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Anxiety Disorders

Anxiety Disorders

What are anxiety disorders?

Anxiety disorders are a group of mood disorders characterised by excessive worry, fear and anticipation of impending danger. Common types of anxiety disorders include "panic disorder", "separation anxiety disorder", "social anxiety disorder", "specific phobia" and "generalised anxiety disorder". Anxiety disorders can cause significant distress and impairments of daily life to the patient.

Anxiety is a basic human emotion which has essential meaning for survival but excessive anxiety is harmful

Everyone experiences some level of anxiety each day. Anxiety and fear are a natural response to potential threats. The uncomfortable nature of "anxiety experience" alerts us to avoid danger. However, when anxiety is excessive, it becomes highly uncomfortable and negatively affects our functioning. The relationship between performance and anxiety level takes an inverted U shape; moderate level of anxiety improves performance, but when anxiety gets too high, performance will decrease.

The relationship between performance and anxiety level

When anxiety becomes pathological

To determine if the anxiety we feel is too much and become pathological, we have to see whether the level of anxiety is appropriate to our threat, whether it has persisted for too long, and how much it has adversely affected our daily functioning. The duration, intensity and circumstances for the excessive anxiety vary widely among different forms of anxiety disorders.

 

How common are anxiety disorders?
Prevalence rate

Prevalence rates of anxiety disorders vary for different countries and age groups. For Chinese Hong Kong residents aged 16-75, prevalence rate of generalised anxiety disorder is 4.2%, while other anxiety disorders have a prevalence rate of 1.5%.

Gender ratio

The proportion of female to male patients for anxiety disorders is approximately 2:1, but there is no significant gender difference for social anxiety disorder.

Age of onset

Most cases of separation anxiety and specific phobias develop during childhood; most cases of social anxiety disorder develop in adolescence or early adulthood; most cases of panic disorder and generalised anxiety disorder develop during later adulthood, with a greater dispersion of onset age. Certainly, there are individual differences for illness onset.

 

What causes anxiety disorders?

 what causes anxiety disorders?

Genetic and environmental factors are both involved. A family history of anxiety disorder, traumatic experience in childhood, heightened anxiety in parents, stressful life events, and insufficient coping strategies, etc. all contribute to the risk of anxiety disorders.

 

What are the symptoms of anxiety disorders?

Below are some major symptoms of anxiety disorders:

Cognitive and emotional
  • Highly distressing and excessive worry
  • Anticipation of impending danger with little chance to escape
Physiological
  • Abruptly increased heart beat, rapid breathing
  • Anticipation of impending danger with little chance to escape
  • Chest and gastrointestinal problems
  • Muscle tension, aches or fatigue
  • Dry mouth
  • Sweating
Below are the symptoms of common types of anxiety disorders:
Specific phobia

Specific phobia is characterised by excessive and irrational fear to a particular object or situation. Sometimes, panic attack can be triggered. Commonly feared objects and situations include flying, heights, animals, receiving an injection, and seeing blood, etc. In extreme cases, the fear response is not only cued by the real object or situation, but also at the mere mentioning or sight of visual representations of it, leading to avoidance behaviours. Some patients may suffer from more than one type of specific phobia at the same time.

Social anxiety disorder

Social anxiety disorder is characterised by persistent strong fears of social situations where others’ judgment and evaluation are expected. This fear can be so strong that individuals may avoid places or events where they may act in a way that will be negatively evaluated, or they would remain quiet in social situations to avoid drawing others’ attention. When around other people, they may palpitate, blush, tremble, draw a blank, stutter, sweat, or even have difficulty breathing and feel dizzy.

Generalised anxiety disorder

Generalised anxiety disorder (GAD) is characterised by multiple excessive worries persisting for few days or even months. Worries can widely involve various kinds of daily events, such as job, safety of family members, finances, or infection, etc. These worries are often uncontrollable and shifting. Patients are usually overwhelmed by persistent symptoms including fatigue, fidgeting, difficulty concentrating, irritability, insomnia, and so forth.

Panic disorder

Panic disorder is characterised by repeated ‘panic attacks’, which, under no obvious threats, lead to intense fear and physical symptoms such as palpitation, shortness of breath, sweating, trembling, chest discomfort, and dizziness etc. Patients often perceive these symptoms as signs of life-threating illnesses, and worry for losing control or even imminent death. To prevent intense physical symptoms and distress, patients often make great efforts to avoid certain places or situations. But such avoidance can increase feelings of fear and anxiety, resulting in a vicious cycle of panic and anxiety. Some patients with panic disorder may also develop agoraphobia, which is an avoidance of crowded places or places where immediate escape is difficult (e.g. railway station, intercity buses, or unfamiliar subway).

