In our current-day society, adaptive anxiety can serve as an alert signaling a serious or threatening situation; a call to action and the avoidance of physical or emotional harm. Examples of anxiety provoking situations are high noise levels, several people giving orders at the same time, or being on overload with many confronting tasks. Feeling anxious in the example situations signals a need for action: getting the noise level low and under control, stopping too many people from speaking to you at one time, and taking a deep breath and prioritizing the tasks at hand so they can be more easily managed. So, anxiety is normal or adaptive when it serves as a signal or as an emotional response to a perceived threat.

Fear is similar to anxiety in that the emotional and physiological states are very similar experiences. They feel the same to the person who is having the experience. But, fear is different from anxiety in that fear is a response to a threat that is known, external, and definite in origin. For example, an oncoming truck presents a serious and very real threat, a threat about which immediate action is necessary in order to avoid physical harm. You would know that being in the path of an oncoming truck presents a real and definite possibility of being hit by that truck without immediate action.

An upcoming social event where there will be new and unfamiliar people can generate a high level of anxiety for some people. Attending such a social event does not constitute a “real” threat even though there can be high levels of anxiety at the thought of such an event. That high level of anxiety signals as though there were a “real” threat and that feeling is experienced as fear although it does not fit the criteria for fear: there is not a known threat, there is not an external threat present, and there is not a definite origin of threat.

However, fear can lead to anxiety. For example, a confrontation with a growling and barking dog in childhood would elicit a fear response from the child being attacked. The initial fear in that situation could persist in the presence of any dog even when there is not a "real" and definite threat in the situation. This persistence is an anxiety response.

Anxiety has been divided into three categories:

• general anxiety

• phobias

• panic disorders


General Anxiety

General anxiety is also called “free floating anxiety”. As the word general indicates, the feelings of anxiety are not related to particular events or situations throughout the day. The turmoil of anxiety is present in varying degrees consistently. It is not always clear to the person experiencing general anxiety the exact source of the anxiety. Because the source of the anxiety is not discernible or identifiable, there is anxiety about the anxious feelings and a vicious cycle begins where anxiety feeds off of itself. The person is just aware of feeling anxious. In this case, the anxiety takes on a life of its own and blossoms into a general state of anxiety.


Anxiety Disorders

“Normal” anxiety is brief and mild and is usually precipitated by a stressful event such as going on a job interview, public speaking, preparing for a vacation, etc. Feelings of anxiety prompt one to cope and take the necessary steps to deal with pressing or stressful situations. Normal anxiety will disappear when the stressful situation is either under control or the situation has ended. An anxiety disorder is likely present when anxiety continues beyond the time frame of the stressful event or situation. But when anxiety increases to the point of interfering with day-to-day functioning causing dread over everyday situations, anxiety has become a disabling disorder.

Anxiety disorders plague about 40 million Americans 18 years of age and older causing fearfulness and uncertainty beyond the “normal” anxiety levels. Unlike the relatively mild feelings of anxiety, caused by a stressful situation or event, anxiety disorders last at least six months and continue to get worse.

Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse. Alcohol and drug use might temporarily mask anxiety symptoms but when the feelings of anxiety emerge, those symptoms will feel more intense and out of control. This cycling of anxiety, uncertainty, and fearfulness temporarily tempered by the use of alcohol or drugs is a major contributor to addiction. The individual using alcohol or drugs to make stressful situations more bearable is at risk for addiction at which point there is more than one disorder to deal with.

As stated above, other physical or mental illnesses might be present along with anxiety. It is important that any physical or mental illness be treated before a person will respond to treatment for the anxiety disorder.

Effective therapies for anxiety disorders are available, and research is uncovering new treatments that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment right away because left untreated, anxiety can become worse.


The five major types of anxiety disorders are:

Generalized Anxiety Disorder (GAD)

Obsessive-Compulsive Disorder (OCD)

Panic Disorder

Post Traumatic Stress Disorder (PTSD)

Social Phobia or Social Anxiety Disorder


Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and uncontrollable worry that persists more often than not for a period of at least six months and at least three of the following six symptoms are present:

• restlessness or feeling on edge

• fatigue

• poor concentration• irritability

• muscle tension

• insomnia


When symptoms interfere with normal functioning and are not due to alcohol or drug abuse, physical illness, or another psychiatric disorder, the individual is likely to be experiencing Generalized Anxiety Disorder.

"I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go.""I'd have terrible sleeping problems. There were times I'd wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were: when I got a stomach ache, I'd think it was an ulcer."

