Coping with Anxiety and Stress Disorders

Coping with Anxiety and Stress Disorders-MainPhoto

Anxiety and Stress Disorders: How to Cope

What are Anxiety Disorders
What Causes Anxiety Disorders
Types of Anxiety Disorders
Anxiety and Age
Diagnosing Anxiety
What You Should Know about Medications
Special Section: Alternative Approaches
Making Treatment Work for You

Dear Reader,

We live in anxious times. Merely turning on the news or talking with friends can unleash a barrage of concerns—large-scale natural and man-made disasters, economic worries, international conflicts, terrorism, and climate change, to name a few. Many of us have anxiety about personal issues, such as our health, jobs, financial security, or relationships with family and friends. Even everyday annoyances, such as getting stuck in traffic, dealing with a computer problem, or preparing for a work presentation, can stir up anxiety in vulnerable people.

Some degree of anxiety is normal and even necessary. Anxiety signals us that something is awry or might need our attention. However, you don’t want the response to become exaggerated or to dominate your life. For example, anxiety can make you feel so uneasy with social interaction that you isolate yourself, avoiding social gatherings and passing up potential friendships. Anxiety can fill you with such obsessive thoughts or dread of ordinary activities that you cannot work. It can even cause chest pain so severe you think you’re having a heart attack.

If feelings of worry, fear, and stress have begun to rule your days (or nights), take heart. Many forms of anxiety disorders are treatable and relief is possible, even when you have lived with high levels of anxiety for a long time. Reading this report will help you understand the various types of anxiety disorders and learn about effective treatments that can help you enjoy a fuller, happier life.

Know that you’re not alone in feeling anxiety. Anxiety disorders are the most common type of psychiatric condition in the United States. They affect about 40 million adults each year, almost twice as many people as the roughly 21 million American adults with mood disorders like depression and bipolar disorder.

If you think you may have an anxiety disorder, the first step is to see your doctor. With proper evaluation and a well-tailored treatment plan, you can bring your anxiety under control. In this report, you’ll find up-to-date information about the latest and most effective treatment approaches, including cognitive behavioral therapies, psychotherapy, and medications. A special section delves into alternative treatments for anxiety, such as relaxation techniques, mindfulness meditation, and biofeedback. We hope that this report will give you an incentive to seek help today so that you’ll feel better soon.


Ann R. Epstein, M.D.
Medical Editor

What Are Anxiety Disorders?

Ask a handful of people with an anxiety disorder to describe it, and they’re likely to paint different pictures. One might dread speaking in public, while another is gripped by intense fear at the mere thought of getting on an airplane. A third might label herself a “chronic worrier” because she regularly frets about all sorts of things. A fourth experiences unpredictable episodes of panic, with shortness of breath, sweating, and chest pains. Many people would undoubtedly mention that they have trouble sleeping.


Why the broad array of symptoms? It’s because anxiety and stress disorders aren’t actually a single condition, but rather a spectrum of related disorders. However, many different anxiety disorders are believed to have the same biological underpinnings. That helps explain why more than half of all people with one anxiety disorder also have another. While each anxiety disorder has its own set of symptoms (see Table 1), they share some symptoms, too (see “Common symptoms, Additionally, people with anxiety disorders frequently have symptoms of depression, too, and vice versa.

