Anxiety disorders are mental illnesses in which patients feel excessive anxiety, fear or distress during situations in which most other people would not experience these symptoms. Normally, anxiety is part of the body’s alarm system, alerting a person to danger or providing extra energy to help accomplish a task. However, people with anxiety disorders experience disabling anxiety and distress that dramatically reduces their productivity and significantly diminishes their quality of life and ability to function on a daily basis.
Anxiety is also a symptom of other mental health disorders, physical conditions and a side effect of some medications and substances including alcohol and recreational drugs. An anxiety disorder is diagnosed when anxiety is the main symptom that requires help from a mental health professional.
Anxiety disorders are among the nation’s most common mental disorders, according to the Anxiety Disorders Association of America. There are five major categories of anxiety disorders, including:
- Generalized anxiety disorder. Diagnosed when a person worries excessively about all types of life issues (e.g., health, family, money, work) for more than six months.
- Obsessive-compulsive disorder. Diagnosed when a person is unable to control intrusive and unwanted thoughts (obsessions) and/or to stop performing ritual actions (compulsions), such as repetitive handwashing.
- Panic disorder. Diagnosed when a person regularly experiences panic attacks – sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes and cause physical symptoms such as racing heartbeat, heavy perspiration and shortness of breath.
- Phobias. Diagnosed when a person has extreme and irrational fear of objects or situations that in actuality pose little or no threat to them.
- Post-traumatic stress disorder. Diagnosed when a patient who has experienced an extremely traumatic event such as war, rape, child abuse or a natural disaster later begins to have nightmares, flashbacks, depression and/or other symptoms.
The exact cause of most anxiety disorders is unknown. However, a combination of psychological, biological, genetic and environmental factors may be responsible. Patients diagnosed with anxiety disorders have several effective treatment options. In many cases, a combination of psychotherapy and medications is the best treatment.
About anxiety disorders
Anxiety disorders are mental health conditions in which patients feel excessive anxiety, fear or distress during situations in which most other people would not experience these symptoms. People with these disorders may feel chronic, intense and irrational anxiety on a regular or even daily basis. As a result, anxiety disorders seriously diminish quality of life, hampering a person’s ability to work, travel or form and maintain interpersonal relationships.
Normally, anxiety is part of the body’s alarm system, alerting a person to danger or providing an extra energy to help accomplish a task. However, some people experience anxiety for no particular reason, or that is out of proportion with the actual threat that may be present. Some of these individuals may have an anxiety disorder. Others may experience anxiety in conjunction with another mental disorder, such as depression, or as a side effect of prescribed medications.
Anxiety Disorders are among the most common mental illnesses in America and account for one-third of the total mental health bill in the United States, according to the National Mental Health Association.
Depression is often associated with anxiety disorders. Symptoms of depression include feelings of sadness, hopelessness and low energy. Despite the fact that many anxiety disorders are highly treatable, just one-third of those who experience symptoms actually visit a physician, according to the ADAA. Patients who have previously undergone treatment for an anxiety disorder but did not find it effective should not be discouraged. Most cases of anxiety disorder that do not respond to one form of treatment will respond to another. In addition, new approaches are emerging all the time. Patients should tell their physician about their previous treatment regimen (including types of medications or psychotherapy) and whether or not it was effective.
Types and differences of anxiety disorders
There are five major categories of anxiety disorders. All share the quality of excessive and irrational fear. The fear may be of a specific object or situation (e.g., spiders or public speaking), or it may be generalized fear that the patient feels without being able to identify a specific source of that fear. Although each anxiety disorder has its own distinct features, in all cases the patient’s fear dramatically reduces productivity and/or significantly diminishes quality of life. The categories include:
- Generalized anxiety disorder. Diagnosed when a person worries excessively about all types of life issues, including health, family, money and work, for six months or longer. Patients with this disorder may find themselves unable to relax, even when there are no signs of trouble in their lives.
- Obsessive-compulsive disorder. Diagnosed when a person is helpless to control intrusive and unwanted thoughts (obsessions) and/or to stop performing ritual actions (compulsions), such as counting, handwashing or repetitively checking locks.
- Panic disorder. Diagnosed when a person regularly experiences panic attacks – sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes and cause symptoms such as racing heartbeat, heavy sweating and shortness of breath. In some cases, panic disorder may be accompanied by agoraphobia, a condition in which patients fear being caught in a place or situation in which escape might be difficult, or being trapped in circumstances in which medical help might not be available during a panic attack. In other cases, panic disorder actually causes agoraphobia.
