What Is Anxiety Disorder

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When experienced on occasion, anxiety is normal, but have you heard of anxiety disorder? 

Overview

Anxiety disorder refers to a group of mental health conditions characterised by persistent and excessive terror, anxiety, and apprehension. In some cases, people with anxiety disorders can also experience panic attacks, which are characterised by sudden feelings of intense anxiety and fear that peak rapidly.1

Anxiety disorders can lead people to withdraw from specific situations or become reliant on other people or objects to cope.1 Anxiety disorders interfere with a person’s life, daily activities, and functionality since people cannot control the symptoms they experience. Overall, these disorders are a leading cause of disability worldwide.2,3 

Oftentimes, people with anxiety disorders end up completely avoiding certain situations and places in an attempt to prevent these feelings.4

Causes of anxiety disorder

While anxiety disorders are highly prevalent, their causes are complex and multifaceted. The majority of anxiety disorders have an onset during childhood or early adulthood. Research over the years has suggested that anxiety disorders have a strong heritability. In fact, twin studies have revealed a 30% to 40% heritability.5,6 Therefore, individuals with a family history of anxiety disorders are most likely to develop the disorder themselves.5,6 

Studies have pointed to various genes that are thought to increase susceptibility to anxiety disorders. For instance, CRHR1 and COMT are risk factors for panic disorder.3,7 

Anxiety disorders are associated with modifications in the brain’s chemistry, particularly in relation to neurotransmitters involved in mood, emotion, and behaviour regulation, like dopamine, serotonin, and nor epinephrine. Imbalances in these neurotransmitters can result in increased anxiety symptoms. For instance, low serotonin levels can lead to increased depression and anxiety. 

However, brain chemistry alone cannot cause anxiety disorders; other factors such as lifestyle and environment also contribute to the development of anxiety disorders. Stressful events, trauma, abuse, or major life changes can trigger or worsen anxiety disorder symptoms.8,9

Signs and symptoms of anxiety disorder

Anxiety disorders can critically impact a person's daily functioning and life. They can manifest in several ways, with symptoms ranging from psychological to physical. 

One of the hallmark symptoms of anxiety disorders includes excessive worrying about social situations or everyday activities. This may lead to avoidance behaviours, in which an individual may avoid activities or situations that could trigger anxiety.10,11,12

Psychological symptoms associated with anxiety disorders include: 

  • Nervousness or restlessness
  • A feeling of impending fear
  • Tiredness
  • Difficulty concentrating
  • Irritability 

Physical symptoms associated with anxiety disorders include:

  • Headaches
  • Stomach aches
  • Muscle aches
  • Trembling
  • Sweating
  • Hyperventilation
  • Palpitations
  • Insomnia

Management and treatment for anxiety disorders

Symptoms of anxiety disorders can be managed in several ways, leading to overall life improvement. If you are diagnosed with an anxiety disorder, the first step of treatment is psychotherapy. This comes before any medications. Psychological treatment (or psychotherapy) involves talking therapy, such as Cognitive Behavioural Therapy (CBT). 

CBT has proven to be one of the most effective anxiety disorder therapies. It teaches you skills that help in symptom improvement and problem management. It focuses on changing the way you think and behave. The goal is to progressively return to the activities you have avoided and feared. It can be conducted either through a workbook or a computer course. While you do this in your own time, you also meet your therapist, usually once per week.10,11,13

A type of CBT is exposure therapy that enables you to confront your fears and exposes you to situations you have been avoiding. 

Occasionally exposure therapy is used along with relaxation exercises.12 These exercises help you relax your muscles during situations that stress you out and cause you anxiety. You learn to relax your muscles rapidly in response to a trigger. In relaxation therapy, you meet your therapist once a week for 4 months.10

A newer form of therapy is Acceptance and Commitment Therapy (ACT). This type of therapy focuses on goal setting, mindfulness, and other strategies for the reduction of anxiety and discomfort. 

If these psychological treatments do not work, you might be offered medication. Medication prescription requires regular doctor appointments for progress assessment. Usually, the medication that is given initially is a selective serotonin reuptake inhibitor (SSRI), such as sertraline, paroxetine or escitalopram, which are a type of antidepressant. Another type of medication for anxiety disorder is serotonin and noradrenaline reuptake inhibitors (SNRI), such as venlafaxine and duloxetine.10,12

If neither SSRIs nor SNRIs work, you may be prescribed pregabalin. While this medication is usually given to treat epilepsy, it is also known to help anxiety. 

During a particularly severe anxiety period, you may be offered benzodiazepines (e.g., diazepam) on a short-term basis. These are sedatives that help with symptoms of anxiety. Keep in mind that if these medications are not having the desired effect after 2 months of treatment, you should consult your doctor.10

FAQs

How is anxiety disorder diagnosed

Anxiety disorders can be tricky to diagnose since their symptoms are also present in other mental health conditions. It is challenging to diagnose anxiety disorder because it often occurs along with substance misuse or other mental health problems, such as depression.11

There is no single test to diagnose anxiety disorders. In fact, there are several steps that need to be taken for an accurate diagnosis. It is a lengthy process that requires mental health tests, physical examinations, and psychological questionnaires.14 

Your symptoms will be compared to the diagnostic criteria published by the American Psychiatric Association (DSM-5) to diagnose anxiety disorders.15 Your healthcare professional will also give you a psychological evaluation where you will discuss your thoughts, behaviours, and feelings. 

Can anxiety disorder be prevented

While it may not be possible to completely prevent anxiety disorders, there are things that you can do to decrease the risk of developing the symptoms associated with these. Lifestyle changes play a major role in preventing anxiety disorder. These can include staying active, engaging in activities that make you happy and enjoying relationships and social interactions. 

Finally, avoidance of drug and alcohol use is crucial for preventing these disorders. However, note that even though these factors can prevent anxiety disorders up to a certain point, it may not be possible to completely prevent these disorders.11,14

It is also extremely important to seek help early if you fear that you’re developing an anxiety disorder. 

What are the types of anxiety disorders

There are various types of anxiety disorder:11,12,14,16,17

  • Generalized anxiety disorder is characterized by impending worry about events and activities. This persistent anxiety can affect how you feel, and it is hard to control
  • Panic disorder includes persistent episodes of intense anxiety and terror that reach a peak extremely rapidly
  • Agoraphobia is the fear and avoidance of situations or places that make you feel helpless and cause panic attacks
  • Anxiety disorder due to medical conditions refers to excessive anxiety that results from a health problem
  • Separation anxiety disorder arises in childhood and is characterised by anxiety resulting from being separated from the parents
  • Substance-induced anxiety disorder results from drug use or withdrawal symptoms from drugs. 
  • Specific phobias arise from exposure to certain situations or objects that cause excessive anxiety
  • Selective mutism is characterised by a failure to speak in specific situations and typically affects only children
  • Social anxiety disorder is when feelings of embarrassment or concern about judgement from others lead to increased stress and anxiety
  • Other specified and unspecified anxiety disorders are anxiety disorders that do not meet any exact criteria

Who is at risk of anxiety disorder

Anxiety disorders can severely impact a person’s life but, fortunately, there are several factors that can help identify the people who are at higher risk of developing an anxiety disorder so that they can receive the necessary care as soon as possible. 

Apart from genetic and environmental factors that are mentioned above and can predispose people to anxiety disorders, women, in general, tend to be more affected by anxiety disorders.18,19 If at least one of two parents has an anxiety disorder, there is a two-fold to four-fold increased risk of the child developing an anxiety disorder.20 Other risk factors include certain personality traits such as nervousness and shyness during childhood. Other health conditions (thyroid problems) can also be considered a risk factor. Caffeine and specific medications can also worsen or trigger anxiety.12,14

How common is anxiety disorder

Anxiety disorders affect millions of people worldwide. In fact, anxiety disorders are the most prevalent mental health disorder, with a prevalence of 15-20%.12,14,21,22 In 2019, approximately 301 million people were estimated to be living with an anxiety disorder. In 2020, the number of individuals diagnosed with anxiety disorder increased by 26% due to the Covid-19 pandemic.23

When should I see a doctor

Although anxiety feelings are normal to experience for everyone, you should contact your healthcare professional if these feelings are causing you distress or notably interfere with your daily life, activities, work, and relationships. Moreover, if you have problems with your physical health linked to anxiety or drug abuse, or are experiencing suicidal thoughts, you should seek help.10,11

Summary

Anxiety disorders are mental health conditions that cause feelings of excessive worry and fear. These usually interfere with an individual’s daily activities and everyday life. There are several types of anxiety disorders, such as generalized anxiety disorder, panic disorder, phobias, etc.

The causes of these disorders are not completely clear but are thought to include a combination of genetic and environmental factors. Moreover, there are certain risk factors, such as sex, medical conditions andtrauma that can predispose you to anxiety disorder. 

Symptoms of anxiety disorders can be both physical and psychological, and treatment includes psychotherapy and medications. It is fundamental to seek professional help if you are experiencing any symptoms since early diagnosis and intervention can improve outcomes.

References

  1. Craske MG, Stein MB, Eley TC, Milad MR, Holmes A, Rapee RM, Wittchen HU. Anxiety disorders. Nature Reviews; 2017. 3: 17024.
  2. Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jonsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Slavador-Carulla L, Simon R, Steinhausen HC. The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology; 2011. 21: 655-679.
  3. Christopher P, Murray JL. Global, regional, and national comparative risk assessment of 79 behavioral environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet; 2016. 388: 1659-1724.
  4. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci; 2015. 17(3): 327-335.
  5. Shimada-Sugimoto M, Otowa T, Hettema JM. Genetics of anxiety disorders: Genetic epidemiological and molecular studies in humans. Psychiatry and Clinical Neurosciences; 2015. 69: 388-401.
  6. Kendler KS. Twin Studies of Psychiatric Illness. JAMA Psychiatry; 2001. 58(11): 1005-1014.
  7. Howe A, Buttenschøn H, Bani-Fatemi A, Maron E, Otowa T, Erhardt A, Binder EB, Gregersen NO, Mors O, Woldbye DP, Domschke K, Reif A, Shlik J, Koks S, Kawamura Y, Miyashita A, Kuwano R, Tokunaga K, Tanii H, Smoller JW, Sasaki T, Koszycki D, De Luca V. Candidate genes in panic disorder: meta-analyses of 23 common variants in major anxiogenic pathways. Mol Psychiatry; 2016. 21: 665–679. 
  8. Liu Y, Zhao J, Guo W. Emotional roles of mon-aminergic neurotransmitters in major depressive disorder and anxiety disorders. Front Psychol; 2018. 9.
  9. Ressler KJ, Nemeroff CB. Role of serotonergic and noradrenergic systems in the pathophysiology of depression and anxiety disorders. Depression and Anxiety; 2000. 12: 2-19.
  10. National Health Services (NHS). 2023. Generalised anxiety disorder in adults. https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/
  11. Mayo Clinic. 2023. Anxiety Disorders. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
  12. National Institute of Mental Health. 2023. Anxiety Disorders. https://www.nimh.nih.gov/health/topics/anxiety-disorders
  13. Rapee RM, Schniering CA, Hudson JL. Anxiety disorders during childhood and adolescence: origins and treatment. Annual Review of Clinical Psychology; 2009. 5: 311-341.
  14. HealthLine. 2023. Everything you need to know about anxiety. https://www.healthline.com/health/anxiety
  15. American Psychiatric Association. 2023. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). https://www.psychiatry.org/psychiatrists/practice/dsm
  16. Beesdo K, Knappe S, Pine DS. Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am; 2011. 32(3): 483-524.
  17. Martin P. The epidemiology of anxiety disorders: a review. Dialogues Clin Neurosci; 2003. 5(3): 281-298. 
  18. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences inaniety disorders: prevalence, course of illness, comorbidity, and burden of illness. Journal of Psychiatric Research; 2011. 45: 1027-1035. 
  19. Beesdo-Baum K, Knappe S. Developmental epidemiology of anxiety disorders. Child & Adolescent Psychiatric Clinics; 2012. 21: 457-478.
  20. Lieb R, Isensee B, Hofler M, Pfister H, Wittchen HU. Parental major depression and the risk of depression and other mental disorders in offspring: A prospective-longitudinal community study. JAMA Network; 2022. 59(4): 365-374. 
  21. Sine DS, Cohen P, Gurley D, Brook J, Ma Y. The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry; 1998. 55(1): 56-64.
  22. Bowen RC, Offord DR, Boyle MH. The prevalence of overanxious disorder and separation anxiety disorder: results from the Ontario Child Health study. J Am Acad Child Adolesc. Psychiatry; 1990. 29(5): 753-758. 
  23. World Health Organization. 2023. Mental Disorders. https://www.who.int/news-room/fact-sheets/detail/mental-disorders

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