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INSIDE THE MIND

Anxiety disorders have been linked to health conditions like . High ABOUT ONE IN FIVE OF US HAS AN —BUT MANY GO UNDIAGNOSED AND UNTREATED. HERE’S HOW TO IDENTIFY THE PROBLEM AND GET THE HELP YOU NEED.

» BY DIANA KELLY LEVEY

rom the time she was a to help her deal with the panicky, child, Tara Mandarano worst-case she was always felt a little anxious. experiencing, and medication after F But when she became she stopped breastfeeding her baby pregnant with her daughter, her at four months. “I stopped constantly anxiety reached new heights. having that my baby was “I started to about everything, somehow lost in my bed, or that she incessantly. I was terrified I would had stopped , or that I would lose my baby. I would sit in the accidentally drop her.” bathroom in the dark, sobbing, and Anxiety disorders like the one my husband would have to comfort Mandarano experienced are me and try to talk me down from extremely common among men and whatever catastrophic thoughts I women of all ages and backgrounds. was having,” recalls the 41-year-old Anxiety disorder is the most Ontario, Canada–based writer. common mental illness in the U.S., Mandarano finally got the help experienced by about 19 percent of she needed when she was diagnosed adults in the past year, according with perinatal generalized anxiety to the National Institute of , a condition Health. And an estimated 31 percent that affects 8 to 10 percent of women of adults will cope with an anxiety during pregnancy and 4 to 10 percent disorder at some point in their lives. postpartum. She received treatment In fact, you’ve likely felt anxious throughout her pregnancy and into at some point in your life, whether her postpartum period, including it was a nervous before a cognitive behavioral therapy (CBT) big test or an interview, or some

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excitement and uneasiness before a first date. “It’s important to remember that anxiety as an is totally normal—and in fact, it’s essential for survival,” says Dana Dorfman, PhD, who treats patients at a private practice in New York City. “It’s not always and pathological. Anxiety is only problematic when it interferes with one’s functioning in [his or her] home or work life.” techniques, ● The Rise of Anxiety , Anxiety disorders can be grouped into several categories, including yoga and generalized anxiety disorder (GAD), disorder, acupuncture disorder, obsessive compulsive disorder, post- may all help to disorder and specific . And it seems like we are feeling more treat anxiety anxious, more often. A 2018 survey from the American disorders. Association found 40 percent

of Americans say they felt more Women are twice anxious than they did the previous as likely as men to that can influence anxiety include year. That followed a 36 percent be affected with the death of a loved one, a serious increase from 2016 to 2017. generalized anxiety illness or financial stress. Finally, disorder, which But while these disorders there can also be some learned often co-occurs with millions of Americans, only 36 major . behavior involved. “Anxiety is very percent of those with a disorder ‘emotionally contagious,’” says receive treatment, according to the Dorfman. “So if you’re around Anxiety and Depression Association a lot of anxious people, there’s a of America (ADAA). Much of that there’s less around struggling symptoms must be severe enough or ‘What if I seem awkward at the upbringing and what you’ve learned mirroring quality that happens. may have to do with an ingrained bias with anxiety as a lifestyle condition to interfere with your personal or party?” Here, the core is around throughout your life, and it’s not Oftentimes people are at greater against receiving help. “It may be a versus as a sign of that [someone is] professional life. negative evaluations from others. just your biology, but it’s really for becoming anxious when challenge for someone to be willing permanently damaged or weak.” Anxiety also comes in many forms, Obsessive-Compulsive Disorders how they interact with each other,” they are around other people to accept it as a condition to manage, including the following: (OCD) are often associated with says Kissen. who are anxious.” versus a deep character flaw,” says ● Defining the Generalized Anxiety Disorder obsessive hand-washing or needing Genetics, or having a family Sometimes, anxiety may seem Debra Kissen, PhD, executive director Different Disorders (GAD) is characterized by what feels things to be symmetrical, but this history of anxiety, plays a big part like it crops up out of nowhere. “I’d and owner of the Light On Anxiety Like most mental illnesses, in order like out-of-control worries, says chronic disorder has more to do in anxiety disorders. “If a parent been told I might have anxiety after CBT Treatment Center in Chicago for someone to be diagnosed with an Kissen. “When you hear someone with order (which might surface in or suffers from anxiety, it going to a couple of walk-in clinics and co-chair of the ADAA. anxiety disorder, there are specific saying, ‘I just can’t stop worrying,’ or your career or physical appearance) significantly increases one’s genetic for chest in my early 20s, and I But a growing awareness about criteria that they need to exhibit— ‘I spent all night worrying about my as well as recurring thoughts and predisposition,” says Dorfman. was having panic attacks somewhat anxiety disorders may be helping especially for insurance to pay for finances or health’—those are signs of repetitive behaviors. “OCD-related Trauma—either ongoing stresses regularly for years, but I didn’t get more people get the help they need. treatment. Those symptoms may generalized anxiety.” disorders that we see a lot of include or having experienced trauma as a help for it until age 27,” says Lauren “There’s more education, include excessive anxiety is where perfectionism or needing things child or having witnessed a traumatic Coffin, a 31-year-old baker/cake consumer awareness, and worry, worry that the core characteristic is fear of to be just right,” says Kissen. event—can also make you more likely decorator and writer in Boston. “For more of a dialogue is difficult to control, negative evaluation or judgment. “It to develop anxiety as an adult. reasons I still don’t really know, my on mental health in No. 1 feelings of restlessness, might look like the person has a lot ● Who’s More Prone Working an extremely stressful anxiety flared up in my mid-20s and general in society,” Anxiety disorders easily fatigued, of worries and anxiety or stress, but A number of factors play a part job, and not managing those worries simply didn’t stop. I even ended up says Kissen. “For are the most common and what they’re really worried about are when it comes to developing an in a healthy way, may also be a in the hospital. I think what made anxiety specifically, mental illness in disturbances. These things like, ‘What if I do a bad job?’ anxiety disorder. “It’s not just your contributing factor. Other stressors the difference that time was that the U.S.

