THERAPY SPECIALTIES

Anxiety Disorders

Anxiety is a normal emotion and common experience, and it represents one of the most basic of human emotions. At one time or another, all of us are likely to be “stressed out”, worried about finances or health or the children, fearful in certain situations and concerned what other people think. In general, anxiety serves to motivate and protect an individual from harm or unpleasant consequences.​

For many people, however, constant or excessive anxiety disrupts their daily activities and quality of life; for others, panic, which seems to come out of nowhere, can cause terrible physical symptoms, such as faintness, chills, and even extreme chest pains. Anxiety disorders are so common that more than 1 in every 10 Americans will suffer with one at some point in their life.

Here is the list of anxiety problems I treat:

  • You feel shortness of breath or heart palpitations that seem to come out of the blue, you fear you might have a heart attack and die or lose control and go crazy. Read more about Panic Attacks.

  • You don’t like or avoid social situations because you are worried people will judge you negatively or you will somehow embarrass yourself, or you constantly replay past social interactions in your mind. Read more about Social Anxiety.

  • You constantly worry about your health, you are continually tracking your bodily symptoms, you avoid going to doctors or going to doctors all the time even though you were not diagnosed with a serious illness. Read more about Health Anxiety.

Generalized Anxiety Disorder

Everyone gets anxious sometimes, but if your worries and fears are so constant that they interfere with your ability to function and relax, you may have generalized anxiety disorder (GAD). GAD is a common anxiety disorder that involves constant and chronic worrying, nervousness, and tension. This anxiety can be long-lasting, making normal life difficult and relaxation impossible. Generalized anxiety disorder is mentally and physically exhausting. It drains energy, interferes with sleep, and wears out your body.

If you have GAD, you may worry about the same things that other people do, but you take these worries to a new level. 

Whether you realize that your anxiety is more intense than the situation calls for or believe that your worrying protects you in some way, the end result is the same. You can’t turn off your anxious thoughts. They keep running through your head on endless repeat. But no matter how overwhelming things seem now, you can break free from chronic worrying, learn to calm your anxious mind, and regain your sense of hope.

The difference between “normal” worrying and generalized anxiety disorder is that the worrying involved in GAD is:

  • Excessive

  • Intrusive

  • Persistent

  • Disruptive

Panic Attacks

A panic attack is defined as a sudden rush of intense fear or dread, which usually goes along with several of the following physical symptoms and thoughts: shortness of breath or smothering feelings, dizziness, feeling faint or unsteady, racing or pounding heart, trembling or shaking, sweating, choking sensation, nausea or abdominal distress, feelings of being detached or of things seeming unreal, numbness or tingling sensations, hot flashes or cold chills, chest pain or discomfort. Individuals with Panic Disorder often fear that their panic attacks might cause them to have a heart attack or stroke, to go crazy, or to lose control.

Panic attacks include the following features:

  • The suddenness with which fear is experienced—panic attacks usually occur and peak in a very short time (1 to 10 minutes), and the peak lasts only 5 to 10 minutes on average. This makes it very different from other types of worry;

  • The strong urge to escape and reach safety (also known as the fight-or-flight response);

  • The attack occurs “out of the blue,” with no obvious outside cause. Over time, however, most attacks become connected with specific situations (such as being in a crowed movie theater, or traveling long distances from home).

Panic disorder is distinguished from other anxiety disorder by the unexpected nature of the alarm reactions as well as the continuing anxiety about their return.

Agoraphobia

Agoraphobia refers to a pattern of avoiding, hesitating about, or feeling very nervous in situations where panic attacks or other physical symptoms (such as nausea or diarrhea) are expected to occur.

Typical Agoraphobic situations are:

  • Driving/flying/traveling by subway/bus/taxi

  • Waiting in lines

  • Crowds, stores, restaurants, theaters

  • Being long distances from home/being at home alone

  • Unfamiliar areas/places

  • Wide open spaces/closed-in spaces

  • Elevators

All of these situations share one thing in common: they create the sense of being trapped (i.e., “difficulty” to escape) or of being away from safety (i.e., where help is not available). Usually, a history of panic attacks precedes symptoms of agoraphobia. Many sufferers become housebound. Some experience claustrophobic symptoms.

Social Anxiety Disorder/Social Phobia

Social anxiety is a marked and persistent fear of social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. In other words, social anxiety is the fear and anxiety of being judged and evaluated negatively by other people. It often creates feelings of inadequacy, embarrassment, humiliation, and depression. If you usually become anxious in social situations, but feel fine when you are alone, then “social anxiety” may be the problem.

A specific social phobia would be the fear of speaking in front of groups or speaking to authority figures, whereas generalized social anxiety indicates that the person is anxious, nervous, and uncomfortable in almost all (or the majority of) social situations.

People with social anxiety disorder usually experience significant emotional distress in the following situations:

  • Being introduced to other people

  • Being teased or criticized

  • Being the center of attention

  • Being watched while doing something

  • Meeting people in authority (“important people”)

  • Most social encounters, particularly with strangers

  • Making “small talk” at parties

  • Going around the room in a circle and having to say something

This list is certainly not a complete list of symptoms—other feelings may be associated with social anxiety as well.

The physiological manifestations that accompany social anxiety may include intense fear, racing heart, turning red or blushing, dry throat and mouth, trembling, swallowing with difficulty, and muscle twitches.

Health Anxiety (Hypochondriasis)

If you constantly worry about your health even though you were not diagnosed with a serious illness, you might have health anxiety. Health anxiety ranges from mild and transient to severe and chronic. In its persistent and chronic form, it’s called “hypochondriasis.” People with hypochondriasis are convinced they have a serious disease that has been undetected by medical investigation. Disease conviction arises from misinterpretation of bodily changes and sensations.

Following are the clinical features of hypochondriasis.

Cognitive features:

  • Disease conviction: belief that one has a serious disease

  • Disease preoccupation: recurrent thoughts and images of disease and death

  • Hypervigilance for bodily changes

  • Difficulty accepting medical reassurance

Somatic features:

  • Anxiety-related bodily reactions (e.g., palpitations)

  • Benign bodily changes and sensations (e.g., blemishes, mild aches and pains) that are misinterpreted

Hypochondriacal fears:

  • Fear of currently having a disease

  • Fear of contracting a disease in the future

  • Fear or anxiety of exposure to disease-related stimuli

Behavioral responses:

  • Repeatedly checking one’s body

  • Reassurance-seeking (e.g., from physicians or significant others) that one does not have serious symptoms

  • Repeated requests for medical tests

  • Checking other sources of medical information (e.g., Internet searches of medical websites)

  • Avoiding or escaping disease-related stimuli

People with health anxiety have 80% more doctors’ visits and are very likely to have other problems—most commonly depression and other anxiety disorders. In some cases, health anxiety is so severe that the person actually neglects seeing a doctor, feeling certain that an examination will reveal the dreaded news.