Anxiety disorders

Frequently asked Qs

• The key facts
  • Anxiety can make you feel worried or scared. 
  • Anxiety can cause physical symptoms such as a fast heartbeat or sweating. 
  • It is a normal human response to be anxious in certain situations. You may have an anxiety disorder if you feel anxious all or most of the time.
  • You can recover from anxiety disorders. Treatment and support are available for you.
  • Your doctor can offer you treatment. What you are given will depend on your symptoms and how severe they are.
• What are anxiety disorders?

  We all have feelings of anxiety, worry and fear sometimes. These can be normal responses to certain situations. So, you might worry about a job interview. Or about paying a bill on time. These feelings can give you an awareness of risks. And what you need to do in a difficult or dangerous situation. This reaction is known as ‘fight, flight or freeze’.

  Your brain responds to a threat or danger by releasing stress hormones. Such as adrenaline and cortisol. Even if the danger is not real, these hormones cause the physical symptoms of anxiety. Once the threatening situation has stopped, your body will usually return to normal.

  Having an anxiety disorder is different. These feelings of fear and danger can be ongoing. And interrupt your daily routine long after the threat has gone. They can make you feel as though things are worse than they actually are.

  Everyone’s experience of anxiety disorders is different. Not everyone who has an anxiety disorder will experience the same symptoms.

  Mental symptoms of anxiety can include:

  • racing thoughts,
  • uncontrollable over-thinking,
  • difficulties concentrating,
  • feelings of dread, panic or ‘impending doom’,
  • feeling irritable,
  • heightened alertness,
  • problems with sleep,
  • changes in appetite,
  • wanting to escape from the situation you are in, and
  • dissociation.

  If you dissociate, you might feel like you are not connected to your own body. Or like you are watching things happen around you, without feeling them.

  Physical symptoms of anxiety can include:

  • sweating,
  • heavy and fast breathing,
  • hot flushes or blushing,
  • dry mouth,
  • shaking,
  • hair loss,
  • fast heartbeat,
  • extreme tiredness or lack of energy
  • dizziness and fainting, and
  • stomach aches and sickness.

  Anxiety can lead to depression if left untreated.                                        

  For more information, see our webpage on Depression.

• What are the different types of anxiety disorder?

  This section provides an overview of the most common types of anxiety disorders.

  • Generalised anxiety disorder (GAD)
  • Panic disorder
  • Social anxiety disorder
  • Phobias
  • Obsessive-compulsive disorder (OCD)
  • Skin-picking 
  • Hair-pulling 
  • Health anxiety
  • Body dysmorphic disorder (BDD)
  • Post-traumatic stress disorder (PTSD)

  What is generalised anxiety disorder (GAD)?

  GAD is common. The main symptom of GAD is over worrying about different activities and events. This may feel out of your control.  You feel anxious a lot of the time if you have GAD. You might feel ‘on edge’ and alert to your surroundings.

  This can affect your day-to-day life. You might find that it affects your ability to work, travel places or leave the house. You might also get tired easily. Or have trouble sleeping or concentrating. You might have physical symptoms, such as muscle tension and sweating.  

  It is common to have other conditions if you have GAD. Such as depression or other anxiety disorders. 

  GAD can be difficult to diagnose. It does not have some of the unique symptoms of other anxiety disorders. You may have felt anxious for most days over six months. And it has had a bad impact on areas of your life. If so, your doctor is likely to say you have GAD.  

  What is panic disorder?

  You will have regular panic attacks with no particular trigger, if you have panic disorder. They can happen suddenly and feel intense and frightening. You may also worry about having another panic attack.  

  Panic disorder symptoms can include the following: 

  • An overwhelming sense of dread or fear 
  • Chest pain or a sensation that your heart is beating irregularly
  • Feeling that you might be dying or having a heart attack
  • Sweating and hot flushes or chills and shivering
  • A dry mouth, shortness of breath or choking sensation
  • Nausea, dizziness and feeling faint
  • Numbness, pins and needles or a tingling sensation in your fingers
  • A need to go to the toilet
  • A churning stomach
  • Ringing in your ears

  You may also dissociate during a panic attack. That is, feeling detached from yourself.  

  Certain situations can cause panic attacks. For example, you may have a panic attack if you do not like small places, but you have to use a lift. This does not mean that you have panic disorder.  

  What is social anxiety disorder?

