Anxiety disorders include conditions such as:

Panic Disorder

Panic disorder (PD) is one of the many types of anxiety disorders and is associated with panic attacks that can occur out in open spaces or in the privacy of your home. Panic attacks are terrifying, and you are not alone if you feel that you are experiencing PD – about 6 million people in the U.S. suffer from this condition.

People with PD live in constant fear of panic attacks as it is common for them to occur unexpectedly, or without warning. Symptoms of an attack usually last anywhere from from 15 to 45 minutes, but in extreme cases they may last for more than an hour.

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The DSM-5 defines panic attacks as surges of intense fear or discomfort that peak within minutes. There are two categories for panic attacks—with agoraphobia and without agoraphobia. Panic attacks occur when a person experiences four or more of the following:

  • Danger or threat of impending disaster
  • Anxiety about losing control or losing one’s life
  • Heart pounding at a rapid rate
  • Trembling, shaking, or sweating
  • Feeling short of breath or a tightness in the throat
  • Feelings of chills and hot flashes
  • Nausea or chest pains
  • Dizziness, lightheadedness, or faintness
  • Numbness or tingling sensation

As a primary symptom of panic disorders, panic attacks are usually unexpected and recurrent. Further, at least one panic attack is generally followed by one month or more of anxiety that causes a change in behavior and the avoidance of situational triggers of attacks.

Treatment of Panic Disorder

Fortunately, there are ways to prevent panic attacks that can be achieved by using medications, psychotherapy, or a combination of both. The duration of treatment depends on the severity of the condition and the response to treatment.

Medication Management

To help make panic attacks less frequent or less severe, we will typically prescribe medication including serotonin selective reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs). SSRIs target serotonin, a neurotransmitter associated with mood. By balancing serotonin levels, SSRIs help regulate mood, decrease anxiety, and improve sleep.

The anxiety and fear caused by panic disorder can also be reduced by anti-anxiety medications like benzodiazepines. Medication like this can cause the central nervous system to slow down, which can make a person feel calmer and more relaxed. As useful as this may be for treating anxiety, such medications may also lead to dependence or abuse, cognitive deficits and in some cases a paradoxical agitation/rebound anxiety, which is why we work carefully with you to prevent adverse effects.

Psychotherapy

Psychotherapy is also effective in treating panic disorder and is often combined with medication management for the best possible outcome. Treatment involves an in-depth approach to explore your thoughts and feelings in order to help you identify the triggers of your panic attacks and change your thinking, behaviors, and reactions. As you begin to respond differently to stimuli, the attacks decrease and may ultimately stop.

Obsessive-compulsive Disorder

Obsessive-compulsive disorder (OCD) is a medical condition that is characterized by excessive unwanted thoughts (obsessions) that cause significant anxiety, which may result in repetitive behaviors (compulsions) to decrease that anxiety.

The term OCD is often used rather casually, like when a person is characterized as being too “rigid” wanting to do things a particular way. Many of us may exhibit OCD-like symptoms occasionally, but most of us can handle these symptoms and get on with our daily lives. A diagnosed case of OCD, however, is much more nuanced, severe, and complex.

OCD is diagnosed by the presence of obsessions and compulsions that are time-consuming (sometimes up to several hours a day), cause significant distress, and interfere with social or occupational functioning. Particular themes are often emphasized or exaggerated in OCD. For example, when a person is constantly afraid of being infected by germs, this may lead them to spend hours washing their hands excessively until their hands are chapped and sore. It is often recommended to seek professional help when the obsessions or compulsions take over your life, impact everyday activities, or trigger extreme anxiety throughout the day.

