08 July 2021

Anxiety disorders: definition, causes, symptoms, treatments and tips

This article gives information on anxiety disorders. It explains the different types of anxiety, symptoms, treatments and ways to manage an anxiety disorder. This article is for people with anxiety disorders, their carers, relatives and friends.

What are anxiety disorders?

Anxiety disorders differ from normal feelings of nervousness or anxiousness. These disorders involve prolonged feelings of fear or danger that can interfere with daily life. Some people with anxiety disorders can also experience depression at the same time. Anxiety symptoms may not go away on their own and, if left untreated, they can affect the day-to-day life of the affected person.

Experiencing feelings of anxiety, worry or fear is a natural part of life. These heightened feelings, known as a ‘fight or flight response’, make you very aware of risks and can help you manage challenging or dangerous situations. The brain responds to this threat or danger by releasing the stress hormones adrenaline and cortisol. Even if the danger is not real, or the threat has long passed, these hormones can still cause the physical symptoms of anxiety.

The symptoms and experience of anxiety is unique to each individual. 1 in 6 people report experiencing a common mental health problem (like anxiety and depression) in any given week in England. We are able to define different types of anxiety disorders by the most common symptoms.

Types and symptoms of anxiety disorders

What is generalised anxiety disorder?

Generalised anxiety disorder (GAD) is a long-term condition where you feel anxious the majority of the time. The anxiety is due to a range of situations and issues, rather than one specific event.

People living with GAD feel anxious most days and can struggle to remember a time where they felt relaxed. When anxiety subsides about one issue or thought, another may appear about something else.

GAD can cause psychological and physical symptoms which can vary between each individual.

They include:

  • a feeling of restlessness or worry
  • anger or irritability
  • trouble concentrating or sleeping
  • dizziness
  • heart palpitations.

What is panic disorder?

Panic disorder is a type of anxiety disorder where you have frequent sudden panic attacks. When a panic attack happens, you get a sudden burst of intense mental and physical symptoms which can come on quickly and, sometimes, with no known reason.

Panic attacks can be very distressing and most last between 5 to 20 minutes, though some can last up to an hour.

Symptoms include:

  • a racing heartbeat
  • feeling faint or dizzy
  • sweating
  • feeling sick
  • chest pain
  • shortness of breath
  • uncontrollable shaking
  • hot flushes
  • chills
  • a choking feeling
  • numbness or pins and needles
  • dry mouth
  • an urgent need to go to the toilet
  • ringing in your ears
  • a feeling of dread or a fear of dying
  • a sudden churning or upset stomach
  • a tingling in your fingers
  • feeling like you're not connected to your body.

The frequency of panic attacks you will have depends on the severity of your condition. While some have panic attacks once per month, others may have them several times per week. The frequency may change depending on individual circumstances.

Although panic attacks are frightening, rest assured that they're not dangerous. They will not cause you physical harm, and you likely will not need to be admitted to hospital if you have one.

What is Obsessive Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that they feel the urge to repeat over and over.

OCD symptoms may come and go, ease over time or worsen. People living with OCD may try to help themselves by avoiding things or situations that trigger their obsessions or compulsions. There is a risk that individuals may turn to alcohol or drugs to feel calm.

Obsession

Obsessions are thoughts, urges, or mental images that repeat and cause anxiety.

Symptoms include:

  • fear of germs
  • unwanted forbidden or taboo thoughts that can involve sex, religion, or harm
  • aggressive thoughts towards others or yourself
  • having things in a perfect order, for example with perfect symmetry.

Compulsion

Compulsions are repetitive behaviors that someone living with OCD feels compelled to do in response to an obsessive thought.

Common compulsions include:

  • excessive cleaning and/or handwashing
  • ordering and arranging things in a particular way
  • repeatedly checking on things, such as repeatedly checking to see if an appliance is turned off or a door is locked
  • compulsive counting, sometimes to a particular number or specifically to an odd or even number.

It’s important to note that these symptoms do not always indicate OCD. However, people with OCD typically do experience the below:

  • inability to control thoughts or behaviours
  • spending at least 1 hour a day on these thoughts or behaviors
  • no longer getting pleasure when performing the behaviours or rituals but may feel a sense of relief from completing them
  • symptoms interfere with daily life, for example by affecting sleep, the ability to go to work or socialise and occupying excessive amounts of time.

Some people with OCD also have a tic disorder. Tics can be movement or vocal based. Movement tics involve repetitive movements such as eye blinking, head or shoulder jerking. Vocal tics include repetitive throat-clearing, sniffing, or grunting.

What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by frightening or distressing events.

Someone living with PTSD will often relive the traumatic event in nightmares or flashbacks. They may also experience feelings of isolation, anger and guilt. They may also have difficulty sleeping and find concentrating difficult.

