What are the Different Types of Anxiety Disorders?
Image by @lexoge on Unsplash
Everybody experiences temporary feelings of anxiety. However, when a person has an anxiety disorder, they experience fear and discomfort intensely, frequently, and disproportionately to their current circumstances. There are several types of anxiety disorders, including generalized anxiety, specific phobias, and several others.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is perhaps what most people think of when they think about anxiety. People with GAD experience excessive worry that interferes with their daily lives. Feelings of dread may persist even when the person has no clear reason to worry, and they may worry a disproportionate amount over everyday stressors. Even in scenarios that warrant anxiety, somebody with GAD may experience more fear than somebody who does not have GAD. Some signs of GAD include:
restlessness and difficulty relaxing
difficulty sleeping
experiencing physical symptoms, such as headaches or stomach aches, when feeling anxious
difficulty quieting one’s mind
trouble focusing
excessive worry
becoming startled easily
feeling exhausted due to worry
lightheadedness or difficulty breathing when nervous
irritability
Panic Disorder
People with panic disorder often experience panic attacks, sometimes at unexpected times and without an apparent cause. Some signs of a panic attack include:
intense feelings of dread
racing heart
feelings of doom or even death
dizziness or lightheadedness
difficulty breathing
nausea
stomach or chest pain
chills or shaking
numbness
Not every person who has experienced a panic attack has a panic disorder. What sets panic disorder apart is its frequency and relative unpredictability.
Obsessive-Compulsive Disorder
There is some debate over whether obsessive-compulsive disorder (OCD) should be classified as an anxiety disorder. While previous versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) classified OCD as such, more recent versions do not. Instead of falling under the anxiety disorder category of the DSM, OCD and related disorders now have their own classification.
OCD is included in this guidebook because some people with OCD report an intense connection between their disorder and anxiety symptoms.
OCD causes obsessions, which are intense and repetitive thoughts that the person is unable to release. These obsessions cause compulsions, or behaviors, that temporarily provide relief from the obsession.
In many cases, obsessions are rooted in anxiety or fear. However, obsessions may also be connected to feelings of guilt or other emotional difficulties.
Separation Anxiety Disorder
Separation anxiety disorder primarily impacts children, but it may also occur in adults or teenagers. People with separation anxiety disorder experience intense fear when separated from a parent or caretaker. Some signs of separation anxiety disorder include:
intense reactions and maladaptive behaviors when separated from the caregiver
refusing to be separated from the caregiver for even a short period of time
worrying about separation even when with the caregiver
worrying about the caregiver being lost or harmed
worrying that they will experience harm any time they are not in the presence of the caregiver
refusing to be home alone or away from home, even in later childhood or adolescence
physical symptoms of anxiety, such as stomach pain
nightmares featuring separation
It is important to understand that many young children experience separation anxiety without developing a separation anxiety disorder. Children with separation anxiety often outgrow this issue when they develop an understanding that their caregiver always returns for them. A child may have a disorder if they continue to experience this anxiety, especially long after their peers have outgrown it.
Social Anxiety Disorder
Social anxiety disorder (SAD) causes an intense fear of being perceived and judged, and this fear often emerges during social situations. As a result, the thought of socialization itself can cause excessive worry. According to Yale Medicine, up to 13% of Americans may experience SAD, though it may be underdiagnosed due to individuals not seeking help and support.
A person with SAD may dread otherwise innocuous situations, such as raising one’s hand in class or asking for a utensil at a restaurant, due to fear of being watched and scrutinized. They may also limit social engagement, which can provide temporary relief but also result in long-term loneliness.
Agoraphobia
Agoraphobia is a widely misunderstood condition. On television and in movies, it is often portrayed as a “fear of leaving the house” or “fear of public places.” While it is true that many people with agoraphobia experience these specific fears, agoraphobia may manifest in other ways as well.
Agoraphobia is the fear of places or scenarios that cause distressing feelings, such as:
panic
getting lost
being embarrassed
feeling trapped with no way to escape
inability to get help if needed
These fears are both subjective and disproportionate to the amount of legitimate danger the person is facing. Therefore, people experience agoraphobia in various ways. For instance, some people may fear enclosed spaces, while others may fear open spaces. Some may fear leaving their home at all, while others may only fear leaving their home by themselves. Some people with agoraphobia may fear unfamiliarity, and may therefore be able to leave their house as long as they are going to a place they know well.
Specific Phobias
People with specific phobias experience intense and irrational fear of specific things. Sometimes, the object of the phobia is generally harmless, such as a balloon or bird. In other cases, the object of the phobia may cause peril, but that peril is unlikely to occur, such as a flood. The DSM-5 lists five main types of specific phobia, as explained by the Perelman School of Medicine at the University of Pennsylvania:
animals
natural environment
blood, injection, or injury
situational
other
Some examples of common phobias include:
spiders or other bugs
specific animals
heights
needles
blood
driving
water
storms
public speaking
Virtually any situation or object may become an object of a phobia. This may occur due to genetics or trauma.
Selective Mutism
Selective mutism is the inability to speak in specific situations due to anxiety. In spite of the word “selective,” this condition does not cause people to avoid speaking intentionally. Those with selective mutism do not make a decision to stop speaking because ot their anxiety. Rather, their anxiety causes a temporary loss of speaking abilities. Some people with selective mutism describe feeling as if there is a physical barrier between their words and their ability to verbalize them.
