- Thoughts: worries about bad or unwanted things that could happen, difficulty concentrating or making decisions. People who are anxious often have difficulty controlling their worries.
- Behaviors: avoiding things we’re afraid of: places, situations, objects, people, or behaviors that we think will result in negative or threatening experiences. People who are anxious often avoid things they would otherwise want to approach/do.
- Emotional feelings: fear, dread, distress, regret, guilt, or irritability.
- Physical feelings: muscle tension, racing heart, light-headedness, dry mouth, hot or cold, chest or abdominal pain, pit in the stomach, or shortness of breath.
Anxiety is common
~42% of people will have an anxiety disorder at some point in their lives (Kessler, et al., 2012). ~60-80% of people with an anxiety disorder also have a depressive disorder (or vice versa) (Lamers, et al., 2011).
Anxiety and safety are things that we learn
We are not born in this world naturally fearing anything. We learn to have anxiety towards certain things, which also means we can learn the opposite: that some things are safe. Part of therapy is to learn which things to be anxious about and which things are safe.
Anxiety can vary from topic to topic
Some people have general anxiety; other people are only anxious about specific things. The process is the same across most/all topics. Anxiety makes us worry that something bad will happen. Below are various anxiety disorders and what topics they make us afraid of.
Anxiety is very treatable!
The gold standard treatment for anxiety is cognitive-behavioral therapy; the “behavioral” part of that is exposure therapy. I provide both!
Social Anxiety Disorder
~13% of people will have social anxiety disorder at some point in their lives (Kessler, et al., 2012).
Some examples of social anxiety disorder include fear, anxiety, or worries about:
What other people think of you (e.g., that people will dislike you, criticize you, or reject you).
Public speaking, initiating conversations, meeting new people, performing in front of people, or many other social situations.
Making requests of others or declining requests others make of you.
Being "awkward" or experiencing "awkwardness" in social interactions (e.g., "awkward" silences).
Social anxiety disorder also includes avoidance of certain social situations; or, if you’re already in a social situation, engaging in specific behaviors to avoid social rejection (e.g., spending most of your time with known, trusted, comfortable people to reduce anxiety or avoid potential rejection).
Social anxiety can really reduce our quality of life because so many enriching experiences in life are social. But if we’re too anxious to have the social life we want, that can be really limiting.
Generalized Anxiety Disorder
- ~9% of people will have generalized anxiety disorder at some point in their lives (Kessler, et al., 2012).
- Generalized anxiety disorder involves anxiety, worry, or avoidance regarding a variety of topics. These topics can be anything but might include finances, work, school, health, relationships, personal aspirations, hobbies, and spirituality.
- Generalized anxiety disorder can include recurring worry about various topics, difficulty concentrating or making decisions, difficulty with uncertainty, muscle tension, difficulty sleeping, and irritability (see my publication on generalized anxiety disorder and depression here).
Specific Phobia
- ~18% of people will have specific phobia at some point in their lives (Kessler, et al., 2012).
Specific phobia involves elevated fear or anxiety of situations/members of one of five categories: - Animals or insects (e.g., dogs, spiders)
- Natural environment (e.g., heights, storms, water)
- Blood-injection-injury (e.g., needles, invasive medical procedures)
- Situational (e.g., airplanes, elevators, enclosed spaces)
- Others (e.g., choking, vomiting, clowns or costumed characters)
Specific phobia involves fear or anxiety when encountering the feared organism, object, or situation or efforts to avoid them (e.g., for dog phobia, not going to a friend’s home if they have a dog; not going in elevators if afraid of enclosed spaces).
I am the Text Editor for Specific Phobia in the official diagnostic manual used in psychology (see page Roman numeral “x”).
Panic Disorder
- ~7% of people will have panic disorder at some point in their lives (Kessler, et al., 2012).
- Panic disorder involves feeling intense anxiety or fear that usually ramps up and peaks within around 10 minutes (i.e., a panic attack). These feelings are usually physical – like a racing heart, light-headedness, dizziness, trembling, sweating, tingling – or can also be cognitive, like feeling unreal or outside of one’s body. The aftermath of a panic attack can result in continued anxiety for minutes or hours. Panic attacks are sometimes predictable or other times out-of-the-blue.
- Panic disorder involves worry/anxiety about having another panic attack or avoidance of specific places, behaviors, or feelings in an effort to prevent panic attacks.
Agoraphobia
- ~4% of people will have agoraphobia at some point in their lives (Kessler, et al., 2012).
