Understanding Anxiety Disorders: Types, Symptoms, Impact, and Treatment

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I. What is Anxiety and Anxiety Disorder?

• Anxiety is a normal biological response to perceived threat, serving as a protective mechanism to guard against danger. It manifests as emotional and physical symptoms, which can vary from person to person. These symptoms often include tightness in the chest, racing thoughts, rapid heart rate, and shortness of breath.
• Anxiety disorders, however, involve more than occasional worry or fear. For individuals with these disorders, anxiety does not go away, is felt in many situations, and can get worse over time. A mental health professional may diagnose an anxiety disorder if the level of anxiety is so severe that symptoms are overpowering and interfere with daily life. While occasional anxiety is an expected part of life, for someone with an anxiety disorder, the anxiety persists.

II. Types of Anxiety Disorders

There are several types of anxiety disorders, sharing common features like excessive fear and behavioral avoidance.

• Generalized Anxiety Disorder (GAD): Characterized as future-oriented, “what-if” thinking, with worries about a number of life areas and fear of catastrophic future outcomes. It involves excessive anxiety for no specific reason, often accompanied by an inability to stop worrying, which can take a huge toll on one’s life. People with GAD worry endlessly over everyday issues like health, money, or family problems, even if there’s little cause for concern. They may startle easily, struggle to relax and concentrate, and have difficulty sleeping. GAD affects roughly 6.8 million Americans every year and is very common.
• Panic Disorder: Involves unexpected and repeated episodes of intense fear accompanied by physical symptoms like a racing heart, shortness of breath, and sweating. These sudden periods of intense fear or impending doom can trigger heart palpitations, sweating, shortness of breath, or, in severe cases, feel like a heart attack, leading to emergency room visits. Not everyone who experiences panic attacks develops panic disorder, but if attacks recur without warning, creating fear of future attacks, it’s likely panic disorder. It affects about 6 million U.S. adults.
• Specific Phobias: Occur when certain situations or objects, such as elevators, airplanes, snakes, or even simple medical procedures, cause strong fear and avoidance. This can include conditions like vehophobia (anxiety with driving).
• Social Anxiety Disorder (Social Phobia): Arises from everyday social interactions or performance situations, resulting in anxiety and fear of embarrassment or negative evaluation by others. It can have a crippling effect on day-to-day activities, characterized by a feeling or fear of being judged, rejected, or offending others in social situations. It affects about 15 million U.S. adults.
• Other Related Conditions Often Discussed Alongside Anxiety Disorders:
  • Post-traumatic stress disorder (PTSD): Occurs after witnessing or experiencing a traumatic event. Symptoms can arise immediately or years later. PTSD is considered a common type of anxiety disorder.
  • Obsessive-Compulsive Disorder (OCD): Can include excessive hand-washing, continuous counting, endless “security” checks, or repeatedly obsessing and ruminating over certain thoughts. Individuals often cannot stop performing routines or rituals despite their best efforts.
  • Agoraphobia and Separation Anxiety Disorder are also listed as types of anxiety disorders.

III. Prevalence and Scope

• Commonality: Feeling anxious is a normal part of life, but anxiety disorders involve more than occasional worry or fear.
• Statistics:
  • Approximately a third of U.S. adolescents and adults experience an anxiety disorder at some point in their lives.
  • About 40 million U.S. adults have some type of anxiety disorder.
  • Nearly 1 in 5 American adults are affected by anxiety disorders each year.
  • Anxiety disorders make up almost 30% of all diagnosed mental disorders.
  • About half of diagnosable mental health disorders start by age 14, with an estimated 1 in 3 children or adolescents suffering anxiety at some point.

IV. How Anxiety Impacts Health and Daily Life

Anxiety disorders can have significant negative effects on overall physical, relationship, and mental health and well-being, as well as one’s ability to function at work.

• Physical Symptoms and Effects:
  • In people with anxiety, emotional distress often manifests physically.
  • Common physical complaints include fatigue, low energy, sleep disturbances, and pain.
  • Prolonged emotional stress and worry can lead to various health concerns and influence hormonal levels.
  • The body’s central nervous system goes into overdrive, releasing cortisol, which can boost sugar levels and triglycerides. Constant cortisol triggers can result in:
    • Short-term memory loss and concentration problems.
    • Digestive disorders.
    • Lowered immune system.
    • Elevated blood pressure.
    • In rare cases, even a heart attack.
  • Anxiety disorders can also raise the risk for other medical problems such as heart disease, diabetes, and substance abuse.
• Emotional/Mental Symptoms and Effects:
  • Symptoms include restlessness, irritability, trouble concentrating, and difficulty sleeping.
  • Emotional symptoms are debilitating and include incessant worry, dread, inability to relax, spinning thinking, racing thoughts, negativity, projected negative outcomes, fixation on thoughts surrounding safety or death, feeling a looming dark cloud, feeling hopeless about the future, and at times feeling like one is losing their mind. These thoughts are often all-consuming, inescapable, and difficult to control.
• Impact on Functioning (Work, Relationships, Daily Activities):
  • Symptoms can interfere with daily life and routine activities, such as job performance, schoolwork, and relationships.
  • Individuals with severe anxiety may have difficulty driving (vehophobia), working, studying, shopping, and visiting a doctor.
  • Anxiety can limit social interaction and the ability to sign up for new activities, negatively impacting both physical and mental health.
  • It keeps individuals in their comfort zone, making trying new things and taking risks very difficult, impacting quality of life and leading to exhaustion from constant worry.
  • In the workplace, individuals may experience difficulty in meetings, confronting peers, or asking for help. Working from home can sometimes ease these feelings.
  • Relationships can be harder to maintain, leaving individuals constantly stressed, uncontrollably worried, and second-guessing their relationships.
• Brain Changes:
  • Research shows a cyclical effect: if anxiety disorders are left undiagnosed and untreated, certain areas of the brain, such as the prefrontal cortex and hippocampus, can decrease in size. These areas register and even create anxious feelings, so their reduction can contribute to a cycle of negative thinking.
• Connection with Other Conditions:
  • Anxiety disorders often go hand in hand with depression. Many people who experience depression also have anxiety disorders.
  • NIMH-supported research explores the overlap of anxiety with other disorders, such as depression and eating disorders.

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V. Factors Contributing to Anxiety Disorders

• Biological/Genetic: Anxiety disorders tend to run in families, although no specific genes have been found to directly cause them. NIMH conducts research examining genetic factors and studies brain development and biology among people with and without anxiety disorders.
• Environmental/Life Events: Environmental factors contribute to the risk for anxiety disorders in individuals of all ages. Research examines rates and symptoms of anxiety disorders after major life events like pregnancy, trauma, or illness.
• Societal/Modern Stressors:
  • Loss of community: A softening and loss of community for many people can be a source of discomfort, as community can be very comforting.
  • Unpredictability: This is one of the things that drives anxiety for many people.
  • Social media use: Kids are heavily exposed to social media, including bullying, and the scale of exposure (hundreds of people vs. a few in person) is vastly different, contributing to anxiety issues in younger folks.

VI. Treatment and Management Options

Anxiety is a manageable disorder, and treatment options can make a big difference in overall health and well-being. Most anxiety disorders get better with therapy.

• Professional Treatments:
  • Cognitive Behavioral Therapy (CBT): Considered one of the gold standard treatments for anxiety.
    • It is a form of psychotherapy based on the idea that thoughts and behaviors impact how we feel.
    • CBT is collaborative, time-limited, and structured; therapists work with patients to identify patterns in thoughts and behaviors contributing to anxiety.
    • Patients learn skills to change problematic patterns, such as identifying cognitive errors (e.g., all-or-nothing thinking) and adopting a more balanced view of situations.
    • It also helps patients watch carefully for behaviors like avoidance that keep them stuck, effectively breaking the anxiety cycle.
    • Research strongly supports the effectiveness of CBT, showing it improves symptoms and has lasting positive effects on everyday functioning and quality of life.
    • CBT is also helpful because it teaches people to use emotion regulation strategies more effectively.
  • Medication: Can be used alongside talking therapy. Various medications are effective for anxiety. Patients may need to try several medicines before finding the right one. It’s crucial to follow instructions, be aware that full benefits may take weeks, and discuss any side effects or pregnancy concerns with a doctor.
  • Other Therapies (Talk Therapy, Emotion Regulation): Different types of talk therapy are available. Psychotherapy (talk therapy or counseling) is generally short-term and focuses on current thoughts, feelings, and issues, helping to cope and prepare for future challenges. Therapists help individuals learn skills, change problematic behaviors, and find solutions. Emotion regulation strategies are also a focus, helping individuals adjust their emotions to avoid harmful behaviors like avoidance.
• Self-Help and Coping Strategies:
  • General things that can help include good sleep, regular exercise, and trying to modify stressors.
  • Other self-help methods that can reduce symptom severity include meditating, journaling, and changing your diet.
  • Finding ways to relax, talking about it, and connecting with family and friends can also help individuals cope.
  • Identifying personalized stress management techniques is key, as what works varies from person to person (e.g., listening to music, fly-fishing, walking, dancing, mindfulness, yoga).
  • Stress management techniques and mindfulness meditation may help relieve anxiety symptoms.
• Importance of Seeking Treatment:
  • Only about a third of adults with anxiety disorders seek treatment, which is unfortunate given the effectiveness of treatments like CBT.
  • Anxiety disorders are described as “one of the most treatable mental health problems,” yet many people don’t get the help that could benefit them.
  • If symptoms don’t go away, it’s important to talk with a healthcare provider.
  • The best way to start is often by talking with a family doctor or pediatrician, who can help identify problems and guide patients to appropriate care.
  • Support groups, whether in-person or online, can help individuals feel less isolated.
  • For crisis situations, immediate help is available via calling or texting 988 (Suicide & Crisis Lifeline) or calling 911 for life-threatening situations.

VII. Research and Future Directions

• NIMH Research Focus:
  • Examines environmental and genetic factors contributing to anxiety disorders, including brain development and biology.
  • Studies family and other environmental factors influencing risk across all age groups.
  • Investigates anxiety disorder rates and symptoms after major life events, trauma, or illness.
  • Focuses on predictors and symptoms among youth, including during college transitions and in relation to social media use.
  • Supports research on interventions and treatments for different types of anxiety disorders.
  • Explores the overlap of anxiety with other disorders like depression and eating disorders, and how symptoms, severity, and treatment needs change with age.
• Clinical Trials: Clinical trials are research studies exploring new ways to prevent, detect, or treat diseases and conditions, with information available for participants.
• Brain Imaging and Treatment Prediction: NIH-funded studies are using MRI to create detailed images of adolescent brains to link brain structures and activities to anxiety and depression. Analysis of brain connections may help predict which adults with social phobia will respond best to CBT. The ultimate goal is for brain imaging to predict clinical outcomes and tailor treatment (psychotherapy or medication) to each individual.

VIII. Finding Help and Support

• If you or someone you know is struggling, resources are available through websites like the Substance Abuse and Mental Health Services Administration (SAMHSA).
• Crisis hotlines: Call or Text 988 (National Suicide & Crisis Lifeline). For life-threatening situations, call 911.
• Consider talking to a healthcare provider, such as a family doctor, nurse practitioner, or mental health professional.
• Many health organizations and resources provide free health information, science updates, and statistics on anxiety disorders.

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Frequently Asked Questions About Anxiety Disorders

1. What is anxiety, and how does it differ from an anxiety disorder?

Anxiety is a normal biological response to perceived threat. It serves as your body’s way of protecting you from danger. Many people experience worry about common life aspects such as health, money, school, work, or family, which is a normal part of life. These feelings can even be helpful, providing a boost of energy or aiding focus. Anxiety manifests with emotional and physical symptoms, which can vary from person to person, including tightness in the chest, racing thoughts, rapid heart rate, and shortness of breath.

However, anxiety disorders involve more than occasional worry or fear. For individuals with these disorders, anxiety is long-lasting, does not go away, is felt in many situations, and can worsen over time, often occurring even when there is no actual threat or danger. A mental health professional may diagnose an anxiety disorder if the level of anxiety is so severe that its symptoms are overpowering and interfere with daily life. While your body can deal with short bursts of the physical response to anxiety, prolonged periods of anxiety disorders can have significant negative effects on overall physical, relationship, and mental health and well-being, as well as one’s ability to function at work.

2. What are the different types of anxiety disorders?

There are several types of anxiety disorders, often grouped together due to common features like excessive fear and behavioral avoidance. Some of the most common types include:

• Generalized Anxiety Disorder (GAD): This is characterized as future-oriented, “what-if” thinking, with worries about a number of life areas and a fear of catastrophic future outcomes. People with GAD worry endlessly over everyday issues like health, money, or family problems, even when there’s little reason for concern. They may startle easily, find it hard to relax or concentrate, and struggle with falling or staying asleep. GAD affects roughly 6.8 million Americans every year and is defined as excessive anxiety for no specific reason, often with an inability to stop the worry, taking a huge toll on one’s life. It is about twice as common in women as in men.

• Panic Disorder: This involves unexpected and repeated episodes of intense fear, known as panic attacks, accompanied by physical symptoms like a racing heart, shortness of breath, or sweating. During a panic attack, a person might feel like they can’t breathe, are having a heart attack, or are losing control, sometimes leading to emergency room visits. Not everyone who experiences panic attacks will develop panic disorder, but if the attacks recur without warning and create a fear of having another attack at any time, it is likely panic disorder. This disorder affects about 6 million American adults and is also twice as common in women as in men.

• Specific Phobias: These cause strong fear and avoidance in response to certain situations or objects, such as elevators, airplanes, snakes, or even simple medical procedures.

• Social Anxiety Disorder (Social Phobia): This occurs when fear arises from everyday social interactions or performance situations, resulting in anxiety, fear of embarrassment, or negative evaluation by others. It can have a crippling effect on day-to-day activities, characterized by a fear of being judged, rejected, or offending others in social situations. This is one of the most common types of anxiety disorders, affecting about 15 million U.S. adults equally between women and men. People with social phobia may worry for days or weeks before a social event and find it hard to talk to others.

• Post-Traumatic Stress Disorder (PTSD): This occurs after witnessing or experiencing a traumatic event. Symptoms can arise immediately after the event or take years to manifest. PTSD is not limited to combat trauma.

• Obsessive-Compulsive Disorder (OCD): This can include excessive behaviors like hand-washing, continuously counting items, or endless “security” checks, or repeatedly obsessing and ruminating over certain thoughts. Individuals with OCD often cannot stop themselves from performing these routines or rituals, or from experiencing unwanted thoughts, despite their best efforts.

• Agoraphobia and Separation Anxiety Disorder are also types of anxiety disorders.

While many anxiety disorders share similar emotional and physical symptoms, certain stressful situations may impact individuals with different disorders differently, and they are classified based on the thought processes involved and their impact on daily life.

3. How common are anxiety disorders?

Anxiety disorders are very common. About a third of U.S. adolescents and adults experience an anxiety disorder at some point in their lives. Specifically, nearly 1 in 5 American adults are affected by anxiety disorders each year. The National Institute of Mental Health reports that about 40 million U.S. adults have some type of anxiety disorder. Globally, anxiety disorders make up almost 30% of all diagnosed mental disorders.

4. How do anxiety disorders impact a person’s daily life and overall health?

Anxiety disorders can profoundly impact various aspects of a person’s life, as symptoms can interfere with daily life and routine activities such as job performance, schoolwork, and relationships.

