Jenner certainly isn’t alone: An estimated 40 million Americans have an anxiety disorder, according to the National Alliance on Mental Illness. Because many of these people wait years before seeking help, the United States Preventive Services Task Force (USPSTF), a group of experts who draw up voluntary health guidelines for Americans, recently released draft guidance recommending that doctors screen all adults under age 65 for anxiety at wellness checkups. If you have anxiety or suspect that you do, Jenner’s claim may have you wondering if a brain scan could give you some answers about what you’re experiencing. The psychiatrist Allison Young, MD, an adjunct professor of psychiatry at the New York University Grossman School of Medicine in New York City and a medical reviewer for Everyday Health, talks about anxiety, brain scans, and how you can get the help you need for this condition. This interview has been edited for length and clarity. Everyday Health: What is anxiety? Dr. Allison Young: Anxiety is a mental health condition that impacts how people react to situations happening to them or around them. Some anxiety is natural and understandable, such as a parent reacting to a serious medical diagnosis given to their child. Even though it’s a reasonable response to a difficult situation, people can manage this kind of anxiety by getting their questions answered, talking to a friend or clergy member, or even by engaging in deep breathing to relieve tension. That’s different from anxiety that keeps people from meeting their own needs or goals. For example, being so anxious about grocery shopping that you can’t get out to the store, or so fearful of new social situations that you spend time alone even though you’d like the company of others: These are indications that anxiety should be professionally treated to help you live your best life. EH: Can a brain scan actually diagnose anxiety? AY: Not really. Unlike, say, a broken thumb, which an X-ray can show, anxiety is not a “broken” part of the brain that shows up on a scan. I say “not really” only because sometimes a person may come to the emergency room or doctor’s office with anxiety or agitation. Especially if we’re told that it’s not usual for the person, we may order a brain scan to rule out a clot, tumor, or a stroke, all of which can cause a change in a person’s behavior. I want to emphasize that in those instances, we’re not ordering a scan to look for anxiety per se; we’re looking for a serious medical emergency, and anxiety may be a symptom of that. The same would be true of people who see their doctors because they’re experiencing symptoms such as headaches, head pain, or involuntary movements. Evaluating those symptoms may involve ordering a brain scan of some kind. And again, the test itself may make people anxious. That’s why if Kendall was feeling anxious during her scan — and, as I said, many people do — the areas of her brain that were active as a result of feeling anxious in that moment could light up and show up on the scan. But that would be a moment-in-time capture of how she was feeling and wouldn’t indicate a chronic anxiety disorder. EH: How do doctors diagnose anxiety? AY: They use a series of interviews and conversations with individuals to understand how these people feel in certain situations and how debilitating these feelings are for them, and then compare these conversations with the criteria for anxiety disorders described in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), the diagnostic tool professionals use to diagnose mental health conditions. EH: And how is anxiety treated? AY: That is very specific to each individual. For instance, people who feel anxious about a situation — say, attending a party on their own — may ask a friend to go with them; that’s their solution to an anxious situation. On the other hand, people who see danger in typically nondangerous situations and it prevents them from enjoying their lives, such as keeping a child at home to avoid potential danger at a park or being so anxious that they cancel job interviews, likely need professional treatment. This could include talk therapy, for example, or medication in some cases. EH: Who should people reach out to if they feel that their anxiety is interfering with their lives and they would like help? AY: Your primary care doctor is a great place to start. You don’t need to wait for a full checkup. Many practices offer short appointments for specific issues. After listening to you describe how you are feeling, your doctor can recommend a range of strategies that he or she thinks might be beneficial. Strategies might include talking to a friend you trust; yoga, which has been shown to help relieve some kinds of anxiety; joining a support group; and seeing a specialist — for example, therapists, social workers, psychologists, and psychiatrists — who are trained to help people handle anxiety. In some situations, doctors may recommend a course of medications to help you cope with your symptoms. You may just be on the medication short term, while you work on other strategies to help relieve anxiety, or you may stay on medication long term. Be sure to verify the following with your doctor:
How long you’ll need to take the medicationHow often you’ll need to take the medication and the dose you should take each timeAny possible side effects you’ll experience and when you should call your doctor to report any side effectsWhen your next appointment with your doctor will be
EH: But Kendall Jenner sounded so convincing. What would you say to people who’d still like to undergo a brain scan to see if they have anxiety? AY: I would say that brain scans are invaluable tools for diagnosing and ruling out serious and life-threatening conditions, such as blood clots or tumors. But in the case of anxiety — where there is no medical evidence to back up the idea that a brain scan can diagnose this condition — the potential risks are just not worth it. The scan that Kendall had requires dye to be injected into a person’s arm. That dye travels to the brain so that radiologists — the doctors who evaluate imaging scans — can get a better picture of what’s going on in the brain. For aneurysms and other conditions, the contrast dye allows an abnormality to show up much more clearly. In extremely rare cases, someone can have an allergic reaction to the contrast dye, in which case another drug is injected quickly to stop the allergic reaction. But an allergic reaction is not a risk worth taking if there’s no medical reason to have a brain scan. EH: If I opted for a scan anyway, would my health insurance cover it? AY: That’s really unlikely. Most scans that aren’t emergencies would need an insurer’s approval before they can even be scheduled. And there’s no insurer code for a brain scan to diagnose anxiety. If you decided to pay out of pocket, assuming that you found a doctor willing to do what seems to be an unnecessary imaging test, you could expect to pay thousands of dollars. EH: Any other advice on dealing with anxiety? AY: There are so many resources in the community for help. If you have a primary care doctor, start there. If not, reach out to 988 on your phone. It’s a new service by the federal Department of Health and Human Services that will connect you to trained counselors who can assist you with a mental health crisis or other issues. They can also send you information and point you to websites and community resources that can help.
