It is now considered that anxiety disorders are one of the most prevalent psychological problems affecting as many as 13% of children and adolescents. They are often accompanied by other conditions such as depression, eating disorders and behavioral problems.

First of all, it is important to distinguish between fear and anxiety. Fear is the body’s way of initiating the ‘fight or flight’ response and avoiding or dealing with danger that can be seen.  Anxiety, on the other hand, can be felt with or without the presence of actual danger. One can feel anxious about an imminent threat and then feel the fear when the threat becomes fact. After the fact, when the threat has been dealt with, anxiety returns in the form of worry about future attacks or consequences.

Children with anxiety disorders typically feel intense fear, anxiety and uneasiness over a long period of time. It is not like seeing a scary movie and needing some reassurance or feeling bad about an event that happened during the day and needing to sleep with the hall light on for a night or two. Children with anxiety disorders can’t be calmed with soft words or a hall light. Their fears and anxieties persist and impact their daily routines negatively.

The kinds of problems include poor performance at school, low self esteem, substance abuse and difficulty in social situations as well as physical symptoms such as high blood pressure, ulcers, diarrhea and respiratory problems.   There are six different types of disorders which affect children –

• Generalized Anxiety Disorder
• Separation Anxiety Disorder
• Phobias
• Panic Disorder
• Obsessive-Compulsive Disorder
• Post Traumatic Stress Disorder.

It can be hard to recognize the difference between normal anxiety and pathological anxiety in children as they don’t know that what they are experiencing isn’t any different to what others experience. They cannot express that they are feeling constant fear and anxiety. Parents and carers need to look out for signs that the child is starting to avoid certain places or situations; not wanting to go to school or a neighborhood party for example. Headaches, problems sleeping, poor concentration, low self esteem, being overly critical of oneself and stomach pain are some of the symptoms of a possible anxiety disorder.

The good news is that once these conditions are diagnosed, successful treatment is possible.

 Because of these differences, there are three different types of stress – acute, episodic acute and chronic. Psychological stress can also be considered a fourth type. Each type of stress requires a different treatment.

Acute Stress

Acute stress is the most common type and is the result of the daily challenges each of us must face. There are situations where this kind of stress is good for us as in an athlete about to compete in a race. Without the adrenaline rush that feeling acute stress brings about, they would not have the energy they need to perform at their optimum level.

Everyone has felt this kind of stress which is usually only present in short bursts. A rapid heartbeat, cold sweats, muscular tension and a headache are some of the most common symptoms.

Episodic Acute Stress

As the term implies, this kind of stress is felt by those people who experience acute stress more often than usual. These people are intent on being high achievers but somehow, when push comes to shove, they are unable to perform. As a result, they become irritable with themselves as well as with those colleagues or family members close to them. These kinds of people find their workplace a very stressful place to be in.

Likewise, episodic acute stress can be experienced by the worriers in life. Pessimistic individuals who always fear the worst and find little to look forward to feel anxiety for no good reason  

Chronic Stress

Chronic stress is the most harmful of the different types. It more often than not builds up slowly and insidiously until it affects the person emotionally or physically.  It is the kind of stress felt by people who live in poverty, war torn countries, unhappy relationships and dysfunctional families. In most cases, chronic stress is a response to some kind of trauma which has not been dealt with adequately.

Chronic stress builds up so gradually that the person affected is often unaware that it is even present. They come to feel that their condition is just their personality and so innate in them; if they recognise it at all that is. It is more often than not completely ignored. The problem here is that it then affects that person’s quality of life.

 Up to 10% of women and 3.5% of men are estimated to suffer from clinical depression worldwide.  It is the leading cause of disability and the third most important workplace issue after family and stress. In America alone, it is estimated to cost $70 billion to industry in medical costs and lost productivity. According to recent statistics released by the World Health Organization, it will be the second-most debilitating disease by 2010 (the first being cardiovascular disease).

The impact of clinical depression is huge. Yet, despite the fact that it responds very well to treatment, only one third of sufferers receive the proper treatment or seek it in the first place.

 What is Clinical Depression?

 Clinical depression is not the emotion that we feel from time to time when things get us down. It is a mental disorder that affects every aspect of that person’s life. It is a very low mood that persists and is characterized by a lack of joy in anything that was previously enjoyed.

