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Dickey, MarilynAnxiety Disorders.National Inst. of Mental Health (DHHS), Rockville,MDISBN-0-16-045253-8; NIH-94-3879Sep 9429p.U.S. Government Printing Office, Superintendent ofDocuments, Mail Stop: SSOP, Washington, DC20402-9328.Reports Descriptive (141)

MF01/PCO2 Plus Postage.*Anxiety; *Coping; *Emotional Problems; *MentalHealth; Posttraumatic Stress Disorder; Psychological

PatternsNational Institute of Mental Health; ObsessiveCompulsive Behavior; *Panic Disorder

Anxiey, in general, helps one to cope. It rouses aperson to action and gears one up to face a threatening situation. Itmakes students study harder for exams, and keeps presenters on theirtoes when making speeches. But an anxiety disorder can prevent onefrom coping and can disrupt daily life. Anxiety disorders are notjust a case of "nerves," they are illnesses, often related tobiological makeup and life experiences of the individual, and theyfrequently run in families. This pamphlet was produced in order tohelp laypersons understand anxiety disorders, and to explain the roleof research in conquering anxiety and other mental disorders. Thereare several types of anxiety disorders, each with its own distinct

features. This brochure offers brief explanations of generalizedanxiety disorder, panic disorder (which is sometimes accompanied byagoraphobia), specific phobias, obsessive-compulsive disorder, andpost-traumatic stress disorder. Information on treatment and how toget help for anxiety disorders is provided, along with 11 additional

sources of information. (JBJ)

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Reproductions supplied by EDRS are the best that can be madefrom the original document.

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NatithalhstituteofMentalHealth

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U.S. DEPARTMENT OF EDUCATIONOffice of Educational Research and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

This document has been reproduced asreceived from the person or organizationoriginating it.Minor changes have been made toimprove reproduction quality.

Points of view or opinions stated in thisdocument do not necessarily representofficial OERI position or policy.

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Message fromthe NationalInstitute ofMental Health

Research conducted and supportedby the National Institute of MentalHealth brings hope to millions ofpeople who suffer from mentalillness and to their families andfriends. In many years of workwith animal as well as humansubjects, researchers have advancedour understanding of the brain andvastly expanded the capability ofmental health professionals todiagnose, treat, and prevent mentaland brain disorders.

Now, in the 1990s, which thePresident and Congress havedeclared the "Decade of the Brain,"we stand at the threshold of a newera in brain and behavioralsciences. Through research, we willlearn even more about mental andbrain disorders such as anxietydisorders, depression, bipolardisorder, and schizophrenia. Andwe will be able to use thisknowledge to develop new therapiesthat can help more peopleovercome mental illness.

The National Institute of MentalHealth is part of the NationalInstitutes of Health (NIH), theFederal Government's primaryagency for biomedical andbehavioral research. NIH is acomponent of the U.S. Departmentof Health and Human Services.

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Anxiety DisordersEverybody knows what it's like to feel

anxiousthe butterflies in your stomach before afirst date, the tension you feel when your boss isangry, the way your heart pounds if you're indanger. Anxiety rouses you to action. It gears youup to face a threatening situation. It makes youstudy harder for that exam, and keeps you onyour toes when you're making a speech. Ingeneral, it helps you cope.

But if you have an anxiety disorder, thisnormally helpful emotion can do just theoppositeit can keep you from coping and candisrupt your daily life. Anxiety disorders aren'tjust a case of "nerves." They are illnesses, oftenrelated to the biological makeup and lifeexperiences of the individual, and they frequentlyrun in families. There are several types of anxietydisorders, each with its own distinct features.

An anxiety disorder may make you feelanxious most of the time, without any apparentreason. Or the anxious feelings may be souncomfortable that to avoid them you may stopsome everyday activities. Or you may haveoccasional bouts of anxiety so intense they terrifyand immobilize you.

