Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Anxiety

(Chronic Free-Floating Anxiety; Generalized Anxiety Disorder)
by Amy Scholten, MPH
Definition

Anxiety is a normal state of dread, tension, and unease. It is considered a normal response to stress or uncertain situations. Prolonged or intense periods of anxiety may suggest an anxiety disorder. A disorder may also be indicated if anxiety:

  • Impairs daily functioning
  • Occurs without an external threat (“free-floating” anxiety)

The most common types of anxiety disorders are:

Anxiety is often complicated by the presence of alcohol or drug abuse and depression .

Causes

Anxiety may result from many factors including:

  • Biological factors:
    • Brain chemistry imbalances (eg, serotonin and norepinephrine)
    • Personality traits
  • Drugs that affect the nervous system, such as:
  • Appropriate response under stressful circumstances
  • Faulty perceptions and irrational beliefs (eg, phobias)
  • Unresolved emotional conflicts
Risk Factors

A risk factor increases your chance of getting a disease or condition. Risk factors for anxiety include:

  • Family member with anxiety disorders
  • History of physical or psychological trauma
  • Ineffective coping strategies
  • Sex: female
  • Stressful life events
Symptoms

Psychological symptoms may include:

  • Ambivalence
  • Fear or panic
  • Impatience
  • Irritability
  • Obsessive or intrusive thoughts
  • Restlessness
  • Sense of imminent danger or catastrophe
  • Trouble concentrating
  • Worry or dread

Physical symptoms may include:

  • Choking sensation
  • Constipation
  • Diarrhea
  • Difficulty sleeping
  • Dry mouth
  • Feeling of "butterflies" in the stomach
  • Flushing or blushing
  • Frequent urination
  • Lightheadedness or faintness
  • Muscle tension
  • Nail biting or other habitual behavior
  • Nausea or vomiting
  • Rapid or irregular heartbeat
  • Sexual difficulties
  • Shaking
  • Shortness of breath
  • Sweating, especially the palms
  • Tingling sensations

Diagnosis

Your doctor will ask about your symptoms and medical history. A psychiatric evaluation will be done. Your doctor may also perform a physical exam and diagnostic tests. Usually the results of these tests are normal. You may be referred to a psychotherapist for further evaluation.

Treatment

Effective treatment usually involves a combination of interventions, including:

Lifestyle Changes
Relaxation Techniques
  • Deep breathing
  • Deep muscle relaxation
  • Engaging in pleasurable activities
  • Massage
  • Meditation
  • Yoga
Social Support
  • Counseling to improve coping skills
  • Strong support system of family and friends
  • Support groups
Psychotherapy

This therapy addresses thoughts, feelings, and behaviors that play a role in anxiety. It helps you work through traumas and conflicts.

Cognitive-behavioral therapy can help you identify negative thought patterns and behaviors. Over time, you can learn to retrain your thinking. This will help you choose better options in response to stress and anxiety.

Cognitive-behavioral therapy has been found to be particularly effective in children and teens. BE

Medication

For severe anxiety or anxiety disorder, medicines may include:

  • Antidepressants (eg, tricyclic antidepressants, selective serotonin reuptake inhibitors [SSRIs])
  • Benzodiazepines
  • Buspirone

If you are diagnosed with an anxiety disorder, follow your doctor's instructions .

Prevention

To help prevent anxiety, consider taking the following steps:

  • Work with a therapist .
  • Avoid situations, occupations, and people that cause you stress.
  • Avoid using nicotine or other drugs. Drink alcohol in moderation
  • Challenge irrational beliefs and counterproductive thoughts.
  • Correct misperceptions. Ask others for their views.
  • Develop and maintain a strong social support system.
  • Express your emotions when they happen.
  • Find a relaxation technique that works for you. Use it regularly.
  • If unavoidable, confront and overcome situations that provoke anxiety.

BE = This therapy has the best evidence available showing that it is effective.

Last reviewed: September 2011 by Ryan Estevez, MD, PhD, MPH.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed July 15, 2009.
  • Generalized anxiety disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 21, 2011. Accessed March 10, 2011.
  • Generalized anxiety disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/ . Accessed June 18, 2008.
  • Nietzel MT, Wakefield JC. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders . 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.
  • Tierney LM, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment . 45th ed. New York, NY: McGraw-Hill;2006.
  • 12/4/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Javnbakht M, Hejazi Kenari R, Ghasemi M. Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract. 2009;15(2):102-104.