Anxiety is one of the most common mental and emotional ailments clients face. Ironically, anxiety is natural part of life. It is intimately tied to the nervous system to help push individuals. Just like stress, it can help serve individuals to meet deadlines, face problems, and persevere under pressure. To remove all stress and stressors would be a bad thing in life, as well as to remove all future angst about future issues. Anxiety itself is ontological and part of one’s being. It is part of being alive (McRay, 2016).
The DSM-V-TR defines anxiety as “anticipation of future threat (2022)”. However, when anxiety is not proportionate with the actual threat, then it becomes a malignant worry. It creates a negative mood, but the mood becomes excessive and creates a variety of somatic physiological symptoms and tensions when it becomes a disorder (Barlow, et al., 2023). So, if a student has anxiety the night before an exam, this is not reflective of an anxiety disorder, but a true reflection of potential worry of not passing the exam, however, if a student exhibits consistent worry about not being good enough to succeed in life and this filters into almost every venue of life, then one can see where anxiety can unravel into pathology.
Please also review AIHCP’s Healthcare Certification programs in mental health.
Causes of Anxiety Disorders
How one reacts and handles stressors and future problems is key to living a successful life. It is not about not feeling these interior movements, but being able to cope with them and maintain them within normal levels. There are biological, psychological and social conditions that need to be considered to explain why some individuals are more prone to anxiety disorders than others. Biologically, individuals with anxiety disorders have lower levels of gamma-aminobutryic acid (GABA) which helps keep the neurons from firing and hence keeps individuals calmer (Barlow, et al., 2023). In addition, some individuals have issues within the limbic system and its association with fight of flight. An overstressed autonomic nervous system can keep a person’s sympathetic branch more alert and on fire due to past trauma. While PTSD is now considered a trauma disorder, anxiety is still closely tied to PTSD, and individuals suffering from a variety of anxiety disorders also experience overactive sympathetic branches (Barlow, et al., 2023).
Psychologically, there are different interpretations for why anxiety exists in some and not others. Psychoanalytic schools of Freud see anxiety a severe mechanical break down of systems. Freud considered anxiety to be an internal warning sign of the ego regarding subconscious conflicts or forbidden impulses. Behaviorists considered anxiety to be due to learned behavior regarding modeling from others or cognitively through uncorrelated ideas about the self and one’s surroundings (McRay, 2016). Parents who teach their child control and predictability also help create a healthy mindset for healthier thoughts about life, coping and resiliency (Barlow, et al., 2023). In addition, parents who are overbearing and controlling, impede the child’s ability to become resilient and also incur interior fears about life that can later manifest as anxiety.
Social factors also play a key role in one’s dance with anxiety. Past traumatic events can weaken the autonomic nervous system. In addition, numerous losses, as well as interpersonal distresses ranging from divorce to loss of a family member can lower one’s ability to resist future anxiety disorders. These disorders then can effect other aspects of social functioning (Barlow, et al., 2022).
Spiritually, one’s faith can also play as a key anchor against anxiety. In fact, any world view or existential meaning in life can help one find security in times of angst. Existentialist philosophy teaches that the world is filled with trouble, loss and anxiety but it how one faces it that determines one’s control of life direction. Instead of avoidance, hiding, or fear, world views can help individuals find courage, fortitude and faith in their direction.
An integrated model for anxiety vulnerability best illustrates why some succumb to anxiety disorders and others do not. One must look a diathesis models that look at genetic vulnerabilities, life stressors, and mental and cognitive world views that all come together to overwhelm an individual. Biological vulnerabilities include inherited traits. Generalized psychological vulnerabilities include world views, such as believing the world is a dangerous and unsafe place. Finally, specific psychological vulnerabilities are what one learns from individual experience or what is taught in childhood (Barlow, et al., 2022). When an event occurs that challenges everything, some individuals may be weakened enough to enter into a disproportionate response of anxiety.
