Introduction
Anxiety is a natural protective reaction. An anxiety disorder is diagnosed when the anxiety is excessively strong or persistent, does not match the actual threat, and significantly impairs daily life.
Anxiety disorders are among the most common mental illnesses. Many forms occur more frequently in women than in men.
In addition to psychological tension, physical and autonomic symptoms often occur:
- palpitations or racing heart
- shortness of breath and a feeling of tightness in the chest
- sweating and trembling
- nausea and abdominal pain
- dizziness
- tingling or numbness, so-called paresthesias
- muscle tension, inner restlessness and sleep disturbances
The physical complaints are real. Depending on the symptomatology, possible physical causes as well as the influence of medications, caffeine or other substances must be considered.
Phobia
A specific phobia is a pronounced, persistent and disproportionate fear of a particular object, living creature or situation. Typical triggers are spiders, heights, flying, blood or injections.
Confrontation with the trigger usually leads immediately to intense fear. Affected individuals avoid corresponding situations or endure them only under considerable distress. The disorder often begins in childhood or adolescence.
Case 1 â Spider phobia
A 25-year-old woman experiences heart racing, trembling and sweating at the sight of a spider. She immediately leaves the room and avoids the basement. Although she perceives her fear as exaggerated, she can hardly control it.
Case 2 â Fear of heights
A 38-year-old man develops intense fear with dizziness and weak knees on a secured balcony. He fears falling and therefore avoids tall buildings and viewing platforms.
The treatment of choice is cognitive behavioral therapy with exposure. Under therapeutic guidance, affected individuals deliberately confront the fear trigger. They learn to tolerate the anxiety, to examine their fears and to reduce avoidance behavior.
For certain phobias, exposure in virtual reality can be used. Medications are not part of the standard treatment for specific phobias.
Social anxiety disorder
Social anxiety disorder, also called social phobia, is characterized by a pronounced and persistent fear of social situations. Central is the fear of being judged negatively, rejected or embarrassed by others.
Typical situations are:
- speaking in front of a group
- conversing with unfamiliar people
- eating or drinking in front of others
- participating in meetings or social events
The complaints often begin during puberty or adolescence. They go far beyond normal shyness and can significantly impair school, work and relationships.
A 19-year-old student has great fear of presentations. He fears blushing, trembling or losing his train of thought and then being laughed at. He already sleeps poorly days in advance. Eventually he avoids events and thus jeopardizes his studies.
A central treatment is cognitive behavioral therapy with exposure and behavioral experiments. Social situations are practiced intentionally and negative expectations are examined.
Medically, selective serotonin reuptake inhibitors, abbreviated SSRI, or the serotoninânoradrenaline reuptake inhibitor venlafaxine may be considered.
Panic
A panic attack is a suddenly occurring episode of intense fear or severe discomfort. The symptoms peak within minutes.
Typical symptoms are racing heart, shortness of breath, chest pain, sweating, trembling, dizziness and paresthesias. Often there is fear of dying or fear of losing control. Some affected individuals experience their surroundings as unreal or feel detached from themselves.
The duration varies.
A single panic attack does not yet constitute a panic disorder.
Definition
A panic disorder is characterized by recurrent, unexpected panic attacks. The attacks occur without a clear situational trigger.
In addition, affected individuals often develop pronounced anticipatory anxiety, i.e., fear of further attacks. They monitor their body particularly closely and change their behavior, for example by avoiding physical exertion.
(According to DSM-5-TR, after at least one attack there must be persistent concerns or significant maladaptive behavioral changes for at least one month.)
A 32-year-old man experiences repeated sudden heart racing, shortness of breath and fear of dying over several weeks. A recognizable trigger is lacking. Between attacks he constantly checks his pulse. For fear of another attack he gives up sports and increasingly leaves his apartment less often.
Medically, especially SSRI or SNRI may be considered. The choice depends, among other things, on comorbidities, tolerability and individual needs. Cognitive behavioral therapy is also an option for treatment.
Generalized anxiety disorder
Generalized anxiety disorder, abbreviated GAD, is characterized by excessive and difficult-to-control worries about various areas of life. The worries often concern one’s own health, family, work or financial security.
Typical accompanying symptoms are:
- inner restlessness and nervousness
- easy fatigability
- concentration problems
- irritability
- muscle tension
- difficulty falling or staying asleep
The disorder can occur at any age. It is often recognized in adulthood but also occurs in children and adolescents.
A 45-year-old woman has been worrying daily for over a year about her children’s health, her financial situation and possible mistakes at work. Although there is no concrete reason, she can hardly interrupt the rumination. She sleeps poorly, is tired during the day and suffers from neck tension.
Medically, especially SSRI or SNRI may be considered. The choice depends, among other things, on comorbidities, tolerability and individual needs. Cognitive behavioral therapy is also an option for treatment.
Separation anxiety disorder
Separation anxiety disorder is present when the fear of separation from important attachment figures markedly exceeds the age-appropriate level and impairs daily life.
Affected individuals, for example, fear that something will happen to an attachment figure during their absence. School avoidance, difficulties sleeping alone, nightmares or physical complaints before separation can occur.
The disorder often begins in childhood, but can also be present in adults or occur for the first time.
An eight-year-old boy regularly complains of abdominal pain and nausea before school in the morning. At the farewell from his mother he cries and fears she might die during his absence. As soon as he is allowed to stay home, the complaints improve.
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Note
In pronounced acute anxiety states, benzodiazepines such as alprazolam may be considered short-term in selected cases. They relieve anxiety and inner tension but carry a risk of dependence.
Propranolol may be considered for situational performance anxiety and primarily alleviates physical symptoms such as racing heart, trembling or palpitations.