Anxiety Disorders


We have all felt the effects of stress at one time or another. Our bodies tell us when we need to slow down because we are overloaded. If stress continues unchecked, it can develop into a more serious problem called anxiety. It has been estimated that over 20 million Americans suffer from an anxiety disorder at any one time and that another 30 million will experience the problem at least once during their lifetime (Hunt, 2005).

However, anxiety is a normal reaction to stress. Slight anxiety can actually motivate us in school or at work to perform better and achieve results. However, high levels of anxiety, especially over extended periods of time, is quite detrimental and often requires some kind of medical intervention. Individuals affected with this disorder experience an inappropriate and excessive level of arousal, which is often followed by feelings of uncertainty, fear, and apprehension. Consistent stress and anxiety can greatly affect our spirit, making life seem less meaningful.

However, there is no one theory of anxiety that explains the various clinical and biological data. Many theories have suggested possible etiological factors in the development of anxiety; the three main theories are psychodynamic, behavioral, and biological (Hansell and Damour, 2005).

Psychodynamic View

Freud proposed that anxiety is the result of unconscious psychic conflicts. When these conflicts, or forbidden impulses, threaten to become conscious, anxiety is experienced. Anxiety then becomes a signal to the ego to take defensive actions to suppress it. When the defense mechanism is successful, anxiety is lowered and a sense of security returns. However, if the conflict is intense and the defense mechanism is not successful, symptoms will display in the form of phobias, regression or ritualistic behaviors.

Cognitive Behavioral View

Behavioral theory suggests that anxiety is a result of learned or conditioned responses. Techniques utilized in the treatment of phobias and obsessive-compulsive behaviors support this theory. According to this hypothesis, anxiety results from a series of responses to certain stimuli. Over time, a person would develop a learned or conditioned response to the stimuli. This concept suggests that anxiety can be learned and unlearned as a result of experience.

Biological View

From the biological perspective, manifestations of anxiety may be experienced by physiological irregularity. Anxiety may be a warning of an underlying physiological process. In this case, anxiety could be caused by physical disease or abnormality and not necessarily by an emotional conflict. For example, people with multiple sclerosis, brain tumor, diabetes, or, anemia may experience anxiety stemming from their physiological processes.

Examples of Anxiety Disorders

Though there are varying categories of anxiety disorders, the most common are Generalized Anxiety Disorder (GAD), Panic Disorders, Obsessive-Compulsive Disorder (OCD), Phobias, and Post-Traumatic Stress Disorder (PTSD).

Generalized anxiety disorder (GAD) manifests itself with feelings of chronic and persistent anxiety that last for six months or longer. A person who is experiencing GAD often feels as if they have no control or management capacity over their anxiety. This person may experience insomnia, restlessness, fatigue, uncontrolled behavior, and muscle tension. GAD can also result in a number of physical symptoms such as sweating, dry mouth, and tension headaches. This disorder can be debilitating enough to interrupt an individual’s social and professional life.

Generalized Anxiety Disorder

Generalized anxiety disorder originates from two main factors: biological vulnerability to anxiety and stress due to negative environmental stressors. An individual may be genetically predisposed or have a natural inner tendency to live life in a tense manner. Any undue amounts of stress can move this naturally tense person into a level of nervousness that gradually moves into worry, then create physiological changes, and finally lead to GAD. Individuals affected with GAD show less responsiveness on most physiological measures such as heart rate, blood pressure, and respiration rate. They often experience chronic muscle tension, as well as intense cognitive processing in the frontal lobes, especially in the left hemisphere of the brain. This indicates worry without images, which cause the individual to experience extreme levels of worry without having the ability to create images for their current thought.

Individuals with GAD are extremely sensitive to threat, especially threat with personal bearing. They seem to be more aware and attentive than people without GAD, and this awareness seems to be unconscious. They usually avoid negative effects associated with the threat at hand; therefore overlooking what may be a solution to their problem. This prevents the person from facing the feared situation and makes adaptation difficult.

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder also known as OCD is a chronic mental disorder most commonly characterized by intrusive, repetitive thoughts. These thinking patterns produce a compulsive behavior that the person feels driven to perform. Often, the sufferer would follow a personal routine applying special rules aimed at preventing some imagined anxiety-producing events. The obsession aspect of OCD is where individuals experience troubling repetitive thoughts, images, or impulses that are not only upsetting, but may not make much sense to the individual. Typical obsessions are in the area of cleanliness, such as a fear of germs, contamination, and dirt.

The compulsion aspect of OCD is where individuals seek to cope with or manage their anxiety using routine, methodic actions known as rituals. These compulsions somehow help the sufferer negate worrying thoughts, but usually the impact of the rituals is short-lived causing the person to repeat them. Both obsessions and compulsions are troubling and embarrassing, so many people with this condition often hide their fears and rituals though they are not able to stop acting on them. A majority of the people affected by OCD have both obsessions and compulsions with only a small amount having only one aspect of the malady.

