Anxiety

Anxiety—the most common of all mental disorders—currently affects about one in 13 people (7.3 percent).The study also found that, while clinical depression is common throughout the lifespan, anxiety becomes less common in men and women over the age of 55. Prevalence estimates of anxiety disorders are generally higher in developed countries than in developing countries.

Both major depression and anxiety are found more commonly in women than in men.

Like many other mental health conditions, anxiety disorders also seem to be a result of a combination of biological, psychological, and other individual factors.

There are many different types of anxiety disorders—and many effective treatments and self-help strategies. Once you understand your anxiety disorder, there are steps you can take to reduce your symptoms and regain control of your life.

Definition

Everyone feels anxious now and then. It’s a normal emotion. Many people feel nervous when faced with a problem at work, before taking a test or making an important decision. But if your worries and fears seem overwhelming and interfere with your daily life, you may be suffering from an anxiety disorder. The feelings can interfere with daily activities such as job performance, school work, and relationships. 

 Anxiety is defined as “a state of intense apprehension, uncertainty, and fear resulting from the anticipation of a threatening event or situation, often to a degree that normal physical and psychological functioning is disrupted”

“Fear is the emotional response to a real or perceived threat, whereas anxiety is the anticipation of future threat”

Signs And Symptoms –

Physical :

• Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Chills or heat sensations
  • Paresthesias (numbness or tingling sensations

• Electric shock feeling
• Shooting pains in the face
• Weakness in legs
• Feeling like you are going crazy
• Inability to rest
• Sleep problems

Emotional :

• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or going crazy
  • Fear of dying
  • Excessive fear and worry
  • Catastrophizing
  • Obsessive thinking

Behavioral:

Avoidance of situations that make you feel anxious which can impact on study, work, or social life

Types of Anxiety Disorders –

Some of the major types are listed below –

• Separation Anxiety Disorder
• Selective Mutism
• Social Anxiety Disorder (Social Phobia)
• Panic Disorder
• Generalized Anxiety Disorder
• Specific Phobia
• Post Traumatic Stress Disorder
• Obsessive Compulsive Disorder

Separation Anxiety Disorder

“A condition in which an individual experiences excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment (e.g. a parent, caregiver, or siblings). It is most common in infants and small children, typically between the ages of 6–7 months to 3 years. “

Separation anxiety is a natural part of the developmental process. It indicates healthy advancements in a child’s cognitive maturation and should not be considered a developing behavioral problem. But in separation anxiety disorder there is an excessive display of fear and distress when faced with situations of separation from the home or from a specific attachment figure. The anxiety that is expressed is categorized as being atypical of the expected developmental level and age. The severity of the symptoms ranges from anticipatory uneasiness to full-blown anxiety about separation.

Trigger –

It can also occur after a stressful life event such as:

• moving to a new home
• switching schools
• divorce
• the death of a close family member

Selective Mutism :

Selective Mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.

Although onset is usually before age five, the disturbances may come to clinical attention only with entry into school.

• In most cases the disturbance lasts only a few weeks or months, although in a few it continues for several years.
• There may be severe impairment in social and school functioning.
• School failure and teasing or scapegoating by peers are common complications.

Predisposing factors – Maternal overprotection, speech disorders. Mental Retardation, immigration, hospitalization or trauma before age three, and entering school may be predisposing factors.

Social Anxiety Disorder (Social Phobia) :

Social anxiety disorder, also known as social phobia, is an anxiety disorder involving irrational discomfort around social interaction, and concern about being embarrassed and judged by others. This discomfort will be experienced as fear and anxiety and will be accompanied by autonomic arousal, including diaphoreses, apnea, tremors, tachycardia, and nausea. The discomfort that people with Social Anxiety Disorder experience can be generalized to routine activities such as eating in front of others, fear of blushing (erythrophobia), or urinating in a public lavatory (shy bladder). The fear, anxiety, or avoidance is persistent.

Panic Disorder –

Panic disorder is characterized by the spontaneous and unexpected occurrence of panic attacks, the frequency of which can vary from several attacks per day to only a few attacks per year.

Panic attacks are defined as a period of intense fear in which 4 of 13 defined symptoms develop abruptly and peak rapidly in less than 10 minutes from symptom onset.

Panic attacks may start off by coming on suddenly and without warning, but over time, they’re usually triggered by certain situations.

Common features of panic attacks

They include an accelerated heart rate or pounding heartbeats, chest pain, sweating, trembling, shortness of breath, a choking sensation, nausea, dizziness or light-headedness, numbness, chills or heat, a feeling of being detached from one’s self, fear of losing control and fear of dying.

Generalized Anxiety Disorder –

“Excessive or disproportionate anxiety about several aspects of life, such as work, social relationships, or financial matters, almost every day for six months or more may signal generalized anxiety disorder”

Cause –

As with many mental health conditions, the exact cause of generalized anxiety disorder isn’t fully understood, but it may include genetics as well as other risk factors.

Specific Phobia :

Fear is a natural response caused by real danger. For example, we are all scared of coming face to face with a wild, hungry animal, and fear is a survival instinct that warns us against certain things or situations.

A phobia, on the other hand, is an irrational fear of an object or situation that causes little or no danger. For example, arithmophobia (fear of numbers) may cause certain individuals anxiety, but the fear itself won’t cause any danger. Phobias are linked to our subconscious, and because they are irrational, they can often be dealt with effectively.

Types of Specific Phobia

There are five different types of specific phobia.

• Animal Type (e.g. dogs, snakes, or spiders)
• Natural Environment Type (e.g., heights, storms, water)
• Blood-Injection-Injury Type (e.g. fear of seeing blood, receiving a blood test or shot, watching television shows that display medical procedures)
• Situational Type (e.g., airplanes, elevators, driving, enclosed places)
• Other Types (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds like balloons popping or costumed characters like clowns)

Post-Traumatic Stress Disorder Or PTSD :

PTSD used to be considered a type of anxiety disorder. But accordingly, to the latest DSM-5 Criteria, it was moved into a new category: “Trauma and Stress-related Disorders”. 

It is a serious potentially debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, terrorist incident, sudden death of a loved one, war, violent personal assault such as rape, or other life-threatening events.

Signs And Symptoms –

People with PTSD often experience feelings of panic or extreme fear, similar to the fear they felt during the traumatic event. A person with PTSD experiences four main types of difficulties.

• Reliving the event (also called re-experiencing symptoms)
• Avoiding situations that remind you of the event
• Negative changes in beliefs and feelings
• Feeling keyed up (also called hyperarousal)

Obsessive-Compulsive Disorder or OCD :

According to DSM 5 guidelines, OCD is removed from the Anxiety section and is now grouped -separately as Obsessive-Compulsive and Related Disorders.

Obsessive-compulsive disorder (OCD) is a mental disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), and behaviors that drive them to do something over and over (compulsions)

The symptoms of OCD include both obsessive and compulsive behaviors.

Signs of obsession include:

• Repeated unwanted ideas
• Fear of contamination
• Aggressive impulses
• Persistent sexual thoughts
• Images of hurting someone you love
• Thoughts that you might cause others harm
• Thoughts that you might be harmed

Signs of compulsion include:

• Constant checking
• Constant counting
• The repeated cleaning of one or more items
• Repeatedly washing your hands
• Constantly checking the stove or door locks
• Arranging items to face a certain way
• Following a strict routine
• Demanding reassurances

Management :

Medications –

• Homeopathy – Homoeopathy is one of the safest and effective modes of treatment for all types of Anxiety Disorders.The remedy selection is based on symptom similarity. each person who is suffering from any of the anxiety disorder is unique, at physical, mental and emotional level, in his own way. The remedy selection is based on these individualising characteristics. However, some of the homeopathy medicines which are commonly used are – Gelsemium, Arsenic Album, Lycopodium, Boron, Alumina, Beryllium, Crotalus Horridus, Stramonium, and many more based on symptom similarity.

• Modern Medicine – benzodiazepines, antidepressants, Beta-Blockers, Buspirone

Psychosocial Treatment –

• Hypnotherapy – Hypnotherapy can help to identify the root cause of the phobia and enable individuals to react to the particular object or situation they once feared in a calmer manner when encountering it in the future. Phobias are displaced fears and because they are not rational, they can be dealt with. Hypnotherapy can also help with relaxation and visualisation techniques for desensitisation and forming new habits such as being more calm and relaxed.

• Cognitive Behavioural Therapy (CBT) – a psycho therapeutic approach that addresses dysfunctional emotions, maladaptive behaviours and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures.

• Behaviour Therapy – like flooding, systematic desensitisation, exposure and response prevention, relaxation techniques

• Desensitisation or exposure therapy focuses on changing your response to the object or situation that you fear and may be helpful for phobias. Gradual, repeated exposure to the cause of your phobia may help you learn to conquer your anxiety. 

• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.

• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Don’t use alcohol or drugs. Exercise according to your healthcare provider’s instructions.

• Self Help Groups