DO I HAVE A MENTAL ILLNESS?

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First, let's clarify what a mental illness is and is not. Mental health professionals use symptom criteria from a diagnostic manual, called the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV, to determine the presence of a mental illness, now more commonly referred to as a “mental disorder.”

 According to DSM-IV, a mental disorder is defined as “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with significantly increased risk of suffering, death, pain, or disability, or an important loss of freedom.” Many of the disorders in the DSM-IV include anxiety as a prominent symptom. Further, introductory psychology textbooks generally recognize a mental disorder as a harmful dysfunction in which behavior becomes unusual, disturbing, unhelpful, and unjustifiable.

Therefore, if your problems with anxiety seem atypical, distressing, and markedly interfere with your functioning, you may have a mental disorder. This may be the result of a variety of causes—for example, the structure of the brain, the way the brain cells chemically interact, increased stress, and learned ways of thinking and behaving.

What a mental illness is not, however, is an indication that a person has weak character or limited moral development. Unfortunately, this is the stigma we may carry around or worry about. Mental illness also does not automatically imply that the sufferer is “crazy” or of unsound mind. The truth is that most mental illnesses do not lead to a loss of one's grip on reality (psychosis). Anxiety disorders are rarely associated with psychosis, and sufferers are unlikely to appear any different than the average person.

Source: The Anxiety Answer book by Laurie Helgoe,PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD 

RECOGNIZING THE SYMPTOMS OF ANXIETY

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          You may not know if you suffer from anxiety or an anxiety disorder. That’s because anxiety involves a wide range of symptoms. Each person experiences a slightly different constellation of these symptoms. And your specific constellation determines what kind of anxiety disorder you may have. For now, you should know that some signs of anxiety appear in the form of thoughts or beliefs. Other indications of anxiety manifest themselves in bodily sensations. Still other symptoms show up in various kinds of anxious behaviors. Some people experience anxiety signs in all three ways, while others only perceive their anxiety in one or two areas.

Thinking anxiously

Folks with anxiety generally think in ways that differ from the ways that other people think. You’re probably thinking anxiously if you experience

 ✓ Approval addiction: If you’re an approval addict, you worry a great deal about what other people think about you.

✓ Living in the future and predicting the worst: When you do this, you think about everything that lies ahead and assume the worst possible outcome.

 ✓ Magnification: People who magnify the importance of negative events usually feel more anxious than other people do.

 ✓ Perfectionism: If you’re a perfectionist, you assume that any mistake means total failure.

 ✓ Poor concentration: Anxious people routinely report that they struggle with focusing their thoughts. Short-term memory sometimes suffers as well.

 ✓ Racing thoughts: Thoughts zip through your mind in a stream of almost uncontrollable worry and concern.

Behaving anxiously

We have three words to describe anxious behavior — avoidance, avoidance, and avoidance. Anxious people inevitably attempt to stay away from the things that make them anxious. Whether it’s snakes, heights, crowds, freeways, parties, paying bills, reminders of bad times, or public speaking, anxious people search for ways out.

In the short run, avoidance lowers anxiety. It makes you feel a little better. However, in the long run, avoidance actually maintains and heightens anxiety. One of the most common and obvious examples of anxiety-induced avoidance is how people react to their phobias. Have you ever seen the response of a spider phobic when confronting one of the critters? Usually, such folks hastily retreat.

Finding anxiety in your body

Almost all people with severe anxiety experience a range of physical effects. These sensations don’t simply occur in your head; they’re as real as this book you’re holding. The responses to anxiety vary considerably from person to person and include:

 ✓ Accelerated heartbeat

 ✓ A spike in blood pressure

 ✓ Dizziness

 ✓ Fatigue

 ✓ Gastrointestinal upset

 ✓ General aches and pains

 ✓ Muscle tension or spasms

 ✓ Sweating

Copyright © Charles H. Elliot, PhD, Laura L. Smith, PhD – Originally appeared in Overcoming Anxiety for Dummies 2nd editionby Charles H. Elliot, PhD, Laura L. Smith, PhD

WHAT DOES ANXIETY CAUSE YOU?

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Obviously, if you have a problem with anxiety, you experience the cost of distressed, anxious feelings. Anxiety feels lousy. You don’t need to read a book to know that. But did you know that untreated anxiety runs up a tab in other ways as well? These costs include

 ✓ A physical toll: Higher blood pressure, tension headaches, and gastrointestinal symptoms can affect your body. In fact, recent research found that certain types of chronic anxiety disorders change the makeup of your brain’s structures.

 ✓ A toll on your kids: Parents with anxiety more often have anxious children. This is due in part to genetics, but it’s also because kids learn from observation. Anxious kids may be so stressed that they can’t pay attention in school.

