Anxiety Disorders, Obsessive-Compulsive Disorder, Post Traumatic Stress Disorder, and Stress Reactions

Most people experience feelings of anxiety before an important event such as a big exam, business presentation, or first date.  Anxiety disorders, however, are illnesses that fill people's lives with overwhelming anxiety and fear that are chronic and unremitting, and can grow progressively worse.  In more extreme cases, people with anxiety disorders may be tormented by panic attacks, obsessive thoughts, flashbacks of traumatic events, nightmares, or countless frightening physical symptoms.  Fortunately, there are effective treatments that can help.

 

Anxiety disorders are the most common mental illness in America.  More than 19 million American adults are affected by these debilitating illnesses each year. Children and adolescents can also develop anxiety disorders.

 

It is common for an anxiety disorder to accompany depression, eating disorders, substance abuse, or another anxiety disorder.  Anxiety disorders can also co-exist with illnesses such as cancer or heart disease.  In such instances, the accompanying disorders will also need to be treatted.  Before beginning any treatment, however, it is important to have a thorough medical examination to rule out other possible causes of symptoms.

 

Agoraphobia  Fears that include being outside the home alone; being in a crowd or standing in a line; or being in any situation or place from which escape might be difficult or embarrassing. 

 

Panic Disorder  Repeated episodes of intense fear that strike often and without warning.  Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.

 

Obsessive-Compulsive Disorder  Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.  (See more below.)

 

Post Traumatic Stress Disorder  Persistent symptoms that occur after experiencing or witnessing a traumatic event such as a rape or other criminal assault, war, child abuse, natural or human-caused disasters, or crashes.  Nightmares, flashbacks, numbing of emotions, depression, and feeling angry, irritable or distracted and being easily startled are common symptoms.  Family members of victims can also develop this disorder. (See more below.)

 

Phobias  Two major types of phobias are social phobia and specific phobia.  People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities.  People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.

 

Social Phobia  Fear of social or performance situations in which someone is exposed to unfamiliar people or to possible scrutiny by others.  The individual fears that he or she will act in a way that will be humiliating or embarrassing.

 

Generalized Anxiety Disorder (GAD)  Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months.  Almost always anticipating the worst even though there is little reason to expect it, accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.

 

For more information regarding anxiety disorders, visit http://www.adaa.org/GettingHelp/Briefoverview.asp. or

http://www.calmclinic.com (This website offers comprehensive info regarding anxiety as well as their own non-standardized anxiety test. The site also promotes several publications available at a cost and which are in no way connected to Craig Mental Health.)

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder that is characterized by the presence of obsessions and/or compulsions that are severe enough to be time consuming or cause distress and impaired functioning.

 

Obsessions are persistent thoughts, ideas, or images that are experienced as intrusive and inappropriate.  The most common obsessions are repeated thoughs about contamination (e.g., being contaminated by shaking hands), repeated doubts (e.g., wondering whether the door was locked or the oven turned off), a need to have things in a particular order (e.g., intense distress when things are disorganized or assymetrical), thoughts of aggressive or horrific behavior (e.g., an impulse to hurt one's child or shout obscenities in church), and sexual imagery (e.g., recurrent pornographic images).  The thoughts or images are not simply excessive worries about real-life problems and are unlikely to even be related to a real-life problem.

 

People with obsessions usually attempt to ignore or suppress them, or neutralize them with some other thought or action (e.g., compulsions).  For example, someone plagued by doubts about having turned off the stove will attempt to neutralize the doubts by repeatedly checking to ensure that it is off.

 

Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress.  Usually, the person feels driven to perform the compulsion to reduce the distress that accompanies an obsession or to prevent some dreaded event or situation.

 

Adults with OCD at some point recognize that the obsessions or compulsions are excessive or unreasonable. This does not apply to children because they may lack sufficient cognitive awareness to make this judgment.  OCD may occur in the presence of other mental illnesses, such as depressive disorders, eating disorders, or other anxiety disorders.

 

Treatment for OCD is the same as for other anxiety disorders--cognitive-behavioral therapy and medication.  Some SSRI anti-depressants have been proven to dramatically reduce OCD sypmtoms.

 

For more information about OCD, go to http://www.mayoclinic.com/health/obsessive-compulsive-disorder/DS00189.

PTSD is an anxiety disorder that develops after exposure to a traumatic event, such as a violent attack, an accident or a natural disaster.  The person may experience the traumatic event directly, may witness an event that involves other people or may learn about a traumatic event that happened to a family member or close friend.

 

Whether the traumatic event is experienced, witnessed or learned of, one of the defining characteristics of PTSD is that the event involves the actual or perceived threat of serious injury or death to the person or others.  In addition, the person who experienced, witnessed, or learned of the traumatic event reacts to it with intense fear, helplessness or horror.

