Anxiety Disorders
Anxiety disorders are characterized by fear, worry, or dread that is disproportionate to the situation and impairs a person’s ability to function normally. Research indicates that anxiety disorders involve dysfunction in the parts of the limbic system and hippocampus that regulate emotions and response to fear.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, there are many types of anxiety disorders:
(1) Generalized anxiety disorder is excessive worry or apprehension about a number of events or activities. Symptoms may include:
- Feeling restless, wound-up, or on-edge
- Being easily fatigued
- Having difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Difficulty controlling feelings of worry
- Sleep disturbance, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep.
(2) Separation anxiety is often thought of as something that only children deal with. However, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being apart from people to whom they are attached. They often worry that some something harmful will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.
(3) Panic disorder is characterized by recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.
During a panic attack, people may experience:
- Heart palpitations, pounding heartbeat, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath, smothering, or choking
- Feelings of impending doom
- Feelings of being out of control.
People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause significant problems in various areas of the person’s life, including the development of agoraphobia (see below).
(4) Post-traumatic stress disorder (PTSD) is characterized by an intense re-experiencing of a traumatic event by distressing recollections, dreams, and/or associations (such as things or situations that remind the individual of the traumatic event). Some examples include witnessing or experiencing a natural disaster, being in a serious automobile accident, or witnessing a violent crime.
(5) Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions (i.e., recurrent thoughts, impulses, or images that are difficult to control and cause significant distress) and/or compulsions (i.e., behaviors that the individual engages in to make the distress feel better, such as handwashing, checking, or redoing). Some examples of obsessive-compulsive disorder may include excessive concerns about germs or lucky/unlucky numbers.
(6) Phobia-related disorders. A phobia is an intense fear of, or aversion to, specific objects or situations. The fear people with phobias feel is out of proportion to the actual danger caused by the situation or object. People with phobias:
There are several types of phobias and phobia-related disorders:
- Specific phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:
• Flying
• Heights
• Specific animals, such as spiders, dogs, or snakes
• Blood or injections - Social anxiety disorder (previously called social phobia) is characterized by intense fear or anxiety about social or performance situations. Individuals with social anxiety disorder worry that their actions will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes them to avoid social situations. Social anxiety disorder can be present in a range of situations, such as within the workplace or school environment.
- Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:
• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Standing in line or being in a crowd
• Being outside of the home alone
People with agoraphobia often avoid these situations, in part, because they think that they won’t be able to leave in the event that they have a panic attack. In the most severe form of agoraphobia, an individual can become housebound.
- Perhaps the most common manifestation of an anxiety disorder in children and adolescents is school refusal. “School refusal” has largely supplanted the term “school phobia” because actual fear of school is exceedingly rare. Most children who refuse to go to school have separation anxiety, social anxiety disorder, panic disorder, specific phobia, or a combination. The possibility that the child is being bullied at school must also be considered.
Some children complain directly about their anxiety, describing it in terms of worries (e.g., “I am worried that I will never see you again” [separation anxiety] or “I am worried the kids will laugh at me” [social anxiety disorder]). However, most children couch their discomfort in terms of somatic or physical complaints (e.g., “I cannot go to school because I have a stomachache”). These children are typically telling the truth because stomachaches, nausea, and headaches often develop in children with anxiety. Several long-term follow-up studies confirm that many children with somatic complaints, especially abdominal pain, have an underlying anxiety disorder.
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