Difficulties with anxiety are common. The last National Survey of Mental Health and Wellbeing showed that anxiety disorders are the most common type of mental health disorder in Australia. It revealed that approximately 1 in 4 people experience an anxiety disorder during their lifetime (26%) and 14% of people have an anxiety disorder in any one year. So you’re not alone if you find anxiety challenging. There are different types of anxiety disorders. This is a brief rundown:
General Anxiety Disorder (GAD)
The main difficulty in GAD is the excessive worry that feels hard to control, along with a tendency to feel anxious much of the time for several months. While many people may worry briefly from time to time, in GAD the worry feels intense, frequent and prolonged. The focus of the worry can vary but is typically about everyday events, work, the health and welfare of themselves or others, relationships, finances, the future or even global/political affairs. People with GAD often notice feeling nervous and on edge much of the time, along with irritability, fatigue, muscle tension (for example, in the back or shoulders) and find that the worry and anxiety disrupt sleep and concentration. However, not everyone will experience all of those symptoms. A common feature of excessive worry in GAD is the tendency to jump to negative conclusions about the future and the belief that worry can’t be controlled. People with GAD often find they do things to make themselves feel better like avoiding certain situations or engaging in excessive planning, checking or reassurance-seeking. Our Sydney-based psychologists have expertise in treating GAD by using scientifically supported treatment approaches (like cognitive behavioural therapy) to teach people to effectively control their worry and anxiety.
Social Anxiety Disorder (or Social Phobia)
In social anxiety disorder, peoples’ primary concern is of embarrassing themselves or being judged negatively by other people in social interactions or social performance-type situations (like public speaking). Common anxiety-provoking situations here can include speaking to unfamiliar people, speaking to authority figures, dating situations, making phone calls, being in a work or social group setting or speaking to a group. It can also include situations of being in public like eating or writing in front of others or any situation where someone feels like the centre of attention. People with Social Anxiety Disorder often feel uncomfortable before entering, and on being, in these situations. They may notice physical anxiety symptoms like feeling hot and flushed, butterflies, muscle tension, faster heart rate and breathing rate. As a result, people often avoid many of these situations or do things to make it easier to cope like avoiding eye contact, staying quiet or sticking to people they’re more familiar with.
In panic disorder, people are concerned about having a panic attack or panic-like symptoms. They are often concerned that these may occur unpredictably and may represent, or cause, a serious consequence like fainting, a heart attack or death. A panic attack is a sudden, intense physical feeling of fear or dread that appears to happen out of the blue. Features of a panic attack include multiple physical symptoms (racing heart, nausea, dizziness, shortness of breath, shaking, muscle tension, sweating, hot/cold flushes, and perceptual changes to vision and hearing), which prompt catastrophic thoughts that something is seriously wrong. They usually peak within 5-15 minutes, but then leave people feeling unwell, tired or anxious. Having a panic attack does not necessarily mean that someone has panic disorder. Rather, in panic disorder, people fear the possibility of further panic attacks or panic symptoms. As a result, they may remain anxious and be on the lookout for further panic attacks or panic symptoms and make changes to their behaviour to try to prevent panic. Examples of these behavioural changes may be avoiding exercise, sex, caffeine or hot environments.
It’s common for people with a fear of panic to also experience Agoraphobia. In Agoraphobia, people are concerned about the consequences of having a panic attack or panic symptoms and so avoid multiple situations (e.g. public transport, being alone, being outside the home, open spaces like shopping centres, crowds, or enclosed spaces like movie theatres). Common concerns include not getting help, not being able to escape or feeling embarrassed if panic symptoms occur.
In specific phobia, people experience significant fear and anxiety when in the presence of particular objects or situations. The intensity of their fear is often out of proportion to the actual level of threat present. While people realise this, they still find it understandably hard to handle the associated anxiety. As a result, people will often avoid these situations. While there are many different types of specific phobia, they typically fall into these categories:
- Animal (e.g. spiders, insects, dogs, snakes)
- Environmental (heights, water, the dark, storms)
- Medical/injury (e.g. injections, needles, seeing an injury, having a medical procedure)
- Situational (e.g. enclosed spaces like lifts, bridges, flying)
- Other (e.g. vomiting, clowns, the number thirteen)
The following conditions of OCD, PTSD and Illness Anxiety Disorder (health anxiety) are mostly currently classified separately from the other anxiety disorders by the primary diagnostic manuals such as the DSM-5 and the ICD-11. However, in everyday terms we often consider these to be a form of anxiety. This is because anxiety is a core feature and because we often use treatments similar to those for other anxiety disorders.
Obsessive-Compulsive Disorder (OCD)
The primary concern in OCD is recurrent, intrusive ideas (obsessions) that make people distressed or anxious. Examples of these concerns may be thoughts of accidentally causing harm to others, doubts about whether doors are locked or appliances turned off, germs/contamination or other thoughts that seem inappropriate. Obsessions can take the form of intrusive thoughts, mental images, memories, urges or impulses. These concerns then prompt people to engage in behavioural or mental acts, often according to personal rules, in order to reduce the distress or to prevent the obsessional concerns from coming true. These behavioural and mental acts are referred to as compulsions. Examples of compulsions can include repeated checking, cleaning/handwashing, counting or engaging in certain routines or “rituals.”
If people find that obsessions or compulsions cause significant distress or get in the way of daily activities, then it might suggest OCD. It’s possible to have OCD even if someone only experiences obsessions or compulsions, but most of the time people with OCD experience both.
Some of the common forms that OCD can take include:
- Concerns of germs and contamination prompting washing/cleaning compulsions
- Fear of accidentally causing harm to others causing avoidance and ritualising
- Fear of sexually inappropriate thoughts causing avoidance and ritualising
- Excessive doubt (e.g. about leaving doors unlocked or appliances on, or having unintentionally said something to offend someone) and compulsive checking or prevention
However, OCD is highly individual so the way someone experiences it may be different from the forms above.
Illness Anxiety Disorder (Health Anxiety)
In Illness Anxiety Disorder (health anxiety or hypochondriasis) people are concerned that they have or will develop a serious health condition. This is more than an occasional concern. Rather, it feels like a preoccupation. Example concerns may be having or developing cancer, HIV, a serious heart problem or another serious illness. This causes people to experience significant anxiety and to engage in behaviours like checking and monitoring themselves for symptoms, checking the internet for health-related information, repeated visits to the doctor and seeking medical tests for reassurance. While people find that these behaviours may bring temporary relief in anxiety and worry about health, the anxiety comes back when they next notice a particular symptom or have a health-related worry.
Posttraumatic Stress Disorder (PTSD)
PTSD can occur after exposure to a traumatic event. A traumatic event is a situation in which there is a severe physical threat, which risks or causes injury or death. People may be exposed to traumatic events by experiencing them directly, witnessing them, learning of them happening to a close friend or family member, or repeatedly encountering the details of the traumatic event. Examples of traumatic events include car accidents, work or industrial accidents, physical or sexual assault, combat and natural disasters. The traumatic event may be discrete or may have happened repeatedly over time. Common features of PTSD include experiencing the memory of the trauma in an unwanted, distressing way (e.g. through nightmares or flashbacks), increased anxiety and physical arousal, efforts to avoid the memory and its reminders, and negative mood and thinking. Click here for more information about PTSD and traumatic stress.