Anxiety disorders

What is anxiety?

Anxiety is a normal emotion which represents feelings of worry, fear and uncertainty, it functions as a warning towards potential danger. Whereas fear is a primary emotion which has a strong biological component which warns us of imminent, current, dangerous stimuli, anxiety is a reaction to danger that could potentially happen, a fear of danger that is being expected.

It’s normal to feel a certain level of anxiety in different stressful situations, like a job interview, a medical evaluation or different types of test situations.

Anxiety disorders are a group of mental disorders which share the same main characteristic of overwhelming feelings of anxiety. When it comes to these disorders a real source of fear and danger doesn’t exist, or if it does exist the anxious reaction to it is far too dramatic. These feelings of anxiety have a negative impact on everyday functioning, they often lead to avoiding the thing that creates the anxiety and can lead to loss of self – confidence, social isolation and career failures.

Typical symptoms of anxiety disorders:

The main symptoms for this group of disorders are the overwhelming feelings of fear, worry and anxiety. Apart from these, some other symptoms are:

• Feelings of panic, uneasiness, tension, being “on edge”
• Anticipating the worst outcome, feelings of approaching danger
• Problems with concentration
• Disordered sleep and feelings of exhaustion
• Irritability
• Feelings of guilt and inadequacy
• Avoiding the stimuli which create anxiety (places, people, situations)

Apart from these, physical symptoms are also typical for situations in which anxiety is manifested:

• Increased heartrate
• Shortness of breath or hyperventilation
• Tremor
• Nausea
• Muscle tension
• Sweating, cold sweat, sweating palms
• Lightheadedness
• Stomach pain and cramps
• Inability to relax
• Dry mouth
• Digestive problems

The presence of some of these symptoms in a significant quantity can be an indication of anxiety disorders. What differentiates between different anxiety disorders is when the symptoms arise and in what fashion, what is the source of the anxiety.

Types of anxiety disorders:

Generalized anxiety disorder – diagnostically it’s characterized by anxiety connected to at least two everyday situations. This type of anxiety isn’t connected to a specific source of anxiety, instead, the symptoms are constant and follow the individual who cannot regulate or control them, causing difficulties in everyday functioning. This form of anxiety is also known as “free floating”, it means the anxiety is ever – present and is derived from a multitude of potential danger sources in the perception of the individual.

Social anxiety (social phobia) – anxiety is caused by everyday social interactions. People with this disorder suffer from fears of public speaking, social evaluation, judgment and criticism. They fear that they will make a mistake in the interaction and embarrass themselves in some way which will lead to others judging them to be worthless. Fear of social rejection and judgment, as well as being nervous before performing in front of people is completely normal and to be expected, the problem arises when it becomes a continued rumination on this topic and the person cannot function normally. It can lead to avoiding all kinds of social situations and social isolation.

Panic disorder – characterized by panic attacks, which have intense, unexpected and very physical symptoms. The most common symptoms are increased heart rate, sweating, feelings of suffocation, chest pain, feelings of approaching danger, lightheadedness, nausea, fear of insanity and fear of death. It is not uncommon for panic attacks to repeat in certain situations, which can be said to cause them, the person will probably start avoiding this situation altogether. A panic attack usually passes after a few minutes, but can sometimes last for hours, it can look like a heart attack or stroke. Panic attacks aren’t dangerous on their own but can get worse over time and resemble serious issues, so it's very important to consult a medical professional.

Phobias – feelings of intense fear caused by a certain object or situation, for example: heights, flying, small spaces, blood, spiders... It’s more difficult and intense than normal fears and it makes everyday life difficult.

Agoraphobia – an intense fear and anxiety of leaving familiar and safe surroundings, the assumption that something bad will happen and that it will be impossible to escape that danger or find help. It’s most often connected to open spaces, public spaces, situations in which a large crowd of people is present. In extreme cases it can lead to people with this disorder considering their home as the only safe and familiar space and refusing to leave it.

Separation anxiety – it is considered something which only occurs with children but can be diagnosed in adults too. These individuals fear separating from the people they are closest to because of fears that something bad will happen to them. They can tend to avoid solitude, the symptoms might worsen when the separation is about to happen.

Selective mutism – a rare anxiety disorder, it’ most commonly found in children under the age of five. Even though they have normal language and speaking capabilities, they cannot manage to talk in certain social situations. It is often connected to extreme shyness, fear of embarrassment or compulsive traits.

Causes of anxiety disorders:

There isn’t a completely clear understanding of what leads to anxiety disorders, but some of the established causes are: genetic dispositions, stressful and traumatic events, hormonal disbalance, misuse of psychoactive substances, reactions to certain medication, personality traits and other health issues (thyroid gland, asthma, diabetes, heart disease, depression) can cause and worsen symptoms.

Diagnosis of anxiety disorders:

A doctor can ask questions about symptoms, their intensity, how long they have been present, their appearance, and so on. Firstly, they will determine that it’s not a matter of a different medical state which could have similar symptoms. It is highly likely that they could refer the individual to a psychiatrist or psychologist in order to determine a diagnosis. They can conduct different types of tests, as well as conversation, to understand the severity of the symptoms, what causes them, and their influence on the everyday life and functioning of the individual.

Treating anxiety disorders:

Anxiety disorders are generally treated using psychotherapy, pharmacotherapy or a combination of these two.

Psychotherapy:

Psychotherapy in situations with anxiety involves developing healthy coping mechanisms, changing negative core values which shape how one perceives the world and themselves, developing and strengthening self – confidence, gaining insight into the cause of the symptoms, understanding the emotional, cognitive, and behavioral patterns which perpetuate these states.

The psychotherapeutic approach which has the most success with treating anxiety disorders is cognitive behavioral therapy (CBT) – fast paced, with a predetermined number of sessions, efficient and economical. It is primarily concerned with understanding the relationship between beliefs and behavior. It’s focused on learning and developing new, positive, ways of thinking, looking at things and developing healthy behaviors.

One of the most commonly used techniques in treating anxiety disorders is exposure therapy. It consists of gradual exposure and confrontation with the object that causes anxiety, so as to show its harmlessness.

Pharmacotherapy:

The use of pharmacotherapy should be decided and conducted in accordance with the counsel of a medical professional. Different medication is used in the treatment of different types of anxiety disorder and can have negative consequences in case of misuse.

The most commonly used are antidepressants, anxiolytics and sedatives. The goal of pharmacotherapy is to regulate the symptoms by regulating the chemical processes in the brain. In some cases, this allows for psychotherapeutic intervention, which would otherwise be impossible due to the overwhelming symptoms.

Changes in everyday life can help alleviate and regulate anxious symptoms. Support groups, socialization, rest and relaxation, regulation of stress, adequate sleep, physical activity, a healthy diet, lowering caffeine intake and not consuming alcohol or recreational drugs, are all factors which can significantly help the betterment of anxious symptoms.

Written by: Bachelor of Psychology, Aleksa Holcer

Reference:

Anxiety disorders. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/anxiety-disorders

Anxiety disorders - Symptoms and causes - Mayo Clinic. (2018, May 4). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

ICD-10 version:2016. (n.d.). https://icd.who.int/browse10/2016/en#/F41

Mitchell, K. (2024, May 6). Anxiety disorders. WebMD. https://www.webmd.com/anxiety-panic/anxiety-disorders#1-1

What are anxiety disorders? (n.d.). https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders

World Health Organization: WHO. (2023, September 27). Anxiety disorders. https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders