your mind, or on the verge of death.
Panic attacks can occur at any time, even during sleep. An attack generally peaks within 10 minutes, but some symptoms may last much longer.
Panic disorder affects about 2.4 million adult Americans1 and is twice as common in women as in men.2 It most often begins during late adolescence or early adulthood.2 Risk of developing panic disorder appears to be inherited.3 Not everyone who experiences panic attacks will develop panic disorder-for example, many people have one attack but never have another. For those who do have panic disorder, though, it's important to seek treatment. Untreated, the disorder can become very disabling.
Many people with panic disorder visit the hospital emergency room repeatedly or see a number of doctors before they obtain a correct diagnosis. Some people with panic disorder may go for years without learning that they have a real, treatable illness.
Panic disorder is often accompanied by other serious conditions such as depression, drug abuse, or alcoholism4,5 and may lead to a pattern of avoidance of places or situations where panic attacks have occurred. For example, if a panic attack strikes while you're riding in an elevator, you may develop a fear of elevators. If you start avoiding them, that could affect your choice of a job or apartment and greatly restrict other parts of your life.
Some people's lives become so restricted that they avoid normal, everyday activities such as grocery shopping or driving. In some cases they become housebound. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person.
Basically, these people avoid any situation in which they would feel helpless if a panic attack were to occur. When people's lives become so restricted, as happens in about one-third of people with panic disorder,2 the condition is called agoraphobia. Early treatment of panic disorder can often prevent agoraphobia.
Panic disorder is one of the most treatable of the anxiety disorders, responding in most cases to medications or carefully targeted psychotherapy.
You may genuinely believe you're having a heart attack, losing your mind, or are on the verge of death. Attacks can occur at any time, even during sleep.
Depression
Depression often accompanies anxiety disorders4 and, when it does, it needs to be treated as
well. Symptoms of depression include feelings of sadness, hopelessness, changes
in appetite or sleep, low energy, and difficulty concentrating. Most people
with depression can be effectively treated with antidepressant medications,
certain types of psychotherapy, or a combination of both.
Panic DisorderPanic disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief. Many people with panic disorder develop intense anxiety between episodes. It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have occurred, such as in supermarkets or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. Facts About Panic Disorder
Fortunately, research—including studies
supported by NIMH—has led to the development of treatments to help people
with panic disorder. Treatments for Panic DisorderTreatments for panic disorder include medications, commonly the selective serotonin reuptake inhibitors, and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety. 4 NIMH is conducting a large-scale study to evaluate the effectiveness of combining these treatments. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70 to 90 percent of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode. Research FindingsHeredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder. 4 The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation. Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which underlie anxiety disorders, such as panic disorder. 5 Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body's fear response is coordinated by a small structure deep inside the brain, called the amygdala. The amygdala, although relatively small, is a very complicated structure, and recent research suggests that anxiety disorders may be associated with abnormal activation in the amygdala. One aim of research is to use such basic scientific knowledge to develop new therapies.
All material in this fact sheet is in the public domain and may be copied or reproduced without permission from the Institute. Citation of the source is appreciated. NIH Publication No. 01-4596 ----------------------------------- References 1 Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1, 1998. Unpublished. 2 Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991. 3 Regier DA, Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry Supplement, 1998; (34): 24-8. 4 Hyman SE, Rudorfer MV. Anxiety disorders. In: Dale DC, Federman DD, eds. Scientific American® Medicine. Volume 3. New York: Healtheon/WebMD Corp., 2000, Sect. 13, Subsect. VIII, p. 1. 5 LeDoux J. Fear and the brain: where have we been, and where are we going? Biological Psychiatry, 1998; 44(12): 1229-38. |
Updated: January 01, 2001
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Obsessive-Compulsive
Disorder
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James couldn’t sleep and couldn’t eat
for 3 days. He felt at constant
vigilance to check each of the odors in his house and windows and then recheck them
in the reverse order followed by a period of three hours rest. His wife had called in to see if the clinic
might help. As James was having
difficulty leaving the house the first challenge was to see if there was help
that could go to him. The County had an
emergency response team that was able to go to James house and speak with
him. He was highly agitated following
what he described as the inhumane treatment of a dog a few nights earlier. He had heard an animal being mistreated and
he had tried to ‘lock out the sound.’
His wife had described him as being extremely organized as someone who
never left the house without checking three times. He also checked his appearance in the mirror three times before
leaving in the morning and would check the email and voice messaging several
times as well,” just in case.’ She had found these rituals quirky and endearing
but had never seen him in this type of difficult situation. James was hospitalized for 72 hours and given
medication and ongoing treatment with the county psychologist. During the course of his treatment a history
of abuse of him and the family pet emerged.
Screening tools http://www.adaa.org/Public/ScreeningTool.cfm
From the NIMH Brochure
"I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a "bad" number.
"Getting dressed in the morning was tough because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me.
"I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy."
Obsessive-compulsive disorder, or OCD, involves anxious thoughts or rituals you feel you can't control. If you have OCD, you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals.
