Occasional anxiety and worry is a normal part of life.

In fact, anxiety is a natural human response to potential danger, perceived threat, and other stressors. It is what motivates us to study for an upcoming test or prevents us from walking out onto a busy highway. Typically, these normal anxious reactions are temporary and serve to prompt individuals to take action, solve problems, or prepare effectively for challenges. However, when these feelings are disproportionate to the situation or persist over time, they can become problematic.

Anxiety symptoms that are overwhelming, difficult to control, and seem to not go away, even when things are going well, however, are a concern. This type of anxiety can begin to cause a lot of problems, making it hard for the person to enjoy the things that they used to enjoy.

Anxiety disorders are not as simple as just “worrying too much.” They are patterns of fear, worry, or rituals that stay on and start running work, sleep, or relationships. This page is not a diagnosis. A first visit is how we sort it out.

 

Generalized anxiety

In generalized anxiety disorder, worry is frequent. It is more intense than the situation calls for, and it is hard to turn off. It is present most days, for months, and can move from work to health to money to family, even during a quiet week. People also feel it in the body: muscle tension, restlessness, fatigue, and trouble sleeping.

About 2.7% of U.S. adults have generalized anxiety disorder in a given year.

The first-line psychological treatment is cognitive-behavioral therapy (CBT). CBT helps you notice the habits that keep worry going, such as checking and rehearsing, and practice responding differently. The alarm system is sensitive, not broken. Treatment does not erase it. It teaches that a thought about next Tuesday is not the same as danger.

 

Panic

A panic attack is a sudden episode of intense fear with physical symptoms that mimic the body’s response to real danger: a pounding heart, shortness of breath, dizziness, chest tightness, heat, or the fear of dying or losing control. Panic disorder means these attacks keep happening, often without warning, and the person begins to fear the next one. Many people start avoiding driving, gyms, crowds, or being alone. One attack is not the same as the disorder. Chest pain still needs a medical check.

About 2.7% of U.S. adults have panic disorder in a given year.

The first-line psychological treatment is CBT with exposure, including to the body sensations themselves once we know they are fear and not a medical emergency. You learn that an attack can rise and fall without escape. The fast alarm fired, and the thinking system read the racing heart as the emergency. Treatment teaches a second lesson: that surge was a false alarm.

 

Social anxiety

Being a little self-conscious is ordinary. Social anxiety is when the fear of being judged, embarrassed, or "found out" starts running the week: you skip the meeting, leave the party early, or replay what you said for hours. It can show up as blushing, a shaking voice, a blank mind, or a body that feels like it is on stage even in a small room. A diagnosis is usually on the table when that fear has lasted months, is out of proportion to the actual social risk, and you are avoiding people, speaking, or being seen in a way that costs you work, school, or the relationships you want. Shyness is not automatically the disorder.

About 7.1% of U.S. adults have social anxiety disorder in a given year.

Treatment here is CBT with exposure. We pick the situations you have been arranging your life around (introductions, eating with others, speaking up) and stay long enough for the prediction to have a chance to be wrong. The point is not to become the most outgoing person in the room. The alarm tagged other people's attention as danger. Avoiding the room keeps that tag in place. Approaching it, on purpose, writes a second memory: you were seen, and it was not the disaster.

OCD

In obsessive-compulsive disorder, a person is troubled by intrusive, distressing thoughts and feels pressure to carry out repetitive behaviors or mental rituals. Common examples include washing, checking, repeating, or reviewing in one’s head. The ritual brings only brief relief, and the thought returns. The cycle can take an hour or more each day and interfere with work, sleep, or relationships.

About 1.2% of U.S. adults have OCD in a given year.

The first-line behavioral treatment is exposure and response prevention (ERP). Dr. Rovnak has specialized training in ERP. You approach the thought or the cue on purpose and do not do the ritual, so the feared prediction has a chance to fail. The ritual had been teaching the brain that the thought was dangerous. ERP stops reinforcing that lesson.

 

Hoarding

Hoarding disorder is difficulty letting possessions go, a strong pull to save, and clutter that crowds out rooms, beds, or relationships. It is not the same as being messy, and it is not automatically OCD. Shame, isolation, and arguments at home about the piles are common.

About 2.5% of adults meet criteria in studies that look for it.

The first-line treatment is skills-based CBT for saving and discarding. It is not a one-day cleanout, and it is not the same protocol as OCD ERP. Treatment slows what comes in, practices letting a specific item leave, and works toward using the rooms again. Keeping the object can feel like safety. Treatment tests that belief one item at a time.

 

Specific phobias

A specific phobia is an intense, persistent fear of one object or situation that is out of proportion to the actual danger: flying, needles, vomit, driving, animals, or heights. The person may know the fear is excessive and still rearrange travel, medical care, or ordinary errands to avoid it. The fear has usually lasted months, not one bad day.

About 9.1% of U.S. adults have a specific phobia in a given year, which makes it the most common of these conditions.

The first-line treatment is exposure. We pick the cue, make a prediction, and stay long enough for that prediction to have a chance to be wrong. Feeling calmer in the moment is not the measure of success. Avoiding the cue keeps the danger tag in place. Approaching it on purpose writes a second memory: this time it was not the disaster.