Learn about anxiety disorders

Each anxiety condition has its own set of features, and anxiety symptoms combine differently in each individual. Some common symptoms of all anxiety disorders include:

• Physical: panic attacks, sweating, nausea, racing heart, tightening of the chest, quick breathing, restlessness, or feeling tense
• Psychological: excessive fear, worry, or obsessive thinking
• Behavioral: avoidance of situations that make you feel anxious

Although the exact causes are unclear, scientists believe that several factors, alone or in combination, may contribute to the development of an anxiety disorder. As is the case with depression, inherited characteristics, brain chemistry, and environmental factors such as stressful life events may all play a role in bringing about an episode of anxiety.

Personal Factors

• Personality– People with low self-esteem, who are perfectionists, shy, or inhibited are more likely to develop anxiety.
• Drug and alcohol use – People with anxiety may turn to drugs and alcohol to manage their symptoms. However, this may lead to a substance use problem. Substance use can actually make anxiety symptoms worse when the effects of the substance wear off.
• Family history – People with a close relative who has anxiety may be at an increased genetic risk to develop anxiety.
• Physical health problems – The worry and stress of dealing with a serious illness such as asthma can lead to anxiety.

Life Circumstances

• Long-term difficulties – Ongoing stress caused by issues such as an abusive relationship or work stress can cause anxiety over time.
• Life events – Stressful times or events such as getting divorced or losing your job, or even positive changes like getting married, may trigger anxiety in people who are already at risk. Major emotional shock following a stressful event may also be a cause of anxiety.
• Trauma or grief – Physical, emotional or sexual abuse or grief after the death of a loved one can trigger anxiety in people who are already at risk.
   

There are 6 most common types of anxiety:

• Generalized Anxiety Disorder (GAD)
• Social Anxiety Disorder
• Specific Phobia
• Obsessive Compulsive Disorder (OCD)
• Panic Disorder
• Post-Traumatic Stress/Acute Stress Disorder

Unlike other anxiety disorders, the anxiety experienced in GAD is not limited to specific situations or circumstances. Rather, the focus of worry and repetitive thinking is on many or most areas of a person’s life (e.g., academic or job performance, finances, social relationships, crime, etc.).

People with GAD find it very difficult or impossible to control their worry.

GAD anxiety lasts for six months or longer and is associated with at least three of these symptoms:

• Feeling restless or on-edge
• Feeling easily tired or fatigued
• Having difficulty concentrating
• Irritability
• Tenseness in muscles
• Difficulty sleeping

People with social anxiety disorder have a strong and persistent fear of being judged by other people or humiliating themselves in social situations such as:

• Speaking or performing a task in front of others
• Eating in front of others
• Meeting new people
• Attending parties or gatherings

People with social anxiety disorder have severe anxiety (or even panic) whenever they find themselves in situations where they fear they will be judged negatively by others.

People with social anxiety disorder typically go to great lengths to avoid these activities or situations (e.g., completely avoiding classes that involve public speaking).

Social anxiety disorder causes problems with school, work, and social relationships.

Specific phobias (often referred to simply as phobias) are disorders in which individuals have an excessive fear of a specific object, animal or situation.

People with specific phobias experience intense fear (sometimes full-blown panic) nearly every time they come in contact or anticipate coming in contact with the feared object or situation.

People with phobias often make great efforts to avoid the feared object or situation (e.g., someone with a dog phobia will avoid walking down streets where they may encounter a dog). This avoidance can greatly interfere with activities.

Phobias typically fall into one of the following categories:

Animal Type. Involves fear of animals (e.g., snakes or insects)

Natural Environment Type. Involves fear of natural environmental objects or situations (e.g., heights, bodies of water, or storms)

Blood-Injection-Injury Type. Involves fear of seeing blood, receiving an injection or other medical procedure

Situational Type. Involves fears of everyday situations (e.g., tunnels, bridges, flying, driving, closed places, etc.)

