By Michael Lardon, M.D.

What is an anxiety disorder?

Anxiety disorders are extremely common. Women have a 30% chance of developing an anxiety disorder in their life and men have about a 20% chance. Everyone experiences anxiety. Anxiety is characterized by an unpleasant, vague sense of apprehension that often is accompanied by increased heart rate, tightness in the chest, and mild stomach discomfort.

What is the difference between anxiety and fear?

Anxiety is considered an alerting signal to warn one of impending danger. However fear and anxiety should be differentiated. Fear is a response to a known external threat whereas anxiety is a response to a threat that is vague and unknown.

What are the two most common forms of anxiety?

Most anxiety disorders fall into two general categories. Either an individual has discreet panic attacks, which is called panic disorder, or a chronic feeling of uneasiness throughout the day, which is called a generalized anxiety disorder. Less common anxiety disorders are phobias, post-traumatic stress disorder, and obsessive-compulsive disorder.

What is a panic attack?

A good way to imagine a panic attack is to simply visualize yourself swimming in the ocean and coming upon a Great White shark. In this hypothetical case, your heart rate would increase, you would start trembling and feel shortness of breath, chest discomfort, abdominal distress and fear. In this hypothetical case (coming upon a great white shark while swimming) a panic attack is a normal physiologic response to danger (it is also called the “flight or fight” response). However, when an individual has panic attacks in situations that are not life-threatening or dangerous, then these panic attacks are maladaptive and may be considered part of a panic disorder. Sometimes panic disorders are not full-blown and have more limited symptoms. Sometimes panic attacks are only circumscribed to special situations which can include competition or performance-related activities.

What is generalized anxiety?

In contrast, general anxiety disorders are characterized by excessive anxiety and worry that is difficult to control and causes difficulty concentrating, irritability, sleep disturbance, decreased energy and muscle tension. Individuals experience anxiety most days throughout the day.

Are these medical or psychological weaknesses?

All of these disorders are medical conditions that can be successfully treated. They are not psychological weaknesses. The biologic basis of anxiety disorders is fairly-well understood, implicating three major neuro-transmitter systems which include norepinephrine, serotonin, and GABA. Genetic studies have shown that there is a large genetic component to many anxiety disorders and, additionally, there are specific areas of the brain (and the amygdala) that mediate the anxiety reaction.

Are there good treatment options for Anxiety?

Biofeedback is a treatment for anxiety and stress related disorders that has demonstrated efficacy in research spanning nearly 30 years. An individual receiving biofeedback training receives real time information regarding the biological markers of the fight or flight response (increase heart rate, increased blood pressure, increased muscle tension). Armed with this information, the individual is taught specific techniques to reduce anxiety, improve focus and concentration, and ultimately achieve peak performance. The biofeedback therapist acts as a coach, standing at the sidelines setting goals and limits on what to expect and giving hints on how to improve performance. Medicines are also very effective coupled with cognitive-behavioral therapies.

What is choking?

When an athlete develops a panic attack during competition that athlete is often said to be “choking.” If you want to learn more about choking in sport, please see the article titled “Acute Performance Failure.” If you would like to learn more about anxiety disorders in the world of athletics, please click on the Sports Illustrated article titled “Prisoners of Depression” in our Media Center. If you want to learn more go to the National Institute of Mental Health website ( or see your local mental health expert.