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# **ANXIETY DISORDERS**

|                                      |  | Generalized Anxiety Disorder |
|--------------------------------------|--|------------------------------|
| Panic Disorder                       |
| Phobias                              |
| Obsessive-Compulsive Disorder        |
| Post-Traumatic Stress Disorder       |
| How to Get Help for Anxiety Disorder |
| For More Information                 |

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### **Anxiety Disorders**

 Everybody knows what it's like to feel anxious--the butterflies in your      stomach before a first date, the tension you feel when your boss is angry,      the way your heart pounds if you're in danger. Anxiety rouses you to      action. It gears you up to face a threatening situation. It makes you      study harder for that exam, and keeps you on your toes when you're making      a speech. In general, it helps you cope. 

 But if you have an *anxiety disorder,* this normally helpful      emotion can do just the opposite--it can keep you from coping and can      disrupt your daily life. Anxiety disorders aren't just a case of "nerves."      They are illnesses, often related to the biological makeup and life      experiences of the individual, and they frequently run in families. There      are several types of anxiety disorders, each with its own distinct      features. 

 An anxiety disorder may make you feel anxious most of the time, without      any apparent reason. Or the anxious feelings may be so uncomfortable that      to avoid them you may stop some everyday activities. Or you may have      occasional bouts of anxiety so intense they terrify and immobilize you.    

 Anxiety disorders are the most common of all the mental disorders. At      the National Institute of Mental Health (NIMH), the Federal agency that      conducts and supports research related to mental disorders, mental health,      and the brain, scientists are learning more and more about the nature of      anxiety disorders, their causes, and how to alleviate them. NIMH also      conducts educational outreach activities about anxiety disorders and other      mental illnesses. 

 Many people misunderstand these disorders and think individuals should      be able to overcome the symptoms by sheer willpower. Wishing the symptoms      away does not work--but there are treatments that can help. That's why      NIMH has produced this pamphlet--to help you understand these conditions,      describe their treatments, and explain the role of research in conquering      anxiety and other mental disorders. 

 This brochure gives brief explanations of generalized anxiety disorder,      panic disorder (which is sometimes accompanied by agoraphobia), specific      phobias, social phobias, obsessive-compulsive disorder, and post-traumatic      stress disorder. More detailed information on some of these anxiety      disorders is available through NIMH or other sources. (See the listings at      the end of this pamphlet.) 

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### **Generalized Anxiety Disorder**

*-- "I always thought I was just a worrier. I'd feel keyed up      and unable to relax. At times it would come and go, and at times it would      be constant. It could go on for days. I'd worry about what I was going to      fix for a dinner party, or what would be a great present for somebody. I      just couldn't let something go."*

 -- "I'd have terrible sleeping problems. There were times I'd wake      up wired in the morning or in the middle of the night. I had trouble      concentrating, even reading the newspaper or a novel. Sometimes I'd feel a      little lightheaded. My heart would race or pound. And that would make me      worry more." 

 Generalized anxiety disorder (GAD) is much more than the normal anxiety      people experience day to day. It's chronic and exaggerated worry and      tension, even though nothing seems to provoke it. Having this disorder      means always anticipating disaster, often worrying excessively about      health, money, family, or work. Sometimes, though, the source of the worry      is hard to pinpoint. Simply the thought of getting through the day      provokes anxiety. 

 People with GAD can't seem to shake their concerns, even though they      usually realize that their anxiety is more intense than the situation      warrants. People with GAD also seem unable to relax. They often have      trouble falling or staying asleep. Their worries are accompanied by      physical symptoms, especially trembling, twitching, muscle tension,      headaches, irritability, sweating, or hot flashes. They may feel      lightheaded or out of breath. They may feel nauseated or have to go to the      bathroom frequently. Or they might feel as though they have a lump in the      throat. 

 Many individuals with GAD startle more easily than other people.      They tend to feel tired, have trouble concentrating,      and sometimes suffer  depression, too. 

 Usually the impairment associated with GAD is mild and people with the      disorder don't feel too restricted in social settings or on the job.      Unlike many other anxiety disorders, people with GAD don't      characteristically avoid certain situations as a result of their disorder.      However, if severe, GAD can be very debilitating, making it difficult to      carry out even the most ordinary daily activities. 

