Counseling in Tokyo

Types of Anxiety Disorder

The discussion below assumes there is no substance use involved. Persons who use cocaine, ecstasy, LSD, and other substances may induce an anxiety-like disorder in themselves, the characteristics of which may differ from the discussion below and are beyond the scope of this web site.

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder is characterized by excessive anxiety and worry, restlessness, irritability, muscle tension, fatigue and disturbed sleep over at least 6 months. These are exactly those types of persons who conclude that “if I could just fix this or that I would not have any worry anymore". They also often report that, “I thought something was physically wrong with me but the Dr. told me I was fine".

The fact is that there is “something physically wrong" with these people in that there is some abnormality in the brain functions that control anxiety, it is just that there is no simple medical test yet on the complexities of the brain to prove this and there is no “obvious" physical problem-unless you consider debilitating anxiety physical which is probably the case. However, twin studies show a high incidence of concordance of this disorder. Also, stress can push people over the edge into this kind of anxiety, but usually the stress is such that most persons would bounce-back to normality quickly, indicating that persons with GAD have some kind of vulnerability to anxiety. Counseling can help these persons to stop fixating on and amplifying their problems; and medication can help alleviate the underlying anxiety.

Panic Disorder

Persons with Panic Disorderare more shocked by the intensity and sudden nature of their anxiety than those with GAD. They have repetitive panic attacks with anxiety that is intense, sudden, usually out of the blue and may awaken the person at night. They have palpitations, sweating, rapid respirations, choking, dizziness, shaking, feeling like the world will come to an end, and tingling in their extremities (secondary to metabolic changes from all the hyperventilation). These persons begin to worry about when and where the next panic will occur (anticipatory anxiety), and also start to avoid going to places where they may not be able to get help (phobic avoidance or agoraphobia).

Persons with panic attacks are often first seen in the emergency room, given a sedative and told “there is nothing wrong with you". Lately, medical doctors are more aware of panic attacks, but many still do not refer the patient to a psychiatrist. Again, the “there is nothing wrong with you" is not true, the person has Panic Disorder, and as noted above, there is some evidence from brain scans and other test that this is probably due to a dysregulation of some anxiety areas I the brain; there is just no standard medical problem (on rare occasion these persons have hyperthyroidism or other endocrine problems, and it is best to be seen by an M.D. psychiatrist who can diagnose these disorders). Again, if you put “panic disorder and brain scans" into the Pub Med web site of the U.S. National Library of Medicine or other search sites you can see the types of biologic findings in panic disorder.

First degree relatives are 8 more times to also have Panic Disorder than the general population, and medication is extremely effective to turn off the panic. Sometimes panic attacks only occur in the context of depression, and in this case we like to consider that the panic is an associated symptom of depression rather than give a person 2 mental illness diagnoses as the panic will go away with the depression.

Psychotherapy is extremely important in education, decreasing irrational fears, decreasing self-recrimination of one’s personality flaws which are usually not really there, and in breaking the cycle of anticipatory anxiety and phobic avoidance. Cognitive restructuring, gradually increasing doses of exposure to fears, and support of one’s innate strengths, can be of immense help to these persons who are usually very grateful to the therapist for their help.

Go to anxiety page three.

Summary of the links on this page:

AnxietyPersonality DisorderPsychodynamic PsychotherapyCore Issue-DefenseCognitive TherapyGeneralized Anxiety DisorderPanic DisorderSocial Anxiety Disorder
Obsessive-Compulsive DisorderPost-Traumatic Stress Disordermood disordersmedication treatmentPub Medanxiety medication treatmenttreatment of anxiety

Counseling Tokyo provides counseling, support, and advice, for both the international community in English, as well as the local Japanese community in Japanese.