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Anxiety – causes and therapy

by Josephine Andrews
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Fear is usually a healthy reaction to a threatening situation. It can also be a symptom of a mental or physical disorder. For some sufferers, the fear is so strong that it restricts their quality of life. Read here what triggers anxiety and how you should deal with it.

quick overview

  • what is fear Basically a normal reaction to threatening situations. Anxiety is pathological when it occurs without a specific reason, becomes a frequent/constant companion and impairs the quality of life.
  • Forms of morbid anxiety : generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, phobias (such as claustrophobia , spider phobia, social phobia), post- traumatic stress disorder , cardiac neurosis, hypochondria, anxieties associated with schizophrenia and depression.
  • Causes of morbid anxiety : various explanations (psychoanalytic, behavioral therapy and neurobiological). Factors that trigger anxiety include stress, trauma, alcohol and drug use, certain medications, thyroid dysfunction , heart disease, and brain disease.
  • When to the doctor? Excessively severe anxiety, increasing or increasing anxiety that cannot be overcome on one’s own, anxiety without an objective reason and/or severely restricted quality of life due to anxiety.
  • Symptoms : palpitations, increased heart rate, sweating, tremors, difficulty breathing, dizziness. In severe cases, chest pain, vomiting, diarrhea, feelings of anxiety, loss of consciousness, feeling out of place or losing your mind, fear of death with panic attacks, pain with general anxiety.
  • Diagnosis: Detailed discussion, questionnaires, possibly further examinations.
  • Therapy: cognitive behavioral therapy , depth psychological methods, medication.
  • Prophylaxis: relaxation methods, healthy lifestyle with plenty of exercise and a healthy diet.

Fear: description

Fear, like joy, desire and anger, is one of the basic human emotions. It is crucial for survival: if you are afraid, you act particularly carefully and attentively in critical situations – or you do not go into danger at all. In addition, when afraid, the body mobilizes all the reserves it needs for fight or flight.

Anxiety: Symptoms

Anxiety comes with a variety of physical symptoms. This includes:

  • palpitations
  • accelerated pulse
  • sweating
  • Tremble
  • difficulty breathing
  • dizziness

If you are very afraid, you may also experience chest pain, vomiting, diarrhea, anxiety and even loss of consciousness. Those affected have the feeling of being beside themselves or losing their mind. Those affected by panic attacks are often afraid of dying. General fears, in turn, are often associated with pain.

Fear: what is normal, what is pathological?

How anxious a person is depends on various factors. Predisposition plays an important role . But experiences , especially those in early childhood, also shape anxiety. So it’s totally normal that some people are more shy, worry more easily, and are more cautious than others.

One speaks of a pathological fear when the fear occurs without a specific reason or even becomes a constant companion. Then it can significantly reduce the quality of life of those affected. Such fears are not a normal reaction to a concrete threat, but an independent clinical picture that should be treated psychotherapeutically.

forms of anxiety disorders

The term anxiety disorder refers to a group of mental disorders in which symptoms of anxiety occur without an external threat . These anxiety symptoms can be physical (palpitations, sweating, etc.) and psychological in nature (thinking about catastrophes, avoidance behavior such as refusal to go out the door, etc.). An anxiety disorder can manifest itself in different forms:

Generalized Anxiety Disorder

Worries and fears are constant companions for people with generalized anxiety disorder . These fears often have no specific reason (diffuse worries, fears and general nervousness). However, they can also refer to real threats (possibility of a car accident or illness of close relatives, etc.), although the anxiety symptoms are exaggerated here. The feeling of fear is often so strong that everyday life is severely restricted in many areas.

obsessive compulsive disorder

Obsessive – compulsive disorder is characterized by obsessive thoughts and/or compulsions. For example, sufferers become tense and anxious when prevented from performing certain rituals. This includes, for example, being forced to wash, count objects or repeatedly check whether the windows are locked. For example, obsessions can be aggressive, offensive, or frightening.


People with a phobia are overly afraid of certain situations or objects. Most of those affected know that their fears are actually unfounded. Nevertheless, the corresponding key stimuli sometimes trigger violent fear reactions.

