Every physician knows that the tendency of anxiety is to intensify any symptoms of physical disease which may be present, as anxiety is something which affects, the total individual. It may incapacitate the patient more than any actual disease present, and it is part of the doctor's job to determine how much of the patient's distress is due to anxiety and how much to an actual physical condition that exists, if one does.
Anxiety attacks characteristically produces alarming symptoms such as respiratory difficulties, discomfort in the region of the heart, dizziness, perspiration, palpitation of the heart, weakness, disturbances of stomach and intestines, muscular pain and headache.
If the patient with these anxiety symptoms is carefully questioned, he usually betrays certain fears, fears which may be of wide variety.
Many times the appearance of the patient is suggestive. He has a tense, restless, uneasy look. Examination reveals cold, moist lands and feet, dry mouth and lips, a pulse rate and blood pressure which may vary from time to time.
In the early stages of the anxiety state, the patient is tense, restless, irritable easily tired, and suffers from sleeplessness and other panic attack symptoms. He may find his memory faulty, his powers of concentration lessened, and his ability to make decisions weakened.
Later when his panic attack symptoms deepen, it may concentrate on some organ or system of the body or take the form of depression, hysteria, or the. feeling of being compelled to do certain actions or think certain thoughts.
As a rule, patients with anxiety dislike crowds, new and unfamiliar situations, tension and struggle. Since these things tire them quickly, they prefer to remain in the familiar groove with people - preferably a few or even one person - whom they know well. They show a .loss in general effectiveness, impairment in memory, concentration, sleep and appetite.
It is important to recognize that anxiety symptoms have a purpose. They serve to control some threat to the personality. Quite often they permit the patient to cut down on his activities, thus keeping him away from places, situations and relationships that, arouse anxiety.
It is of the greatest importance that such patients have a complete, careful physical examination when they first come to the physician. Unlike most persons with real organic diseases, people with anxiety states are extremely difficult to convince that their symptoms are not dangerous.
They tend to view their distress as a sign of future disaster and to try to reassure them on anything but firm factual grounds will serve to increase their anxiety and, hence, their symptoms.
