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Anxiety and Related Disorders FOR PATIENTS AND FAMILIES

INSIDE: What are the symptoms of disorders?...... 2 What causes anxiety disorders?...... 2 How are anxiety disorders diagnosed?...... 3 How are anxiety disorders treated?...... 4 If you’re worried about your child or teen...... 6 Family or friend? What you can do...... 7 Self-management action plan...... 8 What are anxiety disorders? Anxiety is a normal part of life. But anxiety disorders are different from everyday worries. They are chronic medical disorders that cause severe ANXIETY DISORDERS and irrational , tension, , or dread. Without treatment, they can ARE REAL grow to overwhelm every aspect of daily life. They are medical conditions that Anxiety and related disorders include these common types: more than 40 million • Generalized anxiety disorder (GAD) Americans, according to the Anxiety and • Obsessive-compulsive disorder (OCD) Association • disorder of America. • Post-traumatic disorder (PTSD) Anxiety disorders can also cause severe • (SAD, also called social phobia) symptoms. For some While each disorder has distinct features, they are bound together by a people, these symptoms common fact: all are highly treatable. If you are one of the many people make normal life nearly impossible. suffering from an anxiety disorder, take heart. You can be optimistic about finding relief. With treatment, you can overcome your anxiety But, with care, most people with disorder — and live a healthier, fuller life. anxiety disorders can overcome them. What are the symptoms of anxiety disorders? Anxiety and related disorders have different patterns of symptoms.

GENERALIZED ANXIETY OBSESSIVE-COMPULSIVE DISORDER (GAD) DISORDER (OCD) The core symptom of panic People with GAD feel a People with OCD suffer from disorder is a panic attack. A steady tension that they one or both of the following panic attack is a sudden can’t control. They may symptoms: of overwhelming fear. It can worry constantly, even when occur seemingly without • Persistent, unwelcome there is no obvious reason. reason and bring on extreme thoughts (obsessions) Tension and worry can cause and physical signs, these symptoms: • Urgent need to repeat such as: certain ritual behaviors • Restlessness or • Pounding heart, chest , (compulsions) “on edge” , sweating, People with OCD realize that trembling, dizziness • Fatigue and trouble their thoughts and impulses concentrating • Feeling unreal or aren’t normal. They try to disconnected • and muscle ignore them. They may try to • tension hide them from other people. Fear of having a heart attack or “going crazy” • Trembling, sweating, and But despite their efforts, people with OCD remain in For some people, a hot flashes the grip of their obsessions panic attack is a one-time • Feeling dizzy or out and compulsions. Eventually, event. But panic disorder of breath the thoughts and actions usually means having 2 or • Trouble falling asleep or that stem from OCD can more attacks — and constantly sleeping through the night overwhelm daily life. fearing another.

“I worry about everything “I know these routines — “They come out of the blue — and nothing — and I can the double-checking, the these intense surges of fear. never really relax. I have a counting — aren’t normal. My heart pounds and I start lot of trouble sleeping, too. But I can’t stop them. And shaking. I dread it happening Sometimes I can barely drag now they’re taking over my again, and I avoid places myself to work.” whole life.” where I had one before.”

What causes anxiety disorders? Scientists believe that many factors may combine to cause anxiety disorders. Here are a few of the most likely: • Brain chemistry. Brain chemistry is almost • Family history (genetics). Studies show that certainly a factor in anxiety disorders. How anxiety disorders run in families. This is probably do we know? Symptoms are often relieved by due mostly to genetics. Identical twins are more medications that alter levels of chemicals in likely to share an anxiety disorder than twins who the brain. are not identical. Anxiety disorders can begin in childhood. If you are a parent, watch your children • Life experiences. Exposure to , , for symptoms so they can be treated early. or poverty may increase the likelihood of getting these illnesses. • Learned behaviors and thinking patterns. People with low self-esteem and poor skills may be prone to anxiety disorders.

