Anxiety disorder

Whether spider phobia or panic of crowds: An anxiety disorder can be very stressful. An important step out of fear is to confront it. With the help of an appropriate therapy, an anxiety disorder can often be brought under control. Read what forms of anxiety disorders there are and how they can be treated.

This text complies with the requirements of medical literature, medical guidelines and current studies and has been reviewed by medical experts.

Anxiety disorder

Everybody knows the feeling of fear. And that’s just as well: Fear is a useful emotion because it can protect us from danger – for example, by avoiding a threatening situation or fleeing from something.

If our ancestors had not fled at the sight of a wild animal, it would probably have cost them their lives. And even today, fear often prevents us from taking too great a risk.

Anxiety is therefore quite normal and even (super-)vital. In people with an anxiety disorder, however, anxiety is pathologically increased.What is an anxiety disorder?

People with an anxiety disorder show strong fear reactions, although there is no objective reason for it. Sufferers can hardly or not at all control the exaggerated anxiety. An outdated term for anxiety disorder is anxiety neurosis.

Only when a fear unreasonably strong and is out of proportion to the situation, one speaks of an anxiety disorder. For example, many people feel discomfort or disgust when they see a spider – but only a fraction of them actually have a spider phobia. Others are reluctant to give a speech, but this does not mean they have an anxiety disorder that requires treatment.

Forms of anxiety disorders

There are different forms of anxiety disorders:

  • Phobias (also: phobic disorders): Phobics have a strong fear of certain situations and objects, even though they know that this fear is actually unfounded. Phobias are divided into:
  • Agoraphobia: Agoraphobics avoid certain places or situations, such as public places, crowds, or travel. People with agoraphobia fear not being able to escape during a panic, or they are afraid of not getting help in an emergency.
  • Social phobia: People with social phobia have an exaggerated fear of social situations (z. B. Meeting strangers, being the center of attention).
  • Specific (isolated) phobias: These include fears of certain objects or situations such as. B. of spiders, dogs, blood, flying or of closed rooms (claustrophobia).

In addition there are Mixed forms, which cannot be assigned exactly to one or the other form. Anxiety and depression can also be mixed, also a combination with compulsions.

How common are anxiety disorders?

Anxiety disorders are among the most common mental illnesses. It is estimated that 15 out of every 100 people have an anxiety disorder within a year. Women are diagnosed significantly more often than men.

The specific phobias (z. B. fear of heights, claustrophobia, animal phobias) are the most common, but only relatively rarely require psychiatric or psychotherapeutic treatment. In contrast, panic disorder, while less common, is most likely to require treatment.

Anxiety disorder: symptoms

An anxiety disorder can manifest itself through many different symptoms. The disorder affects not only the mental experience, but also the body.

Individuals with an anxiety disorder usually fear losing control. For example, they interpret physical symptoms as an impending heart attack. Or they are worried about losing consciousness, collapsing, or going crazy in the situation.

The following signs are indicative of an anxiety disorder:

  • disproportionate fear
  • Avoidance behavior
  • Physical symptoms
  • Fear of being afraid and catastrophic thinking
  • The fear interferes with everyday life

Video: 5 symptoms that indicate an anxiety disorder

Anxiety disorder: symptoms of agoraphobia

Individuals with agoraphobia have a fear of situations in which they feel like outside their usual environment stop. The affected persons fear in such situations "in case of emergency" Not being able to escape – for example, fainting or not being able to control their bladder. As a result of these fears, the sufferer avoids the anxiety-provoking situations, so that they are increasingly restricted in their freedom of movement. Agoraphobia often occurs in conjunction with panic disorder.

Typical situations that agoraphobics avoid are:

  • staying in public places
  • being in crowds
  • waiting in a queue
  • traveling in a train, bus or car
  • long distances from home

Anxiety Disorder: symptoms of social phobia

A social phobia manifests itself through a persistent, intense fear of social situations, especially judging by other. People with a social phobia, for example, are afraid of them,

  • of giving a lecture,
  • eating in front of other people,
  • of other people,
  • participate in events or
  • participate in social gatherings.

The affected person knows that their fear is exaggerated, but can hardly defend themselves against it. You try to avoid the anxiety-provoking situations. Social phobia goes far beyond normal shyness and often occurs in conjunction with low self-esteem and fear of criticism.

Typical symptoms in a social situation are

  • Blushing
  • Avoidance of eye contact
  • Hand trembling
  • difficulty speaking in public

Anxiety disorder: symptoms of a specific phobia

A specific phobia is characterized by a persistent fear of a specific object or situation. Common forms are:

  • Fear of animals, especially dogs, insects, spiders, snakes, or mice
  • Fear of blood (hematophobia)
  • fear of closed rooms (claustrophobia)
  • fear of heights (acrophobia) (aviophobia)
  • Fear of infection (pathophobia)

Such fears are widespread. They are only considered pathological when they interfere with daily routines, usual social activities or relationships, or cause significant distress.

