ANXIETY DISORDERS

What is an anxiety or panic attack?

An anxiety or panic attack is an acute manifestation of intense anxiety and fear associated with emotional and physical discomfort, which the individual is unable to control. The individual is often afraid of passing out or dying.

In a panic attack, anxiety symptoms are virtually mixed with physical symptoms that can be strong enough to evoke a heart attack or epileptic seizure. More often than not the diagnosis of a panic and anxiety attack is made in the Emergency Room after a complete medical workup rules out the existence of a medical cause.

This anxiety attack is particularly prevalent in less intense forms such as sweating, dizziness, shortness of breath.

Usually it occurs in situations where the individual has the impression that escape might be difficult such as an elevator, train, plane, car on a highway, or business meeting.

The anxiety or panic attack lasts several minutes to several hours, at the peak of which the individual may experience dissociative phenomena such as de-personalization or de-realization. After a panic attack, the individual may be worried about the occurrence of a new panic episode: it is the anticipatory anxiety that leads them to avoid places where the crisis had occurred: hence the appearance of agoraphobia.

What are the causes of a panic attack?

The causes of an anxiety or panic attack crisis are many: biological, psychoanalytic, learned, genetic.

Very often an anxiety or panic attack will occur out of the blue: its occurrence often signals a limit to the coping strategies that the individual has used thus far. The need to have one’s emotions in check in certain professional contexts, the pressure to cope can only increase the likelihood of an anxiety or panic attack.

Often the anxiety attack or panic attack is associated with other psychological problems such as depression, phobias (social phobia, agoraphobia or public transportation phobia), generalized anxiety disorder, addiction problems, eating disorders (anorexia, bulimia, binge eating).

The onset of anxiety or panic attack necessitates evaluation and follow-up with a mental health professional such as a psychiatrist, psychotherapist, to work not only on the causes and triggers of anxiety attack but also on treatment modalities.

Treatment

It is difficult to be on your own in a state where one panic attack succeeds to another. It is therefore recommended to contact a provider who is familiar with the condition, such as a psychiatrist with experience in psychotherapy treatment of anxiety disorders. This will usually entail a treatment strategy involving for example cognitive behavioral therapy (CBT), but also a trial of medication if your symptoms are severe (anxiolytics, antidepressants given for their anti-panic potential).

The psychotherapy follow-up treatments will help you manage your vulnerability in regard to an anxiety or panic attack, challenge your coping strategy, and help you face triggers.

The treatment of anxiety attacks often involve the need to develop helpful coping strategies such as the practice of yoga, meditation, and the time to engage in leisure activities.

The onset of an anxiety or panic attack is often a “life-saving” signal that refocuses us on what is important in our lives!

What causes Obsessive Compulsive Disorder or OCD?

As with other anxiety disorders, the causes of obsessive compulsive disorder are multi-factorial, consisting of an interaction of genetic, congenital, learning and social factors.

What are the common symptoms of OCD or obsessive compulsive disorder?

People with obsessive compulsive disorder (OCD) typically present with:

Obsessions: pictures, ideas, and impulses invading repeatedly the mental field, which the individual recognizes as issued from their own mental activity and causing in them distress; The individual feels personally responsible for these obsessions and for preventing them from happening.

Compulsions: repetitive ritualistic behavior, which can be considered as abnormal by the individual but temporarily reduces anxiety;

An example would be an obsession of having dirty hands, which is followed by a ritual of washing the hands: these symptoms occur at an unreasonable rate in a given day, without the hands being objectively dirty.

When a person has somatic or hypochondriacal concern, for example this may be a fear of stomach cancer (obsession) which is checked with gastroscopy (compulsion).

A particular type of symptom that is part of obsessive compulsive disorder (OCD) are aggressive obsessions: the individual is engulfed by a desire to act contrary to his values. One example is a mother who has the impression that she could harm her child. The act is never committed but it causes a feeling of intense discomfort with great guilt.

Contamination and aggressive obsessions are the most common.

Obsessive compulsive disorder (OCD) may be limited or rather pose a serious handicap on a person’s professional and personal life.

How to treat obsessive compulsive disorder (OCD)?

Antidepressant treatments have proven their ability to mitigate the symptoms of obsessive-compulsive disorder and will be considered in situations where obsessive compulsive disorder (OCD) is particularly intense or disabling.

The therapies remain the treatment of choice in the long run. Although cognitive and behavioral therapies (CBT) are referenced as a leading approach in OCD, other approaches can be adapted to the situation: group therapy (especially for working self-confidence), relaxation or meditation (work on letting go), EMDR (work on emotions).

What is the Generalized Anxiety Disorder or Anxiety?

Anxiety is common phenomenon that we face in unpleasant situations in our daily life: exams, concerns over one’s health or the health of a significant other, threats to one’s job, to name a few. Anxiety allows us to be alert to take action and address these situations of concern.

The individuals suffering from generalized anxiety disorder or anxiety have a particularly low response threshold: they become anxious about innocuous situations of daily life. Everything becomes a reason for anxiety: the delay of a relative, the lack of immediate response to a text message, the phone ringing or receiving mail, or the bad headline news on television.

There is a “worry” -chain of negative thoughts, predominantly verbal, aimed at problem solving. It involves catastrophizing, and a subjective difficulty to control. Such worry chain is ego-syntonic. The content and nature of generalized anxiety disorder worry is very similar to “normal”, but associated with more negative thoughts and beliefs about worry.

This generalized anxiety disorder or anxiety eventually impacts the occupational, social and emotional life of the individual who is affected.

What are the causes of generalized anxiety disorder or anxiety?

The causes of generalized anxiety disorder or anxiety would be a combination of genetic, learned, cultural and environmental factors.

It is considered that patients who develop generalized anxiety disorder or anxiety have a physiological and psychological predisposition that will be enhanced through learning, the personal and occupational environment.

Very often the generalized anxiety disorder or anxiety is associated with other psychiatric problems: depression, phobias (social phobia, agoraphobia or public transportation phobia), panic attacks, addiction problems or eating disorders (anorexia, bulimia, binge eating).

What are the symptoms of Generalized Anxiety Disorder or Anxiety?

Symptoms of generalized anxiety disorder are both physical, behavioral and emotional, for example:

• insomnia
• difficulties concentrating and memory problems
• muscle tension and spasms
• headaches
• nausea or diarrhea
• anxiety or panic attacks
• a risk of addiction: alcohol, smoking, cannabis…
• The physical symptoms (cardiac, respiratory, digestive …) are connected to the psychological symptoms which are characterized by a worried expectation about the future, as if the individual were expecting an imminent catastrophe.

Symptoms fluctuate in intensity but are constantly present, which differentiates Generalized Anxiety Disorder from Panic Disorder.

How to treat Generalized Anxiety Disorder or Anxiety?

Generalized anxiety disorder or anxiety potentially affects all areas of life; the individual lives with a feeling of intense discomfort, and relatives feel helpless of not being able to reassure them.

If you recognize these symptoms, consult a provider who can make an accurate diagnosis.

This will be the first step that will allow you to take action: a psychotherapeutic approach such as cognitive behavioral therapy (CBT), but also in some cases a trial of medication. You will also need to think about all the activities that can lower your level of anxiety: the practice of meditation or yoga, regular exercise, hobbies such as gardening, camping or fishing.