The Facts

Everyone experiences anxiety from time to time as a result of a situation that we perceive as threatening or stressful, such as having to do an oral presentation, having a near-miss with a car, or waiting for the results of a lab test.

Anxiety is normal in many situations, and some level of anxiety can even be helpful. Anxiety can help people deal with a threatening situation, study harder for an exam, and perform better in sports. Anxiety is not necessarily harmful and usually only lasts a short period of time.

But when anxiety becomes persistent and interferes with the ability to cope and disrupts daily life, the person may have an anxiety disorder. There are several types of anxiety disorders. They include:

• panic disorder (sudden anxiety that occurs without warning)
• agoraphobia (avoiding specific situations, such as public places or places where crowds gather, from which they can't easily escape)
• specific phobias (many types of intense fear reactions of specific objects or situations, such as fear of spiders, flying, or heights)
• social anxiety disorder or social phobia (fear of being judged or embarrassed in social situations)
• generalized anxiety disorder (general feeling of anxiety most of the time)

Anxiety disorders often occur together with other medical conditions, such as depression, eating disorders, or substance use problems.

Anxiety disorders are the most common of all mental disorders. About 1 out of every 4 adults has an anxiety disorder sometime in their life and about 1 out of every 10 people currently has an anxiety disorder. They are more common in women and can affect both children and adults.

Many people misunderstand these disorders and think they can get over them on their own (i.e., without treatment). This is usually not the case. Fortunately, there are many treatments available today to help.

Causes

Although researchers don't know exactly why some people experience anxiety disorders, they do know that there are various factors involved. Like many other mental health conditions, anxiety disorders seem to be a result of a combination of biological, psychological, and other individual factors.

How we think and react to certain situations can affect anxiety. Some people may perceive certain situations to be more dangerous than they actually are (e.g., fear of flying). Others may have had a bad experience and they fear this will happen again (e.g., a dog bite). Some psychologists believe that childhood experiences can also contribute to anxiety.

Researchers know that problems with brain chemistry can contribute to the development of anxiety disorders. Certain neurotransmitters (chemical messengers) in the brain involved in anxiety include serotonin, norepinephrine, and gamma-aminobutyric acid (GABA). Researchers have also shown that changes in activity in certain areas of the brain are involved in anxiety. Many anxiety disorders run in families and likely have a genetic cause.

Certain medical conditions such as anemia and thyroid problems can also cause symptoms of anxiety. As well, other factors such as caffeine, alcohol, and certain medications can cause anxiety symptoms.

Traumatic life events such as the death of a family member, witnessing a death, war, and natural disasters such as hurricanes and earthquakes may trigger anxiety disorders.

Symptoms and Complications

Many symptoms of anxiety are common to all types of anxiety disorders. Other symptoms are more specific to a certain type of anxiety disorder. Listed below are some of the most common symptoms associated with each type of anxiety disorder.

• Panic disorder involves having recurring panic attacks, which come on unpredictably without any clear trigger. Symptoms of panic attacks can include chest pain, heart palpitations, sweating, shortness of breath, feeling of unreality, trembling, dizziness, nausea, hot flashes or chills, a feeling of losing control, or a fear of dying. Some people start to avoid situations that might trigger a panic attack. A panic attack usually lasts 10 minutes or less, but it can last longer.
• Agoraphobia: involves fearing situations, such as public places or places where crowds gather, from which they can't easily escape or get help if they were to panic. Many people who have agoraphobia also have panic disorder. Fear of having another panic attack leads them to avoid situations/places that they think will trigger another panic attack.
• Specific phobias involve a fear of something specific, such as an animal, storms, heights, or flying. Symptoms can include sweating, muscle tension, and dizziness. People may also go to extremes to avoid the situation they fear.
• Social anxiety disorder, also known as social phobia, is more than just shyness and involves excessive anxiety in social situations where people fear being embarrassed or made fun of. Situations that can trigger social anxiety include small group discussions, dating, going to a party, and playing sports. Common symptoms of social anxiety include blushing, sweating, and dry mouth. People with social phobia often avoid social situations that cause anxiety.
• Generalized anxiety disorder (GAD) is associated with continual excessive anxiety and worry about a number of things (e.g., work, money, children, and health). There is no specific source of fear. Symptoms can include muscle tension, trembling, shortness of breath, fast heartbeat, dizziness, dry mouth, nausea, sleeping problems, and poor concentration.

Complications of anxiety disorders are mostly linked to feelings of inadequacy or depression, because people with these conditions know their behaviour is irrational and damaging to their lives. Depression is particularly common with anxiety disorders.

Making the Diagnosis

A person who thinks they might have an anxiety disorder should see a doctor. A doctor may perform some tests to make sure that the anxiety does not have a physical cause and will ask questions about the anxiety to determine whether it is an anxiety disorder or may be related to a type of depression. It's important for people to tell their doctor about how they are feeling and what they are concerned about, so the doctor can accurately diagnose the cause of their anxiety.

Treatment and Prevention

Treatment varies depending on the specific type of anxiety disorder.

Many psychological treatments can help with anxiety, but the most effective form of treatment is cognitive behavioural therapy (CBT).

With CBT, irrational fears are challenged in a logical fashion. As a part of CBT, exposure therapy may be used and involves confronting the object of the fear. This may need to be done slowly. Exposure therapy works best for specific phobias (like fear of spiders or flying) that often don't respond to medications. Support groups may also be helpful for some people.

Medications that help control anxiety affect the three main chemical messengers involved with anxiety: serotonin, norepinephrine, and gamma-aminobutyric acid (GABA). Medications used may include selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine*, paroxetine, escitalopram), serotonin-norepinephrine reuptake inhibitors (SNRIs; e.g., duloxetine, venlafaxine), GABA derivatives (e.g., pregabalin) and anti-anxiety medications such as benzodiazepines (e.g., lorazepam, alprazolam, clonazepam). For a small number of people, benzodiazepines can be habit-forming.

Other medications that can be used include tricyclic antidepressants (TCAs), such as clomipramine, monoamine oxidase inhibitors (MAOIs; e.g., phenelzine, tranylcypromine), and buspirone.

Not all of the medications used in anxiety disorders are approved by Health Canada for this purpose. Some people with mild anxiety or anxiety from something they can avoid easily may choose not to receive help for their condition.

Many people with anxiety benefit from lifestyle modifications, including the following approaches:

• Reduce caffeine consumption.
• Reduce alcohol consumption.
• Reduce or stop smoking.
• Practice relaxation techniques (e.g., proper breathing, yoga, meditation).
• Eat a healthy diet, sleep well, and exercise regularly.
• Gain perspective by talking about your feelings with someone close or with a professional counsellor.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.