anxiety disorders and depression - an overview

Anxiety a very common condition that few people will completely avoid during their life times.

It generally presents as a combination of different symptoms that effect the way a person feels physically and emotionally, the way they behave and the way they think. Thinking is often characterised by worry about what might happen. WHAT IF?

Anxiety symptoms differ between people, and can present in different ways and at different times. It can be short lived or may last for long periods and can cause much unhappiness and suffering to the individual sufferer and also to their friends and families. When anxiety persists or goes untreated people can become disabled by it and this may lead to the breakdown of relationships, drug and alcohol abuse and depression.

The good news is that anxiety, can in most cases be treated with CBT or medication or a combination of both.

OCD is made up of a combination of the following.

- Intrusive Thoughts. These are unwanted, upsetting or disturbing thoughts that come often into your mind
- Compulsive Behaviours that you feel compelled to do over and over again until you feel “right”
These behaviours can include, washing, cleaning, repeating, collecting, counting, praying, blinking, positioning, stepping, to name just a few.
- Avoidance behaviours around people, places, situations, things and thoughts.

All of these behaviours and many many more, are all done in the service of trying to Feel better, safer or right in some way.

People with OCD often feel frightened, guilty, responsible or anxious in other ways. All of which can make their life a misery. Often the sufferer knows that rationally what they are doing doesn't make much sense but they feel compelled to keep on doing it with devastating effects on their own lives as well as the lives of family and friends.

BDD is a strongly held belief and worry, and preoccupation with some aspect of your physical appearance. The feeling of upset and worry can lead to checking, comparing, scrutinizing, and camouflaging behaviours that take up a lot of your time and may stop you going out or being around other people. Confidence and mood drops and the sufferer can start to feel really unattractive, unworthy, angry and depressed.

Although many people feel dissatisfied with their appearance at times People with BDD can not reassured by the opinions of others and their thoughts about their appearance tend to dominate and distress them most of the time.

The sufferer fears that other people will humiliate, embarrass, or will think badly of them or that they will disgrace themselves in some way. This anxiety can be triggered by a worry that they may:- blush, sweat, shake, faint, vomit, appear less interesting than they would like, make mistakes, not be taken seriously, or be judged as less attractive or intelligent than other people . These thoughts and worries often lead the sufferer to try and hide certain behaviours, to stop doing things that they would like or need to do and start avoiding situations and other people and not take up important opportunities.

Panic Attacks are a rapid escalation of a variety of physical symptoms including, heart racing, sweating, stomach pains, an urgent need to go to the toilet , breathlessness, pains in the chest , dizziness and blurring of vision. Panic attacks can occur in three ways:
1. As an immediate consequence of a particular trigger. i.e. the sight of a snake to a person suffering with snake phobia
2. Invariably occurs in specific situations i.e. when watching TV or visiting the supermarket, but may not always happen at that time.
3. For no apparent reason whatsoever.

Panic attacks provide a truly frightening experience, especially if you don’t understand what is happening to you, and flight from the situation is a first response, often with a resulting avoidance of situations where panic attacks have previously occurred. People who suffer with panic attacks may think that they are having a heart attack , are going to collapse, may be going mad or even about to die and often behave in ways which they think and hope will help to protect them.

Panic disorder is the recurrence of types 3 or unexpected panic attacks followed by a period of time when the person was worried about having another attack, the implications or outcomes of having a panic attack and changes in behaviour because of the panic attack.

It is important to know that whilst panic attacks are extremely unpleasant and frightening they are not in themselves harmful.

Agoraphobia is a fear of not being able to escape from a situation to a safe place, and, or, that if disaster strikes their will be no one to help them. The fear is intense and can be triggered in a variety of situation including shops, lifts, motorways, or anywhere that is not perceived or thought of as being safe.

The fear can be related to thoughts and worries about losing control, behaving in an inappropriate way, vomiting, being incontinent, fainting, having a heart attack or going mad.

People with agoraphobia start to change their behaviour to avoid an increasing number of situations which limits their day to day existence and may result in them becoming housebound. Sometimes the agoraphobia is triggered or accompanied by a panic attack.

