What’s in a name?
Anxiety is a very common mental health symptom, but for most people, its symptoms are very difficult to describe. It is especially difficult if you are Latino as you might not use the word “anxiety” to describe what you are experiencing.
This difficulty could come because English is not your first language, which could complicate your communication with your healthcare provider. It is also possible that as Latino you do not identify with the mainstream health culture. You might say you have nerves (nervios) or stress or you might be seeking help for chest pains or headaches that are caused by anxiety. Latinos are less likely to seek mental health care than other ethnic groups and one reason might be related to communication.
For starters, you might think that your symptoms have nothing to do with mental health so you might not be asking for a referral to a mental health specialist, like a psychologist or psychiatrist. Additionally, you might be trying to talk to your health care provider about your symptoms, but they might not interpret your description as anxiety. You might say you are feeling nerves or stress and this might be taken as a normal reaction to stressors and not as a mental health condition that merits attention. It is also possible that you are seeking health care for physical symptoms because a panic attack is easily confused with a heart condition. You might think that muscle tension that can be caused by worries is a muscle or nervous condition.
So how do you know if it is anxiety and how can you ask for the help you need?
The first step is identification of symptoms. Anxiety disorders comprise many different conditions, but most of them present with excessive fear and worries. Fear is the physical response caused by anxiety and this includes heart palpitations, chest pain, muscle pains, difficulty breathing, excessive sweating, nausea, and tremors among others. These symptoms can suddenly appear in the form of a panic attack and these attacks are described as a moment when you think you are dying or having a heart attack. But, this is not a heart condition, and after some minutes, the symptoms go away. Worries are recurrent thoughts about things in your mind – they might be day-to-day things that you need to do, or they might be troubling thoughts about what others think of you. Both fear and worries could be a normal response to everyday stressors, but when these symptoms are intrusive or persistent or cause trouble at home, work or your studies, they might be pointing to an anxiety disorder.
You might already have figured out that these symptoms are not “normal” or part of a physical condition and might find it difficult to ask a health care provider about them. It is not usual for Latinos to talk about anxiety or disorders, so you might be saying “I feel nervous (nervioso)”, “I have nerve attacks (ataque de nervios)”, “I suffer from nerves (nervios)” or “I have so much stress”. Many health care workers do not interpret these phrases as anxiety symptoms because they are not included in the descriptions given by the diagnostic criteria for anxiety disorders. For example, an ataque de nervios is an episode of extreme distress where the person might feel outside of reality and can feel sadness, anger or fear. At first glance, it does not seem like a manifestation of an anxiety disorder, but most studies have found that these ataque de nervios are related to diagnosis such as panic disorder and post-traumatic stress disorder. It seems like an ataque de nervios is a cultural way in which some Latinos express anxiety.
If you are having symptoms of fear, worries, excessive stress or ataque de nervios /nerves, tell a health care provider that you might be dealing with an anxiety disorder. Ask for a referral to a mental health specialist, which might be a counselor, social worker, psychologist or psychiatrist. If you do not feel comfortable talking to someone in the health care field, talk to your community leader or to your spiritual guide. They usually know how you can access a mental health evaluation that can clarify if this is a normal reaction that will go away with time, or a medical condition that needs therapy or medications.
Karen G. Martinez, MD, MSc is a child and adolescent psychiatrist in San Juan, Puerto Rico. She is an assistant professor at the University of Puerto Rico where she directs the Center for the Study and Treatment of Fear and Anxiety. As the director of this Center, she leads an interdisciplinary team in the development of research and treatment protocols aimed at improving the assessment and treatment of anxiety in Puerto Ricans. This Center consists of an interdisciplinary group of psychiatrists, neuroscientists, psychologists and occupational therapists studying the role of physiological fear on anxiety disorders and cultural adaptation of treatments for anxiety disorders. She received both her master’s degree in clinical research and her medical degree from the University of Puerto Rico. She also completed a Post-doctoral Master’s in Clinical Research in 2006 and has then continued to receive institutional, NIH and Susan G. Komen Foundation support for her research. Her multiple awards recognize her research work including the Career Development Award from the Anxiety and Depression Association of America (ADAA), and a Minority Faculty Award from the American College of Neuropsychopharmacology (ACNP). She is an active member of several professional organizations, such as the ADAA where she has spearheaded multiple projects in order to increase outreach to diverse population including being the co-chair of the Multicultural Special Interest Group.
