Anxiety Disorders: More Than Just Butterflies
Over 40 million Americans suffer from some form of anxiety disorder, making it the most common psychiatric affliction in the nation. Some believe these disorders are caused by biochemical abnormalities in the brain, while others attribute them to the frenetic pace of life in the 21st century. But whatever the origin, anxiety is a plague that causes tremendous suffering and even embarrassment for its victims.
Almost everyone has experienced it: the sensation of butterflies in your stomach as you prepare for a presentation or an appearance in traffic court. The dry mouth that makes you feel like you're spitting cotton. The rapid heart rate and slight shortness of breath that characterize a normal response to stressful stimuli. In other words, you're feeling anxious.
Now imagine those sensations writ large. Instead of butterflies, you feel nausea and may even vomit or experience diarrhea. Your hands tremble visibly and your voice shakes whenever you try to speak. Your heart pounds; you break out in a cold sweat; your throat closes up. And worst of all, you have the horrid suspicion that if you don't run away from the situation, you just might have a heart attack and die.
Anxiety disorders are among the most common mental illnesses in early 21st century America. Tens of millions of men, women, and children suffer from one or more of these maladies, which include---but are not limited to---obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and the phobias. What's more, anxiety goes hand-in-glove with many of the major psychiatric illnesses, particularly the affective disorders.
Almost any event that occurs in the course of one's life can contribute to the development of anxiety that rises to the level of impairment. Childhood trauma, such as physical or sexual abuse, is thought to be a common cause; so are the adult experiences of war and natural disaster. But sometimes, anxiety or panic can arise from comparatively insignificant occurrences, such as being laid off or enduring a minor surgical procedure, and the intensity can be so severe that it renders the sufferer incapable of completing even normal daily activities.
To say the least, the cost to society in lost productivity and health care utilization is staggering. A severely anxious person is paralyzed, in effect; he or she may not be able to focus on work or school, attend to everyday business such as paying bills, or even perform basic laundry or meal preparation. Substance abuse is common among this population, as victims will often try to self-medicate their anxiety by consuming large amounts of alcohol or turning to marijuana and illegally obtained prescription drugs. And tragically, unrelieved anxiety---like its companion, major depression---can even lead to suicide.
What can be done to help the anxious patient? For one thing, medication in the form of antidepressants like paroxetine (Paxil) and fluoxetine (Prozac) have mild anxiolytic properties, and this may be all some people need to calm the storm. However, those with more complex and severe anxiety may require stronger agents called benzodiazepines, which unfortunately carry a high risk of dependency, but are often the only effective pharmaceuticals for this condition.
These include short-acting medications like lorazepam (Ativan, or "Vitamin A" as health professionals often call it) and drugs with moderate duration like alprazolam (Xanax), as well as the long-acting clonazepam (Klonopin). All are controlled substances which must be prescribed by a doctor---preferably a psychiatrist---and carefully monitored for abuse, as tolerance tends to develop with the passage of time. Ideally, benzos should be used only for a brief period to bring a crisis under control, but since anxiety disorders are often chronic, the meds may be taken for months and even years. (Note: a patient should NEVER attempt to stop a benzo on his/her own; withdrawal may cause seizures, along with a rapid increase in symptoms.)
Psychotherapy can also be helpful in managing anxiety and panic. Mindfulness and cognitive behavioral therapy are popular forms of treatment in which patients learn how to be aware of their thoughts during periods of stress, and to replace negative thinking patterns with healthier ones. Another therapeutic intervention is one in which the patient is gradually re-introduced to situation(s) that contribute to his/her anxiety, and taught more constructive methods of handling them. The latter remains controversial, but can be extremely effective for some patients.
But above all, people with anxiety disorders need to know that the condition is not their fault. They are NOT being 'weak' or 'silly'. Research has shown that the brain goes through changes during exacerbations, thus the need for medication and treatment of episodes. The good news is, anxiety---like almost all mental illnesses---can be managed if not cured, and sufferers can regain their ability to live happy, productive lives.Last edit by Joe V on May 10, '13
About VivaLasViejas, ASN, RN Guide
Joined: Sep '02; Posts: 26,810; Likes: 43,972
RN and blogger extraordinaire; from OR , US
Specialty: 20 year(s) of experience in LTC, assisted living, geriatrics, psychMay 10, '13Thanks Viva! As a longstanding GAD patient, you hit the nail right on the head in describing how I feel! Celexa is my wonderdrug :-)May 10, '13Thank you SO MUCH for this post, Viva...
For longer than I care to admit, I have struggled with all of the symptoms described above. There are times when I sit alone and wonder " what the hell is wrong with me?!!...why are some things so hard for me, when they seem so simple for other people?? Why are my coping mechanisms so erratic, impulsive and riddled with panic?"
My family doesn't understand why I do the things I do ( or have done) and for most of my life I have carried an insurmountable load of guilt, shame and fear.
I come from a small family...with a very long history of abuse. To make a long story short, I was physically and mentally abused by my step-mother for most of my childhood ( whilst my father turned a blind eye). I then married at the age of 19 to a somewhat abusive man. After 8 years of marriage we divorced and I later married a man that turned my life upside down and subsequently, left me for another woman. I've intentionally remained single over the last several years ( minus one or two short, insignificant relationships).
