Stress

What is Anxiety?

Virginia J. Duffy PhD Psychiatric NP

Anxiety is an unpleasant feeling that may also cause physical symptoms. It is feelings and thoughts of worry, fear, concern, and sometimes dread, often with no apparent cause.

"Normal" anxiety is often felt before trying something new, taking a test etc. This type of anxiety is helpful in increasing motivation.

More severe anxiety may cause "butterflies" in the stomach, sweating heart racing and shortness of breath. In severe cases this may lead to panic.

There are four types of anxiety disorders listed in the current Diagnostic and Statistical Manual (DSM 4 TR). This is the "Bible" of psychiatric diagnosis. It lists criteria necessary to make a diagnosis. The intent of this manual is to help those in the mental health field make accurate diagnoses. One of its goals is to make the diagnosis more consistent between providers. Unfortunately it is often used haphazardly.

1. Generalized Anxiety Disorder

This is a chronic condition with ongoing, usually mild, anxiety. It may be difficult to treat with medication.

2. Panic Attacks

A form of anxiety that includes discrete episodes of feelings of panic that may be accompanied by shortness of breath, nausea, fear of death, dread, and chest pain. Persons experiencing panic attacks may believe they are having a heart attack and are dying. It is nearly impossible to convince them otherwise. They may make many visits to emergency rooms. Panic disorder is usually quite responsive to medication.

3. Obsessive-Compulsive Disorder

OCD is an anxiety disorder that can be severe and in extreme cases look like psychosis. Patient usually has obsessive thoughts and compulsive behaviors. Obsessive thoughts are almost impossible to stop and they often have to do with fears or dreadful events. Compulsive behavior is behavior that is uncontrollable, and repetitive (cleaning, hand washing, checking a variety of rituals). Medication can be very helpful.

4. Post Traumatic Stress Disorder

This is a diagnosis that is given when certain symptoms follow a severe trauma. Symptoms are thought to be a response to this trauma. There is no medication particularly for PTSD. Rather, specific symptoms determine the use of medications; antidepressants are commonly used for both depression and anxiety. Psychotherapy is crucial in PTSD.

Other Anxiety- Like Problems

Some conditions may cause or look like anxiety. These include:

1. Mitral Valve Prolapse: A heart condition that mimics panic. It causes shortness of breath and racing heart.

2. Psychosis: Can cause feelings of anxiety or panic in response to a thought disorder.

3. Dementia: Often the first symptom of dementia is a "free floating" anxiety. This is general anxiety without an identifiable reason or precipitant.

4. Hyperthyroidism: High levels of thyroid hormone can produce anxiety and panic like symptoms.

5. Drug Interaction / Side Effects: Many drugs can cause anxiety-like symptoms. Drugs for asthma are a common cause, as is caffeine. Combinations of medications can be particularly troublesome.

6. Social Stress / Chronic Worry: Medication will not take away stress or worry. It will not change situations or personality. Medications may be helpful in patients whose underlying anxiety worsens in response to life stress.

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