Download Anxiety Disorders

Anxiety Disorders
Definition:
Anxiety is a normal reaction to stress. In general, it helps one cope. But when anxiety becomes
an excessive, irrational dread of everyday situations, it has become a disabling disorder. These
disorders 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.
Statistics:
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Anxiety disorders are serious medical illnesses that affect approximately 19 million
American adults (approximately one in nine) of the adult U.S. population (ages 18-54).
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Anxiety disorders cost the U.S. more than $42 billion a year, almost one third of the $148
billion total mental health bill for the U.S.
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People with an anxiety disorder are three-to-five times more likely to go to the doctor and
six times more likely to be hospitalized for psychiatric disorders than non-sufferers.
Causes:
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Genetics
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Brain Chemistry
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Life experiences (long-term exposure to abuse, violence, or poverty may affect
individuals’ susceptibility to these illnesses)
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Personality
Types of Anxiety Disorders:
Each anxiety disorder has its own distinct features, but they are all bound together by the
common theme of excessive, irrational fear and dread.
Five major types of anxiety disorders are:
1. Generalized Anxiety Disorder (GAD)
2. Obsessive-Compulsive Disorder (OCD)
3. Panic Disorder
4. Post-Traumatic Stress Disorder (PTSD)
5. Social Phobia (Social Anxiety Disorder)
1. Generalized Anxiety Disorder (GAD) - an anxiety disorder characterized by chronic
anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.
Statistics:
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GAD affects twice as many women as men.
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The risk is highest between childhood and middle age.
Symptoms:
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Fatigue
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Headaches
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Muscle tension
Muscle aches
Difficulty swallowing
Trembling
Twitching
Irritability
Sweating
Hot flashes
Difficulty sleeping
Trouble concentrating
2. Obsessive-Compulsive Disorder (OCD) - an anxiety disorder and is characterized by
recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions).
Repetitive behaviors such as hand washing, counting, checking, or cleaning are often
performed with the hope of preventing obsessive thoughts or making them go away.
Performing these so-called "rituals," however, provides only temporary relief, and not
performing them markedly increases anxiety.
Statistics:
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OCD afflicts about 3.3 million adult Americans.
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It strikes men and women in approximately equal numbers and usually first appears in
childhood, adolescence, or early adulthood.
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1/3 of adults with OCD report having experienced their first symptoms as children.
3. Panic Disorder - an anxiety disorder and is characterized by unexpected and repeated
episodes of intense fear accompanied by physical symptoms that may include chest pain,
heart palpitations, shortness of breath, dizziness, or abdominal distress.
Statistics:
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Panic disorder affects about 2.4 million adult Americans.
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It is twice as common in women as in men.
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Has a very high comorbidity rate with major depression.
Symptoms:
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Feelings of terror that strike suddenly and repeatedly with no warning
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Heart pounding
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Sweaty
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Weak
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Faint
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Dizzy
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Hands tingle or feel numb
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Flushed or chilled
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Nausea
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Chest pain
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Smothering sensations
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Sense of unreality
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Loss of control
4. Post-Traumatic Stress Disorder (PTSD) - an anxiety disorder that can develop after
exposure to a terrifying event or ordeal in which grave physical harm occurred or was
threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural
or human-caused disasters, accidents, or military combat.
Statistics:
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PTSD affects about 5.2 million adult Americans.
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Women are more likely than men to develop PTSD.
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Rape is the most likely trigger of PTSD, 65% of men and 45.9% of women who are raped
will develop the disorder.
Symptoms:
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Persistent frightening thoughts and memories
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Feeling emotionally numb
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Sleep problems
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Feeling detached or numb
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Easily startled
5. Social Phobia (Social Anxiety Disorder) - an anxiety disorder characterized by
overwhelming anxiety and excessive self-consciousness in everyday social situations. Social
phobia can be limited to only one type of situation such as a fear of speaking in formal or
informal situations, or eating or drinking in front of others or, in its most severe form, may be
so broad that a person experiences symptoms almost anytime they are around other people.
Statistics:
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Social phobia affects about 5.3 million adult Americans.
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Women and men are equally likely to develop social phobia and usually begins in
childhood or early adolescence.
Symptoms:
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Blushing
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Profuse sweating
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Trembling
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Nausea
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Difficulty talking
Diagnosis:
*** Please refer to the DSM-IV for specific diagnostic criteria.
Treatments:
Two types of treatment are available for an anxiety disorder:
1. Medication
2. Psychotherapy (sometimes called "talk therapy")
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Both approaches can be effective for most disorders. The choice of one or the other, or both,
depends on the patient's and the doctor's preference, and also on the particular anxiety disorder.
1. Medications:
Antidepressants - Selective serotonin reuptake inhibitors (SSRIs)
- Monoamine oxidase inhibitors (MAOIs)
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Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram are among the SSRIs
commonly prescribed for panic disorder, OCD, PTSD, and social phobia.
Venlafaxine, a drug closely related to the SSRIs, is useful for treating GAD.
Tricyclics have been around longer than SSRIs and are useful in treating people with cooccurring anxiety disorders and depression.
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Clomipramine, the only antidepressant in its class prescribed for OCD, and
imipramine, prescribed for panic disorder and GAD, are examples of tricyclics.
The most commonly prescribed MAOI is phenelzine, which is helpful for people with
panic disorder and social phobia.
