Anxiety disorder: definition, types, symptoms, causes, and treatments
Table of content
- What is an anxiety disorder?
- What are the different types of anxiety disorder?
- When does an anxiety disorder begin?
- What are the symptoms of anxiety disorder?
- Physical symptoms
- Mental symptoms
- Behavioral symptoms
- What are the causes of anxiety disorder?
- What are the treatments available for anxiety disorder?
- 1. Anti-anxiety medications
- 2. Antidepressants
- 3. Beta-blockers
- 4. Cognitive behavioral therapy (CBT)
- 5. Exposure therapy
- Can anxiety disorder be prevented?
- How to help someone with anxiety disorder?
- Is anxiety disorder a chemical imbalance?
Anxiety disorder is defined as a term that refers to multiple disorders characterized by fear, anxiety, and nervousness or panic that affects a person’s quality of life.
Types of anxiety disorders include generalized anxiety disorder, social anxiety disorder, phobias, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, separation anxiety disorder, selective mutism, and anxiety disorder caused by substances or medical conditions.
Symptoms of anxiety disorder can be physical, mental, and behavioral. Physical symptoms include cold hands, dry mouth, heart palpitations, nausea, numbness or tingling in hands and feet, muscle tension, and shortness of breath. Mental symptoms include a feeling of panic, nightmares, obsessive thoughts, and flashbacks. Behavioral symptoms include the inability to stay calm, compulsive behaviors, and trouble sleeping.
The causes of anxiety disorders include a combination of chemical imbalance, heredity, and environmental factors.
Treatment for anxiety disorders includes a combination of therapy and medications. The main goal of the treatment is to lessen the intensity of anxiety attacks and help a person improve their quality of life.
What is an anxiety disorder?
Anxiety disorder is a mental illness indicated by overwhelming anxiety and fear that interferes with a person’s daily functioning. It’s not a single condition, but a term that includes multiple mental illnesses whose prominent symptoms are feeling of unease, worry, fear, and panic. People who have an anxiety disorder respond to certain situations with intense physical and psychological symptoms.
It is important to mention that having some anxiety is normal. That’s how we react to negative stimuli or stress. In fact, anxiety helps us identify dangerous disputations and helps us stay safe. However, anxiety is a problem when it becomes unexpectedly severe or lasts longer than expected to the point it affects the daily life of a person and symptoms occur even in situations that don’t pose threat or danger.
Anxiety disorders are included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association. In 1980 anxiety, or more precisely generalized anxiety disorder, became a diagnosable condition with the release of DSM-3. Before that, people with symptoms of anxiety were considered to have stress or nervousness. Since medical professionals didn’t have proper training and their understanding of anxiety was little, many people didn’t receive effective treatment.
However, the history of anxiety is a lot longer than that and spans several centuries. A paper by Dr. Marc-Antoine Crocq at Maison des Adolescents du Haut-Rhin in France, which was published in the September 2015 issue of Dialogues in Clinical Neuroscience reported that ancient physicians described mental problems with symptoms similar to anxiety. One such example stems from The Hippocratic Corpus, a collection of Greek medical texts written down or attributed to Hippocrates, which describes the case of a man named Nicanor with an intense fear of flute. The man displayed a typical case of phobia.
In addition, Latin Stoic papers such as treatises of Cicero and Seneca mentioned a mental illness that we know as anxiety today. Those writings explained that worry, affliction, and anxiety are disorders, which are not the same as sadness.
The concept of anxiety seems to have vanished from written records in a period between classical antiquity and modern psychiatry. While people with anxiety existed at that point, they were diagnosed with other diagnostic terms including neurasthenia.
English author Robert Burton published his book The Anatomy of Melancholy in 1621. While the book is largely about depression, it is also concerned with anxiety. That wasn’t the only time where melancholy applied to more problems rather than just depression. For example, in the 18th century, medical authors described panic attacks not as a separate illness, but as symptoms of melancholia.
During the late 19th and 20th centuries, anxiety was a major component of several diagnostic categories ranging from neurasthenia to neuroses. Sigmund Freud was the first person to separate anxiety neurosis from neurasthenia. In fact, Freud coined many terms that are used for various anxiety disorders today.
German psychiatrist, Emil Kraepelin paid a lot of attention to anxiety as a symptom linked to other diagnoses but didn’t focus on it as a separate illness. However, in the 8th edition of his textbook, Kraepelin described anxiety as the most common of all distressing affects. One of the most significant contributions of Kraepelin to this field was his description of the presence of anxiety in a manic-depressive illness, such as a condition that we know as bipolar disorder today.
Understanding of anxiety changed over the years from one DSM to another. Today it is regarded as a separate mental illness whose symptoms can be debilitating.
How common are anxiety disorders?
Anxiety disorders are the most common of all mental disorders. According to the American Psychiatric Association, around 30% of adults develop an anxiety disorder at some point in their lifetime. The same report shows that in any given year, 8-12% of U.S. adults have a specific phobia, 7% suffer from a social anxiety disorder, 2-3% have panic disorder, 1-2.9% have agoraphobia, 2% suffer from a generalized anxiety disorder, and 0.9-1.9% have a separation anxiety disorder.
The prevalence of anxiety disorders could be even higher than previously believed. For example, the Anxiety and Depression Association of America (ADAA) reports that 6.8 million people, or 3.1% of adults in the U.S. have a generalized anxiety disorder.
