The nature of anxiety/panic disorders, prevalence, symptoms

Anxiety is an integral part of modern life. In everyday life, it is natural to be anxious from time to time. It would be abnormal if the person did not feel anxious about any situation that could actually be dangerous or where they could fail (such as an exam).

From an evolutionary point of view, anxiety has an important role to play - to get a person to pull themselves together to prepare for escape. This helped to stay alive, the body was activated to escape, freeze, and prepare for the fight. All people can feel anxiety as a reaction to stress. In some situations or locations, anxiety is felt on a different scale. For instance, a little anxiety before an exam, sports competition, a trip, or a birthday is more or less familiar to everyone.

Short information about anxiety/panic disorders

Anxiety can be manifested by different sensations - for example, tingling in the stomach, a feeling of tension in some parts of the body or head, nausea, heart palpitations, restless thoughts, fear of losing control, fear of death. Anxiety turns into an anxiety disorder when it begins to disrupt everyday life. An anxiety disorder differs from normal anxiety in that the accompanying feeling of anxiety is very strong or lasts longer (several months, does not decrease after the stressful situation has passed) and can lead to phobias that disrupt a person's life. For example, a person cannot fall asleep normally due to disturbing thoughts or begins to completely avoid normal situations (going to school or work, eating) that make them anxious. A person starts to assess certain conditions as dangerous when they are not.

The main symptoms of anxiety disorder are:

- Mental symptoms: strong, unreasonable fear of a situation or object.
- Physical symptoms: rapid breathing or heartbeat, elevated blood tension, shivering or flinching, sweating, choking, nausea, discomfort in the stomach, dizziness, numbness, hot flashes, and others.
- Fear of death or losing control of a situation, losing mind, feeling of unreality, or a sense of detachment.

What is panic disorder?

A panic attack, a manifestation of panic disorder, is an attack of fear that happens out of blue. They are usually manifested in rapid heartbeat, sweating, chest pain, shortness of breath, weakness, fainting, dizziness, and elevated blood pressure.  Hot flashes, itching, burning, or numbness in hands can be also felt. During an attack, it is common to have a fear of unexplained physical symptoms. The person starts to perceive the surrounding world as unreal, has a strong fear of death or of losing control. Often, during an attack, people believe that they are having a heart attack, that they are losing their mind. People are not able to predict where and when a panic attack may begin, in between them they are very worried and afraid of a new attack. The attack reaches its peak within ten minutes, but some symptoms may last longer. The person who has the attack should keep in mind that it is an unpleasant but not life-threatening experience.

When does the disorder develop?

Panic attacks most often begin between adolescence and early adulthood. Not all who have panic attacks develop panic disorder. Many have a single episode that never recurs. The tendency for the appearance/development of panic attacks is associated with heredity.

Repeated panic attacks can make people incapacitated and need to find the right treatment before they start avoiding the place and situation where they once had a panic attack. For instance, if an attack was in an elevator, some people may develop a fear of elevators. This can impact the choice of work or place of residence and limit a person’s opportunities for entertainment. Fear of elevators can also limit how you can access health care if you need to use an elevator to get where you can get help.

Some people may become so limited in their lives that they avoid normal activities such as grocery shopping or driving. About a third of these people become domestic recluses or may only come into contact with unwanted frightening situations when accompanied by a spouse or other confidants. If the condition develops this far, then it is classified as agoraphobia or fear of public places.

Panic disorder is a disease that can be effectively treated so people suffering from it should definitely seek timely medical assistance.

What is agoraphobia?

The word agoraphobia comes from the Greek language and means fear of openness or squares. In psychology, the main characteristic of the disorder is the fear of panic attacks. A person with the disorder fears and avoids situations where getting out may be difficult or in the case of an attack, it is impossible to get help. Agoraphobia is the most widespread anxiety disorder (about 5% of the population). It affects people from all social strata and spheres of life (mostly women). The most common places where agoraphobia occurs are:

- Crowded places such as grocery stores, shopping centers, restaurants;
- Enclosed or confined spaces such as bridges, tunnels;
- Public transport (bus, train, plane);
- Finding home alone;
- Leaving home alone.

Worth noting that people are afraid of these places not because of their signs, but because in a panic attack, it is difficult to get out or it can create an embarrassing situation. A person with the disorder is not scared only of developing a panic attack but also of what other people may think when they see their panic.

The most typical sign of agoraphobia is fear that there are no quick ways out of a situation that creates an attack, and a fear of leaving home or a trusted person (spouse, roommate, parent). In the most severe cases, a person cannot move further than a meter from the house by himself or cannot leave the house at all. A person with agoraphobia is in anxiety most of the time: he is afraid not only of possible dangerous situations but the very knowledge that he may get into such a situation. Often agoraphobia in such people is accompanied by depression since he feels that he does not control the situation and is not able to change it in any way.

