- The Washington Times - Monday, May 31, 2004

Rebecca Smith of Brentwood is worried that she worries too much.

Miss Smith, 24, who asked that her named be changed for privacy, has generalized anxiety disorder. Although she fears many situations, she is most nervous around people and about how they view her. She also spends long periods of time agonizing about the future.

“The therapist tells me to look at things in the present time,” she says. “What matters today is all about today. What happens tomorrow is something that should be dealt with tomorrow. There is no certainty. All I need to worry about is the present.”

Anxiety disorders plague approximately 19.1 million American adults ages 18 to 54, about 13.3 percent of people in this age group, in a given year, according to the National Institute of Mental Health in Bethesda. Although the conditions can be crippling, people who suffer from the diseases can overcome them by seeking professional assistance.

Several illnesses fall under the umbrella of anxiety disorders, including panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder and various phobias, says Dr. David Goldstein, director of the Mood and Anxiety Disorders Program at Georgetown University Hospital in Northwest.

About two times as many women as men suffer from panic disorder, post-traumatic stress disorder, generalized anxiety disorder, agoraphobia and other phobias. However, about the same number of women and men have obsessive-compulsive disorder and social phobia.

Although each of the specific illnesses is unique, many people have more than one anxiety disorder. The primary underlying symptom of all the sicknesses is excessive irrational anxiety that occurs for more than six months. A constant, vague feeling of dread is a major symptom, Dr. Goldstein says. Physiological arousal, such as increased heart rate, sweating, rapid breathing, diarrhea, frequent urination, difficulty sleeping and muscle tension, also could signify that a person has an anxiety disorder.

Even though medical professionals aren’t completely sure what causes anxiety disorders, Dr. Goldstein says stressful experiences can provoke the diseases.

“The difference between anxiety that people have as part of their regular lives and a disorder is if it reaches a level that interferes with functioning,” he says. “Traumatic experiences early in life predispose a person for an anxiety disorder.”

Although a person doesn’t have to be depressed to be anxious, depression may wear down a person’s emotional strength, which makes it easier for anxiety to surface, says Lourdes Griffin, administrator for outpatient behavioral health services at Washington Hospital Center. Anxiety disorders frequently occur along with depressive disorders, eating disorders or substance abuse.

Also, a severe medical condition may lead to an anxiety disorder, she says. Ms. Griffin holds a doctorate in psychology.

“I had a patient once that had caught pneumonia,” she says. “Due to her difficulty in breathing with pneumonia, it triggered a panic disorder.” She thought she wouldn’t be able to breathe if she went out of the house.

Comedian Jay Mohr, 33, author of “Gasping for Airtime: Two Years in the Trenches at Saturday Night Live,” once had a panic attack that caused him to run 44 blocks to his apartment from 30 Rockefeller Center in New York City.

A panic attack is an episode triggered by an instability of adrenaline. Under healthy circumstances, if a person is presented with a challenge, adrenaline is pumped into the system. With a panic attack, adrenaline is circulated in the body spontaneously.

“I thought I was having a nervous breakdown, but that didn’t explain why my pulse was 180 when I was sitting still on my couch in my dressing room,” Mr. Mohr says. “It feels like you have to vomit and everything on the inside [of you] wants on the outside [of you]. It’s absolute doom. It feels as if someone is pushing in on your throat.”

After seeking medical help, Mr. Mohr says he has learned to better control his panic attacks. He has undergone therapy and daily takes a milligram of Klonopin, a medication used to treat panic disorders. Since the condition can be hereditary, he did some research and learned that members of his family have had episodes of panic.

“It’s absolutely gotten better,” he says. “The anticipatory dread has changed to anticipatory anxiety, which is appropriate at times. … It’s very treatable. You don’t have to keep doing this.”

Along with prescription medication, therapy is an important component in the treatment of anxiety disorders, says David Carbonell, a psychologist who works at the Anxiety Treatment Center, a private practice with offices in Long Island, N.Y., and Chicago. Mr. Carbonell, who has a doctorate in psychology, has found cognitive behavioral therapy helps his patients.

“It’s distinct from traditional kinds of therapy,” he says. “It focuses on present life. We’re not looking to help somebody by reviewing early childhood, and ‘Why do you have this problem? What produced it?’ We’re concerned with how the problem works in the present and what keeps it coming. What can you do differently that will make the problem smaller than bigger?”

For those patients who don’t want to take prescription drugs, Dr. James Dee, chairman of the department of psychiatry at Inova Mount Vernon Hospital, says channeling energy into productive tasks may be a good way to handle anxiety. For instance, Winston Churchill, the former British prime minister who wrote “Painting as a Pastime,” painted as a way to discharge internal restlessness. He also would lay bricks as a way of controlling his anxiety.

“The more time you have to worry about things, the more you will worry,” Dr. Dee says. “If you are busy with crafts and hobbies, you have less time to get into anxiety.”

The main way to overcome most anxiety disorders is to effectively deal with stress, says Reid Wilson, author of “Don’t Panic, Taking Control of Anxiety Attacks.” He is a clinical associate professor of psychiatry at the University of North Carolina School of Medicine in Chapel Hill, N.C. He holds a doctorate in clinical psychology.

“We have to teach people to tolerate uncertainty, or they won’t get better,” he says. “That’s one of the reasons medications can be so attractive. As long as ‘I take my pills, I’ll be OK.’ You can’t really get better if you have zero symptoms. Then, you’re not learning anything.”

FIVE MAJOR TYPES OF ANXIETY DISORDERS

• GENERALIZED ANXIETY DISORDER (GAD) IS MUCH MORE THAN THE NORMAL ANXIETY PEOPLE EXPERIENCE DAY TO DAY. IT’S CHRONIC AND FILLS ONE’S DAY WITH EXAGGERATED WORRY AND TENSION, EVEN THOUGH THERE IS LITTLE OR NOTHING TO PROVOKE IT. HAVING THIS DISORDER MEANS ALWAYS ANTICIPATING DISASTER, OFTEN WORRYING EXCESSIVELY ABOUT HEALTH, MONEY, FAMILY OR WORK. SOMETIMES, THOUGH, THE SOURCE OF THE WORRY IS HARD TO PINPOINT. SIMPLY THE THOUGHT OF GETTING THROUGH THE DAY PROVOKES ANXIETY.

• OBSESSIVE-COMPULSIVE DISORDER (OCD) IS CHARACTERIZED BY RECURRENT, UNWANTED THOUGHTS (OBSESSIONS), REPETITIVE BEHAVIORS (COMPULSIONS) OR BOTH. REPETITIVE BEHAVIORS SUCH AS HAND WASHING, COUNTING, CHECKING OR CLEANING OFTEN ARE PERFORMED WITH THE HOPE OF PREVENTING OBSESSIVE THOUGHTS OR MAKING THEM GO AWAY. PERFORMING THESE SO-CALLED “RITUALS,” HOWEVER, PROVIDES ONLY TEMPORARY RELIEF, AND NOT PERFORMING THEM MARKEDLY INCREASES ANXIETY.

• PANIC DISORDER IS CHARACTERIZED BY UNEXPECTED AND REPEATED EPISODES OF INTENSE FEAR ACCOMPANIED BY PHYSICAL SYMPTOMS THAT MAY INCLUDE CHEST PAIN, HEART PALPITATIONS, SHORTNESS OF BREATH, DIZZINESS OR ABDOMINAL DISTRESS. PANIC ATTACKS CAN OCCUR AT ANY TIME, EVEN DURING SLEEP. AN ATTACK GENERALLY PEAKS WITHIN 10 MINUTES, BUT SOME SYMPTOMS MAY LAST MUCH LONGER.

• POST-TRAUMATIC STRESS DISORDER (PTSD) IS A DEBILITATING CONDITION THAT CAN DEVELOP FOLLOWING A TERRIFYING EVENT. OFTEN, PEOPLE WITH PTSD HAVE PERSISTENT FRIGHTENING THOUGHTS AND MEMORIES OF THEIR ORDEAL AND FEEL EMOTIONALLY NUMB, ESPECIALLY WITH PEOPLE TO WHOM THEY WERE ONCE CLOSE. PTSD WAS FIRST BROUGHT TO PUBLIC ATTENTION BY WAR VETERANS, BUT IT CAN RESULT FROM ANY NUMBER OF TRAUMATIC INCIDENTS. THESE INCLUDE VIOLENT ATTACKS SUCH AS MUGGING, RAPE, OR TORTURE; BEING KIDNAPPED OR HELD CAPTIVE; CHILD ABUSE; SERIOUS ACCIDENTS SUCH AS CAR OR TRAIN WRECKS; AND NATURAL DISASTERS SUCH AS FLOODS OR EARTHQUAKES.

• SOCIAL PHOBIA, OR SOCIAL ANXIETY DISORDER, IS AN ANXIETY DISORDER CHARACTERIZED BY OVERWHELMING ANXIETY AND EXCESSIVE SELF-CONSCIOUSNESS IN EVERYDAY SOCIAL SITUATIONS. SOCIAL PHOBIA CAN BE LIMITED TO ONLY ONE TYPE OF SITUATION — SUCH AS A FEAR OF SPEAKING IN FORMAL OR INFORMAL SITUATIONS, OR EATING OR DRINKING IN FRONT OF OTHERS — OR, IN ITS MOST SEVERE FORM, MAY BE SO BROAD THAT A PERSON EXPERIENCES SYMPTOMS ALMOST ANYTIME THEY ARE AROUND OTHER PEOPLE.

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