What Are Anxiety Disorders.docx

What Are Anxiety Disorders?
Anxiety disorders are serious mental illnesses that cause significant worry or fear that
doesn't go away and may even get worse over time. We all feel anxious at times, but
with an anxiety disorder, the anxiety tends to be fairly constant and has a very negative
and intrusive impact on quality of life.
According to the National Institute of Mental Health (NIMH), approximately 19.1% of
adults in the United States have some type of anxiety disorder.1
Women are also more likely to be affected by anxiety, which is why
experts now recommend that women and girls over the age of 13 should be
screened for anxiety disorders as part of routine medical care.2
Types of Anxiety Disorders
There are several types of anxiety disorders. While all are characterized by symptoms of
anxiety, each has its own unique set of characteristics, symptoms, and criteria for
diagnosis.
Agoraphobia
Agoraphobia is an irrational and extreme fear of being in a situation where escape is
impossible. People often fear that they will experience symptoms of panic or other
symptoms in public, which leads them to avoid any situation where they may feel
panicked, helpless, or trapped.
These avoidance behaviors are often life-limiting, often causing people to avoid driving,
shopping in public, air travel, or other situations. In some cases, this fear can become so
severe that people are unable to leave their homes.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) involves excessive worry and anxiety related to
various activities and events. This worry is difficult to control and often shifts from one
concern to another.
While there is no specific threat, people with GAD find themselves feeling anxious about
everyday daily events, current events in the news, relationships, or potential events that
might occur.
Panic Disorder
Panic disorder involves experiencing intense and persistent panic attacks that occur
unexpectedly with little or no warning. A panic attack has physical and emotional
symptoms such as rapid heartbeat, increased respiration, and feelings of extreme
terror.
Selective Mutism

Selective mutism is an anxiety disorder that occurs during childhood. It involves
experiencing anxiety, embarrassment, or fear that prevents children from speaking in
specific settings, such as while at school or around strangers.
Selective mutism usually occurs between the ages of two and four and is often
accompanied by fidgeting, lack of eye contact, and lack of expressions when faced with
a situation the child fears.
Social Anxiety Disorder
Social anxiety disorder (SAD), previously known as social phobia, involves a fear of
social situations. This fear may center on specific events, such as public speaking, or
may involve a more generalized fear of many different social situations.
People who have this condition have an exaggerated sense that other people scrutinize
everything they do. They may be very critical of themselves and experience both
physical and emotional symptoms of fear in social situations.
Such symptoms include shaking, racing heartbeat, stomach upset, and dread. These
symptoms often lead people to avoid social situations whenever possible.
Specific Phobias
Specific phobias involve intense fear of a specific object or situation that is
overwhelming, irrational, and out of proportion to the actual threat. When they
encounter the source of their fear, people with a specific phobia experience immediate
symptoms such as sweating, crying, shaking, rapid heartbeat, and increased
respiration.
As often happens with other anxiety disorders, people with a phobia may go to great
lengths to avoid the source of their fear. Such avoidance behaviors can cause additional
stress and limit daily activities.
Are OCD and PTSD Anxiety Disorders?
The fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5),
which healthcare providers use to diagnose mental health conditions, breaks what have
generally been considered anxiety disorders into three categories:
 Anxiety disorders
 Obsessive-compulsive and related disorders
 Trauma- and stressor-related disorders
This differentiation shows that while the disorders have a commonality and are related,
they are distinctly different. These classifications have remained in place in the most
recent edition of the diagnostic manual, the DSM-5-TR.
While OCD and PTSD are no longer officially categorized as anxiety disorders, they share
many characteristics, and anxiety symptoms are common in both conditions.
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) involves experiencing intrusive thoughts, known
as obsessions, and behaviors, known as compulsions. Before the publication of the

DSM-5, OCD was considered a type of anxiety disorder, because these obsessions create
significant anxiety for many people.
Obsessions may focus on things such as a fear of germs, a need to have things in a
certain order, or disturbing thoughts about taboo topics. Compulsions are behaviors that
people often engage in as a way to relieve the anxiety caused by obsessive thoughts.
They might involve actions such as counting, ordering, checking, or washing.
Conditions related to OCD and also listed in the category "OCD and related disorders"
include body-dysmorphic disorder, hoarding disorder, and trichotillomania.
Post Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a condition that can occur following a traumatic
event. It includes symptoms such as changes in mood, arousal, and reactivity. People
may have intrusive thoughts, memories, and nightmares related to the trauma.
Flashbacks, hypervigilance, anxiety, and avoidance of reminders are other common
symptoms.
Other trauma- and stressor-related disorders in this DSM group include adjustment
disorders, and reactive attachment disorder
Recap
Types of anxiety disorders include agoraphobia, generalized anxiety disorder, panic
disorder, selective mutism, social anxiety disorder, and specific phobias. Other
conditions, including OCD and PTSD, also feature symptoms of anxiety.
Do You Have Normal Anxiety or a Disorder?
Anxiety Disorder Symptoms
Anxiety disorders come with a host of symptoms and no one person has the same
experience. Each disorder tends to have different symptoms as well. The symptoms
common to anxiety disorders in general include:
 Difficulty sleeping
 Dizziness
 Dry mouth
 Feelings of nervousness, worry, panic, fear, and unease
 Muscle tightness
 Nausea
 Rapid or irregular heartbeat
 Sweaty or cold hands and/or feet
 Tingling or numbness in the hands or feet
 Unable to be calm or hold still
When you experience the physical and psychological signs of fear and anxiety such as
sweating, racing heart, shortness of breath, trembling, worry, or stress, these are cues
that something is happening that could be a threat and that you need to deal with it.
Can Anxiety Really Kill You?
This “flight or fight” reaction activates the physical and psychological resources
necessary to deal with the potential danger. Although this system works well most of the
time, sometimes it can go into overdrive and do more harm than good. When this
happens, it might indicate you have an anxiety disorder.

Most people experience some anxiety from time to time. The difference between normal
anxiety and an anxiety disorder involves the amount of distress it causes and how it
affects your ability to function normally.3
Causes
Millions of American adults (as well as children and teens) will experience an anxiety
disorder at some point in their lives. No one knows exactly what causes
anxiety disorders, although genetics, environment, stress level, brain changes, and
trauma may all play a role.
Researchers are discovering more about these links all the time. A combination of
factors likely plays a role in causing anxiety conditions. Some factors that have been
implicated include:
 Brain chemistry: Severe or prolonged stress can contribute to changes in the
chemical balance in the brain. Such changes can play a part in the onset of
anxiety disorders.4
 Experiences: Stressful or traumatic events can also contribute to feelings of
anxiety.
 Family history: Having close family members with symptoms of anxiety
disorders increases the risk that a person will also develop an anxiety condition.5
 Genetic factors: Certain genes may predispose a person to a higher likelihood
of developing an anxiety disorder.
 Medical conditions: Some underlying health conditions can contribute to
feelings of anxiety. Some of these include chronic pain, heart disease, diabetes,
thyroid problems, respiratory conditions, drug use, and drug withdrawal.
 Personality: People with certain personality traits, such
as introversion and neuroticism, may be more prone to experiencing higher
levels of anxiety.
Diagnosis
There are no lab tests that can be done to diagnose an anxiety disorder, though a doctor
may perform some tests to rule out physical problems.6
Your doctor may refer you to a
mental health professional, such as a psychiatrist, a psychologist, or a counselor, who
will use specific diagnostic tools and questions to help determine what sort of disorder
you may have.
A doctor or mental health professional will ask questions and use assessment tools to
help determine if you have a disorder. They will want to know the nature of your
symptoms, how long they last, and how severe they are. They will also want to
understand how they interfere with your ability to function in your everyday daily life.
Healthcare practitioners use the "Diagnostic and Statistical Manual of Mental Disorders"
(DSM) to diagnose these conditions. Each disorder in the DSM lists specific symptom
criteria that a person must meet to be diagnosed with a particular condition.
Generalized Anxiety Disorder Discussion Guide
Get our printable guide to help you ask the right questions at your next doctor's
appointment.

DOWNLOAD PDF
Learn the best ways to manage stress and negativity in your life.
SIGN UP
Treatments
There are a variety of options available to treat anxiety disorders. A mental health
professional can help determine what works best for you.
Psychotherapy
Psychotherapy can help people learn to manage the emotional, cognitive, and
behavioral aspects of anxiety. One particularly effective form of psychotherapy for
anxiety disorders is cognitive behavioral therapy (CBT). This approach focuses on
helping people identify the automatic negative thoughts and cognitive distortions that
contribute to feelings of anxiety.
Exposure therapy is another type of CBT that can be helpful for some types of anxiety.
In this approach, people are gradually exposed to the things that they fear, often while
simultaneously using relaxation techniques to help calm the body's stress response.
Research has found that CBT can be effective in the treatment of anxiety disorders,
including generalized anxiety disorder, social anxiety disorder, and specific phobias. It
can also be helpful for anxiety that occurs as part of OCD and PTSD.7
Medications
Some medications can also be prescribed to help relieve symptoms of anxiety. Some of
the medications that are most often used for anxiety include:
 Antidepressants can help alter the levels of certain neurotransmitters in the
brain to help relieve symptoms of anxiety.
 Benzodiazepines work quickly and are often used as a short-term treatment.
 Beta-blockers are usually used to treat high blood pressure, but can also help
relieve some of the physical symptoms of anxiety.
Coping Strategies
Coping strategies often focus on ways to manage anxiety more effectively. Lifestyle
changes such as limiting caffeine intake, getting enough rest, and engaging in regular
exercise may be helpful.

One study found that exercise significantly reduces symptoms of anxiety, suggesting
that it may be useful for preventing and even treating symptoms of anxiety.8
Stress management techniques including deep breathing, yoga, and progressive
muscle relaxation can also be beneficial when managing feelings of anxiety.
If you have an anxiety disorder, there are plenty of treatment options available to help
you live your life to the fullest. Remember, treatment can take time before you and your
physician discover the best options for you. Be patient and keep communication open
with your mental health professional in order to figure out the plan best tailored to your
individual needs.
Anxiety is a common problem for many American adults. In fact, according to the
National Institute of Mental Health, anxiety disorders are the most common types of
mental health conditions in the United States, affecting almost 20% of all
adults.1
Anxiety is also common among children and adolescents.2
However, not all anxiety is the same. The butterflies you feel in your stomach before
giving a presentation at work feel very different than the sense of dread and foreboding
you might feel when watching the nightly news. The source of your anxiety influences
how you might experience it. It also impacts how you might go about addressing it.
Anxiety can have different causes, which means that each type of anxiety may require
different solutions.
Understanding the different types of anxiety and which one you are experiencing can
offer you insight into why you feel the way you do.
Anticipatory Anxiety
Anticipatory anxiety refers to the feelings of fear that you experience before an event.
While it is normal to feel stress about future events, anticipatory anxiety involves an
excessive worry about the future.
A certain degree of stress can be adaptive and help you perform your best. When this
anxiety becomes severe, it can be debilitating. This type of anxiety might cause you to
become overly focused on adverse outcomes. It can also be all-consuming and
long-lasting.
Instead of feeling a little nervous right before an event, you might find yourself
overwhelmed with feelings of worry and fear for weeks or months beforehand.
You might experience this type of anxiety in response to a wide variety of events,
including:
 Social events
 Romantic dates
 Work meetings
 Presentations or public speaking engagements
 Job interviews
 Athletic events
 Musical performances
While it might involve anxiety about upcoming events, it can also occur in response to
everyday occurrences. For example, you might experience anxiety about driving to work
or catching the train.

Anticipatory anxiety is not a distinct mental health condition. Instead, it is often a
symptom of anxiety disorders, including social anxiety disorder, panic disorder, or
generalized anxiety disorder.
One way to deal with anticipatory anxiety is to try relabeling your emotions. Instead of
calling your feelings nervousness or anxiety, work on reframing them as excitement and
anticipation. For example, instead of saying “I’m nervous,” you would say, “I’m so
excited.”
This technique, known as anxiety reappraisal, is an effective strategy that helps people
change their interpretations of physical arousal symptoms.3
Generalized Anxiety
Generalized anxiety is a chronic and exaggerated worry that occurs without having a
specific source. This type of anxiety is also sometimes referred to as free-floating
anxiety.
People who experience this type of anxiety spend a lot of time worrying about a wide
variety of future events. Such anxiety may center on health, social interactions, work,
relationships, and everyday events.
If a person experiences excessive worry that interferes with essential areas of life and
lasts most days for longer than six months, they may be diagnosed with generalized
anxiety disorder (GAD).
Some symptoms of generalized anxiety disorder include:4
 Always feeling on edge
 Always thinking of the worst possible outcome in every situation
 An inability to stop worrying
 Problems coping with uncertainty
 Problems concentrating
 Worries that are out of proportion to the actual danger
Generalized anxiety tends to be twice as common in women as in men. Women tend to
experience anxiety disorders at higher rates, so experts suggest that women and girls
over the age of 13 should be screened during routine health exams.5
If you experience generalized anxiety, you should talk to a primary healthcare provider
or a mental health professional. They can determine if your symptoms meet the
generalized anxiety disorder diagnostic criteria. They can also recommend effective
treatments, including psychotherapy and medications.
Finding strategies to help cope with generalized anxiety can also be helpful. Finding
social support, practicing mindfulness, and learning emotional acceptance may be
helpful.
Panic
Panic is a type of anxiety that involves sudden and intense feelings of fear. When a
person experiences a panic attack, they may experience racing heartbeat, chest pain,
trembling, sweating, a sense of impending doom, feeling out of control, or feeling as if
they are dying.

Panic attacks are a symptom of an anxiety disorder known as panic disorder. People
with this condition worry that they will have a panic attack in the future, so they often
avoid places or situations where they think they might experience feelings of panic.
Treatments for panic disorder include medications and psychotherapy. Healthcare
providers may prescribe antidepressants or benzodiazepines to treat symptoms of panic.
Antidepressants tend to take longer to work and can lessen feelings of anxiety over time.
Benzodiazepines, on the other hand, are fast-acting and can help reduce symptoms of
acute anxiety.
Learning relaxation techniques can also be helpful when you feel yourself beginning to
experience symptoms of panic. Deep breathing can be particularly helpful since people
often engage in rapid, shallow breathing when they are panicked.6
What to Do If You Have Extreme Anxiety
Performance Anxiety
Performance anxiety involves anxiety related to a person's ability to perform a specific
task. Sometimes known as stage fright, this type of anxiety emerges when a person is
expected to perform a task, such as giving a speech or competing in an athletic event.
Common symptoms of performance anxiety include trembling, stomach upset, nausea,
shortness of breath, and an increased number of mistakes while performing. Escape
behaviors, such as finding an excuse to avoid the task or performance, may also occur.
Types of performance anxiety can include:
 Musical performance anxiety
 Sexual performance anxiety
 Speech anxiety
 Test anxiety
Sometimes this type of anxiety involves mild nervousness. To a certain point, feeling a
little stress can help improve performance.
When you are stressed, your body goes into a state of alert, known as the fight or flight
response. This response prepares you both physically and mentally to handle the
situation.
However, when this anxiety becomes excessive, it can negatively affect performance.
You might forget important details, get distracted, or be completely unable to perform.
In some cases, stage fright can lead to panic attacks.
Phobia-Related Anxiety
Sometimes anxiety can result from a phobia, which is an intense and exaggerated fear
of a specific object or situation. Common examples of specific phobias include feeling
extreme fear in response to blood, flying, heights, needles, spiders, or snakes.
When people have a phobia, they may experience a great deal of anxiety and worry
about potentially encountering the source of their fear.
They will also take steps to avoid what they are afraid of, often in ways that limit their
ability to function normally. For example, a person might stop leaving their house

altogether because they are so worried about coming into contact with the thing they
fear.
Exposure therapy can be very effective for this type of anxiety. In exposure treatments,
a person is gradually exposed to the source of their fear in a safe, controlled manner.7
This exposure may also be paired with a variety of relaxation techniques so that people
can replace anxiety with calmer responses.
Separation Anxiety
Separation anxiety involves excessive anxiety in response to being separated from a
caregiver, loved one, or another attachment figure. It is often associated with early
childhood, but it can also occur at other points throughout life.
This type of anxiety is a normal and healthy part of child development that typically
occurs between eight and 14 months. It is regarded as a normal part of development up
until age two. Signs of this type of anxiety include excessive crying, clinginess, and
refusal to interact with others after a parent or caregiver leaves.
When this anxiety occurs after age two, it may be diagnosed with separation anxiety
disorder. It can also affect adults. Signs of the condition include excessive distress,
worry, and reluctance when separated from an attachment figure.
Separation anxiety can sometimes occur during times of stress or transition. Starting
school, going to college, moving to a new town, or starting a new job might trigger
feelings of this type of anxiety.
Situational Anxiety
Situational anxiety is a type of anxiety that is triggered by certain situations. Many
people experience this type of anxiety from time to time. For example, you might feel
situational anxiety on the first day at a new job or before an important presentation at
work.
When facing something that causes feelings of situational anxiety, you might experience
a range of symptoms. For example, you might have trouble sleeping or have an upset
stomach. Muscle tension, diarrhea, nausea, sweating, and restlessness are also
common.
People can often deal with this type of anxiety using relaxation techniques like deep
breathing or visualization. Being well-prepared for the situation can also be helpful.
For example, if you know that you will be anxious during an upcoming job interview,
practicing the interview and being prepared to answer questions can make you feel less
anxious.
Social Anxiety
If the thought of having to make small talk with a room full of strangers makes you feel
tense and anxious, then you might be experiencing social anxiety. Social anxiety is
commonly defined as a fear of social situations. However, it can manifest in several
different ways.

For some people, social anxiety is primarily triggered by unfamiliar social situations. This
might involve meeting new people in situations such as job interviews or work-related
events. Sometimes this anxiety only occurs during high-pressure moments, such as
giving a speech in front of a large group of people.
In other cases, however, people find themselves experiencing feelings of fear and
anxiety in almost every social encounter. Everyday activities like answering the phone or
eating in a public place can become daunting or scary.
Social anxiety can cause a range of physical and cognitive symptoms. For example,
during an anxiety-inducing social situation, you might experience physical symptoms
such as blushing, shortness of breath, dry mouth, and a trembling voice.
Negative thoughts and beliefs are also common. You might tell yourself that everyone is
judging you or that you aren't interesting enough.
As a result of this fear, people often begin avoiding situations that lead to feelings of
anxiety. The problem is that this strategy leads to isolation and loneliness. It also tends
to make social anxiety worse. If a person's social anxiety is persistent and disrupts their
daily functioning, they may be diagnosed with social anxiety disorder.
So what does work for combatting this type of anxiety? While each person’s needs are
different, practicing social skills is often very effective. By becoming more skilled at
talking to other people, people become more confident in social situations.
Phobia Symptoms, Types, and
Treatment
According to the American Psychiatric Association, a phobia is an irrational and
excessive fear of an object or situation. In most cases, the phobia involves a sense of
endangerment or a fear of harm.1
For example, those with agoraphobia fear being
trapped in an inescapable place or situation.
Phobia Symptoms
Phobic symptoms can occur through exposure to the feared object or situation, or
sometimes merely through thinking about the feared object. Typical symptoms
associated with phobias include:
 Breathlessness
 Dizziness, trembling, and increased heart rate
 Fear of dying
 Nausea
 Preoccupation with the feared object
 A sense of unreality
In some cases, these symptoms may escalate into a full-scale anxiety attack.2
In response to these symptoms, some individuals may develop social anxiety disorder
(SAD)—previously known as social phobia—and begin to isolate themselves, leading to
severe difficulties with functioning in daily life and with maintaining relationships.

In other cases, such as with hypochondriasis, a person may seek out medical care due
to a constant concern with imagined illnesses or imminent death.
Types of Phobias
The American Psychiatric Association defines phobias as anxiety disorders and
categorizes them into three different types:
 Agoraphobia: This describes a fear of being trapped in an inescapable place or
situation. As a result, the phobic individual may begin to avoid such situations. In
some cases, this fear can become so pervasive and overwhelming that the
individual even fears to leave their home.
 Specific phobias: These involve the fear of a particular object (such as snakes
or butterflies and moths). Such phobias typically fall into one of four different
categories: situational, animals, medical, or environmental. A few examples
of common fear objects include spiders, dogs, needles, natural disasters,
heights, and flying.
 Social phobias: A fear of social situations includes an extreme and pervasive
fear of social situations. In some cases, this fear may center on a very particular
type of social situation such as public speaking. In other instances, people may
fear to perform any task in front of other people for fear that they will be
somehow publicly embarrassed.
More examples of the four major types of specific phobias3
include:
 Animal: Fear of snakes, rodents, cats, or birds.
 Medical: Fear of seeing blood or visiting a doctor.
 Natural environment: Fear of lightning, water, storms, hurricanes,
tornadoes, or mudslides.
 Situational: Fear of bridges, leaving home, or driving.
Prevalence of Social Anxiety Disorder
According to the National Institute of Mental Health, social anxiety disorder affects
about 7% of adult Americans in a given year and specific phobias affect approximately
9%. In general, women are affected more than men.4
According to the Diagnostic and Statistical Manual of Mental Disorders, only about 10%
of reported phobia cases become life-long phobias.
Phobia Treatments
There are a number of treatment approaches for phobias, and the effectiveness of each
approach depends on the person and their type of phobia.
In exposure treatments,5
the person is strategically exposed to their feared object in
order to help them overcome their fear. One type of exposure treatment is flooding, in
which the patient is confronted by the feared object for an extended length of time
without the opportunity to escape. The goal of this method is to help the individual face
their fear and realize that the feared object will not harm them.
Another method often used in phobia treatment is counter-conditioning. In this method,
the person is taught a new response to the feared object. Rather than panic in the face

of the feared object or situation, the person learns relaxation techniques to replace
anxiety and fear.
This new behavior is incompatible with the previous panic response, so the phobic
response gradually diminishes. Counter-conditioning is often used with people who are
unable to handle exposure treatments and has been effective for treating children and
adolescents.6
Finally, for both adults and children with social phobia, medication like a low dose of
a benzodiazepine or potentially an antidepressant (like a selective serotonin reuptake
inhibitor, or SSRI) in combination with cognitive-behavioral therapy can prove helpful
Generalized anxiety disorder (GAD) can be a challenge to diagnose. People
consider panic attacks a hallmark of all anxiety disorders, but GAD is different in that
there are generally no panic attacks associated with the condition.1
As a result of this misconception, without the experience of panic attacks, a person may
think they are "just worrying too much." Their struggles with constant worry may be
minimized or dismissed and, in turn, not properly diagnosed or treated.1
Most of us experience worry and situations that can cause us to feel anxious, so what are
professionals looking for to help determine if someone's worry and anxiety are related to
GAD?
The first step is to evaluate symptom criteria, as outlined in "The Diagnostic and
Statistical Manual of Mental Disorders," 5th Edition, Text Revision (also known as the
DSM-5-TR). Mental health professionals look for factors like excessive, hindering worry
paired with a variety of physical symptoms,2
then use proven diagnostic assessments to
make a diagnosis and rule out other possibilities.

Verywell / Cindy Chung
Symptoms of GAD
The DSM-5-TR outlines specific criteria to help professionals diagnose generalized
anxiety disorder. Having a standard set of symptoms to reference when assessing
clients helps them to more accurately diagnose mental health concerns and, in turn,
create a more effective plan of care.
Criteria for Diagnosing GAD
When assessing for GAD, clinical professionals are looking for the following:
. The presence of excessive anxiety and worry about a variety of topics, events, or
activities. Worry occurs more often than not for at least six months and is clearly
excessive.
. The worry is experienced as very challenging to control. The worry in both adults
and children may easily shift from one topic to another.
. The anxiety and worry are accompanied by at least three of the following
physical or cognitive symptoms (In children, only one of these symptoms is
necessary for a diagnosis of GAD):
 Edginess or restlessness
 Tiring easily; more fatigued than usual
 Impaired concentration or feeling as though the mind goes blank
 Irritability (which may or may not be observable to others)
 Increased muscle aches or soreness
 Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at
night, or unsatisfying sleep)
Excessive worry means worrying even when there is no specific threat present or in a
manner that is disproportionate to the actual risk.3
Someone struggling with GAD
experiences a high percentage of their waking hours worrying about something. The
worry may be accompanied by reassurance-seeking from others.4
In adults, the worry can be about job responsibilities or performance, one’s own health
or the health of family members, financial matters, and other everyday, typical life
circumstances. In children, the worry is more likely to be about their abilities or the
quality of their performance (for example, in school).5
Many people with GAD also
experience symptoms such as sweating, nausea, or diarrhea.6
The anxiety, worry, and other associated symptoms make it hard to carry out
day-to-day activities and responsibilities. They may cause problems in relationships, at
work, or in other important areas of life.7
In order to give a diagnosis of GAD, these symptoms also must be unrelated to any other
medical conditions and cannot be explained by a different mental disorder or by the
effect of substance use, including prescription medication, alcohol, or recreational drugs
CAUSES
There is no singular cause of generalized anxiety disorder (GAD) that has been
identified. Evidence has shown that multiple factors are usually at play, influencing the
development of GAD.1

Some of the common factors include things like genetic predisposition,
brain chemistry, family background, social influence, and life
experiences.

Genetics
Your genetics may play a role in determining whether or not you will develop GAD. As
with many other mental and medical health conditions, a person can be genetically
predisposed to developing certain symptoms. This is the same with generalized anxiety
disorder.
Technological and methodological advances have allowed researchers to examine the
role genes play in the development of GAD in more detail, but the research is still in
preliminary stages. Despite this, it has significant implications for anyone who
faces anxiety disorders.
We know, for example, that a person can have a genetic vulnerability to developing GAD
if certain genetic markers have been passed onto them. Vulnerability, in combination
with certain environmental factors, can trigger the development of symptoms.
Studies have shown that first degree relatives of someone with GAD are more likely to
develop mood and anxiety disorders in general, with a specific increased risk for
developing GAD.
First degree relatives would include family members most closely related to you, such as
a parent, sibling, or child.
Finally, women are more prone to anxiety disorders in general. In fact, statistics from
the ADAA show that women are actually twice as likely to be impacted by a generalized
anxiety disorder.
Although the condition typically begins around 30 years old, many of those who are
diagnosed are found to have been struggling with symptoms for years before seeing a
professional and being properly diagnosed. GAD comes on gradually, with the greatest
risk between childhood and middle age.
Brain Structure
The limbic system is a collection of brain structures that, among other functions, is
involved in the regulation of many of our basic emotional reactions. Although it can be
under the control of the "thinking" part of the brain, it can respond to stimuli on its own
as well.
The Amygdala
The amygdala, in particular, is the part of the limbic system involved in the automatic
fear response, as well as in the integration of memory and emotion.
Although a lot of research on amygdala function has been focused on anxiety disorders
like post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD),
there are some patterns of brain structure and function that have presented in research
as consistent for patients with GAD.
Understanding that the amygdala is an important player in people's ability to discern and
feel fear, it may not be a surprise that imaging studies of people diagnosed with GAD
show elevated amygdala activity during the processing of negative emotions.

