Anxiety Disorders
Anxiety, worry and fear are feelings that everyone experiences now and
again. They can be useful emotions, helping us to be aware of risks and
respond to challenging or dangerous situations. They prepare the body to
take action to protect itself (the so-called 'fight or flight' response).
16% of adults suffer from some sort of anxiety disorder.1 This means that
they experience anxiety, worry, fear or panic at a greater level than is
normal. The anxiety can be caused by specific situations or it can be
present constantly. Anxiety disorders are generally more common in
women than in men, but this can vary depending on the type of condition.2
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An anxiety disorder is diagnosed when someone feels anxious all, or a
lot of the time for no logical reason to the extent that this impacts on
everyday life.
Obsessive compulsive disorder, agoraphobia, post-traumatic stress
disorder, and specific phobias (of anything from balloons, busy rooms
or sharks) are examples of anxiety disorders.
Anxiety disorders can be difficult to tell apart in some cases, and a
person will often have more than one diagnosis. They are often
experienced by people with other mental health conditions such as
depression.3
Anxiety disorders can cause both physical and psychological
symptoms.
Sometimes severe anxiety can cause panic attacks which are acute
episodes of anxiety. If this happens repeatedly it is called ‘panic
disorder’.
Anxiety Disorders are some of the most common mental health
problems. They affect 16% of adults and there is evidence that they
tend to run in families.4
The disorders can be treated with talking therapies, medication or both,
and many people recover.
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This factsheet covers:
1. What are the symptoms of anxiety disorders?
2. What are the different types of anxiety disorders?
a) Generalised anxiety disorder (GAD)
b) Panic disorder
c) Post-traumatic stress disorder (PTSD)
d) Social anxiety disorder (social phobia)
e) Specific phobias (e.g. of spiders)
f) Obsessive compulsive disorder (OCD)
g) Body dysmorphic disorder (BDD)
h) Trichotillomania (TTM - hair pulling)
3. What causes anxiety?
4. What are the different treatments for anxiety disorders?
1. What are the symptoms of anxiety disorders?
The symptoms of anxiety can include:
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Feeling constantly irritable or worried
Difficulties sleeping
Difficulties concentrating
Feelings of dread or impending doom
Feelings of anxiety can also be experienced as physical symptoms
including:
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Heart palpitations (irregular beat)
Sweating
Tension and pains
Heavy and rapid breathing
Dizziness
Fainting
Indigestion
Diarrhoea
Stomach aches and sickness (especially in young children)
Many people feel one or more of these at one time or another, but people
with anxiety disorders experience them more frequently and to the extent
that they interfere with their lives. Which symptoms and how severely they
are experienced will be different for each disorder and person.
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2. What are the different types of anxiety disorder?
Anxiety disorder is a general term given to a range of diagnosable anxiety
conditions. The following illnesses are covered in more detail below:
a)
b)
c)
d)
Generalised anxiety disorder (GAD)
Panic disorder
Post-traumatic stress disorder (PTSD)
Social anxiety disorder (social phobia)
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e)
f)
g)
h)
Specific phobias (e.g. of spiders)
Obsessive compulsive disorder (OCD)
Body dysmorphic disorder (BDD)
Trichotillomania (TTM - hair pulling)
a) Generalised anxiety disorder
About 1 in every 22 people in England suffers from generalised anxiety
disorder.5 The main characteristic of generalised anxiety disorder (GAD) is
a constant feeling of worry that seems uncontrollable as there doesn’t
seem to be any reason for it. This worry can affect daily functioning and
lead to withdrawal from social situations or fear of going to work. GAD can
occur with other anxiety disorders, depressive disorders or substance
abuse. It is often difficult to diagnose because it lacks some of the more
noticeable symptoms such as panic attacks that are present in other
anxiety disorders. For a diagnosis to be made, worry must be present
more days than not, for at least 6 months.6
Many people with GAD may feel ‘keyed up’ or ‘on edge’. They could also
be easily fatigued or have trouble sleeping or concentrating. Physical
symptoms may also be experienced such as muscle tension, sweating,
nausea (feeling sick), stomach cramps (or ‘butterflies’) and a fear of
fainting.7
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b) Panic disorder (panic attacks)
Having a panic disorder means having repeated and frequent panic
attacks. A panic attack is a sudden episode of intense fear or discomfort
accompanied by four of the following symptoms:
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Palpitations, pounding heart or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
A feeling like choking
Chest pain or discomfort
Feeling sick or stomach pain
Feeling dizzy, unsteady, light headed or faint
Derealisation (feelings of unreality) or of depersonalisation (being
detached from oneself)
Fear of losing control
Fear of dying
Numbness or tingling sensations
Chills or hot flushes. Trembling, shivering or shaking.
An attack usually peaks in approximately 5 - 10 minutes, but can take
much longer to subside completely. The general pattern of onset of an
episode is usually the same. First there is a sudden increase in anxiety,
then a range of unpleasant sensations in the body and finally a fear that
something terrible is going to happen (or a sense of ‘doom’).8
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There are different types of panic attacks:
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Unexpected (spontaneous or not triggered by anything): The attack
"comes out of the blue" without warning and for no apparent reason.
Situational: The attack always, or is most likely to, happen in certain
situations either externally (contact with a certain object or situation
such as entering a tunnel) or internally (a certain thought or feeling).
Panic disorder is diagnosed when a person experiences recurrent (at least
two) unexpected panic attacks. This must be followed by at least 1 month
of persistent concern about having another attack, or of the consequences
of another attack. This includes any significant behavioural changes that
are related somehow to this concern, such as avoiding a scene of a
previous attack. The worries people might have may be about the physical
consequences of the panic attacks. Many become convinced that the
attacks indicate an undiagnosed physical illness.9
How often and how severe the attacks are varies from person to person.
Some people suffer from repeated attacks for weeks, while others might
have short bursts of very severe attacks in a short time. The age of onset
of panic disorders is during the mid-teens to early adulthood. 20% of
American adults with the disorder (results for the UK are probably similar)
say they can trace their condition back to childhood.10
Agoraphobia develops often, but not always, with panic disorder. This is a
fear of having a panic attack in a place from which escape is difficult (or
embarrassing) such as on public transport or whilst using a lift. Many
people with agoraphobia fear leaving their homes or have a fixed area or
route (maybe between home and work) that they can’t stray from.11
Some advice on panic attacks from the Institute of Psychiatry Centre for
Anxiety Disorders:
 No matter how bad it feels, panic attacks cannot actually harm you.
 Panic attacks do not last forever – they always pass after a while.
 You can try to control how long your panic attack lasts by thinking
positive thoughts.
 If you ignore a panic attack, you might be making things harder for
yourself in the long term.12
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c) Post-traumatic stress disorder
Post traumatic stress disorder (PTSD) develops following exposure to a
traumatic event that involves actual or threatened death, or serious injury.
This may be witnessed rather than directly experienced. Even learning
about something bad that has happened to a family member or close
friend can be traumatic enough for PTSD to be triggered.
PTSD can occur at any age from childhood to old age. Traumatic stress
can also increase over a lifetime causing PTSD. Responses to trauma
include feelings of intense fear, helplessness, and horror. Sufferers may
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experience flashbacks, panic attacks and being extra sensitive of
surroundings (having ‘heightened awareness’).
Types of triggers:
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Fear of death or severe injury
Being a victim of serious violent crime
Surviving a serious accident or disaster
Witnessing incidents whilst being a member of the armed forces or
emergency services
Having had a severe illness, such as traumatic childbirth
Witnessing the death, near death or serious injury of another person
For someone to be diagnosed with PTSD, they must have symptoms for
more than a month. They would feel less able to socialise, work or carry
out everyday activities. PTSD is one of several illnesses that someone
could suffer from after having experienced a traumatic event.
