Anxiety Disorders: Nothing to be Afraid of?

Well it’s October and the holidays are just around the corner. Fall is definitely here and the presidential campaign dominates the news and commercial time. One way or another, it will be a relief to see the incredibly negative attacks stop once the election is over. One side or another, we encourage you to vote and to vote smart.

October is also National Domestic Violence Awareness Month. We join with others in calling your attention to how frequent and severe partner-on-partner violence is. One in four women has experienced domestic violence in her lifetime and nearly three out of four Americans personally know someone who is or has been a victim of domestic violence. If you feel you are in danger, call 911, or the National Domestic Violence Hotline at 1-800-799-7233.

With this E-Letter, we celebrate the seventh anniversary of providing information to our patients, contacts, and the community at large. We have enjoyed the feedback we have received and believe that we have truly made a difference to some.

In this October E-letter, we present information about Anxiety Disorders, our Ask the Doc question is about preadolescent withdrawal, and our email of the month is about vitamin F. We hope you find the enclosed information helpful. As always, we appreciate your questions and feedback.

Parent Education and Family Stabilization Course. We have been certified by the Department of Children and Families, State of Florida, to offer the Parent Education and Family Stabilization Course. Sometimes referred to as the Divorce Class, this 4 hour class is state mandated for divorcing parents of involved children. This course is intended to teach parents about the effects divorce has on children, to lessen the impact of difficult transitions, and to improve the ways they communicate with each other and their children. Our course is provided live and in small groups. Please contact our office at 954 755-2885 for further information.

Low cost counseling: Denise Champagne, M.S., is offering low cost counseling as a mental health intern. She is currently seeing patients and is available to take on new patients. This allows those individuals who cannot afford treatment to obtain it and allows her to get the required training. If you or someone you know is in need of counseling but just cannot afford it, please call the office and ask for Denise. All treatment provided by Denise will be reviewed and supervised by Dr. Kimmel.

Testings. If you are concerned about your child’s school placement for the next school year, this would be a good time to have them evaluated. Recent questions from parents have ranged from should their child be retained to whether they are gifted to whether they have a disability that can qualify for accommodations at school. Our practice does different types of evaluations to help answer those questions and information about these evaluations can be found on our website. If you have more specific questions, please contact Dr. Kimmel who would be happy to answer them.

Qualified Supervisor. Dr. Joel Kimmel has been certified by the State of Florida to supervise mental health counselors seeking supervision to meet the licensing requirements. If you or anyone you know needs a qualified supervisor to meet these requirements, contact Dr. Kimmel for further information.

Our E-Letter this month focuses on a very common issue that many people suffer from, Anxiety Disorders. This is not to be confused with the normal feeling of anxiety which is an emotion that occurs in response to a perceived or misperceived threat. Anxiety is both a psychological and physiological response that has emotional, cognitive, somatic, and behavioral components. When anxiety becomes overwhelming and/or chronic, it can become an anxiety disorder. Anxiety Disorders affect about 40 million American adults annually. They last at least 6 months and can worsen if not treated.

While everyone feels anxious at times, especially before a test, appearing before a large group of people, or having to face and confront someone, anxiety disorders are much more severe. General symptoms of an anxiety disorder include: feelings of fear and panic, obsessive thinking, compulsive behaviors, nightmares, heart palpitations, difficulty breathing, nausea, numbness, dizziness, cold or sweaty hands, dry mouth, irritability, and difficulty sleeping. General responses of individuals with an anxiety disorder include avoidance, substance abuse, withdrawal, overeating, overmedicating, overworking and other addictive behaviors.

If you wonder whether you have an anxiety disorder, ask yourself:

• Do you constantly fear that something bad will happen?
• Do you think you have to do things a certain way or think in a certain way to prevent a bad thing from happening?
• Are you constantly tense, tired, or worried?
• Do you catastrophize and think that there is always danger no matter what you do?
• Do you wake up frequently worrying about something?
• Do you feel like your heart beats like it is going to jump out of your chest?
• Do you panic?
• Do you have difficulty going to school or work because you are so worried about what can happen?

