While severe anxiety has been recognized as a problem since antiquity, it was typically considered only a symptom of melancholia (depression). This is understandable given that even modern mental health care providers seldom encounter seriously depressed patients who are not also anxious to a significant degree. While the first modern medical description of anxiety appeared in Richard Burton’s 1621 compendium The Anatomy of Melancholia it was not until the 19th century that anxiety was first recognized as a common thread running through a set of related conditions. In the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) the section on anxiety disorders immediately follows the depressive disorders to recognize of the strong relationship between the two categories of distress.
Everyone knows what it is like to feel anxious—that uncomfortable, apprehensive feeling that comes over us when we are stressed. At normal levels, anxiety rouses us to action. It causes us to study more for an exam; it prepares us for action in a dangerous situation; it keeps us on task as we give an important presentation to our boss. Anxiety is a normal cognitive and physiological response that God designed to call our attention to the seriousness of an event or situation and motivate us to action. With an anxiety disorder, however, the anxiety is not mild and brief as described above, but severe and chronic. Panic attacks, a consuming wave of fear and dread, are a common characteristic of the anxiety disorders.
A panic attack is a sudden surge of overwhelming fear and anxiety that reaches a peak within minutes. The DSM-5 lists 13 potential symptoms of a panic attack; increased heart rate, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills or heat sensations, numbness or tingling, feelings of unreality or depersonalization (being detached from oneself), fear of losing control, or fear of dying. Four or more of these symptoms must be present for the episode to be considered a panic attack. A panic attack may be a one-time occurrence in an individual’s life, but many people experience multiple episodes.
Types of Anxiety Disorders
Separation Anxiety Disorder
Separation Anxiety Disorder is characterized by inappropriate and excessive fear or anxiety concerning separation from home or those to whom the individual is attached. The fear or anxiety is persistent, lasting at least four weeks in children and adolescents and six months or more in adults.
Selective Mutism is characterized by an inability to speak in some social settings and to some people for at least one month. A child with selective mutism may talk normally at home, or when alone with her parents, but cannot speak at all, or speak above a whisper, in other social settings. The disorder is often marked by high social anxiety.
Specific Phobia is characterized by extreme and irrational fear or anxiety about a specific object or situation. Specific phobias commonly focus on animals, insects, germs, heights, thunder, driving, public transportation, flying, dental or medical procedures, and elevators.
Social Anxiety Disorder
Social Anxiety Disorder is characterized by marked fear or anxiety about social situations in which the individual is exposed to possible scrutiny or judgment by others. The fear or anxiety causes clinically significant distress, lasting for six months or more.
Panic Disorder is characterized by recurrent panic attacks that strike suddenly and without warning. Persons with panic disorder often develop intense anxiety between episodes, worrying about when and where the next panic attack will occur. To compensate for this anxiety, panic-disordered individuals often begin to avoid places and situations in which they have experienced an attack. Some people’s lives become restricted to the point that they avoid even everyday activities such as driving or going to the store.
Agoraphobia is characterized by the avoidance of situations or places in which it is thought that escape might be difficult or help might be unavailable in the event of a panic attack or other incapacitating or embarrassing symptoms.
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and worry, even though there is little or nothing to provoke it, occurring for at least six months. In GAD, the anxiety is severe enough to affect the individual’s ability to function in their daily lives. The person will often recognize that their anxiety is more intense than the situation warrants, however they may have difficulty in controlling these thoughts and feelings. With GAD, the anxiety is usually accompanied by physical symptoms such as fatigue, sleeplessness, headache, muscle tension, sweating, shortness of breath, irritability, and hot flashes. During the course of the disorder, the focus of worry may shift from one concern to another.
Prevalence and Age of Onset
Anxiety disorders are the most common mental illness in the United States, affecting approximately 40 million adults (18% of the population). The lifetime prevalence of the anxiety disorders in the United States is estimated to be 5.2% for separation anxiety disorder, 0.5% for selective mutism, 12.5% for specific phobia, 12.1% for social anxiety disorder, 4.7% for panic disorder, 1.4% for agoraphobia and 5.7% for generalized anxiety disorder. Women are twice as likely to be diagnosed with an anxiety disorder as men. The age of onset of selective mutism is usually before 5 years while separation anxiety disorder, specific phobia, and social anxiety disorder usually first manifest in later childhood. The common age of onset for panic disorder and agoraphobia is early adulthood while generalized anxiety disorder has the latest onset of the anxiety disorders, around 30 years. Individuals with anxiety disorders are at high risk for coexisting conditions, such as depression and substance abuse.
Treatment & Support
Anxiety disorders, like many psychiatric disorders, are most effectively treated with a combination of medication and psychotherapy. In addition, there are a number of lifestyle changes people can make that will help reduce their anxiety. Anxiety disorders and stimulants such as caffeine or nicotine do not mix. Because stimulants increase the likelihood and severity of panic attacks, they should be avoided. Individuals with an anxiety disorder should increase their level of exercise. Aerobic exercise over fifteen weeks or more has been shown to reduce anxiety significantly. A healthy lifestyle that includes exercise, adequate rest, and good nutrition can help reduce the impact of anxiety disorders.