What is a generalized or generalized anxiety disorder?

Generalized anxiety disorder is distinguished by persistent, chronic anxiety, restlessness, and tension. It usually lasts half a year, but it is not accompanied by panic attacks, phobias, or obsessive thoughts. Anxiety usually focuses on several circumstances (for instance, financial situation, relationships, academic/work success, etc.). It is inherent in the disorder that a person has many reasons for anxiety, they spend most ofthe time in anxiety and cannot take control of the situation. The scale of the experience is usually greater than the real likelihood that the anticipated events might actually happen; after constant worry, other additional symptoms generally appear. For example, restlessness, easy fatigue, inability to focus, muscle tension, sleep disorders, irritability. The disorder can occur at any age and the exact cause is unknown. Most likely, its occurrence is influenced by heredity and experiences from childhood (high expectations, rejection by the parents), promoting anxiety disorder.

Diagnosis of anxiety/panic disorders

If you notice a change in your mental state to such an extent that it interferes with everyday life or your loved ones have noticed it, then you should contact your family doctor or psychotherapist. If you are uncomfortable walking alone, you can take a loved one with you. The family doctor has the knowledge and ability to initiate appropriate treatment. Contact your family doctor if:

- Symptoms of anxiety last too long, i.e. when they persist when the stressful situation is already in the past.
- The symptoms of anxiety are too strong for you to be controlled.
- Physical symptoms (e.g. complaints of heart problems) arise along with anxiety and general health needs to be monitored.
- Anxiety arises for no particular reason.
- All of the above began to interfere with your daily life, work, hobbies, and relationship problems.
- You want to seek help from a psychologist or psychiatrist, but do not know where, how, and who to contact.

To diagnose anxiety disorders, clinical interviews or questionnaires are used to clarify the state of the anxiety disorder. Various questionnaires can be used to help clarify the different degrees of disorders.

Self-Assessment Questionnaire for Anxiety

The use of an anxiety self-assessment questionnaire in diagnosing anxiety disorders can be helpful for the family doctor in the initial detection of the disease. Most often, the questionnaire is completed by the patients themselves.

Objective complaints (mood disorders, anxiety). In most cases, it is easy for the patients to fill them in and it does not take much time. In addition, the questionnaire is filled out several times, after certain periods of time (for example, once a week, or once every two weeks, once a month), this makes it possible to get an overview of the change in your condition.

Therapy of anxiety/panic disorders

The therapy begins with talking to your family doctor or therapist. During the visit, the nature of anxiety disorders and the factors that aggravate and alleviate the disease are clarified. Self-help techniques are also recommended, information is provided on the possibilities of treatment and recovery, the course of the disease, and signs of an exacerbation.

In the case of panic disorder, the main goal of therapy is to diminish the incidence and severity of panic attacks. In the case of agoraphobia, it is crucial to lower and eventually eliminate the tendency to avoid places and situations that stimulate severe anxiety. For generalized anxiety, therapy can help lower anxiety and tension.

Choice of treatments

In a discussion with your doctor, you will learn about the most suitable therapeutic option. The choice is influenced by the severity of symptoms and your preferences. Self-help techniques should preferably be used immediately after starting treatment. If they do not help and symptoms persist, your doctor may recommend using either psychotherapy (cognitive behavioral therapy is preferred) or medications (antidepressants, for example, Anafranil). If each of the methods of treatment separately did not give results, they can be combined.

Treatment tolerance

Good cooperation between doctor and patient is a prerequisite for successful treatment.  As therapy of anxiety disorders can sometimes take a long time, patience and continuity are essential.

If you start to feel severe side effects while taking medication, do not interrupt their use on your own, but be sure to inform your doctor about this, who will find ways to continue the treatment or change it. If the symptoms of the disorder begin to disappear quickly with the use of medications, the patient may want to prematurely interrupt the course of treatment. But after that, the symptoms of the disorder return again. Problems can also arise when prescribed medications remain unbought, if you take more or less than prescribed or take them irregularly. You need to inform your doctor about all this, and on the basis of this data, the doctor will be able to evaluate the results of treatment, your consent to the therapy, and the adverse reactions caused by the medication during each visit.

Self-help for patients

First of all, you need to learn self-help techniques you’re your doctor. Besides, it is advised to make positive changes to your current lifestyle such as:

- Eat regularly and in a balanced way
- Lower the intake of excess caffeine. Caffeine primarily affects the physical symptoms of anxiety (e.g. rapid heartbeat), which can lead to enhanced anxiety and panic attacks.
- Avoid drinking too much alcohol.
- Smoking is recommended to quit.
- Be physically active. Physical activity can help relieve stress and tension. Moderate physical activity should take at least 2.5 hours per week.
- Take time to do what you love and pause from time to time in your daily work.

Post by: John De Vries, clinical pshychiatrist, Amsterdam, Netherlands