What is an anxiety disorder?
Anxiety is an integral part of our lives. From time to time, almost all of us experience it. Usually anxiety arises as a temporary situational reaction to the stresses of everyday life. The presence of anxiety disorder, we can assume in those cases when anxiety becomes so strong that it deprives a person of the ability to normal life and activity.
Anxiety disorder is a separate disease with a peculiar symptomatology. The two most common anxiety disorders are adaptive disorder with an anxious mood and generalized anxiety disorder. With adaptive disorder, excessive anxiety or other emotional reactions develop in combination with the difficulties of adapting to a particular stressful situation. With a generalized anxiety disorder, excessive anxiety persists constantly and is directed at many life circumstances. Excessive anxiety, tension and fear experienced by people with anxiety disorders can be accompanied by physical ailments, such as a "nervous stomach", shortness of breath and rapid heartbeat. Many people, along with anxiety disorders, have depressive disorders.
What triggers / Causes of Anxiety Disorder:
There are many psychological and biological theories that explain the causes of anxiety disorders.
Psychological theories. Psychoanalytic theory views anxiety as a signal of the appearance of an unacceptable, forbidden need, or impulse (aggressive or sexual) that induce an individual unconsciously to prevent their expression. Symptoms of anxiety are seen as incomplete containment ("crowding out") of unacceptable needs.
From the standpoint of behaviorism, anxiety and, in particular, phobias initially arise as a conditioned reflex response to painful or intimidatory stimuli. In the future, an alarming reaction may occur without an incentive.
Later, emerging cognitive psychology focuses on the erroneous and distorted mental images preceding the onset of symptoms of anxiety. For example, a patient with panic disorder may exaggerately respond to normal bodily sensations (such as mild dizziness or palpitations), which leads to increased fear and anxiety that builds up to a panic attack.
Biological theories consider anxiety disorders as a consequence of biological anomalies, linking them, in particular, with a marked increase in the output of neurotransmitters.
For many symptoms of anxiety, perhaps the so-called. A blue spot located in the trunk of the brain. The electrical stimulation of this area causes noticeable fear and anxiety. Drugs like yohimbine, increasing the activity of the blue spot, increase anxiety, and drugs that reduce its activity (benzodiazepines, clonidine and propranolol) have an anti-anxiety effect.
Many patients with panic disorder are extremely sensitive to a barely noticeable increase in the carbon dioxide content of the air.
According to traditional domestic taxonomy, anxiety disorders belong to the group of neurotic (functional) disorders (neuroses), i.e. To psychogenically conditioned disease states, characterized by the partiality and egotism of diverse clinical manifestations, awareness of the disease and the absence of changes in the self-awareness of the individual.
Symptoms of Anxiety Disorder:
According to ICD-10, anxiety disorders are divided into:
Anxious - phobic disorders (so-called other anxiety disorders, which include):
- panic disorder;
- generalized anxiety disorder;
- mixed anxiety-depressive disorder;
- obsessive-compulsive disorder;
- reactions to severe stress.
Anxious - phobic adaptation disorders:
- Post-traumatic stress disorder;
- panic disorder;
- obsessive-compulsive disorder.
Panic disorder. The main symptom of a panic disorder is a recurrent panic attack, i.e. Sudden occurrence of fear and discomfort associated with symptoms such as shortness of breath, palpitations, dizziness, suffocation, chest pain, trembling, increased sweating and the fear of dying or going insane. Usually, these seizures last from 5 to 20 minutes. Often patients mistakenly believe that they have a heart attack.
After experiencing several such attacks, many begin to feel a strong fear of the next, which can happen in a place where they can not get out or where they can not get help - in a tunnel, in the middle of a row in a cinema, on a bridge or in a crowded elevator. They begin to avoid all these situations and bypass such places at a great distance, sometimes restricting their home to a home or refusing to go out without an escort whom they trust. This phenomenon is known as "agoraphobia", which in Greek literally means "fear of market areas".
Some patients get rid of a panic disorder spontaneously, others for many years after the first attack there are relapses, finally, there are also those that become home-grown for many years.
The main feature of the generalized anxiety disorder (F41.1 for ICD-10) is anxiety, which is generalized and persistent, is not limited to any specific environmental circumstances and does not even arise with obvious preferences in these circumstances (ie, "unfixed").
For the diagnosis, the primary symptoms of anxiety should be present in the patient for at least a few weeks. Most often in this capacity are:
- Fears (anxiety about future failures, a sense of excitement, difficulty in concentration, etc.);
- Motor tension (fussiness, tension headaches, trembling, inability to relax);
- Vegetative hyperactivity (sweating, tachycardia or tachypnea, epigastric discomfort, dizziness, dry mouth, etc.).
The heading F41.2 (Mixed anxiety and depressive disorder) is used when the patient has symptoms of both anxiety and depression, but neither individually nor individually is clearly dominant or expressed enough to determine the diagnosis.
As it is not difficult to see, the diagnostic criteria for these conditions are less clear than, for example, panic disorder and are rather built on the principle of exclusion. Symptomatic of generalized anxiety disorder carries features of diffuse, generalized and blurred anxiety of moderate or weak intensity, which is characterized by vague anxiety, constant in time. This is its main difference from panic disorder, in which paroxysms of anxiety affect excessive intensity.
This variant of the anxiety state is called "freely floating alarm"; Uncertain anxiety is expressed in a state of internal tension, a premonition of unhappiness and threat, which are often provoked by real insignificant conflicts and frustrating situations. At the same time, in a system of patient personal coordinates, such situations grow to enormous problems and seem insoluble. Often, anxiety is accompanied by increased aggressiveness. Constant internal tension leads to disruptions in the activity of the vegetative-endocrine system, which is in constant excitement and ready for struggle and flight, which, in turn (according to the principle of a vicious circle), increases the state of internal tension. The same applies to the musculoskeletal system - the muscle tension gradually increases and the tendon reflexes increase, which is the basis of the feeling of fatigue and myalgia.
According to most researchers, generalized anxiety disorder does not represent a single diagnostic category, but rather reflects a particular disturbing phenomenon that occurs with different diagnoses. Thus, in some of its phenomenological manifestations, it is close to the anxiety anticipated characteristic of panic disorder. At the same time, unlike the latter, generalized anxiety reactions are characterized by less participation of vegetative manifestations, an earlier and more gradual onset of the disease, and a more favorable prognosis. At the same time, anxiety symptomatology is tonic, not clonic, as in a panic, character. It should also be borne in mind that in some patients with panic disorder further generalized anxiety disorder may develop and vice versa.
Social phobia is an excessive fear of experiencing humiliation or embarrassment in front of other people, forcing the patient to avoid situations such as public speaking, the need to write anything in the presence of people, eating in restaurants, using public toilets. If the fear of one type of situation is usually associated with moderate life limitations, multiple fears often lead to agoraphobia and severe restrictions.
A simple phobia is a constant strongest fear of a particular object or situation, for example fear of snakes, blood, lifts, flight, height, dogs. Fear is not caused by the object itself, but the consequences of meeting with it or falling into a particular situation. When there is a meeting with such an object or situation, there are symptoms of intense anxiety - horror, trembling, sweating, palpitations.
Obsessive-compulsive disorder includes obsessions, often in combination with compulsiveness. Obsessions are persistent and persistent ideas, thoughts or impulses that persecute people, which are perceived as senseless and unpleasant, such as blasphemous thoughts, thoughts of murder or sex. Man realizes that these obsessions emanate from within (in contrast to hallucinations that seem to come from outside), and unsuccessfully tries to ignore or suppress them. Compulsivity is a repetitive, purposeful and intentional behavior, arising as a reaction to obsession with the goal of neutralizing or preventing psychological discomfort. It should be emphasized that such behavior is always unreasonable and excessive.
One of the most common types of obsessive-compulsive disorder is associated with thoughts on the topic of dirt and pollution, leading to obsessive washing and avoiding "polluting" objects. Sufferers of this disease can spend on washing and taking a shower many hours a day. Another type is a pathological account and an obsessive check, for example multiple checks, if gas is turned off, or returning to the same street to make sure that nobody has crushed. Compulsive behavior differs from excesses in drinking or eating, gambling or increased sexuality in that true compulsions are always unpleasant to the patient himself.
Post-traumatic stress is a mental illness that occurs as a result of severe shocks or physically traumatic events, such as war, being in a concentration camp, brutal beatings, rape or car accidents. Characteristic signs are the repeated experience of trauma, mental numbness and increased excitability. The repeated experience of trauma consists in constantly recurring memories and nightmares. Mental numbness is expressed in the withdrawal from social activity, loss of interest in daily activities and a decrease in the ability to experience emotions. Excessive arousal leads to difficulty falling asleep, nightmares and increased fearfulness.
In the course of disorders caused by post-traumatic stress, there are three stages. The first is a reaction to a trauma, expressed in extreme anxiety and full focus on what happened. After about a month, feelings of helplessness, decreased emotionality and nightmares may arise. At the third stage, demoralization and decline of spirit occur.
People with anxious personality disorder are too concerned about their shortcomings and form relationships with others only if they are sure that they will not be rejected.
