This overview offers the basic facts about anxiety disorders – what are they, why do people develop them, what are the most common signs and symptoms, and how should they be treated?

Around 12 percent of people in the US suffer from anxiety disorders, along with around six percent in Europe. Generalized anxiety disorder (GAD) is the most common anxiety disorder in primary care settings, but there are many others. While some anxiety is normal, pathological anxiety that causes extreme fear and worry and interferes with your quality of life requires treatment. 

Numerous different diagnoses belong to the "anxiety disorder" family:

  • Generalized anxiety disorder (GAD) leads to excessive and constant worry about the future and everyday situations.
  • Panic disorders are characterized by repeated episodes of sudden and intense anxiety and fear that can quickly culminate in panic attacks. A person mostly experiences shortness of breath and a pounding heart, and is struck by overwhelming fear of another panic attack, so they might even avoid situations and places where panic attacks have happened in the past.
  • Social anxiety disorder is characterized by excessive worry and self-consciousness about being negatively judged by other people. It affects every aspect of a person’s life, from social interactions to careers.
  • Agoraphobia is an anxiety disorder in which symptoms of anxiety occur in places the person (inappropriately) deems unsafe. Places that are commonly hated by people with agoraphobia are open spaces like public transit, shopping malls, and in severe cases – everywhere except their home.
  • A specific phobia can be any type of anxiety that causes irrational fear and common panic attacks. A person with this condition will try to do anything to avoid the object or situation that causes anxiety. There are hundreds of these phobias and some of the most common examples are an irrational fear of animals (such as spiders), dentists, lightning, elevators, flying, and getting sick.
  • Separation anxiety disorder is a type of anxiety where an individual (most often a child) experiences increased anxiety when separated from home or a person with whom they have a close relationship such as a parent or a caregiver, or even a spouse.
  • Selective mutism is a complex disorder characterized by nervousness and the inability to speak in front of other people in certain situations. These people can only communicate where they feel appreciated and confident.

Signs and symptoms of anxiety

Anxiety disorders often creep on you and it can be hard to determine when normal anxiety transitions to a disorder. Regular anxiety about an event or a situation lasts for a while, until the event occurs and goes away, but anxiety disorders are persistent and usually not connected to a certain event. They’re constantly present and make day-to-day functioning a challenge.

Psychological symptoms of anxiety disorders include:

  • Constant worry
  • Obsessive thinking or “overthinking”
  • Predicting catastrophes — a persistent feeling of "impending doom"
  • Feeling "on edge"

Physical symptoms of anxiety disorders include:

  • A pounding heart
  • Cold or more commonly hot flashes
  • Fast breathing or difficulty breathing

Behaviorally, an anxiety disorder will cause people to avoid situations that make them feel anxious even at the cost of losing out socially, romantically career-wise, or in any other area.

This shouldn’t be your diagnostic tool — these symptoms serve only as a rough guide, and it’s very important to go see a professional if these symptoms sound familiar and you suspect you fall somewhere on the anxiety disorder spectrum.

Criteria for diagnosing anxiety disorders

Most of us get worried about day-to-day things at some point in our lives and experience situations that can cause us to feel anxious, but do you know what symptoms professionals look for when trying to diagnose – let’s say – generalized anxiety disorder (GAD) or panic disorders?

According to The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, which is the product of efforts by many international experts from all fields of mental health, the first step in diagnosing anxiety disorders is searching for excessive, debilitating worry in combination with at least three physical symptoms present (one in children) for a longer period in a week for more than six months:

  • Fatigue
  • Chronic headaches
  • Muscle tension
  • Restlessness
  • Irritability
  • Difficulty concentrating
  • Bad or unsatisfying sleep
  • Gastrointestinal problems

In specialized institutions such as anxiety disorders clinics, there are standardized tools and assessment test available to help the clinician with diagnosis. The doctor is likely to give you an interview with a standardized set of questions, and how you answer leads the clinician to the right diagnosis.

Anxiety disorders: Risk factors

Even though anyone can develop anxieties and anxiety disorders, certain people are at higher risk:

  • Females are at higher risk of developing anxiety disorders than males
  • Those with family history of anxiety disorder and major depressive disorder
  • Those with low self-esteem
  • Those who are frequently stressed
  • People suffering stress caused by an illness
  • Inherent personality can play a role as well
  • People who experienced trauma or sexual abuse in childhood
  • Research shows that Caucasians develop all anxiety disorders except post traumatic stress disorder (PTSD) more commonly than other races
  • Early parental loss is another risk factor

Possible causes of anxiety disorders

There’s a wide range of factors that can work together and cause anxiety. People with anxiety disorders are usually genetically predisposed towards them, but there are some other physical factors brain chemistry and hormonal imbalances that can contribute to their development, as well as:

  • Chronic pain
  • Diabetes
  • Heart conditions
  • Hyperthyroidism
  • Respiratory diseases such as asthma or obstructive pulmonary disease
  • Irritable bowel syndrome
  • Withdrawal from certain medications (especially anti-anxiety drugs), recreational drugs, or alcohol
  • Various types of rare tumors

Experts consider that anxiety disorders arise from underlying medical condition in cases when:

  • Parents or close relative don’t suffer from anxiety disorders
  • A person doesn’t avoid situations and people due to anxiety
  • A person experiences sudden onset in no way connected to current life events
  • A person didn’t have childhood anxiety

Anxiety disorders in combination with other mental conditions

Like one disorder isn’t enough! It is quite common for a person to have two or more separate mental disorders at the same time, meaning it is quite possible to be diagnosed with GAD, eating disorder, and depression. When two or more disorders happen, it’s called co-occurring disorders, or comorbid disorders.