At the National Institute of MentalHealth (NIMH), the Federal agency that conductsand supports research related to mental disorders,mental health, and the brain, scientists arelearning more and more about the nature ofanxiety disorders, their causes, and how toalleviate them.

Many people misunderstand thesedisorders and think individuals should be able toovercome the symptoms by sheer willpower.Wishing the symptoms away does not workbutthere are treatments that can help. That's whyNIMH has produced this pamphletto help youunderstand these conditions, describe theirtreatments, and explain the role of research inconquering anxiety and other mental disorders.

This brochure gives brief explanations ofgeneralized anxiety disorder, panic disorder (which

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is sometimes accompanied by agoraphobia),specific phobias, social phobias,obsessive-compulsive disorder, and post-traumaticstress disorder. More detailed information onsome of these anxiety disorders is availablethrough NIMH or other sources. (See the listingsat the end of this pamphlet.)

GeneralizedAnxiety Disorder

I always thought I was just a worrier. I'dfeel keyed up and unable to relax. At times itwould come and go, and at times it would beconstant. It could go on for days. I'd worry aboutwhat I was going to fix for a dinner party, orwhat would be a great present for somebody. Ijust couldn't let something go.

I'd have terrible sleeping problems.There were times I'd wake up wired in themorning or in the middle of the night. I hadtrouble concentrating, even reading thenewspaper or a novel. Sometimes I'd feel a littlelightheaded. My heart would race or pound. Andthat would make me worry more.

Generalized Anxiety Disorder (GAD) ismuch more than the normal anxiety peopleexperience day to day. It's chronic andexaggerated worry and tension, even thoughnothing seems to provoke it. Having this disordermeans always anticipating disaster, often worryingexcessively about health, money, family, or work.Sometimes, though, the source of the worry ishard to pinpoint. Simply the thought of gettingthrough the day provokes anxiety.

People with GAD can't seem to shaketheir concerns, even though they usually realizethat their anxiety is more intense than thesituation warrants. People with GAD also seemunable to relax. They often have trouble falling orstaying asleep. Their worries are accompanied by

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GAD comes on gradually and most oftenhits people in childhood or adolescence, but canbegin in adulthood, too. It's more common inwomen than in men and often occurs in relativesof affected persons. It's diagnosed when someonespends at least 6 months worried excessively abouta number of everyday problems.

Having GAD means alwaysanticipating disaster, often worrying

excessively about health, money,family, or work. Worries are oftenaccompanied by physical symptoms

like trembling, muscle tension,and nausea.

In general, the symptoms of GAD seemto diminish with age. Successful treatment mayinclude a medication called buspirone. Researchinto the effectiveness of other medications, such asbenzodiazepines and antidepressants, is ongoing.Also useful are cognitive-behavioral therapy,relaxation techniques, and biofeedback to controlmuscle tension.

Panic DisorderIt started 10 years ago. I was sitting in a

seminar in a hotel and this thing came out of theclear blue. I felt like I was dying.

For me, a panic attack is almost aviolent experience. I feel like I'm going insane. Itmakes me feel like I'm losing control in a veryextreme way. My heart pounds really hard, thingsseem unreal, and there's this very strong feeling ofimpending doom.

In between attacks there is this dreadand anxiety that it's going to happen again. Itcan be very debilitating, trying to escape thosefeelings of panic.

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People with panic disorder have feelingsof terror that strike suddenly and repeatedly withno warning. They can't predict when an attackwill occur, and many develop intense anxietybetween episodes, worrying when and where thenext one will strike. In between times there is apersistent, lingering worry that another attackcould come any minute.

When a panic attack strikes, most likely

your heart pounds and you may feel sweaty,weak, faint, or dizzy. Your hands may tingle orfeel numb, and you might feel flushed or chilled.You may have chest pain or smotheringsensations, a sense of unreality, or fear ofimpending doom or loss of control. You may

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genuinely believe you're having a heart attack orstroke, losing your mind, or on the verge ofdeath. Attacks can occur any time, even duringnondream sleep. While most attacks average acouple of minutes, occasionally they can go on forup to 10 minutes. In rare cases, they may last anhour or more.

