Anxiety disorders

It is possible to regain control of your health and learn to cope better with your disorder if you take one step at a time. A better understanding of the disorder and knowing how it affects you is an important first step.

Anxiety is an emotional reaction caused by apprehension surrounding painful events and corresponds to an important natural function: recognizing danger and reacting to it. It is universal and adaptive: everyone experiences anxiety at some point or another. Sometimes though, anxiety can exert too much influence over certain individuals, or its presence can be excessive or repeated in certain situations that negatively impact your ability to function in your daily life. When anxiety becomes a source of distress and suffering and harms your ability to function, we may be dealing with an anxiety disorder.

Whatever the scale of the disorder, not only can the disorder be managed using a variety of methods, it is also possible to regain normal functioning and good mental health. To learn more, please refer to the tabs on the right side of the page or contact us.

For additional information, please click on the sections below

Whatever the scale of the disorder, not only can the disorder be managed using a variety of methods, it is also possible to regain normal functioning and good mental health. To learn more, please refer to the tabs on the right side of the page or contact us.

Brian Bexton, M.D., Psychiatrist and Psychoanalyst, Vice-President of Revivre

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What is social phobia?

People who suffer from social phobia feel intense and persistent fear in one or more social or “performance” situations (e.g.: eating with a group, speaking to strangers, speaking in front of an audience, talking to authority figures, etc.). The anxiety is associated with a fear of being negatively judged, ridiculed, or humiliated. Some people also have a fear of exhibiting signs of anxiety (e.g.: blushing or trembling), behaving awkwardly, or feeling shame. Anyone can feel uncomfortable in certain situations, but social phobia is much more overwhelming and intense.

We do not yet know a great deal about the causes, but certain psychological factors are often present: low self-esteem, lack of selfconfidence, high standards for success, extreme self-criticism, and placing a lot ofimportance on the opinions of others.

Social phobia sometimes develops as the result of a trauma. Humiliating experiences or persistent rejection and social exclusion during childhood and adolescence may increase the likelihood of developing the disorder.

Some studies have also demonstrated a chemical imbalance in certain areas of the brain involving a number of neurotransmitters (norepinephrine, GABA, serotonin, and dopamine).

The disorder usually appears in childhood or adolescence, and tends to run in families. The numbers vary from study to study, but the disorder affects somewhere between 2% and 13% of the population. People who suffer from social phobia often have other disorders as well (e.g.: generalized anxiety, specific phobia, panic disorder, avoidant personality, and certain mood disorders, including depression).

Warning signs

The first signs of social anxiety are often discomfort and unpleasant feelings in social situations like the ones mentioned above.

People who suffer from social phobia oftenfeel a great deal of distress and have trouble functioning normally in their daily, professional, and social lives. They may also adopt avoidance behaviours in certain situations, which can significantly diminish their quality of life, and lead to isolation.

This disorder affects different people to varying degrees. Some people start by avoiding activities that they are interested in, and end up isolating themselves from others completely, which can leave them feeling extremely lonely.

Symptoms

The most common symptoms include palpitations, blushing, trembling, sweating, digestive problems, nausea, inability to speak, mumbling, dry mouth, confusion, and panic attacks.

Treatment

If the disorder does not take over a number of areas of their life, it is sometimes possible for people to recover on their own with time. However, psychotherapy can offer invaluable support in a number of ways. There are several different therapeutic approaches for learning how to manage anxiety: relaxation techniques, social skills training, and exercises aimed at working on anxiety-related thoughts and beliefs. People can also learn to modify their behaviour in order to face situations rather than run away from them.

Certain medications, such as benzodiazepines and antidepressants, can also be prescribed to help relieve the symptoms. Benzodiazepines can provide temporary relief, and can be used as needed when an anxiety-causing situation arises, but antidepressants are often prescribed as a more long-term treatment, because they cause fewer dependency and addiction problems than benzodiazepines.

Self-help groups – such as those at Revivre – can help to break the isolation by bringing people who are going through similar situations together. They provide a place where you can share your feelings without fear of being judged. It can also be helpful to hear the stories of other people who have learned to live with the disorder.

Where to go for help

If you think you have social phobia and you want to learn more about the available treatments, one of the first steps may be to talk to a doctor. For psychological help, you can consult a psychotherapist who is recognized by a professional association, such as a psychologist or a social worker.

