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Anxiety, Panic, & Phobias

The experience of anxiety is a natural part of life and is useful to promote safety, optimal performance of some tasks and motivation to initiate and complete others.  For some people, however, anxiety can be intense, persistent and interfere with participation in activities and fulfillment of responsibilities. In other words, anxiety can impair functioning and diminish quality of life. Children, adolescents and adults can suffer from debilitating anxiety.


In psychology and psychiatry, the system used to categorize anxiety disorders is the Diagnostic and Statistical Manual of Mental Disorders-5 or the DSM-5. The DSM-5 defines seven anxiety disorders. Four of those are described here.


People with Panic Disorder experience sudden, intense anxiety or fear that occurs unexpectedly without an apparent cause. The episode typically last minutes but can occur in waves of anxiety for a couple of hours. Panic is characterized by the occurrence of symptoms that can include shortness of breath, sweating, hot or cold flashes, chest discomfort, rapid heart rate, dizziness or faintness, trembling, nausea, choking sensation, numbness in hands or feet and fears of losing control, “going crazy,” or dying. Medical causes such as hypoglycemia or hyperthyroidism are ruled out prior to a diagnosis of panic disorder. The Anxiety and Depression Association of America indicated that in a given year about 2-3 percent of Americans experience the disorder.


Cognitive behavior treatment for panic disorder includes relaxation training, identification and elimination of catastrophic thoughts, voluntary habituation to the physical symptoms of panic and lifestyle changes. Medications such as selective serotonin reuptake inhibitors, e.g., Paxil or Zoloft, are best used in conjunction with cognitive behavior therapy.


Agoraphobia is basically a fear of a panic attacks, including fears of being unable to escape, to get help or to be embarrassed if others see them panicked. Persons with agoraphobia experience anxiety when outside a “safe zone,” which is close to home and often to a particular person. People avoid venturing away from home or being alone because of their fears; activities can become quite restricted.


Treatments include the same as those for panic disorder plus gradual exposure to feared situations. Medications may be used in conjunction with cognitive behavior therapy including selective serotonin reuptake inhibitors.


Specific Phobias are characterized by intense fear and avoidance of an object or situation, for example, animals, heights, elevators, flying, weather, blood, physicians or dentists. Contact with the object or situation may set off a panic reaction. The fear and avoidant behavior can be disruptive to persons’ lives and cause distress.


Treatment includes relaxation training, changing patterns of thinking and gradual exposure to actual or simulated feared situations or objects.


Generalized Anxiety Disorder involves anxiety associated with persistent and excessive worry focused on life circumstances like finances, school, work or relationships. People with this disorder find it difficult to control worry, and they tend to expect the worst even in the absence of legitimate reasons for concern. Symptoms include restlessness, being easily fatigued, irritability, muscle tension and sleep and concentration difficulties. For a diagnosis of GAD, persons must report three or more of these symptoms and difficulty controlling worry more days than not for at least three months. This disorder is often accompanied by other conditions, such as depression, substance abuse and other anxiety disorders.


Treatment for GAD typically focuses on thoughts, behaviors and physical symptoms characteristic of the disorder using cognitive behavior therapy. Selective serotonin reuptake inhibitors may be useful in combination with therapy.

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