Have you ever experienced anxiety? Chances are you have.Anxiety
disorders are one of the most common reasons for visits to psychologists and other
practitioners in the field of mental health. More than 23 million Americans suffer
from a diagnosable and treatable form of anxiety.
Almost everyone experiences anxiety to some degree at some point in his/her life, and
there are times when anxiety becomes a cause for concern. An important question to
be answered regarding anxiety, therefore, is, "How can I know if I should be
concerned about my anxiety?" The answer to this question is: Any degree
of anxiety that causes you concern or distress warrants therapeutic attention.
Therapeutic services can serve to decrease or eliminate any level of anxiety, whether it
is moderate or severe, so that you can function more effectively and comfortably in your
daily life.
Students can experience anxiety when facing situations such as beginning a new career,
experiencing relational problems, or preparing for that dreaded final exam. There
are times, however, when anxiety becomes extreme and distressful, preventing one from
functioning adequately at school or work, or from engaging in satisfying social
interactions. Whenever this happens, your anxiety may meet the criteria for being
considered a disorder.
This leads to the question, "What type of anxiety disorder do my symptoms of
distress indicate?" There are several anxiety disorders that vary according to
the type and severity of symptoms one experiences, as well as the focus of the anxiety.
The following sections will describe the different anxiety disorders recognized in the
DSM-IV-TR (2000, American Psychiatric Association). If you do realize that you are
suffering from an anxiety disorder, please remember that anxiety is treatable and that
help is available. The Counseling Center has a variety of resources to help you.
John, a 22 year-old student, began experiencing chronic anxiety after he failed his
freshman year courses. He blamed himself for his academic failure--sure that his
lack of regard for the course's required readings and assignments had led to his low
grades. He was also worrying because he had let down his parents and his girlfriend,
who had so much confidence in him making it through college. For weeks John was
unable to sleep well--spending long hours lying in bed at night worrying about his grades.
He could not think clearly enough to do well on his tests, and felt like he was
"blanking-out" on one occasion when he could not remember some of the materials
he had studied and memorized the day before. He felt insecure most of the time and
did not follow through on several commitments he had made. He was contemplating
dropping out of college when he learned about the Counseling Center and came for help.*
The primary feature of this disorder is an unrelenting preoccupation with, or worry
about a number of life issues. Approximately 5% of people meet the criteria for this
disorder at some point in their life--women receiving diagnosis twice as often as men.
The events that lead to this constant worry are usually related to everyday
matters. For instance, you may feel constantly "stressed" about school,
the health of your parents, and your current relationship with a boyfriend or girlfriend.
These worries may seem to consume a large amount of your time and the enduring
distraction may keep interfering with daily tasks that need to be completed. The
anxiety experienced, although pervasive, is usually mild to moderate in intensity.
As its name suggests, it is best described as a general worry extending into several
dimensions of one's life. At least three of several specific symptoms are
experienced by persons with this disorder, including feelings of restlessness or
"edginess," fatigue, problems with concentration and distraction from tasks,
irritability, muscle tension, and sleep disturbances (difficulty falling or staying asleep
or poor quality of sleep).
Criteria:
- Extreme anxiety and worry that persists for the majority of days within at least a
6-month period, about several events or activities (such as school or dating).
- The worry is persistent and feels out of one's control.
- The anxiety and worry are accompanied by at least three of the following six symptoms:
- Restlessness or "edginess."
- Fatigue.
- Problems with concentration.
- Irritability or moodiness.
- Tension.
- Problems associated with sleep.
The anxiety or worry causes mental anguish or disruption in areas related to work,
social life, or other personally meaningful activities.
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Mary was a senior in college when she came to counseling. Her primary concern
was her fear of heights. She could not go to the library because the main area faced
the backyard that was two-stories below. She felt fearful of crossing the covered
walkways connecting different buildings. She avoided the elevators and did not take
classes that were given on or above the second floor of a building. Outside school
she avoided high buildings and even high seats at the football stadiums. When she
came to counseling for help she felt ridiculous. She could not understand why she
was so afraid of heights, nor what counseling could do to help her. Fortunately, her
needs to overcome her anxiety were more powerful than her doubts about undergoing therapy.
