Anxiety disorders are a group of mental illnesses that ''share features of excessive fear and anxiety and related behavioural disturbances'' (DSM-V) more specifically GAD (Generalized Anxiety Disorder), Agoraphobia, SAD (Social Anxiety Disorder), Panic Disorder, Specific Phobia Disorder, Substance/Medication-Induced Anxiety Disorder, Selective Mutism and Separation Anxiety Disorder.

These are considered the second most frequent mental disorders being estimated that in 2017, circa 3,8% of the world's population was suffering from one of them.

Even though this is a frequent condition in today's society, feeling stressed or worrying doesn't directly imply that a person has an anxiety disorder. Worry is a cognitive characteristic based on thinking about actual or possible negative scenarios while stress is a physiological response to an external stimulus. Anxiety is, superficially summarizing, the aggregation of the cognitive (worry) and physical (stress) components and it's only considered a disorder when:

1. Happens in disproportionate moments;

2. Happens frequently:

3. It interferes in the daily life of the individual.

Despite being included in the same group, each anxiety disorder has its own characteristics, symptoms and treatments, which will be clarified and specified in the following paragraphs.

 

 

General Anxiety Disorder (GAD)

General Anxiety Disorder (GAD) is one of the most frequent anxiety disorders and its related to a state that doesn't show many signals or a relevant social deterioration, since most of its symptoms are considered personality traits that cannot be changed, which makes it harder for the patient to recognize they need help. However, it does have an effect on social relationships and in the individual's life overall since the worries connected to the disorder are usually excessive, intense and dreadful; besides their duration. The individual can be harmed for it prevents him to do tasks fast and accurately.

 

Symptoms:

Physical- fatigue, insomnias and trouble sleeping, muscle tension, difficulty concentration, trembling, perspiration and hyperventilation.

Mental- excessive anxiety and worry about a range of concerns, difficulty controlling their worries or feelings, easily scared, intrusive and uncontrollable thoughts.

Note: For a diagnosis of GAD, the patients must have the symptoms (besides worry) for at least 6 months.

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Causes:

The specific causes of GAD are still unknown, however some of the likely causes are:

-Genetics (there's a heritability of approximately 30%);

-Traumatic experiences (such as domestic violence, child abuse, bullying);

-A disproportion of serotonin and noradrenaline (neurotransmitters involved in the control and regulations of mood).

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According to their age, GAD patients have different worries: children and teens are usually more concerned about school and academic performance, even when they aren't being evaluated, while older patients usually have their thoughts more connected to the family well-being or their own health. In addition to this, children are usually more affected by the symptoms and they can become excessively perfectionists and insecure, seeking for constant approval.

In spite of fact that the individuals who worry excessively can easily compose possible problems, they show inefficiency on creating solutions for them. There are considered 3 types of problems:

1.Immediate problems that are based on reality, yet can be solved.

2.Immediate problems that are based on reality, however cannot be solved.

3.Very unlikely events that are not based on reality and, therefore, cannot be solved.

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Treatment:

The most common treatments for GAD are psychological therapies and medication (usually antidepressants or anti-anxiety medication).

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Agoraphobia

Agoraphobia is a disorder characterized by an intense fear or anxiety provoked by an exposure (real or anticipated) to situations that lead the patient to feel cornered, defenceless, embarrassed and/or afraid, affecting their daily life. These situations are usually categorized into 5 sections:

1. Use of public transports.

2. Remaining in open spaces.

3. Remaining in enclosed spaces.

4. Remaining on a queue or staying in the middle of a crowd.

5. Being outside alone.

Commonly, agoraphobia patients feel the symptoms in, at least, two of these situations.

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Symptoms:

The symptoms are usually connected to the fear the individual feels (for example, constantly avoiding the situations they fear and feeling the need of having help from others to live their daily life) however, the main symptoms to this disorder are the panic attacks triggered when the individual is exposed to the situations they fear (either in real life or imagination). Once the panic attack occurs, the patient is likely to generalize this event to all of the future situations within the same nature. If the disorder advances, the patient starts avoiding daily activities and stays inside most of the time.

There are considered three types of panic attacks:

1. Unexpected Panic Attacks where the triggering situation stimuli is unknown. These are associated with Panic Disorder.

2. Situation Panic Attacks, associated with Specific Phobias and Social Anxiety Disorder, where the triggering situation stimuli is known.

3. Situationally Predisposed Panic Attacks where the triggering situation stimuli can likely be identified. These are the ones connected to Agoraphobia and they usually happen after the individual has gone through the situation they fear.

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Causes:

-Genetics (among the various phobias, agoraphobia is the one where genetics play a more likely factor being 61% hereditary)

-Environmental (stressful events such as being attacked or mugged)

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Treatment:

The treatment to agoraphobia lies in exposure tactics, i.e., exposing the patient to the situations they fear. This treatment is usually accompanied by a psychologist. The use of psychotropic drugs is not advised for although they improve the symptoms and the depression, anxiety and panic that might be correlated, the relapse and long-term effects when the patient stops taking them, in spite of the fact that remain unknown, cannot be ignored.

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Social Anxiety Disorder (SAD)

Social Anxiety Disorder (SAD), or as previously named, Social Phobia, is a recurrent type of anxiety disorder. It consists on the discomfort and anxiety an individual feels during a social interaction, stimulated by a fear of being ''embarrassed, humiliated, rejected or looked down on in social interactions''.

(Parekh, R. (2017, January) What Are Anxiety Disorders? American Psychiatric Association Retrieved from https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders)

Social situations usually feared by individuals with social phobia:

• Starting and/or keeping conversations;

• Scheduling a meeting with someone (and going);

• Go to a party;

• Behaving assertively (e.g., expressing disagreement or rejecting a request);

• Phone calls (specially with people that they don't know very well);

• Speaking with people with authority;

• Returning a product to the store where it was bought;

• Making eye contact with people they don't know;

• Giving and receiving compliments;

• Public speaking;

• Acting in front of others;

• Being the centre of the attention;

• Eating/drinking in public;

• Writing/working when it's being observed;

• Using public bathrooms.

(Goldberg, D., & Huxley, P. (1996). P.27)

Although it is considered normal to feel anxious in certain situations, social anxiety disorder contemplates a range of other symptoms.

 

Symptoms:

• Fear of judgment, intense concern about embarrassing themselves or showing symptoms of embarrassment, fear of interacting with strangers, avoiding situations where they have to speak with others or where they can be the centre of attention, being pessimistic about possible social scenarios.

• Physical: Blushing, nausea, muscle tension, dizziness, accelerated heart beat and trembling.

 

Causes:

• Temperamental: behavioural inhibition and fear of negative judgement;

• Environmental: Childhood maltreatment and adversity;

• Genetic and physiological: besides the possibility of being inherited, social anxiety disorder is also influenced by traits prone to develop it like behavioural inhibition which, when present with environmental causes, prospects the disorder.

 

Consequences:

The difficulty on behaving in social interactions usually leads to other problems such as lack of self-esteem, pessimistic thoughts, depression, being vulnerable to criticism and low development of social skills. The individuals with this disorder try to avoid potential situations that can lead to anxiety, and, when they try to endure them, they tend to analyse their own behaviour, so they can improve it.

 

Treatment:

The treatment to this disorder includes psychotherapy and the use of selective serotonin reuptake inhibitors (SSRI's), that increase the amount of serotonin in the brain (a neurotransmitter which effects mood, emotions and sleep). The use of antidepressants, anti-anxiety medication and beta blockers can also be prescribed.

 

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Specific phobias

Specific phobia patients are characterized for being afraid, anxious and trying to dodge the situation feared, in a persistent and unreasonable level. There are five types of specific phobias:

Type

Situation feared

Animal

Any animal (More common: snakes, spiders, insects, cats, rats and birds.)

Natural Environment

Storms, water and heights.

Blood-Injection-Injury

Blood, injections, medical care and injuries.

Situational

Enclosed spaces, driving, lifts and airplanes.

Others

Situations that can lead to choking or vomiting

Note: 75% of those with a specific phobia, fear more than one situation/object, being given two separated diagnosis.

 

Symptoms:

• Immediate fear and/or anxiety when facing the situation feared;

• The fear is unreasonable to the actual danger;

• The fear, anxiety and dodging the situation interfere with the regular social and occupational activities;

• The panic sensed is uncontrollable and persistent;

• Avoiding constantly the situation feared;

• Knowing that their fear is irrational but not being able to control it;

• Psychical Symptoms: tachycardia, anxiety symptoms, sweating excessively and tremors.

 

The irrationality and exaggeration- the response people have when facing their phobia is usually very extreme: they either become unable to move or, on the contrary, they get very disturbed and start running away and/or screaming.

The avoidance- this is one of the most recurrent symptoms and probably the most concerning one as well, since the constant avoidance of the situations feared usually has an impact in how the individual behaves in society.

 

Causes:

Just like every other anxiety disorder, the following causes are just possible causes, since there’s still much more to know about these illnesses.

• Negative experiences with the situation feared.

• Genetics and environment- if the patients parents suffer from any kind of specific phobia or anxiety, this can be transmitted to the patient himself, either from genetics or from being used to see a certain reaction to a specific situation.

• Changes in brain functioning.

 

Some of the consequences of this disorder is the social isolation, as previously mentioned, the development of mood disorders, the likeliness to substance abuse (as an escape from the stressful events in daily life) and, in an extreme point, suicide.

 

Treatment:

The most common treatments are psychotherapy and medication (beta blockers, that block the effects of adrenaline, and sedatives such as benzodiazepines that help the patient relax).

 

 

Panic Disorder (PD)

This disorder is defined by the frequents panic attacks, either unexpected or expected. However, having a panic attack doesn't necessarily make an individual suffer from PD, since this aspect is regularly in comorbidity with other anxiety disorders.

 

Panic attack:

A panic attack is an abrupt episode of fear and anxiety, lasting from 5-20 minutes (or up to 1 hour), that triggers physical and mental involuntary reactions, irrational to the situation. Some of these reactions include:

• Pounding heart or fast heart rate;

• Perspiration;

• Trembling or shaking;

• Difficult breathing;

• Chest pain;

• Feeling dizzy, light-headed or faint;

• Feeling of suffocating;

• Numbness or tingling;

• Chills;

• Nausea or abdominal pains;

• Feeling detached from the body;

• Fear of losing control and dying.

As previously mentioned, (in Agoraphobia), there are three types of panic attacks. The most frequent ones in PD are the unexpected ones (meaning, the ones where there isn't an obvious trigger) although the occurrence of expected panic attacks don't necessarily exclude the possibility of having a panic disorder.

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Symptoms:

Besides the main symptom (panic attacks) there are other concepts present in this illness such as:

• Avoiding others, locals or situations associated with the panic attacks;

• Adjust daily life to ensure that assistance is always available;

• Consistent concern about possible panic attacks.

Note: The panic attacks must have occurred for at least a month even though their frequency changes depending on the severeness of the condition.

 

Causes:

Temperamental:  personality traits such as neuroticism and anxiety awareness are some of the causes of panic attacks, however there isn't yet a direct relation to the disorder itself. Another factor that can, probably, lead to the development of PD is a report of feeling some of the symptoms without fulfilling the whole criteria to be considered a panic attack.

Environmental:  Sexual and physical abuse in childhood is a common ground in individuals suffering from this disorder as well as smoking.

Genetics and physiological: researchers suspect various genes give susceptibility to the disorder even though they haven't yet been identified. The current studies accentuate the importance of the amygdala and related structures. Another risk factor is having parents with anxiety, depressive and bipolar disorders.

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The brain and PD:

As said in the previous paragraph, the amygdala and related structures influence PD. According to Fiametta Cosci, a professor of clinical psychology, in a 2012 study, the brain process in a panic attack lies in the amygdala which stimulates patterns of reactions in the brain and the body. That frightening experience creates an emotion memory (an anxiety response) which will be triggered in the following experience (either real or foreseen).  At the same time, the hippocampus documents the context of the attack, so that a few specifics components of the situation can be correlated with panic attack and therefore anticipating it when those factors are present.

 

Consequences:

Some of the consequences to this disorder are:

• High degree of social, occupational and physical infirmity;

• Ample economic costs;

• Highest number of medical checks amid anxiety disorders.

Note: These consequences are aggravated with the simultaneous existence of agoraphobia.

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Treatment:

Frequently the treatment to Panic Disorder it is based on psychotherapy and medicine such as SSRI's, Serotonin and norepinephrine reuptake inhibitors (SNRI's), which affect neurotransmitters known to regulate emotions, and benzodiazepines (however, since they can cause dependence, they're only used on short-term).

 

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Substance/medication-induced anxiety disorder

Substance/medication-induced anxiety disorder consists on having panic or anxiety, resulting from the use of a substance (e.g., drug, medication or toxin).

Substances that can provoke the development of substance-induced anxiety disorder:

• Alcohol; Caffeine; Cannabis; Phencyclidine; Inhalant; Cocaine.

Medications that can generate a medication-induced anxiety disorder:

• Anaesthetics; Analgesics, Thyroid Medications; Antihistamines.

