The Who, What and Why of Anxiety Disorders

 “Nobody realizes that some people expend tremendous energy merely to be normal”

-Albert Camus


Why Do I Get Anxious?

Have you ever wondered what makes people anxious and why some people seem to be more fearful than others? Fear and anxiety are natural inborn mechanisms necessary for survival. Fear occurs when a real or perceived imminent threat arises. This causes our body to shift into a “fight or flight” response to protect ourselves from danger. In anxiety, our mind becomes preoccupied with anticipation of future threats. When optimal, these adaptive responses allows us to get our work done and avoid potentially dangerous situations.

Too Much Fear and Anxiety Can Have Negative Consequences

When fear and anxiety responses become excessive they can overtake our lives and hamper our ability to succeed. Individuals with anxiety disorders develop a distorted perception of their environment and have decreased focus, attention and memory recall. This impairs their ability to complete everyday tasks and to have healthy relationships with their social contacts. They may also have physical sensations such as headache, nausea, lightheadedness, increased perspiration or heart palpitations.


Demographics of Anxiety Disorders

Anxiety disorders as a group are the most common type of mental illness. 25% of people will meet the criteria for an Anxiety Disorder in their lifetime and 18% each year. Women have twice the incidence as men and the prevalence decreases with higher socioeconomic status.



How Do People Develop Anxiety?

Anxiety has many contributing causes. Often, there are strong environmental stressors or a traumatic event that occurs prior to onset of symptoms.  Affected individuals frequently have psychological and biological factors that predispose them to this diagnosis.


Psychological factors include unmet needs from caregivers, or learned fear from physical, sexual or emotional abuse as a child. These events lead to development of poor self esteem, maladaptive coping skills and immature defense mechanisms which can induce anxiety.


Biologically, multiple studies have implicated abnormal brain and body levels of Norepinephrine, Serotonin, GABA, Galanin and Cortisol. These often rise with increased anxiety and then themselves perpetuate the effects. Some people are born with abnormal levels of these molecules and this increases their risk for developing an anxiety disorder. Brain imaging studies have discovered abnormalities in the right cerebral hemisphere, the frontal cortex and the amygdala. Some studies have demonstrated remission of anxiety when portions of the limbic system are removed from the brain. Many other areas of the brain have been implicated in specific anxiety disorders. There is a clear genetic basis for the development of anxiety. For instance, half of those diagnosed with Panic Disorder have a relative with the same condition.


What is the Treatment?

For severe anxiety, a combination of psychopharmacology and psychotherapy is the gold standard. Medications will tamper down the subjective feelings of anxiety and modulate the biological components of the disorder. Therapy helps discover psychological contributors and attempts to resolve them, while improving cognitive assessment and coping skills when confronted with stress.


Have you personally or do you know someone who has suffered from an anxiety disorder. What interventions have you found beneficial or harmful? Share you questions and comments below.



Ariel Mintz, MD
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