The anxiety disorders include various disorders related to excessive anxiety and difficult to manage, which are manifested in very different ways. These can include attacks or acute panic attacks, phobias, generalized anxiety disorders. There are also several classifications of these disorders, differing slightly between countries.
In the general population, all anxiety disorders have a prevalence of about 15% in about 12 months (and up to 20 to 30% if we take into account the whole life). They are among the most common mental disorders. Generalized anxiety disorder affects 2 to 6% of adults (slightly more women than men).
While occasional anxiety is normal, people with anxiety disorders experience excessive, persistent anxiety that seriously affects their quality of life. The diagnosis is made if the fear is disproportionate (in duration, intensity or frequency) compared to the real situation, and if the symptoms persist more than 6 months.
It is a mental health disorder that requires adequate medical and psychological care.
Anxiety disorders manifest themselves in a very variable way, ranging from panic attacks to a very precise phobia, through generalized and almost constant anxiety, which is not justified by any particular event.
In France, the Haute Autorite Sante (HAS) lists six clinical entities (European classification ICD-10) among the anxiety disorders:
- generalized anxiety disorder,
- panic disorder with or without agoraphobia,
- social anxiety disorder,
- the specific phobia (for example the phobia of heights or spiders),
- obsessive compulsive disorder,
- The state of post-traumatic stress.
The most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V , published in 2014, widely used in North America, proposes categorizing the various anxiety disorders as follows:
- anxiety disorders,
- obsessive-compulsive disorder and other related disorders
- disorders associated with stress and trauma
Each of these categories includes about ten “subgroups”. Thus, among the “anxiety disorders”, there are, among others: agoraphobia, generalized anxiety disorder, selective mutism, social phobia, anxiety induced by drug treatment or by drugs, phobias, etc.
Symptoms vary from one person to another, and usually include many of these signs:
- feeling afraid of worry, panic or discomfort
- heart palpitations
- sweat (sweaty hands, hot flashes …)
- shortness of breath, dry mouth
- choking sensation
- chest pain
- dizziness or lightheadedness
- tingling or numbness in the limbs
- sleeping troubles
- other various physical symptoms
The panic disorder (or panic attacks) is characterized by recurrent and unpredictable panic attacks, during which the person has trouble breathing, feel intense fear, uncontrollable, and other symptoms such as nausea or palpitations.
The general anxiety is, as the term suggests, a general and constant feeling of anxiety difficult to control.
The social phobia, in turn, results in excessive fear about social situations, which could be embarrassing, humiliating, or that are associated with a notion of performance.
Specific phobias can be associated with a wide variety of situations or objects / animals. They cause a totally unreasonable fear, for example spiders, lifts, public transport…
The obsessive-compulsive disorder (OCD) is an anxiety event and they result in obsessive ideas, invasive, and compulsive behaviors (eg, an obsession with cleanliness, the need to constantly check whether this or that is in his place, etc …).
The compulsive accumulation disorder is now recognized as part of anxiety disorders: it is reflected in the irrepressible need to accumulate objects (brochures, objects found on the street, etc.).
Finally, post-traumatic stress disorder is a deep malaise, a fear arising from a traumatic event, sometimes a few months later.
In general, specific phobias appear early in childhood or adolescence, whereas generalized anxiety, panic disorder or posttraumatic stress disorder occurring on average later, between 24 and 50 years.
Above all, it is useful to remember that anxiety is a normal emotion, which appears when one feels threatened or in danger. It becomes harmful and problematic when it manifests itself excessively in relation to the real threat or persists for a long time, thus interfering with the activities and daily functioning of the person.
The causes of anxiety disorders are not perfectly known. They involve genetic, physiological and environmental factors.
Thus, we know that a person is more likely to have anxiety disorders if someone in his family suffers. Being a woman is also recognized as a risk factor for anxiety disorder.
Having experienced stressful or traumatic events, especially in childhood, or the presence of another psychiatric disorder (for example, bipolar disorder) may also contribute to anxiety disorders.
Finally, we know that the occurrence of an anxiety disorder is linked, among other things, to physiological disturbances in the brain, particularly at the level of certain neurotransmitters, these substances that serve as messengers to the nerve impulses of a neuron. ‘Other. More specifically, GABA (the main inhibitor of all excessive reactions of neurons), nor epinephrine and serotonin are involved. The drug treatments of anxiety disorders act precisely on the regulation of these neurotransmitters. Cortisol (the stress hormone) also plays a role.
Prevention of anxiety disorders
The occurrence of anxiety disorders is not really rationally explained. It is therefore difficult to know who is likely to suffer.
On the other hand, some stressful and traumatic events can promote the occurrence of anxiety disorders. It is therefore recommended that you do not delay in obtaining psychological help after such an event, especially for children.
Finally, good lifestyle habits are essential to try to limit anxiety:
- have a regular sleep pattern and long enough nights
- practice regular physical activity
- avoid the use of stimulants, cannabis, alcohol and other drugs
- Surround yourself and be able to be supported in case of anxiety too strong.
Treatment of anxiety disorders
The treatment of anxiety disorders is based on medical and / or psychological interventions. In all cases, medical care is necessary to put in place an appropriate therapy, adapted to the patient’s needs, to his symptoms and to his family and social situation.
Psychological care is necessary in case of anxiety disorders.
It can even be the only treatment, or be associated with pharmacological treatment, depending on the severity of the disorders and the expectations of the person affected.
Cognitive and behavioral therapy is the therapy that has been most studied in the treatment of anxiety disorders, including social phobia, panic disorder and obsessive-compulsive disorder. By focusing on the factors that cause and maintain anxiety and by giving the patient control tools, this type of therapy is generally effective in a sustainable way (12 to 25 sessions of 45 minutes in general). According to HAS, structured cognitive and behavioral therapies are even as effective as drug treatments.
Other types of therapies, such as mindfulness therapy, have also been shown to be effective in clinical studies. The goal is to pay attention and focus on the present moment, and learn to control anxiety.
Analytical psychotherapy can be initiated to understand the origins of anxiety, but its effectiveness on symptoms is less rapid and less recognized.
If the symptoms are too intense and the psychotherapy is not enough to control them (for example in case of generalized anxiety), a drug treatment may be necessary.
Several medications are known to be effective against anxiety, especially anxiolytics (benzodiazepines, buspirone, pregabalin) that work quickly, and some antidepressants that constitute the background treatment, namely selective serotonin reuptake inhibitors. (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).
These medications can cause anxiety to worsen at the start of treatment and therefore close medical supervision is necessary.
Because of the risk of dependence, benzodiazepines must be prescribed temporarily (ideally not more than 2 to 3 weeks). Both initiation and discontinuation of treatment should be supervised by the physician.
Since pregabalin does not induce dependence and its efficacy is immediate, it is sometimes preferred to benzodiazepines.