After approximately three months, Mary was able to reach every place on campus.
Soon thereafter, she attended some of the best football games of the season, sat in
the highest places, and enjoyed the games.*
In contrast to Generalized Anxiety Disorder in which the focus of anxiety encompasses
several broad areas of one's life, the focus of a phobia is much more specific and usually
limited to one particular object or activity. Around 4 to 5% of Americans experience
this disorder. If you suffer from a phobia, anxiety or panic-like symptoms arise
immediately when you are confronted with the object or activity that you find frightening,
and you will usually go out of your way to avoid coming into contact with it.
Occasionally, you may manage to confront the phobic situation, but will continue to be
extremely anxious. Although you realize that your fear is either unreasonable or
excessive, a pattern develops in which you avoid many situations or objects that are
somewhat similar to or related to your original phobia. It is easy to see how this
may lead to significant disruptions in your daily functioning at work, school, or in
social interactions. Usually the fear and anxiety associated with a phobic object or
situation increases the nearer it is, and the less likely escape from it may be.
Phobic disorders are divided into three general categories: Specific Phobia, Social
Phobia, and Agoraphobia.
I. Specific Phobia is an irrational fear or avoidance of a
specific object or situation. This disorder is seen among approximately 11% of the
population at some point during their lifetime. If you have a specific phobia, you
may fear being harmed in some way by a particular object; this is the case if you have a
spider phobia and fear being bitten and dying from the spider's poison. Alternatively,
your fear may center around your reaction to an object. For instance, you may be afraid of
heights due to a fear of fainting because high altitudes make you dizzy, rather than
fearing injuries due to a fall.
In order to be diagnosed with a specific phobia, your fear and avoidance must cause you
extreme distress or interfere with your participation or performance in important areas of
your daily life. For instance, if you are a student who has a fear of enclosed
places, you may find it impossible to attend classes that are on the fifth floor of a
building because a fear of elevators or stairwells prevents you from getting to the
classroom, or because the classroom itself feels too "closed in." Some
common specific phobias include:
- Animal Type--The focus of the phobia are animals or insects (snakes and spiders).
- Natural Environment Type--The focus of the phobia is an object in nature (storms,
heights, water).
- Blood-Injection-Injury Type--The focus of the phobia is the experience of seeing blood
or an injury or by getting an injection or other medical procedure.
- Situational Type--The focus of the phobia is a specific situation (public
transportation, elevators, flying, enclosed places, or driving).
- Other Type--The focus of the phobia is something other than those listed above (choking,
vomiting, or falling down without some means of support).
Criteria
- Extreme, continuous, and irrational fear when exposed to a specific object or situation.
- Confrontation with the feared object or situation almost inevitably and immediately
produces anxiety which may be experienced as a situationally-bound or
situationally-predisposed panic attack.
- The individual is aware that the fear is extreme and irrational.
- The feared object or situation is avoided or confronted with extreme anguish or anxiety.
- This avoidance response or the experience of anxiety when confronted with the object or
situation leads to significant disruptions in the individual's daily routine, work or school
performance, or social relationships, or there is extreme anguish associated with the phobia.
- For persons under age 18, these symptoms have lasted at least 6 months.
II. Social Phobia is a fear of being in certain types of social
or performance situations where you may be easily embarrassed. Social phobias are
evidenced in 3 to 13% of persons at some time during their lives. It usually occurs
in situations where you must interact with and be evaluated by people who are unfamiliar.
Social phobias fall into one of two categories (generalized or
performance-oriented) that are based on the pervasiveness and specificity of symptoms.
