What Are Types of Anxiety Disorders?

Worry that's difficult to control is a symptom of generalized anxiety disorder.

Anxiety disorders are a common type of psychiatric disorder characterized by anxiety or fear that does not go away over time.

There are several types of anxiety disorders, including the following:

• Generalized anxiety disorder
• Social anxiety disorder (social phobia)
• Panic disorder
• Agoraphobia
• Separation anxiety disorder
• Selective mutism
• Phobias
• Substance/medication-induced anxiety disorder
• Anxiety disorders due to other medical conditions

Obsessive-compulsive disorder (OCD), acute stress disorder, and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders but are no longer considered anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Symptoms of anxiety disorders vary depending on the specific condition.

Symptoms of generalized anxiety disorder include:

• Excessive anxiety and worry that is difficult to control
• Anxiety and worry are associated with at least three of the following six symptoms occurring more days than not for at least 6 months:
  • Restlessness or feeling on edge
  • Being easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep problems

Symptoms of social anxiety disorder (social phobia) include the following:

• Fear of social situations and exposure to possible scrutiny by other that can inhibit a person's ability to function at work or in school
• Fear of humiliation or embarrassment

Symptoms and signs of panic disorder include the following:

• Chest pain
• Shortness of breath
• Feeling like you're having a heart attack (Patients with panic disorder often come to a hospital's emergency department because they fear a heart attack is occurring.)
• Sudden onset of fear, usually reaching its peak within 10 minutes
• Recurrent panic attacks, with one or more attacks followed by at least 1 month of fear of another panic attack or significant behavior changes related to the attacks
  • A panic attack is a sudden period of intense fear or discomfort accompanied by four or more of the following 13 symptoms:
    • Palpitations or fast heart rate
    • Sweating
    • Trembling or shaking
    • Shortness of breath or feeling of being smothered
    • Feeling of choking
    • Chest pain or discomfort
    • Nausea or abdominal upset
    • Dizziness, unsteadiness, lightheadedness, or fainting
    • Feeling hot or cold
    • Numbness or tingling sensations
    • Disconnection from surroundings or oneself (derealization or depersonalization)
    • Fear of losing control or going crazy
    • Fear of death
    • Sense of impending doom
    • Urge to flee or escape
    • Headache
    • Cold hands
    • Diarrhea
    • Insomnia
    • Fatigue
    • Intrusive thoughts
    • Repetitive thoughts (ruminations)
• May result in changes in personality, such as a person becoming more passive, dependent, or withdrawn

Symptoms of agoraphobia include:

• Intense anxiety when the patient is exposed to specific situations such as heights, animals, small spaces, or storms
• Fear of being trapped without escape

Symptoms of specific (simple) phobias include:

• Irrational and out of proportion fear to specific situations (for example, animals, insects, blood, needles, flying, heights)
• Fear can be disabling and can lead to other anxiety disorders, depression, suicidal ideation, and substance-abuse disorders.

There are numerous possible causes of anxiety disorders, such as

• genetic factors,
• environmental factors such as early childhood trauma,
• known or unrecognized medical condition, and
• substance-induced, such as from use of over-the-counter (OTC) medications, herbal medications, and drugs of abuse.

Health care providers often diagnose anxiety disorders with a psychological evaluation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, provides diagnostic criteria for an anxiety disorder.

Lab studies to diagnose or exclude medical conditions that may cause anxiety disorders include the following:

• Complete blood cell (CBC) count
• Chemistry profile
• Thyroid function tests
• Urinalysis
• Urine drug screen

Tests to rule out central nervous system (CNS) disorders that can cause anxiety include the following:

• Electroencephalography (EEG)
• Lumbar puncture
• Brain computed tomography (CT) scan
• Magnetic resonance imaging (MRI) of the brain
• Neurologic consultation
• Positron emission tomography (PET) scan

Tests to rule out heart conditions that can cause anxiety include

• electrocardiography (ECG) and
• treadmill ECG.

Tests to rule out infectious causes of anxiety include

• rapid plasma reagent test,
• lumbar puncture (CNS infections), and
• HIV testing.

Other tests to rule out other physical causes of anxiety include

• arterial blood gas analysis and
• chest X-ray.

Treatment for anxiety disorders usually consists of a combination of medication and/or psychotherapy.

The following medications treat anxiety disorders:

• Antidepressants
• Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor and Effexor XR) and duloxetine (Cymbalta)
• Atypical antidepressants such as nefazodone (Serzone), mirtazapine (Remeron), and trazodone (Desyrel)
• Tricyclic antidepressants such as imipramine (Tofranil) and clomipramine (Anafranil)
• Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate), and isocarboxazid (Marplan)
• Benzodiazepines, especially in emergency situations, such as lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax)
• Anti-anxiety drugs such as buspirone (BuSpar)
• Anticonvulsants such as pregabalin (Lyrica), divalproex (Depakote), and gabapentin (Neurontin)
• Antihypertensive drugs such as clonidine (Catapres), propranolol (Inderal, Betachron E-R, InnoPran XL), nadolol (Corgard), and atenolol (Tenormin)

Types of therapy used to treat anxiety disorders include the following:

• Behavioral therapy and cognitive behavioral therapy (CBT)
• Computerized CBT (FearFighter)
• Psychodynamic therapy (or insight-oriented therapy) is rarely used on its own for phobias but may be used for phobic disorders that overlap personality disorders.
• Interpersonal psychotherapy
• Relaxation therapy
• Supportive psychotherapy
• Mindfulness therapy

Other treatments used for anxiety disorders include

• cranial electrotherapy stimulator (CES) for treatment of anxiety, depression, and insomnia.

Hospitalization may be indicated to treat anxiety disorders in severe cases such as

• severe functional impairment (cannot meet own daily needs),
• suicide or homicide risk, and
• deficits in social skills.

Dietary changes that help treat anxiety disorders include

• avoiding caffeine and
• using caution with over-the-counter preparations and herbal remedies because ephedrine and other herbal compounds may cause or worsen anxiety symptoms.

Complications of anxiety disorders include

• major depression,
• alcohol and drug abuse,
• significant functional impairment and decreased quality of life from social phobias, and
• suicide (in severe cases).