Anxiety: Five Major Types of Anxiety Disorders

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by The Studio of Mental Health and Psychology

Anxiety is a primary emotion that has long been considered an adaptive resource for danger and threats. Charles Darwin maintained that fear reactions are essentially the product of natural selection. Sigmund Freud saw fear and anxiety as aversive and universally experienced emotions distinct from other negative emotions. He argued that a certain degree of anxiety is normal. However, traumatic experiences, repressed memories and emotions and poor coping skills give rise to neuroses (pathological anxiety or worry). From the cognitive-behavioural perspective, anxiety is seen as a tendency to overestimate a potential danger. 

Epidemiologists and anthropologists have since confirmed the commonness of anxiety as a human experience. Although people from all cultural backgrounds have been seen to experience anxiety, there are huge individual differences in the strength of the anxiety response and in circumstances in which certain stimuli can induce anxiety.

Proponents of the dimensional understanding of anxiety sometimes make fun of efforts to categorise exact anxiety disorders, indicating significant similarities across the disorders. Conversely, experts who work closely with patients seeking treatment for anxiety are fascinated with being able to cluster anxiety symptoms into readily distinguishable syndromes.

Here I will review the categorical standpoint on anxiety.

Diagnostic classifications are products of cultural clarification, and identifying when feeling anxious is severe enough to be extreme can be ambiguous. Most common anxiety symptoms are known to be clinically significant when they interfere with daily functioning, but there are patients suffering anxiety whose functioning does not appear to be impaired. These clients have adjusted their lifestyles to contain the symptoms, which can nevertheless remain problematic.

According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety disorders share features of extreme anxiety and fear and associated maladaptive behavioural responses. These disorders include:

  • generalised anxiety disorder (GAD), 
  • social anxiety disorder (social phobia), 
  • agoraphobia, 
  • specific phobia,
  • panic disorder, 
  • separation anxiety disorder, 
  • anxiety disorder induced by substance/medication,
  • anxiety disorder induced by another medical condition, 
  • selective mutism.

I will briefly present diagnostic measures for the five most common anxiety disorders here.

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Panic Disorder

The main characteristic of panic disorder is unanticipated panic attacks, which consist of extreme anxiety with an abrupt and often unforeseen onset. The intense feeling of anxiety usually decays within a few minutes, but it may sometimes be hours before the person feels that they returned to a normal condition. A panic attack typically involves several physical signs of anxiety, including a pounding heart, shortness of breath, trembling or sweating. Most people also have thoughts of catastrophic medical dangers or embarrassment. During an attack, patients often strongly believe these awful things will happen (or are happening), and some individuals continually rush to the hospital emergency thinking they have a heart attack. Between attacks, patients feel normal, but most report a persistent fear of upcoming episodes. 

Agoraphobia

As a result of this continuous fear, many patients with panic disorder develop agoraphobia at least to some extent. At the core of agoraphobia is the fear of being unable to escape from a certain place or seek aid in the occurrence of a panic attack. As a result of this fear, patients with agoraphobia avoid circumstances in which it might be difficult to get assistance or embarrassing to flee in the event of a panic attack. Agoraphobia can range from mild (e.g., feeling “trapped”) to absolute avoidance (e.g., housebound except when escorted by a reliable companion). 

Specific Phobia

Specific phobia is relatively foreseeable and linked to the specific situation. Confrontation of the feared situation or object or even the expectation of doing so generates an immediate strong anxiety response. Although the patient knows that the fear is either extreme or irrational (phobic children, however, may lack this understanding), they nevertheless remain scared of the provoking stimulus and feel anxious in its occurrence or anticipation of its happening. The closer the client approaches the feared stimulus, the more extreme the fear response assuming there is no chance to escape or avoid it. Functional impairment ranges from none (e.g., fear of flying, without a real necessity to fly) to considerable (e.g. the terror of bridges when one lives in Venice). Patients can often alleviate their fear by avoiding it, but some things simply cannot be avoided. Because the stimulus is often expectable and easy to control (in contrast to social situations), researchers have often considered specific phobia as an example of pathological fear. 

