How does a psychiatrist diagnose anxiety?
When a patient comes to me and says they can’t stop worrying or they feel anxious, then I think what could be contributing to it? There are many kinds of anxiety. It’s important to understand what kind you have. And if you have several kinds of anxiety it’s important to understand what came first or what seems to be the driving or most powerful issue.
Social anxiety is common. This comes from exaggerating the importance of what other people think about you. Life is not a popularity contest. But sometimes it can feel that way. We might think terrible things will happen if somebody doesn’t think good of us, but rarely do those catastrophes happen (unless you are a politician or rock star.). Maybe a friend changes their opinion about you and is no longer your friend, but you can always get another friend.
Relationship anxiety is another issue. You can imagine terrible things will happen, if you ask someone out on a date and they say no. If you place too much importance on what someone else says or does, you can come across needy, which generally doesn’t come across very attractive to other people. So it’s important to overcome relationship anxiety by thinking flexibly and adapting. If someone doesn’t want to go out on a date with you, you can always ask someone else. But a lot of people nowadays skip the whole “date“ thing and just go out for coffee with people they want to get to know and then get to know them. Then, if the two of you aren’t really finding each other interesting, you can both go find someone else you find interesting without all the messy breakup stuff.
I go over confidence building skills in my book, “Prescription For Positivity,“ but basically it’s about being reasonable and kind to yourself. Accept that not everybody is interested in everybody else all the time.. And that’s OK. That’s just people being people. With friendship-building skills, there will always be other people you can get to know and you likewise can let them get to know you.
Another kind of anxiety comes after trauma. It is called post traumatic stress disorder. It’s defined by first experiencing a trauma, and then re-experiencing it with recurrent, intrusive thoughts and emotions. You might startle easily. You might avoid any emotional relationships. Some people have nightmares and flashbacks.
I’ve worked with people who have PTSD from every war since and including World War II, and also PTSD from assault, car crashes, and natural disasters like tornadoes and tsunamis. PTSD responds to a combination of medications, such as prazosin at night to diminish nightmares, and SSRI’s like sertraline to diminish obsessive thoughts and anxiety about the trauma. Cognitive behavior therapy as well as mindfulness training can be very effective, especially if a person is getting good sleep at night. During sleep the brain “consolidates “the new thinking and new experiences you’re getting from applying what you’ve learned in your counseling work. Another good medication for PTSD is ketamine and ketamine assisted psychotherapy. I wrote about this in my “Q and A” book on ketamine, available on my website.
Commonly, with post-traumatic stress disorder, the victim develops a pessimistic attitude, believing the anxiety is stronger than them. That of course only reinforces the post-traumatic stress disorder. This kind of pessimism can be counteracted by learning optimism, which I go over in my book, “Prescription For Positivity.“
When anxiety comes out of the blue, and leaves the person with a sense of impending doom, that is a panic attack. Panic attacks also leave people short of breath with a rapid heartbeat and shaky, sweaty hands. It responds very well to medication and counseling, similar to how PTSD responds.
Of course, anxiety sometimes comes from something else. And so it’s important to work with an experienced clinician who takes a thorough history and asks about all sorts of issues that may contribute to anxiety. These issues can include: lack of good bonding with parents when a child, substance-abuse, anxious attachment patterns, pessimism, losses in life, presence of a personality disorder, lack of a social support system and lack of meaning in life from spirituality.
If you don’t control these contributing factors, whatever they might be, then often medicine and counseling eventually quit working. For this reason it’s good to have a trusting relationship with a psychiatrist so you can really open up about what’s on your mind and on your heart. That sure helps to put anxiety behind you!