Coping with Anxiety and Phobias

By Harvard Health Publications
Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

Dear Reader,

We live in anxious times. By just turning on the evening news, you're barraged with new concerns — a sagging economy, international conflict, or global warming, to name a few. Personal issues, too, provoke anxiety, about such things as your physical health, your job and financial security, and your relationships with family and friends. Even everyday annoyances such as getting stuck in traffic, dealing with a computer problem, or preparing for a work presentation can provoke anxiety in vulnerable people.

When do feelings of worry, fear, and stress cross the line from a normal part of everyday existence into an emotional mindset that governs your life? For many people, this distinction is not immediately obvious. Sadly, it's the failure to recognize anxiety as a treatable disorder that often keeps people from seeking the help they need to feel better. An experience I had as a doctor and a teacher brought this point into sharp focus. After I presented a lecture on anxiety to a medical school class, two of my students told me that they had suffered for years with the anxiety symptoms I described, yet never knew there was help available for the problem.

Other issues, as well, can present obstacles to relief and recovery from anxiety. Anxiety symptoms themselves often stand in the way of reaching out. For example, anxiety can cause you to become so uneasy with social interaction that you isolate yourself, skirting social gatherings and passing up potential friendships. Anxiety can also fill you with such obsessive thoughts or inexplicable dread of ordinary activities that you cannot work. It can even cause chest pain so severe that you think you're having a heart attack.

Adding to the problem is the longstanding stigma surrounding anxiety that makes people shy away from treatment. Anxiety sufferers are often ashamed to admit to phobias and persistent worries, which seem like signs of weakness.

It may help to know that you're not alone. Anxiety disorders are the most prevalent type of psychiatric condition in the United States. More than 40 million American adults are affected by anxiety disorders each year. If you think you may have an anxiety disorder, see your doctor. With proper evaluation and a tailored treatment plan involving medication, psychological therapy, or both, anxiety can be brought under control.

This report provides up-to-date information about the causes and treatment of anxiety disorders, including behavior therapies, relaxation techniques, and medications. And we hope that it gives you something more: an incentive to seek help and feel better.


Michael J. Mufson, M.D. Medical Editor

What are anxiety disorders?

It's likely that if you ask any two people with an anxiety disorder to describe it, they'll paint different pictures. One person might dread speaking in public, while another is gripped by intense fear at the mere thought of getting on an airplane. Someone else might describe herself as a "chronic worrier" because she regularly frets about all sorts of things. Another experiences unpredictable episodes of panic, with shortness of breath, sweating, and chest pains. Many people would undoubtedly mention that they have trouble sleeping.

Why the broad array of symptoms? It's because anxiety disorders aren't actually a single condition, but rather a spectrum of related disorders, including panic attacks, panic disorder, phobic anxiety states, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, anxiety due to a medical condition, and substance-induced anxiety (see Table 1). However, many different anxiety disorders are believed to have the same biological underpinnings, which helps explain why more than half of all people with one anxiety disorder also have another. While each anxiety disorder has its own set of symptoms, they also have some symptoms in common (see "Common symptoms"). In addition, depression and anxiety are closely linked, and many people with anxiety disorders have symptoms of depression as well (see "Links to depression").

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Anxiety costs the United States more than $42 billion every year-that's almost a third of the country's total mental health bill.