Understanding Anxiety Disorders

Anxiety disorders are serious mental illnesses that cause significant worry or fear that doesn't go away and may even get worse over time. We all feel anxious at times, but with an anxiety disorder, the anxiety tends to be fairly constant and has a very negative and intrusive impact on quality of life.

According to the National Institute of Mental Health (NIMH), approximately 19.1% of adults in the United States have some type of anxiety disorder. Women are also more likely to be affected by anxiety, which is why experts now recommend that women and girls over the age of 13 should be screened for anxiety disorders as part of routine medical care.

Types of Anxiety Disorders

There are several types of anxiety disorders. While all are characterized by symptoms of anxiety, each has its own unique set of characteristics, symptoms, and criteria for diagnosis.

Agoraphobia

Agoraphobia is an irrational and extreme fear of being in a situation where escape is impossible. People often fear that they will experience symptoms of panic or other symptoms in public, which leads them to avoid any situation where they may feel panicked, helpless, or trapped.

These avoidance behaviors are often life-limiting, often causing people to avoid driving, shopping in public, air travel, or other situations. In some cases, this fear can become so severe that people are unable to leave their homes.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) involves excessive worry and anxiety related to various activities and events. This worry is difficult to control and often shifts from one concern to another. 

While there is no specific threat, people with GAD find themselves feeling anxious about everyday daily events, current events in the news, relationships, or potential events that might occur.

Panic Disorder

Panic disorder involves experiencing intense and persistent panic attacks that occur unexpectedly with little or no warning. A panic attack has physical and emotional symptoms such as rapid heartbeat, increased respiration, and feelings of extreme terror. 

Selective Mutism

Selective mutism is an anxiety disorder that occurs during childhood. It involves experiencing anxiety, embarrassment, or fear that prevents children from speaking in specific settings, such as while at school or around strangers.

Selective mutism usually occurs between the ages of two and four and is often accompanied by fidgeting, lack of eye contact, and lack of expressions when faced with a situation the child fears. 

Social Anxiety Disorder

Social anxiety disorder (SAD), previously known as social phobia, involves a fear of social situations. This fear may center on specific events, such as public speaking, or may involve a more generalized fear of many different social situations.

People who have this condition have an exaggerated sense that other people scrutinize everything they do. They may be very critical of themselves and experience both physical and emotional symptoms of fear in social situations. 

Such symptoms include shaking, racing heartbeat, stomach upset, and dread. These symptoms often lead people to avoid social situations whenever possible. 

Specific Phobias

Specific phobias involve intense fear of a specific object or situation that is overwhelming, irrational, and out of proportion to the actual threat. When they encounter the source of their fear, people with a specific phobia experience immediate symptoms such as sweating, crying, shaking, rapid heartbeat, and increased respiration.

As often happens with other anxiety disorders, people with a phobia may go to great lengths to avoid the source of their fear. Such avoidance behaviors can cause additional stress and limit daily activities.

Are OCD and PTSD Anxiety Disorders?

The fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), which healthcare providers use to diagnose mental health conditions, breaks what have generally been considered anxiety disorders into three categories:

• Anxiety disorders
• Obsessive-compulsive and related disorders
• Trauma- and stressor-related disorders

This differentiation shows that while the disorders have a commonality and are related, they are distinctly different. These classifications have remained in place in the most recent edition of the diagnostic manual, the DSM-5-TR.

While OCD and PTSD are no longer officially categorized as anxiety disorders, they share many characteristics, and anxiety symptoms are common in both conditions.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) involves experiencing intrusive thoughts, known as obsessions, and behaviors, known as compulsions. Before the publication of the DSM-5, OCD was considered a type of anxiety disorder, because these obsessions create significant anxiety for many people. 

Obsessions may focus on things such as a fear of germs, a need to have things in a certain order, or disturbing thoughts about taboo topics. Compulsions are behaviors that people often engage in as a way to relieve the anxiety caused by obsessive thoughts. They might involve actions such as counting, ordering, checking, or washing.

Conditions related to OCD and also listed in the category "OCD and related disorders" include body-dysmorphic disorder, hoarding disorder, and trichotillomania.

Post Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a condition that can occur following a traumatic event. It includes symptoms such as changes in mood, arousal, and reactivity. People may have intrusive thoughts, memories, and nightmares related to the trauma. Flashbacks, hypervigilance, anxiety, and avoidance of reminders are other common symptoms.