  Social anxiety disorder is sometimes known as social phobia. Lots of people may worry about social situations. 

  But if you have social anxiety, you will have an intense fear or dread of social or performance situations. This can happen before, during or after the event. 

  Some common situations where you may experience anxiety are the following:

  • Speaking in public or in groups
  • Meeting new people or strangers
  • Dating
  • Eating or drinking in public

  You may be worried that you will do something or act in a way that is embarrassing. 

  You might feel aware of the physical signs of your anxiety. This can include sweating, a fast heartbeat, a shaky voice and blushing. You may worry that others will notice this or judge you. 

  You might find that you try to avoid certain situations. You might realise that your fears are excessive. But you find it difficult to control them. 

  Your GP will ask you questions about your symptoms. And might ask you to fill out a questionnaire. This will help them find out how anxious you feel in social situations. They may refer you to a mental health specialist for a full assessment. 

  It might feel too difficult for you to see your GP in person. If so, you can ask for a telephone appointment.

  What is a phobia?

  A phobia is an overwhelming fear of an object, place, situation, feeling or animal.

  Phobias are stronger than fears. They develop when a person has increased feelings of danger about a situation or object. Someone with a phobia may arrange their daily routine to avoid the thing that is causing them anxiety. 

  Common examples of phobias include the following. 

  • Animal phobias. Such as spiders, snakes or rodents.
  • Environmental phobias. Such as heights and germs.
  • Situational phobias. Such as going to the dentist.
  • Body phobias. Such as blood or being sick. 
  • Sexual phobias. Such as performance anxiety.

  What is agoraphobia?
  Agoraphobia is a fear of being in situations where escape might be difficult. Or situations where help wouldn't be available if things go wrong.  This could be the following.

  • Leaving your home. 
  • Being in public spaces.
  • Using public transport.
  • Being in crowded spaces.

  You might find that these situations make you feel distressed, panicked and anxious. You may avoid some situations altogether. This can affect day-to-day life.

  Agoraphobia can make it difficult to make an appointment with your GP to talk about your symptoms. You might not feel able to leave your house or go to the GP surgery. You can arrange a telephone appointment if you have symptoms of agoraphobia.  A GP will decide on the best treatment options for you depending on what you tell them.

  What is obsessive-compulsive disorder (OCD)?  

  You will have obsessions, compulsions or both if you have OCD. 

  • Obsession. An obsession is an unwelcome thought or image that you keep thinking about and is largely out of your control. They can be difficult to ignore. These thoughts can be disturbing, which can make you feel distressed and anxious.
  • Compulsion. A compulsion is something you think about or do repeatedly to relieve anxiety. This can be hidden or obvious. Such as saying a phrase in your head to calm yourself. Or checking that the front door is locked.

  You might believe that something bad will happen if you do not do these things. You may realise that your thinking and behaviour is not logical but still find it very difficult to stop. 

  Speak to your GP if you think you have OCD. They should discuss treatment options with you. Or you could try to self-refer to an NHS talking treatment service. 

  For more information, see our webpage on Obsessive compulsive disorder.

  What is skin-picking?

  Skin-picking is medically known as dermatillomania. You will regularly pick at your skin. 

  Often you will pick healthy skin. This can cause damage to your skin, including bleeding, bruising and sometimes permanent marks. 

  You will find it difficult to stop yourself doing it. 

  Skin-picking can be triggered by different things. For example, boredom  or to relieve tension and stress. Skin-picking disorder is related to OCD. 

  Your GP may arrange for you to see a specialist mental health doctor like a psychiatrist for diagnosis.

  What is hair-pulling?

  Hair-pulling is medically known as trichotillomania. You feel the urge to pull out your hair if you have this condition. This can be from your scalp or other places such as your arms, eyelashes, legs or pubic area. You will find it difficult to stop yourself doing this.

  You might experience a build-up of tension which you can relieve by pulling out the strand of hair. You might not even be aware that you are doing it. 

  It can be difficult to stop, which can lead to hair loss. This in turn can make you feel guilty, embarrassed and affect how you feel about yourself. Or how your friends and family see you. 

  Your doctor will look at the following to diagnose your condition.  

  • If you repeatedly pull your hair out, causing noticeable hair loss.
  • If you feel increasing tension before you pull your hair out.
  • If you feel relief or pleasure when you have pulled your hair out.
  • That there are no underlying illnesses, such as a skin condition, causing you to pull your hair out.
  • Whether pulling your hair out affects your everyday life or causes you distress.

