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Anxiety disorders
Overview
Experiencing occasional anxiety is a normal part of life. However,
people with anxiety disorders frequently have intense, excessive and
persistent worry and fear about everyday situations. Often, anxiety
disorders involve repeated episodes of sudden feelings of intense
anxiety and fear or terror that reach a peak within minutes (panic
attacks).
These feelings of anxiety and panic interfere with daily activities, are
difficult to control, are out of proportion to the actual danger and can
last a long time. You may avoid places or situations to prevent these
feelings. Symptoms may start during childhood or the teen years and
continue into adulthood.
Examples of anxiety disorders include generalized anxiety disorder,
social anxiety disorder (social phobia), specific phobias and separation
anxiety disorder. You can have more than one anxiety disorder. Sometimes
anxiety results from a medical condition that needs treatment.
Whatever form of anxiety you have, treatment can help.
Symptoms
Common anxiety signs and symptoms include:
- Feeling nervous, restless or tense
- Having a sense of impending danger, panic or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Sweating
- Trembling
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the
present worry
- Having trouble sleeping
- Experiencing gastrointestinal (GI) problems
- Having difficulty controlling worry
- Having the urge to avoid things that trigger anxiety
Several types of anxiety disorders exist:
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Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety
disorder in which you fear and often avoid places or situations that
might cause you to panic and make you feel trapped, helpless or
embarrassed.
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Anxiety disorder due to a medical condition includes
symptoms of intense anxiety or panic that are directly caused by a
physical health problem.
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Generalized anxiety disorder includes persistent and
excessive anxiety and worry about activities or events — even
ordinary, routine issues. The worry is out of proportion to the
actual circumstance, is difficult to control and affects how you
feel physically. It often occurs along with other anxiety disorders
or depression.
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Panic disorder involves repeated episodes of sudden
feelings of intense anxiety and fear or terror that reach a peak
within minutes (panic attacks). You may have feelings of impending
doom, shortness of breath, chest pain, or a rapid, fluttering or
pounding heart (heart palpitations). These panic attacks may lead to
worrying about them happening again or avoiding situations in which
they've occurred.
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Selective mutism is a consistent failure of children to
speak in certain situations, such as school, even when they can
speak in other situations, such as at home with close family
members. This can interfere with school, work and social
functioning.
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Separation anxiety disorder is a childhood disorder
characterized by anxiety that's excessive for the child's
developmental level and related to separation from parents or others
who have parental roles.
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Social anxiety disorder (social phobia) involves high
levels of anxiety, fear and avoidance of social situations due to
feelings of embarrassment, self-consciousness and concern about
being judged or viewed negatively by others.
-
Specific phobias are characterized by major anxiety when
you're exposed to a specific object or situation and a desire to
avoid it. Phobias provoke panic attacks in some people.
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Substance-induced anxiety disorder is characterized by
symptoms of intense anxiety or panic that are a direct result of
misusing drugs, taking medications, being exposed to a toxic
substance or withdrawal from drugs.
-
Other specified anxiety disorder and unspecified anxiety disorder are
terms for anxiety or phobias that don't meet the exact criteria for
any other anxiety disorders but are significant enough to be
distressing and disruptive.
When to see a doctor
See your doctor if:
- You feel like you're worrying too much and it's interfering with
your work, relationships or other parts of your life
- Your fear, worry or anxiety is upsetting to you and difficult to
control
- You feel depressed, have trouble with alcohol or drug use, or have
other mental health concerns along with anxiety
- You think your anxiety could be linked to a physical health problem
- You have suicidal thoughts or behaviors —
if this is the case, seek
emergency treatment immediately
Your worries may not go away on their own, and they may get worse over
time if you don't seek help. See your doctor or a mental health provider
before your anxiety gets worse. It's easier to treat if you get help
early.
Causes
The causes of anxiety disorders aren't fully understood. Life
experiences such as traumatic events appear to trigger anxiety disorders
in people who are already prone to anxiety. Inherited traits also can be
a factor.
Medical causes
For some people, anxiety may be linked to an underlying health issue. In
some cases, anxiety signs and symptoms are the first indicators of a
medical illness. If your doctor suspects your anxiety may have a medical
cause, he or she may order tests to look for signs of a problem.
Examples of medical problems that can be linked to anxiety include:
- Heart disease
- Diabetes
- Thyroid problems, such as hyperthyroidism
- Respiratory disorders, such as chronic obstructive pulmonary disease
(COPD) and asthma
- Drug misuse or withdrawal
- Withdrawal from alcohol, anti-anxiety medications (benzodiazepines)
or other medications
- Chronic pain or irritable bowel syndrome
- Rare tumors that produce certain fight-or-flight hormones
Sometimes anxiety can be a side effect of certain medications.
It's possible that your anxiety may be due to an underlying medical
condition if:
- You don't have any blood relatives (such as a parent or sibling)
with an anxiety disorder
- You didn't have an anxiety disorder as a child
- You don't avoid certain things or situations because of anxiety
- You have a sudden occurrence of anxiety that seems unrelated to life
events and you didn't have a previous history of anxiety
Risk factors
These factors may increase your risk of developing an anxiety disorder:
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Trauma. Children who endured abuse or trauma or witnessed
traumatic events are at higher risk of developing an anxiety
disorder at some point in life. Adults who experience a traumatic
event also can develop anxiety disorders.
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Stress due to an illness. Having a health condition or
serious illness can cause significant worry about issues such as
your treatment and your future.
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Stress buildup. A big event or a buildup of smaller
stressful life situations may trigger excessive anxiety — for
example, a death in the family, work stress or ongoing worry about
finances.
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Personality. People with certain personality types are more
prone to anxiety disorders than others are.
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Other mental health disorders. People with other mental
health disorders, such as depression, often also have an anxiety
disorder.
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Having blood relatives with an anxiety disorder. Anxiety
disorders can run in families.
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Drugs or alcohol. Drug or alcohol use or misuse or
withdrawal can cause or worsen anxiety.
Complications
Having an anxiety disorder does more than make you worry. It can also
lead to, or worsen, other mental and physical conditions, such as:
- Depression (which often occurs with an anxiety disorder) or other
mental health disorders
- Substance misuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Headaches and chronic pain
- Social isolation
- Problems functioning at school or work
- Poor quality of life
- Suicide
Prevention
There's no way to predict for certain what will cause someone to develop
an anxiety disorder, but you can take steps to reduce the impact of
symptoms if you're anxious:
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Get help early. Anxiety, like many other mental health
conditions, can be harder to treat if you wait.
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Stay active. Participate in activities that you enjoy and
that make you feel good about yourself. Enjoy social interaction and
caring relationships, which can lessen your worries.
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Avoid alcohol or drug use. Alcohol and drug use can cause
or worsen anxiety. If you're addicted to any of these substances,
quitting can make you anxious. If you can't quit on your own, see
your doctor or find a support group to help you.
Diagnosis
You may start by seeing your primary care provider to find out if your
anxiety could be related to your physical health. He or she can check
for signs of an underlying medical condition that may need treatment.
However, you may need to see a mental health specialist if you have
severe anxiety. A psychiatrist is a medical doctor who specializes in
diagnosing and treating mental health conditions. A psychologist and
certain other mental health professionals can diagnose anxiety and
provide counseling (psychotherapy).
To help diagnose an anxiety disorder, your mental health provider may:
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Give you a psychological evaluation. This involves
discussing your thoughts, feelings and behavior to help pinpoint a
diagnosis and check for related complications. Anxiety disorders
often occur along with other mental health problems — such as
depression or substance misuse — which can make diagnosis more
challenging.
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Compare your symptoms to the criteria in the DSM-5. Many
doctors use the criteria in the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), published by the American Psychiatric
Association, to diagnose an anxiety disorder.
Treatment
The two main treatments for anxiety disorders are psychotherapy and
medications. You may benefit most from a combination of the two. It may
take some trial and error to discover which treatments work best for
you.
Psychotherapy
Also known as talk therapy or psychological counseling, psychotherapy
involves working with a therapist to reduce your anxiety symptoms. It
can be an effective treatment for anxiety.
Cognitive behavioral therapy (CBT) is the most effective form of
psychotherapy for anxiety disorders. Generally a short-term treatment,
CBT focuses on teaching you specific skills to improve your symptoms and
gradually return to the activities you've avoided because of anxiety.
CBT includes exposure therapy, in which you gradually encounter the
object or situation that triggers your anxiety so you build confidence
that you can manage the situation and anxiety symptoms.
Medications
Several types of medications are used to help relieve symptoms,
depending on the type of anxiety disorder you have and whether you also
have other mental or physical health issues. For example:
- Certain antidepressants are also used to treat anxiety disorders.
- An anti-anxiety medication called buspirone may be prescribed.
- In limited circumstances, your doctor may prescribe other types of
medications, such as sedatives, also called benzodiazepines, or beta
blockers. These medications are for short-term relief of anxiety
symptoms and are not intended to be used long term.
Talk with your doctor about benefits, risks and possible side effects of
medications.
Lifestyle and home remedies
While most people with anxiety disorders need psychotherapy or
medications to get anxiety under control, lifestyle changes also can
make a difference. Here's what you can do:
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Keep physically active. Develop a routine so that you're
physically active most days of the week. Exercise is a powerful
stress reducer. It may improve your mood and help you stay healthy.
Start out slowly and gradually increase the amount and intensity of
your activities.
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Avoid alcohol and recreational drugs. These substances can
cause or worsen anxiety. If you can't quit on your own, see your
doctor or find a support group to help you.
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Quit smoking and cut back or quit drinking caffeinated beverages. Both
nicotine and caffeine can worsen anxiety.
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Use stress management and relaxation techniques. Visualization
techniques, meditation and yoga are examples of relaxation
techniques that can ease anxiety.
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Make sleep a priority. Do what you can to make sure you're
getting enough sleep to feel rested. If you aren't sleeping well,
see your doctor.
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Eat healthy. Healthy eating — such as focusing on
vegetables, fruits, whole grains and fish — may be linked to reduced
anxiety, but more research is needed.
Alternative medicine
Several herbal remedies have been studied as a treatment for anxiety,
but more research is needed to understand the risks and benefits. Herbal
and dietary supplements aren't monitored by the Food and Drug
Administration (FDA) the same way medications are. You can't always be
certain of what you're getting and whether it's safe. Some of these
supplements can interfere with prescription medications or cause
dangerous interactions.
Before taking herbal remedies or dietary supplements, talk to your
doctor to make sure they're safe for you and won't interact with any
medications you take.
Coping and support
To cope with an anxiety disorder, here's what you can do:
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Learn about your disorder. Talk to your doctor or mental
health provider. Find out what might be causing your specific
condition and what treatments might be best for you. Involve your
family and friends and ask for their support.
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Stick to your treatment plan. Take medications as directed.
Keep therapy appointments and complete any assignments your
therapist may give you. Consistency can make a big difference,
especially when it comes to taking your medication.
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Take action. Learn what triggers your anxiety or causes you
stress. Practice the strategies you developed with your mental
health provider so you're ready to deal with anxious feelings in
these situations.
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Keep a journal. Keeping track of your personal life can
help you and your mental health provider identify what's causing you
stress and what seems to help you feel better.
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Join an anxiety support group. Remember that you aren't
alone. Support groups offer compassion, understanding and shared
experiences. The National Alliance on Mental Illness and the Anxiety
and Depression Association of America provide information on finding
support.
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Learn time management techniques. You can reduce anxiety by
learning how to carefully manage your time and energy.
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Socialize. Don't let worries isolate you from loved ones or
activities.
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Break the cycle. When you feel anxious, take a brisk walk
or delve into a hobby to refocus your mind away from your worries.
Preparing for your appointment
You may start by seeing your primary care provider. He or she may refer
you to a mental health professional.
What you can do
Before your appointment, make a list of:
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Your anxiety symptoms. Note when they occur, whether
anything seems to make them better or worse, and how much they
affect your day-to-day activities and interactions.
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What causes you stress. Include any major life changes or
stressful events you've dealt with recently. Also note any traumatic
experiences you've had in the past or as a child.
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Any family history of mental health problems. Note if your
parents, grandparents, siblings or children have struggled with any
mental health problems.
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Any other health problems you have. Include both physical
conditions and mental health issues.
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All medications you're taking. Include any medications,
vitamins, herbs or other supplements, and the doses.
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Questions to ask your doctor to make the most of your
appointment.
Some basic questions to ask your doctor include:
- What's the most likely cause of my anxiety?
- Are there other possible situations, psychological issues or
physical health problems that could be causing or worsening my
anxiety?
- Do I need any tests?
- Should I see a psychiatrist, psychologist or other mental health
provider?
- What type of therapy might help me?
- Would medication help? If so, is there a generic alternative to the
medicine you're prescribing?
- In addition to treatment, are there any steps I can take at home
that might help?
- Do you have any educational materials that I can have? What websites
do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor will likely ask you several questions, such as:
- What are your symptoms, and how severe are they? How do they impact
your ability to function?
- Have you ever had a panic attack?
- Do you avoid certain things or situations because they make you
anxious?
- Have your feelings of anxiety been occasional or continuous?
- When did you first begin noticing your feelings of anxiety?
- Does anything in particular seem to trigger your anxiety or make it
worse?
- What, if anything, seems to improve your feelings of anxiety?
- What traumatic experiences have you had recently or in the past?
- What, if any, physical or mental health conditions do you have?
- Do you take any prescription drugs?
- Do you regularly drink alcohol or use recreational drugs?
- Do you have any blood relatives who have anxiety or other mental
health conditions, such as depression?
Preparing and anticipating questions will help you make the most of your
time.
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