Anxiety is a natural and universal emotion, generated by a psychological mechanism of response to a threat. When anxiety persists even after the end of the potentially anxiogenic events, it becomes a pathological condition known as anxiety disorder, characterized by a permanent state of tension that compromises the person’s ability to function and making judgements. Pathological anxiety has negative effects on the life-quality for those who suffer from it; it can cause social isolation, it can compromise the regular performance of daily activities and work and, over time, can also lead to health issues.
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Tests and diagnosis
In order to diagnose an anxiety disorder and exclude other conditions, your doctor may ask you to complete a psychological questionnaire. Your doctor will carry out a physical examination to check for signs of links between anxiety and an underlying medical condition.
To reach a diagnosis of anxiety, you must fulfil the criteria listed by the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association, and it used by doctors and psychologists to diagnose mental health conditions. Diagnostic criteria and symptoms are different for each form of anxiety disorder. Anxiety disorder is often accompanied by other mental health issues, such as depression or substance misuse, which may make diagnosis and treatment more challenging.
Complications
Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:
- Depression (which often occurs with an anxiety disorder)
- Substance abuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Headaches
- Teeth grinding
Risk factors
Sex. Women are more prone to developing an anxiety disorder.
Childhood trauma. Children who endured abuse or trauma are at higher risk of developing an anxiety disorder at some point in life.
Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.
Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety; for example, a death in the family, work stress or ongoing worry about finances.
Personality. People with certain personality types are more prone to anxiety disorders than others are. Moreover, some personality disorders such as borderline personality disorder may be related to an anxiety disorder.
Family history. If you have a direct relative with an anxiety disorder, you are more likely to develop it too.
Drugs and alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.
Droghe o alcol. Uso o abuso di droga o alcool possono causare o peggiorare l’ansia.
Causes
Just like for many mental health conditions, causes of anxiety are not fully understood. There are several theories on the origin of anxiety. Some say it comes from pre-existing psychological conflicts (life experiences or traumatic events seem to trigger anxiety disorders in people who are already prone to become anxious), while others focus on the biological elements of anxiety, that is to say, changes to some chemicals found in the nervous system, caused neurotransmitters. These changes may cause psychological issues.
Medical causes
For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.
Examples of medical problems that can be linked to anxiety include:
- Heart diseases
- Diabetes
- Thyroid problems (such as hypothyroidism or hyperthyroidism)
- Asthma
- Drug abuse
- Alcohol withdrawal
- Withdrawal from anti-anxiety medications (benzodiazepines)
- Rare tumours that produce certain hormones
- Muscle cramping or spasms
It’s possible that your anxiety may be due to an underlying medical condition if:
- symptoms of anxiety start after the age of 35
- You don’t have any blood relatives (such as a parent or sibling) with an anxiety disorder
- You didn’t have an anxiety disorder as a child
- There have been no events in your life which may have triggered an anxiety disorder
- Anti-anxiety medication does not seem to relieve or treat symptoms of anxiety
Symptoms
Anxiety can cause psychological as well as physical symptoms.
- Psychological symptoms include:
- Tension
- Feeling nervous
- Excessive worry for yourself and others
- Insomnia
- Crying easily
The fear of crowded places or the dark gradually increases, leading to panic attacks, which are characterised by a deep distress that leads to a progressive reduction of activity which may cause the subject to feel paralyzed. People suffering with anxiety live in a constant feeling of danger and tension causing them to fear accidents, misfortunes or failure, which makes them unable to tolerate waiting and competitive situations.
- Symptoms of anxiety can affect the whole body, and they include:
- Palpitations
- Vertigo
- Nausea
- Sweating
- Sexual dysfunctions
- Visual difficulties
- Migraine
- Weakness
- Shaking
- Breathing rapidly
- Colitis
Several types of anxiety disorders exist:
Panic attacks can start suddenly and cause worry, fear, or terror. You may feel an impending sense of doom, have troubles breathing, have palpitations or chest pain. You may feel like you are about to choke.
Agoraphobia is an anxiety disorder related to open spaces, and situations that might cause you to panic and make you feel trapped or helpless.
Specific phobias are characterized by major anxiety when the subject is exposed to a specific object and they may cause the desire to avoid it. These phobias can sometimes cause panic attacks in some people.
Social anxiety involves high levels of anxiety caused by being exposed to certain social situations, causing the desire to avoid them.
Obsessive-compulsive disorder involve persistent, recurring thought, images or impulses (obsessions) associated with the overwhelming desire to perform irrational or seemingly pointless rituals or actions (compulsions). It often involves both obsessive and compulsive behaviours.
Post-traumatic stress disorder causes you to feel like you are about to experience a traumatic event again. It involves intense emotions and physical reaction, as well as a desire to avoid anything that may remind you of the specific event.
Acute stress disorder causes symptoms similar to those of post-traumatic stress disorder, but these happen immediately after an extremely traumatic event.
A generalized anxiety disorder involves at least six months of persistent and excessive anxiety cause by little or big worries. This type of anxiety disorder can often start at an early age. It is often associated with other forms of anxiety or depression.
Anxiety disorder due to a medical condition includes symptoms of intense anxiety that are directly caused by a physical health problem.
Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, or a toxic substance.
Separation anxiety disorder is a childhood disorder characterized by anxiety related to separation from parents or others who have parental roles.
The term “unspecified anxiety disorder” is used for anxiety or phobias that don’t meet the exact criteria for any other anxiety disorders but are significant enough to be painful and disruptive.