 ✓ Fat!: Anxiety and stress increase the stress hormone known as cortisol. Cortisol causes fat storage in the abdominal area, thus increasing the risk of heart disease and stroke. Stress also leads to increased eating.

 ✓ More trips to the doctor: That’s because those with anxiety frequently experience worrisome physical symptoms. In addition, anxious people often worry a great deal about their health.

 ✓ Relationship problems: People with anxiety frequently feel irritable. Sometimes, they withdraw emotionally or do the opposite and dependently cling to their partners.

 ✓ Downtime: Those with anxiety disorders miss work more often than other people, usually as an effort to temporarily quell their distress.

Copyright © Charles H. Elliot, PhD, Laura L. Smith, PhD – Originally appeared in Overcoming Anxiety for Dummies 2nd editionby Charles H. Elliot, PhD, Laura L. Smith, PhD

HOW COMMON ARE ANXIETY DISORDERS?

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Anxiety disorders represent the most common type of mental disorder in the United States, and affect more than 20 million Americans. In addition, about 25% of American adults has suffered intense anxiety at some point. The National Institute of Mental Health (NIMH) has useful data on anxiety disorders in American adults between the ages of 18 and 54. Here is what the NIMH studies reveal:

1.    About 4 million adult Americans (3.6%) are diagnosed with generalized anxiety disorder each year. Many experts believe this disorder is under diagnosed, and estimate the prevalence to be as high as 8-9%.)

2.    Panic disorder affects around 1.7%, or 2.4 million, of American adults. This disorder is much higher in adolescence, and has been estimated any between 3.5% and 9% for this group. Panic disorder tends to peak at 25 years of age. One in three panic sufferers will also develop agoraphobia.

3.    Obsessive-compulsive disorder affects about 2.3%, or 3.3 million, of adults.

4.    Posttraumatic stress disorder (PTSD) occurred in about 3.6% of the population studied, although other community-based studies have found that 8% of the total adult population will be diagnosed with PTSD at some point in life. Whereas PTSD is twice as common in women as in men, it is notable that about 30% of Vietnam veterans developed PTSD after the war.

5.    Estimates of the prevalence of social phobia are difficult to obtain, as most people with this disorder are not diagnosed or treated unless they come in with an additional anxiety disorder. Still, the NIMH studies revealed that 5.3 million of adults, or 3.7%, are diagnosed with this disorder each year.

6.    Agoraphobia affects 2.2%, or 3.2 million, of American adults.

7.    Specific phobias were found in 4.4%, or 6.3 million, of the population studied.

Anxiety disorders are more common in women than men, and women are twice as often diagnosed with panic disorder, agoraphobia, specific phobias, PTSD, and generalized anxiety disorder. These findings may be due, in part, to the tendency for women to seek help more readily for mental health problems. Only obsessive-compulsive disorder and social phobia were found to be equally common in men and women.

Source: The Anxiety Answer Book by Laurie A. Helgoe,PHD, Laura R. Wilhelm,PHD, Martin J. Kommor,MD 

THE LEARNED ASPECTS OF ANXIETY

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Learning to be anxious starts very early in life—in infancy, if not before. You learn to sense (or “pick up”) worry when a parent signals disapproval with gestures such as frowning, tightening the lips or jaw, grimacing, or pointing fingers at you. Anxiety is a very uncomfortable feeling, and being around an anxious person can make you feel anxious, too. In this sense, anxiety is contagious.

As an infant, you learned what displeased or created anxiety in your parents, and as a result you fashioned your behavior, and maybe even your personality, to please them. You also acted in the way they approved because it reduced your anxiety—the calmer they were, the calmer you were. You learned the “good me” (what your parents approved of), the “bad me” (what your parents disapproved of), and the “not me” (aspects of living so dreadful or horrifying, at least according to your parents, that they may be dissociated and not remembered in adulthood, even when someone else points them out).

          According to Harry Stack Sullivan, a feeling of anxiety is most apt to occur in situations in which your dignity and prestige are threatened by other people, and from which you are unable to escape. This includes embarrassing or unfamiliar settings. 

Copyright © Carolyn Chambers Clark,ARNP,EDD – Originally appeared in Living Well With Anxiety edition by Carolyn Chambers Clark,ARNP,EDD

WHAT CAUSES ANXIETY?

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Everyone experiences anxiety. It is what makes us more human than otherwise, to paraphrase Dr. Harry Stack Sullivan. This psychoanalyst created The Theory of Interpersonal Relations and taught that much mental suffering is a result of communication that is interfered with by anxiety. According to Sullivan, anxiety is a normal reaction to unmet needs and other stresses, such as disapproval (first from parents and then from oneself or others). Anxiety can also be viewed as a protective mechanism that keeps you safe from situations believed to be threatening.

