Stress and anxiety are among the most common mental disorders. Unfortunately, many people who struggle with anxiety disorders turn to alcohol or drugs to manage their symptoms. Understanding the signs and symptoms of anxiety disorder and how to manage them can help people with these disorders avoid self-medicating with drugs or alcohol.
What Are Anxiety Disorders?
Anxiety disorder is generally defined as a chronic condition that causes an excessive, persistent sense of apprehension along with physical symptoms of sweating, palpitations and stressful feelings. However, anxiety disorders are not all alike, and the National Institutes of Mental Health has described five major types of anxiety disorder. Each type is based on the specific effects of anxiety that someone experiences:
- Generalized Anxiety Disorder (GAD)
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Social Phobia (also known as Social Anxiety Disorder)
Each category can be further classified based on the signs and symptoms that someone experiences. There is also a sixth category that involves specific phobias, such as a fear of heights or needles.
Causes of Anxiety Disorder
A large amount of evidence shows that anxiety disorders are caused by a combination of biological and environmental factors. Environmental factors include psychological vulnerabilities, such as beliefs, patterns of thought and how we “choose” to respond to stressful situations.
The role of biology in anxiety is incredibly complex, and there is much that is not yet understood. However, it is clear that biological factors (including a person’s genetics and physiology) are major contributors to the development of anxiety disorders.
In recent years, a number of studies have looked at gene expression levels in people with generalized anxiety disorders. Neuroimaging studies have looked to evaluate how the brain responds to stressful events in people with an anxiety disorder. Most of these studies have found significant differences between people with an anxiety disorder and people without one.
Researchers are also studying the effects of genetic and environmental factors in twins. A recent twin study found that anxiety is influenced by genetics but that environmental factors also make a significant contribution. In other words, even if someone inherits genes that increase the risk of developing an anxiety disorder, they may never actually develop one.
One theory about environmental factors involves how young people respond to stress. Because the brain develops during adolescence, the brain of a child may develop differently due to trauma. Some neuroimaging studies have supported this hypothesis. In one neuroimaging study, people with panic disorder were found to have larger amygdalas (the part of the brain that responds to stress and fear) than other people.
Anxiety Disorders Symptoms
Although each type of anxiety disorder has a unique set of symptoms, several symptoms are commonly found in all types. The most common psychological symptoms of anxiety include:
- An overall sense of apprehension or dread
- Expecting the worst outcome
Physical symptoms of anxiety disorders include:
- Elevated heart and respiration rates
- Fatigue and insomnia
- Upset stomach
- Frequent urination
Common signs of an anxiety disorder that another person might notice include:
- Trembling or shaking
- Excessive sweating
- Panic attacks
- Hyperventilation (breathing rapidly)
- Specific phobias (fear of public speaking, for example)
Common Types of Anxiety Disorders
While there are five recognized types of anxiety disorder, they can be further characterized based on a few factors. These factors include the trigger for an anxiety attack, how long the attack lasts and how the person experiencing the anxiety attack responds.
Short-Term Anxiety Disorders
Strictly speaking, short-term anxiety disorders are in a different category than long-term anxiety disorders. However, this does not reduce the very real and often debilitating consequences of anxiety attacks related to a temporary anxiety issue.
Importantly, there is a difference between stress and anxiety. According to the Anxiety and Depression Association of America, stress is a response to an external event, while anxiety is an internal response to stress.
Short-term anxiety disorders include:
- Substance-Induced Anxiety Disorder
Many drugs can cause anxiety, and stimulants are generally the most likely to cause anxiety. Legal stimulants like prescription ADHD medications (Ritalin, Adderall) and even caffeine can induce a feeling of anxiety. Illicit drugs like methamphetamine can also cause anxiety.
