• Trying to block out thinking or talking about the event because you get upset when you remember what happened
• Staying away from people or places that remind you of the trauma
• Losing interest in life or feeling distant from people
• Sensing somehow that you don't have a long future
• Feeling numb or detached
You feel on guard and stirred up in several ways:
• Becoming startled more easily
• Losing your temper quickly and feeling irritable
• Feeling unable to concentrate as well as before
• Sleeping poorly
The diagnosis of PTSD is complicated. If you suspect that you may have it, you should seek professional help. On the other hand, you may realize that you have a few of these symptoms but not the full diagnosis. If so, and if your problem feels mild and doesn't interfere with your life, you may want to try working on the difficulty on your own for a while. But seek help if you don't feel better soon.
The following example of Wayne illustrates what living with PTSD is like. Wayne struggles daily with his demons.
Wayne was late for work. He started the long trek from his car to his office at the Pentagon, and he heard the loud engine of an airplane just overhead. He was shocked to see how low the plane was flying. The next thing he knew, he was thrown to the ground by a loud explosion and a burst of wind. He remembers people streaming out of the building screaming and crying, some injured. Wayne can't recall many of the details of that day. He was told that his late arrival certainly saved his life. Many friends and co-workers weren't so lucky.
Wayne believes he should be more grateful. Physically he was banged up a little. But his emotional injuries were extensive. Wayne has trouble sleeping. He tries to block the memories of that horrible day, but they seem to flood his brain. He can't concentrate, and he feels like he's in another world detached from others. He can't face going to work and takes an early retirement.
Wayne has PTSD. Like many others with the disorder, he witnessed a horrible event that his mind doesn't know how to cope with. Many veterans returning from active duty suffer from PTSD. Treatment can be very effective. See Chapter 8 for strategies.
Obsessive-compulsive disorder: Over and over and over again
Obsessive-compulsive disorder (OCD) wreaks incredible havoc on people's lives because OCD frustrates and confuses not only the people afflicted with it but their families and loved ones as well. If untreated, it's likely to last a lifetime. Even with treatment, symptoms often recur. That's the bad news. Thankfully, highly effective treatments are available. For much more information, read our book Obsessive-Compulsive Disorder For Dummies (Wiley).
Distinguishing between obsessions and compulsions
A person with OCD may exhibit behaviors that include an obsession, a compulsion, or both. So what's the difference between obsessions and compulsions?
Obsessions are unwelcome, disturbing, and repetitive images, impulses, or thoughts that jump into the mind. For example, a religious man may have a thought urging him to shout obscenities during a church service, or a caring mother may have intrusive thoughts of causing harm to her baby. Thankfully, people with OCD don't carry out these kinds of thoughts, but the obsessions haunt those who have them. Most people who have OCD know that their obsessions are not entirely realistic but can't seem to stop believing them.
Compulsions are repetitive actions or mental strategies carried out to temporarily reduce anxiety or distress. Sometimes, an obsessive thought causes the anxiety; at other times, the anxiety relates to some feared event or situation that triggers the compulsion.
For example, a woman may wash her hands literally hundreds of times each day in order to reduce her anxiety about germs, or a man may have an elaborate nighttime ritual of touching certain objects, lining up clothes in a specific way, arranging his wallet next to his keys in a special position, stacking his change, getting into bed in precisely the correct manner, and reading one section of the Bible before turning out the light. And if he performs any part of the ritual in less than the "perfect" way, he feels compelled to start all over until he gets it right. Otherwise, he worries that he won't be able to sleep and that something bad may happen to those he cares about.
Table 2-1 presents some common obsessions and compulsions experienced by those with OCD.
Seeing OCD when it isn't there
You may recall walking to school with your friends and avoiding cracks in the sidewalk. If you stepped on one, perhaps someone chided, "If you step on a crack, you'll break your mother's back!" And sometimes you walked to school by yourself and that same thought occurred to you, so you avoided stepping on the cracks. Obviously, you knew that stepping on a crack wouldn't break your mother's back. So not stepping on cracks almost qualifies as a compulsion. That's because you may have done it repeatedly while knowing that it wouldn't stop anything bad from happening. If you did it simply as a game and it didn't bother you that much, avoiding cracks was no big deal, and it wasn't OCD. Besides, kids often have magical or superstitious thinking, which they usually outgrow.
On the other hand, if some part of you really worried that your mother might suffer if you stepped on a crack and if you sometimes couldn't even get to school because of your worry, you probably had a full-blown compulsion. Many people check the locks more than once, go back to make sure the coffeepot is turned off a couple of extra times, or count stairs or steps unnecessarily. It's only when doing these things starts taking too much time and interferes with relationships, work, or everyday life that you really have a problem.
