If you open your front door and a tiger leaps at you, it's normal to be afraid. But if you open that door and find no tiger—and you're still afraid—that's an anxiety disorder.
Do you fear the tiger, or do you fear the fear? That's a key question with anxiety disorders, says Wandal Winn, M.D., of Anchorage, Alaska, a public affairs representative for the American Psychiatric Association.
Not so long ago, anxiety disorders didn't even have names. Some people ask if there's much to them, or whether doctors and drug companies have just put labels on feelings people have always had.
Yes, people have always had them, says Kami White, Ph.D., director of behavioral medicine at Boston University's Center for Anxiety and Related Disorders. But for a long time, no one knew those feelings could cross the line to become severe ailments that need treatment, says Dr. White. "The old adage was 'Oh, she just has a case of nerves.'" The result was a great deal of needless torment.
Chronic and relentless
Anxiety disorders plague an estimated 19 million U.S. residents, says the National Institute of Mental Health (NIMH). These serious illnesses "fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless and can grow progressively worse if not treated," the NIMH says.
But the line between a shy guy and one with social anxiety disorder can be thin. These conditions can be misdiagnosed, overdiagnosed or wrongly self-diagnosed. That's especially true as drug companies promote a stream of medications to treat depression, anxiety and stress.
According to NIMH, symptoms of a general anxiety disorder (GAD) include constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. A person with GAD always anticipates the worst even though there is little reason to expect it. Other symptoms include fatigue, trembling, muscle tension, headache, or nausea.
"There is more and more pressure to deal with this at the primary physician's office, someone other than a mental health professional," says clinical psychologist Rudy Nydegger, Ph.D., a psychology professor at Union College in Schenectady, N.Y. "There's a tendency to diagnose quickly and prescribe quickly when the patient clearly is in distress."
But Dr. Nydegger says "medication alone simply alleviates some of the troubling symptoms. Medication alone doesn't deal with significant causes or underlying causes."
See your doctor first
That's not to say someone with anxiety symptoms shouldn't first see the family doctor. Based on a patient's medical history and an exam, the doctor can often tell that what the patient is going through has a physical rather than psychological cause, or that it's a one-time thing.
Medication may ease a panic attack, but it's not going to get someone with social anxiety disorder "back to the picnic," Dr. White says. "Ultimately, it's up to a doctor or a psychologist to get people back into the social world they've left."
"Not everybody who has anxiety needs to be on medication," Dr. Winn says. "In my practice, it may be approaching 50-50." He says he's wary of medications because they can cause psychological or physical addictions or side effects—including anxiety.
Several types of "talk therapy" can treat anxiety disorders.
"Medication isn't the first thing that comes to my mind when I'm helping that person," Dr. Winn says. "The first thing is education. Anxiety tends to feed in the dark. If a person knows what he really has, that is a very powerful antidote."