Anxiety comes in many forms for 40 million Americans






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If one looks closely, one can find anxiety everywhere.

Anxiety is the number one diagnosed mental health condition in the world. In our country, the government tells us that there are 40 million Americans (18 percent), who are diagnosed with an anxiety condition.

Before psychology and medicine took over the domain of anxiety, philosophers wrote of anxiety and worry in different ways: “dread” (Kierkegaard), “angst” (Heidegger), and “nausea” and “anguish” (Sartre.)

Today, anxiety comes in many different psychiatric diagnoses because it mimics and reflects so much of our daily possible human existence. Anxiety can be found throughout the human life-span.

The very young child can have a “separation anxiety disorder,” where intense, developmentally inappropriate anxiety comes from being apart from those adults to whom the child is most attached.

“Selective mutism” is seen in children who refuse to speak in social or educational settings that arouse anxiety, often around achievement issues.

Children and adults can exhibit anxiety in the form of “specific phobias,” where there is marked fear of a specific object or situation. Objects can be animals (spiders, snakes, dogs), the natural environment (heights and storms), medical procedures (needles), situations and places (airplanes, shopping malls) or other things (clowns, costumes.) Many phobias begin in early childhood.

Some exhibit a “social anxiety disorder”, which involves a marked fear about social situations, especially if one feels that he or she will be exposed to possible scrutiny. This disorder is so severe that individuals may wait 10 years or more before seeking help.

Perhaps, no anxiety disorder is more upsetting than a “panic disorder”, which is often accompanied by intense physical symptoms (heart palpitations, feelings of choking or being smothered, shortness of breath, a fear of dying and many others.) Unfortunately, panic disorders are often found in individuals with a major depression.

“Agoraphobia” is the marked anxiety some feel in open spaces, while using public transportation, standing in line or being in an enclosed space (elevators.)

The reader will notice that many of the anxiety conditions, noted so far, involve the individual being isolated from others and from both the ‘business’ and the ‘pleasures’ of daily life with others.

A “generalized anxiety disorder” involves excessive, pervasive anxiety that seems to almost lack a precipitant. Difficulty with sleep, as well as fatigue, irritability, muscle tension, restlessness and difficulty concentrating. This disorder affects woman twice as much as men.

Anxiety may be induced by substance abuse, a medical condition or it may be the side effect of a prescribed medication. Endocrine, cardiovascular, respiratory and neurological disorders can induce anxiety.

Anxiety is also an important element in “obsessive compulsive disorder,” with its recurrent, persistent thoughts and repetitive compulsive behaviors. One-third of this disorder’s population begins in childhood.

Anxiety is also part of a “body dysmorphic disorder.” This anxiety disorder involves an intense preoccupation with what one considers to be flaws in their physical appearance. “Trichotillomania” (recurrent hair pulling), “excoriation disorder” (recurrent skin picking that results in lesions,) “hoarding disorder” (an inability to discard or part with possessions) and “post-traumatic stress disorder” are mental health disorders that have anxiety as an important component.

Finally, clinicians know that depression is often intertwined with anxiety, adding another aspect of suffering to this universal mental disorder.

Next week’s column will look at treatment options for anxiety.

Philip Kronk, M.S., Ph.D. is a child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk has a doctorate in clinical psychology and a post-doctoral degree in clinical psychopharmacology. His year-long internship in clinical psychology was served at the University of Colorado Medical School. Dr. Kronk writes a weekly, Friday online column for the Knoxville News Sentinel’s website, He can be reached at (865) 330-3633.