What are anxiety disorders?
Having an anxiety disorder is not the same thing as experiencing anxiety. Anxiety and fear can be normal, adaptive responses to stressful and scary situations. Anxiety symptoms can also occur in the context of other mental and physical disorders or as effects of medication or drugs of abuse. In anxiety disorders, however, the feelings of anxiety or fear are recurrent, excessive, consistent, and persistent. They may also be accompanied by other symptoms, like sleep disturbances or panic attacks.
Anxiety disorders are defined by the 5th edition of the American Psychological Association (APA)’s Diagnostic and Statistical Manual (DSM-5) as a group of disorders "that share features of excessive fear and anxiety and related emotional disturbances".[11] The most common anxiety disorders in adults are specific phobias, panic disorder, social anxiety disorder, generalized anxiety disorder, and agoraphobia.[12]
What are the main signs and symptoms of anxiety disorders?
Just experiencing anxiety symptoms does not mean that someone has an anxiety disorder. The American Psychological Association (APA) sets out diagnostic criteria for specific anxiety disorders in its Diagnostic and Statistical Manual of Mental Disorders (DSM). This table summarizes the symptoms used to diagnose the most common anxiety disorders.[11]
| Disorder | Summary of symptoms |
|---|---|
| Generalized anxiety disorder | Excessive anxiety and worry which are difficult to control, which cause distress or difficulty functioning, and which are associated with at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, tension, sleep disturbance. |
| Social anxiety disorder | Consistent, persistent, and disproportionate fear or anxiety around being judged by others in one or more social situations which results in intense distress or in difficulties functioning. |
| Specific phobia | A specific object or situation consistently and persistently provokes intense fear or anxiety out of proportion to the actual danger that results in intense distress or difficulties functioning. |
| Panic disorder | Recurrent, unexpected panic attacks, prompting worry or behavioural change. |
| Agoraphobia | Consistent, persistent, disproportionate fear and anxiety about being in two or more of the following specific situations: public transportation, open spaces, enclosed spaces, being in a crowd or a line, or being away from home alone. The fear and anxiety cause avoidant behaviour and distress/difficulty functioning. |
Adapted from: American Psychological Association. (2013) Anxiety Disorders. In Diagnostic And Statistical Manual of Mental Disorders (5th ed.)
For all of the above anxiety disorders, the diagnosis will only be made if the symptoms can't be better explained by the effects of a medication or drug, by another medical condition, or by another mental disorder.
How are anxiety disorders diagnosed?
Anxiety disorders shouldn’t be self-diagnosed: It takes clinical experience to distinguish between normal and disordered anxiety. Diagnosing an anxiety disorder is done through a psychological evaluation performed by a clinician, after ruling out other symptom causes such as medication, drugs, or medical conditions.[13] The psychological evaluation is typically based on diagnostic criteria set by a publication such as the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) or the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD). The symptoms in the APA’s diagnostic criteria for the most common anxiety disorders are summarized in What are the main signs and symptoms of anxiety disorders? The diagnosis can only be made if the symptoms can't be better explained by the effects of a medication or drug, by another medical condition, or by another mental disorder.
What are some of the main medical treatments for anxiety disorders?
Antianxiety medications like beta-blockers and antidepressants are commonly used either alone or in conjunction with therapy for the relief of anxiety symptoms. Types of therapy used for anxiety disorders include cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).[13]
Have any supplements been studied for anxiety disorders?
Several supplements have been studied for relief of anxiety symptoms, both in the contexts of anxiety disorders and in other contexts. While some supplements have been studied for anxiety relief in the context of anxiety disorders, there aren’t many with strong evidence.
- Lavender oil capsules were effective in two trials in people with anxiety disorders.[14]
- A 2010 systematic review noted that the majority of randomized controlled trials of kava saw significantly reduced anxiety in people with anxiety disorders or anxiety-related disorders, although the supplement carries a possible risk of inducing liver toxicity.[2] However, in a 2022 review of studies, it was not as effective in people with generalized anxiety disorder.[15]
How could diet affect anxiety disorders?
Certain dietary patterns may assist with anxiety symptoms, including in the context of anxiety disorders. See What’s the connection between diet and anxiety symptoms? on the anxiety symptoms page.
Are there any other treatments for anxiety disorders?
Some evidence shows that meditation can reduce anxiety symptoms,[16] performing better than no intervention or sham interventions in people without diagnosed anxiety disorders and comparably to other active therapies among people with diagnosed anxiety disorders.[17]
Exercise, particularly high-intensity aerobic exercise and resistance training, may be effective for treating anxiety symptoms, including in the context of anxiety disorders.[18][19]
What causes anxiety disorders?
The causes of anxiety disorders are complex and not fully understood. Genetics, the environment, and brain biology can all play a role.[12]
Examine Database: Anxiety
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Frequently asked questions
Having an anxiety disorder is not the same thing as experiencing anxiety. Anxiety and fear can be normal, adaptive responses to stressful and scary situations. Anxiety symptoms can also occur in the context of other mental and physical disorders or as effects of medication or drugs of abuse. In anxiety disorders, however, the feelings of anxiety or fear are recurrent, excessive, consistent, and persistent. They may also be accompanied by other symptoms, like sleep disturbances or panic attacks.
Anxiety disorders are defined by the 5th edition of the American Psychological Association (APA)’s Diagnostic and Statistical Manual (DSM-5) as a group of disorders "that share features of excessive fear and anxiety and related emotional disturbances".[11] The most common anxiety disorders in adults are specific phobias, panic disorder, social anxiety disorder, generalized anxiety disorder, and agoraphobia.[12]
Anxiety, as defined by the APA, combines uneasiness or dread about future events, physical symptoms of tension, and the anticipation of impending danger.[20] In contrast, fear is an emotional and physiological response to an immediate threat.[21] Anxiety and fear are both normal emotions that everyone experiences from time to time. In anxiety disorders, however, anxiety and fear are persistent — present for longer than 6 months — and either are excessive or are present long after they’re developmentally appropriate. Anxiety disorders can often interfere with daily activities, either directly (as with selective mutism, in which people cannot talk in some situations) or because people with anxiety disorders may rearrange their lives to avoid situations that trigger their symptoms (as with agoraphobia, in which certain spaces or situations trigger anxiety).
The 5th edition of the American Psychological Association (APA)’s Diagnostic and Statistical Manual (DSM-5) defines the following anxiety disorders:[11]
- Separation Anxiety Disorder
- Selective Mutism
- Specific Phobia (e.g. fear of spiders)
- Social Anxiety Disorder (also known as social phobia)
- Panic Disorder
- Agoraphobia
- Generalized Anxiety Disorder
- Substance/Medication-Induced Anxiety Disorder
- Anxiety Disorder Due to Another Medical Condition
- Other Specified Anxiety Disorder
- Unspecified Anxiety Disorder
Anxiety symptoms and panic attacks can be associated with any of these disorders.
Just experiencing anxiety symptoms does not mean that someone has an anxiety disorder. The American Psychological Association (APA) sets out diagnostic criteria for specific anxiety disorders in its Diagnostic and Statistical Manual of Mental Disorders (DSM). This table summarizes the symptoms used to diagnose the most common anxiety disorders.[11]
| Disorder | Summary of symptoms |
|---|---|
| Generalized anxiety disorder | Excessive anxiety and worry which are difficult to control, which cause distress or difficulty functioning, and which are associated with at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, tension, sleep disturbance. |
| Social anxiety disorder | Consistent, persistent, and disproportionate fear or anxiety around being judged by others in one or more social situations which results in intense distress or in difficulties functioning. |
| Specific phobia | A specific object or situation consistently and persistently provokes intense fear or anxiety out of proportion to the actual danger that results in intense distress or difficulties functioning. |
| Panic disorder | Recurrent, unexpected panic attacks, prompting worry or behavioural change. |
| Agoraphobia | Consistent, persistent, disproportionate fear and anxiety about being in two or more of the following specific situations: public transportation, open spaces, enclosed spaces, being in a crowd or a line, or being away from home alone. The fear and anxiety cause avoidant behaviour and distress/difficulty functioning. |
Adapted from: American Psychological Association. (2013) Anxiety Disorders. In Diagnostic And Statistical Manual of Mental Disorders (5th ed.)
For all of the above anxiety disorders, the diagnosis will only be made if the symptoms can't be better explained by the effects of a medication or drug, by another medical condition, or by another mental disorder.
Anxiety disorders shouldn’t be self-diagnosed: It takes clinical experience to distinguish between normal and disordered anxiety. Diagnosing an anxiety disorder is done through a psychological evaluation performed by a clinician, after ruling out other symptom causes such as medication, drugs, or medical conditions.[13] The psychological evaluation is typically based on diagnostic criteria set by a publication such as the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) or the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD). The symptoms in the APA’s diagnostic criteria for the most common anxiety disorders are summarized in What are the main signs and symptoms of anxiety disorders? The diagnosis can only be made if the symptoms can't be better explained by the effects of a medication or drug, by another medical condition, or by another mental disorder.
Antianxiety medications like beta-blockers and antidepressants are commonly used either alone or in conjunction with therapy for the relief of anxiety symptoms. Types of therapy used for anxiety disorders include cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).[13]
Several supplements have been studied for relief of anxiety symptoms, both in the contexts of anxiety disorders and in other contexts. While some supplements have been studied for anxiety relief in the context of anxiety disorders, there aren’t many with strong evidence.
- Lavender oil capsules were effective in two trials in people with anxiety disorders.[14]
- A 2010 systematic review noted that the majority of randomized controlled trials of kava saw significantly reduced anxiety in people with anxiety disorders or anxiety-related disorders, although the supplement carries a possible risk of inducing liver toxicity.[2] However, in a 2022 review of studies, it was not as effective in people with generalized anxiety disorder.[15]
Yohimbine and yohimbine-containing products — as well as supplements that have a similar mechanism, such as rauwolscine — should be avoided, because they can provoke anxiety in people with anxiety disorders.[22]
Additionally, although stimulants do not always cause anxiety symptoms, many create a stress response that could worsen existing symptoms. People with anxiety disorders might not need to stop using stimulants entirely, but they may want to avoid frequent use, especially if anxiety symptoms worsen.
Caffeine is the stimulant least likely to cause anxiety symptoms. Ideally, 100–200 mg of caffeine should be paired with an equal dose of theanine, an amino acid that can tame the anxiety caused by caffeine in some people without impairing caffeine’s stimulatory effect. In fact, the improvements in concentration (focus and attention span) induced by caffeine and theanine, respectively, have been shown to be synergistic (work together).
Certain dietary patterns may assist with anxiety symptoms, including in the context of anxiety disorders. See What’s the connection between diet and anxiety symptoms? on the anxiety symptoms page.
Some evidence shows that meditation can reduce anxiety symptoms,[16] performing better than no intervention or sham interventions in people without diagnosed anxiety disorders and comparably to other active therapies among people with diagnosed anxiety disorders.[17]
Exercise, particularly high-intensity aerobic exercise and resistance training, may be effective for treating anxiety symptoms, including in the context of anxiety disorders.[18][19]
The causes of anxiety disorders are complex and not fully understood. Genetics, the environment, and brain biology can all play a role.[12]
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References
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