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Anxiety Disorders


Dr. Peter Melgaard Thompson

I have been talking about mood disorders and now would like to switch gears. Mental disorders range from minor peccadilloes to total dysfunction. The next group of illnesses follows along this general pattern. This very diverse group is collectively and probably incorrectly called anxiety disorders. There are basically six disorders in this group and they are: panic disorder; generalized anxiety disorder; post-traumatic stress disorder; obsessive-compulsive disorder; social phobia; and simply phobia. They can be minor irritants in one's life, like a cold, or they can be catastrophic leading to death like cancer.

Let us spend a little time and talk about normality. Most people would say that anxiety is an inescapable aspect of life. To those I say "you're absolutely correct.". When we encounter different life situations we become temporarily anxious, but for some people the anxiety never goes away and the anxiety occurs when it should not. Let me take a page out of a physiology textbook. When a person or animal is confronted or threatened by something, the immediate reaction is fear. This state is both emotional and physiological. You feel fear. Your heart races. You become more aware of your surroundings. Your senses are heightened. You feel more, hear more, see more. You are ready to react -- to fight or have flight. After the threat is removed your heightened senses and reactions return to their usual state. This is considered normal and adaptive behavior. In contrast, when one is in the anxious state when there is no clear threat, the heightened emotional and physiological reactions continue to occur for an extended period of time. Since the body is not prepared to sustain this heightened reaction, body systems begin malfunctioning and wear down. This is an abnormal non-adaptive behavior and leads to pathology and/or a disease state that we are now calling collectively the anxiety disorders.

Of historical note, these illnesses were called the classic neuroses, specifically anxiety/phobic neurosis. They were thought to arise from the incomplete regression of a primary drive, e.g., libidinal. A more current concept is that these illnesses represent a very diverse group of illnesses whose origins are unknown and that the final behavioral manifestation of them are feelings of anxiety. For example, obsessive-compulsive disorder has very little to do with inappropriate anxiety. Rather, it is a brain disorder where a person has thoughts that recur repetitively and very destructively. In addition, these people often have rituals that they feel compelled to complete, and if they do not complete the rituals they feel anxious. So, is this disorder the feeling of anxiety that you get when you don't complete the ritual or is it the compulsion to do the ritual? At this point most people believe it's the compulsion to complete the ritual.

As we discovered with the mood disorders, there is a tremendous amount of social stigma attached with having one of these disorders. If you were to tell someone that you had panic disorder, that is, you might suddenly feel like you were having a heart attack and were going to die with no clear reason, they would say, "Well, it's in your head, and you should fix it." Well, if it was that easy you would have done it already. And that's where the role of the psychiatrist comes in. There are multiple forms of treatment. They involve both medication and psychotherapy. We shall talk in the next few articles about the particular anxiety disorders, their treatments, and their response rates to treatment which in general are very good.

© 1997 Peter Melgaard Thompson

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