Anxiety Disorders: An Overview of Generalized Anxiety Disorder, Panic Disorder, and a Discussion of Stigma

Fear and stress are natural emotional responses that make up an undeniable part of the human experience. When these feelings become excessive, out of control, and begin to disturb daily functioning, however, they become the characteristic symptoms of anxiety disorders. With these conditions, both general perceived threats of future dangers and stress induced by specific triggers can be dramatically heightened and persist for long periods of time. Many of the anxiety disorders develop in childhood and tend to continue into adulthood, especially in the absence of appropriate treatment (American Psychiatric Association, 2013). Although adversities experienced in childhood and unhealthy family relationships may increase the risk of generalized anxiety disorder (GAD), no environmental factors have been identified to serve as a definite and reliable diagnostic marker (American Psychiatric Association, 2013). The personality trait of high neuroticism in the Big Five Personality Model has also been shown to be correlated with the development of GAD, although the majority of the risk is genetic. There is no evidence to suggest that the propensity for excessive worrying is related to culture, although the content of worry can be culturally specific. Irrational anxiety can severely impact an individual’s ability to focus and carry out everyday tasks efficiently, their worrying taking up a significant amount of time and energy and possibly even affecting the confidence of others close to them (American Psychiatric Association, 2013).

 

The DSM-5 provides a detailed and comprehensive overview of the diagnostic criteria and symptoms of anxiety disorders, of which generalized anxiety disorder and panic disorder are focused on here. In the general population across the United States and several European countries, the 12-month prevalence for panic disorder is around 2%-3%, while the prevalence for panic attacks alone in the United States is around 11.2% (American Psychiatric Association, 2013). Simply experiencing a panic attack is not sufficient for a diagnosis of panic disorder, however. For generalized anxiety disorder, the 12-month prevalence in the general population of the United States is around 0.9% among adolescents and 2.9% among adults (American Psychiatric Association, 2013). In panic disorder, the individual experiences recurrent, unexpected panic attacks that may or may not be tied to a specific object or circumstance. They are often persistently worried about having more panic attacks in future, sometimes changing their behavior in order to avoid situations that could potentially trigger an attack. Panic attacks are abrupt surges of intense fear or discomfort that reach a peak within minutes, accompanied by physical symptoms such as palpitations, accelerated heart rate, trembling, shortness of breath, and feelings of light-headedness (American Psychiatric Association, 2013). Individuals with panic disorder are often frequently absent from work or school, spending a significant amount of time for doctor and emergency room visits, impairing social and occupational functioning. The key features of generalized anxiety disorder are excessive and persistent worry surrounding a variety of topics, the most prominent being work and school performance. Physical symptoms such as restlessness, fatigue, irritability, muscle tension, and sleep disturbance often appear as well, causing considerable impairment to the functioning of everyday life (American Psychiatric Association, 2013). Throughout the course of the disorder, the focus of worry may shift from one area to another. Both panic disorder and GAD are often comorbid with other conditions such as depression and bipolar disorder. 

 

Anxiety disorders have always been present as a part of the human experience. Yet it took many years for anxiety to gain recognition as a medical condition, and even longer to develop adequately successful treatment. In the modern world, social media and educational campaigns have generally helped the public gain an awareness of anxiety disorders. Researchers have made significant advancements in understanding the causes and biological basis of anxiety, yet before the start of the 20th century, very little was known about these conditions. 

 

The study of anxiety began around 2000 years ago in the Greco-Roman world. Writers like Hippocrates, Cicero, and Seneca described people with irrational fears or continual worry, much like the symptoms of anxiety disorders that we recognize today, though they were uncertain what caused this kind of behavior (Heston-Davis, 2023). Many philosophers encouraged these people to practice introspection and focus on the present as they believed the symptoms were caused by unrealistically negative feelings. In the 1600s, a condition known as melancholia began to appear in writing, covering a spectrum of anxiety and depressive symptoms (Heston-Davis, 2023). At the time, doctors hadn’t yet understood that anxiety and depression were two distinct conditions, or that there were different types of anxiety disorders. In the 1700s, French physician Boissier de Sauvages identified the term panophobia hysterica in his book, a disorder with symptoms that involved intense fear and high heart rates (Spectrum CBT, 2022). This was one of the earliest modern definitions of panic. The term “neurasthenia” then appeared in 1869, covering a broad range of anxiety disorder symptoms, and the medical field with psychiatrists such as Sigmund Freud began working on defining and diagnosing anxiety with increased interest in the late 1800s and early 1900s. The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 1952, but many of the subtypes of anxiety disorders weren’t named until the DSM-III was published in 1980, including panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder (Heston-Davis, 2023). 

 

The key brain regions involved in anxiety disorders include the amygdala, prefrontal cortex (PFC), anterior cingulate cortex (ACC), and hippocampus. Together, these structures form what is known as a prefrontal-limbic network (Nature Index, n.d.). A variety of anxiety disorders have been found to be associated with volume reductions in the ACC and other related structures, and abnormalities in the connectivity and regulation of the prefrontal-limbic network seem to underpin the excessive worry and hypervigilance of anxiety conditions (Nature Index, n.d.). Furthermore, the ACC has been shown to amplify fearful signals sent from the amygdala. When patients with anxiety were shown pictures of fearful faces, the ACC and the amygdala along with other brain regions displayed substantially increased activity, producing an anxious response (Gadye, 2018). On the other hand, the PFC seems to suppress the signals coming from the amygdala. Individuals with anxiety disorders are likely to have damage to this brain region, thus experiencing abnormal levels of fear and worry as signaling from the amygdala is amplified. 

 

The amygdala is often highlighted as the primary brain structure involved in anxious emotions, serving as the “hub of fear and anxiety” (Gadye, 2018, para. 4). Originally, inappropriate fear and anxiety have been thought to be caused by a hyperactive amygdala. Today, scientists have come to understand that anxiety is the result of not just the activity from a single brain region, but the interactions within a network of connected structures– “a fear network” (Gadye, 2018, para. 5). In 2018, researchers discovered a neural circuit in the amygdala that contributed to anxiety. They also identified the role of a signaling molecule known as dynorphin that provided a potential direction for the development of anxiety disorder treatments to target (Li, 2018). Their experiments in mice revealed that anxiety began with increased excitation of neurons in the amygdala. When a perceived threat elicits fear, for example, these neurons release dynorphin, which interferes with a mechanism in the circuit that would normally calm the activation of neurons in the amygdala. The result is overexcitation and a display of anxious behavior. 

 

The main treatment methods for panic attacks and panic disorder are medication and psychotherapy. Effective treatment plans have been shown to significantly reduce the risk of suicidal ideation in individuals experiencing anxiety (Cleveland Clinic, 2023). Antidepressant medications have been successful in reducing the severity of panic symptoms and lessening the occurrence of panic attacks (Ham et al., 2005). The most commonly prescribed types include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs are typically recommended as the first choice of medication for patients, including fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft). Benzodiazepines are another type of medication that serve as central nervous system depressants. These are generally only used short-term because there is a significant risk of developing dependence, especially for those who have had problems with alcohol or drug use (Mayo Clinic, 2026). The choice of medication often depends on the patient’s side effect profiles and individual preferences (Ham et al., 2005). 

 

Psychotherapy, also known as talk therapy, can be effective in helping the patient understand panic attacks and gradually learn that panic symptoms are not inherently dangerous. In a form of psychotherapy known as cognitive behavioral therapy (CBT), the therapist will help the patient re-create the process of a panic attack in a safe, controlled manner and environment. When the patient no longer finds the physical symptoms of a panic attack to be threatening, attacks begin to lessen and fear may gradually subside (Mayo Clinic, 2026). In exposure therapy, the patient is gradually and repeatedly exposed– in imagination or in reality– to the particular stimuli that trigger a panic attack (Cleveland Clinic, 2023). Over time, paired with relaxation techniques, the situation becomes less threatening. In addition, lifestyle interventions such as physical exercise, dietary restrictions (avoiding caffeine and alcohol), and refraining from smoking can help lower the risk of having a panic attack. Treatments for generalized anxiety disorder similarly involve psychotherapy (typically CBT) and medication (typically antidepressants such as SSRIs). 

 

“Everyone feels anxious”. A true statement that is the cause of a lot of misunderstanding and stigma towards those with anxiety disorder, because anxiety experienced as a disorder is fundamentally different from the everyday worries of life. Over the past couple of years, the word anxiety has also been gradually generalized to mean the same as stress, softening the severity of the condition in the eyes of the public and encouraging dismissal. Anxiety as the result of an anxiety disorder is persistent, excessive, and extremely difficult to control. The intensity, duration, or frequency of the anxiety is often out of proportion to the actual impact of the event, and the worries associated with generalized anxiety disorder typically interfere significantly with the cognitive and social functioning of everyday life. In contrast, stress as a normal part of the human emotional experience is often attached to a specific situation or stimuli. Once the external matter is resolved, the stress subsides. The anxiety of generalized anxiety disorder frequently occurs and persists with a much longer duration without any specific triggers. Patients often do realize that they are overreacting in an irrational way, yet experience helplessness and an inability to control their symptoms regardless. Continuously normalizing anxiety disorders by equating their struggles with stress as a natural part of life not only creates barriers to understanding mental illness, but also prevents the patient from reaching out for help. As Dominique Castro (2017) writes, “No one wants to feel like a prisoner of their own mind” (para. 18). Concerns of being judged negatively by others due to visible panic symptoms further leads to masking of the disorder and a reluctance to seek professional treatment for fear of carrying an undesirable label. 

 

Most of the anxiety disorders occur more frequently in females than in males, with an approximately 2:1 ratio (American Psychiatric Association, 2013). However, men appear to have a higher perceived stigma towards anxiety compared to women, often being more likely to conceal their condition and deny their need for help. This is likely due to cultural stereotypes and differences in emotional processing between genders. In many cultures, an emphasis is often placed on the idea that men are meant to be strong and tough, influencing the beliefs of children from a very young age. Furthermore, adolescents appear to experience the stigma surrounding anxiety disorders with greater severity, often being less willing than adults to openly discuss panic attacks. Self-consciousness and the need for peer acceptance is usually stronger at this age, meaning that it may be harder for a teenager to open up about their struggles compared to an adult. Thus, it is crucial that mental health education is popularized and widely implemented into school curriculums so that adolescents may begin to recognize and accept necessary treatment.