People with anxiety disorders experience a variety of symptoms. However, these disorders all share two core features: excessive fear and unsuccessful attempts to escape it. Ultimately, those escape strategies interfere with a person’s ability to work, sustain relationships, and fully engage with life. We all feel fear, but anxiety is disabling fear.
Remember that there’s a difference between anxiety as an emotion and anxiety as a disorder. There are many situations where anxiety is a natural response. If you’re stepping up to a stage to deliver a presentation to hundreds of people, then anxiety is a normal reaction. If you get laid off from a job during a recession, then anxiety comes as no surprise. If you get diagnosed with a chronic illness, then feeling anxiety for a little while is a normal and appropriate response.
Anxiety turns into a mental health problem only under certain specific conditions—when it lasts a long time, and when it becomes a barrier to carrying out the tasks of everyday life. If this is your experience, then you might be dealing with an anxiety disorder such as
With generalized anxiety disorder (GAD), you feel profound fear on a daily basis. When thinking about the events of your day, you anticipate disasters. You find it difficult to relax, have trouble sleeping, and startle easily. You might feel a sudden burst of rage and the urge to attack someone physically or verbally. Sometimes these symptoms might be related to specific events, but often they seem to occur for no reason. GAD, in short, is a tormenting experience of uncertain fear.
GAD can include any of the physical sensations described earlier—blushing, dizziness, rapid breathing, shaking hands, heart palpitations, and sweating. Over time and with repeated anxiety attacks, the symptoms can expand to include hives, excess stomach acid, restless sleep, chronic headaches, and muscle tension.
People are diagnosed with GAD when their symptoms are present for at least six months. As with many illnesses, GAD ranges from mild to moderate or severe. People with mild symptoms might manage to hold down a job, manage a household, and make friends. For people with severe GAD, however, carrying out even the simplest daily activities becomes a frightening chore.
The symptoms of simple phobias overlap with those of GAD. Unlike GAD, however, simple phobias are tied to specific objects. Some people experience anxiety even at the thought of finding a snake in their backyard. Other people have the same reaction to cats, dogs, insects, or birds.
Simple phobias also include exaggerated and disabling fear of situations such as
With a social phobia, you experience anxiety symptoms when you’re around other people. You feel excessively self-conscious in social situations, such as going to work or school, eating in a restaurant, or attending a party. At the bottom of these feelings is an extreme fear of being seen, judged, rejected, or humiliated in public. It’s as if all eyes are focused on you.
Social phobias can also be mild, moderate, or severe. People with a mild form of this condition can take part in social events. However, they might dread these events for weeks ahead of time and feel extreme discomfort while they’re actually in the presence other people. With extreme social phobias, people may refuse to see anyone other than a spouse or immediate family members. Even the prospect of writing something that will be read by other people can be enough to trigger the experience of anxiety.
People with social phobias often feel like prisoners. They might avoid social situations, travel only a limited distance from home, or refuse to leave home at all.
The hallmark of this disorder is a panic attack—a sudden, intense burst of anxiety. An attack usually peaks within ten minutes, though some of the symptoms can last for hours.
In Embracing the Fear, Bemis and Barrada describe a panic attack:
Imagine for a moment that you are driving down the freeway. Suddenly, for no apparent reason, your heart begins to race. Your breathing becomes labored. You find it difficult to swallow. Feeling light-headed, you grip the steering wheel and notice that your hands are perspiring. A feeling of panic washes over you. Your mind races as you try to grasp what’s happening. You struggle to stay in control, but the harder you try, the more out of control you feel. You tell yourself, Just stay calm! But the panic continues to escalate. You try to distract yourself by listening to the car radio or focusing your attention on the traffic around you. Another wave of panic! Seconds pass like minutes. What if I pass out? Maybe this is a heart attack!
Terrified, overwhelmed with a sense of impending doom, you head for the nearest exit in a desperate attempt to get help. Once off the freeway, the feeling gradually subsides, leaving you shaken and bewildered.1
Something like this can happen to people in many other situations—at a shopping mall, coffee shop, grocery store, or church service; during a meeting at work; or even during the middle of the night. A panic attack can trigger the thought that you’re having a heart attack, losing your mind, or about to die. Though the details vary, the core reaction is the same—terror.
When panic attacks become a regular event in someone’s life, they can be disabling. People who experience these attacks in elevators, for example, are profoundly limited in where they can live and work. And people who experience panic attacks during social events find it difficult to make friends and sustain close relationships.
As with other anxiety disorders, a panic attack often occurs at two levels. The first level involves negative thoughts and physical sensations of extreme discomfort. The second level is terror at the mere prospect of experiencing those thoughts and sensations. People with panic disorders commonly worry about when their next attack will occur—a “fear of fear itself.”
Post-traumatic stress disorder (PTSD) refers to anxiety that’s triggered by a terrifying event, such as
According to the National Institute of Mental Health, symptoms of PTSD fall into three main categories:2
Re-experiencing symptoms. People with PTSD mentally relive traumatic events through nightmares, flashbacks, and other frightening thoughts. They remember sights and sounds in vivid detail and feel the accompanying physical sensations again. Certain words, objects, or situations can become reminders of the event and trigger these symptoms.
Avoidance symptoms. Another set of symptoms involves efforts to stay away from reminders of a traumatic experience. These avoidance strategies can lead to
Changes in behavior can result as well. Someone who survives a car accident, for instance, may avoid driving or riding in a car.
Hyperarousal symptoms. These include being easily startled, feeling “on edge,” and having outbursts of anger. Unlike other PTSD symptoms, hyperarousal symptoms persist. They are not triggered by specific reminders of a traumatic event. Feelings of stress and anger become daily events, as can problems with sleeping and concentrating on daily tasks.
Note: Some people with PTSD don’t show any symptoms for weeks or months after a traumatic event. Other people experience PTSD symptoms for only a few weeks. This is called acute stress disorder (ASD). In contrast, symptoms of PTSD can persist for months or years.
True to its name, obsessive-compulsive disorder (OCD) is marked by two sets of symptoms.
One is obsession—the experience of recurring and extremely unpleasant thoughts. For example, a person with OCD might have vivid images of physically attacking a loved one, engaging in taboo sexual behaviors, or desecrating a sacred religious object.
The other major symptom of OCD is compulsion—repeating certain behaviors with the hope of making obsessive thoughts go away. These ritualized behaviors might involve
In addition, some people with OCD refuse to throw away unwanted objects. These people often clutter their entire living space with trash—a symptom called hoarding. Hoarding can also involve keeping dozens of dogs, cats, or other animals in a confined space.
As with other anxiety disorders, OCD can lead to social isolation. People with OCD may also try to self-medicate their symptoms with alcohol or other drugs.
Over time, OCD symptoms can change. They can disappear for a time and then suddenly resume, becoming more severe.
In addition, OCD rituals are paradoxical. On the one hand, doing them provides only temporary relief. At the same time, not doing them increases the obsession-related anxiety. Even though people with OCD carry out rituals with the hope of controlling their anxiety, the rituals eventually take control of the person. And even though many adults with OCD recognize that a ritual is ineffective, they repeat the behavior anyway.