Get Well Wednesday: Are You Anxious? Here’s What To Do About It

WHAT IS ANXIETY AND WHAT ARE SOME OF THE MOST COMMON ANXIETY DISORDERS?

Anxiety is a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome. It is a normal reaction to stressful situations however in some cases, it becomes excessive and can cause sufferers to dread everyday situations.

There are a variety of anxiety disorders, each with their own signs and symptoms. Although many of the signs and symptoms overlap, individuals may experience different signs and symptoms at different levels of severity and durations. The following are some of the more common types of anxiety disorders: Generalized Anxiety Disorder is the most common anxiety disorder, followed by (in no particular order) Panic disorder, Social anxiety disorder, Obsessive-compulsive disorder (OCD), Post-traumatic stress disorder (PTSD) and Separation anxiety disorder.

 WHAT ARE THE SYMPTOMS OR SIGNS OF AN ANXIETY OR PANIC ATTACK?

Anxiety comes in many forms such as panic attacks, phobia, and social anxiety. the distinction between an official “anxiety disorder” diagnosis and “normal anxiety” isn’t always clear. However, if a person experiences any of the following symptoms on a regular basis, and it interferes with their functioning, they should consult with their doctor: excessive worry, sleep disruption, irrational fears, chronic indigestion, panic attacks, flashbacks, perfectionism, compulsive behaviors, self-doubt, self-consciousness and stage fright.

 Panic attacks occur with panic disorder. They may also occur with other psychiatric disorders. During a panic attack, the symptoms are sudden and extremely intense. These symptoms usually occur unexpectedly without an obvious, immediate cause. The symptoms are usually overwhelming and become severe within 10 minutes and then dwindle. However, the duration of some attacks may last longer or may occur in sequence, making it difficult to determine when one attack ends and another begins.

A panic attack is characterized by four or more of the following symptoms:

• Heart palpitations, pounding heart, or accelerated heart rate
• Excessive sweating
• shaking/trembling
• Sensations, shortness of air, difficulty breathing, or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed, or faint
• Feelings of unreality (derealization) or being detached from oneself (depersonalization)
• Sense of danger or doom (i.e. fears dying)
• Numbness or tingling sensations (parenthesis)
• Chills or hot flashes

WHY ARE ATHLETES MORE AT RISK OF HAVING ANXIETY DISORDERS?

 Many athletes struggle with stress and anxiety on a daily basis. Each athlete reacts to the stress and anxiety differently. Younger athletes may find it challenging to manage the stress and anxiety that comes along with a full class load, while trying to balance that with the demands of their sport, as well as the pressures of their family and friends. They should be encouraged to seek help from their school’s counseling center, to manage and limit their stress and anxiety.

Professional athletes also struggle with stress and anxiety. It is challenging to face the pressure to perform within their sport; they can be impacted by intense public scrutiny; they compete in a culture that inhibits them from seeking the help they need.

One of my patients who is a professional athlete and has severe anxiety said that their coach told them to “take it out on the court/field” “Be strong/tough,” which are FALSE mentalities and the WORST ways to manage their mental health issues.

It is important for the athlete’s coaches and trainers to be educated on the difference between “normal anxiety” and an “anxiety disorder” and recognize the signs and symptoms of the latter. Equally important, it is recommended that coaches and trainers encourage their athletes to seek help.

 WHO ARE SOME OF THE ATHLETES WHO HAVE SPOKEN PUBLICLY ABOUT THEIR MENTAL HEALTH CHALLENGES?

• NBA legend Jerry West has struggled for decades with depression and low self-esteem.
• New York Giants wide receiver Brandon Marshall calls mental health awareness and acceptance “the civil rights movement of our era.” He was diagnosed with borderline personality disorder in 2011
• Kevin Love (NBA)-Panic attacks
• Serena Williams (American Tennis Player and Medalist)- Anxiety
• Arian Foster (NFL)-Panic Attacks
• Simone Biles (Olympian Gymnast and medalist)-ADHD
• Michael Gatlin (Olympian Track star and medalist)- ADHD
• Michael Phelps (Olympian Swimmer and medalist)-Severe depression; contemplated suicide
• Royce White (MLB)-Anxiety and obsessive thoughts
• Imani Boyette (WNBA)-severe depression and self-harm behaviors
• Mardy Fish (American Tennis Player)- Severe anxiety disorder with panic attacks
• Rick Ankiel (MLB)-Severe Anxiety
• Brandon Brooks (NFL)-severe anxiety
• Allison Schmitt (Olympian Swimmer)- depression
• Chamique Holdsclaw (WNBA player) – bipolar disorder

 WHY IS MENTAL ILLNESS SO TABOO IN THE AFRICAN AMERICAN COMMUNITY?

