Symptoms and Types of Anxiety Disorder?

by Rethink

What Are The Symptoms Of Anxiety Disorders?

Introduction

Anxiety, worry and fear are feelings that everyone experiences from time to time. Over short periods of time they can be useful emotions, helping us to respond to challenging or dangerous situations. They prepare the body to take action to protect ourselves (the so-called 'fight or flight' response).

Some people experience anxiety, worry, fear and panic disproportionally to the threats around them. They may feel excessively anxious in certain situations, such as when they are with other people, or anxious a great deal of the time. Some people find that fear and anxiety are triggered by particular things (phobias), for example by spiders, by heights or groups of people, whilst others cannot pinpoint any particular trigger (anxiety). When fear and anxiety are excessive they can be a significant problem and can have profound consequences on life. Anxiety disorders are the most common form of psychiatric illness.

The general symptoms of anxiety include:

• Feeling worried a lot of the time;
• Feeling tired;
• Difficulties concentrating;
• Being irritable;
• Problems sleeping;
• Heart palpitations (irregular beat);
• Sweating;
• Tension and pains;
• Heavy and rapid breathing;
• Dizziness;
• Fainting;
• Indigestion;
• Diarrhea; and
• Stomach aches and sickness (especially in young children)
• Feelings of dread or impending doom.

Many people feel one or more of these at one time or another but people with anxiety disorders experience them more frequently and to the extent that they interfere with their lives.

Specific symptoms and the intensity of them are distinct to each disorder.

What Are The Different Types Of Anxiety Disorder?

Anxiety disorders are categorized as:

• Generalized anxiety disorder
• Obsessive-compulsive disorder
• Panic disorder
• Post-traumatic stress disorder
• Social anxiety disorder
• Specific phobias
• Separation anxiety disorder

generalized anxiety disorder

The essential characteristic of a generalized anxiety disorder (GAD) is excessive uncontrollable worry about everyday things. This constant worry affects daily functioning and can cause physical symptoms. GAD can occur with other anxiety disorders, depressive disorders or substance abuse. GAD is often difficult to diagnose because it lacks some of the dramatic symptoms, such as unprovoked panic attacks, that are seen with other anxiety disorders, for a diagnosis to be made, worry must be present more days than not for at least 6 months.

The focus of GAD worry can shift, usually focusing on issues like job, finances, health of both self and family; but it can also include more mundane issues such as chores, car repairs and being late for appointments. The intensity, duration and frequency of the worry are disproportionate to the issue and interferes with the sufferer's performance of tasks and ability to concentrate. Physical symptoms include:

• muscle tension
• sweating
• nausea
• stomach ache or diarrhoea
• cold, clammy hands
• difficulty swallowing
• jumpiness

Sufferers tend to be irritable and complain about feeling on edge, are easily tired and have trouble sleeping.

obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is characterized by uncontrollable obsessions and compulsions which the sufferer usually recognizes as being excessive or unreasonable. Obsessions are recurring thoughts or impulses that are intrusive or inappropriate and cause the sufferer anxiety. Some common obsessions are:

• Thoughts about contamination, for example, when an individual fears coming into contact with dirt, germs or "unclean" objects;

• Persistent doubts, for example, whether or not you have turned off the iron or oven, locked the door or turned on the answering machine;

• Extreme need for orderliness;

• Aggressive impulses or thoughts, for example, being overcome with the urge to yell "fire" in a crowded theatre.

Compulsions are repetitive behaviors or rituals performed by the person with OCD, performance of these rituals neutralizes the anxiety caused by obsessive thoughts, relief is only temporary. Compulsions are incorporated into the person's daily routing and are not always directly related to the obsessive thought, for example, a person who has aggressive thoughts may count floor tiles in an effort to control the thought. Some of the most common compulsions are:

• Cleaning
Sufferers concerned with germs and contamination tend to clean constantly, either repeatedly washing their hands, showering, or constantly cleaning their home;

• Checking
Individuals may check several or even hundreds of times to make sure that stoves are turned off and doors are locked;

• Repeating
Some people repeat a name, pharase or action over and over;

• Slowness
Some individuals may take an excessively slow and methodical approach to daily activities, they may spend hours organising and arranging objects;

• Hoarding
Hoarders are unable to throw away useless items, such as old newspapers, junk mail, even broken appliances; sometimes the hoarding reaches the point that whole rooms are filled with saved items.

