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  Anxiety 

What is anxiety?

"I'm feeling scared … there's nothing to fear, but I'm afraid. I'm worried. I'm jumping out of my skin. I can't stop thinking the same thing or doing the same thing over and over." Fear, worry, dread, panic, obsession or compulsion – all of these feelings are types of anxiety. Fear is your body's innate response to actual danger or threat. On the other hand, anxiety is your body's similar reactions to a perceived or anticipated danger or threatening situation.

Sometimes you might be anxious in anticipating an actual situation, such as an upcoming interview, but other times feelings of anxiety seem unfounded, or their source is a perceived threat than an actual one. Sometimes anxiety occurs after a situation that causes stress, such as overwork or a traumatic event. Other times, a situation is not immediately apparent; anxiety, panic, fear, or dread can seem to develop spontaneously.

What causes anxiety?

There is still much to be learned about anxiety disorders. They often co-occur, and are also commonly seen with other disorders such as depression, substance abuse or eating disorders. Anxiety may be a response to a traumatic event, or may also have its roots in emotional trauma. Recent research on the structure and chemistry of the brain indicate that some kinds of anxiety are probably genetic. Having an anxiety disorder is NOT a sign of weakness - anyone can develop anxiety, given the right "mix" of genetics and life circumstances.

What are the symptoms of anxiety?

People who are feeling anxious report many physical symptoms, such as:

• rapid or irregular heartbeat (palpitations)
• stomach problems (gnawing feeling, "butterflies," diarrhea, irritated bowel syndrome)
• breaking out in a sweat, or feeling cold and clammy
• headaches, lightheadedness or dizziness
• bodily tension or aches
• fatigue

Other symptoms of anxiety are more emotional, such as:

• a general sense of apprehension and dread
• difficulty falling asleep or staying asleep
• jumpiness
• irritation

What do I do if my anxiety seems unmanageable or excessive?

There are some logical steps to determining the cause and treatment of anxiety:

First: Rule out any possible medical condition.
Some medications or diseases may create symptoms of anxiety such as rapid heartbeat, headache, nervousness, or other reactions. A change in medication or a correct diagnosis of a particular disorder may solve the anxiety problem. Make a list of all your symptoms before going to your doctor.

Next: Consider your life circumstances.
If your anxiety symptoms are not caused by a medical condition, then review the stressors in your life. You may be reacting to being over-tired or worried or afraid of something happening in your job or family. If you have difficulty figuring this out on your own, or if you just don't know what to do with the stress, you may need to find a therapist for some help.

Finally: See a psychotherapist.
If you have ruled out medical and drug disorders, and you either cannot identify a reason for anxious symptoms or can't seem to manage them, you need help. Some kinds of anxiety are readily controlled by medications (often called anti-anxiety medications or mood stabilizers), which can be prescribed and monitored by a psychiatrist. The use of medications is somewhat controversial, and you should gather information to decide if this is the best option for you. In any case, whether or not you are taking medications, you should also see a therapist to help you handle the feelings you have about events and stressors in your life. (For information on finding a qualified therapist, see Resources below.)

What will a therapist do to treat my anxiety?

It depends on the circumstances and also on the therapist's approach. Some therapists will help you see what you learned growing up and how your beliefs and habits may be causing you pain. Others will focus more on the present, and will help you learn to recognize the triggers for your symptoms of anxiety. Many anxiety disorders are treated by Cognitive Behavioral therapy, which helps you recognize how your thoughts, feelings, and actions are related, and to make changes that will help you feel better. You might also learn some relaxation techniques and stress management tools. Many therapists will also refer you to a psychiatrist to determine if anti-anxiety medications would be useful in managing symptoms.

There are also new techniques for rapid treatment of anxiety that were initially discovered by chance and then refined. These interventions use such approaches as rapid eye movement, sounds, tapping on acupuncture points, subtle gestures and movements, and completion of "frozen" impulses. Although the exact mechanism for how these techniques work is not yet clearly understood, their validity is being researched and appears to be supported. Helpguide provides more information on treatment of anxiety symptoms through these newer mind-body approaches (see Resources below).

What are some of the types of anxiety disorders?

Following are several of the most commonly experienced types of anxiety disorders. Each of these types of anxiety disorders (with symptoms, treatments, and additional online resources) is discussed in greater detail on other Helpguide pages (see links below).

Generalized Anxiety Disorder

Everyone experiences anxiety from time to time. Most people, for example, would feel a little anxious because of an upcoming exam, or experience some anxiety or worry about finances after losing a job. But when unrealistic, persistent anxiety is a part of everyday life, generalized anxiety disorder (GAD) may be present.

Panic Disorder

Panic disorder is a type of anxiety characterized by repeated, unexpected panic attacks – strong physical and emotional reactions that occur even though there is no apparent threat. Panic disorder is often associated with agoraphobia, a type of anxiety associated with being in places where escape or help is not perceived to be possible in case of panic.

