Anxiety is one of the many emotions we experience, such as happiness, anger, sadness, surprise, disgust, and fear. Feeling anxious is a normal and healthy response. However, when experienced excessively and reaches a disturbing level for an individual, it starts to negatively impact mental health. It manifests itself as an excessive level of fear, worry, tension, and restlessness.
While fear is an emotional response to an actual danger, anxiety is the emotion experienced in anticipation of a possible threat or danger in the future. Although these two emotions may overlap at times, they differentiate at certain points: Fear triggers automatic arousal during an actual threat, leading to the “fight or flight” response, an immediate reaction to confront or escape the danger.
Anxiety, on the other hand, is more about the observed tension in the muscles, staying alert, and being vigilant for possible future threats. When anxiety is excessive, individuals tend to seek various ways to alleviate it. The coping mechanism used (avoidance) may provide relief in the moment, but anxiety will return in the next stage. While avoidance may lead to a temporary reduction in anxiety, it is not a suitable coping mechanism for long-term problem-solving. For example, an individual with Social Anxiety who avoids crowded places may experience a reduction in anxiety by staying at home, but their functionality will be negatively affected due to staying away from social environments. Therefore, psychotherapy is recommended to help the individual cope with the problem and learn a sustainable problem-solving method; in some cases, it is applied concurrently with medical treatment.
What is Anxiety Disorder?
Anxiety Disorder is a condition characterized by an excessive level of fear, worry, tension, and restlessness. Disturbing thoughts accompany emotional states, and individuals experiencing anxiety respond with various physiological reactions: changes in blood pressure, increased heart rate, sweating, rapid breathing, and digestive system activity, among others.
While anxiety is a normal and vital emotion, it can significantly affect an individual’s daily life, work, and social relationships when excessive. In some cases, the condition may present as Panic Disorder, and in other cases, it may manifest as phobic avoidance. Individuals with Social Anxiety may avoid entering social situations they desire due to fear, and while avoidance may reduce anxiety in the short term, anxiety will return. Therefore, psychotherapy is recommended to enable individuals to develop permanent problem-solving skills; in some cases, it is applied concurrently with medical treatment.
Types of Anxiety Disorders
Anxiety disorders are diagnostically categorized into various subtypes: Separation Anxiety, Selective Mutism, Specific Phobias, Social Anxiety, Panic Disorder, Agoraphobia, Generalized Anxiety Disorder.
Separation Anxiety: It is an intense fear and worry experienced when separating from the attachment figure, with concerns about potential harm to the primary attachment figure (such as abduction, being held captive, illness, injury, death). Intense anxiety, reluctance to go to work or school, difficulty falling asleep, and various physical complaints (headache, stomach ache, vomiting, etc.) are among the symptoms observed. It is more common in children under 12, and studies do not indicate a gender-specific prevalence. Psychological support is essential in situations lasting longer than four weeks in children and more than six months in adults. Cognitive-behavioral therapy and medical treatment are among the treatment methods used.
Selective Mutism: It is the difficulty of speaking in specific social situations (such as school) despite having the ability to speak and having no problems in speech and language areas. For example, a child may speak quietly or not speak at all in places outside the home. Selective Mutism is a type of anxiety disorder. Parents often refer to this reaction from their children as shyness and social withdrawal, but it is a serious problem that needs to be addressed. Selective Mutism can be observed in preschool or when starting school. Although the prevalence in society is less than 1%, it is more common in children than in adolescents or adults. It is crucial to seek psychological support in situations that have been going on for more than a month, and play therapy and/or medical treatment are among the methods used in the treatment process.
Specific Phobias: Intense fear and anxiety about a specific object (plane, spider, dog, etc.), animal, or situation (height, crowd, elevator, etc.) characterize specific phobias. When fear reaches an extreme level, the individual starts to avoid the feared object or situation. After a while, just the thought of the feared object or situation can be triggering. Avoidance of the feared object or situation significantly affects the individual’s functionality and impairs their quality of life. The prevalence of specific phobias is around 6%, and it is more frequently observed in women than men. Professional help is essential when intense anxiety, fear, and avoidance behavior persist for more than six months. Cognitive-behavioral therapy, virtual reality, and medication are effective methods used in the treatment of specific phobias.
Social Anxiety Disorder (Social Phobia): It is an intense fear and anxiety observed in social situations (public speaking, giving a presentation, meeting new people). The fear of being observed by others (such as eating in public) is predominant. Individuals with social anxiety often excessively care about what others think of them. The fear of being judged and embarrassed accompanies the condition. Symptoms such as blushing, sweating, trembling, fear of making a mistake are frequently observed during any action performed in a group. Due to this fear, individuals may avoid actions that require being in a group (such as giving a presentation in front of a group) or situations requiring social interaction (such as asking for directions or talking to someone in public transport). Anxiety symptoms may occur in situations where they are forced, leading to physical symptoms (sweating, trembling, palpitation, hot-cold flashes, difficulty controlling breathing, etc.). The prevalence is around 2%, and it is more common in adolescence. Professional help is necessary for situations lasting more than six months. Cognitive-behavioral therapy, Social Skills Training, Schema Therapy, and medication are among the interventions used in social phobia.
