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Anxiety Disorders an Information Guide A everyone feels anxiety , but only some people experi - n x i e ence anxiety disorders. This guide explores the difference t y d between normal anxiety and anxiety disorders, such as i s Anxiety o r panic disorder, specific phobias, obsessive-compulsive d e r disorder and post-traumatic stress disorder. It looks at the s reasons why some people develop anxiety disorders and A presents an overview of psychological and medication n disorders i n treatments. The guide also looks at long-term strategies to f o r help people with anxiety disorders manage their anxiety m a t and suggests ways that family members can help. i o n g u An i d e For more information on addiction and mental health issues, or to download a copy of this brochure, please visit our website: information www.camh.net This publication may be available in other formats. For information about alternate formats, to order multiple copies of this brochure, or to order other CAMH publications, please contact Sales and Distribution: guide Toll-free: 1 800 661-1111 Toronto: 416 595-6059 E-mail: [email protected] Online store: http://store.camh.net To make a donation, please contact the CAMH Foundation: Tel.: 416 979-6909 Neil A. Rector, PhD E-mail: [email protected] Danielle Bourdeau, MD If you have questions, concerns or compliments about services Kate Kitchen, MSW at CAMH, please contact the Client Relations Service: Linda Joseph-Massiah, RN, PhD Tel.: 416 535-8501 ext. 2028 or 2078 Disponible en français. 1 4 0 P / 1 1 0 2 - 2 0 / b 3 A Pan American Health Organization / 7 9 World Health Organization Collaborating Centre 3 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page i Anxiety disorders An information guide Neil A. Rector, PhD Danielle Bourdeau, MD Kate Kitchen, MSW Linda Joseph-Massiah, RN, PhD 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page ii Library and Archives Canada Cataloguing in Publication Anxiety disorders: an information guide: a guide for people with anxiety and their families / Neil A. Rector ... [et al.]. 1. Anxiety—Popular works. 2. Anxiety—Patients—Family relationships. I. Rector, Neil A. II. Centre for Addiction and Mental Health. RC531.A634 2005 616.85’22 C2004-907081-9 isbn: 978-1-77052-428-6 (print ) isbn: 978-1-77052-429-3 (pdf ) isbn: 978-1-77052-430-9 (html ) isbn: 978-1-77052-431-6 (epub ) pm 041 Printed in Canada Copyright © 2005, 2008 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher—except for a brief quotation (not to exceed 200 words) in a review or professional work. This publication may be available in other formats. For information about alternate formats or other camh publications, or to place an order, please contact Sales and Distribution: Toll-free: 1 800 661-1111 Toronto: 416 595-6059 E-mail: [email protected] Online store: http://store.camh.net Website: www.camh.net Disponible en français sous le titre : Les troubles anxieux : Guide d'Information This guide was produced by the following: Development: Michelle Maynes, camh Editorial: Diana Ballon, Kelly Coleman, Nick Gamble, camh Graphic design: Nancy Leung, Eva Katz, camh Print production: Christine Harris, camh 3973 / 02-2011 / pm 041 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page iii CONTENTS v ACKNOWLEDGMENTS vi INTRODUCTION 1 Anxiety and anxiety disorders 1 What is normal anxiety? How does anxiety affect us? When is anxiety a problem? What are the anxiety disorders? 2 What causes anxiety disorders? 14 Psychological factors Biological factors Other factors 3 Treatments for anxiety disorders 21 Cognitive-behavioural therapy Medication options 4 Recovery and relapse prevention 33 Preventing relapse and promoting wellness Relationship with a partner 5 Help for partners and families 37 What happens when someone you love has an anxiety disorder? When your relative is first diagnosed How to relate to your family member Partners and families need to take care of themselves Explaining anxiety disorders to children 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page iv iv Anxiety disorders: An information guide REFERENCES 45 SUGGESTED READINGS 46 INTERNET RESOURCES 49 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page v v ACKNOWLEDGMENTS We would like to thank the people who shared their personal experiences with anxiety with us, and the people with anxiety disorders, family members and mental health professionals who reviewed earlier drafts. Reviewers included Sheila Gamblen and Veronica King; professional reviewers were Sandie Leith, msw , rsw , Mary Lalonde, ot, and Donna Weick, msw , rsw . We would also like to thank past authors of other guides in this series whose work provided a foundation for the information presented here. In particular, we would like to thank Christina Bartha, Carol Parker and Cathy Thomson. 