- 1 How do I know if I have an anxiety disorder?
- 2 Where can I get treatment for anxiety disorder in Singapore?
- 3 Do I have symptoms of anxiety?
- 4 How does anxiety affects your social life?
- 5 What do your family and friends say about you?
- 6 How can I be diagnosed with anxiety disorder?
- 7 What are the conditions that mimic anxiety disorder?
- 8 Types of anxiety disorders
- 9 How can I get treated for anxiety in Singapore?
- 10 References
How do I know if I have an anxiety disorder?
Anxiety is an uneasy feeling of fear and worry.
It can be a normal reaction to stress. For example, you might feel anxious before taking an exam, or before a job interview.
Anxiety was very useful in the stone ages: it kept our species alive. However, in the modern world, some of our anxiety might be misplaced; it might be irrational, persistent and even interfering with your daily life.
When it starts to get in the way of getting things done, it probably needs treatment.
Where can I get treatment for anxiety disorder in Singapore?
You can be treated by us, a team of psychologists working closely with family doctors with a special interest in mental health. A visit to a neighbourhood GP is like a walk in the park. Every one visits a GP clinic once in a while. In fact, most people with anxiety will see a GP first. Unfortunately, not every GP is comfortable with diagnosing and treating this condition.
There are other alternatives: IMH and NUH have big teams of psychiatrists, psychologists and social workers, they are the standard of care. We look to them for valuable guidance from time to time. Private psychiatrists are also a good option if you are unable to wait for an appointment. You can also work with counsellors or other “free” services out there, but from experience, the results are more variable and depends on your luck.
What is the difference between all of them? Read this article.
Do I have symptoms of anxiety?
Reference: (Murtagh, 2016), (NAMI, 2017)
Apart from the feelings of uncontrollable worry and anxiety, you can have the following:
Bodily sensations of anxiety:
- Tiredness or fatigue
- Dry mouth
- Difficulty swallowing
- Choking feeling
- Sleep disturbances and nightmares
- Muscle tension
- Very fast heart rate
- Difficulty breathing
Feelings associated with anxiety:
- Feeling that something awful will happen
- Expecting the worst and being watchful for signs of danger
- Avoidance behaviour
- Feelings of apprehension or dread
- Feeling tense or jumpy
- Restlessness or irritability
Having anxiety not only affects yourself, but also the people around you.
You may avoid situations which make you feel anxious. Social anxiety can cause you to avoid people. As a result, you are isolating yourself, and missing out on opportunities to mingle and bond with the people around you. Over time, your relationships with your family and friends may be strained.
Here’s another example: a person with generalised anxiety disorder may worry about a dating situation. You worry that if the other party does not want to date you, it means that you are boring, you are not lovable, you are ugly, blah, blah. As a result, you rarely date as you get older (Butcher, Hooley, & Mineka, 2013).
What do your family and friends say about you?
“You seem reserved and aloof.”
People with social anxiety may fear making small talk and eye contact (Butcher, Hooley, & Mineka, 2013).
“You have been getting angry easily.”
Someone with a fear of being alone (autophobia) may be a “tense” person when she starts to demand that her family members accompany her everywhere (Meyer, & Weaver, 2012).
“There is no problem, this is just who you are.”
Anxiety is seen in our daily lives. It can be used to help us plan and prepare for possible threat. In mild to moderate degrees, it actually enhances learning and performance.
For example, a mild amount of anxiety about how you are going to do in your next exam, or in your next tennis match, can actually be helpful.
Unfortunately, anxiety becomes harmful when it happens all the time and in a severe degree (Butcher, Hooley, & Mineka, 2013).
How can I be diagnosed with anxiety disorder?
There are no lab tests to tell whether or not you have an anxiety disorder.
If you have physical symptoms such as those above, the doctor may run some tests on you, mainly to make sure that you are not having a condition that mimics anxiety (what are they? Read on). If the doctor determines that your symptoms are not due to an obvious physical cause, he may refer you to a psychologist.
The psychologist will then start a chit chat with you. The topics will range from your own life, to your family and how you feel. A mental state examination will be conducted where clues are gleaned from the way you look, talk and dress. All these information will help us come to a better conclusion about what is bothering you.
How do I know how severe I am?
Depending on how often during the last 2 weeks you have been bothered by the following problems, you may be deemed to have either mild, moderate or severe anxiety (Spitzer, Kroenke, Williams, & Löwe, 2006).
It is definitely severe if you start to have suicidal ideas.
What are the conditions that mimic anxiety disorder?
There are quite a long list of conditions that can mimic this, as anxiety disorder tends to affect multiple body systems.
The common mimics are:
- Thyroid disorder
- Alcohol or other ilicit drugs use
- Heart attacks
- Heart rhythm problems
- Salt or hormone imbalance
- Personality Disorders
Types of anxiety disorders
The symptom of feeling constant fear and worry is shared among the major types of anxiety disorders.
Panic attacks, which represent an extreme form of anxiety, can occur with most of these anxiety disorders, though they are not typically associated with generalised anxiety disorder (GAD).