National Alliance on Mental Illness (NAMI) reported that over 40 million adults in the United States have anxiety. At the same time, 7% of children and adolescents experience anxiety each year. In a period between 2016 and 2019, about 9.4% of children and adolescents (or 5.8 million) had anxiety, according to the CDC.
What are the different types of anxiety disorder?
Different types of anxiety disorders are listed below:
- Generalized anxiety disorder (GAD): indicated by excess worry about everyday situations and issues that last longer than six months. People with GAD feel anxious about a wide range of situations rather than one specific event.
- Obsessive-compulsive disorder (OCD): a condition characterized by obsessive thoughts and compulsive behaviors. This long-lasting disorder involves thoughts that are repeated, persistent, and uncontrollable. These thoughts lead to repetitive behaviors, obsession with germs and cleanliness, counting in certain patterns, or being obsessed with order and symmetry. Compulsive behaviors provide only temporary relief from symptoms of anxiety.
- Panic disorder: indicated by sudden attacks of fear or panic that happen regularly. Everyone experiences panic in dangerous situations, but a person with panic disorder exhibits intense physical reactions when there is no apparent cause or real danger.
- Post-traumatic stress disorder (PTSD): a condition where severe anxiety occurs due to a terrifying or traumatic event that a person experienced and witnessed.
- Social anxiety disorder (SAD): also known as social phobia, an overwhelming long-term fear of social situations. Social phobia can be very distressing and has a major impact on a person’s life.
- Phobias: indicated by persistent and excessive fear of a situation or an object even when they pose little to no threat or danger. The most common phobias include acrophobia (fear of heights), claustrophobia (fear of tight spaces), and trypanophobia (fear of needles).
- Separation anxiety disorder: excessive and recurrent distress and intense fear of being separated from a caregiver or loved one. People with this disorder constantly anticipate bad things to happen and are afraid of losing parents, significant other, or siblings to the point they experience intense physical reactions and behavioral changes.
- Selective mutism: severe anxiety disorder indicated by the inability to speak in certain social situations, such as to relatives a person doesn’t often see or with their classmates.
- Substance- or medication-induced anxiety disorder: indicated by symptoms of anxiety when a person is taking the drug or stops using it.
- Anxiety disorder due to another medical condition: characterized by symptoms of anxiety or panic that stem directly from a physical health problem.
When does an anxiety disorder begin?
An anxiety disorder begins when a person becomes unable to cope or go through daily life properly as they experience exaggerated physical and mental reactions to stressful situations. Anxiety is normal; everyone feels nervousness at some point in their life. For example, people can be nervous about upcoming exams, medical tests, or job interviews. In these and similar situations, it’s normal to be nervous. However, anxiety disorder occurs when it becomes difficult to control worries and physical or mental reactions, even in situations that aren’t threatening. For instance, a person with phobia experiences symptoms of anxiety in the presence of an object, situation, or event that isn’t dangerous to them. Signs that imply anxiety disorder begins are listed below:
- Your ability to perform daily tasks is hampered by anxiety.
- When anything sets off your emotions, you frequently overreact.
- Your reactions to situations are beyond your control.
1. Your ability to perform daily tasks is hampered by anxiety
Inability to perform daily tasks refers to challenges at home and in personal life as well as difficulty with productivity at work/school. People with anxiety tend to struggle with performance at work or home alike. That happens because anxiety impairs productivity.
Forbes, in the article published in July 2020 by former contributor Alice Boyes, explains that anxiety decreases concentration and it’s easier to feel overwhelmed. Tasks that usually feel within a person’s capacity may seem overwhelming. People can misinterpret anxiety and see it as a sign they’re not competent enough. Difficulty concentrating in people with anxiety is scientifically confirmed. For example, a study by L.S. Hallion et al. from the January 2018 issue of Journal of Anxiety Disorders showed that 90% of participants with GAD had trouble concentrating, which mediated the relationship between worry and severity.
Inability to perform daily tasks due to anxiety is best identified with poor focus and concentration, difficulty remembering things, and feeling overwhelmed by so much to do at work or home. Depending on anxiety disorder, other aspects of life suffer due to intense focus on anxious thoughts. For example, a person with anxiety may neglect personal hygiene, such as showering or brushing their teeth, because they are too focused on keeping their home in symmetry and the right order. People are different, and these signs depend on the specific anxiety disorder, but failing to perform seemingly easy and natural tasks could indicate the onset of anxiety.
2. When anything sets off your emotions, you frequently overreact
When anything sets off emotions, a person frequently overreacts and refers to exaggerated reactions and responses in the presence of any negative stimuli. People with anxiety tend to overreact or respond excessively to emotionally negative stimuli, even if they are minor inconveniences. According to a paper that Dr. Ananda B. Amstadter from Auburn University published in the February 2008 issue of Journal of Anxiety Disorders, people with anxiety disorders, such as PTSD, experience difficulties with emotion regulation. They may attempt to suppress their emotions, which further worsens their symptoms.
Frequently overreacting as a sign of the onset of anxiety disorder is best identified by being more sensitive than before, being triggered by minor inconveniences, and failing to recognize or acknowledge someone else’s perspective. A person also finds it difficult to accept the current situation or circumstance. Their reactions are out of proportion.
3. Your reactions to situations are beyond your control
Reactions to situations being beyond control refer to a person’s inability to regulate how they respond to negative or stressful stimuli. People with anxiety struggle to keep their reactions under control, whether they are physical, mental, or behavioral.
