In the United States, anxiety disorders are the most commonly diagnosed mental condition of the adult population ages eighteen through fifty-four. Anxiety disorders cost more than $42 billion a year, almost one-third of the $148 billion total mental health bill. More than $22.84 billion of those costs are due to the repeated use of health-care services because anxiety disorders can mimic physical illnesses.
Diagnosing Your Condition
The first thing a physician will do is diagnose your anxiety to see if you have a disorder. Your practitioner will take a thorough history, keeping in mind that your chief complaint may not be anxiety at all. In fact, many individuals with anxiety disorders often have vague complaints such as diarrhea, insomnia, dizziness, or shortness of breath. They’re not always sure what is causing the problem.
You will be asked questions about your feelings of anxiety, nervousness, fear, and depression. You may be asked whether similar symptoms have ever occurred in the past, what helped you to resolve them, if you’ve tried those actions recently, and whether they help now.
Some questions you may be asked are: “What was the attitude toward drinking in your family?” or “Did your parents or grandparents tend to drink when under pressure?” or “Did anyone in your family ever have problems with nerves, such as having a nervous breakdown?” or “How is your anxiety interfering with your life?”
Because many physical problems can lead to anxiety symptoms, your health-care practitioner will also try to rule out diseases of the heart, thyroid, kidney, nervous system, lung, and blood by doing a physical examination. You may also be asked about nutritional deficiencies (including lack of B-vitamins and iron) as well as what drugs you take, and how much alcohol you take, because they can also make you anxious.
Generalized Anxiety Disorder (GAD)
Women are twice as likely as men to be afflicted with generalized anxiety disorder (GAD). One-third of afflicted adults had their first symptoms in childhood. The essential characteristic of GAD is excessive uncontrollable worry about everyday things. Everybody worries, but GAD is diagnosed when constant worry affects your ability to function in daily life for at least six months. GAD can occur in combination with other anxiety disorders, depression, or substance abuse. Physical symptoms include muscle tension, sweating, nausea, cold and clammy hands, difficulty swallowing, jumpiness, stomach and intestinal discomfort, and diarrhea. If you suffer from GAD, you tend to be irritable and complain about feeling on edge, you tire easily and have trouble sleeping. If you’re in a relationship, GAD is apt to impact it negatively.
Because GAD lacks some of the dramatic symptoms of panic attacks or phobias, it may be difficult to diagnose. To make a diagnosis, your physician may ask you…
Will, a twenty-eight-year-old mechanic, was having trouble falling asleep. He tossed and turned and woke up feeling tired. He felt on edge a lot of the time and as a result got into arguments with the other mechanics; he had unreasonable worries about the work he was doing and didn’t feel he had any control over his discomfort. Will’s physician diagnosed him with generalized anxiety disorder and gave him a prescription for an anti-anxiety drug.
Panic Disorder
About 3 million Americans, women more than men, are likely to be afflicted with panic disorder. A panic attack is defined as the abrupt onset of an episode of intense fear or discomfort that peaks in approximately ten minutes and includes at least four of the following symptoms: feeling of imminent danger or doom, need to escape, palpitations, sweating, trembling, shortness of breath or a smothering feeling, a feeling of choking, chest pain or discomfort, nausea or abdominal discomfort, dizziness or light-headedness, a sense of things seeming unreal (depersonalization), a fear of losing control or “going crazy,” a fear of dying, tingling sensations, chills or hot flashes.
Three types of panic attack can be diagnosed. Unexpected panic attacks come “out of the blue” without warning and for no discernible reason. Situational panic attacks occur in specific situations, for example upon entering an elevator or a tunnel. Situationally predisposed panic attacks occur only sometimes in upsetting situations; for example, an individual may sometimes have a panic attack while driving, but not always. Many people diagnosed with panic attacks also suffer from major depression.
To be diagnosed with panic disorder, you must suffer at least two unexpected panic attacks, followed by at least one month of concern over having another attack. You may also be prone to situational panic attacks and worry about the physical and emotional consequences of your attacks. You may be convinced that the attacks you suffer indicate a serious illness and you will submit to frequent medical tests. Even after all the tests come back negative, you will probably remain worried that you do have a serious condition. You may even try to avoid the scene of a previous attack, hoping you can prevent another one.
The age of onset of panic disorder varies from adolescence to mid-thirties. Very few suffer from panic attacks in childhood.
Agoraphobia, or the fear of having a panic attack in a place from which you cannot escape, often coincides with panic disorder. You may refuse to leave your home, or develop a fixed “safe” route, such as between home and work, from which you cannot deviate. It may feel impossible to travel beyond what you consider your safety zone without suffering severe anxiety.
To diagnose your condition, your physician will probably ask you…
Obsessive-Compulsive Disorder (OCD)
OCD includes uncontrollable obsessions. These are recurring thoughts or impulses that are intrusive or inappropriate and cause you anxiety; for example, coming into contact with dirt, germs, or “unclean” objects, doubts about locking doors or turning off machines or appliances, extreme orderliness, or aggressive impulses or thoughts (such as to yell “fire” in a crowded theater).
Compulsions can also be involved. Compulsions are repetitive behaviors; for example, cleaning your house constantly, washing your hands repeatedly, or showering many times a day.
In both cases, you realize your actions are excessive and unreasonable but you’re unable to stop them. Compulsions include behaviors like checking several or even hundreds of times daily to make sure your stove is turned off or your doors are locked. Repeating a name, phrase, or action over and over also qualifies as a compulsion, as does taking an excessively slow and methodical approach to daily activities so that you spend hours organizing and arranging objects, or hoarding them. Hoarders are unable to throw away useless items, such as old newspapers, junk mail, even broken appliances. When hoarding reaches epic proportions, whole rooms can be filled with saved items.
