Anxiety is the anticipation of danger, a negative event or a negative outcome. Nearly all people experience anxiety at times. An anxiety disorder is an excessive level of anxiety that typically persists for at least six months and causes a great deal of unhappiness or creates problems in a person’s life. A person who suffers from an anxiety disorder may avoid situations or endure feared situations with a great deal of distress.

1. ANXIETY DISORDERS
Overview
Anxietyisthe anticipationof danger,anegative eventora negative outcome.Nearlyall people
experience anxietyattimes.Ananxietydisorderisanexcessive levelof anxietythattypicallypersistsfor
at leastsix monthsandcausesa greatdeal of unhappinessorcreatesproblemsinaperson’slife.A
personwhosuffersfromananxietydisordermayavoidsituationsorendure fearedsituationswitha
great deal of distress.
Accordingto the National Institute of Mental Health,anestimated40millionAmericans,or18 percent
of adultmenandwomen,experience thisillnesswithinagivenyear.Asmanyas 33 percentof American
menand womenmayexperience ananxietydisorderatsome pointintheirlifetime.
Anxietycanbe expressedphysicallythroughsymptomssuchas:
 A rise inbloodpressure
 A fastheart rate
 Rapidbreathing
 An increase inmuscle tension
 Nauseaor diarrhea
Anxiousbehaviorscaninclude:
 Avoidance
 Seekingreassurance
 Ritualisticbehaviorssuchaschecking,repeating,makingthings“justright”
 Overpreparing
 Restlessnessorfidgeting
Anxiousthoughtstypicallyfocusonpotential negativeoutcomesorscenariosornegative pastevents
such as trauma,fearedmistakesorembarrassingsituations.
Withouttreatment,ananxietydisordercansignificantlydisruptaperson’slife because symptomsmay
persistorbecome progressivelyworse.Tormentedbypanicattacks,irrational thoughtsandfears,
compulsive behaviorsorrituals,flashbacks,nightmaresorcountlessfrighteningphysical symptoms,
people withanxietydisordersmayseekhelpinemergencydepartmentsandoftenrelyheavilyonother
medical servicestoaddresstheirsymptoms.
Theirwork,familyandsocial livesare disrupted,andsome evenbecomehousebound.Individualswith
anxietydisordersmayhave othermental disorderssuchasdepressionorsubstance abuse.

2. Fortunately,treatmentforanxietydisordersis,ingeneral,veryeffective.Earlydiagnosismayaidearly
recovery,preventthe disorderfrombecomingworseandpossiblyprevent the disorderfromdeveloping
intodepression.Yet,because of awidespreadlackof understandingandthe stigmaassociatedwith
anxietydisorders,onlyaboutone-thirdof those whoexperience themare diagnosedandreceive
treatment.
In the fifthedition of the DiagnosticandStatistical Manual of Mental Disorders,the AmericanPsychiatric
Associationdefinesseveral anxietydisorders.Additionally,theyidentifyobsessive compulsive disorder
and post-traumaticstressdisorderascloselyrelatedtothe anxietydisorders.Forsimplicity,thisarticle
usesthe termanxietydisorderscollectivelytoincludethe following:
 Generalizedanxietydisorder(GAD) affectsabout6.8millionAmericansandaffectsnearlytwice
as many womenasmen.GAD ischaracterized byat leastsix monthsof a more-or-lessconstant
state of tensionorworry.A personwithGADmay alwaysexpectacatastrophe to happen.The
personmayworry evenwhenthingsare goingrelativelywell.The anxiousthoughtsandfeelings
are difficulttocontrol or turn off.The worriesthataccompanyGAD are focusedonone or more
areas of a person’slife,suchashealth,finances,workorrelationships.More thanhalf the
people whosufferfromGADalsohave anotheranxietydisorderordepression.
 Panicattacks developabruptlyandgenerallyreachapeakwithin10 minutes.Theymaybe
triggeredbya specificeventorsituationormayseemtocome out of the blue.Common
symptomsof panicattacks include heartpalpitations;sweating;shaking;afeelingof
breathlessnessorsmotheringsensations;numbnessortinglingsensationsinthe hands,face or
feet;dizzinessorfeelingfaint,chillsorhotflushes;depersonalizationorafeelingof analtered
reality;fearof dying;fearof havinga heart attack; or fearof losingcontrol.
 Panicdisorder,definedasrepeatedunexpectedpanicattacksor worryaboutsuch attacks,
affectsabout6 millionAmericans.Ittypicallystrikesinlate adolescence orearlyadulthood.
Womenare twice aslikelyasmentodeveloppanic disorder.People withpanicdisordermay
alsosufferfromdepression,abuse alcoholorabuse drugssuch as marijuana.Aboutone-thirdof
people withpanicdisorderdevelopagoraphobia,inwhichapersonfearsoravoidssituations
where theybelievetheywillhave difficultyescapingorgettinghelpinthe eventof apanic
attack or otherembarrassingorunpleasantphysical symptoms.Peoplewithagoraphobiamight
avoiddrivingonthe highway,usingpublictransportation,goingtocrowdedplacessuchas
shoppingmallsorconcertsand,in severe cases,mayavoidleavingtheirhomes.
 Phobiasare irrational,involuntaryfearsof commonobjects,livingthingsorsituations,suchas
heights,small enclosedspaces,animals,insects,airtravel,bloodormedical procedures.While
theyvary inseverity,phobiascanbe incapacitating.Mostpeople whosufferfromphobiasare
aware of the irrationalityof theirfear,yettheyavoidthe fearedobjectsorsituationsorendure

