Dr Caitlin: Anxiety Disorders

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Dr Caitlin O’Connor of Tralee Medical Centre in St Brendan’s Park on anxiety issues…

Most people feel anxious from time to time. However, anxiety can become abnormal if it interferes with your day-to-day activities.

Anxiety is a symptom of various anxiety disorders which are discussed below. They can often be treated. Treatments include various talking treatments and medication.

What is anxiety?

When you are anxious you feel fearful and tense. In addition you may also have one or more unpleasant physical symptoms – for example, you might have:

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• A fast heart rate.

• The sensation of having a ‘thumping heart’ (palpitations).

• A feeling of sickness (nausea).

• Shaking (tremor).

• Sweating.

• Dry mouth.

• Chest pain.

• Headaches.

• Fast breathing.

The physical symptoms are partly caused by the brain which sends lots of messages down nerves to various parts of the body when you are anxious.

The nerve messages tend to make the heart, lungs, and other parts of the body work faster. In addition, you release stress hormones, such as adrenaline (epinephrine), into the bloodstream when you are anxious.

These can also act on the heart, muscles and other parts of the body to cause symptoms.

Anxiety is normal in stressful situations and can even be helpful. For example, most people will be anxious when threatened by an aggressive person, or before an important race.

The burst of adrenaline (epinephrine) and nerve impulses which we have in response to stressful situations can encourage a ‘fight or flight’ response.

Anxiety is abnormal if it:

• Is out of proportion to the stressful situation; or

• Persists when a stressful situation has gone, or the stress is minor; or

• Appears for no apparent reason when there is no stressful situation.

What are anxiety disorders?

There are various conditions (disorders) where anxiety is a main symptom.

You may have an anxiety disorder if anxiety symptoms interfere with your normal day-to-day activities, or if worry about developing anxiety symptoms affects your life.

About 1 in 20 people have an anxiety disorder at any one time. The following is a brief overview of the main anxiety disorders. Some people have features of more than one type of disorder.

Reactions to stress

Anxiety can be one of a number of symptoms as a reaction to stressful situations. There are three common types of reaction disorders:

Acute reaction to stress (sometimes called acute stress reaction)

Acute means the symptoms develop quickly, over minutes or hours, reacting to the stressful event.

Acute reactions to stress typically occur after an unexpected life crisis such as an accident, bereavement, family problem, bad news, etc. Sometimes symptoms occur before a known situation which is difficult. This is called situational anxiety.

This may occur, for example, before an examination, an important race, a concert performance, etc.

Symptoms usually settle fairly quickly but can sometimes last for several days or weeks. Apart from anxiety, other symptoms include low mood, irritability, emotional ups and downs, poor sleep, poor concentration, and wanting to be alone.

Adjustment reaction

This is similar to the above but symptoms develop days or weeks after a stressful situation, as a reaction or adjustment to the problem. For example, as a reaction to a divorce or house move. Symptoms are similar to acute reaction to stress but may include depression. The symptoms tend to improve over a few weeks or so.

Post-traumatic stress disorder (PTSD)

PTSD may follow a severe trauma such as a serious assault or life-threatening accident. Symptoms last at least one month, often much longer. Anxiety is only one symptom which may come and go. The main symptoms of PTSD are:

• Recurring thoughts, memories, images, dreams, or flashbacks of the trauma, which are distressing.

• You try to avoid thoughts, feelings, conversations, places, people, activities or anything else which may trigger memories or thoughts of the trauma.

• Feeling emotionally numb and detached from others. You may find it difficult to have loving feelings.

• Your outlook for the future is often pessimistic. You may lose interest in activities which you used to enjoy.

• Increased arousal which you did not have before the trauma. This may include difficulty sleeping, being irritable, difficulty concentrating, and increased vigilance.Generalised anxiety disorder (GAD)

If you have GAD you have a lot of anxiety (feeling fearful, worried and tense) on most days. The condition persists long-term.

Some of the physical symptoms of anxiety (detailed above) may come and go. Your anxiety tends to be about various stresses at home or work, often about quite minor things. Sometimes you do not know why you are anxious.

In addition, you will usually have three or more of the following symptoms:

• Feeling restless, on edge, or ‘keyed up’ a lot of the time.

• Tiring easily.

• Difficulty concentrating and your mind going blank quite often.

• Being irritable a lot of the time.

• Muscle tension.

• Poor sleep (insomnia). Usually it is difficulty in getting off to sleep, or difficulty in staying asleep.

• Mixed anxiety and depressive disorder

In some people, anxiety can be a symptom when you have depression. Other symptoms of depression include:

• Low mood.

• Feelings of sadness.

• Sleep problems.

• Poor appetite.

• Irritability.

• Poor concentration.

• Decreased sex drive.

• Loss of energy.

• Guilt feelings.

• Headaches.

• Aches and/or pains.

• The sensation of having a ‘thumping heart’ (palpitations).

• Treatment tends to be aimed mainly at easing depression, and the anxiety symptoms often then ease too.

• Obsessive-compulsive disorder (OCD)

• OCD consists of recurring obsessions, compulsions, or both.

Obsessions are recurring thoughts, images, or urges that cause you anxiety or disgust. Common obsessions are fears about dirt, contamination, germs, disasters, violence, etc.

Compulsions are thoughts or actions that you feel you must do or repeat. Usually a compulsion is a response to ease the anxiety caused by an obsession.

A common example is repeated hand washing in response to the obsessional fear about dirt or germs. Other examples of compulsions include repeated cleaning, checking, counting, touching, and hoarding of objects.

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