Types of Anxiety Disorder

ANXIETY – INTRODUCTION

• Anxiety is a natural human response to stress or perceived danger.
• It becomes a clinical concern when it is excessive, persistent, and interferes with daily functioning.
• In such cases, the individual may be experiencing one of the various anxiety disorders recognized in modern psychiatric practice.
• The following is a brief description of the clinical features of the subtypes of anxiety disorders.

GENERALIZED ANXIETY DISORDER (GAD)

Core Features

• Generalized Anxiety Disorder (GAD) is marked by chronic, excessive, and uncontrollable worry that spans various life areas, such as health, finances, work, or interpersonal relationships.
• Unlike other anxiety disorders that are situation-specific, GAD involves pervasive anxiety occurring more days than not for at least six months.

Diagnostic Criteria

• Persistent and excessive anxiety and worry.
• Difficulty controlling the worry.
• Presence of at least three of the following symptoms (one for children):
  • Restlessness or feeling keyed up
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbances

Other Features

• Individuals with Generalized Anxiety Disorder (GAD) often describe themselves as lifelong worriers.
• They may feel anxious even when there is no clear stressor, and their symptoms often overlap with depressive disorders.
• GAD may significantly impair social and occupational functioning and is frequently comorbid with other anxiety disorders.

PANIC DISORDER

Core Features

• Panic Disorder is characterized by recurrent, unexpected panic attacks and persistent worry about future attacks or their consequences.
• These panic attacks are abrupt surges of intense fear or discomfort that peak within minutes.

Panic Attack Symptoms

• At least four of the following symptoms must occur:
• • Palpitations
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feelings of choking
  • Chest pain
  • Nausea or gastrointestinal distress
  • Dizziness or faintness
  • Chills or heat sensations
  • Paresthesia
  • Derealization or depersonalization
  • Fear of losing control
  • Fear of dying

Behavioral Features

• Individuals with Panic Disorder often change their behavior significantly, avoiding physical activity or unfamiliar places to prevent triggering a panic attack.
• Over time, this can lead to the development of agoraphobia.

AGORAPHOBIA

Core Features

• Agoraphobia involves intense fear or anxiety about being in situations where escape might be difficult or where help may not be available in case of panic-like symptoms or other incapacitating events.

Situational Fears

• Fear or avoidance must occur in at least two of the following:
• • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces
  • Standing in line or being in a crowd
  • Being outside the home alone

Additional Features

• People with Agoraphobia often avoid feared situations entirely or require the presence of a companion.
• It may develop independently or co-occur with Panic Disorder.
• When Agoraphobia is comorbid with Panic Disorder, both diagnoses should be made.

SPECIFIC PHOBIA

Core Features

• Specific Phobia is characterized by marked fear or anxiety about a specific object or situation.
• The fear is excessive and unreasonable, typically resulting in avoidance behavior.

Subtypes of Specific Phobia

• Animal Type: e.g., dogs, spiders
• Natural Environment Type: e.g., heights, storms
• Blood-Injection-Injury Type: e.g., needles, surgeries
• Situational Type: e.g., airplanes, elevators
• Other Type: e.g., loud noises, choking

Duration and Impact

• For a diagnosis of Specific Phobia, the fear must persist for at least six months and cause significant distress or impairment.
• Specific Phobia often begins in childhood and may persist into adulthood if untreated.

SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)

Core Features

• Social Anxiety Disorder (Social Phobia) involves intense fear of social situations where an individual may be scrutinized or judged by others.
• The person fears embarrassment, humiliation, or rejection.

Common Social Triggers

• Public speaking
• Eating in front of others
• Interacting with authority figures
• Initiating conversations

Associated Features

• People with Social Anxiety Disorder may experience blushing, trembling, or sweating in feared situations.
• The condition often starts in adolescence and can severely impair academic, occupational, and interpersonal functioning.
• Social Anxiety Disorder frequently coexists with depression and substance use disorders.

SEPARATION ANXIETY DISORDER

Core Features

• Although traditionally seen in children, Separation Anxiety Disorder is now recognized as occurring in adults as well.
• It involves excessive fear or anxiety about separation from home or attachment figures.

Symptoms

• At least three of the following must be present:
• • Recurrent distress about separation
  • Persistent worry about losing attachment figures
  • Fear of being alone
  • Refusal to go to school, work, or other places
  • Nightmares involving separation
  • Physical symptoms upon separation

Duration

• At least four weeks in children and adolescents
• At least six months in adults

Additional Features

• Adults with Separation Anxiety Disorder may avoid travel, experience extreme distress when their partner is away, or have difficulties sleeping alone.
• It may present with panic symptoms when separation is anticipated.

SELECTIVE MUTISM

Core Features

• Selective Mutism is defined by a consistent failure to speak in certain social situations despite speaking in others (such as at home).
• The absence of speech interferes with educational or occupational achievement.

Diagnostic Requirements

• Symptoms persist for at least one month
• Not due to lack of knowledge of the spoken language
• Not better explained by a communication disorder

Associated Features

• Selective Mutism is often associated with Social Anxiety Disorder.
• Children may use nonverbal means to communicate.
• Without early intervention, Selective Mutism can persist and affect academic and social development.

SUBSTANCE/MEDICATION-INDUCED ANXIETY DISORDER

Core Features

• Substance/Medication-Induced Anxiety Disorder occurs when prominent anxiety or panic symptoms are the direct result of substance use, withdrawal, or exposure to a toxin.

Common Triggers

• Caffeine, amphetamines, cocaine
• Alcohol or benzodiazepine withdrawal
• Medications like corticosteroids or thyroid hormones

Diagnosis Requires

• Onset of symptoms during or soon after substance use
• Significant distress or impairment
• Symptoms not better explained by another anxiety disorder

ANXIETY DISORDER DUE TO ANOTHER MEDICAL CONDITION

Core Features

• Anxiety Disorder Due to Another Medical Condition involves clinically significant anxiety or panic that is attributable to the physiological effects of a medical condition.

Common Medical Causes

• Hyperthyroidism
• Cardiac arrhythmias
• Hypoglycemia
• Chronic obstructive pulmonary disease (COPD)
• Neurological disorders (e.g., epilepsy)

Clinical Considerations

• Proper diagnosis of Anxiety Disorder Due to Another Medical Condition requires clear evidence from clinical evaluation or laboratory findings.
• Treating the underlying medical condition often alleviates the anxiety symptoms.

CONCLUSION

• Anxiety disorders encompass a wide and varied spectrum of mental health conditions.
• Each of the anxiety disorders has unique diagnostic criteria, symptom patterns, and clinical presentations.
• However, they all share common features of excessive fear, anticipatory worry, and avoidance behavior that cause significant distress or functional impairment.
• Early identification and evidence-based treatment—including Cognitive Behavioral Therapy (CBT), pharmacological interventions, and psychoeducation—can lead to substantial recovery.