Updated: Jan 17
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Remember the increased heart rates and sweaty palms on our first day of school or work? The occasional feeling of anxiety is normal – it is your brain’s way of reacting to stress and alerting you to potential danger. However, when the feeling of anxiety becomes too extreme or too frequent, it can be a sign that you might have an anxiety disorder.
What are anxiety disorders?
Anxiety disorders are mental health disorders that cause the sufferer to feel extreme apprehension and fear.  Although anxiety is part and parcel of life, the apprehension and fear that are experienced in anxiety disorders are far more serious in terms of severity and duration – they can affect daily life.
Anxiety disorders affect a large proportion of the world’s population, with 284 million people suffering from anxiety disorders in 2017. This makes anxiety disorders one of the most prevalent mental health disorders in the world. 
What is generalised anxiety disorder?
Generalised anxiety disorder (GAD) is the most common form of anxiety disorders. People who suffer from GAD often worry excessively over events or thoughts that seem to have no causes for concern.  This can occur several times in a day and can last for months.
What are the causes of anxiety disorders?
Like all other mental health disorders such as depression, many studies and research have been conducted to determine the causes. This helps in the diagnosis and treatment of the disorders. Scientists and researchers have identified the cause of anxiety disorders to be affected by several factors such as biological factors, genetic factors as well as environmental factors.
There are some biological factors that can result in the development of an anxiety disorder such as:
Certain medical conditions such as hyperthyroidism can produce symptoms of an anxiety attack. Symptoms of certain medical conditions, for example, arrhythmia (irregular heartbeats) may also trigger anxiety.
Deficiencies in neurotransmitters, especially serotonin, dopamine, norepinephrine and gamma-aminobutyric acid (GABA) can affect various communication pathways in the brain and result in anxiety. Serotonin and dopamine are known as ‘happy hormones’ and are responsible for feelings of pleasure and satisfaction, which is why deficiencies can result in mental health disorders such as anxiety and depression.
Studies have identified that genes contribute about 30-50% to the development of an anxiety disorder. This means that people who have a family history of anxiety disorder, or an immediate family member suffering from an anxiety disorder, are more likely to develop one.
Environmental factors such as stress and trauma can play important roles in the development of anxiety disorders. According to a study, chronic stress or a traumatic event can result in changes in the brain’s structure, which can result in the development of an anxiety disorder.
What types of anxiety disorders are there?
According to the Diagnostic & Statistical Manual of Mental Disorders 5 (DSM 5), anxiety disorders have a few sub-types, such as: 
Panic disorder is an anxiety disorder where the sufferer regularly has sudden attacks of fear and panic. These attacks may cause the sufferer to become breathless, induce chest pains and heart palpitations.
Social anxiety disorder:
Social anxiety disorder is an anxiety disorder where the sufferer is extremely fearful of being in social situations and being exposed to unfamiliar people.
Separation anxiety disorder:
Separation anxiety disorder is typically a childhood anxiety disorder where the child has an extreme fear of being separated from home or an individual to whom they are attached to.
Post-traumatic Stress Disorder (PTSD):
PTSD is an anxiety disorder whereby the individual develops feelings of fear, horror or helplessness after experiencing or witnessing something life-threatening or extremely distressing.
Generalised Anxiety Disorder (GAD):
GAD is the most common form of anxiety disorders and is characterised by persistent and excessive worry which the sufferer finds hard to control.
Specific phobia is the excessive fear of a specific object or situation which triggers intense fear when exposed to it. Examples include phobia of snakes, spiders or heights.
Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help may not be available in the presence of anxiety symptoms. Examples include being in enclosed areas, use of public transportation or standing in line.
This is a complex childhood anxiety disorder whereby the child is unable to speak in social settings such as school or public areas. However, they can speak in other settings when they are relaxed, such as at home.
Substance/Medication-induced Anxiety Disorder:
This is an anxiety disorder that results in anxiety or panic attacks after the consumption of alcohol, drugs or other medications.
Anxiety Disorder Due to Another Medical Condition:
This is an anxiety disorder that was caused by a medical condition such as hyper- or hypothyroidism, as well as heart conditions.
