Anxiety Disorders: Types, Causes, Symptoms, & Treatment

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Anxiety Disorders

Anxiety or anxiety disorders? Anxiety is a natural emotional response to a threatening situation. Feelings of worry, nervousness, or unease about an upcoming speaking engagement, exams, or workplace pressures are common to all of us.

Usually, these feelings are reasonable and we adapt to the situation, despite how uncomfortable our initial response might be.

These feelings might even last two to three weeks, depending on the stressful nature of the situation. A person may request short-term treatment to help cope with the event.

However, this does not indicate an anxiety disorder and it is important to understand the difference between short-term anxiety and an anxiety disorder.

It is estimated that 2.5 to 7% of people suffer from anxiety disorders and that 25% of people will experience at least one anxiety disorder in their lifetime. There are many different types of Anxiety Disorders.

Among them are Panic Attack, Panic Disorder, Agoraphobia, Agoraphobia without a history of Panic Disorder, Panic Disorder with Agoraphobia, Specific Phobia, Social Phobia, Post Traumatic Stress Disorder, Obsessive-Compulsive Disorder, Anxiety Disorder Due to Medical Conditions, Substance-Induced Anxiety Disorder, Separation Anxiety, and Generalized Anxiety Disorder.

Each of these disorders has its own specific group of symptoms but all are characterized by excessive irrational fear and dread and therefore many psychological and medication treatments will be common among the disorders.

It is important to seek treatment for these conditions, realizing they are treatable medical disorders, and not make the mistake of viewing them as weaknesses or instability of character.

Types of Anxiety Disorders

There are a large number of disorders that are considered to be a form of anxiety disorder. Although each of these disorders has unique characteristics, they have one thing in common; which is excessive irrational fear and dread that interferes with normal daily activity. The different types of anxiety disorders include:

Panic Disorder

Panic disorder is characterized by panic attacks that occur without warning, in which at least some of the attacks are not associated with any specific situation. These attacks cause the person to have a persistent fear of further attacks.

Not everyone who has a panic attack has panic disorder. Some people may have only one attack or may have attacked only in specific situations.

A panic attack is a specific period of intense fear. It usually comes on relatively quickly, builds up over about a 10-minute period, and rarely lasts for more than 20 to 30 minutes.

During this period people may experience heart pounding, chest pain, shortness of breath, faintness, dizziness, nausea, flushing, chills, a sense of loss of control or going crazy, light-headed, or fear of dying.

Agoraphobia

Agoraphobia is irrational anxiety or fear of open or public places, in a person without a history of panic attacks. As a result, the person avoids the situation, enters the situation under extreme anxiety, or requires someone to be present with them in order to go into the situation.

Panic Disorder with Agoraphobia

It is characterized by recurrent unexpected panic attacks, resulting in a person avoiding situations for fear of a panic attack or needing to be accompanied by another person in order to go into the situation.

Specific-Phobia

Phobias are extreme or irrational fears of something, such as spiders, thunderstorms, seeing blood, elevators, driving across bridges, or choking. Most people experience extreme anxiety when they anticipate a situation. As a result, they avoid the situation when possible or enter the situation with an unreasonable degree of anxiety.

Social-Phobia

Social phobia is Social Anxiety Disorder. It is characterized by persistent fear or anxiety related to a specific performance, such as a public speaking engagement or it may be a more generalized phobic response to a number of social situations such as parties, participating in small group settings, public performances, or other socially interactive situations.

Obsessive-Compulsive Disorder

It is a condition in which people are plagued by persistent unwanted thoughts (obsessions) and the feeling of needing to do certain things (compulsions) in an attempt to relieve the anxiety symptoms. Examples include:

Obsession

Leave door unlocked
Turn the stove off
Hit someone while driving
Contamination

Compulsion

Repeatedly returning to check the door
Repeatedly checking the stove
Repeatedly driving around the block to check
Repeated hand washing

Post Traumatic Stress Disorder

People who have experienced or seen a terrifying event in their lives such as a fatal accident, war, rape, or some natural disaster might go on to experience intense fear, helplessness or horror, reliving the terrifying experience in their minds (flashbacks), depression, anger or irritability. The symptoms are intense, persistent, and may interfere with relationships and normal daily functioning.

Generalized Anxiety Disorder

This disorder is characterized by almost daily, excessive worry or anxiety which lasts six months or more over a variety of situations. This anxiety is accompanied by a number of symptoms such as sleep disturbance, irritability, concentration problems, or muscle tension.

Anxiety Disorder Due to General Medical Illness

It is best described as anxiety as a symptom of a medical illness, rather than as a disorder. In these cases, treating the illness is often all that is required to alleviate the anxiety symptoms. Medical illnesses that can produce anxiety symptoms include:

Endocrine conditions- hypo or hyperthyroidism, hypoglycemia, hyperadrenocorticism
Heart conditions- congestive heart failure, arrhythmia, pulmonary embolism
Respiratory conditions- pneumonia, hyperventilation, chronic obstructive lung disease
Metabolic conditions-Vitamin B 12 deficiency

Substance-Induced Anxiety Disorder

Again, this is a situation in which anxiety is best described as a symptom experienced as a side effect of a medication, illicit drug use, or a toxic chemical. Removing the offending substance usually results in the disappearance of the anxiety symptoms.

Separation Anxiety Disorder

This type of anxiety disorder is most commonly develops in children before the age of 18. It is characterized by excessive anxiety, beyond what is expected for the age when separated from someone to whom the child is attached. It is labeled a disorder when it lasts beyond 4 weeks and interferes with normal functioning. Because palpitations, fear, and dizziness are not common before adolescence, symptoms may appear as nightmares, preoccupation with either losing the person or being reunited with them, sleeping with the person or outside their door, if not allowed in, and talking about getting lost.

Symptoms

Anxiety symptoms vary among different people and according to the type of anxiety disorder. However, one symptom common to all anxiety disorders is the irrational fear that makes it difficult to carry out normal daily activities. Symptoms include:

Excessive worry and anxiety over routine life activities (work school)
Physiological symptoms (nausea, trembling, fatigue, muscle tension, headaches)
Irritability
Difficulty concentrating,
Sleep disturbance (frequent awakening, wake up tired, difficulty getting to sleep)
Panic attacks (rapid heartbeat, smothering or choking sensation, fear of going crazy, feeling of impending doom, losing control, chilled, flushed, fear of dying, sweating, weak, faint, dizzy, light-headed, chest pain, nausea, tingling in the hands, trembling, shaking)
Avoiding going out for fear of panic attacks (agarophobia-crowds, bus, plane)
Excessive worry over panic in specific situations (speech, exam, interview)
Excessive worry in social situations (work, school, church, party)
Anxious, intrusive worries (turn off the stove, lock the door, contaminated objects)
Nightmares, flashbacks, depression, sleep disturbance, exaggerated startle response after a traumatic event.

What causes anxiety disorders?

Causes for anxiety disorder will vary according to the different types of anxiety disorder which you can be viewed in-depth under the Types of Anxiety Disorders disorders.

Causes of anxiety disorders include:

Traumatic event (i.e. war, attack, rape, witness to a fatal accident)
Medical condition
Substance abuse
Medication
Family history (genetic cause)
Family patterns of behavior (environmental cause)
Developmental issues
Behavioral issues
Chemical imbalances (need further research)
Thinking habits and patterns
Unresolved issues

Anxiety Treatment

In situations where anxiety symptoms are associated with a substance being used or a medical condition, it would be hoped the resolution of the condition or removal of the offending substance would resolve the anxiety symptoms.

In anxiety disorders not associated with substance use or medical conditions two types of treatment are available, medication and non-medication treatments. Specific types of psychotherapeutic therapies (talking therapies) appropriate to the specific disorder are often used by psychiatrists, psychologists, social workers, or other mental health care workers.