If you answered yes to several of these questions, you may very well have an unrecognized anxiety disorder.

Common types of anxiety disorders include:

• Phobias which are unrealistic fears of a thing, animal, or an object that in reality presents little danger such as spiders, clowns, heights, and flying
• Generalized Anxiety Disorder (GSD) where the person worries constantly, has a persistent feeling that something bad is going to happen, is irritable, has difficulty concentrating and may also have frequent upset stomachs and insomnia
• Panic Disorder which includes unexpected panic attacks and then the fear of having another one especially in places where escape or help is difficult
• Social Anxiety Disorder (Social Phobia) where the individual has an overwhelming fear of being seen negatively by others or of being embarrassed or humiliating oneself especially in performance situations
• Obsessive-Compulsive Disorder includes unwanted thoughts or behaviors that seem to be uncontrollable or unstoppable and include washing hands over and over, checking door locks, and frequent counting
• Post-Traumatic Stress Disorder (PTSD) occurs in the aftermath of a life-threatening or traumatic event and can include hypervigilance, flashbacks, withdrawal, nightmares, and avoidance

Frequent treatments for anxiety disorders include medication and psychotherapy. Anti-anxiety and antidepressant medications are commonly prescribed as a form of treatment although they really do not solve problems. They may make it easier to get through tough times and may have side effects but problem resolution is up to the individual. In psychotherapy, especially Cognitive Behavioral Therapy, one’s irrational thinking and perceptions can be challenged and replaced with more realistic thought patterns. Systematic desensitization and exposure therapy are two common behavior therapy techniques for safely reducing anxiety when in the presence of a feared object or activity. Things that can be done on one’s own to deal with an anxiety disorder include making time for relaxation and practicing deep breathing, meditation, and yoga techniques. Eating healthy and practicing good sleep hygiene can be quite helpful. Limiting alcohol, nicotine, and caffeine intake can lead to less anxiety. Eating healthy and eliminating addictive behaviors will also reduce anxiety. Regular exercise and partaking in confidence building activities decreases self doubt and worry. Finally, having a social support system will allow one to feel accepted and have a venue to express their thoughts and feelings. Anxiety Disorders can be successfully treated so seek professional help if the anxiety becomes debilitating.

We offer the following information on Anxiety Disorders:

• Anxiety is a normal reaction to a stressor and helps to cope or deal with the situation
• People with anxiety feel fearful which is usually caused by some stressful event
• Anxiety is a normal human emotion that everyone has; anxiety disorders are far more distressful, can interfere with the ability to lead a normal life, and can be incapacitating
• When anxiety becomes overwhelming it can lead to an anxiety disorder marked by excessive worry and fear, constant irrational thoughts, and exaggerated concerns
• Anxiety disorders affect almost 40 million American adults every year
• People with anxiety disorders often have heart palpitations, fatigue, nausea, muscle tension, stomach distress, difficulty breathing, sweating, headaches, weakness, difficulty concentrating, trembling, and difficulty falling or staying asleep
• Social anxiety or social phobia can be a fear of embarrassing oneself or being humiliated in social situations
• Panic, an anxiety disorder which usually peaks in 10 minutes and rarely lasts more than 30 minutes, is an episode of intense fear and happens suddenly and without warning; people think they are going to die, have a heart attack, or lose control
• Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after a life threatening or traumatic event and has symptoms of hypervigilance and flashbacks
• Phobias are intense fears of very specific objects or situations such as heights, flying, elevators, certain animals, clowns, etc.
• Generalized Anxiety Disorder (GAD) includes exaggerated and excessive worry, chronic anxiety, and constant irrational thoughts that interfere with daily functioning
• Obsessive-compulsive disorder is an anxiety disorder characterized by repetitive and unwanted thoughts and/or behaviors that can’t seem to be stopped voluntarily
• Test or performance anxiety is due to the fear of failing a test or a task and being negatively evaluated or embarrassed
• Anxiety can also be the symptom of a health issue such as COPD, heart arrhythmia, or prolapsed mitral valve
• Anti-anxiety and antidepressant medications will not cure anxiety disorders but will control them while the person is getting psychotherapy

