Anxiety Disorders

Overview

What is an anxiety disorder?

An anxiety disorder is a type of mental health condition. If you have an anxiety disorder, you may respond to certain things and situations with fear and dread. You may also experience physical signs of anxiety, such as a pounding heart and sweating.

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, take a test or make an important decision. And anxiety can even be beneficial. For example, anxiety helps us notice dangerous situations and focuses our attention, so we stay safe.

But an anxiety disorder goes beyond the regular nervousness and slight fear you may feel from time to time. An anxiety disorder happens when:

  • Anxiety interferes with your ability to function.
  • You often overreact when something triggers your emotions.
  • You can’t control your responses to situations.

Anxiety disorders can make it difficult to get through the day. Fortunately, there are several effective treatments for anxiety disorders.

Who is at risk for anxiety disorders?

A mix of genetic and environmental factors can raise a person’s risk for developing anxiety disorders. You may be at higher risk if you have or had:

  • Certain personality traits, such as shyness or behavioral inhibition — feeling uncomfortable with, and avoiding, unfamiliar people, situations or environments.
  • Stressful or traumatic events in early childhood or adulthood.
  • Family history of anxiety or other mental health conditions.
  • Certain physical conditions, including thyroid problems and heart arrhythmias (unusual heart rhythms).

Anxiety disorders occur more often in women. Researchers are still studying why that happens. It may come from women’s hormones, especially those that fluctuate throughout the month. The hormone testosterone may play a role, too — men have more, and it may ease anxiety. It’s also possible that women are less likely to seek treatment, so the anxiety worsens.

What are the types of anxiety disorders?

There are several types of anxiety disorders, including:

  • Generalized anxiety disorder (GAD).
  • Panic disorder.
  • Phobias.
  • Separation anxiety.

Other mental health conditions share features with anxiety disorders. These include post-traumatic stress disorder and obsessive-compulsive disorder.

What is generalized anxiety disorder (GAD)?

With GAD, you may feel extreme and unrealistic worry and tension — even if there’s nothing to trigger these feelings. Most days, you may worry a lot about various topics, including health, work, school and relationships. You may feel that the worry continues from one thing to the next.

Physical symptoms of GAD can include restlessness, difficulty concentrating and sleeping problems.

What is a panic disorder?

If you have a panic disorder, you get intense, sudden panic attacks. These attacks often feature stronger, more intense feelings than other types of anxiety disorders.

The feelings of terror may start suddenly and unexpectedly or they may come from a trigger, like facing a situation you dread. Panic attacks can resemble heart attacks. If there’s any chance you’re experiencing a heart attack, go to the emergency room. It’s better to err on the side of caution and have a healthcare professional check you.

During a panic attack, you may experience:

Panic attacks are very upsetting. People with panic disorder often spend a lot of time worrying about the next panic attack. They also try to avoid situations that might trigger an attack.

What are phobias?

Phobias are an intense fear of certain situations or objects. Some of these fears may make sense, such as a fear of snakes. But often, the level of fear doesn’t match the situation.

Like with other anxiety disorders, you may spend a lot of time trying to avoid situations that may trigger the phobia.

A specific phobia, or a simple phobia, is an intense fear of a particular object or situation. It may cause you to avoid everyday situations. Some specific phobias include fear of:

  • Animals, such as spiders, dogs or snakes.
  • Blood.
  • Flying.
  • Heights.
  • Injections (shots).

Social anxiety disorder

Healthcare providers used to call this condition social phobia. You may have overwhelming worry and self-consciousness with daily social situations. You may worry about others judging you or you may be anxious that you’ll embarrass yourself or open yourself up to ridicule. People with social anxiety disorder may avoid social situations entirely.

Agoraphobia

If you have agoraphobia, you may have an intense fear of being overwhelmed or unable to get help. Usually, you have a fear of two or more of these environments:

  • Enclosed spaces.
  • Lines or crowds.
  • Open spaces.
  • Places outside your house.
  • Public transportation.

In severe situations, a person with agoraphobia may not leave the house at all. They’re so terrified of having a panic attack in public that they prefer to stay inside.

What is separation anxiety disorder?

This condition mostly happens to children or teens, who may worry about being away from their parents. Children with separation anxiety disorder may fear that their parents will be hurt in some way or not come back as promised. It happens a lot in preschoolers. But older children and adults who experience a stressful event may have separation anxiety disorder as well.

How common are anxiety disorders?

Anxiety disorders are the most common mental health conditions in the U.S. They affect about 40 million Americans. They happen to nearly 30% of adults at some point. Anxiety disorders most often begin in childhood, adolescence or early adulthood.

How do anxiety disorders affect children?

It’s normal for children to feel some amount of anxiety, worry or fear at certain points. For example, a child may feel scared of a thunderstorm or barking dog. A teenager might get anxious about an upcoming test or school dance.

But sometimes, children approach these situations with overwhelming dread or they can’t stop thinking about all the fears tied to one of these events. It may seem that none of your comforts help. These children often get “stuck” on their worries. They have a hard time doing their daily activities, like going to school, playing and falling asleep. They’re extremely reluctant to try something new.

When thinking about your child’s anxiety levels, “getting stuck” is key. It separates the regular worries of childhood from an anxiety disorder that needs professional help. If the anxiety or worry interferes with your child’s ability to function, it may be time to seek help

Symptoms and Causes

What causes anxiety disorders?

Anxiety disorders are like other forms of mental illness. They don’t come from personal weakness, character flaws or problems with upbringing. But researchers don’t know exactly what causes anxiety disorders. They suspect a combination of factors plays a role:

  • Chemical imbalance: Severe or long-lasting stress can change the chemical balance that controls your mood. Experiencing a lot of stress over a long period can lead to an anxiety disorder.
  • Environmental factors: Experiencing a trauma might trigger an anxiety disorder, especially in someone who has inherited a higher risk to start.
  • Heredity: Anxiety disorders tend to run in families. You may inherit them from one or both parents, like eye color.

What are the symptoms of an anxiety disorder?

Symptoms vary depending on the type of anxiety disorder you have. General symptoms of an anxiety disorder include:

Physical symptoms:

Mental symptoms:

  • Feeling panic, fear and uneasiness.
  • Nightmares.
  • Repeated thoughts or flashbacks of traumatic experiences.
  • Uncontrollable, obsessive thoughts.

Behavioral symptoms:

  • Inability to be still and calm.
  • Ritualistic behaviors, such as washing hands repeatedly.
  • Trouble sleeping.

How do I know if my child has an anxiety disorder?

Anxiety-related problems in children share four common features. The anxiety:

  • Is typically a fear or fixation that interferes with the ability to enjoy life, get through the day or complete tasks.
  • Is puzzling to both the child and parents.
  • Does not improve after logical explanations to address the worries.
  • Is treatable.

Diagnosis and Tests

How are anxiety disorders diagnosed?

If you have symptoms of an anxiety disorder, talk to your healthcare provider. They’ll start with a complete medical history and physical examination.

There are no lab tests or scans that can diagnose anxiety disorders. But your provider may run some of these tests to rule out physical conditions that may be causing symptoms.

Who can diagnose anxiety disorders?

If your provider finds no signs of physical illness, they may refer you to a psychiatrist or psychologist. These mental health professionals specialize in diagnosing and treating mental illnesses. They may use specially designed interview and assessment tools to figure out if you have an anxiety disorder. Typically, the provider bases a diagnosis on:

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

Providers also consult the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The American Psychiatric Association publishes the DSM-5. It’s the standard reference manual for diagnosing mental illnesses.

Management and Treatment

How are anxiety disorders treated?

An anxiety disorder is like any other health problem that requires treatment. You can’t will it away. It’s not a matter of self-discipline or attitude. Researchers have made a lot of progress in the last few decades in treating mental health conditions. Your healthcare provider will tailor a treatment plan that works for you. Your plan may combine medication and psychotherapy.

How does medication treat anxiety disorders?

Medications can’t cure an anxiety disorder. But they can improve symptoms and help you function better. Medications for anxiety disorders often include:

  • Anti-anxiety medications, such as benzodiazepines, may decrease your anxiety, panic and worry. They work quickly, but you can build up a tolerance to them. That makes them less effective over time. Your healthcare provider may prescribe an anti-anxiety medication for the short-term, then taper you off or the provider may add an antidepressant to the mix.
  • Antidepressants can also help with anxiety disorders. They tweak how your brain uses certain chemicals to improve mood and reduce stress. Antidepressants may take some time to work, so be patient. If you feel like you’re ready to stop taking antidepressants, talk to your provider first.
  • Beta-blockers, usually used for high blood pressure, can help reduce some of the physical symptoms of anxiety disorders. They can relieve rapid heartbeat, shaking and trembling.

Your healthcare provider will work with you to find the right medication combination and dosage. Don’t change the dose without consulting your provider. They’ll monitor you to make sure the medicines are working without causing negative side effects.

How does psychotherapy treat anxiety disorders?

