Generalized
Anxiety Disorder
The
patient with a generalized anxiety disorder worries excessively about everything
all the time. If this persists for more than at least 6 months, the psychiatrist
or psychologist will diagnose this disorder. The following conditions also have
to be met:1. the patient cannot control the worry. 2. at least three
items of the following list accompany the anxiety or worry: restlessness - tiring
easily - being irritated - muscle tension - sleep disturbance - concentration
problem. 3. the worries and anxiety may not be perceived by the patient
as"excessive", but on further questioning it is clear that it interferes
significantly with normal functioning in social situations, at work and in other
areas important to the patient's normal life activities. 4. the disorder
is not due to another mental illness and is not due to a substance or medical
illness. 5. the intensity, the time it lasts and the frequency of attacks
are completely out of proportion with how a normal person would react to the feared
event. Patients with generalized anxiety disorder tend to worry about ordinary
day to day responsibilities at home or at work. Symptoms of generalized
anxiety disorder: Patients with this disorder will complain about
muscular symptoms such as a feeling shaky, trembling, pain, soreness and twitching.
Patients may somatisize and complain of various symptoms such as cold hands and
feet, dryness in the mouth, diarrhea or nausea, a lump in the throat, frequency
of urination, sweating or clammy hands. Sometimes the doctor might find in addition
a medical condition such as irritable bowel syndrome or tension type headaches.
To complicate matters, generalized anxiety disorder can occur together with other
psychiatric conditions such as: 1. a mood disorders such as dysthymic or
major depressive disorder 2. panic disorder, social phobia or specific phobia 3.
a substance-related disorder (hypnotic, alcohol, anxiolytic dependency).
Treatment of generalized anxiety disorder: Many
treatment attempts with counseling have not yielded the desired good outcome.
It seems to be easier to simply put the patient on a small dosage of an anxiolytic
medication such as benzodiazepines like alprazolam (brand name: Xanax), clonazepam
(brand names: Rivotril, Klonopin), diazepam (brand names: Valium, Valrelease,
Zetran), lorazepam( brand name: Ativan) and oxazepam (brand name: Serax).
They
are all effective in controlling acute anxiety and generalized anxiety disorder.
However, on the long term there can be a problem with dependency on the medication
with these anxiolytics. Usually the literature quotes high dropout rates for people
with generalized anxiety disorder( Ref. 7). These authors found that the presence
of general anxiety disorder, when it coexisted with obsessive-compulsive disorder,
was the reason for dropping out of the behavior therapy for the obsessive-compulsive
disorder. However, it appears that with a combination of cognitive therapy and
behavior therapy the presence of generalized anxiety disorder in the treatment
of social phobia had a very good treatment outcome as the authors of Ref. 8 showed.
Analytical hypnotherapy can be used as another tool to help patients with generalized
anxiety disorder, but not every patient will get into a good trance. Once
patients get into a good trance and feel comfortable talking under hypnosis or
communicating with ideomotor signals (usually finger signals), then the root of
the psychiatric problem in the subconscious memory stores can be quickly identified
and alternative ways of coping with different life situations can be suggested.
It is often rewarding for the patient as well as the therapist to see that only
a few hypnotherapy sessions can solve a seemingly hopeless anxiety problem in
a short period of time. Once successfully treated with hypnotherapy the patient
stays symptom free from then onwards. This is so, because the subconscious pattern
of thinking that was disorderly before is normalized after the successful treatment.
Cognitive and behavioral therapy is useful as well, but it does not seem to penetrate
as deep into the subconscious (where the fears and anxieties are located) as hypnotherapy
does (Ref.5, 6 and 9). Here is a guest editorial about generalized anxiety
disorder: Incorrect
Panic Attack Treatments By :Ryan Rivera About the Author: Ryan
Rivera has authored numerous articles on panic attacks and has suffered through
them himself. He writes about panic attacks and anxiety at http://www.calmclinic.com.
One of the least understood anxiety disorders is the panic attack. Even
those that understand the disorder can rarely describe the symptoms, and most
doctors are ignorant of its existence completely, knowing only the terminology
but not how the disorder manifests. It's important, however, that you understand
panic attacks in their entirety, because in many ways these misunderstandings
lead to greater panic related issues.
