Generalised Anxiety and Panic Disorder: A Help Guide
While anxiety can be a survival instinct and a useful tool, many individuals suffer with anxiety problems. Two key anxiety signs are fear and worry. Fear is a response to a known threat whereas worry is a feeling of apprehension in response to an unknown threat.
GAD can be understood by excessive and irrational worry about everyday life that is disproportionate to the actual experience of life.
Panic Disorder can be understood by the reoccurrence of severe panic attacks. The causes and triggers to these attacks are varied and can often be linked with an underlying issue and/or further mental health problems.
Diagnosis of GAD is made if a person has experienced a lasting period with prominent tension, worry and feelings of apprehension, about every-day events and problems. Some associated symptoms include the following:
- Palpitations or accelerated heart rate
- Trembling or shaking
- Dry mouth
- Difficulty breathing
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, faint or light-headed
- Feeling that objects or self are unreal
- Fear of losing control or passing out
- Fear of dying
- Hot flushes or cold chills
- Numbness or tingling sensations
- Muscle tension or aches and pains
- Restlessness and inability to relax
- A sensation of a lump in the throat or difficulty swallowing
- Exaggerated response to minor surprises or being startled
- Difficulty concentrating
- Persistent irritability
- Difficulty sleeping
The clear sign of a Panic Disorder involves having a series of intense episodes of extreme anxiety whilst having a panic attack. These attacks can last from 1 minute to 1 hour, although typically last for approximately ten minutes.
Estimates vary yet some research has indicated that GAD is the most common of the anxiety disorders, which affects approximately 5-10% of the population at any one time. Research indicates that the overall prevalence of panic disorder is difficult to measure as co-morbidity with other mental health problems is so common.
A range of ages and ethnicities suffer from these anxiety disorders. A common age of onset is early 20s.
Women are more likely to experience GAD and panic disorder than men. Although highly prevalent, estimates show that only 25% of sufferers actually seek treatment. One key reason for this may be that some people are not able to recognise or differentiate their symptoms.
GAD and panic disorder is often associated with co-morbidity with a specific phobia, agoraphobia, social phobia, bipolar, substance use and depression.
There are many known causes to a GAD and Panic Disorder. There is a range of models that can be used to understand their development, and in many cases there are a number of contributing factors.
Learning from our personal experiences can be a main contributor to the development of an anxiety disorder. For example, the experience of an anxiety-provoking event can lead to further anxiety about similar situations in the future. This can be a coping mechanism that serves a useful purpose, however for many the anxiety can become severe.
The reason for this is that the response to an anxiety provoking event can often be intertwined with pre-existing negative beliefs and poor coping strategies. This may lead to a heightened sense of worry. Some anxieties can interfere with everyday life and can be disproportionate to the actual threat.
Some negative life experiences which may contribute to the development include physical, sexual, emotional abuse, physical illness, war experience, and other traumas. If such experiences are left emotionally unresolved, this can often take the form of mental health problems including anxiety problems.
Further environmental factors may enhance an existing anxiety problem such as poor social support and stress. There is also evidence to suggest that anxiety problems can derive from social observational learning. This means that some individuals may develop anxiety problems, solely from observing others who show anxiety, worry and distress. We learn from others and imitate their behaviours, particularly our parents when at a young age.
Many individuals may not be able to identify a specific cause. Some research suggests that these individuals may have suppressed certain memories into their subconscious mind, therefore not consciously knowing why their anxiety disorder has developed.
Further correlations have been found with GAD and panic disorder. These include low self esteem and low confidence. Therefore this suggests that some personality types may be more likely to develop such anxiety problems. There have also been genetic findings that may contribute. Research indicates that a slight difference in a serotonin transporter gene (SLC6A4) may be associated with the development of GAD. The hormone called ‘serotonin’ is associated with feelings of well-being and happiness. This finding shows that there may be some genetic influence to these anxiety disorders.
Panic and other anxiety symptoms have been found to be a possible side effect of certain medications. It is important to read the patient information leaflet of any medication being taken if concerned.
All individuals experience anxiety at times and can understand how negative anxiety can feel. Although there is this link between sufferers and non-sufferers, many have explained that there are false public understandings. Many think of high anxiety levels as irrational and unnecessary. It is important to acknowledge that sufferers cannot help the way they respond to day-to-day life and that many people suffer with acute symptoms which can result in unhappiness, avoidance and interference with everyday life.
There is also research to suggest that there are some public misunderstandings of panic attacks. Many individuals have mistaken these for life threatening illnesses such as heart attacks. This can lead to admission into emergency rooms and the undergoing of extensive tests to diagnose the physical health problem. Understandably, this can lead to further anxiety. Furthermore, once life threatening illnesses have been ruled out, people may feel as though a lot of time and resources have been wasted. This simply serves to create even more anxiety for the panic disorder sufferer.
GAD is understood by the core symptoms of fear and worry, decreased concentration, disturbed sleep, irritability, muscle tension, fatigue, and feelings of anxiety. According to the DSM-IV-TR, patients with GAD experience a number of these symptoms for more days than not for at least 6 months.
The DSM-IV-TR for panic disorder suggests symptoms are unexpected, recurrent panic attacks, followed in at least one instance by at least a month of a significant
and related behaviour change, a persistent concern of more attacks, or a worry about the attack's consequences.
There are two types of panic disorder, one with and one without agoraphobia. Diagnosis is excluded by attacks due to a drug or medical condition, or by panic attacks that are better accounted for by other existing mental health disorders.
One risk if left untreated is the worsening of symptoms and the development of other mental health problems. GAD and panic disorder are associated with significant impairment in occupation, interpersonal relationships and everyday functioning.
Even if it seems an anxiety disorder has become less strenuous, the course of the illness can often involve relapse. Individuals suffering with symptoms should seek help and
should not delay treatment.
There can be high success rates in treatment for GAD and Panic Disorder. Research, experiments, and clinical practice have led to the development of many evidence based treatments. These can result in an alleviation of illness and improvement in mental health.
Some famous people who have been associated with anxiety disorders include Sheryl Crow, Michael Jackson and Naomi Campbell.
The National Institute for Health and Clinical Excellence (NICE) was set up in 1999 to reduce variation in the availability and quality of NHS treatments and care - the
so called ‘postcode lottery’.
NICE quality standards are a set of specific, concise statements that act as markers of high quality, cost effective patient care, covering the treatment and prevention of
different diseases and conditions. NICE provides information related to common mental health problems including anxiety disorders, ‘Good communication between healthcare professionals and patients is essential. It should be supported by evidence-based written information tailored to the patient's needs. Treatment and care, and the information patients are given about it, should be culturally appropriate.’
For further information about NICE visit http://www.nice.org.uk/
Much research suggests that the best approach to treatment is almost always psychology based. Some anti-anxiety medication can ease symptoms, however some suggest they often do not alleviate the problem, therefore are not an effective treatment exclusively.
There are many evidence based treatments available.
Psychotherapy and counselling has been found to be very useful in overcoming GAD and panic disorder. This approach can focus on getting to the root of the cause, possible triggers and working with the therapist to resolve the problem by developing positive coping strategies.
Some psychological approaches can involve cognitive behavioural therapy (CBT), which explores your thoughts, feelings and behaviour around everyday life and how this relates to anxiety. Practical ways of effectively dealing with the anxiety disorder are developed.
Other psychological approaches can involve Mindfulness and learning relaxation techniques. This can help with personal awareness and the development of calming coping styles.
Pharmacological approaches can also be used and many have been tested. Prescribed medication can include anti-depressants and anti-anxiety tablets.
Many people may benefit from one or a combination of such approaches.
When you feel ready there are many ways in which you can help, support and advice. Firstly it may be worthwhile reading a self-help book:
- Helen Kennerley, Overcoming Anxiety - A Self-Help Guide (1997).
- ‘Emma Fletcher and Martha Langley. Free Yourself from Anxiety: A self-help
guide to overcoming anxiety disorders (2008).
Some self-help websites include:
• NHS website for GAD: http://www.nhs.uk/conditions/anxiety/Pages/Introduction.aspx
• NHS website for panic disorder: http://www.nhs.uk/Conditions/Panic-disorder/Pages/Introduction.aspx
Some useful telephone numbers include:
• NHS Direct- 0845 4647
• No Panic (Help line for anxiety sufferers)- 0800 138 98889
There are now many counselling and therapeutic services and organisations available. There are many trained professionals who will be able to support you such as Counsellors, Psychotherapists, Psychologists and Psychiatrists. Here are details of available services:
The NHS- seeing your GP and asking for a referral to see a specialist.
Charities- (such as MIND, Rethink, Young Minds and the Mental health foundation) some may provide support groups, therapy and advice in your local or near-by area. See their websites for further details.
Counselling and psychotherapy clinics and services- Search through online directories or contact your council for organisations that offer can therapeutic help. (Harley Therapy is one such clinic)
When seeing a healthcare professional you are likely to be offered an initial assessment. You will be some questions to identify the issues, causes and problems with a view to understanding and assisting you to recovery.
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- Baillie and Rapee, (2005) A.J. Baillie, R.M. Rapee. Panic attacks as risk markers for mental disorders. Soc. Psychiatry Psychiatr. Epidemiol., 40 (2005), pp. 240–244.
- Ballenger, (1993) Panic disorder: Efficacy of current treatments. Psychopharmacol. Bull., 29 (1993), pp. 477–486.
- Bandelow, Seidler-Brandler, Becker, Wedekind, Ruther (2007) Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatments for anxiety disorders. World J Biol Psychiat, 8 (3) pp. 175–187.
- Chartier-Otis, Perreault, Belanger (2010) Determinants of barriers to treatment for anxiety disorders. Psychiat Q, 81 (2) pp. 127–138.
- Charney et al., (1987) D.S. Charney, S.W. Woods, W.K. Goodman, G.R. Heninger. Serotonin function in anxiety II: effects of the serotonin agonist MCPP in panic
- disorder patients and healthy subjects. Psychopharmacology, 92 pp. 14–24.
- Diagnostic and statistical manual of mental disorders (DSMIV). (2004) Washington, DC: American Psychiatric Association.
- Mineka S, Zinbarg R. A (2006) Contemporary learning theory perspective on the etiology of anxiety disorders: it’s not what you thought it was. Am Psychol. 61:10–26.
- Posmontier (2012) Managing Generalized Anxiety Disorder in Primary Care. The Journal for Nurse Practitioners. Volume 8, Issue 4, Pages 268–274.
- Hofmann, Sawyer, Witt, Oh (2010) The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol, 78 (2) pp. 169–183.
- Nutt, Argyropoulos, Hood, Potokar (2006) Generalized anxiety disorder: A comorbid disease. Eur Neuropsychopharmacol, 16 (Suppl 2) pp. S109–S118.
- Wittchen HU, Beesdo K, Gloster AT. (2009) The position of anxiety disorders in structural models of mental disorders. Psychiatry. Clin North Am. 32:465–481.
- Wittchen, (1986) H.U. Wittchen. Epidemiology of panic attacks and panic disorders. Hand, H.U. Wittchen (Eds.), Panic and Phobias: Empirical Evidence of Theoretical
- Models and Longterm Effects of Behavioral Treatments, Springer, Berlin, pp. 18–28.