Mistakes in anxiety

Mistakes in anxiety – Anxiety can be interpreted in many ways, meaning it’s not always interpreted correctly! In the last few decades, along with progress made in the field of genetics and cerebral images, there have been numerous campaigns formed against the stigmatization of psychological conditions. What was promoted was the idea that psychological disorders are brain illnesses, just like physical disorders are body illnesses. Sadly, multiple studies showed that these campaigns had the opposite effect to what they intended. An even more negative attitude towards people with mental disorders rose out of their actions. As a result, they had lower chances of recognizing and healing their disorders and of functioning normally, being seen as unpredictable and dangerous. An even stronger wish of rejecting the ones affected was born.

It’s important that the wide public understands that psychological conditions are just as real as physical ones, and are not just “in our head”. It is also vital that people become aware that these conditions are all different amongst themselves, in diagnostic, evolution, and treatment

The brain is still one of the great mysteries medicine struggles to solve. In spite of recent progress, there are lots of unknown aspects about psychological conditions: from the way they are transmitted and produced, to the way they can be cured or treated.

Mistakes in anxiety – The issue

In case of a somatic disease, you go to the doctor, tell them what’s bothering you, and they can tell you their suspicions. In order to get a diagnostic, you will need the confirmation of testing. Testing generally has a high level of accuracy. A few simple tests on the glucose levels in the blood can infirm or not the doctor’s suspicion. If the tests do turn out positive, then we get a diagnostic and treatment option.

In case of psychological conditions, like anxiety, things are much different. As of now, there are no such simple blood tests, nor genetic or image-based ones. They cannot help in the process of deciding a diagnostic or through which we could follow the evolution of the anxiety.

In psychiatry, diagnostic manuals, such as ICD 11 or DSM 5, developed by world experts in mental health are used.

They contain a series of symptoms associated to different diagnostics, that doctors can identify in patients. Psychiatric diagnostics are very different from somatic ones, however. In the rest of the medical field, a diagnostic represents a biological condition that causes the patient’s signs and symptoms.

Mistakes in anxiety – Example

Diabetes is the diagnosis of a patient that urinates frequently, eats a lot, and is thirsty. In psychiatry, the diagnostic is descriptive, and does not actually explain the biological mechanism that triggers the respective symptoms, because it is not known. Thus, a patient that feels excessive fear and worry that affects their daily life is diagnosed with an anxiety disorder. This diagnostic provides little information regarding the causes of the disorder. This is also the reason why, most often, we call them physical diseases and psychological disorders. The two are commonly used as synonyms, but this is untrue.

A disease is a condition with a clear cause, that appears following a pathological body response to internal or external factors. For example: cancer, pneumonia, asthma, cardiovascular diseases, diabetes.

A disorder, like anxiety, represents an abnormally functioning body or body part.

In the introduction to the Diagnostic and Statistical Manual of Mental Disorders 4 (DSM 4), the authors state that mental disorders are constructs, not diseases. These are descriptive, not explanatory. They are useful in providing a common language to doctors as well as in determining treatment, but there is no homogeneity or clear boundaries between conditions.

Another common mistake is to categorize anxiety as acute or chronic, as we do with many physical illnesses.

According to the World Health Organization, chronic diseases are not transmitted from one person to another, are long-lasting and generally have a slow evolution.

The 4 types of chronic diseases are:

• cardiovascular diseases (such as high blood pressure or heart failure)
• cancer
• chronic respiratory diseases (asthma or chronic obstructive pulmonary disease)
• diabetes

Generally, chronic conditions affect multiple body systems, cannot be cured by treatment, and persist for a long time.

In contrast, acute conditions usually affect only one part of the body and respond to treatment. They appear suddenly and only last a short time, with an often fulminant evolution. They are also more severe than chronic ones.

Mistakes in anxiety – Establishing the acute and chronic characteristics

Determining whether a condition is acute or chronic is important for both treatment and prognosis. These labels such as chronic anxiety or acute anxiety do not apply nor are they currently useful.

Essentially, from the second century AD, when Soranus of Ephesus wrote “About acute and chronic diseases”, in which he categorized lethargy, rabies and catatonia as acute diseases and headaches or melancholia as chronic diseases. Mental conditions were no longer classified in this kind.

However, with the advancement of psychiatry, the division of mental conditions, such as anxiety, into acute and chronic has been replaced by classifications related to the triggers of the disorders or specific symptoms. An example of classification is that of anxiety disorders, which are among the most widespread mental illnesses. The term “anxiety stages” is incorrectly used, but quite often encountered.

In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM 5, there are 8 distinct mental disorders within this category:

• separation anxiety,
• selective mutism,
• specific phobias,
• social anxiety disorder,
• panic disorder,
• agoraphobia,
• generalized anxiety disorder
• substance/medication-induced anxiety.

They are differentiated according to the object that induces fear, anxiety, avoidant behaviors and associated thoughts. This classification allows for targeted therapeutic treatment of anxiety-triggering stimuli.

Another inadequate approach to mental illness

Mistakes in anxiety – The idea of staging may have come from the diagnosis and treatment of cancer. In that context, it is mandatory to establish the stage of the disease’s evolution, based on histopathological, imaging, genetic and/or molecular testing. It is necessary because it guides treatment, and provides valuable information regarding prognosis. Such a staging may seem tempting because there would be the possibility of finding out whether or not we are in an “advanced” stage of our depression or anxiety. It could provide us with a clear recovery interval.

This is not possible in psychiatry, because there are no tools available to make these distinctions.

It is true, however, that mental illnesses exist on a continuum. A person may have a subclinical level of distress, where they do not meet all the criteria to be diagnosed with a particular mental disorder. And most of us find ourselves in this category at some point in our lives. Also, among those diagnosed there is the informal concept of “high functioning”. It refers to people diagnosed with a mental illness who function better in society than most people with the same disorder.

Words are both the scalpel and the diagnostic laboratory and even lifesaving treatment in psychiatry. So it’s extremely important to make sure we use the right and appropriate language when talking about anxiety.