Anxiety Disorders

Although commonly separated into 7 categories (Panic Disorder, Agoraphobia, Social Phobia, Obsessive-Compulsive Disorder, Generalised Anxiety Disorder, Specific Phobias, and Post-Traumatic Stress Disorder), they are all very similar and appear to be variations of a single “Anxiety Disorder”.

Everybody experiences anxiety and fear. It is a natural human emotion. However, for individuals with Anxiety Disorder, anxious thoughts are a regular occurrence and the associated anxiety experienced as a result can start to create many difficulties in a person's life, such as interfering with school, work, and social/family life.

When someone becomes anxious or fearful three things happen in their body and mind. First, the body prepares itself for danger through activation of the Fight-Flight response. The heart begins to speed up, breathing quickens, muscles become tense, and so forth.

Second, the mind shifts your attention to search for signs of danger resulting in an increase in thoughts of danger such as "Am I having a heart attack?" and "Everybody is staring at me". Your mind is desperately trying to find the danger. This attention shift is also why people with Anxiety Disorder often report concentration problems.

Third, the mind also tries its best to motivate you to do something to avoid, escape from, or neutralise the danger. While this seems to help in the short-term, it can actually strengthen the fears in the long run.

1.1 Panic Disorder

Panic Disorder is a very common condition, affecting about 2.6% of the population at any given time. Panic Disorder is characterised by having had two or more panic attacks, followed by at least one month of apprehension or anxiety about having another attack. Most people with Panic Disorder, however, have more than two panic attacks and have been apprehensive about the attacks for much more than one month. Individuals with Panic Disorder often worry that a panic attack is:

  1. actually a serious medical problem (e.g., heart attack)
  2. that it might have negative physical consequences (e.g., lose control while driving)
  3. that it might have negative psychological consequences (e.g., going "crazy")
  4. that it might have negative social consequences (e.g., embarrassment) Apprehension about having panic attacks can lead to people avoiding places or situations in which they have previously had panic attacks, or believe they might have panic attacks. This is known as Agoraphobia.

Panic attacks are rushes of intense fear, terror, or anxiety that are accompanied by symptoms such as:

  • Racing or pounding heart
  • Shortness of breath
  • Choking sensations
  • Shaking or trembling
  • Dizziness or lightheaded feelings
  • Nausea
  • Numbness or tingling sensations
  • Tight or painful chest
  • Sweating
  • Fears that you may be dying, losing control, or going crazy

People with other anxiety disorders may also experience panic attacks when in feared situations, but individuals with Panic Disorder also experience panic attacks at times or in places where they wouldn't expect to have a panic attack.

1.2 Agoraphobia

Agoraphobia is a disabling Anxiety Disorder that most commonly occurs together with Panic Disorder, although it may be present without panic in some cases. About one third of people with panic disorder develop Agoraphobia. Agoraphobia is characterised by a strong fear of not been able to escape from certain situations or places if one had a Panic Attack or other physical problems, such as diarrhoea or nausea.

Individuals with Agoraphobia may become avoidant of the feared situations, and often develop “safe places" or "fixed routes” to avoid suffering severe anxiety. They may also carry safety aids, such as mobile telephones or medication bottles, if they must enter the feared situations. In the most severe cases, individuals may become housebound refusing to leave their homes for long periods, sometimes even years.

Among the most common avoidances are driving, shopping centres, crowded places such as arenas, stadiums, or theatres, travelling long distances, standing in lines, being alone, meetings, and social gatherings. Approximately 2.8% of the Australian population experience Agoraphobia.

1.3 Social Anxiety Disorder

Social Anxiety Disorder (also known as Social Phobia) is an Anxiety Disorder that is characterized by an intense fear of social situations, such as:

  • Speaking in public
  • Standing in line
  • Meeting new people
  • Attending meetings
  • Making small talk
  • Being observed

Individuals with Social Anxiety Disorder may also experience severe anxiety and feel threatened when they have to face performance situations. Individuals with Social Anxiety Disorder tend to be very concerned about negative evaluations by others, embarrassment, and humiliation.

