Anxiety Disorders

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. Some anxiety can even be beneficial — it 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.
• Your reactions are often out of proportion to situations (overreactions).
• You can’t control your responses to situations.

Children, adolescents and adults can experience anxiety disorders. Women and people assigned female at birth are about twice as likely as men and people assigned male at birth to have one.

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

Types of anxiety disorders

There are several types of anxiety disorders according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is the standard reference manual for diagnosing mental health conditions. Types of anxiety disorders include:

• Generalized anxiety disorder (GAD): This condition causes fear, worry and a constant feeling of being overwhelmed. It’s characterized by excessive, frequent and unrealistic worry about everyday things, such as job responsibilities, health or chores.
• Agoraphobia: This condition 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.
• Panic disorder: This condition involves multiple unexpected panic attacks. A main feature of the condition is that the attacks usually happen without warning and aren’t due to another mental health or physical condition. Some people with panic disorder also have agoraphobia.
• Specific phobias: A phobia is when something causes you to feel fear or anxiety that’s so severe it consistently and overwhelmingly disrupts your life. 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.
• Social anxiety disorder: This condition (formerly known as social phobia) happens when you experience intense and ongoing fear of being judged negatively and/or watched by others.
• Separation anxiety disorder: This condition happens when you feel excessive anxiety when you’re separated from a loved one, 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: This condition happens when you don’t talk in certain situations because of fear or anxiety. It usually affects young children, but it can also affect adolescents and adults.

Other mental health conditions share features with anxiety disorders. These include post-traumatic stress disorder (PTSD), acute stress disorder and obsessive-compulsive disorder (OCD). But the American Psychiatric Association classifies them as distinct conditions and not anxiety disorders.

How common are anxiety disorders?

Anxiety disorders are some of the most common mental health conditions:

• Specific phobias affect up to 12% of the U.S. population.
• Social anxiety disorder affects about 7% of the U.S. population.
• Generalized anxiety disorder affects about 3% of the U.S. population.
• 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 the symptoms of anxiety disorders?

Symptoms of anxiety disorders vary depending on the type.

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 healthcare provider or a mental health professional if you frequently experience these symptoms.

What causes anxiety disorders?

Like other types of mental health conditions, researchers don’t know exactly what causes anxiety disorders. But they think a combination of factors plays a role:

• 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.

How are anxiety disorders diagnosed?

If you or your child are experiencing symptoms of an anxiety disorder, see a healthcare provider. They’ll start with a medical evaluation. They’ll do 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 provider may run some of these tests to rule out physical conditions that may be causing your symptoms, like hyperthyroidism, for example. If there isn’t an underlying physical cause, your provider may refer you to a mental health professional.

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. They use criteria in the American Psychiatric Association’s DSM-5 to make diagnoses of anxiety disorders.

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.

How are anxiety disorders treated?

An anxiety disorder is like any other health condition 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 include a combination of medication and psychotherapy (talk therapy).

Medication for anxiety disorders

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

• Antidepressants: While they mainly treat depression, these medications can also help with anxiety disorders. They adjust how your brain uses certain chemicals to improve mood and reduce stress. Antidepressants may take some time to work, so try to be patient. SSRIs and SNRIs are the go-to types of antidepressants for anxiety. Tricyclic antidepressants are another option, but they cause more side effects.
• Benzodiazepines: This class of medications may decrease your anxiety, panic and worry. They work quickly, but you can build up a tolerance to them. They also have addiction potential, so you have to take them cautiously. Your healthcare provider 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 can help reduce some of the physical symptoms of anxiety disorders, like rapid heartbeat, shaking and trembling. They don’t treat the psychological aspects of anxiety disorders.

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

Psychotherapy for anxiety disorders

“Psychotherapy,” also called talk therapy, is a term for a variety of treatment techniques that aim to help you identify and change unhealthy emotions, thoughts and behaviors. A mental health provider talks through strategies to help you better understand and manage an anxiety disorder. Approaches include:

• Cognitive behavioral therapy (CBT): This is the most common type of psychotherapy to help manage anxiety disorders. 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 provider 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.

Can I prevent developing an anxiety disorder?

Currently, there’s no known way to prevent anxiety disorders. But you can lessen many of the related issues with treatment. Seeking help as soon as symptoms appear can help decrease the disruption to your life.

What is the prognosis for people with anxiety disorders?

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

• 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.

How can I take care of myself if I have an anxiety disorder?

Aside from seeking professional medical help and treatment, certain strategies can help you manage an anxiety disorder and make treatment more effective. They include:

• Stress management: Chronic or intense stress worsens anxiety disorders. Explore stress management techniques, like meditation, breathing exercises, mindfulness and regular exercise. 
• Support groups: Participating in a support group for people with anxiety — in-person or online — can provide opportunities to relate to others, share experiences and learn different coping strategies.
• Education: Learning more about your condition and educating loved ones can help you and them better understand the condition and offer support.
• Limiting or avoiding caffeine: Caffeine can make the physical symptoms of anxiety worse. Talk to your healthcare provider if you’re concerned about your level of caffeine consumption.

When should I see my healthcare provider?

Your healthcare provider is your partner in your care. If you feel like treatment for an anxiety disorder isn’t working or have questions about your medication, contact your provider. Together, you can figure out how to best move forward.