What are Anxiety Disorders

Anxiety disorders are a group of mental health conditions that cause an individual to experience intense anxiety, fear, worry, stress and other symptoms that are out of proportion to his or her situation and they persist and are difficult, or at times impossible, to control ¹, ². If you have an anxiety disorder, you may respond to certain things and situations with fear and worry. You may also experience physical signs of anxiety, such as a pounding heart and sweating. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

It’s normal to have some anxiety. You may feel anxious or nervous if you have to tackle a problem at work, go to an interview, giving a speech, taking an important exam, meeting someone new or make an important decision. Some anxiety can even be beneficial — it helps you notice dangerous situations and focuses your attention so you stay safe. But an anxiety disorder goes beyond the regular nervousness and slight fear you may feel from time to time. Furthermore, the worry and fear that someone with an anxiety disorder experiences is much more extreme, and it often occurs even in situations in which there are no logical reasons to be anxious. The feelings persist and are difficult to control or lessen without professional assistance. The anxiety causes impairment in your life. Anxiety disorders can make it difficult to get through your day. Anxiety disorder may cause poor performance at work or school, an inability to meet responsibilities, or social isolation.

An anxiety disorder happens when:

• Anxiety interferes with your ability to function.
• Your reactions are often out of proportion to situations (overreactions).
• You can’t control your responses to situations.

The onset of most anxiety disorders occurs during childhood, adolescence or early adulthood ³. Children, adolescents and adults can experience anxiety disorders. Women are about twice as likely as men to have an anxiety disorder and the reasons for this increased risk are unclear ⁴, ⁵. Emerging evidence suggests that men and women differ in how they form conditional fear memories and extinguish fear memories ⁶ . In addition, gonadal hormones, such as estrogens, can influence neurogenesis, synaptic plasticity and the expression of receptors that are key substrates for learning and memory ⁴. For example, estrogen receptors are expressed in key nodes of the fear network, including the medial prefrontal cortex, hippocampus and amygdala, and their expression fluctuates across the estrous cycle in the female rat ⁷. Increased estrogen levels during extinction learning significantly enhance the recall of extinction memory when tested at 24 hours in the majority of studies conducted in female rodents and in women ⁸. This enhanced extinction recall in women correlated with increased activation within the ventromedial prefrontal cortex, hippocampus and amygdala ⁹. This topic is clearly a crucial area of future research, as the neurobiology underlying sex differences could explain epidemiological findings and could also inform the development of sex-specific treatments.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ¹⁰, there are several types of anxiety disorders that include generalized anxiety disorder (GAD), specific phobias and social anxiety disorder, all of which cause excessive worry, but often with different triggers.

Types of Anxiety Disorders ¹⁰:

• Generalized Anxiety Disorder (GAD): Excessive worry and anxiety about many things, often without a specific cause. Generalized anxiety disorder (GAD) causes fear, worry and a constant feeling of being overwhelmed about activities or events — even ordinary, routine issues. Generalized anxiety disorder is characterized by excessive, frequent and unrealistic worry about everyday things, such as job responsibilities, health or chores. 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 or depression.
• Panic Disorder: Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). Panic disorder involves multiple unexpected panic attacks. You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). A main feature of panic disorder is that the panic attacks usually happen without warning and aren’t due to another mental health or physical condition. Some people with panic disorder also have agoraphobia.
• Social Anxiety Disorder (social phobia): Social anxiety disorder previously known as social phobia happens when you experience intense and ongoing fear and anxiety of being judged negatively and/or watched by others and you avoid social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.
• Specific phobias: Intense and irrational fear and anxirty of specific objects or situations. A phobia is when something causes you to feel fear or anxiety that’s so severe it consistently and overwhelmingly disrupts your life. Phobias provoke panic attacks in some people. There are hundreds of different types of phobias, and there’s one diagnosis for almost all of them: specific phobia. Only one phobia, agoraphobia, is a distinct diagnosis.
• Agoraphobia: Fear of places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed, where escape might be difficult or help unavailable. Agoraphobia is a type of anxiety disorder that causes an intense fear of becoming overwhelmed or unable to escape or get help. People with agoraphobia often avoid new places and unfamiliar situations, like large, open areas or enclosed spaces, crowds and places outside of their homes.
• Separation anxiety disorder (SAD): Separation anxiety disorder happens when you feel intense fear or excessive anxiety when you’re separated from a loved one or a close attachment figure, like a primary caregiver. While separation anxiety in babies and toddlers is a normal stage of development, separation anxiety disorder can affect children and adults.
• Selective mutism: Selective mutism happens when you don’t talk in certain situations because of fear or anxiety. Selective mutism usually affects young children where they can’t speak in certain situations, such as at 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. Selective mutism can also affect adolescents and adults.
• Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.
• 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.

