3/17/2017 NIMH Anxiety Disorders

TheNationalInstituteofMentalHealth:https://www.nimh.nih.gov/health/topics/anxietydisorders/index.shtml

TheNationalInstituteofMentalHealth:www.nimh.nih.gov

AnxietyDisorders
Definition
Occasionalanxietyisanormalpartoflife.Youmightfeelanxiouswhenfacedwithaproblematwork,
beforetakingatest,ormakinganimportantdecision.Butanxietydisordersinvolvemorethan
temporaryworryorfear.Forapersonwithananxietydisorder,theanxietydoesnotgoawayandcanget
worseovertime.Thefeelingscaninterferewithdailyactivitiessuchasjobperformance,schoolwork,
andrelationships.Thereareseveraldifferenttypesofanxietydisorders.Examplesincludegeneralized
anxietydisorder,panicdisorder,andsocialanxietydisorder.

SignsandSymptoms
GeneralizedAnxietyDisorder
Peoplewithgeneralizedanxietydisorderdisplayexcessiveanxietyorworryformonthsandfaceseveral
anxietyrelatedsymptoms.

Generalizedanxietydisordersymptomsinclude:

Restlessnessorfeelingwounduporonedge
Beingeasilyfatigued
Difficultyconcentratingorhavingtheirmindsgoblank
Irritability
Muscletension
Difficultycontrollingtheworry
Sleepproblems(difficultyfallingorstayingasleeporrestless,unsatisfyingsleep)

PanicDisorder

Peoplewithpanicdisorderhaverecurrentunexpectedpanicattacks,whicharesuddenperiodsofintense
fearthatmayincludepalpitations,poundingheart,oracceleratedheartratesweatingtremblingor
shakingsensationsofshortnessofbreath,smothering,orchokingandfeelingofimpendingdoom.

Panicdisordersymptomsinclude:

Suddenandrepeatedattacksofintensefear
Feelingsofbeingoutofcontrolduringapanicattack
Intenseworriesaboutwhenthenextattackwillhappen
Fearoravoidanceofplaceswherepanicattackshaveoccurredinthepast

SocialAnxietyDisorder

Peoplewithsocialanxietydisorder(sometimescalledsocialphobia)haveamarkedfearofsocialor
performancesituationsinwhichtheyexpecttofeelembarrassed,judged,rejected,orfearfulof
offendingothers.

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Socialanxietydisordersymptomsinclude:

Feelinghighlyanxiousaboutbeingwithotherpeopleandhavingahardtimetalkingtothem
Feelingveryselfconsciousinfrontofotherpeopleandworriedaboutfeelinghumiliated,
embarrassed,orrejected,orfearfulofoffendingothers
Beingveryafraidthatotherpeoplewilljudgethem
Worryingfordaysorweeksbeforeaneventwhereotherpeoplewillbe
Stayingawayfromplaceswherethereareotherpeople
Havingahardtimemakingfriendsandkeepingfriends
Blushing,sweating,ortremblingaroundotherpeople
Feelingnauseousorsicktoyourstomachwhenotherpeoplearearound

Evaluationforananxietydisorderoftenbeginswithavisittoaprimarycareprovider.Somephysical
healthconditions,suchasanoveractivethyroidorlowbloodsugar,aswellastakingcertain
medications,canimitateorworsenananxietydisorder.Athoroughmentalhealthevaluationisalso
helpful,becauseanxietydisordersoftencoexistwithotherrelatedconditions,suchasdepressionor
obsessivecompulsivedisorder.

RiskFactors
Researchersarefindingthatgeneticandenvironmentalfactors,frequentlyininteractionwithone
another,areriskfactorsforanxietydisorders.Specificfactorsinclude:

Shyness,orbehavioralinhibition,inchildhood
Beingfemale
Havingfeweconomicresources
Beingdivorcedorwidowed
Exposuretostressfullifeeventsinchildhoodandadulthood
Anxietydisordersinclosebiologicalrelatives
Parentalhistoryofmentaldisorders
Elevatedafternooncortisollevelsinthesaliva(specificallyforsocialanxietydisorder)

TreatmentsandTherapies
Anxietydisordersaregenerallytreatedwithpsychotherapy,medication,orboth.

Psychotherapy

Psychotherapyortalktherapycanhelppeoplewithanxietydisorders.Tobeeffective,psychotherapy
mustbedirectedatthepersonsspecificanxietiesandtailoredtohisorherneeds.Atypicalsideeffect
ofpsychotherapyistemporarydiscomfortinvolvedwiththinkingaboutconfrontingfearedsituations.

CognitiveBehavioralTherapy(CBT)

CBTisatypeofpsychotherapythatcanhelppeoplewithanxietydisorders.Itteachesapersondifferent
waysofthinking,behaving,andreactingtoanxietyproducingandfearfulsituations.CBTcanalsohelp
peoplelearnandpracticesocialskills,whichisvitalfortreatingsocialanxietydisorder.

TwospecificstandalonecomponentsofCBTusedtotreatsocialanxietydisorderarecognitivetherapy
andexposuretherapy.Cognitivetherapyfocusesonidentifying,challenging,andthenneutralizing
unhelpfulthoughtsunderlyinganxietydisorders.