Social Phobia

In social phobia, phobic anxiety is similar to the specific phobia in that anxiety is triggered by recognisable external factors, i.e. social exchanges. At the core of social phobia is a fear of undesirable evaluation from others, and communication with other people incites the phobic response. In this sense, the characteristics of social phobia also bear a resemblance to panic disorder, because the client cannot always control or predict when a social contact will spontaneously occur. 

Social phobia often involves extreme discomfort in a wide range of social circumstances. Some patients experience social anxiety only in particular circumstances. These people can feel socially competent in usual social situations (with family members, for instance), but they experience intense anxiety in certain circumstances (e.g. public speaking or public washrooms). Individuals with social phobia usually acknowledge their unreasonable beliefs about social situations and exhibit avoidance behaviours.

Generalised Anxiety Disorder (GAD)

The fundamental feature of generalised anxiety disorder (GAD) is constant, uncontrollable worry, experienced in combination with symptoms of anxious arousal (e.g. insomnia, irritability, muscle tension, hypervigilance). The worry often surrounds one’s own wellbeing and the current and future welfare of loved ones. While the content of worries is similar to everyday concerns that many people have, including money, family relationships and academic or job performance, the course is somewhat special. Worry as faced in GAD is problematic or impossible to control. Clients are incapable to alter their mindsets, and troublesome worries preoccupy them. Suppressing the worrisome thoughts only makes things severer. A generalised feeling of anxiety often occurs within other anxiety conditions as well, but the characteristic uncontrollable worry (about contents other than the specific things of other anxiety conditions) distinguishes the separate diagnosis of GAD.

Historically, thinkers from Freud forward have attempted to explain the observation that some people become unreasonably anxious in response to fairly minor occurrences that would result in little, if any, anxiety in other people. This anxiety susceptibility was described as neuroticism by Eysenck in 1968. Longitudinal research, in which scientists observe individuals over years, has discovered links between neuroticism and the incidence of anxiety disorders. 

Compared to the preceding fourth edition of the DSM, posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) are no longer mentioned as anxiety disorders in the DSM-5. These conditions, however, are closely linked to anxiety disorders. The sequential order of these sections in the DSM-5 indicates this close association.

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Risk Factors for Anxiety

Research into anxiety points out that both the environment and genetic predisposition comprise the risks for anxiety conditions. Although the risks factors for each anxiety disorder can differ, some shared perils for all types of anxiety comprise the following:

  • traumatic life events;
  • a history of an anxiety disorder or other mental health issues in genetic relatives;
  • certain somatic conditions, such as thyroid problems or heart arrhythmias
  • behavioural inhibition in childhood or an overexpressed personality trait of shyness.

Substances such as caffeine or certain medicines can trigger or exacerbate a feeling of anxiety. In assessing an anxiety condition, a full health examination is beneficial.

Treatment of Anxiety

Anxiety is usually treated by means of psychotherapy, pharmacology or both. There are various psychotherapeutic approaches to treating anxiety. In collaboration with their psychologists or psychiatrists, people can find out which option is the most effective.

Cognitive Behavioural Therapy (CBT)

CBT is an evidence-based psychological treatment known to be effective in managing anxiety. CBT educates patients on how to start thinking differently and how to learn to interpret anxiety-producing stimuli more adaptively. It teaches people how to start acting rationally and stop being preoccupied with uncertainties and fears. CBT also aids in acquiring and exercising social skills critical for managing social anxiety. Two CBT techniques are usually used to manage anxiety disorders: exposure and cognitive reappraisal.

Medication

Medicines can strikingly improve anxiety symptoms. Anxiety medications are prescribed by psychiatrists and often include anxiolytics, antidepressant medications and beta-blockers. It is necessary to discuss with the psychiatrist which substances and medications must be avoided during the treatment of anxiety.

Stress Management 

Mindfulness and relaxation are known to be effective in managing stress and increasing the effectiveness of therapy.

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