Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships. There are several different types of anxiety disorders. Examples include generalized anxiety disorder, panic disorder, and social anxiety disorder.
People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms.
Generalized anxiety disorder symptoms include:
- Restlessness or feeling wound-up or on edge
- Being easily fatigued
- Difficulty concentrating or having their minds go blank
- Muscle tension
- Difficulty controlling the worry
- Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)
People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom.
Panic disorder symptoms include:
- Sudden and repeated attacks of intense fear
- Feelings of being out of control during a panic attack
- Intense worries about when the next attack will happen
- Fear or avoidance of places where panic attacks have occurred in the past
People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others.
Social anxiety disorder symptoms include:
- Feeling highly anxious about being with other people and having a hard time talking to them
- Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
- Being very afraid that other people will judge them
- Worrying for days or weeks before an event where other people will be
- Staying away from places where there are other people
- Having a hard time making friends and keeping friends
- Blushing, sweating, or trembling around other people
- Feeling nauseous or sick to your stomach when other people are around
Evaluation for an anxiety disorder often begins with a visit to a primary care provider. Some physical health conditions, such as an overactive thyroid or low blood sugar, as well as taking certain medications, can imitate or worsen an anxiety disorder. A thorough mental health evaluation is also helpful, because anxiety disorders often co-exist with other related conditions, such as depression or obsessive-compulsive disorder.
What are some of the causes of anxiety?
- Worries about the future
- Pressures from family, school, friends, work
- Financial problems
- Relationship problems
- A sense of overwhelming responsibility or obligation
- Negative coping patterns
- Substance abuse
- Lack of support system
- Going against your own values or beliefs
- Family history of anxiety
- Feelings and emotions that you don’t understand, are unacceptable or with which you do not know how to cope
- Medical conditions, such as overactive thyroid
- Poor diet
- B-vitamin deficiency
- Too much caffeine
- History of trauma or abuse
When anxiety does not diminish, and when a person has ongoing problems over a period of days or weeks, this may indicate some type of anxiety disorder. When a person continues to experience a sense of dread or doom, even when there is no apparent reason to worry, or if anxiety becomes pervasive and interferes with daily life, this may indicate a problem.
- Common symptoms:
- Pronounced heartbeat
- Body tingling
- Stomach problems
- Tightness in chest
- Breath-holding or rapid shallow breathing
- Low self-esteem
What are the types of anxiety disorders?
- Generalized anxiety disorder
- Panic disorder
- Obsessive-Compulsive disorder
- Post-traumatic stress disorder
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.
Some forms of depression are slightly different, or they may develop under unique circumstances, such as:
- Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
- Perinatal depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
- Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
- Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
- Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.
Clinically, major depression involves at least two weeks with five or more of the following symptoms:
- Depressed mood most of the day
- Sleep problems, either insomnia or sleeping all the time
- Appetite problems, either loss of appetite or weight gain
- Lack of energy, apathy, no interest in anything
- Feelings of restlessness or being slowed down
- Feelings of worthlessness, hopelessness or guilt
- Difficulty concentrating or indecisiveness
- Decreased libido
- Suicidal thoughts or attempts
How can you tell if someone is thinking about suicide? Many people (but not everyone) give clues to their intentions and these can include:
- Previous attempts
- Threats to hurt themselves
- Reporting feelings of hopelessness/helplessness
- Depression symptoms
- Changes in personality or behavior
- Putting affairs in order, saying goodbyes or giving away possessions
Sometimes a friend is not aware that s/he is depressed. This particularly happens when the depression comes on slowly and friends blame themselves for not coping as they normally would, rather than thinking they might have an illness. Suggestions for being a supportive friend include:
Listening can really help
Avoid saying, “pull yourself together,” or other remarks that make your friend think that it is their fault that they are ill
If your friend’s problems persist for a week or so, suggest that s/he see a doctor. Remind him/her that this is not a sign of weakness or failure
Remind him/her that they have an illness and will get better
Try to help them avoid resorting to drugs or alcohol in attempts to self-medicate
Encourage physical activities
Remind your friend that depression is treatable
What are Attention Deficit Disorder (ADD) and Attention Deficit Disorder with hyperactivity (ADHD)?