Lisa's story depicts someone with OCD who worries about contamination. Like many people with OCD, her fears have some chance of coming true, but she greatly exaggerates the risks.
Lisa likes a neat and clean home. In college, she ended up staying in a single dorm room because she couldn't stand the mess of other students. Now, married and with a new baby, Lisa spends hours cleaning and straightening the house. Her husband doesn't seem to mind. He works very long hours and likes coming home to a neat house and a hot meal.
Lisa's television is usually on during the day while she cleans and tends to the baby. She first hears about a possible flu outbreak on cable news. The death of a toddler in a nearby state frightens her, and she begins obsessing about a worldwide pandemic. She believes that by sanitizing her house, she will keep the virus from infecting her family. Lisa orders her groceries and cleaning supplies over the Internet so that she can avoid leaving the house, fearing contamination. She now spends most of the day cleaning except when she is feeding the baby. Her husband, starting to get concerned, asks her if maybe she's becoming a bit too uptight about germs.
Like many people with OCD, Lisa's fear of germs starts off with a normal tendency to be clean and neat. However, OCD takes over her life when she can't seem to clean enough and constantly worries about getting the flu.
Seeing How Anxiety Differs from Other Disorders
Anxious symptoms sometimes travel with other company. Thus, you may have anxiety along with other emotional disorders. In fact, about half of those with anxiety disorders develop depression, especially if their anxiety goes untreated. Recognizing the difference between anxiety and other emotional problems is important because the treatments differ somewhat.
Depression: Depression can feel like life in slow motion. You lose interest in activities that used to bring you pleasure. You feel sad. Most likely, you feel tired, and you sleep fitfully. Your appetite may wane, and your sex drive may droop. Similar to anxiety, you may find it difficult to concentrate or plan ahead. But unlike anxiety, depression saps your drive and motivation. For more information, see our book Depression For Dummies (Wiley).
Bipolar disorder: If you have bipolar disorder, you seesaw between ups and downs. At times, you feel that you're on top of the world. You believe your ideas are unusually important and need little sleep for days at a time. You may feel more special than
other people. You may invest in risky schemes, shop recklessly, engage in sexual escapades, or lose your good judgment in other ways. You may start working frantically on important projects or find ideas streaming through your mind. Then suddenly you crash and burn. Your mood turns sour and depression sets in. (Check out Bipolar Disorder For Dummies by Candida Fink, MD, and Joe Kraynak [Wiley] for more about this disorder.)
Psychosis: Not only may psychosis make you feel anxious, but the symptoms also profoundly disrupt your life. Psychosis weaves hallucinations into everyday life. For example, some people hear voices talking to them or see shadowy figures when no one is around. Delusions, another feature of psychosis, also distort reality. Common psychotic delusions include believing that the CIA or aliens are tracking your whereabouts. Other delusions involve grandiose, exaggerated beliefs, such as thinking you're Jesus Christ or that you have a special mission to save the world.
If you think you hear the phone ringing when you're drying your hair or in the shower, only to discover that it wasn't, you're not psychotic. Most people occasionally hear or see trivial things that aren't there. Psychosis becomes a concern only when these perceptions seriously depart from reality. Fortunately, anxiety disorders don't lead to psychosis.
Substance abuse: When people develop a dependency on drugs or alcohol, withdrawal may create serious anxiety. The symptoms of drug or alcohol withdrawal include tremors, disrupted sleep, sweating, increased heartbeat, agitation, and tension. However, if these symptoms only come on in response to a recent cessation of substance use, they don't constitute an anxiety disorder.
Those with anxiety disorders sometimes abuse substances in a misguided attempt to control their anxiety. If you think you have an anxiety disorder, be very careful about your use of drugs or alcohol. Talk to your doctor if you have concerns.
Chapter 3: Sorting Through the Brain and Biology
In This Chapter
Looking at the anxious brain
Exploring what anxiety does to the body
Uncovering anxiety imposters
Most people with anxiety describe uncomfortable physical symptoms that go along with their worries. They may experience heart palpitations, nausea, dizziness, sweats, or muscle tension. Those symptoms are evidence that anxiety is truly a disorder of both the mind and the body.
In this chapter, we review some of the biological roots of anxiety, as well as the consequences of chronic stress on health. Then we tell you about medications or food that can actually make you feel anxious. Finally, we discuss how some illnesses can cause or mimic anxiety.
Examining the Anxious Brain
The brain takes in information about the world through sight, taste, smell, sound, and touch. Constantly scanning the world for meaning, the brain integrates information from the past with the present and plans what actions to take. For most people, most of the time, the brain does a pretty good job. But for those with chronic anxiety, something goes awry.
