From the early days of humanity, whenever an individual faced any incoming danger, the body went into fight-or-flight mode, setting alarms. These alarms become prominent in the form of an increased heartbeat, sweating, and heightened sensitivity to surroundings. Such feelings of anxiety helped humans in dealing with a potential threat and in moving to safety.

However, when a person feels excessive levels of anxiety regularly, it can become a medical disorder.

What is Anxiety?

The American Psychological Association (APA) describes anxiety as – “An emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” When individuals sense uncertain danger, they switch to a mental state of both distress and arousal. 

It’s a reaction encompassing both cognitive elements – anxiousness or feelings of dreadfulness anticipating some future bad outcome and physical sensations, like jitteriness and racing heartbeat. According to the National Institute of Health, nearly one-third of adults in the U.S. at some point in their lives, face anxiety, and the condition is more prevalent in women than men. 

Anxiety disorders can manifest in different ways, and each is often diagnostically distinct. General anxiety disorder is a chronic state of severe worry and tension, often without any provocation. It can escalate to episodes of intense fear, behavioral changes, and even accompanied by depression (in cases of underlying trauma or genetic architecture). 

Types of Anxiety

Earlier, Obsessive-Compulsive Disorder (OCD)- compulsive behavior to carry out a specific action, such as handwashing and Post-Traumatic Stress Disorder (PTSD) – an anxious feeling developed after experiencing or witnessing a traumatic event, were considered as a part of anxiety disorder. Now, these mental health difficulties have been identified separately and not under anxiety disorders.

The Diagnostic and Statistical Manual of Mental Health Disorders: Fifth Edition (DSM-V) has classified anxiety disorders into different categories. 

Generalized Anxiety Disorder (GAD): 

GAD is a chronic disorder that involves excessive long-lasting anxiety and worries that interfere with daily activities. Often it is about nonspecific life events, job responsibilities, objects, and situations. 

In some cases, it might also be accompanied by physical symptoms, such as restlessness, feeling on edge, fatigued, difficulty concentrating, muscle tension, or problems sleeping. It is the most common anxiety disorder that people always find difficulty identifying the cause of their anxiety.

Panic Disorder: 

The main characteristic of panic disorder is sudden attacks of intense terror and an overwhelming combination of physical and psychological distress. They are recurring in nature and might last for hours. The intensity escalates rapidly after occurring and peaks after 10 minutes. 

An individual might experience several of these symptoms in combination with a panic attack.

• Increased palpitations or rapid heart rate
• Sweating
• Shaking
• Choking sensations or feeling of shortness of breath 
• Chest pain
• Dizziness
• Numbness or tingling sensation
• Chills or hot flashes
• Nausea
• Feeling detached
• Fear of losing control
• Fear of dying

Frightening experiences or prolonged stress can usually trigger the panic disorder, but it may also occur without any specific triggers. Many people often misinterpret it as symptoms of a life-threatening illness like heart attack and might also visit the ER. Some even make drastic changes in their behavior to avoid such future attacks. The average age of panic disorder onset is 22-23, and it may occur with other mental disorders like PTSD and depression.

Phobias & Specific Phobia: 

Unlike other anxiety disorders, phobias relate to specific causes. It is an irrational, excessive, and persistent fear of an object, situation, or activity that might not be harmful in reality. A person with a phobia fails to control the feelings of anxiety around the trigger. 

Even if they know their fear is illogical and excessive, they cannot overcome it. The trigger can be anything ranging from situations and animals to everyday objects like fear of water, fear of spiders, fear of flying, or fear of darkness. 

Agoraphobia: 

Agoraphobia is an often misunderstood psychological disorder that deals with the fear of being in difficult escaping or embarrassing circumstances or situations where help might not be available in the case of panic symptoms. The person begins to fear and avoid places, events, or situations in which they can get trapped. The unrealistic fear, in contrast to the actual situation, can generally last six months or more.

Those having agoraphobia often experience fear in two or more situations like 

• Using public transportation
• Being in open spaces
• Being in enclosed places like elevators
• Standing in line or moving in a crowd
• Fear of leaving home or being outside alone

Such individuals require a companion to confront the intense fear or anxiety or actively avoid the situation. Untreated agoraphobia might make a person unable to leave the house. It gets diagnosed only when the fear significantly interferes with daily activities.

Social Anxiety Disorder, or Social Phobias: 

People with social anxiety disorder fear negative judgment from others in a social environment. They significantly feel anxiety and discomfort in social interactions about being embarrassed, humiliated, rejected, or looked down on. 

People with this disorder will try to avoid social gatherings and situations that cause them anxiety. Some common social phobia instances are extreme fear of public speaking or stage fright, meeting new people, eating/drinking in public, etc. When left untreated, a person can avoid public situations and human contact to the point that everyday living becomes immensely tricky. 

Selective Mutism: Some children can experience selective mutism – an inability to speak in certain places or contexts like school, even if they have excellent verbal communication skills around people familiar to them. It is an extreme form of social phobia. 

Separation Anxiety Disorder:

When a person experiences excessive fear or anxiousness to separate from a person or a place that provides them feelings of security or safety, it may be due to separation anxiety disorder. If this feeling is beyond the appropriate age limit of a person (four weeks in children and six months in adults) and causes problems functioning, it is best to reach out to professional help.

Under this situation, the fear of losing the person closest to them always bothers them. They remain reluctant to go out or sleep away from home or without that person. They might even experience nightmares about separation resulting in panic symptoms.  

Causes

There is no single definitive cause for anxiety disorders. It’s mostly a combination of factors, like genetic, environmental, psychological, and other developmental. Most anxiety disorders occur at once; while some may lead to others, some might not unless another significant factor is present first.

The complicated network of causes for an anxiety disorder:

Environmental Factors: 

Various elements in the environment around a person can cause stress buildup, leading to anxiety disorder like 

• Personal relationship issues
• Family issues
• A work environment or job-related issues, loss of job
• Issues at school
• financial predicament

Even hypoxia (low oxygen levels in the body due to exposure to high-altitude areas) can add to anxiety symptoms.

Genetics or Biological Factors:

People who have family members (blood relations) suffering from anxiety disorders are more likely to have themselves. Those with a complicated health condition or serious illness can feel stressed about treatment and the future, leading to anxiety disorder.

Medical Factors: 

Side effects of medication, symptoms of a disease, lifestyle adjustments, and pain or restricted movement from disease can cause anxiety disorders.

Psychological Factors or Brain Chemistry:

Children exposed to abuse or traumatic experience are more likely to develop anxiety disorders in adulthood. Even adults experiencing traumatic events or the death of a family member can experience an anxiety disorder. 

Psychologists and neurologists also believe that even some personality types, mental health conditions like depression, and mood disorders due to disruptions in hormones and electrical signals in the brain can cause anxiety disorders. 

Use of or Withdrawal from Unauthorized Substance Abuse:

Drug, alcohol, and substance use or misuse and withdrawal symptoms can also lead to anxiety disorders in a person. 

Symptoms

People with anxiety disorder often worry excessively and uncontrollably. The symptoms of anxiety show itself in both mind and body. When a person perceives a threat (whether real or imagined), the amygdala in the brain signals the hypothalamus – a central command center, broadcasting it further through the autonomic nervous system and sets off a cascade of hormones, including adrenaline. 

Adrenaline further stimulates multiple physical symptoms of anxiety, like increased heart rate, pulse rate, and blood pressure. It also accelerates the breathing of a person, making them feel shortness of breath. The other physical symptoms include 

• Dizziness
• Muscle tension
• Trembling or shaking
• Dry mouth
• Sweating
• Stomach ache
• Headache
• Difficulty concentrating
• Irritability
• Being easily fatigued
• Sleep disturbances

How to recognize the signs of anxiety and understand when it needs treatment?

Today, most anxieties revolve around work, money, family life, health, and other crucial issues that demand an individual’s attention without the ‘fight-or-flight’ reaction. However, circumstances can make people feel restless, on edge, and irritable. 

Most people suffer from Generalized Anxiety Disorder (GAD) and excessively worry, irrationally believing that the worst-case scenario is inevitable. If you see at least three physical signs, apart from excessive, uncontrollable worry, then consider it the criterion for clinical diagnosis.

Treatment

The treatment of anxiety disorders is done successfully with a combination of psychotherapy, behavioral therapy, and medication. If an anxiety disorder is due to alcohol dependence, depression, or other conditions that affect mental well-being, get it under control first before undergoing an anxiety disorder treatment. 

Self-Treatment

In some cases, you can treat anxiety disorders at home without clinical supervision, but it is not useful for those with severe or long-term anxiety conditions. Self-treatment includes several exercises and activities that help a person cope with milder, more focused, and shorter-term anxiety disorders. 

Stress Management: 

Learning to manage stress, identify the triggers, organize any upcoming pressure or deadline, and take time off from work or study can help limit potential anxiety attacks. 

Adopting Relaxing Activities:

Meditation, yoga, deep breathing exercises, long-relaxing baths, and resting in the dark are some of the relaxing activities that a person can adopt to deal with routine anxiety issues. 

Positive Thought Exercises:

It is a process of replacing negative thoughts with positive ones. A person begins by making a list of all negative thoughts that cause anxiety and then moves on to write believable positive ones next to it, replacing them. It helps in creating a positive mental image of successfully conquering the fear or phobia, causing anxiety.  

Support Group Services:

Talking to a friendly, supportive person like a friend or a family member and joining a support group that might be available locally or online can help cope with anxiety.

Physical Exercise:

It can improve a person’s self-image and enable the release of chemicals in the brain that triggers positive feelings. 

Psychotherapy:

A variety of trained professionals like psychiatrists, psychologists, social workers, or licensed counselors perform psychotherapy. It encompasses many kinds of treatment. An anxiety disorder patient and therapist work together collaboratively, examine, and gain insight into life choices and difficulties faced by individuals, couples, or families.

The goal is to work together and bring identifiable improvement and positive change over time in the patient. 

Counseling:

Psychological counseling is also a part of the therapy used for treating anxiety. Psychiatrists, psychologists, or licensed counselors use it to understand the anxiety triggers, emotional distress, and mental health problems. It can include cognitive-behavioral therapy (CBT), psychotherapy, or a combination of it, for providing life-changing benefits to a patient.

Cognitive-behavioral Therapy (CBT):

It is a psychotherapy that works towards reconstructing dysfunctional emotions, behaviors, and thoughts by questioning and uprooting negative or irrational beliefs. It aims to recognize and change harmful thought patterns that cause anxiety disorders in a person.

For example, a psychotherapist giving CBT to a person for panic disorder will attempt to strengthen the facts about panic attacks and show how it was not a heart attack to deal with his health anxiety. 

Exposure Therapy:

It is a form of CBT, wherein trained professionals allow the patients to safely and gradually get exposed to their fears and phobia causing anxiety. It reduces the fear and anxiety response towards it and enables them to become less sensitive over time. Such therapy has been found highly useful in cases of obsessive-compulsive disorder (OCD) and phobias.

Medications

Medications support people with anxiety management, but they do not cure the underlying condition. 

Fast-acting Benzodiazepines help for a limited period, but they can be highly addictive. Some commonly prescribed Benzodiazepines like Diazepam, or Valium, have side effects like drowsiness and even possible dependence. 

Beta-blockers also offer short-term relief as they help with anxiety symptoms, like racing heartbeat or trembling hands for a specific event. 

Antidepressants, like selective serotonin reuptake inhibitors (SSRIs), help with anxiety and target depression but likely cause jitters, nausea, and sexual dysfunction when treatment begins. 

Tricyclics, older than SSRIs, are used as long-term treatment as it takes a few weeks or months to work. But, these also cause side effects like dizziness, drowsiness, dry mouth, and weight gain.

It is always prudent to immediately seek medical advice if any adverse effects occur due to prescribed medications.

Ways to Manage Anxiety

Lifestyle changes and habits like exercising, sleeping well, eating nutritious food, and limiting caffeine intake, alcohol consumption can help with anxiety issues. 

Some researchers arguably give value to mindfulness meditation in managing anxiety. Taking deep breaths and witnessing one-another thoughts without judgment can reduce feelings of tension. 

Identifying the anxiety triggers; and pushing against irrational anxious thoughts can help manage anxiety better, making one feel adequately prepared for the future.