ANXIETY AND PHOBIAS

by Royal College of Psychiatrists

Introduction

Anxiety is a normal human feeling. We all experience it when faced with situations we find threatening or difficult. People often call this feeling stress, but the word "stress" can be used to mean two different things - on the one hand, the things that make us anxious and on the other, our reaction to them. This makes it a confusing word and so it will not be used in this article.

When our anxiety is a result of a continuing problem, such as money difficulties, we call it worry. If it is a sudden response to an immediate threat, like looking over a cliff or being confronted with an angry dog, we call it fear.

Normally both fear and anxiety can be helpful, helping us to avoid dangerous situations, making us alert and giving us the motivation to deal with problems. However, if the feelings become too strong or go for too long, they can stop us from doing the things we want to, and can make our lives miserable.

A phobia is a fear of particular situations or things that are not dangerous and which most people do not find troublesome.

Symptoms of anxiety

In the mind:

• feeling worried all the time
• feeling tired
• unable to concentrate
• feeling irritable
• sleeping badly

In the body:

• irregular heartbeats (palpitations)
• sweating
• muscle tension and pains
• breathing heavily
• dizziness
• faintness
• indigestion
• diarrhoea

These symptoms are easily mistaken by anxious people for evidence of serious physical illness. Their worry about this can make the symptoms even worse. Sudden unexpected surges of anxiety are called panic, and usually lead to the person having to quickly get out of whatever situation they happen to be in. Anxiety and panic are often accompanied by feelings of depression, when we feel glum, lose our appetite, and see the future as bleak and hopeless

Phobias

A person with a phobia has intense symptoms of anxiety, as described above. But they only rise from time to time in the particular situations that frighten them. At other times they do not feel anxious. If you have a phobia of dogs, you will feel OK if there are no dogs around. If you are scared of heights, you feel OK at ground level, and if you cannot face social situations, you will feel calm when there are no people around.

A phobia will lead the sufferer to avoid situations in which they know they will be anxious, but this will actually make the phobia worse as time goes on. It can also mean that the person's life becomes increasingly dominated by the precautions they have to take to avoid the situation they fear. Sufferers usually know that there is no real danger, they may feel silly about their fear, but they are still unable to control it. A phobia is more likely to go away if it has started after a distressing or traumatic event.

Are they common?

About one in every ten people will have troublesome anxiety or phobias at some point in their lives. However, most will never ask for treatment.

Causes

Some of us seem to be born with a tendency to be anxious - research suggests that it can be inherited through our genes. However, even people who are not naturally anxious can become anxious if they are put under enough pressure.

Sometimes it is obvious what is causing anxiety. When the problem disappears, so does the anxiety. However, there are some circumstances that are so upsetting and threatening that the anxiety they cause can go on long after the event. These are usually life-threatening situations like car crashes, train crashes, or fires. The people involved can feel nervous and anxious for months or years after the event, even if they have been physically unharmed. This is part of what we now call post-traumatic stress disorder.

Sometimes anxiety may be caused by using street drugs like amphetamines, LSD, or Ecstasy. Even the caffeine in coffee can be enough to make some of us feel uncomfortably anxious. On the other hand, it may not be clear at all why a particular person feels anxious, because it is due to a mixture of their personality, the things that have happened to them, or life-changes such as pregnancy.

Seeking help

If we are put under a lot of pressure, we may feel anxious and fearful for much of the time. We usually cope with these feelings because we know what is causing them and we know when the situation will end. For instance, most of us will feel very anxious before taking a driving test, but we can cope because we know that the feelings will disappear once the test is over.

However, some of us have these feelings for much of the time without knowing what is causing them, and so not knowing when they might end. This is much harder to cope with and will usually need some help from somebody else. People will sometimes not want to ask for help because they think that people might think that they are "mad". In fact, people with anxiety and fears hardly ever have a serious mental illness. It is much better to get help as soon as you can, rather than suffer in silence.

People with anxiety and phobias may not talk about these feelings, even with family or close friends. Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense, and may be easily startled by normal sounds such as a doorbell ringing or a car horn. They will tend to be irritable, and this can cause arguments with those close to them, especially if they do not understand why the sufferer feels that they cannot do certain things. Although friends and family can understand the distress caused by anxiety, they can find it difficult to live with, especially if the fears seem unreasonable.