In order for OCD to be diagnosed, the obsessions and/or compulsions must take up a considerable amount of the sufferers time, at least one hour every day, and interfere with normal routines (a person, for example, people who cannot make left turns when driving), occupational functioning, social activities, or relationships. OCD can interfere with your ability to concentrate, and it is not uncommon for a sufferer to avoid certain situations, for example, someone who is obsessed with cleanliness may be unable to use public toilets.

Onset of OCD is usually gradual and most often begins in adolescence or early adulthood. Unlike adults, children with OCD do not realize that their obsessions and compulsions which are most often washing, checking and ordering variety, are excessive.

panic disorder

A panic attack is defined as the abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms:

• a feeling of imminent danger or doom
• the need to escape
• palpitations
• sweating
• trembling
• shortness of breath or smothering feeling
• a feeling of choking
• chest pain or discomfort
• nausea or abdominal discomfort
• dizziness or light headedness
• a sense of things being unreal, depersonalization
• a fear of losing control or "going crazy"
• a fear of dying
• tingling sensations
• chills or hot flushes.

There are there types of panic attacks:

• Unexpected - the attack "comes out of the blue" without warning and for no apparent reason.

• Situational - situations in which an individual always has an attack, for example, upon entering a tunnel.

• Situationally predisposed - situations in which an individual is likely to have a panic attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.

Panic disorder is diagnosed when an individual experiences at least two unexpected panic attacks, followed by at least 1 month of concern over having another attack. Sufferers are also prone to situationally predisposed attacks. The frequency and severity of the attacks varies from person to person, an individual might suffer from repeated attacks for weeks, while another will have short bursts of very severe attacks. The sufferer often worries about the physical and emotional consequences of the panic attacks. Many become convinced that the attacks indicate an undiagnosed illness and will submit to frequent medical tests. Even after tests come back negative, a person with panic disorder will remain worried tht they have a physical illness. Some individuals will change their behavioral patterns, avoiding a scene of a previous attack for example, in the hopes of preventing having another attack.

Agoraphobia often, but not always, coincides with panic disorder. Agoraphobia is characterized by a fear of having a panic attack in a place from which escape is difficult. Many sufferers refuse to leave their homes, often for years at a time. Others develop fixed route, or territory, from which they cannot deviate, for example the route between home and work. It becomes impossible for these people to travel beyond what they consider to be their safety zones without suffering severe anxiety.

The age of onset of panic disorder varies between late adolescence to mid-thirties. Relatively few suffer from the disorder in childhood.

post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is not a disorder to be associated solely with people in the military, as it has been in the past. It has been shown that exposure to traumas such as a serious accident, a natural disaster, or criminal assault can result in PTSD. When the aftermath of a traumatic experience interferes with normal functioning, the person may be suffering from PTSD. The increasing stress of living in the 21st century, on both a global and person level has been sufficient to considerably elevate the numbers of people who suffer from PTSD.

PTSD can occur at any age, from childhood to old age and traumatic stress can be cumulative over a lifetime. Responses to trauma include feelings of intense fear, helplessness, and/or horror. There are three types of generally recognised stressors:

• Threatened death or serious injury to one's person;
• Learning about the death, near death, or close friend;
• Witnessing the death, near death or serious injury of another person.

For PTSD to be diagnosed, symptoms must be present for more than a month and be accompanies by a drop-off in the ability to socialize, work or participate in other areas of daily functioning. Symptoms of PTSD are:

• Reexperiencing the event, which can take the form of intrusive thoughts and recollections, or recurrent dreams;

• Avoidance behaviour in which the sufferer avoids activities, situations, people, and.or conversations which s/he associates with the trauma;

• A general numbness and loss of interest in surroundings; this can also present as detachment;

• Hypersensitivity, including: inability to sleep, anxious feelings, overactive startle response, hypervigilance, irritability and outbursts of anger.

