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Anxiety disorders

Background

Anxiety can be defined as a disproportionate feeling of worry, nervousness, or unease about something with an uncertain outcome.  It can be brief, often in response to a frequently identifiable trigger, or more enduring.  Anxiety can be generalised with no obvious trigger (free floating) or focused in response to a specific cause (phobic).  It can also be a key feature of Post-Traumatic Stress Disorder (PTSD) and is very common in autism spectrum conditions and some genetic conditions, for example fragile X syndrome.

A phobia is an intense aversion to a specific object or situation.  It is associated with fear of the particular stimulus, expressed as an "anxiety state" in particular circumstances with a specific focus when extreme.  In extreme instances it is experienced by the affected individual as a panic attack.  This is associated with avoidance of the feared object, thought or situation.  In PTSD it may take the form of psychological "re-enactments of the happening"; for example repeated revisiting of the experience in the mind, or through nightmares, and avoidance, showing as efforts not to think about the feared object or experience, or actual avoidance of the place or situation involved.

The "panic" attack is a combination of psychological and physiological responses to danger. The body prepares to "fight or flight"; heart rate and breathing rate increase and sweating occurs.  Individuals can also experience a range of other physical symptoms including dizziness, light-headedness and faintness, going pale and becoming nauseous.  All these symptoms act to produce intense feelings of panic and impending threat.  Panic attacks are self-limiting, although phobic individuals may feel them to be life-threatening.  However, some individuals find them to be a recurring problem.

Common phobias include agoraphobia (fear of open space), claustrophobia (fear of enclosed space), acrophobia (fear of heights), snake phobia, spider phobia, going to the dentist, or having blood drawn.

Obsessive compulsive disorder describes situations where the individual has to perform specific actions ("compulsions"), or specific repeated thoughts ("obsessions"), which may show as counting rituals and other repetitive thoughts and actions undertaken to reduce associated activity but nonetheless leading to further urges to engage in them.  In very severe cases these activities may reach such proportions that an individual's entire life, and the life of their family, is affected by them.

Separation anxiety disorder is a specific condition where the child's anxiety over real or anticipated separation from carers is of extreme and debilitating severity, often associated with problems with everyday functioning.  This may show itself as school refusal or extreme reluctance to be parted from the main carer.

Hypochondriasis occurs when anxiety takes the form of overwhelming, debilitating and persisting worries about physical ailments in the absence of genuine physical illness.  This may be so extreme that the individual experiences genuine distressing symptoms - "somatisation disorder".

Credits

Last updated June 2019 by Professor Jeremy Turk, Emeritus Professor of Developmental Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College, University of London, and Consultant Child and Adolescent Psychiatrist, Community Child and Adolescent Mental Health Services, Isle of Wight NHS Trust.

Although great care has been taken in the compilation and preparation of all entries to ensure accuracy, we cannot accept responsibility for any errors or omissions. Any medical information provided is for education/information purposes and is not designed to replace medical advice by a qualified medical professional.

What are the symptoms?

Individuals experience an intense sense of panic usually associated with physical sensations including breathlessness (which may lead to over-breathing), racing heart, tremor, sweating, dry mouth and faintness.  Individuals actively avoid situations which may bring them in to contact with the feared object or situation.  Even thinking about the feared object or situation can bring on a panic attack.

What are the causes?

Anxiety can run in families, suggesting a genetic predisposition in some instances. Temperament and learning from parental behaviour is also important.  Specific adverse life experiences can trigger anxiety and phobias.  Some objects or activities seem particularly prone to produce anxiety and panic (snakes, dentists, heights) whilst others usually do not (lambs, houses).

How is it diagnosed?

Diagnosis is based upon the above features, sometimes with history of feared or distressing situations having produced particular anxieties, as happens in Post-Traumatic Stress Disorder.

How is it treated?

For all forms of anxiety disorder, cognitive and behavioural psychotherapies are strongly supported by research evidence.  Medication may have a limited role in extreme circumstances, but only on a short-term basis in order to facilitate psychological approaches.  Medication should always be in addition to psychological therapies, time-limited, and as a means to an end; never an end in itself.

Inheritance patterns and prenatal diagnosis

Inheritance patterns
There may be a familial tendency, but usually this is not the case.  Prenatal diagnosis is not possible.

Is there support?

Anxiety UK

Tel: 03444 775 774
Email: support@anxietyuk.org.uk
www.anxietyuk.org.uk

The Organisation is a Registered Charity in England and Wales No. 1113403. It provides information and support to those living with anxiety disorder. Services include 1:1 therapy, and help with specific phobias.  

Group details last updated June 2019.