Anxiety Disorders: Types, Causes, Symptoms and Treatments

What are anxiety disorders?

Anxiety is a normal homeostatic (i.e. self-regulatory) response to stress which causes physiological adaptations. Fundamentally, this response is vital for survival in terms of avoidance, increased vigilance and preparedness to fight or flight.¹ while such behaviour is commonly seen in animals where their survival is threatened, in humans it is more commonly seen that the anticipation of a stressor will instigate this similar response.

In itself experiencing anxiety is a normal part of life. This is because people may feel anxious or worry about stressors such as health, money, work, family, or even significant life events. Crucially these forms of anxiety are occasional, temporary and often self-correcting. However, anxiety disorders involve frequently experiencing intense, excessive, and persistent worry and fear about everyday situations that are disproportionate to the actual danger of the stressor. In turn, this type of mental health condition contributes to decreased quality of life and functional impairment as it hinders an individual’s ability to function adequately, alongside maladaptive, atypical, and often irrational behaviour, and personal distress.

Types of anxiety disorders

There are numerous types of anxiety disorders since anxiety can be experienced chronically or acutely and in response to different situations or objects. Here is a list of the different types of anxiety disorders classified under the anxiety disorders section of the DSM-5, which is the handbook used by healthcare professionals worldwide to help with the diagnosis of mental disorders.

Generalised anxiety disorder

Generalised anxiety disorder (GAD) is characterised by persistent and excessive anxiety or worry towards activities, objects or events that can interfere with daily life, and be triggered both directly and implicitly without warning.

Unlike occasional worry or fleeting anxiety, people with GAD experience worry that is disproportionate to the actual circumstance, is challenging to control themselves, and affects their physical and psychological health. This form of anxiety is experienced over the course of months, if not years, therefore it is an ongoing issue that individuals must learn to cope with.

Panic disorder

Panic disorder is characterised by frequent and unexpected panic attacks. Panic attacks are sudden periods of intense fear, discomfort, or a spiraling sense of losing control that rapidly escalate within a matter of minutes.

Such panic attacks likely feature stronger, more intense feelings than other types of anxiety disorders. They can occur several times daily or be as infrequent as a few times yearly, regardless of how often they actually happen individuals can still suffer from the disorder.  However, it should be noted that not everyone who experiences a panic attack will develop a panic disorder.

In response, people with panic disorders attempt to mitigate the prospective feelings and prevent future attacks that may occur during their next attack by actively practicing avoidance behaviour.

Phobia related disorders (specific/simple phobias)

A specific or simple phobia is an intense fear of or aversion to specific objects and/or situations. The experienced fear is argued to be out of proportion to the actual danger the object/situation poses. Consequently, people with phobias attempt to mitigate the prospective feelings and prevent future attacks that may occur during their next attack by actively practicing avoidance behaviour.

There are different types of specific/simple phobias including:

• Animal phobias (e.g., dogs, insects, rodents or large mammals)
• Natural environment phobias (e.g., heights, darkness, germs or lightning)
• Blood-based phobias (e.g., giving/seeing blood, receiving shots/injections, injuries )
• Situational type phobias (e.g., the dentist, enclosed places or elevators)
• Sexual phobias (e.g., sexual acts or nudity)
• Other types of phobias (e.g., clowns, loud sounds or certain situations/foods)

Unlike simple/specific phobias, complex phobias are more disruptive and possess a more overwhelming and arguably debilitating impact on life. These conditions tend to develop later on in life but may also develop from a young age. The most common complex phobias include social phobia or social anxiety disorder and agoraphobia which will both be discussed in due course.

Social anxiety disorder (previously social phobia)

Social anxiety disorder is a complex phobia that refers to a generalised intense fear and anxiety towards social or performative situations. This is predominantly because individuals are increasingly self-conscious and worry about being negatively evaluated by others for their actions/behaviours and the subsequent embarrassment that follows.

As a result, individuals with social anxiety disorder tend to avoid social situations which in turn contribute towards significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Agoraphobia

Agoraphobia is a complex phobia that is characterised by intense fear and often avoidance of certain places and open spaces that make individuals feel panic, trapped, helpless and embarrassed. Usually, individuals will have a fear of two or more of the following environments:

• Being in open or enclosed spaces
• Lines or crowds of people
• Travelling by car, bus or plane
• Places outside their house
• Being alone outside

Consequently, many people with agoraphobia find it challenging to leave the place they live in and in severe situations, they may not leave their house at all since they are petrified of having a panic attack in public, so they prefer to stay inside.

Separation anxiety disorder

Separation anxiety disorder is a childhood disorder characterised by excessive anxiety related to separation from a child’s caregiver. Nevertheless, adults can also be diagnosed with the disorder but in the context of being separated from an attached (i.e., with whom the individual has a deep emotional bond) figure, such as their spouse or children.

