November 2008 Anxiety

The Doctor Is In

Gail Hacker MD
Gail Hacker, MD

November 2008

Anxiety Disorders; Just In Time for Finals

health clinic graphic icon of stethoscope

Everyone feels nervous, uptight, and anxious some times. You are supposed to get a little jittery, maybe have sweaty palms and even feel a little nauseous just before you give a big presentation in class. This "fight or flight" phenomenon is nature's way of making sure you ready to do your best. But some folks feel like this just going to the grocery store or the Laundromat. In extreme cases people don't ever leave their homes, a condition called agoraphobia.

There are five basic types of anxiety disorders:

Generalized anxiety disorder (GAD) causes a persistent worried sensation without an obvious need for concern.  People with GAD always feel on edge, are hyper-aware of their surroundings, and may even have some physical complaints such as chronic fatigue or muscle pain.

Obsessive compulsive disorder (OCD) causes people to focus on a few thoughts or behaviors. Some people have to flick the light switch 5 times each time they enter or leave a room.  Other rituals include repetitive hand washing or locking and unlocking doors a certain number of times before retiring to bed. Some people only have recurrent thoughts or fears and phobias.

Panic disorders are usually associated with disturbing physical symptoms, such as chest pain or shortness of breath, that have no physical explanations. Sudden onset of symptoms with very little warning is typical. Irrational fears are common. It is not uncommon for people to present to the hospital emergency department convinced that they are in imminent danger or are dying.

Post-traumatic stress disorder (PTSD) usually develops after an identifiable occurrence, such as rape or other assault, or after a period of exposure to horrible circumstances, such as war. People with PTSD often relive the episode repeatedly. They may become severely depressed, irritable, and hyper- sensitive for prolonged periods of time.

Social anxiety disorder is like stage fright ten times over. People become paralyzed by fear when faced with certain challenges, such as giving a speech or presentation. They may feel physically ill to the point of being incapable of completing the task at hand. They feel as if the whole world is watching them, waiting for them to make a mistake.

So, how do you know if you have a true anxiety disorder or simple, physiologic anxiety? Do your symptoms limit your activities? Are they repetitive and predictable? Are important relationships in your life being adversely affected by your thoughts and/or behaviors? If so, you may have an issue that you should discuss with your health care provider.

What can be done to help people with anxiety disorders? "Talk therapy" is usually the best place to start. Helping to identify inciting factors can be helpful. Certain techniques used to deal with the symptoms can be taught by trained therapists. In extreme circumstances medication may be advised. Most professionals agree that long term preventative medications, such as certain antidepressants and heart medications, are preferable to short term treatments like valium or xanax, which are extremely addictive and can be associated with life threatening withdrawal symptoms.

This is a very brief overview of a very complex topic. For more information, the National Institute of Mental Health has a very good website: Here you will find lots of good information regarding anxiety disorders as well as many other mental health issues.

Remember, when it feels like you can't take any more, stop and breathe.  Count to 10, it really works. Imagine a peaceful beach scene, smell the ocean, feel the warm breeze on your face. If you feel like you need more advice or assistance, give us a call, or call your primary care provider.

woman in sunshineSupporting you in good health,
Gail Hacker, MD