What Is an Anxiety Disorder?
Learn the signs and symptoms of anxiety disorders like GAD, SAD, OCD, and panic disorder, as well as how clinicians differentiate between ADHD and true anxiety.
Everyone feels anxious from time to time. Worrying occasionally about your job, your family, or money is part of the human experience. For some people, however, worry begins to take on a life of its own — seeping beyond the inner psyche and manifesting as physical symptoms. In those cases, anxiety disorder may be to blame.
By definition, anxiety is a “baseless, irrational fear.” Those who suffer from anxiety disorder may fear something awful is about to happen — all of the time. If the anxiety is untreated, it can become overwhelming, leading to panic attacks or withdrawal from society.
Generalized anxiety disorder, or GAD, is what most of us mean when using the umbrella term “anxiety.” GAD affects approximately 6.8 million adults a year and afflicts women at twice the rate of men. It occasionally appears to run in families, but researchers still aren’t certain why some people have it and others don’t. Substance abuse — especially over the long-term — can increase the odds of developing GAD. Heavy caffeine consumption has also been linked to anxiety disorder, as has experiencing a traumatic event — like the death of a loved one.
About 25 percent of people with ADHD also have an anxiety disorder. The two share common symptoms, such as lack of focus and insomnia. Nervousness, however, can be a possible side effect of stimulant medications used to treat ADHD. If you have unexplained and persistent fears, or you experience panic attacks, and feel that your ADHD treatment is not working, talk with your doctor about an anxiety disorder.
Symptoms of Anxiety
Someone suffering from GAD will generally experience several of these symptoms:
- Excessive worry
- Unrealistically negative view of problems
- Restlessness, or feeling “on edge”
- Muscle tension
- Difficulty concentrating
- Difficulty falling or staying asleep, and suffering restless/unsatisfying sleep
These symptoms can vary in severity from day to day, but they tend to dominate the person’s state of mind, daily activities, and personal relationships. The other common anxiety disorders — namely social anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) — each has a unique set of symptoms with which your doctor should be familiar.
Types of Anxiety:
Anxiety can manifest in several ways. Aside from GAD, anxiety disorders include:
1. Social anxiety disorder (SAD), also called a “social phobia,” is just what it sounds like — extreme fear and anxiety related to social situations. Experts once thought it was limited to a fear of public speaking, but we now know that SAD can occur in any setting with unfamiliar people. Extreme social anxiety can stop a person from interacting with the world around him — fearing routine tasks like ordering food — and can lead to social withdrawal.
Studies show that 2 to 13 percent of the U.S. population experiences social anxiety, at some point in their lives. It is the most common type of anxiety disorder in teenagers. It is more common in women and often starts in childhood or early adolescence. Some research has found that if you have SAD, you are six times more likely to also have depression, dysthymia or bipolar disorder.
The following are all symptoms of SAD, though not all people with SAD experience all of these symptoms. Some people might exhibit symptoms in only one type of situation, while others might experience multiple symptoms in various social situations.
- Self conscious in front of other people
- Extreme fear that others will judge you
- Can worry for days or weeks before an event
- Avoidance of situations requiring social interaction and intensely uncomfortable if in a social situation
- Keeps conversation with others to a minimum
- Difficulty making or keeping friends
- Panic attacks, including shaking, blushing, nausea or sweating, when in a social situation
- Difficulty talking to others
2. Panic disorder is characterized by “panic attacks,” which are sudden onsets of acute fear that something terrible is going to happen. Symptoms include rapid heartbeat, dizziness, and hyperventilation, and may be mistaken for a more serious ailment, like a heart attack. Panic attacks usually don’t last longer than 20 minutes, but their damage can stretch beyond the attack itself. Anxiety about it happening again — in many cases, triggering more panic attacks — is categorized as panic disorder.
Panic disorder sometimes runs in families, but researchers don’t know why it skips some people and afflicts others. One theory suggests that the brain of a person with panic disorder misinterprets innocuous daily sensations as threats.
Signs and symptoms include the following:
- Sudden and frequent attacks of fear
- A frightening lack of control during panic attacks
- Distracting worry about when the next attack will happen
- A fear or avoidance of places where panic attacks may occur
- Physical symptoms such as a pounding or racing heart, chest or stomach pain, sweating, shortness of breath, weakness or dizziness, feeling hot or a cold chill, or numb extremities during an attack.
3. Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by “obsessions” (obtrusive unwelcome thoughts) and “compulsions” (repetitive behaviors). A repeated unwanted violent fantasy is a common example of an obsession. Compulsions — like repeatedly washing hands — are sometimes created in response to obsessions, but often they take on a life of their own — and cause more anxiety when they’re not carried out.
