Why Do Doctors Not Refer Anxiety Patients To Psychiatrists? It Can’t Be Taken Lightly
In continuation of our series on mental health issues, Ali Madeeh explains what anxiety is, what is anxiety caused by, and are there any different types of anxiety. Read his earlier article on depression here.
Here is a scene played out several times a day in my clinic. A person walks in (generally of either gender although women outnumber men slightly). They can be any age, from teenagers to people over 80 years old. They all complain of the same thing: they feel restless, anxious and unable to relax. There is an impending feeling of doom, as if something bad is going to happen.
They have a variety of ‘physical symptoms’: dry mouth, sweating, palpitations, stomach problems (‘gas’, bloating, diarrhea or constipation etc) and many others.
They have seen numerous doctors, undergone medical test after test and yet nothing has been found. All their doctors have told them there is nothing wrong with them. Very few of them have encouraged them to see a psychiatrist.
What is Anxiety?
Like many emotional disturbances, anxiety is an exaggerated version of the same emotion that all of us have experienced many times. If you have ever been disciplined by a parent or an irate boss, taken an exam, gotten married, faced a court case or been in an accident, you know what anxiety feels like: the same symptoms outlined above which generally resolve promptly after the stress dissipates.
But what would it be like if those same symptoms persisted hour after hour, day after day, week after week, month after month. The moment you wake up you feel the panic, your heart races, your stomach grumbles, your mouth is constantly dry, you feel as if you are about to choke or die. What would it be like to never have any relief? Never feel relaxed or happy? Never be able to enjoy the moment without feeling like something bad was about to happen.
This is the daily experience of those who suffer from anxiety disorders where a normal human emotion magnifies and grows until it dominates every waking moment.
What causes Anxiety?
Like most psychiatric illnesses, the causes of anxiety can be manifold. A person can inherit a genetic tendency towards being anxious from their parents or family. Traumatic experiences in childhood or adulthood can also trigger anxiety which can become disabling.
Childhood (or adult) physical or sexual abuse, accidents, injuries or illnesses can trigger anxiety. Many medical illnesses can also cause or worsen anxiety symptoms. Abuse of alcohol and illicit drugs can lead to many symptoms of anxiety which can become permanent if help is not sought.
In many cases, one cannot identify any ‘one’ cause of anxiety. It appears to accumulate over a period of months or years through every day stresses: school, college, work, children, family. At some point in time, the person finally ‘tips over’ into an anxiety disorder.
Once a person has an attack of anxiety though, it becomes self-perpetuating. The person becomes afraid of having another attack and that fear itself becomes a trigger to further anxiety.
Are there different types of Anxiety?
Yes. Even though people with anxiety experience similar symptoms (both physical and mental), anxiety related illness can present in different ways.
Some people can develop what are called ‘Panic attacks’ which are exactly what they sound like: an attack of acute, overwhelming anxiety in which a person can have chest pain, shortness of breath, numbness and tingling in the hands and feet and a feeling of impending doom or death.
Others can have a persistent feeling of being ‘keyed up’ all the time along with physical symptoms such as diarrhea, palpitations, sweaty palms etc. Yet others can develop intrusive negative thoughts (often related to religion or sex or other taboo subjects or to cleanliness and being ‘contaminated’).
Some people can develop anxiety attacks and nightmares after being exposed to a life threatening situation such as being in an accident, facing a serious illness or even being exposed to catastrophic stress such as being in a war zone or having been exposed to a terrorist incident.
All of these anxiety disorders present with the ‘core’ symptoms of anxiety although they can manifest in different ways. The treatment accordingly varies between the many illnesses. More on that next time.
The writer is a psychiatrist practicing in Lahore. He taught and practiced Psychiatry in the United States for 16 years. He tweets @Ali_Madeeh