This document provides an overview of anxiety, including definitions, types of anxiety disorders, causes, symptoms, treatments, and statistics. It defines anxiety as a feeling of apprehension or fear from an unknown source. The main types of anxiety disorders discussed are generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Causes of anxiety disorders include genetics, brain chemistry, life stressors, and personality traits. Both conventional treatments like medication and therapy as well as alternative treatments are overviewed.

1. ANXIETY
Hongbiao (Hank) Liu MD PhD
Luna Medical Care PC

2. Overview
• What is Anxiety?
• What are the different types of anxiety
disorders?
• What are the causes?
• What are the symptoms?
• What are the treatments?
• Professional Resources available.

3. Definition of Anxiety
• Anxiety is a feeling of apprehension or fear. The
source of this uneasiness is not always known or
recognized, which can add to the distress you
feel.
• Anxiety disorders are a group of psychiatric
conditions that involve excessive anxiety.

4. Anxiety Facts
• Most common mental illness in the U.S. with 19 million of the adult
(ages 18-54) U.S. population affected.
• Anxiety disorders cost more than $42 billion a year.
• More than $22 billion are associated with the repeated use of healthcare
services, as those with anxiety disorders seek relief for symptoms that
mimic physical illnesses.
• Anxiety is highly treatable (up to 90% of cases), but only one-third of
those who suffer from it receive treatment
• People with an anxiety disorder are three-to-five times more likely to go
to the doctor and six times more likely to be hospitalized for psychiatric
disorders than non-sufferers.
• Depression often accompanies anxiety disorders
2003 Anxiety Disorders Association of America

5. Types of Anxiety Disorders
• Panic Disorder
• Obsessive-Compulsive Disorder
• Post-Traumatic Stress Disorder
• Phobias
• Generalized Anxiety Disorder

6. Panic Disorder
• The abrupt onset of an episode of intense fear or
discomfort, which peaks in approximately 10
minutes, and includes at least four of the
following symptoms:
• A feeling of imminent danger or doom • Nausea or abdominal discomfort
• The need to escape • Dizziness or lightheadedness
• Palpitations • A sense of things being unreal,
• Sweating depersonalization
• Trembling • A fear of losing control or "going crazy"
• Shortness of breath or a smothering • A fear of dying
feeling • Tingling sensations
• A feeling of choking • Chills or hot flushes
• Chest pain or discomfort

7. Panic Disorder
There are three types of Panic Attacks:
1. Unexpected - the attack "comes out of the blue" without
warning and for no discernable reason.
2. Situational - situations in which an individual always
has an attack, for example, upon entering a tunnel.
3. Situationally Predisposed - situations in which an
individual is likely to have a Panic Attack, but does not
always have one. An example of this would be an
individual who sometimes has attacks while driving.

8. Obsessive-Compulsive
Disorder
Characterized by uncontrollable obsessions and
compulsions which the sufferer usually recognizes as
being excessive or unreasonable.
• Obsessions are recurring thoughts or impulses that are
intrusive or inappropriate and cause the sufferer anxiety:
– Thoughts about contamination, for example, when an individual
fears coming into contact with dirt, germs or "unclean" objects;
– Persistent doubts, for example, whether or not one has turned off
the iron or stove, locked the door or turned on the answering
machine;
– Extreme need for orderliness;
– Aggressive impulses or thoughts, for example, being overcome
with the urge to yell 'fire' in a crowded theater

9. Obsessive-Compulsive
Disorder
• Compulsions are repetitive behaviors or rituals performed by the
OCD sufferer, performance of these rituals neutralize the anxiety
caused by obsessive thoughts, relief is only temporary.
– Cleaning. Repeatedly washing their hands, showering, or constantly
cleaning their home;
– Checking. Individuals may check several or even hundreds of times to
make sure that stoves are turned off and doors are locked;
– Repeating. Some repeat a name, phrase or action over and over;
– Slowness. Some individuals may take an excessively slow and
methodical approach to daily activities, they may spend hours organizing
and arranging objects;
– Hoarding. Hoarders are unable to throw away useless items, such as old
newspapers, junk mail, even broken appliances
• In order for OCD to be diagnosed, the obsessions and/or
compulsions must take up a considerable amount of the sufferers
time, at least one hour every day, and interfere with normal routines .

