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Health and Disease Neuroscience

Anxiety Disorder: Exploring The Reality Behind Having Anxiety

Anxiety. A term that is used so frequently that it lost its meaning. This article covers the biology of the illness, how it is processed in the brain, its influences on individuals and the various diagnosis and treatment. 

Anxiety. A term that is used so frequently that it lost its meaning. This article covers the biology of the illness, how it is processed in the brain, its influences on individuals and the various diagnosis and treatment. 

Introduction

Experiencing anxiety or feeling anxiousness is a part of life. However, people suffering from anxiety disorders usually experience severe, excessive, and persistent worry and fear about ordinary events. These uncomfortable, hard to regulate, out-of-proportion to the real threat, and protracted sensations of worry and panic interfere with daily activities. According to the American Psychiatric Association entitled “What are Anxiety Disorders?” (1),  Anxiety is a typical response to stress and in some circumstances, it can be beneficial. It can alert us about potential threats and assist with planning and attention. Anxiety disorders are distinguished from typical sensations of nervousness or anxiety by the presence of excessive fear or anxiety. According to the Nami National Alliance on Mental Illness, titled, “Anxiety Disorders”(2),  they stated that “ Anxiety disorders are the most common type of mental illness in the United States. In the US, approximately 40 million persons (19.1%) suffer from an anxiety illness. Meanwhile, approximately 7% of children aged 3-17 experience issues with anxiety each year, and most people develop symptoms before age 21.”

 To add on, there are 5 major types of Anxiety. Generalized Anxiety Disorder, Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD), and Social Phobia (or Social Anxiety Disorder). 

What causes Anxiety Disorder?

Having Anxiety Disorder interferes with daily activities and is difficult to control. And so, what is the cause? The specific cause of anxiety disorders is unknown to researchers. Although, throughout examination, researchers have found that there are various causes of Anxiety Disorder, and each is based on its different types. 

It can be caused by genetics, since Anxiety Disorders may run in families. There could be environmental stress, such as childhood abuse and neglect, the death of a loved one, and several other traumatic situations. Anxiety Disorders can be caused with drug abuse or withdrawal. Some anxiety symptoms may be concealed or reduced with specific medications, and so alcohol and drug abuse can go hand in hand with anxiety disorders. Some heart, lung, and thyroid diseases can exacerbate or induce symptoms that are similar to those of anxiety disorders. (4)

According to several studies, dysfunctional brain circuits that regulate emotions and fear may be responsible for anxiety disorders. They are characterized by a variety of neuroendocrine, neurotransmitters, and neuroanatomical abnormalities. The great degree of interconnectedness between neurotransmitter- and neuropeptide-containing circuits in limbic, brain stem, and higher cortical brain areas complicates identifying the most functionally significant differences. Additionally, environmental events and underlying genetic predisposition may lead to a primary alteration in brain structure or function or in neurotransmitter signaling; such abnormalities might raise the risk for psychopathology. (3)

To continue, it’s important to consider the neurotransmitters that allow communication between different regions. When there is an increased activity in the limbic system and various emotion-processing brain regions, patients who have Anxiety Disorder could have a decrease in inhibitory signals by by γ-amino-butyric-acid (GABA) or increased excitatory neurotransmission by glutamate. Each anxiety disorder, as well as major depressive disorder (MDD), is vulnerable due to both genetic and environmental factors.

Overall, Anxiety is produced by an imbalance in the brain chemicals serotonin and noradrenaline, which are important in mood regulation; a combination of past trauma such as assault, abuse, or bullying; chronic pain condition; or inherited causes, among other things. The decision to identify MDD, PD, PTSD, SAD, and GAD as different illnesses must be established on pathophysiology, genetics, duration of illness, and treatment response data, in addition to clinical phenomenology. The variations in neuroendocrine, neurotransmitter, and neuroanatomical functions between individuals with mood or anxiety disorders and healthy control subjects must be evaluated with caution (Table 3). Brain areas and neurotransmitter systems associated in mood and anxiety disorders perform a variety of activities, many of which are unrelated to the etiology of psychiatric diseases. (3)

Figure 1: Pearson: “Structures under the Cortex: The Limbic 

System”

Figure 2: National Library of Medicine: “The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and Psychoneuroendocrinology.”

Symptoms of Anxiety

The primary symptoms of Anxiety prevail of 

  • panic
  • uneasiness
  • hyperventilation
  •  tense muscles
  •  rumination
  • fervently avoiding dreaded things or locations
  • Having an increased heart rate
  • Sweating
  • Feeling weak 
  • difficulty focusing or thinking about anything but the current issue 
  • Having digestive issues 
  • having trouble managing worry 
  • a desire to stay away from things that make you anxious

How Anxiety affects individuals

An anxiety-inducing scenario or impending event is a typical physical response to stress. This reaction starts in the Amygdala, a part of the brain that sends distress signals to the hypothalamus. (Fig 1).  The remainder of the body receives these signals, which triggers a “fight or flight” reaction. A short-term, physiologically positive stress reaction occurs when the adrenaline hormone, an elevated heart rate, increased blood supply to the brain, and the ensuing surge of oxygen compel us to focus on the issue and find a solution. However, long-term repetitive stress reactions to anxiety, excessive worry, and a variety of day-to-day concerns. There are 5 major types of Anxiety and each type affects the individual differently.