What is Generalised anxiety disorder (GAD)?
It is an excessive anxiety and worry about a variety of topics, events, or activities (eg. school or work performance, health). Patients have difficulty controlling the worry, and experience symptoms such as restlessness, feeling tired easily, impaired concentration or feeling as though the mind goes blank, irritability, increased muscle aches or soreness, and sleep disturbance.
The anxiety, worry or associated symptoms make it hard to carry out day-to-day activities. This may cause problems in relationships, at work or other important areas.
The ultimate list of symptoms of a Panic Attack
A panic attack is an sudden surge of intense fear or discomfort that reaches a peak within minutes. You might feel the following:
- Palpitations where you feel that the heart is racing or skipping a beat
- A pounding heart
- Very fast heart beat
- Sweating excessively
- Trembling or shaking, especially of the hands and feets
- Sensations of shortness of breath or suffocating. Some people describe a feeling of “out of air” and will have to exit the place, for example the MRT or bus.
- Feeling of choking
- Chest pain or discomfort. Most people describe as being “pressed” on the chest.
- Nausea or abdominal distress
- Vomiting is quite common as well
- Feeling dizzy, unsteady, light‐headed, or faint. Most people will experience a near black out feeling. Like “seeing stars”.
- Chills or heat sensations, could be just a specific part of the body.
- Paresthesias (numbness or tingling sensations), over the hands and feets are quite common.
- Derealisation (feelings of unreality), as if everything is not real.
- Depersonalisation (being detached from oneself), as if you are looking at yourself from outside of your body, or the “body doesn’t belong to you”.
- Fear of losing control or “going crazy”
- Fear of dying, especially feeling of impending doom
What are Panic disorders?
Panic disorders are characterised by the experience of recurrent, unexpected panic attacks.
Obsessive-compulsive disorder (OCD)
OCD is no longer classified under anxiety disorders under the newer DSM-5.
OCD is characterised by unwanted distressing thoughts, ideas, or impulses (i.e. obsessions) and urges to perform rituals to neutralise these thoughts and reduce distress (i.e. compulsions). (S & L, 2013) These obsessive thoughts can result in severe anxiety.
Post-traumatic stress disorder (PTSD)
Social phobia is a persistent fear of social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The patient fears that he or she will act in a way that will be embarrassing and humiliating.
Exposure to these situations will result in anxiety, which may take the form of a panic attack. As a result, he/she tries to avoid these situations, or endure them with intense anxiety and distress. Such behaviours and feelings interfere with his/her normal day-to-day routine, relationships and work performance.
A specific phobia is an abnormal fear or dislike of a specific object or situation. Some examples include phobias of heights (acrophobia), spiders (arachnophobia) and thunder (brontophobia). There are even unusual ones like a phobia of belly buttons (omphalophobia)!
While most of us may feel uncomfortable or even afraid of things such as standing atop a high building, most of us generally manage to control our fears and carry out daily activities as usual.
However, people with phobias tend to avoid these situations or objects and become anxious (panic attacks may also occur) when they anticipate having to meet them. They know that their fear may not make any sense, but they feel powerless to stop it. (Anxiety and Depression Association of America)
Having phobias can disrupt day-to-day life, hamper work efficiency, reduce self-esteem, and strain relationships because people with phobias will do whatever they can to avoid the distressing and scary feelings of phobic anxiety.
How can I get treated for anxiety in Singapore?
Fortunately, anxiety disorders can be effectively treated with medications and/or psychotherapy and counselling. Most patients are able to reduce or eliminate symptoms after several (or fewer) months of psychotherapy. Many patients will notice improvement after just a few sessions.
A crucial first step in overcoming a psychological problem is to learn more about it, i.e. “psychoeducation.”
Name it to tame it
You may find that just by understanding your problems better, you are already making a large step towards recovery. (Bystritsky, Khalsa, Cameron, & Schiffman, 2013)
You may also find it useful for family members and friends to learn more about your problem so that they can help you in your recovery journey. You should absolutely bring them along for your doctor or psychology visits.
The first step is to find a trusted psychologist who is properly trained to diagnose and treat anxiety disorders. He/she will then teach you ways to cope with your problem.
Cognitive-behavioural therapy (CBT) is widely used to treat anxiety disorders. CBT has been associated with improvements in quality of life in anxiety patients. (Kaczkurkin & Foa, 2015). Through CBT, psychologists help patients learn to identify and manage the factors that contribute to their anxiety.
Exposure is a commonly used method in the treatment of anxiety disorders. (Ougrin, 2011) In exposure, patients are presented with whatever they fear, be it a thought, an image or situation, in a gradual and systematic manner. If you do this for a long enough time, the anxious feelings decrease without them avoiding or escaping. (Bystritsky, Khalsa, Cameron, & Schiffman, 2013)
An example of exposure therapy:
Let’s suppose you have a fear of dogs.
You might first be shown a picture of a dog …
Then asked to stand across the street from a pet shop…
Then asked to see a dog on your friend’s lap…
then pat the dog…
then finally hold a dog in your arms for 1 min…
then finally hold a dog longer and longer…
You will repeat each step until you feel your anxiety decreasing before moving to the next step.
At first, you would be terrified, but after a while, when nothing happens, your mind will start to adapt.
You will get used to the dog, and instead of believing that all dogs are dangerous, you will start to have a more accurate belief that most pet dogs are not threatening. The ideal outcome would be that you will no longer have a phobia of or avoid all dogs.
Through the cognitive component of therapy, you will learn to understand how your thoughts contribute to your anxiety symptoms. By learning to rewrite those thought patterns, you can reduce the likelihood and intensity of these anxiety symptoms. (American Psychological Association) Homework may be assigned to you so that you can practice these skills in your daily life, and apply what you have learnt even after treatment has ended. (Kaczkurkin & Foa, 2015)
You may also be taught mindfulness, a type of meditation that has been adapted from Buddhist psychology. It involves nonjudgmental awareness of the present moment, including one’s sensations, thoughts, bodily states, consciousness, and the environment, while encouraging openness, curiosity, and acceptance.
While practicing mindfulness, one will embrace and accept each experience, whether pleasant or not. It is through this deep acceptance that relief can be found (Snyder et al., 2012), and anxiety can be reduced.
You may be prescribed medications if our doctor feels that you require and will benefit from them. The types of medications include the following.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are considered to be the first line of therapy for anxiety disorders. They help to reduce the symptoms and allow the patient to feel more control. Examples include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Faverin).
SSRIs have few side effects, and have low potential for abuse. However, some patients may experience some side effects, including:
- sexual side effects e.g. diminished sexual interest, performance, or satisfaction (Farach et al., 2012)
Although widely used to treat anxiety in the past, benzodiazepines are no longer considered to be first-line therapies because of the risks associated with their chronic use. They are very effective in reducing acute anxiety, as they generally produce almost immediate effects, and thus may be prescribed for short-term, “as-needed” use. (Longo & Johnson, 2000)
Examples of benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan).
However, they can cause adverse side effects when used long-term in high doses, including:
- dependence, the need to take higher and higher doses over time.
- drowsiness and sleepiness, which can be hazardous to driving, or if you are doing a job that needs intense focus.
- a potentially lethal overdose when mixed with alcohol or opioids
- impaired memory
As a result, the use of benzodiazepines is often restricted to the short-term treatment of acute anxiety or as therapy for anxiety that cannot be treated by other drugs. (Bystritsky, Khalsa, Cameron, & Schiffman, 2013)
QnA about medications
By now, you may be having some questions about medications. Fret not, we will try to answer them below.
Q: Which is better, medication or psychotherapy?
A: The use of medications alone without psychotherapy may not be ideal for some disorders, because drugs themselves generally do not cure disorders (Butcher, Hooley, & Mineka, 2013). You can discuss with our family physician who can advise you about medications and whether to see our psychologist as well.
Q: Do I really need to take medications?
A: Medications may be used at the start together with psychotherapy to quickly make you feel better. Some patients might also have no time, or are not willing to go for psychotherapy.
Q: When should I stop taking medications?
A: This question should always be answered by your own doctor or by our family physicians. A serious discussion of benefits and risks will give you a lot more information about when you can stop medications. Generally we can stop when therapy has progressed well, the patient has no symptoms or has a compelling reason to stop medications. Please do not stop them by yourself! Always consult your doctor.
Q: What happens when I stop taking medication?
A: When medication is discontinued, there is a risk of of the condition coming back. This should be discussed with our family physician if reducing the dosage or changing to a milder type of medication may need to be done first. The medications usually should be slowly stopped and tailed down in discussion with our doctors.
Antony, M. M., Swinson, R., Canada, & Health Promotion and Programs Branch. (1996). Anxiety disorders and their treatment: a critical review of the evidence-based literature. Ottawa: Health Promotion and Programs Branch, Health Canada.
Butcher, J. N., Hooley, J. M., & Mineka, S. M. (2013). Abnormal Psychology (16 edition). Boston: Pearson.
Meyer, R. G., & Weaver, C. M. (2012). Case Studies in Abnormal Behavior (9 edition). Boston: Pearson.
Murtagh, J. (2016). Murtagh’s Patient Education 7e (7th edition edition). McGraw-Hill Education / Australia.
Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry, 11, 200. https://doi.org/10.1186/1471-244X-11-200
Post-traumatic Stress Disorder. (n.d.). Retrieved May 3, 2018, from http://www.apa.org/topics/ptsd/index.aspx
S, A. J., & L, M. B. (2013). Obsessive-Compulsive Disorder. In The Wiley Handbook of Cognitive Behavioral Therapy (pp. 1043–1062). American Cancer Society. https://doi.org/10.1002/9781118528563.wbcbt44
Shelton, C. I. (2004). Diagnosis and Management of Anxiety Disorders. The Journal of the American Osteopathic Association, 104(3_suppl_1), S2–S5.
Specific Phobias | Anxiety and Depression Association of America, ADAA. (n.d.). Retrieved May 3, 2018, from https://adaa.org/understanding-anxiety/specific-phobias
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-1097.