10. Post-Traumatic Stress
Disorder
• Exposure to traumas such as a serious accident, a natural
disaster, or criminal assault can result in PTSD. When the
aftermath of a traumatic experience interferes with normal
functioning, the person may be suffering from PTSD.
• Symptoms of PTSD are:
– Reexperiencing the event, which can take the form of intrusive thoughts
and recollections, or recurrent dreams;
– Avoidance behavior in which the sufferer avoids activities, situations,
people,and/or conversations which he/she associates with the trauma;
– A general numbness and loss of interest in surroundings;
– Hypersensitivity, including: inability to sleep, anxious feelings, overactive
startle response, hypervigilance, irritability and outbursts of anger.

11. Social Phobia/Anxiety
• Social anxiety disorder, also known as social phobia, is an
intense fear of social situations. This fear arises when the
individual believes that they may be judged, scrutinized or
humiliated by others.
• Individuals with the disorder are acutely aware of the
physical signs of their anxiety and fear that others will
notice, judge them, and think poorly of them.
• In extreme cases this intense uneasiness can progress
into a full blown panic attack.

12. Social Phobia/Anxiety
• Common anxiety provoking social situations include:
– public speaking
– talking with people in authority
– dating and developing close relationships
– making a phone call or answering the phone
– interviewing
– attending and participating in class
– speaking with strangers
– meeting new people
– eating, drinking, or writing in public
– using public bathrooms
– driving
– shopping

13. Generalized Anxiety
Disorder
• Excessive uncontrollable worry about
everyday things. This constant worry
affects daily functioning and can cause
physical symptoms.
• GAD can occur with other anxiety
disorders, depressive disorders, or
substance abuse.

14. Generalized Anxiety
Disorder
• The focus of GAD worry can shift, usually
focusing on issues like job, finances, health
of both self and family; but it can also
include more mundane issues such as,
chores, car repairs and being late for
appointments.
• The intensity, duration and frequency of the
worry are disproportionate to the issue

15. Specific Disorder Facts
• Generalized Anxiety Disorder
– Women are twice as likely to be afflicted than men.
– Very likely to exist along with other disorders.
• Obsessive Compulsive Disorder
– It is equally common among men and women.
– One third of afflicted adults had their first symptoms in childhood.
• Panic Disorder
– Women are twice as likely to be afflicted than men.
– Occurs with major depression in very high rates.
2003 Anxiety Disorders Association of America

16. Specific Disorder Facts
• Posttraumatic Stress Disorder
– Women are more likely to be afflicted than men.
– Rape is the most likely trigger of PTSD, 65% of men and 45.9% of
women who are raped will develop the disorder.
– Childhood sexual abuse is a strong predictor of lifetime likelihood
for developing PTSD.
• Social Anxiety Disorder
– It is equally common among men and women.
• Specific Phobia affects
– Women are twice as likely to be afflicted as men
2003 Anxiety Disorders Association of America

17. Anxiety Statistics
Anxiety Disorders
One-Year Prevalence (Adults)
Percent Population Estimate*
(Millions)
Any Anxiety Disorder 13.3 19.1
Panic Disorder 1.7 2.4
Obsessive-Compulsive 2.3 3.3
Disorder
Post-Traumatic Stress 3.6 5.2
Disorder
Any Phobia 8.0 11.5
Generalized Anxiety 2.8 4.0
Disorder
* Based on 7/1/98 U.S. Census resident population estimate of 143.3 million, age 18-54

18. Recent Studies
Freedom From Fear conducted a survey among 410 attendees during
National Anxiety Disorders Screening Day on May 7, 2003. The results :
•An increase in physical aches and pains is directly attributed to anxiety
disorders and depression
•60%) of the respondents with undiagnosed medical conditions said that on
days when they feel anxious or depressed, there is a moderate (41%) to
severe (19%) change in their physical symptoms or aches and pains. These
physical symptoms or aches and pains include backaches (13%), vague
aches and pains (14%), headaches (14%), digestive pain (11%) and
dizziness (8%).
•50% of respondents with diagnosed medical conditions, such as arthritis,
migraines, diabetes, heart and respiratory diseases, reported that on days
when they feel anxious or depressed, there is a moderate (38%) to severe
(12%) change in their physical symptoms or aches and pains.

