“The stress response is incredibly ancient evolutionarily,” says Robert Sapolsky, professor of neurology at Stanford University. “...just look at the dichotomy between what your body does during real stress — for example, something is intent on eating you and you're running for your life — versus what your body does when you're turning on the same stress response for months on end for purely psychosocial reasons.”
But when that stress response is chronic and interferes with your quality of life on most days, it means you may have an anxiety disorder. If you do, you’re not alone — an estimated 3 million Canadian adults (11.6%) have a mood and/or anxiety disorder.
Keep reading to inform yourself on the types of anxiety disorders and their differences, in addition to symptoms, risk factors, diagnosis, and treatment options.
Types of anxiety disorders: An overview
Anxiety disorders come in several not-so-fun flavours that are important to identify for the right treatment approach. They can occur separately or overlap with each other. Talk to a healthcare practitioner if you see yourself in any of the following:
Generalized anxiety disorder (GAD)
Generalized anxiety disorder is a common type of anxiety that’s characterized by persistent worrying for at least six months.
GAD isn’t specific to any one life event, and it comes with physical symptoms such as muscle tension, difficulty sleeping, irritability, and restlessness. People who experience GAD may fixate on the possibility of worst case scenarios, need a lot of reassurance from the people in their life, or over-prepare for simple tasks.
Panic disorder causes episodes of intense fear, either out of nowhere or due to a variety of triggers. Panic attacks are characterized by shortness of breath, a racing heartbeat, shaking, sweating, dizziness, tingling, or nausea. You may also experience disassociation, a feeling of being disconnected from yourself or your surroundings. Most panic attacks last between five and 20 minutes.
If you experience a panic attack, it doesn’t necessarily mean you have panic disorder. While up to a third of Canadians may have a panic attack at some point in their life, only 4% of Canadians have panic disorder.
You may have panic disorder if your panic attacks are increasing in frequency over a period of weeks or months. People with panic disorder fear the panic attacks themselves, which can bring on more panic attacks — it’s a vicious cycle that’s a marker of the condition.
Obsessive compulsive disorder (OCD)
Obsessive compulsive disorder (OCD) is the complex interplay between obsessions — intrusive thoughts, images, or impulses — and compulsive behaviours such as washing, checking, counting, etc. that are meant to assuage the obsessions.
OCD affects 1%–2% of Canadians. You may have OCD if you spend an hour or more of your day thinking about your obsessions and then carrying out your compulsions without receiving any pleasure or satisfaction.
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is an anxiety disorder triggered by a traumatic event like sexual violence, physical violence, serious injury, threatened death, etc. You may develop PTSD if you witness these events, too. An estimated 8% of Canadians who experience a traumatic event develop PTSD.
The symptoms of PTSD include intrusive thoughts or unwanted dreams related to the event, on top of hyper-vigilance, anger, irritability, difficulty sleeping, or avoidance of anything related to the event. PTSD can last anywhere from a few weeks to several years, and people can begin to see symptoms at any point after the event happened.
Social anxiety disorder
Social anxiety disorder is a phobia of social situations, such as meeting new people or speaking in front of others. People who experience social anxiety are preoccupied by a fear of looking “stupid” in front of other people, and they may feel scared to be judged.
The physical symptoms of social anxiety include stomachaches, shallow breathing, sweating, tightness in your chest, a racing heartbeat, dizziness, and muscle tension. People with social anxiety may avoid any situation that can trigger the anxiety, which can affect their personal relationships, work advancement, or their ability to have new life experiences.
Separation anxiety disorder
Separation anxiety disorder is usually diagnosed in children, but adults can experience it, too.
People who experience separation anxiety disorder have an intense fear of being away from their loved ones, often worrying that something bad will happen to their family or friends while they’re away. They often experience many of the physical symptoms of anxiety when they’re separated from their attachment figures.
Agoraphobia is an intense fear of public places, specifically where it may be difficult to escape or find help if something bad happened. People with agoraphobia may be housebound in the most extreme cases, but more commonly they fear elevators, bridges, public transportation, airplanes, and malls. They may also fear certain places where they have experienced a panic attack.
Agoraphobia can develop at any point in life, but people typically show signs in late adolescence or early adulthood. Between 0.5%–1% of Canadians experience agoraphobia.
Phobias are anxiety directed to specific situations or things, such as:
Flying in an airplane
Insects or other animals
Symptoms of anxiety disorders
Anxiety symptoms vary by type, but the most common symptoms include:
Excessive worrying or fixation on worst case scenarios
Difficulty sleeping or poor quality sleep
Irritability and restlessness
Weakness, dizziness, or fatigue
Stomach issues, such as cramps, diarrhea, or constipation
Hyperventilation or shortness of breath
Avoidance of people, places, or situations
Why does anxiety develop in some people and not others?
The exact cause of anxiety is unknown, but psychologists and other healthcare professionals think a combination of genetic predisposition, environmental factors, life triggers, and personality traits may all contribute to whether or not someone develops anxiety at some point in their life.
Here are some possible risk factors for anxiety:
Family history of anxiety
Exposure to a stressful event
Other physical or mental health conditions that cause anxiety
First, your healthcare practitioner will ask about your symptoms to rule out any underlying physical conditions, such as a thyroid or hormone condition. Some chronic health conditions have symptoms that are similar to anxiety, and your doctor may order blood tests or a urine analysis if they suspect your symptoms are physical.
Do you have trouble falling or staying asleep, or sleeping too much?
Do you have trouble concentrating on things, such as reading the newspaper or watching television?
Are you fidgety or restless that you have been moving a lot more than usual?
Do you feel nervous, anxious, or on edge?
Are you unable to stop or control worrying?
Your healthcare practitioner will ask you to answer each question based on whether or not you experience the situation within the last two weeks as not at all, several days, more than half the days, or nearly every day. Each answer is scored, and further evaluation is recommended when the score is 10 or higher.
If your healthcare practitioner thinks you have an anxiety disorder based on the initial assessment, they may prescribe medication, ask more questions to specify the type of anxiety disorder, and/or refer you to a therapist, psychologist, or psychiatrist for more treatment.
Anxiety treatment options
Anxiety is a condition that should be managed with a multi-pronged approach. A combination of medication, behavioural therapy, and lifestyle changes is the strongest strategy to treat anxiety disorders. Here’s what that strategy can look like:
Medications for anxiety
Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can treat anxiety in addition to depression, as the mechanisms behind both are similar. Medications like Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), and Lexapro (escitalopram) are commonly prescribed for anxiety.
Many people who take antidepressants for anxiety see a reduction in disruptive physical symptoms, such as difficulty sleeping, muscle tension, and headaches. While they may still feel anxious, antidepressants may take the edge off enough so that someone can get the benefits of therapy.
Keep in mind that it can take three weeks for antidepressants to take effect, and they do come with side effects such as nausea, diarrhea, insomnia, drowsiness, headache, dry mouth, dizziness, restlessness, and low libido — but these symptoms usually get better or go away after four to eight weeks.
Benzodiazepines are medications like Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam).
Benzodiazepines affect the GABA neurotransmitter, which is responsible for muscle relaxation and sleep. They’re taken when someone needs immediate relief from anxiety, as they act fast and don’t stay in the body for very long.
Side effects of benzodiazepines are similar to any medication that can make you drowsy, including confusion, dizziness, impaired coordination, and vision problems.
Propranolol, a beta-blocker, is sometimes prescribed off-label for event-based anxiety. Beta-blockers may also be prescribed for long-term use, especially for post-traumatic stress disorder.
Beta-blockers prevent the release of the stress hormones adrenaline and noradrenaline, which slows heart rate and reduces the symptoms of anxiety by slowing heart rate. They’re more commonly prescribed to treat a variety of heart conditions, and they should never be prescribed to anyone who has asthma, as they can trigger asthma attacks.
Medication can be an effective treatment but most do come with side effects so be sure to discuss that with your healthcare practitioner.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is the most effective form of talk therapy for anxiety. With CBT, people with anxiety learn to identify, question, and change the thoughts and beliefs that lead to their reactions in situations that cause anxiety.
A CBT therapist will ask questions that guide a person with anxiety to monitor and record their thoughts in upsetting situations so they can identify thought distortions, recognize that their thoughts are not necessarily facts, and consider their thoughts through a new lens.
Lifestyle changes to manage anxiety
While anxiety disorders require therapy and/or medication for proper management, there are some things you can do on your own to improve your quality of life as you work through your anxiety.
If you are having suicidal thoughts, please seek help immediately by going to your nearest emergency department or by calling 911. You can also contact Crisis Services Canada's national suicide-prevention hotline at 1-833-456-4566 if you are considering suicide or are concerned about someone who may be.