There are a number of anxiolytic (anxiety-relieving) drugs available for health professionals to prescribe. For years the standard medication used to treat anxiety disorders has been a class of medications called benzodiazepines. Examples of this type of medication include Xanax, Klonopin, Valium, and Ativan. The most common side effect of these drugs is daytime drowsiness, or what some have described as a “hung-over feeling.” Benzodiazepines lower anxiety by increasing the activity of the neurotransmitter GABA. There is a serious risk of dependency and abuse with these medications, so they are generally prescribed for only short periods of time. Individuals who have had problems with drug or alcohol abuse are not good candidates for treatment with benzodiazepines because they may become dependent on them. Buspirone (BuSpar) is a unique anxiolytic agent that is in a class of drugs known as the azapirones. Clinical trials have found it to be effective in treating generalized anxiety disorder. While the exact mechanism of action for buspirone is unknown, it is thought that its anti-anxiety effects are the result of changes produced in the serotonin neurotransmitter system. Common side effects include dizziness, drowsiness, and nausea. Unlike the benzodiazepines, buspirone is not addictive and must be taken for at least two weeks to counteract the symptoms of anxiety.
Due to the addictive risks associated with benzodiazepines, antidepressant medications—particularly selective serotonin reuptake inhibitors (SSRIs)—are increasingly being used as the initial treatment for anxiety disorders. Examples of SSRIs include Prozac, Zoloft, Paxil, and Celexa. As mentioned previously, these drugs work specifically to increase levels of serotonin in the brain. Older medications such as tricyclic antidepressants (e.g., Anafranil) and monoamine oxidase inhibitors (e.g., Nardil) that affect a wider range of neurotransmitters are also prescribed for anxiety disorders. These medications have been shown to be as effective as the SSRIs in treating anxiety disorders; but because the side effects of these medications can be severe, most physicians and patients prefer the SSRIs.
The psychotherapeutic approach shown to be most effective in treating anxiety disorders is cognitive-behavioral therapy (CBT). The focus of CBT is to reduce anxiety by eliminating beliefs and behaviors that help to maintain the disorder. To be effective, the therapy must be specific to the individual’s anxieties. For example, an individual with a specific phobia who is fearful of dirt and germs may be encouraged to actually get his or her hands dirty during a session. As anxiety builds because of the “contamination,” the therapist works with the patient to develop skills for managing the physical sensations and negative thoughts. Over a number of sessions the therapist might encourage the person to wait for increasingly longer periods of time before washing. Treatment usually lasts from twelve to twenty weeks. It may be conducted individually or in a group setting, provided the people in the group have similar problems.
A Spiritual Perspective
The anxiety disorders result from a neurobiological dysfunction. They are brain disorders! The overwhelming panic described by David in Psalm 55 is not the same as the normal levels of worry and concern that Jesus talks about in the Sermon on the Mount (Matthew 6:25–34) and the apostles Paul (Philippians 4:6) and Peter (1 Peter 5:7) mention in their epistles. As the Body of Christ we must be aware of this difference when ministering to those struggling with anxiety disorders. The Scriptures do not teach that anxiety is a sin but rather anticipate and expect that we will all experience fear and anxiety at some level. The great truth the Bible does teach us about anxiety is that when we do struggle, God is present (Psalm 94:19), taking care of our needs and providing the sustaining grace needed to persevere in a fallen world.
Mental Health Care Providers
When assisting an individual it is important to help them find the right type of mental health care provider. These links will assist you in beginning your provider search. Knowing and building relationships with providers in your area can prove invaluable. Both in aiding the individual in getting an appointment, as well as, being able to better support them once they begin receiving professional treatment.
An individual struggling with an anxiety disorder will most likely need to see both a clinical psychologist or therapist for psychotherapy (talk therapy) and a psychiatrist for medication.
By providing your zip code the following search engines will give you information about local mental health care providers.
In some people, anxiety disorders can become so severe that a hospital stay is needed. This may be necessary if the individuals seeking your care can’t take care of themselves properly or are in immediate danger of harming themselves or someone else. Psychiatric treatment at a hospital can help keep them calm and safe until their mood improves.
Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.
By providing your zip code the following search engine will give you information about mental health treatment facilities in your area.
Recognizing that community is one of the factors necessary for successful recovery, attending support groups can be a powerful and meaningful way to connect with others facing similar challenges. Support group experiences allow people affected by mental health difficulties and disorders to connect in a safe and supportive environment. Support groups are led by trained facilitators and teach coping skills, help reduce anxiety, build resiliency and provide a place for people to share common concerns and receive emotional support.
These links will give you information on support groups for anxiety disorders in your area.
Supporting the Family
Many times the family caring for an individual with a mental illness is overlooked. They are often the front line support for the individual. The responsibility of care can take a physical and psychological toll on caregivers. Many times the caregiver needs as much support as the individual that has the illness. Caregiver support groups are available for the families of those struggling with anxiety disorders.
These links will give you information on caregiver (family) support groups in your area.
Anxiety and Depression Association of America – Family Support Group National Alliance on Mental Illness – Family Support Group National Alliance on Mental Illness – Family to Family Support GroupGrace Alliance Fresh Hope for Mental Health
Here are some links to aid you in learning more about anxiety disorders. The more knowledge you have, the better you are able to help those seeking your guidance.
First Step – What to do once a diagnosis has been made.
Daily Steps – Developing a holistic mental health care plan.
Difficult Steps – Navigating destructive behavior and legal issues.