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Anxiety DisordersWhat Does it Mean to have an Anxiety Disorder?Anxiety is the body and mind’s response to stimuli that creates stress. Stimuli can be external, such as an approaching hurricane, or internal, such as a fear of crossing the street, or unconscious conflicts such as an argument with a family member. An estimated 40 million Americans suffer from anxiety disorders. The DSM-IV-TR® (a medical reference for diagnosing psychiatric disorders) categorizes anxiety into 13 groups. Substance-induced anxiety disorder is discussed at the end of this section. “People with anxiety disorders face an increased risk of developing substance abuse [disorder] if they self-medicate their symptoms with drugs or alcohol, according to a study presented at the Canadian Psychiatric Association 60th Annual Conference…Although drugs and alcohol may alleviate symptoms of anxiety in the short term, there is evidence to show that in the long term they can exacerbate symptoms — particularly panic.” (source: Medscape Today, Canadian Psychiatric Association (CPA) 60th Annual Conference, Kate Johnson, “Risk for Future Substance Abuse for Anxious Patients Who Self-Medicate, 11/10, http://www.medscape.com/viewarticle/729765) Types of Anxiety Disorders
(There are several other forms of anxiety which are not included in the above list and are grouped with childhood disorders or sexual disorders). Anxiety disorders are based on the body’s memory of a trauma. A set of triggers associated with the original trauma set off an alarm within the body. These triggers may be chemically induced (internal) or physically induced (external). If a fire alarm goes off in the middle of the night and you arise terrified, you may develop a phobia around the sound of fire alarms. These phobias can then lead to demoralization (often expressed as depression), discouragement, shame, and unhappiness about the difficulties of carrying out normal routines. Treatment for anxiety disorders can combine medication and behavior therapy. In therapy, patients learn how to manage the triggers, symptoms, and negative worries of anxiety disorder. Panic AttacksPanic attacks are categorized as unexpected, situationally bound, or situationally predisposed. 1. Unexpected panic attacks occur when a person suddenly becomes fear-stricken over something. They believe, in the midst of the panic attack, themselves to be on the verge of losing control or dying. 2. Situationally bound panic attacks are induced by circumstances that confront an individual. The classic example is that of a person who has to give a speech in front of a group and is overwhelmed with anxiety and panic. This type of panic attack is usually associated with another anxiety disorder.
3. Situationally predisposed panic attacks occur when a person experiences or engages in a normal activity, such as reading the newspaper. Upon reading an article about the downturn in the economy, the person’s fear of economic insecurity is initiated. That fear then blossoms into a panic attack. Panic attacks can occur at any time of the day or night. According to the National Institute of Mental Health, they affect more women than men and they seem to have a genetic predisposition. One third of people suffering from panic disorders will become housebound (they will not leave their homes) unless accompanied by a close friend or relative. If the condition is left untreated, it can progress to become agoraphobia. Generally, this condition is tied to substance abuse or alcoholism. Patients who suffer from frequent panic attacks, such as weekly or monthly, often believe that some medical condition, such as a seizure or cardiac disease, is the source of the panic attack. They will seek out multiple medical tests searching for the origin of their condition. Sometimes people who suffer from panic attacks will change everything in their life, but never admit the presence of panic attacks. This denial can lead to avoidance behaviors that create other anxiety disorders such as agoraphobia. Symptoms of Panic AttacksThe foundation of a panic attack is the extreme presence of an intense fear or discomfort that lasts for a specific period; the crucial aspect of the panic attack is the absence of real danger with no clear precipitating event. Some of the symptoms are listed below:
Panic Attacks and Substance Abuse“The risk of a comorbid substance use disorder in patients with panic disorder was 2.4 times higher than that in the general population. Most of the literature examining panic disorder and substance use disorders has focused on alcoholism rather than substance abuse”. (source: Medscape Today, “Review of Comorbidity of Affective, Anxiety, and Substance Use: Anxiety Disorder”, http://www.medscape.com/viewarticle/452725_4) While many people suffering from mental health disorders will attempt to self-medicate, it is also known that certain drugs such as cocaine, marijuana, and other stimulants are able to induce panic attacks in the users. AgoraphobiaAgoraphobia, often coupled with panic disorder, is a fear of being in a place or situation in which escape is embarrassing, difficult, or even impossible. People suffering from agoraphobia tend to stay home, as traveling to work, to the store, or with their children to the doctor’s office may feel overwhelming. This disorder is also seen in people who have a fear of going on planes, being on a bridge, traveling in an automobile, or being in crowds. Signs of AgoraphobiaAgoraphobia means that a patient does not feel safe in public places. To negotiate this fear, a person may become:
