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What Your Doctor May Not Tell You About Anxiety, Phobias and Panic AttacksThe All-Natural Program That Can Help You Conquer Your Fears
By Douglas Hunt
Warner BooksCopyright © 2005 Douglas Hunt, M.D.
All right reserved.
Chapter OneWhat Your Doctor May Not Be Telling You
Picture someone who suffers with an anxiety disorder. Do you immediately think of a withdrawn recluse who trembles at the thought of social interaction? Perhaps you envision a neurotic young man who cannot hold a job because of obsessive-compulsive behavior such as constant hand washing or counting aloud.
I want you to imagine the following patients who were recently diagnosed with an anxiety disorder in my clinic:
Jill, age thirty, a rising young actress and costar in a television sitcom who lives in fear that her mind will go blank and she will forget her lines.
Sam, age forty-one, a well-known criminal attorney who suffers with sleep disorder and fear of flying.
Carmen, age fifty, a boutique owner and mother of four whose husband ran off with a young business colleague without any warning, leaving her with feelings of rejection and fears of abandonment.
Matt, age twenty-seven, a bright doctoral student with a family history of anxiety and phobias who has a fear of heights and social interaction.
The truth is that most people wouldn't associatethese men and women with having an anxiety disorder. But these people reflect the new face of anxiety disorders. Perhaps you even see yourself in their descriptions.
I've successfully treated these adults-and thousands more-from a host of anxiety disorders that used to engulf them in fear, phobias, panic, and obsessions. Today, they live happy, stable lives and have learned natural ways to alleviate the anxiety and cope with the uncomfortable symptoms.
OUR ANXIOUS NATION
If you or a loved one suffers with an anxiety disorder, you are not alone. The latest surveys show that more than 20 million Americans suffer from an anxiety disorder in any given year and another 30 million will have the problem at least once during their lifetime. From panic, fears, and phobias to obsessive-compulsive disorder and post-traumatic stress, anxiety manifests in mysterious ways and does not discriminate by age, gender, or race. Statistics indicate that specific phobias lead the list with 6.3 million people affected, and panic disorder affects another 2.4 million.
No matter what type of anxiety disorder you or a loved one might have, you know it can plague all aspects of life: your marital and family relationships, productivity and ability to earn a good living, sleep, eating habits, exercise and activity, and overall well-being.
While anxiety disorders impose a high personal burden, they are costly to society as well. Anxiety sufferers utilize up to a third of every dollar spent on health care in the United States, with doctor visits at nearly $22 billion a year. Along with emergency care, prescription drugs, and hospitalization, we have lost productivity, absenteeism, and a combination of malingering and genuine discomfort.
Anxiety disorders don't just disappear overnight. They usually are chronic problems and are just as disabling as any physical ailment. In the most severe cases, depression and suicide attempts often follow long-term unresolved anxiety.
Besides living with the burden of a chronic, dysfunctional state, the anxiety patient often endures a lack of respect for having this disease. Many physicians reflect societal prejudice that anxiety patients simply suffer from a flawed character. Despite the prevalence of significant psychiatric disorders, fewer than one in three adults ever seek help for this problem. And, when they do seek help, it's often for another medical reason and therefore confusing to the health care provider.
Very often, the first time a doctor sees a patient suffering from anxiety, the presenting symptom is a physical complaint. For instance, post-traumatic stress disorder (PTSD) patients often seek help for cardiovascular, neurological, respiratory, or musculoskeletal problems. During a doctor's consultation, they rarely mention anxiety unless the physician discovers the underlying problem and mentions it first. Generalized anxiety disorder (GAD) patients often seek help for nonspecific pains in the chest, which they believe to be angina or heart-related. Many anxiety patients see themselves as being less physically and psychologically capable than others and may even perceive themselves as having a disability.
UNDERSTANDING ANXIETY DISORDERS
The word "anxiety" means to anticipate future danger or misfortune, internal or external, and to be apprehensive about it. The body reacts to these thoughts by creating physical tension and significant discomfort. Throughout this book, I'll be talking about anxiety at a level exceeding that of the average person's distress, to a point where anxiety has become a disease. There are certain criteria that must be met if a condition is to be designated an anxiety disorder:
1. There must be significant mental distress; and
2. There must be impairment in the social, work, or other important areas of daily life.
When we categorize anxiety, this does not mean that nothing else may be going on. Categorizing by similarities is one method of organizing and nothing more. All of those patients who constitute a category are still people with different personalities and possibly other emotional or physical problems. The classifications of these disorders are strictly for clinical, educational, and research purposes. In reality, it has become part of a system necessary for third-party payment and various legalities. Perhaps, more than anything else, the system provides a method of communication between participants in the health system.
