What are anxiety disorders?

We all experience occasional feelings of anxiety, worry and fear. These can be normal responses to certain situations. For example, you might worry about an upcoming interview for a job, or that you are able to pay a bill on time. If you are in a difficult or dangerous situation, these feelings can give you an awareness of the risks and what you need to do.
If you have an anxiety disorder, these feelings are more noticeable and difficult to live with. They can make you feel as though things are worse than they actually are. This can lead to you worrying all or most of the time and can affect your day to day life.
Symptoms of anxiety include:

• feelings of dread, panic or ‘impending doom’,
• feeling on edge or irritable,
• heightened alertness,
• difficulties sleeping,
• changes in appetite,
• difficulties concentrating,
• depersonalisation, and
• wanting to escape from the situation you are in.

You might also experience physical symptoms, which can include:

• sweating,
• heavy and fast breathing,
• hot flushes or blushing,
• dry mouth,
• shaking,
• hair loss,
• fast heartbeat,
• dizziness and fainting

What are the different types of anxiety disorder and how are they diagnosed?

There are different types of anxiety disorders. The following sections go into more detail for each condition.

• Agoraphobia
• Body dysmorphic disorder (BDD)
• Generalised anxiety disorder (GAD)
• Hair pulling (Trichotillomania)
• Obsessive compulsive disorder (OCD)
• Panic disorder (panic attacks)
• Post-traumatic stress disorder (PTSD)
• Skin picking
• Social anxiety disorder
• Toilet-related anxiety

Agoraphobia

Agoraphobia is an anxiety disorder where you have an intense fear of certain situations, including:

• leaving your home,
• being in public spaces,
• using public transport, and
• being in crowded spaces
• You might find that these situations make you feel distressed, panicked and anxious. You may avoid some situations altogether. This can affect your day-to-day life.

Agoraphobia can make it difficult to make an appointment with your GP to talk about your symptoms. You might not feel able to leave your house or go to the GP surgery. You can arrange a telephone appointment if you have symptoms of agoraphobia. A GP will make a diagnosis by asking you questions about your symptoms. You may need further assessment from a psychiatrist for to get a formal diagnosis.

Body dysmorphic disorder (BDD)

If you have body dysmorphic disorder (BDD), you will worry a lot about how you look or a particular part of your body. Although other people may not notice or see it the same way, it will make you feel distressed. You may think you have an odd body shape compared to other people or that a scar makes you look unattractive. BDD is not the same as being vain or self-obsessed.
BDD can make you do things that take up a lot of time.

• Staring at your face or body in the mirror
• Comparing your features with other people’s
• Covering yourself excessively with makeup
• Considering plastic surgery when you do not need it

BDD can lead to depression. Some people with BDD have suicidal thoughts or feelings.
If you think you have BDD, you should speak to your GP. If they feel you have BDD, then they should discuss treatment options with you. The GP may arrange for a mental health worker who is experienced in BDD to help you.

Generalised anxiety disorder (GAD)

If you have generalised anxiety disorder (GAD), you feel anxious a lot of the time. This may feel out of your control. You might feel ‘on edge’ and alert to your surroundings.
This can affect your day-to-day life. You might find that it affects your ability to work, travel places or even leave the house. You might also get tired easily or have trouble sleeping or concentrating. You might experience physical symptoms, including :

• muscle tension,
• headaches,
• sweating,
• nausea,
• ‘butterflies’ in your stomach, and
• a fear of fainting.

It is common to have other conditions such as depression or other anxiety disorders if you have GAD.
GAD can be difficult to diagnose because it does not have some of the obvious symptoms of other anxiety disorders. Your doctor is likely to say you have GAD if you have felt anxious for most days over six months.

Hair pulling (Trichotillomania)

Hair pulling is a condition where you feel the urge to pull out your hair. This can be from your scalp or other places such as your arms, eyelashes, legs or pubic area. You will find it difficult to stop yourself doing this. It is linked to obsessive compulsive disorder (OCD).
You might experience a build-up of tension, which you can relieve by pulling out the strand of hair. You might not even be aware that you’re doing it.
It can be difficult to stop, which can lead to hair loss. This in turn can make you feel guilty, embarrassed and affect how you feel about yourself or how your friends and family see you.
Your GP will look at the following to diagnose your condition:

• You repeatedly pull your hair out, causing noticeable hair loss
• You feel increasing tension before you pull your hair out
• You feel relief or pleasure when you have pulled your hair out
• There are no underlying illnesses, such as a skin condition, causing you to pull your hair out
• Pulling your hair out affects your everyday life or causes you distress
• If you are concerned about your appearance, you could arrange a wig from the NHS.

