1) Miriam is out shopping on 13th Avenue, trying to get everything she needs before the Yom Tov, when suddenly she begins to feel a nervousness overcome her. Gradually the nervousness becomes a strong fear. She looks around her and everything appears normal. The fear turns to panic. She feels faint, short of breath, and can hear her heart racing. Her sense of dread makes no sense to her. She turns quickly and runs home. The panic subsides, evaporating as mysteriously as it came. Ashamed of this irrational behavior, she remains silent and doesn't share it with anyone, including her husband, yet she dreads a possible recurrence in the future.

2) Mendy can't get the thought out of his mind. He is experiencing chest pain and is sure he is having a heart attack. A visit to the doctor later shows that there is nothing wrong with his heart. Later he has headaches and is certain he must have a tumor on his brain. Again the doctor refutes these fears. So it goes, on and on. With every new pain, a new fear arises that his life is in danger.

In both of the above cases, the person experiences a strong fear. In the first case, the fear is not connected to anything; in the second, it is connected to a physical symptom. What is common in both cases is that the fear is intense and real, yet it is not reasonable and logical. It is unfounded.

The truth is that fear is a normal human emotion. It occurs when we feel threatened or in danger. Normal fear is always connected to a real event. We always know why we are afraid. Certain people, however, can experience intense fear with no apparent reason at all. This type of fear is called pathological fear, anxiety or panic disorder. Sometimes this intense, irrational fear attaches itself to an object or a circumstance. For example, people may have a panic attack if they are near insects or if they find themselves in a closed space such as an elevator or a tunnel. This type of fear is called a phobia. We are not going to discuss phobia in this article. It will be treated in a future article. Presently we will only discuss the generalized anxiety symptoms pictured earlier.

There are a number of symptoms that a persona can experience when he or she is subject to this disorder. They are:

-constant feelings of vague fear
-physical tension and extreme nervousness
-lack of concentration
-sleeping problems
-feeling tired all the time
-irregular breathing pattern
-irregular heartbeat or a racing heart
-restlessness
-a low stress tolerance
-dizziness or feelings of being faint
-trembling
-numbness or tingling in the extremities
-a feeling of illogical dread or impending doom

These symptoms can be difficult to live with. They cause a lot of suffering to a person having them. If one is married to a person with an anxiety disorder, his/her marriage can be affected. People usually lose patience with their suffering spouse because they cannot understand these "crazy, illogical fears." This causes the sufferer even more pain because he/she is made to appear "crazy" or as a malingerer seeking attention.

What causes these anxiety disorders? There are two possible causes:

1) Sometimes these anxiety symptoms are caused by an actual physical condition. Hypoglycemia, hyperthyroidism, epilepsy, cardiac arrhythmia and audiovestibular dysfunction can all produce symptoms of anxiety. Of course in these cases a medical specialist needs to treat the physical condition. Treating the physical condition eventually eliminates the anxiety associated with it.

2) In most cases anxiety and panic disorders are psychological in origin. They result from some kind of damage to personality development as it occurs in childhood. This damage specifically applies to the development of self-esteem and self-worth. The person learns as a young child from his environment that certain feelings are shameful and prohibited. Such feelings include feelings of anger toward a loved one. To maintain a sense of self-worth, the person represses and denies these feelings so that he is no longer conscious of them. However, even though these repressed feelings are dormant, nevertheless they are quite alive and energetic, always attempting to break through to the surface, into consciousness.

As an adult this person may experience certain situations that suddenly create the possibility that these repressed feelings will become conscious. This possibility triggers an intense fear or anxiety attack. Since this fear originates from a danger that is within, it is unrelated to reality and appears to the person to be crazy and illogical.

In a religious Jewish community, anxiety disorders may be even more prevalent. Many religious households create overly strict standards for those feelings that are permitted for children. Anger is oftentimes treated as a sinful emotion, so that a child feels strong shame and guilt when he gets angry. As a result these children begin to repress and deny these feelings from consciousness. Later, as adults, they become increasingly vulnerable to the possibility of these feelings surfacing into consciousness, thereby triggering an anxiety disorder.

There are two major treatment modalities for anxiety disorders:

1) Medication - Without question psychiatric medication, such as tranquilizers, are among the best treatments for anxiety symptoms. Many effective medications have been developed for this purpose. Unfortunately these medications can do little to alter the inner psychological causes of anxiety.

2) Intensive psychotherapy - For the long-term removal of these symptoms so that the anxiety disorder disappears completely, in-depth psychotherapy is the treatment of choice. In my practice I have treated many clients with anxiety disorders effectively with intensive psychotherapy. Clients become conscious of their underlying feelings of shame, guilt and rage, and express them in a safe and gentle environment that oftentimes alleviates their anxiety symptoms.

They don't have to suffer in silence anymore.