Common features of anxiety disorder
Everyone experiences anxiety to a certain extent. However, there are instances where anxiety becomes too excessive, pervasive, and/or prolonged that it disrupts everyday life. This is when regular anxiety moves into the disordered category. In this post, I will discuss six common anxiety disorders, their causes, and provide some information on evidence-based strategies to tackle them. And we’ll start with the commonalities. There are certain aspects of anxiety disorders that are generally ubiquitous among all anxiety disorders.
1. Anxiety disorders are excessive. First and foremost, the anxiety that people experience when they have an anxiety disorder is excessive compared to the actual danger presented by the situation. For example, a person with a phobia of snakes may have a very strong reaction to even a picture of a snake.
2. Anxiety disorders are persistent. Diagnostic manuals usually indicate that an anxiety must be present for at least 6 months before it can be classified as a disorder.
3. Anxiety disorders are pervasive. This means that most – if not all – situations that contains the feared thing/object/situation will lead to fear or avoidance. For example, a person avoiding any situation associated with having to be in a plane.
4. Anxiety disorders are avoided or endured with great distress. People with an anxiety disorder will try to avoid the situation or, if they have to be in the situation, it is endured with great distress.
5. Anxiety disorders causes distress and/or impairment. This point is a common feature in all disorders because we want to make a distinction between something that is normative (like regular anxiety), and something that is a bonafide disorder. Therefore, it is diagnostically important that the anxiety causes a lot of distress and/or affects a person’s everyday life.
That’s a lot of commonalities. So what’s the main difference between anxiety disorders? The main difference that allows us to differentiate between anxiety disorders is the root of the fear. That is, what is 1) the objection/situation that the person fears and 2) what is the negative outcome that the person is afraid of happening?
Six Types of Anxiety Disorders
1. Social Anxiety Disorder. The main root of anxiety in social anxiety disorder is negative evaluation. People with social anxiety disorder are worried that someone(s) will judge them poorly (e.g., “they’ll think I’m stupid, boring, worthless”). This can occur in several different social situations, such as with unfamiliar people at a party, eating food in front of others, engaging in public speaking, among others. It is again important to recognize that anxiety can be present (most people are generally afraid of public speaking), but the fear and impairment must be above and beyond what people typically experience. For example, someone willing to fail out of their course to avoid a presentation at school is more likely to be diagnosed with social anxiety disorder.
2. Panic Disorder. People with panic disorder have experienced recurrent, unexpected panic attacks (i.e., sudden peaks of anxiety that happens within minutes and include symptoms like heart-racing, difficulty breathing, chest pain, tingling, fear of going crazy or doing, etc.). After these panic attacks, a person with panic disorder is afraid of getting more panic attacks or the consequences of a panic attack, such as worried of having a heart attack. These individuals will typically avoid situations where a panic attack might come, like public places or exercising.
3. Agoraphobia. The anxiety in agoraphobia is the fear of having panic, incapacitating, or embarrassing symptoms in situations without being able to ‘escape’. These can include: having a breakdown in public; peeing your pants; having a panic attack in a line, among others. Put more simply, people with agoraphobia are afraid they will be put in a bad position with no way to get help or get out if they need to. Common places that they would avoid, or need a friend to feel more comfortable, include: public transportation, being in public, elevators, standing in line, and being on planes. For some individuals, they may decide to avoid leaving the house to prevent any feared situations associated with agoraphobia from occurring.
4. Generalized Anxiety Disorder. Generalized anxiety disorder is unique because there is no specific fear. People with generalized anxiety disorder are typically excessively worried about a variety of things, such as family, relationships, work, health, and day to day activities (e.g., making appointments). Some think of generalized anxiety disorder as a ‘fear of the unknown’ and having low tolerance for uncertainty (e.g., “what if I can’t finish all my tasks”, “what if my son gets sick”, “what if I lose my job”?). The lack of perceived safety in their everyday lives makes people with generalized anxiety constantly worry.
5. Illness Anxiety Disorder. People with illness anxiety disorder are often worried about their health and possible signs being indicative of something worse. For example, that a headache might be a sign of an aneurysm or that they have cancer. A lot of time is often spent on researching possible illnesses and they seek reassurance from doctors regarding their else. However, they may not feel relieved even if the doctor prescribes a clean bill of health.