Psychotherapy, or counseling, helps you deal with your emotional response to the illness. A mental health provider talks through strategies to help you better understand and manage the disorder. Approaches include:

  • Cognitive behavioral therapy (CBT) is the most common type of psychotherapy used with anxiety disorders. CBT for anxiety teaches you to recognize thought patterns and behaviors that lead to troublesome feelings. You then work on changing them.
  • Exposure therapy focuses on dealing with the fears behind the anxiety disorder. It helps you engage with activities or situations you may have been avoiding. Your provider may also use relaxation exercises and imagery with exposure therapy.

What happens if I don’t get treatment for my child with an anxiety disorder?

Getting your child help for an anxiety disorder can improve their development and self-esteem. But untreated anxiety disorders can harm:

  • Family relationships.
  • School performance.
  • Social functioning.

Your child may also end up with more serious mental and physical health problems. Fortunately, there are several treatments for anxiety disorders. The right treatment can help your child manage their symptoms and feel their best.

Prevention

Can anxiety disorders be prevented?

You can’t prevent anxiety disorders. But you can take steps to control or reduce your symptoms:

  • Check out medications: Talk to a healthcare provider or pharmacist before taking over-the-counter medications or herbal remedies. Some of these contain chemicals that may make anxiety symptoms worse.
  • Limit caffeine: Stop or limit how much caffeine you consume, including coffee, tea, cola and chocolate.
  • Live a healthy lifestyle: Exercise regularly and eat a healthy, balanced diet.
  • Seek help: Get counseling and support if you experienced a traumatic or disturbing event. Doing so can help prevent anxiety and other unpleasant feelings from disrupting your life.

Outlook / Prognosis

What’s the outlook for people with anxiety disorders?

Anxiety disorders can often go undiagnosed and untreated. Fortunately, treatment can help. The right treatment can help improve your quality of life, relationships and productivity. It can also support your overall well-being.

You don’t need to live with constant worry and fear. If you notice symptoms of an anxiety disorder, talk to your healthcare provider. It’s best to get diagnosed and treated as soon as possible. Doing so can limit the problems that anxiety disorders can cause. Often, a combination of medications and counseling for anxiety can help you feel your best.

Living With

How can I best cope with an anxiety disorder?

There are several steps you can take to cope with anxiety disorder symptoms. These strategies can also make your treatment more effective:

  • Explore stress management: Learn ways to manage stress, such as through meditation.
  • Join support groups: These groups are available in-person and online. They encourage people with anxiety disorders to share their experiences and coping strategies.
  • Get educated: Learn about the specific type of anxiety disorder you have so you feel more in control. Help friends and loved ones understand the disorder as well so they can support you.
  • Limit or avoid caffeine: Many people with anxiety disorder find that caffeine can worsen their symptoms.
  • Talk to your healthcare provider: Your provider is your partner in your care. If you feel like treatment isn’t working or have questions about your medication, contact your provider. Together, you can figure out how to best move forward.

Some people feel the effects of stress in their stomachs. People with IBS have uncomfortable problems with digestion, including stomach pain, constipation and diarrhea. They also frequently have anxiety and depression, which can make symptoms worse.

The connection between IBS and anxiety comes from the nervous system partly controlling the colon. The nervous system’s response to stress may affect the stomach. Among people who get treated for IBS, anywhere from 50% to 90% may also have an anxiety disorder or depression. Treatment for IBS may include stress management and psychotherapy to relieve symptoms.

When should I go to the emergency room for an anxiety disorder?

Symptoms of an anxiety disorder can resemble symptoms of a heart attack or another health emergency. If you’re experiencing an anxiety attack for the first time, or you’re concerned in any way about your health, call 911 or head to the nearest ER. A healthcare provider will check you for serious or life-threatening conditions.

If you’re having an anxiety attack and unsure whether you should head to an ER or not, it’s better to go. Healthcare professionals can make sure you’re OK and give you any necessary treatment.

What else should I ask my healthcare provider?

If you have an anxiety disorder, ask your provider:

  • What’s the best treatment for me?
  • Do I need medication? What type?
  • How long should I take medication?
  • What type of psychotherapy will work best?
  • What else can I do to manage my symptoms?
  • What other conditions am I at risk for?

A note from Cleveland Clinic

An anxiety disorder can make it difficult to get through your day. Anxiety disorder symptoms include feelings of nervousness, panic and fear. You may also have physical symptoms such as sweating and a rapid heartbeat. But you don’t need to live like this. Several effective anxiety disorder treatments are available. Talk to your healthcare provider to figure out your diagnosis and the best treatment plan. Often, treatment combines medications and therapy. Anti-anxiety medications and antidepressants, together with CBT, can help you feel your best.

Last reviewed by a Cleveland Clinic medical professional on 12/17/2020.

References

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy