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Anxiety
I INTRODUCTION

Anxiety, emotional state in which people feel uneasy, apprehensive, or fearful. People usually
experience anxiety about events they cannot control or predict, or about events that seem
threatening or dangerous. For example, students taking an important test may feel anxious
because they cannot predict the test questions or feel certain of a good grade. People often use
the words fear and anxiety to describe the same thing. Fear also describes a reaction to
immediate danger characterized by a strong desire to escape the situation.

The physical symptoms of anxiety reflect a chronic “readiness” to deal with some future threat.
These symptoms may include fidgeting, muscle tension, sleeping problems, and headaches.
Higher levels of anxiety may produce such symptoms as rapid heartbeat, sweating, increased
blood pressure, nausea, and dizziness.

All people experience anxiety to some degree. Most people feel anxious when faced with a new
situation, such as a first date, or when trying to do something well, such as give a public speech.
A mild to moderate amount of anxiety in these situations is normal and even beneficial. Anxiety
can motivate people to prepare for an upcoming event and can help keep them focused on the
task at hand.

However, too little anxiety or too much anxiety can cause problems. Individuals who feel no
anxiety when faced with an important situation may lack alertness and focus. On the other
hand, individuals who experience an abnormally high amount of anxiety often feel
overwhelmed, immobilized, and unable to accomplish the task at hand. People with too much
anxiety often suffer from one of the anxiety disorders, a group of mental illnesses. In fact,
more people experience anxiety disorders than any other type of mental illness. A survey of
people aged 15 to 54 in the United States found that about 17 percent of this population suffers
from an anxiety disorder during any given year.

II ANXIETY DISORDERS

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders , a handbook for
mental health professionals, describes a variety of anxiety disorders. These include generalized
anxiety disorder, phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic
stress disorder.

A Generalized Anxiety Disorder

People with generalized anxiety disorder feel anxious most of the time. They worry excessively
about routine events or circumstances in their lives. Their worries often relate to finances,
family, personal health, and relationships with others. Although they recognize their anxiety as
irrational or out of proportion to actual events, they feel unable to control their worrying. For
example, they may worry uncontrollably and intensely about money despite evidence that their
financial situation is stable. Children with this disorder typically worry about their performance
at school or about catastrophic events, such as tornadoes, earthquakes, and nuclear war.
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People with generalized anxiety disorder often find that their worries interfere with their ability
to function at work or concentrate on tasks. Physical symptoms, such as disturbed sleep,
irritability, muscle aches, and tension, may accompany the anxiety. To receive a diagnosis of
this disorder, individuals must have experienced its symptoms for at least six months.

Generalized anxiety disorder affects about 3 percent of people in the general population in any
given year. From 55 to 66 percent of people with this disorder are female.

B Phobias

A phobia is an excessive, enduring fear of clearly defined objects or situations that interferes
with a person’s normal functioning. Although they know their fear is irrational, people with
phobias always try to avoid the source of their fear. Common phobias include fear of heights
(acrophobia), fear of enclosed places (claustrophobia), fear of insects, snakes, or other animals,
and fear of air travel. Social phobias involve a fear of performing, of critical evaluation, or of
being embarrassed in front of other people. See Phobia.

C Panic Disorder

Panic is an intense, overpowering surge of fear. People with panic disorder experience panic
attacks—periods of quickly escalating, intense fear and discomfort accompanied by such
physical symptoms as rapid heartbeat, trembling, shortness of breath, dizziness, and nausea.
Because people with this disorder cannot predict when these attacks will strike, they develop
anxiety about having additional panic attacks and may limit their activities outside the home.
See Panic Disorder.

D Obsessive-Compulsive Disorder

In obsessive-compulsive disorder, people persistently experience certain intrusive thoughts or

images (obsessions) or feel compelled to perform certain behaviors (compulsions). Obsessions
may include unwanted thoughts about inadvertently poisoning others or injuring a pedestrian
while driving. Common compulsions include repetitive hand washing or such mental acts as
repeated counting. People with this disorder often perform compulsions to reduce the anxiety
produced by their obsessions. The obsessions and compulsions significantly interfere with their
ability to function and may consume a great deal of time. See Obsessive-Compulsive Disorder.

E Post-Traumatic Stress Disorder

Post-traumatic stress disorder sometimes occurs after people experience traumatic or

catastrophic events, such as physical or sexual assaults, natural disasters, accidents, and wars.
People with this disorder relive the traumatic event through recurrent dreams or intrusive
memories called flashbacks. They avoid things or places associated with the trauma and may
feel emotionally detached or estranged from others. Other symptoms may include difficulty
sleeping, irritability, and trouble concentrating. See Post-Traumatic Stress Disorder.
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III CAUSES

Most anxiety disorders do not have an obvious cause. They result from a combination of
biological, psychological, and social factors.

A Genetics and Neurobiology

Studies suggest that anxiety disorders run in families. That is, children and close relatives of
people with disorders are more likely than most to develop anxiety disorders. Some people
may inherit genes that make them particularly vulnerable to anxiety. These genes do not
necessarily cause people to be anxious, but the genes may increase the risk of anxiety disorders
when certain psychological and social factors are also present.

Anxiety also appears to be related to certain brain functions. Chemicals in the brain called
neurotransmitters enable neurons, or brain cells, to communicate with each other. One
neurotransmitter, gamma-amino butyric acid (GABA), appears to play a role in regulating one’s
level of anxiety. Lower levels of GABA are associated with higher levels of anxiety. Some studies
suggest that the neurotransmitters norepinephrine and serotonin play a role in panic disorder.

B Psychological Factors

Psychologists have proposed a variety of models to explain anxiety. Austrian psychoanalyst

Sigmund Freud suggested that anxiety results from internal, unconscious conflicts. He believed
that a person’s mind represses wishes and fantasies about which the person feels
uncomfortable. This repression, Freud believed, results in anxiety disorders, which he called
neuroses.

More recently, behavioral researchers have challenged Freud’s model of anxiety. They believe
one’s anxiety level relates to how much a person believes events can be predicted or controlled.
Children who have little control over events, perhaps because of overprotective parents, may
have little confidence in their ability to handle problems as adults. This lack of confidence can
lead to increased anxiety.

Behavioral theorists also believe that children may learn anxiety from a role model, such as a
parent. By observing their parent’s anxious response to difficult situations, the child may learn
a similar anxious response. A child may also learn anxiety as a conditioned response. For
example, an infant often startled by a loud noise while playing with a toy may become anxious
just at the sight of the toy. Some experts suggest that people with a high level of anxiety
misinterpret normal events as threatening. For instance, they may believe their rapid heartbeat
indicates they are experiencing a panic attack when in reality it may be the result of exercise.

C Social Factors

While some people may be biologically and psychologically predisposed to feel anxious, most
anxiety is triggered by social factors. Many people feel anxious in response to stress, such as
a divorce, starting a new job, or moving. Also, how a person expresses anxiety appears to be
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shaped by social factors. For example, many cultures accept the expression of anxiety and
emotion in women, but expect more reserved emotional displays from men.

IV TREATMENT

Mental health professionals use a variety of methods to help people overcome anxiety
disorders. These include psychoactive drugs and psychotherapy, particularly behavior therapy.
Other techniques, such as exercise, hypnosis, meditation, and biofeedback, may also prove
helpful.

A Medications

Psychiatrists often prescribe benzodiazepines, a group of tranquilizing drugs, to reduce anxiety

in people with high levels of anxiety. Benzodiazepines help to reduce anxiety by stimulating the
GABA neurotransmitter system. Common benzodiazepines include alprazolam (Xanax),
clonazepam (Klonopin), and diazepam (Valium). Two classes of antidepressant drugs—tricyclics
and selective serotonin reuptake inhibitors (SSRIs)—also have proven effective in treating
certain anxiety disorders.

Benzodiazepines can work quickly with few unpleasant side effects, but they can also be
addictive. In addition, benzodiazepines can slow down or impair motor behavior or thinking and
must be used with caution, particularly in elderly persons. SSRIs take longer to work than the
benzodiazepines but are not addictive. Some people experience anxiety symptoms again when
they stop taking the medications.

B Psychotherapy

Therapists who attribute the cause of anxiety to unconscious, internal conflicts may use
psychoanalysis to help people understand and resolve their conflicts. Other types of
psychotherapy, such as cognitive-behavioral therapy, have proven effective in treating anxiety
disorders. In cognitive-behavioral therapy, the therapist often educates the person about the
nature of his or her particular anxiety disorder. Then, the therapist may help the person
challenge irrational thoughts that lead to anxiety. For example, to treat a person with a snake
phobia, a therapist might gradually expose the person to snakes, beginning with pictures of
snakes and progressing to rubber snakes and real snakes. The patient can use relaxation
techniques acquired in therapy to overcome the fear of snakes.

Research has shown psychotherapy to be as effective or more effective than medications in

treating many anxiety disorders. Psychotherapy may also provide more lasting benefits than
medications when patients discontinue treatment.