Understanding Anxiety Disorders

When fear and worry dominate every-day life

Fear is a vital emotion because it warns us of dangers at an early stage and urges us to be careful and avoid them. In the case of anxiety disorders, however, this warning system is disturbed, so that intense anxiety also develops in “danger-free” situations. The anxiety reaction is often accompanied by additional unpleasant physical symptoms such as increased heart rate, sweating, shortness of breath, hot flushes, nausea, a feeling of loss of control or fainting, which in turn can then further intensify the anxiety reaction. In extreme cases, the reaction chain leads to a full-blown panic attack, which can  be accompanied by fear of death or ‘losing control’ and often ends in a state of exhaustion.

The best-known examples of anxiety disorders are recurrent panic attacks, agoraphobic fears (e.g. fear of crowded places such as shopping centres or train stations – places and situations from which it is difficult to escape), social phobias (extreme fear of embarrassment or feeling overwhelmingly uncomfortable in a social context), specific phobias (e.g. of dogs, spiders, blood and syringes, fear of heights, etc.) and generalised anxiety disorders ( where everyday life is dictated by by constant worries).

How do I recognize an anxiety disorder?

The development of an anxiety disorder is usually a gradual process. Normal or adaptive feelings of anxiety are recognised by all of us through our development. The first signs of maladaptive anxiety reactions usually become salient to an individual when they tend to experience anxiety in situations that are actually safe and do not trigger a comparable reaction in most people.

How are anxiety disorders treated?

Left untreated, acute and chronic anxiety disorders often result in functional limitations in social, professional and family environments and can lead to feelings of isolation and depression.

Anxiety disorders are primarily treated with psychotherapy. High efficacy has been demonstrated in particular for cognitive behavioural therapy (CBT).

What types of anxiety disorders are there?

  • Panic Attacks and Panic Disorder
  • Agoraphobia
  • Social Phobia
  • Specific Phobia
  • Generalized Anxiety Disorder
Panic Attacks and Panic Disorder

A panic attack is a state of intense anxiety that often occurs unpredictably and without a specific trigger. The anxiety reaches its peak within 10 minutes, sometimes with fear of death, and then may dissipate. Panic attacks often come with various physical symptoms, such as chest pain, suffocation and shortness of breath, dizziness and feelings of alienation. Many people experience at least one panic attack in their lives. About 2-4% of the population develop a panic disorder. A panic disorder is a condition in which the person is constantly fearful of a new panic attack.

Cognitive Behavioural Therapy (CBT) facilitated by a qualified Psychologist (for example) is shown to greatly help people with panic disorders . In CBT, the person  learns to face their fears in a protected setting and to behave contrary to the phobia using specific strategies and tricks with the aim of normalizing the fear reaction.
Panic attacks can also occur as part of a depressive disorder. In this case, it is generally advised that symptoms of depression should be first addressed.


Agoraphobia is characterized by the fear of situations or places from which it is difficult to escape or from which help is difficult to obtain. Typical situations and places are subway and suburban trains, long trips in elevators, flying by plane, being alone at home or far away from home, large crowds, waiting in a queue at the supermarket (for example). Because the fear reaction is exaggerated and therefore increases the risk of the person experiencing a panic attack, these situations and places are avoided or only entered with another person (safety anchor) and “survived” under great discomfort. If the avoidance behaviour is strengthened and maintained, this leads to an increased restriction in the person’s everyday activities, which can affect work performance, social relationships and practical exercises such as shopping for groceries or using public transport. In extreme cases, a person with chronic and untreated agoraphobia are extremely adverse to leaving their own home.
Many patients who develop agoraphobia have had recurrent panic attacks or panic disorder in the past. Due to the fear of another panic attack, situations and places from which it is difficult to escape or receive help are avoided.
Agoraphobia is often confused with claustrophobia. Claustrophobia, i.e. the fear of closed rooms, is classified as a specific phobia.

Social Phobia

People with a social phobia fear situations in which they are potentially the focus of attention and something embarrassing happens to them or they might embarrass themselves. For these people, there is a constant and sometimes debilitating perception of being negatively evaluated by the people in their environment. Social phobic people usually have relatively low self-esteem and may be regarded as rather fearful and reserved. People with social phobia tend to avoid situations like speaking in front of other people (e.g. giving a presentation), eating in front of others, writing, having to move around, e.g. running to the bus, performing at school. Social anxiety is usually accompanied by physical symptoms such as blushing, trembling, soft knees, shaky voice or increased bowel movements.  These symptoms often exacerbate the feeling and increase the fear of embarrassment. Constant avoidance of these situations can lead to tremendous social, school, study or work restrictions, resulting in a feeling of isolation.

Specific Phobia

This form of anxiety is usually limited to narrowly defined situations. Specific phobias can be attributed to any possible situations. Usually the fear is related to coming into contact with certain animals (e.g. spiders, insects, birds, dogs) or to feel confronted by closed rooms, towers, heights, thunder, darkness, deep water, blood, syringes, hospitals, public toilets, dirt and injuries. A person with one of these specific phobias usually feels some sort of physical reaction, such as trembling, hot flushes, weak knees, shortness of breath.
As with other anxiety disorders, repeated exposure therapy as part of  Cognitive Behavioural Therapy can be beneficial.

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) applies to people who have a constant feeling of anxiety and worry towards a wide range of everyday tasks. An example of this would be someone who feels persistent worry that they or someone close to them will suffer an acute illness or accident. This often manifests itself as an endless chain of negative emotion and stress. Negative stories in the news and across social media, for example, may trigger anxiety attacks for people with this disorder so they therefore might avoid exposure to these channels. People with Generalized Anxiety Disorder may rely on excessive reinsurance behaviours, such as relying on friends, family members or (often) medical professionals to reassure them of their safety and remind them they are not experiencing a perceived threat or illness. Physical reactions such as nervousness, muscle tension, tremor, drowsiness, palpitations, dizziness or abdominal pain are typical symptoms caused by Generalized Anxiety Disorder.

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