Obsessive-compulsive disorder (OCD)

An obsession is an unwelcome thought or image that repeatedly enters your mind and is largely out of your control. These can be difficult to ignore. You may not want these thoughts and they can be disturbing, which can make you feel distressed and anxious.
Compulsions are things you think about or do repeatedly to relieve the anxiety from your obsessive thoughts.
You might believe that you or someone close to you might come to harm if you do not do these things. You may realise that your thinking and behaviour is not logical but still find it very difficult to stop.
There are different types of OCD, which include:

• Contamination
• Checking
• Intrusive thoughts
• Hoarding

When you first see a healthcare professional like a GP about your symptoms, he or she will ask you about them. This helps them to find out if you have OCD, how severe your symptoms are and what treatment will be best for you.

Panic disorder (panic attacks)

A panic attack makes you feel anxious and frightened. It happens suddenly and feels intense. You also have physical symptoms. These can include the following.

• An overwhelming sense of dread or fear
• Chest pain and/or a sensation that your heart is beating irregularly
• Feeling that you might be dying or having a heart attack
• Sweating and hot flushes or chills and shivering
• A dry mouth, shortness of breath or choking sensation
• Nausea, dizziness and feeling faint
• Numbness, pins and needles or a tingling sensation in your fingers
• A need to go to the toilet
• A churning stomach
• Ringing in your ears

It can be common for people having panic attacks to experience a sense of detachment from who they are. This is known as depersonalisation. It is thought that this may be the mind’s way of dealing with the intense sensations associated with panic attacks.
For some people, certain situations cause panic attacks. For example, if someone has a fear of small spaces and has to board a plane, they may have a panic attack then.
Panic attacks can be linked to variety of different anxiety disorders. Panic disorder is where you have regular panic attacks and there is no particular trigger. This can make you worry about when you might have another attack. If this happens, you may get a diagnosis of panic disorder.

Post-traumatic stress disorder (PTSD)

You can develop post-traumatic stress disorder (PTSD) if you experience a traumatic or frightening event. It can develop shortly after the event, or sometimes months or years later. Types of situations that can cause PTSD include:

• being a victim of serious violent crime or sexual assault,
• being subjected to prolonged sexual abuse, violence or severe neglect,
• witnessing a death or a violent attack on someone else,
• being involved in military combat,
• situations working for the emergency services,
• surviving a severe accident, such as a road traffic accident,
• being held hostage, and
• experiencing natural disasters, such as an earthquake.

PTSD causes feelings of intense fear, helplessness and horror. You can have panic attacks, nightmares and flashbacks (seeing images or visions of the past event in your mind).
You may find it very difficult to relax. This can lead to problems with sleep, concentration and anger management.
People with PTSD often avoid places, people, conversations or experiences which remind them of the trauma. This can become very isolating and can lead to emotional numbing.
To get a diagnosis of PTSD, you will usually have to show symptoms for more than a month. You may feel less able to socialise, work or carry out everyday activities.

Skin-picking

Skin-picking is a condition where you will repetitively pick at your skin. This can cause damage to your skin, including bleeding, bruising and sometimes permanent marks. You will usually pick the skin on your face, but might also pick other areas of the body. You will find it difficult to stop yourself doing it.
It seems that skin-picking can relieve tension and stress. However, often the relief is short-lived, and you will feel the urge to continue picking. You may not be aware that you are doing it.
Because skin-picking leaves visible marks, you might go to lengths to hide these using makeup or clothing.
Your GP may arrange for you to see a specialist mental health doctor like a psychiatrist for diagnosis.

Social anxiety disorder

Social anxiety disorder (sometimes known as social phobia), means you will have an intense fear or dread of social or performance situations.
Some common situations where you may experience anxiety are:

• Speaking in public or in groups
• Meeting new people or strangers
• Dating
• Eating or drinking in public

You will be worried that you will do something or act in a way that is embarrassing or humiliating.
You might feel very aware of the physical signs of your anxiety. This can include sweating, a fast heartbeat, a shaky voice and blushing. You may worry that others will notice this or judge you. As a result you might find that you try to avoid such situations completely. You might realise that your fears are excessive, but will find it difficult to control them.
Your GP will ask you questions about your symptoms, and might ask you to fill out a questionnaire. This will help them find out what how anxious you feel in social situations.
If you feel that it would be difficult to visit your GP, you can ask for a telephone appointment.

Toilet anxiety

This is a fear of using toilets in either your own home, someone else’s home or in public spaces. This can lead to difficulty and embarrassment when needing to use the toilet.
You may:

• fear that other people can hear you using the toilet,
• worry about the cleanliness of the toilet, or
• worry about being able to use the toilet at all.

Anxiety UK runs a special project on toilet anxiety. You can find their contact details at the end of this section.

• Irritable bowel syndrome (IBS), stomach aches and sickness.

