Anxiety disorders
What is an anxiety disorder?
An anxiety disorder is a mental health condition characterized by persistent feelings of fear, tension, and restlessness. It goes beyond normal anxiety and can significantly affect your daily functioning. You may have an anxiety disorder if you experience excessive anxiety or worry over a longer period of time that is difficult to control and disproportionate to the situation.
These symptoms are often accompanied by other complaints, such as restlessness, irritability, difficulty concentrating, muscle tension, sleep problems, and physical symptoms like heart palpitations or a feeling of shortness of breath. It can feel as though your body is constantly “on,” making it difficult to relax. These symptoms are present on a daily basis and can interfere with your functioning in social, work-related, or other areas of life. You may find yourself avoiding certain situations, struggling to focus, or becoming overwhelmed more quickly. Everyday tasks can require more energy, and the ongoing tension can disrupt your sleep and recovery.
An anxiety disorder can range from mild to severe and exists in different forms. Diagnosis is made by mental health professionals such as psychologists, psychiatrists, or therapists. With the right treatment, it is possible to reduce symptoms and experience more calm and balance again.
Overactive threat response
In an anxiety disorder, your brain remains in a constant state of alertness. It reacts more quickly to potential threats or tension, even without a clear trigger, keeping your body in a state of readiness.
Physical tension
Anxiety often manifests as ongoing restlessness, persistent worrying, and physical tension. Your mind remains active while your body struggles to relax, making it difficult to truly unwind.
Comorbidity
Anxiety disorders often occur alongside depressive symptoms. This comorbidity is common and can influence both the course of the condition and the approach to treatment.
Symptoms of Generalized Anxiety Disorder (GAD) according to the DSM-5
According to the DSM-5, generalized anxiety disorder (GAD) is characterized by persistent and excessive anxiety and worry about various topics. These worries are difficult to control and are often disproportionate to the situation.
The symptoms are present on most days for at least six months and cause significant distress or impairment in daily functioning, such as at work, in social situations, or in everyday life. The symptoms cannot be better explained by substance use, a medical condition, or another mental disorder.
In addition, adults must experience at least three of the following symptoms:
- Restlessness: feeling keyed up or on edge
- Fatigue: easily tired, low energy
- Difficulty concentrating: trouble focusing or a “blank mind”
- Irritability: becoming easily irritated or short-tempered
- Muscle tension: for example in the neck, shoulders, or jaw
- Sleep disturbances: difficulty falling asleep, staying asleep, or restless sleep
Important
Anxiety symptoms can build up gradually. What starts as tension or worrying can slowly increase and begin to affect your daily functioning more and more. Recognizing and addressing these symptoms early can help prevent them from worsening.
How does the brain work in anxiety disorders?
Overactive fear and stress system
In anxiety disorders, certain systems in the brain function differently than usual. The communication between brain regions involved in detecting threat and regulating emotions becomes imbalanced. Your brain is more quickly put into a state of alertness. It reacts faster and more strongly to potential threats, even when there is no immediate danger. As a result, your body remains in a prolonged state of tension.
Neurotransmitters such as serotonin, GABA, and norepinephrine play an important role in this process. When their balance is disrupted, it becomes more difficult to regulate stress and return to a calm state.
Amygdala and prefrontal cortex
In anxiety disorders, the amygdala, the brain region involved in detecting threat, is often more sensitive or more easily activated. This causes situations to be perceived as threatening or unsafe more quickly, even when there is no objective reason for concern. At the same time, regulation from the prefrontal cortex, which helps evaluate, interpret, and regulate emotions, becomes less effective. This makes it harder to challenge anxious thoughts or reassure yourself during moments of stress.
The hippocampus also plays a role, particularly in recognizing context and safety. When this process is disrupted, it can be more difficult to assess situations as safe, allowing the anxiety response to persist. This altered interaction between brain regions can make anxiety feel more intense and longer-lasting, both mentally and physically.
The impact of anxiety disorders
Anxiety can affect your daily functioning in different ways. Understanding this impact is an important step toward recovery and appropriate treatment.
Confidence and self-doubt
Anxiety can make it harder to trust yourself. You may find yourself doubting your thoughts, feelings, or decisions more often, which can increase feelings of uncertainty.
Work and study
Ongoing tension and worrying can make it more difficult to concentrate. Making decisions may require more energy, and you may become overwhelmed more easily.
