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Anxiety disorders fact sheet

woman Samantha's story

Samantha is scared to death of flying. She never flies anymore, even though her children live more than 2000 miles away. She used to start dreading a plane trip a month before she was due to leave. She felt awful when the airplane door closed; she felt trapped. Her heart pounded, and she dripped with sweat.

woman Tamara's story

In any social situation, Tamara felt fear. She would be anxious before she even left the house, and it escalated as she got closer to a college class, a party, or whatever. She felt sick in her stomach. It almost was like she had the flu. Her heart pounded, her palms would get sweaty, and she had this sense of being removed from herself and from everybody else.

woman Sue's story

Sue was raped when she was 25 years old. For a long time, she spoke about the rape as though it was something that happened to someone else. She was very aware that it had happened to her, but there was just no feeling. Then she started having flashbacks. They kind of came over her like a splash of water. She felt terrified. Suddenly, she was reliving the rape. Every instant was startling. She wasn't aware of anything around her. She was in a bubble, just kind of floating. The rape happened the week before Thanksgiving, and she feels fearful every year around the anniversary date.

What is anxiety?

Anxiety is a normal reaction to stress. It helps you deal with a tense situation in the office, study harder for an exam, or keep focused on an important speech. In general, it helps you cope. But when anxiety becomes an excessive, irrational dread of everyday things, it can be disabling.

Anxiety disorders affect about 40 million American adults age 18 years and older (about 18 percent). It's not the same as the mild stress you may feel when you have to speak in public, or the butterflies you may feel in your stomach when going on a first date. Anxiety disorders can last at least six months and can get worse if they are not treated.

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What are the five major types of anxiety disorder?

The five major types of anxiety disorder are:

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What is generalized anxiety disorder (GAD)?

All of us worry about things like health, money, or family problems at one time or another. But people with GAD are extremely worried about these and many other things, even when there is little or no reason to worry about them. They may be very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks.

People with GAD:

  • Worry very much about everyday things for at least six months, even if there is little or no reason to worry about them
  • Can't control their constant worries
  • Know that they worry much more than they should
  • Can't relax
  • Have a hard time concentrating
  • Are easily startled
  • Have trouble falling asleep or staying asleep

Common body symptoms are:

  • Feeling tired for no reason
  • Headaches
  • Muscle tension and aches
  • Having a hard time swallowing
  • Trembling or twitching
  • Being irritable
  • Sweating
  • Nausea
  • Feeling lightheaded
  • Feeling out of breath
  • Having to go to the bathroom a lot
  • Hot flashes

GAD develops slowly. It often starts during the time between childhood and middle age. Symptoms may get better or worse at different times, and often are worse during times of stress.

People with GAD may visit a doctor many times before they find out they have this disorder. They ask their doctors to help them with the signs of GAD, such as headaches or trouble falling asleep, but don't always get the help they need right away. It may take doctors some time to be sure that a person has GAD instead of something else.

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What is obsessive-compulsive disorder (OCD)?

People with OCD have upsetting thoughts (obsessions) that cause anxiety. They do things over and over again (compulsions) to control the anxiety these thoughts cause. Often the rituals end up controlling the person. For example, someone with OCD may relock their door many times before going to bed. Or, a person with OCD may wash their hands over and over again because the person is afraid of getting sick. While it is good to wash your hands before eating or after using the bathroom, a person with OCD may wash their hands hundreds of times a day.

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What is panic disorder?

People with panic disorder have sudden attacks of terror. These attacks include:

  • A pounding heart
  • Sweatiness
  • Weakness
  • Faintness
  • Dizziness
  • Feeling overly warm or chilled
  • Tingling or numb hands
  • Nausea, chest pain, or smothering sensations

Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control. A fear of one's own unexplained physical symptoms is also a sign of panic disorder. People having panic attacks sometimes believe they are having heart attacks, losing their minds, or are dying. They can't predict when or where an attack will occur, and, between episodes, many worry a lot and fear the next attack.

Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer.

People who have full-blown, repeated panic attacks can become very disabled by their condition and should seek treatment before they start to avoid places or situations where panic attacks have occurred. For example, if a panic attack happened in an elevator, someone with panic disorder may develop a fear of elevators that could affect the choice of a job or an apartment. This fear could also restrict where that person can seek medical attention or enjoy entertainment.

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What is post-traumatic stress disorder (PTSD)?

PTSD starts after a scary ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

PTSD can cause many symptoms. These symptoms can be grouped into three categories:

1. Re-experiencing symptoms:

  • Flashbacks — reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts

Re-experiencing symptoms may cause problems in a person's everyday routine. They can start from the person's own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger symptoms.

2. Avoidance symptoms:

  • Staying away from places, events, or objects that are reminders of the experience
  • Feeling emotionally numb
  • Feeling strong guilt, depression, or worry
  • Losing interest in things that were enjoyable in the past
  • Having trouble remembering the dangerous event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

3. Hyperarousal symptoms:

  • Being easily startled
  • Feeling tense or "on edge"
  • Having difficulty sleeping, and/or having angry outbursts

It's normal to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don't show any symptoms for weeks or months.

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What is social phobia (social anxiety disorder)?

Social phobia, also called social anxiety disorder, is diagnosed when people become very anxious and self-conscious in everyday social situations. People with social phobia have a strong fear of being watched and judged by others. They embarrass easily.

Social phobia can happen in one kind of situation, such as talking to people, eating or drinking, or writing on a blackboard in front of others. Or, it may be so broad that the person experiences anxiety around almost anyone other than family members.

Physical symptoms include:

  • Blushing
  • Profuse sweating
  • Trembling
  • Nausea
  • Difficulty talking

When these symptoms occur, people with social phobia feel as though everyone is watching them.

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What are some common specific phobias?

A specific phobia is an intense, irrational fear of something that poses little or no actual danger. Some of the more common specific phobias are fears of:

  • Closed-in places
  • Heights
  • Escalators
  • Tunnels
  • Highway driving
  • Water
  • Flying
  • Dogs
  • Injuries involving blood

These fears are irrational. For example, you may be able to ski the world's tallest mountains with ease but be unable to go above the fifth floor of an office building. Adults with phobias know that these fears are irrational but they often find that facing, or even thinking about facing their fears brings on a panic attack or severe anxiety.

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Can anxiety disorders be treated?

Yes, there are treatments that can help people with anxiety disorders. Their is no cure for anxiety disorder yet, but treatments can give relief to people who have it and help them live a more normal life. The first step is to go to a doctor or health clinic to talk about your symptoms. The doctor will do an exam to make sure that another physical problem isn't causing the symptoms. The doctor may make a referral to a mental health specialist.

Doctors may prescribe medication to help relieve anxiety disorders. It's important to know that some of these medicines may take a few weeks to start working. In most states only a medical doctor (a family doctor or psychiatrist) can prescribe medications.

The kinds of medicines used to treat anxiety disorders are listed below. Some are used to treat other problems, such as depression, but also are helpful for anxiety disorders:

  • Antidepressants
  • Anti-anxiety medicines
  • Beta blockers

If you are pregnant or breastfeeding, you should talk to your doctor about your anxiety treatment. Stopping your treatment all of a sudden could be harmful to you. Some medications used to treat anxiety cross the placenta and can be transmitted to the baby in your uterus. Also, because your medication can be passed into your breast milk, breastfeeding may pose some risk for a nursing infant.

However, a number of research studies show that certain antidepressants, such as some of the SSRIs (see box) have been used relatively safely during breastfeeding. You should discuss with your doctor whether breastfeeding is an option or whether you should plan to feed your baby formula. Although breastfeeding has some advantages for your baby, most importantly, as a mother, you need to stay healthy so you can take care of your baby.

What are SSRIs?

Selective serotonin reuptake inhibitors (SSRIs) are a kind of antidepressant for treating depression and anxiety disorders.

Before taking medication for an anxiety disorder:

  • Ask your doctor to tell you about the effects and side effects of the drug.
  • Tell your doctor about any alternative therapies or over-the-counter medications you are using.
  • Ask your doctor when and how the medication should be stopped. Some drugs can't be stopped abruptly but must be tapered off slowly under a doctor's supervision.
  • Work with your doctor to determine which medication is right for you and what dosage is best.
  • Be aware that some medications are effective only if they are taken regularly and that symptoms may come back if the medication is stopped.

Doctors also may ask people with anxiety disorders to go to talk therapy with a licensed social worker, psychologist, or psychiatrist. This treatment can help people with anxiety disorders feel less anxious and fearful. If you know someone with signs of an anxiety disorder, talk to him or her about seeing a doctor. Offer to go along for support.

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What can I do to help myself if I have an anxiety disorder?

Many people find it helps to join a support group because they can share their problems and successes with others who are going through the same thing. Internet chat rooms can be useful for support, but any advice received over the Internet should be used with caution. Internet friends may have never seen each other, and false identities are common.

While it doesn't take the place of mental health care, talking with trusted friends or a member of your faith community can also be very helpful. Family members can play an important role in a person's treatment by offering support. Learning how to manage stress will help you to stay calm and focused. Research suggests that aerobic exercise (like jogging, bicycling, and swimming) may be calming. Other studies have found that caffeine, illegal drugs, and some over-the-counter cold medicines can worsen the symptoms of these disorders. Check with your doctor or pharmacist before taking any over-the-counter medicines.

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Where can I find help for my anxiety disorder?

If you don't know where to go for help, talk to someone you trust who has experience in mental health — for example, a doctor, nurse, social worker, or religious counselor. Ask their advice on where to seek treatment. If there is a university nearby, its departments of psychiatry or psychology may offer private and/or sliding-scale fee clinic treatment options. Otherwise, check the Yellow Pages under "mental health," "health," "social services," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for a mental health problem, and will be able to tell you where and how to get further help.

Listed below are the types of people and places that will make a referral to, or provide mental health care and information.

  • Family doctors
  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Religious leaders/counselors
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • Universities or medical schools
  • State hospital outpatient clinics
  • Social service agencies
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical and/or psychiatric societies

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More information on anxiety disorders

For more information about anxiety disorders, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

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The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Anxiety disorders fact sheet was reviewed by:

Catherine Roca, M.D.,
Office for Special Populations
National Institute of Mental Health/National Institutes of Health
Bethesda, MD

Content last updated: July 16, 2012.

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