Anxiety Disorders

Anxiety is a normal human experience.  Mild to moderate levels of anxiety can facilitate and enhance concentration, energy, and motivation.   However, more severe and intense levels of anxiety can induce feelings of helplessness, confusion, and excessive worry that are disproportionate to the reality of the feared object or event.   Anxiety affects the portion of the brain involved with communication.  For this reason, extreme anxiety interferes with an individual’s capacity for creative and emotional expression and impairs interpersonal functioning. 

Symptoms. Symptoms of anxiety can be both physical and emotional:

• Involuntary trembling, twitching, or shaking
• A full or blocking sensation in the throat or chest
• Shortness of breath or rapid heartbeat
• Lightheadedness or dizziness
• Increased perspiration or cold, clammy hands
• Feelings of restlessness or skittishness
• Muscle tension, aches, or soreness (myalgia)
• Extreme fatigue
• Problems sleeping, such as the inability to fall asleep or to stay asleep, waking at inordinately early hours in the morning, or feelings of not being well-rested or deprived of adequate sleep
• Restlessness, irritability, or restiveness
• Excessive worrying disproportionate to the true threat posed by a feared event
• Feelings of impending doom or adversity
• Inability to concentrate and/or frequent mind-blanks

Causes. The exact causes of anxiety disorders are unknown.  Anxiety can oftentimes be a symptom of another condition, such as depression.

Treatment. Anxiety that disrupts daily functioning is not considered normal.  The proper and effective management of symptoms requires therapeutic intervention and/or treatment with medication.

Specific Types of Anxiety Disorders.  The following is a list of some commonly occurring types of anxiety disorders discussed in greater detail below:

o   generalized anxiety disorder

o   obsessive-compulsive disorder

o   post-traumatic stress disorder

o   panic attacks

o   social anxiety disorder

Generalized Anxiety Disorder (GAD).  Generalized anxiety disorder (GAD) is defined as excessive apprehension or worry that occurs within multiple contexts and settings on an almost daily basis.           

Symptoms of GAD may include any of the following:                                                                       

• Excessive worry and anxiety concerning a wide range of issues
• Repeatedly seeking the approval of teachers and other authority figures
• Lacking explanation or sound basis for worries and anxiety
• Inability to cease worrying despite persistent and frequent adult reassurance
• Refusal or reluctance to attend school
• Avoidance of academic and peer-related activities
• Self-criticism and poor self-esteem
• Difficulty concentrating, following directions, or focusing in class due to persistent worry and anxiety

Treatment for generalized anxiety disorder includes counseling and medication as well as school- and home-based interventions designed to minimize exposure to the primary sources of anxiety.  Counseling equips individuals with behavioral strategies for managing stress and anxiety. 

Obsessive-Compulsive Disorder (OCD).  Obsessive-compulsive disorder, or OCD, is a disorder in which a person becomes preoccupied with recurring, unwanted thoughts (obsessions) or behaviors (compulsions) that are beyond the ability of the individual to control.  Some common examples of obsessions include a debilitating concern over germ contamination, persistent worry that a family member may fall ill, or an excessive preoccupation with cleanliness, perfection, or tidiness.  Examples of some commonly occurring compulsions, also known as rituals, include silent word repetition, counting, or praying, and incessant hand washing, surface tapping, or persistent checking of the locks.  Individuals with OCD are driven to perform such ritualistic behaviors by the belief that doing so will prevent the occurrence of a troubling or feared incident.  An individual who obsesses over germs transferred to the skin through contact with contaminated surfaces will engage in rituals of compulsive and excessive hand washing.  Unlike ordinary concerns and behavioral routines, the obsessions and behavioral compulsions characteristic of OCD are frequently a source of great distress in the life of the individual with OCD and can interfere with normal living and daily activities.           