According to NICE guidelines the symptoms of PTSD include:
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Unwanted thoughts and memories of the trauma
Flashbacks
Nightmares
Feeling emotionally upset when reminded of the trauma
Physical symptoms when reminded of trauma (sweating, shaking and
racing heart)
Being overly vigilant or on the look out for threat, exaggerated startle
responses (the body’s automatic response to the unexpected, such as
a loud noise), irritability and difficulty in concentrating or sleeping.
Avoiding talking about the trauma and all things associated with it.
Feeling emotionally numb or not being able to remember some of the
event.
Suffering from depression, generalised anxiety, shame, guilt and
reduced libido.
Finding it difficult to be close to anyone13
Young children who have suffered a trauma may have dreams about the
event, which within a few weeks may turn into general nightmares.
Children will often relive the event through play. They may also have
physical symptoms, such as headaches and stomach aches.14
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d) Social anxiety disorder (social phobia)
Social anxiety disorder (SA) is an intense fear of social or performance
type situations. People with this disorder are intensely aware of the
physical signs of their anxiety (palpitations, tremors, sweating or blushing)
and fear that others will notice, judge or think poorly of them.15
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Common fears associated with the disorder include speaking in public or
to strangers, meeting new people, and a fear of activities that may
potentially be embarrassing such as writing, working, eating or drinking in
public. This fear may result in an extreme worry before a particular activity,
or when faced with a particular activity, or it could lead to the person
avoiding the activity altogether. Adults usually recognise that their fears
are excessive, but cannot prevent them.
Onset of SA usually happens between the ages of 14 and 20 with the
average age being around 15. If it occurs before the age of 11, recovery
may be more difficult. Although children and young people are usually not
affected in the company of people they know, they can find it very worrying
to be in other social situations. This causes problems for the child when
making new friends or dealing with situations at school. Older children
describe a fear of humiliation or embarrassment which leads them to avoid
social situations.16
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e) Specific phobias
A specific phobia is when there is a marked fear or avoidance of a specific
object or situation. Coming into contact with the feared object or situation
provokes either an anxiety response or acute panic. Adults with phobias
usually recognise that their fear is exaggerated and unreasonable, but
they are unable to eliminate the fear or reduce the avoidance.
Specific phobia is diagnosed when an individual's fear interferes with their
daily routine, employment (e.g. missing out on a promotion because of a
fear of flying), social life (e.g. inability to go to crowded places), or if having
the phobia is significantly distressing. If a fear is reasonable it cannot be
classed as a phobia.
Specific phobia may have its onset in childhood, and is often brought
about by a traumatic event. Getting bitten by a dog, for example, may
bring about a fear of dogs. They may also be learned from parents.
Phobias that begin in childhood may disappear as the individual grows
older. Fear of a certain type of animals is the most common class of
specific phobia. The disorder can be experienced at the same time as
panic disorder and agoraphobia.17
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f) Obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) is the name given to someone who
has obsessions, compulsions or both. The sufferer is usually aware of
these being excessive or unreasonable. Obsessions are recurring
thoughts or impulses that are intrusive or inappropriate and cause the
individual anxiety. Some of the most common obsessions are:
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Thoughts about contamination, for example, when an individual fears
coming into contact with dirt, germs or "unclean" objects.
Persistent doubts, for example, someone doubting whether or not they
have turned off the iron or oven, locked the door or turned on the
answering machine.
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Religious, sacrilegious or blasphemous thoughts.
Sexual thoughts, for example someone thinking they are a paedophile,
or thoughts of sexual violence.
Urge to hoard useless or worn out possessions.
Aggressive impulses or thoughts, for example, someone being
overcome with the urge to yell "fire" in a crowded theatre, or thoughts
of killing their own child.
Compulsions are repetitive behaviours or mental acts that the person feels
driven to perform. They can either be visible to others or not, making them
hard to monitor. A compulsion is not in itself pleasurable and this is what
distinguishes it from an impulsive act such as shopping or gambling.
Performing these rituals temporarily relieves the anxiety caused by
obsessive thoughts. Compulsions become part of the person's daily
routine and are not always directly related to the obsessive thought. For
example, a person who has aggressive thoughts may count floor tiles in
an effort to control the thought. Some of the most common compulsions
are:
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Checking: checking several or even hundreds of times to make sure
that cookers are turned off and doors are locked.
Cleaning: concern about germs and contamination leading to
excessive cleaning of the self or of the home.
Mental compulsions: for example, thinking over a prayer or a phrase in
a set order, or counting to ten
Counting: counting the number of shoes in a cupboard
Repeating acts: switching a light switch on and off fifteen times
Ordering or being exact: an excessively slow and methodical approach
to daily activities, such as spending hours organising and arranging
objects.
Hoarding: hoarders are unable to throw away useless items, such as
old newspapers, junk mail, even broken appliances. Sometimes
hoarding can reach a point where whole rooms are filled with saved
items.
A combination of compulsions and obsessions is called ‘rumination’. To
‘ruminate’ is when someone thinks about the same subject for long
periods of time and doesn’t feel they have any control over it. This may
include thoughts the person doesn’t want to have, doubts and questions
as well as attempts at answering them.
In order for OCD to be diagnosed, the obsessions and/or compulsions
must take up a considerable amount of the person’s time (at least one
hour every day) and interfere with normal routines, social activities, or
relationships. OCD can interfere with your ability to concentrate, and it is
not uncommon for a sufferer to avoid certain situations (e.g. someone who
is obsessed with cleanliness may be unable to use public toilets). Onset of
OCD is usually gradual and most often begins in adolescence for men or
in early adulthood for women. Insight into the condition is usually a feature
of OCD although not always (especially in those who hoard). Children with
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OCD do not recognise that their obsessions and compulsions are
excessive. 18
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g) Body dysmorphic disorder (BDD – formerly
Dysmorphophobia)
Body dysmorphic disorder refers to a distressing preoccupation with a
particular part of the body that most people do not really notice or think
important. Most commonly this can be the nose, hair, skin, eyes, eyelids,
lips, jaw, chin or body build in general. Any part of the body may be the
focus and there can often be several body parts involved at the same time.
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People with BDD may engage in time consuming behaviours such as
mirror-gazing, comparing particular features with those of others,
excessive camouflaging tactics to hide the defect, skin picking and
reassurance seeking. There is usually either an avoidance of social
situations and intimacy or dependency on alcohol or drugs during these
situations. Adults with BDD have high rates of unemployment and social
isolation, are sometimes housebound and may be at risk of suicide. BDD
can be present in children who most commonly are concerned with their
skin or hair. 20
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h) Trichotillomania (TTM - hair pulling)
Despite the misleading name, this is not a mania. It is seen as an ‘impulse
control disorder’ which can be a form of addiction or part of a compulsive
disorder. It involves irresistible urges to pull out hair and can occur on its
own or with OCD or BDD. A person with TTM sometimes experiences a
build up of tension, which can be relieved by pulling hair out. The sufferer
is not always entirely aware of what they are doing.
The most common place that people with TTM pull hair from is the scalp
(leaving the sides almost untouched) but they can also pull from
eyelashes, eyebrows, face, arms, legs, abdomen and pubic area, and
even sometimes from family members and pets. Hair sucking or chewing
(sometimes resulting in hair ingestion) may also occur which can lead to
intestinal problems requiring surgery. People with TTM will usually have
tried stopping the behaviour themselves in a variety of ways, including
taping their fingers together, or wearing hats and gloves. People with TTM
often have low self esteem. The disorder can be treated and controlled
with a combination of therapy and/or medication21
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3. What causes anxiety?
The causes of anxiety are not fully known, but things to do with your
family, your body and what has happened to you in the past are all
believed to be involved. Studies have shown that some people are born
more likely to have high levels of anxiety. You are probably more likely to
suffer from an anxiety disorder if someone in your family does.22
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Drug use and some physical conditions can also lead to increased anxiety
as can one or more events that cause significant adjustments in everyday
life (e.g. marriage, injury or retirement).23
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4. What are the different treatments for anxiety disorders?
Anxiety disorders are highly treatable. Effective methods are psychological
therapy, medicines and self help.
Medication
Selective serotonin reuptake inhibitors (SSRI's - a type of antidepressant)
are commonly used to treat generalised anxiety disorder and panic
disorders. Other medications may be offered if these do not work.
Benzodiazepines provide rapid relief from the symptoms of anxiety. This
group of drugs should only be used to treat anxiety that is severe,
disabling or subjecting the individual to extreme distress. This is because
there is a chance that patients can become dependent on them.24
Psychological treatments
There are several psychological approaches that have been shown to be
effective, including Cognitive Behavioural Therapy (CBT).25 You can ask
your GP for a referral or in some areas you may be able to refer yourself.
Further information on medication and talking therapies can be found in
our factsheets ‘Antidepressants’, ‘Benzodiazepines’ and ‘Talking
Therapies’, which are available to download for free from
www.rethink.org/factsheets or by contacting the Rethink Advice &
Information Service directly. Our contact details are at the end of this
factsheet.
The National Institute for Health and Clinical Excellence (NICE) produces
guidance for the NHS on how to treat certain conditions. There is guidance
for treating a number of anxiety disorders including:
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Anxiety (which includes generalised anxiety disorder and panic
disorder)
Obsessive compulsive disorder and body dysmorphic disorder
Post traumatic stress disorder.
Copies of these are available for free download from the NICE website
(www.nice.org.uk) or hard copies are available by contacting NICE
publications on 0845 003 7783. There are copies of these guidelines
specifically written for patients and carers
Some people find ways to manage their anxiety on their own if they feel
they have sufficient support from family and friends. Advice about this
should be sought from your GP but some of the links in the ‘further
information’ section of this factsheet may
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also help. The Mental Health Foundation offer podcasts which might help
you deal with your anxiety and they are available free from their website
(details of which you can also find below).
Self help
Your doctor may offer you self help resources, such as the one made
available by Northumberland, Tyne and Wear NHS Foundation Trust at
the following web address:
http://www.ntw.nhs.uk/pic/leaflets/Anxiety%20A4%202010.pdf.
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The Mental Health Foundation offer information and advice and also
produces podcasts which could help with anxiety.
Tel: 020 7803 1100
Email: [email protected]
Web: www.mentalhealth.org.uk
Anxiety care is a London-based charity that specialises in helping people
to recover from anxiety disorders and to maintain that recovery. This
involves helping to plan, initiate and carry through personal recovery
programmes. There is a charge for many of their services.
Anxiety Care
Cardinal Heenan Centre
326 High Road
Ilford
Essex
IG1 1QP
Tel: 020 8478 3400 (Open Monday and Wednesday 9.45am-3.45pm)
Email: [email protected]
Web:
www.anxietycare.org.uk
OCD Action exists to provide information, advice and support for people
with obsessive compulsive disorder and related disorders such as body
dysmorphic disorder, compulsive skin picking and trichotillomania.
OCD Action, Suite 506-509
Davina House
137-149 Goswell Road
London
EC1V 7ET
Tel: 0845 390 6232 or 020 7253 2664
Email: [email protected]
Web: www.ocdaction.org.uk
Social Anxiety UK is the central organisation for sufferers of social
anxiety in the UK. They are a web-based organisation. It serves as a
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source of information, a hub for people with social anxiety and to raise the
profile of the illness.
Email: [email protected]
anxiety.org.uk
Web: www.social-
Anxiety UK (The National Phobics Society) is a user led organisation
that supports anyone with anxiety, phobias, panic attacks or other anxiety
related disorders. They can be contacted at:
Anxiety UK
Zion Community Resource Centre
339 Stretford Road
Hulme
Manchester
M15 4ZY
Tel: 08444 775 774 or 0161 227 9898 (Monday to Friday 9.30am – 5.30pm)
Fax: 0161 226 7727
Email: [email protected]
Web:
www.anxietyuk.org.uk
No Panic supports sufferers of panic attacks, phobias, obsessivecompulsive disorder and generalised anxiety disorder and tranquilliser
withdrawal.
No Panic
93 Brands Farm Way
Telford
Shropshire
TF3 2JQ
Help line (Freephone): 0800 138 8889 (open 10am to 10pm daily)
Fax: 01952 270962
Email: [email protected]
Web: www.nopanic.org.uk
The Centre for Anxiety Disorder and Trauma (Institute of Psychiatry
and Maudsley Trust) – This centre provides information and treatment for
the range of disorder covered by this factsheet.
99 Denmark Hill
London
SE5 8AF
Tel: 0207 919 2101
Email: [email protected]
http://psychology.iop.kcl.ac.uk/cadat/
Web:
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1
Centre for Anxiety Disorders and Trauma, General Information (2009) Retrieved on
04/08/11 from http://psychology.iop.kcl.ac.uk/cadat/default.aspx
2
As note 1
3
National Institute for Health and Clinical Excellence (2011) Generalised anxiety
disorder and panic disorder (with or without agoraphobia) in adults: management in
primary, secondary and community care CG113 London: National Institute for Health and
Clinical Excellence. at pg 516
4
As note 3, at pg 20
5
As note 3, at pg 18. Actual figure given is 4.4% in England.
6
Based on the DSM-IV diagnostic criteria. See note 3, pg 19.
7
As note 3, see personal accounts at pgs 52-64
8
NHS Choices, Panic Disorder (2010) Retreived on 04/08/11 from
http://www.nhs.uk/Conditions/Panic-disorder/Pages/Symptoms.aspx
9
As note 3, at pgs 516-517
10
Anxiety Care, Panic Disorder (Episodeic Paroxysmal Anxiety) (2002-11) Retrieved on
04/08/11 from http://www.anxietycare.org.uk/docs/panicdisorder.asp
11
As note 3 at pg 20
12
Centre for Anxiety Disorders and Trauma, Panic Disorder (2009) Retrieved on
04/08/11 from http://psychology.iop.kcl.ac.uk/cadat/anxiety-disorders/panicdisorder.aspx#practical_advice
13
National Institute for Health and Clinical Excellence (2005) The management of PTSD
in adults and children in primary and secondary care. CG26. London: National Institute
for Health and Clinical Excellence. Page 5-6, 8,10,13
14
The Royal College of Psychiatrists, Post Traumatic Stress Disorder, Children and
PTSD Retrieved on 14 04/08/11 from
http://www.rcpsych.ac.uk/mentalhealthinfo/problems/ptsd/posttraumaticstressdisorder.as
px
15
Social Anxiety UK Retrieved 21/10/11 from http://www.social-anxiety.org.uk/
16
The Royal College of Psychiatrists: Mental Health and Growing Up, Worries and
anxieties – helping children to cope (2008) Retrieved on 04/08/11 from
http://www.rcpsych.ac.uk/mentalhealthinfo/mentalhealthandgrowingup/worriesandanxietie
s.aspx
17
NHS Choices, Phobias (2009) Retrieved 04/08/11 from
http://www.nhs.uk/conditions/Phobias/Pages/Introduction.aspx and linked pages.
18
National Institute for Health and Clinical Excellence (2006) Core interventions in the
treatment of obsessive compulsive disorder and body dysmorphic disorder. CG31.
London: National Institute for Health and Clinical Excellence. Page 15-23
19
As note 18 p24-25
20
As note 18 p27
21
NHS choices, Trichotillomania (2010) Retrieved 04/08/11 from
http://www.nhs.uk/conditions/trichotillomania/Pages/introduction.aspx
22
As note 3, pgs 17-19
23
Anxiety Care, Transitional Changes – Some Origins of Anxiety (2002-11) Retrieved on
04/08/11 from http://www.anxietycare.org.uk/docs/origins.asp
24
As note 3, pg 180
25
National Institute for Health and Clinical Excellence (2005) Generalised anxiety
disorder and panic disorder (with or without agoraphobia) in adults: management in
primary, secondary and community care. CG113. London: National Institute for Health
and Clinical Excellence. Page 12-23, also see guidance at notes13 and 18
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RET0075 © Rethink Mental Illness 2011
Last updated October 2011
Next update October 2013
Last updated 01/10/2010
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