What are the types of anxiety? A registered therapist looks at the types, symptoms and causes
from a Holistic Psychology and Social Work Perspective.
In this article, we are going to look at the types of anxiety that there are, their symptoms, and their causes. At Savasana Collective - Holistic Psychology and Social Work, we like to remind people that we are not our labels. We also like to normalise and not pathologise life.
Before we get into the types and the symptoms of the types as prescribed by the Diagnostic Manual used by clinicians the DSM, a recent research article has described the DSM as “scientifically meaningless”.
The research article found Psychiatric diagnoses all use different decision-making rules and the overall findings were -
There is a huge amount of overlap in symptoms between diagnoses
Almost all diagnoses mask the role of trauma and adverse events
Diagnoses tell us little about the individual patient and what treatment they need.
So when reading this article remember this, although it can be validating and sometimes helpful to understand the type of anxiety you have, it really is just a description of your symptoms and NOT WHO YOU ARE. It also doesn’t describe the exact treatment that you need because every person is different, which is why it’s so important as some stage to link in with a professional to understand yourself, and YOUR unconscious patterns and behaviours. Understanding symptoms also doesn’t explain away the capitalistic, urbanised, artificial environment that contributes to the anxiety, burnout and relationship issues many of us have in the fast paced individualistic western world we live in.
Disclaimer over! Let’s jump in.
Generalised Anxiety Disorder
It’s natural to feel anxious from time to time, especially during stressful seasons of life. However, Generalised Anxiety Disorder (or GAD) can leave you feeling anxious and worried most of the time, to a level that interferes with your everyday life. For adults, this unrelenting worry can be about work, health of self or others, finances, and can also be about everyday life situations that would not otherwise cause stress.
Keeping in mind that the following are symptoms and not who you are, let’s take a closer look at GAD as outlined by the Diagnostic Manual used by clinicians (the DSM).
When assessing for GAD, a clinician is looking for:
The presence of excessive anxiety and worry about a variety of topics, events or activities. Worry occurs more often than not for at least six months and is clearly excessive.
The worry is experienced as very challenging to control. The worry both in adults and children may easily shift from one topic to another.
The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (in children, only one of these symptoms is necessary for a diagnosis of GAD):
Edginess or restlessness
Tiring easily, more fatigued than usual
Impaired concentration or feeling as though the mind goes blank
Irritability (which may or may not be observable to others)
Increased muscle aches or soreness
Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep.
The DSM considers excessive worry to be worrying that continues even when there is no specific threat present, or to a level that is disproportionate to the actual risk.
What causes GAD?
As with many mental health conditions, the causes of GAD are likely a combination of genetic and environmental factors, which may include:
Differences in brain chemistry and function
Genetics
Development experiences and personality
Differences in the way threats are perceived by the brain and body.
Social Anxiety Disorder
A core experience in Social Anxiety Disorder is that of significant and ongoing fear of social situations, where someone may be embarrassed or rejected. This type of anxiety often presents through physical symptoms.
Social anxiety may happen before or during:
Performing in front of other people - for example giving a speech
Social situations - such as catching up with friends or meeting new people
Specific situations - for example, someone may experience anxiety initiating conversations around new people, yet feel comfortable running a meeting at work.
When assessing for Social Anxiety Disorder a clinician is looking for:
Cognitive symptoms
Fearing situations where you don’t know other people
Worrying that others will judge you
Fear of becoming embarrassed or being humiliated in front of others
Thinking that other people will notice your anxiety
Dreading upcoming events weeks in advance.
Physical symptoms
Racing heart
Profuse sweating
Trembling hands and muscle tension
Blushing
Nausea and dizziness
Panic attacks.
Behavioural symptoms
Avoiding the social and performance situations that cause the symptoms
Leaving situations to reduce the anxiety
Taking steps to control or limit social or performance experiences.
Causes of Social Anxiety Disorder
There are thought to be a number of factors that can contribute to Social Anxiety Disorder, including:
Genetics and differences in brain chemistry
Challenging environmental experiences, especially during childhood or adolescence, for example: having an overly critical parent, being bullied, experiencing childhood abuse and/or trauma
Temperament: children and adolescents who are shy or socially inhibited may be at greater risk of experiencing Social Anxiety Disorder.
Agoraphobia
Agoraphobia (or ag-uh-ruh-foe-be-uh) is an acute, persistent fear of being somewhere that’s difficult or impossible to escape from, or fear of experiencing an embarrassing event in a public place. A common experience for people with Agoraphobia is the fear of leaving home.
According to the DSM, people with Agoraphobia have a marked fear (disproportionate to the situation) about two or more of the following scenarios:
Open spaces, for example parking lots or bridges
Public transport, such as a bus, train or plane
Enclosed spaces, like stores or movie theatres
Standing in line or being in a crowd
Being outside of home by themselves
When in these situations, someone with Agoraphobia may experience:
Fear about not being able to escape the situation
Avoiding the situation, or needing a support person present, or enduring the situation whilst experiencing immense distress
Experiencing significant distress in social situations, at work, or in other areas of life due to fear, anxiety or avoidance.
The phobia and avoidance usually lasts six months or longer.