3. themwithintense anxiety.Specificphobiasare amongthe mostcommonmental health
disorders.About19.2 millionAmericanssufferfromspecificphobias,andtheyare twice as
commonin womenasmen.
 Social phobia,orsocial anxietydisorder,iscausedbya fearof beingembarrassedinasocial
situationorpubliclyscrutinizedandhumiliated.Socialphobiaisoftenaccompaniedby
depressionandmayleadtoalcohol or otherdrugabuse.About15 millionpeoplehave social
phobia,whichisequallycommonamongwomenandmen.The disordertypicallybegins in
childhoodorearlyadolescenceandrarelydevelopsafterage 25.
 Obsessive-compulsive disorder(OCD) ischaracterizedbyrecurrent,persistentandintrusive
thoughts,imagesorimpulsesthatcause anxiety.These mentalimagesorideasare called
obsessions.The persontriestocontrol or neutralize these obsessionsandrelievethe anxietyby
performingrepetitive behaviorscalledcompulsions.The compulsionsare oftenrigidandmust
be performedina certaintime-consumingorder.AlthoughadultswithOCD oftenknow these
ritualsare excessive,theycannotstopdoingtheminspite of strenuouseffortstoignore or
suppressthe thoughtsoractions.Repeatedhandwashing,reorderingof belongings,rechecking
objectsinone’shouse,orsilentlyrepeatingwords,numbersorprayersare examplesof
compulsions.About2.2 millionAmericanshave OCD.One-thirdof adultsaffectedwithOCDhad
theirfirstsymptomsinchildhood.OCDaffectsmenandwomenwithequalfrequency.OCD
shouldnotbe confusedwithobsessive-compulsive personalitydisorder,whichischaracterized
by traitssuch as beingaperfectionist,excessivelyconscientious,morallyrigidandpreoccupied
withrulesandorder.These traitsdo notnecessarilyoccurinpeople withOCD.
 Post-traumaticstress disorder(PTSD) developsafterexposure toanextremelystressful event
that involvedthreatenedoractual death,seriousinjuryorsexual violence foroneself or
someone else.About7.7millionpeoplesufferfromPTSD.Itmay stemfrom traumasuch as a
rape,childhoodsexual abuse,militarycombatorwar-relatedincidentsandnatural disasters.
Althoughanxietyisanormal humanresponse tostress,healthcare professionalsandresearchersdon’t
knowexactlywhysome peopledevelopsevereanxietyorpanic. Theybelieve itismostlikelythe result
of a combinationof biological andpsychosocialfactorssuchas:
 A biological tendencytowardanxiety,includinggreatersensitivitytothe effectsof hormones
releasedduringanxiety,suchasadrenaline;oranimbalance of certainsubstancescalled
neurotransmitters(chemical messengersinthe brain)
 Geneticor familial factors.Peoplewhohave close relativeswithanxietydisordersare more
likelytosufferfromanxietydisordersthemselves.
 Familybackground,suchasan earlychildhoodconflictortrauma,or “learned”fearsorphobias
 Negative orstressful life events
 Otherillnessesormedicationscancause symptomsof an anxietydisorder
While anxietydisorderscanstrike anyone of anyage,genderor socioeconomicbackground,theymost
oftenbegininyoungadulthood.Theyoftenstartmildlyandprogress,althoughGADappearstobe the

4. mostcommon formof anxietyinolderages.Inaddition,exceptforOCDand social anxietydisorder,
anxietydisordersstrike womenatapproximatelytwicethe rate of men.
Diagnosis
The firststepto properlydiagnosingananxietydisorderistorule out anothermedical condition.
Because anxietyaccompaniessomanymedical conditions,some serious,itisextremelyimportantfor
your healthcare professional touncoveranyphysiological medical problemsormedicationsthatmight
underlie orbe maskedbyanxietysymptoms.
Thus,a physical examinationandmedical andpersonal historyare essential.Youshoulddescribe any
historyof anxietydisordersordepressioninyourfamilyandmentionanyothercontributingfactors,
such as excessive caffeineuse,recentlife changesorstressful events.Itisveryimportanttobe honest
withyourhealthcare professional aboutall conditions,includingsubstanceabuse orotherpsychological
or moodstatesthat mightcontribute toor resultfromthe anxietydisorder.
Panicattacks may mimicor accompanydiseasesof the heartandlungs,butanxietyattacksdonot cause
heartor lungdisease.Anxiety-like symptomsmayoccurwithothermedical problems,including
epilepsy,hypoglycemia,adrenal-glandtumorsandhyperthyroidism.Womencanalsoexperience intense
anxietyattackswithhotflashesduringmenopause.Manydrugs,includingsome forhighblood pressure,
diabetesandthyroiddisorders,canproduce symptomsof anxiety,ascan withdrawingfromcertain
drugslike those usedtotreat sleepdisordersoranxiety.
Panicdisorderoftencoexistswithdepression,andsometimesthe symptomsoverlapbecause anxious
feelings,agitation,insomniaandproblemswithconcentrationoftenaccompanydepression.
Thus,your healthcare professionalwilluse amedical evaluationtorule outalternativeexplanationsof
anxietysymptoms.
Healthcare professionalscanuse varioustestsfromthe AmericanPsychiatricAssociationandother
professionalorganizationstodetermine the causes,type,severityandfrequencyof youranxiety.Most
are written,multiple-choiceteststhatcanbe administeredonpaperorverballyandare centeredon
definingthe kindsof symptomsyouexperience aspartof your anxiety.
Specificanxietydisordersare diagnosedbasedonthe severityanddurationof symptomsandon
additional behavioral characteristicsthataccompanythe symptomsof anxiety.Specifically:
Generalizedanxietydisorder(GAD)
isconfirmedif youmeetthe criteriaspelledoutinthe DiagnosticandStatistical Manual of Mental
Disorders(DSM) publishedbythe AmericanPsychiatricAssociation.Thesecriteriainclude:
Excessive anxietyandworryaboutseveral eventsandactivitiesmore daysthannotfor at leastsix
months