Other mental health conditions share features with anxiety disorders. These include post-traumatic stress disorder (PTSD), acute stress disorder (a short-term mental health condition that can develop within a month after a traumatic event, characterized by symptoms like intrusive memories, avoidance behaviors, and increased arousal, similar to PTSD, but with a shorter duration) and obsessive-compulsive disorder (OCD). But the American Psychiatric Association classifies them as distinct conditions and not anxiety disorders ¹⁰.

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).

Anxiety disorder treatment can be successfully completed with therapy, medication, lifestyle changes, relaxation techniques, and other strategies.

Anxiety disorders treatment is effective and usually includes:

• Psychotherapy (talk therapy): Cognitive Behavioral Therapy (CBT), exposure therapy, and other types of therapy can help individuals manage their anxiety.
• Medication: Antidepressants and other medications can be used to help manage anxiety symptoms.
• Self-Help Strategies: Relaxation techniques, mindfulness, and lifestyle changes can also be helpful in managing anxiety.

What is anxiety?

Anxiety is a common mental health condition characterized by excessive worry, fear, and apprehension that can significantly impact your daily life, often accompanied by physical symptoms like rapid heartbeat and sweating. Anxiety is a natural human emotion that can be a normal response to stress or perceived threats.  However, when anxiety becomes persistent, intense, and difficult to control, it can indicate an anxiety disorder. Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear that impair a person’s social, occupational, and personal functions.

Symptoms of Anxiety:

• Emotional or Psychological: Excessive worry, fear, restlessness, difficulty concentrating, feeling on edge, and a sense of impending doom.
• Physical: Rapid heartbeat, sweating, trembling, shortness of breath, stomach problems, and difficulty sleeping

How common are anxiety disorders?

Anxiety disorders are some of the most common mental health conditions in most western societies and are a leading cause of disability ¹¹, ¹², ¹², ¹³, ¹⁴, ¹⁵, ¹⁶:

• Specific phobias affect up to 12% of the U.S. population or 34.3 million adults. Women are twice as likely to be affected than men. Symptoms typically begin in childhood; the average age of onset is 7 years old.
• Social anxiety disorder affects about 7.1% of the U.S. population or 15 million adults. Social anxiety disorder is equally common among men and women and typically begins around age 13. According to a 2007 Anxiety and Depression Association of America survey, 36% of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help.
• Generalized anxiety disorder affects about 3.1% of the U.S. population or 6.8 million adults. Women are twice as likely to be affected as men. Generalized anxiety disorder often co-occurs with major depression.
• Panic disorder affects 6 million adults or 2.7% of the U.S. population. Women are twice as likely to be affected as men.
• Agoraphobia affects up to 1.7% of the U.S. population.
• Separation anxiety disorder affects about 4% of children, 1.6% of adolescents and up to 1.9% of adults.
• Selective mutism is the least common anxiety disorder. It affects between 0.47% and 0.76% of the U.S. population.

What are panic attacks?

Panic attacks (the key feature of Panic Disorder) are abrupt surges of intense fear or intense discomfort that reach a peak within minutes, accompanied by physical and/or cognitive symptoms ¹⁰. A panic attack happens suddenly. Symptoms usually peak within 10 minutes after it starts and then disappear soon after. Panic attacks can be seen as a blend of biological, emotional and psychological reactions. The emotional response is purely fear. Limited-symptom panic attacks include fewer than four symptoms. Panic attacks may be expected, such as in response to a typically feared object or situation, or unexpected, meaning that the panic attack occurs for no apparent reason ¹⁰. Panic attacks function as a marker and prognostic factor for severity of diagnosis, course, and comorbidity across an array of disorders, including, but not limited to, the anxiety disorders (e.g., substance use, depressive and psychotic disorders) ¹⁰. Panic attack may therefore be used as a descriptive specifier for any anxiety disorder as well as other mental disorders ¹⁰.

Physical symptoms of a panic attack include ¹⁷:

• Skipping, racing or pounding heart
• Sweating
• Trembling or shaking
• Shortness of breath or difficulty breathing or hyperventilation
• Choking sensations
• Chest pain, pressure or discomfort
• Nausea, stomach problems or sudden diarrhea
• Dizziness, lightheadedness, feeling faint
• Tingling or numbness in parts of your body or in your fingers or toes
• Hot flushes or chills
• Feeling things around you are strange, unreal (derealization), depersonalization (feeling detached from yourself), unfamiliar, or feeling detached from your body
• Thoughts of losing control or going crazy
• Fear of dying

Panic attacks are very unpleasant and can be frightening. As you can see from the list, many of the symptoms are similar to what you might experience if you were in a truly dangerous situation. A panic attack can be very frightening and you may feel a strong desire to escape the situation. Many of the symptoms may appear to indicate some medical condition and some people seek emergency assistance. However, panic attacks, while very frightening, are not life-threatening or dangerous or harmful to your health. Following a panic attack, you may feel fatigued and drained, even after the symptoms subside. Frequent panic attacks can lead to a decrease in your quality of life and other psychosocial issues. And not everyone who experiences a panic attack develops panic disorder.

If you have panic attacks but not a diagnosed panic disorder, you can still benefit from treatment. If panic attacks aren’t treated, they can get worse and develop into panic disorder or phobias. Treatment can help reduce the intensity and frequency of your panic attacks and improve your function in daily life.

Characteristics of a Panic Attack

• It peaks quickly between 1 to 10 minutes
• The apex of the panic attack lasts for approximately 5 to 10 minutes (unless constantly rekindled)
• The initial attack is usually described as “coming out of the blue” and not consistently associated with a specific situation, although with time panics can become associated with specific situations
• The attack is not linked to marked physical exertion
• The attacks are recurrent over time
• During an attack the person experiences a strong urge to escape to safety
• Many people believe that they may faint whilst having a panic attack. This is highly unlikely because the physiological system producing a panic attack is the opposite of the one that produces fainting.
• Sometimes people have panic attacks that occur during the night when they are sleeping. They wake from sleep in a state of panic. These can be very frightening because they occur without an obvious trigger.
• Panic attacks in, and of themselves, are not a psychiatric condition. However, panic attacks constitute the key ingredient of Panic Disorder if the person experiences at least 4 symptoms of the Panic attack symptoms previously described, the attacks peak within about 10 minutes and the person has a persistent fear of having another attack.
• Panic attacks are the main feature of Panic Disorder. But they can happen alongside other conditions, such as:
  • Anxiety disorders
  • Mood disorders
  • Phobias
  • Psychotic disorders
  • Substance use disorders
  • Trauma- and stressor-related disorders
  • Certain medical conditions.

What triggers panic attacks?

There’s often no specific trigger for panic attacks. But people who have a phobia can experience phobia-related triggers that lead to a panic attack. For example, someone with trypanophobia (intense fear of needles) may experience a panic attack if they have to get their blood drawn for a medical test. For some people, the fear of having a panic attack is often enough to trigger one. It’s important to note that one of the criteria for panic disorder is that the panic attacks don’t have a known trigger.

Anxiety disorder types

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ¹⁰, there are several types of anxiety disorders that include generalized anxiety disorder (GAD, specific phobias and social anxiety disorder.

Types of Anxiety Disorders ¹⁰:

• Generalized Anxiety Disorder (GAD): Excessive worry and anxiety about many things, often without a specific cause. Generalized anxiety disorder (GAD) causes fear, worry and a constant feeling of being overwhelmed about activities or events — even ordinary, routine issues. Generalized anxiety disorder is characterized by excessive, frequent and unrealistic worry about everyday things, such as job responsibilities, health or chores. 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 or depression.
• Panic Disorder: Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). Panic disorder involves multiple unexpected panic attacks. You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). A main feature of panic disorder is that the panic attacks usually happen without warning and aren’t due to another mental health or physical condition. Some people with panic disorder also have agoraphobia.
• Social Anxiety Disorder (social phobia): Social anxiety disorder previously known as social phobia happens when you experience intense and ongoing fear and anxiety of being judged negatively and/or watched by others and you avoid social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.
• Specific phobias: Intense and irrational fear and anxirty of specific objects or situations. A phobia is when something causes you to feel fear or anxiety that’s so severe it consistently and overwhelmingly disrupts your life. Phobias provoke panic attacks in some people. There are hundreds of different types of phobias, and there’s one diagnosis for almost all of them: specific phobia. Only one phobia, agoraphobia, is a distinct diagnosis.
• Agoraphobia: Fear of places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed, where escape might be difficult or help unavailable. Agoraphobia is a type of anxiety disorder that causes an intense fear of becoming overwhelmed or unable to escape or get help. People with agoraphobia often avoid new places and unfamiliar situations, like large, open areas or enclosed spaces, crowds and places outside of their homes.
• Separation anxiety disorder (SAD): Separation anxiety disorder happens when you feel intense fear or excessive anxiety when you’re separated from a loved one or a close attachment figure, like a primary caregiver. While separation anxiety in babies and toddlers is a normal stage of development, separation anxiety disorder can affect children and adults.
• Selective mutism: Selective mutism happens when you don’t talk in certain situations because of fear or anxiety. Selective mutism usually affects young children where they can’t speak in certain situations, such as at 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. Selective mutism can also affect adolescents and adults.
• Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.
• 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.

Other mental health conditions share features with anxiety disorders. These include post-traumatic stress disorder (PTSD), acute stress disorder (a short-term mental health condition that can develop within a month after a traumatic event, characterized by symptoms like intrusive memories, avoidance behaviors, and increased arousal, similar to PTSD, but with a shorter duration) and obsessive-compulsive disorder (OCD). But the American Psychiatric Association classifies them as distinct conditions and not anxiety disorders ¹⁰.

Anxiety disorders causes

Like many mental health conditions, scientists don’t know exactly what causes anxiety disorders. But they think anxiety disorders are caused by a combination of genetic, environmental, and psychological factors:

• Chemical imbalances: Several neurotransmitters and hormones play a role in anxiety, including norepinephrine, serotonin, dopamine and gamma-aminobutyric acid (GABA). Imbalances in these chemicals can contribute to an anxiety disorder.
• Brain changes: A part of your brain called the amygdala plays an important role in managing fear and anxiety. Studies show that people with anxiety disorders show increased amygdala activity in response to anxiety cues.
• Genetics: Anxiety disorders tend to run in biological families. This suggests that genetics may play a role. You may be at an increased risk of developing one if you have a first-degree relative (biological parent or sibling) with an anxiety disorder.
• Environmental factors: Severe or long-lasting stress can change the balance of neurotransmitters that control your mood. Experiencing a lot of stress over a long period can contribute to an anxiety disorder. Experiencing a traumatic event can also trigger anxiety disorders.
• Stressful life events, trauma, and certain medical conditions can also contribute to the development of anxiety disorders. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety.
  
• Substance or Medication-Induced Anxiety Disorder. Substance or Medication-Induced Anxiety Disorder involves anxiety symptoms due to substance intoxication or withdrawal or to medical treatment.
• Medical causes. 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
  • Diabetes
  • Hypoglycemia (low blood sugar level)
  • Cushing syndrome also known as hypercortisolism, a condition caused by prolonged exposure to high levels of cortisol, a hormone produced by the adrenal glands, leading to various symptoms like weight gain, high blood pressure, and muscle weakness.
  • Congestive heart failure
  • Arrhythmia
  • Pulmonary embolism
  • Pneumonia
  • Neurological illnesses
  • Encephalitis
  • Seizure disorder
  • Thyroid problems, such as hyperthyroidism (overactive thyroid)
  • Lung and breathing 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
  • Irritable bowel syndrome
  • Rare tumors that produce certain ‘fight-or-flight’ hormones e.g, pheochromocytoma, a rare tumor that develops in the adrenal glands, specifically in the adrenal medulla, which produces hormones like adrenaline and noradrenaline, leading to potential symptoms like high blood pressure and rapid heartbeat
• 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

Risk factors for anxiety disorder

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.