Loss and rejection are so painful that these people choose loneliness, instead of risking and somehow getting involved with people.
- Hypersensitivity to criticism or failure.
- Self-isolation from society.
- Extreme degree of shyness in social situations, although there is a strong desire for close relationships.
- Avoiding interpersonal relationships.
- Dislike of physical contact.
- Feeling of inferiority.
- Extremely low self-esteem. Self-disgust.
- Distrust of other people.
- Extreme degree of modesty / shyness.
- Avoidance of intimate relationships.
- Easy embarrassment / shyness.
- Self-critical to their problems in dealing with other people.
- Problems in professional work.
- Feeling of loneliness.
- Feeling of "second-rate" in relation to other people.
- Mental or chemical addiction.
Diagnosis of Anxiety Disorder:
The diagnosis of anxiety is made exclusively by a psychiatrist. For the diagnosis, the primary symptoms of anxiety should be present in the patient for at least a few weeks.
The diagnosis of anxiety disorder in most cases does not cause difficulties. The main diagnostic difficulties arise when determining the specific type of anxiety disorder, since they have common symptoms and differ mainly in the time and place of their occurrence. To diagnose anxiety disorders, psychological tests are widely used: Spielberger-Khanina, a hospital scale of anxiety and depression, a personal scale of anxiety, and others.
If there is a suspicion of an anxiety disorder, several things should be assessed:
- the presence of symptoms of increased anxiety (feelings of anxiety, fears, sleep disorders and autonomic regulation, etc.);
- duration of the existence of symptoms (with anxiety disorders, symptoms persist for several weeks or longer);
- The existing symptoms are not a normal response to stress (a person is not in a war zone, he and his family are not at risk);
- the existing symptoms are not associated with diseases of the internal organs (for example, a panic attack has much in common with an attack of angina, therefore, in the presence of severe vegetative symptoms, a general practitioner examination is necessary) and are not secondary to mental disorders;
- Conditions in which symptoms appear (constant anxiety in generalized anxiety disorder, attacks that do not clearly depend on conditions in panic disorder, attacks associated with a particular object in simple phobias, or occur in certain situations with agoraphobia and social phobia).
Treatment of Anxiety Disorder:
Anxiety disorders can be effectively treated with rational belief, drugs, or both. Supportive psychotherapy can help a person understand the psychological factors that trigger anxiety disorders, and also teach them how to deal with them gradually. The manifestations of anxiety are sometimes reduced by relaxation, biofeedback and meditation. There are several types of medications that allow some patients to get rid of such painful phenomena as excessive fussiness, muscle tension or inability to sleep. Taking these medicines is safe and effective if you follow the directions of your doctor. In this case, the intake of alcohol, caffeine, as well as cigarette smoking, which can increase anxiety should be avoided. If you are taking medication for an anxiety disorder, then first contact your doctor before you start drinking alcohol or taking any other medicines. Not all methods and regimens are equally suitable for all patients. You and your doctor should decide together which combination of treatment methods is best for you.
When deciding on the need for treatment, it should be borne in mind that in most cases, the anxiety disorder does not pass on its own, but is transformed into chronic diseases of the internal organs, depression or takes a severe generalized form. Stomach ulcer, hypertension, irritable bowel syndrome and many other diseases are often the result of a triggered anxiety disorder.
The basis of therapy for anxiety disorders is psychotherapy. It allows you to identify the true cause of the development of anxiety disorder, teach a person ways to relax and control their own condition. Special techniques allow to reduce sensitivity to provoking factors. The effectiveness of treatment largely depends on the patient's desire to correct the situation and the time elapsed from the onset of symptoms before the start of therapy.
Medical treatment of anxiety disorders includes the use of antidepressants, tranquilizers, adrenoblockers.
Betta-adrenoblockers are used to relieve vegetative symptoms (palpitations, increased blood pressure).
Tranquilizers reduce the severity of anxiety, fear, help normalize sleep, relieve muscle tension. The downside of tranquilizers is the ability to cause addiction, dependence and withdrawal syndrome, so they are prescribed only on strict indications and a short course. It is unacceptable to drink alcohol while treating with tranquilizers - it is possible to stop breathing. With caution should take tranquilizers in work that requires increased attention and concentration: drivers, dispatchers, etc.
In most cases, in the treatment of anxiety disorders, antidepressants are preferred, which can be prescribed by a long course, since they do not cause addiction and dependence.
A special feature of the drugs is the gradual development of the effect (for several days and even weeks), related to the mechanism of their action. An important result in treatment is easing anxiety. In addition, antidepressants increase the threshold of pain sensitivity (used for chronic pain syndromes), contribute to the removal of vegetative disorders.