What are the different types of anxiety disorders?

Anxiety disorders differ from one another in the types of objects or situations that induce fear, anxiety or avoidance, and duration. There are a number of different types of anxiety disorders (see Table 10):

Generalised anxiety disorder (GAD).
Panic disorder.
Agoraphobia.
Social anxiety disorder (SAD).
Specific phobia.

There are some differences in the way that DSM-5-TR and ICD-11 classify anxiety disorders. In relation to GAD, for example, while both systems base the diagnosis on the presence of anxiety and worry in relation to different life situations, events or activities, the ICD-11 also allows for ‘free-floating anxiety’, or general apprehension that is not focused on any particular circumstance. Another difference is in the length of time symptoms are required to be present to receive a diagnosis (i.e., at least 6-months for DSM-5-TR relative to ‘at least several months’ in ICD-11 [155]).

A case study example of how a person experiencing co-occurring anxiety and AOD use disorder may present is illustrated in Box 5. It should be noted that OCD, PTSD, and acute stress disorder were previously categorised as anxiety disorders but have been moved from this broader disorder category in
the DSM-5-TR. These disorders are described later in this chapter.

Table 10: Anxiety disorders

Disorder	Symptoms
Generalised anxiety disorder (GAD)	GAD is marked by excessive anxiety or worry, occurring more days than not, for at least six months, about a number of events or activities (e.g., performance at work or school). The worry or anxiety is difficult to control and is associated with at least three of the following: Restlessness or edginess. Being easily fatigued. Difficulty concentrating. Irritability. Muscle tension. Sleep disturbance (difficulty falling or staying asleep, restless, unsatisfying sleep). These symptoms cause significant distress or interfere with a person’s occupational or social functioning.
Panic disorder	Panic disorder involves the experiencing of unexpected panic attacks followed by at least one month of persistent concern or worry about having another attack, and the implications of having another attack. As a result the person changes their behaviour in relation to the attacks. Panic disorder is sometimes accompanied by agoraphobia.
Agoraphobia	Agoraphobia involves marked fear or anxiety about two or more of the following, for at least six months: Using public transportation (e.g., buses, trains, taxis, planes, ships). Being in open spaces (e.g., parking lots, bridges). Being in enclosed spaces (e.g., shops, movie theatres). Standing in line or being in a crowd. Being outside the home alone. The person avoids these situations because anxiety about being in places or situations from which escape might be difficult or embarrassing, or in which help may not be available, in the event of a panic attack. The person avoids these places or situations, or if such situations are endured there is considerable distress or anxiety, or the need for a companion.
Social anxiety disorder (SAD)	SAD (formerly known as social phobia) is characterised by excessive anxiety or worry about one or more social situations for at least six months, where their actions may be analysed by others. Examples of these kinds of situations include meeting new people, or eating, drinking, performing, or speaking in public. A person with SAD fears they will be negatively evaluated, humiliated, embarrassed, or rejected. The social situations almost always provoke the same feelings of distress or anxiety and are avoided or endured with intense fear or anxiety, which is disproportionate to the actual threat posed by the situation. Fearing embarrassment, humiliation, or rejection is not necessarily unusual, but a person with SAD will fear the situation to the point where their avoidance or anxiety causes significant distress and interferes with their ability to function.
Specific phobia	Specific phobia is characterised by excessive or unreasonable fear of a specific object or situation that causes immediate anxiety and/or panic attacks, for at least six months. Phobic cues may include animals; blood, injury or injections; situations involving the natural environment (such as heights or storms); or other specific situations such as airplanes, lifts, or enclosed spaces. The person avoids the feared places or situations, or if such situations are endured there is considerable distress or anxiety. Having a fear is not so unusual, but when it interferes with performing the responsibilities in a person’s life it can become a problem. For example, having a fear of flying is not a problem until a person finds themselves planning a holiday overseas or that they need to travel for work.

Box 5: Case study E: What does co-occurring anxiety and AOD use look like? Declan’s story

Case study E: Declan’s story

Declan, a 37-year-old account executive for a high-profile advertising agency, was referred to his local AOD service after a recent hospital admission. Declan’s job is extremely stressful, with numerous social activities and events, that he has been finding increasingly difficult. He is very fit and attends the gym most days before work.

On assessment, Declan told the AOD worker that he didn’t know if he should be there at all, he didn’t think he had much of a problem, but his recent hospital trip had scared him, and he thought it wouldn’t hurt to see if he needed help. Declan said that his job required him to meet with important clients and also present in client meetings, which he hated. In particular, he hated the attention and having people looking at him when he spoke. After presenting at a meeting with important clients about 18 months ago, Declan was asked a very difficult question and felt his mind go blank. He felt everyone looking at him and started sweating and shaking, had difficulty breathing, with tightness in his chest accompanied by chest pain. He thought he was having a heart attack and collapsed mid-meeting. Declan was taken by ambulance to hospital, where he was told he had experienced a panic attack.

While his colleagues are also his mates, they have also taken to making fun of the incident, often asking before big client meetings whether Declan will make it through, or should they have the ambulance on stand-by. Declan has since been terrified of having another panic attack, and has been feeling increased anxiety at client lunches, meetings, and seminars. One evening, Declan told his boss about his anxiety, but his boss did not seem to understand the severity of Declan’s fear, and replied, ‘yes, I used to feel nervous before presenting as well. Don’t worry, it’ll get easier the more you do it, I’ll put you down to do a few more’. In talking to another close colleague about his anxiety about a year ago, his colleague mentioned that he also sometimes felt nervous before big meetings but felt much better after doing a couple of lines. Since that time, Declan has been using cocaine before client lunches and meetings and found that it increased his confidence and reduced his anxiety.

Declan’s most recent hospital admission followed another incident where he was taken to emergency after collapsing in a client meeting mid-presentation. He expected to be told that he had experienced another panic attack but was shocked when he was told by the doctors that he had experienced a heart attack. His blood tests showed recent amphetamine type substance use.

Key Points

What are the primary concerns for Declan?
Where to from here?

Case study E continues in Chapter B7.