The official Diagnostic and Statistical Manual of Mental Disorders is commonly used as a guideline for diagnosis of anxiety, phobias, panic, and stress-related problems. However, as a physician, I believe that this manual is not the be-all and end-all when it comes to making an accurate finding. If you expect absolute precision in the diagnosis of an anxiety disorder, you will be disappointed, as there are no specific boundaries to encompass this type of disorder. That's because there are so many perspectives from which to view anxiety, including distress, adaptability, self-control, disability, inflexibility, irrationality, cause, a measure of deviation, and so on. There also is a great deal of leeway in the present diagnostic system, allowing room for a clinician's personal opinion. The openness of the system does not leave gaps as one might think, but rather it allows for greater flexibility. In other words, the experienced clinician can exercise her own personal judgment as to what she is seeing and treating with the patient.
To summarize, nothing is black-and-white in the present system of diagnosis for anxiety disorders. Many patients come to see me because they have already seen three to five health care professionals and are discouraged by a lack of concrete diagnosis or by what they suspect to be a misdiagnosis of their anxiety problem. They are also frustrated by the resultant ineffective treatment. With most medical problems, we are used to a laboratory test that determines the exact problem and medication that treats that problem. But there is no specific laboratory test or exact medication that will end anxiety disorders quickly. Rather, it takes time for you to work with your doctor to narrow down the diagnosis and then use trial and error to find the exact pharmaceuticals or nutrients that work with your body's chemistry to resolve the problem. I always remind patients that the boundaries of each type of anxiety disorder are flexible. This fluidity is primarily due to the many theories as to how people become ill. I will cover this more throughout the book.
ANXIETY KNOWS NO BARRIERS
As stated, anxiety knows no barrier in age or gender. In addition, increasingly more children today harbor high anxiety, which can lead to depression or other disabilities. The onset of anxiety at a young age, combined with some depression and moodiness, can significantly affect schoolwork and sabotage academic success. For instance, in findings published in August 2003 in the journal Archives of General Psychiatry, researchers set out to determine the level of disability in children incurred by problems such as anxiety. A representative sample of participants was followed for six years to measure the disability that occurred secondary to psychological symptoms. The authors identified three areas that were specifically affected, including family, school, and peer relationships. They concluded that boys had more trouble in school, while girls had more problems with their family. The childhood anxiety was as likely to result in disability, as was depression.
In a follow-up study, 1,420 children ages nine to thirteen were assessed annually for a psychiatric disorder until they were sixteen. During that period, 13.3 percent of the participants had at least one psychiatric disorder (panic, depression, anxiety, social anxiety, or substance abuse), although it was not necessarily chronic or long lasting. Girls, in particular, seemed to cycle back and forth from anxiety to depression. The authors concluded that the risk of a child having at least one psychiatric disorder by age sixteen is much higher than previously suggested and that girls are more likely to be affected.
Although the initial cause of anxiety may emanate as much from family situations as from other factors, the existence of the anxiety state further destabilizes all other aspects of a youngster's life. If the trigger that initiates the anxiety is particularly severe stress, then the victim may feel as if her life has changed forever.
Anxiety rears its ugly head among older adults as well, with 15 percent of older men and women reporting anxiety symptoms (feeling fearful, tense, or nervous). Moreover, 43 percent of those with depression experience anxiety, according to research published in the April 2003 issue of the Journal of the American Geriatrics Society. In this particular study, 3,041 patients were asked if they experienced at least two episodes a week of intense anxiety. The results were no surprise-they did. Other studies have indicated a higher incidence of anxiety. If there were difficulties with hearing, or if they experienced incontinence, hypertension, or poor sleep (common in the elderly), the number of patients reporting anxiety increased significantly. Patients whose social functioning was poor and who needed extra emotional support were more likely to have greater and often chronic anxiety symptoms.
It is believed that anxiety in the elderly may be a better predictor than depression of eventual dementia. One illuminating study published in the July 2002 issue of the journal Medicine and Science in Sports and Exercise revealed that chronic anxiety might lead to memory impairment, further cognitive decline, and finally senility.
