Anxiety Disorders

What Are Anxiety Disorders?

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5,) anxiety disorders are mental health conditions that have features of fear and anxiety. Fear is defined here as an emotional reaction to a real threat or the perception that a threat exists. Alternately, anxiety is the experience of worrying that a future threat will occur.

Anxiety disorders differ from the healthy and appropriate response of fear and anxiety by their nature of being excessive, persistent, and developmentally inappropriate. They typically last six months or longer, although this period may be briefer in children.

Taking cultural factors into account can be extremely important when assessing whether a person’s experience of anxiety is excessive and interfering with their daily life. People of different cultures show symptoms of anxiety disorders in varying ways. Due to this, it is very important that healthcare providers understand issues related to a person’s background or location of origin. Having this cultural competence helps providers to accurately diagnose mental health disorders and provide the best mental health treatment possible.

Types of Anxiety Disorders

There are numerous types of anxiety disorders listed in the DSM-5. These include separation anxiety disorder, selective mutism, phobias, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder.

Separation Anxiety Disorder

Separation anxiety disorder involves persistent worrying about being away from home or being away from one’s attachment figure. This figure could be a parent, child, spouse, or other important individual in someone’s life. The fear causes significant impairment and distress and may impede the ability to attend work or school. It can also involve worry that harm will come to an attachment figure and can include experiencing nightmares. Both adults and children can experience separation anxiety disorder.

Selective Mutism

Selective mutism usually presents during childhood and involves a person being unable to speak during certain social situations. If treatment is not received, it can persist into adulthood. This disorder usually appears at a developmentally significant time during a child’s life, such as the beginning of school or during a separation from attachment figures for longer periods than previously experienced. It must be present for a month or longer to be diagnosed.

Specific Phobia

A specific phobia involves a person experiencing intense anxiety when being exposed to (or worrying about being exposed to) a specific stimulus that is the basis of their fear. There are five categories of specific phobia listed in the DSM-5:

• Natural environment phobias (water, fire, heights, natural disasters)
• Animal phobias (such as fear of snakes or spiders)
• Medical and blood phobias (needle injections, medical procedures)
• Situational phobias (airplane flights, claustrophobia)
• Other types of phobias (anything that does not fit into the above categories)

Social Anxiety Disorder

Social anxiety disorder (sometimes known as social phobia) involves an extreme fear of being in social situations. This often includes persistent fear of being scrutinized or criticized by others during these situations. This can lead to avoiding social situations and missing out on work, school, and interpersonal relationships. The rate of adults who experience social anxiety disorder in the US is 13%. 

Panic Disorder

Panic disorder is present when a person experiences recurrent panic attacks that often are not caused by a specific trigger. A person going through panic disorder may experience intense fear as a result of feeling a loss of control or worrying that such a loss will occur.Panic attacks can include the following physical experiences:

• Increased heart rate
• Dizziness
• Feelings of nausea
• Sweating or chills
• Trembling or shaking
• Shortness of breath
• Abdominal or chest pain
• Worries about losing control
• Fear of death

The DSM-5 states that 5.2% of Americans will struggle with a panic disorder during their lifetime.

Agoraphobia

Agoraphobia involves a debilitating fear of situations or locations that could incite panic, make a person feel trapped or helpless, or result in embarrassment. A person with this anxiety disorder may find it hard to leave home; they may have significant difficulty traveling, using elevators, or being in crowds (such as at concerts, movie theaters, or the mall). Panic attacks can be experienced with agoraphobia.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is a condition wherein a person experiences persistent anxiety related to everyday occurrences that are not in proportion to any actual threat. This fear can be experienced for months or years.

A person with GAD is often aware of their excessive worrying and has trouble controlling it.

Other Anxiety Disorders

Other types of anxiety disorders include substance/medication-induced anxiety disorder, anxiety disorder due to another medical condition, other specified anxiety disorders, and unspecified anxiety disorder.

Risk Factors for Anxiety Disorders

A variety of biopsychosocial risk factors can lead to the development of mental health conditions like anxiety disorders. These factors include:

• Personality
• Individual biology
• Childhood experiences
• Education
• Learned behaviors
• Culture
• Social environment

Risk factors also include not receiving appropriate, evidence-based treatment, which can result in comorbid depression, neuroticism, behavioral inhibition, further social impairment, problematic behaviors, and feelings of suicidality, in addition to not receiving relief for specific anxiety symptoms.

Another risk factor associated with untreated anxiety disorders includes people not fulfilling their potential in life, as anxiety disorders can worsen educational experiences, reduce work opportunities, cause stigma and discrimination, cause social isolation, and a reduce an individual’s ability to advocate for one’s rights. The physical and emotional risk factors associated with not getting treatment can equate to a full decade or two of reduced life expectancy.

