Anxiety and anxiety disorders
Anxiety is an unpleasant emotion triggered by anticipation of future events, memories of past events, or ruminations about the self.
Stimulated by real or imagined dangers, anxiety afflicts people of all ages and social backgrounds. When the anxiety results from irrational fears, it can disrupt or disable normal life. Some researchers believe anxiety is synonymous with fear, occurring in varying degrees and in situations in which people feel threatened by some danger. Others describe anxiety as an unpleasant emotion caused by unidentifiable dangers or dangers that, in reality, pose no threat. Unlike fear, which is caused by realistic, known dangers, anxiety can be more difficult to identify and to alleviate.
Rather than attempting to formulate a strict definition of anxiety, most psychologists simply make the distinction between normal anxiety and neurotic anxiety, or anxiety disorders. Normal (sometimes called objective) anxiety occurs when people react appropriately to the situation causing the anxiety. For example, most people feel anxious on the first day at a new job for any number of reasons. They are uncertain how they will be received by coworkers, they may be unfamiliar with their duties, or they may be unsure they made the correct decision in taking the job. Despite these feelings and any accompanying physiological responses, they carry on and eventually adapt. In contrast, anxiety that is characteristic of anxiety disorders is disproportionately intense. Anxious feelings interfere with a person's ability to carry out normal or desired activities. Many people experience stage fright—the fear of speaking in public in front of large groups of people. There is little, if any, real danger posed by either situation, yet each can stimulate intense feelings of anxiety that can affect or derail a person's desires or obligations. Sigmund Freud described neurotic anxiety as a danger signal. In his id-ego-superego scheme of human behavior, anxiety occurs when unconscious sexual or aggressive tendencies conflict with physical or moral limitations.
According to a standard manual for mental health clinicians, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revised (also known as the DSM-IV-TR), the following disorders are considered anxiety disorders:
- Panic disorder without agoraphobia—A person with this disorder suffers from recurrent panic attacks and worries about experiencing more attacks, but agoraphobia is not present. Panic attacks are sudden attacks of intense fear or apprehension during which the sufferer may experience shortness of breath, increased heart rate, choking, and/or a fear of losing control. Agoraphobia is anxiety about places or situations from which escape might be difficult, or in which help might not be available.
- Panic disorder with agoraphobia—A person with this disorder also experiences recurrent panic attacks but also has agoraphobia. The anxiety about certain places or situations may lead to avoidance of those places or situations.
- Agoraphobia without history of panic disorder—The person with this disorder suffers from agoraphobia and experiences panic-like symptoms but does not experience recurring panic attacks.
- Specific phobias—A person diagnosed with a specific phobia suffers from extreme anxiety when he or she is exposed to a particular object or situation. The feared stimuli may include: particular animals (dogs, spiders, snakes, etc.), situations (crossing bridges, driving through tunnels), storms, heights, and many others.
- Social phobia—A person with social phobia fears social situations or situations in which the individual is expected to perform. These situations may include eating in public or speaking in public, for example.
- Obsessive-compulsive disorder—A person with this disorder feels anxiety in the presence of a certain stimulus or situation, and feels compelled to perform an act (a compulsion) to neutralize the anxiety. For example, upon touching a doorknob, a person may feel compelled to wash his or her hands four times, or more.
- Post-traumatic stress disorder—This disorder may be diagnosed after a person has experienced a traumatic event, and long after the event, the person still mentally re-experiences the event along with the same feelings of anxiety that the original event produced.
- Acute stress disorder— Disorder with similar symptoms to post-traumatic stress disorder, but is experienced immediately after the traumatic event. If this disorder persists longer than one month, the diagnosismay be changed to post-traumatic stress disorder.
- Generalized anxiety disorder—A person who has experienced six months or more of persistent and excessive worry and anxiety may receive this diagnosis.
- Anxiety due to a general medical condition—Anxiety that the clinician deems is caused by a medical condition.
- Substance-induced anxiety disorder—Symptoms of anxiety that are caused by a drug, a medication, or a toxin.
- Anxiety disorder not otherwise specified—This diagnosis may be given when a patient's symptoms do not meet the exact criteria for each of the above disorders as specified by DSM-IV-TR.
Amen, Daniel G. Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness.New York: Crown Publishing Group, 2000.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revised. Washington DC: American Psychiatric Association, 2000.