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Anxiety disorders

Anxiety disorders are conditions in which symptoms of anxiety are so severe, or occur so regularly, they start to interfere with your everyday life.

Anxiety is a feeling of unease. Everybody gets anxious when faced with a stressful situation, for example an exam or interview, or during a worrying time such as illness. It's also normal to feel anxious when you face something difficult or dangerous. Mild anxiety can often be positive and useful, particularly if you’re better at working under pressure.

If you have anxiety that is long-lasting and severe, it can interfere with your everyday activities. This can lead to other mental health problems, such as depression.

Types of anxiety disorder

There are different types of anxiety disorders. Below are some examples.

Phobias

A phobia is when you have a fear that is out of proportion to any real danger. If a phobia interferes with your ability to lead a normal life, then it may be considered an anxiety disorder. Common phobias include fears of heights, spiders, mice, blood, injections or enclosed spaces.

Panic disorder

If you have panic disorder, you can suddenly develop intense periods of fear known as panic attacks. You may find that something triggers your panic attacks, or they may develop for no apparent reason. Panic attacks usually last between five and 20 minutes, but they can last longer.

Obsessive-compulsive disorder

If you have obsessive-compulsive disorder (OCD), you may have repeated obsessions and/or compulsions that make you feel anxious. Obsessions are recurrent ideas that make you feel distressed or anxious, such as thoughts about being contaminated with germs. Compulsions are actions or rituals that you feel necessary to cancel out the obsessions, such as washing your hands. OCD symptoms vary from mild to severe.

Post-traumatic stress disorder

You can develop post-traumatic stress disorder if you have had, or have witnessed, a traumatic event. Post-traumatic stress disorder symptoms include anxiety, which may come and go, and recurring thoughts, memories, images, dreams or distressing 'flashbacks' of the trauma. It may develop years after the traumatic event has occurred.

Generalised anxiety disorder

Anxiety can be a long-term disorder where you feel worried most of the time about things that might go wrong. This is called generalised anxiety disorder. If you have generalised anxiety disorder, you may also have panic attacks and some phobias.

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Details

  • Symptoms Symptoms of anxiety disorders

    Anxiety disorders can cause both psychological and physical symptoms.

    If you have an anxiety disorder, your main symptom will be feeling anxious. However, this can lead to other psychological symptoms such as:

    • sleeping difficulties (insomnia)
    • feeling tired
    • being irritable or quick to get angry
    • being unable to concentrate
    • feeling out of control of your actions, or detached from your surroundings

    When you're anxious, you may also have a range of physical symptoms. This is caused by the release of the hormone adrenaline – your body's so-called 'fight or flight' response. Physical symptoms of anxiety include:

    • rapid heartbeat or palpitations
    • stomach cramps
    • diarrhoea
    • dry mouth
    • shortness of breath
    • dizziness
    • needing to urinate more often than usual
    • feeling of a lump in your throat
    • trembling or shaking
    • hot or cold sweats
    • nausea or sickness
    • headaches

    These symptoms may be caused by problems other than anxiety disorders. If you have any of these symptoms, speak to your GP for advice.

  • Diagnosis Diagnosis of anxiety disorders

    If you think feelings of anxiety are affecting your day-to-day life, see your GP.

    Your GP will want to identify what’s causing your anxiety. He or she will ask about your symptoms.

    In some circumstances, depending on the severity of your symptoms, your GP may refer you to a counsellor, therapist or psychiatrist for further diagnosis.

  • Treatment Treatment of anxiety disorders

    Self-help

    There are various lifestyle changes you can make to help reduce feelings of anxiety. Taking part in regular physical activity, staying away from stimulants such as cigarettes and alcohol and eating a healthy diet can help improve your symptoms. Contacting and talking to other people who have anxiety disorders through charities and patient groups can be a good source of support and advice. Your GP may be able to advise you about services available in your area.

    Talking therapies

    Your GP may refer you to a counsellor or a therapist for treatment.

    Talking through your problems with a counsellor may help you to deal better with your anxiety. Counselling may be particularly helpful if you have a panic disorder, social phobia or generalised anxiety disorder, especially in the short term, but it isn’t suitable for everyone. For more information, speak to your GP.

    Cognitive behavioural therapy (CBT) is a short-term psychological treatment. It can help you change how you think (‘cognitive’) and what you do (‘behaviour’). As CBT helps to challenge negative thoughts, feelings and behaviour, it’s particularly suitable if you have problems such as phobias or panic attacks.

    Medicines

    There are a number of different types of medicines that can be used to treat anxiety disorders. Your GP may prescribe you one of the following medicines, depending on how much your anxiety affects you.

    • Benzodiazepines. These may be used for the short-term relief of severe anxiety. They aren’t prescribed for long-term use because of the risk of addiction.
    • Antidepressants. These can be used on their own for chronic anxiety or in combination with a benzodiazepine.
    • Beta-blockers. These may help to reduce some of your physical symptoms, such as rapid heartbeats or palpitations and shaking. However, they don’t help with the psychological symptoms of anxiety.

    Always ask your GP for advice, and read the patient information leaflet that comes with your medicine.

    Complementary therapies

    Some relaxation techniques such as meditation and low impact yoga or t’ai chi exercises may help you to deal with your anxiety. However, there isn’t enough research on these types of therapy to tell if they are effective or not. You should always speak with your GP before you start any complementary therapy courses or treatments.