Other specified anxiety disorder:
This category of anxiety disorder applies to individuals who have an anxiety disorder listed above, but do not meet the full requirements (e.g. anxiety attacks are not as frequent or severity of symptoms are lower).
Unspecified anxiety disorder:
This category of anxiety disorder applies to individuals who do not exactly meet the criteria for anxiety disorders but suffer from anxiety attacks that are distressing and disruptive.
What are the symptoms of anxiety disorder?
General symptoms of anxiety disorders include: 
Nervousness or restlessness
Having a sense of impending danger, panic or doom
Increased heart rate
Increased breathing rate or hyperventilation
Trouble concentrating or focusing on other things except for your worry
Having trouble sleeping
Gastrointestinal (GI) problems
When should I see a doctor for my anxiety disorder?
As anxiety is a common feeling that everyone would experience, it can be quite confusing determining when you should see a doctor about your anxiety attacks. You should see a doctor if you:
Find that your anxiety attacks are getting more frequent
Feel that your anxiety is starting to affect your daily life (e.g. school, work, family, friends)
Feel that your anxiety is distressing and hard to control
Are feeling suicidal or contemplating hurting yourself
If you suspect that you may be suffering from an anxiety disorder, do not hesitate to seek professional help. Without treatment, anxiety disorders can often get worse over time. 
What are tests to diagnose anxiety disorders in Singapore?
To diagnose anxiety disorders in Singapore, a series of tests have to be run. Firstly, the doctor will look at the patient’s medical history, including whether the patient is suffering from any medical conditions or consuming any medications that may result in symptoms of anxiety.
The doctor will then do a physical examination which includes measurement of height, weight, blood pressure and heart rate. Your doctor may also order additional laboratory tests such as blood tests to determine if any underlying medical conditions are causing anxiety symptoms.
The doctor will also perform a psychological evaluation, by determining if there is a family history of anxiety disorders or depression. During this psychological evaluation, the doctor will ask:
When did your symptoms start
Frequency of the symptoms
How long have the symptoms lasted?
The DSM-5 is the standard tool that healthcare professionals use to determine the severity and type of anxiety disorders that the patient suffers from. Other tests or questionnaires that the doctor may use to diagnose anxiety disorders include Hamilton Anxiety Scale and Beck Anxiety Inventory.
What are treatments to treat anxiety disorders in Singapore?
There are many treatment options for anxiety disorders available, ranging from medication to therapy. Your doctor will prescribe a suitable treatment according to your diagnosis and the severity of your anxiety disorder. 
Pharmacotherapy treats anxiety disorders with drugs. Pharmacotherapy is effective in treating anxiety disorders and alleviating their symptoms, especially in generalised anxiety disorder, panic disorder and social anxiety disorder.
Some common drugs given to patients suffering from anxiety disorders include:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs work by inhibiting the reuptake of serotonin, which helps to regulate our mood and anxiety. While they are commonly used in the treatment of depression, SSRIs have also shown to be effective in treating anxiety disorders. Examples of SSRIs include fluoxetine (Prozac) and sertraline (Zoloft).
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs work by inhibiting the reuptake of serotonin and norepinephrine to help improve mood, reduce anxiety and help alleviate anxiety attacks. SNRIs are typically used when SSRIs fail or have a lack of response. An example of SNRIs includes venlafaxine.
Tricyclic antidepressants (TCAs)
TCAs work by blocking the reuptake of serotonin and norepinephrine into the body, resulting in an improvement in mood and alleviating anxiety symptoms. TCAs are also commonly used in the treatment of depression, but it is shown to be effective in treating anxiety disorders too. One major disadvantage is that TCAs can be lethal in an overdose, hence great care must be taken. An example of TCA is imipramine (Tofranil).
This is the oldest class of medication used to treat anxiety. Benzodiazepines work by enhancing the effect of the neurotransmitter, GABA, which is responsible for sending calming ‘messages’ to the body. Benzodiazepines are usually safe and effective in treating many medical conditions but can cause dependence in the long run. Examples of benzodiazepines are diazepam (Valium) and lorazepam (Ativan).
