Anxiety disorders

The word anxiety, from the Latin angere or "tighten", communicates very well the feeling of unease experienced by those who suffer from it. Since it is a word that is often used in everyday language we see specifically what it is really about.

Anxiety is an innate reaction part of human nature. It is the normal response of our body that is preparing to face what it perceives as a threat. When our ancestors faced the threat of wild animals or hostile peoples, the changes taking place in their bodies prepared them to “fight or flight”.

Nowadays, the dangers are of a completely different nature, but to face we perceive as threatening, the same changes occur in us.

When anxiety is moderate it can be useful, because it alerts us to a difficult situation and allows us to react quickly. It can become a real problem when it is excessive, compared to the situation we are facing or it lasts too long.

 Anxiety manifests itself differently from person to person, but in general its characteristics are:

  • anxious thoughts (I will make a fool of myself, I will not be up to it, I will feel bad...);
  • anxious emotions (fear, fear, anxiety);
  • altered bodily sensations (muscle tension, rapid breathing, rapid heart rate, sweating, fainting sensations, dizziness ...);
  • altered behavior (agitation, increase/decrease in appetite, avoidance of certain situations...).

What Disorders?

Let's see what are the most common Anxiety Disorders according to the medical classification.
  • Generalized Anxiety Disorder
  • Panic Disorder
  • Specific Phobia
  • Social Phobia
  • Hypocondria


Generalized Anxiety Disorder

We all sometimes have concerns, but if we suffer from Generalized Anxiety Disorder, anxiety and discomfort are constant, up to interfering with everyday life.

Generalized anxiety disorder is characterized by generalized and persistent anxiety symptoms induced by worries.

The content of these concerns usually extends to different thematic areas, such as:

  • family
  • money
  • work
  • health


Concerns are focused on things that are unlikely to happen, and you can feel tense and anxious all day without real motivation. Sometimes just the thought of facing the day is a source of anxiety.

Even if you realize that anxiety is more intense than the situation requires, or you think that caring is a kind of protection against sudden misfortunes, the result does not change. It is not possible to remove negative thoughts which continue to torment the mind in an endless repetition.



The symptoms of generalized anxiety disorder are fluctuating. You may notice improvements and deteriorations over the same day or within a few days.

Not all people with this disorder experience the same symptoms, but most experience a combination of some of the physical and psychological symptoms listed below:

 Physical symptoms

  • Muscular tension, joint pain
  • Difficulty falling asleep or sleeping
  • Stomach problems, nausea, diarrhea
  • Restlessness and nervousness
  • Tiredness

Psychological symptoms

  • Irritability
  • Sense of fear
  • Inability to control anxious thoughts
  • Inability to relax
  • Difficulty concentrating
  • Fear of losing control

Over time, anxiety and constant worries can determine tension headaches, epigastric disorders and insomnia.



The NICE guidelines (National Institute for Health and Clinical Excelence, 2011) indicate Cognitive Behavioral Therapy (CBT) as an evidence-based treatment for Generalized Anxiety Disorder.

Panic Attacks

Those who have experienced a panic attack describe it as a bolt from the blue, a terrible experience.
Panic attack

Why me?

The patient who turns to me because he suffers from panic attacks always has many doubts, uncertainties and questions. In general, he has been suffering from panic attacks for some time and is sometimes even agoraphobic. He has already tried to use drugs and to follow some therapies, but without obtaining results.

The doubts that the patients have, most of the time, depend on the therapeutic paths that they have followed before:

  • The first route usually taken is the pharmacological one. The patient begins to take anxiolytics and in some cases, even antidepressants. But thoughts and concerns remain.
  • A second path is to resort to an analytical therapy for panic attack disorder, from which the patient can hardly get the expected results. It is easy enough to understand his dissatisfaction. This type of therapy often takes a long time, while the disorder continues to be operative in the patient's life.


What a panic attack is?

A panic attack is a brief episode of intolerable anxiety. Panic attacks can occur at any time and place, without obvious reasons.

Many people who suffer from panic attacks say that during the first attack they were convinced they were going crazy, having a stroke or a heart attack.

