Anxiety Disorders • Causes, Symptoms & Therapy

Fear is a natural reaction of the body and mind to dangerous situations. But what is an anxiety disorder, how is it recognized and treated?

Anxiety disorders severely limit the quality of life of those affected, but they can be treated well.

Fear is part of life and is inevitable and necessary because it also protects us. Fear becomes a disease when it is inappropriately strong, occurs too often and for too long, is associated with loss of control or compulsive acts, causes severe psychological stress, and leads to avoidance of the triggers.

Up to 20 percent of people have an anxiety disorder. This makes it the most common mental illness in women, ahead of depression. In men, it comes second only after alcohol disease. The most common anxiety disorders are:

  • generalized anxiety disorder / generalized anxiety disorder (GAE)
  • Panic disorder
  • social phobia (fear of people)
  • specific phobia (fear of spiders, tight spaces, fear of flying and similar fears)

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What is an anxiety disorder?

A long-standing anxiety disorder causes people to withdraw and avoid situations that frighten them. Withdrawal from social and public life often leads to isolation, which can lead to depression, which is why an anxiety disorder should definitely be treated. In generalized anxiety disorder, the fear is non-specific about any situation that might arise. Physical and psychological symptoms of anxiety, such as racing heart or sweating, actually occur.

What are the causes behind an anxiety disorder?

The causes are still largely unexplained. It is clear, however, that there are physical and psychological causes of anxiety disorders on the one hand. In addition, certain medications, such as those often given in Parkinson's disease, as well as alcohol and drug abuse can lead to delusions and anxiety disorders, as these substances influence the brain metabolism.

The physical causes include:

  • Life-threatening diagnoses and diseases: Cancer, cardiovascular diseases or asthma can trigger a strong fear that leads to an anxiety disorder.
  • Neurological diseases such as multiple sclerosis, Parkinson's disease
  • Thyroid diseases with severe overactive function (hyperthyroidism)
  • Mental causes

Today we know that anxiety disorders, like many mental illnesses, have a similar explanatory model: biological, biographical and psychosocial factors come into play to different degrees at different points in life. Only in their interaction does the psyche become susceptible to stress and anxiety disorders can arise.

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Generalized anxiety disorder cannot be traced back to a single, clear cause. Various factors work together. However, little is known about the history of the development of the disease, as it is neither tied to regular triggers (as in the case of specific phobias), nor is it characterized by dominant panic attacks (as in panic disorder). The following factors seem to play a role:

  • Hereditary / genetic factors: Anxiety disorders occur more often in families; it is assumed that certain genes interact
  • Neurobiological factors: in the case of anxiety disorders, the neurotransmitters serotonin, noradrenaline or gamma-aminobutyric acid (GABA) are not in balance; In addition, areas of the brain that are responsible for feelings are changed in those affected
  • Traumatic experiences in childhood (physical or psychological violence, sexual abuse) or later, but also long-lasting and stressful burdens and stressful life situations

Symptoms and forms of an anxiety disorder

The symptoms of the different anxiety disorders are very similar. The symptom of fear is not pathological at first, because fear is part of every person's emotional world. Only when it exceeds a certain level and restricts the person concerned because the thoughts are constantly revolving around the fears, it is an anxiety disorder.

What are the types of anxiety disorders?

  • Panic disorder: Sudden attacks of fear (panic attacks) with racing heart, sweating, shortness of breath, feeling of tightness, … characterized by fear of death and the feeling of loss of control; occur suddenly and gain strength for about ten minutes; often associated with agoraphobia
  • Agoraphobia (Fear of crowds and confined spaces) with / without panic disorder: In agoraphobia with panic disorder, there is a fear of spaces in which escape would be difficult in the event of a panic attack; Anxiety attacks are most common in front of crowds, tight spaces like elevators, or public transport; Fear is less when a trusted person is there
  • Generalized Anxiety Disorder / Generalized Anxiety Disorder (GAE): physical symptoms of anxiety: tremors, racing heart, dizziness, muscle spasms combined with nervousness, concentration problems and other psychological symptoms; Appear as a subliminal permanent state, not as a seizure
  • Social phobia: Fear of contact with people, such as when going to office, when speaking in front of other people, when talking to the boss, …; Fear of embarrassing yourself or being viewed negatively by others
  • Specific phobia: Fear of concrete things or situations such as fear of heights, fear of flying, fear of spiders – mostly refer to original fears from nature
  • Mixed form of anxiety and depressive disorder: Combination of anxiety and depression, both of which may only exist in the weak form; otherwise both diagnoses (anxiety disorder and depression)

How is an anxiety disorder diagnosed?