Source:  https://www.rethink.org/diagnosis-treatment/conditions/anxiety-disorders

New Research into Anxiety Disorders

Nearly one in five Americans have been diagnosed with some form of anxiety disorder. These range from panic attacks and post-traumatic stress disorder to social phobias and obsessive-compulsive disorders.
Anti-anxiety drugs or antidepressants can curb symptoms that interfere with day-to-day life. And these drugs are big business. In 2013, Americans filled 48 million prescriptions for the benzodiazepine drug alprazolam (Xanax). Patients also picked up 27 million prescriptions for sertraline (Zoloft), an antidepressant drug that also helps some people with anxiety.

Yet, while many people do find relief in these drugs, they don’t work for everyone. Benzodiazepines can interfere with normal thinking and induce drowsiness. They also can be highly addictive, so doctors are reluctant to prescribe them for people with a history of substance abuse. Zoloft and other selective serotonin reuptake inhibitors (SSRIs) also don’t work for everyone. They can cause nausea, jitters, insomnia, suicidal thoughts, and loss of libido.
However, researchers are teasing out another option for reducing anxiety. When stress kicks in, so would this experimental drug.
“By targeting specific enzymes,” said neuroscientist J. Megan Gray, “we can minimize side effects.”
Researchers from Calgary to Southern California are investigating the inner struggle between one brain chemical that keeps stress in check and another that is part of the body’s fight or flight response. Many of these investigators talked about their latest findings during the November 2014 Society for Neuroscience conference in Washington, D.C.
The brains of humans and some animals naturally synthesize endocannabinoids, molecules that help regulate functions including appetite, mood and response to stress. An ample supply of endocannabinoids keeps anxiety under control, and this is the function that Gray and her colleagues at the Hotchkiss Brain Institute at the University of Calgary want to boost.
When something stressful happens — a deadline approaches or travel plans go awry — the fight or flight response floods the brain with corticotropin-releasing hormone (CRH). It degrades endocannabinoids and turns anxiety on. That’s like releasing the parking brake when a car is parked on a hill. The new drug would boost the level of endocannabinoids in the brain, creating a buffer against CRH’s action.
Endocannabinoids and the active compounds in marijuana both bind to the same brain receptors, which is why some people self-medicate by smoking marijuana.
“Often, if you go to a medical marijuana place and tell them you have anxiety, they’ll give you marijuana,” said James Lim, a neuroscientist at the University of California-Irvine. The problem is that cannabis also contains many other chemicals, including harmful tars, that complicate the reaction. If researchers can design an endocannabinoid-boosting compound that is simpler, said Gray, “we can better understand what people are exposing themselves to.”
Previously, researchers assumed that the stress “parking brake” system acted the same in everyone. But new research during the November conference points to a different model — that some people’s brains synthesize more endocannabinoids than others, and that people with higher levels can handle more stress.
Researchers have long known that some people can take more metaphorical heat than others. “Some kids can undergo a lot of traumatic events in early life and turn out just fine,” said University of Michigan researcher Pam Maras. “Some undergo relatively minor things and turn out to have severe anxiety and depression.”
Numerous researcher teams are using rat models to try to understand how stress responses can be manipulated, and they reported their findings at the conference.
In separate experiments, Gray and Lim tinkered with endocannabinoid levels in rats. Both found that rats with higher levels acted less anxious after being exposed to stress. Lim made part of a maze scary by tainting it with the scent of a fox’s feces. Rats with more stress-braking power would explore the tainted regions of the maze. More timid rats avoided it for as long as seven days after the scent was laid down.
Two other research groups, working independently in Ohio and Colorado, manipulated CRH levels in different ways but arrived at complementary results.
At Kent State University, neuroscientist Lee Gilman blocked CRH receptors in mice, shutting out the stress-inducing peptide and enabling them to approach other, unfamiliar mice.
At the University of Colorado-Boulder, Christopher Lowery is interested in how the brain responds to repeated social defeat. For example, what happens when a child is repeatedly bullied? He mimicked this by putting a male rat into the home cage of another male rat, where the newcomer would be forced to surrender to the more dominant native. In his study, rats that faced social defeat over and over produced more CRH each time, and were more quickly immobilized by fear during later encounters.
However, as Lim and Gilman both observed, some animals can put the brake on anxiety longer than others. Clinicians know this is true for humans; what the laboratory scientists are probing is when and how those differences manifest in the brain.
Michigan researcher Pam Maras sees evidence that these differences begin early in development. Her more nervous rats began displaying excessive anxiety as early as 11 days after birth, which corresponds to the fifth week of life for an infant. Animals that did not manifest anxiety at that point grew up to be more resilient to stress, though Maras can’t say why.
“We don’t have an answer for that right now,” said Maras. “It’s exciting sometimes when you don’t have an answer, because that means that there’s more to do.”
Some people are probably born more vulnerable to anxiety disorders than others. And although they might benefit greatly from a medication that puts a brake on runaway anxiety, scientists have a lot to learn before such a drug will be ready for clinical use.

Source:  http://psychcentral.com/blog/archives/2015/01/15/new-research-into-anxiety-disorders/