Types of Anxiety Disorders
The DSM-V-TR lists 7 anxiety disorders. Again, it is important to notate, OCD and PSTD are no longer listed with core anxiety disorders albeit they exhibit anxious symptoms and are closely related. In addition, hoarding and various picking at self disorders are tied with OCD. The manual follows life span development as its means of listing order for anxiety, as well as all disorders. It lists Separation Anxiety, Selective Mutism, Phobia, Social Anxiety Disorder, Panic Disorder, Agoraphobia, General Anxiety, and Substance/Meditation-Induced Anxiety Disorder (DSM-V-TR, 2022).
In this short blog, we will look at General Anxiety Disorder (GAD), phobias, Social Anxiety Disorder (SAD), Panic Disorders with Agoraphobia and Separation Anxiety. Please also review AIHCP’s Stress Management Program.
GAD
General Anxiety Disorder involves unsubstantiated worry over numerous dimensions of life and is not just tied to one thing, such as an attachment to one person, or how one is viewed in public. The disturbances are excessive in nature and occurring for more days than not over a period of 6 months. The individual is unable to stop or control worrying. The symptoms are tied to restlessness or being on edge, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbance. The DSM-V-TR states that only 3 or more of these symptoms are required. Key to the diagnosis is that the anxiety causes extreme impairment in social, occupational, or other important areas of functioning (DSM-V-TR, 2022). GAD is also associated with increase suicidal thoughts and behaviors. It also can have a comorbidity with depression disorders. Anxiety is usually tied at a higher percentage to women but also occurs in men.
Selective Phobias
Phobias are unrealistic reactions to things that cause heightened anxiety even without the object or thing or place present. Natural to survival and the autonomic nervous system is the reaction to fear through the sympathetic branch and its fight or flight responses. Hence fear is a negative effect within the sympathetic nervous system that alarms the body to present danger (Barlow, et al., 2023). It is important to note that many fears that become phobias are tied to natural biological and evolutional reactions. Avoiding the dark, or being careful in high places, or be cautious around potential poisonous creatures as snakes or spiders are good things but phobias hijack the sympathetic nervous system and cause disproportionate anxiety to these things even when they are not present. Phobias are coded in the DSM-V-TR according to animals such as snakes or spiders, natural environment such as heights, water or storms, blood injection-injury such bodily fluids, needles, or injections, or situational such as airplanes, elevators or enclosed places (2022).
Diagnosis involves a heightened and fearful anxiety regarding any of the listed phobias. The situation or thing must always provoke immediate anxiety or fear. These things or places are actively avoided or endured with intense fear. The fear or anxiety is out of proportion with the reality of danger. The fear or anxiety is persistent for 6 months are more. The fear or anxiety causes social impairment in social, occupational or other areas of functioning and these symptoms are not explained through other mental or substance issues (DSM-V-TR, 2022).
SAD
Social anxiety disorder is anxiety that is disproportionate based on social implications of performance, speaking, or being in social settings. Ironically, for some performers, regular social settings may not cause anxiety but for others everyday interaction in social settings, even if they are not speaking or performing can cause anxiety. Hence these individuals become extremely nervous even in school, or parties, or other events. It revolves around perceptions of how they perceive they are seen, or viewed by others. A microscopic lens is placed over every action or word they say. This may be due to fear of rejection, embarrassment or ridicule. While again, it is natural sometimes to feel some anxiety within social norms in everyday life or if performing the next day, the anxiety associated with SAD impairs functioning. It overtakes the person and causes intense somatic symptoms even upon the thought of social activity. In addition, panic attacks can associate with SAD prior to an event or during a social setting. Many sometimes will completely avoid functions, or mask it with substance abuse issues. Social anxiety disorders are more highly diagnosed with women and also children entered into their teen age years but can happen to both men and women.
