Anxiety is normal, say psychiatrists. Anxiety disorders are not. The most common mental illness in the U.S., anxiety disorders afflict 40 million adults—twice as many women as men—and take a toll on the economy of more than $40 billion each year due to health-care costs and lost productivity.
People with anxiety are often at greater risk for suicide than depressed patients, because the latter usually lack the energy and motivation to kill themselves. "Anxiety, however, drives people to do things to get rid of the discomfort," says Kenneth Robbins, MD, clinical professor of psychiatry at the University of Wisconsin–Madison.
Fears that aren't real
On Sunday nights, Michelle Roe's body went through a ritual: She got pain in her stomach, her fingertips went numb, her face and neck felt flushed and prickly, and she would run into the bathroom to dry heave. "I thought I was going to die if I went to work," says the 32-year-old resident of Adrian, Mich. "I was an accountant, so it was not like my job was dangerous."
I thought I was going to die if I went to work. I was an accountant, so it was not like my job was dangerous.
—Michelle Roe, Anxiety Disorder Patient
Roe sought treatment from her obstetrician, her primary care doctor, and a psychologist that her employer paid for. She cycled through several medications, including Prozac and Celexa, and eventually learned to manage her panic attacks and paralyzing fears through self-help books and support from her husband. "I still have fear," she says, "but I am able to step back and see that it's not real. I realize that nothing is going to hurt me."
The challenge of diagnosing anxiety disorders is that everybody has some degree of anxiety, unless they are in a coma or are a psychopath, says Sally Winston, PsyD, codirector of the Anxiety and Stress Disorders Institute of Maryland in Towson. "It's disordered when it interferes with life or causes a lot of distress."
Stress and hormones are common triggers for anxiety disorders. There is also a strong genetic predisposition, says Winston, that is independent of behavior that can be learned from an anxious family member, such as obsessive hand washing. People with a disorder often experience their first episodes of disabling anxiety during adolescence, after the loss of a job, or after the birth of a child.
Brooke Cooper, 27, of Selmer, Tenn., gave birth to a premature baby boy in the spring of 2007 and found herself in the throes of anxiety. Any mother would be worried, but she was obsessive. "I wouldn't even close my eyes, because I was scared. 'What if he stops breathing?' I had vivid images of going to his bassinet and see that he is not breathing. What if I trip and drop him?"
She consulted her primary care physician and began seeing a therapist, but the anxiety may have compromised Cooper's ability to further her treatment, because she put her son's welfare over her own. "I wasn't comfortable going on medication, even though they say that it saves," she says. "I worried about taking any risks with him."
High risk of substance abuse
Research suggests that a combination of cognitive-behavioral therapy and medication can help control symptoms and lead to complete remission in some people.
Unfortunately, many people with anxiety disorders also drink or abuse prescription drugs to tamp down their symptoms, which can complicate treatment. "The connection between serious anxiety disorders and substance abuse is very high," says Winston. "Studies have shown that one-third of the people who have anxiety disorders struggle with substance abuse, and that one-third of substance abusers also have an anxiety disorder."