Anorexia
Anorexia nervosa, often simply called anorexia, is a treatable eating disorder in which people have a low body weight based on personal weight history. Although many people with anorexia look very thin, some may not look thin and others may look overweight. But they’ve actually lost weight or failed to gain needed weight.
People who have anorexia often have a strong fear of gaining weight and may think they’re overweight, even when they’re thin. To prevent weight gain or continue to lose weight, people with anorexia often limit the amount or type of food they eat. They place a high value on controlling their weight and shape and use extreme efforts that can greatly harm their lives.
Anorexia can cause changes in the brain due to very poor nutrition, also called malnutrition. This is when people don’t get the nutrients that their bodies need to stay healthy. So it’s not a choice to continue the risky and damaging behavior.
If left untreated, weight loss can get to a point where people with anorexia are at high risk of serious physical harm or death. Anorexia has the second-highest death rate of any mental illness, surpassed only by opioid overdoses. Most deaths related to anorexia stem from heart conditions and suicide.
Anorexia, like other eating disorders, can take over people’s lives and be very hard to overcome. Because it’s related to changes in the brain, anorexia behaviors are not choices, and the illness is not really about food or looking a certain way. With proven treatment, people with anorexia can return to a healthy weight, develop more-balanced eating habits, and reverse some of anorexia’s serious medical and mental health complications.
The causes of anxiety disorders aren’t fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety. Inherited traits also can be a factor.
Medical causes
For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.
Examples of medical problems that can be linked to anxiety include:
- Heart disease.
- Diabetes.
- Thyroid problems, such as hyperthyroidism.
- Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma.
- Drug misuse or withdrawal.
- Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications.
- Chronic pain or irritable bowel syndrome.
- Rare tumors that produce certain fight-or-flight hormones.
Sometimes anxiety can be a side effect of certain medications.
It’s possible that your anxiety may be due to an underlying medical condition if:
- You don’t have any blood relatives (such as a parent or sibling) with an anxiety disorder.
- You didn’t have an anxiety disorder as a child.
- You don’t avoid certain things or situations because of anxiety.
- You have a sudden occurrence of anxiety that seems unrelated to life events and you didn’t have a previous history of anxiety.
Common anxiety signs and symptoms include:
- Feeling nervous, restless or tense.
- Having a sense of impending danger, panic or doom.
- Having an increased heart rate.
- Breathing rapidly (hyperventilation).
- Sweating.
- Trembling.
- Feeling weak or tired.
- Trouble concentrating or thinking about anything other than the present worry.
- Having trouble sleeping.
- Having an upset stomach or other problems with digestion.
- Having difficulty controlling worry.
- Having the urge to avoid things that trigger anxiety.
Several types of anxiety disorders exist:
- Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.
- Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.
- Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders or depression.
- Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they’ve occurred.
- Selective mutism is a consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.
- Separation anxiety disorder is a childhood disorder characterized by anxiety that’s excessive for the child’s developmental level and related to separation from parents or others who have parental roles.
- Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.
- Specific phobias are characterized by major anxiety when you’re exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.
- Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.
- Other types of anxiety disorders. Certain types of anxiety disorders or phobias don’t fit neatly into a category. But they cause major distress and disrupt daily life.
See your doctor if:
- You feel like you’re worrying too much and it’s interfering with your work, relationships or other parts of your life.
- Your fear, worry or anxiety is upsetting to you and difficult to control.
- You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety.
- You think your anxiety could be linked to a physical health problem.
- You have suicidal thoughts or behaviors. If this is the case, contact your provider right away. Or contact a suicide hotline.
Your worries may not go away on their own, and they may get worse over time if you don’t seek help. See your doctor or a mental health provider before your anxiety gets worse. It’s easier to treat if you get help early.
The U.S. Preventive Services Task Force recommends screening children and teens ages 8 to 18 for anxiety. This screening is for those who don’t have a diagnosis of anxiety disorder. It’s important because many children and teens have high levels of anxiety but they may not show it. The task force has not yet suggested how often this screening should happen.
