Anxiety Disorders
Table of Contents
What Is Anxiety?
All people are familiar with anxiety, which ranges from a vague apprehension to an intensely uncomfortable feeling similar to fear. Anxiety is a normal part of being human. Anxiety serves an important purpose: It is a warning signal, triggered by a conscious or unconscious perception of danger. It helps us pay attention to something important. Anxiety is experienced both physically and psychologically. Physical symptoms of anxiety include:
- Muscle tension or trembling
- Pounding heart
- Dizziness or light-headedness
- Sweating, feeling hot or flushed
- Tightness in chest or throat, breathing difficulties
- Trouble falling asleep, waking in the night or too early
- "Butterflies in the stomach"
- Low appetite, nausea, indigestion
- "Hypervigilence," feeling "on edge"
Psychological and cognitive symptoms of anxiety include:
- Poor concentration or lack of focus, distractibility
- Excessive worrying or thinking something is going to go wrong
- Specific fears (e.g., fear of heights, fear of crowds)
- Self-criticism, self-doubt
- Trust issues, paranoia
These symptoms are natural in many situations, and most people have some of these symptoms from time to time. However, there is a point at which anxiety may become extreme and interfere with day-to-day living. In such cases, one needs to consider whether an anxiety disorder may be present, requiring some type of treatment.
Anxiety Disorders
When anxiety is higher than what is typical, is ongoing, and causes problems, it may be considered an anxiety disorder. Anxiety disorders are the most common mental health issue in the United States, affecting up to 18 percent of people each year. However, because some anxiety is normal for all people, it can be difficult to determine when anxiety is a problem. Questions to consider are:
- Is this anxiety part of a repeated, ongoing pattern?
- How much does it get in the way of my life?
If a repeated pattern of anxiety increases to the point where it is hard to control and interferes with your ability to work or have relationships, you can be said to have an anxiety disorder.
Since our natural "warning systems" are complex, there are many ways in which anxiety can show up. Sometimes anxiety is a rare occurrence, triggered only by specific situations. Sometimes it is always present, subtly distracting us and wearing us down. Some common anxiety problems are described in the following sections.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) involves higher than usual levels of day-to-day worry and anxiety about a variety of areas, such as school or work, relationships, day-to-day tasks, health, money, and self-image. As the name implies, the anxiety is not focused on one particular thing. The disorder develops gradually and can begin at any point in the life cycle but usually develops between childhood and middle age. Other anxiety disorders, depression, or substance abuse often accompany GAD. GAD can be mild, moderate, or severe, and the level of severity will impact how well the person can function.
Phobias
Phobic disorders involve fear of a specific thing or situation (e.g., crowds, enclosed spaces, spiders) and are characterized by fear or discomfort triggered by that thing or situation and avoidance of or distress from the situation that interferes with school, social life, or other important aspects of living. Phobias are very common, affecting 4 to 5 percent of the U.S. population in a given year and up to 11 percent of people in their lifetime.
Panic Disorder
Panic disorder involves repeated episodes of panic, which hit suddenly. Symptoms of a panic attack include:
- Shortness of breath or choking feeling
- Racing heart or chest pain
- Sweating, chills, or hot flashes
- Nausea, dizziness, or shaking
- Fear of dying or going crazy
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) involves having either obsessions or compulsions that interfere with your life.
- Obsessions are intrusive thoughts or images that recur despite attempts to stop them, such as worries about germs or fears that something will happen to a loved one.
- Compulsions are behaviors that are repeated in an attempt to prevent or decrease anxiety. Compulsions are hard to control and interfere with everyday life and/or take up excessive time. Examples are excessive cleaning or hand-washing and needing to check things (e.g., whether you locked the door) multiple times.
Obsessive-compulsive disorder affects 2 to 3 percent of the population.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) involves a reaction to experiencing or witnessing an extremely frightening event, such as being assaulted or raped or having a serious accident. People who suffer from PTSD:
- Re-experience the event through nightmares or waking "flashbacks"
- Avoid places and situations that are reminders of the event
- May feel emotionally numb or even have partial amnesia as a way of psychologically avoiding reliving the experience
- Have symptoms of increased arousal, including being easily startled
- Often have insomnia and poor concentration
Problems Causing or Resulting From Anxiety
Anxiety is often caused by a combination of genetic and environmental factors. In some cases, it may be due to an underlying medical problem, such as a thyroid disorder, or to a drug or medication. Amphetamines, cocaine, LSD, Ecstasy and other substances can cause symptoms of anxiety.
Conversely, the presence of an anxiety disorder can lead to substance abuse as a way to try and "self-medicate." For example, pot and alcohol are commonly used by people with anxiety. It is important to know that anxiety can coexist with symptoms of depression or other disorders.
Treatment
There are effective treatments for anxiety disorders. Treatments fall into two categories: 1) psychotherapy, involving counseling by a licensed therapist (who may be a psychiatrist, psychologist, licensed clinical social worker, or licensed marriage and family counselor), and 2) pharmacotherapy, involving the use of psychotropic medications (prescribed by a psychiatrist or other physician).
Psychotherapy
Behavioral therapy is probably the most common treatment for anxiety disorders. In general, this involves some type of controlled exposure to the triggers of anxiety, along with the use of coping skills, so that the automatic anxiety reaction occurs less often and less intensely and the person learns effective ways to deal with their anxiety. A trained therapist can be helpful in starting this type of process. Self-help books, websites, and apps can be used along with therapy and give you a chance to practice new coping strategies. The benefits of treatment include reduced symptoms, greater insights, feeling supported and understood, improved coping skills, and better overall quality of life. The main drawbacks of therapy are the time, effort, and sometimes cost involved.
Pharmacotherapy
Two types of medication are commonly used in treating anxiety: benzodiazepines and antidepressants. Benzos, such as Valium (diazepam), Ativan (lorazepam), and Xanax (aprazolam), work rapidly to numb anxiety but only provide short-term relief. Their continued use can lead to to dependence and depression. Antidepressant medications such as Paxil (paroxetine), Lexapro (escitalopram), and Effexor (venlafaxine) can be helpful for the longer term, but they generally take a few weeks to work, are not always effective, and may be accompanied by side effects. Certain other non-antidepressant and non-benzodiaepine medicines are sometimes used to treat anxiety.
CAPS and the Student Health Center may not always recommend medications for anxiety and often will recommend therapy and lifestyle changes first.
Therapy vs. Medications
One of the main advantages of therapy over medication is that the benefits may be longer lasting and without medication's side effects. Discontinuation of medication always presents a risk of relapse. Nonetheless, there are times when an anxiety reaction is particularly overwhelming and therapy alone is ineffective. At such times, a combination of medications and therapy can be most helpful.
Resources
Call CAPS at (831) 459-2628, the Student Health Center at (831) 459-2500, or your off-campus therapist or medical clinician to make an appointment and/or get referrals for the treatment of anxiety disorders.
See our Resources page for information, self-help tools, and links to other resources.
Visit our Crisis page for crisis/emergency resources.