Brian Bexton, M.D., Psychiatrist and Psychoanalyst, Vice-President of Revivre

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What is specific phobia?

Specific phobia, or simple phobia, is an intense, unreasonable, and persistent fear caused by the presence or anticipation of a specific object or situation. It provokes an immediate anxiety response that can sometimes take the form of a panic attack. This intense fear often leads to avoidance, and causes severe distress when the situation can’t be avoided.

Phobias are classified into different subtypes.

  • Situational type: concerns a specific situation, such as the fear of flying, bridges, elevators, driving, etc.
  • Blood-injection-injury type: also includes any invasive medical procedure. This kind of phobia is often associated with a feeling of light-headedness that may be followed by fainting in certain cases.
  • Natural environment type: fear of storms, heights, the dark, water, etc.
  • Animal type: fear of insects, dogs, snakes, rodents, spiders, etc.
  • Other type: phobias can be caused by a wide variety of objects or situations that don’t fit the categories listed above. These include a fear of choking, loud noises, contracting an illness, vomiting, etc.

Some phobias may be innate, and may have contributed to our survival as a species by helping us to better adapt to our environment thousands of years ago, but they are no longer useful in the modern world. Examples include the fear of spiders, snakes, and heights.

Sometimes, the fear is associated with a factor than is connected to the object of the phobia, such as the fear of fainting in the case of a blood phobia, or the fear of experiencing dizziness in the case of a phobia about heights.

According to the various studies, phobias affect 7% to 11% of the population at some point in their life, and are generally more common among women, with percentages varying depending on the type of phobia. It is interesting to note that the objects of phobias vary from culture to culture.

Children often experience fears related to their stage of development (fear of strangers, monsters, being separated from parents, the dark, sleeping alone, physical danger, school, social rejection, etc.). These are generally temporary, and should not be considered to be phobias unless they cause significant problems in terms of normal functioning. For example, a child who is so afraid of physical danger that he won’t go out of the house may have a phobia.

Warning signs

When the fear of an object interferes with someone’s daily habits, ability to function at work, or social life, or if the fear causes the person great distress, this might be a sign of a phobic disorder, and treatment may be necessary in order to regain a sense of wellbeing. However, if the fear does not cause any serious problems (e.g.: a fear of flying for someone who doesn’t travel), the person will not be diagnosed as having specific phobia.

It is not uncommon for several members of the same family to have the same phobia. This may be due to learning through observation. A phobia can also be conveyed by other people (e.g.: parents warning their children about certain dangers). In addition, when a family adapts to a child’s avoidance behaviour and lets the child avoid the object of the fear, the family may be playing a role in perpetuating the phobia. Finally, phobias are often caused by traumatic events or direct unpleasant experiences.

Symptoms

The first symptoms of phobia often appear during childhood or adolescence, but phobias that are caused by traumatic events can appear at any age. The anxiety response almost always occurs immediately when the person is confronted with the object of the phobia. This can sometimes cause symptoms of panic, such as rapid heart rate, dizziness, light-headedness, chills or hot flashes, the fear of dying, going crazy, or losing control, sweating, trembling, chest pain, a choking sensation, or a feeling of unreality or being detached from oneself. Simply anticipating contact with the object of the phobia can be enough to trigger these symptoms.

Treatment

Psychotherapy is the treatment of choice for specific phobias. There are several types of therapy that are potentially beneficial. The quality of the bond with the psychotherapist is an important factor. Certain techniques used in cognitive-behavioural therapy are recognized as being particularly effective. One of the common responses to a phobia is to run away from or avoid the situation. Paradoxically, this helps to reinforce and solidify the phobia. In light of this, one of the techniques that is used in psychotherapy is exposure, which involves having the person face the phobia-causing object or situation in a controlled, gradual, and regular manner until the fear recedes, rather than avoiding it.

In certain cases, medications such as benzodiazepines can be helpful in reducing the intensity of the reaction in the presence of the object of the phobia. However, they should be used with caution and sparingly, because they can cause tolerance and addiction problems. In addition, although these medications can provide temporary relief from anxiety, therapy will help the person to suffer less from the phobia over the long term.

Self-help groups – such as those at Revivre – can help to break the isolation by bringing people who are going through similar situations together. They provide a place where people can share their feelings without fear of being judged. It can also be helpful to hear the stories of other people who have learned to live with the disorder.

Where to go for help

If you think you have specific phobia and you want to learn more about the available treatments, one of the first steps may be to talk to a doctor. For psychological help, you can consult a psychotherapist who is recognized by a professional association, such as a psychologist or a social worker.

In complex cases, the primary care doctor can refer children and their families to the various paediatric psychiatric services in Québec for more specialized care.

Brian Bexton, M.D., Psychiatrist and Psychoanalyst, Vice-President of Revivre

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What is generalized anxiety disorder?

People who suffer from generalized anxiety disorder worry constantly and excessively about a number of everyday issues that are not necessarily related to each other, such as health, work, and relationships. Their worries are hard to control and out of proportion, and often focus on minor events. People who suffer from this disorder tend to imagine future catastrophes that are very unlikely to occur.

Although we don’t yet know the exact causes of generalized anxiety disorder, there appears to be a genetic predisposition, along with certain biological risk factors (three neurotransmitters may play a particular role: GABA, serotonin, and norepinephrine). Environmental stressors can also play an important role.

Generalized anxiety disorder affects approximately 5% of the population. It is diagnosed more often in women (55% to 60%) than in men. The disorder often appears in adolescence or early adulthood, but many people say that they have lived with anxiety their whole lives, or can’t remember when it started. People who suffer from generalized anxiety disorder often have other anxiety disorders or depression as well.

Warning signs

When worries are chronic, or in other words, when they last at least 6 months, and when they relate to several life events, are excessive and uncontrollable, cause significant distress, and interfere with normal functioning (at work, in social settings, or in some other important area), this may indicate generalized anxiety disorder.

Symptoms

In order for a diagnosis of generalized anxiety disorder to be made, excessive anxiety must be accompanied by at least three of the following symptoms (only one for children):

  • Restlessness;
  • Being easily fatigued;
  • Difficulty concentrating;
  • Irritability;
  • Muscle tension;
  • Sleep disturbance.

Treatment

There are two forms of treatment that are generally recognized as being effective for generalized anxiety disorder: medication and psychotherapy.

Antidepressants are often the treatment of choice. However, it takes several weeks for them to reach their full effect. Anti-anxiety medications, such as benzodiazepines, can temporarily relieve the symptoms. Benzodiazepines can provide temporary relief, and can be used as needed when an anxiety-causing situation arises, but antidepressants are often prescribed as a more long-term treatment, because they cause fewer dependency and addiction problems than benzodiazepines.

In terms of psychotherapy, there are a number of different approaches, each of which can produce results. Research supports the value of the cognitive-behavioural approach in particular for treatment of this disorder. This type of psychotherapy can help people to become aware of the thoughts and beliefs associated with their anxiety, and teach them to replace them with more realistic thoughts. It can also help to change certain behaviours in order to promote better anxiety management.

Self-help groups – such as those at Revivre – can help to break the isolation by bringing people who are going through similar situations together. They provide a place where you can talk about your feelings without being judged. It can also be helpful to hear the stories of other people who have learned to live with the disorder.

Where to go for help

If you think you have generalized anxiety disorder and you want to know for sure, a doctor can help you evaluate the situation and prescribe appropriate treatment, if necessary. For psychotherapy, you can consult a mental health specialist who is recognized by a professional association, such as a psychologist or a social worker, for support and help in dealing with this disorder.

Brian Bexton, M.D., Psychiatrist and Psychoanalyst, Vice-President of Revivre

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What is obsessive-compulsive disorder?

People who suffer from obsessive-compulsive disorder (OCD) are overcome by excessive worries (obsessions), usually accompanied by ritual routines or gestures (compulsions) aimed at reducing the anxiety caused by these obsessions. People with OCD are often, but not always, aware that their behaviour is excessive, but can’t stop themselves from doing it.

Obsessions are intrusive, irrational, and uncontrollable. The individual realizes that these thoughts absurd and all in the mind, and that they have no basis in reality, but he cannot avoid them. These obsessions sometimes conflict with the person’s personal values, and may be accompanied by disgust and fear. The worries have no connection to real life problems (work, money, etc.). The obsessions can focus on several themes, but often involve the following:

  • Cleanliness and a fear of contamination;
  • Concern for the safety of others;
  • Fear of committing aggressive or outrageous acts;
  • Thoughts of a sexual or religious nature;
  • Fear of making mistakes or causing a disaster;
  • Order or symmetry;
  • Recurring doubts.

