Anxiety is a protective mechanism. It prepares an individual for real or imagined threat. For example, somebody is standing in the middle of the busy highway, Anxiety of getting hit by oncoming traffic make him quickly move to get out of the way of oncoming traffic. In another example Anxiety of taking test or interview make someone to prepare for the test.
The physiological implication of anxiety. (Sympathetic stimulation)
- Cause heart to pump blood to muscles to provide sufficient nutrients.
- Cause the lungs to deliver oxygen.
- Cause muscles to get ready for fight or flight mode.
- In a life-threatening situation, increased blood flow to the heart, lungs and brain is imperative to make a quick assessment of the situation and act on it like fight or flight from the situation.
Mild to moderate anxiety is beneficial and it can increase performance. (Imagine if someone is standing in the middle of a busy highway and don’t get anxious)
Moderate to severe anxiety is pathological and it can severely impair performance.
If normal anxiety response is exaggerated and it causes excessive worries and excessive physical symptoms, like rapid heartbeat and high breathing rate and feeling nervous in response to ordinary life events (irrational anxiety) it can be disabling and can interfere with proper functioning in social occupational or other important areas of life.
Biological Aspect of Anxiety: Areas of brain Amygdala and Anterior Hippocampus are associated with anxiety regulation. (Research has shown that higher activity in these brain areas is predictive of anxious temperament and vulnerability to having anxiety issues). Nature, 12 August 2010; 466:864-868
- Prevalence: (13 years to18 years old kids)
- Lifetime prevalence is 25.1 %. According to the National Institute of Mental Health (NIMH, 2008),
- Approximately 40 million American adults (i.e., 18.1 %) have an anxiety disorder in a given year, with their first episode occurring before the age of 21.5 years.
- Being Female: Generalized anxiety disorder female to male Ratio is 2:1
- Except for OCD (Obsessive Compulsive Disorder) where male female ratio is the same.
- Trauma in early life: Abused (physical/sexual) Children are at greater risk of having anxiety symptoms. Chronic trauma increases the risk more than short-lived trauma. Big impact even if it is short-lived can cause anxiety.
- Illness: Chronic physical/mental ill health. Repeated hospitalizations. Repeated infections and ill health in general. Frequent emergency room visits can increase the risk of anxiety disorders.
- Stress: Acute and/or Chronic stress can predispose to future anxiety disorders. It can be financial stress, relationship stress, and death in the family, separation, natural disaster, and war, major downward change in the social status, loss of job, repeated failure etc.
- Personality Type: Certain personality types are more prone to anxiety disorders, like Borderline personality, paranoid personality trait, etc.
- Genetics: Family history of anxiety increases the risk of anxiety.
- Substance abuse: ETOH/Drug use.
- Comorbid with other mental illness: Anxiety can be a comorbid to bipolar disorder, major depressive disorder, and or psychotic disorder.
- Anxiety in Children and Adolescent: Anxiety is the most frequently reported type of psychopathology across all three age groups. (8 years, 12 years, 17years).
Anxiety is a state of mind, which can lead to uncomfortable feelings resulting in physical symptoms, emotional symptoms and predictable Cognitive/behaviour changes
- Physical symptoms: headache, nauseous feeling, irritability, rapid heartbeat, breathlessness, being panicky, excessive sweating,
- Emotional Symptoms: Feeling of anger, Helplessness, disappointment.
- Cognitive Symptoms: Difficulties concentrating, thinking negatively, Comparing to others.
Classification of anxiety:
- Generalized Anxiety disorder
- Excessive (irrational) worries about anything and everything, like grades, family issues, parent’s safety, financial issues etc.
- People having this type of anxiety are hard on them and usually, have negative expectations.
Fear of being separated from loved ones. For example, the first day in school child might not leave the parents for fear of harm to them. They will be clinging, crying and does not want to be away from the parents or caretaker. Separation anxiety is usually at its highest level between 8 months to 5-6 years. (Adults can have separation anxiety).
Post-traumatic stress disorder:
- Intense fear and anxiety months followed by trauma.
- There is a presence of flashbacks of the events.
- Avoidance of anything associated with trauma, like places, articles, persons etc.
- Startle response and constant state of fearfulness.
Obsessive Compulsive Disorder:
- Excessive unwanted intrusive thoughts leading to compulsions as an effort to relieve anxiety.
- Development of rituals to satisfy anxiety which is unsuccessful.
- Exposure to certain triggers followed by repeated irrational behaviour patterns. Like excessive hand washing, checking doorknobs, checking stoves etc.
- Excessive severe anxiety resulting in symptoms cluster of palpitation, breathlessness, chest tightness, sweating, nauseous feelings, headache feeling like loss of control or going to die.
- Fear of having another similar attack.
- Miscellaneous Anxiety disorders:
Irrational fear of specific object like dogs, darks, needles etc.
- Social anxiety: Fear of speaking in public or facing situation.
- Selective mutism: Unable to speak where it is expected.
- Anxiety: Anticipation of real or imagined threat which may or may not happen.
- Fear: Being afraid of immediate danger.
- Anxiety Disorders are real, serious and most treatable psychiatric condition.
- Helpful Hints for the parents:
- Pay attention to your child’s feelings.
- Stay calm when your child becomes anxious about a situation or event.
- Recognize and praise small accomplishments.
- Don’t punish mistakes or lack of progress.
- Be flexible and try to maintain a normal routine.
- Modify expectations during stressful periods.
- Plan for transitions (For example, allow extra time in the morning if getting to school is difficult).
Treatment modalities of Anxiety disorders:
- Psychotherapy treatment of anxiety.
- Medication treatment for anxiety.
Research shows combination treatment is superior to either treatment alone.
- Cognitive behaviour therapy: Dysfunctional thoughts lead to extreme emotional states and leads to maladaptive behaviours. (Core schema is an assumption of, self, others and world influence our behaviour) CBT helps to correct and replace negative thoughts with a positive one.
- Exposure versus response prevention: Usually used for OCD. (Where the person is exposed to the trigger and is not allowed acting on intrusive thoughts instead to master the anxiety feelings.
- Gradual Exposure: Step by step exposure to the anxiety-provoking situations with reassurance.
- Flooding: Sudden exposure to anxiety-provoking situation.
- SSRIs (selective serotonin reuptake inhibitor)
- Mood stabilizers.
- Atypical Antipsychotics.
- A community study of anxiety in children and adolescents
Kashani and Orvaschel Am J Psychiatry.1990; 147: 313-318
- Anxiety Disorders: Theories and Therapies: Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, PhD & Fugen Neziroglu, PhD. Of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. And Mark Dombeck, PhD Updated: Jun 28th 2010
- CBT (here and now) works for anxiety disorder while psychodynamic and psychoanalytic therapy may not work: (does not work) Deacon & Abramowitz, 2004; Norton & Price, 2007; Stewart & Chamblass, 2009).
- Carr, A. (ed.) (2000) ‘What Works with Children and Adolescents?’ – A Critical Review of Psychological Interventions with Children, Adolescents and their Families.London: Brunner-Routledge
- Generalized anxiety disorder (includes overanxious anxiety disorder of childhood). In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed.Arlington,Va.: American Psychiatric Association; 2000. Http://www.psychiatryonline.com. Accessed June 10, 2011.
- Schneier SR. Generalized anxiety disorder: Epidemiology, clinical manifestations, and diagnosis. Http://www.uptodate.com/home/index.html. Accessed June 10, 2011.
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