If you suffer from a generalized social phobia, you often feel shy and inhibited in
social situations. This "social shyness" usually poses a problem for you
in many types of situations. If you suffer from a performance-oriented social
phobia, you will experience anxiety only in situations where you are subjected to
evaluation by others. Again, the anxiety you experience, regardless of which
category, is so extreme that it interferes with your normal functioning. For
example, a social phobia, characterized as a general pattern of social inhibition and
shyness, would have very upsetting consequences for a CEO of a big corporation who had to
regularly conduct meetings, give presentations, or meet with clients for lunch.
Either this CEO would lose his/her job for refusing to perform these job duties, or he/she
would have to suffer through them in misery.
Similarly, a marketing student burdened by a performance-oriented social phobia, whose
classes necessitated frequent presentations and/or speeches in front of a group of peers,
would be likely to experience a significant impairment in his academic functioning.
In fact, a fear of public speaking is the most common expression of social phobia.
Criteria
- Extreme, continuous and irrational fear when exposed to one or more social or
performance situations in which the individual is evaluated or introduced to people who are
unfamiliar. Particularly, the individual fears that he/she will be suffer extreme
embarrassment or humiliation.
- Confrontation with the feared social situation almost inevitably produces anxiety that
may occur in the intense form of a situationally bound or situationally predisposed panic
attack.
- The individual is aware that his/her fear is irrational and extreme.
- The feared social or performance situations are avoided or confronted with extreme
anxiety or anguish.
- This avoidance reaction or experience of anxiety when confronted with the feared
situation produces a significant disruption in one's daily activities, work or school
performance, or social relationships, or experiences severe anguish concerning the phobia.
- For persons under age 18, the symptoms have lasted for a minimum of 6 months.
- The fear or avoidance is not a direct consequence of the effects of a substance.
III. Agoraphobia is a fear of being in places or situations
where it would be difficult for you to obtain help or where you could be easily
embarrassed while trying to escape the situation. If you suffer from agoraphobia,
you may avoid traveling long distances from home by yourself, or sitting in the middle row
of chairs in a crowded classroom. You may sometimes feel anxious being in a place
where help would not be available in the event of having a panic attack or panic-like
symptoms in which you may experience shortness of breath, racing heart, sweating, chest
pain, dizziness, and an overwhelming urge to get away from the current situation.
Unlike the other two phobias where there are just one or a few areas to avoid, as an
agoraphobic individual you will avoid a variety of situations since the focus of your fear
is on any place in which escape would be problematic or help unavailable. As is the
case with certain phobias, this avoidance can lead to severe disruptions in your daily
life and may become so extreme you can not leave your house. You may feel more
comfortable going out when you are with a friend or family member. If you are a
student, you may never even be able to attend classes or may only attend classes when
accompanied by a classmate.
There are two distinct patterns of agoraphobia, characterized by fundamental
differences in the focus of fear. If you experience sudden and severe bursts of
fear, known as panic attacks, when you are in a public place, the agoraphobic pattern is
labeled panic disorder with agoraphobia because your fear is mainly due to having a panic
attack sometime in the future. When the focus of your fear primarily centers on
being away from home and having a few panic-like symptoms, you would be diagnosed with
agoraphobia without history of panic disorder.
Criteria
- Anxiety related to being in places from which escape would be difficult or embarrassing
or in which help may be unavailable in the event of experiencing an unexpected or
situationally-predisposed panic attack.
- The situations are routinely avoided or confronted with a great degree of anguish or
anxiety about having a panic attack or panic-like symptoms or necessitate being accompanied
by a friend.
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Chuck experienced all the symptoms of an obsessive-compulsive person. He was
obsessed with order and could not spend less than 30 minutes straightening his desk at the
bank in the mornings. He was also the last one to leave his office at night because
he needed to make sure that everything was completely organized on his desk (the same
things he will organize again on the following morning!). At school he could not
turn in his class assignments because they were never organized to his satisfaction.
