Anxiety Disorders: More Than Just "A Bad Case of Nerves"

By Richard S. Schloss, M.D.

Anxiety seems to be an ever-growing part of everyday life. Everyone believes he has a pretty good idea of what anxiety is; we all know more-or-less synonymous terms for anxiety, such as "ner-vousness, tension, jitteriness, edginess, jumpiness, irritability," and so forth. But what is the defi-nition of anxiety?

Perhaps a good way to begin to conceptualize anxiety is a sense of uneasiness: a literal rendering of the term, "disease." But this definition is complicated by the fact that there are both emotional (or psychic) and physical components to the experience of anxiety. The physical experience of anxiety is more familiar to us than we might at first think; we have all, at one time or another, suffered from sweaty palms, dry mouth, shortness of breath, pounding heart, or "lump in the throat."

So anxiety is bad, right? Not necessarily. Anxiety is merely a warning signal, a message that "something bad could happen." At the appropriate moment, anxiety can trigger behavior which will have life-saving consequences.

However, much of our anxiety today may be a response to threats that are either imaginary or symbolic. We are much less likely than our ancestors to be devoured by saber-toothed tigers or set upon by marauding bands of Neanderthals. The genuine threats to our everyday existence are more likely to be the loss of the necessary components to happiness: loss of income, loss of affection, loss of self-esteem.

When anxiety begins to interfere with one's ability to function or feel secure, we speak of "Anxiety Disorders:" a state in which anxiety has become pathological rather than adaptive. Perhaps the most devastating of the "pure" anxiety disorders is Panic Disorder, in which the sufferer has spontaneous "attacks" at irregular intervals.

These attacks may last from 30 seconds to 10 minutes and are marked by several (or all) of the physical manifestations of anxiety, along with an overwhelming sense of panic or impending doom. The victim generally experiences palpitations or shortness of breath and often believes he is dying, having a heart attack, or going crazy. If the attack occurs in view of others, an ambulance may be called to take the victim to an Emergency Room. Usually, by the time of arrival at a hospital, the attack is over; an electrocardiogram done at that time reveals nothing abnormal, and the embarrassed victim is sent home.

After one or two more such episodes, the panic sufferer is driven to seek medical evaluation, and may undergo a lengthy series of neurologic or cardiologic tests before the correct diagnosis is made. Unfortunately, the fear of having an attack away from home, where one will be either unable to get help or embarrassed and humiliated, sometimes drives sufferers to avoid going out unless accompanied by someone they trust, a condition known as "Agoraphobia."

Fortunately, Panic Disorder can usually be well controlled with antianxiety or antidepressant medications, either alone or in combination. Such medications should only be prescribed by a qualified psychiatrist. If agoraphobia is present, a course of behavioral therapy under a psychiatrist's supervision is generally helpful, once the panic symptoms themselves have been controlled with medication. The importance of early recognition and referral to a qualified psychiatrist cannot be overemphasized in terms of preventing needless suffering and loss of function.

A second, potentially devastating illness, also classified as an Anxiety Disorder, is called "Obsessive-Compulsive Disorder." This disorder, usually referred to as "OCD" for short, was once thought to be rare, but is now believed to afflict about 2% of the population (about twice as common as schizophrenia). Many place the estimate of OCD's true prevalence much higher.

OCD is defined by the presence of obsessions (unwanted, intrusive, repetitive, often nonsensical thoughts); compulsions (repetitive or ritualistic behaviors driven by irresistible urges); or both simultaneously. Obsessions about accidental contamination, coupled with compulsive urges to wash or clean, are among the most familiar forms of OCD phenomena; checking stoves, doors, or windows is another common compulsion. Attempts on the part of the sufferer to resist carrying out compulsions almost always provoke intolerable anxiety, prompting the classification of OCD as an Anxiety Disorder.

Several subtypes of OCD exist, including Trichotillomania, or the urge to pull out one's hair. Victims of this seemingly bizarre disorder may cause one bald patch or may denude the entire scalp. Sometimes facial or body hair is involved as well.

The good news about OCD is that it, too, is eminently treatable. A select group of antidepressants has shown impressive results in reducing (and sometimes eliminating) obsessions and compulsions. One drug in particular has been beneficial in both OCD and Trichotillomania. Often a combination of medication and behavioral therapy yields even greater improvement. The key, once again, is recognition and referral to a qualified psychiatrist. When a patient says, "I think it's my nerves," that should mark not the end of treatment, but the beginning.