All about Anxiety

Anxiety comes in many flavors. We organize anxiety symptoms into four general categories:
- Feelings
- Behaviors
- Thoughts
- Physical Symptoms
Below we provide basic information about the most common anxiety disorders. Please note that Obsessive Compulsive Disorder (OCD) and Post Traumatic Stress Disorder (PTSD) are considered anxiety disorders but are not reviewed here.

Medical conditions can cause anxiety
Many medical problems can cause anxiety symptoms. Below is a table of conditions and the appropriate diagnostic tests.
Diagnosing anxiety disorders
Anxiety disorders can be categorized based on whether a trigger can be identified for the anxiety symptoms. See the algorithm below.

Criteria for common anxiety disorders
Generalized Anxiety Disorder
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
- Restlessness or feeling keyed up or on edge.
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Irritability.
- Muscle tension.
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).
- Cognitive Behavioral Therapy
- Mindfulness Based Stress Reduction
- Psychodynamic Psychotherapy
Medications
- Selective Serotonin Reuptake Inhibitors (SSRIs): FDA Approved: Escitalopram (FDA Approved), Paroxetine (FDA Approved)
- Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine (FDA Approved), Duloxetine (FDA Approved)
- Benzodiazepines: FDA Approved: Clonazepam (Klonopin)
- Buspirone (Buspar)
- Hydroxyzine (Vistaril)
- Tricyclic Antidepressants (TCAs)
- Monoamine Oxidase Inhibitors (MAOIs)
- Anticonvulsant Mood Stabilizers (e.g., Valproic acid, Lamotrigine, Gabapentin, Pregabalin)
Separation Anxiety Disorder
A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
- Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
- Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
- Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
- Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
- Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
- Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
- Repeated nightmares involving the theme of separation.
- Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.
C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.
D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.
Social Anxiety Disorder (Social Phobia)
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or offend others).
C. The social situations almost always provoke fear or anxiety.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Specify if Performance only: If the fear is restricted to speaking or performing in public.
- Cognitive Behavioral Therapy
- Exposure Therapy
- Interpersonal Psychotherapy
- Psychodynamic Psychotherapy
- Selective Serotonin Reuptake Inhibitors
- Serotonin Norepinephrine Reuptake Inhibitors
- Propranolol (Inderal)
- Benzodiazepines
Panic Attacks
Panic attacks can occur alone or as part of another anxiety disorder or psychiatric disorder such as depression, posttraumatic stress disorder, and substance use disorders. Panic attacks can also be caused or worsened by some medical conditions such as heart disease, thyroid disease, lung disease, inner ear problems, or stomach/intestinal issues. Panic attacks are defined as an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. During a panic attack, an individual may experience any combination of the following symptoms:
- Palpitations, pounding heart, or accelerated heart rate.
- Sweating.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, light-headed, or faint.
- Chills or heat sensations.
- Paresthesia (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control or “going crazy.”
- Fear of dying
Panic Disorder
- Cognitive Behavioral Therapy
- Exposure Therapy
- Interpersonal Psychotherapy
- Psychodynamic Psychotherapy
- Selective Serotonin Reuptake Inhibitors (used to prevent future panic attacks)
- Serotonin Norepinephrine Reuptake Inhibitors (used to prevent future panic attacks)
- Propranolol (Inderal)
- Benzodiazepines (used to abort the panic attack)
What is Agoraphobia?
Agoraphobia is a marked fear or anxiety about any of the following situations:
- Using public transportation (e.g., automobiles, buses, trains, ships, planes).
- Being in open spaces (e.g., parking lots, marketplaces, bridges).
- Being in enclosed places (e.g., shops, theaters, cinemas).
- Standing in line or being in a crowd.
- Being outside of the home alone.
Review Video
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Category: Anxiety Disorders, Cognitive Behavioral Therapy