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We all worry from time to time for various reasons, such as illness or financial problems. When we worry about one thing in particular, or if the worry is a realistic one, this is a normal reaction to an unpredictable situation and not a clinical anxiety disorder. Clinical anxiety disorders involve unrealistic or excessive worry about multiple areas of life. This may include worrying about misfortune to children and grandchildren, finances, or physical health. Anxiety disorders become more common as we get older because medical, psychological, and social problems tend to build up. Some community surveys suggest that perhaps one in five older adults suffer anxiety symptoms severe enough to warrant treatment. Persistent or extreme anxiety can seriously decrease quality of life and can be a sign of other problems, such as depression, dementia, physical illness, or side effects to drug treatment. Anxiety can be a symptom associated with many medical disorders common in older adults, including heart disease, lung disease, thyroid and other endocrine problems, neurologic illness, dietary problems (eg, excess caffeine intake or vitamin B12 deficiency), psychological illnesses, and side effects to medications.
Symptoms of Anxiety The signs of anxiety fall into four general categories:
Types of Anxiety Disorders Specific anxiety disorders include the following:
Anxiety is also associated with many other mental and physical health problems. Generalized anxiety disorder The most common type of anxiety problem is termed general anxiety disorder (GAD). Symptoms of GAD include the following:
However, symptoms alone are not enough for a clinical diagnosis of GAD. For a clinical diagnosis of GAD to be made, these symptoms must 1) have occurred for at least 6 months, 2) be accompanied by decreases in activities or some sort of impairment, and 3) be caused by more than one worry. For example, intense worry over financial matters or a medical illness alone, even with all the associated symptoms, does not mean someone has GAD. Panic attacks Panic attacks are among the most recognizable anxiety disorders. These "attacks" are sudden, distinct episodes of intense anxiety that are in reaction to some perceived emotional or environmental threat. The attacks are relatively short, lasting between a few minutes and a half hour. Symptoms may include the following:
Attacks can be quite dramatic, and many sufferers feeling like they will die or lose control. Panic attacks can happen without triggers. However, they often lead people to change the way they live to avoid having another attack. Panic attacks can lead to agoraphobia, which is a fear of open spaces, usually characterized by the fear of being in public places with no way to "escape." Common examples of feared situations include being caught in a crowd or trapped in traffic. Many people with agoraphobia tend to remain at home, avoiding most outside contacts. This can result in social isolation and a significant decrease in quality of life. Older adults who get panic attacks usually had a history of such attacks when they were younger. It is relatively rare for attacks to begin for the first time after age 55. Panic attacks that do begin late in lifer are usually milder with fewer panic symptoms and less agoraphobia. Phobias Phobias represent intense fears, and, when the feared object is seen, they can lead to intense anxiety, just like in panic attacks. These fears are typically categorized as "specific" or "social" phobias. A specific phobia involves fear of a specific person, animal, place, object, event, or situation that results in symptoms of anxiety. Someone with a phobia may recognize that the fear is unrealistic and irrational but can’t control the reaction. The level of anxiety usually increases immediately when someone sees the feared person or object, and becomes stronger as it gets nearer. The anxiety is even worse if the person feels that he or she can’t escape. Examples of common phobias include fear of specific animals (eg, snakes, spiders, or mice), closed spaces, flying, or heights. Among older adults, fear of crime becomes particularly common, especially for those living in urban areas. Specific phobias can be seen along with panic attacks, with or without agoraphobia. Specific phobias often involve a great deal of anxiety in anticipation of seeing the feared person or object. In other words, sufferers worry about even the possibility of seeing the thing that triggers the phobia. This often leads to avoidance behaviors that can cause personal difficulties, interfere with work and daily routines, and decrease opportunities to enjoy life and have fun. Anxiety and avoidance behaviors may also contribute to frustration, hopelessness, and a sense of not being in control. Social phobias are fears associated with social situations. The usual fear is of behaving inappropriately in a certain situation and feeling incompetent or embarrassed. Commonly feared situations involve giving public speeches, going on dates, or simply socializing with others at a party or other function. As with specific phobias, social phobias are often accompanied with a significant degree of anxiety in anticipation, avoidance, or both. As we get older, common social phobias include the inability to eat food in the presence of strangers and, especially in men, being unable to urinate in public bathrooms. Obsessive-compulsive disorder Obsessive-compulsive disorder involves having persistent thoughts (obsessions) that cause anxiety, and then behaving (compulsions) in ways to decrease the anxiety. Obsessions are persistent ideas, thoughts, impulses, or images that cause anxiety. These obsessive thoughts or ideas often come to mind while performing a specific task or during a particular situation. Compulsions are behaviors that are done over and over for a specific purpose in response to an obsession. Again, the goal of compulsive behavior is to decrease discomfort and anxiety. An example of obsessive-compulsive behavior is repeated hand washing. A person may wash his hands repeatedly, for hours at a time, after shaking hands with a stranger. In this case, the obsessive thought may be being exposed to a serious disease carried by a stranger. The act of repeated hand washing is the compulsive behavior performed in an attempt to remove the anxiety caused by the obsessive thought. Obsessive-compulsive disorder is chronic and often disabling. Like panic attacks, an obsessive-compulsive disorder rarely begins in later life. However, obsessions may develop along with depression or early dementia in older adults. For example, obsessing about paying bills on time may develop in someone who has difficulty in remembering, estimating time, or planning. Post-traumatic stress disorder In post-traumatic stress disorder a person has experienced (either as a witness or a victim) a traumatic event and reacted with feelings of fear and helplessness. Examples of traumatic events often involve actual or threatened death or serious injury, such as war, violent crime, accidents, or natural disasters. The event can also include threats to one’s integrity, witnessing an event that involves death or serious injury of another person, or even hearing about death or serious injury of a family member or close friend or associate. People who have experienced traumatic events commonly "re-experience" the same feelings a month or more later. These people also try to avoid seeing or even thinking about anything associated with the event. Other symptoms include difficulty falling or staying asleep, edginess, extreme wariness, and being easily startled. Post-traumatic stress is often associated with depression, panic disorder, and substance abuse. Anxiety associated with other disorders Anxiety is often associated with other mental disorders, such as depression, dementia, and delirium (see also Depression, Delirium, and Dementia). Anxiety is especially associated with depression, making it difficult to tell these two problems apart. In both of these conditions, older adults may talk about suffering from unpleasant feelings and seek help for their symptoms. In general, both conditions can be associated with distress and unpleasant emotions, and at times, it can be difficult to distinguish between them. However, depression is usually associated with decreases in positive emotions and the ability to experience pleasure, while anxiety is not. Conversely, anxiety, is often associated with overarousal, while depression is not. Anxiety disorders are also commonly seen with other medical conditions, including heart disease, lung diseases, side effects of medications, and high thyroid hormone levels. Some conditions are made worse by anxiety (eg, the common cold or influenza), and others can even be triggered by high levels of anxiety (eg, heart attacks). Diagnosis and Treatment An evaluation for anxiety usually begins with a discussion about the problem. Your healthcare provider will ask questions about the course and type of your symptoms and review any other mental or physical health problems. Additional laboratory or psychological tests may be recommended. Treatment for anxiety disorders includes both behavioral (ie, psychological) and drug therapies, often used in combination. Behavioral therapy There are several behavioral techniques for treating anxiety. Relaxation training involves soothing music, odors, visual images, and instruction in relaxation techniques. This mental "restructuring" can help you identify things that trigger or maintain anxiety, and to slowly gain more control over them. Other techniques involve facing your anxiety triggers in a controlled setting to "decondition" your anxiety response associated with the trigger. Successful behavior therapy in older adults typically includes a combination of more than one approach. Success also depends on having an appropriate level of mental function, a support network, and motivation. Referral to a mental health professional is often helpful. Drug therapy Anti-anxiety drugs are often prescribed when symptoms either interfere with a person’s ability to function or aggravate another illness. This is often the case in older adults who are facing a crisis, such as the stress of hospitalization, grief, or a change in living circumstances. Commonly prescribed drugs include antidepressants or short-term use of benzodiazepines. Regardless of the choice of drug, use in older adults must be monitored very carefully. These drugs should be used cautiously because of the potential for side effects. Common side effects from benzodiazepines include sleepiness, clumsiness and staggering, mood problems, and difficulty in thinking. These side effects are increased by drinking alcohol or taking other medications that affect the central nervous system. Symptoms of toxicity include staggering, difficulty speaking, lack of coordination, unsteadiness, and slowed reactions. Symptoms are often worse at night. Difficulties in thinking caused by benzodiazepines are characterized by increased forgetfulness and decreased attention. This may resemble the early stages of a dementia (eg, Alzheimer’s disease). If the problem is caused by side effects of the drug, it is generally reversible. Once the drug is stopped, memory, attention, and concentration usually improve. Older adults often have side effects from anti-anxiety drugs at lower dosages than younger adults. Having other physical or emotional illness can make matters worse. For example, any central nervous system disorder, such as stroke, Parkinson’s disease, or dementia, may lead to an increased effects of benzodiazepines. Interactions with other medications can also cause problems. Medications that cause sleepiness (eg, some antidepressants or antihistamines) can especially increase the central nervous system side effects of these anti-anxiety drugs. Another potential problem with anti-anxiety drugs is "rebound anxiety." This means that anxiety returns after the effects of the medication have worn off. Rebound anxiety is often more intense than the original anxiety. No one is exactly sure why this rebound anxiety occurs. One possibility is that high blood levels of prescribed medications may signal the body to stop producing natural anti-anxiety substances. So when the medication wears off, there is a complete lack of anti-anxiety substances, and the anxiety rebounds stronger than ever. |
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Published: 5/25/2005