The Physical Link With Panic
Attacks
The issue with panic attacks is that while they're solely a
mental health problem, it causes issues that make it feel as though it's affected
by your physical health. The symptoms of panic attacks are one of the primary
reasons that people believe that panic attacks are a physical disorder. Panic
attacks don't necessarily cause what most people see as "panicking thoughts."
When people hear the term, they picture someone screaming about their worries
and thinking the world is going to crash around them.
While there are certainly
some people that experience those emotions, most people experience emotions that
- in the moment - would not be considered irrational. Those that suffer from panic
attacks often feel as though something is seriously wrong with their health. Their
heart rate increases dramatically, they feel weak or light headed - some people
even feel feint. These types of symptoms mimic symptoms of real, physical problems.
When describing these to a doctor, most refuse to believe that something mental
could cause those types of symptoms.
In addition, most people suffering from
panic attacks have a problem believing they can be mental health related as well,
because they see themselves reacting to something physical. When you suffer from
panic attacks you become hyper sensitive to your own physical responses. That
hypersensitivity causes a normal, mild physical response to become much more powerful,
giving it the impression that something is physically wrong.
It's for that
reason that panic attacks are also self-sustaining. They tend to follow a very
specific pattern:
Person suffers a panic attack.
- Person becomes
hypersensitive to their own physical reactions.
- Person gets anxious worrying
about next panic attack.
- Person's heart rate increases as a result of
that anxiety.
- Person's hypersensitivity makes them feel something is physically
wrong with them.
- Person suffers a panic attack.
It's for these
reasons and more that doctors often see panic attacks as a physical health issue
rather than a mental health issue, and most people that suffer from panic attacks
are happy to believe them. The problem is that the medicines they prescribe to
treat these issues may also be the least suitable for them.
Medicines
and Panic Attack Treatment
Doctors generally prescribe tranquilizers
(extremely potent anti-anxiety medications) and anti-depressants for those suffering
from panic attacks. Neither of these may be a good option.
It's important
to remember that your doctor may also find that you are not suffering from panic
attacks, and that there may be something physical that needs to be treated. Furthermore,
there are some people that experience panic attacks so severe that medicines may
be necessary. None of this should be considered above medical advice from a trained
professional.
But it's also important to note that improperly prescribed medicine
may actually have a more harmful effect on your long term ability to recover from
panic disorder than medicine at all. Consider the following:
- Side
Effects - Panic attacks cause you to be hypersensitive to changes in your
body, so that any change can trigger a panic attack. Both tranquilizers and anti-depressants
have side effects that could cause your body to react in a way that a panic attack
would be triggered if your body was physically capable of triggering it. Thus
it's possible to have more panic attacks, just with a decrease in severity.
- Weaning
Off - The self-sustaining nature of panic attacks also makes getting off
the drugs especially difficult. As soon as you take less of any given drug, you
will most likely find your anxiety coming back. Your over-sensitivity will then
more easily trigger a panic attack, and the severity may be worse since your body
may not be used to the anxiety any longer.
- Overkill - Many
people only experience mild to moderate anxiety beyond the panic attack, and if
the panic attack wasn't triggered, they'd have almost no problem living a happy
and healthy life. But because panic attacks can feel so severe, these extremely
powerful medicines are often prescribed, and the effects of these medicines can
reduce your quality of life during the times that you would not have been suffering
from a panic attack.
Finally, none of these medicines can cure
panic attacks permanently, and unless you experience a panic attack, you can't
be behaviorally trained to cope with the symptoms.
Dealing With
Panic Attacks
Panic attacks and panic disorder are dreadfully misunderstood,
and the results of those misunderstandings can have a serious effect on your ability
to cure and cope with the disorder. While you should always consult your doctor,
especially if you want to rule out any physical problems, remember that panic
attacks are entirely mental, and if you have a panic disorder, you should strongly
consider counseling and safe forms of therapy that will help you cope with the
problems.
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