What is an Anxiety Disorder?
Information provided by Mental Health America
Everyone experiences anxiety at some time—anxiety can be quite useful in helping a person to avoid dangerous situations and motivate the solving of everyday problems. Anxiety can vary in severity from mild uneasiness to a terrifying panic attack. Anxiety also can vary in how long it lasts, from a few minutes to many years. An anxiety disorder differs from normal anxiety in the following ways:
It is more intense
It is long lasting
It interferes with the person’s work, activities, or relationships
Approximately 18 percent of US adults have an anxiety disorder in a given year. Anxiety disorders tend to begin in childhood, adolescence, or early adulthood. The median age of onset is 11 years, which means half the people have their first episode by this age. Anxiety disorders often occur with mood disorders and substance use disorder. Anxiety disorders are more common in females than in males.
Anxiety can show in a variety of ways: physical, psychological, and behavioral. General symptoms of anxiety can be found in anxiety disorders.
Symptoms of Anxiety
Cardiovascular: pounding heart, chest pain, rapid heartbeat, flushing
Respiratory: hyperventilation, shortness of breath
Neurological: dizziness, headache, sweating, tingling, numbness
Gastrointestinal: choking, dry mouth, stomach pains, nausea, vomiting, diarrhea
Musculoskeletal: muscle aches and pains (especially neck, shoulders, and back), restlessness, tremors and shaking, inability to relax
Unrealistic and/or excessive fear and worry (about past and future events), mind racing or going blank, decreased concentration and memory, indecisiveness, irritability, impatience, anger, confusion, restlessness or feeling “on edge” or nervous, tiredness, sleep disturbance, vivid dreams.
Avoidance of situations, obsessive or compulsive behavior, distress in social situations, phobic behavior.
Types of Anxiety Disorders
There are many different types of anxiety disorders that impact adults and children. Specific types of anxiety disorders include: specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and anxiety disorders due to a medical condition. The most common anxiety disorders are phobic disorders, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder.
Generalized Anxiety Disorder
The main symptoms of generalized anxiety disorder (GAD) are overwhelming, unfounded anxiety and worry (about things that may go wrong or one’s inability to cope) accompanied by multiple physical and psychological symptoms of anxiety or tension occurring more days than not for at least six months. People with generalized anxiety disorder worry excessively about money, health, family, and work, even when there are no signs of trouble. The anxiety appears difficult to control. Other characteristics include an intolerance of uncertainty, belief that worry is a helpful way to deal with problems, and poor problem-solving skills. GAD can make it difficult for people to concentrate at school or work, function at home, and generally get on with their lives.
Generalized Anxiety Disorder affects 3.1% of American adults in any given year with the median age of onset being 31 years.
It is important to distinguish between a panic attack and a panic disorder. A panic attack is a sudden onset of intense apprehension, fear, or terror. These attacks begin suddenly and develop rapidly. This intense fear is inappropriate for the circumstances in which it is occurring. Other symptoms, many of which can appear similar to those of a heart attack, can include racing heart, sweating, shortness of breath, chest pain, dizziness, feeling detached from oneself, and fears of losing control. Once a person has had one of these attacks, they often fear another attack and may avoid places where attacks have occurred. The person may avoid exercise or other activities that produce physical sensations similar to those of a panic attack.
Having a panic attack does not necessarily mean that a person will develop a panic disorder. A person with a panic disorder experiences recurring panic attacks and, for at least one month, is persistently worried about possible future panic attacks and possible consequences of panic attacks, such as losing control or having a heart attack. Some people may develop panic disorder after only a few panic attacks, while others may experience many panic attacks without developing a panic disorder. Some people with panic disorder go on to develop agoraphobia, where they avoid places in fear of having a panic attack.
Panic Disorder affects 2.7% of US adults in any given year and the median age of onset of the disorder is 24 years old.
A person with a phobic disorder avoids or restricts activities because of persistent and excessive fear. They may have an unreasonably strong fear of specific places, events, or objects and often avoid these completely.
Agoraphobia involves avoidance of situations where the person fears having a panic attack. The focus of his/her anxiety is that it will be difficult or embarrassing to get away from the place if a panic attack occurs or that there will be no one present who can help. This leads to avoiding certain situations out of fear. Some may avoid only a few situations or places, such as crowds, shopping malls or other enclosed spaces, or driving. Others may avoid leaving home altogether. Agoraphobia (without panic) affects 0.9% of the US adult population in any given year and has a median age of onset of 20 years old.
Social Anxiety Disorder is the fear of any situation where public scrutiny may occur, usually with the fear of behaving in a way that is embarrassing or humiliating. It often develops in shy children as they move into adolescence. Commonly fears situations include speaking or eating in public, dating, and social events. Social Anxiety Disorder, formerly known as Social Phobia, affects 6.8% of the US adult population any given year and has a median age of onset of 13 years.
Specific phobias are phobias of specific objects or situations. The most common are spiders, bugs, mice, snakes, and heights. Other feared objects or situations include an animal, blood, injections, storms, driving, flying, or enclosed places. Because they involve specific situations or objects, these phobias are usually less disabling than agoraphobia and social phobia. Specific Phobia affects 8.7% of American adults each year and has a median age of onset of 7 years.
Acute Stress Disorder and Post-Traumatic Stress Disorder
Acute stress disorder and post-traumatic stress disorder occur after a distressing or catastrophic event. Common examples include involvement in a war, accidents (such as traffic or physical accidents), assault (including physical or sexual assault, mugging or robbery, or family violence), or witnessing a significant event. Mass traumatic events include terrorist attacks, mass shootings, and severe weather events (such as hurricane, tsunami, or forest fire).
In acute stress disorder, the person gets over the event within a month, whereas in post-traumatic stress disorder, the distress last longer. Some who experience acute stress disorder go on to develop post-traumatic stress disorder. A person is more likely to develop post-traumatic stress if the response to an event involves intense fear, helplessness, or horror.
A major symptom is re-experiencing the trauma. This can include recurrent dreams, flashbacks, intrusive memories, or unrest in situations that bring back memories of the original trauma.
There is also avoidance behavior, such as persistent avoidance of stimuli associated with the event, as well as emotional numbing, which may continue for months or years, and reduced interest in others and the outside world. Persistent symptoms of increased arousal also can occur, such as constant watchfulness, irritability, jumpiness, being easily startled, outbursts of rage, or insomnia.
For information on how to help someone who has experienced a traumatic event, see First Aid for Adults Affected by Traumatic Events and First Aid for Children Affected by Traumatic Events.
Post-Traumatic Stress Disorder affects 3.5% of the US adult population within any one given year and has a median age onset of 23 years.
Obsessive-compulsive disorder is the least common anxiety disorder but can be very disabling. Obsessive thoughts and compulsive behaviors accompany feelings of anxiety. Obsessive thoughts are recurrent imposes and images that are experienced as intrusive, unwanted, and inappropriate and cause marked anxiety. Obsessive thoughts and impulses include fear of contamination, the need of symmetry and exactness, safety issues, sexual impulses, aggressive impulses, and religious preoccupation.
Compulsive behaviors are repetitive behaviors or mental acts that the person feels driven to perform to reduce anxiety. Common compulsions include washing, checking, repeating, ordering, counting, hoarding, or touching things over and over.
Obsessive-Compulsive Disorder affects 1.0% of American adults in any given year and has a median age of onset of 19 years.
Mixed Anxiety, Depression, and Substance Abuse
Many people have anxiety problems that do not fit neatly into a particular type of disorder. It is common for people to have some features of several anxiety disorders. A person who experiences a high level of anxiety over a long period will often develop depression, so many have a mixture of anxiety and depression.
Substance abuse frequently occurs with anxiety disorders as a form of self-medication. Alcohol and other drug abuse can also lead to increased anxiety.
What Causes Anxiety Disorders?
Anxiety is mostly caused by perceived threats in the environment, but some people are more likely than others to react with anxiety when threatened. Those most at risk:
Have a more sensitive emotional nature and tend to see the world as threatening
Have a history of anxiety in childhood or adolescence, including marked shyness
Have had a traumatic experience
Some family facts that increase risk are:
Difficult childhood (for example, experiencing physical, emotional or sexual abuse, neglect, or over strictness)
Family background that involves poverty or lack of job skills
Family history of anxiety disorders
Parental alcohol problems
Separation and divorce
Anxiety symptoms also can result from:
Some medical conditions, including endocrine conditions such as hyperthyroidism, cardiac conditions such as arrhythmias, respiratory conditions such as chronic obstructive pulmonary disease, and metabolic conditions such as vitamin B12 deficiency
Side effects of certain prescription drugs
Intoxication with alcohol, amphetamines, caffeine, marijuana, cocaine, hallucinogens, and inhalants
Withdrawal from alcohol, cocaine, sedatives, and anti-anxiety medications
Some develop ways of reducing anxiety that actually cause further problems. For example, people with phobias avoid anxiety-provoking situations. This avoidance reduces their anxiety in the short term, but can limit their lives in significant ways. Similarly, people with compulsions reduce their anxiety by repetitive acts such as frequent hand washing. These compulsions become problems in themselves. Some people will use drugs or alcohol to cope, which can increase anxiety in the long term.
Importance of Early Intervention for Anxiety Disorders
It is important that anxiety disorders are recognized and treated early. Anxiety disorders often develop in childhood and adolescence, and if not treated, the person is more likely to have a range of adverse outcomes later in life, such as depression, alcohol dependence, illicit drug dependence, suicide attempts, lowered educational achievement, and early parenthood. Because of these long-term consequences, it is important that anxiety disorders are recognized early and people get appropriate professional help.
Facts on Traumatic Events
A traumatic event is any incident perceived to be traumatic. Common examples include accidents (such as traffic or physical accidents), assault (including physical or sexual assault, mugging or robbery, or family violence), or witnessing something terrible. Mass traumatic events include terrorist attacks, mass shootings, and severe weather events (such as hurricane, tsunami, forest fire).
Trauma isn’t always a single event; it can occur over time. Common examples of recurring trauma include sexual, physical, or emotional abuse; torture; and bulling in the schoolyard or workplace. Sometimes the memories of a traumatic event suddenly or unexpectedly return weeks, months, or even years afterwards.
It is important to know that people differ in how they react to traumatic events:
One person may perceive an event as deeply, with another may not.
Particular types of trauma affect some individuals more than others.
A history of trauma may make some people more susceptible to later traumatic events, while others become more resilient.
Action A: Assess for risk of suicide or harm
The technique that is helpful for assessing risk in someone with anxiety is similar to that used with someone experiencing depression.
Approach the person about the concerns regarding their anxiety.
Find a suitable time and space where you both feel comfortable.
If the person does not initiate a conversation with you about how they are feeling, you can begin a dialogue.
Respect the person’s privacy and confidentiality.
Crises that may be associated with anxiety include:
An extreme level of anxiety (this may be a panic attack or a reaction to a recent traumatic event in a person’s life)
Suicidal thoughts and behaviors
Engaging in nonsuicdal self-injury
If you determine the person is not in crisis, you can ask how they are feeling, how long they have been feeling that way, and move on to Action L.
Suicidal thoughts may not be as evident as extreme anxiety, but there is a risk of suicide in anxiety disorders. Therefore, in any interaction with a person, be alert to any warning signs of suicide.
The risk of suicide in people with anxiety disorders is not as high as for some other mental disorders. However, the risk increases if the person has a concurrent mood or substance use disorder.
Let the person know that you are concerned and are willing to help.
If it appears the person is having a panic attack, see First Aid for Panic Attacks.
If the person is distressed after experiencing a traumatic event, see First Aid for Traumatic Events.
If there is concern about suicidal thoughts, see First Aid for Suicidal Thoughts and Behaviors.
If you have serious concerns, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
If the person is engaging in nonsuicidal self-injury, see First Aid for Nonsuicidal Self-Injury.
Symptoms of a Panic Attack
A panic attack is a distinct episode of high anxiety with fear or discomfort. It develops abruptly and has its peak within 10 minutes. During the attack, several of the following symptoms are present:
Palpitations, pounding heart, rapid heart rate
Trembling and shaking
Shortness of breath, sensations or choking or smothering
Chest pain or discomfort
Abdominal distress or nausea
Dizziness, light-headedness, feeling faint or unsteady
Feelings of unreality or being detached from oneself
Fear of losing control or “going crazy”
Fear of dying
Numbness or tingling
Chills or hot flashes
Action L: Listen nonjudgementally
Engage the person in discussing their feelings
Listen to the person without judging
Pay close attention to what the person says
Reflect or restate what the person has said
Ask clarifying questions to show that you want to understand
Maintain comfortable eye contact
Use minimal prompts, such as “I see” and “ah”
Be patient and do not interrupt
Maintain an open body position
Do not be critical of the person
Do not express frustration at the person for having such symptoms
Do not give flippant or unhelpful advice such as “pull yourself together”
Avoid confrontation unless necessary to prevent harmful acts
Action G: Give reassurance and information
Treat the person with respect and dignity
Do not blame the person for the illness
Have realistic expectations for the person
Offer consistent emotional support and understanding
Give the person hope for recovery
Provide practical help
What isn’t supportive?
It is important to know that recovery from anxiety disorders requires facing situations that can provoke anxiety. Avoiding such situations can slow recovery and make anxiety worse. Sometimes, family and friends think they are being supportive by facilitating the person’s avoidance of anxiety-provoking situations, but this can inadvertently slow recovery.
Other actions that are not supportive include dismissing fears as trivial, for example, by saying, That is nothing to be afraid of, telling them to toughen up or don’t be so weak, or using a patronizing tone of voice.
Action E: Encourage appropriate professional help
Many people with anxiety disorders do not realized there are treatments that can help. In the United States, only 42 percent of the people who had an anxiety disorder in the past year received treatment for their problem. Even when people finally seek help, a delay of 10 years or more is not unusual. These delays can cause serious consequences in the person’s life, limiting social and occupational opportunities and increasing the risk for depression and drug and alcohol problems.
Discuss Options for Seeking Professional Help
Offer the person help to manage their feelings. If help is needed, then respond as follows:
Discuss appropriate professional help and effective treatment options.
Encourage the person to use these options.
Offer to help them seek out these options.
Encourage the person not to give up seeking appropriate professional help.
Professionals Who Can Help
A variety of health professionals can provide help to a person with anxiety disorders:
Primary care physicians
Mental health professionals
Certified peer specialists
If the person is uncertain about what to do, encourage consultation with a primary care physician first, as the physician can check for an underlying physical health cause for this anxiety and refer the person to the appropriate specialized help.
Treatments Available for Anxiety Disorders
Research shows that both medication and cognitive behavioral therapy (CBT) are effective treatments.
Different types of antidepressants have been found to be effective in treating specific anxiety disorders. Anti-anxiety medications (benzodiaxepines) also are effective but should be restricted to short-term use because of concerns about possible side effects of dependency, sedation, rebound anxiety, and memory impairment.
Cognitive Behavioral Therapy
Various psychological therapies are used for anxiety disorders, but CBT has, by far, the strongest evidence for effectiveness. CBT may include:
Education about self-managing the anxiety
Problem solving where the person and the clinician work together to identify problems and generate and implement solutions
Exposure-response therapy to feared situations or symptoms aiming to overcome the avoidance behavior
Cognitive restricting focusing on identifying automatic negative thoughts and considering alternative was of thinking
Emotion regulation through relaxation and learning detachment from strong anxiety
Social skills strategies to use in anxiety-provoking situations
Relapse prevention plan for coping with anxiety if it returns
A person can undertake a program of CBT in a number of different ways. CBT can be delivered by a therapist working one-to-one or in a group of people with similar problems or through systematically working through a self-help book or a self-help website.
What if the person doesn’t want help?
The person may not want to seek professional help, so you might probe to discover the reason. For example, the person might be concerned about finances or about not have a doctor they like. You may be able to help the person overcome the worry about seeking help. If the person still doesn’t want help after you have explored the reasons, let them know that if they change their mind about seeking help, they can contact you. Respect the person’s right not to seek help unless you believe they are at risk of harming self or others.
Action E: Encourage self-help and other support strategies
Other people who can help
Encourage the person to consider other available support, such as family, friends, faith communities, or people who have also experienced troublesome anxiety (peer supporters). There is also evidence that mutual support groups may be helpful for people with depression and anxiety problems.
People who are troubled with anxiety frequently use self-help strategies. The person’s ability and desire to use self-help will depend on their interests and the severity of their symptoms. Therefore, do not be overly forceful when trying to encourage the person to use self-help strategies.
Therapies with scientific evidence for effectiveness with anxiety disorders include:
Self-help books based on CBT
For Anxiety Disorders
Anxiety and Depression Association of America
ADAA promotes the early diagnosis, treatment, and cure of anxiety disorders.
Anxiety Panic Attack Resource Site
This site provides information pertaining to a variety of treatments and resources on anxiety. The site also provides questionnaires, links to treatment resources, a message board, and lists helpful publications.
Benson-Henry Institute for Mind Body Medicine
The Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital has an online store providing CDs, DVDs, and books on relaxation techniques.
The E-couch website provides information about emotional problems (including depression and anxiety disorders)—what causes them, how to prevent them, and how to treat them. It also provides a set of evidence-based online interventions designed to equip the user with strategies to improve mood and emotional state, along with a workbook to track progress and record experiences.
Freedom From Fear
The Freedom From Fear website provides information, screening tools, and other resources on many types of anxiety disorders.
Mental Health America
Visit Mental Health America’s site for information on mental health, getting help, and taking action.
National Council for Behavioral Health
To locate mental health and addictions treatment facilities in your community, use the “Find a Provider” feature on the National Council’s website.
National Institute of Mental Health
The website for the National Institute of Mental Health has a wealth of information on anxiety disorders.
The Obsessive-Compulsive Foundation website includes information about obsessive-compulsive disorder, including information about effective treatments, how to find a health professional who has experience treating the disorder, and links to other websites.
Bourne, E. J. (2010) The anxiety and phobia workbook. (5th ed.). Oakland, CA: New Harbinger Publications, Inc.
This is a self-help book based on cognitive behavioral therapy (CBT).
Marks, I. (2001) Living with fear. McGraw-Hill Education, Berkshire, England.
This book is based on CBT. It includes a very useful chapter on self-help for fears and anxiety. Research has shown that people with phobias who follow the instructions in this chapter improve as much as people treated by a professional.
Antony, M. M. and McCabe, R. (2004) 10 simple solutions to panic: how to overcome panic attacks, calm physical symptoms, and reclaim your life. New Harbinger Publications, Oakland, CA.
This small-format self-help book is based on CBT principles and may help people who experience panic attacks. The focus is on thinking realistically about future attacks rather than worrying about them.
Zuercher-White, E. (1998) An end to panic: breakthrough techniques for overcoming panic disorder. New Harbinger Publications, Oakland, CA.
This self-help workbook is based on CBT principles and may help people who experience panic attacks, panic disorder, and agoraphobia.
Antony, M. M. and McCabe, R. (2005) Overcoming animal & insect phobias: how to conquer fear of dogs, snakes, rodents, bees, spiders & more. New Harbinger Publications, Oakland, CA.