Generalised Anxiety Disorder (GAD)

With GAD, you experience excessive, unreasonable tension and concern for little to no reason. You worry excessively about most everyday circumstances and can’t recall the last time you felt calm and collected. This constant stress and tension may be accompanied by bodily symptoms such as restlessness, feeling on edge or quickly fatigued, difficulties concentrating, muscle strain, or sleeping issues. Worries about ordinary things such as job duties, family health, or minor issues such as chores, car maintenance, or appointments are common. (1)

Obsessive-Compulsive Disorder (OCD)

OCD can induce obsessive, intrusive thoughts that can be stressful, as well as an overpowering desire or compulsion to execute a routine repeatedly. This could be shown in his or her behaviors, such as cleaning or washing hands excessively, putting goods in a drawer in a specific way, folding away clothes, and so on. (5)

Panic Disorder

Panic Disorder involves recurrent episodes of abrupt, severe feelings of worry, fear, or terror that peak in just a few minutes (panic attacks). You might experience dread, breathlessness, chest pain, or a rapid, fluttering, or hammering heart (heart palpitations). These episodes don’t coincide with a recognized phobia or stressor; instead, they happen “out of the blue.” (7), and so these panic attacks might lead you to worry about them happening again or to avoid circumstances where they have happened.

Post-Traumatic Stress Disorder (PTSD)

PTSD is a psychiatric disease that can arise in people who have encountered or witnessed a traumatic event such as a natural catastrophe, a catastrophic accident, a terrorist attack, war/combat, or rape, or who have been threatened with death, sexual violence, or serious injury. People suffering from PTSD have powerful, unsettling thoughts and sensations about their experience that remain long after the traumatic event has finished. They may relive the event in flashbacks or dreams, experience sadness, dread, or fury, and feel disconnected or estranged from others. Persons suffering from PTSD may avoid circumstances or people that remind them of the traumatic experience, and they may have significant unpleasant reactions to seemingly innocuous things such as a loud noise or an unintentional touch. (6)

A traumatic incident must have occurred in order for PTSD to be diagnosed. The exposure, however, may be indirect rather than direct. A person who sees the violent death of a close family member or friend, for example, may develop PTSD. Some of the many symptoms and diagnosis of PTSD include Intrusive thoughts, resisting reminders of the traumatic event, changes in cognition and personality, and changes in arousal and reactivity. (6)

Social Phobia (Social Anxiety Disorder)

Social anxiety disorder (social phobia) is characterized by intense anxiety, fear, and avoidance of social interactions as a result of emotions of humiliation, self-consciousness, and concern about being judged or seen adversely by others.

Risk factors

Anxiety disorders are caused by a variety of reasons, including genetic, environmental, psychological, and developmental factors. Anxiety disorders can run in families, implying that the diseases are caused by a mix of genes and environmental factors. (1). A few factors are, 

  • Truma
  • Stress from an illness
  • Other mental health disorders 
  • Drug or alcohol 
  • And many others.

Diagnosis and Treatment

The first step is to see your doctor to ensure that there is no physical problem causing the symptoms. If you are diagnosed with an anxiety disorder, a mental health expert can help you find the appropriate treatment. Unfortunately, many people suffering from anxiety problems do not seek treatment; they are usually unaware that they are suffering from a disease. Although each anxiety condition is distinct, the majority respond effectively to two methods of treatment: psychotherapy (often known as “talk therapy”) and medicines. These treatments can be administered individually or in combination. 

Psychotherapy, often known as talk therapy or psychological counseling, entails working with a therapist to minimize your anxiety symptoms. It might work well as an anxiety therapy. 

The most effective type of psychotherapy for anxiety problems is cognitive behavioral therapy (CBT). CBT is a short-term treatment that focuses on teaching you how to think, react, and behave differently in order to feel less nervous. There are particular strategies to help you improve your symptoms and gradually return to the activities you’ve avoided due to anxiety. 

CBT incorporates exposure treatment, in which you gradually expose yourself to the object or event that causes your anxiety in order to gain confidence in your ability to manage the situation and anxiety symptoms. (8)

 Although medications will not cure anxiety disorders, depending on the type of anxiety disorder you have and whether you also have other physical or mental health problems, they can provide significant relief from symptoms. The most often given drugs are antidepressants and anti-anxiety meds, which are typically only provided temporarily.

In some cases, your doctor may prescribe other medications, such as sedatives, often known as benzodiazepines, or beta-blockers, which are commonly used to treat cardiac issues, are also used to treat physical symptoms of anxiety. These drugs are meant for short-term alleviation of anxiety symptoms and should not be used indefinitely. (8)

Self-Help, Coping, and Managing

People can also do a variety of things to help cope with the symptoms of anxiety disorders and make treatment more successful. Meditation and stress-reduction methods can be beneficial. They can join support groups (in person or online) that can allow people to share their experiences and coping mechanisms. They can learn more about the nuances of a disorder and assist family and friends in better understanding the condition can also be beneficial. To include, caffeine, which can aggravate symptoms, should be avoided, and any drugs should be discussed with your doctor.

Akshaya Ganji, Youth Medical Journal 2022

 References 

  1. American Psychiatric Association: “What are Anxiety Disorders?”-https://psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
  2. Nami National Alliance on Mental Illness: “Anxiety Disorders”-https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders 
  3. National Library of Medicine: “The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and Psychoneuroendocrinology.”-https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961 
  4. WbMD: “Anxiety Disorders”-https://www.webmd.com/anxiety-panic/guide/anxiety-disorders 
  5. MayoClinic: “Anxiety Disorders”-https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961 
  6. American Psychiatric Association: “What is Posttraumatic Stress Disorder (PTSD)?”-https://psychiatry.org/patients-families/ptsd/what-is-ptsd 
  7. National Institute of Mental Health: “Panic Disorder”-https://www.nimh.nih.gov/health/statistics/panic-disorder 
  8. MayoClinic: “Anxiety Disorders (Dignonis)-https://www.mayoclinic.org/diseases-conditions/anxiety/diagnosis-treatment/drc-20350967 

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