General Anxiety and Panic

Anxiety is a normal response to stress or danger. The purpose of anxiety is to help prepare the body for action, and it can improve performance in a range of situations, this is known as the fight or flight response and is the body’s way of helping you in dangerous situations. Anxiety becomes a problem when it is experienced, inappropriately, intensely and interferes with a person's daily life. 

Anxiety disorders can be loosely grouped into 3 categories:- 
Generalised anxiety, 
Panic disorder, 
Phobias. 

They tend to overlap considerably and it is not uncommon for people to have features of several of the disorders.

Generalised anxiety disorder is characterised by anxiety symptoms that can include :- Inner tension, agitation, Fear of losing control, Dread that something catastrophic is going to happen, such as a blackout, seizure, heart attack or death. Irritability. Feelings of detachment, as if being trapped in a bubble separate from the world. Racing heart beat (palpitations). Breathing fast, feeling short of breath or finding it hard to 'get breath'. Chest tightness. Dry mouth, Butterflies in the stomach, Feeling sick. An urge to pass urine. Tremor and Sweating. 

With generalised anxiety disorder the symptoms a person experiences can be present for much of the time and not restricted to specific situations.

In panic disorder, repeated panic attacks occur unpredictably and often without obvious causes, a person can even awaken in the night having a panic attack. The attacks consist of severe anxiety with physical and psychological symptoms, they can be terrifying for the sufferer who often feels as if they are having a heart attack, they can not breathe or “they are going mad”. 

A phobia is a fear that is out of proportion to the situation that causes it and cannot be explained away. The person typically avoids the feared situation, since this helps to reduce the anxiety. 

Some phobias represent heightened normal anxiety towards situations that people are evolutionarily 'prepared' to fear, e.g. snakes, heights and sharp objects. 

In other instances, a phobia may arise by a non-threatening situation being associated with a traumatic experience. Having a car crash in Spain may lead to a phobia of Spain itself, holidays, driving or flying. 

Phobias typically occur in specific situations, e.g. a fear of dentists. People experience 'anticipatory anxiety' when thinking of the situation and so attempt to avoid it. They are common in the general population, but are only severe enough to prove disabling in 2 per cent of people. 

Simple phobias are phobias that are specific to objects or situations. Specific phobias include: 
• Animal phobias (e.g. dogs, snakes, spiders): the start of these phobias is often in childhood, usually before the age of seven years. 
• Blood and injury phobias: the fear of blood tests or the sight of blood that results in fainting. 
• Vertigo: a fear of heights. 
• Agoraphobia: an intense fear of leaving the home, being in crowded spaces, travelling on public transport and being in any place that is difficult to leave. Around 75 per cent of sufferers are women, and it occurs in just under 1 per cent of people. Agoraphobia may follow a life event and be associated with a fear of 'what if it comes back while I am away from home'. It commonly occurs with panic attacks. The person may have a panic attack when outside the home and this reinforces the belief that it is safer to stay inside. Agoraphobia is often associated with depression. 
• Social phobia: a fear of social interaction with others, talking to people, eating, drinking and speaking in public. In contrast to agoraphobia, men and women are affected equally. Many people have a mixture of both agoraphobia and social phobia. Social phobia is also a common symptom of depression.