Anxiety disorder is defined as excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). The person finds it difficult to control the worry. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Some of the prevalent types of anxiety disorders are:

• Separation Anxiety
• Social Anxiety or Phobia
• Selective Mutism
• Obsessive Compulsive Disorder (OCD)
• Post Traumatic Stress Disorder
• Panic Disorder
• Agoraphobia
• Generalized Anxiety Disorder
• Specific Phobia

Separation Anxiety:
This is defined as developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:

• recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
• persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
• persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
• persistent reluctance or refusal to go to school or elsewhere because of fear of separation
• persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
• persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
• repeated nightmares involving the theme of separation
• repeated complaints of physical symptoms (such as headaches, stomach aches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

Social Anxiety/Phobia:
Social Anxiety disorder (also known as social phobia) is generally understood as extreme fear in the face (or anticipation) of social interaction. Social Anxiety is not mere shyness, but a medically recognized disorder that severely hampers the quality of life. Multiple causes are suspected, especially a combination of genetic makeup, early growth and development, and later life experience. These causes are grouped into the following categories:

• Genetic predisposition: sensitivity to criticism or social scrutiny may be passed on from one generation to the next. It is possible that the child of one or two shy parents may inherit genetic code that amplifies shyness into social anxiety disorder.
• Ethology (study of animal behavior): Averting the gaze is common in people with social anxiety disorder. Though exact cues and reinforcements for these behaviors must vary widely, their role in the development and maintenance of social anxiety seems significant.
• Development: Social anxiety emerges at different developmental stages. Babies develop a fear of strangers at seven months, not before. Separation anxiety is quite clear in some children. Being alone is difficult for children ages six to eight, but actually becomes desirable as they approach puberty and adolescence. Solitude becomes more important as anxiety about physical appearance and performance in school increases. We also know that traumatic or stressful life events occurring at an early developmental stage may increase the risk of social anxiety disorder.
• Chemical disturbances in the brain: Individuals with social anxiety disorder probably have abnormalities in the functioning of some parts of their anxiety response system. One theory is that social anxiety disorder may be related to an imbalance of a chemical called serotonin that transports signals between nerve cells in the brain. The anxiety response system is influenced by four areas of the human brain:
  • the brain stem (cardiovascular and respiratory functions)
  • limbic system (mood and anxiety)
  • prefrontal cortex (appraisals of risk and danger)
  • motor cortex (control of muscles)

Selective Mutism:
Selective mutism is defined as the consistent failure to speak in specific social situations where speech is expected (e.g. school) despite speaking in other situations (e.g. home). This failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language in the social situation. The disturbance is not caused by a communications disorder (e.g. stuttering) and does not occur exclusively during the cause of a pervasive development disorder, autism, schizophrenia or mental retardation.

Many practitioners and researchers feel that selective mutism might be best conceptualized as a childhood anxiety disorder. According to research there is a significant relation between selective mutism and social phobia, avoidant disorder of childhood or adolescence, simple phobia and high levels of anxiety symptoms. The severity of anxiety and social anxiety correlate with the severity of mutism. Selective mutism may be a symptom of social anxiety, rather than a distinct diagnostic syndrome.

There is a lot of uncertainty about the causes of selective mutism (SM), due to a lack of empirical research. According to research emotional and physical trauma are not the main causes, but that biologically mediated temperament and anxiety components play the major role in the cause of SM.

• SM is more apparent in the extremely shy child with social anxiety.
• A family history of SM, social anxiety, extreme shyness, or anxiety disorders such as obsessive compulsive disorder (OCD), social phobia and panic disorder may predispose the child to develop SM.
• Children with SM often meet diagnostic criteria for both a developmental and an anxiety disorder.
• A neurotic family life: overprotective/domineering mothers, or strict and remote fathers.
• SM might develop due to some trauma such as early hospitilization at a young age or any kind of abuse.

