What is Anxiety?

iStock_000060940758_LargeAnxiety disorders are the most common mental health disorders. They affect 18% of adults in the United States in any given year, with a lifetime prevalence of 29% of all Americans (National Institute of Mental Health). Nearly all people experience anxiety at times, such as prior to public speaking or taking an exam. An anxiety disorder is more than just a temporary feeling. It is relatively long-lasting, can get worse over time, and significantly interferes with a person’s daily activities.

There are several different types of anxiety disorders. The most common anxiety disorders are:

These disorders take different forms, but share a common feature of excessive fear or anxiety. Fear is the emotion people feel in response to an immediate threat, whether real or imagined.  Anxiety is the anticipation of future threat. Another common feature of anxiety disorders is avoidance behavior, such as excessive hand-washing to prevent contamination (active avoidance) or not leaving home for fear of having a panic attack (passive avoidance).

Until recently, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) were grouped with anxiety disorders because of the role of fear and anxiety in both of these disorders. In the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013, these disorders were for the first time considered separately, although most clinicians agree that they are still closely related to anxiety.

Anxiety disorders or anxiety-like symptoms can also be caused by substance use or withdrawal, prescribed medications, or the physical effects of a medical condition.

Anxiety disorders are frequently seen with other mental health conditions known as co-occurring disorders. The most common co-occurring disorders for anxiety are: depression, substance use disorders, ADHD, autism spectrum disorders and eating disorders.


Most people feel anxiety in certain situations and circumstances. For a diagnosis of a specific anxiety disorder to be made, a qualified health professional must:

• evaluate the symptoms and course of the illness over a period of at least six months
• rule out causes by other medical conditions, psychiatric disorders or substance use
• determine that the disorder has caused a significant impairment in the person’s functioning

Specific anxiety disorders share some features in common, while others are unique to each disorder. Some common signs of an anxiety disorder are:

Excessive worry – Frequent intense worry about situations, activities or events that is out of proportion to the likelihood or impact of the anticipated event. This is the essential feature of generalized anxiety disorder.
Avoidance – This is the flight part of the brain’s “fight or flight” response, as when someone goes out of his way to avoid a situation or object that arouses his anxiety. It is a common feature of all anxiety disorders.
School refusal – A specific avoidance strategy which families and school officials are seeing with greater frequency among children and adolescents diagnosed with a variety of anxiety-related disorders.
Arousal – Physical sensations that are felt when the body switches to fight or flight mode, such as increased pulse and breathing rates, difficulty breathing, excessive sweating, nausea and dizziness.  Arousal is a common feature in all anxiety disorders and is a prominent feature of panic disorder.
Intrusive thoughts – Unwelcome, involuntary thoughts that often lead to a kind of predictive anxiety that the person will not be able to cope. Intrusive thoughts are a prominent feature of obsessive-compulsive disorder, though also present in most other anxiety disorders.
Vigilance – Being highly attuned to the environment and alert to circumstances that may cause a person to be anxious or feel trapped in an anxiety-provoking situation.
Threat estimation – Overestimating the gravity of a threat and underestimating one’s ability to cope with it. This is a common feature of generalized anxiety and other anxiety disorders.
Irrational fear – When the fear or anxiety is out of proportion to the actual danger posed by an object or situation. This is common in specific phobias, such as fear of animals, heights or needles.
Separation fear – Excessive worry or distress over separation from or well-being of a major attachment figure, such as a parent. This is the key sign of a separation anxiety disorder.
Fear of crowds – Marked fear and avoidance of crowds or public situations such as using public transportation, standing in line, being in either closed or open spaces, or being outside of the home.  Fear of crowds is the defining feature of agoraphobia.
Selective mutism – Consistent inability to speak and communicate effectively in certain social situations such as school, but not in other situations. Selective mutism disorder is usually seen in children but has the potential to continue into adulthood if untreated.

Many anxiety disorders develop in childhood and tend to persist if not treated. Symptoms of separation anxiety disorder can appear in children as early as age three, while the average age of onset for generalized anxiety disorder is 31. As a group, people with anxiety disorders are more likely to acknowledge they need help than people with other mental health disorders, such as schizophrenia. However, only about a third of those affected receive treatment. The good news is that anxiety disorders are very treatable. Many people who live with anxiety are able to work, go to school and enjoy healthy, supportive relationships with friends and family.

Most anxiety disorders can be treated with therapy or medication, often in combination with one another.  The following treatments and supportive services may be helpful to a person with anxiety:

Medication Management/Monitoring
Cognitive Behavior Therapy
Dialectical Behavior Therapy
Eye Movement Desensitization and Reprocessing (EMDR)
Exposure Therapy

Complementary and Supportive Services
Mindfulness Meditation
Peer Support
Psychosocial Rehabilitation
Self-management Strategies
Stress and Relaxation Techniques
Supported Employment
Supported Education
Supportive Parenting for Anxious Childhood Emotions (SPACE)
Supported Housing

Resources to Recover’s Directory of Family-Endorsed Providers lists several practices and organizations which provide these services and treatments. Please consult our Family-Endorsed Providers page for more information on these providers, or email us at for help obtaining services.

Anxiety disorders typically affect the entire family because they are so common and tend to appear earlier in life than most mental health conditions. Parents may be the first to become aware of a problem when a child starts refusing to attend middle school or even earlier when a toddler cannot bear to part with his mother at drop-off time for nursery school. Parents and other family members are often drawn into elaborate and frequently exhausting accommodation routines that unintentionally reinforce the anxious person’s avoidance strategies.

Many adults are tempted to believe that anxiety is a problem that exists solely in a child’s mind, the way a cavity is a problem that exits solely in her mouth.  But as the authors of the book, Treating Childhood and Adolescent Anxiety point out “when a child suffers from anxiety the problem exists both within the child and in the interpersonal space of the relationship between parent and child.”  In many cases, an anxious child’s dependency on family members continues into young adulthood and beyond. Young people with anxiety disorders can benefit from treatment that looks at the entire family and considers each person’s role and behavior.

If you or a family member struggle with anxiety, can help you find the right mental health resources to treat the problem. For free personalized assistance contact one of our Resource Specialists.

Anxiety Resources
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