Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What is anxiety?

Anxiety can be a normal "alarm system" alerting you to danger. Imagine coming home and finding a burglar in your home. Your heart beats faster. Your palms get sweaty. Your mind races. In a situation such as this, anxiety can be helpful. It can add an extra spark to help you get out of danger. Under more normal but busy times, it can give you energy to help you get things done.

But sometimes anxiety may go out of control, giving you an overwhelming sense of dread and fear for no apparent reason. This kind of anxiety can disrupt your life.

Are there different types of anxiety?

Yes. Anxiety can be a general feeling of worry, an attack of feeling panicky, a fear of a certain situation or a response to a traumatic experience.

What is generalized anxiety?

Generalized anxiety disorder is ongoing worry or fear that isn’t related to a particular event or situation, or is way out of proportion to what you would expect - for instance, constantly worrying about the health of a child who is perfectly healthy.

Symptoms of generalized anxiety disorder include muscle tension, trembling, shortness of breath, fast heartbeat, dry mouth, dizziness, nausea, irritability, loss of sleep and not being able to concentrate.

What is panic disorder?

Panic disorder is another type of anxiety. It occurs when you have repeated periods of extreme panic, called panic attacks.

Suppose one day you’re getting out of your car and about to go to work. Suddenly your chest feels tight. Your heart races. You begin to feel dizzy and think you might faint. You start to choke. You feel as if the end is near. Was it all in your head? No. most likely, you had a panic attack.

Panic attacks last about five to 30 minutes and may include all or any of the symptoms listed. Panic attacks have often been confused with heart attacks, brain tumors or other disorders. They can lead to phobias if they aren’t treated.

Panic attack symptoms

	Feeling like you’re going to choke
	Chest pressure or chest pain
	Pounding heart
	Racing pulse
	Dizziness or lightheadedness
	Shortness of breath
	Sweating
	Trembling or shaking
	Nausea
	Tingling or numbness in the hands or feet
	Hot flashes or chills
	Sense of unreality or dreamlike sensations
	Fear of losing control, doing something embarrassing, going "crazy" or dying

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder is the type of anxiety in which you have certain thoughts or ideas over and over, or do certain things over and over (rituals).

The thoughts may be unrelated to what you’re doing. They may be violent, or somehow distasteful or frightening to you. The rituals may include washing your hands because of a fear of getting an infection, constantly checking windows or doors because of a fear they may not be locked, or straightening objects because of a fear something bad might happen if they aren’t in just the right place.

Most people with obsessive-compulsive disorder know the rituals aren’t normal, but they can’t seem to stop themselves.

What is a phobia?

Phobias are when you have a lot of fear and anxiety in response to something specific. Examples include fear of crowds, bridges, snakes, spiders, heights, open places or social embarrassment.

A phobia is only considered a disorder when it keeps you from living a normal life. An example is being so afraid of open places that you can’t leave home. This is called agoraphobia.

What is post-traumatic stress?

Post-traumatic stress disorder is the type of anxiety that can happen if you’ve had a physically or emotionally traumatic experience, such as serving in a war, suffering a violent crime such as assault or rape, or surviving an airplane crash, car wreck, flood, tornado or torture.

People with post-traumatic stress disorder re-live the traumatic event through flashbacks, dreams or memories. If they don’t get help, they may become withdrawn or emotionally numb, and avoid any event that reminds them of the trauma.

What causes anxiety disorders?

Suppose the fire alarm goes off in your home. You race around frantically to find the fire. Instead, you find that the alarm isn’t working properly. You take it in to be repaired.

It’s the same with anxiety disorders. Your body mistakenly triggers your alarm system when there is no danger. This may be due to a chemical imbalance in your body. It may also be related to an unconscious memory, to a side effect of a medicine, or to an illness.

Can anxiety be treated?

Yes. Talk to your family doctor if you think you have an anxiety disorder. He or she can help you form a plan to develop skills to cope with your anxiety. Your doctor can also prescribe medicine if it’s needed. Here are some tips on forming a plan.

Control your worry. Pick a place and time to do your worrying. Make it the same time in the same place every day. Spend 30 minutes thinking about your concerns and what you can do about them. Try not to dwell on what "might" happen. Focus more on what’s really happening, instead of what might happen.

Relax. You may learn techniques to help you relax. These may include muscle relaxation, yoga, biofeedback and deep breathing. Muscle relaxation is simple. Start by choosing a muscle and holding tight for a few seconds. Relax the muscle after a few seconds. Do this with all of your muscles. Try starting with your feet and working up your body.

Steps to deep breathing

1. Lie down on a flat surface.
2. Place one hand on your stomach, just above your navel. Place the other hand on your chest.
3. Breathe in slowly and try to make your stomach rise a little.
4. Hold your breath for a second.
5. Breathe out slowly and let your stomach go back down.

Confront the things that have made you anxious in the past. Begin by just picturing yourself confronting these things. By doing this, you can begin to get used to the idea of confronting the things that make you anxious before you actually do it. After you begin to feel more comfortable picturing yourself confronting these things, you can begin to actually face them.

You might find it helpful to make a list of things that cause you to feel anxious. Begin by confronting the thing that causes you the least anxiety and work your way up the list.

If you feel yourself getting anxious, practice one of your relaxation techniques or focus on a simple task, such as counting backward.

Although the feelings of anxiety are scary, they won’t hurt you. Label the level of your fear from zero to 10 and watch it go up and down. Notice that it doesn’t stay at a very high level for more that a few seconds. When the fear comes, accept it. Wait and give it time to pass without running away from it.

Don’t be surprised if you have bouts of anxiety even after it begins to go away. This is normal.

	Exercise regularly. People who have anxiety often quit exercising. But exercise can give you a sense of well-being and help decrease feelings of anxiety.
	Get plenty of sleep.
	Avoid alcohol or substance abuse. It may seem that alcohol or drugs relax you. But in the long run, they worsen anxiety and depression.
	Avoid caffeine. It’s found in coffee, tea, soft drinks and chocolate. Caffeine may increase your sense of anxiety. Also avoid over-the-counter diet pills, and cough or cold medicines.
	Use medicine if it helps. Your doctor may give you medicine to help reduce anxiety while you learn new ways to respond to the things that stimulate your anxiety. Many types of medicine are available. The type that’s right for you will depend on your needs and your doctor’s suggestions.
	Talk about your anxiety with your doctor. This is important so your doctor can make sure your plan is working the way it should be. You may also need to get some counselling with your doctor or with a counselor. Counselling can help you learn to express your needs and wants so you can feel more in control and have less suppressed anger and anxiety. Support groups can also be helpful.

The most important thing is to take action. Any action you take will be helpful because it will help you gain a sense of control over your anxiety.

PDF Version

Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.