Riverview Psychiatric Center

Psychology Articles by Dr. Arthur Dingley - Living With Anxiety

Dr. Art Dingley

Fear is good. It keeps us out of harm’s way. But what if we’re afraid of things that aren’t really dangerous? That’s anxiety. There are a surprising number of ways to be inappropriately fearful. Psychiatrists find it helpful to think about anxiety in categories. We call these, “anxiety disorders”.

Generalized Anxiety Disorder consists of chronic worrying and ruminating about events or activities. The person cannot stop worrying. She worries about the past and the future. She is restless, wound up, tired, and irritable. She can’t concentrate and her mind goes blank. She forgets things. She can’t relax and has trouble falling asleep. She may become depressed. Most people who develop Generalized Anxiety Disorder report that they have been anxious for many years, often from childhood. About three percent of the population have Generalized Anxiety Disorder.

Chronically anxious people may develop Panic Disorder, consisting of recurrent unexpected panic attacks. Panic attacks almost always occur when a chronically anxious person becomes intently focused on some normal bodily sensation, like increased heart rate from climbing a flight of stairs. He misinterprets this sensation as a sign that something is wrong. His fear then increases the physical sensation, which further amplifies the fear. In this way, intense fear builds quickly, accompanied by heart palpitations, sweating, shaking, shortness of breath, nausea, and dizziness. The person may feel that he is having a heart attack or is dying. Some people begin to associate their panic attacks with certain places or activities. When that happens, they begin to avoid things, and they become isolated. About one or two percent of people have Panic Disorder.

Phobias are intense unreasonable fears of specific objects or situations. The individual recognizes that the fear is excessive and unreasonable, but is unable to “talk herself out of it”. The person may experience a panic attack, but only when confronted by the one thing she fears. Common phobias include fear of certain animals, snakes, spiders, insects, heights, enclosed spaces, and flying, but the list is almost endless. A person with a Phobia will go to great lengths to avoid the object or situation she fears. She may drive miles out of her way to avoid crossing a high bridge, or climb many flights of stairs to avoid an elevator. Phobias most often begin in childhood, although people in their twenties are also prone to developing Phobias. About ten percent of the population has a Phobia.

Social Phobia is a fear of being embarrassed or being the focus of attention. Again, the person recognizes that his fear is unreasonable but cannot “talk himself out of it.” Some people with Social Phobia become fearful in almost any situation where they have to interact with people they don’t know. These folks avoid meeting new people and fear making introductions. They may avoid going to gatherings and avoid going on dates. Job interviews may be extremely difficult. Other people with Social Phobia may only fear having to speak in front of a group. A student with Social Phobia may dread being called upon in class or dread having to make a presentation in front of her classmates. The anxiety which comes with anticipating the feared situation may lead to a self-fulfilling prophecy: the person may be so anxious about having to speak that she forgets what she was going to say. This results in a poor performance and results in actual embarrassment which worsens the Social Phobia. Usually, Social Phobia begins in the teenage years and is continuous. Often, these teenagers were very shy children. About twenty percent of people are very anxious at having to speak in front of a group, but only about two percent of the population are so compromised by this fear that they can be said to have Social Phobia.

This raises an important point: anxiety is not pathological. Everyone has anxiety. In order for a person to be diagnosed with an “anxiety disorder”, his anxiety must be so extreme that it interferes with normal routines such as work, school, relationships, or social functioning. In previous columns, we saw that schizophrenia and bipolar disorder are equally common in men and women. Anxiety disorders, on the other hand, are much more common in women. Panic disorder, for example, is twice to three times more common in women.

Obsessive-Compulsive Disorder (OCD) is another anxiety disorder. It consists of two parts. The first is obsession. Obsessions are persistent disturbing ideas or images. The most common obsessions are thoughts of contamination from shaking hands or touching things, repeated doubts, such as whether the stove has been turned off or the door locked, the need to keep things in exactly the same place, horrific impulses to hurt one’s child or shout obscenities, or inappropriate sexual images. When attempts to suppress these thoughts or images fail, the person may begin to neutralize them with specific behaviors called compulsions, the second feature of OCD. Compulsions are repetitive behaviors, such as hand washing, tapping on things, or repeatedly going home to check the doors or stove.

Compulsions may also take the form of mental acts such as praying, counting, or saying words silently. At some point, the person recognizes that his behavior is excessive and unreasonable but feels compelled to perform his compulsions in order to avoid being flooded with anxiety.

People with OCD often keep it to themselves, feeling ashamed. They may go to great lengths to avoid situations which exacerbate their obsessions, and devise ways to conceal their compulsions. There is a famous comedian with OCD, and a fear of contamination. Last week, I saw him on TV demonstrating how he greets others by bumping knuckles with them “gangsta” fashion, sidestepping the embarrassment of refusing a hand shake.

Again, most people engage in little superstitions and rituals, avoiding things which bring them “bad luck”, and indulging things they believe bring “good luck”. Sailors, brides, and athletes are famous for this. In OCD, however, the distress is extreme. The compulsions consume more than an hour a day or interfere significantly with work, school, relationships, or social activity.

Unlike the other anxiety disorders, OCD is equally common in men and women. One or two percent of the population has OCD.

What makes anxiety disorders worse? Stress from poverty, physical illness, or disrupted relationships always increases anxiety. Alcohol decreases anxiety temporarily, but a major side effect of this drug is depression – the last thing an anxious person needs. People with anxiety disorders must stay away from caffeine. Obviously, illegal stimulant drugs like cocaine and methamphetamine are hugely harmful to people with anxiety disorders. Avoidance of things which increase anxiety always makes it worse in the end. In fact, as long as an anxious person can avoid the things which increase her anxiety, it will never get better.

How are anxiety disorders treated? A particular kind of psychotherapy called cognitive behavioral therapy (CBT) is the best treatment for anxiety disorders. Antidepressant medicines are very helpful for most people with anxiety and the combination of medicine and CBT is more powerful than either alone. One group of antidepressant medicines (SSRIs) takes away about two thirds of the symptoms of OCD. Cognitive behavioral therapy is very helpful for OCD. Using desensitization techniques, the therapist helps the person overcome the need to perform his compulsive rituals.

There is one more important anxiety disorder, Post Traumatic Stress Disorder, which I will treat as a separate topic in a future column.

Dr. Dingley is a psychiatrist at Evergreen Behavioral Services in Farmington. He may be contacted at adingley@fchn.org

Agency information

Riverview Psychiatric Center

Psychology Articles by Dr. Arthur Dingley - Living With Anxiety

Featured links

RPC news