According to the American Psychiatry Associations Diagnostic and Statistics Manual (DSM), five of the following symptoms must be experienced for a period of more than two weeks –

• Mood – a feeling of being down, sad or depressed. Feeling tearful or overly irritable may indicate these feelings as can physical aches and pains which have no physical cause.
• Loss of interest – withdrawal from activities once enjoyed as well as from social contact.
• Weight loss or gain
• Sleep problems – can be either too much or too little
• Inappropriate motor activity – can be either too agitated or too slow.
• Fatigue.
• Lack of self-worth – a feeling of not being worthy enough, self loathing or inappropriate guilt.
• Trouble concentrating.
• Thoughts of death – threatening to or attempting suicide.

 Clinical Depression and Panic Disorder

There is a high comorbidity between these two conditions. Comorbidity means that two or more diseases or illnesses are present at the same time. It is important that each condition be recognized as treating one without the other is ineffective. In some cases it may be that depression is accompanied by panic attacks whereas in others it may be that panic and anxiety disorders result in depression which is the more likely. They are comorbid to such an extent that the DSM has called for further investigation into a disorder it called Mixed Anxiety-Depression.

The presence of both conditions at the same time results in a much more serious illness which usually requires a longer treatment therapy.

Treatment

Treatment options include drugs and psychological therapies. Many studies have concluded that a combination of the two is the most effective.

Selective Serotonin Reuptake Inhibitors (SSRIs) have been found to be the most effective drugs for the treatment of comorbid depression and anxiety disorders. The difficulty in treating comorbid conditions is that while one may respond better to lower doses, the other may need higher doses. This would need to be closely monitored by the prescribing doctor.

CBT, or Cognitive Behavioral Therapy, is the most popular psychological therapy for anxiety disorders and depression at the current time. CBT concentrates on the cognitive or thinking processes first and then focuses on changing behavior. On the other hand, a study to be published in the February edition of the American Psychologist concludes that Psychodynamic Psychotherapy is equally as effective. Psychodynamic psychotherapy is a more traditional verbal therapy which focuses on the unconscious workings of the mind with the premise that it is there that the problems lie.

Agoraphobia has always been defined as a fear of open spaces. It is now increasingly being defined as a fear of panic attacks. Agoraphobia is one of the results if treatment for panic attacks is not sought and the panic disorder worsens. While not all agoraphobics have panic disorder, over two thirds of them do. In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, the two conditions that concern us here are listed as three separate disorders – panic disorder with agoraphobia, panic disorder without agoraphobia and agoraphobia without a history of panic disorder.

Panic attacks are embarrassing. Dealing with the symptoms is a nightmare, but having an audience is worse. It’s not something that goes through your mind at the time but afterwards when you think about it, you wonder what people thought or think of you; you think about how awful you must have looked. It is the fear of having another panic attack that leads to changes in behavior. The fear of having another panic attack in public gradually leads to agoraphobia. While it may develop at any time, it is usually within the first year of recurring panic attacks that agoraphobia occurs.

Many agoraphobics feel safe only when following a specific routine or going to set places. Anything different will trigger an attack. These are panic attacks with the intense feeling of fear, heart palpitations, sweating and/or getting the chills, feeling faint and dizzy. Agoraphobics also experience the depersonalization that some panic attack sufferers feel; as if they are floating above their bodies and witness what is happening as if it is to someone else. Another symptom they have in common is the feeling they are going crazy or the fear that they are going to die. In severe cases, agoraphobia results in the person becoming completely housebound, sometimes for years.

It is no simple thing to allow your fear to control your behavior to such an extent as to severely limit the choices you feel able to make. Treatment may take some time, months or even more. The condition has taken years to develop; and so, it will take time to cure. Agoraphobia is treatable, however, and does respond well to treatment. Usually, a combination of therapies is the best approach with a limited use of medication (if necessary) and a therapy such as cognitive behavior therapy or interoceptive exposure.

The first step in treating agoraphobia is an examination of the conditions in which it developed in the first place.  Family background, upbringing, genetics, stress factors, diet and lifestyle all contain clues of the cause or causes of panic disorders and phobias.

