What is an Anxiety Disorder?
Anxiety is a term used to describe uncomfortable feelings of nervousness, worry, and tension, which we all feel from time to time. Anxiety can affect anyone. It affects our thoughts, physical reactions, moods and behaviours.
Anxiety can be a normal response to a stress in our lives and some degree of anxiety can improve our performance in certain stressful situations. However, if anxiety occurs too often or for little reason, or if it begins to interfere with our life and prevent us from doing things, then it has become a problem.
Anxiety can affect you in 4 main ways:
- Thoughts – Anxiety can lead to frequent negative thoughts such as “I will not be able to cope” or “I’m going to fail”. It can also cause frequent distressing images in the mind.
- Physical effects – Anxiety can produce many physical symptoms, such as a pounding heart, a churning stomach, light-headedness, muscle tension or breathing difficulties.
- Mood – Persistent anxiety can also lead to feelings of being down or depressed.
- Behaviour – Anxiety can change how we behave by changing the things which we feel able to do. This can result in avoidance of many things which actually just results in strengthening the feelings of worry.
All of these 4 areas influence and interact with each other as outlined in the below diagram, sometimes forming into a cycle that is hard to break
For people with anxiety disorders, worry and fear can become overwhelming and interfere with their ability to lead normal lives.
What are the treatments for anxiety disorders?
The treatments for anxiety disorders involve psychotherapy (usually a cognitive behavioural therapy model) and/or medication, usually an antidepressant such as an SSRI. Most people who suffer from anxiety disorders may be offered a combination of psychological and medication treatment.
This is a talking therapy which involves regularly meeting with a therapist in either an individual or group basis over a course of several weeks to months or longer in some cases. In relation to anxiety disorders, the most effective form of psychotherapy is known as cognitive behavioural therapy (CBT).
In CBT the thinking styles and behaviours that may play a role in causing and maintaining anxiety are looked at, and more helpful ways of thinking and acting are discovered and encouraged. This can then help to reduce anxiety and improve coping.
Medication can play an important role in helping to reduce anxiety.
Antidepressants: these have been shown to be effective as part of the treatment of anxiety disorders, even in the absence of depression. The SSRI class of medication is usually the first line choice antidepressant but in some cases alternative classes (such as SNRI or TCA medication) are used, especially when a person has tried an SSRI previously but found it unhelpful. All antidepressants take between 2 to 4 weeks before they begin to work, and they must be taken regularly to be effective.
Benzodiazepines: These medications are sometimes used in the short-term management of anxiety. However, as they can become addictive when they are used regularly for a period as short as 4 weeks, their use is best reserved for help in coping with severe anxiety, and even then should be limited to no more than 2 weeks duration.
Other medications: Depending on the nature and severity of anxiety, several other medications are sometimes recommended by doctors in addition to the above.
- Beta Blockers (which can help with the physical symptoms of anxiety, such as shaking or sweating or palpitations);
- Pregabalin (these can help generalized anxiety symptoms);
- Low-dose antipsychotic medication (these are sometimes used in addition to antidepressant medications in those with severe OCD or PTSD or in cases where there is significant agitation).
The following links contain further information on anxiety disorders:
- Anxiety, panic and phobias (Royal College of Psychiatrists – UK)
- Information on anxiety disorders and their treatment (helpguide.org – American online resource for mental health information)
- Anxiety Overview (netdoctor.co.uk)
- Overcoming Panic Attacks with Dr Harry Barry
- Advice for young people on panic attacks (ReachOut Ireland)
Different types of Anxiety Disorder
Generalised Anxiety Disorder occurs when a person feels tense and anxious nearly all of the time, and cannot relax or unwind even when in peaceful or objectively relaxing circumstances. The person’s thoughts will be preoccupied by different daily worries and they will feel like they can’t switch off from this high level of ‘background’ anxiety. Physical symptoms of anxiety are common and persistent, such as feelings of butterflies in the stomach, headache and muscle tension. Concentration becomes impaired and fatigue is prominent, so that one’s ability to perform normal daily tasks deteriorates.
Panic Disorder is characterised by frequent, unpredictable and intense attacks of anxiety. Symptoms come on suddenly and reach a peak within minutes, but can take some time before settling down.
Symptoms of a panic attack can include:
- Fear that something terrible is about to happen, or of ‘going crazy’ or losing control.
- Palpitations or pounding of the heart.
- Feeling short of breath.
- A choking sensation.
- Tingling sensation in the toes or fingers.
- Dry mouth.
- Trembling or feeling hot and clammy.
These attacks can be so sudden and severe that it is not uncommon for people to fear that they are going to die, or that they are having a heart attack. Many people who attend A&E departments with chest pain will actually turn out to have had a panic attack.
In between attacks, people can become preoccupied with worry about when the next panic episode will occur – this is known as anticipatory anxiety and it can be the most disabling part of the disorder.
Phobic Anxiety Disorders involve an irrational fear about something which is not actually dangerous in reality. People tend to cope with phobias through avoidance of the feared situation or item. This can cause a lot of disability or disruption in a person’s normal daily life if the situation is very common and so can’t be avoided easily.
Examples of phobic anxiety disorders include:
This is a fear of public places where escape seems difficult (like when in a crowded place, when travelling on public transort, etc.). It usually begins with a panic attack in a public place, and this leads to fear of experiencing more panic attacks in public such that the person begins to avoid certain places. In severe cases, people can become housebound because they become anxious and fearful when they think about even leaving their own homes.
Social phobia (or Social Anxiety Disorder)
This is fear of being with other people in social group settings. The person worries that they are being scrutinized or judged in a negative way by others, that people think they are boring or foolish, or that they will do or say something that is humiliating such that they may avoid social situations or find them intensely anxiety-provoking if they have to endure them.
These are isolated irrational fears about a specific thing, e.g. flying, fear of heights, spiders, etc. Specific phobias are very common in the general population. People generally do not seek treatment for them as avoidance of the item which they are fearful of can generally be accomplished without it affecting their lives to a great extent.
Obsessive-compulsive disorder is an anxiety disorder in which a person experiences frequent distressing thoughts, images or impulses which are known as obsessions These obsession don’t make any sense to the person experiencing them (e.g. a person may experience a recurrent mental image of being violent to a family member whom they love dearly, or a fear of being contaminated by germs in food or on everyday items) and so the person can fear that they are losing their mind or are going mad.
The obsession is always distressing and causes anxiety, which the person learns to cope with and reduce by engaging in compulsive behaviour or actions (e.g. hand-washing in those with a fear of contamination). These compulsive behaviours lessen anxiety only temporarily, and so the person becomes trapped in a cycle of obsessions and compulsions which can disrupt their lives considerably.
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder which results from experiencing a traumatic event during which the person feels in mortal danger (e.g. a serious accident, a violent assault, a natural disaster, or learning about a life-threatening illness).
Symptoms of PTSD usually commence soon after experiencing the trauma, but in some it may be several months before symptoms develop.
There are three main features of PTSD:
- Re-living experiences. These take the form of either recurrent, intrusive mental images of the trauma during the waking day, or vivid nightmares of the even during sleep. They are distressing and associated with panic when they occur.
- Avoidant behaviour. The person attempts to avoid anything which reminds them of the trauma, e.g. avoidance of car travel after a road traffic accident.
- Hypervigilance. This is a feeling of being alert, tense and on edge most of the time. The person may startle easily.