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Coping with Anxiety and Phobi... Health Article

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Diagnosing anxiety

If you think you suffer from an anxiety disorder, see your primary care physician for a physical exam. This exam can rule out physical disorders with symptoms similar to anxiety, such as an ulcer, asthma, or an overactive thyroid, as well as the overuse of substances that can cause anxiety symptoms, especially caffeine, diet pills, or decongestants.

Medical history and general physical exam

Your doctor will probably begin by asking you to describe exactly what you mean when you say that you feel anxious. Are you worried much of the time? Do you become frightened in particular circumstances? Do you have physical sensations, such as sweating or palpitations, along with emotional symptoms? The answers to these questions will help your doctor determine whether you have an anxiety disorder and, if so, which one.

Your doctor will also ask about your personal and family medical history. Have you or an immediate family member ever had an anxiety disorder? Have you been ill recently? Expect other questions about your personal habits. Which over-the-counter or prescription drugs do you take regularly? Do you smoke? Do you drink coffee, and if so, how many cups a day? These questions are important because certain medical conditions, medications, and substances (such as nicotine and caffeine) can cause anxiety symptoms.

Then the doctor will proceed with a general checkup to look for signs of physical illnesses, especially those with symptoms that mimic anxiety disorders.

Screening tests

As part of the checkup, the doctor will evaluate whether you have depression, since anxiety and depression often coexist. He or she may order a test to determine whether thyroid function is normal. You may be asked for a urine sample, for tests to assess the functioning of your adrenal glands and to check for traces of illegal drugs. Abnormal thyroid or adrenal function can cause hormone imbalances that contribute to anxiety. Use of illicit drugs can also cause or exacerbate anxiety symptoms (see "Substance-induced anxiety disorder").

Psychiatric evaluation

If a medical cause has been ruled out, your primary care physician may refer you to a psychiatrist or psychologist. There is no laboratory test or paper-and-pencil questionnaire to aid in diagnosing anxiety disorders. Instead, the mental health clinician makes the diagnosis after observing and talking with you. He or she will ask you to describe your experiences in detail, noting your main symptoms. He or she may also ask some of the following questions: Do you worry all the time, even about little things? Do you break out in a cold sweat when you have to meet new people? Is it hard for you to work up the courage to call someone you don't know well? Do you stutter and become visibly agitated when discussing certain memories? Each of these feelings or behaviors is a sign of a different anxiety disorder.

Treating anxiety

When anxiety is related to a medical condition or to substance use, treatment focuses on the underlying causes. For the other anxiety disorders, there are three primary approaches:

behavioral therapy (usually either cognitive behavioral therapy or exposure therapy)
medication (antidepressants, benzodiazepines, and other drugs)
other treatments (such as relaxation techniques and transcranial magnetic stimulation).

Keep in mind that for many people with anxiety, two treatments are usually better than one. In particular, many doctors recommend both cognitive behavioral therapy and medication. Most research suggests that this dual approach offers longer-lasting results than either medication or therapy alone.

The choice of treatment depends on the type of anxiety disorder, its severity, which symptoms are predominant, and whether you have certain other conditions, such as depression, alcohol dependence, or another anxiety disorder. Other factors influence the choice of treatment, including your age (for example, older people are more apt to have side effects when taking benzodiazepines) and your personal preferences. You and your doctor should discuss the benefits and side effects of each treatment before deciding which one, or which combination, to use.

It's important to understand what anxiety treatment can and can't do. An accurate diagnosis and proper treatment increases the odds that your symptoms will lessen significantly or disappear altogether. Once symptoms are under control, treatment can keep them from flaring up again and can help prevent a second anxiety disorder from developing. Treatment often improves or controls the problems caused by anxiety. For example, if anxiety is impairing your ability to work or creating friction between you and your family and friends, treatment can help you function better and improve your relationships.

Getting these benefits often requires some trial and error, especially with medications. While several types may be appropriate for your anxiety disorder, the first one you try may not work well for you, or it may cause a side effect that you can't tolerate. Responses to medications can vary greatly from person to person. You may need to try two or more drugs before you find the one that offers you the most relief. Finally, although treatment can dramatically reduce your symptoms or even, for a time, eliminate them, there's no cure for most anxiety disorders. In many cases, symptoms don't subside completely or they eventually return.