 GAD comes on gradually and most often hits people in childhood or      adolescence, but can begin in adulthood, too. It's more common in women      than in men and often occurs in relatives of affected persons. It's      diagnosed when someone spends at least 6 months worried excessively about      a number of everyday problems. 

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****Having GAD means always  anticipating disaster, often    worrying  excessively about health, money,  family, or work.    Worries are often  accompanied by physical symptoms  like    trembling, muscle tension,  and nausea.****

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 In general, the symptoms of GAD seem to diminish with age. Successful      treatment may include a medication called buspirone. Research into the      effectiveness of other medications, such as benzodiazepines and      antidepressants, is ongoing. Also useful are cognitive-behavioral therapy,      relaxation techniques, and biofeedback to control muscle tension. 

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### **Panic Disorder**

*-- It started 10 years ago. I was sitting in a seminar in a hotel      and this thing came out of the clear blue. I felt like I was dying."*

 "For me, a panic attack is almost a violent experience. I feel      like I'm going insane. It makes me feel like I'm losing control in a very      extreme way. My heart pounds really hard, things seem unreal, and there's      this very strong feeling of impending doom." 

 "In between attacks there is this dread and anxiety that it's      going to happen again. It can be very debilitating, trying to escape those      feelings of panic." 

 People with panic disorder have feelings of terror that strike suddenly      and repeatedly with no warning. They can't predict when an attack will      occur, and many develop intense anxiety between episodes, worrying when      and where the next one will strike. In between times there is a      persistent, lingering worry that another attack could come any minute.    

When a  panic attack       strikes, most likely your heart pounds and you may feel sweaty, weak,      faint, or dizzy. Your hands may tingle or feel numb, and you might feel      flushed or chilled. You may have chest pain or smothering sensations, a      sense of unreality, or fear of impending doom or loss of control. You may      genuinely believe you're having a heart attack or stroke, losing your      mind, or on the verge of death. Attacks can occur any time, even during      nondream sleep. While most attacks average a couple of minutes,      occasionally they can go on for up to 10 minutes. In rare cases, they may      last an hour or more. 

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****You may genuinely believe you're  having a heart attack,    losing your  mind, or on the verge of death.  Attacks can occur    any time, even  during nondream sleep.****

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 Panic disorder strikes between 3 and 6 million Americans, and is twice      as common in women as in men. It can appear at any age--in children or in      the elderly--but most often it begins in young adults. Not everyone who      experiences panic attacks will develop panic disorder-- for example, many      people have one attack but never have another. For those who do have panic      disorder, though, it's important to seek treatment. Untreated, the      disorder can become very disabling. 

 Panic disorder is often accompanied by other conditions such as      depression or alcoholism, and may spawn phobias, which can develop in      places or situations where panic attacks have occurred. For example, if a      panic attack strikes while you're riding an elevator, you may develop a      fear of elevators and perhaps start avoiding them. 

 Some people's lives become greatly restricted--they avoid normal,      everyday activities such as grocery shopping, driving, or in some cases      even leaving the house. Or, they may be able to confront a feared      situation only if accompanied by a spouse or other trusted person.      Basically, they avoid any situation they fear would make them feel      helpless if a panic attack occurs. When people's lives become so      restricted by the disorder, as happens in about one-third of all people      with panic disorder, the condition is called *agoraphobia.* A      tendency toward panic disorder and agoraphobia runs in families.      Nevertheless, early treatment of panic disorder can often stop the      progression to agoraphobia. 

 Studies have shown that proper treatment--a type of psychotherapy      called cognitive-behavioral therapy, medications, or possibly a      combination of the two--helps 70 to 90 percent of people with panic      disorder. Significant improvement is usually seen within 6 to 8 weeks.    

 Cognitive-behavioral approaches teach patients how to view the panic      situations differently and demonstrate ways to reduce anxiety, using      breathing exercises or techniques to refocus attention, for example.      Another technique used in cognitive-behavioral therapy, called exposure      therapy, can often help alleviate the phobias that may result from panic      disorder. In exposure therapy, people are very slowly exposed to the      fearful situation until they become desensitized to it. 

