Q. I'm worried about my 72-year-old mother. Lately she's been loathe to leave the house. She's quit her garden club and her bowling league for no good reason that I can see. She's in pretty good health and still drives. Any idea what could be going on?

A. There are a number of things that could be going on— either mental or physical or both. You should encourage your mother to get a thorough physical examination as a first step. Although older people have a lot of anxiety, 90 percent of all anxiety disorders first occur before age 40. So if someone is having symptoms that feel like panic attacks and they're 70 and they never had them before, the likelihood is that they are not having an anxiety disorder. They could, however, be experiencing depression or a physical illness. For instance, anxiety is often a very early symptom of Parkinson's disease. Or someone losing her memory may become very anxious. It is also rare for obsessive compulsive disorder to strike in older age. However, anxiety disorders are considered "chronic intermittent" disorders, meaning they come and go over the course of a lifetime. Maybe your mother had agoraphobia 40 years ago and now it's back. If she is diagnosed with an anxiety disorder and your health care professional prescribes antianxiety medication like benzodiazepines, question it. These drugs are sedating, particularly in the elderly, and could lead to falls. Ask about other options such as antidepressants if your mother needs medication.
—Sally Winston, PsyD
Codirector, Anxiety and Stress Disorders Institute of Maryland
Towson, MD

A. First, try not to accommodate your wife's problem. In other words, don't help her avoid situations that trigger her anxiety. Instead, encourage her to face her fears and learn that the situation is not dangerous. Second, don't ridicule or be harsh with your wife. This will only make her more stressed out, which will make the symptoms worse. Instead, be understanding.

In general, if you or other family members are angry about your wife's problems with anxiety—if they cause distress for the whole family, for instance—direct your anger at the anxiety disorder, not at your wife. In other words, say something like: "I really hate how these anxiety problems keep us from having a good relationship," rather than, "Why don't you just get over it so we can have a normal family?" The first step toward recovery is diagnosis, so your wife is on the right road. Make sure she is being treated by a professional trained in treating OCD, who is up on the most effective psychological and medical options.
—Jonathan S. Abramowitz, PhD
Director, Anxiety and Stress Disorders Clinic
University of North Carolina
Chapel Hill, NC

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