It is this heightened activity within the amygdala that researchers believe might
influence the inaccurate interpretations of social behavior for patients with GAD.
People with GAD may inaccurately perceive a social cue or interaction as threatening
when it is not actually threatening.
Gray Matter
The volume of gray matter is another factor that has been researched in relation to GAD
and other anxiety and mood disorders. An increased volume of gray matter at certain
locations in the brain has been repeatedly found in people with GAD compared to
controls.
One area of the brain that consistently shows an increased volume of gray matter in
patients with GAD is called the right putamen.
Researchers found that a larger volume of gray matter in the right putamen was
positively correlated with childhood maltreatment.
In other words, the greater the report of childhood maltreatment, the greater the
likelihood of increased volume of gray matter in that area of their brain.
Life Experiences
Although genetic and biologic factors clearly contribute to the development of GAD, a
greater percentage of the risk for GAD lies in complex psychological, environmental, and
social factors.
Experiencing Trauma
Mental health researchers have found that trauma in childhood can increase a person's
risk of developing GAD.2
Difficult experiences such as physical and mental abuse,
neglect, the death of a loved one, abandonment, divorce, or isolation can all be
contributing factors.
When a person has gone through particularly hard experiences that leave them feeling
uncertain, humiliated, or apprehensive to trust others, it is understandable that they
may become anxious in a variety of situations in the future.
People with GAD have difficulty accurately interpreting threats. Experiences or
interactions that may seem harmless to most could feel emotionally threatening,
dangerous, and anxiety-producing for someone with GAD.
Interestingly, research has shown that life events that result in specific feelings of loss,
humiliation, entrapment, and danger are reliable predictors of the development and
onset of generalized anxiety disorder.
It is important for medical and mental health practitioners to gather family and social
history as this is information that can help lead to an accurate diagnosis.
Learned Behavior

Some behavioral scientists believe that anxiety is a learned behavior, suggesting that if
a person has a parent or caregiver who demonstrates anxious behavior, they may tend
to mirror that same anxious behavior.3
Children learn from caregivers and other important people close to them how to handle
challenging, stressful situations. When they model less effective methods of stressful
management, children tend to do the same. These early social learning experiences can
influence the development of long-lasting anxiety.
Societal Factors
Of people who are on social media, it has been shown that approximately 30% are
plugged into social media for 15 hours or more per week. Researchers are finding that
the use of social media, particularly in excess, can greatly impact mental health,
sometimes resulting in anxiety and depression.
Interacting with others through social media can also present us with the same
challenges as when we are interacting in people, such as feelings of loneliness, rejection,
abandonment, or humiliation.
People with GAD are less effective in accurately interpreting social cues and interactions,
leaving them to potentially feel a heightened sense of danger or rejection, even when
there is no observable threat present.4
Interactions through social media can be interpreted in these same inaccurate ways,
possibly even more so when we are, at times, missing essential non-verbal cues in
communication such as facial expressions, body language, and tone potentially
exacerbating GAD.
Lifestyle Factors
Additionally, lifestyle factors like the substances we use and our relationships can
increase the risk of experiencing anxiety.
Caffeine
Using everyday addictive substances like caffeine can heighten feelings of worry or
nervousness, contributing to the development of anxiety.5
Our culture tends to ask more
and more of us, pushing us to perform, and leaving us to fear feeling left behind, socially,
financially, physically, or otherwise.
Relying on caffeine sources such as coffee, tea, soda, and energy drinks can cause some
people to feel restless and anxious, especially when used in large quantities.
Relationships
Relationships can be a source of great comfort, but also pain. Relationships can be a
significant source of anxiety for women, in particular.
Women are twice as likely as men to develop GAD. Because women are more likely to
experience anxiety disorders, experts recommend that women and girls aged 13 and
older should be screened for anxiety during routine health exams.6

Research has shown that two factors contributing to anxiety, specifically related to
women, were being afraid of and/or humiliated by a current partner or
ex-partner. Dangerous and fearful experiences within intimate relationships can also
influence the development of anxiety.
Job Stress
Work can be a great source of stress and become a trigger in the development of
anxiety.7
Some employers expect extraordinarily high levels of performance and
productivity that can threaten a person's sense of employment security.
When looking for work, you may find yourself competing with many others who are
highly qualified and experienced, causing stress related to the ability to provide for
ourselves and your family. Career and work-related stress, particularly the loss of a job,
can be a significant source of heightened anxiety.
In general, the potential for developing anxiety-related conditions is increased during
periods of severe and prolonged stress—regardless of source.
For example, some people discover they have GAD while going through a challenging life
transition such as divorce or loss of a loved one.

Psychotherapy


Medication


Self-Help


The Best Option for You

Everyone experiences anxiety. But people with generalized anxiety disorder (GAD) are
frequently distracted by their worries, avoidant of activities that might stir up the
anxiety, and "on edge" without explanation. In most cases of GAD, the anxiety
negatively impacts the individual’s relationships and/or performance at school or work.
Treatment for GAD aims to help people feel better mentally and physically and to
increase engagement with the people, places, and situations that previously elicited
worry.
Given the far-reaching effect that anxiety can have on day-to-day functioning,
even low-grade anxiety that does not meet the threshold for a firm diagnosis can be
worth working on.

Press Play for Advice On Dealing With Anxiety
Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell
Mind Podcast, featuring radio host Charlamagne Tha God, shares how to manage
anxiety. Click below to listen now.
Subscribe Now: Apple Podcasts / Spotify / Google Podcasts
Psychotherapy
Psychotherapy is a popular form of treatment for GAD. "Talk therapy" can be performed
by a variety of mental health professionals, and though the approaches described below
can overlap, they are guided by differing theories and emphases.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy1
and one of
the most popular treatments for GAD. Proven to work for adults2
just as effectively as it does for younger patients,3
CBT focuses on present
difficulties and current situations. CBT is typically a short-term, structured
treatment that focuses on the interplay between the conscious thoughts, feelings,
and behaviors that perpetuate anxiety.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) is another present- and problem-focused
talk therapy used to treat GAD. Although similar to CBT, the goal of ACT is to reduce the
struggle to control anxious thoughts or uncomfortable sensations and increase
involvement in meaningful activities that align with chosen life values. ACT can produce
symptom improvement in people with GAD, and may be a particularly good fit for older
adults.4
Other Talk Therapies
Two other types of "talk therapy"—psychodynamic therapy and interpersonal
psychotherapy—can also be used in the treatment of GAD.
Psychodynamic psychotherapy, also known as insight-oriented therapy, is based on the
idea that thoughts and emotions that are outside of our consciousness (i.e., outside of
our awareness) can lead to internal conflict and manifest as anxiety.
Interpersonal psychotherapy (IPT) is a time-limited, present-focused treatment based
on the assumption that symptoms may be caused or maintained by problems in
relationships, and that resolving these problems can help reduce symptoms.
What Is Panic Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), panic
disorder is a type of anxiety disorder that is characterized by intense, recurrent, and
unexpected panic attacks.1
Fear and anxiety can be normal reactions to specific situations and stressful events.
Panic disorder differs from this normal fear and anxiety because it is often extreme, and
may seem to strike out of the blue.
A person with panic disorder may experience symptoms such as severe feelings of terror,
rapid breathing, and rapid heart rate. People with panic disorder may experience these
attacks unexpectedly and for no apparent reason, but they can also be preceded by
some sort of triggering event or situation.
The National Institute of Mental Health (NIMH) reports that approximately 2.7% of the
adult U.S. population experiences panic disorder each year. Approximately 44.8% of
these individuals experience cases of panic disorder that are classified as "severe."

Symptoms
According to the Anxiety and Depression Association of American, nearly six million
American adults experience the symptoms of panic disorder during any given year.2
While panic disorder can strike at any point in life, symptoms most often begin during
late adolescence or early adulthood and affect twice as many women as men.
Many people living with panic disorder describe feeling as though they are having a heart
attack or on the verge of dying, and experience some or all of the following symptoms:3
 Chest pain
 Dizziness
 Feelings of extreme terror that occur suddenly without warning
 Numbness in the hands and feet
 Pounding heart
 Rapid breathing
 Sweating
 Trembling
 Weakness
Panic disorder can lead to serious disruptions in daily functioning and make it difficult to
cope with normal, everyday situations that may trigger feelings of intense panic and
anxiety.
The Symptoms of Panic Disorder
Diagnosis
To be diagnosed with a panic disorder, a person must experience recurrent and often
unexpected panic attacks, according to the DSM-5. In addition, at least one attack
needs to be followed by one month or more of the person fearing that they'll have more
attacks.
Your healthcare provider will also need to rule out other potential causes of your
symptoms, including:
 The direct physiological effects of a substance (such as drug use or a medication)
or a general medical condition
 Another mental disorder, including social phobia or another specific phobia,
obsessive-compulsive disorder (OCD), post-traumatic stress
disorder (PTSD), or separation anxiety disorder
DSM-5 Criteria for Diagnosing Panic Disorder
Avoidance Behaviors and Panic Disorder
Because panic disorder often leads to a person avoiding certain situations or objects, it
can also lead to the development of phobias. For example, a person living with panic
disorder might stop leaving home in order to prevent having an attack or losing control
in public.
In time, this person might develop agoraphobia, a marked fear of being in a variety of
situations outside of the home in which escape might be difficult or help might not be
available if debilitating symptoms develop.

While previous versions of the DSM categorized panic disorder as occurring with or
without agoraphobia, the newest edition of the diagnostic manual lists the two as
distinct and separate disorders.
Causes
Although the exact causes of panic disorder are not clearly understood, many mental
health experts believe that a combination of environmental, biological, and
psychological factors play a role:
 Age: Panic disorder typically develops between the ages of 18 and 35.1
 Gender: According to the National Institute of Mental Health, women have more
than twice the risk of panic disorder than men.4
 Genetics: If you have a close biological family member with panic disorder, you
are much more likely to develop the condition. Although up to half or more of
people with panic disorder do not have close relatives with the condition.5
 Trauma: Experiencing a traumatic event, such as being the victim of physical or
sexual abuse, can increase risk of panic disorder as well.1
 Life transitions: Going through a life transition or difficult life event, including
the death of a loved one, divorce, marriage, having a child, or losing a job may
increase also risk.6
What Are Risk Factors for Panic Disorder?
Types of Panic Attacks
There are two main types of panic attacks: unexpected and expected. People with panic
disorder most commonly experience unexpected panic attacks, but some do experience
both types.
 Unexpected panic attacks occur suddenly without any external or internal
cues. In other words, they seem to happen "out of the blue" when you feel
relaxed.
 Expected panic attacks occur when someone is exposed to a situation for
which they carry fear. For example, having a panic attack during take-off on a
plane.
An Overview of the Types of Panic Attacks
Treatment
Panic disorder, like other anxiety disorders, is often treated with psychotherapy,
medication (antidepressants or anti-anxiety drugs), or a combination of both.
Psychotherapy
Psychotherapy for panic disorder can include several different approaches, including:
 Cognitive behavioral therapy (CBT) can help people with panic disorder
learn new ways of thinking and reacting to anxiety-provoking situations. As part
of the CBT process, therapists help clients identify and challenge negative or
unhelpful patterns of thinking and replace these thoughts with more realistic and
helpful ways of thinking.

 Exposure therapy involves progressively exposing people with panic disorder
to the object and situations that trigger a fear response while teaching and
practicing new relaxation strategies.
 Panic-focused psychodynamic psychotherapy (PFPP) aims to uncover
underlying conflicts and experiences that may have influenced the person’s
development of panic and anxiety.7
Medication
Medications for panic disorder fall into one of two categories: antidepressants and
anti-anxiety drugs.8
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class
of antidepressants used for panic disorder, including:
 Paxil (paroxetine)
 Prozac (fluoxetine)
 Celexa (citalopram)
 Zoloft (sertraline)
Benzodiazepines are a commonly prescribed class of anti-anxiety medication that can
help reduce the severity of panic attacks acutely, including:
 Ativan (lorazepam)
 Klonopin (clonazepam)
 Valium (diazepam)
 Xanax (alprazolam)
What Is Selective Mutism?
By
Arlin Cuncic
Updated on September 21, 2022
Medically reviewed by
Aron Janssen, MD
Print

Brand X Pictures / Johner Images / Getty Images
Table of Contents
VIEW ALL
Table of Contents



Symptoms


Diagnosis


Causes


Treatment

Selective mutism (SM) is a childhood anxiety disorder characterized by an inability to
speak or communicate in certain settings. The condition is usually first diagnosed in
childhood. Children who are selectively mute fail to speak in specific social situations,
such as at school or in the community.
It is estimated that less than 1% of children have selective mutism. The first described
cases date back to 1877 when German physician Adolph Kussmaul labeled children who
did not speak as having "aphasia voluntaria."
Selective mutism can have a number of consequences, particularly if it goes untreated.
It may lead to academic problems, low self-esteem, social isolation, and social anxiety.
How to Communicate With a Nonspeaking Autistic Person
Symptoms
If you believe that your child may be struggling with selective mutism, look for the
following symptoms:
 Expression of a desire to speak that is held back by anxiousness, fear, or
embarrassment
 Fidgeting, eye contact avoidance, lack of movement or lack of expression when
in feared situations
 Inability to speak in school and other specific social situations
 Use of nonverbal communication to express needs (e.g., nodding head,
pointing)
 Shyness, fear of people, and reluctance to speak between 2 and 4 years of age
 Speaking easily in certain situations (e.g., at home or with familiar people), but
not others (e.g., at school or with unfamiliar people)
While these behaviors are self-protective, other children and adults may often perceive
them as deliberate and defiant.1
Recognizing Symptoms of Anxiety in Children
Diagnosis
Although selective mutism is believed to have its roots in anxiety, it was not classified as
an anxiety disorder until the fifth edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) published in 2013.
The use of the term "selective" was adopted in 1994, prior to which the disorder was
known as "elective mutism." The change was made to emphasize that children with
selective mutism are not choosing to be silent, but rather are too afraid to speak.

The primary criterion for a diagnosis of selective mutism is a consistent failure to speak
in specific social situations in which there is an expectation of speaking (e.g., school),
despite speaking in other situations.
In addition to this primary symptom, children must also display the following:
 Symptoms of selective mutism must have been present for at least one month,
and not simply the first month of school.
 Your child must understand spoken language and have the ability to speak
normally in some situations (usually at home with familiar people).
 Finally, a lack of speech must interfere with your child's educational or social
functioning.
Children who stop talking temporarily after immigrating to a foreign country or
experiencing a traumatic event would not be diagnosed with selective mutism.
Causes
Because the condition tends to be quite rare, risk factors for the condition are not fully
understood. It was once believed that selective mutism was the result of childhood
abuse, trauma, or upheaval.
Research now suggests that the disorder is related to extreme social anxiety and that
genetic predisposition is likely.2
Like all mental disorders, it is unlikely that there is one
single cause.
Kids who develop the condition:
 Tend to be very shy
 May have an anxiety disorder
 Fear embarrassing themselves in front of others3
Other potential causes include temperament and the environment. Children who are
behaviorally inhibited or who have language difficulties may be more prone to
developing the condition. Parents who have social anxiety and model inhibited behaviors
may also play a role.
Selective mutism also often co-occurs with other disorders including:4
 Anxiety
 Depression
 Developmental delays
 Language problems
 Obsessive-compulsive disorder (OCD)
 Panic disorder
Treatment
Selective mutism is most receptive to treatment when it is caught early. If your child has
been silent at school for two months or longer, it is important that treatment begin
promptly.
When selective mutism is not caught early, there is a risk that your child will become
used to not speaking, and as a result, being silent will become a way of life and more
difficult to change.
Treatment for selective mutism may include psychotherapy, medication, or a
combination of the two.
Psychotherapy
A common treatment for selective mutism is the use of behavior management
programs.2
Such programs involve techniques like desensitization and positive
reinforcement, applied both at home and at school under the supervision of a
psychologist.
Medication
Medication may also be appropriate, particularly in severe or chronic cases, or when
other methods have not resulted in improvement. The choice of whether to use
medication should be made in consultation with a doctor who has experience prescribing
anxiety medication for children.
SOCIAL ANXIETY DISORDER

Symptoms of Social Anxiety Disorder
By
Arlin Cuncic
Updated on April 28, 2022
Daniel B. Block, MD
Print
People with social anxiety disorder (SAD) experience significant and chronic fear of
social or performance-related situations where they might be embarrassed, rejected, or
scrutinized. In these situations, people with SAD almost always experience physical
anxiety symptoms.
Although they know their fear is unreasonable, they can't seem to do anything to stop it,
so they either avoid these situations altogether or get through them while feeling
intense anxiety and distress. In this way, social anxiety disorder extends
beyond everyday shyness and can be extremely impairing.
This article explains the common symptoms of social anxiety disorder. It also describes
potential complications and how symptoms may present differently in children.

Verywell / Brianna Gilmartin
Signs & Symptoms
Symptoms of social anxiety disorder typically fall within three different areas. While
everyone's experience is different, symptoms of the condition typically result in physical,
cognitive, and behavioral symptoms.
Physical Symptoms
The physical symptoms of SAD can be extremely distressing.1
Common physical
symptoms include:
 Blurred vision
 Blushing
 Chest pain and tightness
 Chills
 Diarrhea
 Dizziness
 Dry mouth
 Feelings of unreality (derealization) or feelings of detachment from oneself
(depersonalization)
 Headaches
 Heart pounding (palpitations) and racing (tachycardia)
 Lump in the throat
 Muscle tension
 Nausea
 Paresthesias (tingling)
 Ringing in the ears
 Shaking
 Shortness of breath
 Sweating
 Trembling voice
In some cases, these physical symptoms may become so severe that they escalate into
a full-blown panic attack. However, unlike those with panic disorder, people with SAD
know that their panic is provoked by fears of social and performance-related situations
rather than fears about the panic attacks themselves.
Cognitive Symptoms
Social anxiety disorder also involves cognitive symptoms, which are dysfunctional
thought patterns. If you have this condition, you might find that you are bothered by
negative thoughts and self-doubt when it comes to social and performance-related
situations.2
Below are some common symptoms that you may experience:
 Negative beliefs: Strongly held beliefs about your inadequacy in social and/or
performance-related situations3
 Negative bias: A tendency to discount positive social encounters and magnify
the social abilities of others
 Negative thoughts: Automatic negative evaluations about yourself in social or
performance-related situations4
For example, imagine you start a new job or arrive on the first day of a new class. The
instructor or manager asks everyone to introduce themselves to the group.
If you have social anxiety disorder, you may start to have negative thoughts such as,
“Everyone else looks so much more relaxed,” “What if I say something dumb?” or “What
if everyone notices my voice shaking?”
These thoughts start to rapidly spiral out of control to the point that you don't hear
anything anyone else has said. When it comes to your turn, you say as little as possible
and hope that no one has noticed your anxiety.
Negative thought patterns can also erode your self-esteem over time, so it's important
to seek treatment.
Behavioral Symptoms
Social anxiety disorder can also cause you to act in certain ways. In many cases, you
might find yourself making choices based on fear and avoidance rather than your actual