Such key stimuli can be certain situations (air travel, high altitude, elevator ride, etc.), natural phenomena (thunderstorms, open water, etc.) or certain animals (such as spiders, cats). Sometimes things associated with illness and injury (blood, needles, etc.) also trigger a phobia.

Experts distinguish three main forms of phobia:

  • Agoraphobia (“fear of claustrophobia”) : Patients with agoraphobia have a fear of the outside world, especially unfamiliar places or crowds. They fear situations that they cannot escape from or control. The fear can increase to the point of a panic attack (panic disorder with agoraphobia). In the medium term, those affected often withdraw completely for fear of the fear and no longer leave their homes.
  • Social phobia : Sufferers fear being the center of attention, being embarrassed, or failing. Therefore, they withdraw more and more from social life.
  • Specific phobia : The phobia here has a narrowly defined trigger. This is the case, for example, with spider phobia, needle phobia, fear of flying, claustrophobia (fear of narrow spaces) and fear of heights (phobia of heights).

Not every phobia needs treatment. Therapy is only advisable if this anxiety disorder restricts the quality of life of those affected.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) occurs as a result of an extremely stressful or threatening experience (trauma). This can be, for example, war experiences, a natural disaster, a serious accident, the death of a close relative, sexual abuse or other experiences of violence. Not only those directly affected, but also witnesses of such traumatic events can subsequently develop post-traumatic stress disorder.

So-called flashbacks are typical of PTSD . These are suddenly occurring, extremely stressful fragments of memory in which the affected person relives the traumatic experience over and over again. Flashbacks are triggered, for example, by noises, smells or certain words that are closely linked to the traumatic experience. In order to avoid these stimuli, many traumatized people withdraw. You are extremely nervous and irritable, suffer from sleep and concentration problems, but at the same time appear increasingly emotionless.

panic disorder

Patients with panic disorder have repeated massive anxiety attacks with severe physical and psychological symptoms. These include shortness of breath, rapid heartbeat, a tight or choking feeling in the throat, sweating, nausea, fear of dying or losing control, and feelings of unreality.

A panic attack usually lasts less than half an hour. It can occur unexpectedly or be triggered by certain situations. Panic disorder is very often coupled with agoraphobia (“fear of claustrophobia”): In certain situations (e.g. in crowds) or in certain places (e.g. public places, public transport) those affected have a panic fear of not getting away fast enough or of embarrassment Getting noticed by your own panic symptoms.

Women are more likely to develop panic disorder than men.

Other types of morbid anxiety

People with hypochondria (new name: hypochondriacal disorder ) live in constant fear of suffering from a serious or even fatal illness. They misinterpret harmless physical symptoms. Even the assurances from doctors that they are healthy cannot convince or reassure them.

Hypochondria is one of the so-called somatoform disorders – just like cardiac neurosis : those affected suffer from palpitations and shortness of breath and fear a heart attack without being able to find an organic cause for the symptoms.

Sometimes the anxiety appears as a symptom of other illnesses . For example, people with schizophrenia often suffer from severe anxiety. They perceive their outside world as threatening, have hallucinations or paranoia. Depression is often accompanied by objectively unfounded fears.

Fear: causes

There are various theories about the development of pathological anxiety or anxiety disorders:

  • Psychoanalytic approaches assume that anxiety disorders occur in people who have not learned to deal with normal anxiety. In conflict situations, they are overwhelmed, resulting in uncontrollable, childlike feelings of fear.
  • Cognitive- behavioral approaches , on the other hand, regard fears as learned. An example is the fear of flying. It can arise if the person concerned has experienced a threatening situation (e.g. severe turbulence) on board. Accordingly, fears can develop through mere observation – for example, when a child experiences that its mother is afraid of a spider.
  • Neurobiological approaches , on the other hand, assume that the vegetative nervous system is more unstable in anxious patients than in healthy people and therefore reacts particularly quickly and violently to stimuli.

Factors that can trigger anxiety

  • Stress : Strong mental stress can lead to permanent feelings of anxiety or panic attacks.
  • Trauma : Traumatic experiences such as war, accidents, abuse or natural disasters can trigger recurring fears.
  • Alcohol and Drug Use : Using drugs such as alcohol, LSD, amphetamines, cocaine, or marijuana can also cause anxiety or panic.
  • Medications : Certain medications can cause palpitations, shortness of breath, and anxiety as side effects. This applies in particular to substances that affect the psyche, the brain and nerve functions, affect the heart and breathing or interfere with the hormonal balance.
  • Heart diseases : Organic heart problems such as cardiac arrhythmias or heart problems ( angina pectoris ) can also trigger massive feelings of anxiety.
  • Brain diseases : In rare cases, an organic disease of the brain, such as inflammation or a brain tumor, is behind the fears.

When should you see a doctor?

If any of the following applies to you, you should see a doctor about your anxiety:

  • Your fear is excessive.
  • Her anxiety is becoming more frequent and more intense each time.
  • You cannot overcome your fear on your own.
  • Your current living conditions cannot explain the extent of the fear.
  • Your quality of life is severely restricted due to your fears.
  • You withdraw from social life because of your fears.

Don’t hesitate to see a doctor! The longer the symptoms of an anxiety disorder last, the more they can become entrenched. The therapy is then usually more difficult and longer. Therefore, if you experience signs of an anxiety disorder, you should seek professional help as soon as possible.

Fears that have a comprehensible cause may also require treatment. For example, when a life-threatening disease such as cancer is accompanied by massive fears.

What does the doctor?

The doctor makes the diagnosis after a detailed conversation, in which possible causes and triggers of the fears are also discussed (anamnesis). Specialized questionnaires help with this. They enable an assessment of how strong your fear is and what it is directed against. In some cases, further examinations are necessary to rule out organic causes of the anxiety symptoms.

Once your fears have been clarified, the doctor can suggest a suitable treatment.

Cognitive Behavioral Therapy

Cognitive behavioral therapy has proven to be particularly effective in the treatment of anxiety. This allows fear-triggering behavior patterns, thoughts and feelings to be discovered and questioned. Targeted exercises help to change these anxiety-provoking patterns.

In confrontation therapy , for example, the patient consciously exposes himself to the fear-triggering situation – first in his imagination, then in reality. The therapist helps him deal with the fear. In this way, the patient experiences that the feared catastrophe does not materialize and the fear subsides of its own accord. The brain stores this experience so that each time it is confronted with its trigger, the fear decreases. Phobias and obsessive-compulsive disorders can be treated particularly well with exposure therapy.

Patients with social phobia can try out frightening situations in role-playing games in a safe space. In this way, they gain self-confidence and social skills. This helps them overcome their fears.

depth psychological methods

Sometimes depth psychological therapy (e.g. psychoanalysis ) can also be useful. In doing so, deeper-lying psychological problems can be uncovered and processed as the root of fear.


In addition to psychotherapeutic measures, medication can help to get anxiety under control. Antidepressants , among others, have proven effective in this regard. Sedatives like benzodiazepines can also relieve anxiety. However, since they can be addictive, they should only be taken under medical supervision and for a limited time.

Treatment of causative diseases

If other diseases (such as schizophrenia) are the cause of morbid anxiety, they should be treated professionally.

What you can do yourself

If you suffer from chronic anxiety, you should seek psychotherapeutic help as soon as possible. Because the longer an anxiety disorder lasts, the harder it becomes to treat it.

Face fear with ease

In any case, it makes sense to learn a relaxation method. The reason: relaxation and fear are two emotional states that are mutually exclusive. So if you master a relaxation technique, you can use it to manage anxiety and even panic attacks. Examples include special breathing exercises, yoga , autogenic training and progressive muscle relaxation according to Jacobson .

Fit against fear

A healthier lifestyle can also have a positive effect on anxiety symptoms. Sport reduces stress and improves fitness. In addition, the movement improves sleep, which is significantly disturbed in many anxiety patients. A healthy diet provides extra energy. All of this also has an effect on psychological stability – if you feel more awake and fitter, you can deal better with problems, conflicts and fear.

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