  What is health anxiety? 

  You may have health anxiety if you spend a lot of time worrying about if you are ill. Or worrying about getting ill. You may:

  • worry that your doctor has missed something,
  • check your body a lot for signs of illness,
  • constantly worry about your health,
  • spend a lot of time asking people if they think you are ill,
  • spend a lot of time looking at health information in the media, or
  • act as if you were ill.

  Symptoms like headaches or a racing heartbeat can be caused by anxiety. But if you have health anxiety you may mistake these for signs of illness.

  What is body dysmorphic disorder (BDD)?

  You will have upsetting thoughts about the way you look if you have BDD. The thoughts do not go away and have a big effect on daily life.

  This is not the same as being vain about your appearance. You may believe that you are ugly and that everyone sees you as ugly. Even if they reassure you that this is not true. Or you may believe that people are focused on an area of your body such as scar or birthmark. It can be very distressing and lead to depression. 

  You may spend a large amount of time doing the following: 

  • Staring at your face or body in the mirror
  • Comparing your features with other people’s
  • Covering yourself with lots of makeup
  • Thinking about plastic surgery when you do not need it

  Speak to your GP if you think you have BDD. They should discuss treatment options with you. The GP may arrange for a team with more BDD experience to help you.  

  What is post-traumatic stress disorder (PTSD)?

  You may have PTSD if your anxiety symptoms developed after a stressful or distressing event. Or if you have experienced trauma over a long period of time.  

  For more information, see our webpage on Post-traumatic stress disorder.

• What causes anxiety disorders?

  We do not fully understand what causes anxiety disorders. But it is thought that the following factors can cause anxiety. 

  Genetics. Some people seem to be born more anxious than others. You may get anxiety through your genes. 

  Life experience. This could be bad experiences such as being abused or losing a loved one. It could also include big changes in life such as moving home, pregnancy or losing your job. 

  Drugs. Caffeine in coffee and alcohol can make you feel anxious. Illegal drugs, also known as street drugs, can also have an effect. 

  Circumstances. Sometimes you know what is causing your anxiety. If the problem goes, so does your anxiety. This can include eco-anxiety. This is the fear of environmental damage or disaster. 

  Hormonal changes. Sometimes you can have low mood or anxiety when peri-menopausal or menopausal.  You can also experience anxiety if you have premenstrual dysphoric disorder (PMDD).  This is a disorder linked to someone’s period cycle.

  For more information, see our webpage on Premenstrual dysphoric disorder.

• How can I get help?

  You should make an appointment to talk with your GP if you are worried about your symptoms. Or they are causing problems in your day-to-day life. 

  Your doctor will look at different things when deciding on your treatment such as the following:

  • Your diagnosis and symptoms
  • What options you have tried already
  • Your goals and preferences
  • Any other conditions you have
  • Guidance from the National Institute for Health and Care Excellence (NICE)

  What are NHS talking therapies?
  The NHS talking therapies programme has made psychological therapy more available on the NHS.  Talking therapies services mainly provide support for low to moderate anxiety and depression. 

  The service can be run by the local NHS Trust or a non-NHS agency, like a charity who work with the local Trust.

  Talking therapies is available in all areas of the country. You can self-refer or ask your GP to refer you. 

  To find your local NHS talking therapies service you can search online here. 

  You can also ask your GP or patient advice and liaison service (PALS) for details of local talking therapies services.

  For more information see our webpages on the following:

  • GPs and your mental health
  • Medication - Choice and managing problems
  • Talking therapies
• How are anxiety disorders treated?

  You can check what treatment and care is recommended for anxiety disorders on the National Institute for Health and Care Excellence (NICE) website: www.nice.org.uk 

  NICE produce guidelines for how health professionals should treat certain conditions. NICE only provide guidelines for:

  • Generalised anxiety disorder (GAD) and panic disorder: www.nice.org.uk/guidance/cg113 
  • Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD):  www.nice.org.uk/guidance/cg31
  • Post-traumatic stress disorder: (PTSD): www.nice.org.uk/guidance/ng116 
  • Social anxiety disorder: www.nice.org.uk/guidance/cg159 

  The NHS does not have to follow these recommendations. But they should have a good reason for not following them.