We diagnose OCD by the symptoms, behaviors, and conditions listed and defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The following are symptoms one might experience when diagnosed with OCD:

  • Fear of being contaminated with germs or dirt or of infecting others
  • Fear of losing control and harming yourself or others
  • Intrusive sexually explicit or violent thoughts and images
  • Excessive focus on religious or moral ideas
  • Fear of losing or not having things you might need
  • Excessive double-checking of things such as locks, appliances, and switches
  • Repeatedly checking in on loved ones to make sure they’re safe
  • Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
  • Spending a lot of time washing or cleaning

Treatment of OCD

We work to find the appropriate medication and therapy for people with OCD based on various factors such as age, symptoms, and severity. Specialized OCD treatment typically results in a better quality of life and improved functioning for patients. In addition to a better quality of life, the treatment will enable them to work, attend school, and participate in leisure activities without disruptions.

Medication Management

Following evaluation, we determine if medication management is appropriate for you. The most common type of medication prescribed to treat OCD is an SSRI or selective serotonin reuptake inhibitor. SSRIs tend to be the most frequently prescribed medication for depression and are also helpful in treating OCD. There is also the use of adjuncts such as atypical antipsychotics, as well as  short term use of benzodiazepines in some severe cases.

It’s important to note that treatment is not always accompanied by medication and can vary based on each patient’s severity and response to other psychotherapy treatments.

Psychotherapy

Psychotherapy is emphasized in the treatment of obsessive-compulsive disorder. The two scientifically-based methods of cognitive behavioral therapy (CBT) for treating OCD are cognitive therapy and exposure and response prevention (ERP).

Cognitive therapy for OCD is a specialized type of therapy which is conducted in stages of treatment. The typical course of treatment usually requires six months to a year, however the process can be made to go faster with the use of medications. Therapy sessions involve intentionally exposing patients to feared thoughts or images related to their obsessions, which initially increases anxiety. If nothing harmful happens following repeated exposure, the patient eventually becomes desensitized and experiences less anxiety in response to the obsessions.

Cognitive therapy is often coupled with ERP, particularly when compulsions are prominent. ERP therapy also exposes patients to their obsessions, but they are asked to not engage in compulsive behaviors that usually relieve anxiety. Eventually, your brain learns that nothing terrible happens when you stop performing compulsive rituals. It may seem unconventional, but this new way of confronting your fears leads directly to fewer and less intense fears or obsessions.

Post Traumatic Stress Disorder (PTSD)

Post traumatic stress disorder (PTSD) occurs when the brain struggles to deal with anxious feelings and thoughts after experiencing or witnessing a traumatic event, or series of events, that is perceived to be life threatening. PTSD is often associated with veterans, but 50% of all people will experience a traumatic event at least once in their lifetime, and 20% of those people will develop PTSD.

After experiencing a traumatic event, such as being in a major car accident or being the victim of a burglary or sexual assault, it is entirely normal to react with shock, anger, nervousness, fear, and possibly even guilt. Typically, these reactions subside over time. However, a person may continue to experience intense feelings and have disturbing thoughts long after the trauma has passed, which interferes with their daily lives. In that case, they may have PTSD and should seek psychiatric treatment.

PTSD is not diagnosed immediately after exposure to trauma. Rather, a person may be diagnosed with PTSD if they still experience symptoms months after a traumatic event. Mental health professionals diagnose PTSD based on the following symptoms, behaviors, and conditions as listed and defined in the DSM-5:

  • Re-experiencing symptoms
    • Flashbacks that cause you to feel like you are going through the event again
    • Nightmares, frightening thoughts
  • Avoidance
    • Staying away from places, events, and objects that serve as reminders of the trauma. A car accident might cause you to stop driving, for example.
    • Avoiding thoughts and feelings associated with the trauma. For example, you might try to stay busy to avoid thinking about what happened.
  • Alterations in cognition and mood
    • Being easily startled
    • Feeling tense or “on edge”
    • Having difficulty sleeping
    • Having angry outbursts
  • Alterations in arousal and reactivity
    • Trouble remembering important things about the traumatic event
    • Negative thoughts about yourself or the world
    • Feelings of guilt and self-blame
    • Loss of interest in something you enjoyed
    • Difficulty concentrating

These symptoms can lead to significant impairment in a person’s life, whether socially, professionally, or otherwise, and may require psychiatric treatment.