On the other hand, compulsions are excessive behaviours or mental acts (e.g.: counting) aimed at neutralizing the obsessions and reducing the associated distress. There is usually no real connection with the thing they are supposed to be warding off. Common compulsions include the following:

  • Repeatedly cleaning objects or washing oneself;
  • Checking things multiple times (making sure the door is locked, the oven is off, the lights are off, etc.);
  • Ordering, classifying, arranging, and touching objects;
  • Counting and numbering;
  • Performing magical, superstitious rituals.

This disorder affects 2% to 3% of the population, and occurs equally among women and men. The first symptoms often appear during adolescence or early adulthood, but may begin in childhood. Depression is often linked with OCD. People who suffer from OCD may also have other anxiety disorders at the same time, such as panic disorder and phobias, eating disorders, or obsessive-compulsive personality disorder. There is also a higher incidence of OCD among people who are affected by Tourette’s syndrome.

We do not yet know exactly what causes obsessive-compulsive disorder, but there seems to be a genetic component and neurotransmitter abnormalities (serotonin may play a role). There also seem to be psychological factors, such as an excessive feeling of responsibility or need to control one’s thoughts. Paradoxically, attempting to neutralize obsessions using compulsions can actually cause a new wave of obsessions.

Warning signs

If obsessions or compulsions take over a person’s life to the extent that they occupy more than an hour of time during the day or interfere with professional and family life and cause serious distress, then that person may have obsessive-compulsive disorder.

Treatment

There are two kinds of treatment for obsessive-compulsive disorder: medication and psychotherapy. If you think you have this disorder, one of the first steps may be to talk to your doctor. Certain antidepressants that act on serotonin can be effective and produce results in only a few weeks.

In terms of psychotherapy, there are a number of different approaches, each of which can produce results. Research supports the value of the cognitive-behavioural approach in particular for treatment of this disorder. One treatment approach involves exposing the person to situations that cause the anxiety while preventing him from performing the associated rituals.

Self-help groups – such as those at Revivre – can help to break the isolation by bringing people who are going through similar situations together. They provide a place where people can share their feelings without fear of being judged. It can also be helpful to hear the stories of other people who have learned to live with the disorder.

Where to go for help

If you think you might have obsessive-compulsive disorder and you want to know for sure, a doctor can help you evaluate the situation, and can prescribe appropriate medication, if necessary. For psychotherapy, you can consult a mental health specialist who is recognized by a professional association, such as a psychologist or social worker, for support and help in dealing with this disorder.

Brian Bexton, M.D., Psychiatrist and Psychoanalyst, Vice-President of Revivre

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What is panic disorder?

A panic attack is a sudden episode of very intense fear, accompanied by at least four of the following symptoms:

  •  Palpitations or accelerated heart rate;
  •  Dizziness, light-headedness, or feeling faint;
  •  A sensation of suffocating or shortness of breath;
  •  Nausea or upset stomach;
  •  Tingling or numbness;
  •  Chills or hot flashes;
  •  Fear of dying;
  •  Fear of going crazy or losing control;
  •  Sweating;
  •  Trembling or shaking;
  •  Chest pain or discomfort;
  •  A feeling of choking;
  •  Feeling detached from oneself or a feeling of unreality.

A panic attack reaches its peak quickly – usually in less than 10 minutes – and is limited in duration. It is frequently associated with the feeling that a disaster is about to happen, and the person often feels an urgent need to flee. It can happen anywhere at anytime.

Panic attacks can occur with other anxiety disorders, such as social phobia or specific phobia. For example, for someone who has a phobia involving spiders, seeing a spider can trigger a panic attack. On the other hand, even though people who suffer from panic disorder sometimes have panic attacks that are associated with or made more likely by a particular situation, the diagnosis of panic disorder requires that panic attacks occur unexpectedly.