Sometimes closely tied to SAD is body image. Since SAD focuses on anxiety surrounding on perceptions of others, Body Dysmorphic Disorder can play a big role especially in teens. BDD focuses on minute or even non-existent perceived flaws in the body. This subjective issue becomes a obsessive pursuit through various compulsions to alter or make better these small blemishes. For some, this disorder is then tied to SAD.
The DSM-V-TR utilizes the following diagnosis criteria. It lists marked fear or anxiety regarding one or more social interactions that expose an individual to possible scrutiny that involves conversations, social events, dates, meeting unfamiliar people, as well being observed by others. The manual notes that individuals feel they will be negatively evaluated, humiliated, or embarrassed or rejected. The social settings must always provoke fear or anxiety. In addition, the individual will look to avoid these settings and the fear and anxiety is out of proportion with the actual sociocultural context. The fear or anxiety must present itself for 6 months or more and causes intense impairment. These conditions are not attributed to other mental disorders or substances (2022).
Panic Disorders and Agoraphobia
Panic disorders are continual and persistent panic attacks. Arogaphobia is fear of public places with crowds due to the fear of possible panic attacks. Both are separate disorders but are tied closely together due to the nature of panic attacks. Panic disorder according to the DSM-V-TR is a recurrent phenomenon where an abrupt level of anxiety manifests within minutes. It can be expected or triggered or even unexpected in some cases. The attacks can occur one per week for months, or less frequent attacks separated by weeks or months. Not all panic attacks are tied to Panic Disorder since some panic attacks are tied to Social Anxiety Disorder. Panic Disorder and panic attacks cause somatic physiological symptoms that include palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills or heat sensations, paresthesias, derealization, and fear of loss of control or dying (2022). The DSM-V-TR also states that anxiety and fear over future panic attacks are followed within the month, especially in regards to the symptoms, as well as maladaptive measures to avoid future panic attacks (2022). Of course, these disturbances are not due to any other diagnosed mental issue or substance or medication.
Those who suffer with Agoraphobia fear public situations where possible panic attacks could occur and the embarrassment or issues that may occur if in a public area because of it. The DSM-V-TR lists public transportation, open public spaces like super markets or parking lots, enclosed places like theatres, large crowds or standing in line, or being alone outside of the home. The person faces extreme anxiety over these thoughts and will actively look to avoid these places to the point of impairing one’s social, professional and academic life. The fear is disproportionate, persistent and lasts for over 6 months and is not caused due to other diagnosed mental illness, substance or medication (2022).
Separation Anxiety
Separation anxiety deals with intense disproportionate fear and dread of being separated from a caregiver, loved one, or a child. It is more common in children but can also manifest in adults with children. This should not be misinterpreted for natural anxiety after a traumatic event or even a new parent, but is a persistent and disproportionate reaction that involves fear and dread of losing a loved on or something bad happening to oneself when the loved one is not present. Traumatic events, unhealthy attachments as a child, or overbearing parenting can lead to potential development of Separation Anxiety Disorder.
The DSM-V-TR states criteria for diagnosis states that excessive fear or anxiety regarding anxiety must manifest in three or more examples. Recurrent or inappropriate fear when anticipating or experiencing separation. Persistent worry about losing a major attachment figure to illness, injury, disaster or death. Worry of kidnapping, accidents, illness, or unfounded events. Refusal to go other places for fear of separation with figure. Persistent fear about being alone with the other figure. Trouble sleeping without or being away from home without the other figure. Repeated nightmares involving the scheme of separation with the figure and somatic physiological ailments such as headaches, stomach aches, vomiting and nausea stemming from the anxiety (2022). These issues must persist for 6 months in adults and 4 weeks in children and cause impairment in all social spheres of life. Again, it cannot be attributed to other mental illness, substance or medication.
Treatment
In all of these cases of anxiety, suicidal ideation can be a symptom to closely monitor. Obviously, some individuals will exhibit mild, moderate or severe and need treatments based on their individual needs. In addition, it is important during treatment to be aware of any comorbidities such as depression that may exist with presenting problem or diagnosis. It is also important to be mindful of cultural aspects that can normalize certain actions that may seem abnormal to other cultures. Finally, it is important to be delicate in diagnosis to prevent labeling and other mental health stigma (DSM-V-TR, 2022).