 

 Symptoms:

 Some of the symptoms, besides anxiety, include:

• Trembling;

• Chills and sweating;

• Difficulty staying focused and remembering things;

• Nausea;

• Insomnias;

• Chest pain;

• Fear of losing control (and ''go crazy'');

• Difficulty breathing.

 

Treatment:

The treatment to this disorder must start with quitting the substance (if not already done). Then, considering the type of substance that commenced the disorder, the patients might need a professional detox. If not, therapy is usually the procedure to take, along with support groups such as Alcoholics Anonymous (AA) or Narcotic Anonymous (NA).

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Selective mutism

Selective mutism is a rare disorder usually present in childhood, however, if not given the adequate treatment, it can persist to adulthood. Either way, it's defined by the inefficiency to talk and communicate adequately in certain social settings which means, even though the child can speak in situations where they feel comfortable and relaxed, they are literally unable to when these two factors aren't present. This impotence is not due to a communication disorder and doesn't occur due to an autism spectrum disorder or a psychotic disorder

 

Symptoms:

• Fear of social embarrassment;

• Pessimistic;

• Compulsive traits;

• Clinging;

• Nervous and socially awkward;

• Have temper tantrums;

• Exageratted shyness;

• Physical Symptoms: nauseas, stomach ache, headaches, feeling nervous and scared.

Note 1: The symptoms must be constant for at least a month.

Note 2: The individuals with this disorder are often also diagnosed with social anxiety disorder (SAD)

 

Causes:

Temperamental- since, like said previously, selective mutism is a rare disorder, the influence of temperamental factors is not accurately defined. Nevertheless, it is suspected that neuroticism, behavioural inhibition and even the child's parents' traits such as timidity and social anxiety may play a role.

Environmental- the influence of parents, for example if they also suffer from selective mutism, can lead the children to follow these attitudes.

Genetic and physiological factors- selective mutism is often in comorbidity with SAD therefore there might be genetic factors in this condition.

 

Consequences:

The major consequence of this disorder, besides all the discomfort provoked on the child (or adult), is the interference with daily and social life since the individual is limited by their ability to deal with their emotions and overcome their anxiety.

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Treatment:

There are different approaches that can be done in the treatment of this disorder.  Some of the most common are Behavorial Therapy (through Positive Reinforcement, a technique to reinforce a stimulus subsequent to a specific attitude, and Desensitization, to lessen the intensity of an emotion), Play Therapy and Cognitive Behavioural Therapy (which changes behaviours by modifying negative situations into optimist thoughts), besides medication such as SSRI's.

Another approach is by consulting a speech-language pathologist. A few of the techniques used by this professional are:

• Stimulus fading- although it starts with a person accompanying the child, it can then slowly proceed to joining someone new, which will help the individual to confront new situations.

• Shaping- the child will receive rewards for their progresses no matter how little, such as simply mouthing or whispering, since that itself is already hard for the patients with his disorder.

• Self-modelling technique- in this technique the SLP might use videos of the child talking so they can feel more confident about the way they speak.

 

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Separation anxiety disorder

Separation anxiety disorder is an exorbitant fear or anxiety towards a separation from a figure to whom the individual is attached or home, more prominent in children.

 

Symptoms:

Besides the anxiety felt when anticipating or being physically separated from the attachment figures, the individual also feels:

• A constant concern about losing them or them being possibly harmed;

• A constant worry about an unexpected event happening to themselves, that could lead to a disengagement from them;

• A consistent hesitation to leave the attachment figure, due to the fear of separation;

• Regular dreams about separation;

•  A perpetual complaint of physical symptom when away from the attachment figure.

Note: The symptoms must last 4 weeks minimum in children and 6 months in adults

 

Causes:

Environmental- a specific loss can be an intensifier factor to the development of the disorder.  According to DSM-V, it is considered a ''loss'':

• the death of a relative or pet;

•  an illness of the individual or a relative;

•  a change of schools;

• parental divorce;

•  a move to a new neighbourhood; immigration;

• a disaster that involved periods of separation from attachment figures.

Genetic and physiological - it is estimated that this disorder can be heritable in children, with a 73% of heritability.

 

Consequences:

The perturbation can affect the individuals social, academic and/or occupational activities.

 

Treatment:

The treatment to this disorder subsists on psychotherapy and cognitive behavioural therapy (CBT), being regularly supplemented with the use of antidepressants (more specifically, SSRI's).