Phobias

A phobia is type of anxiety that involves an extreme, unrealistic fear of a specific object/activity (such as a particular animal, or of flying) or of certain situations (such as being in open spaces, or in social situations).

Post-traumatic stress disorder (PTSD)

Exposure to a traumatic event (for example, a natural or human-caused disaster) or to an ongoing traumatic situation (such as living in an abusive environment) can cause a type of anxiety characterized by severe emotional reactions that sometimes do not even seem related to the original trauma.

Obsessive-compulsive disorder

A person with OCD experiences a type of anxiety with the main symptom being repeated, unwanted thoughts or behaviors that seem impossible to stop or control.

Separation Anxiety Disorder

Separation anxiety disorder is an extreme level of anxiousness in children about leaving their parents. Separation anxiety disorder usually begins at around 4 years of age but often also appears at 7-8, and can seriously delay social and emotional development.

Anxiety Disorders in Children and Adolescents

What are anxiety disorders?

Anxiety disorders cause people to feel excessively frightened, distressed, and uneasy during situations in which most others would not experience these symptoms. Left untreated, these disorders can dramatically reduce productivity and significantly diminish an individual’s quality of life. Anxiety disorders in children can lead to poor school attendance, low self-esteem, deficient interpersonal skills, alcohol abuse, and adjustment difficulty.

Anxiety disorders are the most common mental illnesses in America; they affect as many as one in 10 young people. Unfortunately, these disorders are often difficult to recognize, and many who suffer from them are either too ashamed to seek help or they fail to realize that these disorders can be treated effectively.

What are the most common anxiety disorders?

• Panic Disorder -- Characterized by panic attacks, panic disorder results in sudden feelings of terror that strike repeatedly and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, feelings of unreality, and fear of dying. Children and adolescents with this disorder may experience unrealistic worry, self- consciousness, and tension.
• Obsessive-compulsive Disorder (OCD) -- OCD is characterized by repeated, intrusive, and unwanted thoughts (obsessions) and/or rituals that seem impossible to control (compulsions). Adolescents may be aware that their symptoms don’t make sense and are excessive, but younger children may be distressed only when they are prevented from carrying out their compulsive habits. Compulsive behaviors often include counting, arranging and rearranging objects, and excessive hand washing.
• Post-traumatic Stress Disorder -- Persistent symptoms of this disorder occur after experiencing a trauma such as abuse, natural disasters, or extreme violence. Symptoms include nightmares; flashbacks; the numbing of emotions; depression; feeling angry, irritable, and distracted; and being easily startled.
• Phobias -- A phobia is a disabling and irrational fear of something that really poses little or no actual danger. The fear leads to avoidance of objects or situations and can cause extreme feelings of terror, dread, and panic, which can substantially restrict one’s life. "Specific" phobias center around particular objects (e.g., certain animals) or situations (e.g., heights or enclosed spaces). Common symptoms for children and adolescents with "social" phobia are hypersensitivity to criticism, difficulty being assertive, and low self-esteem.
• Generalized Anxiety Disorder -- Chronic, exaggerated worry about everyday, routine life events and activities that lasts at least six months is indicative of generalized anxiety disorder. Children and adolescents with this disorder usually anticipate the worst and often complain of fatigue, tension, headaches, and nausea.

Other recognized anxiety disorders include: agoraphobia, acute stress disorder, anxiety disorder due to medical conditions (such as thyroid abnormalities), and substance-induced anxiety disorder (such as from too much caffeine).

Are there any known causes of anxiety disorders?

Although studies suggest that children and adolescents are more likely to have an anxiety disorder if their caregivers have anxiety disorders, it has not been shown whether biology or environment plays the greater role in the development of these disorders. High levels of anxiety or excessive shyness in children aged six to eight may be indicators of a developing anxiety disorder.

Scientists at the National Institute of Mental Health and elsewhere have recently found that some cases of obsessive-compulsive disorder occur following infection or exposure to streptococcus bacteria. More research is being done to pinpoint who is at greatest risk, but this is another reason to treat strep throats seriously and promptly.

What treatments are available for anxiety disorders?

Effective treatments for anxiety disorders include medication, specific forms of psychotherapy (known as behavioral therapy and cognitive-behavioral therapy), family therapy, or a combination of these. Cognitive-behavioral treatment involves the young person’s learning to deal with his or her fears by modifying the way he or she thinks and behaves by practicing new behaviors. Ultimately, parents and caregivers should learn to be understanding and patient when dealing with children with anxiety disorders. Specific plans of care can often be developed, and the child or adolescent should be involved in the decision-making process whenever possible. Permission is granted for this fact sheet to be reproduced in its entirety, but it must include the NAMI name and all contact information.

Anxiety Disorders