Anxiety disorders prevention

Currently, there’s no known way to prevent anxiety disorders. 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.

Anxiety disorders signs and symptoms

Symptoms of anxiety disorders vary depending on the type you have.

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)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (gut) problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety

Psychological symptoms may include:

• Feeling panic, fear, dread and uneasiness.
• Feeling on edge or irritable.
• Uncontrollable, obsessive thoughts.
• Difficulty concentrating.

Physical symptoms may include:

• Restlessness.
• Heart palpitations.
• Shortness of breath.
• Muscle tension.
• Cold or sweaty hands.
• Dry mouth.
• Nausea.
• Numbness or tingling in your hands or feet.
• Difficulty falling asleep or staying asleep (insomnia).

It’s important to talk to your doctor or a mental health professional if you frequently experience these symptoms.

Anxiety disorders complications

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
• Suicide

Anxiety disorders diagnosis

If you or your child are experiencing symptoms of an anxiety disorder, see a doctor or mental health professional. Your doctor usually start with a medical evaluation. Your doctor will perform a physical exam and ask about your medical history, any medications you’re taking and if any of your family members have been diagnosed with an anxiety disorder.

There aren’t any blood tests or imaging scans that can diagnose anxiety disorders. But your doctor may run some of these tests to rule out physical conditions that may be causing your symptoms, like hyperthyroidism (overactive thyroid), for example. If there isn’t an underlying physical cause, your doctor may refer you to a mental health professional or psychiatrist (a medical doctor who specializes in diagnosing, treating, and preventing mental, emotional, and behavioral disorders).

A mental health professional, such as a psychologist or psychiatrist, will do an interview or survey, asking questions about your symptoms, sleeping habits and other behaviors.

To help diagnose an anxiety disorder, your psychologist or psychiatrist 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 American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (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.

Typically, a psychologist or psychiatrist bases a diagnosis of anxiety disorder on:

• Your reported symptoms, including how intense they are and how long they last.
• Discussion of how the symptoms interfere with your daily life.
• Their observation of your attitude and behavior.

Anxiety disorders DSM-5 Diagnostic Criteria

Note: An asterisk denotes features stated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and a double-dagger symbol denotes features stated in the International Classification of Diseases, Tenth Edition (ICD-10).

Separation anxiety disorder

• Marked fear or anxiety about separation from attachment figures (such as family members) to a degree that is developmentally inappropriate
• Persistent fear or anxiety about harm coming to attachment figures and events that could lead to loss or separation from them
• Reluctance to leave attachment figures
• Nightmares and physical symptoms of distress, such as stomach aches
• Symptoms usually develop throughout childhood but can also develop throughout adulthood*
• Diagnosis requires a 4-week duration in childhood, and a longer duration, typically of at least 6 months, in adulthood*

Selective (elective) mutism

• Consistent failure to speak in particular social situations (for example, school) in which an expectation to speak exists, despite speaking in other situations
• Not limited to interaction with adults
• Not explained by absence of familiarity with the spoken language
• Persists for at least 1 month (beyond the first month of school)*

Specific phobias

• Marked fear, anxiety or avoidance of circumscribed objects or situations
• Fear is out of proportion to the actual threat posed*
• The individual recognizes that the symptoms are excessive or unreasonable‡
• Typically persists for at least 6 months*
• Subtypes include animal, natural environment (for example, heights or storms), blood–injection–injury (for example, needles), situational (for example, aeroplanes) or other phobias

Social anxiety disorder

• Marked fear, anxiety or avoidance of social interactions and situations in which one is scrutinized, or situations in which one is the focus of attention (such as being observed while speaking, eating or performing)
• Fear of negative judgment from others, in particular, fear of being embarrassed, humiliated, rejected or of offending others
• Fear is out of proportion to the actual threat posed*
• The individual recognizes that the symptoms are excessive or unreasonable‡
• Physical symptoms and symptoms of blushing, fear of vomiting, or urgency or fear of micturition or defaecation‡
• Typically persists for at least 6 months*
• Social anxiety can be limited to performance situations only

