In everyday contexts, anxiety is a term used to describe uncomfortable and unpleasant feelings that an individual experiences when in stressful or fearful situations. As an emotion, it is characterized primarily by feelings of dread, worry, fear and apprehension. The experience of anxiety can best be understood on a continuum from a normal, adaptive response, to the demands of a hectic life full of pressures, deadlines and stress, to a more severe form which disrupts a person’s daily functioning. Anxiety is a normal phenomenon which is characterized by a state of apprehension or unease arising out of anticipation of danger. Anxiety is differentiated from fear, as fear is an apprehension in response to an external danger while in anxiety the danger is largely unknown (Ahuja, 2002). A certain amount of anxiety is considered essential to get a person to perform at his/her highest levels of efficiency and productivity, but beyond a point it adversely affects both these. Thus, anxiety may be a positive or negative condition in a person though it generally originates as a symptom of Psychiatric disorders (Veeraraghavan, V. & Shalini, S., 2002).
Anxiety is the commonest psychiatric symptom in clinical practice and anxiety disorders are one of the commonest psychiatric disorders. In other words Anxiety disorders are possibly the most common and frequently occurring mental disorders. Normal anxiety becomes pathological when it causes significant subjective distress and/or impairment in functioning of the individual. It can disrupt a person’s ability to concentrate and cause hyperventilation, a racing heart, chest pains, dizziness, panic, and extreme fear. As mentioned earlier, Anxiety, which may be understood as the pathological counterpart of normal fear, is manifest by disturbances of mood, as well as thinking, behavior and physiological activity. According to National Institute of Mental Health, anxiety disorders are the most common type of mental illness in the U.S.A., with approximately 40 million people over the age of 18 affected each year. Anxiety disorders not only are common in the United States, but they are ubiquitous across human cultures (Chugh S., 2001; Regier et al., 1993). The term “Anxiety disorder” is given to the state of a person where persistent feelings of apprehension, tension, or uneasiness are the predominant disturbance. Anxiety disorder is a blanket term covering several different forms of fear, phobia and nervous condition that come on suddenly and prevent pursuing normal daily routines. Anxiety disorders include General anxiety disorder, Social anxiety sometimes known as “social phobia” or “social anxiety disorder” (SAD), Specific phobias, Obsessive-compulsive disorder, Agoraphobia, Claustrophobia, Panic disorder, Separation anxiety disorder, Post-traumatic stress disorder, Acute stress disorder, Anxiety due to a general medical condition and Substance induced anxiety disorder. The characteristics of an anxiety disorder include
- Anxiety which is constant, unrelenting, and all-consuming
- Anxiety which causes self-imposed isolation or emotional withdrawal
- Anxiety which interferes with normal activities like going outside or interacting with other people. (Smith M.,2006)
Anxiety disorders frequently co-occur with other psychiatric disorders such as depression, schizophrenia etc and disorders such as Eating disorders and the like. We would look more into disorders such as Obsessive-compulsive disorder and Eating disorder at a latter stage.
Symptoms of anxiety disorders.
The primary symptoms of anxiety disorders are fear and worry. However, anxiety disorders are also characterized by additional emotional and physical symptoms.
Emotional/psychological Symptoms.
· Apprehension, uneasiness, and dread
· Behavioral problems (especially in children and adolescents)
· Impaired concentration or selective attention
· Nervousness and jumpiness
· Feeling restless or on edge
· Self-consciousness and insecurity
· Avoidance
· Hyper vigilance
· Irritability and confusion
Physical Symptoms.
· Heart palpitations or racing heartbeat
· Sweating and Dizziness and Chest pain
· Tremors, twitches and jitters
· Hot flashes or chills and Headaches
· Cold and clammy hands
· Fatigue and Insomnia
· Stomach upset and frequent urination or diarrhea
· Shortness of breath
Causes of Anxiety disorders.
There are a number of complex factors that contribute to the development of anxiety disorders. Our environment, personality, family dynamics, brain chemistry and genetics all can play a role. In addition, major life stressors such as financial difficulties, marital problems, or bereavement often trigger the onset of an anxiety disorder.
Environmental factors.
A person’s environment can play a huge role in the development of anxiety disorders. Difficulties such as poverty, early separation from the mother, family conflict, critical and strict parents, parents who are fearful and anxious themselves, and the lack of a strong support system can all lead to anxiety disorder.
Personality traits.
Personality differences can affect whether or not an anxiety disorder develops. People with anxiety disorders often view themselves as powerless and the world as a threatening place. This pessimistic perspective can lead to low self-confidence and poor coping skills.
Brain Chemistry.
Some studies suggest that an imbalance of neurotransmitters such as serotonin, GABA (Gamma amino butyric acid), and Norephinephrine may contribute to anxiety disorders. GABA is the most prevalent inhibitory neurotransmitter in the central nervous system. (Ahuja, 2002)
Heredity.
Anxiety disorders tend to run in families. People with anxiety disorders often have a family history of anxiety disorders, mood disorders, or substance abuse. Although this is often due to the home environment, researchers also believe that there are genetic factors which represent an inherited risk for anxiety disorders.
Trauma.
An anxiety disorder may develop in response to a traumatic event, such as a car accident or a marital separation. Anxiety may also have its roots in early life abuse or developmental trauma. Trauma in infancy and early childhood can be particularly damaging, leaving a pervasive and lasting sense of helplessness that can develop into anxiety or depression in later life. (Smith M., 2006)
At this stage I would like to take a deep look at two of the major disorders which I mentioned earlier namely Obsessive-Compulsive disorders and Eating disorders.
Obsessive-Compulsive Disorders (OCD).
Obsessive-Compulsive Disorder (OCD) is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as an Anxiety Disorder. Obsessions are recurrent, intrusive thoughts, impulses, or images that are perceived as inappropriate, grotesque, or forbidden (DSM-IV). An obsession is defined as an idea, impulse or image which intrudes into conscious awareness repeatedly. These thoughts, impulses, or images are not simply worries about real-life problems. The person tries to suppress or ignore such thoughts, impulses or images but the more the person resists these thoughts, the greater is the intensity with which they reappear. (Veeraraghvan, V. & Singh, S. 2002). The obsessions which elicit anxiety and marked distress are recognized as one’s own idea but are termed “ego-alien” or “ego-dystonic” because their content is quite unlike the thoughts that the person usually has (Ahuja, N., 2002; U.S. Department of Health and Human Services, 1999). Obsessions are perceived as uncontrollable, and the sufferer often fears that he or she will lose control and act upon such thoughts or impulses. Failure to resist these Obsessions leads to marked distress.
Compulsions are repetitive behaviors or mental acts that reduce the anxiety which accompanies an obsession or “prevent” some dreaded event from happening (DSM-IV). The person is faced with an irresistible desire to do something repetitively although he knows that it is unwanted, irrational and irrelevant. Compulsions include both overt behaviors such as hand washing or checking, and mental acts including counting or praying. A person who suffers with Obsessions and Compulsions may try to avoid the situations which would increase his/her anxiety. Dan J. Stein characterizes Obsessive-Compulsive Disorders as intrusive thoughts that increase anxiety and ritualistic behaviors or mental acts that serve to decrease anxiety (Stein D.J & Hollander.E., 2002)
Prevalence.
Obsessive-Compulsive Disorder (OCD) is an example of the positive impact of modern research on mental disorders. As recently as in the 1980s, OCD was considered an uncommon disorder, hardly responsive to treatment, whereas it is now recognized to be more prevalent than previously believed and often very responsive to treatment (Maj M. et al., 2002). Current epidemiological data suggest that OCD is the fourth most common mental disorder (Kaplan H.I., Sadock B.J. & Grebb J.A. (Eds), 1994). OCD appears to be the tenth most disabling of all medical conditions (Murray & Lopez, 1996). Lifetime prevalence rates of OCD vary considerably between countries. Recent studies show the life-time prevalence of OCD to be as high as 2-3% (Ahuja N., 2002). The lowest rates were observed in Taiwan (Yeh E.K., et al, 1985) varying between 0.5% and 0.9 % and in India where the prevalence was 0.6 % (Kanna S., et al, 1993). In North and central Europe, the lifetime prevalence rates ranges between 2.6% and 3.2% (Degonda M, et al., 1993). OCD typically begins in adolescence to young adult life in males and in young adult life in females (DSM-IV). A summary of long-term follow-up studies shows that about 25% remained unimproved over time, 50% had moderate to marked improvement while 25% had recovered completely (Ahuja N, 2002.).
Researchers have classified OCD into four clinical syndromes such as Washers, Checkers, Pure Obsessions and Primary Obsessive Slowness. Washers are the commonest type and here the obsession is of contamination with dirt, germs, body excretions and the like. The compulsion is washing of hands or the whole body, repeatedly many times a day. It usually spreads on to washing of clothes, washing of bathroom, bedroom, door knobs and personal articles gradually. The person tries to avoid contamination but is unable to, so washing becomes a ritual.
The next common syndrome of OCD is the Checkers. In this type, the person has multiple doubts, (e.g). the door has not been locked, counting of money was not exact, kitchen stove has been left open, etc. The compulsion of course is checking repeatedly to remove the doubt. Any attempt to stop the checking leads to mounting anxiety. Before one doubt could be cleared, other doubts may creep in.
Pure obsessions are the next clinical syndrome classified as part of OCD. This syndrome is characterized by repetitive intrusive thoughts, impulses or images which are not associated with compulsive acts. The content is usually sexual or aggressive in nature. The distress associated with these obsessions is dealt with by counter-thoughts (e.g. counting).
A relatively rare syndrome, Primary Obsessive Slowness is characterized by severe obsessive ideas and/or extensive compulsive rituals, in the relative absence of manifested anxiety. This leads to marked slowness in daily activities.
Causes of Obsessive-Compulsive Disorders.
The old belief that OCD was the result of life experiences has been weakened before the growing evidence that biological factors are a primary contributor to the disorder. The fact that OCD patients respond well to specific medications that affect the neurotransmitter serotonin suggests the disorder has a neurobiological basis. For that reason, OCD is no longer attributed only to attitudes a patient learned in childhood–for example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Instead, the search for causes now focuses on the interaction of neurobiological factors and environmental influences, as well as cognitive processes.
In an effort to identify specific biological factors that may be important in the onset or persistence of OCD, NIMH-supported investigators have used a device called the Positron emission tomography (PET) scanner to study the brains of patients with OCD. Several groups of investigators have obtained findings from PET scans suggesting that OCD patients have patterns of brain activity that differ from those of people without mental illness or with some other mental illness. There is also evidence that treatment with medications or behavior therapy induce changes in the brain coincident with clinical improvement.
Also, recent preliminary studies of the brain using Magnetic Resonance Imaging (M.R.I.) showed that the people with obsessive-compulsive disorder had less white matter than people with no mental disorders, suggesting a widely distributed brain abnormality in OCD. All these findings lead us to the fact the Obsessive Compulsive Disorder is caused by the biological factors that affect our brains (Understanding OCD, 2003).
Eating Disorders.
Eating is controlled by many factors, including appetite, food availability, family, peer, and cultural practices, and attempts at voluntary control. Dieting to a body weight leaner than needed for health is highly promoted by current fashion trends, sales campaigns for special foods, and in some activities and professions. Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, at some point move beyond control in some people and develop into an eating disorder. Eating disorders involve severe disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight (Gilbert S., 2005).
Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa (American Journal of Psychiatry, 2000) A third type, binge-eating disorder, has been suggested but has not yet been approved as a formal psychiatric diagnosis (DSM-IV). Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood (Becker, A.E., Grinspooon, S.K., Klibanski & A., Horzog, D.B., 1999). Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia (Andersen, A.E., 1995) and an estimated 35 percent of those with binge-eating disorder (Spitzer, R.L., et al, 1993) are male.
Anorexia Nervosa
The term Anorexia Nervosa is derived from the Greek word anorexia, which literally means “lack of appetite” (Fairburn and Brownell, 2001). But on the contrary to the literal meaning, individuals with anorexia nervosa are always hungry; they are starving; yet they choose to deny their hunger. An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime (American Journal of Psychiatry, 2000).
Symptoms of anorexia nervosa include:
· Resistance to maintaining body weight at or above a minimally normal weight for age and height
· Intense fear of gaining weight or becoming fat, even though underweight.
· Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
· Infrequent or absent menstrual periods (in females who have reached puberty)
People with this disorder see themselves as overweight even though they are dangerously thin. The people with Anorexia Nervosa develop unusual eating habits, such as avoiding food and meals, picking out few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period. The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse; and others experience a chronically deteriorating course of illness over many years. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population (Sullivan, P.F., 1995). The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.
Bulimia Nervosa
The term Bulimia Nervosa is derived from the Greek word boulimia, which literally means “ox hunger” and is thought to symbolize the voracious and insatiable appetite that is characteristic of the disorder (Fairburn and Brownell, 2001). An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime (American Journal of Psychiatry).
Symptoms of bulimia nervosa include:
· Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
· Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise
· The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
· Self-evaluation is unduly influenced by body shape and weight.
Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform their behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.
Conclusion.
Anxiety Disorders such as Obsessive-Compulsive disorder and Eating Disorder may occur to any of us at any stage of our lives. But the good news is that those forms of Anxiety disorders can be treated and cured if diagnosed in an early stage through various forms of therapies such as Cognitive-Behavioral Therapy (CBT), Psychoanalytical Psychotherapy, Relationship therapy and Counseling (Veeraraghavan V. & Singh S., 2002). Also, a healthy and balanced lifestyle can help control and reduce such above mentioned disorders.
Copyright 2006 Jerrickson Daniel. All rights reserved. Reproduction with acknowledgement permitted.May God bless you!
