Anxiety disorders—an out-of-control fear?

How frequent are anxiety disorders? What are the stats?

Research indicates that over 25% of the general population has to cope with anxiety disorders at some point in their lives, which means that every four people face this challenge. However, many anxiety disorders may never appear in the psychiatry statistics since they are managed by family doctors, other physicians, and psychologists or psychotherapists. Therefore, the percentage of people affected is likely higher, which underscores the need for effective treatments and support systems to be in place.

Prevalence of anxiety disorders in society:

• Generally, women are more anxious, with a ratio of 5 women to 1 man, and those who are separated or divorced tend to be more worried than those in a couple.
• Anxiety disorders generally develop between the ages of 25 and 45, except for phobias, which usually occur around age 10.
• People living in cities tend to be more anxious than those residing in smaller communities or rural areas.
• Furthermore, people from higher social classes generally experience more anxiety than those from lower social classes.
• The personality type also influences anxiety, as avoidant or obsessive individuals are usually more worried.
• Finally, adverse life events, shocks, and stress are risk factors and often triggers for anxiety disorders.

What differentiates anxiety from fear?

Both fear and anxiety bring about uncomfortable feelings, persistent thoughts, and sometimes physical reactions, making them quite similar. What differentiates it is that anxiety often lacks a clear source, while fear is usually linked to a specific reason (people can easily understand why they are afraid). It can happen unexpectedly and without warning, making it difficult to identify a cause.

Surprisingly, people often find fear during panic attacks less tolerable than physical pain. Although fear is a normal and protective human emotion that signals danger, when its intensity becomes uncontrollable or seems exaggerated—beyond what the person considers appropriate for the situation—the resulting distress quickly leads them to seek medical help.

In other cases, especially with generalized anxiety disorder, the extended period of nervousness and uneasiness causes the most bother. It’s important to note that anxiety-focused therapy is not about eliminating fear, but about helping patients manage it in their daily lives. The goal is to reduce the intensity and duration of fear, enabling those affected to live their lives more fully.

What are the impacts of anxiety disorders?

Anxiety disorders substantially impact various aspects of the psyche:

• A panic attack can dominate a person’s focus, hindering their ability to concentrate on even the most straightforward tasks.
• Consequently, memory is impaired since it depends on attention.
• Awareness is also affected, as people focus on their negative inner experiences and become less connected to the present outer reality.
• Finally, perception and thought processes are notably changed.

Physical symptoms linked to anxiety disorders

Being afraid is not just an abstract emotion; it is something we feel in our body (or rather, “the anxiety speaks to us through our body,” often symbolically). Therefore, various physical symptoms that are actually linked to anxiety disorders may be misinterpreted as other health problems.

Palpitations are probably the most common symptom, and they often lead patients to the emergency room with suspicion of a heart attack. Here is when collaboration between the cardiologist and the psychiatrist becomes crucial.

Other physical manifestations, such as the feeling of inner tremor, dizziness, lightheadedness, excessive sweating, shivering, hot and cold flashes, goosebumps, numbness in the arms or legs, chest pain, a sensation of suffocation, a fluttery feeling (like butterflies in the stomach), nausea, vomiting, diarrhea may indicate a visit to a neurologist, internist, or general practitioner.

The diverse physical symptoms make anxiety disorders a common concern among other medical specialists, and it often requires time (and laboratory or imaging tests) to rule out other potential physical illnesses before diagnosing the root cause, a mental health disorder.

Psychological symptoms of anxiety

Besides the emotional and physical conditions, anxiety also involves thoughts, especially regarding unlikely catastrophic scenarios that might occur in the future:

• fear of the future (often manifesting as performance anxiety – the fear of not being good enough),
• fear of losing control (on oneself or on the external events),
• fear of losing one’s mind (of going crazy), or
• fear of death (or of dying before achieving what one deemed important to accomplish)

Sometimes, patients experience states of derealization (seeing reality as if it were in a movie) and depersonalization (feeling confused about their own identity).

What are the different types of anxiety disorders?

Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety, and specific phobias, all of which stimulate intense feelings of fear, worry, or unease. The most common types of anxiety disorders include:

• Generalized anxiety disorder is a feeling of constant fear floating throughout the day.
• Panic attacks: sudden and paroxysmal fear.
• Agoraphobia often accompanies panic attacks, which is the fear of open spaces, crowds of people, crossing streets or bridges, or traveling by means of transportation.
• Mixed anxiety-depressive disorder: characterized by symptoms of both anxiety and depression, it involves excessive worry, restlessness, and nervousness alongside feelings of sadness, hopelessness, and fatigue.
• Various phobias, such as a fear of blood, knives, natural phenomena, animals, and tight spaces, as well as social phobia, which is characterized by a fear of public speaking, close interpersonal interactions, and using public toilets, among other things.

Also, anxiety symptoms appear in almost all psychiatric disorders, from affective disorders (such as depression or bipolar disorder) to schizophrenia, and from obsessive-compulsive disorder (OCD) to the stress-related conditions such as adjustment disorder or post-traumatic stress disorder (PTSD).

