Anxiety disorders


Fear of flying, panic in an elevator, arachnophobia - fears are widespread among the population. If such anxiety is pathologically increased and interferes with everyday life, experts speak of an anxiety disorder. However, it can usually be cured well with therapy.

Overview: What is an anxiety disorder?

In principle, fears are necessary for survival. Without them, we would drown in a raging river, fall from a high tree or blindly trust every villain. For some people, however, these sensible emotions go beyond normal levels. Their fear exceeds the objective danger posed by a situation. Those affected are often no longer able to control their feelings in this situation. Experts then speak of an anxiety disorder.

How does an anxiety disorder manifest itself?

Affected people often avoid situations that (could) cause them anxiety. Some people become increasingly socially isolated. Sufferers are often more likely to talk to others about somatic complaints such as sleep disorders or pain associated with anxiety than about the trigger for the anxiety. These accompanying physical symptoms can in turn trigger fears of a threatening illness, such as a heart attack.

Frequency and causes of an anxiety disorder

Anxiety disorders are a particularly common mental illness. Around 15 to 20 percent of all Swiss people are affected by this in the course of their lives. Experts assume that at least one in ten Swiss people have already experienced a panic attack. The risk of developing an anxiety disorder is twice as high for women as for men.

There are many causes of anxiety disorders. People with difficult childhood experiences and multiple life stresses are more at risk. Genetic factors can also play a role. People with few social relationships are more frequently affected. Animal phobias, fear of heights and claustrophobia (fear of confined spaces) are particularly common. In some cases, those affected develop strategies to deal with the anxiety adequately and do not need professional treatment. However, if anxiety leads to more severe impairment of life, it usually needs to be treated.

People can develop fear of a wide variety of situations, things or animals. In the case of an anxiety disorder, the fears go beyond feeling uncomfortable in a situation and are often associated with physical reactions. Experts distinguish between the following forms of anxiety disorders:

  • Panic disorder: Do you suddenly feel anxious? Do symptoms such as a racing heart, sweating, trembling, shortness of breath or even fear of death occur?
  • Agoraphobia: Do strong fears occur in certain places, such as public places or in crowds?
  • Social phobia: Are you afraid that other people might judge your behavior as stupid or embarrassing? Do you avoid meeting strangers or speaking in front of a group?
  • Specific phobia: Are you afraid of certain animals, such as dogs, spiders or insects? Or are you afraid of a situation, such as a thunderstorm or high altitude? Blood, syringes or injuries can also trigger a phobia.
  • Generalized anxiety disorder: Do you often spend a long time thinking about problems that, objectively speaking, are not so threatening? Are you constantly worried or afraid that misfortune might befall you?

Sometimes there are mixed forms of various anxiety disorders. An anxiety disorder often occurs in conjunction with other mental illnesses, such as depression or obsessive-compulsive disorder.

Symptoms: What happens with an anxiety disorder

In an anxiety disorder, fear dominates the entire thoughts and usually also the body of the person affected. The thoughts focus only on the (perceived) problem. Typically, this anxiety only occurs in certain situations. Over time, however, the expectation of an anxiety reaction in certain situations can also be added, the “fear of fear”. In order to avoid the associated negative feelings, the person concerned increasingly avoids these situations. However, this also reduces the routine of dealing with such situations and the fear of fear becomes ever greater. In many cases, those affected are even aware that their fears are exaggerated. Nevertheless, they cannot defend themselves against it.

Physical symptoms of an anxiety disorder

Strong feelings of anxiety are often accompanied by physical complaints. Possible physical symptoms of an anxiety disorder are

  • Sweat breakout
  • Palpitations
  • Trembling
  • Blush
  • Nausea
  • Urge to urinate
  • Muscle tension
  • Tightness in the chest
  • Shortness of breath
  • Dizziness

In the case of a panic attack in particular, these symptoms can be so pronounced that those affected initially assume a physical illness, such as a heart attack, and have themselves examined in an emergency. Typically, investigations by the family doctor or the emergency ward reveal that “everything is fine”.

Diagnosis: How we make our diagnosis for anxiety disorders

It often takes a long time for those affected to come to us. They describe their physical side effects rather than the core of the illness. In some cases, false shame also prevents those affected from seeking help.

The examination with us consists primarily of a joint discussion in which you describe your complaints and we get as accurate a picture as possible of the symptoms and possible causes. The interview is usually supplemented by standardized questionnaires, which help to assess how severe the symptoms are and how much they affect everyday life.

What the psychotherapists ask

At the first meeting, we will ask a series of questions (anamnesis) to classify the illness. Possible questions are:

  • In which situations do you notice the fear?
  • How does it express itself?
  • When did the anxiety start?
  • Do you feel physical symptoms during such situations?
  • Are there other factors besides anxiety that are weighing heavily on you?
  • What strategies help you to deal with your fears?

We also often ask you to keep an anxiety diary. Write down when, in which situation, for how long and how often the complaints occur.

Physical examinations

Some physical illnesses can cause similar symptoms to anxiety disorders, such as hyperthyroidism or cardiovascular disease. Therefore, in certain cases a physical examination is arranged at the beginning of therapy. Changes in the brain can also be visualized in a head MRI.

Anxiety disorder: prevention and prognosis

As it is usually not possible to identify a single cause for an anxiety disorder, there are few options for prevention. However, as with all mental illnesses, it is important to find a balance between stressful and relieving aspects of life. A stable network of social relationships, hobbies and regular exercise – both sport and walks – can help. Anyone who experiences symptoms of an anxiety disorder and feels impaired in their everyday life as a result is welcome to contact us: The earlier a sufferer is treated, the better the chances of recovery. Overall, anxiety disorders can be treated well. Around 70 to 80 percent of patients recover.

Course of an anxiety disorder

Phobias that occur in childhood often disappear on their own in adulthood. Some children are terrified of spiders or insects, but overcome this fear as they get older. Even in adults, some specific phobias can diminish over time – often depending on other life circumstances. For some sufferers, anxiety creeps in slowly, for others it comes on suddenly. Agoraphobia and social phobias usually become more severe the longer they remain untreated. Such anxiety disorders often develop over a long period of time, sometimes even over many years. The longer they exist, the more the problems expand.

A panic disorder also usually persists with ups and downs for years and becomes chronic. In severe cases, the anxiety disorder has an impact on the entire life of those affected. Some hardly leave the house and can no longer work. Social contacts also suffer. This situation can also result in alcohol and drug abuse in the sense of self-medication. We can provide valuable help here.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.