Treatment of PTSD

Psychological and biological reactions to trauma can be intense and painful. Some people live their lives with few or no symptoms, while for others, the intensity and pain persist. Traumatic psychological wounds can be challenging to treat with medication alone, so the most effective treatment usually involves both medication management and psychotherapy.

Medication Management

We will recommend medication management as a tool to help manage your reaction to trauma. Medication can help people dealing with PTSD control and relieve their symptoms, allowing them to participate more effectively in psychotherapy.

Antidepressants, including SNRIs and SSRIs (selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors), are commonly used to treat PTSD. Also second generation antipsychotics have been shown to have some benefit in certain cases.

Psychotherapy

For the best possible outcome, we will recommend the use of medications alongside various psychotherapy treatments, such as:

  • Cognitive-behavioral therapy (CBT) – This form of talk therapy can help you understand your feelings, process the traumatic event, and change your negative thinking patterns.
  • Exposure therapy – During exposure therapy sessions, patients will relive aspects of trauma in a safe environment to help desensitize and break patterns of avoidance and fear.
  • Eye Movement Desensitization and Reprocessing (EMDR) – EMDR therapy involves briefly exposing patients to traumatic memories while simultaneously focusing on an external stimulus, such as combining the patient’s eye movements with the therapist’s hands.

With PTSD, the risk of developing a comorbid depressive disorder is three to five times greater. Therefore we highly recommend you seek help immediately

Generalized Anxiety Disorder

Generalized anxiety disorder  causes people to worry uncontrollably about everyday events and situations at a level that is out of proportion to their severity.

When faced with stressful situations, we are likely to feel anxious or worried. However, if you have extreme anxiety or worries that negatively impact your life, we recommend seeking treatment.

As outlined in the DSM-5, GAD is characterized by having trouble controlling worry on most days over a six-month period and displaying three or more of the following symptoms:

  • Persistent anxiety or worry about many things that are out of proportion to the impact of the events
  • Over-analyzing plans and potential outcomes for worst-case scenarios
  • Perceiving situations and events as threatening, even when they aren’t
  • Difficulty coping with uncertainty
  • Trouble sleeping
  • Muscle tension or muscle aches
  • Trembling, feeling twitchy
  • Nervousness, or easy to startle

Most importantly, these symptoms can negatively impact functioning in personal, social, or occupational settings. GAD symptoms can overlap with other mood and anxiety disorders, and in many cases, can occur along with other disorders. The male to female ratio is 1:1 and it can be debilitating so please reach out for specialized treatment if you are experiencing similar symptoms.

Treatment of GAD

Generalized anxiety disorder may occur in children or adults. Treatment can be a long-term process for many people because the topic of worries often changes over time. However, successful treatment helps reduce anxiety by enhancing mental and physical wellbeing. It also increases engagement with people, places, and situations that previously caused anxiety. Medication and psychotherapy are often used together to treat or improve the symptoms of this condition.

Medication Management

We tend to focus on long-term success in GAD treatment. Therefore, anti-anxiety medications that provide temporary relief are only recommended as a short-term measure to alleviate symptoms when starting the treatment process. We instead utilize medications that have demonstrated long-term success in treating GAD symptoms, including SSRIs, SNRIs, and tricyclic antidepressants.

Psychotherapy

Psychotherapy is often emphasized in treating anxiety disorders such as GAD. Cognitive-behavioral therapy (CBT) is a form of psychotherapy that is commonly used to treat GAD. It is usually a short-term, structured treatment that focuses on the interplay between the conscious thoughts, feelings, and behaviors that perpetuate anxiety. Psychotherapy helps patients recognize and control their anxious thoughts while changing their behavior and thinking. Broad topics discussed during therapy sessions include in-depth analysis of the anxious thoughts, learning coping skills, relaxation techniques, imagined exposure to worries, modification of behaviors that have resulted from the worries, and problem-solving.

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