 Some people find the greatest relief from panic disorder symptoms when      they take certain prescription medications. Such medications, like      cognitive-behavioral therapy, can help to prevent panic attacks or reduce      their frequency and severity. Two types of medications that have been      shown to be safe and effective in the treatment of panic disorder are      antidepressants and benzodiazepines. 

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### **Phobias**

 Phobias occur in several forms. A *specific phobia* is a fear      of a particular object or situation. *Social phobia* is a fear of      being painfully embarrassed in a social setting. And *agoraphobia,* which often accompanies panic disorder, is a fear of being in any      situation that might provoke a panic attack, or from which escape might be      difficult if one occurred. 

#### **Specific Phobias**

*-- "I'm scared to death of flying, and I never do it anymore.      It's an awful feeling when that airplane door closes and I feel trapped.      My heart pounds and I sweat bullets. If somebody starts talking to me, I      get very stiff and preoccupied. When the airplane starts to ascend, it      just reinforces that feeling that I can't get out. I picture myself losing      control, freaking out, climbing the walls, but of course I never do. I'm      not afraid of crashing or hitting turbulence. It's just that feeling of      being trapped. Whenever I've thought about changing jobs, I've had to      think, "Would I be under pressure to fly?" These days I only go      places where I can drive or take a train. My friends always point out that      I couldn't get off a train traveling at high speeds either, so why don't      trains bother me? I just tell them it isn't a rational fear."*

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****Phobias aren't just extreme fear;  they are irrational fear.    You may be  able to ski the world's tallest  mountains with ease    but feel panic  going above the 10th floor of an  office building****

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 Many people experience specific phobias, intense, irrational fears of      certain things or situations--dogs, closed-in places, heights, escalators,      tunnels, highway driving, water, flying, and injuries involving blood are      a few of the more common ones. Phobias aren't just extreme fear; they are      irrational fear. You may be able to ski the world's tallest mountains with      ease but panic going above the 10th floor of an office building. Adults      with phobias realize their fears are irrational, but often facing, or even      thinking about facing, the feared object or situation brings on a panic      attack or severe anxiety. 

 Specific phobias strike more than 1 in 10 people. No one knows just      what causes them, though they seem to run in families and are a little      more prevalent in women. Phobias usually first appear in adolescence or      adulthood. They start suddenly and tend to be more persistent than      childhood phobias; only about 20 percent of adult phobias vanish on their      own. When children have specific phobias--for example, a fear of      animals--those fears usually disappear over time, though they may continue      into adulthood. No one knows why they hang on in some people and disappear      in others. 

 If the object of the fear is easy to avoid, people with phobias may not      feel the need to seek treatment. Sometimes, though, they may make      important career or personal decisions to avoid a phobic situation. 

 When phobias interfere with a person's life, treatment can help.      Successful treatment usually involves a kind of cognitive-behavioral      therapy called desensitization or exposure therapy, in which patients are      gradually exposed to what frightens them until the fear begins to fade.      Three-fourths of patients benefit significantly from this type of      treatment. Relaxation and breathing exercises also help reduce anxiety      symptoms. 

 There is currently no proven drug treatment for specific phobias, but      sometimes certain medications may be prescribed to help reduce anxiety      symptoms before someone faces a phobic situation. 

#### **Social Phobia**

*-- "I couldn't go on dates or to parties. For a while, I      couldn't even go to class. My sophomore year of college I had to come home      for a semester."*

 "My fear would happen in any social situation. I would be anxious      before I even left the house, and it would escalate as I got closer to      class, a party, or whatever. I would feel sick to my stomach--it almost      felt like I had the flu. My heart would pound, my palms would get sweaty,      and I would get this feeling of being removed from myself and from      everybody else." 

 "When I would walk into a room full of people, I'd turn red and it      would feel like everybody's eyes were on me. I was too embarrassed to      stand off in a corner by myself, but I couldn't think of anything to say      to anybody. I felt so clumsy, I couldn't wait to get out." 

 Social phobia is an intense fear of becoming humiliated in social      situations, specifically of embarrassing yourself in front of other      people. It often runs in families and may be accompanied by depression or      alcoholism. Social phobia often begins around early adolescence or even      younger." 