- Phobias. Diagnosed when a person has extreme and irrational fears of something that in actuality poses little or no threat. Social phobia (also known as social anxiety disorder) involves a fear of being judged by others, whereas people with specific phobias suffer from intense fear of certain objects (such as fear of snakes) or situations (such as fear of heights). Agoraphobia is a phobia closely related to panic disorder (see above). People with phobias avoid objects or situations that they view as threatening.
- Post-traumatic stress disorder (PTSD). Diagnosed when a patient who has experienced a traumatic event such as war, rape, child abuse or a natural disaster begins to have nightmares, flashbacks, depression or other symptoms for more than a month. Stress disorders that occur within a month of the traumatic event are known as acute stress disorders.
Other anxiety disorders are related to physiological changes that are induced by substances (e.g., recreational drugs, alcohol, caffeine) or a medical condition (such as thyroid abnormalities). Some patients may have intense anxiety that does not fit the criteria for any of the recognized anxiety disorders. In such cases, a diagnosis known as “anxiety disorder not otherwise specified” may be made.
Risk factors and causes of anxiety disorders
The exact cause of most anxiety disorders is unknown. However, a combination of psychological, biological and environmental factors may be responsible. Heredity is also believed to play a role in many anxiety disorders. The combination of heredity and the anxiety experienced may vary.
Research is ongoing into how the brain creates feelings of anxiety and fear. Scientists believe that an almond-shaped structure called the amygdala serves as a central location that coordinates messages between the parts of the brain that process incoming sensory signals and the parts that interpret those signals. The amygdala signals the body when a threat is present, triggering anxiety or fear.
Another brain structure called the hippocampus also helps process threatening signals and changes information into memories. Research shows that people who have experienced severe stress (such as child abuse or combat experience) appear to have a smaller hippocampus. Most anxiety disorders begin in childhood, adolescence or early adulthood. In many cases, anxiety disorders affect women more often than men. However, in other disorders – such as social anxiety disorder – the percentages are nearly equal.
Signs and symptoms of anxiety disorders
Symptoms related to anxiety disorders may differ slightly depending on the nature of the disorder affecting a patient. For example, patients with panic disorder may experience panic attacks that include rapid heartbeat, heavy sweating and shortness of breath. Meanwhile, patients with obsessive-compulsive disorder may find themselves unable to stop thinking certain thoughts or to stop performing rituals repetitively, to the point that the rituals become time-consuming.
Patients diagnosed with one form of anxiety disorder often are also diagnosed with a second anxiety disorder. In addition, many patients with anxiety disorders also are diagnosed with other mental health disorders, such as depression, eating disorders or substance abuse.
Some of the symptoms associated with major anxiety disorders are as follows:
|Panic disorder||Recurrent episodes of panic attacks which feature rapid or pounding heartbeat or palpitations, heavy sweating and shortness of breath|
|Phobias||Extreme and irrational fears of something that in actuality poses little or no threat.|
|Obsessive-compulsive disorder||Recurrent and persistent thoughts or impulses – examples include excessive handwashing or checking repeatedly to make sure the stove is off|
|Post-traumatic stress disorder||Flashbacks or nightmares, emotional numbness, headaches, dizziness, chest pain|
|Acute stress disorder||Anxiety, dissociation and other symptoms within a month of exposure to trauma|
|Generalized anxiety disorder||Excessive anxiety and worry, irritability, restlessness, fatigue, trembling|
Diagnosis methods for anxiety disorders
In some cases, patients may be unaware that they have an anxiety disorder and will visit a physician because of physical symptoms that they experience. For example, a patient with panic disorder may visit a physician believing that symptoms such as chest discomfort, heart palpitations and shortness of breath indicate a heart problem rather than an anxiety disorder.
In such cases, a physician will have to rule out the possibility of an underlying medical illness such as heart disease before suspecting that an anxiety disorder may be causing physical symptoms. Blood tests such as a complete blood count or tests such as an echocardiogram (an image of the heart produced by ultrasound) may be used to rule out certain heart conditions.
In other cases, patients may not experience acute physical symptoms, but may instead report feelings of unease or anxiety. These patients may find that anxiety is interfering with their lives and that they require medical treatment to help alleviate the problem.