The best way to identify overreaction as a sign of the onset of anxiety disorder is through response to stressful situations and triggers that cause anxiety. When a person tries to control their response and fails because anxiety symptoms keep becoming intense, it’s a sign they are developing an anxiety disorder. For example, a person with PTSD may not be able to control their response when a trigger reminds them of the trauma they experienced. At the same time, a person with a phobia isn’t able to control their reaction in situations where they face fear. A person with a social anxiety disorder can’t control their reactions in situations where they have to spend time with people they don’t know.
What are the symptoms of anxiety disorder?
Symptoms of anxiety disorder are dependent on the specific type of disorder a person has. However, different anxiety disorders can have symptoms in common because they are the hallmark symptoms of anxiety. The most common symptoms of anxiety disorder are listed below:
- Physical symptoms:
- Cold or sweaty hands
- Dry mouth
- Heart palpitations
- Numbness or tingling in hands or feet
- Muscle tension
- Shortness of breath
- Mental symptoms:
- Feeling panic, fear, and uneasiness
- Repeated thoughts or flashbacks of traumatic experiences
- Uncontrollable, obsessive thoughts
- Behavioral symptoms:
- Inability to be still and calm
- Ritualistic behaviors, such as washing hands repeatedly
- Trouble sleeping
Physical symptoms refer to physical changes that people experience when facing triggers of their anxiety. These symptoms are further elaborated on below.
1. Cold or sweaty hands
Cold or sweaty hands are a physical reaction that happens regardless of the temperature outside. A person may have cold or sweaty hands even when it’s winter. It is known as hyperhidrosis i.e., the overactivity of the sympathetic nervous system. When the sympathetic nervous system is overactive, the arteries become narrow, and sweat glands are overly stimulated. The blood flow to the hands is limited, which makes them cold or sweaty.
This is a common symptom of anxiety disorders, especially social anxiety disorder. A review by Elad Nahaloni and Iulian Iancu published in the October 2014 issue of Israeli journal Harefuah showed that avoidance in a social setting is frequently accompanied by sweating.
Cold or sweaty hands become a symptom of anxiety because anxiousness activates the body’s stress response and thereby increases perspiration. It is one of the symptoms of anxiety disorders because an affected person can’t control this physical reaction.
This symptom is easy to identify because it appears in the form of cold, sweaty, or clammy palms.
2. Dry mouth
A dry mouth, or xerostomia, is defined as a condition wherein salivary glands in the mouth fail to produce enough saliva to keep the mouth wet. People usually have dry mouth as a side effect of medications or due to dehydration, but it can also occur as a symptom of illness. It is common to have a dry mouth due to nervousness and anxiety.
A study by N. Gholami et al. from the Autumn 2017 issue of the Journal of Dental Research, Dental Clinics, Dental Prospects confirmed that anxiety as well as stress, and depression could influence unstimulated salivary flow rate and contribute to xerostomia.
A dry mouth is a symptom of anxiety disorder because anxiety reduces the flow of saliva and increases cortisol levels.
People have dry mouths when they experience anxiety, especially panic attacks, because their bodies may shift their fluids from the mouth to other parts of the body. This usually happens with the activation of fight-or-flight instincts when a person gets excess water in sweat glands, which results in a dry mouth.
A dry mouth is recognized by symptoms such as dry lips, bad breath, dry or grooved tongue, dryness or feeling of stickiness in mouth, changed sense of taste, and saliva appearing thick or stringy.
3. Heart palpitations
Heart palpitations are defined as heartbeats that become more noticeable. Most of the time people aren’t aware of their heartbeat, but when they suddenly become aware, it means they have heart palpitations. They can occur due to medication, exercise, or rarely a medical condition.
A common cause of heart palpitations is anxiety. According to a review by R.K. Wexler et al. from the July 2011 issue of American Family Physician, anxiety is a common non-cardiac cause of palpitation. Anxiety causes heart palpitations because the trigger of anxiety engages a fight-or-flight response, which speeds up the heart rate to get more blood flow. As the blood flow increases, energy levels go up and people notice their heart starts beating faster.
In other words, people get heart palpitations because their anxiety activates the autonomic nervous system (ANS), which consists of the parasympathetic and sympathetic nervous systems, which regulate functions such as fight-or-flight response, heart rate, and breathing.
Heart palpitations are characterized by a fast heartbeat, flip-flopping, rapid fluttering, pounding, and feeling like the heart is skipping a beat.
Nausea is defined as the sensation of having to vomit or having the urge to do so. It may or may not be accompanied by vomiting. Nausea is not a disease but a symptom of many conditions, such as food poisoning, infection, overeating, motion sickness, brain injury, migraine, or appendicitis.
Anxiety can cause nausea and gastrointestinal problems. The digestive system contains the second largest number of nerves in the body, outside the brain. Scientists refer to the gut as the second brain. Anxiety causes nausea because neurotransmitters released in the fight-or-flight response get into the digestive tract and upset the gut microbiome.
Nausea is a symptom of anxiety disorder because it is a physical reaction that occurs when the delicate balance of microorganisms in the gut is disturbed, explains Medical News Today.
Nausea is identified by having the urge to vomit, profuse sweating, lack of appetite, stomachache, feeling of unease, and vomiting (which doesn’t always happen).
5. Numbness or tingling in hands or feet
Numbness or tingling in hands or feet is an unpleasant sensation that results from a wide range of causes, including pinched nerve, alcohol, toxins, strain injury, pregnancy, multiple sclerosis, vitamin deficiency, autoimmune conditions, or infections.
