Anxiety Attacks and Disorders

Understanding anxiety disorders

It’s normal to worry and feel tense or scared when under pressure or facing a stressful situation. Anxiety is the body’s natural response to danger, an automatic alarm that goes off when we feel threatened.

Although it may be unpleasant, anxiety isn’t always a bad thing. In fact, anxiety can help us stay alert and focused, spur us to action, and motivate us to solve problems. But when anxiety is constant or overwhelming, when it interferes with your relationships and activities—that’s when you’ve crossed the line from normal anxiety into the territory of anxiety disorders.

Signs and symptoms of anxiety disorders

Because the anxiety disorders are a group of related conditions rather than a single disorder, they can look very different from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party. Someone else may struggle with a disabling fear of driving or uncontrollable, intrusive thoughts. Still another may live in a constant state of tension, worrying about anything and everything.

But despite their different forms, all anxiety disorders share one major symptom: persistent or severe fear or worry in situations where most people wouldn’t feel threatened.

Emotional symptoms of anxiety

In addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include:

Feelings of apprehension or dread Trouble concentrating Feeling tense and jumpy Anticipating the worst

Irritability Restlessness Watching for signs of danger Feeling like your mind’s gone blank

Physical symptoms of anxiety

Anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety involves a wide range of physical symptoms. Because of the numerous physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.

Common physical symptoms of anxiety include:

Pounding heart Sweating Stomach upset or dizziness Frequent urination or diarrhea Shortness of breath

Tremors and twitches Muscle tension Headaches Fatigue Insomnia

Anxiety attacks and their symptoms

Anxiety attacks, known as panic attacks in mental health circles, ­are episodes of intense panic or fear. Anxiety attacks usually occur suddenly and without warning. Sometimes there’s an obvious trigger— getting stuck in an elevator, for example, or thinking about the big speech you’re giving in a few hours—but in other cases, the attacks come out of the blue.

Anxiety attacks usually peak within ten minutes, and they rarely last more than a half hour. But during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control. The physical symptoms are themselves so frightening that many people believe they’re having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape.

Symptoms of an anxiety attack include:

Surge of overwhelming panic Feeling of losing control or going crazy Heart palpitations or chest pain Feeling like you’re going to pass out Trouble breathing or choking sensation

Hyperventilation Hot flashes or chills Trembling or shaking Nausea or stomach cramps Feeling detached or unreal

Types of anxiety disorders

There are six major types of anxiety disorders, each with their own distinct symptom profile: generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, post-traumatic stress disorder, and social anxiety disorder.

Generalized anxiety disorder

If constant worries and fears distract you from your day-to-day activities or you’re troubled by a persistent feeling that something bad is going to happen, you may be suffering from generalized anxiety disorder (GAD). People with GAD are chronic worrywarts who feel anxious nearly all of the time, though they may not even know why. Anxiety related to GAD often shows up as physical symptoms like insomnia, stomach upset, restlessness, and fatigue. Read More

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may be troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over. Read More

Panic disorder

Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode. Panic disorder may also be accompanied by agoraphobia, which is a fear of being in places where escape or help would be difficult in the event of a panic attack. If you have agoraphobia, you are likely to avoid public places such as shopping malls or confined spaces such as an airplane. Read More

Phobia

A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights. In the case of a severe phobia, you might go to extreme lengths to avoid the thing you fear. Unfortunately, avoidance only strengthens the phobia. Read More

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. Symptoms of PTSD include flashbacks or nightmares about what happened, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event. Read More

Social anxiety disorder

If you have a debilitating fear of being seen negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia. Read More

Self-help for anxiety and anxiety disorders

Not everyone who worries a lot has an anxiety disorder. You may be anxious because of an overly demanding schedule, lack of exercise or sleep, pressure at home or work, or even from too much coffee.

The bottom line is that if your lifestyle is unhealthy and stressful, you’re likely to feel anxious—whether or not you have an anxiety disorder. So if you feel like you worry too much, take some time to evaluate how well you’re caring for yourself.

• Do you make time each day for relaxation and fun?
• Are you getting the emotional support you need?
• Are you taking care of your body?
• Are you overloaded with responsibilities?
• Do you ask for help when you need it?

If your stress levels are through the roof, think about how you can bring your life back into balance. There may be responsibilities you can give up, turn down, or delegate to others. If you’re feeling isolated or unsupported, find someone you trust to confide in. Just talking about your worries can make them seem less frightening.

When to seek professional help for anxiety

While self-help coping strategies for anxiety can be very effective, if your worries and fears have become so great that they’re causing extreme distress or disrupting your daily routine, it is important to seek professional help.

If you’re experiencing a lot of physical anxiety symptoms, you should start by getting a medical checkup. Your doctor can check to make sure that your anxiety isn’t caused by a medical condition, such as a thyroid problem, hypoglycemia, or asthma. Since certain drugs and supplements can cause anxiety, your doctor will also want to know about any prescriptions, over-the-counter medications, herbal remedies, and recreational drugs you’re taking.

If your physician rules out a medical cause, the next step is to consult with a therapist who has experience treating anxiety disorders. The therapist will work with you to determine the cause and type of your anxiety disorder and devise a course of treatment.

Here are a few ways to find a qualified professional who treats anxiety problems:

• Search online at the anxiety disorder website listed to the right
• Ask a doctor, nurse, or school counselor for a referral.
• Call local hospitals, counseling centers, or mental health clinics.
• Contact the psychology department of a local college or university.
• Call the National Alliance on Mental Illness Information Helpline at 1-800-950-NAMI (6264).

Anxiety treatment options

Anxiety disorders respond very well to treatment—and often in a relatively short amount of time. The specific treatment approach depends on the type of anxiety disorder and its severity. But in general, most anxiety disorders are treated with behavioral therapy, medication, or some combination of the two. New research has also revealed a number of beneficial complementary treatments for anxiety.

Behavioral therapy for anxiety disorders

Cognitive-behavioral therapy and exposure therapy are two effective anxiety disorder treatments. Both are types of behavioral therapy, meaning they focus on behavior rather than on underlying psychological conflicts or issues from the past. Behavioral therapy for anxiety usually takes between 5 and 20 weekly sessions.

• Cognitive-behavior therapy – As the name suggests, cognitive-behavioral therapy focuses on thoughts—or cognitions—in addition to behaviors. When used in anxiety disorder treatment, cognitive-behavioral therapy helps you identify and challenge the negative thinking patterns and irrational beliefs that are fueling your anxiety.
• Exposure therapy – In exposure therapy for anxiety disorder treatment, you confront your fears in a safe, controlled environment. Through repeated exposures, either in your imagination or in reality, to the feared object or situation, you gain a greater sense of control. As you face your fear without being harmed, your anxiety gradually diminishes.

Medication for anxiety disorders

A variety of medications, including benzodiazepines and antidepressants, are used in the treatment of anxiety disorders. But medication is most effective when combined with behavioral therapy. When compared to those who use medication alone, anxiety sufferers treated with both therapy and medication benefit from a greater reduction in symptoms and a lower risk of relapse.

For certain types of anxiety disorders like phobias or social anxiety disorder, medication may only be needed from time to time, such as right before boarding an airplane or performing at a recital.

For other anxiety disorders, such as obsessive-compulsive disorder and generalized anxiety disorder, medication may be necessary for a longer period of treatment.

Medication may also be used in the short-term to relieve severe anxiety symptoms so that other forms of therapy can be pursued.

Complementary treatments for anxiety disorders

Several new anxiety treatments are showing promise as complements to both therapy and medication. In mild anxiety disorder cases, these treatments may provide sufficient relief on their own.

• Exercise – Exercise is a natural stress buster and anxiety reliever. Research shows that as little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.
• Relaxation techniques – When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, controlled breathing, and visualization can reduce anxiety and increase feelings of relaxation and emotional well-being.
• Biofeedback – Using sensors that measure specific physiological functions—such as heart rate, breathing, and muscle tension—biofeedback teaches you to recognize the body’s anxiety response and learn how to control them using relaxation techniques.
• Hypnosis – Hypnosis is sometimes used in combination with cognitive-behavioral therapy for anxiety. While you’re in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.

Related links for anxiety attacks and anxiety disorders

Anxiety disorder signs and symptoms

Anxiety Disorders – Guide to the different types of anxiety disorders, their symptoms, and how to get help. (National Institute of Mental Health)

Anxiety & Panic Attacks Symptoms – Extensive list of the signs and symptoms of anxiety disorders and anxiety attacks. (National Panic & Anxiety Disorder News)

Anxiety disorder treatment

Anxiety Treatment Options – Article looks at the many treatment options for anxiety, including exercise and breathing techniques. (Better Health Channel)

Find a therapist – Search for anxiety disorder treatment providers in your area and find advice on  selecting the right doctor or therapist. (Anxiety Disorders Association of America)

Anxiety Disorders: The Role of Psychotherapy in Effective Treatment – Covers the different types of anxiety disorders, why treatment is important, and what treatment options are available. (American Psychological Association)

Cognitive Behavioral Therapy – Covers how cognitive behavior therapy is used to reduce and eliminate anxiety disorders. (University of Houston)

What are the Psychotherapeutic and Other Non-Drug Approaches to Anxiety Disorder? – Overview of therapies and complementary treatments for anxiety. (University of Maryland Medical Center)

Complementary treatments for anxiety

Depression and Anxiety: Exercise Eases Symptoms – Learn how even small amounts of exercise can help reduce anxiety. (Mayo Clinic)

Progressive Muscle Relaxation – Step by step guide to progressive muscle relaxation for the reduction of anxiety. (A Guide to Psychology and its Practice)

Biofeedback – Overview of biofeedback, a mind-body therapy that can teach you to control some of the symptoms of anxiety. (Mayo Clinic)

Meditation – Harvard Medical School’s guide to meditation as an alternative treatment for anxiety disorders, stress, and other health problems. (Aetna InteliHealth)

Melinda Smith, M.A., created this article with contributions from Robert Segal, M.A., and Jeanne Segal, Ph.D. Last modified on: 6/06/08.