Anxiety is often described as having a cognitive, a somatic, an emotional and a behavioral component (Seligman, Walker & Rosenhan, 2001). The cognitive component entails expectation of a diffuse and uncertain danger. Somatically the body prepares the organism to deal with threat (known as an emergency reaction); bloodpressure and heartrate is increased, sweating is increased, bloodflow to the major musclegroups is increased, and immunesystem function and digestive function is decreased. Externally, somatic signs of anxiety may include pale skin, sweating, trembling and pupillary dilation. Emotionally, anxiety causes a sense of dread or panic, nausea and chills. Behaviorally, both voluntary and involuntary behaviors may arise directed at escaping or avoiding the source of anxiety. These behaviors are frequent and often maladaptive in the anxiety disorders. However, anxiety is not always pathological or maladaptive: it is a common emotion alongside fear, anger, sadness and happiness, and it has a very important function in relation to survival. Neural circuitry involving the amygdala and hippocampus is thought to underlie anxiety (Rosen & Schulkin, 1998). When confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show an increased bloodflow in the amygdala (Zald & Pardo, 1997; Zald, Hagen & Pardo, 2002). In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors such as feeding on rotten food. A chronically recurring case of anxiety that has a serious effect on your life may be clinically diagnosed as an Anxiety disorder. The most common are Generalized anxiety disorder, Panic disorder, Social anxiety disorder, phobias, Obsessive-compulsive disorder, and posttraumatic stress disorder (PTSD).
As there is a high association for anxiety for other psychiatric problems including drug abuse and depression, the physical examination should include checking for evidence of intravenous drug use or previous episodes of self-harm.
Generalized anxiety disorder is a common chronic disorder that affects twice as many women as men and leads to considerable impairment (Brawman-Mintzer & Lydiard, 1996, 1997). As the name implies, generalized anxiety disorder is characterized by long-lasting anxiety that is not focused on any particular object or situation. In other words it is unspecific or free-floating. People with this disorder feel afraid of something but are unable to articulate the specific fear. They fret constantly and have a hard time controlling their worries. Because of persistent muscle tension and autonomic fear reactions, they may develop headaches, heart palpitations, dizziness, and insomnia. These physical complaints, combined with the intense, long term anxiety, make it difficult to cope with normal daily activities.
In panic disorder, the person suffers brief attacks of intense terror and apprehension that cause trembling and shaking, dizziness, and difficulty breathing. One who is often plagued by sudden bouts of intense anxiety might be said to be afflicted by this disorder. The American Psychiatric Association (2000) defines a panic attack as fear or discomfort that arises abruptly and peaks in 10 minutes or less.
Although panic attacks sometimes seem to occur out of nowhere, they generally happen after frightening experiences, prolonged stress, or even exercise. Many people who have panic attacks (especially their first one) think they are having a heart attack and often end up at the Doctor or E.R to be checked. Even if the tests all come back normal the person will still worry, with the physical manifestations of anxiety only reinforcing their fear that something is wrong with their body. Extreme awareness of every little thing that happens or changes with their body can make for a stressful time. Normal changes in heartbeat, such as when climbing a flight of stairs will be noticed by a panic sufferer and lead them to think something is wrong with their heart or they are about to have another panic attack. Some begin to worry excessively and even quit jobs or refuse to leave home to avoid future attacks. It is labeled panic disorder when several apparently spontaneous attacks lead to a persistent concern about future attacks. A common complication of panic disorder is Agoraphobia--anxiety about being in a place or situation where escape is difficult or embarrassing (Craske, 2000; Gorman, 2000).
People with phobias have especially powerful imaginations, so they vividly anticipate terrifying consequences from encountering such feared objects as knives, bridges, blood, enclosed places, or certain animals. These individuals recognize that their fears are excessive and unreasonable but are generally unable to control their anxiety.
In addition to specific phobias, such as fears of knives, rats or spiders, there is another category of phobias known as social phobias. Individuals with this disorder experience intense fear of being negatively evaluated by others or of being publicly embarrassed because of impulsive acts. Almost everyone experiences "stage fright" when speaking or performing in front of a group. But people with social phobias become so anxious that performance is out of the question. In fact, their fear of public scrutiny and potential humiliaton becomes so pervasive that normal life is impossible (den Boer 2000; Margolis & Swartz, 2001).
Some of the SSRIs (selective serotonin reuptake inhibitors) have been used with varying degrees of success to treat patients with chronic anxiety, the best results seen with those who exhibit symptoms of clinical depression and non-specific anxiety or general anxiety disorder concurrently. Beta blockers are also sometimes used to treat the somatic symptoms associated with anxiety, especially the shakiness of "stage fright."
Behavioral and Cognitive therapy are the most popular and most effective forms of Psychotherapy used to treat anxiety. Exercise and other physical activities are thought to relieve stress and anxiety as well. Alcoholic drinks are probably the most widely used substance for the alleviation of anxiety, although alcohol is also a powerful depressant and has a plethora of dangerous and uncomfortable side effects in addition to being highly addictive.
A variety of over the counter medications are also used for their alleged anti-anxiety properties. Kava Kava is a popular herbal treatment, small doses either taken regularly through the day, or when early symptoms are noticed by the patient. Valerian Root is also reputed to have anti-anxiety and sedative properties, as are Passion Fruit, Hops, and Chamomile.
Many scientists believe that the benzodiazepines and other antianxiety drugs are greatly overprescribed and potentially addictive. See, for example, Fred Leavitt's The REAL Drug Abusers (Rowman & Littlefield, 2003). The addicitive nature of the Benzodiazepine class became apparent in the mid 1960's when Valium (Diazepam), the first drug in the class to win FDA approval, resulted in thousands of people who quickly showed the classic symptoms of addiction when used for more than a week or two consistently.
The most addictive of the benzodiazepines appears to be Xanax (alprazolam) due to its rapid onset and short half life in the blood stream. Xanax also has the dubious distinction of being the only benzodiazepine that often requires hosptialization for discontinuation as a precaution against dangerous and sometimes fatal seizures as part of the detoxification process. No other medications in this class have shown this fatal side effect, although abrupt discontinuation of virtually any benzodiazepine can result in cravings, stomach pains, cramps, increased anxiety, insomnia and other signs of withdrawal.
Self help and Relaxation techniques also play an important role in relieving anxiety symptoms. Self help includes proper diet (reduction in caffeine and sugar consumption), exercise, laughing, breathing techniques, brisk walk, proper sleep, etc. Various types of relaxation therapy are available - you might want to discuss this with your doctor.