We all experience mild forms of anxiety, phobia and obsessions, but it's when they become extreme that mental health is threatened. ivillage has linked with the mental health charity SANE to bring you the facts

Everyone knows the feeling of anxiety - the fear that some significant event in the future may go wrong. It is probably part of our biological inheritance, a way of preparing for a stressful situation. People become anxious when they face upsetting things like illness, unemployment, surgery or divorce. This is all completely normal but, for some people in certain circumstances, anxiety can become so extreme it is disabling.

Anxiety disorders are mental illnesses in which severe and recurrent anxiety is a main feature: it can be so serious that you find anxiety and fear take over your life.

Anxiety disorders are different from psychotic disorders such as schizophrenia and bipolar depression because, however severe the symptoms may be, you rarely lose touch with reality. These disorders also have a self-perpetuating quality because the physical symptoms of anxiety (such as dizziness or palpitations) can themselves be so alarming that they make you even more anxious.

Generalised anxiety disorder
GAD is similar to the normal anxiety we all suffer but much more intense, long lasting and without an obvious cause. Signs of an anxiety disorder include: strained face and furrowed brows, tense posture, restlessness, pale skin and sweaty hands and feet.

Some people suffer a whole range of physical symptoms simply because their fear causes them to take rapid, shallow breaths, called over-breathing, which results in dizziness, noises in the ears, headache, faintness, numbness and tingling in the hands and face. Over-breathing can set off panic attacks. Some people seem to be of a more anxious disposition than others. They are more nervous about new situations, more concerned about travelling, new jobs, children, more apprehensive about illness. Anxiety seems to be built into their personality. These people are certainly not ill, but there is some evidence that they are more likely to develop GAD.

By contrast, a disastrous event such as a serious car or aircraft accident, a fire, shipwreck, rape or war can trigger a severe, long-lasting anxiety known as post-traumatic stress disorder. Its cause is extremely clear, although its start is often delayed for some considerable time after the incident. The symptoms are those of a serious GAD and include reliving the event.

How is GAD treated?
Many cases of GAD are not very severe and supportive treatment with discussion and explanations from the doctor are all that is required. Relaxation treatment, including yoga exercises, can also help. Cognitive behaviour therapy in combination with relaxation is also an effective way of managing anxiety. Drugs can also be used to bring symptoms under control quickly when the anxiety is serious and other methods do not work.

Panic disorder
Panic attacks are episodes of severe and sudden anxiety with physical symptoms that reinforce the attack. When panic attacks are severe and frequent (four or more in four weeks) they constitute panic disorder. One to two people in 100 aged 18-65 suffer from panic disorder at some time in their lives. It is about twice as common in women as in men. Panic attacks of lesser severity are about five times as common.

What causes panic disorder
There are three main theories on the cause of panic disorder: a chemical abnormality in the brain, over-breathing and a form of psychological 'feedback'.

The psychological feedback or cognitive theory is based on the observation that people who have panic disorder are often more concerned about health than others. This causes them to be over-concerned about the physical symptoms of their anxiety.

How is panic disorder treated?
Treatment is usually by drugs or cognitive behaviour therapy. Anxiolytic drugs are less effective in treating panic disorder than in GAD. Cognitive behaviour therapy tries to show sufferers that the symptoms that alarm them so much are easily explained.

Phobias
A phobia is an anxiety disorder in which you feel intense fear of a particular object or situation, but know all the time that there is no real danger. The fear occurs whenever the object appears or the situation arises, but at other times there are no symptoms. When you are overcome by the phobia, the psychological and physical symptoms may be so severe that you become afraid of your own fear of the anxiety.

Simple phobias are those which are confined to a single class of object or situation and don't give much trouble between attacks. Most simple phobias are concerned with illness, injury and animals. Such phobias are common and probably normal in children but usually fade by early adolescence. Adult phobias usually date from early childhood and continue for many years, but a smaller number start in adult life after a very stressful experience. These phobias are more likely to respond to treatment than the long-standing variety developed in childhood. Two or three people in 100 suffer from simple phobias, roughly twice as many women as men.

Agoraphobia
Some phobias are of a more complex kind with a more generalised pattern of fear, often with other associated problems. People with agoraphobia become anxious if they have to enter public places like shops, streets or public transport unaccompanied. The symptoms are much like those of GAD but there may also be spontaneous panic attacks, depression, depersonalisation and claustrophobia. Unlike simple phobias, the situations that provoke anxiety and avoidance may gradually extend until the sufferer is more or less imprisoned in his or her own home.

Behaviour therapy, in which sufferers are exposed to the situations that bring on their phobia, combined with anxiety management, can be effective in softening the fear. In these cases, drugs are seen as a secondary treatment.

Social phobia
A person who becomes inappropriately anxious when required to appear at some social function may be suffering from social phobia. The phobia occurs if the person has to speak in public or do anything which makes them think that they will be observed or criticised.

Obsessive compulsive disorder (OCD)
Obsessions are recurrent thoughts that are distressing and disturbing and intrude forcibly against conscious resistance. The person experiencing them usually realises that they are irrational, but finds that fighting them only increases the anxiety.

What causes OCD?
We all have mild obsessions. You may feel a need to check that you have locked the front door, posted an important letter properly or feel you need to count a certain number of times before a particular event. The difference between this normal behaviour and that of someone with OCD is one of degree: the intensity and distress of the intrusive thoughts, the difficulty of stopping them, the frequency with which they occur, the duration of the symptoms, and how they effect the functioning of the individual.

How is OCD treated?
OCD affects two or three people in 100 at some time in their life. It is more or less equally shared between men and women. Two thirds of cases improve or are cured within a year. Those that have not cleared up during this time may continue for many years, but with lengthy remissions. The disorder may go into remission, almost irrespective of treatment. Behavioural treatment can substantially improve compulsive rituals but are not so effective in controlling obsessional ruminations.

Self-help in anxiety disorders

It is important to realise that all therapies take some time to work and require patience and persistence.

Accept that anxiety, phobias, panic attacks or obsessions are not signs that you are going mad or losing control.

Enlist the support of a spouse or relative in therapy and try to discuss your fears in a constructive way.

Relatives can help by showing you that they understand the fears and obsessions, no matter how bizarre or unreasonable they may appear. Talking to a professional may be positive in this regard.

For more information about anxiety, phobias and obsession visit
www.sane.org.uk

For further help contact
SANELINE