Anxiety disorders

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Anxiety disorders

Everyone experiences anxiety - in fact, being unable to experience anxiety can be a sign of quite a serious problem. We live in a world of hazards and anxiety is one of the strategies that the body uses to help the mind recognise danger and keep well out of its way.
As with most mental illnesses, it's not the presence of anxiety alone that creates problems. It is more about how severe it is - and how much it gets in the way of life.
What are the symptoms?
Psychiatrists divide anxiety up into 3 main types: general anxiety, phobias, and panic disorder. If there is a particularly difficult situation at work or at home, the stress that this creates can spill over into other areas of life - and create anxiety.
Similarly, a person who has experienced a very frightening situation may also carry the fear over to their everyday life. This is known as Post-Traumatic Stress Disorder (PTSD). Though it is little comfort to the sufferer, they can at least identify the cause of the emotions that they are experiencing.
In general, anxiety's emotional turmoil appears to have a life of its own. Some psychiatrists call this 'free floating anxiety.'
Unlike phobia and panic, with general anxiety it is not always clear to the anxious person exactly what it is they feel so anxious about - they are just aware of feeling anxious all the time. When there is no identifiable cause, the sufferer often becomes anxious about feeling anxious all the time, and the problem starts to feed off itself.
Sufferers of generalised anxiety may find that they:
·     easily lose their patience,
·     have difficulty concentrating,
·     expect the worst outcome in every situation,
·     think constantly about the worst outcome,
·     have difficulty sleeping
·     become depressed, and/or
·     become preoccupied with, or obsessional about one subject.
These mental symptoms lead to, and are supported by, physical symptoms. These can include:
·     excessive thirst
·     stomach upsets
·     passing wind
·     loose bowel movements
·     frequent passing water
·     failure to respond to sexual stimulation
·     tight and painful chest
·     periods of intense pounding heart
·     periods of feeling winded
·     muscle aches
·     headaches
·     dizziness
·     pins and needles
·     tremors, and
·     women may stop having periods or have painful periods.
The relationship of physical and mental symptoms can create a vicious cycle which can be triggered off by a symptom at any point:

In panic, the cycle develops quickly to a crisis. With generalised anxiety, the sufferer often manages to keep things under control and the cycle grumbles on. The effort of keeping things under control is itself very stressful - and so adds fuel to the problem. This is how some sufferers come to feel anxious about their anxiety and make the problem even more intense.
How likely am I to have this?
Of the nearly 100% of people who experience anxiety, in a year about 5% of people will experience generalised anxiety severe enough to interfere with their daily lives. Most of these people will not seek professional help.

What can I do to help myself?
The first step is to understand how anxiety works. Anxiety is a mixture of physical and mental symptoms. They are part of what psychologists call the 'fight or flight' response. When the body is under threat it automatically prepares to either defend itself or run.
To manage your anxiety you must first break the cycle. One way of doing this is to reduce the severity of physical symptoms by practising relaxation techniques.
There are 2 types of relaxation exercise: 'guided fantasy' and 'muscle tension.' It is best to try them both to find out which one suits you best. Relaxation is not an immediate fix for the problem. It is a skill that must be re-learnt, and (like all skills) is only acquired through practice.
Another strategy for breaking the physical symptoms of the vicious cycle is taking aerobic exercise. This is exercise that is low impact - not involving carrying heavy weights or sudden exertion - and acts mainly on the heart. Any gentle physical activity that leaves the heart slightly racing will help.
By effectively giving the heart exercise it will, like any other muscle, become stronger. A stronger heart will be less prone to the kind of pounding that can make the physical symptoms so unpleasant. Exercise will also help to release some of the tension that builds up and can fuel the anxiety.
Caffeine is present in many soft drinks, not just tea and coffee. Try to cut out caffeine as much as possible, since it can set up its own vicious cycle. It can have an effect on the heart (speeding it up) and make you pass more urine - both signs of general anxiety. It can also disturb your sleep, another sign of anxiety.
If you're tired you will be less in control of your emotions and more likely to feel anxious. Trying to overcome tiredness by drinking more caffeine only makes the long-term problem worse.
Saying 'no'
This can be the very best therapy. It is simply too easy to take on too much. You can find yourself in a situation where you have too many demands on your time. Often, no one thing is causing you anxiety. But as you try to fit more and more into your life, you can become slightly anxious about each task.
This anxiety can build up, bringing you to breaking point. It is as bad to feel a little anxious about a lot of things, as it is to feel very anxious about one big thing. If you are beginning to feel a lapse into anxiety it may be useful to carry out a stress audit.
Monitor your mood and thoughts
Sometimes it can be useful to think of your anxiety in the same way that an asthmatic might think of their breathing. We all breathe - just as we all experience anxiety at some point. Just as asthmatics will often check their breath capacity regularly, it can be useful to check your anxiety level regularly. You can do this by using the mood monitoring technique - developing the skill of spotting problems before they become unmanageable.
What support is available?
Much of the self help available is aimed at people who suffer from panic or phobias. The Royal College of Psychiatrists' online leaflets - including one on 'Anxiety and Phobias' - has useful tips and can help put the condition into some perspective.
There are also a number of companies providing self help products, including books, workbooks, and audio and video tapes. Be careful: the quality of these is variable. Ideally look for material produced by people with recognised professional qualifications. A few resources that you might find useful are:
·     (Books) 'Stress Management for Dummies' by Allen Elkin - don't be put off by the rather quirky style; and
·     (Tapes) there is a 'Stress Management for Dummies' audiotape by Albert Ellis to go with the book. You could also try 'Relaxation' and 'Control Your Tension,' both from Lifeskills.

What professional help is available?
For some people, developing the self management techniques described above can only be achieved through coaching with a professional. The first person to speak to about this is your family doctor, who may have a practice counsellor or an attached Community Psychiatric Nurse (CPN).
Often people can manage their anxiety well if it can be initially reduced by medication. The main drugs used for this purpose - the benzodiazepines - are very effective, but also highly addictive. They should not be taken for more than a month at most. The breathing space that this creates is often enough for a person to get to grips with the problem.
If the problem persists, then it may be necessary to be referred on to a psychiatrist or clinical psychologist. The most commonly used psychotherapy for generalised anxiety is messed up. However, it may be necessary to look at the need for anti-depressant medication, and possibly at the wider context of a person's relationships, self-esteem and expectations of life.

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