Symptoms of generalized anxiety disorder

Individuals with generalized anxiety disorder have a long-lasting or recurrent exaggerated fear that is not limited to specific situations or objects (so-called. free-floating anxiety).

The anxiety may relate to various life circumstances or everyday situations. However, those affected are often unable to say exactly what they are afraid of. For example, they worry excessively that something might happen to their loved ones. The anxiety recurs over a period of months or years. People with generalized anxiety disorder are only able to distract or distance themselves from this anxiety for short periods of time.

Generalized anxiety disorder is manifested by typical symptoms such as:

  • severe inner tension, accompanied by trembling, muscle tension, and restlessness,
  • uncontrollable overexcitability manifested by feelings of anxiety, sweating, dry mouth, dizziness, and/or
  • Excessive alertness and heightened attention, manifested by a feeling of tension, excessive jumpiness, sleep disturbances, and irritability.

People who have generalized anxiety disorder worry almost constantly. Whether fear of illness, job loss or financial ruin:

Anxiety disorder: symptoms of panic disorder

Repeated, unexpected fears are characteristic of panic disorder Panic attacks. During a panic attack, an intense fear suddenly appears – as if out of the blue. Within a few minutes, the anxiety rises to a peak and then slowly subsides. Many sufferers experience fear of death.

In addition to strong feelings of anxiety, pronounced physical symptoms are typical during a panic attack, for example:

    , Heart phobia
  • Feeling of anxiety , shortness of breath
  • Sweating
  • Dry mouth
  • Feelings of unreality; the feeling of "being beside oneself (depersonalization)
  • tingling, numbness

Often, the affected person is afraid of the next attack (anticipatory anxiety) and thus withdraws more and more.

When the physical symptoms of panic disorder are focused on the heart (e.g., anxiety, anxiety, anxiety, anxiety, anxiety, anxiety, anxiety, anxiety, anxiety, anxiety, anxiety, anxiety, anxiety, anxiety). B. heart palpitations, tightness in the chest), one speaks of a Heart phobia. This form of panic disorder mainly affects middle-aged men. The trigger for a cardiac phobia is often a heart disease in the immediate vicinity of the affected person or an overly intensive preoccupation with this clinical picture.

Anxiety disorder: diagnosis

Often a long time passes before an anxiety disorder is diagnosed. This can have different reasons. On the one hand, in some people the fear is expressed primarily by physical symptoms. The doctor may therefore first look for the cause of the symptoms in the physical sphere. On the other hand, an anxiety disorder can limit your life so much that you avoid going to the doctor. This may be the case, for example, if the sufferer has agoraphobia and is unable to leave the house due to fear. Last but not least, many sufferers are ashamed of their fears and find it difficult to seek psychological help. This affects men in particular.

First contact can be the family doctor, a psychiatrist or a psychotherapist. During the interview he will ask some questions. For example, he will want to know,

  • in which situations the anxiety occurs,
  • how strong the fear is,
  • since when the symptoms have existed,
  • whether the anxiety has come on suddenly or gradually,
  • which physical symptoms occur during anxiety, and
  • whether the patient has noticed any other discomfort.

To aid in the diagnostic interview, the clinician can use structured interview guides or questionnaires.

Diagnosis of anxiety disorder: exclude other diseases

Certain physical illnesses can be accompanied by symptoms that are similar to those of an anxiety disorder. Such diseases include, for example

  • Hyperthyroidism,
  • Cardiovascular Diseases,
  • some neurological diseases or
  • Certain lung diseases.

Some medications can also cause symptoms reminiscent of an anxiety disorder.

To rule out the possibility that the anxiety symptoms are due to a physical cause, a doctor should therefore perform a comprehensive physical examination of the affected person.

In addition, the key factor in treatment is whether the anxiety is primary or whether it is a concomitant of another mental illness (e.g. B. Depression) occurs.

So-called anxiety diaries are often used as an important diagnostic tool. The person affected keeps a diary over a longer period of time, recording how often, in which situations and how severe the anxiety has been. The anxiety diary also makes it easier for the therapist to plan the treatment individually.

Anxiety disorder: treatment

The sooner people with an anxiety disorder receive appropriate treatment, the greater the chance of recovery. In most cases, an anxiety disorder can be treated well.

Psychotherapy is the most suitable treatment for anxiety disorders. In some cases, it can be helpful if the treating physician prescribes additional medication.

Treatment depends on the type of anxiety disorder and how severe it is. On the other hand, the individual wishes and preferences of the patient are important.

Psychotherapy for anxiety disorders

Cognitive behavioral therapy in particular has been shown to be effective in treating anxiety disorders. However, some people feel more comfortable with a different type of therapy. A discussion with the doctor or psychotherapist can help in the decision-making process. Together with the patient, he can find out which treatment is most suitable.

Psychotherapy can help with mental health problems. But which method is suitable for whom? What steps are necessary to gain access to the T

Cognitive behavioral therapy

The basic assumption of cognitive behavioral therapy is that thoughts, feelings and behaviors influence each other.

