Anxiety Disorders
There are several types of anxiety disorders:
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is characterized by feelings of persistent worry. The worries are excessive, uncontrollable, and last for an extended period of time. People with GAD often realize that their worries are out of proportion to the situation but are unable to contain their anxiety.
Symptoms
The symptoms of GAD include:
- Excessive worry
- Fatigue
- Difficulty concentrating
- Restlessness
- Irritability
- Sleep disturbance
- Muscle tension
Causes and Risk Factors
GAD occurs approximately twice as often in the female population as in the male population. The disorder increases slowly over time, but the highest risk of onset is typically between childhood to middle age. Those suffering from GAD often suffer from additional mental disorders such as other anxiety disorders, depression or substance abuse.
Diagnosis
For a doctor to make a diagnosis of GAD, one must be suffering from excessive worry and three or more of the aforementioned symptoms for at least six months.
Treatment
Common treatment for GAD includes cognitive-behavioral therapy and/or medications such as anti-depressants and benzodiazepines.
Panic Disorder
Panic disorder, also called panic attack, is characterized by recurrent, unexpected and discrete periods of intense fear. Panic attacks can occur at unpredictable times and for unknown reasons. Those suffering a panic attack may believe that they are losing their mind or that they are dying. In between episodes, people with panic disorder may worry excessively that they will suffer another attack, often preventing them from doing certain activities or going certain places.
Symptoms
A panic attack is a period of intense fear or discomfort that typically reaches a peak within 10 minutes and may include:
- Palpitations, pounding heart, elevated heart rate
- Sweating
- Trembling
- Shortness of breath or a sensation of being smothered
- Choking sensation
- Chest pain
- Nausea
- Feelings of dizziness, lightheadedness
- Feeling faint
- Feelings of unreality or detachment
- Fear of losing control or losing one's mind
- Fear of dying
- Numbness or tingling sensation
- Chills and/or hot flashes
Causes and Risk Factors
The onset of panic disorder typically occurs in late adolescence and early adulthood. Lifetime prevalence is between 1.5 and 3.5 percent of the population. Panic disorder is twice as common in women as in men and often occurs with other anxiety disorders, depression and drug and alcohol abuse.
Diagnosis
For a doctor to make a diagnosis of panic disorder, one must have recurrent unexpected panic attacks with at least one attack being followed by a period of a month or more where the person has persistent worry about having additional attacks, about the implications or consequences of the attack, and/or a significant change in behavior related to the attacks.
Treatment
Panic Disorder can be treated with medication (benzodiazepines, antidepressants) and cognitive psychotherapy which aim to change thinking patterns that lead to anxiety and fear.
Social Anxiety Disorder (Social Phobia)
Social anxiety disorder is characterized by a marked and persistent fear of social situations or performance tasks in which one might become embarrassed such as public speaking or meeting new people. While those who suffer from social anxiety understand that the fear is unreasonable and excessive, they are unable to contain their anxiety. This fear often results in avoidance of social situations and can interfere with one's daily routine, work and social functioning.
Symptoms
People with social anxiety disorder may feel a hypersensitivity to criticism, negative evaluation or rejection, difficulty being assertive and low self-esteem. When a person with social anxiety is faced with a triggering situation the following physical symptoms may occur:
- Blushing
- Excessive sweating
- Trembling
- Nausea
- Difficulty speaking
- Difficulty making eye contact
Causes and Risk Factors
Three to 13 percent of people with social anxiety will experience the condition throughout their lifetime. The onset is typically early or mid-adolescence, occurs equally in men and women and there is some evidence of genetic involvement in the development of the disorder. Social anxiety disorder often occurs with other mental and anxiety disorders such as depression.
Diagnosis
For a doctor to make a diagnosis of social anxiety disorder, one must have a marked and persistent fear of social or performance situations. The person often has concerns that they will behave in a way that will embarrass them. Other criteria include:
- Exposure to a feared situation elicits excessive anxiety
- The person recognizes that the fear is unreasonable
- The feared situations are either avoided or endured with intense anxiety and distress
- The avoidance, anticipation, and distress encountered by the feared situation interferes significantly with the person's normal routine, occupational/academic functioning, and/or social activities and relationships
Treatment:
Social anxiety disorder may be treated with medication (benzodiazepines, anti-depressants) and cognitive psychotherapy.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is characterized by the development of symptoms following exposure to an extremely traumatic stressor. This stressor usually involves direct personal experience with, witnessing of, or learning about a situation that involved actual or threatened death or injury. Those suffering from PTSD may startle easily, experience a numbing of emotion, lose interest in previously enjoyed activities, and may show increased aggression or violent tendencies. They may avoid situations or stimuli that serve as reminders of the traumatic event. Sufferers often re-experience the traumatic event through flashbacks or nightmares.
Symptoms
After a traumatic event, an individual suffering from PTSD may experience the following symptoms
- Complaints of physical aches and pains
- Drastic changes in personality
- Edginess, exaggerated startle response
- Feeling threatened
- Feelings of hopelessness
- Feelings of shame or guilt
- Feelings of unreality or feeling
- Disconnected from the world or the self
- Flashbacks of the event
- Impulsive behavior
- Social withdrawal
Causes and Risk Factors
PTSD can occur at any age, including childhood. Symptoms typically begin within three months of the traumatic event, although it is possible for a delay of months or years before symptoms appear. The severity, duration, and closeness of the individual's exposure to the trauma are the most important factors influencing the development of this disorder. Social support, family history, past experiences, and preexisting mental conditions may also influence the development of PTSD. From one to 14 percent of the population will experience PTSD in their lifetime.
Diagnosis
For a doctor to diagnosis PTSD, the individual must have been exposed to an event in which the person experienced or witnessed a situation that involved actual or threatened death or harm. Typically the individual's response involves intense fear, helplessness, or horror. In addition the following must be present for at least one month:
- The traumatic event is persistently re-experienced (flashbacks, dreams)
- The person persistently avoids stimuli or situations associated with the trauma
- Numbing of emotional responsiveness
- The person experiences symptoms of increased arousal (for example, difficulty sleeping, exaggerated startle response)
- Disturbances cause impairment in social and work/school functioning
Treatment:
PTSD can be treated with medication (benzodiazepines, anti-depressants) and cognitive psychotherapy.
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is characterized by either obsessions or compulsions. Obsessions include persistent ideas, thoughts, impulses, or images that can be inappropriate and intrusive and cause stress and anxiety. Compulsions include repetitive behaviors or mental acts that are done with the goal of reducing or preventing anxiety or distress. In OCD, obsessions and compulsions are severe enough to become time consuming and cause marked distress or significant impairment in one's normal routine, occupational functioning, and social life. Individuals suffering from OCD often come to recognize that the obsessions and/or compulsions are excessive and unreasonable, but cannot discontinue their thoughts and actions.
Causes and Risk Factors
About 2.5 percent of the general population experience OCD. Onset is typically in adolescence or early-adulthood, with onset for men usually earlier than for women. Some individuals exhibit an exacerbation of symptoms due to stress. OCD often occurs with other anxiety disorders, depression, or eating disorders. There is believed to be a genetic component in some cases of OCD.
Diagnosis
For a doctor to diagnosis OCD, one must be experiencing obsessions and/or compulsions. Additionally the following must be present:
- The individual recognizes that the obsessions or compulsions may be excessive or unreasonable
- The obsessions or compulsions cause marked distress
- The obsessions or compulsions are time consuming (more than one hour a day)
- The obsessions or compulsions significantly interfere with the person¿s normal routine, occupation and social functioning
Treatment
OCD can be treated with cognitive psychotherapies and medication.
Resources at Cedars-Sinai
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