What are anxiety disorders?

We all have things that we’re afraid of. Whether it’s seeing a spider, giving a speech, or jumping out of an airplane, some things just make our knees shake, hearts race, and our mouths dry up.
Evolutionarily speaking, fear is a good thing.
Fear is the emotional and physiological alarm that goes off in your body, signaling to you that there is an immediate threat that needs to be dealt with. But like any alarm, fear works best when it goes off at the right time and at the right intensity. Your alarm clock is great for getting you up in the morning, but if it were so quiet that you couldn’t hear it (or so loud that it was deafening) it might actually do more harm than good. You also probably wouldn’t be very happy if your alarm went off when you didn’t need to wake up (so much for sleeping in!).
This is the primary challenge facing people with anxiety disorders. Their response to perceived threats and challenges can be too sensitive (feeling fear when there is no danger) or too intense (feeling extreme fear when the risk of danger is low), which can lead them to engage in various behaviors to reduce their fear and anxiety. Sometimes these behaviors end up being harmful to the individual or others.

Fear, Anxiety, and Panic

To understand anxiety disorders, it’s important to understand three ways we respond to perceived threats: fear, anxiety, and panic.
Fear, as mentioned above, is the emotional and physiological response we have to an immediate threat (e.g., A bear is running toward you right now!) and is most associated with the body’s fight or flight response. Given the perceived urgency, there is typically a surge of energy with a focus on trying to escape or survive the scary situation (also called “escape behavior”).
Anxiety is the emotional and physiological response we have in anticipation of future threats (such as, “I’m nervous that if I leave my cabin there might be a bear out there”). Anxiety can make you hyper-aware of your surroundings and is associated with muscle tension and being on the look out for possible danger. The goal of feeling anxious is to avoid future danger.
Panic is a particular type of fear response in which you have an extreme emotional, physiological, and behavioral response in the absence of actual danger. Imagine you are waiting in line at the grocery store, and suddenly you think about a bear running at you. If your heart starts pounding and you feel dizzy and afraid, even though there isn’t a bear anywhere near you, you are experiencing panic.
While fear and panic tend to be a relatively brief experience, anxiety can be chronic and persistent, leading to serious negative outcomes. Chronic anxiety is harmful not only due to its effects on the body and mind, but also because of its effects on lifestyle and behavior, such as constantly avoiding fearful situations, social isolation, difficulty at school or work, and feelings of depression and hopelessness.

Types of Anxiety Disorder

While all anxiety disorders are characterized by intense and frequent fear, anxiety, and/or panic, they differ from each other in their specific symptoms and types of situations and objects that cause the symptoms to occur (we’ll get into this in more detail below).
In order to be diagnosed with an anxiety disorder, the symptoms related to anxiety and fear must interfere with normal functioning (day-to-day activities) and/or cause significant distress. For most disorders, the symptoms must not be related to drug use and must persist for more than 6 months.

Specific Phobias

People with specific phobias are afraid or anxious about specific objects or situations (called the “phobic stimulus”), and try to avoid them at all costs. Feelings of extreme fear start immediately in response to the stimulus and are out of proportion to the actual amount of danger present. People with specific phobias usually understand that their fear is excessive, but can’t seem to make it stop. Different types of phobias are categorized in the following groups:
  1. Animal (e.g., snakes, dogs, sharks)
  2. Natural environment (e.g., heights, lightning, water)
  3. Blood-injection-injury (e.g., needles, surgery)
  4. Situational (e.g., flying in an airplane, riding on an elevator)
  5. Other (e.g., clowns, choking, loud noises)

Social Anxiety Disorder

Social anxiety disorder (also known as “social phobia”) is characterized by persistent and unrealistically intense fear and anxiety about social situations, such as going to a party, working in teams, or even just being around other people. People with social anxiety disorder often worry they might be judged or scrutinized by others, or that they might embarrass themselves. People with social anxiety disorder avoid social interactions in the same way a person with a specific phobia would avoid their phobic stimulus. Given how important social interactions are to a healthy lifestyle, social anxiety disorder can have very serious consequences.

