Anxiety Disorders

Anxiety Disorders - General Information

Anxiety disorders affect approximately 19 million adults in the United States. This makes anxiety disorders about as common as substance use disorders and more common than mood disorders (e.g., depression, bipolar disorder). Anxiety disorders are also among the most common types of psychiatric problems seen in children and adolescents. Anxiety disorders account for approximately 31% of the total mental health care costs. In addition, they are also associated with impaired occupational, social, and marital functioning - as well as with a decrease in overall life satisfaction.

There are several different types of anxiety disorders, but they all share a common theme of excessive fear and dread. Although everyone experiences anxiety from time to time, anxiety disorders distinguish themselves from normal anxiety in that the anxiety that is experienced is too frequent or out of proportion with the actual threat present. In addition, anxiety disorders are often chronic conditions; the anxiety does not simply surround a stressful life situation and resolve once that situation is over (as with normal anxiety). Although anxiety may wax and wane, if left untreated, most anxiety disorders tend to grow progressively worse over time.

Each anxiety disorder has its own distinct features. The primary anxiety disorders are:

  • Panic Disorder (with or without agoraphobia)
  • Obsessive Compulsive Disorder
  • Social Phobia
  • Generalized Anxiety Disorder
  • Specific Phobias
  • Post Traumatic Stress Disorder
  • In addition to Obsessive- Compulsive Disorder, there are also several disorders that share many common features with OCD. These disorders are commonly referred to as OCD - spectrum disorders. They are:

  • Trichotillomania
  • Skin picking
  • Body Dysmorphic Disorder
  • In addition, current research also indicates that Irritable Bowel Syndrome (IBS) may be linked to panic disorder and respond to similar treatments that are used for panic.

    It is not uncommon to have more than one anxiety disorder. In addition, those with anxiety problems may also suffer from depression - sometimes, these feelings of sadness are produced by the way their lives are limited or affected by their anxiety symptoms.

    Symptoms of depression include: feelings of sadness, hopelessness, loss of interest in things that were previously enjoyed, changes in appetite or sleep, low energy, difficulty concentrating, and thoughts about life not being worth living. If more than one psychological problem is present, a mental health professional is often needed to determine which diagnosis should be treated first or if the disorders can be treated at the same time

    Common Physical Symptoms of Anxiety:

    When you are fearful or worried, this can cause you to experience many different bodily sensations associated with anxiety. For more information on this bodily response, see Anxiety/Fear and your Body section. Some common physiological symptoms of anxiety are:

  • heart racing or pounding
  • dizziness
  • nausea
  • shortness of breath
  • smothering sensations (i.e., cannot get enough air)
  • trembling, shaky
  • blurred vision
  • headaches
  • depersonalization or derealization (i.e., feelings of unreality)
  • muscle aches
  • tightness or pain in the chest
  • ringing in the ears
  • diarrhea
  • blushing
  • chills
  • tingling in the fingers, toes, or face
  • frequent urination
  • In children, anxiety may also be expressed by crying, tantrums, being frozen in place, or shying away from situations. When people experience several of these physical sensations accompanied by a sudden rush of intense fear, this usually means that they are having a panic attack. Most panic attacks peak quickly (within 10 minutes) but can take longer to subside. Panic attacks are also commonly accompanied by the thoughts/fears that one is: “going crazy”,“losing control”, or “having a heart attack”.

    Panic attacks can occur in any of the anxiety disorders - panic disorder, obsessive compulsive disorder, social anxiety disorder, generalized anxiety disorder, specific phobia, and post- traumatic stress disorder. Usually, in these disorders, panic attacks occur when the person approaches the thing that they fear (e.g., public speaking in social phobia, a dirty bathroom for those with OCD contamination fears, etc.) However, in panic disorder, people fear the panic attacks themselves and often experience these attacks as coming on without warning or “out of the blue”.

    Anxiety/Fear and Your Body

    All humans experience anxiety and fear. This is a biologically determined response that is very important to our survival. We probably wouldn't live too long if we did not have any fear -- for example, if we weren't fearful when we see a growling dog or a car speeding toward us. So, the bottom line is that some fear and anxiety is good. However, for people with anxiety disorders, anxiety and fear are experienced too frequently or out of proportion to the realistic danger that is actually present.

    Anxiety and fear are actually two very different things. Anxiety is typically what people experience before the “dangerous“ situation is encountered. In other words, anxiety is the way that our body begins to prepare for facing the threat. This type of future orientation of fears is especially clear in Generalized Anxiety Disorder; in this disorder, worries frequently take the form of future oriented “what if ” questions (e.g., “What if you get sick?”, “What if I don't get a good job?,” “What if no one likes me at school?”). This type of anxiety response tends to be more verbal (e.g., people talk a lot about their worries) rather than physiological (e.g., shaking hands, sweating).

    However, as people begin to approach (e.g., either in time or location) the situation/object that is feared, they begin to experience a greater physiological anxiety response. Many people speak of “anticipatory anxiety“ or anxiety that occurs in anticipation of approaching the feared situation or object. Anticipatory anxiety can be experienced in any of the anxiety disorders - for example, a person with the contamination type of OCD may experience anticipatory anxiety because they know that the next day they will have to go to some place they perceive as “dirty;“ a person with social anxiety disorder may experience anticipatory anxiety about a class presentation that needs to be given the following week; or a person with panic disorder may experience anticipatory anxiety because they know that tomorrow they will be visiting the same place where they had their first panic attack.

    Fear (and panic) are activated when the threat situation is actually encountered (not just anticipated). People in a state of fear experience a very intense and immediate physiological response and their ability to think or talk about the situation is usually very limited. This kind of automatic fear response is designed to be very protective - as it is designed to automatically activate a series of bodily responses that will help you in times of danger. This automatic response is often termed the “fight/flight“ response - because if true danger were present, it allows you to protect yourself and survive by mobilizing your body to either fight the danger or to flee from the dangerous situation. However, in anxiety disorders, panic attacks or fear responses are often activated when there is no real danger present. Panic attacks can occur in any of the anxiety disorders when the feared situation is encountered.

    Specifically, when the feared situation is encountered, a branch of your autonomic nervous system, the sympathetic nervous system, activates the fight/flight response. As a result, your body releases two chemicals called adrenalin and noradrenalin into your system. These two chemicals produce many changes in your body such as increased heart rate, respiration, and sweating. All the changes that occur are designed to help you in a truly dangerous situation. However, if there is no danger that is really present (and you do not need to fight or flee), people often experience unpleasant bodily side effects of this protective system. None of these side effects are dangerous but they can be very distressing.

    My Family Member has an Anxiety Disorder -- Am I to Blame?

    No. Certainly no one would chose to have an anxiety disorder and, likewise, no one would wish these symptoms on someone that they love. It is currently unknown what exactly causes these disorders, but they are likely due to a combination of multiple factors. Two types of anxiety disorders, panic disorder and blood/injury/injection phobia, have been found to be slightly more genetically based than some of the other anxiety disorders. In other words, these two disorders are more likely to “run in families“ than some of the other disorders.

    For the other types of anxiety disorders, what seems to be “inherited“ is more of a generalized vulnerability. In other words, you are vulnerable to developing an anxiety disorder, but not inclined to develop a specific anxiety disorder. So, in other words, what may be inherited is a biological tendency to have an over-reactive sympathetic nervous system (fight/flight system). This biological tendency combined with early developmental experiences (e.g., what we are taught about the world and how threatening it is influences future perceptions and experiences) and later stressful life experiences, may then determine what type of anxiety disorder develops (or if one develops at all).

    Are Anxiety Disorders caused by “Chemical Imbalances“?

    Many people are frequently surprised to learn that there are a combination of factors that lead to anxiety disorders because they have heard that these fears “may be due to a chemical imbalance in my brain“. In general, anxiety disorders are determined by various different factors. Current research indicates that there seems to be some genetic contribution in terms of who is more vulnerable to developing an anxiety disorder. However, this is a general genetic vulnerability to developing an anxiety disorder, but not to developing a specific type of anxiety disorder. There appears to be a slightly higher genetic vulnerability for those who develop panic disorder and for those who have blood/injection/injury phobia.

    Thus, genetics are involved, but one's genetic vulnerability is only one factor that influences who develops anxiety disorders. Early developmental experiences and important life events have also been found to be very important in the development of anxiety disorders. In addition, recent research indicates that people's behaviors affect the chemicals (or neurotransmitters) in their brains. Therefore, if people already have extensive fears and avoid feared situations, it is no wonder that there may be some differences in the “chemicals“ in their brain. It is the chicken and the egg phenomenon, it is unknown which comes first - the distress and related behaviors or the chemical changes. In addition, research shows that it is not just mediations that have the ability to alter brain chemicals, but if people change their behaviors, they can actually also create changes in those same brain chemicals -- even without any medications!

    If you are interested in learning more about anxiety disorders and their treatment, and you live in the Los Angeles area, contact Dr. Nelson at (310) 963-4891 or e-mail her at