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Anxiety Disorders
What are anxiety disorders?
Feeling anxious at times is a normal part of life. It can even be helpful when it alerts you to danger. Anxiety
becomes a disorder when it occurs frequently, feels intense, lasts hours or even days, and begins to interfere with
your daily life, like school, work, sleep, and important relationships. This type of anxiety can greatly reduce your
enjoyment of life, and may even lead to health problems.
There are many types of anxiety disorders that may be causing changes in your behaviour, thoughts, emotions,
and physical health. These include panic disorder, social phobias, specific phobias, acute stress disorder, posttraumatic stress disorder, generalized anxiety disorder, and obsessive-compulsive disorder.
These disorders are explained in more detail in the What are the signs and symptoms? section below, but they
all have one thing in common: they can generally be treated by medications, counselling, lifestyle changes, or a
combination of these things. So take heart, and read on for more information.
How common are anxiety disorders?
Anxiety disorders are the most common of all mental health problems. Research into these disorders has shown
that up to 1 in 4 adults will have an anxiety disorder in their lifetime, and that up to 1 in 10 people will have an
anxiety disorder each year. These disorders are the number one mental health problem in women, and the
second-most common mental health problem in men, just behind addiction.
Unfortunately, people may suffer for years before seeking help, sometimes avoiding the stigma attached to these
types of mental health issues, and sometimes believing the common misconception that they are simply a sign of
weakness or instability. The fact is, they are medical disorders that can be diagnosed and treated.
Who gets an anxiety disorder?
As mentioned above, anxiety disorders commonly affect both men and women, though they occur more often in
women. They also develop in children.
Though the causes of anxiety disorders are not totally understood, it is believed that they develop due to a mix of
biological factors along with your individual situation, much like other health problems. Some of the risk factors for
developing an anxiety disorder include:
• A traumatic experience as a child. If you have suffered abuse or trauma, or witnessed a traumatic event as a
child, you have a higher risk of developing an anxiety disorder at some point in your life.
• Stress due to a physical illness. Living with a chronic or serious illness, such as cancer, can lead to worries
and anxiety about the future.
• General stress build-up. This can occur as a single big event, or as a series of smaller stressful situations that
trigger anxiety, such as the death of a loved one or ongoing financial worries.
• Your personality. It appears that certain personality types are more likely to develop anxiety disorders than
others. Also, some personality disorders, including borderline personality, can be associated with anxiety
disorders.
• Being related to someone with an anxiety disorder.
• Substance abuse. Drugs or alcohol can cause or worsen anxiety.
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Anxiety Disorders
For some people, what appears to be an anxiety disorder may mostly be due to an underlying medical condition.
Treating the physical condition in these cases will also help resolve the anxiety. This is usually the case in adults
over the age of 35 who do not respond to drugs that normally work to treat anxiety symptoms, and who do not
have any of the risk factors listed above, besides substance abuse. In fact, the signs and symptoms of anxiety
may be the first indication that you have a medical illness.
How to prevent anxiety disorders
Since it is nearly impossible to predict what will cause a person to develop an anxiety disorder, it is just as difficult
to prevent one. However, there are some practical things you can do to help reduce the symptoms of anxiety
when they begin:
• Get help as soon as your anxiety becomes excessive. It may be harder to treat your symptoms if you wait.
• Keep a journal of your daily life. Though this may not necessarily help you in the short term, the details you
capture of your reactions to things and how you cope may give your healthcare provider some insight into your
condition.
• Set your priorities. Managing your time and energy may help you reduce your anxiety levels.
• Stay away from drugs and unhealthy amounts of alcohol. These two habits can be a source of or worsen
anxiety, and quitting can also make you anxious. If quitting on your own is too difficult, consider getting help.
What are the signs and symptoms?
The signs and symptoms of anxiety disorders may be different from one person to the next, especially depending
on which type of anxiety you have. General symptoms may include one or more of the following:
• Feeling nervous
• Feeling powerless
• A sense of impending danger, panic or doom
• An increased heart rate
• Rapid breathing, which can lead to faintness (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
The different types of anxiety disorders also have their own unique symptoms, including:
• Panic disorder. You will experience repeated, unexpected panic attacks, which may involve physical symptoms
such as heart palpitations, raised heart rate, sweating, trembling, dizziness or nausea, or shortness of breath.
People often think they are having a heart attack or feel like they are being smothered. These symptoms may
lead to you avoiding different situations that cause anxiety, such as places you associate with panic attacks,
crowded places such as malls, and physical activities.
• Specific phobias. These are persistent, irrational fears of specific objects or situations. Types of specific
phobias include animal phobias (i.e., mice or spiders), natural environment phobias (i.e., storms or heights),
blood-injection-injury phobias, situational phobias (i.e., elevators or enclosed spaces), and other types, such
as the fear of choking or vomiting. You will likely feel very anxious when exposed to your phobia trigger, and
have a real desire to avoid it. The physical response to your phobia may include sweating, muscle tension and
dizziness, and even the symptoms of a full-blown panic attack.
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• Social phobias. These are persistent, irrational fears of social or performance situations that may lead to
embarrassment. This fear of doing something terribly wrong in front of others can lead to avoidance of almost
any social interaction. Physical symptoms may include blushing, sweating, or dry mouth.
• Acute stress disorder. This type of anxiety disorder usually follows the experience or witnessing of one or more
events involving a physical threat to yourself or someone else, including actual or threatened serious injury or
death. Symptoms begin within a month of the traumatic event, leading to memories that can cause disturbing
emotional reactions and a feeling of reliving the moment. Physical symptoms can include restlessness and
difficulty concentrating or sleeping, easy and exaggerated startling, and feelings of tension, numbness or being
on edge. People with this disorder tend to avoid situations that remind them of the traumatic event, and can
have intense emotional reactions or show almost no emotional response to everyday situations.
• Post-traumatic stress disorder (PTSD). Much like acute stress disorder, PTSD follows an extremely stressful
event or experience. The person’s reaction to this experience must involve fear, helplessness, or horror.
Symptoms will usually begin later than with acute stress disorder, within about 3 months of the event, but there
may be a delay of months or even years. One symptom is the reliving of the experience in repeated memories,
dreams and flashbacks that cause distress. Physical symptoms include disturbed sleep and nightmares,
irritability or angry outbursts, and an heightened sense of danger. People with PTSD tend to avoid thoughts,
feelings, conversations, activities, places or people that they associate with the traumatic event.
• Generalized anxiety disorder (GAD). When suffering from GAD, people will have excessive worry and anxiety
on most days for at least 6 months, concerning several events or activities. Typically, people with GAD have
difficulty controlling their worries. Physical symptoms include muscle tension, difficulty relaxing, restless and
irritable feelings, and sleep that is disturbed by worry. GAD can cause people to avoid news media, and to
restrict their daily activities out of concern for what might happen.
How are anxiety disorders diagnosed?
Having your anxiety disorder properly diagnosed is key to beginning the right treatment, but for many people,
10 or more years may pass before they get that diagnosis. This could be due in part to the fact that many family
physicians are unequipped with enough knowledge to identify and treat the many anxiety disorders, and that a
specialist might be more appropriate. Also, since anxiety disorders often develop along with other mental health
problems, such as depression or substance abuse, they can be challenging to diagnose properly. If you are
concerned that you are suffering from an anxiety disorder, finding a specialized clinic may help.
A diagnosis of an anxiety disorder is only made if you meet the criteria of the Diagnostic and Statistical Manual
of Mental Disorders (DSM for short), a manual used to diagnose many different types of mental conditions.
Symptoms are different for each type of condition, as you can see in the What are the signs and symptoms?
section above. Looking those over will give you a better idea of what healthcare professionals will be looking for in
their diagnosis.
How are anxiety disorders treated?
There are many treatments that can help with anxiety disorders. Some psychological treatments, such as
relaxation training, biofeedback, and stress management, can be helpful, as can supportive counselling or couples
or family therapy. Medications are also available to ease symptoms, and may be taken in combination with some
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of the psychological treatments. However, according to the Canadian Mental Health Association, there is expert
agreement that one form of therapy is the most effective–cognitive-behavioural therapy, or CBT.
Medications – Antidepressants
Though medications will not cure anxiety disorders, they are used quite successfully to treat the symptoms, often
with psychotherapy. They are generally broken down into two categories: antidepressants, which are commonly
used to treat both anxiety disorders and depression, and sedatives, which are helpful in treating anxiety and
sleep problems. Other medications can also be used to treat specific anxiety symptoms, such as beta-blockers
to reduce hand tremors or slow heart rate, or drugs to help reduce sweating. Some of these medications are
prescribed at the same time.
The different types of antidepressants are generally categorized by which natural chemicals they affect in your
brain to help change your mood. They can also be broken down into categories of older and newer drugs. The
following chart provides a very brief overview of several types of antidepressants currently available in Canada:
Older drugs
Drug class
Typical side effects
• Monoamine oxidase inhibitor (MOAIs) – the first
antidepressants
Anticholinergic effects, such as:
• Cyclics (or tricyclic antidepressants)
• constipation
­• dry mouth
• difficulty urinating
• blurry vision
Newer drugs
• Specific Serotonin Reuptake Inhibitors (SSRIs)
• headache
• Serotonin and Norepinephrine Reuptake
Inhibitors (SNRIs)
• insomnia
• increased anxiety
• sedation
• sexual problems
Medications are usually increased gradually to optimize their effects. The first weeks may be more about
managing any side effects rather than real symptom relief, which can take a while to begin for some. But don’t
be discouraged, the side effects can be managed, and the relief will be welcome when it begins. Plus, when your
anxiety is successfully reduced, you will be able to begin working to change the way you behave in response to
anxiety through psychotherapy.
It should also be noted that different anti-depressants may be tried, as some people will respond well to one, and
not at all to another. Plus, although these drugs may really help some people, they will not relieve all symptoms of
anxiety.
Medications – Sedatives (Benzodiazepines), Buspirone, and Herbal Remedies
The major beneficial effect of sedatives is to reduce feelings of anxiety and excitement. They can help you feel
more quiet and calm, and cause drowsiness to make it easier to fall asleep and stay asleep through the night.
Sedatives are usually used to treat acute anxiety symptoms on a short-term basis, and often with antidepressants, especially in the first few weeks when the anti-depressants are not fully optimized. Sedatives can be
habit-forming, making them a poor choice for people who have had an addiction, or had problems with alcohol or
drug abuse. Side effects can include drowsiness, reduced coordination, and problems with memory and balance.
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Buspirone is an anti-anxiety medication that may be taken on an ongoing basis. Like anti-depressants, it can take
a few weeks to become effective. Side effects include light-headedness after taking a dose, as well as headaches,
nausea, nervousness and insomnia.
There are also some herbal remedies that are taken to help relieve some of the symptoms of anxiety, though how
much they actually help, and what their side effects may be have not been fully researched. These include:
• Kava, which is believed to help you relax without making you feel sedated, though it is also linked to liver
problems
• Valerian, which is most commonly used as a sleep aid due to its sedative effect
• B vitamins, particularly the B vitamin inositol, which are nutrients that may help relieve anxiety through their
impact on the production of certain brain chemicals
Psychotherapy – Cognitive-behavioural Therapy (CBT)
Psychotherapy is a term used to describe treatment that involves talking through issues with a psychotherapist.
CBT is one of the most common forms of psychotherapy used to treat anxiety disorders, and is generally
considered short-term, typically consisting of 12 to 15 one-hour weekly sessions.
In the first few sessions, the therapist works with you to discover your specific issues. Your anxiety symptoms
are looked at to determine what the goals of therapy should be. Then you will be given certain cognitive and
behavioural tasks, so that you can learn skills to reduce your symptoms. When your symptoms are reduced, the
focus of your sessions will shift to any underlying issues that may lead to a return of symptoms, which is referred
to as a relapse.
This type of therapy involves homework, or things you have to do between sessions to help your symptoms. This
can include actually facing a feared situation alone, taking notes about thoughts and feelings in different situations
that cause anxiety, or simply reading assignments. When treatment is considered complete, your therapist may
schedule less frequent sessions to help maintain your recovery, often referred to as ‘booster’ sessions.
CBT uses the technique of gradually having you face a fear, either directly or through your imagination, called
exposure therapy. The idea is to have you learn that your fears are overblown and unfounded, and with practice,
to have your anxiety decrease through a process known as habituation.
Of course, your therapist won’t likely throw you into an extremely stressful situation right away. You will start with
situations that provoke mild to moderate anxiety, and gradually work your way up to more difficult situations. As
you get better at responding to these situations, you will be asked more frequently to face them between sessions,
on your own. How slowly or quickly you progress through treatment will depend on you.
Another key element of CBT is getting you to identify, question and correct your habit of overestimating danger,
along with your inability to cope with it. In combination with exposure therapy, you will develop cognitive strategies
to help you realize that your thoughts, beliefs, and assessments can make you and keep you anxious. You will
even develop alternative responses to your feared object or situation, to help reduce the anxiety. Hopefully, you will
also learn that your avoidance strategies around your anxiety are not going to be successful in the long term, and
you will begin to change your behaviour.
The success of CBT in treating anxiety disorders, and helping people stay well after treatment, has made it the first
choice for psychotherapy in these conditions.
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Living with an anxiety disorder
Your recovery from an anxiety disorder will depend on the type and severity of your illness. Anxiety disorders are
not illnesses with a ‘cure’, so once you get your symptoms under control, you will work to prevent a relapse. This
may include medications and psychotherapy, as well as a plan to manage any symptoms as they may appear.
The following are some tips to help aid in recovery, and to reduce your chances of a relapse:
• Learn about the illness and its treatment
• Follow your treatment plan carefully, including taking any and all medications as prescribed
• Involve your family, and ask for their support as you would for any other illness
• Take action, and work with your doctor to figure out what makes you anxious, and ways to address this
• Nurture meaningful relationships and social support, and take strength from your caring relationships,
instead of isolating yourself
• Learn to cope with stress, with breathing techniques, yoga, or some other strategy, and be sure to identify
and pay attention to situations you find stressful
• Break the cycle of anxiety, by doing something to take your mind off your worries, such as starting a hobby or
exercising
• Develop a healthy lifestyle, including proper nutrition, exercise and good sleep habits
• Strike a balance between work, family, friends and leisure
• Avoid alcohol and illegal drugs, since they can worsen anxiety
• Quit smoking and cut back on or quit drinking coffee, as both nicotine and caffeine can also worsen
anxiety
Remember that learning as much as possible about your disease – and actively working with your health care
professionals–are effective ways to regain control over your life. There is a great deal of information out there that
can help. Check out some of the websites listed below to get started.
Empowering both the patient and the caregiver
Patients as well as their caregivers can access the following sites to find out more information about the major
forms of anxiety disorders, their symptoms, treatment options as well as recent related scientific discoveries.
Resources
Helpful information and support networks on the internet:
Canadian Mental Health Association (www.cmha.ca)
Health Canada www.hc-sc.gc.ca
Mental Health Commission of Canada (www.mentalhealthcommission.ca)
Mental Health Works (www.mentalhealthworks.ca)
Mental Health Canada (www.mentalhealthcanada.com)
MentalHelp.net (www.mentalhelp.net)
National Institute of Mental Health (www.nimh.nih.gov)
World Federation for Mental Health (www.wfmh.org)
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