You may genuinely believe you'rehaving a heart attack, losing your

mind, or on the verge of death.Attacks can occur any time, even

during nondream sleep.

Panic disorder strikes at least 1.6 percentof the population and is twice as common inwomen as in men. It can appear at any ageinchildren or in the elderlybut most often itbegins in young adults. Not everyone whoexperiences panic attacks will develop panicdisorderfor example, many people have oneattack but never have another. For those who dohave panic disorder, though, it's important to seektreatment. Untreated, the disorder can becomevery disabling.

Panic disorder is often accompanied byother conditions such as depression or alcoholism,and may spawn phobias, which can develop inplaces or situations where panic attacks haveoccurred. For example, if a panic attack strikeswhile you're riding an elevator, you may developa fear of elevators and perhaps start avoidingthem.

Some people's lives become greatlyrestrictedthey avoid normal, everyday activitiessuch as grocery shopping, driving, or in somecases even leaving the house. Or, they may beable to confront a feared situation only ifaccompanied by a spouse or other trusted person.

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Basically, they avoid any situation they fear wouldmake them feel helpless if a panic attack occurs.When people's lives become so restricted by thedisorder, as happens in about one-third of allpeople with panic disorder, the condition is calledagoraphobia. A tendency toward panic disorderand agoraphobia runs in families. Nevertheless,early treatment of panic disorder can often stopthe progression to agoraphobia.

Studies have shown that propertreatmenta type of psychotherapy calledcognitive-behavioral therapy, medications, orpossibly a combination of the twohelps 70 to 90percent of people with panic disorder. Significantimprovement is usually seen within 6 to 8 weeks.

Cognitive-behavioral approaches teachpatients how to view the panic situationsdifferently and demonstrate ways to reduceanxiety, using breathing exercises or techniques torefocus attention, for example. Another techniqueused in cognitive-behavioral therapy, calledexposure therapy, can often help alleviate thephobias that may result from panic disorder. Inexposure therapy, people are very slowly exposedto the fearful situation until they becomedesensitized to it.

Some people find the greatest relief frompanic disorder symptoms when they take certainprescription medications. Such medications, likecognitive-behavioral therapy, can help to preventpanic attacks or reduce their frequency andseverity. Two types of medications that have beenshown to be safe and effective in the treatment ofpanic disorder are antidepressants andbenzodiazepines.

PhobiasPhobias occur in several forms. A specific

phobia is a fear of a particular object or situation.Social phobia is a fear of being painfullyembarrassed in a social setting., And agoraphobia,

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which often accompanies panic disorder, is a fearof being in any situation that might provoke apanic attack, or from which escape might bedifficult if one occurred.

Specific Phobias

I'm scared to death of flying, and I neverdo it anymore. It's an awful feeling when thatairplane door closes and I feel trapped. My heartpounds and I sweat bullets. If somebody startstalking to me, I get very stiff and preoccupied.When the airplane starts to ascend, it justreinforces that feeling that I can't get out. Ipicture myself losing control, freaking out,climbing the walls, but of course I never do. I'mnot afraid of crashing or hitting turbulence. It'sjust that feeling of being trapped. Whenever I'vethought about changing jobs, I've had to think,"Would I be under pressure to fly?" These days Ionly go places where I can drive or take a train.My friends always point out that I couldn't get ofja train traveling at high speeds either, so whydon't trains bother me? I just tell them it isn't arational fear.

Many people experience specific phobias,intense, irrational fears of certain things orsituationsdogs, closed-in places, heights,

Phobias aren't just extreme fear;they are irrational fear. You may be

able to ski the world's tallestmountains with ease but feel panicgoing above the lath floor of an

office building.

