Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience.

It is also present in a wide range of psychiatric disorders, including generalized anxiety

disorder, panic disorder, and phobias. Although each of these disorders is different, they
all feature distress and dysfunction specifically related to anxiety and fear.

In addition to anxiety, people often also have physical symptoms, including shortness of
breath, dizziness, sweating, rapid heartbeat, and/or tremor. Anxiety disorders often
substantially change people's daily behavior, including leading them to avoid certain
things and situations.

Anxiety and closely related disorders emerge from “triple vulnerabilities,”a combination
of biological, psychological, and specific factors that increase our risk for developing a
disorder. 

a. Biological vulnerabilities refer to specific genetic and neurobiological factors that

might predispose someone to develop anxiety disorders. No single gene directly causes
anxiety or panic, but our genes may make us more susceptible to anxiety and influence
how our brains react to stress. 
 
b. Psychological vulnerabilities refer to the influences that our early experiences have on
how we view the world. If we were confronted with unpredictable stressors or traumatic
experiences at younger ages, we may come to view the world as unpredictable and
uncontrollable, even dangerous.

c. Specific vulnerabilities refer to how our experiences lead us to focus and channel our
anxiety. If we learned that physical illness is dangerous, maybe through witnessing our
family’s reaction whenever anyone got sick, we may focus our anxiety on physical
sensations. If we learned that disapproval from others has negative, even dangerous
consequences, such as being yelled at or severely punished for even the slightest offense,
we might focus our anxiety on social evaluation.

Types of Anxiety Disorders

There are several types of anxiety disorders:
 Generalized anxiety disorder. You feel excessive, unrealistic worry and tension
with little or no reason.
 Panic disorder. You feel sudden, intense fear that brings on a panic attack. During
a panic attack you may break out in a sweat, have chest pain, and have a pounding
heartbeat (palpitations). Sometimes you may feel like you’re choking or having a
heart attack.
 Social anxiety disorder. Also called social phobia, this is when you feel
overwhelming worry and self-consciousness about everyday social situations. You
obsessively worry about others judging you or being embarrassed or ridiculed.
  Specific phobias. You feel intense fear of a specific object or situation, such as
heights or flying. The fear goes beyond what’s appropriate and may cause you to
avoid ordinary situations.
 Agoraphobia.You have an intense fear of being in a place where it seems hard to
escape or get help if an emergency occurs. For example, you may panic or feel
anxious when on an airplane, public transportation, or standing in line with a
crowd.  
 Separation anxiety. Little kids aren’t the only ones who feel scared or anxious
when a loved one leaves. Anyone can get separation anxiety disorder. If you do,
you’ll feel very anxious or fearful when a person you’re close with leaves your
sight. You’ll always worry that something bad may happen to your loved one. 
 Selective mutism. This is a type of social anxiety in which young kids who talk
normally with their family don’t speak in public, like at school.
 Medication-induced anxiety disorder. Use of certain medications or illegal drugs,
or withdrawal from certain drugs, can trigger some symptoms of anxiety disorder.

Course Illness
Causes of Anxiety Disorder
Some causes of anxiety disorders are: 
 Genetics. Anxiety disorders can run in families. 
 Brain chemistry. Some research suggests anxiety disorders may be linked to faulty
circuits in the brain that control fear and emotions. 
 Environmental stress. This refers to stressful events you have seen or lived
through. Life events often linked to anxiety disorders include childhood abuse and
neglect, a death of a loved one, or being attacked or seeing violence.  
 Drug withdrawal or misuse. Certain drugs may be used to hide or decrease certain
anxiety symptoms. Anxiety disorder often goes hand in hand with alcohol and
substance use.
 Medical conditions. Some heart, lung, and thyroid conditions can cause symptoms
similar to anxiety disorders or make anxiety symptoms worse. It’s important to get
a full physical exam to rule out other medical conditions when talking to your
doctor about anxiety. 

