Anxiety disorders

What is it about ?

Anxiety is a normal, healthy reaction, and it can often help us. Anxiety puts the body in a sort of state of alert. He is thus preparing to defend himself against dangers and threats.

But, sometimes, mundane everyday situations trigger anxious reactions of such intensity (the reaction is disproportionate) that they prevent us from functioning normally and / or cause us to suffer mentally. When this type of reaction lasts for several months, it is called an anxiety disorder.

The cause is not entirely clear. Several factors can play a role. Some people seem more fragile than others, and family studies also indicate an “inherited” sensitivity. Certain substances in the brain (neurotransmitters) are thought to play a role in the predisposition to anxiety or panic. Past experiences and acquired reactions (especially through education) also partly determine how we deal with our feelings of anxiety.

There are different types of anxiety disorders:

• the generalized anxiety disorder manifests in the form of constant anxiety that is difficult to control, such as excessive stress and exaggerated worry about everyday matters and the future. Physical symptoms may be present as well as trouble sleeping. This form is often associated with other mental disorders.
• the panic disorder is characterized by panic attacks and fear of having fits. A panic attack is characterized by physical and mental symptoms.
• the social anxiety disorder is characterized by disproportionate and persistent anxiety in situations of social interaction (at restaurants, at work, when in contact with strangers, at gatherings, etc.). The person is extremely afraid of the reactions or criticisms of others. If this anxiety manifests itself only when the person has to intervene in public (speak, make a representation,…), we speak of stage fright.
• A specific phobia is disproportionate and persistent anxiety about specific objects or situations. The most common phobias relate to heights (vertigo), darkness, small closed spaces (claustrophobia), snakes, spiders and insects.
• the post-traumatic stress disorder (PTSD) follows a traumatic event. The sufferer often relives the event in thoughts or dreams.
• the obsessive-compulsive disorder (OCD) is characterized by obsessive thoughts (obsessions) or compulsive behaviors (compulsions) that recur regularly and disturb the person who suffers from them.

In whom and how often do they occur?

Anxiety disorders are among the most frequent mental disorders. They usually appear between the ages of 15 and 30. In the general population, anxiety disorders affect 6% of all people over the age of 15, and up to 25% of the population would suffer from it at one time or another in their lifetime.

Out of 1,000 people who consult a general practitioner in Belgium, 1.72 suffer from an anxiety disorder. It is twice as common in women as in men. In Belgium, 39% of adults seek professional help, in most cases (80%) going to a general practitioner or a psychiatrist.

How to recognize them?

Anxiety disorders manifest as a continuous state of anxiety and / or anxiety attacks (panic attack).

Anxiety can manifest itself with one or more of the following symptoms:

• Fear,
• Nervousness, restlessness,
• Difficulty concentrating,
• Difficulty falling asleep,
• Feeling of tightness in the chest, feeling of suffocation,
• Palpitations,
• Sweating, hot flashes or chills,
• Nausea or stomach aches,
• Dizziness,
• Tremors,
• Voice that trembles,
• Complexion that reddens,
• Sensation of fainting,
• Tingling or numbness in the hands and / or feet,
• Headache, tension in the muscles of the neck and lower back,
• Sensation of a lump in the throat.

During a panic attack, you may also be afraid of losing control, afraid of going crazy, and / or afraid of dying.

All of these symptoms are the result of an overactivation of the nervous system. They can be so intense and scary that you are worried about having another panic attack. Suddenly, people will often do everything to avoid their source of anxiety. They ask others to solve problematic situations or decide to “numb themselves” by consuming substances or drugs.

How is the diagnosis made?

The doctor will listen carefully to your symptoms and try to identify the causes and circumstances of your anxiety. He will also find out if a physical condition is responsible for your anxiety (anemia, heart conditions, lung problems, thyroid problems, infections). A clinical examination will therefore be performed as well as possibly an ECG (electrocardiogram) and a blood test.

The doctor will also check the medicines and other substances you use and ask you questions about your alcohol consumption. It is also important to distinguish between anxiety disorder and depression. Both can occur at the same time, which often makes it difficult to make a quick and correct diagnosis.

What can you do ?

As difficult as it can be, try not to avoid situations that make you nervous. The more you avoid them, the more they will worry you.

Here are some tips to help you better understand your anxiety and take back control:

• Write down what you think and feel in the situations that trigger anxiety and how you react to them. Do this as soon as you start to feel anxious.
• In these moments, also try to put into perspective the (automatic) thoughts that worry you and try to think about what could reassure you. It can be helpful to write down these positive thoughts somewhere, so that you can read them again during difficult times.
• Find a way to relax. So when you feel the tension and anxiety building, you can take your attention away.
• Enlist the support of people you trust and have them read this patient guide.
• Know that the panic and tension that accompany your anxiety subside on their own after 1 or 1:30. It is especially important to “put on the big back” and to go through the situations that distress you. You will find that there is nothing to be afraid of.
• Avoid excess caffeine and alcohol, as these products can trigger and worsen anxiety symptoms.

What can your doctor do?

The doctor will start by checking whether you have an anxiety disorder and which one. The success of treatment depends on the correct diagnosis and recognition of the problems and emotions you are facing. He will then explain to you how you can try to manage them.

Severe anxiety disorders are treated with a combination of counseling and medication. You are more likely to feel better after a few sessions of psychotherapy. The doctor will then refer you to a psychologist. Cognitive behavioral psychotherapy is the most scientifically studied psychological treatment for anxiety disorders. The goal of this treatment is to reduce anxiety symptoms and to end avoidance behavior. In certain situations, the therapist will offer you, with him, to expose yourself to the situations that distress you in order to learn to react to them in a more normal way (exposure therapy).

Treatment with medication may sometimes be necessary. Most often, it is an antidepressant. Painkillers, such as benzodiazepines, should be avoided even if they reduce symptoms in the short term. Because of their rapid effect, you tend to take them all the time, which gives them a very addictive character. They are sometimes used at the start of antidepressant treatment, but are then reduced and stopped as soon as possible.

Want to know more?

• Cognitive-behavioral therapies (CBT) – AEMTC – Association for the Study, Modification and Therapy of Behavior
• Antidepressants – CBIP – Belgian Center for Pharmacotherapeutic Information

• Alcohol, the point on your consumption – Stop or else?

• Sleeping pills and sedatives, think of other solutions first. Brochure to be found on this page of the FPS Public health, safety of the food chain and the environment
• Sleeping pills or tranquilizers, an update on your consumption – Stop or else?

Are you looking for more specialized help?

• Find a therapist – AEMTC – Association for the Study, Modification and Therapy of Behavior
• Find a psychologist – Commission des psychologues
• Mental Health Services – The Social Guide

• Alcohol aid – Le Pélican & Le center ALFA
• AA – Alcoholics Anonymous
• Infor-Drogues – Another listen

Sources

• Foreign clinical practice guide ‘Anxiety disorder’ (2000), updated on 29.09.2011 and adapted to the Belgian context on 30.03.2018 – ebpracticenet
• Hassink-Franke Lieke, Terluin Berend, van Heest Florien, Hekman Jan, van Marwijk Harm, van Avendonk Mariëlle. NHG Standaard Angst M62 (herziening versie 2004), Nederlands Huisartsen Genootschap 2012. https: //www.nhg.org/standaarden/volledig/nhg-standaard-angst