We all know what it’s like to feel anxious; that feeling of dread or apprehension accompanied by tightness in the chest, and physical symptoms like sweating, trembling and rapid heartbeat.
These feelings of anxiety are normal when people are threatened, and for most of us these feelings fade once the event that caused them passes or the problem is solved. But for some of us, anxiety is ongoing and continues for no particular reason making daily activities difficult or impossible. These people are said to have an anxiety disorder.
Around 14 per cent of Australians are affected by an anxiety disorder each year, but only a small percentage of these will seek treatment. The good news is that most anxiety disorders can be successfully treated.
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- Suicide Call Back Service on 1300 659 467
What causes anxiety disorders?
There is no single cause of anxiety disorders, but researchers have identified a number of risk factors that seem to predispose some of us towards anxiety:
- Family history. Anxiety disorders tend to run in families, suggesting there’s a genetic factor involved in the cause. Studies show that if one identical twin has an anxiety disorder, the second twin is more likely to have an anxiety disorder than if they were unrelated.
- Personal characteristics. Researchers believe people who are introverted, perfectionists, have low self-esteem and poor coping skills may be prone to anxiety disorders.
- Biochemistry. Some people who are prone to anxiety may have too many or too few neurotransmitters in the brain, causing the normal anxiety-producing pathways to overreact. Serotonin and gamma aminobutyric acid (GABA) are two of the neurotransmitters that may be involved, although their exact role is poorly understood.
- Physical illness. Certain ongoing health conditions such as heart disease, diabetes and hormonal problems have been linked to anxiety.
- Substance use. Alcohol and drugs – such as cannabis or amphetamines – can cause people to develop anxiety. Even caffeine can worsen anxiety symptoms.
- Stressful events. Stressful life events – eg relationship breakdown; job stress; moving house; sexual, physical or emotional abuse; or death of a loved one – can trigger anxiety in some people.
The most common features of anxiety disorders include:
- a feeling of being on edge and nervous, or having high levels of anxiety
- persistent and irrational fears or excessive worry
- difficulty concentrating and remembering things
- trouble sleeping
- avoidance of situations, places, people, activities, thoughts or feelings that trigger anxiety.
The physical symptoms of anxiety include:
- a pounding heart
- shortness of breath or difficulty breathing
- tightness in chest
- sweating, trembling, tingling or numbness
- dry mouth.
People who experience anxiety over long periods of time can also develop muscle tension and headaches.
Types of anxiety disorders
Anxiety disorders come in a wide variety of shapes and sizes, depending on what triggers the anxiety and how it manifests:
- Generalised Anxiety Disorder (GAD). People with this condition worry excessively – they have irrational fears and apprehension about a range of everyday things, such as the health of themselves of their loved ones, money, work or relationships. They worry so much they can’t relax or fall asleep, and are often tense and irritable.
- Panic Disorder (PD). People who have this condition experience sudden and unpredictable episodes of panic in situations where other people would not be afraid. They are convinced something disastrous will happen, that they may die or go crazy. They get chest pains, shortness of breath, dizziness, nausea, numbness, trembling. In some cases, panic disorder occurs with agoraphobia, where people avoid going out all together because they are so scared of experiencing a panic attack in a situation they cannot escape from.
- Agoraphobia. This is a fear of places and situations that may be difficult or embarrassing to escape from. People with agoraphobia experience anxiety in crowded places of all kinds, supermarkets and department stores, public transport, lifts, freeways and heights. To avoid this happening, they often confine themselves to home.
- Specific Phobia. A phobia is an intense and irrational fear about a particular object or situation. It might be a fear of heights, closed spaces, water, dogs, snakes or spiders. When the feared object or situation isn’t present, the person is perfectly normal. But when confronted with the object of their phobia, they become highly anxious and may even experience a panic attack, so they go to great lengths to avoid being exposed to the situation or object they fear.
- Social Phobia. This is extreme discomfort or fear in social settings, where the person worries they will embarrass themselves in front of others and be judged or criticised. It can include a variety of social interactions, such as meeting unfamiliar people, asking for directions, speaking with a stranger, going out to dinner or a party, eating in public places, or giving a speech. Many people with Social Phobia avoid uncomfortable social situations, or endure them with high levels of anxiety. Some use alcohol or drugs to help cope with social situations.