6. Specific Phobia. Specific phobias are exactly as they sound – an exaggerated fear response to a specific object, place, or situation. Examples include spiders (arachnophobia), acrophobia (fear of heights, claustrophobia (fear of enclosed spaces); trypanophobia (fear of needles), and many more.
Interestingly, two disorders can present with the same fear. For example, somebody who has a specific phobia for planes and somebody who has agoraphobia could both avoid planes or endure them with great distress. How might you differentially diagnosis between these two disorders? Well, one way is to ask the person what their fear is. A person with a specific phobia might say “I’m scared that the plane is going to crash, and I am going to die” whereas an agoraphobic thought might be “I’m afraid to have a panic attack and not be able to leave the plane”. In this case, the specific nature of the fear is different even if the situation (being on a plane) is the same.
Causes of anxiety disorders and how it is maintained
In many cases, people develop anxiety disorders through learned associations – either through lived experience or observed from other people. For example, if a child was bitten by a dog, then this would create a fear association between the dog and danger. Fears can also be learned through observation and teaching – for example, if the child sees that their parent fears planes and tells the child that planes are dangerous. The diathesis-stress model provides an explanation for how disorders develop. Diatheses refer to vulnerabilities that make it more likely for somebody to have an anxiety disorder, such as an overactive fear response (because of amygdala activation). Stress refers to the specific trigger that initially creates anxiety (e.g., bitten by a dog; being laughed at in public). When these two components interact with each other – a disorder is born.
How is Anxiety Maintained?
Anxiety is primarily maintained by avoidance. People who avoid anxious situations 1) never learn if their scary beliefs are true or not and 2) never learn whether they can cope with the bad situation happening. Because of this, avoidance leads to short-term relief but long-term pain. Although avoidance can appear obvious, it can also sometime appear in sneaky ways: I’ll list some examples for avoidance in social anxiety disorder to showcase how tricky they can be.
- Avoiding social interactions / presentations
- Overpreparing for presentations (i.e., remembering every single line)
- Not making eye contact (to avoid potentially seeing evidence of others not liking them)
- Having a friend with them to reduce distress
- Drinking alcohol or taking other substances to reduce anxiety beforehand
As you can see, all of these behaviours are forms of avoidance, but they can manifest in different ways. Some people avoid fears of failing by overpreparing; some avoid by getting away from the situation altogether; and some engage safety behaviours such as drinking alcohol or dragging a friend along to reduce anxiety. All these behaviours maintain our anxiety to some extent.
Evidence-based strategies to reduce anxiety
Strategies to reduce anxiety
Here, I’ll introduce a few behavioural and cognitive strategies to tackle your anxiety.
1. Exposure therapy. Exposure therapies can be a great way to deal with anxiety disorders by slowly engaging the feared activities at a pace that is not too challenging. Over time, the person becomes more and more accustomed to the feared situation and recognizes that the danger is lower than their expectations. See here on an article on developing exposure hierarchies.
2. Relaxation techniques. Relaxation strategies, like breathing exercises, guided imagery, and progressive relaxations, are a good way to reduce basal arousal and feel less anxious on a day-to-day basis. This article expands on how to do three different relaxation exercises.
3. Behavioural experiments. Behavioural experiments allow you to take on the role of a curious experimenter, and systematically investigate whether your feared beliefs are actually true or not. By gaining lived experience about whether these predictions are true (and if it is true, how well you can cope with the situation), you gradually become less fearful of anxious situations. See here on a guide to conducting behavioural experiments.
4. Cognitive strategies. There are also cognitive techniques to restructure our beliefs and negative thoughts (which are usually a bit of an exaggeration) into more balanced thoughts based on the evidence. Please see this post on developing thought records if you are interested!
5. Medication. There are also anxiety medications (e.g., benzodiazepines) that can help manage anxiety. Should pharmacotherapy be a treatment option you are interested in, I would recommend you discuss this with your primary care provider or psychiatrist.
I hope this article was helpful to understanding a little more about some different anxiety disorders! Please consider subscribing to the mailing list to learn more about mental health!