Anxiety disorders are serious medical illnesses that affect approximately 19
million American adults.1 These disorders fill people’s lives with
overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused
by a stressful event such as a business presentation or a first date, anxiety
disorders are chronic, relentless, and can grow progressively worse if not
Effective treatments for anxiety disorders are available, and research is
yielding new, improved therapies that can help most people with anxiety
disorders lead productive, fulfilling lives. If you think you have an anxiety
disorder, you should seek information and treatment.
This brochure will
- help you identify the symptoms of anxiety disorders,
- explain the role of research in understanding the causes of these
- describe effective treatments,
- help you learn how to obtain treatment and work with a doctor or therapist,
- suggest ways to make treatment more effective.
The anxiety disorders discussed in this brochure are
- panic disorder,
- obsessive-compulsive disorder,
- post-traumatic stress disorder,
- social phobia (or social anxiety disorder),
- specific phobias, and
- generalized anxiety disorder.
Each anxiety disorder has its own distinct features, but they are all bound
together by the common theme of excessive, irrational fear and dread.
The National Institute of Mental Health (NIMH) supports scientific
investigation into the causes, diagnosis, treatment, and prevention of anxiety
disorders and other mental illnesses. The NIMH mission is to reduce the burden
of mental illness through research on mind, brain, and behavior. NIMH is a
component of the National Institutes of Health, which is part of the U.S.
Department of Health and Human Services.
“It started 10 years ago, when I had just graduated from college and started
a new job. I was sitting in a business seminar in a hotel and this thing came
out of the blue. I felt like I was dying.
“For me, a panic attack is almost a violent experience. I feel disconnected
from reality. I feel like I’m losing control in a very extreme way. My heart
pounds really hard, I feel like I can’t get my breath, and there’s an
overwhelming feeling that things are crashing in on me.
“In between attacks there is this dread and anxiety that it’s going to happen
again. I’m afraid to go back to places where I’ve had an attack. Unless I get
help, there soon won’t be anyplace where I can go and feel safe from
People with panic disorder have feelings of terror that strike suddenly and
repeatedly with no warning. They can’t predict when an attack will occur, and
many develop intense anxiety between episodes, worrying when and where the next
one will strike.
If you are having a panic attack, most likely your heart will pound and you
may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and
you might feel flushed or chilled. You may have nausea, chest pain or smothering
sensations, a sense of unreality, or fear of impending doom or loss of control.
You may genuinely believe you’re having a heart attack or losing your mind, or
on the verge of death.
Panic attacks can occur at any time, even during sleep. An attack generally
peaks within 10 minutes, but some symptoms may last much longer.
Panic disorder affects about 2.4 million adult Americans1 and is
twice as common in women as in men.2 It most often begins during late
adolescence or early adulthood.2 Risk of developing panic disorder
appears to be inherited.3 Not everyone who experiences panic attacks
will develop panic disorder—for example, many people have one attack but never
have another. For those who do have panic disorder, though, it’s important to
seek treatment. Untreated, the disorder can become very disabling.
Many people with panic disorder visit the hospital emergency room repeatedly
or see a number of doctors before they obtain a correct diagnosis. Some people
with panic disorder may go for years without learning that they have a real,
Panic disorder is often accompanied by other serious conditions such as
depression, drug abuse, or alcoholism4,5 and may lead to a pattern of
avoidance of places or situations where panic attacks have occurred. For
example, if a panic attack strikes while you’re riding in an elevator, you may
develop a fear of elevators. If you start avoiding them, that could affect your
choice of a job or apartment and greatly restrict other parts of your life.
Some people’s lives become so restricted that they avoid normal, everyday
activities such as grocery shopping or driving. In some cases they become
housebound. Or, they may be able to confront a feared situation only if
accompanied by a spouse or other trusted person.
Basically, these people avoid any situation in which they would feel helpless
if a panic attack were to occur. When people’s lives become so restricted, as
happens in about one-third of people with panic disorder,2 the
condition is called agoraphobia. Early treatment of panic disorder can
often prevent agoraphobia.
Panic disorder is one of the most treatable of the anxiety disorders,
responding in most cases to medications or carefully targeted psychotherapy.
You may genuinely believe you’re having a heart attack, losing your
mind, or are on the verge of death. Attacks can occur at any time, even during
Depression often accompanies anxiety disorders4 and, when it does,
it needs to be treated as well. Symptoms of depression include feelings of
sadness, hopelessness, changes in appetite or sleep, low energy, and difficulty
concentrating. Most people with depression can be effectively treated with
antidepressant medications, certain types of psychotherapy, or a combination of
“I couldn’t do anything without rituals. They invaded every aspect of my
life. Counting really bogged me down. I would wash my hair three times as
opposed to once because three was a good luck number and one wasn’t. It took me
longer to read because I’d count the lines in a paragraph. When I set my alarm
at night, I had to set it to a number that wouldn’t add up to a “bad”
“Getting dressed in the morning was tough because I had a routine, and if I
didn’t follow the routine, I’d get anxious and would have to get dressed again.
I always worried that if I didn’t do something, my parents were going to die.
I’d have these terrible thoughts of harming my parents. That was completely
irrational, but the thoughts triggered more anxiety and more senseless behavior.
Because of the time I spent on rituals, I was unable to do a lot of things that
were important to me.
“I knew the ritual
Bipolar disorder, also known as manic-depressive illness,
is a brain disorder that causes unusual shifts in a person’s mood, energy, and
ability to function. Different from the normal ups and downs that everyone goes
through, the symptoms of bipolar disorder are severe. They can result in damaged
relationships, poor job or school performance, and even suicide. But there is
good news: bipolar disorder can be treated, and people with this illness can
lead full and productive lives.
More than 2 million American adults,1 or about
1 percent of the population age 18 and older in any given year,2 have
bipolar disorder. Bipolar disorder typically develops in late adolescence or
early adulthood. However, some people have their first symptoms during
childhood, and some develop them late in life. It is often not recognized as an
illness, and people may suffer for years before it is properly diagnosed and
treated. Like diabetes or heart disease, bipolar disorder is a long-term illness
that must be carefully managed throughout a person’s life.
“Manic-depression distorts moods and thoughts, incites dreadful behaviors,
destroys the basis of rational thought, and too often erodes the desire and will
to live. It is an illness that is biological in its origins, yet one that feels
psychological in the experience of it; an illness that is unique in conferring
advantage and pleasure, yet one that brings in its wake almost unendurable
suffering and, not infrequently, suicide.”
“I am fortunate that I have not died from my illness, fortunate in having
received the best medical care available, and fortunate in having the friends,
colleagues, and family that I do.”
Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p.
(Reprinted with permission from Alfred A. Knopf, a division of Random
What Are the Symptoms of
Bipolar disorder causes dramatic mood swings—from overly
“high” and/or irritable to sad and hopeless, and then back again, often with
periods of normal mood in between. Severe changes in energy and behavior go
along with these changes in mood. The periods of highs and lows are called
episodes of mania and depression.
Signs and symptoms of mania
(or a manic episode) include:
- Increased energy, activity, and restlessness
- Excessively “high,” overly good, euphoric mood
- Extreme irritability
- Racing thoughts and talking very fast, jumping from one idea to another
- Distractibility, can’t concentrate well
- Little sleep needed
- Unrealistic beliefs in one’s abilities and powers
- Poor judgment
- Spending sprees
- A lasting period of behavior that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with three or more of
the other symptoms most of the day, nearly every day, for 1 week or longer. If
the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression (or a
depressive episode) include:
- Lasting sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in activities once enjoyed, including sex
- Decreased energy, a feeling of fatigue or of being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleeping too much, or can’t sleep
- Change in appetite and/or unintended weight loss or gain
- Chronic pain or other persistent bodily symptoms that are not caused by
physical illness or injury
- Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most
of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person
who experiences it and may even be associated with good functioning and enhanced
productivity. Thus even when family and friends learn to recognize the mood
swings as possible bipolar disorder, the person may deny that anything is wrong.
Without proper treatment, however, hypomania can become severe mania in some
people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of
psychosis (or psychotic symptoms).
Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise
sensing the presence of things not actually there) and delusions (false,
strongly held beliefs not influenced by logical reasoning or explained by a
person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend
to reflect the extreme mood state at the time. For example, delusions of
grandiosity, such as believing one is the President or has special powers or
wealth, may occur during mania; delusions of guilt or worthlessness, such as
believing that one is ruined and penniless or has committed some terrible crime,
may appear during depression. People with bipolar disorder who have these
symptoms are sometimes incorrectly diagnosed as having schizophrenia, another
severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as
a spectrum or continuous range. At one end is severe depression, above which is
moderate depression and then mild low mood, which many people call “the blues”
when it is short-lived but is termed “dysthymia” when it is chronic. Then there
is normal or balanced mood, above which comes hypomania (mild to moderate
mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur together
in what is called a mixed bipolar
state. Symptoms of a mixed state often include agitation, trouble sleeping,
significant change in appetite, psychosis, and suicidal thinking. A person may
have a very sad, hopeless mood while at the same time feeling extremely
Bipolar disorder may appear to be a problem other than mental illness—for
instance, alcohol or drug abuse, poor school or work performance, or strained
interpersonal relationships. Such problems in fact may be signs of an underlying
Diagnosis of Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet be identified
physiologically—for example, through a blood test or a brain scan. Therefore, a