This blog comes from a parent of a child with “invisible disabilities.” It comes from a teacher whose students miss class for mental illnesses that no one can verify. It comes from a woman who lived 35 years thinking that the feeling of her heart racing, being short of breath, and having sleepless nights were normal because she didn’t know otherwise.
Anxiety disorders are associated with chronic life stress. Unpredictable, unrelenting, unresolvable stressors chronically stimulate the stress hormone system and cardiovascular system, and lead to states of constant increased activity. Biologically, the body has evolved to deal with imminent and concrete danger in the environment, rather than continuous stressors. Under normal conditions where chronic stress is low, exposure to a sudden threat activates the autonomic nervous system, i.e. increased levels of adrenaline and faster breathing, and racing heart rate. These reactions in turn trigger activation of stress hormones, such as cortisol. One of the effects of these stress hormones is to increase glucose levels in the bloodstream in order to respond to the imminent threat, so that muscles can be activated for the flight or fight response. Another effect of stress hormones is to supress the immune system, since processes such as healing and repair can wait until after the threat subsides. However, in someone with an anxiety disorder, where there is constant activation of these responses to everyday stressors, the stress hormone system loses its ability to control immune function, thus contributing to heightened systemic inflammation that increases risk for cardiovascular and even autoimmune disorders. Neuroscience and clinical research continues to investigate how anxiety disorders increase individual risk for developing physical health co-morbidities in hopes of identifying new treatments that may alleviate suffering from and prevent the development of these whole-body disorders.
Almost everyone experiencing symptoms of a panic attack needs evaluation. Unless the person has a history of having panic attacks, is otherwise healthy, and is experiencing a typical attack, they must be evaluated promptly by a doctor. The level of evaluation depends on many factors. Err on the side of safety when deciding whether to go to a hospital's emergency department.
An anxiety attack can be described as a sudden attack of fear, terror, or feelings of impending doom that strike without warning and for no apparent reason. This strong sensation or feeling can also be accompanied by a number of other symptoms, including pounding heart, rapid heart rate, sweating, lightheadedness, nausea, hot or cold flashes, chest pain, hands and feet may feel numb, tingly skin sensations, burning skin sensations, irrational thoughts, fear of losing control, and a number of other symptoms. (While other symptoms often do accompany anxiety attacks, they don’t necessarily have to.)
Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.
Until recently, panic disorder was not distinguished from agoraphobia (distressing anxiety resulting from being outside the home, travelling via public transit, being in open or claustrophobic environments, or being in crowds that generally leads to extreme avoidance due to fear of not being able to escape in those situations; APA, 2013). As it stands in the current Diagnostic and Statistical Manual of Mental Disorders - 5 agoraphobia is one of the most common disorders to co-occur with panic disorder. Current estimates contend that just under 2% of teens and adults have agoraphobia (Kessler et al., 2012). Often, people associate panic attacks or their panic disorder with certain places, people, or events and the fear of another attack occurring can lead to comorbid fears of the location or idea that there is no escape, which leads to extreme avoidance. Panic disorder can also occur simultaneously with other anxiety disorders, such as Generalized Anxiety Disorder (GAD) and/or Social Anxiety Disorder (SAD), for example.
"Anxiety" is a general term that describes a variety of experiences, including nervousness, fear, apprehension, and worry, that are common in several mental health disorders. While most of us have anxiety at some time, this is completely different from an anxiety attack or anxiety disorder. Normal feelings of nervousness, worry, and fear often have a known trigger (a major exam, money issues, or seeing a bug). But when you're having a full blown panic attack or anxiety attack, the symptoms — chest pain, flushing skin, racing heart, and difficulty breathing — can make you feel as though you're going to faint, lose your mind, or die. The reality is, you won’t. The key to surviving is to learn all you can about anxiety attacks and practice the skills you need to get through them.
Now as you feel slightly calmer, you need to identify and face the roots of the anxiety attack. The truth is – there’s always a trigger for it. Even if it’s not obvious, it’s always there. Panic attacks can happen as a response to a stressful or traumatic issue that happened months ago. Try digging into your mind and thinking of the exact cue that might have caused it. Remember, an anxiety attack is just a host of physical reactions. No matter how real it feels, the danger is usually non-existent.
Be smart about caffeine, alcohol, and nicotine. If you struggle with anxiety, you may want to consider reducing your caffeine intake, or cutting it out completely. Similarly alcohol can also make anxiety worse. And while it may seem like cigarettes are calming, nicotine is actually a powerful stimulant that leads to higher, not lower, levels of anxiety. For help kicking the habit, see How to Quit Smoking.
Given that anxiety attacks aren’t specifically outlined as a diagnosis in the DSM-5, the usage of the word is open to interpretation and different individuals may use it in varying ways and circumstances. For one person, an anxiety attack might be overthinking about a specific worry to the extent that they are unable to concentrate on anything else; for another, anxiety attack might refer to sweating and shortness of breath when faced with a certain situation.
Exposure therapy has been around for a long time. It involves exposing the patient in a safe and controlled environment to physical sensations they experience during a panic attack much the same way you‘d expose in small increments a person with a fear of trains or puppies or snakes to the things that scares them. With panic disorder, there’s often a heightened sensitivity to ordinary physical sensations such as racing heart, stomach ache or feeling faint. In exposure therapy, the therapist will ask you to mimic activities—like running around or doing jumping jacks or holding your breath—to cause panic symptoms. The idea is that by repeating the things that may trigger a panic attack those triggers will eventually lose their power.
It's important to note that everyone feels anxiety to some degree regularly throughout their life - fear and anxiety are adaptive and helpful emotions that can function to help us notice danger or threat, keep us safe, and help us adapt to the environment. Anxiety disorders represent states when fear or anxiety becomes severe or extreme, to the extent that it causes an individual significant distress, or impairs their ability to function in important facets of life such as work, school, or relationships. It is also important that risk factors don't at all imply that anxiety is anyone's fault; anxiety disorders are a very common difficulty that people experience. In this section, we will review risk factors for anxiety disorders. There are many potential risk factors for anxiety disorders, and most people likely experience multiple different combinations of risk factors, such as neurobiological factors, genetic markers, environmental factors, and life experiences. However, we do not yet fully understand what causes some people to have anxiety disorders.
Panic disorder is a type of anxiety disorder that is characterized by fear and worry. One of the most salient symptoms is the experience of persistent and often unanticipated panic attacks. Panic attacks are typically experienced through a combination of frightening physical sensations and distressing thoughts and emotions. These attacks bring on severe apprehension and discomfort, despite a lack of actual threat or danger.
To receive a diagnosis of panic disorder, the panic attacks must be unexpected and during the attack four or more of the above symptoms must occur. For panic attacks that are expected, meaning they might not be expected by the individual but are expected in relation to any phobia, anxiety or other mental health disorder, four or more symptoms must also occur.
Physical symptoms of an anxiety disorder can be easily confused with other medical conditions, like heart disease or hyperthyroidism. Therefore, a doctor will likely perform an evaluation involving a physical examination, an interview and lab tests. After ruling out an underlying physical illness, a doctor may refer a person to a mental health professional for evaluation.
Says Clyman: "You might start to consider your emotions as changing experiences that are always fluctuating. When we feel distressed, it can seem like the distress is going to go on and on forever until we emotionally combust. But instead, emotions act more like a wave, at times increasing and becoming more intense. But inevitably they'll reach a plateau, subsiding and finally passing."
Obsessive-Compulsive Disorder (OCD) is characterized by uncontrollable anxious thoughts or behaviors. Individuals with OCD are plagued by persistent, unwelcome thoughts and images or by the urgent need to engage in certain rituals. Some OCD sufferers may only have obsessive thoughts without the related rituals. The disturbing thoughts or images (e.g., fear of germs) are called obsessions, and the rituals performed to try to get rid of them (e.g., hand washing) are called compulsions. For example, people who are obsessed with germs may wash their hands excessively. The individual is not happy to be performing the ritual behaviors but finds this to be the only way to get temporary relief from the obsessive thought.