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escalators, tunnels, highway driving, water, flying,and injuries involving blood are a few of the morecommon ones. Phobias aren't just extreme fear;they are irrational fear. You may be able to skithe world's tallest mountains with ease but panicgoing above the 10th floor of an office building.Adults with phobias realize their fears areirrational, but often facing, or even thinkingabout facing, the feared object or situation bringson a panic attack or severe anxiety.

Specific phobias strike more than 1 in 10people. No one knows just what causes them,though they seem to run in families and are alittle more prevalent in women. Phobias usuallyfirst appear in adolescence or adulthood. Theystart suddenly and tend to be more persistent thanchildhood phobias; only about 20 percent of adultphobias vanish on their own. When children havespecific phobiasfor example, a fear ofanimalsthose fears usually disappear over time,though they may continue into adulthood. Noone knows why they hang on in some people anddisappear in others.

If the object of the fear is easy to avoid,people with phobias may not feel the need to seektreatment. Sometimes, though, they may makeimportant career or personal decisions to avoid aphobic situation.

When phobias interfere with a person'slife, treatment can help. Successful treatmentusually involves a kind of cognitive-behavioraltherapy called desensitization or exposure therapy,in which patients are gradually exposed to whatfrightens them until the fear begins to fade.Three-fourths of patients benefit significantly from1-6;c type of treatment. Relaxation and breathingexercises also help reduce anxiety symptoms.

There is currently no proven drugtreatment for specific phobias, but sometimescertain medications may be prescribed to helpreduce anxiety symptoms before someone faces aphobic situation.

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Social Phobia

I couldn't go on dates or to parties. For awhile, I couldn't even go to class. My sophomoreyear of college I had to come home for a semester.

My fear would happen in any socialsituation. I would be anxious before I even leftthe house, and it would escalate as I got closer toclass, a party, or whatever. I would feel sick tomy stomachit almost felt like I had the flu. Myheart would pound, my palms would get sweaty,and I would get this feeling of being removedfrom myself and from everybody else.

When I would walk into a room full ofpeople, I'd turn red and it would feel likeeverybody's eyes were on me. I was tooembarrassed to stand off in a corner by myself,but I couldn't think of anything to say toanybody. I felt so clumsy, I couldn't wait to getout.

Social phobia is an intense fear ofbecoming humiliated in social situations,specifically of embarrassing yourself in front ofother people. It often runs in families and may beaccompanied by depression or alcoholism. Socialphobia often begins around early adolescence oreven younger.

If you suffer from social phobia, you tendto think that other people are very competent inpublic and that you are not. Small mistakes youmake may seem to you much more exaggeratedthan they really are. Blushing itself may seempainfully embarrassing, and you feel as though alleyes are focused on you. You may be afraid ofbeing with people other than those closest to you.Or your fear may be more specific, such as feelinganxious about giving a speech, talking to a boss orother authority figure, or dating. The mostcommon social phobia is a fear of public speaking.Sometimes social phobia involves a general fear ofsocial situations such as parties. More rarely itmay involve a fear of using a public restroom,eating out, talking on the phone, or writing in the

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Treatment for .

Many people with anxiety disorders can be helpecinvolves medication or specific forms of psychoth

Medications, although not cures, can be N

thanks to research by scientists at NIMH and othavailable than ever before to treat anxiety disordeothers to try. In addition, new medications to tre

For most of the medications that are presstarts the patient on a low dose and gradually inceffects, but they usually become tolerated or dimidoctor may advise the patient to stop taking thedrugsbefore trying another one. When treatmergradually.

Research has also shown that behavioraleffective for treating several of the anxiety disord

Behavioral therapy focuses on changing sior stop unwanted behavior. For example, one teclspecial breathing exercise involving slow, deep bripeople who are anxious often hyperventilate, takiheartbeat, lightheadedness, and other symptoms.exposes patients to what frightens them and help:

Like behavioral therapy, cognitive-behavicsituations and bodily sensations that trigger panicpatients also learn to understand how their thinkichange their thoughts so that symptoms are less Icombined with exposure and other behavioral tec,For example, someone who becomes lightheaded I

be helped with the following approach used in co,spin in a circle until he becomes dizzy. When he Idie," he learns to replace that thought with a moidizzinessI can handle it."

