Checkup on Health: When is anxiety a clinical condition?

One man's experience

John Schmidt

In the 1980s, John Schmidt fearlessly climbed on the San Francisco Bay Bridge and even helped repair it after the Loma Prieta earthquake. Yet getting into an elevator petrified the electrical engineer.

"I'd be with a group and I could not get in the elevator with them; I'd make up a reason to take the stairs," he recalls. "It got pretty embarrassing."

Schmidt couldn't do many of the things most people did everyday. He was often so afraid of dying that he had trouble sleeping at night and couldn't board an airplane. He sometimes became so dizzy that he collapsed at the office and was rushed to the hospital.

Read more in UC Davis Medicine magazine

By Richard Maddock, M.D. 

Occasional anxiety is part of life for most people. It can be a normal response to risky situations, stress or uncertainty. However, anxiety can sometimes be a sign of an anxiety disorder, a condition that may benefit from specific treatments.

There are currently five anxiety disorders recognized as distinct diagnoses: panic disorder, social anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, and generalized anxiety disorder. Each disorder appears to have different causes. Ongoing scientific research is trying to understand what causes each of these conditions, as well as trying to demonstrate new treatments that are effective.

Current research at UC Davis Medical Center focuses on a metabolic abnormality observed in the brains of patients who suffer from panic disorder. Patients with panic disorder accumulate higher levels of lactate acid in their brains during ordinary mental activity. Lactic acid is known to trigger panic attacks. If lactic acid is causing some patients to have panic attacks, it may be possible to develop treatments that specifically correct this abnormality.

Recognizing anxiety disorder

How can you tell if your anxiety is normal or a sign of an anxiety disorder?

  • Interference 
    If your anxiety is just bothersome, but is not interfering with your life, then it is probably not an anxiety disorder. But, if your anxiety is getting in the way of important activities, it is more likely to be an anxiety disorder. Anxiety disorders can sometimes dictate the life choices a person makes, such as their career or educational goals, or limit a person’s participation in social or family activities. Anxiety disorders can sometimes lead to serious complications, such as depression, alcoholism or drug abuse.

  • Severity
    If your anxiety is unpleasant but not constant, severe or overwhelming, then it is probably not an anxiety disorder. Anxiety disorders typically cause severe anxiety, which can be persistent, exhausting and demoralizing. A panic attack is an episode of severe anxiety accompanied by physical symptoms such as shortness of breath, racing heart, sweating, dizziness, nausea, trembling, feelings of unreality, etc. Infrequent panic attacks can be normal, but repeated panic attacks occurring for no obvious reason are more likely to be a sign of an anxiety disorder.

  • Appropriateness
    People often feel anxiety when confronted by a situation that really is stressful or risky. With an anxiety disorder, however, a person feels anxiety that is out of proportion to the risk or danger involved. A person with an anxiety disorder usually can tell that their reactions are exaggerated and unnecessarily strong, but they cannot easily bring their anxiety under control.

If anxiety symptoms are interfering with your life, you probably should seek treatment. If your anxiety symptoms are severe or persistent and are out of proportion to the dangers you face, you would probably benefit from treatment.

Diagnosis and treatment

To diagnose anxiety disorder, an experienced professional carefully reviews your medical and psychiatric history, and reviews your specific pattern of anxiety symptoms. The most effective treatments for anxiety disorders include specific medications and cognitive-behavioral therapies (CBT). Both have been proven effective for the treatment of most anxiety disorders.

The most commonly used medications are often called “antidepressants,” but their use is not restricted to the treatment of depression. In fact, most “antidepressants” work as well (or better) in the treatment of anxiety disorders as they do for depression. The name “antidepressant” was given to these medicines before it was discovered that they were very effective treatments for most anxiety disorders.

CBT or cognitive therapy is a type of psychotherapy that focuses on the specific symptoms a patient has right now, rather than focusing on the patient’s childhood or stressful events from the past. CBT teaches the patient ways of changing some of the thinking patterns and behavior patterns that contribute to the anxiety.

About the Author

Dr. MaddockDr. Maddock is a professor in the UC Davis Department of Psychiatry and Behavioral Sciences and an expert in the pathophysiology and treatment of anxiety and mood disorders.

Most people who suffer from an anxiety disorder will receive significant benefit from treatment with either CBT or a medication. Often both treatments are given, with even better results. If you suffer from an anxiety disorder, there is a very good chance your condition will improve with treatment.

Other resources

The Anxiety Disorders Association of America offers tips for dealing with financial anxiety.

November 2008 — Patients are needed for a UC Davis study that seeks to advance understanding of the physiological causes of panic disorder. The study uses brain scans to study amounts of brain lactate, and seeks both people who currently experience panic disorder and those who are in remission. For information, call (916) 734-7732.