 If you suffer from social phobia, you tend to think that other people      are very competent in public and that you are not. Small mistakes you make      may seem to you much more exaggerated than they really are. Blushing      itself may seem painfully embarrassing, and you feel as though all eyes      are focused on you. You may be afraid of being with people other than      those closest to you. Or your fear may be more specific, such as feeling      anxious about giving a speech, talking to a boss or other authority      figure, or dating. The most common social phobia is a fear of public      speaking. Sometimes social phobia involves a general fear of social      situations such as parties. More rarely it may involve a fear of using a      public restroom, eating out, talking on the phone, or writing in the      presence of other people, such as when signing a check. 

 Although this disorder is often thought of as shyness, the two are not      the same. Shy people can be very uneasy around others, but they don't      experience the extreme anxiety in anticipating a social situation, and      they don't necessarily avoid circumstances that make them feel      self-conscious. In contrast, people with social phobia aren't necessarily      shy at all. They can be completely at ease with people most of the time,      but particular situations, such as walking down an aisle in public or      making a speech, can give them intense anxiety. Social phobia disrupts      normal life, interfering with career or social relationships. For example,      a worker can turn down a job promotion because he can't give public      presentations. The dread of a social event can begin weeks in advance, and      symptoms can be quite debilitating. 

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****People with social phobia aren't  necessarily shy at all.    They can be  completely at ease with people most  of the time, but    in particular  situations, they feel intense anxiety.****

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 People with social phobia are aware that their feelings are irrational.      Still, they experience a great deal of dread before facing the feared      situation, and they may go out of their way to avoid it. Even if they      manage to confront what they fear, they usually feel very anxious      beforehand and are intensely uncomfortable throughout. Afterwards, the      unpleasant feelings may linger, as they worry about how they may have been      judged or what others may have thought or observed about them. 

 About 80 percent of people who suffer from social phobia find relief      from their symptoms when treated with cognitive-behavioral therapy or      medications or a combination of the two. Therapy may involve learning to      view social events differently; being exposed to a seemingly threatening      social situation in such a way that it becomes easier to face; and      learning anxiety-reducing techniques, social skills, and relaxation      techniques. 

 The medications that have proven effective include antidepressants      called MAO inhibitors. People with a specific form of social phobia called      performance phobia have been helped by drugs called beta-blockers. For      example, musicians or others with this anxiety may be prescribed a      beta-blocker for use on the day of a performance. 

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### **Obsessive-Compulsive Disorder**

*-- "I couldn't do anything without rituals. They transcended      every aspect of my life. Counting was big for me. When I set my alarm at      night, I had to set it to a number that wouldn't add up to a "bad"      number. If my sister was 33 and I was 24, I couldn't leave the TV on      Channel 33 or 24. I would wash my hair three times as opposed to once      because three was a good luck number and one wasn't. It took me longer to      read because I'd count the lines in a paragraph. If I was writing a term      paper, I couldn't have a certain number of words on a line if it added up      to a bad number. I was always worried that if I didn't do something, my      parents were going to die. Or I would worry about harming my parents,      which was completely irrational. I couldn't wear anything that said Boston      because my parents were from Boston. I couldn't write the word "death"      because I was worried that something bad would happen."*

 "Getting dressed in the morning was tough because I had a routine,      and if I deviated from that routine, I'd have to get dressed again. I knew      the rituals didn't make sense, but I couldn't seem to overcome them until      I had therapy." 

----

****The disturbing thoughts or images  are called obsessions, and    the rituals  performed to try to prevent or  dispel them are    called compulsions.  There is no pleasure in carrying out  the    rituals you are drawn to, only  temporary relief from the     discomfort caused by the obsession.****

----

 Obsessive-compulsive disorder is characterized by anxious thoughts or      rituals you feel you can't control. If you have OCD, as it's called, you      may be plagued by persistent, unwelcome thoughts or images, or by the      urgent need to engage in certain rituals. 

 You may be obsessed with germs or dirt, so you wash your hands over and      over. You may be filled with doubt and feel the need to check things      repeatedly. You might be preoccupied by thoughts of violence and fear that      you will harm people close to you. You may spend long periods of time      touching things or counting; you may be preoccupied by order or symmetry;      you may have persistent thoughts of performing sexual acts that are      repugnant to you; or you may be troubled by thoughts that are against your      religious beliefs. 

