For many Americans, fear is a way of life

Health: Anxiety disorders afflict millions of people, no matter how secure their lives.

Health & Fitness

March 03, 2002|By William Hathaway | William Hathaway,Special to the Sun

When anxiety hits Betty Simpson, her mind becomes a sort of Daytona 500, where thoughts, worries and fears careen around in a blinding blur.

Her hands clutch the steering wheel so tightly her knuckles turn white. Or, trying to outrace her repetitious thoughts, the 42-year-old social worker from Rocky Hill, Conn., loads the dishwasher and starts her laundry, only to ditch both chores and go for a bike ride.

"When you go over the edge, you can't concentrate, you can't focus, your memory goes," said Simpson. "You can't shake the feeling that something bad is about to happen if you don't keep going."

Simpson is one of the estimated 19 million American adults who suffer from an anxiety disorder, a diverse group of ailments sculpted from the primal emotion of fear. As many as one in four people will experience some type of anxiety disorder in their lifetimes.

Science and the experiences of people like Simpson shed light on reasons why we fear -- and how events can turn an emotion that was designed by nature to preserve our lives into a devouring obsession.

Fear is perhaps the oldest of all emotions. Its ancient genesis can be seen in the recoil of a single-celled organism from a dangerous stimulus.

While a human may inherit a propensity for anxiety, the form it takes seems to be shaped primarily by the environment, said William Clark, professor emeritus at the University of California, Los Angeles.

Simpson, for instance, suffers from generalized anxiety disorder, characterized by an excessive concern about nonthreatening events or situations. In the aftermath of the Sept. 11 attacks, many Americans have reported feeling the edginess, sleeplessness and remoteness from family and friends that are classic symptoms of generalized anxiety.

Many people with generalized anxiety disorder also experience depression, which scientists are now recognizing as a closely related condition, and panic disorder, which is in essence a paralyzing fear of fear itself.

Clark and other scientists believe that evolution branded fearfulness deep into the genome of our species. Those who lacked the sufficient fear response tended to perish, leaving the more timid and cautious to pass on their genes to generations to come.

"The question is, if fear is such a valuable adaptation, why does it feel so bad?" said Ned Kalin, professor of psychiatry at the University of Wisconsin. "The answer is that physical and psychological pain orients us to take care of the problem."

Fear and anxiety result from a complicated interplay of brain circuitry, hormones and chemical messengers called neurotransmitters. In humans, the fear response can be moderated by information processed in the frontal cortex, the seat of intelligence and self-awareness. However, the balance seems to be weighted to produce anxiety; in essence, fear is the default setting.

In people with anxiety disorders, the regulation of that complex interplay gets out of whack.

"It is a regulatory problem," Kalin said.

In Simpson's life, anxiety has not always been an enemy. In some ways, her need to mask nagging worries and concerns with bursts of activity has helped her become a productive person.

A certain amount of anxiety enhances performance of many tasks, said Dr. Nicholas DeMartinis, a psychiatrist at the University of Connecticut Health Center in Farmington.

"People's performance actually improves as the level of anxiety increases," DeMartinis said. "But there comes a point when anxiety begins to interfere with performance instead of helping."

People with panic disorder become fixated on their emotions, which careen wildly out of control, said Dr. John Saksa, an associate research scientist at the Yale University School of Medicine in New Haven, Conn.

In contrast, those with generalized anxiety disorder tend to fixate on something external, such as constantly worrying that a roof may leak.

Fortunately, the majority of patients suffering from generalized anxiety disorder or panic attack can get substantial relief through counseling, drug treatments or both, DeMartinis said.

William Hathaway is a reporter for The Hartford Courant, a Tribune Publishing newspaper.

TYPES OF ANXIETY

More than 13 percent of adults suffer from some form of anxiety disorder:

Generalized anxiety disorder: Characterized by excessive, unrealistic worry that lasts six months or more. Patients likely to have other anxiety disorders and depression.

Obsessive-compulsive disorder: Patients feel compelled to perform acts to relieve obsessive thoughts.

Panic disorder: Marked by recurrent, unexpected panic attacks.

Post-traumatic stress disorder: Can follow exposure to a traumatic event. Symptoms include the re-experience of the event, the need to avoid stimuli associated with it, and emotional numbing.

Social anxiety disorder: Marked by a desire to escape social situations that might prove embarrassing.

Specific phobias: Intense, usually inappropriate fear reaction to a specific object or situation, such as heights or closed spaces.

Sources: National Institute of Mental Health, Anxiety Disorders Association of America

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