5. The anxietyisnotbetterexplainedbyothermental healthissues,suchaspost-traumaticstressdisorder
(PTSD),substance abuse orpanicdisorder
Difficultycontrollingfeelingsof worry
At leastthree of the followingsymptomsinadultsandone inchildren:fatigue,restlessness,trouble
concentrating,muscle tension,sleepproblemsorirritability
Symptomsshouldcause significantdistressandimpairnormal functioning.
Panic disorder
 isdiagnosedif youmeetthe diagnosticcriteriaoutlinedinthe DSM,including:
 Recurrent,unexpectedpanicattacks
 Worry abouthavinganotherpanicattack or losingcontrol
 Avoidance of situationsyouthinkmaytriggerapanic attack
 Panicattacks that aren’tcausedby substance abuse oranothermental healthconditionsuchas
social phobiaor agoraphobia
 Panicattacks include fourormore of the followingsymptomsthatdevelopsuddenlyandreacha
peakwithin10 minutes:
 Palpitations,poundingheart,oracceleratedheartrate
 Sweating
 Tremblingorshaking
 Sensationsof shortnessof breathorsmothering
 Feelingsof choking
 Chestpainor discomfort
 Nauseaor abdominal distress
 Feelingdizzy,unsteady,light-headed,orfaint
 Chillsorheatsensations
 Numbnessortinglingsensations
 Feelingsof unrealityordepersonalization
 Fear of losingcontrol orgoingcrazy
 Fear of dying
Agoraphobia
occurs inabout one-thirdof peoplewithpanicdisorder.Itinvolvesfearoravoidance of multiple
situationssuchasusingpublictransportation,beinginopenspacessuchasmarketplacesorbridges,
beinginclosedspacessuchas theatersorshops,standinginline orbeingina crowd,or beingoutside of
the home alone.Insuch situations,the persontypicallyworriesthatthere wouldbe noescape orhelp
wouldbe unavailableshouldpanic-like symptomsorotherunpleasantorembarrassingsymptomsoccur.
A personwithagoraphobiamightmake complicatedplanstoavoidconfrontingfearedsituationsand
limitherselftoplacesthatfeel safe suchashome.

6. Specificphobias
occurs whensomeone fearsandmayavoidspecificobjects,livingthingsorsituationssuchassmall
enclosedspaces,particularanimalsorinsects,heights,airtravel,blood,injuryorinjections.Although
people withspecificphobiasmayhave panicattacks,theirfearisnot focusedonpanicsymptoms.
Instead,theyworrythatthe fearedobjectorsituationitself will cause harm(e.g.,the plane will crash,
theywill fall orjumpfrom a highplace,a dog will bite them).A personwithaspecificphobiamay
experience the followingsymptomsaroundthe phobicobjectorsituation:
 Panickyfeelings
 Sweating
 Rapidheartbeat
 Avoidance behavior
 Difficultybreathing
Social phobia,
alsoknownas social anxietydisorder,isafearof beingembarrassedornegativelyevaluatedinsocial
situations.Symptomsvaryinintensity,rangingfrommildandtolerable anxietytoafull-blownpanic
attack. People withsocial phobiaworrythatotherswill perceive themasboring,stupid,weirdor
unlikable.Theymayalsoworrythat theiranxietywill be evidentdue toblushing,trembling,shakingor
stammering.Social phobiaisoftenaccompaniedbydepressionandmayleadtosubstance abuse.
Obsessive-compulsive disorder (OCD)
isdiagnosedif obsessionsandcompulsionsinterfere withyournormal activitiesorcause emotional
distressoranxiety,especiallyif the ritualisticbehaviorcannotbe carriedout.Adultswiththiscondition
usuallyrecognize theirobsessionsorcompulsionsasexcessive andunreasonable,yetfeel compelledto
engage inthem.The obsessive thoughtsorimagescanrange from mundane worriesaboutwhetherone
has lockedadoor to bizarre or frighteningfantasiesof behavingviolentlytowardalovedone.The
compulsive actstriggeredbysuchobsessionsmightinclude repetitive checkingof lockeddoorsorunlit
stove burnersor callsto lovedonesatfrequentintervalstobe sure theyare safe.Some people are
compelledtowashtheirhandseveryfew minutesorspendinordinate amountsof time cleaningtheir
surroundingstosubdue the fearof contagion.Certainotherobsessive disorders,includingbody
dysmorphicdisorder(BDD),trichotillomaniaandTourette’sdisorder,maybe part of the OCD spectrum.
In BDD, people are obsessivelypreoccupiedwithanimagineddefectintheirappearance.People with
trichotillomaniacontinuallypull outtheirhair,sometimesleavingbaldpatches.Symptomsof Tourette’s
disorderinclude bothmotortics,like eye blinking,facial twitchingandjerkingmotionof armsor head,
and vocal tics,like grunting,sniffingandthroatclearing.These symptomsusuallystartbefore age 18 and
continue forat leastone year.
Post-traumatic stress disorder (PTSD)