People with Generalized Anxiety Disorder go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke that level of anxiety. They anticipate disaster and are overly concerned about situations such as health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day can produce anxiety. Again, this excessive level of anxiety symptomatic of an anxiety disorder; worry, feeling out of control, and tension, are exaggerated and can be crippling and incapacitating.

GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. People with GAD can't seem to get rid of their concerns, can’t seem to quiet the unnerving feelings, even though they often realize that their anxiety is more intense than the situation warrants.

They can't relax; they startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Their minds are going constantly during this awakened period. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, light headedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.

When their anxiety level is mild, people with GAD can function socially and hold down a job with successful treatment. Although individuals with GAD don't always avoid certain situations they can have difficulty carrying out the simplest daily activities when their anxiety is severe.

GAD affects about 6.8 million adult Americans. Twice as many women are affected as men. The disorder comes on gradually which makes seeking treatment early when the symptoms begin. GAD can begin at any time in the life cycle, though the risk is highest between childhood and middle age. GAD is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems that might or might not be considered stressful. There is evidence that genetics can play a modest role in GAD. High levels of anxiety in response to stress can also be learned through modeling and learning high level anxiety responses from family members. One such situation is the fear of spiders or of mice. Chances are the parent of a high level anxiety responder also deals with the stress in a similar manner.

Other anxiety disorders, depression, and/or substance abuse often accompany GAD. GAD occurs alone and is commonly treated with medication or cognitive-behavioral therapy. It is important to note that co-occurring conditions must also be treated using the appropriate therapies to obtain a successful outcome in the treatment of GAD.


Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder. The essential feature of obsessive-compulsive disorder is the symptom of recurrent unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions) adequately severe enough to cause distress to the individual. Both the obsessions and the compulsions are time consuming and significantly hinder normal daily routines, occupational functioning, relationships, and usual social interaction.

A person with obsessive-compulsive disorder could have either obsessions, compulsions, or both. An obsession is an obtrusive thought, feeling, idea or sensation. An obsession is a mental event compared with a compulsion which is a conscious, standardized, ritualized, and recurrent behavior such as counting, checking, or avoiding. An obsession with germs might foster the repetitive pattern or compulsion of hand washing. An obsession with intruders might begin the ritual of repeatedly checking to ensure that a door is locked. Such compulsive behaviors are carried out in an attempt to reduce or avoid the feelings of anxiety due to obsessive thoughts.

Performing rituals and repetitive behaviors may or may not be successful in reducing anxiety levels or quelling anxiety producing thoughts and may increase that anxiety level. The compulsive behavior often controls the person not the anxiety related to obsessive thoughts. The person with OCD realizes the obsession or compulsion is irrational and is often successful at hiding the compulsive behaviors.

"I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a 'bad' number."

"I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy."

"Getting dressed in the morning was tough, because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me."

There have been few studies of genetic influence on obsessive-compulsive disorder but there are some cases where heredity has played a role. But there is not a distinct genetic probability.

Obsessions and compulsions share certain features:

• a thought or an impulse to act imposes intensely and persistently into the individual’s awareness

• a feeling of anxious dread accompanies the intrusion and the individual usually resists the initial thought or impulse

• the obsession or compulsion is experienced as something foreign to the person

• regardless of how vivid or compelling the obsession or compulsion is, the person is aware of how illogical and irrational it is

• the individual suffering from obsessions and compulsions feels a strong desire to resist them

There are four symptom patterns that are most commonly exhibited in obsessive-compulsive disorder. The most common is an obsession with contamination followed by washing. The feared object is usually difficult to avoid as most are common in everyday life such as feces and urine. Individuals will scrub the skin off their hands in an attempt to lessen the anxiety over contamination.

The second most common symptom pattern is an obsession of doubt followed by the compulsion to keep checking. The obsession often implies a threat of violence. For example, the individual has an obsession of intruders breaking into the house, the compulsion to go back many times into the house to check the window locks or door locks. If the obsession is forgetting to turn the stove off, the compulsion is to return to the house many times to check the stove.

A less common symptom pattern in obsessive-compulsive disorder is the presence of intrusive thoughts, obsessions, without the presence of a compulsion to act. Such obsessions are repetitious and often sexual or aggressive in nature.

There is a manifestation of obsessive-compulsive disorder where the obsession and the compulsion are exhibited as one. For example, obsessive slowness where the person can take hours to eat dinner or shave their face.


Panic Disorder and Agoraphobia

Psychological and emotional disorders are complex disorders that more often than not have overlapping symptoms. Panic disorder and agoraphobia are two such anxiety disorders. Both can occur together or both can be stand-alone diagnoses in a given current situation. Mental health professionals are trained in differentiating one disorder from another and determining pre-conditions that might have precipitated a current condition of panic disorder.

Panic disorder and agoraphobia are often coupled because of the widespread belief that people diagnosed with agoraphobia have had a preexisting panic disorder. For example, an individual might have a high level of anxiety while standing in a crowded area. There might be a good reason for the anxiety or the anxiety might be a general anxiety response particular to the fears of the individual. This level of anxiety is less severe and is a signal to deal with feelings of fear or a realistic threat.

The next time the person is (1) about to enter a crowded room and (2) remembers the anxiety in the previous crowded situation, there is a setup for an initial panic attack. The panic attack might not be a full blown attack, but the physical and emotional components of such an attack can feel like a serious life threat. (See symptoms of a panic attack).

After one or two panic attacks the primary fear becomes the fear of having another panic attack or more panic attacks and that fear can cause the individual to avoid crowds, public events, crowded stores, the possibility of a crowd at a bank, etc.


Panic Disorder

Panic disorder is an anxiety disorder characterized by repeated and unexpected episodes of intense fear accompanied with sometimes severe physical symptoms. There are two major types of panic disorder – with and without agoraphobia. In order to arrive at a diagnosis of panic disorder, physical ailments must first be ruled out because some of the symptoms of panic disorder mimic organic, or physical conditions such as mitral valve prolapse. That does not mean, however, that mitral valve prolapse cannot coexist with panic disorder. Also, because there are no exclusion criteria for the existence of other psychiatric disorders, a disorder such as depression might also be present.

Some research has indicated that panic disorder appears when there is not any psychosocial provocation; clinical data argues that the number and level of psychosocial stressors was at an increased level preceding the onset of panic disorder. The onset of panic disorder is usually preceded by one or more panic attacks. Patients are usually not overly alarmed after one or two panic attacks but as the frequency and intensity of the attacks increase, concern and fear of another occurrence become a major concern.

Anxiety attacks and panic attacks are due to a less than adequate defense against anxiety-provoking circumstances and events which can vary from one person to another. For example public speaking is an anxiety producing event. Some people can function through the anxiety of giving a public speech while others may not have adequate defense mechanisms in place to handle the high level of fear and anxiety.

Feelings of high anxiety can and often do come before the initial panic attack. This initial and less-severe period of anxiety can develop into panic disorder as overwhelming feelings or apprehension and terror become more intense and frequent. The first panic attack can appear to be spontaneous and unrelated to an event or a particular situation, but more likely a panic attack results from a period of high agitation, excitement, or mild emotional trauma. They may also be rooted in a threatening or severe experience in childhood that may or may not be remembered as an adult. Some childhood experiences do not appear to be related to anxiety attacks, panic attacks, or other anxiety disorders. The adult simply compartmentalizes childhood experiences and does not relate traumatic childhood experiences as a predisposition for high levels of anxiety and/or panic attacks.


Symptoms of Panic Disorder

The following table of diagnostic criteria for panic disorder are taken from the DSM:

* At some time during the disturbance one or more discrete periods of intense fear or discomfort (panic attack) have occurred that were (1) unexpected and (2) not triggered by situations in which the person was the focus of others’ attention

* Either four attacks, as described above, have occurred within a four-week period, or one or more attacks have been followed by a period of at least a month of persistent fear of having another attack

* At least four of the following symptoms developed during at least one of the attacks:

1. shortness of breath or smothering sensations

2. dizziness, unsteady feelings, or faintness

3. palpitations or accelerated heart rate

4. trembling or shaking

5. sweating

6. choking

7. nausea or abdominal distress

8. depersonalization or derealization

9. numbness or tingling sensations

10. flushes or chills

11. chest pain or discomfort

12. fear of dying

13. fear of going crazy or of doing something uncontrolled

* During at least some of the attacks, at least four of the above symptoms developed suddenly and increased in intensity within 10 minutes of the beginning of the first symptom noticed in the attack.

* It cannot be established that an organic factor initiated and maintained the disturbance. For example: amphetamine or caffeine, intoxication, hyperthyroidism.

The increase of intensity and frequency then trigger more fear and anxiety and the cycle can become self-perpetuating developing into panic disorder replete with mental, emotional, and physical symptoms.

Panic disorder can be debilitating due to disruption of interpersonal relationships, job function, and social activities.

The major symptoms of panic disorder are spontaneous, intense, and intermittent periods of anxiety that usually last less than an hour. These periods of anxiety can occur more or less than twice weekly.

People who are diagnosed with panic disorder usually experience agoraphobia as well.


Agoraphobia