by Sanjay Chugh

Anxiety disorders are possibly the most common and frequently occurring mental disorders. They include a group of conditions that share extreme anxiety as the principal disturbance of mood or emotional tone. Anxiety, which may be understood as the pathological counterpart of normal fear, is manifest by disturbances of mood, as well as of thinking, behavior and physiological activity. Included in this category are panic disorder (with or without a history of agoraphobia), agoraphobia (with or without a history of panic disorder), generalized anxiety disorder, specific phobia, social phobia, obsessive-compulsive disorders, acute stress disorder and post-traumatic stress disorder.

Anxiety disorders are ubiquitous across human cultures. The longitudinal course of these disorders is characterized by relatively early ages of onset, chronicity, relapsing or recurrent illness and periods of disability. Panic disorder and agoraphobia are particularly associated with suicidal tendencies.

PANIC ATTACKS

A panic attack is a period of intense fear or discomfort that is associated with numerous physical and psychological symptoms such as:
• Palpitations
• Sweating
• Trembling
• Shortness of breath
• Sensations of choking or smothering
• Chest pain
• Nausea or gastrointestinal distress
• Dizziness
• Tingling sensations
• Chills or blushing
• Hot flashes

The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes. Most people report a fear of dying or a loss of control over emotions and behavior. This generally evokes a strong urge to flee the place where the attack begins and, when associated with chest pain or shortness of breath, frequently leads to seeking urgent assistance from a hospital emergency room. Yet an attack rarely lasts for more than 30 minutes. According to current diagnostic practice, a panic attack must be characterized by at least four of the associated physical and psychological symptoms described above. The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature.

Panic attacks are not always indicative of a mental disorder, and up to 10 per cent of otherwise healthy people experience an isolated panic attack per year.

PANIC DISORDER

When a person has experienced at least two unexpected panic attacks, develops persistent concern or worries about having further attacks or changes his or her behavior to avoid such attacks, he is diagnosed with panic disorder. Whereas the number and severity of the attacks varies widely, concern and avoidance behavior are essential features. The diagnosis is inapplicable, however, when the attacks are caused by drugs or medication or by another disorder, such as hyperthyroidism.

COMPLICATIONS

Major depressive disorder, alcoholism and substance abuse frequently complicate panic disorder. Panic disorder also co-occurs with other specific anxiety disorders, including social phobia (up to 30 per cent), generalized anxiety disorder (up to 25 per cent), specific phobia (up to 20 per cent), and obsessive-compulsive disorder (up to 10 per cent.) Approximately half the people with panic disorder at some point develop such severe avoidance as to warrant a separate description.

Panic disorder is about twice as common among women as men. Age of onset is mostly between late adolescence and mid-adulthood, with the onset relatively uncommon past the age of 50. Typically, an early onset of panic disorder carries greater risks of chronicity and impairment. Panic disorder also occurs as a familial condition.

AGORAPHOBIA

The ancient term 'agoraphobia' is translated from Greek as 'fear of an open marketplace'. Agoraphobia today describes severe and pervasive anxiety about being in situations from which escape might be difficult or avoidance of situations such as being alone outside one's home, traveling in a car, bus, or airplane, or being in a crowded area.

ANXIETY DISORDERS

The likelihood of developing anxiety involves a combination of life experiences, psychological traits, and genetic factors. There are several major psychological theories explaining anxiety-psychoanalytic, psycho-dynamic, behavioral and cognitive theories. Anxiety disorders are so heterogeneous that the relative roles of these factors are likely to differ. Some anxiety disorders, like panic disorder, appear to have a stronger genetic basis than others, although actual genes have not been identified. Other anxiety disorders are more rooted in stressful life events.

It is not clear why more women than men suffer from anxiety disorders, although some theories have suggested the possible role of steroids. Research on women's responses to stress suggests that women experience a wider range of life events that are stressful as compared to men.

TREATMENT

• Counseling and Psychotherapy
Anxiety disorders are responsive to counseling and to a wide variety of psychotherapies. During the past several decades, there has been an increasing enthusiasm for focused, time-limited therapies that address ways of coping with anxiety symptoms directly, rather than exploring unconscious conflict or other personal vulnerabilities.

• Pharmacotherapy
The medications typically used to treat patients with anxiety disorders benzodiazepines, antidepressants and newer compounds such as buspirone.

• Combination Treatment
Some patients with anxiety disorders may benefit both from psychotherapy and pharmacotherapy treatment, either combined or used in sequence. It is likely that such combinations are not uniformly necessary and are probably more cost-effective when reserved for patients with more complex, complicated or severe disorders.

Panic disorders are extremely debilitating and common, yet respond well to treatment if started early enough in the course of the disease. It is not a condition to be taken lightly in view of its effect on the quality of the sufferer's life.

Dr Sanjay Chugh,
91-11-6833414, 6319241