Anxiety Disorders

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Most people have experienced situational apprehension and “butterflies” in the proverbial stomach.  We get jitters and particular fears.  Clinically significant anxiety can be torturous.  Even when not the primary symptom, it can significantly increase the suffering from depression and psychosis.  Anxiety prevents people from engaging in necessary activities, like flying and driving.  It prevents some people from leaving their home.  Chronic anxiety can manifest in physical illness.  Many symptoms of anxiety overlap with physical ailments; for example, heart disease.  As it is very difficult to separate symptoms of heart disease from anxiety, I often have patients note anxiety test items they believe to be secondary to their medical condition.  Tachycardia (racing heart), diaphoresis (sweaty), clamminess, blurred vision and thoughts of dying could be a myocardial infarction or acute anxiety.  Persistent negative rumination over years may adversely effect one’s cardiopulmonary status.  Patients with chronically low blood oxygen saturation and elevated blood carbon dioxide will typically suffer with anxiety.  Anxiety secondary to medical factors will make even the calmest person feel terrible.

From these thoughts one can gather that it is best to be cautious in diagnosing anxiety.  It is safest to first rule out a medical problem, since the psychological symptom of anxiety is not, fortunately, a fatal one.  Younger woman should rule out a mitral valve prolapse, for example, before embarking on the time and expense of mental health treatment.  If you suffer from anxiety and chronically labored breathing, consider having your medical doctor check oxygen saturation.

It is often easier for a clinician to diagnosis phobias and panic than generalized anxiety.  Phobias elicit anxiety over particular stimuli; typically not anxious removed from the unpleasant stimuli.  Panic involves stark symptoms that are unique to the phenomenon.  One of the most bizarre is the scotoma, or alarming narrowing of one’s visual field-like looking backward through a telescope!  I have created a separate subcategory for panic, and invite people to leave their thoughts on panic in that category.  Many patient’s come to me complaining of panic, but not many of them actually have the disorder.  This is fortunate for them.

Most symptoms of anxiety respond to cognitive-behavioral psychotherapy and/or medications.  Often the greatest hurdle is obtaining and accurate diagnosis.  The next big hurdle is the various prescription pads filled with benzodiazepines (Valium, Librium, Xanax, etc.).  I recommend using medication in combination with cognitive-behavioral therapy, but do not support the use of medication without any behavioral therapy.  If one starts with psychotherapy as the solo treatment, the psychologist can always seek medication consultation at a later time.  If one starts off with medication, it can complicate the process of psychotherapy, and make one unsure as to which is the most beneficial.  The take home message is to take heart, help is available, and typically effective.  Please leave your comments regarding this post in the space provided below.

  • By NervousNelly, April 14, 2010 @ 9:37 am

    Will you be blogging about obsessive-compulsive disorder? I think I have a mild case and would be curious what you have to say about drawing the line between a habit and a compulsion. And methods to get beyond the compulsions. Thanks.

  • By orlandopsychcom, April 15, 2010 @ 11:59 am

    Dear Nervous Nelly,

    I will be making a post regarding obsessive-compulsive disorder within the next few weeks. You draw an interesting distinction between a habit versus a compulsion. My off-the-cuff response is that a compulsion is considered to be less functional than a habit, though I need to think this through before I write a post! Addressing ways to “get beyond” the compulsion(s), is a method to decrease the senseless nonfunctional aspects of the compulsion, in order to free more time for what you consider to be useful activity. I will try to address these topics in my post. Thanks for the thoughtful comment. Dr. Holzmacher.

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