Panic disorder may or may not be accompanied by agoraphobia, which is a condition that causes an individual to make an effort to avoid places or situations where it would be hard to escape or find help in the case of a panic attack (e.g.: avoiding pools, crowds, and mass transit, being afraid of traffic jams, etc.). When these situations can’t be avoided, it causes severe distress or intense fear of a panic attack.

Panic disorder affects between 1.5% and 3.5% of the population, and although there is a great deal of variation in terms of the age when it first appears, it is often between late adolescence and the mid-thirties. Panic disorder without agoraphobia is twice as frequent among women as men. Panic disorder with agoraphobia is three times as frequent among women. Biological and psychosocial factors are believed to play a role in this disorder. Traumatic events, separation anxiety during childhood, and learning through observation may increase the likelihood of occurrence. From a biological perspective, certain neurotransmitters may be involved, such as norepinephrine, serotonin, and GABA.

50% to 60% of people who suffer from panic disorder also suffer from depression, and one-third of these people suffered from depression before they developed panic disorder. People often have other anxiety disorders as well.

Warning signs

For some people, panic disorder begins or intensifies when there’s a break in or loss of a significant relationship. Signs that panic disorder may be developing include the following: an individual has experienced more than two unexpected panic attacks and the fear of having a panic attack has lasted for a month or more; the individual experiences significant distress and has problems performing daily activities and getting work done; the individual does not take advantage of interesting opportunities because of a fear of having a panic attack.

Symptoms

The symptoms of panic disorder can manifest as anxieties concerning the possible consequences or implications of a panic attack. For example, people who suffer from panic disorder may be afraid that their symptoms are caused by a serious illness (heart problems, etc.) or that they will lose control permanently and go insane. Many people may even go to the emergency room or call an ambulance.

People who suffer from agoraphobia may become more and more isolated, to the point where they significantly limit their activities and social life.

The frequency of panic attacks among those who suffer from panic disorder varies significantly from one person to another. Some people have several per day, while others may only experience them once per month. They also vary in severity.

Treatment

The two main forms of treatment for this disorder are psychotherapy and medication. Psychotherapy helps to alter certain beliefs and thoughts that can intensify the symptoms of panic attacks. One form of therapy that has been recognized as effective for panic disorder consists of gradually exposing the person to problematic situations in order to replace avoidance behaviours with more appropriate behaviours.

In terms of medication, antidepressants that act on serotonin are often recommended for panic disorder. Benzodiazepines may also be prescribed, but should be used in moderation, because they can lead to addiction and dependency.

Self-help groups – such as those at Revivre – can help to break the isolation by bringing people who are going through similar situations together. They provide a place where you can talk about your feelings and anxieties without fear of being judged. It can also be helpful to hear the stories of other people who have learned to live with the disorder.

Where to go for help

If you think you have panic disorder and you want to learn more about the available treatments, one of the first steps may be to talk to a doctor. For psychological help, you can consult a psychotherapist who is recognized by a professional association, such as a psychologist or a social worker.

Élise St-André, M.D., Psychiatrist

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What is post-traumatic stress disorder?

People who are exposed to severe, disturbing, intense, or out of the ordinary events that cause or could cause disability or severe, life-threatening injuries (e.g.: accidents, fires, wars, physical or sexual assault, witnessing a murder, the sudden death of a loved one, etc.) may exhibit acute physical and/or psychological reactions for a number of days in response to the terrible stress that they experienced. These reactions are considered to be normal for a while. However, if they last for more than four weeks, it is considered to be post-traumatic stress disorder (PTSD).

PTSD is characterized by very intense fear combined with a feeling of despair or horror (disorganization or agitation among children).A person who suffers from PTSD continually relives the traumatic event, and avoids situations that remind him of it. People who suffer from PTSD also have dulled emotional responses and multiple anxiety reactions.

Approximately 9% of Canadians will develop this disorder at some point in their lives. The rates are higher in areas of the world where there is armed conflict. Women are twice as likely to suffer from PTSD as men are. PTSD can also develop after witnessing someone else going through such a traumatic event, or even learning that it happened to a family member or a friend.

30% to 80% of people who suffer from PTSD also suffer from depression. Trauma can also give rise to additional disorders, such as substance abuse (alcohol and drugs) and other anxiety disorders. Anxiety is also known to exacerbate physical problems.