- Obsessive-Compulsive Disorder (OCD). People with this condition experience intrusive and unwanted thoughts such as fears of contamination, of not locking the house properly, of committing violent acts, or bizarre sexual images. These intrusive thoughts are called obsessions. To get rid of them or to feel less anxious, they may perform elaborate rituals like washing hands or checking things over and over (the compulsions). These rituals are usually time-consuming and interfere with normal life. People with this disorder are often extremely embarrassed about it and keep it a secret from others. In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this category has been expanded to include hoarding disorder and excoriation (skin-picking) disorder, and already includes body dysmorphic disorder (when people have an excessive and irrational fear that they have a defect in their physical appearance) and trichotillomania (hair-pulling disorder)
- Illness Anxiety Disorder (Severe Health Anxiety or Hypochondriasis). People with this condition worry excessively about their health. They fear that they have a serious illness which has gone undiagnosed, or are afraid that they will develop a serious illness. This anxiety remains even after getting the ‘all-clear’ from their doctor. People with this disorder frequently check their body for signs and symptoms of illness, avoid places that remind them of illness, or where they are afraid of potentially becoming ‘contaminated’ and contracting illnesses, such as hospitals. They seek reassurance from their friends, family and doctors, as well as the internet about their health.
Diagnosis and treatment
Only about a half of those with anxiety disorders seek treatment. Fortunately, there are a range of effective treatments available, and anxiety is a very manageable condition. Sometimes more than one type of treatment is needed, and it might take a while for someone to find the right treatment for them.
If you are experiencing anxiety, your GP is the best place to start looking for treatment. They can assess you and make a GP Mental Health Care Plan. They will either start appropriate treatment or refer you on.
For many people with anxiety disorders, psychological techniques, which are sometimes called ‘talk therapy’, can help enormously. These techniques can help change underlying patterns of thought and behavior. Your GP may be able to provide this, or they may refer you on to a psychologist or psychiatrist.
There are a range of psychological therapies available for anxiety, but cognitive behavioural therapy (CBT) has been found to provide the most consistent and lasting positive results.
CBT is a form of structured therapy, which aims to change the way a person thinks and behaves in certain situations by teaching them techniques to manage their anxiety, such as slow-breathing and changing the focus of their attention away from worries and anxiety. It can also help change an unhelpful thinking style to one that is more rational, using a technique called thought challenging.
CBT also teaches people to confront their feared situations using graded exposure, a technique which involves gradually and repeatedly exposing a person to situations or things that trigger their fear: people start with tasks that push them outside of their comfort zone, and then when they become more confident, they increase the degree of exposure. The aim is to build the person’s confidence and desensitise them to the point where the fear no longer poses a threat. It’s used in the treatment of many phobias and anxiety and depressive disorders.
As CBT requires special training, it’s usually done by a psychologist or psychiatrist, and typically requires 10 to 12 sessions to be effective.
Online CBT can be as effective as seeing a clinician for treatment. You can do online therapies on their own (see below for a list of recommended sites) or in conjunction with support from a therapist.
There are a number of self-help courses available including:
This Way Up (a collaboration between University of New South Wales and St Vincent’s Hospital) provides online courses for people with generalized anxiety disorder, panic disorder and agoraphobia, social phobia, obsessive compulsive disorder, post traumatic stress disorder, major depression and mixed anxiety and depression. Research has shown 80 per cent of people who complete these courses report benefits.
MyCompass (BlackDog Institute) is a self-help tool promoting resilience and wellbeing. It contains modules that help you manage mild to moderate stress, anxiety and depression.
E-couch (Australian National University) is an self-help interactive program aimed at younger adults, it has modules on depression, generalised anxiety and worry, social anxiety, relationship breakdown, and loss and grief.
eCentreClinic (Centre for Emotional Health, Macquarie University) develops and tests state-of-the-art free online treatment courses for people with symptoms of worry, anxiety (including OCD and PTSD), stress, depression, low mood and other health conditions, including chronic pain.
Medication can help people deal with the more debilitating symptoms of anxiety disorders. While medications do not necessarily address the underlying causes of anxiety and are not a long-term solution, they can be very beneficial – especially when the anxiety is severe, or psychological therapies have not helped.
Medications used in the treatment of anxiety disorders include:
- Anti-depressants including selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, citalopram, escitalopram, and sertraline. Antidepressants can take up to six weeks to take effect and have a variety of side effects.
- Benzodiazepines, such as temazapam, alprazolam, diazepam and clonazepam, are sedatives that can help with short-term relief of symptoms in anxiety disorders but should not be used for treatment because of side effects such as drowsiness, addiction and withdrawal symptoms. Benzodiazepines may also interfere with new learning, which means they may stop you from benefiting from learning new skills from CBT.
Mental health crises don’t always happen during office hours. But if you find yourself having to help someone there are people who can help – at any time.
National crisis and counselling contacts available 24/7:
- Lifeline – 13 1114
- Suicide Call Back service – 1300 659 467 – Provides free nationwide professional telephone or online counseling.
- Kids Help Line – 1800 55 1800 – Provides counselling and support for young people aged 5-25.
- Men’s Line Australia – 1300 78 99 78 – Provides counselling and support services for men – especially those involved in the breakdown of relationships.
This article was reviewed by Gavin Andrews AO, Professor of Psychiatry at Clinical Research Unit for Anxiety and Depression University of New South Wales at St Vincent’s Hospital Sydney Australia.