Anxiety Disorders Overview

Fears are not normal, however, when they become overwhelming and interfere with daily living. They are symptoms of an anxiety disorder, the most common and most successfully treated form of mental illness.

As a group, anxiety disorders afflict nearly nine percent of Americans during any six-month period. Symptoms can be so severe that patients are almost totally disabled--too terrified to leave their homes, to enter the elevator that takes them to their offices, to attend parties or to shop for food.

"Anxiety" is a word so commonly used that many people don't understand what it means in mental health care. Complicating matters is the fact that "anxiety" and fear are often used to describe the same thing. When the word "anxiety" is used to discuss a group of mental illnesses, it refers to an unpleasant and overriding mental tension that has no apparent identifiable cause. Fear, on the other hand, causes mental tension due to a specific, external reason, such as when your car skids out of control on ice.

The Disorders

"Anxiety disorders" refers to a group of illnesses: generalized anxiety disorder, phobias, panic disorders, post-traumatic stress disorder and obsessive-compulsive disorders. When people suffering from anxiety disorders talk about their condition, they often include these descriptions:

• unrealistic or excessive worry
• unrealistic fears concerning objects or situations
• exaggerated startle reactions
• "flashbacks" of past trauma
• sleep disturbances
• ritualistic behaviors as a way of with dealing with anxieties
• shakiness
• trembling
• muscle aches
• sweating
• cold/clammy hands
• dizziness
• jitteriness
• tension
• fatigue
• racing or pounding heart
• dry mouth
• numbness/tingling of hands, feet or other body part
• upset stomach
• diarrhea
• lump in throat
• high pulse and/or breathing rate

In addition, people suffering from anxiety disorders are often apprehensive and worry that something bad may happen to themselves or loved ones. They often feel impatient, irritable and easily distracted.

Generalized Anxiety Disorder

People with generalized anxiety disorder suffer with unrealistic or excessive anxiety and worry about life circumstances. For example, they may feel panicky about financial matters even though they have a good bank balance and have paid their debts. Or they may be preoccupied constantly about the welfare of a child who's safe at school. People with generalized anxiety disorder may have stretches of time when they're not consumed by these worries, but they are anxious most of the time. Patients with this disorder often feel "shaky," reporting that they feel "keyed up" or "on edge" and that they sometimes "go blank" because of the tension that they feel. They often suffer also with depression.

Phobias

This type of anxiety disorder afflicts over 12 percent of all Americans during their lifetimes. People who suffer from this illness feel terror, dread or panic when confronted with the feared object, situation or activity. Many have such an overwhelming desire to avoid the source of fear that it interferes with their jobs, family life and social relationships. They may lose their jobs because they can't go to business lunches for fear of eating in front of others. They may quit a job in a highrise office to work on the ground floor because they fear elevators. They may become so fearful of leaving their homes that they live like hermits. The following are common phobias:

Social phobia is the fear of situations in which a person can be watched by others, such as public speaking, or in which the behaviors which arise from the person's feelings might prove embarrassing, such as eating in public. It begins in late childhood or early adolescence.

Simple phobia is the fear of specific objects or situations that cause terror . The condition can begin at any age. Examples are fear of snakes, fear of flying, or fear of closed spaces. Some of these phobias are often normal in early childhood.

Agoraphobia, the fear of being alone or in a public place that has no escape hatch (such as a public bus), is the most disabling because victims can become housebound. The illness can begin any time from late childhood through early adulthood and, left untreated, worsens with time.

Panic Disorders

Panic disorders afflict 1.5 million Americans during any six-month period. Victims suddenly suffer intense, overwhelming terror for no apparent reason. The fear is accompanied by at least four of the following symptoms:

• sweating
• heart palpitations
• hot or cold flashes
• trembling
• feelings of unreality
• choking or smothering sensations
• shortness of breath
• chest discomfort
• faintness
• unsteadiness
• tingling
• fear of losing control, dying or going crazy

Often, people suffering a panic attack for the first time rush to the hospital, convinced they are having a heart attack. Sufferers can't predict when the attacks will occur. Certain situations, however, such as driving a car, can become associated with them if it was in those situations where the first attack occurred. Untreated, panic sufferers can despair and become suicidal.

