Anxiety Disorders

Anxiety Disorder is an umbrella term for different disorders, all of which have anxiety as a significant symptom. These are: Generalized Anxiety Disorder, Panic Disorder (including Agoraphobia), Social Phobia, Specific Phobia, Obsessive-Compulsive Disorder (OCD), Post-Traumatic-Stress-Disorder (PTSD) and Adjustment Disorder.

The Nature of Anxiety

Everyone experiences anxiety from time to time in highly stressful and/or threatening situations. Anxiety, in itself, is normal and is a part of the human experience. In fact, anxiety has an important role in keeping us safe. It enables us to react very quickly in life-threatening situations, in a way that might save us.

For example, let us imagine you are walking down a dark lane on your own and suddenly notice someone following you. You may appraise the situation as dangerous. Your heart may start pounding and you may feel anxious because of increased adrenalin secretion into your bloodstream. This will enable you to either run to safety or fight the perpetrator, if they attack you.

This is a part of what is called “the fight or flight response,” and is considered a life-preserving mechanism. In cases when a person perceives danger but cannot take action to protect themselves, the anxiety may intensify. In a way, having an anxiety disorder is like having an over-sensitive alarm system. The alarm goes off, i.e. anxiety is triggered even though there is no real danger. People with an anxiety disorder tend to react to stressful situations with anxiety, even though there is no real danger.

 Symptoms of Anxiety

Aside from the feeling of intense fear, anxiety has many physiological symptoms such as heart palpitations, dry mouth, nausea, stomach upset, breathing difficulties, choking sensation, dizziness, tingling sensation in the limbs, tightness in chest, trembling or shaking, muscle tension and faintness. Because of the nature of these symptoms, people who are having an anxiety attack may think they are having a heart attack. The next few paragraphs contain a brief description of each disorder. For more detailed information please refer to the recommended books and websites at the end of this section.

 Generalized Anxiety Disorder (GAD)

Individuals with GAD are often described by others and themselves as “worriers”, “worryworts” or simply as “worried about everything all the time.” They tend to worry over everyday events and difficulties and feel they cannot control the anxiety. In addition to anxiety and worry, these people experience other symptoms such as restlessness, difficulty concentrating, irritability, fatigue, muscle tension and disturbed sleep. People who receive a GAD diagnosis have had at least 3 of the above symptoms, for at least 6 months. The individual having GAD will often describe the anxiety as uncontrollable and debilitating.

Specific Phobias

The word phobia is Greek and it means intense fear. People with specific phobias experience intense and unwarranted fear of specific objects or situations, such as fear of spiders, elevators, needles, heights, water, etc. the phobia interferes with the individual’s life and activities and may cause the person to avoid situations that may trigger the anxiety.

For example, someone with fear of needles may avoid going to the lab for blood tests. Some phobias are more debilitating than others, depending on where the person lives and their lifestyle. For example, if someone who lives in a large North American city has a snake phobia, they may not be as affected and as debilitated by the phobia as they would if they had an elevator phobia.

Obsessive-Compulsive Disorder (OCD)

As the name implies, this disorder commonly has two parts: obsessive thoughts and compulsive behaviors. The obsessive thoughts are unwanted, repetitive, and intrusive, and cause significant anxiety. The compulsive behaviors are repetitive, unwanted and are time-consuming. The compulsive behaviors help to temporarily relieve the anxiety that is caused by the thoughts, and have therefore been called “neutralizing behaviors”. To receive a diagnosis of OCD, a person must have these symptoms for over 2 weeks. For a more detailed description of OCD, including a case example, click here.

Panic Disorder and Agoraphobia

Panic Disorder is characterized by recurrent and unpredictable attacks of intense fear or anxiety, which may be described as a wave; the attack may start relatively low, then rise, peak and finally subside. In addition to the experience of fear, at least 5 of the symptoms mentioned under symptoms of anxiety should be present. A complication of Panic Disorder is Agoraphobia, which is fear and avoidance of places outside of the home. Click here for a more detailed description of Panic Disorder and Agoraphobia.

Adjustment Disorder

Anxiety is a normal reaction to internal or external sources of significant stress. However, when anxiety is excessive and interferes with daily functioning for a prolonged period of time, the person may be having an adjustment disorder. Adjustment disorder is a maladaptive reaction to a specific and identifiable stressor, such as illness of oneself or a loved one, or a loss of income. Individuals with an adjustment disorder experience significant psychological and physiological symptoms of anxiety, that start within the first 3 months following the identifiable, stressful event.

To distinguish from Generalized Anxiety Disorder (GAD), we can simply say that while individuals with GAD “worry about everything all the time” individuals with an adjustment disorder “worry too much and too long about one thing”. In cases where the anxiety about a specific stressful event lasts more than 6 months, it may be defined as a chronic adjustment disorder.

Post Traumatic Stress Disorder (PTSD)

This disorder often results from a terrifying, possibly life-threatening experience that is considered to be “outside the range of usual human experience” (DSM-IV). Common events that may cause PTSD include war and terror attacks, natural disasters, personal assaults, accidents, and imprisonment in inhumane conditions. The most distinguishing symptom of PTSD is the recurrent reliving of the traumatic event through images, flashbacks and nightmares. Individuals with PTSD may experience intense anxiety on exposure to images, flashbacks and dreams, as well as to cues that bring the trauma back to life. These people often have disturbed sleep, poor memory and a decreased ability to concentrate.

Treatment Options

The good new about anxiety disorders, is that they are highly treatable. The first step in the recovery process should be education. To win the battle against anxiety one has to know and understand it. Understanding what happens to you and your body and why, could be crucial to recovery, by offering a sense of control. A sense of control is very important because one of the most disturbing features of anxiety is the feeling of being out of control. Self-help books can be an excellent source of information and most of them include useful exercises that may help a person manage their anxiety.

Psychotherapy – Consulting with a certified and experienced therapist may be helpful in managing an anxiety disorder. It is a good idea to make sure that the therapist has knowledge and experience in treating people with anxiety disorders.

Cognitive-Behavioural Therapy – is the treatment of choice for anxiety disorders, and one may wish to inquire whether or not their therapist is familiar with this type of therapy. Finally, it is important to discuss one’s expectations with the therapist. Learning to manage the anxiety may be a more realistic expectation than never feeling any anxiety ever again.

Medication – There are some very effective medications in the market that may alleviate anxiety symptoms. A family physician or a psychiatrist can prescribe medications. It is a good idea to discuss the pros and cons of taking medications, such as possible side effects, with the prescribing physician.

Further Readings

  • Andrews, G., Crino, R., Lampe, L. Hurt, C., & Page, A. (1994). The treatment of anxiety disorders: Clinician’s guide and patient manuals. New York, NY: Cambridge University Press.
  • Bourne, E. et al. (2003). Coping with anxiety. New Harbinger Publications.
  • Bourne, E. (2000). The anxiety and phobia workbook. New Harbinger

For more information, contact Dr Regev at her Vancouver office Tel: 604-671-7356 Email: