Anxiety disorders – When fears determine life

23. March 2022

Every time we ride in our car, we are highly attentive, obey all traffic laws, don’t exceed the speed limit, and furthermore, bring our vehicle in for regular service – and yet we can be fatally injured by a wrong-way driver on the highway. We eat a healthy diet, drink enough, exercise and go for preventive checkups – and we can still suffer a heart attack. Knowing that we can’t protect ourselves against countless dangers every day, despite taking preventive measures, requires a permanent fear management. In the course of this, it is not surprising that a large number of people suffer from anxiety and that anxiety disorders are among the most common mental disorders in Western affluent societies.

How does an anxiety disorder manifest itself?

In general, fear is enormously important for survival, because it protects us from exposing ourselves to any kind of danger. It only becomes problematic when it takes on a life of its own, strikes even in harmless situations and leads to immense restrictions and suffering in everyday life. In such cases, where a sensible alarm signal becomes a false alarm, we are dealing with an anxiety disorder. Anxiety disorders can manifest themselves in both psychological and physical symptoms – here is an excerpt:

  • Inner restlessness
  • Discomfort
  • Despair
  • Nervousness and stress
  • Lack of concentration
  • Irritability and agitation
  • Palpitations
  • Shortness of breath
  • Trembling
  • Nausea
  • Dizziness
  • Sleep disturbances

Different faces of anxiety disorder

There is not THE one anxiety disorder. Just as different as the spectrum of symptoms can be the scope and the associated limitations of such a disorder. The following forms of anxiety disorders can be distinguished:

Panic disorders: Affected individuals experience massive panic attacks and are continually preoccupied with thoughts of them and how to prevent them. Such an attack is a short phase of extreme suffering, associated with enormous fear and physical and/or emotional symptoms. Particularly during the first panic attacks, it is not uncommon for those affected to experience mortal fear, the emergency physician is often called and a detailed medical evaluation is performed. Panic attacks can occur as a reaction to a specific situation (e.g., boarding an airplane) or for no apparent reason.

Phobic disorders: These include fear of specific situations (e.g., heights or confined spaces) or living things (e.g., spiders or dogs). Also observable is social phobia , in which everyday social demands (e.g., talking to strangers, eating in public, or talking on the phone) are highly anxiety-provoking. In agoraphobia, on the other hand, there is a fear of crowds. Affected individuals have difficulty leaving the house, using public transportation, going to the movies, or shopping. Panic attacks can also occur with phobic disorder.

Excursus: There are specific phobias that cause hardly any problems because the trigger can be easily avoided. For example, people with a fear of flying can only go on vacation to regions that can be reached by other means of transportation.

Generalized anxiety disorder: Here, there is an almost constant worry and tension that something bad might happen. The fears relate to various areas that other people also worry about (e.g., that you or someone close to you could fall seriously ill) – but they are much more pronounced than those of other people.

How does an anxiety disorder develop?

Anxiety disorders have a broad repertoire of causes! Very obvious are formative events in the biography. For example, someone who was bitten by a dog in the past could develop a dog phobia, or someone who has been stuck in an elevator for a long time could consequently be afraid of closed confined spaces. However, anxiety disorders are not always preceded by specific threatening experiences. Another trigger can be in childhood or the caregivers there, if there was no adequate support in fearful situations. This can be caused by an overprotective caregiver who, through his or her exemplary fearful behavior, makes the child perceive the world as particularly dangerous.

Similarly, anxiety disorders can also result from the fact that early caregivers were completely unconcerned and showed no understanding for the child’s fears. In this case, it was also not possible to learn adequate anxiety management strategies. Traumatic experiences such as separation or loss, stressful situations or excessive demands can also be responsible for the onset of an anxiety disorder. In addition, it is suspected that a certain genetic component already ensures that some people tend to release more stress hormones than others.

The physical component as a trigger also becomes clear once again when the disorder occurs as an accompanying symptom of diseases such as thyroid disorders, blood pressure crises or asthma attacks. Lastly, the use of drugs such as ecstasy, other amphetamines, or even larger amounts of caffeine can also trigger anxiety.

Confronting Anxiety

The suffering pressure of many affected persons is enormously high and confronting the fear very often seems impossible. Nevertheless, the only way out of anxiety is by confronting it. Two different methods can support patients on their way back to a self-determined life:

  1. Drug therapy for anxiety disorders

To determine the right medication for an anxiety disorder, it is first necessary to distinguish between acute therapy and long-term therapy. Many medications aimed at treating anxiety have a high risk of dependence if taken for a long time and should only be prescribed in the event of an acute panic attack or for a very limited period of time. The first point of contact in the case of an anxiety disorder can be the family doctor, but in the case of regular and prolonged use of medication, a psychiatrist should be consulted.

A psychiatrist can better assess whether anxiety is a symptom of another mental illness and whether the medication should be adjusted accordingly. If a drug with a potential for habituation is selected, it is essential that other therapeutic measures such as anxiety management training or psychotherapy are taken at the same time.

  1. Psychotherapy for anxiety disorders

In the context of talk therapy, the individual causes and maintaining factors of the anxiety disorder can be illuminated in addition or as an alternative to drug therapy. Particularly when such a disorder has already existed for a long period of time, a vicious circle of anxiety and avoidance behavior has often already established itself and makes everyday life more difficult for those affected. Since recurring fears in particular are incredibly stressful, those affected tend to avoid precisely these triggering situations.

This is a fundamentally sensible strategy, but not all activities can be avoided so easily. And the more frequently a situation is avoided, the less able sufferers are to learn that the feared catastrophe usually does not occur at all and that they are able to cope with their feelings of anxiety. Only when the vicious circle is interrupted by professional support can new strategies be learned and self-determination and freedom be regained.

In severe cases, where patients are unable to leave their homes, go to work, or even maintain relationships, the risk of depression with loneliness and hopelessness increases. In such cases, an inpatient stay in a psychiatric clinic can be considered.

The special role of relatives

The relatives of patients with anxiety disorders have a special role in the context of this mental disorder. In contrast to many other clinical pictures, those affected rarely deny or trivialize their symptoms. On the contrary, many sufferers seek support and reassurance from people around them. It is not uncommon for those around them to be directly involved in the avoidance behavior and to take over activities such as shopping, walking the dog, or accompanying sufferers to appointments outside the home.

The problem is not only that much is demanded of the relatives in the course of this, they also become part of the problem. Through them, patients with anxiety disorders can easily maintain their avoidance behavior and the improvement of the actual symptomatology moves into the far distance. At the same time, support is immensely sustaining and important. A conducive level of support can be described using the example of a broken bone: The patient will have to take it easy at first, but after a short time he can start physiotherapy to build up his muscles. Relatives can remind the patient to do the exercises and stay close by in case help is needed. However, it is impossible to perform the exercises vicariously for the affected person.

References
  • Meermann, Rolf; Okon, Eberhard: Anxiety Disorders: Agoraphobia, panic disorder, specific phobias. Stuttgart, 2006.
  • Nickel, Marius: Anxieties, compulsions and stress reactions. Vienna, 2008.
  • Rupprecht, Rainer; Kellner, Michael: Anxiety disorders. Stuttgart, 2012.
  • Wagner, Elisabeth: Understanding mental disorders. Berlin, 2021.

Categories: Anxiety disorders

Verena Klein
Autor:in Verena Klein
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