19. Common Causes
• There is no one cause for anxiety disorders. Several
factors can play a role
– Genetics
– Brain biochemistry
– Overactive "fight or flight" response
• Can be caused by too much stress
– Life circumstances
– Personality
• People who have low self-esteem and poor coping skills may be more prone
• Certain drugs, both recreational and medicinal, can lead
to symptoms of anxiety due to either side effects or
withdrawal from the drug.
• In very rare cases, a tumor of the adrenal gland
(pheochromocytoma) may be the cause of anxiety.

20. Symptoms of Anxiety
Anxiety is an emotion often accompanied by
various physical symptoms, including:
• Twitching or trembling
• Muscle tension
• Headaches
• Sweating
• Dry mouth
• Difficulty swallowing
• Abdominal pain (may be the only symptom of stress
especially in a child)

21. Additional Symptoms of Anxiety
Sometimes other symptoms accompany
anxiety:
• Dizziness
• Rapid or irregular heart rate
• Rapid breathing
• Diarrhea or frequent need to urinate
• Fatigue
• Irritability, including loss of your temper
• Sleeping difficulties and nightmares
• Decreased concentration
• Sexual problems

22. Physical Reaction to Anxiety
Auditory and Visual Stimuli:
sights and sounds are processed
first by the thalamus, which filters
the incoming cues and shunts
them either directly to the
amygdala or to the other parts of
the cortex.
Olfactory and tactile stimuli:
Smells and touch sensations
Bypass the thalamus altogether,
Taking a shortcut directly to the
Amygdala. Smells, therefore,
Often evoke stronger memories
Or feelings than do sights or
Sounds.

23. Physical Reaction to Anxiety
Thalamus:
The hub for sights and sounds,
The thalamus breaks down
Incoming visual ques by size,
Shape and color, and auditory
Cues, by volume and
Dissonance, and then signals
The appropriate part of the
Cortex.
Cortex:
It gives raw sights and sounds
meanings, enabling the brain
to become conscious of what it
Is seeing or hearing. One
region, the prefrontal cortex,
may be vital to turning off the
anxiety response once a threat
has passed.

24. Physical Reaction to Anxiety
Amygdala:
emotional core of the brain, the
amygdala has the primary role
of triggering the fear response.
information that passes through
the amygdala is tagged with
emotional significance.
Bed Nucleus of Stria Terminalis:
unlike the Amygdala, which sets
off an immediate burst of fear,
the BNST perpetuates the fear
response, causing the longer
term unease typical of
anxiety.

25. Physical Reaction to Anxiety
Locus Ceruleus:
It receives signals from the
amygdala and is responsible
for initiating many of the
classic anxiety responses:
rapid heartbeat, increased
blood pressure, sweating and
pupil dilation.
Hippocampus:
This is the memory center,
vital to storing the raw
information coming in from
the senses along with the
emotional baggage attached
to the data during their trip
through the amygdala.

26. Social Effects of Anxiety
• Depression
– Not as involved with family and friends the way you
used to be
– Lowered quality of relationships
– Low energy
– Lack of motivation to do the things you once looked
forward to doing
• Unable to convey the person that you are
• Fear and avoidance of situations where previous
attacks occurred

27. Allopathic Treatments
• Medications (Drug Therapy):
• Behavioral Therapy
• Cognitive Behavioral Therapy
• Psychodynamic Psychotherapy

28. Alternative Treatments
• Acupuncture
• Aromatherapy
• Breathing Exercises
• Exercise
• Meditation
• Nutrition and Diet Therapy
• Vitamins
• Self Love

29. Medications
• Buspirone: shown to be effective but usually
takes 3-4 weeks, particularly useful in elderly
patients
• Benzodiazepines: include Xanax and Valium, act
rapidly and successfully but can be addictive and
loses effectiveness over time
• Side Effects: dizziness, headaches, nausea,
impaired memory

30. Behavioral and Cognitive
Therapy
• Teaches patient to react differently to situations and
bodily sensations that trigger anxiety
• Teaches patient to understand how thinking patterns that
contribute to symptoms
• Patients learn that by changing how they perceive
feelings of anxiety, the less likely they are to have them
• Examples: Hyperventilating, writing down list of top fears
and doing one of them once a week, spinning in a chair
until dizzy; after awhile patients learned to cope with the
negative feelings associated with them and replace them
with positive ones

