Types of Anxiety Disorders

Overview

It is normal to experience occasional anxiety, especially in stressful situations. However, continuing to experience extreme and persistent anxiety, can be a sign of an anxiety disorder presence. This is referring to those who feel their feelings becoming difficult to control and begin to cause psychological distress and interfere with daily functioning. There are several different types of anxiety disorders, including: 

Generalized Anxiety Disorder

Social Anxiety Disorder

Panic Disorder

Agorphobia

Separation Anxiety Disorder

Selective Mutism

Types of Anxiety Disorders - 3

While it is difficult to determine the exact causes of anxiety disorders, there are several risk factors 3 for developing one, including:

Genetics

Brain Structure and Chemistry

Personality Characteristics

Stressful or Traumatic Characteristics

Low Self-esteem

Familty History of Depression

Certain Medical Conditions

Substance abuse problems

Although anxiety disorders can be disabling, they are highly treatable 4.

Types of Anxiety Disorders

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) experience overwhelmingly high amounts of anxiety and worry about numerous situations, activities, and events. They typically worry about daily life circumstances, including matters related to their family, relationships, finances, or health. They often also worry about minor issues. 

The amount of anxiety they feel is disproportionate to the object or situation itself, or they may not even have a specific reason for their worries. 

People with GAD may also experience the following:

• Feelings of restlessness or being “on edge” and difficulty relaxing

• Being easily fatigued

• Difficulty concentrating / mind going blank

• Irritability Muscle tension

• Trouble falling or staying asleep

• Trembling, twitching, or feeling shaky

• Physical symptoms such as increased heart rate, sweating, headaches, nausea, or diarrhea

While the median age of onset for GAD is 30 years, it can also occur during childhood or adolescence. Individuals with GAD often describe that they have felt anxious for their entire lives.

Social Anxiety Disorder (Social Phobia)

People with social anxiety disorder experience extreme fear or anxiety in social situations. Situations that may include interacting with others, performing in front of others, or being observed by others. The anxiety experienced in social cases is developed from a fear of being judged, rejected, or embarrassed by others. Some people may also fear that they will offend others by accident.

To be diagnosed with social anxiety disorder, the social situation fears must almost always trigger anxiety in the individual. This triggered anxiety must be deemed excessive. 

People with social anxiety disorder may also:

• Spend many days worrying about an upcoming social event

• Excessively prepare for anticipated social interactions

• Show overly rigid body posture

• Have inadequate eye contact

• Speak in an overly quiet voice

• Seek jobs where social connection is not required

• Experience physical symptoms of anxiety in social situations, such as trembling, sweating, rapid      heartbeat, or blushing

The typical age at onset for social anxiety disorder is between 8 and 15 years. It may develop slowly, or it may onset after experiencing a particularly humiliating or stressful event.

Types of Anxiety Disorders - 4

Panic Disorder

Any friends or family members that you know struggling with panic disorders are known to repeatedly have unexpected panic attacks. According to professionals, panic attacks are sudden episodes of intense fear or discomfort that reach a peak within minutes. 

During a panic attack, at least four of the following symptoms occur:

Palpitations, pounding heart
• Accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath
• Smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, faint
Chills or heat sensations
Numbness or tingling sensations 
Feelings of unreality (derealization)
• Feeling detached from oneself 
Fear of losing control or “going crazy.”
Fear of dying

To be diagnosed with panic disorder or other mental illnesses, panic attacks must be unexpected. This means that they are not triggered by anything. Instead, the panic attacks seemingly occur from out of the blue. Individuals with panic disorder continuously worry about having additional panic attacks.

The age at onset for panic disorder typically begins in early adulthood, between the ages of 20-24. Although it is less common, panic disorder can also occur in childhood or adolescence.

Treatments (Overview)

Clinical trials have shown anxiety disorders can be treated with psychotherapy, medication, or a combination of both 5. Research has shown that psychotherapy and medication are both effective treatments for anxiety disorders. Talking with your doctor to find a suitable treatment option would be extremely beneficial.

Psychotherapy

Psychotherapy, or “talk therapy,” involves working with a licensed mental health professional to identify, understand, and treat the psychological symptoms and difficulties you are having.

Research shows that individuals who receive psychotherapy, experience an improvement in their functioning. About 75% 6 of people receiving psychotherapy experience some benefit from it.

