Naturopathic Control: Anxiety Disorders

In a different post, I discussed the decision-making and preparation for getting help for psychological concerns. In that post, I used the example of major depressive disorder (MDD) and bipolar disorder types 1 and 2. This post continues that discussion by briefly discussing common types of anxiety disorder (Social Anxiety Disorder / SAD).

Anxiety is a normal human reaction to stress and danger. However, when it occurs beyond the normal extent and even forces the sufferer to alter their life (to avoid the fear), it is considered 'extreme' and called a 'disorder'. However, the term 'anxiety disorder' collectively refers to a group of mental health problems. Each anxiety disorder has its own unique features and is therefore treated accordingly. The most common forms and their approximate frequency within the population include the following. It is also possible for single individuals to have multiple forms. However, in order to arrive at such a scenario, it is necessary to pay special attention to the subtle differences such as the particular objects of fear. After all, there are subtle elements that overlap between types of anxiety disorder. In short, it is a matter of finding the best fit. Furthermore, in all cases, the disorder should not be explained by extraneous factors like drugs or other illnesses that cause anxiety.

specific PHOBIA, 8 to 12% of the population.. Specific phobias refer to the irrational fears of a specific object or situation. Phobias (including agoraphobia discussed below) are an extreme type of fear to the extent that they are no longer considered a mere 'fear' (much like how 'anxiety disorders' surpass the significance of normal human 'anxiety'). Sufferers catastrophize, ie they assume that the probability of a negative outcome is nearly 100% (when in reality, it might be very small). Since sufferers feel powerless against these phobias, they may go to great lengths to avoid exposure. Exposure commonly results in exaggerated responses like trembling, sweating to an extent that exceeds their norm and so on. Unlike fears, phobias, disrupt daily life. This is what differentiates normal levels of anxiety from anxiety disorder.

Treatment commonly include carefully planned safe exposure to the trigger. This exposure may even be through imagined or virtual reality exposure, especially when real exposure is impractical. Based on an hierarchy of phobias, triggers may be prioritized for treatment if there are multiple ones. Another type of treatment is cognitive restructuring. This involves addressing the irrational nature of the phobia, like assuming an abnormally high probability of a worst-case outcome.

Example(s) of phobia.

Medical.

hemophobia is the fear of blood or needles.

Situational:

Agoraphobia is the fear of being helpless and trapped in a situation. Escape may be either difficult or embarrassing.

Environmental:

claustrophobia is the fear of enclosed spaces.
urban phobia is the fear of cities or urban environments.

Animal-related:

Ophidiophobia is the fear of snakes.
Arachnophobia is the fear of spiders.

agoraPHOBIA, 1 to 3% of the population. Agoraphobia is the fear of being in public places from which escape would be difficult if needed. Essentially, it is a fear of being trapped. This fear is commonly associated with public places from which sufferers wish to escape back to a safe space like their homes. Such people tend not to venture out much. This phobia may have developed as a result of an unresolved panic disorder.

Fears of crowd; like in music concerts or shopping malls

social anxiety disorder (SAD, aka social phobia disorder), 7% of the population. SAD is the overwhelming concern of being humiliated, ill-treated or embarrassed in social situations. While all humans fear humiliation, harsh judgement, feel shy at times and so on, SAD exceeds those experiences beyond the normal levels. Unlike agoraphobia (where the fear relates to being physically trapped), sufferers fear socially difficult situations. In order for this intense experience to be considered a disorder, it must affect normal routine and relationships. Additionally, the problem must be persistent, specifically at least 6 months. The social situations may vary by person. For instance, for some individuals, the anxiety is triggered by public speaking at work, for others, it may be meeting new people and so on. The situation may become compounded by the fact that, being aware of their affliction, afflicted persons may then develop the additional fear that others can detect the affliction. In some severe cases, persons also experience derealization.

While anxiety occurs normally when meeting new people before diminishing and entirely going away after becoming more familiar with those erstwhile 'new' people, someone suffering with SAD continues to suffer the same heightened level of anxiety, even after becoming better acquainted. This therefore extends beyond the norm. Furthermore, if the impact is some type of avoidant behavior that disrupts his or her life, perhaps he or she no longer seeks to meet new people and keeps a distance from others, then such a person can be said to be suffering from SAD.
Fear of eating in front of others even despite familiarity.
Fear of public speaking that continues, even several hours after the speech has occurred.

panic disorder, 2% - 3% of the population. Panic disorder is characterized by recurrent panic attacks. A panic attack is normal experience that happens to most people at least once in their lives. It is a sudden and intense feeling of fear that something bad will happen. It manifests anxiety in its most severe form. Panic attacks are an aspect of the fight or flight response. These attacks are so intense that there are even physiological signs like heart palpitations, shortness of breath and sweating. They may last between a few minutes or, in more severe cases, several hours. Patients often think they are having a life threatening experience like a heart attack. The DSM-5 stipulates that patients can be said to experience a panic attack if they observe at least 4 (of 13) criteria. Sufferers can be diagnosed with the disorder if i) the attacks are recurrent and unexpected, ii) the patient worries persistently and changes behavior (because of the attacks). Attacks can not be attributable to drugs or other substances (and can not be explained by other types of phobia like agoraphobia, etc). Since attacks are unexpected, patients must be treated before they begin to shut down by altogether in seclusion by avoiding places where attacks occur. Panic attacks often occur along with other disorders.

Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
A feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Feelings of unreality (derealization) or being detached from oneself (depersonalization)
Fear of losing control or going crazy
Fear of dying
Numbness or tingling sensations (paresthesias)
Chills or hot flushes

generalized anxiety disorder (GAD), 2% of the population. GAD is an exaggerated feeling of uneasiness of impending doom. Unlike other forms of anxiety, such as social anxiety disorder or agoraphobia that deal very specifically with social situations or physical spaces respectively, GAD has a broader set of triggers. Some such triggers may include the following. finances, physical security, etc. Signs and symptoms include edginess / restlessness, mind going blank, irritability, difficulty concentrating, digestive problems (from over or under eating), muscle aches (from anxious tension) and sleeping problems (which can often lead to chronic fatigue). As with other forms of anxiety, the disorder affects the normal course of life. However, in severe cases, the disorder is entirely debilitating, leaving the afflicted person unable to perform the simplest daily activities. Since the level of severity exists on a continuum, persons with mild cases can be able to function socially in a job for instance. However, the levels can worsen or improve over time. For an official diagnosis, the worry should extend for at least 90 days out of 180 days (ie more than half of the time). The person must have trouble calming themselves down (ie self soothing). (Only 1 of these symptoms is required for the diagnosis in children). Common evidence of this disorder includes: difficulty going to school or work.
Separation anxiety disorder. This involves fear of losing someone to whom one is attached.
Post Traumatic Stress Disorder / PTSD has been reclassified in the DSM-5 from being an anxiety disorder. One way in which it can be seen as different is the fact that it involves an external event. Read more about PTSD.

If you have not yet been diagnosed but have done research and have suspicions about certain conditions, research its official definition and associated list of symptoms in the Diagnostic & Statistical Manual (DSM) used by mental health professionals. Note those symptoms that you observe in yourself. It is useful to consider clear examples. As you will notice from the DSM, conditions apply only if you have the 'A criteria' (ie those criteria that you must definitely have in order for the condition to apply at all) and meet the minimum number of symptoms. In other words, if these criteria are not met, there is no need to proceed further with the particular condition.

The 'A' criteria for anxiety are at least 3 of the following signs and symptoms.