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It usually takes around four weeks for an SSRI to start to work; if you need help in the meantime with ANATOMY OF severe panic or anxiety attacks, AN ANXIETY ATTACK you might also need a fast- caused it and could be a downward spiral. medication like a or a It’s not just your mind racing; all your wondering, “Why is my Your fingertips like Klonopin, Xanax bodily systems body freaking out all might get cold as or Valium, says Dorfman. “They can react when you start of a sudden?” blood moves away work within 30 minutes or so, but the to panic. Here’s what may from the periphery effects may only last for a few hours.” happen inside your to the core. These have a tendency to be more “An anxiety or panic body when an anxiety You might become habit-forming and are a “quick fix” attack is simply your attack strikes: nauseous or Your heart rate experience other but don’t necessarily address the root sympathetic nervous system activating the speeds up as you gastrointestinal of the problem, she adds. fight-or-flight response start to breathe faster distress as blood Coffin—who was diagnosed of the body,” says in an effort to pump leaves the stomach and with generalized anxiety disorder Debra Kissen, PhD. “It’s more blood and oxygen heads to large muscle and —says she an adaptive response to your major muscles groups so you are benefited from a combination of that you have when to help you to run ready to flee or fight. treatments, including CBT and you’re facing an from or fight this Your pupils may “immediate threat.” dilate, so you can taking benzodiazepine. “It got me immediate threat, like if you were in a Some people might see more of any down to having a only burning building or a feel like they’re perceived threats. once or twice a year. It was a massive loved one was about to suffocating and their You might feel improvement, but it took months of get hit by a car. All chests get tight as dizzy, experience Only 40 percent hard work to get there.” Eventually, systems would say, ‘go’ the body takes in more or have of employees who her doctor encouraged her to try to attempt to survive oxygen than it actually trouble concentrating. say stress interferes SSRIs again and they worked for this immediate threat.” needs. These small You could feel shaky, with their work talk breaths of air throw off or like all of your her within a week. “The difference But a panic or to their employer anxiety attack is a false the alkaline level in the muscles are tense. has been astonishing!” says Coffin. about the problem. alarm where your brain blood and can lead to You may experience “I genuinely had a moment of has decided that you’re a feeling of not getting tension wondering, ‘What is this nice feeling in imminent danger— enough air, which can that feels like a rubber I’m having?’ It was calm. I hadn’t even though you might cause you to want to band is wrapped the care team walked me through felt purely calm in months. My not even know what breathe even more, in around your head. the steps I needed to take in order to Common symptoms of anxiety anxiety right now feels like holding seek treatment.” a candle. If it gets too hot, I can put include feeling nervous, irritable or it down. My anxiety before felt like ● Getting Help spontaneous combustion.” A licensed therapist can help you on edge; having an impending sense Remember, no matter what identify your core and provide therapies you go with, you have to you with tips and tools to assist you of doom; an increased heart rate; give treatments time to work. “I tell in calming down and alleviating the patients that if they went to a gym sense of alarm. “Often, there’s no rapid breathing and GI distress. and lifted weights, they wouldn’t single solution to moving past panic, see a result necessarily that day or but instead [you need] a combination the next day, and the same can be of techniques and tools that will more reasonable beliefs,” says Kissen. using a combination of medications true for mental health changes and work best for you,” says Kissen. “You’ll learn how to disentangle like selective serotonin reuptake results,” says Kissen. Cognitive behavioral therapy (CBT), yourself from these core beliefs and inhibitors (SSRIs) and CBT may But it is important to start for one, has the highest evidence- identify and address the maladaptive be necessary. “It’s like a one- somewhere. “I wish I realized much based support as a treatment modality behaviors that might be reinforcing two punch,” says Kissen. “They sooner that you don’t have to wait for anxiety. “CBT involves identifying things. It’s a very action-oriented work really well together because until you hit a certain level of mental maladaptive beliefs, like ‘I need to therapy, very here-and-now, [and the medication helps enhance illness in order to get help,” says be perfect to be loved,’ or, ‘The world there’s] lots of to work on the learning you’re getting in Coffin. “No one would ever tell you is dangerous and I’m never OK,’ outside of the session to move past the therapy. It’s kind of increasing the that you’re too physically healthy to or whatever it might be, and then issues you’re talking about in-session.” , allowing for the go to the gym, right? Think of your revising that belief to come up with For moderate to severe anxiety, brain to learn these new concepts.” mental health in the same way.” ●

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