“I can’t stop feeling on edge and I can’t sleep.” “There are places and situations I’m too scared to face, so I avoid them.” “I’m afraid to be around other people.” — If intense anxiety or fear like this has been continuing for a long time, it may be a sign of an anxiety disorder.
Anxiety disorder is an umbrella term for several conditions, including panic disorder, social anxiety disorder, and generalized anxiety disorder. While the symptoms and the shape of distress differ depending on the type, all of them can be expected to improve with appropriate treatment. In this article, we provide an overview of the main types, symptoms, and treatment approaches for anxiety disorders.
Keldsen Family Clinic is a family-oriented clinic offering both Psychosomatic Medicine and Internal Medicine, a 1-minute walk from ‘Oizumi Yubinkyoku’ bus stop, accessible by Seibu Bus from Oizumi-Gakuen Station. We are open on weekends and holidays and also offer telemedicine. “I just want someone to listen first” — please feel free to reach out with that thought in mind.
About Anxiety Disorders as a Group
In the DSM-5, one of the major diagnostic classification systems in psychiatry, anxiety disorder falls under the category known as “Anxiety Disorders.” The terms “anxiety disorder” and “anxiety disorders” both refer to the same group of conditions, and both are used in clinical and everyday contexts.
Feeling anxiety or fear is a natural response that helps protect us from danger. In anxiety disorders, however, the intensity of anxiety or fear is disproportionate to the actual threat, persists over a long period, and significantly interferes with daily life. This is not simply being “a worrier” or “overthinking things” — it is believed to reflect a state in which the brain’s anxiety-processing system has become hypersensitive.
Anxiety disorders are among the most common groups of mental health conditions in many countries, including Japan. Research both in Japan and internationally has reported that a meaningful proportion of people experience some type of anxiety disorder during their lifetime — these conditions are far from rare.
It is also well known that anxiety disorders frequently co-occur with depression. When anxiety persists over time, it can lead to a loss of energy and a gradual decline in mood. Seeking help while the issue is “just anxiety” — before it progresses further — can shorten the path to recovery.
What Is an Anxiety Disorder?
An anxiety disorder is an umbrella term (category name) for a group of mental health conditions in which excessive anxiety, fear, and tension persist over a long period and interfere with daily life.
Feeling nervous or worried is something everyone experiences from time to time. Being tense before an exam or an important presentation is perfectly natural — in fact, that tension can sometimes help sharpen your focus. In anxiety disorders, however, the anxiety and fear are fundamentally different from everyday nervousness in the following ways:
- Excessive intensity: Anxiety or fear arises that is far stronger than the situation warrants
- Persistence: The anxiety lingers long after the event has passed, continuing for weeks or months
- Uncontrollable: Even when you tell yourself to “stop worrying,” you cannot turn it off
- Impact on daily life: Work, school, going out, and relationships are all affected
The different types of anxiety disorders are classified according to what triggers the intense anxiety or fear. For example, panic disorder centers on “sudden attacks and the dread of them recurring,” social anxiety disorder is triggered by “situations where one is exposed to the scrutiny of others,” and generalized anxiety disorder is characterized by “a vague, persistent worry about all aspects of daily life.” Even within the same category of anxiety disorders, the shape of distress can vary greatly from person to person.
Another hallmark of anxiety disorders is that they often manifest as physical symptoms. Palpitations, shortness of breath, dizziness, stomach discomfort, headaches — it is not uncommon for someone to visit an internist with these complaints, only to have tests come back normal, and then later be diagnosed with an anxiety disorder by a psychosomatic medicine specialist.
Because physical symptoms often appear first, Keldsen Family Clinic is equipped to provide both Internal Medicine and Psychosomatic Medicine care under one roof. If you have been told “there’s nothing wrong on the tests” but still don’t feel well, please don’t hesitate to reach out.
Types of Anxiety Disorders and Their Features
There are several types of anxiety disorders, each with different symptoms and triggers. Below are the most common types.
Generalized Anxiety Disorder (GAD)
Excessive, hard-to-control worry about a wide range of everyday matters — work, family, health, finances — persists for six months or more. The hallmark is a feeling of “always being anxious about something” or “not being able to get the worry out of my head,” with the anxiety continuing even without a specific trigger. The focus of worry often shifts from one subject to the next — many people describe it as “even when one worry is resolved, another one takes its place.” Muscle tension, fatigue, and insomnia are common accompanying symptoms. What distinguishes GAD from panic disorder or social anxiety disorder is that the anxiety is not focused on a single object or situation.
Panic Disorder
Panic disorder involves recurrent, unexpected episodes of intense anxiety (panic attacks). During an attack, symptoms such as palpitations, shortness of breath, dizziness, and an overwhelming fear of “I might be dying” surge suddenly, but typically subside within 10 to 20 minutes. Severe fatigue and a sense of physical depletion may linger afterward. Even after the attack passes, many people develop anticipatory anxiety — the persistent fear that “it might happen again” — which can interfere with daily activities. Agoraphobia may also develop, in which the person begins avoiding places or situations (such as trains, buses, or crowded spaces) where escape might feel difficult.