These factors may increase your risk of developing an anxiety disorder:
- Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.
- Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.
- Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress or ongoing worry about finances.
- Personality. People with certain personality types are more prone to anxiety disorders than others are.
- Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.
- Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.
- Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.
Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:
- Depression (which often occurs with an anxiety disorder) or other mental health disorders.
- Substance misuse.
- Trouble sleeping (insomnia).
- Digestive or bowel problems.
- Headaches and chronic pain.
- Social isolation.
- Problems functioning at school or work.
- Poor quality of life.
- Suicide.
There’s no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you’re anxious:
- Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
- Stay active. Participate in activities that you enjoy and that make you feel good about yourself. Enjoy social interaction and caring relationships, which can lessen your worries.
- Avoid alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you’re addicted to any of these substances, quitting can make you anxious. If you can’t quit on your own, see your doctor or find a support group to help you.
You may start by seeing your primary care provider to find out if your anxiety could be related to your physical health. He or she can check for signs of an underlying medical condition that may need treatment.
However, you may need to see a mental health specialist if you have severe anxiety. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and certain other mental health professionals can diagnose anxiety and provide counseling (psychotherapy).
To help diagnose an anxiety disorder, your mental health provider may:
- Discuss your thoughts, feelings and behaviors when you feel anxious.
- Ask about other mental health problems, such as depression or alcohol or drug misuse, which can happen along with anxiety. This can make a diagnosis more challenging.
The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.
Psychotherapy
Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.
Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. Generally a short-term treatment, CBT focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you’ve avoided because of anxiety.
CBT includes exposure therapy, in which you gradually encounter the object or situation that triggers your anxiety so you build confidence that you can manage the situation and anxiety symptoms.
Medications
Several types of medications are used to help relieve symptoms, depending on the type of anxiety disorder you have and whether you also have other mental or physical health issues. For example:
- Certain antidepressants are also used to treat anxiety disorders.
- An anti-anxiety medication called buspirone may be prescribed.
- In limited circumstances, your doctor may prescribe other types of medications, such as sedatives, also called benzodiazepines, or beta blockers. These medications are for short-term relief of anxiety symptoms and are not intended to be used long term.
Talk with your doctor about benefits, risks and possible side effects of medications.
References
- Anxiety disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Jan. 27, 2023.
- Anxiety disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Accessed Jan. 27, 2023.
- Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. March 5, 2018.
- Anxiety disorders. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Anxiety-Disorders/Overview. Accessed Jan. 27, 2023.
- What are anxiety disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders. Accessed Jan. 27, 2023.
- Reinhold JA, et al. Pharmacological treatment for generalized anxiety disorder in adults: An update. Expert Opinion in Pharmacotherapy. 2015;16:1669.
- Bandelow B, et al. Efficacy of treatments for anxiety disorders: A meta-analysis. International Clinical Psychopharmacology. 2015;30:183.
- Find support. National Alliance on Mental Illness. https://www.nami.org/Find-Support. Accessed Jan. 27, 2023.
- Bazzan AJ, et al. Current evidence regarding the management of mood and anxiety disorders using complementary and alternative medicine. Expert Review of Neurotherapeutics. 2014;14:411.
- Natural medicines in the clinical management of anxiety. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 26, 2018.
- Sarris J, et al. Plant-based medicines for anxiety disorders, Part 2: A review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27:301.
- Bystritsky A. Complementary and alternative treatments for anxiety symptoms and disorders: Herbs and medications. https://www.uptodate.com/contents/search. Accessed Jan. 27, 2023.
- Bystritsky A. Pharmacotherapy for generalized anxiety disorder in adults. https://www.uptodate.com/contents/search. Accessed Feb. 26, 2018.
- Medical reviewer (expert opinion). Mayo Clinic. Feb. 27, 2023.
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