Taking tests was very difficult because he spent most of his testing time making
sure everything was ready for him to start and then obsessing about possible mistakes in
choosing his answers. He was unable to turn in his tests unless he had checked his
answers several times. He was also compelled to recheck his scantron choice to make
sure he had marked the right choice.*
Obsessive Compulsive Disorder has two basic components: (1) obsessions, and (2)
compulsions. Obsessions are constant ideas, thoughts, or images that keep intruding into
your mind and cause you a great deal of anxiety and distress. Compulsions are
specific and repetitive behaviors that you use in an effort to reduce the anxiety or
distress produced by your obsession. Although you are aware that these obsessions or
compulsions are unreasonable or excessive, you can't resist performing repetitive acts,
and you feel driven to perform these behaviors in order to reduce your mental anguish or
prevent some dreaded event from taking place. For instance, if you suffer from
obsessive compulsive disorder you may constantly call to check on a relative to make sure
they are safe because you have constant obsessions about your relative being killed, feel
responsible for these thoughts, and, consequently, the safety of your relative.
You may experience some of the most common obsessions which involve thoughts about
contamination from dirt or germs; repeated doubts, such as whether you left the oven on;
and sexual imagery. Common compulsions you may experience involve checking things
repeatedly, repeating verbal chants or mantras, counting, repeatedly rearranging and
ordering items, and praying. These behaviors seem either extremely excessive or do
not seem to be connected in any logical way to the obsession that you are attempting to
cancel out or prevent.
These activities usually consume a large amount of your time and interfere with your
work, school, or social activities. It may take you hours to finish a simple project
because you are constantly distracted by obsessions, or involved in performing
compulsions. For instance, if you are trying to write a term paper, you may feel
driven to perform a lengthy and detailed ritual of some kind after every line of writing.
Criteria
- Either Obsessions or Compulsions
Obsessions
- Repeated and insistent thoughts, urges, or images that feel intrusive and inappropriate and
that cause significant anxiety or intrusiveness.
- These thoughts, urges or images amount to more than disproportionate worries about realistic
life events.
- The individual tries to rid himself/herself of these intrusions or engages in some action
intended to cancel them out.
- The individual realizes that the obsessions originate from his/her own mind and are not
thoughts transferred to their mind by external sources.
Complusions
- Continual behaviors or mental acts that a person feels urged to perform as a result of an
obsession, or in compliance to a very specific and detailed set of rules.
- These behaviors are motivated by a desire to prevent or cancel out a dreaded outcome or
relieve the individual's distress; yet, are not related in a realistic way to the outcome they
are to affect.
- The person has realized at some point that the obsessions or compulsions are irrational
or extreme.
- The obsessions or compulsions cause significant anguish, are time-consuming (last more
than one hour a day), or disrupt one's normal daily routine, performance at work, or
school or social activities.
- These problems are not attributable to the direct effects of a substance or general
medical condition.
TOP
A panic attack is a very sudden rush of intense fear or terror accompanied by a sense
of impending doom and a frantic urge to flee. An estimated 36% of persons have
experienced a panic attack at some point in their lives. You will experience a minimum of
4 out of 13 physical or cognitive symptoms, which come on almost instantly and reach a
peak within 10 minutes. You may experience physical symptoms such as shortness of
breath, racing heart, dizziness, and sweating. Cognitive symptoms of a panic attack
involve fears of going crazy or dying.
There are two different types of panic attacks which vary depending on the situation
that triggers the onset of the attack:
- Unexpected (uncued) panic attacks do not have a specific situation that
sets the panic symptoms in motion. They occur spontaneously or "out of the
blue." For instance, you may experience an unexpected panic attack while you
are taking notes in class and not thinking about anything in particular.
- Situationally bound (cued) panic attacks occur every time that you are
in a particular situation. This specific situational "cue" almost never
fails to trigger a panic attack. For example, you may panic every time that you are
driving or taking an exam. Situationally predisposed panic attacks are more likely
to occur when you are in a particular situation, although the specific situation will not
always trigger a panic attack. For instance, panic attacks may be more likely to
occur when you are taking an exam, but there are times when you complete an exam without
experiencing a panic attack.
