How does one recognize an anxiety disorder? Pavel Alfimov, a psychiatrist, speaks about panic and neuroses caused by quarantine

When to run to a doctor and why it is not a defeat
Irina Sycheva | 17 July 2020

The fear of getting infected with coronavirus and anxiety for loved ones who may also get sick is the reality of recent months. There is also insomnia, lack of joy, and even panic attacks, the ones during which you cannot breathe and it seems that you are dying. Pavel Alfimov, a psychiatrist, told Pravmir why this happens to many of us, how to help ourselves and when to see a doctor.

Pavel Alfimov

Recently, many people have been complaining about high anxiety and having trouble sleeping. What is the reason for this?

I believe this is due to the social conscience, primarily to the information flow. Indeed, there is a risk of getting coronavirus, this is obvious. However, the amount of panic exceeds the actual risk by many times, even by an order, probably. We all communicate, watch TV, go to social networks, read papers. And 90% of nowadays content is about coronavirus and its consequences.

I personally know some quite sane, reasonable professionals, including my friends, who have experienced anxiety and panic disorder because of this. That is, neurosis or hypochondriasis – the obsessive fear over your health.

The virus itself does not cause neurosis. In general, it is not a critical disaster, it is not a plague or even measles. Yes, it must be dealt with and everyone does it, but there is no need to lose yourself in this whirlpool like in a catastrophe.

How to recognize an anxiety disorder

Do people go to doctors with anxiety disorders more often now?

Anxiety disorders are a fairly broad and diverse group, which includes panic disorder, post-traumatic stress disorder, and generalized anxiety disorder.

One can say that, in general, the population anxiety level, that is the level of inner stress, foreboding of some disaster, is higher than normal now, perhaps. But I cannot say that now I have more patients in connection with the coronavirus. About the same amount.

Paradoxically, some people, who already have an anxiety disorder, are calm amidst the epidemic and quarantine situation, because they live their entire lives in the anticipation of a disaster and when it happens, they finally mobilize.

The problem is that in our country people rarely go to psychiatrist with an anxiety disorder. They go to everyone else but them. For psychiatry as a medical discipline is stigmatized, social conscience associates it only with severe mental disorders, with schizophrenia in the first place.

That is, a psychiatrist treats schizophrenia and nothing else. And many people, who are even quite reasonable and pursue healthy logic in their actions, refuse to go to a psychiatrist to the last, because they think that it is some desperate step, a failure, a defeat.

Of course, experts do not think so, and it would be great if people with anxiety would ask for help more often, receive necessary treatment, which can actually improve the quality of life and working efficiency, and improve not only mental, but also physical health, in general.

Therefore, the anxiety has most likely increased, but it is unlikely that people have started going to a psychoneurologic clinic more often.

What symptoms can signal that a person has an anxiety disorder?

It is easy. Anxiety is a normal, natural part of our lives. This is something that any person experiences in one way or another: agitation, nervousness or inner stress, inability to relax and some recurring doubts or disturbing thoughts.

There is an adaptive anxiety which occurs as a result of a situation and helps a person adapt to it. And there is a pathological anxiety, that is a phobic anxiety that breaks away from the world around us, our lives, and exists on its own. And this pathological anxiety reduces our adaptation level in all areas of life.

A person with the pathological anxiety has reduced working efficiency, they have problems with social life, family, and education. That is, they stop coping with things in one or more areas in their lives at the usual load level. This is a so-called functional criterion. If a person begins to function poorly, then their anxiety is an illness, and they need to see a psychologist first, and then make some decisions.

If a person understands that it is because of anxiety, agitation, and stress that they cannot relax, fry eggs, finish a phone conversation, come to a business meeting, meet with loved ones, then it is time to do something about it.

Of course, it is not always necessary to prescribe medications – tranquilizers or antidepressants, to a person with severe pathological anxiety. As a rule, psychological counseling helps many people. This is now very affordable, qualified psychologists are available in clinics, as well as in numerous private centers.

If, despite the anxiety, a person still lives an ordinary life, and anxiety takes only a small part of it, its relative weight is very low, then this is just some normal stage, you do not need to worry about it.

What to do in case of a panic attack

What is a panic attack?

A panic attack is the height of anxiety, it is when it becomes overwhelming, accompanied by vegetative, that is, physical symptoms. This is a subspecies of anxiety, a severe anxiety symptom.

A typical example of a panic attack is the state of the intense internal discomfort with a sense of fear, approaching disaster, to the extent of fear for your life, fear of death. And, as a rule, this is accompanied by the so-called hyperventilation, that is, feeling short of breath and rapid breathing, as well as other vegetative syndromes, for example, rapid heart rate or blood pressure fluctuations, often upwards.

Many people may experience body discomfort during a panic attack, such as pain and tightness of the chest, some intestinal symptoms, and changes in the skin sensitivity in the form of numbness or tingling.

Usually, when this happens for the first time, a person gets scared a lot, believing that something dangerous, life- and health-threatening is happening to them. So they call an ambulance, go to the emergency department or run to the nearest hospital, where they are given a glass of water, sometimes medicine, they calm down and the attack passes.

It is difficult to confuse it with something else. Many patients describe a panic attack as some unimaginable pressure, as if they were crushed by a concrete slab. One patient told me that during a panic attack, he feels as if he is standing on the rails with a speed train rushing at him and he cannot move.

