Anxiety-Related Disorders

Core Concepts

The common architecture: fear, anxiety, and avoidance

Fear is the response to an immediate threat; anxiety is anticipation of a future threat. Both are normal. In anxiety disorders they become excessive, persistent, and impairing, and the person's life reorganizes around avoidance — steering clear of the situations, places, or thoughts that trigger the feeling. Avoidance works in the short term (it brings relief) but maintains the disorder in the long term (the person never learns that the feared situation is manageable). This cycle — trigger → fear → avoidance → relief → stronger fear — is the engine behind every disorder in this topic.

Panic attacks and panic disorder

A panic attack is an abrupt surge of intense fear or discomfort that peaks within minutes, with physical symptoms such as palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and feelings of unreality, plus cognitive symptoms such as fear of dying or losing control. Panic disorder is recurrent unexpected panic attacks plus persistent worry about additional attacks (or their consequences) plus significant behavioral change, such as avoiding exercise or certain places for fear of triggering an attack.

The nursing safety point cannot be overstated: panic symptoms overlap with cardiac, respiratory, and endocrine emergencies. The nurse ensures that a medical evaluation happens first, per facility protocol, and supports the person through the episode with a calm presence, short simple sentences, and staying nearby — not by dismissing the symptoms or by mirroring the panic.

Generalized anxiety disorder (GAD)

GAD is excessive worry about a wide range of everyday matters (health, finances, family, work) that occurs more days than not for at least six months, is hard to control, and is out of proportion to the actual risk. It travels with physical symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. Unlike panic disorder's discrete attacks, GAD's worry is chronic and diffuse — a background hum rather than a siren.

The phobias: specific, social, and agoraphobia

• Specific phobia — intense, out-of-proportion fear of a specific object or situation (flying, needles, animals, heights, blood), leading to avoidance or endurance with extreme distress. The person usually knows the fear is excessive.
• Social anxiety disorder — marked fear of social or performance situations where the person may be negatively evaluated (speaking, eating in public, meeting new people); fear of showing anxiety symptoms and being humiliated drives avoidance.
• Agoraphobia — fear and avoidance of situations where escape might be difficult or help might not be available: crowds, public transport, open or enclosed spaces, being outside the home alone. It often — but not always — develops after panic attacks, when the person begins avoiding places where an attack might occur.

Separation anxiety disorder

Separation anxiety disorder is developmentally inappropriate, intense fear or anxiety about separation from attachment figures — worry about harm befalling the attachment figure, reluctance to leave home, nightmares about separation, and physical symptoms at the time of separation. It is most visible in children (classically as school refusal) but can persist into adolescence and adulthood.

Nursing care: recognition, support, escalation

• Assess the pattern: what triggers the anxiety, what the person avoids, physical signs, and impact on daily life.
• Communicate calmly: acknowledge the feeling, use simple concrete language — especially during panic — and never argue with or minimize the person's experience.
• Support, don't perform therapy: exposure-based treatments (a core part of cognitive-behavioral therapy) are delivered by qualified therapists; the nurse supports and reinforces the treatment plan, encourages follow-up, and teaches that avoidance maintains anxiety — educational, not prescriptive.
• Safety and escalation: chest pain or breathlessness triggers a medical evaluation, not a label; any expression of hopelessness or suicidal thoughts is reported immediately to the provider and the team, per facility policy. Nurses never step in as sole interveners in a crisis.
• Scope note: diagnosis and treatment planning are provider and advanced-practice roles; institutional protocols vary, and the nurse documents observations and reports rather than deciding whether someone "has" a disorder.

Common Confusions