2 ANXIETY AND OTHER RELATED DISORDERS POST-TRAUMATIC SOCIAL ANXIETY STRESS DISORDER DISORDER (SAD, (PTSD) ALSO CALLED SOCIAL PTSD can happen to someone PHOBIA) who has experienced or People with SAD feel witnessed a trauma like , overwhelming anxiety in rape, abuse, or violent crime. everyday social situations. Other experiences can also They have an intense fear of lead to PTSD, such as serious being judged by others or accidents, natural disasters, being embarrassed by their or the sudden of a own actions. loved one. For some people, anxiety People with PTSD have is linked to one type of repeated and frightening situation, such as public thoughts and memories of speaking. For others, the the trauma. They may be fear is far broader and causes depressed. They may feel symptoms almost any time OTHER CONDITIONS emotionally numb, especially they’re around others. Many THAT MAY CO-EXIST toward people they were people with this illness have WITH ANXIETY once close to. They may a hard time making and DISORDERS feel irritable and be more keeping friends. aggressive than they used to People with anxiety be. In severe cases, people disorders often have with PTSD may have trouble “Talking with anyone other mental working or socializing. except my family was nerve- problems as well. A wracking. Speaking in class person with an anxiety “They said that time would was out of the question. And disorder may also have: if I can’t hold a conversation, heal me. Not in my case. I try • Depression not to think or talk about it, how can I have friends? ” • Another anxiety disorder but the memory floods over me nearly every day.” • If you have one of these problems, you’ll need to treat it as well. How are anxiety disorders diagnosed? Doctors use several different tools to learn about conditions and make a diagnosis: • Questionnaires. Your doctor may use questionnaires (forms) to check for anxiety and other mental health problems. The questionnaires ask about your symptoms, stress, coping style, and support system. • Medical history. Your doctor asks about your past and present illnesses and your family history. • Physical exam. An exam helps your doctor know if your symptoms come from something other than an anxiety disorder. • Guidelines for diagnosis. Your doctor compares your information to standard medical definitions for mental health disorders. ANXIETY AND OTHER ANXIETY AND OTHER 3 RELATED DISORDERS RELATED DISORDERS How are anxiety COUNSELING disorders treated? Also called or “talk therapy,” counseling can help you understand your You have several options for treatment. Your problems and develop ways to work doctor or other healthcare provider will work through them. with you to create a treatment plan that fits What to expect… your needs. It may include a coordinated team if you choose this type of treatment approach with counseling, medication, care • There are different types of counseling, each management, or a combination of the three. with a special focus. For example, counseling Although these treatments may not cure your may focus on changing your thinking patterns. It can also teach new ways to help anxiety disorder, they can help relieve your you cope. Cognitive-behavioral therapy (CBT) symptoms. And as your symptoms ease, your combines these strategies to help you unlearn health improves. It can take some time and old patterns and adopt healthier thoughts several visits to find the right treatments, but it’s and reactions. worth the effort to feel better. • Counseling is geared to the person’s situation and development. For example, There are also some basic steps you can take to counseling for children may include play manage your condition and feel better. These therapy or involve the family. Counseling for an elderly person may include screening for include regular exercise, a healthy diet, getting conditions that come on with age, or involve enough sleep, and others — see page 8. family and . • A key to successful counseling is finding a counselor you feel comfortable with. Counseling is a partnership that requires . • Keep in mind that although counseling can be short-term, it often takes time to work. What to do… to self-manage this part of treatment • Talk with your doctor about the kind of therapy you may want to pursue. Shop around until you find a counselor you “click” with. • To learn more about CBT, check out these books: –– The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program, by William Knaus, EdD THOUGHTS OF –– The Anxiety and Worry Workbook: The Anxiety symptoms can lead a person to think Cognitive Behavioral Solution, by David of ending it all. These thoughts are dangerous Clark, PhD, and Aaron Beck, MD and can put you and your family at risk. If • Be consistent with counseling. Stay focused you have thoughts like these while you are on the goals you with your counselor. being treated for an anxiety disorder, be sure • Follow your doctor’s directions. Complete to contact your doctor right away. Effective any assignments you’re given. Ask for help treatment can help you see the of life from family and friends when you need it. clearly again. Behavior change is hard, but it’s worth it.

4 ANXIETY AND OTHER RELATED DISORDERS MEDICATION CARE MANAGEMENT Several different types of medications are Care management uses a team approach to used to treat these disorders. If one type isn’t coordinate mental health treatment with working, remember that there are options. other healthcare needs. You and your family Working with your doctor, you can find the are important members of the team and take best medication and dosage for you. an active role in your care. What to expect… What to expect… if you choose this type of treatment if you choose this type of treatment • During the first few months of treatment, Your doctor will lead a team that includes you your doctor may schedule several follow-up and various other team members, depending visits to see how you’re doing and adjust your on your needs. medication if necessary. • A care manager keeps in touch with • Every person has unique chemistry, and it can you, gives you information, and helps to take time to find the right medication for you. resolve problems. If the first medication you try doesn’t relieve • A psychiatrist or psychiatric nurse can your symptoms, don’t be discouraged. There consult with your doctor on medications are other alternatives. This can be a frustrating and treatment. process, but your doctors can help. • A mental health provider can provide • There are several types of medications for counseling. anxiety disorders. The most common are: • NAMI (the National Alliance on –– Selective serotonin reuptake inhibitors Mental Illness) — a consumer support (SSRIs). These can be taken daily to control organization — offers free information, the symptoms of anxiety disorders. They , and support. may take a few weeks to start working, and sticking with treatment greatly improves What to do… your chances of feeling better. Side effects to self-manage this part of treatment are mild and can include , , • Talk to your care manager about the kind of sleep problems, and agitation. support you might find most helpful. That –– Benzodiazepines. These control the physical will help your care manager know how to symptoms of anxiety disorders immediately best support you and your family throughout and are taken only during an anxiety attack. your treatment. They can become habit-forming, especially if you don’t take them as directed. Side effects include drowsiness and dizziness. • Anxiety medications can interact with other medications. Give your doctor a list of No matter what your all medications you’re taking — including over- treatment plan — the-counter drugs, supplements, and vitamins. Self-management is central. What to do… The most important factor in your to self-manage this part of treatment recovery is self-management. Self- • Take your medication exactly as prescribed. management means doing your part to Don’t take too much, and don’t share your keep up with treatment and stay in touch medications with others. with your healthcare team. It also means • Never stop taking your medication without rebuilding your by staying active first talking to your doctor. in daily routines. • Keep all follow-up appointments with In addition to medication or other your doctor. treatment, you can take some simple actions • If you have questions or concerns about your to help yourself recover. See page 8 for a medication or its side effects, call your doctor or care manager. self-management action plan.

ANXIETY AND OTHER 5 RELATED DISORDERS What about anxiety and related disorders in children and teens? Do you think anxiety disorders only happen to adults? Think again. According to estimates, anxiety disorders affect 1 in 8 children and 1 in 12 teens. Unfortunately, it’s often overlooked or misunderstood. Myths about anxiety in kids often mean that they don’t get the help they need.

MYTH. “Emotional and behavioral problems are a normal part of growing up.” If you’re worried about TRUTH. Not always. Sometimes, changes in your child or teen… moods and behavior are signs of anxiety. Don’t be too quick to dismiss them as part of an • Watch for signs of anxiety. For the most part, “awkward phase.” symptoms in kids are the same as in adults (see pages 2 and 3). In children and adolescents, MYTH. “Anxiety in children and teens isn’t avoiding social situations (not wanting to “play” that big a deal. They’ll get over it.” or join in with friends) can be a sign of an TRUTH. Although some people recover anxiety disorder. Complaining about body pain, on their own, not treating anxiety is a big stomachaches, or headaches can also be a sign. risk. Research shows that untreated children These things don’t always mean a child has an tend to struggle in school and miss out on anxiety disorder — but they can help you monitor sleepovers, parties, and other social events. your child’s behavior. If these signs are severe or Kids with anxiety disorders are also more likely go on for a long time, the chance of an anxiety to abuse drugs and alcohol than others. disorder increases.

MYTH. “I should help my child avoid • Check in with a doctor if you notice any mental, stressors as much as possible.” behavioral, or emotional changes that worry you. Anxiety is a normal part of childhood. But if TRUTH. It’s more helpful to support your you can’t comfort your child, or if your child starts child through stressful situations than to avoid them. Recognize and praise small avoiding certain places or activities, talk to a doctor. accomplishments, and don’t punish mistakes Anxiety is serious AND highly treatable for children. or lack of . When in , seek professional help. • If your child is diagnosed with anxiety, learn as MYTH. “There’s not much you can do for much as you can. Good information will help you a kid with an anxiety disorder.” make good decisions for your child’s treatment. TRUTH. Most kids need professional Should you see a specialist in childhood mental guidance to overcome an anxiety disorder. health? Should medication be part of treatment? Effective treatment is usually a combination of When is the right time for therapy? What can you medication and counseling. Care management and your family do to help your child recover? can also be helpful. The care team will customize a treatment plan to best help Talk to your child’s doctor, and see the resources your child. on page 7.

6 ANXIETY AND OTHER RELATED DISORDERS Family or friend? Here’s what you can do WHERE CAN I LEARN MORE ABOUT It’s hard to see someone you care about struggling with an ANXIETY DISORDERS? anxiety disorder. What can you do? Here are a few ideas. Ask your doctor about support groups and other DO... DON’T resources in your area. • Remind yourself that anxiety • Don’t take your loved one’s Books disorders are medical anxiety personally. You • Extinguishing Anxiety: conditions, not just character didn’t cause it. You can’t Whole Brain Strategies flaws or everyday worries cure it. If your loved one says to Relieve Fear and and . Know that your something hurtful, keep in Stress, by Catherine loved one can’t just “get mind that they’re suffering. Pittman, PhD, and over it.” They’re prone to saying Elizabeth Karle, MLIS • Encourage your loved one things they don’t truly mean. • Stop Obsessing! to get proper treatment. • Don’t ignore remarks about How to Overcome Drive them to the doctor, suicide or signs of worsening Your Obsessions and if necessary. anxiety. Help your loved one Compulsions, by Edna Foa, • Listen and be patient. Pay by calling a doctor for advice. PhD and Reid Wilson, PhD attention to your loved • Don’t try to nag someone • Facing Panic: one’s . Stay calm, into feeling better. The more Self-Help for People even when your loved one is you tell someone what they with Panic Attacks, anxious. Remember that no should be doing, the worse by Reid Wilson, PhD one has anxiety on purpose they’ll feel. Instead, give • The Post-Traumatic Stress and that recovery takes time. , encouragement, Disorder Sourcebook: • Support and celebrate and compliments. A Guide to Healing, recovery. Encourage your • Don’t let your loved one’s Recovery, and Growth, loved one to stay active. illness consume you. No one by Glenn Schiraldi, PhD Keep inviting them to will be helped if you become • Triumph Over : gatherings and events. overwhelmed. Respect and Conquering Social Applaud their efforts and value your own mental health Anxiety Disorder, by milestones toward recovery. first. You’ll be a good model. Murray Stein, MD, MPH, • Take care of your own and John Walker, PhD emotional and physical health. Feeling dragged Internet Resources down by your loved one’s anxiety? Think about your Intermountain Healthcare’s natural way of seeking Mental Health Online Center: support, and follow it. It may intermountainhealthcare.org/ help to get counseling, join services/behavioral-health a , or discuss National Association your feelings with friends. on Mental Illness: • Understand the disorder. nami.org For example, if your loved Anxiety and Depression one has panic attacks, know Association of America: that they are real physical adaa.org experiences. Stay calm and National Institute of talk to the person’s doctor Mental Health: about what you should do. nimh.nih.gov American Academy of Child and Adolescent : aacap.org

ANXIETY AND OTHER 7 RELATED DISORDERS Self-management action plan Your doctor and others can help you recover, but you’re in charge of the process. After all, only you can make decisions about your treatment, follow through on your plan, and know what’s working for you. This is self-management — and experts agree that it’s a vital part of successful treatment for anxiety disorders. For different areas of your life, choose realistic goals that match your natural “style” and personality. Work on only one goal at a time, and reward yourself for any progress you make.

• Develop your treatment plan –– Nutrition and sleep. Mind and body Get good information from your doctor and go hand in hand. Example goals: Drink 8 glasses of water each day. Eat 5 to 10 fruits other trusted sources. Keep in mind that mental and vegetables daily. Get 8 hours of sleep health treatment isn’t “one size fits all.” With each night. your doctor, decide on a plan that fits your unique situation. Example goals: Take your My Goal: medication. Participate in counseling and care management. Keep appointments. Call your –– Recreation and renewal. Commit to having doctor with questions. fun and soothing your spirit. Example goals: Do your hobby. Listen to music. Attend religious or My Goal: cultural events. Write in a journal. Meditate.

My Goal: • Set goals for healthy living

Finding balance in your life speeds your recovery. • Stick to your treatment It also paves the way for happier, healthier Give treatment a chance to work. Take any times ahead. Set goals to make sure your medication as directed. Keep your appointments. whole life is in balance: Talk to your doctor if you don’t see good –– Relationships. Connect to family and results — you can always adjust your plan. friends. Positive social support reduces anxiety and stress. Example goals: Phone a friend • Celebrate your recovery every day. Attend social events. Volunteer. Reward yourself for meeting your “healthy My Goal: living” goals. Celebrate the milestones in your recovery. Did you sleep well through the night? –– Exercise. Elevate your mood and reduce Go a few hours without obsessing? Face down stress and anxiety by exercising regularly. one of your fears? Congratulate yourself! Example goals: Walk every day. Take the Your work is paying off. stairs. Ride your bike.

My Goal:

REMEMBER… If you feel your treatment plan isn’t working, don’t just abandon it. Talk to your doctor. Most people with anxiety disorders can reduce their fears and find . With time and help, you can, too!

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