Anxiety

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Anxiety refers to an unpleasant emotional state, a response to anticipated threat or to specific psychiatric disorders. In anxiety, the anticipated threat is often imagined. Anxiety consists of physiological and psychological features. The physiological symptoms can include breathing dif-ficulties (hyperventilation, shortness of breath), palpitations, sweating, light-headedness, diarrhea, trembling, frequent urination, and numbness and tingling sensations. The anxious person is usually hypervigilant and startles easily. The subjective psychological experience of anxiety is characterized by feelings of apprehension or fear of losing control, depersonalization and derealization, and difficulties in concentration. Strains around the performance of social roles (e.g., spouse, parent, wage earner) and certain life situations (e.g., separating from parents when starting school or leaving home, illness) can generate anxiety symptoms. Other factors can contribute to the etiology of anxiety, such as use of alcohol, caffeine and otherstimulant drugs (e.g., amphetamine), a family history of anxiety symptoms, ora biological predisposition. In certain cases, recurrent anxiety symptoms will lead an individual to avoid certain situations, places, or things (phobias). In many cases, an anxious emotional state can motivate positive coping behaviors (e.g., anxiety that leads to studying foran exam). When the anxiety becomes excessive and impairs functioning, it can lead to the development of psychiatric illness. Individuals differ in their predisposition to anxiety.

Different constellations of anxious mood, physical symptoms, thoughts, and behaviors, when maladaptive, constitute various anxiety disorders. Panic disorder is characterized by brief, recurrent, anxiety attacks during which individuals fear death orlosing theirmind and experience intense physical symptoms. People with obsessive compulsive disorder experience persistent thoughts that they perceive as being senseless and distressing (obsessions) and that they attempt to neutralize by performing repetitive, stereotyped behaviors (compulsions). The essential feature of phobic disorders (e.g., agoraphobia, social phobia, simple phobia) is a persistent fear of one or more situations orobjects that leads the individual to either avoid the situations orobjects orendure exposure to them with great anxiety. Generalized anxiety disorder is diagnosed in individuals who persistently and excessively worry about several of their life circumstances and experience motor tension and physiologic arousal. Anxiety disorders are the psychiatric illness most frequently found in the general population.

Anxiety states can result from underlying medical conditions, and therefore these conditions should always be looked forwhen evaluating problematic anxiety. When anxiety develops into a psychiatric illness, various forms of treatment are available to reduce it. The choice of treatment often depends on the specific disorder. Medications may be used, including anxiolytics (e.g., BENZODIAZE-PINES, buspirone) and ANTIDEPRESSANTS (e.g., imipramine, fluoxetine). Psychotherapies offered generally consist of cognitive-behavioral interventions (e.g., exposure therapy), but they can include psychotherapy of a supportive nature or more psychodynamically oriented approaches. Some people with severe anxiety may turn to alcohol or nonprescribed sedative-hypnotics for symptom relief, and this in turn may exacerbate the underlying condition.