Anxiety Attacks and Disorders:

What is an anxiety disorder?

Anxiety disorders can take many forms. You may experience free-floating anxiety without knowing exactly why you’re feeling that way. You may suffer from sudden, intense panic attacks that strike without warning. Your anxiety may come in the form of extreme social inhibition or in unwanted obsessions and compulsions. Or you may have a phobia of an object or situation that doesn’t seem to bother other people.

Despite their different forms, all anxiety disorders share one thing in common: persistent—and often overwhelming—fear or worry. The frequency and intensity of these fears can be immobilizing, distressing, and disruptive. Characteristics of an anxiety disorder include:

• Anxiety which is constant, unrelenting, and all-consuming
• Anxiety which causes self-imposed isolation or emotional withdrawal
• Anxiety which interferes with normal activities like going outside or interacting with other people

The toll an anxiety disorder takes on your life can lead to other problems as well, such as low self-esteem, depression, and alcoholism. Anxiety can also negatively impact your work and your personal relationships. But the good news is that anxiety disorders are highly treatable. With the help of a qualified mental health professional, you can get relief from your worries and lead the life that you want.

Anxiety attacks and panic attacks

Anxiety attacks, also called panic attacks, are unexpected episodes of intense terror or fear. Anxiety attacks usually come without warning, and although the fear is generally irrational, the perceived danger is very real. A person experiencing an anxiety attack will often feel as if they are about to die or pass out.

Symptoms of an anxiety attack include:

Shortness of breath Palpitations or pounding heart Chest pain or discomfort Trembling or shaking

Dizziness Nausea or stomach distress Fear of losing control or going crazy Hot or cold flashes

Signs and symptoms of anxiety disorders

The primary symptoms of anxiety disorders are fear and worry. However, anxiety disorders are also characterized by additional emotional and physical symptoms.

Emotional/Psychological Symptoms
Apprehension, uneasiness, and dread Impaired concentration or selective attention Feeling restless or on edge Avoidance Hypervigilance Irritability Confusion	Behavioral problems (especially in children and adolescents) Nervousness and jumpiness  Self-consciousness and insecurity Fear that you are dying or going crazy Strong desire to escape

Physical Symptoms
Heart palpitations or racing heartbeat Chest pain  Hot flashes or chills Cold and clammy hands Stomach upset or queasiness Frequent urination or diarrhea Shortness of breath	Sweating Dizziness Tremors, twitches, and jitters Muscle tension or aches Headaches Fatigue Insomnia

Causes and risk factors for anxiety

There are a number of complex factors that contribute to the development of anxiety disorders. Your environment, personality, family dynamics, brain chemistry, and genetics all can play a role. In addition, major life stressors such as financial difficulties, marital problems, or bereavement often trigger the onset of an anxiety disorder. It is important to realize that no single factor causes an anxiety disorder. The various anxiety risk factors are interrelated and can interact with and impact one another.

Interrelated Anxiety Disorder Risk Factors
Environmental factors	A person’s environment can play a huge role in the development of anxiety disorders. Difficulties such as poverty, early separation from the mother, family conflict, critical and strict parents, parents who are fearful and anxious themselves, and the lack of a strong support system can all lead to chronic anxiety.
Personality traits	Personality differences can affect whether or not an anxiety disorder develops. People with anxiety disorders often view themselves as powerless and the world as a threatening place. This pessimistic perspective can lead to low self-confidence and poor coping skills.
Brain chemistry	Some studies suggest that an imbalance of neurotransmitters such as serotonin, GABA, and epinephrine may contribute to anxiety disorders. Abnormalities in the stress hormone cortisol have also been found. Many medications prescribed for anxiety disorders aim to readjust the brain’s chemical balance.
Heredity	Anxiety disorders tend to run in families. People with anxiety disorders often have a family history of anxiety disorders, mood disorders, or substance abuse. Although this is often due to the home environment, researchers also believe that there are genetic factors which represent an inherited risk for anxiety disorders. One risk factor may be a biological vulnerability to stress.
Trauma	An anxiety disorder may develop in response to a traumatic event, such as a car accident or a marital separation. Anxiety may also have its roots in early life abuse or developmental trauma. Trauma in infancy and early childhood can be particularly damaging, leaving a pervasive and lasting sense of helplessness that can develop into anxiety or depression in later life. For more information, see Helpguide’s Emotional and Psychological Trauma: Causes, Symptoms, Effects, and Treatments.

Types of anxiety disorders

There are several major types of anxiety disorders, each with its own distinct profile and set of symptoms. Click on the links below for Helpguide’s in-depth overviews of the different anxiety disorders, including treatment options and self-help tips.

Generalized Anxiety Disorder (GAD) – If constant worries and fears distract you from your day-to-day activities or you’re troubled by a persistent feeling that something bad is going to happen, you may be suffering from GAD. People with GAD feel anxious nearly all of the time, though they may not even know why. Anxiety related to GAD often manifests itself in physical symptoms like headaches, stomach upset, and fatigue.