Panic Disorder

Panic disorder is characterized by recurring panic attacks, which are sudden and intense rushes of extreme fear or discomfort that gradually increases within minutes. This response is not related to specific situations or objects and can be brought on by worrying about having future panic attacks. Associated symptoms include:
  • Accelerated heart rate
  • Sweating
  • Shaking
  • Difficulty breathing
  • Nausea
  • Tingling sensations
  • Fear of dying
  • Feeling detached from yourself
After reading that list of symptoms, it’s easy to see why if you ever had a panic attack, you would do everything you could to avoid having another one! But, since the cause of the attack is often unknown, it isn’t always clear what should be avoided to prevent a similar event in the future.

Agoraphobia

Agoraphobia (translated from Greek, literally means “fear of the marketplace”) is defined by debilitating worry of being in a public place where it would be difficult or embarrassing to escape if intense anxiety or panic symptoms occurred. Until recently, agoraphobia was considered to be a subtype of panic disorder, but it is now an independent diagnosis. For some people, the fear of experiencing panic in a public place is so extreme that they are unable to leave their neighborhood, their house, or even their bedroom.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by persistent and excessive anxiety and worry about multiple events or activities. Examples of such worry include common concerns such as finances, health, career, and personal relationships. However, these individuals become consumed by their worry, making day-to-day life very difficult. Overwhelming worry such as this can result in restlessness, fatigue, irritability, and trouble sleeping.

Causes and Development of Anxiety Disorders

It’s important to remember that there is no single cause of anxiety disorders. Like all psychological disorders, there are many factors that influence chronic anxiety. So why do some people develop anxiety disorders and others do not? It may be helpful to think of having an anxiety disorder as being in a physical location.
If someone told you they were in New York City, would you know for sure how they got there? Maybe they took a plane, a car, a train, or maybe they walked there. Maybe they were born there! To go further, even if you found out how that one person came to be in New York City, would that tell you exactly how a different person got there? Probably not.
Rather than trying to find “the way to get to anxiety”, psychologists have worked to understand some of the common pathways to developing an anxiety disorder. Some pathways are related to a person’s biology, while others are related to a person’s environment and behavior.

Biological Factors

The heritability of anxiety disorders ranges from 20-50%, depending on the specific disorder. You can think of this as meaning that 20-50% of people with anxiety disorders got there by way of the genes they inherited from their parents. However, this doesn’t mean that there is one anxiety gene, but rather that combinations of many genes may work together to result in a person being more likely to experience anxiety.

Environmental/Behavioral Factors

Overprotective and critical parenting, childhood abuse, and other traumatic events (like experiencing a natural disaster or witnessing violence) have all been linked to the development of anxiety disorders. As is the case with genetic factors, these environmental factors likely don’t directly cause anxiety disorders, but instead may increase a person’s vulnerability to anxiety.
Behavioral theories regarding the development of anxiety disorders (particularly specific phobias) suggest a two-step process that can lead to chronic anxiety.
  1. The initial reaction of fear/panic is learned through classical conditioning. This type of learning occurs when we associate a situation or object, which are often times neutral, with strong negative feelings. Even though the situation or object didn’t directly cause these feelings, these two factors may become linked in our minds.
    For example: a big earthquake happened while you were driving over a bridge. Even though the earthquake is what actually scared you, every time you look at that bridge you start to feel nervous and scared.
  2. As a result, the person then tries to lessen their conditioned fear/panic by avoiding the situation or object evoking the response. This process (called operant conditioning) rewards people for avoiding the things they are afraid of, because doing so reduces their fear.
    For example: the thought of driving over the bridge associated with the earthquake causes anxiety. So, even though it takes twice as long to reach your destination, you take a different route to avoid it.

How are anxiety disorders treated?

Although there is no cure for anxiety disorders, there are several effective treatments to help manage symptoms. Medications such as antidepressants, beta-blockers, or anti-anxiety drugs have been shown to reduce anxiety symptoms. While medication can be a short-term help, cognitive and behavioral therapies may have more long-term benefits.
Cognitive therapies focus on changing the thought patterns that cause and maintain anxiety. Working with a mental health professional, people can develop strategies to reduce anxiety and better deal with it when it arises.
Behavioral therapies are focused on breaking the cycle of anxiety by exposing the person to the situation or object that they have been avoiding. This type of exposure can take many forms, and is tailored to the specific needs of each person. Sometimes this is done gradually in a therapist’s office over the course of many weeks or months, while for others it may be appropriate to do so in a single session.
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