• A: African-Americans are disproportionately more likely to experience circumstances that increase the chances of having a mental illness (poverty, unemployment rate, crime, cultural insensitivity from providers)
• Only 20% more likely to have psychological distress vs non-Hispanic whites
• Young African-American Adults with higher levels of education are LESS likely to seek help

Some reasons that prevent African-Americans from seeking treatment and receiving quality mental health care include:

• Cultural competence (providers insensitive to the African-American experience, especially doctors of a different ethnic background.)
• Mistrust of authorities –Exclusion from receiving good service/care (i.e. slavery, sharecropping, exclusion from health, educational, social and economic resources)
• Sign of weakness to receive help-Some African-Americans have normalized their own suffering
• Lack access/insurance coverage
• In denial (some admit to seeking services but not ok to acknowledging they have a problem)
• Perception: fear of being labeled, “crazy”
• Fear of medicine and its effects on the brain/body
• Not being educated by providers about management of the LIFESTYLE for having anxiety
• Praying alone may not help

HOW DID YOUR FAMILY REACT TO YOUR DIAGNOSIS?

My family was supportive of my diagnosis and continues to be supportive of my continued management. I was diagnosed with ADHD at age 33. I had no idea ADHD stippled my ability to perform at my best. While in medical school, I failed my medical board exams 5 times over a 6-year period and when I sought help at that time, performance anxiety (due to test-taking anxiety) was diagnosed.

I was not evaluated for ADHD because I did not present with the classic ADHD symptoms and my grades did not reflect any concerns. It was not until my final year of my child psychiatry fellowship at Baylor College of Medicine that one of my mentors suggested that I be evaluated for ADHD. Initially, I denied the diagnosis due to my lack of understanding that ADHD can present differently, especially in girls versus boys.

HOW DO YOU CONVINCE SOMEONE THAT NEEDS HELP TO GET HELP AND TO TAKE THEIR MEDICINE?

• Let them know that there is an important conversation that you need to have with them.
• Approach them with empathy and non-judgement. Consider saying “I know this is really hard for you, but I’m talking to you because I love you. If I didn’t care, we wouldn’t be having this talk.”
• Be prepared for resistance. Try not to be defensive.
• Refrain from using words like “crazy” or “abnormal.”
• Use “I” statements, such as “I am concerned about you.” Avoid “you” statements.
• Leverage your help. Phrase your concern in a way that you are asking them to seek help to help others. i.e. “This would be the best thing you could do for your child. Please do it for him. He needs for you to receive proper help more help than I or any of our family members know how to provide.”
• Help locate a mental health professional and schedule an appointment on their behalf. Offer to attend at least the first appointment with them. Regardless if they go or not, go and discuss your concerns with the professional. There have been successes with a loved one eventually receiving the help they need after a family member or friend attended the first appointment.
• If possible, offer to pay for the appointment if given the excuse that it costs too much

Dr. Brown answers your ‘Text Tom’ questions on the next page.

I just want to know is depression a real illness or another way doctors and counselors rake in more money.

Depression is a real illness. It affects how you feel, think and behave and can lead to a variety of emotional and physical problems. It is the most common debilitating mental health disorder in our world.

It is a mood disorder that causes a constant feeling of sadness, loss of interest, decreased concentration, hopelessness, helplessness, worthlessness, loss of sleep, decreased appetite, feeling fatigue/loss of energy and/or feelings of guilt. If it is severe, it can also cause a person to overeat, sleep constantly or even experience hallucinations (hear or see things that other people don’t.) When it is at its worst, depression can cause a person to contemplate self-harm or suicide.

My fiancé has anxiety and depression and sometimes it scares me because whatever happens to her is amplified. What kind of exercises can we do to calm her fears? Sometimes we breathe and relax but sometimes I just get worried.