Obsessive-Compulsive Disorders

Obsessive-compulsive disorders (OCD) afflict 2.4 million Americans. People with OCD suffer with obsessions, which are repeated, intrusive, unwanted thoughts that cause distress and extreme anxiety. They may also suffer with compulsions, which psychiatrists define as rituals--such as hand washing--that the person with the disorder goes through in an attempt toreduce his or her anxiety. People who suffer from obsessive disorders do not automatically have compulsive behaviors. However, most people with compulsions also have obsessions.

Victims of obsessions are plagued with involuntary, persistent thoughts or impulses that are distasteful to them. Examples are thoughts of violence or of becoming infected by shaking hands with others. These thoughts can be fleeting and momentary or they can be lasting ruminations.

The most common obsessions focus on a fear of hurting others or violating socially acceptable behavior standards such as swearing or making sexual advances. They also can focus on religious or philosophical issues, which the patient never resolves.

People with compulsions go through senseless, repeated and involuntary ritualistic behaviors which they believe will prevent or produce a future event. However, the rituals themselves have nothing to do with that event. For example, a person may constantly wash his or her hands or touch a particular object. Often, people with this disorder also suffer from a complementary obsession such as a worry over infection.

Examples of compulsive rituals include:

• Cleaning , which affects women more often than men. If victims come in contact with any dirt, they may spend hours washing and cleaning even to the point that their hands bleed.
• Repeating a behavior , such as repeatedly saying a loved one's name several times whenever that person comes up in conversation.
• Checking , which tends to affect men more than women. For example, victims check and recheck that doors are locked or electric switches, gas ovens and water taps are turned off. Other patients will retrace a route they have driven to check that they did not hit a pedestrian or cause an accident without knowing it.

Obsessive-compulsive disorders often begin during the teens or early adulthood. Generally they are chronic and cause moderate to severe disability in their victims.

Post-Traumatic Stress Disorder (PTSD)

Often associated with war veterans, post-traumatic stress disorder can occur in anyone who has experienced a severe and unusual physical or mental trauma. People who have witnessed a mid-air collision or survived a life-threatening crime may develop this illness. The severity of the disorder increases if the trauma was unanticipated. For that reason, not all war veterans develop PTSD, despite prolonged and brutal combat. Soldiers expect a certain amount of violence. Rape victims, however, are unsuspecting of the attack on their lives.

People who suffer from PTSD re-experience the event that traumatized them through:

• Nightmares, night terrors or flashbacks of the event. In rare cases, the person falls into a temporary dislocation from reality in which he or she relives the trauma. This can last for seconds or days.
• Psychic numbing," or emotional anesthesia. Victims have decreased interest in or involvement with people or activities they once enjoyed.
• Excessive alertness and highly sharpened startle reaction. A car backfiring may cause people once subjected to gunfire to instinctively drop to the ground.
• General anxiety, depression, inability to sleep, poor memory, difficulty concentrating or completing tasks, survivor's guilt.

Theories About Causes

Probably no single situation or condition causes anxiety disorders. Rather, physical and environmental triggers may combine to create a particular anxiety illness.

Psychoanalytic theory suggests that anxiety stems from unconscious conflicts that arose from discomfort during infancy or childhood. For example, a person may carry the unconscious conflict of sexual feelings toward the parent of the opposite sex. Or the person may have developed problems from experiencing an illness, fright or other emotionally laden event as a child. By this theory, anxiety can be resolved by identifying and resolving the unconscious conflict. The symptoms that symbolize the conflict would then disappear.

Learning theory says that anxiety is a learned behavior that can be unlearned. People who feel uncomfortable in a given situation or near a certain object will begin to avoid it. However, such avoidance can limit a patient's ability to live a normal life.

More recently, research has indicated that biochemical imbalances are culprits. Many scientists say all thoughts and feelings result from complex electrochemical interactions in the central nervous system. Moreover, some studies indicate that infusions of certain biochemicals can cause a panic attack in some people. According to this theory, treatment of anxiety should correct these biochemical imbalances. Although medications first come to mind with this theory, remember that studies have found biochemical changes can occur as a result of emotional, psychological or behavioral changes.

No doubt each of these theories is true to some extent. A person may develop or inherit a biological susceptibility to anxiety disorders. Events in childhood may lead to certain fears that, over time, develop into a full-blown anxiety disorder.

Treatments of Anxiety Disorders

Generally, anxiety disorders are treated by a combination approach. Phobias and obsessive-compulsive disorders often are treated by behavior therapy. This involves exposing the patient to the feared object or situation under controlled circumstances, until the fear is cured or significantly reduced. Successfully treated with this method, many phobia patients have long-term recovery.

Medications are effective treatments, sometimes used alone and often in combination with behavior therapy or other psychotherapy techniques. In addition to behavior modification techniques and medication, talking issues out in psychotherapy can be crucial.

There is good reason for optimism about treatment of even the most severe anxiety disorders. Research indicates that 65 percent of the phobic and obsessive-compulsive patients who can cooperate with the therapist and conscientiously follow instructions will recover with behavior therapy. Studies have shown that while they are taking the medications, 70 percentof the patients who suffer from panic attacks improve. Medication is effective for about half of those suffering from obsessive-compulsive disorder.

(c) Copyright 1988 American Psychiatric Association

Produced by the APA Joint Commission on Public Affairs and the Division of Public Affairs. This document contains text from a pamphlet developed for educational purposes and does not necessarily reflect opinion or policy of the American Psychiatric Association.

Revised 1994

Additional Resources

Agras, M.W. Panic: Facing Fears, Phobias, and Anxiety . New York: W.H. Freeman, 1985.

Barlow, D. Anxiety and Its Disorders: the Nature and Treatment of Anxiety and Panic . New York: Guilford Press, 1988.

Barlow, D. and Cerny, J. The Psychological Treatment of Panic . New York: Guilford Press, 1988.

Beck, A. Anxieties and Phobias . New York: Basic Books, 1985.

Goodwin, D.W. Anxiety . New York: Oxford University Press, 1986.

Gorman, J. The Essential Guide to Psychiatric Drugs . New York: St. Martin's Press, 1990.

Greist, J., Jefferson, J. and Marks, I.M. Anxiety and Its Treatments: Help Is Available . Washington, DC: American Psychiatric Press, Inc., 1986.

Insel, T., ed. New Findings in Obsessive-Compulsive Disorder . Washington, DC: American Psychiatric Press, Inc., 1984.

Mathew, A.M., Gelder, M.G. and Johnston,D.W. Agoraphobia: Nature and Treatment . New York: Guilford Press, 1981.

National Phobia Treatment Directory (second edition). Anxiety Disorders Association, 1986.

Pasnau, R. Diagnosis and Treatment of Anxiety Disorders . Washington, DC: American Psychiatric Press, Inc., 1984.

Sheehan, D. The Anxiety Disease and How to Overcome It . New York: Bantam, 1990.

Zane, M. and Milt, H. Your Phobia . Washington, DC: American Psychiatric Press, Inc., 1984.

Other Resources:

Anxiety Disorders Association of America
(301) 231-9350

National Alliance for the Mentally Ill
(703) 524-7600

National Institute of Mental Health Information Resources and Inquiries Branch
(301) 443-4513

National Mental Health Association
(703) 684-7722

National Self-Help Clearinghouse
25 West 43rd Street
New York, NY 10036
(212) 354-8525