Sarah Goodwin

Kathi Ovnic
Holly Korschun
August 2, 1999
WHEN BUTTERFLIES IN THE BELLY BECOME BATS: Diagnosing and Treating Anxiety Disorders

We all get the jitters, but not all of us become so paralyzed with anxiety our daily functioning is affected. Still, the National Institute of Mental Health estimates anxiety disorders are the most common mental illnesses in America (see the institute's fact sheet attached).

Health professionals and the public are beginning to distinguish between "normal" stress and anxiety ­ which are, in fact, essential to survival (ask any caveman hiding from a dinosaur) ­ and anxiety gone awry, which can hinder survival.

Clues that butterflies in one's belly have become anxiety-filled bats are often related to the length and intensity of anxiety episodes, and assessments of how disruptive they are to one's daily routine, says anxiety researcher Philip Ninan, M.D., associate professor of psychiatry and behavioral sciences at the Emory University School of Medicine.

Do feelings of worry and nervousness persist for weeks at time? Does the anxiety become so paralyzing one chooses to avoid certain situations? Has sound sleep been compromised? Questions similar to these are part of the Anxiety Disorder Self-Test (attached) developed by the Anxiety Disorders Association of America. The full test is available at

Research into the genetics, brain chemistry and brain anatomy associated with anxiety disorders has increased knowledge of how anxiety disorders affect the body, the mind and behavior ­ and has pointed to new directions in drug and behavioral treatments, Dr. Ninan says.

"We are beginning to understand the anatomy underlying anxiety and the physiological process involved," says Dr. Ninan, who also directs Emory's mood and anxiety disorders program. "Functional brain imaging techniques such as positron emission tomography (PET) have been critical to these advances."

Emory psychiatric researchers are using PET imaging to evaluate cerebral activity while patients with PTSD, panic disorder or social phobia are experiencing episodes of acute anxiety. They can determine how and when anxiety attacks occur and can "see" the brain regions involved.

"An important application of this type of research will be to test the effectiveness of new therapies," Dr. Ninan says. "We can evaluate the effects of new medications, for instance, by administering them to study subjects in the PET scanner, exposing subjects to anxiety-producing scenarios, then evaluating brain scans and patients' perceived improvements."

Information on clinical research at Emory's mood and anxiety disorders program, including studies for which persons with anxiety disorders are being sought, is available by calling 404/727-8968 or visiting the following website: