Linda Hubbard, L.M.F.T.
Psychiatry & Psychology
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Stress and feeling anxious are common and normal. Your body naturally produces these reactions to situations that could lead you to harm's way.
Stress is a normal psychological and physical reaction to the demands of life. It's normal to feel anxious from time to time, especially during times of stress. This can be helpful, as it can help you remain focused and make better decisions.
However, people with anxiety disorders have frequent, sustained and excessive worry that they can't control. They also may feel fear, terror and panic in everyday situations.
There are many types of anxiety. Here are explanations of each, including symptoms and common treatments:
Generalized anxiety disorder
This type of anxiety involves persistent and excessive worry. If you have generalized anxiety disorder, you may have an uneasy feeling about most everything. This worry feels difficult to control and interferes with your daily life. You may overthink plans and solutions to worst-case scenarios. Or you may anticipate disaster and be overly concerned about money, health, family, work and other life events.
Generalized anxiety disorder can lead to worrying more than what seems warranted about situations or expect the worst even then there's no apparent reason to do so. You may feel an inability to relax or enjoy quiet time. You may feel tense all the time and have body aches.
You avoid stressful situations and may have difficulty concentrating. You may find it hard to tolerate uncertainty and may feel a sense of dread or impending doom. This disorder can cause you to struggle with intrusive thoughts about the worst that could happen.
Generalized anxiety disorder can cause you to not sleep well, or feel jumpy or restless. You may have an upset stomach or heart palpitations, shakiness, sweating, a dry mouth, difficulty breathing or a lump in your throat. You could feel dizzy; have cold chills, hot flashes, or numbness and tingling; or may have persistent irritability.
Ongoing generalized anxiety disorder may manifest physically through chronic neck and back pain, headache, irritable bowel syndrome, or stomach and abdominal pain.
There is evidence that biological factors, stressful life experiences, lack of personal security and lack of positive role-modeling of anxious behaviors can lead to generalized anxiety disorder.
Generalized anxiety disorder is treatable, but it takes persistence. A person can find significant relief with psychotherapy, relaxation and mindfulness techniques, or medication. Support groups also help.
Practicing helpful ways of thinking and stress coping skills can lessen the amount of worry. Seek healthy connections with others and a lower-stress lifestyle to find greater freedom from your anxiety. Set healthy boundaries in your life. Use humor and practice to manage your negative anxious tendencies. Exercise can help by relieving the built-up stress and tension.
One of the most important principles of overcoming anxiety is facing your fears. Therapy can help develop a plan, and little by little, you'll grow in self-confidence to manage and cope with anxiety.
If you struggle with social anxiety, everyday interactions cause significant anxiety, self-consciousness and embarrassment. It is related to the fear of being scrutinized or judged negatively by others. It is intense and affects your work or social life.
You may worry about blushing, trembling, or fear you may look foolish or unintelligent to other people. You may have generalized anxiety disorder symptoms that are mainly associated with social situations. You may fear meeting new people, talking to others at work or school, or speaking in public. Some people with social anxiety fear using a public restroom, being seen eating or drinking in public, or having to perform in front of others.
You may experience feelings of panic or panic attacks, and feel self-conscious or awkward in front of others. You may have difficulty speaking and may avoid situations you feel may trigger anxiety.
Your body may feel rigid and tense while your voice may be soft during social interactions. You may have difficulty making eye contact with others and be sensitive to criticism. You may feel a low self-worth and have a lot of negative self-talk.
Sometimes people with social anxiety may not seek treatment because they feel this uncomfortable way of being is just a part of their personality. However, without treatment for this disorder, these people cannot achieve their potential at school, work or in their personal life.
Social anxiety is treated using the same methods as generalized anxiety disorder.
A panic attack causes a sudden intense fear or discomfort that peaks within minutes. Other symptoms may include a rapid heart rate, sweating, shakiness, shortness of breath and hot flashes. A person may feel lightheaded, have a sense of impending doom, chills, nausea, abdominal or chest pain, headaches, and numbness or tingling.
Many people feel something is physically wrong when they have a panic attack and that they may be having a heart attack or stroke.
Expected panic attacks occur when there is an obvious cue or trigger, such as with generalized anxiety disorder or a specific phobia. Panic disorder is when a person has frequent, unexpected panic attacks. These panic attacks seem to come out of the blue without a trigger or apparent explanation. If you have panic disorder, you may not be able to stand the thought of experiencing the physical discomfort that has happened when you have panicked before and may always be on guard for another one potentially happening.
Treatment for panic disorder is similar to that of generalized anxiety disorder and social anxiety. Persistence and practice of healthy thinking and coping tools will help develop a better level of confidence in your ability to cope with stress, as well as with the strong feelings of anxiety or panic.
