The Soldier

In Shakespeare’s day, the soldiers – many of them men in their prime – marched off to do battle and often didn’t return. Luckily, Canada has enjoyed five decades of peace, but young men and women have become involved in battles on other fronts: fighting for a post-secondary degree, career advancement and material comforts.

Although most 25- to 35-year-olds are likely to be healthier than they will ever be, some now are seeking a sense of community and fulfilment that seems to be missing in society, says Dr. Sid Kennedy, director of the mood and anxiety disorders program at the Centre for Addiction and Mental Health in Toronto. “There’s no doubt that people are much more isolated and stressed, and they feel less in control of their lives than they used to,” says Dr. Kennedy, who is also a professor of psychiatry.

According to last year’s Annual Report Card on Canadians’ Health from the Heart and Stroke Foundation of Canada, 43 per cent of Canadian adults aged 30 and over said they felt overwhelmed by their jobs, families or finances. Such emotions can have both short- and long-term consequences on physical and psychological health, says Dr. Brian Baker, an associate professor of psychiatry with an expertise in cardiovascular disorders. When people are unable to cope with negative stress, they frequently develop unhealthy habits such as overeating, under-exercising, smoking and using alcohol or other drugs, he says. This means that some in their 20s and 30s are literally “priming the pump” for heart attacks or stroke in their 40s and 50s.

Women seem to be particularly vulnerable to the psychological effects of negative stress, says Dr. Donna Stewart, professor and Lillian Love Chair of University Health Network and University of Toronto. “Women’s reproductive years are the highest in anxiety, stress and depression. Because most women now work and are balancing jobs with child-rearing, their main health concern is exhaustion,” she says.

It is well known that the rate of depression among women during childbearing years is double that of men, and that depression is most common among younger women. But even though young working women complain about stress, population studies show that women who go out to work are still generally happier and healthier than those who stay at home, says Dr. Stewart.

While people in their 20s and 30s worry about age-old issues such as unemployment, poverty, family tension and politicial unrest, they are also concerned about things that would probably mystify their parents and grandparents – for example, the current preoccupation with physical appearance that is entrenched in the media. “People today tend to assume that you can judge a person’s character by his or her appearance,” says Carla Rice, clinical programs specialist with the Body Image Project at Regional Women’s Health Centre, Sunnybrook and Women’s College Health Sciences Centre in Toronto. This has led to increasing feelings of dissatisfaction and low self-esteem in the person who is being judged, because they are treated differently, says Rice. “Women think they are too fat, which can perpetuate eating disorders such as yo-yo dieting, anorexia and bulimia. Young men think they need to bulk up, which can lead to their ingesting steroids and working out obsessively.”

Dr. Gary Rodin, head of U of T’s psychiatry, health and disease program and psychiatrist-in-chief at the University Health Network, agrees: “When you look at our culture, you find that between one-third and one-half of normal-sized women feel overweight. The overriding cultural ideal of thinness makes people feel there is something wrong with them.”

In a very small segment of the population – about one per cent – this preoccupation with weight and shape becomes extreme, and people may develop Body Dysmorphic Disorder (BDD). It is most common in young adults, probably because body consciousness and concerns about physical appearance are most prevalent in this age group, says Rodin. People with BDD are preoccupied with some imagined defect in their appearance: either a facial feature, their hair, or some aspect of their body size or shape. The person’s concern is almost always unrealistic and causes significant emotional distress. Some react by withdrawing from social contact, while others may obsessively seek surgery to correct imagined defects.

Dr. Kennedy believes the current focus on the body, including the struggle against growing old, seems to be starting earlier and lasting longer than ever before. “It used to be that you could stop worrying about your appearance after age 35 or 40,” he says. “But not in today’s culture.”

The years between 25 and 35 should be the time of life when people establish healthy habits that will ensure their continuing health in middle age and later, says Dr. Baker. However, certain troubling trends appear to be coming out of recent research in the United States – the country whose lifestyle most closely resembles Canada’s own. For example, a study that appeared in the medical journal Circulation last year found that one in six donor hearts removed from deceased teenagers showed signs of atherosclerosis (a plaque buildup in the arteries). It also found that the number of sudden cardiac deaths among Americans aged 15 to 34 rose about 10 per cent between 1989 and 1996. The overall increase may be caused in part by the increased prevalence of cardiovascular risk factors such as obesity among adolescents, according to Zhi-Jie Zheng, lead author of the study. “What’s happening in the U.S. is likely happening here, too,” says Dr. Baker.

Panic disorder in young adults
About three-and-a-half per cent of Canadians are affected by panic disorder, says Dr. Neil Rector, an assistant professor of psychiatry who heads the Anxiety Disorder Clinic at Toronto’s Centre for Addiction and Mental Health. They experience “out of the blue” panic attacks, which include symptoms such as dizziness, tingling hands and feet, trembling, chest pain, palpitations, shortness of breath, nausea, chills or hot flushes.

Panic attacks occur in people of all ages, but they often start in early adulthood (the mean age is 25). Recurrent incidents constitute a panic disorder that must be treated to prevent life-affecting consequences. “A core feature of panic disorder is intense fear of the next attack,” explains Dr. Rector. “This can lead a person to avoid places where a previous attack has occurred. He or she may not venture beyond a safe zone – a pattern of avoidance known as agoraphobia.”

Panic disorder also appears to affect twice as many women as men, although this may simply reflect that men are less likely to seek help and potentially more likely to medicate their symptoms with alcohol.

Cognitive-behavioural therapy can help the majority of people confront and overcome their fears, while such antidepressant drugs as selective seratonin uptake inhibitors seem to dampen the symptoms of panic.