  Some anxiety disorders, such as generalised anxiety disorder (GAD) may get better by themselves with no treatment at all. Or they may improve after education and advice from your doctor.  

  Your doctor will monitor your symptoms to see if they improve.  And they will talk to you about medications that you can get without a prescription.  These are sometimes called over-the-counter medications.

  We have described some of the treatments for anxiety disorders below.  The treatments you will be offered depend upon the type of anxiety disorder you are experiencing.

  For more information see our webpages on the following:

  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder (OCD)

  What is individual non-facilitated self-help? 

  This involves working from a book or a computer programme. You will be supported by a trained professional. It could include:

  • written or electronic information based on cognitive behavioural therapy principles.
  • instructions to work through the material over at least 6 weeks. 
  • very brief support from a therapist such as a 5-minute telephone conversation.

  What about individual guided self-help? 

  You should:

  • get written or electronic materials, 
  • get support to use the materials, either face-to-face or over the telephone, and
  • be supported by a trained professional, who delivers the self-help programme. And reviews progress and outcomes.

  What is cognitive behavioural therapy (CBT)?

  CBT helps you understand the links between your thoughts, feelings and behaviour. It can help you to find ways to overcome your anxiety by challenging negative thoughts and beliefs.

  Depending upon the type of anxiety disorder you have, you may be offered individual or group sessions. ,   If you have social anxiety disorder you should not be offered group CBT sessions. 

  CBT is also recommended for people who experience anxiety caused by the menopause. 

  What are psychoeducational groups? 

  Psychoeducation means that you will learn about your symptoms and how to manage them.

  Your learning should:

  • be based on CBT, 
  • get you involved,
  • include presentations from a trained professional, 
  • include self-help manuals, 
  • have 1 therapist to about 12 people, and
  • usually be 6 weekly sessions, each lasting 2 hours.  

  If these treatments do not work you should be offered cognitive behavioural therapy (CBT), applied relaxation or medication. 

  What is applied relaxation?

  Applied relaxation means that you will focus on relaxing your muscles in a certain way and at a certain time. For example, learning how to relax your muscles so that you can fall asleep easier. 

  A trained therapist will teach you different techniques to manage your situation.

  Depending on the anxiety that you have, you will usually get 12–15 weekly sessions each lasting 1 hour. You will get less if you recover sooner and more if you need it.  

  What is short-term psychodynamic therapy?

  This type of therapy focuses on the different forces in your life that are causing you problems. The aim is to look at, understand and work through these difficulties, which may have begun in childhood. Your therapist will also help you to improve your social skills. 

  This type of therapy is specifically used for people with social anxiety disorder. You will usually have up to 25 or 30 sessions which last 50 minutes. The therapy will usually take place over 6 to 8 months. 

  What is exposure and response prevention (ERP)?

  This treatment is particularly used for people living with obsessive-compulsive disorder (OCD). 

  Your therapist will encourage you to experience your obsessive thoughts and help you to manage them in a different way. They will build up the difficulty of each task.  

  What is eye movement desensitisation and reprocessing (EMDR)? 

  This talking therapy is used mainly for people living with post-traumatic stress disorder (PTSD).

  You will make eye movements while thinking about the traumatic event. EMDR helps make your brain deal with painful memories in a different way so these can become less painful for you.

  What types of medication might be prescribed? 

  What are selective serotonin reuptake inhibitors (SSRIs)?
  SSRIs are a type of antidepressant used to treat anxiety disorders. Sertraline is the most common SSRI suggested for anxiety, but there are other SSRIs available. 

  What are serotonin and noradrenaline reuptake inhibitors (SNRIs)?
  SNRIs are a type of antidepressant. You may be prescribed an SNRI if SSRIs did not help your anxiety. 

  What is pregabalin? 
  Pregabalin is a type of medication known as an anticonvulsant. Anticonvulsants are usually used to treat epilepsy. But pregabalin has been found to help people living with anxiety disorders.

  Pregabalin is not recommended if you are pregnant or may become pregnant. This is because it may harm your baby. 

  There is an increased risk that your baby may not develop properly in the womb if you take pregabalin while pregnant.   So, the NHS recommend you use effective contraception if you are taking pregabalin. 

  If you take pregabalin and become pregnant, the NHS say do not stop taking the medicine suddenly. Get advice from your GP as soon as you can. 

