There are a number of different types of anxiety disorders. They include:
Anxiety disorders make up one of the most common groups of psychiatric disorders. According to the National Comorbidity Study:
There is solid evidence that heredity is a predisposing factor in the development of anxiety disorders. Nearly half of all patients with panic disorder have at least one relative with the same condition. Data from studies of twins also indicate that anxiety disorders are at least partially genetically determined.
From a psychodynamic perspective, the goal of therapy is not necessarily to eliminate all anxiety a person feels but to increase anxiety tolerance and use it as a signal to investigate the underlying conflict that has created it. Anxiety appears in response to various situations during a lifespan, and though medications may improve symptoms, they may do nothing to address one’s life situation or internal responses that lead to anxiety.
Generalized anxiety disorder is diagnosed when a person has excessive anxiety and worry concerning events or activities, such as work or school performance, occurring more days than not for at least 6 months. The individual has difficulty controlling the worry, and has three or more of the following symptoms:
Generalized Anxiety Disorder Epidemiology
Generalized Anxiety Comorbidity
Psychosocial Factors of Generalized Anxiety Disorder
The most effective treatment of generalized anxiety disorder is probably one that combines psychotherapy, pharmacotherapy, and supportive approaches.
In terms of psychotherapy, cognitive approaches address an individual’s distorted thoughts, while behavioral approaches address somatic symptoms. The major techniques of used in behavioral approaches are relaxation and biofeedback. Supportive therapy offers patients reassurance and comfort. Insight-oriented psychotherapy focuses on uncovering unconscious conflicts and identifying ego strengths. Most patients experience a marked reduction in anxiety when given the opportunity to discuss their difficulties with a concerned and sympathetic physician or therapist.
The most effective prescription drugs for the treatment of generalized anxiety disorder are benzodiazepines, SSRIs (Zoloft, Prozac, Paxil, etc.), SNRIs (Effexor, Cymbalta, etc.), and buspirone (BuSpar). Other drugs that may be useful are tricyclic drugs (Nortriptyline, Amytriptyline, etc.) and beta-adrenergic antagonists or blockers (Propranolol).
Separation anxiety disorder is developmentally inappropriate and excessive fear or anxiety concerning separation from loved ones. The anxiety lasts at least 4 weeks in children and adolescents, and typically 6 months or more in adults. The diagnosis requires at least three of the following symptoms:
The most effective treatment of generalized anxiety disorder is probably one that combines psychotherapy, pharmacotherapy, and supportive approaches.
In terms of psychotherapy, cognitive approaches address an individual’s distorted thoughts, while behavioral approaches address somatic symptoms. The major techniques of used in behavioral approaches are relaxation and biofeedback. Supportive therapy offers patients reassurance and comfort. Insight-oriented psychotherapy focuses on uncovering unconscious conflicts and identifying ego strengths. Most patients experience a marked reduction in anxiety when given the opportunity to discuss their difficulties with a concerned and sympathetic physician or therapist.
The most effective prescription drugs for the treatment of generalized anxiety disorder are benzodiazepines, SSRIs (Zoloft, Prozac, Paxil, etc.), SNRIs (Effexor, Cymbalta, etc.), and buspirone (BuSpar). Other drugs that may be useful are tricyclic drugs (Nortriptyline, Amytriptyline, etc.) and beta-adrenergic antagonists or blockers (Propranolol).
Separation anxiety disorder is developmentally inappropriate and excessive fear or anxiety concerning separation from loved ones. The anxiety lasts at least 4 weeks in children and adolescents, and typically 6 months or more in adults. The diagnosis requires at least three of the following symptoms:
Social anxiety disorder is diagnosed when a person has excessive fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions, such as having a conversation, meeting new people, being observed while eating or drinking, and performing in front of others (e.g., giving a speech). In children, the anxiety must occur in peer settings and not just during interactions with adults.
The fear, anxiety or social avoidance typically lasts for 6 months or more, and causes significant distress or impairment in social, occupational, or other important areas of functioning. A diagnosis of social anxiety disorder cannot be explained by the physiological effects of a substance (e.g., a drug of abuse or medication) or another medical condition. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury is present) the fear, anxiety or avoidance is clearly unrelated or is excessive. Social anxiety disorder may be diagnosed as “performance only” if the fear is restricted to speaking or performing in public.
Social Anxiety Disorder Epidemiology & Genetics
Both psychotherapy and pharmacotherapy are useful in treating social anxiety disorder. Some studies indicate that the use of both pharmacotherapy and psychotherapy is more effective than either therapy alone.
The most effective prescription drugs for the treatment of social anxiety disorder are benzodiazepines, SSRIs (Zoloft, Prozac, Paxil, etc.), SNRIs (Effexor, Cymbalta, etc.), and buspirone (BuSpar). Other drugs that may be useful are tricyclic drugs (Nortriptyline, Amytriptyline, etc.) and beta-adrenergic antagonists or blockers (Propranolol).
Psychotherapy for social anxiety disorder usually involves behavioral and cognitive approaches, including cognitive retraining, desensitization, rehearsal during sessions, and a range of homework assignments.
A panic disorder diagnosis is given to a person who has recurrent unexpected panic attacks. A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within minutes. During this time, four or more of the following symptoms occur:
A diagnosis of panic disorder request that at least one of the attacks be followed by 1 month or more of one or both of the following:
Moreover, the disturbance cannot be explained by the physiological effects of a substance (e.g., drug of abuse or medication), another mental condition (e.g., hyperthyroidism or cardiopulmonary disorders), or another mental disorder, such as post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD).
Panic Attack / Panic Disorder Epidemiology
Panic Attack / Panic Disorder Comorbidity
Psychodynamic Themes in Panic Attacks / Panic Disorder
Psychodynamic theory considers the interplay of conscious and unconscious factors that may develop through interpersonal relationships and during childhood. Psychodynamic themes often seen in patients with panic disorder include:
Panic Attack Disorder vs. Medical Disorders
Panic disorder must be differentiated from a number of medical conditions that produce similar symptoms. These include cardiovascular diseases, pulmonary diseases, neurological diseases, and endocrine diseases.
The two most effective treatments for panic attacks / panic disorder are medications and cognitive behavioral therapy. Family and group therapy may also help patients and their families.
Pharmacotherapy
In general, selective serotonin reuptake inhibitors (SSRIs) and clomipramine (Anafranil) are shown to be more effective and better tolerated than benzodiazepines, monoamine oxidase inhibitors and tricyclic and tetracyclic drugs. Some reports suggest a role for venlafaxine (Effexor) and buspirone (BuSpar). Venlafaxine is approved for treatment of generalized anxiety disorder and may help in patients with both panic disorder and depression.
Cognitive & Behavior Therapies
Cognitive and behavior therapies are effective treatments for panic disorder. Several studies have found that the combination of cognitive or behavioral therapy with pharmacotherapy is more effective than either approach alone.
The most effective prescription drugs for the treatment of generalized anxiety disorder are benzodiazepines, SSRIs (Zoloft, Prozac, Paxil, etc.), SNRIs (Effexor, Cymbalta, etc.), and buspirone (BuSpar). Other drugs that may be useful are tricyclic drugs (Nortriptyline, Amytriptyline, etc.) and beta-adrenergic antagonists or blockers (Propranolol).
To treat panic disorders, selective serotonin reuptake inhibitors (SSRIs) and clomipramine (Anafranil) are shown to be more effective and better tolerated than benzodiazepines, monoamine oxidase inhibitors and tricyclic and tetracyclic drugs. Some reports suggest a role for venlafaxine (Effexor) and buspirone (BuSpar). Venlafaxine is approved for treatment of generalized anxiety disorder and may help in patients with both panic disorder and depression.
Agoraphobia is a marked fear or anxiety about two or more of the following situations:
The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of incontinence or fear of falling in the elderly). The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. The fear, anxiety or avoidance typically lasts for 6 months or more, and causes significant distress or impairment in social, occupational or other important areas of functioning.
Agoraphobia will be diagnosed irrespective of the presence of panic disorder.
Agoraphobia Epidemiology
The lifetime prevalence of agoraphobia varies between 2 to 6 percent across studies.
Agoraphobia vs. Other Disorders
Agoraphobia must be differentiated from a number of other medical conditions that produce similar symptoms. These include major depressive disorder, schizophrenia, paranoid personality disorder, avoidance personality disorder, and dependent personality disorder.
Pharmacotherapy
Benzodiazepines have the most rapid onset of action against panic. Xanax and Ativan are the most commonly prescribed benzodiazepines. Clonazepam has also been shown to be effective.
Benzodiazepines have the potential for dependency, cognitive impairment and abuse, especially with long-term use. However, when used appropriately under medical supervision benzodiazepines are effective and generally well-tolerated. Their most common side effects are mild dizziness and sedation, both of which are often reduced by time or by adjustment of dosing.
Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line agents for treatment of panic disorders with or without agoraphobia, and they can help reduce or prevent relapse. The main advantage of SSRIs is their improved safety profile and more tolerable side effects.
Tricyclic and tetracyclic drugs are also effective treatments, although they require careful dosing and close monitoring of side effects, which can include jitteriness, possible seizures and potentially harmful cardiac effects.
Psychotherapy
A variety of different types of psychotherapy may be used to treat agoraphobia.
Substance/medication-induced anxiety disorder can affect individuals during or after ingesting a number of different drugs or substances. These can include:
A diagnosis of substance/medication induced anxiety is when an individual suffers from panic attacks or anxiety soon after substance intoxication or withdrawal, or after taking a medication. Moreover, the panic attacks or anxiety cannot be attributed to another anxiety disorder apart from the substance or medication use.
Selective mutism is a type of anxiety disorder that is diagnosed when an individual is afraid to speak in specific social situations where there is an expectation for speaking, such as at school or work, despite speaking in other situations.
An anxiety disorder diagnosed because of a specific phobia is based on an individual’s marked fear or anxiety about a specific object or situation. Examples include flying in planes, heights, animals, receiving an injection, or seeing blood. In children, the fear or anxiety may be expressed by crying, tantrums, freezing or clinging behavior. The diagnosis requires that:
A diagnosis for anxiety disorder due to another medical condition can be made when:
A diagnosis for unspecific anxiety disorder applies to situations in which anxiety symptoms do not meet the full criteria for any of the established anxiety disorders. The anxiety symptoms still cause significant distress or impairment in social, occupational, or other important areas of functioning. The clinician, however, lacks information to categorize the anxiety into one of the specific anxiety disorders. This may occur in emergency room situations.
No. Sometimes, individuals may be diagnosed with an anxiety disorder, even though their symptoms do not meet the normal diagnostic guidelines. This can happen with: