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types of anxiety *Image courtesy google, www.healthfitnessresource.com

1. Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD), is characterized by persistent and excessive worry about everyday life events with no obvious reasons for a period of six months or more.

People diagnosed with GAD are often found expecting the worst in most situations. They anticipate disaster and may be overly concerned about money, health, family, work, or other issues. This worry is often unrealistic or out of proportion for the situation. In fact, sometimes just the thought of getting through the day produces anxiety.

They don’t know how to stop the worry cycle and feel that it is beyond their control.

The anxiety may dominate one’s life to such a major extent, that day to day functioning is affected.

Let us look at the symptoms of GAD:

  • Excessive, ongoing worry and tension
  • An unrealistic view of problems
  • Restlessness or a feeling of being "edgy"
  • Irritability
  • Muscle tension
  • Headaches
  • Sweating
  • Difficulty concentrating
  • Nausea
  • The need to go to the bathroom frequently
  • Tiredness
  • Trouble falling or staying asleep
  • Trembling
  • Being easily startled

People with GAD often have other anxiety disorders (such as panic disorder or phobias), obsessive-compulsive disorder and clinical depression.

The onset of GAD is usually reported in childhood or adolescence most often but in some rare cases, it may begin in adulthood. It is more common in women than in men.

2. Social Phobia

As the name suggests, Social Phobia or Social Anxiety Disorder is characterized by the fear of interacting with other people.

The individual fears being scrutinized and judged and evaluated negatively by other people, which results in him avoiding situations involving social contact.

The idea of being negatively examined by everyone around leads to feelings of inadequacy, inferiority, embarrassment, humiliation, and depression in individuals suffering from this disorder.

Social anxiety disorder usually begins in childhood or adolescence, and children are prone to clinging behaviour, tantrums, and even mutism.

Some people may fear speaking in front of groups only (specific social anxiety) while others feel anxious, nervous, and uncomfortable in almost all social situations (generalized social anxiety).

It is much more common for people with social anxiety to have a generalized type of this disorder. ​

Emotional signs and symptoms

  • Excessive self-consciousness and anxiety in everyday life events
  • Intense worry for days, weeks, or even months before an approaching social circumstance
  • Extreme fear of being watched or judged by others, particularly strangers
  • Fear that you'll act in embarrassing and humiliating ways
  • Fear that others will notice your nervousness

Physical signs and symptoms

  • Red face or blushing
  • Breathlessness
  • Nausea, vomiting or stomach ache
  • Trembling or shaking (including shaky voice)
  • Racing heart or tightness in chest
  • Sweating or hot flashes
  • Feeling dizzy

Emotional signs and symptoms

  • Avoiding social situations to such an extent that it starts disrupting your life
  • Staying quiet or hiding in the background in order to escape notice and embarrassment
  • A need to always bring a friend along with you wherever you go
  • Drinking/ taking drugs before social situations in order to soothe your nerves

3. Specific Phobias

A specific phobia, formerly called a simple phobia, is an unreasonable fear caused by the presence or thought of a specific object or situation that usually poses little or no actual threat.

Adults with a specific phobia recognize that the fear is excessive or unreasonable, yet are unable to overcome it.

Having phobias can disrupt daily routines, limit work efficiency, reduce self-esteem, and place a strain on relationships because people will do whatever they can to avoid the uncomfortable and often-terrifying feelings of phobic anxiety.

Lets take a look at the different types of phobias

  • Animal phobias : Fear that relates to animals or insects. Examples include the fear of dogs, cats, snakes, insects, mice etc. Animal phobias are the most common specific phobias.
  • Situational phobias : fear of specific situations. Examples include the fear of flying, driving, going over bridges or in tunnels, elevator etc
  • Natural environment phobias : Fear associated with the natural environment. Examples include the fear of fire, storms, heights, or water.
  • Blood-injection-injury phobias : These involve a fear of being injured, of seeing blood or of invasive medical procedures, such as blood tests or injections.
  • Other phobias : These include a fear of falling down, a fear of loud sounds, and a fear of costumed characters, such as clowns.

Symptoms of Specific Phobia:

The fear is persistent, typically lasting at least 6 months

Behavioural symptoms:

  • Excessive or irrational fear of a specific object or situation
  • Avoidance of situation e.g. (not walking down a street where there may be a dog)
  • The anxiety or avoidance associated with the situations or objects makes it difficult to go about daily life (e.g. interferes with working, studying or seeing friends and family).

Physical Symptoms:

  • Panic attack
  • Pounding heart
  • Nausea
  • Diarrhea
  • Sweating
  • Trembling or shaking
  • Numbness or tingling
  • Breathlessness
  • Feeling lightheaded
  • A choking feeling

4. Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is characterised by unreasonable thoughts, images, urges and fears (obsessions) that lead to compulsive and repetitive behaviours.

The following lists common obsessive themes and compulsive rituals:

Obsessions Symptoms:

  • Repeated unwanted ideas
  • Fear of contamination
  • Aggressive impulses
  • Persistent sexual thoughts
  • Images of hurting someone you love
  • Thoughts that you might cause others harm
  • Thoughts that you might be harmed

Contamination:

The individual fears coming into contact with dirt, germs, sticky substances, or chemicals (e.g., household cleansers), or getting sick, or getting others sick after touching "dirty" or "contaminated" items.

Accidental harm to self or others:

In this case an individual fears the consequence of being even remotely careless. For example, "what if I didn't clean off the window properly and there are still germs on it, and my mom gets sick because of me!"

Symmetry and exactness:

This is characterized by a need to have items ordered in a certain way, maybe according to size, colour or in certain direction. For example, a child with OCD might say that he or she needs to arrange all the teddy bears from smallest to biggest or else something bad will happen to family. Most people are aware that these thoughts are odd and bizarre yet have no control over it.

A need for perfection:

Some people feel a strong need for things to be perfect or 100 percent right.

Forbidden thoughts:

Entering into adolescence is a time of sexual maturity and most teens think about sex and sexual identity during this time. However, for some teens they are overwhelmed with unwanted thoughts and images about being gay when they know they are not, or thinking about engaging in sexual behaviour that feels upsetting and even disgusting to them.

Compulsions Symptoms​

  • Constant checking
  • Constant counting
  • The repeated cleaning of one or more items
  • Repeatedly washing your hands
  • Constantly checking the stove or door locks
  • Arranging items to face a certain way

Washing or cleaning:​

Washing hands unreasonably.

There are many other types of washing behaviours, including:

  • Toilet rituals (e.g., excessive wiping)
  • Grooming/tooth brushing rituals (e.g., brushing each tooth in a particular order)
  • Showering rituals (e.g., washing each body part a certain number of times or in a particular order)
  • Cleaning compulsions (e.g., rituals and rules for how to wash laundry, clean the bathroom, kitchen, etc.)

Checking:

These types of compulsions can involve checking doors, locks, or backpacks, to make sure everything is harmless. Some people check to make sure that everyone is okay. For example, making calls to family members every 15 minutes to ‘check’ if they’re safe.

Counting, tapping, touching, or rubbing:

Compulsions can involve counting, touching, or tapping objects in a particular way.

Ordering/arranging

This compulsion involves organizing items in specific ways, such as bed sheets, files and documents, shoes, baggage/ luggage and so on.

Mental rituals: Some people perform rituals in their head, such as saying prayers or trying to substitute a negative image or thought with a positive image or thought.

What causes OCD?

OCD is thought to develop from a combination of genetic and environmental factors.

  • Biological factors – OCD has been interconnected to numerous neurological factors. For example, there is a strong link between OCD and irregular levels of serotonin (a chemical that transmits messages between brain cells).
  • Environmental / learned behaviours – Some specialists suggest that OCD may develop as a result of learned behaviour, either by direct conditioning (e.g. developing a washing compulsion after contracting a disease from contact with an animal) or observational learning, i.e copying the parent or role model.

Emotional Symptoms of OCD:

Sufferers of OCD are generally very anxious and emotional. They display many non-OCD symptoms, such as signs of depression, excessive worry, extreme tension, and the constant feeling that nothing is ever right.

Physical Symptoms of Obsessive-Compulsive Disorder:

A person with OCD unfortunately can develop physical problems as well. For example, a person with a germ obsession may wash his hands so much that the skin on them becomes red, raw and painful.

Short-Term and Long-Term Effects of OCD:

A person with OCD may experience multiple short-term effects, including the failure to function as a contributing member of society, difficulties at school or work, or trouble maintaining friendships or romantic relationships.

The long-term effects of OCD generally develop due to the meagre quality of life that most extreme sufferers have. Long-term effects include depression, constant anxiety and an increased risk of substance abuse.

5. Post Traumatic Stress Disorder (PTSD)

PTSD (Post traumatic stress disorder) is a mental health condition characterised by failure to recover after experiencing or witnessing a shocking, scary, or dangerous event.