Probably every tenth patient in a general practice suffers from generalized anxiety disorder. The typical anxiety patient usually comes first because of other complaints, such as sleep disorders, which means that the anxiety disorder is often not recognized directly.

Those affected who notice typical, pronounced symptoms or feel restricted in their quality of life should not be afraid to confide in their family doctor. If necessary, he or she can issue a referral to a specialist.

In a personal conversation, the medical history is asked and questions about the personal situation are asked. Standardized questionnaires help to assess the severity of the anxiety disorder. This is followed by a physical examination with the determination of blood values, an EKG and a thyroid diagnosis. If necessary, physical causes for the symptoms, such as coronary heart disease or bronchial asthma, must be ruled out. The diagnosed anxiety disorder is assessed using the ICD-10 and DSM IV diagnostic criteria.

Therapy for an anxiety disorder

The person affected should be informed about the various options for treating their anxiety disorder and decide together with the doctor what is suitable for them. Pharmocotherapy with drugs and psychotherapy are generally available. The type of treatment and the medication you can take differ depending on the anxiety disorder.

For all anxiety disorders, however, when it comes to psychotherapy, the first choice is cognitive behavioral therapy (CBT). Should this prove to be ineffective, psychodynamic psychotherapy can be used. Exceptions are the specific phobias, because CBT with exposure therapy makes sense for them in order to overcome the specific, irrational fear.

Antidepressants are also used as medication for anxiety disorders. Frequently used drug groups are SSRIs (escitalopram, paroxetrin, sertraline), SNRIs (venlafaxine) and tricyclic antidepressants (clomipramine, opipramol). Here, too, the specific phobias are an exception, as no drug treatment is provided for in the guidelines.

A further measure recommended for anxiety disorders is visiting a self-help group and, for family members, a group of relatives. In the case of panic disorder and agoraphobia, an additional endurance training three times a week.

Rules for dealing with fear

There are mnemonics that have proven effective in dealing with fearful situations. They can be used at any time regardless of the treatment method.
In all areas of our life, the most successful way to learn something new is: We have to expose ourselves to the situation. This also applies to coping with fear. These rules are intended as a reminder that people with an anxiety disorder must experience repeatedly that fear does not turn into disaster.

  1. Feelings of anxiety and the associated physical symptoms are increased normal stress reactions.
  2. Anxiety reactions are not harmful to health.
  3. Do not reinforce fear responses with terrifying imaginations.
  4. Remain in reality, observe and internally describe what is really going on around you.
  5. Stay in the situation until the fear is gone.
  6. Watch the fear subside on its own.
  7. Do not avoid fearful situations.
  8. Expose yourself to any situation that scares you.
  9. Be proud of your successes, even the very little ones.
  10. Take your time in fearful situations.

Prevent anxiety disorders and relapses

Due to the combination of causes, preventing an anxiety disorder is not possible. The education about anxiety disorders in childhood and adolescence seems to have a positive preventive effect.

For all mental illnesses, effective relapse prophylaxis is usually only possible with a combination of socio, psychopharmaceutical and psychotherapy. In the case of generalized anxiety disorders and other anxiety disorders, a combined treatment concept makes a fundamental contribution to significantly improving the quality of life of those affected.

Generalized anxiety disorder tends to be chronic. The risk of relapse is different for each individual. In this respect, in addition to acute improvement, long-term effectiveness and symptom relief are important therapeutic goals. People who undergo cognitive behavioral therapy tend to feel better after they stop. The active participation of relatives in the therapy also makes sense and prevents further relapses. After successful psychotherapeutic treatment of an anxiety disorder, those affected face the difficult task of having to reorganize their lives and relationships. Here again, a corresponding psychotherapeutic offer can be an important aid.

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