Research has found in many cases a combination of medication and non-medication treatment is the best option for a number of these disorders. In some anxiety disorders, for instance, in specific phobias, psychotherapy is necessary for effective treatment as medication alone has not been found to be effective.

Anxiety Medication

A number of medication treatments are available for the various anxiety disorders and it is important to realize if one has not worked that there are other possibilities and so you should not give up hope but realize you might have to try different courses of action until you find the course that is most suitable for you and your condition.

Benzodiazepines

These agents are among the best-known medications for treating anxiety. Although all benzodiazepines are known to relieve anxiety symptoms some have FDA approval for anxiety treatment while others are approved for use as sleeping agents (sedative-hypnotics) while others are used for both purposes.

There are short-acting, intermediate, and long-acting medications in this class. The length of action of the medication is determined by how fast the body breaks down (metabolizes) the active part of the medication and eliminates it from the body.

Anti-Anxiety

Alprazolam (Xanax) – [Intermediate acting]
Bromazepam (Lectopam) – [Intermediate acting]
Lorazepam (Ativan) – [Intermediate acting]
Oxazepam (Serax) – [Intermediate acting]
Temazepam (Restoril) – [Intermediate acting]
Chlordiazepoxide hydrochloride (Librium) – [Long acting]
Clorazepate (Tranxene) – [Long acting]
Diazepam (Valium) – [Long acting]

Sedative/Hypnotics

Midazolam (Versed) – [Short acting]
Triazolam (Halcion) – [Short acting]
Alprazolam (Xanax) – [Intermediate acting]
Bromazepam (Lectopam) – [Intermediate acting]
Lorazepam (Ativan) – [Intermediate acting]
Oxazepam (Serax) – [Intermediate acting]
Temazepam (Restoril) – [Intermediate acting]
Flurazepam (Dalmane) – [Long acting]
Nitrazepam (Mogadon) – [Long acting]
Clorazepate (Tranxene) – [Long acting]
Diazepam (Valium) – [Long acting]

Side effects – The most common side effects of these medications are drowsiness, fatigue, confusion, and disorientation-primarily in the elderly, dizziness, decreased concentration, decrease memory, dry mouth, and blurred vision.

Precautions – These medications can impair the ability to drive operate machinery or perform dangerous tasks. The lower tolerance to alcohol and increase confusion and impairment due to their own side effects when taken in conjunction with alcohol so alcohol and benzodiazepines should not be taken together. Physical and psychological dependence can occur, with withdrawal symptoms which are in keeping with dosages and length of time taking these medications.

Antihistamine – Hydroxyzine (Atarax) is an antihistamine that has anti-anxiety properties. It is indicated for use in anxiety and tension in preparation for dental procedures and acute emotional problems. It is also used in managing anxiety associated with organic disturbances and as add-on therapy in alcoholism and allergic conditions such as chronic itching and contact allergies. People with allergic conditions with a strong anxious or emotional component such as asthma might also benefit from hydroxyzine as a medication choice.

Side effects – Common side effects are often mild and disappear after several days on the medications. They are drowsiness, dry mouth, and headache.

Precautions – Patients need to take caution or avoid tasks that require alertness such as driving or operating dangerous equipment, side effects disappear, avoid drinking alcohol, or taking other medication which has similar (CNS depressant) effects.

Azapirone – Buspirone (Buspar) This is a class of drugs that help in anxiety but are not related to benzodiazepines. They can be useful in patients with a history of substance or alcohol abuse or patients for whom it is important not to have side effects that might cause sedation or psychomotor impairment. 4 Buspirone is indicated in generalized anxiety disorder. It has demonstrated positive effects in chronic anxiety, post-traumatic stress disorder, social phobia, and alcohol withdrawal.

Side effects – The common side effects of this medication are seen at the beginning of treatment and generally decrease or go away with continued use or a decreased dose. They are headache, dizziness, lightheadedness, nervousness, excitement, fatigue, nausea, clamminess, or sweatiness.

