What to know about anxiety

Anxiety is a natural emotion. However, it can also lead to physical symptoms, such as shaking and sweating. Anxiety disorders can interfere with daily life, but the good news is that they can improve with treatment.

Anxiety disorders are a group of mental health conditions that lead to excessive nervousness, fear, apprehension, and worry.

This article discusses the symptoms, causes, and treatments for anxiety.

According to the Anxiety and Depression Association of America (ADAA), around 40 million people in the United States suffer from an anxiety disorder, making it the most common group of mental illnesses in the country. However, only 36.9% of people with an anxiety disorder receive treatment.

The American Psychological Association (APA) defines anxiety as “an emotion characterised by feelings of tension, worried thoughts, and physical changes like increased blood pressure.”

Understanding the difference between typical feelings of anxiety and an anxiety disorder requiring medical attention can help a person identify and treat the condition effectively.

Anxiety and anxiety disorders

Anxiety is a complex response to real or perceived threats. It involves cognitive, physical, and behavioural changes. Real or perceived danger triggers a rush of adrenaline, a hormone and chemical messenger in the brain, which initiates anxiety reactions in a process known as the fight-or-flight response. Some people may experience this response in difficult social situations or around important events or decisions.

The duration or severity of anxiety can sometimes be out of proportion to the original trigger or stressor. Physical symptoms, such as increased blood pressure and nausea, may also develop. When these responses go beyond typical anxiety, it can develop into an anxiety disorder.

Symptoms of Anxiety Disorders

There are several types of anxiety disorders, each with its own set of symptoms. Common symptoms of anxiety include:

• restlessness
• uncontrollable feelings of worry
• increased irritability
• difficulty concentrating
• sleep difficulties

While many people experience these symptoms occasionally, those with generalised anxiety disorder (GAD) experience them at persistent or extreme levels.

The Diagnostic and Statistical Manual of Mental Health Disorders: 5th Edition, text revision (DSM-5-TR) classifies anxiety disorders into several main types.

In previous editions of the DSM-5-TR, anxiety disorders also included obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), as well as acute stress disorder. However, these conditions are no longer categorised under anxiety disorders.

The anxiety disorders now include:

GAD

This chronic disorder involves excessive, long-lasting anxiety and worries about nonspecific life events, objects, and situations. GAD is the most common anxiety disorder, and people with it are not always able to identify the cause of their anxiety.

Panic disorder

Brief or sudden attacks of intense terror and apprehension characterize panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. Panic attacks tend to occur and escalate rapidly.

Panic disorders usually occur after frightening experiences or prolonged stress but may also occur without a trigger.

Specific phobia

This is a fear and avoidance of a particular object or situation. Phobias are not like other anxiety disorders, as they relate to a specific cause.

A person with a phobia might acknowledge fear as illogical or extreme but remain unable to control feelings of anxiety around the trigger—triggers for a phobia range from situations and animals to everyday objects.

Agoraphobia

This is a fear and avoidance of places, events, or situations from which it may be difficult to escape or where help would not be available in emergencies.

People often misunderstand this condition as a phobia of open spaces and the outdoors. A person with agoraphobia may fear leaving home or using elevators and public transport.

Selective mutism

Some children experience this form of anxiety, in which they cannot speak in certain places or contexts, even though they may have excellent verbal communication skills around familiar people.

Social anxiety disorder

This is a fear of adverse judgment from others in social situations or of public embarrassment. Social anxiety disorder includes a range of feelings, such as stage fright, a fear of intimacy, and anxiety around humiliation and rejection.

Separation anxiety disorder

High anxiety levels after separation from a person or place that provides feelings of security or safety characterize separation anxiety disorder. Separation anxiety is most common in young children but can affect people of all ages.

Causes of Anxiety Disorders

The causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present.

Possible causes include:

• Environmental stressors: Relationship problems, family issues, or work stress.
• Genetics: A family history of anxiety disorders may increase the risk.
• Medical factors: Certain illnesses or the side effects of medications.
• Substance withdrawal: Withdrawal from substances like alcohol or drugs can trigger anxiety.

Treatment for Anxiety

Treatment often involves a combination of psychotherapy, behavioural therapy, and medication.

In some cases, underlying conditions such as alcohol dependence or depression must be treated first before addressing the anxiety disorder.

Self-treatment

Some individuals can manage milder, more focused, or short-term anxiety at home without clinical supervision. However, this may not be effective for severe or long-term anxiety disorders.

There are various strategies to help cope with milder anxiety, including:

• Stress management techniques
• Relaxation exercises
• Maintaining a support network
• Physical exercise

Counseling

A standard way of treating anxiety is psychological counseling. This can include cognitive behavioral therapy (CBT), psychotherapy, or a combination of therapies.

CBT is a type of psychotherapy that aims to recognize and change harmful thought patterns that form the foundation of anxious and troublesome feelings.

Medications

A person can support anxiety management with several types

 of medication.

Medicines that might control some physical and mental symptoms include antidepressants, benzodiazepines, and tricyclic antidepressants.

• Benzodiazepines: A doctor may prescribe these for certain people with anxiety, but they can cause addiction. Diazepam, or Valium, is a common benzodiazepine.
• Antidepressants: These commonly help with anxiety, even though they also target depression. Serotonin reuptake inhibitors (SSRIs), fluoxetine, and citalopram are examples.
• Tricyclic antidepressants: These are an older class of drugs that benefit most anxiety disorders other than obsessive-compulsive disorder (OCD). Imipramine and clomipramine are two examples of tricyclics.

Additional drugs a person might use to treat anxiety include:

• monoamine oxidase inhibitors (MAOIs)
• beta-blockers
• buspirone

Seek medical advice if the adverse effects of any prescribed medications become severe.

Understanding anxiety and how to manage it is crucial for improving quality of life. If you or someone you know is struggling with anxiety, seek professional help to find the best treatment plan tailored to individual needs.