Anxiety Disorders: Anxiety, in other words, anxiety is a frequently encountered situation in daily life. This emotional state, which is extremely normal, can become a health problem if it gets out of control. In order for anxiety, worry, and fear to be characterized as a disorder rather than being normal emotions, these emotions must become excessive, disproportionate, and uncontrollable and make it difficult for people to live their daily lives. Anxiety disorder occurs when there is an imbalance of brain chemicals called serotonin and noradrenaline, which act as mood stabilizers in the brain.
This condition, which is called anxiety disorder, may differ according to the areas of anxiety or may appear as a general anxiety disorder in patients.
What is Anxiety?
Anxiety, known in psychology as anxiety, is the “signal to the body that it must be ready to challenge” in dangerous situations. When natural and necessary anxiety begins to be felt, breathing and heartbeat accelerate, providing more oxygen to the muscles. Thus, the body prepares itself for dangerous situations. When it is necessary to be aware of dangerous situations, the person is on the alert with this urge. Thanks to this impulse, which is called natural anxiety, it helps situations such as sudden intervention at the steering wheel in any dangerous situation in traffic, and better performance in the exam. In fact, worrying is necessary to cope with problems in daily life and to make quick decisions when faced with vital situations.
Anxiety disorder, on the other hand, is the feeling of anxiety that manifests itself when there is no danger, persists for a long time, and is felt very strongly, in which case treatment is required. Severe anxiety disorder can make people very uncomfortable and make it difficult for them to perform their daily functions. The social life of the person with an anxiety disorder also affects the relations with other people negatively.
People with anxiety are often aware that they feel anxiety intensely. However, they cannot control themselves and cannot calm down. When the situation reaches this level, people need to be treated in order to lead a healthy life.
What are Anxiety Symptoms?
Temporary anxiety about certain stressors is considered normal. Anxiety before an important exam or interview or stress before a major change is classified as an anxiety disorder. The transformation of anxiety into a mood disorder occurs when there are recurrent and long-lasting effects of this condition and people have difficulty controlling these feelings.
The symptoms of anxiety can vary from person to person, but certain effects occur in all patients. Among them;
- Panic, restlessness, increased fear, and anxiety,
- Sweating, cold hands and feet
- Shortness of breath,
- tachycardia (heart rhythm disorder),
- dry mouth,
- There are symptoms such as difficulty concentrating.
Anxiety can also increase a person’s risk of developing diseases such as cardiovascular disease, obesity, heart disease, and diabetes. This is thought to be caused by increased systemic inflammation due to the change in stress hormone. At the same time, anxiety can be accompanied by eating disorders, and in such cases, people may choose to overeat for relaxation.
The effects of chronic stress on the body can also lead to physical problems. Chronic stress, which means prolonged and high stress, is a situation that the body is not used to evolutionarily. Increased stress in the face of immediate dangers releases the hormone cortisol in the body and can suppress certain functions along with it. Among them is the immune system. In the case of chronic stress, the immune system, which is constantly suppressed in the body, can also increase the risk of cardiovascular diseases.
Common anxiety signs and symptoms include:
- Feeling nervous, restless, or tense
- Having a sense of impending danger, panic, or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the present worry
- Having trouble sleeping
- Experiencing gastrointestinal (GI) problems
- Having difficulty controlling worry
- Having the urge to avoid things that trigger anxiety
What are the Causes of Anxiety Disorders?
Anxiety can occur for many different reasons, but it usually results from the combination of more than one stressor. An anxiety attack can happen once, or it is possible for the attacks to become chronic. Not every anxiety attack has the risk of turning into an anxiety disorder.
Environmental stress factors, genetic predispositions, complications due to other diseases, and irregularities in brain chemistry are among the main triggers of anxiety.
Problems in school, workplace, family and social environment, relationship problems, and traumatic events are among the main factors of the disease. Having various anxiety disorders in the family can also make people more vulnerable to anxiety. In addition, anxiety can also occur due to other medical conditions. Conditions such as heavy surgeries and long recovery periods can also cause various types of anxiety. In addition, substance abuse is also shown among anxiety triggers.
For some people, anxiety may be linked to an underlying health problem. In some cases, signs and symptoms of anxiety are the first indications of a medical illness. If your doctor suspects that there may be a medical reason for your concern, they may order tests to look for signs of a problem.
Examples of medical problems that can be associated with anxiety include:
- Heart disease
- Thyroid problems such as hyperthyroidism
- Respiratory disorders such as chronic obstructive pulmonary disease (COPD) and asthma
- Drug abuse or withdrawal
- Withdrawal from alcohol, anti-anxiety medications (benzodiazepines), or other medications
- Chronic pain or irritable bowel syndrome
- Rare tumors that produce certain fight-or-flight hormones
Sometimes anxiety can be a side effect of certain medications.
It’s possible that your anxiety may be due to an underlying medical condition if:
- You don’t have any blood relatives (such as a parent or sibling) with an anxiety disorder
- You didn’t have an anxiety disorder as a child
- You don’t avoid certain things or situations because of anxiety
- You have a sudden occurrence of anxiety that seems unrelated to life events and you didn’t have a previous history of anxiety
What are the types of Anxiety Disorders?
In anxiety disorders, there is excessive fear and worry about the real or perceived danger in the person.
General anxiety disorder
In generalized anxiety disorder, people experience excessive and uncontrollable anxiety and tension for no apparent reason. Anxiety, which is a normal emotion, is so intense that it interrupts people’s lives; One of the most common conditions in general anxiety disorder is that people change their daily lives, jobs, academic or social lives to escape from negativities or to alleviate their worries. Physical symptoms such as fatigue, headache, nausea, difficulty swallowing, sweating, and hot flashes can be seen.
Panic disorder, more commonly known as panic attacks, occurs with a sudden intense feeling of panic. There is no obvious trigger in this disorder. People may have delusions that they are having a heart attack or drowning and may apply to the hospital with symptoms such as sweating, chest pain, and tachycardia. In these people, anxiety is experienced against the re-development of a panic attack. The duration of attacks can vary from a few minutes to an hour. The prevalence of the panic disorder in the community is between 2-4%. It is seen twice as often in women.
Social anxiety disorder
This disorder, also called social phobia, manifests itself when people become intensely and excessively anxious about events in the normal course of daily life. Anxiety about experiencing an embarrassing event or being judged is among the most dominant emotions in these people. If such anxieties persist for more than six months, a diagnosis of social anxiety disorder is made.
Phobias may be directed towards certain objects or situations. A person’s excessive fear, worry, and anxiety towards a certain situation or object are classified as a phobia.
Fear of heights, phobia of spiders, agoraphobia, fear of toilets, phobia of blood, and disease (hypochondria) can be given as examples of phobias that can cause anxiety. In phobias, the person does not necessarily have to encounter the situation or object in question. Even the thought of this situation or object can trigger the phobia and cause the person to develop excessive anxiety and even panic attacks. The person’s fear is often excessive, and people may develop various behavioral patterns to avoid these situations. People with a phobia are mostly aware that their fear is excessive, but they cannot prevent it.
Separation anxiety, which is mostly seen in children, may continue in adulthood if it is not resolved in the child’s development and may turn into a fear of abandonment by a loved one or family members. Even if the caregiver, family elders, or parents are out of sight in childhood, it can trigger separation anxiety in the child. At the same time, people with separation anxiety often have the delusion that something bad will happen to their loved ones.
Anxiety induced by drugs
The use of certain drugs or drugs can trigger anxiety disorder. In addition, individuals trying to quit drugs may also have anxiety symptoms.
Anxiety due to other mood disorders
Anxiety may also develop in patients with OCD, in other words, obsessive-compulsive disorder (obsessive-compulsive disorder) or post-traumatic stress disorder (PTSD: Post Traumatic Stress Disorder).
- Post-traumatic stress disorder develops as a result of the inability of people to overcome the effects of a traumatic event. The disorder is more likely to develop after the loss of a loved one, car accident, war, or violent events. Simpler events such as divorce, school change, or moving can also lead to stress-related disorders. In addition, acute stress disorder or adjustment disorder can be considered in this context and may lead to concerns about the repetition of the event in question or the occurrence of a similar event (eg, refraining from moving, remarriage, etc.).
- In obsessive-compulsive disorder, repeated and persistent thoughts push people to some compulsive behaviors. There are types such as fear of getting sick, fear of forgetting (forgetting the iron in the socket, forgetting to lock the door, etc.), symmetry disease, order disease. Compulsions include checking repeatedly, counting, lining up, repeating certain behaviors (hand gestures, etc.), hoarding, body image disorders, skin or hair pulling. Worries in OCD are largely irrational.
What are the Risk Factors?
Risk factors that cause anxiety disorders include neurobiological factors, genetics, environmental factors, and experiences. In anxiety disorders, more than one type of anxiety disorder usually develops together in people. These disorders usually have the same causes but show different manifestations.
Although anxiety is not defined as a hereditary disease, genetic predisposition is among the risk factors. However, having a genetic predisposition does not necessarily mean that they will develop an anxiety disorder. In this context, the impact of environmental factors is undeniable. In anxiety disorders, it has been determined that the rate of having any anxiety-based disorder in a family affects the development of similar disorders in other members of the family between 30-67%. It has been found that small changes in people’s gene structures increase susceptibility to anxiety disorder. Some of these genes are involved in stress hormone regulation.
Family relationships are at the forefront of environmental factors. Controlling and critical parents in their relations with their children are shown among the reasons for the development of anxiety in the future. In addition, anxious parents can also cause this behavior to develop in their children.
In addition, chronic stress experienced in childhood is one of the triggers of anxiety. Situations such as domestic conflict and incompatibility, sexual, physical, or emotional abuse, loss of parents at an early age, or early separation/abandonment with parents are also among the factors.
Shyness, shyness or negative emotion tendencies may also increase the likelihood of anxiety. Chronic stress can also lead to the development of anxiety in later years. A chronic health problem, having a serious illness, dealing with a patient at home for a long time can also cause anxiety.
Some health problems can also cause anxiety-like symptoms. For this reason, it is necessary to perform tests to determine whether there is an underlying physical reason for people with anxiety complaints. Diseases such as thyroid diseases, menopause, heart disease, diabetes can show anxiety symptoms. Sleep problems can also lead to anxiety disorder. In such cases, if physical ailments are not eliminated, anxiety and physical discomfort may trigger each other, and a difficult situation may arise.
These factors may increase your risk of developing an anxiety disorder:
- Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.
- Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.
- Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress, or ongoing worry about finances.
- Personality. People with certain personality types are more prone to anxiety disorders than others are.
- Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.
- Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.
- Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.
Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:
- Depression (which often occurs with an anxiety disorder) or other mental health disorders
- Substance misuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Headaches and chronic pain
- Social isolation
- Problems functioning at school or work
- Poor quality of life
There’s no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you’re anxious:
- Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
- Stay active. Participate in activities that you enjoy and that make you feel good about yourself. Enjoy social interaction and caring relationships, which can lessen your worries.
- Avoid alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you’re addicted to any of these substances, quitting can make you anxious. If you can’t quit on your own, see your doctor or find a support group to help you.
Diagnosis of Anxiety disorders
You can start by seeing your primary care provider find out if your concern is related to your physical health. He or she can check for signs of an underlying medical condition that may need treatment.
However, you may need to see a mental health professional if you have severe anxiety. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and some other mental health professionals can diagnose anxiety and provide counseling (psychotherapy).
To help diagnose an anxiety disorder, your mental health provider may:
- Give you a psychological evaluation. This includes discussing your thoughts, feelings, and behaviors to help determine a diagnosis and control for related complications. Anxiety disorders often co-occur with other mental health problems (such as depression or substance abuse), which can make diagnosis more difficult.
- Compare your symptoms with the criteria in the DSM-5. Many doctors use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose an anxiety disorder.
How Are Anxiety disorders Treated?
In order for the anxiety treatment to be carried out correctly, the triggers of the patient’s anxiety disorder and its manifestation should be determined first. Anxiety is largely treated through behavioral therapy, psychotherapy, and various medications. These three methods are often used together in treatment. However, in milder cases, psychotherapy and behavioral therapy may be sufficient.
Psychotherapy is a long-term form of treatment. The method to be used in the treatment of anxiety is determined according to questions such as the dimensions of the person’s anxiety, whether it is combined with other disorders, which behavioral patterns are active. The aim is for the patient to reach a stage where they can manage their emotions on their own. For this, the person needs to develop methods of coping with stress and understand his own behavior patterns. This is a time-consuming but highly effective method.
Cognitive Behavioral Therapy
Cognitive-behavioral therapy is a shorter-term therapy. It is one of the evidence-based treatments. It is helpful in areas such as changing negative and irrational thought patterns and preventing panic attacks. It is aimed to provide people with practical skills related to emotion management.
In the drug treatment of anxiety disorders, antidepressants, non-sedating behavioral regulators and beta-blockers can be used to regulate heart rhythm.
In addition, long-term confrontation therapy is especially effective in post-traumatic stress disorder and phobias. Treatment based on eye movement control, called EMDR, is similar to face-to-face therapy. It is aimed to help people to deal with their traumatic memories with a new eye and to reduce the pressure of these memories on people’s emotional states.
In cases of mild anxiety or anxiety and anxiety experienced in the face of situations encountered in daily life, people can take precautions with methods such as stress management, relaxation techniques, exercise, behavioral changes, or socialization.
Controlling the stress in daily life will also help prevent the development of many other diseases besides anxiety. Learning time and emotion management techniques and using them in daily life, prioritizing jobs and relationships, sharing stress sources with the employer or family can help reduce the negative effects of stress on people’s health.
Techniques such as walking, exercise, team sports, meditation, breathing exercises, long baths, and yoga can help control anxiety symptoms and alleviate anxiety.
If repetitive disturbing thoughts trigger anxiety, mental exercises are recommended to develop alternative thoughts and distract from negative thoughts. Instead of suppressing negative thoughts, people’s active efforts to replace them with positive ones can help break this cycle over time. This work can also be used to break phobias or some mild obsessive thought patterns.
In addition to all these, it will be beneficial for people to have a social environment where they can share their anxieties and worries and receive emotional support or participate in support groups.
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