What Causes Anxiety Disorders?

According to the DSM-5, the exact causes of developing anxiety disorders are not known but are thought to involve an interplay of elements such as environmental, psychological, genetic, and developmental factors. Stressors from the environment can include difficult or traumatic experiences, including:

• Serious and prolonged illness
• Abuse
• Death of someone close to the person
• Exposure to violence
• Substance misuse

In summary, increased exposure to risk factors and decreased availability of protective factors are causes of increased rates of anxiety disorders.

How Common Are Anxiety Disorders?

According to the DSM-5, 19% of adults (or 40 million) currently have an anxiety disorder, with 7% of children between the ages of three and 17 experiencing one. It further states that most individuals develop related symptoms before age 21.

In children and adolescents, the overall prevalence rate for anxiety disorders is between 5% and 19%, making them one of the most common forms of mental health conditions in these age groups. In addition, almost 80% of kids and adolescents diagnosed with an anxiety disorder also meet the diagnostic criteria for another mental health disorder. The most commonly seen of these are other anxiety disorders, attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD), and mood disorders.

What are the Symptoms of an Anxiety Disorder?

Anxiety disorders appear via numerous types of symptoms. These include physical, mental, and behavioral symptoms.

Physical Symptoms

Physical symptoms caused by anxiety disorders include:

• Dizziness
• Heart palpitations
• Shortness of breath
• Excessive sweating
• Abdominal discomfort
• Chills
• pain in the chest
• Trembling or feeling jittery
• Lethargy
• Tense muscles

Mental Symptoms

Anxiety disorders often present with mental symptoms such as worry of losing control of oneself, including:

• Fear of panic attacks
• Significant performance anxiety
• Fear of immediate danger
• Heightened vigilance
• Anticipatory anxiety
• Fear of rejection
• Excessive fear of offending other people
• Marked anxiety in social situations
• Fear of dying

Behavioral Symptoms

Numerous behavioral symptoms are also often experienced. Among these are:

• Expected or unexpected panic attacks
• Avoiding objects or situations that may cause anxiety
• Being overly cautious
• Decreased ability to focus
• Disrupted sleep
• Impaired social interaction
• Use of substances in an attempt to self-medicate
• Decreased performance and achievement
• Unwillingness to participate in novel experiences
• Avoidance of open or crowded places
• Inability to go out alone

Complications Caused by Anxiety Disorders

Anxiety disorders can cause numerous complications, including the following:

• Ongoing fatigue
• Physical effects such as muscle tension
• Chronic irritability
• Disruptive feelings of restlessness
• Impairment in sleep, such as trouble falling asleep, staying asleep, or inadequate sleep quality
• Difficulty concentrating

The complications listed above often lead to marked distress. They can also cause impairment in school, work, relationships, and other areas of functioning.

Diagnosis

Anxiety disorders are diagnosed by certified professionals using the criteria and related explanations delineated in DSM-5. They can be diagnosed by healthcare and mental healthcare professionals, including physicians, clinical social workers, certified counselors, and psychiatrists. This can occur in various settings such as outpatient, inpatient, partial hospitalization, private practice, and primary care doctors’ offices. Sharing information with a provider about anxiety symptoms being experienced is a primary step in getting diagnosed with an anxiety disorder and receiving subsequent help.

Taking cultural factors into account can be extremely important when assessing whether a person’s experience of anxiety is excessive and interfering with their daily life. People of different cultures show symptoms of anxiety disorders in varying ways. Due to this, healthcare providers must understand issues related to a person’s background or location of origin. This cultural competence helps providers accurately diagnose mental health disorders and implement the best form of treatment.

Brief screening tests, such as the Generalized Anxiety Disorder-7 (GAD-7), are used to help diagnose anxiety disorders by assessing for symptoms listed in the DSM-5. By receiving a formal diagnosis, the most appropriate form of treatment can be decided upon and subsequently obtained.

Managing and Treating Anxiety Disorders

Treatment for anxiety disorders is recommended when a person is going through significant distress or experiencing complications from anxiety, such as substance use or abuse, depression, or suicidal feelings. To help a client or patient who is experiencing an anxiety disorder, the first steps a provider takes include giving the patient information about symptoms of anxiety disorders and diagnosis and explaining options for evidence-based treatment methods.

How Are Anxiety Disorders Treated?

The two proven treatments for anxiety disorders are psychotherapy and medication, with a combination of both being especially helpful. Physical activity has also shown promise as a means of treating anxiety disorders. Alternative interventions that can be incorporated in treating anxiety disorders include yoga, meditation, and other forms of mindfulness practices.

Anxiety disorders are most commonly treated through outpatient care, although inpatient care may be best if depression, and particularly suicidal ideation, are being experienced. Providing psychoeducation about anxiety and related diagnoses is also a fundamental aspect of treatment and includes teaching about causes, treatment approaches, and how antianxiety medications work. Additionally, treatment planning for anxiety should take into account a person’s individual preferences as well as the known effects and efficacy of treatment modalities.

How Does Medication Treat Anxiety Disorders?

Medications treat anxiety disorders by altering the brain’s neurochemistry. Primary medications, whose category names indicate the way they work on the brain to decrease anxiety, include selective serotonin reuptake inhibitors (SSRIs, including pharmaceuticals such as Zoloft) and serotonin-norepinephrine reuptake inhibitors (SNRIs, including Effexor).

Other pharmaceutical treatments include:

• Tricyclic antidepressants
• The anxiety medication buspirone
• Moclobemide (an MAO inhibitor)
• Pregabalin (used to treat nerve pain and seizures)

Benzodiazepines are not among the recommended routine treatments for anxiety disorders. They may be used to manage symptoms and panic attacks but will not treat an anxiety disorder.

In cases where antidepressants are prescribed, relief can take two to four weeks (and up to six weeks) to occur, with symptoms sometimes worsening before improving during the first two weeks. Providing a client or patient with a lowered dose effectively lowers this risk. Considerations in using medication to treat anxiety disorders include history of treatment, other present health or mental health conditions, severity of symptoms being experienced, and healthcare availability factors such as cost and wait times for receiving treatment.

How Does Psychotherapy Treat Anxiety Disorders?

Psychotherapy is used best in treatment when a provider takes multiple factors into account before beginning therapy, such as an individual’s preference for treatment, whether they have gotten help for anxiety in the past, comorbid physical and mental health conditions (including whether an individual is pregnant or planning to have children), sex, age, and healthcare access and related expenses. Taking these elements into account is important to tailor the provision of psychotherapy in a manner best suited to the individual experiencing an anxiety disorder.

Cognitive behavioral therapy (CBT), a particular psychotherapeutic approach, is the most evidence-based treatment modality for treating anxiety disorder effectively. Cognitive behavioral therapy is designed to assist people in understanding the connection between their thoughts and feelings and how they relate to particular behaviors.

What Happens If I Don’t Get Treatment for My Child with an Anxiety Disorder?

Cognitive behavioral therapy to treat anxiety disorders in children serves to reduce related symptoms that interfere with a child’s well-being and overall functioning. Therefore, if a parent does not get treatment for their child with an anxiety disorder, the child will not experience a lower incidence of diagnosis rates or the relief of symptoms that come with receiving evidence-based treatment.

This could lead to avoidance of school and social situations that could otherwise be enjoyable. Additionally, the physical, mental, and behavioral symptoms delineated above may continue to be experienced if treatment is not provided for the child.

Can Anxiety Disorders Be Prevented?

The prevention of anxiety disorders can be classified and explained on three levels. The first level is primary prevention, which involves lowering the incidence of new cases of the disorders in the population. The next level is secondary prevention, which aims to reduce the length of cases and, therefore, lower the overall prevalence of the disorders. Finally, tertiary prevention, the third level, seeks to resolve the residual adverse effects of associated conditions on the public.

Promotion of good mental health also helps to prevent anxiety disorders, and one way this is done is by enhancing physical health. This can be achieved by increasing physical activity, which is a protective factor against developing such disorders. Physical activity is thought to impact psychological and biological factors that can help reduce not just physical health risks but also mental health effects that anxiety disorders can cause.

Another means of preventing anxiety disorders is understanding the neurodevelopmental factors related to them and continuing to broaden this general understanding among professionals and the general public.  Additionally, prevention can be enacted by specifically reducing a person’s exposure to the risk factors listed and explained in the section above.

How Can I Best Cope with an Anxiety Disorder?

Combined treatment involving psychotherapy and medication is the gold standard to help a person cope with an anxiety disorder. However, engaging in physical activity is a step anyone can take to help protect against the effects of anxiety disorders. Not only can it help lessen their effects, but it can also be a tool to help cope with them. Physical activity, like yoga, can decrease psychological and physical symptoms, thus providing a range of positive benefits.

Other ways to cope with anxiety disorders include practicing non-pharmacological interventions such as meditation to increase mindfulness.

Finding Help for an Anxiety Disorder

Anxiety disorders involve excessive worry that can cause significant impairment in daily living and overall well-being. While anxiety disorders are common, they are treatable, and they do not have to be dealt with alone.

Numerous options for therapy exist, including individual psychotherapy, group therapy, and inpatient treatment options, all of which can include medication provision. Talk with your doctor today to explore the many treatment avenues available for people living with anxiety.