In both instances, individuals worry about potential harm or unexpected things that could happen to them when away from their attached figure. In turn, such fear results in separation avoidance specifically from their attachment figure and more generally from being alone.

Selective mutism

Selective mutism is the consistent selectivity of children to speak only in certain situations (e.g., at home with certain family members), and avoid other situations (e.g., at school). Notably, this disturbance is not due to a lack of knowledge, or comfort with the spoken language demanded in social situations since individuals do possess normal language skills, therefore it is the environment they are in which causes such hindrances. Predominantly manifesting in children before the age of 5 years it can severely interfere with education achievement, social communication and overall functioning.

Anxiety disorder due to a medical condition

An anxiety disorder due to a medical condition includes persistent symptoms of intense anxiety or panic directly caused by a physical health problem.

Substance/medicated induced anxiety disorder

Substance-induced or medication-induced anxiety disorders refer to intense anxiety or panic experienced as a direct result of misuse of alcohol, drugs, or medication. This occurs during the intoxication or withdrawal phases of using a substance or medication.

Specified/unspecified anxiety disorders

Other specified and unspecified anxiety disorders refer to anxiety or phobias which fail to meet the exact criteria for the aforementioned anxiety disorder but are still themselves significant enough to be equally as distressing and disruptive.

There are other mental health conditions that share features with anxiety disorders but are not themselves classified as anxiety disorders in the DSM-5. Obsessive-compulsive disorder is classified under obsessive-compulsive and related disorders, whilst post-traumatic stress disorder falls under trauma and stressor-related disorders.

Obsessive compulsive disorder (OCD)

Obsessive-compulsive disorder is characterised by recurrent, unwanted thoughts (obsessions) and/or repetitive, ritualistic behaviours (compulsions) that cause individuals significant distress.

The obsessions themselves cause strong, uncomfortable feelings of anxiety which the individual feels compelled to act on to remove the discomfort which they do through performing compulsions that only provide temporary relief. However, each time a compulsion is performed the cyclical nature of this maladaptive sequence is reinforced therefore increasing the likelihood that compulsions will be continuously executed to satisfy the obsessions which ultimately traps the individuals in this repetitive, vicious cycle.

Post traumatic stress disorder (PTSD)

Post-traumatic stress disorder usually develops after exposure to (through either experiencing or witnessing) a terrifying event during which significant physical harm occurred or was threatened. Examples of traumatic events that can trigger PTSD include violent personal attacks, natural disasters, accidents, or military combat.

Some disorders that most frequently occur in addition to generalised anxiety or other anxiety disorders include headaches, irritable bowel syndrome, sleep disorders, substance use disorders, chronic pain, fibromyalgia, body dysmorphic disorder and other anxiety disorders.

Here, individuals that experience more than one disorder are said to be comorbid which effectively means the disorders are co-existing and overlapping with one another which increases the complexities of diagnosis and treatment for both the patient and healthcare professional.²

Symptoms of anxiety disorders

The general signs and symptoms of anxiety disorders commonly experienced by individuals fall into four broad categories that include:

It should be noted that each anxiety disorder in itself has its own specific symptoms relevant to that specific disorder which may occur beyond the general ones listed above. 

Causes and risk factors of anxiety disorders

The exact, definitive causes of anxiety are not fully understood. Instead, it is thought that both genetic and environmental factors contribute to the risk of developing an anxiety disorder.

Causes of anxiety disorders

Some of the causes of anxiety disorders include:

• Genetics: Anxiety disorders can run in families as demonstrated by the fact that 25% of those diagnosed with anxiety have a first-degree relative with a similar diagnosis.³

• Brain chemistry: Anxiety disorders may be linked to faulty circuits in the brain (in particular the HPA axis which connects the following three brain areas: the hypothalamus, pituitary and adrenal cortex) that control fear and emotions. Moreover, alterations in neurotransmitter signalling (the chemical messaging that occurs inside the brain) in relation to the neurotransmitters serotonin, norepinephrine and GABA all play a crucial role.⁴ Such differences in brain structure, circuitry and signalling are commonly seen across those with anxiety disorders hence there is seen to be a contributing biological cause to the disorder⁵ 

• Environmental stressors: Witnessing or experiencing stressful life events, such as childhood abuse and neglect, the death of a loved one, or displays of violence, can prompt an individual to develop an anxiety disorder⁶
• Drug withdrawal or misuse: Certain drugs work to decrease or overshadow anxiety symptoms; therefore, alcohol and substance use may be exploited as self-medicators⁷
• Medical conditions: Certain heart, lung, and thyroid conditions can cause similar symptoms to that of anxiety disorders or may exaggerate/worsen pre-existing anxiety symptoms⁸

