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July 1, 2019

How to Treat Different Types of Anxiety Disorders

different-types-of-anxiety-disorders

In today’s post, we will explore the different types of anxiety disorders. We will be periodically adding resources that will help you overcome the various types of anxiety disorders if you struggle with one or many.

If you’ve never had an anxiety attack, count yourself lucky. Those who have, however, know the terrifying and paralyzing feeling. Everything seems to be collapsing around you. You can’t breathe or focus on anything.

In that moment, it seems that everything is wrong and may never be right again.

The truth is, “anxiety attacks” are not an actual clinical diagnosis, yet everyone knows what one is.  People can feel extreme anxiety for a number of reasons.  Read more to find out about the different types of anxiety disorders and how they can be treated.  Any of these conditions can cause people to become overwhelmed by intense anxiety in a way that looks similar; however, understanding how they are different helps one get proper treatment and long term relief.

Different Types of Anxiety

Anxiety is the most common mental illness in the U.S.

Some people with anxiety disorders just seem like a “Nervous Nelly” while others experience debilitating panic attacks.  The symptoms can become more or less intense depending on certain factors, such as environmental stress, medical problems, and ability to develop adequate coping skills.

However, with proper treatment, anxiety can be quite manageable. Let’s explore different types of anxiety disorders:

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (which used to be referred to as “Free Floating Anxiety”) sounds relatively harmless, but it can be quite draining.

People who suffer from GAD are under the constant strain of excessive anxiety and worry. They find it very difficult to control their worry and this worry causes some degree of impairment in their lives. This means that the anxiety and worry affect their level of functioning or ability to enjoy important aspects of their lives.  They also experience physiological symptoms related to their anxiety such as difficulty sleeping, feeling keyed up or on edge, fatigue, muscle tension, irritability, and difficulty concentrating.

There are times when it is perfectly appropriate to be worried about something.  So, how is GAD different from regular, appropriate worry? While it is normal, for example,  for people who drive to recognize the possibility of being in a car accident, those who suffer from GAD may not be able to think of anything else.  The worry thoughts “stick” and grow in intensity rather than diminish.  People with GAD also seem to have many more worries and seem to struggle with their ability to just enjoy the moment, than those with appropriate worry.  In most cases, people with appropriate worry can set it aside and move on to other subjects while those with GAD become consumed with their worry thoughts.

In many cases, people with GAD recognize that their fears and worries are excessive but they find it impossible to control them.  Ultimately, this leads to a reduced quality of life and a constant feeling of stress.

People with GAD can really benefit from learning techniques that help them to relax their bodies or their minds.  Skills such as deep breathing, yoga, progressive muscle relaxation, and mindfulness meditation are important in learning how to calm yourself in the face of intense worry.  Cognitive Behavioral therapy can also help people with GAD identify their distorted thoughts and replace them with more balanced thoughts.  Learning these skills require practice and over time, implementing these skills will become more automatic and effective.

Are you struggling with this type of anxiety disorder? Learn about generalized anxiety disorder treatment.

Panic Disorder

Of all the different types of anxiety, panic disorder causes some of the most dramatic and uncomfortable distress. Panic disorder is diagnosed when a person has “recurrent unexpected panic attacks.”  In the DSM-5, a panic attack is defined as “an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four (or more) of the following symptoms occur:

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feelings of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, light headed, or faint
  9. Chills or heat sensations
  10. Paresthesias (numbness or tingling sensations)
  11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  12. Fear of losing control or “going crazy.”
  13. Fear of dying.”

Panic disorder can present in a variety of ways.  Some people have occasional panic attacks while others can have them on a regular basis.  Often, the attacks can get worse when the individual is under stress.  Once someone has experienced several panic attacks, which is extremely disruptive to your life, he or she will develop a “fear of the fear.”  This means that they become fearful of having another panic attack.  As a result of this concern, they start to do things that they believe “keep them safe” from having future panic attacks.  This usually results in the person avoiding certain places or situations (particularly places where they had a panic attack in the past) and thus creating a situation where it becomes harder and harder for them to leave the house or leave the house without another person. So ultimately, the person’s life becomes controlled by the panic attacks and they are very limited in what they are able to do.

People with panic disorder often wind up in emergency rooms and doctor’s offices because the physical symptoms are so intense and often appear to have a biological cause.  While medical tests may indicate increased heart rate at the time of the event, typically, all medical tests are normal, which will lead medical professionals to conclude that it is likely anxiety causing these experiences.  Because these symptoms are so scary to the person having them, it is not unusual for the person to go repeatedly for medical testing and for the results to be normal each time.

Like other anxiety disorders, panic disorder is treated with cognitive behavioral therapy. CBT addresses panic disorder in a few ways.  It generally starts with education about the disorder in order to help the person understand that the symptoms are associated with anxiety and not a medical problem.  The person with panic disorder must learn to identify and tolerate the physical discomfort associated with the panic.  Cognitive strategies that help the person begin to think in a more rational, calm way and relaxation skills are key to the therapy.  Therapy must also address the avoidance that the person has been engaging in as well.  Over time, the person receiving treatment will be instructed to return to all the activities and places that they began to avoid as a way of managing the panic. While they do these exposure exercises, they will practice the cognitive and relaxations strategies they learned earlier in the therapy.  This is an especially important component of the treatment because it allows the person to live life more fully and stay engaged in his or her relationships, professional responsibilities, and personal needs.

There are a variety of reasons why someone might develop this disorder.  For some people, there is a genetic underpinning of their disorder.  For others, they may be going through a significant life transition or life stressor.  Ultimately, it will be important to understand the things that may be contributing to or maintaining the anxiety as well.

Medication is often used, especially in the early stages of this disorder, to help the person cope.  In the short term, benzodiazepines (tranquilizers), can be helpful to give the individual immediate relief.  This ultimately is not a solution because the person never learns the skills or develops any kind of understanding of what triggers the panic.  If the person finds that he or she just can’t make adequate progress in therapy, it may be advisable to consult with a psychiatrist to see if a medication such as an SSRI might help reduce anxiety on a more general level.

Are you struggling with this type of anxiety disorder? Learn more about panic disorder treatment.

Social Anxiety Disorder

It’s not uncommon to be nervous in large groups of people or when speaking in public. For those without anxiety, you may feel that apprehension and then go ahead with the activity anyway.  For those with social anxiety disorder, this common discomfort becomes extreme, often preventing the development of social relationships and even leading to fear of leaving the house.

For some, they have trouble maintaining jobs, friendships, and romantic relationships because they feel so anxious about speaking and interacting with others. At the core of their fear is the concern that they will be judged negatively by others and ultimately rejected by others.  People with social anxiety fear that they will behave in front of others that shows their anxiety and that it will be embarrassing or humiliating.  Often, after engaging socially, people with social anxiety will spend a lot of time ruminating in an anxious way about how they performed or about something they said.

Cognitive-behavioral therapy is extremely helpful in the treatment of social anxiety disorder.  It typically involves exposure to a variety of social situations where the individual is to use new coping skills.  In many communities, it is possible to find group therapy for social anxiety, which is helpful because the treatment itself involves others and can be quite therapeutic.

Phobias

A phobia is a marked fear or anxiety related related to a specific object or situation.  People with a specific phobia will go to great lengths to avoid that situation and the fear is quite enduring.  People can suffer with phobias for many years and some have even changed their life circumstances in order to avoid the thing they are afraid of.

Incredibly, 75% of Americans fear public speaking, making it the most common phobia.

Phobias cause extreme life-altering habits and behaviors over time as the patient learns to avoid their fears at all costs. A type of psychotherapy called exposure therapy is the most common treatment for phobias. Exposure therapy takes gradual steps toward restructuring the way the patient reacts to their fear. These steps include visualization, looking at pictures or videos of the feared situation, and eventually full exposure to their phobia all while practicing relaxation responses.

Separation Anxiety Disorder

Separation anxiety is something typically associated with children however, it can be diagnosed at any age.  Individuals with separation anxiety have a developmentally inappropriate fear of being alone or separated from major attachment figures (such as a parent, relative, partner, friend or caretaker).Often these people will refuse to go out, go to school, or participate in activities unless that other person is close by.  It is a particularly problematic disorder because it makes it very difficult to these individuals to become fully independent and do things on their own.  In children, it often appears as an unwillingness to play with other children and being “clingy.”  In adults, they appear distressed when not in the presence of these attachment figures and worry about something bad happening when that person is not present.

