American Medical Association Family Medical Guide - American Medical Association [461]
If you think you may have a specific or social phobia, tell your doctor, especially if your fears are keeping you from functioning fully in your everyday life. It is difficult to change the way you feel without help from a professional.
Diagnosis
If your doctor thinks you may have a phobia, he or she will perform a physical examination and ask you to describe your symptoms. Doctors can usually diagnose phobias based on a person’s explanation of the way he or she feels.
Treatment
To treat a specific phobia, your doctor will recommend a type of cognitive-behavioral therapy known as desensitization or exposure therapy, which gradually and in increasing stages exposes you to the object or situation that frightens you until your fear diminishes. For example, if you are afraid of flying, you may first be taught relaxation exercises (see page 59), shown pictures of airplanes, and asked to imagine flying in an airplane. The next step would be to go to an airport and then, eventually, fly in an airplane. About 75 percent of people with specific phobias find relief from their symptoms with this type of therapy. No drugs are available for treating specific phobias, although your doctor may prescribe an antianxiety medication (see page 713) for a limited time to help reduce your symptoms.
Exposure therapy also can benefit people with social phobia because it allows them to gradually become more comfortable in social situations and helps them learn how to handle disapproval or criticism. However, for people with social phobia, most doctors recommend exposure therapy in combination with antidepressant medications (see page 712) called selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs). People who have public-speaking anxiety sometimes benefit from drugs called beta blockers (medications used for lowering blood pressure), which they take before participating in the event they are anxious about.
Generalized Anxiety Disorder
Feelings of anxiety that arise before an important event, such as a wedding or the first day of a new job, are normal and experienced by most people. But people with generalized anxiety disorder feel worried and tense constantly, worrying excessively about everyday events as well as special occasions. People who have the disorder always seem to expect the worst, are unable to relax, and are easily irritated.
Generalized anxiety disorder affects about 4 million people in the United States every year. More women than men are affected. The disorder most often begins in childhood or adolescence but also can first appear in adulthood. It does not seem to run in families but may coexist with other psychological disorders, including depression (see page 709), substance abuse (see page 732), or another anxiety disorder. Some physical conditions, such as irritable bowel syndrome (see page 765), also can accompany generalized anxiety disorder.
Symptoms
The hallmark symptom of generalized anxiety disorder is constant, excessive, and often unrealistic worrying about family, finances, work, or other routine aspects of life. Physical symptoms—including fatigue, headaches, muscle tension and pain, trembling, sweating, hot flashes, poor concentration, nausea, or insomnia—often accompany the worry. A person also can be irritable, have trouble concentrating, and develop insomnia.
Diagnosis
If you think you may have generalized anxiety disorder, tell your doctor about your excessive worrying and any physical symptoms you may have. He or she will want to know if any family member has had an anxiety disorder or depression, if you consume a lot of caffeine or alcohol, or if you have experienced any stressful events recently. The doctor may ask you to take a test that can evaluate your anxiety levels to help diagnose generalized anxiety disorder.
Treatment
Treatment of generalized anxiety disorder usually combines antianxiety medications (see