anxiety disorder anxiety disorder anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatiguability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual. anxiety disorderthe scream (norwegian: skrik) a painting by norwegian artist edvard munchspecialtypsychiatry, clinical psychologysymptomsworrying, fast heart rate, shakinesscomplicationsdepression, trouble sleeping, poor quality of life, substance use disorder, alcohol use disorder, suicideusual onset15–35 years olddurationover 6 monthscausesgenetic, environmental, and psychological factorsrisk factorschild abuse, family history, povertydiagnostic methodpsychological assessmentdifferential diagnosishyperthyroidism; heart disease; caffeine, alcohol, cannabis use; withdrawal from certain drugstreatmentlifestyle changes, counselling, medicationsmedicationbenzodiazepines, antidepressants, anxiolytics, beta blockers, pregabalinfrequency12% per year in casual discourse, the words anxiety and fear are often used interchangeably. in clinical usage, they have distinct meanings: anxiety is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas fear is an emotional and physiological response to a recognized external threat. the umbrella term anxiety disorder refers to a number of specific disorders that include fears (phobias) or anxiety symptoms. there are several types of anxiety disorders, including generalized anxiety disorder, illness anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. the individual disorder can be diagnosed using the specific and unique symptoms, triggering events, and timing. if a person is diagnosed with an anxiety disorder, a medical professional must have evaluated the person to ensure the anxiety cannot be attributed to another medical illness or mental disorder. it is possible for an individual to have more than one anxiety disorder during their life or at the same time and anxiety disorders are marked by a typical persistent course. anxiety disorders are the most common of mental disorders and affect nearly 30% of adults at some point in their lives. however, anxiety disorders are treatable and a number of effective treatments are available. treatment helps most people lead normal productive lives. types facial expression of someone with chronic anxiety generalized anxiety disorder main article: generalized anxiety disorder generalized anxiety disorder (gad) is a common disorder, characterized by long-lasting anxiety which is not focused on any one object or situation. those with generalized anxiety disorder experience non-specific persistent fear and worry, and become overly concerned with everyday matters. generalized anxiety disorder is "characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance". generalized anxiety disorder is the most common anxiety disorder to affect older adults. anxiety can be a symptom of a medical or substance use disorder problem, and medical professionals must be aware of this. a diagnosis of gad is made when a person has been excessively worried about an everyday problem for six months or more. these stresses can include family life, work, social life, or their own health. a person may find that they have problems making daily decisions and remembering commitments as a result of lack of concentration and/or preoccupation with worry. a symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae, and they may be tearful, which can suggest depression. before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes. in children, gad may be associated with headaches, restlessness, abdominal pain, and heart palpitations. typically it begins around 8 to 9 years of age. specific phobias the single largest category of anxiety disorders is that of specific phobias, which includes all cases in which fear and anxiety are triggered by a specific stimulus or situation. between 5% and 12% of the population worldwide have specific phobias. according to the national institute of mental health, a phobia is an intense fear of or aversion to specific objects or situations. individuals with a phobia typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. common phobias are flying, blood, water, highway driving, and tunnels. when people are exposed to their phobia, they may experience trembling, shortness of breath, or rapid heartbeat. thus meaning that people with specific phobias often go out of their way to avoid encountering their phobia. people understand that their fear is not proportional to the actual potential danger but still are overwhelmed by it. panic disorder main article: panic disorder with panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and/or difficulty breathing. these panic attacks, defined by the apa as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours. attacks can be triggered by stress, irrational thoughts, general fear or fear of the unknown, or even exercise. however, sometimes the trigger is unclear and the attacks can arise without warning. to help prevent an attack, one can avoid the trigger. this can mean avoiding places, people, types of behaviors, or certain situations that have been known to cause a panic attack. this being said, not all attacks can be prevented. in addition to recurrent unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. as such, those with panic disorder experience symptoms even outside specific panic episodes. often, normal changes in heartbeat are noticed, leading them to think something is wrong with their heart or they are about to have another panic attack. in some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis). agoraphobia main article: agoraphobia agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable. agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. a common manifestation involves needing to be in constant view of a door or other escape route. in addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that individuals often develop. for example, following a panic attack while driving, someone with agoraphobia may develop anxiety over driving and will therefore avoid driving. these avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. in a severe case of agoraphobia, the person may never leave their home. social anxiety disorder social anxiety disorder (sad; also known as social phobia) describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. this fear can be specific to particular social situations (such as public speaking) or, more typically, is experienced in most (or all) social interactions. roughly 7% of american adults have social anxiety disorder, and more than 75% of people experience their first symptoms in their childhood or early teenage years. social anxiety often manifests specific physical symptoms, including blushing, sweating, rapid heart rate, and difficulty speaking. as with all phobic disorders, those with social anxiety often will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation. children are also affected by social anxiety disorder, although their associated symptoms are different than that of teenagers and adults. they may experience difficulty processing or retrieving information, sleep deprivation, disruptive behaviors in class, and irregular class participation. social physique anxiety (spa) is a subtype of social anxiety, involving concern over the evaluation of one's body by others. spa is common among adolescents, especially females. post-traumatic stress disorder main article: post-traumatic stress disorder post-traumatic stress disorder (ptsd) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in dsm-v) that results from a traumatic experience. ptsd affects approximately 3.5% of u.s. adults every year, and an estimated one in eleven people will be diagnosed with ptsd in their lifetime. post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even a serious accident. it can also result from long-term (chronic) exposure to a severe stressor— for example, soldiers who endure individual battles but cannot cope with continuous combat. common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger and depression. in addition, individuals may experience sleep disturbances. people who have ptsd often try to detach themselves from their friends and family, and have difficulty maintaining these close relationships. there are a number of treatments that form the basis of the care plan for those with ptsd. such treatments include cognitive behavioral therapy (cbt), prolonged exposure therapy, stress inoculation therapy, medication, and psychotherapy and support from family and friends. post-traumatic stress disorder (ptsd) research began with vietnam veterans, as well as natural and non-natural disaster victims. studies have found the degree of exposure to a disaster has been found to be the best predictor of ptsd. separation anxiety disorder main article: separation anxiety disorder separation anxiety disorder (sepad) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder. separation anxiety disorder affects roughly 7% of adults and 4% of children, but the childhood cases tend to be more severe; in some instances, even a brief separation can produce panic. treating a child earlier may prevent problems. this may include training the parents and family on how to deal with it. often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child. in addition to parent training and family therapy, medication, such as ssris, can be used to treat separation anxiety. obsessive–compulsive disorder main article: obsessive–compulsive disorder obsessive–compulsive disorder (ocd) is not an anxiety disorder in the dsm-5 or the icd-11. however older versions: the dsm-iv and icd-10, classified ocd as anxiety disorder. ocd manifests in the form of as obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to repeatedly perform specific acts or rituals), that are not caused by drugs or physical disorder, and which cause anxiety or distress plus (more or less important) functional disabilities. ocd affects roughly 1–⁠2% of adults (somewhat more women than men), and under 3% of children and adolescents. a person with ocd knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior. their symptoms could be related to external events they fear, such as their home burning down because they forgot to turn off the stove, or worry that they will behave inappropriately. the compulsive rituals are personal rules they follow to relieve discomfort, such as needing to verify that the stove is turned off a specific number of times before leaving the house. it is not certain why some people have ocd, but behavioral, cognitive, genetic, and neurobiological factors may be involved. risk factors include family history, being single (although that may result from the disorder), and higher socioeconomic class or not being in paid employment. of those with ocd about 20% of people will overcome it, and symptoms will at least reduce over time for most people (a further 50%). selective mutism selective mutism (sm) is a disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. selective mutism usually co-exists with shyness or social anxiety. people with selective mutism stay silent even when the consequences of their silence include shame, social ostracism or even punishment. selective mutism affects about 0.8% of people at some point in their life. testing for selective mutism is important because doctors must determine if it is an issue associated with the child's hearing, movements associated with the jaw