Psychotherapy is important for individuals with this disorder.  For families with a child with separation anxiety, family therapy can help them understand what may be the root cause of this anxiety and to learn the skills required to help the child feel more comfortable doing things more independently.  It can also be helpful to have the child evaluated to make sure there aren’t other issues, such as learning problems or attachment disorders that are at the core of the separation anxiety.  In adults, psychotherapy may be quite similar to what is done with children.  Ultimately, once a thorough history is taken, the individual will work on skills that allow them to do more things alone.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder, or PTSD, is a mental health condition that is caused by the experience of a horrific, life threatening event that occurred either directly to the person or to someone close to the person. Typical symptoms of PTSD are flashbacks, nightmares, hypervigilance, intrusive memories, dissociative reactions, and severe anxiety (especially in reaction to reminders of the event).

While some people who go through traumatic events can adjust in time through coping and good self-care, others may experience symptoms for months or even years. If these symptoms occur for an extended period of time and interfere with your day-to-day functioning, you may have PTSD.  It is important to remember that PTSD is a whole body disorder.  The fear and anxiety related to the original event is not just remembered in the mind, but throughout the body via the nervous system. So even though the person fully understands that the event is no longer occurring, they continue to experience the after-effects through dysregulation of the nervous system which causes emotional, physical, and cognitive symptoms.

Prior to the DSM-5, PTSD was included in the category of Anxiety Disorders because anxiety was such a prominent feature of the disorder and it shares some characteristics with other anxiety disorders.  Now it is in a separate category called Trauma and Stressor-Related Disorders.  PTSD was included in this blog because trauma so often accompanies other anxiety-related conditions and it is important to acknowledge and treat the role of trauma in people’s suffering.  Having it’s own diagnostic category only underscores the significance of this particular disorder and helps to raise awareness of this devastating condition.

Getting timely help can help support and prevent normal stress reactions from turning into the development of PTSD.  Furthermore, it is important to seek treatment for PTSD from someone who is trained in trauma treatment, which may also include somatically based therapies, in addition to traditional psychotherapy.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder, or OCD, is a common and a life-long disorder.  In order to receive this diagnosis, a person must have both obsessions, which are repetitive and persistent thoughts, images or urges, and compulsions (or rituals) that are also repetitive behaviors or mental acts.  The obsessions are not pleasant or voluntary and the compulsions are a way that the person neutralizes the obsessive thought. The thoughts are experienced as intrusive and unwanted and the compulsions are a behavior that the person feels driven to perform.  These obsessions and compulsions are time consuming and interfere with a person’s normal functioning. Typical themes of OCD are a fear of contamination, fear of a specific danger, placing too much importance on a specific thought, or inflated sense of responsibility.  Common compulsions include, washing, checking, counting, or ordering.

In many cases, the individual recognizes that his or her fear is far in excess of reality and express frustration at their inability to control the thoughts or the behaviors.  OCD is a self-sustaining disorder because every time the person engages in a compulsion, or ritual, they feel better and therefore reinforce the distorted, irrational thought.  So treatment addresses this problem by using Exposure and Response Prevention techniques where the individual must tolerate the distress they feel from the obsessive thoughts without engaging in the compulsion in order to break the cycle.

Like PTSD, OCD now has been separated from the diagnostic category of Anxiety Disorders and put into it’s own category of Obsessive-Compulsive and Related Disorders. This category includes other disorders such as Hoarding Disorder, Body Dysmorphic Disorder, and Trichotillomania (hair pulling disorder). It is worth mentioning OCD in this blog because the treatment for OCD is so similar to that for phobias and other anxiety-related conditions and because individuals with anxiety disorders can also have OCD.

Mental Health Services

Anxiety disorders, along with other mental health disorders, can be devastating to your daily life and prevent you from reaching your goals.  People often try to conceal their struggles, which only makes them harder to cope with.

If you’re ready to reach out for help, contact us and we would love you improve your quality of life!

We Can Help You Overcome These Different Types of Anxiety Disorders

I’m Dr. Amy Boyers, a Clinical Psychologist in Miami who specializes in eating disorder treatment (all types including anorexia treatmentbulimia treatment, and binge eating treatment) and other long term conditions, including anxiety disorders, addictions, bipolar, and OCD. I offer personalized and sophisticated eating disorder treatment services, individual and family psychotherapy, family member support and education, in-home meal support, cognitive behavioral therapyanxiety treatmentdepression treatment, and much more.

Have any questions about the eating disorder recovery process? I’d be happy to answer them. Simply reach out to me and I’ll be sure to answer anything you want to know.

I look forward to helping you obtain a brighter tomorrow.

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