SIX TYPES OF ANXIETY DISORDERS

by Hal Baumchen, PsyD, LP, LADC

Everyone gets anxious, worried, and has occasional fears. Anxiety disorders are different. Anxiety disorders refer to a wide range of difficulties characterized by disabling levels of dread, worry, and anxiety that is not brief or passing. In co- occurring disorders, as anxiety increases, the need to escape the discomfort propels the addict to use alcohol or drugs to reduce the tension and stress and cope with the anxiety. In this lesson we will examine the six main types of anxiety disorders including: Generalized Anxiety Disorder, Panic Disorder, Social anxiety Disorder, Specific phobia, Obsessive Compulsive Disorder, and Post-Traumatic Stress Disorder. This skill builder exercise provides checklists to identify symptoms in each of the six major anxiety categories.

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Content © 2018 Hal Baumchen, PsyD, LP, LADC journeytorecovery.com

SIX TYPES OF ANXIETY DISORDERS

Everyone gets anxious, worried, and has occasional fears. Anxiety disorders are IN THIS different. Anxiety disorders refer to a wide range of difficulties characterized CHAPTER by disabling levels of dread, worry, and anxiety that is not brief or passing. An individual may have more than one type of anxiety disorder. Let's examine the ƒ Define the six six main types of anxiety disorders including: major types of anxiety disorders ƒ Generalized Anxiety Disorder (GAD) ƒ Identify common ƒ Panic Disorder characteristics for each anxiety ƒ Social Anxiety Disorder disorder ƒ Specific Phobia ƒ Explore strategies ƒ Obsessive-Compulsive Disorder (OCD) to manage or get ƒ rid of anxiety Post-Traumatic Stress Disorder (PTSD) Additionally, we will mention some common strategies you can use and behaviors you can practice to avoid or manage anxiety. Some anxiety is considered normal, and even constructive. For instance, someone who is mildly anxious about an interview may take time to prepare for it. In this regard, anxiety plays a useful purpose to inspire and motivate.

The primary traits of all anxiety disorders include subjective feelings of anxiety, stress, worry, fear, emotional distress, negative thinking, muscle tension, sleep disturbance, feeling out of control, avoidance patterns, and interruptions in daily life. Negative thought patterns continue the cycle of distress, followed by attempts to avoid the anxiety-producing situation or circumstance.

Following are the anxiety disorder types and common symptoms for each one.

All content © 2018 Hal Baumchen, PsyD, LP, LADC Six Types of Anxiety Disorders page 1 NOTES GENERALIZED ANXIETY DISORDER The symptoms of generalized anxiety disorder may appear relatively unfocused, low-key, and chronic. There may be no panic attacks or high states of anxiety. Many clients cannot specifically name what causes them to be anxious or tense. In order to fit the criteria for generalized anxiety disorder, symptoms must appear more than half the days, for at least six months. The symptoms may impair the ability to function normally at work or in relationships. Additionally, the client states he or she has difficulty controlling the symptoms.

Although general anxiety disorder may vary in how it is exhibited, common symptoms include:

† Constant worry about an event, † Being indecisive and distressed often out of proportion to its actual when making decisions significance † Feeling irritable † Feeling restless, tense, or on edge † Trouble relaxing or sitting still † Being easily fatigued or worn out † Trembling or shaking † Muscle tension or headaches † Significant muscle tension † Having difficulty staying focused or † Sleep disturbance concentrating PANIC DISORDER Panic disorder is a common anxiety disorder in which the client experiences more than one panic attack and often worries about having more of them. Almost immediately following the first panic attack, there are concerns of “what if I have another one, what if I have one in a crowded movie theater, what if I have one during an interview?” Panic attacks are extremely painful experiences clients try to avoid. Those with panic disorder often meet criteria for a depressive disorder as well. Half of all clients with panic disorder have agoraphobia, which is the fear and avoidance of unknown situations and anxiety-producing circumstances.

Panic symptoms include:

† Heart palpitations or accelerated † Dizziness, feeling faint or heart rate lightheaded † Trembling or shaking † Feeling like things are not real, † Shortness of breath watching life from the outside † Excessive sweating † Avoidance of activities or environments that trigger panic † Sensations of choking symptoms † Chest pain or constriction in † Fear of dying or losing control one’s chest † Recognizing the fear is † Gastrointestinal symptoms, unreasonable including nausea

Six Types of Anxiety Disorders page 2 All content © 2018 Hal Baumchen, PsyD, LP, LADC SOCIAL ANXIETY DISORDER NOTES Social anxiety disorder is best defined as an excessive fear of social situations. It affects between two and thirteen percent of the US population. About one in five patients with social anxiety disorder also suffer from an alcohol or substance use disorder. One common theory suggests alcohol is a means of coping with social fear and anxiety. It is believed by many that alcohol reduces feelings of tension and awkwardness, and lowers inhibitions, thus making it easier to interact in a social setting.

Signs and symptoms of social anxiety disorder can include:

† Frequent fear you will be judged unfavorably in a social situation † Being concerned you will humiliate or embarrass yourself † Fear of rejection or disapproval from those most important to you † Worrying you will hurt someone’s feelings † An undue fear you appear to others as anxious and socially awkward † Experiencing concern that certain physical symptoms such as blushing, sweating, trembling, or having a shaky voice will be noticed by others † Wanting to avoid speaking with others out of fear of embarrassment † Avoiding situations where you might be the center of attention † An intense fear of interacting with strangers † Anxiety in anticipation of a feared activity or event † After a social situation, constantly analyzing and thinking through your performance to identify flaws in your interactions † Expecting the worst possible consequences from a real, or perceived, negative social interaction

People with social anxiety disorder are often afraid of several situations rather than just one specific thing. Most people with a social anxiety disorder are cautious, worried, easily intimidated, and insecure in a variety of situations. A specific fear or worry often becomes generalized to a wide variety of normally insignificant situations. As it grows, social anxiety can interrupt the normal ease and peace of everyday life.

Common, everyday experiences that provoke social anxiety may include:

† Speaking in public † Dating, including asking for the † Eating or drinking in front of others date, making phone calls, initiating intimacy † Writing or working in front of others † Making small talk † Reading aloud † Returning purchases to a store † Being the center of attention † Expressing your opinion † Interacting with people † Talking in front of authority figures † Giving reports in a group such as police, attorneys, bosses, † Expressing disagreement with teachers someone’s opinion † Using public toilets † Making eye contact † Taking exams

All content © 2018 Hal Baumchen, PsyD, LP, LADC Six Types of Anxiety Disorders page 3 NOTES † Asking questions in a group † Going to a party—especially if you † Entering a room where people have do not know everyone already gathered or are seated † Interacting with strangers † Talking on the telephone † Initiating conversations † Taking part in a performance such as † Going to work or school a play, athletic event, or concert

SPECIFIC PHOBIA A specific phobia is an unreasonable fear associated with a specific object or experience. Clients with phobias have unwarranted fear; facing a feared object will immediately make him or her feel tense, nervous, and panicky. This condition is known as anticipatory anxiety as the client looks ahead and is made increasingly more anxious. A phobia is more difficult to live with when it actually interrupts or interferes with your life.

Common specific phobias include fear of:

† Flying † Spiders † Elevators † Heights † Rodents † Closed spaces † Snakes † Travel † Thunderstorms † Dogs † Crowds † Earthquakes † Insects † Blood

Diagnostic symptoms of specific phobias include:

† An unreasonable, excessive, strong, and persistent fear † Fear triggered by a specific object or situation that is present or anticipated † The fear-object almost always provokes an immediate anxiety response † The patient acknowledges the fear is unrealistic or unreasonable † The phobia interferes with usual routines, job, relationships, and personal functioning † The person avoids the phobic stimulus or the environment where it may occur † If the person is exposed to the object, they may endure the anxiety with great distress

OBSESSIVE-COMPULSIVE DISORDER Obsessive-compulsive disorder (OCD) is comprised of two major components, obsessions and compulsions. It is a psychological disorder and causes recurrent and persistent thoughts or images, leading to significant distress. Obsessions are thoughts or other impulses pushing in and causing anxiety and distress. These obsessions go beyond normal life worries and become unrealistic and exaggerated. There is some recognition on the client's part the recurrent thoughts are irrational and inaccurate. People with this disorder use behavioral responses to reduce anxiety.

Six Types of Anxiety Disorders page 4 All content © 2018 Hal Baumchen, PsyD, LP, LADC Compulsions are the repetitive behaviors engaged in as an attempt to reduce the NOTES obsessive thought and rumination. Those with OCD deal with interfering thoughts and images, and often fight obsessions with rigid and repetitive behaviors, following strict, self-imposed rules.

Symptoms of OCD include:

† Recurring and persistent thoughts or images that intrude into a person’s awareness, causing anxiety † Obsessions that go beyond extreme worry about ordinary problems † Trying to suppress, ignore, or disregard the obsessive thoughts † Feeling the need to repeat physical behaviors such as checking, cleaning, repeating words, counting things, or organizing things † The behavioral responses to an obsession reduce anxiety or follow certain strictly applied rules † There is some recognition the obsessive thoughts are a product of his or her own mind † The compulsion serves to reduce anxiety. If anxiety does not go down when the behavior is conducted, it may lead to a repetition of the same behavior. † The compulsions interfere with personal and occupational functioning or a usual routine † Obsessions commonly take up more than one hour per day † The obsessive thoughts and compulsive behaviors are distressing for the individual

The most common obsessive thoughts and obsessive actions experienced are:

† Disturbing thoughts of germ contamination † Extreme levels of guilt or regret † Fear of immoral thoughts † Need to be repeatedly reassured † Fear of harming someone † Fear of spreading disease † Repeated cleaning of hands † Checking locks, home appliances, and doors in order to make sure they are safe † Reordering and rearranging things in order to make them right or safe † Counting certain numbers repeatedly or grouping by a particular number † Compulsively hoarding or saving unneeded household items, such as newspapers

OCD can be debilitating, but change is possible. Excessive concern about doing something wrong, being sick, hurting others, looking just right, saving things, preventing misfortune, and being clean, orderly, or germ-free are common sources of

All content © 2018 Hal Baumchen, PsyD, LP, LADC Six Types of Anxiety Disorders page 5 NOTES obsessions and compulsions. Distinguishing constructive thoughts from unfounded worries and obsessions is an important first step. Help is available. Relabeling concerns and tiresome habits as obsessions and compulsions reduces their power and sets the stage for change. POST-TRAUMATIC STRESS DISORDER Post-traumatic stress disorder (PTSD) is a condition that often follows a severe, traumatic event such as a natural disaster, surviving combat, rape, childhood neglect, abduction, airplane crash, hostage situation, car accident, assault, sudden death of a loved one, physical or sexual abuse, or kidnapping. The threat of these catastrophes or traumas is often enough to cause symptoms. This chronic anxiety disorder causes the person to re-live the traumatic situation through unpleasant or distressing thoughts, nightmares, and flashbacks. The person may act or feel as if the event is actually occurring or may have intense psychological or physiological reactions to cues of the event. Symptoms include feeling emotionally numb, a loss of interest in usual activities, increased or exaggerated startle response, sleep disturbance, hyper- vigilance, and irritable, angry outbursts. These symptoms weaken general well-being and damage relationships.

There are symptoms of physiological hyper-arousal, as well as symptoms causing the client to feel numb or "dead" inside. Symptoms do not usually occur immediately following the trauma, and there is often a delay of days or weeks. In general, the more enduring and long-lasting the trauma, the greater likelihood of developing symptoms. PTSD symptoms are thought to occur in one-fourth of heavy combat survivors and about two-thirds of former prisoners of war. Older adults are less likely to develop symptoms than younger individuals. Some clients recover within a few months and report few or no symptoms. For a diagnosis to be made, symptoms must persist for more than one month. Some clients suffer years of frequent symptoms and functional impairment.

Symptoms of PTSD include:

† Exposure to a traumatic event involving actual, or threatened, death or serious physical injury to self or others † Symptoms are persistent, recurrent, upsetting, and distressing † Intense emotional responses including fear, horror, and helplessness † Disturbing nightmares or memories associated with the traumatic event † Recurring flashbacks, distressing or disturbing thoughts of the event, or illusions of the event as if it is reoccurring † Extreme distress in response to internal or external cues that resemble some part of the trauma † Physiological responses such as a rapid heartbeat and elevated blood pressure † Avoidance of activity, places, or people that are reminders of the traumatic experience † Inability to remember important aspects of the trauma † Decreased interest or participation in usual activities

Six Types of Anxiety Disorders page 6 All content © 2018 Hal Baumchen, PsyD, LP, LADC † Feeling detached or isolated from others NOTES † Avoidance of trauma-related stimuli including thoughts, feelings, or conversations about the event † Inability to experience emotions such as joy, peace, happiness, fulfillment, and love † Pessimistic, fatalistic regard for the future † Insomnia, restlessness, or early morning awakening † Irritability and angry outbursts † Poor concentration † Hyper-vigilance † Exaggerated startle response † Feeling sad, guilty, or depressed † Increased alcohol or drug use and abuse † Suicidal thoughts † Increased interpersonal conflict, especially in intimate relationships † Verbally or physically violent or threaten violence

COGNITIVE BEHAVIORAL THERAPY In cognitive behavioral therapy (CBT), a therapist helps examine and change the way you think and feel about anxiety and the causes of it. CBT also helps develop skills to change the way you respond to your fears and anxieties as they arise. Behavioral therapy helps replace anxious responses with more positive behaviors, using techniques such as deep breathing, for healthier outcomes. TREATING ANXIETY DISORDERS Anxiety disorders can be complicated, but there are effective treatment options. The right treatment plan will depend on many factors, including which anxiety disorder a client has, how they respond to medication and therapy, how much stress they are under, and personal history. By working together with a healthcare professional, you can create a treatment plan foundational for your recovery journey.

Anxiety disorders can be complicated, but there are EFFECTIVE TREATMENT OPTIONS.

All content © 2018 Hal Baumchen, PsyD, LP, LADC Six Types of Anxiety Disorders page 7 NOTES

Six Types of Anxiety Disorders page 8 All content © 2018 Hal Baumchen, PsyD, LP, LADC