Anxiety is a common cause of numbness or tingling in hands or feet. It causes this symptom due to hyperventilation. As people hyperventilate, the balance between oxygen and carbon dioxide levels in the body becomes impaired. When that happens, a person experiences numbness or tingling in their hands or feet.
This symptom of anxiety disorder may also stem from a psychological perspective because a person becomes more aware of their bodily sensations in anxiety. Additionally, blood vessels constrict in moments of panic, which leads to a higher heart rate and increased blood pressure. The blood flow to different parts of the body is reduced, which causes tingling and numbness.
This symptom is best identified by feeling like hands or feet are numb or that they have a tingling sensation.
6. Muscle tension
Muscle tension is a condition wherein one or more muscles remain semi-contracted for a prolonged period. It is a common cause of muscle pain and usually occurs as a physiological effect of stress.
Muscle tension is a common symptom of anxiety, but the relationship between the two is poorly understood. The January 2009 issue of the Journal of Anxiety Disorders published a paper by M. Pluess et al. reveal multiple pathways that are testable and contributing to the link between muscle tension and anxiety.
Anxiety causes muscle tension because it leads to muscle contraction, just like prolonged stress does. This contraction leads to tension after a while. Muscles naturally contract upon activation of the fight-or-flight response.
Muscle tension is a symptom of an anxiety disorder because it’s a physical reaction to a trigger of panic or anxiety that a person can’t control.
Muscle tension is identified by stiffness, rigidity, and weakness of the affected area i.e. one muscle or more of them.
7. Shortness of breath
Shortness of breath, or dyspnea, is defined as a feeling of being unable to get enough air into the lungs. It is an uncomfortable sensation that occurs due to strenuous exercise and other causes, such as hot air temperatures.
Anxiety can cause shortness of breath as well. It causes this symptom due to changes in heart rate. A comparative study by C.S.H. Ho et al. from the January 2019 issue of the International Journal of Environmental Research and Public Health found a strong connection between anxiety and respiratory symptoms, including shortness of breath.
Shortness of breath is a symptom of anxiety because the fight-or-flight response makes the heart pump faster, which causes a person to breathe more quickly in order to deliver more oxygen to the muscles. This causes shortness of breath.
Shortness of breath is identified by difficulty catching breath, feeling a need to take deeper breaths, not feeling able to take full breaths, and feeling huffy and puffy.
Mental symptoms refer to psychological reactions to the triggers of anxiety. These symptoms are further elaborated on below.
1. Feeling panic, fear, and uneasiness
Feeling of panic, fear, and uneasiness is an episode of severe discomfort that causes physical reactions such as shortness of breath or heart palpitations. Fear is a normal response to dangerous and threatening situations. However, people with anxiety disorder experience fear and panic even when they are not in danger by overreacting to negative stimuli.
Anxiety causes panic through a fear network in the brain, centered in the amygdala and interacting with the hippocampus and medial prefrontal cortex, according to a paper by Dr. Yong-Ku Kim at College of Medicine, Korea University published in January 2019 issue of Psychiatry Investigation.
Panic or fear, or uneasiness, is a symptom of anxiety because when a person is anxious, the body releases stress hormones such as cortisol and adrenaline. It is a reaction to a situation that a person perceives as stressful or threatening. Moreover, experiencing this symptom makes a person attempt to avoid situations that cause anxiety and panic. This creates a cycle of “fear of fear,” which aggravates the sense of panic and fear.
This symptom is best identified by a sense of intense fear and dread followed by physical symptoms such as a racing heartbeat, dizziness, sweating, and shortness of breath.
Nightmares are disturbing dreams that may cause a strong emotional response. These vividly realistic dreams are connected to negative feelings and may be threatening, bizarre, and upsetting.
According to a review by J. Vanek et al. from the September 2020 issue of the Neuro Endocrinology Letters, nightmares in most severe cases are associated with heart problems, sleep problems, permanent fatigue, and high levels of anxiety. January 2014 issue of Behavioral Sleep Medicine published a paper by M.R. Nadorff et al. confirmed that people with GAD have more bad dreams than their counterparts who don’t have an anxiety disorder.
Nightmares in people with anxiety disorder occur due to unresolved distress as a person goes through emotionally-charged experiences. Anxiety dreams could be how a part of the brain aims to process and respond to situations that cause discomfort and fear.
Bad dreams are a symptom of anxiety disorder because they are a psychological reaction to negative stimuli and are out of a person’s control.
Nightmares are best identified by dream scenarios that make a person feel sad, anxious, or disgusted afterward. People tend to wake up from nightmares feeling stressed out and uncomfortable.
3. Repeated thoughts or flashbacks of traumatic experiences
Repeated thoughts or flashbacks are vivid experiences wherein a person relives specific aspects of a traumatic event or feels as if the event is happening at the moment. Flashbacks don’t necessarily involve seeing images or reliving events from beginning to end.
Flashbacks are common in people with PTSD, but people with other anxiety disorders have them too. A good example is social anxiety disorder. According to a paper by Arthur Kummer and Estefania Harsanyi at the Federal University of Minas Gerais, Brazil from the July-September 2008 issue of the Indian Journal of Psychiatry, flashbacks are still poorly understood, but the amygdala appears to be a pivotal structure in their pathophysiology. This part of the brain recognizes danger signals faster than other brain regions and thereby amplifies emotional valence before the formation of memory to ensure that information is easier to access in the future. Flashbacks, according to that paper, aren’t necessarily realistic copies of traumatic events and may result from an exaggerated perception of trauma. For that reason, flashbacks in anxiety disorder could occur due to hypersensitivity of the amygdala to fear-inducing information.
Flashbacks are a symptom of anxiety because they occur as a response to a specific trigger that reminds a person of a traumatic experience.
Flashbacks are best identified as vivid and disturbing memories of past events that feel like they’re happening now. These memories are accompanied by intense emotional reactions such as fear and anger. People experience flashbacks as visual images, whereas others experience them as sounds, smells, or sensations linked to trauma.
4. Uncontrollable, obsessive thoughts
Uncontrollable, obsessive thoughts are recurrent or repeated thoughts and mental images that a person can’t get out of their head. Even when a person tries to distract themselves from these thoughts, they persist because this thinking pattern is intense.
Anxiety and extreme stress trigger uncontrollable or obsessive thoughts. The exact mechanism of action through which anxiety causes obsessive thoughts is poorly understood. It could be due to altered brain chemistry in people with anxiety disorder. For many people, certain events or situations may cause a great deal of distress and anxiety to which they react with thoughts they can’t control. The natural course of action is to distract oneself, but it only makes the obsessive thoughts more intense.
Uncontrollable, obsessive thoughts are a symptom of anxiety disorder because they are generated by anxiety itself i.e., a specific trigger that may vary from one person to another.
Obsessive thoughts are best identified as thoughts that occur suddenly and won’t go away. They keep getting worse and are repetitive and also present themselves as urges, doubts, and pictures that appear in a person’s mind.
Behavioral symptoms are the effects of anxiety disorder on a person’s behavior and demeanor. Anxiety disorders induce behavioral reactions that a person usually struggles to control. These symptoms are further elaborated on below.
1. Inability to be still and calm
The inability to be still and calm, or restlessness, is defined as feeling to move constantly or being unable to control the mind. A person can experience a combination of the two as well.
Anxiety is a common cause of restlessness, especially in children and adolescents. It causes restlessness due to the direct activation of the fight-or-flight response. When that happens, adrenaline levels go up. For that reason, a person can’t be calm or remain still.
The inability to be still and calm is a symptom of anxiety because it’s a behavioral effect of a trigger that causes severe stress and anxiety. The effect a person can’t control.
The inability to be still and calm is best identified as a feeling of being on edge, nervous, and irritable.
2. Ritualistic behaviors, such as washing hands repeatedly
Ritualistic behaviors, also called compulsive behaviors, are repetitive behaviors or mental acts that a person feels compelled to perform in response to obsessive thoughts. The ritualistic behavior temporarily provides relief from obsession, but a person is more likely to repeat it.
Anxiety can cause compulsive behaviors by affecting brain chemistry and producing obsessive thoughts. For affected individuals, the only way to feel better and reduce the intensity of those thoughts is to repeat certain behaviors. This creates a vicious cycle that is difficult to break. In other words, compulsive behavior acts as a coping mechanism for a person with an anxiety disorder such as OCD.
Ritualistic behaviors are a symptom of anxiety disorder because they are directly caused by a trigger that causes anxiety and obsessive thoughts.
Ritualistic behaviors are identified by repetitive actions such as washing hands constantly, constant cleaning and washing, checking e.g. to see if doors are locked, counting, ordering and arranging, hoarding, and repeating words in your head.
3. Trouble sleeping
Trouble sleeping refers to the inability to get enough sleep during the night for a prolonged period of time. People can experience trouble sleeping due to irregular bedtime schedules, stimulating activities before bed, watching TV, or due to stress and concerns they may have in their life.
Anxiety is a common cause of sleeping problems. According to a paper that Sarah L. Chellappa at University of Cologne and Daniel Aeschbach from University of Bonn Medical Center published in the February 2022 issue of Sleep Medicine Reviews, around 50% of people with anxiety experience sleep disturbances, especially insomnia. Not only does anxiety lead to sleeping problems, but insufficient sleep can worsen anxiety.
Anxiety disorder causes trouble sleeping because fear, panic, and excessive worry make it difficult to fall asleep. Also, people release cortisol and adrenaline when anxious, which makes them excited. When that happens, it’s difficult to fall asleep or get sufficient good night’s rest.
Trouble sleeping is a symptom of anxiety disorder because the reactions to negative stimuli act on a person’s sleep cycle and contribute to problems such as insomnia.
This symptom is best identified by struggling to fall asleep, waking up frequently, lying awake at night, still feeling tired after waking up, having difficulty taking naps during the day even when tired, and being irritable and moody throughout the day.
What are the causes of anxiety disorder?
The causes of anxiety disorder include a combination of factors as listed below:
- Chemical imbalance
- Environmental factors
1. Chemical imbalance
Chemical imbalance is defined as having an excessive or insufficient level of neurotransmitters. A neurotransmitter is a chemical that helps nerve cells communicate with one another. By transmitting signals or sending messages, neurotransmitters help us function.
Imbalances in neurotransmitters and structural or functional impairments can contribute to the development of anxiety disorder. A paper by E.I. Martin et al. from the September 2009 issue of The Psychiatric Clinics of North America reports that symptoms of anxiety stem from a disruption in the balance of activity in the emotional centers of the brain. Enhanced activity in emotion-processing brain areas results from reduced inhibitory signaling by GABA (gamma-aminobutyric acid) or elevated excitatory neurotransmission by glutamate. GABA helps regulate mood, just like glutamate, which also participates in shaping learning and memory.
Besides the abovementioned neurotransmitters, other brain chemicals are also involved in anxiety. For example, Dr. Mohammad-Reza Zarrindast at Tehran University of Medical Sciences and Fatemeh Khakpai at the Institute for Cognitive Science Studies, Tehran published a paper in the September 2015 issue of Archives of Iranian Medicine which showed that dopamine is involved in anxiety modulation in several parts of the brain. Dopamine receptors were found to be decreased in patients with OCD, according to a paper that M-X. Dong et al. published in the December 2020 issue of Frontiers in Neuroscience.
It is also useful to mention that reduced serotonergic activity has been implicated in the development of both anxiety and depression, according to a study by P.R. Albert et al. from the June 2014 issue of Frontiers in Behavioral Neuroscience. That means an imbalance of serotonin also plays a role in the development of anxiety.
Chemical imbalance causes anxiety disorder because imbalances of neurotransmitters have a direct effect on a person’s thinking and behavioral patterns. It is a cause of anxiety because neurotransmitters are important for all functions in our body, including emotions and moods. As levels of neurotransmitters are impaired, a person is unable to react to stressful or negative stimuli in a healthy manner.
Heredity refers to a genetic predisposition for developing a certain mental or physical illness. Parents pass down genes or variations to their children, which increases their susceptibility to a health problem, in this case, a mental illness, anxiety disorder.
Genetics plays a role in the development of many mental conditions ranging from depression to schizophrenia. Anxiety is among them, as well. A review by Katharina Domschke and Eduard Maron at the University of Wurzburg published in the September 2013 issue of Modern Trends in Pharmacopsychiatry shows anxiety disorders have a considerable heredity of 30% to 67%. Several genes are associated with anxiety, including 5-HT1A, MAO-A, 5-HTT, and NPSR1. The March 2019 issue of Current Psychiatry Reports published a review, by Sandra M. Meier and Jurgen Deckert, which confirmed that anxiety disorders are complex and polygenic. The term polygenic refers to the involvement of two or more genes.
Heredity causes anxiety because specific genes are passed on in families. While genetic predisposition can contribute to anxiety, it’s not the only cause. A person may not develop anxiety only because their parents had it. Heredity is combined with other factors that cause anxiety. Genetics is a cause of anxiety because mental illnesses tend to have a genetic component.
3. Environmental factors
Environmental factors are social and cultural factors that play a role in a person’s mental health and can thereby influence the development of mental illnesses.
Medical News Today explains a wide range of environmental factors can influence the onset of symptoms of anxiety disorders. These include a person’s family dynamics, childhood experiences, and cultural or religious upbringing. Social life and behavior are also involved in the development of anxiety, according to a paper by D. Nechita et al. from the April 2018 issue of Romanian Journal of Morphology and Embryology.
When it comes to environmental factors, it’s useful to mention a study by N. Kascakova et al. from the January 2020 issue of the International Journal of Environmental Research and Public Health that revealed the link between childhood trauma and anxiety.
Environmental factors cause anxiety because situations that happen in daily life from our childhood to adulthood help shape our mental health. They contribute to the way people respond to negative stimuli and how they process them. Environmental factors can affect thinking and behavioral patterns. Stressful environments can contribute to an imbalance of chemicals in the brain, which can also lead to anxiety.
In other words, environmental factors are causes of anxiety because the surrounding plays a major role in the way people learn to cope with situations they perceive as stressful or threatening.
What can I expect from an anxiety disorder?
From an anxiety disorder you can expect physical and psychological symptoms as a response to stressful situations or events that past trauma. The specific type of anxiety disorder determines what to expect. A person with panic disorder may have feelings of impending doom accompanied by chest pain and heart palpitations. Someone with GAD worries too much or is out of proportion to the reality of their situation. People with specific phobia experience panic attacks when facing the object of their fear.
Symptoms of anxiety disorders occur in episodes i.e. when they are triggered by a specific situation or event, such as having to speak in public to a lot of people, having thoughts of losing someone, or when exaggerating worries about everyday situations.
What people can expect from an anxiety disorder is that it doesn’t go away on its own, which is why it shouldn’t be taken lightly or ignored.
Who is at risk for anxiety disorders?
People with a history of trauma are at a high risk of developing anxiety disorders. Witnessing or experiencing trauma is a risk factor for anxiety disorder, regardless of whether it happened in childhood or adulthood, according to Mayo Clinic.
Stress buildup can lead to anxiety as well. It can be due to a major life stressor or an accumulation of smaller stressful situations that a person didn’t process in a healthy manner. Situations like work stress or the loss of a loved one, and financial difficulties can trigger anxiety.
People with serious illnesses are also at risk for anxiety disorder because they worry a lot about their treatment and future. Other risk factors include drug or alcohol use, family history, and personal history of other mental disorders such as depression.
A study by C. Blanco et al, from the September 2014 issue of the journal Depression and Anxiety, reported that anxiety is associated with risk factors such as low self-esteem, female gender, childhood sexual abuse, white race, and disturbed family environment. A number of traumatic experiences and years of education also play a role in a person’s risk of anxiety disorders.
How are anxiety disorders diagnosed?
To diagnose anxiety disorder, a doctor may perform a physical exam first. The main objective of a physical exam is to determine whether symptoms of anxiety occur due to a specific physical illness. To do so, a doctor will order blood tests and urine tests. These tests can also show if a person used drugs.