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,nxiety Disorders

with treatment. Therapy for anxiety disorders oftenapy.

-y effective at relieving anxiety symptoms. Today,research institutions, there are more medicationsSo if one drug is not successful, there are usually

anxiety symptoms are under development.ibed to treat anxiety disorders, the doctor usuallyases it to the full dose. Every medication has sidesh with time. If side effects become a problem, the:dication and to wait a weekor longer for certainis near an end, the doctor will taper the dosage

:rapy and cognitive-behavioral therapy can bes.

cific actions and uses several techniques to decreaseique trains patients in diaphragmatic breathing, a

the to reduce anxiety. This is necessary becauserapid shallow breaths that can trigger rapid

lother technique exposure therapy graduallyhem cope with their fears.

therapy teaches patients to react differently to thettacks and other anxiety symptoms. However,; patterns contribute to their symptoms and how to

to occur. This awareness of thinking patterns isiques to help people confront their feared situations.ring a panic attack and fears he is going to die canitive-behavioral therapy. The therapist asks him to:omes alarmed and starts thinking, "I'm going toappropriate one, such as, "It's just a little

16BEST COPY AVAILABLE

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presence of other people, such as when signing acheck.

Although this disorder is often thought ofas shyness, the two are not the same. Shy peoplecan be very uneasy around others, but they don'texperience the extreme anxiety in anticipating asocial situation, and they don't necessarily avoidcircumstances that make them feel self-conscious.In contrast, people with social phobia aren'tnecessarily shy at all. They can be completely atease with people most of the time, but particularsituations, such as walking down an aisle in publicor making a speech, can give them intenseanxiety. Social phobia disrupts normal life,interfering with career or social relationships. Forexample, a worker can turn down a jobpromotion because he can't give publicpresentations. The dread of a social event canbegin weeks in advance, and symptoms can bequite debilitating.

People with social phobia aren'tnecessarily shy at all. They can be

completely at ease with people mostof the time, but in particular

situations, they feel intense anxiety.

People with social phobia are aware thattheir feelings are irrational. Still, they experience agreat deal of dread before facing the fearedsituation, and they may go out of their way toavoid it. Even if they manage to confront whatthey fear, they usually feel very anxiousbeforehand and are intensely uncomfortablethroughout. Afterward, the unpleasant feelingsmay linger, as they worry about how they mayhave been judged or what others may havethought or observed about them.

About 80 percent of people who sufferfrom social phobia find relief from their

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symptoms when treated with cognitive-behavioraltherapy or medications or a combination of thetwo. Therapy may involve learning to view socialevents differently; being exposed to a seeminglythreatening social situation in such a way that itbecomes easier to face; and learninganxiety-reducing techniques, social skills, andrelaxation techniques.

The medications that have proveneffective include antidepressants called MAOinhibitors. People with a specific form of socialphobia called performance phobia have beenhelped by drugs called beta-blockers. For example,musicians or others with this anxiety may beprescribed a beta-blocker for use on the day of aperformance.

Obsessive-CompulsiveDisorder

I couldn't do anything without rituals.They transcended every aspect of my life.Counting was big for me. When I set my alarmat night, I had to set it to a number that wouldn'tadd up to a "bad" number. If my sister was 33and I was 24, I couldn't leave the TV onChannel 33 or 24. I would wash my hair threetimes as opposed to once because three was agood luck number and one wasn't. It took melonger to read because I'd count the lines in aparagraph. If I was writing a term paper, Icouldn't have a certain number of words on aline if it added up to a bad number. I wasalways worried that if I didn't do something, myparents were going to die. Or I would worryabout harming my parents, which was completelyirrational. I couldn't wear anything that saidBoston because my parents were from Boston. Icouldn't write the word "death" because I wasworried that something bad would happen.

