< PreviousAnxiety disorders can cause a heavy burden of illness for those who suffer from them. Anxiety can shrink your world as avoidance begins to take over. When an individual avoids situations or places as a way of trying to prevent future experiences with anxiety, they may find temporary relief. Unfortunately, anxiety will recur, and the person now finds themselves avoiding new situations. Avoidance just breeds more avoidance until the person becomes severely impaired or even housebound. The individual is fearful of trying new things or meeting new people. This cycle erodes self-confidence and self-esteem. Social withdrawal may occur. Changes to one's thinking become common. The individual predicts failure or catastrophic outcomes rather than telling themselves that success is possible. The brain begins to find more situations or people to fear and worry about. In other words, fears become more generalized. Indecisiveness and difficulty making decisions can be frequent problems. Emotional consequences of this worry cycle may ensue, and depression, hopelessness, and discouragement prevail. Irritability can be common which can negatively impact relationships. In other cases, the person may become increasingly dependent on family or a partner leading to relationship stress. Anxiety can result in conditioned responses. Just the thought of the feared situation or object can produce a cascade of physical sensations which are unpleasant or even frightening to the individual. Preoccupation with physical illness may be present. The individual may frequent their doctor's office in search of an answer for the symptoms and may undergo expensive workups. Unfortunately, some individuals turn to very unhealthy coping strategies to manage the symptoms of anxiety. Avoidance of every feared situation is common. Excessive use of alcohol or drugs may result in abuse or physical dependence. When anxiety disorders overwhelm our normal coping mechanisms, every area of life can be impacted. Emotions, cognition, and behaviors are affected and associated with changes that make effective functioning impaired. Anxiety is no longer a normal, adaptive emotion but a pathological condition that needs treatment. The Burden on Anxiety: Functional Impairment 7Perfectionists make very high demands and set high standards. They push hard to meet their self-determined standards. While they may make demands on others, they often place the most demands on themselves. This can leave them feeling very frustrated and sad if they fall short of their intended goal. They struggle with anxiety whenever they fear not meeting the high, uncompromising standards that they set. Perfectionists share common traits: • They often think in terms of "should" and "must" • Blame is assigned when the target is not achieved • Assume that everyone around them will follow their self-imposed rules and express anger or disappointment when they do not meet their goal. • They have a rigid sense of rules about how the world operates • The often view the world in a black-and-white way. Things are viewed as all good or all bad but there is no in-between. • They often exhibit catastrophic thinking-in other words, they predict failure and disaster. • Perfectionists are very susceptible to developing problems with anxiety.Some fears are quite common in children. Things such as fears about animals or being in the dark are often present in early childhood, but most children overcome these fears as they grow without treatment. When these fears grow and continue to inhibit a child's progress, they may need professional help. Anxiety disorders often have an early onset in childhood or adolescence. Some forms of anxiety disorders common in childhood include separation anxiety disorder, selective mutism, and phobias. Separation anxiety disorder may be a forerunner of panic disorder in adulthood. Over The Lifespan Children: 9As individuals age, they may face medical conditions and treatments that may make them more vulnerable to anxiety. Grief, loss, social isolation, changes in living situations, and role changes as people exit the workforce can cause stress and worry. Young adult years have pressures associated with entering the job market and successfully living independently. They also must navigate social and dating relationships that may come with rejections and disappointments. Taking on new roles such as that of a spouse or a parent brings new challenges and worries. Adolescence is a challenging time of development. Teens are already grappling with their identity, sense of self, emotional regulation, and preparing to take on adult roles and responsibilities. They are developing social skills and problem-solving skills. The process of acquiring these skills and internal abilities is not always a smooth one. Adolescence is a period of development when individuals can be very vulnerable to social pressures, environmental influences, and emotional struggles. It is not surprising that for many teens, anxiety is a problem. Young adults must transition from home into independent living. Not every young adult is ready for this task. They face educational and employment challenges. They must navigate relationships. This is another vulnerable time in development. When such transitions are not successfully navigated, anxiety and depression can be a consequence. Older Adults:Young Adults: Adolescents: 10Anxiety disorders are the most common mental health disorders. Anxiety disorders often occur alongside other disorders. Some of the commonly co-occurring illnesses include: • Other anxiety disorders • Major Depressive Disorder • Dysthymic Disorders (chronic depression) • Obsessive Compulsive Disorders • Somatoform Disorders • Substance Use Disorders • Trauma-related disorders such as PTSD • ADHD • Eating Disorders Patients with anxiety disorders often present to emergency rooms or their PCP office because of the physical manifestations of anxiety such as shortness of breath, heart palpitations, dizziness, trembling, shaking, excessive sweating, and stomach aches. Additionally, many medical conditions, or their treatments, can cause a patient to feel very anxious including: • Thyroid Disorder • Periods of hormonal change such as menopause • Lung diseases such as asthma and COPD • Cardiovascular illness: arrhythmias, chest pain, fear after a cardiac event • Irritable Bowel Disorder • Cushing's Disease • Migraine • Neurological illnesses • Pain Disorders •Medications: steroids, bronchodilators, weight loss medications, decongestants Treatment outcomes can be less favorable- requires a comprehensive approach to care that addresses both conditions Anxiety complicates the treatment of depression-often requires more than one type of treatment to be successful. Anxiety often predates the onset of the depressive illness. 11Patients who have co-occurring anxiety and depression often have a longer duration of episodes of depression. Patients with Treatment-Resistant Depression should be evaluated for anxiety disorders and symptoms Early intervention is vital to improving your overall health Suicidal thoughts may be more common Patients with both anxiety and depression often have more co-occurring medical problems 12Twin studies have also suggested susceptibility to specific phobias. About one-third of the risk for the development of generalized anxiety disorder is thought to be genetic. Heritability is quite high for agoraphobia. Medications and over-the-counter products can play a role in triggering anxiety. Additionally, overuse of alcohol or other drugs can trigger anxiety. Withdrawal from alcohol and drugs often is associated with pronounced anxiety symptoms. In addition to the illnesses described above which may cause anxiety, any period of severe or prolonged illness may present many stresses that can leave a person vulnerable to anxiety. Cancer diagnosis and treatment is a common example as fear of death, disfigurement, pain, and complications of treatment present many challenges. What are the Causes of Anxiety? There is convincing evidence from family and twin studies to suggest that inheritance may play a role in the development of anxiety disorders. Studies have identified children with traits of high behavioral inhibition may be more susceptible to environmental stresses or behavioral modeling by parents. Relatives of a patient with Social Anxiety Disorder are 2-6 times more likely to develop the disorder. Patients with anxiety sensitivity, negative affectivity, behavioral inhibition, or harm reduction traits are at greater risk for panic disorder. Family history of parents with anxiety, depression, or bipolar disorder may increase the risk for panic disorder among children. Twin studies have demonstrated high heritability for separation anxiety disorder, a disorder that often heralds panic disorder later in life. 13Stress is a part of life. Everyone encounters stress. Not everyone has the same tolerance for stress nor develops the same skills in managing stress. When life stresses are very severe, especially early in life, the burden of the stresses may overwhelm the capacity of the individual to cope. Certain types of stress have been associated with increasing a person's vulnerability to stress. In childhood, being the victim of bullying, the loss of a parent, or trauma can increase one's likelihood of developing anxiety. Childhood maltreatment and adversity have also been identified as increasing the risk for anxiety disorders. A history of trauma, childhood adversity, and stressful life experiences are frequently reported by individuals who suffer from panic disorder. When a person's coping mechanisms are overwhelmed, they may turn to less adaptive ways of coping. Among teens this could appear as deliberate self-injury, fighting with family members, developing reliance on a less desirable peer group, or experimentation with drugs or alcohol. Young adults as well as teens may withdraw socially and be unwilling to take steps toward individuation and independence. For all ages, overuse of medications, drugs, and alcohol represents a serious risk for those with poorly managed or untreated anxiety disorders. When a person experiences an unpleasant reaction or a negative outcome associated with an event or a social interaction, they try to find a reason for it. They may make assumptions as to the cause of any unpleasant symptoms. Often these assumptions are based on connections between an event, the time, and the onset of symptoms. For example, if someone was in an elevator at the time they experience a panic attack, they may associate the event with the elevator. They now decide that elevators are unsafe. Therefore, the individual now believes that any future exposure to an elevator will result in the development of panic symptoms. 14 Patients who suffer from anxiety develop cognitive distortions, also known as automatic negative thoughts. Automatic negative thoughts drive worries about future symptoms and play a prominent role in the development of behaviors such as avoidance that drive disability and impairment Cognitive DisordersTraumatic experiences can both make a person vulnerable to developing an anxiety disorder and may cause significant symptoms in response to the traumatic event(s). A history of physical, emotional, or sexual abuse puts an individual at higher risk of developing an anxiety disorder. Such experiences leave the individual unable to trust important figures who should protect and care for the child. The child grows up feeling unsafe, vulnerable, fearful, and often is unable to develop skills for emotional regulation. Victims of sexual assault have high rates of subsequent anxiety symptoms. The same is true for victims of physical assault. People who live in areas of severe social unrest, war, or high crime may also be quite vulnerable. Immigrants who leave behind homes, jobs, families, culture, and support systems may face significant adjustment challenges and may exhibit problems with anxiety. Social determinants of health may play a role in the development of anxiety disorders. When an individual grows up in an environment that is unsafe (gang violence, domestic violence, war) they naturally will be in a state of heightened awareness to danger. If an individual lacks safe housing or experiences food insecurity, it is difficult to have the support required to develop strong emotional regulation. When a stressful situation such as being in legal jeopardy arises, anxiety may be common. Loss of a job and facing financial insecurity for oneself or one's family can rapidly increase an individual's anxiety levels.Anxious BrainHealthy Brain The fear center in the brain is the amygdala. Once the brain recognizes danger or threat, the amygdala signals the nervous system and the sympathetic nervous system is activated. The adrenal glands begin to respond to the signal by releasing epinephrine, signaling the body to prepare to flee or to fight. Stress can cause alterations in the amygdala. The Hypothalamic Pituitary Axis (HPA) is the central area that controls the stress response. Under stress, the HPA becomes hyperactive. Stress hormones such as cortisol are released and can induce changes in the amygdala. The amygdala can become hyperactive, leaving the individual susceptible to stress-related disorders such as anxiety and depression.Next >