• WHAT IS AN ANXIETY DISORDER?

Feelings of anxiety can be a result of life experiences, such as job loss, relationship breakdown, serious illness, major accident, or the death of someone close. Feeling anxious in these situations is appropriate and usually we feel anxious for only a limited time. Because feelings of anxiety are so common, it is important to understand the difference between feeling anxious appropriate to a situation and the symptoms of an anxiety disorder.

Anxiety disorders are not just one illness but a group of illnesses characterised by persistent feelings of high anxiety, and extreme discomfort and tension. People are likely to be diagnosed with an anxiety disorder when their level of anxiety becomes so extreme that it significantly interferes with their daily life and stops them doing what they want to do. Anxiety disorders are the most common form of mental illness, and affect one in 20 people at any given time. They often begin in early adulthood, but can start in childhood or later in life. Women are more likely to experience most anxiety disorders than men.
Anxiety disorders often come out of the blue, with no apparent reason. They are generally accompanied by intense physical sensations, such as breathlessness and palpitations. Other symptoms can include sweating, trembling, feelings of choking, nausea, abdominal distress, dizziness, pins and needles, feelings of losing control and/ or feelings of impending doom. Anxiety disorders affect the way a person thinks, feels, and behaves and, if not treated, can cause considerable distress and disruption to the person’s life. Fortunately, treatment of anxiety is usually very effective.

• WHAT ARE THE MAIN TYPES OF ANXIETY DISORDER?

There are a number of different anxiety disorders.

• GENERALISED ANXIETY DISORDER

Generalised anxiety disorder is characterized by excessive, uncontrollable, and unrealistic worry about everyday things, such as health, family, friends, money, or career. People with this disorder worry constantly and irrationally about harm affecting themselves or their loved ones, and the worry is accompanied by a feeling of constant apprehension.

• PANIC DISORDER WITH AND WITHOUT AGORAPHOBIA

People with this disorder experience extreme panic attacks in situations where most people would not be afraid. The attacks are accompanied by very unpleasant physical symptoms of anxiety, such as feeling like you are having a heart attack. There is also fear of “going crazy” or fear that the attack will lead to death or a total loss of control. These fears lead some people to start to experience agoraphobia, which can severely interfere with their lives.

• AGORAPHOBIA

This is not a specific disorder, but a component of anxiety characterized by fear of being in places or situations from which it may be difficult or embarrassing to get away, or the fear that help might be unavailable if needed. People with agoraphobia most commonly experience fear in a cluster of situations such as supermarkets and department stores, crowded places of all kinds, confined spaces, public transport, lifts,
and expressways. People experiencing agoraphobia may find comfort in the company of a safe person or object. This may be a spouse, friend, pet, or medicine carried with them.

• SPECIFIC PHOBIA

Everyone has some irrational fears, but phobias are intense fears about particular objects or situations that interfere with a person’s life. These might include fear of heights, water, dogs, closed spaces, snakes, or spiders. Someone with a specific phobia is fine when the feared object is not present. However, when faced with the feared object or situation, they can become highly anxious and experience a panic attack. People affected by phobias can go to great lengths to avoid situations that would force them to confront the object or situation they fear.

• SOCIAL PHOBIA

Social phobia is a strong and persistent fear of social or performance situations. The person fears they will be scrutinised and negatively judged by others. Social phobia can interfere significantly with a person’s life because people cope by avoiding the social situation or enduring it with intense distress. They may limit what they do in front of others –especially eating, speaking, drinking, or writing – or withdraw from contact with others.

• CO-OCCURRING MENTAL HEALTH PROBLEMS

People with one anxiety disorder are likely to have another, and also to experience depression. Harmful alcohol and other drug use often co-occurs with anxiety. This makes treatment more complex, and effectively managing alcohol and other drug use is important.

• OBSESSIVE COMPULSIVE DISORDER

This anxiety disorder involves constant unwanted thoughts, and often results in the performance of elaborate rituals in an attempt to control or banish the persistent thoughts. The rituals are usually time consuming and seriously interfere with everyday life. For example, people may be constantly driven to wash their hands, recheck that the door is locked or the oven is turned off, or follow rigid rules of order. People with obsessive compulsive disorder are often acutely embarrassed and keep their rituals a secret, even from their families.

• POST TRAUMATIC STRESS DISORDER

People who have experienced major trauma, such as war, torture, vehicle accident, fire, or personal violence can continue to feel terror long after the event is over. Not everyone who experiences trauma develops post traumatic stress disorder (PTSD). People with PTSD repeatedly re-live the traumatic event through intrusive, distressful recollections, such as nightmares or flashbacks. The flashbacks are often brought about by triggers related to the experience, which the person then tries to avoid. Becoming emotionally numb is also characteristic of PTSD.

• WHAT CAUSES ANXIETY DISORDERS?

There are many interrelated factors associated with anxiety disorders. The causes of a particular disorder vary, and it is not always easy to determine a cause in every case.

• GENETIC FACTORS

It is well established that the tendency to develop anxiety disorders runs in families. This is similar to a predisposition to other illnesses, such as diabetes and heart disease. People may also learn anxious responses from parents or other family members.

• BIOCHEMICAL FACTORS

Some anxiety disorders may be related, in part, to a chemical imbalance in the brain. The neurotransmitter that regulates feelings and physical reactions may be involved.

• TEMPERAMENT

People with certain temperaments are more prone to anxiety disorders. People who are easily aroused and upset, and are very sensitive and emotional, are more likely to develop anxiety disorders. People who as children were inhibited and shy may be prone to develop certain anxiety disorders, such as social phobia.

• LEARNT RESPONSE

Some people exposed to situations, people or objects that are upsetting or anxiety-arousing may develop an anxiety response. This response can be re-activated when faced with or thinking about the situation, person, or object again.

• STRESS

Stressful life experiences are associated with the development of some anxiety disorders, particularly post traumatic stress disorder.

• WHAT TREATMENT IS AVAILABLE?

Anxiety disorders can be very effectively treated. Although each disorder has its own specific characteristics, most respond well to psychological treatments and/or medication. Treatments combining both psychological therapy and medication often have better long-term results. Effective treatments for anxiety disorders include the following:

Psychological therapies, such as Cognitive Behavioural Therapy (CBT), are aimed at changing patterns of thinking, behaviours, and beliefs that may trigger anxiety. Therapy may also involve gradually exposing a person to situations that trigger their anxiety (desensitisation).

• ANXIETY MANAGEMENT AND RELAXATION TECHNIQUES.

Anti-depressants play an important role in the treatment of some anxiety disorders as well as treating associated or underlying depression.

Anti-anxiety medications that specifically influence the neurotransmitter system in the brain are sometimes useful. Medication will not cure anxiety disorders but can keep symptoms under control while a person receives psychological treatment. The family and friends of people with anxiety disorders can often feel confused and distressed. Support and education, as well as better community understanding, are an important part of treatment.

USEFUL WEB SITES FOR FURTHER INFORMATION

National Institute of Mental Health
www.nimh.nih.gov/

SANE Australia
www.sane.org/information/factsheets-podcasts

Royal Australian and New Zealand College of Psychiatrists
www.ranzcp.org/resources/clinical-practice-guidelines.html

The Royal College of Psychiatrists
www.rcpsych.ac.uk/

Internet Mental Health
www.mentalhealth.com/

Beyondblue Australia
www.beyondblue.org.au

Black Dog Institute
www.blackdoginstitute.org.au

Australian Psychological Society
www.psychology.org.au/

Mental Health in Multicultural Australia (MHiMA)
www.mhima.org.au