Anxiety disorders are a frequent mental illness which is expressed in various forms (generalized anxiety, phobias, panic disorder, etc.) and greatly disrupts daily life. Numerous psychological, biological and environmental factors can favor their occurrence. There are also several classifications of these disorders, differing slightly between countries.

In the United States, about 40 millions adults suffer from anxiety disorders, making them the most common mental illness in the country according to the Anxiety and Depression Association of America. Generalized anxiety disorder affects 2-6% of adults (slightly more women than men).

While the occasional anxiety is normal, people with anxiety disorders struggle with excessive, persistent anxiety that seriously affects their quality of life. The diagnosis is made if the fear is disproportionate (in duration, intensity or frequency) compared to the real situation, and if the symptoms persist for more than 6 months.

Anxiety is a real mental health disorder that requires adequate medical and psychological management.

The different types of anxiety disorders

Anxiety disorders manifest themselves in a very variable way, ranging from panic attacks to a very specific phobia, including generalized and almost constant anxiety, which is not justified by any particular event.

In France, the Haute Autorité de Santé (HAS) lists six clinical entities2 (European classification CIM-10) among anxiety disorders:

• generalized anxiety disorder
• panic disorder with or without agoraphobia,
• social anxiety disorder,
• specific phobia (e.g. phobia of heights or spiders),
• obsessive-compulsive disorder
• post-traumatic stress disorder.

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, published in 2014, widely used in North America, proposes to categorize the various anxiety disorders as follows:

• anxiety disorders,
• obsessive-compulsive disorder and other related disorders
• disorders associated with stress and trauma

Each of these categories includes about ten “sub-groups”. Thus, among the “anxiety disorders”, we find, among others: agoraphobia, generalized anxiety disorder, selective mutism, social phobia, anxiety induced by medication or drugs, phobias, etc.

Symptoms of anxiety

Symptoms vary from person to person, and usually include several of these signs:

• feeling of fear of worry, panic or discomfort
• heart palpitations
• sweating (sweaty hands, hot flashes, etc.)
• tremors
• shortness of breath, dry mouth
• feeling of suffocation
• chest pain
• nausea
• dizziness or lightheadedness
• tingling or numbness in the limbs
• sleeping troubles
• various other physical symptoms

Panic disorder is characterized by unpredictable and recurring panic attacks, in which the person has difficulty breathing, experiences intense, uncontrollable fear, and other symptoms such as nausea or palpitations.

Generalized anxiety is, as the term suggests, a general, constant feeling of anxiety that is difficult to control.

Social phobia, on the other hand, results in excessive fear in the face of various social situations, which could be embarrassing, humiliating, or which are associated with the notion of performance.

Specific phobias can be associated with a wide variety of situations or objects / animals. They cause a totally irrational fear, for example of spiders, elevators, public transport …

Obsessive-Compulsive Disorder (OCD) is a manifestation of anxiety and results in obsessive, overwhelming ideas, and compulsive behaviors (e.g. obsession with cleanliness, the need to constantly check whether something is right or wrong, etc.).

Compulsive accumulation disorder (Hoarding Disorder) is now recognized as part of anxiety disorders: it results in the overwhelming need to accumulate objects (brochures, objects found in the street, etc.).

Post-traumatic stress disorder is a deep discomfort, a fear that arises following a traumatic event, sometimes a few months later.

In general, specific phobias appear early, in childhood or adolescence, while generalized anxiety, panic disorders or post-traumatic stress disorder appear on average later, between the ages of 24 and 50.

It is important to note that anxiety disorders vary in severity. Some people who suffer from it are unable to lead a normal life (for example leaving their homes, driving, taking public transportation, etc.), others live with more occasional, but unpredictable, crises. Certain events can worsen the symptoms and make certain anxieties reappear. It should also be noted that many people with anxiety disorders are not diagnosed and therefore do not benefit from medical monitoring.

In all cases, medical care and psychological evaluation will be useful in improving the quality of life.