History of PTSD:

Cases of PTSD were first documented during the First World War when soldiers developed shell shock as a result of the harrowing conditions in the trenches.

But the condition wasn't officially recognised as a mental health condition until 1980, when it was included in the Diagnostic and Statistical Manual of Mental Disorders, developed by the American Psychiatric Association.

Causes of PTSD:

The type of events that can cause PTSD include:

  • severe road accidents
  • violent personal assaults, such as sexual assault, mugging or robbery
  • prolonged sexual abuse, violence or severe neglect
  • witnessing violent deaths
  • military combat
  • being held hostage
  • terrorist attacks
  • natural disasters, such as severe floods, earthquakes or tsunamis

To know more on how trauma can lead to PTSD or even depression click here

PTSD can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later.

Signs and Symptoms:​

Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD.​

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms

Re-experiencing symptoms include:

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s day to day routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.​

Avoidance symptoms include:

  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. A person who survived a terrorist bombing while traveling in a local train may avoid traveling in local trains.

Arousal and reactivity symptoms include:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts

Arousal symptoms are usually continuous. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

Cognition and mood symptoms can begin or worsen after the traumatic event. These symptoms can make the person feel alienated or detached from friends or family members.

What other problems do people with PTSD experience?

People with PTSD may also have other problems. These include:

  • Feelings of hopelessness, shame, or despair
  • Depression or anxiety
  • Drinking or drug problems
  • Physical symptoms or chronic pain
  • Employment problems
  • Relationship problems, including divorce

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems.

6. Panic Disorder

People with panic disorder experience unexpected and repeated panic attacks, which are sudden feelings of terror when there is no real danger.

Panic disorder can be characterised by:

  • The presence of recurring and unexpected (‘out of the blue’) panic attacks.
  • Worrying for at least a month after having a panic attack that you will have another one.
  • Worrying about the implications or consequences of a panic attack (such as thinking that the panic attack is a sign of an undiagnosed medical problem). For example, some people have repeated medical tests due to these worries and, despite reassurance, still have fears of being unwell.
  • Significant changes in behaviour that relate to the panic attacks (such as avoiding activities like exercise because it increases the heart rate).

Panic attacks can happen anytime, anywhere, and without warning.

One may live in fear of another attack and may avoid places where you have had an attack. For some people, fear takes over their lives and they cannot leave their homes.

Panic disorder is more common in women than men. It usually starts when people are young adults. Sometimes it starts when a person is under a lot of stress.​

Difference between panic attacks and panic disorder?

  • Panic attacks are fairly common and having one does not mean that you have panic disorder. For example, if you are feeling very stressed or overtired, or if you have been doing excessive exercise, you might have a panic attack. This does not mean that you have panic disorder.
  • Panic attacks only become a problem, if you are regularly worried about having more attacks, or if you are afraid that something bad will happen because of a panic attack. For example, people worry that they will faint, embarrass themselves, have a heart attack, go crazy, or die.
  • In panic disorder, the panic attacks are unexpected and unpredictable. It is common for people with other anxiety disorders to have panic attacks, and this is not panic disorder. For example, people with a phobia of dogs might have a panic attack whenever they are near a dog. But in this case, the panic attack is expected, and the person is afraid of the dog not the panic attack.

What causes panic disorder?

There is no single cause for panic disorder. A number of factors are usually involved, including:

  • Family history / Genetic component – People with panic disorder tend to have a family history of anxiety disorders or depressive conditions.
  • Biological factors – Some medical conditions (cardiac arrhythmias, hyperthyroidism, asthma, chronic obstructive pulmonary disease and irritable bowel syndrome) are associated with panic disorder.
  • Negative experiences – Extremely stressful life experiences, such as childhood sexual abuse, redundancy or bereavement, loss of job, retirement and many more integral life changes have been linked to panic attacks.

Periods of ongoing, unrelenting stress are also a risk factor.

Diagnostic criteria:

It is important to know that the symptoms of panic disorder may mimic many other anxiety disorders and/or medical conditions. Only your doctor or mental health professional can diagnose panic disorder.

To meet the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition (DSM-5) criteria for panic disorder, panic attacks must be associated with longer than 1 month of subsequent persistent worry about:

1. having another attack or consequences of the attack

OR

2. significant maladaptive behavioral changes related to the attack.

To make the diagnosis of panic disorder, panic attacks cannot directly or physiologically result from substance use (intoxication or withdrawal), medical conditions, or another psychiatric disorder.