Common compulsions include the following:
- Counting or repeating: the need to repeat a specific behavior or pattern of behaviors
- Checking or questioning: the need to check and recheck something
- Arranging and organizing: the need to organize items in a certain way; becoming upset if anything is changed
- Collecting or hoarding: saving books, magazines, ticket stubs, birthday cards, or other items in the belief that they are important and cannot be thrown away
- Cleaning and/or washing: the need to lather and rinse an exact number of times in the shower or to brush one’s hair a certain number of times in a pattern
- “Preening:” Examples are nail or cuticle biting, picking at sores or scabs, twirling or pulling hair, eye-brows, or eyelashes, “cleaning off” dry skin.
Like ADHD, OCD has a strong genetic component and tends to run in families. The age of onset for OCD typically falls within two age ranges: The first is between the ages of 10-12, the other is late teens into early adulthood.
4. Post-Traumatic Stress Disorder (PTSD) used to be known as “combat fatigue,” due to its prevalence in soldiers returning from war. Now mental health professionals recognize that PTSD can affect anyone who has lived through a severe accident or traumatic situation. Even though the trauma has passed, the person still feels like they’re in danger. Symptoms can include frightening flashbacks, depression, and constant feelings of being ready for an attack.
To determine whether you’re suffering from anxiety, your doctor should perform an in-depth screening of your mental and physical health. Your doctor should rule out depression, ADHD, or a specific phobia, all of which can look like GAD. Certain physical conditions, like thyroid disorders or heart conditions, can also mimic anxiety-like symptoms. Your doctor can rule out most of these with simple blood and urine tests — though some more complicated conditions may require x-rays or physical stress tests.
Substance abuse may also lead to anxiety-like symptoms, so don’t be surprised if your doctor questions your use of substances. Patients with a history of substance abuse are at increased risk if they mix illicit substances with the prescription medications used to treat anxiety, so it’s important for doctors to have the full picture before beginning treatment.
When drugs are involved, it’s important for your doctor to figure out which came first: the anxiety or the addiction. In many cases, an existing anxiety disorder leads a patient to “self-medicate” with substances. However, even if the substance abuse preceded the anxiety, treating an addiction will likely not eradicate all symptoms. In either scenario, your doctor should devise a treatment plan that focuses on both the anxiety and the substance abuse as stand-alone problems.
Treatment Options for Anxiety
Following a diagnosis of GAD, treatment should begin immediately to stop negative side effects from disrupting your life. Anxiety treatment shouldn’t take a one-size-fits-all approach, but most doctors recommend two main treatments: psychotherapy and medication.
Several types of medications are used to treat general anxiety:
You should talk with your doctor about the benefits, risks, and possible side effects of each. If your anxiety exists alongside another condition — like depression, alcoholism, or ADHD — your doctor may advocate getting the other condition under control first before focusing on the anxiety. In some cases, anxiety is secondary to the other condition, and patients experience relief sooner than if they had focused on the anxiety alone.
Anxiety and ADHD
When someone experiences anxiety, he or she might feel restless and have difficulty staying on task and focusing — symptoms very similar to someone with ADHD and a short attention span. The fact is, both conditions show evidence of being overactive, as well as inattentive.
The key to differentiating the two is understanding that anxiety is usually related to specific thoughts or experiences; whereas ADHD is neurologically based and is experienced as chronic and pervasive. If the restlessness and/or inattention begins at a certain time and/or occurs during certain situations, anxiety should be considered the cause. However, if these behaviors are experienced over an extended period of time (chronic) and in many life situations (pervasive), they should be considered neurologically based.
Other clinicians contend that manifestations of anxiety stem from the hyperarousal of ADHD. Many people with ADHD struggle to accurately name their emotions. They do not use emotional labels in the same way that neurotypical people do, and this leads to misunderstanding and misdiagnosis.
When a person with ADHD complains of severe anxiety, Dr. William Dodson advises the clinician to not immediately accept the patient’s label for her emotional experience. Instead, the clinician should say, “Tell me more about your baseless, apprehensive fear,” which is the definition of anxiety. More times than not, the person with ADHD hyperarousal will respond, “I never said I was afraid.” If the patient can drop the label, she might offer a more revealing description of symptoms like “I am always tense; I can’t relax enough to sit and watch a movie or TV program. I always feel like I have to go do something.” The patient is describing the inner experience of hyperactivity when it is not being expressed physically.
At the same time, a person with ADHD may also experience fears based on real events in his life. A person with an ADHD nervous system is consistently inconsistent. He is never sure that his abilities and intellect will show up when they are needed. Not being able to measure up work, at school, or in social circles is humiliating. It is understandable that people with ADHD live with persistent fear. These fears are real, so they do not indicate an anxiety disorder. A correct diagnosis is the key to good treatment outcomes. The distinction between anxiety and hyperarousal makes a big difference in which treatments will work.