Laura L. Smith - Anxiety For Dummies

Every so many years, groups of mental health professionals provide research and clinical experience in order to develop a list of emotional disorders. They publish their findings in a manual referred to as the DSM. Currently, the field is using the fifth edition. The diagnoses allow professionals to communicate with a common language. However, the formal role of diagnoses has its detractors. Many professionals believe it’s more useful to focus on symptoms as opposed to specific disorders. For your information, the DSM-5 currently lists the following major categories of anxiety disorders:

Generalized anxiety disorder (GAD)

Social phobia

Panic disorder

Agoraphobia

Specific phobias

Separation anxiety disorder

Selective mutism

Anxiety disorder due to another medical condition

The previous few editions of DSM categorized obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) as anxiety disorders. No longer. Today, OCD has its own section, Obsessive Compulsive Related Disorders, and PTSD is categorized as a Trauma-and Stressor-Related Disorder. The controversies surrounding these changes are complex. And in most people with emotional problems, there are almost always overlapping symptoms. In other words, someone with anxiety is likely to have at least a few symptoms in one diagnostic category and a few others in a different category.

Maurice has social anxiety. Drug and alcohol abuse often accompany social phobia because people with social phobia feel desperate to quell their anxious feelings. And drugs and alcohol offer a quick fix. Unfortunately, that fix often causes additional embarrassment and may lead to an addiction.

Of course, everyone feels a little panicked from time to time. People often say they feel panicked about an upcoming deadline, an impending presentation, or planning for a party. You’re likely to hear the term used to describe concerns about rather mundane events such as these.

But people who suffer with panic are talking about entirely different phenomena. They have periods of stunningly intense fear and anxiety. If you’ve never had a panic attack, trust us, you don’t want one. The attacks usually last about ten minutes, and many people who have them fully believe that they will die during the attack. Not exactly the best ten minutes of their lives. Panic attacks normally include a range of robust, attention-grabbing symptoms, such as

An irregular, rapid, or pounding heartbeat

Perspiring

A sense of choking, suffocation, or shortness of breath

Vertigo or lightheadedness

Pain or other discomfort in the chest

A feeling that events are unreal or a sense of detachment

Numbness or tingling

Hot or cold flashes

A fear of impending death, though without basis in fact

Stomach nausea or upset

Thoughts of going insane or completely losing control

Panic attacks begin with an event that triggers some kind of sensation, such as physical exertion or normal variations in physiological reactions. This triggering event induces physiological responses, such as increased levels of adrenaline. No problem so far.

But the otherwise normal process goes awry at the next step — when the person who suffers from panic attacks misinterprets the meaning of the physical symptoms. Rather than viewing the physical symptoms as normal, the person with panic disorder sees them as a signal that something dangerous is happening, such as a heart attack or stroke. That interpretation causes escalating fear and thus more physical arousal. Fortunately, the body can sustain such heightened physical responses only for a while, so it eventually calms down.

Professionals say that in order to have a formal diagnosis of panic disorder, panic attacks must occur more than once. People with panic disorder worry about when the next panic attack will come and whether they’ll lose control. They often start changing their lives by avoiding certain places or activities.

The good news: Many people have a single panic attack and never have another one. So, don’t panic if you have a panic attack. Maria’s story is a good example of a one-time panic attack.

Maria resolves to lose 20 pounds by exercising and watching what she eats. On her third visit to the gym, she sets the treadmill to a level six with a steep incline. Almost immediately, her heart rate accelerates. Alarmed, she decreases the level to three. She starts taking rapid, shallow breaths but feels she can’t get enough air. Sweating profusely and feeling nauseous, she stops the machine and staggers to the locker room. She sits down; the symptoms intensify, and her chest tightens. She wants to scream but can’t get enough air. She’s sure that she’ll pass out and hopes someone will find her before she dies of a heart attack. She hears someone and weakly calls for help. An ambulance whisks her to a nearby emergency room.

At the ER, Maria’s symptoms subside, and the doctor explains the results of her examination. He says that she has apparently experienced a panic attack and inquires about what may have set it off. She answers that she was exercising because of concerns about her weight and health.“Ah, that explains it,” the doctor reassures. “Your concerns about health made you hypersensitive to any bodily symptom. When your heart rate naturally increased on the treadmill, you became alarmed. That fear caused your body to produce more adrenaline, which in turn created more symptoms. The more symptoms you had, the more your fear and adrenaline increased. Knowing how this works may help you; hopefully, in the future, your body’s normal physical variations won’t frighten you. Your heart’s in great shape. Go back to exercising.“Also, you might try some simple relaxation techniques; I’ll have the nurse come in and tell you about those. I have every reason to believe that you won’t have another episode like this one.”

Maria had one panic attack and may never experience another one. If she believes the doctor and takes his advice, the next time her heart races, she probably won’t get so scared. She may decide to see how things go before seeking treatment for her problem. However, if she has a recurrence, treatment works pretty well for this issue.

Panic attack symptoms, such as chest pain, shortness of breath, nausea, and intense fear, often mimic heart attacks. Alarmed, those who experience these terrifying episodes take off in the direction of the nearest emergency room. Then, after numerous tests come back negative, overworked doctors tell the victim of a panic attack in so many words that “It’s all in your head.” Many patients with panic attacks doubt the judgment of the physician and strongly suspect that something important was missed or wasn’t found.

The next time an attack occurs, panic attack victims are likely to return to the ER for another opinion. Even a second or third visit may not convince those with panic attacks that the feeling wasn’t caused by a heart problem. The repeat visits frustrate people with panic attacks as well as ER staff. However, a simple 20- or 30-minute psychological intervention in the emergency room decreases the repeat visits dramatically. The intervention is pretty simple — just providing education about what the disorder is all about and describing a few deep relaxation techniques to try when panic hits.

Approximately half of those who suffer from panic attacks have an accompanying problem: agoraphobia. Unlike most fears or phobias, this anxiety problem usually begins in adulthood. Individuals with agoraphobia symptoms live in terror of being trapped and unable to escape. They desperately avoid situations from which they can’t readily escape, and they also fear places where help may not be readily forthcoming should they need it.