In people with anxiety disorder, these tests show symptoms that can’t be explained by a medical condition. When that happens, a doctor refers a patient to a psychiatrist for psychiatric evaluation. The process of psychiatric evaluation involves discussing a patient’s thoughts, behaviors, and feelings. A patient may need to complete a questionnaire about their symptoms.
Diagnosing anxiety disorders can be challenging because they tend to co-occur with other mental conditions, such as substance abuse and depression.
To make an accurate diagnosis, the psychiatrist will use DSM-5 to check whether symptoms meet diagnostic criteria. Psychiatrists diagnose anxiety disorders when symptoms have a major impact on a person’s daily functioning. Each type of anxiety disorder has its diagnostic criteria. For example, GAD is diagnosed when symptoms occur for at least six months.
How are anxiety disorders treated?
Anxiety disorders are treated with a well-structured treatment program. See the doctor in a timely manner i.e. when symptoms of anxiety occur and are persistent. Encourage a friend or family member to see a healthcare professional if they experience symptoms of anxiety. Reach out to friends or family for support, since it has a beneficial impact on the treatment progress and a person’s motivation to get better. Adhere to the doctor-recommended treatment religiously. That means, a patient diagnosed with an anxiety disorder should take medications exactly as prescribed and recommended. It is also necessary to go to therapy sessions regularly. Adhering to the treatment protocol is the best way to get better.
What are the treatments available for anxiety disorder?
Treatments available for anxiety disorder are a combination of psychotherapy and medications. They are listed below:
- Anti-anxiety medications
- Cognitive behavioral therapy (CBT)
- Exposure therapy
1. Anti-anxiety medications
Anti-anxiety medications, or anxiolytics, are medications formulated to reduce the symptoms of anxiety, such as extreme fear or worry and panic attacks. The most common medications prescribed for this purpose are benzodiazepines. They treat anxiety by enhancing the activity of GABA neurotransmitters thus promoting a sense of calm.
Anti-anxiety medications are among the treatments for anxiety disorders because they help people tackle the most intense symptoms of their anxiety disorder.
Anxiolytic medications such as benzodiazepines are effective in the treatment of anxiety disorders. For example, a meta-analysis by J. Breilmann et al. from the March 2019 issue of Cochrane Database of Systematic Reviews found that benzodiazepines were more effective than placebo in the treatment of panic disorder in adults.
How long it takes for anti-anxiety medications to work depends on the type of medication. For example, benzodiazepines work rapidly within 30 to 60 minutes. People who take buspirone, another anti-anxiety medication, may experience its effects for one to two weeks or longer up to three or four weeks.
Antidepressants are a class of medications that are prescribed for the treatment of clinical depression or to prevent it from recurring. Classes of antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can help treat anxiety.
Antidepressants treat anxiety because they work on neurotransmitters in the brain such as serotonin and norepinephrine. These neurotransmitters play a role in mood, sleep, anxiety, and a general feeling of well-being. As a person takes these medications, levels of these neurotransmitters in the brain improve, which could help with anxiety symptoms.
The use of antidepressants in treatment for anxiety disorders is due to their potential to support the balance of chemicals in the brain i.e., neurotransmitters that can help reduce symptoms that people experience.
Antidepressants are effective for patients with anxiety disorder. A review by R. Schmitt et al. from the March 2005 issue of the Brazilian Journal of Psychiatry reported that antidepressants are superior to a placebo in the treatment of GAD and are a reasonable treatment for this mental illness. A study by Y.A. de Vries et al. in the June 2018 issue of Depression and Anxiety found antidepressants are equally effective across severity levels for social anxiety disorder, OCD, and PTSD.
Most antidepressants need one to two weeks to start working, with full benefits occurring in four to eight weeks.
Beta-blockers are a class of medications that are primarily prescribed for the management of abnormal heart rhythm or to protect the heart from a second heart attack when patients have already experienced one.
These medications aid the treatment of anxiety disorder by addressing physiological concerns. They help with heart palpitations, shaking, or tremors.
The use of beta-blockers for the treatment of anxiety disorder is effective, but more research is necessary. A paper that professor A.V. Srinivasan at the Indian Institute of Technology published in the January-March 2019 issue of the Annals of the Indian Academy of Neurology reported that a beta-blocker, Propranolol helps address hyperactivity and hyperarousal associated with anxiety. This medication has a long history of use for anxiety. The paper explains it was first prescribed for anxiety back in the 1960s. The medication can alter the way memories are stored in the brain and may exhibit an amnestic effect on unpleasant memories.
Beta-blockers are among the treatments for anxiety disorder because they can successfully relieve major physical reactions to triggers of anxiety.
Beta-blockers such as Propranolol should start working within an hour or two, but their effects start to fade about four hours after taking the medication.
4. Cognitive behavioral therapy (CBT)
Cognitive-behavioral therapy is a type of talk therapy that helps patients manage problems by changing the way they think or behave. It is the most common type of therapy used for people with anxiety disorders.
Cognitive behavioral therapy works for anxiety by helping patients recognize irrational or unrealistic and negative thought patterns in order to replace them with more rational and positive alternatives. A therapist works closely with the patient to help them change the problematic thought patterns because thinking influences emotions and behaviors. During CBT sessions, patients also learn skills that improve their functioning, such as communication skills.
The reason CBT is one of the treatments for anxiety disorders is that it aims to stop negative cycles by breaking down things that make a person feel anxious or scared. This therapy makes problems more manageable and improves how a person feels about themselves or handles and copes with negative stimuli.
Evidence, such as a paper by Dr. Christian Otte at University Medical Center Hamburg-Eppendorf published in December 2011 issue of Dialogues in Clinical Neuroscience, confirms that CBT is an effective therapy type for people with anxiety disorders. Additionally, a paper by J.E. Curtiss et al. from the June 2021 issue of the journal Focus reported that CBT is an effective therapy for anxiety disorders that can serve as a standalone treatment or work in combination with medications or novel interventions such as mindfulness.
People with anxiety disorder may need between six and 20 sessions to achieve improvements. The exact number of sessions depends on the severity of anxiety disorder and its symptoms.
5. Exposure therapy
Exposure therapy is a type of psychological treatment that aims to help people confront their fears. It is typically used to help people with anxiety disorders such as phobias, GAD, OCD, panic disorder, social anxiety disorder, and PTSD.
This type of therapy works by gradually exposing a patient to an event, situation, or object that triggers fear, panic, and anxiety. Exposure is performed in a safe and controlled setting. The main goal is to change reactions to the feared stimuli and lessen symptoms of anxiety. The therapist usually starts small. A patient may be exposed to images or virtual reality before they graduate to in vivo exposure. This is done according to the patient’s pace and how they overcome each stage of exposure.
Exposure therapy is a treatment for anxiety disorders because it is a practical way for people to adapt their reactions to negative or feared stimuli. With exposure therapy, their symptoms can noticeably decrease.
Although more research is necessary, exposure therapy is effective for people with anxiety disorder. For example, a paper by D. Boeldt et al. from the October 2019 issue of Frontiers in Psychiatry shows exposure therapy techniques such as virtual reality improve the treatment of anxiety disorders by allowing for individualized, gradual, controlled, and immersive exposure.
People with an anxiety disorder may need nine to 12 sessions, but there is also prolonged exposure therapy which requires eight to 15 sessions.
Can anxiety disorder be prevented?
No, anxiety disorder can’t be prevented, Cleveland Clinic explains. The exact causes of anxiety disorders are unclear, which is why it’s difficult to prevent them. After all, genetics plays a role in the development of anxiety disorder as well. However, it is possible to reduce the risk of anxiety, prevent future episodes or avoid complications associated with it.
How to prevent having an anxiety disorder?
You can’t prevent an anxiety disorder, but you can lower the risk of it or prevent new episodes. Tips on how to prevent having an anxiety disorder are listed below:
- Prioritize self-care
- Consult a doctor about over-the-counter medications or herbal medicines you’re taking, because they may worsen the symptoms
- Get professional help to process trauma
- Take care of mental health with therapy
- Limit caffeine intake
- Manage stress
- Eat a well-balanced diet
- Exercise regularly
- Avoid alcohol, drugs, and tobacco
- Keep a journal to track your moods, stress, and anxiety
- Keep things organized, especially if your lifestyle is hectic
How to help someone with anxiety disorder?
Tips for how to help someone with anxiety disorder are listed below:
- Get educated about the symptoms of a specific anxiety disorder
- Be a good listener
- Make sure a person with anxiety disorder knows they have support i.e., they’re not alone
- Communicate with them
- Look after yourself
- Avoid enabling their anxiety
- Make sure not to constantly talk or discuss their disorder
- Encourage the person to breathe slowly and deeply when having a panic attack
- Offer to accompany them to therapy and learn skills to better support them
- Spend time together engaging in fun and relaxing activities
Is anxiety disorder a chemical imbalance?
No, anxiety disorder is not a chemical imbalance. It is more complex than that. However, chemical imbalance is one of the causes of anxiety disorder. Long-lasting and severe stress can affect the chemical balance that controls a person’s mood, Cleveland Clinic explains.
Experiencing stress over an extended period of time can lead to anxiety. People with anxiety have impaired levels of neurotransmitters such as GABA and glutamate, and dopamine and serotonin, as seen above in this post.
To sum up, while anxiety disorder can be caused by an impaired balance of neurotransmitters, it’s not the same thing as a chemical imbalance. Chemical imbalance is one of several causes of anxiety disorders, and it is also involved in other conditions, such as depression.
What is the difference between anxiety disorder and depression?
The difference between anxiety disorder and depression is in the symptoms they exhibit. Also, depression is a single disease, whereas anxiety disorder is an umbrella term that refers to multiple mental illnesses that share symptoms of anxiety.
Symptoms of depression revolve mainly around feelings of sadness, hopelessness, loss of interest, and low energy and motivation. On the other hand, anxiety disorders are indicated by dread, worry, and nervousness, WebMD explains.
What is the difference between anxiety disorder and panic disorder?
The difference between anxiety disorder and panic disorder is that the latter is a form of anxiety disorder. The term anxiety disorder involves a wide spectrum of conditions and panic disorder is one of them. What makes panic disorder different from other anxiety disorders is that it includes episodes of panic attacks accompanied by physical symptoms.
What is the difference between anxiety disorder and stress?
The difference between anxiety disorder and stress is that the latter occurs as a response to a recognized threat whereas anxiety doesn’t always have an identifiable trigger. In the presence of a recognized threat, stress tends to be short-term, whereas anxiety can linger, Medical News Today explains. Stress usually occurs due to external causes, whereas the origin of anxiety is internal.