Article | March 2018

Anxiety Disorders

Information from the National Alliance for Mental Illness (NAMI)

What are anxiety disorders?

Everyone knows what it's like to feel anxious. Have you felt butterflies in your stomach before a first date? Or jitters before giving a speech? Maybe you've had sweaty palms or a racing heartbeat during challenging or dangerous situations. These feelings are normal. But what if you felt anxious most of the time? What if you couldn't even find a reason for feeling this way? What if you found yourself avoiding everyday routines or activities? What if you became paralyzed by your own nervousness? This is what life is like for people who suffer from anxiety disorders. These are mental illnesses based in biology. Let's learn more about the different types of anxiety disorders.

What are the different types of anxiety disorders?

Panic disorder

People who suffer from panic disorder have panic attacks. Panic attacks are instances of extreme fear or discomfort. They start suddenly and build to a peak, usually within ten minutes. Panic attacks come with physical symptoms, like:

  • Heart palpitations
  • Sweating
  • Trembling
  • Shortness of breath
  • The feeling of choking
  • Chest pain
  • Nausea
  • Dizziness
  • Disorientation
  • Fear of losing control or dying
  • Numbness
  • Chills
  • Hot flashes

Panic attacks usually come with a sense of looming danger and the strong desire to escape. Attacks can be brought on by specific triggers or can come out of the blue. The frequency of attacks varies person to person.

To be diagnosed with panic disorder, you must have:

  • Panic attacks followed by at least one month of steady worry about having more attacks,
  • Concern about why the attacks have happened and what they mean (fears of having a serious physical illness or "losing one's mind" are common), or
  • A significant change in behavior brought on by the attacks (many feel the need to avoid or remove themselves from certain situations or places).

Panic disorder is diagnosed more often in women than in men. Age of onset varies, but it most often appears between the late teens and mid-thirties. Up to half of those with panic disorder also have agoraphobia.1

Phobias

Phobias are exaggerated, involuntary, and irrational fears. Phobias are fears of certain situations or things. They're usually generally divided into three separate types: specific phobias, social phobia, and agoraphobia.

  • Specific (or simple) phobia: This type is brought on by a specific object or situation. Common phobias include flying, heights, needles, or snakes. Specific phobias are generally more common in women than in men. They usually first appear during childhood.
  • Social phobia (social anxiety disorder): Social phobia is limited to social situations. It involves extreme fear of meeting new people. People with social phobia are afraid of being embarrassed, humiliated, or judged by others. It's equally common among men and women. It usually first appears in the mid-teens. And it's more common in people who were shy as children. To be diagnosed with specific or social phobia, you must meet three criteria. Exposure to the feared object or situation must induce anxiety. You must recognize that your fear is irrational. And your phobia must be disruptive to your lifestyle.
  • Agoraphobia: People with agoraphobia have an intense fear of being trapped. Or they fear not being able to find help if they have a panic attack. This phobia is often triggered by large crowds or being alone in an open area. People with agoraphobia often avoid these situations.

Obsessive-compulsive disorder (OCD)

OCD is characterized by obsessions and compulsions. Obsessions are intrusive thoughts, impulses, or images that run through one's mind. Compulsions are repetitive behaviors that one feels they must do. Common obsessions include:

  • Fear of contamination
  • Fixation on lucky or unlucky numbers
  • Fear of danger to oneself or others
  • Need for order or exactness
  • Excessive doubt

The most common compulsions done in response to these obsessions include:

  • Ritualistic handwashing
  • Counting
  • Checking
  • Hoarding
  • Arranging

Most people experience these thoughts and behaviors at some times. OCD is diagnosed when these symptoms are felt for more than an hour each day. Symptoms must interfere with one's life or cause great anxiety. OCD is equally common in males and females. But it often appears earlier in males. OCD may start in childhood. But it most often appears in adolescence or early adulthood.2

Posttraumatic stress disorder (PTSD)

PTSD is caused when one experiences trauma. This trauma is often a violent or tragic event. The experience results in feelings of intense fear, helplessness, or horror. Events that can lead to PTSD include rape, war, natural disasters, abuse, and serious accidents. It's common to feel anxious or depressed for a time after trauma. But those with PTSD continually relive the traumatic event. They may have nightmares, hallucinations, or flashbacks. They might avoid all things related to the event. And they might show increased arousal (e.g., difficulty sleeping, irritability, difficulty concentrating, extreme alertness, or jumpiness).

Those diagnosed with PTSD have symptoms for longer than one month. They're unable to function as they did before the event. PTSD usually appears within three months of the trauma. But sometimes it can appear months or even years later. PTSD can occur at any age.

Acute stress disorder is similar to PTSD. Acute stress disorder also appears after a stressful event. And it has similar symptoms. There are two main differences. People with acute stress disorder show more dissociation. They feel detached; they withdraw from reality, or may even have amnesia. And acute stress disorder is only diagnosed if the disturbance happens within four weeks of the trauma. It must last at least two days and no more than four weeks.

Generalized anxiety disorder (GAD)

People with GAD feel anxious about everyday activities. Their anxiety is hard to control. It causes issues in work and social settings. Physical symptoms include:

  • Edginess
  • Fatigue
  • Trouble concentrating
  • Irritability
  • Muscle tension
  • Sleep problems

A GAD diagnosis requires you to feel excessive anxiety most days for six months or longer. Most people with GAD say they've felt anxious for their entire lives. The disorder is often first seen in childhood or adolescence. However, adult onset of the disorder is not uncommon.

Other anxiety disorders

Sometimes anxiety is caused by a medical condition or substance use disorder. Some people show certain signs of anxiety disorders without meeting all the criteria for diagnosis.

Anxiety Frequently Asked Questions

How common are anxiety disorders?

Anxiety disorders are the most common mental illnesses in the United States. More than 20 million Americans (about one in nine) are affected each year.3

Are anxiety disorders associated with other disorders?

Yes! It's very common to have more than one anxiety disorder. People with anxiety disorders often suffer from depression, substance-related disorders, and or eating disorders. Over half of those with panic disorder or OCD have depression too.4

What causes anxiety disorders?

Several factors seem to cause anxiety disorders. Research suggests that these disorders run in families. And they're the result of brain chemistry. Life experiences and one's general personality also play a role.5

How can anxiety disorders be treated?

Effective treatments are available for anxiety disorders. Both medication and talk therapy can help to relieve the symptoms.

  • Medications: The most common medications used to treat anxiety disorders are antidepressants and benzodiazepines. A number of drugs are available. So if one doesn't work, another might. And many new drugs are on the horizon. Talk to your doctor if you have questions or concerns about medications.
  • Talk therapy: Behavioral therapy and cognitive-behavioral therapy (CBT) are effective ways to treat anxiety disorders. Behavioral therapy involves gradual exposure to the anxiety trigger. CBT works on helping people react differently by changing their thinking patterns.
anxiety disorders

1Anxiety and Depression Association of America; Understanding the Facts – Panic Disorders
2Psych Scene; Obsessive Compulsive Disorder (OCD) – A Primer on Neurobiology, Diagnosis and Treatment
3Anxiety and Depression Association of America; About ADAA – Facts and Statistics
4National Institute of Mental Health; Anxiety Disorders
5Harvard Health Publishing; What Causes Depression?

Other Organizations

  • American Psychiatric Association, 1400 K Street, N.W., Washington, DC 20005; phone: (202) 682- 6000; Web site: www.psych.org/public_info/anxiety.html.
  • Anxiety Disorders Association of America, 11900 Parklawn Drive, Suite 100, Rockville, MD 20852; phone: (301) 231-9350; Web site: www.adaa.org.
  • Freedom From Fear, 308 Seaview Avenue, Staten Island, NY 10305; phone: (718) 351-1717; Web site: freedomfromfear.org.
  • National Institute of Mental Health, 6001 Executive Boulevard, Room 8184, MSC 9663 Bethesda, MD 20892-9663; phone: (301) 443-4513; email: nimhinfo@nih.gov; Web site: www.nimh.nih.gov/anxiety.
  • National Mental Health Association, 1021 Prince Street, Alexandria, VA 22314-2971; phone: (703) 684-7722; Web site: www.nmha.org/infoctr/factsheets/index.cfm.

Books

  • Overcoming Panic, Anxiety, & Phobias: New Strategies to Free Yourself from Worry and Fear By Shirley Babior and Carol Goldman. Whole Person Associates, 1996.
  • The Sky is Falling: Understanding and Coping with Phobias, Panic, and Obsessive-Compulsive Disorders by Raeann Dumont. W.W. Norton & Company, 1996.
  • Triumph Over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks, and Phobias by Jerilynn Ross. Bantam Books, 1994.

Web Sites

This material is provided by Cigna for informational/educational purposes only. It is not medical/clinical advice. Only a health care provider can make a diagnosis or recommend a treatment plan. For more information about your behavioral health benefits, you can call the member services or behavioral health telephone number listed on your health care ID card.