Getting dressed in the morning wastough because I had a routine, and if I deviatedfrom that routine, I'd have to get dressed again.

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I knew the rituals didn't make sense, butI couldn't seem to overcome them until I hadtherapy.

Obsessive-compulsive disorder ischaracterized by anxious thoughts or rituals youfeel you can't control. If you have OCD, as it'scalled, you may be plagued by persistent,unwelcome thoughts or images, or by the urgentneed to engage in certain rituals.

You may be obsessed with germs or dirt,so you wash your hands over and over. You maybe filled with doubt and feel the need to checkthings repeatedly. You might be preoccupied bythoughts of violence and fear that you will harmpeople close to you. You may spend long periodsof time touching things or counting; you may bepreoccupied by order or symmetry; you may havepersistent thoughts of performing sexual acts thatare repugnant to you; or you may be troubled bythoughts that are against your religious beliefs.

The disturbing thoughts or images arecalled obsessions, and the rituals that areperformed to try to prevent or dispel them arecalled compulsions. There is no pleasure incarrying out the rituals you are drawn to, onlytemporary relief from the discomfort caused bythe obsession.

A lot of healthy people can identify withhaving some of the symptoms of OCD, such aschecking the stove several times before leaving thehouse. But the disorder is diagnosed only whensuch activities consume at least an hour a day, arevery distressing, and interfere with daily life.

Most adults with this condition recognizethat what they're doing is senseless, but they can'tstop it. Some people, though, particularly childrenwith OCD, may not realize that their behavior isout of the ordinary.

OCD strikes men and women inapproximately equal numbers and afflicts roughly1 in 50 people. It can appear in childhood,adolescence, or adulthood, but on the average itfirst shows up in the teens or early adulthood. Athird of adults with OCD experienced their first

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The disturbing thoughts or imagesare called obsessions, and the rituals

performed to try to prevent ordispel them are called compulsions.There is no pleasure in carrying outthe rituals you are drawn to, only

temporary relief from thediscomfort caused by the obsession.

symptoms as children. The course of the disease isvariablesymptoms may come and go, they mayease over time, or they can grow progressivelyworse. Evidence suggests that OCD might run infamilies.

Depression or other anxiety disordersmay accompany OCD. And some people withOCD have eating disorders. In addition, they mayavoid situations in which they might have toconfront their obsessions. Or they may tryunsuccessfully to use alcohol or drugs to calmthemselves. If OCD grows severe enough, it cankeep someone from holding down a job or fromcarrying out normal responsibilities at home, butmore often it doesn't develop to those extremes.

Research by NIMH-funded scientists andother investigators has led to the development ofmedications and behavioral treatments that canbenefit people with OCD. A combination of thetwo treatments is often helpful for most patients.Some individuals respond best to one therapy,some to another. Two medications that have beenfound effective in treating OCD are clomipramineand fluoxetine. A number of others are showingpromise, however, and may soon be available.

Behavioral therapy, specifically a typecalled exposure and response prevention, has alsoproven useful for treating OCD. It involvesexposing the person to whatever triggers the

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problem and then helping him or her forego theusual ritualfor instance, having the patient touchsomething dirty and then not wash his hands.This therapy is often successful in patients whocomplete a behavioral therapy program, thoughresults have been less favorable in some peoplewho have both OCD and depression.

Post-TraumaticStress Disorder

I was raped when I was 25 years old.For a long time, I spoke about the rape on anintellectual level, as though it was something thathappened to someone else. I was very aware thatit had happened to me, but there just was nofeeling. I kind of skidded along for a while.

I started having flashbacks. They kind ofcame over me like a splash of water. I would beterrified. Suddenly I was reliving the rape. Everyinstant was startling. I felt like my entire headwas moving a bit, shaking, but that wasn't so atall. I would get very flushed or a very dry mouthand my breathing changed. I was held insuspension. I wasn't aware of the cushion on thechair that I was sitting in or that my arm wastouching a piece of furniture. I was in a bubble,just kind of floating. And it was scary. Having aflashback can wring you out. You're really shaken.

