Anxiety is a common, normal, and sometimes useful response that may improve performance for those facing life's challenges and dangers. But in some people, anxiety spins out of control. Anxiety disorders are characterized by either recurrent or persistent psychological and physical symptoms-such as intense fear, worry, dizziness, and palpitations-that interfere with normal functioning, continue in the absence of obvious external stresses, or are excessive responses to these stresses. Anxiety disorders may result from hyperactivity in certain areas of the brain or decreased activity of a neurotransmitter (a chemical messenger) called gamma-aminobutyric acid (GABA), which suppresses the action of neurons. Luckily, effective treatments are available, including psychotherapy, medication, and coping behaviors.
This section includes information on:
- Panic disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Phobic disorders
The cardinal features of panic disorder are short-lived, sudden attacks of terror and fear of losing control. Attacks begin without warning during non-threatening activities. Affected individuals often go to the emergency room or consult a cardiologist because their physical symptoms-severe difficulty in breathing; a pounding, rapid heart rate; and a choking sensation-may appear to be a heart attack. (Patients who suspect that they are having a heart attack should see a doctor immediately.) Panic attacks generally peak within 10 minutes and dissipate within 20 to 30 minutes. They are characterized by some combination of the following symptoms:
- shortness of breath or hyperventilation
- heart palpitations or a racing pulse
- discomfort in the chest
- dizziness, lightheadedness, or feeling faint
- choking, nausea, or stomach pain
- hot or cold flashes
- trembling or shaking
- sense of unreality
- tingling or numbness
- fear of dying or losing one's mind.
Symptoms of depression and anxiety are frequent in persons with panic disorder and in members of their family. Although both panic attacks and symptoms of depression or anxiety may respond to antidepressant medications for some patients, others may require separate medications for the panic disorder and for the depression and anxiety. The prevalence of panic disorder is 1 to 2 percent in both men and women. Attacks commonly begin in the late teens or early 20s and often go undiagnosed and untreated.
The most common complication of panic disorder is agoraphobia-fear of being in public places, especially when alone-which develops as a result of trying to avoid situations that have triggered panic attacks in the past. Left untreated, panic attacks and agoraphobia can markedly restrict an individual's lifestyle. Panic disorder is also associated with an increased frequency of major depression, alcohol and drug dependency, and suicide.
GAD affects 2 to 3 percent of the population. Although people with GAD know that the intensity, duration, or frequency of their anxiety and worry are well out of proportion to the actual likelihood or impact of the feared event, they still have difficulty controlling their emotions. Perpetual anxiety may impair concentration, memory, and decision-making ability; decrease attention span; and lead to a loss of confidence. Normal activities, such as working, socializing with friends, or maintaining intimate relationships, may become difficult or impossible.
GAD may also produce a range of physical symptoms, including heart palpitations, sweating, headaches, and nausea. Some GAD sufferers, not realizing that GAD is a treatable illness, become accustomed to their condition and assume that it is normal to feel on edge all the time. But the constant anxiety can also lead to alcohol or drug abuse.
OCD is marked by recurrent, repetitive thoughts (obsessions), behaviors (compulsions), or both that a person recognizes as unreasonable, unnecessary, or foolish yet are intrusive and cannot be resisted. People with OCD do not necessarily have both obsessions and compulsions, but either one often interferes with day-to-day activities and relationships with others.
Obsessions are sometimes of an aggressive or violent nature. The sufferer will try to suppress or ignore these uncomfortable thoughts and often recognizes that they are unrealistic. Typical obsessions are fear of contamination from germs, thoughts of violent behavior, fear of making a mistake, and a constant need for reassurance.
Compulsions are ritualistic, repetitive, and purposeful behaviors that are performed according to certain rules or stereotypical patterns. The behavior, although clearly excessive, temporarily relieves the tension and discomfort brought on by the obsessive thinking. Common compulsions are rechecking to be sure doors are locked, windows are closed, and the iron is unplugged; excessive neatness; and repetitive hand washing that accompanies an obsession with dirt and germs.
OCD occurs in about 2 percent of the population. It most often starts in the teens or the early 20s. Probably the most common complication is depression; others include alcoholism, abuse of sleeping pills or tranquilizers, and marked interference with normal social and occupational behaviors.
Post-traumatic stress disorder is a form of chronic psychological stress that follows exposure to a traumatic event such as an earthquake, a violent crime (rape, child abuse, murder), torture, an accident, terrorism, or warfare.
The symptoms include the following:
- recurrent, intrusive, distressing dreams and memories of the trauma
- a sudden sense that the event is recurring; experiencing flashbacks
- inability to remember aspects of the trauma
- markedly diminished interest in important activities
- feelings of detachment and estrangement from loved ones
- low expectations for the future
- insomnia or excessive fatigue
- extreme irritability
- inability to concentrate
Symptoms must last at least one month for a diagnosis of post-traumatic stress disorder. In the acute syndrome, symptoms begin within six months of the trauma. The chronic syndrome may be delayed in onset until more than six months after the event or may persist for more than six months afterward. Complications include anxiety, alcohol or drug abuse, depression, and marital or occupational problems.
The hallmarks of phobic disorders are persistent, irrational fears and avoidance of the specific things (for example, animals, heights, or closed spaces) or activities that induce these fears. The diagnosis of a phobic disorder is made only when the phobia significantly impairs the individual's social or occupational functioning.
A common type of phobia is social phobia, which is an undue fear of embarrassment in social situations. Although most people feel some anxiety from being in a situation that forces them to meet and talk to new people, social phobia causes such an extreme reaction to this everyday aspect of life that it interferes with daily functioning. To help determine if you have social phobia, see the social phobia self-test.
Content excerpted from the Johns Hopkins White Paper on Depression and Anxiety.