Cognitive-Behavioral Therapy

Studies show that cognitive-behavioral therapy (CBT) is the most effective 7 types of therapy for treating anxiety disorders. CBT helps people understand the relationship between their thoughts, feelings, and behaviors. Also, to focus on teaching people practical coping skills and problem-solving skills. Therapists often give their patients “homework” assignments so that they can practice the new skills they learn in their daily lives.

Two methods of CBT 8 are commonly used to treat anxiety disorders: cognitive therapy and exposure therapy. When using cognitive therapy techniques, your therapist will help you learn how your thoughts and beliefs are contributing to your anxiety symptoms.

Also, exposure therapy is especially beneficial for people who tend to avoid the things they fear, as it allows them to learn to confront their fears. In exposure therapy, your therapist will slowly “expose” you to the situation or object that provokes anxiety in a safe environment.

Over time, you will become less and less sensitive to the feared situation or object, until, eventually, it no longer evokes fear. When treating panic disorder 9, interoceptive exposure may be used.

Medications

Three standard classes of medications 10 used to treat anxiety disorders include antidepressants, benzodiazepines, and beta-blockers.

Some medications help with anxiety symptoms immediately, while others may take several weeks until improvement is felt. Certain medications may work better for specific anxiety disorders, and, sometimes, medications may be combined to best treat symptoms.

It may take some trial and error to find the right drug and dosage for you, but your doctor will work with you until you find the right one.

Antidepressants

Antidepressants are frequently used to treat most anxiety disorders. Two newer types of antidepressants 11 are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Both are considered first-line drug treatments for anxiety disorders.

Tricyclic antidepressants (TCAs) may also be used to treat anxiety disorders, but is used less often because it is capable of producing more side-effects than others. As antidepressants have a low risk of dependency, it can take 2 to 6 weeks before symptoms may begin to improve.

Examples of SSRIs 12 Commonly Prescribed for Anxiety Disorders:

Paxil

Prozac

Zoloft

Lexapro

Celexa

Examples of SNRIs 13 Commonly Prescribed for Anxiety Disorders:

Pristiq

Cymbalta

Effexor XR

Examples of TCAs 14 Commonly Prescribed for Anxiety Disorders:

Elavil

Tofranil

Pamelor

Benzodiazepines

Benzodiazepines are effective in rapidly relieving anxiety symptoms soon after they are taken. However, taking benzodiazepines for extended periods can lead to problems related to dependence and tolerance. Instead, benzodiazepines are commonly used 15 for short-term symptom relief.

When someone suddenly stops taking their benzo medication, withdrawal symptoms are likely to develop. Because of this, your doctor can help you gradually reduce your usage to help make these effects minimal.

Examples of Benzodiazepines 16 Commonly Prescribed for Anxiety Disorders:

Xanax

Klonopin

Valium

Ativan

Beta-Blockers

Although beta-blockers are typically used to treat high blood pressure or heart conditions, they may also be used to treat certain anxiety disorders.

While they do not relieve feelings of anxiety, they can help reduce the various physical symptoms of anxiety, such as rapid heart rate, trembling, and sweating.

Examples of Beta-Blockers 17 Commonly Prescribed for Anxiety Disorders:

Tenormin

Inderal

Alternative Methods of Treatment

Other ways to manage anxiety symptoms are listed below.

 It is recommended that you use these methods along with psychotherapy, medication, or both.

Deep breathing exercises 18
Progressive muscle relaxation 19
• Binaural beats 20
Regular exercise, especially 30 min/cardio
Limiting alcohol, nicotine & caffeine intake
Meditation
Yoga
Acupuncture
Aromatherapy
Journaling

Video (How To Cope With Anxiety)

Video Transcript
Imagine that you’re getting ready to go to a party. You feel excited, but also nervous, and you’ve got this feeling in your stomach almost like another heartbeat. There’s something holding you back, holding you back from getting too happy. “No, you mustn’t get too happy. Better to be cautious, otherwise, something bad might happen.” You start wondering, “Who should I talk to when I get there? What if no one wants to talk to me? What if they’ll think I’m weird?” When you arrive at the party, someone comes up to you and starts talking with you, and as this is happening, your mind starts racing, your heart begins pounding, you start sweating, and it feels almost like you’re dissociating from yourself, like it’s an out-of-body experience, and you’re just watching yourself talk. “Keep it together,” you say to yourself, but you can’t. And it’s just getting worse: after a few minutes of conversation, the person you’ve been speaking to leaves, and you feel utterly defeated. This has been happening to you in social situations for a long time. Or imagine every time you go out, and you’re in crowded places, you feel this panic starting to arise. When you’re surrounded by lots of people, like on a bus, you start to feel hot, nauseous, uneasy, and to prevent this from happening, you start avoiding a lot of places which makes you feel lonely and isolated. You or the person in both of these scenarios have anxiety disorders, and what I can tell you is that anxiety is very common, much more than people think. Right now, one in 14 people around the world have an anxiety disorder, and each year, it costs over 42 billion dollars to treat this mental health problem. To show you the impact that anxiety has on someone’s life, I will just mention that anxiety can lead to depression, school dropout, suicide. It makes it harder to focus, and to hold down a job, and it can lead to relationship breakdown. But a lot of people don’t know this, that’s why, a lot of times, people sweep anxiety under the rug as just nerves that you need to get over, as a weakness, but anxiety is so much more than that. A reason why so many people don’t think it’s important is that they don’t know what it is. Is it your personality? Is it an illness? Is it a normal sensation? What is? That’s why it’s important to differentiate what is normal anxiety from what is an anxiety disorder. Normal anxiety is an emotion that we all get when we’re in stressful situations. For example, let’s say, you’re out in the woods, and you come face-to-face with a bear. This will probably make you feel a little bit anxious, and you’ll probably want to start running like crazy. This anxious feeling that you get is good because it protects you, it saves you, and it makes you on a hightail it out of there, although maybe it’s not such a good idea to start running when you see a bear. I really don’t think you can outrun a bear. Anxiety helps us meet our deadlines at work and deal with emergencies in life, but when this anxiety emotion is taken to the extreme and arises in situations which don’t pose a real threat, then that’s when you might have an anxiety disorder. For example, people with generalized anxiety disorder worry excessively and constantly about everything going on in their lives, and they find it very difficult to control this worry. They also have symptoms like restlessness, fear, they find it hard to fall asleep at night, and they can’t concentrate on tasks. In spite of whatever kind of anxiety you might be suffering from, there is something that you can do to lower it. It works, and it’s simpler than you may think. All too often, we’re given medication for mental disorders, but it doesn’t always work in the long run. Symptoms often come back, and you’re back to where you started. So here’s something else to consider: the way you cope or handle things has a direct impact on how much anxiety you’re experiencing, and if you tweak the way you’re coping, then you can lower your anxiety. In our study at the University of Cambridge, we showed that women living in poor areas have a higher risk for anxiety than women living in richer areas. These results didn’t surprise us, but when we looked closer, we found that women living in poor areas, if they had a particular set of coping resources, they didn’t have anxiety, while women living in poor areas without these coping resources had anxiety. Other studies showed that people who had faced extreme circumstances, who had faced adversity, been through wars and natural disasters, if they had coping resources, they remained healthy and free of mental disorders, while others, facing the same hardships but without coping skills went on a downward spiral and developed mental disorders. So what are some of these coping resources, and how can we use them to lower our anxiety? And before I dive into what they are, I’d like to point out – and I think this is so interesting – you can develop these coping resources or coping skills on your own through the things that you do; you can take charge of your anxiety and lower it, which I think is so empowering. Today I’ll be talking about three coping resources, and the first one is feeling like you’re in control of your life. People who feel like they’re more in control of their life have better mental health. If you feel like you’re lacking in control in life, then research shows that you should engage in experiences that give you greater control. I’ll show you what I mean: do you sometimes find that you put off starting something because you just don’t feel ready enough? Do you find it hard to make decisions like what to wear, what to eat who to date, which job to take up? Do you tend to waste a lot of time deciding what you might do while nothing gets done? A way to overcome indecision and this lack of control in life, is to do it badly. There’s a quote by writer and poet GK Chesterton that says, “Anything worth doing is worth doing badly the first time.” The reason why this works so well is that it speeds up your decision-making and catapults you straight into action, otherwise, you can spend hours deciding how you should go about doing something or what you should do. This can be paralyzing and can make you afraid to even begin. All too often, we aim for perfection, but never end up doing anything because the standards that we set for ourselves are too high, they’re intimidating, which stresses us out so we delay starting something, or we might even abandon the whole thing altogether. Do it badly frees you up to take action. I mean you know how it is: so often, we want to do something perfectly we can’t start until it’s the perfect time, until we’ve got all the skills, but this can be daunting and stressful so why not just jump into it just do it however, without worrying if it’s good or bad? This will make it that much easier to start something and as you’re doing it badly to finish it, and when you look back, you’ll realize, more often than not, that actually it’s not that bad. A close friend of mine who has anxiety started using this motto, and this is what she said, “When I started using this motto, my life transformed. I found I could complete tasks in much shorter time periods than before. Do it badly gave me wings to take risks, to try something differently, and to have way more fun during the whole process. It took the anxiety out of everything and replaced it with excitement.” So do it badly, and you can improve as you go along. I’d like to ask you to think about this: if you start using this motto today, how would your life change? The second coping strategy is to forgive yourself, and this is very powerful if you use it. People with anxiety think a lot about what they’re doing wrong, their worries, and how bad they’re feeling. Imagine if you had a friend who constantly pointed out everything you’re doing wrong, and everything that was wrong with your life. You would probably want to get rid of this person right away, wouldn’t you? Well, people with anxiety do this to themselves all day long. They’re not kind to themselves. So maybe it’s time to start being kinder with ourselves, time to start supporting ourselves, and a way to do this is to forgive yourself for any mistakes you think you might have made just a few moments ago to mistakes made in the past. If you had a panic attack and are embarrassed about it, forgive yourself; if you wanted to talk to someone, but couldn’t muster up the courage to do so, don’t worry about it, let it go; forgive yourself for anything and everything and this will give you greater compassion towards yourself. You can’t begin to heal until you do this. And last but not least, having a purpose and meaning in life is a very important coping mechanism. Whatever we do in life, whatever work we produce, however much money we make, we cannot be fully happy until we know that someone else needs us, that someone else depends on our accomplishments, or on the love that we have to share. It’s not that we need other people’s good words to keep going in life, but if we don’t do something with someone else in mind, then we’re at much higher risk for poor mental health. The famous neurologist Dr. Victor Frankel said, “For people who think there’s nothing to live for and nothing more to expect from life, the question is getting these people to realize that life is still expecting something from them.” Doing something with someone else in mind can carry you through the toughest times. You’ll know the why for your existence and will be able to bear almost any how; almost any how. So the question is do you do at least one thing with someone else in mind? This could be volunteering, or it could be sharing this knowledge that you gained today with other people, especially those who need it most, and these are often the people who don’t have money for therapy, and they’re usually the ones with the highest rates of anxiety disorders. Give it to them, share with others, because it can really improve your mental health. So I would like to conclude with this: another way you can do something with someone else in mind is finishing work that might benefit future generations. Even if these people will never realize what you’ve done for them, it doesn’t matter, because you will know, and this will make you realize the uniqueness and importance of your life. Thank you.

References

1.https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml

2.https://www.childhealthdata.org/browse/survey/results?q=4965&r=1

3.https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml

4.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147018/

5.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628173/

6.https://www.apa.org/helpcenter/understanding-psychotherapy

7.https://cogbtherapy.com/how-effective-is-cbt-compared-to-other-treatments

8.https://www.apa.org/helpcenter/anxiety

9.https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy

10.https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145338

11.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/

12.https://www.webmd.com/depression/ssris-myths-and-facts-about-antidepressants#1-3

13.https://www.rxlist.com/the_comprehensive_list_of_antidepressants/drug-class.htm#snris

14.https://www.rxlist.com/the_comprehensive_list_of_antidepressants/drug-class.htm#tcas

15.https://www.health.harvard.edu/mind-and-mood/benzodiazepines_and_the_alternatives

16.https://www.aafp.org/afp/2000/1001/p1591.html

17.https://www.medicinenet.com/beta_blockers_vs_xanax/article.htm

18.https://www.healthline.com/health/breathing-exercises-for-anxiety

19.https://www.law.berkeley.edu/files/Progressive_Muscle_Relaxation.pdf

20.https://www.healthline.com/health-news/your-brain-on-binaural-beats