Imagine this scenario: you have interviewed for your dream job. The people who interviewed you are going to call you at a certain time of a day to let you know if you got the job. You really want this job. So what happens as the hour closes in for the phone call to be made? You feel a little restless and nervous, cannot concentrate on other things that you do, and have butterflies in your stomach. After you receive the phone call and you get the job, your anxiety begins to subside and, in time, disappear. As this scenario illustrates, people feel anxious for variety of reasons. Anxiety is a commonly experienced and normal emotion that people experience in response to certain situations. In fact, research has shown that optimal performance on certain tasks requires a certain level of anxiety.

Now imagine that you experience the same sensations as you did waiting for your dream job; however, you experience them more intensely and for no apparent reason. When feeling of anxiety reaches such intensity that it begins to interfere with the normal functioning of the person, an anxiety disorder is present. Other symptoms of anxiety include insomnia, trembling, lightheadedness and dizziness, shortness of breath, sweating, tingling of the skin, irregular heartbeat, and even diarrhea.

Anxiety Disorders

DSM-IV (Diagnostic and Statistical Manual-IV) lists several conditions under anxiety disorder. Some of the most common ones include panic attack, agoraphobia (fear of open spaces), specific phobia, Social phobia, Obsessive Compulsive Disorder, Posttraumatic Stress Disorder, and Generalized Anxiety Disorder. Although excessive- and out-of-proportion arousal or fear is common among these conditions, each has unique associated symptoms and specific treatments.

The lifetime prevalence rate for anxiety disorders is 25%. Some estimates put anxiety as the most common mental disorder in the United States, afflicting nearly 37 million individuals per year. Women experience this disorder twice as often as do men. Research has indicated that women may experience more anxiety due to gonadal steroids. Furthermore, psychological research has shown that women experience a wider range of emotions in stressful situations than men do; thus, they experience more anxiety as well.

Generalized Anxiety Disorder is characterized by low-level and chronic anxiety, in absence of any apparent stress. Individuals who have irrational fear in certain situations or to certain objects (such as spiders or high altitude) may be diagnosed with Specific Phobia. Social Phobia is characterized by excessive fear towards social situations. Panic Attack involves discrete period with sudden and intense apprehension, fearfulness and feelings of impending doom. In Obsessive Compulsive Disorder the individual has persistent, intrusive, and troublesome thoughts known as obsessions, and the person recognizes that his/her obsessions are irrational. The individual may also have compulsions. Compulsions, such as excessive hand washing, are repetitive behaviors or rituals in response to an obsession. If development of anxiety is solely due to a situational stress, such as losing one’s job, then the disorder is called an adjustment disorder.

Causes of anxiety

According to a report by the U.S. Surgeon General’s Office, development of anxiety involves a combination of genetic factors, biological factors, life experiences, and personal and psychological traits. Genetics appear to play a prominent role in panic disorders. In Generalized Anxiety Disorder, biological factors play a role. Until recently, the role of neurotransmitters (brain chemicals) was the main focus of biological research as the cause of anxiety. However, newer research has focused on the abnormal regulation of two regions of the brain called the Hippocampus and the Amygdala. These two regions, being a part of the limbic system of the brain, play a major role in emotions.

Several psychological theories have been put forth to explain development of anxiety. Among them is the psychodynamic model, which focuses on the expression of underlying and unconscious conflicts. Behavioral theories have emphasized the importance of learning in development of fearful behavior. Cognitive psychologists point to the way people think about different situations as the culprit. In explaining the higher number of anxiety cases among women than men, there is evidence that women may ruminate more about distressing life events compared with men, suggesting that a cognitive risk factor may predispose them to higher rates of anxiety and depression.

Anxiety due to general medical condition and substances

It is important to note that anxiety symptoms may also be due to a general medical condition. Adrenal tumor, cardiac arrhythmia, hyperthyroidism, and pulmonary embolism are among the general medical conditions that produce symptoms of anxiety. Chemical substances can also induce anxiety. Amphetamines, cocaine, caffeine and some nasal decongestants have been shown to induce anxiety. Therefore, it is very important to check for any underlying medical and/or substance problems prior to start of any treatment for anxiety.

Treatment

Treatment of anxiety frequently requires medications (pharmacotherapy). The main class of medication used for anxiety is Benzodiazepines. Some of the trade names in this class of medications are Valium, Ativan, Xanax, and Halcion. Benzodiazepines can be addictive; hence the appropriate duration of use depends on the severity of the disorder. Some physicians have found antidepressants, such as Prozac and Zoloft, as appropriate substitutes for Benzodiazepines and effective agents for anxiety. One main concern regarding use of medication is a high rate of relapse after discontinuation of treatment. For example, 95% of individuals with Obsessive-Compulsive Disorder tend to relapse after they stop taking their medication. Psychological treatments of anxiety-including stress management, cognitive-behavioral treatment, and relaxation training-have been effective. Psychological treatments, although not as effective as pharmacotherapy, have lower relapse rates. Some studies have suggested that combined pharmacotherapy and psychotherapy is the most effective mode of treatment.