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page vi vi vi INTRODUCTION This guide is for people with anxiety disorders, their families, partners, friends and anyone else who might be interested. The many aspects of anxiety disorders discussed in this book will answer some common questions, and help readers discuss anxiety disorders with treatment providers. 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page 1 1 1. Anxiety and anxiety disorders Everyone feels anxiety from time to time. Few people get through a week without some anxious tension or a feeling that something is not going to go well. We may feel anxiety when we’re facing an important event, such as an exam or job interview, or when we perceive some threat or danger, such as waking to strange sounds in the night. However, such everyday anxiety is generally occa - sional, mild and brief, while the anxiety felt by the person with an anxiety disorder occurs frequently, is more intense, and lasts longer—up to hours, or even days. Unfortunately, anxiety disorders are common. Research shows that up to one in four adults has an anxiety disorder sometime in their life, and that one person in 10 is likely to have had an anxi - ety disorder in the past year. Anxiety disorders are the most com - mon mental health problem in women, and are second only to substance use disorders in men. Anxiety disorders can make it hard for people to work or study, to manage daily tasks and to relate well with others, and often result in financial strain and profound personal suffering. People often live with anxiety disorders for years before they are diagnosed and treated. If you suspect that you have an anxiety dis - order, it is important to seek professional treatment as soon as possible. Anxiety disorders are treatable, and early treatment can help to ensure treatment success. 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page 2 2 Anxiety disorders: An information guide The six main categories of anxiety disorders are phobias , panic dis - order (with or without agoraphobia), generalized anxiety disorder , obsessive-compulsive disorder , acute stress disorder and posttraumatic stress disorder (American Psychiatric Association [ apa ], 2000). Each of these anxiety disorders is distinct in some ways, but they all share the same hallmark features: • irrational and excessive fear • apprehensive and tense feelings • difficulty managing daily tasks and/or distress related to these tasks. In the following examples, Susan, John and Linda* show these common features, although the precise nature of their fears differ. Susan has had recurrent and unexpected panic attacks for the past five years: It started on a night when I was driving home in the rain. I began to feel shaky and dizzy, and had trouble focusing. At first, I thought it was something that I had eaten earlier, but then my mind started to drift, and I thought, “What if I pass out?” and “What if I’m dying?” I started to shake all over, and it was as if my entire body was wired. I quickly pulled the car over and called my daughter to come and get me. Since then, I’ve had dozens and dozens of these attacks. At first, the attacks occurred just when I was driving, but now I experience them in shopping malls, standing in line-ups and even on the bus. It seems as if I spend most of my day worrying and waiting for the next attack. John describes a lifelong pattern of being excessively shy and fear - ing embarrassment in social situations: For as long as I can remember, and as far back as when I was *All names and identifying details have been changed. 3973-MHB-AnxietyINS_ENG.qxd:3973-MHB-Anxiety.eng 3/1/11 12:31 PM Page 3 Anxiety and anxiety disorders 3 seven years old, I hated being the centre of attention. In class, I tried to remain as invisible as possible, praying that the teacher would not call upon me to answer a question. When it was my turn to make presentations, I wouldn’t sleep for a week, worrying that I would forget what I was supposed to say, stumble over my words, and look completely stupid. It’s as if nothing’s changed: now at work I dread having to attend meetings, meet with the boss, have lunch with colleagues, and the worst, give monthly reports to the team.
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