Anxiety Disorders

What Is Anxiety?

Liam had always looked out for his younger brother Sam. But whenever Sam took the late bus after soccer practice, Liam worried about him so much he couldn't concentrate on his homework. Liam watched the clock, worrying and imagining the worst — picturing bus accidents and fearing, for no particular reason, that Sam might be injured or dead. Only when Sam arrived home safe could Liam finally relax.

It's completely normal to worry when things get hectic and complicated. But if worries become overwhelming, you may feel that they're running your life. If you spend an excessive amount of time feeling worried or nervous, or you have difficulty sleeping because of your anxiety, pay attention to your thoughts and feelings. They may be symptoms of an anxiety problem or disorder.

Anxiety is a natural human reaction that involves mind and body. It serves an important basic survival function: Anxiety is an alarm system that is activated whenever a person perceives danger or threat.

When the body and mind react to danger or threat, a person feels physical sensations of anxiety — things like a faster heartbeat and breathing, tense muscles, sweaty palms, a queasy stomach, and trembling hands or legs. These sensations are part of the body's fight-flight response. They are caused by a rush of adrenaline and other chemicals that prepare the body to make a quick getaway from danger. They can be mild or extreme.

The fight-flight response happens instantly when a person senses a threat. It takes a few seconds longer for the thinking part of the brain (the cortex) to process the situation and evaluate whether the threat is real, and if so, how to handle it. If the cortex sends the all-clear signal, the fight-flight response is deactivated and the nervous system can relax.

If the mind reasons that a threat might last, feelings of anxiety might linger, keeping the person alert. Physical sensations such as rapid, shallow breathing; a pounding heart; tense muscles; and sweaty palms might continue, too.

Normal Anxiety

Everyone experiences feelings of anxiety from time to time. Anxiety can be described as a sense of uneasiness, nervousness, worry, fear, or dread of what's about to happen or what might happen. While fear is the emotion we feel in the presence of threat, anxiety is a sense of anticipated danger, trouble, or threat.

Feelings of anxiety can be mild or intense (or anywhere in between), depending on the person and the situation. Mild anxiety can feel like a sense of uneasiness or nervousness. More intense anxiety can feel like fear, dread, or panic. Worrying and feelings of tension and stress are forms of anxiety. So are stage fright and the shyness that can come with meeting new people.

It's natural for new, unfamiliar, or challenging situations to prompt feelings of anxiety or nervousness. Facing an important test, a big date, or a major class presentation can trigger normal anxiety. Although these situations don't actually threaten a person's safety, they can cause someone to feel "threatened" by potential embarrassment, worry about making a mistake, fitting in, stumbling over words, being accepted or rejected, or losing pride. Physical sensations — such as a pounding heart, sweaty hands, or a nervous stomach — can be part of normal anxiety, too.

Because anxiety makes a person alert, focused, and ready to head off potential problems, a little anxiety can help us do our best in situations that involve performance. But anxiety that's too strong can interfere with doing our best. Too much anxiety can cause people to feel overwhelmed, tongue-tied, or unable to do what they need to do.

Anxiety Disorders

Anxiety disorders are mental health conditions that involve excessive amounts of anxiety, fear, nervousness, worry, or dread. Anxiety that is too constant or too intense can cause a person to feel preoccupied, distracted, tense, and always on alert.

Anxiety disorders are among the most common mental health conditions. They affect people of all ages — adults, children, and teens. There are many different types of anxiety disorders, with different symptoms. They all have one thing in common, though: Anxiety occurs too often, is too strong, is out of proportion to the present situation, and affects a person's daily life and happiness.

Symptoms of an anxiety disorder can come on suddenly, or they can build gradually and linger until a person begins to realize that something is wrong. Sometimes anxiety creates a sense of doom and foreboding that seems to come out of nowhere. It's common for those with an anxiety disorder to not know what's causing the emotions, worries, and sensations they have.

Different anxiety disorders are named to reflect their specific symptoms.

• Generalized anxiety. With this common anxiety disorder, a person worries excessively about many things. Someone with generalized anxiety may worry excessively about school, the health or safety of family members, and the future. They may always think of the worst that could happen.
  
  Along with the worry and dread, people with generalized anxiety have physical symptoms, such as chest pain, headache, tiredness, tight muscles, stomachaches, or vomiting. Generalized anxiety can lead a person to miss school or avoid social activities. With generalized anxiety, worries can feel like a burden, making life feel overwhelming or out of control.
• Obsessive compulsive disorder (OCD). For a person with OCD, anxiety takes the form of obsessions (bad thoughts) and compulsions (actions that try to relieve anxiety).
• Phobias. These are intense fears of specific situations or things that are not actually dangerous, such as heights, dogs, or flying in an airplane. Phobias usually cause people to avoid the things they are afraid of.
• Social phobia (social anxiety). This intense anxiety is triggered by social situations or speaking in front of others. An extreme form called selective mutism causes some kids and teens to be too fearful to talk at all in certain situations.
• Panic attacks. These episodes of anxiety can occur for no apparent reason. With a panic attack, a person has sudden and intense physical symptoms that can include a pounding heart, shortness of breath, dizziness, numbness, or tingling feelings causes by overactivity of the body's normal fear response. Agoraphobia is an intense fear of panic attacks that causes a person to avoid going anywhere a panic attack could possibly occur.
• Posttraumatic stress disorder (PTSD). This type of anxiety disorder results from a traumatic or terrifying past experience. Symptoms include flashbacks, nightmares, or constant fear after the fact.

How Anxiety Disorders Affect People

For people dealing with anxiety disorders, symptoms can feel strange and confusing at first. For some, the physical sensations can be strong and upsetting. For others, feelings of doom or fear that can happen for no apparent reason can make them feel scared, unprotected, and on guard. Constant worries can make a person feel overwhelmed by every little thing. All this can affect someone's concentration, confidence, sleep, appetite, and outlook.

People with anxiety disorders might avoid talking about their worries, thinking that others might not understand. They may fear being unfairly judged, or considered weak or scared. Although anxiety disorders are common, people who have them may feel misunderstood or alone.

Some people with anxiety disorders might blame themselves. They may feel embarrassed or ashamed, or mistakenly think that anxiety is a weakness or a personal failing. Anxiety can keep people from going places or doing things they enjoy.

The good news is, doctors today understand anxiety disorders better than ever before and, with treatment, a person can feel better.

What Causes Anxiety Disorders?

Experts don't know exactly what causes anxiety disorders. Several things seem to play a role, including genetics, brain biochemistry, an overactive fight-flight response, stressful life circumstances, and learned behavior.

Someone with a family member who has an anxiety disorder has a greater chance of developing one, too. This may be related to genes that can affect brain chemistry and the regulation of chemicals called neurotransmitters. But not everyone with a family member who has an anxiety disorder will develop problems with anxiety.

Things that happen in a person's life can also set the stage for anxiety disorders. Frightening traumatic events that can lead to PTSD are a good example.

Growing up in a family where others are fearful or anxious can "teach" a child to view the world as a dangerous place. Likewise, someone who grows up in an environment that is actually dangerous (if there is violence in the family or community, for example) may learn to be fearful or expect the worst.

Although everyone experiences normal anxiety in certain situations, most people — even those who experience traumatic situations — don't develop anxiety disorders. And people who develop anxiety disorders can get relief with proper treatment and care. They can learn ways to manage anxiety and to feel more relaxed and at peace.

How Are Anxiety Disorders Treated?

Anxiety disorders can be treated by mental health professionals, or therapists. A therapist can look at the symptoms someone is dealing with, diagnose the specific anxiety disorder, and create a plan to help the person get relief.

A particular type of talk therapy called cognitive-behavior therapy (CBT) is often used. In CBT, a person learns new ways to think and act in situations that can cause anxiety, and to manage and deal with stress. The therapist provides support and guidance and teaches new coping skills, such as relaxation techniques or breathing exercises. Sometimes, but not always, medication is used as part of the treatment for anxiety.

What to Do

Getting the problem treated can help a person feel like himself or herself again — relaxed and ready for the good things in life. Someone who might be dealing with an anxiety disorder should:

• Tell a parent or other adult about physical sensations, worries, or fears. Because anxiety disorders don't go away unless they are treated, it's important to tell someone who can help. If a parent doesn't seem to understand right away, talk to a school counselor, religious leader, or other trusted adult.
• Get a checkup. See a doctor to make sure there are no physical conditions that could be causing symptoms.
• Work with a mental health professional. Ask a doctor, nurse, or school counselor for a referral to someone who treats anxiety problems. Finding out what's causing the symptoms can be a great relief.
• Get regular exercise, good nutrition, and sleep. These provide your body and brain with the right fuel and time to recharge.

Try to stay patient and positive. It can take time to feel better, and courage to face fears. But letting go of worry allows space for more happiness and fun.