Example: Mr. M. a woman with a dog comes towards him while he is out walking. Mr. M. has the thought that the dog might bite him. He remembers that just the other day he read about an attack by a dog. He classifies the situation as dangerous, gets scared and changes sides of the road. Another person would possibly evaluate the same situation quite differently. For example, he would be happy to see the dog, pet it, etc.

How a person evaluates something depends, among other things, on what experiences he or she has had in the past. Certain events or experiences can cause a person to develop erroneous beliefs or beliefs that are unfavorable to them.

In the cognitive therapy The person should recognize how thinking, feeling and behavior influence each other. It learns which of its thought processes and behaviors lead to anxiety being maintained.

In the Exposure procedure the person enters the feared situation under therapeutic guidance – usually first in imagination and later in reality. The goal is to remain in the situation until the anxiety noticeably subsides. This allows the person to realize that their anxiety is unfounded. If exposure is not possible or only possible with difficulty – for example, in the case of a fear of flying – specific phobias also come in the form of an Virtual reality exposure used: instead of the real situation, the patient learns to reduce his fears in a virtual world.

Psychodynamic methods

Psychodynamic methods include analytical as well as depth psychology-based psychotherapy.

Supporters of psychodynamic psychotherapy assume a psychoanalytical approach from: Accordingly, everything a person thinks, feels, or does is influenced by unconscious experiences. Thus, inner, mostly unconscious conflicts can be behind strong fears in particular. These conflicts may have arisen, for example, as a result of certain events from childhood and may manifest themselves in the form of fear.

In treatment, the therapist and the anxiety patient first discuss the underlying conflict and then work on it.

anxiety disorders: Drug treatment

Medications can also be used in the treatment of an anxiety disorder. Mostly antidepressants are involved. Important to know: It takes at least two weeks for antidepressants to take full effect.

If an immediate effect is desired, for example, if the anxiety is so great that it makes psychotherapy very difficult, there are also the so-called anxiolytics (mostly from the benzodiazepine family). However, these anxiety-relieving drugs are not recommended because of their dependency potential only temporarily suitable.


In anxiety disorders, so-called

  • Selective serotonin reuptake inhibitors (SSRIs) or
  • Serotonin-norepinephrine reuptake inhibitors (SNRI)

positive effects. SSRIs include agents such as sertraline, paroxetine, escitalopram and citalopram. Among the SNRIs, venlafaxine may help.

In the brain there are billions of nerve cells. They ensure that information can be processed in the brain. Information is passed from nerve cell to nerve cell in the form of electrical stimuli – until it reaches its destination.

Neighboring nerve cells are not directly connected to each other. For an electrical stimulus to travel from one cell to the next, it requires certain messengers called neurotransmitters. The neurotransmitters are released on demand by the irritated nerve cell. Once they have fulfilled their task, the transmitters are either broken down or taken up again by the cell.

The concentration of messenger substances such as Serotonin or Norepinephrine is often out of balance in the case of an anxiety disorder. For example, there are not enough transmitters available or they are reabsorbed too quickly by the cell.

Antidepressants interfere with brain metabolism and concentration ratios of certain neurotransmitters between the nerve cells. For example, some antidepressants specifically prevent serotonin from being reabsorbed into the nerve cells, thus prolonging their positive effect.

Possible side effects of SSRI/SNRI are for example

  • cardiovascular complaints, , and
  • gastrointestinal problems.

In addition to SSRIs and SNRIs, doctors also use so-called MAO inhibitors such as moclobemide and tricyclic antidepressants such as clomipramine to treat anxiety:

  • MAO inhibitorsprevent the degradation of the so-called monoamines (dopamine, adrenaline, noradrenaline, serotonin), so that they are present in higher concentration, which has a depressive and anxiety-relieving effect. Possible side effects of MAO inhibitors include dry mouth, restlessness, gastrointestinal problems, and headaches.
  • Tricyclic antidepressantsRelieve anxiety and inner turmoil in particular. They increase the concentration of various neurotransmitters in the brain by inhibiting the uptake of the neurotransmitters into the nerve cells. Adverse side effects include low blood pressure, dry mouth, or dizziness.

After the end of drug therapy, some patients experience discontinuation symptoms that can last for a long time. To avoid these symptoms, the medication should not be stopped abruptly, but phased out slowly.

Benzodiazepines: Do not take over a long period of time

For severe anxiety, doctors sometimes prescribe benzodiazepines. They belong to the group of sedatives and sleeping pills.

Benzodiazepines show their calming effect very quickly. However, they can become addictive after only a few weeks. Then higher and higher doses are necessary to achieve an anxiety-relieving effect.

Therefore: Take benzodiazepines only for a short time and not longer than necessary. Consult regularly with your treating physician. It is important to learn in therapy that it is also possible to overcome anxiety without medication.

Other agents for the treatment of anxiety disorders

Other agents that may be used for anxiety disorders include:

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