You may be obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. You may have frequent thoughts of violence, and fear that you will harm people close to you. You may spend long periods touching things or counting; you may be pre-occupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs.
The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent or get rid of them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the anxiety that grows when you don't perform them.
A lot of healthy people can identify with some of the symptoms of OCD, such as checking the stove several times before leaving the house. But for people with OCD, such activities consume at least an hour a day, are very distressing, and interfere with daily life.
Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary.
OCD afflicts about 3.3 million adult Americans.1 It strikes men and women in approximately equal numbers and usually first appears in childhood, adolescence, or early adulthood.2 One-third of adults with OCD report having experienced their first symptoms as children. The course of the disease is variable-symptoms may come and go, they may ease over time, or they can grow progressively worse. Research evidence suggests that OCD might run in families.3
Depression or other anxiety disorders may accompany OCD,2,4 and some people with OCD also have eating disorders.6 In addition, people with OCD may avoid situations in which they might have to confront their obsessions, or they may try unsuccessfully to use alcohol or drugs to calm themselves.4,5 If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home.
OCD generally responds well to treatment with medications or carefully targeted psychotherapy.
The disturbing thoughts or images are called obsessions, and the rituals performed to try to prevent or get rid of them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the anxiety that grows when you don't perform them.
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NIMH Obsessive-Compulsive DisorderPeople with obsessive-compulsive disorder (OCD), an anxiety disorder, suffer intensely from recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions) that they feel they cannot control. Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to carry out rituals can take over a person's life. OCD is often a chronic, relapsing illness. Fortunately, research—including studies supported by NIMH—has led to the development of treatments to help people with OCD. Facts About OCD
Treatments for OCDTreatments for OCD include medications and behavioral therapy, a specific type of psychotherapy. The combination of these treatments is often most effective. 6 Several medications have been proven helpful for people with OCD: clomipramine, fluoxetine, fluvoxamine, sertraline, and paroxetine. If one drug does not work, others should be tried. A number of additional medications are currently being studied.
Research FindingsThere is growing evidence that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called the striatum. 7 OCD is not caused by family problems or attitudes learned in childhood, such as an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in individuals with OCD, both behavioral therapy and medication produce changes in the striatum. This is graphic evidence that both psychotherapy and medication affect the brain. Persons with OCD use different brain circuitry in performing For More Information National Institute of Mental
Health (NIMH) ----------------------------------- All material in this fact sheet is in the public domain and may be copied or reproduced without permission from the Institute. Citation of the source is appreciated. NIH Publication No. 01-4598 ----------------------------------- References 1 Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1, 1998. Unpublished. 2 Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991. 3 Regier DA, Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry Supplement, 1998; (34): 24-8. 4 Wonderlich SA, Mitchell JE. Eating disorders and comorbidity: empirical, conceptual, and clinical implications. Psychopharmacology Bulletin, 1997; 33(3): 381-90. 5 Sheppard DM, Bradshaw JL, Purcell R, et al. Tourette's and comorbid syndromes: obsessive compulsive and attention deficit hyperactivity disorder. A common etiology? Clinical Psychology Review, 1999; 19(5): 531-52. 6 Hyman SE, Rudorfer MV. Anxiety disorders. In: Dale DC, Federman DD, eds. Scientific American® Medicine. Volume 3. New York: Healtheon/WebMD Corp., 2000, Sect. 13, Subsect. VIII, p. 1. 7 Rauch SL, Savage CR, Alpert NM, et al. Probing striatal function in obsessive-compulsive disorder: a PET study of implicit sequence learning. Journal of Neuropsychiatry and Clinical Neuroscience, 1997; 9(4): 568-73. |
A
type of behavioral therapy known as "exposure and response
prevention" is very useful for treating OCD. In this approach, a person
is deliberately and voluntarily exposed to whatever triggers the obsessive
thoughts, and then is taught techniques to avoid performing the compulsive
rituals and to deal with the anxiety.Updated: January 01, 2001
|
SOCIAL ANXIETY DISORDER |
Charles could no longer do his job because of the after
hours social events. Walking into a room
of known and new people made him nervous and sweaty. He always bolted before he made it to the buffet. When colleagues invited him out
to lunch he would always have a reason not to go. He became less and less present at family gatherings as new significant
relationships were invited to the holiday events. His boss referred him to the mental health services as he valued
his work and on job efforts. During
therapy Charles admitted to stuttering when he was in an unfamiliar
situation. He was able to get through
this with the therapist but would actually panic at the thought of a new social
situation. The therapist suggested a
medical evaluation at which Paxilä was prescribed and a speech evaluation was suggested. A coordinated effort a systematic desensitization
was designed starting with the least stressful of family events a 4th
of July barbecue. He then progressed to
work lunches onto the bigger events.
From
NIMH Booklet
"In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate, as I got closer to a college class, a party, or whatever. I would feel sick at my stomach-it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else.
