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Anxiety


By M. Katherine Shear, M.D., Associate Professor of Psychiatry, University of Pittsburgh, Director, Anxiety Disorders Clinic.

”Anxiety is a normal part of everyday life. It acts as a signal which motivates us to improve performance and alerts us to impending dangers. Yet anxiety can get out of hand. When this happens, the normal warning signal mechanism of anxiety becomes a psychiatric symptom.

Anxiety symptoms occur in a group of disorders characterized by “free-floating” anxiety (panic disorder and generalized anxiety disorder), phobic anxiety (specific and social phobia), traumatic anxiety (posttraumatic stress disorder and acute stress disorder) and obsessive compulsive symptoms. Each of these disorders includes features of symptomatic anxiety, such as high levels of bodily arousal, excessive worries about potential danger, and avoidance of feared situations.

The disorders differ in the degree of preoccupation with body symptoms, the focus of worry and the extent and type of avoidance. Many clinicians and most consumers and their families are unfamiliar with the differences between these diagnoses and tend to view anxiety as a general and overall symptom. This is particularly true when an anxiety disorder occurs along with another illness, and when the latter illness is the focus of treatment. Nevertheless, the different anxiety disorders have different ways of working in the body and also have different responses to different kinds of treatment.

Anxiety disorders are the most common psychiatric conditions in the community. These disorders are often trivialized, in part because of their high frequency and in part because anxiety is a normal part of life. However, anxiety can become debilitating. Anxiety disorders have been shown to cause difficulty in people’ s ability to function in their daily lives and can affect quality of life as well. Experiencing a major depression greatly increases the likelihood of having an anxiety disorder. When an anxiety disorder is also present, depression is more severe and is more likely to fail to respond to treatment. The presence of panic attacks increases substantially the risk of suicide in a depressed individual. Other debilitating anxiety disorders, including social phobia, obsessive compulsive disorder, and post-traumatic stress disorder, are also commonly seen with depression.

Anxiety disorders appear to be common in people with bipolar disorder as well, yet anxiety is rarely discussed in the medical literature on bipolar illness. Clinicians and people with bipolar disorder may well be unaware of the potential very negative consequences of this seemingly unimportant complication.”

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