Employee & Community Health

FAQs about anxiety disorders

10/10/2019 by Craig Sawchuk, PhD, LP

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Anxiety disorders are the most common mental health condition in the United States, affecting nearly 30% of the population at some point in their lifetime. The most common anxiety disorders are specific phobias, which affect 19 million people and social anxiety disorder, affecting 15 million. Obsessive-compulsive disorder is the least common, affecting 2 million people each year, yet it can be one of the most impairing. The answers to these frequently asked questions can help you gain a better understanding of these disorders and their treatment. 

Q: Where do anxiety disorders come from?

A: Anxiety disorders typically come from a combination of biological, environmental and learned factors. Certain anxiety disorders, such as obsessive-compulsive disorder and social anxiety disorder, tend to run in families. Sometimes, certain health conditions, such as hyperthyroidism and asthma, may mimic symptoms of anxiety or make existing anxiety problems worse. Environmental stress can also lead to the onset of anxiety disorders. Other anxiety disorders may be due to negative learning experiences. 

Q: What are the different types of anxiety disorders?

A: These are the types of phobias providers see most often:

Specific phobias: This type of anxiety involves intense fear of:

  • Certain situations, such as driving or flying
  • Animals, such as dogs or spiders
  • Environments, such as storms or the dark
  • Medical situations, such as injections or the site of blood

Individuals with a specific phobia will often experience significant anxiety, even at the thought of managing the triggers for their fears. Avoiding triggers for their phobia is also very common. 

Separation anxiety disorder: This type of anxiety involves intense dread and worry about being away from caregivers and loved ones. Uncertainty about their absence can feel intolerable and multiple attempts at seeking reassurance — think phone calls or texts — may be common. Although this tends to be more likely in children, adults can also experience significant anxiety over separation from others. 

Generalized anxiety disorder: This type of anxiety involves difficulties controlling worry. Individuals worry about a wide variety of situations, such as health, finances, relationships, work or school. Their worry tends to jump to the worst-case scenarios, they assume these situations are likely to happen, and they doubt their ability to copy with them if they occur. Muscle tension and sleep disruption are also commonly associated with excessive worry. 

Panic disorder: This type of anxiety involves the experience of intense surges of physical anxiety, such as rapid heart rate, difficulties breathing, chest tightness, lightheadedness, dizziness, sweating and tingling in the hands and feet. It's also common to experience significant worry over what these symptoms mean, such as fear of losing control or having a heart attack/stroke. Panic attacks can be triggered by specific situations, but they may also seemingly come out of the blue, even waking people up in the middle of the night. The anxiety tends to be about the fear of fear-related symptoms. Avoiding situations because of fear of having these attacks and seeking emergency medical care can be common. 

Social anxiety disorder: This type of anxiety involves fears of being negatively evaluated or criticized by others. Worries over making mistakes and embarrassing oneself tend to be common. Individuals often experience significant anticipatory dread even before getting into social situations. They may replay their performance in a negative way after these situations are over, even if nothing objectively negative happened. Avoiding social situations can be common. Social anxiety is often associated with an increased risk for depression. 

Obsessive-compulsive disorder: This type of anxiety involves the experience of recurring, intrusive and unwanted thoughts or images (obsessions) and engaging in behaviors to try to reduce or eliminate anxiety (compulsions). Common obsessions include fears of getting contaminated; doubting whether they did something correctly; worry about losing control and causing harm to others; and intrusions related to sexual, moral or religious themes. Most of the time, compulsions are related to the obsessions, such as washing excessively to eliminate fear of contamination, repeatedly checking door locks when feeling doubtful, and praying when experiencing religious intrusions. However, other compulsions can involve more rule-governed, superstition-like behaviors, such as having to get dressed in a particular way, counting in groups of threes, or having to repeat phrases over and over until they sound "just right". 

Post-traumatic stress disorder: With this form of anxiety, individuals experience extreme distress in reaction to an event that involved the threat of death, violence or serious injury. A variety of symptoms can be common, including re-experiencing the event(s) in the form of flashbacks and nightmares; being easily startled and hypervigilant to one's surroundings; having mood changes; and avoiding situations or reminders of the traumatic event(s). 

Q: What happens if anxiety disorders aren't treated?

A: The annual estimated cost of untreated anxiety disorders is approximately $60 billion due to lost wages, unemployment and health care. In comparison to those without anxiety disorders, individuals who experience them are at greater risk for depression and substance abuse. 

Q: How are these disorders treated?

A: Anxiety disorders are very treatable mental health conditions. Unfortunately, only about one-third of individuals are receiving evidence-based care for their condition. The most effective treatments include cognitive behavioral therapy (CBT) and medication management. CBT is a skills-based approach in which individuals learn to gain control over their anxiety by facing their fears (exposure therapy) and directly challenging negative beliefs (cognitive reframing). The most common medications used to treat anxiety disorders are selective serotonin reuptake inhibitors (SSRIs). 

Q: How do I get help?

A: Talk with your health care provider about effective treatments for anxiety disorders. Many primary care teams are skilled in treating these disorders with medication strategies. When looking for psychotherapy, be a good consumer of your care and ask to work with a clinician skilled in CBT. CBT providers will often assign homework between sessions, which is extremely important in your recovery. The Association for Behavioral and Cognitive Therapies may be able to help locate CBT providers in your area. 

The Anxiety and Depression Association of America is an excellent resource for up-to-date information on anxiety disorders and their treatment. Several self-help books and smartphone CBT apps are also available. A listing of helpful apps for anxiety disorders can be found at PsyberGuide

Dr. Craig Sawchuk is a clinical psychologist in Employee and Community Health's (ECH) Division of Integrated Behavioral Health (IBH). He is a professor of psychology and co-chairs the Divisions of Integrated Behavioral Health and Professionalism within the Department of Psychiatry and Psychology at Mayo Clinic in Rochester.