Anxiety

Anxiety disorders are the most commonly diagnosed type of mental illness in the United States, affecting up to 40 million American adults. Experts define different types of anxiety disorders based on the type of symptoms someone experiences and the situations that trigger those symptoms.

Common anxiety disorders include:

• Agoraphobia is characterized by anxiety that occurs when a person is in a situation that may be difficult to escape or where help might not be accessible. People with agoraphobia have intense fear in situations including being in open spaces, standing in a large crowd, or using public transportation.

• Generalized anxiety disorder manifests as excessive worry and anxiety that is out of proportion to the actual situation. Feelings of anxiety may focus on routine tasks like household chores, doctor’s appointments, or work responsibilities.

• Obsessive-compulsive disorder is a disorder in which people feel compelled to reduce their anxieties through excessive ritual and repeated behaviors, such as handwashing, counting, or cleaning, even when the person is aware the behavior is irrational.

• Panic disorder is marked by recurring panic attacks, periods of a sudden, extreme and crippling sense of mental and physical distress. Panic attack symptoms can be so disabling that people who experience them think they are having a heart attack or some other life-threatening event.

• Post-traumatic stress disorder (PTSD) occurs after a traumatizing event in which a person experienced intense physical or mental harm or was in danger of such harm. A person with PTSD may have nightmares or flashbacks about the event in response to either internal triggers, such as emotions or physical sensations, or external triggers, such as holidays, sensory stimuli, or specific locations.

• Separation anxiety disorder causes an intense fear of being physically separated from loved ones. While some separation anxiety can be normal, particularly among children, people with social anxiety disorder may persistently refuse any situation in which they are separated from a specific person, including short trips outside the home.

• Social anxiety disorder, previously known as social phobia, is a persistent fear of public social situations that may cause embarrassment, humiliation or rejection. People with social anxiety disorder will go to great lengths to avoid social situations or meeting new people.

• Specific phobia occurs when someone has an irrational and persistent fear of a certain object, environment or activity. Common specific phobias include fear of flying, fear of heights, and fear of public speaking.
  

A key characteristic of an anxiety disorder is that anxiety becomes so extreme that instead of helping a person to deal with stress, it negatively impacts the ability to cope and function in everyday life.

For example, driving slowly and cautiously on a snowy day is a normal reaction to the stress of icy road conditions. On the other hand, being so anxious about snow that a person is unable to come out of the house on a snowy day is an excessive reaction that will negatively impact a person’s life.

The symptoms of anxiety and anxiety disorders can manifest in one’s mood, behavior, thoughts and emotions. Physical symptoms can occur as well.

Typical symptoms of anxiety and anxiety disorders include:

• Diarrhea

• Difficulty falling asleep or staying asleep, or not feeling rested after sleep (insomnia)

• Feeling tense or irritable

• Excessive feelings of fear, panic, dread or alarm (known as anxiety attacks or panic attacks)

• Headache

• Muscle tension

• Nausea and vomiting

• Palpitations, chest pain, or chest discomfort

• Restlessness or excessive worrying

• Shortness of breath

• Sweating, or cold, clammy hands

• Trouble concentrating

The sensation of anxiety is the result of the body’s reaction to stress, called the fight-or-flight response. This natural defense reaction developed in early human evolution as a means to increase alertness and readiness to react to dangerous stressors, such as the threat of a man-eating predator.

When confronted with a stressor, your body reacts by releasing the chemical epinephrine, also known as adrenaline. Epinephrine produces effects that make your body better able to physically “fight or take flight” from a stressor. Effects include increased alertness and more rapid breathing and heart rate. These effects prepare the muscles with extra oxygen and energy they will need to work hard.

In the modern world, people most often experience stressors that cannot be addressed effectively by fighting or running away. However, epinephrine still circulates through the body in response to modern stressors, such as losing a job, balancing finances on a tight budget, cramming for a test, going through a divorce, or being late for an important appointment. This excessive circulating epinephrine results in symptoms that can manifest in one’s mood, behavior, thoughts and emotions. Physical symptoms also occur and do not let up until your body believes it is safe again.

Anxiety disorders are generally caused by underlying anxiety that is recurring or continuous or is at an extreme level that interferes with the ability to function effectively in everyday life. High levels of anxiety can also be caused by certain untreated underlying medical conditions, such as hyperthyroidism (overactive thyroid) and hypoxia (lack of oxygen reaching body tissues).

