Anxiety

Anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. Symptoms may start during childhood or the teen years and continue into adulthood.

Examples of anxiety disorders include social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. A person can have more than one anxiety disorder.

Sometimes anxiety results from a medical condition that needs treatment. Whatever form of anxiety you have, treatment can help.

SYMPTOMS
Common anxiety signs and symptoms include:

Feeling nervous,Feeling powerless,Having a sense of impending danger, panic or doom,Having an increased heart rate, Breathing rapidly (hyperventilation)Sweating,Trembling, Feeling weak or tired, Trouble concentrating or thinking about anything other than the present worry

Several types of anxiety disorders exist:

Separation anxiety disorder is a childhood disorder characterized by anxiety that is excessive for the developmental level and related to separation from parents or others who have parental roles.Selective mutism is a consistent failure to speak in certain situations, such as school, even when you can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, heart palpitations or chest pain.Agoraphobia is anxiety about, and often avoidance of, places or situations where you might feel trapped or helpless if you start to feel panicky or experience embarrassing symptoms, such as losing control.Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues. The worry is usually out of proportion to the actual circumstance, is difficult to control and interferes with your ability to focus on current tasks. It often occurs along with other anxiety disorders or depression.Substance-induced anxiety disorder is characterized by prominent symptoms of anxiety or panic that are a direct result of abusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.Anxiety disorder due to a medical condition includes prominent symptoms of anxiety or panic that are directly caused by a physical health problem.Specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don't meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.
See your doctor if:
You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your lifeYour fear, worry or anxiety is upsetting to youYou feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxietyYou think your anxiety could be linked to a physical health problemYou have suicidal thoughts or behaviors — seek emergency treatment immediately

Your worries may not go away on their own, and they may actually get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It may be easier to treat if you get help early.

CAUSES
As with many mental health conditions, the exact cause of anxiety disorders isn't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to becoming anxious. Inherited traits also can be a factor.

Medical causes

For some people, anxiety is linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order lab tests and other tests to look for signs of a problem.

Examples of medical problems that can be linked to anxiety include:

Heart diseaseDiabetesThyroid problems, such as hypothyroidism or hyperthyroidismAsthmaDrug abuse or withdrawalWithdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medicationsIrritable bowel syndromeRare tumors that produce certain \"fight-or-flight\" hormonesPremenstrual syndrome

Sometimes anxiety can be a side effect of certain medications.

It's more likely that your anxiety may be due to an underlying medical condition if:

You don't have any blood relatives (such as a parent or sibling) with an anxiety disorderYou didn't have an anxiety disorder as a childYou don't avoid certain things or situations because of anxietyYou have a sudden occurrence of anxiety that seems unrelated to life events and you didn't have a previous history of anxiety

COMPLICATIONS
Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical health conditions, such as:

Depression (which often occurs with anxiety disorder) Substance abuse Trouble sleeping (insomnia) Digestive or bowel problemsHeadachesSuicide Poor quality of life

DIAGNOSIS
To help diagnose an anxiety disorder and rule out other conditions, your doctor or mental health provider may have you fill out a psychological questionnaire. Your doctor will probably do a physical exam to look for signs that your anxiety might be linked to a medical condition.

To be diagnosed with an anxiety disorder, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Symptoms and diagnostic criteria differ for each type of anxiety disorder. However, they all share the features of excessive fear and problems with functioning as a result. Anxiety disorders often occur along with other mental health problems — such as depression or substance abuse — which can make diagnosis and treatment more challenging.

In cases where anxiety is caused by or occurs with a medical illness, a doctor also performs a physical exam during the initial evaluation. A child and adolescent psychologist and a psychiatrist who specialize in anxiety disorders staff the clinic. This staffing allows for an integrated medical and psychological understanding of your child's symptoms.

TREATMENT
The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.

Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build upon your initial success.

Medications

Several types of medications are used to treat anxiety disorders, including those below. Talk with your doctor about benefits, risks and possible side effects.

Antidepressants. These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. Examples of antidepressants used to treat anxiety disorders include fluoxetine (Prozac, Sarafem), imipramine (Tofranil), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and venlafaxine (Effexor XR). Citalopram (Celexa) and escitalopram (Lexapro) also can be effective, but dosages of 40 milligrams (mg) a day of citalopram or 20 mg a day of escitalopram warrant discussion of risks versus benefits. Your doctor also may recommend other antidepressants.Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.Benzodiazepines. In limited circumstances, your doctor may prescribe one of these sedatives for relief of anxiety symptoms. Examples include alprazolam (Niravam, Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you've had problems with alcohol or drug abuse.