Anxiety is a dynamic feeling that can manifest in different forms and at different severities. There are several different types of anxiety disorders a person can suffer from, and each type of anxiety has its own symptoms, causes, and challenges. The most recent diagnostic manual for mental health disorders organizes anxiety disorders into three categories: the anxiety classification, the obsessive-compulsive classification, and the trauma or stress induced classification. In each category there are different types of mental health diagnoses, and each diagnosis has its own characteristics and challenges.
Separation Anxiety Disorder
Separation anxiety disorder is a disorder in which a patient, who is typically a toddler or child, develops an anxious attachment to prominent attachment figures, such as a parent, guardian, or sibling, in his or her life. There could be several different triggers for this anxious attachment. There may be a fear of the attachment figure being hurt or harmed when not with the patient that causes anxiety when away from the attachment figure. There may also be a fear of abandonment, which fuels intense anxiety when the attachment figure leaves the patient alone. Untreated cases of separation anxiety disorder in children can follow into adulthood, so it is important to seek treatment if a child shows symptoms of separation anxiety disorder.
- Panic when left alone
- Crying spells and tantrums
- Distress when separated from attachment figure
- Nightmares and night terrors
- Excessive worrying about harm coming to attachment figure
- Excessive worrying about being forcibly separated from attachment figure (Going to school or activities, getting kidnapped, playing outside alone, being left home alone, being forced to sleep in own room or bed)
- Reports of stomachaches, nausea, vomiting, indigestion, etc. when confronted with idea of being separated from attachment figure
Selective mutism is a disorder that causes inability for a patient to speak or express himself or herself in social or performance-based situations. This selective mutism will affect the patient’s ability to perform academically or professionally. He or she may also suffer socially, but this is not the case for all patients. Selective mutism may affect people at any age from childhood grade school years through adulthood. If not treated, the condition may worsen or remain unchanged.
- Recurrent, frequent, or consistent failure or inability to speak in specific situations (parties, school, leadership roles, extra-curricular activities, group settings), despite being well-versed in what needs to be said or communicated, or what is expected of the patient.
- Issues with speaking or communicating affect performance and prevents advancement in achievement-based situations, like school, career, or social situations.
- Recurrent issues with speaking or communicating lasting for at least one month.
A person who suffers from a specific phobia has an intense fear or anxiety about a specific object or situation. This will cause a person to actively avoid, and fall into distress when confronted with, the feared object or situation. A phobia is more than just a fear or discomfort about something considered unpleasant or alarming. It will induce several panic-like symptoms for the patient.
Symptoms (when confronted with feared object or situation):
- Racing heartbeat
- An intense need to flee or escape perceived danger
- Chest pain
- Numbness in arms and legs
- Panic or anxiety attacks
A social phobia is a phobia that is specific to social situations. A person with social phobia will struggle with social situations, like group settings, crowded spaces, meeting new people, making small talk and making phone calls. He or she may also have an intense fear of being judged or misperceived by others. This fear effectively causes the patient to shut down and be turned off to social situations.
- Avoidance of social situations
- Fear of judgment from others
- Performance anxiety
- Nausea or indigestion when confronted with a social situation
- Freezing up during conversations
- Muscle tension
- Overanalyzing gestures and looks from others
- Feeling ‘on the spot’ when in social situations
Panic disorder is a disorder in which a patient experiences frequent panic attacks. These panic attacks may or may not be provoked by a trigger, and can happen to a patient at any time, in any situation. Recurring panic attacks take a toll on a patient’s nerves, and often leads to other disorders, like agoraphobia and depression.
- Recurrent panic attacks that reach a peak and decline within 10-15 minutes
- Avoidance of feared places or situations that may trigger a panic attack
- Depressed mood or irritability
- Having at least one panic attack per month for at least 3 months
- Intense fear of dying, especially when having a panic attack
- Worrying or preoccupation with having a panic attack
Agoraphobia is a disorder in which a patient is apprehensive about being in places or situations that he or she perceives as dangerous. This fear triggers avoidance behavior as the patient actively avoids places and situations that he or she feels jeopardizes his or her safety and wellbeing. Such places can include:
- Open spaces
- Closed spaces
- Crowded places
- Public transportation
- Anywhere outside of the home (In extreme cases)
- Intense fear of entering triggering places and situations
- Panic attacks and related symptoms
- Active avoidance of feared places and situations
Generalized Anxiety Disorder
Generalized anxiety disorder in which a person experiences persistent anxiety on a daily or regular basis. This anxiety tends to interfere with many aspects of a patient’s life, as it causes excessive worry and irrational fears.
- Anxiety about performance-based situations (academics, work, extra-curricular activities)
- Preoccupation with having and maintaining control of a situation, especially when uncomfortable or anxious
- Racing negative or intrusive thoughts
- Fatigue and sleep issues
- Difficulty concentrating
- Muscle tension
- Mood swings
Obsessive-compulsive disorder (OCD) is a disorder in which a person has obsessive and distressing thoughts and/or compulsive behaviors. These compulsive behaviors can be either mental (counting, spelling, etc.) or physical (compulsive checking, aligning or organizing objects, rituals, etc). These obsessions and compulsions cause a major strain on the patient’s ability to live a happy day-to-day life.
- Obsessive fear of or preoccupation with issues or situations (contamination, danger, perception of reality, organization, intrusive thoughts or impulses)
- Compulsive compensatory behavior that exists either on their own or with the purpose of counteracting the obsessive thoughts (checking appliances, washing and rewashing body and objects, tapping, ritualistic behavior, hoarding)
Body Dysmorphic Disorder
People who suffer from body dysmorphic disorder obsess over real or perceived bodily imperfections for most of their day, every day. A patient with body dysmporphic disorder will obsess about his or her appearance, have intense and intrusive negative thoughts about his or her appearance, and will not accept or believe others who say the imperfections are not real, or not as bad as he or she believes they are.