A panic attack must have 4 of 13 physical and/or cognitive symptoms:
- Heart palpitations, racing or pounding heart.
- Sweating.
- Trembling or shaking.
- Shortness of breath or smothering.
- Choking sensations.
- Chest pain.
- Nausea.
- Dizziness, or feeling faint.
- Depersonalization (feeling detached from one's body) or derealization (feelings of
unreality).
- Fear of losing control or going crazy.
- Fear of dying.
- Numbness or tingling in the arms or legs.
- Chills or hot flashes.
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Mike came to the Counseling Center after being in college for two years. He
described his panic attacks as terrifying. Sometimes he would be strong enough to
leave his home, only to return minutes later suffering intense fear. Most days he
was not able to make it to school or work, and when he did, he could not stay for long.
He spent most of his time at home, afraid that he would suffer another panic
attack. His grades were suffering and he did not know what else he could do, since
joining a study group or going to the university was not possible for him due to his
panic. After working in counseling for one semester, he wrote the following:
"I found that . . . I no longer had the anxiety problem that I was originally seeking
help for. What the method showed me was that it is possible for me to relax.
It is possible . . . to alleviate and/or "head off" anxiety as or before it
rears its ugly head . . . What I can tell you is that I am now able to work, live, and
accomplish without the stumbling block of anxiety."*
You may meet the conditions for having a panic disorder if you have repeated,
unexpected panic attacks and worry for some time afterwards that you will have another
attack; or, if you feel that the attacks represent something seriously wrong with you, or
feel that they will be detrimental to some aspect of your life. Furthermore, you may begin
to act differently because of the panic attacks you experience. For instance, you
may tend to catastrophize the consequences of an attack, thinking "I am going to
die," "I am going to go crazy," or "I am going to completely lose
control and humiliate myself."
For example, if you have had at least two panic attacks, you may become consumed with
worry that you will have another one at some point, that you are going crazy because you
experience these attacks for apparently no reason, and may begin to avoid social
situations for fear of embarrassing yourself by having a panic attack. A key point
in your experience of panic is that the attacks are not triggered by real threats to your
safety or well being; that is, most people in an identical situation would not panic.
You must have had at least two unexpected panic attacks, although
situationally-predisposed and situationally-bound attacks are common as well. Panic
disorder can follow one of two distinct patterns:
After being involved in a major traffic accident the year before, Tracey could not
get behind the wheel of a car anymore. She was very distressed by not being able to
drive since she was a commuter. She had been carpooling with other people, but she
was afraid of what might happen should her other classmate not be able to make it to
school someday. Tracey's symptoms included shaking and sweating, and feeling
helpless whenever she tried to start driving again. For this reason, she had not
tried to drive for the last four months.*
If you have ever endured a traumatic event in which you were seriously injured or
threatened, or in which you witnessed the death or injury of another person, then it is
possible that you may experience Posttraumatic Stress Disorder. A range of symptoms
similar to Panic Disorder are also common to this disorder; however, in this case, the
symptoms have been brought about by a real threat to your safety or well-being. Some
examples of a real traumatic event include war, automobile accidents, acts of terrorism,
or sexual assault. These are situations in which extreme anxiety would be a normal
human reaction. Additionally, to be diagnosed with Posttraumatic Stress Disorder,
you must have responded to these events with extreme fear, helplessness, or horror.
Furthermore, you must have had episodes of reexperiencing the event, continuously
avoiding situations or objects related to the event, continuously experiencing symptoms of
heightened arousal or alertness, and a general emotional "numbness" that have
lasted for longer than a month. Statistics for persons in general show that this
disorder occurs in anywhere from 1 to 14% of the population, whereas at-risk groups, such
as veterans of war, and victims of crime, show rates of 3 to 58%.
This disorder may follow one of three different courses. It is labeled:
- Acute--if the symptoms last less than 3 months.