Panic Disorder: The situation where physical and psychological stress occurs dominantly with repeated panic attacks is called panic disorder. Symptoms such as palpitation, rapid heart rate, trembling, difficulty breathing, chest pain, feeling like fainting, numbness, tingling, choking feeling, dizziness, muscle pain, loss of control, and fear of death are manifested. When these symptoms occur, a person may experience a panic attack. The prevalence is around 2-3%, and it is more common in women than in men. In panic disorder, psychotherapy (psychoeducation) and/or medical treatment are effective treatment methods.
Agoraphobia: Agoraphobia is intense fear and anxiety when a person thinks it would be difficult or embarrassing to escape in situations where escape might be difficult or where help may not be available if panic-like symptoms occur. The person has intense fear of being helpless, getting into an embarrassing or difficult-to-escape situation, being helpless in the presence of others, or having a panic attack in public. Therefore, the person avoids such situations. Agoraphobia may start in individuals with Panic Disorder. The prevalence is around 1-2%, and psychotherapy (Cognitive-Behavioral Therapy, Virtual Reality) and/or medical treatment are functional therapy types.
Generalized Anxiety Disorder: It indicates a persistent and excessive level of anxiousness that negatively affects daily life. A continuing state of anxiety and tension, along with physiological symptoms (fatigue, restlessness, muscle tension, difficulty concentrating, sleep problems, etc.), is observed. Anxiety can focus on daily responsibilities (household chores, work-related responsibilities, childcare, etc.) or chronic illness in the family. The prevalence is approximately 0.4-3%, and psychotherapy (Cognitive-Behavioral Therapy, Schema Therapy, etc.) and medication are the most frequently used treatment methods.
Risk Factors in Anxiety Disorders
Personality, genetic, physiological, and environmental factors are highly influential in anxiety disorders. Being a difficult baby with a difficult and anxious temperament from infancy is a risk factor related to temperament. In addition to genetic predisposition, being overly protective and anxious, parental loss or separation history, and a history of physical and sexual abuse are among the main risk factors.
Anxiety Disorders in Children
The classification made for adults regarding anxiety disorders is also valid for children. Anxiety disorders in children primarily manifest with physical symptoms: gastrointestinal problems (digestive problems, abdominal pain, constipation, etc.), palpitations, fatigue, sweating, changes in breathing, self-squeezing, etc. In addition to physical symptoms, differences are observed in thoughts, emotions, and behaviors. Anxiety-inducing thoughts related to the past, present, or future can lead to behavioral problems in children: reluctance to go to school, unwillingness to participate in social activities, choosing to stay at home rather than expected behaviors for their age, etc.
Different types of anxiety disorders can be observed in children, such as Selective Mutism in certain social situations, Specific Phobias (fear of spiders, elevator fear, etc.), or Generalized Anxiety Disorder.
When working with children, as with adults, the aim is to help the child establish a connection between anxiety-inducing thoughts and feelings and behaviors. Psychoeducation is provided to help them become aware of physical symptoms and learn coping skills instead of avoiding when these symptoms occur. Therefore, therapeutic interventions that support social skills are implemented. Cognitive-Behavioral Therapy is the most commonly used therapy type in children, and it is observed that children also benefit from medical treatment, depending on the severity of anxiety disorders.
Treatment of Anxiety Disorders
Anxiety disorders can be accompanied by mood disorders such as depression or various conditions like Obsessive-Compulsive Disorder. Anxiety disorders are treated with psychotherapy and medication. In some cases, only psychotherapy or only medication may be used. Psychotherapy and medication are also used concurrently in the treatment of anxiety disorders.
In psychotherapy, the focus is on strengthening the individual’s coping skills by providing psychoeducation, social skills training, and focusing on the relationship between thoughts, emotions, and behaviors. Cognitive-Behavioral Therapy is the most commonly used therapy type for anxiety disorders. In smaller children, play therapy is also among the methods used, especially in cases like Selective Mutism. Through psychotherapy, the individual’s self-confidence increases, and they learn coping mechanisms to control anxiety levels and cope with anxiety in case of recurrence.
In medical treatment, various medications (beta-blockers) are used to control anxiety symptoms by controlling the release of epinephrine (adrenaline). The prescription and use of these medications under the supervision of a doctor are crucial.