Risk factors of anxiety disorders

Risk factors are things that can make an individual more likely to develop an anxiety disorder. Risk factors for anxiety disorders include:

• History of a mental health disorder: Having another mental health disorder, like depression, can raise the risk of developing an anxiety disorder.⁹ As previously mentioned, this is referred to as the comorbidity of mental health conditions. Additionally, anxiety disorders can run in the family so having a blood relative with an anxiety disorder increases one’s own risk of developing an anxiety disorder
• Childhood abuse or trauma: During childhood, emotional, physical and sexual abuse or neglect is linked to anxiety disorders that may manifest in later life¹⁰
• Trauma and adverse life events: Witnessing or experiencing a traumatic event increases the risk of post-traumatic stress disorder, which can cause panic attacks. Meanwhile, stressful or negative life events, such as the death of a loved one or displays of violence, also increase one’s risk of developing an anxiety disorder¹¹
• Severe illness or chronic health conditions: Constant worry about health, whether it be their own or that of a loved one or caring for a sick individual can cause feelings of anxiousness and be overwhelmed.
• Substance abuse: The use of alcohol and illegal drugs increases the risk of developing an anxiety disorder¹² Such substances are often used as self-medication to help hide or diminish pre-existing anxiety symptoms.

Ultimately, if you think that you may be suffering from an anxiety disorder then get in contact with a healthcare professional who will help you reach a diagnosis that is applicable and recommend adequate treatment to help best manage your situation.

Diagnosis of anxiety disorders

There is no set definitive pathway toward obtaining a diagnosis of an anxiety disorder. Therefore, if an individual feels as if they are experiencing symptoms of an anxiety disorder which is becoming increasingly hard for them to manage alone and it is having a significant impact on their ability to function normally then they should get in contact with a healthcare professional.

Whilst one of the first steps is to obtain a comprehensive medical history and conduct a physical, if there are no signs of physical illness or any physical conditions that may be causing the symptoms then they may refer the individual to a psychiatrist or psychologist for more tailored and specialist care. These mental health professionals are specifically trained and specialise in the diagnosis and treating mental health conditions, therefore they will assess one’s situation and provide a diagnosis based on:

• The duration and intensity of the reported symptoms
• The assessor’s observation of the individual’s attitude and behaviour
• Consulting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychological Association) which outlines the standardised criteria for diagnosis
• Uncovering specifically how and to what extent these symptoms interfere with one’s daily life and ability to function normally

After a diagnosis is reached (if applicable) steps can then be taken to provide a tailored healthcare plan for the individual based on their specific circumstance in order to help them as must as possible.

Treatment of anxiety disorders

There are certain measures individuals with anxiety disorders can try and integrate into their lifestyle to help manage their condition to minimise the impact it has on their life. Broadly, there are two primary treatment options that are available which are psychotherapy and medication.

In most instances, medication alters the neurochemistry of the brain and works on a more superficial level to better manage the symptoms associated with the disorder. In comparison, psychotherapy operates on a more psychological level to cognitively reconstruct and reframe one’s thoughts and emotions thereby working on a deeper level to combat the underlying cause of the disorder.

Overall, precisely how feasible and effective these treatment options are for each individual differs therefore it is vital that each individual works alongside their healthcare professional to find a tailored treatment plan that is just right for them.

Psychotherapy

Psychotherapy or “talk therapy” helps people with anxiety disorders deal with their emotional responses by directing the session toward their specific anxieties. Fundamentally, a healthcare professional talks the individual through various strategies to help them better understand and manage their disorder, whilst simultaneously setting practical tasks and goals to exercise such a change by confronting the anxieties.

There are various different approaches towards psychotherapy, the most common include:

Cognitive behavioural therapy (CBT)

Essentially, cognitive behavioural therapy works by cognitively reframing how you perceive and think about the anxiety-inducing stressor so that it no longer causes you as much anxiety as it originally did. It achieves this by teaching the individual to recognise their maladaptive thought patterns and behaviours that lead to anxiousness before actively working to change them. CBT provides different ways of thinking, behaving, and reacting to situations to help them feel less anxious and fearful.

Exposure therapy

Exposure therapy is a type of CBT method that focuses on directly, yet, gradually confronting the triggering fears underlying an anxiety disorder to help combat and prevent avoidance behaviours.

Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy is an action-oriented approach to psychotherapy that aims to develop and expand psychological flexibility through the use of alternative strategies, in particular mindfulness and goal setting, to reduce anxiety and fear.

Individuals learn to accept their maladaptive inner emotions and feelings that they originally struggle with. By increasing their awareness and understanding through this individuals learn that they should not be prevented from proceeding with their life because of such hardships. Consequently, they begin to implement behavioural changes to help combat their anxieties.

