Anxiety

If a patient explains, “I get really anxious,” the diagnosis is easy.  But oftentimes anxious people experience a variety of physical symptoms.  These may be classic, like heart palpitations, tremors, and sweaty palms.  But other symptoms may lead them to seek care, like headache, shortness of breath, dizziness, tingling hands & lips, insomnia, or just fatigue.  Then we have to rule out other causes of those various symptoms before arriving at anxiety as a diagnosis.

There are a wide variety of types of anxiety, some of which include:

  • General Anxiety Disorder: a person simply feels anxious, without knowing why.  This is likely genetic or hereditary.
  • Panic Disorder:  often goes along with General Anxiety Disorder; a person gets sudden panic attacks, that can be disabling
  • Social Phobia:  feeling anxious in social situations
  • Agoraphobia:  feeling anxious when out of the house and in public
  • Obsessive-Compulsive Disorder:  anxious because of an irrational unexplainable need to have things perfectly clean, or in order
  • Post-Traumatic Stress Disorder (PTSD):  due to past trauma, often sexual, or major life-threatening situations like war and battle.  People may have flashbacks, nightmares, or be hypervigilant (always on edge)

Anxiety can also cause any kind of chest pain.  It’s often on the left, so the person thinks it’s their heart, worries more, and the pain gets worse.  We diagnose this by ruling out other possibilities, especially heart disease.  Chest pain from anxiety is:

  • Not worse with exertion
  • Long-lasting (aside from a frank heart attack, angina heart pain only lasts 1-5 minutes)

Chest pain that hurts while lying in bed at night is almost always due to anxiety.  There may be shortness of breath then also; when patients tell us this, and that they feel fine exercising, we have the diagnosis for sure.  If with shortness of breath they feel tingling in hands and/or lips, it’s hyperventilation, also anxiety for sure.

Blood tests only help rule out other conditions; the only way to make the diagnosis if for the patient themselves to achieve insight.  Psychotherapy (now called โ€œCognitive Behavioral Therapyโ€ or CBT) can help with anxiety, as can medications.  Usually a combination of the two works best.

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