 The disturbing thoughts or images are called obsessions, and the      rituals that are performed to try to prevent or dispel them are called      compulsions. There is no pleasure in carrying out the rituals you are      drawn to, only temporary relief from the discomfort caused by the      obsession. 

 A lot of healthy people can identify with having some of the symptoms      of OCD, such as checking the stove several times before leaving the house.      But the disorder is diagnosed only when such activities consume at least      an hour a day, are very distressing, and interfere with daily life. 

 Most adults with this condition recognize that what they're doing is      senseless, but they can't stop it. Some people, though, particularly      children with OCD, may not realize that their behavior is out of the      ordinary. 

 OCD strikes men and women in approximately equal numbers and afflicts      roughly 1 in 50 people. It can appear in childhood, adolescence, or      adulthood, but on the average it first shows up in the teens or early      adulthood. A third of adults with OCD experienced their first symptoms as      children. The course of the disease is variable--symptoms may come and go,      they may ease over time, or they can grow progressively worse. Evidence      suggests that OCD might run in families. 

 Depression or other anxiety disorders may accompany OCD. And some      people with OCD have eating disorders. In addition, they may avoid      situations in which they might have to confront their obsessions. Or they      may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD      grows severe enough, it can keep someone from holding down a job or from      carrying out normal responsibilities at home, but more often it doesn't      develop to those extremes. 

 Research by NIMH-funded scientists and other investigators has led to      the development of medications and behavioral treatments that can benefit      people with OCD. A combination of the two treatments is often helpful for      most patients. Some individuals respond best to one therapy, some to      another. Two medications that have been found effective in treating OCD      are clomipramine and fluoxetine. A number of others are showing promise,      however, and may soon be available. 

 Behavioral therapy, specifically a type called *exposure and      response prevention,* has also proven useful for treating OCD. It      involves exposing the person to whatever triggers the problem and then      helping him or her forego the usual ritual--for instance, having the      patient touch something dirty and then not wash his hands. This therapy is      often successful in patients who complete a behavioral therapy program,      though results have been less favorable in some people who have both OCD      and depression. 

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### **Post-Traumatic Stress Disorder**

*-- "I was raped when I was 25 years old. For a long time, I      spoke about the rape on an intellectual level, as though it was something      that happened to someone else. I was very aware that it had happened to      me, but there just was no feeling. I kind of skidded along for a while."*

 "I started having flashbacks. They kind of came over me like a      splash of water. I would be terrified. Suddenly I was reliving the rape.      Every instant was startling. I felt like my entire head was moving a bit,      shaking, but that wasn't so at all. I would get very flushed or a very dry      mouth and my breathing changed. I was held in suspension. I wasn't aware      of the cushion on the chair that I was sitting in or that my arm was      touching a piece of furniture. I was in a bubble, just kind of floating.      And it was scary. Having a flashback can wring you out. You're really      shaken." 

 "The rape happened the week before Christmas, and I feel like a      werewolf around the anniversary date. I can't believe the transformation      into anxiety and fear." 

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****Ordinary events can serve as  reminders of the trauma and    trigger  flashbacks or intrusive images.  Anniversaries of the    event are often  very difficult.****

----

 Post-Traumatic Stress Disorder (PTSD) is a debilitating condition that      follows a terrifying event. Often, people with PTSD have persistent      frightening thoughts and memories of their ordeal and feel emotionally      numb, especially with people they were once close to. PTSD, once referred      to as shell shock or battle fatigue, was first brought to public attention      by war veterans, but it can result from any number of traumatic incidents.      These include kidnapping, serious accidents such as car or train wrecks,      natural disasters such as floods or earthquakes, violent attacks such as a      mugging, rape, or torture, or being held captive. The event that triggers      it may be something that threatened the person's life or the life of      someone close to him or her. Or it could be something witnessed, such as      mass destruction after a plane crash. 

 Whatever the source of the problem, some people with PTSD repeatedly      relive the trauma in the form of nightmares and disturbing recollections      during the day. They may also experience sleep problems, depression,      feeling detached or numb, or being easily startled. They may lose interest      in things they used to enjoy and have trouble feeling affectionate. They      may feel irritable, more aggressive than before, or even violent. Seeing      things that remind them of the incident may be very distressing, which      could lead them to avoid certain places or situations that bring back      those memories. Anniversaries of the event are often very difficult. 

