Treatment of Anxiety Disorders

Treatment can include medication—particularly selective serotonin reuptake inhibitors (SSRIs)—as well as types of therapy and lifestyle. More than 40 million adults in the United States have an anxiety disorder, which equates to nearly one in five American adults. According to the National Alliance on Mental Health, an additional 7% of children ages three to 17 have some anxiety problem every year. Yet those were the statistics before the Covid pandemic began, and it’s likely those numbers, or at least the severity of symptoms among those with an already diagnosed condition, have increased over the past two years of uncertainty, restrictions, fear, and grief. Screening, recognizing, and treating an anxiety disorder or referring a patient for treatment is integral to primary and specialty healthcare. Yet according to the Anxiety and Depression Association of America, only just over a third (37%) of people with anxiety disorders are receiving treatment. 

Symptoms of Anxiety 

Although there are several types of anxiety disorders, some symptoms can be similar across the different diagnoses, particularly ”persistent, excessive fear or worry in situations that are not threatening,” according to NAMI. Specific emotional symptoms common to all anxiety disorders include the following: 

• Feelings of apprehension or dread
• Feeling tense or jumpy
• Restlessness or irritability
• Anticipating the worst and being watchful for signs of danger

The physical symptoms that can manifest from anxiety include the following: 

• Rapid heartbeat or feeling of a “racing heart”
• Shortness of breath or feeling as though the patient “can’t breathe”
• Sweating, tremors, and twitches
• Headaches
• Difficulty sleeping, including insomnia
• Fatigue or sleepiness
• Upset stomach or nausea
• Frequent urination or diarrhea 

Types of Anxiety Disorders

The most common anxiety disorder is a social anxiety disorder, which affects approximately 15 million American adults, or 6.8% of the US population. Yet up to 19 million adults (8.7%) have a specific phobia, which qualifies as an anxiety disorder when it interferes with someone’s ability to function, such as not being able to complete work duties because of an inability to fly in an airplane. Below is an overview of the significant types of anxiety disorders. 

• Social Anxiety Disorder is driven by a fear that a person will embarrass or humiliate themselves in social situations, such as saying something “dumb” or simply not knowing what to say. Social anxiety disorder can involve panic attacks and prevent people from engaging in activities like class discussions, work meetings, social conversations, or other everyday social interactions. About a third of all people with social anxiety disorder experience symptoms for at least ten years before getting treatment. 

• Generalized Anxiety Disorder (GAD) affects an estimated 6.8 million US adults (3.1% of the population), and less than half (43%) receive treatment for the condition. GAD often occurs in people with major depression and affects women twice as often as men. It manifests as ongoing exaggerated anxiety about everyday life that interferes with people’s ability to carry out personal, family, or work obligations. Common physical symptoms include headaches, tension, and nausea from worrying. 

• Panic Disorder, affecting 6 million US adults (2.7%), also affects women twice as often as men and causes panic attacks or sudden feelings of terror that appear out of the blue. Panic disorder is particularly associated with physical symptoms, such as chest pain, heart palpitations, dizziness, shortness of breath, and stomach problems, all of which can lead people to mistake a panic attack for a heart attack. 

• Obsessive-Compulsive Disorder (OCD) affects about 2.2 million adults (1%) with an average age of onset at 19. Nearly a quarter of all people with OCD receive their diagnosis by age 14, and about a third of all adults with OCD report that their symptoms began when they were children. OCD affects men and women at similar rates and can be especially debilitating, growing worse without treatment. 

• Post-Traumatic Stress Disorder (PTSD) affects 7.7 million US adults (3.5%) and occurs more often among women than men. This may be because the most common trigger of PTSD is rape, which happens more frequently among women than men. The Anxiety and Depression Association of America estimates that two out of three men (65%) and nearly half of all women (46%) who are raped will develop PTSD. In addition, children who have experienced sexual abuse are also very likely to develop PTSD.

• Specific Phobias involve anxiety symptoms triggered by a particular object or experience, such as heights, flying, blood, dentist visits, confined spaces, open or public places, or specific animals, such as spiders, dogs, snakes, insects, or mice. The National Health Service in the UK divides phobias into categories of animal, environmental, situational, bodily, or sexual phobias. Often these phobias are mocked in public without recognition that they can be as debilitating as any other anxiety disorder, with symptoms that include nausea, sweating, heart palpitations, shortness of breath, trembling, and dizziness or lightheadedness. They affect an estimated 19 million adults or 8.7% of all Americans. 

Screening Tools

The most common screening tool specific to general anxiety screening is the Generalized Anxiety Disorder (GAD)-2 tool, followed by the GAD-7 if the GAD-2 screen is positive (score greater than 3). However, most healthcare workers are more familiar with the Patient Health Questionnaire (PHQ)-2, a two-item depression screen that should lead to the PHQ-9 for patients scoring greater than 3. Another common tool is the 21-item Beck Anxiety Inventory (BAI), though many others exist. 

Patients can also screen themselves for anxiety disorders at home using the tools provided by the Anxiety and Depression Association of America, which include the Screen for Child Anxiety-Related Disorders (SCARED) for children. The site also has self-screens for GAD, OCD, panic disorder, PTSD, social anxiety disorder, social phobia (SPIN), and specific phobias or complementary practices, such as meditation, biofeedback activities, and exercise. The most effective psychotherapy depends on the anxiety disorder. While cognitive behavior therapy (CBT) can be effective for most anxiety disorders, other therapies, such as exposure therapy, may be appropriate for others, such as PTSD or specific phobias. Patients who begin SSRIs or another drug for anxiety should be made aware of the potential short-term and long-term side effects of different medications.