It’s not possible to predict who will get PTSD; it occurs in people of all ages and races. Some factors, however, may increase its risk:
“A little anxiety is motivating,” says Dr. Ken Duckworth, a psychiatrist and associate medical director for behavioral health at Blue Cross Blue Shield of Massachusetts. “But large amounts of anxiety are debilitating.”
How we react to anxiety
Anxiety stamps its mark on us physically and psychologically. Physical symptoms may include a pounding heart, sweating, trembling, feeling hot or icy, blushing, agitation, being hyper-alert, faintness, dizziness, chest pain, nausea or a sensation of smothering. Psychological symptoms may include worry, dread, unease, uncertainty, fear, nervousness, panic, outbursts of anger, an out-of-body sensation or even the conviction that you’re about to die.
When persistent anxiety interferes with your daily tasks, activities, or enjoyment of life, it’s best to seek professional help (see “Getting Help”). At this point, your coping behaviors may be hurting you, too. Perhaps you can’t leave home because you’re afraid you’ll have a panic attack in public. Maybe you’re driven to perform certain rituals — washing hands, for example, or repeatedly touching, checking on or counting things — to relieve distress. Perhaps you’re isolating yourself because any social occasion makes you unbearably nervous, or abusing alcohol or drugs to help calm anxiety.
A common thread
Anxiety disorders are very common, affecting roughly 40 million Americans 18 or older each year. Some often start in childhood or teenage years, such as obsessive-compulsive disorder (OCD) and social phobia. For anxiety to cross into the realm of a disorder, it must affect daily functioning.
Common anxiety disorders are:
• Generalized anxiety disorder: Excessive worries, tension and varied concerns about money, work, relationships and health with little rational reason. Affects 6.8 million American adults. Continual spikes in worry and tension, skipping from one anticipated disaster to the next are a few symptoms.
• Obsessive-compulsive disorder (OCD): Persistent, upsetting thoughts (obsessions) and rituals (compulsions) that relieve the anxiety sparked only temporarily. Fear of germs that prompts repeated hand washing is one example. Affects about 2.2 million American adults. Repeated rituals and behaviors — counting, hoarding, arranging items symmetrically — are a few symptoms.
• Panic disorder: Sudden attacks of terror, usually peaking within 10 minutes and often accompanied by a sense of unreality, impending doom, or fear of losing control. Inability to predict when the next attack may occur causes great anxiety. Affects about 6 million American adults. Pounding heart, sweating and faintness are a few symptoms.
• Post-traumatic stress disorder (PTSD): Witnessing or being the victim of violence, natural disasters or combat may lead to PTSD, which affects about 7.7 million American adults. Not everyone in these circumstances develops PTSD, however. Nightmares, intrusive thoughts, startling easily are a few symptoms.
• Social phobia (or social anxiety disorder): Feeling extremely anxious, excessively self-conscious and watched and judged in everyday social situations. Affects about 15 million American adults. Trembling, blushing, feeling that all eyes are watching are a few symptoms.
• Specific phobia: Intense, irrational fear of something — dogs, small spaces, flying — that poses relatively little or no danger. Affects about 19.2 American adults. Severe anxiety, pounding heart, sweating are a few symptoms.
Very often, anxiety disorders co-exist with depression. Or they are compounded by substance abuse, a self-medication strategy likely to hamper improvement and cause additional problems. If necessary, seek professional help for these issues, too.
First, talk to your doctor, who can consider whether a health problem or medication could be prompting anxiety. For example, an overactive thyroid or stimulant drugs taken for attention-deficit disorder or another health issue could make you feel very anxious. After ruling out these issues, your doctor can refer you to a mental health professional. Depending on how much anxiety affects you, you may want to try coping skills, such as exercise and relaxation techniques, first to see if this helps you sufficiently before seeing a mental health professional.
Treatments for anxiety
Generally, mental health professionals treat anxiety with a combination of coping strategies plus exposure therapy and cognitive behavioral therapy described below. When necessary, medications are added.
• Cognitive-behavioral therapy (CBT): CBT helps change unhelpful thought and behavior patterns. Someone with OCD who fears germs might be encouraged to get his hands dirty, then wait before washing for increasing amounts of time. A woman who has panic attacks might first need to learn she’s not having a heart attack, then be taught strategies to help her tolerate symptoms.
• Exposure therapy: A therapist helps you face your anxiety through a series of gradual steps. The goal is to learn to tolerate anxiety for increasing lengths of time. Exposure therapy is not typically used for PTSD, but works well for phobias like fear of snakes or flying and most other anxiety disorders.
• Medications: Depending on the disorder, a doctor may prescribe anti-anxiety drugs, which can block physical symptoms of anxiety, or other medications.
• Other emerging treatments, such as eye-movement desensitization and reprocessing (EMDR) for PTSD are being studied to see if they are effective.
Anxiety is a very common, treatable problem. You don’t need to entirely erase anxiety, but you’ll be able to manage it better if you understand what level of anxiety you face and attend to it accordingly.