  • Worried about mental health?

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  • Causes Causes of anxiety disorders

    There are many different causes of anxiety disorders. It may not be clear why you have an anxiety disorder, but you may be more likely to develop one if you:

    • go through a stressful, life-changing event such as a bereavement, or witness something traumatic
    • have another mental health condition, such as depression or alcohol dependence
    • have a physical illness, such as a thyroid disorder
    • take illegal substances such as amphetamines, LSD and ecstasy
    • are withdrawing from long-term use of some medicines, such as tranquillisers

    Some people seem to be born with a tendency to be more anxious than others. This means anxiety disorders may be genetically inherited. Equally, people who aren’t naturally anxious can become so if they are put under intense pressure.

  • FAQs FAQs

    How can I help reduce my anxiety myself?

    Answer

    There are a number of self-help measures you can take to help reduce your anxiety. Everyone is different, so it's important to try different things and see which works best for you.

    Explanation

    Taking part in regular physical activity can help you to feel less anxious. When you exercise, your brain releases hormones called endorphins, which can improve how you feel.

    Avoiding stimulants such as coffee, cigarettes and alcohol can also help you to relax. If you eat a healthy, well balanced diet and get enough sleep, you will be able to cope better with stress.

    Even talking to friends or relatives about the things that are making you feel anxious can help. This may encourage you to seek practical advice for your problems if you need to.

    Learning to relax in any way that suits you is also important.

    How long will it take for medicines or cognitive behavioural therapy (CBT) to improve my anxiety disorder?

    Answer

    Medicines and CBT don’t work instantly. Both types of treatment can take a number of weeks before you notice any improvements.

    Explanation

    If your GP prescribes a medicine for your anxiety, it's important to understand that it may not work immediately and your symptoms may even get worse for a short time. Medicines such as antidepressants that are often used to treat anxiety disorders usually take about two to four weeks before they start working.

    A typical treatment course of CBT lasts about six weeks to six months and involves weekly sessions lasting up to an hour each. You may have CBT sessions on an individual basis, or with a group of people in a similar situation to you. For some people, the symptoms can get worse in the short term. If this happens, it’s important not to stop treatment. It may be that you need more CBT sessions to make sure you can cope better with your anxiety.

    What is trichotillomania and how is it treated?

    Answer

    Trichotillomania is a condition in which people have an obsessive urge to pull out their own hair, causing considerable hair loss. It can be treated with emotional support and CBT.

    Explanation

    Trichotillomania usually starts in childhood. The main symptom is pulling hair from your scalp and having increased stress levels and anxiety. If emotional support from friends, family or support groups hasn’t helped to change your behaviour, you may be offered CBT. This is made up of three important elements.

    • Self-monitoring, where you keep a record of your hair-pulling behaviour and learn to recognise the situations that make you pull out your hair.
    • Stimulus control, where you learn to stay away from situations that make you pull out your hair, or use techniques to stop you from doing it.
    • Stimulus-response intervention, where you start doing different activities, such as taking a walk or relaxing, instead of hair-pulling.

    What treatments can my child get for anxiety?

    Answer

    Children and teenagers can be treated for anxiety with medicines, but it's generally better to try psychological therapies first.

    Explanation

    Some antidepressant medicines can be used to treat anxiety disorders in children and teenagers. For example, some types of selective serotonin re-uptake inhibitors (SSRIs) have been found to help children and young adults deal with obsessive-compulsive disorder (OCD). These medicines are only available on prescription from your GP or specialist and will only be considered after all other treatment options have been looked at.

    Instead of prescribing medicines, your GP or specialist may want to try a course of psychotherapy known as CBT. This is a type of talking therapy carried out by a specially trained therapist. CBT can help children and parents understand how the problem developed and what they can do to overcome the anxiety. If you need further information, visit your GP for more advice.

  • Resources Resources

    Further information

    Sources

    • Understanding anxiety and panic attacks. Mind. www.mind.org.uk, accessed 6 August 2012
    • Anxiety, panic and phobias. The Royal College of Psychiatrists. www.rcpsych.ac.uk, published September 2011
    • Fear and anxiety. Mental Health Foundation. www.mentalhealth.org.uk, accessed 6 August 2012
    • Anxiety disorders. eMedicine. www.emedicine.medscape.com, published 23 January 2012
    • Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. National Institute for Health and Clinical Excellence (NICE), 2005. www.nice.org.uk
    • Post-traumatic stress disorder. The Royal College of Psychiatrists.www.rcpsych.ac.uk, published March 2010
    • Cognitive behavioural therapy (CBT). The Royal College of Psychiatrists. www.rcpsych.ac.uk, published February 2012
    • The anxious child. Mental Health Foundation. www.mentalhealth.org.uk, accessed 6 August 2012
    • Joint Formulary Committee. British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2012
    • Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol, 2005;19(6): 567–96
    • Krisanaprakornkit T, Sriraj W, Piyavhatkul N, et al. Meditation therapy for anxiety disorders. Cochrane Database of Systematic Reviews 2009, Issue 1. doi:10.1002/14651858.CD004998.pub2
    • Trichotillomania. eMedicine. www.emedicine.medscape.com, published August 2011
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