Tranylcypromine and isoprocarboxazid are also used to treat anxiety disorders.
Anti-Anxiety Medications
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Benzodiazepines include clonazepam, which is used for social phobia and GAD;
alprazolam, which is helpful for panic disorder and GAD; and lorazepam, which is
also useful for panic disorder.
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Buspirone, a member of a class of drugs called azipirones, is a newer anti-anxiety
medication that is used to treat GAD. Possible side effects include dizziness,
headaches, and nausea. Unlike the benzodiazepines, buspirone must be taken
consistently for at least two weeks to achieve an anti-anxiety effect.
Other Medications
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Beta-blockers, such as propanolol, are often used to treat heart conditions but have also
been found to be helpful in certain anxiety disorders, particularly in social phobia.
2. Psychotherapy:
Psychotherapy involves talking with a trained mental health professional, such as a
psychiatrist, psychologist, social worker, or counselor to learn how to deal with problems
like anxiety disorders.
Accommodations:
Memory:
Provide written instructions
Post written instructions for use of equipment
Use a wall calendar
Use a daily or weekly task list
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Provide verbal prompts and reminders
Use electronic organizers or hand held devices
Allow the employee to tape record meetings
Provide written minutes of each meeting
Allow additional training time
Lack of Concentration:
Reduce distractions in the work environment
Provide space enclosures or a private space
Allow for the use of white noise or environmental sound machines
Allow the employee to play soothing music using a cassette player and a headset
Increase natural lighting or increase full spectrum lighting
Divide large assignments into smaller goal oriented tasks or steps
Plan for uninterrupted work time
Time Management/Performing or Completing Tasks:
Make daily TO-DO lists and check items off as they are completed
Divide large assignments into smaller tasks and steps
Schedule weekly meetings with supervisor, manager, or mentor to determine if goals are being
met
Remind employee of important deadlines via memos or e-mail
Disorganization:
Use calendars to mark meetings and deadlines
Use electronic organizers
Hire a professional organizer or organizational coach
Assign a mentor to assist employee
Coping with Stress:
Allow longer or more frequent work breaks
Provide backup coverage for when the employee needs to take breaks
Provide additional time to learn new responsibilities
Restructure job to include only essential functions
Allow for time off for counseling
Assign a supervisor, manager, or mentor to answer employee's questions
Working Effectively with a Supervisor:
Giving assignments, instructions, or training in writing or via e-mail
Provide detailed day-to-day guidance and feedback
Provide positive reinforcement
Provide clear expectations and the consequences of not meeting expectations
Develop strategies to deal with problems
Interacting with Co-workers:
Encourage the employee to walk away from frustrating situations and confrontations
Allow employee to work from home part-time
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Provide partitions or closed doors to allow for privacy
Provide disability awareness training to coworkers and supervisors
Dealing with Emotions:
Refer to employee assistance programs (EAP)
Use stress management techniques to deal with frustration
Allow the use of a support animal
Allow telephone calls during work hours to doctors and others for needed support
Allow frequent breaks
Sleep Disturbance:
Allow the employee to work one consistent schedule
Allow for a flexible start time
Combine regularly scheduled short breaks into one longer break
Provide a place for the employee to sleep during break
Muscle Tension or Fatigue:
Build in "stretch breaks" during the workday
Allow private space to meditate or do yoga
Allow time off for physical therapy or massage therapy
Encourage use of the company's wellness program
Absenteeism:
Allow for a flexible start time or end time, or work from home
Provide straight shift or permanent schedule
Modify attendance policy
Panic Attacks:
Allow the employee to take a break and go to a place where s/he feels comfortable to use
relaxation techniques or contact a support person
Identify and remove environmental triggers such as particular smells or noises
Allow the presence of a support animal
Diarrhea/Vomiting/Nausea:
Allow flexible bathroom breaks
Move employee to location where he/she can access the bathroom discreetly
Provide space for storing extra clothing or personal hygiene products
Headaches: Provide alternative lighting
Take breaks from computer work or from reading print material
Practice stress-relieving techniques
Transportation Issues:
Eliminate non-essential travel
Provide a driver
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Allow extra time for travel
Allow the employee to bring a support person
Recommended Readings:
Job Accommodations Network (JAN)The Job Accommodations Network (JAN) is a free consulting service that provides information
about job accommodations, the Americans with Disabilities Act (ADA), and the employability pf
people with disabilities.
http://www.jan.wvu.edu/links/
Anxiety Disorders Association of America (ADAA)The Anxiety Disorders Association of America (ADAA) is the only national, non-profit
membership organization dedicated to informing the public, healthcare professionals and
legislators that anxiety disorders are real, serious and treatable. The ADAA promotes the early
diagnosis, treatment and cure of anxiety disorders, and is committed to improving the lives of the
people who suffer from them.
http://www.adaa.org/index.cfm
Research Articles:
Thomas, J. Ressler. 1995. Post-traumatic stress disorder: Vocational considerations. [Peer Reviewed
Journal] Journal of Applied Rehabilitation Counseling. Vol. 26(10), 9-12.
Miranda, Robert Jr.; Rollins, Carolyn W. 1997. Obsessive compulsive disorder: A vocational
perspective. [Peer Reviewed Journal] Journal of Applied Rehabilitation Counseling. Vol. 28(1)
28-30.
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