Other trauma- and stressor-related disorders in this DSM group include adjustment disorders, and reactive attachment disorder

Anxiety Disorder Symptoms

Anxiety disorders come with a host of symptoms and no one person has the same experience. Each disorder tends to have different symptoms as well. The symptoms common to anxiety disorders in general include:

• Difficulty sleeping
• Dizziness
• Dry mouth
• Feelings of nervousness, worry, panic, fear, and unease
• Muscle tightness
• Nausea
• Rapid or irregular heartbeat
• Sweaty or cold hands and/or feet
• Tingling or numbness in the hands or feet
• Unable to be calm or hold still

When you experience the physical and psychological signs of fear and anxiety such as sweating, racing heart, shortness of breath, trembling, worry, or stress, these are cues that something is happening that could be a threat and that you need to deal with it.

This “flight or fight” reaction activates the physical and psychological resources necessary to deal with the potential danger. Although this system works well most of the time, sometimes it can go into overdrive and do more harm than good. When this happens, it might indicate you have an anxiety disorder.

Causes

Millions of American adults (as well as children and teens) will experience an anxiety disorder at some point in their lives. No one knows exactly what causes anxiety disorders, although genetics, environment, stress level, brain changes, and trauma may all play a role.

Researchers are discovering more about these links all the time. A combination of factors likely plays a role in causing anxiety conditions. Some factors that have been implicated include:

• Brain chemistry: Severe or prolonged stress can contribute to changes in the chemical balance in the brain. Such changes can play a part in the onset of anxiety disorders.
• Experiences: Stressful or traumatic events can also contribute to feelings of anxiety. 
• Family history: Having close family members with symptoms of anxiety disorders increases the risk that a person will also develop an anxiety condition.
• Genetic factors: Certain genes may predispose a person to a higher likelihood of developing an anxiety disorder.
• Medical conditions: Some underlying health conditions can contribute to feelings of anxiety. Some of these include chronic pain, heart disease, diabetes, thyroid problems, respiratory conditions, drug use, and drug withdrawal.
• Personality: People with certain personality traits, such as introversion and neuroticism, may be more prone to experiencing higher levels of anxiety.
  

Diagnosis

There are no lab tests that can be done to diagnose an anxiety disorder, though a doctor may perform some tests to rule out physical problems. Your doctor may refer you to a mental health professional, such as a psychiatrist, a psychologist, or a counselor, who will use specific diagnostic tools and questions to help determine what sort of disorder you may have. 

A doctor or mental health professional will ask questions and use assessment tools to help determine if you have a disorder. They will want to know the nature of your symptoms, how long they last, and how severe they are. They will also want to understand how they interfere with your ability to function in your everyday daily life.

Healthcare practitioners use the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) to diagnose these conditions. Each disorder in the DSM lists specific symptom criteria that a person must meet to be diagnosed with a particular condition.

Generalized Anxiety Disorder Discussion Guide

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Treatments

There are a variety of options available to treat anxiety disorders. A mental health professional can help determine what works best for you.

Psychotherapy

Psychotherapy can help people learn to manage the emotional, cognitive, and behavioral aspects of anxiety. One particularly effective form of psychotherapy for anxiety disorders is cognitive behavioral therapy (CBT). This approach focuses on helping people identify the automatic negative thoughts and cognitive distortions that contribute to feelings of anxiety.

Exposure therapy is another type of CBT that can be helpful for some types of anxiety. In this approach, people are gradually exposed to the things that they fear, often while simultaneously using relaxation techniques to help calm the body's stress response.

Medications

Some medications can also be prescribed to help relieve symptoms of anxiety. Some of the medications that are most often used for anxiety include:

• Antidepressants can help alter the levels of certain neurotransmitters in the brain to help relieve symptoms of anxiety.
• Benzodiazepines work quickly and are often used as a short-term treatment.
• Beta-blockers are usually used to treat high blood pressure, but can also help relieve some of the physical symptoms of anxiety.

Coping Strategies

Coping strategies often focus on ways to manage anxiety more effectively. Lifestyle changes such as limiting caffeine intake, getting enough rest, and engaging in regular exercise may be helpful.

Stress management techniques including deep breathing, yoga, and progressive muscle relaxation can also be beneficial when managing feelings of anxiety. Apps for anxiety can help guide you through these techniques.

If you have an anxiety disorder, there are plenty of treatment options available to help you live your life to the fullest. Remember, treatment can take time before you and your physician discover the best options for you. Be patient and keep communication open with your mental health professional in order to figure out the plan best tailored to your individual needs.