Obsessive Compulsive Disorder (OCD)  – OCD is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. You may be troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over. 

Panic Attacks and Panic Disorder – Panic disorder is characterized by repeated, unexpected panic attacks. These panic attacks strike without warning and usually last a terrifying 15 to 30 minutes. Panic disorder may also be accompanied by agoraphobia, which is a fear of being in places where escape or help would be difficult in the event of a panic attack. If you have agoraphobia, you are likely to avoid public places such as shopping malls or confined spaces such as an airplane.

Phobias – A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights. In the case of a severe phobia, you might go to extreme lengths to avoid the thing you fear.

Separation Anxiety – Separation anxiety is a normal part of child development. It consists of crying and distress when a child is separated from a parent or away from home. If separation anxiety persists beyond a certain age or interferes with daily activities, it may be a sign of separation anxiety disorder.

Social Anxiety / Social Phobia – If you have a debilitating fear of being seen negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia.

Diagnosing anxiety disorders

If you’ve experienced intense anxiety or worry for six months or more, you may be suffering from an anxiety disorder. Worry that interferes with your work, relationships, and activities is also a red flag that you’ve crossed from normal worrying into the territory of anxiety disorders. If your anxiety and fears have become so great that they are causing extreme distress or disrupting your daily routine, it is important to seek out help.

First, you should consult with a doctor to rule out possible medical conditions. Some medications or diseases create anxiety-like symptoms such as rapid heartbeat, dizziness, nausea, and nervousness. A change in medication or the correct diagnosis of a medical illness may take care of your anxiety problem. Your doctor will give you a physical examination and may also run some laboratory tests.

Medical Conditions Which Can Mimic or Cause Anxiety
Thyroid Disorders Diabetes Hypoglycemia Asthma Sleep Disorders	Adrenal Disorders Epilepsy Certain heart conditions Migraines Other psychiatric illnesses

Medications and Substances Which can Induce Anxiety
Caffeine and other stimulants Drugs such as heroin, cocaine, and amphetamines Over-the-counter medications such as decongestants Steroids such as cortisone and prednisone Weight loss products Hormones (birth control pills, thyroid medication)	Inhalers and other respiratory medications Herbal remedies such as Ma huang and ephedra High blood pressure medication Withdrawal from alcohol ADHD medications (Ritalin, Adderall, Dexedrine) Withdrawal from benzodiazepines (Xanax, Valium)

Anxiety can also exacerbate many pre-existing medical conditions, such as ulcers, hypertension, and respiratory conditions including asthma and chronic obstructive pulmonary disease. Furthermore, anxiety is associated with mitral valve prolapse, chronic fatigue syndrome, sleep apnea, irritable bowel syndrome, and chronic tension headaches. Because of the many medical issues that can cloud the diagnostic picture, working hand-in-hand with both a physician and a mental health professional is key.

If your physician rules out medical complications, your next step is to consult with a qualified psychotherapist or counselor. Your therapist will work with you to determine the cause and type of your anxiety disorder and devise a course of treatment.

Treatment and help for anxiety

Anxiety disorders respond very well to treatment, so if you’re suffering from one, don’t hesitate to seek help. This is unfortunate because Treatment can offer immense relief, often in a relatively short amount of time. Most anxiety disorders are treated with cognitive-behavioral therapy (CBT), medication, or a combination of the two.

Cognitive-Behavioral Therapy

Cognitive-behavior therapy (CBT) is very effective in the treatment of anxiety disorders. As the name suggests, CBT focuses on changing both maladaptive thinking patterns—or cognitions—and behaviors. If you’re suffering from an anxiety disorder, CBT will help you identify and challenge the negative and irrational beliefs that are holding you back from working through your fears. Another key component of CBT is exposure. In exposure therapy, you confront your fears in a safe, controlled environment. Through repeated exposures, you will gain a greater sense of control over your anxieties. As you learn new skills for dealing with stressful situations, you will begin to get the upper hand on anxiety.
Cognitive-behavior therapy for anxiety usually takes between 12 and 20 weeks. CBT is conducted both in individual therapy and in groups of people with similar anxiety problems.

Medication

A variety of medications are used in the treatment of anxiety disorders, including traditional anti-anxiety drugs, antidepressants, and beta-blockers. Medication is sometimes used in the short-term to alleviate severe symptoms so that other forms of therapy can be pursued. Anxiety medications can be habit forming and may have unwanted side effects, so be sure to research your options.

Natural and Herbal Treatments

Herbal remedies such as valerian root and kava kava have been used to treat anxiety for many years. However, the effectiveness and safety of these products has not been well-documented. Keep in mind that some herbal remedies can make anxiety worse.

Keep in mind that some herbal remedies can make anxiety worse. Supplements may also interact with other prescription or over-the-counter drugs you are taking, so it’s important to check with your doctor first.