The good news is that a panic attack in itself does not pose a threat to the life of an ordinary healthy person. Panic in an elderly, weakened patient with heart conditions may cause heart rate problems or ischemia.

However, for the vast majority of adults who experience panic, it is not a threat.

Yet if a person experiences panic attacks and they are recurring – this is a good reason to see a specialist: a psychiatrist or a psychotherapist. And to try to understand this problem in detail, because panic is a serious enough symptom that can greatly interfere with life.

Could this be a beginning of some serious illness?

Panic itself is not a first sign of some serious illness, because it is neurosis. And neurosis, despite the fact that it can be a very serious problem, is rather a mild mental disorder.

During a panic, you can be afraid of losing your mind, losing control over yourself, but that never happens.

What should one do during a panic attack?

People who often face it and receive specialized help, usually have some kind of emergency medication. For example, sedatives in the pill form.

There are specially designed breathing exercises to help break out of a panic state, in which a person gets worked up and plunges further into it. There are methods of so-called progressive muscle relaxation, there are some types of auto-training that help some people very well. There are different options for how to deal with this without medication.

For a person, who has never seen a psychologist and who does not know anything about this state, the change of scenery is the most correct thing to do. If they are indoors, it is better to go outside; if they are walking on the street, it is better to sit on a bench, drink a glass of cool water and try to think of something else, something pleasant. This is a very simple advice. Of course, it will not help everyone, but it can help someone.

We must understand that panic is a short-term process, you cannot stay in it for long. This usually lasts for a few seconds or minutes, and it is unlikely to last for several hours.

Why insomnia occurs

If a person has started to sleep poorly, how do you know if that is a short-term state or a serious condition?

I would probably also focus here on how adapted a person is to life. If a person can no longer work properly, play with children, talk with their spouse because of insomnia, then it a serious condition.

If a person wakes up every two weeks in the middle of a night with disturbing thoughts, having read a newspaper, which described the horrors of coronavirus, the day before, then perhaps this is not a symptom of a disorder, but simply a reaction of their personality to the receipt of such disturbing information.

How does one deal with sleep disorders?

If there are persistent sleep disorders, that is, a person stops sleeping normally and it lasts more than a week, I recommend that you first see a psychologist or psychotherapist in a clinic.

You may need to start taking a short course of sleeping pills or anti-anxiety medications, but you can do this only if you have a doctor’s prescription.

Self-treatment is possible only if you are taking some light solutions, for example, derived St.John’s wort extract, valerian, motherwort or combinations of them. There are a lot of such drugs, they are sold without a prescription and are generally quite harmless. And they can be of much help to a person, who has not previously taken any medication.

When it is time to see a doctor

Can one get over the anxiety with over-the-counter medications?

I believe it is safe to use over-the-counter anti-anxiety medications based on medical plants for any person, who has experienced insomnia or anxiety. Of course, it is advisable to use them for a short time, the instructions always indicate the optimal course for an adult, which is usually from 15 to 60 days.

If a problem does not go away during this time, then, of course, it is better to see a doctor so that they can write some prescription.

What symptoms are the reason to see a doctor? 

You cannot absolutely ignore suicidal thoughts. This is a rather disturbing symptom, and it requires the attention of a psychiatrist. Of course, planning of suicide or a high risk of it are not always behind the thoughts of not wanting to live. But in any case, if you have such thoughts, you should see a specialist.

Another important symptom is such a manifestation of depression as the so-called loss of taste for life, lack of enjoyment.

If due to anxiety or some circumstances a person loses the ability to enjoy usual activities as before, it lasts more than a day or two, and it is a persistent problem, in this case, you can also suspect a depressive state and see a specialist.

Panic is also a pretty convincing symptom that requires seeing a psychologist or psychiatrist.

In what cases one cannot do without medications? Should one be afraid of pharmacological therapy?

There is such a widespread prejudice that you can “get hooked” on antidepressants and constantly need them. But it has little to do with reality. Medications, primarily antidepressants, are a medical tool, which should be used according to indications and must be prescribed by a specialist, a psychiatrist.

You should not be afraid of this, just as you should not be afraid of all other medical tools. No one is afraid of MRI, aspirin, or a band-aid. If all this is used for their intended purposes and correctly, then it will bring more benefits than risks.

There are situations when you should not use antidepressants. However, in general, the current generation of antidepressants is well-tolerated and is suitable for long-term use, since chemical dependence to them does not occur.

Yet, if you do not get cured completely, if you use drugs carelessly and ignore medical recommendations, then the symptoms return.

How can a healthy person prevent anxiety disorders?

It is important to look for sources of support. Any person, even the strongest, toughest, and most successful one, needs it. This may be close ones, friends, or it may be specialists-psychotherapists.

The current times allow you to rethink your values a little. For modern life is quite stressful, we are faced with a lot of requirements, large amounts of information, high speed of all processes. Not everyone can cope with it. We cannot keep up with the technological progress.

Maybe these are the times when you need to have a quiet private life, realize that you have loved ones, that you need to nail down the skirting board, fix your shoes, pay your taxes, read your favorite book, go to the pool or gym. These simple things are actually much more effective at dealing with anxiety than obsessive reading of newspapers, magazines, and Internet feeds.

One of my colleagues recommends reading the news for no more than an hour a day. I agree with him. For if you read more, you start worrying so much that you cannot think of anything else.

Translated by Julia Frolova

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