Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Manifestations of Mental Illness: Anxiety
Anxiety is one of the most readily accessible and easily understood of the major symptoms of mental disorders. Each of us encounters anxiety in many forms throughout the course of our routine activities. It may often take the concrete form of intense fear experienced in response to an immediately threatening experience such as narrowly avoiding a traffic accident. Experiences like this are typically accompanied by strong emotional responses of fear and dread as well as physical signs of anxiety such as rapid heart beat and perspiration. Some of the more common signs and symptoms of anxiety are listed in Table 2-2. Anxiety is aroused most intensely by immediate threats to ones safety, but it also occurs commonly in response to dangers that are relatively remote or abstract. Intense anxiety may also result from situations that one can only vaguely imagine or anticipate.
Anxiety has evolved as a vitally important physiological response to dangerous situations that prepares one to evade or confront a threat in the environment. The appropriate regulation of anxiety is critical to the survival of virtually every higher organism in every environment. However, the mechanisms that regulate anxiety may break down in a wide variety of circumstances, leading to excessive or inappropriate expression of anxiety. Specific examples include phobias, panic attacks, and generalized anxiety. In phobias, high-level anxiety is aroused by specific situations or objects that may range from concrete entities such as snakes, to complex circumstances such as social interactions or public speaking. Panic attacks are brief and very intense episodes of anxiety that often occur without a precipitating event or stimulus. Generalized anxiety represents a more diffuse and nonspecific kind of anxiety that is most often experienced as excessive worrying, restlessness, and tension occurring with a chronic and sustained pattern. In each case, an anxiety disorder may be said to exist if the anxiety experienced is disproportionate to the circumstance, is difficult for the individual to control, or interferes with normal functioning.
In addition to these common manifestations of anxiety,
obsessive-compulsive disorder and post-traumatic stress disorder are generally
believed to be related to the anxiety disorders. The specific clinical features
of these disorders will be described more fully in the following chapters;
however, their relationship to anxiety warrants mention in the present context.
In the case of obsessive-compulsive disorder, individuals experience a high
level of anxiety that drives their obsessional thinking or compulsive behaviors.
When such an individual fails to carry out a repetitive behavior such as hand
washing or checking, there is an experience of severe anxiety. Thus while the
outward manifestations of obsessive-compulsive disorder may seem to be related
to other anxiety disorders, there appears to be a strong component of abnormal
regulation of anxiety underlying this disorder. Post-traumatic stress disorder
is produced by an intense and overwhelmingly fearful event that is often
life-threatening in nature. The characteristic symptoms that result from such a
traumatic event include the persistent reexperience of the event in dreams and
memories, persistent avoidance of stimuli associated with the event, and
increased arousal.
Table 2-2. Common signs of acute anxiety
| Feelings of fear or dread |
| Trembling, restlessness, and muscle tension |
| Rapid heart rate |
| Lightheadedness or dizziness |
| Perspiration |
| Cold hands/feet |
| Shortness of breath |
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