Anxiety disorders

Making sense of anxiety

It’s natural to worry during the stressful times we all experience from time to time in life. Someone with an anxiety or related disorder, however, feels persistently anxious in a way which is excessive and out of keeping with the situation they are in.

Understanding how anxiety disorders ‘work’ then, is an important first step in taking control of symptoms and getting better.

What causes Anxiety disorders?

Anxiety disorders are thought to be caused by a combination of factors. Most anxious people are probably born with a genetic vulnerability to develop an anxiety disorder. Personality traits and responses to stressful life events may trigger the condition or make it worse.

Common stressful life events include:

• being in an unpredictable new situation such as a change of school or workplace, or travelling overseas.
• break-up of a relationship.
• experiencing the death of somebody close.
• financial or work problems.
• experiences during early childhood.
• excessive drug or alcohol use.
• physical health problems.

What do people experience if they have Anxiety disorder?

When someone has an anxiety disorder, the worry and discomfort they experience is persistent (lasting six months or longer). It can express itself physically as well as psychologically, and also affect behaviour.

These changes in how someone feels, thinks, and acts can then start to interfere with their ability to live a normal life, to work, and to relate to other people.

Psychological symptoms of Anxiety disorder

Anxiety disorders vary and affect people in different ways and to different degrees, but common psychological symptoms include:

• excessive feelings of dread and worry about what might happen in the future.
• persistent worry and endlessly thinking about events in the past.
• obsessive thoughts which are difficult to stop.
• feelings of panic and fear in situations where there is no actual danger.

Physical symptoms of Anxiety disorder

Anxious thoughts and feelings can lead to physical responses too, as the body reacts to the ‘false alarm’ of anxiety. It goes into ‘flight or fight’ mode, as though you were in real danger and had to act fast:

• breathing faster
• muscle tension – for example, aching back, shoulders, or jaw
• trembling and sweating
• chronic headaches
• stomach problems or nausea
• teeth-grinding
• feeling frequently weary, even after sleep
• restlessness and difficulty relaxing and sleeping.

These physical symptoms can sometimes occur without awareness that they are associated with anxiety.

How Anxiety disorders can affect people’s lives

It’s understandable that people will change their behaviour to try to avoid distressing symptoms of Anxiety disorders. This can then start to have an impact on their lives.

Someone with a Social anxiety disorder, for example, will avoid situations where other people are present. This can lead to them having no social life, experiencing great loneliness, and even stopping them from working.

Anxiety disorders are often accompanied by depression, so that both will need to be treated – see Depression).

People who experience psychotic symptoms such as delusions and hallucinations – such as those with schizophrenia, for example – may also experience symptoms of an anxiety disorder – see Bipolar disorder and Schizophrenia.

What are the different types of Anxiety disorders?

Each person’s experience of an Anxiety disorder can be very individual, but common forms include:

Generalised anxiety disorder (GAD)

GAD is characterised by persistent worry that the person realises is excessive or unrealistic. It can be about almost anything – money, work, health, relationships or being harmed.

People affected by GAD often worry and ruminate over everyday events in their life, until these assume a significance out of proportion to reality.

Constantly reacting to fearful thoughts and feelings, they may often feel irritable, nervy, and haunted by a sense of unease and dread. Sleeping problems are also common.

People may drink alcohol excessively in order to ‘take the edge’ off this sense of general anxiety.

Phobias

Phobias are intense, irrational fears about specific objects or situations – for example, a fear of heights, storms, dogs, enclosed spaces, snakes or spiders where the danger is greatly overestimated.

Many people affected try to cope by avoiding the feared objects or situations. They may not recognise that they have an anxiety disorder. These fears can interfere with a person’s life, and can occur when someone has another form of anxiety disorder too.

Panic disorder

Panic disorder involves frequent sudden attacks of intense fear (panic attacks). These may occur when a person feels ‘trapped’. They may even feel as if they are about to die.

When someone experiences panic they may feel breathless, dizzy, choking, or faint. They may feel their heart pounding. It is common for people to believe that these symptoms are caused by a serious physical condition such as a heart attack or stroke.

Because these physical symptoms are distressing and frightening, the person experiencing them becomes even more anxious and fearful of ‘triggering’ them. They may start to avoid situations associated with feelings of panic, or in which they feel they could not escape or get help – such as on public transport, in crowded places, or being completely alone.

Social anxiety disorder

Social anxiety disorder involves intense anxiety associated with social situations, such that the person’s ability to live a normal life is affected. There is an intense fear of embarrassing oneself in public or being scrutinised by others.

This anxiety can lead to physical symptoms such as blushing, sweating, shaking and heart pounding, which in themselves can cause embarrassment.

Social anxiety disorder may initially occur in only certain situations (such as public speaking or large gatherings), but it can spread to involve any type of social interaction.

Those affected often react by becoming withdrawn or avoiding social situations, or by drinking alcohol excessively when attending them, which can lead to further problems.

Anxiety disorders are closely related to three other types of disorders

Anxiety disorders are closely related to Obsessive compulsive and related disorder (OCD), Hoarding disorder and Trauma and stress-related disorders. It is not uncommon for people with these conditions to experience symptoms of anxiety.

Obsessive compulsive disorder (OCD)

OCD is characterised by intrusive thoughts about unpleasant things that might happen. OCD is highly distressing for the person experiencing it and for those who care about them.

Common concerns include fear of contamination from germs, intrusive sexual thoughts, fears about leaving doors unlocked or appliances turned on, and fears of violence or causing harm to others.

The person may feel compelled to ritually check, clean, or count. They may avoid situations where their fears might be triggered or where they don’t feel they can trust themselves.

Hoarding disorder

Hoarding disorder is characterised by a persistent difficulty discarding or parting with possessions due to a perceived need to save the item, regardless of its actual value. The person may experience significant distress and anxiety if and when they try to discard the items that they have collected.

Trauma and stress-related disorders

Trauma and stress related disorders follow a traumatic event which causes intense fear or feelings of helplessness. Witnessing a traumatic event directly or indirectly can also lead to this condition.

The symptoms typically develop shortly after the event, although it may take years before they develop. Symptoms include re-experiencing the trauma through nightmares, rumination, and flashbacks.

People affected may avoid situations, people, and objects which remind them of the traumatic event. For example, after a serious car accident, someone might avoid driving or being a passenger in a car.

There is also increased anxiety in general and the person may become very jumpy and startled easily. Some people find themselves less emotionally responsive to others, describing themselves as feeling emotionally ‘numb’.

Anxiety disorders are treatable

Treatment for an anxiety disorder doesn’t just deal with immediate symptoms. It also helps tackle the triggers for symptoms and other contributing factors. You learn to control the anxiety so its effect on your life is reduced or even eliminated.

With treatment you will feel better mentally, emotionally, and physically.

General practitioner

A General Practitioner (GP) is the best person to see if you are concerned you may have an Anxiety disorder.

Ask for a longer appointment so there is time to discuss your concerns. It helps to take along a few written notes too. The GP can check first for any possible physical cause of the symptoms, such as thyroid disease or low glucose, for example.

If the GP diagnoses an anxiety or related disorder, a mental health plan can be prescribed, usually involving a course of psychological treatment. This may be provided by the GP or through a referral to another suitably-qualified health professional.

Psychiatrists

Psychiatrists are medically-qualified doctors who specialise in the study and treatment of mental illnesses, including Anxiety disorders.

For further information, please see the ‘Psychological treatments’ section in the Guide to Medication and other Treatments.

Psychologists and other clinicians

Clinical and counselling psychologists specialise in the treatment of mental illnesses, including Anxiety disorders. They can provide psychological treatments, which are usually the most effective treatments for Anxiety disorders.

For further information, please see the ‘Psychological treatments’ section in the Guide to Medication and other Treatments.

What are psychological treatments?

Psychological treatments play a vital role in the treatment of people with Anxiety disorders. This type of treatment helps by giving an opportunity to talk about thoughts and feelings with a psychiatrist, psychologist or other suitably-qualified health professional in a structured way.

There is a range of psychological treatments for Anxiety disorders, of which cognitive behavioural therapy is one of the most effective for managing symptoms. Other forms of psychotherapy may also be of value in dealing with related issues.

Cognitive behavioural therapy (CBT)

CBT helps people recognise how their thoughts, feelings and behaviour can get stuck in unhelpful patterns. It supports people in trying new ways of thinking and behaving.

The steps are:

1.The first step is to agree on the goals of the treatment. Therapy then begins with an explanation of how anxiety can cause the symptoms, and what strategies can be used to manage them.

2.The person will then be taught some techniques to help control the symptoms, and asked to practise these at home.

3.The next step is learning not to fear the symptoms of anxiety. The therapist and the person affected work together to decide on tasks that the person can try outside, as well as within, the sessions, to confront and overcome their fears and anxieties.

It is usual to take a step-by-step approach rather than ask someone to confront these concerns all at once.

A course of CBT usually consists of 10-15 weekly sessions that last for up to one hour each.

For further information, please see the ‘Psychological treatments’ section in the Guide to Medication and other Treatments.

Online resources

There is a range of online resources to help people manage the symptoms of anxiety. See the Australian government’s mindhealthconnect website for an up-to-date list of reputable and helpful websites - www.mindhealthconnect.org.au

What about medication?

While psychotherapy is the most effective treatment for managing the symptoms of Anxiety disorders, medication may also helpful for some people where symptoms are severe or persistent or where there is a co-existing condition such as depression.

Medication may also help temporarily to reduce anxiety when beginning a course of psychotherapy, to make it easier to get started.

Antidepressants

There are many different types of antidepressant medication available. Choosing the best one is not always straightforward because the way individuals respond to them is different.

Discuss with your doctor whether medication would be helpful for you – considering your particular symptoms of anxiety, any other conditions and symptoms you have (including physical illnesses), and how this would complement any psychotherapy you might be receiving.

Be sure to tell the doctor if you are pregnant or planning a pregnancy, and also about any herbal or other complementary remedies you are taking, as these may interact with the medication prescribed.

It can take a few weeks after the first dose of medication before it has a positive effect. For some people it can take longer – a few months – before they start to feel better. It can be six months before the maximum benefit is felt.

Antidepressants are not addictive and do not act as ‘uppers’. Newer antidepressants are generally not fatal in overdose.

For further information, please see the ‘Medication’ section of the Guide to Medication and other Treatments

The possible side-effects of antidepressants

As with any other medications, antidepressants may have side-effects. These will often settle down after a few weeks, when your body has adapted to the medication, while others may persist.

Possible side-effects include:

• diarrhoea or constipation
• nausea
• headaches
• sleep disturbance
• lower sexual responsiveness
• dizziness or blurred vision
• weight gain
• dry mouth
• sweating.

Let your doctor know as soon as possible if you experience and are concerned about any of these side-effects.

The doctor can provide reassurance and change the dosage if necessary. The medication can also be changed to one which is more effective for you, or has fewer side-effects. Because our bodies’ reactions are so individual, this is common, normal part of the treatment process.

It’s a good idea to tell family or friends about the medication, its benefits, and any side-effects, too, so that they can support you.

Anti-anxiety (anxiolytic) and sedative medications

These medications are sometimes prescribed as a short-term treatment for symptoms of anxiety disorders when symptoms are severe.

They may be prescribed in addition to an antidepressant, while waiting for it to take effect. These can provide immediate and short-term relief of the symptoms of anxiety or insomnia, but don’t treat the underlying condition that causes the Anxiety disorder.

Long-term use is generally not recommended as they also cause drowsiness, can be addictive, and symptoms usually return once someone stops taking them.

For further information, please see the Guide to Medication and other Treatments.

Reducing anxiety in your life

There are lots of things you can do for yourself to help reduce feelings of stress and anxiety.

The experience of having an Anxiety disorder varies from person to person. While managing symptoms can often be difficult, and this should not be underestimated, discuss with your treating health professional what you can do to help yourself.

Understanding is power

The more we understand about Anxiety disorders, the better prepared we are to start dealing with them. Understanding the symptoms, causes, and symptoms of anxiety can help us to tackle it better.

Learning to tolerate uncertainly

Many anxious people feel a strong need to ‘know for sure’ about situations or about the future. This often just isn’t possible.

Do what you can to accept that things often are uncertain, and to ‘wait and see’.

Mutual support

Many people affected by Anxiety disorders find it helpful to meet and talk with others who have had similar experiences.

Discussing symptoms and tips for dealing with them in a relaxed, understanding environment such as this can be a great support in recovery from anxiety. Contact 1800 18 SANE (7263) or the SANE Online Helpline for details of a group in your area, or find on online community at www.mindhealthconnect.org.au.

Everything is not an emergency

As someone starts to feel extremely anxious they often experience a similar pattern of warning signs – symptoms such as feeling on edge or becoming short of breath. Emotions and physical responses react as though there were real danger – but this is the big lie of anxiety disorders, for ‘everything is not an emergency’.

Learn to recognise the warning signs

Learn to recognise the warning signs, so you can re-assess your situation and try to nip the anxiety in the bud.