Psychotherapy treats anxiety disorder through talking to a mental health professional such as a therapist, psychiatrist or psychologist. Psychotherapy helps the patient to acknowledge the negative emotions, feelings or thoughts that they have and help them eliminate or control them.
Cognitive-behavioural therapy (CBT) is the most common psychotherapy method used in the treatment of anxiety disorders. CBT helps people identify negative or destructive thoughts, and uses a wide range of strategies to help them overcome these thoughts.  CBT usually takes months to work but research has shown that it has been very effective in treating a wide range of anxiety disorders.
Exposure therapy is another commonly used psychotherapy method and has been proven to be effective in the treatment of anxiety disorders. Exposure therapy is a treatment that encourages the exposure of a feared stimulus to reduce the patient’s fear and their reaction to that stimulus.
What are the risk factors of anxiety disorder?
While biological, genetic and environmental factors are shown to play a part in the development of anxiety disorders, some risk factors can increase the chances of developing anxiety disorders.
Some risk factors include:
Shyness and tendency of distress or withdrawal in new situations during childhood
Exposure to stressful or negative life events.
A family history of anxiety or other mental illnesses
Medical conditions such as arrhythmia and thyroid issues
Having these risk factors does not mean that you are going to develop an anxiety disorder. However, you may wish to track any signs or symptoms that may help in identifying the development of an anxiety disorder.
Can I treat anxiety disorders naturally?
Good news for those who are searching for alternative or natural treatments for anxiety disorders — there are plenty of natural remedies that can help alleviate the symptoms of anxiety.
Natural remedies for anxiety disorders include:
Regular exercise: Exercising releases “happy hormones” such as dopamine, which can help improve your mood and reduce anxiety.
Herbal medicine: Herbs such as chamomile, rosemary and lavender have shown to be effective in reducing the symptoms of anxiety.
Meditation/Yoga: Mindfulness practices such as meditation and yoga have been shown to reduce anxiety.
Deep breathing: Taking deep breaths and focusing on your breaths can help to recenter your mind and calm you down.
3-3-3 rule: The 3-3-3 rule works by first looking around you and naming 3 things that you can see, followed by naming 3 sounds you can hear and lastly, moving 3 different parts of your body. This helps to change your focus and help to recenter your mind.
Does anxiety disorder go away?
Anxiety disorders can be treated, unfortunately, they cannot be cured permanently. This means that there is a possibility of recurring anxiety disorders even after treatment, especially when the patient is subjected to high stress.
Get tips on how to effectively manage your stress here.
However, with treatment, most people can learn how to manage their feelings, and significantly reduce the severity of the symptoms observed in anxiety disorders.
What are the complications of anxiety disorder?
Apart from the drastic decrease in the quality of life, anxiety disorders can give rise to medical complications such as:
Gastrointestinal problems like irritable bowel syndrome (IBS), Crohn’s disease or peptic ulcers
Headaches and migraines
High blood pressure
Cognitive effects such as poor memory, shorter attention span, lowered decision-making skills and poor emotional control
How long do anxiety attacks last?
During an anxiety attack, the sufferer may feel breathless, heart palpitations and have sweaty palms. These symptoms tend to be at their worst about 10 minutes after the start of the anxiety attack.  Sometimes, these symptoms may be so severe that the sufferer thinks that he or she is having a heart attack. However, anxiety attacks typically last no more than 30 minutes. 
How much do anxiety disorder treatments cost in Singapore? Is it claimable by Medisave?
The cost of anxiety disorder treatments can vary depending on the type of treatment you are given. Medications given for anxiety disorders in Singapore cost about $90 per month while therapy can cost anywhere from $60 to more than $200 per session, depending on whether you are visiting a therapist in a government hospital or a private clinic. There are also free hotlines available if you need someone to talk to.
Yes, anxiety disorder treatments are claimable by Medisave under the Chronic Disease Management Programme. Up to $500 can be withdrawn from Medisave per year to pay for outpatient treatments for anxiety disorders.
We hope that this article has highlighted the severity of anxiety disorders and how they can affect daily routines. Do seek professional help as soon as possible if you suspect you may be suffering from an anxiety disorder.
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This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.
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