31. Psychodynamic
Psychotherapy
• Psychodynamic therapy is a general name for therapeutic
approaches which try to get the patient to bring to the surface
their true feelings, so that they can experience them and
understand them. Psychodynamic Psychotherapy uses the
basic assumption that everyone has feelings held in the
subconscious which are too painful to be faced. We then come
up with defenses (such as denial) to protect us knowing about
these painful feelings.
• Psychodynamic psychotherapy assumes that these defenses
have gone wrong and are causing more harm than good,
making you seek help. It tries to subdue them, with the
intention that once you are aware of what is really going on in
your mind the feelings will not be as painful.
• Takes an extremely long time and is labor intensive

32. Acupuncture
• Caused by the imbalance of chi coming about by
keeping emotions in for too long
• Emotion effects the chi to move in an abnormal
way: when fearful it goes to the floor, when angry
the neck and shoulders tighten
• Redirects the chi into a balanced flow, releases
tension in the muscles, increases flow of blood,
lymph, and nerve impulses to affected areas
• Takes 10-12 weekly sessions

33. Aromatherapy
• Calming Effect: vanilla, orange blossom, rose,
chamomile, and lavender
• Reducing Stress: Lavender, sandalwood, and
nutmeg
• Uplifting Oils: Bergamot, geranium, juniper, and
lavender
• Essential Oil Combination: 3 parts lavender, 2
parts bergamot, and 1 part sandalwood

34. Exercise
• Benefits: symbolic meaning of the activity, the
distraction from worries, mastery of a sport,
effects on self image, biochemical and
physiological changes associated with exercise,
symbolic meaning of the sport
• Helps by expelling negative emotions and
adrenaline out of your body in order to enter a
more relaxed, calm state to deal with issues
and conflicts

35. Meditation
• Cultivates calmness to create a sense of control
over life
• Practice: Sit quietly in a position comfortable to
you and take a few deep breaths to relax your
muscles, next choose a calming phrase (such as
“om” or that with great significance to you),
silently repeat the word or phrase for 20 minutes

36. Nutrition and Diet Therapy
• Foods to Eat: whole grains, bananas, asparagus,
garlic, brown rice, green and leafy veggies, soy
products, yogurt
• Foods to Avoid: coffee, alcohol, sugar, strong
spices, highly acidic foods, foods with white flour
• Keep a diary of the foods you eat and your
anxiety attacks; after awhile you may be able to
see a correlation
• East small, frequent meals

37. Vitamins
• B-Vitamins stabilize the body’s lactate levels
which cause anxiety attacks (B-6, B-1, B-3)
• Calcium (a natural tranquilizer) and magnesium
relax the nervous system; taken in combination
before bed improves sleep
• Vitamin C taken in large doses also has a
tranquilizing effect
• Potassium helps with proper functioning of
adrenal glands
• Zinc has a calming effect on the nervous system

38. Self Love
• The most important holistic treatment of all
• Laugh: be able to laugh at yourself and with
others; increases endorphin levels and decreases
stress hormones
• Let go of frustrations
• Do not judge self harshly: don’t expect more from
yourself than you do others
• Accept your faults

39. Where to Get Help
• SFSU Health Center - The services of the Center are open to
regularly enrolled (matriculated) undergraduate and graduate
students.
Office hours are 8AM to Noon and 1PM to 7PM Monday through
Thursday and until 5PM on Friday. Appointments may be made by
phone (415) 338-2208 or in person at Student Services Building
Room 208.
• Any licensed psychologist or psychiatrist
• U.S. Dept. of Health & Human Services – Substance Abuse &
Mental Health Services Administration – find resources in your area
http://www.mentalhealth.samhsa.gov/databases

40. Additional Links
• Anxiety Screening Tools
• Anxiety Disorders Association of America (ADAA)
• Freedom From Fear (www.freedomfromfear.org)
• National Institute of Mental Health (
www.nimh.nih.gov)
• U.S. Dept. of Health & Human Services (
http://www.mentalhealth.samhsa.gov/topics/explore/s
)

41. The End