What are the Five Major Types of Anxiety Disorders

Anxiety is your body’s natural response to undue stress. It's a feeling of fear, worry, or tension. If you are not familiar with what exactly anxiety is, check out our article before continuing.

However, your anxiety isn’t as simple as fear or worry. It is much more complex and can be categorized into five common types of anxiety disorders. Your anxiety could fall into one or more of these categories.

There are different signs and symptoms unique to each type. Each anxiety disorder also will respond differently to the various types of therapy available.

Different Types of Anxiety Disorders

There are five common types of anxiety disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The manual is a result of the past 10 years of effort and input from hundreds of experts within the mental health field.

The DSM-5 is used by clinicians and researchers to diagnose and classify mental disorders with concise and explicit assessments. There are five common anxiety disorders classified:

1. Generalized Anxiety Disorder (GAD)

2. Social Anxiety Disorder (SAD)

3. Specific Phobia

4. Agoraphobia

5. Panic Disorder

In the past, Post-Traumatic Stress Disorder (PTSD) and Obsessive-Compulsive Disorder (OCD) were classified under Anxiety Disorders. However, in the latest revision, they are now classified under their own separate sections.

How Common Are Anxiety Disorders?

In any given year the estimated percent of US adults with various anxiety disorders are:

Generalized Anxiety Disorder (GAD)

Excessive and chronic anxiety, worry, or tension about a number of events, activities, or objects.

The anxiety is not focused on one specific object or situation. Individuals with GAD tend to exaggerate everyday worries such as about money, health, family, or work.

People with GAD are usually unable to break out of the worry cycle and may feel even more overwhelmed just thinking about getting through the day.

Worries can be difficult to control and lead to excessive stress that can take a toll. This may lead to feeling restlessness, irritability, difficulty concentrating, or sleeping problems.

Social Anxiety Disorder (SAD)

Also known as social phobia, it is a fear or anxiety about social situations where you are exposed to judgement, scrutiny, or rejection in a social or performance situation. This includes:

• having a conversation

• meeting unfamiliar people

• being observed

• performing in front of others

The fear of being embarrassed or viewed as being stupid or boring can lead to avoidance and have an impact on relationships, school, and work.

Specific Phobia

Fear or anxiety in the presence of or in anticipation of a specific object or situation. There are many different types of phobias that are classified into five main categories:

• Animal Type: dogs, snakes, or spiders

• Natural Environment Type: heights, storms, or water

• Blood/Injury Type: fear of seeing blood, receiving a blood test or shot, or watching tv shows that display medical procedures

• Situational Type: airplanes, elevators, driving, or enclosed places

• Other Types: avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds like balloons popping or costumed characters like clowns

People with phobias realize their fear is irrational, however, thinking about it can cause extreme anxiety.

Most people experience fear from specific objects or situations throughout their lives. Phobias are different because it interferes with daily tasks or routines and can cause unhealthy avoidance behaviors.

Agoraphobia

Fear or anxiety of being in a place that seems hard to escape or help might not be available in the event of panic-like symptoms occurring. This includes:

• public transportation

• open spaces

• enclosed spaces

• standing in line

• in a crowd

• outside your home alone

Some people with agoraphobia find it difficult to travel beyond their safety zone because they develop a safety zone or define a route for traveling or getting around.

This often causes people to avoid these situations or at its most severe form, individuals can become housebound due to their fears.

Panic Disorder

A panic disorder is when a person experiences an abrupt surge of intense fear or discomfort that is unexpected and recurrent.

This sudden episode is known as a panic attack and is generally accompanied by physical symptoms such as chest pain, heart palpitations, shortness of breath, and dizziness.

People with panic disorders often worry about when the next panic attack will occur. They will actively try to prevent triggering more panic attacks.

Signs and Symptoms

Although anxiety disorders have many common symptoms such as panic, fear, and tension, there are signs and symptoms unique to each type of anxiety disorder that you should pay attention to.