The rape happened the week beforeChristmas, and I feel like a werewolf around theanniversary date. I can't believe thetransformation into anxiety and fear.

Post-Traumatic Stress Disorder (PTSD) isa debilitating condition that follows a terrifyingevent. Often, people with PTSD have persistentfrightening thoughts and memories of their ordealand feel emotionally numb, especially with peoplethey were once close to. PTSD, once referred toas shell shock or battle fatigue, was first broughtto public attention by war veterans, but it can

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result from any number of traumatic incidents.These include kidnapping, serious accidents suchas car or train wrecks, natural disasters such asfloods or earthquakes, violent attacks such as amugging, rape, or torture, or being held captive.The event that triggers it may be something thatthreatened the person's life or the life of someoneclose to him or her. Or it could be somethingwitnessed, such as mass destruction after a planecrash.

Whatever the source of the problem,some people with PTSD repeatedly relive thetrauma in the form of nightmares and disturbingrecollections during the day. They may alsoexperience sleep problems, depression, feeling

Ordinary events can serve asreminders of the trauma and trigger

flashbacks or intrusive images.Anniversaries of the event are often

very difficult.

detached or numb, or being easily startled. Theymay lose interest in things they used to enjoy andhave trouble feeling affectionate. They may feelirritable, more aggressive than before, or evenviolent. Seeing things that remind them of theincident may be very distressing, which could leadthem to avoid certain places or situations thatbring back those memories. Anniversaries of theevent are often very difficult.

PTSD can occur at any age, includingchildhood. The disorder can be accompanied bydepression, substance abuse, or anxiety. Symptomsmay be mild or severepeople may become easilyirritated or have violent outbursts. In severe casesthey may have trouble working or socializing. Ingeneral, the symptoms seem to be worse if theevent that triggered them was initiated by apersonsuch as a rape, as opposed to a flood.

Ordinary events can serve as reminders ofthe trauma and trigger flashbacks or intrusive

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images. A flashback may make the person losetouch with reality and reenact the event for aperiod of seconds or hours or, very rarely, days.A person having a flashback, which can come inthe form of images, sounds, smells, or feelings,usually believes that the traumatic event ishappening all over again.

Not every traumatized person getsfull-blown PTSD, or experiences PTSD at all.PTSD is diagnosed only if the symptoms lastmore than a month. In those who do have PTSD,symptoms usually begin within 3 months of thetrauma, and the course of the illness varies. Somepeople recover within 6 months, others havesymptoms that last much longer. In some cases,the condition may be chronic. Occasionally, theillness doesn't show up until years after thetraumatic event.

Antidepressants and anxiety-reducingmedications can ease the symptoms of depressionand sleep problems, and psychotherapy, includingcognitive-behavioral therapy, is an integral part oftreatment. Being exposed to a reminder of thetrauma as part of therapysuch as returning to thescene of a rapesometimes helps. And, support fromfamily and friends can help speed recovery.

How to Get Helpfor Anxiety Disorders

If you, or someone you know, hassymptoms of anxiety, a visit to the familyphysician is usually the best place to start. Aphysician can help you determine if the symptoms.are due to an anxiety disorder, some other medicalcondition, or both. Most often, the next step togetting treatment for an anxiety disorder isreferral to a mental health professional.

Among the professionals who can helpare psychiatrists, psychologists, social workers,and counselors. However, it's best to look for aprofessional who has specialized training incognitive-behavioral or behavioral therapy andwho is open to the use of medications, should

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counselors sometimes work closely with apsychiatrist or other physician, who will prescribemedications when they are required. For somepeople, group therapy or self-help groups are ahelpful part of treatment. Many people do bestwith a combination of these therapies.