What is body dysmorphic disorder (BDD)?

Body dysmorphic disorder (BDD), or body dysmorphia, is an anxiety disorder where a person worries a lot about flaws in their appearance. Sometimes, these flaws are often unnoticeable to others.

BDD can affect people of any age, though it is most common in teenagers and young adults.

People living with BDD experience the below symptoms:

  • worry about a specific area of the body
  • looking at themselves in mirrors a lot or avoiding mirrors altogether
  • feeling the need to conceal flaws, for example by spending a long time applying makeup or choosing clothes
  • skin picking to make it “smooth”.

BDD can seriously impact on your daily life, including your social life and work

What are phobias?

A phobia is a type of anxiety disorder involving an overwhelming and debilitating fear of an object, place, situation, feeling or animal. A phobia is more intense than a fear and they can develop when someone has a heightened sense of danger about a situation or object. Symptoms may not be experienced until the individual comes into contact with the source of the phobia.

If a phobia becomes severe, someone may organise their life to avoid the situations or things causing them anxiety.

Symptoms may include:

  • dizziness
  • feeling sick
  • sweating
  • increased heart rate and/or palpitations
  • shortness of breath
  • trembling or shaking
  • an upset stomach

Types of phobias

Phobias can be split into two groups: specific/simple (fears of particular situations or objects) or complex (known to be more disruptive to daily life). Complex phobias tend to be more challenging and disabling than simple ones, usually developing in adulthood.

Specific or simple phobias

Specific or simple phobias include, but are not limited to:

  • animal phobias, for example of dogs, spiders, snakes or rodents
  • environmental phobias, for example of heights or germs
  • situational phobias, for example of clinical settings such as hospitals
  • bodily phobias, for example of blood, vomit or having injections
  • sexual phobias, for example a fear of having sex, performance anxiety or the fear of getting a sexually transmitted infection (STI).

Complex phobias

Complex phobias include, but are not limited to:

  • agoraphobia - a fear of entering open or crowded places, of leaving one's own home, or of being in places from which escape is difficult.
  • social phobia or social anxiety disorder - an overwhelming fear of social situations, for example meeting friends or strangers and a fear of making eye contact.

Risk factors: what causes anxiety disorders?

What causes general anxiety disorder (GAD)?

The exact cause of GAD is still being debated, although it's likely that a combination of things play a role.

These these may include:

  • overactivity in parts of the brain that control emotions or behaviours
  • a imbalance of chemicals in the brain, serotonin and noradrenaline, involved in controlling mood
  • genetics - if your parents have GAD, you have an increased risk of experiencing it yourself
  • a history of stressful or traumatic experiences, for example domestic violence, bullying, or childhood abuse
  • living with a long-term painful health condition
  • a history of drug or alcohol abuse.

However, some people may develop GAD for no apparent reason.

What causes post-traumatic stress disorder (PTSD)?

PTSD can be caused by an extremely stressful or frightening situation and, therefore, there is a wide range of potential causes.

These can include:

  • violent assaults
  • childhood trauma
  • serious health problems
  • childbirth experiences.

The disorder can develop immediately after experiencing a disturbing event, or it can occur at any point afterwards, for example months or even years down the line.

PTSD affects a third of all people who have a traumatic experience, but not everyone will develop the condition.

What causes body dysmorphic disorder (BDD)?

The exact causes of BDD are inconclusive, but research suggests hat biological or environmental factors may The causes of BDD are unclear, but certain biological and environmental factors may contribute to it.

These include:

  • genetics
  • serotonin imbalance in the brain
  • personality traits
  • life experience, including childhood trauma and abuse.

What causes obsessive compulsive disorder (OCD)?

The exact causes of BDD are not yet known, however experts believe that a combination of biological and environmental factors may be involved.

These include:

  • personal experience
  • behaviour learned from friends or family
  • long-term anxiety or stress
  • childbirth experiences
  • serotonin imbalance in the brain
  • personality traits.

What causes phobias?

Phobias are usually caused by a combination of factors, for example by:

  • a particular incident or trauma
  • a learned response developed early in childhood by a friend or family member
  • genetics - some research suggests a genetic predisposition to anxiety.

Treatments and therapies

Talking therapies or psychotherapy

Most GPs will offer you self-help resources in the first instance. Then, if these don't work, your doctor should offer a talking treatment. There are two main types of talking treatment recommended for anxiety disorders:

  • Cognitive behavioural therapy (CBT) – this focuses on how your thoughts affect your feelings and behaviour, and teaches you coping skills for dealing with different problems
  • Applied relaxation therapy – this involves learning how to relax your muscles in situations where you normally experience anxiety.