Antidepressants – A number of antidepressants are used in anxiety disorders. Patients sometimes resist these treatments, reporting “but I am not depressed.” However, the neurotransmitters and areas of the brain involved in anxiety and depression have considerable overlap and interaction with each other.

It stands to reason, then, that the same medications will sometimes be useful for both disorders. This is the case with anxiety and many antidepressants are found to be effective for these disorders.

Two groups of newer medications with fewer side effects than older antidepressant medications are SSRIs Selective Serotonin Reuptake Inhibitors i.e. paroxetine (Paxil) and SNRIs Serotonin Norepinephrine Reuptake Inhibitors ie venlafaxine (Effexor) are used for anxiety disorder.

Both paroxetine and venlafaxine have received approval for use in anxiety. Other SSRIs are fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram which are also commonly seen in various disorders.

The list below shows medications that have gained approval from regulating bodies for specific disorders, while some of the other SSRIs may still have ongoing studies in the various disorders and may be tried for these disorders by your physician for a variety of reasons such as drug interactions or side effects from one of the approved medications.

Obsessive-Compulsive Disorder – [SSRI]
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Obsessive-Compulsive Disorder – [Tricyclic Antidepressant]
• Clomipramine (Anafranil)

Panic Disorder – [SSRI]
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Post Traumatic Stress Disorder – [SSRI]
• Paroxetine (Paxil)

Social Phobia
• Paroxetine (Paxil) – [SSRI]
• Venlafaxine (Effexor) – [SNRI]

Monoamine oxidase inhibitors – These are the oldest class of antidepressants. Phenelzine (Nardil) and tranylcypromine (Parnate) are still available today. They have more side effects and drug interactions than many of the newer classes of effective drugs. Some have been useful in anxiety disorders such as social phobias and panic disorder but diet restrictions and some serious interactions generally mean other safer medications will be tried first.

Beta-blockers – These medications are used to treat heart and blood pressure problems. They have however been used for anxiety disorders such as social phobia when one has had to do a presentation and have been effective in reducing a pounding heart rate, shaking hands, and other physiological symptoms from developing.

Beta-blockers – Many mental health workers, psychiatrists, psychologists, social workers, or counselors are trained in ‘talking’ therapy which can help people with anxiety disorders learn how to deal with their problems.

A common and effective psychotherapeutic approach used in many anxiety disorders is called Cognitive-Behavioral Therapy. Cognition is knowing or understanding things through our thinking. This therapy then helps the person to learn to think about things differently, in ways that might help them to not respond with anxiety.

They can help a person recognize faulty thinking and develop new healthy thinking patterns. The behavioral aspect of the therapy involves encouraging the person to expose themselves to the anxiety-provoking situation for brief periods or in a controlled manner and then help them deal with the emotions that arise from the exposure.

Patients may initially participate in this through pictures or movies and then be encouraged when they are ready to enter the real situation with the therapist present and then alone. Patients are not forced into these situations. They are in control of determining if they are willing, how long, or when they are willing to begin or end the process.

They set the pace for what they can comfortably handle. Since the therapist’s goal is to reduce anxiety and not provoke it, they need to remember and be comfortable with this fact and understand that therapy will be tailored to their specific need.

Sometimes a combination of psychotherapy and medication treatment is more effective than either form of treatment used alone. It is also important to realize that a patient with an anxiety disorder may be treated and remain symptom-free for a period of time, only to have the symptoms return later.

It is not uncommon for a number of mental disorders to have relapses. Remain optimistic. The best solution is to return to your physician as soon as you may become concerned that relapse is taking place and be followed by your physician. You might need to return to medication or psychotherapy for another period of time and the best results are obtained the earlier a patient receives treatment.

Sources

Mental Health https://ourworldindata.org/mental-health#anxiety-disorders
Anxiety Treatment