Other Type. Involves fear of situations not covered in the other categories (e.g., choking or vomiting)

People with OCD typically have recurring, excessive fears (or obsessions) that something terrible might happen.

These obsessions, which the person cannot control, are often troubling or upsetting.

Common obsessions include:

• Feeling dirty or contaminated despite frequent bathing or washing
• Fear that a stove or kitchen appliance was left on even after checking to make sure it was turned off
• Fear of accidentally harming someone (e.g., fear that you will hit someone with your car when you go over a bump in the road)

Often, people with OCD cannot resist the urge to engage in repetitive behaviors (or compulsions) that help reduce the anxiety caused by the obsessions.

Common compulsions include:

• Washing hands excessively, often to the point that the person’s skin cracks and bleeds
• Repeatedly checking locks to make sure they are secure or checking the stove to make sure it is turned off
• Counting to a certain number over and over
• Repeating a specific prayer or statement over and over

People with OCD spend a great amount of time each day (often hours) obsessing over their fears and/or engaging in compulsive behavior to help neutralize these fears

People who suffer from panic disorder have sudden, unexpected anxiety attacks (or panic attacks) that involve at least four of the following symptoms:

• Heart palpitations or rapid heart beat
• Intense sweating
• Trembling or shaking
• Shortness of breath
• Feelings of choking
• Chest pain or discomfort
• Feelings of nausea
• Feeling dizzy or faint
• Feeling detached from your body or feeling that things around you seem unreal
• Feeling that you are losing control or going crazy
• Fear of dying
• Numbness or tingling in limbs
• Chills or hot flashes

A panic attack may feel like a heart attack. They tend to develop abruptly, usually peak within 10 minutes, and end within 20 to 30 minutes. Panic attacks often occur at unpredictable times and with no obvious trigger.

After a panic attack, people with panic disorder have intense worry that they will have another attack. Sometimes this worry is so intense that people suffering from panic disorder will avoid places or situations where it would be difficult to escape or get help if they had another panic attack (e.g., crowded stores or classrooms). This is called agoraphobia.

PTSD and ASD are anxiety conditions that occur after someone experiences or witnesses a traumatic event in which their life or safety (or the life or safety of someone else) is perceived as being threatened. The symptoms of ASD overlap with those for PTSD. However, while an ASD diagnosis can be given in the first month following a trauma, a PTSD diagnosis cannot be given until symptoms have lasted for at least one month. Most people recover from initial symptoms of trauma naturally with time. People who continue to experience symptoms for at least one month and at a level that interferes with daily life may be diagnosed with PTSD.

Events that commonly lead to trauma include, but are not limited to:

• Seeing someone killed or badly injured, or seeing someone close to you in mortal danger
• Being in an accident that could have led to death
• Being a victim of rape or sexual assault

There are 3 main features of PTSD and ASD:

Re-experiencing the traumatic event

• Having repeated distressing memories of the event that you cannot control
• Repeatedly having dreams about the event
• Repeatedly feeling or acting as though you are reliving the event (sometimes taking the form or flashbacks or hallucinations)
• Feeling great emotional distress or physical agitation when something reminds you of the traumatic event

Avoiding things or situations that remind you of the trauma, along with feelings of emotional numbness

• Trying to avoid thoughts, feelings, conversations, activities, people, or places that remind you of the trauma
• Difficulty remembering important parts or events that took place during the trauma
• Feeling less interest in activities you normally enjoy
• Feeling detached from others
• Feeling like you can’t experience a full range of emotions
• Feeling like the future is uncertain or that you don’t have a future

Feeling physically anxious, jumpy, or on-edge

• Difficulty sleeping
• Acting in an irritable manner or having angry outbursts
• Difficulty concentrating
• Frequently feeling on-guard or alert
• Feeling easily startled

Szuhany KL, Simon NM. (2022). Anxiety Disorders: A Review. JAMA. 328(24):2431–2445.

McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. Journal of psychiatric research, 45(8), 1027-1035.

National Institute of Mental Health. (2024). Anxiety Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml