Anxiety

It's one thing to feel occasionally nervous or tense. But for someone with an anxiety disorder, these emotions can become debilitating. According to the National Institute of Mental Health (NIMH), anxiety disorders are the most common of all mental disorders, with some 40 million Americans affected by these debilitating illnesses each year. (Read about "Mental Health")

Normally, feelings of nervousness develop in response to a particular situation, help us by making us more alert and aware of potential dangers in this situation, and then the feelings subside. But anxiety disorders are different. The American Psychiatric Association says anxiety symptoms often occur for no apparent reason and do not go away. Left untreated, they can drive individuals to take drastic actions to avoid the situations that trigger their anxiety, and can interfere with relationships and the ability to hold down a job.

Symptoms and types of anxiety

Symptoms of anxiety can include nervousness and tension, as well as physical conditions such as rapid heartbeat, tremors or sweating. (Read about "Sweating") Of course, these physical symptoms can also indicate heart or other physical problems, and if someone suspects a medical emergency, they should get help immediately. (Read about "Heart Attack")

If the symptoms are related to an anxiety disorder, however, the American Psychological Association says there are several different types to be aware of:

• Generalized anxiety disorder (GAD) is characterized by chronic worrying and fears that have no apparent cause. People with GAD may experience an overall sense of impending disaster and have a hard time relaxing. They may startle easily. They may often feel lightheaded.
• Panic disorder is marked by sudden feelings of intense fear or terror that strike with no warning and for no rational reason. Panic attacks can trigger rapid heartbeat, shaking, nausea, a feeling of being trapped and/or a feeling of being out of control. Panic attacks can also make people avoid places and situations where an attack might occur, causing them to stop driving, for example, or be unable to leave their home. (Read about "Panic Disorder")
• Phobias involve irrational fears of particular things or circumstances such as fear of heights or fear of flying. Social phobia is an excessive fear of being embarrassed in social situations, sometimes leading a person to avoid social interaction as much as possible. (Read about "Phobias" "Social Phobia")
• Obsessive-compulsive disorder (OCD) is marked by recurring and unwelcome thoughts or images. These thoughts can drive someone to perform certain rituals over and over… washing their hands, for example, because of an obsessive concern about germs (Read about "Microorganisms"), or checking the stove dozens or more times a day to make sure it's really shut off. (Read about "Obsessive Compulsive Disorder")
• Post-traumatic stress disorder can develop after someone experiences a particularly frightening event, causing them to relive the horror of the event again and again. (Read about "Post-Traumatic Stress")

Not just a case of "nerves"

What makes an anxiety disorder different from everyday stress (Read about "Stress") is the degree to which the symptoms are experienced and the extent to which the feelings interfere with a person's life. For example, it's one thing to return home once to make sure you shut the stove. But someone with OCD may feel compelled to check the stove over and over, to the point where it interferes with their ability to do other things.

Who's at risk

Anxiety disorders may have a biological basis and often tend to run in families. For example, the American Psychiatric Association says that if one identical twin has an anxiety disorder, the second twin is likely to have an anxiety disorder as well. Life experiences also make some people more susceptible to anxiety disorders. People with low self-esteem or poor coping skills may be prone to anxiety disorders, as can those subjected to physical or mental abuse, violence or poverty. (Read about "Violence and Abuse")

According to the National Alliance for the Mentally Ill (NAMI), both medication and talk therapy can help people with anxiety disorders. NAMI says that among the common medications used to treat anxiety disorders are certain antidepressants and benzodiazepines. As always, people should speak with their healthcare provider about any medication questions or concerns. Among the forms of talk therapy most often effective in treating anxiety disorders, according to NAMI, are behavioral therapy and cognitive-behavioral therapy. Behavioral therapy involves relaxation techniques and gradual exposure to the thing or situation that causes the anxiety. Cognitive-behavioral therapy works on helping individuals change their thought patterns so they can react differently to whatever is triggering their anxiety.

Anxiety is sometimes dismissed by friends or even by the person experiencing the symptoms as "just a case of nerves," but it's often impossible for someone with an anxiety disorder to make their feelings of fear simply disappear. A doctor can help you determine if you or a family member suffers from an anxiety disorder and if so, the most appropriate form of therapy.

NIMH supports research into the causes, diagnosis, prevention and treatment of anxiety disorders and other mental illnesses. (Read about "Clinical Studies") Studies examine the genetic (Read about "Genetics") and environmental risks for major anxiety disorders, their course - both alone and when they occur along with other diseases such as depression - and their treatment. (Read about "Depressive Illnesses") The ultimate goal is to be able to cure, and perhaps even to prevent, anxiety disorders.

Several parts of the brain (Read about "The Brain") are key actors in a highly dynamic interplay that gives rise to fear and anxiety. Using brain imaging technologies and neurochemical techniques, scientists are finding that a network of interacting structures is responsible for these emotions. Much research centers on the amygdala, an almond-shaped structure deep within the brain. The amygdala is believed to serve as a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret them. It can signal that a threat is present, and trigger a fear response or anxiety. It appears that emotional memories stored in the central part of the amygdala may play a role in disorders involving very distinct fears, like phobias, while different parts may be involved in other forms of anxiety.

Other research focuses on the hippocampus, another brain structure that is responsible for processing threatening or traumatic stimuli. The hippocampus plays a key role in the brain by helping to encode information into memories. Studies have shown that the hippocampus appears to be smaller in people who have undergone severe stress. This reduced size could help explain why individuals with PTSD have flashbacks, deficits in explicit memory and fragmented memory for details of the traumatic event.

Also, research indicates that other brain parts called the basal ganglia and striatum are involved in obsessive-compulsive disorder.

By learning more about brain circuitry involved in fear and anxiety, scientists may be able to devise new and more specific treatments for anxiety disorders.

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