When Fear Works Its Way Into The Body

10. January 2017
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People with generalised anxiety disorder constantly have exaggerated worries. Even children can suffer from it. Somatic symptoms often dominate the scope of attention – the condition itself is therefore often overlooked. Psychotherapy is helpful in many cases.

Trump, Erdogan, Putin, global threat of terrorism and refugee crisis: at the moment there are reasons for many people to worry. Nevertheless, most of them cannot be thrown completely off track. The situation is different for people suffering from generalised anxiety disorder: they continuously have worries that are in most cases unfounded. It causes them to feel greatly hindered and they are often no longer able to cope with their normal, everyday lives. Their concerns do not differ from those of other people constitutively – but these people spend much more time engaged with them: while patients with generalised anxiety disorder spend 60 percent of their day worrying, healthy individuals spend only 18 percent of their time as such.

Their fears are often about matters that concern them, their relatives or other people close to them: these include worries about their own health, their job and their professional capabilities, financial matters, problems with social relationships or about everyday matters. Those affected often have the unfounded fear that something may happen to their partner or their children. They call them several times a day to make sure that things are definitely ok. The family members often feel annoyed or controlled on account of this – so that the very relationship with the person so important to the patient ends up suffering.

Generalised fears are, after phobias (whereby fears of very concrete things are involved, such as crowds or heights) the second most common anxiety disorder; about five percent of the population is affected by them during their lifetime. Even children suffer from generalised anxiety, as a recent article by child psychiatrist Erin Dillon-Naftolin from Seattle Children’s Hospital in the United States shows. Among them, the incidence of generalised anxiety disorders is even estimated to be over ten percent.

Somatic symptoms in the foreground – actual disorder gets overlooked

Both children and adults with generalised fear disorder often end up being predominantly treated in response to their physical symptoms. Hence the constant fear and strong inner tension involved can lead to motor symptoms such as physical restlessness, tension headaches or shakiness, as well as vegetative symptoms such as dizziness, palpitations, gastrointestinal complaints, tightness in the chest or breathing problems. Those affected often search out a doctor for these reasons. The idea that behind the symptoms there lies a psychological problem is something often overlooked by treating physicians.

“Even if the children or adolescents do not mention concerns or fears, a screening for anxiety disorders should be carried out as a possible cause for somatic symptoms”, writes Dillon-Naftolin. “A generalised anxiety disorder is often not diagnosed and is then not treated appropriately”.

Beginning often at a young age

Even if the constant worrying does not quite occur in childhood, the disorder often begins early in life, usually between the ages of 20 and 30. At this age, increasing responsibilities – through occupation, marriage or having children of their own – contribute to the development of fears and concerns. In addition onerous life circumstances also often play a triggering role. At the same time those affected often indicate having been particularly anxious or nervous before the start of the illness. Girls and women are more often affected by generalised anxiety – women about twice as often as men. Why this is so is thus far not exactly understood.

In addition to physical symptoms, typical psychological symptoms occur. These include difficulty concentrating, nervousness, insomnia as well as derealisation (when the environment is perceived as strange or unreal) and depersonalisation (when someone experiences him or herself or his or her body as strange, unreal or not belonging to him or herself). According to the International Classification of Diseases (ICD-10) the respective symptoms must be present for at least six months. Furthermore, any organic cause for the complaints – such as hyperthyroidism – has to be excluded.

Several factors contribute to its development

These diverse worries and fears can conceal very different underlying unseen causes. Experts believe that patients carry genetically determined predisposition for developing strong anxiety. This inherited trait can then by way of prolonged stress or stressful events lead to ongoing concerns and fears. Sufferers are in a state of constant vigilance and strongly overestimate the probability of negative events. What’s more if parents have been very protective of their children during childhood, this could contribute to the development of the disease – because children do not have the experience of learning that they can cope alone with problems.

Some researchers assume the persistent self-worry to be a kind of “problem solving process without problem solution”. Through the constant playing through of all possible catastrophes, the persons concerned have the feeling that they can in this way prevent actual disasters – along the lines of: “I have to worry constantly, or else something bad will happen”. The mental preoccupation with worries temporarily results in calming – although the fears are not processed emotionally in this way and persist over the long term.

Although the symptoms over time often become stronger and more diverse, and the condition tends to be chronic, it can be well treated using appropriate measures. This primarily involves psychotherapy, supplemented in some cases by medications.

Psychotherapy with promise

One method which has proved particularly suitable for treating anxiety disorders is cognitive behaviour therapy. Here the patients first learn which factors cause their fears and concerns to arise. Thereafter they learn strategies to deal with their fears. This includes in particular dividing their fears in thought (“in sensu”) and into real situations (“in vivo”). In this way they can have the experience of feared catastrophes not actually occurring. At the same time the fears and anxieties are processed emotionally, so that the fear eventually subsides of its own accord. In addition, relaxation methods are practised in therapy which help to reduce the high internal tension.

Various studies have shown that behavioural therapy for generalised anxiety leads to a significant improvement in symptoms which persist beyond the therapy. Complementary to this, in severe pronounced cases anxiety antidepressants can be prescribed, usually from the selective seretonin group and serotonin-noradrenaline-reuptake inhibitor (SSRI and SSNRI) groups. They affect the serotonin system in the brain, which is out of balance in anxiety disorders, and can thus help to reduce the anxiety.

Older adults as well do not uncommonly suffer generalised anxiety disorder – and with them cognitive behavioural therapy results in significant improvements, such as a current meta-analysis shows. Above all, a significant reduction in worrying was observed. These changes were observed even six months after the end of therapy.

Relax and accept uncertainty

With children and adolescents as well cognitive behavioural therapy is the treatment of choice. In some cases it may be useful to combine them with SSRIs – particularly with moderate to severe pronounced anxiety. “With young patients the use of a relaxation method can be useful in order to reduce the high physical arousal that leads to the different somatic symptoms,” says Dillon-Naftolin. In addition, with children and adolescents the parents should be involved in the therapy. They can set an example to their children in accepting uncertainty regarding future events. And they can show them that life is not as worrisome as it seems from the perspective of those affected.

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Image copyright: Bianca Moraes, flickr / Licence: CC BY
Medicine, Psychiatry, Research

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hypnotherapy is very effective!

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