This book is part of the “I Can Do It” Series. It uses a self-help approach to graded exposure, a form of CBT, for overcoming animal and insect phobias.
Antony, M. M. and Watling, M. (2006) Overcoming medical phobias: how to conquer fear of blood, needles, doctors, and dentists. New Harbinger Publications, Oakland, CA.
Medical phobias can lead to significant medical problems, as individuals may resist seeking medical help for emerging problems and emergencies. This book is part of the “I Can do It” Series. It uses a self-help approach to graded exposure, a form of CBT, for overcoming medical phobias.
Social Anxiety Books
Antony, M. M. (2004) 10 simple solutions to shyness: how to overcome shyness, social anxiety, and fear of public speaking. New Harbinger Publications, Oakland, CA.
This small-format book is an excellent accompaniment to the book listed below. Based on the principles of CBT, it may be useful not only to individuals with a clinical disorder but also to those who are nervous in social situations or speaking in public.
Antony, M. M., & Swinson, P. R. (2008) The shyness and social anxiety workbook: proven step-by-step techniques for overcoming your fears. (2nd ed.). Oakland, CA: New Harbinger Publications, Inc.
This large-format self-help workbook uses the principles of CBT to help people overcome shyness and social phobia.
Stein, M. B., & Walker, J. R. (2002) Triumph over shyness: conquering shyness & social anxiety. New York, NY: McGraw-Hill.
This self-help book is copublished and endured by the Anxiety Disorders Association of America. It may be useful for people with social phobia but also those who struggle with nonclinical shyness. A range of approaches is used.
Obsessive-Compulsive Disorder Books
Foa, E. B. and Wilson, R. (2001) Stop obsessing: how to overcome your obsessions and compulsions. Revised edition. Bantam Books, New York, NY.
A CBT-based self-help manual for overcoming OCD. Readers are encouraged to tailor a CBT program to target specific obsessions and compulsions. It also includes self-tests and case studies from he authors’ significant clinical backgrounds.
The following four books are a suite of self-help workbooks that focus on practical strategies for overcoming specific types of OCD. By selecting the workbook that focuses on the main compulsive symptom (checking, washing, or hoarding) and then adding the workbook on obsessions, an individual can create their own CBT program for overcoming OCD.
Munford, P. (2004) Overcoming compulsive checking: free your mind from OCD. New Harbinger Publications, Oakland, CA.
Munford, P. (2004) Overcoming compulsive washing: free your mind from OCD. New Harbinger Publications, Oakland, CA.
Neviroglu, F. and Bubrick, J. (2004) Overcoming compulsive hoarding: why you save and how you can stop. New Harbinger Publications, Oakland, CA.
Purdon, C. and Clark, D. A. (2005) Overcoming obsessive thoughts: how to gain control of your OCD. New Harbinger Publications, Oakland, CA.
American Psychiatric Association Answer Center
Live operators, available from 8:30 a.m. to 6 p.m., Eastern time, refer you to local board-certified psychiatrists.
American Psychological Association Public Education Line
Follow the automated instructions and press the number 1. Then an operator refers you to local board-certified psychologists.
American Self-Help Group Clearinghouse
This searchable database contains more than 1,100 self-help and caregiver support groups, including many for anxiety disorders. Also listed are local self-help clearinghouses worldwide, research studies, information on starting face-to-face and online groups, and a registry for persons interested in starting national or international self-help groups.
National Alliance on Mental Illness
On the home page, click on “Find Support.”
On the home page, click on “Find A Meeting” to find the next Recovery International meeting in your area.
Recovery International, a Chicago-based self-help mental health organization, sponsors weekly group peer-led meetings across the United States, as well as telephone and internet-based meetings.
If you feel you or a loved one might be suffering from anxiety, contact us and we can help you get connected to resources in your area.
If you or a loved one are experiencing suicidal thoughts, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
For more information and resources, visit tlaiorg.org. Reach out and ask for help; together, we are stomping out the stigma surrounding mental health.