Anxiety Disorders

Panic Disorder—Sudden acute anxiety, with a perception of overwhelming loss of control

Phobias—Irrational fears

Obsessive Compulsive Disorders—Anxiety associated with obsessive thoughts and compulsive behaviors

Post-Traumatic Stress Disorder—Anxiety following a significant traumatic event

Generalized Anxiety Disorder—Chronic free-floating persistent anxiety  

A panic attack is a discrete period of intense anxiety accompanied by four or more of the following symptoms: accelerated heart rate, sweating, shortness of breath, trembling, feeling of choking, chest pain, derealization, nausea, chills or hot flushes, paresthesias, fear of losing control, and fear of dying.  The feelings of anxiety come on very quickly, often producing a feeling of terror in the individual.  Some people experience only one attack in their lives and never experience another.  People who have recurrent attacks have Panic Disorder (PD) and can experience significant disability if untreated.  Panic attacks can occur at any age but most often begin in young adults. PD affects between 3 and 6 million Americans.  About twice as many women as men are diagnosed with panic attacks.

People with Obsessive-Compulsive Disorder (OCD) have either obsessions, or compulsions, or both.  These may be severe enough to cause significant distress in their employment, personal lives, and social relationships.

Obsessions:  People with obsessions are bothered by thoughts or images that continue to repeat themselves and are almost impossible to ignore.  These thoughts, which are annoying, distracting and inappropriate, tend to cause moderate to severe anxiety and other emotional discomfort. People who suffer from OCD worry excessively. Common obsessive thoughts include themes of violence, fear of germs and/or infection, and pathological doubts about one's character and/or behavior.

Compulsions:  Compulsions are specific behaviors which are often in direct response to the individual’s troublesome, obsessive thinking.  People engage in compulsive behaviors to reduce their obsessive thoughts.  Some of the most common compulsions are repeated checking of doors, locks, electrical appliances; frequent cleaning of hands or clothes; strict attempts to keep various personal items in careful order; and mental activities that are repetitious, such as counting or praying.

Post-Traumatic Stress Disorder (PTSD) develops when a person witnesses or experiences a traumatic event and later suffers physical and emotional distress due to that experience.  Examples of traumatic events known to lead to PTSD include military combat, violent criminal attacks, sexual assaults, natural or manmade disasters, and severe automobile accidents.  Very effective psychotherapeutic and medical treatments are available, and these disorders are often very treatable once the problem is accurately identified.  

Anxiety disorders are generally treated by a combined treatment approach utilizing both medication and behavioral psychotherapy.  

Anxious Physician (Ethical Dilemmas)  

A mid-career male otolaryngologist consulted a psychiatrist because of increasing anxiety in anticipation of doing routine procedures.  His anxiety was quite specific, albeit paradoxical, in that more complicated surgeries did not seem to evoke the same degree of anxiety.

They successfully started a Serotonin Reuptake Inhibitor to decrease the symptom intensity.  The patient and his psychiatrist were soon involved in discussions about the patient's homosexuality.  His orientation had been hidden from colleagues and mentors.  In his words, it was an "ordinary" part of him that he was always afraid of showing because that would cause shame and damage to his career.  Over the process of the therapy, he made the difficult decision to "come out."  He was astonished by how easily this anxiety-filled "normal" fact was accepted by his colleagues and patients, including his commitment ceremony in an "accepting" religious environment.

There was, however, a tense time in the treatment before he implemented his decision to disclose his sexuality.  His increased anxiety led to a worrisome increase in alcohol use.  The psychiatrist prescribed Antabuse. An ethical question that occurred during this time was whether the otolaryngologist's performance was impaired enough to pose a continuing threat to patient care.  If so, the treating physician would be obligated to report the physician to the Texas Medical Board.


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Last Updated On

January 26, 2012

Originally Published On

March 23, 2010