- Preoccupation with appearance will negatively affect other aspects of life (school, work, relationships, etc.)
- Excessive attempts to hide perceived imperfections
- Obsession or preoccupation with physical appearance
- Comparing patient’s own body to others
- Either compulsively checking or actively avoiding mirrors
- Excessive efforts to look ‘good’ (excessive exercising, excessive grooming, frequent wardrobe changes, seeking surgical or cosmetic alterations)
Hoarding disorder is a disorder in which a person will compulsively collect useless, broken, or unnecessary items to the point of severe accumulation. People with hoarding disorder experience extreme anxiety over the thought of discarding their belongings, even if it is considered garbage or is detrimental to the their health. People with hoarding disorder often struggle to see the issue with their hoarding behavior, which puts a strain on interpersonal relationships and mental health.
- Obsession or preoccupation with ‘collecting’ useless items or items that are unrelated to each other
- Intense anxiety and mood swings when confronted with the idea of purging belongings
- Noticeable buildup of clutter
- Disorganized lifestyle
Trichotillomania is a disorder in which a patient will pull his or her hair out. Patients have difficulty resisting the urge to pull out their hair, especially when confronted with a stressor or feelings of anxiety. People with trichotillomania may pull out hair from their scalp, face, eyebrows, or any other part of their body.
- Difficulty resisting pulling out hair
- Efforts to hide bald spots or skin irritation from pulling out hair
- Pulling out hair to relieve stress, tension or anxiety
- Unsuccessful efforts to refrain from pulling out hair
- Anxiety and/or shame about hair pulling habit
People with excoriation disorder compulsively pick at their own skin. This recurrent and compulsive skin picking leaves sores, rashes, scars, and scabs, which increases in frequency and severity when feeling stressed or uncomfortable. A person with excoriation disorder will also pick at his or her skin if he or she perceives the targeted part of skin as imperfect or defective.
- Compulsively picking, scratching, or rubbing skin
- Skin irritation, pain, swelling, bleeding, or bruising
- Unsuccessful attempts to control impulses to pick at skin
- Skin picking increases in frequency and severity when under stress
- Efforts to hide skin abrasions from others
Trauma / Stress Induced Classification
Reactive Attachment Disorder
Reactive attachment disorder is a disorder that affects children who were exposed to negligent or abusive environments or situations during critical developmental periods. Children with reactive attachment disorder will fail to develop a healthy attachment with their parents, guardians, or peers, as a result of emotional negligence. Through soothing as a child, people learn empathy and healthy attachment habits. Without learning these habits the child will be socially, emotionally, and mentally impacted.
- Detached from others, especially children and parents or guardians
- Apathy to efforts to soothing or signs of affection
- Limited expressions of emotions
- Avoidance of adults and peers
- Withdrawn behavior in social situations
Disinhibited Social Engagement Disorder
Disinhibited social engagement disorder affects children. Children with disinhibited social engagement disorder will have poor social boundaries, as they actively approach and interact with strangers and unfamiliar adults. The child will not hesitate to approach or engage with people who he or she does not know, will not be mindful of personal boundaries, and will not hesitate to wander off without supervision of a parent or guardian. This behavior is often the result of emotional neglect or failure to receive emotional support and comforting from primary caregiver.
- Socially inappropriate interactions with strange adults
- Little or no hesitance for approaching strangers
- Poor social boundaries
- Lack of concern for whereabouts of parents or guardians
- Lack of concern for going off alone or without parents or guardians
- History of social, emotional, or mental neglect
Posttraumatic Stress Disorder
Posttraumatic stress disorder is a disorder that a person may develop after experiencing a traumatic event. Traumatic events are subjective, and depend on the stress tolerance of the individual, not the severity of the actual event. Several things can trigger a person to react to trauma and develop posttraumatic stress disorder, like:
- Witnessing the death or injury of a loved one
- Unexpected death of a loved one
- Being kidnapped or held hostage
- Being victim to an act of terror
- Being victim to verbal, physical, mental or sexual assault or abuse
- Being victim or witnessing domestic violence.
- Being a war veteran or having a high-stress job
Each of these situations and more may cause a person to develop posttraumatic stress disorder. People tend to believe that posttraumatic stress disorder is a disorder that exclusively war veterans experience, but this is not the case. Anyone can develop posttraumatic stress disorder after experiencing a traumatic event.
- Avoiding stressful or triggering situations
- Nightmares or night terrors
- De-realization or dissociation from stressful situations
- Panic attacks
- Mood swings
Acute Stress Disorder
Acute stress disorder is similar to posttraumatic stress disorder. People develop acute stress disorder after experiencing a traumatic event, like the examples listed above. In order to be classified as acute stress disorder rather than posttraumatic stress disorder, symptoms must last only between 3 days and 4 months after the traumatic event.
- Experiencing a traumatic event that triggers intense fear
- Emotional detachment
- Lack of interest in enjoyable activities
- De-realization, avoidance, and dissociation symptoms
- Recurrent nightmares about event
- Mood swings
Adjustment disorder is characterized as a difficulty adjusting to a new or unexpected life stressor. Any sort of change in a person’s life may trigger adjustment disorder. Common examples include:
- A shift in a family dynamic
- Moving to a new home
- Transitioning between life events (going to college or graduating from college, career changes, etc.)
- Relationship issues or loss
- Chronic illness
- Mood swings
- Depressed mood
- Muscle tension
- Nightmares or night terrors
- Social withdrawal
- Work-related or academic issues
- Heightened levels of anxiety