- Acute Stress Disorder
This is a response to a traumatic event. For acute stress disorder, symptoms must resolve within a month of the event. Otherwise, a diagnosis of post-traumatic stress disorder is made. Acute stress disorder symptoms may include recurring, distressing memories or dreams related to the event. It can also include flashbacks, an altered sense of reality, inability to concentrate and efforts to avoid people or places that may trigger thoughts of the event.
- Adjustment Disorder With Anxious Features
An adjustment disorder with anxiety means that a person has developed marked distress from adjusting to a life-changing event. This disorder impairs their ability to function in social settings. Adjustment disorder symptoms include excessive worry, nervousness, jitteriness and fear of separation from attachment figures. Adjustment disorder in children and adolescents is quite common.
Long-Term Anxiety Disorders
Chronic anxiety disorders feature prolonged anxiety that is so intense that it interferes with someone’s ability to function normally. There are five types of anxiety disorder and a sixth category that represents specific phobias:
- Generalized Anxiety Disorder
For generalized anxiety disorder, excessive worry and related symptoms must persist for more than six months and occur more days than not. Symptoms include persistent and debilitating anxiety, restlessness, excessive vigilance, muscle tension, insomnia, and agitation.
- Social Anxiety Disorder
Social anxiety disorder is more than being shy or uncomfortable in social settings. For social anxiety disorder, someone must have a phobia of one or more social activities that seriously limit normal social functioning, such as using public restrooms or public speaking. Signs of social anxiety include avoiding specific social events and if they can’t be avoided, significant anxiety that negatively affects performance. Social anxiety disorder causes people to miss out on normal activities that their friends, family, and co-workers participate in.
- Post-traumatic Stress Disorder
Post-traumatic stress disorder is an intense, prolonged emotional reaction to a traumatic event. Post-traumatic stress disorder causes people to limit their exposure to anything that reminds them of the event, which often substantially affects their ability to carry out normal daily activities. Post-traumatic stress disorder symptoms include flashbacks, nightmares, emotional numbness, memory loss, hypervigilance, jumpiness and quickness to anger.
- Obsessive-Compulsive Disorder
People with obsessive-compulsive disorder fixate on a specific idea to the point where they are driven to act. For example, someone who has a fear of contamination may wash their hand’s dozens of times every day. Obsessive-compulsive disorder symptoms include an irrational obsession that does not go away until an action is taken that relieves the thought.
- Panic Disorder
Panic disorder is characterized by sudden and irrational fight-or-flight responses that are not related to a stressful event. Panic disorder symptoms include sudden panic or extreme distress, continued anxiety about unexpected attacks and attempts to avoid situations where an attack was experienced.
- Specific Phobias
The definition of a specific phobia is an irrational fear of a specific object or situation. There are four overall types of specific phobias, including blood-injury-injection, situational (such as elevators or airplanes), environmental (such as heights) and animals. A fifth “other” category includes less common phobias, such as fear of choking.
Anxiety Disorder Statistics
Approximately 19% of American adults met the criteria for having an anxiety disorder or phobia in 2017. The prevalence of anxiety disorders tends to be higher in women, with 23.4% of women meeting criteria for an anxiety disorder compared to 14.3% of men. The majority of anxiety disorders are mild (43.5%) or moderate (33.7%), with 22.8% being serious.
Anxiety Disorders In Children and Teens
The prevalence of anxiety disorders is higher among adolescents than adults, with approximately 32% of teenagers meeting the criteria. As with adults, adolescent girls have a higher rate of anxiety disorders (38%) than boys (26%).
Anxiety and Substance Abuse
Substance abuse and anxiety disorders are often linked. Unmanaged anxiety disorders can be incredibly frustrating and often force people to miss out on events or activities. Some people turn to drugs or alcohol to help them manage their anxiety symptoms.
Alcohol and marijuana are two of the most commonly misused drugs associated with anxiety. However, prescription anti-anxiety medications are often powerfully addictive, and there has been a huge upsurge in prescription medication misuse in recent years.