Separation anxiety disorder

Separation anxiety disorder often occurs during childhood. Patients show developmentally inappropriate and excessive anxiety when being separated from their attachment figures, such as their parents or caregivers. Cognitively, they often worry about being abandoned by their parents or losing them due to accidents. As a result, they are unwilling to be left alone. Behaviourally, they may call their parents excessively to seek assurance during separation, or simply refuse to go to school.

In addition to children, separation anxiety disorder can also occur during adolescence or adulthood. The figure of attachments can be their parents, caretakers, spouse or offspring.

 

 

What are the treatments of anxiety disorders?

Treatment of anxiety disorders mainly include psychotherapy and medication.

Psychotherapy

Cognitive-behavioural therapy aims to build up the affected persons' own abilities to manage their problems, and it is an effective treatment choice for most anxiety disorders such as specific phobia, social anxiety disorder, generalised anxiety disorder and panic disorder. Its treatment usually covers the domains of cognition, behaviour, and physiology.

  Way of treatment
Cognition
  • The main focus is on modifying catastrophic, irrational and maladaptive thoughts such as developing a more balanced appraisal on the possibility of catastrophe occurrence, modifying absolute thinking or overgeneralization
Behaviour
  • This may include exploring active ways of problem-solving, effective skills of stress management
  • If a particular situation triggers anxiety, exposure of the situation may be gradually increased to build up the patient's successful experiences and confidence in coping with the situation
Physiology
  • This is to equip patients with relaxation skills and techniques to cope with or ease their stress reactions
Medication

When there are serious symptoms of anxiety or panic, patients may follow doctor's prescription to alleviate their symptoms with medication.

Type Second generation antidepressants Tranquilizers
Common drugs
  • Selective Serotonin Reuptake Inhibitors (SSRI), e.g.
    • Citalopram (Cipram)
    • Fluxetine (Prozac)
    • Sertraline (Zoloft)
  • Serotonin and Noradrenaline Reuptake Inhibitors (SNRI), e.g.
    • Venlafaxine (Efexor)
  • Benzodiazepines, e.g.
    • Diazepam (Valium)
    • Lorazepam (Ativan)
    • Alprazolam (Xanax)
Indications Effective in treating most anxiety disorders except specific phobia
  • Relieve the symptoms of anxiety
  • Have calming and sleep promoting effects
Mechanism of action Work by regulating the neurotransmitters activities, such as norepinephrine and serotonin in the brain Work by regulating the neurotransmitters activities, such as GABA, serotonin, noradrenaline on the brain GABA receptors
Side effects /points to note
  • SSRIs:
    • Fatigue, nausea, gastro-intestinal upsets, sweating
  • SNRIs:
    • Dry mouth, gastro-intestinal upsets, nausea, fatigue
  • Because it takes 2 to 4 weeks for the medications to bring out symptoms improvement, at the beginning of treatment, the patient might still have much distress from the symptoms
  • Dizziness, drowsiness, somnolence, fatigue, body imbalance, loss of memory, difficulty in carrying out voluntary movements, dry mouth, impaired coordination, drugs dependence, withdrawal symptoms
  • Avoid taking any alcoholic beverages
  • This kind of drugs has a high potency to be abused, so patients must comply with doctors’ instructions when taking these medications

If patients experience any undesirable side effects during drug treatment, please consult the doctor as soon as possible to clarify the worries and make appropriate adjustments.

 

How to help and support people with anxiety disorders?
Tips for caregivers:
Avoid blaming:

People with anxiety disorders may get anxious from situations that are difficult for others to understand; they may avoid social contact, isolate themselves, or be involved in various kinds of inconveniences. Families should try to learn more knowledge about the disorders and avoid blaming them to prevent adding further distress to them.

Be a good listener:

Encouraging, but not forcing, them to share their feelings and difficulties, listening to them patiently, showing acceptance, and giving time and appropriate supports to them.

Maintain regular life:

Providing a peaceful and comfortable environment for them, and facilitating them to engage in regular daily activities as far as possible.

Encourage social interactions:

Encouraging them to maintain personal interactions with others, such as keeping contacts with those they have good relationship or they feel comfortable to meet.

Get more understandings:

Helping them to gain more understanding of their course of illness, and encouraging or accompanying them to seek treatment and cooperate with mental health care professionals.

Monitor regularly:

It is not uncommon for people with anxiety disorders also suffer from depressed mood. Pay attention to any changes in mood and mental state of the individual. If any self-harming behaviours and/or abnormal behaviours are noted, one should seek help from health care professionals as soon as possible.

Take care of yourself:

Supporting emotionally disturbed people is a long-term challenge. So carers need to look after their own physical and mental health, to rest and regenerate, and then to accompany patients to get out from troubled time. Ask for help when necessary.

 

 

 

 

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Reference source(s): Websites of the Institute of Mental Health Castle Peak Hospital, Kwai Chung Hospital and Child Assessment Service, Department of Health