Panic attacks can include a wide range of signs and symptoms, including:

  • A feeling of overwhelming fear
  • Feeling like you are going crazy or losing control
  • Fear that you are going crazy, going to die, or pass out
  • Feeling like you are in grave danger
  • Feeling like you are dying
  • Feeling you might pass out
  • A surge of doom and gloom
  • An overpowering sense of dread
  • Feeling like things are surreal
  • Feeling like you are losing touch with reality
  • Feeling like you need to urgently escape
  • Dizziness
  • Heart Palpitations
  • Trembling, shaking
  • Sweating
  • Shortness of breath
  • Chest pressure or pain
  • Turning pale
  • Weak in the knees
  • Burning skin
  • Pins and needles
  • Hot and cold flashes
  • Numbness and tingling sensations

The above panic attack disorder symptoms and signs can be accompanied by:

  • Choking sensation, tightening throat, it feels like your throat is closing, it feels like something is stuck in your throat
  • Confusion
  • Depersonalization (feeling detached from reality, separate from one-self, separate from normal emotions)
  • Derealization (feeling unreal, in a dream-like state)
  • Dizziness, lightheadedness, unsteadiness
  • Emotional distress
  • Emotional upset
  • Inability to calm yourself down
  • Knot in the stomach, tight stomach
  • Nausea
  • Panicky feeling
  • Pounding, racing heart
  • Butterflies in the stomach
  • Sudden urge to go to the bathroom (urinate, defecate)
  • Vomiting
  • Feel like crying
  • Feel like freaking out

Consequences of panic disorder:

Panic disorder can lead to a significant hindrance in lifestyle. Individuals with panic disorder also may face problems with employment and depression. In addition, persons with panic disorder have a much higher risk of alcohol abuse or dependence and suicidality than the general population.

7. Agoraphobia

According to the Diagnostic and Statistical Manual of Mental Disorder 5 (DSM-5), agoraphobia is an anxiety disorder which is dominated by the fear of places where it is hard to escape or where help may not be available.

Places that can induce agoraphobia include those that can make a person feel embarrassed, helpless, or trapped, such as crowded areas, bridges, public transport and remote areas.

Most people develop agoraphobia after having had one or more panic attacks. These attacks cause them to fear further attacks, so they try to avoid the situation in which the attack occurred.

People with agoraphobia may need help from a companion such as a relative or friend, to go to public places, and may at times feel unable to leave home.

Diagnostic Criteria:

In DSM-4, a person younger than 18 years of age, had to have the condition for at least 6 months to receive a diagnosis.

In DSM-5, the 6-months duration has been extended to all patients irrespective of the age. The DSM-4 also linked the diagnoses for panic disorder and agoraphobia. In fact agoraphobia was considered a part of panic disorder. However, this changed in DSM-5 because it was observed that a considerable number of patients with agoraphobia did not experience panic symptoms.

Panic disorder and agoraphobia are now two separate diagnoses and are considered as independent entities.

Causes:

There are a number of theories about what can cause agoraphobia.

One theory is that agoraphobia develops in response to repeated exposure to anxiety-provoking events.

Mental-health theory that focuses on how people react to internal emotional conflicts (psychoanalytic theory) describes agoraphobia as being the result of an unresolved Oedipal conflict, which is a tension between the feelings the person has toward the opposite-sex parent and a sense of competition with the same-sex parent.

Even though, agoraphobia, like other mental disorders, is related to a number of psychological and environmental risk factors, it also tends to run in families, and for some individuals, may have a clear contributing genetic component.

Women are more likely to develop agoraphobia compared to men.

It is also essential to note that agoraphobia very often develops in response to other anxiety disorders.

Signs and symtoms:

Agoraphobia involves a combination of multiple fears, feelings, and physical symptoms.

As mentioned above, a person with agoraphobia will commonly fear:

  • Spending time alone
  • Being in crowded places, open spaces, or small spaces
  • Embarrassment, or of showing embarrassment
  • losing control in a public place
  • Others staring
  • Losing sanity
  • Death, or that a panic attack will be life-threatening

Apart from fear, a person with agoraphobia may experience the following feelings:

  • Detachment from others
  • Helplessness
  • Agitation
  • Loss of control
  • A feeling that the body is not real
  • A feeling that the environment is not real

Some people become excessively dependent on others or remain isolated for long periods of time.

Physical symptoms can also occur, such as:

  • Chest pain or discomfort
  • Dizziness
  • Racing heart
  • Shortness of breath
  • Sweating
  • Trembling
  • Upset stomach, nausea, and diarrhea
  • Flushing and chills
  • Choking