Some psychiatric disorders that often come in combination with anxiety are:

  • Depression
  • Eating Disorders
  • Sleep disorders
  • Avoidant personality disorder
  • Substance abuse
  • Hoarding disorder
  • Attention deficit/Hyperactivity disorder (ADHD)
  • Schizophrenia

Anxiety disorders: Treatment and therapies

Medications

Anxiety disorders are commonly treated with medications such as tricyclic antidepressants (TCAs), benzodiazepines, and selective serotonin reuptake inhibitors (SSRIs).

  • Benzodiazepines are prescribed for anxiety disorders, as well as being among the most prescribed psychoactive drugs in the US. They help relax muscles and ease anxiety symptoms, but also help with alcohol withdrawal symptoms and insomnia. Some well-known benzodiazepines include alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), clorazepate (Tranxene), clonazepam (Klonopin), flurazepam (Dalmane), temazepam (Restoril), and a few others. They can be quite habit-forming and even result in death if abused in doses higher than prescribed by a doctor.
  • Tricyclic antidepressants for anxiety disorders include imipramine (Tofranil), desipramine (Norpramin, Pertofrane), nortriptyline (Pamelor, Aventyl), amitriptyline (Elavil), and doxepin (Sinequan, Adapin). Caution is recommended when prescribing them, due to their high toxicity and potential lethality if consumed in amounts bigger than recommended.
  • SSRIs for anxiety disorders are considered safer, more effective, and far more tolerable when compared to TCAs. Experts recommend that they should be the preferred choice when treating anxiety disorders in cases when TCAs and SSRIs are similarly effective. When it comes to social phobia or obsessive-compulsive disorder (OCD), SSRIs are the preferable option because TCAs are not that effective.
  • Beta blockers aren’t recommended as a routine medication for anxieties and panic disorders. According to studies, their day-to-day use is accompanied with physical symptoms, especially cardiovascular complaints.

Talk therapy

Finding a good therapist is an important key to getting better. Forget about the yellow pages; good ones are rarely found randomly. Ask your physician to recommend a good psychotherapist. Some of the most effective talk therapy approaches include:

  • Cognitive behavioral therapy (CBT) is perhaps the best anti-anxiety treatment available nowadays. According to research, it is beneficial in the treatment of social anxiety, various phobias, and panic disorder, as well as generalized anxiety disorder, and many other conditions. The cognitive part of the therapy helps you figure out how negative thoughts play a part in your anxiety. Behavioral therapy teaches a person how to react in certain situations that trigger anxious feelings.
  • Exposure therapy puts a person into situations that they fear in a controlled environment. The idea behind these repeated exposures is to increase control over the objects or situations so the anxiety diminishes – a technique known as habituation. The therapist mostly asks a person to imagine what scares them, but some ask to confront the fears in real life, which isn’t always good as a person might not be ready for this step.
  • Interpersonal therapy (IPT) to help people overcome anxiety disorders is popular, but it is definitely still in the development phase. In a small study done on nine people, 78 percent of them found IPT helpful in the treatment of anxiety, but much more research is needed to actually say whether it’s working.
  • Acceptance and commitment therapy (ACT) is – as the name says – an acceptance-based behavior therapy that focuses on teaching a person to accept problematic and troubling thoughts and feelings that they can’t change immediately. ACT is all about accepting your thoughts until you’re ready or able to change.

Alternative treatments for anxiety disorders

Even though therapy and medications are the most effective treatments for anxiety disorders, some people decide to battle their anxieties alone and turn to more natural options such as exercise, yoga, herbal supplements, or vitamins.

A large percentage of people with anxiety disorders self-medicate with both drugs and alcohol, and overeat to shut down emotions, but this is not the way to banish anxiety for good and the “solution” only temporarily numbs the problem. To feel better in the long run, you have to tackle the problem with a healthy day-to-day routine.

Some of the most popular alternative methods that people use against anxiety include:

  • Physical activity – anything from dancing to jogging is definitely beneficial when it comes to distracting your mind from worries, but it also releases feel-good hormones and looses tense muscles.
  • Relaxation techniques such as deep breathing, meditation, progressive muscle relaxation, as well as visualization and guided imagery can help reduce anxiety symptoms by slowing down your racing thoughts. When practiced on a daily basis, relaxation techniques can greatly impact your emotional health.
  • Herbs and other dietary supplements such as GABA amino acids, as well as vitamins B, C, D, and E help to reduce anxiety in more than one way. You can use plants such as kava kava or lavender to treat milder forms of anxiety. Despite the popular belief that chamomile has calming properties, studies have shown it’s not as effective against anxiety disorders as – let’s say – kava plant. If you’re deprived of nutrients, it can only make your anxieties worse.
  • Journaling – According to a study from 2016, creative writing helps with childhood anxieties, and it makes sense – some people are probably relieved after putting their frustrations on paper.
  • Hypnosis is said to manage anxiety disorders well and it’s a mainstream method of increasing awareness and making a person more open for discussion. It’s an addition to psychotherapy, and rarely a treatment on its own.

What if anxiety disorders are left untreated?

Untreated anxiety can ruin your life by leading to extremely negative thoughts – when it comes to a severe state you may no longer be able to work, go to school, or hang out with friends. People with panic disorder may feel as though they’ll lose air, or like they’re having a heart attack.

Also, if you don’t treat it, anxiety causes isolation and will significantly diminish the quality of your life. It tends to lead to other mental disorders including substance abuse and depression. People with untreated anxiety disorders are at higher risk of self-harm behaviors, as well as suicide.

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