Billions of nerve cells (neurons) reside in the brain. They're organized into a variety of complex structures or circuits. Some of these structures are particularly involved in producing feelings of anxiety, fear, and stress. These brain structures communicate with one another by sending chemical messengers, known as neurotransmitters, back and forth among them.
In the following sections, we explain how the brain interprets information and what role the brain's chemicals play in making you anxious.
Seeing how the brain's circuits are connected
Think of the brain as having many interconnected circuits. One circuit involves the limbic system and the frontal lobes. The limbic system (particularly the amygdala) registers danger and threats and gives rise to reflexive fear responses. The frontal lobes use thought and reason to process incoming information. For example, the limbic system could set off alarms reflexively upon seeing a snake. However, the frontal lobes may signal the system to calm down as it processes the fact that the snake is in a glass cage.
In anxiety disorders, either the limbic system or the frontal lobes (or both) may fail to function properly. Thus, the limbic system may trigger fear responses too easily and too often, or the frontal lobes may fail to use logic to quell the fears set off by the limbic system. When the brain signals danger, the body responds by getting ready for action. The next section explains the chemical aspects of fear.
Communicating chemicals
Neurotransmitters help nerve cells communicate feelings, fears, emotions, thoughts, and actions through an intricate orchestration. Four major neurotransmitter systems and some of their functions include
The noradrenergic system, which produces norepinephrine and epinephrine. It also stimulates organs required in the fight-or-flight response (see the following section).
The cholinergic system, which activates the noradrenergic neurotransmitters and facilitates formation of memories.
The dopaminergic system, which is involved in movement and is also related to feelings of pleasure and reward. Dopamine disruptions cause problems with attention, motivation, and alertness, and appear to be quite important in the development of fear responses.
The serotonergic system, which is related to moods, anxiety, and aggression.
As these neurotransmitters pulse through your brain, the brain circuitry involved in fear and anxiety lights up. Your body then responds with a full-system alert known as the fight-or-flight response.
Preparing to Fight or Flee
When danger presents itself, you reflexively prepare to stand and fight or run like you've never run before. Your body mobilizes for peril in complex and fantastic ways. Figure 3-1 gives you the picture.
Your body responds to threats by preparing for action in three different ways: physically, mentally, and behaviorally.
Physically: The brain sends signals through your nervous system to go on high alert. It tells the adrenal glands to rev up production of adrenaline and noradrenaline. These hormones stimulate the body in various ways. Your heart pounds faster and you start breathing more rapidly, sending increased oxygen to your lungs while blood flows to the large muscles, preparing them to fight or flee from danger.
Figure 3-1: When presented with danger, your body prepares itself to flee or stand and fight.
Stress and the common cold
Research has shown that the way people perceive things — possibly more than what's happening in reality — affects the immune system and the tendency to come down with colds.
Psychologist Dr. Sheldon Cohen and colleagues have conducted research on the role of stress in susceptibility to the common cold virus. In one of his earlier studies, Dr. Cohen asked volunteers to describe their stress levels in the previous months. He then exposed the participants to the cold virus. Those who reported high stress came down with colds at far higher rates than the volunteers who reported having low stress.
A more recent study reported in the journal Health Psychology (2008) found that people's self-reported sense of their socioeconomic status also predicted who would come down with a cold after exposure to the virus. Those who felt themselves to be at a lower status level got sick more frequently than the others. Interestingly, objective measures of socioeconomic status were not so predictive of who would get colds. Thus, it seems it's people's perception of their socioeconomic ranking that matters, not the actual ranking itself.
These studies show that the mind and body have an intricate relationship. Other research has been consistent with this idea, showing that stress also slows wound healing, diminishes the effectiveness of vaccinations, and increases inflammation. In other words, the way people think about things that happen to them strongly affects their bodies.
Digestion slows to preserve energy for meeting the challenge, and pupils dilate to improve vision. Blood flow decreases to hands and feet to minimize blood loss if injured and keep up the blood supply to the large muscles. Sweating increases to keep the body cool, and it makes you slippery so aggressors can't grab hold of you. All your muscles
tense to spring into action.
Mentally: You automatically scan your surroundings intensely. Your attention focuses on the threat at hand. In fact, you can't attend to much of anything else.
Behaviorally: You're now ready to run or fight. You need that preparation in the face of danger. When you have to take on a bear, a lion, or a warrior, you'd better have all your resources on high alert.
Granted, in today's world, you're not very likely to encounter lions and bears. Unfortunately, your body reacts too easily with the same preparation to fight traffic, meet deadlines, speak in public, and cope with other everyday worries.
Overcoming Anxiety For Dummies, 2nd Edtion Page 6