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Current understanding classifies anxiety disorders in 5 main groups:-
Generalized Anxiety Disorder (GAD)
Obsessive Compulsive Disorder (OCD)
Social Anxiety Disorder (Social Phobia)
Panic Disorder
Post Traumatic Stress Disorder (PTSD)
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder involves feeling anxious about almost everything (and anything) for no apparent reason. Often, people with GAD will
worry constantly over a wide range of things such as health, safety, money, work, school and relationships.
Greater than the normal worries that we all have, with GAD the worry is constant and uncontrollable and people who suffer with this problem can
exist in a state of raised anxiety for much of the time.
A diagnosis of GAD may be given, if:-
• Worrying significantly affects our daily life, including work and social life.
• The worries are extremely stressful and upsetting.
• We worry about all sorts of things and also have a tendency to think the worst.
• The worrying is uncontrollable.
• We have felt worried nearly every day for at least 6 months.
Symptoms associated with GAD not only include the mental elements (worrying, over-thinking etc.) but also physical aspects relating to
anxiety in the moment and the long-tern effects of raised anxiety on the body. As such, they include:-
• A sense of dread
• Restlessness
• Irritability
• Ruminating
• Difficulty concentrating
• Feeling shaky and 'on edge' constantly
• Palpitations (strong/rapid/irregular heartbeat)
• Trembling
• Shortness of breath
• Sweating excessively
• Dizziness
• Dry mouth
• Feeling Sick
• Tiredness
• Muscle aches and tension
• Stomach pains
• Headaches
• Pins and needles
• Sleep problems
• Constant colds and flus
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Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder (OCD) generally involves persistent, uncontrollable and upsetting thoughts (obsessions) coupled with actions
and behaviours that we are compelled to do, seemingly against our own will (compulsions). In most cases, people are driven to perform the
compulsive behaviour in order to alleviate anxiety caused by the obsessive thoughts. It usually involves the following pattern:-
1. Obsession – unwanted, intrusive and often distressing thoughts, images or urges that repeatedly enter our mind.
2. Anxiety – the obsession makes us become extremely distressed and anxious.
3. Compulsion – repetitive behaviours and/or mental acts that we feel driven to perform to allay the anxiety caused by the obsession.
4. Relief (temporary) – the compulsive act or behaviour temporarily relieves the anxiety, but the obsession and anxiety soon returns,
causing the cycle to start again.
We all have bad, negative thoughts occasionally. In one study, fully 80% of the 'normal' people questioned (people that didn't have OCD) reported having obsessive
thoughts. The most common obsessions include:-
• Fear of contamination
• Fear of causing harm to someone else
• The fear of behaving unacceptably
• A need for symmetry or exactness
For obsessive thoughts to be diagnosed as a problem a number of criteria are considered. These include:-
 They must be present on most days for at least 2
successive weeks.
They must be a source of distress or interference
with activities.
They must be recognized as the individual's
own thoughts.
There must be at least one thought that
is still resisted unsuccessfully, even though others may be present which the sufferer no longer resists.
The thought of carrying out the act must not
in itself be pleasurable.
The thoughts or images must be unpleasantly
repetitive.
Generally speaking, the obsessive thought leads to corresponding compulsions, for example: If we just can't get it out of our mind that something is dirty (even if it isn't) we will
clean it incessantly no matter how clean it actually is.
Compulsive behaviours/actions often include:-
• Cleaning and washing
• Hand washing
• Constant Checking – eg. that doors are locked and appliances are switched off
• Counting
• Ordering and arranging
• The need for symmetry
• Hoarding
• Repeating words in our head
• Thinking 'neutralising' thoughts to counter the obsessive thoughts
For compulsive behaviours to be diagnosed as a problem a number of criteria are considered. These include:-
They must be present on most days for at least 2
successive weeks.
They must be a source of distress or interference
with activities.
They must be recognized as the individual's
own impulses.
There must be at least one act that
is still resisted unsuccessfully, even though others may be present which the sufferer no longer resists.
The thought of carrying out the act must not
in itself be pleasurable.
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Social Anxiety Disorder (Social Phobia)
Social anxiety disorder, also called social phobia, is a long-lasting and overwhelming fear of social situations. The feared situations can be numerous and
varied, however a common theme of being frightened of rejection flows through them all. This is often reflected in:-
• Worrying excessively that other people are looking at us and judging (critically) what we are doing.
• Feeling very uncomfortable and inadequate when being introduced to other people.
• Being really scared of going into shops or restaurants and the related...
• Worry about eating or drinking in public.
• Being unable to be assertive or stand up for our rights.
It's important to realise that the fears in social phobia are much stronger than those most people feel in social situations. Yes, we all get anxious to some
degree when entering rooms full of strangers or meeting new people, but with social anxiety disorder it's not just about nervousness, shyness or mild anxiety, it's
about extreme fear and panic – we are totally panic stricken. As such, the other main symptoms that we experience when social phobic are ones that relate to those mental
and physical aspects of anxiety (see GAD above) and panic.
A diagnosis of social anxiety disorder may be given when fears and anxieties severley restrict normal day-to-day activities.
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Panic Disorder
The common thread running through almost all anxiety disorders is panic. The excessive worrying (in GAD) can build into panic; we panic if we're unable to carry out
the compulsions and allay our anxiety (in OCD), and panic often ensues when we have to face social situations that scare us.
However, when we have a deep fear of the panic itself and panic attacks are experienced frequently 'out of the blue', with no apparent trigger, this is classified as panic disorder.
The symptoms of panic disorder comprise not only those mental and physical aspects of 'in the moment' panic, such as feelings of dread, a racing heartbeat, trembling, dizziness,
sweating etc. but also involve an extra mental element. This is another 'dread' or fear and revolves around the belief that there is something seriously
wrong with us.
Are we having a heart attack?
Are we going to die?
Are we going mad?
These fears are often so great that we live in almost constant dread of another panic attack, and quickly enter into a cycle of living in fear of
panicking → panic → fear of panicking → panic etc.
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Post Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) often results from the experience of frightening and traumatic events, either personally or as a witness. It is often seen in war
veterans (due to the horrors of war) but a wide range of traumatic experiences can give rise to this disorder. A common cause (not related to war) often involves
frequent emotional or physical abuse.
The symptoms of PTSD usually fall into three distinct categories:-
i) Re-experiencing
Re-experiencing is the most typical symptom of post traumatic stress disorder. This is when we frequently relive the traumatic event (involuntarily and vividly) in
the form of:-
• Nightmares
• Flashbacks
• Repetitive and distressing images or sensations
• Physical sensations, such as pain, sweating, feeling sick or trembling
ii) Avoidance and Emotional Numbing
This involves trying to avoid being reminded of the traumatic event(s) in a number of different ways:-
• Avoiding certain people or places that remind us of the trauma and not talking to anyone about the experience.
• Trying to push memories of the event out of our mind, often distracting our self with work or hobbies.
• Attempting to deal with feelings by trying not to feel anything at all. This is known as emotional numbing.
These actions can lead to becoming isolated and withdrawn.
iii) Hyperarousal (Feeling 'on edge')
Here, we are constantly aware of any possible threats around us, which causes us to become more sensitive, both physically and mentally. This is
often shown by:-
• Feeling constantly apprehensive
• Increased resting heartbeat rate
• Feeling tense and stressed often
• Irritability and difficulty concentrating
• Angry outbursts
• Sleep problems
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The above five 'disorders' define how we think about anxiety-related problems in society today. It is based on the medical model of these problems, which
views them as (mental) illnesses caused by something going wrong (in our brain), and that the answer lies in 'fixing' the thing that has gone wrong – often
with medication.
But is there a better explanation for these problems?
And a better solution?
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