Causes and risk factors

Above all, it is useful to remember that anxiety is a normal emotion, which appears when you feel threatened or in danger. It becomes harmful and problematic when it manifests itself in excess of the actual threat or persists for a long time, thereby interfering with a person’s daily activities and functioning.

The causes of anxiety disorders are not fully understood. They involve genetic, physiological and environmental factors.

Thus, we know that a person is at greater risk of developing anxiety disorders if someone in their family has it. Being female is also recognized as a risk factor for anxiety disorder.

Having lived through stressful or traumatic events, especially in childhood, or the presence of another psychiatric disorder (bipolar disorder, for example) can also promote anxiety disorders.

The onset of an anxiety disorder is linked, among other things, to physiological disturbances in the brain, in particular in certain neurotransmitters, these substances which serve as messengers for nerve impulses from one neuron to the next. More specifically, GABA (the main inhibitor of all overreactions of neurons), noradrenaline and serotonin are involved. Drug treatments for anxiety disorders act precisely on the regulation of these neurotransmitters. Cortisol (the stress hormone) also plays a role.

Prevention of anxiety

There is no real rational explanation for the occurrence of anxiety disorders. It is therefore difficult to know who is at risk of suffering from it.

On the other hand, certain stressful and traumatic events can favor the onset of anxiety disorders. It is therefore recommended that you do not delay in obtaining psychological help after such an event, especially in children.

Finally, good lifestyle habits are essential in trying to limit anxiety:

• have a regular sleep pattern and long enough nights
• practice regular physical activity
• avoiding the use of stimulants, cannabis, alcohol and other drugs
• Surround yourself with supportive people and do accept the support in case of too much anxiety.

Treatment of anxiety disorders

The treatment of anxiety disorders is based on drug and/or psychological interventions. In all cases, medical care is necessary to put in place an adequate therapy, adapted to the patient’s needs, his symptoms and his family and social situation.

• Psychological care

Psychological support is necessary in the event of anxiety disorders. It may even constitute the only treatment, or be associated with pharmacological treatment, depending on the severity of the disorders and the expectations of the person affected.

Cognitive behavioral therapy is the therapy that has been the most studied in the treatment of anxiety disorders, particularly for social phobia, panic disorder and obsessive-compulsive disorder. By focusing on the factors that cause and maintain anxiety and by giving the patient tools for control, this type of therapy is generally effective in a sustainable way (12 to 25 sessions of 45 minutes in general). According to some studies, structured cognitive and behavioral therapies are even as effective as drug treatments.

Other types of therapy, such as mindfulness therapy, have also been shown to be effective in clinical studies. The goal is to pay attention and focus on the present moment, and thus learn to control your anxiety.

Analytical psychotherapy can be initiated to understand the origins of anxiety, but its effectiveness on symptoms is slower and less recognized.

• Drug treatment

If the symptoms are too intense and psychotherapy is not enough to control them (for example, in generalized anxiety), drug treatment may be necessary.

Several drugs are recognized for their effectiveness against anxiety, in particular anxiolytics (benzodiazepines, buspirone, pregabalin) which act quickly, and certain antidepressants which constitute the basic treatment, namely the selective serotonin reuptake inhibitors (SSRIs) and serotonin and the serotonin–norepinephrine reuptake inhibitors (SNRIs).

These medicines can make anxiety worse when starting treatment and close medical supervision is therefore necessary.

Because of the risk of dependence, benzodiazepines should be prescribed on a temporary basis (ideally no more than 2 to 3 weeks). Both initiation and discontinuation of treatment should be supervised by the doctor.

As pregabalin does not induce a risk of dependence and its effectiveness is immediate, it is sometimes preferred to benzodiazepines.

In conclusion

Anxiety disorders come with various warning signs. The doctor who meets the person will take into account the history, the date of onset of the symptoms, their intensity, frequency and existing associated disorders such as headache, neurovegetative signs, the presence of a depressive state (depression), etc. The person will also discuss the impact of anxiety disorders on their family, social and professional life.

If you suffer from anxiety disorders and the symptoms take up too much space in your life, you should get psychological care. It will allow you to reduce your symptoms and improve your psychological and social functioning. The psychologist will help you find a more peaceful life.