Children may exhibit specific symptoms; they may have more trouble expressing their emotions, which manifests as disorganized or agitated behaviour. They may play games that involve the themes of the event over and over, or have nightmares with no recognizable content pertaining to the trauma. Children may also try to recreate the specific situation.

Finally, sexual assault does not have to be violent in order to be traumatizing. Any sexual experience that is inappropriate for a child’s developmental stage can cause PTSD.

Warning signs

When symptoms last more than one month, cause difficulties with normal functioning, either socially, professionally, or in other important areas, or cause significant distress, they could be due to PTSD.

However, not everyone who experiences a traumatic event develops PTSD. There are certain factors that can make someone more vulnerable, such as biological fragility, being very young or very old, a past history of traumatic reaction to physical or sexual abuse, other mental health problems, a history of childhood or adolescent behavioural problems, or chronic stress.

Symptoms

The symptoms of PTSD can appear soon after the event, or the can be delayed and resurface much later (e.g.: a new stress or the anniversary date can reawaken the memory of an earlier trauma).

The symptoms can be grouped into three main categories:

Persistent re-experiencing of the traumatic event

  • Memories (images, thoughts, perceptions) of the event that continually reemerge;
  • Recurring nightmares;
  • The feeling that the situation is going to happen again, or a sudden certainty of reliving the event;
  • Flashbacks, which can last anywhere from a few hours to a few days;
  • Severe distress and physiological responses triggered by reminders of the trauma.

Avoidance of stimuli associated with heightened general reactions

  • Avoidance of any reminder of the trauma, and efforts to avoid the thoughts, feelings, conversations, activities, places, and people associated with the event;
  • Inability to remember an important aspect of the event;
  • Marked loss of interest or decreased participation in activities that were important to the person before the trauma;
  • The feeling of being in a fog; Feeling detached from others;
  • Trouble experiencing certain feelings;
  • Losing hope for plans that used to be very important.

Hyperarousal symptoms

  • Difficulty sleeping;
  • Irritability;
  • Anger;
  • Difficulty concentrating;
  • Hyper vigilance;
  • Being easily startled.

The severity and duration of the disorder may vary from one person to another, and you don’t have to exhibit all of the symptoms in each of the categories in order to be diagnosed with PTSD.

Treatment

An ounce of prevention! The period immediately following a traumatic event is crucial. Don’t stay by yourself (this is when you should take advantage of friends and family). Get together with other people who have been through something similar. In the event of a mass catastrophe, avoid watching the news over and over (this is even more important for children. Some findings show that children can develop symptoms of PTSD after seeing images of disasters, even if they were far away from the event). Be sure to get enough sleep (if necessary, consult a pharmacist at first). Avoid using alcohol or drugs (alcohol gives the illusion of a good sleep, but it disrupts the normal stages of sleep, and leads to increased anxiety, irritability, and depression the next day). Pay attention to your reactions, if you are able to. If the symptoms persist or are more than you can handle, get help.

For many people, getting support quickly – within 24 to 72 hours after the event – can help to prevent the development of PTSD at a later date. However, it is better not to insist or pressure someone in order to get them to talk. Just be available. Talking doesn't work for everyone, and in some cases, it can actually help symptoms to take hold by forcing the person to relive the event.

Among the various psychotherapeutic
approaches that are available, cognitivebehavioural therapy focused on the trauma is recognized for the treatment of PTSD in particular. One technique that is often used is to gradually expose the person to various elements associated with the event, beginning with having them imagine scenes related to the trauma, until the anxiety recedes. Using this approach, the person is encouraged to face the emotions rather than run away from them. Another process that is often used in this type of therapy is cognitive restructuring, which involves identifying and changing problematic thoughts pertaining to the event, such as those that cause feelings of guilt or responsibility.

EMDR (Eye Movement Desensitization and Reprocessing) is another technique that is receiving growing recognition. After a complete evaluation, the therapist encourages the patient to talk about a negative thought associated with the traumatic situation, and to find a positive outcome. After identifying the emotion in question and the level of distress, the patient visualizes “the worst image” associated with the trauma, while at the same time being asked to move his eyes from side to side (e.g.: following the therapist’s fingers) until the distress associated with the image fades. The theory behind this technique is that eye movements help to incorporate the information into the memory.

