CAPS: Psychiatric Services
ANXIETY DISORDERS
Table of Contents
- What is Anxiety?
- Anxiety Disorders
- Phobias
- Panic Disorder
- Obsessive-Compulsive Disorder
- Post-traumatic Stress Disorder
- Problems Associated with Anxiety
- Treatment
- Psychotherapy
- Pharmacotherapy
- Therapy vs. Medications
- UCSC Resources
What is Anxiety?
All people are familiar with anxiety. At times a vague apprehension, more rarely an intensely uncomfortable feeling, it is part of being human. From a medical standpoint, anxiety is a warning signal, triggered by a conscious or unconscious perception of danger, that is experienced both physically and psychologically. Physical symptoms of anxiety include:
- muscle tension
- heart pounding
- dizziness, or light-headedness
- sweaty palms
- butterflies in the stomach
- chest tightness, or choking feelings
Psychological symptoms of anxiety include:
- poor sleep
- poor concentration
- distractibility
- excessive worrying
These symptoms are natural and cannot be avoided. However, there is a point at which anxiety may become extreme, and interfere with day to day living. In such cases, one needs to consider whether an anxiety disorder may be present, requiring some type of treatment.
Anxiety Disorders
Since anxietyis a normal part of all people, it can be difficult to decide if it is a problem. The questions to consider are:
- Is this anxiety part of a repeated pattern?
- How much does it get in the way of my life?
If a pattern of anxiety increases to the point where it is hard to control, and interferes with the ability to work or have relationships, the person can be said to have an anxiety disorder.
Since our warning systems are complex, there are many ways in which anxiety can manifest itself. Sometimes anxiety is a rare occurrence, triggered only by specific situations. Sometimes it is always present, subtly distracting us and wearing us down. Some common anxiety problems are described below.
Phobias
Phobic disorders involve fear of a specific situation and are characterized by:
- Fear or discomfort triggered by specific situations, such as crowds, enclosed spaces, heights etc.
- Avoidance of or distress from the situation, that interferes with school or social life.
Panic Disorder
Panic disorder involves repeated episodes of panic, which hit suddenly. Symptoms of a panic attack include:
- shortness of breath, or choking
- racing heart, or chest pain
- sweating, chills or hot flushes
- nausea, dizziness, shaking
- fear of dying or going crazy
Panic disorder affects 1-4% of the population.
Obsessive-Compulsive Disorder
Obsessive-Compulsive disorder involves having either obsessions or compulsions that interfere with your life.
- Obsessions are excessive thoughts or images that recur despite attempts to stop them, such as worries about germs or fears that something will happen to a loved one.
- Compulsions are behaviors that are repeated against the person's will. Examples are a need to clean or groom excessively, or a need to recheck some things multiple times.
Obsessive-Compulsive Disorder (OCD) affects 2-3% of the population.
Post-traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) involves the reaction to the experience of an extremely fearful event, such as being assaulted or raped, or a near-fatal accident. People who suffer from PTSD:
- Re-experience the event through dreams or waking 'flashbacks'
- Avoid places and situations that are reminders of the event
- Are emotionally numb or even have partial amnesia as a way of psychologically avoiding reliving the experience
- Have symptoms of increased arousal including being easily startled
- Often have poor concentration and insomnia
Problems Associated with Anxiety
Anxiety may be due to an underlying medical problem, such as a thyroid disorder, or to a drug or prescribed medication. Amphetamines, cocaine, LSD and Ecstasy can all cause symptoms of anxiety. The presence of an anxiety disorder can lead to substance abuse. Alcohol is commonly use to self-medicate anxiety. It is important to know that anxiety can coexist with symptoms of depression. The combination of anxiety and Depression often leads to a worsening feeling of life being out of control.
Treatment
There are effective treatments for many of the anxiety disorders. Treatments fall into two categories: psychotherapy, involving visits to a licensed therapist (who may be a psychiatrist, psychologist, licensed clinical social worker or licensed marriage and family counselor) and pharmacotherapy, involving taking psychotropic medications (prescribed by a psychiatrist or other physician.)
Psychotherapy
Behavioral therapy is probably the most common treatment for anxiety disorders. In general, this involves some type of controlled exposure to the triggers of anxiety, so that the reflexive anxiety reaction can be desensitized. While a trained therapist can be very helpful in starting this type of procedure, self-help books are available that describe some of the techniques. The main drawback of therapy is the time and effort involved.
Pharmacotherapy
Two types of medication are commonly used in treating anxiety. Benzodiazepines, such as Valium (Diazepam), Ativan (Lorazepam), and Xanax (Aprazolam), work rapidly to numb anxiety, but only provide short-term benefits. In the long run their continued use can lead to to dependence and depression. Antidepressant medications such as Paxil (Paroxetine), Lexapro (Escitalopram), and Effexor (Venlafaxine), can be helpful for the longer term, but they generally take a few weeks to work, are not always effective, and may be accompanied by side effects. Certain other non-antidepressant and non-benzodiaepine medicines such as Buspar (Buspirone), Neurontin (Gabapentin) and Inderal (Propranolol) are also sometimes used to treat anxiety; they have the advantage that they do not cause dependence, but as with antidepressants they do not work for everyone and there may be problems with side effects.
Therapy vs. Medications
One of the main advantages of therapy over medications is that the benefits tend to persist. Discontinuation of medications always presents a risk of relapse. Nonetheless, there are times when an anxiety reaction is particularly overwhelming, and therapy alone is ineffective. At such times, a combination of medications and therapy can be most helpful.
UCSC Resources
Appointments and Referral for Treatment of Anxiety
- Student Health Center 459-2500
- Counseling & Psychological Services 459-2628
Assistance for Psychological Crisis
- Counseling & Psychological Services 459-2628
- Suicide Prevention Service of Santa Cruz County 458-5300 or 688-1818
- UC Police (for emergency response and/or transportation) 911
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