• Anxiety Disorders — Just in Your Head?

young woman with her head in her hands, sad, worried, anxious, depressed

This was her third trip to the Emergency Department in two days. She had been home watching TV when all of a sudden her heart started racing, she felt her face flush, her hands tingle, and it was hard to catch her breath.

She was scared because she felt like she was dying.

She started crying uncontrollably, making it all the more difficult to breathe. She was frustrated with the emergency room staff because they felt a healthy 20-year-old who had a thorough medical workup completed two days before was not having a heart attack but, rather, an anxiety attack.

The above scenario is not an uncommon one, especially the frustration a person may feel if they believe doctors are not taking their condition seriously or saying “it’s all in your head.”

In a way, they are not entirely wrong. Anxiety is all in the head. Here’s why:

We all experience some anxiety at different periods in time. It’s the brain’s way of getting us ready to face or escape danger, or deal with stressful situations.

For example, anxiety before exams can make one study more and, hence, do well on a test. However, at times, the anxiety can be quite severe or exaggerated in relation to the actual situation. This can lead to intense physical sensations, anxious thoughts, worries and avoidant behaviors that impact one’s life.

An example would be skipping school the day of a test because one is so anxious or having a panic attack to the point that one can’t take a test.

But why does anxiety manifest with physical symptoms?

Consider this simplified explanation: The brain is an extremely powerful organ. It's, in a way, the central command center for the rest of the body and has an influence over all the different organ systems. When this central command system is hijacked by anxiety, the anxiety has free reign to cause havoc in the different organ systems, creating actual physical symptoms even though there's nothing wrong with the organ itself.

Primary care and emergency medicine providers usually are the first line of defense. Their methodical approach to rule out medical causes — such as thyroid, heart and other hormonal problems — and then diagnose an anxiety disorder is a positive approach to diagnosing an anxiety condition.

The good news is anxiety disorders are manageable.

Medications are available to help in the short- or long-term. A number of drug-free ways of managing anxiety, including stress reduction techniques, exercise, breathing exercises and yoga, exist. Cognitive behavioral therapy, which teaches your brain to change thought patterns, also can help.

So when you hear “it’s an anxiety disorder,” don’t despair or think no one is taking you seriously. Rejoice in the fact there is no life-threatening medical problem causing your symptoms, and ask your health care provider about the best way for you to gain control over anxiety.

Filza Hussain, M.D., is a psychiatrist who sees patients in Behavioral Health at Mayo Clinic Health System in Rice Lake, Wisconsin.

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