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Exposuretherapyfocusesonconfrontingthefearsunderlyingananxietydisorderinordertohelppeople
engageinactivitiestheyhavebeenavoiding.Exposuretherapyisusedalongwithrelaxationexercises
and/orimagery.Onestudy,calledametaanalysisbecauseitpullstogetherallofthepreviousstudies
andcalculatesthestatisticalmagnitudeofthecombinedeffects,foundthatcognitivetherapywas
superiortoexposuretherapyfortreatingsocialanxietydisorder.

CBTmaybeconductedindividuallyorwithagroupofpeoplewhohavesimilarproblems.Group
therapyisparticularlyeffectiveforsocialanxietydisorder.Oftenhomeworkisassignedfor
participantstocompletebetweensessions.

SelfHelporSupportGroups
Somepeoplewithanxietydisordersmightbenefitfromjoiningaselfhelporsupportgroupandsharing
theirproblemsandachievementswithothers.Internetchatroomsmightalsobeuseful,butanyadvice
receivedovertheInternetshouldbeusedwithcaution,asInternetacquaintanceshaveusuallyneverseen
eachotherandfalseidentitiesarecommon.Talkingwithatrustedfriendormemberoftheclergycan
alsoprovidesupport,butitisnotnecessarilyasufficientalternativetocarefromanexpertclinician.

StressManagementTechniques

Stressmanagementtechniquesandmeditationcanhelppeoplewithanxietydisorderscalmthemselves
andmayenhancetheeffectsoftherapy.Whilethereisevidencethataerobicexercisehasacalming
effect,thequalityofthestudiesisnotstrongenoughtosupportitsuseastreatment.Sincecaffeine,
certainillicitdrugs,andevensomeoverthecountercoldmedicationscanaggravatethesymptomsof
anxietydisorders,avoidingthemshouldbeconsidered.Checkwithyourphysicianorpharmacistbefore
takinganyadditionalmedications.

Thefamilycanbeimportantintherecoveryofapersonwithananxietydisorder.Ideally,thefamily
shouldbesupportivebutnothelpperpetuatetheirlovedonessymptoms.

Medication
Medicationdoesnotcureanxietydisordersbutoftenrelievessymptoms.Medicationcanonlybe
prescribedbyamedicaldoctor(suchasapsychiatristoraprimarycareprovider),butafewstatesallow
psychologiststoprescribepsychiatricmedications.

Medicationsaresometimesusedastheinitialtreatmentofananxietydisorder,orareusedonlyifthere
isinsufficientresponsetoacourseofpsychotherapy.Inresearchstudies,itiscommonforpatients
treatedwithacombinationofpsychotherapyandmedicationtohavebetteroutcomesthanthosetreated
withonlyoneortheother.

Themostcommonclassesofmedicationsusedtocombatanxietydisordersareantidepressants,anti
anxietydrugs,andbetablockers(visitMentalHealthMedications).Beawarethatsomemedicationsare
effectiveonlyiftheyaretakenregularlyandthatsymptomsmayrecurifthemedicationisstopped.

Antidepressants

Antidepressantsareusedtotreatdepression,buttheyalsoarehelpfulfortreatinganxietydisorders.
Theytakeseveralweekstostartworkingandmaycausesideeffectssuchasheadache,nausea,or
difficultysleeping.Thesideeffectsareusuallynotaproblemformostpeople,especiallyifthedose
startsofflowandisincreasedslowlyovertime.

PleaseNote:Althoughantidepressantsaresafeandeffectiveformanypeople,theymayberiskyfor

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children,teens,andyoungadults.Ablackboxwarningthemostserioustypeofwarningthata
prescriptioncancarryhasbeenaddedtothelabelsofantidepressants.Thelabelsnowwarnthat
antidepressantsmaycausesomepeopletohavesuicidalthoughtsormakesuicideattempts.Forthis
reason,anyonetakinganantidepressantshouldbemonitoredclosely,especiallywhentheyfirststart
takingthemedication.

AntiAnxietyMedications

Antianxietymedicationshelpreducethesymptomsofanxiety,panicattacks,orextremefearandworry.
Themostcommonantianxietymedicationsarecalledbenzodiazepines.Benzodiazepinesarefirstline
treatmentsforgeneralizedanxietydisorder.Withpanicdisorderorsocialphobia(socialanxiety
disorder),benzodiazepinesareusuallysecondlinetreatments,behindantidepressants.

BetaBlockers

Betablockers,suchaspropranololandatenolol,arealsohelpfulinthetreatmentofthephysical
symptomsofanxiety,especiallysocialanxiety.Physiciansprescribethemtocontrolrapidheartbeat,
shaking,trembling,andblushinginanxioussituations.

Choosingtherightmedication,medicationdose,andtreatmentplanshouldbebasedonapersonsneeds
andmedicalsituation,anddoneunderanexpertscare.Onlyanexpertcliniciancanhelpyoudecide
whetherthemedicationsabilitytohelpisworththeriskofasideeffect.Yourdoctormaytryseveral
medicinesbeforefindingtherightone.

Youandyourdoctorshoulddiscuss:

Howwellmedicationsareworkingormightworktoimproveyoursymptoms
Benefitsandsideeffectsofeachmedication
Riskforserioussideeffectsbasedonyourmedicalhistory
Thelikelihoodofthemedicationsrequiringlifestylechanges
Costsofeachmedication
Otheralternativetherapies,medications,vitamins,andsupplementsyouaretakingandhowthese
mayaffectyourtreatment
Howthemedicationshouldbestopped.Somedrugscantbestoppedabruptlybutmustbetapered
offslowlyunderadoctorssupervision.

Formoreinformation,pleasevisitMedicationsHealthTopicwebpagedevelopedbytheNational
InstituteofMentalHealth(NIMH).Pleasenotethatanyinformationonthiswebsiteregarding
medicationsisprovidedforeducationalpurposesonlyandmaybeoutdated.Informationabout
medicationschangesfrequently.PleasevisittheU.S.FoodandDrugAdministration(FDA)websitefor
thelatestinformationonwarnings,patientmedicationguides,ornewlyapprovedmedications.

JoinaStudy
Clinicaltrialsareresearchstudiesthatlookatnewwaystoprevent,detect,ortreatdiseasesand
conditions,includinganxietydisorders.Duringclinicaltrials,treatmentsmightbenewdrugsornew
combinationsofdrugs,newsurgicalproceduresordevices,ornewwaystouseexistingtreatments.The
goalofclinicaltrialsistodetermineifanewtestortreatmentworksandissafe.Althoughindividual
participantsmaybenefitfrombeingpartofaclinicaltrial,participantsshouldbeawarethattheprimary
purposeofaclinicaltrialistogainnewscientificknowledgesothatothersmaybebetterhelpedinthe
future.

PleaseNote:Decisionswhethertoapplyforaclinicaltrialandwhichonesarebestsuitedforagiven
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individualarebestmadeincollaborationwithyourlicensedhealthprofessional.

ClinicalTrialsatNIMH/NIH
ScientistsattheNIHcampusconductresearchonnumerousareasofstudy,includingcognition,
genetics,epidemiology,andpsychiatry.ThestudiestakeplaceattheNationalInstituteofHealths
(NIH)ClinicalCenterinBethesda,Maryland,andrequireregularvisits.Aftertheinitialphone
interview,youwillcometoanappointmentattheclinicandmeetwithaclinician.VisittheNIMH
ClinicalTrialsParticipantsorJoinaStudyformoreinformation.

HowDoIFindaClinicalTrialNearMe?

Tofindaclinicaltrialnearyou,youcanvisitClinicalTrials.gov.Thisisasearchableregistryandresults
databaseoffederallyandprivatelysupportedclinicaltrialsconductedintheUnitedStatesandaround
theworld.ClinicalTrials.govgivesyouinformationaboutatrialspurpose,whomayparticipate,
locations,andphonenumbersformoredetails.Thisinformationshouldbeusedinconjunctionwith
advicefromhealthprofessionals.

LearnMore
FreeBookletsandBrochures
GeneralizedAnxietyDisorder(GAD):WhenWorryGetsOutofControl:Abrochureon
GADthatexplainsthesigns,symptoms,andtreatment
ObsessiveCompulsiveDisorder:WhenUnwantedThoughtsTakeOver:AbrochureonOCD
thatexplainsthesigns,symptoms,andtreatments
PanicDisorder:WhenFearOverwhelms:Abrochureonpanicdisorderthatexplainsthesigns,
symptoms,andtreatments
SocialPhobia(SocialAnxietyDisorder):AlwaysEmbarrassed:Abrochureonsocialphobia
thatexplainsthesigns,symptoms,andtreatments.

Multimedia

Watch:BullyingExertsPsychologicalEffectsintoAdulthoodOnceconsideredachildhood
riteofpassage,bullyingisnolongerseenasbenign.Itseffectslingerwellintoadulthood.Bullies
andvictimsalikeareatriskforpsychiatricproblemssuchasanxiety,depression,substanceabuse,
andsuicidewhentheybecomeadults,accordingtoastudypartiallyfundedbytheNIMHthatwas
publishedintheApril2013issueofJAMAPsychiatry.
See:MultimediaaboutAnxietyDisorders

FederalResources
AnxietyDisordersMedlinePlusalsoenEspaol
AnxietyDisordersNIHSeniorHealth.gov
SpecificPhobias:U.S.DepartmentofVeteransAffairs

ResearchandStatistics

JoinaStudy:AdultsAnxietyDisorders
JoinaStudy:ChildrenAnxietyDisorders
JournalArticles:ReferencesandabstractsfromMEDLINE/PubMed(NationalLibraryof

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Medicine).
Statistics:AnxietyDisorderinAdults
Statistics:AnxietyDisorderinChildren

LastRevised:March2016

Unlessotherwisespecified,NIMHinformationandpublicationsareinthepublicdomainandavailable
forusefreeofcharge.CitationoftheNIMHisappreciated.PleaseseeourCitingNIMHInformation
andPublicationspageformoreinformation.

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