Anxiety disorders can co-exist and, as the above list indicates, agoraphobia can be accompanied by symptoms with or without panic attacks. The symptoms for agoraphobia without panic disorder are still severe and include dizziness and diarrhea. The number and severity of the symptoms determines whether anxiety disorders are combined. Substance Abuse and AgoraphobiaIt is estimated that between 5-42% of people suffering from panic and/or agoraphobia have problems with substance abuse. The large variable is attributable to withdrawal symptoms as well. Researchers have found higher rates of panic disorder and agoraphobia among alcoholics than among substance abusers. Another issue that impacts treatment for panic and agoraphobia is the addictive nature of some of the drugs prescribed. Benzodiazepines do bring relief for certain anxiety disorders, however, if a person is already addicted to substances, this class of drugs is dangerous. Specific PhobiasSpecific phobia must be a persistent fear. The fear is centralized around an object or situation. This type of anxiety disorder is the most common of all psychiatric disorders. Individuals with specific phobias avoid that of which they are fearful. The avoidance behaviors can interfere with a person’s daily life, occupational functioning, or social life (these avoidance behaviors are the criteria for such a diagnosis). In this anxiety disorder category, the patient usually acknowledges that the fear is excessive and unreasonable. According to the DSM-IV, these types of phobias usually occur with other anxiety disorders, mood disorders, and substance-related disorders. Common specific phobias:
Specific Phobias and Substance Abuse
According to recent studies, 7.13% of those studied for dual diagnosis disorder suffered from substance abuse and a specific phobia. However, the figure for substance-related disorders (those using drug or alcohol who experienced symptoms of specific phobia) was almost equal at 7.14%. Social Anxiety DisorderFrom ordering a cup of coffee to giving a presentation to a large group, people suffering from social anxiety disorder are overwhelmed by an anxious self-consciousness in everyday situations. People suffering from social anxiety disorder fear being judged by others and by doing something that will embarrass them. The fear can cause a patient to worry for weeks before an encounter, or worry endlessly following a feared event or occurrence. This disorder affects 15 million Americans and occurs in equal numbers of women and men. There is also a strong genetic link for this anxiety disorder. According to the medical literature, people who suffer from social anxiety disorder suffer from hypersensitivity to criticism, low self-esteem, feelings of inferiority, and difficulty being assertive. These discomforts will present as: Symptoms of social anxiety disorder
Performance at both school and work is negatively impacted by a specific social fear. Onset can occur during childhood, but more often it manifests in the mid-teens. Social Anxiety Disorder (SAD) and Substance Abuse and Alcoholism
It is not unusual for people suffering from social anxiety disorder to become alcoholics or drug addicts. According to the Anxiety Disorder Association of America, drinking to excess in an attempt to self-medicate feelings of anxiety and fear is very common. Furthermore, a recent study has shown there is a very high rate of alcohol use disorder and social anxiety. “Approximately 48% of individuals with a lifetime diagnosis of SAD also met criteria for a lifetime diagnosis of an AUD[alcohol use disorder]”. Obsessive-Compulsive Disorder (OCD)People suffering from obsessive-compulsive disorder are plagued by time consuming rituals and repetitive thoughts. The obsession comes from thoughts that are repeated over and over again. A person worries about catching germs and avoids shaking hands. The thoughts are intrusive and unrelenting. Sometimes, people suffer from only obsessions; in such cases these obsessions tend to be personally harmful in nature. (Diagnosis, Conceptualization, and Treatment Planning for Adults: A Step by Step Guide, e-book 2009, p167) Compulsions are based on a fearful thought and are repeated behaviors that become ritualized; they must be performed in an effort to neutralize the fear. The most familiar compulsion to the public is repetitive hand washing. These rituals attempt to reduce the stress caused by obsessive thoughts. They do not exist in isolation. The ritual behaviors are not necessarily grounded in reality. For example, a person may need to jiggle the door handle, count to one hundred, and then jiggle the door handle again before he or she can trust that the door is locked. Avoidance patterns “are maintained by the negative reinforcement of fear reduction. In the case of OCD, passive-avoidance