Anxiety Disorders: A Comprehensive Overview from a Psychiatric Perspective
Anxiety, when experienced occasionally, is a normal response to stress. However, when it becomes chronic, intense, or disproportionate to the situation, it may signal an anxiety disorder—a group of mental health conditions characterized by excessive fear or worry. From a psychiatric perspective, anxiety disorders are medical conditions rooted in neurobiological, psychological, and environmental factors. They are diagnosable, treatable, and best addressed through a biopsychosocial model of care.
This article outlines common anxiety disorders—generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder—including their symptoms, causes, and evidence-based psychiatric treatments.
Types of Anxiety Disorders
Anxiety disorders are classified in the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision). Each has specific diagnostic criteria and treatment recommendations.
Generalized Anxiety Disorder (GAD)
DSM-5-TR Criteria:
- Excessive anxiety and worry, more days than not, for at least six months
- Difficulty controlling the worry
- Associated with at least three of the following:
- Restlessness
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
Psychiatric Insight:
GAD often presents chronically with fluctuating severity. Psychiatrists rule out conditions like hyperthyroidism. Depression commonly co-occurs.
Social Anxiety Disorder (SAD)
DSM-5-TR Criteria:
- Marked fear or anxiety about one or more social situations involving possible scrutiny
- Social situations almost always provoke fear
- Fear is disproportionate and impairs functioning
Psychiatric Insight:
Patients may internalize symptoms, delaying diagnosis. Psychiatrists distinguish between shyness and clinical anxiety. Comorbidities often include avoidant personality disorder or alcohol use.
Panic Disorder
DSM-5-TR Criteria:
- Recurrent, unexpected panic attacks
- At least one attack followed by a month of worry about future attacks or consequences
Common Symptoms:
- Palpitations
- Chest pain
- Derealization
- Fear of dying
Psychiatric Insight:
Often confused with cardiac or respiratory issues, panic disorder frequently leads patients to ER visits. Psychiatrists rule out physical causes and start treatment.
Etiology and Neurobiology of Anxiety Disorders
Neurotransmitter Imbalance
- Involves serotonin (5-HT), norepinephrine (NE), and GABA
- Reduced serotonin and GABA are common in anxiety
Brain Structures
- Amygdala: overactive in fear response
- Prefrontal cortex: underactive in emotional regulation
Genetics and Environment
- Family and twin studies suggest heritability
- Early trauma, abuse, and chronic stress increase risk
Diagnosis and Psychiatric Evaluation
A thorough psychiatric assessment includes:
- Clinical interview and mental status exam
- Standardized tools (e.g., GAD-7, LSAS)
- Screening for comorbidities (e.g., depression, PTSD)
- Medical and substance use rule-out
- Suicide risk assessment
Treatment Options for Anxiety Disorders
Treatment is individualized and may include medication, therapy, or both.
1. Pharmacotherapy
First-Line Medications:
- SSRIs (escitalopram, sertraline, paroxetine)
- SNRIs (venlafaxine XR, duloxetine)
Adjunct/Second-Line:
- Buspirone – good for GAD, non-sedating
- Hydroxyzine – antihistamine with calming effect
- Pregabalin – used for GAD/SAD in some countries
Short-Term Relief:
- Benzodiazepines – effective but risk dependency
- Beta-blockers (propranolol) – for performance anxiety
2. Psychotherapy
Psychiatrists may provide therapy or collaborate with psychologists and licensed therapists.
- CBT (Cognitive Behavioral Therapy): Gold standard
- ERP (Exposure and Response Prevention): Especially for social and panic disorders
- Psychodynamic Therapy: Explores deeper, longstanding emotional patterns
3. Integrative & Lifestyle Approaches
- Sleep hygiene
- Nutrition and exercise counseling
- Mindfulness-Based Stress Reduction (MBSR)
- Reducing stimulants (e.g., caffeine, nicotine)
When to Refer or Hospitalize
Inpatient care may be necessary for:
- Suicidal thoughts or self-harm
- Severe functional impairment
- Co-occurring psychotic or severe mood disorders
Outpatient care is appropriate for most cases.
Prognosis
- Most individuals improve with early, personalized treatment
- Maintenance therapy may last 6–12 months or longer
- Untreated anxiety can lead to depression, substance misuse, or disability
Frequently Asked Questions About Anxiety Disorders
Common symptoms include chronic worry, restlessness, fatigue, muscle tension, difficulty concentrating, sleep issues, and physical symptoms like a racing heart or shortness of breath.
A psychiatrist uses clinical interviews, standardized questionnaires, and screening tools like the GAD-7 or LSAS to assess symptoms, rule out other conditions, and identify co-occurring disorders.
Yes. Many people benefit from therapy alone—especially Cognitive Behavioral Therapy (CBT) and mindfulness-based approaches. Lifestyle changes like sleep, nutrition, and exercise also support recovery.
Common medications include SSRIs such as escitalopram or sertraline, SNRIs like venlafaxine, and sometimes buspirone or hydroxyzine. Benzodiazepines may be used short-term for acute relief under close supervision.
Anxiety disorders are highly treatable, and many people achieve long-term relief. Early intervention, consistent therapy, and supportive lifestyle practices can lead to lasting improvement or full remission.
A panic attack is a sudden surge of intense fear or discomfort, often with physical symptoms like chest pain, shortness of breath, or a racing heart. It may occur without an obvious trigger. An “anxiety attack” is not a formal diagnosis but is often used to describe a gradual buildup of worry or tension in response to stress.
Performance anxiety is common and treatable. Strategies may include cognitive-behavioral therapy, exposure-based techniques, beta-blockers (like propranolol) for physical symptoms, and mindfulness practices. A psychiatrist can help tailor the approach to your specific needs.
Many people experience significant relief or full remission of symptoms with proper treatment. Some may have occasional relapses, especially under stress, but long-term management with therapy, lifestyle adjustments, or medication can lead to lasting wellness.
Yes. Anxiety often manifests physically — including muscle tension, headaches, chest tightness, gastrointestinal issues, dizziness, and rapid heartbeat. These symptoms are real and common, and can be addressed with both medical and therapeutic strategies.
If anxiety interferes with your daily life, relationships, sleep, or work — or if symptoms persist for more than a few weeks — it’s time to seek professional support. A psychiatrist can provide a comprehensive evaluation and recommend evidence-based treatment options.
Conclusion: The Psychiatrist’s Role in Managing Anxiety
Anxiety disorders are highly treatable. A psychiatrist provides an accurate diagnosis and personalized treatment plan, often combining medication and psychotherapy. Collaborative care with other professionals improves long-term outcomes.
As awareness grows, stigma fades. Early intervention leads to better quality of life.
Dr. Anna Wachtel, MD
Psychiatrist – Upper East Side, NYC
📞 (212) 534-8816
Offering in-person and telepsychiatry sessions for anxiety, mood disorders, and trauma-related conditions.