Anxiety can be caused by a number of conditions: mental/emotional stress, untreated medical conditions, social stressors, etc. Depending on the cause will help determine how to manage these symptoms. Therefore, I recommend that she speak with her doctor if she is unaware of what is causing her anxiety since it may require different management. Breathing techniques, meditation, prayer, muscle relaxation can all help temporary anxiety from worsening. However, maintaining a good sleep hygiene, eating balanced meals and regular aerobic exercises also help manage and prevent anxiety from becoming disabling.

My son curses for 24 hours at a time. Anything could trigger it, like me saying no when he asks for money or my car or baby mama drama. His perception is off a lot. Sometimes  I’m afraid he”ll hit me. I came home recently he and his girlfriend were inside fighting. He’s 26 years old. What do I do?

Life can be stressful. Some of us may be dealing with something that we are not aware of and it is impacting how we feel, communicate, and react. If you are afraid that your son will become aggressive towards you and/or his girlfriend, I recommend that you talk to him about your concerns and encourage him to get help from a mental health professional.

If he is resistant and his behaviors have not changed, then I recommend the following:

• Let him know that there is an important conversation that you need to have with him.
• Approach him with empathy and non-judgement. Consider saying “I know this is really hard for you, but I’m talking to you because I love you. If I didn’t care, we wouldn’t be having this talk.”
• Be prepared for his resistance. Try not to be defensive.
• Refrain from using words like “crazy” or “abnormal.”
• Use “I” statements, such as “I am concerned about you.” Avoid “you” statements.
• Leverage your help. Phrase your concern in a way that you are asking him to seek help to help others. i.e. “This would be the best thing you could do for your child. Please do it for him. He needs for you to receive proper help, more help than I or any of our family members know how to provide.”
• Help locate a mental health professional and schedule an appointment on his behalf. Offer to attend at least the first appointment with him. Regardless if he goes or not, go and discuss your concerns with the professional. There have been successes with a loved ones eventually receiving the help they need after a family member or friend attended the first appointment.

If possible, offer to pay for the appointment if given the excuse that it costs too much.

My mother was in the emergency room. We were laughing and talking. Then she said “I’m gonna die.” She looked away, and within a minute, she died. Could I be suffering from PTSD? I see this in my mind every day. It’s been a year and a half. I still cry a lot

I am so sorry to know this happened to you. Considering the situation, I would need additional information to answer your question, however, you are at risk of having PTSD. The best solution I can provide is to encourage you to schedule an appointment with a therapist or a psychiatrist, so that they can complete a comprehensive evaluation to determine if you are suffering from a mental health disorder, such as PTSD, and provide you with safe and appropriate treatment recommendations.

So, is there a difference between anxiety and just being nervous? I get nervous in some situations like interviewing and when I feel unprepared when giving a speech. I start feeling hot, sweaty and my hands start shaking. It’s like a tingling all over, a heightened sense of stress if you will. This feeling recently came over me in line at the movies when I thought I would miss out on the last two seats! Is this anxiety?

Yes! This is a perfect example of anxiety or nervousness. So, there is natural/healthy or anxiety/worry that a person feels when preparing for a speech or before an interview. When people feel this type of nervousness, it can be uncomfortable, however it can also work in a person’s favor.

Clinical studies have shown us that having some natural anxiety can help us to perform at our best. Healthy anxiety also “kicks in” when you are in a life threatening or dangerous situation, your body will respond much more quickly because of your anxiety. However, if you experience the symptoms you mentioned on a regular basis, at an intense level and it interferes with your functioning, I advise you to consult with your doctor.

 Anxiety will likely come when a person is unprepared, as you mentioned in your question. So, the best way to prevent being unprepared is to prepare ahead of time for important tasks and events; this will help ease the anxiety that you may experience.

I have an 11-year-old daughter diagnosed with PTSD and depressive anxiety. She is a swimmer and has had panic attacks in the water. Any suggestions besides additional medication?

Considering the situation, I would need additional information to answer your question (i.e. What led to the diagnosis of PTSD? Is being in the water a trigger for her?, What other symptoms is she endorsing? What are the current medical, emotional and social stressors that she is trying to manage?

These, and other questions would be important in determining the management options for your daughter. Medication, when therapeutic, can be helpful for anxiety disorders however, clinical studies have revealed that the combination of medication management and therapy is most helpful with managing anxiety. If she is not engaging in therapy, I would recommend you discuss this option with her doctor.

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