 PTSD can occur at any age, including childhood. The disorder can be      accompanied by depression, substance abuse, or anxiety. Symptoms may be      mild or severe--people may become easily irritated or have violent      outbursts. In severe cases they may have trouble working or socializing.      In general, the symptoms seem to be worse if the event that triggered them      was initiated by a person--such as a rape, as opposed to a flood. 

 Ordinary events can serve as reminders of the trauma and trigger      flashbacks or intrusive images. A flashback may make the person lose touch      with reality and reenact the event for a period of seconds or hours or,      very rarely, days. A person having a flashback, which can come in the form      of images, sounds, smells, or feelings, usually believes that the      traumatic event is happening all over again. 

 Not every traumatized person gets full-blown PTSD, or experiences PTSD      at all. PTSD is diagnosed only if the symptoms last more than a month. In      those who do have PTSD, symptoms usually begin within 3 months of the      trauma, and the course of the illness varies. Some people recover within 6      months, others have symptoms that last much longer. In some cases, the      condition may be chronic. Occasionally, the illness doesn't show up until      years after the traumatic event. 

 Antidepressants and anxiety-reducing medications can ease the symptoms      of depression and sleep problems, and psychotherapy, including      cognitive-behavioral therapy, is an integral part of treatment. Being      exposed to a reminder of the trauma as part of therapy--such as returning      to the scene of a rape--sometimes helps. And, support from family and      friends can help speed recovery. 

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### **How To Get Help For Anxiety Disorders**

 If you, or someone you know, has symptoms of anxiety, a visit to the      family physician is usually the best place to start. A        physician can help you  determine if the        symptoms are due to an anxiety disorder, some other medical condition,        or both. Most often, the next step to getting treatment for an      anxiety disorder is referral to a mental health professional. 

 Among the professionals who can help are psychiatrists,        psychologists, social workers, and counselors.       However, it's best to look for a professional who        has specialized training in cognitive-behavioral or behavioral therapy        and who is open to the use of medications, should they be needed.    

 Psychologists, social workers, and counselors sometimes work closely      with a psychiatrist or other physician, who will prescribe medications      when they are required. For some people, group therapy or self-help groups      are a helpful part of treatment. Many people do best with a combination of      these therapies. 

 When you're looking for a health care professional, it's important to      inquire about what kinds of therapy he or she generally uses or whether      medications are available. It's important that you feel comfortable with      the therapy. If this is not the case, seek help elsewhere. However, if      you've been taking medication, it's important not to quit certain drugs      abruptly, but to taper them off under the supervision of your physician.      Be sure to ask your physician about how to stop a medication. 

 Remember, though, that when you find a health care professional you're      satisfied with, the two of you are working as a team. Together you will be      able to develop a plan to treat your anxiety disorder that may involve      medications, behavioral therapy, or cognitive-behavioral therapy, as      appropriate. Treatments for anxiety disorders, however, may not start      working instantly. Your doctor or therapist may ask you to follow a      specific treatment plan for several weeks to determine whether it's      working. 

 NIMH continues its search for new and better treatments for people with      anxiety disorders. The Institute supports a sizeable and multifaceted      research program on anxiety disorders--their causes, diagnosis, treatment,      and prevention. This research involves studies of anxiety disorders in      human subjects and investigations of the biological basis for anxiety and      related phenomena in animals. It is part of a massive effort to overcome      the major mental disorders, an effort that is taking place during the      1990s, which Congress has designated the Decade of the Brain. 

