INTRODUCTION

Anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behavior. Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger. Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships. In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:

TYPES OF ANXIETY DISORDERS

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.

Generalized anxiety disorder symptoms include:

·         Feeling restless, wound-up, or on-edge

·         Being easily fatigued

·         Having difficulty concentrating; mind going blank

·         Being irritable

·         Having muscle tension

·         Difficulty controlling feelings of worry

·         Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Panic Disorder

People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.

During a panic attack, people may experience:

·         Heart palpitations, a pounding heartbeat, or an accelerated heartrate

·         Sweating

·         Trembling or shaking

·         Sensations of shortness of breath, smothering, or choking

·         Feelings of impending doom

·         Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause significant problems in various areas of the person’s life, including the development of agoraphobia (see below).

Phobia-related disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia:

·         May have an irrational or excessive worry about encountering the feared object or situation

·         Take active steps to avoid the feared object or situation

·         Experience immediate intense anxiety upon encountering the feared object or situation

·         Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

·         Flying

·         Heights

·         Specific animals, such as spiders, dogs, or snakes

·         Receiving injections

·         Blood

Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.

Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

·         Using public transportation

·         Being in open spaces

·         Being in enclosed spaces

·         Standing in line or being in a crowd

·         Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.

Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders.

CAUSES

The most common factors that cause anxiety disorders are:

·       Family history: People who have a history of mental health issues in the family may usually have problems with anxiety. For instance, OCD can be passed down in a family.

·       Stressful events: Stress at the workplace, loss of a loved one, or troubled relationships, can also trigger symptoms of anxiety.

·       Health issues: Ailments such as thyroid problems, asthma, diabetes or a heart disease can also cause anxiety. People suffering from depression can also develop symptoms of anxiety disorders. For instance, someone who has been suffering from depression for a long period, may start to underperform at work. This can then lead to work-related stress which could trigger anxiety.

·       Substance use: People who are heavy users of drugs, alcohol and other substances, develop anxiety problems when the effects of the substance begin to wear off (in withdrawal).

·       Personality factors:Sometimes, people with certain personality traits such as perfectionists or people who like to be in control, develop anxiety-related issues.

RISK FACTORS

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although the risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include:

·       Temperamental traits of shyness or behavioral inhibition in childhood

·       Exposure to stressful and negative life or environmental events in early childhood or adulthood

·       A history of anxiety or other mental illnesses in biological relatives

·       Some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder.

DIAGNOSIS

Physical symptoms of an anxiety disorder can be easily confused with other medical conditions, like heart disease or hyperthyroidism. Therefore, a doctor will likely perform an evaluation involving a physical examination, an interview and lab tests. After ruling out an underlying physical illness, a doctor may refer a person to a mental health professional for evaluation.

Using the Diagnostic and Statistical Manual of Mental Disorders (DSM) a mental health professional is able to identify the specific type of anxiety disorder causing symptoms as well as any other possible disorders that may be involved. Tackling all disorders through comprehensive treatment is the best recovery strategy.

TREATMENT

Different anxiety disorders have their own distinct sets of symptoms. This means that each type of anxiety disorder also has its own treatment plan. But there are common types of treatment that are used. 

Psychotherapy

Cognitive Behavioral Therapy (CBT) is the most researched psychotherapy for anxiety disorders. In general, CBT focuses on finding the counterproductive thinking patterns that contribute to anxiety. CBT offers many constructive strategies to reduce the beliefs and behaviors that lead to anxiety.

CBT is also effective when delivered outside of the traditional in-person setting. Working with a therapist using telehealth technology — like video or phone calls or online learning modules that teach CBT concepts — can be just as effective as traditional face-to-face therapy.

CBT has the largest research base to support its effectiveness, though it can be difficult to figure out which therapists are trained in CBT. There is no single national certification program for this skill. Ask your therapist how they approach treating anxiety and their trainings in these approaches.

Exposure Response Prevention is a psychotherapy for specific anxiety disorders like phobias and social anxiety. Its aim is to help a person develop a more constructive response to a fear. The goal is for a person to “expose” themselves to that which they fear, in an attempt to experience less anxiety over time and develop effective coping tools.

Medication

Some people find that medication is helpful in managing an anxiety disorder. Talk with your health care provider about the potential benefits, risks and side effects.

Complementary Health Approaches

More and more people have started using complementary and alternative treatments along with conventional treatment to help with their recovery. Some of the most common approaches for treating anxiety include: