What to know about pathological anxiety

What is pathological anxiety?

Pathological, or maladaptive anxiety, means that an individual experiences intense anxiety or anxiety in situations that usually would not cause anxiety. Essentially, it is extreme anxiety that extends beyond a typical emotional response.

While anxiety is a natural human response to certain social situations or unusual activities, maladaptive anxiety is not.

A doctor may diagnose pathological anxiety if an individual experiences the following symptoms:

• excessive worry
• avoidance behaviors
• physiological arousal, such as increased breathing rate or blood pressure
• hypervigilance, an elevated state of constantly assessing potential threats

However, it is important to emphasize that many individuals living with pathological anxiety may not meet the full disorder criteria for the condition.

Causes

Experts do not know what causes pathological anxiety precisely, although genetics and trauma may play a role.

Research indicates that developing anxiety disorders is approximately 30–50% heritable, meaning that family history can be a contributing cause in some cases.

Amygdala hijack may also contribute to pathological anxiety. The amygdala is the emotional hub of the human brain and plays a part in fear and the “fight or flight” response that helps people react quickly in response to danger.

In an amygdala hijack, a person cannot respond rationally to a threat as the amygdala overpowers the frontal lobes, creating an exaggerated stress response.

Research is also looking at gamma aminobutyric acid (GABA) receptors that help the chemical messenger GABA enter nerve cells. GABA reduces nerve impulses and plays a role in processing anxiety.

Symptoms

Individuals may experience anxiety differently and react in various ways to the same trigger or event.

Symptoms of general pathological anxiety can include:

• increased heart rate
• rapid breathing
• frightening thoughts
• continuously feeling surrounded by threats
• restlessness
• difficulty concentrating
• excessive worry
• sleeping problems
• avoidance behaviors

However, individuals need to understand that many people have difficulties with pathological anxiety without experiencing these symptoms.

Diagnosis

Because pathological anxiety can manifest in various ways and other factors, such as illness, can cause it, a doctor may use various assessments to help them diagnose the condition.

They may begin with a complete physical exam and thorough medical history to help rule out any other medical disorders that could cause the individual symptoms.

The doctor may then order laboratory tests such as:

• a complete blood cell count
• blood biochemistry profile
• thyroid function tests
• urinalysis
• urine drug screen

Depending on the results of these tests, a doctor may recommend further evaluations, including:

• electroencephalography
• a CT scan
• electrocardiography
• tests for infection
• arterial blood gas analysis
• chest radiography

The doctor may also use specialized mental health tests to help them diagnose the individual. These may include self-assessment questionnaires, interviews with therapists, and various clinical scales such as the Generalised Anxiety Disorder Assessment-7 and the Severity Measure for Panic Disorder.

Treatment and management

Doctors typically treat anxiety problems with medication, psychotherapy, or a combination of the two.

Medication

Doctors may recommend the following medications for pathological anxiety:

• Selective serotonin reuptake inhibitors (SSRIs): Include fluoxetine, sertraline, paroxetine, escitalopram, and citalopram. Doctors consider these as medications of choice for anxiety.
• Serotonin and norepinephrine reuptake inhibitors: Include venlafaxine and duloxetine. These options are as effective as SSRIs, and doctors also consider them as first-line treatments.
• Tricyclic antidepressants: Include amitriptyline, imipramine, and nortriptyline and are valuable in treating anxiety disorders but have significant side effects.
• Benzodiazepines: Including alprazolam, clonazepam, diazepam, and lorazepam and can help with short-term anxiety management as they are fast-acting. They promote relaxation and reduce muscular tension but can lead to problems with tolerance and dependence.
• Buspirone: This takes around 2 weeks to start working. It is a mild tranquilizer but has a less sedative effect than benzodiazepines. It also has less potential for dependents and has minimal withdrawal effects.
• Beta-blockers: Include propranolol and atenolol to control physical anxiety symptoms, including rapid heart rate, sweating, and dizziness.

Psychotherapy

Cognitive behavioral therapy is one of the most effective forms of psychotherapy. It is a talking therapy that helps people manage their anxiety issues by changing how they think and behave in response to triggers. It allows people to change disturbing or destructive thought patterns that influence their behavior.

Doctors may recommend exposure therapy to help people confront their fears instead of avoiding them. It aims to break the pattern of avoidance and fear and provide a safe environment to expose people to the objects, activities, or situations they fear and avoid. People then learn that their anxiety is a false alarm, and they do not need to fear the trigger. Instead, they can cope effectively.

Learn more about some types of therapy available.

Outlook

Anxiety disorders, such as pathological anxiety, have very high morbidity, meaning it causes other medical problems, including:

• substance misuse
• alcohol use disorder
• major depression
• increased risk of heart problems

In some people, anxiety harms their ability to form healthy social relationships and can affect their quality of life. In addition, experts have linked severe anxiety to increased rates of suicide.

However, anxiety disorders are highly treatable. Most people living with anxiety can reduce or eliminate their symptoms after several months of psychotherapy. In fact, many notice improvements after a few sessions.

Pathological anxiety vs. anxiety

Anxiety is an expected part of life, and most people experience its symptoms at some point. Typical feelings of anxiety help an individual to identify and respond to danger. However, if these feelings become disproportionate to the situation, doctors may consider this pathological anxiety.

Anxiety and pathological anxiety may present with the same symptoms. However, the two differ because pathological anxiety is more intense, lasts longer, or occurs more frequently. It can also interfere with a person’s general functioning if it becomes chronic.

So, while anxiety as an emotion can be useful and generally does not affect a person’s day-to-day lifestyle, pathological anxiety prevents people from functioning typically and negatively affects their well-being to a far greater degree.

Summary

Pathological anxiety is an overestimation of a perceived threat or danger, leading to excessive and inappropriate responses. It is extreme anxiety above and beyond the typical emotional response that negatively affects an individual’s everyday functioning.

Doctors may use a range of tests to diagnose pathological anxiety and rule out any potential causes. Once they have excluded underlying medical problems, they may recommend treating the anxiety with a combination of medications and psychotherapy.

Anxiety disorders are highly treatable, and individuals should seek help if they are experiencing any symptoms of anxiety that are affecting their quality of life.