Physical health
Anxiety also affects your body. You may experience symptoms such as heart palpitations, muscle tension, fatigue, and sleep disturbances.
Social interactions
Interacting with others may feel more demanding or stressful. You may withdraw or find that social situations require more energy, which can affect your relationships.
Emotions and energy
Ongoing tension can make you feel more easily overwhelmed. It may take more effort to relax, causing your energy levels to decrease faster than usual.
Control and uncertainty
Anxiety is often linked to difficulty tolerating uncertainty. You may try to maintain control over situations, but this can unintentionally keep the tension going.
Oorzaken en vormen van angststoornissen
Anxiety related symptoms often develop gradually. In many cases, there is no clear starting point or single cause. Instead, it is often a combination of factors that influence how your brain and body respond to stress. In addition to biological processes, personal and psychological factors also play a role. How you typically cope with stress, how you relate to uncertainty, and your past experiences can all contribute to the development of anxiety symptoms. Prolonged stress, significant life events, or periods of overload can also increase the likelihood of developing an anxiety disorder.
There is often an underlying sensitivity as well. Some people are naturally more reactive to stress or change. Genetic predisposition can play a role, making one brain more likely to remain in a state of alertness than another.
What types of anxiety disorders are there?
Within clinical diagnosis, a distinction is made between different types of anxiety disorders, such as generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias. Each type has its own characteristics.
Different types of anxiety disorders
Anxiety can present itself in different ways. While one person mainly experiences ongoing tension and excessive worrying, another may deal with panic attacks or fear in specific situations.
Generalized Anxiety Disorder (GAD)
In generalized anxiety disorder, persistent and excessive worrying is central. You may find yourself worrying about different areas of life, it can feel difficult to stop or control these thoughts.
Your mind remains active and your body feels tense. Relaxing can be difficult because there is always something on your mind.
Social anxiety disorder
In social anxiety disorder, fear of being judged by others plays a central role. Social situations can trigger anxiety, such as conversations, presentations, or being in groups.
You may worry about doing something wrong or being negatively evaluated, which affects how you feel in social interactions.
Panic disorder
Panic disorder is characterized by recurring panic attacks. These are sudden, intense episodes of fear that can be accompanied by physical symptoms such as heart palpitations, shortness of breath, or dizziness.
There is often also a fear of having another attack, which can change how you experience certain situations or lead you to avoid them.
Specific phobia
A specific phobia involves a strong fear of a particular object or situation, such as flying, blood or injections, heights, enclosed spaces, or certain animals.
The fear is usually immediate and clearly linked to a specific trigger, and can lead to intense anxiety when you encounter it.
Advice for family and loved ones
When someone in your environment is dealing with anxiety, it can be difficult to know how to help. You may feel the urge to reassure them or protect them from stress. This is completely understandable, but it does not always help in the long term.
In anxiety disorders, avoiding situations or providing constant reassurance can unintentionally reinforce the anxiety, making it more persistent and harder to reduce over time.
What can be helpful is supporting someone without taking over the anxiety. Stay calm, listen, and acknowledge that the anxiety feels real, without trying to immediately eliminate it. Encourage small steps and allow space for the person to face and manage their own anxiety.
You do not have to fix everything or adapt to the anxiety. By remaining consistent and calm, you can support someone more effectively over time. If you are unsure what is helpful in a given situation, it may be valuable to seek advice or guidance.
Comorbidity with depression
Anxiety disorders and depression often occur together. Many people who experience long-term anxiety symptoms also develop low mood, fatigue, or a loss of energy. Conversely, depression can also be accompanied by increased tension and persistent worrying. This combination is referred to as comorbidity. When anxiety and depression occur together, the symptoms can reinforce each other. Ongoing tension and restlessness may lead to exhaustion, while low mood can make it more difficult to cope with anxiety. As a result, the recovery process can become more complex.
When do we treat anxiety with rTMS?
rTMS is currently best supported for treatment-resistant depression. When anxiety symptoms occur alongside a depression that has not responded sufficiently to previous treatments, rTMS may help restore balance in brain activity. In these cases, we often see improvements not only in mood, but also in experienced anxiety and tension. For anxiety disorders without a depressive component, the effectiveness of rTMS is currently less well established. We therefore carefully assess whether your symptom profile is suitable for this type of treatment.
Take the step towards recovery
There is a treatment that works, even when previous therapies have not helped enough. Discover rTMS or ask a question.