preferences, desires, or ambitions. For example, you may drop a class to avoid doing a
presentation or turn down a job promotion because it meant increased social and
performance demands.
Below are some common behavioral symptoms:5
 Avoidance: The things done or not done to reduce anxiety about being in social
or performance-related situations
 Safety behaviors: Actions taken to control or limit experiences of social or
performance-related situations
 Escape: Leaving or escaping from a feared social or performance situation.
What Are Avoidance Behaviors?
Complications & Comorbidities
Social anxiety disorder can lead to serious complications in your life. It can result in
panic attacks, which can be frightening and contribute to increased feelings of fear and
avoidance.
Avoidance of social situations can make it difficult to maintain interpersonal
relationships. This can affect your ability to work, attend school, and participate in other
social events. It can contribute to feelings of isolation and loneliness, which can have a
detrimental impact on your health and well-being.
In severe cases, if left untreated, social anxiety disorder can increase your risk of having
a poor quality of life. You might have few or no friends and no romantic relationships. It
may even lead you to drop out of school or quit jobs, and use alcohol to tolerate anxiety.
Symptoms in Kids
Social anxiety disorder in children and teens may appear differently than in
adults.6
Young children with the disorder may cling to a parent, have a tantrum when
forced into a social situation, refuse to play with other kids, cry, or complain of an upset
stomach or other physical problem.
Behavioral inhibition during childhood is often a precursor for later social anxiety.7
Later
during adolescence, teens with SAD may avoid group gatherings altogether or show
little interest in having friends.
Understanding the Causes of Social
Anxiety Disorder
By
Arlin Cuncic
Updated on February 19, 2021
Steven Gans, MD
Print
Table of Contents
Table of Contents

Genetic


Environmental


Societal



Brain Structure/Biological

If you have been diagnosed with social anxiety disorder (SAD), you may wonder what
caused you to develop the illness. Rather than there being a single causative factor, it is
likely a complex interplay of variables that result in the disorder.

Illustration by Brianna Gilmartin, Verywell
Genetic
If you are diagnosed with SAD, you probably have specific genes that made you more
prone to developing the disorder. If you have a first degree relative with SAD, you may
also be two to six times more likely to develop the disorder.1
The genetic component of social anxiety disorder is also known as the “heritability” of
the disorder. Although heritability rates can vary a great deal in studies, it has been
estimated at around 30 to 40 percent, meaning that roughly one-third of the underlying
causes of SAD comes from your genetics.
Heritability is the proportion of variation in a phenotype (trait, characteristic, or physical
feature) that is thought to be caused by genetic variation among individuals. The
remaining variation is usually attributed to environmental factors. Studies of heritability
typically estimate the proportional contribution of genetic and environmental factors to
a particular trait or feature.
So far, researchers have not found a particular genetic makeup linked to SAD. They
have, however, found certain genes linked to other anxiety disorders such
as agoraphobia and panic disorder.2
Environmental
The psychosocial causes of social anxiety disorder (SAD) include factors in the
environment that influence you as you grow up. If one of your parents has social anxiety
disorder (SAD), then you are more likely to develop the disorder yourself. This could be
due to both genetic and environmental influences.1
Psychologists have developed theories about how children may become socially anxious
through learning.
Ways Children Learn Social Anxiety
 Direct conditioning: Did you forget your lines in the class play? Did other kids
make fun of you or were you the victim of constant teasing or bullying? While it
is not a necessary trigger, going through an early traumatic event may have an
impact on the development of social anxiety, sometimes years later.
 Observational learning: If you did not experience a traumatic event yourself,
did you see someone else in a traumatic social situation? For those already
vulnerable to the disorder, this may have the same impact as going through the
situation firsthand.
 Information transfer: Fearful and socially anxious parents unknowingly
transfer verbal and non-verbal information to their children about the dangers of
social situations. If your mother worries a lot about what other people think of
her, chances are you have developed some of this same anxiety yourself.
Your upbringing can also impact the likelihood that you will develop SAD. You are more
likely to develop the disorder if:
 As a child, you were not exposed to enough social situations and were not
allowed to develop appropriate social skills.
 One or both of your parents was rejecting, controlling, critical, or overprotective.
Children that do not form a proper attachment to their primary caregiver are at
greater risk because they can't calm and soothe themselves when in stressful
situations.
Behavioral Inhibition in Childhood
Do you know a toddler or young child who always becomes extremely upset when
confronted with a new situation or unfamiliar person? When faced with these types of
situations does the child cry, withdraw, or seek the comfort of a parent?
This type of behavior in toddlers and young children is known as behavioral inhibition.
Children who show behavioral inhibition as a toddler are at greater risk for developing
SAD later in life.3
Because this temperament shows up at such a young age, it is likely an inborn
characteristic and the result of biological factors.
If you are concerned that your child is excessively withdrawn or fearful in new situations,
it may be helpful to discuss your worries with a professional. Since we know that
behaviorally inhibited toddlers are more likely to become socially anxious children and

socially phobic adults, any kind of early intervention may help prevent more serious
problems later in life.
Societal
Societal factors that can influence the development of social anxiety include growing up
in a culture with a strong collectivistic orientation, such as Japan or Korea. The
syndrome taijin kyofusho in these cultures involves a fear of making other people
uncomfortable and reflects a culture in which concern for how you fit as part of the larger
group is emphasized.1
What Is Taijin Kyofusho?
Brain Structure/Biological
Just as x-rays are used to “see inside” your body, the same can be done for your brain.
Medical researchers use a technique called “neuroimaging” to create a picture of the
brain. Newer techniques can look not only at brain structure but at types of functions in
specific regions of the brain.
For mental disorders, researchers may look differences in blood flow in specific areas of
the brain for people who are known to have a particular disorder.
We know that four areas of the brain are involved when you experience anxiety.
Brain Areas Involved in Anxiety
 The brain stem (controls your heart rate and breathing)
 The limbic system (effects your mood and anxiety level)
 The prefrontal cortex (helps you to appraise risk and danger)
 The motor cortex (controls your muscles)
A study of blood flow in the brain published in 2001 found differences in the brains of
social phobics when speaking in public. For this study, they used a type of neuroimaging
called “Positron Emission Tomography” (PET).4
The PET images showed that people with social anxiety disorder had increased blood
flow in their amygdala, a part of the limbic system associated with fear.
In contrast, the PET images of people without SAD showed increased blood flow to the
cerebral cortex, an area associated with thinking and evaluation. It seems that or people
with social anxiety disorder, the brain reacts to social situations differently than people
without the disorder.
Neurotransmitters
If you have social anxiety disorder, there are likely imbalances of certain chemicals in
your brain, known as neurotransmitters. These neurotransmitters are used by your
brain to send signals from one cell to another.
Neurotransmitters Involved in Anxiety
 Norepinephrine
 Serotonin
 Dopamine
 Gamma-aminobutyric acid (GABA)
People with social anxiety disorder have been shown to have some of the same
imbalances of these neurotransmitters as people with agoraphobia and panic disorder.5
Understanding how these brain chemicals relate to social anxiety disorder is important
to determine the best medications for treatment.
Treating Social Anxiety Disorder
By
Arlin Cuncic
Updated on July 18, 2020

Akeem Marsh, MD
Print
Table of Contents
Table of Contents

Prescription Medications


Psychological Therapies


Complementary Treatments


Finding Treatment

Treatments for social anxiety disorder (SAD) depend on the severity of your emotional
and physical symptoms and how well you function daily. The length of treatment also
varies. Some people may respond well to initial treatment and not require anything
further, while others may require some form of support throughout their lives.
Both medication and therapy have been shown effective in treating social anxiety
disorder. Social anxiety that occurs in all situations responds best to a combination of
medication and therapy, while therapy alone is often sufficient for people with anxiety
specific to one type of performance or social situation.1 2
So, if you've been diagnosed or
think you may have SAD, know that it's possible to overcome it.