Overall, ACT attests that mindful behaviour, attention to personal values, and commitment to action are valid alternatives to changing the way one thinks.¹³

Medication

Crucially, medication does not cure anxiety disorders rather it helps to improve the symptoms individuals experience to help promote their functionality. Similar to psychotherapy, there are several types of medication that can be taken to relieve symptoms. However, which medication is most effective for each individual will vary and depend on the type of anxiety disorder they have and whether they also have other mental or physical health issues.

Commonly prescribed medications for anxiety disorders include:

Anti depressants medication

Commonly used to treat depression, anti-depressant medications are also helpful for treating anxiety disorders as they help improve the way the brain uses certain chemicals to improve mood and reduce stress. Modern antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are prescribed to someone with an anxiety disorder. These drugs work by increasing the chemical messaging in the brain specifically by increasing the levels of two key neurotransmitters, serotonin and norepinephrine.

Occasionally, some users may experience increased suicidal ideation or tendencies when taking antidepressant medication, especially when they first start or are getting their dose change.¹⁴ In turn, it is vital to keep an eye on these individuals during the first few weeks of treatment.  

Notably, such medication has a slight time lag as it is reported individuals should wait at least two weeks before seeing an improvement.¹⁵ Additionally, this medication should not suddenly be stopped as it can cause withdrawal symptoms, therefore a healthcare professional should be consulted to help safely decrease the dose.

Anti anxiety medication

Anti-anxiety medication helps reduce symptoms of anxiety, panic, and worry. Whilst such medication does work, individuals can build up a tolerance to them thereby diminishing their effectiveness over time and risking dependency.¹⁶ This is why such medication is primarily only a short-term treatment option.

The most common anti-anxiety medication is called benzodiazepines which are effective in relieving anxiety and are faster acting than anti-depressants medication.¹⁷ Benzodiazepines work by enhancing the activity of the neurotransmitter GABA (a brain chemical) which helps promotes feelings of calmness.

Beta blocker medication

Despite being a treatment option for high blood pressure, beta-blockers help relieve the physical symptoms of anxiety disorder, such as elevated heart rate, shaking, trembling, and blushing, albeit only for a short period. They are also effective during acute anxiety attacks as they can be taken “when required”, especially before a stressful or potentially triggering event. However, beta-blockers are not useful for long-term treatment.

Overall, individuals should consult their healthcare professional about the benefits, risks and possible side effects of any prospective or current medication. The professional will ensure the right medication, medication dose, and treatment plan is in place based on the person’s needs and medical situation. Additionally, they should keep this professional updated on any changes or issues they may experience whilst on these drugs to ensure these drugs are working as effectively as they can in an intended manner.

FAQs

How common are anxiety disorders?

Anxiety disorders are fairly common and affect a wide demographic of individuals. Research shows us that:

• In the UK, over 8 million people experience an anxiety disorder at any one time.
• In Great Britain, around one in three (34%) adults experiences high levels of anxiety, with many adults being aged between 16 to 29 years (42%).
• In England, compared to men, women are almost twice as likely to be diagnosed with anxiety disorders.¹⁸

How can anxiety disorder affect children?

Similar to adults, children may also experience normal amounts of anxiety. However, when this worry and fear occurs in excess where the child struggles to stop thinking about all their fears and your attempts at comfort are ineffective then your child may be suffering from an anxiety disorder. These children will begin to fixate on their thoughts, struggle to conduct regular daily activities, and be reluctant to try new things. Fundamentally, if the child is “stuck” and unable to move past these worries then this may be a cause for concern.

Again, get in contact with a healthcare professional if you believe your child is suffering and are concerned about how their anxiety is interfering with their ability to function adequately.

When to see a doctor

A doctor or healthcare professional should be approached when one’s ability to function and conduct their day-to-day life is significantly impaired or causing undue distress. Additionally, such professionals should be contacted for any queries or changes in medication or circumstances to see how they could affect one’s treatment plan going forward.

Summary

Anxiety in itself is a normal physiological process, however, anxiety disorders involve frequently experiencing intense, excessive, and persistent worry and fear about everyday situations that are disproportionate to the actual danger of the stressor. Whilst there are many symptoms of anxiety disorders they can be best understood as being somatic, behavioural, emotional or cognitive. Moreover, there are various types of anxiety disorders that specifically relate to different stressors. Whilst there are various causes behind the disorders, the treatment options of psychotherapy or medications, which are typically delivered in conjunction with one another, remain the same. Ultimately, with the right understanding and treatment, individuals with anxiety disorders can learn to manage their symptoms as best they can to live a truly fulfilling life.