Anxiety is not only common but also multifaceted in its appearance. Different anxiety disorders, such as specific phobias or social anxiety, have unique features.
Anxiety disorders are very common. Approximately one in five adults has experienced one in the past year. Further, these disorders come in many different forms. It is important to consider these differences because they influence the types of treatment available.
We are each individual, so the way anxiety is manifested is unique to that person. In order to understand it, though, doctors group the symptoms together in a manner that makes it possible to be studied.
General Anxiety Disorder
The features that many people have in common have come to be known as Generalized Anxiety Disorder, or GAD. The general qualities of GAD, as expressed in a widely used psychiatric manual (the ‘DSM V’), include:
- Excessive anxiety or worry on a majority of days for at least six months.
- A person finds this difficult to control.
- The presence of at least three of the following symptoms (one, in children):
- Muscle tension
- Difficulty concentrating
- Sleep difficulty or other symptoms lead to significant distress or decreased functioning at home or work
- The anxiety is not related to medicine the person may be taking, a medical condition, or some other disorder (for instance, thinking about past trauma in post-traumatic stress disorder).
GAD and depression
GAD can occur alone, but also often appears in combination with depression. A person diagnosed with GAD often goes on to develop major depression within one year. When the two occur together, the impact on a person’s life and health is often much greater.
Some scientists point to commonalities between the two conditions, including some similarities in genetics and overlapping biological features. They are both often treated with the same medicines, such as the SSRIs, though other medicines differ.
The general format of the most widely used psychotherapy-cognitive behavioral therapy-is the same for both, though with different emphases.
Some have speculated that there is a similar type of susceptibility. However, some people respond more with anxiety, while others become depressed or both, for reasons that are not yet understood.
Whether or not this turns out to be the case, they appear so often together that it is difficult in a practical sense to talk about the one without the other.
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Other related anxiety disorders
In addition to GAD, there are a number of other related anxiety disorders. These include:
People with panic disorder unexpectedly experience discrete episodes of ‘panic attacks’, These are characterized by the following:
- rapid heartbeat
- shortness of breath
- chest discomfort
- a sense of choking
- a sense of impending doom
- or other symptoms
The symptoms begin suddenly and have a peak in intensity within 10 minutes or so. The attack may last up to 30–45 minutes. As with GAD, part of the criteria for panic disorder is that the events do not seem to be related to the effects of a substance or medical disorder.
Often, a person experiencing a panic episode may believe they are having a heart attack. It feels like they are experiencing what seems to be a life-threatening event. Thus, many end up going to emergency rooms for help.
To meet the formal criteria of panic disorder, the panic attack is followed by at least one month of persistently worrying about future episodes. Their changes in behavior reflect this worry. Indeed, these events can be so frightening that some persons develop qualities of post-traumatic stress disorder.
Some studies have found that the impact of panic disorder on mental well-being can be greater than that of heart disease and cancer. Although panic episodes are often thought of as being in the daytime, about three-quarters of persons experiencing them have also had them at night.
Panic episodes, either unexpected or expected, can occur alone or in other anxiety disorders including GAD, agoraphobia, and social anxiety disorder.
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Specific phobias are excessive fear or anxiety about very specific situations (for instance, flying or high places) or objects (blood, animals). This may lead to avoidance of the feared thing. It often affects daily functioning.
Often, a person realizes that the fear is irrational but feels unable to control it. There is also anticipatory anxiety if it seems possible that he/she will encounter the feared object. And, experiencing it can lead to panic attacks.
Sometimes the phobia begins to incorporate additional objects. Initially, phobias may appear to be without obvious cause. However, once present, they can persist for a long time. Sometimes, these types of phobias will clear up on their own.
Taken from the Greek word ‘agora’ for the marketplace, this is fear of being in open places, public transportation, or crowds. A common theme is that there is a sense of not being able to escape to somewhere safe. The experience may lead to a full or partial panic attack.
This may lead to staying home more and more, with increasing degrees of social isolation. Indeed, about one-third of those affected feel they cannot leave home. Often, he/she becomes extremely dependent on another person for doing errands or for accompanying on forays away from home.
Social anxiety disorder
Social anxiety disorder occurs when someone experiences excessive anxiety or embarrassment when interacting with others. Examples include anxiety about talking to strangers, going out to dinner with a group, or speaking or performing in public. The symptoms’ duration must be at least six months’ duration to meet the criteria for the disorder.
The fear is often that one will be judged negatively by others. Or, that they may be found lacking in social skills, or be embarrassed by anxiety symptoms. There is a tendency to emphasize any threatening qualities of the situation.
Afterward, the individual may think about and replay the social event in a negative way. Sometimes, individuals will use alcohol or drugs in an attempt to deal with the anxiety. This, of course, can create problems of its own.
Separation anxiety disorder
People with separation anxiety disorder worry excessively and have about being away from a person important in one’s life. Although at first glance this sounds like a condition in children, it may appear in adults too.
When seen in adulthood, there is not necessarily a history of difficulty with separation persisting from childhood. Typical symptoms can include the following:
- a great deal of worry about being separated from an important figure
- fear that harm will come to this person
- or a desire to stay home to be close
There are often nightmares involving separation. The formal diagnosis requires that these symptoms go on for at least six months and result in distress or impaired functioning socially or at work.
Selective mutism is a less common condition (in less than 0.05 percent of schoolchildren) in which a person does not speak in certain social settings, even though having normal language ability in other situations. It often starts before age 5.
A child may be mute at school, for instance, while speaking easily at home. Parents can mistakenly believe that the child is refusing to speak. They may feel that this is manipulative or controlling behavior.
Selective mutism is usually associated with shyness and withdrawal. It is often accompanied by other anxiety disorders and can persist into adulthood. Children with selective mutism are not more likely to have histories of abuse or neglect.
Some immigrant children who are uncomfortable with a new language may be hesitant to speak in strange situations. This is not usually thought of as selective mutism.
The bottom line
Anxiety is not only common but also multifaceted in its appearance. It occurs in all ages. It’s of particular concern when in combination with depression, where it is associated with a number of health issues.
The good news is that there are many effective treatments, and if you suspect that you might have an anxiety disorder, it’s important to seek consultation from a doctor or therapist.
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Wallace Mendelson, MD is Professor of Psychiatry and Clinical Pharmacology (ret) at the University of Chicago. He is a Distinguished Fellow of the American Psychiatric Association and a member of the American Academy of Neuropsychopharmacology. He was the director of the Section on Sleep Studies at the National Institute of Mental Health, the Sleep Disorders Center at the Cleveland Clinic Foundation, and the Sleep Research Laboratory at the University of Chicago.
He is the author of seven books and numerous professional papers. Among his honors have been the Academic Achievement Award from the American Sleep Disorders Association in 1999 and a special award for excellence in sleep and psychiatry from the National Sleep Foundation in 2010.
Originally published at https://thedoctorweighsin.com on October 13, 2019.