Difference between occasional anxiety and an attack

Dear Dr. Roach: My daughter-in-law has anxiety attacks. It gets so bad that she ends up throwing up. She has seen a doctor, but so far it has not helped. Can you give her any advice? — M.L.

Dear M.L.: Anxiety is something that nearly everyone has felt when confronted by a difficult, unexpected or time-consuming problem. An anxiety disorder is different.

Generalized anxiety disorder is “excessive and persistent worrying that is hard to control, causes significant distress or impairment, and occurs on more days than not for at least six months.” Some physical symptoms are hallmarks: Poor sleep, fatigue, headaches and pain in the neck, shoulders and back are among the most common, but vomiting is possible in people with more-severe cases of anxiety. Panic attacks often co-exist with severe anxiety disorders.

Many regular doctors, including primary care doctors like me, may not recognize the symptoms of an anxiety disorder or be comfortable providing treatment. A referral to a mental health professional is wise. When the condition is diagnosed, the doctor needs to assess the severity to determine what kind of treatment is best. For many people, that will include psychotherapy, such as cognitive behavioral therapy. This has been shown to be effective, but it may be difficult to find in some areas of the country. Medication treatment is also effective, and the combination of the two is more effective than either separately.

Since your daughter-in-law is having severe symptoms, I would really recommend she see an expert.