• Dispute your irrational thoughts and face your fears rather than avoid them
• Change your diet by limiting your intake of caffeine, energy drinks, and chocolate
• Exercise regularly and eat a healthy breakfast with small meals throughout the day
• Engage in relaxation activities and practice yoga, meditation, deep breathing, mindfulness, and self-hypnosis
• Reduce alcohol and nicotine intake and insure that you get enough sleep
• Build your confidence by succeeding at tasks and challenges
• Seek professional help if you cannot reduce your anxiety on your own or you have had an upsetting or traumatic experience

HG writes: I have a 12 year old son who started middle school a few months ago. He is an A student who did very well in his elementary school. He played sports and the flute and seemed real happy. My husband and I were thrilled at how well he was doing. However, this year is very different. Since he started middle school, he doesn’t care about his grades and gave up the flute. He stays in his room and only comes out when we call him to eat. He no longer has any friends and just plays video games. It’s getting harder and harder to get him to go to school and he refuses to see a counselor. What do you think we should do?  

Dr. Joel Kimmel replies: Your son seems like he has withdrawn from his usual social environment and the question is why. What makes this more frustrating is that he won’t talk to you and give you any clues as to what is going on. There are several possible reasons for his behavior that I would explore with him if he was in my office.

Since he won’t communicate with a counselor, you need to try and best guess on your own. Ask yourself if you are aware of any events or traumatic situations that might have happened to him besides a change of schools. By the way, the change to middle school is significant. Children are given more independence and responsibility at a time when they are in or entering puberty. They are exposed to more and different kids than they were in elementary school. Their whole world changes including their bodies, their attitudes, and their capabilities. Most kids grow into these changes and emerge healthy and happy. So, puberty may account for some of your child’s behaviors but not all.

Another possibility for his withdrawal is bullying. Are you aware of his being targeted and victimized by another kid or kids. Has he mentioned being called names? Do you see any bruises? Does his backpack or books contain derogatory names or words? Often, children who refuse to go to school do so because they want to be safe at home and not hurt by others. Is this a possibility?

Another thing to consider may be a conflict with a teacher or teachers. Is it possible that he thinks a teacher doesn’t like him or he had some disagreement with one and is avoiding by withdrawing?

These are all possible situations. Since he won’t tell you, you will need to do some detective work to find out what is going on. Meet with his teachers and find out how he is doing in school and what his behavior is like in class. Contact some of his old friends and see if they will provide you with how they see him today. Check his Facebook and computer usage to see if he is being influenced negatively online. Have him medically evaluated to rule out any medical reasons for his withdrawal.

Finally, I would suggest that you continue to try to get him to speak with a therapist. If he is close with a grandparent or another family member, perhaps they can suggest to him to see a therapist and that they will go with him if he agrees. If you can’t solve this situation directly, you will need to do so indirectly.

We would like to thank Elizabeth B. for sending us the following email:

Vitamin F!

Why do I have a variety of friends who are all so different in character? How can I get along with them all? I think that each one helps to bring out a “different” part of me.

With one of them I am polite.
With another, I joke.
I sit down and talk about serious matters with one.
With another I laugh a lot.
I listen to one friend’s problems.
Then I listen to another one’s advice for me.

My friends are like pieces of a jigsaw puzzle. When completed, they form a treasure box. A treasure of friends! They are my friends who understand me better than I understand myself. They’re friends who support me through good days and bad. We all pray together and for each other.

Real Age doctors tell us that friends are good for our health. Dr. Oz calls them Vitamin’s F (for Friends) and counts the benefits of friends as essential to our well being. Research shows that people in strong social circles have less risk of depression and terminal strokes.

If you enjoy Vitamins F constantly you can be up to 30 years younger than your real age. The warmth of friendship stops stress and even in your most intense moments, it decreases the chance of a cardiac arrest or stroke by 50%.

We should value our friends and keep in touch with them. We should try to see the funny side of things and laugh together and pray for each other in the tough moments.