"When I would walk into a room full of people, I'd turn red and it would feel like everybody's eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn't think of anything to say to anybody. It was humiliating. I felt so clumsy; I couldn't wait to get out.
"I couldn't go on dates, and for a while I couldn't even go to class. My sophomore year of college I had to come home for a semester. I felt like such a failure."
Social phobia, also called social anxiety disorder, involves overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work or school, and other ordinary activities. While many people with social phobia recognize that their fear of being around people may be excessive or unreasonable, they are unable to overcome it. They often worry for days or weeks in advance of a dreaded situation.
Social phobia can be limited to only one type of situation- such as a fear of speaking in formal or informal situations, or eating, drinking, or writing in front of others-or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people. Social phobia can be very debilitating-it may even keep people from going to work or school on some days. Many people with this illness have a hard time making and keeping friends.
Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, nausea, and difficulty talking. If you suffer from social phobia, you may be painfully embarrassed by these symptoms and feel as though all eyes are focused on you. You may be afraid of being with people other than your family.
People with social phobia are aware that their feelings are irrational. Even if they manage to confront what they fear, they usually feel very anxious beforehand and are intensely uncomfortable throughout. Afterward, the unpleasant feelings may linger, as they worry about how they may have been judged or what others may have thought or observed about them.
Social phobia affects about 5.3 million adult Americans.1 Women and men are equally likely to develop social phobia.10 The disorder usually begins in childhood or early adolescence,2 and there is some evidence that genetic factors are involved.11 Social phobia often co-occurs with other anxiety disorders or depression.2,4 Substance abuse or dependence may develop in individuals who attempt to "self-medicate" their social phobia by drinking or using drugs.4,5 Social phobia can be treated successfully with carefully targeted psychotherapy or medications.
Social phobia can severely disrupt normal life, interfering with school, work, or social relationships. The dread of a feared event can begin weeks in advance and be quite debilitating.
From Drug Gives New Hope to Social Phobics
United Press International
Friday, June 28, 2002
MONTREAL, Jun 27, 2002 (United Press International via COMTEX) -- People with disabling social anxiety disorder, or SAD, showed reduced symptoms after four to six weeks of therapy on venlafaxine HCl, an antidepressant, two studies presented Thursday revealed.
Social anxiety disorder is the third most common psychiatric disorder in the United States, afflicting about 10 million people each year. SAD sufferers have overwhelming and disabling fears of scrutiny, embarrassment, or humiliation in social situations, which they tend to avoid or curtail severely.
Researchers estimate 70 percent to 80 percent of SAD patients have co-existing psychiatric conditions, including a 40-50 percent chance of lifelong major depression.
The studies, announced at the Collegium Internationale Neuro-psychopharmacologium annual meeting, both were undertaken at the New York State Psychiatric Institute in New York City. Subjects were given venlafaxine HCl -- distributed under the trade name Effexor XR -- once daily in doses ranging from 75 to 225 milligrams. The subjects had suffered from SAD an average of 22 years in the first study and 26 years in the second. The subjects' average age was 38. forty-four percent were women.
In the first study, the subjects showed reductions in standardized anxiety scores by week six, with greater reductions appearing by week 12. In the second study, anxiety scores were reduced by the fourth week and continued to improve through week 12.
Specific
Phobias are most often
treated with a cognitive behavioral approach that would include systematic
desensitization and self help techniques.
from the NIMH brochure
"I'm scared to death of flying, and I never do it anymore. I used to start dreading a plane trip a month before I was due to leave. It was an awful feeling when that airplane door closed and I felt trapped. My heart would pound and I would sweat bullets. When the airplane would start to ascend, it just reinforced the feeling that I couldn't get out. When I think about flying, I picture myself losing control, freaking out, climbing the walls, but of course I never did that. I'm not afraid of crashing or hitting turbulence. It's just that feeling of being trapped. Whenever I've thought about changing jobs, I've had to think,’ Would I be under pressure to fly?' These days I only go places where I can drive or take a train. My friends always point out that I couldn't get off a train traveling at high speeds either, so why don't trains bother me? I just tell them it isn't a rational fear."
A specific phobia is an intense fear of something that poses little or no actual danger. Some of the more common specific phobias are centered around closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood. Such phobias aren't just extreme fear; they are irrational fear of a particular thing. You may be able to ski the world's tallest mountains with ease but be unable to go above the 5th floor of an office building. While adults with phobias realize that these fears are irrational, they often find that facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.
Specific phobias affect an estimated 6.3 million adult Americans1 and are twice as common in women as in men.10 The causes of specific phobias are not well understood, though there is some evidence that these phobias may run in families.11 Specific phobias usually first appear during childhood or adolescence and tend to persist into adulthood.12
If the object of the fear is easy to avoid, people with specific phobias may not feel the need to seek treatment. Sometimes, though, they may make important career or personal decisions to avoid a phobic situation, and if this avoidance is carried to extreme lengths, it can be disabling. Specific phobias are highly treatable with carefully targeted psychotherapy.
Continue to Treatment of Anxiety Disorders