What causes the anxiety?

Various viewpoints interpret the underlying causes of anxiety:

• Biological psychiatry sees anxiety as a chemical imbalance at the level of neurotransmitters (the substances inside the brain, such as serotonin, noradrenaline, or GABA). Their treatment is based on medical treatment (with pills).
• Psychoanalysts discuss unconscious conflicts and the failure of defensive mechanisms to counteract frustrated inner impulses, and offer psychological techniques to address these issues.
• Cognitivists consider it an exaggerated reaction to outer events.
• Behaviorists believe that anxiety arises from the application of a dysfunctional learned behavior as a solution in various situations.
• Existentialists hold that existential angst arises from the awareness that time passes and that death is inevitable.
• A well-established—though still unclear—way is how anxiety is transmitted through genetics. At the same time, the intergenerational transmission of an educational model (i.e., when and how to experience fear) is well understood.
• Finally, many physical illnesses can lead to anxiety: the most common are hormonal disorders, especially thyroid diseases, and some endocrine tumors.

How are anxiety disorders diagnosed?

First, physicians shall rule out the physical causes of anxiety:

• Suppose someone gets into an emergency room with a panic attack. In that case, they conduct a health exam by electrocardiogram (ECG) (to exclude a heart attack) and take basic measurements such as pulse, blood pressure, oxygen saturation, and blood sugar levels.
• When a person first visits a general practitioner (GP), the doctor conducts initial lab tests and often refers the patient to other medical specialists based on their symptoms to rule out other physical illnesses.
• Frequently, patients turn to a psychologist, who may refer them to a psychiatrist only if symptoms are severe and medication appears necessary.
• When a psychiatrist eventually sees the patient, the main goal is to rule out other psychiatric disorders before diagnosing anxiety.

What happens next?

Most anxiety disorders fluctuate over time; their intensity rises and falls depending on stressful events or other risk factors. 

• Sometimes these conditions resolve without treatment, other times patients “self-medicate” with alcohol or drugs. 
• Many people seek medical help when faced with panic attacks, with overwhelming experiences of fear. 
• Others may experience unexpected, prolonged anxiety. 
• Additionally, phobias can cause avoidance behaviors that profoundly affect one’s quality of life. 

Fortunately, educational programs can help people comprehend anxiety better and manage their emotions, fostering a more positive and fulfilling experience in their daily lives.

How are anxiety disorders treated?

Psychotherapy

The first line of treatment typically involves “talk therapy” sessions with a psychologist. The role of psychotherapy is to uncover the sources of anxiety, manage the patient’s reactions, and find alternative (and healthier) emotions, thinking patterns, and behaviors.

Psychiatric treatment

Psychiatric treatment with prescribed medications is generally the second-line treatment. Still, in practice, if the anxiety is too intense and the patient needs comfort and time to address the psychological roots of the fear, the medication is given in parallel with psychological intervention.

The medicinal treatment typically involves antidepressants and anxiolytics (tranquilizers, sedatives) and other drugs such as mood stabilizers, antipsychotics, beta-blockers, or sleeping pills. Almost all antidepressants, at lower doses, are effective for anxiety disorders and also have the advantage of not developing addictions. Sedatives are typically prescribed at the beginning of the treatment because they have a rapid calming effect. Still, the downside is that most of them are highly addictive if taken for lengthy periods of time.

Accompanying prescribed medication, a relatively broad spectrum of over-the-counter mineral supplements (often magnesium-based) and natural herbal remedies (such as valerian, passiflora, and hypericum) provide effective treatment, especially for mild forms of anxiety.

Additional techniques dedicated to treating anxiety-related conditions

Perhaps the most widely known are relaxation techniques that focus on imagination, breathing, body awareness, physical well-being, and grounding in sensory reality. Other widely used methods include Jacobson’s progressive muscle relaxation, Schultz’s autogenic training, hypnotherapy, biofeedback, and EMDR (Eye Movement Desensitization and Reprocessing).

And then what? How much time does it take to heal?

The medical treatment generally lasts for one year, but sometimes more time is needed for the psychotherapeutic interventions, in case of particularly intense conditions (such as PTSD) or deep-rooted sorrows (such as attachment or personality disorders). Compared to other psychiatric illnesses, anxiety disorders are relatively easy to manage, and for most of them, a complete remission is achievable.

In conclusion

Fear is a natural emotion that everyone encounters at some point in life. At the same time, anxiety-related disorders represent some of the most widespread mental health challenges today, affecting millions worldwide. Anxiety disorders have a significant impact on both mental and physical health, transforming everyday situations into daunting and complicated ones, making it essential to seek appropriate support and intervention.

Anxiety is not merely an abstract phenomenon; it is often felt within the body, revealing itself through various symptoms that may be mistaken for other health issues, which highlights the importance of collaborative care between the FirstMed medical team.

If you or someone you know is experiencing challenges related to anxiety, consider reaching out to Dr. Cezar Danilevici, a highly experienced psychiatrist who can provide valuable insights and treatment options. Taking this step can lead to a better understanding of your experiences and pave the way for improved overall well-being.