Symptoms develop suddenly and reach their maximum peak intensity within 10 minutes, then run out within 20-30 minutes and during which some or all of the following symptoms may occur:

  • Panic - the feeling that something incredibly serious and horrible can happen and the person can do nothing to avoid it
  • Strongly accelerated heart beat (Tachycardia)
  • Palpitations, chest pain
  • Confusion, dizziness, vertigo and nausea
  • Difficulty breathing, feeling of suffocation
  • Hyperventilation
  • Hot or cold flashes
  • Tingling and insensitivity to the hands
  • Tremors or shocks
  • Sense of unreality, realization, depersonalization)
  • Fear of losing control, of going crazy or doing something embarrassing
  • Fear of dying


An essential feature of Panic Attack Disorder is the presence of recurrent and unexpected attacks. The person experiences an intense fear of just having another attack. This fear - called anticipatory anxiety or "fear of fear" - can clearly affect the lifestyle, compromising the performance of normal daily activities (work, sport, social life).

People who develop these issues will tend to avoid situations that could trigger other attacks. The consequence is less freedom in personal life and tensions and conflicts in social relations. This condition is called Agoraphobia, and it is the anxiety related to being in places or situations from which it can be difficult or embarrassing to leave or in which help may not be available in the event of a panic attack or panic-like symptoms.

Even sleep can be disturbed by attacks that can occur during the night causing distressing awakenings.

Many people with panic disorder fear that the symptoms are due to serious illnesses, for example, a heart disease, a respiratory problem or a neurological disorder, even if medical checks highlight their non-existence.

It is important to highlight that, often, the first attack can occur following exposure to periods or situations of intense and prolonged stress, such as work, study or family problems. Many people also report having had panic attacks after surgery, illness or the birth of a child.



Cognitive Behavioral Therapy has proven to be the most effective in treating panic attacks. Studies conducted in different countries show that, on average, more than 80% of people get rid of panic attacks after a short period of treatment (APA, Division 12).

Specific Phobia

We can all have an irrational fear (needles, elevators, planes, insects). But for most people these fears are nothing, for others they can cause anxiety that is so terrible that it interferes with everyday life.

The Diagnostic and Statistic Manual of Mental Disorders 5 (DSM-5, American Psychiatric Assosiation) defines phobia as a fear or anxiety marked towards an object or specific situations.

The most common phobias concern closed places, height, driving on the highway, flying, insects, snakes, needles, etc. There is however the possibility of developing a phobia for anything. Most of them arise in childhood, but can also appear in adulthood.


How do you learn phobias?

 In three ways:

  • Due to a traumatic event, eg following a car accident or a dog bite
  • From a series of sub-traumatic events, eg we were scared of a dog more than once
  • Model learning, ie being in contact with people who have intense specific phobias, eg. the child learns from his mother to be afraid of bees.


If you have a phobia, you are probably aware that this is irrational and excessive, yet you cannot control this feeling. Just thinking about what frightens you, can make you feel a certain anxiety and when you are actually in the presence of that object or in that situation the terror is automatic and unsustainable. This experience is so heavy that it leads you to avoid it in every way, even damaging yourself or changing your lifestyle.

Anxiety can also be anticipatory: try anxiety only by predicting the feared situation and that is why you implement avoidance behaviors.


There are four general types of fears and common phobias:

ANIMALS PHOBIA: they are fears triggered by animals or insects. Examples include the fear of snakes (ofidiophobia), spiders (arachnophobia), rodents (musophobia), dogs (cynophobia), birds (ornithophobia), insects (entomophobia).

PHOBIA OF NATURAL EVENTS: triggered by elements found in nature such as height (acrophobia), thunderstorms (ceraunofobia), water (hydrophobia), darkness (acluophobia).

SITUATIONAL FOBIA: they are triggered by specific events such as being in closed places (claustrophobia), using elevators, fear of flying (aviophobia), dentists (odontophobia).

BLOOD AND PHYSICIAN PHOBIA: include seeing blood (hemophobia), receiving a puncture (aichmophobia), fear of injuries, medical examinations.



The most commonly used and most effective treatment for phobias is a cognitive behavioral technique called systematic desensitization or exposure therapy. This technique is really effective. According to the National Institute of Mental Health (NICE), about 75% of people overcome their phobias through cognitive behavioral therapy (CBT).

Social Phobia

Many of us in social situations may have experienced some shyness, but those suffering from social anxiety have an excessive fear of acting embarrassingly and being judged stupid or not good enough.

Social anxiety is a psychological disorder characterized by an intense and persistent fear of facing situations in which, one is exposed to the presence and judgment of others, for the fear of appearing embarrassed, of appearing incapable and ridiculous and of acting in an inappropriate and humiliating way (APA, 2000).


There are many situations that can be a source of stress for people who suffer from this disorder, such as:

  • Meet new people
  • Being at the center of attention
  • Being observed while doing something
  • To chat
  • Speak in public
  • Perform in public
  • Be criticized, judged or teased
  • Talk to "important" people or authorities
  • Making interventions in the classroom
  • Go to an appointment
  • Phone
  • Use a public bathroom
  • Support examinations
  • Eating or drinking in public
  • Ask questions or speak out loud
  • Participate in parties or other social events


Just because you sometimes feel nervous in social situations doesn't mean you suffer from social anxiety disorder. Many people feel embarrassed from time to time, but this does not affect their daily life. Social anxiety, on the other hand, interferes with the person's usual activities and causes deep distress.

For example, it is perfectly normal to feel tense before having to speak in front of many people. But if you suffer from a social anxiety disorder you will start to worry weeks before the event, maybe you will get sick to avoid facing the situation or you will begin to tremble so much that you can barely say a sentence.


Psychological symptoms

  • Intense worries days, weeks or even months before a social event
  • Excessive fear of being observed or judged by others, particularly by little-known people
  • Strong embarrassment and anxiety in everyday social situations
  • Fear of acting in ways that can cause embarrassment or humiliation
  • Fear that others notice the nervousness felt
  • Avoidance of social situations to the point of limiting and penalizing activities of daily life


Physical symptoms

  • Heartbeat or sense of constriction in the chest
  • Tremors in the voice
  • shortness of breath
  • Sweats or hot flushes
  • Nausea and closed stomach
  • Dry mouth
  • Shakes and tremors
  • Muscular tension
  • Redness
  • Dizziness, dizziness
  • Sweaty hands
  • Tic


It is possible to distinguish forms of social anxiety in which fears concern one or some specific situations, called specific social anxiety such as speaking or performing in public, and forms in which the variety of feared situations can be very wide and include most of the interpersonal and social spheres, generalized social anxiety. In the case of generalized social anxiety, one may be afraid to meet acquaintances or strangers in any context, formal or informal, especially if they are people who have a position of authority. A frequent form is social anxiety towards the other sex.



Of all the available treatments, Cognitive Behavioral Therapy (TCC) has been shown to be the most effective for social anxiety disorder.


Who presents this disorder is usually considered an "imaginary patient" because of his groundless and constant conditions of being sick.

When a person suffers from hypochondria or Illness Anxiety Disorder (DSM-5), he becomes obsessed with having a very serious health problem that has not yet been diagnosed.

Those who suffer from it use much of their time and energy to think about their health in various ways (eg, with careful and accurate checks of their bodies) and to seek help or reassurance about their symptoms by turning to professionals and / or family members, through intensive research of information on the internet, etc. This can compromise and deteriorate work, family and social functioning, affecting the quality of life of the person who is affected by it.



Characteristic symptoms of the disorder are the presence of excessive thoughts, feelings or behaviors aimed at somatic symptoms or health concerns and can be summarized as follows:

  • marked concern about having a serious illness, which may or may not be accompanied by somatic symptoms;
  • very high levels of anxiety about one's health;
  • constant and intensive implementation of health-related behaviors or maladaptive avoidances (e.g., avoiding hospitals);
  • excessive expenditure of time and energy on health issues / concerns.



Although hypochondria is a long-term condition, it is important to know that Cognitive Behavioral Therapy is recognized as the treatment of choice for hypochondriacal symptoms and can lead to a significant improvement in the quality of life of the individual.