Impact on Daily Functioning:

• Individuals with severe anxiety may find it difficult to perform routine tasks like driving, working, studying, shopping, or visiting a doctor.
• They may avoid social encounters or refuse to leave their home.
• Anxiety can keep individuals within their comfort zone, making it very difficult to try new things or take personal risks for growth.
• It impacts self-esteem, career, hobbies, and can limit a person’s comfortable activities, negatively affecting both physical and mental health.
• Driving anxiety (vehophobia), stemming from traumatic events or fear of enclosed spaces, can impact social life and the ability to work outside the home.
• Work-related anxiety can make it difficult to keep jobs, attend meetings, confront peers, or ask for help, although working from home may sometimes ease symptoms.
• Relationships can be harder to maintain, as individuals may be constantly stressed, uncontrollably worried, and second-guessing their connections. Those who do not experience anxiety may find it difficult to understand these changes in their loved ones.

Impact on Physical and Mental Health:

• Prolonged emotional stress and worry can lead to a variety of health concerns and influence hormonal levels. The body’s central nervous system goes into overdrive, releasing cortisol, which can boost sugar levels and triglycerides.
• Constantly triggered cortisol can result in physical reactions such as short-term memory loss, concentration problems, digestive disorders, sleep disorders, a lowered immune system, and elevated blood pressure, and in rare cases, even a heart attack. Many people struggling with anxiety present to their primary care doctor with physical complaints like fatigue, low energy, and pain, rather than explicitly stating they are anxious. Panic attacks are frequently mistaken for heart attacks, leading to emergency room visits.
• Emotional symptoms are equally debilitating, including incessant worry, dread, inability to relax, spinning/racing thoughts, negativity, projected negative outcomes, fixation on thoughts surrounding safety or death, feeling a looming dark cloud, feeling hopeless about the future, and at times feeling like one is losing their mind. These thoughts are often all-consuming, inescapable, and difficult to control.
• Research indicates a cyclical effect of anxiety on the brain: when anxiety disorders are left undiagnosed and untreated, certain areas of the brain, such as the prefrontal cortex and hippocampus (where anxious feelings are registered and created), can decrease in size. This reduction can contribute to existing negative, anxious thoughts, creating a cycle of negative thinking.
• Anxiety disorders can also raise the risk for other medical problems such as heart disease, diabetes, substance abuse, and depression.

5. What causes anxiety disorders?

The exact cause of anxiety disorders is not fully understood, but many different factors contribute in complex ways. Anxiety disorders tend to run in families, suggesting a genetic component. However, no specific genes have been found to solely cause an anxiety disorder. Instead, researchers believe that a combination of factors, including genes, stress, and the environment, have small, additive effects that influence a person’s risk.

NIMH conducts and funds research to examine these environmental and genetic factors, including studies comparing brain development and biology among people with and without anxiety disorders. Family and other environmental factors that may influence the risk for anxiety disorders in infants, children, adolescents, and adults are also researched. Studies also examine rates and symptoms of anxiety disorders after major life events like pregnancy, trauma, or illness, and predictors among youth, especially during the college transition and in relation to social media use.

Societal changes are also believed to contribute to rising anxiety symptoms. A “softening” or loss of community, where people are less connected with family and friends than in the past, can reduce comfort for many. Additionally, unpredictability is a major driver of anxiety. For younger individuals, extensive exposure to social media, which can involve bullying and exposure to hundreds of people daily compared to a smaller group in school, is a significant factor contributing to anxiety issues.

6. How are anxiety disorders treated?

The good news is that most anxiety disorders get better with treatment. They are considered “one of the most treatable mental health problems”. Treatment options typically include psychotherapy (“talk therapy”), medication, or a combination of both. The specific course of treatment depends on the type of anxiety disorder.

Psychotherapy (Talk Therapy):

• Cognitive Behavioral Therapy (CBT) is considered one of the gold standard treatments for anxiety. It is a form of psychotherapy based on the idea that our thoughts and behaviors impact how we feel.
• Other types of talk therapy are also effective.
• Therapy helps individuals learn coping skills, change problematic behaviors, and find solutions for current life issues, sometimes involving understanding past events.

Medication:

• Medications are very effective for anxiety and can be used alongside talk therapy.
• Antidepressants can help improve mood and coping skills for those with depression, which often co-occurs with anxiety.
• It may take several tries to find the best medication and dosage, and full benefits can take up to 4 weeks. It is crucial not to stop taking medication suddenly without consulting a doctor, as this can worsen symptoms.

Overall Treatment Goals:

• The goal of treatment is not to eradicate anxiety but to manage it more effectively and keep it in a range where it is useful and helpful rather than interfering with life.
• Despite the effectiveness of treatments, only about a third of adults with anxiety disorders seek help.

7. What is Cognitive Behavioral Therapy (CBT) and how does it work?

Cognitive Behavioral Therapy (CBT) is a gold standard form of psychotherapy for anxiety. It is distinct from traditional talk therapy because it is collaborative, time-limited, and structured.

How it Works:

• CBT is based on the idea that our thoughts and behaviors significantly impact how we feel.
• You and your therapist work together to identify patterns in your thoughts and behaviors that contribute to anxiety.
• From there, you develop skills to change these problematic patterns.
• For example, you learn to identify “cognitive errors” like all-or-nothing thinking (seeing events as either good or bad, perfect or awful, with no middle ground).
• Through CBT, patients learn techniques and strategies to adopt a more balanced view of situations and to watch carefully for behaviors, such as avoidance, that keep them “stuck” in the anxiety cycle.
• Research strongly supports the effectiveness of CBT, showing that it improves symptoms of anxiety and has lasting positive effects on everyday functioning and quality of life.
• CBT is also helpful because it teaches people to more effectively use emotion regulation strategies, making them more competent in managing their emotions in daily life.
• Brain imaging research suggests that analysis of brain connections might even help predict which adults with social phobia will respond best to CBT, potentially allowing for tailored treatment approaches.

8. Can anxiety disorders co-exist with other mental health conditions?

Yes, anxiety disorders frequently co-exist with other mental health conditions.

• Depression and anxiety disorders often go hand-in-hand. Many people who experience depression also have other mental health conditions. NIMH supports research exploring the overlap of anxiety with other disorders like depression and eating disorders.
• Anxiety disorders can also raise your risk for other medical problems such as substance abuse, and there is a high prevalence of smoking among adults with mental health conditions like anxiety.
• Social media use has been linked to increased rates of anxiety and depression, particularly among youth.

9. Where can I find help and support for anxiety disorders?

If you or someone you know is struggling with anxiety disorders, help is available and can make a big difference.

• Start by talking with your family doctor or nurse practitioner, or your child’s pediatrician if you are a parent. These health professionals are generally prepared to help identify such problems and direct patients to appropriate care.
• The next step may be talking to a mental health professional, such as a psychiatrist or psychologist. It’s beneficial to find someone trained in cognitive-behavioral therapy (CBT) who is also open to using medication if needed.
• You can find help and support through resources like:
  • The 988 Suicide & Crisis Lifeline: Call or text 988 if you or someone you know is struggling or having thoughts of suicide. In life-threatening situations, call 911.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) website for mental health services in your area.
  • Clinical trials for anxiety disorders can be found on Clinicaltrials.gov or through specific NIMH studies for adults and children.
  • Joining a self-help or support group can provide a sense of community and help you share problems and achievements with others, reducing feelings of isolation.
  • Many health systems, such as Summa Health and Mass General Brigham, offer behavioral health institutes with dedicated teams of skilled psychiatrists and psychologists.

10. Are there self-help strategies for managing anxiety?

Yes, alongside professional treatment, several self-help methods can help reduce the severity of anxiety symptoms and manage stress effectively. These include:

• Exercising more regularly.
• Meditating and practicing mindfulness.
• Journaling.
• Changing your diet.
• Finding ways to relax and talk about your feelings.
• Connecting with family and friends can help you cope.
• Modifying stressors in your life where possible.
• Identifying what personally helps you manage stress, which could include listening to music, engaging in hobbies like fly-fishing, taking walks, going dancing, or practicing yoga.
• Cultivating an attitude of gratitude.
• Managing spending wisely to avoid stress from overspending or comfort spending.
• Taking vacations to boost mental health and lower stress.
• Laughter can be a great stress reliever, improving circulation and muscle relaxation.

It’s important to remember that personalized approaches to stress management are key; what works for one person may not work for another.