PTSD can occur at any age, although it is less frequent in the elderly. Young children who have suffered a trauma may have dreams of the event, which within a few weeks, turn into general nightmares. Children will often relive the event through play. They may also exhibit physical symptoms, such as headaches and stomachaches.

Symptoms usually begin within three months of a trauma, although there can be a delayed onset and six months can pass between trauma and the appearance of symptoms. In some cases years can pass before symptoms appear, in this case the symptoms are often triggered by the anniversary of the trauma, or with the experience of nother traumatic event. Symptoms may vary in frequency and intensity over time.

social anxiety disorder (social phobia)

Social anxiety disorder (SA) is characterized by an intense fear of situations, usually social or performance situations, where embarrassment may occur. Individuals with the disorder are acutely aware of the physical signs of their anxiety and fear that others will notice, judge them, and think poorly of them. This fear often results in extreme anxiety in anticipation of an activity, a panic attack when faced with an activity, or in the avoidance of an activity altogether. Adults usually recognize that their fears are unfounded or excessive, but suffer from them nonetheless. Symptoms of social phobia manifest themselves physically and can include:

• palpitations
• tremors
• sweating
• diarrhoea
• confusion
• blushing

Blushing when in social situation is particularly common and often causes the sufferer further embarrassment.

People with social phobia tend to be sensitive to criticism and rejection, have difficulty asserting themselves, and suffer from low self-esteem. The most common fears associated with the disorder are a fear of speaking in public or to strangers, a fear of meeting new people, and performance fears (activities that may potentially be embarrassing), such as writing, eating or drinking in public. Sufferers usually fear more than one type of social setting.

Onset of the disorder is usually in mid to late adolescence, but children have also been diagnosed with social phobia. Children with the disorder are prone to excessive shyness, clinging behaviour, tantrums and even mutism. there is usually a marked decline in school performance and the child will often try to avoid going to school or taking part in age appropriate social activities. Their fears are centered on peer settings rather than social activities involving adults, with whom they may feel more comfortable. For a child to be diagnosed with social phobia, symptoms must persist for at least six months.

specific phobias

Specific phobia is characterized by the excessive fear of an object or a situation, exposure to which causes an anxious response, such as panic attack. Adults with phobias recognize that their fear is excessive and unreasonable, but they are unable to control it. The feared object or situation is usually avoided or anticipated with dread.

Specific phobia is diagnosed when an individual's fear interferes with their daily routing, employment (e.g. missing out on a promotion because of a fear of flying), social life (e.g. inability to go to crowded places), or if having the phobia is significantly distressful. The level of fear felt by the suffere varies and can depend on the proximity of the fear object or chances of escape from the feared situation. If a fear is reasonable it cannot be classed as a phobia.

Specific phobia may have its onset in childhood, and is often brough on by a traumatic event; being bitten by a dog, for example, may bring about a fear of dogs. Phobias that begin in childhood may disappear as the individual grows older. Fear of certain types of animals is the most common specific phobia. The disorder can be experienced at the same time as panic disorder and agoraphobia.

separation anxiety disorder

Agoraphobia and panic often go together and are common in children who have separation anxiety disorder. This disorder concerns worry about being away from home or about being far away from parents, that is much more than is normal for that child's age. In adolescents this might include worry about loved ones being harmed in some way, fear that they will not return home, fear of sleeping alone and refusal to go to school. A child with SAD may experience:

• repeated nightmares about separation
• repeated occurrence of
• stomach ache
• headache
• constipation

• nausea and vomiting
• excessive distress such as anxiety, crying, tantrums, misery, apathy or social withdrawal.

It seems that SAD and generalized anxiety disorder are related in children and adolescents depending on psyhcological development. That is 'life worries' will present at different levels and will be concerned with different souces according to a child's physical and emotional age. A child with SAD will probably worry about the attachment figure disappearing and be clingy and focus heavily on help-seeking; while a child with generalized anxiety disorder will worry excessively about his or her adequacy in many areas and be constantly focused on personal shortcomings. Studies show that SAD affects around 6-7% of children predominating at age 11.

What Causes Anxiety Disorders?

The causes of anxiety are not fully known, but both genetic, physiological and psychological factors are involved. Drug use and some physical conditions can also lead to increased anxiety.

genetic causes

When identical twins were split at birth and brought up separately the risk of one developing panic disorder when the first did was 30% greater. The risk of a father, mother, brother, sister, parent or child of someone with a panic disorder is 10-20% more likely to develop a panic disorder. About 40% of people with agoraphobia have a close relative with agoraphobia. Evidence points towards phobias being genetically related to panic disorder, but depression and generalised anxiety are not. Genetic differences between us can lead to differences in the physiological and psychological responses to stress.

physiological causes

Many scientists believe that all thoughts and feelings result from complex electrical and chemical interactions in the brain. Disturbances in chemical messengers in the brain active during a period of anxiety can lead to malfunctioning of the bodys natural alarm system to create an anxiety disorder. An increased sensitivity of some neurotransmitter pathways in the brain could be the cause of the physiological crisis that results in panic.

Physiological causes of anxiety could be predisposed by the genetic makeup of a person but they may also be brought on by environmental and psychological causes.

psychological causes

Psychologically, anxiety is viewed as a response to environmental stressors, such as the ending of a close relationship of exposure to a life-threatening disaster.

Psychoanalytic theory suggests that anxiety disorders stem from unconscious conflicts that arose from discomfort during infancy or childhood. For example, the person may have developed problems from experiencing an illness or fright as a child. By this theory, anxiety can be resolved by identifying and resolving the unconscious conflict.

Learning theory suggests that anxiety is a learned behavour that can be unlearned. People who feel uncomfortable in a given situation or near a certain object will begin to avoid it. Such avoidance can limit a person's ability to live a normal life.

drug use

Certain drugs, both recreational and prescribed can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. Such drugs include:

• caffeine
• alcohol
• nicotine
• cold remedies
• decongestants
• bronchodilators for asthma
• tricyclic antidepressants
• cocaine
• amphetamines
• diet pills
• ritalin
• thyroid medications

physical causes

In very rare cases, a tumour of the adrenal gland (pheochromocytoma) may be the cause of anxiety. This happens because of the overproduction of hormones responsible for the feeling and symptoms of anxiety.

Treatments for Anxiety Disorders

Anxiety disorders are highly treatable yet only one-third of those suffering from an anxiety disorder receive treatment. Talking therapies are usually most effective although medication is often used in the initial stages of treatment to help the patient be more receptive to psychological input.

Medication

Benzodiazepines provide rapid relief from the symptoms of anxiety. This group of drugs should only be used to treat anxiety that is severe, disabling or subjecting the individual to extreme distress.

Selective serotonin reuptake inhibitors (SSRI's) (a type of antidepressant) are commonly used to treat generalised anxiety disorder. You should be started on a low dose which should take effect within 6-12 weeks. They should not be abruptly because people with anxiety disorders are particularly sensitive to withdrawal symptoms.

Other drugs that you may be prescribed if you have an anxiety disorder include:

• Tricyclic antidepressants
They have more side-effects that SSRIs but are also effective

• Other antidepressants
New medications such as Efexor are also effective and well tolerated.

• Antihistamines
these are older medications used for mild to moderate anxiety. Like benzodiazepines they work quickly.

• Anti psychotics may be used in cases where anxiety is severe enough to cause disorganization of thoughts and abnormal physical and mental sensations, such as the sense that things around you are not real or that you are disconnected with your body.

Psychological Treatments

There is good evidence to support the use of psychological therapies in the treatment of anxiety disorders. There are several approaches that have proven to be effective

• behaviour therapy
• cognitive therapy
• cognitive behaviour therapy
• relaxation techniques
• exposure therapy

About the Author

www.rethink.org
Rethink is the largest severe mental illness charity in the UK. We are dedicated to improving the lives of everyone affected by severe mental illness, whether they have a condition themselves, care for others who do, or are professionals or volunteers working in the mental health field.