Symptoms. The thoughts and behaviors associated with obsessive-compulsive disorder are often perplexing to parents, teachers, and peers and may go unrecognized.  Persisting, disruptive thought patterns are not outwardly visible and are commonly misinterpreted as willful disregard, oppositional behavior, defiance, or meaningless and undue worry. In addition, students may attempt to conceal their symptoms or may be unable to express what they are experiencing.  Further, behaviors exhibited in the home vs. at school that are symptomatic of OCD can vary considerably.  Families often seek treatment once symptoms begin to interfere with the student’s academic performance.  A student with OCD may experience any of the following symptoms:

• Difficulty concentrating, which may affect a multitude of school-related tasks
• Inability to focus in class
• Inability to follow directions
• Inability to complete assignments in the allotted time
• Social isolation or withdrawal from peer interaction
• Low self-esteem in social and academic contexts
• Interpersonal conflict and problematic behaviors originating from misunderstandings about the student’s conduct in the classroom and with peers

Causes are largely unknown for the condition.  OCD is a condition with complex genetic and environmental origins.  OCD is NOT the result of a personality flaw, poor attitude, or behavioral issues.           

Treatment options for OCD include counseling and/or medication.  Counseling provides individuals with important information about the disorder and equips them with the tools necessary to manage symptoms.  Most importantly, counseling can help to reduce the impact that symptoms have on daily life.  If left untreated, the condition may lead to considerable limitations in other facets of life including peer relationships, academic performance, and family functioning.  The resulting anxiety, isolation, and limitations of daily living can lead to depression, the desire to inflict self-harm, and suicidal thoughts and behaviors.

Post-Traumatic Stress Disorder (PTSD).  Post-traumatic stress disorder, or PTSD, is an intense and enduring emotional response to a distressing or traumatic experience such as war, violent crimes, natural disaster, or neighborhood and school violence.  When the initial feelings of anger, confusion, and fear surrounding a traumatic experience fail to diminish and begin to escalate over time, PTSD is a likely diagnosis.              

Symptoms of PTSD may include:

• night terrors or flashbacks about the traumatic event
• an inability to feel or to express emotion toward loved ones
• extreme irritability
• conflict in relationships with friends and family due to diminished interpersonal functioning
• poor academic performance or unexpected decline in grades          

Treatment options for PTSD include counseling and/or medication.  A psychiatric evaluation may be necessary if it is determined that more intensive therapy and/or treatment with medication may be beneficial to the student.

Panic Attacks.  A panic attack is defined as the sudden onset of extreme and overwhelming feelings of fear and anxiety. 

Symptoms of an ensuing panic attack include:

• feelings of impending death or a loss of self-control
• increased respiratory rate (rapid breathing and hyperventilation)
• increased heart rate (rapid heartbeat)
• dizziness or light-headedness
• increased perspiration and unexplained sweating
• trembling or shakiness
• labored and difficult breathing
• pain or tightness in the chest
• irregular heartbeat          

Triggers for panic attacks are often stressful life events.  They can also occur unexpectedly and seemingly without cause.  The onset is sudden, and an attack can last from a few minute to a few hours.         

Treatment options available for panic attacks include counseling and/or medication.   A psychiatric evaluation is necessary in order to begin treatment with medication.

Social Anxiety Disorder.  Social anxiety disorder (or social phobia) is a condition characterized by feelings of extreme anxiety and distress surrounding an individual’s behaviors and conversation with others in social settings. This fear encompasses both a fear of speaking in public and a fear of daily social interactions.  Social phobias are distinct from general shyness or the typical nervousness experienced prior to speaking in public or performing in some manner before a group of people. The fear and apprehension experienced in social anxiety disorder can begin in the weeks or even months preceding a social gathering or public event. Some individuals fear only select types of social situations. For others, several types of situations induce stress, anxiety, and fear.  Social anxiety disorder affects daily life.  The stress and anxiety – and the fear – that characterize the condition will often compel an individual to avoid public or social situations entirely.  Children and adolescents may find ways to avoid or miss school and may have frequent absences.  Children suffering from social anxiety disorder may also appear to have few friends, may often sit alone, and may rarely speak or interact with their school peers.

Symptoms may be both physical and emotional and can include the following: 

• tension, anxiety, irritability, or sadness experienced prior to or during social events
• excessive concern over impending adversity
• increased perspiration
• involuntary trembling and shakiness
• increased heart rate
• difficulty maintaining focus
• severe and uncontrollable flushing or reddening of the face during social interactions and in social settings

Causes of social anxiety disorder are currently unknown.  Considerable debate exists about whether the condition is caused by genetics or by trauma exposure.                                                  

Treatment options for social anxiety disorder include counseling and/or treatment with medication such as antidepressants.  Social anxiety disorder may need to be treated in conjunction with other coexisting conditions, such as depression.