Anxiety and pbobias in children

Most children go through times when they feel very frightened about things. It is a normal part of growing up. For instance, toddlers get very attached to the people who look after them. If for any reason they are separated from them, they can become very anxious or upset. Many children are scared of the dark, or of imaginary monsters. These fears usually disappear as a child grows older, and they do not usually spoil a child's life or interfere with their development. Most will feel anxious about important events like their first day at school, but they stop being frightened afterwards and are able to get on and enjoy their new situation.

Teenagers may often be moody. They tend to be worried about how they look, what other people think of them, how they get on with people in general, but especially about how they get on with the opposite sex. These worries can usually be dealt with by talking about them. However, if they are too strong other people may notice that they are doing badly at school, behaving differently, or feeling physically unwell.

If a child or teenager feels so anxious or fearful that it is spoiling their life, it is a good thing to ask the family doctor to look into it.

Helping people with anxiety and phobias

Talking about the problem can help when the anxiety comes from recent knocks, like a spouse leaving, a child becoming ill or losing a job. Who should we talk to? Try friends or relatives who you trust, whose opinions you respect, and who are good listeners. They may have had the same problem themselves, or know someone else who has. As well as having the chance to talk, we may be able to find out how other people have coped with a similar problem.

Self-help groups are a good way of getting in touch with people with similar problems. They will both be able to understand what you are going through, but may be able to suggest helpful ways of coping, These groups may be focussed on anxieties and phobias, or may be made up of people who have been through similar experiences - women's groups, bereaved parent's groups, survivors of abuse groups.

Learning to relax can be a great help to learn a special way of relaxing, to help us control our anxiety and tension. We can learn these through groups, through professionals, but there are several books and videotapes we can use to teach ourselves (see end of article). It is a good idea to practice this regularly, not just when we are in a crisis.

Psychotherapy is a more intensive talking treatment which can help us to understand and to come to terms with reasons for our anxieties that we may not have recognised ourselves. The treatment can take place in groups or individually and is usually weekly for several weeks or months. Psychotherapists may or may not be medically qualified.

If this is not enough, there are several different kinds of professionals who may be able to help - the family doctor, psychiatrist, psychologist, social worker, nurse, or counsellor

Medication can play a part in the treatment of some people with anxiety or phobias. The most common tranquilisers are the valium-like drugs, the benzodiazepines (most sleeping tablets also belong to this class of drugs). They are very effective at relieving anxiety, but we now know that they can be addictive after only four weeks regular use. When people try to stop taking them they may experience unpleasant withdrawal symptoms which can go on for some time. These drugs should be only used for short periods, perhaps to help during a crisis. They should not be used for longer-term treatment of anxiety.

On the other hand, antidepressants are not addictive, and can help to relieve anxiety as well as the depression for which they are usually prescribed. Some even seem to have a particular effect on individual types of anxiety. One of their drawbacks is that they usually take 2 to 4 weeks to work and some can cause drowsiness, dizziness, dry mouth, and constipation. Taking a certain kind of antidepressant, the MAOIs, may mean that you have to stick to a special diet.

Advice

Advice is obtainable from:
The Phobic Society
4 Cheltenham Road
Chorlton-cum-Hardy
Manchester
M21 9QN
0161-881 1937

The Anxiety Disorders Association (formerly Phobic Action)
20 Church Street
Dagenham
Essex
RM10 9RU
020-8270 0999 (Mon.-Fri. 10a.m. to 4p.m.)

Relaxation For Living
12 New Street
Chipping Norton
Oxford
OX7 5LI
01608 646100

The Stress Foundation
1 Speldhurst Court
Queens Rd
Maidstone
Kent
ME16 OJH

The Thanet Phobic Group
47 Orchard Rd
Westbrook
Margate
Kent
CT9 5JS
01843 833720

Books

Anxiety and Depression
by Robert Priest
(McDonald and Co.)
Don't Panic: A Guide To Overcoming Panic Attacks
by Sue Breton
(McDonald and Co.)
Living With Fear
by Isaac Marks
(McGraw Hill)
Peace From Nervous Suffering
by Claire Weekes
(Angus and Robertson)
Self-Help For Your Nerves
by Claire Weekes
(Angus and Robertson)

Tapes

Control Your Tension
Lifeskills
Bowman House
6 Billetfield
Taunton
Somerset
TA1 3NN
01823 451771

The Mitchell Method Of Relaxation
Laura Mitchell
8 Gainsborough Gardens
London
NW3 1BJ