Fear Factor

23 July 2006

By Leigh Woosley

Editor's note: This is the first in a series of five articles looking at the complex problem of anxiety disorders, the most prevalent mental health disease in America.

I must be dying, she thought. Dying or going crazy. Jane Vantine's heart was pounding. Sounds from the party around her swirled and separated her from reality. Her body was racing, wouldn't slow down.

Death. Brink of insanity. Those were the only explanations she could think to explain these feelings. Had Vantine known what a panic attack was, she might have realized she was having one.

But people didn't talk about such things back in 1969.

When Vantine called the mental health crisis line later that night, the person who answered couldn't explain her symptoms. The doctor she consulted the next day, fearing a heart attack, said she was fine and prescribed Xanax, an anti-anxiety medication similar to Valium.

Vantine didn't take it.

The episode was the first sign that Vantine had panic disorder, one of several diagnosable anxiety disorders that stir inexplicable fear in about 40 million American adults, according to the National Institute of Mental Health.

With more than 18 percent of the U.S. population having a diagnosable anxiety disorder, it is the most common mental illness. Chances are you know someone who struggles with it.

Today Vantine is a local licensed professional counselor who specializes in treating anxiety disorders. She was inspired to help others after living a "real hell on Earth" for more than a decade, so stricken with anxiety that she hardly left the house except for work.

She went to the emergency room another two or three times with symptoms of a panic attack. Doctors repeatedly gave her the same answer - a pill to calm down and a wave home.

Anxiety disorders in those days were hardly in the medical vernacular, much less talked about in public.

Vantine didn't know what was wrong with her, but she knew it was bad.

"Anxiety disorders have just come full circle," she said. "They are out of the closet for a lot of people. Now they're joking about them in sitcoms. But a lot of people still don't understand."

Costs to society

Those with anxiety disorders are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders, according to "The Economic Burden of Anxiety Disorders," a study commissioned by the Anxiety Disorders Association of America and published in the Journal of Clinical Psychiatry.

The medical field commonly bandages the anxiety without addressing what's causing it.

The right treatment for anxiety disorders is highly effective. Medication, therapy or a combination of both helps many patients, allowing them to function and enjoy life.

True anxiety disorders go beyond what we see on the TV comedy "Monk" or in movie cameos. Anxiety disorders ruin lives.

The name is almost a misnomer. All humans feel anxiety, which is a healthy trait that protects us from danger.

But the anxiety felt by someone with an anxiety disorder is far beyond the normal level. They often feel anxious about innocuous things so they avoid them and oftentimes shut out life.

The intense worry engulfs people. They avoid everyday situations and struggle to maintain relationships.

"It gets so bad that your life is adversely affected," said Jack Gorman, former president and psychiatrist-in-chief at McLean Psychiatric Hospital at Harvard Medical School, "so that you can't function at your job or in your ordinary social roles. You can't take care of your children. You can't do the things you need to do."

Anxiety often breeds depression because people can't escape the fear. Some turn to drugs and alcohol looking for relief.

Twenty percent to 50 percent of people with substance-abuse problems have some kind of associated anxiety disorder, said David Barlow, director of the Center for Anxiety Disorders and Related Disorders at Boston University.

"That's one of the ways some people, particularly males, choose to cope with their anxiety and fear to get them through the day," Barlow said.

Some people with an anxiety disorder worry obsessively all day long. Sleeping is hard. They dread waking up because it's another day of fighting fear and angst.

Others experience floods of anxiety that cause heart pounding, chest-tightening fear.

For too many, it's both.

The 'animal' of anxiety

Becky Moyer can go to the grocery store by herself. It's a victory for the 46-year-old who last year hardly left the house.

Diagnosed with panic disorder and agoraphobia, Moyer was scared of having a panic attack in public.

She holed up in her family's remote ranch home near Quapaw for years, missing her grandchildren's ballgames, shopping trips with her daughter and playing slots at the casino with her niece.

Anxiety stole her favorite things and never gave them back.

The isolation led to depression, and not long ago Moyer begged her family to leave her alone and forget she ever existed.

Anxiety disorders appear in different forms, taking the shape of various monsters, but the field of psychology has divided them into five major types.

Most people with one anxiety disorder have or will develop another one, so diagnosis of the problem is rarely clear-cut.

The disorders most familiar are probably specific phobias, like the fear of flying or of heights; and obsessive compulsive disorder or OCD, which is much more expansive than the commonly depicted fear of germs and obsession for order.

OCD causes anxious thoughts and sparks rituals that people feel they can't control, causing many to completely shut down and withdraw.

Thoughts

A therapist diagnosed Kevin Gaylor with OCD last fall, but for almost 30 years he's wrestled obsessive thoughts and compulsions. His most pervasive symptom is the fear that he'll hurt someone, especially a child.

Gaylor's fear is not unusual in people with OCD. Experts say that OCD patients obsessed by these thoughts would never act on them.

But Gaylor didn't know that. For most of his life he believed himself a diabolical, perverted person, doomed to hell for thoughts he can't control.

