Anxiety Disorders Update
by Jeffrey P. Kahn, M.D.

         There's a lot of talk these days about anxiety disorders. But what are they?
         When people feel ordinary anxiety, they are usually thinking about something bad that has happened-or could happen. Those thoughts seem to offer reason enough for the anxiety. But sometimes nervousness lasts a long time, becomes overwhelming or starts to affect daily activities and relationships. At that point, it's time to think about whether an anxiety disorder is part of the cause.
         Panic disorder, social anxiety and obsessive-compulsive disorder are commonplace in our society. They have different symptoms and treatments, but all three are frequently unrecognized and unremedied-panic disorder most commonly of all.

Panic Disorder
         The core feature of panic disorder is panic attacks. Perhaps one in 10 people have these attacks. Laboratory studies suggest that while the other nine people can get nervous, they may be physically unable to have actual panic attacks. The attacks come in different forms, with symptoms that include sudden-onset episodes of panic, anxiety or rage.
         The episodes also include other sudden symptoms, such as shortness of breath; racing or pounding heart; chest pain or pressure; sweating; feeling hot, cold, shaky, lightheaded, nauseous; experiencing fears of dying, losing control or having a heart attack; experiencing tingling sensations in hands or feet, feeling detached from the world, or experiencing a desire to flee. No matter how bad people feel inside, most panic attacks are not noticeable on the outside.
         A family death, a promotion at work or some other life event can make panic disorder worse, but much of the time the cause is not obvious. After panic disorder has started, other symptoms can also set in. Fear of attacks, for example, can lead to "anticipatory anxiety," which can leave people nervous or irritable pretty much all of the time. Sometimes, the attacks can intensify and lead to a serious depression.
         Without realizing it, some people use alcohol or drugs in an attempt to control the attacks and anxiety. Still others develop phobias, because they try to avoid situations that either might trigger a panic attack, or where an attack would be especially unpleasant. Better known phobias include flying, driving, elevators, heights and closed spaces. In addition, panic can also make people uncomfortable in emotionally close relationships, making them want to pull or push away.

Social Anxiety
         The core feature of social anxiety (also called social phobia) is a fear of self-embarrassment in social situations. Common situations include public speaking, meeting new people, attending parties or even working on a project that will later be viewed by others. The emotional symptoms build gradually, sometimes starting when a speech is first assigned, or when a party invitation is received. Physical symptoms also come on gradually, and can include racing heart, sweating and facial flushing. Social anxiety can lead to serious shyness, and to avoidance of social relationships at home and at work.
         Some people use alcohol to ease their social anxiety, but the underlying problem doesn't get better, and the alcohol can become a habit. Others put great effort into fine-tuning social skills, and can learn to excel at public speaking, meeting new people and salesmanship. Even so, the social anxiety symptoms can often continue to cause distress. Social anxiety and panic disorder can occur together, along with the somewhat less common obsessive-compulsive disorder.
         Panic attacks, anticipatory anxiety, social anxiety, shyness, depression, phobias, relationship problems, alcohol, drugs, physical symptoms and possible underlying medical problems can get pretty hard to sort out. A psychiatrist with expertise in anxiety disorders is a good resource for figuring out what the problems are, how they are related and what can be done. Solutions can include practical advice, certain psychotherapies and specific medication for panic disorder or social phobia. Therapy and medication are best used in combination. With the right diagnoses and treatment, these anxiety disorders usually get better swiftly, making related problems easier to solve.

         Dr. Kahn is president of Manhattan-based WorkPsych Associates (, providing a range of executive assessment, development and treatment services, as well as corporate benefits and management consultation. He is also editor of Mental Health in the Workplace: A Practical Psychiatric Guide, and teaches at the Weill Medical College of Cornell University.

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