7. symptomscan occur weeks,monthsorevenyearsafterthe traumaticevent.A personwhosuffersfrom
PTSD may have the followingsymptoms:
 Recurrentintrusive memoriesordistressingdreamsaboutthe event
 Dissociative reactionsinwhichthe personfeelsthe eventis recurring
 Avoidance of remindersof the event
 Sleeplessness
 Depression
 Irritabilityorangryoutbursts
 Feelingsof being“onalert”at all times
 Emotional withdrawal
 Hopelessness
 Mood swings
 Guiltoversurvivingthe event
 Inabilitytoconcentrate
 Excessive startle responsetonoise
Acute stress disorder (ASD)
issimilartoPTSD, exceptitcan be diagnosedimmediatelyafteratraumaticeventandlastsfor three
daysor more,butno longerthanone monthafterthe trauma.Like PTSD,it istriggeredbya traumatic
eventsuchas witnessingacar accidentornatural disasterorbeingviolentlyassaulted.ASDsymptoms
overlapwiththose of PTSD.In some cases,angeror dissociativesymptoms,suchasnot knowingwhere
youare or feelingseparate fromyourbody,may be the mainsymptoms.Some people whosufferASD
may have previouslyhadPTSD,andmany whogetASD go on to developPTSD.
Finding the Right Health Care Professional
Because of widespreadlackof understandingandthe stigmaassociatedwithanxietydisorders,many
people withthese disordersdon’treceive adiagnosisandsodon’treceive treatmentsproveneffective
throughresearch.Yetanxietydisorders,like othermental disorders,are anillnessandshouldnotbe
facedwithshame or fear.Enormousprogresshasbeenmade inthe scientificunderstandingof the
underlyingcausesandmechanismsof anxietydisorders.
To be a smart healthcare consumer,youneedtoensure thatthe healthcare professional yousee is
able to recognize ananxietydisorder.While mentalhealthtreatmentcanbe receivedfromawide range
of professionals,includingprimarycare physicians,psychiatrists,psychologistsandsocial workers,you
may wantto considerseekingoutananxietyspecialist,particularlysomeonewhocanoffer the
treatmentsfoundtobe mostsuccessful,suchascognitive behavioral therapyandmedications.
You can contact the AnxietyDisordersAssociationof Americaorthe AssociationforBehavioral and
Cognitive Therapies tofindprofessionalsspecializingin anxiety.Make sure youfollow the stepsfor
seekingtreatmentasoutlinedinyourhealthinsurance plan.Youmaybe required,forexample,tosee a

8. primarycare physicianfirst.Some healthinsurance planscovermentalhealthservices;some don’t.
Checkyour policyorask yourplanadministratorsoyoucan determinewhatyourout-of-pocket
expensesmightbe.Don’toverlookthe simplefactthatyoushouldlike yourtreatingprofessional.If you
can’t developarapportwithinthe firsttwoor three sessions, yourtherapyprobablywon’tbe
successful,sokeepsearchingforsomeone withwhomyou’re comfortable.
Treatment
Anxietydisordersrequire professionaltreatment;simplytryingtotalkyourself outof anxietyisasfutile
as tryingto talkyourself outof a heart or stomachproblem.Fortunately,the vastmajorityof people
withan anxietydisordercanbe helpedwiththe rightprofessionalcare.Researchsuggeststhatwiththe
righttreatment,manypeople withanxietydisordersexperiencesignificantimprovement.There are no
guarantees,however,andsuccessratesvarywithcircumstances.
Treatmentperiodsvary,withsome requiringonlyafew monthsof treatmentandothersneedingayear
or more.People withanxietydisordersoftenhave more thanone disorder orsufferfromsubstance
abuse or clinical depression.Whenmore thanone mental health-relatedconditionispresent,eachmust
be accuratelydiagnosedandtreated.
Treatmentsforanxietydisordersvary,withboththerapy,particularlycognitive behavioral therapy
(CBT),and medication,used.Often,the mosteffectiveapproachforanxietydisordersisacombination
of the two.WithOCD, a specifictype of CBT calledexposure andresponse preventionshouldbe used,
usuallyincombinationwithmedication.
Medications
Medicationsusedtotreatanxietydisordersinclude:
 Selectiveserotoninreuptakeinhibitors(SSRIs)are first-linemedicinesusedtotreatanxiety
disorders.Althoughthese medicationswereinitiallyapprovedasantidepressants,theyare
effectiveinthe treatmentof anxiety.Some of themhave beenapprovedbythe FDA forthe
treatmentof one or more of the anxietysyndromes.Theyinclude fluoxetine(Prozac),sertraline
(Zoloft),paroxetine (Paxil),citalopram(Celexa),fluvoxamine (Luvox) andescitalopramoxalate
(Lexapro).Theyworkbyaffectingthe concentrationof serotonin,achemical inthe brain
thoughtto be linkedtoanxietydisorders,andhave traditionallybeenusedtotreatdepression.
SSRIsmay take several weekstohave aneffect.Theyshouldnotbe stoppedsuddenlyasthey
may cause withdrawal symptomsthatare unpleasantbutnotharmful.The mostcommonside
effectsare nauseaandgastrointestinalproblems,drowsiness,sweating,headache,difficulty
sleepingandmildtremor,all of whichusuallywearoff asyourbodyadjuststo the medication.
Weightgainand sexual dysfunctioncanalsobe side effectsof thiscategoryof medications.
Occasionallytheycancause agitationorworseningof anxiety.Notifyyourclinicianimmediately
if thisoccurs.
 Tricyclicantidepressants(TCA) are oldermedicationsthatwere firstusedfortreating
depression.Theyare alsoeffective inblockingpanicattacksandfor anxietyandPTSDbecause