"You have to realize, I just thought I was evil," said the 36-year-old, who works at HOPE Testing Clinic. "I was, like, 'Only a bad person would have these thoughts, so I'm a bad person.' I had really black-and-white thinking about it."

The train of thought can become unbearable. To derail it, Gaylor counts.

He counts the letters in words people say, words in e-mails, words on billboards. This is the compulsive side of his disorder, and he's done it since second grade.

It deflects the anxiety caused by his obsessive thoughts. It's hard to stop because it works - the anxiety does abate - although therapy has helped him gain control over his compulsions.

Another familiar anxiety disorder is post-traumatic stress disorder, which is severe anxiety caused by reliving a traumatic event, such as 9/11 or Hurricane Katrina.

Panic disorder and generalized anxiety disorder, which together affect almost 13 million American adults, are seldom discussed but are extremely debilitating. They also are more elusive and difficult for people to pinpoint because they often appear as overall anxiety.

In the genes

Anxiety disorders do not discriminate. They strike the richest and the poorest, the ugliest and the most beautiful.

The disorders don't necessarily result from a painful past, a falling-out with family or a traumatic experience. In fact, some people with anxiety disorders lead quasi-normal lives and can't give a reason for the problem.

Leeanna Weaver was a nervous child. That's what her parents always said. She was afraid of restaurants, high school and just being in public. This was 30 years ago when nobody talked about anxiety disorders.

Weaver began having panic attacks when her son - now 20 years old - had health problems at a very young age.

"I felt very overwhelmed about it," said the 45-year-old librarian for Union Public Schools. "I started having all the body symptoms you get with anxiety - the fast heartbeat, the pounding and crushing feeling in your chest. My blood pressure would go up. I had some real issues for a while."

Today Weaver's son, Dylan, also fights anxiety.

It's becoming more apparent that genes are partly to blame. A growing amount of research shows the propensity for anxiety disorders is passed on in families.

Those with the genetic predisposition are vulnerable to anxiety disorders, but whether a worrisome personality grows into a diagnosable disorder is likely determined by life experiences.

"We're pretty sure that the risk for having an anxiety disorder is about 30 to 40 percent determined by genes that we inherit," Gorman said. "The rest is because of stressful or adverse life experiences."

Studies supported by the NIMH on twins have found a genetic link in panic disorder and social phobia. Other studies suggest genes play a role in anxiety disorders. But "heredity alone can't explain what goes awry," the NIMH reports.

Local psychiatrist Charles Cobb, who specializes in anxiety disorders and treats Moyer, said "there is no question that anxiety disorders are passed down in families . . . There is absolutely no question there is a genetic component to this."

Learning what causes an anxiety disorder and how it affects the brain helps researchers develop more effective treatments. But while research continues, those with anxiety disorders take on a future blackened by fear.

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Where to go for help

If you or someone you know struggles with anxiety, help is available.

The Mental Health Association of Tulsa offers resources to treat anxiety and an anxiety disorders support group, which meets at 6:30 p.m. the second and fourth Tuesday of every month at 1870 S. Boulder Ave. It is free and open to the public. 

Other helpful resources:

Anxiety Disorders Association of America: www.adaa.org

National Institute of Mental Health on anxiety disorders: www.nimh.nih.gov/publicat/anxiety.cfm

American Psychiatric Association: www.healthyminds.org

Freedom from Fear: www.freedomfromfear.org

Effects of anxiety disorders

Many people with anxiety disorders show characteristics from an early age, and something later in life intensifies their symptoms, forcing them to find help. For many, the breaking point is a panic attack.

People with unrecognized anxiety disorders often go to the emergency room complaining of physical symptoms related to unrelenting stress. Pounding heart. Shortness of breath. Throbbing head.

Is it a heart attack, a stroke, a brain tumor? Most don't realize they're having a panic attack.

Anxiety disorders cost the United States more than $42 billion a year, about one third of the nation's $148 billion total mental health bill, according to "The Economic Burden of Anxiety Disorders," a study commissioned by the Anxiety Disorders Association of America and published in the Journal of Clinical Psychiatry.

More than $22.84 billion of those costs arise because people with anxiety disorders repeatedly use healthcare services, many seeking relief for anxiety-provoked symptoms that mimic physical illness.

Generalized anxiety disorder

Ø People affected: 6.8 million adults, 3.1 percent of the population.

Ø Median age of onset: 31

Ø Symptoms: GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months.

People with GAD can't seem to get rid of their concerns, even though they usually realize their anxiety level is abnormal. They can't relax, startle easily, and have difficulty concentrating.

Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath and hot flashes.

Ø Qualities: People with GAD can function socially and hold down a job when the anxiety is mild. If anxiety is severe, people with GAD can have difficulty carrying out the simplest daily activities.

GAD is commonly treated with medication or cognitive-behavioral therapy, but co-occurring conditions also must be treated using the appropriate therapies.

Copyright 2006. Used with permission from Leigh Woosley and Tulsa World