It’s not uncommon for someone with Agoraphobia to also be diagnosed with Panic Disorder, although they are separate conditions (see below for information about Panic Disorder).
Causes of Social Anxiety Disorder
Similar to other types of anxiety, environment, genetics and someone’s learning experiences may all play a role in the development of Agoraphobia.
Panic Disorder
Panic Disorder is a type of anxiety that can exist alongside the other types mentioned in this post. In order to be diagnosed with Panic Disorder, someone must experience unexpected panic attacks on a regular basis.
When assessing for Panic Disorder, a clinician will look for:
Recurrent and unexpected panic attacks
At least one panic attack is followed by one month or more where the person fears they will experience further panic attacks, causing them to change their behaviour (for example, avoiding situations that might bring on a panic attack)
That the panic attacks are not the result of the physiological effects of a substance (for example drugs or medication), and not accounted for by another medical condition or mental health condition
The presence of four or more of the following symptoms:
Excessive sweating
Palpitations or accelerated heart rate
Numbness or tingling
Trembling or shaking
Shortness of breath
Chest discomfort or pain
Feeling choked
Nausea or stomach discomfort
Dizziness, lightheadedness or feeling faint
Feeling that the world around you is not real (derealisation)
Fear of dying
Fear or losing control or going crazy
Chills or hot flushes.
What causes Panic Disorder?
Research suggests that there may be a genetic factor involved, with studies showing people with Panic Disorder often have other people in their family with anxiety or depression.
Our biology can also play a role, with some medical conditions that affect the heart, lungs and gut thought to be connected.
Additionally, panic attacks can arise from the experience of negative events, such as highly stressful life experiences and ongoing, unrelenting stress.
Specific Phobia
A Specific Phobia is a condition where someone experiences a disproportionate level of fear about a specific situation or object. This is different to feeling anxious about dangerous situations or things - this experience of anxiety is the mind’s way of keeping us safe.
In contrast, someone with a Specific Phobia may experience a debilitating fear of small spaces (Claustrophobia), an extreme fear of heights (acrophobia), or fear of thunder and lightning (astraphobia), to name a few.
In order to make a diagnosis of Specific Phobia, a clinical will look for:
The experience of unreasonable, excessive persistent and intense fear triggered by a specific object or situation
An immediate anxiety response caused by the object or situation (that is out of proportion to the actual danger)
Avoidance or extreme distress, with the person either going out of their way to avoid the object or situation, or enduring it with extreme distress
The phobia is life-limiting in that it impacts someone’s personal, work or school life
The duration of the Panic Disorder symptoms must last for at least six months, and must not be caused by another disorder.
Causes of Specific Phobia
Similar to the other types of anxiety, Specific Phobias can form from a number of factors, including genetics, stressful life experiences and particular temperaments that can increase someone’s risk of experiencing anxiety.
What is the difference between stress and anxiety?
On the surface, stress and anxiety can look similar, and most people will experience some level of stress and anxiety at some point in their lives.
However, although they share many of the same physical and psychological symptoms, stress and anxiety usually have different causes.
Stress is tied to a specific situation or trigger.
Stress is a natural response to any event or experience that places a demand on your brain and/or body and leaves you feeling nervous or frustrated.
Stress is often a response to an external cause, such as a looming deadline or an argument with a loved one. Stress usually subsides once the situation or cause has been resolved.
If you experience stress that does not subside with the resolution of a situation, you may be experiencing chronic stress, or stress that occurs due to prolonged and ongoing challenges such as a continually demanding job.
Anxiety doesn’t always have a specific trigger and persists beyond a specific situation or stressor.
On the other hand, anxiety is someone’s specific response to stress, and is an internal experience. Unlike stress, anxiety persists after a situation has resolved, and continues to cause a persistent feeling of dread, even in situations that are not directly threatening.
Anxiety can also occur without a specific situation or object to cause it.
If you’re unsure whether it’s stress or anxiety that’s behind your symptoms, it can help to ask yourself:
What’s going on in my life right now?
Are there any specific sources of stress at the moment?
What is my mind typically worrying about?
Can the source of my worry be resolved?
If I resolve it, will I still feel worried or anxious?
Support for Anxiety
If you’ve noticed that stress or anxiety is starting to affect your day-to-day life, talking with a mental health professional can help you to identify the source of your worry, and create a holistic support plan to lessen its impact on you.
At Savasana Collective, we take a holistic approach to supporting our clients, understanding the role that other experiences in our lives (such as trauma, neurodiversity, and the capitalist structures we live in that prioritise hustle culture) play in contributing to our experiences of anxiety.
If you’re reading this post because you’re experiencing symptoms of anxiety, please know that you’re not alone, and support is available.
If you enjoyed this post and want more, get your free anxiety resources check out our retreats, our podcast and social accounts or book into our services. And if you’re a health professional come connect with us over at Therapist VA.
Sources:
Science Daily Website: “Psychiatric diagnosis 'scientifically meaningless” https://www.sciencedaily.com/releases/2019/07/190708131152.htm
The Centre for Treatment of Anxiety and Mood Disorders Website https://centerforanxietydisorders.com/
Book: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)
