Anxiety Health Article

Symptoms of anxiety

In order to understand the diagnosis and treatment of anxiety, it is helpful to have a basic understanding of its symptoms.

SOMATIC. The somatic or physical symptoms of anxiety include headaches, dizziness or lightheadedness, nausea and/or vomiting, diarrhea, gastrointestinal problems, tingling, pale complexion, sweating, numbness, difficulty breathing or sleeping, and sensations of tightness in the chest, neck, shoulders, or hands. These symptoms are produced by the hormonal, muscular, and cardiovascular reactions involved in the fight-or-flight reaction.

BEHAVIORAL. Behavioral symptoms of anxiety include pacing, trembling, general restlessness, hyperventilation, pressured speech, hand wringing, or finger tapping.

COGNITIVE. Cognitive symptoms of anxiety include recurrent or obsessive thoughts, feelings of doom, morbid or fear-inducing thoughts or ideas, and confusion or inability to concentrate.

EMOTIONAL. Feeling states associated with anxiety include tension or nervousness, feeling "hyper" or "keyed up," and feelings of unreality, panic, or terror.

DEFENSE MECHANISMS. In psychoanalytic theory, the symptoms of anxiety in humans may arise from or activate a number of unconscious defense mechanisms. Because of these defenses, it is possible for a person to be anxious without being consciously aware of it or appearing anxious to others. These psychological defenses include:

• Repression. The person pushes anxious thoughts or ideas out of conscious awareness.
• Displacement. Anxiety from one source is attached to a different object or event. Phobias are an example of the mechanism of displacement in psychoanalytic theory.
• Rationalization. The person justifies the anxious feelings by saying that any normal person would feel anxious in their situation.
• Somatization. The anxiety emerges in the form of physical complaints and illnesses, such as recurrent headaches, stomach upsets, or muscle and joint pain.
• Delusion formation. The person converts anxious feelings into conspiracy theories or similar ideas without reality testing. Delusion formation can involve groups as well as individuals.

Diagnosis

The diagnosis of anxiety is difficult and complex because of the variety of causes and the highly personalized and individualized nature of its symptom formation. When a doctor examines an anxious patient, he or she will first rule out physical conditions and diseases that have anxiety as a symptom. Apart from these exclusions, the physical examination is usually inconclusive. Some anxious patients may have their blood pressure or pulse rate affected by anxiety, or may look pale or perspire heavily, but others may appear physically normal. The doctor will then take the patient's medication, dietary, and occupational history to determine if they are taking prescription drugs that may cause anxiety; if they are abusing alcohol or mood-altering drugs; if they are consuming large amounts of caffeine; or if their workplace is noisy or dangerous. In most cases, patient history is the most important source of diagnostic information. The doctor may administer a brief psychological test to help evaluate the intensity of the patient's anxiety and some of its features. Some tests that are often performed include the Hamilton Anxiety Scale and the Anxiety Disorders Interview Schedule (ADIS). Many doctors will check a number of chemical factors in the blood, such as the level of thyroid hormone and blood sugar.

The diagnosis of GAD is made when a person experiences anxiety coupled with physical symptoms that exists a majority of the time over a six-month period. The following conditions must be ruled out to confirm the GAD diagnosis:

• cardiovascular disease
• pulmonary disease
• myasthenia gravis
• alcohol and substance abuse

Treatment

Not all patients with anxiety require treatment, but for more severe cases, treatment is recommended. Because anxiety often has more than one cause and is experienced in highly individual ways, its treatment usually requires more than one type of therapy. In addition, there is no way to predict how patients will respond to a specific drug or therapy. Sometimes, the doctor will need to try different medications or methods of treatment before finding the best combination for the particular patient. It usually takes about six to eight weeks for a doctor to evaluate the effectiveness of a treatment regimen.