Health Anxiety is associated with a belief and preoccupation about the person’s own health, where they believe that they have or are about to contract a particular or serious illness which they will not be able to deal with. This often leads the person to carry out a variety of checking behaviours including frequent visits to the Doctor or other health professionals for tests or reassurance. The worry is not ended despite reassurance from Doctors or test results showing no evidence of illness.

Sufferer’s with this problem really do feel physically and psychologically unwell as they often have a variety of physical symptoms plus the constant worry which can lead to increased stress and a drop in mood and motivation.

GAD is characterised by almost constant and excessive anxiety and worry most days and about a variety of things for more than 6 months. Often people with GAD worry about their worrying or worry to try to protect themselves from something worse happening. Sufferers often experience tension in their muscles, feel generally tense and uneasy all of the time.

The anxiety and worry causes changes in behaviour and sufferers may find it difficult to concentrate, tire easily have problem sleeping and are unable to concentrate.

'To esteem' means to value or positively regard. If you have low self esteem you are likely to perceive or think of yourself as having little value or worth which may lead you to behave in unhelpful ways that reinforce your beliefs and lead you to feel badly about yourself.

Where does self worth come from?

Our own perception of worth as a human being is often a reflection of how we have been treated or things that have happened to us. The ideas and beliefs that we have about ourselves are often formed in childhood but can come from later experiences where perhaps our sense of self has been changed by an event, situation or another person.

What is often not realised is that self esteem is one’s own valuation and not necessarily shared by others

What are the effects of low self esteem?

If you believe yourself to be of little value you are likely to have lower expectations of yourself and of others . You may also feel that you are not very safe in this world and feel that you need to act in certain ways to make yourself more valuable or safer. Trying to be perfect, looking after others, keeping a low profile are just some examples. Feeling this way can often lead people to accept 2nd best or tolerate situations and circumstances that are unpleasant because they do not feel they can or should expect more. Others may feel that they have to try and impress other people all of the time in order to appear valued, leading them to feel under constant pressure to protect their fragile façade and hide their real selves.

It is important to remember that in evolutionary terms our status within a group is very important. It helps to keep us alive. Consequently when our self worth or status is threatened we feel ourselves to be at risk and need to secure a place for ourselves within a group to guarantee our survival.

Why it is important to have a balanced view of our selves.

All human beings are made up of positive, neutral and negative qualities. In order to be the best that we can be it is important to see our selves as accurately as possible so that we can know what needs to be improved or changed.

In order to improve or change ourselves we have first to make a balanced assessment of all of our qualities. If we believe that we are wonderful and better than any one else we are deluding ourselves and missing the opportunity to consider our neutral and negative aspects that might benefit from examination .

The same applies if we believe that we are worthless or of no account,. The threat of self examination would pose too greater threat, after all we already know that we are useless, consequently we are unable to consider the strengths and positive qualities that we do have or to improve upon our neutral qualities. Instead our negative qualities are magnified in our minds and our behaviour reflects our lack of worth encouraging others to take advantage of us which of course reaffirms our initial negative self assessment and becomes yet another vicious circle.

Depression s characterised by feelings of numbness, sadness and loss. Especially a loss of positive feelings towards the self, others and the world in general. When someone is depressed they often feel worthless and helpless. People, activities and things that used to bring pleasure no longer do so. Thinking often becomes negative and it may become difficult to concentrate, cope with problems or motivate themselves to do anything. Consequently their behaviour reflects how they are feeling and thinking and the depressed person might start to sleep longer or have problems sleeping, lose interest in their appearance, begin to withdraw from others and may spend hours just sitting or lying in bed not wanting to talk.

CBT is a useful psychological treatment for mild to moderate depression which can be supplemented by an anti depressant if prescribed by a GP. However, if depression becomes more severe it is unlikely that the person will benefit from CBT, due to the severity of their symptoms and difficulties they are experiencing, and they should seek help and advice from their GP, NHS Direct, or their Psychiatrist.

As an outpatient therapy service it would be inappropriate to offer treatment to anyone who is actively suicidal or who has recently attempted to take their life or who is seriously self harming due to the lack of crisis support available.

If you feel that this description applies to you or a member of your family, or friend please do contact your GP, NHS direct or other health professional as soon as possible.