9. theyregulate serotoninand/ornorepinephrine inthe brain.The mostcommonTCAsusedfor
the treatmentof panicdisorderare imipramine (Tofranil),desipramine(Norpramin)and
nortriptyline(Pamelor).TCAsare alsoeffective intreatingagoraphobia.Clomipramine
(Anafranil),whichisthe onlyTCA approvedforobsessive-compulsive disorder(OCD),
significantlyreducessymptomsforpatientswhocantolerate it.Tricyclicantidepressantshave
more adverse side effectsthanSSRIs,whichiswhySSRIsare oftentriedfirstinthe treatmentof
anxietydisorders.Tricyclicsusuallytake twoorthree weekstotake effect.Sideeffectsinclude
dry mouth,blurredvision,sexualdysfunction,weightgain,difficultyurinating,constipation,
disturbancesinheartrhythm,drowsinessanddizziness.Bloodpressuremaydropslightlywhen
sittingupor whenstandingfroma sittingposition,causingdizziness.Tricyclicsalsocanhave
serious,althoughrare,side effectsandcanbe potentiallyfatal inoverdose.Elderlypatientsand
those witha historyof seizures,cardiacproblems,closed-angle glaucomaandurinaryretention
or obstructionshouldbe closelysupervisedwhentakingtricyclics.
 Serotonin-norepinephrine reuptake inhibitors(SNRIs) are alsofrequentlyusedfortreatmentof
anxietydisorders.These includevenlafaxine (Effexor) andduloxetine(Cymbalta).Venlafaxine is
approvedtotreat GAD, panicdisorderandsocial anxietydisorder,while duloxetineisapproved
thusfar onlyfor GAD. Desvenlafaxine(Pristiq) isthe newestdruginthiscategoryand so far is
not approvedtotreat anxietydisordersbutissometimesusedoff-label fortreatment.The side
effectsof SNRIsare similartothose of the SSRIs althoughtheyappeartohave more pronounced
withdrawal symptomswhenthe medicationisstopped.
 Mirtazapine (Remeron)actsbyincreasingnorepinephrine andserotonininadifferentwaythan
the SSRIsand SNRIs.It isapprovedbythe FDA for depression,butitalsocan be effectivefor
treatinggeneralizedanxiety,panicdisorderandPTSD.Side effectsinclude drymouth,
constipation,increasedappetite,weightgainandsedation.Thismedicationcanalsoincrease
cholesterol andtriglycerides.Becauseof these sideeffects,the use of mirtazapine isbest
reservedforpatientsexperiencingweightlossandinsomniadue totheiranxiety.
 Monoamine oxidase inhibitors(MAOI),typicallyphenelzine(Nardil) ortranylcypromine
(Parnate),are olderantidepressantsusedforpanicdisorder,social anxietydisorderorPTSDthat
doesnotrespondto othertreatments.Theyworkbyblockingthe effectof a brainchemical that
breaksdownserotoninandnoradrenaline.Commonside effectsinclude asuddendropinblood
pressure uponstanding,drowsiness,dizziness,sexualdysfunctionandinsomnia.The most
seriousside effectissevere hypertension,whichcanbe broughton byeatingcertainfoodswith
hightyramine content,suchasaged cheeses,redwines,sauerkraut,vermouth,chickenlivers,
driedmeatsandfish,cannedfigs,favabeansandconcentratedyeastproducts.Theycanalso
interactwithothermedications,suchasover-the-counterdecongestantsandprescription
stimulants.Youshouldn’ttake MAOIsif you’re pregnantortakingotherantidepressantssuchas
SSRIsand shouldhave at leasta two-weekbreakbetweenendingone antidepressantand
startingon MAOIs.Because these drugscan cause a hypertensive crisisfrominteractionwith
othermedicationsandcertainfoods,theyare rarelyused.There are manysaferdrugsthat are
effectiveforanxiety.(Note:In2004, the U.S. Foodand Drug Administrationissuedawarning
that all antidepressantsmayleadtoan increasedsuicideriskinadolescentsandchildren.This

10. was subsequentlyrevisedtoinclude youngadultsthroughage 25. Therefore,itisimportantto
watch anyone takingantidepressantsforsignsof suicidal behaviorgenerallythroughthe first30
daysof treatment.)
 Benzodiazepineslike alprazolam(Xanax),lorazepam(Ativan),diazepam(Valium) and
clonazepam(Klonopin) have beenthe treatmentof choice foranxietydisordersforyears.
Benzodiazepinesare mildsedativesthatbelongtoagroup of medicationscalledcentral nervous
systemdepressants.These drugsmaybe habit-forming,especiallywhentakeninhighdosesor
for an extendedtime.Benzodiazepinesworkrelativelyquickly.Theirprincipalside effectsare
drowsiness,fatigue,dizziness,slurredspeech,impairedconcentrationandshort-termmemory
loss,buttheyhave the potential fordependencyafteronlyafew weeks.Thus,if youstoptaking
themaftertakingthemfor a longperiod,you mayexperience reboundsymptoms,sleep
disturbance andanxietywithinafew days.Youshouldnotstopthese medicationssuddenly,
because youmayhave withdrawal symptomsthatcanresultinseizures(generallywithhigh
dosesthatare takenmultiple times perday).Alwaystalktoyourhealthcare providerbefore
youstop takingbenzodiazepines.Youshouldalwaystaperoff slowlywiththe helpof your
clinician.However,benzodiazepinescanbe veryhelpfulwhentakenunderthe directionof your
healthcare provider.Benzodiazepinesare oftenusedduringthe initialtreatment,alongwith
othermedication(suchasSSRIs),because theywill helpimmediatelywiththe anxietybefore the
otherdrugs take effect.Theycanthenbe graduallydiscontinued.Theymaybe usedlong-termin
certainsituationsandcan be effectiveasa single dose forapanicattack because theyprovide
quickrelief.
 Buspirone isthe onlydrugavailable inthe classcalledazapirones.Itworksviaone of the
serotoninreceptors.Buspirone is approvedforgeneralizedanxietydisorder.Itusuallytakes
several daystoweeksforthe drug to become effective,anditisnotuseful againstpanicattacks.
Unlike the benzodiazepines,buspirone isnotaddictive,evenwithlong-termuse,anditseemsto
have lesspronouncedside effectsandnowithdrawal effects,evenwhenthe drugis
discontinuedquickly.Because the drugdoesnotproduce anyimmediate euphoriaorchange in
sensation,those whohave takenbenzodiazepinesmaybelieve it’snotworking.Commonside
effectsincludedizziness,drowsinessandnausea.Buspirone shouldnotbe usedwithMAOIs.
 Beta-blockers,includingpropranolol (Inderal) andatenolol (Tenormin),reduce the effectsof
adrenaline byblockingcellularreceptorsforadrenaline.Theyaffectonlythe physical symptoms
of anxiety,whichmaythenlessenthe psychological symptoms.Theyare mosthelpfulfor
performance anxietyandare usedpriorto such situationsasmusical performancesorpublic
speaking.Theyare lesshelpful forotherformsof anxiety.Theyworkquicklyandaren’thabit
formingbutshouldn’tbe usedwithcertainpre-existingmedical conditionssuchasasthma,
congestive heartfailure,diabetes,vasculardisease,hyperthyroidismandanginapectoris.
Researchersare currentlyworkingondevelopingdrugsthattargetspecificbraincellsinvolvedinanxiety
disorders.
Therapy