Agoraphobia involves fear, anxiety, or avoidance of situations that are difficult to escape or help might not be available in the event of a panic attack, incapacitation (e.g., seriously injuring oneself), or embarrassment (e.g., incontinence). Situations include: - Using public transportation (e.g., automobiles, trains, airplanes, boats/ships, buses).
- Being in open spaces (e.g., parking lots, markets)
- Being in enclosed spaces (stores, restaurants, movie theaters).
- Standing in line or being in a crowd.
- Being outside the home alone.
Agoraphobia often occurs with panic disorder but not always. It can be a stand-alone diagnosis and centers on fear/avoidance of difficult-to-escape situations in the event a personally limiting event occurs (e.g., panic, incapacitation, embarrassing symptoms).
Health Anxiety (Illness Anxiety Disorder)
- 1–13% of people experience health anxiety at some point in their lives (Kikas, et al., 2024)
- Health anxiety involves excessive fear or worry about having or developing a serious medical condition, despite little or no medical evidence. The distress is real and can significantly interfere with daily life.
- Some examples of health anxiety include fear, anxiety, or worries about:
- Normal bodily sensations being signs of serious illness.
- Minor or common symptoms being interpreted as dangerous.
- Missing a diagnosis or not catching an illness early.
- Medical uncertainty or test results.
- Health anxiety often includes reassurance-seeking behaviors, such as symptom checking, online research, frequent medical visits, or asking others for reassurance. These behaviors may provide short-term relief but tend to worsen anxiety over time.
- Health anxiety also commonly involves avoidance, such as avoiding medical settings, health-related information, physical activity, or situations that might trigger symptoms or fear.
- Common Forms of Health Anxiety
- Somatic-focused: excessive attention to bodily sensations.
Reassurance-seeking: repeated checking, testing, or reassurance.
Avoidant: avoidance of doctors, tests, or health information.
Disease-focused: fixation on a specific illness (e.g., cancer, heart disease)
Obsessive-Compulsive Disorder (OCD)
~2–3% of people will experience obsessive-compulsive disorder (OCD) at some point in their lives (Kessler, et al., 2005)
- Obsessive-compulsive disorder involves obsessions, compulsions, and often avoidance, which can significantly interfere with daily life, relationships, and overall well-being.
- Obsessions are unwanted, intrusive thoughts, images, or urges that cause significant distress, anxiety, or discomfort. These thoughts are typically inconsistent with a person’s values and feel difficult to control.
- Compulsions are behaviors or mental acts that a person feels driven to perform in response to obsessions, usually to reduce anxiety or prevent something bad from happening. Although compulsions may bring temporary relief, they tend to reinforce OCD over time.
- Some examples of OCD-related fears, worries, or urges include:
- Intrusive thoughts or images that feel disturbing, immoral, unsafe, or unacceptable.
- Excessive doubts or uncertainty (e.g., “What if I made a mistake?” or “What if something bad happens?”).
- A strong need for things to feel “just right,” complete, or symmetrical.
- Fears about contamination, illness, harm, or responsibility for causing harm to oneself or others.
- OCD also commonly includes avoidance, such as avoiding people, places, objects, or situations that might trigger obsessions (e.g., avoiding public restrooms, knives, driving, or certain conversations). People with OCD may also engage in subtle avoidance or safety behaviors within situations to reduce distress (e.g., reassurance-seeking, mentally reviewing events, or distracting themselves from intrusive thoughts).
Common OCD Subtypes
Although OCD can take many forms, some commonly recognized subtypes include:
Contamination OCD
Involves fears about germs, illness, dirt, bodily fluids, or environmental contaminants. Compulsions often include excessive handwashing, cleaning, sanitizing, or avoiding perceived sources of contamination.
Checking OCD
Involves fears about safety or responsibility for harm (e.g., fires, accidents, break-ins). Compulsions may include repeatedly checking locks, appliances, doors, or seeking reassurance from others.
Symmetry and “Just Right” OCD
Involves a strong need for symmetry, order, balance, or things feeling “just right.” Compulsions may include arranging, counting, touching, or repeating actions until they feel correct.
Harm OCD
Involves intrusive thoughts or images about harming oneself or others, despite having no desire or intention to do so. Compulsions often include mental checking, reassurance-seeking, or avoiding situations where harm feels possible.
Sexual or Religious (Scrupulosity) OCD
Involves intrusive thoughts, images, or doubts related to sexual content or religious/moral beliefs. Compulsions may include mental reviewing, confessing, praying excessively, or seeking reassurance.
Relationship OCD (ROCD)
Involves persistent doubts about one’s relationship or feelings toward a partner (e.g., “Do I really love them?”). Compulsions may include reassurance-seeking, comparing relationships, or repeatedly analyzing feelings.
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