Table 1: Anxiety and stress disorders at a glance
Type Main symptoms
Panic attack A sudden wave of intense anxiety, apprehension, fearfulness, or terror, with physical symptoms such as shortness of breath, palpitations, sweating, and chest pains.
Panic disorder Recurrent panic attacks that occur suddenly and without warning, causing persistent concern and interfering with social functioning. Sometimes this leads people to avoid leaving home (agoraphobic avoidance).
Specific (simple) phobia Substantial anxiety caused by exposure to a particular feared object or situation.
Social phobia (social anxiety disorder) Substantial anxiety caused by certain social situations or performing in front of a group, such as speaking in public.
Obsessive-compulsive disorder Recurrent distressing thoughts (obsessions) and uncontrollable repetitive behaviors (rituals or compulsions) intended to reduce anxiety provoked by those thoughts. Symptoms last more than an hour a day and cause significant distress or interfere with normal functioning.
Acute stress disorder Anxiety symptoms that last for up to a month following a traumatic experience.
Post-traumatic stress disorder Intrusive and distressing thoughts, sleep problems, hypervigilance, social withdrawal, anger, and other anxiety symptoms that occur for more than a month following a life-threatening or severely traumatic experience.
Generalized anxiety disorder Excessive anxiety and worry about a variety of things on most days for at least six months. Physical symptoms, such as muscle tension, increased heart rate, and dizziness, may also occur.
Medical conditions that mimic or provoke anxiety symptoms Pronounced anxiety, panic attacks, obsessions, or compulsions caused by a medical condition such as thyroid disease, treatment with steroids, or respiratory disease that causes difficulty breathing.
Substance-induced anxiety Pronounced anxiety, panic attacks, obsessions, compulsions, or possibly paranoia caused by a medication, drug abuse, or exposure to a toxin. Examples include amphetamine or cocaine use.

It’s not that people with anxiety disorders have these symptoms and other people never do. At some time, most of us feel afraid, tense, or even anxious enough to become short of breath. The difference is that people who don’t have anxiety disorders experience these reactions in response to genuine threats. When a burglar breaks into the house, for example, anxiety can be a lifesaver, spurring an individual to call the police or flee the building. But people with anxiety disorders face worry and fear even in ordinary, relatively harmless situations (see Table 2).

Table 2: When does worry become a disorder?Everyone worries from time to time, but not everyone who worries has an anxiety disorder. The severity of your symptoms and your ability to manage them can help you tell the difference.
Everyday anxiety Anxiety disorder
You worry about paying bills or getting a new job. You think about your finances or job prospects constantly, to the point where these thoughts interfere with your daily life.
You sometimes get nervous before a big test or presentation at work. You have panic attacks, where you break into a sweat, shake, and have heart palpitations. You live in constant fear of another panic attack.
You’re afraid of bees because you’re allergic to them. You’re terrified of something that doesn’t pose a threat to you, like tall trees or the color red—and you do everything you can to avoid it.
You sometimes get embarrassed or feel awkward at parties and other social gatherings. You avoid social situations out of fear that people will laugh at or judge you.

It’s possible to live with a mild anxiety disorder. But when the anxiety is severe enough to interfere with everyday life, treatment is usually the only way to control it. Treatment options include medication, psychotherapy, or both. Without treatment, it’s likely that the disorder will worsen or that another anxiety disorder will develop. Treatment is also important for conditions that often accompany anxiety, such as depression and alcohol or drug dependence.

Common symptomsThe following are characteristic of all anxiety disorders:
  • irrational feelings of fear, dread, or danger
  • tension
  • worry
  • physical symptoms such as agitation, trembling, nausea, hot or cold flashes, dizziness, shortness of breath, or frequent urination

Links to Depression

Anxiety and depression are two related conditions that often coexist. Two-thirds of people with anxiety disorders also suffer from depression at some point in their lives, and 58% of people with depression also have an anxiety disorder. This combination is so common that many mental health experts now consider it a distinct disorder, known as mixed anxiety-depressive disorder (MADD). The hallmark of MADD is pronounced anxiety and rumination—often veering toward morbid thoughts—that occurs during an episode of major depression. Women are more likely than men to be diagnosed with MADD.

The presence of depression in people with anxiety disorders increases the severity of both illnesses, the likelihood of alcohol or substance abuse, and the risk of suicide. It also reduces the chances that treatment will succeed, unless both disorders are fully treated.

Anxiety and depression are much more closely linked than was once thought. Many scientists now believe that anxiety and depression are different expressions of a single, shared underlying biological problem. They point out, for example, that the same kinds of abnormalities in neurotransmitters (chemical messengers in the brain) that promote depression can also trigger anxiety. Researchers have also found that the brain structures that react to perceived threats are hypersensitive in some people who have either depression or anxiety disorders, or both.

Other risk factors include early trauma or abuse, difficulties at school, early loss of or separation from a parent, having a parent with a history of mental illness, financial problems, and substance abuse. Given the similarities between depression and anxiety disorders, it’s no surprise that many of the medications used to treat anxiety are antidepressants.

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