11. Behavioral techniques
focuson changingnegative thinkingandbehaviorsthatcan contribute toanxietydisorders.Talkingtoa
mental healththerapistcanprovide relief,leadtonew insightsandhelpreplace unhealthybehaviors
withmore effectivewaysof coping.Mostmental healthprofessionalstailortheirapproachestothe
needs,problemsandpersonalitiesof the peopleseekinghelpandmaycombine differenttechniquesin
the course of therapy.The varioustypesof behavioral techniquesusedtotreatanxietydisorders
include:
Cognitive-behavioral therapy
focusesonidentifyingandmodifyingthe faultythoughtsandnegative behaviorsthatkeepaperson
stuck inthe anxietypattern.There are several partstothistherapy.Treatmentbeginswitheducation
aboutthe disorder:the causes,commonsymptomsandtreatmentplan.Next,the personlearnsto
identifythe specificthoughtsbehindtheiranxiety(forexample,whatspecificallyare theythinkingwhen
theyfeel anxious?).Theyexamine these thoughtsusingevidencetoensure thattheyare lookingat
thingsaccuratelyandnot exaggeratingthe likelihoodof negative eventsoroutcomesorthe potential
consequencesof them.Theylearntorecognize andthengive uptheiranxiousbehaviors(e.g.,
avoidance,rituals,reassurance seeking) andincrease positive,healthybehaviorslikegoodsleep,
exercise,problemsolvingorassertiveness.The secondpartof the therapyconsistsof facingthe stimulus
or situationthattriggersanxietysothatthe anxiousresponse will decrease overtime andthe person
learnsthatthe fearedoutcome rarelyhappensorisnotas catastrophicas theythoughtit wouldbe.
Systematic desensitization
requiresawomanto graduallyconfrontthe objectof fearwitha goal of breakingthe linkbetweenthe
anxiety-provokingstimulusandthe anxietyresponse.First,youundergorelaxationtrainingand
compose a listthatprioritizesanxiety-inducingsituationsbythe degreeof feartheyinvoke.Next,you
undergothe desensitizationprocedure,confrontingeachitemonthe list,startingwiththe least
stressful.Thistreatmentisespeciallyeffective forsimple phobias,social phobias,agoraphobiaandpost-
traumaticstressdisorder.
Breathing retraining
helpswomenwithpanicdisorderpractice measured,controlledbreathing.Becausemanypeoplewith
panicdisorderhyperventilate,breathingrapidlyandtenselyandexpellingtoomuchcarbon dioxide,
theysufferfromchestpain,dizziness,tinglingof the mouthandfingersandmuscle cramps.People learn
to practice diaphragmaticbreathing,takingslow deepbreathsversusrapid,shallow ones.Bycorrecting
herbreathing,a womancan relieveunpleasant(thoughharmless) symptomsandmayavoidthe onsetof
a panic attack.This technique isfrequentlyusedinconjunctionwithothertreatmentsforanxiety
disorders.
Otherformsof psychotherapy,commonlycalled“talk”therapies,deal more withchildhood rootsof
anxietyandusually,althoughnotalways,requirelongertreatments.Theyincludeinterpersonal therapy,

12. supportive psychotherapy,attentioninterventionandpsychoanalysis.Someexpertsbelievethatsuch
therapiesmightbe more useful forgeneralizedanxiety,whichmayrequire more sustainedworkovera
longer time.
Hypnotherapy,whichusesthe techniqueof hypnosis,mayalsobe an appropriate treatmentoptionfor
some people.Hypnosisisaformof intense receptiveconcentration.Accordingly,hypnosisoftenisused
to modifybehaviorandovercome phobiasandbadhabits—itcanhelpyoumake changesthatyou’ve
beenunable tomake otherwise.Oftenhypnotherapyiscombinedwithotherrelaxationtechniques.
Prevention
People withanxietydisorders oftenare knownas“worriers,”concernedaboutcontrol and
perfectionism.Thesecanbe goodtraits to have.Butwhenthe needforperfectionismorcontrol
interfereswithyourlife,youmayhave an anxietydisorder.The firststepinpreventionistolook athow
youcan responddifferentlytosituationsthatmake youanxious,modifythe physiological responseto
those situationsandmasternegative thinking.
A healthylifestyle thatincludesregularaerobicexercise,relaxationtechniquessuchasyoga, adequate
restand good nutritioncanhelpreduce the impactof anxiety.
To preventyournormal anxiousfeelingsfromgoingtoofar,try these suggestions:
 Identifysituationsthatmake youanxious,consideractionsthatwill reduce the threatandtry
themout (forexample,attendchildbirthpreparationclassestodeal withthe stressof laborand
delivery;eliminate orreduce caffeine intakeif nervousnessalone isthe problem).
 Avoidpotentiallydangerouswaysof copingwithanxiety,like smoking,alcohol,drug
dependence orabnormal eatingpatterns.
 Expressyourfeelingstosomeone youtrustandcan talkwithcomfortably.Thisoftenleadstoa
relief of anxiousfeelings.
 Try relaxationtechniquesormeditationsuchasyogaor stressreductionclasses.
 Try walking,jogging,swimmingoranyaerobicexercise.
 Avoidunnecessarystressbyeliminatingasmanynonessential activitiesaspossible fromyour
dailyroutine.Delegate taskswhenpossible andpractice saying“no,”ratherthantakingon more
responsibilities thanyoucanmanage.
 If your anxietypersistsorbecomeschronic,seekoutacompetentmental healthprofessional.
You can ask for helpora referral fromyourprimaryhealthcare professional,acommunity
mental healthcenter,amental healthassociation oryourlocal healthdepartment.
Facts to Know
1. Accordingto the National Institute of Mental Health,anestimated40millionAmericanadults
experience anxietydisorderswithinagivenyear.
2. Withouttreatment,ananxietydisordercansignificantlydisrupt yourlife.Youmaybe tormented
by panicattacks,irrational thoughtsandfears,compulsivebehaviorsorrituals,flashbacks,