Great questions. Unfortunately, there is usually no clear cut answer – and like many mental health disorders – it is likely caused by a combination of genetic, behavioral, and developmental factors. Anatomically speaking, Generalized Anxiety Disorder is most closely related to a disruption in the functional connectivity of the amygdala – the “emotional control center” of the brain – and how it processes feelings of fear and anxiety. Genetics also play a role in Generalized Anxiety Disorder. If you have a family member that also suffers from this disorder, your chances of suffering from it are increased, especially in the presence of a life stressor. Interestingly, long-term substance abuse also increases your chances of Generalized Anxiety Disorder, as the use of benzodiazepines can worsen your anxiety levels, as can excessive alcohol use. Tobacco use and caffeine are also both associated with increased levels of anxiety.
Anxiety disorders reflect disorders that share a general feature of excessive fear (i.e. emotional response to perceived or real threat) and/or anxiety (i.e. anticipation of future threat) and demonstrate behavioral and functional disturbances as a result. Panic attacks are a feature that can occur in the context of many anxiety disorders and reflect a type of fear response.
Panic disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain, as well as biological processes, play a key role in fear and anxiety. Some researchers think that people with panic disorder misinterpret harmless bodily sensations as threats. By learning more about how the brain and body functions in people with panic disorder, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.
If you’ve ever experienced a sudden surge of overwhelming anxiety and fear then you’re familiar with the feeling of having a panic attack. Your heart pounds, you can’t breathe, and you may even feel like you’re dying or going crazy. Left untreated, panic attacks can lead to panic disorder and other problems. They may even cause you to withdraw from normal activities. But panic attacks can be cured and the sooner you seek help, the better. With the right treatment and self-help, you can reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life
These attacks are a symptom of panic disorder, a type of anxiety disorder that affects some 2.4 million U.S. adults. The disorder most often begins during the late teens and early adulthood and strikes twice as many American women as men. No one knows what causes panic disorder, though researchers suspect a combination of biological and environmental factors, including family history (panic disorder seems to run in families), stressful life events, drug and alcohol abuse, and thinking patterns that exaggerate normal physical reactions.
The typical course of panic disorder begins in adolescence and peaks in early to mid-twenties, with symptoms rarely present in children under the age of 14 or in older adults over the age of 64 (Kessler et al., 2012). Caregivers can look for symptoms of panic attacks in adolescents, followed by notable changes in their behavior (e.g., avoiding experiencing strong physical sensations), to help potentially identify the onset of panic disorder. Panic disorder is most likely to develop between the ages of 20-24 years and although females are more likely to have panic disorder, there are no significant sex differences in how the disorder presents (McLean et al., 2011).
We all tend to avoid certain things or situations that make us uncomfortable or even fearful. But for someone with a phobia, certain places, events or objects create powerful reactions of strong, irrational fear. Most people with specific phobias have several things that can trigger those reactions; to avoid panic, they will work hard to avoid their triggers. Depending on the type and number of triggers, attempts to control fear can take over a person’s life.
For example, a person with obsessive-compulsive disorder may experience a panic attack when their schedule or compulsions are interrupted. Individuals who struggle with specific phobias are also susceptible to panic attacks. A person with an extreme fear of heights (acrophobia) may experience a panic attack in a penthouse apartment. And for someone with generalized anxiety disorder (GAD), a condition characterized by extreme fear or worry, the unending anxiety can escalate to a panic attack. People with post-traumatic stress disorder (PTSD) have a higher incidence of panic disorder than the general population. Illness or traumatic events increase the chances of panic attacks.
Anxiety is a normal reaction to danger, the body’s automatic fight-or-flight response that is triggered when you feel threatened, under pressure, or are facing a stressful situation. In moderation, anxiety isn’t necessarily a bad thing. It can help you to stay alert and focused, spur you to action, and motivate you to solve problems. But when anxiety is constant or overwhelming—when it interferes with your relationships and daily activities—you’ve likely crossed the line from normal anxiety into the territory of an anxiety disorder.
If you're having lots of panic attacks at unpredictable times and there doesn't seem to be a particular trigger or cause, you might be given a diagnosis of panic disorder. It's common to experience panic disorder and agoraphobia (a type of phobia) together. People who experience panic disorder may have some periods with few or no panic attacks, but have lots at other times.
Primarily, it is important to stay calm, patient, and understanding. Help your friend wait out the panic attack by encouraging them to take deep breaths in for four seconds and out for four seconds. Stay with them and assure them that this attack is only temporary and they will get through it. You can also remind them that they can leave the environment they are in if they would feel more comfortable elsewhere and try to engage them in light-hearted conversation.
Specialized coils that targetes deeper brain regions than rTMS. A patient wears a cushioned helmet (similar to the type of helmet worn during an fMRI). The coil used in dTMS was approved by the FDA in 2013 for treating depression but is currently being studied for the treatment of anxiety disorders such as OCD. The procedue is administered for 20 minutes for 4-6 weeks. Patients can resume their daily lives right after each treatment.
It is common for a person with one anxiety disorder to also have another anxiety disorder. Anxiety disorders are also frequently accompanied by depression or substance abuse. Anxiety disorders can coexist with physical health conditions as well. In such instances, these physical health conditions will also need to be treated. Before undergoing any treatment, it is important to have a thorough medical exam to rule out other possible causes.
Mitral valve prolapse (MVP), also called "click murmur syndrome" and "Barlow's syndrome," is the most common type of heart valve abnormality. Usually, people with mitral valve prolapse have no signs and symptoms; however, if the prolapsed valve is severe, symptoms may appear. When symptoms of severe mitral valve prolapse do appear, they may include, fatigue, palpitations, chest pain, anxiety, migraine headaches, and pulmonary edema. Echocardiography is the most useful test for mitral valve prolapse. Most people with mitral valve need no treatment. However, if the valve prolapse is severe, treatment medications or surgery may be necessary to repair the heart valve.
A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.
Anxiety disorders are the most common mental health disorder in the U.S., affecting more than 18% of the population. They are even more common among children, affecting an estimated 25% of children between the ages of 13 and 18. The most common anxiety disorders are Specific Phobias, affecting 8.7% of the population, and Social Anxiety, affecting 6.8% of the population.
Often, a combination of psychotherapy and medications produces good results in the treatment of panic disorder. Improvement is usually noticed in about two to three months. Thus, appropriate treatment for panic disorder can prevent panic attacks or at least substantially reduce their severity and frequency, bringing significant relief to 70%-90% of people with the illness. More than 18% of people who are assessed but not treated for this condition tend to relapse in less than two years. As these statistics indicate, access to appropriate mental health care is key to a positive prognosis for people who suffer from panic attacks. Therefore, it is imperative to alleviate the well documented economic and racial disparities that exist in having and using access to care. Combating other social disparities, like educational, employment, housing, and criminal justice, is also seen as being important to improving the prognosis for recovering from panic attacks and other health problems.
People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked. However, panic attacks experienced by those with panic disorder may also be linked to or heightened by certain places or situations, making daily life difficult.
Yes, panic attacks are real and potentially quite emotionally disabling. Fortunately, they can be controlled with specific treatments. Because of the disturbing physical signs and symptoms that accompany panic attacks, they may be mistaken for heart attacks or some other life-threatening medical problem. In fact, up to 25% of people who visit emergency rooms because of chest pain are actually experiencing panic. This can lead to people with this symptom often undergoing extensive medical testing to rule out physical conditions. Sadly, sometimes more than 90% of these individuals are not appropriately diagnosed as suffering from panic.
The prognosis for people who suffer a panic attack is overall, good. Some people have a single attack and are never bothered again. Yet, two-thirds of people experiencing a panic attack go on to be diagnosed with panic disorder. Also, half of those who go through a panic attack might develop clinical depression within the following year, if not treated promptly. Occasionally, a person will, after a long evaluation, be diagnosed with a medical condition that causes panic symptoms.
The avoidance, anticipation of, or distress of the phobic object/situation must cause significant distress or interferes with the individual's daily life, occupational, academic, or social functioning to meet diagnosis. The symptoms cannot be better accounted for by another mental disorder or be caused by substances, medications, or medical illness.
When taking medications, it is important for clients to be educated about potential side effects, the rationale for the type of medication prescribed, and other drugs or substances that may counteract or interact with the effects of the medications. Before stopping taking the prescribed drug, or if the medication does not seem to alleviate symptoms, the doctor should be consulted.
Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.