Overview

Anxiety is normal part of emotional life, which helps us prepare and plan. Usually, this kind of anxiety is triggered by an external event like before taking tests, presentations, major life events etc. and it is short lived. However, sometimes anxiety is for no reason or intensity of anxiety is extraordinary compared to the trigger. This type of anxiety interferes with your ability to perform day to day functions.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety, agoraphobia, and various other disorders.

Generalized Anxiety Disorder

 

People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, for various reasons or no reason. The fear and anxiety can cause significant problems in their routine day to day functioning.

Generalized anxiety disorder symptoms include:

  • Feeling restless, wound-up, or on-edge
  • Being easily fatigued
  • Having difficulty concentrating; mind going blank
  • Being irritable/sensitive
  • Having muscle tension
  • Difficulty controlling feelings of worry
  • Having sleep problems, such as difficulty falling or staying asleep, restlessness

Panic Disorder

Panic attacks are sudden onset, spontaneous or triggered, periods of intense fear, accompanied by physical symptoms like difficulty breathing, chest pain, dizziness etc., reach their peak within minutes and last for several minutes. People with panic disorder have recurrent unexpected panic attacks, often worry about having more panic attacks, make extreme efforts to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks.

During a panic attack, you 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

Phobia-related Disorders

phobia is an intense fear or aversion to specific objects or situations. The fear 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

Some examples of phobias include the fear of:

  • Flying
  • Heights
  • Specific animals, such as spiders, dogs, or snakes
  • Receiving injections
  • Blood

Social Anxiety Disorder (social phobia)

People with social anxiety disorder have a general intense fear of social or performance situations. They worry that their actions or behaviors will be negatively evaluated by others, leading to feelings of embarrassment. They often avoid social situations, avoid engaging in group activities, often end up in solitary lifestyle and this fear interferes with their social life.

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- elevators
  • 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.

Separation Anxiety Disorder

Separation anxiety can be seen in children or adults though children are more likely to be diagnosed. People who have separation anxiety disorder are afraid of separating from their attachment figure, 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 sleep problems or physical symptoms of anxiety/panic attacks.

Selective Mutism

A somewhat rare disorder 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.

Co-existing/Co-morbid Disorders

Other mental health disorders, trauma, stress, medical conditions

Risk Factors

  • Genetic factors – family history of anxiety or other mental illnesses in biological family
  • Environmental factors – Exposure to stressful and negative life
  • Physical health conditions, such as thyroid problems or heart arrhythmias,
  • Use of excessive caffeine or other substances/medications

Treatments and Therapies

Anxiety disorders are generally treated with psychotherapy, medication, or both.

Psychotherapy

Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.

Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder.

Medication

Medication does not cure anxiety disorders but can help relieve symptoms. The most common classes of medications used to combat anxiety disorders are anti-anxiety drugs (such as benzodiazepines), antidepressants, and beta-blockers.

Benzodiazepines are highly effective in relieving anxiety however you can develop a tolerance to them if these medicines are taken regularly for long period of time. Risk of developing tolerance is more in people who have substance use problems (current or past) or who are combining benzodiazepines with other addictive medicines like opioids. These medicines are associated with intense withdrawal symptoms also so they have to be tapered off gradually. This is the reason these medicines are used as needed only.

A different type of anti-anxiety medication is buspirone. Buspirone is a non-benzodiazepine medication specifically indicated for the treatment of chronic anxiety.

Antidepressants are used to treat depression, and anxiety disorders. Antidepressants can take time to work, so it’s important to give the medication a chance to work, usually take 4 to 6 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. Once you start feeling better, usually after a course of 6 to 12 months, you may be able to gradually taper off the antidepressants. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding please let us know prior to starting the medicines.

Beta blockers are medicines that can help block some of the physical symptoms of anxiety and panic attack, such as an increased heart rate, sweating, or tremors. Beta-blockers are commonly the medications of choice for the “performance anxiety” type of social anxiety.

Holistic approach

  • Getting regular exercise such as brisk walk, swimming, jogging etc. helps with anxiety and depression and promote sleep in addition to the physical benefits of work out
  • Yoga and anaerobic exercise have also shown beneficial effects on mental health
  • Keep a mood log
  • Be mindful of your triggers and warning signs
  • Eat healthy and nutritious diet
  • Maintain regular follow ups with your care providers
  • Take all medicines as prescribed, consult your doctor before making any medicine changes
  • Avoid misuse of alcohol or other drugs
  • Adopt good sleep habits
  • Mindful breathing