Phobias are an overwhelming and unreasonable fear of objects or situations that pose little real danger but provoke anxiety and avoidance. Fear and phobia are different. Fear is a temporary emotion; whereas, a phobia is longstanding. Phobias can create fear that is so strong it becomes debilitating. When this occurs, a phobic fear has become an anxiety disorder.
Your sense of danger or fear is designed to protect you from danger. It can trigger your flight-or-fight instinct so you're ready to take action to protect yourself. A phobia overestimates the threat of a particular situation and triggers intense anxiety leading you to avoid that situation in the future. Avoidance worsens the phobia because it reinforces the brain's exaggerated association between the situation and its threat level.
There are various phobias, including a phobia of animals, insects or spiders; a phobia of natural phenomena like storms or water; and a phobia of blood or injury, blood tests or needles.
Social anxiety can lead to a phobia. Often this comes with agoraphobia, which is a phobia of any place or situation that you fear you can't escape or get help easily. You might avoid travel on public transportation, being in a crowded area or being alone in public. It's rooted in the fear of having intense anxiety or a panic attack in certain places rather than a fear of the place itself.
Health care professionals do not clearly understand why people develop phobias. Often, they begin in childhood — similar to panic disorders.
If you struggle with a phobia, you may notice a racing heart rate, difficulty breathing, trembling, sweating, nausea, dry mouth, and chest pain or tightness. You may feel an overwhelming anxiety or fear. You know your fear is irrational, but you feel powerless to overcome it. You may fear losing control and feel an intense need to escape.
According to research, cognitive therapy and exposure therapy tend to be the best treatment for phobias. Social skills training, mindfulness and medication may help, as well.
Obsessive-compulsive disorder, also known as OCD, is a pattern of unwanted thoughts and fears, or obsessions, that lead a person to do repetitive behaviors, or compulsions. The typical onset of OCD is before age 20.
OCD often develops related to a theme. For example, being fearful of germs — an obsession — leads to excessive hand-washing — a compulsion — to reduce the thoughts and fears. If you don't have control over your thoughts, you wash your hands more. This becomes a vicious circle that worsens, and it can become a debilitating lifestyle if not addressed.
Other types of OCD may be needing to have things in perfect symmetrical order; having taboo or other unwanted thoughts; having aggressive thoughts toward yourself or others; and fear of causing harm or danger to self or others by not turning off the stove or not locking the door, so you check and recheck.
Compulsions are the direct result of the obsessive thoughts that lead to repetitive behaviors. These are done in the hope of reducing the anxiety and preventing something bad from happening. Sometimes, actions bring temporary relief but no pleasure. Common compulsions include counting, checking, washing or cleaning; strict routines; orderliness; and a need for reassurance. Symptoms may come and go over time and seem to worsen when a person is under stress.
While adults may recognize their irrational fears and behavior, children may not. Usually, medication and psychotherapy are recommended and can help alleviate many OCD symptoms.
Post-traumatic stress disorder
If you suffer from post-traumatic stress disorder, you have significant anxiety and uncontrolled thoughts triggered by a terrifying or life-threatening event. This could be a terrible accident, a tornado, domestic violence, war, the sudden death of a loved one, critical illness, a near-death experience, kidnapping, terrorist attacks, an assault or a direct threat to your life, or witnessing someone else being attacked.
Some people work through these experiences and learn to cope and adjust with time. Occasionally, people find themselves reliving it, and this affects their ability to function. You may struggle with post-traumatic stress disorder if you get stuck in a state of fear and your symptoms don't improve or worsen.
Symptoms may include avoidance, intrusive memories, changes in emotional reactions, negative changes in thinking and mood, flashbacks, jumpiness and emotional detachment. You may struggle with an overwhelming sense of guilt or shame, sleep disturbances, difficulty concentrating, always being on guard for danger, irritability, angry outbursts, aggressive behavior, and self-destructive behavior. You may feel negative about yourself, have a lack of interest in activities you used to enjoy or have difficulty maintaining your relationships. You could experience memory problems, feelings of hopelessness about the future, and feeling emotionally numb or unable to experience positive emotions.
Having post-traumatic stress disorder increases your risk for depression, anxiety, eating disorders and substance use disorders. It is important to seek treatment if you struggle with intrusive memories, avoid thinking or talking about the trauma, have negative changes to your thinking and mood, and have changes in your physical and emotional reactions to life and others. Treatment may include psychotherapy, exposure therapy called EMDR, medication and other therapies.
For more information, watch this video for ways to combat stress and anxiety:
Learn more about anxiety:
- 5, 4, 3, 2, 1: Countdown to take control of anxiety
- 9 ways to tame anxiety during the COVID-19 pandemic
- 11 tips for coping with an anxiety disorder
- Identifying signs of anxiety and depression