Anxiety Disorder Treatment
While there are many anxiety disorder medications available, they should be used with caution. Benzodiazepines, including Valium and Xanax, are the most common prescription anxiety medication. These drugs are incredibly addictive, even when used as directed.
Prescribing guidelines specify that benzodiazepines are intended for short-term, intermittent use. Unfortunately, some doctors put their patients at risk by providing prescriptions that include long-term, daily use of these drugs.
The safest and most effective types of therapy for anxiety disorders include cognitive behavioral therapy (CBT) and other forms of talk therapy. In particular, CBT has been shown to be incredibly beneficial for people with anxiety. The goal of these types of therapy is to reframe someone’s negative internal dialogue in a more positive way, allowing them to reduce their anxiety level.
Dual diagnosis treatment involves an anxiety disorder that is present with a co-occurring substance use disorder. An undiagnosed anxiety disorder can lead to someone misusing drugs or alcohol, and a dual diagnosis helps address both the anxiety disorder and substance use simultaneously. Many people find that once their anxiety is properly managed, they are able to have better control over their substance use.
Key Points: Anxiety Disorders
There are several important points to remember about anxiety disorders:
- There are six types of anxiety disorder, including general anxiety, social anxiety, panic disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and specific phobias
- Anxiety disorders are often debilitating and significantly impair a person’s ability to function
- People with unmanaged anxiety disorders may turn to alcohol or drugs in an attempt to get their anxiety under control
- There are medications and therapies that can help manage anxiety
Anxiety disorders often prevent people from enjoying a healthy, productive lifestyle. If you or a loved one may be suffering from anxiety, reach out to our expert mental health care team at Baptist Health to begin treatment today. If you believe you or a loved one are struggling with co-occurring anxiety and addiction contact us at The Recovery Village Palm Beach at Baptist Health to begin your road to recovery.
Shiel, William C. “Medical Definition of Anxiety Disorder.” MedicineNet, (n.d.). Accessed January 9, 2020.
National Institute of Mental Health. “What are the five major types of anxiety disorders?” February 2014. Accessed January 9, 2020.
Barlow, David H.; Ellard, Kristen K. “Chapter 10: Anxiety and Related Disorders.” General Psychology, 2018. Accessed January 10, 2020.
Wingo, Aliza P.; Gibson, Greg. “Blood gene expression profiles suggest altered immune function associated with symptoms of generalized anxiety disorder.” Brain, Behavior, and Immunity, January 2015. Accessed January 10, 2020.
Maron, Eduard; Nutt, David. “Biological markers of generalized anxiety disorder.” Dialogues in Clinical Neuroscience, June 2017. Accessed January 10, 2020.
Davies, Matthew N.; et al. “Generalised Anxiety Disorder – A Twin Study of Genetic Architecture, Genome-Wide Association and Differential Gene Expression.” PLoS One, August 2015. Accessed January 10, 2020.
Yoon, Sujung; et al. “Subregional Shape Alterations in the Amygdala in Patients with Panic Disorder.” PLoS One, June 2016. Accessed January 10, 2020.
National Alliance on Mental Illness. “Anxiety Disorders.” December 2017. Accessed January 10, 2020.
Barnhill, John W. “Acute Stress Disorder (ASD).” Merck Manual, October 2018. Accessed January 10, 2020.
Anxiety and Depression Association of America. “Stress.” (n.d.). Accessed January 10, 2020.
Johns Hopkins Medicine. “Adjustment Disorders.” (n.d.). Accessed January 10, 2020.
National Institute of Mental Health. “Statistics: Any Anxiety Disorder.” November 2017. Accessed January 10, 2020.
Lembke, Anna. “Benzodiazepines: our other prescription drug epidemic.” STAT News, February 2018. Accessed January 9, 2020.
Kaczkurkin, Antonia N.; Foa, Edna B. “Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence.” Dialogues in Clinical Neuroscience, September 2015. Accessed January 10, 2020.