Panic disorder

• Recurrent unexpected (for example, occur without an apparent cue) panic attacks
• Concern or worry about having more panic attacks or maladaptive behavioral changes*
• Persists for at least 1 month*

Agoraphobia

• Marked fear, anxiety or avoidance of situations such as public transportation, open spaces, enclosed places, lines or crowds, or outside the home alone
• Fears that escape might be difficult or help is not available in the event of panic-like symptoms or other incapacitating or embarrassing symptoms*
• Fear is out of proportion to the actual threat posed*
• Individual recognizes the symptoms are excessive or unreasonable‡
• Typically persists for at least 6 months*

Generalized anxiety disorder

• Anxiety and worry, more days than not, about various domains, such as work and school performance, that are difficult to control
• Physical symptoms of tension, such as restlessness, being keyed up or on edge, easily fatigued, difficulty concentrating, muscle tensions and sleep disturbance
• Symptoms of autonomic arousal (such as hyperventilation and tachycardia)‡
• Typically persists for at least 6 months*

Anxiety disorders treatment

Your psychologist or psychiatrist will tailor a treatment plan that works for you. The two main treatments for anxiety disorders are psychotherapy (talk therapy) 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.

Psychotherapy

Psychotherapy 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, cognitive behavioral therapy (CBT) focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you’ve avoided because of anxiety. CBT for anxiety teaches you to recognize and identify thought patterns and behaviors that lead to troublesome feelings. You then work on changing the thoughts and your reactions to triggering situations.
• Exposure therapy: This is a type of therapy in which a mental health professional creates a safe environment to expose you to your fears. Fears may be things, situations and/or activities. Exposure therapy helps show you that you’re capable of confronting your fears. You’ll learn to attach new, more realistic beliefs to the things you’re afraid of. You’ll become more comfortable with the experience of fear.

Medications

Several types of medications are used to help relieve your 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.
  • Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the go-to types of antidepressants for anxiety. Tricyclic antidepressants (TCAs e.g., amitriptyline, imipramine, and nortriptyline) are another option, but they cause more side effects.
• An anti-anxiety medication called buspirone may be prescribed. Buspirone is a mild tranquilizer that is slow acting as compared to benzodiazepines and takes about 2 weeks to start working. It has the advantage of being less sedating and also not being addicting with minimal withdrawal effects. It works for generalized anxiety disorder (GAD).
• 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.
  • Benzodiazepines: This class of medications (e.g., alprazolam, clonazepam, diazepam, and lorazepam) may decrease your anxiety, panic and worry. Benzodiazepines work quickly, but you can build up a tolerance to them. They also have addiction potential, so you have to take them cautiously. Your doctor may prescribe a benzodiazepine for the short term, then taper you off. Benzodiazepines that can help treat anxiety disorders include alprazolam, clonazepam, diazepam and lorazepam.
  • Beta-blockers: These medications (e.g., propranolol and atenolol) can help reduce some of the physical symptoms of anxiety disorders, like rapid heartbeat, shaking and trembling. Beta-blockers don’t treat the psychological aspects of anxiety disorders.

Talk with your doctor about benefits, risks and possible side effects of these medications.

Lifestyle and home remedies

While most people with anxiety disorders need psychotherapy or medications to get their anxiety under control, lifestyle changes also can make a difference. Here’s what you can do:

• Exercise daily. 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. Develop a routine so that you’re physically active most days of the week.
• 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. Caffeine can make the physical symptoms of anxiety worse.
• 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.
• Learn about your disorder. Talk to your doctor or mental health professional. 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.
• 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 professional 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.

Alternative medicine

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.

Anxiety disorders prognosis

Left untreated, anxiety disorders can lead to serious complications, including ¹⁸:

• Difficulty with social situations and decreased quality of life.
• Substance use disorders, including alcohol use disorder.
• Major depressive disorder.
• Suicide (in cases of severe anxiety).

Constant anxiety also increases your risk of cardiac events, like a heart attack. This is why it’s crucial to seek help if you have an anxiety disorder. Treatment is effective. The right treatment can help improve your quality of life, relationships and productivity. It can also support your overall well-being.

If untreated, anxiety disorders tend to be chronic with waxing and waning symptoms ¹⁹, although symptom reduction might occur for ~40% of patients ²⁰, ²¹.

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