The transition from fear to anxiety is sliding and many people experience periods in their lives with concerns and fears for the future without it being classed as a disorder.
Three types of anxiety
Doctors and psychologists typically divide anxiety into three different groups:
These groups can further be divided into subgroups, each of which can display mild, moderate or severe symptoms. Common to all anxiety disorders is that the person has a feeling of a diffuse threat and that the body responds with a stress reaction, which readies the person for fight or flight and behaviour where the person tries to deal with or avoid the diffuse threat.
Lost signalling function
To diagnose a definite anxiety disorder, the anxiety must have lost its normal function of signalling a threat to be reacted to.
For some, anxiety can be so strong that they are inhibited or prevented from taking part in normal life, for example, shopping, taking part in social activities, taking the bus or walking outdoors alone.
This lack of signalling function means that anxiety is triggered in non-threatening situations, that the anxiety reaction is too powerful or long-lasting in relation to the actual threat, or that the anxiety is directed toward circumstances far ahead in the future.
Agoraphobia covers a number of phobias whose shared feature is that you can have an anxiety attack in situations where it is difficult or embarrassing to get away. This may be in shops, on public transport, or in places where there are lots of people, for example, at a concert, on a bridge or in a tunnel. For some, the condition is so severe that it can be problematic for the person to leave home. The anxiety can typically be alleviated if the person is accompanied by a trusted acquaintance.
But it also means that agoraphobia commonly affects a family's social life and that the person with agoraphobia develops a dependency on their supportive partner.
On the other side, the partner may find that they have to make many considerations, which can lead to tension in the relationship.
Simple phobias are limited to isolated situations or things, for example, certain animals, enclosed spaces such as caves, elevators, trains and planes.
Simple phobias have three elements:
- Expectation anxiety over encountering that which triggers anxiety (e.g. having to take a flight)
- Actual anxiety that is experienced in the situation
- Avoidance behaviour directed at evading the things and situations that can provoke anxiety.
Social phobia is characterised by the person experiencing anxiety when together with other people in smaller groups. This may especially be in situations where the person is the object of attention, for example, in company or dining situations, or if you have to make a presentation and will be evaluated, for example, at a job interview or exam.
The person will typically experience problems with blushing, have difficulty breathing, trembling hands and a fear of throwing up. The person is afraid of making a fool of themselves, being humiliated or being laughed at.
Social phobia can lead to pronounced avoidance behaviour, where the person isolates themselves which can lead to social handicaps and result in the person missing out on many important events.
Obsessive anxiety is characterised by the person continually experiencing recurrent obsessive thoughts that give rise to a pronounced mental or physical unease, and impulses to carry out repetitive ritual behaviours. A common example is recurrent thoughts of a serious threat of infection which leads to frequent hand washing before the person can become calm.
- Obsessive thoughts and compulsive actions are two different phenomena:
- Obsessive thoughts covers irresistible, recurrent and unwanted thoughts, mental images, feelings or sensations.Compulsive actions covers a repeated, ritual and typically symbolically loaded behaviour that the person is unable to resist doing. Compulsive actions do not lead to happiness but can relieve tension and anxiety.
In professional terminology this anxiety is termed Obsessive Compulsive Disorder, better known as OCD.
Panic anxiety is experienced as a very frightening sensation of being about to die, go insane or lose control. The person experiences very powerful bodily reactions such as quickened heart rate, palpitations, sweating, tightness in the chest and head and breathing difficulties.
Psychologically, the person experiences extreme fear verging on terror.
Panic attacks can occur unexpectedly and suddenly or in connection with having to expose yourself to situations you find unpleasant.
Generalised anxiety disorder
Generalised anxiety is experienced as a state of persistent anxiety that is not limited to particular situations.
Common experiences are tension, nervousness, shaking, stomach problems, sweating and tremors and breathing difficulties.
A diagnosis of generalised anxiety is made if a person has experienced these sort of symptoms through most of the day over several months.
Anxious worry is a condition where a person's thoughts are dominated by things that might go wrong, for example personal finances, health, accidents or imagining being abandoned by those closest to them.
This can be common for all and is only considered an anxiety disorder when the scope and intensity begin to hinder the person's daily life.
Expectation anxiety is the fear of being in situations that could trigger an anxiety attack - also known as the fear of fear. Expectation anxiety is often more disturbing than the situations which originally gave rise to the anxiety. That is why expectation anxiety is the source of avoidance behaviours that lead to limitation and loss of quality of life by hindering your participation in normal social life.
Chronic anxiety/tension is expressed as physical symptoms such as muscle tension, fatigue, insomnia, irritability, restlessness and concentration problems.
These are commonly the symptoms that you and people around you notice, either when you visit your doctor or feel out of sorts and uncomfortable for a long period.
Traumatic anxiety can arise following a violent incident that may have threatened your health, safety or life. This can take the form of reliving an event, either in images, sounds or ideas or a persistent feeling of being on alert.
This is closely related to the diagnosis post-traumatic stress disorder (PTSD) and it is important to determine whether it is PTSD or not with your own doctor.