Generalized Anxiety Disorder

Diagnosis criteria for GAD:

• Excessive anxiety and worry about a number of events or activities

• Overthinking plans and solution

• Perceiving situations and events as threatening

• Difficulty handling uncertainty

• Indecisiveness and fear of making the wrong decision

• Is persistent and occurs more days than not for at least 6 months

• Difficult to control the worry

• Difficulty concentrating or mind going blank

Physical Symptoms

• Restlessness or feeling on edge

• Easily fatigued

• Irritability

• Muscle tension

• Difficulty sleeping

Social Anxiety Disorder

Diagnosis criteria for SAD:

• Fear of situations in which you may be judged

• Feelings of humiliation or embarrassment

• Intense fear of interacting or talking with strangers

• Avoiding situations where you might be the center of attention

• Analyzing your performance and identifying flaws in your interactions after a social situation

• Social situations are avoided or endured with intense fear or anxiety

• Is persistent and typically lasts 6 months or more

Physical Symptoms

• Blushing

• Racing heart-rate

• Trembling

• Sweating

• Upset stomach or nausea

• Dizziness or light-headed

• Feeling your mind going blank

Specific Phobia

Diagnosis criteria for Specific Phobia:

• Provokes immediate fear or anxiety

• Avoidance of objects or situations

• Fear or anxiety is out of proportion to actual danger posed

• Is persistent and typically lasts 6 months or more

• Causes significant distress or impairment in social, occupational, or other areas of functioning

Physical Symptoms

• Difficult functioning normally

• Sweating

• Racing heart-rate

• Shortness of breath

• Nausea

• Feeling dizzy or faint

Agoraphobia

Diagnosis criteria for Agoraphobia:

• Marked fear or anxiety about:

  • Using public transportation

  • Being in open spaces

  • Being in enclosed spaces

  • Standing in line or being in a crowd

  • Being outside of the home alone

• Avoidance of those situations because of the thought of escaping might be difficult if panic-like symptoms or embarrassing symptoms occur

• Those situations are actively avoided, require the presence of a companion, or endure the situation but are extremely distressed

• Is persistent and typically lasts 6 months or more

Physical Symptoms:

• Rapid heart-rate

• Trouble breathing or a feeling of choking

• Chest pain or pressure

• Light-headed or dizziness

• Feeling shaky, numbness, or tingling sensation

• Excessive sweating

• Sudden flushing or chills

• Upset stomach or diarrhea

• Feeling a loss of control

• Fear of dying

Panic Disorder

Diagnosis criteria for Panic Disorders:

• Recurrent unexpected panic attacks (abrupt surge of intense fear or discomfort)

• Persistent worry about additional panic attacks

• Avoidance of activities that have caused panic attacks

Physical Symptoms

• Racing heart-rate

• Sweating

• Trembling or shaking

• Shortness of breath

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, light-headed, or faint

• Chills or heat sensations

• Numbness or tingling sensations

• Feelings of unreality or being detached from one's self

• Fear of losing control

• Fear of dying

Everyone experiences something different with their anxiety. This makes it challenging to describe what is happening to you. Here are some simple ways to explain how your anxiety feels to others that don’t have it.

Treatment

There are many different options for treating anxiety disorders. Although one treatment option may be effective for treating a particle disorder, it isn’t always effective for everyone.

Your therapist will work with you to determine what treatment option may work best for your situation and problems you experience. Here are a few of the common treatment options you may encounter.

Cognitive Behavioral Therapy (CBT)

CBT is a type of talking therapy focused on exploring the link between your thoughts, emotions, and behaviors. It is a goal-oriented, time-based, structured treatment that is focused on teaching you to be your own therapist.

It requires active participation and collaboration with your therapist. You need to put in the effort and work to benefit from this type of treatment.

It is the most widely researched psychotherapy and has a strong ever-evolving evidence-based practice. This makes it effective for treating a wide range of disorders including GAD and most other anxiety disorders.

The main focus of CBT is altering irrational thoughts and behaviors. This is achieved by teaching you to:

• identify problems and build awareness

• distinguish between facts and irrational thoughts

• consciously challenge and reframe cognitive errors

• be more resilient and in control

• practice relapse prevention

Dialectical Behavioral Therapy (DBT)

DBT is a form of talking therapy that focused on providing you with the skills aimed to improve your ability to manage painful emotions.

DBT consists of four particular modules:

1. Mindfulness: To build awareness and learn to focus on living in the present.

2. Emotion Regulation: Learn to navigate your feelings and effectively identify, name, and change your emotions.

3. Distress Tolerance: Learn to work through distressful situations with easily accessible and repeatable coping techniques.

4. Interpersonal Effectiveness: Helps you to listen and communicate more effectively and deal with challenging interpersonal relationships.

Exposure Therapy

Exposure therapy is a treatment focused on confronting your fears directly. It is effective for treating social anxiety disorder, specific phobia, and agoraphobia and helps more than 90% of people treated.

There are four main variations of exposure therapy. Your therapist will determine which strategy is best suited to your fears.

• In Vivo Exposure: A direct confrontation of feared object, situation, or activity in real life. For example, someone with social anxiety may be instructed to give a presentation.

• Imaginal Exposure: Vividly imagining the feared object, situation, or activity and verbally describing or writing a description of the experience. For example, someone who’s had a traumatic event might be asked to recall and describe their traumatic experience.

• Virtual Reality Exposure: Use of virtual reality technology to give the illusion of immersion in an interactive environment. It is designed to replicate objects, situations, or activities feared in real life that would not be practical to use in vivo exposure. For example, someone with a fear of flying could experience a virtual flight.

• Interoceptive Exposure: Deliberately inducing the physical sensations of the fear without the feared object, situation, or activity itself. For example, someone who experiences a panic attack might be asked to run on a treadmill to induce a racing heart-rate symptom.

Exposure therapy can be paced in different ways. This includes:

• Graded Exposure: This involves creating an exposure fear hierarchy that is ranked by intensity. The therapist will gradually expose you to your fears starting with the least intense which allows you to control your fear at each step.

• Flooding: Using the fear hierarchy but this time starting with the most intense fear and allowing prolonged exposure which may initially be discomforting.

• Systematic Desensitization: This follows a three-step process

1. Relax: You will learn relaxation techniques such as progressive muscle relaxation or deep breathing.

2. Fear Hierarchy: A fear hierarchy will be created and ranked by intensity

3. Exposure: You will gradually be exposed to your fears starting with least intense, but this time utilizing the relaxation techniques to make the fear feel more manageable

Interpersonal Therapy (IPT)

Interpersonal Therapy can help you communicate better and improve your relationships by addressing interpersonal issues. IPT can help treat social anxiety disorder when CBT or other therapies are not effective.

Stages of IPT

IPT is a structured and time-based treatment program. It consists of three stages:

1. Assessment: An assessment of the interpersonal environment is conducted by identifying current and past relationships and any interpersonal issues.

2. Addressing Your Problems: IPT model sets specific goals and strategies for each of the interpersonal areas.

   • Role Disputes

   • Role Transitions

   • Grief

   • Interpersonal Deficits

3. Review and Next Steps: A focus on relapse prevention as the treatment nears its end. A review of the treatment progress is evaluated and any future steps are discussed.

Techniques

• Clarification: The therapist will help figure out how your misconceptions are playing a role in your relationships.

• Supportive Listening: Your therapist will listen judgment free and make you feel comfortable by being supportive.

• Role-Playing: Role-playing interpersonal situations with your therapist is good practice and helps you see things in a different way.

• Communication Analysis: You would be asked to describe in detail a social interaction that caused you a lot of anxiety. You will work together to identify unhealthy patterns or behaviors and what you could do differently.

• Managing Emotions: You will learn to express and manage your emotions by working with your therapist.

Panic-Focused Psychodynamic Psychotherapy (PFPP)

PFPP focuses on stressful life experiences preceding the onset of panic disorder symptoms and the meaning that event has. Conflicts from childhood are analyzed to increase emotional awareness and foster resolution.

PFPP consists of:

1. Identifying the meaning of panic systems

2. Identifying core conflicts underlying panic disorder

Although there is a growing evidence-based for the efficacy of PFPP, the evidence does not suggest it is as effective as other treatment options such as CBT.