A number of factors are thought to increase your chances of having an anxiety disorder or are associated with anxiety. Not everyone with risk factors will develop an anxiety disorder.

Risk factors for anxiety disorders include:

• Alcohol or drug abuse

• Being a woman, child or adolescent

• Being socially isolated

• Chronic fatigue syndrome or chronic illnesses

• Family history of anxiety

• Irritable bowel syndrome

• Long-term, excessive stress

• Migraines

• Mitral valve prolapse

• Premenstrual syndrome

• Traumatic events or stressors, such as the loss of a loved one, severe illness, loss of a job, or a divorce

It is not possible to definitively prevent an anxiety disorder from developing; however, you may be able to reduce your risk of anxiety by:

• Getting enough sleep, rest and relaxation

• Not drinking alcohol or limiting alcohol intake to one drink per day for women and two drinks per day for men

• Not smoking or using recreational drugs

• Participating in a regular exercise program

• Reducing excessive stress

• Reducing or eliminating caffeine

• Regularly participating in leisure activities or other activities you enjoy

• Seeking regular medical care and following your treatment plan for short-term and chronic illnesses

If you have already been diagnosed with an anxiety disorder, these steps can also help you manage symptoms and improve your likelihood of successful treatment.

No diet can cure anxiety, but certain types of foods can make symptoms better or worse. Generally, eating a balanced, nutritious diet improves both your physical and mental health, and increases the likelihood of finding effective treatment for many chronic conditions.

Some diet and nutrition tips for people with anxiety include:

• Avoiding or limiting alcohol, which may feel relaxing when first consumed, but can interfere with sleep and increase feelings of anxiety

• Avoiding or limiting caffeine, which increases feelings of jitteriness and can disrupt sleep routines

• Avoiding refined sugars and simple carbohydrates, which create unsteady blood sugar levels and energy crashes

• Drinking plenty of water to avoid dehydration

• Eating complex carbohydrates, such as whole-grain breads, quinoa, or oatmeal, which digest slowly and keep blood sugar levels steady

• Not skipping meals, as missed meals can result in sudden drops in blood sugar

• Starting the day with a breakfast that includes protein, which helps keep blood sugar steady

Talk to your doctor before making any major changes to your diet, especially if you have other chronic conditions such as diabetes or heart disease.

People with anxiety disorders often have a co-occuring mental disorder or physical condition that may or may not be directly related to their anxiety. However, these comorbidities can worsen anxiety symptoms and make treatment more difficult.

Conditions that may occur with anxiety disorders include:

• Adult ADHD (attention-deficit/hyperactivity disorder)

• Body dysmorphic disorder

• Chronic pain

• Depression

• Eating disorders

• Fibromyalgia

• Headache

• Hoarding disorder

• Irritable bowel syndrome (IBS)

• Sleep disorders

• Substance abuse disorders

If you are living with anxiety disorder along with any of these conditions, talk to your doctor and care teams about all of your symptoms so you can work together to develop a treatment plan that addresses all facets of your physical and mental health.

There is no specific test to diagnose anxiety. Your doctor will evaluate certain factors, including your symptoms, medical history, behavioral assessment, sleep inventory, and a physical exam to determine an anxiety disorder diagnosis.

Because anxiety symptoms can result from a variety of conditions, your healthcare provider likely will first rule out any possible underlying causes of your anxiety. Asthma, COPD (chronic obstructive pulmonary disease), diabetes, hyperthyroidism (overactive thyroid), lupus, schizophrenia, and sleep apnea all have been linked to feelings of anxiety. Some medications, including certain drugs for Parkinson’s disease, rheumatoid arthritis, and psoriasis, can also cause anxiety symptoms.

Along with performing a physical exam, your doctor will ask you questions about your symptoms and medical history.

Questions your provider may ask include:

• What symptoms have you been experiencing? How long have you had these symptoms?

• Have you been diagnosed with any other conditions, both physical and mental?

• Do you have a family history of anxiety disorders or other mental illnesses?

• What medications are you currently taking?

• Have you recently experienced or witnessed any trauma or did you as a child? Are you going through a stressful time now?

Your healthcare provider may also order blood tests to rule out underlying conditions that may be causing symptoms of anxiety.

If your doctor does not identify signs of a physical illness, he or she will likely refer you to a psychologist or psychiatrist for further evaluation. These specialists are trained to identify and diagnose mental health conditions through personal interviews, assessment tools, and consultation of the guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The overall treatment goal for people living with excessive anxiety or anxiety disorders is to feel better and live normal, functional and productive lives. The first step to addressing excessive anxiety or an anxiety disorder is to diagnose and treat any underlying medical conditions, such as hyperthyroidism or hypoxia, which can cause anxiety.

There are many ways to address and reduce, even eliminate, the symptoms of anxiety. Taking inventory of stressors and developing strategies to cope with or eliminate them is an important approach.

For example, you can increase activities that help you relax or reduce anxiety, such as taking a quiet walk, getting a massage or spa treatment, or enjoying social gatherings with friends. The most important thing is to recognize what helps you to reduce anxiety and to ensure that you incorporate it regularly into your life.

Treatment of anxiety or anxiety disorders may include:

• Complementary or alternative treatments, such as acupuncture, massage therapy, tai chi, and yoga may help to reduce stress, produce a calm state, clear the mind of anxiety-producing thoughts, and improve overall well-being. Complementary treatments are not meant to substitute for full medical care.

• Regular exercise may allow the muscles to use and “work off” the body’s buildup of stress-induced epinephrine, which can produce symptoms of anxiety, such as irritability and muscle tension.

• Psychotherapy (talk therapy) is when a psychotherapist builds a relationship with a client, establishes trust, and helps the client address anxiety through such techniques as communication and behavior therapy. These techniques can help you to recognize and work through situations and thought patterns that trigger anxiety, and can teach you more effective patterns of thinking, behaving and coping.

• Regular follow-up care is very important to help monitor your treatment and progress and to promptly address any problems, medication side effects, or complications.
  

Medications may be used in combination with other treatments to treat anxiety and anxiety disorders. Commonly prescribed medications include:

• SSRIs, selective serotonin reuptake inhibitors, such as Prozac, Paxil and Zoloft
  
• SNRIs, serotonin and norepinephrine reuptake inhibitors, such as Effexor
  
• Benzodiazepines, such as Ativan and Xanax
  
• Tricyclic antidepressants, such as Tofranil

If you experience troublesome side effects while on medication for anxiety, do not stop taking the medication on your own. Talk to your doctor about other treatment options and the most effective way to transition to a new medication or therapy.

By definition, an anxiety disorder has a significant, intrusive, and often debilitating impact on a person’s daily life. Symptoms of anxiety disorders prevent many people from holding steady jobs, traveling to new places, socializing with friends, or even leaving the house for simple errands. This can result in financial instability, social isolation, and poor overall health.

Fortunately, treatment is often very effective in helping people with anxiety disorders not only function, but lead thriving, fulfilling lives. Along with your doctor’s prescribed treatment plan—including medication, talk therapy, or a combination of the two—you can take steps to manage your anxiety symptoms throughout the day.

Coping tips for living with anxiety disorders include:

• Being aware of your thoughts, particularly negative feelings like racing thoughts, rumination or catastrophizing, and learning to reframe these thoughts

• Eating a healthy, balanced diet focused on foods that keep blood sugar levels steady throughout the day

• Exercising regularly, which naturally increases serotonin to improve mood, encourages better sleep, and builds overall physical health

• Getting quality sleep by establishing a nightly sleep routine and making rest a priority

• Keeping a journal of your symptoms and identifying situations that trigger anxious thoughts

• Practicing meditation and mindfulness to help relax yourself both physically and emotionally

• Seeking out support groups, both online and in person, where you can share experiences and coping strategies with others like you

• Taking time for self-care with activities you enjoy, such as watching funny videos, cooking a new recipe, or listening to soothing music

• Using breathing exercises to calm anxious thoughts and regain control of your response to certain situations

Complications of anxiety or an anxiety disorder can be serious and even become life-threatening in some cases. You can minimize the risk of serious complications of anxiety or an anxiety disorder by following the treatment plan you and your healthcare professional design specifically for you.

Complications of anxiety include:

• Decreased ability to function in work, school or daily life

• Decreased sexual desire

• Depression

• Disability

• Migraine headaches, backaches, and other chronic pain

• Poor quality of life

• Sleep disturbances

• Suicidal thoughts or actions

• Worsening of symptoms of chronic diseases

Seek immediate medical care (call 911) if you or someone near you is expressing suicidal thoughts or threatening to harm themselves or others.