Anxiety Part 3: Diagnosis and Treatment

*** Disclaimer*** Please know that I am very passionate about helping others with every type of mental illness and disorder; however, I need to make a disclaimer related to this section. These articles are not meant for you to diagnose yourself with any type of anxiety disorder. If you believe you have an anxiety disorder, the best thing to do is to call your primary care provider and make an appointment to discuss it.

Diagnosing Anxiety

Now that we’ve talked about worry versus anxiety, let’s talk about how anxiety is officially diagnosed.  In psychiatry and psychology as well as other mental health practices, we use the Diagnostic and Statistical Manual of Mental Disorders. Currently everyone uses the 5th edition, so we fondly refer to this book as the DSM 5.  The DSM 5 looks at all sorts of mental illnesses and disorders and it provides specific criteria that need to be met in order to diagnose a particular illness.

For anxiety, the criteria depends on the type of anxiety disorder. Generalized Anxiety Disorder (GAD) is the most common anxiety disorder among people. According to the Anxiety and Depression Association of America, “GAD affects 6.8 million adults, or 3.1% of the U.S. population, yet only 43.2% are receiving treatment. Women are twice as likely to be affected as men. GAD often co-occurs with major depression.”

Other anxiety disorders include phobias (fears) of something specific (such as public speaking), separation anxiety, panic disorder, selective mutism, social anxiety disorder, agoraphobia, substance or medication induced anxiety disorders, and anxiety disorder due to another medical condition. Obsessive-Compulsive Disorder used to be considered an anxiety disorder but now it’s in a separate category. PTSD is under trauma related disorders.

Since the most common anxiety disorder is Generalized Anxiety Disorder (GAD), let’s talk about the criteria for diagnosis.  Generally, GAD is characterized by excessive anxiety and worry that is difficult to control. Remember anxiety is a normal emotion when we are threatened by a real danger; however, someone with GAD exhibits the symptoms of danger and the “threats” are usually out of proportion to what is actually occuring. Basically, in GAD, people worry about everyday events and activities and they fear the worst. For example a college student might be a straight A student but have anxiety that they are going to fail. Often there are different events or activities that might cause someone to get “keyed up” or edgy.  This is not a one time problem. Usually GAD is a lifelong problem. It doesn’t mean that someone is a bad person or has a moral failing but rather, it may be genetic, or caused by  illness or a medication. If it’s caused by an illness or a medication, these are different diagnoses; however, I wanted you to understand why this type of anxiety may occur.

GAD is a disturbance of normal functioning. It causes physical symptoms such as restlessness, fatigue, inability to concentrate, irritability, difficulty sleeping, and muscle tension.  Although the following are not mentioned as criteria in the DSM 5, people can experience other symptoms such as nausea and headaches or other physical symptoms. All these symptoms occur more days out of the week than not. Just because someone has GAD doesn’t mean they’re constantly anxious or fearful.  There are times that a person is not anxious or fearful during the day.

We have all undoubtedly heard about “panic attacks.” Panic Disorder is also in the DSM 5 and is different from GAD. You can have both. In other words, many other psychiatric illnesses can have panic as a part of the diagnosis. For example, a person with post-traumatic stress disorder most assuredly will have panic.

People with Panic Disorder, spend a lot of time worrying about when these physical panic symptoms will occur again and they make significant changes in their routines or keep away from certain places or things in order to avoid having symptoms.  People who have panic attacks may experience a number of physical symptoms:

• Palpitations
• Sweating
• Trembling or shaking
• Feeling short of breath
• Feeling like they are choking
• Chest pain or pressure
• Nausea or feeling sick to your stomach, vomiting
• Dizziness or lightheadedness
• Chills or sweats
• Numbness or tingling of the hands and/or feet
• The feeling that people or places around you are not real or that you are outside your body
• Fear of losing control or like you’re going crazy
• Fear of dying

Non-MedicationTreatment

There are lots of treatments for anxiety. Many treatments work really well together and using multiple treatments can be very effective. Keep in mind that all of these modalities are tools. Maybe you will use a saw and a hammer but not a wrench for whatever you are building.

Some of the important aspects of reducing anxiety include meditating. For Christians, this meditating on God’s Word.  One of my favorite verses to meditate on is Joshua 1:9, “Have I not commanded you be strong and Courageous? Do not be afraid or discouraged, for the Lord your God is with you wherever you go.“ Other strategies include getting appropriate sleep, doing creative activities that you enjoy, daily exercise, getting outside in nature, being active in your church and community, eating a healthy diet, avoiding or decreasing caffeine, and having others to talk to are all health ways to reduce stress and anxiety.

Many therapies are effective for helping to control symptoms of anxiety disorders. In the near future, I will be posting blogs about common therapies and how to find a therapist.  Many people in faith communities believe that going to a therapist means that you aren’t trusting in God or that they will somehow brainwash you into believing things that are not true.  Well, it’s the same with medical providers. You can find a good medical doctor who works with you and gives you good advice based on scientific research or you can find a medical provider who does not look at the research and fills your mind with untruths based upon what you want to believe. I can tell you that there are good therapists and not so good therapists and fortunately the good therapists outweigh the not good. Finding the right therapist can be difficult but again, we will discuss how to find the right therapist for you in the near future.

Therapies that are good for anxiety include Cognitive Behavioral Therapy (CBT), mindfulness, Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy, Art Therapy, and Exposure Therapy. Again, these will be explained in the near future. Particularly for children and adolescents first, learning skills to cope with anxiety is the most important thing to start with.

Medication

Along with therapy, medications can also be useful.  First line medications for anxiety are called Selective Serotonin Reuptake Inhibitors or Selective Norepinephrine reuptake inhibitors. These are also known as SSRI’s or SNRI’s (antidepressants). Many of the parts of the brain which are related to depression are also related to anxiety. There are other medications that can also help with anxiety that work with different types of neurotransmitters to help decrease anxiety. When we talk about depression, we’ll talk more specifically about how SSRI’s and SNRI’s some of the other medications are effective.  We’ll talk more in depth about depression soon, but for example, both depression and GAD share the symptoms of:

• Difficulty with sleep
• Difficulty concentrating
• Fatigue
• Symptoms of moving too much or too little

Please ask questions if you have any. We’ll be talking next about depression.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

https://adaa.org/understanding-anxiety/facts-statistics

Stahl, S. M. (2014). Stahl’s essential psychopharmacology (4th ed.). Cambridge University Press.