strategies, such as those used by phobics, are not sufficient to control distress…Therefore, compulsions, or active avoidance strategies, develop and are maintained by their success in reducing fear and alleviating distress.” (Comprehensive Handbook of Personality and Psychopathology, Vol 2, 2006, p. 171). With OCD, a patient sometimes comes to realize that the thoughts and actions are not based on reality and are excessive or unreasonable. According to researchers at the University of Amsterdam, “there is considerable overlap between OCD and other anxiety disorders. Over half of the obsessive-compulsive clients have a lifetime prevalence of simple phobia, social phobia, or panic disorder… Depression is a frequent complication of OCD”. (Diagnosis, Conceptualization, and Treatment Planning for Adults: A Step by Step Guide, e-book 2009, p169). Substance Abuse and OCD
In a 2006 study on substance abuse and OCD, the researchers found that “70% of participants with comorbid SUD [substance use disorder] reported that OCD preceded SUD onset by at least one year.” Other studies found that there was a greater lifetime use of alcohol among OCD suffers and that these same individuals are at an increased risk for of substance use dependence. Post-Traumatic Stress Disorder (PTSD)There are a number of factors that can produce post-traumatic stress disorder in both adults and children. Generally these factors revolve around violence, the threat of violence (physical or psychological), natural events (hurricanes), manmade disasters (war), severe accidents, serious illness, and unexpectedly witnessing a death or seeing a dead body. The physical proximity to the trauma can create triggers that later will recreate the feelings of the original experience. These are considered flashbacks and are accompanied by intense distress. Symptoms associated with PTSD:
In order to minimize the reoccurring trauma, a patient may withdraw from normal activities, situations, or social interactions, thus experiencing reduced intimacy and sexual desire accompanied by a sense of a diminished future. In some cases, patients who experience some of the symptoms prior to the traumatic event are not considered to be suffering from PTSD. Substance Abuse (SUD) and PTSDStudies have consistently found that people who are suffering from PTSD have a high probability of seeking substance use and alcohol to help alleviate the symptoms of PTSD. Among men suffering from PTSD, 51.9% have a substance use disorder (SUD) and 34.5% have an alcohol disorder. Among women the rates were 27.9% SUD and 26.9% for alcohol. (source: Lisa M. Najavits, “Assessment of Trauma, PTSD, and Substance Use Disorder, A Practical Guide”, Ch. 16, pp. 466-467, http://www.seekingsafety.org/7-11-03 arts/FIN SCND asmt chp.pdf) Generalized Anxiety Disorder (GAD)People who suffer from generalized anxiety disorder are racked with worry and tension about money, health, family, work, etc. They worry excessively about many things and are unable to control their worries. They experience a number of somatic symptoms:
GAD often co-exists with other mental health disorders, such as specific phobias, panic disorder, or a depressive disorder. About 6.8 million American adults suffer from GAD, with twice as many women as men suffering from this disorder. GAD can begin at almost any time in a person’s life, though onset for the majority of people suffering from this disorder occurs from childhood through middle age. (NIMH) Substance Abuse and Generalized Anxiety DisorderFor those who suffer from generalized anxiety disorder, using substances and alcohol leaves them susceptible to “higher overall vulnerability for additional psychopathology…and higher use of alcohol and drugs to relieve anxiety symptoms”. (source:PubMed.gov, Alegria AA, et al, “Comorbidity of Generalized Anxiety Disorder and Substance Use Disorders: Results from the National Epidemiologic Surviey on Alcohol and Related Conditions, http://www.ncbi.nlm.nih.gov/pubmed/20923623) Substance-Induced Anxiety DisorderAs the name of this disorder implies, substances, such as drugs, alcohol, or poison, can induce an anxiety disorder. Depending upon the substance and the “context in which the symptoms occur…the disturbance may involve prominent anxiety, panic attacks, phobias, or obsessions and compulsions. Furthermore, the symptoms must arise during intoxication or during withdrawal. Symptoms that occur only during intoxication are not part of this disorder. Substance-induced anxiety disorders are common in illicit drug use, including the abuse of prescription drugs. Amphetamine, cocaine, and caffeine use has been associated with anxiety disorder symptoms. (Synopsis of Psychiatry, tenth edition, p.629) Using drugs or alcohol may nullify the symptoms of pre-existing anxiety conditions for a while, but it will not resolve them. Furthermore, when an addict or alcoholic suffering from pre-existing anxiety disorder detoxes, the symptoms of the pre-existing disorder seem to be amplified. Drugs and alcohol do nothing to resolve the underlying issue or the cause of the anxiety. If recovery is to be successful, these underlying issues must be addressed. |
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