Anxiety: what it is, what it isn’t…part 1

By Alan Koenigsberg, M.D.

The articles for the last few weeks dealt with depression and depressive disorders. These next few weeks, I’ll cover anxiety and the anxiety disorders — what they are, what they aren’t and how we help people afflicted with those conditions.

To start off, just about everybody has experienced the unpleasant sensation of anxiety…rapid heart racing, worry, fear, sweating, bowel churning, tension headaches, neck pain, lightheadedness, dread, along with an array of many other similar symptoms.

These experiences are a normal part of being human, when faced with a potentially dangerous situation. The timeworn flight-or-fight when facing a saber-toothed tiger is fairly well-known, but in these days, it could be an adult facing an IRS audit or a student studying for a final exam or someone preparing for a major talk in front of a large audience.

We have all had the experience in which we experienced feelings of anxiety when faced with these situations. The key difference between normal anxiety and an anxiety disorder is that in everyday anxiety, the anxiety fades quickly when the anxiety-provoking situation is resolved.

With an anxiety disorder, the symptoms tend to be ever-present and do not subside. In addition, they are not generally in anticipation of some potentially dangerous event, but rather a baseline of dread.

Over time, the person begins to catastrophize and worry that everyday situations will be a source of dread. For instance, if anxiety appears while driving on the highway, the person may gradually avoid driving on highways, rationalizing that it’s safe to drive on the streets.

When the anxiety continues while driving on the streets, the person may avoid leaving the house completely.

So what I plan to do is discuss the major forms of anxiety disorders, what their common symptoms are, how they different from each other and what treatments are available.

As an overview, the anxiety disorders together occur in about 19% of the adult population. Regarding adolescents, the recent research indicates that about 32% of adolescents meet criteria for an anxiety disorder. For each population group, women seem significantly more likely to be afflicted with these conditions.

A reliable source of information is

From a medical perspective, these are very common conditions and deserve our attention, care and respect.

Generalized Anxiety Disorder (GAD) is a condition in which the anxiety is pervasive and persistent, is not associated with a precipitant and can cause considerable distress and dysfunction at home and at work.

Panic Disorder consists of having anxiety attacks that may mimic the chest and arm pain of a heart attack, rapid heart beating, sweating, intense anxiety and imminent dread and fear of dying.

Agoraphobia is the fear of leaving the house for concern about something dreadful happening.

Obsessive-Compulsive Disorder includes ruminative thinking, worrying, along with behaviors that are an attempt to calm the worry.

Social Anxiety Disorder occurs when faced with a specific social situation: for example, speaking in public, using a public restroom, eating in public.

Phobias are feelings of intense anxiety when faced with a specific trigger, such as heights, spiders, needles, flying and so on.

Over the next few weeks, I’ll discuss each of these conditions in more detail, along with how we help people identify and take care of these conditions.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.

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