Moreover, people with Social Anxiety Disorder are sensitive to criticism and rejection, and they fear others may notice their anxiety, judge them, and think poorly of them. When in social situations, individuals with Social Anxiety Disorder can experience severe anxiety and, in some cases, will have panic attacks. It is estimated that approximately 4.7% of the Australian population suffers from Social Anxiety Disorder.

1.4 Obsessive-Compulsive Disorder

Roughly 2% of adults currently have Obsessive-Compulsive Disorder (OCD), and twice that many have had it at some point in their lives. This disorder is characterised by uncontrollable obsessions and compulsions that are excessive, unreasonable, and distressing.

Obsessions are intrusive or inappropriate recurring thoughts or impulses that cause anxiety. Common obsessive thoughts include:

  • Thoughts that one is contaminated by germs, dirt, or other substances
  • Doubts about whether you correctly completed a task such as locking the door or turning off the stove
  • Aggressive impulses
  • Thoughts that you may have accidentally harmed someone
  • Embarrassing or distressing thoughts of a sexual, religious/sacrilegious, or inappropriate nature
  • A looming feeling that something "bad" is going to happen

Compulsions, on the other hand, are repetitive behaviours or rituals that are performed to reduce anxiety or neutralise the obsessive thought. Compulsions may involve behaviours such as:

  • Excessive cleaning and washing
  • Hoarding of useless items
  • Checking and re-checking
  • Repetitive time consuming routines
  • Saying or thinking certain things to get rid of, or make amends for, the obsessive thought

In most cases, OCD usually involves having both obsessions and compulsions; however, a person with OCD may have only one or the other.

1.5 Generalised Anxiety Disorder

Generalised Anxiety Disorder (GAD) is a relatively common anxiety disorder that affects approximately 2.7% of the Australian population. It is characterised by excessive and uncontrollable worry, anxiety, and fear about a number of things, such as:

  • Minor matters
  • Finances
  • Work or school
  • Health
  • Safety of loved ones
  • Community or world affairs

While worry is a normal process for most people, individuals with GAD worry about things when most people would say there is no reason to worry, such as worrying frequently about finances despite having plenty of money in savings. With GAD, the worry interferes with daily functioning.

GAD is often accompanied by bothersome physical symptoms such as muscle tension, sleep and concentration difficulties, and restlessness. This excessive worry is present almost daily for at least 6 months, and is intense and frequent. GAD may also occur together with other anxiety disorders, depression or with substance abuse.

1.6 Specific Phobias

Approximately 10% of the population will develop a Specific Phobia sometime in their lives. Phobias are characterised by the excessive fear of a specific object or situation that may lead to severe distress and, in some cases, panic attacks. Among the most common Phobias are fears of:

  • Animals such as dogs, snakes, or insects
  • Situations such as flying, small enclosed spaces, or driving
  • Blood, needles, injections, or minor injuries
  • Things in nature, such as storms, water, or heights
  • Other things, including fears of vomiting, doctors, dentists, or choking

Individuals with Specific Phobias recognise that their fear is unreasonable however, they cannot overcome it. While most people feel anxious or apprehensive about certain objects or situations, individuals with a Specific Phobia have their daily routines, employment, or social lives disrupted by their fears.

1.7 Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after experiencing a very traumatic or life-threatening event such as but not limited to:

  • Combat
  • Sexual assault or rape
  • Physical attack
  • Motor vehicle accident
  • Robbery
  • Injury
  • Natural or man-made disaster

PTSD can involve (1) actually experiencing the traumatic event, (2) witnessing a traumatic event involving another person, or (3) learning of a traumatic event of a family member or close associate.

Individuals who develop PTSD have symptoms including persistent re-experiencing of the event through memories or nightmares, avoidance of places or situations that remind them of the trauma, and general increased arousal like sleeplessness, uncharacteristic irritability or difficulty concentrating. Individuals with PTSD may also find themselves withdrawing physically and emotionally from others around them. These symptoms can be extremely frightening and disabling in the individual’s work and social life. PTSD is a surprisingly common disorder affecting approximately 6.4% of the adult population in Australia.