Obsessive Compulsive Disorder (OCD):
Obsession Compulsive Disorder (OCD) is an anxiety disorder where a person has recurrent and unwanted ideas or impulses (called obsessions) and an urge or compulsion to do something to relieve the discomfort caused by the obsession. The obsessive thoughts range from the idea of losing control, to themes surrounding religion or keeping things or parts of one's body clean all the time. Compulsions are behaviors which help reduce the anxiety surrounding the obsessions. Most people (90%) who have OCD have both obsessions and compulsions. The thoughts and behaviors a person with OCD has are senseless, repetitive, distressing, and sometimes harmful, but they are also difficult to overcome.

As the name indicates, this disorder comprises of two facets:

• obsessions
  Obsessions are unwanted ideas or impulses that repeatedly well up in the mind of a person with OCD. Common ideas include persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated -- I must wash them" or "I may have left the gas on" or "I am going to injure my child." These thoughts tend to be intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness. (NIMH). Some examples of obsessions are:
  • Obsessions with aggressive content: The fear of having caused some terrible tragedy, such as a fatal fire. Repeating intruding images of violence.
  • Superstitious fears: The belief that certain numbers or colors are "lucky" or "unlucky."
  • Obsessive need for order or symmetry: An overwhelming need to align objects "just so." Abnormal concerns about the neatness of one's personal appearance or environment.
  • Obsessions about hoarding or saving: Stashing away useless trash, such as old newspapers or items rescued from trash cans. The inability to discard anything because it "may be needed sometime." A fear of losing something or discarding something by mistake.
  • Repetitive rituals: Repeating routine activities for no logical reason. Repeating questions over and over. Rereading or rewriting words or phrases.
  • Nonsensical doubts: Unfounded fears that one has failed to do some routine task, such as paying the mortgage or signing a check.
• compulsions
  In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary. (NIMH). Some examples of compulsions are:
  • Cleaning and washing compulsions: Excessive, ritualized hand washing, showering, bathing or teeth brushing. The unshakable feeling that household items, such as dishes, are contaminated or cannot be washed enough to be "really clean."
  • Compulsions about having things "just right." The need for symmetry and total order in one's environment. The need to keep doing things until things are "just right."
  • Checking compulsions: Repeatedly checking to see if a door is locked or an appliance is turned off. Checking and rechecking for mistakes, such as when balancing a checkbook. Checking associated with bodily obsessions, such as repeatedly checking oneself for signs of a catastrophic disease.
  • Other compulsions: Blinking or staring rituals. Asking over and over for reassurance. Behaviors based on superstitious beliefs, such as fixed bedtime rituals to "ward off" evil or the need to avoid stepping on cracks in the pavement. A feeling of dread if some simple act is not performed. The need to touch, tap or rub certain objects repeatedly. Counting compulsions, such as counting panes in windows or signs along the road. Mental rituals, such as reciting silent prayers in an effort to make a bad thought go away.
  • Excessive list making.

Post Traumatic Stress Disorder:
Post-Traumatic Stress Disorder (PTSD) is a debilitating condition that follows a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. PTSD can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, or torture, or being held captive. The event that triggers it may be something that threatened the person's life or the life of someone close to him or her. Or it could be something witnessed, such as mass destruction after a plane crash.

Signs and symptoms of post-traumatic stress disorder typically appear within 3 months of the traumatic event. However, in some instances, they may not occur until years after the event, and may include:

• Flashbacks and distressing dreams associated with the traumatic event.
• Distress at anniversaries of the trauma.
• Efforts to avoid thoughts, feelings and activities associated with the trauma.
• Feelings of detachment or estrangement from others, inability to have loving feelings.
• Markedly diminished interest or participation in activities that once were an important source of satisfaction.
• In young children, delayed or developmental retrogression in such areas as toilet training, motor skills and language.
• Hopelessness about the future — no hope of a family life, career or living to old age.
• Increased physical and psychological arousal — not present before the trauma — with at least two of the following: trouble sleeping, anger, difficulty concentrating, exaggerated startle response to noise and physiologic reaction to situations that remind you of the traumatic event. Physiologic reactions may include an increase in blood pressure, rapid heart rate, rapid breathing, muscle tension, nausea and diarrhea.

Panic Disorder:
In panic disorder, brief episodes of intense fear are accompanied by multiple physical symptoms (such as heart palpitations and dizziness) that occur repeatedly and unexpectedly in the absence of any external threat. These "panic attacks," which are the hallmark of panic disorder, are believed to occur when the brain's normal mechanism for reacting to a threat – the so-called "fight or flight" response – becomes inappropriately aroused. Most people with panic disorder also feel anxious about the possibility of having another panic attack and avoid situations in which they believe these attacks are likely to occur. Anxiety about another attack, and the avoidance it causes, can lead to disability in panic disorder.

During a panic attack, some or all of the following symptoms occur:

• Terror – a sense that something unimaginably horrible is about to happen and one is powerless to prevent it
• Racing or pounding heartbeat
• Chest pains
• Dizziness, lightheadedness, nausea
• Difficulty breathing
• Tingling or numbness in the hands
• Flushes or chills
• Sense of unreality
• Fear of losing control, going "crazy," or doing something embarrassing
• Fear of dying

Agoraphobia:
Agoraphobia is defined as an incapacitating fear of open spaces. It is a disorder characterized by avoidance of crowds, and open and public places, particularly if escape or assistance is not immediately available. It may occur alone, or may accompany panic disorder.

Symptoms include:

• Fear of being alone
• Fear of losing control in a public place
• Fear of being in places where escape might be difficult
• Becoming house bound for prolonged periods
• Feelings of detachment or estrangement from others
• Feelings of helplessness
• Dependence upon others
• Feeling that the body is unreal
• Feeling that the environment is unreal
• Anxiety or panic attack (acute severe anxiety)
• Unusual temper or agitation with trembling or twitching

General Anxiety Disorder:
This disorder is characterized by diffuse feelings of apprehension with physiological symptoms. A generalized anxiety disorder (GAD) is one of the most common types of anxiety disorder. It is characterized by excessive anxiety and worry about two or more life circumstances for a period of six months or longer. The exact cause of this disorder may be unknown but biological and genetic factors play a role. Stressful life situations or nonadaptive behavior acquired through learning may also contribute to GAD. The disorder may start at any time, including childhood, and a history of excessive worry is common. GAD occurs somewhat more often among women than among men.

Symptoms include:

• typical symptoms of anxiety
• irritability or restlessness
• fatigue
• trembling or feeling shaky
• muscle tension, aches or soreness
• sweating, clammy skin
• a dry mouth
• difficulty swallowing or lump in the throat
• sleep disturbances
• nightmares
• poor concentration
• excessive worry
• muscle tension
• restlessness
• fatigue
• shortness of breath or breathing difficulty, especially lying down
• palpitations
• dizziness
• nausea, diarrhea
• flushing or chills
• fainting
• an exaggerated startle response
• difficulty with concentrating, confusion
• feeling keyed up
• complaining of urinary frequency or urgency

Specific Phobia:
Many people experience specific phobias, intense, irrational fears of certain things or situations -- dogs, closed-in places, heights, escalators, tunnels, highway driving, water, flying, and injuries involving blood are a few of the more common ones. Phobias aren't just extreme fear; they are irrational fear. Adults with phobias realize their fears are irrational, but often facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.

Specific phobias strike more than 1 in 10 people. No one knows just what causes them, though they seem to run in families and are a little more prevalent in women. Phobias usually first appear in adolescence or adulthood. They start suddenly and tend to be more persistent than childhood phobias; only about 20 percent of adult phobias vanish on their own. When children have specific phobias--for example, a fear of animals--those fears usually disappear over time, though they may continue into adulthood. No one knows why they hang on in some people and disappear in others.

If the object of the fear is easy to avoid, people with phobias may not feel the need to seek treatment. Sometimes, though, they may make important career or personal decisions to avoid a phobic situation. When phobias interfere with a person's life, treatment can help. Successful treatment usually involves a kind of cognitive-behavioral therapy called desensitization or exposure therapy, in which patients are gradually exposed to what frightens them until the fear begins to fade. Three-fourths of patients benefit significantly from this type of treatment. Relaxation and breathing exercises also help reduce anxiety symptoms. There is currently no proven drug treatment for specific phobias, but sometimes certain medications may be prescribed to help reduce anxiety symptoms before someone faces a phobic situation.