CENTRAL  SOUTH  DAKOTA  MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
9/13/2001

ANXIETY

           Once upon a time a long time ago, one of our ancestors was wandering about trying to gather food when he noticed a lion stalking him across the plain. He knew the lion would charge as soon as he ran and he might or might not be able to make it to safety before the lion caught him. He began to think about various alternatives such as which direction to go, where help might be obtained, what he might do to get the lion an alternative meal or what it might feel like to have the lion pounce upon him. As you might imagine, he became very anxious.  With his anxiety, his heart began to beat faster, his blood pressure went up, he began to breathe more rapidly, his muscles tensed, his mind was racing, his pupils dilated. Somehow or other he figured out what to do because you and I are here today. Such is the survival value of that emotion we call anxiety.

Today, with the wild beasts that threaten us the story is quite different. I have never been attacked by a lion, a tiger or a bear although I understand that some members of our society have. Yet everyday, some of us are confronted with situations that seem as bad as lions or tigers or bears.

An example today would be the gentleman who is in a meeting which is not going his way and he begins to become anxious because "the stakes are high." He begins breathing a little more rapidly although he is not aware of that. His muscles tense and he is not aware of that either. He develops a tightness in his chest and recalls that a friend complained of tightness in his chest before the friend had a heart attack. The gentleman in our meeting begins to think maybe he is having a heart attack and the meeting is not even going right. His thoughts shift from the meeting itself to the heart attack he might be having. He has a wife and three children, and what would happen to them if he had a heart attack over this stupid meeting. The anxiety builds with him and soon he is in the emergency room. While heart attacks do happen, about four out of five people who come to the emergency room because of chest pain or chest tightness are not having a heart attack but they are very, very anxious.

While the gentleman above came to medical attention in an emergency room, anxiety attacks are most generally dealt with on an individual basis although the consequences can have a major impact on the person's life. As an example, I once saw a young lady who was having problems with abdominal pain. She indicated that it had been occurring for the last several years since she graduated from college. I asked her for a time when it was most detailed in her mind and she described driving to another city for a job interview. As she was driving, she developed the abdominal pain and recalls having to stop the car to get out and walk around. She vomited and remembers getting a tingling sensation and decided that she was unable to proceed for the interview and returned home. After an extensive medical workup, she eventually recognized that she was having panic attacks. She now uses a type of medication called an SSRI (serotonin reuptake inhibitor) and the panic attacks with abdominal pain have ceased. In her case, the panic attacks prevented her from even trying for a job that she very badly wanted.

Anxiety can be loosely defined as that feeling that comes when the individual is threatened but feels out of control and unable to effectively deal with their threat. Their body then mobilizes "the fight or flight" response. Long ago when our ancestors were trying to flee from a lion, the anxiety response was probably some help but today when a young lady is applying for a job, it was intensely destructive.

As an additional problem for the anxious person, our society is not kind or tolerant of anxiety. High respect, even reverence is afforded to the “John Wayne's” in our society who never become anxious. John Wayne was always in control, knew what do, and was confident everything would be fine. Everyday, one can hear comments such as, "calm down" or "relax" or "hey, chill out" or "don't get your tail in a knot" or "don't get your bowels in an uproar" or etc, etc, etc. Interestingly, the word anxiety is derived from the Latin word angere which means to choke or strangle. The sensation of not being able to breathe or choking is a common anxiety symptom. Some place on every sports page in our newspapers is the mention of some athlete who "choked" at the crunch point of the game. Thus, people are reluctant to acknowledge that they are anxious and rarely can believe that their grotesque symptoms are coming from an internal response not related to disease of the heart, the stomach or the lungs, etc.

The word syndrome means a group of signs or symptoms that allow a healthcare professional to make an accurate prediction of what is wrong with an individual, what will happen to that individual if they are allowed to pursue their natural history, and what will happen to that individual if medical intervention is undertaken. There are a number of anxiety syndromes that are now clinically well recognized and can be effectively treated. Among these are panic attacks, generalized anxiety disorder and posttraumatic stress disorder. These medically recognized clinical syndromes can result in very severe medical consequences and expense. This is especially true when the anxiety component of a person's symptoms is not recognized and there results a fruitless search for ulcers or cancers or heart attacks that are not present.

In next week's column, a person with posttraumatic stress disorder will be described along with the very significant medical consequences that resulted. How this person was effectively cared for and discussions for treatment of anxiety disorders will be addressed in a third column. The healthcare professional at your local clinics must first deal with the potential for organic disease such as heart attacks, ulcers, cancers, etc, but when a person's symptoms cannot be attributed to such a problem, it is sometimes in an individual's interest to recognize the role of anxiety in the person's symptoms and how to deal with those anxiety-related problems.