OCD usually starts gradually, most often in adolescence or early adulthood. Unlike adults, children with OCD do not realize that their obsessions and compulsions are excessive.
To be diagnosed with this disorder, your obsessions and/or compulsions must take up at least one hour every day and interfere with normal routines (for example, if you can’t make left turns when driving), occupational functioning, social activities, or relationships. You may feel the need to avoid certain situations. If you’re obsessed with cleanliness, you may not be able to use public rest rooms.
Questions your physician may ask to determine whether you have OCD include…
Laura, age thirty-one, could not leave her house unless she washed her hands ten times. She’d taken biochemistry in college and knew humans swim in a sea of bacteria and viruses and she feared the dirt and disease-causing organisms in her environment. The hand-washing seemed to help at first, but then her skin became chapped and red, and she knew she had to stop it. But no matter how hard she tried, she couldn’t stop washing. Her primary-care physician diagnosed her with obsessive-compulsive disorder and started her on a drug regimen.
Post-Traumatic Stress Disorder (PTSD)
Exposure to traumas, especially life-threatening ones, such as a serious accident, a natural disaster, war, or witnessing the death (or threat of death) of another person, or being assaulted can result in PTSD when the aftermath of the experience interferes with daily functioning. Common symptoms include avoiding activities, situations, people, and/or conversations associated with the event. Responses to trauma can include feelings of intense fear, helplessness, and/or horror, reexperiencing the event in thought or recurrent dreams, numbness and loss of interest in surroundings (detachment), inability to sleep, anxious feelings, being easily startled, irritability, angry outbursts, extreme vigilance, and a sense that your life opportunities have shrunk.
PTSD can occur at any age, although older adults rarely have it. Young children who have suffered a trauma may have nightmares, relive the event through play, and complain of headaches and stomachaches. Symptoms usually occur between three and six months after the trauma. In some cases, especially when the trauma is too terrible to allow into awareness, it could be years before symptoms appear. For these sufferers, symptoms are often triggered by the anniversary of the trauma or by the experience of another traumatic event.
For PTSD to be diagnosed, your symptoms must be present for more than a month and must result in decreased ability to work, socialize, and participate in other areas of daily functioning.
Your physician will probably ask you the following questions…
Jeff, age forty-one, came back from active duty in Iraq. Four of his buddies had died when their jeep passed over a land mine. He was thrown from the vehicle, but his buddies were killed. His physical injuries were severe enough for him to be sent back to the United States. In the VA hospital, Jeff lost interest in living and tried to hang himself. He began to have flashbacks of the incident in Iraq, couldn’t keep his mind on a TV show, startled easily, couldn’t sleep, and had unpredictable outbursts of anger. His nurse practitioner diagnosed him with post-traumatic stress disorder.
Social Phobia
If you have an intense fear and embarrassment in social or performance situations, you may be suffering from social phobia. If this is the case, you may be acutely aware of the physical signs of your anxiety (blushing, palpitations, tremors, sweating, diarrhea, confusion) and worry that others will notice, judge them, and think poorly of you. This kind of anxiety can lead to a panic attack when you are faced with a social situation or avoidance of the activity altogether.
If you suffer from social phobia, you tend to be sensitive to criticism and rejection, have difficulty asserting yourself, and suffer from low self-esteem. Common situations that bring out social phobia are performance related (speaking in public or to strangers, fear of meeting new people, writing, eating, and/or drinking in public).
Onset of social phobia is mid-to-late adolescence, but children may also exhibit symptoms. In childhood, the condition includes excessive shyness, clinging behavior, tantrums, mutism, decline in school performance, and avoidance of school and social activities with peers.
To diagnose social phobia, your physician may ask you…
Specific Phobia
Specific phobia refers to a discomfort, including a panic attack, due to an object or situation that interferes with daily routine, with employment (for example, missing out on a promotion because of a fear of flying), or with social life (for example, inability to go on a date to a crowded restaurant). If you have a phobia, you recognize that your reaction to the object or situation is unreasonable but are unable to control it. As a result, you may dread the object or situation, and try to avoid it.
Specific phobia may have its beginning in childhood, and is often brought on by a traumatic event, such as being bitten by a dog (leading to a dog phobia), almost being pushed off a high place (leading to fear of heights), and so forth. Fear of specific animals is the most common specific phobia. This condition can exist with panic disorder and agoraphobia.
Your physician may ask the following questions to diagnose your specific phobia…
Robby, age thirty-five, suffered from a fear of being bitten by a large dog. As a youngster, he had witnessed his brother being bitten by a rabid rottweiler. As Robby got older, he almost forgot about his fear until a neighbor bought a large dog that barked at him one day when he was out for a walk. Robby started to sweat and feel dizzy. His heart raced and he couldn’t catch his breath. After that, he stopped taking walks and consulted his physician. Robby was diagnosed with specific phobia.
Other Diagnostic Questions
It’s not unusual to have depression or substance abuse while suffering from an anxiety disorder. So, in addition to the questions listed above for each condition, your physician might also ask you…
Your Anxiety Condition
Go back and see which of the anxiety conditions described in this chapter is most bothersome to you. As you work through this book, pay special attention to the symptoms you have and think about medical and self-actions that may be beneficial. The next chapter describes the effects prescribed medications may have on you.