Illustration by Brianna Gilmartin, Verywell
Prescription Medications
Several different types of medications are prescribed to treat SAD. Each has its
advantages and disadvantages depending on your particular situation.
A systematic review of the effectiveness of medication in SAD treatment showed a small
to medium-sized effect—with all of the following categories of medications showing
improvements.3
This means that several different types of medication may be helpful in improving
symptoms of social anxiety disorder, and that one may be a useful form of treatment for
you.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are considered the first-line pharmacotherapy treatment due to their tolerable
side effects and ease of administration. However, due to the potential for withdrawal
effects, SSRIs should always be tapered when ending treatment.4
Options include:
 Paxil CR (paroxetine)
 Luvox CR (fluvoxamine)
 Zoloft (sertraline)
 Lexapro (escitalopram)
 Celexa (citalopram)
 Prozac (fluoxetine)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs are a class of antidepressants used in anxiety treatment that act on the
neurotransmitters serotonin and norepinephrine. Options include:
 Effexor XR (venlafaxine)
 Cymbalta (duloxetine)
 Pristiq (desvenlafaxine)
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs were once considered the most useful treatment for social anxiety disorder;
however, these medications carry with them the risk of serious side effects if dietary and
medication guidelines are not followed. Options included:
 Nardil (phenelzine)
 Parnate (tranylcypromine)
 Marplan (isocarboxazid)
Beta Blockers
Beta blockers are usually taken orally prior to an anxiety-inducing event such as a
performance to reduce symptoms of anxiety such as rapid heart rate, hand tremors, and
the “butterflies in the stomach” feeling. Options include:
 Inderal (propranolol)
 Tenormin (atenolol)
Beta blockers are useful in situations that require mental sharpness because they do not
have adverse effects on cognitive ability.
Benzodiazepines
Benzodiazepines are mild tranquilizers that alleviate the symptoms of anxiety by
slowing down the central nervous system. Although fast-acting and well-tolerated,
benzodiazepines have the potential to be habit-forming and should not be prescribed for
someone with a substance abuse disorder. Options include:
 Ativan (lorazepam)
 Valium (diazepam)
 Xanax (alprazolam)
 Klonopin (clonazepam)
This class of medications is not considered the first-line of treatment for social anxiety
disorder.
Other Anxiety Medications
There are several other medication options doctors may consider, including:
 Vistaril (hydroxyzine)
 BuSpar (buspirone hydrochloride)

If you are not sure of your treatment options, talk to your doctor about the potential use
of medication for your particular situation.
Psychological Therapies
Psychotherapy can be used alone or together with prescription medications. The various
options are psychological methods geared towards helping someone change their
behavior to something desirable. There is a common stigma associated with going to
a psychotherapist or psychiatrist, but millions of people go and benefit from it. There is
nothing to be embarrassed or ashamed of.
You can try asking your primary care physician for a referral to a therapist or mental
health professional. There is also an increasing number of websites that can help match
you with a professional based on your symptoms, schedule, and health insurance.
The Best Online Therapy Programs We've tried, tested and written unbiased reviews of
the best online therapy programs including Talkspace, Betterhelp, and Regain.
Try taking a few notes on your thoughts and feelings so you have a starting point for
discussion on your first appointment. Though it may feel difficult at first, the more
honest you are with your doctor, the more progress you can begin to make with
managing your anxiety.
Diagnostic Criteria for a Specific
Phobia
By
Lisa Fritscher
Updated on May 28, 2021
Daniel B. Block, MD


Print

SDI Productions / Getty Images
Table of Contents
Table of Contents

DSM-5 Criteria


Types of Specific Phobias


Causes


Treatments


Preparing for Treatment

A specific phobia is an intense and irrational fear of a specified object or situation. A
phobia is an excessive and overwhelming fear that results in avoidance or extreme
distress. Some phobias are centered on a specific fear object, while others are complex
and tied to different situations or circumstances.
Phobias affect about 19 million adults, and women are two times more likely than men
to have a specific phobia.1
Some people experience multiple specific phobias
simultaneously. Approximately 75% of people with a specific phobia fear more than one
object or situation.2
DSM-5 Criteria for a Specific Phobia
Diagnosis
A fear and a phobia are not the same, so it's important to know the difference. Many
people experience fears or aversions to objects or situations, but this does not
necessarily mean that they would be diagnosed with a specific phobia.
Therapists cannot use a lab test to make this diagnosis, so they and other mental health
professionals consult the DSM-5 (Diagnostic and Statistical Manual, 5th Edition). This
guide provides diagnostic criteria for specific phobia from the American Psychiatric
Association:3
 Unreasonable, excessive fear: The person exhibits excessive or
unreasonable, persistent and intense fear triggered by a specific object or
situation.
 Immediate anxiety response: The fear reaction must be out of proportion to
the actual danger and appears almost instantaneously when presented with the
object or situation.
 Avoidance or extreme distress: The individual goes out of their way to avoid
the object or situation, or endures it with extreme distress.
 Life-limiting: The phobia significantly impacts the individual’s school, work, or
personal life.
 Six months duration: In children and adults, the duration of symptoms must
last for at least six months.
 Not caused by another disorder: Many anxiety disorders have similar
symptoms. A doctor or therapist would first have to rule out similar conditions
such as agoraphobia, obsessional-compulsive disorder (OCD), and separation
anxiety disorder before diagnosing a specific phobia.
Recognizing Fear As Irrational Is Not Required
In previous DSM editions, adults with specific phobias had to recognize that their fears
are out of proportion to reality, but children did not. The 2013 edition now says the
adults no longer have to recognize the irrationality of their behavior to receive a
diagnosis.

Types of Specific Phobias
There are five types of specific phobias:3
. Natural/environment type: These are phobias of nature, weather, and
environmental events or situations. These can include the fear of thunder and
lightning (astraphobia) or water (aquaphobia).
. Injury type: This type of fear is related to a fear of physical harm or injury.
These include a fear of the dentist (dentophobia) or injections (trypanophobia).
. Animal type: These fears are centered on animals or insects. This can include
the fear of dogs (cynophobia), snakes (ophidiophobia),
and insects (entomophobia).
. Situational type: This type of phobia centers on fears triggered by specific
situations. These include the fear of washing (ablutophobia) and enclosed
spaces (claustrophobia).
. Other types: Fears that don't fit into the other four types are included in this
category. This can include things such as a fear of dolls, vomiting, or loud
sounds.
Causes
There are a number of different factors that can contribute to the development of
specific phobias. These include:
 Temperament: Research suggests that people who exhibit more behavioral
inhibition have a higher risk for a variety of anxiety disorders, including specific
phobias.4
 Genetics: People who have a family member with an anxiety disorder or phobia
are more likely to also develop some type of phobia.5
 Experiences: Stressful or traumatic experiences can also play a role in the
formation of a phobia. A single incidence of being bitten by a dog, for example,
can play a role in the development of a fear of dogs.
What Causes Phobias to Develop?
Treatment
While specific phobias can be serious and debilitating, effective treatments are available.
These can help reduce or even eliminate symptoms. They include:
Medication
While medication is not usually used on its own to treat phobias, it may sometimes be
prescribed to help people manage physical and emotional reactions associated with
phobias. Such medications are usually most effective when paired with psychotherapy.
Psychotherapy
There are a number of psychotherapy techniques that may be used to treat phobias, but
exposure therapy and cognitive-behavioral therapy (CBT) are the two that are more
commonly used.
 Exposure therapy involves gradual and progressive exposure to the feared
object or situation.6
Such exposure is paired with relaxation strategies until the
fear reaction is reduced or extinguished.
 Cognitive-behavioral therapy involves helping people learn to identify and
then change the automatic negative thoughts that contribute to phobic
reactions.
The DSM-5 states that people with specific disorders also have an elevated risk for
suicide. These phobias also tend to commonly occur alongside other mental health
conditions including panic disorder, post-traumatic stress disorder (PTSD),
and substance use disorder.2
Because of this, getting appropriate treatment is essential.
If you are having suicidal thoughts, contact the National Suicide Prevention
Lifeline at 988 for support and assistance from a trained counselor. If you or a loved
one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Preparing for Treatment

If you have decided it's time to seek professional help for your fear, take some time to
prepare yourself for your first appointment. To make the most of your appointment, and
help your therapist determine if you have a fear or a phobia, create three lists:
. Symptoms: Make a list of physical and psychological symptoms, including your
trigger, how you cope with your fear, and things that make your anxiety better
or worse.
. Personal life: Make a list of anything stressful going on in your life, including
relationship issues or trouble at work. Listing new situations that seem like a
positive thing, including promotion or a budding romance, is also important, as
good news can cause anxiety, too.
. Medication and supplements: Make a list of all medication and supplements
you take regularly, such as vitamins and herbal teas. These substances can
affect your mental state and interfere with treatment.
What Is Obsessive-Compulsive
Disorder (OCD)?
By
Owen Kelly, PhD
Daniel B. Block, MD
Print

Peter Dazeley / Getty Images
Table of Contents
VIEW ALL
Table of Contents

What Is OCD?