There are two main causes of depression. The first is where there is unresolved grief in situations involving death, relationship break-ups, a feeling of abandonment or a traumatic event. The second cause results from a feeling of emotional detachment due to a lack of connection with others.

Because adolescence is already a turbulent time of mood swings and unpredictable behavior, teenage depression is difficult to spot. This is one of the reasons why only 20% of teens suffering from depression get the treatment they need. Of the teens diagnosed with depression, about two thirds of them were found to already have an existing problem such as anxiety disorder, bipolar disorder or antisocial disorder. It has also been found that genetics plays a part in determining who suffers from the condition; though it is not a defining cause in that even teenagers with no family history of depression can still suffer from it.

In one study, it was found that adolescents who went to bed at 10p.m. at the latest and had an average of 8-9 hours of sleep were less likely to suffer from depression than those who went to bed at midnight and averaged 5 -6 hours of sleep.

Adolescent anxiety disorder can co-exist with depression and while they may seem similar conditions, they are not. A recent study reported in the Journal of Child Psychology and Psychiatry concluded that the two disorders are separate and should be treated as such. Furthermore, where the two conditions co-exist, symptoms have found to be more severe.

However, both conditions respond well to treatment. A growing number of researchers are supporting behavior therapies for adolescents rather than the use of medications.  These may be individual talk therapies or group therapies which involve other depressed teens or may be family oriented. The focus in each case is changing the mindset that leads to negative feelings and behaviors.

Well, you may think that but it’s not so. Everybody has problems and a lot of them might be very similar to yours. It’s just that no-one likes admitting that they can’t cope. Life today is a lot more isolationist than it was in the past. Nowadays, we tend to live in our own little cocoons whereas in the past, Mum and Dad lived next door and Grandma lived across the road. Families were more intimate and communities were more interested in everyone’s well-being.

There are support groups for everything these days, even for those who can’t manage to get all their housework done. To a large extent, support groups have taken the place of the tea-time chats that we used to have with friends and family but just can’t find the time anymore. Some support groups meet to discuss their issues while others are anonymous, like those on the internet. The latter have the advantage of being available 24 hours a day so if you are in despair at 3.00 am, then it is likely that there is someone out there you can share your problems with.

Everyone feels lonely when they have a problem and this is so true for anxiety disorders and panic attacks. They are so debilitating because you often feel you are going mad. Why can’t you get yourself together? Everyone else can. But you see, not everyone else can and, in fact, there are millions in the same situation. Doesn’t just knowing that give you some comfort? They may have some ideas that you haven’t thought of. They may have experience of therapies that you don’t know if you should try.

You are not the only one sitting at home losing heart. You are not the only one only just getting by in the world by the skin of your teeth; hoping no-one notices your knees shaking. By sharing your problems and experiences, you begin to take control of your condition. It is the first step – asking for help. It is the biggest step – admitting that you have a problem. No-one in a support group will put you down or think less of you because they are, or were, in the same situation. Your peers will listen with open minds, no matter how awful you think you sound.

Should you join an anxiety support group? Oh, yes. Ask your doctor or health care provider or look up some groups on the internet. You can read what others are saying before you join so it’s easy to find one that suits you best.

Sufferers of chronic anxiety disorder are constantly apprehensive to the point that the quality of their lives is undermined. This worry may be about something specific such as the safety of family members or work performance or it may be about everything in general and nothing in particular. For some, it may be a vague feeling always in the back of their mind while for others, it may be all-encompassing and omnipresent. For the former, life may not be as grand as they’d like but they can get on with it. For the latter, however, they may feel so burdened that they have difficulty finding the strength to get out of bed, shower or go to work.

The Causes of Chronic Anxiety

The causes of chronic anxiety disorder are varied. In some cases, it can surface suddenly as a response to a traumatic event and in others it can be traced back to an anxious temperament, lack of self esteem or troubled childhood. Anyone who watches news broadcasts or reads the newspapers regularly must know that we live in troubled times. Sufferers of chronic anxiety disorder take the troubles to heart and worry about them incessantly.

As to why some people are so affected by what they see and hear while others carry on is still not certain. Anxiety is linked to a feeling of a lack of control over circumstances as well as the sense that danger is lurking around every corner.  It can also be a learned response as a result of one or both parents responding anxiously to events. It may be diet and lifestyle that lead to chemical reactions in the body that cause anxious responses.

The Symptoms of Chronic Anxiety

In order to be diagnosed with a chronic anxiety disorder, the symptoms must have been present for at least six months. Physical symptoms include racing heartbeat, sweating, stomach problems and muscle aches and pains. High anxiety levels will have lead to symptoms such as sleep disorders, depression, fatigue and a feeling of detachment. In extreme cases, panic attacks may develop which in turn leads to avoidance behaviour such as agoraphobia.

Treatment

Luckily, anxiety can be treated. The aim of treatment is the reduction of symptoms to the point where they no longer impact daily life. Treatment needs to be individually tailored as the journey for each patient is unique. Medication, psychological therapy, self help strategies and diet and lifestyle changes are all ways anxiety is reduced. Usually a combination of these therapies gives the best long term result. The road to recovery is not an easy one and it requires dedication and commitment on behalf of the patient. Having said that, a life without chronic anxiety is a goal worth fighting for.

There are very few cases of agoraphobia that are not preceded by a panic disorder. Therefore, treatment for the former is firstly treatment of the latter. Similarly, treatment of panic disorder will prevent agoraphobia from developing. If you find yourself starting to avoid certain situations for no good reason, don’t. Make yourself go there, if not alone then with someone you trust. The more you shun a place or situation, the more you imagine it to take on qualities it simply does not have.

 If it’s already too late for that, then there are treatment options. There is no general panacea as everyone has arrived at their panic disorder via different routes so the best bet is a treatment plan designed for the individual. While there are disagreements as to which course is best, it is generally believed that a combination of medication, psychotherapy and diet and lifestyle changes are the most effective. 

Alcohol, caffeine and illegal drugs can be triggers for panic attacks and anxiety disorders as well as make the symptoms worse. Your first step should be to avoid these stimulants in order for your body to be able to regain its natural equilibrium.

 Relaxation techniques like yoga, meditation, breathing exercises and guided visualization are a vital part of many treatment processes. Don’t dismiss them as new wave theories as they have been proven to work wonders in learning how to deal with panic attack symptoms as well as preventing a full blown attack if you feel the beginning of one.

 Sleep is an important part of treatment regimes. Unfortunately, a lot of people who suffer from panic attacks and anxiety disorders also have disrupted sleep patterns. If you are worried about something, it is difficult to get a good night’s sleep but when our bodies are tired and our minds don’t get the benefit of the restoration quality sleep brings, then we are much more vulnerable to panic attacks. Our physical and mental defences are down and we are more prone to diseases and conditions.

 Make sure you drink the required amount of water every day – most experts agree that this means a minimum of 8 glasses daily. If we are dehydrated, our bodies react by releasing chemicals into the bloodstream which lead to anxiety.

 We are what we eat. This is true for everybody but even more so if you suffer from panic attacks. There are foods which are alkaline – tomatoes, avocadoes and green vegetables – and there foods which are acidic – sweets, alcohol, saturated fats, meats, dairy products etc. A diet comprising 80% alkaline foods and 20% acidic ones is considered ideal for maintaining an optimal Ph level which in turn affects everything the body does – in fact, if the Ph level is not slightly alkaline it cannot assimilate the vitamins and minerals necessary to heal itself.

Unfortunately, nowadays we tend to eat too many acidic foods. Thus, the body will try to make the acidic Ph level more alkaline by using alkaline minerals and, if there are not enough of these in our diets, then acidosis, or a build up of acids in the cells, will result. This leads to a host of problems including low energy and chronic fatigue, depression, lack of joy and enthusiasm and the tendency to stress easily.

Other things you can do to help yourself is to take up some form of exercise. It doesn’t have to be anything too strenuous – walking is an ideal way to start.

Also, knowing you are not alone in suffering from panic attacks can do a great deal to improve your state of mind so consider joining a support group. Nowadays, you can do this without leaving home as there are numerous on-line groups out there. Find one that you like and the suggestions and shared experiences you find there will help you feel that you are not alone.

Finally, positive thinking when you feel your first anxious thoughts coming to the fore may be enough to nip a panic attack in the bud. This will take some practice but many find it a valuable skill.