Your anxiety may be a medical problem

Fear is a normal psychological response to danger. It is called the ‘fight or flight’ response, which we have evolved for survival as it allows us to escape from danger. However, when our threshold for triggering this response is too low, things that do not actually pose a threat are perceived as dangerous and cause us to worry or avoid a situation. When this excessive reaction, that is difficult to control, causes impairment of our daily functioning at work, play or home, it could be classified as an anxiety disorder. The modern medical world has identified a number of conditions that cause excessive fear as ‘Anxiety Disorders’. A broad classification is as follows:

  1. General Anxiety Disorder: characterised by excessive and difficult to control worrying about general everyday issues that should not create anxiety.

  2. Panic Disorder: characterised by recurrent panic attacks and avoidant behaviour.

  3. Social Anxiety: characterised by the fear and avoidance of social situations.

  4. Agoraphobia: a fear of being unable to escape and so being away from home is often avoided.

  5. Specific Phobia: the most common type of anxiety disorder characterised by marked fear or anxiety about a specific situation (for example, fear of heights) or object (for example, animals, insects or needles).

  6. Obsessive-Compulsive Disorder: characterised by intrusive thoughts and/or compulsive behaviour.

  7. Post-Traumatic Stress Disorder: a cluster of anxiety symptoms developed within the context of a major traumatic experience.

Anxiety disorders can be debilitating and can impact on one’s quality of life and function dramatically. From a public health perspective, anxiety disorders constitute anywhere from one quarter to one half of all mental illnesses in the community and are most commonly seen in the primary care sector. In addition to the significant impact on the functioning of individual patients, the plethora of medical procedures to which these sufferers are subjected can be rather daunting. However, this is necessary to rule out another medical condition that may be precipitating the symptoms. Unfortunately, this may result in a large indirect economic burden. Discouragingly, the data shows that these disorders continue to be grossly underdiagnosed and undertreated in this sector. Effective treatments for anxiety disorders have been available for at least three decades.

Concerted efforts by the World Health Organization (WHO), the World Psychiatric Association and similar organisations here in Trinidad & Tobago (T&T) are needed to change this picture.

In T&T, a similar situation exists. What adds to the problem is that, most cases are mild to moderate and are not perceived as serious problems. When the anxiety is moderate to severe, like most psychiatric conditions, because a stigma is usually attached to these disorders, families of the sufferer tend to hide the problem to avoid having to seek assistance from the official mental health system. Therefore, a big part of addressing the problem would include initiatives to break the stigma and sensitivity drives to the community. Through raising awareness and the education of those living with friends and family who suffer from mental illness, and in addition to the wider public, everyone in society can help those with the condition to live their lives to the fullest.

At the level of the individual consultation with one’s doctor, if you are suspected to have an anxiety disorder, your clinician will conduct a thorough medical history, physical exam and order laboratory work to rule out any other possible medical cause that could account for the symptoms. For example, dysfunction of the thyroid gland is a common differential diagnosis for anxiety disorder. Hypo or hyperthyroidism can present with similar symptoms as anxiety disorders. Therefore, it is essential to do a thyroid function blood test as part of the work-up of a patient suspected to have an anxiety disorder. All anxiety disorders share a common set of symptoms that centre around the emotion of anxiety. These include:

  • Racing of the heart or palpitations

  • Generalised cold sweating or sweating specifically of the palms  

  • Shortness of breath or tightness in the chest

  • Gastrointestinal symptoms, for example, nausea, vomiting, diarrhoea or stomach cramps

  • Shakes, tremor or trembling

  • Feeling faint, lightheaded or weak which may be associated with headaches

  • Feeling anxious, worried or stressed

  • Trouble controlling worry

  • Trouble concentrating or thinking about anything other than the present worry

  • Difficulty sleeping

  • Feeling of panic due to a sense of impending danger or doom

  • Having the urge to avoid things that trigger anxiety

The average person may have one or a few of these symptoms ever so often as part of a natural anxiety reaction to stressors. This is called physiologic anxiety as it is considered normal. However, to meet the diagnostic criteria the anxiety, worry or physical symptoms need to be severe enough to cause clinically significant distress or impairment in social, occupational or other important areas of function.

Once a medical condition, use of medication or substance abuse are ruled out, a diagnosis of anxiety disorder can be made. In panic attacks, there may be no identified trigger. However, depending on the trigger of the anxiety elicited, one of the others may fulfil the diagnosis.

The causes of anxiety disorders are not fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety. Inherited traits also can be a factor. Often it is attributed to an imbalance of chemicals in the brain called neurotransmitters that is a cumulative result of a combination of environmental and genetic factors. Nevertheless, regardless of their cause, anxiety disorders can be debilitating and can affect one’s quality of life and function dramatically. However, if correctly diagnosed and evidence-based treatment is implemented, the patient’s life could truly be changed. Treatment modalities for anxiety disorders include psychotherapy, specifically Cognitive-Behavioural Therapy (CBT), and pharmacotherapy which include antidepressants and benzodiazepines (only if needed and not recommended as a mainstay of treatment). If there is remission of symptoms with pharmacotherapy, the medications should be continued for six to 12 months after symptoms resolve and coming off them requires a physician’s guidance. These therapies are usually instituted by a psychologist and/or psychiatrist.

We must however remember that lifestyle and diet are also crucial in treating anxiety disorders. A balanced, healthy diet is necessary so that one’s body is healthy and can help bring one’s mental state back to normal. Exercise is also crucial as it not only makes us physically fit which helps with improving symptoms, but regular exercise also affects the functioning of the brain to be more resilient against mental disorders. In fact, studies have shown that regular yoga and meditation enhances the effect of normal exercise where mental disease is concerned.  These lifestyle changes must be maintained throughout life.

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