Anxiety disorders

Key information

What is anxiety?

Anxiety is an emotional state that involves three types of reactions or symptoms of anxiety:

  • A physiological alert response (increased blood pressure or heart rate).
  • Negative thoughts and perception of threat.
  • Danger avoidance behaviors.

Anxiety is a ubiquitous psychological phenomenon, omnipresent in living beings. Anxiety is inherent to life and a normal human experience.

Anxiety disorders

So when does anxiety constitute a disorder?

A disorder is considered to exist when:

  • The anxiety has an unreasonably high intensity.

  • Follows a dysfunctional pattern (or independent of the expected provoking factors).

  • And has an impact on the person’s quality of life and functionality. That is, it has an impact on the person’s ability to perform the roles and functions that s/he had been performing or that corresponds to her/him due to age and biopsychosocial development.

Causes of anxiety disorders

Anxiety disorders are the most prevalent mental disorders, the most frequent today at least in the West.

In most cases, the disorder begins before the age of 25 and is frequently associated with other disorders such as depression, substance abuse, or another anxiety disorder.

With respect to its causes, there seems to be a combination of genetic and other biological factors, as well as psychosocial events during the development of the person that can lead to a greater predisposition to suffer from these disorders. We do not know the neurobiology of these disorders in detail, but it has been possible to reach certain generalizations about their causes.

Regarding the biological aspects, certain brain areas have been identified, as well as different neurotransmitters whose disregulation seems to be correlated with a greater vulnerability to suffering from anxiety disorders

Among them, some brain structures such as the hippocampus or the amygdala seem to be involved and mainly the neurotransmitters serotonin, norepinephrine or gamma-aminobutyric acid (GABA).

Among the biopsychological factors, exposure in childhood to situations of abuse, neglect or trauma stands out, which clearly predispose to suffering from anxiety disorders, among other disorders. Other explanations point to conditioning phenomena (learning) or lack of sufficient development of abilities to correctly interpret signals that come from the body (somatic signals).

Types of anxiety disorders and their main characteristics

The two main international diagnostic classification manuals (DSM and ICD) readapted the category of anxiety disorders in their latest updates (DSM-5 and ICD-11) and made both classifications similar. Thus, the entities currently present in the category of anxiety disorders in both diagnostic systems are the following:

· Generalized Anxiety Disorder

Characterized by almost constant fear and worry and present most of the days, with clear repercussions on person’s life.

· Panic Disorder

Characterized by unexpected, sudden and repetitive episodes of high anxiety that cause fear and concern that they will happen again and avoidance of situations that could trigger them.

· Agoraphobia

Characterized by intense fear of any situation in which it might be difficult to escape or be cared for and conscious avoidance of such situations.

· Specific Phobia

Exaggerated or disproportionate fear and discomfort in the face of certain situations or objects that do not represent such a danger (spiders, height, flying, etc).

· Separation Anxiety Disorder

It is characterized by high anxiety and fear before the potential separation of attachment figures and the avoidance of said separation.

· Selective Mutism

Inability to express oneself through speech in a certain context (for example, when facing an examination board or at school) but without difficulty in doing so in other situations (for example, at home).

· Social Phobia (or Social Anxiety Disorder)

Anxiety about social situations in general and fear of being seen by others as anxious. These situations are avoided or simply endured with intense discomfort.

Obsessive-compulsive disorders, as well as stress-related disorders, such as Post-traumatic stress Disorder (which are closely related to Anxiety Disorders) have been classified separately and not included in the category of anxiety D. in the most recent version of both classifications, when previously they were.

In DSM-5, but not in ICD-11, the diagnoses of substance/medication-induced anxiety disorder as well as Anxiety Disorder due to another medical condition are included.

Can anxiety disorders be cured?

With the advancement of pharmacological treatments and psychotherapy, high recovery rates and good control of symptoms are achieved.

Although anxiety disorders have historically been considered mild disorders, this is not entirely correct in a relative percentage of cases. Anxiety disorders unfortunately have a tendency to become chronic and can persist for long periods in life. They can be debilitating to the point that they are a common cause of work absenteeism, reduced productivity, sick leave and healthcare costs.

An early evaluation of the symptoms and a correct management and treatment are crucial when it comes to improving the prognosis. The cases that remain without treatment have, as a rule, a worse prognosis.

How is anxiety treated?

The treatment of anxiety disorders includes non-pharmacological as well as pharmacological interventions.

Within the former we find different types of psychotherapy (cognitive behavioral therapy stands out for its empirically proven effectiveness). Relaxation techniques and other forms of behavioral therapy are also helpful.

Regarding pharmacological treatments, SSRIs (selective serotonin reuptake inhibitors) are the most widely used. It is also common to prescribe Benzodiazepines, Hypnotics, other antidepressants as well as other drugs indicated in these disorders, such as Buspirone or B-adrenergic antagonists such as Propranolol.

Normally, it is the correct combination of drugs and therapeutic interventions, based on the particular needs of the patient, which, in the course of proper follow-up plans, first allows the relief of symptoms, then the remission of the disorder and finally its complete resolution after a certain period of time, in the most favorable cases.

When certain symptoms persist or if the clinical picture does not remit completely, it is necessary to help the patient minimize the impact that anxiety has on their relationships, on their projects and on their life in general. Adequate supervision of the treatment and the prevention of problems derived from it, such as dependence on BZD or adverse effects, is an essential part of the care that must be provided to the patient throughout the follow-ups.

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