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| **For More Information**                                                                                                                    |
|---------------------------------------------------------------------------------------------------------------------------------------------|
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| Anxiety Disorders Association of America  Dept A. 6000        Executive Boulevard, Department A  Rockville, MD 20852  (301)        231-9350 | Freedom from Fear  308 Seaview Avenue  Staten Island, NY        10305 (718) 351-1717 | National Anxiety Foundation  3135 Custer Drive         Lexington, KY 40517-4001  (606) 272-7166 |
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Obsessive Compulsive (OC) Foundation, Inc.  P.O. Box 70       Milford, CT 06460  (203) 878-5669 

| American Psychiatric Association  1400 K Street, N.W.         Washington, DC 20005  (202) 682-6220             | American Psychological Association  750 First Street, N.E.         Washington, DC 20002-4242  (202) 336-5500                           |                                                                                                                                                                    |
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| Association for the Advancement of Behavior Therapy  305 7th        Avenue  New York, NY 10001  (212) 647-1890 | National Alliance for the Mentally Ill  200 North Glebe Road,        Suite 1015  Arlington, VA 22203-3754  (800) 950-NAMI (-6264)      | National Institute of Mental Health  Toll-free information        services:  Depression: 1-800-421-4211  Panic and Other Anxiety        Disorders:  1-800-647-2642 |
|                                                                                                                |
| National Mental Health Association  1201 Prince Street         Alexandria, VA 22314-2971  (703) 684-7722       | National Mental Health Consumers'  Self-Help Clearinghouse         1211 Chestnut Street  Philadelphia, PA 19107  (800)        553-4539 | Phobics Anonymous  P.O. Box 1180  Palm Springs, CA 92263         (619) 322-COPE (-2673)                                                                            |
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| Society for Traumatic Stress Studies  60 Revere Drive, Suite        500  Northbrook, IL 60062  (708) 480-9080  |                                                                                                                                        |
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#### **Related NIMH Brochures**

 The following brochures, giving more detailed information on various      anxiety disorders and related topics, are available by contacting: NIMH,      Room 7C-02, 5600 Fishers Lane, Rockville, MD 20857-8030. 

 Understanding Panic Disorder  (NIH Pub. No. 93-3482) 

 Obsessive-Compulsive Disorder  (NIH Pub. No. 94-3755) 

 Medications (DHHS Pub. No. (ADM) 92-1509) 

 Plain Talk About Depression  (NIH Pub. No. 94-3561) 

#### ***Message From The National Institute Of Mental Health***

*The year 1996 marks the fiftieth anniversary of the National      Institute of Mental Health (NIMH). Throughout the past 50 years, the      results of research supported by the Institute have brought new hope to      millions of people who suffer from mental illness and to their families      and friends. In work with animals as well as human participants,      researchers have advanced our understanding of the brain and vastly      expanded the capability of mental health professionals to diagnose, treat,      and prevent mental and brain disorders.*

 During this last decade of the twentieth century--designated " The      Decade of the Brain" by the U.S. Congress-- knowledge of brain      function has exploded. Research is yielding information about the causes      of mental disorders such as depression, bipolar disorder, schizophrenia,      panic disorder, and obsessive-compulsive disorder. With this knowledge,      scientists are developing new therapies to help more people overcome      mental illness. 

 The National Institute of Mental Health is part of the National      Institutes of Health (NIH), the Federal Government's primary agency for      biomedical and behavioral research. NIH is a component of the U.S.      Department of Health and Human Services. 

#### **Acknowledgments**

 This brochure was written by Marilyn Dickey, a freelance writer in      Washington, DC. Scientific information and review was provided by NIMH      staff members Hagop Akiskal, M.D.; Jack Maser, Ph.D.; Barry Wolfe, Ph.D.;      and Susan Solomon, Ph.D. Also providing review and assistance were Jim      Broatch, M.S.W., OC Foundation; Stephen Cox, M.D., National Anxiety      Foundation; Jack Gorman, M.D., Columbia University; Alec Pollard, Ph.D.,      St. Louis University; Jerilyn Ross, M.A., L.I.C.S.W., Anxiety Disorders      Association of America; and Sally Winston, Psy.D., Anxiety and Stress      Disorders Institute of Maryland. Editorial direction was provided by Lynn      J. Cave, NIMH. 

 All material in this publication is free of copyright restrictions and      may be copied, reproduced, or duplicated without permission of the      Institute; citation of the source is appreciated. 

 National Institutes of Health  National Institute of Mental Health    

 NIH Publication No. 97-3879  Printed 1994, Reprinted 1995, 1997    

 Bulk sales (Stock No. 017-024-01541-5) by the U.S. Government Printing      Office, Superintendent of Documents, Mail Stop: SSOP, Washington, DC      20402-9328. 

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