I have seen my GP on occasion...seeking help and understanding about my struggles...only to be met with a rather brusque, condescending attitude...and I leave feeling ridiculous and weak.
When I've expressed how I'm feeling to family...I typically get " Get over it, let it go, your holding onto the past"...( and my all time favorite " You are in control of your life...you can choose to let things affect you the way they do, you know!"?
So the end result?....I remain feeling as though I have failed myself and those around me.
Why are things so much easier for my sister? Why am I the only one that feels this way?
The circuit of thoughts go round and round in my head.
Events that are just " everyday" things...render me panicked and breathless with fear. So I do the "avoidance dance"...procrastinating to the point where I have serious consequences...then become so overwhelmed with the fear...all I know how to do is cower and hide....and pray that no one finds out!!
As a health practitioner...I know there is a problem...but all avenues of help seem to point to the fact that I just need to " grow up!"
I do have the physical manifestations...rapid HR, hot/cold rushes, dry mouth and an overall feeling of paralysis!!!
This has left me in some pretty " sticky wickets" in my life....leaving my family, children and observers just shaking there heads, with such disdain and disappointment. -----and me?? Just feeling like fool and a failure.Last edit by weemsp on May 10, '13May 10, '13The sky is falling!!
That's me. It boggles my mind, but believe it or not my sense of doom has diminished as I've aged. I think it's because my life has such a routine. I've worked the same job > 10 years. Lived in the same house > 20 years. Married .... My life has very few surprises, therefore very few stressors. Kind of boring, but I prefer the even keel over the panic.
I don't even need the meds anymore.
I guess getting older doesn't stink as much as I thought.May 10, '13I know this probably counts as counter-transference and should be avoided (I need better, firmer patient boundaries) but I find it hard when patients are having anxiety. It's not directly a trigger but I can sure and quickly enough put myself in their shoes.
The panic disorder is mostly under control but there's always this underlying edge of anxiety, easily tripped. I swear, there's many a time where I've had a co-worker "sneak" up on me while I'm distracted or thinking about something else and I've been ready to jump out of my skin.May 10, '13Quote from dolcebellalunaI hate being startled worse than almost anything! Even when I was a kid, I never liked balloons or jack-in-the-boxes because of the element of surprise. And I very nearly disemboweled my husband when we were first married, because I wasn't yet used to having someone else in my apartment and he snuck up on me while I was cutting up a chicken. That's when he learned it's generally best to avoid startling me.I know this probably counts as counter-transference and should be avoided (I need better, firmer patient boundaries) but I find it hard when patients are having anxiety. It's not directly a trigger but I can sure and quickly enough put myself in their shoes.
The panic disorder is mostly under control but there's always this underlying edge of anxiety, easily tripped. I swear, there's many a time where I've had a co-worker "sneak" up on me while I'm distracted or thinking about something else and I've been ready to jump out of my skin.May 10, '13Wow, thank you so much for this post! I was actually a bit embarrassed that my anxiety started to worsen in nursing school. It's comforting to know that other people struggle with this at times.May 11, '13*sighs* us nurses are only human, and those of us nurses who have been through more than our share of trauma, drama or what-have-you. Well, we need a little help (in whatever form) just as much as our patients. Love my Cymbalta!! Keeps me "even"May 11, '13I started having panic attacks the day my divorce from my first husband was finalized in 1985. Within a year they had progressed to full-blown agoraphobia. I did not leave my house for over a year because I was sure that if I set foot out the door the world would come to an end & it would be my fault. It took lots of therapy & a few years of Xanax to get me through that. I still get panic attacks once in a while but I now have tools I did not have back then & I don't become incapacitated by them. I now know that I'm more powerful than the panic!Last edit by poppycat on May 11, '13 : Reason: spellingMay 11, '13Panic attacks here too! Among other things, almost missed med-surg 2 final exam, I was convinced I was dying even though I had had panic attacks in the past. Good to know I'm not alone!May 13, '13Quote from VivaLasViejaslol..And I very nearly disemboweled my husband when we were first married...
well my son had a very bad habit of coming up behind me or from behind a corner. I tried to warn him that I could literally die if he kept it up, but apparently he didn't care, the little rat
Good article sweetie. I have allowed anxiety to rule over major areas of my life and because of my addiction history, I don't want to take anxiolytics the proverbial rock and a hard place ... it has become more manageable but it still is really bad sometimes!May 13, '13Well, as you know I have an ETOH history, but for some reason I never became cross-addicted to pills. I was very blessed to have avoided this problem. I've got two different benzo's sitting around, but I've never abused them nor even been tempted to do so (except for the time I was suicidal, back in early 2012). I don't take them to get stoned or high, I take them because my default position is anxiety, and I can't manage it on my own.May 13, '13Some of the SSRIs and SNRIs have good results for GAD, too. Benzos seem to give a lot of folks too much "fog" to be able to work, though I suppose you could get used to it after a while.
Thank you for this article.
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