Diagnosis
DSM-5 criteria for anxiety disorders
Anxiety disorders share features of excessive fear and anxiety and related behaviour
disturbances and tend to be highly comorbid. However, they can be differentiated by
close examination of the types of situations that are feared and the content of the
associated thoughts.
Note that the DSM-5 classification of anxiety no longer includes obsessive-compulsive
disorder (now included with the obsessive-compulsive and related disorders) or
posttraumatic stress disorder and acute stress disorder (now included with the trauma-and
stressor-related disorders). Also, the DSM-5 now classifies separation anxiety disorder
and selective mutism disorder as anxiety disorders. In the DSM-IV-TR, they were
classified as disorders usually first diagnosed in infancy, childhood or adolescence.

Generalized anxiety disorder

A. Excessive anxiety and worry, occurring more days than not for at least six months,
about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three or more of the following six
symptoms (with at least some symptoms having been present for more days than not for
the past six months):
Note: Only one item is required in children.
1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbances.
D. The anxiety, worry or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.

Panic disorder
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear
or discomfort that reaches a peak within minutes, and during which four or more
symptoms occur.
B. At least one of the attacks has been followed by one month or more of one or both of
the following:
1. persistent concern or worry about additional panic attacks or their consequences.
2. a significant maladaptive change in behaviour related to the attacks (such as
avoidance).
C. The disturbance is not attributable to the physiological effects of a substance or
another medical condition.
D. The disturbance is not better explained by another mental disorder.

Agoraphobia
A. Marked fear or anxiety about two or more of the following five situations:
1. using public transportation (e.g., automobiles, buses, trains, ships, planes)
2. being in open spaces (e.g., parking lots, marketplaces, bridges)
 3. being in enclosed places (e.g., shops, theatres, cinemas)
4. standing in line or being in a crowd
5. being outside of the home alone.
B. The individual fears or avoids these situations because of thought that escape might be
difficult or help might not be available in the event of developing panic-like symptoms.
C. The agoraphobic situations almost always provoke fear or anxiety.
D. The agoraphobic situations are actively avoided, require the presence of a companion,
or are endured with intense fear or anxiety.
Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If a
person's presentation meets criteria for panic disorder and agoraphobia, both diagnoses
should be assigned.

Social phobia (social anxiety disorder)

A. Marked fear or anxiety about one or more social situations in which the individual is
exposed to possible scrutiny by others.
B. The individual fears that he or she will act in a a way or show anxiety symptoms that
will be negatively evaluated.
C. The social situations almost always provoke fear or anxiety.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation
and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

Specific phobia
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights,
animals, receiving an injection, seeing blood)
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific
object or situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.

Substance/medication-induced anxiety disorder

A. Panic attacks or anxiety is predominant in the clinical picture.
B. There is evidence from the history, physical examination or laboratory findings of
both:
1. the symptoms in Criterion A developed during or soon after substance intoxication
or withdrawal or after exposure to a medication
 2. the involved substance/medication is capable of producing the symptoms in
Criterion A.
C. The disturbance is not better explained by an anxiety disorder that is not
substance/medication-induced.
D. The disturbance does not occur exclusively during the course of a delirium.
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or
substance withdrawal only when the symptoms in Criterion A predominate in the clinical
picture and they are sufficiently severe to warrant clinical attention.

Objective signs and symptoms

Mental symptoms of anxiety can include:
 racing thoughts,
 uncontrollable over-thinking,
 difficulties concentrating,
 feelings of dread, panic or ‘impending doom’,
 feeling irritable,
 heightened alertness,
 problems with sleep,
 changes in appetite,
 wanting to escape from the situation you are in, and
 dissociation.

Physical symptoms of anxiety can include:

 sweating,
 heavy and fast breathing,
 hot flushes or blushing,
 dry mouth,
 shaking,
 hair loss,
 fast heartbeat,
 extreme tiredness or lack of energy
 dizziness and fainting, and
 stomach aches and sickness.

Source:
https://www.webmd.com/anxiety-panic/guide/anxiety-disorders
https://nobaproject.com/modules/anxiety-and-related-disorders
https://www.porticonetwork.ca/treatments/disorders-qr/anxiety-disorders/anxiety-
disorders-assessment-diagnosis
https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-
conditions/anxiety-disorders/