Although intense anxiety is commonplace in modern-day urban life, it is not considered a disorder until it interferes with normal activities. If you don't have an anxiety disorder, you might wonder what your risk is of developing one in the future. Here are some of the latest statistics:
25 percent chance of an anxiety disorder
2 to 3 percent chance of a panic disorder
4 to 5 percent chance of agoraphobia
3 percent chance of obsessive-compulsive disorder
13 percent chance of social phobia
11 percent chance of any specific phobias
7 to 8 percent chance of post-traumatic stress disorder
MY PROBLEMS WITH DRUG THERAPY
So, if you are diagnosed with an anxiety disorder, you simply pop a pill to alleviate it, right? Wrong! While some anxiety disorders respond to pharmaceuticals, there are short- and long-term adverse effects to be considered that can often be more crippling than the disorder itself. In addition, pharmaceuticals are extremely costly compared to natural therapies, which are usually found over-the-counter at your local health food store. My holistic program will show you a safer, cheaper, and more effective way to strengthen the body and increase wellness, and in doing so, reduce anxiety.
When I started my practice in the 1960s, pharmaceuticals were usually reserved for hospitalized patients and psychotics. Of course, there were many other modalities available then, and I'll get to them in a moment. But first I want to share with you my initial experiences with psychotropic drugs, which explain why I resisted the pressure of joining other doctors in embracing prescription drugs as mainstream psychiatric therapy.
Keep in mind that "psychotropic" and "psychoactive" have virtually the same meaning and are often interchangeable words. They describe a drug, generally used to treat mental illness, which has the ability to alter moods, anxiety, behavior, thinking processes or mental tension.
Short-Term Side Effects
I'm a prime example of someone whose body and mind are not the least bit compatible with mind-altering drugs. For example, if I take a stimulant such as a mild appetite suppressor or even a cup of coffee, I will develop tachycardia (rapid heartbeat) and an arrhythmia (irregular heartbeat) that lasts anywhere from hours to days. This is dangerous, to say the least-not to mention unpleasant. When I am in this altered, medicated state, I am unable to focus my thoughts or do any constructive work. If I ingest a tranquilizer (a downer), I am zonked out for a day and a half.
To give you an idea, when I was an intern, I once took a 10 milligram (mg) Valium (diazepam), a commonly prescribed class of drug called benzodiazepine, before going to work. After taking this anti-anxiety agent, I literally was unable to get off the couch for a full day. I had to call in sick-the only day of my entire internship that I missed. Psychoactive drugs and I simply do not get along.
Many of my patients have experienced the same adverse effect with benzodiazepines. Along with the drowsiness, they have reported slurred speech and dizziness. One patient, thirty-two-year-old Victoria, said she was unable to wake up until noon after taking medication the night before for mild anxiety. When she awoke, she discovered that her two preschoolers had unlocked the front door and were playing in the front yard near a busy highway. I'm sure Victoria's mild anxiety turned into outright panic when she thought of what could have happened to her unsupervised young children.
Another woman, Caroline, age forty-seven, took Valium to help ease anxiety during a lengthy divorce. She came to me for a natural therapy, saying the tranquilizer made her so numb that she was devoid of all emotions. "The drug calmed my anxiety," Caroline said, "but after taking it for a week, it also dulled any joy or enthusiasm I had for life."
People who do not have problems with drugs are often puzzled by or suspicious of those who say they can't take mind-altering medications. To them I say, why not see this for what it is-one extreme along the spectrum of responses to chemicals. At the other extreme are those who never feel normal without drugs. These people can easily become abusers. In between, we find the average person, who can tolerate the majority of drugs pretty well. Still, there is more to the problem of taking drugs than simple tolerance.
Long-Term Adverse Effects
Along with the short-term uncomfortable side effects of drug therapy, there can be long-term adverse effects that can sometimes be toxic. Any drug that acts on the central nervous system (such as an analgesic, a stimulant, or a depressant) is potentially able to cause noxious side effects such as cognitive impairment, dependence, habituation, or neurological disorders. In fact, up to 10 percent of patients using psychotropic drugs report serious side effects, including hepatitis, dermatitis, low white blood cell count, amnesia, paradoxical excitation, changes in vision, hearing alterations, breathing problems, hypertension, low blood pressure, fast or slow heartbeat, palpitations, and headaches, among others.
Excerpted from What Your Doctor May Not Tell You About Anxiety, Phobias and Panic Attacks by Douglas Hunt Copyright ©2005 by Douglas Hunt, M.D. . Excerpted by permission.
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