Anxiety disorder – panic disorder – agoraphobia – social phobia – specific phobia – generalised anxiety disorder
Fears are part of everyone's life. They appear in a wide variety of situations and contexts, indicate impending dangers and thus have an important protective function for humans. When those affected can no longer cope with their fears over a longer period of time, suffer greatly from them, and their quality of life, self-confidence, relationships and everyday activities are increasingly affected by them, we speak of an anxiety disorder. Anxiety disorders are characterised by the loss of the warning function of normal fear perception. The fear reactions become stronger, more frequent and inappropriate.
Anxiety disorders are the most common mental illness, accounting for about 16 per cent of cases (frequency of illnesses per year). Women develop this condition about twice as often as men. It is not uncommon for the physical symptoms of anxiety, such as dizziness, rapid heartbeat, trembling, gastrointestinal problems and reduced resilience, to be so prominent that those affected undergo repeated medical and physical examinations before an anxiety disorder is diagnosed. Additional complications are the danger of attempted self-treatment with alcohol, drugs or addictive medication, and often depressive disorders also develop.
What causes anxiety disorders?
According to the current state of science, it is assumed that both psychosocial and biological factors play a role in the development of anxiety disorders. An increased susceptibility to anxiety disorders can also be hereditary, e.g. due to a particularly easily reacting autonomic (unconscious) nervous system. Normal fears exist in all children depending on their stage of development. If these are accompanied by either insensitive or overprotective parents, there is an increased risk that appropriate coping strategies will be insufficiently developed, that fears will remain or resurface in reactivating situations later in life. Stressful life events, high levels of stress over a long period of time, but also, for example, shameful experiences can trigger an anxiety disorder. This is then joined by maintaining factors with increased self-observation of bodily functions with misjudgments as dangerous, fear of renewed anxiety, catastrophising thoughts and increasing avoidance of situations falsely blamed for triggering the anxiety.
What symptoms are triggered by anxiety disorders?
- Racing or irregular heartbeat, rise in blood pressure
- Tightness in the chest, occasionally also chest pain
- Sweating, clammy hands
- Flushing, hot flushes and cold shivers, goose bumps
- Shortness of breath up to a feeling of suffocation or accelerated breathing
- Difficulty swallowing or the feeling of having a lump in the throat
- Dry mouth
- Tremors, muscle tension
- Numbness or tingling of the skin
- Nausea, frequent urination, diarrhoea
- Sleep disorders
Alongside fear as a basic feeling that is sometimes not perceptible to the person affected:
- Discomfort and disquiet
- Inner restlessness
- Feeling of being trapped
- Nervousness, stress
- Agitation and irritability
- Lack of concentration
- Inability to respond meaningfully
- Alienated perception (derealisation) and an altered sense of personality (depersonalisation)
- Fear of losing control
- Feeling crazy or "freaking out"
- Sometimes also fear of dying
- Language difficulties
- Uncontrolled crying
How are anxiety disorders diagnosed?
After ruling out physical causes for the symptoms, the diagnosis of anxiety disorder is made through a consultation. The description of the symptoms and the content of the fears, as well as the situations avoided, enables a sub-classification of the anxiety disorders. Psychological test questionnaires complement the diagnosis.
A distinction is made between the following anxiety disorders:
Unexpected, intense anxiety with physical symptoms, especially affecting the cardiovascular and respiratory systems, sweating, trembling, hot and cold shivers, dizziness or light-headedness. These so-called panic attacks are accompanied by fears of dying, going crazy or fainting. These states occur in situations without any objectively understandable danger and can lead to avoidance behaviour towards places or situations associated with the panic states.
Phobic avoidance behaviour originally involved fear of wide places or crowds and now refers to a person's general fear of not being able to leave a situation easily, such as when using public transport or queuing at a busy checkout at the grocery shop. If complete avoidance is not possible, the situations will only be visited with an escort. Often, the affected person's scope of life is increasingly limited to the home environment. Sometimes they can no longer be alone there either.
An important characteristic is the expectation or belief of being observed and negatively evaluated by others in a social situation. The patient avoids such situations for fear of embarrassment. The most common sources of this insecurity are public speaking, eating or drinking together, or public events. In contrast to shyness, social life or occupational functioning is significantly impaired by anxiety-related avoidance behaviour. Blushing, trembling, urge to go to the toilet or even fear of vomiting may occur.
Generalised anxiety disorder
Anxieties focus on excessive worry and unrealistic fears about possible bad events within all areas of life. The fears and worries are experienced as extremely intense and hardly controllable and are accompanied, among other things, by increased physical tension, restlessness, nervousness, sleep disturbances, concentration problems and reduced performance.
The fear of individual and precisely describable objects or delimitable situations is conscious to those affected as exaggerated and unfounded, but nevertheless entails increasing avoidance behaviour. Examples are fears of certain animals (dogs, spiders), of environmental phenomena (e.g. thunderstorms), of blood or medical interventions, of diseases (AIDS) or very specific spatial situations (aeroplane, lift). Many people live with such phobias without serious limitations. If they require treatment, they can usually be treated well on an outpatient basis and very rarely require inpatient treatment.
How are anxiety disorders treated?
In the majority of cases, anxiety disorders can be treated well on an outpatient basis. However, if there is no significant improvement during outpatient treatment or if the condition is very severe, inpatient hospital treatment may be necessary. Often, even leaving the everyday/overwhelming situation results in a helpful distancing from tasks and conflicts. The temporary inpatient community is a good training ground for newly learned skills, different interaction behaviour can be tried out, and in addition, several treatment approaches can be linked together in an inpatient setting.
Our treatment concept for anxiety disorders includes therapies that take into account the physical, psychological and spiritual dimensions.
In cases of more pronounced anxiety disorders, the concomitant prescription of certain antidepressants may be considered. Prescriptions are always examined on a case-by-case basis. With anthroposophic medicines, the individual's self-healing powers are stimulated. External applications, compresses, rubs and oil dispersion baths support the healing process. Movement and physiotherapy improve body awareness and restore confidence in the functions of one's own body.
We provide our patients with knowledge (psycho-education) about anxiety, especially about the connections between feelings and bodily processes (vicious circle of anxiety). Therapeutic painting, music therapy, therapeutic eurythmy, as well as therapeutic sculpting and modelling support the healing process.
Psychotherapeutic methods (Schema therapy according to J. Young, behavioural therapy, depth psychology-based psychotherapy, anthroposophic psychotherapy) and meditation are also used.
The aim of treatment is to develop an understanding of which individual external and internal factors, biographical backgrounds and learning experiences are contributing to the development and persistence of the symptoms. At the same time, patients learn strategies to deal with their fears appropriately (e.g. anxiety management training).
Prospects: living with the disease
Anxiety disorders are among the most successful mental illnesses to be treated with psychotherapy. In addition to inpatient treatment, outpatient therapy is necessary in most cases for lasting improvement.