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Anxiety

Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention.  Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect more than 25 million Americans. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.  Diagnostic and Statistical Manual of Mental Disorders, (DSM-5) 2013

The Center for Disease Control (CDC) characterizes anxiety as:

Anxiety is an unpleasant emotional state ranging from mild uneasiness to intense fear. A certain amount of anxiety is normal and serves to improve performance. Clinical anxiety differs from everyday anxiety in its intensity and the degree to which it interferes with people’s lives. Anxiety is often associated with depression. Onset of anxiety disorders is usually in early to late adolescence.

Anxiety disorders are characterized by excessive and unrealistic worry about everyday tasks or events, or may be specific to certain objects or rituals. Simple phobias involve excessive anxiety evoked by specific objects (e.g., marked fear of snakes). As its name implies, social phobias are fears of interacting with others, particularly in large groups. In obsessive-compulsive disorder (OCD), the individual experiences an obsession – an intrusive and recurrent thought, idea, sensation or feeling – coupled with a compulsion – a behavior that is recurrent and ritualized, such as checking, avoiding, or counting.1  In addition to being helped by pharmacotherapies, anxiety disorders are often addressed by exposure (to the object or event obsessed over) and response prevention –not permitting the compulsive behavior, to help the individual learn that it is not needed.1

  • Anxiety disorders, which include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population.5
  • The estimated lifetime prevalence of any anxiety disorder is over 15%, while the 12-month prevalence is more than 10%.5
  • Prevalence estimates of anxiety disorders are generally higher in developed countries than in developing countries.5
  • Most anxiety disorders are more prevalent in women than in men.6
  • One study estimated the annual cost of anxiety disorders in the United States to be approximately $42.3 billion in the 1990s, a majority of which was due to non-psychiatric medical treatment costs. This estimate focused on short-term effects and did not include the effect of outcomes such as the increased risk of other disorders.7

Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect more than 25 million Americans. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.

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.

Anxiety disorders can cause people into try to avoid situations that trigger or worsen their symptoms. Job performance, school work and personal relationships can be affected.

In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:

  • Be out of proportion to the situation or age inappropriate
  • Last six months or longer
  • Hinder your ability to function normally

Generalized Anxiety Disorder

Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments.

Panic Disorder

The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination:

  • Palpitations, pounding heart or rapid heart rate
  • Sweating
  • Trembling or shaking
  • Feeling of shortness of breath or smothering sensations
  • Chest pain
  • Feeling dizzy, light-headed or faint
  • Feeling of choking
  • Numbness or tingling
  • Chills or hot flashes
  • Nausea or abdominal pains
  • Feeling detached
  • Fear of losing control
  • Fear of dying

Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness. Panic attacks may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason. The median age for onset of panic disorder is 24. Panic attacks may occur with other mental disorders such as depression or PTSD.

Phobias, Specific Phobia

A specific phobia is excessive and persistent fear of a specific object, situation or activity that is generally not harmful. Patients know their fear is excessive, but they can’t overcome it. These fears cause such distress that some people go to extreme lengths to avoid what they fear. Examples are fear of flying or fear of spiders.

Agoraphobia

Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms. The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed places
  • Standing in line or being in a crowd
  • Being outside the home alone

The individual actively avoids the situation, requires a companion or endures with intense fear or anxiety. Untreated agoraphobia can become so serious that a person may be unable to leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely upsetting, or if it significantly interferes with normal daily activities.

Social Anxiety Disorder (previously called social phobia)

A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.

Separation Anxiety Disorder

A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.

In any given year the estimated percent of U.S. adults with various anxiety disorders are:

  • 7 to 9 percent: specific phobia
  • 7 percent: social anxiety disorder
  • 2 to 3 percent: panic disorder
  • 2 percent: agoraphobia
  • 2 percent: generalized anxiety disorder
  • 1 to 2 percent: separation anxiety disorder

Women are more likely than men to experience anxiety disorders.

The causes of anxiety disorders are currently unknown but likely involve a combination of factors including genetic, environmental, psychological and developmental. Anxiety disorders can run in families, suggesting that a combination of genes and environmental stresses can produce the disorders.

Self-Help, Coping, and Managing

There are a number of things people do to help cope with symptoms of anxiety disorders and make treatment more effective. Stress management techniques and meditation can be helpful. Support groups (in-person or online) can provide an opportunity to share experiences and coping strategies. Learning more about the specifics of a disorder and helping family and friends to understand better can also be helpful. Avoid caffeine, which can worsen symptoms, and check with your doctor about any medications.

Related Conditions

  • PTSD – posttraumatic stress disorder
  • Obsessive-compulsive disorder
  • Acute stress disorder
  • Adjustment disorder

References

  1. Sadock BJ, Sadock VA. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (10th ed.). Philadelphia, PA, Lippincott, Williams & Wilkins; 2007.

More detail on mental health/mental illnesses may be found at: http://www.nimh.nih.gov/health/index.shtml or www.samhsa.gov/

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