Anxiety Disorders

Anxiety Disorders are the most common type of abnormal behavior. They share similarities with mood disorders: both are defined in terms of negative emotional responses, close relationship between symptoms of anxiety and depression, stressful life events seem to play a role in the onset of both depression and anxiety. People with anxiety disorders share a preoccupation with, or persistent avoidance of, thoughts or situations that provoke fear or anxiety. The diagnosis of anxiety disorders depends on several types of symptoms.

What’s the difference between fear and anxiety?

Anxiety is associated with the anticipation of future problems. Future is the key word. On the flip side, a person experiences fear when facing real, immediate danger. Anxiety involves more general or diffuse emotional reactions than fear, where the feelings build up fast and evaporate quickly. Anxiety tends to be out of proportion to the threat. Fear is generally a natural response to a dangerous situation.

What are some signs that someone may have an anxiety disorder?

Individuals with an anxiety disorder worry excessively. Individuals with anxiety disorders brood over whatever makes them anxious constantly in their minds. This brooding is usually a relatively uncontrollable sequence of negative, emotional thoughts that are concerned with possible future threats or danger.

There is a difference in normal worrying and pathological worrying. The distinction between the two hinges on quantity and quality of worrisome thoughts.

Panic Attacks 

Panic attacks are sudden, overwhelming experiences of terror or fright. When someone experiences a panic attack, the emotional response more focused than diffuse in nature. The emotions are more intense than anxiety. There is often little to no warning when someone is about to experience a panic attack. It has been theorized that a panic attack is an appropriate fear response that is experienced at an inappropriate time.

To officially be diagnosed with a panic attack, four or more of the following symptoms must develop abruptly and reach maximum intensity within 10 minutes.

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, lightheaded, or faint
  9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  10. Fear of losing control or going crazy
  11. Fear of dying
  12. Paresthesias (numbness or tingling sensations)
  13. Chills or hot flushes

Panic attacks are either cued or unexpected. Described in situations in which they occur. A cued if expected, or if it occurs only in the presence of a particular stimulus. Unexpected panic attacks appear without warning or expectation, as if “out of the blue.”


Phobias are defined as persistent, irrational, narrowly defined fears that are associated with a specific object or situation. Avoidance is the important component. Phobic reactions are irrational and unreasonable.

Agoraphobia is the most complex and incapacitating phobic disorder. It literally means fear of the marketplace and is usually described as fear of public places. An individual with agoraphobia might experience significant anxiety when he or she is expecting to be in crowded streets and shops or to travel on public transportation.

What’s the difference between an obsession and a compulsion?

Obsessions are unwanted, anxiety-provoking thoughts. Obsessive thoughts may seem silly or crazy, and are rarely acted upon.

Compulsions cannot be resisted without the individual experiencing distress. Acting upon compulsions reduces anxiety, but they do NOT produce pleasure. The two most common forms of compulsions are checking on something and cleaning.


Anxiety and abnormal fears did not play a prominent role in psychiatric classification systems during the second half of the nineteenth century. Freud and his followers were responsible for some of the first extensive clinical descriptions of pathological anxiety states.

The DSM-IV-TR approach to classifying disorders is based primarily on descriptive features, rather than etiological hypotheses.

It recognizes several specific subtypes:

Panic disorder

Recurrent, unexpected panic attacks

At least one of the attacks must be followed by a period of 1 month or more with persistent concerns about having additional attacks.

Divided into two subtypes, depending on the presence or absence of agoraphobia

Specific Phobia

A “marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation.”

Exposure to phobic stimulus must be followed by an immediate fear response.

The person must appreciate the fact that the fear is excessive or unreasonable.

Social Phobia

Nearly identical to that for specific phobia but includes additional element of performance.

Afraid of or avoids social situations

Situations fall under two broad headings:

Performance Anxiety

Interpersonal interaction

Fear of humiliation or embarrassment

Image via Wikipedia – Age-standardised disability-adjusted life year (DALY) rates from Obsessive-compulsive disorder by country (per 100,000 inhabitants)

Obsessive-compulsive disorder  

Recognition that the obsessions or compulsions are excessive or unreasonable.

Attempts to ignore, suppress, or neutralize the unwanted thoughts or impulses.

Generalized anxiety

Excessive anxiety and worry

Trouble controlling the worries

Worries lead to significant distress

Worry must occur more days than not for a period of at lease 6 months

Worries must be about different events or activities

Posttraumatic stress disorder

What might someone with an anxiety disorder expect down the road?

Anxiety disorders are often chronic conditions, and some people do not recover. The frequency and intensity of panic attacks tend to decrease during middle age. Tony Soprano was an exception. Agoraphobic avoidance typically remains stable. In other words, agoraphobics have a difficult time overcoming their anxiety. OCD follows a pattern of improvement mixed with some persistent symptoms.

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