Exposure therapy

Exposure therapy involves exposing yourself to the cause of your anxiety to help you overcome it. It's generally advised that you make a list of the situations, places or objects that you fear, arrange them from the least scary to the most scary. Then, starting with the least scary cause of anxiety, you would then start exposing yourself to it. Successful exposure is rewarded and congratulated to reinforce positive behaviours.

There are a range of ways that you can safely gain exposure, for example by directly facing it in real life, vividly imagining it, or using virtual reality.

Medication for anxiety disorder

If the psychological talking therapies don't work or you'd prefer not to try them, medication will likely be offered as an alternative. There are a range of long term and short-term medications that can be prescribed, though each of them requires regular check-ins with a GP.

Short term treatment - Benzodiazepines

Benzodiazepines are a sedative drug that can be used as short-term anxiety treatment. The symptoms are eased within 30 to 90 minutes of taking the drug so they are beneficial in severe cases.

If you're prescribed a benzodiazepine, it'll usually be diazepam.

However, benzodiazepines should be taken with caution and short term only as they are highly addictive if used for more than 4 weeks. After this amount of time, they also lose their effectiveness.

Side effects can include:

  • drowsiness
  • difficulty concentrating
  • headaches
  • vertigo
  • uncontrollable body shakes
  • low sex drive.

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant medication and they are often the first ones that GPs prescribe for anxiety. These are long-term treatments. SSRIs work by increasing the level of serotonin in your brain.

Examples of SSRIs you may be prescribed include:

  • sertraline
  • escitalopram
  • paroxetine.

As with all antidepressants, SSRIs can take several weeks to start working. You will be started on a low dose which will likely gradually increase to allow for the body to adjust to the medicine.

SSRIs can have a range of side effects, including:

  • feeling agitated, shaky or anxious
  • feeling or being sick
  • indigestion
  • diarrhea or constipation
  • loss of appetite and weight loss
  • dizziness
  • blurred vision
  • dry mouth
  • excessive sweating
  • insomnia
  • drowsiness
  • headaches
  • low sex drive
  • difficulty achieving orgasm during sex or masturbation
  • erectile dysfunction.

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

SNRIs are another form of antidepressant sometimes used to treat anxiety disorders. This medication increases the amount of serotonin and noradrenaline in the brain.

Examples of SNRIs you may be prescribed include:

  • venlafaxine
  • duloxetine.

Side effects of these drugs include:

  • feeling sick
  • headaches
  • drowsiness
  • dizziness
  • dry mouth
  • constipation
  • insomnia
  • sweating.

Beta blockers (or beta-blockers)

Beta-blockers (beta-adrenergic blocking agents) prevent adrenaline — a stress-related hormone — from making contact with your heart’s beta receptors. This means that adrenaline cannot make your heart pump harder or faster - two things that commonly happen during a bout of anxiety.

There are many beta-blockers available, but some of the more common ones include:

  • atenolol
  • bisoprolol
  • metoprolol
  • propranolol

All beta-blockers used to treat anxiety are prescribed off-label. This means that, while they may sometimes be prescribed for anxiety disorders, it is not as common as other treatments. Beta-blockers primarily treat angina, heart failure and high blood pressure.

Side effects can include:

  • feeling tired, dizzy or lightheaded (these can be signs of a slow heart rate)
  • cold fingers or toes (beta blockers may affect the blood supply to your hands and feet)
  • difficulties sleeping or nightmares
  • feeling sick.

Support groups

Support groups are groups where individuals experiencing anxiety disorders get together to talk about their challenges, sharing stories with other like minded individuals. The solidarity and sharing of experiences can help those experiencing anxiety to feel less alone.

You can find support groups and other resources near you via the Hub of Hope.

Guided self help

Your GP may offer guided self-help resources as a first course of action as they are freely available online and it may mean that you do not need other treatments. Guided self-help resources can include a range of media including workbooks, online courses and videos.

Here are some examples:

  • Reading Well, which offers free books
  • online cognitive behavioural therapy (CBT) programmes. Search the NHS apps library to find an app to suit.

Self-managing symptoms

There are steps that can be taken and lifestyle changes that can help you feel better without needing to visit a GP. These include:

  • talking to a trusted individual
  • managing worries with a creative outlet such as knitting or painting
  • caring for physical health including exercising and a healthy diet
  • avoiding potential triggers such as caffeine
  • regularly getting outside and connecting to nature
  • keeping a diary
  • mindfulness, breathing exercises and relaxation techniques
  • complementary therapies such as yoga, meditation, massage and aromatherapy.

As a leading employer of nurses and carers in the UK, we take the mental health and wellbeing of our staff seriously. That's why we offer virtual GP appointments and mental health support for all staff, free of charge. Find out more here.