In clinical settings, Cognitive Behavioral Therapies (CBT) are the most utilized behavioral therapy to help the person reframe and rethink their anxieties. Some individuals with Anxiety Disorders have a recognition of of illogical thinking despite the feelings and can rationalize while others have differing levels of lack of logical thinking and are completely controlled by these thoughts. For instance, an adult with Separation Anxiety Disorder may acknowledge the improbability of bad things occurring to loved a one but still feel the anxiety while others may be completely under the delusion that something will happen. This happens also in cases of hoarding and OCD. CBT can help individuals better rationally reframe reality from fantasy and help individuals rethink what they are experiencing. For instance, someone who is facing Social Anxiety Disorder, may be able to reframe negative images and perceptions of what others are thinking into positive and more likely things, or even recognize that their perception of being the center of attention is not a reality. In regards to phobia, exposure therapies are a key way to help individuals face exaggerated anxiety. Many behaviorists believe that pathology is tied to operant and classical conditioning during childhood. How someone was raised or how their behavior was influenced plays key roles to phobias and anxiety. With phobias, new learned experiences can help reshape the neuroplasticity of the brain and how it perceives threats. Exposure therapies gradually create new experiences (Barlow, et al., 2022).
In addition to CBT and other cognitive behaviors, pharmacological treatments can help alleviate anxiety. Benzodiazaphines can help GABA levels become more stable and calm the person (McRay, 2016). Xanax, as well as Ativan can help alleviate the intense lack of calm and anxiousness and help the person find peace but it is important to note that long term use of these drugs exceeding 2 weeks or a month can lead to addiction. Hence these drugs are more for acute purposes instead of long term treatment. Many issues associated with anxiety is also tied with serotonin levels. SRRI can play a role in helping regulate mood. Paxil is a common drug used to help individuals with anxiety that can be used long term and help regulate mood (Barlow, et al., 2023).
Other holistic and natural remedies can also be utilized. Supplements for GABA under the care of a healthcare professional can be utilized as well as calming techniques, meditation, and prayer. In addition, hypnosis and EFT can also play key roles in helping manage anxiety. Please review AIHCP’s EFT Practitioner Program
From a Pastoral approach, pastoral care givers should be ready to refer clients to clinical professionals but they can also aid with coping skills, reframing, and helping individuals find meaning. For Christians, biblical approaches that tie the person to the life of Christ and how biblical characters faced anxiety can be modeling examples. In addition, how does one’s faith approach anxiety and worry? Analyzing faith and teachings can help build resiliency within the person. Spirituality is many times forgotten or swept under the rug, but spirituality plays a key role in how one thinks and feels in life. It is hence important to include pastoral approaches that address existential and spiritual explanations for anxiety in life (McRay, 2016).
Conclusion
Anxiety is natural but also the most common mental malady. Diagnosis is not a simple process but a complex one. While all these disorders differ in some degree, the primary culprit is a disproportionate anxiety response. Causes can range from biological, psychological, social and spiritual in nature. Helping others understand and sometimes helping them at a medical level is key to helping control and maintain anxiety.
Please also review AIHCP’s Stress Management Consulting Program as well as AIHCP’s multiple healthcare certifications in grief, crisis, anger, meditation, trauma informed care and spiritual counseling.
Additional AIHCP Blogs
Stress Management and Anxiety Disorders, Click here
EFT and Anxiety. Access here
Additional Resources
Anxiety Disorders. Mayo Clinic. Access here
Anxiety Disorders. Cleveland Clinic. Access here
Guy, Evans, O. (2025). “7 Types of Anxiety Disorders: Signs, Causes, & Management”. Simply Psychology. Access here
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.
Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th ed.). Cengage Learning
McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic