Anxiety Disorders – What are they?

Anxiety disorders are a group of mental illnesses characterized by intense anxiety and fear. They include generalized anxiety disorder, phobias, and panic disorder. A person can be diagnosed with more than one kind of anxiety disorder at the same time.

Types of anxiety disorder

There are many different types of anxiety disorder, defined and distinguished from each other by the situations or other triggers that lead to extreme feelings of fear or worry.^[1] The most common types of anxiety disorders are described below. In all cases, the symptoms must have a significant impact on a person’s daily life and last for a long time, usually at least six months.^[1]

Separation anxiety disorder

Separation anxiety disorder is often associated with children but can also occur in adults. It is an extreme fear of or anxiety about being separated from a loved one.

Symptoms include:^[1]

• Feelings of distress when separated from home or a loved one, or when expecting to be separated from them.
• Intense anxiety about something happening to a loved one, such as an accident, illness,or death.
• Intense anxiety about something happening to oneself, such as an accident, kidnapping or getting lost, which would result in separation from a loved one.
• Refusing to go to school or work to avoid being separated from a loved one.
• Intense fear of being alone.
• Refusing to sleep away from home or without a loved one.
• Recurring nightmares about being separated from a loved one.
• Recurring physical symptoms such as headaches or stomach-ache when separated or when expecting to be separated from a loved one.

Phobias

A phobia is an excessive fear of or worry about a specific object or situation. Common examples include an irrational fear of animals such as spiders and snakes and fear of situations like flying or enclosed spaces. While many people dislike spiders or get nervous about flying, a specific phobia is more extreme, prompting intense feelings of fear and distress, and persistent avoidance of the object or situation. Phobias can trigger panic attacks (see below).^[1]

Social anxiety disorder (social phobia)

Social anxiety disorder, also known as social phobia, is a fear of social situations that may involve being watched or judged by others, such as public speaking, meeting new people or eating in front of others. It stems from a worry about being judged, humiliated, and rejected by others. The impact is significant, causing the person to avoid the circumstances that trigger the anxiety.^[1]

Panic disorder

Panic disorder is diagnosed in people who have recurring panic attacks, and who live with a constant worry that another attack will occur. It can lead them to avoid circumstances that may trigger a panic attack or situations where having a panic attack would be particularly problematic, such as stressful situations and crowded spaces. Some may develop agoraphobia.^[1]

Panic attacks

A panic attack is a sudden, intense feeling of fear that lasts a few minutes. Someone having a panic attack may experience some or all of the following symptoms:^[1]

• Rapid heartbeat, palpitations,or a feeling like your heart is pounding
• Sweating
• Shaking or trembling
• Difficulty breathing
• A choking sensation
• Chest pains
• Nausea or stomach pains
• Dizziness or feeling faint
• Chills or feeling too hot
• Numbness or tingling
• Derealization (feeling detached from your surroundings) or depersonalization (feeling detached from yourself)
• Fear that you are going ‘crazy’
• Fear of death

As so many panic attack symptoms are physical, it can feel as though you are having a medical emergency such as a heart attack.^[1]

Panic attacks are a feature of several different anxiety disorders. Just over one in ten people a year will have a panic attack, but only a small number go on to develop panic disorder.^[1]

Agoraphobia

Agoraphobia is an intense fear of being in two or more of the following environments or situations:^[1]

• Public transport such as buses or trains
• Open spaces like parking lots or on bridges
• Confined spaces like shops
• Crowds and queues
• Being alone outside of the home

Being in or anticipating being in these situations or environments can be distressing and may lead to panic attacks. Someone with agoraphobia will avoid situations that trigger this distress, which can, in severe cases, lead to them refusing to leave their home altogether.^[1]

Generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is, as the name suggests, a type of anxiety disorder where a person is overly worried most of the time, for a long time, about several different situations. These situations are often everyday things like work, money, health, and family. Someone with generalized anxiety disorder will worry about these things more than other people do and will find the worries difficult to control or manage.^[1]

Generalized anxiety disorder causes the following symptoms:^[1]

• Feeling restless or ‘on edge’
• Becoming tired easily
• Problems with concentration or thinking straight
• Being irritable
• Tension in the muscles
• Problems with sleep

People with generalized anxiety disorder usually also have another anxiety disorder and depression.^[1]

What causes anxiety disorders?

Some people appear to be more prone than others to developing anxiety disorders. A person may experience more than one anxiety disorder, which can develop and evolve throughout a person’s life.^[1] For example, someone who experienced separation anxiety disorder as a child may have panic attacks later in life, which may become so severe they become panic disorder, which can in turn lead to agoraphobia.^[1] These are known as comorbid anxiety disorders, as they overlap with one another.

Studies show that anxiety disorders can run in families and are more common where family members have anxiety disorders, depressive disorders, or bipolar disorder. Women are more likely to experience anxiety disorders than men.^[1]

Anxiety disorders may be more common in people who experienced childhood trauma such as abuse. Separation anxiety disorders can develop in children following the divorce of their parents, a death of a loved one, health issues or being bullied. Anxiety disorders can also develop later in life after stressful incidents or significant life changes. Phobias can be triggered by specific traumatic events; a phobia of dogs, for example, might develop after being attacked or seeing someone else attacked by a dog. Agoraphobia can develop in someone who is attacked in public. Social anxiety disorder can be caused by previously experiencing public humiliation or by life changes such as starting a new job. ^[1]

Treating anxiety disorders

The usual treatment option for anxiety disorders is a combination of medication and therapy.^[2]

Medication

Different medications can be prescribed to alleviate the symptoms of anxiety disorders. ^[2]

These include:

• Antidepressants, especially those that work on controlling serotonin levels in the brain.
• Pregabalin, which is an epilepsy medication that can help with people withanxiety disorders.
• Beta blockers, which help with physical symptoms such as heart rate and trembling.
• Benzodiazepines, which are tranquilizers that can help with anxiety

Therapy

The most common talking therapy for anxiety disorders is cognitive behavioral therapy (CBT). CBT helps by identifying triggers for anxiety and teaching coping skills. CBT can help with all different kinds of anxiety disorders.^[2]

For phobias including agoraphobia, additional therapies can be tried.^[3]

These include:

• Exposure therapy, whichinvolves being slowly exposed to the situation or object that causes fear. It is done with a professional and builds from looking at pictures of the object of the phobia to gradually working up to being in or near the object of the phobia.
• Hypnotherapy, which involves using hypnosis to create a relaxed state in which you can address and change the thoughts and feelings causing anxiety.

For social anxiety disorder (social phobia), acceptance and commitment therapy (ACT) may be helpful. ACT uses mindfulness and other techniques to reduce anxiety levels.^[4]

For panic disorder, the American Psychiatric Association recommends panic-focused psychodynamic psychotherapy (PFPP) ^[5], which aims to uncover the underlying reasons for a person’s panic attacks.