There are a number of treatment methods for OCD ranging from psychotherapy to self-help and medication. Cognitive behavioral therapy has been shown to be the most effective form of therapy for because it challenges the dysfunctional and irrational beliefs and thoughts that lie underneath the obsession, as well as the fear that such obsessions produce. During this type of therapy, an OCD sufferer may have a dual approach of gradual exposure to the feared stimulus combined with medication that tempers the anxious emotional state. In regard to the latter, it is believed that individuals with OCD have a lower level of the neurotransmitter serotonin. Serotonin has an important role in regard to proper regulation of mood, sleep, and other functions.

A class of antidepressant that has been shown to treat OCD most effectively is the serotonin reuptake inhibitors (SSRIs). Antidepressants can help with the treatment of OCD because they increase levels of serotonin in which OCD sufferers have been known to have a lesser amounts. Specific antidepressants that have been effective in treating OCD include Clomipramine (Anafranil), Fluvoxamine (Luvox), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), and Citalopram (Celexa).

Post-Traumatic Stress Disorder

In comparison to GAD and OCD, post-traumatic stress disorder (PTSD) may be the most experientially troubling of the anxiety disorders. Also known by popular phrases such as railway spine, stress syndrome, shell shock, and battle fatigue, the sufferer of PTSD is haunted by horrific experiences that have attached the person’s emotions, psyche, and senses (visual, auditory, and even olfactory). Such events might be rape, various forms of abuse, natural disasters, and battle experience, all coming back to the sufferer in such forms as flashbacks and nightmares that can significantly impair social and occupational functioning long after the event has passed.

Similar to GAD, there also seems to be a negative impact in certain brain functioning with PTSD. For example, soldiers who experienced intense fighting in the Vietnam War with PTSD showed a 20% reduction in the volume of their hippocampus compared with veterans who did not have PTSD. In addition to this evidence, it has been theorized that the amygdala may be in a semi-permanent state of hyperarousal, where the sufferer is not able to “turn off” the hypersensitivity of the amygdala, which regulates the fight or flight response.
Treatment of PTSD has been greatly helped by Horowitz’s creation of the Stress Response Syndrome. This is a model that maps a common pattern of typical responses to stressors, real or imagined. In regard to the sometimes unpredictable and shifting symptoms of PTSD, the Stress Response Syndrome has helped therapists with a logical and phased outline of emotional or impulsive states in which to guide a PTSD sufferer through. These states are: Stressful event, Outcry, a dual state of Intrusion and Denial, Working through, and finally Completion. It has been theorized though, because of the sometimes shocking memories associated with PTSD events, that sufferers may not adequately ever reach the final state of completion. This may be especially true because PTSD often enter deep episodes of depression, substance abuse as a coping method, and even periods of psychosis.

Like other anxiety disorders, treatment is varied for PTSD sufferers with psychotherapy and medication. Again, a cognitive behavioral approach is advised, especially by using gradual exposure or remembrance of the stressor with the therapist being careful to not have the patient experience the exposure too deeply. Medications are meant to manage PTSD symptoms from intrusive flashbacks (antidepressants and antipsychotics), hyperarousal (antidepressants, benzodiazepines, and anticonvulsants), psychosis (atypical antipsychotics and anticonvulsants), depression (antidepressants), and panic attacks (antidepressants, MAO inhibitors, and benzodiazepines).

A Non-Traditional Setting for Anxiety

Besides traumatic situations, anxiety can also surface in areas that are not seen as traditionally stressful, for example, sports. Athletes must often experience and manage various levels of nervousness, apprehension, and fear. Sport psychologists believe that anxiety is a reaction that is measured using various scales through the observation of cognitive and physiological symptoms that appear in reaction to a stimulus. In relation to the environmental stressors associated with sports, this could be upcoming performance, intense competition, or possibly the expectation put on athletes by friends and family. Anxiety in connection with sports is a provocative topic for research since its management can affect a person’s athletic performance positively or negatively (Mellalieu, Hanton & O’Brien, 2004).

The relationship between anxiety and sports is a complex one, since it involves anxiety responses that are unique for each athlete along with the variable of different sports. For example, anxiety responses felt by athletes in an individual, non-contact sport (such as tennis) might differ greatly from anxiety responses felt by athletes in a team, contact sport (such as football). This disparity elicits different anxiety responses due to the divergent task demands of the sports (Mellalieu, Hanton & O’Brien, 2004).

Unlike general sufferers of anxiety disorders, athletes on the other hand have a kind of built-in outlet for the anxiety as well. In fact, there is a great amount of literature regarding the beneficial relationship of anxiety in conjunction with sports. In particular, there have been many studies that have exclusively focused on children, and how beneficial sports activities have done to improve their self-esteem, confidence, mood, and mental health, in spite of the presence of anxiety as well. For an in depth look at this specific subject, further research is required.

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Mellalieu, S. D., Hanton, S. & O’Brien, M. (2004). Intensity and direction of competitive anxiety as a function of sport type and experience. Scandinavian Journal of Medicine & Science in Sports 14, 326-334.