13. nightmaresorcountlessfrighteningphysical symptoms.Yet,becauseof widespreadlackof
understandingandthe stigmaassociated withthesedisorders,onlyaboutone-thirdof those
whoexperience thisproblemare diagnosedandreceive treatment.
3. Generalizedanxietydisorderaffectsabout6.8millionAmericansandischaracterizedby
excessiveworryaboutanumberof life issueslike health,work,financesorrelationships.The
worryis difficulttocontrol andispresentmore daysthannot for six monthsor more.
4. Panicdisorderaffectsabout6 millionAmericans.Ittypicallystrikesinlate adolescence orearly
adulthood.Womenare twice aslikelyasmentodeveloppanicdisorder.People withpanic
disordermayalsosufferfromdepression;inaddition,those withpanicdisorderare more likely
to abuse alcohol anddrugs.Aboutone-thirdof peoplewithpanicdisorderdevelopagoraphobia,
an illnessinwhichtheybecomeafraidof beinginanyplace orsituationwhere escape mightbe
difficultorhelpunavailable inthe eventof panic-like symptomsorsome otherunpleasantor
embarrassingphysical symptom.
5. About15 millionpeoplehave social phobiaorsocial anxietydisorder.Social phobiainvolvesfear
that a personwill embarrassherself orthatotherswill evaluatehernegatively.The disorder
typicallybeginsinchildhoodorearlyadolescenceandrarelydevelopsafterage 25.
6. About2.2 millionAmericanshave obsessive-compulsivedisorder(OCD).OCDaffectsmenand
womenwithequal frequency.
7. About7.7 millionAmericanssufferfromposttraumaticstressdisorder(PTSD).Traumasuchas a
rape,childhoodsexual abuse,militarycombatorwar-relatedincidents,andnatural disastersare
commoncauses.PTSD can developatanyage,includingchildhood.Depression,alcohol orother
substance abuse oranotheranxietydisorderoftenaccompaniesPTSD.
8. Anxietydisordersmostoftenbegininyoungadulthood,startingmildlyandprogressing.
Generalizedanxietydisorderappearstobe the mostcommonform of anxietyatolderages.In
addition,exceptforOCDand social anxietydisorder,anxietydisordersstrike womenat
approximatelytwice the rate of men.A woman’shormonal cycle mayaffectheranxiety
disorder,withsymptomsgettingworse premenstrually.
9. Anxietyattackscanmimicor accompanydiseasesof the heartand lungs,butanxietyattacksdo
not cause heartor lungdisease.Anxiety-like symptomsmayoccurwithothermedical problems,
includingepilepsy,hypoglycemia,adrenal-glandtumorsandhyperthyroidism.Womencanalso
experience intenseanxietyattackswithhotflashesduringmenopause.Manydrugs,including
some forhighbloodpressure,diabetesandthyroiddisorders,canproduce symptomsof anxiety.
10. Fortunately,treatmentforanxietydisordersis,ingeneral,veryeffective.Earlyidentificationand
treatmentof an anxietydisordermayhelpyourecovermore easilyandpreventdepression.
Treatmentsforanxietydisordersvaryandinclude therapy,particularlycognitivebehavioral
therapy,andmedication.Oftenthe mosteffective approachformostanxietydisordersisa
combinationof the two.
Key Q&A
1. What isan anxietydisorder?Anxiety isthe anticipationof danger,negative eventsornegative
outcomes.Nearlyall people experience anxietyattimes.Ananxietydisorderisanexcessive

14. level of anxietythattypicallypersistsforatleastsix monthsandcausesa great deal of distress
or causesproblemsina person’slife.Anindividual whosuffersfromananxietydisordermay
avoidsituationsorendure fearedsituationswithagreatdeal of distress.Anxietydisorderscan
interfere withrelationships,impairfunctioningatwork,consume significantamountsof time,
preventapersonfromdoingthingstheywishtodo and significantlyreduce qualityof life.
2. Who getsthisillnessandwhy?Anxietydisordersstrike menandwomenof all races,agesand
social status,but(exceptforOCD andsocial anxietydisorder) theyare abouttwice ascommon
inwomenandtheytendto strike more ofteninyoungadulthood.Anxietydisorderscanbe
causedby biological,chemical orgeneticfactors;can be broughtaboutby psychosocial factors
such as environmental factorsandstressfullifeevents;orcan be attributedtocertainmedical
conditionsormedications.Inmostcases,anxietydisordersare thoughttobe causedby a
combinationof these factors.
3. Are there differenttypesof anxietydisorders?Yes,there are several typesof anxietydisorders,
including:
 Generalizedanxietydisorderischaracterizedbyworryabouta numberof life areassuchas
health,work,finances,relationshipsandminormatterslikebeingontime.The worryis
excessive,difficultto control andispresentmore daysthan notfor six monthsor more.
Alongwiththe worry,a personexperiencessymptomssuchasrestlessness,irritability,
muscle tensionanddifficultysleeping.
 Panicattacks are characterizedbya suddenrushof anxietywithmultiplephysical symptoms
such as rapidheartbeat,sweating,trembling,chestpainortightness,shortnessof breath
and fearsof dying,losingcontrol orgoingcrazy. These attackstypicallyreachtheirpeak
within10 minutes.People withall differentformsof anxietymayexperiencepanicattacks.
A personwithpanicdisorderexperiencespanicattacksthatseemto come out of the blue.
The personchangesherbehaviortoavoidsuch attacks or worriesaboutwhentheymight
occur.
 Phobiasare irrational,involuntaryandoverwhelmingfearsthatleadapersonto avoid,or
endure withgreatanxiety,commonobjects,livingthingsorsituations.
 Social phobia,orsocial anxietydisorder,ischaracterizedbyapersistentfearof humiliation
insocial or performance situations.Itoftenleadstoavoidance of these situations.
 Obsessive-compulsive disorderischaracterizedbyrecurrent,persistentandintrusive
thoughtsor impulsesthatthe persontriestocontrol or neutralizebyperformingcertain
behaviorsormental rituals.
 Post-traumaticstressdisorder(PTSD) isadisorderthatcan developafterexposure toa
terrifyingeventorordeal inwhichgrave physical harmoccurred,wasthreatenedorwas
witnessed.TraumaticeventsthatmaytriggerPTSDinclude violentpersonal assaults,natural
or human-causeddisasters,accidentsormilitarycombat.
 Acute stressdisorder(ASD) issimilartoPTSD,exceptitoccurs betweenthree daysandone
monthafterthe trauma.Like PTSD,it istriggeredbya traumatic eventsuch as witnessinga
severe caraccidentor natural disasteror beingviolentlyassaulted.

15. 4. How can I tell if Ihave an anxietydisorder?If youfeel“onedge”mostof the time;if you
experience panickyfeelings,sweating,rapidheartbeatanddifficultybreathingaroundspecific
objectsor situations;if youfeelcompulsionstoperformspecificandtime-consumingrituals;if
youhave recurrentdisturbingthoughts;if youregularlyexperience distressingsleeplessness,
irritabilityordifficultyconcentrating;and if these feelingspersistorimpairnormal functioning,
youshoulddiscussthemwithyourhealthcare professional.
5. How are anxietydisorderstreated?Mostanxietydisordersrespondwell totreatment,usually
medicationand/orcognitive-behaviortherapy.Specificmedicationshave beendevelopedto
combat anxiety,withantidepressantmedicationssuchasSSRIsprovingparticularlyeffective.
Behavioral therapieshelppatientsregaincontrol of theirreactionstostressandfearedobjects
or situationsandchange unhelpful patternsof thinking.
6. Do antianxietymedicationshave sideeffects?How longwillIhave totake thismedication?The
newerantidepressants,includingserotoninreuptakeinhibitors,cause fewerside effectsthan
the oldertypesof drugsusedto treat anxiety.Bothtypesof medicationcancause side effects
such as nausea,drowsiness,gastrointestinal upset,anxietyandinsomnia,whichmaysubside
afterabout a month.Some people make the mistakeof stoppingthe medicationwhentheyfirst
start to experience sideeffectsorwithoutspeakingtotheirhealthcare professional aboutthe
side effects.Sexual dysfunction(erectile dysfunction,lossof desire,inabilitytoreachorgasm) is
a commonside effectof some medications.Because manytypesof antianxietymedicationsare
available,itislikelythatone canbe identifiedthatproducesthe fewestside effectswithbest
results.Mostpeople don’thave totake antianxietymedicationsforever.Once youranxiety
subsides,youcandeterminewithyour healthcare teamwhatthe bestcourse is foryou.Short-
termtreatment,fromsix monthstoone year,is common.But longertreatmentmaybe
necessarytopreventarecurrence.
7. Can antianxietymedicationsbe takenduringpregnancyorbreastfeeding?Ifyouare nursing,
pregnant,plantobecome pregnantor couldpossiblybecomepregnant,youshoulddiscusswith
your healthcare professional the possibleeffectsof anymedications.If the mental healthof an
expectantmotherdependsontakingantidepressantsduringpregnancy,manyhealthcare
professionalsrecommendthatshe continue takingthe drugs,soshe cancare for herself andher
family.Researchisunclearabouthow antidepressantsmayaffectanursingbabythoughit is
knownthat these drugspassthrough to breastmilk.Fora womanwho istakingantianxiety
medicationandisconcernedaboutbreastfeeding,mosthealthcare professionalswill discuss
the latestresearchonmedicationoptionsandhelpherweighthe risksof takingmedication
alongwiththe potential benefitsthatnursingcouldprovide.
8. What’sthe firststepingettingtreatment?If youthinkyoumayhave ananxietydisorder,talkto
your primarycare physicianaboutyoursymptomsandaskfor a referral toa medical
professionalwhocandiagnose andtreatanxiety.There are manygoodsourcesof information
aboutanxietyandothertypesof mental illnessonthe Web,throughlibrariesandfrommental
healthorganizations.Manyorganizationshave hotlinestohelpgetyoustartedtalkingabout
symptoms.If youfeel suicidal,seekhelpimmediately.

16. For more informationvisitusourwebsite:http://www.healthinfi.com