Apr. 27, 2001 (Houston Chronicle) - Larry was in college cramming
for his final exams when he suddenly felt a panic so overwhelming
it took over his mind and body.
His heart was racing. He was sweating. He was unbelievably
jittery.
``I felt like I was about to step in front of a firing squad,''
says Larry, who is now 52 and asked that his last name not be used.
``I didn't know what was happening.''
In the three decades since then, anxiety has been a battle for
this Houstonian. As isolated as Larry sometimes feels, he isn't
alone.
Anxiety disorders are the most common mental illnesses in the
United States, affecting more than 19 million people each year,
according to the National Mental Health Association. They are also
the most treatable, doctors say, but only if they are diagnosed
properly.
These days, television, magazines and newspapers are saturated
with advertising for prescription drugs to treat anxiety disorders,
which cost Americans more than $40 billion annually, in medical
expenses and workplace losses.
A commercial for Paxil shows an anguished woman whose
social-anxiety disorder leaves her too shy and fearful to leave her
home. Another, for BuSpar, uses an animated commercial to inform
people about generalized anxiety disorder.
Other ads seek participants for clinical trials of the next
generation of anti-anxiety drugs.
So what's the line between normal, everyday stress (described as
physical or psychological tension but without the fear component)
and a life-altering - sometimes crippling - disorder?
``We all have stress,'' says Shirley Riff, director of Terrap
Anxiety & Stress Center in Houston. ``We're a two-part system -
mind and body. The mind handles stress. If there's too much of it,
it spills over into the body. But the body isn't equipped to handle
stress, so it stores it.''
Excess worry can produce or trigger headaches, muscle tension,
muscle aches, stomachaches and panic attacks. It can also cause
sleeping problems, irritability, problems concentrating and
restlessness.
``If you can't handle stress with the mind, then it becomes
anxiety,'' Riff continues. ``Then people begin to start avoiding
places and people where they feel that anxiety.''
Doctors say when stress begins to impair a person's ability to
function at work or in other areas of life, continues for a long
time or becomes too intense to handle, it's probably part of an
anxiety disorder.
There are five types of anxiety disorders: panic disorder
(recurrent panic attacks), obsessive-compulsive disorder
(uncontrollable, repetitive behaviors or thoughts), post-traumatic
stress disorder (recurrent, distressing dreams and flashbacks after
an accident or violence such as war or rape), generalized anxiety
disorder (persistent worry about everyday life events such as
finances or health) and phobias (specific phobias such as fear of
snakes or social phobias, also called social anxiety disorder).
Celebrities such as actress Kim Basinger and former football
great Earl Campbell suffer from panic attacks. Donny Osmond has
social anxiety. Katie Couric has a fear of heights. And Howard
Stern is obsessive-compulsive.
Dr. Melinda Stanley, professor of psychiatry and behavioral
sciences at the University of Texas-Houston Health Science Center,
says the most common disorders are generalized anxiety and social
anxiety.
She says studies show that 15 percent to 50 percent of adults
have had an anxiety disorder sometime in their lives. A World
Health Organization study shows the odds of developing an anxiety
disorder have doubled in the past four decades.
``It's a big problem,'' says Stanley, director of the Anxiety
Disorders Research Clinic in the center's Mental Sciences
Institute.
Riff says her clinic is seeing more patients, half of them men.
In the past, most of its patients were women.
``The world is so fast-paced now, and we think we have to be
perfectionists,'' Riff says.
Jerilyn Ross, president and CEO of the Anxiety Disorders
Association of America and a Washington, D.C., clinical social
worker, says she's not sure if the problem is getting worse or if
physicians are getting better at recognizing and diagnosing them.
After all, anxiety disorders weren't named until the 1980s.
``Anxiety disorders are real, serious and treatable,'' says
Ross, author of ``Triumph Over Fear.''
Stanley believes advertising for anti-anxiety medications is
increasing awareness of the disorders, but she fears the ads may
lead people to believe only medication can help them.
In fact, she says, there are nonmedication treatments. One is
cognitive behavior therapy, which teaches people to change the way
they think and behave, helping them control anxiety by recognizing
triggers and learning relaxation techniques.
``For none of these disorders do we have strong data that
suggests that medication is more helpful than any other kind of
treatment,'' Stanley says. ``If you learn to control the symptoms,
then you have a better chance of maintaining the gains you make.''
That's not to say medication doesn't have its place in
controlling anxiety, Stanley says.
If a patient has depression along with an anxiety disorder (a
common occurrence), medication should probably be prescribed, she
says. If the patient is not depressed, cognitive behavior therapy
might be a better first choice, with the option of adding
medication later.
Some of the most common anxiety meds happen to be
antidepressants, such as Paxil, Prozac and Zoloft. There are also
benzodiazepines such as Xanax and Valium.
However, these drugs can have such side effects such as
drowsiness and sexual dysfunction and can be habit forming.
Stanley says some studies suggest that anxiety disorders run in
families, but anxiety can also be a learned behavior.
Anxiety can even afflict the young and elderly.
Recent studies published in the Journal of Personality and
Social Psychology showed that anxiety levels among children and
college students have skyrocketed so much that children in the
1980s reported more anxiety than child psychiatric patients in the
1950s.
The study blamed the climbing anxiety levels on crime, diseases
such as AIDS and an increasing lack of social connections and a
rise in divorce rates.
Stanley, whose expertise is anxiety disorders in the elderly,
says such disorders are surprisingly more prevalent than depression
in the elderly. They worry about their health, loss of control in
their lives and their role in life, she says.
``You have those who've had (anxiety) as long as they can
remember and those who've developed it into their lives,'' Stanley
says. ``Older people also tend to be less willing to talk about
psychological things.''
Social phobia, more recently called social anxiety disorder, may
sound like shyness, but it's not. It differs from shyness because
it leads people to avoid social settings or activities in which
they really want to participate, Stanley says.
Riff, who battled panic attacks for eight years, says an anxiety
problem should not be ignored, because often it can lead to
alcoholism or drug abuse. She says alcohol makes people with
anxiety problems feel relaxed and confident.
In the late 1970s, Riff was driving in a hurry when she had her
first panic attack just before reaching a bridge.
``All of a sudden my heart started pounding,'' she says. ``I was
shaking all over. It seemed like the bridge was moving.''
Riff was so shaken that she asked a stranger to drive her car
across the bridge. She eventually entered therapy to learn what
triggered her panic attacks.
``I had to change my beliefs and my behaviors,'' she says. ``I
learned it wasn't the bridge that caused my anxiety, but it was the
place where it reached its peak, and so I associated bridges with
my panic attacks.''
People who suspect they might have an anxiety disorder should
see their family or primary doctors to discuss the symptoms.
``These are treatable problems,'' Stanley says. ``Being able to
function more normally is not out of the realm of possibility.''
That's what Larry is hoping for. He believes his generalized
anxiety disorder coupled with depression has slowed his career in
business management and interfered with his family life.
``I feel like I have butterflies in my stomach all the time,''
Larry says.
He hopes cognitive behavior therapy, which he's been in for
several months, will help him get to the root of his problem -
something medications couldn't do.
``I want to have some peace in my life and feel like I'm calling
the shots,'' Larry says.