 

It should be emphasized that most people who are exposed to traumatic events do not develop PTSD.  Furthermore, many people with symptoms (such as difficulty falling asleep) after a trauma show gradual improvement with time.  However, in some cases, symptoms continue and negatively impact the person's life (for example, impairing their work, their studies or their relationships with others).  In such cases, PTSD may be present.

 

Persons with PTSD display three types of symptoms:

1.  Intrusive re-experiencing symptoms are when a person has memories, flashbacks, or nightmares of the event(s).

2.  Avoidant or numbing symptoms are when a person withdraws from people or activities that are reminders of the traumatic event.

3.  Hyperarousal symptoms are when a person is easily startled, irritable, on edge, or has trouble falling asleep.

 

When children have PTSD, symptoms are expressed in different ways.  For example, children may re-experience the traumatic event through repetitive play (e.g., a child who witnessed a robbery may reenact the robbery again and again using her toys).

 

Scientists have suggested that PTSD tends to be more intense and lasts longer when the traumatic event involves human violence.  They have also found good evidence that the likelihood of developing PTSD increases with the severity, length and proximity of exposure to the traumatic event.

 

PTSD symptoms may seem similar to those of other anxiety disorders, such as acute stress disorder or obsessive-compulsive disorder.  However, there are some distinct differences.  In general, the symptoms of acute stress disorder must occur within four weeks of an event and come to an end within that four-week time perios.  If symptoms last longer than one month and follow other patterns common to PTSD, a person's diagnosis may change from acute stress disorder to PTSD.

 

While both PTSD and obsessive-compulsive disorder (OCD) have recurrent, intrusive thoughts as a symptom, the thoughts present in OCD do not usually relate to a past traumatic event.

 

There are two main treatmenst for PTSD:  psychotherapy and medication.  Therapy provides a safe place where anything can be discussed regardless of how shocking or painful and is a way for people with PTSD to begin to reestablish a sense of trust with others.  Therapy also helps people with PTSD learn to manage their symptoms, particularly through cognitive-behavioral therapy. This type of therapy helps people better understand how their actions or behaviors are related to their mental processing of external stimuli. A person may also work with the therapist on particular exercises, such as gradually exposing themselves to situations that remind them of the trauma, which ultimately helps to reduce anxiety.

 

( Eye Movement Desensitization and Reprocessing, or EMDR, was developed in the late 1980s and has been found to be successful in many cases of Post Traumatic Stress Disorder.  For more information, go to www.emdr.com. )

 

Medication can also help, particularly certain kinds of antidepressants. These medications actually work to decrease the PTSD symptoms, and have the added advantage of being useful for the co-occurring anxiety or depression symptoms that are common with PTSD.

 

For more information about PTSD, go to http://www.ptsdinfo.org/.

 

Strong emotional and physical reactions to traumatic events are common and quite normal.  They may appear immediately, a few hours or days later, or even weeks and months after the trauma.  The signs and symptoms may last anywhere from a few days to a few months and usually pass more quickly with understanding and the support of others.  Occasionally the symptoms are severe enough that assistance from a mental health professional may be necessary.  This does not imply weakness or "craziness."  It simply means that an event was just too powerful for a person to manage on his or her own.

 

Common signs and symptoms of a stress reaction include:

 

Physical

fatigue, headaches, weakness, dizziness, elevated blood pressure, nausea, rapid heart rate, thirst

 

Cognitive

confusion, poor concentration, memory problems, hypervigilance, intrusive images, nightmares, poor problem-solving

 

Emotional

anxiety, guilt, grief, fear, depression, irritability, anger, apprehension

 

Behavioral

withdrawal, suspiciousness, loss or increase of appetite, pacing, inability to rest, emotional outbursts, change in activity, change in communication

 

This is only a partial list.  There are other stress reactions that are also considered normal.  If you or someone you know is experiencing any of these symptoms and needs help, contact a mental health professional.

 

For more information about Stress Reactions, go to http://www.healthline.com/galecontent/acute-stress-disorder.

A number of medications that were originally approved for treating depression have been found to be effective for anxiety disorders as well.  Some of the newest of these antidepressants are called selective serotonin reuptake inhibitors (SSRIs).  Other antianxiety medications include groups of drugs called benzodiazepines and beta-blockers.  If one medication is not effective, others can be tried.  New medications are always under development.   (see Commonly Prescribed Psychotropic Medications)

 

Two clinically-proven effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy.  Behavioral therapy focuses on changing specific actions and uses several techniques to stop unwanted behaviors.  In addition to the behavioral therapy techniques, cognitive-behavioral therapy teaches patients to understand and change their thinking patterns so they can react differently to the situations that cause them anxiety.

For more information on anxiety disorders, visit http://www.adaa.org/