21 Apr Anxiety Disorders
By Mehran Motamed, MD
Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. At times, anxiety involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).
These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. You may avoid places or situations to prevent these feelings. Symptoms may start during childhood or teen years and continue into adulthood.
Examples of anxiety disorders include generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. You can have more than one anxiety disorder. Sometimes anxiety results from a medical condition that needs treatment. Whatever form of anxiety you have, treatment can help.
Common anxiety signs and symptoms include:
- Feeling nervous, restless or tense
- Having a sense of impending danger, panic or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the worry
- Having trouble sleeping
- Experiencing gastrointestinal (GI) problems such as nausea or abdominal distress
- Having difficulty controlling worry
- Having the urge to avoid things that trigger anxiety
Several types of anxiety disorders exist:
- Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.
- Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.
- Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary and routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders.
- Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they’ve occurred.
- Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.
Symptoms of social anxiety include:
- Fears of meeting or talking to people
- Avoidance of social situations
- Few friends outside the family
- Specific phobias are characterized by major anxiety when you’re exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.
- Extreme fear about a specific thing or situation (ex. dogs, insects, or needles)
- Fears causing significant distress and interfering with usual activities
- Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.
- Other specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don’t meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.
Anxiety and Children
All children experience some anxiety. Anxiety in children is expected and normal at specific times in development. For example, from approximately age 8 months through the preschool years, healthy youngsters may show intense distress (anxiety) at times of separation from their parents or other people with whom they are close. Young children may have short-lived fears, such as fear of the dark, storms, animals, or a fear of strangers.
Anxious children are often overly tense or uptight. Some may seek a lot of reassurance, and their worries may interfere with activities. Parents should not dismiss their child’s fears. Because anxious children may also be quiet, compliant, and eager to please, their difficulties may be missed. Parents should be alert to the signs of severe anxiety so they can intervene early to prevent complications.
There are quite a few different types of anxiety in children:
Separation Anxiety: Symptoms of separation anxiety include
- Constant thoughts and intense fears about the safety of parents and caretakers
- Refusing to go to school
- Frequent stomachaches and other physical complaints
- Extreme worries about sleeping away from home
- Being overly clingy
- Panic or tantrums at times of separation from parents
- Trouble sleeping or nightmares
Selective Mutism is a consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.
- Extreme fear about a specific thing or situation (ex. dogs, insects, or needles)
- Fears causing significant distress and interfering with usual activities
Other symptoms of anxious children include:
- Many worries about things before they happen
- Constant worries or concerns about family, school, friends, or activities
- Repetitive, unwanted thoughts (obsessions) or actions (compulsions)
- Fears of embarrassment or making mistakes
- Low self esteem and lack of self-confidence
Severe anxiety problems in children can be treated. Early treatment can prevent future difficulties, such as loss of friendships, failure to reach social and academic potential, and feelings of low self-esteem. Treatments may include a combination of the following: individual psychotherapy, family therapy, medications, behavioral treatments, and consultation to the school.
If anxieties become severe and begin to interfere with the child’s usual activities (for example separating from parents, attending school, and making friends), parents should consider seeking an evaluation from a qualified mental health professional or a child and adolescent psychiatrists
When to see a doctor
See your doctor if:
- You feel like you’re worrying too much and it’s interfering with your work, relationships or other parts of your life
- Your fear, worry or anxiety is upsetting to you and difficult to control
- You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety
- You think your anxiety could be linked to a physical health problem
- You have suicidal thoughts or behaviors — if this is the case, seek emergency treatment immediately
Your worries may not go away on their own and they may get worse over time if you don’t seek help. See your doctor or a mental health provider before your anxiety gets worse. It’s easier to treat if you get help early.
The causes of anxiety disorders aren’t fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety. Inherited traits also can be a factor.
Medical causes for anxiety:
For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.
Examples of medical problems that can be linked to anxiety include:
- Heart disease
- Thyroid problems, such as hyperthyroidism
- Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma
- Drug misuse or withdrawal
- Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications
- Chronic pain or irritable bowel syndrome
- Rare tumors that produce certain fight-or-flight hormones
Sometimes anxiety can be a side effect of certain medications.
It’s possible that your anxiety may be due to an underlying medical condition if:
- You don’t have any blood relatives (such as a parent or sibling) with an anxiety disorder
- You didn’t have an anxiety disorder as a child
- You don’t avoid certain things or situations because of anxiety
- You have a sudden occurrence of anxiety that seems unrelated to life events and you didn’t have a previous history of anxiety
These factors may increase your risk of developing an anxiety disorder:
- Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.
- Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.
- Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress or ongoing worry about finances.
- Personality. People with certain personality types are more prone to anxiety disorders than others are.
- Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.
- Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.
- Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.
Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:
- Depression (which often occurs with an anxiety disorder) or other mental health disorders
- Substance misuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Headaches and chronic pain
- Social isolation
- Problems functioning at school or work
- Poor quality of life
There’s no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you’re anxious:
- Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
- Stay active. Participate in activities that you enjoy and that make you feel good about yourself. Enjoy social interaction and caring relationships, which can lessen your worries.
- Avoid alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you’re addicted to any of these substances, quitting can make you anxious. If you can’t quit on your own, see your doctor or find a support group to help you.
You may start by seeing your primary care provider to find out if your anxiety could be related to your physical health. He or she can check for signs of an underlying medical condition that may need treatment.