Certain medications, such as antidepressants, may be prescribed during medical follow-up in order to reduce the symptoms. Propranolol is considered to be effective immediately following trauma (studies involving its use later in the illness are currently being conducted). Benzodiazepines should only be used with extreme caution, because they can lead to overuse, dependence, and disinhibition in times of danger (possible suicidal thoughts). Preliminary findings also suggest that these medications might actually increase the risk of developing posttraumatic stress disorder.

Where to go for help

If you think you are suffering from post-traumatic stress disorder, a doctor can help you to evaluate the situation and prescribe appropriate treatment, if necessary. For psychotherapy, you can consult a mental health specialist who is recognized by a professional association, including some psychiatrists or a psychologist or social worker, who can provide you with support on a regular basis, develop a treatment plan with you, and help you to improve your quality of life.

Hugues Simard, M.D, Child Psychiatrist, and Anxiety Clinic members, CHU Sainte-Justine

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What is anxiety?

Anxiety is a normal response to perceived danger, like a warning signal. It is experienced as a general feeling of discomfort, distress, or a sense of danger, and often an intense feeling of fear.

Among children and adolescents, anxiety is a normal part of certain developmental stages, and manifests itself as fears that are specific to these stages, such as the fear of strangers (6-18 months), the fear of monsters, the fear of being separated from parents (2-3 years), fear of the dark, fear of sleeping alone (3-6 years), fear of physical danger, fear of school (6-10 years), and anxieties concerning friendship and rejection (10-12 years), identity, fitting in, and the future (adolescence).

Anxiety disorders

Anxiety becomes problematic when it hinders development or significantly affects general functioning. Avoidance of anxietyproducing situations (like school) starts to take over. At that point, we call it an “anxiety disorder.”

Signs

Among children, the signs of an anxiety disorder may be different depending on the child’s age and developmental stage. You may see separation anxiety (an intense fear of being away from the parent) or selective mutism (an inability to talk outside of the family). As the child develops, the signs progressively start to resemble those found in adults: specific phobia (the fear of an object or situation, such as a fear of school or a fear of vomiting); generalized anxiety (excessive worry, a sense of imminent disaster); social phobia (the fear of being judged by others or of being humiliated, to the point of avoiding social situations); panic disorder (episodes of intense acute anxiety, with a fear of dying or losing control, heart palpitations and trouble breathing, trembling, hot flashes, etc.); and obsessive-compulsive disorder (intrusive, unpleasant ideas or images – fear of contamination, for example – and gestures aimed at neutralizing the obsessive ideas – such as excessive washing, for example). Among children who have experienced severe trauma, you may also see post-traumatic stress disorder (reliving the traumatic event through intrusive memories or flashbacks, avoiding situations that recall the event, or being hypervigilant).

Anxiety disorder can also underlie specific problems, such as school avoidance, performance anxiety, and somatization (often manifested as stomach pain with no physical cause).

These problems tend to run in families. Children who have an inhibited temperament may be more likely to develop an anxiety disorder later in life. Studies show that the prevalence of anxiety disorder among children and adolescents is between 10% and 20%, which means that it is the most common mental disorder among that age group.

What to do

  • The first step is to obtain a proper diagnostic evaluation.
  • Once the diagnosis is established, there are a variety of treatment approaches, depending on the situation. The parents are usually part of the treatment process. There are a number of psychotherapeutic approaches, including cognitive- behavioural therapy, psychodynamic therapy, group therapy, relaxation therapy, family therapy, etc. In more severe cases, medication may be required in combination with psychotherapy.

Collaboration with school practitioners is often required as well, particularly in connection with the issue of school refusal.

Where to go for help

Initial requests for services should go through the primary care network – pediatrician, general practitioner, psychologist, social worker, or psychoeducator – often via the CLSC.

In more complex cases, the primary care doctor can refer children and their families to the various pediatric psychiatric services in Québec for more specialized care.

Anxiety self-assessment

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The psycho-educational workshops of Revivre’s J’avance! program provide support for health self-management.This strategy the efficiency of which has been proven is increasingly recognized as an indispensable component in the treatment of those suffering from anxiety or mood disorders.

J’avance! Website (French only)

Support groups (French only)

Participants are given the opportunity to share their experiences and offer mutual support in a welcoming and respectful environment.

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Where : At Revivre