  What are benzodiazepines?
  Doctors should only prescribe benzodiazepines if you are in crisis.  This is because they are addictive, and they may become less effective over time.

  What are beta-blockers?
  These can help with the physical signs of anxiety. They can help to lower a fast heartbeat.  

  What are complementary therapies?

  Complementary therapies are treatments that are not usually part of mainstream NHS care. Some people find them useful for helping with symptoms of anxiety. They can include yoga and hypnotherapy. 

  For more information see our webpages on the following:

  • Talking therapies
  • Antidepressants
  • Benzodiazepines 
  • Complementary and alternative treatments for mental health
• What can I do to manage my symptoms?

  You can learn to manage your symptoms by looking after yourself. Self-care is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling. 

  What lifestyle changes can I make?

  Making small lifestyle changes can improve your wellbeing and can help your recovery.  

  Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once a week.

  How can breathing exercises help?

  Breathing exercises can help to calm you when you are feeling anxious. Or having a panic attack. You will get the most benefit if you do them regularly, as part of your daily routine. 
   
  There is more information about breathing exercises in the Further Reading section below.  

  What about support groups?

  You could join a support group. A support group is where people come together to share information, experiences and give each other support.   

  You might be able to find a local group by searching online. 

  Rethink Mental Illness have support groups in some areas. You can find out what is available in your area if you follow this link.

  What is a recovery college?

  Recovery colleges are part of the NHS. They offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. 

  You can usually self-refer to a recovery college. But the college may inform your care team. 

  Unfortunately, recovery colleges are not available in all areas. To see if there is a recovery college in your area you can search online. 

  For more information, see our webpage on Recovery and mental illness.

• Further reading

  NHS – Breathing Techniques
  This NHS website has information on calming breathing techniques. These techniques can help you when you feel anxious or are having a panic attack.

  Website: www.nhs.uk/mental-health/self-help/guides-tools-and-activities/breathing-exercises-for-stress/

  NHS – Every Mind Matters
  This website has lots of useful information and practical tips on how to manage symptoms of anxiety.

  Website: www.nhs.uk/oneyou/every-mind-matters/anxiety/

  No Panic - Resources
  The No Panic website has lots of resources to help people who are living with anxiety. This includes information on breathing techniques, relaxation techniques and advice on how to stop a panic attack.

  Website: nopanic.org.uk/resources/

  Centre for Clinical Interventions
  This website is provided by the Department of Health in Western Australia. They have some useful information sheets and a workbook for people who are experiencing body dysmorphic disorder (BDD).

  Website: www.cci.health.wa.gov.au/Resources/For-Clinicians/Body-Dysmorphic-Disorder

• Useful contacts

  Anxiety UK 
  A user-led organisation that supports anyone with anxiety, phobias, panic attacks or other anxiety disorders. Anxiety UK has a paid-for service called TAUK to us. The TAUK to us service provides personalised support and information for anyone living with anxiety. You can book an appointment with a TAUK to us adviser using the link below.

  Address: Nunes House, 447 Chester Road, Manchester, M16 9HA
  TAUK to us: www.anxietyuk.org.uk/tauk-to-us/
  Website: www.anxietyuk.org.uk

  Been There
  Been There is a charity with an app that connects people aged 18 and over with a vetted and trained Mentor to help with any body image issues. This gives them the opportunity to speak to someone who has ‘Been There’ themselves. 

  Email: info@beenthereapp.com
  Website: beenthereapp.com/what-is-been-there/ 

  Social Anxiety UK 
  Offers support with social anxiety disorder. They are a web-based organisation and offer forums, a chat room and information about social anxiety.

  Email: contact@social-anxiety.org.uk         
  Website: www.social-anxiety.org.uk 

  OCD-UK 
  Gives information, advice and support on obsessive compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD), skin-picking and hair-pulling. 

  Telephone: 01332 588 112     
  Address: 8 Chapel Street, Belper, Derbyshire, DE56 1AR 
  Email via website: www.ocduk.org/contact-us/
  Website: www.ocduk.org 

  No Panic 
  Offers emotional support and information on anxiety disorders and medication including tranquilizers. They have a 1-to-1 mentoring scheme and a telephone recovery group available to their members.

  Telephone: 0300 772 9844 
  Address: 51a Market Street, Oakengates, Telford, Shropshire, TF2 6EL
  Email: info@nopanic.org.uk 
  Website: www.nopanic.org.uk

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