However, you may need to see a mental health specialist if you have severe anxiety. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and certain other mental health professionals can diagnose anxiety and provide counseling (psychotherapy).
To help diagnose an anxiety disorder, your mental health provider may:
- Give you a psychological evaluation. This involves discussing your thoughts, feelings and behavior to help pinpoint a diagnosis and check for related complications. Anxiety disorders often occur along with other mental health problems — such as depression or substance misuse — which can make diagnosis more challenging.
- Compare your symptoms to the criteria in the DSM-5. Many doctors use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose an anxiety disorder.
The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.
Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.
Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. Generally a short-term treatment, CBT focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you’ve avoided because of anxiety.
CBT includes exposure therapy, in which you gradually encounter the object or situation that triggers your anxiety so you build confidence that you can manage the situation and anxiety symptoms.
Several types of medications are used to help relieve symptoms, depending on the type of anxiety disorder you have and whether you also have other mental or physical health issues. For example:
- Certain antidepressants are also used to treat anxiety disorders.
- An anti-anxiety medication called buspirone may be prescribed.
- In limited circumstances, your doctor may prescribe other types of medications, such as sedatives, also called benzodiazepines, or beta blockers. These medications are for short-term relief of anxiety symptoms and are not intended to be used long term.
Talk with your doctor about benefits, risks and possible side effects of medications.
Lifestyle and home remedies
While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here’s what you can do:
- Keep physically active. Develop a routine so that you’re physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
- Avoid alcohol and recreational drugs. These substances can cause or worsen anxiety. If you can’t quit on your own, see your doctor or find a support group to help you.
- Quit smoking and cut back or quit drinking caffeinated beverages. Both nicotine and caffeine can worsen anxiety.
- Use stress management and relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
- Make sleep a priority. Do what you can to make sure you’re getting enough sleep to feel rested. If you aren’t sleeping well, see your doctor.
- Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.
Several herbal remedies have been studied as a treatment for anxiety, but more research is needed to understand the risks and benefits. Herbal and dietary supplements aren’t monitored by the Food and Drug Administration (FDA) the same way medications are. You can’t always be certain of what you’re getting and whether it’s safe. Some of these supplements can interfere with prescription medications or cause dangerous interactions.
Before taking herbal remedies or dietary supplements, talk to your doctor to make sure they’re safe for you and won’t interact with any medications you take.
Coping and support
To cope with an anxiety disorder, here’s what you can do:
- Learn about your disorder. Talk to your doctor or mental health provider. Find out what might be causing your specific condition and what treatments might be best for you. Involve your family and friends and ask for their support.
- Stick to your treatment plan. Take medications as directed. Keep therapy appointments and complete any assignments your therapist may give you. Consistency can make a big difference, especially when it comes to taking your medication.
- Take action. Learn what triggers your anxiety or causes you stress. Practice the strategies you developed with your mental health provider so you’re ready to deal with anxious feelings in these situations.
- Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what’s causing you stress and what seems to help you feel better.
- Join an anxiety support group. Remember that you aren’t alone. Support groups offer compassion, understanding and shared experiences. The National Alliance on Mental Illness and the Anxiety and Depression Association of America provide information on finding support.
- Learn time management techniques. You can reduce anxiety by learning how to carefully manage your time and energy.
- Socialize. Don’t let worries isolate you from loved ones or activities.
- Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
Preparing for your appointment
You may start by seeing your primary care provider. He or she may refer you to a mental health professional.
What you can do
Before your appointment, make a list of:
- Your anxiety symptoms. Note when they occur, whether anything seems to make them better or worse, and how much they affect your day-to-day activities and interactions.
- What causes you stress. Include any major life changes or stressful events you’ve dealt with recently. Also note any traumatic experiences you’ve had in the past or as a child.
- Any family history of mental health problems. Note if your parents, grandparents, siblings or children have struggled with any mental health problems.
- Any other health problems you have. Include both physical conditions and mental health issues.
- All medications you’re taking. Include any medications, vitamins, herbs or other supplements, and the doses.
- Questions to ask your doctor to make the most of your appointment.
Some basic questions to ask your doctor include:
- What’s the most likely cause of my anxiety?
- Are there other possible situations, psychological issues or physical health problems that could be causing or worsening my anxiety?
- Do I need any tests?
- Should I see a psychiatrist, psychologist or other mental health provider?
- What type of therapy might help me?
- Would medication help? If so, is there a generic alternative to the medicine you’re prescribing?
- In addition to treatment, are there any steps I can take at home that might help?
- Do you have any educational materials that I can have? What websites do you recommend?
Don’t hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor will likely ask you several questions, such as:
- What are your symptoms, and how severe are they? How do they impact your ability to function?
- Have you ever had a panic attack?
- Do you avoid certain things or situations because they make you anxious?
- Have your feelings of anxiety been occasional or continuous?
- When did you first begin noticing your feelings of anxiety?
- Does anything in particular seem to trigger your anxiety or make it worse?
- What, if anything, seems to improve your feelings of anxiety?
- What traumatic experiences have you had recently or in the past?
- What, if any, physical or mental health conditions do you have?
- Do you take any prescription drugs?
- Do you regularly drink alcohol or use recreational drugs?
- Do you have any blood relatives who have anxiety or other mental health conditions, such as depression?
Preparing and anticipating questions will help you make the most of your time.