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6 most common causes
What is anxiety?
Anxiety is the most common mental illness in the U.S, affecting 18% of adults, according to the Anxiety and Depression of Association of America. Anxiety increased dramatically in 2020.
Anxiety can feel like fear and intense worry. It often causes physical symptoms, such as a racing heart or muscle tension.
There are different types of anxiety disorders, including generalized anxiety, panic attacks, and phobias.
Anxiety is a natural response to stress. It is caused by something triggering the fight or flight response. Hormones like cortisol and adrenaline are released, setting off a cascade of responses like increased heart rate, shortness of breath, shallow breathing, muscle tension, and sweating.
Though anxiety is a normal response to stressful triggers, it becomes disordered when the fear, worry, and physical symptoms remain long after a stressor is gone. The response is typically greater than the actual threat. If the anxiety is chronic, distressing, and interferes with daily activities, it is a diagnosable mental health condition.
Mental health providers can help you better understand the root of your anxiety, and help you regain control over thoughts or experiences.
How do you diagnose anxiety?
I listen for things like, “I am so stressed. I cannot relax. Sometimes I have episodes where it is hard to breathe and I feel like I am dying. My sleep is terrible, and I often feel pressured and irritable. I stress eat/don’t eat.” I always ask about family history and if they have other symptoms. I also often have them talk with a medical provider to rule out hypothyroidism. —Dr. Bobbi Wegner
Types of anxiety disorders
1. Generalized anxiety disorder
- Persistent worry
- Inability to relax
- Inability to stop thinking about things that create anxiety
- Difficulty concentration
- Sleep disruption
- Muscle tension
Generalized anxiety disorder causes worry and anxiety for at least 6 months. The thoughts are hard to control and can be about big or small concerns, including work, health, safety of children, or just arriving on time to appointments. Anxiety can become so overwhelming that it interferes with work, school, and your relationships.
Treatment includes cognitive behavioral therapy (CBT), medications, getting enough sleep, meditation, and exercise.
2. Panic attacks/panic disorder
- Anxiety or panic attacks
- Chest tightness, feeling like you’re having a heart attack
- Rapid breathing and shortness of breath
- Increased heart rate or feeling like your heart is pounding
- Tingling in your fingers
- Feeling like you are dying or losing control
- Feeling detached (disconnected) from reality or from yourself (like you’re outside your body)
- Nausea or upset stomach
- Temperature changes—like chills or feeling waves of heat
- Difficulty breathing, feeling out of breath
- Dizziness or lightheadedness, feeling like fainting
- Throat tightness
- Difficulty falling asleep and staying asleep
Panic disorder is when you have repeated episodes of panic attacks, which are intense bouts of fear that make you feel like you are losing control or dying. People often go to the emergency room with panic attacks, thinking they are having a heart attack. Panic disorder also causes you to worry about future attacks, which often gets in the way of daily life.
Panic disorder is treated with a combination of meditation (to reduce everyday anxiety), exercise, talk therapy, and possibly medication.
3. Obsessive-compulsive disorder (OCD)
- Fear of germs
- Difficulty coping with uncertainty
- Fear of losing control
- Unwanted and intrusive thought
- Checking (like checking doors are locked)
- Need for things to be organized
- Repetitively praying
Obsessive-compulsive disorder (OCD) causes people to obsess over certain thoughts. They may feel they can only relieve the pressured feeling of those thoughts by completing a specific behavior.
For example, a person might feel like they have to disinfect the counter 100 times before they can eat off of it, because they fear contamination of germs. Or someone might feel like they have to flip a light switch a certain number of times or else something bad might happen to them or their loved ones. OCD ranges in severity, and can be incredibly disruptive to a person’s life.
The most common treatment for OCD is CBT, though medications may help as well.
Does anxiety need to be treated with medication?
People often think they need medication for anxiety—that is not true. Most anxiety is successfully treated by mental health providers. If your doctor thinks you need medication, ask why. —Dr. Wegner
4. Acute stress disorder
- Disturbing dreams or flashbacks related to the trauma
- Sadness and lack of normal positive emotions
- Feelings of dissociation
- Problems with concentration, sleep, and emotional responses
Acute stress disorder (ASD) is caused by trauma, especially a violent attack such as robbery, assault, or combat. Symptoms usually appear within days of the traumatic event, and can last for about a month. The symptoms can get in the way of daily life and relationships.
Treatment includes CBT and sometimes medication, such as antidepressants, benzodiazepines, and beta-blockers.
5. Specific phobia disorder
- Intense fear in a specific situation such as exposure to heights, needles, or enclosed spaces
- Shortness of breath
- Feeling of choking
A phobia is an intense fear of a specific place, thing, or person.
There are many types of specific phobias, like acrophobia (fear of heights), agoraphobia (fear of public places), and claustrophobia (fear of closed-in places).
Other common phobias involve social situations, tunnels, highway driving, water, flying, animals, and blood.
Phobias are very treatable. The most effective treatment is exposure therapy, a type of talk therapy that slowly and safely exposes you to the feared situation.
- Unintentional weight loss
- Hand tremors
- Heart palpitations
- Irritability, agitation, or mood swings
- Insomnia or restlessness
- Excess sweating and uncomfortable warmth
- Skin irritation such as clammy or itchy skin
Hyperthyroidism, while not a type of anxiety, mimics many of the symptoms of anxiety. When too much thyroid hormone is released, it can speed up the body’s metabolism. This causes symptoms that can be confused with anxiety, such as tremor, sweating, and an accelerated heartbeat.
Treatment typically includes drugs to reduce your thyroid activation.
Important questions to ask your doctor
What kind of treatment is needed? Can you recommend any good mental health providers who treat anxiety? —Dr. Wegner
When to call the doctor
You should see a mental health provider if you're experiencing the following:
- You have constant worry or physical symptoms that feel like strain and tension
- You wonder if you have anxiety or feel overly stressed
- Your eating, sleeping, and energy level is disrupted
- You have any thoughts of hurting yourself
Should I go to the ER?
Many people go to the emergency room for panic attacks because they think they are having a heart attack. The medical team can help determine if you are having a heart attack or a panic attack.
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