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Summary

Anxiety disorders are conditions that cause patients to feel anxious or distressed for no logical reason. Normally, anxiety is part of the body’s alarm system, alerting a person to danger or providing extra energy to help accomplish a task. However, people with anxiety disorders are nervous for no particular reason or experience fear that is out of proportion with the actual threat that is present.

Anxiety is also a symptom of other mental health disorders, physical conditions and a side effect of some medications. An anxiety disorder is diagnosed when anxiety is the main symptom that requires help from a mental health professional.

More than 19 million Americans are affected by anxiety disorders, making them among the nation’s most common mental disorders, according to the Anxiety Disorders Association of America. There are five major categories of anxiety disorders, including:

• Generalized anxiety disorder. Diagnosed when a person worries excessively about all types of life issues (e.g., health, family, money, work) for more than six months.
  
  
• Obsessive-compulsive disorder. Diagnosed when a person is unable to control intrusive and unwanted thoughts (obsessions) and/or to stop performing ritual actions (compulsions), such as repetitive hand washing.
  
  
• Panic disorder. Diagnosed when a person regularly experiences panic attacks –sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes and cause physical symptoms such as racing heartbeat, heavy perspiration and shortness of breath.
  
  
• Phobias. Diagnosed when a person has extreme and irrational fear of objects or situations that in actuality pose little or no threat to them.
  
  
• Post-traumatic stress disorder. Diagnosed when a patient who has experienced an extremely traumatic event such as war, rape, child abuse or a natural disaster later begins to have nightmares, flashbacks, depression and/or other symptoms.

About anxiety disorders

Anxiety disorders are conditions in which patients feel anxious or distressed for no logical reason. People with these disorders may feel chronic, intense and irrational anxiety on a regular or even daily basis. As a result, anxiety disorders can seriously diminish quality of life, hampering a person’s ability to work, travel, and form and maintain interpersonal relationships.

Normally, anxiety is part of the body’s alarm system, alerting a person to danger or providing an extra energy to help accomplish a task. However, some people experience anxiety for no particular reason, or that is out of proportion with the actual threat that may be present. Some of these individuals may have an anxiety disorder. Others may experience anxiety in conjunction with another mental disorder, such as depression, or as a side effect of prescribed medications.

More than 19 million Americans are affected by anxiety disorders, according to the Anxiety Disorders Association of America. They are among the most common mental illnesses inmental health bill in the United States, according to the National Mental Health Association.

Anxiety disorders can affect all aspects of a person’s overall health. For example, patients with anxiety disorders are three times to five times more likely to visit a physician than those without anxiety disorders. They are also six times more likely to be hospitalized for psychiatric disorders.

In addition, depression is often associated with anxiety disorders. Symptoms of depression include feelings of sadness, hopelessness and low energy. For more information, see Depression.

Types and differences of anxiety disorders

There are five major categories of anxiety disorders. All share the quality of excessive and irrational fear. The fear may be of a specific object or situation, or it may be generalized fear that the patient feels without being able to identify a specific source of that fear. Each anxiety disorder has its own distinct features. They include:

• Generalized anxiety disorder. Diagnosed when a person worries excessively about all types of life issues, including health, family, money and work, for more than six months. Patients with this disorder may find themselves unable to relax, even when there are no signs of trouble in their lives.
  
  
• Obsessive-compulsive disorder. Diagnosed when a person is helpless to control intrusive and unwanted thoughts (obsessions) and/or to stop performing ritual actions (compulsions), such as counting, hand washing or repetitively checking locks.
  
  
• Panic disorder. Diagnosed when a person regularly experiences panic attacks – sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes and cause symptoms such as racing heartbeat, heavy sweating and shortness of breath. In some cases, panic disorder may be accompanied by agoraphobia, a condition in which patients fear being caught in a place or situation in which escape might be difficult, or being trapped in circumstances in which medical help might not be available during a panic attack. In other cases, panic disorder actually causes agoraphobia.
  
  
• Phobias. Diagnosed when a person has extreme and irrational fears of something that in actuality poses little or no threat. Social phobia (also known as social anxiety disorder) involves a fear of being judged by others, whereas people with specific phobias suffer from intense fear of certain objects (such as fear of spiders) or situations (such as fear of heights). Agoraphobia is a phobia closely related to panic disorder (see above). People with phobias avoid objects or situations that they view as threatening.
  
  
• Post-traumatic stress disorder (PTSD). Diagnosed when a patient who has experienced a traumatic event such as war, rape, child abuse or a natural disaster begins to have nightmares, flashbacks, depression or other symptoms for more than a month. Stress disorders that occur within a month of the traumatic event are known as acute stress disorders.

Risk factors and causes of anxiety disorders

The exact cause of most anxiety disorders is unknown. However, a combination of psychological, biological and environmental factors may be responsible. Heredity is also believed to play a role in many anxiety disorders. The combination of heredity and the anxiety experienced may vary. For example, many people may experience the same trauma during combat, but only a few of them develop post-traumatic stress disorder.

Research is ongoing into how the brain creates feelings of anxiety and fear. Scientists believe that an almond-shaped structure called the amygdala serves as a central location that coordinates messages between the parts of the brain that process incoming sensory signals and the parts that interpret those signals. The amygdala signals the body when a threat is present, triggering anxiety or fear.

Another brain structure called the hippocampus also helps process threatening signals and changes information into memories. Research shows that people who have experienced severe stress (such as child abuse or combat experience) appear to have a smaller hippocampus.

Signs and symptoms of anxiety disorders

Symptoms related to anxiety disorders may differ slightly depending on the nature of the disorder affecting a patient. For example, patients with panic disorder may experience panic attacks that include rapid heartbeat, heavy sweating and shortness of breath. Meanwhile, patients with obsessive-compulsive disorder may find themselves unable to stop thinking certain thoughts or to stop performing rituals repetitively, to the point that the rituals become time-consuming.

Patients diagnosed with one form of anxiety disorder often are also diagnosed with a second anxiety disorder. In addition, many patients with anxiety disorders also are diagnosed with other disorders, such as depression, eating disorders or substance abuse.

Some of the symptoms associated with major anxiety disorders are as follows:

Condition	Symptoms
Panic disorder	Recurrent episodes of panic attacks which feature rapid or pounding heartbeat or palpitations, heavy sweating and shortness of breath
Phobias	Extreme and irrational fears of something that in actuality poses little or no threat. Includes social phobia and specific phobias.
Obsessive-compulsive disorder	Recurrent and persistent thoughts or impulses – examples include excessive hand-washing or checking repeatedly to make sure the stove is off
Post-traumatic stress disorder	Flashbacks or nightmares, emotional numbness, headaches, dizziness, chest pain
Acute stress disorder	Anxiety, dissociation and other symptoms within a month of exposure to trauma
Generalized anxiety disorder	Excessive anxiety and worry, irritability, restlessness, fatigue, trembling

Diagnosis methods for anxiety disorders

In many cases, patients will be unaware that they have a anxiety disorder and will visit a physician because of physical symptoms that they experience. For example, a patient with panic disorder may visit a physician believing that symptoms such as chest discomfort, heart palpitations and shortness of breath indicate a heart problem rather than an anxiety disorder.

In such cases, a physician will have to rule out the possibility of an underlying medical illness such as heart disease before suspecting that an anxiety disorder may be causing physical symptoms. Blood tests such as a complete blood count or tests such as an echocardiogram (an image of the heart produced by ultrasound) may be used to rule out certain heart conditions.

In other cases, patients may not experience acute physical symptoms, but may instead report feelings of unease or anxiety. These patients may find that anxiety is interfering with their lives and that they require medical treatment to help alleviate the problem.

In all cases, a physician will perform a complete medical examination and compile a thorough medical history. Once other conditions have been ruled out, the physician may diagnose an anxiety disorder if certain criteria are present.

All anxiety disorders have their own, specific criteria as defined by the American Psychiatric Association (APA). For example, panic disorder is diagnosed when the patient has recurrent, unexpected panic attacks, and when for a month or more after at least one attack, the patient has one or more of the following:

• Ongoing concern about future attacks
  
  
• Concerns about the significance of future attacks and their potential consequences
  
  
• Change in behavior to reduce the likelihood of future attacks

In addition, to diagnose a panic disorder, symptoms should not be caused by a general medical condition or the use of substances, and cannot better be explained by another anxiety disorder or mental condition.

Treatment options for anxiety disorders

Patients diagnosed with anxiety disorders have a number of effective treatment options. In many cases, a combination of psychotherapy and medications may be the best treatment. In other cases, one form may be more beneficial than another. For example, certain phobias respond only to psychotherapy.

Antidepressant medications such as sertraline, paroxetine and fluoxetine are usually effective in treating anxiety disorders, even in patients who are not depressed. These drugs sometimes take several weeks to become effective, so patients should not become discouraged if they do not see immediate improvement.

Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Anti-anxiety medications (e.g., clonazepam or alprazolam) also may be prescribed. They generally are prescribed only for short periods of time, because patients tend to develop a tolerance to them. This means that over time, it takes increasing dosage levels to achieve the same effect from the drug, which may lead to drug dependency. However, patients with panic disorder may take the drug for as long as six months to a year.

Patients should not stop using antidepressant or anti-anxiety medications unless under close supervision of a physician, because this may cause withdrawal symptoms.

Beta blocker medications – which are typically used to treat heart conditions – are effective in treating some anxiety disorders, particularly social phobia. Patients who know that they soon will be in an anxiety-provoking situation – such as giving a speech – may be prescribed beta blockers to reduce symptoms such as a pounding heart or trembling hands.

Psychotherapy is particularly effective for anxiety disorders such as social phobia and panic disorder. It is likely to take the form of behavioral therapy and cognitive therapy, or a combination of the two (cognitive-behavioral therapy). In behavioral therapy, the patient learns to change specific actions and to use different techniques to stop harmful behavior. The patient may learn relaxation techniques such as deep breathing and may be gradually exposed to situations that are frightening and in which the patient can test new coping skills.

Cognitive therapy involves learning new skills to react differently to situations that typically trigger anxiety. Patients also learn more about negative thinking patterns that increase anxiety and ways to redirect such thinking.

Prevention methods for anxiety disorders

While anxiety disorders cannot always be prevented, they can be more effectively managed by taking steps that can reduce symptoms. Relaxation techniques such as meditation, muscle relaxation, breathing techniques and guided imagery may help people feel more relaxed.

Taking time to engage in leisure and recreational activities can help restore balance to patients’ lives, leaving them less vulnerable to anxiety, stress and panic. Eating a healthy diet, exercising and avoiding certain substances – such as some types of medications, caffeine, amphetamine and marijuana – can reduce the likelihood of symptoms related to anxiety disorders.

Questions for your doctor on anxiety disorders

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to anxiety disorders:

1. How can I tell the difference between normal worry and an anxiety disorder?
   
   
2. What is causing my anxiety disorder?
   
   
3. Is it possible that I might have several different types of anxiety disorders at the same time?
   
   
4. Is my anxiety disorder medically dangerous?
   
   
5. What are my treatment options?
   
   
6. Will I have to take medication every day, or only when symptoms are especially severe?
   
   
7. How effective are the treatments you’re recommending?
   
   
8. How long will my treatment take?
   
   
9. Will I ever be cured of my anxiety disorder?
   
   
10. How can I prevent symptoms associated with anxiety disorders?