Anxiety disorders come in many forms: OCD, PTSD, panic attacks

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Intermittent bouts of anxiety are an ordinary part of life, but when you have intense, persistent, or excessive anxiety about routine situations you may have an anxiety disorder. Oftentimes the anxiety (and accompanying feeling of panic) interferes with everyday activities and may even cause you to avoid places or situations.

There are many different types of anxiety disorders, but we’ll focus on five of the major and most common ones.

Generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) occurs when you experience excessive worry and anxiety that impact and interfere with your day-to-day activities for months or longer. Its exact cause in unknown, but may be a combination of genetics and other risk factors.

Symptoms include:

  • Restlessness or feeling wound-up or on edge;
  • Being easily fatigued;
  • Difficulty concentrating or having your mind go blank;
  • Irritability;
  • Muscle tension;
  • Difficulty controlling the worry; and
  • Difficulty falling or staying asleep, or restless, unsatisfying sleep.

Risk factors for developing GAD include having a temperament that’s timid or negative or avoids anything dangerous, having a genetic history in your family, and being female.

Treatment for GAD consists of psychotherapy and medications. Medications include:

Panic disorder

Panic attacks are unexpected episodes of intense fear triggering extreme physical reactions without any real danger or cause. Panic disorder is when you experience recurrent panic attacks and live in constant fear of another one.

No one knows for sure what causes a panic attack or panic disorder, but genetics, major stress, a sensitive temperament, and possibly certain changes in your brain’s functioning are thought to play a role. Panic attacks are usually triggered by a specific situation, and some research shows your fight-or-flight mechanism of your body may be involved.

Symptoms of a panic attack include palpitations, pounding heart, or increased heart rate; sweating; trembling or shaking; feeling short of breath, smothering, or choking; and a sensation of impending doom.

Symptoms of panic disorder may include the following:

  • Sudden, repeated attacks of intense fear;
  • Feeling of being out of control during a panic attack;
  • Intense worry about when the next attack will happen; and
  • Fear or avoidance of places where attacks have previously occurred.

There are some risk factors that may increase your likelihood of developing panic attacks or panic disorder. If you have a family history, have had a major life stress or traumatic event, have had a major change in your life, if you smoke or excessively intake caffeine, or if you have a history of childhood physical or sexual abuse, you may be at a higher risk.

If you do develop panic attacks or panic disorder, your treatment options are psychotherapy and medications. Medications include:

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is when you have unreasonable thoughts and fears (obsessions) that cause you to do repetitive behaviors (compulsions), and you are unable to stop the cycle. While the exact cause is unknown, changes in your body’s chemistry or brain function, some genetic component, or even an environmental factor are all considered as possibilities.

Common symptoms of obsessions include:

  • Fear of germs or contamination;
  • Unwanted forbidden or taboo thoughts involving sex, religion, and harm;
  • Aggressive thoughts towards others or self; and
  • Having things symmetrical or in a perfect order.

Common symptoms of compulsions include:

  • Excessive cleaning and/or handwashing;
  • Ordering and arranging things in a particular, precise way;
  • Repeatedly checking on things; and
  • Compulsive counting.

General symptoms that distinguish a person with OCD are

  • They can’t control their thoughts or behaviors;
  • They spend at least one hour a day on these thoughts or behaviors;
  • They don’t get pleasure when performing the behaviors or rituals; and
  • They experience significant problems in their daily life due to the thoughts or behaviors.

Risk factors that may increase the likelihood of your developing OCD include having a family history of OCD, experiencing traumatic or stressful life events, and having other mental disorders (i.e. anxiety disorders, depression, substance abuse, or tic disorders).

Treatment for OCD includes psychotherapy and medications, such as

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is triggered by either experiencing or witnessing a terrifying event that involves actual or threatened death, serious injury, or sexual violation.

No one knows exactly what causes PTSD. It is most likely a combination of stressful experiences, inherited mental health risks (i.e. a family history of anxiety and depression), your temperament, and the way your brain functions in response to stress.

Symptoms of PTSD usually begin within three months of the traumatic incident, but may begin years afterwards. They must last for at least a month and be severe enough to interfere with relationships or work to be categorized as PTSD. For an adult to be diagnosed with PTSD, they must have all of the following for a minimum of one month:

  • One or more re-experiencing symptom;
  • One or more avoidance symptom;
  • Two or more arousal and reactivity symptoms; and
  • Two or more cognition and mood symptoms.

Re-experiencing symptoms are flashbacks, bad dreams, and frightening thoughts.

Avoidance symptoms are staying away from reminders of the traumatic experience, or avoiding thoughts or feelings related to it.

Arousal and reactivity symptoms are being easily startled, feeling tense or “on edge,” having difficulty sleeping, or having angry outbursts.

Cognition and mood symptoms are trouble remembering key features of the traumatic event, negative thoughts about yourself or the world, distorted feelings, or loss of interest in enjoyable activities.

Risk factors for developing PTSD include the following:

  • Experiencing intense or long-lasting trauma;
  • Having experienced earlier trauma in life;
  • Having a job that increases your risk of exposure to traumatic events;
  • Having other mental health problems;
  • Having substance misuse problems;
  • Lacking a good support system; and
  • Having a family history of mental health problems.

PTSD treatment consists of psychotherapy and medications, including:

Social anxiety disorder

Social anxiety disorder is when everyday social interactions cause intense anxiety, self-consciousness, and embarrassment from a fear of being judged by others. The exact cause is unknown, but possible ones are genetics, an overactive structure in your brain (the amygdala), and as a learned behavior.

Symptoms of social anxiety disorder include:

  • Feeling extremely anxious about being with other people and having a hard time talking to them;
  • Feeling very self-conscious in front of other people and worrying about feeling humiliated, embarrassed, or rejected, or fearful of offending others;
  • Being very afraid others will judge them;
  • Worrying for days or weeks before an event where other people will be;
  • Staying away from places where there are other people;
  • Having a hard time making and keeping friends;
  • Blushing, sweating, or trembling around other people; and
  • Feeling nauseous or sick to your stomach when other people are around.

Your risk of developing social anxiety disorder may increase if you have a family history, you have negative social or other life events, you have a shy or timid temperament, if new social or work demands are suddenly placed on you, and if you have an appearance or condition that draws attention to you.

Treatment involves psychotherapy, as well as medications. First line drugs include Paxil or Zoloft, while Effexor XR may also be an option.

About the Author

Julie Kaplan, Pharm. D.
Julie Kaplan is a licensed pharmacist in Virginia and the District of Columbia. She received a Bachelor’s of Arts in English from The College of William and Mary and a Doctor of Pharmacy from Virginia Commonwealth University. She has experience in patient communication from working as a retail pharmacist.