In most cases, a physician will perform a complete medical examination and compile a thorough medical history. Once other conditions have been ruled out, the physician may diagnose an anxiety disorder if certain criteria are present.
All anxiety disorders have their own, specific criteria as defined by the American Psychiatric Association (APA). For example, panic disorder is diagnosed when the patient has recurrent, unexpected panic attacks, and when for a month or more after at least one attack, the patient has one or more of the following:
- Ongoing concern about future attacks
- Concerns about the significance of future attacks and their potential consequences
- Change in behavior to reduce the likelihood of future attacks
In addition, to diagnose a panic disorder, symptoms should not be caused by a general medical condition or the use of substances, and cannot better be explained by another anxiety disorder or other mental illness. A patient who appears to have an anxiety disorder may be referred to a mental health professional such as a psychiatrist to confirm diagnosis and treat the disorder. Experts in mental health care can establish a diagnosis for one or more anxiety disorders or another mental illness such as depression.
Treatment options for anxiety disorders
Patients diagnosed with anxiety disorders have a number of effective treatment options. In many cases, a combination of psychotherapy and medications may be the best treatment. In other cases, one form may be more beneficial than another. For example, certain phobias respond only to psychotherapy.
Many antidepressant medications are approved by the U.S. Food and Drug Administration for the treatment of anxiety disorders. These drugs are usually effective, even in patients who are not depressed. However, they sometimes take several weeks to become effective, so patients should not become discouraged if they do not see immediate improvement.
Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior. However, in most cases, the benefits of such medications outweigh the potential risks.
Anti-anxiety medications may also be prescribed. They are generally used only for short periods of time, because some patients may develop a tolerance to some of these drugs. This means that over time, it takes increasing dosage levels to achieve the same effect from the drug, which may lead to drug dependency. However, patients with panic disorder may take the drug for as long as six months to a year.
Patients should not stop using antidepressant or anti-anxiety medications unless under close supervision of a physician, because this may cause withdrawal symptoms.
Beta-blocker medications – which are typically used to treat heart conditions – are effective in treating some anxiety disorders, particularly social phobia. Patients who experience severe and disabling anxiety and are aware that they soon will be in an anxiety-provoking situation – such as giving a speech – may be prescribed beta blockers to reduce symptoms such as a pounding heart or trembling hands.
Psychotherapy is particularly effective for anxiety disorders such as social phobia and panic disorder. It is likely to take the form of behavioral therapy and cognitive therapy, or a combination of the two (cognitive-behavioral therapy). In behavioral therapy, the patient learns to change specific actions and to use different techniques to stop harmful behavior. The patient may learn relaxation techniques such as deep breathing and may be gradually exposed to situations that are frightening and in which the patient can test new coping skills.
Cognitive therapy involves learning new skills to react differently to situations that typically trigger anxiety. Patients also learn more about negative thought patterns that increase anxiety and ways to redirect such thinking. Psychotherapy for those with anxiety disorders is likely to last around 12 weeks. It may be conducted one-on-one or in a group setting. Patients also may be treated for other psychological or physical conditions while they receive treatment for an anxiety disorder.
Prevention methods for anxiety disorders
Although anxiety disorders cannot be prevented, they can be more effectively managed by taking steps that can reduce symptoms. Relaxation techniques such as meditation, muscle relaxation, breathing techniques and guided imagery may help people with anxiety disorders feel more relaxed.
Taking time to engage in leisure and recreational activities may help restore balance to patients’ lives, leaving them less vulnerable to anxiety, stress and panic. Eating a healthy diet, exercising and avoiding certain substances – such as some types of medications, caffeine, amphetamines and marijuana – can reduce the likelihood of symptoms related to anxiety disorders. Support groups can also help patients relieve their anxiety. These are sessions in which people with anxiety disorders share their own experiences and offer encouragement and understanding to one another.
Questions for your doctor on anxiety disorders
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to anxiety disorders:
- How can I tell the difference between normal worry and an anxiety disorder?
- What is causing my anxiety disorder?
- Is it possible that I might have several different types of anxiety disorders at the same time?
- Is my anxiety disorder medically dangerous?
- What are my treatment options?
- Will I have to take medication every day, or only when symptoms are especially severe?
- How effective are the treatments you’re recommending?
- How long will my treatment take?
- Will I ever be cured of my anxiety disorder?
- How can I prevent symptoms associated with anxiety disorders?