When you're looking for a health careprofessional, it's important to inquire about whatkinds of therapy he or she generally uses orwhether medications are available. It's importantthat you feel comfortable with the therapy. If thisis not the case, seek help elsewhere. However, ifyou've been taking medication, it's important notto quit certain drugs abruptly, but to taper themoff under the supervision of your physician. Besure to ask your physician about how to stop amedication. 24

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Remember, though, that when you find ahealth care professional you're satisfied with, thetwo of you are working as a team. Together youwill be able to develop a plan to treat youranxiety disorder that may involve medications,behavioral therapy, or cognitive-behavioraltherapy, as appropriate. Treatments for anxietydisorders, however, may not start workinginstantly. Your doctor or therapist may ask youto follow a specific treatment plan for severalweeks to determine whether it's working.

NIMH continues its search for new andbetter treatments for people with anxietydisorders. The Institute supports a sizeable andmultifaceted research program on anxietydisorderstheir causes, diagnosis, treatment, andprevention. This research involves studies ofanxiety disorders in human subjects andinvestigations of the biological basis for anxietyand related phenomena in animals. It is part of amassive effort to overcome the major mentaldisorders, an effort that is taking place during the1990s, which Congress has designated the Decadeof the Brain.

For More InformationAnxiety Disorders Association of AmericaDept. A6000 Executive BoulevardRockville, MD 20852(301) 231-9350

National Anxiety Foundation3135 Custer DriveLexington, KY 40517-4001(606) 272-7166

Obsessive Compulsive (OC) Foundation, Inc.PO Box 70Milford, CT 06460(203) 878-5669

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American Psychiatric Association1400 K Street, NWWashington, DC 20005(202) 682-6220

American Psychological Association750 1st Street, NEWashington, DC 20002-4242(202) 336-5500

Association for the Advancementof Behavior Therapy

305 7th AvenueNew York, NY 10001(212) 647-1890

National Alliance for the Mentally Ill2101 Wilson Boulevard, Suite 302Arlington, VA 22201(800) 950-NAMI (-6264)

National Mental Health Association1201 Prince StreetAlexandria, VA 22314-2971(703) 684-7722

National Mental Health Consumers'Self-Help Clearinghouse

311 South Juniper Street, Suite 1000Philadelphia, PA 19107(800) 553-4539

Phobics AnonymousPO Box 1180Palm Springs, CA 92263(619) 322-COPE (-2673)

Society for Traumatic Stress Studies60 Revere Drive, Suite 500Northbrook, IL 60062(708) 480-9080

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Related NIMH Brochures

The following brochures, giving moredetailed information on various anxiety disordersand related topics, are available by contacting:NIMH, Room 7C-02, 5600 Fishers Lane,Rockville, MD 20857.

Understanding Panic Disorder(NIH Pub. No. 93-3482)

Obsessive-Compulsive Disorder(NIH Pub. No. 94-3755)

Medications (DHHS Pub. No. (ADM) 92-1509)

Plain Talk About Depression(NIH Pub. No. 94-3561)

This brochure was written by Marilyn Dickey, a freelance

writer in Washington, DC.

Scientific information and review was provided by NIMH staff

members Hagop Akiskal, M.D.; Jack Maser, Ph.D.; BarryWolfe, Ph.D.; and Susan Solomon, Ph.D. Also providingreview and assistance were Jim Broatch, M.S.W., OCFoundation; Stephen Cox, M.D., National AnxietyFoundation; Jack Gorman, M.D., Columbia University; Alec

Pollard, Ph.D., St. Louis University; Jerilyn Ross, M.A.,L.I.C.S.W., Anxiety Disorders Association of America; and

Sally Winston, Psy.D., Anxiety and Stress Disorders Institute

of Maryland. Editorial direction was provided by Lynn J.

Cave, NIMH.

All material in this publication is free of copyright restrictions

and may be copied, reproduced, or duplicated withoutpermission of the Institute; citation of the source isappreciated.

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NIH Publication No. 94-3879September 1994

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