The word “selective” comes from the fact that nonverbal episodes depend on the person’s circumstances. A person with selective mutism is not nonverbal in every situation. For instance, somebody with this condition may be able to speak while alone or with trusted friends and family members.
To receive a diagnosis of selective mutism, an individual must experience speaking difficulties that are specifically caused by anxiety, rather than another cause such as autism, language barriers, or physiological differences.
This condition is most common in young children, but people of all ages may experience selective mutism.
Complications of Anxiety Disorders
People who experience anxiety disorders may experience certain complications as a result. Many of these complications arise due to avoidance behaviors. Those with anxiety may go to great lengths to avoid situations that worsen their symptoms, and this avoidance may severely impact their overall quality of life by limiting their options.
Loneliness and Isolation
All types of anxiety may limit a person’s social opportunities, which can then cause loneliness and isolation. This loneliness may then lead to other complications, such as depression or a reduced quality of life.
Career and Goal Limitations
Chronic anxiety may also limit a person’s career options if it causes them to avoid advancement opportunities. For example, a person with social anxiety may avoid asking for a raise due to fear of judgment from their boss, or a person with selective mutism may find themself unable to speak in this situation at all.
Non-career goals may also be limited by anxiety. For instance, somebody who has always wanted to learn to paint might not pursue classes if they experience agoraphobia.
Fear Reinforcement
When a person limits their behaviors due to fear, they repeatedly confirm that the object of avoidance is indeed scary. This creates a loop that reinforces the fear. The longer the person avoids situations that cause anxiety, the more frightening the situation may become, and the more difficult it will become to face the fear.
Comorbid Conditions
In addition to complications caused by avoidance behaviors, anxiety disorders frequently co-occur with other mental health conditions. The most common comorbid conditions among people with anxiety are mood disorders, physical health conditions, and substance use disorders. These conditions may worsen anxiety symptoms and vice versa.
How are Anxiety Disorders Treated?
There are several treatment options available for people who experience anxiety disorders. Anxiety disorders impact people on a physical and emotional level. Therefore, the treatment options for this condition include both physical approaches, such as medication, and mental approaches, such as therapy.
Therapy
There are several types of therapy available for people with anxiety disorders. Therapy can help people recognize their symptoms, face specific fears, and discover helpful strategies for dealing with anxiety.
Options include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), exposure therapy, and several others. The right type of therapy depends on the individual, their specific anxiety condition, any comorbid conditions, and the severity of their anxiety.
Medication
Anxiety disorders are also commonly treated with medication.
Some medications may be taken on a daily basis. For example, doctors often prescribe selective serotonin reuptake inhibitors (SSRIs), which also treat depression, for anxiety disorders. These medications increase the brain’s available serotonin by preventing receptors from removing the serotonin too quickly. Because serotonin is a calming brain chemical, many people find that SSRIs significantly reduce their anxiety symptoms.
Other medications, such as benzodiazepines, provide immediate relief and are not intended for daily use. They are often prescribed for sudden and intense forms of anxiety, such as panic attacks.
In some cases, a medication that was not originally intended to treat anxiety may be prescribed “off label” for symptom relief. For example, beta blockers are a class of drugs that treat high blood pressure by blocking adrenaline. As a result, they can also relieve some physical symptoms of anxiety, such as shaking or fast heart rate.
Accommodations
Some people with anxiety may benefit from certain accommodations at school or in their workplace. For example, a person with selective mutism might use an augmentative and alternative communication device (AAC) to communicate with other people during nonverbal periods. A student with a severe public speaking phobia may seek an exemption or alternative assignment in classes that require presentations.
Treating the Primary Cause
Anxiety may also be the result of a different condition. Treating the primary condition may, therefore, provide anxiety relief.
For example, there is a strong connection between anxiety conditions and attention deficit hyperactivity disorder (ADHD). Anecdotally, many people with both conditions report that their anxiety symptoms significantly improved once their ADHD symptoms were treated.
This may be because, reportedly, some people rely heavily on their anxiety to negate the impact of their ADHD. For example, a person with social anxiety might harness their fear-based adrenaline to finish an assignment on time, thus avoiding the judgment and shame that may result from turning in the assignment late.
Another example comes from substance use disorder (SUD), which also has a strong connection with anxiety. Because many substances can worsen anxiety, treating the SUD may provide significant relief from both conditions over time.
Stress Relief and Coping Strategies
In addition to receiving anxiety treatment, people with anxiety may also benefit from stress relief and coping strategies. Some options include:
meditation
massage
deep breathing
exercise
nutritional strategies
However, these approaches are not replacements for therapy and medical care. While some people with mild anxiety may find that these strategies provide enough relief, others may need therapy, medication, accommodations, or all three. Stress relief strategies may supplement other forms of care, but the existence of stress relief options does not negate some people’s need for other treatment.
Sources:
Agoraphobia: Symptoms and Causes - Mayo Clinic
Anxiety Disorders - National Institute of Mental Health (NIMH)
Anxiety Medication: List, Types, and Side Effects - Medical News Today
Obsessive-Compulsive Disorder (OCD) - Johns Hopkins Medicine
Panic Disorder: When Fear Overwhelms - National Institute of Mental Health (NIMH)
Separation Anxiety Disorder: Symptoms and causes - Mayo Clinic