Anxiety disorders only infrequently occur in isolated, pure form. They can vary in their presentation and co-exist extensively with other anxiety disorders and with depression and substance abuse. All patients with depression and substance abuse should be screened for anxiety disorders. A significant portion of female alcoholism may be associated with panic and agoraphobia.
Full, functional recovery from anxiety disorders is an achievable goal, but complete resolution of symptoms and invulnerability to relapse are unlikely outcomes. Lingering symptoms, vulnerability to "normal" anxiety, and stress-related intensification of symptoms and anxiety often contribute to an ongoing risk of relapse. These factors are directly addressed in cognitive-behavior therapy (CBT), which is probably why it improves long-term outcomes.
Panic disorder is characterized by rapid onset of severe episodes of anxiety/distress/discomfort, accompanied by physical symptoms that are often suggestive of cardiac, endocrine or neurologic disorder. Panic patients become frightened of fear itself and its symptoms. Panic attacks can be associated with fear/avoidance of crowds, driving, being closed in, being far from home alone, etc. (agoraphobia). The first line treatment for panic disorder is CBT and/or medication (SSRIs).
Generalized: Excessive anxiety/distress in nearly all situations in which there is social scrutiny or evaluation. Specific: Anxiety and avoidance of a specific, social performance situation (public speaking, using public restrooms, etc.).
Social anxiety is extremely common, can be severely debilitating, and is often minimized or ignored. Patients are also generally embarrassed and avoidant, so they often won't disclose their symptoms unless specifically asked. May have panic attacks but they are confined to situations in which the patient may be the center of attention.
The first line treatment for social phobia is CBT . Medication is also used for social anxiety. SSRIs and other antidepressants that effect serotonin can be effective. Beta-blockers have little direct impact on anxiety but can be helpful in performance situations where physical manifestations of anxiety (e.g., sweating, tremor) undermine the performance or become distractions. Some patients need social skills training.
Specific phobias are characterized by marked fear of specific, circumscribed objects or situations associated with severe distress upon exposure and avoidance of the feared stimulus. Impairment is often not evident to the patient, especially if they have incorporated accommodation to the phobia into their lives. Fear of flying, height phobias, and claustrophobia are among the most commonly treated phobias. Snake and spider phobias are among the most common in the community but few people with these seek treatment. Blood, illness, and injury phobias are common, impede medical care, and should be treated, though they sometimes keep patients from even visiting the doctor's office.
Treatment - CBT for phobias is simple, quick, and extremely effective. The University of Louisville Cognitive Therapy Program has therapists that are specifically trained to help persons with phobias. The Virtual Reality Therapy Program uses innovative computer technology to enhance treatment for phobias and other anxiety disorders.
Generalized Anxiety Disorder (GAD)
The hallmark of this disorder is chronic, excessive worry. Patients often recognize that their worry is excessive and struggle with their inability to control it. Additional symptoms include restlessness, insomnia, poor concentration, fatigue and irritability. Though GAD can occur in isolation, it is far more common to see it in association with depressive symptoms, or other anxiety disorders. Many patients referred with suspected GAD turn out to have major depression with intense, ruminative anxiety.
The first line treatments for GAD are antidepressant medication (SSRIs) and cognitive-behavior therapy (CBT).
Adapted with permission from the University of Michigan Depression Center Web site.