Think about what happens when you start to feel anxious. If you often feel like you are going to have a panic attack on public transport, for example, make a list of how you feel and what happens to your body when this happens.

Alongside this, make a list of how you could manage these symptoms – such as slow breathing or thinking about something very positive, for example.

Build on what you know helps

You probably already have some healthy ways of helping yourself feel less anxious. Recognise and build on these.

For example, every time you find yourself slipping into a spiral of worry over a past event or something that might happen in the future, tell yourself to stop and focus on the here-and-now, on enjoying being immersed in the present moment.

Some people find it helpful to have a mantra (a helpful, inspiring phrase) or powerful mental image to help them do this: for example, imagining their life as a vast sphere and the worry as a tiny speck beside it.

Break problems down to tackle them

When you feel anxious it can seem like there’s no way out from problems that trouble you. Try to take a fresh approach which helps you look at the problem from a different angle, so that stress and worry can be reduced.

If something is troubling you, try not to dwell on it but write it down in black-and-white, then put down all the different ways you could tackle it. Consider which is the most realistic and useful, and what practical steps you could take to carry it out. Discuss these with your health professional.

Slow breathing

It’s likely your GP, psychologist or other treating professional will talk to you about breathing slowly as a way of dealing with anxiety. This can be a surprisingly simple and effective way of helping your body relax and switch off the tense ‘flight or fight’ emergency response which anxiety triggers.

Take a slow breath in for six seconds, hold it briefly, then breathe out slowly. Don’t rush the breaths, and repeat for a minute or so.

Being physically healthy is good for our mental health

Our physical and mental health interact continually. Getting enough sleep, eating healthy meals, and avoiding recreational drugs and excessive alcohol not only does your body good, but will make you feel good too.

Too much caffeine can contribute to feeling anxious, so try reducing or even giving up coffee or other drinks which contain caffeine.

Physical exercise is also a proven way of improving mood, probably because of healthy changes this brings about in the body and brain. This doesn’t have to mean going to a gym, but can be something as simple as riding a bicycle to work or taking a brisk walk for half-an-hour or more a few times a week.

For further information, please see the Guide to Healthy Living.

Make time to relax

Make time every week to do things you enjoy and which relax you. Going for a walk, having a massage, listening to music or simply immersing yourself in reading or watching a movie can help calm you and reduce anxiety.

People affected by Anxiety disorders are often hyper-alert a lot of the time, so it’s good to deliberately tell yourself that your mind and body are ‘off duty’ and have a right to relax.

Don’t be too hard on yourself

Try to develop a habit of being flexible rather than over-demanding on yourself or others. Don’t try too hard to be perfect in everything you do.

Remember that you’ll never be able to control everything that happens around you, or what other people do and think, so why not accept this and concentrate on enjoying just being yourself.

If a family member or friend is affected by an anxiety disorder, talk to your GP or other health professional about where you can find out more about anxiety disorders, and about support for yourself as well as the person affected.

Family and friends can make a big difference to the lives of people affected by anxiety, but you have to make sure you look after your own mental health as well.

Draw on the support you need

Don’t forget that being a good support person means getting support for yourself too.

This may mean mutual carer support online or by attending a group of others who are in the same situation; education and training in looking after yourself as well as the person with the Anxiety disorder, and finding respite care too so you can take a break.

Accept that change has occurred

When someone you care about becomes unwell, it is not only their situation that changes – it affects you too.

Try not to pretend to yourself or others that things haven’t changed. Express your feelings and find out more about how you can adapt to helping the person affected.

Break tasks into small steps

Sometimes getting better can feel overwhelming to the person affected. Encourage them to break things into manageable steps, so that gradual progress can be made.

For example, if you are encouraging someone to get out of the house regularly, you could offer to go with them on walks. You might start with walking around the block slowly together at a quiet time of day, and then work on varying the time and going for longer distances.

Develop realistic expectations

Reducing symptoms of Anxiety disorders can often be a long-term project.

It is important to accept the person as they are now, and to have sensible expectations of what can be achieved and how long it may take.

Learning more about the disorder and about treatments helps to develop realistic expectations about this process.

For further information

• SANE Guide for families
• For details of carer support groups in your area, contact our Helpline on 1800 18 SANE (7263) or email This email address is being protected from spambots. You need JavaScript enabled to view it..
• SANE Forum for Carers - join in discussions concerning looking after others, and ourselves as well