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
- Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
- Hyperactivity means a person seems to move about constantly, including situations in which it is not appropriate when it is not appropriate, excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with their activity.
- Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity.Most children have the combined type of ADHD.
In preschool, the most common ADHD symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:
- are more severe
- occur more often
- interfere with or reduce the quality of how they functions socially, at school, or in a job
People with symptoms of inattention may often:
- Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
- Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
- Not seem to listen when spoken to directly
- Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
- Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
- Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers
- Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
- Be easily distracted by unrelated thoughts or stimuli
- Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
People with symptoms of hyperactivity-impulsivity may often:
- Fidget and squirm in their seats
- Leave their seats in situations when staying seated is expected, such as in the classroom or in the office
- Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
- Be unable to play or engage in hobbies quietly
- Be constantly in motion or “on the go,” or act as if “driven by a motor”
- Talk nonstop
- Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation
- Have trouble waiting his or her turn
- Interrupt or intrude on others, for example in conversations, games, or activities
Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.
ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.
ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.
- What is obsessive-compulsive disorder (OCD)?
- Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent, unwanted, disturbing thoughts (obsessions) and/or repetitive, ritualized behaviors that a person feels driven to perform (compulsions).
- A person with OCD will repeat their behavior or ritual in an attempt to get relief from their obsessions. The relief can be temporary, however, and the person will feel the need to repeat the behaviors over and over again. The result is that the behaviors often become very time-consuming or demanding, which creates anxiety, shame, or even despair for the person.
- Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.
People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.
Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:
- Fear of germs or contamination
- Unwanted forbidden or taboo thoughts involving sex, religion, and harm
- Aggressive thoughts towards others or self
- Having things symmetrical or in a perfect order
Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:
- Excessive cleaning and/or handwashing
- Ordering and arranging things in a particular, precise way
- Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
- Compulsive counting
Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:
- Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
- Spends at least 1 hour a day on these thoughts or behaviors
- Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
- Experiences significant problems in their daily life due to these thoughts or behaviors
Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.
Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.
If you think you have OCD, talk to your doctor about your symptoms. If left untreated, OCD can interfere in all aspects of life.
Some common obsessions include:
- Fear of being contaminated by germs or dirt
- Fear of causing harm to oneself or others
- Intrusive sexually explicit or violent thoughts and images
- Excessive focus on religious or moral ideas
- Fear of losing or not having things you might need
- Order and symmetry: the idea that everything must line up “just right.”
- Superstitions: excessive attention to something considered lucky or unlucky
- Inventory, and for a detailed discussion of how obsessions are experienced, visit Obsessions.
Compulsions are behaviors or rituals that a person does to try and get rid of the anxiety brought up by their obsessions. For example, if someone is obsessed with being contaminated, that person might develop elaborate hand-washing rituals. If an obsessive worry is whether or not the door was locked, then a compulsive response might be to check the lock a certain number of times before leaving the house or going to bed.
Some common compulsive behaviors are:
- excessive double-checking
- hand washing
Anger is a normal human emotion, but sometimes it can get out of control or be destructive. It can lead to problems at work, school, in relationships, and also affect one’s overall sense of well-being.
People who are easily angered have what psychologists call a low tolerance for frustration, which basically means that they feel they should not have be subjected to frustration, inconvenience or annoyance. There are physiological changes associated with anger, including higher blood pressure, heart rate and adrenaline levels. Some are actually born with more of a propensity towards anger than others, and some people never learned as children how to channel their frustration in more healthy ways. When handling situations as adults, they continue to react with overt anger or sullenness and irritability. It is never too late, though, to learn healthier ways to deal with problems.
Grief is an intense emotion that your friend feels when a significant loss or series of small losses has been experienced. It is a natural and normal human emotional reaction and is also the process of working through the pain of a loss. Grieving is not a sign of weakness. Most people think of the death of a loved one as a time of grieving, but there are also other losses about which a friend may grieve:
- death of a loved one
- divorce or relationship break-up
- loss of a friendship
- death of a pet
- serious accident
- diagnosis of a serious or chronic medical condition
- devastating failure
- Financial losses
- Loss of status
- Having to give up a lifelong dream