Anxiety Disorders

Anxiety Disorders - Generalized Anxiety Disorder, Phobia, Panic Disorder, Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder

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Anxiety disorders are the most common of all the mental disorders. They affect an estimated 8 to 10 of every 100 children and adolescents. These are illnesses that cause people to feel frightened, distressed and uneasy for no apparent reason. Young people with anxiety disorders experience excessive fear, worry, or uneasiness that interferes with their daily lives.

There are several types of anxiety disorders, each with their own distinct features:

1. Generalized Anxiety Disorder

Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However, if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has a generalized anxiety disorder (GAD).

Symptoms: Chronic, exaggerated worry, tension, and irritability that appear to have no cause or are more intense than the situation warrants. Physical sings, such as restlessness, clammy hands, difficulty swallowing, diarrhea, nausea, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating often accompany the psychological symptoms.

Formal Diagnosis: When someone spends at least six months worried excessively about everyday problems is considered having GAD.

Treatment: Anxiety is among the most common, most treatable mental disorders. Effective treatments include Cognitive Behavioral Therapy, relaxation techniques, and biofeedback to control muscle tension. Medication such as Diazepam or Lorazepam may be required in some cases.

2. Phobia

Two major types of phobias are social phobia and specific phobia. People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities. People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.

3. Panic Disorder

Repeated episodes of intense fear that strike often and without warning are typical for people suffering from panic disorder. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.

4. Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a brain disorder that causes problems in information processing. Research suggests that genes do play a role in the development of OCD in some cases. OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are prominently involved in OCD. The disorder is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are often 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. About 2 percent of the children in the USA experience OCD.

Obsessions: Obsessions are thoughts, images, or impulses that occur over and over again and feel out of your control. The person does not want to have these ideas, finds them disturbing and intrusive, and usually recognizes that they don't really make sense. People with OCD may worry excessively about dirt and germs and be obsessed with the idea that they are contaminated or may contaminate others. They may have obsessive fears of having inadvertently harmed someone else, although this may be unrealistic. Obsessions are accompanied by uncomfortable feelings such as fear, disgust, doubt, or a sensation that things have to be done in a way that is "just right."

Compulsions: People with OCD typically try to make their obsessions go away by performing compulsions. These are acts the person performs over and over again often according to certain "rules." People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. Some may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure.

Other Features: OCD symptoms cause distress, take up a lot of time (more that an hour a day), or significantly interfere with the person's work, social life, or relationships. Most individuals with OCD recognize at some point that their obsessions are coming from within their own minds and are not just excessive worries about real problems, and that the compulsions they perform are "over-the-top" and unreasonable.

Treatment: Since the cause of OCD is believed to be insufficient serotonin levels, many psychiatrists recommend medications such as Prozac, Luvox, Paxil, or Zoloft. Also Behavior Therapy (exposure and response prevention therapy) can be used. There is recent proof that Cognitive Behavioral Therapy (changing beliefs and thinking patterns) is also helpful, sometimes requiring long-term care in a Therapeutic Boarding School or Residential Treatment Center. Family members should seek therapeutic help and a possible educational support group.

5. Post-Traumatic Stress Disorder

PTSD is a psychiatric disorder that can occur following a person experiencing or witnessing an event that involved threat to one's own or another's life or physical integrity and where the person responded with intense fear, helplessness, or horror. There are a number of traumatic events that have been shown to cause PSTD in children and adolescents, such as natural disasters, violent crimes (kidnapping, rape or murder of a parent, sniper fire, and school shootings), motor vehicle or airplane crashes, severe burns, exposure to community violence, peer suicide, war, and sexual and physical abuse. Of those children and adolescents who have experienced trauma, 3 to 15 percent of girls and 1 to 6 percent of boys develop PSTD. Studies have shown that up to 100 percent of children who witness a parental homicide or sexual assault develop PTSD. Similarly, 90 percent of sexually abused children, 77 percent of children exposed to a school shooting, and 35 percent of urban youth exposed to community violence develop PTSD.

Those most vulnerable of developing PTSD are:

those who experience greater stressor magnitude and intensity, unpredictability, uncontrollability, sexual victimization, real or perceived responsibility, and betrayal
those with prior vulnerability factors such as genetics, early age of onset and longer lasting childhood trauma, lack of functional social support, and concurrent stressful life events
those who report greater perceived threat or danger, suffering, upset, terror, and horror of fear
those with a social environment that produces shame, guilt, stigmatization and self-hatred

Symptoms: Psycho-physiological alterations associated with PTSD include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities. Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, and discomfort in other parts of the body are common. Often there are problems with the family and other interpersonal relationships. The co-occurring disorders can include depressive episodes, alcohol abuse, and phobias.

Treatment: PTSD is treated in several ways. Cognitive Behavioral Therapy, Exposure Therapy, and Group Therapy have appeared quite promising. Long-term care can be provided in a Residential Treatment Center or Therapeutic Boarding School. The most widely used drug treatment has been Prozac and Zoloft.