Social Anxiety Disorder
Social anxiety disorder involves intense anxiety and fear in situations where one is exposed to the scrutiny of others — presentations, dining with others, phone calls, meeting new people. The fear of “being embarrassed” or “being criticized” can lead to avoidance of those situations. Specific worries such as “What if I can’t speak properly in front of people?” or “What if my hands shake while eating and everyone notices?” build up over time, causing the person to skip work meetings or social gatherings, gradually narrowing the scope of their life. When the impact goes beyond ordinary shyness and begins to interfere with work, school, or daily activities, it is a sign to consider seeking professional help.
Specific Phobia
Specific phobia involves disproportionately intense fear of a particular object (heights, animals, insects, blood, injections, enclosed spaces, etc.) or situation (flying, elevators, etc.), along with strong avoidance behavior. The person often recognizes that the fear is excessive, yet the avoidance becomes so thorough that daily life is increasingly restricted. For example, someone with a fear of heights may have to turn down invitations to visit high-rise buildings, or someone with claustrophobia may always choose a taxi over the train — small restrictions that gradually narrow one’s range of activity.
Separation Anxiety Disorder
Separation anxiety disorder involves intense anxiety and fear about being separated from an attachment figure (a caregiver, family member, or partner). Although it has traditionally been associated with children, it also occurs in adults. In adults, it may manifest as an inability to stop contacting a partner during a business trip out of fear that “something terrible has happened,” or being unable to focus on anything until a family member returns home. If you find yourself unable to be alone or constantly worrying that something has happened to a loved one, consider consulting a specialist.
Some people experience more than one type of anxiety disorder at the same time. Even if you are unsure which type applies to you, the most important step is to talk to a doctor about your symptoms and the difficulties you are facing.
For more detailed information on specific types, please see our dedicated pages: Generalized Anxiety Disorder / Panic Disorder
Treatment and Strategies for Anxiety Disorders
Treatment for anxiety disorders typically involves a combination of medication, psychosocial support, environmental adjustments, and self-care. The best approach depends on the type and severity of symptoms, but research consistently shows that starting treatment early can help prevent the condition from becoming chronic. Rather than trying to cope alone, the first step is to consult a specialist.
1. Medication
In the pharmacological treatment of anxiety disorders, SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are often used as first-line options and are recommended by clinical guidelines both in Japan and internationally. Although they are widely known as antidepressants, they can also be effective for anxiety symptoms. Because it generally takes two to four weeks for these medications to reach their full effect, it is important to continue taking them without rushing.
When severe anxiety or insomnia persists, benzodiazepine-class anti-anxiety medications or sleep aids may be used on a short-term, supplementary basis. However, due to the potential for dependence, long-term continuous use is generally avoided, and these medications should be taken under a doctor’s supervision. Stopping medication on your own can lead to a relapse of symptoms, so any adjustments should always be discussed with your doctor.
2. Psychosocial Support
- Cognitive Behavioral Therapy (CBT): A method for identifying and reshaping thought patterns and behavioral habits that fuel anxiety. It is one of the most well-supported psychological treatments for anxiety disorders. Exposure therapy — gradually becoming accustomed to feared situations — is an approach that falls within the CBT framework.
- Supportive psychotherapy: A process of talking with a doctor to organize your thoughts and circumstances and regain a sense of security.
- Relaxation techniques: Methods such as breathing exercises and progressive muscle relaxation that help release physical tension.
At Keldsen Family Clinic, we take the time to listen carefully during consultations and, when appropriate, outline a plan that may include psychological approaches.
3. Adjustments at School or Work
- Speak to a supervisor or teacher early if certain tasks or classes trigger strong anxiety
- Identify a rest area or a place you can step away to in advance
- Share your situation with a trusted supervisor, colleague, or teacher
- If symptoms are severe, consider options such as a leave of absence or a change in duties as needed
A medical certificate can be an important document for explaining your situation to a workplace or school. Talk to your doctor about whether one may be helpful.
4. Support at Home
- Rather than dismissing the person’s anxiety as “overthinking” or “exaggerating,” start by accepting what they are feeling
- Instead of criticizing avoidance behavior, help create an environment where small steps forward are possible
- Make time for activities together, such as a walk or light exercise
- Family members should also have someone they can talk to about their own feelings
Anxiety disorders are conditions in which the person is often already thinking, “I want to get better, too.” The warm support of family and loved ones can make a real difference in recovery.
5. Self-Care in Daily Life
- Sleep: Go to bed and wake up at the same time each day; avoid screens and caffeine before bed
- Exercise: Light aerobic activities such as walking or yoga have been reported to help ease anxiety
- Diet: Maintain regular meals and limit caffeine and alcohol intake
- Breathing exercises: Even simply exhaling slowly and deeply can help regulate the autonomic nervous system
- Anxiety journal: Writing down the circumstances and content of your anxiety can be a helpful reference during appointments
Anxiety is not something to be eliminated entirely — it is something to learn to live with. Take things at your own pace, one step at a time.
Anxiety disorders are conditions from which recovery can be expected with appropriate treatment and support. There is no need to wonder whether your concerns are “serious enough” to seek help. At Keldsen Family Clinic, we provide individualized care from both a Psychosomatic Medicine and Internal Medicine perspective. We are a 1-minute walk from ‘Oizumi Yubinkyoku’ bus stop, accessible by Seibu Bus from Oizumi-Gakuen Station, open on weekends and holidays, and also offer telemedicine. Please feel free to reach out.