Other Anxiety Disorder Treatments

• Relaxation techniques – Relaxation techniques such as progressive muscle relaxation, controlled breathing, and guided imagery may reduce anxiety.
• Biofeedback – Using sensors that measure physiological arousal brought on by anxiety (such as changes in heart rate and muscle tension), biofeedbackteaches you to recognize and control these body processes.
• Hypnotherapy – Hypnosis for anxiety is conducted by a clinical hypnotherapist who works with you using different therapeutic techniques while you’re in a state of deep relaxation.
• Acupuncture – Long used in traditional Chinese medicine, acupuncture may help reduce anxiety.

Managing and coping with anxiety

A healthy and balanced lifestyle can help you control and reduce your anxiety. Here are a number of things you can do to keep anxiety at bay:

Self-Help Tips for Controlling & Reducing Anxiety
Exercise regularly	Exercise is an effective treatment for anxiety. Yoga and aerobic activities are particularly calming.
Get enough sleep	Lack of sleep can exacerbate anxiety. Getting the Sleep You Need describes the importance of a full-night’s rest and offers tips on how to sleep well.
Eat a healthy diet	Healthy eating can help you in your battle against anxiety and stress. Make sure your diet includes plenty of fruits and vegetables. Read Healthy Eating for guidelines and tips.
Meditate	Many types of meditation have been shown to reduce anxiety. Common types of meditation include mindfulness, walking meditation, and transcendental meditation.
Practice relaxation techniques	Relaxation techniques such as deep breathing and visualization can help reduce anxiety.
Avoid alcohol and drugs	Don’t use substances to cope with your anxiety. They can make the problem worse, and eventually will cause problems of their own.
Eliminate caffeine	Stop drinking or cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine can increase anxiety, cause insomnia, and even provoke panic attacks.
Cultivate a support system	Spend as much time as possible with people who make you feel good and are emotionally supportive. The more social support you have from friends and family, the less vulnerable you will be to anxiety and stress.

Related links for anxiety

General information on Anxiety Disorders

Anxiety Disorders – Comprehensive patient education resource on the types, causes, diagnosis, and treatment of anxiety disorders. Written in 2002. (University of Maryland Medical Center)

Anxiety Disorders – Guide to the different types of anxiety disorders, their symptoms, and how to get help. (National Institute of Mental Health)

Anxiety Disorders Treatment

Anxiety Treatment Options – Article looks at the many treatment options for anxiety, including exercise and breathing techniques. (Better Health Channel)

Cognitive Behavioral Therapy – Covers how cognitive behavior therapy is used to reduce and eliminate anxiety disorders. (University of Houston)

What are the Psychotherapeutic and Other Non-Drug Approaches to Anxiety Disorder? – Overview of therapies and complementary treatments for anxiety. (University of Maryland Medical Center)

Depression and Anxiety: Exercise Eases Symptoms – Learn how even small amounts of exercise can help reduce anxiety. (Mayo Clinic)

Natural and Alternative Treatments

Natural Therapies and Supplements for Anxiety Disorders – Reviews the types of herbs and natural supplements used to treat anxiety, as well as their effects.  (HealthyPlace)

Progressive Muscle Relaxation – Step by step guide to progressive muscle relaxation for the reduction of anxiety. (A Guide to Psychology and its Practice)

Biofeedback – Overview of biofeedback, a mind-body therapy that can teach you to control some of the symptoms of anxiety. (Mayo Clinic)

Hypnosis: Focusing Subconscous on Change – Learn how hypnosis can help you reduce and control anxiety and panic attacks. (WebMD)

Meditation Balances the Body's Systems – Learn about the psychological and health effects of meditation, including its effectiveness for easing anxiety. (WebMD)

Meditation – Harvard Medical School’s guide to meditation as an alternative treatment for anxiety disorders, stress, and other health problems. (Aetna InteliHealth)

Self-Help and Support for Anxiety Disorders

Online Screening for Anxiety – Take a preliminary online screening test that evaluates your anxiety symptoms. (NYU Medical Center)

Anxiety Disorders Association of America – Nonprofit organization provides treatment information, self-tests, and a searchable database of self-help groups.

Lifeline Anxiety Disorders Newsletter – Quarterly newsletter with current news and articles on various anxiety disorder topics. (Lifeline Anxiety Disorders Newsletter, Canada)

Anxiety in Children and Teenagers

Being Afraid – Article for kids talks about what happens when you’re scared and why people have anxiety. (KidsHealth)

All About Anxiety – Provides teenagers with a look at anxiety and how they might be affected. (TeensHealth)

Facts for Families: The Anxious Child – Learn about the different types of anxiety children have and what signs parents should watch for. (American Academy of Child & Adolescent Psychiatry)

Delving Deeper into Anxiety Disorders

Anxiety Disorders – Physician’s perspective on anxiety disorders, including clinical signs, differential diagnosis, and medication. (eMedicine)

Melinda Smith created this article with contributions from Gina Kemp, M.A., Heather Larson, Jaelline Jaffe, Ph.D., and Jeanne Segal, Ph.D. Last modified on: 1/21/08.