- Chronic--if they last three months or longer.
- Delayed Onset--if the symptoms do not occur until 6 months after the traumatic event
took place.
Criteria:
- The individual has experienced a traumatic event in which both of the following were
present:
- The person witnessed or encountered an event that threatened serious injury or death to
himself/herself or someone else.
- The person's reaction to the event included extreme fear, helplessness, or terror.
- The process of reexperiencing the event may be manifested in one (or more) of the
following ways:
- Disturbing recollections of the event that continuously surface and may take the form of
images, thoughts, or perceptions.
- Continuous and disturbing dreams related to the event.
- The experience of reliving the event that includes flashbacks, illusions, and
hallucinations.
- Extreme psychological distress when exposed to objects or situations reminiscent of the
event.
- "Physiological reactivity" or bodily stress reactions when exposed to
reminiscent objects.
- Avoidance of event-related situations and general emotional numbing include three (or
more) of the following:
- Efforts to avoid thoughts, feelings, or conversations related to the traumatic event.
- Efforts to avoid activities, places, or people reminiscent of the event.
- Loss of memory related to a key aspect of the traumatic event.
- Significantly decreased interest or participation in previously meaningful activities.
- Feeling of alienation or detachment from others.
- Expectations of a limited or foreshortened future.
- Heightened symptoms of arousal are indicated by two (or more) of the following:
- Problems falling or staying asleep.
- Irritability or having a "short fuse."
- Problems concentrating.
- Being overly vigilant and watchful.
- Being easily startled.
- The above symptoms have occurred for at least a one-month period.
- The above symptoms cause significant anguish or disruption in one's activities.
TOP
If you suffer from Acute Stress Disorder, a disorder that affects approximately 5% of
persons at some point, you have probably shown many of the same symptoms as someone with
Posttraumatic Stress Disorder. Having confronted a traumatic event in which you were
either seriously injured, or witnessed another person being injured or killed, you most
likely have responded with extreme fear, helplessness, or horror during or shortly after
it occurred. Additionally, you must have experienced a range of symptoms similar to
those of Posttraumatic Stress Disorder that have lasted for at least 2 days and no longer
than 4 weeks, occurred within one month of the traumatic event, and interfered
significantly with your job or social interactions, or other important areas of your life.
Criteria
- The individual has experienced a traumatic event in which both of the following were
present:
- The person witnessed or encountered an event that threatened serious injury or death to
himself/herself or someone else.
- The person's reaction to the event included extreme fear, helplessness, or terror.
- The process of reexperiencing the event may be manifested in one (or more) of the
following ways:
- Personal feeling of "numbing," detachment, or lack of emotion in response to
others or events.
- Feeling less "aware" of one's surroundings; "being in a fog."
- Derealization--feeling that things are unreal or mechanical.
- Depersonalization--feeling that one is an outside observer of one's own body or thoughts.
- Dissociative amnesia--memory loss related to a key part of the traumatic event.
- The traumatic event is repeatedly reexperienced in the form of: continuous images,
thoughts, dreams, illusions, flashback episodes, or a reliving of the event; or anguish is
associated with reminders of the event.
- Pronounced avoidance of objects or situations reminiscent of the event.
- Pronounced symptoms of anxiety or heightened arousal (e.g., sleep problems, irritable
mood, difficulty with concentration, startle response, restlessness, and extreme alertness).
- These symptoms cause mental anguish or disruptions in performance for an important area
of one's life.
- The symptoms persist for at least 2 days and no more than 4 weeks and occurs within 4
weeks of the traumatic event.
- The symptoms are not directly attributable to the effects of a substance.
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If you would like to learn more about Anxiety, the Counseling Center has a variety of
resources to help you. Call or stop by the Counseling Center to make an appointment
to talk with a counselor. The Counseling Center is located across from the Lee Drain
Building, next to the Farrington Building. The telephone number is (936) 294-1720.
* All case descriptions are fictional.
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