Types of Anxiety Disorders
Anxiety disorders are the most common mental health conditions worldwide, affecting approximately 1 in 13 people globally. They are characterised by excessive fear, worry, or anxiety that is disproportionate to the actual threat and significantly impairs daily functioning.
| Type | Key Features | Duration Criterion |
|---|---|---|
| Generalised Anxiety Disorder (GAD) | Excessive worry about multiple topics, restlessness, fatigue, poor concentration, muscle tension | ≥6 months |
| Panic Disorder | Recurrent unexpected panic attacks — palpitations, sweating, trembling, chest pain, fear of dying | Ongoing fear of future attacks |
| Social Anxiety Disorder | Intense fear of social situations, scrutiny by others, avoidance of social settings | ≥6 months |
| OCD (Obsessive-Compulsive Disorder) | Intrusive obsessive thoughts and repetitive compulsive behaviours to reduce distress | Time-consuming, distressing |
| PTSD (Post-Traumatic Stress Disorder) | Flashbacks, nightmares, hypervigilance following trauma exposure | ≥1 month post-trauma |
Blood Tests to Rule Out Medical Causes
Several medical conditions can cause or worsen anxiety symptoms. Before diagnosing an anxiety disorder, doctors typically investigate these treatable causes:
| Condition | Test | How it mimics anxiety |
|---|---|---|
| Hyperthyroidism (overactive thyroid) | TSH (low in hyperthyroidism), Free T4 | Causes palpitations, tremor, sweating, restlessness, panic-like symptoms |
| Hypoglycaemia (low blood sugar) | Fasting glucose, HbA1c | Adrenaline surge from low glucose causes sweating, palpitations, anxiety |
| Anaemia | CBC, Haemoglobin, Ferritin | Reduced oxygen delivery causes breathlessness, palpitations, anxiety |
| Cardiac arrhythmia | ECG, electrolytes (potassium, magnesium) | Palpitations from arrhythmia can trigger panic symptoms |
| Caffeine / stimulant excess | Clinical history | Excessive caffeine directly causes anxiety, tremor, palpitations |
| Phaeochromocytoma (rare adrenal tumour) | 24-hr urine metanephrines or plasma metanephrines | Episodic catecholamine release causes hypertensive crisis, sweating, palpitations mimicking panic attacks |
Treatment Options
Cognitive Behavioural Therapy (CBT)
CBT is the first-line psychological treatment for all anxiety disorders. It involves identifying and challenging distorted thoughts (cognitive restructuring) and gradual exposure to feared situations. For panic disorder, CBT with interoceptive exposure is particularly effective. Treatment typically involves 12–20 sessions. Online CBT programmes are also available.
Medication — SSRIs and SNRIs
SSRIs (sertraline, escitalopram, paroxetine) are first-line pharmacological treatment for GAD, panic disorder, social anxiety, PTSD and OCD. SNRIs (venlafaxine, duloxetine) are also effective. They take 4–6 weeks to work fully. Short-term benzodiazepines may be used cautiously for acute anxiety but are not recommended for long-term use due to dependence risk.
Lifestyle Modifications
Regular exercise significantly reduces anxiety. Reducing caffeine and alcohol, practising mindfulness or meditation, adequate sleep, and maintaining social connections all help manage anxiety. Breathing exercises (4-7-8 breathing, diaphragmatic breathing) can help during acute anxiety episodes.
Questions to Ask Your Doctor
- Have medical causes like thyroid disease or anaemia been excluded?
- Is this likely GAD, panic disorder, or another anxiety type?
- Would CBT alone be sufficient, or do I need medication too?
- What is the GAD-7 score and how will you track my progress?
- Are there any lifestyle changes that could reduce my symptoms?