What Are Anxiety Disorders?
Anxiety is a normal, adaptive emotion that prepares us to respond to threat. An anxiety disorder exists when anxiety becomes persistent, disproportionate to the actual danger, and begins to impair daily functioning. Anxiety disorders are the most common mental health conditions globally, affecting 284 million people worldwide and 40 million adults in the United States.
Types of Anxiety Disorders
Generalised Anxiety Disorder (GAD)
Excessive, difficult-to-control worry about multiple everyday topics (work, health, finances, family) on most days for at least 6 months. Associated with restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. GAD affects ~6.8 million US adults.
Panic Disorder
Recurrent unexpected panic attacks — sudden surges of intense fear peaking within minutes — accompanied by physical symptoms (pounding heart, sweating, shortness of breath, chest pain, dizziness, feeling of unreality or detachment). Crucially, persistent worry about future attacks and behavioural changes to avoid them distinguish panic disorder from isolated panic attacks.
Social Anxiety Disorder (Social Phobia)
Intense fear of social situations in which the person might be scrutinised or judged — leading to avoidance of social interactions, public speaking, eating in public, or meeting new people. It is one of the most common anxiety disorders, often beginning in adolescence, and is consistently undertreated.
Specific Phobias
Marked, disproportionate fear of specific objects or situations — spiders, heights, flying, blood, needles — that provokes immediate anxiety and is actively avoided. Specific phobias are highly treatable with exposure therapy.
Agoraphobia
Fear and avoidance of situations where escape would be difficult or help unavailable during a panic attack — open spaces, public transport, crowds, queues, or being outside the home alone.
What Causes Anxiety Disorders?
Anxiety disorders arise from an interaction of genetic vulnerability (family history increases risk ~5-fold), early life adversity, temperament (behavioural inhibition in childhood), and environmental stressors. Neurobiologically, overactivation of the amygdala (fear centre) and underregulation by the prefrontal cortex play central roles.
Evidence-Based Treatments
Cognitive Behavioural Therapy (CBT)
CBT is the gold standard psychological treatment for all anxiety disorders, with the strongest evidence base. It targets the cognitive distortions (catastrophic thinking, overestimating threat) and behavioural patterns (avoidance) that maintain anxiety. Exposure therapy — systematically confronting feared situations — is the most powerful component, producing lasting improvements in 60–80% of patients.
SSRIs and SNRIs
Selective serotonin reuptake inhibitors (sertraline, escitalopram, paroxetine) and SNRIs (venlafaxine, duloxetine) are first-line pharmacotherapy for GAD, panic disorder, and social anxiety. They take 4–6 weeks to show full effect. SSRIs are generally well tolerated; common side effects include initial nausea, sleep changes, and sexual dysfunction. They should be continued for 9–12 months after response before gradual tapering.
Buspirone
A non-benzodiazepine anxiolytic effective for GAD. Not addictive, no sedation, but requires 2–4 weeks to work. Not effective for panic disorder.
Benzodiazepines
Fast-acting (lorazepam, diazepam, clonazepam) but carry significant risks: tolerance, dependence, cognitive impairment, falls in older adults, and withdrawal seizures on abrupt discontinuation. Generally reserved for short-term crisis use or situations where faster relief is needed while waiting for SSRIs to work.