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education PATHOLOGY PERSPECTIVES 40 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 6 Worrying About Worrying Massage Therapy and Anxiety Disorders By Ruth Werner Anxiety disorders affect roughly one in every eight adults in the United States. These conditions cross over all races and ages, but because they can make it difficult to keep a job or maintain relationships, and because medical intervention can be difficult to access, they are disproportionately high among the lowest socioeconomic groups. Anxiety and stress are closely related, but they are not the same thing. An experience of emotional stress in response to everyday challenges is considered normal, but anxiety is considered by some professionals to be a complication of living in a stressful state over a prolonged period of time. In other words, stress is a response to life's challenges; anxiety is a pathological reaction to stress. Anxiety can be a transient problem in connection with specific events like surgery or other major challenges, or a freestanding condition that may last a lifetime. A person can be affected by multiple anxiety disorders, along with other mental conditions, all at the same time. And, amazingly, massage therapy may help. Research shows that massage therapy can be a useful intervention for these common, complicated, convoluted conditions. How do we know this? How do we measure the severity of a mental state? Does the effectiveness of massage therapy in this context impact our scope of practice? And if massage therapy is helpful, does that make us mental health-care providers? WHAT IS AN ANXIETY DISORDER? Anxiety disorders are mental conditions that center on the experience of various kinds of fear. That fear may be altogether irrational or based on something realistic, but distorted out of proportion. While we are occasionally overwhelmed by events around us, people who live with anxiety disorders may be mildly or completely debilitated by their perceptions of threat; feeling overwhelmed and powerless threatens their physical health and becomes a defining feature of their lives. Anxiety disorders are common— affecting up to 40 million Americans— but they are often undiagnosed and untreated. Anxiety disorders and other mental health challenges can also overlap, so a person may be affected by more than one challenge at any time. WHAT IS THE DSM-5? The DSM-5 refers to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It is the reference doctors around the world use to study and treat psychiatric conditions. It is regularly updated to reflect the most current findings in mental disorder diagnoses, treatments, and prognoses. The most current edition has reorganized the way some of the psychiatric conditions are classified and discussed. A brief overview of the new DSM-5 organization of anxiety disorders and related conditions is included under "DSM-5 Headings" on page 41. TYPES OF ANXIETY DISORDERS • General anxiety disorder (GAD): GAD describes constant consuming worry and anticipation of any possible catastrophe. Primary symptoms include restlessness or a feeling of being on edge, easy fatigability, irritability, muscle tension, poor concentration, and sleeping problems. • Panic attack, panic disorder: Panic disorder is characterized by the sudden onset (often with no identifiable trigger) of very extreme sympathetic symptoms: a pounding heart, alternating flushing and chilling, chest pain, dizziness, faintness, and sweatiness. Hyperventilation causes numbness and tingling in the lips and extremities. A feeling of being smothered, of impending doom, and the nearness of death usually lasts for about 10 minutes, but may persist for many hours. A person can have a single panic attack without having panic disorder. But when episodes repeat, especially if they are associated with a certain place or situation, panic disorder may be diagnosed. • Agoraphobia: About one-third of panic disorder patients develop agoraphobia—a situation where people avoid any situations they feel might trigger a panic attack. Agoraphobia can also be a freestanding disorder, without a preliminary history of panic attacks. It is frequently defined as fear of open spaces, but a more accurate description might be fear and avoidance of places or circumstances that feel threatening for any reason. • Phobias, social and specific: Social phobia—Also called social anxiety disorder, social phobia is characterized by fear of being judged negatively by others. Physical symptoms are not always present, but may include blushing, nausea, sweating, and trembling. People