What are anxiety disorders?
Anxiety disorders are a group of mental illnesses that cause people to feel excessively frightened, distressed, or uneasy during situations in which most other people would not experience these same feelings. When they are not treated, anxiety disorders can be severely impairing and can negatively affect a person’s personal relationships or ability to work or study. In the most severe cases, anxiety disorders can make even regular and daily activities such as shopping, cooking or going outside incredibly difficult. Anxiety disorders can further cause low self-esteem, lead to substance abuse, and isolation from one’s friends and family.
Anxiety disorders are the most common mental illnesses in America: they affect around 20 percent of the population at any given time. Fortunately there are many good treatments for anxiety disorders. Unfortunately, some people do not seek treatment for their illness because they do not realize how severe their symptoms are or are too ashamed to seek help. Furthermore, these disorders are often difficult to recognize for friends, family and even some doctors.
What are the most common anxiety disorders?
Panic Disorder—Characterized by “panic attacks,” panic disorder results in sudden feelings of terror that can strike repeatedly and sometimes without warning. Physical symptoms of a panic attack include chest pain, heart palpitations, shortness of breath, dizziness, upset stomach, feelings of being disconnected and fear of dying. Some people with this disorder may experience unrealistic worry of having more panic attacks and become very ashamed and self-consciousness. This can result in some people feeling too afraid to go to certain places (e.g., airplanes, elevator) which can be very intrusive in their daily lives.
Obsessive-compulsive Disorder (OCD)—OCD is characterized by repetitive, intrusive, irrational and unwanted thoughts (obsessions) and/or rituals that seem impossible to control (compulsions). Some people with OCD have specific compulsions (e.g.,counting, arranging, cleaning) that they “must perform” multiple times each day in order to momentarily release their anxiety that something bad might happen to themselves or to someone they love. People with OCD may be aware that their symptoms don’t make sense and are excessive, but on another level they may fear that the thoughts have are having might be true.
Posttraumatic Stress Disorder (PTSD)—When people experience or witness a traumatic event such as abuse, a natural disaster, or extreme violence, it is normal to be distressed and to feel “on edge” for some time after this experience. Some people who experience traumatic events have severe symptoms such as nightmares, flashbacks, being very easily startled or scared, or feeling numb/angry/irritable/distracted. Sometimes these symptoms last for weeks or even months after the event and are so severe that they make it difficult for a person to work, have loving relationships, or “return to normal.” This is when a person may be suffering from PTSD. Many people with PTSD have difficulty discussing their symptoms because they may be too embarrassed or scared to recall their trauma. This is common in victims of sexual abuse and in combat veterans.
Phobias—A phobia is a disabling and irrational fear of something that really poses little or no actual danger for most people. This fear can be very disabling when it leads to avoidance of objects or situations that may cause extreme feelings of terror, dread and panic. “Specific” phobias center on particular objects (e.g., caterpillars, dogs) or situations (e.g., being on a bridge, flying in an airplane). Many people are very sensitive to being criticized and are ashamed of their phobias which can lead to problems with self-esteem.
Generalized Anxiety Disorder (GAD)—A severe, chronic, exaggerated worrying about everyday events is the most common symptom in people with GAD. This is a worrying that lasts for at least six months, makes it difficult to concentrate and to carry out routine activities, and happens for many hours each day in some people. Some people with this disorder anticipate the worst and often experience physical symptoms of fatigue, tension, headaches and nausea due to the severity of their anxiety.
Social Anxiety Disorder—An intense fear of social situations that leads to difficulties with personal relationships and at the workplace or in school is most common in people with social anxiety disorder. People with social anxiety disorder often have an irrational fear of being humiliated in public for “saying something stupid,” or “not knowing what to say.” People with this illness may have symptoms similar to “panic attacks” (e.g., heart palpitations, dizziness, shortness of breath) or may experience severe sweating (hyperhidrosis) when in social situations. This leads to avoidance of social situations which can make it difficult to go to parties, school, or even family gatherings.
Other recognized anxiety disorders include: agoraphobia, acute stress disorder, anxiety disorder due to medical conditions, such as thyroid abnormalities, and substance-induced anxiety disorder, such as from too much caffeine.
Some people with other mental illnesses, such as depression or schizophrenia, may have symptoms of severe anxiety. These symptoms of worrying, panic attacks or compulsions may make treating their primary illness more complicated for mental health professionals. Therefore, complete treatment of depression or schizophrenia often requires treatment of anxiety symptoms.
People with anxiety disorders are more likely to use or abuse alcohol and other drugs including benzodiazepines (e.g., diazepam, alprazolam and clonazepam), opiates (e.g., pain-killers, heroin) or cigarettes. This is known as self-medication. Some people use drugs and alcohol to try and reduce their anxiety. This is very dangerous because even though some drugs make people feel less anxious when they are high, anxiety becomes even worse when the drugs wear off. Other people are anxious because they are intoxicated or withdrawing from drugs and alcohol.
Are there any known causes of anxiety disorders?
Although studies suggest that people are more likely to have an anxiety disorder if their parents have anxiety disorders, it has not been shown whether biology or environment plays the greater role in the development of these disorders. Some anxiety disorders have a very clear genetic link (e.g., OCD) that is being studied by scientists to help discover new treatments to target specific parts of the brain.
Some anxiety disorders can also be caused by medical illnesses. Scientists at the National Institute of Mental Health and elsewhere have discovered a link between some cases of OCD that occur following infection or exposure to a certain bacteria. This connection is described by the term Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS). Other anxiety disorders can be caused by brain injury. Scientists have also found that certain areas of the brain, including a part of the brain called the amygdala, work differently in people with anxiety disorders.
The sudden appearance of severe anxiety symptoms in a person of any age requires immediate attention by both caregivers and doctors. Parents and friends should be aware that a traumatic event may be causing their loved one to become more nervous or to have other symptoms of anxiety disorders. Doctors should be aware that many medical problems including hormonal and neurological illnesses can cause symptoms of anxiety.
What treatments are available for anxiety disorders?
Effective treatments for anxiety disorders include psychotherapy, aerobic exercise and medications. Some psychotherapy techniques known as behavioral therapies or cognitive behavioral therapies are most useful in the treatment of anxiety disorders and are referred to as “first-line treatments.” Cognitive-behavioral therapy involves examining the connection between thoughts, feelings, and behaviors. This is used to teach a person to address their fears by modifying the way he or she thinks and responds to stressful events. Relaxation techniques including mindfulness and meditation are also useful for people with anxiety disorders to decrease their stress and to help them cope with severe worrying.
In most cases, a combination of psychotherapy and medications is most beneficial for people with severe anxiety disorders. Some commonly used medications for anxiety disorders are anti-depressant medications called selective serotonin reuptake inhibitors (SSRIs). These include fluvoxamine (Luvox), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). Another commonly used type of medications are benzodiazepines: including diazepam (Valium), clonazepam (Klonopin) and alprazolam (Xanax).
Ask your doctor if the medication he or she is recommending is FDA approved for your specific condition. If they are recommending a compound that is not FDA approved (an off label use), ask them to help you better understand their reasoning so you can make an informed choice.
The importance of having a good diet and getting enough sleep are known to decrease symptoms in people with anxiety disorders. Regular exercise has also been scientifically proven to be effective.
Family and friends who have loved ones with anxiety disorders should attempt to be understanding of the symptoms that their loved one is trying to overcome. Family and friends should be careful not to blame themselves but rather to encourage their loved one to seek treatment for these complicated illnesses.
Reviewed by Ken Duckworth, M.D. and Jacob L. Freedman, M.D., April 2012