Do I have an anxiety disorder?

But I'm fourth year medical student and I'm wondering if i have a diagnosis of an anxiety disorder..

My problem is that I get extremely nervous during public speaking situations.. ie: giving formal presentations etc. Also, sometimes even presenting patients to my attending when I realize someone is listening (makes it hard for me to focus). I'm fine in informal presentations, presentations ot people im relatively close to (i still get nervous as heck.. but i can usually get through it in one peice), and presenting to attendings if its one on one. When I'm presenting I can feel my sympathetics firing like mad... tachy, dry mouth, not sure if im tachypnic.. but sometimes i get tingling.. so probably am... the biggest problem is that my mind goes blank and its very hard for me to concentrate on the task at hand. Sometimes even if im smoothly presenting a patient to an attending (not even a hint of being nervous), and i see someone else listening in, ill lose my train of thought and get nervous.. (i'm fine in social situations with strangers etc.. i can carry on a conversation with just about anyone)

I've always hated presentations, but i've just attributed it to 'fear of public speaking' like 50% of the population.. but its starting to interfere with my work.. I was put in charge of running a simulated trauma code today and i totally froze up.. even though i knew exactly what to do (ie: ABCDE) i couldn't really bring myself to say it.. my mind was all over the place.. like what should i do etc. (ive also had a few situations in recent presentations where although I was adaquately prepared, i couldn't really get through it without stuttering like crazy and then just reading the material from the slides .. very poor form)

I've tried to get through it by telling myself that its an irrational fear and that i'm well prepared.. but usually i go to pieces right before i present or have to speak.

i've thought about the various treatments associated with this (ie: systematic desensitization, which ive tried on myself but its hard because its difficult for me to replicate the exact set of circumstances that'll make me anxious.. but maybe self treatment isn't the best solution).. im thinking maybe some beta blockers will help tone down my sympathetic drive when im working as a short term solution?

The reason this is becoming an issue now is that I'm about to apply to residency soon, and I'm concerned that I won't be performing up to par on my Sub-Internships to secure the necessary letters of recommendations... i've considered in the past that i may have a specific anxiety disorder in the past (especially during my psych clerkship), but I assumed either i was being a regular hypochondriac med student (who thinks they have every new/rare disease they learn about, until they learn about a new disease) or that my fear was normal... and I've always assumed that I can get by by just winging it (which has gotten me through 3rd years of med school with pretty decent grades and evaluations), but im beginning to think that is not the best idea going forward.

My question is.. if this is indeed a psych problem and not just me being overly worried (im not a worrier by nature).. is this a problem i can solve (or cope with) in a short period of time, or is this something that'll take much longer? (ie: months- years). My first Sub-Internship is in 2 weeks!

(another issue is that my school health insurance sucks and i don't even know how soon i'd be able to see a professional much less afford all the copays and fees (since it is summer, i may need to pay out of pocket).. so thats another reason that i'm hesitant about going to the doctor)

any advice?

Medication may help your situation although YOU SEEM VERY HEALTHY and it is just that being a doctor requires a healthiness ABOVE AND BEYOND what is healthy and normal for the rest of the population....as far as cost you may find a clinic with a sliding scale and I do believe the money will be worth it to save your career down the line and I do believe you will make a great doctor...here is a link that might help, too..

http://speech-anxiety.healthyplace2.com/

Hope to see you around the health field- I'm going to be a nurse

I had that problem, in excess of "normal" (would forget my name if I had to stand up and talk).

I'd find a Toastmaster's group and see if you can make any headway in a few weeks (or calm yourself some that you are at least working on the problem?):

http://www.toastmasters.org/

I had 20 years therapy and I can talk now without dying but I'm still anxious, I can recover though and make it through. I think you have too much focus on the fear/yourself and not enough "out there" and I found that hard to learn to adjust, give myself "space" between what I'm asked/the "problem" and my response. One has to learn to short circuit that initial panic and then things can "flow" naturally. With therapy that can take a long time but I've never had meds so I don't know if they'd help or hinder/slow your thinking down so even if you weren't panicked, you wouldn't be able to remember/think as well? I'd try them maybe, see if they help and join a public speaking group to see if that could help. The best remedy is practice and that takes lots of time too.

I think therapy can help in any area of your life that doesn't feel comfortable. And particularly in areas that are important in your career development. This is an important issue for the field you are entering.

Therapy could help you discover what your fear is that shows itself when you have to talk. There's something behind the having to talk.

You might want to call some therapists and ask if they work with your specific issue so that you will know who you want to see when school and insurance starts again. Also, many schools offer some counselling and you may be able to get help there or they may be know just who to refer you to, as I would guess that many others have sought help for this.

Hi anxiousMS,
It has been a few years since you posted about your situation. I am currently feeling the same way you have. I am curious to how you progressed. Thanks.

I am too a 4th year medical student and I am going through the same issues and could really use your help. Please let me know if you can PM me with any advice. Thanks again.