How do you know when the anxiety that you are experiencing is more than what is considered to be “normal”?
There are many classifications of anxiety disorder. Below, we’ll look at the 6 most common anxiety disorders and their characteristics in detail, as well as define and briefly discuss the rest.
Each one has a list of common symptoms that are grouped into 4 areas:
Behavior
Emotions
Physical
Thoughts
If anxiety is experienced at a high frequency and intensity for extended periods of time, for example almost daily and continues for months at a time, you may be experiencing some type of anxiety disorder. These symptoms are usually disruptive and create significant interruptions in your life, affecting many areas including work, social activities, athletics and relationships to name just a few. Many people also find that the anxiety symptoms they are experiencing will fall under more than one anxiety type, but the good news is that most forms of anxiety can be treated using the same methods.
Common types of anxiety:
Generalized Anxiety Disorder (GAD)
Those who have Generalized Anxiety Disorder experience excessive and uncontrollable worry about daily life events and activities. They often have physical symptoms, including anxiety symptoms (racing heart, sweating, upset stomach, etc), fatigue and sore muscles, restlessness and they can also have trouble sleeping and concentrating. GAD is a chronic condition and is usually diagnosed once you have experienced anxiety and excessive worry nearly every day for a least 6 months.
People who have GAD tend to worry more often and about more things than other people do. Worrying about minor issues and small decisions are characteristic of someone who experienced GAD. In addition, those with GAD tend to have “chaining worries”, meaning one worry will lead to many others.
Other characteristics of GAD include perfectionism, being unable to tolerate uncertainty, looking to others to make decisions for you, avoidance or procrastination, being unable to delegate to others, information seeking or list-making, or excessively seeking reassurance.
Social Anxiety
While it is common to feel anxiety in social situations every so often, people with social anxiety disorder tend to feel quite nervous or uncomfortable in most, if not all, social situations. They worry that they will do something to embarrass or humiliate themselves, or that others will form a bad opinion of them. Those with social anxiety tend to be self-conscious and will constantly feel like they are being watched or are “on display”.
According to Anxiety Canada, there are 2 main classifications of social situation. These are performance interactions and interpersonal interactions. Performance interactions involve engaging in activities where they might be observed by others and include the following:
Participating in meetings or classes, eating in front of others, writing in front of others, entering a room where others are already seated or performing in front of people.
Interpersonal interactions are those that involve interacting with others and developing relationships. They include:
Job interviews, ordering food at a restaurant, talking on the phone, expressing opinions, dating, meeting new people or inviting others out socially.
Characteristics of social anxiety include: Thoughts – having negative thoughts about oneself or excessively thinking about anxious feelings. Common thought patterns may include “people will think I’m stupid” or “everyone will notice that I’m feeling anxious”; Physical symptoms – racing heart, sweating, dizziness, blurred vision, shaking, nausea/upset stomach or dry mouth. People with social anxiety tend to worry about others noticing these physical signs of anxiety; Avoidance behaviors – those who have social anxiety will often avoid or try to get out of social situations. They may also engage in protective behaviors to keep themselves “safe”. Examples of these are drinking alcohol, avoiding eye contact, or staying quiet.
Panic Disorder
People with panic disorder experience repeated panic attacks that take place at unexpected times. They become terrified that they will experience more attacks and they become fearful that something bad will happen as a result of the panic attack, for example, going crazy, losing control, or even dying.
A panic attack is different from panic disorder in that panic attacks are common and can occur as a result of feeling stressed, being overtired, or even from exercising excessively. Having the occasional panic attack does not signal panic disorder. Panic disorder is diagnosed in those who frequently worry about having more panic attacks or become fearful that something bad will happen as a result of their panic attacks, for example, fainting, having a heart attack, or dying.
This can become confusing, as panic attacks can also occur in those who experience other anxiety disorders, but the difference is that the panic attacks experienced in people who have panic disorder are unexpected and unpredictable. A panic attack experienced by someone due to a different anxiety disorder is triggered by a specific triggering event, for example, a person who is afraid of public speaking having a panic attack before giving a presentation.
Characteristics of panic disorder include changes in behavior to make oneself feel safer. Examples of this include having a companion accompany you places, making a point of sitting near exits or bathrooms, avoiding foods or beverages that might trigger panic symptoms or avoiding activities that may incite feelings of panic.
Obsessive-Compulsive Disorder (OCD)
People with Obsessive-Compulsive Disorder (OCD) will experience obsessions or compulsions or both. Obsessions are disturbing, unwanted images, impulses, and thoughts that enter the mind suddenly and cause a great deal of stress or anxiety. Compulsions are behaviors or thoughts that are carried out deliberately in order to counteract anxiety caused by obsessions. Examples of these include hand washing, checking or ordering, as well as counting to oneself or praying.
What exactly are obsessions?
There are many types of obsessions and those who have OCD tend to experience more than one. They are varied and depend strongly on the individual experiencing them. Obsessions often lead to compulsions and include the following: a need for things to be symmetrical or exact, fear of accidentally bringing harm to oneself or to others, consistently experiencing self-doubt, fear of coming into contact with germs, or repugnant obsessions which include doing something terrible to a loved one, sexual obsessions or obsessions that violate religious beliefs.
Characteristics of obsessions are: they are unwanted, out of control, or intrusive; they are time-consuming (occurring more than 1 hour each day); they cause stress or anxiety and interfere in your day-to-day life and they often lead to compulsions.
What are compulsions?
People who engage in compulsive behaviors as a way to try to prevent something bad from happening. Unfortunately, compulsions such as repeatedly checking can make people feel less sure of themselves. Examples of compulsions include repeated checking, washing rituals, ordering rituals, hoarding, mental rituals, or the need to confess.
Characteristics of compulsions are: they are repetitive, deliberate, and time-consuming (1 hour to perform per day at minimum). Compulsions cause a great deal of long-term anxiety and are related to obsessions.
Specific Phobias
Specific phobias are exactly as they sound – a fear of a specific thing, place or situation. People who experience these phobias will do whatever they can to avoid their specific phobia. These phobias are separated into 5 different categories:
Situational (fear of the dark or of being alone)
Animals (fear of dogs, spiders, etc)
Natural environment (fear of thunder, heights, etc)
Blood-injection injury (fear of needles, blood, etc)
Other (fear of becoming ill, choking, etc)
The most common reaction to a phobia is avoidance. While this is effective in the short term, over time it can make the phobia worse as you are telling yourself that there is danger present and will continue to avoid it as a result. In doing this, you are preventing yourself from learning new information about your phobia (for example, most spiders are harmless) and will make the phobia even stronger. Other reactions range from mild to severe anxiety, including experiencing panic attacks, feeling as though you are losing control or might die or physical symptoms like sweating, nausea, feeling faint, and increased heart rate or blood pressure.
Agoraphobia – while agoraphobia is its own classification of anxiety disorder, I have chosen to include it under the umbrella of phobias for simplicity. Agoraphobia is a fear of being in a situation where it may be difficult to escape or get help if it is needed. People who have agoraphobia are trying to avoid situations that they feel may cause them to have a panic attack or experience other anxiety symptoms. Situations that people with agoraphobia will try to avoid include: being in open spaces, riding public transportation, being in a line or in a crowd, being outside of their home alone, or being in an enclosed space.
If phobias become severe, they can affect your ability to effectively get through your day. The best way to overcome a phobia is to practice facing it head-on, rather than avoiding it.
Post Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD) is a mental health disorder that occurs after witnessing, being exposed to or experiencing a major trauma. These exposures can be related to actual or threatened death (for example, witnessing a murder, serious accident or natural disaster), serious injuries requiring extensive hospitalization; or sexual assault.
Exposure to these events is defined as:
Directly experiencing the event
Witnessing the event in person
Learning that it has happened to a close friend or family member
Experiencing repetitive extreme exposure to aversive details of the event
How common is PTSD?
While the majority of people will have at least one traumatic experience in their lifetime, most will not develop PTSD. The chance of experiencing PTSD is higher if the trauma was severe, lasted for a long period of time or if the event happened right in front of you. People who are most likely to develop PTSD are those who were in combat, victims of rape or sexual assault or those who experienced neglect or abuse in childhood.
PTSD symptoms are placed into the following 4 categories and you have to be experiencing symptoms from each category to have a diagnosis of PTSD.
- Intrusive symptoms. These include:
- Nightmares about the trauma
- Reliving the trauma
- Experiencing distress when reminded about the trauma
- Experiencing panic-like symptoms when reminded of the trauma
- Disturbing recurring memories about the traumatic event
- Symptoms of avoidance
- Avoiding thoughts, feelings, or memories of the trauma. Reminders can include conversations, people, places, objects, situations, or activities.
- Negative changes in mood or thinking
- Feeling distant or detached from others
- Negative beliefs or expectations
- Persistent negative mood
- Being unable to experience positive feelings
- Loss of interest in activities
- Being unable to recall details of the trauma
- Distorted beliefs about the cause/consequences of the trauma
- Arousal
- Behaving in reckless or self-destructive ways
- Angry outbursts or irritability
- Being startled easily
- Being hypervigilant
- Trouble sleeping
- Having difficulty concentrating
It is important to note that most people with PTSD will usually develop symptoms within 3 months of experiencing trauma, however, some may take months or even years to see symptoms that may not be triggered until they experience major stress or are exposed to something that reminds them them of the trauma.
PTSD is a complex disorder and the above information is intended to provide some information and insight into its characteristics. If you believe that you or a loved one may be suffering from PTSD, please do not try to self-diagnose. Seek a proper diagnosis from a registered psychologist or psychiatrist.
Other anxiety disorders include:
Separation Anxiety – Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. (Source: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5)
Hoarding Disorder – Persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty is due to a perceived need to save the items and to the distress associated with discarding them. (Source: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5)
Health Anxiety – Preoccupation with having or acquiring a serious illness. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals). Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. (Source: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5)
Body Focused Repetitive Behaviors – Body-Focused Repetitive Behaviours, or BFRBs, are a cluster of habitual behaviors that include hair pulling, skin picking, nail-biting, nose picking, and lip or cheek biting. Currently, the most recent edition of the clinician’s diagnostic manual (DSM-5), lists both hair pulling, called Trichotillomania, and skin picking, called Skin Excoriation, as BFRBs that are of clinical concern. (Source: Anxiety Canada – https://www.anxietycanada.com/disorders/body-focused-repetitive-behaviours/)