Is fear and depression dangerous

Anxiety disorder and panic attacks : 75 percent of mental illnesses before the age of 24

Christoph Correll is director of the psychiatric clinic for children and adolescents at Charité Berlin and speaks in an interview about anxiety disorders and panic disorders in childhood, adolescence and young adulthood.

Mr. Correll, what is fear?
First of all, fear can be an important signal in terms of survival strategy: One is afraid of things that are dangerous. Historically, this had advantages for the survival of the species. Fear helps to assess the dangers and risks of one's own trading. You regulate your behavior either as an individual or as a group. If you were a little more fearful, avoided dangerous things, and went through life with more caution, that naturally had a survival advantage. This tendency to fear has persisted in us to this day.

When does this “healthy” fear turn into an anxiety disorder?
In general, one can say: mental illnesses are not uncommon. One in three people will develop mental illness at some point in their life. The most common of these is anxiety disorder. But like everything in life, the danger of a poison depends on the dose. If things or experiences that are actually not dangerous cause the experience of fear, this can lead to subjective suffering or a functional limitation, which are the hallmark of illnesses. Symptoms in and of themselves do not mean a disease: this is defined by the additional dimension of suffering or functional impairment. The most common anxiety disorder is the simple phobia, i.e. spider or snake phobia or fear of heights.

What are the symptoms then?
Fear comes from the Latin and stands for tightness - your heart becomes tight, you have pressure on your chest, you breathe very quickly, you can no longer breathe, or you may feel asphyxiated. Palpitations, sweating, dilated pupils, tremors and a lump in the throat are other symptoms. Sometimes you are scared to death, you have to somehow get out of the situation because you have the feeling that you cannot take it. This releases adrenaline, as well as the stress hormone cortisol. One is inundated by the feeling of fear and the messenger substances in the brain.

And does this fear turn into panic?
Exactly, when all of this increases rapidly and reaches a climax that is completely overwhelming, it is called a panic attack. When you practically mean to lose control and the body and soul become independent.

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At what age do those affected develop such fears?
Anxiety disorders usually appear relatively early in life and peak in childhood and adolescence. 50 percent of mental illnesses begin before the age of 14, 75 percent before the age of 24. Particularly in childhood, adolescence and young adulthood, when the brain is still strong and we are developing biologically and psychosocially, the susceptibility to such diseases is very high. Since many of the fears are not quite as strong or people adjust to them and it is a generally humane feeling, fears are often recognized and treated very late. Those affected then live in a great restriction in which they adapt to this fear and often allow it to dominate.

Can this dominance increase if it is not treated?
Exactly, you learn in the wrong direction. You learn: Avoidance is good and if something happens then the fear is all the greater and you withdraw even more. You practically move into the house of fear.

Why do some people develop anxiety disorders and others not?
Genetic predisposition plays an important role. There are people who react to stress by withdrawing, becoming anxious or depressed. Still others react with aggression. On the one hand, this has something to do with the genetic makeup and, on the other hand, it has to do with the behaviors or coping strategies each person has learned from their environment. For example, finding a conversation, activity or relaxation can help some. Others take refuge in media consumption or use alcohol or substances as a quick anti-anxiety aid. These strategies can be more or less constructive.

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What is the "fear of fear" about?
Yes, the so-called "phobophobia" - that is the move into the house of fear that I have named. The moment you are afraid of the fear, you no longer go out. There are people who have panic attacks but are still only slightly restricted in their options for action. The people who, however, think in advance that they could have panic attacks, almost no longer expose themselves to the supposed danger and the world. Then the fear becomes independent and changes the behavior of the person concerned profoundly. For many, panic feels like fear of death. Those affected want to avoid this and accept many restrictions in return.

You head the Clinic for Child and Adolescent Psychiatry at the Charité. Which anxiety patients are you treating?
We have many patients with school phobias where the young people are afraid to go to school. With social phobia, those affected fear exposure and failure. Many are afraid to speak in front of their classmates when they are called. Often these are even intelligent students who get bad grades because they are so trapped in this fear corset. In addition, these students are sometimes teased, which happens quickly when someone is so intimidated and upset - a spiral that can lead to these children and young people not going to school for months.

So is the social phobia most common in your patients?
No, there is also generalized anxiety disorder, in which patients are afraid of many everyday and future situations without precise reasons and causes and thus limit their scope of action, can also develop sleep disorders or become depressed. And then there are also fears that have to do with abuse and traumatic experiences.

What treatment options are there?
There are very effective psychotherapeutic treatments for all of these anxiety disorders, including panic attacks. And if these are not sufficiently effective, medication can also be used to provide support. It is worst when people move into the House of Fear and stay there and do not seek or find any help. That cuts them off from being many of their opportunities to experience themselves and other people, to act out. That is then lost life and development time.

Schools have been closed because of the corona virus since mid-March. An advantage for your patients who do not dare to go to school?
We are currently conducting a study on what the positive and negative influences of the coronavirus pandemic are, also in relation to the restrictions imposed. For patients with anxiety disorders, the current situation is initially a relief. This is again the strategy of avoidance: In school there are social interactions where not everyone is always a winner. Of course, for those who are bullied, it is better not to be in school. Even for those who are worried about speaking in front of others and are afraid of exposing themselves, it is easier to learn online and via video chat. That is the subgroup that is actually doing better at the moment. But this group is currently being deprived of the opportunity to test themselves socially, to grow and to overcome their fears in an active manner, in order to be able to go back to life more freely from the house of fear.

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