Symptoms


Diagnosis


Causes


Types

What Is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by
obsessions and compulsions that interfere with daily life. OCD was formerly classified as
an anxiety disorder because people affected by this mental illness often experience
severe anxiety as a result of obsessive thoughts. They may also engage in extensive
rituals in an attempt to reduce the anxiety caused by obsessions.
In the newest edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), OCD was moved to its own disorder class of "Obsessive-Compulsive
and Related Disorders." Related conditions in the class include body-dysmorphic
disorder, hoarding disorder, and trichotillomania.
Symptoms
Symptoms of OCD usually appear gradually and can be long-lasting if not treated.
People with OCD may experience symptoms of obsessions, compulsions, or both. Such
symptoms interfere with many areas of life including school, work, relationships, and
normal daily functioning.
Obsessions
Obsessions are thoughts, images, or ideas that won't go away, are unwanted, and are
extremely distressing or worrying ("What if I become infected with a deadly disease?" or
"What if I hurt someone?").
Some common symptoms of obsessions include:
 Aggressive thoughts about other people or one's self
 A need to have everything in a certain order
 Fear of germs
 Unwanted thoughts of forbidden or taboo topics such as sex, religion, or harming
others
Compulsions
Compulsions are behaviors that have to be done over and over again to relieve anxiety.
Compulsions are often related to obsessions. For example, if you are obsessed with
being contaminated, you might feel compelled to wash your hands repeatedly. However,
this is not always the case.
Some common compulsions include:
 Counting things over and over again
 Excessive washing or cleaning
 Ordering things in a particular or symmetrical way
 Repeated checking (such as checking that the door is locked or that the oven is
off)

Diagnosis
It is important to be aware that not all habits or repetitive behaviors are synonymous
with compulsions. Everyone has repeated thoughts or engages in double-checking
things from time to time. In order to be diagnosed with OCD, their experience is
characterized by:1
 An inability to control their thoughts or behaviors, even when they recognize
that they are excessive or irrational
 Spending an hour or more a day on these obsessions and compulsions
 Experiencing significant problems and disruptions in daily life because of these
thoughts and behaviors
 Not gaining pleasure from thoughts or behaviors, but engaging in compulsive
behaviors may provide a brief relief from the anxiety that the thoughts cause
OCD is a relatively common disease that affects about 2.3% of people over their lifetime.
It is experienced equally by men and women and affects all races and cultures.2
OCD usually begins around late adolescence/young adulthood, although young children
and teenagers can also be affected. Parents and teachers often miss OCD in young
children and teenagers, as they may go to great lengths to hide their symptoms.
Causes
The exact causes of OCD are not known, but there are a few factors that are believed to
play a role.
 Biological factors: One theory is that OCD comes from a breakdown in the
circuit in the brain that filters or "censors" the many thoughts, ideas, and
impulses that we have each day. If you have OCD, your brain may have difficulty
deciding which thoughts and impulses to turn off. As a result, you may
experience obsessions and/or compulsions. The breakdown of this system may
be related to serotonin abnormalities.3
 Family history: You may also be at greater risk if there is a family history of the
disorder. Research has shown that if you, a parent, or a sibling have OCD, there
is a 25% chance that another immediate family member will also have it.4
 Genetics: Although a single "OCD gene" has not been identified, OCD may be
related to particular groups of genes.
 Stress: Stress from unemployment, relationship difficulties, problems at school,
illness, or childbirth can be strong triggers for symptoms of OCD.
People who are vulnerable to OCD describe a strong need to control their thoughts and
a belief that strange or unusual thoughts mean they are going crazy or will lose control.
While many people can have strange or unusual thoughts when feeling stressed, if you
are vulnerable to OCD, it may be difficult to ignore or forget about these thoughts. In
fact, because these thoughts seem so dangerous, you end up paying even more
attention to them, which sets up a vicious cycle.
Understanding Risk Factors for OCD
Types
Obsessive-compulsive disorder can present in a few different ways. Some people
experience only obsessions, some only compulsions, while others experience both.
There are no official subtypes of OCD, but research suggests that the most common
obsessions and compulsions tend to center on:5
 Cleanliness or fear of contamination
 A need for order, symmetry, or perfection
 Taboo thoughts
 Collecting or hoarding
Some other types of OCD that people may experience include symptoms that center on
checking things repeatedly, counting certain objects, and ruminating on certain
thoughts or topics.
Parents should also be aware of a subtype of OCD in children exacerbated or triggered
by strep throat, in which the child's own immune system attacks the brain. This Pediatric
Autoimmune Neuropsychiatric Disorder (PANDAS) form of OCD accounts for 25% of the
children who have OCD.

Unlike normal OCD, which develops slowly, PANDAS OCD develops quickly and has a
variety of other symptoms not associated with typical cases of OCD.
Treatment
Treatments for OCD may include medications, psychotherapy, or a combination of the
two.
Medication
There are a variety of medications that are effective in reducing the frequency and
severity of OCD symptoms. Many of the medications that are effective in treating OCD,
such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Anafranil
(clomipramine), and Luvox (fluvoxamine) affect levels of serotonin.
Psychotherapy
Psychological therapies are also highly effective treatments for reducing the frequency
and intensity of OCD symptoms. Effective psychological treatments for OCD emphasize
changes in behavior and/or thoughts.
When appropriate, psychotherapy can be done alone or combined with medication. The
two main types of psychological therapies for OCD are cognitive behaviorial therapy
(CBT) and exposure and response prevention (ERP) therapy.
What Is Obsessive-Compulsive
Disorder (OCD)?
By
Owen Kelly, PhD
Daniel B. Block, MD
Print

Unlike normal OCD, which develops slowly, PANDAS OCD develops quickly and has a
variety of other symptoms not associated with typical cases of OCD.
Treatment
Treatments for OCD may include medications, psychotherapy, or a combination of the
two.
Medication
There are a variety of medications that are effective in reducing the frequency and
severity of OCD symptoms. Many of the medications that are effective in treating OCD,
such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Anafranil
(clomipramine), and Luvox (fluvoxamine) affect levels of serotonin.
Psychotherapy
Psychological therapies are also highly effective treatments for reducing the frequency
and intensity of OCD symptoms. Effective psychological treatments for OCD emphasize
changes in behavior and/or thoughts.
When appropriate, psychotherapy can be done alone or combined with medication. The
two main types of psychological therapies for OCD are cognitive behaviorial therapy
(CBT) and exposure and response prevention (ERP) therapy.
Causes and Risk Factors of PTSD
By
Matthew Tull, PhD

Updated on April 21, 2021
Steven Gans, MD
Print
People often use the word "traumatic" in a general sense when they are describing very
stressful life events. For example, the American Psychological Association (APA) defines
"trauma" as a person's emotional response to an extremely negative (disturbing) event.
However, mental health professionals define traumatic events in very specific ways. The
guidelines they use have changed and continue to evolve as their understanding of what
constitutes a traumatic event has increased. This understanding is especially important
when they are trying to learn whether or not a person may have post-traumatic stress
disorder (PTSD).

Illustration by JR Bee, Verywell
The DSM Definition of a Traumatic Event
Compared to previous editions of the Diagnostic and Statistical Manual of Mental
Disorders (DSM), the 5th edition more clearly details the elements of a traumatic event,
particularly within the framework of diagnosing PTSD.1
The DSM-5 defines PTSD triggers as exposure to actual or threatened:
 Death
 Serious injury
 Sexual violation
Furthermore, the exposure must result from one or more of the following situations, in
which the individual:
 Directly experiences the traumatic event
 Witnesses the traumatic event in person
 Learns that the traumatic event occurred to a close family member or close
friend (with the actual or threatened death being either violent or accidental)
 Experiences first-hand, repeated, or extreme exposure to aversive (unpleasant)
details of the traumatic event (does not learn about it through media, pictures,
television, or movies, except for work-related events)
Signs That Someone May Have Been Through a Traumatic
Event
Simply put, it depends. Even if you’re very close to the person, you might not notice
the common symptoms of trauma, which can include appearing shaken up and “out of it.”
A person may also dissociate or disconnect—for example, may not respond to your
questions or comments, as if he or she weren’t there.
However, other signs that a person is traumatized may be easier for you to spot:
 Anxiety, which may appear in the form of, for example, edginess, irritability,
poor concentration, mood swings, “night terrors,” or panic attacks
 Emotional outbursts or moods such as anger or sadness
 Physical signs can manifest as a racing heartbeat, fatigue, paleness, or lethargy.
Risk Factors
Trauma exposure is the initiating factor behind PTSD, however, there could be additional
influential elements to consider.
Not everyone who experiences trauma will develop post-traumatic stress disorder.
Although it is nearly impossible to determine with certainty who will experience PTSD
after trauma and who won't, we can consider the following risk factors that might
contribute to the likelihood of developing post-traumatic stress disorder.
Genetic Factors
Research continues to explore the role of genetics in the development of PTSD. There
have been studies showing genetic influence on the development of mental health
conditions such as schizophrenia, bipolar disorder, and major depressive disorder, and
researchers are finding genetic influence in the development of PTSD as well.2
Women are considered more likely to develop PTSD than men. The prevalence of PTSD
over the lifespan has been found to be 10 percent to 12 percent among women and 5
percent to 6 percent in men.
Researchers have found among European-American females in particular, close to
one-third (29 percent) of the risk for developing PTSD after a traumatic event was
influenced by genetic factors. The genetic risk rate was found to be much lower in
males.3
The first author of the study, Dr. Laramie Duncan, concluded that "PTSD may be one of
the most preventable of the psychiatric disorders." Understanding that not all people
who experience trauma will develop PTSD, she shares the importance of this genetic
research to be able to intervene quickly after trauma for those individuals who are
identified as more genetically at risk.
Current Research

What Are Anxiety Disorders.docx

What Are Anxiety Disorders.docx

Recommended

Recommended

More Related Content

Similar to What Are Anxiety Disorders.docx

Similar to What Are Anxiety Disorders.docx (10)

Recently uploaded

Recently uploaded (20)

What Are Anxiety Disorders.docx