Anxiety and its Disorders
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Disorders Causing Anxiety and Worry and Their Treatment
1. Defining Terms: You may be worrying too much, or too little, it may be bad, it may be good. Let’s first define our terms. Anxiety is defined as fear of the unknown, with fear you know what it is that that you’re afraid of, worry seems to a combination of both. Worry, anxiety and fear, like pain or any discomfort are there for a reason to warn you that something is wrong with your body, mind or environment and you need to do something about it, to continue to have pleasure, to avoid more discomfort, and to literally survive. This is why too little or no worry, anxiety, fear, pain and other discomforts is a bad thing.
2. Two Kinds of Biological Based Anxiety: Worry which we know is necessary for pleasure, to avoid pain and to ensure survival of self and the species. It seems to come in two forms a more mild general free floating surveillance type, that gives a general mild warning and one that is more severe, sharper in focus, that can have a attack like quality, giving an intense specific warning. When the brain chemistry that control these feelings is out of balance mental health problems may occur, like General Anxiety Disorder [GAD], representing the free floating type, and Panic Disorder for the attack like worry.
3. Brain Chemistry or Environment: Worry and anxiety problems like all mental health problems are a combination of nature and nurture, everything has a biological basis, with brain chemistry causes, and is also conditioned by the environment, and learned. The more biology involved, the more a medication may help, the more it is environmental non medication approaches are appropriate. In severe and long lasting anxiety problems both are needed. The ideal and optimal treatment should be biopsychosocial and above all educational. Especially in anxiety disorders, anxiety being the fear of the unknown, the more you know ,the better you will do. Really knowing in itself is therapeutic. One way of really knowing is through mindfulness meditation, which will be also discussed as both a diagnostic and therapeutic tool.
4. Anxiety Wears Many Masks: Anxiety Disorders in all of its forms, generalized, a specific fear, or panic like can occur at any age and be disguised as any other mental health disorder, or any physical disorder. Examples are some forms of: Infantile Colic, Temper Tantrums, Separation Anxiety, Disruptive Behaviors at home or school, especially ADHD look alkies’, Learning Problems, School issues of Refusal, Absences, Avoidance, and Truancy, Drug, Alcohol, Cigarette abuse and dependence, Eating Disorders, Schizophrenia, Bipolar Disorder, resistant treatment Depression, Tourette’s and Tic Disorders, Irritable Bowel, Gastric Reflux, and other GI problems , Hives, itchiness and skin rashes, speech problems like Stuttering, Headaches, Back and Neck Pain, Chronic Fatigue, Seizures, to name some.
5. Rule Out and Treat all other Causes: People who worry too much may have more than one Anxiety Disorder including Generalized Anxiety Disorder, but first all physical and other mental health disorders, including medications prescribed and over the counter, drugs and alcohol must be ruled out and treated. Once this is done and you are still having the problems listed above either they are caused in part or totally by excessive anxiety and worry, and or you may have an undiagnosed or untreated Anxiety Disorder.
6. Anxiety Disordered People Under report Symptoms: People with anxiety disorders are quiet shy passive, fearful by nature, often ashamed , self conscious, and guilty and tend to under report anxiety symptoms, that might explain their other problems or symptoms, even when asked, thus never get treatment, and when they do often for the same reasons get improper or inadequate treatment. Some of these underreported symptoms are: many physical complains considered normal like sleep problems, headaches, other aches and pains considered not significant, panic attacks and their physical manifestations, stage fright, social anxiety, especially obsessions and compulsions.
7. More History From Others is Needed: Some of these problems can only be gotten from another historian who knows the patient well, like a parent, spouse, other close relative friend, other professional, co worker, co student, teacher etc,. The evaluating health professional must be aware of this and gently dig for the unreported problems, or lack of adequate response from treatment. People rather have something physical rather than mental or emotional, if emotional, talk about anything but your shameful, embarrassing anxiety related symptoms, it is built in the nature of the diagnosis to not or under report anxiety symptoms, who wants to admit their afraid, especially in our culture, a boy or man, or anyone in a position of authority.
8. Mental Health Problems that Look Like Anxiety Disorders: Certain diagnoses have strong components of worry, avoidance , fears, phobias, anxiety and panic like attacks, and if not diagnosed properly the wrong medication will be given with bad results. Sometimes the bad result is caused by the medication itself being the problem. Among these are Bipolar and Unipolar Depressions, Attention Deficit Hyperactivity Disorder, Schizophrenia and other Psychoses, Autistic Spectrum Disorders, Tourette’s and other Movement Disorders, Neurological Disorders, Medical Disorders with Anxiety , Medication/Alcohol, Abuse able Substance Induced Anxiety, Psychotropic Medications, Environmentally Related Adjustment, and Learning Disorders.
9. First Treat the Primary Disorder or Problem with its Medication or Intervention of Choice. This usually eliminates most of the anxiety symptoms, and equally importantly it allows successful treatment secondarily with a traditional anxiety medication, without making the primary problem worse. The other way around may initially seem to help, but only in the short run, and may destabilize the primary condition. For example mood stabilizers for Bipolar, neuroleptics for Schizophrenia, adjust seizure medication for a Seizure problem, eliminate the offending medication or drugs of abuse the may be causing the anxiety, get remedial education for the learning disordered child, and so on.
10. DSM Classification of Anxiety Disorders: a. Panic Disorder one has recurrent, unexpected Panic Attacks and there is persistent concern about having another attacks causing a significant change in behavior, if with Agoraphobia avoidance of situations associated with attacks. b. Social Anxiety Disorder fear of social situations where one might be scrutinized and embarrassed. C. Obsessive Compulsive Disorder has recurrent, persistent, intrusive thoughts, or failure to perform rituals correctly causes anxiety, d. Post Traumatic Stress Disorder anxiety , fear, increased arousal around re experiencing and avoiding a severe trauma, e. Specific Phobia has extreme fear around a specific feared object, f. Generalized Anxiety Disorder is unfocused free floating anxiety about multiple things that is difficult to control, g. Anxiety Disorder Not Otherwise Specified not fitting any of the above.