Next month Amy turns 49, but it’s unlikely to be a happy birthday. Five years ago she had what she terms a breakdown — it was later diagnosed as generalized anxiety disorder — and life has never been the same since.

“At the time I had many worries and was trying to be superwoman like so many other moms,” says Ann. “I worried about my son in the Navy, my daughter who was having health problems and my mother who was finding it increasingly hard to care for my mentally retarded brother. My husband and I had drifted apart and had little in common.

“I was also unknowingly into menopause, and I was doing the career thing, trying to get a national organization of teachers started.”

Once tipped over the edge, Ann began to suffer a legion of symptoms, from panic attacks and insomnia to ringing in her ears, nausea and trembling. She’s tried a string of drugs, to little avail, and is no longer able to work.

She describes a typical night: “I would pace, cry, pray, cry, pace, pace, pace. I would beg God to help me, but it goes on and on. My startle reflex would go into overdrive—I would jump at the sound of a pin falling.

“You do not eat. You cannot think or concentrate; your whole body screams for relief. It feels like torture…. You get suicidal thoughts. You feel as if you are dragging everyone you love down with you, and your muscles cramp up so tight you cannot move.”

Anxiety disorders — of which generalized anxiety disorder is just one type — are America’s No. 1 mental health problem, affecting almost 19 million people between the ages of 9 and 54 and costing the nation more than $42 billion in doctors’ bills and workplace losses—almost one-third of its total mental health bill. What’s more, many therapists believe that these disorders are on the rise.

There are several different kinds of anxiety disorders:

Panic disorder—Characterized by panic attacks, sudden feelings of terror that strike repeatedly and without warning.

Jerilyn Ross, president of the Anxiety Disorders Association of America (ADAA), explains why these very different disorders are grouped together under one heading.

What anxiety disorders have in common

“They all involve irrational, seemingly uncontrollable and frightening thoughts, which often results in avoidance behavior. And in all cases, the person with the disorder is fully aware that their behavior is irrational,” says Ross. “This differentiates this group of illnesses from psychotic illnesses. What’s more, in most cases the disorder impairs the person’s normal functioning.”

Ross says she isn’t convinced that anxiety cases are on the rise. “But we have become better at diagnosing them, and people are more forthcoming about reporting them,” she says.

Although the different anxiety disorders are considered to be a family of related conditions, we know much more about some of them than about others. GAD is the newest of the group in terms of our understanding. Before it was identified, people would be dismissed in a condescending way as the “worried well.”

“A recent study by the World Health Organization suggests that the odds of developing an anxiety disorder have doubled in the last 40 years.”

PTSD: Recurring Panic and Flashbacks

By contrast, post-traumatic stress disorder was identified at the start of the last century. Back then it was called shell shock or battle fatigue and was used to describe the mental health problems of servicemen who were traumatized in World War I.

For many people with PTSD, just thinking about the original cause of trauma is enough to bring on a panic attack. In fact, the chief problem with post-traumatic stress disorder is that its sufferers repeatedly relive their trauma through nightmares, flashbacks and visceral memories. They may also experience insomnia, depression and extreme irritability. Some people even become violent.

A recent study by the World Health Organization suggests that the odds of developing an anxiety disorder have doubled in the last 40 years. Harvard Medical School’s Ronald Kessler, who coauthored the study, explains, “A lot of it has to do with the world we live in. It’s a scary place. People are moving to strange cities, taking jobs in new industries; there’s a lot of uncertainty about the future. And things like mugging, murders, car accidents and terrorism are on the rise.”

For most people, worrying is not pathological. And feeling anxious or fearful is a normal response to stressful or threatening situations. You need to be alert when taking an exam, meeting performance targets at work, negotiating difficult traffic or fleeing from an attacker—it’s part of the body’s “fight or flight” reflex.

With anxiety disorders, though, the body sends out regular false alarms, driving people into paroxysms of fear and palpitating panic attacks. In other words, the body primes itself to meet a threat when no threat exists.

According to the ADAA, between 3 million and 6 million people in America suffer panic attacks. Without any provocation at all, they feel the same emotional and physical sensations they would if their lives were in jeopardy. The attacks seem to materialize out of thin air, and the symptoms are alarming in the extreme, ranging from a racing heartbeat, chest pains, dizziness and nausea to difficulty breathing, tingling or numbness and irrational fearfulness.

Not everyone who suffers a panic attack develops a panic disorder; some people never have a second attack. But those who suspect they have a disorder should seek treatment, because it can become extremely disabling if left untreated. Panic disorders can compound existing problems, such as depression or alcoholism, and spawn phobias.

In severe cases, people can end up avoiding social contact and shunning everyday activities like driving and shopping, even leaving the house. When people’s lives become so restricted, the condition is called agoraphobia (Greek for “fear of the market”). Clinical research suggests that early treatment of panic disorder can often stop it from progressing to agoraphobia.

Anxiety Disorder Clinical Research Trials

Dr. David Spiegel, director of clinical and medical programs at Boston University’s Center for Anxiety-Related Disorders, has been involved in trials monitoring more than 300 patients suffering from panic disorder. The results, published this summer in the New England Medical Journal, showed that the use of antidepressants and cognitive therapy work equally well, but that a combination of the two produced no curative leap.

The upshot is that people should go with one treatment or the other. The only proviso is that relapse rates were much higher among those treated with medication.

Spiegel says that anxiety disorders tend to run in families. Indeed, research on identical twins has shown that there is a genetic component to most anxiety disorders. But only 30 percent of cases are attributable to genetics.

“What accounts for the rest is a combination of psychological factors,” says Spiegel. “Some people are more stress-sensitive than others and will rush to the ER when they experience a racing heartbeat, when someone else might just surmise that they’d drunk too much coffee that day.”

More anxiety disorders in developed countries?

Spiegel does not share Ronald Kessler’s view that a more stressful and angst-ridden society begets more anxiety disorders, because no correlation has been found between the level of development and incidences of anxiety disorder in other countries.

“Genetically, there is little reason to believe that you would find a difference in developed and undeveloped countries, because the flight or fight system…arises in the most primitive part of the brain. In fact, it’s even found in snails,” says Spiegel.

“What differs are the levels of stress different cultures place on individuals and how much a society is willing to tolerate and share that stress,” he says. “In a culture where there are strong support networks, someone with an anxiety disorder may not be identified at all.”

“Modern American society is less tolerant,” says Spiegel, “and the consequences of not being able to perform at your peak are greater. Also, our support networks have been decimated by families moving far away from another; people are on their own more and more.”

Support Networks to Help with Anxiety

In recognition of people’s need for support networks, the ADAA has installed a chatroom on its website where people with different anxiety disorders can meet. One participant, who I’ll call Tyrone, has Obsessive-Compulsive Disorder. He cannot leave the house without checking everything—the stove, the taps, the lights—several times over before going out. Tyrone takes no pleasure in this ritual behavior; all it provides is temporary relief from feeling anxious.

“Being member of the ADAA has helped me enormously,” says Tyrone, who joined the site’s chatroom out of desperation. “My anxiety is sometimes so acute, I can’t leave the house for days. I was isolated, and I was hurting mentally and physically…. A few individuals [in the chatroom] were friendly and helpful. Eventually I learned that I wasn’t the only one, that my symptoms were common.”

There’s more good news for people with anxiety disorders: The NIMH appointed Yale professor Dennis Charney in 2000 to head up a new mood and anxiety disorders program. Charney is expected to coordinate this research activity with new research in experimental therapeutics.