Whether or not anxiety develops into a chronic condition that interferes with your life depends on your genes, your early family experiences, your ongoing stress (which can affect brain activity), medical conditions, toxins you encounter, and drugs and stimulants you take. Let’s examine these in a little more detail.

1.     Your genes can contribute to anxiety conditions

 if you are born a volatile, excitable, reactive type of person who is easily set off by a threat. In this case, you may be especially prone to panic attacks, which are really just your body overreacting by pouring adrenaline out of your adrenal glands and into your bloodstream. This leads to a racing heart, shallow breathing, profuse sweating, trembling and shaking, and cold hands and feet as your body readies itself to either fight or flee. Since there is no real threat, you are left with the chemical reactions flooding your body. Luckily, the adrenaline released during panic tends to be reabsorbed by the liver and kidneys within a few minutes, and the attack subsides. 

2. Childhood experiences can contribute to anxiety conditions

If you had parents who were overly cautious or critical, if you were neglected, rejected, abandoned, incurred physical or sexual abuse, grew up in a family where one or both parents were alcoholic, or had parents who suppressed your expression of feelings and selfassertiveness.

Jeff, a kindergarten teacher, was sexually abused by his uncle, a pet store owner. Jeff didn’t seem to have any anxiety problems until he turned nineteen, when he developed phobias about animals and heights. He stayed away from high places and animals and was able to complete college and start teaching. Gradually he be came unable to leave his house or even his bedroom. He found a therapist who worked with him until he was able to leave his bedroom and eventually his house. He has returned to teaching but continues to see his therapist monthly as a preventive measure.

3. Cumulative stress over many years has also been implicated in the development of anxiety conditions, and a stressful lifestyle that avoids exercise, healthy nutrition, daily relaxation, social support, and self-nurturing activities can put you at increased risk. Years of heavy smoking often precede anxiety disorders, especially agoraphobia, generalized anxiety, and panic disorder. The connection appears to be impaired breathing ability. Your serotonin level may be involved, especially if you develop obsessive-compulsive traits. There is also a theory that reduced levels of gamma-aminobutyric acid (GABA) can contribute to generalized anxiety. There are numerous medical conditions that can lead to increased anxiety or panic attacks. 

Hyperventilation syndrome is a condition in which you breathe in the upper part of your chest. This results in symptoms very much like panic attacks, including light headedness, shortness of breath, dizziness, trembling, and/or tingling in your hands.

Hypoglycemia, or low blood sugar level, also mimics the symptoms of panic.

Hyperthyroidism (excess secretion of thyroid hormone) can lead to heart palpitations, insomnia, anxiety, and sweating that can add to your normal anxiety.

 Mitral valve prolapsed (a harmless defect in the valve separating the upper and lower chambers of the heart that may cause the heart to beat out of rhythm) occurs more frequently in people who have panic attacks.

Premenstrual syndrome (PMS) can worsen panic attacks.

Inner ear disturbances can lead to dizziness, light-headedness, and unsteadiness,any of which can add to your anxiety.

Other situations that can set off or worsen anxiety or panic include taking stimulants (cocaine, amphetamines, caffeine, aspartame), high blood pressure, exposure to environmental toxins (pesticides, food additives, lead, chlorine, fluoride, or cadmium, for example), heart failure or  irregular heartbeats, clot in the lung, emphysema, deficiencies in vitamins or minerals, concussion, epilepsy, parathyroid disease, Cushing’s syndrome, thyrotoxicosis, and withdrawal from drugs (especially tranquilizers, sedatives, and alcohol).

Panic attacks or phobias (persistent and unreasonable fear that results in a strong desire to avoid a dreaded object, activity, or situation) can also be triggered by past traumatic situations.

 Copyright © Carolyn Chambers Clark,ARNP,EDD – Originally appeared in Living Well With Anxiety edition by Carolyn Chambers Clark,ARNP,EDD

WHAT IS ANXIETY?

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The word anxiety has been used since the 1500s and comes from the Latin word anxius, which means worry of an unknown event. Worry then leads to a state of apprehension and uncertainty, which results in both physical and psychological effects.

         Although you may not know the difference between anxiety and fear, the two terms refer to entirely different feelings. Fear is usually directed at an external danger. The event you fear is identifiable. You may fear stepping off a curb when a car is speeding by at sixty miles an hour, or when a neighbor’s dog suddenly jumps out at you.  Anxiety has no such easily recognizable source and is often called an unexplained discomfort. You may have a sense of danger when experiencing anxiety, but the feeling is vague, and if asked, you may

say your feeling is related to “something bad happening,” or “losing control.”

Anxiety has physical, emotional, mental, and even spiritual effects. Physical effects include shortness of breath, heart palpitations, trembling or shaking, sweating, choking, nausea or abdominal distress, hot flashes or chills, dizziness or unsteadiness. Because anxiety is so uncomfortable, you may convert your anxiety into anger or other feelings. Emotional effects include feelings such as worry, anger, panic, and terror. Mental effects include thinking you’re going to die, or that you’re going crazy or are out of control. Spiritual effects include alienation and feeling detached and out of touch with yourself and others.

Copyright © Carolyn Chambers Clark,ARNP,EDD – Originally appeared in Living Well With Anxiety edition by Carolyn Chambers Clark,ARNP,EDD 

A Traditional Medical Approach May Not Be Enough

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For most anxiety-related conditions, the best that medicine can do is keep some of your symptoms at bay, and even that claim is questionable. The more we learn about the medications used to treat anxiety, the more we learn that these drugs often have unwanted effects that are worse than the anxiety itself.  The root cause of anxiety is rarely—if ever—addressed in a medical model. Only the symptoms are treated. That means you may never learn the source of your anxiety, and, as you may have already discovered, fear of the unknown brings on the worst kind of anxiety. 

You may be fearful your anxiety is untreatable, or that it means you are crazy, or on your way to a lifetime of hospitalization and treatment. You may be  fearful your anxiety may build into dramatically worsening conditions and phobias. You may be fearful that even though you’re learning to deal with your anxiety, you suspect that new symptoms will appear and you will be unable to control them. You may be fearful that for the most part, doctors, unless they

are psychiatrists, think you’re faking it, or that your problems are all in your head. You may be fearful because most doctors don’t have an answer when you ask if your anxiety is going to affect your family, work, and friends. You may be fearful that, over time, your anxiety is going to lead to other, more dangerous, conditions such as heart attacks, suicide, or even cancer. You may be afraid that you will never be able to overcome your anxiety, that you cannot stop its inexorable march as it seems to envelop and overtake every facet of your life. You may be afraid that there are no answers, no cure, no respite from the discomfort you feel and that no one really understands what you’re going through.

Rest assured, there are answers, and there are ways you can learn to reduce your anxiety.

               You just aren’t likely to hear them from the typical HMO or primary-care physician, who may not even recognize or diagnose your condition, much less know how to treat it, especially now that typical HMO appointments are mandated to end in fifteen minutes or less. You may not be able to obtain an answer from the average psychiatrist, either. These doctors must rush through dozens of patients a day, prescribing drugs and monitoring their effects. They simply won’t have the time, and sometimes don’t have the know-how, to  delve into the complicated and connected conditions anxiety evokes. And even those medical doctors who consider themselves experts in treating anxiety rarely venture into the uncharted territory of dealing with the source of anxiety. Most are content to focus on treating the symptoms of anxiety, not the source. They are comfortable prescribing anti-anxiety drugs, but ask these doctors how to help you remove the source of your anxiety and they will probably  draw a blank.

Copyright © Carolyn Chambers Clark,ARNP,EDD – Originally appeared in Living Well With Anxiety edition by Carolyn Chambers Clark,ARNP,EDD  

WHAT IS IT?

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Anxiety conditions are the number-one mental health problem among American women and are second only to alcohol and drug abuse among men. The frequency of anxiety is also increasing among children, and it contributes to decreased social connectedness(divorce ,living alone, decreased birthrate, marriage later in life). Increases in physical or psychological threats (violent crime, worry about nuclear war, fear of diseases such as AIDS, and the entrance of more women into the workforce) are identified as significant factors in the upswing of anxiety. 

Approximately 10 percent of the population of the United States, or more than 30 million people, suffer from anxiety disorders each year, yet only a small proportion receive treatment. Many who suffer from high anxiety are too embarrassed or ashamed to discuss their anxieties.

Let’s take a look at some of the varied conditions that result from

uncontrolled anxiety.

1.     Hillary wakes up every night a couple of hours after going to sleep,

her heart racing, feeling dizzy, with a tightness in her throat, and fearful something terrible is going to happen.

2.     Joe just got a promotion because of his Internet sales ability. Now

he must contribute to group sales meetings and he knows he’s going

to be tongue-tied, stammer instead of speak coherently, and get so restless he won’t be able to sit still.

3.     Ruth, a bank teller, has been forcing herself to go to work, and once she gets there, she’s afraid she might say or do something silly, and want to leave.

4.     Adam just entered college, and he’s afraid to speak up in class, even though he knows the answer, and he freezes when he has to take a written exam.

5.     Sylvia was raped a year ago. She continues to have repetitive distressing

thoughts about the event, as well as nightmares, flashbacks, and emotional numbness.
Copyright © Carolyn Chambers Clark,ARNP,EDD – Originally appeared in Living Well With Anxiety edition by Carolyn Chambers Clark,ARNP,EDD