1. ANXIETY DISORDERS Symptoms, Causes and Treatment

2. PRESENTED BY Adelbert Scholtz [counselling psychologist & retired pastor]

3. ONLY IMAGINATION? Why do people become anxious? Why do people get panic attacks? Is it attention-seeking? Only imagination?

4. World Health Organisation: REAL DISEASES F 40 Phobic anxiety disorders F 40.0 Agoraphobia F 40.1 Social phobias F 40.2 Specific (isolated) phobias F 41 Other anxiety disorders F 41.0 Panic disorder [episodic paroxysmal anxiety] F 41.1 Generalized anxiety disorder F 41.2 Mixed anxiety and depressive disorder

5. SYMPTOMS

6. ICD-10: F 40 Phobic anxiety disorders A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous. As a result these situations are characteristically avoided or endured with dread. The patient's concern may be focused on individual symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression often coexist.

7. ICD-10: F 40.0 Agoraphobia A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes. Panic disorder is a frequent feature of both present and past episodes. Depressive and obsessional symptoms and social phobias are also commonly present as subsidiary features. Avoidance of the phobic situation is often prominent, and some agoraphobics experience little anxiety because they are able to avoid their phobic situations.

8. ICD-10: F 40.1 Social phobias Fear of scrutiny by other people leading to avoidance of social situations. More pervasive social phobias are usually associated with low self-esteem and fear of criticism. They may present as a complaint of blushing, hand tremor, nausea, or urgency of micturition, the patient sometimes being convinced that one of these secondary manifestations of their anxiety is the primary problem. Symptoms may progress to panic attacks.

9. ICD-10: F 40.2 Specific (isolated) phobias Phobias restricted to highly specific situations such as proximity to particular animals, heights, thunder, darkness, flying, closed spaces, urinating or defecating in public toilets, eating certain foods, dentistry, or the sight of blood or injury. Though the triggering situation is discrete, contact with it can evoke panic as in agoraphobia or social phobia.

10. ICD-10: F 41 Other anxiety disorders Disorders in which manifestation of anxiety is the major symptom and is not restricted to any particular environmental situation. Depressive and obsessional symptoms, and even some elements of phobic anxiety, may also be present, provided that they are clearly secondary or less severe.

11. ICD-10: F 41.0 Panic disorder [episodic paroxysmal anxiety] The essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable. As with other anxiety disorders, the dominant symptoms include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization). There is often also a secondary fear of dying, losing control, or going mad.

12. ICD-10: F 41.1 Generalized anxiety disorder Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is "free- floating"). The dominant symptoms are variable but include complaints of persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. Fears that the patient or a relative will shortly become ill or have an accident are often expressed.

13. ICD-10: F 41.2 Mixed anxiety and depressive disorder This category should be used when symptoms of anxiety and depression are both present, but neither is clearly predominant, and neither type of symptom is present to the extent that justifies a diagnosis if considered separately. When both anxiety and depressive symptoms are present and severe enough to justify individual diagnoses, both diagnoses should be recorded and this category should not be used.

14. CAUSES

15. FEAR A normal human condition/emotion Babies are born with a fear instinct Survival value May become excessive, irrational & pathological

16. CONTEMPORARY LIFE Our lives are being ruled by gangsters, burglars, rapists & drug dealers The result: over-protected children & fearful adults

17. PHOBIAS Excessive and unrealistic fears Greek: φόβος (phobos) = fear

18. PHOBIAS: CAUSES Some people more vulnerable than others Trigger: rude shock or traumatic experience Fear imprinted on the brain – a network of neurons is fixed Brain chemistry

19. NEURONS & NEUROTRANSMITTERS Brain cells (neurons) form networks and communicate by means of chemicals called neurotransmitters

20. BRAIN CHEMISTRY Phobias, anxiety & panic attacks often accompanied by lack of neurotransmitters GABA, Serotonin & Dopamine (responsible for feelings of security, self-confidence & excitement)

21. ANXIETY & PANIC ATTACK Often connected to phobias, agoraphobia or social phobia Often accompanied by depression

22. PANIC ATTACKS: CAUSES Lack of certain neurotransmitters Overdose of stress Hyper-ventilation May be due to medical condition (e.g. asthma, heart problems)

23. SOCIAL PHOBIA Excessive fear of people & social situations Blush or sweat Dizziness or nausea Dry mouth Difficulty talking - stutter and stammer Stomach pain Heart palpitations and trembling Paralyzing panic attack

24. SOCIAL PHOBIA: CAUSES Inherited tendency Trigger: embarrasment or humiliation in public Results: social isolation, no life partner, cannot work with people & depression

25. AGORAPHOBIA Greek: άγορά (agora) = market square Excessive fear of open spaces & being away from home May loose self-control in public Helplessness when among other people Fear of being hedged in Light-headedness or dizziness Headaches Beating heart Nausea Sweatiness Panic attacks

26. AGORAPHOBIA: CAUSES Inherited tendency Trigger: traumatic experience People with chemical dependency more amenable

27. AGORAPHOBIA - RESULTS Social isolation Cannot work outside home or go shopping Dependent upon others

28. XENOPHOBIA Fear of or bias towards strangers & aliens Not a real phobia

29. HOMOPHOBIA Bias towards gay people Not a real phobia

30. TREATMENT

31. MEDICATION Medical practitioners often prescribe antidepressants Not always effective Take long to work (if at all) Don’t solve any problems Side-effects

32. PHOBIAS: TREATMENT Goal: removal of symptoms, slaying the monsters Behaviour therapy: flooding, gradual exposure, progressive desentization Group therapy Hypnosis Emotional Freedom Technique Exercise Nutritional supplements

33. AGORAPHOBIA: TREATMENT Psychologist has to visit home of sufferer Behaviour therapy Hypnosis Exercise Emotional Freedom Technique Nutritional supplements

34. ANXIETY ATTACK: TREATMENT Relaxation exercises Behaviour therapy Exercise Hypnosis Emotional Freedom Technique Nutritional Supplements

35. THE BENEFIT OF EXERCISE Relaxation Pain management Secretes endorphins Health improves Self-confidence improves

36. PANIC ATTACK: SELF-HELP Breathe into paper bag to counter hyper-ventilation Deliberate relaxation exercises

37. EAT HEALTHY Lots of fruit and fresh veggies Provide fibre Enough water Avoid fat, oil, sugar, alcohol & caffeine Supplement vitamins, minerals & Omega-3 fatty acids Amino acids (GABA, 5-HTP)

38. YOUR SPIRITUAL NEEDS Phobic, anxious and panicky people feel powerless Faith in God may restore power

39. TRUST IN GOD Ps 27:1 The LORD is my light and my salvation; whom shall I fear? The LORD is the strength of my life; of whom shall I be afraid?

40. GET A CLEAR CONSCIENCE Unresolved guilt may cause depression, fears, anxiety & panic Read Ps 103 You may forgive yourself – no need to punish yourself

41. GOD MADE MAN TO BE HAPPY Gen 1:27 – 41 God created man in his own image. In God`s image he created him; male and female he created them. God blessed them. (….) God saw everything that he had made, and, behold, it was very good.

42. GOD MADE MAN TO BE HAPPY Eccl 11:9 Rejoice, young man, in your youth, and let your heart cheer you in the days of your youth, and walk in the ways of your heart, and in the sight of your eyes; but know that for all these things God will bring you into judgment.

43. SEEK HELP! Join a support group Consult a mental health practitioner

44. SERENITY IS POSSIBLE